A computer model for the study of breast cancer.
*Computer Simulation; Breast Neoplasms/epidemiology/mortality/*pathology; Female; Humans; Incidence; Life Expectancy; Lymphatic Metastasis; Neoplasm Metastasis; SEER Program; Software; United States/epidemiology
A computer model was designed as a relational database to assess breast cancer screening in a cohort of women where the growth and development of breast cancer originates with the first malignant cell. The concepts of thresholds for growth, axillary spread, and distant sites are integrated. With tumor diagnosis, staging was performed that includes clinical and sub-clinical states. The model was parameterized to have staging characteristics similar to data published by the Surveillance, Epidemiology, and End-Results (SEER) Program. Validation was accomplished by comparing simulated staging results with non-SEER sources, and simulated survival with independent clinical survival data.
Carter Kimbroe J; Castro Frank; Kessler Edward; Erickson Barbara
Computers in biology and medicine
2003
2003-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/s0010-4825(03)00003-9" target="_blank" rel="noreferrer noopener">10.1016/s0010-4825(03)00003-9</a>
Admission to the Intensive Care Unit is Associated With Changes in the Oral Mycobiome.
*Intensive Care Units; 80 and over; Adult; Aged; Candida albicans; Candida Albicans; Candida albicans/*isolation & purification; Candidiasis; critical care; Critical Care; Cross Infection/microbiology/prevention & control/*transmission; Female; Human; Humans; Length of Stay; Male; Middle Aged; mycobiome; Mycobiome/*immunology; Mycological Typing Techniques; Mycoses; Oral Health; Oral/microbiology/prevention & control/*transmission; Prospective Studies; Risk Factors; United States/epidemiology; Young Adult
A prospective exploratory study was conducted to characterize the oral mycobiome at baseline and determine whether changes occur after admission to the intensive care unit (ICU). We found that ICU admission is associated with alterations in the oral mycobiome, including an overall increase in Candida albicans.
Watkins Richard R; Mukherjee Pranab K; Chandra Jyotsna; Retuerto Mauricio A; Guidry Chrissy; Haller Nairmeen A; Paranjape Charudutt; Ghannoum Mahmoud A
Journal of intensive care medicine
2017
2017-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/0885066615627757" target="_blank" rel="noreferrer noopener">10.1177/0885066615627757</a>
Altered mental status in older emergency department patients.
Aged; Emergency Service; Hospital/*statistics & numerical data; Humans; Incidence; Mental Disorders/diagnosis/*epidemiology; Mental Status Schedule; United States/epidemiology
This article reviews the significance of altered mental status in older emergency department patients. Specific diagnoses are discussed, including delirium, stupor and coma, and dementia, with a focus on delirium. Finally, an approach to all older patients is suggested that should result in increased clinician comfort with older patients, improved ability to communicate with other physicians, increased quality of care, and improved patient and family satisfaction.
Wilber Scott T
Emergency medicine clinics of North America
2006
2006-05
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.emc.2006.01.011" target="_blank" rel="noreferrer noopener">10.1016/j.emc.2006.01.011</a>
CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2009-2013.
Adolescent; Adult; Brain Neoplasms/*epidemiology; Central Nervous System Neoplasms/*epidemiology; Child; Epidemiological Monitoring; Female; Humans; Infant; Male; Newborn; Preschool; Registries; Societies; United States/epidemiology; Young Adult
Ostrom Quinn T; Gittleman Haley; Xu Jordan; Kromer Courtney; Wolinsky Yingli; Kruchko Carol; Barnholtz-Sloan Jill S
Neuro-oncology
2016
2016-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/neuonc/now207" target="_blank" rel="noreferrer noopener">10.1093/neuonc/now207</a>
Characterization of combat-related spinal injuries sustained by a US Army Brigade Combat Team during Operation Iraqi Freedom.
*Iraq War; 2003-2011; Adolescent; Adult; Female; Humans; Incidence; Male; Middle Aged; Military Personnel/statistics & numerical data; Spinal Injuries/*epidemiology; United States/epidemiology; Young Adult
BACKGROUND CONTEXT: The United States is presently engaged in the largest scale armed conflict since Vietnam. Despite recent investigations into the scope of injuries sustained by soldiers in Iraq and Afghanistan, little information is available regarding the incidence and epidemiology of spine trauma in this population. PURPOSE: Characterize the incidence and epidemiology of spinal injuries sustained during combat by soldiers of a US Army Brigade Combat Team (BCT) that participated in Operation Iraqi Freedom. STUDY DESIGN: Descriptive epidemiologic study. PATIENT SAMPLE: A total of 4,122 soldiers who served in Iraq with an Army BCT during "The Surge" operation. OUTCOME MEASURES: Spine injury epidemiology was calculated for the BCT, including the spine combat casualty rate, and percent medically evacuated (MEDEVAC). METHODS: Unit rosters were obtained, and a comprehensive database identifying all combat-related spine injuries was created by querying each soldiers' electronic medical record and the unit's casualty rosters. Demographic information was recorded including age, sex, rank, injury mechanism, presence of polytrauma, and injury outcome. Injury outcomes were classified as killed in action, died of wounds, MEDEVAC, or returned to duty. The incidence of spine injuries was determined, and epidemiology was characterized using calculations of the spine combat casualty rate and percent MEDEVAC. Comparisons were made to published reports from previous conflicts. RESULTS: A total of 29 soldiers sustained 31 combat-related spine injuries. These accounted for 7.4% (29 out of 390) of all casualties sustained during combat. Blunt trauma to the spine, often resulting from an explosive mechanism, was encountered in 65% of cases. Closed fractures of the spine occurred in 21% of casualties and open injuries occurred in 7%. The spine combat casualty rate was 5.6 out of 1,000 soldier combat-years, and the percent MEDEVAC was 19%. CONCLUSIONS: This investigation is the first of its kind, documenting the nature of spine trauma in a major American conflict. The incidence of spine injuries in this study is the highest ever documented and is indicative of the tactics used by the enemy in the current war. Given this fact, it is likely that the prevalence of combat-related spine trauma will increase in the future. Larger, more extensive, studies of this kind must be conducted in the future.
Schoenfeld Andrew J; Goodman Gens P; Belmont Philip J Jr
The spine journal : official journal of the North American Spine Society
2012
2012-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.spinee.2010.05.004" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2010.05.004</a>
Characterization of the incidence and risk factors for the development of lumbar radiculopathy.
Adolescent; Adult; Age Distribution; Aged; Female; Humans; Incidence; Lumbar Vertebrae; Male; Middle Aged; Military Personnel/*statistics & numerical data; Radiculopathy/*epidemiology; Risk Assessment; Risk Factors; Sex Distribution; United States/epidemiology; Young Adult
STUDY DESIGN: Epidemiological study of a prospectively collected database. OBJECTIVES: This investigation sought to evaluate the incidence of symptomatic lumbar radiculopathy, and identify risk factors for its development, among individuals serving in the United States military over a 10-year period. SUMMARY OF BACKGROUND DATA: Risk factors for the development of lumbar radiculopathy are poorly understood and the incidence of this disorder has not been characterized earlier for a young, high-demand population. METHODS: The Defense Medical Epidemiology Database was queried for the years 2000 to 2009 using the International Classification of Diseases ninth revision code for lumbar radiculopathy (724.4). Overall incidence was determined and multivariate Poisson regression analysis was carried out to identify the influence of risk factors such as age, sex, race, military rank, and branch of service on the development of this condition. RESULTS: In this population, the overall incidence of lumbar radiculopathy was 4.86 per 1000 person-years. Multivariate Poisson regression analysis showed that female sex, white race, senior positions within the rank structure, and service in the Army, Navy, or Air Force increased the risk of developing lumbar radiculopathy. Servicemembers of 30 years and older were found to have \textgreater3 times the risk of developing lumbar radiculopathy when compared with individuals \textless20. CONCLUSIONS: The incidence of lumbar radiculopathy in this young, racially diverse, and physically active population is higher than many other degenerative conditions. In this study female sex and white race increased the risk of developing lumbar radiculopathy. However, increasing age seems to be one of the most significant independent factors for developing this disorder. LEVEL OF EVIDENCE: Level II, prognostic study.
Schoenfeld Andrew J; Laughlin Matthew; Bader Julia O; Bono Christopher M
Journal of spinal disorders & techniques
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).
<a href="http://doi.org/10.1097/BSD.0b013e3182146e55" target="_blank" rel="noreferrer noopener">10.1097/BSD.0b013e3182146e55</a>
Effect of influenza on outcomes in patients with heart failure.
Female; Humans; Male; Aged; Retrospective Studies; Risk Factors; United States/epidemiology; Incidence; Follow-Up Studies; heart failure; hospitalization; Hospitalization/trends; vaccination; influenza; Survival Rate/trends; Risk Assessment/methods; Inpatients; Morbidity/trends; Hospital Mortality/trends; Propensity Score; Heart Failure/complications/epidemiology; Influenza Human/complications/epidemiology/prevention & control; Vaccination/methods
OBJECTIVES: This study sought to determine whether influenza infection increases morbidity and mortality in patients hospitalized with heart failure (HF). BACKGROUND: Patients with HF may be at increased risk of morbidity and mortality from influenza infection. However, there are limited data for the associated hazards of influenza infection in patients with HF. METHODS: We queried the 2013 to 2014 National Inpatient Sample database for all adult patients (18 years of age or older) admitted with HF with and without concomitant influenza infection. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Outcomes included in-hospital mortality, in-hospital complications, length of stay, and average hospital costs. RESULTS: Of 8,189,119 all-cause hospitalizations in patients with HF, 54,590 (0.67%) had concomitant influenza infection. Patients with concomitant influenza had higher incidence of in-hospital mortality (6.2% vs. 5.4%, respectively; odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.03 to 1.30]; p = 0.02), acute respiratory failure (36.9% vs. 23.1%, respectively; OR: 1.95 [95% CI: 1.83 to 2.07]; p < 0.001), acute respiratory failure requiring mechanical ventilation (18.2% vs. 11.3%, respectively; OR: 1.75 [95% CI: 1.62 to 1.89]; p < 0.001), acute kidney injury (AKI) (30.3% vs. 28.7%, respectively; OR: 1.08 [95% CI: 1.02 to 1.15]; p = 0.01), and AKI requiring dialysis (2.4% vs. 1.8%, respectively; OR: 1.37 [95% CI: 1.14 to 1.65]; p = 0.001). Patients with influenza had longer mean lengths of stay (5.9 days vs. 5.2 days, respectively; p <0.001) but similar average hospital costs ($12,137 vs. $12,003, respectively; p = 0.40). CONCLUSIONS: Influenza infection is associated with increased in-hospital morbidity and mortality in patients with HF. Our results emphasize the need for efforts to mitigate the incidence of influenza, specifically in this high-risk patient cohort.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
Journal of the American College of Cardiology. Heart failure
2019
2019-02
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.jchf.2018.10.011" target="_blank" rel="noreferrer noopener">10.1016/j.jchf.2018.10.011</a>
PMID: 30611718
Epidemiology and clinical outcomes of patients with Fusobacterium bacteraemia.
*Hospital Mortality; 80 and over; 80 and Over; Adult; Aged; Bacteremia – Mortality; Bacteremia – Physiopathology; Bacteremia/*mortality/physiopathology; Creatinine – Blood; Creatinine/blood; Female; Fusobacterium Infections – Mortality; Fusobacterium Infections – Physiopathology; Fusobacterium Infections/*mortality/physiopathology; Hospital Mortality; Hospitals; Human; Humans; Intensive Care Units – Statistics and Numerical Data; Intensive Care Units/statistics & numerical data; Length of Stay – Statistics and Numerical Data; Length of Stay/statistics & numerical data; Male; Middle Age; Middle Aged; Retrospective Design; Retrospective Studies; Risk Factors; Special – Statistics and Numerical Data; Tertiary Care Centers/*statistics & numerical data; Treatment Outcome; Treatment Outcomes; United States; United States/epidemiology
This 10-year retrospective study assessed the epidemiology and outcomes of patients with Fusobacterium bacteraemia (FB) at a tertiary-care hospital in the
Goldberg E A; Venkat-Ramani T; Hewit M; Bonilla H F
Epidemiology and infection
2013
2013-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1017/S0950268812000660" target="_blank" rel="noreferrer noopener">10.1017/S0950268812000660</a>
Epidemiology of cervical spine fractures in the US military.
Adult; Cervical Vertebrae/*injuries; Databases; Factual; Female; Humans; Incidence; Male; Military Personnel/statistics & numerical data; Spinal Cord Injuries/epidemiology/etiology; Spinal Fractures/complications/*epidemiology; United States/epidemiology; Young Adult
BACKGROUND CONTEXT: The epidemiology of cervical spine fractures and associated spinal cord injury (SCI) has not previously been estimated within the American population. PURPOSE: To determine the incidence of cervical spine fractures and associated SCI and identify potential risk factors for these injuries in a large multicultural military population. STUDY DESIGN: Query of a prospectively collected military database. PATIENT SAMPLE: The 13,813,333 military servicemembers serving in the US Armed Forces between 2000 and 2009. OUTCOME MEASURES: The Defense Medical Epidemiology Database (DMED) was queried to identify all servicemembers diagnosed with cervical spine fractures with and without SCI during the time period under investigation. Data were used to determine the incidence of cervical spine fractures and SCI as well as identify risk factors for their development. METHODS: The DMED was queried for the years 2000 to 2009 using the International Classification of Diseases, Ninth Revision, Clinical Modification code for cervical spine fractures with and without SCI (805.0, 805.1, 806.0, and 806.1). The database was also used to determine the total number of servicemembers within the military during the same period. The incidence of cervical spine fractures and fractures associated with SCI was determined, and unadjusted incidence rates were calculated for the demographic characteristics of sex, race, military rank, branch of service, and age. Adjusted incidence rate ratios were then determined using multivariate Poisson regression analysis to control for other factors in the model and identify significant risk factors for cervical spine fractures and cervical injuries associated with SCI. RESULTS: From 2000 to 2009, there were 4,048 cervical spine fractures in a population at risk of 13,813,333 servicemembers. The overall incidence of cervical spine fractures was 0.29 per 1,000 person-years, and the incidence of fracture associated SCI was 70 per 1,000,000. The cohorts at highest risk of cervical spine fracture were males, whites, Enlisted personnel, those serving in the Army, Navy, or Marine Corps, and servicemembers aged 20 to 29. Risk of fracture-associated SCI was significantly increased in males, Enlisted personnel, servicemembers in the Army, Navy, or Marines, and those aged 20 to 29. CONCLUSIONS: This study is the largest population-based investigation to be conducted within the United States regarding the incidence of SCI and the only study addressing incidence and risk factors for cervical spine fractures. Male sex, white race, Enlisted military rank, service in the Army, Navy, or Marine Corps, and ages 20 to 29 were found to significantly increase the risk for cervical fractures and/or fracture associated SCI. Our findings support previously published data but also represent best available evidence based on the size and diversity of the population under study. LEVEL OF EVIDENCE: Prognostic; Level II.
Schoenfeld Andrew J; Sielski Bernadette; Rivera Kenneth P; Bader Julia O; Harris Mitchel B
The spine journal : official journal of the North American Spine Society
2012
2012-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.spinee.2011.01.029" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2011.01.029</a>
Estimating the annual frequency of synchronous brain metastasis in the United States 2010-2013: a population-based study.
Adolescent; Adult; Age Distribution; Aged; Brain Neoplasms/*epidemiology/*secondary; Breast Neoplasms/epidemiology/*pathology; Cancer registries; Community Health Planning; Female; Humans; Lung cancer; Lung Neoplasms/epidemiology/*pathology; Male; Metastatic brain tumors; Middle Aged; Retrospective Studies; SEER; United States/epidemiology; Young Adult
Brain metastases (BM) are one of the most common types of brain tumors and are a relatively common event in the disease process for several high-incidence cancer types, including breast and lung cancers. Historically, information on metastases including BM have not been collected as part of national cancer registration in the US, but BM at time of primary cancer diagnosis (SBM), is now collected by the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) system. Using data from 18 SEER registries from 2010 to 2013, we assessed the frequency of SBM at time of primary diagnosis in the US by site, histology group, sex, race, age, and insurance status. There were 1,634,954 total primary cancer cases in SEER from 2010 to 2013, 1.7% of which presented with SBM. The cancer type with the highest proportion of SBM was lung cancer (10.8% of cases with SBM), followed by esophageal (1.5%), kidney (1.4%), and melanoma (1.2%). SBM varied by age, sex, race, and insurance status for most histologies. Our results reflect the high proportion of patients who are diagnosed with lung cancer at late stages and present with SBM, in contrast to other common cancers in the US where SBM is less common. Demographic variation in molecular subtype and risk behavior may influence variation in SBM. BM is a relatively common event in late stage cancer and cause significant morbidity and mortality, and assessment of accurate population-based data is critical to estimate total disease burden.
Kromer Courtney; Xu Jordan; Ostrom Quinn T; Gittleman Haley; Kruchko Carol; Sawaya Raymond; Barnholtz-Sloan Jill S
Journal of neuro-oncology
2017
2017-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s11060-017-2516-7" target="_blank" rel="noreferrer noopener">10.1007/s11060-017-2516-7</a>
Falls and cognitive decline in Mexican Americans 75 years and older.
Female; Humans; Male; Aged; United States/epidemiology; Sex Factors; depression; Neuropsychological Tests; Accidental Falls/*statistics & numerical data; cognition; Cognition Disorders/epidemiology/*etiology; Depression/epidemiology/etiology; Educational Status; elderly; Hand Strength; Mexican Americans/psychology/*statistics & numerical data; Psychiatric Status Rating Scales; 80 and over
BACKGROUND: Little is known about long-term emotional and cognitive consequences of falls. We examined the association between falls and subsequent cognitive decline, and tested the hypothesis that depression would mediate any falls-cognition association among cognitively intact Hispanic Elders. METHODS: We used data from the Hispanic Established Population for the Epidemiological Study of the Elderly to examine change in Mini Mental State Examination (MMSE) scores over the 6-year period according to number of falls. All participants (N=1,119) had MMSE scores \textgreater/=21 and complete data on Center for Epidemiologic Studies of Depression Scale, social and demographic factors, medical conditions (diabetes, heart attack, stroke, and hypertension), and hand grip muscle strength. RESULTS: At baseline, participants' mean age was 80.8 years (range, 74-109), mean education was 6.3 years (range, 0-17), and mean MMSE was 25.2 (range, 21-30). Of the 1,119 participants, 15.8% experienced one fall and 14.4% had two or more falls. In mixed model analyses, having two or more falls was associated with greater decline in MMSE score (estimate =-0.81, standard error =0.19, P\textless0.0001) compared to having no fall, after adjusting for age, sex, marital status, and education. The magnitude of the association decreased (estimate =-0.65, standard error =0.19, P=0.0007) when adjustment was made for high depressive symptoms, suggesting a possible mediating effect of depression on the falls-cognition association. Female sex, high level of education, and high performance in hand grip muscle strength were associated with a slower decline in MMSE scores. CONCLUSION: Having two or more falls was independently associated with steeper decline in cognition over 6 years, with a possible mediating effect of depression on the falls-cognition association.
Padubidri Anokha; Al Snih Soham; Samper-Ternent Rafael; Markides Kyriakos S; Ottenbacher Kenneth J; Raji Mukaila A
Clinical interventions in aging
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).
<a href="http://doi.org/10.2147/CIA.S59448" target="_blank" rel="noreferrer noopener">10.2147/CIA.S59448</a>
Frailty and subclinical coronary atherosclerosis: The Multicenter AIDS Cohort Study (MACS).
Acquired Immunodeficiency Syndrome/diagnosis/*epidemiology; Asymptomatic Diseases; Atherosclerotic; Cardiac CT; Computed Tomography Angiography; Coronary Angiography/methods; Coronary artery calcium; Coronary Artery Disease/diagnostic imaging/*epidemiology; Coronary atherosclerosis; Cross-Sectional Studies; Exercise; Frailty; Frailty/diagnosis/*epidemiology/physiopathology; Health Status; HIV-Infection; Humans; Linear Models; Male; Middle Aged; Multivariate Analysis; Muscle Strength; Muscle Weakness; Plaque; Prevalence; Prognosis; Risk Factors; United States/epidemiology; Vascular Calcification/diagnostic imaging/*epidemiology; Weight Loss
BACKGROUND AND AIMS: Frailty and cardiovascular disease share many risk factors. We evaluated whether frailty is independently associated with subclinical coronary atherosclerosis and whether any relationships differ by HIV-serostatus. METHODS: We studied 976 [62% HIV-infected] male participants of the Multicenter AIDS Cohort Study who underwent assessment of frailty and non-contrast cardiac CT scanning; of these, 747 men also underwent coronary CT angiography (CCTA). Frailty was defined as having \textgreater/=3 of 5 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity. Coronary artery calcium (CAC) was assessed by non-contrast CT, and total plaque score (TPS), mixed plaque score (MPS), and non-calcified plaque score (NCPS) by CCTA. Multivariable-adjusted regression was used to assess the cross-sectional associations between frailty and subclinical coronary atherosclerosis. RESULTS: Mean (SD) age of participants was 54 (7) years; 31% were black. Frailty existed in 7.5% and 14.3% of
Korada Sai Krishna C; Zhao Di; Tibuakuu Martin; Brown Todd T; Jacobson Lisa P; Guallar Eliseo; Bolan Robert K; Palella Frank J; Margolick Joseph B; Martinson Jeremy J; Budoff Matthew J; Post Wendy S; Michos Erin D
Atherosclerosis
2017
2017-11
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/10.1016/j.atherosclerosis.2017.08.026" target="_blank" rel="noreferrer noopener">10.1016/j.atherosclerosis.2017.08.026</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
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.hrthm.2018.09.021" target="_blank" rel="noreferrer noopener">10.1016/j.hrthm.2018.09.021</a>
Incidence and epidemiology of cervical radiculopathy in the United States military: 2000 to 2009.
*Military Personnel/statistics & numerical data; Adult; Age Factors; Cohort Studies; Databases; Factual; Female; Humans; Incidence; Male; Prospective Studies; Radiculopathy/diagnosis/*epidemiology; Risk Factors; Sex Factors; United States/epidemiology; Young Adult
STUDY DESIGN: Epidemiological review of a prospectively collected military database. OBJECTIVE: This investigation sought to determine the incidence of cervical radiculopathy and risk factors for its development within the population of the United States military from 2000 to 2009. SUMMARY OF BACKGROUND DATA: Currently, the epidemiology of cervical radiculopathy remains poorly understood and risk factors for its development have not been reliably defined. METHODS: The military's Defense Medical Epidemiological Database was used to identify all servicemembers diagnosed with cervical radiculopathy (International Classification of Diseases code 723.4) between 2000 and 2009. Demographic data was obtained for all identified individuals including age group, sex, race, military rank, and branch of service. Like data was recorded for all servicemembers within the Armed Forces during the time period under study. The incidence of cervical radiculopathy was calculated and unadjusted incidence rate ratios were determined. Risk factors were analyzed by performing multivariate Poisson regression analysis, controlling for all other factors within the model. RESULTS: Between 2000 and 2009, about 24,742 individuals were diagnosed with cervical radiculopathy among a population-at-risk of 13,813,333, for an incidence of 1.79 per 1000 person-years. Statistically significant differences (P\textless0.001) in adjusted incidence rate ratios were identified for each successive age group with mutually exclusive 95% confidence intervals. Those age 40 years and above were found to have the greatest risk of cervical radiculopathy. Female sex (P\textless0.001), White race (P\textless0.001), senior positions within the rank structure (P\textless0.001), and service in the Army (P\textless0.001) or Air Force (P=0.01) were also identified as significant risk factors for cervical radiculopathy. CONCLUSIONS: This study is the first to attempt to define the incidence of cervical radiculopathy and characterize risk factors for its development within an American population. Findings presented here indicate that age is most likely the greatest risk factor for cervical radiculopathy, with female sex, White race, senior military positions, and Army or Air Force service also influencing risk to varying degrees.
Schoenfeld Andrew J; George Alan A; Bader Julia O; Caram Pedro M Jr
Journal of spinal disorders & techniques
2012
2012-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/BSD.0b013e31820d77ea" target="_blank" rel="noreferrer noopener">10.1097/BSD.0b013e31820d77ea</a>
Incidence and epidemiology of spinal cord injury within a closed American population: the United States military (2000-2009).
*Military Personnel; Adolescent; Adult; Female; Humans; Incidence; International Classification of Diseases; Male; Middle Aged; Retrospective Studies; Risk Factors; Spinal Cord Injuries/*epidemiology; United States/epidemiology; Young Adult
STUDY DESIGN: Cohort study. OBJECTIVES: The objective of this study was to characterize the incidence of spinal cord injury (SCI) within the population of the United States military from 2000-2009. This investigation also sought to define potential risk factors for the development of SCI. SETTING: The population of the United States military from 2000-2009. METHODS: The Defense Medical Epidemiology Database was queried for the years 2000-2009 using the International Classification of Diseases, Ninth Revision, Clinical Modification codes for SCI (806.0, 806.1, 806.2, 806.3, 806.4, 806.5, 806.8, 806.9, 952.0, 952.1, 952.2, 952.8, 952.9). The raw incidence of SCI was calculated and unadjusted incidence rates were generated for the risk factors of age, sex, race, military rank and branch of service. Adjusted incidence rate ratios were subsequently determined via multivariate Poisson regression analysis that controlled for other factors in the model and identified significant independent risk factors for SCI. RESULTS: Between 2000 and 2009, there were 5928 cases of SCI among a population at-risk of 13,813,333. The raw incidence of SCI within the population was 429 per million person-years. Male sex, white race, enlisted personnel and service in the Army, Navy or Marine Corps were found to be significant independent risk factors for SCI. The age groups 20-24, 25-29 and \textgreater40 were also found to be at significantly greater risk of developing the condition. CONCLUSIONS: This study is one of the few investigations to characterize the incidence, epidemiology and risk factors for SCI within the United States. Results presented here may represent the best-available evidence for risk factors of SCI in a large and diverse American cohort.
Schoenfeld A J; McCriskin B; Hsiao M; Burks R
Spinal Cord
2011
2011-08
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1038/sc.2011.18" target="_blank" rel="noreferrer noopener">10.1038/sc.2011.18</a>
Is mortality due to primary malignant brain and other central nervous system tumors decreasing?
80 and over; Adult; Age Distribution; Age Factors; Aged; Aging; Brain tumors; Centers for Disease Control and Prevention (U.S.)/statistics & numerical data; Central Nervous System Neoplasms/*epidemiology/*mortality; Female; Glioma; Glioma/*epidemiology/*mortality; Humans; Incidence; Incidence-based mortality; Male; Middle Aged; Mortality; National Cancer Institute (U.S.)/statistics & numerical data; Prevalence; Retrospective Studies; Sex Factors; Time trends; United States/epidemiology; Young Adult
Primary malignant brain and other central nervous system tumors (BT) are a rare cancer that causes morbidity and mortality disproportionate to their incidence. This study presents the most up-to-date mortality data for malignant BT in the United States (US) by histology groupings, age, race, and sex. Mortality rates for malignant BT were generated using the Center for Disease Control's National Vital Statistics Systems (NVSS, \textasciitilde100% of US) data from 1975 to 2012. Histology-specific incidence-based mortality rates were calculated using the National Cancer Institute's Surveillance, Epidemiology, and End-Results 9 (SEER9, \textasciitilde9.4% of US) data from 1975 to 2012. Joinpoint modeling was used to estimate trends. Mortality was similar in both the NVSS and SEER9 datasets. Overall, mortality from 1975 to 2012 was higher among men, higher in older individuals, and higher in Whites compared to other races. Persons age 65+ years had significant increases in mortality for all malignant tumors overall and for glioma histologies, while persons age \textless20 years had no significant changes in mortality. This study reports up-to-date mortality rates by histology groupings, age, race, and sex for malignant BT. There have been no significant changes in overall mortality due to these tumors from 1975 to 2012. There have been significant increases in mortality in the elderly (age 65+ years), especially those age 75-84 years, mirroring the effect of overall population aging. Examining age-, race-, sex-, and histology-specific morality at the population level can provide important information for clinicians, researchers, and public health planning.
Gittleman Haley; Kromer Courtney; Ostrom Quinn T; Blanda Rachel; Russell Jeffrey; Kruchko Carol; Barnholtz-Sloan Jill S
Journal of neuro-oncology
2017
2017-06
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/10.1007/s11060-017-2449-1" target="_blank" rel="noreferrer noopener">10.1007/s11060-017-2449-1</a>
Ischemic colitis revisited: a prospective study identifying hypercoagulability as a risk factor.
80 and over; Aged; Blood Coagulation Disorders/*complications; Colitis; Female; Humans; Ischemic/blood/epidemiology/*etiology; Male; Middle Aged; Prevalence; Prospective Studies; Risk Factors; United States/epidemiology
BACKGROUND: Although causes for ischemic colitis have been identified, many cases are deemed idiopathic. Some reports suggest an association between ischemic colitis and coagulation disorders. Our purpose was to explore the relationship of ischemic colitis and clotting abnormalities. METHODS: Eighteen patients consented to undergo a hypercoagulability evaluation. Tests included protein C, protein S, activated protein C resistance, factor V Leiden, anticardiolipin antibodies, antineutrophil cytoplasmic antibodies, rheumatoid factor, antithrombin III, anti-smooth muscle antibody, lupus anticoagulant panel, and prothrombin 20210G/A mutation (in women undergoing hormone replacement therapy). RESULTS: Five of 18 patients tested positive for coagulation abnormalities, including factor V and activated protein C resistance, protein S deficiency, prothrombin 20210G/A mutation, and anticardiolipin antibody. CONCLUSION: To our knowledge, this is the largest series of patients with ischemic colitis studied for coagulation defects in the United States. The prevalence of clotting disorders in our study (28%) was higher than that in the general population (8.4%). Coagulation disorders should be considered in some cases of ischemic colitis that are thought to be idiopathic.
Midian-Singh Robin; Polen Ann; Durishin Catherine; Crock Ronald D; Whittier Frederick C; Fahmy Nabil
Southern medical journal
2004
2004-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/01.SMJ.0000066655.54770.88" target="_blank" rel="noreferrer noopener">10.1097/01.SMJ.0000066655.54770.88</a>
Low thigh muscle mass is associated with coronary artery stenosis among
*Computed Tomography Angiography; *Tomography; Aged; Atherosclerotic; Body Composition; Chi-Square Distribution; Coronary Angiography/*methods; Coronary Artery Disease/*diagnostic imaging/epidemiology/pathology; Coronary artery stenosis; Coronary atherosclerosis; Coronary Stenosis/*diagnostic imaging/epidemiology/pathology; Coronary Vessels/*diagnostic imaging/pathology; Cross-Sectional Studies; HIV Infections/diagnosis/*epidemiology; HIV-infection; Humans; Male; Middle Aged; Multivariate Analysis; Muscle; Muscle mass; Odds Ratio; Plaque; Predictive Value of Tests; Prevalence; Prospective Studies; Risk Factors; Sarcopenia; Sarcopenia/*diagnostic imaging/epidemiology/physiopathology; Skeletal/*diagnostic imaging/physiopathology; Thigh; United States/epidemiology; X-Ray Computed
BACKGROUND: HIV-infected individuals are at increased risk for both sarcopenia and cardiovascular disease. Whether an association between low muscle mass and subclinical coronary artery disease (CAD) exists, and if it is modified by HIV serostatus, are unknown. METHODS: We performed cross-sectional analysis of 513 male MACS participants (72% HIV-infected) who underwent mid-thigh computed tomography (CT) and non-contrast cardiac CT for coronary artery calcium (CAC) during 2010-2013. Of these, 379 also underwent coronary CT angiography for non-calcified coronary plaque (NCP) and obstructive coronary stenosis \textgreater/=50%. Multivariable-adjusted Poisson regression was used to estimate prevalence risk ratios of associations between low muscle mass (\textless20th percentile of the
Tibuakuu Martin; Zhao Di; Saxena Ankita; Brown Todd T; Jacobson Lisa P; Palella Frank J Jr; Witt Mallory D; Koletar Susan L; Margolick Joseph B; Guallar Eliseo; Korada Sai Krishna C; Budoff Matthew J; Post Wendy S; Michos Erin D
Journal of cardiovascular computed tomography
2018
2018-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jcct.2018.01.007" target="_blank" rel="noreferrer noopener">10.1016/j.jcct.2018.01.007</a>
Lumbar spine fractures within a complete American cohort: epidemiology and risk factors among military service members.
*Warfare; Adolescent; Adult; Age Distribution; Aged; Cohort Studies; Comorbidity; Female; Humans; Lumbar Vertebrae/*injuries; Male; Middle Aged; Military Personnel/*statistics & numerical data; Prevalence; Retrospective Studies; Risk Factors; Sex Distribution; Spinal Cord Injuries/*epidemiology; Spinal Fractures/*epidemiology; United States/epidemiology; Young Adult
STUDY DESIGN: Retrospective database review. OBJECTIVE: To describe the incidence of, and risk factors for, lumbar spine fractures within the population of the US military. SUMMARYOF BACKGROUND DATA: Fractures of the lumbar region are an important health concern; however, the epidemiology of this injury has not been extensively studied in the United States. METHODS: International Classification of Diseases, Clinical Modification, Ninth Revision codes for lumbar spine fractures were used in a search of the Defense Medical Epidemiology Database, identifying all individuals who sustained such injuries between 2001 and 2010. The database was also used to obtain the complete number of individuals serving in the Armed Forces over the same time period. Information regarding race, rank, branch of service, sex, and age was obtained for all individuals identified as having lumbar spine fractures as well as for the whole military population. The incidence of lumbar spine fractures was determined for the cohort. Unadjusted incidence rates were derived for risk factors and multivariate Poisson regression analysis, controlling for all other risks, was used to obtain adjusted incidence rate ratios and identify statistically significant risks for lumbar fractures. RESULTS: Between 2001 and 2010, the overall incidence of lumbar fractures was 0.38 per 1000 person-years. Male sex, white race, enlisted ranks, service in the Army and Marines, and age were found to be significant predictors of lumbar spine fracture. Service in the Army demonstrated the highest rate of lumbar fractures (0.48 per 1000 person-years). CONCLUSIONS: This investigation is the first to document the incidence and postulate risk factors for lumbar spine fracture in an American population. In this study, males, whites, enlisted personnel, those serving in the Army and Marines, and individuals aged 20-24 or greater than 40 were found to be at an increased risk of lumbar fracture.
Schoenfeld Andrew J; Romano David; Bader Julia O; Walker John J
Journal of spinal disorders & techniques
2013
2013-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/BSD.0b013e31823f3237" target="_blank" rel="noreferrer noopener">10.1097/BSD.0b013e31823f3237</a>
Non-health Care Facility Medication Errors Associated with Hormones and Hormone Antagonists in the United States.
80 and over; Adolescent; Adult; Age Distribution; Aged; Child; Databases; Drug-Related Side Effects and Adverse Reactions/diagnosis/*epidemiology/mortality/therapy; Factual; Female; Hormone antagonists; Hormone Antagonists/*adverse effects; Hormones; Hormones/*adverse effects; Humans; Infant; Male; Medication Errors/*statistics & numerical data; Middle Aged; Newborn; Oral hypoglycemic medications; Poison control center; Poison Control Centers; Preschool; Retrospective Studies; Risk Factors; Sex Distribution; Time Factors; Unintentional therapeutic error; United States/epidemiology; Young Adult
INTRODUCTION: Hormones and hormone antagonists are frequently associated with medication errors and may result in important adverse outcomes. The purpose of this study is to investigate non-health care facility (non-HCF) medication errors associated with hormones and hormone antagonists in the United States (US). METHODS: A retrospective analysis of National Poison Data System data was conducted to identify characteristics and trends of unintentional non-HCF therapeutic errors involving hormones and hormone antagonists among individuals of all ages from 2000 to 2012. RESULTS: From 2000 to 2012, US poison control centers received 169,695 calls regarding unintentional non-HCF therapeutic errors associated with hormone therapies, averaging 13,053 medication error calls annually. The rate of reported errors increased significantly by 162.6% (p \textless 0.001), from 2.24 per 100,000 US residents in 2000 to 5.89 per 100,000 in 2012. Two thirds of the errors (65.2%) occurred among females. The medications most commonly associated with errors were thyroid preparations (23.2%), corticosteroids (21.9%), and insulin (20.0%). All nine deaths and 93.2% of major effects were attributed to hypoglycemic agents. Sulfonylureas alone accounted 43.9% of major effects. The number and rate of therapeutic errors increased significantly for all medication categories except estrogen and thiazolidinediones. Most errors were managed at the site of exposure (82.9%) and did not result in serious medical outcomes (95.6%). CONCLUSIONS: This study provides an overview of non-HCF medication errors associated with hormones and hormone antagonists in the US. While most errors did not result in adverse outcomes, their increasing frequency places a greater burden on the health care system.
Magal Pranav; Spiller Henry A; Casavant Marcel J; Chounthirath Thitphalak; Hodges Nichole L; Smith Gary A
Journal of medical toxicology : official journal of the American College of Medical Toxicology
2017
2017-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s13181-017-0630-8" target="_blank" rel="noreferrer noopener">10.1007/s13181-017-0630-8</a>
Recreational injuries among older Americans, 2001.
*Recreation; 80 and over; Age Distribution; Aged; Athletic Injuries/epidemiology; Bone/epidemiology; Emergencies; Exercise; Female; Fractures; Humans; Male; Sex Distribution; United States/epidemiology; Wounds and Injuries/*epidemiology
OBJECTIVE: To describe the epidemiology of non-fatal recreational injuries among older adults treated in United States emergency departments including national estimates of the number of injuries, types of recreational activities, and diagnoses. METHODS: Injury data were provided by the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP), a nationally representative subsample of 66 out of 100 NEISS hospitals. Potential cases were identified using the NEISS-AIP definition of a sport and recreation injury. The authors then reviewed the two line narrative to identify injuries related to participation in a sport or recreational activity among men and women more than 64 years old. RESULTS: In 2001, an estimated 62 164 (95% confidence interval 35 570 to 88 758) persons \textgreater/=65 years old were treated in emergency departments for injuries sustained while participating in sport or recreational activities. The overall injury rate was 177.3/100 000 population with higher rates for men (242.5/100 000) than for women (151.3/100 000). Exercising caused 30% of injuries among women and bicycling caused 17% of injuries among men. Twenty seven percent of all treated injuries were fractures and women (34%) were more likely than men (21%) to suffer fractures. CONCLUSIONS: Recreational activities were a frequent cause of injuries among older adults. Fractures were common. Many of these injuries are potentially preventable. As more persons engage in recreational activities, applying known injury prevention strategies will help to reduce the incidence of these injuries.
Gerson L W; Stevens J A
Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention
2004
2004-06
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/10.1136/ip.2004.005256" target="_blank" rel="noreferrer noopener">10.1136/ip.2004.005256</a>
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
Safety and efficacy of cangrelor, an intravenous, short-acting platelet inhibitor in patients requiring coronary artery bypass surgery.
Adult; Female; Humans; Male; Middle Aged; Aged; Treatment Outcome; Prevalence; United States/epidemiology; Risk Assessment; Adenosine Monophosphate/administration & dosage/*analogs & derivatives; Blood Transfusion/*statistics & numerical data; Coronary Artery Bypass/*statistics & numerical data; Drug-Related Side Effects and Adverse Reactions/epidemiology; Placebo Effect; Platelet Aggregation Inhibitors/administration & dosage; Postoperative Hemorrhage/*epidemiology/*prevention & control; Premedication/*statistics & numerical data; Purinergic P2Y Receptor Antagonists/administration & dosage; Pyridines/*administration & dosage; Injections; 80 and over; Intravenous; Administration; Drug Therapy; Oral; Combination/statistics & numerical data
OBJECTIVE: Oral P2Y(1)(2) platelet receptor inhibitors are a cornerstone of reducing complications in patients with acute coronary syndromes or coronary stents. Guidelines advocate discontinuing treatment with P2Y(1)(2) platelet receptor inhibitors before surgery. Cangrelor, a short-acting, reversible, intravenously administered P2Y(1)(2) platelet inhibitor is effective in achieving appropriate platelet inhibition in patients who are awaiting coronary artery bypass grafting (CABG) and require P2Y(1)(2) inhibition. The objective of this study was to assess the effects of preoperative cangrelor on the incidence of perioperative complications, which are currently unknown. METHODS: Patients (n = 210) requiring preoperative clinical administration of thienopyridine therapy were randomized in a multicenter, double-blinded study to receive cangrelor or placebo while awaiting CABG after discontinuation of the thienopyridine. Optimal platelet reactivity, which was defined as \textless240 P2Y(1)(2) platelet reaction units, was measured with serial point-of-care testing (VerifyNow). Pre- and postoperative outcomes, bleeding values, and transfusion rates were compared. To quantify potential risk factors for bleeding, we developed a multivariate logistic model. RESULTS: The differences between the groups in bleeding and perioperative transfusion rates were not significantly different. The rate of
Firstenberg Michael S; Dyke Cornelius M; Angiolillo Dominick J; Ramaiahm Chandrashekar; Price Matthew; Brtko Miroslav; Welsby Ian; Chandna Harish; Holmes David R; Voeltz Michele; Tummala Pradyumna; Hutyra Martin; Manoukian Steven V; Prats Jayne; Todd Meredith; Liu Tiepu; Chronos Nicholas; Dietrich Markus; Montalescot Gilles; Cannon Louis A; Topo Eric J
The heart surgery forum
2013
2013-04
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/10.1532/HSF98.20121103" target="_blank" rel="noreferrer noopener">10.1532/HSF98.20121103</a>
SENTINEL1: Two-Season Study of Respiratory Syncytial Virus Hospitalizations among U.S. Infants Born at 29 to 35 Weeks' Gestational Age Not Receiving Immunoprophylaxis.
Humans; Male; Female; Infant; Infant Newborn; Odds Ratio; Multivariate Analysis; Antiviral Agents/therapeutic use; United States/epidemiology; Intensive Care Units Pediatric; Community-Acquired Infections/epidemiology; Respiration Artificial; Hospitalization/statistics & numerical data; Infant Premature; Respiratory Syncytial Virus Human; Infant Premature Diseases/epidemiology/prevention & control/therapy; Palivizumab/therapeutic use; Respiratory Syncytial Virus Infections/epidemiology/prevention & control/therapy
OBJECTIVE: The SENTINEL1 observational study characterized confirmed respiratory syncytial virus hospitalizations (RSVH) among U.S. preterm infants born at 29 to 35 weeks' gestational age (wGA) not receiving respiratory syncytial virus (RSV) immunoprophylaxis (IP) during the 2014 to 2015 and 2015 to 2016 RSV seasons. STUDY DESIGN: All laboratory-confirmed RSVH at participating sites during the 2014 to 2015 and 2015 to 2016 RSV seasons (October 1-April 30) lasting ≥24 hours among preterm infants 29 to 35 wGA and aged <12 months who did not receive RSV IP within 35 days before onset of symptoms were identified and characterized. RESULTS: Results were similar across the two seasons. Among infants with community-acquired RSVH (N = 1,378), 45% were admitted to the intensive care unit (ICU) and 19% required invasive mechanical ventilation (IMV). There were two deaths. Infants aged <6 months accounted for 78% of RSVH observed, 84% of ICU admissions, and 91% requiring IMV. Among infants who were discharged from their birth hospitalization during the RSV season, 82% of RSVH occurred within 60 days of birth hospitalization discharge. CONCLUSION: Among U.S. preterm infants 29 to 35 wGA not receiving RSV IP, RSVH are often severe with almost one-half requiring ICU admission and about one in five needing IMV.
Anderson EJ; DeVincenzo JP; Simões EAF; Krilov LR; Forbes ML; Pannaraj PS; Espinosa CM; Welliver RC; Wolkoff LI; Yogev R; Checchia PA; Domachowske JB; Halasa N; McBride SJ; Kumar VR; McLaurin KK; Rizzo CP; Ambrose CS
American Journal of Perinatology
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/10.1055/s-0039-1681014" target="_blank" rel="noreferrer noopener">10.1055/s-0039-1681014</a>
Short-term and long-term outcomes of patients undergoing urgent transcatheter aortic valve replacement under a minimalist strategy.
Female; Humans; Male; Retrospective Studies; Treatment Outcome; Risk Factors; United States/epidemiology; Follow-Up Studies; Severity of Illness Index; Time Factors; Aged 80 and over; Length of Stay; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement/methods; minimalist approach; Hospital Mortality/trends; severe aortic stenosis; urgent procedure; Aortic Valve Stenosis/diagnosis/mortality/surgery; Aortic Valve/diagnostic imaging/surgery; Cardiac Catheterization/methods; Echocardiography Transesophageal; Elective Surgical Procedures/methods; Femoral Artery
OBJECTIVES: Urgent transcatheter aortic valve replacement (TAVR) is associated with worse short-term outcomes compared with elective TAVR; however, little is known about long-term outcomes or the safety of the minimalist strategy in this setting. This study investigated the short-term and long-term outcomes of urgent TAVR compared with elective TAVR under a minimalist strategy (transfemoral [TF] approach with conscious sedation and no transesophageal echocardiography guidance). METHODS: After excluding 2 emergent patients requiring immediate procedures, a total of 474 consecutive patients underwent elective TF-TAVR (396 patients; 83.6%) or urgent
Ichibori Y; Li J; Patel T; Lipinski J; Ladas T; Saric P; Kobe D; Tsushima T; Peters M; Patel S; Davis A; Markowitz AH; Bezerra HG; Costa MA; Kalra A; Attizzani GF
The Journal of invasive cardiology
2019
2019-02
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/" target="_blank" rel="noreferrer noopener"></a>
PMID: 30700628
Suppression of acute proinflammatory cytokine and chemokine upregulation by post-injury administration of a novel small molecule improves long-term neurologic outcome in a mouse model of traumatic brain injury.
Animal; Animals; Brain Injuries/blood/epidemiology/genetics/*physiopathology; Cerebral Cortex/physiopathology; Chemokine CCL2/genetics/physiology; Chemokines/*genetics; Cytokines/*antagonists & inhibitors; Disease Models; Hippocampus/physiopathology; Inflammation/genetics/*physiopathology; Interleukin-1beta/genetics/physiology; Interleukin-6/genetics/physiology; Male; Mice; Tumor Necrosis Factor-alpha/genetics/physiology; United States/epidemiology; Up-Regulation
BACKGROUND: Traumatic brain injury (TBI) with its associated morbidity is a major area of unmet medical need that lacks effective therapies. TBI initiates a neuroinflammatory cascade characterized by activation of astrocytes and microglia, and increased production of immune mediators including proinflammatory cytokines and chemokines. This inflammatory response contributes both to the acute pathologic processes following TBI including cerebral edema, in addition to longer-term neuronal damage and cognitive impairment. However, activated glia also play a neuroprotective and reparative role in recovery from injury. Thus, potential therapeutic strategies targeting the neuroinflammatory cascade must use careful dosing considerations, such as amount of drug and timing of administration post injury, in order not to interfere with the reparative contribution of activated glia. METHODS: We tested the hypothesis that attenuation of the acute increase in proinflammatory cytokines and chemokines following TBI would decrease neurologic injury and improve functional neurologic outcome. We used the small molecule experimental therapeutic, Minozac (Mzc), to suppress TBI-induced up-regulation of glial activation and proinflammatory cytokines back towards basal levels. Mzc was administered in a clinically relevant time window post-injury in a murine closed-skull, cortical impact model of TBI. Mzc effects on the acute increase in brain cytokine and chemokine levels were measured as well as the effect on neuronal injury and neurobehavioral function. RESULTS: Administration of Mzc (5 mg/kg) at 3 h and 9 h post-TBI attenuates the acute increase in proinflammatory cytokine and chemokine levels, reduces astrocyte activation, and the longer term neurologic injury, and neurobehavioral deficits measured by Y maze performance over a 28-day recovery period. Mzc-treated animals also have no significant increase in brain water content (edema), a major cause of the neurologic morbidity associated with TBI. CONCLUSION: These results support the hypothesis that proinflammatory cytokines contribute to a glial activation cycle that produces neuronal dysfunction or injury following TBI. The improvement in long-term functional neurologic outcome following suppression of cytokine upregulation in a clinically relevant therapeutic window indicates that selective targeting of neuroinflammation may lead to novel therapies for the major neurologic morbidities resulting from head injury, and indicates the potential of Mzc as a future therapeutic for TBI.
Lloyd Eric; Somera-Molina Kathleen; Van Eldik Linda J; Watterson D Martin; Wainwright Mark S
Journal of neuroinflammation
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).
<a href="http://doi.org/10.1186/1742-2094-5-28" target="_blank" rel="noreferrer noopener">10.1186/1742-2094-5-28</a>
The epidemiology of respiratory tract infections.
80 and over; Adolescent; Adult; Age Factors; Aged; Child; Community-Acquired Infections/epidemiology; Cross Infection/epidemiology; Drug Resistance; Female; Humans; Incidence; Infant; Male; Microbial; Middle Aged; Newborn; Preschool; Respiratory Tract Diseases/*epidemiology/mortality/prevention & control; Risk Factors; United States/epidemiology
Respiratory tract infections (RTIs) are the most common, and potentially most severe, of infections treated by health care practitioners. Lower RTIs along with influenza, are the most common cause of death by infection in the United States. Risk factors for pneumonia and other respiratory tract infections include: extremes of age (very young and elderly), smoking, alcoholism, immunosuppression, and comorbid conditions. The microbial cause of RTIs vary depending on the infection (i.e., pneumonia compared with acute bacterial sinusitis), setting (i.e., community-acquired compared with nosocomial), and other factors. The causative pathogens associated with CAP have changed in prevalence over time. Although Streptococcus pneumoniae remains the most common causative pathogen, a number of newer pathogens, such as Chlamydia pneumoniae and sin nombre virus, have been recognized in recent years. The emerging antimicrobial resistance of respiratory pathogens (most notably S. pneumoniae) has also increased the challenge for appropriate management of RTI. An awareness of the epidemiology and cause of specific respiratory infections should optimize care.
File T M
Seminars in respiratory infections
2000
2000-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1053/srin.2000.18059" target="_blank" rel="noreferrer noopener">10.1053/srin.2000.18059</a>
Timing and type of surgical treatment of Clostridium difficile-associated disease: a practice management guideline from the Eastern Association for the Surgery of Trauma.
*Clostridium difficile; *Practice Guidelines as Topic; *Societies; *Traumatology; Clostridium Difficile; Clostridium Infections – Epidemiology; Clostridium Infections – Microbiology; Clostridium Infections – Surgery; Clostridium Infections/epidemiology/microbiology/*surgery; Cross Infection – Epidemiology; Cross Infection – Microbiology; Cross Infection – Surgery; Cross Infection/epidemiology/microbiology/*surgery; Human; Humans; Incidence; Medical; Medical Organizations; Meta Analysis; Operative Time; Practice Guidelines; Survival – Trends; Survival Rate/trends; Systematic Review; Time Factors; Traumatology; United States; United States/epidemiology
BACKGROUND: Clostridium difficile infection is the leading cause of nosocomial diarrhea in the United States; however, few patients will develop fulminant C. difficile-associated disease (CDAD), necessitating an urgent operative intervention. Mortality for patients who require operative intervention is very high, up to 80% in some series. Since there is no consensus in the literature regarding the best operative treatment for this disease, we sought to answer the following:PICO [population, intervention, comparison, and outcome] Question 1: In adult patients with CDAD, does early surgery compared with late surgery, as defined by the need for vasopressors, decrease mortality?PICO Question 2: In adult patients with CDAD, does total abdominal colectomy (TAC) compared with other types of surgical intervention decrease mortality? METHODS: A subcommittee of the Practice Management Guideline Committee of the Eastern Association for the Surgery of Trauma conducted a systematic review and meta-analysis for the selected questions. RevMan software was used to generate forest plots. Grading of Recommendations, Assessment, Development and Evaluations methodology was used to rate the quality of the evidence, using GRADEpro software to create evidence tables. RESULTS: Reduction in mortality was significantly associated with early surgery, with a risk ratio (RR) of 0.5 (95% confidence interval [CI], 0.35-0.72). The quality of evidence was rated "moderate." Considering only the first procedure performed, mortality seemed to trend higher for TAC, with an RR of 1.11 (95% CI, 0.69-1.80). Considering only the actual procedure performed, the point estimate switched sides, showing a trend toward decreased mortality with TAC (RR, 0.86; 95% CI, 0.56-1.31). The quality of evidence was rated "very low." CONCLUSION: We strongly recommend that adult patients with CDAD undergo early surgery, before the development of shock and need for vasopressors. We conditionally recommend total or subtotal colectomy (vs. partial colectomy or other surgery) when the diagnosis of The Centers for Disease Control and Prevention is known.
Ferrada Paula; Velopulos Catherine G; Sultan Shahnaz; Haut Elliott R; Johnson Emily; Praba-Egge Anita; Enniss Toby; Dorion Heath; Martin Niels D; Bosarge Patrick; Rushing Amy; Duane Therese M
The journal of trauma and acute care surgery
2014
2014-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/TA.0000000000000232" target="_blank" rel="noreferrer noopener">10.1097/TA.0000000000000232</a>
Unified theory of the origins of erosive arthritis: conditioning as a protective/directing mechanism?
Humans; United States/epidemiology; *Paleontology; Catchment Area (Health); Arthritis; Tuberculosis; Spondylitis; Ankylosing/complications/epidemiology; Osteoarticular/complications/epidemiology; Rheumatoid/epidemiology/*etiology
OBJECTIVE: To validate the western Tennessee River limits of the originally described rheumatoid arthritis (RA) catchment area and to assess the possibility that absence of tuberculosis allowed the original development of RA. The hypothesis that RA was related to tuberculosis was once a driving force in treatment approach. RA initially was very limited in geographic distribution, in contrast to tuberculosis. Classical tubercular lesions were not observed in the rheumatoid catchment area in ancient times. Similarities between clinical and radiologic manifestations of spondyloarthropathy (SpA) and adjuvant arthritis raised the possibility of a potential conditioning role for occurrence of nonrheumatoid erosive arthritis. METHODS: Skeletal samples from ancient RA catchment and non-catchment areas were compared for frequency of tubercular-relatable pathologies. RESULTS: Tubercular-relatable osseous pathologies were found only outside the rheumatoid catchment area (p \textless 0.0001). The original RA catchment area was confirmed not to extend beyond the western portion of the Tennessee River. CONCLUSION: There is an inverse relationship between occurrence of tuberculosis and RA in the Archaic and Early Woodland periods of North America. The virtually universal presence of tuberculosis in contiguous Amerindian populations contrasts dramatically with its absence in the ancient catchment area for RA. Conversely, SpA and tuberculosis do occur in the same populations. Tuberculosis may represent a conditioning agent for development of SpA, but at least potentially provides protection against development of RA.
Rothschild Bruce M; Rothschild Christine; Helbling Mark
The Journal of rheumatology
2003
2003-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
US emergency department visits for hip fracture, 1992-2000.
80 and over; Age Factors; Aged; Analgesia/statistics & numerical data; Emergency Medical Services/*statistics & numerical data; Female; Hip Fractures/diagnosis/*epidemiology/therapy; Humans; Male; Middle Aged; Sex Factors; United States/epidemiology
BACKGROUND: Hip fracture is a significant injury for older persons. Little has been reported about emergency department (ED) care of these patients. OBJECTIVE: To characterize the management of older patients treated in the ED for hip fracture with specific attention to the use of analgesia. METHODS: This study analysed data from the National Hospital Ambulatory Medical Care Survey ( approximately 400 hospitals report each year) for the years 1992-2000. We included records of patients who were at least 50 years old and had a diagnosis of hip fracture (International Classification of Disease, 9th revision, clinical modification 820-820.9) in any of the three fields allowed for recording diagnosis. RESULTS: There were 1,935,000 ED visits ( approximately 215,000 a year), predominantly among older white women. The rate in those over 80 years old was 25 times that of the youngest group. Fifty-six per cent of patients received analgesia (44% narcotics). There were no ethnic or racial distinctions in the use of analgesia. CONCLUSIONS: The ED visit presents a largely untapped opportunity for focused efforts in fall and hip fracture prevention, especially in countries with comprehensive geriatric services and well integrated healthcare delivery systems. Despite the high likelihood of pain, the administration of analgesics appears to be low and may be a worthy focus for practice improvement.
Gerson Lowell W; Emond Jennifer A; Camargo Carlos A Jr
European journal of emergency medicine : official journal of the European Society for Emergency Medicine
2004
2004-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/00063110-200412000-00005" target="_blank" rel="noreferrer noopener">10.1097/00063110-200412000-00005</a>
Weakness and fatigue in older ED patients in the United States.
80 and over; 80 and Over; Aged; Cross Sectional Studies; Cross-Sectional Studies; Demography; Fatigue – Diagnosis; Fatigue – Epidemiology; Fatigue/diagnosis/*epidemiology; Female; Health Care Surveys; Human; Humans; Male; Muscle Weakness – Diagnosis; Muscle Weakness – Epidemiology; Muscle Weakness/diagnosis/*epidemiology; Prevalence; Surveys; United States; United States/epidemiology
BACKGROUND: The objectives of this study are to estimate the prevalence of weakness and fatigue visits in older emergency department (ED) patients, to compare demographics and resource use in these patients with those without these complaints, and to determine their ED diagnoses and disposition. METHODS: We performed a cross-sectional cohort analysis of ED visits in patients aged older than 65 years from the 2003 to 2007 National Hospital Ambulatory Medical Care Surveys. Weakness and fatigue visits had a reason for visit code of generalized weakness (1020.0) or tiredness and exhaustion (1015.0); the comparison cohort lacked these codes. Descriptive data are presented as totals, means, and proportions with 95% confidence intervals (CIs). Comparisons between cohorts used chi(2) for proportions and the adjusted Wald test for means. RESULTS: There were an estimated 575 million ED visits, those aged 65 years and older made 14.7% (95% CI, 14.2-15.3) of visits. Overall, 6.0% (95% CI, 5.6-6.4) of these visits had weakness and fatigue; this was the fifth most common primary reason for visit. Weakness and fatigue visits increased with age. Weakness and fatigue visits had longer ED lengths of stay (300 vs 249 minutes, P \textless .001), more diagnostic tests (7.7 vs 5.0, P \textless .001), procedures (5.7 vs 4.7, P \textless .001), and hospital admissions (55% vs 35%, P \textless .001). The most common primary diagnoses for the weakness and fatigue cohort were "other malaise and fatigue," pneumonia, and urinary tract infection. CONCLUSION: Weakness and fatigue are common in older ED patients. These patients undergo more tests and procedures, and most are admitted.
Bhalla Mary Colleen; Wilber Scott T; Stiffler Kirk A; Ondrejka Jason E; Gerson Lowell W
The American journal of emergency medicine
2014
2014-11
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/10.1016/j.ajem.2014.08.027" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2014.08.027</a>