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Webber AA, Perati S, Su EM, Ata A, Beyer TD, Applewhite MK, Canete JJ, Lee EC. Psychiatric Diagnoses Are Associated With Postoperative Disparities in Patients Undergoing Major Colorectal Operations. Am Surg 2024:31348241248690. [PMID: 38650166 DOI: 10.1177/00031348241248690] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Over 50% of hospitalized patients have comorbid psychiatric diagnoses, resulting in increased risk of morbidity such as longer lengths of stay, worse health-related quality of life, and increased mortality. However, data regarding colorectal surgery postoperative outcomes in patients with psychiatric diagnoses (PD) are limited. METHODS We queried a single institution's National Surgical Quality Improvement Program from 2013-2019 for major colorectal procedures. Postsurgical outcomes for patients with and without PD were compared. Primary outcomes were prolonged length of stay (pLOS) and 30-day readmission. RESULTS From a total of 1447 patients, 402 (27.8%) had PD. PD had more smokers (20.9% vs 15%) and higher mean body mass index (29.1 kg/m2 vs 28.2 kg/m2). Bivariate outcomes showed more surgical site infections (SSI) (10.2% vs 6.12%), reoperation (9.45% vs 6.35%), and pLOS (34.8% vs 29.0%) (all P values <.05) in the PD group. On multivariate analysis, PD had higher likelihood of reoperation (OR 1.53, 95% CI: [1.02-2.80]) and SSI (OR 1.82, 95% CI: [1.25-2.66]). DISCUSSION Psychiatric diagnoses are a risk factor for adverse outcomes after colorectal procedures. Further studies are needed to evaluate the benefit of perioperative mental health support services for these patients.
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Affiliation(s)
- Alexis A Webber
- General Surgery Resident, Albany Medical Center, Albany, NY, USA
| | - Shruthi Perati
- General Surgery Resident, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Emily M Su
- General Surgery Resident, Summa Health System, Akron, OH, USA
| | - Ashar Ata
- Surgery, Albany Medical Center, Albany, NY, USA
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2
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Ottaviano KE, Palange DC, Hill SS, Ata A, Chismark AD, Canete JJ, Valerian BT, Lee EC. Use of a 5-Item Modified Frailty Index for Assessing Outcomes After Hartmann's Reversal: An ACS-NSQIP Study. Am Surg 2024; 90:875-881. [PMID: 37978813 DOI: 10.1177/00031348231216483] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Half of all patients with an end colostomy after sigmoid colectomy (Hartmann's procedure) never undergo Hartmann's reversal, frequently secondary to frailty. This retrospective cohort study evaluates the utility of a five-item modified frailty index (mFI-5) in predicting post-operative outcomes after Hartmann's reversal. METHODS The National Surgery Quality Improvement Program (NSQIP) database captured patients with elective Hartmann's reversals from 2011 to 2020. Clinical covariates were evaluated with univariate analysis and modified Poisson regression to determine association with overall morbidity, overall mortality, and extended length of stay (eLOS) when categorized by mFI-5 score. RESULTS 15,172 patients underwent elective Hartmann's reversal (91.6% open and 8.4% laparoscopic). Patients were grouped by mFI-5 score (0: 48.7%, 1: 38.2%, ≥ 2: 13.1%). Adjusted multivariable analysis showed frail patients (mFI-5≥2) had increased overall mortality (OR 2.23, 95% CI 1.21-4.11), morbidity (OR 1.23, 95% CI 1.12-1.35), and eLOS (OR 1.12, 95% 1.02-1.23). Among frail patients, a laparoscopic approach was associated with decreased overall morbidity (OR .64, 95% CI 0.56-.73) and decreased eLOS (OR .46, 95% CI 0.39-.54) when compared to open approach. DISCUSSION An mFI-5 of ≥2 was associated with greater morbidity, mortality, and eLOS following Hartmann's reversal. However, there were no mortality or eLOS differences in patients with an mFI-5 of 1 and only a 14% increase in any morbidity, making these patients potentially good candidates for Hartmann's reversal. Furthermore, laparoscopic surgery was associated with a protective effect for overall morbidity and eLOS, potentially mitigating some of the risk associated with higher frailty scores.
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Affiliation(s)
| | | | - Susanna S Hill
- University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Ashar Ata
- Albany Medical Center, Albany, NY, USA
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3
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Wladis EJ, Ata A, Li C, Peng X, Waxman MJ, Pauze DR, Lum F. The impact of month and season on the incidence of giant cell arteritis: an Intelligent Research in Sight (IRIS) Registry analysis. Graefes Arch Clin Exp Ophthalmol 2024; 262:609-614. [PMID: 37819458 DOI: 10.1007/s00417-023-06268-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE Previous investigations into the relationship between season and the incidence of giant cell arteritis (GCA) have produced conflicting results. This study aimed to explore the impact of season and new diagnoses of GCA in a more definitive sense by employing the large dataset of the Intelligent Research in Sight (IRIS) database. METHODS The IRIS Registry was queried to identify new cases of GCA from 2013 to 2021. Statistical analyses were performed to determine the significance of the relationship between the time of year and the incidence of GCA on regional and nationwide bases via Cochran's Q statistical test. RESULTS A total of 27,339 eyes with a new diagnosis of GCA were identified. Neither the month nor the season of the year correlated with the incidence of GCA, regardless of geographic location within the USA (p > 0.05 for each variable). CONCLUSIONS In the USA, the incidence of GCA does not appear to vary by month or season. While this finding contradicts certain previous studies that identified a relationship, the cohort of patients identified from the IRIS Registry is much larger than that of previous investigations. Clinicians should be mindful of the possibility of GCA, regardless of the time of the year.
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Affiliation(s)
- Edward J Wladis
- Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany, NY, USA.
- Department of Otolaryngology, Albany Medical College, Albany, NY, USA.
| | - Ashar Ata
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Charles Li
- American Academy of Ophthalmology, San Francisco, CA, USA
| | - Xuan Peng
- American Academy of Ophthalmology, San Francisco, CA, USA
| | - Michael J Waxman
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Denis R Pauze
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, CA, USA
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Varelas PN, Kananeh M, Brady P, Holden D, Mehta C, Ata A, Abdelhak T, Greer D, Rehman M. The Relationship Between Manifestation of Diabetes Insipidus and Estimated Glomerular Filtration Rate in Brain Death. Crit Care Med 2024; 52:e58-e66. [PMID: 37966309 DOI: 10.1097/ccm.0000000000006131] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Systematic reviews have revealed that up to 50% of patients with brain death have residual hypothalamic/pituitary activity based on the absence of central diabetes insipidus (DI). We hypothesized that different degrees of renal dysfunction may impact the presence of DI in patients with brain death. DESIGN Single-center prospective data collection. SETTING ICUs in a tertiary academic hospital. PATIENTS All adult patients declared brain dead over 12 years. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS DI was diagnosed by polyuria, low urine specific gravity, and increasing serum sodium, measured in close proximity. Renal function was assessed by the estimated glomerular filtration rate (eGFR), calculated using the simplified modification of diet in renal disease equation. Analysis was completed in 192 of 234 patients with brain death after excluding those with missing data, those younger than 18 years and those on vasopressin infusions. One hundred twenty-two patients (63.5%) developed DI and 70 patients (36.5%) did not. The proportion of DI decreased significantly with decreasing eGFR: for eGFR greater than 60 mL/min, DI was present in 77.2%; for eGFR 15-60 mL/min, DI was present in 54.5%; for eGFR 14.9-9.8 mL/min, DI was present in 32%; none of the 14 patients with eGFR less than or equal to 9.7 mL/min ever experienced DI ( p < 0.001). Using logistic regression, for every 10 mL/min decrease in eGFR, the odds of DI decreased 0.83 times (95% CI, 0.76-0.90, p < 0.001). CONCLUSIONS Renal dysfunction significantly impacts DI's clinical manifestation in brain death. We report that patients who experience brain death with severe renal dysfunction may not develop clinical signs of DI.
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Affiliation(s)
| | | | - Paul Brady
- Capital Health Medical Center, Hopewell, NJ
| | - Devin Holden
- Department of Pharmacy, Albany Medical Center, Albany NY
| | - Chandan Mehta
- Department of Neurology, Henry Ford Health, Detroit, MI
| | - Ashar Ata
- Department of Surgery, Albany Medical College, Albany, NY
| | - Tamer Abdelhak
- Department of Neurology, Albany Medical College, Albany, NY
| | - David Greer
- Department of Neurology, Boston University, Boston, MA
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Barlin JN, Mahar B, Ata A, Cormier B, Michelin D, Salani R, Backes F, Levinson K, Cantrell LA, Weinberg L, Wagreich A, Savage D, Gasson C, Denniston K, Martin J, McElrath T, Timmins PF. Lunchbox trial: A randomized phase III trial of cisplatin and irradiation followed by carboplatin and paclitaxel versus sandwich therapy of carboplatin and paclitaxel followed by irradiation then carboplatin and paclitaxel for advanced endometrial carcinoma. Gynecol Oncol 2024; 180:63-69. [PMID: 38052110 DOI: 10.1016/j.ygyno.2023.11.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The objective was to compare sequencing strategies for treatment of advanced endometrial carcinoma. METHODS Patients were eligible if they had FIGO 2009 Stage III or IVA endometrial carcinoma or Stage I or II serous or clear cell endometrial carcinoma and positive cytology. Patients were randomized to: Cisplatin 50 mg/m2 IV Days 1 and 29 plus radiation followed by Carboplatin AUC 5 or 6 plus Paclitaxel 175 mg/m2 q 21 days for 4 cycles (chemoRT then chemo) vs. Carboplatin AUC 6 plus Paclitaxel 175 mg/m2 q 21 days for 3 cycles followed by radiation followed by Carboplatin AUC 5 or 6 plus Paclitaxel 175 mg/m2 q 21 days for 3 cycles (sandwich therapy). Futility analysis was planned. The primary objective was to determine if chemoRT then chemo improves recurrence-free survival (RFS) compared to sandwich therapy. RESULTS Of the 48 patients enrolled at 8 sites, 42 patients were eligible for futility analysis, and the trial was closed early. The median follow-up was 30.9 months. The 3-year RFS was 85.7% (95% confidence interval [CI], 62 to 95) in the chemoRT then chemo arm and 73.4% (95% CI, 43 to 89) in the sandwich therapy group (p = 0.58). The 3-year overall survival (OS) was 88.4% (95% CI, 61 to 97) in the chemoRT then chemo arm and 80.9% (95% CI, 51 to 93) in the sandwich therapy group (p = 0.55). CONCLUSION There was no observed significant difference between chemoRT then chemo compared to sandwich therapy in terms of RFS, OS, or adverse events, although the trial was underpowered and closed early due to low accrual.
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Affiliation(s)
| | - Barb Mahar
- Women's Cancer Care Associates, Albany, NY, USA
| | - Ashar Ata
- Albany Medical Center, Albany, NY, USA
| | - Beatrice Cormier
- Centre Hospitalier de l'Université de Montréal, Montreal, Canada
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6
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Cochran-Caggiano N, Till S, Holt C, Lang N, Ata A, Cerone J, Dailey MW. Children and Restraints Study in Emergency Ambulance Transport: An Observational Study and Analysis of Current Pediatric Ambulance Transport Practices. Pediatr Emerg Care 2023; 39:e66-e71. [PMID: 36867513 DOI: 10.1097/pec.0000000000002919] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVES The aims of this study were to identify the pediatric transport methods used by Emergency Medical Services (EMS) personnel in our area and to highlight the need for federal standards to unify prehospital transport of children. METHODS Children and Restraints Study in Emergency Ambulance Transport is a retrospective observational study of EMS arrivals to an academic pediatric emergency department for 1 year. Review of existing security footage from the ambulance entrance focused on the appropriateness of the selected restraints and the correctness of their application. A total of 3034 encounters were adequate for review and were matched to an emergency department encounter. Weight and age were identified from the chart. Patient weight was used in conjunction with video review to assess for the appropriateness of restraint selection. RESULTS A total of 53.5% (1622) of patients were transported using a weight appropriate device or restraint system. In 77.1% of all cases (2339), the devices or restraint systems were applied incorrectly. The best results were observed for commercial pediatric restraint devices (54.5% secured appropriately) and for convertible car seats (55.5%). Ambulance cot was used alone in 69.35% of all transports despite it being the appropriate choice in just 18.2% of transports. CONCLUSIONS Our findings confirmed that most pediatric patients transported by EMS are not appropriately secured and are at increased injury in a crash and potentially during normal vehicle operation. Opportunity exists for regulators, industry, and leaders in EMS and pediatrics to develop fiscally and operationally prudent techniques and devices to improve the safety of children in ambulances.
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Affiliation(s)
| | | | - Christian Holt
- Division of Emergency Medicine, Department of Medicine, University of Chicago, Chicago, IL
| | | | | | - Jennifer Cerone
- Division of Neonatology, Department of Pediatrics, Albany Medical Center, Albany, NY
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7
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Tram JK, Yalamanchili SP, Ata A, Pauze DR, Wladis EJ. Association of open globe injury characteristics with outcome measures in the emergency department. Graefes Arch Clin Exp Ophthalmol 2023; 261:3031-3039. [PMID: 37129633 DOI: 10.1007/s00417-023-06087-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023] Open
Abstract
PURPOSE To evaluate the association of demographic and clinical features of emergency department (ED) patients presenting with open globe injuries (OG) with outcomes such as inpatient admission rate, length of stay (LOS), and total cost. METHODS The Nationwide Emergency Department Sample database 2018 and 2019 was used to analyze the association of demographic and clinical features of OG patients with outcome measures. RESULTS 8404 OG patients were identified. Medicaid patients were associated with higher ED costs and a higher frequency of extended LOS. The 70+ age group was associated with higher inpatient admission. Frail patients were associated with significantly increased likelihood of inpatient admission, higher likelihood of extended LOS and higher total combined ED cost. Falls and being struck were associated with shorter LOS. CONCLUSION This study describes the most common demographic and clinical characteristics of OGIs that present to the ED, as well as the association of these characteristics with outcome measures such as inpatient admission rates, LOS, and total cost. The study further identified potential high-risk patients for prolonged length of stay. The findings will better optimize patient care protocols to improve outcomes.
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Affiliation(s)
- Justin K Tram
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany (Slingerlands), New York, USA
| | - Siri P Yalamanchili
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany (Slingerlands), New York, USA
| | - Ashar Ata
- Department of Emergency Medicine, Albany Medical College, Albany, New York, USA
| | - Denis R Pauze
- Department of Emergency Medicine, Albany Medical College, Albany, New York, USA
| | - Edward J Wladis
- Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical College, Albany (Slingerlands), New York, USA.
- Department of Otolaryngology, Albany Medical College, Albany, New York, USA.
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8
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Nguyen M, Kaminaka A, Brutus NN, Gonzalez LA, Ratanpal A, Alperovich M, Jeffe DB, Ata A, Mason HRC, Butler PD. Changing Faces: Factors Associated with the Intention to Pursue Plastic Surgery and Practice in Underserved Areas. Plast Reconstr Surg Glob Open 2023; 11:e5177. [PMID: 37577250 PMCID: PMC10419697 DOI: 10.1097/gox.0000000000005177] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/22/2023] [Indexed: 08/15/2023]
Abstract
Improving the number of plastic and reconstructive surgeons who provide care to patients in underserved communities is critical to achieving health equity. We aimed to identify factors associated with graduating medical students' intentions to pursue plastic surgery and practice in underserved areas. Methods De-identified data for US medical school graduates were obtained from the Association of American Medical Colleges for students who matriculated in academic years 2007-2008 and 2011-2012. Data collected included self-reported demographic and future practice intentions. Multivariate analysis was conducted to determine indicators of students' interest in plastic surgery, and their intention to practice in underserved areas. Results Of the 57,307 graduating US medical students in our cohort who completed the Graduation Questionnaire, 532 (0.9%) reported an intention to pursue plastic surgery. Hispanic [adjusted odds ratio (aOR): 1.45; 95% confidence interval (95% CI), 1.07-1.98] and multiracial (aOR: 1.59; 95% CI, 1.03-2.45) students were more likely to pursue plastic surgery compared with other surgical specialties. Among students interested in plastic surgery, compared with non-Hispanic White students, Black (aOR: 6.15; 95% CI, 1.96-19.26) students were more likely to report intention to practice in underserved areas. Students with community-engagement experiences were more likely to report intention to practice in underserved areas. Conclusions Diversity among medical trainees pursuing plastic and reconstructive surgery is critical for maintaining and expanding plastic surgery services rendered in underserved areas. These findings suggest that student demographics and experiences with community-engagement experiences are positive indicators of practicing in underserved communities.
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Affiliation(s)
- Mytien Nguyen
- From the School of Medicine, Yale University, New Haven, Conn
| | | | | | | | | | - Michael Alperovich
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Donna B. Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | | | | | - Paris D. Butler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
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Parikh RM, Ata A, Edwards MJ. A Contemporary Review of Surgical Approach and Outcomes in Pediatric Hypertrophic Pyloric Stenosis. J Surg Res 2023; 285:142-149. [PMID: 36669393 DOI: 10.1016/j.jss.2022.12.034] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/02/2022] [Accepted: 12/25/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION In order to define optimal resources and outcome standards for infant pyloromyotomy, we sought to perform a contemporary analysis of surgical approach (laparoscopic versus open) and outcomes. METHODS The National Surgical Quality Improvement Project Pediatrics Participant Use File (NSQIP PUF) was queried from 2016 to 2020. Utilization of laparoscopy was trended over time. Complication rates and length of stay were compared by operative approach. RESULTS 9752 pyloromyotomies were included in the analysis. The utilization of laparoscopy steadily increased over the study time period (66% to 79%) and was associated with a shorter operative time. On multivariate regression, the utilization of laparoscopy was associated with a lower risk of overall complications, length of stay, and superficial surgical site infections. Overall complication rates were lower than previously reported (2.02%). The most common complication was superficial infection (1.2%). CONCLUSIONS In facilities reporting to pediatric National Quality Improvement Project, utilization of laparoscopy has steadily increased, and complication rates are lower than previously reported. Complication rates and length of stay were lower with the laparoscopic approach in this contemporary cohort. These results offer benchmarks for quality improvement initiatives. The laparoscopic approach should be standard in facilities performing this procedure.
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Affiliation(s)
| | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, New York
| | - Mary J Edwards
- Department of Surgery, Albany Medical Center, Albany, New York.
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10
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Zaman J, Teixeira L, Patel PB, Ridler G, Ata A, Singh TP. From transabdominal to totally extra-peritoneal robotic ventral hernia repair: observations and outcomes. Hernia 2023; 27:635-643. [PMID: 36973467 PMCID: PMC10042403 DOI: 10.1007/s10029-023-02767-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/02/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE While robotic-assisted hernia repair has increased the popularity of minimally invasive hernia surgery, selecting between the types of approaches is a challenge for both experts and novices alike. In this study, we compared a single surgeon's early experience transitioning from transabdominal hernia repair with sublay mesh in either the pre-peritoneal or retrorectus space (TA-SM) and enhanced-view totally extra-peritoneal (eTEP) ventral hernia repair in the peri-operative and long-term post-operative time periods. METHODS We conducted a retrospective review of 50 eTEP and 108 TA-SM procedures to collect demographics, intraoperative details, and 30-day and 1-year post-operative outcomes. Statistical analysis was performed utilizing Chi-square analysis, Fisher's test, and two sample t-tests with equal variances. RESULTS There were no significant differences in patient demographics or comorbidities. eTEP patients had larger defects (109.1 cm2 vs. 31.8 cm2, p = 0.043) and mesh used (432.8 cm2 vs. 137.9 cm2, p = 0.001). Operative times were equivalent (158.3 ± 90.6 min eTEP and 155.8 ± 65.2 min TA-SM, p = 0.84), but conversion to alternate procedure type was higher for the transabdominal approach (4% eTEP vs. 22% TA-SM, p < 0.05). Hospital stay was less in the eTEP cohort (1.3 days vs. 2.2 days, p < 0.05). Within 30 days, there were no significant differences in emergency visits or hospital readmissions. There was a greater propensity for eTEP patients to develop seromas (12.0% vs. 1.9%, p < 0.05). At 1 year, there was no statistically significant difference in recurrence rate (4.56% eTEP vs. 12.2% TA-SM, p = 0.28) respective to average time to recurrence (9.17 months eTEP vs. 11.05 months TA-SM). CONCLUSION The eTEP approach can be adopted safely and efficiently, and may have superior peri-operative outcomes including fewer conversions and reduced hospital stay.
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Affiliation(s)
- J Zaman
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA.
| | - L Teixeira
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
| | - P B Patel
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
| | - G Ridler
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
| | - A Ata
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
| | - T P Singh
- Department of Surgery, Albany Medical College, 50 New Scotland Avenue, Albany, NY, 12208, USA
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11
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Wilkinson K, Ata A, Neaton S, Woll C. Evaluation of Safety Measures at a Medical Summer Camp During the SARS-CoV-2 Pandemic. Wilderness Environ Med 2023; 34:77-81. [PMID: 36517390 PMCID: PMC9688782 DOI: 10.1016/j.wem.2022.10.006] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION SARS-CoV-2 poses challenges for the safe delivery of a camp experience with a medically complex camper population. Multiple studies have investigated the effect of nonpharmaceutical interventions for preventing SARS-CoV-2 transmission in traditional summer camp settings, but none in the medical summer camp settings. Our objective was to describe and evaluate the nonpharmaceutical interventions on SARS-CoV-2 transmission rate in a medical summer camp setting. METHODS This was a single-institution cross-sectional study conducted between June 2021 and August 2021 in a rural summer camp setting in upstate New York. Nonpharmaceutical interventions consisted of prearrival guidance on low-risk activities, obtaining negative SARS-CoV-2 polymerase chain reaction results within 72 h prior to arrival, adult SARS-CoV-2 vaccine mandate, universal masking mandate, small cohorts, daily symptom screening, and rapid testing on site. Primary cases were defined as an individual with a positive SARS-CoV-2 test result of any type while at camp or 2 wk after departure from camp without any known exposure at camp; secondary cases were defined as cases from potential exposures within camp. RESULTS Two hundred and ninety-three campers were included. Nine individuals were tested owing to potentially infectious symptoms while at camp. Thirty-four campers were tested because they arrived from a county with an a priori intermediate level of SARS-CoV-2 community spread. Zero on-site rapid tests were positive for SARS-CoV-2. CONCLUSIONS We describe the implementation of multilayered nonpharmaceutical interventions at a medical summer camp during the SARS-CoV-2 pandemic.
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Affiliation(s)
| | - Ashar Ata
- Departments of Surgery and Emergency Medicine, Albany Medical Center, Albany, NY
| | | | - Christopher Woll
- Double H Hole-in-the-Woods Ranch, Lake Luzerne, NY; Departments of Pediatrics and Emergency Medicine, Albany Medical Center, Albany, NY.
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12
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Waseem M, Morrissey K, Nelsen A, Ata A, Asad H. Should Teachers Carry Guns? An Emergency Room Survey of Parents of Two New York Communities. Cureus 2023; 15:e34962. [PMID: 36938284 PMCID: PMC10018999 DOI: 10.7759/cureus.34962] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION The purpose of this study was to compare parents' perceptions of threats and solutions to school gun violence in two different communities. METHODS Parents of school-aged children visiting emergency rooms of two large trauma centers in Upstate New York (UNY) and New York City (NYC), between October 2019 and December 2020, were surveyed (UNY: n=202, NYC: n=100). Responses were compared by site, firearm experience, and concern for school safety. RESULTS Respondents from the two sites differed by sociodemographic characteristics. Of the 302 respondents, 64% feared a school shooting incident, but UNY respondents were less likely to report concern (46.5% vs 99%, p<0.001). UNY respondents were more likely to feel safe for their children (75.3% vs 7%, p<0.001) and to report feeling safer if guns were available to teachers (22.3% vs 6%, p <0.001). Both sites' respondents agreed on the need for armed police presence (76.7% vs 74%, p=0.11). Of the 193 parents concerned about a school shooting, 11.9% indicated feeling safer if guns were available to teachers versus 25.7% of those who were not (p=0.002). Agreement on solutions for making schools safer differed by the site. NYC respondents were unanimously supportive, but UNY support ranged from 52% for metal detectors to 84.5% for controlled entry points. CONCLUSION Although perceptions of child safety and experience with guns varied by location, most parents agreed on potential solutions, that it should be the security officers, not teachers, who should be carrying firearms and that armed police should be present in schools to provide safety.
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Affiliation(s)
- Muhammad Waseem
- Department of Emergency Medicine, New York City (NYC) Health and Hospitals Lincoln Medical Center, New York City, USA
| | - Kirsten Morrissey
- Department of Emergency Medicine, Albany Medical Center, Albany, USA
| | - Ashley Nelsen
- Department of Emergency Medicine, Albany Medical Center, Albany, USA
| | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, USA
| | - Hina Asad
- Department of Emergency Medicine, New York City (NYC) Health and Hospitals Lincoln Medical Center, New York City, USA
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13
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Mason HRC, Ata A, Nguyen M, Nakae S, Chakraverty D, Eggan B, Martinez S, Jeffe DB. First-generation and continuing-generation college graduates' application, acceptance, and matriculation to U.S. medical schools: a national cohort study. Med Educ Online 2022; 27:2010291. [PMID: 34898403 PMCID: PMC8676688 DOI: 10.1080/10872981.2021.2010291] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/10/2021] [Accepted: 11/20/2021] [Indexed: 06/13/2023]
Abstract
Many U.S. medical schools conduct holistic review of applicants to enhance the socioeconomic and experiential diversity of the physician workforce. The authors examined the role of first-generation college-graduate status on U.S. medical school application, acceptance, and matriculation, hypothesizing that first-generation (vs. continuing-generation) college graduates would be less likely to apply and gain acceptance to medical school.Secondary analysis of de-identified data from a retrospective national-cohort study was conducted for individuals who completed the 2001-2006 Association of American Medical Colleges (AAMC) Pre-Medical College Admission Test Questionnaire (PMQ) and the Medical College Admissions Test (MCAT). AAMC provided medical school application, acceptance, and matriculation data through 06/09/2013. Multivariable logistic regression models identified demographic, academic, and experiential variables independently associated with each outcome and differences between first-generation and continuing-generation students. Of 262,813 PMQ respondents, 211,216 (80.4%) MCAT examinees had complete data for analysis and 24.8% self-identified as first-generation college graduates. Of these, 142,847 (67.6%) applied to U.S. MD-degree-granting medical schools, of whom 86,486 (60.5%) were accepted, including 14,708 (17.0%) first-generation graduates; 84,844 (98.1%) acceptees matriculated. Adjusting for all variables, first-generation (vs. continuing-generation) college graduates were less likely to apply (odds ratio [aOR] 0.84; 95% confidence interval [CI], 0.82-0.86) and be accepted (aOR 0.86; 95% CI, 0.83-0.88) to medical school; accepted first-generation college graduates were as likely as their continuing-generation peers to matriculate. Students with (vs. without) paid work experience outside hospitals/labs/clinics were less likely to apply, be accepted, and matriculate into medical school. Increased efforts to mitigate structural socioeconomic vulnerabilities that may prevent first-generation college students from applying to medical school are needed. Expanded use of holistic review admissions practices may help decision makers value the strengths first-generation college graduates and other underrepresented applicants bring to medical educationand the physician workforce.
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Affiliation(s)
- Hyacinth R. C. Mason
- Department of Medical Education Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ashar Ata
- Department of Surgery and Emergency Medicine, Albany Medical Center, Albany, New York, USA
| | - Mytien Nguyen
- Yale University, School of Medicine, New Haven, Connecticut, USA
| | - Sunny Nakae
- Medical Education, California University of Science and Medicine, Colton, California, USA
| | - Devasmita Chakraverty
- Ravi J. Matthai Centre for Educational Innovation, Indian Institute of Management Ahmedabad, Ahmedabad, India
| | - Branden Eggan
- Department of Nursing, Siena College, Loudonville, New York, USA
| | | | - Donna B. Jeffe
- Department of Medicine, Director, Medical Education Research Unit, Office of Education, Washington University School of Medicine, St. Louis, Missouri, USA
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14
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Dikranian L, Barry S, Ata A, Chiotos K, Gist K, Bhalala U, Danesh V, Heavner S, Gharpure V, Bjornstad EC, Irby O, Heneghan JA, Montgomery V, Gupta N, Miller A, Walkey A, Tripathi S, Boman K, Bansal V, Kumar V, Kashyap R, Sayed I, Woll C. SARS-CoV-2 With Concurrent Respiratory Viral Infection as a Risk Factor for a Higher Level of Care in Hospitalized Pediatric Patients. Pediatr Emerg Care 2022; 38:472-476. [PMID: 36040468 PMCID: PMC9426307 DOI: 10.1097/pec.0000000000002814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE As of early 2021, there have been over 3.5 million pediatric cases of SARS-CoV-2, including 292 pediatric deaths in the United States. Although most pediatric patients present with mild disease, they are still at risk for developing significant morbidity requiring hospitalization and intensive care unit (ICU) level of care. This study was performed to evaluate if the presence of concurrent respiratory viral infections in pediatric patients admitted to the hospital with SARS-CoV-2 was associated with an increased rate of ICU level of care. DESIGN A multicenter, international, noninterventional, cross-sectional study using data provided through The Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study database. SETTING The medical ward and ICU of 67 participating hospitals. PATIENTS Pediatric patients younger than 18 years hospitalized with SARS-CoV-2. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 922 patients were included. Among these patients, 391 required ICU level care and 31 had concurrent non-SARS-CoV-2 viral coinfection. In a multivariate analysis, after accounting for age, positive blood culture, positive sputum culture, preexisting chronic medical conditions, the presence of a viral respiratory coinfection was associated with need for ICU care (odds ratio, 3.6; 95% confidence interval, 1.6-9.4; P < 0.01). CONCLUSIONS This study demonstrates an association between concurrent SARS-CoV-2 infection with viral respiratory coinfection and the need for ICU care. Further research is needed to identify other risk factors that can be used to derive and validate a risk-stratification tool for disease severity in pediatric patients with SARS-CoV-2.
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Affiliation(s)
- Lea Dikranian
- From the Pediatric Emergency Medicine, Division of Emergency Medicine, Childrens Hospital of Michigan, Detroit, MI
| | - Suzanne Barry
- Section of Critical Care Medicine, Department of Pediatrics
| | - Ashar Ata
- Departments of Surgery and Emergency Medicine, Albany Medical Center, Albany, NY
| | - Katie Chiotos
- Division of Critical Care Medicine, Department of Anesthesia and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia PA
| | - Katja Gist
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Utpal Bhalala
- University of Texas Medical Branch, Driscoll Health System, Corpus Christi, TX
| | | | | | - Varsha Gharpure
- Department of Pediatrics, Advocate Children's Hospital, Park Ridge, IL
| | - Erica C. Bjornstad
- Division of Nephrology, Department of Pediatrics, University of Alabama Birmingham, Birmingham, AL
| | - Olivia Irby
- Division of Critical Care Medicine, Department of Pediatrics, Arkansas Childrens Hospital, Little Rock, AK
| | - Julia A. Heneghan
- Division of Pediatric Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Vicki Montgomery
- Division of Critical Care Medicine, Department of Pediatrics, University of Louisville and Norton Childrens Hospital, Louisville, KY
| | - Neha Gupta
- Department of Pediatrics, Section of Critical Care Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK
| | - Aaron Miller
- St. Louis University School of Medicine, St. Louis, MO
| | - Allan Walkey
- The Pulmonary Center, Division of Pulmonary, Allergy, Sleep and Critical Care; Department of Medicine; Boston University School of Medicine, Boston, MA
| | - Sandeep Tripathi
- Department of Pediatrics OSF Saint Francis Medical Center/University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Karen Boman
- Division of Nephrology and Hypertension, Department of Medicine; Mayo Clinic, Rochester, MN
| | - Vikas Bansal
- Division of Research, Hospital Corporation of America Healthcare, Nashville, TN
| | - Vishakha Kumar
- Division of Nephrology and Hypertension, Department of Medicine; Mayo Clinic, Rochester, MN
| | - Rahul Kashyap
- Division of Research, Hospital Corporation of America Healthcare, Nashville, TN
| | - Imran Sayed
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Childrens Hospital Colorado, Aurora, CO
| | - Christopher Woll
- Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Albany Medical Center, Albany, NY
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Barrie U, Williams M, Nguyen M, Kenfack YJ, Mason H, Ata A, Aoun SG, Pilitsis JG. Characteristics of graduating medical students interested in neurosurgery with intention to practice in underserved areas: Implications for residency programs. Clin Neurol Neurosurg 2022; 218:107293. [DOI: 10.1016/j.clineuro.2022.107293] [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] [Received: 03/21/2022] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
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16
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Kim W, Slipak SH, Webber A, Ata A, Canete JJ, Chismark AD, Valerian BT, Darling RC, Lee EC. Detection of Ischemic Colitis on Routine Lower Endoscopy and Its Implications After Repair of Ruptured Abdominal Aortic Aneurysm. Am Surg 2022:31348221101520. [PMID: 35574985 DOI: 10.1177/00031348221101520] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ischemic colitis (IC) is a known significant complication after repair of a ruptured abdominal aortic aneurysm (rAAA). Lower endoscopy (colonoscopy or flexible sigmoidoscopy) is a helpful adjunct to aid decision making for surgical exploration. We believe routine use of lower endoscopy after rAAA repair provides better patient care through expeditious diagnosis and surgical care. METHODS We performed a retrospective chart review of rAAA repairs from 2008 to 2019. All patients undergo screening lower endoscopy after rAAA repair at our institution. The incidence of IC, mortality, and diagnostic characteristics of routine lower endoscopy was analyzed. RESULTS Of these, 182 patients underwent rAAA repair, among which 139 (76%) underwent routine lower endoscopy. Ischemic colitis of any grade was diagnosed in 25% of patients. The 30-day mortality was 11% compared to 19% in those without lower endoscopy. The presence of IC portended a 4-fold increase in mortality rate compared to those without (26% vs 6%, P = .005). Surgical exploration rate was 8% after routine lower endoscopy. Grade III ischemia on lower endoscopy had a sensitivity of 50% (95% CI 12-88) and specificity of 99% (95% CI 94-100) for transmural necrosis. DISCUSSION We found increased incidence of IC and reliable diagnostic characteristics of routine lower endoscopy in predicting the presence of transmural colonic ischemia. There was decreased mortality with use of routine lower endoscopy but this was not statistically significant.
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Affiliation(s)
- Woihwan Kim
- Department of Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Sasha H Slipak
- Section of Colon and Rectal Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Alexis Webber
- Department of Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Ashar Ata
- Department of Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Jonathan J Canete
- Section of Colon and Rectal Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - A David Chismark
- Section of Colon and Rectal Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Brian T Valerian
- Section of Colon and Rectal Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Ralph C Darling
- Division of Vascular Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Edward C Lee
- Section of Colon and Rectal Surgery, 138207Albany Medical Center, Albany, NY, USA
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Nguyen M, Mason HRC, Barrie U, Jeffe DB, Cavazos JE, Ata A, Boatright D. Association Between Socioeconomic Background and MD-PhD Program Matriculation. J Gen Intern Med 2022; 37:1794-1796. [PMID: 34159550 PMCID: PMC9130359 DOI: 10.1007/s11606-021-06962-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Mytien Nguyen
- MD-PhD Program, Yale School of Medicine, New Haven, CT, USA.
| | - Hyacinth R C Mason
- Departments of Medical Education and Family and Community Medicine, Albany Medical College, Albany, NY, USA
| | - Umaru Barrie
- Southwestern MSTP, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Donna B Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jose E Cavazos
- South Texas MSTP, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ashar Ata
- Departments of Surgery and Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
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18
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Carnes KM, Singh Z, Ata A, Mian BM. Interventions to Reduce Opioid Prescriptions following Urological Surgery: A Systematic Review and Meta-Analysis. J Urol 2022; 207:969-981. [DOI: 10.1097/ju.0000000000002447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kevin M. Carnes
- Division of Urology, Albany Medical College, Albany, New York
| | - Zorawar Singh
- Division of Urology, Albany Medical College, Albany, New York
| | - Ashar Ata
- Department of Surgery, Albany Medical College, Albany, New York
| | - Badar M. Mian
- Division of Urology, Albany Medical College, Albany, New York
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19
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Waxman MJ, Ray M, Schechter-Perkins EM, Faryar K, Flynn KC, Breen M, Wojcik SM, Berry F, Zheng A, Ata A, Lerner EB, Lyons MS, McGinnis S. Patients' Perspectives on Emergency Department COVID-19 Vaccination and Vaccination Messaging Through Randomized Vignettes. Public Health Rep 2022; 137:774-781. [PMID: 35465764 PMCID: PMC9066270 DOI: 10.1177/00333549221085580] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Emergency departments (EDs) could play an important role in the COVID-19 pandemic response by reaching patients who would otherwise not seek vaccination in the community. Prior to expanding COVID-19 vaccination to the acute care setting, we assessed ED patients’ COVID-19 vaccine status, perspectives, and hypothetical receptivity to ED-based vaccination. Methods: From January 11 through March 31, 2021, we conducted a multisite (Albany Medical Center, Boston Medical Center, Buffalo General Hospital, University of Cincinnati Medical Center, and Upstate Medical Center), cross-sectional survey of ED patients, with embedded randomization for participants to receive 1 of 4 vignette vaccination messages (simple opt-in message, recommendation by the hospital, community-oriented message, and acknowledgment of vaccine hesitancy). Main outcomes included COVID-19 vaccination status, prior intention to be vaccinated, and receptivity to randomized hypothetical vignette messages. Results: Of 610 participants, 122 (20.0%) were vaccinated, 234 (38.4%) had prior intent to be vaccinated, 111 (18.2%) were unsure as to prior intent, and 143 (23.4%) had no prior intent to be vaccinated. Vaccine hesitancy (participants who were vaccine unsure or did not intend to receive the vaccine) was associated with the following: age <45 years, female, non-Hispanic Black, no primary health care, and no prior influenza vaccination. Overall, 364 of 565 (64.4%; 95% CI, 60.3%-68.4%) were willing to accept a hypothetical vaccination in the ED. Among participants with prior vaccine hesitancy, a simple opt-in message resulted in the highest acceptance rates to hypothetical vaccination (39.7%; 95% CI, 27.6%-52.8%). Conclusions: EDs have appropriate patient populations to initiate COVID-19 vaccination programs as a supplement to community efforts. A simple opt-in approach may offer the best messaging to reach vaccine-hesitant ED patients.
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Affiliation(s)
- Michael J Waxman
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Maile Ray
- Center for Human Services Research, State University of New York at Albany, Albany, NY, USA
| | | | - Kiran Faryar
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Karen Coen Flynn
- Center for Human Services Research, State University of New York at Albany, Albany, NY, USA
| | - Mandi Breen
- Center for Human Services Research, State University of New York at Albany, Albany, NY, USA
| | - Susan M Wojcik
- Department of Emergency Medicine, Upstate Medical University, Syracuse, NY, USA
| | | | - Amy Zheng
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - Ashar Ata
- Department of Emergency Medicine, Albany Medical College, Albany, NY, USA
| | - E Brooke Lerner
- Department of Emergency Medicine, Jacobs School of Medicine & Biomedical Sciences, Buffalo, NY, USA
| | - Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Sandra McGinnis
- Center for Human Services Research, State University of New York at Albany, Albany, NY, USA
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20
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Hutchinson ID, Ata A, DiCaprio MR. Is Metformin Use Associated with Prolonged Overall Survival in Patients with Soft Tissue Sarcoma? A SEER-Medicare Study. Clin Orthop Relat Res 2022; 480:735-744. [PMID: 34779790 PMCID: PMC8923596 DOI: 10.1097/corr.0000000000002045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/19/2021] [Accepted: 10/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Metformin, an oral drug used to treat patients with diabetes, has been associated with prolonged survival in patients with various visceral carcinomas. Although the exact mechanisms are unknown, preclinical translational studies demonstrate that metformin may impair tumor cellular metabolism, alter matrix turnover, and suppress oncogenic signaling pathways. Currently used chemotherapeutic agents have not been very successful in the adjuvant setting or for treating patients with metastatic sarcomas. We wanted to know whether metformin might be associated with improved survival in patients with a soft tissue sarcoma. QUESTIONS/PURPOSES In patients treated for a soft tissue sarcoma, we asked: (1) Is there an association between metformin use and longer survival? (2) How does this association differ, if at all, among patients with and without the diagnosis of diabetes? METHODS The Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database was used to identify patients with a diagnosis of soft tissue sarcoma from 2007 to 2016. Concomitant medication use was identified using National Drug Codes using the Medicare Part D event files. This database was chosen because of the large number of captured sarcoma patients, availability of tumor characteristics, and longitudinal linkage of Medicare data. A total of 14,650 patients were screened for inclusion. Patients with multiple malignancies, diagnosis at autopsy, or discrepant linkage to the Medicare database were excluded. Overall, 4606 patients were eligible for the study: 598 patients taking metformin and 4008 patients not taking metformin. A hazard of mortality (hazard ratio) was analyzed comparing patients taking metformin with those patient groups not taking metformin and expressed in terms of a 95% confidence interval. Cox regression analysis was used to control for patient-specific, disease-specific, and treatment-specific covariates. RESULTS Having adjusted for disease-, treatment-, and patient-specific characteristics, patients taking metformin experienced prolonged survival compared with all patients not taking metformin (HR 0.76 [95% CI 0.66 to 0.87]). Associated prolonged survival was also seen when patients taking metformin were compared with those patients not on metformin irrespective of a diabetes diagnosis (HR 0.79 [95% CI 0.66 to 0.94] compared with patients with a diagnosis of diabetes and HR 0.77 [95% CI 0.67 to 0.89] compared with patients who did not have a diagnosis of diabetes). CONCLUSION Without suggesting causation, we found that even after controlling for confounding variables such as Charlson comorbidity index, tumor grade, size, stage, and surgical/radiation treatment modalities, there was an association between metformin use and increased survival in patients with soft tissue sarcoma. When considered separately, this association persisted in patients not on metformin with and without a diabetes diagnosis. Although metformin is not normally prescribed to patients who do not have a diabetes diagnosis, these data support further study, and if these findings are substantiated, it might lead to the performance of multicenter, prospective clinical trials about the use of metformin as an adjuvant therapy for the treatment of soft tissue sarcoma in patients with and without a preexisting diabetes diagnosis. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Ian D. Hutchinson
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Matthew R. DiCaprio
- Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY, USA
- Department of Surgery, Albany Medical Center, Albany, NY, USA
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Chang AK, Lee S, Le R, Ata A, Harland K, Khan A, McMillan M, Mohr N. Influence of Society for Academic Emergency Medicine Foundation's Research Training Grant on postaward academic federal funding. Acad Emerg Med 2022; 29:874-878. [PMID: 35108429 DOI: 10.1111/acem.14456] [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] [Received: 08/13/2021] [Revised: 01/08/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective was to measure the impact of the Society for Academic Emergency Medicine Foundation's (SAEMF) Research Training Grant (RTG) by comparing academic success in grant recipients versus non-recipient applicants. Our primary outcome was subsequent federal funding as a principal investigator (PI) or multiple principal investigator (MPI). Our secondary outcomes included subsequent K-award funding, R-series funding, R01 funding, and academic productivity measured by first author peer-reviewed publications. METHODS The authors examined all SAEMF RTG applicants from 2002 through 2019 (n = 109). Data were collected using the National Institutes of Health RePORTER database, a literature search using PubMed, and an online survey sent to all RTG applicants. Relative risks (RRs) with 95% confidence intervals (95% CI) were calculated. RESULTS Over 18 years, 18 of 109 (16.5%) RTG applicants were awarded by SAEMF. Subsequent federal funding as PI or MPI was obtained by 11 of the 18 RTG recipients compared to 29 of the 91 nonrecipients (61% vs. 33%, RR = 1.9; 95% CI = 1.2-3.1). The RTG award was also associated with increased probability of receiving a federal Career Development Award (K-series) (RR 2.0; 95% CI 1.1-3.9) and R-series award (RR 2.0; 95% CI 1.1-3.9) but not an R01 award (RR 2.1; 95% CI 0.8-5.3). The median number of first-authored peer reviewed manuscripts did not differ between RTG award recipients (14, IQR 8,44) and nonrecipients (14, IQR 6,30) (p = 0.5) though RTG recipients had a higher percentage of their publications as a first author (49% vs. 33%, p = 0.04). CONCLUSIONS SAEMF RTG awards were associated with increased probability of future federal funding, including career development awards and R-series awards but not R01 awards. RTG recipients also had a higher percentage of their peer reviewed publications as first author.
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Affiliation(s)
- Andrew K. Chang
- Department of Emergency Medicine Albany Medical College Albany New York USA
| | - Sangil Lee
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Rachel Le
- Department of Emergency Medicine Albany Medical College Albany New York USA
| | - Ashar Ata
- Department of Emergency Medicine Albany Medical College Albany New York USA
| | - Kari Harland
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
| | - Ayesha Khan
- Department of Emergency Medicine Albany Medical College Albany New York USA
| | - Melissa McMillan
- Society for Academic Emergency Medicine Des Plaines Illinois USA
| | - Nick Mohr
- Department of Emergency Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
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22
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Edwards MJ, Jenkel T, Weller B, Weber A, Zhu K, Parikh R, Ata A, Danziger C. Computed Tomography Scan Utilization in Pediatric Trauma: Impact on Length of Stay and Incidence of False Positive Findings. Pediatr Emerg Care 2021; 37:e1478-e1481. [PMID: 32205803 DOI: 10.1097/pec.0000000000002087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Computerized tomography (CT) scans are the mainstay of diagnostic imaging in blunt trauma. Particularly in pediatric trauma, utilization of CT scans has increased exponentially in recent years. Concerns regarding radiation exposure to this vulnerable population have resulted in increased scrutiny of practice. What is not known is if liberal imaging practices decrease length of stay by eliminating the need for clinical observation, and the impact of false-positive rates from liberal use of CT scanning on clinical outcomes. METHODS Medical records from a nonaccredited pediatric trauma center with a practice of liberal imaging were reviewed over a 2-year period. Total CT scans obtained were recorded, in addition to length of stay, age, and Injury Severity Score (ISS). Rates of clinically significant imaging findings were recorded, as were false positive findings and complications of imaging. RESULTS Out of 735 children, 58% underwent CT scanning, and if scanned, received an average of 2.4 studies. Clinically significant findings were documented in 20% of head CTs, 2% of cervical spine CTs, 3.5% of chest CTs, 24% of facial CTs, and 14.7% of abdominal CTs. False-positive findings were found in 1.5% of head CTs, 1.2% of cervical spine CTs, 2.4% of chest CTs, and 2.5% of abdominal CTs. Liberal CT scanning was not associated with decreased length of stay. In contrast, obtaining CT scans on more than 4 body regions was independently predictive of longer length of stay, independent of ISS. CONCLUSIONS False-positive rates of CT scans for trauma were low in this cohort. However, when scanning the cervical spine or the chest, for every 2 clinically significant findings obtained, there was at least one false positive result, calling into question the practice of liberal imaging of these regions. Liberal utilization of CT scan did not allow for more rapid discharge home, and for more than 4 CTs was independently associated with longer hospital stay.
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Affiliation(s)
- Mary J Edwards
- From the Department of Surgery, Albany Medical College, Albany, NY
| | | | | | - Alexis Weber
- From the Department of Surgery, Albany Medical College, Albany, NY
| | | | | | - Ashar Ata
- From the Department of Surgery, Albany Medical College, Albany, NY
| | - Carrie Danziger
- Department of Emergency Medicine, Albany Medical College, Albany, NY
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Gopalakrishnan M, Ashar ZM, Ata A, Zaman JA. Racial Disparities in Postoperative Outcomes after Bariatric Surgery. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.025] [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: 10/20/2022]
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24
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Abreu C, Jawiche J, Nguyen M, Chang AK, Ata A, Reid S, Mason HRC, Rebagliati D, Myers JM, Pinto D, B Jeffe D, Boatright D. Characteristics of medical students interested in emergency medicine with intention to practice in underserved areas. AEM Educ Train 2021; 5:S65-S72. [PMID: 34616975 PMCID: PMC8480495 DOI: 10.1002/aet2.10672] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Emergency departments serve a wide variety of racial, ethnic, socioeconomic, and gender backgrounds. It is currently unknown what characteristics of students who express interest in emergency medicine (EM) are associated with a simultaneous desire to work in medically underserved areas. We hypothesize that those who are underrepresented in medicine, are female, learn another language, and have more student debt will be more likely to practice in a medically underserved area. METHODS Data from the National Board of Medical Examiners, Association of American Medical Colleges (AAMC) Student Record System, and the AAMC Graduation Questionnaire were collected on a national cohort of 92,013 U.S. medical students who matriculated from 2007 through 2012. Extracted variables included planned practice area, intention to practice in underserved areas, race/ethnicity, sex, medical school experiences, age at matriculation, debt at graduation, and first-attempt USMLE Step 1 score. RESULTS EM-intending students who identified as female, non-Hispanic Black/African American, or Latinx/Hispanic; had a larger debt at graduation; had experiences with health education in the community; had global health experience; and had learned more than one language were more likely to report an intention to practice in underserved areas. CONCLUSION With the increasing importance of physician diversity to match those of the community being served, this study identifies factors associated with a desire of EM students to work in underserved areas. Medical schools and EM residencies may wish to consider these factors in their admissions process.
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Affiliation(s)
| | | | - Mytien Nguyen
- School of MedicineYale UniversityNew HavenConnecticutUSA
| | - Andrew K. Chang
- Department of Emergency MedicineAlbany Medical CollegeAlbanyNew YorkUSA
| | - Ashar Ata
- Department of Emergency MedicineAlbany Medical CollegeAlbanyNew YorkUSA
| | | | - Hyacinth R. C. Mason
- Office of Student AffairsTufts University School of MedicineBostonMassachusettsUSA
| | | | - Joy M. Myers
- University of Tennessee College of MedicineMemphisTennesseeUSA
| | - Dorcas Pinto
- Department of Emergency MedicineAlbany Medical CollegeAlbanyNew YorkUSA
| | - Donna B Jeffe
- Medical Research Unit, Office of EducationWashington University School of MedicineSt. LouisMissouriUSA
| | - Dowin Boatright
- Department of Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
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Stain SC, Matthews JB, Ata A, Adams DB, Chen H, Potts JR. US Medical Licensing Exam Performance and American Board of Surgery Qualifying and Certifying Examinations. J Am Coll Surg 2021; 233:722-729. [PMID: 34438078 DOI: 10.1016/j.jamcollsurg.2021.08.674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Program directors use United States Medical Licensing Exam (USMLE) scores as criteria for ranking applicants. First-time pass rates of the American Board of Surgery (ABS) Qualifying (QE) and Certifying (CE) Examinations have become important measures of residency program quality. USMLE Step 1 will become pass/fail in 2022. STUDY DESIGN American Board of Surgery QE and CE success rates were assessed considering multiple characteristics of highly ranked (top 20) applicants to 22 general surgery programs in 2011. Chi-square, t-test, Wilcoxon Rank sum, linear and logistic regression were used, as appropriate. RESULTS The QE and CE first attempt pass rates were 96% (235/244) and 86% (190/221), respectively. QE/CE success was not significantly associated with sex, race, research experience, or publications. Alpha Omega Alpha (AΩA) status was associated with success on the index CE (98% vs 83%; p = 0.008). Step 1 and Step 2 Clinical Knowledge (CK) scores of surgeons who passed QE on their first attempt were higher than scores of those who failed (Step 1: 233 vs 218; p = 0.016); (Step 2CK: 244 vs 228, p = 0.009). For every 10-point increase in Step 1 and 2CK scores, the odds of passing CE on the first attempt increased 1.5 times (95% CI 1.12, 2.0; p = 0.006) and 1.5 times (95% CI 1.11, 2.02, p = 0.008), respectively. For every 10-point increase in Steps 1 and 2CK scores, the odds of passing the QE on the first attempt increased 1.85 times (95% CI 1.11, 3.09; p = 0.018) and 1.86 times (95% CI 1.14, 3.06, p = 0.013), respectively. CONCLUSIONS USMLE Step 1 and Step 2 CK examination scores correlate with American Board of Surgery QE and CE performance and success. The USMLE decision to transition Step 1 to a pass/fail examination will require program directors to identify other factors that predict ABS performance for ranking applicants.
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Affiliation(s)
- Steven C Stain
- The Lahey Hospital and Medical Center, Department of Surgery, Burlington, MA.
| | | | - Ashar Ata
- Albany Medical College, Department of Surgery, Albany, NY
| | - David B Adams
- Medical University of South Carolina, Department of Surgery, Charleston, SC
| | - Herbert Chen
- University of Alabama, at Birmingham, Department of Surgery, Birmingham, AL
| | - John R Potts
- Superior Value in Program Accreditation, Chicago, IL
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26
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Nikolla DA, Ata A, Brundage N, Carlson JN, Frisch A, Wang HE, Markovitz B. Change in Frequency of Invasive and Noninvasive Respiratory Support in Critically Ill Pediatric Subjects. Respir Care 2021; 66:1247-1253. [PMID: 33947789 PMCID: PMC9994364 DOI: 10.4187/respcare.08712] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Noninvasive respiratory support has become more popular in the pediatric population and may prevent or replace invasive procedures, such as endotracheal intubation, in certain circumstances. The objective was to examine the frequency of invasive and noninvasive respiratory support from 2009 to 2017 in critically ill pediatric patients and to determine patient-related factors associated with invasive support using the Virtual Pediatric Systems, LLC database. METHODS This was an analysis of prospectively collected data on admissions with respiratory support from 17 pediatric ICUs from 2009 to 2017 reported within the Virtual Pediatric Systems database. We determined the frequency of invasive and noninvasive respiratory support over the study period by measuring the number of admissions with either invasive or noninvasive support within a given year divided by the total number of pediatric ICU admissions with respiratory support during the same year. Factors associated with invasive support were examined in univariate and multivariate regressions. RESULTS A total of 69,262 cases of respiratory support were included. There was a decrease in the rate of invasive support over the study period from 66.9% to 48.5% (P value for test of trend < .001) and an increase in the rate of noninvasive support from 28.7% to 57.7% (P value for test of trend < .001). Trauma cases and subjects < 1 month old were more likely to receive invasive support. Cases occurring in later years and subjects with Black or Hispanic race were less likely to receive invasive support. CONCLUSIONS From 2009 to 2017, the frequency of admissions with invasive respiratory support decreased, and those with noninvasive respiratory support increased. By 2017, the frequency of noninvasive respiratory support was greater than that of invasive respiratory support.
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Affiliation(s)
- Dhimitri A Nikolla
- Department of Emergency Medicine, Allegheny Health Network, Erie, Pennsylvania.
| | - Ashar Ata
- Department of Emergency Medicine, Albany Medical Center, Albany, New York
| | | | - Jestin N Carlson
- Department of Emergency Medicine, Allegheny Health Network, Erie, Pennsylvania
| | - Adam Frisch
- Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Henry E Wang
- Department of Emergency Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - Barry Markovitz
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
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Wu A, Edwards MJ, Le R, Ata A, Adderly J, Savage C, Rosati C, Edwards K, Duncan L. Pediatric evidence-based imaging guidelines for adult trauma providers significantly reduces radiation exposure to children. Trauma 2021. [DOI: 10.1177/14604086211028452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction Evidence suggests that stand-alone pediatric trauma centers outperform adult and combined adult/pediatric trauma centers in limiting radiation exposure to injured children. We sought to determine the impact of implementing evidence-based guidelines for pediatric imaging at a combined adult (level 1) and pediatric (level 2) center. The initiative focused on trauma/critical care surgeons as the pediatric surgeons did not participate in the resuscitation and initial evaluation of injured children. Methods Imaging guidelines were developed from existing clinical studies. After 3 months of education, guidelines were implemented, and regular feedback was given to providers regarding compliance. Data were collected from the trauma registry for all pediatric patients (aged less than 15 years), in calendar years 2017 (pre-guideline) and 2019 (post-guideline). All admissions were analyzed, with subgroup analysis of children with multisystem trauma admitted to the trauma surgery service. Results Following guideline implementation, mean computed tomography (CT) scans per injured child fell by over 50% (.93 vs .45). For patients admitted to the trauma service, the mean fell by 58% (1.82 vs 0.76). The number of patients receiving more than 1 CT significantly decreased for all children (26% vs 10%), and particularly those admitted to the trauma service (52% vs 17%). During this time, there was only one injury missed at the initial admission, which was clinically insignificant (non-displaced skull fracture). Conclusions Implementation of evidence-based guidelines for imaging eliminates disparity in practices between a combined adult/pediatric trauma center and stand-alone pediatric trauma centers.
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Affiliation(s)
- Anna Wu
- Department of Surgery, Albany Medical College and Center, Albany, NY, USA
| | - Mary J Edwards
- Department of Surgery, Albany Medical College and Center, Albany, NY, USA
| | - Rachel Le
- Department of Emergency Medicine, Albany Medical College and Center, Albany, NY, USA
| | - Ashar Ata
- Department of Surgery, Albany Medical College and Center, Albany, NY, USA
| | - Jasmine Adderly
- Department of Surgery, Albany Medical College and Center, Albany, NY, USA
| | - Colleen Savage
- Department of Surgery, Albany Medical College and Center, Albany, NY, USA
| | - Carl Rosati
- Department of Surgery, Albany Medical College and Center, Albany, NY, USA
| | - Kurt Edwards
- Department of Surgery, Albany Medical College and Center, Albany, NY, USA
| | - Luke Duncan
- Department of Emergency Medicine, Albany Medical College and Center, Albany, NY, USA
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Topp G, Bouyea M, Cochran-Caggiano N, Ata A, Torres P, Jacob J, Wales D. Biomarkers Predictive of Extubation and Survival of COVID-19 Patients. Cureus 2021; 13:e15462. [PMID: 34258124 PMCID: PMC8256763 DOI: 10.7759/cureus.15462] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Many patients with COVID-19 who develop acute respiratory distress syndrome (ARDS) require prolonged periods of mechanical ventilation. Mechanical ventilation may amplify ventilator-associated complications and extend resource utilization. A better understanding of prognostic indicators could help in the planning and distribution of resources, particularly in resource-limited areas. We analyzed laboratory studies of intubated COVID-19 patients with the goal of identifying biomarkers that may predict extubation success and survival to discharge. Methods A retrospective chart review was performed on all COVID-19 patients requiring mechanical ventilation between January 3, 2020, and January 7, 2020, in a single academic tertiary care center in Northeastern New York State. The electronic medical record was used to collect 14 laboratory variables at three time points: admission, intubation, and extubation (including terminal extubation) for all intubated intensive care unit (ICU) patients treated for COVID-19. Mean laboratory values were analyzed with the Mann-Whitney U test. Categorical variables were analyzed with the two-sample Wilcoxon rank-sum test. Results Seventy-two patients met the inclusion criteria. Forty-three patients were male. The mean age was 61 years. The overall mortality was 50%. On admission, intubated patients who survived had significantly higher platelet counts (p=0.024), and absolute lymphocyte counts (ALC; p=0.047). Notably, ferritin (p=0.018) and aspartate transaminase (AST; p=0.0045) levels were lower in survivors. At the time of intubation, survivors again had a higher platelet count (p=0.024) and ALC (p=0.037) levels. They had a lower D-dimer (p=0.0014), ferritin (p=0.0015), lactate dehydrogenase (LDH; p=0.0145), and AST (p=0.018) compared to intubated patients who died. At extubation, survivors had higher platelet count (p=0.0002), ALC (p=0.0013), and neutrophil/lymphocyte ratio (NLR; p=0.0024). Survivors had lower d-dimer (p=0.035), ferritin (p=0.0012), CRP (p=0.045), LDH (p=0.002), AST (p<0.001), and ALK (p=0.0048). Conclusions Biomarkers associated with increased risk of mortality include platelet count, ALC, lymphocyte percentage, NLR, D-dimer, ferritin, C-reactive protein (CRP), AST, alanine transaminase (ALT), and alkaline phosphatase (ALK). This study provides additional evidence that these biomarkers have prognostic value in patients with severe COVID-19. The goal is to find objective surrogate markers of disease improvement or success of extubation. When considered within the larger body of data, it is our hope that a mortality risk calculator can be generated for intubated COVID-19 patients.
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Affiliation(s)
- Gregory Topp
- Department of Medicine, Albany Medical College, Albany, USA
| | - Megan Bouyea
- Department of Medicine, Albany Medical College, Albany, USA
| | | | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, USA
| | - Pedro Torres
- Department of Surgery, Albany Medical Center, Albany, USA
| | - Jackcy Jacob
- Department of Medicine, Albany Medical Center, Albany, USA
| | - Danielle Wales
- Department of Medicine, Albany Medical Center, Albany, USA.,School of Public Health, State University of New York at Albany, Albany, USA
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Chang AK, Chang IY, Lord S, White N, Ata A. Emergency Physicians' Interpretation of 3- and 7-day Supplies of Opioids. Acad Emerg Med 2021; 28:586-588. [PMID: 33131116 DOI: 10.1111/acem.14165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew K. Chang
- From the Department of Emergency Medicine Albany Medical College Albany NYUSA
| | - Isabella Y. Chang
- From the Department of Emergency Medicine Albany Medical College Albany NYUSA
| | - Spencer Lord
- From the Department of Emergency Medicine Albany Medical College Albany NYUSA
| | - Noah White
- From the Department of Emergency Medicine Albany Medical College Albany NYUSA
| | - Ashar Ata
- From the Department of Emergency Medicine Albany Medical College Albany NYUSA
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30
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Gregory J, Huynh B, Tayler B, Korgaonkar-Cherala C, Garrison G, Ata A, Sorum P. High-Dose vs Standard-Dose Amoxicillin Plus Clavulanate for Adults With Acute Sinusitis: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e212713. [PMID: 33755168 PMCID: PMC7988367 DOI: 10.1001/jamanetworkopen.2021.2713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Acute bacterial sinusitis is common, but currently recommended antibiotic treatment provides minimal benefit. OBJECTIVE To confirm the previous finding that high-dose amoxicillin plus clavulanate (with double the amount of amoxicillin) may be superior to standard-dose amoxicillin plus clavulanate in adults. DESIGN, SETTING, AND PARTICIPANTS This double-blind, comparative-effectiveness randomized clinical trial was conducted from February 26, 2018, through May 10, 2020, at the academic primary care internal medicine and pediatrics practice of Albany Medical Center, located in Cohoes, New York. Participants included adults aged 18 years or older who were prescribed amoxicillin plus clavulanate for acute bacterial sinusitis diagnosed in accordance with the Infectious Diseases Society of America guidelines. INTERVENTIONS Amoxicillin 875 mg with clavulanate 125 mg plus either placebo (standard dose) or amoxicillin 875 mg (high dose) twice a day for 7 days. MAIN OUTCOMES AND MEASURES The primary efficacy outcome was a global rating of "a lot better" or "no symptoms" at the end of 3 days of treatment using a Global Rating of Improvement scale, with outcomes ranging from 1 (a lot worse) to 6 (no symptoms). The primary adverse effect outcome was severe diarrhea at 3 or 10 days after the start of treatment. RESULTS At an unplanned interim analysis prompted by COVID-19 restrictions, 157 of a projected 240 participants had been enrolled (mean age, 48.5 [range, 18.7-84.0] years; 117 women [74.5%]), with 79 randomized to the standard dose and 78 to the high dose; 9 and 12, respectively, withdrew or were lost to follow-up before the assessment of the primary outcome. At day 3, 31 of 70 participants (44.3%) in the standard-dose group reported a global rating of "a lot better" or "no symptoms," as did 24 of 66 (36.4%) in the high-dose group, for a difference of -7.9% (95% CI, -24.4% to 8.5%; P = .35). The study was, therefore, stopped for futility. Diarrhea was common in both groups by day 3, with any diarrhea reported in 29 of 71 participants (40.8%) receiving the standard dose and 28 of 65 (43.1%) receiving the high dose and severe diarrhea reported in 5 of 71 (7.0%) and 5 of 65 (7.7%), respectively. CONCLUSIONS AND RELEVANCE The results of this randomized clinical trial suggest that adults treated for clinically diagnosed acute sinusitis did not appear to benefit from taking high-dose compared with standard-dose amoxicillin plus clavulanate. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03431337.
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Affiliation(s)
- Jennifer Gregory
- Medicine and Pediatrics, Albany Medical Center Hospital, Cohoes, New York
- Englewood Health Medical Center, Englewood, New Jersey
| | - Bichtram Huynh
- Medicine and Pediatrics, Albany Medical Center Hospital, Cohoes, New York
| | - Brittany Tayler
- Medicine and Pediatrics, Albany Medical Center Hospital, Cohoes, New York
| | - Chaitali Korgaonkar-Cherala
- Albany Medical College, Albany, New York
- Department of Obstetrics-Gynecology, Stony Brook University Hospital, Stony Brook, New York
| | - Gina Garrison
- Department of Pharmacy Practice, Albany College of Pharmacy and Health Sciences, Albany, New York
| | - Ashar Ata
- Department of Surgery, Albany Medical College, Albany, New York
- Department of Emergency Medicine, Albany Medical College, Albany, New York
| | - Paul Sorum
- Department of Internal Medicine, Albany Medical College, Albany, New York
- Department of Pediatrics, Albany Medical College, Albany, New York
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31
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Carnes KM, Ata A, Cangero T, Mian BM. Impact of Enhanced Recovery after Surgery Protocols on Opioid Prescriptions at Discharge after Major Urological Cancer Surgery. Urology Practice 2021; 8:270-276. [PMID: 37145624 DOI: 10.1097/upj.0000000000000207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Enhanced recovery after surgery protocols are designed to limit the use of opioids during inpatient stay to facilitate recovery and early discharge. It is not clear whether the enhanced recovery after surgery related limitations on opioids are associated with opioid prescribing at discharge. We wished to evaluate whether the enhanced recovery after surgery efforts had an impact on opioid prescriptions given after discharge following major urological cancer surgery. METHODS We reviewed the opioid prescription data following hospital discharge after major urological cancer surgery from 2016 to 2018, including cystectomy, renal surgery (total, partial) and prostatectomy. Patient calls and refill requests were recorded for 30 days after discharge. Multivariable analysis was performed to evaluate the effect of various factors on normalized opioid tablets given at discharge. RESULTS A total of 409 patients met the inclusion criteria, with 207 before and 202 after ERAS protocols. Following enhanced recovery after surgery, potent opioid (oxycodone, hydrocodone) prescriptions decreased by 53% while tramadol use increased by more than four-fold (p <0.001). Reduction in opioid prescriptions was noted for prostatectomy (30%, p <0.001), cystectomy (27%, p=0.02) and all renal procedures (32%, p <0.001) after enhanced recovery after surgery protocol. On multivariable analysis, enhanced recovery after surgery protocol was an independent predictor of reduced opioids given at discharge. CONCLUSIONS Enhanced recovery after surgery protocol implementation was associated with a significant decrease in the opioid prescriptions at discharge after all major urological cancer procedures. Prescribing patterns shifted away from more potent opioids. These findings provide a benchmark for further interventions and reduction in the outpatient opioid prescriptions after open and minimally invasive surgery. KEY WORDS enhanced recovery after surgery; opioid epidemic; pain management; medication therapy management; analgesics, opioid.
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Affiliation(s)
- Kevin M. Carnes
- Division of Urology, Albany Medical College, Albany, New York
| | - Ashar Ata
- Department of Surgery, Albany Medical College, Albany, New York
| | - Theodore Cangero
- Department of Information Services, Albany Medical College, Albany, New York
| | - Badar M. Mian
- Division of Urology, Albany Medical College, Albany, New York
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32
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Chang AK, Edwards RR, Morrison RS, Argoff C, Ata A, Holt C, Bijur PE. Disparities in Acute Pain Treatment by Cognitive Status in Older Adults With Hip Fracture. J Gerontol A Biol Sci Med Sci 2021; 75:2003-2007. [PMID: 31560758 DOI: 10.1093/gerona/glz216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We examined the disparities in emergency department (ED) pain treatment based on cognitive status in older adults with an acute hip fracture. METHODS Observational study in an academic ED in the Bronx, New York. One hundred forty-four adults aged 65 years and older with acute hip fracture were administered the Telephone Interview for Cognitive Status (TICS) while in the ED. The primary outcome was receipt of any parenteral analgesic. The risk factor of interest was cognitive impairment (TICS ≤ 25). Secondary outcomes included receipt of any opioid, receipt of any analgesic, total dose of analgesics in intravenous morphine equivalent units (MEQ), and time to receiving first analgesic. RESULTS Of the 87 (60%) study patients who were cognitively impaired, 60% received a parenteral analgesic compared to 79% of the 57 cognitively unimpaired patients (RR 0.76 [95% CI 0.61, 0.94]). The effect of cognitive impairment on receiving any opioids (RR: 0.81, 95% CI 0.67, 0.98) and any analgesic (RR: 0.85; 95% CI: 0.71, 1.01) was similar. The median analgesic dose in cognitively impaired patients was significantly lower than in cognitively unimpaired patients (4 MEQ vs 8 MEQ, p = .003). CONCLUSION Among older adults presenting to the ED with acute hip fracture, cognitive impairment was independently associated with lower likelihood of receiving analgesia and lower amount of opioid analgesia.
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Affiliation(s)
- Andrew K Chang
- Department of Emergency Medicine, Albany Medical College, New York
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Charles Argoff
- Department of Neurology, Albany Medical College, New York
| | - Ashar Ata
- Department of Emergency Medicine, Albany Medical College, New York
| | - Christian Holt
- Department of Emergency Medicine, Albany Medical College, New York
| | - Polly E Bijur
- Department of Emergency Medicine, Albert Einstein College of Medicine, Bronx, New York
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33
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Kim W, Ahn N, Ata A, Adamo MA, Entezami P, Edwards M. Pediatric cervical spine injury in the United States: Defining the burden of injury, need for operative intervention, and disparities in imaging across trauma centers. J Pediatr Surg 2021; 56:293-296. [PMID: 32561174 DOI: 10.1016/j.jpedsurg.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/17/2020] [Accepted: 05/03/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pediatric cervical spine injury (PCSI) in children is rare. Incidence of PCSI requiring intervention is not known, and imaging practices for screening in United States trauma centers are not well described. METHODS The 2016 NTDB was queried for patients younger than 15 years with PCSI. Incidence of PCSI, operative interventions, and imaging rates were analyzed by age and ACS accreditation status. RESULTS Of 84,554 children, 873 (1.03%) had PCSI. Patients <4 years were less likely to have PCSI (0.68% vs. 1.1%, RR 0.59, p < 0.001). 165 children (0.20%) required an intervention for PCSI. 12.8% of all children were screened for PCSI with imaging, 9.3% with CT, and 3.2% with plain X-rays. In spite of similar injury and intervention rates, stand-alone pediatric trauma centers were less likely than others to image patients without PCSI (11% vs. 13% p < 0.001), less likely to utilize CT scan (5.8% vs. 10.6% p < 0.001) and more likely to utilize plain films (5.2% vs. 2.4% p < 0.001). CONCLUSION Despite exceedingly low rates of PSCI requiring intervention (0.2%), imaging rates for screening are significant. Stand-alone pediatric trauma centers outperform others in limiting unnecessary imaging. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Woihwan Kim
- Department of Surgery, Albany Medical Center, Albany, NY
| | - Nicholas Ahn
- Department of Surgery, Albany Medical Center, Albany, NY
| | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, NY
| | - Matthew A Adamo
- Department of Surgery, Division of Neurosurgery, Albany Medical Center, Albany, NY
| | - Pouya Entezami
- Department of Surgery, Division of Neurosurgery, Albany Medical Center, Albany, NY
| | - Mary Edwards
- Department of Surgery, Division of Pediatric Surgery, Albany Medical Center, Albany, NY.
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Abstract
This cross-sectional study uses 2007-2012 data from the Association of American Medical Colleges’ Matriculating Student Questionnaire to evaluate student factors and academic outcomes associated with taking a leave of absence from medical school.
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Affiliation(s)
- Mytien Nguyen
- School of Medicine, Yale University, New Haven, Connecticut
| | - Seo Ho Song
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | | | - Ashar Ata
- Albany Medical College, Albany, New York
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35
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Abreu C, Wales DP, Eichelman A, Ata A, Ramani R, Waxman M. 1059. Evaluating Hepatitis C Screening Rates and Successful Interventions at an Outpatient Medicine/Pediatrics Practice. Open Forum Infect Dis 2020. [PMCID: PMC7777538 DOI: 10.1093/ofid/ofaa439.1245] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Despite the 2013 United States Preventive Services Task Force (USPSTF) recommendations, Hepatitis C (HCV) screening rates among patients born between 1945-1965 has remained below 25% (MacLean, 2018). At our outpatient academic suburban primary care practice in Albany County, NY, our hepatitis C baseline prior to interventions was 31.75%. In collaboration with Project FOCUS through Gilead, our practice attempted to increase screening rates among this birth cohort.
Methods
We performed a retrospective chart review on patients eligible for HCV screening with birth years 1945-1965 at the time of their visit at the Albany Med Internal Medicine/Pediatrics practice. We report monthly HCV screening from January 2018 to April 2020. In addition, we determined whether HCV screening rates differed by race, gender, ethnicity, private vs public insurance, and risk stratification or RAF (standard vs. high-risk patient).
Results
The chance that a test conducted for eligible patients increased from 29.9% (pre-intervention) to 58.76% in 2019 (post-intervention). From June 2019- December 2019, the testing rates were consistently above the 2019 average (Figure 1). There were no significant differences in HCV screening due to gender, race, ethnicity, or type of insurance (Table 1).
Figure 1. Hepatitis C Screening Rates at an Outpatient Medicine/Pediatrics Practice 2018-2020
Table 1. Demographics - Hepatitis C Screening Rates
Conclusion
In this outpatient Med/Peds practice, hepatitis C screening rates increased dramatically after incorporation of an EMR prompt, as well as nursing-generated orders for patients due for screening. There was no statistical difference in screening based on race, ethnicity, gender, or insurance type. Of note, high-risk patients were more likely to be screened, perhaps as they receive more case management services and are more likely to be in the office, increasing the opportunities for screening. The next step would be to adapt these interventions to screening all patients age 18-79, as per the updated 2020 USPSTF guidelines.
Disclosures
Danielle P. Wales, MD, MPH, Gilead (Grant/Research Support) Abigale Eichelman, MA, Gilead FOCUS Foundation (Other Financial or Material Support, Employee of Albany Medical Center with Salary Support on Grant) Ashar Ata, MD, MPH, PHD, GILEAD FOCUS Foundation (Grant/Research Support) Michael Waxman, MD, MPH, Gilead FOCUS Foundation (Grant/Research Support)
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Affiliation(s)
| | | | - Abigale Eichelman
- George Washington University School of Public Health, Arlington, Virginia
| | - Ashar Ata
- Albany Medical College, Guilderland, New York
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Segal TA, Ata A, Rowden A, Wales DP, Waxman M. 1058. Demographics of Hepatitis C Virus Antibody and RNA Positivity within an Emergency Department Screening Program. Open Forum Infect Dis 2020. [PMCID: PMC7777052 DOI: 10.1093/ofid/ofaa439.1244] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background In support of the recent United States Preventive Services Task Force’s (USPSTF) revised recommendations for non-targeted HCV screening, we have noted a shift away from active infections within the birth cohort (patients born between 1945-1965), as these individuals have often undergone successful treatment, and a shift towards younger adults who are RNA positive, especially people who use intravenous drugs (PWID). Methods Located in Northeastern New York State, Albany Medical Center conducts routine emergency department (ED) HCV screening, with active linkage to care. We performed a retrospective study of our HCV linkage to care data from April 2019 to June 2020. Patients were offered screening if they belonged to the birth cohort, were PWID, or at staff discretion. We estimated the effect of birth cohort, intravenous drug use and other potential risk factors on RNA positivity via Chi-square tests and Modified Poisson Regression. Results There were 242 people that were HCV antibody positive. The mean age was 50.9 years-old, with 118 (46.8%) in the birth cohort and 103 (42.56%) PWID. As compared to the birth cohort, a significantly greater proportion of non-birth cohort patients were PWID (62% vs 21.2%, p< 0.01) and homeless (17.7% vs 9.3%, p=0.05). Birth cohort patients were 0.55 times (95%CI: 0.39 to 0.79) less likely to be RNA positive. PWID were 2.22 times (95% CI: 1.58 to 3.13) and homeless people were 2.05 times (95% CI: 1.50 to 2.80) more likely to be RNA positive. After multivariable adjustment, birth cohort was not a significant risk factor for RNA positivity but PWID (RR: 1.84; 95% CI: 1.26 to 2.68) and homelessness (RR: 1.69; 95% CI: 1.20 to 2.39) were significantly associated with RNA positivity. Conclusion These data suggest that the RNA positivity rate is higher among the non-birth cohort age group but is explained by the higher prevalence of drug use and homeless. The findings support USPSTF’s new guidelines for testing all adults and shed light on the demographics of populations at risk for active infection vs. populations who are antibody positive and RNA negative. Further research might explore (a) whether these findings are applicable to other clinical settings and geographic locations and (b) the feasibility of targeting patients with active infection in settings such as the ED. Disclosures Talia A. Segal, BS, GILEAD FOCUS Foundation (Grant/Research Support) Ashar Ata, MD, MPH, PHD, GILEAD FOCUS Foundation (Grant/Research Support) Adam Rowden, DO, GILEAD FOCUS Foundation (Grant/Research Support) Danielle P. Wales, MD, MPH, Gilead (Grant/Research Support) Michael Waxman, MD, MPH, Gilead FOCUS Foundation (Grant/Research Support)
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Affiliation(s)
| | - Ashar Ata
- Albany Medical College, Albany, New York
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Ottaviano K, Brookover R, Canete JJ, Ata A, Sheehan J, Valerian BT, David Chismark A, Lee EC. The Impact of an Enhanced Recovery Program on Loop Ileostomy Closure. Am Surg 2020; 87:1920-1925. [PMID: 33377796 DOI: 10.1177/0003134820982847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The implementation of enhanced recovery after surgery (ERAS) protocols has decreased the length of stay (LOS) and complications in colorectal procedures. However, little data has been published on the subset of patients undergoing loop ileostomy closure. We investigated the outcomes of loop ileostomy reversals prior to and after initiation of an ERAS protocol. METHODS Patients undergoing ileostomy reversal over a 5-year period by 4 colorectal surgeons were studied and divided into pre-ERAS patients and ERAS patients in a retrospective, case-control study. Patient demographics, comorbidities, LOS, underlying disease process, index intra-abdominal procedure, readmission rate, and complications were evaluated. RESULTS Overall, 208 patients were analyzed 149 pre-ERAS and 59 ERAS-with median LOS significantly lower in the ERAS group than the pre-ERAS group (50.8 hours vs. 96.1 hours, P < .0001). In subgroup analysis, the LOS was significantly lower if the index procedure performed was laparoscopic when comparing ERAS to pre-ERAS (49.9 hours vs. 96.6 hours, P < .001). ERAS did not confer a significant decrease in the LOS during ileostomy reversal with open index procedures (72.9 hours vs. 95.5 hours, P = .05). CONCLUSION Utilizing an ERAS protocol is safe and effective for loop ileostomy closure with a shorter LOS and no difference in complication rates or 30-day readmission rates.
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Affiliation(s)
| | | | | | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | - Jordan Sheehan
- Department of Surgery, Albany Medical Center, Albany, NY, USA
| | | | | | - Edward C Lee
- Department of Surgery, Albany Medical Center, Albany, NY, USA
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Croasdale DR, Su EM, Olutola OE, Polito CP, Ata A, Keenan M, Valerian BT, David Chismark A, Canete JJ, Lee EC. The Effect of an Enhanced Recovery Program on Elective Right Hemicolectomies for Crohn's Disease vs. Colon Cancer: A Retrospective Cohort Analysis. Am Surg 2020; 88:120-125. [PMID: 33356439 DOI: 10.1177/0003134820982573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) protocols are widely employed in colorectal surgery, successful in reducing postoperative morbidities and hospital length of stay (LOS). However, ERAS effects on the inflammatory bowel disease population remain unclear. This study examines the postoperative course of both Crohn's disease (CD) and colon cancer (CC) patients after elective right hemicolectomies and compares the effectiveness of ERAS protocol. METHODS A retrospective analysis was performed on patients with CD and CC undergoing elective right hemicolectomies and ileocecectomies from January 2014 through June 2016 (pre-ERAS) and January 2017 through April 2019 (post-ERAS) from a single tertiary care center. Patient demographics and perioperative variables were examined, including prolonged postoperative ileus (PPOI), hospital LOS, and 30-day readmission. RESULTS 98 CC patients and 91 CD patients met the inclusion criteria. The pre-ERAS CC and post-ERAS CC cohorts were significantly different: post-ERAS had fewer patients with congestive heart failure and chronic obstructive pulmonary disease and had higher albumin levels. The pre-ERAS CC cohort had significantly longer operative durations and higher rates of concomitant procedures than the post-ERAS CC cohort. Both patients with CC and CD had a reduction in LOS with implementation of ERAS, decreasing by 2.24 days (P = .002) and 1.21 days (P = .038), respectively. There was a reduction in rates of organ space infections with CD (pre .132, post .00, P = .007). There was a trend towards an increased rate of PPOI with CD (Pre .079, Post .226, P = .062). DISCUSSION The ERAS protocol significantly reduced LOS for both groups, without increasing 30-day readmission rates or other morbidities.
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Affiliation(s)
| | | | | | - Caroline P Polito
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Ashar Ata
- Department of Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Megan Keenan
- Department of Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - Brian T Valerian
- Department of Surgery, 138207Albany Medical Center, Albany, NY, USA
| | - A David Chismark
- Department of Surgery, 138207Albany Medical Center, Albany, NY, USA
| | | | - Edward C Lee
- Department of Surgery, 138207Albany Medical Center, Albany, NY, USA
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Malizia RA, Martinolich JL, Ata A, Fitz NG, Williams KK, Valerian BT, Stain SC, Lee EC. Management of Nonoperative Diverticulitis : Is Surgical Admission Always Best? Am Surg 2020; 87:321-327. [PMID: 32967441 DOI: 10.1177/0003134820950292] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Institutional pathways (IPs) allow efficient utilization of health care resources. Recent literature reports decreased hospital length of stay (LOS), complications, and costs with the admittance of surgical disease to surgical services. Our study aimed to demonstrate that admission to surgery for nonoperative, acute diverticulitis reduces hospital LOS, and cost, with comparable complication rates. METHODS In January 2017, we defined IPs for diverticulitis, mandating emergency department admission to a surgical service. Patients admitted from October 2015 to June 2016 (pre-protocol, control cohort) were compared with those admitted January 2017-September 2018 (post-protocol, IP cohort). Primary outcomes included hospital LOS, direct cost, indirect cost, total cost, and 30-day readmission. Student's 2-tailed t-test and chi-square analysis were utilized, with statistical significance P < .05. RESULTS Nonoperative management of acute diverticulitis occurred in 62 (74%) patients in the control cohort. One hundred and eleven patients (85%) were admitted to the IP cohort. Patient characteristics were similar, except for a higher percentage of surgical patients utilizing private insurance and younger in age. Interestingly, no difference in hospital LOS (3.8 vs 4.7 days; P = 0.07), direct cost ($2639.44 vs $3251.52; P = .19), or overall cost ($5968.67 vs $6404.08, P = .61) was found between cohorts. Thirty-day readmission rates were comparable at 8% and 11% (P = .59). CONCLUSION Institutional policy mandating admissions for patients receiving nonoperative management of diverticulitis to surgical services does not reduce hospital LOS or cost. This argues that admission to medical services may be an acceptable practice. This raises the question, is acute diverticulitis always a surgical issue?
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Affiliation(s)
| | | | - Ashar Ata
- Department of Surgery, Albany Medical College, Albany, NY, USA
| | - Nicholas G Fitz
- Department of Surgery, Albany Medical College, Albany, NY, USA
| | | | | | - Steven C Stain
- Department of Surgery, Albany Medical College, Albany, NY, USA
| | - Edward C Lee
- Department of Surgery, Albany Medical College, Albany, NY, USA
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Fabian T, Van Backer JT, Ata A. Perioperative Outcomes of Thoracoscopic Reoperations for Clinical Recurrence of Pulmonary Malignancy. Semin Thorac Cardiovasc Surg 2020; 33:230-237. [PMID: 32858221 DOI: 10.1053/j.semtcvs.2020.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/20/2020] [Indexed: 11/11/2022]
Abstract
The utility of thoracoscopic lung surgery is well established, however, reoperation for pulmonary resections has not been thoroughly studied. We sought to evaluate patient perioperative outcomes following redo thoracoscopic pulmonary resections for malignancy by comparing first and second ipsilateral operations. We included patients undergoing redo thoracoscopic pulmonary resections for clinically recurrent disease following prior lung resection for malignancy from January 1, 2011 to May 31, 2019. Nonmalignant indications were excluded. We analyzed type of procedure, diagnosis, rate of conversion to open, estimated blood loss, operating time, margin status, length of stay and complications. Forty-one patients met our inclusion criteria. The median age was 68 years (range 13-84) and 20 were women. Redo operations had longer lengths of stay with a trend toward higher rate of conversion to thoracotomy, but other perioperative outcomes were similar. No difference in outcomes was seen when patients were grouped by indication for reoperation (recurrence, multiple primaries, and metastasis) or approach of first operation (VATS vs open). However, patients undergoing an anatomic resection after a prior anatomic resection had more complications, higher blood loss, higher rate of conversions to thoracotomy, significantly longer length of stay and longer operative times than nonanatomic resections. Thoracoscopic reoperation for recurrent, metachronous, or metastatic cancer to the lung is a reasonable approach. However, the surgeon must recognize and counsel patients that in patients undergoing a redo anatomic resection, thoracoscopic reoperations are more difficult with more adverse outcomes.
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Affiliation(s)
- Thomas Fabian
- Department of Surgery, Division of Thoracic Surgery, Albany Medical Center, Albany, New York
| | - Justin T Van Backer
- Department Surgery, Division of General Surgery, Albany Medical Center, Albany, New York.
| | - Ashar Ata
- Department Surgery, Division of General Surgery, Albany Medical Center, Albany, New York
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Abstract
BACKGROUND Pain control is an important aspect of rib fracture management. With a rise in multimodal care approaches, we hypothesized that transdermal lidocaine patches reduce opioid utilization in hospitalized patients with acute rib fractures not requiring continuous opioid infusion. METHODS We performed a retrospective analysis of adult trauma patients with acute rib fractures admitted to the Trauma Service from January 2011 to October 2018. We compared patients who received transdermal lidocaine patches to those who did not and evaluated cumulative opioid consumption, expressed in morphine milligram equivalents (MMEs). Secondary outcomes included the rate of pulmonary complications and length of hospital stay. RESULTS Of the 21 190 trauma admissions, 3927 (18.5%) had rib fractures. Overall, 1555 patients who received continuous opioid infusion were excluded. Of the remaining 2372 patients, 725 (30.6%) patients received lidocaine patches. The mean total MME of patients who received lidocaine patches was 55.7 MME (30.7 MME on multivariate analysis) and was lower than that of patients who did not receive lidocaine patches (P ≤ .01). There was no difference in hospital length of stay (no lidocaine patches vs received lidocaine patches: 6.2 days vs 6.5 days, P = .34) or pulmonary complications (1.7% vs 2.8%, P = .08). DISCUSSION In admitted trauma patients with acute rib fractures not requiring continuous intravenous opiates, lidocaine patch use was associated with a significant decrease in opiate utilization during the patients' hospital course.
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Affiliation(s)
- Matthew Johnson
- Department of Surgery, Division of Trauma Surgery, Albany Medical Center, NY, USA
| | - Lauren Strait
- Department of Surgery, Division of Trauma Surgery, Albany Medical Center, NY, USA
| | - Ashar Ata
- Department of Surgery, Division of Trauma Surgery, Albany Medical Center, NY, USA
| | - Ashley Bartscherer
- Department of Surgery, Division of Trauma Surgery, Albany Medical Center, NY, USA
| | - Claire Miller
- Department of Surgery, Lewis Katz School of Medicine, Philadelphia, PA, USA
| | - Andrew Chang
- Department of Emergency Medicine, Albany Medical Center, Albany, NY, USA
| | - Steven C Stain
- Department of Surgery, Division of Trauma Surgery, Albany Medical Center, NY, USA
| | - Marcel Tafen
- Department of Surgery, Division of Trauma Surgery, Albany Medical Center, NY, USA
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Hosain F, Lee J, Ata A, Bhullar RK, Chang AK. Physician Renewal of Chronically Prescribed Controlled Substances Based on Urine Drug Test Results. J Prim Care Community Health 2020; 10:2150132719883632. [PMID: 31646927 PMCID: PMC6820170 DOI: 10.1177/2150132719883632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective: The effect of specific urine drug testing (UDT) results on physician prescribing habits has not been well described. The primary objective was to report renewal rates of chronically prescribed controlled substances based on types of inconsistent UDT results. Methods: We conducted a retrospective chart review over a 5-month period comparing prescription renewals rates for patients with consistent versus inconsistent UDTs. Inconsistent UDTs were defined by prescribed drug not detected or the presence of heroin, cocaine, nonprescribed opioids, nonprescribed benzodiazepines, or marijuana. Results: Of the 474 UDTs reviewed, 214 (45.1%) were inconsistent. The most common findings among inconsistent UDTs, including overlapping results, were prescribed drug not detected (26.8%) and the presence of marijuana (20.7%), nonprescribed opioids (9.9%), and nonprescribed benzodiazepines (6.1%). In contrast, cocaine (5.5%) and heroin (0.4%) were less likely to be found on UDTs for this population. The relative risk (RR) of prescription renewal was 0.64 (95% CI 0.57-0.71) for inconsistent UDTs versus consistent UDTs. Within the inconsistent UDTs, the renewal rates when marijuana (79.6%) or nonprescribed opioids or benzodiazepines (63.6%) were present were much higher than when heroin or cocaine were present (0.0%; P < .001). Patients whose prescribed controlled substance was not detected had a 55.8% renewal rate. Conclusions: Prescription renewal rates were high when patient UDTs contained nonprescribed marijuana, opioids, and benzodiazepines, or when the prescribed drug was not detected. Prescription renewal rates were low when illicit drugs, such as heroin and cocaine, were detected.
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Affiliation(s)
| | | | - Ashar Ata
- Albany Medical Center, Albany, NY, USA
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Lopez-Soler RI, Chen P, Nair L, Ata A, Patel S, Conti DJ. Sirolimus use improves cancer-free survival following transplantation: A single center 12-year analysis. Transplantation Reports 2020. [DOI: 10.1016/j.tpr.2020.100040] [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
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Sharp SP, Ata A, Chismark AD, Canete JJ, Valerian BT, Wexner SD, Lee EC. Racial disparities after stoma construction in colorectal surgery. Colorectal Dis 2020; 22:713-722. [PMID: 31876362 DOI: 10.1111/codi.14943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/29/2019] [Indexed: 12/12/2022]
Abstract
AIM Racial disparities are under-recognized among patients undergoing colorectal surgery. The purpose of this study was to determine the complication rates and surgical outcomes stratified by race and ethnicity among patients undergoing colorectal surgery with intestinal stoma creation. METHOD The ACS NSQIP database from 2013 to 2016 was used. Colon, rectum and small bowel cases requiring intestinal stoma creation were selected. Both African-American and other groups of minority patients were compared with Caucasian patients using a complex multivariable analysis model. Primary outcomes of interest were complication rates, mortality and extended hospital length of stay. RESULTS The study included 38 088 admissions. After multivariable analysis, African-American patients still had a prolonged length of hospital stay and higher complication rates. Other minorities also had a prolonged length of hospital stay and higher complication rates. CONCLUSIONS Both African-American and other groups of minority patients requiring an ostomy suffer significantly higher postoperative complication rates and a prolonged hospital length of stay, even after comorbidity adjustment. Access to care, socioeconomic status and comorbid disease management are all important factors for minority patients who undergo colorectal surgery requiring intestinal stoma construction.
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Affiliation(s)
- S P Sharp
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, New York, USA.,Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - A Ata
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, New York, USA
| | - A D Chismark
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, New York, USA
| | - J J Canete
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, New York, USA
| | - B T Valerian
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, New York, USA
| | - S D Wexner
- Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
| | - E C Lee
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, New York, USA
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Koutroumpakis E, Gosmanova EO, Stahura H, Jou S, Alreshq R, Ata A, Sidhu MS, Philbin E, Boden WE, Lyubarova R. Attainment of Guideline-Directed Medical Treatment in Stable Ischemic Heart Disease Patients With and Without Chronic Kidney Disease. Cardiovasc Drugs Ther 2020; 33:443-451. [PMID: 31123935 DOI: 10.1007/s10557-019-06883-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Stable ischemic heart disease (SIHD) is prevalent in patients with chronic kidney disease (CKD); however, whether guideline-directed medical therapy (GDMT) is adequately implemented in patients with SIHD and CKD is unknown. HYPOTHESIS Use of GDMT and achievement of treatment targets would be higher in SIHD patients without CKD than in patients with CKD. METHODS This was a retrospective study of 563 consecutive patients with SIHD (mean age 67.8 years, 84% Caucasians, 40% females). CKD was defined as an estimated glomerular filtration rate (eGFR) of < 60 mL/min/1.73m2 using the four-variable MDRD Study equation. We examined the likelihood of achieving GDMT targets (prescription of high-intensity statins, antiplatelet agents, renin-angiotensin-aldosterone system inhibitors (RAASi), and low-density lipoprotein cholesterol levels < 70 mg/dL, blood pressure < 140/90 mmHg, and hemoglobin A1C < 7% if diabetes) in patients with (n = 166) and without CKD (n = 397). RESULTS Compared with the non-CKD group, CKD patients were significantly older (72 vs 66 years; p < 0.001), more commonly female (49 vs 36%; p = 0.002), had a higher prevalence of diabetes (46 vs 34%; p = 0.004), and left ventricular systolic ejection fraction (LVEF) < 40% (23 vs. 10%, p < 0.001). All GDMT goals were achieved in 26% and 24% of patients with and without CKD, respectively (p = 0.712). There were no between-group differences in achieving individual GDMT goals with the exception of RAASi (CKD vs non-CKD: adjusted risk ratio 0.73, 95% CI 0.62-0.87; p < 0.001). CONCLUSIONS Attainment of GDMT goals in SIHD patients with CKD was similar to patients without CKD, with the exception of lower rates of RAASi use in the CKD group.
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Affiliation(s)
- Efstratios Koutroumpakis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Elvira O Gosmanova
- Division of Nephrology and Hypertension, Department of Medicine, Albany Medical College, Albany, NY, USA.,Nephrology Section, Stratton VA Medical Center, Albany, NY, USA
| | - Heather Stahura
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - Stephanie Jou
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - Rabah Alreshq
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - Ashar Ata
- Department of General Surgery, Albany Medical College, Albany, NY, USA
| | - Mandeep S Sidhu
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - Edward Philbin
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA
| | - William E Boden
- Massachusetts Veterans Epidemiology, Research, and Informatics Center (MAVERIC), VA New England Healthcare System, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Radmila Lyubarova
- Division of Cardiology, Department of Medicine, Albany Medical College, 43 New Scotland Avenue, A2 wing, Albany, NY, 12208, USA.
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Gillis A, Pfaff A, Ata A, Giammarino A, Stain S, Tafen M. Are there variations in timing to tracheostomy in a tertiary academic medical center? Am J Surg 2020; 219:566-570. [PMID: 32005496 DOI: 10.1016/j.amjsurg.2020.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/21/2019] [Accepted: 01/19/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is unclear what drives variation in timing to tracheostomy among different patients. METHODS Age, ethnicity, admission service, and income were retrospectively collected for patients undergoing tracheostomy in a Level 1 trauma center from 2007 to 2017. The primary outcome was time to tracheostomy with early tracheostomy (ET) or late tracheotomy (LT) defined as 3-7 or ≥ 10 days post-intubation, respectively. Secondary outcomes included length of stay (LOS), ventilator associated pneumonia, and mortality. RESULTS Among 1,640 patients, more men had ET compared to women (30% vs 28%; p = 0.05). The mean time to tracheostomy was 11.2 ± 7.7 days. Neurology and trauma patients had significantly shorter time to tracheostomy compared to other services. Age, ethnicity, and income showed no differences in timing to tracheostomy. Patients who underwent LT had a longer LOS (46 vs 32 days, p < 0.01) and higher mortality (19% vs 13% p < 0.01). CONCLUSIONS There were no disparities in timing to tracheostomy based on age, ethnicity, or income. We detected a hesitation in performing tracheostomies by certain providers with shorter LOS and improved mortality in ET.
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Affiliation(s)
- Andrea Gillis
- Department of General Surgery, Albany Medical Center, 43 New Scotland Ave, MC 50, Albany, NY, 12208, USA.
| | - Ashley Pfaff
- Department of General Surgery, Albany Medical Center, 43 New Scotland Ave, MC 50, Albany, NY, 12208, USA
| | - Ashar Ata
- Department of General Surgery, Albany Medical Center, 43 New Scotland Ave, MC 50, Albany, NY, 12208, USA
| | - Alexa Giammarino
- Department of General Surgery, Albany Medical Center, 43 New Scotland Ave, MC 50, Albany, NY, 12208, USA
| | - Steven Stain
- Department of General Surgery, Albany Medical Center, 43 New Scotland Ave, MC 50, Albany, NY, 12208, USA
| | - Marcel Tafen
- Department of General Surgery, Albany Medical Center, 43 New Scotland Ave, MC 50, Albany, NY, 12208, USA
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Sharp SP, Malizia R, Skancke M, Arsoniadis EG, Ata A, Stain SC, Valerian BT, Lee EC, Wexner SD. A NSQIP analysis of trends in surgical outcomes for rectal cancer: What can we improve upon? Am J Surg 2020; 220:401-407. [PMID: 31964524 DOI: 10.1016/j.amjsurg.2020.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/01/2019] [Accepted: 01/04/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is significant variation in rectal cancer outcomes in the USA, and reported outcomes have been inferior to those in other countries. In recognition of this fact, the American College of Surgeons (ACS) recently launched the Commission on Cancer (CoC) National Accreditation Program for Rectal Cancer (NAPRC) in an effort to further optimize rectal cancer care. Large surgical databases will play an important role in tracking surgical and oncologic outcomes. Our study sought to explore the trends in surgical outcomes over the decade prior to the NAPRC using a large national database. METHODS The ACS National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2017 was used to select colorectal cancer cases which were divided into abdominal-colonic (AC) and pelvic-rectal (PR) cohorts based upon the operation performed. Outcomes of interest were occurrence of any major surgical complication, mortality within 30 days of procedure, and postoperative length of stay (LOS). Chi-square and two sample t-tests were used to evaluate association between various risk factors and outcomes. Modified Poisson regression was used to compare and estimate the unadjusted and adjusted effect of procedure type on the outcomes. STATA 15.1 was used for analysis and statistical significance was set at 0.05. RESULTS A total of 34,159 patients were analyzed. AC cases constituted 50.7% of the overall cohort. The two groups were relatively similar in demographic distribution, but the PR patients had higher rates of hypoalbuminemia and were sicker (ASA class 3 or greater). Rates of non-sphincter preserving operations ranged from 30 to 34%. Higher complication rates in the PR cohort were mainly infectious and surgical site complications, while rates of deep vein thrombosis and pulmonary embolism were similar between the two cohorts. On bivariate analysis, rates of mortality were similar between the two groups (AC: 1.02% vs PR: 0.91%, p = 0.395), while PR patients were found to be 1.36 times (95% CI: 1.32-1.41) more likely to have major complications and 1.40 times (95% CI: 1.35-1.44) more likely to have an extended LOS as compared to the AC patients. After multivariable analysis, PR patients continued to have a higher likelihood of major complications (IRR: 1.31, 95% CI 1.25-1.36) and extended LOS (IRR: 1.38, 95% CI: 1.33-1.43). 10-year trends showed a significant reduction in the percentage of patients with prolonged lengths of hospitalization as well as a reduction of nearly 20% in the mean LOS, but without improvement in morbidity or mortality. CONCLUSIONS Patients undergoing PR operations were more likely to have had major complications than were patients who underwent AC procedures; unfortunately no improvement in the rate of these complications or in mortality occurred. Perhaps the significant reduction in LOS is due in part to an increased prevalence of minimally invasive surgery and/or enhanced recovery protocols. Data were found to be lacking within NSQIP for several important variables including key oncologic data, stratification by surgical volume, and patient geographic location. We anticipate that the NAPRC should help improve PR surgical and oncologic outcomes including decreasing morbidity and mortality rates during the next decade.
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Affiliation(s)
- Stephen P Sharp
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA; Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA
| | - Robert Malizia
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA
| | - Matthew Skancke
- Department of General Surgery and Colorectal Surgery at the George Washington University Hospital, Washington, DC, USA
| | | | - Ashar Ata
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA
| | - Steven C Stain
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA
| | - Brian T Valerian
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA
| | - Edward C Lee
- Division of Colon and Rectal Surgery, Albany Medical Center, Albany, NY, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA.
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Wales DP, Khan S, Suresh D, Ata A, Morris B. Factors associated with Tdap vaccination receipt during pregnancy: a cross-sectional study. Public Health 2019; 179:38-44. [PMID: 31726399 DOI: 10.1016/j.puhe.2019.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 07/30/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Pertussis morbidity and mortality disproportionately affect infants younger than 1 year, who constitute 70% of deaths from pertussis. In 2017, 43% of infants younger than 6 months diagnosed with pertussis were hospitalized. In 2012, the Advisory Committee on Immunization Practices recommended that all pregnant women should receive Tdap (tetanus-diphtheria-acellular pertussis) vaccine between 27- and 36-weeks gestation in an effort to reduce infant pertussis morbidity and mortality. However, Tdap vaccination rates among pregnant women remain far from robust. The aim of this study was to assess factors associated with maternal Tdap uptake to help providers identify best practices that can improve Tdap receipt and identify women at risk for not receiving this important vaccine. STUDY DESIGN A retrospective cross-sectional study. METHODS A review of prenatal and delivery records was performed on all maternal-infant dyads with infants older than 36 weeks gestation admitted to the term nursery at Albany Medical Center from January 1, 2016 to April 16, 2016. A chi-squared analysis using STATA®, version 14.1, was performed to determine if any variables were associated with Tdap uptake, with statistical significance defined as P < 0.05. Multivariate analysis was performed to identify the variables which had the greatest effect on Tdap receipt. RESULTS Tdap vaccine was received by 65.8% of pregnant women (n = 400) in the study; median gestational age of receipt was 30 weeks. Maternal influenza vaccine receipt, infant hepatitis B vaccine receipt, provider recommendation of Tdap vaccination, and on-site availability of Tdap vaccine were all positively associated with maternal Tdap receipt during pregnancy. CONCLUSION Receipt of Tdap by pregnant women was highest in those who had received a provider recommendation about its benefits and who also received influenza vaccine during pregnancy. Because women who received the influenza vaccine themselves and also consented to have their infants receive the hepatitis B vaccine had significantly higher uptake rates, encouraging vaccines usage and combating vaccine hesitancy in general can improve Tdap uptake rates. A small, but statistically significant association with receipt of assisted reproductive technologies was also seen, meriting future research.
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Affiliation(s)
- D P Wales
- Albany Medical Center, Division of Internal Medicine/Pediatrics, 1019 New Loudon Road, Cohoes, NY, 12047, USA.
| | - S Khan
- Albany Medical College, 47 New Scotland Avenue, Albany, NY, 12208, USA.
| | - D Suresh
- Albany Medical College, 47 New Scotland Avenue, Albany, NY, 12208, USA.
| | - A Ata
- Albany Medical Center, Department of Surgery, 50 New Scotland Avenue, Albany, NY, 12208, USA.
| | - B Morris
- Albany Medical Center, Department of Obstetrics & Gynecology, 391 Myrtle Avenue, Albany, NY, 12208, USA.
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Ata A, Küçük A, Eskici Ş, Şanlı T, Nayır E. Comparison of combined chemoradiotherapy regimens; Paclitaxel plus carboplatin and cisplatin plus etoposide for locally advanced non-small cell lung cancer: A randomised phase III trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz436.005] [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: 11/13/2022] Open
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Pfaff AC, Miller CP, Ata A, Stolarski AE, Evans L, Johnson M, Bartscherer A, Rosati C, Stain SC, Tafen M. Impact of a Comprehensive Multidisciplinary Rib Fracture Treatment Protocol on Patient Outcomes at a Level I Trauma Center. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.654] [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: 11/16/2022]
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