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Apostolos A, Ktenopoulos N, Chlorogiannis DD, Katsaros O, Konstantinou K, Drakopoulou M, Tsalamandris S, Karanasos A, Synetos A, Latsios G, Aggeli C, Panoulas V, Tsioufis C, Toutouzas K. Mortality Rates in Patients Undergoing Urgent Versus Elective Transcatheter Aortic Valve Replacement: A Meta-analysis. Angiology 2024:33197241245733. [PMID: 38613209 DOI: 10.1177/00033197241245733] [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: 04/14/2024]
Abstract
Patients with severe aortic stenosis (AoS) often present with acute heart failure and compensation, frequently leading to cardiogenic shock. Transcatheter Aortic Valve Replacement (TAVR) has been recently performed as a bailout treatment in such patients. The aim of our meta-analysis is to compare urgent TAVR with elective procedures. We systematically screened three databases searching for studies comparing urgent vs elective TAVR. Primary endpoint is the 30-days mortality. Secondary endpoints included in-hospital mortality, device success, periprocedural vascular complications, 30-days stroke, 30-days acute kidney injury (AKI), permanent pacemaker implantation (PPM), moderate or severe paravalvular leakage, and 30-days bleeding. Seventeen studies were included, with a total of 84,495 patients. Urgent TAVR was associated with an increased risk for 30-days mortality [Risk Ratio (RR): 2.53, 95% Confidence Intervals (CI): 1.81-3.54)], in-hospital mortality (RR: 2.67, 95% CI: 1.94-3.68), periprocedural vascular complications (RR: 1.91, 95% CI: 1.28-2.85) and AKI (RR: 2.83, 95% CI: 1.93-4.14), compared with elective procedure. No differences were observed in the other secondary endpoints. Urgent TAVR was associated with higher in-hospital and 30-days mortality, possibly driven by the increased incidence of AKI and vascular complications in urgent TAVR. The results highlight the importance of early TAVR in stable AoS patients.
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Affiliation(s)
- Anastasios Apostolos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Ktenopoulos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Odysseas Katsaros
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Konstantinou
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Maria Drakopoulou
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsalamandris
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Karanasos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Synetos
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Latsios
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantina Aggeli
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Costas Tsioufis
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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McMurry AJ, Zipursky AR, Geva A, Olson KL, Jones JR, Ignatov V, Miller TA, Mandl KD. Moving Biosurveillance Beyond Coded Data Using AI for Symptom Detection From Physician Notes: Retrospective Cohort Study. J Med Internet Res 2024; 26:e53367. [PMID: 38573752 PMCID: PMC11027052 DOI: 10.2196/53367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/30/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Real-time surveillance of emerging infectious diseases necessitates a dynamically evolving, computable case definition, which frequently incorporates symptom-related criteria. For symptom detection, both population health monitoring platforms and research initiatives primarily depend on structured data extracted from electronic health records. OBJECTIVE This study sought to validate and test an artificial intelligence (AI)-based natural language processing (NLP) pipeline for detecting COVID-19 symptoms from physician notes in pediatric patients. We specifically study patients presenting to the emergency department (ED) who can be sentinel cases in an outbreak. METHODS Subjects in this retrospective cohort study are patients who are 21 years of age and younger, who presented to a pediatric ED at a large academic children's hospital between March 1, 2020, and May 31, 2022. The ED notes for all patients were processed with an NLP pipeline tuned to detect the mention of 11 COVID-19 symptoms based on Centers for Disease Control and Prevention (CDC) criteria. For a gold standard, 3 subject matter experts labeled 226 ED notes and had strong agreement (F1-score=0.986; positive predictive value [PPV]=0.972; and sensitivity=1.0). F1-score, PPV, and sensitivity were used to compare the performance of both NLP and the International Classification of Diseases, 10th Revision (ICD-10) coding to the gold standard chart review. As a formative use case, variations in symptom patterns were measured across SARS-CoV-2 variant eras. RESULTS There were 85,678 ED encounters during the study period, including 4% (n=3420) with patients with COVID-19. NLP was more accurate at identifying encounters with patients that had any of the COVID-19 symptoms (F1-score=0.796) than ICD-10 codes (F1-score =0.451). NLP accuracy was higher for positive symptoms (sensitivity=0.930) than ICD-10 (sensitivity=0.300). However, ICD-10 accuracy was higher for negative symptoms (specificity=0.994) than NLP (specificity=0.917). Congestion or runny nose showed the highest accuracy difference (NLP: F1-score=0.828 and ICD-10: F1-score=0.042). For encounters with patients with COVID-19, prevalence estimates of each NLP symptom differed across variant eras. Patients with COVID-19 were more likely to have each NLP symptom detected than patients without this disease. Effect sizes (odds ratios) varied across pandemic eras. CONCLUSIONS This study establishes the value of AI-based NLP as a highly effective tool for real-time COVID-19 symptom detection in pediatric patients, outperforming traditional ICD-10 methods. It also reveals the evolving nature of symptom prevalence across different virus variants, underscoring the need for dynamic, technology-driven approaches in infectious disease surveillance.
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Affiliation(s)
- Andrew J McMurry
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Amy R Zipursky
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alon Geva
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Karen L Olson
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - James R Jones
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - Vladimir Ignatov
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
| | - Timothy A Miller
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, United States
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Cho J, Yoo S, Lee EE, Lee HY. Impact of a Nationwide Medication History Sharing Program on the Care Process and End-User Experience in a Tertiary Teaching Hospital: Cohort Study and Cross-Sectional Study. JMIR Med Inform 2024; 12:e53079. [PMID: 38533775 PMCID: PMC11004625 DOI: 10.2196/53079] [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: 09/25/2023] [Revised: 01/16/2024] [Accepted: 02/04/2024] [Indexed: 03/28/2024] Open
Abstract
Background Timely and comprehensive collection of a patient's medication history in the emergency department (ED) is crucial for optimizing health care delivery. The implementation of a medication history sharing program, titled "Patient's In-home Medications at a Glance," in a tertiary teaching hospital aimed to efficiently collect and display nationwide medication histories for patients' initial hospital visits. Objective As an evaluation was necessary to provide a balanced picture of the program, we aimed to evaluate both care process outcomes and humanistic outcomes encompassing end-user experience of physicians and pharmacists. Methods We conducted a cohort study and a cross-sectional study to evaluate both outcomes. To evaluate the care process, we measured the time from the first ED assessment to urgent percutaneous coronary intervention (PCI) initiation from electronic health records. To assess end-user experience, we developed a 22-item questionnaire using a 5-point Likert scale, including 5 domains: information quality, system quality, service quality, user satisfaction, and intention to reuse. This questionnaire was validated and distributed to physicians and pharmacists. The Mann-Whiteny U test was used to analyze the PCI initiation time, and structural equation modeling was used to assess factors affecting end-user experience. Results The time from the first ED assessment to urgent PCI initiation at the ED was significantly decreased using the patient medication history program (mean rank 42.14 min vs 28.72 min; Mann-Whitney U=346; P=.03). A total of 112 physicians and pharmacists participated in the survey. Among the 5 domains, "intention to reuse" received the highest score (mean 4.77, SD 0.37), followed by "user satisfaction" (mean 4.56, SD 0.49), while "service quality" received the lowest score (mean 3.87, SD 0.79). "User satisfaction" was significantly associated with "information quality" and "intention to reuse." Conclusions Timely and complete retrieval using a medication history-sharing program led to an improved care process by expediting critical decision-making in the ED, thereby contributing to value-based health care delivery in a real-world setting. The experiences of end users, including physicians and pharmacists, indicated satisfaction with the program regarding information quality and their intention to reuse.
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Affiliation(s)
- Jungwon Cho
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
- Department of Pharmacy, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Eunkyung Euni Lee
- College of Pharmacy & Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea
- Department of Pharmacy, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ho-Young Lee
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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Hershkovitz Y, Ben Yehuda A, Dykman D, Jeroukhimov I. Urgent Paraesophageal Hernia: Can We Do Better? J Laparoendosc Adv Surg Tech A 2024; 34:235-238. [PMID: 38010270 DOI: 10.1089/lap.2023.0421] [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: 11/29/2023] Open
Abstract
Introduction: Paraesophageal hernia (PEH) is a relatively common pathology in the Western population. It may be asymptomatic, but ∼50% of patients with PEH have symptoms that may mimic gastrointestinal, respiratory, and cardiac pathology. Surgery is recommended in all acute cases of PEH, but indications for surgical intervention in asymptomatic or nonacutely symptomatic patient remain unclear. Purpose of this study was to evaluate our experience in management of patients with PEH admitted to the surgical word. Our special interest was in acute cases of emergency admission who were previously discharged from emergency room (ER). Methods: Data of patients who underwent PEH repair from January 1, 2017 to May, 2023, were retrospectively evaluated. Patients were divided into two groups. Group I included patients admitted through ER with acute symptoms of PEH. Patients who underwent elective surgery were included in group II. Group I patients were additionally divided on those who previously visited ER, and signs of PEH were underscored and those who were admitted to ER first time. Results: Ninety-eight patients underwent laparoscopic PEH repair. Group I included 28 patients (28.9%). Significant differences were noticed in patient's age, main complaint, and rate of complications. Fourteen patients from group I were previously discharged from ER, and in 12 of them, imaging study clearly showed diaphragmatic hernia. Conclusion: Patients who underwent elective laparoscopic PEH repair have better outcome. Signs of PEH may be underscored by ER physicians. Higher index of suspicion required to diagnose this relatively rare reason of ER admission.
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Affiliation(s)
- Yehuda Hershkovitz
- Trauma Unit, Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - Amir Ben Yehuda
- Division of Surgery, Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - Daniel Dykman
- Trauma Unit, Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
| | - Igor Jeroukhimov
- Trauma Unit, Shamir Medical Center Affiliated with University Tel Aviv, Zerefin, Israel
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Nana P, Spanos K, Jakimowicz T, Torrealba JI, Jama K, Panuccio G, Rohlffs F, Kölbel T. Urgent and emergent repair of complex aortic aneurysms using an off-the-shelf branched device. Front Cardiovasc Med 2023; 10:1277459. [PMID: 37808886 PMCID: PMC10556233 DOI: 10.3389/fcvm.2023.1277459] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Endovascular repair using off-the-shelf endografts is a viable solution in patients with ruptured or symptomatic complex aortic aneurysms. This analysis aimed to present the peri-operative and follow-up outcomes in urgent and emergent cases managed with the t-Branch multibranched thoracoabdominal endograft. Methods Prospectively collected data from all consecutive urgent and emergent cases managed in two aortic centers between January 1st, 2014, to November 30th, 2022, using the t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) were analyzed. Patients presenting with ruptured aortic complex aneurysms were characterized as emergent and patients with aneurysms >90 mm of diameter, or symptomatic aneurysms were characterized as urgent. Technical success, 30-day mortality, major adverse events (MAE) and spinal cord ischemia (SCI) rates were assessed. Results 225 patients (36.5% females, 72.5 ± 2.8 years) were included; 73.0% were urgent. The mean aneurysm diameter was 109 ± 3.9 mm and 44.4% were type I-III TAAAs. Females (p = .03), para-renal aneurysms (p = .02) and ASA score IV (p < .001) were more common in emergent cases. Technical success was 97.8%. Thirty-day mortality and MAE rates were 17.8% and 30.6%, respectively. SCI rate was 14.7%, (4.8% paraplegia rate) with 22.2% of patients receiving prophylactic cerebrospinal drainage. Thirty-day mortality (13.3% vs. 26.7%, p = .04) and MAE (26.0% vs. 43.0%, p = .02) were more common among emergent cases while technical success (97.6% vs. 98.3%, p = .9), and SCI (13.3% vs. 18.3%, p = .4) were similar. Survival at 12-months was 83.5% (SE 5.9%) for the urgent and 77.1% (SE 8.2%) for the emergent group (log rank, p = 0.96). Conclusion T-Branch represents an effective and safe solution for the management of urgent and emergent cases with complex aortic aneurysms, with high technical success, promising early mortality and SCI rates.
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Affiliation(s)
- Petroula Nana
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Konstantinos Spanos
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Tomasz Jakimowicz
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Jose I. Torrealba
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Katarzyna Jama
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Giuseppe Panuccio
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
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Sigle M, Berliner L, Richter E, van Iersel M, Gorgati E, Hubloue I, Bamberg M, Grasshoff C, Rosenberger P, Wunderlich R. Development of an Anticipatory Triage-Ranking Algorithm Using Dynamic Simulation of the Expected Time Course of Patients With Trauma: Modeling and Simulation Study. J Med Internet Res 2023; 25:e44042. [PMID: 37318826 PMCID: PMC10337428 DOI: 10.2196/44042] [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: 11/03/2022] [Revised: 03/14/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND In cases of terrorism, disasters, or mass casualty incidents, far-reaching life-and-death decisions about prioritizing patients are currently made using triage algorithms that focus solely on the patient's current health status rather than their prognosis, thus leaving a fatal gap of patients who are under- or overtriaged. OBJECTIVE The aim of this proof-of-concept study is to demonstrate a novel approach for triage that no longer classifies patients into triage categories but ranks their urgency according to the anticipated survival time without intervention. Using this approach, we aim to improve the prioritization of casualties by respecting individual injury patterns and vital signs, survival likelihoods, and the availability of rescue resources. METHODS We designed a mathematical model that allows dynamic simulation of the time course of a patient's vital parameters, depending on individual baseline vital signs and injury severity. The 2 variables were integrated using the well-established Revised Trauma Score (RTS) and the New Injury Severity Score (NISS). An artificial patient database of unique patients with trauma (N=82,277) was then generated and used for analysis of the time course modeling and triage classification. Comparative performance analysis of different triage algorithms was performed. In addition, we applied a sophisticated, state-of-the-art clustering method using the Gower distance to visualize patient cohorts at risk for mistriage. RESULTS The proposed triage algorithm realistically modeled the time course of a patient's life, depending on injury severity and current vital parameters. Different casualties were ranked by their anticipated time course, reflecting their priority for treatment. Regarding the identification of patients at risk for mistriage, the model outperformed the Simple Triage And Rapid Treatment's triage algorithm but also exclusive stratification by the RTS or the NISS. Multidimensional analysis separated patients with similar patterns of injuries and vital parameters into clusters with different triage classifications. In this large-scale analysis, our algorithm confirmed the previously mentioned conclusions during simulation and descriptive analysis and underlined the significance of this novel approach to triage. CONCLUSIONS The findings of this study suggest the feasibility and relevance of our model, which is unique in terms of its ranking system, prognosis outline, and time course anticipation. The proposed triage-ranking algorithm could offer an innovative triage method with a wide range of applications in prehospital, disaster, and emergency medicine, as well as simulation and research.
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Affiliation(s)
- Manuel Sigle
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
- University Department of Cardiology and Angiology, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Leon Berliner
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Erich Richter
- University Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Mart van Iersel
- Interactive Simulation Emergency Exercise support limited company, Wemmel, Belgium
| | - Eleonora Gorgati
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Ives Hubloue
- Emergency Department, Universitair Ziekenhuis Brussel, Brussel, Belgium
- Research Group on Emergency and Disaster Medicine, Vrije Universiteit Brussel, Brussel, Belgium
| | - Maximilian Bamberg
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Christian Grasshoff
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Peter Rosenberger
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Robert Wunderlich
- University Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
- German Society for Disaster Medicine (Deutsche Gesellschaft für Katastrophenmedizin), Kirchseeon, Germany
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Algadi MA, Alshathri AA, Alsugair RS, Alyabis MA, Alsaleh SA, Aljerian NA. Trends and patterns in urgent pediatric otolaryngology inter-hospital referrals in Saudi Arabia. Saudi Med J 2022; 43:91-97. [PMID: 35022289 PMCID: PMC9280561 DOI: 10.15537/smj.2022.43.1.20210710] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/23/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives: To assess trends in otolaryngology-head and neck surgery (ORL-HNS) referrals among pediatric patients, and to address common urgent causes of ORL-HNS referrals in this population. Additionally, to give recommendations regarding these causes, and assessing the impacts of coronavirus desease-19 on such referrals. Methods: A retrospective descriptive study were the data was extracted from the referral system of the Saudi Ministry of Health (Ehalati), from 2019-2020. Pediatric patients from all hospitals across Saudi Arabia with problems related to ORL-HNS who have been referred urgently to other hospitals were included. Results: A total of 1318 urgent ORL-HNS referrals were collected. The average age of the sample was 6.5 years, with the unavailability of specialty being the major cause for referrals. Foreign bodies, recurrent epistaxis, and tracheostomy were also common clinical causes. The average time for accepting referrals was 21 hours. Most cases had medical or surgical intervention prior to referral. The Western region of Saudi Arabia was the most common sender and receiver of all referrals. In 2020, referrals decreased by 18.4%. Conclusion: Maternity and pediatric hospitals make up the largest number of referring hospitals for ORL-HNS urgent cases. Expanding ORL-HNS services has been recommended in highly demanding areas. standards for urgent ORL-HNS referrals may limit inappropriate urgent referrals.
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Affiliation(s)
- Marwa A. Algadi
- From the College of Medicine (Algadi, Alshathri, Alsugair, Alyabis), Almaarefa University, from the Department of Otolaryngology - Head and Neck Surgery (Alsaleh), College of Medicine, King Saud University, and from Medical Referrals Center (Aljerian), Ministry of Health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Marwa A. Algadi, Medical Intern, College of Medicine, Almaarefa University, Riyadh, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-8910-6543
| | - Alanoud A. Alshathri
- From the College of Medicine (Algadi, Alshathri, Alsugair, Alyabis), Almaarefa University, from the Department of Otolaryngology - Head and Neck Surgery (Alsaleh), College of Medicine, King Saud University, and from Medical Referrals Center (Aljerian), Ministry of Health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Rawan S. Alsugair
- From the College of Medicine (Algadi, Alshathri, Alsugair, Alyabis), Almaarefa University, from the Department of Otolaryngology - Head and Neck Surgery (Alsaleh), College of Medicine, King Saud University, and from Medical Referrals Center (Aljerian), Ministry of Health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Mohrah A. Alyabis
- From the College of Medicine (Algadi, Alshathri, Alsugair, Alyabis), Almaarefa University, from the Department of Otolaryngology - Head and Neck Surgery (Alsaleh), College of Medicine, King Saud University, and from Medical Referrals Center (Aljerian), Ministry of Health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Saad A. Alsaleh
- From the College of Medicine (Algadi, Alshathri, Alsugair, Alyabis), Almaarefa University, from the Department of Otolaryngology - Head and Neck Surgery (Alsaleh), College of Medicine, King Saud University, and from Medical Referrals Center (Aljerian), Ministry of Health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | - Nawfal A. Aljerian
- From the College of Medicine (Algadi, Alshathri, Alsugair, Alyabis), Almaarefa University, from the Department of Otolaryngology - Head and Neck Surgery (Alsaleh), College of Medicine, King Saud University, and from Medical Referrals Center (Aljerian), Ministry of Health, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
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Guňka I, Krajíčková D, Leško M, Jiška S, Hudák A, Šimůnek L, Raupach J. Efficacy and safety of urgent carotid endarterectomy in patients with acute ischemic stroke. Rozhl Chir 2022; 101:388-394. [PMID: 36208934 DOI: 10.33699/pis.2022.101.7.388-394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Acute symptomatic occlusion of the internal carotid artery (ICA) is associated with unfavorable prognosis. However, no clear definition of its optimal treatment exists. The aim of this study was to evaluate the efficacy and risks of urgent carotid endarterectomy (CEA) in patients with ischemic stroke due to acute extracranial ICA occlusion. METHODS A retrospective analysis was performed of all consecutive patients undergoing urgent CEA for acute extracranial ICA occlusion during the period from July 2014 to June 2021. The primary outcome was functional independence at three months defined as modified Rankin Scale (mRS) score 2. Secondary outcomes included the severity of the neurological deficit at the time of discharge and its comparison with the preoperative condition as assessed using the National Institutes of Health Stroke Scale (NIHSS), the incidence of symptomatic intracerebral hemorrhage (ICH), and 30-day periprocedural mortality. RESULTS During the study period, a total of 42 urgent CEAs were performed for acute extracranial ICA occlusions. The median preoperative NIHSS score was 7 (interquartile range [IQR] 5-13). The median time interval between the onset of symptoms and surgery was 290 minutes (IQR 235-340). Technical success rate of urgent CEA was 97.6% (41 patients). The median NIHSS at the time of hospital discharge was 2 (IQR 3-7; p.
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Mastrorilli D, Mezzetto L, D'Oria M, Fiorini R, Lepidi S, Scorsone L, Veraldi E, Veraldi GF. NIHSS score at admission can predict functional outcomes in patients with ischemic stroke undergoing carotid endarterectomy. J Vasc Surg 2021; 75:1661-1669.e2. [PMID: 34954269 DOI: 10.1016/j.jvs.2021.11.079] [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: 09/17/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of present study was to evaluate the prognostic impact of National Institutes of Health Stroke Scale (NIHSS) score in patients undergoing acute CEA, and to assess clinical and morphological factors that could predict worse outcomes. METHODS The data of 183 consecutive patients who have undergone CEA after ischemic stroke was analyzed from January 2015 to January 2021. Patients were divided into two groups using the NIHSS cut off point of 4. Functional dependence was assessed on hospital discharge and 90 days after. RESULTS In total, 102 patients (55.7%) had a minor stroke (Group A: NIHSS ≤ 4), whereas 81 patients (44.3%) had a moderate-major stroke (Group B: NIHSS > 4). Group A and group B showed significant differences in their intracranial anatomic features: presence of incomplete Circle of Willis (7.8% vs 17.3%; p=.05), volume of Cerebral ischemic lesion volume ≥4000 mm3 (5.9 % vs 24.7%; p=<.001), and high ASPECTS of 8 to 10 (75.5% vs 44.4%; p=<.001). The overall rate of combined perioperative stroke/myocardial infarction/death was 1.1%, with no strokes recorded during the waiting time to carotid endarterectomy (CEA). Patients in group A had a lower rate of functional dependence at discharge (4.9% vs. 35.8%; p = <.001) and at 90 days after index stroke event (2.5% vs. 19.6%; p = <.001) versus those in group B. Using multivariate binary logistic regression, admission NIHSS>4 was significantly associated with higher odds of functional dependence at discharge (OR= 7.9, 95%CI= 2.7-18.5, p = <.001) and at 90 days (OR= 10.4, 95%CI= 2.7-19.3, p = .002). CONCLUSIONS NIHSS>4 at admission will increase the risk of having higher mRS scores both at hospital discharge and at 90 days after index stroke event. acute CEA was safe and feasible in patients with ischemic stroke, even if they had previously undergone intravenous thrombolysis.
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Affiliation(s)
- Davide Mastrorilli
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy.
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, Cattinara University Hospital ASUGI, Trieste, Italy
| | - Roberta Fiorini
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Sandro Lepidi
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, Cattinara University Hospital ASUGI, Trieste, Italy
| | - Lorenzo Scorsone
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Edoardo Veraldi
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
| | - Gian Franco Veraldi
- Department of Vascular Surgery, University Hospital of Verona, University of Verona-School of Medicine, Verona, Italy
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10
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Abstract
In response to the nationwide lockdown on 23 March 2020 in the UK, urgent dental hubs (UDHs) were established in the community to provide emergency dental care.Consecutive referrals to a primary care UDH were prospectively analysed over a one-month period, from 18 May 2020 to 18 June 2020.Of 400 referrals received, the most common were in relation to pain (87%). In 63% neither a radiograph nor photograph was provided with the referral. Seventy percent of patients were telephone triaged within 24 hours of receipt of referral. Fifty-three percent of referrals were accepted for face-to-face treatment, of which 69% were treated by extraction. Of rejected referrals (n=179; 45%), 79% were due to symptoms having settled or being manageable by the time of triage. A small number of referrals were redirected for specialist care. Referrals that were accepted were more likely to have been prescribed antibiotics and less likely to have been referred by the general dental practitioner (GDP) they regularly saw (p <0.01).Patients that were older and those that identified themselves as not having a regular GDP were less likely to have been referred to an UDH. The quality of referrals was poor and there may be a role for virtual consultations moving forwards. We found pre-referral antimicrobial prescriptions were high and a confused public health message may have been sent.
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Affiliation(s)
- Zohaib Khwaja
- Postgraduate Tutor, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London
- GDP, Maidstone Dental & Implant Centre, Kent, UK
| | - Awais Ali
- GDP, Maidstone Dental & Implant Centre, Kent, UK
| | - Manraj Rai
- GDP, Maidstone Dental & Implant Centre, Kent, UK
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11
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Bernstein P, Ko KJ, Israni J, Cronin AO, Kurliand MM, Shi JM, Chung J, Borgo L, Reed A, Kosten L, Chang AM, Sites FD, Funahashi T, Agha Z. Urgent and non-emergent telehealth care for seniors: Findings from a multi-site impact study. J Telemed Telecare 2021:1357633X211004321. [PMID: 33866894 PMCID: PMC10394951 DOI: 10.1177/1357633x211004321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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
INTRODUCTION The global pandemic has raised awareness of the need for alternative ways to deliver care, notably telehealth. Prior to this study, research has been mixed on its effectiveness and impact on downstream utilization, especially for seniors. Our multi-institution study of more than 300,000 telehealth visits for seniors evaluates the clinical outcomes and healthcare utilization for urgent and non-emergent symptoms. METHODS We conducted a retrospective cohort study from November 2015 to March 2019, leveraging different models of telehealth from three health systems, comparing them to in-person visits for urgent and non-emergent needs of seniors based on International Classification of Diseases, 10th edition diagnoses. The study population was adults aged 60 years or older who had access to telehealth and were affiliated with and resided in the geographic region of the healthcare organization providing telehealth. The primary outcomes of interest were visit resolution and episodes of care for those that required follow-up. RESULTS In total, 313,516 telehealth visits were analysed across three healthcare organizations. Telehealth encounters were successful in resolving urgent and non-emergent needs in 84.0-86.7% of cases. When visits required follow-up, over 95% were resolved in less than three visits for both telehealth and in-person cohorts. DISCUSSION While in-person visits have traditionally been the gold standard, our results suggest that when deployed within the confines of a patient's existing primary care and health system provider, telehealth can be an effective alternative to in-person care for urgent and non-emergent needs of seniors without increasing downstream utilization.
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Affiliation(s)
| | - Kelly J Ko
- West Health Institute, La Jolla, CA, USA
| | | | | | | | - Jiaxiao M Shi
- Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
| | - Joanie Chung
- Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
| | - Lina Borgo
- Innovation Studio, Kaiser Permanente, Tustin, CA, USA
| | | | | | | | | | | | - Zia Agha
- West Health Institute, La Jolla, CA, USA
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12
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Kosumi K, Mima K, Morito A, Yumoto S, Matsumoto T, Inoue M, Mizumoto T, Kubota T, Miyanari N, Baba H. Patient Age and Long-term Survival in Colorectal Cancer Patients Who Undergo Emergency Surgery. Anticancer Res 2021; 41:1069-1076. [PMID: 33517317 DOI: 10.21873/anticanres.14864] [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: 12/22/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Emergency surgery for colorectal cancer (CRC) is a high-risk procedure with high morbidity and mortality rates, especially for older patients. The relationship between patient age status and long-term outcomes is unclear. We hypothesize that patient age might be associated with long-term outcomes in patients with CRC who undergo emergency surgery. PATIENTS AND METHODS Utilizing a database of CRC patients who received emergency surgery, we examined the prognostic association of patient age. RESULTS The ≥80-years group was significantly associated with American Society of Anesthesiologists (ASA) physical status, bowel obstruction, N stage, shorter operating time, and less adjuvant chemotherapy (all p<0.03); and also, with shorter recurrence-free survival [multivariable hazard ratio, 2.79; 95% confidence interval, 1.13-7.21; p=0.026]. ASA status and adjuvant chemotherapy were significantly associated with recurrence-free survival (all p<0.03). CONCLUSION Advanced age is associated with shorter recurrence-free survival in CRC patients who undergo emergency surgery.
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Affiliation(s)
- Keisuke Kosumi
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan; .,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kosuke Mima
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Atsushi Morito
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Shinsei Yumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Takashi Matsumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Mitsuhiro Inoue
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Takao Mizumoto
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Tatsuo Kubota
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Nobutomo Miyanari
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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13
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Jimenez MLC, Manzanera R, Carascal MB, Figueras MD, Wong JQ, Moya D, Mira JJ. Factors affecting the non- urgent consultations in the emergency department of a tertiary hospital in the Philippines: A cross-sectional study. Emerg Med Australas 2021; 33:349-356. [PMID: 33470060 DOI: 10.1111/1742-6723.13725] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The non-standard emergency medicine services and the limited utilisation of primary care providers in the Philippines may contribute towards the ED being a preferred area for patients with non-urgent conditions. Our study aims to determine the factors associated with non-urgent consultations in the ED of a tertiary hospital in the Philippines. METHODS From 7 January to 15 February 2020, we surveyed non-urgent ED patients (n = 757) presenting to a tertiary hospital in the Philippines. We evaluated the data using descriptive statistics, while chi-squared and multivariate analyses versus urgent ED patients (n = 281) were used to show the association of factors. RESULTS Our recruited non-urgent patients were mostly 21-40 years old (n = 576 [76%]), single (n = 437 [58%]), with full-time employment (n = 654 [86%]), have Health Maintenance Organization coverage (n = 684 [90%]), self-referred (n = 498 [66%]), and have private means of getting to ED (n = 414 [55%]). They had moderate scores of social support-seeking behaviours (mean 3.92/5; 95% confidence interval [CI] 3.88-3.96), health literacy (mean 3.58/5; 95% CI 3.56-3.61), self-efficacy (mean 3.09/5; 95% CI 3.56-3.61), whereas their ED access score (mean 4.10/5; 95% CI 4.06-4.14) was high. They had moderate self-assessed severity (mean 3.75/6; 95% CI 3.70-3.80), urgency (mean 3.83/6; 95% CI 3.78-3.88), and anxiety (mean 3.88/6; 95% CI 3.83-3.93) scores and high ED satisfaction rating (mean 4.73/6; 95% CI 4.69-4.77). They mostly had digestive (n = 203 [26.8%]) and infection-related (n = 172 [22.7%]) chief complaints and final diagnoses (n = 198 [26.2%] and n = 145 [19.2%], respectively), without previous consultations (n = 577 [76%]), and eventually discharged (n = 755 [99%]). Our urgent patients had similar characteristics, but with higher assessed patient severity, urgency, anxiety and satisfaction with ED services (P < 0.001). CONCLUSION Non-urgent consultations in ED are attributed to multiple factors encompassing socio-demographic, socio-economic and psychosocial dimensions. These factors must be considered in improving the current healthcare management system for the appropriate utilisation of ED in the Philippines.
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Affiliation(s)
- Ma Lourdes Cd Jimenez
- Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Pasig City, Philippines.,Department of Emergency Medicine, The Medical City, Pasig City, Philippines
| | | | - Mark B Carascal
- Department of Emergency Medicine, The Medical City, Pasig City, Philippines.,Institute of Biology, University of the Philippines Diliman, Quezon City, Philippines
| | - Marlouie Dl Figueras
- Department of Emergency Medicine, The Medical City, Pasig City, Philippines.,College of Nursing, Trinity University of Asia, Quezon City, Philippines
| | - John Q Wong
- Ateneo Center for Research and Innovation, Ateneo School of Medicine and Public Health, Pasig City, Philippines
| | - Diego Moya
- Health and Economic Benefits Area, MC Mutual, Barcelona, Spain
| | - Jose J Mira
- Health Psychology Department, Universidad Miguel Hernández, Elche, Spain.,Alicante-Sant Joan Health District, Alicante, Spain
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14
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Bernstein P, Ko KJ, Israni J, Cronin AO, Kurliand MM, Shi JM, Chung J, Borgo L, Reed A, Kosten L, Chang AM, Sites FD, Funahashi T, Agha Z. WITHDRAWN: Urgent and non-emergent telehealth care for seniors: Findings from a multi-site impact study. J Telemed Telecare 2021:1357633X20985389. [PMID: 33461400 DOI: 10.1177/1357633x20985389] [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: 11/16/2022]
Abstract
Ahead of Print article withdrawn by publisher.
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Affiliation(s)
| | - Kelly J Ko
- West Health Institute, La Jolla, CA, USA
| | | | | | | | - Jiaxiao M Shi
- Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
| | - Joanie Chung
- Research and Evaluation, Kaiser Permanente, Pasadena, CA, USA
| | - Lina Borgo
- Innovation Studio, Kaiser Permanente, Tustin, CA, USA
| | | | | | | | | | | | - Zia Agha
- West Health Institute, La Jolla, CA, USA
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15
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Ziegler MA, Bauman JC, Welsh RJ, Wasvary HJ. Can the American College of Surgeons National Surgical Quality Improvement Program Risk Calculator Predict Outcomes for Urgent Colectomies? Am Surg 2020; 88:65-69. [PMID: 33345578 DOI: 10.1177/0003134820973392] [Citation(s) in RCA: 4] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Risk Calculator (RC) predicts postoperative outcomes using 19 risk factors, including operative acuity. Acuity is defined by the calculator as emergent or elective only. The objective of this study is to evaluate the RC's accuracy in urgent (nonelective/nonemergent) cases. METHODS This is a retrospective review of the NSQIP data for patients who underwent urgent colectomies at a single tertiary care center over a 4-year period. Each urgent case was entered into the RC as both elective and emergent, and predicted outcomes were compared to actual postoperative outcomes. Receiver operating characteristic (ROC) curves were used when sufficient statistical power was present and the area under the curve (AUC) was calculated. RESULTS A total of 301 urgent colectomy patients were evaluated, representing 19% of all colectomies performed at our institution during the study period. Of the 15 possible postoperative outcomes, the RC showed high predictive value only for mortality (AUC elective .8467; emergent .8451) and discharge to a nursing/rehabilitation facility (AUC elective .8089; emergent .8105). The RC showed no predictive value for 6 outcomes and the remainder lacked statistical power to draw conclusions. DISCUSSION While the calculator predicted mortality and discharge to a nursing/rehabilitation facility, it did not accurately predict complications for urgent colectomies. Future versions of the calculator should focus on improving the predictive value by including urgent cases as a separate category.
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Affiliation(s)
- Matthew A Ziegler
- Department of Colon and Rectal Surgery, 21818William Beaumont Hospital, USA
| | - John C Bauman
- Department of Colon and Rectal Surgery, 21818William Beaumont Hospital, USA
| | - Robert J Welsh
- Department of Surgery, 21818William Beaumont Hospital, USA
| | - Harry J Wasvary
- Department of Colon and Rectal Surgery, 21818William Beaumont Hospital, USA
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Chen K, Polcari K, Michiko T, Pino JE, Rothenberg M, Faber C, Nores M, Stamou S, Ghumman W, Chait R. Outcomes of Urgent Transcatheter Aortic Valve Replacement in Patients With Acute Decompensated Heart Failure: A Single-Center Experience. Cureus 2020; 12:e10425. [PMID: 33062539 PMCID: PMC7556195 DOI: 10.7759/cureus.10425] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Data on urgent transcatheter aortic valve replacement (TAVR) as rescue therapy for acute decompensated heart failure (ADHF) due to severe aortic stenosis (AS) are limited. We sought to investigate the outcomes of patients who underwent urgent transcatheter aortic valve replacement (TAVR) in a single institution. Methods This is a retrospective cohort study of 602 patients with a history of heart failure (HF) due to AS who underwent TAVR between April 2012 and July 2017. We stratified patient cohort into urgent (n=139) and elective (n=463) TAVR. Urgent TAVR was defined as patients who were admitted for ADHF and underwent TAVR during the same hospitalization. Patients that underwent urgent TAVR for other reasons were excluded. Results Rates of postoperative intra-aortic balloon pump requirement, atrial fibrillation, dialysis requirement, vascular complications, and stroke were similar between the two groups. Compared with elective TAVR, patients undergoing urgent TAVR had a higher rate of cardiac arrest (5.7% vs 1.3%, p=0.005), longer length of stay (LOS) (11 vs. 5, p<0.001), and significant 30-day mortality (8.6% vs 4.1%, HR 2.1, 95% CI 1.04-4.22). Patients who underwent urgent TAVR were also associated with long-term mortality (Log-rank p = 0.0162). Conclusions In our study, urgent TAVR for ADHF was associated with both short-term and long-term mortality as compared to elective TAVR. Further randomized studies are needed to investigate the appropriate management of this population.
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Affiliation(s)
- Kai Chen
- Internal Medicine, University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, USA
| | - Kayla Polcari
- Internal Medicine, University of Miami Miller School of Medicine, Atlantis, USA
| | - Taylor Michiko
- Internal Medicine, University of Miami Miller School of Medicine, Atlantis, USA
| | - Jesus E Pino
- Cardiovascular Medicine, University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, USA
| | - Mark Rothenberg
- Cardiothoracic Surgery, John F. Kennedy (JFK) Medical Center, Atlantis, USA
| | - Cristiano Faber
- Cardiothoracic Surgery, John F. Kennedy (JFK) Medical Center, Atlantis, USA
| | - Marcos Nores
- Cardiothoracic Surgery, John F. Kennedy (JFK) Medical Center, Atlantis, USA
| | - Sotiris Stamou
- Cardiothoracic Surgery, John F. Kennedy (JFK) Medical Center, Atlantis, USA
| | - Waqa Ghumman
- Cardiovascular Medicine, University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, USA
| | - Robert Chait
- Cardiovascular Medicine, University of Miami/John F. Kennedy (JFK) Medical Center, Atlantis, USA
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17
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Somani BK, Pietropaolo A, Coulter P, Smith J. Delivery of urological services (telemedicine and urgent surgery) during COVID-19 lockdown: experience and lessons learnt from a university hospital in United Kingdom. Scott Med J 2020; 65:109-111. [PMID: 32819219 PMCID: PMC8685567 DOI: 10.1177/0036933020951932] [Citation(s) in RCA: 14] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and aims Our departmental planning for COVID-19 was actioned a week before the lockdown (13th March 2020). We look at a 7- week lockdown activity for all scheduled outpatient clinics and urgent procedures. Methods and results A total of 2361 outpatient clinic slots (52.6% oncology slots and 47.4% benign urology slots) were scheduled during this period. The oncology slots included 330 (26.5%) flexible cystoscopy, 555 (44.7%) prostate cancer and 357(28.8%) non-prostate cancer slots. The benign urology slots included 323 (28.8%) andrology, 193 (17.2%) stones and 603 (54%) lower urinary tract symptoms (LUTS) slots. Of the total oncology outpatient slots (n = 1242), 66.3% were virtual consultations, 20% were face-to-face and 13.6% were cancelled. Of the total benign outpatient slots (n = 1119), 81% were virtual consultations, 9.7% were face-to-face and 9.3% were cancelled. A total of 116 anaesthetic surgical procedures were carried out, of which 54 (46.5%) were oncological procedures, 18 (15.5%) were benign urological procedures, and 44 (38%) were diagnostic procedures. Conclusions Hospitals and urologists can benefit from the model used by our hospital to mitigate the impact and prioritise patients most in need of urgent care. Reorganisation and flexibility of healthcare delivery is paramount in these troubled times and will allow clinical activity without compromising patient safety.
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Affiliation(s)
- Bhaskar K Somani
- Professor and Consultant Urological Surgeon, Department of Urology, University Hospital Southampton, UK
| | - Amelia Pietropaolo
- Associate Specialist in Endourology, University Hospital Southampton, UK
| | - Primrose Coulter
- Staff, Patient Service Centre, University Hospital Southampton, UK
| | - Julian Smith
- Clinical Lead and Consultant Urological Surgeon, Department of Urology, University Hospital Southampton, UK
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Abstract
BACKGROUND Radical changes to clinical and endoscopy practice have been rapidly introduced following the spread of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). Urgent endoscopies are, however, intended to proceed as normal with additional personal protective procedures. A perceived reduction in hospital attendances may suggest a number of urgently indicated endoscopic retrograde cholangio-pancreatographies (ERCPs) are being missed. Objectives and Methods: A review of all ERCPs carried out in a large tertiary referral endoscopy unit under healthcare restrictions was compared to the same time period in previous years. The intention was to determine if ERCPs are proceeding as normal or if there is a difference in referral characteristics. RESULTS Under service restrictions (13 March to the end of April 2020), 55 ERCPs were performed compared with 87 ERCPs in 2019. Similar numbers to 2019 were also recorded in the preceding years. One case of coronavirus disease 2019 (COVID-19) was reported in a patient in the days following ERCP, with no cases notified among staff related to endoscopy. CONCLUSIONS A reduction in ERCP referrals raises concern that a cohort of patients with significant biliary disease remain undetected. Whether this results in later, and more severe, presentation remains to be seen but a potential surge in such cases could significantly burden all future endoscopy planning services.
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Affiliation(s)
- John O'Grady
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Padraic MacMathuna
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stephen Stewart
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - T Barry Kelleher
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin, Ireland
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19
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Mirzai S, Saleh S, Balkhy HH, Shah AP, Jeevanandam V, Blair JEA. Urgent Open Atrial Transcatheter Mitral Valve Replacement as Bailout for Planned Surgery. JACC Case Rep 2020; 2:1115-1119. [PMID: 34317429 PMCID: PMC8311715 DOI: 10.1016/j.jaccas.2020.05.054] [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] [Received: 03/12/2020] [Revised: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 11/07/2022]
Abstract
Hybrid transcatheter mitral valve replacement (TMVR) has shown great promise for patients with severe mitral annular calcification. However, there have been limited reports of its use as a bailout for planned surgical MVR. Here, we present a bailout TMVR with an excellent patient outcome. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Saeid Mirzai
- Alabama College of Osteopathic Medicine, Dothan, Alabama
| | - Saleh Saleh
- Jordan University of Science and Technology, Irbid, Jordan
| | - Husam H Balkhy
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - Atman P Shah
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Valluvan Jeevanandam
- Section of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, Illinois
| | - John E A Blair
- Section of Cardiology, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
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20
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Kelahmetoglu O, Camlı MF, Kirazoglu A, Erbayat Y, Asgarzade S, Durgun U, Mehdizade T, Yeniocak A, Yildiz K, Sonmez Ergun S, Guneren E. Recommendations for management of diabetic foot ulcers during COVID-19 outbreak. Int Wound J 2020; 17:1424-1427. [PMID: 32501604 PMCID: PMC7300987 DOI: 10.1111/iwj.13416] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Received: 04/15/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/25/2022] Open
Abstract
COVID‐19 pandemia began in Wuhan, China, in December 2019. A total of 1 878 489 people were infected and 119 044 people were lost because of the disease and its complications by 15 April. Severe morbidity and mortality complications are mostly seen in elderly and patients having comorbidities. Diabetic foot ulcers (DFUs) are one of severe complications of diabetes mellitus and it may require urgent surgical interventions. In this paper, we aimed to create a management algorithm to prevent the unexpected complications that may occur in the patients and health care workers during the evaluation of COVID‐19 in DFU patients who require urgent surgical intervention. We advise the use of thorax computerised tomography for preoperative screening in all DFU patients with severe signs of infection and especially those requiring urgent surgery for both the detection of the possible undiagnosed COVID‐19 in the patient for the need for close follow‐up and protection of the surgical and anaesthesiology team.
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Affiliation(s)
- Osman Kelahmetoglu
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Fatih Camlı
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Kirazoglu
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Yusuf Erbayat
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Susan Asgarzade
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Ufuk Durgun
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Turan Mehdizade
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Ali Yeniocak
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Kemalettin Yildiz
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Selma Sonmez Ergun
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Ethem Guneren
- Department of Plastic Surgery, Bezmialem Vakif University, Istanbul, Turkey
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Tang A, Thuita L, Siddiqui HU, Rappaport J, Blackstone EH, McCurry KR, Ahmad U. Urgently listed lung transplant patients have outcomes similar to those of electively listed patients. J Thorac Cardiovasc Surg 2020; 161:S0022-5223(20)30997-1. [PMID: 32622567 DOI: 10.1016/j.jtcvs.2020.02.140] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 01/30/2020] [Accepted: 02/14/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To (1) determine outcomes after urgent listing compared with elective listing for lung transplant and (2) compare in-hospital morbidity and mortality, survival, and allograft function in these 2 groups. METHODS From January 2006 to September 2017, 201 patients were urgently and 1423 electively listed. Among urgently listed patients, 130 subsequently underwent primary lung transplant as did 995 electively listed patients. Competing-risks analysis for death and transplant after listing and weighted balancing score matching (76 pairs) were used to compare in-hospital morbidity and survival. Mixed-effect longitudinal modeling was used to compare allograft function to 8 years post-transplant. RESULTS At 1 month, mortality was 26% in urgently listed patients, and 58% were transplanted. Risk factors for death included older age, higher bilirubin, and transfer from an outside hospital. At transplantation, urgently listed transplant patients were younger (53 ± 13 vs 55 ± 12 years), had more ventilator and extracorporeal membrane oxygenation support (32/25% vs 20/2.0%), more restrictive lung disease (95/73% vs 509/51%), and a higher lung allocation score (82 ± 13 vs 47 ± 17). In-hospital morbidity and mortality, time-related survival, and longitudinal allograft function were similar between matched groups. CONCLUSIONS Urgent listing more often than not leads to transplantation. Although urgently listed patients are sicker overall, after transplant their perioperative morbidity and mortality, overall survival, and allograft function are similar to those of electively listed patients. Appropriate patient selection and aggressive supportive care allow urgently listed lung transplant patients to achieve these similar post-transplant outcomes.
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Affiliation(s)
- Andrew Tang
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lucy Thuita
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hafiz Umair Siddiqui
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jesse Rappaport
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth R McCurry
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Transplant Institute, Cleveland Clinic, Cleveland, Ohio; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Usman Ahmad
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Transplant Institute, Cleveland Clinic, Cleveland, Ohio; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
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Mosli M, Aldabbagh A, Aseeri H, Alqusair S, Jawa H, Alsahafi M, Qari Y. The diagnostic yield of urgent colonoscopy in acute lower gastrointestinal bleeding. Acta Gastroenterol Belg 2020; 83:265-270. [PMID: 32603045] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND AIMS Lower Gastrointestinal Bleeding (LGIB) is one of the leading causes of ER visits. Colonoscopy is indicated in all patients with LGIB, yet the time frame for performing colonoscopy remains unclear. Whether or not urgent endoscopic evaluation improves outcomes of LGIB has been questioned. We therefore aimed to examine the success of urgent colonoscopy in identifying the source of LGIB. PATIENTS AND METHODS A retrospective study was conducted in which timing of colonoscopy was divided into urgent (performed within the first 24 hours of presentation) and delayed (performed following 24 hours of hospitalization). Data on clinical presentation, investigations and endoscopic findings was collected. Risk ratios were calculated and regression analysis was used to examine associations and identify predictors of endoscopic success. RESULT A total of 183 patients underwent colonoscopies. 55.4% of colonoscopies were performed within 24 hours of presentation. A source of LGIB was identified in 55.7% of first attempt colonoscopies. Endoscopic intervention was required in 10.9% of cases and rebleeding occurred in 24.6%, of which 6.5% required hospital re-admission. 2.7% required emergency colectomy and the calculated mortality rate was 1%. Risk ratios comparing urgent to delayed colonoscopy for source of LGIB identification, colectomy and mortality were 1.01, 4.8 and 1.2, respectively. Age and timing of colonoscopy appeared to be predictive of colectomy on regression analysis. CONCLUSIONS Urgent colonoscopy for LGIB did not improve the rate of identification of the source of bleeding, colectomy rate or mortality rate and was predictive of the need for emergency colectomy.
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Affiliation(s)
- M Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - A Aldabbagh
- Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - H Aseeri
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - S Alqusair
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - H Jawa
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - M Alsahafi
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Y Qari
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Elbadawi A, Elgendy IY, Mentias A, Saad M, Mohamed AH, Choudhry MW, Ogunbayo GO, Gilani S, Jneid H. Outcomes of urgent versus nonurgent transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 96:189-195. [PMID: 31647180 DOI: 10.1002/ccd.28563] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 10/13/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a paucity of data regarding the outcomes of transcatheter valve replacement (TAVR) performed in an urgent clinical setting. METHODS The Nationwide Inpatient Sample (NIS) database years 2011-2014 was used to identify hospitalizations for TAVR in the urgent setting. Using propensity score matching, we compared patients who underwent TAVR in nonurgent versus urgent settings. RESULTS Among 42,154 hospitalizations in which TAVR was performed, 10,114 (24%) underwent urgent TAVR. There was an uptrend in the rate of urgent TAVR procedures (p = .001). The rates of in-hospital mortality among this group did not change during the study period (p = .713). Nonurgent TAVR was associated with lower mortality (odds ratio [OR] = 0.78; 95% confidence interval [CI]: 0.69-0.89, p < .001) compared with urgent TAVR. Nonurgent TAVR was associated with lower incidence of cardiogenic shock (OR = 0.46; 95%CI: 0.40-0.53 p < .001), use of mechanical circulatory support devices (OR = 0.69; 95%CI: 0.59-0.82, p < .001), AKI (OR = 0.60; 95%CI: 0.56-0.64 p < .001), hemodialysis (OR = 0.67; 95%CI: 0.56-0.80 p < .001), major bleeding (OR = 0.94; 95%CI: 0.89-0.99 p = .045) and shorter length of stay (7.08 ± 6.317 vs. 12.39 ± 9.737 days, p < .001). There was no difference in acute stroke (OR = 0.96; 95%CI: 0.81-1.14, p = .636), vascular complications (OR = 1.07; 95%CI: 0.89-1.29, p = .492), and pacemaker insertions (OR = 0.92; 95%CI: 0.84-1.01, p = .067) between both groups. Among those undergoing urgent TAVR, subgroup analysis showed higher mortality in patients ≤80 years (p = .033), women (p < .001), chronic kidney disease (p = .001), heart failure (p < .001), and liver disease (p = .003). CONCLUSION In this large nationwide analysis, almost a quarter of TAVR procedures were performed in the urgent settings. Although urgent TAVR was associated with higher mortality and increased complications compared with nonurgent TAVR, the absolute difference in in-hospital mortality was not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Amgad Mentias
- Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa
| | - Marwan Saad
- Cardiovascular Institute, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | | | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Syed Gilani
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor School of Medicine, Houston, Texas
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24
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Antony P, Harnoss JC, Warschkow R, Schmied BM, Schneider M, Tarantino I, Ulrich A. Urgent surgery in colon cancer has no impact on survival. J Surg Oncol 2019; 119:1170-1178. [PMID: 30977910 DOI: 10.1002/jso.25469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 01/21/2019] [Revised: 03/13/2019] [Accepted: 03/26/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite advances in early detection of colon cancer, a minority of patients still require urgent surgery. Whether such urgent conditions result in poor outcome remains a topic of debate. METHODS Using a prospectively maintained database, patients suffering exclusively from colon cancer and receiving either elective or emergent resection between 2001 and 2014 were analyzed with respect to overall, disease-specific, and relative survival using Cox regression and propensity score analyses. RESULTS From a total of 877 patients analyzed, 2.7% (24) presented with complications requiring urgent surgery. Propensity-scoring identified strongly biased patient characteristics (0.097 ± 0.069 vs 0.028 ± 0.043; P < 0.001). An unadjusted Cox proportional hazards regression analysis revealed urgent surgery as a statistically significant prognostic factor with an approximately 207% increased risk of mortality (hazard ratio [HR] = 3.07; 95% confidence interval [CI]: 1.62-5.81; P = 0.003). After adjusting the data according to the propensity score analysis, urgent surgery was not associated with a decreased overall (HR = 1.67; 95%CI; 0.84-3.36; P = 0.174), disease-specific (HR = 1.62; 95% CI; 0.81-3.24; P = 0.201) or relative survival (HR = 1.86; 95% CI: 0.92-3.79; P = 0.086). CONCLUSIONS After risk-adjustment, using multivariable Cox regression and propensity score analyses, no significant disadvantage could be noted with regard to overall, disease-specific, or relative survival in patients with exclusively colon cancer who received emergent oncological resection.
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Affiliation(s)
- Pia Antony
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Julian C Harnoss
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Rene Warschkow
- Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, Switzerland.,Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Bruno M Schmied
- Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, Switzerland
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ignazio Tarantino
- Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, Switzerland
| | - Alexis Ulrich
- Department of Surgery, Lukas Hospital, Neuss, Germany
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Abstract
Enhanced Recovery after Surgery (ERAS) pathways have become popular in colorectal surgery due to their associated decrease in length of stay (LOS), complications, and readmission rate. However, it is unclear if these pathways are safe, feasible, or effective in unique patient populations such as elderly patients, urgent/emergent surgeries, patients with specific comorbidities, inflammatory bowel disease, or pediatric patients. Enhanced recovery pathways appear safe in elderly patients, associated with decreased complications, though with slightly lower rates of adherence and increased LOS and readmission rates. Modified ERAS pathways have been applied to urgent and emergent surgeries, resulting in decreased morbidity and LOS. There have been no studies that performed subgroup analyses of ERAS pathways in patients with specific comorbidities. Studies investigating patients with inflammatory bowel disease on enhanced recovery pathways are extremely limited, but suggest that they are safe and feasible. Data on ERAS pathways in pediatric patients are still emerging. Therefore, though data are sparse, enhanced recovery pathways appear to be safe in unique patient populations, with similar efficacy in decreasing LOS and complications. There is an urgent need for more studies investigating these specific patient groups to aid perioperative decision making by colorectal surgeons.
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Affiliation(s)
- Grace C Lee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard A Hodin
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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26
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Roussopoulou A, Tsivgoulis G, Krogias C, Lazaris A, Moulakakis K, Georgiadis GS, Mikulik R, Kakisis JD, Zompola C, Faissner S, Chondrogianni M, Liantinioti C, Hummel T, Safouris A, Matsota P, Voumvourakis K, Lazarides M, Geroulakos G, Vasdekis SN. Safety of urgent endarterectomy in acute non-disabling stroke patients with symptomatic carotid artery stenosis: an international multicenter study. Eur J Neurol 2018; 26:673-679. [PMID: 30472766 DOI: 10.1111/ene.13876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2 weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2 days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0-2 days) in comparison to early (3-14 days) CEA in patients with sCAS. METHODS Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70%) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. RESULTS A total of 311 patients with sCAS underwent urgent (n = 63) or early (n = 248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21% in urgent vs. 7% in early CEA; P = 0.001). The 30-day rates of stroke did not differ (P = 0.333) between patients with urgent (7.9%; 95% confidence interval 3.1%-17.7%) and early (4.4%; 95% confidence interval 2.4%-7.9%) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6 days (interquartile range 4-6) vs. 10 days (interquartile range 7-14); P < 0.001]. CONCLUSIONS Our findings highlight that urgent CEA performed within 2 days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets.
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Affiliation(s)
- A Roussopoulou
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - G Tsivgoulis
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - C Krogias
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - A Lazaris
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - K Moulakakis
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - G S Georgiadis
- Department of Vascular Surgery, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - R Mikulik
- Department of Neurology, St Anne's University Hospital in Brno and Masaryk University, Brno, Czech Republic
| | - J D Kakisis
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - C Zompola
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - S Faissner
- Department of Neurology, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - M Chondrogianni
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - C Liantinioti
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - T Hummel
- Department of Vascular Surgery, St Josef-Hospital, Ruhr University, Bochum, Germany
| | - A Safouris
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece.,Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece
| | - P Matsota
- Second Department of Anaesthesiology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - K Voumvourakis
- Second Department of Neurology, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - M Lazarides
- Department of Vascular Surgery, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - G Geroulakos
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
| | - S N Vasdekis
- Department of Vascular Surgery, School of Medicine, 'Attikon' Hospital, University of Athens, Athens, Greece
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27
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Panocchia N, Tazza L, Di Stasio E, Liberatori M, Vulpio C, Giungi S, Lucani G, Antocicco M, Bossola M. Mortality in hospitalized chronic kidney disease patients starting unplanned urgent haemodialysis. Nephrology (Carlton) 2016; 21:62-7. [PMID: 26173588 DOI: 10.1111/nep.12561] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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: 07/07/2015] [Indexed: 11/26/2022]
Abstract
AIM Data on the outcome of chronic kidney disease (CKD) patients who are hospitalized and start unplanned urgent haemodialysis (HD) are lacking. This prospective, longitudinal, observational study aimed to define the hospital mortality rate and associated factors in CKD patients who start unplanned urgent HD. METHODS Between January 2003 and December 2009, all patients with CKD who were hospitalized, diagnosed with ESRD and started unplanned urgent haemodialysis at Haemodialysis Service of the Catholic University of Rome, Italy were recruited. Exclusion criteria were: acute renal failure, prior history of dialysis, multiple organ failure, coma, and dementia. Hospital mortality rate was the primary outcome. RESULTS Three and hundred sixteen patients were studied: 99 died after 19.5 ± 27.3 days and 217 survived until discharge. Of these, 154 were prescribed chronic HD and 63 restored renal function. Patients who died were significantly older and had a higher Charlson Comorbidity Index score. The mortality rates were 51.1% in patients with 81-90 years, 37.8% with 71-80 years, 34.1% with 61-70 years and 13.9% with age ≤60 years. Logistic regression analysis showed that age only was an independent risk factor for all-cause mortality. CONCLUSIONS In CKD patients who need hospitalization and start unplanned urgent haemodialysis the mortality is very high and significantly related to age.
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Affiliation(s)
- Nicola Panocchia
- Haemodialysis Service, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Tazza
- Haemodialysis Service, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Di Stasio
- Department of Biochemistry, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Liberatori
- Haemodialysis Service, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Vulpio
- Haemodialysis Service, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefania Giungi
- Haemodialysis Service, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanna Lucani
- Haemodialysis Service, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Manuela Antocicco
- Department of Geriatrics, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Bossola
- Haemodialysis Service, Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy
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Milana M, Santopaolo F, Lenci I, Francioso S, Baiocchi L. Results of a fast-track referral system for urgent outpatient hepatology visits. Int J Qual Health Care 2015; 27:132-6. [PMID: 25724880 DOI: 10.1093/intqhc/mzv011] [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: 01/22/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE In 2011, our regional district adopted an experimental system for fast referral (within 72 h) by general practitioners to several outpatient specialist evaluations including hepatology. The aim of this study was to assess the characteristics and appropriateness of urgent hepatology visits. DESIGN Retrospective study. SETTING Hospital-based study in Italy. PARTICIPANTS A total of 192 subjects referred to our outpatient hepatology clinic classified as 'urgent' were compared with 397 patients evaluated with standard referral. A comparison with 200 patients visited just before the adoption of the new system was also included. MAIN OUTCOME MEASURES Patients' features and appropriateness of referral in urgent and non-urgent groups using the new system. RESULTS Increase in liver enzymes was the main factor that leads to specialist hepatology consultation and was more frequent in the urgent group (37% vs. 27.1%, P < 0.001). Liver malignancies were identified in 2.6% of patients in the urgent group, whereas this percentage was 10 times lower in the non-urgent group (P = 0.01). Urgent patients required inpatient admission more frequently compared with non-urgent patients (4.2% vs. 0.5%; P = 0.003). Inappropriate referral was recorded in 41% of cases in the urgent group (no reason for urgency 27%; condition not attributable to liver 13.5%). In the non-urgent group, consultations were inappropriate in 20.1% of cases (condition not attributable to liver). In comparison with the old system, the new one allocated >85% of patients with serious illness to urgent group. CONCLUSIONS This strategy is helpful in selecting patients with more serious hepatic conditions. Appropriateness of referral represents a crucial issue.
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Affiliation(s)
- Martina Milana
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
| | - Francesco Santopaolo
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
| | - Simona Francioso
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
| | - Leonardo Baiocchi
- Hepatology Unit, Department of Medicine, University of 'Tor Vergata', Via Montpellier, 1-00133 Rome, Italy
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Naylor H, Woloschuk DMM, Fitch P, Miller S. Retrospective audit of medication order turnaround time after implementation of standardized definitions. Can J Hosp Pharm 2012; 64:346-53. [PMID: 22479087 DOI: 10.4212/cjhp.v64i5.1070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/10/2022]
Abstract
BACKGROUND Standardizing the interpretation of "stat", "emergent", "urgent", and "now" medication orders can improve patient safety. However, the effect of implementing standardized definitions on the turnaround time for medication orders in hospital pharmacy dispensaries has not been studied. OBJECTIVES To examine the effects of using formal definitions for "stat", "emergent", "urgent", and "now" on turnaround time for medication orders within a pharmacy dispensary. METHODS Definitions for "stat", "emergent", "urgent", and "now" orders, as well as for "turnaround time", were developed from the formal literature and the grey literature. The definitions were implemented by educating all pharmacy staff. Retrospective audits of turnaround time were conducted at baseline (for all orders over a 1-month period) and after implementation of the definitions (for a total of 28 days over a 3-month period). Health records and medication orders were used to calculate time from prescribing to administration (total turnaround time) and time from prescribing to departure from the dispensary (dispensary turnaround time). Differences between total and dispensary turnaround times were compared with nonparametric statistics. RESULTS During the baseline audit period, 84 (1.1%) of 7787 orders were identified as "stat", "emergent", "urgent", or "now". After implementation of the formal definitions, 142 (2.6%) of 5365 orders were identified by one of these terms. The percentage of orders meeting the target dispensary turnaround time of less than 15 min was at least 90% both at baseline (76/84 [90%]) and after implementation (129/142 [91%]) (p = 0.80). Median dispensary turnaround time for stat and emergent medication orders combined (10 versus 9 min, p = 0.27) and for urgent and now medication orders combined (10 versus 12 min, p = 0.09) did not change after implementation of formal definitions. Similarly, median total turnaround time did not change for stat and emergent medication orders combined (30 versus 45 min, p = 0.32), but it increased for urgent and now orders combined (35 versus 45 min, p = 0.041). CONCLUSIONS Implementing standardized definitions for "stat", "emergent", "urgent", and "now" had no significant effect on dispensary turnaround time. However, the majority of orders with these designations met the expected target for dispensary turnaround time. Further interventions aimed at other health care professionals may be needed to reduce total turnaround time. This research supports the concept of interdisciplinary interventions for reducing total turnaround time.
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Affiliation(s)
- Heather Naylor
- , BScPharm, ACPR, is with the Winnipeg Regional Health Authority Pharmacy Program, Seven Oaks General Hospital Site, Winnipeg, Manitoba
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30
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Abstract
Urgent treatment of gastrointestinal bleeding is multidisciplinary and often variable by institution. In general, medical management is the first-line therapy for both upper and lower gastrointestinal hemorrhage. In severe upper gastrointestinal hemorrhage, endoscopy is performed prior to other interventions as it is often both diagnostic and therapeutic. Embolization is performed for refractory arterial bleeding. Transjugular portosystemic shunt insertion may be performed to treat refractory variceal bleeding although its use at night is controversial. The treatment algorithm for lower gastrointestinal bleeding is less clear but in general, severe bleeding is handled in the interventional suite by superselective embolization and less severe bleeding is initially treated by endoscopy after an 8- to 12-hour bowel prep. This article will summarize the current approach in my hospital for treating patients with acute gastrointestinal hemorrhage.
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Affiliation(s)
- Brian Funaki
- Section of Vascular and Interventional Radiology, University of Chicago Hospitals, Chicago, Illinois
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