1
|
Mattay G, Mallikarjun K, Grow P, Mintz A, Ciesielski T, Dao A, Mattay S, Cislo G, Mattay R, Narra V, Bierhals A. Communication of Incidental Imaging Findings on Inpatient Discharge Summaries After Implementation of Electronic Health Record Notification System. J Patient Saf 2024:01209203-990000000-00207. [PMID: 38506482 DOI: 10.1097/pts.0000000000001221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Inadequate follow-up of incidental imaging findings (IIFs) can result in poor patient outcomes, patient dissatisfaction, and provider malpractice. At our institution, radiologists flag IIFs during report dictation to trigger electronic health record (EHR) notifications to providers and patients. Nurse coordinators directly contact patients or their primary care physicians (PCPs) regarding IIFs if follow-up is not completed within the recommended time frame. Despite these interventions, many patients and their PCPs remain unaware of IIFs. In an effort to improve awareness of IIFs, we aim to investigate communication of IIFs on inpatient discharge summaries after implementation of our EHR notification system. METHODS Inpatient records with IIFs from 2018 to 2021 were retrospectively reviewed to determine type of IIFs, follow-up recommendations, and mention of IIFs on discharge summaries. Nurse coordinators spoke to patients and providers to determine their awareness of IIFs. RESULTS Incidental imaging findings were reported in 51% of discharge summaries (711/1383). When nurse coordinators called patients and PCPs regarding IIFs at the time follow-up was due, the patients and PCPs were aware of 79% of IIFs (1096/1383). CONCLUSIONS With implementation of EHR notifications to providers regarding IIFs, IIFs were included in 51% of discharge summaries. Lack of inclusion of IIFs on discharge summaries could be related to transitions of care within hospitalization, provider alert fatigue, and many diagnostic testing results to distill. These findings demonstrate the need to improve communication of IIFs, possibly via automating mention of IIFs on discharge summaries, and the need for care coordinators to follow up on IIFs.
Collapse
Affiliation(s)
- Govind Mattay
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | | | - Paula Grow
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Aaron Mintz
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Thomas Ciesielski
- Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Anthony Dao
- Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Shivani Mattay
- Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Geoffrey Cislo
- Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Raghav Mattay
- Department of Radiology and Biomedical Imaging, University of California San Francisco, California
| | - Vamsi Narra
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Andrew Bierhals
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| |
Collapse
|
2
|
Mattay GS, Griffey RT, Narra V, Poirier RF, Bierhals A. Impact of Predictive Text Clinical Decision Support on Imaging Order Entry in the Emergency Department. J Am Coll Radiol 2023; 20:1250-1257. [PMID: 37805010 DOI: 10.1016/j.jacr.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Imaging clinical decision support (CDS) is designed to assist providers in selecting appropriate imaging studies and is now federally required. The aim of this study was to understand the effect of CDS on decisions and workflows in the emergency department (ED). METHODS The authors' institution's order entry platform serves up structured indications for imaging orders. Imaging orders are scored by CDS on the basis of appropriate use criteria (AUC). CDS triggers alerts for imaging orders with low AUC scores. Because free text alone cannot be scored by CDS, an artificial intelligence predictive text (AIPT) module was implemented to guide the selection of structured indications when free-text indications are entered. A total of 17,355 imaging orders in the ED over 6 months were retrospectively analyzed. RESULTS CDS alerts for low AUC scores were triggered for 3% of all imaging study orders (522 of 17,355). Providers spent an average of 24 seconds interacting with alerts. In 18 of 522 imaging orders with alerts, alternative studies were ordered. After AIPT implementation, the percentage of unscored studies significantly decreased from 81% to 45% (P < .001). CONCLUSIONS In a quaternary academic ED, CDS alerts triggered by low AUC scores caused minimal increase in time spent on imaging order entry but had a relatively marginal impact on imaging study selection. AIPT implementation increased the number of scored studies and could potentially enhance CDS effects. CDS implementation enables the collection of novel data regarding which imaging studies receive low AUC scores. Future work could include exploring alternative models of CDS implementation to maximize its impact.
Collapse
Affiliation(s)
- Govind S Mattay
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri.
| | - Richard T Griffey
- Associate Chief, Emergency Medicine, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Vamsi Narra
- Senior Vice Chair, Imaging Informatics and New Business Development, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; Chief, Radiology, Barnes-Jewish West County Hospital, St. Louis, Missouri; Associate Chief Medical Informatics Officer, BJC HealthCare, St. Louis, Missouri
| | - Robert F Poirier
- Associate Chief, Emergency Medicine, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri; Medical Director and Chief of Clinical Operations, Emergency Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
| | - Andrew Bierhals
- Vice Chair, Community Radiology, Vice Chair, Quality and Safety, Medical and Director for CT, Center for Clinical Imaging Research, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; Director of Cardiothoracic Imaging, Barnes-Jewish West County Hospital, St. Louis, Missouri. https://twitter.com/AMdmph
| |
Collapse
|
3
|
Vazquez Guillamet R, Rjob A, Bierhals A, Tague L, Marklin G, Halverson L, Witt C, Byers D, Hachem R, Gierada D, Brody SL, Takahashi T, Nava R, Kreisel D, Puri V, Trulock EP. Potential Role of Computed Tomography Volumetry in Size Matching in Lung Transplantation. Transplant Proc 2023; 55:432-439. [PMID: 36914438 PMCID: PMC10225152 DOI: 10.1016/j.transproceed.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Accumulated knowledge on the outcomes related to size mismatch in lung transplantation derives from predicted total lung capacity equations rather than individualized measurements of donors and recipients. The increasing availability of computed tomography (CT) makes it possible to measure the lung volumes of donors and recipients before transplantation. We hypothesize that CT-derived lung volumes predict a need for surgical graft reduction and primary graft dysfunction. METHODS Donors from the local organ procurement organization and recipients from our hospital from 2012 to 2018 were included if their CT exams were available. The CT lung volumes and plethysmography total lung capacity were measured and compared with predicted total lung capacity using Bland Altman methods. We used logistic regression to predict the need for surgical graft reduction and ordinal logistic regression to stratify the risk for primary graft dysfunction. RESULTS A total of 315 transplant candidates with 575 CT scans and 379 donors with 379 CT scans were included. The CT lung volumes closely approximated plethysmography lung volumes and differed from the predicted total lung capacity in transplant candidates. In donors, CT lung volumes systematically underestimated predicted total lung capacity. Ninety-four donors and recipients were matched and transplanted locally. Larger donor and smaller recipient lung volumes estimated by CT predicted a need for surgical graft reduction and were associated with higher primary graft dysfunction grade. CONCLUSION The CT lung volumes predicted the need for surgical graft reduction and primary graft dysfunction grade. Adding CT-derived lung volumes to the donor-recipient matching process may improve recipients' outcomes.
Collapse
Affiliation(s)
- Rodrigo Vazquez Guillamet
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri.
| | - Ashraf Rjob
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Andrew Bierhals
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri
| | - Laneshia Tague
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Gary Marklin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Laura Halverson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Chad Witt
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Derek Byers
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - Ramsey Hachem
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| | - David Gierada
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri
| | - Steven L Brody
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri; Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri
| | - Tsuyoshi Takahashi
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Ruben Nava
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Daniel Kreisel
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Varun Puri
- Department of Surgery, Division of Thoracic Surgery, Washington University, St Louis, Missouri
| | - Elbert P Trulock
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University, St Louis, Missouri
| |
Collapse
|
4
|
Vazquez Guillamet R, Vazquez Guillamet MC, Rjob A, Bierhals A, Bello I, Abularach AJ, Tague L, Wallendorf M, Marklin GF, Witt C, Byers DE, Kreisel D, Nava R, Puri V, Hachem R, Trulock EP. Uncertainty analysis of chest X-ray lung height measurements and size matching for lung transplantation. J Thorac Dis 2022; 14:1042-1051. [PMID: 35572863 PMCID: PMC9096316 DOI: 10.21037/jtd-21-1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
Abstract
Background Errors in measuring chest X-ray (CXR) lung heights could contribute to the occurrence of size-mismatched lung transplant procedures. Methods We first used Bland-Altman analysis for repeated measures to evaluate contributors to measurement error of chest X-ray lung height. We then applied error propagation theory to assess the impact of measurement error on size matching for lung transplantation. Results A total 387 chest X-rays from twenty-five donors and twenty-five recipients were measured by two raters. Individual standard deviation for lung height differences were independent of age, sex, donor vs. recipient, diagnostic group and race/ethnicity and all were pooled for analysis. Bias between raters was 0.27 cm (±0.03) and 0.22 cm (±0.06) for the right and left lung respectively. Within subject variability was the biggest contributor to error in measurement, 2.76 cm (±0.06) and 2.78 cm (±0.2) for the right and left lung height. A height difference of 4.4 cm or more (95% CI: ±4.2, ±4.6 cm) between the donor and the recipient right lung height has to be accepted to ensure matching for at least 95% of patients with the same true lung height. This difference decreases to ±1.1 cm (95% CI: ±0.9, ±1.3 cm) when the average from all available chest X-rays is used. The probability of matching a donor and a recipient decreases with increasing true lung height difference. Conclusions Individual chest X-ray lung heights are imprecise for the purpose of size matching in lung transplantation. Averaging chest X-rays lung heights reduced uncertainty.
Collapse
Affiliation(s)
- Rodrigo Vazquez Guillamet
- Division of Pulmonary and Critical Care Medicine at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Maria C. Vazquez Guillamet
- Division of Pulmonary and Critical Care Medicine at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
- Division of Infectious Diseases at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Ashraf Rjob
- Division of Infectious Diseases at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Andrew Bierhals
- Radiology Department at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Irene Bello
- Division of Thoracic Surgery and Lung Transplantation at Vall d’Hebron University Hospital, Barcelona, Spain
| | - Alberto Jauregui Abularach
- Division of Thoracic Surgery and Lung Transplantation at Vall d’Hebron University Hospital, Barcelona, Spain
| | - Laneshia Tague
- Division of Pulmonary and Critical Care Medicine at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Michael Wallendorf
- Division of Statistics at Washington University School of Medicine, St. Louis, MO, USA
| | | | - Chad Witt
- Division of Pulmonary and Critical Care Medicine at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Derek E. Byers
- Division of Pulmonary and Critical Care Medicine at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Daniel Kreisel
- Division of Thoracic Surgery at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Ruben Nava
- Division of Thoracic Surgery at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Varun Puri
- Division of Thoracic Surgery at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Ramsey Hachem
- Division of Pulmonary and Critical Care Medicine at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| | - Elbert P. Trulock
- Division of Pulmonary and Critical Care Medicine at Washington University - Barnes Jewish Hospital, St. Louis, MO, USA
| |
Collapse
|
5
|
Self A, Si S, Despotovic V, Bierhals A, Chen L, McEvoy C, Chakinala M. CLINICAL CHARACTERISTICS, TREATMENT RESPONSE, AND SURVIVAL OF PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOSITIS AND PULMONARY ARTERIAL HYPERTENSION. Chest 2020. [DOI: 10.1016/j.chest.2020.08.1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
6
|
Balsara KR, Bierhals A, Vader J, Pasque MK, Itoh A. Implantation of left ventricular assist device in a patient with left ventricular non-compaction. J Card Surg 2017; 32:159-161. [DOI: 10.1111/jocs.13088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Keki R. Balsara
- Division of Cardiothoracic Surgery; Department of Surgery; Washington University in St. Louis School of Medicine; St. Louis Missouri
| | - Andrew Bierhals
- Department of Radiology; Washington University in St. Louis School of Medicine; St. Louis Missouri
| | - Justin Vader
- Division of Cardiology; Department of Medicine; Washington University in St. Louis School of Medicine; St. Louis Missouri
| | - Michael K. Pasque
- Division of Cardiothoracic Surgery; Department of Surgery; Washington University in St. Louis School of Medicine; St. Louis Missouri
| | - Aki Itoh
- Division of Cardiothoracic Surgery; Department of Surgery; Washington University in St. Louis School of Medicine; St. Louis Missouri
| |
Collapse
|
7
|
Heberton GA, Nassif M, Bierhals A, Novak E, LaRue SJ, Lima B, Hall S, Silvestry S, Joseph SM. Usefulness of Psoas Muscle Area Determined by Computed Tomography to Predict Mortality or Prolonged Length of Hospital Stay in Patients Undergoing Left Ventricular Assist Device Implantation. Am J Cardiol 2016; 118:1363-1367. [PMID: 27622708 DOI: 10.1016/j.amjcard.2016.07.061] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 01/06/2023]
Abstract
The purpose of this study is to examine the association of sarcopenia as measured by psoas muscle area and outcomes in patients undergoing left ventricular assist device (LVAD) implantation. We retrospectively examined 333 consecutive patients who underwent implantation of a HeartMate II LVAD at our institution from June 2008 to August 2013. Patients were included if they had a perioperative computed tomography that spanned the L3-L4 vertebrae. Sarcopenia was defined as having the lowest tertile psoas muscle area by gender. The primary end point was the composite of inpatient death or prolonged length of stay of >30 days. One hundred patients met inclusion criteria. The psoas muscle area cut-off values for the lowest tertiles were 12.0 cm2 for men and 6.5 cm2 for women, resulting in 32 sarcopenic patients (32%). The primary outcome of inpatient death or prolonged length of stay occurred in 81% of patients in the sarcopenic versus 60% in the nonsarcopenic group (p = 0.043). There was a trend toward prolonged length of stay in sarcopenic patients but no difference in overall mortality. This demonstrates that sarcopenia as measured by psoas muscle area is associated with increased composite length of stay and mortality after LVAD implantation and may serve as correlate for frailty.
Collapse
Affiliation(s)
- George A Heberton
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Nassif
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew Bierhals
- Division of Diagnostic Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Eric Novak
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Shane J LaRue
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | - Brian Lima
- Cardiology Division, Baylor University Medical Center, Dallas, Texas
| | - Shelley Hall
- Cardiology Division, Baylor University Medical Center, Dallas, Texas
| | - Scott Silvestry
- Florida Hospital Transplant Institute, Florida Hospital, Orlando, Florida
| | - Susan M Joseph
- Cardiology Division, Baylor University Medical Center, Dallas, Texas.
| |
Collapse
|
8
|
Bruchas RR, de Las Fuentes L, Carney RM, Reagan JL, Bernal-Mizrachi C, Riek AE, Gu CC, Bierhals A, Schootman M, Malmstrom TK, Burroughs TE, Stein PK, Miller DK, Dávila-Román VG. The St. Louis African American health-heart study: methodology for the study of cardiovascular disease and depression in young-old African Americans. BMC Cardiovasc Disord 2013; 13:66. [PMID: 24011389 PMCID: PMC3847628 DOI: 10.1186/1471-2261-13-66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/13/2013] [Indexed: 01/20/2023] Open
Abstract
Background Coronary artery disease (CAD) is a major cause of death and disability worldwide. Depression has complex bidirectional adverse associations with CAD, although the mechanisms mediating these relationships remain unclear. Compared to European Americans, African Americans (AAs) have higher rates of morbidity and mortality from CAD. Although depression is common in AAs, its role in the development and features of CAD in this group has not been well examined. This project hypothesizes that the relationships between depression and CAD can be explained by common physiological pathways and gene-environment interactions. Thus, the primary aims of this ongoing project are to: a) determine the prevalence of CAD and depression phenotypes in a population-based sample of community-dwelling older AAs; b) examine the relationships between CAD and depression phenotypes in this population; and c) evaluate genetic variants from serotoninP and inflammatory pathways to discover potential gene-depression interactions that contribute significantly to the presence of CAD in AAs. Methods/design The St. Louis African American Health (AAH) cohort is a population-based panel study of community-dwelling AAs born in 1936–1950 (inclusive) who have been followed from 2000/2001 through 2010. The AAH-Heart study group is a subset of AAH participants recruited in 2009–11 to examine the inter-relationships between depression and CAD in this population. State-of-the-art CAD phenotyping is based on cardiovascular characterizations (coronary artery calcium, carotid intima-media thickness, cardiac structure and function, and autonomic function). Depression phenotyping is based on standardized questionnaires and detailed interviews. Single nucleotide polymorphisms of selected genes in inflammatory and serotonin-signaling pathways are being examined to provide information for investigating potential gene-depression interactions as modifiers of CAD traits. Information from the parent AAH study is being used to provide population-based prevalence estimates. Inflammatory and other biomarkers provide information about potential pathways. Discussion This population-based investigation will provide valuable information on the prevalence of both depression and CAD phenotypes in this population. The study will examine interactions between depression and genetic variants as modulators of CAD, with the intent of detecting mechanistic pathways linking these diseases to identify potential therapeutic targets. Analytic results will be reported as they become available.
Collapse
Affiliation(s)
- Robin R Bruchas
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St, Louis, MO 63110, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Tiwari AK, Bierhals A, Wang JS. An uncommon cause of post-prandial nausea and vomiting. Superior mesenteric artery syndrome. Gastroenterology 2013; 145:520, 698. [PMID: 23900107 DOI: 10.1053/j.gastro.2013.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 06/06/2013] [Indexed: 12/02/2022]
|
10
|
Lee J, Creach K, Bierhals A, DeWees T, Mullen D, Parikh P, Bradley J, Robinson C. Predictors of Rib Fracture and Nonfracture Chest Wall Pain After Lung Stereotactic Body Radiation Therapy (SBRT). Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
11
|
Mathews SJ, de Las Fuentes L, Podaralla P, Cabellon A, Zheng S, Bierhals A, Spence K, Slatopolsky E, Davila-Roman VG, Delmez JA. Effects of sodium thiosulfate on vascular calcification in end-stage renal disease: a pilot study of feasibility, safety and efficacy. Am J Nephrol 2011; 33:131-8. [PMID: 21242673 DOI: 10.1159/000323550] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/12/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Vascular calcification is a major contributor to morbidity and mortality in hemodialysis. The objective of this pilot study was to determine the feasibility, safety and efficacy of sodium thiosulfate (STS) in the progression of vascular calcification in hemodialysis patients. METHODS Chronic hemodialysis patients underwent a battery of cardiovascular tests. Those with coronary artery calcium (Agatston scores >50) received intravenous STS after each dialysis for 5 months (n = 22) and the tests were repeated. Changes in MDCT-determined calcification were assessed as the mean annualized rate of change in 3 vascular beds (coronary, thoracic and carotid arteries) and in L1-L2 vertebral bone density. RESULTS Although individual analyses showed coronary artery calcification progression in 14/22 subjects, there was no progression in the mean annualized rate of change of vascular calcification in the entire group. The L1-L2 vertebral bone density showed no changes. There were no correlations between rates of progression of vascular calcification and phosphorus, fetuin or C-reactive protein levels. Changes in coronary artery calcification scores correlated with those of the thoracic aorta. CONCLUSION STS treatment is feasible, appears safe and may decrease the rate of progression of vascular calcification in hemodialysis patients. A large, randomized, controlled trial is warranted.
Collapse
Affiliation(s)
- Santhosh Jay Mathews
- Cardiovascular Imaging and Clinical Research Core Laboratory and Cardiovascular Division, Washington University School of Medicine, St. Louis, Mo., USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Zheng S, de Las Fuentes L, Bierhals A, Ash-Bernal R, Spence K, Slatopolsky E, Davila-Roman VG, Delmez J. Relation of serum fetuin-A levels to coronary artery calcium in African-American patients on chronic hemodialysis. Am J Cardiol 2009; 103:46-9. [PMID: 19101228 DOI: 10.1016/j.amjcard.2008.08.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 08/19/2008] [Accepted: 08/19/2008] [Indexed: 01/07/2023]
Abstract
Vascular calcium deposition in end-stage renal disease occurs commonly, but its relation to cardiovascular risk factors and fetuin-A levels in African Americans is not known. Compliant African American patients who were undergoing hemodialysis (HD; n = 17) agreed to undergo 64-slice multidetector computed tomography for the assessment of coronary artery calcium score (CACS). The relation between traditional cardiovascular risk factors (i.e., age; gender; dialysis vintage; history of diabetes; means of the previous 3 years of weekly predialysis blood pressure values and hemoglobin levels; means of monthly values of calcium, phosphorus, alkaline phosphatase, uric acid; and albumin; and means of quarterly measurements of parathyroid hormone and lipids) and fetuin-A levels and CACS was explored using univariate analyses. Serum phosphorus levels over the previous 3 years were well controlled. The CACS range was 0 to 3,877 Agatston units (mean 996, median 196). Among the tested variables, only fetuin-A was significantly and inversely associated with CACS (standardized beta = -0.64, 95% confidence interval -18.09 to -3.62, p = 0.006). There was no association between age and fetuin-A level (standardized beta = -0.02, 95% confidence interval -0.10 to 0.23). In conclusion, African-American patients who were undergoing long-term hemodialysis and with good phosphorus control exhibited a strong inverse correlation between fetuin-A level and CACS that was independent of age.
Collapse
Affiliation(s)
- Sijie Zheng
- Division of Nephrology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Woodard PK, Bhalla S, Javidan-Nejad C, Bierhals A, Gutierrez FR, Singh GK. Cardiac MRI in the management of congenital heart disease in children, adolescents, and young adults. Curr Treat Options Cardio Med 2008; 10:419-24. [DOI: 10.1007/s11936-008-0033-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
14
|
Gorse K, Mickey CA, Bierhals A. Conditioning injuries associated with artificial turf in two preseason football training programs. J Athl Train 1997; 32:304-8. [PMID: 16558463 PMCID: PMC1320345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To compare the occurrence of preseason football conditioning injuries in traditional and crossover conditioning programs over five preseasons. DESIGN AND SETTING The turf group performed all preseason conditioning by running or sprinting on artificial turf, and the turf and swim group alternated all preseason conditioning by running and sprinting on artificial turf or kickboard swimming. SUBJECTS Subjects were 519 NCAA Division III physically active football players. MEASUREMENTS Previous conditioning injuries, preseason conditioning injuries, missed practices, and missed conditioning sessions were recorded. Exact numbers and areas of injury for each year and each group were tabulated. A chi-square statistic compared the two groups and a logistic regression model was used to estimate the risk of becoming injured and the types of conditioning injuries experienced in the two groups. RESULTS Prevalence of injury was significantly different in the two groups. In the turf group, 35% of subjects developed a conditioning injury; in the turf and swim group, 13% developed a conditioning injury (x(2)= 33.16, p <.0001). No significant difference in missed practices or missed conditioning sessions was found. CONCLUSIONS The turf and swim group experienced significantly fewer football preseason conditioning injuries than the turf group. The crossover effects of a running and swimming program may decrease the number of overuse injuries associated with repetitive running on artificial turf in traditional preseason conditioning programs.
Collapse
|