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Matta R, Keihani S, Hebert K, Horns JJ, Nirula R, McCrum M, McCormick BJ, Gross JA, Joyce RP, Rogers DM, Wang SS, Hagedorn JC, Selph JP, Sensenig RL, Moses RA, Dodgion CM, Gupta S, Mukherjee K, Majercik S, Broghammer JA, Schwartz I, Elliott SP, Breyer BN, Baradaran N, Zakaluzny S, Erickson BA, Miller BD, Askari R, Carrick MM, Burks FN, Norwood S, Myers JB. PROPOSED REVISION OF THE AMERICAN ASSOCIATION FOR SURGERY OF TRAUMA RENAL TRAUMA ORGAN INJURY SCALE: SECONDARY ANALYSIS OF THE MULTI-INSTITUTIONAL GENITOURINARY TRAUMA STUDY. J Trauma Acute Care Surg 2024:01586154-990000000-00628. [PMID: 38319246 DOI: 10.1097/ta.0000000000004232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND This study updates the American Association for Surgery of Trauma (AAST) Organ Injury Scale (OIS) for renal trauma using evidence-based criteria for bleeding control intervention. METHODS This was a secondary analysis of a multi-center retrospective study including patients with high grade renal trauma from 7 Level-1 trauma centers from 2013-2018. All eligible patients were assigned new renal trauma grades based on revised criteria. The primary outcome used to measure injury severity was intervention for renal bleeding. Secondary outcomes included intervention for urinary extravasation, units of packed red blood cells (PRBCs) transfused within 24 hours, and mortality. To test the revised grading system, we performed mixed effect logistic regression adjusted for multiple baseline demographic and trauma covariates. We determined the area under the receiver-operator curve (AUC) to assess accuracy of predicting bleeding interventions from the revised grading system and compared this to 2018 AAST organ injury scale. RESULTS based on the 2018 OIS grading system, we included 549 patients with AAST Grade III-V injuries and CT scans (III: 52% (n = 284), IV: 45% (n = 249), and V: 3% (n = 16)). Among these patients, 89% experienced blunt injury (n = 491) and 12% (n = 64) underwent intervention for bleeding. After applying the revised grading criteria, 60% (n = 329) of patients were downgraded and 4% (n = 23) were upgraded; 2.8% (n = 7) downgraded from grade V to IV, and 69.5% (n = 173) downgraded from IV to III. The revised renal trauma grading system demonstrated improved predictive ability for bleeding interventions (2018 AUC = 0.805, revised AUC = 0.883; p = 0.001) and number of units of PRBCs transfused. When we removed urinary injury from the revised system, there was no difference in its predictive ability for renal hemorrhage intervention. CONCLUSIONS A revised renal trauma grading system better delineates the need for hemostatic interventions than the current AAST OIS renal trauma grading system. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Rano Matta
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sorena Keihani
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kevin Hebert
- Department of Surgery, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Joshua J Horns
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Raminder Nirula
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Marta McCrum
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Joel A Gross
- Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Ryan P Joyce
- NYU Grossman School of Medicine, New York, NY, USA
| | - Douglas M Rogers
- Department of Radiology, University of Utah Salt Lake City, UT, USA
| | | | - Judith C Hagedorn
- Department of Urology, Harborview Medical Center, University of Washington, Seattle, Washington
| | - J Patrick Selph
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rachel L Sensenig
- Division of Trauma, Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Rachel A Moses
- Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Shubham Gupta
- Department of Urology, Case Western Reserve University, Cleveland, OH, USA
| | - Kaushik Mukherjee
- Division of Acute Care Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Sarah Majercik
- Division of Trauma and Surgical Critical Care, Intermountain Medical Center, Murray, UT, USA
| | | | - Ian Schwartz
- Department of Urology, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Benjamin N Breyer
- Department of Urology, University of California - San Francisco, San Francisco, CA, USA
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Scott Zakaluzny
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | | | - Brandi D Miller
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | - Reza Askari
- Division of Trauma, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Frank N Burks
- Department of Urology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Scott Norwood
- Department of Surgery, UT Health Tyler, Tyler, TX, USA
| | - Jeremy B Myers
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
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Snyder L, Hebert KJ, Horns JJ, Schardein J, McCormick BJ, Downing J, Dy GW, Goodwin I, Agarwal C, Hotaling JM, Myers JB. Incidence and Risk Factors for Postoperative Venous Thromboembolism After Gender Affirming Vaginoplasty: A Retrospective Analysis of a Large Insurance Claims Database. Urology 2023; 182:95-100. [PMID: 37774849 DOI: 10.1016/j.urology.2023.08.041] [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] [Received: 05/04/2023] [Revised: 07/20/2023] [Accepted: 08/14/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To investigate the incidence and associated risk factors of venous thromboembolism (VTE) after gender affirming vaginoplasty. METHODS We searched International Business Machines Corporation (IBM) Marketscan, a commercial claims database, for Current Procedural Terminology and International Classification of Diseases (ICD) procedure codes to identify patients who underwent gender affirming vaginoplasty from 2011-2020. We quantified deep venous thrombosis and pulmonary embolism using ICD-9 and ICD-10 codes found within 90 days after surgery. Univariate and multivariate analyses were performed to establish association between VTE events and age, residency location, and comorbidities. RESULTS We identified 1588 patients who underwent gender affirming vaginoplasty. Overall, 1.1% of patients experienced a VTE within 90 days following surgery. Patients who experienced postoperative VTE were older, more likely to have had a prior VTE, less likely to be from an urban area, and more likely to have a higher Charlson Comorbidity Index score. Among patients with postoperative VTE, 47.1% had previous VTE. Among patients without a postoperative VTE, 1.3% had previous VTE. CONCLUSION In patients undergoing gender affirming vaginoplasty, the incidence of postoperative VTE was 1.1%. Older age, rurality, increased comorbidities, and prior VTE were associated with increased risk of postoperative VTE. Current guidelines do not recommend cessation of gender affirming hormone therapy (GAHT) prior to vaginoplasty. Further research is needed to evaluate if certain high-risk patients would benefit from perioperative adjustment of GAHT or perioperative VTE prophylaxis.
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Affiliation(s)
- Liem Snyder
- Division of Urology, University of Utah, Salt Lake City, UT.
| | - Kevin J Hebert
- Division of Urology, University of Utah, Salt Lake City, UT.
| | - Joshua J Horns
- Division of Urology, University of Utah, Salt Lake City, UT.
| | | | | | - Jae Downing
- Oregon Health and Science University, Portland, OR.
| | - Geolani W Dy
- Oregon Health and Science University, Portland, OR.
| | - Isak Goodwin
- Division of Plastic Surgery, University of Utah, Salt Lake City, UT.
| | - Cori Agarwal
- Division of Plastic Surgery, University of Utah, Salt Lake City, UT.
| | | | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, UT.
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Shair KA, Espinosa SM, Kwon JY, Gococo-Benore DA, McCormick BJ, Heckman MG, Seim LA, Cowdell JC. A Quality Improvement Approach to Decrease the Utilization of Docusate in Hospitalized Patients. Qual Manag Health Care 2023; 32:263-269. [PMID: 36807543 DOI: 10.1097/qmh.0000000000000406] [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: 02/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Docusate sodium is a commonly prescribed medication to relieve constipation, but several studies have demonstrated its ineffectiveness. Its continued use in the hospital setting adds unnecessary cost and risk to patients. At the Mayo Clinic Florida campus, docusate was ordered for 9.7% of patients admitted to the internal medicine resident (IMED) teaching services during the month of January 2020, and the average hospital length of stay (LOS) was 3.1 days. METHODS A multidisciplinary team of internal medicine resident physicians and pharmacists collaborated to address this quality gap through a quality improvement project. It sought to reduce the number of patients admitted to the IMED teaching services who had an order placed for docusate by 50% in less than 6 months without adversely impacting hospital LOS. Two separate interventions were devised using Six Sigma methodology and implemented to reduce the frequency of docusate orders, which involved educating internal medicine residents and hospital pharmacists, and creating an additional process-related barrier to docusate orders. RESULTS The percentage of docusate orders decreased from 9.7% to 2.4% ( P = .004) with a grossly unchanged LOS of 3.1 days to 2.7 days ( P = .12) after 5 weeks. CONCLUSION The implementation of a dual-pronged intervention successfully decreased the use of an ineffective medication in hospitalized patients without impacting the balancing measure, and serves as a model that can be adopted at other institutions with the hope of promoting evidence-based medical care.
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Affiliation(s)
- Kamal A Shair
- Departments of Internal Medicine (Drs Shair, Kwon, Gococo-Benore, McCormick, Seim, and Cowdell) and Cardiovascular Medicine (Dr Espinosa), Mayo Clinic, Jacksonville, Florida; and Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida (Mr Heckman)
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Hebert KJ, Matta R, Fendereski K, Horns JJ, Paudel N, Das R, Viers BR, Hotaling J, McCormick BJ, Myers JB. Genitourinary Radiation Injury Following Prostate Cancer Treatment: Assessment of Cost and Health Care System Burden. Urology 2023; 179:166-173. [PMID: 37263424 DOI: 10.1016/j.urology.2023.03.056] [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] [Received: 01/16/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the healthcare resource impact of radiation injury following prostate cancer treatment. METHODS Using IBM MarketScan, we performed a retrospective study of men with prostate cancer who were treated with radiotherapy and subsequently developed low-grade (LGRI) and high-grade radiation injury (HGRI). Radiation injury diagnoses included bladder neck stenosis, hematuria/cystitis, fistula, ureteral stricture, and incontinence. LGRI and HGRI included injury diagnosis without intervention and with intervention, respectively. Health care visits and costs were measured over 5 time periods including 2 years before radiation, 1 year before radiation, radiation to injury diagnosis, injury diagnosis to first intervention (LGRI), and following first intervention (HGRI). Negative binomial regression modeling was used to assess the effect of radiation injury on average cost adjusting for demographics and comorbidities. RESULTS Between 2008 and 2017, we identified 121,027 men who received radiotherapy following prostate cancer diagnosis of which 10,057 (8.3%) experienced a HGRI. The frequency of urologic visits and average costs were similar in those without injury and LGRI. However, men with HGRI experienced higher visit frequency and monthly costs. Amongst high-grade injuries, urinary fistula had the highest frequency of visit utilization at 378 visits before first intervention and 245 visits after first intervention. Following radiation injury diagnosis, the average monthly cost was twice as high in those with HGRI ($85.78) compared to LGRI ($38.66). CONCLUSIONS HGRI was associated with increased urologic health care use and average monthly cost when compared to those who experienced LGRI or no injury. Urinary fistula was associated with the largest resource burden.
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Affiliation(s)
- Kevin J Hebert
- Division of Urology, University of Utah, Salt Lake City, UT.
| | - Rano Matta
- Division of Urology, University of Utah, Salt Lake City, UT
| | | | - Joshua J Horns
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT
| | - Niraj Paudel
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT
| | - Rupam Das
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT
| | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN
| | - James Hotaling
- Division of Urology, University of Utah, Salt Lake City, UT
| | | | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, UT
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Hebert KJ, Matta R, Horns JJ, Paudel N, Das R, McCormick BJ, Myers JB, Hotaling JM. Prior COVID-19 infection associated with increased risk of newly diagnosed erectile dysfunction. Int J Impot Res 2023:10.1038/s41443-023-00687-4. [PMID: 36922696 PMCID: PMC10015534 DOI: 10.1038/s41443-023-00687-4] [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: 08/21/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/17/2023]
Abstract
We sought to assess if COVID-19 infection recovery is associated with increased rates of newly diagnosed erectile dysfunction. Using IBM MarketScan, a commercial claims database, men with prior COVID-19 infection were identified using ICD-10 diagnosis codes. Using this cohort along with an age-matched cohort of men without prior COVID-19 infection, we assessed the incidence of newly diagnosed erectile dysfunction. Covariates were assessed using a multivariable model to determine association of prior COVID-19 infection with newly diagnosed erectile dysfunction. 42,406 men experienced a COVID-19 infection between January 2020 and January 2021 of which 601 (1.42%) developed new onset erectile dysfunction within 6.5 months follow up. On multivariable analysis while controlling for diabetes, cardiovascular disease, smoking, obesity, hypogonadism, thromboembolism, and malignancy, prior COVID-19 infection was associated with increased risk of new onset erectile dysfunction (HR 1.27; 95% CI 1.1-1.5; P = 0.002). Prior to the widespread implementation of the COVID-19 vaccine, the incidence of newly diagnosed erectile dysfunction is higher in men with prior COVID-19 infection compared to age-matched controls. Prior COVID-19 infection was associated with a 27% increased likelihood of developing new-onset erectile dysfunction when compared to those without prior infection.
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Affiliation(s)
- Kevin J Hebert
- Division of Urology, University of Utah, Salt Lake City, UT, USA.
| | - Rano Matta
- Division of Urology, University of Utah, Salt Lake City, UT, USA
| | - Joshua J Horns
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT, USA
| | - Niraj Paudel
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT, USA
| | - Rupam Das
- Surgical Population Analysis Research Core, University of Utah, Salt Lake City, UT, USA
| | | | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, University of Utah, Salt Lake City, UT, USA
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McCormick BJ, Chirila RM. ANKRD26 Gene Variant of Uncertain Significance in a Patient With Acute Myeloid Leukemia. Cureus 2023; 15:e36152. [PMID: 37065357 PMCID: PMC10101738 DOI: 10.7759/cureus.36152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/16/2023] Open
Abstract
ANKRD26-related thrombocytopenia is a rare inherited disorder associated with an increased risk of malignancy. While the genetic mutations underlying this condition are well understood, there is limited knowledge regarding its contribution to myeloid neoplasms, such as acute myeloid leukemia (AML). We present a case of ANKRD26-related thrombocytopenia with a variant of uncertain significance in a patient with AML and review the pathogenesis and implications of hereditary germline mutations in disease management.
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McCormick BJ, Chirila RM. Gordonia bronchialis Bacteremia in a Patient With Burkitt Lymphoma: A Case Report and Literature Review. Cureus 2022; 14:e30644. [DOI: 10.7759/cureus.30644] [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] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
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Fendereski K, McCormick BJ, Keihani S, Hagedorn JC, Voelzke B, Selph JP, Figler BD, Johnsen NV, da Silva RD, Broghammer JA, Gupta S, Miller B, Burks FN, Eswara JR, Osterberg EC, Carney KJ, Erickson BA, Gretzer MB, Chung PH, Harris CR, Murphy GP, Rusilko P, Anderson KT, Shridharani A, Benson CR, Alwaal A, Blaschko SD, Breyer BN, McKibben M, IanSchwartz, Simhan J, Vanni AJ, Moses RA, Myers JB. The Outcomes of Pelvic Fracture Urethral Injuries Stratified by Urethral Injury Severity: A Prospective Multi-institutional Genitourinary Trauma Study (MiGUTS). Urology 2022; 170:197-202. [PMID: 36152870 DOI: 10.1016/j.urology.2022.09.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To determine patient outcomes across a range of pelvic fracture urethral injury (PFUI) severity. PFUI is a devastating consequence of a pelvic fracture. No study has stratified PFUI outcomes based on severity of the urethral distraction injury. METHODS Adult male patients with blunt-trauma-related PFUI were followed prospectively for a minimum of six months at 27 US medical centers from 2015-2020. Patients underwent retrograde cystourethroscopy and retrograde urethrography to determine injury severity and were categorized into three groups: (1) major urethral distraction, (2) minor urethral distraction, and (3) partial urethral injury. Major distraction vs. minor distraction was determined by the ability to pass a cystoscope retrograde into the bladder. Simple statistics summarized differences between groups. Multi-variable analyses determined odds ratios for obstruction and urethroplasty controlling for urethral injury type, age, and Injury Severity Score. RESULTS There were 99 patients included, 72(72%) patients had major, 13(13%) had minor, and 14(14%) had partial urethral injuries. The rate of urethral obstruction differed in patients with major (95.8%), minor (84.6%), and partial injuries (50%) (p< 0.001). Urethroplasty was performed in 90% of major, 66.7% of minor, and 35.7% of partial injuries (p<0.001). CONCLUSIONS In PFUI, a spectrum of severity exists that influences outcomes. While major and minor distraction injuries are associated with a higher risk of developing urethral obstruction and need for urethroplasty, up to 50% of partial PFUI will result in obstruction, and as such need to be closely followed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jairam R Eswara
- St. Elizabeth's Medical Center, Boston University School of Medicine.
| | | | | | | | | | - Paul H Chung
- Sidney Kimmel Medical College of Thomas Jefferson University.
| | | | | | | | | | | | | | | | | | | | | | - IanSchwartz
- Division of Urology Hennepin County Medical Center, University of Minnesota.
| | | | | | | | - Jeremy B Myers
- University of Utah, Department of Surgery (Primary Investigator).
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Govero A, McCormick BJ, Trautman CL. 39-Year-Old Woman With Severe Weakness. Mayo Clin Proc 2022; 97:1723-1727. [PMID: 36058584 DOI: 10.1016/j.mayocp.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 10/14/2022]
Affiliation(s)
- Austin Govero
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Benjamin J McCormick
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Christopher L Trautman
- Advisor to residents and Consultant in Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL.
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Kuhlman JJ, McCormick BJ, Badar T, Foran JM, Abdel Rahman ZH, Murthy HS. Clinicopathologic characteristics and treatment outcomes of de novo myeloid sarcoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e19002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19002 Background: Extramedullary disease in acute myeloid leukemia (AML), also known as myeloid sarcoma (MS), is an uncommon presentation of de novo AML. Clinicopathologic characteristics and optimal treatment strategies of de novo MS remain unclear in both isolated MS without bone marrow (BM) involvement and synchronous MS with BM involvement. Methods: In a single-site retrospective study, medical records of patients with de novo extramedullary AML who received oncological care at Mayo Clinic, Florida, between 1996 and 2021 were analyzed. Using BlueSky Statistics software, survival outcomes were analyzed using Kaplan-Meier and Cox-proportional hazard models for univariate and multivariate analysis, respectively. Results: 83 patients with de novo MS were identified; 49 (59%) presented with synchronous MS and 34 (41%) exhibited isolated MS. Median age at diagnosis was 56 years (range, 17-89); 63% were male. Next-generation sequencing of the blood +/- BM revealed abnormalities in 24/27 (88%) analyzed patients; aberrations included mutations in RTK-RAS pathways (12/27), NPM1 (10/27), TET2 (6/27), and IDH2 (4/27). Median length of follow-up was 1.73 years (95% CI; 0.03-3.0); 53 patients (64%) had expired. Median event free survival was 0.64 years and 0.61 years in isolated and synchronous MS, respectively (p = 0.5). Median overall survival (mOS) in isolated and synchronous MS was 2.1 years and 1.5 years, respectively (p = 0.5). Induction treatment with intensive chemotherapy (IC) was administered in 70 patients (84%). IC regimens included 7+3, MEC, CLAG-M, and hyper-CVAD. Variables associated with improved survival in both groups included treatment with IC +/- allogenic stem cell transplant (alloSCT) (p < 0.001), normal or favorable risk karyotype (p = 0.001), gastrointestinal, gynecological, or genitourinary site of involvement (p < 0.001), and age less than 60 (p = 0.001). Localized therapy (LT) did not provide an added survival benefit. Patients with synchronous MS were more likely to relapse in the BM and blood than isolated MS (p = 0.02). Conclusions: Enriched with RTK-RAS mutations, de novo MS remains an aggressive form of AML, particularly in patients with intermediate or high-risk genomics or those with skin, soft tissue, or lymphatic involvement. IC should be employed with consideration of alloSCT in eligible patients, particularly in synchronous MS due to a heightened risk for medullary and leukemic relapse.[Table: see text]
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Affiliation(s)
| | | | - Talha Badar
- Division of Hematology, Mayo Clinic, Jacksonville, FL
| | | | - Zaid H. Abdel Rahman
- Division of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, UT
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McCormick BJ, Kuhlman J, Chirila RM. 54-Year-Old Man With Acute Dyspnea on Exertion. Mayo Clin Proc 2022; 97:1008-1013. [PMID: 35410747 DOI: 10.1016/j.mayocp.2021.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/16/2021] [Accepted: 09/21/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Benjamin J McCormick
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Justin Kuhlman
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL
| | - Razvan M Chirila
- Advisor to residents and Consultant in Internal Medicine, Mayo Clinic, Jacksonville, FL.
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Overfield CJ, McCormick BJ, Erben Y, Saunders H, Sheele JM, Moss JE, Toskich B. Infrarenal aortic balloon-expandable stent graft deployment using the sheath control technique in a patient with hemorrhagic shock secondary to an aortoenteric fistula. J Vasc Surg Cases Innov Tech 2021; 7:563-566. [PMID: 34485779 PMCID: PMC8406146 DOI: 10.1016/j.jvscit.2021.04.025] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
A 40-year-old man presented with hemorrhagic shock owing to an aortoduodenal fistula. Angiography demonstrated vasospasm of the right common femoral artery to 2 mm. Treatment using a balloon-expandable stent graft was chosen given the smaller sheath diameter requirement when compared to self-expandable aortic stent graft. Given the undersized 11 mm delivery balloon for the patient's aorta, a sheath control technique was utilized. The stent graft was partially expanded within the sheath and the delivery balloon was exchanged for a 16-mm balloon to complete expansion of the stent graft apposition to the aortic wall, bridging the patient to definitive surgical repair.
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Affiliation(s)
| | | | - Young Erben
- Division of Vascular Surgery, Mayo Clinic, Jacksonville, Fla
| | - Hollie Saunders
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Fla
| | | | - John E Moss
- Division of Critical Care Medicine, Department of Pulmonology, Mayo Clinic, Jacksonville, Fla
| | - Beau Toskich
- Division of Interventional Radiology, Mayo Clinic, Jacksonville, Fla
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Hamad J, McCormick BJ, Sayed CJ, Paci K, Overton M, Daubert T, Figler BD. Multidisciplinary Update on Genital Hidradenitis Suppurativa: A Review. JAMA Surg 2020; 155:970-977. [PMID: 32838413 DOI: 10.1001/jamasurg.2020.2611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a predilection for the genital region. Genital HS requires medical and surgical management as well as close collaboration among a multidisciplinary team. Observations Hidradenitis suppurativa is a disease of the hair follicles that results in recurrent nodules, abscesses, and tunneling sinus tracts. Medical treatment mainstays include antibiotics and retinoids, but the evolving class of biologic medications has gained traction in the treatment of moderate and severe disease. Many of the medical therapies come with adverse effects requiring clinical and laboratory monitoring over the course of treatment. When lesions are refractory to therapy or are too large for medical therapy alone, surgical intervention is required. Surgical procedures can include treatment of affected areas with deroofing or excision of affected skin. When large portions of genital skin are removed, reconstruction is necessary to restore function and aesthetics of the genitals. We describe a variety of reconstructive techniques based on the size and location of the skin deficiency. Conclusions and Relevance Effective management of genital hidradenitis suppurativa requires a thorough understanding of medical and surgical techniques for prevention, treatment, and reconstruction of genital defects.
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Affiliation(s)
- Judy Hamad
- University of North Carolina at Chapel Hill School of Medicine
| | | | | | - Karina Paci
- Department of Dermatology, University of North Carolina at Chapel Hill
| | - Matthew Overton
- Department of Dermatology, University of North Carolina at Chapel Hill
| | - Thomas Daubert
- University of North Carolina at Chapel Hill School of Medicine
| | - Bradley D Figler
- Department of Urology, University of North Carolina at Chapel Hill
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McCormick BJ, Deal A, Borawski KM, Raynor MC, Viprakasit D, Wallen EM, Woods ME, Pruthi RS. Implementation of medical scribes in an academic urology practice: an analysis of productivity, revenue, and satisfaction. World J Urol 2018; 36:1691-1697. [PMID: 29637266 DOI: 10.1007/s00345-018-2293-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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: 12/04/2017] [Accepted: 04/05/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Pressure on physicians to increase productivity is rising in parallel with administrative tasks, regulations, and the use of electronic health records (EHRs). Physician extenders and clinical pathways are already in use to increase productivity and reduce costs and burnout, but other strategies are required. We evaluated whether implementation of medical scribes in an academic urology clinic would affect productivity, revenue, and patient/provider satisfaction. METHODS Six academic urologists were assigned scribes for 1 clinic day per week for 3 months. Likert-type patient and provider surveys were developed to evaluate satisfaction with and without scribes. Matched clinic days in the year prior were used to evaluate changes in productivity and physician/hospital charges and revenue. RESULTS After using scribes for 3 months, providers reported increased efficiency (p value = 0.03) and work satisfaction (p value = 0.03), while seeing a mean 2.15 more patients per session (+ 0.96 return visits, + 0.99 new patients, and + 0.22 procedures), contributing to an additional 2.6 wRVUs, $542 in physician charges, and $861 in hospital charges per clinic session. At a gross collection rate of 36%, actual combined revenue was + $506/session, representing a 26% increase in overall revenue. At a cost of $77/session, the net financial impact was + $429 per clinic session, resulting in a return-to-investment ratio greater than 6:1, while having no effect on patient satisfaction scores. Additionally, with scribes, clinic encounters were closed a mean 8.9 days earlier. CONCLUSIONS Implementing medical scribes in academic urology practices may be useful in increasing productivity, revenue, and provider satisfaction, while maintaining high patient satisfaction.
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Affiliation(s)
- Benjamin J McCormick
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA.
| | - Allison Deal
- Lineberger Comprehensive Cancer Center, Biostatistics and Clinical Data Management Core, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristy M Borawski
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Mathew C Raynor
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Davis Viprakasit
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Eric M Wallen
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Michael E Woods
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
| | - Raj S Pruthi
- Department of Urology, UNC School of Medicine, University of North Carolina at Chapel Hill, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC, 27599-7235, USA
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Abstract
A dilation of the pampiniform venous plexus in the scrotum above the testicle, called a varicocele, affects approximately 15% of the general male population. While the majority is asymptomatic, pain results in up to 10% of cases of varicoceles. The pain associated with varicoceles is typically mild and is described as heavy, achy, or dull—and is usually isolated to the testicle or spermatic cord. Guidelines clearly recommend varicocele repair in males with varicoceles, infertility, and an abnormal semen analysis. While chronic, severe pain is an additional indication for repair, a careful evaluation to rule out other etiologies in addition to a period of conservative management are necessary prior to surgical treatment because of the high incidental prevalence of varicoceles in the general population. Several techniques for varicocele repair have been described, including retroperitoneal, laparoscopic, inguinal, and subinguinal. Additionally, recent adjuncts to improve visualization and identification of critical structures including the operating microscope and microvascular Doppler ultrasound have improved success and complication rates. With careful patient selection, outcomes of varicocele repair with regard to pain are excellent, with over 90% of patients experiencing symptomatic relief. After failure of conservative treatments, a varicocele associated with pain should be considered for repair, and the microsurgical subinguinal approach is the gold standard surgical treatment, offering excellent outcomes while minimizing risk of complications.
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Affiliation(s)
- Ryan C Owen
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | | | - Bradley D Figler
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Robert M Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA.,UNC Fertility LLC, Raleigh, NC, USA
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Pinto NJ, Shah PD, Kahol PK, McCormick BJ. Conducting state of polyaniline films: Dependence on moisture. Phys Rev B Condens Matter 1996; 53:10690-10694. [PMID: 9982634 DOI: 10.1103/physrevb.53.10690] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Kahol PK, Spencer WR, Pinto NJ, McCormick BJ. Magnetic-susceptibility analysis of polyaniline and its derivatives in terms of triplet bipolarons. Phys Rev B Condens Matter 1994; 50:18647-18650. [PMID: 9976305 DOI: 10.1103/physrevb.50.18647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Kahol PK, Pendse V, Pinto NJ, Traore M, Stevenson WT, McCormick BJ, Gundersen JN. Electron-localization effects on the conducting and magnetic states in polyaniline copolymers. Phys Rev B Condens Matter 1994; 50:2809-2814. [PMID: 9976522 DOI: 10.1103/physrevb.50.2809] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Pinto NJ, Kahol PK, McCormick BJ, Dalal NS, Wan H. Charge transport and electron localization in polyaniline derivatives. Phys Rev B Condens Matter 1994; 49:13983-13986. [PMID: 10010348 DOI: 10.1103/physrevb.49.13983] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Kahol PK, McCormick BJ. Magnetic state of poly(m-toluidine): Dependence on absorbed water. Phys Rev B Condens Matter 1993; 47:14588-14590. [PMID: 10005822 DOI: 10.1103/physrevb.47.14588] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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