TY - JOUR AB - BACKGROUND: Major pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. The clinical characteristics and outcomes in major PE managed by a well-organized cardiac care regional urban network and hospitals have not been clarified and were examined in the present study. METHODS AND RESULTS: Data from the Tokyo CCU Network registered cohort in 2005-2006 were analyzed. Among 193 patients with major PE and known severities and outcomes, 42 patients had massive PE, defined as cardiogenic shock or cardiac arrest. The median time from symptom onset to CCU admission was 16.3 h. The in-hospital mortality of the 124 patients who received reperfusion therapy was lower than that of the 69 patients that did not receive reperfusion therapy (11.3% vs 18.8%; P=0.15). In multiple logistic regression analyses after adjusting for advanced age and sex, reperfusion therapy was selected as a significant predictor for in-hospital death (adjusted odds ratio, 0.34; 95%CI, 0.12-0.95; P=0.039), in addition to massive type (adjusted odds ratio, 14.02; 95%CI, 4.71-41.76; P<0.0001). CONCLUSIONS: Early transport and specific reperfusion therapy for major PE were effectively performed by the Tokyo CCU Network, suggesting the efficacy of a specialty management system for major PE. AN - 20019409 DA - Feb DO - 10.1253/circj.cj-09-0623 DP - NLM ET - 2009/12/19 J2 - Circulation journal : official journal of the Japanese Circulation Society KW - Aged Aged, 80 and over Ambulances/*organization & administration Cohort Studies Female Health Services Accessibility/*organization & administration Hospital Mortality Humans Kaplan-Meier Estimate Logistic Models Male Odds Ratio *Outcome and Process Assessment, Health Care Patient Admission Patient Care Team/organization & administration Program Evaluation Pulmonary Embolism/complications/mortality/*therapy Regional Health Planning/*organization & administration Registries *Reperfusion/adverse effects/mortality Risk Assessment Risk Factors Time Factors Tokyo/epidemiology Treatment Outcome Urban Health Services/*organization & administration LA - eng M1 - 2 N1 - 1347-4820 Tokyo CCU Network Scientific Committee Journal Article Japan Circ J. 2010 Feb;74(2):289-93. doi: 10.1253/circj.cj-09-0623. Epub 2009 Dec 18. PY - 2010 SN - 1346-9843 SP - 289-93 ST - Latest management and outcomes of major pulmonary embolism in the cardiovascular disease early transport system: Tokyo CCU Network T2 - Circ J TI - Latest management and outcomes of major pulmonary embolism in the cardiovascular disease early transport system: Tokyo CCU Network VL - 74 ID - 760381 ER - TY - JOUR AB - Kalevi Ratsaspordikooli kaotamise järel sealsetest kasvandikest moodustatud ratsaspordiklubist Team Silver Spur DA - 2010 DB - Index Scriptorium Estoniae PY - 2010 SN - 1736-1435 ST - Team Silver Spur - paljude eesti noorte ratsutajate kasvulava aastatel 2000-2004 / Riina Pill T2 - Oma Hobu TI - Team Silver Spur - paljude eesti noorte ratsutajate kasvulava aastatel 2000-2004 / Riina Pill UR - https://artiklid.elnet.ee/search~S1*est?/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&extended=0&SUBKEY=pulmonary+embolism+response+team/1%2C848%2C848%2CB/frameset&FF=Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&26%2C26%2C ID - 762140 ER - TY - BOOK DA - 2012 DB - Index Scriptorium Estoniae PY - 2012 ST - One NGÒs response to super-typhoon aftermath / Tom Kinderman TI - One NGÒs response to super-typhoon aftermath / Tom Kinderman UR - https://artiklid.elnet.ee/search~S1*est?/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&extended=0&SUBKEY=pulmonary+embolism+response+team/1%2C848%2C848%2CB/frameset&FF=Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&28%2C28%2C ID - 762139 ER - TY - BOOK DA - 2013 DB - Index Scriptorium Estoniae PY - 2013 ST - Resilient leadership and team skills / Regina Phelps TI - Resilient leadership and team skills / Regina Phelps UR - https://artiklid.elnet.ee/search~S1*est?/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&extended=0&SUBKEY=pulmonary+embolism+response+team/1%2C848%2C848%2CB/frameset&FF=Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&10%2C10%2C ID - 762135 ER - TY - BOOK DA - 2014 DB - Index Scriptorium Estoniae PY - 2014 ST - Training & equipping a local hazmat team : Northwest Arkansas reverts to local hazardous materials response / Robert Burke TI - Training & equipping a local hazmat team : Northwest Arkansas reverts to local hazardous materials response / Robert Burke UR - https://artiklid.elnet.ee/search~S1*est?/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&extended=0&SUBKEY=pulmonary+embolism+response+team/1%2C848%2C848%2CB/frameset&FF=Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&11%2C11%2C ID - 762134 ER - TY - JOUR AB - Riskikommunikatsioonist DA - 2014 DB - Index Scriptorium Estoniae M1 - 10 PY - 2014 SN - 1366-9877 SP - 1233-1239 ST - Four questions for risk communication / Roger Kasperson T2 - Journal of Risk Research TI - Four questions for risk communication / Roger Kasperson UR - https://artiklid.elnet.ee/search~S1*est?/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&extended=0&SUBKEY=pulmonary+embolism+response+team/1%2C848%2C848%2CB/frameset&FF=Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&30%2C30%2C VL - 17 ID - 762137 ER - TY - BOOK DA - 2014 DB - Index Scriptorium Estoniae PY - 2014 ST - The role of team goal monitoring in the curvilinear relationship between team efficacy and team performance / Tammy L Rapp; Ryan Mullins; Daniel G Bachrach; Adam A Rapp TI - The role of team goal monitoring in the curvilinear relationship between team efficacy and team performance / Tammy L Rapp; Ryan Mullins; Daniel G Bachrach; Adam A Rapp UR - https://artiklid.elnet.ee/search~S1*est?/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&extended=0&SUBKEY=pulmonary+embolism+response+team/1%2C848%2C848%2CB/frameset&FF=Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&27%2C27%2C ID - 762138 ER - TY - JOUR AB - Pulmonary embolism (PE) is a complex and multidimensional pathophysiology, the diagnosis and management of which spans multiple disciplines. The high morbidity and associated mortality of “massive” and “submassive” acute PE may re... DA - 2015/01/01 01/01 DB - Institute of Scientific and Technical Information of China (English) M1 - 6 PY - 2015 ST - Pulmonary Embolism Response Teams T2 - Current treatment options in cardiovascular medicine TI - Pulmonary Embolism Response Teams UR - https://netl.istic.ac.cn/site/link?cdoi=4d21700b924862920341e658acc7252e&mid=466496091303411EB27FB4298C9BA46C VL - 17 ID - 762131 ER - TY - JOUR AB - The first entries in the US Department of Defense Trauma Registry (DoDTR) (originally the Joint Theater Trauma Registry, JTTR) were in December 2004. Currently containing > 55,000 patient records, this registry offers opportunities for trauma systems and other research unique in the history of warfare. Initially limited to patients surviving to a Role 3 hospital, in 2008 patients admitted to Role 2 hospitals were added. More recently, data has been collected from prehospital and en route care. The similar UK JTTR commenced in 2003. The DoDTR and UK JTTR have been used for planning and quality improvement (quantifying adherence Clinical Practice Guidelines), but their enduring legacy will be trauma systems research just as relevant to civilian as military trauma care. No bibliometric summary of this research output has yet been published. Currently, 133 publications are attributed by PubMed to the DoDTR or the JTTRs, with the first publication in 2006. These have been cited > 6600 times, with an h index of 42 (i. e. 42 papers cited = 42 times)(Google Scholar). Three journals have published > 50% of these papers: the Journal of Trauma and Acute Care Surgery, the Journal of the Royal Army Medical Corps, and Military Medicine. In addition to many papers describing the nature and consequences of various types of wounds and injuries, publications with implications beyond military trauma include: the Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) study demonstrating reduced mortality associated with tranexamic acid given soon after trauma; an analysis of the causes of preventable death before and after admission to hospital, demonstrating the priority that should be given to treating haemorrhage; a demonstration of the reduced mortality associated with a change to mandating forward aeromedical evacuation be provided such that casualties reach surgical care within 60 minutes of wounding. This paper also suggested a lower mortality associated with being taken to a Role 3 hospital compared to a surgical Role 2 hospital ;the low (11.2%) incidence of primary blast lung injury in blast-injured patients surviving to hospital care; two analyses demonstrating reduced mortality in severe trauma when patients are transported by either a multidisciplinary medical/nursing/ paramedic team, or highly-trained critical care flight paramedics, compared to military medics with more basic training; an analysis of vascular injury after blast and ballistic trauma that demonstrated a very low positive predictive value of absent pulses for the presence of vascular injury; and the very high incidence of very early venous thromboembolic disease in severe blast and ballistic trauma. These figures do not include observational studies of other military casualty databases, such as that which identified an association between fresh whole blood (compared to component transfusion) and reduced mortality, and the first observational study to associate lower mortality with higher ratios of plasma to red cells transfused. These databases are available for use by collaborating investigators and present a useful opportunity for ADF clinicians and planners to conduct research. AN - WOS:000396425100002 DA - Oct J2 - J. Mil. Veterans Health KW - Medicine, General & Internal LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: EO0YR Times Cited: 0 Cited Reference Count: 0 [Anonymous] 0 3 AUSTRALASIAN MILITARY MEDICINE ASSOC HOBART J MIL VETERANS HEALT PY - 2016 SN - 1835-1271 SP - 9-81 ST - A Bibliometric Analysis of Military Trauma Registry Publications Abstracts T2 - Journal of Military and Veterans Health TI - A Bibliometric Analysis of Military Trauma Registry Publications Abstracts UR - ://WOS:000396425100002 VL - 24 ID - 761692 ER - TY - JOUR DA - 2016 DB - Index Scriptorium Estoniae M1 - 1 PY - 2016 SN - 2327-6177 SP - 40-47 ST - ATF special response team : A unique K-9 team for a unique federal agency / Jan Kemp T2 - K-9 cop magazine: for police and military working dog handlers TI - ATF special response team : A unique K-9 team for a unique federal agency / Jan Kemp UR - https://artiklid.elnet.ee/search~S1*est?/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&extended=0&SUBKEY=pulmonary+embolism+response+team/1%2C848%2C848%2CB/frameset&FF=Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&3%2C3%2C VL - 8 ID - 762125 ER - TY - BOOK DA - 2016 DB - Index Scriptorium Estoniae PY - 2016 ST - Europès medical emergency response / Monique Pariat TI - Europès medical emergency response / Monique Pariat UR - https://artiklid.elnet.ee/search~S1*est?/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ/Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&extended=0&SUBKEY=pulmonary+embolism+response+team/1%2C848%2C848%2CB/frameset&FF=Xpulmonary+embolism+response+team&searchscope=1&SORT=DZ&29%2C29%2C ID - 762127 ER - TY - JOUR AB - The proceedings contains 130 papers. The topics discussed include: Pilot Assessment of the Angiosome Concept by Intraoperative Fluorescence Angiography After Tibial Bypass Surgery;Outcomes of Laser Atherectomy in Complex Lesions of the Superficial Femoral Artery;Open Distal Revascularization in Chronic Kidney Disease: Is It Worthwhile?;A Promising Novel Treatment for Critical Limb Ischemia and Beyond;International Consortium of Vascular Registries Consensus Recommendations for Peripheral Revascularization Registry Data Collection;Endovascular Repair of Popliteal Artery Aneurysm;Efficacy of XTRACT on Atrial Fibrillation Patients With Peripheral Arterial Disease: Subset Analysis from PRISM Trial;Use of Negative Pressure Wound Therapy With Instillation in Diabetic Foot Wounds: Initial Experience in an Asian Population;End-of-Life Care After Major Amputation for Diabetes or Peripheral Arterial Disease;Use of Home Negative Pressure Wound Therapy in Peripheral Artery Disease and Diabetic Limb Salvage;Implementation of a Multidisciplinary Team Approach in Lower Extremity Amputation Prevention Program for Diabetic Foot Ulcer Referral from Primary Health Care to a Tertiary Center Vascular Surgery Clinic: Initial Experience in an Asian Population;Percutaneous Suture Technique With ProGlide: A Novel Method for Management of Vascular Access Pseudoaneurysm After Percutaneous Coronary Intervention Procedure;Lutonix Drug-Coated Balloon Long Lesion Study: 24-Month Outcomes;Bilateral Lower Limb Disabling Claudication in a Young Man: Mönckeberg Arteriosclerosis, What to Do?;Role of Monocytes in the Treatment of Chronic Limb Ischemia and “Hard to Heal” Ulcers;A Comprehensive Evaluation of Infrainguinal Endotherapy at Our Institution: Cost, Time, Radiation, and Outcomes;The 12-Month Results of the EffPac Trial DB - Embase KW - adult Asian atherectomy atrial fibrillation chronic kidney failure claudication conference review consensus controlled study critical limb ischemia diabetic foot drug-coated balloon endovascular aneurysm repair false aneurysm fluorescence angiography human laser leg amputation limb salvage male monocyte multidisciplinary team patient referral percutaneous coronary intervention percutaneous transluminal angioplasty balloon peripheral occlusive artery disease popliteal artery aneurysm prevention primary health care revascularization superficial femoral artery surgery suture technique terminal care vacuum assisted closure vascular access vascular closure device LA - English M1 - 5 M3 - Conference Review N1 - L2001540467 2019-02-11 PY - 2018 SN - 1097-6809 0741-5214 ST - Abstracts of the 2018 VEITHsymposium Associate Faculty Global Podium Presentations Program and the International Guest Faculty Program T2 - Journal of Vascular Surgery TI - Abstracts of the 2018 VEITHsymposium Associate Faculty Global Podium Presentations Program and the International Guest Faculty Program UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001540467&from=export VL - 68 ID - 760788 ER - TY - JOUR AB - PMID:29511564 DA - 2018/03/02 03/02 DB - PubMed Central DO - 10.1186/s40560-018-0286-8 PY - 2018 SN - 2052-0492 ST - Management of patients with high-risk pulmonary embolism: a narrative review T2 - Journal of Intensive Care TI - Management of patients with high-risk pulmonary embolism: a narrative review UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5834898 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5834898&rendertype=abstract VL - 6 ID - 762102 ER - TY - JOUR AB - The proceedings contains 1803 papers. The topics discussed include: FEASIBILITY AND SAFETY OF DAY CARE THORACOSCOPY FOR UNDIAGNOSED EXUDATIVE PLEURAL EFFUSIONS;SAFETY AND EFFICACY OF BRONCHOSCOPY IN PREGNANCY;CAUSES OF MORTALITY POST SINGLE VS DOUBLE LUNG TRANSPLANTATION FOR COPD;METFORMIN AND LOW DOSE NINTEDANIB AS A NOVEL COMBINATION THERAPY TO REDUCE PULMONARY FIBROSIS IN HUMAN TGF-BETA STIMULATED FIBROBLASTS;DIRECT ORAL ANTICOAGULANTS PRESCRIBING PRACTICES IN THE TREATMENT OF VTE AT A QUATERNARY CARE CENTER: A RETROSPECTIVE REVIEW;DISTAL PARENCHYMAL VASCULAR VOLUME LOSS IN CLINICAL CT IMAGING AS A PREDICTOR OF LONG-TERM OXYGEN REQUIREMENT AFTER SUBMASSIVE PULMONARY EMBOLISM;THE EFFECT OF A PULMONARY EMBOLISM RESPONSE TEAM (PERT) AT UNIVERSITY OF VIRGINIA MEDICAL CENTER ON UTILIZATION OF ADVANCED THERAPIES AND PATIENT OUTCOMES;COMPLEX INFERIOR VENA CAVA FILTER RETRIEVALS: PREDICTORS OF COMPLICATIONS AND FAILURES IN A LARGE, US HEALTHCARE SYSTEM MULTICENTER REFERRAL PROGRAM;PATIENT KNOWLEDGE RETENTION FOLLOWING SHARED DECISION-MAKING FOR LUNG CANCER SCREENING;LUNG CANCER SCREENING WITHOUT SHARED DECISION-MAKING: A MISSING PART OF AN IMPORTANT SCREENING PROGRAM; DB - Embase KW - anticoagulant agent endogenous compound metformin nintedanib oxygen transforming growth factor beta adult advanced cancer bronchoscopy cancer screening cause of death chronic obstructive lung disease complication conference review controlled study day care drug combination drug safety drug therapy feasibility study female fibroblast health care system human information retrieval low drug dose lung cancer lung fibrosis lung transplantation multicenter study patient referral pharmacokinetics pleura fluid pregnancy prescription pulmonary embolism response team retrospective study shared decision making surgery thoracoscopy thorax vena cava filter LA - English M1 - 4 M3 - Conference Review N1 - L2002982504 2019-10-01 PY - 2019 SN - 1931-3543 0012-3692 SP - A1-A2280 ST - CHEST 2019 Annual Meeting Abstracts T2 - Chest TI - CHEST 2019 Annual Meeting Abstracts UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002982504&from=export VL - 156 ID - 760659 ER - TY - JOUR AB - The proceedings contain 262 papers. The topics discussed include: the PREDICT study: a prospective observational study to validate the utility of C-reactive protein trajectory as a predictor of anastomotic leak in patients with a bowel anastomosis; age-specific colorectal cancer incidence trends in England, 1974- 2015: a population-based study showing increased incidence among young adults; variation in radiologically predicted CT staging by 60 colorectal multidisciplinary teams in the pelican ACPGBI IMPACT program; older adults require a targeted prognostic score that encompasses all peri-operative aspects: results from the ELF study; poverty and anal cancer: does it influence survival?; randomized double-blind controlled trial of laser hemorrhoidoplasty, excisional hemorrhoidectomy and recto-anal repair for symptomatic haemorrhoids; and the incidence of DVT amongst patients undergoing curative resection for colorectal cancer - an update. DB - Embase KW - C reactive protein endogenous compound adult aged anastomosis leakage anus cancer cancer incidence cancer patient cancer prognosis cancer surgery cancer survival colorectal cancer conference review controlled study double blind procedure England female hemorrhoidectomy human intestine Ireland laser male multidisciplinary team observational study poverty prospective study randomized controlled trial survival young adult LA - English M3 - Conference Review N1 - L631602237 2020-05-04 PY - 2019 SN - 1463-1318 ST - Association of Coloproctology of Great Britain and Ireland Annual Meeting T2 - Colorectal Disease TI - Association of Coloproctology of Great Britain and Ireland Annual Meeting UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631602237&from=export VL - 21 ID - 760779 ER - TY - JOUR AB - Objectives:ADVOS multi is a recirculating albumin-based dialysis device that supports kidney, liver and lung function by eliminating CO2, water-soluble and protein-bound substances. In the present work in vitro data on the removal of these substances and CO2 are presented. Methods: An ex vivo model using porcine blood was established and applied in detoxification tests for water soluble and protein bound retention solutes. 3 x 3.3L of blood with high bilirubin (30 mg/dl) and lactate levels (>10 mmol/l) were treated with ADVOS multi for 4 hours each. This design, with 3 phases changing blood every 4 hours, led to high concentrations of both markers in blood during the 12 h test period. For CO2 removal tests, 5 liters of blood were used instead. In both cases, a continuous CO2 supply through an additional dialyzer was applied. Results: Bilirubin and lactate were efficiently removed during 12hrs of in vitro detoxification. Lactate removal rates were 90%, 86% and 84% for phase 1, 2 and 3, respectively. Bilirubin elimination rates were 66%, 62%, and 57%, resulting in a total elimination of 1150 mg in 12 hrs. Albumin binding capacity was determined to be >76% at the end of the treatment indicating that albumin was not denatured in the dialysate of the ADVOS system. CO2 removal with ADVOS multi depends on three variables: 1) The amount of supplied CO2 depends on concentrate flow affecting both, blood pCO2 and bicarbonate levels; 2) blood flow, and 3) dialysate pH and composition (i.e., carbonate concentration). A maximum CO2 removal of 142 ml/min was achieved with a carbonate-free dialysate at pH 10, a blood flow of 400 ml/min and a concentrate flow of 160 ml/min. Given that blood gases are maintained within physiological conditions, a CO2 removal rate of 61 ml/min can be achieved. During all the experiments blood pH was set to 7.35-7.45. Discussion:ADVOS multi is a device using albumin recirculation in its secondary circuit. Here, albumin binding capacity remains stable through a systematic modification of its tertiary structure through temperature and pH changes in the ADVOS multi circuit. This facilitates the release of toxins from albumin and allows for further binding. Moreover, presence of albumin, variable dialysate composition and the flexible dialysate pH might facilitate the treatment of patients with multiple organ failure. Objectives:Given the extent of bypass graft failure, the motivation behind this multidisciplinary project is to improve the patency of the current bypass grafts by developing a novel and optimised blood flow augmentation technique. Methods: One of the most significant contributions to the improvement of haemodynamics in grafts was based on a research which showed that the 'spiral flow' is a natural phenomenon in the whole arterial system and is induced by the twisting of the left ventricle during contraction and then accentuated upon entering the aortic arch. The benefit of this flow pattern lies in removing unfavourable haemodynamic environment such as turbulence, stagnation and oscillatory shear stress, which are believed to be the main causes of intimal hyperplasia at anastomotic configurations. Results:This multi-disciplinary engineering venture has resulted in a unique product which makes use of both non-planar helicity and an optimised internal ridge within the graft to achieve a significantly improved haemodynamic condition within the anastomosis (an anastomosis is a surgical connection between autologous/prosthetic grafts and veins/arteries inside the human body) Discussion:This truly multidisciplinary project has integrated fluid mechanics, biomechanics and biology with cardiovascular surgery to develop a novel biomedical device, inspired by the nuclear engineering sector. The novel spiral-inducing bypass graft, nominated for this award, is the best example of how engineering techniques, tools and designs can lead to life-saving innovations that could potentially save the lives of thousands of people and save millions of pounds for the healthcare systems across the world. Such successful engineering stories are what would encourage the next generation of engineers to go beyond the traditional boundaries of engineering disciplines to make a difference. Objectives:The goal of this work was to study methods that will allow increase in spatial freedom of couplers orientation in inductive powering unit for implantable medical devices. An inductive energy transfer system is considered, therefore the freedom of relative orientation of the transmitting and receiving coils must be optimized. Methods:The design procedure of inductive powering unit (IPU) consists of two main steps: design of the power amplifier and optimization of an inductive link. To account for the patient specifics, such as tissue thickness near the implantation site, a number of different couplers were simulated using finite element modeling. Effect of coils geometrical parameters on mutual inductance and inductive link efficiency was examined. Class E power amplifier was chosen as a driver for the transmitting coil. Capacitors in the amplifier loading network were tuned to achieve zero-voltage switching (ZVS). A patient's everyday activity, including walking and even breathing, leads to misalignment of the transmitting and receiving coils, and, as a result, detuning of the amplifier from ZVS and increased losses. Feedback schemes were studied to compensate the misalignments effect on the amplifier. Results:A self-oscillating IPU with class E amplifier was designed that provides stable output power about 0.5 W for the distance between the couplers in range 10-20 mm and the lateral distance up to 20 mm. The use of self-oscillating circuit in the transmitter increases spatial freedom of the transmitting and receiving coils corresponding to ZVS. Discussion: Inductive link geometrical parameters optimization and implementation of self-oscillating class E driver the IPU contributes to stable output power and efficiency of IPU. As a result, less intervention from the patient and physician is required, and patient quality of life is increased Precision medicine emerges from integration of a number of emerging technologies and the data they produce with modern data analytics. For precision diagnostics and for predicting drug responses new computational and in-vitro models are needed from gene regulation to cellular and organ functions. Human induced pluripotent stem cells (hIPSC) derived e.g., from patient blood cells provide means to produce most cell types and thus provide means to get patient specific in-vitro models. New technologies are needed to produce tissues from these cells and to assess the cell functions in-vitro. In addition, computational in-silico models can be used to augment our understanding of the diseases or drug effects. They also provide tools to translate the in-vitro findings to clinical settings and patient populations. We are in transition to turn our in-vitro cell culture models to body-on-chip platforms including environmental control and biophysical functional sensing. We have developed methods to assess the cellular functions based on electrophysiological sensing as well as 2D and 3D bioimaging. For example, we have developed imaging methods to assess functions of hIPSC cardiac cell with simultaneous assessment of electrophysiology such as Calcium and voltage transients as well as mechanobiology in vitro. Further, we have developed in-silico models of various cellular function including multi-cell-type neuronal networks and in-silico population models of the hIPSC cardiomyocytes. The later ones are providing us ionic machinery of hIPSC derived cardiomyocyte electrophysiology in various populations of patiets. We have shown that these computational models can represent pathological patient phenotype cells and populations of patients with specific mutations, e.g., long QT syndrome. We have also demonstrated the power of in-silico as possible pre-screening method for drug effects prior to in-vitro examinations. Moreover, our in-silico results highlight the need of careful consideration of use of HiPSC models before they can be turned from immature cell models to mature tissues in vitro. With integration of novel engineering expertise from multimodal sensing, imaging and computational modelling, we have shown their power on studying diseases and for pre-screening of compounds. Our results demonstrate the power of combined in-vitro and in-silco methods for future precision medicine. Objectives: We have developed in vivo tissue engineered autologous vascular grafts constructed in the subcutaneous of the recipient body. However, since the formation of the vascular grafts depends on the conditions of recipients including high risk or immature patients, immaturity in the fabricated tissues might be problematic for the severely diseased patients because of their suppressed regenerative activity. Therefore, possibility of the xenogeneic or the allogeneic implantation of the grafts should be evaluated. The objective of this study is to fabricate cardiovascular grafts using xenogeneic or allogeneic animals. Methods: Silicone rod molds were placed into subcutaneous pouches of beagle dogs, and after 4 weeks the implants with their surrounded connective tissues were harvested. Those were decellularized with detergents and stored at -20 degrees C for 1 week. Decellularized tubular connective tissues (internal diameter: 2 mm) were xeno-transplanted to abdominal aorta of the rats. Decellularized tubular connective tissues (internal diameter: 5 mm) were cut open and trimmed to elliptical sheets of 15 x 8 mm, they were allo-transplanted to carotid arteries of other beagle dogs as vascular patches. Results: Both xenogeneic vascular grafts and allogeneic patch grafts performed well after transplantation, and the luminal surfaces after resection were very smooth. Histological evaluation also showed host cells infiltration into the grafts. Discussion: Decellularized xenogeneic and allogeneic connective tissue membranes could be ideal vascular grafts. Objectives: This work aimed to print high-resolution, collagen-based, constructs via suspended 3D printing with load-bearing and compositions closer to native bone; for potential use as implant materials. Methods: Collagen type I (Col) and gelatin methacroylate (GelMA) blends were systematically investigated as bio-inks, probing their rheological properties and crosslinking efficiency for printing. An adapted 3D bioprinter (3DDiscovery, regenHU, Switzerland) based on an extrusion principle was used to print constructs. Calcification was investigated, in vitro, using a polymer-induced liquid precursor for the mineralization process. Results: Careful control over the formulation and processing resulted in refined construct properties such as: wall width (500um), lattice length (2cm) and shape (bone trabeculae). Once printed, the ability to cure the GelMA/Col blends was dependent on photo-polymerisation methodology, with enhanced curing and lower remaining soluble fractions (10% vs 40%) for visible light + Riboflavin/SPS in comparison to UV + Irgacure. Control over the construct structure allowed defined mineralisation, and subsequent material responses. Discussion: In recent years the development of 3D printing technologies has attempted to combat the growing need for bone repair solutions, although is limited by the number of bio-inks, and printable resolutions available. Suspended manufacture has sought to address this issue, using a fluid gel to support a secondary biologically relevant bio-ink whilst it undergoes a curing step, during or post-printing. To date, printing techniques have not been shown to provide fully resorbable and/or mechanically satisfactory bone implants. This research has shown promise as the first steps towards printing high resolution constructs with chemical compositions more closely matching that of natural bone. Further works involve deeper investigation of calcification and impact on implants mechanical properties and microstructure. Shifting from treating symptoms to curing chronic diseases by making the transformative promise of Advanced Therapies a reality for the benefit of patients and society and by making Europe a spearhead of Advanced Therapies in Science, Clinics and Biomedical Industry, that is the vision of the large-scale research initiative RESTORE - Health by Advanced Therapies. The increasing prevalence of chronic diseases and multi-morbidity due to demographic factors represents a high socio-economic burden for Europe. The direct health costs increased by 50% during the last decade and reached euro1.526bn in 2017, a staggering 9.6 % of Europe's GDP. As current therapies rarely cure, but merely fight symptoms, never-ending treatment is required, which means diminished quality-of-life, adverse effects and soaring cost for society. There is a high need to reach sustainable improvement for patients or even to cure them of chronic diseases - in other words, to disrupt the paradigm of "treating symptoms" with "restoring health". Advanced Therapies are the game changers that open up transforming therapeutic opportunities. For genetic diseases, immune diseases, cancer and tissue injury potential cures through Advanced Therapies exist - it is reality, not fiction. Some products are already on the market, mostly for rare diseases which means only a few thousand patients worldwide have benefitted from Advanced Therapies until now. At the advent of such a trailblazing change, obstacles and roadblocks abound. To make the disruptive promise of Advanced Therapies to cure chronic diseases a reality and to make Advanced Therapies accessible as standard-of-care for every European patient in need, RESTORE envisage to establish a sustainable pan-European ecosystem integrating transdisciplinary research, clinics, patients, and industry. Please join us for more details. RESTORE is funded by the EU for the preparatory phase of the large-scale research initiative (h2020, No 820292). Our main objective is to develop safe medical products for a minimally-invasive surgical intervention that fulfill all requirements by the new Medical Device Regulation (MDR). The secondary objective is to minimize the time to market by implementing standard conforming processes in a minimalistic way so they can be operated by only a handful of people. The twist in the story is that one of our products of our system will be individualized in the operating theater. While basically everybody is forced to operate in a "learning by doing" mode regarding MDR compliance, we do rely on external trainings provided by notified bodies and other sources like websites, webinars, and dedicated conferences to learn more about how to fulfil regulatory requirements. Additionally, we are partnering with our strategic investor (a manufacturer of class-III implantable active devices) to receive trainings and advice regarding regulatory affairs. However, it has to be stressed that one has to consider all parts of the MDR, especially the annexes and the applicable norms. Here we present our technical approach and our strategy on how we aim full MDR compliance. We established a completely digital workflow for all our documents, including cryptographic signatures, version history, reviews, mainly based on open source tools. This allows us to handle the document management very swiftly. We have one person dedicated to our quality management system. The risk management is integrated as a cross-cutting-concern into all the product development processes. The main challenge in the planning and founding phase of OtoJig GmbH was and still is to estimate what has to be done, which norms do apply, and how much effort (time and money) it is to perform the steps and create all the required documents. A difficulty is that contradicting statements between the MDR and other applicable norms are still under interpretation and public discussion. Objectives: The aim of this work is to study the influence of person physiology and anatomy, which include postoperative edema, movement and breathing of a patient, on the results of designing of inductive powering unit (IPU) for VAD and to propose design recommendations. Methods: A characteristic feature of the IPU is the misalignment of the coils. The stability of the VAD power supply (especially with continuous powering) is very important. Therefore, it is necessary to design an IPU tolerant to coil misalignment. The procedure of geometrical optimization for increasing the stability of energy transfer of IPU was performed for 3 axial distances between coils d (8, 10, 12 mm), which is a typical misalignment with a postoperative edema. The lateral misalignment of the coils reached the value of the outer radius of the receiving coil (35 mm), which characterizes the patient movement or breathing. The operating frequency was taken 1 MHz, and the output power of the system was 10 W. The power drop was within 10%. The results were verified by numerical simulation in MATLAB and PSpice. Results: It was found that with a decrease of d from 12 to 10 and 8 mm, the optimal outer radius of the transmitting coil increases from 53.9 to 54.6 and 55.7 mm. Turn pitch in the transmitting coil increases from 4.9 to 5.2 and 5.3 mm. For a receiving coil, turns pitch is increasing from 3 to 3.2 and 3.6, respectively. For all cases of d in each coil there are 11 turns (except for d = 8 mm, where there are 10 turns in the receiving coil). It is recommended to design coils with a slightly larger coils turns pitch and the outer radius of the transmitting coil because of disappearance of postoperative edema. Discussion: In this work, the influence of person physiology and anatomy on the design of IPU for VAD was investigated, and recommendations for designing were given. Objectives: Membrane oxygenators are an indispensable part of critical care medicine. Though necessary to supply sufficient gas exchange, the high intrinsic surface introduced by the hollow fiber packing has serious side effects on blood platelet parameters. To reduce these side effects the membrane surface must be minimized and gas exchange improved. Methods: Computational fluid dynamics (CFD) can support oxygenator optimization and supplement experimental data by delivering a spatial and temporal resolution of the gas exchange. While current research mostly focusses on the gas transport in the blood flow, this work presents a fully resolved CFD approach including transmembrane transport as well as convective and diffusive blood gas transport on shell- and lumen-side of the hollow fibers. Results: CO2 transport in a packing segment of a prototype hollow fiber module was fully resolved and simulated utilizing an inhouse solver membraneFoam based on the open source CFD code OpenFOAM (R). Simulation results show a CO2 partial pressure decline from 50 to 15 mmHg in the laminar boundary layer and an additional drop of 12 mmHg at the selective membrane surface. Boundary conditions for the gas transport simulations were computed by blood flow simulations of the whole module. Simulation results were compared to in vitro tests comprising measurements of CO2 exchange performance and blood side pressure drop of the prototype module. Discussion: Flow simulations predict the experimentally determined pressure drop of 68 mmHg at blood flow rates of 1280 mL/min accurately. The specific CO2 exchange rate of 220 mL STP/min/m2 is overpredicted due to the reduction of the whole packing to an idealized packing segment. Nevertheless, CFD allows for a structured optimization of membrane oxygenators as design changes can be efficiently investigated. Objectives: Anticoagulation therapy in LVAD patients is essential to reduce hemocompatibility related adverse events (HRAE). Phenprocoumon dose must be adapted and monitored by INR point-of-care-testing (POCT) in outpatients. The study aims to determine if the frequency of INR POCT in LVAD outpatients has an influence on the quality of anticoagulation therapy, HRAE and clinical outcomes. Methods: This retrospective, pseudo-randomized study included n=48 patients who received an LVAD implantation (HMII, HM3 and HVAD) between Jan. 2012 and Oct. 2016. Based on the frequency of weekly INR POCT, we compared a daily (n=36) and a 3x/week (n=12) group, specifically the 1-year anticoagulation quality (% of INR Tests in Range) as well as clinical outcomes, readmissions and HRAE using Kaplan-Meier curves. Readmission profiles and outcomes in three groups, based on the achieved quality of anticoagulation (% of INR Tests in Range) ranging from 0-60% (poor), 60-70% (acceptable), 70-100% (well controlled) were compared. Results: Daily and 3x/week groups were similar in demographic and pre-operative risk factors, INR target (2.0-3.0, p=0.27) and Aspirin daily doses (p=0.29). Freedom from any HRAE (38.9% vs. 25.0%, p=0.44), any readmission (72.2% vs. 75.0%, p=0.97) and 1-year survival (91.7% vs. 91.7%, p=0.98) were comparable in both groups. The % of INR Tests in Range was significantly higher with the daily self-assessments (73.5% vs. 68.4%, p=0.006). Freedom from any neurological event (91.7% vs. 75.0%, p=0.14) was n.s. higher in the daily POCT group. Well vs. poorly controlled INR POCT patients had a significant higher freedom from any neurological event (96.0 vs 69.2%, p=0.024) as well as hemorrhagic strokes (100% vs. 76.9%, p=0.011). Discussion: Well controlled anticoagulation of LVAD outpatients results in less neurological events including hemorrhagic stroke. Daily INR POCT and subsequent dose adjustment of vitamin-K antagonists result in a better quality of anticoagulation than 3x/week checks. Objectives: Spectroscopic method is widely used for non-invasive blood glucose (BG) measurement. Despite the progress in implementation of transmission NIR-spectroscopic method, applicable mostly for earlap measurements, research of non-transmission methods allows for the exapnsion of spectroscopy range of use. The aim of research is to estimate the penetration depth for 1600 nm radiation using reflection NIR-spectroscopy. Sufficiency of penetration depth on this wavelength would allow for the use of a mathematical model implemented in the transmission method. Methods: The developed experimental setup includes a semiconductor laser with wavelength of 1600 nm, two photodiodes, reflecting surface, control unit and power supply. For determining the position of optical elements a MATLAB program was developed, which calculated efficient detected radiation intensity depending on distances between the photodiode and the laser and between the laser and reflective surface. Scheme for measuring BG by reflection NIR-spectroscopy partially repeats the scheme used for transmission method. The main differences are in location of photodiodes on the same plane with the radiation source, while their optical axes are co-aligned and parallel to each other, and the reflecting surface tightly abuts the back wall of analytical cell with test solution. Results: The optimal distance between the photodiode and the laser is 5 mm, and between the laser and the reflective surface is 20 mm. This configuration allows intensity of the reflected radiation at about 20% of incident radiation to be obtained. Taking into account the permissible radiation density for skin, this value is enough for skin probing to a depth of 1.5 mm. Discussion: Reflection NIR-spectroscopy is promising method for non-invasive BG measurement. Research of transmission method has shown that the penetration depth of 1.5 mm is enough for receiving information about BG. Thereby mathematical apparatus applied for transmission NIR-spectroscopy can be used and similar error less than 20% can be expected. Objectives: Proper anatomical fitting of implants is crucial for a successful clinical outcome. However, every patient's anatomy is unique and there is a wide variety in the anatomical and morphological characteristics among individuals. Virtual fitting based on imaging data of a high number of patients has crucial benefits compared to conventional approaches during the design process. Methods: Population based engineering is a method that enables a virtual implantation combined with iterative design optimization based on 3D anatomical models created from imaging data of a high cohort of patients. This approach was successfully used during the design process of a novel inflow cannula for a Ventricular Assist Device and a Total Artificial Heart for maximizing the number of treatable patients. The objective was to create a design that contains all components, but which at the same time works for a wide variety of different body types and sizes. Results: The virtual studies have proven to give results that may not have been possible with conventional approaches. Compared with cadaver studies, this approach was a more accurate and economical way for determining the device fit and identifying areas for improvement. Clinical trials and in vivo studies of the devices have shown positive outcomes. Virtual fitting was able to reduce the risk of inflow obstruction, device-vessel misalignment, unexpected variabilities in the patient's anatomy and improper patient selection due to anatomical constraints. Discussion: Population based engineering is a cost-effective solution for including a large number of patients and anatomy variations in the design process. Additionally, this approach can be used for regulatory submission, e.g. to determine and justify anatomical and morphological eligibility or exclusion criteria for proper patient selection and/or the correct implant size. This is especially important in consideration of the future requirements of the Medical Device Regulation (MDR) for patient-specific implants. Objectives: None Alcoholic Fatty Liver disorders (NAFLD)is a complex systemic disorder becauseit is associated with clinical states such as obesity, insulin resistance, and type 2 diabetes thus involving both liver and pancreas. In particular, pathological pancreas (such as in diabetic patients, in non-alcoholic fatty pancreas disorders patients) led to mis control of insulin secretion (the insulin modulates the lipid accumulation in liver). Methods: Organ on chip approaches is one way to mimic human physiology. In this paper, we will present the development of a liver, pancreas and liver pancreas co-culture model to simulate the interaction between both organs. Results: The morphological analysis confirmed the rat hepatocytes and the rat Langehrans islets were cultivated successfully after the extraction for 7 days. The tissues functionality was confirmed by the production of albumin in the liver on chip models and by the insulin secretion in the pancreas biochips. The RTqPCR analysis confirmed that the pancreas on chip culture contribute to maintain high level mRNA of genes related to glucose insulin homeostasis when compared to Petri control. Then, the GLP1 drug contribute to increase the insulin metabolism in pancreas on chip. In liver pancreas co-culture, we found that the presence of pancreas islet contributed to modify the mRNA levels of glucose-insulin homeostasis related genes in the hepatocytes. It also contributed to increase the insulin production when compared to pancreas biochip control. Discussion: Those results demonstrated the potential of our liver pancreas model to be upgraded to a complex disease model. Objectives: We are developing a novel autologous tissue-engineered heart valve with a unique in-body tissue engineering. This is expected to be a viable bioprosthesis with better biocompatibility. In this study, we developed a conduit-type valve without any foreign materials and tested the feasibility and long-term availability in large animal experiments. Methods: We created plastic molds for Biovalves with a 3D printer easily and quickly considering the recipient character. We embedded them in the subcutaneous spaces of adult goats for about 2 months. After extracting the molds with the tissue en-block and removing the plastic molds only, Biovalves with tri-leaflets similar to those of the native valves were constituted from completely autologous connective tissues and fibroblasts. Total 21 conduit-type Biovalves were implanted in the apico-aortic bypass or the pulmonary artery of goats, (8 and 13, respectively). No anticoagurants were used after implantation. Results: The valves were successfully implanted and showed smooth movement of the leaflets with a little regurgitation in angiogram, and the maximum duration reached to 3 years 7 months. Histological examination of the Biovalves showed the autologous cells covering the laminar surface of the valve leaflets as the endothelium and also migrating into the leaflet body to construct characteristic tissues like native leaflets. Discussion: The valves have a potential to be used for viable bioprosthetic valves and to keep better function and biocompatibility longer than current ones. Objectives: The main purpose of this study is to analyze the correlation between different types of dnDSA and AMR after renal transplantation. Methods: We retrospectively analyzed the patients after renal transplantation from January 2002 to March 2017 in our Center. A total of 47 patients with positive PRA and confirmed as dnDSA were included, which were grouped according to the DSA binding to C1q, C3d and subtypes of IgG. Patients were divided into AMR and non-AMR groups according to the pathology of graft biopsy. Results: The pre-transplantation dialysis time of the non-AMR group was longer than that of the AMR group in 47 patients with dnDSA positive (35.4 +33.2 vs 9.8 +10.5, p=0.014). C1q-binding dnDSA had no significant effect on the graft survival after operation and biopsy. Among 47 patients with dnDSA positive, C3d-binding DSA group had lower graft survival time (p=0.009), higher HLA-DP mismatch (0.1 +/- 0.3, p=0.043) and higher percentage of pericapillary C4d deposition (p=0.042), with statistical significance. The graft survival rate of IgG3 subtype negative patients was higher than that of IgG3 subtype positive patients (p=0.003). Cox analysis found that the risk factors for graft survival included IgG3 (OR = 46.877, 95% CI = 4.211-521.830, P = 0.002), HLA-DR mismatch (OR = 0.103, 95% CI = 0.021-0.496, P = 0.005), proteinuriuria at biopsy (OR = 2.097, 95% CI = 1.184-3.713, p=0.024) and creatinine at biopsy (OR = 1.004, 95% CI = 1.001-1.007, P = 1.007) Discussion: Single-center study showed that there was no significant correlation between the incidence of AMR and different types of DSA. The accurate HLA-DR typing should be emphasized during transplantation. The monitoring of specific types of dnDSA will help us to take interventions and thus contribute to the survival of transplanted kidneys. Objectives: Rotary blood pumps (RBPs) are successfully used in high-risk treatments, but clot formation still threatens their long-term application. To reduce the risk of clot formation, in-vitro thrombogenicity testing could help to improve RBP design, as several studies have shown. Those studies were able to simulate in-vitro clot formation in RBPs, but they had limitations regarding a proper quantification of their thrombotic impact. In this study, we assessed if thromboelastometric analyses (TEM) are feasible to quantify the thrombotic impact of RBPs in-vitro. Methods: Five RBPs (n = 5) were placed into simple pump circuits that were built of silicone tubes and reservoirs. Each circuit was filled with 150 ml of slightly heparinized porcine blood (one donor pig per circuit) and the pumps were brought into operation. The pumps operated until a drastic drop in volume flow indicated thrombus formation. We carefully cleaned the RBPs from blood and documented any found thrombus. Prior to this, blood samples were taken at certain time points during pump operation. The blood samples were then analyzed by TEM. Results: TEM measurements showed a decrease in clotting time (CT) over the duration of the test, which indicates an ongoing increase in the activation of the coagulation system caused by the pump. Correspondingly, RBPs revealed visible blood clots at high-risk thrombus formation spots. Discussion: The decrease in CT over time corresponding to clot formation in the RBPs shows that TEM is able to detect and quantify the thrombotic impact of RBPs in-vitro. Thus, TEM could be used in future studies to compare the thrombogenicity of different RBPs by performing comparison tests similar to hemolysis testing. This could lead towards a standardization of in-vitro thrombogenicity testing of RBPs. Objectives: Cryopreservation of tissue-engineered constructs (TECs) is very important to provide such ready-to-use products for regenerative medicine and clinical application upon demand. Although cryopreservation of isolated cells seems to be well established, there are still a number of challenges associated with the cryopreservation of native and artificial tissues due to adherent cell state, limited heat and mass transfer as well as inadequate cryopreservation protocols. Here, we aim at developing an approach for efficient cryopreservation of electrospun TECs based on multipotent stromal cells (MSCs). Methods: Blend electrospun fibre mats (fibre diameter 0.8 +/- 0.2 mu m, thickness 100 +/- 10 mu m) were produced from polycaprolactone and polylactic acid (PCL-PLA, ratio 100:50) using electrospinning. The fibre mats (diameter 16 mm) were UV sterilised and seeded with MSCs (5x104 cells/cm2). The cells were cultivated on fibre mats for 7 days under static conditions and then frozen using 1 K/min cooling rate in a controlled rate freezer with different formulations of cryoprotective agents (CPAs), such as dimethyl sulfoxide (DMSO) and its combination with sucrose (with and without pre-culture with sucrose for 24 h). The viability of cells growing on fibre mats was monitored for 2 weeks after seeding and 24 h after thawing. Results: The results indicate that PCL-PLA fibre mats are biocompatible with MSCs (viability higher than 82%). Pre-culture with sucrose before freezing as well as its addition to DMSO-containing freezing medium significantly improved cell viability after thawing. Moreover, duration of equilibration of cell-seeded fibre mats with the CPAs before freezing affected cell viability post-thaw. Discussion: We showed that it is feasible to effectively cryopreserve electrospun TECs using controlled technological steps. This work could serve as a solid background for further development of efficient cryopreservation methods for biobanking of electrospun constructs for vascular or corneal tissue engineering. Objectives: There have been discussions on effects of pleural effusion on the breathing muscles dynamics. In particular, hemidiaphragm inversion influence on the pleural pressure (PPL) and ventilation parameters has not been precisely determined. The aim of this study was to analyze changes in PPL and ventilation parameters in patients undergoing therapeutic thoracentesis (TT). Particular attention has been paid to inversion of the hemidiaphragm caused by large one-sided pleural effusion. The analysis was based on virtual experiments performed on an artificial cardio-respiratory patient (AP). Methods: TT was simulated on AP, which consists of several cooperating models of the respiratory system mechanics, gas transport and exchange, and circulation. Three scenarios were considered: a) proper work of the diaphragm, b) flattening and fixation of the hemidiaphragm due to the large amount of fluid, c) paradoxical excursion of the inverted hemidiaphragm. Results: Simulations showed that during progressive pleural fluid withdrawal significant changes in the course of PPL were observed, particularly in scenarios b and c. Paradoxical excursion of the inverted hemidiaphragm significantly influenced the alveolar oxygen partial pressure (PAO2) due to a kind of pendelluft: e.g., air flows out from the corresponding lung during inspiration and thus it flows to the lung in the hemithorax without pleural effusion. Discussion: Flattening and inversion of the hemidiaphragm have an influence on several physiological factors of which PPL and PAO2 seem to be the most important. Hence, TT may improve pulmonary system function particularly in patients with inverted hemidiaphragm. Objectives: Bone loss at implantation sites on oral cavities is a major problem for dental surgeons; in order to combat this issue, we developed 3 types of colagen biomaterial blends: chondrohitin sulfate, carbon nanotubes, and electric stimulated. Methods: Bovine colagen type I was dissoluted at 4% in formic acid 0,1M (Synth - Brazil) and divided in 4 groups: A- with Chondroitin Sulphate (Sigma Aldrich); B - carbon nanotubes suspention (Sigma Aldrich); C- eletric field ; D - control group. All of the samples were crosslinked with NHS (N-hydroxysuccinimide esters) (Thermo Scientific-USA) and freeze dried at a LH2000 equipment (Terroni - Brazil). The samples were analized by: SEM; EDS; XPS; Bartha respirometry and FET. Results: All of the samples have the same macroscopic morphology. The SEM of the group submitted to electric field shows organization of the colagen fibers. The EDS shows atomic content of carbon, oxygen, and nitrogen with other substances Discussion: The absence of contaminants within the samples and the increase in stiffness exhibit the compatibility of this material for use in bone augmentation in implantology. The material is shown to be not toxic, however more tests should be conducted prior to human use. Objectives: The optimization of the long term storage of cells and tissues is a challenging process with many variables but one factor is often overlooked: the freezing device itself. There are freezing containers that have to be placed in a -80 degrees C freezer and the manufacturer promises a cooling rate of 1 K/min. On the other hand there are controlled rate freezers where cooling rates from 0.1 K/min up to 50 K/min are promised. In this study we compared two commercially available freezing containers and four controlled rate freezers with respect to their functioning principle. Furthermore, we investigated the accuracy of the adjusted cooling rate and the nucleation temperature of the samples. Methods: Seven 1.5 ml cryovials filled with 1 ml 0.9% (w/v) sodium chloride solution were dispersed evenly over the rack of each freezing device. Constantan thermocouples (type T) connected to a RedLab device were placed in the middle of the solution of each cryovial to record temperatures every second with the respective software. The cooling rates were calculated from the melting point (-0.6 degrees C) of the solution to -30 degrees C with n=3. For all freezing devices a cooling rate of 1 K/min was set according to the manufacturers guidelines. Results: The freezing containers had sample cooling rates between 0.5 and 0.8 K/min. All controlled rate freezers showed cooling rates similar to the programmed cooling rate of 1 K/min. Higher cooling rates resulted in increasing deviations between programmed and measured cooling rates. The nucleation temperatures of the samples in the freezing containers were mainly between 0 degrees C and -6 degrees C. However, the controlled rate freezers showed nucleation temperatures mainly in the range of -6 degrees C to -12 degrees C. Discussion: Varying definitions from each manufacturer resulted in the observed cooling rate differences of the freezing containers. Limited heat transfer accounted for the increased cooling rate deviation recorded in higher programmed cooling rates. Objectives: Patients using ventricular assist devices (VADs) still suffer from adverse events such as pump malfunctions or thromboembolic events. This can be caused by thrombi that have formed inside the pump (pump thrombus). Therefore, there is a great need to prevent such adverse events through engineering measures in the early development stage of blood pumps. Currently, a numerical model to predict thrombus sites inside VADs is still missing and the risk can only be assessed with in vitro experiments in the late development stage. A recently found model for thrombus formation at high shear rates that was derived from simple stenosis experiments promises great potential in the application in computational simulations (CFD) of VADs. Methods: In this study, advanced high resolution URANS simulations of rotational blood pumps were conducted with the flow solver of StarCCM+ (Siemens) at an operating point of 5L/min at 75 mmHg. A k- omega SST turbulence model and the sliding mesh method was applied. The existing model for predicting high shear thrombus formation was applied and compared with observations from explanted pumps. Based on these results a modification of that model is proposed that suggests a wall normal transport due to the change of shear rate in flow direction. This modification was realized in the CFD by applying a correlation between the computed direction of the pressure gradient and the flow direction. Results: The application of the model shows that thrombus sites are overpredicted in rotational blood pumps when compared with experimental results or observations from explanted pumps. However, with a modification of the model which proposes that the influence is a wall normal transport due to a change in shear rate, a good agreement was found. Discussion: Since there is little data available in the literature that shows the position of pump thrombi the validity of these models remains unclear and has to be experimentally evaluated further. Objectives: Cryptogenic stroke is the cause of 40% of ischaemic acute cerebrovascular events. Study aim was to evaluate the recurrence of ischaemic cerebrovascular events in patients successfully treated by percutaneous closure of patent foramen ovale (PFO). Methods: From February 2004 to January 2019, 314 symptomatic (243 stroke, 71 TIA) patients, (153 M 161 F; mean age 41 yrs, range 10-69) underwent percutaneous closure of PFO. 151 patients/314 (48%) had concomitant migraine, 90 (60%) with aura. 7 different occluder devices were implanted by transesophageal echocardiography, for a total of 317 implants. During follow-up all patients underwent clinical (Rankin modified scale) and quality of life (SF36) evaluations, transcranial Doppler (TCD), trans-thoracic echocardiography, and MRI. Cerebral and angio-MR assessed the degree of lesions by quantitative and qualitative comparative analysis performed before and after treatment. Sizes of lesions were measured by manual segmentation on the axial, coronal and sagittal images acquired. Results: Successful device deployment was achieved in 99% of pateints; patients were discharged home within 3 days. Follow-up was 100% complete (median 55.4, range 1-178 months). At 6 months, Rankin scale was 0 (p<0.0001) in 230 patients (95%) affected by stroke and 10 patients reached score 1. Quality of life improved significantly (P<0.0001). In 101/151 patients (67%) with migraine, intensity and frequency of attacks significantly decreased (P<0.0001). TCD showed residual microembolic signals in 10 patients, 3 patients required secondary successful treatment for an associate defect. TTE (after 1, 3, 6, 12 months and once a year for 5 years) showed optimal sealing of all devices without signs of erosion, incomplete closure and thrombus. In 265 patients cerebral MRI showed no new lesions at 2 years. Discussion: Our 15 year experience suggests that percutaneous treatment of PFO is safe and beneficial for secondary prevention of recurrence of acute cerebrovascular events irrespective of the device used. Objectives: Endovascular stent grafting is the standard treatment for patients with acute traumatic aortic rupture with extensive associated lesions. Very little long term information is available in large series. Methods: From March 1999 to September 2018, 83 patients (72 M and 11 F; mean age: 37.25 +/- 13.46;range 16 to 69) admitted with acute or chronic traumatic aortic lesions underwent endovascular repair. 60 cases had acute traumatic aortic rupture, due to road accidents in 69 patients and accidental falls in 3 patients. All procedures were carried out in the angiography suite. Left subclavian artery was always identified. Patients were followed-up in the out-patient clinic and by yearly angio CT-scan with regard to survival and complications. The follow-up was 100% complete. Results: Endovascular stent-graft treatment was successful in all cases of acute or chronic aortic injury. No post-operative paraplegia occurred. Control angiography showed optimal sealing and complete exclusion of the pseudo-aneurysm from blood flow with no primary endoleak. Patients underwent treatment of all associated lesions later on during hospital stay. Two patients died in the hospital: 1 patient of cerebral haemorrhage and 1 patient of sepsis. During the follow-up 5 patients died (survival: 91.4%) for causes unrelated to the aortic procedure. no cases of perigraft leakage or aortic disruption were detected. During follow-up 1 patient had a steal syndrome and 1 patient paraplegia due to the covering of the left subclavian artery by endovascular graft. 4 years after treatment 1 patient had inner thrombosis of the graft developing a gradient; a new endovascular stent graft was deployed successfully. Freedom from complications was 92.3%. Discussion: The outcomes over 20 years of follow-up proves that endovascular stent graft repair is the first choice treatment in patients with traumatic aortic injuries. Our experience demonstrates the feasibility and safety of endovascular treatment including patients with extensive associated injuries. Objectives: In vitro simulation of an in vivo environment for human stem cell research is crucial for any kind of biomedical purpose. While important factors like 3D-cultivation and physiological oxygen concentrations gain more attention in the scientific community, we still lack reliable methods to visualize the hypoxic response of cells in 2D and 3D in vitro systems. In this study we present human adipose-derived MSCs, modified with a genetically encoded hypoxia-sensor. Methods: We used a lentiviral system to stably integrate the genetic construct into the chromosomal DNA of mesenchymal stem cells. To investigate the features of this novel biosensor we cultivated our cells in a 2D- and 3D-environment under various oxygen levels and evaluated the outset of biosensor-fluorescence via microscopy and flow cytometry. Results: The hypoxia sensor was successfully integrated in mesenchymal stem cells and could easily be induced by cultivating the cells in a hypoxic condition. MSCs, modified with hypoxia biosensors could be cultivated up to passage 20. Trilineage differentiation of MSCs (adipogenous, osteogenous and chondrogenouse differentiation) was also preserved by the cells after transfection. Using these cells we could monitor which 3D-cultivation conditions lead to hypoxic response of MSCs. Discussion: Our findings can help to improve our understanding of the influence of cultivation conditions on in situ oxygen concentrations. Moreover, by choosing the right 3D cultivation system, MSC can be cultivated in vitro under physiological hypoxic conditions. Objectives: Heart failure with reduced Ejection Fraction (HFrEF) is a progressive disease with a low 5-year survival of <50%, which affects 23 million people worldwide. It is characterized by adverse remodeling of the left ventricle (dilated cardiomyopathy) due to an increase in filling pressures and myocardial wall stress. Pharmacological treatment and cardiac resynchronisation therapy have proven beneficial for survival. For patients with end-stage heart failure, a heart transplant or Left Ventricular Assist Device can be considered. A shortage of donors, patient selection and major downsides such as invasiveness and driveline infections limit the use of these treatments. Research has shown a 13% decrease in mortality for every 5% increase in left ventricular ejection fraction. Therefore, we developed a smart memory alloy configuration in order to increase the ejection fraction and obtain an increase of 3,5% in a bench model. To cope with ongoing left ventricular dilatation and rise in wall stress, this should be combined with adjustable and measurable ventricular restraint therapy. Our first aim is to measure local wall stress during a full cardiac cycle. Next, we aim to develop a mathematical model of the left ventricle to characterize the left ventricle in HFrEF patients. Methods: We will characterize in vivo wall stresses during the full cardiac cycle using Transesophageal Echocardiography and a left ventricular pressure catheter in 10 patients undergoing cardiac surgery for heart failure. With these parameters, we will develop a simplified mathematical model of the left ventricle and we will improve our bench model for experimental testing. Results: This research will provide a characterization of the weakened left ventricular wall and the determination of optimal smart material properties and configuration of the cardiac assist device. Discussion: With this information, a patient-specific HFrEF treatment device will be developed combining active cardiac support and restraint therapy. Objectives: Clinical data on the hemocompatibility of membranes used in double filtration lipoprotein apheresis (LP) is virtually unavailable. The present trial compared the hemocompatibility of a recently introduced polyethersulfone (PES) based plasma fractionator membrane, FractioPES (R) 200, to an ethylene-vinyl alcohol copolymer (EVAL) membrane during LP. Methods: In a prospective, randomized, controlled, crossover trial, eight patients on routine LP were subjected to one treatment with PES plasma (0.6 m(2), 3M PlasCure (R) 0.6) and fractionation (1.9 m(2), 3M SelectiCure (R) H19) membranes and one control treatment using a set of EVAL membranes (0.5 m(2), Asahi Plasmaflo OP-05W; 2.0 m(2), Asahi Cascadeflo EC-50W). Intraindividual treatment conditions were kept identical. At defined times, samples were drawn at different sites of the extracorporeal blood and plasma circuit to measure white blood cell (WBC) and platelet (PC) counts, complement factor C5a and thrombin-anti-thrombin III (ATIII). Results: With a nadir at 25 min, WBC in EVAL decreased to 34 % of baseline vs. 64 % at 20 min in PES (P<0.001). PC only marginally decreased over time with both membrane types. Maximum C5a in venous blood was 30.0 +/- 11.2 mu g/L at 30 min with EVAL and 14.0 +/- 12.8 mu g/L at 25 min with PES (P<0.001). Compared to PES (23.3 +/- 15.2 at 5 min and 16.9 +/- 12.3 at 20 min, resp.), highest C5a concentrations were found in plasma after the EVAL plasma (56.1 +/- 22.0 mu g/L at 10 min; P<0.001) and fractionation filters (50.6 +/- 19.4 mu g/L at 30 min; P<0.001). ATIII levels did not rise until the end of the treatment without differences between membranes. Regarding Lp(a), LDL and HDL removal, both membrane sets performed equally (PES, 69.8 +/- 5.7, 64.9 +/- 8.8, and 17.4 +/- 13.6 %, resp., vs. EVAL, 69.5 +/- 6.0, 65.2 +/- 6.9, and 18.2 +/- 7.3 %, resp.). Discussion: Compared to EVAL, PES membranes are more beneficial with respect to the classical hemocompatibility of extracorporeal treatment procedures, namely leukocyte and complement system activation. Objectives: Mechanical circulatory support (MCS) has become a standard therapy for adult end-stage heart failure patients. For pediatric patients, technological development lags behind with no currently approved implantable rotary blood pump. As an alternative, the HeartWare HVAD, originally designed for adults, is increasingly used in pediatric patients. The aim of this multicenter study was to assess in-silico, in-vitro and in-vivo the blood trauma potential of this pump in pediatric application. Methods: Blood trauma potential of the HVAD was investigated in-silico and in-vitro at an adult and pediatric operating point (5L/min and 2.5L/min at 2800rpm and 2200rpm, respectively). The flow was simulated by computational fluid dynamics and analyzed regarding flow structures, shear stresses and washout. Hemolysis was assessed with pumps circulating bovine blood in a temperate flow circuit. Clinical outcome and indicators for in-vivo blood trauma were investigated retrospectively in 14 pediatric HVAD patients (age 11.3 +/- 4.8years). Results: In the pediatric conditions, simulations predicted elevated mechanical stress profile below 50mPa, more stagnant flow field, with longer washout times within the pump. In-vitro measurements revealed an increased normalized index of hemolysis (NIH = 17.5 mg/100L vs. 8.2 mg/100L, (p=0.0021)). In the retrospective in vivo analysis, LDH and D-Dimer values were 1.5 and 3-fold elevated, respectively, compared to adult HVAD patients. Major bleedings were observed in 42.9%, suspected pump thrombosis and neurologic dysfunction in 14.3% of all patients. Discussion: The HVAD, operated at lower speeds and flows, induces elevated blood trauma. These results highlight the need for specifically adapted ventricular assist devices, optimized for the pediatric population. Further studies are required to assess the clinical implications of these findings. Objectives: Native arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, but it still has high rate of failure due to stenosis formation. Convincing evidence supports a key role of local hemodynamics in vascular remodeling, suggesting that disturbed flow conditions may be related to stenosis development. The purpose of our investigation was to explore the feasibility of coupling non-contrast enhanced MRI and high-resolution computational fluid dynamics (HR-CFD) to relate morphological vessel changes to local hemodynamics in AVF over time. Methods: We acquired non-contrast enhanced 3D fast spin echo MRI (CUBE T1) at 1 and 6 weeks, 6 months and 1 year after radio-cephalic AVF creation in one patient. We generated 3D models and evaluated lumen cross-sectional area changes over time. We perfomed CFD simulations using pimpleFoam solver of OpenFoam, prescribing blood flow waveforms derived by Ultrasound examination. We computed the 2 components of the wall shear stress vector over time, namely WSSdir, the component in the mean direction of the WSS vector and WSStr, the transversal component. Results: We observed a dilatation of the vein until 6 months, with a more pronounced increase in the venous outflow as compared to the juxta-anastomotic vein (JAV). The increase in vein's diameter was then followed by a narrowing of JAV at 1 year after AVF surgery. We found high-frequency fluctuations both for WSSdir and WSStr components, in different locations of the vein, at 6 weeks and 6 months after AVF creation. Oscillations of both components damped at 1 year after AVF creation, as a result of vessel remodeling. Discussion: Optimized CUBE T1, coupled with HR-CFD, allowed a characterization of morphological and hemodynamic changes over time. Our MRI-to-CFD pipeline represents a promising approach to elucidate mechanisms of local vascular remodeling and can be used for clinical investigations aimed at identifying critical hemodynamic factors responsible for AVF failure. Objectives: For 30 years, the mortality rate of patients hospitalized in intensive care unit has been drastically reduced. But an increase in muscle dysfunctions at the end of intensive care stay, leading to long term functional disability was observed at the same time. The physiological mechanism remains poorly understood due to a lack of study tools. The objective of this work is therefore to create a new tool for the tissue construction of an in vitro skeletal muscle. This tool should allow a muscle construction which mimics physiological reality, in order to model the disease more accurately. Also, it should allow mechanical and electrical stimulation in order to simulate the resumption of muscle contraction of patients. Methods: Using sol-gel process, we synthesized a new biomaterial, based on an epoxy organic-inorganic hybrid precursor (g-glycidyloxypropyltrimethoxysilane). This biomaterial was deposited as a thin layer (spin-coating process) of 7 mu m thickness on a silicone membrane suitable to undergo mechanical stretching. The biomaterial was microstructured using the UV laser writing lithography to create a line network. This line network was revealed with a 2-minute isopropanol bath and we obtained lines of 8 mu m thickness spaced of 175 mu m. To ensure a biological environment and a strong adhesion of cells on microstructured silicone support during mechanical stretching, we grafted silylated bioactive peptides using dip-coating process. Results: Muscular stem cells which were isolated from patients' quadriceps biopsy were seemed and, by immunofluorescence staining, we observed a growth of muscle fibers along the lines, mimicking the physiological organization of a muscle. Discussion: We were able to model the first stages of a complex muscle organoid in vitro using a new tool manufactured by a fast, simple and reproducible process. With the mechanical and electrical stimulation of this muscle-on-a-chip, this work should allow us to better understand these muscle dysfunctions and find new treatments. Objectives: Cryopreservation of 'ready-to-use' tissue-engineered constructs (TECs) is a promising strategy which may facilitate their future clinical application. This is very challenging and ambitious task and therefore recent efforts have been focused on developing new cryopreservation strategies for long-term storage of TECs. This work covers some practical considerations for cryopreservation of cell-free and cell-seeded scaffolds vastly differing by structure and composition. Methods: The first test system includes 3D porous collagen-hydroxyapatite (HAP) scaffolds prepared by freeze-drying and coaxial alginate macrospheres prepared by electrospraying. Samples were frozen at 1 K/min either in a bulk DMSO solution (with and without sucrose) or after removal of residual solution. After thawing, we evaluated compression (collagen-HAP scaffolds) and rheological properties (coaxial alginate macrospheres) of cell-free systems. Viability of mesenchymal stromal cells (MSCs) within both types of scaffolds was evaluated 24-h post-thaw using live-dead assay. The second test system comprises flat fiber mats (produced from polycaprolactone/polylactic acid using electrospinning) seeded with CHO cells. This system intends to develop plate electrodes for electroporation of attached cells with non-permeable cryoprotective agents (CPAs) such as sugars for future cryopreservation applications. Results: All scaffolds were cytocompatible with corresponding cell types. Freezing after removal of residual solution was superior to conventional freezing. Addition of sucrose increased cell viability (both scaffold types) and improved viscoelastic properties of coaxial macrospheres. Constructed plate electrodes provided good compromise between high cell permeabilisation and viability after electroporation with sucrose at 1.7 kV/cm electric field. Discussion: The findings suggest that it is feasible to cryopreserve cell-free and cell-seeded scaffolds using DMSO and sucrose. As a step further, there are high expectations associated with using electroporation as a mean for intracellular delivery of non-toxic CPAs towards DMSO-free cryopreservation of TECs. Objectives: Tailored Forming is a new manufacturing technology to manufacture solid components out of two or more different metals. The components are joined to a hybrid semi-finished workpiece. Afterwards, a forming process is performed to improve the materials properties. This allows creating hybrid metallic parts that are adjusted to their specific loads and their field of application in comparison to parts made out of monomaterials. The potential use case of Tailored Forming-parts is still being researched. Biomedical implants are a potential field of application. In the presented study, the contact mechanics of two potential concepts for Tailored Forming hip implants were analysed. Methods: Both concepts consist of a magnesium component that should be resorbed in the human body and leads to a better bone growth. A second component in the implants is used to absorb loads. In a numerical analysis the two implants were compared to a conventional implant. For the potential evaluation two load cases "walking" and "walking upstairs" were considered. Results: While one concept leads to higher stresses in the implant, the other concept shows almost similar stress distributions as the conventional implant and has the additional advantage of the better bone growth due to the magnesium component. Discussion: Based on this work further research on different implant concepts has to be made to give a clear statement about the potential of Tailored Forming-Implants. Objectives: In consideration of the recently published implant files, testing of medical devices has gained signifigant importance. Many medical implants are subject to normative testing during their regulatory approval process, such as stents, heart valves and blood pumps. No testing norm or standard, however, exists for regulatory approval of left atrial appendage occlusion devices. Therefore, this study aimed to establish in-vitro bench tests for LAA occlusion (LAAo) devices and compares the clinically most widely used devices. Methods: Seven different LAA occlusion systems with device diameter ranging between 22 and 34 mm were tested regarding tug force and radial force resulting in a total of 24 devices. Radial force was assessed in a commercially available tester whereas tug force was evaluated in a novel in-vitro test setup consisting of bovine tissue. Results: Significant differences in the mechanical properties of the different devices were observed. Radial force ranged between 8.6 N at maximum compression for the LAmbre 2228 device and 0.1 N for the Occlutech 27 mm implant at minimum compression. A similar variability of mechanical properties was seen in the tug test results. Values ranged from 4.6 N to 0.4 N for the Wavecrest 22 mm and the Occlutech 24 mm device, respectively, at maximum and minimum compression. Discussion: Large variations in mechanical properties were seen between the different devices. The study showed that device stability is more dependent on anchoring structures, such as hooks and barbs, than on radial force. A strong positive correlation between the number of anchoring structures per millimeter circumference of an occluder and its tug force was found (r=0.87, p < 0.01). The large variations in mechanical properties aggravate comparison of current LAA occlusion devices which underlines the need for standardized preclinical testing to prompt clinical compatibility. Objectives: Pump thrombosis is a severe adverse event in ventricular assist devices. Current therapy often involves an exchange of the entire pump. Alternative solutions must be explored to reduce surgery numbers. A protocol for in vitro lysis of LVAD specific thrombus with alteplase was established in this study. Methods: A fluid chamber of silicone tubing was filled with isotonic sodium chloride solution. An artificial human thrombus was suspended within. Alteplase was added to the system according to the maximum dose for clinical use, 0.028 mg/ml. Five experiments each were conducted for stasis and fibrin thrombi respectively. Both types were lysis tested for four and 24 hours each. Fluid samples and photographs were taken for dissolution evaluation. Results: Visual inspection of the fibrin thrombus showed clear dissolution. For the stasis thrombus, the 24 h experiment produced no discernible dissolution of the thrombi, while the thrombi investigated over the 4 h period fragmented into small pieces which did not dissolve entirely. D-dimer levels in the fibrin thrombus tests rose steadily through the alteplase treatment for both test durations (short test 12800-25600 ng/ml, long test 25600-51200 ng/ml). For the short term stasis thrombus testing, D-dimer values rose similarly to the fibrin thrombus, but levels remained much lower (short test 1600-3200 ng/ml, long test >200 ng/ml). Long term stasis thrombus tests showed no significant rise in D-dimer levels. Discussion: Alteplase was successful in dissolving fibrin thrombi in our experimental setup. D-dimer analysis supported the visual impression. The fragmentation of stasis thrombi and D-dimer levels measured may be due to the drug's fibrinolytic effect. The amount of erythrocytes in a stasis thrombus may resist lysis and produce challenges in the clinical application of thrombus lysis treatment. With this setup we were able to examine the reaction of the LVAD thrombi to Alteplase. This information can be used to further optimise clinical lysis therapy. Objectives: Methylprednisolon pulse therapy was used in the initial phase of induction therapy in some patients. This study was conducted in order to examine the short and long term effect of methylprednisolone pulse therapy for the lupus nephritis treated with muti-target therapy. Methods: The retrospective st AN - WOS:000482237900001 DA - Aug DO - 10.1177/0391398819860985 J2 - Int. J. Artif. Organs KW - Engineering, Biomedical Transplantation LA - English M1 - 8 M3 - Article N1 - ISI Document Delivery No.: IS6BU Times Cited: 1 Cited Reference Count: 0 [Anonymous] Souza, Lais/AAO-3018-2020; Coish, Elizabeth/AAU-1245-2020; Fetanat, Masoud/J-7666-2015; ARSLAN, Okan/AAA-3232-2020 Fetanat, Masoud/0000-0001-8882-9937; 1 5811 15404 SAGE PUBLICATIONS LTD LONDON INT J ARTIF ORGANS SI PY - 2019 SN - 0391-3988 SP - 386-474 ST - 46th ESAO Congress 3-7 September 2019 Hannover, Germany Abstracts T2 - International Journal of Artificial Organs TI - 46th ESAO Congress 3-7 September 2019 Hannover, Germany Abstracts UR - ://WOS:000482237900001 VL - 42 ID - 761505 ER - TY - JOUR AB - Thrombolytic treatment accelerates the dissolution of thrombus in acute pulmonary thromboembolism (PTE) and is potentially a lifesaving treatment. High-risk PTE is the clearest indication for this therapy, and its use in intermediate-risk cases is still controversial. A PTE response team may enable a rapid and effective determination of risk and treatment in these controversial clinical cases. Approved thrombolytic agents for the PTE treatment are streptokinase, urokinase, and alteplase. Currently, the most widely used agent is alteplase. It has a short infusion time (2 h) and a rapid effect. Newer, unapproved agents for the PTE treatment are tenecteplase and reteplase. The active resolution of thrombus via thrombolytic agents improves rapidly pulmonary perfusion, hemodynamic defect, gas exchange, and right ventricular dysfunction. However, it is important to determine appropriate candidates carefully, to prevent hemorrhage, which is the most important side effect of these drugs. Catheter-directed thrombolysis seems to be an alternative in patients not eligible for systemic thrombolytic therapy. PMID:31258361 DA - 2019/06 06 DB - PubMed Central DO - 10.5152/eurasianjmed.2019.19291 KW - Pulmonary embolism thrombolytic therapy fibrinolytic agents M1 - 2 PY - 2019 SN - 1308-8734 SP - 186-186 ST - Update on Thrombolytic Therapy in Acute Pulmonary Thromboembolism T2 - The Eurasian Journal of Medicine TI - Update on Thrombolytic Therapy in Acute Pulmonary Thromboembolism UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6592452 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6592452&rendertype=abstract VL - 51 ID - 762078 ER - TY - JOUR AB - PMID:33072235 DA - 2020/12 12 DB - PubMed Central DO - 10.1016/j.radcr.2020.10.001 M1 - 12 PY - 2020 SN - 1930-0433 SP - 2617-2617 ST - Point-of-care ultrasound, anchoring bias, and acute pulmonary embolism: A cautionary tale and report T2 - Radiology Case Reports TI - Point-of-care ultrasound, anchoring bias, and acute pulmonary embolism: A cautionary tale and report UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7550182&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7550182 VL - 15 ID - 762000 ER - TY - JOUR AB - Full Text Available DA - 2020/09/17 09/17 DB - J-STAGE (Japan) (English) DO - 10.7134/phlebol.20-40-6 M1 - 2 PY - 2020 SN - 0915-7395 SP - 101-232 ST - 抄録1・2日目 T2 - The Japanese Journal of Phlebology TI - 抄録1・2日目 UR - https://www.jstage.jst.go.jp/article/phlebol/31/2/31_20-40-6/_article/-char/ja/ VL - 31 ID - 762021 ER - TY - JOUR AB - PMID:32497627 DA - 2020/09 09 DB - PubMed Central DO - 10.1016/j.jvsv.2020.05.014 M1 - 5 PY - 2020 SN - 2213-333X SP - 899-899 ST - Reply T2 - Journal of Vascular Surgery. Venous and Lymphatic Disorders TI - Reply UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7263224&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7263224 VL - 8 ID - 762026 ER - TY - JOUR AB - PMID:32861692 DA - 2020/08/27 08/27 DB - PubMed Central DO - 10.1016/j.chest.2020.08.2064 PY - 2020 SN - 0012-3692 ST - Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic T2 - Chest TI - Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7450258 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7450258&rendertype=abstract ID - 762029 ER - TY - JOUR AB - PMID:32835284 DA - 2020/07/15 07/15 DB - PubMed Central DO - 10.1016/j.jaccas.2020.05.034 M1 - 9 PY - 2020 SN - 2666-0849 SP - 1391-1391 ST - Right Ventricular Clot in Transit in COVID-19 T2 - Jacc. Case Reports TI - Right Ventricular Clot in Transit in COVID-19 UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7259913&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7259913 VL - 2 ID - 762038 ER - TY - JOUR AB - PMID:32835283 DA - 2020/07/15 07/15 DB - PubMed Central DO - 10.1016/j.jaccas.2020.05.017 M1 - 9 PY - 2020 SN - 2666-0849 SP - 1383-1383 ST - Difficulties of Managing Submassive and Massive Pulmonary Embolism in the Era of COVID-19 T2 - Jacc. Case Reports TI - Difficulties of Managing Submassive and Massive Pulmonary Embolism in the Era of COVID-19 UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7236704 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7236704&rendertype=abstract VL - 2 ID - 762040 ER - TY - JOUR AB - Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD) artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG) could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI). Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI) capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35), the mean sum of ST elevation (STE) in leads V1 through V6 plus ST depression (STD) in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007). A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37), there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6) and STD (II, III, aVF) on a 12-lead ECG can be used to predict proximal LAD occlusions if performed within the first hour of symptom onset. This should be considered a high-risk finding and may prompt prehospital direction of such patients to PCI-capable hospitals. AD - University of Texas at Houston Medical School, Department of Internal Medicine--Division of Cardiology, Houston, Texas Baylor College of Medicine, Department of Surgery, Houston, Texas; Houston Fire Department, Houston, Texas University of Texas at Houston Medical School and Memorial Hermann Heart and Vascular Institute AN - 108205798. Language: English. Entry Date: 20120106. Revision Date: 20150712. Publication Type: Journal Article AU - Aaertker, Robert A. AU - Barker, Colin M. AU - Anderson, H. Vernon AU - Denktas, Ali E. AU - Giesler, Gregory M. AU - Julapalli, Vinay R. AU - Ledoux, John F. AU - Persse, David E. AU - Sdringola, Stefano AU - Vooletich, Mary T. AU - McCarthy, James J. AU - Smalling, Richard W. DB - CINAHL DO - 10.5811/westjem.2011.2.2083 DP - EBSCOhost KW - Electrocardiography Myocardial Infarction -- Diagnosis Prehospital Care Adult Aged Descriptive Statistics Female Human Male Middle Age Myocardial Infarction -- Classification Myocardial Infarction -- Mortality Pilot Studies Retrospective Design T-Tests M1 - 4 N1 - research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Emergency Care. Grant Information: Grant support was provided in part by Centocor, Lilly, SCIOS, PDL BioPharma, Medtronic-PhysioControl, and Sanofi-Aventis.. NLM UID: 101476450. PMID: NLM22224129. PY - 2011 SN - 1936-900X SP - 408-413 ST - PRehospital 12-lead electrocardiogram within 60 minutes differentiates proximal versus nonproximal left anterior descending artery myocardial infarction T2 - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health TI - PRehospital 12-lead electrocardiogram within 60 minutes differentiates proximal versus nonproximal left anterior descending artery myocardial infarction UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=108205798&site=ehost-live&scope=site VL - 12 ID - 761367 ER - TY - JOUR AB - Objective:Hospital arrival via Emergency Medical Services (EMS) and EMS prenotification are associated with faster evaluation and treatment of stroke. We sought to determine the impact of diagnostic accuracy by prehospital providers on emergency department quality measures.Methods:A retrospective study was performed of patients presenting via EMS between September 2009 and December 2012 with a discharge diagnosis of transient ischemic attack (TIA), ischemic stroke (IS), or intracerebral hemorrhage (ICH). Hospital and EMS databases were used to determine EMS impression, prehospital and in-hospital time intervals, EMS prenotification, NIH stroke scale (NIHSS), symptom duration, and thrombolysis rate.Results:399 cases were identified: 14.5% TIA, 67.2% IS, and 18.3% ICH. EMS providers correctly recognized 57.6% of cases. Compared to cases missed by EMS, correctly recognized cases had longer median on-scene time (17 vs. 15 min,p= 0.01) but shorter transport times (12 vs. 15 min,p= 0.001). Cases correctly recognized by EMS were associated with shorter door-to-physician time (4 vs. 11 min,p< 0.001) and shorter door-to-CT time (23 vs. 48 min,p< 0.001). These findings were independent of age, NIHSS, symptom duration, and EMS prenotification. Patients with ischemic stroke correctly recognized by EMS were more likely to receive thrombolytic therapy, independent of age, NIHSS, symptom duration both with and without prenotification.Conclusion:Recognition of stroke by EMS providers was independently associated with faster door-to-physician time, faster door-to-CT time, and greater odds of receiving thrombolysis. Quality initiatives to improve EMS recognition of stroke have the potential to improve hospital-based quality of stroke care. AN - 119150267. Language: English. Entry Date: 20161111. Revision Date: 20190221. Publication Type: Article AU - Abboud, Michael E. AU - Band, Roger AU - Jia, Judy AU - Pajerowski, William AU - David, Guy AU - Guo, Michelle AU - Mechem, C. Crawford AU - Messé, Steven R. AU - Carr, Brendan G. AU - Mullen, Michael T. DB - CINAHL DO - 10.1080/10903127.2016.1182602 DP - EBSCOhost KW - Emergency Medical Technicians Stroke -- Diagnosis Emergency Care Human Emergency Service Quality of Health Care -- Evaluation Retrospective Design Cerebral Ischemia, Transient -- Diagnosis Emergency Medical Services Prehospital Care Cerebrovascular Disorders Patient Assessment Tomography, X-Ray Computed Electronic Health Records Data Analysis Wilcoxon Rank Sum Test Kruskal-Wallis Test NIH Stroke Scale Scales Race Factors Ethnic Groups Stroke -- Symptoms M1 - 6 N1 - research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Instrumentation: NIH Stroke Scale. NLM UID: 9703530. PY - 2016 SN - 1090-3127 SP - 729-736 ST - Recognition of Stroke by EMS is Associated with Improvement in Emergency Department Quality Measures T2 - Prehospital Emergency Care TI - Recognition of Stroke by EMS is Associated with Improvement in Emergency Department Quality Measures UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=119150267&site=ehost-live&scope=site VL - 20 ID - 761376 ER - TY - JOUR AB - Objective: User acceptance of information technology has been a significant area of research for more than two decades in the field of information technology. This study assessed the acceptance of information technology in the context of Health Information Management (HIM) by utilizing Technology Acceptance Model (TAM) which was modified and applied to assess user acceptance of health information technology as well as viability of TAM as a research construct in the context of HIM.Methods: This was a descriptive- analytical study in which a sample of 187 personnel from a population of 363 personnel, working in medical records departments of hospitals affiliated to Tehran University of Medical Sciences, was selected. Users' perception of applying information technology was studied by a researcher-developed questionnaire. Collected data were analyzed by SPSS software (version16) using descriptive statistics and regression analysis.Results: The results suggest that TAM is a useful construct to assess user acceptance of information technology in the context of HIM. The findings also evidenced the perceived ease of use (PEOU) and perceived usefulness (PE) were positively associated with favorable users' attitudes towards HIM. PU was relatively more associated (r= 0.22, p = 0.05) than PEOU (r = 0.014, p = 0.05) with favorable user attitudes towards HIM.Conclusions: Users' perception of usefulness and ease of use are important determinants providing the incentive for users to accept information technologies when the application of a successful HIM system is attempted. The findings of the present study suggest that user acceptance is a key element and should subsequently be the major concern of health organizations and health policy makers. AD - Maryam Ahmadi, School of Health Management and Information Sciences, Iran, University of Medical Sciences Tehran, Iran, E-mail: M-ahmadi@tums.ac.ir. AN - 107789573. Language: English. Entry Date: 20150508. Revision Date: 20170415. Publication Type: journal article AU - Abdekhoda, M. AU - Ahmadi, M. AU - Dehnad, A. AU - Hosseini, A. F. DB - CINAHL DO - 10.3414/ME13-01-0079 DP - EBSCOhost KW - Attitude of Health Personnel Attitude to Computers Electronic Health Records Health Information Management Medical Informatics Academic Medical Centers Iran Health Information Management Service Questionnaires M1 - 1 N1 - research. Journal Subset: Biomedical; Computer/Information Science; Continental Europe; Europe. Special Interest: Informatics. NLM UID: 0210453. PMID: NLM24248003. PY - 2014 SN - 0026-1270 SP - 14-20 ST - Information technology acceptance in health information management T2 - Methods of Information in Medicine TI - Information technology acceptance in health information management UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=107789573&site=ehost-live&scope=site VL - 53 ID - 761340 ER - TY - JOUR AB - PURPOSE: Catheter directed thrombolysis (CDT) has recently been established as the preferred treatment in intermediate-risk pulmonary embolisms (PE). Despite acquiring the technology for CDT in July 2015, the under diagnosis of intermediate risk PE has led to under utilization of this modality in our facility. We implemented a modified pulmonary embolism response team (PERT) based on Massachusetts General Hospital's existing PERT model with aims to streamline referral process and to increase rates of referral for CDT among eligible patients. METHODS: A retrospective chart review was performed on all patients admitted with a diagnosis of PE from July 2015 to February 2017. Pre-intervention phase was from July 2015 to September 2016 and post-intervention phase was from October 2016 to February 2017. The intervention consisted of educational sessions with hospitalists and internal medicine and family medicine residents. A referral algorithm which both risk-stratified patients and directed them to appropriate therapy was created. Data was collected to risk stratify patients into “high risk”, “intermediate risk” or “low risk” based on hemodynamic stability and evidence of right ventricular strain. The patients that fulfilled the criteria for intermediate risk PE were assessed for CDT eligibility and the treatment modality offered was studied. RESULTS: In the pre-intervention phase, 141 patients were admitted with a diagnosis of PE. Of those, 24 were identified as intermediate-risk PE (17%). Of those 24, 3 (12.5%) received CDT and 21 (87.5%) did not. Of those patients that did not receive CDT but were potentially eligible, 1 had an absolute contraindication and 5 had relative contraindications. Thus, 15 patients (62.5%) were eligible but were not offered CDT. In the post-intervention phase from October 2016 to February 2017, 48 patients were admitted with a diagnosis of PE. Of those, 7 were identified as intermediate-risk PE (14.5%). Of those 7, 3 (42.9%) received CDT and 4 (57.1%) did not. Of those patients that did not receive CDT but were potentially eligible, 1 had an absolute contraindication and 1 had a relative contraindication. Thus, 2 patients (28.6%) were eligible but were not offered CDT. CONCLUSIONS: Despite meeting criteria for intermediate risk PE and not having contraindications to therapy, a large number of patients were not referred for CDT. This could be due to incorrect stratification of patients and inadequate knowledge on the topic. Often hemodynamically stable, these patients are frequently stratified as “low-risk.” Classic risk stratification tools such as PESI and sPESI do not take into account right ventricular dysfunction, myocardial damage, or clot burden, and therefore cannot readily identify this subset of patients. Post-intervention, we saw an increase by 33.9% for the appropriate referral of CDT. Physician education and early risk stratification is the cornerstone of appropriate management of patients with PEs. AD - A. Abdullah, Robert Packer Hospital, Sayre, PA, United States AU - Abdullah, A. AU - Winnicka, L. AU - Aung, Z. AU - Lekkala, M. AU - Duran, C. AU - Pedapati, S. AU - Norville, K. AU - Sattur, S. DB - Embase DO - 10.1016/j.chest.2017.08.1077 KW - adult animal model blood clot lysis catheter community hospital diagnosis education family medicine female general hospital heart muscle injury heart right ventricle failure hemodynamics human internal medicine lung embolism major clinical study male Massachusetts medical record review medical staff patient referral resident retrospective study risk assessment stratification LA - English M1 - 4 M3 - Conference Abstract N1 - L619297403 2017-11-22 PY - 2017 SN - 1931-3543 SP - A1044 ST - Implementation of a modified pulmonary embolism response team (PERT) in a community hospital: Targeting intermediate-risk pulmonary embolism T2 - Chest TI - Implementation of a modified pulmonary embolism response team (PERT) in a community hospital: Targeting intermediate-risk pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619297403&from=export http://dx.doi.org/10.1016/j.chest.2017.08.1077 VL - 152 ID - 760906 ER - TY - JOUR AB - Objective: Catheter-directed interventions (CDIs) are increasingly performed for acute pulmonary embolism (PE). The evolving catheter types and treatment algorithms have an impact on the utilization and outcomes of these interventions. This study aimed to investigate the changes in CDI practice and its impact on outcomes. Methods: Patients who underwent CDIs for PE between 2009 and 2018 were included from a prospectively maintained database. A PE team was launched in 2012, and in 2014, it was established as an official PE response team. CDI annual use trends and clinical failures were recorded. Clinical failure was defined as major bleeding, perioperative stroke or other major procedure-related adverse event, decompensation for submassive PE or persistent shock for massive PE, need for surgical thromboembolectomy, or death. Major bleeding was defined as requiring a blood transfusion or a surgical intervention or suffering from an intracranial bleed. Results: During the study period, 328 patients received a CDI for acute PE (age, 59.1 ± 15.4 years; male, 164 [50.0%]; submassive PE, 300 [91.5%]). Catheter utilization showed a steep increase in the early years of the PE response team, peaking in 2016 with a gradual decline in 2017 and 2018. Ultrasound-assisted thrombolysis was the predominant CDI technique, peaking at 84% of all CDIs in 2014. Suction thrombectomy utilization peaked at 15.2% of CDIs in 2018. Mean alteplase dose decreased from 26.8 ± 12.5 mg in 2013 to 13.9 ± 7.5 mg in 2018 (P <.001). Mean lysis time decreased from 17.2 ± 8.3 hours in 2013 to 11.3 ± 8.2 hours in 2018 (P <.001). Clinical failure for the entire and the submassive PE cohorts was 11.9% and 8.7%, respectively; the major bleed rate was 7.0% and 5.7%. There was no statistically significant difference in adverse events during the years. However, there were two major peaks: one in 2012-2013, mirroring our technical learning curve; and one in 2016, coinciding with our highest annual volume and mirroring a potentially inappropriate selection of patients. The 2018 peak was primarily derived from benign blood transfusions for acute blood loss during suction thrombectomy (Table). Conclusions: CDIs for acute PE have rapidly evolved with high success rates. However, appropriate center expertise is essential for the success of catheter interventions, given the associated learning curves. [Formula presented] AU - Abou Ali, A. AU - Saadeddin, Z. AU - Al-Khoury, G. AU - Rivera-Lebron, B. AU - Toma, C. AU - Maholic, R. AU - Chaer, R. AU - Avgerinos, E. DB - Embase DO - 10.1016/j.jvsv.2019.12.035 KW - alteplase adult algorithm blood transfusion brain hemorrhage catheter conference abstract controlled study human learning curve major clinical study male middle aged prospective study pulmonary embolism response team sonothrombolysis suction surgery surgical thrombectomy treatment failure LA - English M1 - 2 M3 - Conference Abstract N1 - L2004645573 2020-02-06 PY - 2020 SN - 2213-3348 2213-333X SP - 322-323 ST - Evolution and Use of Catheter-Directed Interventions for Acute Pulmonary Embolism T2 - Journal of Vascular Surgery: Venous and Lymphatic Disorders TI - Evolution and Use of Catheter-Directed Interventions for Acute Pulmonary Embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004645573&from=export http://dx.doi.org/10.1016/j.jvsv.2019.12.035 VL - 8 ID - 760593 ER - TY - JOUR AB - Introduction. - Management of vertebral artery-posterior inferior cerebellar artery convergence (VA-PICA) saccular aneurysms requires a specialized neurovascular team. The objective is to preserve the functional outcome while performing a complete and reliable long-term exclusion of the aneurysm. Objective. - The aim of our study was to evaluate the outcome of patients with VA-PICA saccular aneurysms after treatment. Materials and methods. - This was a retrospective series of 21 consecutive patients with a VA-PICA saccular aneurysm treated between 2000 and 2012 at our institution. Treatment option (endovascular or microsurgical) was decided for each patient following a multidisciplinary discussion. Results. - Twenty-one patients were treated for a VA-PICA saccular aneurysm including 16 for a ruptured aneurysm and 5 for an asymptomatic aneurysm. Among all patients, 11 underwent endovascular treatment and 10 had microsurgical treatment. Our results showed a major aneurysm recurrence after endovascular treatment in 3 patients that required a further endovascular treatment in 2 cases. These 3 major recurrences occurred after treatment of a ruptured aneurysm when the initial angiography demonstrated the origin of the PICA at the neck of the aneurysm. After microsurgery, angiography showed a remnant neck in 2 patients including 1 treated by further endovascular procedure. Conclusion. - VA-PICA aneurysms are rare and require multidisciplinary management. Microsurgical treatment should be discussed when the PICA originates from the aneurysmal neck, particularly in patients with a ruptured small aneurysm, in order to obtain a reliable and long-term exclusion of the aneurysm. (C) 2016 Elsevier Masson SAS. All rights reserved. AD - [Aboukais, R.; Zairi, F.; Bourgeois, P.; Lejeune, J. -P.] Lille Univ Hosp, Dept Neurosurg, Rue E Laine, F-59037 Lille, France. [Boustia, F.; Leclerc, X.] Lille Univ Hosp, Dept Neuroradiol, Rue E Laine, F-59037 Lille, France. Aboukais, R (corresponding author), Lille Univ Hosp, Dept Neurosurg, Rue E Laine, F-59037 Lille, France. rabihdoc@hotmail.com AN - WOS:000377843900002 AU - Aboukais, R. AU - Zairi, F. AU - Boustia, F. AU - Bourgeois, P. AU - Leclerc, X. AU - Lejeune, J. P. DA - Apr DO - 10.1016/j.neuchi.2015.12.002 J2 - Neurochirurgie KW - PICA Aneurysm Endovascular Microsurgery INTRACRANIAL ANEURYSMS CEREBRAL ANEURYSMS COIL EMBOLIZATION RISK-FACTORS RUPTURE MANAGEMENT RECANALIZATION Clinical Neurology Surgery LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: DO5SU Times Cited: 1 Cited Reference Count: 38 Aboukais, R. Zairi, F. Boustia, F. Bourgeois, P. Leclerc, X. Lejeune, J. -P. Zairi, Fahed/0000-0003-4158-8798 1 0 3 MASSON EDITEUR MOULINEAUX CEDEX 9 NEUROCHIRURGIE PY - 2016 SN - 0028-3770 SP - 72-77 ST - Vertebral artery-posterior inferior cerebellar artery convergence aneurysms treated by endovascular or surgical treatment: Mid- and long-term outcome T2 - Neurochirurgie TI - Vertebral artery-posterior inferior cerebellar artery convergence aneurysms treated by endovascular or surgical treatment: Mid- and long-term outcome UR - ://WOS:000377843900002 VL - 62 ID - 761711 ER - TY - JOUR AB - BACKGROUND: In recent years, the multidisciplinary approach has become an important concern for the management of intracranial aneurysms. OBJECTIVE: This study aims to evaluate the functional outcomes of patients treated for an intracranial aneurysm (ruptured or unruptured), when the treatment modality was defined in a multidisciplinary fashion. MATERIALS AND METHODS: In this retrospective study, we included all patients (n=209) treated for an intracranial saccular aneurysm at Lille university hospital between January 2009 and December 2009. There were 70 men and 139 women with a mean age of 50.5 years (range 24 to 73 years). The clinical data were recorded before treatment including the American Society of Anesthesiology (ASA) and the World Federation of Neurosurgical Societies (WFNS) scores. Microsurgical approach was performed in 110 patients whereas 99 patients underwent an endovascular procedure. A modified Rankin Scale (mRS) was reported at 3 months after treatment. Intracranial vascular imaging was performed before and immediately after the treatment and then renewed at 3 years in all patients to detect any recurrence. RESULTS: Among the 121 patients with ruptured aneurysm, the functional outcomes were similar between patients who underwent microsurgery and patients who had an endovascular treatment. In the 88 patients with an unruptured aneurysm, functional outcomes were also similar between the two treatment modalities. Among the 99 patients treated by the endovascular approach, 4 had a significant aneurysm reopening on follow-up imaging leading to additional treatment (3 clipping, 1 coiling). No aneurysm recurrence was reported among the 110 patients who underwent microsurgical treatment. CONCLUSION: In a trained team, the multidisciplinary approach appears to be a valuable strategy in the management of intracranial aneurysms, to achieve good functional outcomes. AD - Department of neurosurgery, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France. Electronic address: rabihdoc@hotmail.com. Department of neurosurgery, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France. Department of neuroradiology, Lille university hospital, rue E.-Laine, 59037 Lille cedex, France. AN - 25245925 AU - Aboukais, R. AU - Zairi, F. AU - Thines, L. AU - Aguettaz, P. AU - Leclerc, X. AU - Lejeune, J. P. DA - Dec DO - 10.1016/j.neuchi.2014.06.010 DP - NLM ET - 2014/09/24 J2 - Neuro-Chirurgie KW - Adult Aged Female France Hospitals, University Humans Intracranial Aneurysm/*surgery Male Middle Aged *Patient Care Team Retrospective Studies Young Adult Aneurysm Anévrisme Clippage Clipping Endovasculaire Endovascular Microchirurgie Microsurgery LA - eng M1 - 6 N1 - 1773-0619 Aboukais, R Zairi, F Thines, L Aguettaz, P Leclerc, X Lejeune, J-P Evaluation Study Journal Article France Neurochirurgie. 2014 Dec;60(6):283-7. doi: 10.1016/j.neuchi.2014.06.010. Epub 2014 Sep 20. PY - 2014 SN - 0028-3770 SP - 283-7 ST - Multidisciplinary management of intracranial aneurysms: The experience of Lille university hospital center T2 - Neurochirurgie TI - Multidisciplinary management of intracranial aneurysms: The experience of Lille university hospital center VL - 60 ID - 760327 ER - TY - GEN AB - While systemic intravenous thrombolysis decreases mortality in patients with high-risk pulmonary embolism (PE), it clearly increases haemorrhagic risk. There... AU - Abraham, Paul AU - Arroyo, Diego A. AU - Giraud, Raphael AU - Bounameaux, Henri AU - Bendjelid, Karim DA - 2018/01/01 DB - Federal Science Library - Canada KW - Studies Heart attacks Pulmonary arteries Embolisms Mortality Systematic review Thromboembolism Health risk assessment Patients Drug dosages Age Catheters PY - 2018 SN - 2053-36242398-595X ST - Understanding haemorrhagic risk following thrombolytic therapy in patients with intermediate-risk and high-risk pulmonary embolism: a hypothesis paper TI - Understanding haemorrhagic risk following thrombolytic therapy in patients with intermediate-risk and high-risk pulmonary embolism: a hypothesis paper UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwlV3dS8MwEA86UHzx-2M6R3zyxUrbdP3wTWRjIgqKA99K0iRssnWj3ZD9I_693qXdmOJgewwJ15K7_HKX-yKEube29QcTAjfUkQwSlUjliATsIkclNncTySQLJdqNnQ5rfngvr5gaY_3v0HeYb5pKdbMxcBfg1TiaGpugFoUYzvXWbi28r8BdbtpzuSBnFuC0VxYdWkIFLhcx-Px9PWGUZgKq3xL1k5Wo29pb84_3yW6pb9L7QkAOyIZKD8n2c-lRPyLfncXsFtrlGHmbdTkAIsWwc6pBUIZfOIcdFQZi2J8CKVrkbU1pL6Vladac4psuxfoTmclHGSvLUADSFKsiF6PRpA-Sz7MpVUislw_uKKfd6QhTwfJeDuRGKjsmnVbz_aFtlb0aLFAhPcQpT_tMulooU-LGY4nDA8FsTwqphcuDBmeBloIL4fqRKaITsChBt6Efas5OSCUdpuqM0Ij5ynECHywf7UnpCLuhBPewyZbwQ7tRJdfAqHhUVOOIjRXD_Ljc5hi3OS62uUpuZsxccfmM4astr82EIi4Pfo5dPSPARDCSq-RqPg1HFv0wPFXDCa7BtogY_lAlp4Uwzb_nRgCKgPnn6_36BdmBUViEk9dIZZxN1CXZ0nnfErmug63w-FQ37w11c0x-AEb-EFU VL - 5 ID - 762110 ER - TY - JOUR AB - BACKGROUND: Current guidelines recommend door-to-balloon times of 90 min or less for patients presenting to the emergency department (ED) with ST-segment elevation myocardial infarction (STEMI). OBJECTIVES: To determine if a clinical pharmacist for the ED (EPh) is associated with decreased door/diagnosis-to-cardiac catheterization laboratory (CCL) time and decreased door-to-balloon time. METHODS: A retrospective observational cohort study of ED patients with STEMI requiring urgent cardiac catheterization was conducted. Blinded data collection included timing of ED and CCL arrival, diagnostic electrocardiogram (ECG), and balloon angioplasty. For cases diagnosed after ED arrival, diagnosis time was substituted for door time. Diagnosis was the time ST elevations were evident on serial ECG. EPh present and not-present groups were compared. During the study period there were two EPhs and presence was determined by their scheduled time in the ED. Univariate and multivariate analyses was used to detect differences. RESULTS: Multivariate analysis of 120 patients, controlled for CCL staff presence and arrival by pre-hospital services, determined that EPh presence is associated with a mean 13.1-min (95% confidence interval [CI] 6.5-21.9) and 11.5-min (95% CI 3.9-21.5) decrease in door/diagnosis-to-CCL and door-to-balloon times, respectively. Patients were more likely to achieve a door/diagnosis-to-CCL time≤ 30 min (odds ratio [OR] 3.1, 95% CI 1.3-7.8) and≤ 45 min (OR 2.9, 95% CI-1.0, 8.5) and a door-to-balloon time≤ 90 min (OR 1.9, 95% CI 0.7-5.5) more likely when the EPh was present. CONCLUSIONS: EPh presence during STEMI presentation to the ED is independently associated with a decrease in door/diagnosis-to-CCL and door-to-balloon times. AD - Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA. AN - 20813484 AU - Acquisto, N. M. AU - Hays, D. P. AU - Fairbanks, R. J. AU - Shah, M. N. AU - Delehanty, J. AU - Nobay, F. AU - Guido, J. AU - Haas, C. E. C2 - Pmc3000870 C6 - Nihms216561 DA - Apr DO - 10.1016/j.jemermed.2010.06.011 DP - NLM ET - 2010/09/04 J2 - The Journal of emergency medicine KW - Acute Disease Adult Aged *Angioplasty, Balloon, Coronary Emergency Service, Hospital/*organization & administration/statistics & numerical data Female Humans Male Middle Aged Multivariate Analysis Myocardial Infarction/*therapy Patient Care Team/*organization & administration Pharmacy Service, Hospital/*organization & administration Retrospective Studies Time Factors LA - eng M1 - 4 N1 - 0736-4679 Acquisto, Nicole M Hays, Daniel P Fairbanks, Rollin J Terry Shah, Manish N Delehanty, Joseph Nobay, Flavia Guido, Joseph Haas, Curtis E 1K08EB009090/EB/NIBIB NIH HHS/United States K08 EB009090/EB/NIBIB NIH HHS/United States K23 AG028942/AG/NIA NIH HHS/United States L30 LM008899/LM/NLM NIH HHS/United States K08 EB009090-01A1/EB/NIBIB NIH HHS/United States K23 AG028942-04/AG/NIA NIH HHS/United States L30 LM008899-01/LM/NLM NIH HHS/United States 1K23AG02894201/AG/NIA NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't J Emerg Med. 2012 Apr;42(4):371-8. doi: 10.1016/j.jemermed.2010.06.011. Epub 2010 Sep 2. PY - 2012 SN - 0736-4679 (Print) 0736-4679 SP - 371-8 ST - The outcomes of emergency pharmacist participation during acute myocardial infarction T2 - J Emerg Med TI - The outcomes of emergency pharmacist participation during acute myocardial infarction VL - 42 ID - 760317 ER - TY - JOUR AB - Advances in interventional cardiology, particularly in better efficacy and safety of drug-eluting stents, have made percutaneous coronary revascularisation practical for most patients requiring revascularisation. While this has reduced the perceived need for coronary bypass surgery, it has also focused attention on the appropriate use of coronary stents and the complexity of choosing the right revascularisation strategy. To achieve the best outcomes, it would seem that collaboration rather than competition between cardiac surgeons and interventional cardiologists is necessary. AD - Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. mark.adams@email.cs.nsw.gov.au AN - 23324088 AU - Adams, M. R. DA - Jan DO - 10.1111/imj.12020 DP - NLM ET - 2013/01/18 J2 - Internal medicine journal KW - Cardiology/classification/trends Cooperative Behavior Coronary Artery Bypass/statistics & numerical data Coronary Disease/surgery/therapy Coronary Restenosis/prevention & control Drug-Eluting Stents Follow-Up Studies Humans Meta-Analysis as Topic Multicenter Studies as Topic Myocardial Revascularization/*methods/statistics & numerical data Patient Care Team Percutaneous Coronary Intervention/methods/statistics & numerical data Postoperative Complications/epidemiology Practice Guidelines as Topic Randomized Controlled Trials as Topic Treatment Outcome LA - eng M1 - 1 N1 - 1445-5994 Adams, M R Journal Article Review Australia Intern Med J. 2013 Jan;43(1):18-22. doi: 10.1111/imj.12020. PY - 2013 SN - 1444-0903 SP - 18-22 ST - Coronary artery revascularisation: selecting the appropriate strategy T2 - Intern Med J TI - Coronary artery revascularisation: selecting the appropriate strategy VL - 43 ID - 760525 ER - TY - JOUR AB - INTRODUCTION: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD) artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG) could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI). Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI) capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. METHODS: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. RESULTS: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n = 35), the mean sum of ST elevation (STE) in leads V1 through V6 plus ST depression (STD) in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P = 0.007). A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n = 37), there was no significant difference in ST-segment deviation between the 2 groups. CONCLUSION: The sum STE (V1-V6) and STD (II, III, aVF) on a 12-lead ECG can be used to predict proximal LAD occlusions if performed within the first hour of symptom onset. This should be considered a high-risk finding and may prompt prehospital direction of such patients to PCI-capable hospitals. AD - University of Texas at Houston Medical School, Department of Internal Medicine-Division of Cardiology, Houston, Texas. AN - 22224129 AU - Aertker, R. A. AU - Barker, C. M. AU - Anderson, H. V. AU - Denktas, A. E. AU - Giesler, G. M. AU - Julapalli, V. R. AU - Ledoux, J. F. AU - Persse, D. E. AU - Sdringola, S. AU - Vooletich, M. T. AU - McCarthy, J. J. AU - Smalling, R. W. C2 - PMC3236158 required to disclose all affiliations, funding sources, and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none. DA - Nov DO - 10.5811/westjem.2011.2.2083 DP - NLM ET - 2012/01/10 J2 - The western journal of emergency medicine LA - eng M1 - 4 N1 - 1936-9018 Aertker, Robert A Barker, Colin M Anderson, H Vernon Denktas, Ali E Giesler, Gregory M Julapalli, Vinay R Ledoux, John F Persse, David E Sdringola, Stefano Vooletich, Mary T McCarthy, James J Smalling, Richard W Journal Article West J Emerg Med. 2011 Nov;12(4):408-13. doi: 10.5811/westjem.2011.2.2083. PY - 2011 SN - 1936-900X (Print) 1936-900x SP - 408-13 ST - Prehospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction T2 - West J Emerg Med TI - Prehospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction VL - 12 ID - 760478 ER - TY - JOUR AB - Background: Fetal mediastinal teratomas can be associated with compression of intrathoracic structures and can present with nonimmune fetal hydrops (NIFH) and/or respiratory distress in the newborn. Ex-utero intrapartum therapy (EXIT procedure) is a newer modality of multidisciplinary management of complex fetal anomalies with potential respiratory compromise after birth. We report a case of a large mediastinal teratoma in a fetus with large pericardial effusion and NIFH, which was successfully managed at birth by EXIT procedure. Case: A 31-year-old female at 29-weeks gestational age, was transferred to our institution for further management in view of abnormal obstetric ultrasound. A fetal echocardiogram (FE) performed revealed a large pericardial effusion (PE) occupying nearly 50% of the thoracic area in the short axis views of the chest. The lungs were compressed toward the posterior thoracic cavity by the large PE. There was no pleural effusion or ascites. A large mass with variegated echogenicity was seen in the superior mediastinum extending down into the anterior mediastinum. There were no obvious structural congenital heart defects. The ductus venosus and umbilical venous Doppler were normal. The fetus was closely followed weekly. A follow up FE performed at 31 weeks of gestation revealed signs of NIFH in the form of new onset ascites and subcutaneous edema in the scalp and in the trunk. There was a pulsatile umbilical venous Doppler pattern. Decision-Making: EXIT procedure with a multidisciplinary team was soon performed as follows. A C-section was done and baby's head, shoulder and chest were delivered. The infant was intubated and a sternotomy performed, pericardial effusion drained and the large mediastinal mass removed. The lungs subsequently expanded well. Placental circulation was maintained for 2 hours during this procedure with no adverse events in either the mother or the child. Conclusions: To our knowledge this is the first case to be described of a large mediastinal teratoma and severe pericardial effusion in a fetus in whom an EXIT procedure was safely performed. The placental circulation acts as a natural maternal “cardiopulmonary bypass” during this procedure. AD - A. Agarwal AU - Agarwal, A. AU - Rosenkranz, E. AU - Swaminathan, S. DB - Embase DO - 10.1016/S0735-1097(17)35610-3 KW - adult animal model ascites case report child congenital heart malformation decision making ductus venosus echocardiography female fetus fetus hydrops follow up gestational age head human infant lung mediastinum mass pericardial effusion placenta circulation pleura effusion scalp shoulder sternotomy teratoma thoracic cavity trunk umbilicus LA - English M1 - 11 M3 - Conference Abstract N1 - L617220723 2017-07-12 PY - 2017 SN - 0735-1097 SP - 2221 ST - Exit procedure for fetal mediastinal teratoma with large pericardial effusion T2 - Journal of the American College of Cardiology TI - Exit procedure for fetal mediastinal teratoma with large pericardial effusion UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617220723&from=export http://dx.doi.org/10.1016/S0735-1097(17)35610-3 VL - 69 ID - 760953 ER - TY - JOUR AB - BACKGROUND AND PURPOSE: The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS). METHODS: We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020. During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures. We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020). RESULTS: A total of 754 patients (pandemic-120; pre-pandemic-634) were admitted with a principal diagnosis of AIS; 198 (26.3%) received alteplase and/or mechanical thrombectomy. Despite longer median door to head CT times (16 vs 12 minutes; p = 0.05) and a trend towards longer door to groin puncture times (79.5 vs. 71 min, p = 0.06), the time to alteplase administration (36 vs 35 min; p = 0.83), door to reperfusion times (103 vs 97 min, p = 0.18) and defect-free care (95.2% vs 94.7%; p = 0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, p = 0.48). After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2.90 95% CI 1.77 - 7.17, p = 0.021) CONCLUSION: Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels. Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients. AD - Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: shashank.agarwal@nyumc.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: erica.Scher@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Nirmala.Rossan-Raghunath@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Dilshad.Marolia@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Mariya.Butnar@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Jose.Torres2@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Cen.Zhang@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Sun.Kim@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Matt.Sanger@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Kelley.Humbert@nyulangone.org. Department of Neurosurgery, New York Langone Health, New York, NY, United States. Electronic address: Omar.Tanweer@nyulangone.org. Department of Radiology, New York Langone Health, New York, NY, United States. Electronic address: Maksim.Shapiro@nyulangone.org. Department of Radiology, New York Langone Health, New York, NY, United States. Electronic address: Eytan.Raz@nyulangone.org. Department of Neurosurgery, New York Langone Health, New York, NY, United States. Electronic address: Erez.Nossek@nyulangone.org. Department of Radiology, New York Langone Health, New York, NY, United States. Electronic address: Peter.Nelson@nyulangone.org. Department of Neurosurgery, New York Langone Health, New York, NY, United States. Electronic address: Howard.Riina@nyulangone.org. Department of Neurology, University of Utah, Salt Lake City, UT, United States. Electronic address: Adam.DeHavenon@hsc.utah.edu. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Michael.Wachs@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Jeffrey.Farkas@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Ambooj.Tiwari@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Karthikeyan.Arcot@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: David.Turkel-Parrella@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Jeremy.Liff@nyulangone.org. Department of Emergency Medicine, New York Langone Health, New York, NY, United States. Electronic address: Tina.Wu@nyulangone.org. Department of Emergency Medicine, New York Langone Health, New York, NY, United States. Electronic address: Ian.Wittman@nyulangone.org. Department of Emergency Medicine, New York Langone Health, New York, NY, United States. Electronic address: Reed.Caldwell@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Jennifer.Frontera@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Aaron.Lord@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: Koto.Ishida@nyulangone.org. Department of Neurology, New York Langone Health, New York, NY, United States. Electronic address: shadiyaghi@yahoo.com. AN - 32807471 AU - Agarwal, S. AU - Scher, E. AU - Rossan-Raghunath, N. AU - Marolia, D. AU - Butnar, M. AU - Torres, J. AU - Zhang, C. AU - Kim, S. AU - Sanger, M. AU - Humbert, K. AU - Tanweer, O. AU - Shapiro, M. AU - Raz, E. AU - Nossek, E. AU - Nelson, P. K. AU - Riina, H. A. AU - de Havenon, A. AU - Wachs, M. AU - Farkas, J. AU - Tiwari, A. AU - Arcot, K. AU - Parella, D. T. AU - Liff, J. AU - Wu, T. AU - Wittman, I. AU - Caldwell, R. AU - Frontera, J. AU - Lord, A. AU - Ishida, K. AU - Yaghi, S. C2 - Pmc7305900 DA - Sep DO - 10.1016/j.jstrokecerebrovasdis.2020.105068 DP - NLM ET - 2020/08/19 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Aged Aged, 80 and over Betacoronavirus/*pathogenicity Comprehensive Health Care/*organization & administration Coronavirus Infections/diagnosis/epidemiology/*therapy/virology Critical Pathways/organization & administration Delivery of Health Care, Integrated/*organization & administration Female Humans Male Middle Aged New York City/epidemiology Pandemics Patient Care Team/organization & administration Pneumonia, Viral/diagnosis/epidemiology/*therapy/virology Quality Improvement/*organization & administration Quality Indicators, Health Care/*organization & administration Registries Retrospective Studies Stroke/diagnosis/epidemiology/*therapy *Thrombectomy *Thrombolytic Therapy Time Factors Time-to-Treatment/organization & administration Treatment Outcome Workflow Covid-19 Comprehensive stroke center Quality research Stroke LA - eng M1 - 9 N1 - 1532-8511 Agarwal, Shashank Scher, Erica Rossan-Raghunath, Nirmala Marolia, Dilshad Butnar, Mariya Torres, Jose Zhang, Cen Kim, Sun Sanger, Matthew Humbert, Kelley Tanweer, Omar Shapiro, Maksim Raz, Eytan Nossek, Erez Nelson, Peter K Riina, Howard A de Havenon, Adam Wachs, Michael Farkas, Jeffrey Tiwari, Ambooj Arcot, Karthikeyan Parella, David Turkel Liff, Jeremy Wu, Tina Wittman, Ian Caldwell, Reed Frontera, Jennifer Lord, Aaron Ishida, Koto Yaghi, Shadi Journal Article J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105068. doi: 10.1016/j.jstrokecerebrovasdis.2020.105068. Epub 2020 Jun 20. PY - 2020 SN - 1052-3057 (Print) 1052-3057 SP - 105068 ST - Acute stroke care in a New York City comprehensive stroke center during the COVID-19 pandemic T2 - J Stroke Cerebrovasc Dis TI - Acute stroke care in a New York City comprehensive stroke center during the COVID-19 pandemic VL - 29 ID - 760320 ER - TY - JOUR AB - BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency to support pregnant and postpartum patients with severe cardiac or pulmonary failure, although patient management and clinical outcomes are underreported. This study represents patients who received ECMO during the peripartum period. METHODS: All pregnant or postpartum patients treated with ECMO in the medical intensive care unit between January 1, 2009, and June 30, 2015, were included in this study. Data were analyzed retrospectively. The primary objective was to characterize the circumstances and clinical characteristics of the patients who received ECMO, describe our management during pregnancy and at the time of delivery, evaluate maternal and fetal outcomes, and report bleeding and thrombotic complications. RESULTS: Eighteen peripartum patients were treated with ECMO during the study period; 4 were pregnant at the time of cannulation. Median age was 32.6 years, and median gestational age in pregnant patients was 32 weeks. Sixteen patients (88.9%) survived to hospital discharge. Fetal survival was 14 (77.8%) in the entire cohort and 100% in patients cannulated after fetal viability. Two patients successfully delivered on ECMO. Bleeding complications developed in 6 patients (33.3%) and were associated with disseminated intravascular coagulation. No fetal complications were attributed to ECMO. CONCLUSIONS: ECMO can be used during pregnancy and postpartum with favorable maternal and fetal outcomes, and it outweighs the risk of bleeding or thrombotic complications when managed by an experienced, multidisciplinary team. AD - Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. Division of Pediatric Cardiology, Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. Electronic address: hdb5@cumc.columbia.edu. Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York. AN - 27154158 AU - Agerstrand, C. AU - Abrams, D. AU - Biscotti, M. AU - Moroz, L. AU - Rosenzweig, E. B. AU - D'Alton, M. AU - Brodie, D. AU - Bacchetta, M. DA - Sep DO - 10.1016/j.athoracsur.2016.03.005 DP - NLM ET - 2016/05/08 J2 - The Annals of thoracic surgery KW - Adult *Extracorporeal Membrane Oxygenation Female Humans Postpartum Period Pregnancy Pregnancy Complications/*therapy Puerperal Disorders/*therapy Respiratory Distress Syndrome, Adult/*therapy LA - eng M1 - 3 N1 - 1552-6259 Agerstrand, Cara Abrams, Darryl Biscotti, Mauer Moroz, Leslie Rosenzweig, Erika B D'Alton, Mary Brodie, Daniel Bacchetta, Matthew Journal Article Netherlands Ann Thorac Surg. 2016 Sep;102(3):774-779. doi: 10.1016/j.athoracsur.2016.03.005. Epub 2016 May 4. PY - 2016 SN - 0003-4975 SP - 774-779 ST - Extracorporeal Membrane Oxygenation for Cardiopulmonary Failure During Pregnancy and Postpartum T2 - Ann Thorac Surg TI - Extracorporeal Membrane Oxygenation for Cardiopulmonary Failure During Pregnancy and Postpartum VL - 102 ID - 760379 ER - TY - JOUR AB - Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease that primarily affects women of reproductive age. Disease activity and medication use can complicate pregnancies in SLE, due to the disease itself and/or exposure to teratogenic medications. Therefore, these patients should be counseled and are candidates for highly effective contraceptive methods. Objectives: To examine contraceptive counseling and use among SLE patients attending our Rheumatology Department. Methods: Cross-sectional study in which women aged 15-50 followed in our Rheumatology Centre with SLE diagnosis completed a researcher-administered survey. Premenopausal women who were sexually active were considered at risk of pregnancy. We compared self-reported rates of contraceptive counseling and use, stratified by treatment with terato-genic medications, and by history of thrombosis or antiphospholipid antibodies (aPL). The statistical analysis was performed using SPSS 23.0, and p<0.05 was taken to indicate statistical significance. Results: 95 women were interviewed, of these, 60 were considered to be at risk for unplanned pregnancy. Their median age was 36 years (range 17-48), and median disease duration 9.9 years (range 0.25-37.0). 85% were aware of the complications associated with pregnancy in their medical condition and 73.3% had received contraceptive counseling. Fifty-six patients (93.3%) reported consistent contraceptive use. Younger patients were more likely to have received contraceptive counseling (35.0 [17-46] years versus 42.5 [20-48] years, p=0.021). Counseling was more frequently reported by patients with higher educational level (p=0.026). Those who were counseled were using more effective contraceptives and in logistic regression contraceptive counseling was a predictor of highly effective contraception use (OR=13.1, p<0.0001). Women using teratogenic medications or with a history of thrombosis were no more likely to have received contraceptive counseling or to use more effective contraceptives. Those with positive aPL were using more effective contraceptives (p=0.024). In our model, having a high school degree and positive lupus anticoagulant predicted contraceptive counseling (OR=12.6, p=0.041; OR=3.1, p=0.02, respectively). Conclusion: This study highlights the importance of contraceptive counseling in SLE patients at risk for unplanned pregnancy. A multidisciplinary team including rheumatologists, gynecologists and family phsycians is needed to improve the education and provision of adequate contraceptive counseling to these women. AD - F. Aguiar, Centro Hospitalar Universitário São João, Rheumatology, Porto, Portugal AU - Aguiar, F. AU - Costa, R. AU - Brito, I. DB - Embase DO - 10.1136/annrheumdis-2019-eular.3624 KW - contraceptive agent endogenous compound lupus anticoagulant phospholipid antibody adolescent adult complication conference abstract contraceptive behavior controlled study counseling cross-sectional study data analysis software female gynecologist high risk pregnancy high school human major clinical study multidisciplinary team premenopause rheumatologist rheumatology scientist statistical significance systemic lupus erythematosus teratogenesis thrombosis unplanned pregnancy LA - English M3 - Conference Abstract N1 - L628834906 2019-08-13 PY - 2019 SN - 1468-2060 SP - 1165 ST - Contraceptive counseling and use among women with systemic lupus erythematosus at risk for unplanned pregnancy T2 - Annals of the Rheumatic Diseases TI - Contraceptive counseling and use among women with systemic lupus erythematosus at risk for unplanned pregnancy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628834906&from=export http://dx.doi.org/10.1136/annrheumdis-2019-eular.3624 VL - 78 ID - 760708 ER - TY - JOUR AB - A well-functioning arteriovenous fistula (AVF) is essential for the maintenance of hemodialysis (HD) in patients with chronic renal failure. Our aim is to review our experience of creating AVF and to asses its success rate and common complication. A prospective, hospital-based study was conducted on 73 patients (48 males and 25 females) on chronic HD in Gezira Hospital for Renal Diseases and Surgery, from January to July 2007. Their mean age was 43.9 years (range from 18 to 72 years). Seventy-one (97.3%) of the study subjects had been dialyzed before creation of the AVF, 67 (91.8%) of them having undergone HD with temporary access. All patients (n=73) had a native AVF as the permanent vascular access (VA). A primary radiocephalic AVF was created in 78.1% of the patients, cubital fossa in 20.5% and one case had left snuff box AVF (1.4%). Percentage of AVF maturation was reported in 67.1% of the cases within the first six weeks and in 9.6% of the cases AVF never matured. Failure of AVF function occurred in 26% of the cases, due to thrombosis in 20.5% (n=15) and aneurysm in 5.5% of the cases. We conclude that an optimum outcome is likely when there is a multidisciplinary team approach, and early referral to vascular surgery is paramount. AD - Department of Surgery, Faculty of Medicine, University of Gezira, Gezira, Sudan. AN - 22237243 AU - Ahmed, G. M. AU - Mansour, M. O. AU - Elfatih, M. AU - Khalid, K. E. AU - Ahmed Mel, I. DA - Jan DP - NLM ET - 2012/01/13 J2 - Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia KW - Adolescent Adult Aged *Arteriovenous Shunt, Surgical/adverse effects Chi-Square Distribution Child Female Hospitals, University Humans Kidney Failure, Chronic/*therapy Male Middle Aged Patient Care Team Prospective Studies Referral and Consultation *Renal Dialysis Sudan Time Factors Treatment Outcome Upper Extremity/*blood supply Vascular Patency Young Adult LA - eng M1 - 1 N1 - Ahmed, Gamal Mustafa Mansour, Mustafa Omran Elfatih, Mohamed Khalid, Khalid Eltahir Ahmed, Mohammed El Imam Mohammed Journal Article Randomized Controlled Trial Saudi Arabia Saudi J Kidney Dis Transpl. 2012 Jan;23(1):152-7. PY - 2012 SN - 1319-2442 (Print) 1319-2442 SP - 152-7 ST - Outcomes of arteriovenous fistula for hemodialysis in Sudanese patients: single-center experience T2 - Saudi J Kidney Dis Transpl TI - Outcomes of arteriovenous fistula for hemodialysis in Sudanese patients: single-center experience VL - 23 ID - 760462 ER - TY - JOUR AB - A well-functioning arteriovenous fistula (AVF) is essential for the maintenance of hemodialysis (HD) in patients with chronic renal failure. Our aim is to review our experience of creating AVF and to asses its success rate and common complication. A prospective, hospital-based study was conducted on 73 patients (48 males and 25 females) on chronic HD in Gezira Hospital for Renal Diseases and Surgery, from January to July 2007. Their mean age was 43.9 years (range from 18 to 72 years). Seventy-one (97.3%) of the study subjects had been dialyzed before creation of the AVF, 67 (91.8%) of them having undergone HD with temporary access. All patients (n=73) had a native AVF as the permanent vascular access (VA). A primary radiocephalic AVF was created in 78.1% of the patients, cubital fossa in 20.5% and one case had left snuff box AVF (1.4%). Percentage of AVF maturation was reported in 67.1% of the cases within the first six weeks and in 9.6% of the cases AVF never matured. Failure of AVF function occurred in 26% of the cases, due to thrombosis in 20.5% (n=15) and aneurysm in 5.5% of the cases. We conclude that an optimum outcome is likely when there is a multidisciplinary team approach, and early referral to vascular surgery is paramount. AD - G.M. Ahmed, Department of Surgery, Faculty of Medicine, University of Gezira, Gezira, Sudan. AU - Ahmed, G. M. AU - Mansour, M. O. AU - Elfatih, M. AU - Khalid, K. E. AU - Ahmed, M. I. DB - Medline KW - adolescent adult aged arm arteriovenous shunt article chi square distribution child chronic kidney failure clinical trial controlled clinical trial controlled study female human male middle aged patient care patient referral prospective study randomized controlled trial renal replacement therapy Sudan time treatment outcome university hospital vascular patency vascularization LA - English M1 - 1 M3 - Article N1 - L364272636 2012-02-27 PY - 2012 SN - 1319-2442 SP - 152-157 ST - Outcomes of arteriovenous fistula for hemodialysis in Sudanese patients: single-center experience T2 - Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia TI - Outcomes of arteriovenous fistula for hemodialysis in Sudanese patients: single-center experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L364272636&from=export VL - 23 ID - 761215 ER - TY - JOUR AB - PURPOSE: While there is robust data for management of patients with both massive and low risk pulmonary embolism (PE), consensus treatment strategies for patients with submassive PE are lacking. We believe this creates confusion and delays in care for newly diagnosed PE, therefore we decided to implement a Pulmonary Embolism Response Team (PERT) to assist with management of this complicated group. METHODS: We adopted a “Tiered Approach” similar to that described by Vanderbilt's PERT program. The team is available for consultations from our hospital as well as through our transfer center for outside facilities. Initial PERT consultation is provided by the on call “team leader” who guides initial treatment. Patients are stratified based on European Society of Cardiology. General guidelines were developed to which all PERT members agreed while allowing for deviation if clinically warranted. Low and intermediate-low risk patients are treated with anticoagulation. Intermediate-high risk patients are offered ultrasound assisted catheter directed thrombolysis (UA-CDT). High risk patients are treated with systemic thrombolytics unless contraindicated. If needed, surgical and catheter-assisted embolectomies (CAE) are also available. For more complex cases, including patients referred for intervention, a multidisciplinary discussion is held. Intermediate and high risk patients are followed in our PERT clinic 6-8 weeks after discharge with additional testing including screening for chronic thromboembolic pulmonary hypertension with a repeat echocardiogram. RESULTS: We retrospectively reviewed the charts of 112 PERT activations from 5/01/16 to 2/28/17. As expected, low (n=21) and intermediate-low risk (n=20) patients were treated with anticoagulation alone. In the intermediate-high risk group (n=62), 16 were treated with anticoagulation alone due to additional co-morbidities including advanced age, malignancy, or bleeding risk. Forty one patients underwent UA-CDT with one also receiving CAE due to persistent severe hypoxemia. Three patients underwent surgical embolectomy after right heart thrombus was seen on echocardiography. One patient was given systemic IV thrombolytics after deteriorating prior to planned UA -CDT. In the High risk group (n=9), 2 patients received anticoagulation alone, 1 with a known cerebral aneurysm and 1 with a recent CVA. Three patients underwent UA-CDT, 1 with a recent CVA, 1 with advanced age, and 1 was patient's preference. Four patients underwent systemic IV thrombolysis. There were 4 all cause mortalities (all intermediate-high risk), 2 who underwent surgical embolectomy, 1 who deteriorated prior to planned UA-CDT and received systemic thrombolytics, and one with subsequent thromboembolic event after receiving UA-CDT. Three deaths were directly related to PE, the other due to complication from underlying malignancy. CONCLUSIONS: Implementation of our PERT program provides a framework for a more structured treatment approach to patients with pulmonary emboli within our health care system; in particular patients with intermediate risk PE. AD - S. Ahmed, University at Buffalo, Buffalo, NY, United States AU - Ahmed, S. AU - Nadler, J. AU - Campbell, L. AU - Shujaat, A. AU - Janicke, D. AU - Iyer, V. AU - Phadke, K. AU - Morris, W. AU - Zlotnick, D. DB - Embase DO - 10.1016/j.chest.2017.08.1065 KW - fibrinolytic agent adult all cause mortality anticoagulation bleeding blood clot lysis brain artery aneurysm buffalo cancer surgery cancer susceptibility cardiology catheter chronic thromboembolic pulmonary hypertension comorbidity complication consultation death diagnosis drug therapy echocardiography embolectomy female health care system high risk patient high risk population human hypoxemia intracardiac thrombosis low risk patient lung embolism major clinical study male nonhuman retrospective study risk assessment surgery LA - English M1 - 4 M3 - Conference Abstract N1 - L619296814 2017-11-22 PY - 2017 SN - 1931-3543 SP - A1032 ST - Early experience with pulmonary embolism response team (PERT) at buffalo general medical center T2 - Chest TI - Early experience with pulmonary embolism response team (PERT) at buffalo general medical center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619296814&from=export http://dx.doi.org/10.1016/j.chest.2017.08.1065 VL - 152 ID - 760904 ER - TY - JOUR AB - BACKGROUND: Vascular surgery procedural reimbursement depends on accurate procedural coding and documentation. Despite the critical importance of correct coding, there has been a paucity of research focused on the effect of direct physician involvement. We hypothesize that direct physician involvement in procedural coding will lead to improved coding accuracy, increased work relative value unit (wRVU) assignment, and increased physician reimbursement. METHODS: This prospective observational cohort study evaluated procedural coding accuracy of fistulograms at an academic medical institution (January-June 2014). All fistulograms were coded by institutional coders (traditional coding) and by a single vascular surgeon whose codes were verified by two institution coders (multidisciplinary coding). The coding methods were compared, and differences were translated into revenue and wRVUs using the Medicare Physician Fee Schedule. Comparison between traditional and multidisciplinary coding was performed for three discrete study periods: baseline (period 1), after a coding education session for physicians and coders (period 2), and after a coding education session with implementation of an operative dictation template (period 3). The accuracy of surgeon operative dictations during each study period was also assessed. An external validation at a second academic institution was performed during period 1 to assess and compare coding accuracy. RESULTS: During period 1, traditional coding resulted in a 4.4% (P = .004) loss in reimbursement and a 5.4% (P = .01) loss in wRVUs compared with multidisciplinary coding. During period 2, no significant difference was found between traditional and multidisciplinary coding in reimbursement (1.3% loss; P = .24) or wRVUs (1.8% loss; P = .20). During period 3, traditional coding yielded a higher overall reimbursement (1.3% gain; P = .26) than multidisciplinary coding. This increase, however, was due to errors by institution coders, with six inappropriately used codes resulting in a higher overall reimbursement that was subsequently corrected. Assessment of physician documentation showed improvement, with decreased documentation errors at each period (11% vs 3.1% vs 0.6%; P = .02). Overall, between period 1 and period 3, multidisciplinary coding resulted in a significant increase in additional reimbursement ($17.63 per procedure; P = .004) and wRVUs (0.50 per procedure; P = .01). External validation at a second academic institution was performed to assess coding accuracy during period 1. Similar to institution 1, traditional coding revealed an 11% loss in reimbursement ($13,178 vs $14,630; P = .007) and a 12% loss in wRVU (293 vs 329; P = .01) compared with multidisciplinary coding. CONCLUSIONS: Physician involvement in the coding of endovascular procedures leads to improved procedural coding accuracy, increased wRVU assignments, and increased physician reimbursement. AD - Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass. Electronic address: francesco.aiello@umassmemorial.org. Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass. Division of Vascular Surgery, Yale Medical School, New Haven, Conn. AN - 27146792 AU - Aiello, F. A. AU - Judelson, D. R. AU - Messina, L. M. AU - Indes, J. AU - FitzGerald, G. AU - Doucet, D. R. AU - Simons, J. P. AU - Schanzer, A. DA - Aug DO - 10.1016/j.jvs.2016.02.052 DP - NLM ET - 2016/10/21 J2 - Journal of vascular surgery KW - Academic Medical Centers *Clinical Coding/economics *Current Procedural Terminology *Data Accuracy Documentation/classification/economics Endovascular Procedures/adverse effects/*classification/economics *Fee-for-Service Plans Humans Medicare/classification/economics Patient Care Team/*classification/economics Practice Patterns, Physicians'/classification/economics Prospective Studies *Relative Value Scales Reproducibility of Results *Terminology as Topic United States Vascular Surgical Procedures/adverse effects/*classification/economics LA - eng M1 - 2 N1 - 1097-6809 Aiello, Francesco A Judelson, Dejah R Messina, Louis M Indes, Jeffrey FitzGerald, Gordon Doucet, Danielle R Simons, Jessica P Schanzer, Andres Comparative Study Journal Article Multicenter Study Observational Study United States J Vasc Surg. 2016 Aug;64(2):465-470. doi: 10.1016/j.jvs.2016.02.052. Epub 2016 Apr 14. PY - 2016 SN - 0741-5214 SP - 465-470 ST - A multidisciplinary approach to vascular surgery procedure coding improves coding accuracy, work relative value unit assignment, and reimbursement T2 - J Vasc Surg TI - A multidisciplinary approach to vascular surgery procedure coding improves coding accuracy, work relative value unit assignment, and reimbursement VL - 64 ID - 760421 ER - TY - JOUR AB - OBJECTIVES: To identify the causes of death and main cardiovascular complications in adolescents and adults with congenitally malformed hearts. DESIGN: Retrospective review of 102 necropsy reports from a tertiary centre obtained over a period of 19 years. METHODS: The diagnosis, the operated or non-operated state of the main defect, the cause of death, and main complications were related to the age and gender. Other clinically relevant conditions, and identifiable sequels of previous diseases, were also noted. RESULTS: The ages ranged from 15 to 69 years, with a mean of 31.1 and a median of 28 years, with no difference detected according to the gender. Of the patients, two-thirds had been submitted to at least one cardiac surgery. The mean age of death was significantly higher in non-operated patients (p = 0.003). The most prevalent cause of death in the whole group was related to recent surgery, found in one-third. From them, two-fifths corresponded to reoperations. Among the others, cardiac failure was the main terminal cause in another third, and the second cause was pulmonary thromboembolism in just over one-fifth, presenting a significant association with histopathological signs of pulmonary hypertension (p = 0.011). Infection was the cause of death in 7.8% of the patients, all previously operated. Acute infective endocarditis was present or was the indication for the recent surgery in one-tenth of the patients, this cohort having a mean age of 27.8 years. There was a statistically significant association between the occurrence of endocarditis and defects causing low pulmonary blood flow (p = 0.043). CONCLUSIONS: Data derived from necropsies of adults with congenital heart defects can help the multidisciplinary team refine both their diagnosis and treatment. AD - Laboratory of Pathology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil. AN - 105230645. Language: English. Entry Date: 20100226. Revision Date: 20200708. Publication Type: Journal Article AU - Aiello, V. D. AU - Binotto, M. A. AU - Demarchi, L. M. AU - Lopes, A. A. AU - Barbero Marcial, M. DB - CINAHL DO - 10.1017/S1047951109991077 DP - EBSCOhost KW - Cardiovascular Diseases -- Etiology Cardiovascular Diseases -- Mortality Heart Defects, Congenital -- Complications Heart Defects, Congenital -- Mortality Adolescence Adult Aged Cause of Death Female Human Male Middle Age Retrospective Design Young Adult M1 - 5 N1 - research. Journal Subset: Biomedical; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 9200019. PMID: NLM19709451. PY - 2009 SN - 1047-9511 SP - 511-516 ST - Causes of death and cardiovascular complications in adolescents and adults with congenitally malformed hearts: an autopsy study of 102 cases T2 - Cardiology in the Young TI - Causes of death and cardiovascular complications in adolescents and adults with congenitally malformed hearts: an autopsy study of 102 cases UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=105230645&site=ehost-live&scope=site VL - 19 ID - 761304 ER - TY - JOUR AB - OBJECTIVES: To identify the causes of death and main cardiovascular complications in adolescents and adults with congenitally malformed hearts. DESIGN: Retrospective review of 102 necropsy reports from a tertiary centre obtained over a period of 19 years. METHODS: The diagnosis, the operated or non-operated state of the main defect, the cause of death, and main complications were related to the age and gender. Other clinically relevant conditions, and identifiable sequels of previous diseases, were also noted. RESULTS: The ages ranged from 15 to 69 years, with a mean of 31.1 and a median of 28 years, with no difference detected according to the gender. Of the patients, two-thirds had been submitted to at least one cardiac surgery. The mean age of death was significantly higher in non-operated patients (p = 0.003). The most prevalent cause of death in the whole group was related to recent surgery, found in one-third. From them, two-fifths corresponded to reoperations. Among the others, cardiac failure was the main terminal cause in another third, and the second cause was pulmonary thromboembolism in just over one-fifth, presenting a significant association with histopathological signs of pulmonary hypertension (p = 0.011). Infection was the cause of death in 7.8% of the patients, all previously operated. Acute infective endocarditis was present or was the indication for the recent surgery in one-tenth of the patients, this cohort having a mean age of 27.8 years. There was a statistically significant association between the occurrence of endocarditis and defects causing low pulmonary blood flow (p = 0.043). CONCLUSIONS: Data derived from necropsies of adults with congenital heart defects can help the multidisciplinary team refine both their diagnosis and treatment. AD - Laboratory of Pathology, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil. vera.aiello@incor.usp.br AN - 19709451 AU - Aiello, V. D. AU - Binotto, M. A. AU - Demarchi, L. M. AU - Lopes, A. A. AU - Marcial, M. B. DA - Sep DO - 10.1017/s1047951109991077 DP - NLM ET - 2009/08/28 J2 - Cardiology in the young KW - Adolescent Adult Aged Cardiovascular Diseases/*etiology/*mortality Cause of Death Female Heart Defects, Congenital/*complications/*mortality Humans Male Middle Aged Retrospective Studies Young Adult LA - eng M1 - 5 N1 - 1467-1107 Aiello, Vera Demarchi Binotto, Maria Angélica Demarchi, Lea Maria Lopes, Antonio Augusto Marcial, Miguel Barbero Journal Article England Cardiol Young. 2009 Sep;19(5):511-6. doi: 10.1017/S1047951109991077. Epub 2009 Aug 27. PY - 2009 SN - 1047-9511 SP - 511-6 ST - Causes of death and cardiovascular complications in adolescents and adults with congenitally malformed hearts: an autopsy study of 102 cases T2 - Cardiol Young TI - Causes of death and cardiovascular complications in adolescents and adults with congenitally malformed hearts: an autopsy study of 102 cases VL - 19 ID - 760457 ER - TY - JOUR AB - Background In eligible patients with acute ischaemic stroke, rapid revascularisation is crucial for good outcome. At our treatment centre, we had achieved and sustained a median door-to-needle time of under 30 min. We hypothesised that further improvement could be achieved through implementing a revised treatment protocol and in situ simulation-based team training sessions. This report describes a quality improvement project aiming to reduce door-to-needle times in stroke thrombolysis. Methods All members of the acute stroke treatment team were surveyed to tailor the interventions to local conditions. Through a review of responses and available literature, the improvement team suggested changes to streamline the protocol and designed in situ simulation-based team training sessions. Implementation of interventions started in February 2017. We completed 14 simulation sessions from February to June 2017 and an additional 12 sessions from November 2017 to March 2018. Applying Kirkpatrick's four-level training evaluation model, participant reactions, clinical behaviour and patient outcomes were measured. Statistical process control charts were used to demonstrate changes in treatment times and patient outcomes. Results A total of 650 consecutive patients, including a 3-year baseline, treated with intravenous thrombolysis were assessed. Median door to needle times were significantly reduced from 27 to 13 min and remained consistent after 13 months. Risk-adjusted cumulative sum charts indicate a reduced proportion of patients deceased or bedridden after 90 days. There was no significant change in balancing measures (stroke mimics, fatal intracranial haemorrhage and prehospital times). Conclusions Implementing a revised treatment protocol in combination with in situ simulation-based team training sessions for stroke thrombolysis was followed by a considerable reduction in door-to-needle times and improved patient outcomes. Additional work is needed to assess sustainability and generalisability of the interventions. AD - [Ajmi, Soffien Chadli; Kurz, Martin] Stavanger Univ Hosp, Dept Neurol, Stavanger, Norway. [Ajmi, Soffien Chadli; Ersdal, Hege] Univ Stavanger, Dept Qual & Hlth Technol, Stavanger, Norway. [Advani, Rajiv] Oslo Univ Hosp, Dept Neurol, Stroke Unit, Oslo, Norway. [Fjetland, Lars; Kurz, Kathinka Dehli] Stavanger Univ Hosp, Dept Radiol, Stavanger, Norway. [Kurz, Kathinka Dehli; Kvaloy, Jan Terje] Univ Stavanger, Dept Math & Phys, Stavanger, Norway. [Lindner, Thomas; Ersdal, Hege] Stavanger Univ Hosp, Dept Anesthesiol & Intens Care, Stavanger, Norway. [Lindner, Thomas] Reg Ctr Emergency Med Res & Dev, Res, Stavanger, Norway. [Qvindesland, Sigrunn Anna] Stavanger Acute Med Fdn Educ & Res, Res, Stavanger, Norway. [Goyal, Mayank] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada. [Kvaloy, Jan Terje] Univ Stavanger, Dept Res, Stavanger, Norway. [Kurz, Martin] Univ Bergen, Dept Clin Med, Bergen, Norway. Ajmi, SC (corresponding author), Stavanger Univ Hosp, Neurol, N-4010 Stavanger, Norway. soffiena@yahoo.com AN - WOS:000492375800014 AU - Ajmi, S. C. AU - Advani, R. AU - Fjetland, L. AU - Kurz, K. D. AU - Lindner, T. AU - Qvindesland, S. A. AU - Ersdal, H. AU - Goyal, M. AU - Kvaloy, J. T. AU - Kurz, M. DA - Nov DO - 10.1136/bmjqs-2018-009117 J2 - BMJ Qual. Saf. KW - simulation quality improvement methodologies medical emergency team team training TISSUE-PLASMINOGEN ACTIVATOR INTENSIVE-CARE IMPLEMENTATION OUTCOMES MINUTES MODEL Health Care Sciences & Services Health Policy & Services LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: JG9DB Times Cited: 10 Cited Reference Count: 35 Ajmi, Soffien Chadli Advani, Rajiv Fjetland, Lars Kurz, Kathinka Dehli Lindner, Thomas Qvindesland, Sigrunn Anna Ersdal, Hege Goyal, Mayank Kvaloy, Jan Terje Kurz, Martin Goyal, Mayank/AAE-7323-2019 Safer Healthcare Grant (University Research Fund) SCA is a research fellow funded by a Safer Healthcare Grant (University Research Fund). MG has a consulting agreement with Mentice, the remaining authors report no disclosures. 10 0 5 BMJ PUBLISHING GROUP LONDON BMJ QUAL SAF PY - 2019 SN - 2044-5415 SP - 939-948 ST - Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre T2 - Bmj Quality & Safety TI - Reducing door-to-needle times in stroke thrombolysis to 13 min through protocol revision and simulation training: a quality improvement project in a Norwegian stroke centre UR - ://WOS:000492375800014 VL - 28 ID - 761479 ER - TY - JOUR AB - Background: Odontogenic diseases can be a risk factor for life-threatening infection in patients with hematologic malignancies during chemotherapy that induces myelosuppression of variable severity. Previous studies noted the necessity of the elimination of all odontogenic foci before hematopoietic stem cell transplantation. To enable planning for the adequate dental intervention, the oral medicine team must understand the general status of patient and the intensity of the chemotherapy, which is sometimes difficult to be fully appreciated by dental staff. Therefore, a simplified grading would facilitate the sharing of information between hematologists, dentists and oral hygienists. This study aimed to introduce our myelosuppression grading of chemotherapies for hematologic malignancies and analyze the timing of occurrence of severe odontogenic infection. Methods: 37 patients having received various chemotherapies for hematologic malignancies were enrolled. The chemotherapy regimens were classified into four grades based on the persistency of myelosuppression induced by chemotherapy. Mild myelosuppressive chemotherapies were classified as grade A, moderate ones as grade B, severe ones as grade C, and chemotherapies that caused severe myelosuppression and persistent immunodeficiency (known as conditioning regimens for transplant) as grade D. The timing of occurrence of severe odontogenic infection was retrospectively investigated. Results: Two patients (5.4%) had severe odontogenic infections after grade B or C chemotherapy. One occurred after extraction of non-salvageable teeth; the other resulted from advanced periodontitis in a tooth that could not be extracted because of thrombocytopenia. Both were de novo hematologic malignancy patients. During grade D chemotherapy, no patients had severe odontogenic infections. Conclusions: The simplified grading introduced in this study is considered a useful tool for understanding the myelosuppressive state caused by chemotherapy and facilitating communication between medical and dental staff. During the period around the primary chemotherapy, especially for de novo hematologic malignancy patients who often received grade B to C myelosuppression chemotherapy, caution should be exercised for severe odontogenic infection by the oral medicine team, irrespective of whether invasive treatment is to be performed. AD - [Akashi, Masaya; Shibuya, Yasuyuki; Kusumoto, Junya; Furudoi, Shungo; Komori, Takahide] Kobe Univ, Grad Sch Med, Dept Oral & Maxillofacial Surg, Kobe, Hyogo 657, Japan. [Inui, Yumiko; Yakushijin, Kimikazu; Okamura, Atsuo; Matsuoka, Hiroshi] Kobe Univ, Grad Sch Med, Dept Med, Div Med Oncol Hematol, Kobe, Hyogo 657, Japan. Akashi, M (corresponding author), Kobe Univ, Grad Sch Med, Dept Oral & Maxillofacial Surg, Kobe, Hyogo 657, Japan. akashim@med.kobe-u.ac.jp AN - WOS:000323376200001 AU - Akashi, M. AU - Shibuya, Y. AU - Kusumoto, J. AU - Furudoi, S. AU - Inui, Y. AU - Yakushijin, K. AU - Okamura, A. AU - Matsuoka, H. AU - Komori, T. C7 - 41 DA - Aug DO - 10.1186/1472-6831-13-41 J2 - BMC Oral Health KW - Hematologic malignancy Chemotherapy Tooth extraction Myelosuppression grading Odontogenic septicemia MANAGEMENT TRANSPLANT CARE INFECTION THERAPY Dentistry, Oral Surgery & Medicine LA - English M3 - Article N1 - ISI Document Delivery No.: 204OF Times Cited: 9 Cited Reference Count: 21 Akashi, Masaya Shibuya, Yasuyuki Kusumoto, Junya Furudoi, Shungo Inui, Yumiko Yakushijin, Kimikazu Okamura, Atsuo Matsuoka, Hiroshi Komori, Takahide Akashi, Masaya/X-9847-2019 10 0 12 BMC LONDON BMC ORAL HEALTH PY - 2013 SN - 1472-6831 SP - 7 ST - Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia T2 - Bmc Oral Health TI - Myelosuppression grading of chemotherapies for hematologic malignancies to facilitate communication between medical and dental staff: lessons from two cases experienced odontogenic septicemia UR - ://WOS:000323376200001 VL - 13 ID - 761800 ER - TY - JOUR AB - BACKGROUND AND AIM: Organized stroke care essentially improves prognosis and reduces complications in Acute Stroke. Our aim is to determine the impact of establishing an organized stroke service at a tertiary hospital on patient's outcome. METHODS: Organization of stroke service started in April 2014, with formation of Stroke ward, stroke registry, hiring stroke coordinators & nurse specialist, & setting protocols for thrombolysis, care pathways & investigations. A dedicated multidisciplinary team formed for patient care, evaluating performance measures & coordinating consultations. Outcome measures were mortality, thrombolysis rate, disposition, length of stay (LOS), & complications. RESULTS: Thrombolysis rate increased from 5% to 9%, with mean door- CT time of 21 mins, & mean door-needle time of 51 minutes. Even 17.6% patients got tPA within 30 minutes of arrival. About 66% admitted directly to stroke ward compared to other wards (p=0.001). ICU admissions reduced from 17.4% to 11% (p=0.001). Mean investigation time (echo, carotid US, neuroimaging) was 3.1 days. Complications reduced from 43.5% to 10% (p=0.001), especially aspiration pneumonia (38.5% to 6.3%, p=0.001), UTI (14% to 3.8%, p=0.001), & bedsores (33.3% to 3.0). LOS (<4 days) improved from 45.5% to 57% (p=0.001), while 19% transferred to rehabilitation. Significantly improved mRS (≤ 2) at 3-months follow-up (from 57% to 81.5%, p=0.002). CONCLUSIONS: Establishing an organized stroke care in a tertiary hospital not only improves care of stroke patients, but also increases proportion of patients discharged home to live independently. This also reduces health costs spent in overall care of stroke patients. AD - N. Akhtar AU - Akhtar, N. AU - Kamran, S. AU - Bourke, P. AU - Joseph, S. AU - Santos, M. AU - Shuaib, A. DB - Embase KW - cerebrovascular accident European tertiary health care human blood clot lysis ward patient tertiary care center stroke patient carotid artery nurse needle mortality register prognosis follow up consultation patient care rehabilitation length of stay neuroimaging aspiration pneumonia decubitus medical specialist health LA - English M3 - Conference Abstract N1 - L72223516 2016-04-13 PY - 2015 SN - 1015-9770 SP - 36 ST - Impact of organized stroke care in a tertiary care setting T2 - Cerebrovascular Diseases TI - Impact of organized stroke care in a tertiary care setting UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72223516&from=export VL - 39 ID - 761071 ER - TY - JOUR AB - Chronic as well as acute diseases of the thoracic aorta are attracting increasing attention, both in the light of an ageing Western and Oriental population and with the proliferation of modern diagnostic imaging modalities. While classic surgical strategies still dominate the treatment of pathology of the ascending aorta and the proximal arch region, new endovascular concepts are emerging and are likely to evolve as primary treatment strategies for descending and abdominal aortic pathology. Additionally, aortic arch pathologies are becoming the target of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an attempt to improve outcome by avoiding the high risk of open arch repair or complete replacement. Nonetheless, due to the complexity of the underlying vascular disease, each patient should be discussed in a team consisting of cardiologists, cardiac surgeons, and an imaging specialist in order to design an individualized therapeutic strategy carried out best in a center with experience in both endovascular and surgical procedures. AD - Heart Center Rostock, Department of Internal Medicine I, University Hospital Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland. AN - 21887531 AU - Akin, I. AU - Kische, S. AU - Rehders, T. C. AU - Schneider, H. AU - Ince, H. AU - Nienaber, C. A. DA - Sep DO - 10.1007/s00059-011-3500-1 DP - NLM ET - 2011/09/03 J2 - Herz KW - Aneurysm, Dissecting/diagnosis/mortality/*surgery *Angioplasty Aorta, Thoracic/surgery Aortic Aneurysm, Thoracic/diagnosis/mortality/*surgery Aortography *Blood Vessel Prosthesis Implantation Combined Modality Therapy Cooperative Behavior Follow-Up Studies Humans Image Processing, Computer-Assisted Imaging, Three-Dimensional Interdisciplinary Communication *Patient Care Team Postoperative Complications/mortality Prognosis *Stents Survival Rate Tomography, X-Ray Computed LA - eng M1 - 6 N1 - 1615-6692 Akin, I Kische, S Rehders, T C Schneider, H Ince, H Nienaber, C A Journal Article Review Germany Herz. 2011 Sep;36(6):539-47. doi: 10.1007/s00059-011-3500-1. PY - 2011 SN - 0340-9937 SP - 539-47 ST - TEVAR: the solution to all aortic problems? T2 - Herz TI - TEVAR: the solution to all aortic problems? VL - 36 ID - 760272 ER - TY - JOUR AB - Actually, the further development of surgical and interventional techniques enables the treatment of complex coronary artery disease of severely ill patients. Due to this development there is a growing spectrum of possible indications for the interventional technique. Since SYNTAX trial, the individual risk stratification and discussion of possible strategies in interdisciplinar meetings is of utmost importance again. Risk stratification should contain patients history, as well as objective findings like extent of coronary artery disease, left ventricular function, pathological stress tests and patients comorbidities. Today, controversial indications up until a short time ago were possible indications for interventional techniques like demonstrated in recent trials and registries. The most discussed controversial indications were interventions at multivessel-disease with drug-eluting stents (DES), left-main stem and chronic total occlusions. AD - Medizinische Klinik I, Kardiologie, Pulmologie, Internistische Intensivmedizin, Universitätsklinikum Rostock, Rostock. AN - 20607667 AU - Akin, I. AU - Nienaber, C. A. AU - Chatterjee, A. AU - Kische, S. AU - Rehders, T. C. AU - Schneider, H. AU - Ince, H. AU - Chatterjee, T. DA - Jul 7 DO - 10.1024/1661-8157/a000188 DP - NLM ET - 2010/07/08 J2 - Praxis KW - Algorithms Angioplasty, Balloon, Coronary Contraindications Coronary Angiography Coronary Artery Bypass Coronary Artery Disease/diagnosis/*therapy Drug-Eluting Stents Follow-Up Studies Humans Myocardial Ischemia/diagnosis/therapy Myocardial Revascularization/*methods Patient Care Team Randomized Controlled Trials as Topic Stents LA - ger M1 - 14 N1 - Akin, I Nienaber, C A Chatterjee, A Kische, S Rehders, T C Schneider, H Ince, H Chatterjee, T Comparative Study Journal Article Review Switzerland Praxis (Bern 1994). 2010 Jul 7;99(14):843-52. doi: 10.1024/1661-8157/a000188. OP - Interventionelle Koronarintervention - welche Indikationen sind umstritten? PY - 2010 SN - 1661-8157 (Print) 1661-8157 SP - 843-52 ST - [Coronary intervention - which indications are controversial?] T2 - Praxis (Bern 1994) TI - [Coronary intervention - which indications are controversial?] VL - 99 ID - 760452 ER - TY - JOUR AB - Background: Pulmonary embolism (PE) is a common and life-threatening medical condition with non-specific clinical presentation. Computed tomography pulmonary angiography (CT-PA) has been the diagnostic modality of choice, but its use is not without risks. Clinical decision rules have been established for the use of diagnostic modalities for patients with suspected PE. This study aims to assess the adherence of physicians to the diagnostic algorithms and rules. Methods: A retrospective observational study examining the utilization of CT-PA in the Emergency Department of King Fahd Hospital of Imam Abdulrahman Bin Faisal University for patients with suspected PE from May 2016 to December 2019. The electronic health records were used to collect the data, including background demographic data, clinical presentation, triage vital signs, D-dimer level (if ordered), risk factors for PE, and the CT-PA findings. The Wells score and pulmonary embolism rule-out (PERC) criteria were calculated retrospectively without knowledge of the results of D-dimer and the CT-PA. Results: The study involved a total of 353 patients (125 men and 228 women) with a mean age of 46.7 ± 18.4 years. Overall, 200 patients (56.7%) were classified into the "PE unlikely" group and 153 patients (43.3%) in the "PE likely" group as per Wells criteria. Out of all the CT-PA, 119 CT-PA (33.7%) were requested without D-dimer assay (n = 114) or with normal D-dimer level (n = 5) despite being in the "PE unlikely" group. Only 49 patients had negative PERC criteria, of which three patients had PE. Conclusions: The study revealed that approximately one-third of all CT-PA requests were not adhering to the clinical decision rules with a significant underutilization of D-dimer assay in such patients. To reduce overutilization of imaging, planned interventions to promote the adherence to the current guidelines seem imperative. AD - Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia Department of Internal Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia AN - 143152734. Language: English. Entry Date: 20200519. Revision Date: 20200523. Publication Type: Article AU - Al Dandan, Omran AU - Hassan, Ali AU - Alnasr, Afnan AU - Al Gadeeb, Mohammed AU - AbuAlola, Hossain AU - Alshahwan, Sarah AU - Al Shammari, Malak AU - Alzaki, Alaa DB - CINAHL DO - 10.1186/s12245-020-00281-1 DP - EBSCOhost KW - Emergency Service Pulmonary Embolism -- Diagnosis Decision Making, Clinical Physicians, Emergency -- Psychosocial Factors Guideline Adherence -- Evaluation Algorithms -- Utilization Human Retrospective Design Nonexperimental Studies Electronic Health Records Risk Assessment -- Methods Pulmonary Embolism -- Risk Factors Male Female Adult Middle Age Aged Fibrin Fibrinogen Degradation Products Tomography, X-Ray Computed Physician's Role Saudi Arabia M1 - 1 N1 - research; tables/charts. Journal Subset: Biomedical; Europe; UK & Ireland. PY - 2020 SN - 1865-1372 SP - 1-6 ST - The use of clinical decision rules for pulmonary embolism in the emergency department: a retrospective study T2 - International Journal of Emergency Medicine TI - The use of clinical decision rules for pulmonary embolism in the emergency department: a retrospective study UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=143152734&site=ehost-live&scope=site VL - 13 ID - 761394 ER - TY - JOUR AB - Introduction: Stroke is a major emergency that can cause a significant morbidity and mortality. Advancement in stroke management in recent years has allowed more patients to be diagnosed and treated by stroke teams; however, stroke is a time-sensitive emergency that requires a high level of coordination, particularly within the prehospital phase. This research is to determine whether patients received by Emergency Medical Services (EMS) at a tertiary health care facility had shorter stroke team activation, time to computed tomography (CT), or time to receive intravenous thrombolytics. Methods: This research is a prospective cohort study of adults with stroke symptoms who required stroke team activation at a tertiary medical facility. The study included all patients received from September 1, 2017 through August 31, 2018. The primary outcome was the time difference to stroke team activation between patients received by EMS compared to patients that arrived by a private method of transportation. The secondary outcomes were the difference in time to CT scan and the time to receive intravenous recombinant tissue plasminogen activator (rtPA). Results: There were 75 (34.1%) patients who had been received by EMS, while 145 (65.9%) patients arrived via private transportation method (private car or by a friend/family member). The mean time to stroke team activation, time to CT, and time to receive thrombolytic therapy for the EMS group were: 8.19 (95% CI, 6.97 - 9.41) minutes; 18 (95% CI, 15.9 - 20.1) minutes; and 13.1 (95% CI, 6.95 - 19.3) minutes, respectively. Those for the private car group, on the other hand, were: 16 (95% CI, 12.4 - 19.6) minutes; 23.39 (95% CI, 19.6 - 27.2) minutes; and nine (95% CI, 4.54 -13.5) minutes, respectively. There was a significantly shorter time to stroke team activation for patients arriving via EMS compared to private car (P <= .00), but no significant difference was found on time to CT (P = .259) or time to receive rtPA (P = .100). Conclusion: Emergency Medical Service transportation of stroke patients can significantly shorten the time to stroke team activation, leading to shorter triage and accelerated patient management. However, there was no statistical difference in time to CT or time to receive rtPA. Patients with stroke symptoms may benefit more from EMS transportation compared to private methods of transportation. AD - [Alabdali, Abdullah; Yousif, Sami; Alsaleem, Abdullah; Aldhubayb, Mazen; Aljerian, Nawfal] King Saud Bin Abdulaziz Univ Hlth Sci, Coll Appl Med Sci, Emergency Med Serv Dept, Riyadh, Saudi Arabia. [Alabdali, Abdullah; Yousif, Sami] King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia. [Aljerian, Nawfal] Minist Hlth, Med Referrals Dept, Riyadh, Saudi Arabia. Alabdali, A (corresponding author), King Saud Bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Coll Appl Med Sci, Emergency Med Serv Dept, Riyadh, Saudi Arabia. abdalia@ksau-hs.edu.sa AN - WOS:000524931300006 AU - Alabdali, A. AU - Yousif, S. AU - Alsaleem, A. AU - Aldhubayb, M. AU - Aljerian, N. C7 - Pii s1049023x20000126 DA - Apr DO - 10.1017/s1049023x20000126 J2 - Prehospital Disaster Med. KW - allied health personnel ambulances patient safety patient transfer stroke transportation of patients DELAYS Emergency Medicine LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: LB9EF Times Cited: 0 Cited Reference Count: 11 Alabdali, Abdullah Yousif, Sami Alsaleem, Abdullah Aldhubayb, Mazen Aljerian, Nawfal 0 CAMBRIDGE UNIV PRESS NEW YORK PREHOSP DISASTER MED PY - 2020 SN - 1049-023X SP - 148-151 ST - Can Emergency Medical Services (EMS) Shorten the Time to Stroke Team Activation, Computed Tomography (CT), and the Time to Receiving Antithrombotic Therapy? A Prospective Cohort Study T2 - Prehospital and Disaster Medicine TI - Can Emergency Medical Services (EMS) Shorten the Time to Stroke Team Activation, Computed Tomography (CT), and the Time to Receiving Antithrombotic Therapy? A Prospective Cohort Study UR - ://WOS:000524931300006 VL - 35 ID - 761450 ER - TY - GEN AB - Background AU - Albaghdadi, Mazen S. AU - Dudzinski, David M. AU - Giordano, Nicholas AU - Kabrhel, Christopher AU - Ghoshhajra, Brian AU - Jaff, Michael R. AU - Weinberg, Ido AU - Baggish, Aaron DA - 2018/01/01 DB - Federal Science Library - Canada KW - pulmonary embolism quality of life exercise physiology echocardiography Predictive Value of Tests Prospective Studies Humans Middle Aged Male Pulmonary Embolism - therapy Recovery of Function Exercise Test Hypertrophy, Right Ventricular - physiopathology Time Factors Echocardiography, Doppler Hypertrophy, Right Ventricular - diagnostic imaging Adult Female Ventricular Dysfunction, Right - physiopathology Oxygen Consumption Pulmonary Embolism - diagnosis Exercise Tolerance Aged Health Status Longitudinal Studies Ventricular Function, Right Pulmonary Embolism - physiopathology Ventricular Dysfunction, Right - diagnostic imaging Index Medicus PY - 2018 SN - 2047-9980 ST - Cardiopulmonary Exercise Testing in Patients Following Massive and Submassive Pulmonary Embolism TI - Cardiopulmonary Exercise Testing in Patients Following Massive and Submassive Pulmonary Embolism UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV3dT9swED8xJNBexmAbK2OVeeMlzB9xPp6mCloVEKibqNhbZscOQmpTRKj497lL0o6xSQjxYslRcrHsu_PvfL47ACUPePBEJxgXxdzzPElw_3EiFkaGuZNFhHBciJzihsdj1f8Vnv-g0Jjvi9CYJl3E8vyNBKVW3yTvxrZFSSLx7aQ37JH_ka5pJXUcuwg1sf3l8fnyyIUy8qq6fJqk_ARoaPA22c9_SPy9T_0DPh9h2aTVuYONV4_7PbxrcSjrNYyzCSu-3IL1s9bT_gF-H9YXVW_mE-RTpM76bW0mdkF5Ocordl2yUZOUtWID5KbZPT09QzCOCpSZ0jFUStO2O_pDZ2pnk-tq-hHGg_7F4TBoqzEEAuWaBz60UcELISW3oeJGuUQTQHR5aPIodg6Rple5cwgirbVh4mPUF9455a3WNlWfYLWclf4zsCKNUu0RGaGxRO8ZI6TXvNCpMtoUeQf2F3Of3TRJN7LaWIlERjNGGcqzZsY6sLdYmwwFg7wdpvSzeZWRmz9BOBarDmw3i7YkJlNNtm7agWZtnvsL9ZVCDtp56Qdf4C0OpI5i5NEurN7dzv1XWCuqSWCrogtvZDjC9uj4tFsfB2D7czjo1oz7APX66vc VL - 7 ID - 762108 ER - TY - JOUR AU - Al-Bawardy, R. AU - Rosenfield, K. AU - Borges, J. AU - Young, M. N. AU - Albaghdadi, M. AU - Rosovsky, R. AU - Kabrhel, C. DA - 2018/07/17 07/17 DB - Europe PubMed Central DO - 10.1177/0267659118786830 M1 - 1 PY - 2018 SN - 0267-6591 SP - 22-28 ST - Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature T2 - Perfusion TI - Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature UR - http://europepmc.org/article/MED/30009670 VL - 34 ID - 762099 ER - TY - JOUR AB - BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used to stabilize patients with massive pulmonary embolism though few reports describe this approach. We describe the presentation, management and outcomes of patients who received ECMO for massive pulmonary embolism (PE) in our pulmonary embolism response team (PERT) registry. METHODS: We enrolled a consecutive cohort of patients with confirmed PE for whom PERT was activated and selected patients treated with ECMO. We prospectively captured clinical, therapeutic and outcome data at the time of PERT activation and during the follow-up period for up to 365 days. RESULTS: Thirteen patients who had PERT activation with confirmed PE diagnosis have undergone ECMO since the initiation of our PERT program in 2012. The mean age was 49 ± 19 years. Six (46%) patients were female. All the patients had cardiac arrest, either as an initial presentation or in-hospital cardiac arrest after presentation. All the patients exhibited right ventricular (RV) dilation on echocardiogram with RV hypokinesis. Eight (62%) patients received systemic thrombolysis with intravenous tissue plasminogen activator (tPA) and three (23%) patients underwent catheter-directed thrombolysis therapy using the EKOS system (EKOS Corporation, Bothell, WA, USA). Four (31%) patients underwent surgical embolectomy. Mean ECMO duration was 5.5 days, ranging from 2-18 days. Thirty-day mortality was 31% and one-year mortality was 54%. CONCLUSIONS: Patients with massive pulmonary embolism who suffer a cardiac arrest have high morbidity and mortality. ECMO can be used in conjunction with systemic thrombolysis, catheter-directed therapy or as a bridge to surgical embolectomy. AD - 1 Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA. 2 Department of Hematology, Massachusetts General Hospital, Boston, MA, USA. 3 Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA. AN - 30009670 AU - Al-Bawardy, R. AU - Rosenfield, K. AU - Borges, J. AU - Young, M. N. AU - Albaghdadi, M. AU - Rosovsky, R. AU - Kabrhel, C. DA - Jan DO - 10.1177/0267659118786830 DP - NLM ET - 2018/07/17 J2 - Perfusion KW - Acute Disease Extracorporeal Membrane Oxygenation/*methods Female Humans Male Middle Aged Prognosis Prospective Studies Pulmonary Embolism/*therapy Retrospective Studies *Ecmo *Pert *catheter-directed thrombolysis *massive PE *pulmonary embolism LA - eng M1 - 1 N1 - 1477-111x Al-Bawardy, Rasha Orcid: 0000-0002-5813-340x Rosenfield, Kenneth Borges, Jorge Young, Michael N Albaghdadi, Mazen Rosovsky, Rachel Kabrhel, Christopher Journal Article Review England Perfusion. 2019 Jan;34(1):22-28. doi: 10.1177/0267659118786830. Epub 2018 Jul 16. PY - 2019 SN - 0267-6591 SP - 22-28 ST - Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature T2 - Perfusion TI - Extracorporeal membrane oxygenation in acute massive pulmonary embolism: a case series and review of the literature VL - 34 ID - 760113 ER - TY - JOUR AB - Objectives: Patient blood management (PBM) is increasingly introduced into clinical practice. Minimizing effects on transfusion have been proven, but relevance for clinical outcome has been sparsely examined. In regard to this, the authors analyzed the impact of introducing intraoperative PBM to cardiac surgery. Design: Retrospective case-control study. Setting: Single center. Participants: A total of 3,170 patients who underwent either coronary artery bypass grafting, isolated aortic valve replacement, or a combined procedure at the authors' institution between January 1, 2007, and December 31, 2015. Intervention: In 2013, an intraoperative PBM service was established offering therapy recommendations on the basis of real-time laboratory monitoring. Comparisons to conventional coagulation management were adjusted for optimization of general, surgical, and perioperative care standards by interrupted time-series analysis and risk-dependent confounding by propensityscore matching. Measurements and Main Results: Primary study endpoints were in-hospital mortality and morbidity. Morbidity was defined as clinically relevant prolongation of hospital stay, which was related to accumulation of postoperative complications. Transfusion requirements, bleeding, and thromboembolic complications were not treated as primary endpoints, but were also explored. The recommendations on the basis of real-time laboratory monitoring were adopted by the operative team in 72% of patients. Intraoperative PBM was associated independently with a reduction of morbidity (8.3% v 6.3%, p = 0.034), whereas in-hospitalmortality (3.0% v 2.6%, p = 0.521) remained unaffected. The need for red blood cell transfusion decreased (71.1% v 65.0%, p < 0.001), as did bleeding complications requiring surgical re-exploration (3.5% v 1.8%, p = 0.004). At the same time, stroke increased by statistical trend (1.0% v 1.9%, p = 0.038; after correction for imbalanced type of surgical procedure p = 0.085). Conclusions: Real-time laboratory recommendations achieved a high acceptance rate early after initiation. Improvement of clinical outcome by intraoperative PBM adds to the optimized surgical care. However, the corridor between hemostatic optimization and thromboembolic risk may be narrow. (c) 2020 Elsevier Inc. All rights reserved. AD - [Albert, Alexander; Petrov, George; Dittberner, Julien; Akhyari, Payam; Aubin, Hug; Dalyanoglu, Hannan; Saeed, Diyar; Besser, Veronica; Karout, Abbas; Lichtenberg, Artur] Heinrich Heine Univ, Dept Cardiovasc Surg, Dusseldorf, Germany. [Roussel, Elisabeth; Hoffmann, Till] Heinrich Heine Univ, Dept Hemostaseol & Transfus Med, Dusseldorf, Germany. [Sixt, Stephan Urs] Heinrich Heine Univ, Dept Anesthesiol, Dusseldorf, Germany. Petrov, G (corresponding author), Heinrich Heine Univ, Fac Med, Dept Cardiovasc Surg, Moorenstr 5, D-40225 Dusseldorf, Germany. george@docpetrov.info AN - WOS:000567823200018 AU - Albert, A. AU - Petrov, G. AU - Dittberner, J. AU - Roussel, E. AU - Akhyari, P. AU - Aubin, H. AU - Dalyanoglu, H. AU - Saeed, D. AU - Besser, V. AU - Karout, A. AU - Lichtenberg, A. AU - Sixt, S. U. AU - Hoffmann, T. DA - Oct DO - 10.1053/j.jvca.2020.04.025 J2 - J. Cardiothorac. Vasc. Anesth. KW - cardiac surgery intraoperative PBM algorithm-based PBM coagulation management mortality morbidity transfusion bleeding stroke CELL TRANSFUSION METAANALYSIS COST Anesthesiology Cardiac & Cardiovascular Systems Respiratory System Peripheral Vascular Disease LA - English M1 - 10 M3 - Article N1 - ISI Document Delivery No.: NM0VP Times Cited: 0 Cited Reference Count: 23 Albert, Alexander Petrov, George Dittberner, Julien Roussel, Elisabeth Akhyari, Payam Aubin, Hug Dalyanoglu, Hannan Saeed, Diyar Besser, Veronica Karout, Abbas Lichtenberg, Artur Sixt, Stephan Urs Hoffmann, Till 0 W B SAUNDERS CO-ELSEVIER INC PHILADELPHIA J CARDIOTHOR VASC AN PY - 2020 SN - 1053-0770 SP - 2655-2663 ST - The Impact of Intraoperative Patient Blood Management on Quality Development in Cardiac Surgery T2 - Journal of Cardiothoracic and Vascular Anesthesia TI - The Impact of Intraoperative Patient Blood Management on Quality Development in Cardiac Surgery UR - ://WOS:000567823200018 VL - 34 ID - 761405 ER - TY - JOUR AB - Background: Lower extremity deep vein thrombosis (DVT) is a common vascular condition. The clinical appearance of DVT ranges from mild local symptoms to fatal pulmonary embolism. A clinical risk score (Well's score) combined with D-dimer measurement selects patients appropriate for ultrasonic evaluation. Purpose: This study describes the flow of patients suspected for DVT with focus on the effort of a repeated ultrasonic evaluation after 7 days in patients with a high clinical probability (Well's score >1) and positive D-dimer but with a negative initial ultrasonic evaluation. This setup is based on the pathophysiological rationale that repeated scanning detects propagating distal DVT. Methods: Well's score combined with D-dimer measurement were assessed prospectively to all patients suspected for DVT referred to the Emergency Department at a Hospital, during a 17 months period (Sep. 2014-Jan. 2016). Patients with DVT were managed in a multidisciplinary team that consists of a sonographer, an emergency physician, a cardiologist and a nurse with specialist knowledge in thrombosis and anticoagulation. Results: During this 17 months period 452 patients were referred with suspected lower limb DVT, of which 91 patients (20%) had the diagnosis of DVT confirmed after the initial ultrasonic evaluation. 174 patients (39%) had the ultrasonic evaluation repeated after 7 days and in 17 patients (10%) of these thrombosis was detected. Overall 108 patients (24%) were diagnosed with DVT. They were all treated with anticoagulation: 6 (6%) with Low Molecule Weight Heparin because of cancer, 24 (22%) with Warfarin, 9 (8%) with Apixaban and 69 (64%) with Rivaroxaban. Conclusion: The clinical suspicion of DVT is confirmed in 1 out of 4 patients referred for evaluation. The need of re-evaluation after 7 days is common and in 1 out of 10 cases the diagnosis is confirmed with the ultrasonic re-evaluation. DVT patients are best managed in a multidisciplinary team with a structured setup where both the diagnosis and an appropriate follow-up can be done. (Table Presented). AD - A.E. Albertsen, Regional Hospital Viborg, Department of Cardiology, Viborg, Denmark AU - Albertsen, A. E. AU - Saugmann, P. AU - Oddershede, G. D. AU - Madsen, P. AU - Brandhof, C. L. B. AU - Moeller, D. S. DB - Embase DO - 10.1093/eurheartj/ehw433 KW - apixaban D dimer heparin rivaroxaban warfarin anticoagulation cardiologist deep vein thrombosis diagnosis doctor patient relationship emergency physician emergency ward follow up human lower limb major clinical study molecular weight neoplasm nurse probability ultrasound LA - English M3 - Conference Abstract N1 - L612284044 2016-09-27 PY - 2016 SN - 1522-9645 SP - 783 ST - Management of deep vein thrombosis in a multidisciplinary team T2 - European Heart Journal TI - Management of deep vein thrombosis in a multidisciplinary team UR - https://www.embase.com/search/results?subaction=viewrecord&id=L612284044&from=export http://dx.doi.org/10.1093/eurheartj/ehw433 VL - 37 ID - 761009 ER - TY - JOUR AB - In patients with atrial fibrillation (AF) under oral anticoagulant therapy (OAT), over half of the hemorrhagic complications occur in the gastrointestinal (GI) tract, with an incidence of 1-4% per year. This complication mainly involves older patients, often very compromised from the clinical point of view; mortality rates are not negligible, varying between 4% and 15%. The purpose of the present review was to evaluate the utility of resuming OAT after a major GI hemorrhage in patients with AF. Four observational studies were found in the literature that specifically investigated this issue; three of them had a retrospective design. In these studies almost exclusively warfarin was utilized. OAT was discontinued in all patients at the beginning of GI hemorrhage; in about half of the patients anticoagulation was then restarted and in the other half it was definitively stopped. The results of these studies suggest a beneficial effect of OAT resumption, since it reduced the incidence of thromboembolic events and mortality with a not marked increase in hemorrhagic recurrences. However, these results should be interpreted with caution since, very likely, OAT was resumed in patients in good clinical condition-as suggested by the very low mortality rate during hemorrhagic recurrences (0.7%)-and not in those with very severe hemorrhage and/or very compromised from the clinical point of view. Because of this type of patient selection, we do not know the real hemorrhagic risk in patients resuming OAT after GI hemorrhage. This is a strong limitation in the decision making; in order to acquire this knowledge, randomized studies should be carried out. The evaluation whether or not to restart OAT should be made in the clinical context by a team including the gastroenterologist (or the physician taking care of the GI pathology) and the cardiologist. At present, clinical variables such as site and/or cause of GI bleeding, severity of the anemia and the degree of prolongation of the international normalized ratio, do not appear useful for decision making. The available data suggest that OAT should be resumed in " robust" elderly patients, if the source of bleeding has been identified and corrected, whereas in frail patients and/or with multiple comorbidities, the doubt often remains. The available literature does not offer clear data on the optimal duration of OAT discontinuation after an episode of major GI bleeding. The evaluation should be made in the clinical context; however, therapy discontinuation between 1 week and 1 month appears to be adequate in most cases. On the basis of indirect comparisons, which show many limitations, the most appropriate anticoagulants after GI hemorrhage appear to be warfarin, apixaban and low-dose edoxaban. AD - [Alboni, Paolo] Osped Accreditato Quisisana, Sez Cardiol, Viale Cavour 128, I-44121 Ferrara, Italy. [Stucci, Nicola] Osped Accreditato Quisisana, UO Med, Ferrara, Italy. [Zoli, Giorgio] Univ Ferrara, Osped Cento FE, Ctr Diagnosi & Cura Malattie Intestino, Ferrara, Italy. Alboni, P (corresponding author), Osped Accreditato Quisisana, Sez Cardiol, Viale Cavour 128, I-44121 Ferrara, Italy. alboni.cardiologia@gmail.com AN - WOS:000470324800006 AU - Alboni, P. AU - Stucci, N. AU - Zoli, G. DA - Jun J2 - G. Ital. Cardiol. KW - Atrial fibrillation Gastrointestinal hemorrhage New oral anticoagulants Warfarin DIRECT ORAL ANTICOAGULANTS STROKE PREVENTION ANTITHROMBOTIC THERAPY CLINICAL MANAGEMENT ENDOSCOPIC FINDINGS EUROPEAN-SOCIETY EFFICACY SAFETY THROMBOEMBOLISM WARFARIN Cardiac & Cardiovascular Systems LA - Italian M1 - 6 M3 - Review N1 - ISI Document Delivery No.: IB5PU Times Cited: 0 Cited Reference Count: 34 Alboni, Paolo Stucci, Nicola Zoli, Giorgio 0 1 PENSIERO SCIENTIFICO EDITOR ROME G ITAL CARDIOL PY - 2019 SN - 1827-6806 SP - 367-373 ST - Major gastrointestinal hemorrhage during anticoagulant therapy in patients with atrial fibrillation: when to resume treatment? T2 - Giornale Italiano Di Cardiologia TI - Major gastrointestinal hemorrhage during anticoagulant therapy in patients with atrial fibrillation: when to resume treatment? UR - ://WOS:000470324800006 VL - 20 ID - 761521 ER - TY - JOUR AB - An operation note is a medicolegal document. The Royal College of Surgeons (RCS) of England's Good Surgical Practice 2014 (GSP) sets out 19 points an operation note should include. This study aimed to assess if the introduction of an electronic patient record (EPR) improved the quality of general surgical operation notes. An annonymised retrospective case note review of general surgical operation notes was undertaken over five separate time periods. The first cycle consisted of periods 1 (prior to EPR implementation), 2 (1 week after EPR) and 3 (4 weeks after EPR). Period 4 was a reaudit 2 weeks after the initial results were presented at the local governance meeting. The cycle was then closed with period 5; 1 year after EPR implementation. A comparison was across all 5 time periods for compliance with the RCS guidelines and with subanalysis of the individual categories. 250 operation notes were reviewed during five time periods. Compliance improved by almost 19% (p=0.0003) between periods 1 and 5. Eleven of the 19 points (57.9%) over the audit period achieved 100% compliance post-EPR compared to 0% prior. Poor compliance were noted in the categories of antibiotic use, venous thromboembolism prophylaxis and estimated blood loss (noting that these are often documented in the anaesthetic record and/or WHO checklist). EPRs do not guarantee compliance with GSP. We propose that GSP standards need to be updated to reflect the modernisation of medical records and a team-based approach with multimodality input sources would achieve better patient records and patient care. AD - Department of General Surgery, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK. AN - 31909211 AU - Aldoori, J. AU - Drye, N. AU - Peter, M. AU - Barrie, J. C2 - Pmc6937033 DO - 10.1136/bmjoq-2019-000766 DP - NLM ET - 2020/01/08 J2 - BMJ open quality KW - Documentation/methods/*standards/trends Electronic Health Records/*standards/trends England Humans Inventions Medical Audit/methods/statistics & numerical data Patient Care Team/*trends *audit and feedback *quality improvement *surgery *teams LA - eng M1 - 4 N1 - 2399-6641 Aldoori, Joanna Orcid: 0000-0002-5695-0000 Drye, Naomi Peter, Mark Barrie, Jenifer Journal Article BMJ Open Qual. 2019 Dec 2;8(4):e000766. doi: 10.1136/bmjoq-2019-000766. eCollection 2019. PY - 2019 SN - 2399-6641 SP - e000766 ST - Introduction of an electronic patient record (EPR) improves operation note documentation: the results of a closed loop audit and proposal of a team-based approach to documentation T2 - BMJ Open Qual TI - Introduction of an electronic patient record (EPR) improves operation note documentation: the results of a closed loop audit and proposal of a team-based approach to documentation VL - 8 ID - 760198 ER - TY - JOUR AB - Aim To assess thromboprophylaxis prescribing patterns against current guidelines and report thromboembolism (TE) incidence in multiple myeloma (MM) patients treated with thalidomide (thal) or lenalidomide (len) at a specialist cancer hospital over a one-year period. Method Dispensing records of thal and len, diagnosis of MM, patients' characteristics, disease status, co-prescribed medicines including thromboprophylaxis and incidence of TE were extracted from patients' records and a patient survey conducted to identify patients who sourced thromboprophylactic medicines outside the hospital. Results Enoxaparin was most the commonly prescribed thromboprophylactic agent (43%), followed by low-dose aspirin (26%) and therapeutic warfarin (6%). The thromboprophylactic strategy (including no prophylaxis) could not be determined for 22% of patients. TE incidence (with any thromboprophylaxis) was 9.3 and 9.1% in thal-based and len-based regimens, respectively. Conclusion Both aspirin and enoxaparin thromboprophylaxis were prescribed for patients on both low-risk and high-risk immunomodulatory drug-based regimens, deviating from current consensus guidelines. Treatment of comorbidities constituted the rationale for maintenance on therapeutic warfarin. Fixed low-dose warfarin was not prescribed. TE event rates (with any thromboprophylaxis) were consistent with those reported in the literature. Documentation of a chosen strategy was lacking for nearly a quarter of patients, resulting in uncertainty of treatment plan for other members of the multidisciplinary treating team. Centers need to work towards evidence-based institutional guidelines and improving documentation practices for thromboprophylaxis in their MM patients. AD - [Alexander, Marliese; Lingaratnam, Senthil; Kirsa, Sue; Mellor, James D.] Peter MacCallum Canc Ctr, Dept Pharm, East Melbourne, Vic 3002, Australia. [Teoh, Khai C.] Univ Queensland, Sch Pharm, Brisbane, Qld, Australia. Alexander, M (corresponding author), Peter MacCallum Canc Ctr, Dept Pharm, St Andrews Pl, East Melbourne, Vic 3002, Australia. marliese.alexander@petermac.org AN - WOS:000319217100011 AU - Alexander, M. AU - Teoh, K. C. AU - Lingaratnam, S. AU - Kirsa, S. AU - Mellor, J. D. DA - Jun DO - 10.1111/ajco.12013 J2 - Asia-Pac. J. Clin. Oncol. KW - immunomodulatory drugs lenalidomide multiple myeloma thalidomide thromboprophylaxis NEWLY-DIAGNOSED MYELOMA PLUS DEXAMETHASONE THERAPY PREVENTION ASPIRIN TRANSPLANTATION THROMBOEMBOLISM CHEMOTHERAPY PREDNISONE ENOXAPARIN Oncology LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 148BK Times Cited: 7 Cited Reference Count: 17 Alexander, Marliese Teoh, Khai C. Lingaratnam, Senthil Kirsa, Sue Mellor, James D. Alexander, Marliese/0000-0001-5782-7912 7 0 WILEY-BLACKWELL HOBOKEN ASIA-PAC J CLIN ONCO PY - 2013 SN - 1743-7555 SP - 169-175 ST - Thromboprophylaxis prescribing and thrombotic event rates in multiple myeloma patients treated with lenalidomide or thalidomide at a specialist cancer hospital T2 - Asia-Pacific Journal of Clinical Oncology TI - Thromboprophylaxis prescribing and thrombotic event rates in multiple myeloma patients treated with lenalidomide or thalidomide at a specialist cancer hospital UR - ://WOS:000319217100011 VL - 9 ID - 761804 ER - TY - JOUR AB - INTRODUCTION/AIM OF THE STUDY: To assess the influence of a multidisciplinary approach on the limb salvage rates in the treatment of patients suffering from diabetic ischaemic inferior limb ulcers. MATERIALS & METHOD: From September 2001 until March 2008, a consecutive series of 183 limbs with diabetic ischaemic wounds in 163 patients were treated by combined multi-level angioplasties as the primary revascularization approach in an institutional diabetic programme (two departmental hospitals). The avoidance of limb loss was retrospectively analyzed before and after the year 2005, as a landmark for implementing a "multidisciplinary diabetic foot clinic" in the routine daily care. RESULTS: Initial technical success for endovascular revascularization was noted in 152 limbs (83%). The aggregate limb salvage proportions at 12, 24, 32, 60 and 66 months (+/- SEM) were: 87% (+/- 2.8), 80% (+/- 3.9), 77% (+/- 4.4) and thereafter 77% (+/- 4.4), respectively. A comparison between the limb salvage rates before and after initiating the multidisciplinary group showed a significant difference (p = 0.040, CI: 1.040-5.311, HR: 2.35, Chi square = 4.22) with better results in the latest interval, employing effective team activity. No statistical deviation was found regarding the technique itself for revascularization at the same intervals (p = 0.381). CONCLUSION: Our experience suggests that limb salvage for diabetic ischaemic wounds may be favourably influenced by a co-ordinated multidisciplinary group. Although appropriate revascularization is crucial for limb rescue, a pluralist control of the attending risk factors influencing wound healing might be of matchless importance as well. AD - Department of Vascular and Thoracic Surgery, Princesse Paola Hospital Marche-en-Famenne, Belgium. v.alex@skynet.be AN - 20184051 AU - Alexandrescu, V. AU - Hubermont, G. AU - Coessens, V. AU - Philips, Y. AU - Guillaumie, B. AU - Ngongang, C. AU - Vincent, G. AU - Azdad, K. AU - Ledent, G. AU - De Marre, C. AU - Macoir, C. DA - Nov-Dec DO - 10.1080/00015458.2009.11680519 DP - NLM ET - 2010/02/27 J2 - Acta chirurgica Belgica KW - *Angioplasty, Balloon Clinical Protocols Diabetic Foot/*surgery Humans Limb Salvage/*statistics & numerical data *Patient Care Team Retrospective Studies Vascular Patency Wound Healing LA - eng M1 - 6 N1 - Alexandrescu, V Hubermont, G Coessens, V Philips, Y Guillaumie, B Ngongang, Chr Vincent, G Azdad, K Ledent, G De Marre, C Macoir, C Journal Article England Acta Chir Belg. 2009 Nov-Dec;109(6):694-700. doi: 10.1080/00015458.2009.11680519. PY - 2009 SN - 0001-5458 (Print) 0001-5458 SP - 694-700 ST - Why a multidisciplinary team may represent a key factor for lowering the inferior limb loss rate in diabetic neuro-ischaemic wounds: application in a departmental institution T2 - Acta Chir Belg TI - Why a multidisciplinary team may represent a key factor for lowering the inferior limb loss rate in diabetic neuro-ischaemic wounds: application in a departmental institution VL - 109 ID - 760502 ER - TY - JOUR AB - INTRODUCTION: This study aims to assess the patency, the clinical success and the limb-salvage rates of combined subintimal (SA) coupled to endoluminal angioplasty (EA) as the initial treatment of ischaemic inferior-limb ulcers in diabetic patients and to study the influence of other concurrent factors in the tissue-healing process. MATERIALS AND METHOD: Since September 2002 until December 2007, a consecutive series of 176 limbs with manifold ischaemic wounds in 161 diabetic patients were treated by associated multilevel angioplasties in a multidisciplinary 'diabetic-foot team' (a third-line diabetic-care institution integrating two departmental hospitals). There were 98 associated SA with EA procedures, 26 re-vascularisations by single SA technique and 52 others including selective multilevel EAs that were retrospectively reviewed. The mean follow-up period was 22.1 months (in the range of 1-50 months) by clinical and duplex evaluation (every 6 months). RESULTS: The initial technical success was noted in 149 limbs (84%). For the single or associated SA procedures, 102 of 124 procedures were successful (82%) and 145 of 150 of the miscellaneous EAs (96%) evinced an equally favourable outcome. The 27 initially failed endovascular procedures (22 SA and five EA) required 16 surgical re-vascularisation, eight adjuvant endovascular procedures besides three amputations. A total of 21 secondary and five tertiary angioplasties were equally necessary during the entire follow-up period of these patients. The 30-day survival rate was 99% (one patient died from myocardial infarction). In a intention-to-treat analysis, the cumulative primary and secondary patencies at 12, 24, 36 and 48 months were 62%, 45%, 41% and 38%, together with 80%, 69%, 66% and 66%, respectively. The aggregate clinical success rates at the same intervals were 86%, 77%, 70% and 69%, while the corresponding limb-salvage proportions showed 89%, 83%, 80% and 80%, respectively. The primary patency was negatively affected at 1 and 4 years by the length of the occluded segment (>10 cm) and the end-stage renal disease (ESRD) (p<0.0001). The limb-salvage rates were unfavourably influenced at the same periods by the extent of tissue defects (>3 cm), the ESRD and the presence of osteomyelitis. In addition, at 4 years, the age (>70 years), the accompanying peripheral neuropathy, the bedridden status and the presence of cardiac failure (left ventricular ejection fraction (LVEF)<30%) appeared equally as negative predictors (p<0.0001) for wound healing and limb rescue. CONCLUSION: Primary angioplasty represents a low aggressive and efficacious method to improve the healing process in diabetic ischaemic ulcers. However, beyond appropriate re-vascularisation, even repetitive if necessary, achieving satisfactory limb-salvage rates probably implies a multidisciplinary control of the presenting risk factors for wound healing as well. AD - Department of Surgery, Princesse Paola Hospital, Marche-en-Famenne, Belgium. v.alex@skynet.be AN - 19213580 AU - Alexandrescu, V. AU - Hubermont, G. AU - Philips, Y. AU - Guillaumie, B. AU - Ngongang, Ch AU - Coessens, V. AU - Vandenbossche, P. AU - Coulon, M. AU - Ledent, G. AU - Donnay, J. C. DA - Apr DO - 10.1016/j.ejvs.2008.12.005 DP - NLM ET - 2009/02/14 J2 - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery KW - Age Factors Aged Aged, 80 and over Angioplasty, Balloon/*methods Diabetic Foot/*therapy Female Follow-Up Studies Foot/blood supply Heart Failure/complications Humans Ischemia/*therapy Limb Salvage/methods Male Middle Aged Mobility Limitation Patient Care Team Peripheral Nervous System Diseases/complications Recurrence Retrospective Studies Stents Vascular Patency Wound Healing LA - eng M1 - 4 N1 - 1532-2165 Alexandrescu, V Hubermont, G Philips, Y Guillaumie, B Ngongang, Ch Coessens, V Vandenbossche, P Coulon, M Ledent, G Donnay, J-C Journal Article England Eur J Vasc Endovasc Surg. 2009 Apr;37(4):448-56. doi: 10.1016/j.ejvs.2008.12.005. Epub 2009 Feb 11. PY - 2009 SN - 1078-5884 SP - 448-56 ST - Combined primary subintimal and endoluminal angioplasty for ischaemic inferior-limb ulcers in diabetic patients: 5-year practice in a multidisciplinary 'diabetic-foot' service T2 - Eur J Vasc Endovasc Surg TI - Combined primary subintimal and endoluminal angioplasty for ischaemic inferior-limb ulcers in diabetic patients: 5-year practice in a multidisciplinary 'diabetic-foot' service VL - 37 ID - 760504 ER - TY - JOUR AB - Service or Program: A pharmacy driven transition of care (ToC) initiative that targets patients newly started on warfarin in a secondary care hospital in Qatar. A multidisciplinary team of physicians, pharmacists, and nurses in cardiology, surgery, and internal medicine units are managing patients on warfarin through a focused ToC action plan from hospital admission to post-discharge care. Defined roles and responsibilities agreed among the team include distribution of warfarin booklets (pocket educational/follow up booklet), monitoring of dispensed warfarin quantities, patients education, early completion of discharge summary note, improving timeliness of post discharge follow up, and ensuring proper hands off communication through verbal and written endorsements to the anticoagulation clinic clinical pharmacy specialist. Clinical pharmacists conducted several staff education sessions and ensured that team members roles were carried as described in the action plan and communicated with them in cases of discrepancies. Justification/Documentation: A standardized ToC process for hospitalized patients on warfarin is necessary, but it lacks in our facility. A patient with high thrombosis risk admitted with a thrombotic event, initiated and discharged on warfarin with improper follow up triggered the development of this service. In 6 months, ToC of 21 patients successfully achieved a higher number of patients receiving warfarin booklets (76%), attending first ACC visit within 3 to 7 days of discharge (86%), and achieving therapeutic international normalized ratio (INR) within five days (57%). Adaptability: Proper communication and defined roles and responsibilities are the key to the success of this service in our facility. We are planning to expand and integrate this model at a national level to include all anticoagulation clinics in Qatar. Significance: Evidence suggests that majority of medication errors occur during ToC. Clinical pharmacists have unique roles ensuring safe and effective medication therapies and empowering them running ToC services is of great significance. AD - E. Alhmoud, Pharmacy Department, Hamad Medical Corporation, Doha, Qatar AU - Alhmoud, E. AU - El Samad, O. A. AU - Ahmed, S. AU - Fahmi, A. AU - El Enany, R. DB - Embase DO - 10.1002/jac5.1204 KW - warfarin adult anticoagulation cardiology clinical article clinical pharmacist clinical pharmacy conference abstract documentation female follow up hospital admission hospital patient human international normalized ratio male medication error multidisciplinary team nurse pharmacokinetics physician Qatar responsibility risk assessment running secondary care center staff training thrombosis timeliness transitional care LA - English M1 - 1 M3 - Conference Abstract N1 - L631833577 2020-05-28 PY - 2020 SN - 2574-9870 SP - 324 ST - Anticoagulation management in care transitions after hospital initiation of warfarin: A Pharmacy driven initiative T2 - JACCP Journal of the American College of Clinical Pharmacy TI - Anticoagulation management in care transitions after hospital initiation of warfarin: A Pharmacy driven initiative UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631833577&from=export http://dx.doi.org/10.1002/jac5.1204 VL - 3 ID - 760606 ER - TY - JOUR AB - Objectives: Decision-making around the use of thrombolysis for patients with intermediate-risk (submassive) PE remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (IV tPA), but the risk of major bleeding and hemorrhagic stroke is a deterrent. Catheter-directed thrombolysis (CDT) may be a preferable strategy, as it has been shown to have a lower risk of bleeding than systemic thrombolysis. However, a three-arm randomized control study comparing IV tPA, CDT and anticoagulation alone, with long-term follow up, would be costly and is unlikely to be performed. The aim of this study was to use decision modeling to estimate the projected results of such a study. Methods: We created an individual level state-transition model to simulate a hypothetical three arm clinical trial evaluating IV tPA, CDT and anticoagulation alone. Our model incorporated clinical RCT and longitudinal study data to inform patient characteristics and outcomes specific to each study arm. The base case was a 65 year old patient. Additionally, we utilized preliminary data published by the Pulmonary Embolism Response Team (PERT) at the Massachusetts General Hospital. Variance in model inputs was addressed with deterministic and probabilistic sensitivity analyses. Our primary endpoint was quality-adjusted life years (QALYs). Secondary endpoints included total cost and incremental cost-effectiveness ratios (ICER). Results: CDT [7.388 (7.381, 7.396) QALYs] was the best treatment option for eligible patients compared to anticoagulation alone [7.352 (7.345, 7.360) QALYs] or IV tPA [7.343 (7.336, 7.351) QALYs]. Patients receiving CDT had an elevated risk of hemorrhagic stroke in comparison to anticoagulation alone; however, patients treated with anticoagulation alone were more likely to experience recurrent PE associated adverse outcomes. Results were stable with sensitivity analyses varying age and sex. Our probabilistic sensitivity analysis assessing joint variance predicts CDT to be the most effective strategy in 98.4 % of runs, while systemic thrombolysis was favored over anticoagulation alone 34.4% of the time. The ICER of CDT compared to anticoagulation was $317,042 per QALY gained. Conclusion: In our model, for those eligible, CDT is the most effective strategy (QALYs) for patients with intermediate-risk PE, although it is expensive. Future studies that provide data on longitudinal quality-of-life outcomes of patients treated for PE and characteristics of CDT would be beneficial to verify model assumptions, inputs, and results. AD - A. Ali, Massachusetts General Hospital, Institute for Technology Assessment, United States AU - Ali, A. AU - Hur, C. AU - Choi, J. AU - Kabrhel, C. DB - Embase DO - 10.1111/acem.13203 KW - endogenous compound tissue plasminogen activator adverse outcome aged animal model anticoagulation blood clot lysis brain hemorrhage case report catheter clinical trial conformational transition controlled clinical trial controlled study cost effectiveness analysis disease simulation female follow up general hospital human joint longitudinal study lung embolism male Massachusetts quality adjusted life year randomized controlled trial LA - English M3 - Conference Abstract N1 - L616279700 2017-05-23 PY - 2017 SN - 1553-2712 SP - S247 ST - Catheter-directed thrombolysis for intermediate risk pulmonary embolism: A simulation modeling analysis T2 - Academic Emergency Medicine TI - Catheter-directed thrombolysis for intermediate risk pulmonary embolism: A simulation modeling analysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616279700&from=export http://dx.doi.org/10.1111/acem.13203 VL - 24 ID - 760945 ER - TY - JOUR AB - Introduction: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) provides the respiratory support in acute severe respiratory failure until the underlying acute lung pathology improves. VV-ECMO support for. Aim of the work: We describe our experience in the management of the longest ECMO run in our center. Methods: A 17 years old Male patient who had only vague past medical history of recurrent abdominal pain for 5 years. Patient was admitted with severe ARDS that failed to improve with conventional ventilation, Murray Lung Injury Score was 3.5, RESP score was 1, underwent Veno-venous (V-V) ECMO via femoro-atrial approach using Maquet Cardio help console. The ECMO run duration was 146 days. Patient suffered from several complications during the ECMO run such as pulmonary hemorrhage, Acute cor pulmonale, thrombocytopenia and convulsions. Results: Patient expired on ECMO day 146 with refractory septic shock even after shifting to VAV ECMO support. Conclusion: Prolonged ECMO therapy poses its unique challenges. Multidisciplinary team management plays fundamental role during management of prolonged ECMO therapy. AD - A.S.A. Ali, Faculty of Medicine, Cairo University, Egypt AU - Ali, A. S. A. AU - Yosri, M. AU - Abouelwafa, M. AU - Saad, M. AU - Zaki, K. AU - Mashhour, S. AU - Salah, H. AU - Mohsen, T. AU - Abozeid, A. AU - Khaled, M. AU - Abdelbary, A. AU - Abdelfattah, A. DB - Embase DO - 10.1016/j.ejccm.2018.12.015 KW - extracorporeal membrane oxygenation cannula extracorporeal membrane oxygenation device argatroban bosentan epinephrine hemoglobin hypertensive factor inotropic agent meropenem methylprednisolone midazolam phenytoin abdominal pain acute respiratory failure adolescent adult respiratory distress syndrome antibiotic therapy anticoagulant therapy antifungal therapy antiviral therapy article artificial ventilation assisted ventilation blood gas blood transfusion bronchoscopy case report clinical article clonic seizure community acquired pneumonia convulsion cor pulmonale dyspnea electroencephalography extracorporeal oxygenation follow up hematothorax hemodynamics hemoptysis hemorrhagic shock human hypoxemia lung angiography lung artery pressure lung hemorrhage lung injury lung ventilation male medical history multidisciplinary team persistent pulmonary hypertension pneumothorax septic shock thrombocytopenia treatment duration veno-venous ECMO x-ray computed tomography LA - English M1 - 3 M3 - Article N1 - L2001392120 2018-12-25 2019-01-11 PY - 2018 SN - 2090-7303 SP - 113-121 ST - One hundred forty six days on extracorporeal membrane oxygenation (ECMO): Our longest ECMO run T2 - Egyptian Journal of Critical Care Medicine TI - One hundred forty six days on extracorporeal membrane oxygenation (ECMO): Our longest ECMO run UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001392120&from=export http://dx.doi.org/10.1016/j.ejccm.2018.12.015 VL - 6 ID - 760785 ER - TY - JOUR AB - OBJECTIVES: Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (PH). Despite excellent outcomes following PEA, a small proportion of patients have residual proximal disease or present with recurrent chronic thromboembolic PH and may benefit from further surgery. The aim of this study was to analyse outcomes following reoperative PEA at a high-volume national tertiary referral centre for the management of chronic thromboembolic PH. METHODS: This retrospective analysis was performed using our prospectively maintained PH database to identify all patients who underwent reoperative PEA surgery between the commencement of the programme in 1997 and January 2017, and the patients' data were collected for analysis. RESULTS: Twelve patients underwent reoperative PEA during the period of study. The mean interval between primary procedure and reoperative procedure was 6.3 years. Significant improvements were observed in pulmonary haemodynamics following reoperative PEA. Mean pulmonary arterial pressure decreased from 46.8 to 29.8 mmHg (P < 0.0001) and pulmonary vascular resistance decreased from 662 to 362 dyne·s·cm-5 (P = 0.0007). A significant functional improvement in the 6-min walking test distance was also observed, increasing from 327 to 460 m at 6 months postoperatively (P = 0.0018). Median length of hospital stay was 12 days. In-hospital mortality was 8.3% with 1-year survival of 83.3%. CONCLUSIONS: Reoperative PEA is technically possible and relatively safe, achieving good functional and physiological outcomes. Patients must be carefully selected by a multidisciplinary team, and surgery should be performed in experienced centres. AD - Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK. Pulmonary Vascular Disease Unit, Papworth Hospital, Cambridge, UK. Department of Radiology, Papworth Hospital, Cambridge, UK. AN - 29373658 AU - Ali, J. M. AU - Dunning, J. AU - Ng, C. AU - Tsui, S. AU - Cannon, J. E. AU - Sheares, K. K. AU - Taboada, D. AU - Toshner, M. AU - Screaton, N. AU - Pepke-Zaba, J. AU - Jenkins, D. P. DA - Jun 1 DO - 10.1093/icvts/ivx424 DP - NLM ET - 2018/01/27 J2 - Interactive cardiovascular and thoracic surgery KW - Adult Chronic Disease *Endarterectomy Female Hemodynamics Hospital Mortality Humans Hypertension, Pulmonary/*surgery Male Middle Aged Pulmonary Embolism/*surgery *Reoperation Retrospective Studies Treatment Outcome Vascular Resistance Young Adult LA - eng M1 - 6 N1 - 1569-9285 Ali, Jason M Dunning, John Ng, Choo Tsui, Steven Cannon, John E Sheares, Karen K Taboada, Dolores Toshner, Mark Screaton, Nick Pepke-Zaba, Joanna Jenkins, David P Journal Article England Interact Cardiovasc Thorac Surg. 2018 Jun 1;26(6):932-937. doi: 10.1093/icvts/ivx424. PY - 2018 SN - 1569-9285 SP - 932-937 ST - The outcome of reoperative pulmonary endarterectomy surgery T2 - Interact Cardiovasc Thorac Surg TI - The outcome of reoperative pulmonary endarterectomy surgery VL - 26 ID - 760162 ER - TY - JOUR AB - Summary of recommendations: Pregnant women should be managed by a multidisciplinary team that includes haematologists, obstetricians, neonatologists and anaesthetists (Grade 1C) As for non-pregnant patients, acute myeloid leukaemia (AML) should be diagnosed using the World Health Organization (WHO) classification (Grade 1A) Women diagnosed with AML in pregnancy should be treated without delay (Grade 1B) When the diagnosis of AML is made in the first trimester, a successful pregnancy outcome is unlikely and spontaneous pregnancy loss in this situation carries considerable risks for the mother. The reasons for and against elective termination should be discussed with the patient (Grade 2C) In the case of presentation beyond 32 weeks gestation, it may be reasonable to deliver the foetus prior to commencement of chemotherapy (Grade 2C) Between 24 and 32 weeks, risks of foetal chemotherapy exposure must be balanced against risks of prematurity following elective delivery at that stage of gestation (Grade 1C) The risk-benefit ratio must be carefully considered before using any drugs in pregnancy (Grade 1C) Where AML induction chemotherapy is delivered, a standard daunorubicin, cytarabine 3 + 10 schedule should be used (Grade 1B) Chemotherapy should be dosed according to actual body weight and adjustments made for weight changes during treatment (Grade 1C) Quinolones, tetracyclines and sulphonamide use should be avoided in pregnancy (Grade 1B) Amphotericin B or lipid derivatives are the antifungal of choice in pregnancy (Grade 2C) Cytomegalovirus (CMV)-negative blood products should be administered during pregnancy regardless of CMV serostatus (Grade 1B) A course of corticosteroids should be considered if delivery is anticipated between 24 and 35 weeks gestation, given over a 48-h period during the week prior to delivery (Grade 1A) Use of magnesium sulphate should be considered in the 24 h prior to delivery if this is before 30 weeks gestation (Grade 1A) Where possible, delivery should be planned for a time when the woman is at least 3 weeks post-chemotherapy to minimize risk of neonatal myelosuppression (Grade 1C) Planned delivery is easier to manage than spontaneous labour; induction of labour is usually advised (Grade 2C) Epidural analgesia should be avoided in a woman who is significantly thrombocytopenic (platelet count <80 × 109/l) and/or neutropenic (white blood cell count <1 × 109/l): (Grade 1C) Elective caesarean section should only be recommended for obstetric indications (Grade 2C) Antibiotics should be administered during and after premature rupture of membranes and delivery (Grade 1C). AD - S. Ali, British Society for Haematology, 100 White Lion Street, London, United Kingdom AU - Ali, S. AU - Jones, G. L. AU - Culligan, D. J. AU - Marsden, P. J. AU - Russell, N. AU - Embleton, N. D. AU - Craddock, C. DB - Embase Medline DO - 10.1111/bjh.13554 KW - antibiotic agent antifungal agent antihistaminic agent cyclizine cytarabine daunorubicin metoclopramide ondansetron prochlorperazine promethazine acute myeloid leukemia anemia antibiotic therapy article blast cell blood transfusion bone marrow biopsy cancer chemotherapy cancer palliative therapy cesarean section chemotherapy induced nausea and vomiting cytopenia diagnostic test drug contraindication drug efficacy drug fatality drug indication drug safety dust exposure fetus malformation fetus mortality first trimester pregnancy follow up health impact assessment human induction chemotherapy intervention study limb malformation medical abortion necrotizing enterocolitis neutropenia newborn care outcome assessment patient safety postnatal care practice guideline pregnancy pregnancy termination prematurity priority journal risk benefit analysis second trimester pregnancy sepsis spontaneous abortion symptomatology systemic mycosis teratogenicity therapy delay third trimester pregnancy thrombocytopenia vaginal delivery LA - English M1 - 4 M3 - Article N1 - L604892508 2015-06-23 2019-12-20 PY - 2015 SN - 1365-2141 0007-1048 SP - 487-495 ST - Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy T2 - British Journal of Haematology TI - Guidelines for the diagnosis and management of acute myeloid leukaemia in pregnancy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L604892508&from=export http://dx.doi.org/10.1111/bjh.13554 VL - 170 ID - 761062 ER - TY - JOUR AB - Background to the audit: PVE with consequent hypertrophy of the un-affected liver is used when predicted remnant liver size following surgery, or future liver remnant (FLR) is small, i.e <25% of the total liver volume. Inducing hypertrophy of the FLR reduces the risk of postoperative liver failure. Unnecessary delays can result in disease progression and post-ponement of planned surgery. Standard: Quality improvement for portal vein embolisation (CIRSE 2010). Indicator: % of technical success, complications and surgical resection rates post PVE. Target: 100% technical success, <5% major and <25% minor complications, 85% surgical resection rate. Methodology: PVEs retrospectively identified and electronic medical re-cords interrogated for above targets and dates of: multidisciplinary team (MDT) decision for PVE, procedure request, PVE performed and follow-up computed tomography (CT). Results of first audit round: 38 PVEs between 2011e2014 (three years): 100% technical success, no minor and 2.6% major complication rate (1 case of PV thrombosis), 70.6% (27) had surgery. Average time from MDT decision to performing PVE was 24.2 days. In 50% (19) of patients over half this duration was waiting for clinicians to request the procedure, whilst in the other 50% (19) over half this duration was waiting for the procedure. Both delays are potentially avoidable. First action plan: Appointment of second operator performing procedure Presenting findings to referring clinicians to minimise delays in requesting PVE. Re-audit in two years. Results of second audit round: 35 PVEs from 2015e2016 (two years): 97.1% technical success (one repeat), no major and 8.6% minor complica-tions (two cases non-target embolisation and one non-significant PV dissection), 79.4% had surgery. Delay to PVE from request is 23.4 days, a non-significant difference from previous despite time to request reducing (9.8 versus 13.5 days) and appointing a second operator; a finding perhaps due to an increased departmental workload. More patients had surgery (79.4% versus 70.6%) although this still fails to meet the 85% standard. Minimising delays to performing PVE potentially increases the numbers of patients eligible for curative treatment. Second action plan: Optimising PVE booking strategy. Further presentation to clinical colleagues Re-audit in two years. References: Madoff DC, Hicks ME, VautheyJN, Charnsangavej C, Morello FAJr, Ahrar K, Wallace MJ, Gupta S. Transhepatic portal vein embolization: anatomy, indications, and technical considerations. Radiographics 2002;22(5):1063-76. Denys A, Bize P, Demartines N, Deschamps F, De Baere T. CIRSE guidelines (2010): Quality improvement for portal vein embolization. Cardiovasc Intervent Radiol 2010;33(3):452-56. AvritscherR,de Baere T, Murthy R et al. Percutaneous transhepatic portal vein embolization: rationale, technique, and outcomes. Semin Intervent Radiol 2008;25(2):132- 45. AD - T. Ali AU - Ali, T. AU - Scullion, S. AU - Shaida, N. AU - See, T. C. DB - Embase KW - adult anatomy artificial embolization clinical article complication computer assisted tomography dissection female follow up hepatic portal vein human male practice guideline retrospective study surgery thrombosis total quality management treatment failure workload LA - English M3 - Conference Abstract N1 - L619400768 2017-11-29 PY - 2017 SN - 1365-229X SP - S24 ST - Portal vein embolisation (PVE): A re-audit and service evaluation T2 - Clinical Radiology TI - Portal vein embolisation (PVE): A re-audit and service evaluation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619400768&from=export VL - 72 ID - 760914 ER - TY - JOUR AB - Background: Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department of Nasser Hospital, Gaza Strip. Methods: For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines. Patient confidentiality was maintained, and ethical approval was obtained from the Palestinian Ministry of Health. Findings: Five patient records were not coded and therefore excluded. Of the remaining 95 patients, 51 (54%) were men with a mean age of 67 years (SD 14). 53 patients presented with dysarthria. The duration of stroke symptoms before admission was not reported in 86 (91%) records. A complete blood count and renal function tests were done for all patients, lipid profiling for 87 (92%) patients, electrocardiography for 85 (89%) patients, carotid duplex ultrasound for 32 (34%) patients, and CT scan for all patients. None of the patients had continuous cardiac monitoring or an assessment of swallowing function, and 70 (74%) patients received immediate anti-platelet therapy (325 mg aspirin). 80 (85%) patients received venous thromboembolism prophylaxis. 41 (43%) patients were given antibiotics without a recorded indication. None of the patients received thrombolytic therapy. As recommended in the guidelines, 41 (43%) patients did not receive anti-hypertensive agents on the first day of hospitalisation. 46 (48%) patients had diabetes, and glycaemic control was achieved by day 3 in 26 (57%) patients. Interpretation: No Palestinian guidelines exist for the management of patients with acute ischaemic stroke, and in most cases management was based on personal experience rather than evidence. The development of evidence-based guidelines is mandatory to improve management of ischaemic stroke. Furthermore, implementing staff education activities, regular clinical audit, and team feedback would encourage adherence to such guidelines. Combined with the establishment of a specialised stroke unit and development of a multidisciplinary team approach, patient outcome could be improved further. AD - M.N. Alkhatib, Faculty of Medicine, Islamic University Gaza, Gaza Strip, Gaza City, Palestine AU - Alkhatib, M. N. AU - Abd-Alghafoor, T. AU - Elmassry, A. AU - Albarqouni, L. AU - Böttcher, B. AU - Alfaqawi, M. DB - Embase KW - acetylsalicylic acid antibiotic agent antihypertensive agent lipid aged blood cell count brain ischemia carotid artery clinical audit conference abstract confidentiality diabetes mellitus drug combination drug therapy duplex Doppler ultrasonography dysarthria electrocardiography female fibrinolytic therapy glycemic control human human cell human tissue internal medicine kidney function test major clinical study male medical record medical society monitoring personal experience practice guideline prophylaxis random sample retrospective study staff training stroke unit swallowing venous thromboembolism x-ray computed tomography LA - English M1 - SPEC.ISS 1 M3 - Conference Abstract N1 - L621417436 2018-04-02 PY - 2017 SN - 1474-547X SP - 28 ST - Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip: A clinical audit T2 - The Lancet TI - Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip: A clinical audit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621417436&from=export VL - 391 ID - 760974 ER - TY - JOUR AB - BACKGROUND: Stroke is a leading cause of morbidity and mortality worldwide. The aim of this study was to assess the standard of care for patients with acute ischaemic stroke at the internal medicine department of Nasser Hospital, Gaza Strip. METHODS: For this retrospective clinical audit, we selected a random sample of 100 medical records for patients with stroke who were admitted to Nasser Hospital between January and August, 2016. Clinical practice was compared with the recommendations in the 2013 American Heart Association and American Stroke Association guidelines. Patient confidentiality was maintained, and ethical approval was obtained from the Palestinian Ministry of Health. FINDINGS: Five patient records were not coded and therefore excluded. Of the remaining 95 patients, 51 (54%) were men with a mean age of 67 years (SD 14). 53 patients presented with dysarthria. The duration of stroke symptoms before admission was not reported in 86 (91%) records. A complete blood count and renal function tests were done for all patients, lipid profiling for 87 (92%) patients, electrocardiography for 85 (89%) patients, carotid duplex ultrasound for 32 (34%) patients, and CT scan for all patients. None of the patients had continuous cardiac monitoring or an assessment of swallowing function, and 70 (74%) patients received immediate anti-platelet therapy (325 mg aspirin). 80 (85%) patients received venous thromboembolism prophylaxis. 41 (43%) patients were given antibiotics without a recorded indication. None of the patients received thrombolytic therapy. As recommended in the guidelines, 41 (43%) patients did not receive anti-hypertensive agents on the first day of hospitalisation. 46 (48%) patients had diabetes, and glycaemic control was achieved by day 3 in 26 (57%) patients. INTERPRETATION: No Palestinian guidelines exist for the management of patients with acute ischaemic stroke, and in most cases management was based on personal experience rather than evidence. The development of evidence-based guidelines is mandatory to improve management of ischaemic stroke. Furthermore, implementing staff education activities, regular clinical audit, and team feedback would encourage adherence to such guidelines. Combined with the establishment of a specialised stroke unit and development of a multidisciplinary team approach, patient outcome could be improved further. FUNDING: None. AD - Faculty of Medicine, Islamic University Gaza, Gaza City, Gaza Strip, occupied Palestinian territory. Electronic address: dr.m.khateeb91@gmail.com. Faculty of Medicine, Islamic University Gaza, Gaza City, Gaza Strip, occupied Palestinian territory. Nasser Hospital, Khan Younis, Gaza City, Gaza Strip, occupied Palestinian territory. Center for Research in Evidence-based Practice (CREBP), Bond University, Robina, QLD, Australia. AN - 29553426 AU - Alkhatib, M. N. AU - Abd-Alghafoor, T. AU - Elmassry, A. AU - Albarqouni, L. AU - Böttcher, B. AU - Alfaqawi, M. DA - Feb 21 DO - 10.1016/s0140-6736(18)30394-5 DP - NLM ET - 2018/03/20 J2 - Lancet (London, England) LA - eng N1 - 1474-547x Alkhatib, Mohammed N Abd-Alghafoor, Tamer Elmassry, AlaaEldeen Albarqouni, Loai Böttcher, Bettina Alfaqawi, Maha Journal Article England Lancet. 2018 Feb 21;391 Suppl 2:S28. doi: 10.1016/S0140-6736(18)30394-5. Epub 2018 Feb 21. PY - 2018 SN - 0140-6736 SP - S28 ST - Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip: a clinical audit T2 - Lancet TI - Management of acute ischaemic stroke at Nasser Hospital, Gaza Strip: a clinical audit VL - 391 Suppl 2 ID - 760330 ER - TY - JOUR AB - Introduction: Pregnancy in end stage renal disease (ESRD) women is uncommon and the risk for maternal - fetal complications is high. The rate of successful pregnancies in chronic hemodialysis (HD) patients has improved over the last decade up to 80%. Multidisciplinary team care and intensified hemodialysis regimens contributed in this substantial impact. We are reporting the outcomes of pregnancy in hemodialysis patients from single hemodialysis center in United Arab Emirates. Methods: A retrospective chart review study was conducted at Tawam hospital hemodialysis unit (capacity of 380 patients) over 10 years (Jan 2009 – June 2019). We included all cases of female HD patients get pregnant during study period. Demographic, clinical and laboratory data were collected as well as pregnancy outcomes, maternal and fetal complications were analyzed using descriptive analysis. Results: we identified a total of 5 female ESRD patients on HD, with a total of 7 pregnancies. The mean age was 35.5 years. Three patients were expatriates. The causes of ESRD were type 1 diabetes (2), type 2 diabetes (1), systemic lupus erythematosus (1) and adult polycystic kidney disease (1). Other comorbid conditions were anemia of renal disease (5), hypertension (4), dyslipidemia (4), obesity (2), history of ischemic heart disease (IHD) (1) and peripheral vascular disease (PVD) (1). The average duration on hemodialysis at time of pregnancy was ranging from 3 months to 7 years and two patients were initiated on HD in the first 10 weeks of pregnancy. Three patients were multiparous prior to ESRD, with total number of children (11) and abortion/ fetal death (7). All the 5 patients had spontaneous pregnancies. The frequency of HD increased to 5-6 times per week with 4 hours duration with average pre-dialysis urea levels of 10.5 to 12 mmol/L Qutaiba Hussain*,. The maternal complications during pregnancy in our cohort including: urinary tract infection (1), diabetic foot infection (1), anemia required blood transfusion (3), renal cyst rupture (1), recurrent arteriovenous graft thrombosis (1), preeclampsia (3), premature preterm rapture of membrane (PPROM) and abruptio placenta (2). The successful outcomes of pregnancies were three live births required c sections for preterm delivery at 30 – 34 weeks (2 emergency c/sections for preeclampsia and abruptio placenta). A patient had advanced diabetic type 1 complications with IHD, PVD had a total of 3 pregnancies with poor outcomes due to uteroplacental insufficiency (one fetal death at 25 weeks, one severe intrauterine growth restriction (IUGR)/preeclampsia, and one with PPROM/ IUGR). The fetal complications identified were preterm delivery (3), fetal death (1), post-delivery death (2), severe IUGR (3), abortion (1) and fetal anomalies (2) [anhydramnios (1), membranous ventricular septal defect VSD (1)]. Conclusions: Pregnancy in chronic hemodialysis patients with advanced comorbid conditions has high risk for complications and need comprehensive care. We had a total of 7 pregnancies over 10 years with successful outcomes in three patients (42.8%). AU - Alkindi, F. AU - Mohammed, A. M. AU - Chaaban, A. AU - Hussain, Q. AU - Hakim, M. AU - Eljack, H. AU - Khan, I. AU - Budruddin, M. AU - Boobes, Y. DB - Embase DO - 10.1016/j.ekir.2020.02.234 KW - urea abortion adult anemia anhydramnios arteriovenous graft blood transfusion child complication conference abstract demography diabetic foot dyslipidemia end stage renal disease female fetus fetus death fetus malformation heart ventricle septum defect hemodialysis patient human hypertension intrauterine growth retardation ischemic heart disease kidney cyst kidney polycystic disease live birth major clinical study medical record review multipara non insulin dependent diabetes mellitus obesity parthenogenesis peripheral vascular disease placenta insufficiency preeclampsia pregnancy complication pregnancy outcome retrospective study rupture school child solutio placentae systemic lupus erythematosus thrombosis United Arab Emirates urinary tract infection LA - English M1 - 3 M3 - Conference Abstract N1 - L2005255298 2020-03-25 PY - 2020 SN - 2468-0249 SP - S94 ST - SAT-219 OUTCOMES OF PREGNANCY AMONG CHRONIC HEMODIALYSIS PATIENTS T2 - Kidney International Reports TI - SAT-219 OUTCOMES OF PREGNANCY AMONG CHRONIC HEMODIALYSIS PATIENTS UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005255298&from=export http://dx.doi.org/10.1016/j.ekir.2020.02.234 VL - 5 ID - 760597 ER - TY - JOUR AB - OBJECTIVE: We studied the effect of 24 hr a day, 7 days a week interventional cardiology staff on door-to-balloon (D2B) time and mortality in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). BACKGROUND: Any delay in PPCI in acute STEMI is associated with higher mortality and, therefore, time to treatment should be as short as possible. Despite the use of several strategies, goal D2B time of <90 min remains elusive. METHODS: The study examined 790 consecutive STEMI patients treated with PPCI as the reperfusion therapy of choice. Patients were grouped into a pre-24 x 7 and post-24 x 7 cohort to study the impact of the new protocol on D2B time and major adverse cardiovascular events (MACE) and mortality. RESULTS: Median D2B time decreased from 99 min in the pre-24 x 7 group to 55 min in the post-24 x 7 group (P = 0.001) and was not influenced by time of day or day of week. Adjusted for patient and clinical characteristics, the pre-24 x 7 group had increased in-hospital cardiovascular mortality (odds ratio 1.94, 95% confidence interval 0.95-3.94; P = 0.048) and MACE (odds ratio 1.66, 95% confidence interval 1.10-2.49; P = 0.009) compared with the post-24 x 7 group. Prolonged D2B time was also associated with higher 1-year overall mortality in the pre-24 x 7 group compared with the post-24 x 7 group (12.8% vs. 8.1%; hazard ratio 1.17, 95% confidence interval 1.04-2.66; P = 0.044). CONCLUSIONS: Round-the-clock, in-hospital interventional cardiology team consistently and significantly reduces D2B time, in-hospital cardiovascular mortality, MACE, and 1-year mortality in patients with STEMI. AD - University of Wisconsin School of Medicine, Milwaukee, WI, USA. sallaqaband@yahoo.com AN - 20517963 AU - Allaqaband, S. AU - Jan, M. F. AU - Banday, W. Y. AU - Schlemm, A. AU - Ahmed, S. H. AU - Mori, N. AU - Oldridge, N. AU - Gupta, A. AU - Bajwa, T. DA - Jun 1 DO - 10.1002/ccd.22419 DP - NLM ET - 2010/06/03 J2 - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions KW - After-Hours Care/*organization & administration Aged *Angioplasty, Balloon, Coronary/adverse effects/mortality Cardiology Service, Hospital/*organization & administration Chi-Square Distribution Critical Pathways/organization & administration Feasibility Studies Female Health Services Accessibility/*organization & administration Heart Diseases/etiology Hospital Mortality Humans Kaplan-Meier Estimate Logistic Models Male Middle Aged Myocardial Infarction/mortality/*therapy Odds Ratio Patient Care Team/*organization & administration Personnel Staffing and Scheduling/organization & administration Program Evaluation Proportional Hazards Models Risk Assessment Risk Factors Time Factors Treatment Outcome Wisconsin LA - eng M1 - 7 N1 - 1522-726x Allaqaband, Suhail Jan, M Fuad Banday, Wamiq Y Schlemm, Angela Ahmed, S Hinan Mori, Naoyo Oldridge, Neil Gupta, Anjan Bajwa, Tanvir Journal Article United States Catheter Cardiovasc Interv. 2010 Jun 1;75(7):1015-23. doi: 10.1002/ccd.22419. PY - 2010 SN - 1522-1946 SP - 1015-23 ST - Impact of 24-hr in-hospital interventional cardiology team on timeliness of reperfusion for ST-segment elevation myocardial infarction T2 - Catheter Cardiovasc Interv TI - Impact of 24-hr in-hospital interventional cardiology team on timeliness of reperfusion for ST-segment elevation myocardial infarction VL - 75 ID - 760466 ER - TY - JOUR AU - Allen, J. AU - Miller, B. R. AU - Vido, M. A. AU - Makar, G. A. AU - Roth, K. R. DA - 2020/10/20 10/20 DB - Europe PubMed Central DO - 10.1016/j.radcr.2020.10.001 M1 - 12 PY - 2020 SN - 1930-0433 SP - 2617-2620 ST - Point-of-care ultrasound, anchoring bias, and acute pulmonary embolism: A cautionary tale and report T2 - Radiol Case Rep TI - Point-of-care ultrasound, anchoring bias, and acute pulmonary embolism: A cautionary tale and report UR - http://europepmc.org/article/MED/33072235 VL - 15 ID - 762008 ER - TY - JOUR AB - Objective: Advances in treatment of cancer have increased survival rates for people with malignancies. Many of these patients may present disabilities and impairments, temporary or permanent. It could result from the neoplasm itself or due to consequences that may arise during or after treatment. The role of rehabilitation is proving to be increasingly important in the treatment of this population to improve function, independence, social inclusion and quality of life. Exercise with therapeutic purposes is a valuable tool for rehabilitation of cancer patients. This study aims to answer the most frequent questions about therapeutic exercises and their effect in oncologic patients. Design: A multidisciplinary team elaborated on ten questions about rehabilitation. Secondly, research in the Pubmed Database was performed, aiming for high-quality methodology articles to answer the questions and elaborate on treatment recommendations. Forty English-language articles identified as randomized controlled trials, prospective cohort studies, and nested case-control studies were selected. Multiple reviewers extracted details about statistical analyses, with adjustments for confounding and methodological quality. Differences were solved by consensus. Setting: Centro de Pesquisa do Instituto de Medicina Física e Reabilitac¸ão da Faculdade de Medicina da Universidade de São Paulo. Participants: Subjects of the selected articles. Interventions: Therapeutic exercise, home-based exercise, pulmonary rehabilitation. Main Outcome Measures: Quality of Life, intensity of fatigue, fractures, bleeding (safety of kinesiotherapy for patients with severe thrombocytopenia [below 30,000] induced by chemotherapy) dyspnea, reduction of symptoms of heart failure in cancer patients with cardiotoxic chemotherapy. Results: Exercise programs are often used in rehabilitation patients with cancer and they have proven to be safe and beneficial to improve fatigue, quality of life and respiratory symptoms in patients with cancer during and after cancer treatment. Conclusions: The study enabled the creation of a guideline on the use of therapeutic exercises in patients with cancer. However, there are still unanswered questions due to the lack of high-quality studies on this subject which may compromise the determination of the best approaches. Therefore, more studies are needed on some areas of this subject. AD - E.P.M. Almeida, Instituto do Cancer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil AU - Almeida, E. P. M. AU - Andrade, R. G. AU - Battistella, L. R. AU - Brito, C. M. M. AU - Camargo, F. P. AU - Cecatto, R. B. AU - Imamura, M. AU - Pinto, C. A. AU - Yamaguti, W. P. DB - Embase KW - patient human neoplasm physical medicine rehabilitation kinesiotherapy exercise quality of life cancer patient chemotherapy randomized controlled trial (topic) population independence language survival rate pulmonary rehabilitation data base methodology bleeding dyspnea rehabilitation patient cohort analysis statistical analysis Medline disability case control study consensus stress fracture safety thrombocytopenia heart failure fatigue cancer therapy LA - English M1 - 10 M3 - Conference Abstract N1 - L70909825 2012-11-06 PY - 2012 SN - 1934-1482 SP - S209 ST - Guidelines: Therapeutic exercises in patients with cancer T2 - PM and R TI - Guidelines: Therapeutic exercises in patients with cancer UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70909825&from=export VL - 4 ID - 761189 ER - TY - JOUR AB - Background: Despite modern treatment modalities and an increasing rate of early revascularization, cardiogenic shock (CS) remains associated with a high risk of mortality and morbidity. Impella (Abiomed Inc., Danvers, Massachusetts) is a percutaneous micro-axial left ventricular assist devices (pLVAD) that has been increasingly used in patients with CS. Despite its theoretical hemodynamic advantage, the institutional outcomes associated with these devices remain poor. Methods: Outcomes of patients who received pLVAD for CS in a tertiary center in Northern Ontario between 2016 and 2019 were analyzed retrospectively. In addition, the recent literature and outcomes related to the use of these assist devices use in CS were reviewed by a multidisciplinary team comprised of cardiac intensivists and anesthesiologists, interventional cardiologists, heart failure specialists, cardiac surgeons, and perfusionists. Results: A total of 8 cases with cardiogenic shock who received pLVAD were identified. Seven died with progressive circulatory failure and multi-organ dysfunction. One survived after receiving veno-venous extra corporeal membrane oxygenation (VV ECMO) in addition to pLVAD. After a literature review, the team decided to explore percutaneous veno-arterial (VA) ECMO as the modality of choice in CS patients, especially when present with concomitant severe hypoxemia or right ventricular dysfunction. Serial meetings took place to discuss eligibility and establish a protocol. Contacts were made with national centers of expertise for further recommendations. A year later, percutaneous VA ECMO was successfully utilized in a 50-year-old female with profound cardiogenic shock and severe hypoxemia due to left main thrombotic lesion. The patient had percutaneous angioplasty followed by pECMO for persistent cardiogenic shock secondary to refractory ventricular fibrillatory arrest. She was ultimately de-cannulated within 72 hours with good ventricular recovery and no neurological sequelae. She continues to do well at 6-month follow-up. Conclusion: The development of a multidisciplinary cardiogenic shock team–focused group was key in the selection and the successful implementation of VA ECMO in Northern-Ontario. Categories: OTHER: Quality, Guidelines, Appropriateness Criteria, Cost-Effectiveness, and Public Health Issues AU - Alnasser, S. AU - Manchuk, D. AU - Nalla, B. AU - Hennessey, H. AU - Alqahtani, A. AU - Jessup, T. AU - Anderson, R. AU - Atoui, R. DB - Embase DO - 10.1016/j.jacc.2020.09.195 KW - adult anesthesiologist cardiac surgeon cardiogenic shock cardiologist complication conference abstract cost effectiveness analysis female follow up heart right ventricle failure human hypoxemia intensivist left ventricular assist device major clinical study middle aged multidisciplinary team multiple organ failure neurological complication Ontario percutaneous transluminal angioplasty perfusionist practice guideline public health retrospective study thrombosis total quality management veno-arterial ECMO LA - English M1 - 17 M3 - Conference Abstract N1 - L2008355477 2020-10-26 PY - 2020 SN - 1558-3597 0735-1097 SP - B78 ST - TCT CONNECT-182 Outcomes of Patients With Cardiogenic Shock Requiring Ventricular Assist Devices in Northern Ontario: Quality Improvement Project T2 - Journal of the American College of Cardiology TI - TCT CONNECT-182 Outcomes of Patients With Cardiogenic Shock Requiring Ventricular Assist Devices in Northern Ontario: Quality Improvement Project UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008355477&from=export http://dx.doi.org/10.1016/j.jacc.2020.09.195 VL - 76 ID - 760533 ER - TY - JOUR AB - Stroke is a neurological emergency. The early administration of specific treatment improves the prognosis of the patients. Emergency care systems with early warning for the hospital regarding patients who are candidates for this treatment (stroke code) increases the number of patients treated. Currently, reperfusion via thrombolysis for ischemic stroke and attention in stroke units are the bases of treatment. Healthcare professionals and health provision authorities need to work together to organize systems that ensure continuous quality care for the patients during the whole process of their disease. To implement this, there needs to be an appropriate analysis of the requirements and resources with the objective of their adjustment for efficient use. It is necessary to provide adequate information and continuous training for all professionals who are involved in stroke care, including primary care physicians, extrahospital emergency teams and all physicians involved in the care of stroke patients within the hospital. The neurologist has the function of coordinating the protocols of intrahospital care. These organizational plans should also take into account the process beyond the acute phase, to ensure the appropriate application of measures of secondary prevention, rehabilitation, and chronic care of the patients that remain in a dependent state. We describe here the stroke care program in the Community of Madrid (Spain). AD - Stroke Unit, Department of Neurology, Ramón y Cajal University Hospital, Madrid, Spain. mariaalonsoleci@telefonica.net AN - 19342844 AU - Alonso de Leciñana-Cases, M. AU - Gil-Núñez, A. AU - Díez-Tejedor, E. DO - 10.1159/000200452 DP - NLM ET - 2009/04/15 J2 - Cerebrovascular diseases (Basel, Switzerland) KW - Community Networks/*organization & administration Continuity of Patient Care/organization & administration Critical Pathways/*organization & administration Emergency Service, Hospital/*organization & administration Health Services Accessibility/*organization & administration Hospital Units/*organization & administration Humans Models, Organizational Neurology/*organization & administration Organizational Objectives *Outcome and Process Assessment, Health Care Patient Care Team/organization & administration Program Development Public Health Administration Spain Stroke/diagnosis/*therapy Thrombolytic Therapy Time Factors Transportation of Patients/organization & administration Treatment Outcome LA - eng N1 - 1421-9786 Alonso de Leciñana-Cases, María Gil-Núñez, Antonio Díez-Tejedor, Exuperio Journal Article Switzerland Cerebrovasc Dis. 2009;27 Suppl 1:140-7. doi: 10.1159/000200452. Epub 2009 Apr 3. PY - 2009 SN - 1015-9770 SP - 140-7 ST - Relevance of stroke code, stroke unit and stroke networks in organization of acute stroke care--the Madrid acute stroke care program T2 - Cerebrovasc Dis TI - Relevance of stroke code, stroke unit and stroke networks in organization of acute stroke care--the Madrid acute stroke care program VL - 27 Suppl 1 ID - 760321 ER - TY - JOUR AB - BACKGROUND: The metrics of imaging-to-puncture and imaging-to-reperfusion were recently found to be associated with the clinical outcomes of endovascular thrombectomy for acute ischemic stroke. However, measures for improving workflow within hospitals to achieve better timing results are largely unexplored for endovascular therapy. The aim of this study was to examine our experience with a novel smartphone application developed in house to improve our timing metrics for endovascular treatment. METHODS: We developed an encrypted smartphone application connecting all stroke team members to expedite conversations and to provide synchronized real-time updates on the time window from stroke onset to imaging and to puncture. The effects of the application on the timing of endovascular therapy were evaluated with a secondary analysis of our single-center cohort. Our primary outcome was imaging-to-puncture time. We assessed the outcomes with nonparametric tests of statistical significance. RESULTS: Forty-five patients met our criteria for analysis among 66 consecutive patients with acute ischemic stroke who received endovascular therapy at our institution. After the implementation of the smartphone application, imaging-to-puncture time was significantly reduced (preapplication median time, 127 minutes; postapplication time, 69 minutes; P < 0.001). Puncture-to-reperfusion time was not affected by the application use (42 minutes vs. 36 minutes). CONCLUSION: The use of smartphone applications may reduce treatment times for endovascular therapy in acute ischemic stroke. Further studies are needed to confirm our findings. AD - [Alotaibi, Naif M.; Sarzetto, Francesca; Guha, Daipayan; Yang, Victor X. D.] Univ Toronto, Inst Med Sci, Fac Med, Toronto, ON, Canada. [Alotaibi, Naif M.; Sarzetto, Francesca; Guha, Daipayan; Dyer, Erin; da Costa, Leodante; Yang, Victor X. D.] Sunnybrook Hlth Sci Ctr, Div Neurosurg, Toronto, ON, Canada. [Guha, Daipayan; Lu, Michael; Bodo, Andre; Gupta, Shaurya; Yang, Victor X. D.] Sunnybrook Hlth Sci Ctr, Biophoton & Bioengn Lab, Toronto, ON, Canada. [Howard, Peter] Sunnybrook Hlth Sci Ctr, Dept Radiol, Toronto, ON, Canada. [Swartz, Richard H.; Boyle, Karl] Sunnybrook Hlth Sci Ctr, Div Neurol, Toronto, ON, Canada. [Nathens, Avery B.] Sunnybrook Hlth Sci Ctr, Dept Surg, Toronto, ON, Canada. Yang, VXD (corresponding author), Univ Toronto, Inst Med Sci, Fac Med, Toronto, ON, Canada.; Yang, VXD (corresponding author), Sunnybrook Hlth Sci Ctr, Div Neurosurg, Toronto, ON, Canada.; Yang, VXD (corresponding author), Sunnybrook Hlth Sci Ctr, Biophoton & Bioengn Lab, Toronto, ON, Canada. Victor.Yang@sunnybrook.ca AN - WOS:000415860500094 AU - Alotaibi, N. M. AU - Sarzetto, F. AU - Guha, D. AU - Lu, M. AU - Bodo, A. AU - Gupta, S. AU - Dyer, E. AU - Howard, P. AU - da Costa, L. AU - Swartz, R. H. AU - Boyle, K. AU - Nathens, A. B. AU - Yang, V. X. D. DA - Nov DO - 10.1016/j.wneu.2017.08.042 J2 - World Neurosurg. KW - Application Endovascular Mobile Smartphone Stroke Thrombectomy THROMBECTOMY CARE THROMBOLYSIS METAANALYSIS TIME Clinical Neurology Surgery LA - English M3 - Article N1 - ISI Document Delivery No.: FN2XV Times Cited: 2 Cited Reference Count: 14 Alotaibi, Naif M. Sarzetto, Francesca Guha, Daipayan Lu, Michael Bodo, Andre Gupta, Shaurya Dyer, Erin Howard, Peter da Costa, Leodante Swartz, Richard H. Boyle, Karl Nathens, Avery B. Yang, Victor X. D. Swartz, Rick/0000-0001-6571-5531; Alotaibi, Naif/0000-0002-8227-347X; Gupta, Shaurya/0000-0002-3268-2224; Yang, Victor/0000-0002-1166-8271 Sunnybrook Health Sciences CentreUniversity of Toronto This work was funded in part by the Sunnybrook Health Sciences Centre Surgeon-in-Chief's research support. The funding source did not have a role in the design and analysis of the study. 2 0 1 ELSEVIER SCIENCE INC NEW YORK WORLD NEUROSURG PY - 2017 SN - 1878-8750 SP - 678-683 ST - Impact of Smartphone Applications on Timing of Endovascular Therapy for Ischemic Stroke: A Preliminary Study T2 - World Neurosurgery TI - Impact of Smartphone Applications on Timing of Endovascular Therapy for Ischemic Stroke: A Preliminary Study UR - ://WOS:000415860500094 VL - 107 ID - 761627 ER - TY - JOUR AB - Background Although the initial results of endovascular repair (EVAR) were promising, a comparison of its long-term efficacy against open surgical repair (OSR) remains largely elusive, and late-onset adverse events have not been systematically evaluated. Since OSR and EVAR are currently the only treatment options available in the management of abdominal aortic aneurysms (AAAs), the main question arising in clinical practice is whether EVAR or OSR confers more favourable short and long-term outcomes for patients presenting with unruptured AAAs. Aims The present meta-analysis aims to draw a head-to-head comparison between EVAR and OSR and facilitate the formulation of an evidence-based approach to the clinical management of unruptured AAAs. Methods A systematic review was conducted using three databases to identify all relevant studies with comparative data on EVAR vs. OSR. All-cause mortality was the primary outcome. Procedural outcomes, such as stroke, myocardial infarction, renal complications, rupture, and reintervention rates, were determined as secondary outcomes. Results Sixteen studies were included for comparative analysis, including four randomised-controlled trials and six non-randomised comparative clinical trials. EVAR conferred a clear perioperative survival advantage as compared to OSR (P < 0.00001). However, this survival advantage did not persist beyond two years post- procedure; all-cause mortality rates were comparable between the two treatment groups at two years (P = 0.09), four years (P = 0.58), and six years (P = 0.88) post-procedure. Although no statistically significant differences in aneurysm-related mortality, postoperative stroke, or myocardial infarction were identified, the OSR group had a statistically significant higher rate of postoperative renal complications. On the other hand, there was a statistically significant higher rate of rupture and reintervention following EVAR. Conclusion Whether the initial survival advantage afforded by EVAR is sufficient to justify the long-term risk of rupture, reintervention, and long-term mortality should be determined on a case-by-case basis by the multidisciplinary team overseeing the clinical care of the patient. Currently, it is reasonable to conclude that EVAR is as efficacious as OSR, but it would be invalid to claim it as superior. Ultimately, longer follow-up data must be presented before any definitive conclusions can be established for this potentially revolutionary technique. Presently, one can neither advocate nor refute EVAR over OSR. AD - [AlOthman, Othman] Univ Nottingham, Sch Med, Surg, Nottingham, England. [Bobat, Suleiman] Queens Med Ctr, Vasc Surg, Nottingham, England. AlOthman, O (corresponding author), Univ Nottingham, Sch Med, Surg, Nottingham, England. othmankalothman@hotmail.com AN - WOS:000558633100006 AU - AlOthman, O. AU - Bobat, S. C7 - e9683 DA - Aug DO - 10.7759/cureus.9683 J2 - Cureus KW - endovascular repair evar open surgical repair osr abdominal aortic aneurysm aaa vascular surgery EVAR TRIAL 1 MORTALITY SURVIVAL Medicine, General & Internal LA - English M1 - 8 M3 - Review N1 - ISI Document Delivery No.: MY7YT Times Cited: 0 Cited Reference Count: 30 AlOthman, Othman Bobat, Suleiman 0 CUREUS INC PALO ALTO CUREUS PY - 2020 SP - 18 ST - Comparison of the Short and Long-Term Outcomes of Endovascular Repair and Open Surgical Repair in the Treatment of Unruptured Abdominal Aortic Aneurysms: Meta-Analysis and Systematic Review T2 - Cureus TI - Comparison of the Short and Long-Term Outcomes of Endovascular Repair and Open Surgical Repair in the Treatment of Unruptured Abdominal Aortic Aneurysms: Meta-Analysis and Systematic Review UR - ://WOS:000558633100006 VL - 12 ID - 761418 ER - TY - JOUR AB - Introduction: As part of a multidisciplinary healthcare team, pharmacists are considered one of the most accessible professionals providing clinical patient care in various healthcare settings1. Evidence supporting pharmacists' role in counselling and education of stroke patients, in a variety of healthcare settings is well documented 2. However, there is a paucity of evidence evaluating pharmacists' interventions and their effect on outcomes in primary and secondary stroke prevention. Aim: The present study is a systematic review to explore the evidence evaluating pharmacists' interventions aimed at improving outcomes in stroke patients. Methods: A systematic search of peer-reviewed, healthcare- related, full-text articles and abstracts was performed to identify, describe and evaluate pharmacists' interventions aimed at improving healthcare outcome measures in primary and secondary stroke prevention and ischaemic stroke in adult patients. The databases searched were PubMed, Embase, MEDLINE, Google Scholar, PsycINFO, CINAHL Plus, Scopus, the Science Citation Index, and the Cochrane Library with date limits from 1974 to 2018. Studies were included where pharmacists delivered interventions independently or as part of a multidisciplinary team in any healthcare sector. Research articles published in a language other than English, those involving haemorrhagic stroke, children, physician-only and nurse-only interventions were excluded (Figure 1). The quality of the studies was assessed using the Critical Appraisal Skill Programme (CASP), in accordance with the study design. The majority demonstrated a low risk of bias. This systematic review is registered on PROSPERO ID: CRD42019151267. Results: A total of 21 full-text articles and 3 abstracts were included in this review. The studies had different designs these included randomized control study RCTs (n = 4), retrospective (n = 9), prospective cohort studies (n = 7), and cross-sectional studies (n = 4). The findings and interventions of 11 studies found statistically significant outcomes in favour of pharmacy care. The studies showed supportive evidence of the pharmacists' interventions in multiple settings, including inpatient, outpatient, emergency departments and community pharmacy settings. Pharmacist interventions with statistically significant outcomes include medication reconciliation, thrombolytic drug use assessment, participation in stroke response teams and patient rounds, identification and resolving of drug-related problems, risk-factor reduction, improving adherence to medication, and patient health-related quality of life. Conclusion: The studies demonstrate that pharmacist interventions can be effective in all stages of stroke management. At the primary prevention stage, in primary care, pharmacist counselling, health education and advice may have a crucial part to play in preventing stroke amongst at-risk patients by modifying their risk status. The pharmacists' role in post-stroke (i.e. in secondary prevention) was found to be effective with regards to improving patients' quality of life by treatment management. The strength of this review resides in its comprehensiveness as evidence evaluating the impact of various pharmacists' interventions in primary and secondary stroke prevention and delivered in any health care setting were included. However, articles which may have investigated pharmacists' role in modifiable risk factors but did not specifically mention stroke were not included. Available evidence showed the effectiveness of pharmacists' interventions in improving stroke patient outcomes. Therefore, pharmacists should have a larger role in all stages of stroke management. AD - S. Al-Qahtani, University of Birmingham, Birmingham, United Kingdom AU - Al-Qahtani, S. AU - Mason, J. AU - Paudyal, V. AU - Jalal, Z. DB - Embase KW - fibrinolytic agent adult brain hemorrhage brain ischemia child Cinahl Cochrane Library cohort analysis conference abstract counseling cross-sectional study drug abuse Embase emergency ward female health care cost health education hospital patient human language male medication compliance medication therapy management Medline multidisciplinary team nurse outpatient pharmaceutical care pharmacist pharmacy (shop) physician prevention primary medical care primary prevention prospective study PsycINFO quality of life randomized controlled trial (topic) retrospective study risk assessment risk factor SciSearch Scopus secondary prevention skill stroke patient systematic review LA - English M3 - Conference Abstract N1 - L633048795 2020-10-13 PY - 2020 SN - 2042-7174 SP - 79-80 ST - The role of pharmacists in providing pharmaceutical care in primary and secondary management of stroke: A systematic review T2 - International Journal of Pharmacy Practice TI - The role of pharmacists in providing pharmaceutical care in primary and secondary management of stroke: A systematic review UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633048795&from=export VL - 28 ID - 760581 ER - TY - JOUR AB - INTRODUCTION: Interteam performance and Clavien-Dindo (C-D) complications in renal cell carcinoma with inferior vena cava thrombectomy (RCC-IVCT) have not been reported. We aimed to describe complications by the degree of complexity and surgical teams in a collaborative effort between a National Cancer Institute-designated Comprehensive Cancer Center and a Quaternary Care Teaching Hospital. METHODS: Between January 2011 and May 2019, 73 consecutive RCC-IVCT were included. C-D grades III or higher were captured. Teams involved were urologic-oncology, vascular, hepatobiliary/transplant, and cardiothoracic. The Mayo Clinic tumor thrombus classification was used. RESULTS: Overall complication rate was 42% (n = 31). Nineteen percent had grade III, 18% had grade IV, and 6% had grade V complications. Patients with level IV thrombus had the highest in-hospital mortality rate (75%). Thrombus level did not show a correlation to complication rates (14% level I, 45% level II, 32% level III, 42% level IV). A positive correlation found between the number of teams involved and complication rates (35% with 2-team, 59% with 3-team, P = .059). Thromboembolic events (6% vs 24%, P = .02) and disposition other than home (22% vs 48%, P = .01) were statistically lower for the 2-team groups. Two-team in-hospital mortality was 1/51 (2%) versus 3-team (3/22,14%, (P = .07). No statistical differences were found in infections, thromboembolic events, and grades of complications between surgical teams. CONCLUSIONS: Despite similar interteam performance, the consistency of surgeons in high complexity cases could improve outcomes further. Complexity was higher for hepatobiliary/transplant and cardiothoracic teams. A combination of intraoperative events and patient selection (comorbidities and age) contributed to death. Overall, in-hospital mortality was lower than in most reported series. AD - Department of Transplant Surgery, Tampa General Medical Group, Tampa, FL, USA. Morsani College of Medicine, University of South Florida, Tampa, FL, USA. Office of Clinical Research, Tampa General Hospital, Tampa, FL, USA. Florida Urology Partners, Tampa, FL, USA. Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA. AN - 32997953 AU - Alsina, A. E. AU - Wind, D. AU - Kumar, A. AU - Rogers, E. AU - Buggs, J. AU - Bukkapatnam, R. AU - Sexton, W. J. DA - Aug DO - 10.1177/0003134820942172 DP - NLM ET - 2020/10/01 J2 - The American surgeon KW - Adult Aged Cancer Care Facilities Carcinoma, Renal Cell/*complications Florida Hospital Mortality Hospitals, Teaching Humans Kidney Neoplasms/*complications Middle Aged *Patient Care Team Postoperative Complications/epidemiology/prevention & control Retrospective Studies *Thrombectomy Treatment Outcome Vena Cava, Inferior/*surgery Venous Thrombosis/etiology/*surgery multi-team approach outcomes renal cell carcinoma LA - eng M1 - 8 N1 - 1555-9823 Alsina, Angel E Wind, Daniel Kumar, Ambuj Rogers, Ebonie Buggs, Jacentha Bukkapatnam, Raviender Sexton, Wade J Journal Article United States Am Surg. 2020 Aug;86(8):1005-1009. doi: 10.1177/0003134820942172. PY - 2020 SN - 0003-1348 SP - 1005-1009 ST - Outcomes in Renal Cell Carcinoma With IVC Thrombectomy: A Multiteam Analysis Between an NCI-Designated Cancer Center and a Quaternary Care Teaching Hospital T2 - Am Surg TI - Outcomes in Renal Cell Carcinoma With IVC Thrombectomy: A Multiteam Analysis Between an NCI-Designated Cancer Center and a Quaternary Care Teaching Hospital VL - 86 ID - 760448 ER - TY - JOUR AB - Introduction. The stroke network considers the presence of hospitals with stroke teams (STH), stroke units (SUH) and Comprehensive Stroke Centers (CSC). The aim of the current study is to identify, according to specialized vascular neurologists, the main components needed in different kind of stroke centers. Methods. A survey was carried out between February and March 2008 to know the opinion of 36 vascular neurologists. Questions were about the components needed in each hospital level treating stroke patients. Results. Neurologists considered that STH must have as indispensable requirements the following components: emergency department, laboratory and computerized tomography scan facilities with full time availability (24 hours a day/7 days a week), multidisciplinary team including physiotherapists, action plans and pre-established referral circuits to SUH and CSC. Experts considered indispensable for SUH the aforementioned components and specific beds with multiparametric vitals monitoring, expert vascular neurologists, specialized nursery, neurologist on call, intravenous thrombolysis (full time), intensive care unit (ICU), neurorehabilitation specialists, diagnosis neuroradiologists, social workers, echocardiography, full time available neurosurgery, stroke register and educational programmes for patients and relatives. CSC must have the same components as STH-SUH and neurosurgeons specialized in stroke surgery, vascular surgeons specialized in carotid surgery and doctors specialized in endovascular intervention with full time availability. Conclusions. The results show the components or requirements that are considered necessary by specialized vascular neurologists, evaluated on the basis of different hospital levels treating stroke patients. AD - J. Álvarez-Sabín, Servicio de Neurología, Hospital Universitario Vall d'Hebron, Paseo Vall d'Hebron, 119-129, 08035 Barcelona AU - Álvarez-Sabín, J. AU - Masjuan, J. AU - Alonso De Leciñana, M. AU - Lago, A. AU - Gállego, J. AU - Arenillas, J. AU - López-Fernández, J. C. AU - Calleja, S. DB - Embase Medline KW - fibrinolytic agent article computer assisted tomography craniectomy echocardiography education program emergency ward endovascular surgery fibrinolytic therapy health survey holistic care hospital human intensive care unit laboratory diagnosis medical specialist neurosurgery patient monitoring physiotherapy rehabilitation care social worker Spain cerebrovascular accident stroke unit L1 - http://www.arsxxi.com/Revistas/fframesart.php?MTk=&MTE5NDQ=&QVJU&U1A=&&MTk=&MTE2Mw==&MA== LA - Spanish M1 - 6 M3 - Article N1 - L355410915 2009-11-24 PY - 2009 SN - 0213-4853 1578-1968 SP - 373-378 ST - Necessary components in the hospitals that attend patients with stroke: Results of a survey of Spanish experts T2 - Neurologia TI - Necessary components in the hospitals that attend patients with stroke: Results of a survey of Spanish experts UR - https://www.embase.com/search/results?subaction=viewrecord&id=L355410915&from=export VL - 24 ID - 761265 ER - TY - JOUR AB - INTRODUCTION: The stroke network considers the presence of hospitals with stroke teams (STH), stroke units (SUH) and Comprehensive Stroke Centers (CSC). The aim of the current study is to identify, according to specialized vascular neurologists, the main components needed in different kind of stroke centers. METHODS: A survey was carried out between February and March 2008 to know the opinion of 36 vascular neurologists. Questions were about the components needed in each hospital level treating stroke patients. RESULTS: Neurologists considered that STH must have as indispensable requirements the following components: emergency department, laboratory and computerized tomography scan facilities with full time availability (24 hours a day/7 days a week), multidisciplinary team including physiotherapists, action plans and pre-established referral circuits to SUH and CSC. Experts considered indispensable for SUH the aforementioned components and specific beds with multiparametric vitals monitoring, expert vascular neurologists, specialized nursery, neurologist on call, intravenous thrombolysis (full time), intensive care unit (ICU), neurorehabilitation specialists, diagnosis neuroradiologists, social workers, echocardiography, full time available neurosurgery, stroke register and educational programmes for patients and relatives. CSC must have the same components as STH-SUH and neurosurgeons specialized in stroke surgery, vascular surgeons specialized in carotid surgery and doctors specialized in endovascular intervention with full time availability. CONCLUSIONS: The results show the components or requirements that are considered necessary by specialized vascular neurologists, evaluated on the basis of different hospital levels treating stroke patients. AD - Servicio de Neurología, Hospital Universitario Vall d'Hebron, Barcelona. josalvarez@vhebron.net AN - 19798603 AU - Alvarez-Sabín, J. AU - Masjuan, J. AU - Alonso de Leciñana, M. AU - Lago, A. AU - Gállego, J. AU - Arenillas, J. AU - López-Fernández, J. C. AU - Calleja, S. AU - Quintana, M. DA - Jul-Aug DP - NLM ET - 2009/10/03 J2 - Neurologia (Barcelona, Spain) KW - Data Collection Emergency Service, Hospital Hospital Units/*standards Hospitals/*standards Humans Neurology Patient Care Team Practice Guidelines as Topic Spain *Stroke/diagnosis/therapy Surveys and Questionnaires Tomography, X-Ray Computed LA - spa M1 - 6 N1 - Alvarez-Sabín, José Masjuan, J Alonso de Leciñana, M Lago, A Gállego, J Arenillas, J López-Fernández, J C Calleja, S Quintana, M English Abstract Journal Article Spain Neurologia. 2009 Jul-Aug;24(6):373-8. OP - Componentes necesarios en los hospitales que atienden a pacientes con ictus: resultados de una encuesta de expertos españoles. PY - 2009 SN - 0213-4853 (Print) 0213-4853 SP - 373-8 ST - [Necessary components in the hospitals that attend patients with stroke: results of a survey of Spanish experts] T2 - Neurologia TI - [Necessary components in the hospitals that attend patients with stroke: results of a survey of Spanish experts] VL - 24 ID - 760475 ER - TY - JOUR AB - Introduction. The stroke network considers the presence of hospitals with stroke teams (STH), stroke units (SUH) and Comprehensive Stroke Centers (CSC). The aim of the current study is to identify, according to specialized vascular neurologists, the main components needed in different kind of stroke centers. Methods. A survey was carried out between February and March 2008 to know the opinion of 36 vascular neurologists. Questions were about the components needed in each hospital level treating stroke patients. Results. Neurologists considered that STH must have as indispensable requirements the following components: emergency department, laboratory and computerized tomography scan facilities with full time availability (24 hours a day/7 days a week), multidisciplinary team including physiotherapists, action plans and pre-established referral circuits to SUH and CSC. Experts considered indispensable for SUH the aforementioned components and specific beds with multiparametric vitals monitoring, expert vascular neurologists, specialized nursery, neurologist on call, intravenous thrombolysis (full time), intensive care unit (ICU), neurorehabilitation specialists, diagnosis neuroradiologists, social workers, echocardiography, full time available neurosurgery, stroke register and educational programmes for patients and relatives. CSC must have the same components as STH-SUH and neurosurgeons specialized in stroke surgery, vascular surgeons specialized in carotid surgery and doctors specialized in endovascular intervention with full time availability. Conclusions. The results show the components or requirements that are considered necessary by specialized vascular neurologists, evaluated on the basis of different hospital levels treating stroke patients. AD - [Alvarez-Sabin, J.; Masjuan, J.; Alonso de Lecinana, M.; Lago, A.; Gallego, J.; Arenillas, J.; Lopez-Fernandez, J. C.; Calleja, S.; Quintana, M.] Hosp Univ Vall Hebron, Serv Neurol, Barcelona 08035, Spain. Alvarez-Sabin, J (corresponding author), Hosp Univ Vall Hebron, Serv Neurol, Paseo Vall Hebron 119-129, Barcelona 08035, Spain. josalvar@vhebron.net AN - WOS:000272034400005 AU - Alvarez-Sabin, J. AU - Masjuan, J. AU - de Lecinana, M. A. AU - Lago, A. AU - Gallego, J. AU - Arenillas, J. AU - Lopez-Fernandez, J. C. AU - Calleja, S. AU - Quintana, M. DA - Jul-Aug J2 - Neurologia KW - Integrative stroke care Stroke network Comprehensive stroke centers Primary stroke centers ISCHEMIC-STROKE UNIT CARE MANAGEMENT Clinical Neurology LA - Spanish M1 - 6 M3 - Article N1 - ISI Document Delivery No.: 522XV Times Cited: 7 Cited Reference Count: 25 Alvarez-Sabin, J. Masjuan, J. Alonso de Lecinana, M. Lago, A. Gallego, J. Arenillas, J. Lopez-Fernandez, J. C. Calleja, S. Quintana, M. Arenillas, Juan F./AAE-1142-2020; Fernandez, Juan Carlos Lopez/R-7292-2019; de Lecinana, Maria Alonso/C-1464-2017 Fernandez, Juan Carlos Lopez/0000-0002-3168-0702; de Lecinana, Maria Alonso/0000-0002-4302-6580; Quintana, Manuel/0000-0003-0288-9088 7 0 2 ELSEVIER ESPANA SLU BARCELONA NEUROLOGIA PY - 2009 SN - 0213-4853 SP - 373-378 ST - Necessary components in the hospitals that attend patients with stroke: results of a survey of Spanish experts T2 - Neurologia TI - Necessary components in the hospitals that attend patients with stroke: results of a survey of Spanish experts UR - ://WOS:000272034400005 VL - 24 ID - 761895 ER - TY - JOUR AB - Introduction Therapeutic anticoagulation with low-molecularweight heparin (LMWH) is the international standard of care in the management of venous thromboembolism (VTE) in pregnancy. Careful timing of delivery should allow for safe vaginal delivery and regional anaesthesia, while balancing the risk of VTE and haemorrhage. Methods Review of labour outcome in women on therapeutic heparin in a unit with multidisciplinary care planning. Design: Retrospective data analysis of the cases managed by the joint obstetric-haematology clinic at the CWIUH in Ireland (1 January 2011 to 31 December 2014). Results Thirty-five women required therapeutic anticoagulation peripartum (11 were on life-long anticoagulation and 24 were for treatment of VTE in the index pregnancy). Two women required unfractionated heparin peripartum. The mean age was 31.5 ± 5.8 years, 40% of them were primigravidae. There were two miscarriages. Otherwise, the mean gestational age at delivery was 39 ± 1.9 weeks. There were seven elective cesarean sections, all performed under regional anaesthesia. Six women laboured spontaneously: five delivered vaginally without epidural, within 4 hours of onset of labour and one was breech delivered by caesarean section under spinal anaesthesia. Labour was induced in 20 women, all of whom delivered vaginally except one. Eighteen of 20 had regional anaesthesia and two did not: one for thrombocytopenia secondary to pre-eclampsia and one for history of an adverse reaction to epidural. Blood loss of 700 mL occurred after two of the elective cesarean sections. Prophylactic and therapeutic dose of LMWH were commenced 6-12 and 24 hours post delivery, respectively. Conclusion Multidisciplinary team planning of peripartum care can result in safe vaginal delivery for women requiring therapeutic anticoagulation. AD - F. Al-Washahi, Coombe Women and Infant University Hospital, Dublin, Ireland AU - Al-Washahi, F. AU - Manning, C. AU - Byrne, B. AU - Regan, C. AU - Ryan, K. AU - Lynch, C. AU - Tan, T. DB - Embase DO - 10.1111/14710528.13987 KW - heparin anticoagulation pregnancy society female human cesarean section regional anesthesia bleeding vaginal delivery epidural drug administration planning gestational age spontaneous abortion primigravida risk Ireland hospital venous thromboembolism hematology data analysis preeclampsia thrombocytopenia spinal anesthesia labor onset adverse drug reaction health care quality LA - English M3 - Conference Abstract N1 - L72280475 2016-05-31 PY - 2016 SN - 1470-0328 SP - 34-35 ST - Therapeutic anticoagulation in pregnancy: The challenges of peripartum care T2 - BJOG: An International Journal of Obstetrics and Gynaecology TI - Therapeutic anticoagulation in pregnancy: The challenges of peripartum care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72280475&from=export http://dx.doi.org/10.1111/14710528.13987 VL - 123 ID - 761032 ER - TY - JOUR AB - Purpose: Catheter-directed thrombolysis (CDT) has been recently recommended as a safer alternative treatment for submassive pulmonary embolism (PE), to minimize the risks associated with systemic thrombolysis. The purpose of this study is to assess the safety and feasibility of CDT in the setting of submassive PE. Materials: A single-center retrospective review was performed on 20 consecutive patients (14 females, 6 males; mean age 44) with submassive PE referred for CDT after evaluation by a multi-disciplinary Pulmonary Embolism Response Team (PERT) between June 2014 and September 2015. All patients underwent pulmonary artery catheterization with pressure measurements and overnight catheter-directed thrombolysis with a standard multi-sidehole infusion catheter (UniFuse, Angiodynamics, Queensbury, NY) in a monitored ICU setting. Follow-up post-lysis angiogram and pressure measurements were obtained on the subsequent day. Data collection included: patient demographics, severity of RV dysfunction on echocardiogram, IVC filter placement, procedural technical success, CDT infusion times and doses, pre- and post-lysis pulmonary artery pressure measurements, and death/adverse events up to 30 days after the procedure. Results: Initial technical success achieved in all patients (n = 20). Fifteen patients (75%) had IVC filters placed during procedure. Two patients (10%) deteriorated clinically (hemodynamic instability) necessitating open surgical thrombectomy for massive PE. The mean infusion time was 18.9 hours (±3.6) with mean administered TPA dose of 24.1 mg (±4). Pulmonary artery pressures were significantly decreased from 50/25 mmHg (mean 33) to 30/15 mmHg (mean 20.4) (P< 0.0001). Degree of RV dysfunction also significantly decreased from moderate-severe to normal-mild. (P< 0.0001). There was 1 major bleeding complication (rectus sheath hematoma). Mean length of hospital stay was 7.1 days. All-cause mortality at 30 days was 0%. Conclusions: Catheter-directed thrombolysis is both a safe and technically feasible treatment for submassive pulmonary embolism with rapid improvements in pulmonary artery pressure and right ventricular dysfunction. AD - V. Amin, Icahn School of Medicine at Mount Sinai, New York, NY, United States AU - Amin, V. AU - Patel, R. AU - Tabori, N. AU - Fischman, A. AU - Nowakowski, F. AU - Kim, E. AU - Lookstein, R. DB - Embase KW - blood clot lysis lung embolism society interventional radiology catheter patient human lung artery pressure infusion pressure measurement lysis procedures filter information processing follow up echocardiography heart ventricle function mortality hospitalization hematoma rectus abdominis muscle pulmonary artery catheterization bleeding surgical thrombectomy male female safety risk LA - English M1 - 3 M3 - Conference Abstract N1 - L72229581 2016-04-13 PY - 2016 SN - 1051-0443 SP - S98-S99 ST - Catheter-directed thrombolysis for submassive pulmonary embolism: Technique and initial results T2 - Journal of Vascular and Interventional Radiology TI - Catheter-directed thrombolysis for submassive pulmonary embolism: Technique and initial results UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72229581&from=export VL - 27 ID - 761036 ER - TY - JOUR AB - Despite venous thromboembolism (VTE) policy initiatives, gaps exist between guidelines and practice. In response, hospitals implement clinical decision support (CDS) systems to improve VTE prophylaxis. To assess the impact of a VTE CDS on reducing incidence of VTE, this study used a pretest/posttest, longitudinal, cohort design incorporating electronic health record (EHR) data from one urban tertiary and level 1 trauma center, and one suburban hospital. VTE CDS was embedded into the EHR system. The study included 45,046 admissions; 171,753 patient days; and 110 VTE events. The VTE rate declined from 0.954 per 1,000 patient days to 0.434 comparing baseline to full VTE CDS. Compared to baseline, patients benefitting from VTE CDS were 35% less likely to have a VTE. VTE CDS utilization achieved 78.4% patients assessed within 24 hr from admission, 64.0% patients identified at risk, and 47.7% patients at risk for VTE with an initiated VTE interdisciplinary plan of care. CDS systems with embedded algorithms, alerts, and notification capabilities enable physicians at the point of care to utilize guidelines and make impactful decisions to prevent VTE. This study demonstrates a phased-in implementation of VTE CDS as an effective approach toward VTE prevention. Implications for future research and quality improvement are discussed as well. AD - Solution strategist in Cerner's Population Health organization located in Kansas City,Missouri Director and principal investigator for Cerner Research located in Kansas City, Missouri Scientist of Cerner Research located in Culver City, California Director and Chief Medical Officer for Cerner Lighthouse Engagement Leader in Cerner's Population Health--Strategic Performance Consulting organization, Kansas City Chief Medical Information Officer for Truman Medical Centers in Kansas City, Missouri Medical Director of Quality for Truman Medical Centers AN - 111938616. Language: English. Entry Date: 20170410. Revision Date: 20190103. Publication Type: Article AU - Amland, Robert C. AU - Dean, Bonnie B. AU - Hsing-Ting, Yu AU - Ryan, Hugh AU - Orsund, Timothy AU - Hackman, Jeffrey L. AU - Roberts, Shauna R. DB - CINAHL DO - 10.1111/jhq.12069 DP - EBSCOhost KW - Computer Assisted Instruction Decision Support Systems, Clinical Venous Thromboembolism -- Prevention and Control Inpatients Human Quality Improvement Electronic Health Records Missouri Descriptive Statistics Data Analysis Software Pretest-Posttest Design Prospective Studies Ultrasonography, Doppler Computed Tomography Angiography Odds Ratio Male Female Adult Middle Age Aged Confidence Intervals M1 - 4 N1 - equations & formulas; research; tables/charts. Journal Subset: Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. Special Interest: Patient Safety. NLM UID: 9202994. PY - 2015 SN - 1062-2551 SP - 221-231 ST - Computerized Clinical Decision Support to Prevent Venous Thromboembolism Among Hospitalized Patients: Proximal Outcomes from a Multiyear Quality Improvement Project T2 - Journal for Healthcare Quality: Promoting Excellence in Healthcare TI - Computerized Clinical Decision Support to Prevent Venous Thromboembolism Among Hospitalized Patients: Proximal Outcomes from a Multiyear Quality Improvement Project UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=111938616&site=ehost-live&scope=site VL - 37 ID - 761311 ER - TY - JOUR AB - Background: Providing scalable clinical decision support (CDS) across institutions that use different electronic health record (EHR) systems has been a challenge for medical informatics researchers. The lack of commonly shared EHR models and terminology bindings has been recognised as a major barrier to sharing CDS content among different organisations. The openEHR Guideline Definition Language (GDL) expresses CDS content based on openEHR archetypes and can support any clinical terminologies or natural languages. Our aim was to explore in an experimental setting the practicability of GDL and its underlying archetype formalism. A further aim was to report on the artefacts produced by this new technological approach in this particular experiment. We modelled and automatically executed compliance checking rules from clinical practice guidelines for acute stroke care.Methods: We extracted rules from the European clinical practice guidelines as well as from treatment contraindications for acute stroke care and represented them using GDL. Then we executed the rules retrospectively on 49 mock patient cases to check the cases' compliance with the guidelines, and manually validated the execution results. We used openEHR archetypes, GDL rules, the openEHR reference information model, reference terminologies and the Data Archetype Definition Language. We utilised the open-sourced GDL Editor for authoring GDL rules, the international archetype repository for reusing archetypes, the open-sourced Ocean Archetype Editor for authoring or modifying archetypes and the CDS Workbench for executing GDL rules on patient data.Results: We successfully represented clinical rules about 14 out of 19 contraindications for thrombolysis and other aspects of acute stroke care with 80 GDL rules. These rules are based on 14 reused international archetypes (one of which was modified), 2 newly created archetypes and 51 terminology bindings (to three terminologies). Our manual compliance checks for 49 mock patients were a complete match versus the automated compliance results.Conclusions: Shareable guideline knowledge for use in automated retrospective checking of guideline compliance may be achievable using GDL. Whether the same GDL rules can be used for at-the-point-of-care CDS remains unknown. AD - Health Informatics Centre, LIME, Karolinska Institutet, Tomtebodavägen 18, SE 17177 Stockholm, Sweden. nadim.anani@ki.se. AN - 103958116. Language: English. Entry Date: 20150508. Revision Date: 20170508. Publication Type: journal article AU - Anani, Nadim AU - Chen, Rong AU - Prazeres Moreira, Tiago AU - Koch, Sabine DB - CINAHL DO - 10.1186/1472-6947-14-39 DP - EBSCOhost KW - Artificial Intelligence Decision Making, Computer Assisted Electronic Health Records Guideline Adherence Practice Guidelines Human Retrospective Design Semantics Stroke -- Therapy Time Factors M1 - 1 N1 - research. Journal Subset: Biomedical; Computer/Information Science; Europe; UK & Ireland. Special Interest: Informatics. NLM UID: 101088682. PMID: NLM24886468. PY - 2014 SN - 1472-6947 SP - 39-39 ST - Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR's Guideline Definition Language T2 - BMC Medical Informatics & Decision Making TI - Retrospective checking of compliance with practice guidelines for acute stroke care: a novel experiment using openEHR's Guideline Definition Language UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=103958116&site=ehost-live&scope=site VL - 14 ID - 761380 ER - TY - JOUR AB - Pulmonary embolism represents the third most common cause of cardiovascular death in the United States. Reperfusion therapeutic strategies such as systemic thrombolysis, catheter directed therapies, surgical pulmonary embolectomy, and cardiopulmonary support devices are currently available for patients with high- and intermediate-high–risk pulmonary embolism. However, deciding on optimal therapy may be challenging. Pulmonary embolism response teams have been designed to facilitate multidisciplinary decision-making with the goal to improve quality of care for complex cases with pulmonary embolism. Herein, we discuss the current role and strategies on how to leverage the strengths from pulmonary embolism response teams, its possible worldwide adoption, and implementation to improve survival and change the paradigm in the care of a potentially deadly disease. PMID:30453745 AU - Anaya-Ayala, Javier E. AU - Heresi, Gustavo A. AU - Rivera-Lebron, Belinda N. DA - 2018/11/19 11/19 DB - PubMed Central DO - 10.1177/1076029618812954 KW - high-risk pulmonary embolism intermediate-high–risk pulmonary embolism reperfusion strategies pulmonary embolism response team M1 - 9 Suppl PY - 2018 SN - 1076-0296 ST - Pulmonary Embolism Response Teams: A Novel Approach for the Care of Complex Patients With Pulmonary Embolism T2 - Clinical and Applied Thrombosis/Hemostasis TI - Pulmonary Embolism Response Teams: A Novel Approach for the Care of Complex Patients With Pulmonary Embolism UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6714822&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6714822 VL - 24 ID - 761996 ER - TY - JOUR AB - Purpose Enteral (EN) or parenteral nutrition (PN) is frequently required during allogeneic haematopoietic progenitor cell transplantation (HPCT), however there is limited consensus on the appropriate mode and timing of nutrition support commencement. This study aimed to investigate current nutrition support practices in Australian allogeneic transplant units and explore barriers and enablers to the use of EN and PN. Methods All Australian adult allogeneic HPCT units were eligible to participate. A survey tool was developed, and phone interview with each unit dietitian was completed to explore current nutrition support and perceived barriers and enablers to provision of nutrition care. Results A total of 12 (100%) units agreed to participate. Six (50%) units reported using PN as standard care and six use EN routinely for one or more conditioning regimens. All units using EN place feeding tubes proactively with tolerance of EN reported at 50-95%. The most frequently reported barriers to the use of EN include perception of poor EN tolerance, medical team preference for PN, gastrointestinal symptoms and thrombocytopenia. Reported barriers to the use of PN include fluid overload, elevated liver enzymes, patient apprehension about PN commencement, medical team uncertainty if PN is required and patients approaching engraftment. Conclusion There is wide variation in the mode and timing of nutrition support provided to patients undergoing allogeneic HPCT. Clinical guidelines should be updated to reflect recent findings on EN use and incorporate strategies to optimise EN tolerance. This will assist in standardising practice and facilitate evidence-based nutrition care. AD - [Andersen, Sarah; Banks, Merrilyn; Brown, Teresa] Royal Brisbane & Womens Hosp, Dept Nutr & Dietet, Herston, Qld, Australia. [Andersen, Sarah; Banks, Merrilyn; Brown, Teresa; Bauer, Judy] Univ Queensland, Sch Human Movement & Nutr Sci, Brisbane, Qld, Australia. [Weber, Nicholas; Kennedy, Glen] Royal Brisbane & Womens Hosp, Dept Clin Haematol, Herston, Qld, Australia. Andersen, S (corresponding author), Royal Brisbane & Womens Hosp, Dept Nutr & Dietet, Herston, Qld, Australia.; Andersen, S (corresponding author), Univ Queensland, Sch Human Movement & Nutr Sci, Brisbane, Qld, Australia. sarah.andersen@health.qld.gov.au AN - WOS:000519420200001 AU - Andersen, S. AU - Banks, M. AU - Brown, T. AU - Weber, N. AU - Kennedy, G. AU - Bauer, J. DA - Nov DO - 10.1007/s00520-020-05397-x J2 - Support. Care Cancer KW - Enteral nutrition Parenteral nutrition Nutrition support Allogeneic stem cell transplant ENTERAL NUTRITION GUIDELINES THERAPY PATIENT RELAPSE WEIGHT Oncology Health Care Sciences & Services Rehabilitation LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: NY6VS Times Cited: 1 Cited Reference Count: 30 Andersen, Sarah Banks, Merrilyn Brown, Teresa Weber, Nicholas Kennedy, Glen Bauer, Judy Andersen, Sarah/0000-0002-9200-8186 Royal Brisbane & Women's Hospital Research Foundation This research was supported by grants from the Royal Brisbane & Women's Hospital Research Foundation. 1 0 SPRINGER NEW YORK SUPPORT CARE CANCER PY - 2020 SN - 0941-4355 SP - 5441-5447 ST - Nutrition support during allogeneic stem cell transplantation: evidence versus practice T2 - Supportive Care in Cancer TI - Nutrition support during allogeneic stem cell transplantation: evidence versus practice UR - ://WOS:000519420200001 VL - 28 ID - 761453 ER - TY - JOUR AB - Introduction: 90Y-Ibritumomab tiuxetan (90Y-IT) has become an efficient therapy in B-non-Hodgkin Lymphoma (BNHL). The aim of this study is to analyse our outcomes for 65+ years old patients treated with 90Y-IT. Subjects and Methods: A clinical protocol was created and conducted by a multidisciplinary team. Inclusion criteria: patients ≥ 65 years old, diagnosed as CD20+ NHL who received 90Y-IT in our center, as consolidation of first-line therapy or in a relapsed/refractory status, FDA recommendations were followed and response evaluation were performed 12 weeks after. Period of study: September 2005/ February 2013 Endpoints: objective response rate (ORR), time to relapse (PFS) overall survival (OS) and safety results: 39 patients completed the protocol;M/F: 18/21, mean age 72.8 years (65-87); ECOG 0-1 92.3%. According OMS classification: NHL-follicular 27 (69.2%), mantle cell Lymphoma 7 (17.9%), DLBCL 4 (10.3%) and 1 MALT (2.6%). Score distribution: low risk 19 (48.7%), intermediate 12 (30.8.2%) and poor 8 (20.5%). Previous therapy schedules ≤2 (66.7%). Consolidation group: 13 patients.Median follow-up time: 46.0 months (95% CI: 4.0; 88.0). ORR was 84.6 %; CR: 29 (74.3%); PR 4 (10.2%) and 6 failures (15.4%). Mean OS: 63.1 months (95% CI: 51.7; 74.4). Mean PFS: 39.5 months (95% CI: 32.2; 46.8), for consolidation group: 52,1 months; median PFS NR. Safety: thrombocytopenia being the most frequent G3-4 (35.9%), haematological toxicity followed by neutropenia, median time to developed: fourth week, and median time to recovery were 4.2 and 2.6 weeks respectively. In 5 (12.9%) of patients red blood cell transfusion was required, and 10 platelet transfusions (25.6%). The most frequent non-haematological toxicity was asthenia. One patient developed a severe mucositis. Four patients have concomitant associated tumours (colon, breast, lung and prostate) and two patients over 77 years developed a rectum carcinoma after 18 months of 90Y-IT and another prostate and renal tumour after 8 years. Comments: 90Y-IT is a safety and effective therapy in elderly BNHL-patients. It seems like the use of this treatment as consolidation therapy offers good and maintained response rate with lower toxicity. The OS was not inferior to observed in younger BNHL patients. AD - M.M. Andrade Campos, Department of Haematology and Hemotherapy, Miguel Servet University Hospital, Zaragoza, Spain AU - Andrade Campos, M. M. AU - Montes Limon, A. E. AU - Murillo Florez, I. M. AU - Grasa, J. M. AU - Baringo, T. AU - Giraldo, P. DB - Embase DO - 10.1002/hon.2059 KW - ibritumomab tiuxetan yttrium 90 aged human nonhodgkin lymphoma lymphoma male patient therapy safety toxicity prostate risk mantle cell lymphoma neoplasm rectum carcinoma overall survival clinical protocol classification mucosa inflammation relapse thrombocyte transfusion erythrocyte transfusion neutropenia asthenia breast lung thrombocytopenia follow up electrocorticography Food and Drug Administration large cell lymphoma LA - English M3 - Conference Abstract N1 - L71147786 2013-08-30 PY - 2013 SN - 0278-0232 SP - 250 ST - RIT with 90y ibritumomab tiuxetan in elderly patients with non-hodgkin lymphoma T2 - Hematological Oncology TI - RIT with 90y ibritumomab tiuxetan in elderly patients with non-hodgkin lymphoma UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71147786&from=export http://dx.doi.org/10.1002/hon.2059 VL - 31 ID - 761163 ER - TY - JOUR AB - Introduction: The aim of this study is to analyse our outcomes for long-term follow-up B-cell-Non-Hodgkin Lymphoma (B-NHL) patients treated with 90Y-IT. Subjets and Methods: Between September 2005/February 2013, 102 B-NHL patients were treated according to the protocol performed by a multidisciplinary team in our institution; 28 have been followed by ≥5 years and were included for analysis. Quality of life (QoL) of alive patients have been evaluated by SF36 questionnaires and compared with the Spanish general population. Endpoints: objective response rate (ORR), time to relapse (PFS) overall survival (OS), safety and QoL. Results: M/F 17/11; mean age 65.75 years (39-85); all with ECOG 0-1. According OMS classification: NHL-follicular 21 (75%), MCL 5 (17.9%) and DLBCL 2 (7.1%). Score distribution: low risk 18 (64.3%), intermediate 9 (28.6%) and poor 2 (7.2%). Previous therapy schedules > 2: 60.7%. The median follow-up time: 62 months (95% CI: 4.0; 88.0), mean PFS: 57.8 months (95% CI: 45.1; 70.4)median NR. 5 patients received 90Y-IT as consolidation of first line therapy (17.9%) and 23 relapsed/refractory (82.1%). ORR: 92.9%, CR: 25 (89.3%); PR 1 (3.6%) and 2 failures (7.1%). Mean OS: 71.1 months (95% CI: 60.7; 81.4). Non-relapses were registered on consolidation patients. Safety: neutropenia and thrombocytopenia being the most frequent, G3-4 (21.4%), haematological toxicity: median time to developed 4 weeks; the median time to recovery normal values was 2.7 and 4.5 weeks respectively. In 3 (10.7%) of patients RBC transfusion was required, and 7 platelet transfusions (25.0%). The most frequent non-haematological toxicity was asthenia. Three patients have concomitant tumours (colon, breast and esophagus). Eight patients have dead, 7 were related to disease and 5 of them ≥ 55 months after RIT therapy. QoL had been evaluated and outcomes in physical and mental items are not different to general population. Comments: In our experience 90Y-IT is a safety and effective long-term therapy in patients with B-NHL. According to obtained PFS results, it seems like the use of this kind of therapy as early part of therapy could offers good and sustained response rate with lower toxicity even in long term without impairments in QoL. AD - M.M. Andrade Campos, Department of Haematology and Hemotherapy, Miguel Servet University Hospital, Zaragoza, Spain AU - Andrade Campos, M. M. AU - Montes Limon, A. E. AU - Murillo Florez, I. M. AU - Grasa, J. M. AU - Baringo, T. AU - Giraldo, P. DB - Embase DO - 10.1002/hon.2059 KW - yttrium 90 follow up B lymphocyte lymphoma human patient therapy safety toxicity relapse population classification nonhodgkin lymphoma overall survival risk long term care breast thrombocyte transfusion questionnaire quality of life transfusion asthenia normal value esophagus thrombocytopenia neutropenia erythrocyte large cell lymphoma electrocorticography LA - English M3 - Conference Abstract N1 - L71147787 2013-08-30 PY - 2013 SN - 0278-0232 SP - 250-251 ST - RIT with 90y ibritumumab tiuxetan: Long-term follow-up outcomes in B-cell NHL T2 - Hematological Oncology TI - RIT with 90y ibritumumab tiuxetan: Long-term follow-up outcomes in B-cell NHL UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71147787&from=export http://dx.doi.org/10.1002/hon.2059 VL - 31 ID - 761164 ER - TY - JOUR AB - Introduction: 90Y Ibritumomab tiuxetan (90Y-IT) has become an efficient alternative to therapy in non-Hodgkin Lymphoma, mainly in elderly patients. The aim of this study is to analyse our updated information of patients treated with 90YIbritumomab/tiuxetan in a prospective study according clinical practice setting and to analyse treatment outcome.Subjects and Methods: 39 non Hodgkin lymphoma patients were included in a clinical protocol conducted by a multidisciplinary team and treated in the same centre. According the inclusion criteria: patients over 65 years old diagnosed as CD20+ NHL with neutrophils 1,5 x 109/L, platelets 100 x 109/L, bone marrow lymphocytes CD20+ 25%. All patients received 0,3 or 0,4 mCi /kg IV (88%) of 90YIbritumomab/tiuxetan and response evaluation was performed 12 weeks after. Period of study: September 2005/July 2012. The 90Y-IT was administered as consolidation of first line therapy (Rituximab alone, R-COP, R-CHOP21) or in relapsed/refractory status.Endpoints: Objective response rate (ORR), time to relapse (PFS) overall survival (OS) and safety. Other clinical prognostic factors were observed to assess their possible influence upon treatment value.Results: Until May 2012, 39 patients had received treatment with 90YIbritumomab/tiuxetan and completed the evaluation protocol and were considered to analysis; M/F 18/21 mean age 72.8 years (65-87); ECOG 0-1 92.3%. According OMS classification: NHL-follicular 27 (69.2%), mantle cell Lymphoma 7 (17.9%), DLBCL 4 (10.3%) and 1MALT (2.6%). Score distribution: low risk 19 (48.7%), intermediate 12 (30.8.2%) and advanced 8 (20.5%). Previous therapy schedules 2 (66.7%), >2 (33.3%). The median follow-up time: 42.0 months (95% CI: 4.0; 62.0), mean PFS: 38.1 months (95% CI: 30.8; 45.4) median NR. 13 patients received 90Y-IT as consolidation of first line therapy (33.3%) and 26 relapsed/refractory (66.6%). ORR was 84.6 % CR: 29 (74.3%); PR 4 (10.2%) and 6 failures (15.4%) in relapsed/refractory disease. Mean estimated OS since 90Y-IT: 54.4 months (95% CI: 49.4; 59.3) and mean estimated OS since diagnosis 159 months. Median PFS was NR. The mean PFS for patients in consolidation therapy was 54.2 months (95% CI: 47.4; 61.1). Safety: thrombocytopenia being the most frequent, G3-4 (35.9%), median time to developed haematological toxicity: fourth week, and neutropenia G3-4 (41.0%), the median time to recover normal values was 4.2 and 2.6 weeks respectively. In 5 (12.9%) of patients red blood cell transfusion was required, and 10 platelet transfusions (25.6%). The most frequent non haematological toxicity was asthenia. One patient developed a severe mucositis. Four patients have concomitant associated tumours (colon, breast, lung and prostate) and two patients over 77 years developed a rectum carcinoma after 18 months of 90Y-IT and another prostate and renal tumour after 8 years.Comments: In our experience 90Y Ibritumomab tiuxetan is a safety and effective therapy in patients with NHL over 65 years. According to obtained PFS results, it seems like the use of this kind of therapy as used in early part of therapy offers good and maintained response rate with lower toxicity in this fragile population. The OS in this population was not inferior to observed in younger NHL patients. AD - M.M. Andrade, Hematology, Miguel Servet University Hospital, Zaragoza, Spain AU - Andrade, M. M. AU - Montes, A. AU - Murillo, I. AU - Grasa, J. M. AU - Baringo, T. AU - Giraldo, P. DB - Embase KW - ibritumomab tiuxetan yttrium 90 rituximab patient human nonhodgkin lymphoma society hematology therapy safety toxicity prostate population B lymphocyte thrombocyte follow up diagnosis thrombocytopenia neutropenia mantle cell lymphoma neutrophil prospective study overall survival aged relapse clinical protocol classification risk rectum carcinoma normal value erythrocyte transfusion lung breast mucosa inflammation asthenia neoplasm thrombocyte transfusion clinical practice large cell lymphoma electrocorticography L1 - http://abstracts.hematologylibrary.org/cgi/content/abstract/120/21/2742?maxtoshow=&hits=80&RESULTFORMAT=&searchid=1&FIRSTINDEX=3040&displaysectionid=Poster+Session&fdate=1/1/2012&tdate=12/31/2012&resourcetype=HWCIT LA - English M1 - 21 M3 - Conference Abstract N1 - L70964965 2013-01-17 PY - 2012 SN - 0006-4971 ST - Rit with 90Y ibritumomab tiuxetan in patients with non-hodgkin lymphoma over 65 years T2 - Blood TI - Rit with 90Y ibritumomab tiuxetan in patients with non-hodgkin lymphoma over 65 years UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70964965&from=export VL - 120 ID - 761187 ER - TY - JOUR AB - BACKGROUND: Fractional flow reserve (FFR) is a reliable tool for the functional assessment of coronary stenoses. FFR computed tomography (CT) derived (FFR(CT)) has shown to be accurate, but its clinical usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the impact of FFR(CT) on heart team's treatment decision-making and selection of vessels for revascularization in patients with 3-vessel coronary artery disease. METHODS: The trial was an international, multicenter study randomizing 2 heart teams to make a treatment decision between percutaneous coronary interventions and coronary artery bypass grafting using either coronary computed tomography angiography or conventional angiography. The heart teams received the FFR(CT) and had to make a treatment decision and planning integrating the functional component of the stenoses. Each heart team calculated the anatomic SYNTAX score, the noninvasive functional SYNTAX score and subsequently integrated the clinical information to compute the SYNTAX score III providing a treatment recommendation, that is, coronary artery bypass grafting, percutaneous coronary intervention, or equipoise coronary artery bypass grafting-percutaneous coronary intervention. The primary objective was to determine the proportion of patients in whom FFR(CT) changed the treatment decision and planning. RESULTS: Overall, 223 patients were included. Coronary computed tomography angiography assessment was feasible in 99% of the patients and FFR(CT) analysis in 88%. FFR(CT) was available for 1030 lesions (mean FFR(CT) value 0.64±13). A treatment recommendation of coronary artery bypass grafting was made in 24% of the patients with coronary computed tomography angiography with FFR(CT). The addition of FFR(CT) changed the treatment decision in 7% of the patients and modified selection of vessels for revascularization in 12%. With conventional angiography as reference, FFR(CT) assessment resulted in reclassification of 14% of patients from intermediate and high to low SYNTAX score tertile. CONCLUSIONS: In patients with 3-vessel coronary artery disease, a noninvasive physiology assessment using FFR(CT) changed heart team's treatment decision-making and procedural planning in one-fifth of the patients. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02813473. AD - Centro Cardiologico Monzino, IRCCS, Milan, Italy (D.A., S.M., S.d.M., M.R., G.B., M.G., C.F., P.O., L.C., A.L.B.). Department of Clinical Sciences and Community Health, Cardiovascular Section (D.A.), University of Milan, Italy. Department of Cardiology, Amsterdam University Medical Center, the Netherlands (R.M., Y.K.). Department of Internal Medicine, Cardiology Division, Hospital de Clinicas, University of Campinas, SP, Brazil (R.M.). Cardiovascular Center Aalst, OLV Hospital, Belgium (J.S., C.C.). Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium (K.T., J.C., D.S.). Thoraxcenter, Erasmus MC, the Netherlands (Y.M., Y.O.). University of Zurich, Switzerland (A.P., F.M., P.K.). CHRU Nancy and Universite de Lorraine, Nancy, France (X.O., P.-A.M., T.F.). Jena University Hospital, Friedrich Schiller University of Jena, Germany (G.F., I.D.). Heinrich Braun Klinikum, Zwickau, Germany (M.S.). Cardialysis BV, Rotterdam, the Netherlands (I.L., W.L.). Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College London, United Kingdom (P.W.S.). Department of Biomedical and Clinical Sciences "Luigi Sacco" (A.L.B.), University of Milan, Italy. AN - 31833413 AU - Andreini, D. AU - Modolo, R. AU - Katagiri, Y. AU - Mushtaq, S. AU - Sonck, J. AU - Collet, C. AU - De Martini, S. AU - Roberto, M. AU - Tanaka, K. AU - Miyazaki, Y. AU - Czapla, J. AU - Schoors, D. AU - Plass, A. AU - Maisano, F. AU - Kaufmann, P. AU - Orry, X. AU - Metzdorf, P. A. AU - Folliguet, T. AU - Färber, G. AU - Diamantis, I. AU - Schönweiß, M. AU - Bonalumi, G. AU - Guglielmo, M. AU - Ferrari, C. AU - Olivares, P. AU - Cavallotti, L. AU - Leal, I. AU - Lindeboom, W. AU - Onuma, Y. AU - Serruys, P. W. AU - Bartorelli, A. L. DA - Dec DO - 10.1161/circinterventions.118.007607 DP - NLM ET - 2019/12/14 J2 - Circulation. Cardiovascular interventions KW - *Clinical Decision-Making *Computed Tomography Angiography *Coronary Angiography Coronary Artery Bypass Coronary Artery Disease/*diagnostic imaging/physiopathology/therapy Coronary Stenosis/*diagnostic imaging/physiopathology/therapy Decision Support Techniques Europe *Fractional Flow Reserve, Myocardial Humans *Patient Care Team *Patient Selection Percutaneous Coronary Intervention Predictive Value of Tests Prognosis Severity of Illness Index *angiography *coronary artery disease *coronary computed tomography angiography *decision-making *percutaneous coronary intervention LA - eng M1 - 12 N1 - 1941-7632 Andreini, Daniele Modolo, Rodrigo Katagiri, Yuki Mushtaq, Saima Sonck, Jeroen Collet, Carlos De Martini, Stefano Roberto, Maurizio Tanaka, Kaoru Miyazaki, Yosuke Czapla, Jens Schoors, Danny Plass, Andre Maisano, Francesco Kaufmann, Philipp Orry, Xavier Metzdorf, Pierre-Adrien Folliguet, Thierry Färber, Gloria Diamantis, Ioannis Schönweiß, Marc Bonalumi, Giorgia Guglielmo, Marco Ferrari, Cristina Olivares, Paolo Cavallotti, Laura Leal, Ingrid Lindeboom, Wietze Onuma, Yoshinobu Serruys, Patrick W Bartorelli, Antonio L SYNTAX III REVOLUTION Investigators Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't United States Circ Cardiovasc Interv. 2019 Dec;12(12):e007607. doi: 10.1161/CIRCINTERVENTIONS.118.007607. Epub 2019 Dec 13. PY - 2019 SN - 1941-7640 SP - e007607 ST - Impact of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography on Heart Team Treatment Decision-Making in Patients With Multivessel Coronary Artery Disease: Insights From the SYNTAX III REVOLUTION Trial T2 - Circ Cardiovasc Interv TI - Impact of Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography on Heart Team Treatment Decision-Making in Patients With Multivessel Coronary Artery Disease: Insights From the SYNTAX III REVOLUTION Trial VL - 12 ID - 760149 ER - TY - JOUR AB - PERTs are a new, multidisciplinary approach to PE care. They were conceived to efficiently identify and risk stratify PE patients and standardize care delivery. More research needs to be conducted to assess the effects that PERTs have had on PE care. This study sought to determine the effects of a PERT on quality and overall value of care. This was a retrospective study of all patients 18 years of age or older who presented with a principal diagnosis of an acute PE based on available ICD codes from January 1, 2010 to December 31, 2018. Patients who did not have an imaging study, i.e., CTPA or ECHO, available were excluded. Patients were divided into pre- (before October 2015) and post-PERT eras (after October 2015) and stratified based on the presence of right heart strain/dysfunction on imaging. All quality outcomes were extracted from the EMR, and cost outcomes were provided by the financial department. 530 individuals (226 pre-PERT and 304 post-PERT) were identified for analysis. Quality outcomes improved between the eras; most notably in-hospital mortality decreased (16.5 vs. 9.6) and hospital LOS decreased (7.7 vs. 4.4) (p < 0.05). Total cost of care also decreased a statistically significant amount between the eras. The implementation of a PERT improved quality and cost of care, resulting in improved value. We hypothesize that this may be due to more timely identification and risk stratification leading to earlier interventions and streamlined decision making, but further research is required to validate these findings in larger cohorts. AD - [Annabathula, Rahul] Univ Kentucky, Coll Med, Lexington, KY USA. [Dugan, Adam] Univ Kentucky, Dept Biostat, Lexington, KY USA. [Bhalla, Vikas; Smyth, Susan S.; Gupta, Vedant A.] Univ Kentucky, Gill Heart & Vasc Inst, Div Cardiovasc Med, 900 S Limestone,CTW 320, Lexington, KY 40536 USA. [Davis, George A.] Univ Kentucky, Antithrombosis Stewardship, UK HealthCare, Lexington, KY USA. Gupta, VA (corresponding author), Univ Kentucky, Gill Heart & Vasc Inst, Div Cardiovasc Med, 900 S Limestone,CTW 320, Lexington, KY 40536 USA. rahul.annabathula@uky.edu; adam.dugan@uky.edu; vikas.bhalla@uky.edu; georgedavis@uky.edu; susansmyth@uky.edu; vedant.gupta@uky.edu AN - WOS:000543563300001 AU - Annabathula, R. AU - Dugan, A. AU - Bhalla, V. AU - Davis, G. A. AU - Smyth, S. S. AU - Gupta, V. A. DO - 10.1007/s11239-020-02188-3 J2 - J. Thromb. Thrombolysis KW - PE PERT Value Risk stratification Cost analysis Cardiac & Cardiovascular Systems Hematology Peripheral Vascular Disease LA - English M3 - Article; Early Access N1 - ISI Document Delivery No.: MC8XV Times Cited: 0 Cited Reference Count: 17 Annabathula, Rahul Dugan, Adam Bhalla, Vikas Davis, George A. Smyth, Susan S. Gupta, Vedant A. Annabathula, Rahul/0000-0001-5652-9315 2019 AOA Carolyn L. Kuckein Student Research Fellowship; NIH National Center for Advancing Translational Sciences [UL1TR001998] Rahul Annabathula was supported by a 2019 AOA Carolyn L. Kuckein Student Research Fellowship. The project described was supported by the NIH National Center for Advancing Translational Sciences through Grant Number UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. 0 SPRINGER DORDRECHT J THROMB THROMBOLYS SN - 0929-5305 SP - 9 ST - Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT) T2 - Journal of Thrombosis and Thrombolysis TI - Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT) UR - ://WOS:000543563300001 ID - 761432 ER - TY - JOUR AB - PERTs are a new, multidisciplinary approach to PE care. They were conceived to efficiently identify and risk stratify PE patients and standardize care delivery. More research needs to be conducted to assess the effects that PERTs have had on PE care. This study sought to determine the effects of a PERT on quality and overall value of care. This was a retrospective study of all patients 18 years of age or older who presented with a principal diagnosis of an acute PE based on available ICD codes from January 1, 2010 to December 31, 2018. Patients who did not have an imaging study, i.e., CTPA or ECHO, available were excluded. Patients were divided into pre- (before October 2015) and post-PERT eras (after October 2015) and stratified based on the presence of right heart strain/dysfunction on imaging. All quality outcomes were extracted from the EMR, and cost outcomes were provided by the financial department. 530 individuals (226 pre-PERT and 304 post-PERT) were identified for analysis. Quality outcomes improved between the eras; most notably in-hospital mortality decreased (16.5 vs. 9.6) and hospital LOS decreased (7.7 vs. 4.4) (p < 0.05). Total cost of care also decreased a statistically significant amount between the eras. The implementation of a PERT improved quality and cost of care, resulting in improved value. We hypothesize that this may be due to more timely identification and risk stratification leading to earlier interventions and streamlined decision making, but further research is required to validate these findings in larger cohorts. AD - College of Medicine, University of Kentucky, Lexington, KY, USA. Department of Biostatistics, University of Kentucky, Lexington, KY, USA. Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, 900 S. Limestone, CTW 320, Lexington, KY, 40536, USA. Antithrombosis Stewardship, UK HealthCare, University of Kentucky, Lexington, KY, USA. Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, 900 S. Limestone, CTW 320, Lexington, KY, 40536, USA. vedant.gupta@uky.edu. AN - 32542527 AU - Annabathula, R. AU - Dugan, A. AU - Bhalla, V. AU - Davis, G. A. AU - Smyth, S. S. AU - Gupta, V. A. DA - Jun 15 DO - 10.1007/s11239-020-02188-3 DP - NLM ET - 2020/06/17 J2 - Journal of thrombosis and thrombolysis KW - Cost analysis Pe Pert Risk stratification Value LA - eng N1 - 1573-742x Annabathula, Rahul Orcid: 0000-0001-5652-9315 Dugan, Adam Bhalla, Vikas Davis, George A Smyth, Susan S Gupta, Vedant A Orcid: 0000-0002-0739-153x UL1 TR001998/TR/NCATS NIH HHS/United States UL1TR001998/TR/NCATS NIH HHS/United States 2019 AOA Carolyn L. Kuckein Student Research Fellowship/Alpha Omega Alpha Honor Medical Society/ Journal Article Netherlands J Thromb Thrombolysis. 2020 Jun 15. doi: 10.1007/s11239-020-02188-3. PY - 2020 SN - 0929-5305 ST - Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT) T2 - J Thromb Thrombolysis TI - Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT) ID - 760354 ER - TY - JOUR AB - Purpose: Catheter directed thrombolysis (CDT) is a contemporary technique for the treatment of massive and sub-massive PEs throughout the world. We sort to evaluate the immediate and short term clinical outcomes of patients treated with Angio-jet pulse spray rheolytic treated for PEs at a single tertiary referral hospital over a 2-year period. Material and methods: Medical records and diagnostic tests of all patients treated for massive or sub-massive PEs at The Wollongong Hospital during a 2 year period. Assessment of outcomes based on haemodynamic improvement at 24-48 hrs post op and follow-up imaging with TTE and CTPA at 4 weeks. Results: 23 patients underwent CDT with Angiojet for massive (n=18) or sub-massive (n=5) PE. RV dysfunction was normal in 95% at 24-48hrs postop. 16 patients underwent follow up TTE at 4 weeks post-procedure with 94% (n=15) demonstrating normal RV function. 18 patients underwent follow up CTPA with 88% (n=16) reported normal. 91% (n=21) patients were discharged with no evidence of respiratory compromise. 2 deaths were reported post procedure. Conclusion: The morbidity and mortality associated with PEs is significant. In our centre we have had positive results to date with CDI in massive and sub-massive PE's. Initial results have resulted to the initiation of a PERT team to providing a multi-disciplinary approach to the rapid assessment and management of suitable patients. AD - N. Anning, Dept of Vascular Surgery, Wollongong Hospital, Bondi Junction, NSW, Australia AU - Anning, N. AU - Villalba, L. DB - Embase DO - 10.1007/s00270-019-02282-x KW - adult aerosol blood clot lysis clinical article clinical assessment clinical outcome conference abstract controlled study female follow up hemodynamics human male medical record morbidity mortality outcome assessment tertiary care center thrombectomy catheter LA - English M1 - 3 M3 - Conference Abstract N1 - L629258829 2019-09-13 PY - 2019 SN - 1432-086X SP - S305-S306 ST - Angio-jet rheolytic for massive and submassive PE T2 - CardioVascular and Interventional Radiology TI - Angio-jet rheolytic for massive and submassive PE UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629258829&from=export http://dx.doi.org/10.1007/s00270-019-02282-x VL - 42 ID - 760684 ER - TY - JOUR AB - Background: Systemic Lupus Erythematosus (SLE), Antiphospholipid Syndrome (APS) and Thrombophilia are associated with considerable pregnancy-related morbidity. Multidisciplinary teams allows the application of an experienced protocol to monitor and treat them during pregnancy in order to reduce adverse pregnancy outcomes and this way improve the prognosis of the pregnancy. Objectives: To investigate pregnancy outcomes in women with rheumatic diseases and thrombophilia from a Spanish cohort. Methods: A population of 93 patients diagnosed with SLE, APS and Thrombophilia atended in a specialized multidisciplinary unit of Rheumatic Diseases and pregnancy from the Complejo Hospitalario Universitario De Granada, Spain from January 2012 to December 2016. The following variables were collected: age, presence of antiphospholipid antibodies and anti Ro, thrombotic episodes and prior abortions, treatment during pregnancy, obstetric outcomes births/abortion and pregnancy length. The statistical analysis was done using the McNemar Test. Results: 93 pregnant women were included in the study. 26 were diagnosed with SLE, 32 with APS and 35 with Thrombophilia (mostly, Heterozygotes for MTHFR gene). 47.3% were younger than 35 years and 52.7% were elder than 35 years. 66.7% had one or more prior abortions, meaning a total record of 159 abortions and an average of 1.71±1.76 abortions per patient. The treatment received by the patients is specified in table 1. 9 patients (3 APS and 6 thrombophilia) received a treatment with intravenous gammaglobulin with doses of 400 mg/kg, apart from Low-Molecular-Weight Heparin (LMWH) and Acetylsalicylic Acid (ASA), two days in a row at the beginning and then every three weeks during the whole pregnancy. 90 (96.8%) pregnancies were developed. 6 of them were preterm pregnancies and 84 were term pregnancies. Only 3 abortions (3.2%) occurred in the patients monitored in our unit. The reduction in the number of abortions was statistically significant (p<0.001). Regarding those 3 registered abortions, 2 were patients diagnosed with SLE, with no records of previous abortions and they occurred during the second trimester of pregnancy. 1 was diagnosed with APS and she had records of 2 previous abortions and occurred during the first trimester of pregnancy. Those patients who received treatment with gammaglobulin iv showed an mean of 4.88±1.85 previous abortions per patient and all had a term delivery (100%). Conclusions: Our results demonstrate a decrease in the number of abortions and a larger number of term pregnancies since the inclusion of patients with high risk pregnancies in our unit. Prophylactic treatment is effective for the prevention of abortions, reaching higher rate live birth pregnancies. The multidisciplinary evaluation is essential to prevent complications in women diagnosed with rheumatic diseases with high obstetric risk. AD - I. Añón Oñate, Rheumatology, Complejo Hospitalario Universitario De Granada, Granada, Spain AU - Añón Oñate, I. AU - Notario Ferreira, I. AU - Morales Garrido, P. AU - Ferrer González, M. Á AU - Caro Hernández, C. AU - Pérez Albaladejo, L. AU - Soto Pino, M. J. AU - González Utrilla, A. AU - Raya Álvarez, E. AU - Cáliz Cáliz, R. DB - Embase DO - 10.1136/annrheumdis-2017-eular.6549 KW - acetylsalicylic acid endogenous compound human immunoglobulin low molecular weight heparin methylenetetrahydrofolate reductase (NADPH2) phospholipid antibody abortion adult antiphospholipid syndrome cohort analysis complication conference abstract diagnosis drug combination drug therapy female first trimester pregnancy genetic association heterozygote high risk pregnancy human information processing live birth major clinical study McNemar test pregnancy outcome pregnant woman prevention prophylaxis rheumatic disease second trimester pregnancy Spain systemic lupus erythematosus thrombophilia thrombosis LA - English M3 - Conference Abstract N1 - L621423195 2018-04-02 PY - 2017 SN - 1468-2060 SP - 1228 ST - Pregnancy outcomes in women with rheumatic diseases: A single center-study T2 - Annals of the Rheumatic Diseases TI - Pregnancy outcomes in women with rheumatic diseases: A single center-study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621423195&from=export http://dx.doi.org/10.1136/annrheumdis-2017-eular.6549 VL - 76 ID - 760939 ER - TY - JOUR AB - Purpose: Previous studies have proposed the evaluation of intraventricular inflow cannula position as a prognostic criterion for complications on LVAD. No formal correlation among inflow cannula position and adverse events has been attempted so far. We are missing tools to further improve the positioning of LVADs in a patient-specific fashion. Methods: A multidisciplinary team including cardiac surgeons, biomedical engineers and medical images processing experts was assembled. CT scans of 8 LVAD recipients (HeartMate II) were reconstructed through semi-automatic segmentation (whole heart, implanted device and chest wall) (ITK-Snap). The mitral annulus was defined by the user on 3D CT scan representation. A coordinate system was built to quantify the coaxiality of the inflow cannula with the mitral annulus (Figure 1). Patients were stratified into Group 1 (presenting thromboembolic events, pump dysfunction or thrombosis) and Group 2 (no complications). Follow-up was 25.4 months. Results: The phi and theta angles indicated the rotation of the inflow cannula towards the interventricular septum (IVS) or the lateral left ventricular (LV) wall, and towards the anterior or posterior LV wall, respectively. Data were expressed as percentage deviation from ideal value (0° corresponding to 0% deviation; 90° corresponding to 100% deviation). Group 1 patients presented significantly higher average rotation of inflow cannula towards the interventricular septum (73% ± 28.6 vs. 15% ± 12.4, p= 0.006), although no difference was observed in terms of average rotation towards the anterior or posterior LV wall. Conclusion: There is a potential to predict the likelihood of adverse events at follow-up in LVAD recipients based on the morphological analysis of inflow cannula with respect to the cardiac structures. If confirmed in larger cohorts, preventive interventions could be then foreseen (i.e. adjustment of anticoagulant/antiaggregant therapy). Further studies are ongoing in this perspective. (Table presented). AD - A. Anselmi, Division of Thoracic,and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France AU - Anselmi, A. AU - Collin, S. AU - Verhoye, J. AU - Haigron, P. AU - Flécher, E. DB - Embase KW - recipient society heart lung transplantation cannula human patient left ventricular assist device follow up computer assisted tomography cardiac surgeon thrombosis pump thromboembolism therapy thorax wall devices processing heart left ventricle wall LA - English M1 - 4 M3 - Conference Abstract N1 - L72253986 2016-04-27 PY - 2016 SN - 1053-2498 SP - S320 ST - Association between intraventricular position of inflow cannula and clinical outcomes in lvad recipients T2 - Journal of Heart and Lung Transplantation TI - Association between intraventricular position of inflow cannula and clinical outcomes in lvad recipients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72253986&from=export VL - 35 ID - 761030 ER - TY - JOUR AU - Anthi, A. AU - Konstantonis, D. AU - Theodorakopoulou, M. AU - Apostolopoulou, O. AU - Karampela, I. AU - Konstantopoulou, G. AU - Patsilinakou, S. AU - Armaganidis, A. AU - Dimopoulos, G. DA - 2020/09/24 09/24 DB - Europe PubMed Central DO - 10.12659/ajcr.926915 PY - 2020 SN - 1941-5923 ST - A Severe COVID-19 Case Complicated by Right Atrium Thrombus T2 - Am J Case Rep TI - A Severe COVID-19 Case Complicated by Right Atrium Thrombus UR - http://europepmc.org/article/MED/32963216 VL - 21 ID - 762016 ER - TY - JOUR AB - Introduction. An aorta-to-right atrium fistula is an anomalous communication between the ascending or descending thoracic aorta and the right atrium. In this report we describe a case of an idiopathic aortic root-to-right atrium fistula occasionally found during a coronary angiography performed in a young patient admitted for acute chest pain with evidence of multivessel coronary artery disease. The anatomical peculiarity of this fistulous communication is that it gave origin to collateral vessels furnishing the infero-lateral wall of the left ventricle. The case represented a diagnostic and therapeutic challenge that required a multimodality imaging and a multidisciplinary team approach. Case report. A 48 year-old male with borderline hypertension, familiar hypercholesterolemia and no history of cardiovascular disease, was admitted to our intensive care unit for chest pain at rest and dynamic alterations of the electrocardiogram in left precordial leads (ST segment depression during symptoms); laboratory tests showed mild increase of high sensitivity troponin I levels (3,84 ng/ml n.v. 0,01-0,05 ng/ml). Transthoracic echocardiography showed a moderate, concentric left ventricular hypertrophy, hypokinesis of the mid-basal segments of infero-lateral wall, with normal global ejection fraction (55%); no relevant valvular heart disease nor pericardial effusion were evident. The patient underwent coronary angiography from right radial access, which documented a critical lesion of left main (LM) at bifurcation, a critical lesion of mid-distal left anterior descending artery (LAD) and occlusion of distal apical recurrent LAD (Figure 1A). A thrombotic subocclusion of a first proximal obtuse marginal vessel (OM) was identified as the culprit lesion (Figure 1B). Right coronary artery (RCA) appeared hypoplastic and was occluded at the proximal segment (Figure 1C). An anomalous flow, originating from the aorta just underneath the origin of RCA was detected. At selective injection, it appeared to be a huge fistulous communication between right Valsalva coronary sinus and the right atrium. Unexpectedly from this fistulous communication emerged several collateral vessels, oriented toward postero-lateral wall of the LV. (Figure 2A-B). At this point, due to the ongoing symptoms of ischemia and instability of the patient, a percutaneous coronary angioplasty (PTCA) of the culprit lesion vessel (OM) was performed (Figure 1D) and a drug-coated stent was implanted, in order to minimize the need for dual oral anti-platelet treatment and to allow an eventual stepped surgical procedure on this patient. The procedure did not present complication and the patient remained asymptomatic. An angio-computed tomography (Angio-CT) well showed the pathway of the fistulous communication between ascending aorta and RA (Figure 2CD). A multidisciplinary evaluation in heart team was carried on, which excluded indication to surgical closure of the fistula for 2 main reasons: 1) the presence of collateral vessels originating from the fistulous conduct and apparently furnishing the infero-lateral wall, might have exposed a wide territory of the LV to the risk of ischemia; 2) the lack of pulmonary circulation overload or pulmonary systolic hypertension at right heart catheterization and the absence of heart failure symptoms. An intravascular ultrasound (IVUS) guided percutaneous revascularization was performed (Figure 3A-E) with implantation of two everolimus eluted stents (EES) with a modified T technique at the level of left main bifurcation and two bioresorbable vascular scaffolds (BVS) at mid-distal LAD. The procedure was successfully completed and the patient remained in good hemodynamic condition for the whole hospital stay and still asymptomatic, with a negative stress test at 6 month-follow-up. Conclusions. We present a relatively rare case of congenital aortic-to-RA fistula furnishing coronary branches for the infero-lateral wall of the LV, with associated diffuse coronary artery disease in a young patient. A multimodality imaging approach in the dia nostic phase and a multidisciplinary team-guided management represented the key points for a tailored therapeutic strategy on our patient. (Figure presented). AD - A. Aprile, SC Cardiologia, Ciriè/Ivrea, Ivrea, Italy AU - Aprile, A. AU - Todaro, M. C. AU - Infantino, V. AU - D'Alessandro, G. AU - Zanera, M. AU - Gaetano, P. AU - Di Leo, A. AU - Senatore, G. DB - Embase DO - 10.1714/2794.28295 KW - endogenous compound everolimus troponin I adult aortic root ascending aorta borderline hypertension case report complication computer assisted tomography coronary angiography coronary artery disease coronary sinus drug eluting stent exercise test fistula follow up gene expression heart catheterization heart ejection fraction heart failure heart left ventricle hypertrophy heart right atrium hospitalization human human cell hypercholesterolemia hypokinesia implantation injection intensive care unit intravascular ultrasound ischemia laboratory test left anterior descending coronary artery lung circulation male middle aged pericardial effusion rest revascularization right coronary artery ST segment depression surgery systolic hypertension thorax pain thrombocyte thrombosis transluminal coronary angioplasty transthoracic echocardiography valvular heart disease LA - English M1 - 10 M3 - Conference Abstract N1 - L619997389 2018-01-02 PY - 2017 SN - 1972-6481 SP - e35-e36 ST - An unusual case of aortic-right atrium fistula: A diagnostic and therapeutic challenge T2 - Giornale Italiano di Cardiologia TI - An unusual case of aortic-right atrium fistula: A diagnostic and therapeutic challenge UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619997389&from=export http://dx.doi.org/10.1714/2794.28295 VL - 18 ID - 760907 ER - TY - JOUR AB - Objective: Surveillance ultrasounds in critically ill patients detect many deep venous thrombi (DVTs) that would otherwise go unnoticed. However, the impact of surveillance for DVT on mortality among critically ill patients remains unclear. Design: We are conducting a multicenter, multinational randomized controlled trial that examines the effectiveness of adjunct intermittent pneumatic compression use with pharmacologic thromboprophylaxis compared to pharmacologic thromboprophylaxis alone on the incidence of proximal lower extremity DVT in critically ill patients (the PREVENT trial). Enrolled patients undergo twice weekly surveillance ultrasounds of the lower extremities as part of the study procedures. We plan to compare enrolled patients who have surveillance ultrasounds to patients who meet the eligibility criteria but are not enrolled (eligible non-enrolled patients) and only who will have ultrasounds performed at the clinical team's discretion. We hypothesize that twice-weekly ultrasound surveillance for DVT in critically ill patients who are receiving thromboprophylaxis will have more DVTs detected, and consequently, fewer pulmonary emboli and lower all-cause 90-day mortality. Discussion: We developed a detailed a priori plan to guide the analysis of the proposed study and enhance the validity of its results. AD - [Arabi, Yaseen M.; Alsolamy, Sami; Abdukahil, Sheryl Ann I.; Al-Dawood, Abdulaziz] King Saud Bin Abdulaziz Univ Hlth Sci, Coll Med Riyadh, Intens Care Dept, King Abdullah Int Med Res Ctr, Riyadh 11426, Saudi Arabia. [Burns, Karen E. A.] St Michaels Hosp, Li Ka Shing Knowledge Inst, Interdept Div Crit Care Med, Toronto, ON, Canada. [Al-Hameed, Fahad] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Coll Med Jeddah, Dept Intens Care, Jeddah, Saudi Arabia. [Alsolamy, Sami] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Coll Med Riyadh, Emergency Med Dept, Jeddah, Saudi Arabia. [Almaani, Mohammed] King Saud Bin Abdulaziz Univ Hlth Sci, Dept Pulm & Crit Care Med King Fahad Med City, Jeddah, Saudi Arabia. [Mandourah, Yasser; Almekhlafi, Ghaleb A.] Prince Sultan Mil Med City, Dept Intens Care Serv, Riyadh, Saudi Arabia. [Al Bshabshe, Ali] King Khalid Univ, Asir Cent Hosp, Dept Crit Care Med, Abha, Saudi Arabia. [Alshahrani, Mohammed] Imam Abdulrahman Bin Faisal Univ, Dept Emergency & Crit Care, Dammam, Saudi Arabia. [Khalid, Imran] King Faisal Specialist Hosp & Res Ctr, Dept Med, Crit Care Sect, Jeddah, Saudi Arabia. [Hawa, Hassan] King Faisal Specialist Hosp & Res Ctr, Crit Care Med Dept, Riyadh, Saudi Arabia. [Arshad, Zia] King Georges Med Univ, Dept Anesthesiol & Crit Care, Lucknow, Uttar Pradesh, India. [Lababidi, Hani] King Fahad Med City, Dept Pulm & Crit Care Med, Riyadh, Saudi Arabia. [Al Aithan, Abdulsalam] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Intens Care & Pulm Med, Al Hasa, Saudi Arabia. [Jose, Jesna] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Dept Biostat & Bioinformat, Riyadh, Saudi Arabia. [Afesh, Lara Y.] King Saud bin Abdulaziz Univ Hlth Sci, King Abdullah Int Med Res Ctr, Res Off, Riyadh, Saudi Arabia. Arabi, YM (corresponding author), King Saud Bin Abdulaziz Univ Hlth Sci, Coll Med Riyadh, Intens Care Dept, King Abdullah Int Med Res Ctr, Riyadh 11426, Saudi Arabia. arabi@ngha.med.sa AN - WOS:000451572400104 AU - Arabi, Y. M. AU - Burns, K. E. A. AU - Al-Hameed, F. AU - Alsolamy, S. AU - Almaani, M. AU - Mandourah, Y. AU - Almekhlafi, G. A. AU - Al Bshabshe, A. AU - Alshahrani, M. AU - Khalid, I. AU - Hawa, H. AU - Arshad, Z. AU - Lababidi, H. AU - Al Aithan, A. AU - Jose, J. AU - Abdukahil, S. A. I. AU - Afesh, L. Y. AU - Al-Dawood, A. AU - Grp, Prevent Trial C7 - e12258 DA - Sep DO - 10.1097/md.0000000000012258 J2 - Medicine KW - critical care deep vein thrombosis eligible nonenrolled intensive care intermittent pneumatic compression pulmonary embolism surveillance thromboprophylaxis ultrasound INTENSIVE-CARE-UNIT Medicine, General & Internal LA - English M1 - 36 M3 - Article N1 - ISI Document Delivery No.: HC1PG Times Cited: 2 Cited Reference Count: 12 Arabi, Yaseen M. Burns, Karen E. A. Al-Hameed, Fahad Alsolamy, Sami Almaani, Mohammed Mandourah, Yasser Almekhlafi, Ghaleb A. Al Bshabshe, Ali Alshahrani, Mohammed Khalid, Imran Hawa, Hassan Arshad, Zia Lababidi, Hani Al Aithan, Abdulsalam Jose, Jesna Abdukahil, Sheryl Ann I. Afesh, Lara Y. Al-Dawood, Abdulaziz ALMEKHLAFI, GHALEB A./AAN-7167-2020; Alshahrani, Mohammed Saeed/O-2158-2019; Asonto, Laila Perlas/AAH-3370-2019; bshabshe, ali al/AAR-1799-2020 ALMEKHLAFI, GHALEB A./0000-0002-0323-7025; Alshahrani, Mohammed Saeed/0000-0001-5946-2128; Asonto, Laila Perlas/0000-0001-9239-9650; bshabshe, ali al/0000-0003-0974-7226; King Saud Bin Abdulaziz University for Health Sciences, Jeddah, College of Medicine,/0000-0001-9073-534X; Alsolamy, Sami/0000-0002-0127-0307; Khalid, Imran/0000-0001-9901-926X; Arabi, Yaseen/0000-0001-5735-6241 King Abdulaziz City for Science and Technology, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia The study is funded by King Abdulaziz City for Science and Technology, Riyadh, Kingdom of Saudi Arabia and King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. The study sponsors do not have any role in the study design, collection, management, analysis and interpretation of data or in writing the report. 2 0 4 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA MEDICINE Baltimore PY - 2018 SN - 0025-7974 SP - 4 ST - Surveillance or no surveillance for deep venous thrombosis and outcomes of critically ill patients A study protocol and statistical analysis plan T2 - Medicine TI - Surveillance or no surveillance for deep venous thrombosis and outcomes of critically ill patients A study protocol and statistical analysis plan UR - ://WOS:000451572400104 VL - 97 ID - 761572 ER - TY - JOUR AU - Araszkiewicz, A. AU - Jankiewicz, S. AU - Sławek-Szmyt, S. AU - Klotzka, A. AU - Grygier, M. AU - Mularek-Kubzdela, T. AU - Lesiak, M. DA - 2020/01/17 01/17 DB - Europe PubMed Central DO - 10.5114/aic.2019.90229 M1 - 4 PY - 2020 SN - 1734-9338 SP - 497-498 ST - Rapid clinical and haemodynamic improvement in a patient with intermediate-high risk pulmonary embolism treated with transcatheter aspiration thrombectomy T2 - Postepy Kardiol Interwencyjnej TI - Rapid clinical and haemodynamic improvement in a patient with intermediate-high risk pulmonary embolism treated with transcatheter aspiration thrombectomy UR - http://europepmc.org/article/MED/31933670 VL - 15 ID - 762062 ER - TY - JOUR AU - Araszkiewicz, A. AU - Kurzyna, M. AU - Kopeć, G. AU - Roik, M. AU - Darocha, S. AU - Pietrasik, A. AU - Puślecki, M. AU - Biederman, A. AU - Przybylski, R. AU - Stępniewski, J. AU - Furdal, M. AU - Mularek-Kubzdela, T. AU - Pruszczyk, P. AU - Torbicki, A. DA - 2020/01/28 01/28 DB - Europe PubMed Central DO - 10.5603/cj.2019.0127 M1 - 6 PY - 2020 SN - 1897-5593 SP - 623-632 ST - Expert opinion on the creating and operating of the regional Pulmonary Embolism Response Teams (PERT). Polish PERT Initiative T2 - Cardiol J TI - Expert opinion on the creating and operating of the regional Pulmonary Embolism Response Teams (PERT). Polish PERT Initiative UR - http://europepmc.org/article/MED/31970735 VL - 26 ID - 762060 ER - TY - JOUR AU - Araszkiewicz, A. AU - Sławek-Szmyt, S. AU - Jankiewicz, S. AU - Żabicki, B. AU - Grygier, M. AU - Mularek-Kubzdela, T. AU - Krasiński, Z. AU - Lesiak, M. DA - 2020/09/10 09/10 DB - Europe PubMed Central DO - 10.1155/2020/4191079 PY - 2020 SN - 0896-4327 ST - Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice T2 - J Interv Cardiol TI - Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice UR - http://europepmc.org/article/MED/32904502 VL - 2020 ID - 762024 ER - TY - JOUR AB - Primary tumors arising from the inferior vena cava are extremely rare, leiomyosarcoma is the most common one arising from the smooth muscle cells in the media of the wall of the vena cava. A 42-year-old lady had epigastric pain and back pain for 4 months with signs of deep vein thrombosis of the right lower limb. CT-scan showed a mass related to the inferior vena cava which was proved by histopathological examination to be leiomyosarcoma of the inferior vena cava. A multidisciplinary team is required for the diagnosis and management of tumors the vena cava. Long term follow-up is recommended. AD - A.A. Mohammed, Department of Surgery, College of Medicine, University of Duhok, Azadi Teaching Hospital, 8 Nakhoshkhana Road, 1014 AM, Duhok City, Kurdistan Region, Iraq AU - Arif, S. H. AU - Mohammed, A. A. DB - Embase DO - 10.1016/j.radcr.2019.10.034 KW - vein prosthesis anticoagulant agent adult anticoagulant therapy article backache case report clinical article computer assisted tomography deep vein thrombosis dissection Doppler flowmetry epigastric discomfort epigastric pain female follow up histopathology human human tissue inferior cava vein laparotomy leiomyosarcoma multidisciplinary team nausea priority journal LA - English M1 - 2 M3 - Article N1 - L2003958859 2019-11-28 2019-12-04 PY - 2020 SN - 1930-0433 SP - 133-135 ST - Leiomyosarcoma of the inferior vena cava presenting as deep venous thrombosis; case report T2 - Radiology Case Reports TI - Leiomyosarcoma of the inferior vena cava presenting as deep venous thrombosis; case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003958859&from=export http://dx.doi.org/10.1016/j.radcr.2019.10.034 VL - 15 ID - 760604 ER - TY - JOUR AB - Interdisciplinary team (IDT) rounds were initiated in the intensive care unit (ICU) in June 2010. All catheters were identified by location, duration, and indication. Catheters with no indication were removed. Data were collected retrospectively on catheter days and associated infections in a 20-month period before and after intervention with an aggregate of 19 207 ICU days before and 23 576 ICU days after institution of rounds. Results showed a statistically significant decrease in the number of indwelling urinary catheter (IUC) days (5304 vs 4541 days, P = .05) and catheter-associated urinary tract infection rates (4.71 vs 1.98 infections/1000 ICU days, P < .05). Central line days statistically increased after IDT rounds (3986 vs 4305 days, P < .05) but the catheter-related bloodstream infection rate trended down (3.5 vs 1.6 infections/1000 ICU days, P = .62). This analysis suggests that IDT rounds may have an impact on reducing the number of IUC days and associated infections. AD - Newark Beth Israel Medical Center, Newark, NJ. Newark Beth Israel Medical Center, Newark, NJ JenniferLaRosa@yahoo.com. AN - 24006027 AU - Arora, N. AU - Patel, K. AU - Engell, C. A. AU - LaRosa, J. A. DA - Jul-Aug DO - 10.1177/1062860613500519 DP - NLM ET - 2013/09/06 J2 - American journal of medical quality : the official journal of the American College of Medical Quality KW - Catheter-Related Infections/*epidemiology/prevention & control Catheterization, Central Venous/adverse effects/*statistics & numerical data Female Humans Intensive Care Units Male Middle Aged *Patient Care Team/statistics & numerical data Quality Improvement *Teaching Rounds/methods Urinary Catheterization/adverse effects/*statistics & numerical data Cauti Crbsi catheter-related infections multidisciplinary rounds LA - eng M1 - 4 N1 - 1555-824x Arora, Navneet Patel, Killol Engell, Christian A LaRosa, Jennifer A Journal Article United States Am J Med Qual. 2014 Jul-Aug;29(4):329-34. doi: 10.1177/1062860613500519. Epub 2013 Sep 4. PY - 2014 SN - 1062-8606 SP - 329-34 ST - The Effect of Interdisciplinary Team Rounds on Urinary Catheter and Central Venous Catheter Days and Rates of Infection T2 - Am J Med Qual TI - The Effect of Interdisciplinary Team Rounds on Urinary Catheter and Central Venous Catheter Days and Rates of Infection VL - 29 ID - 760301 ER - TY - JOUR AB - Introduction: Pregnant women with sickle cell disease (SCD) are at increased risk for both pregnancy and SCD related morbidity and mortality. At the Korle-Bu Teaching Hospital (KBTH), a national referral center in Accra, Ghana, the estimated maternal mortality ratio of women with and without SCD is 8,300 and 690 per 100,000 live births respectively (US, general population, maternal mortality ratio 14 per 100, 000 live births). In 2015, a multi-disciplinary obstetric SCD team was formed comprising obstetricians, hematologists, pulmonologists and nurses. In a before and after study design, we tested the hypothesis that implementing a multi-disciplinary team for care of pregnant women with SCD would significantly decrease maternal mortality. Methodology: The study received ethical approval from the Ethical and Protocol Review Committee, College of Health Sciences, University of Ghana Institutional Review Board and Vanderbilt University Medical Center (Data Coordinating Center (DCC). The pre-intervention period was from January 2014 to April 2015, and the post intervention period was May 2015 to May 2016. During the intervention period, members of the multi-disciplinary team evaluated participants at enrollment, during outpatient visits and during acute illnesses (inpatient and outpatient). Simple protocols were implemented for preventing and treating Acute Chest Syndrome (ACS). Balloons were purchased (substituted for incentive spirometry devices) and used routinely during management of acute pain episodes and after surgery. Multiple pulse oximetry machines were integrated into routine clinical practice for monitoring of oxygen desaturation. Close maternal and fetal monitoring were implemented. During the preintervention period, pregnant women were admitted to multiple wards throughout the hospital. Post-intervention, pregnant women were primarily admitted to two designated wards at the Obstetrics Department, for better coordinated care. All participants in the post-intervention period were followed from enrollment until six weeks postpartum. Members of the clinical research team and DCC adjudicated every vaso-occlusive pain episode, ACS episode, and acute event requiring hospitalization. Pain was defined as an acute episode, unrelated to labor and requiring hospitalization. ACS was defined based on the presence of at least 2 of the following criteria: fever, increased respiratory rate, chest pain, pulmonary auscultatory findings, increased O requirement or new radiodensity on chest roentgenogram. Results: A total of 154 and 91 deliveries by women with SCD were evaluated in the pre- and post-intervention period, respectively. The median age for cases in the pre-intervention period was 29 (range 18- 43) years. The median age for cases in post-intervention period was 29 (range 18-41) years and 35 participants had hemoglobin SSand 56had HbSC. Among the 91 participants, rates of pain and ACS were 194.6 (64/32.89) and 42.6 (14/32.89) events per 100 patient-years, respectively. Median gestational age at enrollment was 24 (range 7 - 40) weeks. Median gestational age at delivery was 38 (range 26 - 41) weeks. Perinatal mortality rates preand post-intervention were 74.3 per 1000 total births (11/ 148 X 1000) and 54.9 per 1000 total births (5/91 X 1000) respectively. Maternal mortality pre- and post-intervention were 9.7% (15 of 154) and 1.1% (1 of 91) of total deliveries respectively. The maternal mortality ratio pre- and post-intervention were 10,949 (15/137) and 1,163 (1/86) per 100,000 live births respectively. Cause of death pre-intervention period included: cardiopulmonary disease-60.0%, preeclampsia-6.67%, acute kidney injury-6.67%, severe anemia-20.0%, hypovolemic shock- 6.67%. During the post-intervention period, the only death was an autopsy confirmed massive pulmonary embolism four days postpartum. Conclusion: In a low and middle income setting, a multidisciplinary team approach to care of pregnant women with SCD can dramatically decrease maternal mortality, as well as perinatal mortality. Further strategies must be e ployed to decrease the SCD related maternal mortality and perinatal mortality rates to levels expected in the non-SCD population and to implement multi-disciplinary SCD obstetric teams in other regions. AD - E.V.N.K. Asare AU - Asare, E. V. N. K. AU - Adomakoh, Y. AU - Olayemi, E. AU - Mensah, E. AU - Ghansah, H. AU - Osei-Bonsu, Y. AU - Crabbe, S. AU - Musah, L. AU - Hayfron-Benjamin, C. AU - Boafor, T. AU - Covert, B. AU - Kassim, A. A. AU - James, A. H. AU - DeBaun, M. AU - Oppong, S. A. DB - Embase KW - endogenous compound hemoglobin acute chest syndrome acute kidney failure adult autopsy balloon breathing rate cause of death clinical practice clinical research clinical trial college controlled study cor pulmonale female fetus monitoring fever gestational age Ghana health science hospital patient hospitalization human hypovolemic shock institutional review live birth lung embolism machine major clinical study maternal mortality middle income group obstetric delivery obstetrics outpatient oxygen desaturation perinatal mortality postmarketing surveillance preeclampsia pregnant woman pulse oximetry sickle cell anemia spirometry study design surgery thorax pain thorax radiography university hospital young adult LA - English M1 - 22 M3 - Conference Abstract N1 - L614225407 2017-02-01 PY - 2016 SN - 1528-0020 ST - Prospective implementation of multi-disciplinary obstetric team decreases the mortality rate of pregnant women with sickle cell disease in Ghana T2 - Blood TI - Prospective implementation of multi-disciplinary obstetric team decreases the mortality rate of pregnant women with sickle cell disease in Ghana UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614225407&from=export VL - 128 ID - 760977 ER - TY - JOUR AB - AIM: The aim of this paper to summarize the clinical characteristics of unfavorable results occurred following an unsuitable surgical, endovascular or dermal treatment for vascular anomalies. METHODS: Seventeen patients with vascular anomalies who had unintentional results following an intervention that was not consistent with the one suggested by a local academic multidisciplinary team were enrolled. The medical records of all patients were retrospectively examined. RESULTS: Venous malformation was the most frequent lesion in the patients (41.2%). More than half of the patients (52.9%) had an inadequate treatment as a concomitant of lack of a correct diagnosis. The most frequently occurred unfavorable result was the progression of the disease, the recurrence of the lesions, and clinical deterioration (64.7%). CONCLUSION: The physicians who participating in the management of vascular anomalies should have a higher order of qualification than an average degree. Also, a multidisciplinary approach for the management of these anomalies is recommended. AD - Department of Cardiovascular Surgery, Canakkale Onsekiz Mart University Medicine Faculty, Canakkale, Turkey - hfasgun@yahoo.com. AN - 24452089 AU - Asgun, H. F. AU - Akcali, Y. DA - Feb DP - NLM ET - 2014/01/24 J2 - International angiology : a journal of the International Union of Angiology KW - Adolescent Adult Child Child, Preschool Cicatrix/etiology Clinical Competence Diagnostic Errors Disease Progression Endovascular Procedures/*adverse effects Female Humans Male Pain, Postoperative/etiology Patient Care Team Predictive Value of Tests Recurrence Retrospective Studies Risk Factors Sclerotherapy/*adverse effects Treatment Outcome Vascular Malformations/diagnosis/surgery/*therapy Vascular Surgical Procedures/*adverse effects Young Adult LA - eng M1 - 1 N1 - 1827-1839 Asgun, H F Akcali, Y Journal Article Italy Int Angiol. 2014 Feb;33(1):70-7. PY - 2014 SN - 0392-9590 SP - 70-7 ST - Unfavorable results following surgical, endovascular and dermal treatments of vascular anomalies T2 - Int Angiol TI - Unfavorable results following surgical, endovascular and dermal treatments of vascular anomalies VL - 33 ID - 760351 ER - TY - JOUR AB - Introduction: A care bundle is a group of interventions that, when implemented together, are more effective and improve outcomes compared to individual interventions. The key components of the ventilator care bundle (VCB) are elevation of the head of the bed by 30 degrees, peptic ulcer prophylaxis, deep vein thrombosis prophylaxis and daily sedation interruption. It has been shown that the introduction of a clinical information system (CIS) alters multidisciplinary team dynamics. Our aim was to evaluate the effect of the introduction of a CIS on compliance with care bundles. Method. We carried out a longitudinal observational study in a 25 bed cardiothoracic ICU to audit compliance with VCB and to study the effect of introducing a CIS and electronic prompts. The study consisted of 5 phases of data collection: prior to introduction of a CIS, immediately post introduction of a CIS, 6 months post-CIS, 1 year-CIS and post introduction of electronic prompts. Results. Table presented. Discussion. This study shows that the introduction of a CIS improved compliance with the ventilator care bundle by 6%. It is noteworthy that 100% compliance was only achieved in the single element actionable at the bedside by the nurse to whom the electronic prompts were addressed. Compliance with all elements of the care bundle is dependent on medical prescriptions and the decrease observed immediately post CIS might be explained by unfamiliarity with prescribing. Further observations are needed to understand how to maximize the benefits of such systems. AD - A. Ashworth, Papworth Hospital, Cambridge, United Kingdom AU - Ashworth, A. AU - Armstrong, J. AU - Webb, S. AU - Vuylsteke, A. DB - Embase DO - 10.1053/j.jvca.2010.04.015 KW - ventilator intensive care unit medical information system dynamics clinical audit information processing nurse observational study prophylaxis prescription deep vein thrombosis thrombosis prevention sedation peptic ulcer LA - English M1 - 3 M3 - Conference Abstract N1 - L70157201 2010-06-03 PY - 2010 SN - 1053-0770 SP - S44 ST - A survey of compliance with a ventilator care bundle following the introduction of a clinical information system in a cardiac intensive care unit T2 - Journal of Cardiothoracic and Vascular Anesthesia TI - A survey of compliance with a ventilator care bundle following the introduction of a clinical information system in a cardiac intensive care unit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70157201&from=export http://dx.doi.org/10.1053/j.jvca.2010.04.015 VL - 24 ID - 761250 ER - TY - JOUR AB - Background: Several studies have demonstrated the beneficial effect of exercise; even in human that in horse, but exercise could also represent a physical stress that challenging body homeostasis. Exercise stress pushes the body to find a dynamic equilibrium through adaptive changes to ensure proper management of stress caused by maximal exercise. These changes affect various composition of body fluids, in particular changes in blood composition including an increase in Red Blood Cells (RBC), Hematocrit (Hct) and Hemoglobin (Hgb) values and a change in Platelets (Plt) count. The objective of the present study was to evaluate the effect of repeated jumping exercise on haematological parameters in horse. Material, Methods & Results: For this purpose we evaluated the modifications occurring in cell blood count (CBC) in horses during two international three stars *** show jumping competition performed in two consecutive weekend. After routine clinical examination, twelve well trained Italian Saddle horses were enrolled for this study. For every subject, Red blood cell (RBC), haematocrit (HCT), haemoglobin (HGB) and platelets (PLT) were assessed. Blood samples were collected: in the morning after the meal (7: 30-8: 00 AM), before the beginning of the competition (R-1) and within 10 min after competition ending (C1S1, C1S2) and on the day after competition (R-2). The same procedure was followed on the second weekend (C2S1, C2S2, R-3). Whole blood samples were placed on ice pending analysis that were performed within 2 h after collection and immediately taken to the laboratory for analysis. The obtained data were analyzed with Stats package of R: R Core Team (2013). One-way repeated measures analysis of variance (ANOVA) showed a significant effect on sampling time (P < 0.05) concerning every studied parameter. In particular a significant increase of RBC in C1S1, C1S2, C2S1 and C2S2 versus R-1, R-2 and R-3. Same results were found for Hgb and Hct that have showed a significant increase in C1S1, C1S2, C2S1 and C2S2 versus R-1, R-2 and R-3. A significant increment in Plt was found in R-3 and R-2 versus R-1 and in R-3 versus C1S1 and C1S2. Discussion: In this study it was possible to observe an increasing of RBC, Hgb and Hct levels immediately after the exercise and returning to basal levels during resting time. Instead Plt values increase during resting time and the proximity of the competition induce a thrombocytosis during the second weekend. These increases may be related to the mechanisms of physiological adaptation required in course of exercise, increased oxygen demand by the muscles, release of circulating catecholamine resulting in spleen contraction, and to negative effect of the exercise like fluid loss resulting in dehydration. The return to normal levels during the resting time and the similar trend during the second weekend denotes as a horse, that has been well trained, is able to counterbalance the stress of two sessions of competition so close together. The trend of Plt denotes an increase during the resting time. This demonstrates the slowness in the reuptake of these, so during haematological evaluation in athlete particular attention must be put to Plt evaluation, because exercise stress induces not only the increase of their number, but also the increase of their reactivity and of their capacity to form aggregates, that can be implicated in thrombosis and some other cardiovascular diseases. AD - [Assenza, Anna; Congiu, Fulvio; Giannetto, Claudia; Fazio, Francesco; Piccione, Giuseppe] Univ Messina, Dept Vet Sci, I-98168 Messina, Italy. Piccione, G (corresponding author), Univ Messina, Dept Vet Sci, Polo Univ Annunziata, I-98168 Messina, Italy. giuseppe.piccione@unime.it AN - WOS:000365410000001 AU - Assenza, A. AU - Congiu, F. AU - Giannetto, C. AU - Fazio, F. AU - Piccione, G. C7 - 1305 DA - Sep J2 - Acta Sci. Vet. KW - haematological parameters horse show jumping competition physical exercise PHYSICAL-EXERCISE BLOOD PARAMETERS Veterinary Sciences LA - English M3 - Article N1 - ISI Document Delivery No.: CX0TO Times Cited: 4 Cited Reference Count: 30 Assenza, Anna Congiu, Fulvio Giannetto, Claudia Fazio, Francesco Piccione, Giuseppe Giannetto, Claudia/AAZ-6688-2020; Claudia, Giannetto/AAB-9730-2019; Francesco, Fazio/Q-1598-2019 Francesco, Fazio/0000-0003-3198-2580; Giannetto, Claudia/0000-0003-3049-1181 4 1 14 UNIV FED RIO GRANDE DO SUL PORTO ALEGRE RS ACTA SCI VET PY - 2015 SN - 1678-0345 SP - 6 ST - Haematological Response Associated with Repeted Show Jumping Competition in Horse T2 - Acta Scientiae Veterinariae TI - Haematological Response Associated with Repeted Show Jumping Competition in Horse UR - ://WOS:000365410000001 VL - 43 ID - 761742 ER - TY - JOUR AB - INTRODUCTION.Ischemic Stroke is the leading cause of death amongst Portuguese Population.The existent pre Hospital triage and quick reference to a Stroke Unit, allied to the early recognition of acute neurological signs has contributed to the increasing numbers of effective fibrinolysis in Acute Ischemic Stroke Patients, decreasing morbidity and mortality.However, there are no studies evaluating late outcomes of this population after treatment.OBJECTIVES.The objective of the study is to evaluate mortality and its cause of patients at 3 months, 6 months and 12 months after treatment with Intravenous Fibrinolysis with Alteplase at the researchers' Intensive Care Unit and characterize this population.METHODS.Observational retrospective study based on information retrieved from the Clinical Records of patients admitted in the Intensive Care Unit for Intravenous Fibrinolysis between the 1st of January 2010 and 31st of December 2015, and its statistical analysis.RESULTS.Among the total of patients included (n = 102), 63% were male with an average of 70 years old.The average admission National Institutes of Health Stroke Scale (NIHSS) score was 14 and the average Symptoms-to-Needle time was 156 minutes.There were a total of 23 deaths occurring in the first 3 months after treatment.Of these, 4 were due to Intraparenchymal Hemorrhage after Fibrinolysis, 7 to ineffectiveness of Thrombolythic treatment, 10 to Aspiration Pneumonia, 1 to Septic Shock, and 1 patient died at home, with no reference to cause of death on Clinical Records.Between 3 months and 6 months occured two deaths, caused by Septic Shock in patients with established Limitation of Treatment.Between 6 and 12 months there were no registered deaths.CONCLUSIONS.With the State of The Art Organization and Protocols, Mortality due to to Ischemic Stroke has reduced.The vast majority of deaths occurred in the first 3 months after treatment.Patients who died within 3 months had an average NIHSS stroke of 20 at 12 hours after Fibrinolysis, similar to those who died between 3 and 6 months.Patients who survived the first 12 months, had a lower NIHSS score at 12 hours (7).Although Intraparenchymal Hemorrhage and unresponsiveness to treatment are unavoidable, causes such as Aspiration Pneumonia, which occurred after hospital discharge must be avoided.The focus must shift to the optimization of post-Hospital care in order to help patients recover after stroke and minimize complications which may worsen their condition and lead to death, especially in the first trimester.This would preferably be done by multidisciplinary teams involving Neurology, Internal Medicine and Physiotherapy support and adequate infrastructures and response time. AD - R. Assis, Centro Hospitalar Do Médio Tejo, Intensive Care Unit, Abrantes, Portugal AU - Assis, R. AU - Araújo, A. AU - Lopes, N. AU - Pessoa, L. AU - Pereira, T. AU - Catorze, N. DB - Embase DO - 10.1186/s40635-017-0151-4 KW - alteplase aged aspiration pneumonia bleeding brain ischemia cause of death clinical trial complication drug therapy emergency health service female fibrinolysis first trimester pregnancy hospital care hospital discharge human information processing internal medicine major clinical study male morbidity National Institutes of Health Stroke Scale neurology physiotherapy Portuguese (citizen) reaction time retrospective study scientist septic shock statistical analysis stroke patient stroke unit LA - English M1 - 2 M3 - Conference Abstract N1 - L619044154 2017-11-07 PY - 2017 SN - 2197-425X ST - One year mortality after intravenous fibrinolysis for acute ischemic stroke T2 - Intensive Care Medicine Experimental TI - One year mortality after intravenous fibrinolysis for acute ischemic stroke UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619044154&from=export http://dx.doi.org/10.1186/s40635-017-0151-4 VL - 5 ID - 760913 ER - TY - JOUR AB - Introduction Ischemic Stroke still constitutes the major cause of death in Portugal. With the widespread investment in information to the population and creation of a net of reference hospitals with established protocols of Intravenous Fibrinolysis and endovascular treatment, mortality and morbidity have declined. Objectives The objective of this study is characterize the population undergoing Intravenous Fibrinolysis with alteplase at the Intensive Care Unit of the researchers' hospital, verify the early (48 hours) and 60-days mortality after admission,and identify the causes of death. Methods Observational retrospective study based on information acquired from the clinical records of patients admitted in the Intensive Care Unit for Intravenous Thrombolysis between the 1st of January 2010 and 31st December 2015, and its statistical analysis. Results Among the total of patients included (n = 102), 63 % were male with an average of 70 years old.The average admission National Institutes of Health Stroke Scale (NIHSS) score was 14 and the average Symptoms-to-Needle time was 156 minutes. There was a total of 4 deaths in the first 48 h after admission and 19 deaths between 48 hours and 60 days post admission. Of the early deaths, 2 were due to intracerebral hemorrhage and the other 2 accounted for progression of ischemic disease, unresponsive to thrombolysis. The highest cause of death at 60 days was Aspiration Pneumonia (10), followed by progression of ischemic disease (5), Intracerebral Hemorrhage (2), Septic Shock (1) and 1 prehospital death, with no reference to cause of death on clinical records. The average NIHSS score at twelve hours of patients who died between 48 hours and 60 days was 20. Conclusions With the application of adequate guidelines and evaluation of the patients proposed to Fibrinolysis, early deaths accounted for 17 % of total deaths and were attributed to non effectiveness of fibrinolytic therapy or its hemorrhagic complications. Deaths occurring at 60 days post admission occurred in patients with higher NIHSS scores, revealing important neurological dysfunction. The most frequent cause of death was Aspiration Pneumonia. Being so, it is important to apply prevention measures to patients during ICU and hospital stay, in order to reduce Aspiration Pneumonia's incidence and allow the patient to start physiotherapy as soon as possible to regain lost functionality. Patients suffering stroke should be evaluated by a multidisciplinary team involving Neurology, Internal Medicine and Physiotherapy at regular periods to adequately assist them to resume their lives. AD - R. Assis, Centro Hospitalar Do Médio Tejo, Unidade de Cuidados Intensivos Polivalente, Abrantes, Portugal AU - Assis, R. AU - Filipe, F. AU - Lopes, N. AU - Pessoa, L. AU - Pereira, T. AU - Catorze, N. DB - Embase DO - 10.1186/s40635-016-0098-x KW - alteplase aged aspiration pneumonia brain hemorrhage brain ischemia cause of death complication consensus development disease course drug therapy female fibrinolysis fibrinolytic therapy hospitalization human information processing intensive care unit internal medicine major clinical study male National Institutes of Health Stroke Scale neurologic disease neurology physiotherapy prevention retrospective study scientist septic shock statistical analysis LA - English M3 - Conference Abstract N1 - L617955445 2017-08-29 PY - 2016 SN - 2197-425X ST - Early and 60-days mortality and its causes in patients undergoing intravenous thrombolysis for ischemic stroke T2 - Intensive Care Medicine Experimental TI - Early and 60-days mortality and its causes in patients undergoing intravenous thrombolysis for ischemic stroke UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617955445&from=export http://dx.doi.org/10.1186/s40635-016-0098-x VL - 4 ID - 761007 ER - TY - JOUR AB - Background: Placenta percreta is associated with high hemorrhagic risk and can be complicated with fatal thromboembolic events. Involving a multidisciplinary team in the treatment of these patients is mandatory to reduce morbidity and mortality. Case presentation: This paper reports the case of a 22-year-old patient with placenta percreta who was referred to our tertiary care center for delivery. Few hours after undergoing a successful cesarean hysterectomy, the patient developed a pulmonary embolism and cardiac arrest. A transthoracic echocardiogram done in the intensive care unit (ICU) showed a thrombus in the right ventricle. After cardiac resuscitation, the patient underwent an urgent thoracotomy and a pulmonary artery thrombectomy; many clots were retrieved from the pulmonary artery. After weaning from extracorporeal circulation, an intraoperative transesophageal cardiac ultrasound enabled the medical team to detect a new free-floating thrombus in the right atrium and right ventricle, and consequently to perform an embolectomy and prevent the patient's death. Conclusion: This case emphasizes the role of multidisciplinary team in treating high-risk obstetric cases that could be complicated with massive and fatal thromboembolic events. The use of intraoperative transthoracic echocardiography helps in detecting a new thrombus and guides the anesthesiologist in the intra-operative monitoring. AD - D. Atallah, Saint Joseph University, Beirut, Lebanon AU - Atallah, D. AU - Abou Zeid, H. AU - Moubarak, M. AU - Moussa, M. AU - Nassif, N. AU - Jebara, V. DB - Embase Medline DO - 10.1186/s12884-020-2817-2 KW - acenocoumarol antibiotic agent heparin oral contraceptive agent steroid uterus spasmolytic agent abdominal distension adult arterial gas article bed rest cardiopulmonary arrest case report cesarean section clinical article cyanosis disease course drug withdrawal electrocardiography embolectomy extracorporeal circulation female follow up heart arrest heart right ventricle heart ventricle tachycardia heart ventricle thrombosis hemoperitoneum hospital admission hospital discharge human human tissue hypocapnia hypoxia hysterectomy intensive care unit intracardiac echocardiography laparotomy lung embolism patient referral peroperative echography placenta accreta placenta previa premature labor pulmonary artery resuscitation spotting tachycardia tertiary care center thoracotomy thrombectomy transthoracic echocardiography vagina bleeding vein catheterization young adult LA - English M1 - 1 M3 - Article N1 - L631083169 2020-03-11 2020-03-16 PY - 2020 SN - 1471-2393 ST - "you only live twice": Multidisciplinary management of catastrophic case in placenta Accreta Spectrum-a case report T2 - BMC Pregnancy and Childbirth TI - "you only live twice": Multidisciplinary management of catastrophic case in placenta Accreta Spectrum-a case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631083169&from=export http://dx.doi.org/10.1186/s12884-020-2817-2 VL - 20 ID - 760601 ER - TY - JOUR AB - BACKGROUND: With changing treatment modalities in vascular surgery towards incorporating more endovascular solutions, increased numbers of hybrid operating theatres are being introduced to meet the sterility and imaging quality requirements. These cost-intensive acquisitions however have never been evaluated from an economic perspective. In this study we evaluated cost-relevant parameters before and after the introduction of a hybrid operating room using the example of endovascular aneurysm repair (EVAR) performed in patients with abdominal aortic aneurysms (AAA). METHODS: Retrospective analysis of prospectively collected data. The 4‑year period before the introduction of a hybrid operating room were compared with the 4‑year period following introduction. Between 2007 and 2010, 97 EVAR procedures were performed before the implementation of a hybrid operating room and 50 EVAR procedures were performed with a hybrid operating room (2012-2015). We evaluated process cost-relevant parameters (operating time) and diagnosis-related group (DRG) parameters (case load, case mix, case mix index). RESULTS: The operating time was significantly reduced on average by 23.5 min (120 min [102-140] vs. 96.5 min [90-120]; p < 0.0001) with a hybrid operating room. This led to a reduction in costs of 276.17 EUR for an EVAR procedure. The case load of EVAR increased from 308 cases from 2007-2010 to 380 cases from 2012-2015 . The associated case mix also increased from 1580 to 1986 points. The total number of case mix points of all managed operative interventions in the operating theatre before and after conversion to a hybrid operating room grew significantly by 17.33% from 8420 to 9880 (p < 0.03) in the compared time periods. CONCLUSION: With detailed, demand-oriented planning, a hybrid operating room can have a favourable economic effect due to a reduction of operating time and the overall lowering of process costs. Thus a refinancing in the long-term is feasible. In addition, this can lead to an increase in the total number and complexity of endovascular procedures. AD - Abteilung für Gefäßchirurgie, Department Operative Disziplinen (DOD), Stadtspital Triemli, Zürich, Schweiz. Klink für Endovaskuläre und Gefäßchirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Deutschland. Klink für Gefäßchirurgie, Klinikum Augsburg, Augsburg, Deutschland. Lehrstuhl für Gesundheitsmanagement, Universität Erlangen-Nürnberg, Nürnberg, Deutschland. Finanzcontrolling, Universitätsklinikum Heidelberg, Heidelberg, Deutschland. Klink für Endovaskuläre und Gefäßchirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Deutschland. dittmar.boeckler@med.uni-heidelberg.de. AN - 28466153 AU - Attigah, N. AU - Demirel, S. AU - Hakimi, M. AU - Bruijnen, H. AU - Schöffski, O. AU - Müller, A. AU - Geis, U. AU - Böckler, D. DA - Jul DO - 10.1007/s00104-017-0431-2 DP - NLM ET - 2017/05/04 J2 - Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen KW - Aged Aortic Aneurysm, Abdominal/*economics/*surgery Blood Vessel Prosthesis Implantation/economics/instrumentation Cost Savings *Costs and Cost Analysis Endovascular Procedures/*economics/instrumentation Female Germany Humans Male Operating Rooms/*economics/organization & administration Operative Time Patient Care Team/economics Prospective Studies Radiography, Interventional/*economics/instrumentation Retrospective Studies Surgical Equipment/*economics Aortic aneurysm Diagnosis-related groups (DRG) Evar Process costs LA - ger M1 - 7 N1 - 1433-0385 Attigah, N Demirel, S Hakimi, M Bruijnen, H Schöffski, O Müller, A Geis, U Böckler, D Journal Article Germany Chirurg. 2017 Jul;88(7):587-594. doi: 10.1007/s00104-017-0431-2. OP - Hybridoperationssaal vs. konventioneller Operationssaal : Betriebswirtschaftliche Gegenüberstellung in der Gefäßchirurgie am Beispiel der endovaskulären Aneurysmachirurgie. PY - 2017 SN - 0009-4722 SP - 587-594 ST - [Hybrid operating rooms versus conventional operating rooms : Economic comparisons in vascular surgery using the example of endovascular aneurysm repair] T2 - Chirurg TI - [Hybrid operating rooms versus conventional operating rooms : Economic comparisons in vascular surgery using the example of endovascular aneurysm repair] VL - 88 ID - 760355 ER - TY - JOUR AB - Background: Core measures are publicly reported measures that gauge the quality of the process of patient care reflecting compliance to standards of care. This organization has employed many real-time electronic record enabled tools and clinical decision support to optimize the process of care for every patient every time. After discharge, a random sample of patients are abstracted for required core measures. When a failure is identified, communication and subsequent improvement activities take place. Purpose: Following any core measures failure, hardwire a process of accountability for performance improvement and sustainment of successful process change. Description: A multilayer approach was designed and hard-wired to drive excellence in core measures.-Engagement of a multidisciplinary team including physicians, nursing, business intelligence, and quality to drive change was a critical first step.-Goal identification: drive excellence in outcomes, safety, and experience for all patients.-Development of failure review process: abstractor review, secondary review by quality director, consultation with appropriate physician or nursing personnel as required, and ultimately final decision re: concur or further follow up needed.-Development of performance improvement process: the gaps in performance are trended and from this analysis priorities for improvements are set. Examples of successful enhancements include: short-cycle measures for smoking cessation, vaccinations, education, VTE assessments, normothermia, and beta blockers to provide a worklist at a unit level. Additionally, decision support in EHR is used to create prompts and stops to encourage compliance to selected measures. The teams have oversight from the Quality and Patient Safety Institute, and forums exist where their challenges and improvements are communicated to disseminate best practices across the organization. A continuous educational process is in place to ensure hardwiring of best practices. Specific cases are frequently shared as teaching opportunities. Finally, core measures performance is transparent across the organization from frontline to executive leadership. Performance is measured, improvements implemented and results are recognized. In the last 6 months core measures appropriateness of care at the main campus improved from 94% to 98%. Conclusions: In a new era of transparency and accountability, ownership of performance improvement is crucial. Hardwiring of best practices for improvement is fundamental to decrease variability in practice. Elements of this hardwiring include: (1) establishing meaningful, patientcentered objectives, (2) developing reliable processes to measure progress against the objectives, (3) driving improvement, (4) recognizing results, including communicating progress, sharing best practices, and leadership engagement. AD - M. Auron, Cleveland Clinic, Cleveland, OH, United States AU - Auron, M. AU - LaRochelle, D. AU - Bergomi, G. AU - Vitagliano, S. AU - Warmuth, A. AU - Phillips, S. AU - Henderson, J. M. DB - Embase DO - 10.1002/jhm.1927 KW - beta adrenergic receptor blocking agent organization and management hospital society human patient decision support system leadership physician teaching manager patient care random sample interpersonal communication nursing commercial phenomena intelligence consultation nursing staff follow up smoking cessation vaccination education body temperature patient safety safety LA - English M3 - Conference Abstract N1 - L70698201 2012-03-26 PY - 2012 SN - 1553-5592 SP - S130 ST - Hardwiring a core measures review process: Ownership of improvement in a large tertiary medical center T2 - Journal of Hospital Medicine TI - Hardwiring a core measures review process: Ownership of improvement in a large tertiary medical center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70698201&from=export http://dx.doi.org/10.1002/jhm.1927 VL - 7 ID - 761213 ER - TY - JOUR AB - Objective: Inferior vena cava (IVC) filter retrieval rates remain low. Previous literature identified provider and system factors to enhance retrieval, but patients' perspectives have not been studied. This study compared the attitudes of men and women with retained filters to identify patient factors that would increase compliance and facilitate retrieval when indicated. Methods: A retrospective single-center review of all patients undergoing IVC filter placement between 2009 and 2011 was performed. The electronic medical records were reviewed to identify patients with retained filters who were potential candidates for removal. Patients' demographics, comorbidities, and indication for filter placement were noted. A telephone survey inquiring about the patient's awareness of IVC filters and risks of leaving them permanently in place was conducted. Additional questions addressed patient-physician relations, preferences in communication, and attitudes toward television commercials on IVC filter lawsuits. Patients' characteristics and survey responses were compared between men and women. Results: There were 604 patients who underwent IVC filter placement. The overall retrieval rate was 30%. Telephone survey was conducted for 42 patients with retained filters who were identified as possible candidates for retrieval. There was no difference between the men and women in terms of demographics and comorbidities. The survey demonstrated that 12% of patients were not aware of having an IVC filter, and only 23% knew that it can be removed. Women were significantly more likely than men to know the risks and benefits of IVC filter placement (42.8% vs 14.2%; P <. 03), but there was no significant difference in knowledge of the long-term complications of indwelling filters. Even though the majority of patients (88%) had an established relation with a primary care provider, only 21.4% followed up with the team of physicians of the hospitalization for IVC filter placement. Better education about IVC filters would have improved follow-up in the opinion of 97.6% of patients. Also, 50% relocated since filter placement and 35.7% changed their telephone number. There was no difference regarding use of Internet and interest in receiving educational material, but women (42.8%) significantly preferred receiving health-related communication by electronic mail, whereas men (64%) preferred telephone calls (P = .03). The majority of patients (59.5%) had watched commercials for IVC filter lawsuits, among whom 26% claimed to seek discussion with a medical provider after watching the commercial. The predominant cause for no follow-up was "unaware of risks of leaving the filter" (69%). Conclusions: In this era of modern medicine, vascular specialists must educate the patient and family about IVC filters and long-term effects to optimize the patient's compliance. Electronic communication for follow-up may help capture patients who relocate and change phone numbers and seems to be particularly attractive to women. AD - [Aurshina, Afsha; Brahmandam, Anand; Zhang, Yawei; Yang, Yongli; Chaar, Cassius Iyad Ochoa] Yale Univ, Sch Med, Dept Surg, Div Vasc Surg, New Haven, CT 06520 USA. [Mojibian, Hamid] Yale Univ, Dept Radiol, Div Intervent Radiol, Sch Med, New Haven, CT 06520 USA. [Sarac, Timur] Ohio State Univ, Dept Surg, Div Vasc Surg, Wexner Med Ctr, Columbus, OH 43210 USA. Chaar, CIO (corresponding author), Yale Univ, Sch Med, 333 Cedar St,Boardman 204, New Haven, CT 06520 USA. cassius.chaar@yale.edu AN - WOS:000491546100009 AU - Aurshina, A. AU - Brahmandam, A. AU - Zhang, Y. W. AU - Yang, Y. L. AU - Mojibian, H. AU - Sarac, T. AU - Chaar, C. I. O. DA - Jul DO - 10.1016/j.jvsv.2018.11.011 J2 - J. Vasc. Surg.-Venous Lymphat. Dis. KW - IVC filter IVC filter retrieval AMERICAN-COLLEGE TRAUMA PATIENTS 1602 EPISODES IVC FILTERS RATES REMOVAL PLACEMENT THROMBOEMBOLISM THROMBOSIS SYSTEM Surgery Peripheral Vascular Disease LA - English M1 - 4 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: JF7DI Times Cited: 1 Cited Reference Count: 37 Aurshina, Afsha Brahmandam, Anand Zhang, Yawei Yang, Yongli Mojibian, Hamid Sarac, Timur Chaar, Cassius Iyad Ochoa 30th Annual Meeting of the American-Venous-Forum FEB 20-23, 2018 Tucson, AZ Amer Venous Forum 1 0 ELSEVIER AMSTERDAM J VASC SURG-VENOUS L PY - 2019 SN - 2213-333X SP - 507-513 ST - Patient perspectives on inferior vena cava filter retrieval T2 - Journal of Vascular Surgery-Venous and Lymphatic Disorders TI - Patient perspectives on inferior vena cava filter retrieval UR - ://WOS:000491546100009 VL - 7 ID - 761512 ER - TY - JOUR AB - BACKGROUND In Afghanistan, care of the acutely injured trauma patient commonly occurred in facilities with limited blood banking capabilities. Apheresis platelets were often not available. Component therapy consisted of 1:1 packed red blood cells and fresh frozen plasma. Fresh, whole blood transfusion often augmented therapy in the severely injured patient. This study analyzed the safety of fresh, whole blood use in a resource-limited setting. METHODS A retrospective analysis was performed on a prospectively collected data set of US battle injuries presenting to three US Marine Corps (USMC) expeditionary surgical care facilities in Helmand Province, Afghanistan, between January 2010 and July 2012. Included in the review were patients with Injury Severity Scores (ISSs) of 15 or higher receiving blood transfusions. Univariate analyses were performed, followed by multivariable logistic regression to describe the relationship between the treatment group and posttreatment complications such as trauma-induced coagulopathy, infection, mortality, venous thromboembolism, and transfusion reaction. Propensity scores were calculated and included in multivariable models to adjust for potential bias in treatment selection. RESULTS A total of 61 patients were identified; all were male marines with a mean (SD) age of 23.5 (3.6) years. The group receiving fresh, whole blood was noted to have higher ISSs and lower blood pressure, pH, and base deficits on arrival. Traumatic coagulopathy was significantly less common in the group receiving fresh, whole blood (odds ratio, 0.01; 95% confidence interval, 0.00-0.18). Multivariable models found no other significant differences between the treatment groups. CONCLUSION The early use of fresh, whole blood in a resource-limited setting seems to confer a benefit in reducing traumatic coagulopathy. This study's small sample size precludes further statement on the overall safety of fresh, whole blood use. LEVEL OF EVIDENCE Therapy study, level IV. AD - [Auten, Jonathan D.; Lunceford, Nicole L.; Galindo, Roger M.; Dewing, Chris B.] Naval Med Ctr San Diego, San Diego, CA USA. [Horton, Jaime L.; Galarneau, Mike R.; Zieber, Tara J.] Naval Hlth Res Ctr, San Diego, CA USA. [Shepps, Craig D.] Naval Med Ctr Portsmouth, Portsmouth, Hants, England. Auten, JD (corresponding author), Naval Med Ctr, San Diego, CA 92134 USA. jdauten@gmail.com AN - WOS:000364201100013 AU - Auten, J. D. AU - Lunceford, N. L. AU - Horton, J. L. AU - Galarneau, M. R. AU - Galindo, R. M. AU - Shepps, C. D. AU - Zieber, T. J. AU - Dewing, C. B. DA - Nov DO - 10.1097/ta.0000000000000842 J2 - J. Trauma Acute Care Surg. KW - Whole blood transfusion coagulopathy mortality apheresis platelets IMPROVED SURVIVAL TRAUMA MILITARY COAGULOPATHY MEDICINE TEAMS Critical Care Medicine Surgery LA - English M1 - 5 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: CV3XX Times Cited: 17 Cited Reference Count: 34 Auten, Jonathan D. Lunceford, Nicole L. Horton, Jaime L. Galarneau, Mike R. Galindo, Roger M. Shepps, Craig D. Zieber, Tara J. Dewing, Chris B. Scientific Assembly of the American-College-of-Emergency-Physicians (ACEP) OCT 27-30, 2014 Chicago, IL Amer Coll Emergency Phys Auten, Jonathan/0000-0003-2708-899X 18 0 3 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J TRAUMA ACUTE CARE PY - 2015 SN - 2163-0755 SP - 790-796 ST - The safety of early fresh, whole blood transfusion among severely battle injured at US Marine Corps forward surgical care facilities in Afghanistan T2 - Journal of Trauma and Acute Care Surgery TI - The safety of early fresh, whole blood transfusion among severely battle injured at US Marine Corps forward surgical care facilities in Afghanistan UR - ://WOS:000364201100013 VL - 79 ID - 761738 ER - TY - JOUR AB - Objective: Submassive and massive pulmonary embolism (PE) is associated with high mortality, and effective treatment lies within a short window of time. In these instances, rapid diagnosis and treatment are vital for providing fast and efficacious care. We report a novel technique of intraoperative cone beam computed tomography pulmonary angiography (CBCT-PA) for diagnosis and treatment of PE in selected highly morbid cases. Methods: Between April 2015 and February 2016, patients who underwent intraoperative CBCT-PA were retrospectively reviewed. In our hybrid operating room equipped with a robotic angiography system (Artis zeego; Siemens Healthcare GmbH, Erlangen, Germany), CBCT-PA images were acquired using a 5-second CBCT protocol (syngo DynaCT; Siemens) after injection of 40 mL of 50% iodinated contrast material at 8 mL/s through a pigtail catheter in the main pulmonary artery. Results: Four patients underwent intraoperative CBCT-PA during the study period. Two of four patients (50%) were hemodynamically unstable in the intensive care unit and deemed unstable for transfer to computed tomography imaging in the radiology suite. These patients were taken directly to the operating room under high suspicion of massive PE and for possible intervention. In one patient, CBCT-PA revealed a large embolus in the left pulmonary artery (Fig 1), prompting an attempt at mechanical thrombectomy. In the other patient, CBCT demonstrated only a small subsegmental embolus in the right lower lobe pulmonary artery (Fig 2), which made PE the unlikely cause for acute decompensation. In the remaining two patients, CBCT imaging was performed for follow-up after placement of thrombolytic catheters the day before. CBCT demonstrated residual clot in subsegmental branches, and thrombolytic catheters were repositioned. Both patients did well after removal of thrombolytic catheters and prescription of systemic anticoagulation. Conclusions: CBCT-PA is an effective adjunct imaging tool for diagnosis of PE in the operating room, especially in hemodynamically unstable patients, for whom transfer to the radiology imaging suite is often unsafe, and during catheter-directed thrombolysis. Until conventional computed tomography imaging becomes routinely available in the operating room, such novel intraoperative imaging options can be a valuable addition to the PE response team algorithm to optimize care in patients with PE. AD - P. Auyang, Houston Methodist Hospital, Houston, TX, United States AU - Auyang, P. AU - Chinnadurai, P. AU - Lumsden, A. B. DB - Embase KW - contrast medium adult anticoagulation case report clinical article cone beam computed tomography scanner conference abstract diagnosis drainage catheter female follow up Germany human injection intensive care unit iodination lung angiography lung embolism male mechanical thrombectomy operating room prescription pulmonary artery radiology retrospective study LA - English M1 - 6 M3 - Conference Abstract N1 - L623020423 2018-07-18 PY - 2018 SN - 2213-3348 SP - e157-e158 ST - Intraoperative cone beam computed tomography pulmonary angiography: An effective adjunct imaging tool for rapid diagnosis and safe catheter-directed thrombolysis T2 - Journal of Vascular Surgery TI - Intraoperative cone beam computed tomography pulmonary angiography: An effective adjunct imaging tool for rapid diagnosis and safe catheter-directed thrombolysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L623020423&from=export VL - 67 ID - 760817 ER - TY - JOUR AB - Premature ejaculation (PE) is thought to be the most common male sexual dysfunction; however, the prevalence of lifelong (LL)-PE is relatively low. The aim of this study was to investigate the effects of on-demand vardenafil (10 mg) to modify the intravaginal ejaculatory latency time (IELT) in men with LL-PE without erectile dysfunction. Forty-two men (18-35 years) were enrolled in a 16-week, double-blind, placebo-controlled, cross-over study. Primary end point was the modification from baseline of IELT assessed by stopwatch technique; secondary end points were post-ejaculatory refractory time (PERT) and variations of scores at the Index of Premature Ejaculation questionnaire. The changes in geometric mean IELT were superior after taking vardenafil (0.6+/-0.3 vs 4.5+/-1.1 min, P<0.01), compared with placebo (0.7+/-0.3 vs 0.9+/-1.0 min, ns). PERT dropped significantly after vardenafil (16.7+/-2.0 vs 4.3+/-0.9 min, P<0.001), compared with placebo (15.3+/-2.2 vs 15.8+/-2.3 min). Patients who took vardenafil (vs placebo) reported significantly (P<0.01) increased ejaculatory control (6+/-2 vs 16+/-2), improved overall sexual satisfaction (7+/-2 vs 15+/-1) and distress (4+/-1 vs 8+/-1) scores, respectively. Multiple regression analysis (r(2)=0.86) for IELT by the number of attempts at sexual intercourse showed significant differences between the slopes of lines for placebo and vardenafil (P<0.0001). The most common adverse events for vardenafil (vs placebo) were headache (10 vs 3%), flushing (12 vs 0%) and dyspepsia (10 vs 0%), which tended to disappear over the time. In conclusion, in our study, vardenafil increased IELT and reduced PERT in men with LL-PE. Besides, improvements in confidence, perception of ejaculatory control and overall sexual satisfaction were reported. AD - Chair of Internal Medicine, DFM, Sapienza University of Rome, Italy. antonio.aversa@uniroma1.it AN - 19474796 AU - Aversa, A. AU - Pili, M. AU - Francomano, D. AU - Bruzziches, R. AU - Spera, E. AU - La Pera, G. AU - Spera, G. DA - Jul-Aug DO - 10.1038/ijir.2009.21 DP - NLM ET - 2009/05/29 J2 - International journal of impotence research KW - Adolescent Adult Coitus/physiology/psychology Cross-Over Studies Double-Blind Method Ejaculation/*drug effects Female Humans Imidazoles/administration & dosage/adverse effects/*therapeutic use Male Phosphodiesterase Inhibitors/adverse effects/*therapeutic use Piperazines/administration & dosage/adverse effects/*therapeutic use Prospective Studies Sexual Dysfunction, Physiological/*drug therapy/psychology Sulfones/administration & dosage/adverse effects/therapeutic use Surveys and Questionnaires Triazines/administration & dosage/adverse effects/therapeutic use Vardenafil Dihydrochloride Young Adult LA - eng M1 - 4 N1 - 1476-5489 Aversa, A Pili, M Francomano, D Bruzziches, R Spera, E La Pera, G Spera, G Journal Article Randomized Controlled Trial England Int J Impot Res. 2009 Jul-Aug;21(4):221-7. doi: 10.1038/ijir.2009.21. Epub 2009 May 28. PY - 2009 SN - 0955-9930 SP - 221-7 ST - Effects of vardenafil administration on intravaginal ejaculatory latency time in men with lifelong premature ejaculation T2 - Int J Impot Res TI - Effects of vardenafil administration on intravaginal ejaculatory latency time in men with lifelong premature ejaculation VL - 21 ID - 760494 ER - TY - JOUR AU - Aviram DA - 2016/01/01 01/01 DB - Institute of Scientific and Technical Information of China (English) M1 - 1 PY - 2016 ST - Nomogram for Predicting Pulmonary Hypertension in Patients without Pulmonary Embolism Response T2 - Radiology TI - Nomogram for Predicting Pulmonary Hypertension in Patients without Pulmonary Embolism Response UR - https://netl.istic.ac.cn/site/link?cdoi=a025f0a0a3dee2292ac40662b23dbe89&mid=466496091303411EB27FB4298C9BA46C VL - 280 ID - 762126 ER - TY - GEN AB -: The impact of the Pulmonary Embolism Response Team (PERT) model on trainee physician education and autonomy over the management of high risk pulmonary embolism (PE) is unknown. A resident and fellow questionnaire was administered 1 year after PERT implementation. A total of 122 physicians were surveyed, and 73 responded. Even after 12 months of interacting with the PERT consultative service, and having formal instruction in high risk PE management, 51% and 49% of respondents underestimated the true 3-month mortality for sub-massive and massive PE, respectively, and 44% were unaware of a common physical exam finding in patients with PE. Comparing before and after PERT implementation, physicians perceived enhanced confidence in identifying ( p<0.001), and managing ( p=0.003) sub-massive/massive PE, enhanced confidence in treating patients appropriately with systemic thrombolysis ( p=0.04), and increased knowledge of indications for systemic thrombolysis and surgical embolectomy ( p=0.043 and p<0.001, respectively). Respondents self-reported an increased fund of knowledge of high risk PE pathophysiology (77%), and the perception that a multi-disciplinary team improves the care of patients with high risk PE (89%). Seventy-one percent of respondents favored broad implementation of a PERT similar to an acute myocardial infarction team. Overall, trainee physicians at a large institution perceived an enhanced educational experience while managing PE following PERT implementation, believing the team concept is better for patient care. AU - Ayman, Elbadawi AU - Colin, Wright AU - Dhwani, Patel AU - Yu Lin, Chen AU - Justin, Mazzillo AU - Pamela, Cameron AU - Geoffrey, D. Barnes AU - Scott, J. Cameron DA - 2020/08/03 DB - OpenAIRE PY - 2020 ST - The impact of a multi-specialty team for high risk pulmonary embolism on resident and fellow education TI - The impact of a multi-specialty team for high risk pulmonary embolism on resident and fellow education UR - https://explore.openaire.eu/search/publication?articleId=dedup_wf_001::e989229a6f67a4daaea63f98c7f97a19 ID - 761995 ER - TY - JOUR AB - Background: Sub-massive PE (SPE) is associated with in-hospital mortality of 6-8%. Recent guidelines recommend treatment of SPE with systemic anticoagulation (class I) and fibrinolysis as a class IIb recommendation. However, data regarding the use of ultrasound-assisted catheter directed thrombolytic therapy is lacking. Methods: At our tertiary care center, we used a multidisciplinary team of physicians (interventional cardiologists, vascular surgeons, and pulmonologists) to assess patients with SPE and treated all patients with catheter-directed thrombolytic therapy (CDT) if there were no contraindications. We treated 7 consecutive patients with SPE from June 2011 and December 2011. Patients had an echocardiogram, right heart catheterization, pulmonary angiogram and EKOS catheters placed followed by continuous infusion of alteplase in all patients. Follow-up included repeat echocardiogram, right heart catheterization, and pulmonary angiogram 24 hours post thrombolytic therapy. Patients also had a follow-up office visit at 30 days post hospital discharge. Results: Prior to CDT all patients had significant RV dysfunction on echocardiogram with elevated right sided filling pressures as well as pulmonary hypertension on right heart catheterization. Normalization of RV function and pulmonary pressures occurred within 24 hours of CDT. In-hospital mortality and 30 day mortality was 0%. Conclusion: In patients with SPE, ultrasound-assisted CDT was associated with excellent hemodynamic and clinical outcomes. Therefore, we advocate the use of this novel therapy in patients with SPE. AD - T. Azemi, Hartford Hospital, Hartford, CT, Hartford, CT, United States AU - Azemi, T. AU - Elbash, F. AU - Almahasneh, F. AU - Sadiq, I. DB - Embase DO - 10.1002/ccd.24386 KW - alteplase fibrinolytic therapy lung embolism society angiography ultrasound human patient mortality catheter echocardiography heart catheterization follow up surgeon cardiologist physician lung pressure therapy tertiary health care fibrinolysis anticoagulation continuous infusion ambulatory care hospital discharge pulmonary hypertension LA - English M3 - Conference Abstract N1 - L70744843 2012-05-22 PY - 2012 SN - 1522-1946 SP - S30-S31 ST - Role of ultrasound-assisted thrombolytic therapy in submassive pulmonary embolism T2 - Catheterization and Cardiovascular Interventions TI - Role of ultrasound-assisted thrombolytic therapy in submassive pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70744843&from=export http://dx.doi.org/10.1002/ccd.24386 VL - 79 ID - 761203 ER - TY - JOUR AB - Purpose: Severe frostbite frequently results in ischemia with devastating tissue injury leading to limb amputation. Although historically frostbite injuries were predominantly seen with military work, the last 2 decades have seen a rise in civilian cases, usually associated with winter sports, homelessness, and alcohol consumption. There is a paucity of double-blind randomized trials and grade 1 recommendations regarding the treatment of frostbite injury; however, the last decade has presented a growing body of evidence supporting the use of thrombolytic therapy leading to decreased amputation rates. Our aim is to present a comprehensive review of current management of frostbite injury and what every endovascular specialist needs to know when evaluating and treating frostbite injury. Material and Methods: We present a case of successful revascularization following catheter-directed intra-arterial thrombolyis in a 20-year-old male who suffered third-degree upper extremity frostbite injury. Angiogram of the right upper extremity demonstrated severe hypoperfusion of the right third, fourth, and fifth digits. Along with a comprehensive literature review of this treatment and current recommendations for the management of frostbite injury, we discuss the indication, techniques, and potential complications of this interventional radiological approach. Results: Following infusion catheter placement within the distal ulnar artery and a 24-hour infusion of tissue plasminogen activator and heparin, follow-up angiograph demonstrated complete reperfusion of all digits. The need for surgical amputation was avoided without procedure-related complications. At 1-month clinical follow-up, the patient demonstrated complete return of function and full range of motion of all digits. Conclusions: Frostbite injuries are seen at an increasing rate, and there is an increasing body of evidence supporting the use of thrombolytic therapy for its management. Interventional radiologists should be familiar with the current management of frostbite injury and should play a critical role in the multidisciplinary special trauma team to minimize final tissue loss and maximize functionality of the affected limb. (Figure presented). AD - I. Babin AU - Babin, I. AU - Patel, S. AU - Karmel, M. AU - Jawed, M. AU - Mendenhall, C. AU - Zhang, D. AU - Kobayashi, K. DB - Embase DO - 10.1016/j.jvir.2016.01.014 KW - endogenous compound heparin tissue plasminogen activator adult amputation blood clot lysis catheter controlled clinical trial controlled study fibrinolytic therapy finger follow up frostbite human infusion interventional radiologist male peroperative complication randomized controlled trial range of motion reperfusion revascularization surgery systematic review ulnar artery young adult LA - English M1 - 2 M3 - Conference Abstract N1 - L614668078 2017-03-09 PY - 2016 SN - 1535-7732 SP - e14 ST - Catheter-directed intra-arterial thrombolysis for frostbite injury: Playing a critical role in a multidisciplinary team T2 - Journal of Vascular and Interventional Radiology TI - Catheter-directed intra-arterial thrombolysis for frostbite injury: Playing a critical role in a multidisciplinary team UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614668078&from=export http://dx.doi.org/10.1016/j.jvir.2016.01.014 VL - 27 ID - 761039 ER - TY - JOUR AB - Rationale Long term outcomes after acute pulmonary embolism (PE) vary from complete resolution to chronic thromboembolic pulmonary hypertension (CTEPH). Guidelines on management after acute PE are generally limited to anticoagulation duration with recommendations for follow up targeted to symptomatic patients only Most of the published guidance regarding follow-up is based on data evaluating patients after all types of acute PE (low and high risk). We assessed symptoms, exercise tolerance, and imaging (echocardiogram and V/Q) 2-4 months after our institution's Pulmonary Embolism Response Team (PERT) treated patients for acute intermediate/high risk pulmonary embolus. We hypothesized that symptom assessment alone in this higher risk group might not be sufficient in this high risk group. Methods This was an IRB-approved, single-center observational study of patients who followed up in our Pulmonary Hypertension (PH) clinic at the University of Rochester Medical Center 2-4 months after the PERT treated them for intermediate/high risk PE. We excluded those with an estimated prognosis <1 year. At follow up, we offered patients V/Q scan and echocardiogram. In patients with persistent breathlessness or limitations, the PH clinicians (2 dedicated faculty, RJW & DJL) evaluated and treated heart failure preserved ejection fraction, iron deficiency, and sleep apnea. Results After treatment for acute intermediate/high risk PE, 108 patients followed up in PH clinic (Table 1). Of those, 55% of patients had self-reported limitation in activity. We found CTEPH in 8 patients and likely CTEPH (confirmed testing or patients who declined invasive hemodynamic testing but had convincing signs and symptoms of CTEPH) in 19 patients. 46% of patients had residual perfusion defects on perfusion imaging. At follow up, 91% of patients had either normal or mildly enlarged right ventricles. We identified a large rate of heart failure preserved ejection fraction, iron deficiency, and obstructive sleep apnea contributing to breathlessness after acute PE. In some cases, treatment of these conditions was associated with reduced symptoms. Conclusions Our findings suggest that targeted follow-up should be part of the PERT evaluation and management. We would advocate that those with acute intermediate/high risk PE should continue to follow up 2-4 months after the event in a dedicated PH clinic. We identified a high rate of CTEPH 2-4 months post event and treatable comorbidities that could be contributing to Post-PE syndrome. While an echocardiogram to evaluate for resolution of RV enlargement/dysfunction seems warranted, perfusion imaging did not add to the evaluation of asymptomatic patients (Table Presented). AD - C. Bach, Pulmonary and Critical Care Medicine, University of Rochester, Rochester, NY, United States AU - Bach, C. AU - White, R. AU - Lachant, D. DB - Embase KW - adult chronic thromboembolic pulmonary hypertension clinical evaluation comorbidity conference abstract controlled study dyspnea echocardiography exercise tolerance female follow up heart failure with preserved ejection fraction heart right ventricle hemodynamics high risk population human iron deficiency major clinical study male observational study prognosis pulmonary embolism response team risk assessment scintigraphy sleep disordered breathing symptom assessment LA - English M1 - 1 M3 - Conference Abstract N1 - L632376191 2020-07-27 PY - 2020 SN - 1535-4970 ST - Follow up imaging and assessment after intermediate/high risk pulmonary embolus T2 - American Journal of Respiratory and Critical Care Medicine TI - Follow up imaging and assessment after intermediate/high risk pulmonary embolus UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632376191&from=export VL - 201 ID - 760636 ER - TY - JOUR AB - Long-term outcomes after acute pulmonary embolism vary from complete resolution to chronic thromboembolic pulmonary hypertension (CTEPH). Guidelines after acute pulmonary embolism are generally limited to anticoagulation duration. We assessed patients with estimated prognosis >1 year in our pulmonary hypertension clinic 2–4 months after treatment for intermediate- or high-risk acute pulmonary embolism. At follow-up, ventilation–perfusion scan and echocardiogram were offered. The aim of this study was to assess for recurrent symptomatic disease, residual imaging defects or right ventricular dysfunction, and functional disability after acute management of pulmonary embolism. After treatment for acute intermediate- or high-risk pulmonary embolism, 104 patients followed up in pulmonary hypertension clinic. Of those, 55% of patients had self-reported limitation in activity. No patients had symptomatic recurrence of pulmonary embolism. Forty-eight percent of patients had residual perfusion defects on perfusion imaging, while 91% of patients had either normal or only mildly enlarged right ventricles. We identified heart failure preserved ejection fraction, iron deficiency, and obstructive sleep apnea as significant contributors to breathlessness. Treatment of these conditions was associated with improvement. Surprisingly, we diagnosed CTEPH in nine patients; for some, chronic thrombus may already have been present at the time of index evaluation. Our findings suggest that follow-up in a dedicated pulmonary hypertension clinic 2–4 months after acute intermediate- or high-risk pulmonary embolism may add value to patient care. We identified treatable comorbidities that could be contributing to post-pulmonary embolism syndrome as well as CTEPH. PMID:33014336 AU - Bach, Christina AU - Wilson, Bennett AU - Chengazi, Vaseem AU - Goldman, Bruce AU - Lachant, Neil AU - Pietropaoli, Anthony DA - 2020/09/21 09/21 DB - PubMed Central DO - 10.1177/2045894020952019 KW - pulmonary embolism pulmonary hypertension anticoagulants M1 - 3 PY - 2020 SN - 2045-8932 ST - Clinical and imaging outcomes after intermediate- or high-risk pulmonary embolus T2 - Pulmonary Circulation TI - Clinical and imaging outcomes after intermediate- or high-risk pulmonary embolus UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7509735&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7509735 VL - 10 ID - 762023 ER - TY - JOUR AB - Introduction: Pulmonary Embolism Response Teams (PERTs) have evolved to help improve risk stratification and outcomes in the acute setting of pulmonary embolus (PE). Less attention has been given to follow up in this high risk group after hospital discharge, especially with regard to risk for chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to assess residual thrombotic disease apparent on imaging, extent of recovery in right ventricular (RV) size and function, and functional capacity 8 weeks after hospitalization for patients managed by PERT. Methods: We offered most PERT patients office follow up (if anticipated survival >6 months) and included all patients who came to the University of Rochester Medical Center Pulmonary Hypertension clinic 8 weeks after acute PE discharge. V/Q scan and echocardiogram were performed at the visit to evaluate residual thrombus and assess RV size and function. Clinical data was collected from each patient. We compared conventional anticoagulation (coumadin and low-molecular-weight heparin, LMWH) with direct oral anticoagulants (DOAC). Statistical testing was performed using student t-test. Results: PERT was activated 106 times since August 1, 2017, and we subsequently evaluated 48 patients (45%, Table 1). In total, 8 patients received unfractionated heparin, 41 received LMWH, 5 underwent catheter-directed thrombolysis, two received systemic thrombolysis, and seven underwent surgical embolectomy. Length of hospitalization trended lower in the DOAC group, 6 vs 4 days, p=0.12. Residual thrombus 8 weeks later on V/Q imaging was seen in 16 patients, 41% in conventional therapy and 29% treated with DOAC, p=0.34. There was no difference in residual thrombus for BMI >35, 32% vs 36%, p=0.99. There was no difference in residual thrombus for those with BMI >35 treated with DOAC compared to conventional treatment, 28% vs 38%, p=0.99. There was no clear difference in the extent of recovery in RV size, 47% vs 65%, p= 0.35, or function, 65% vs 77%, p=0.49, between conventional therapy and DOAC. There was no difference in those who achieved NYHA class I/II symptoms between groups, 82% vs 68%, p=0.34. There were two patients per group who would meet criteria for CTEPH. Conclusions: DOAC therapy appears to be as effective as conventional therapy in resolution of thrombus by imaging, restoration of RV size and function, symptom resolution, and rate of CTEPH. Notably, while many question efficacy for DOAC in patients with BMI >35, our findings suggest that DOAC are a viable anticoagulation choice in obese patients with BMI >35 after acute PE (Table Presented). AD - C. Bach, Pulmonary and Critical Care Medicine, University of Rochester, Rochester, NY, United States AU - Bach, C. AU - Wright, C. AU - White, R. AU - Cameron, S. J. AU - Lachant, D. DB - Embase KW - heparin low molecular weight heparin warfarin adult anticoagulation blood clot lysis body mass catheter chronic thromboembolic pulmonary hypertension clinical article clinical evaluation conference abstract controlled study drug therapy echocardiography embolectomy female follow up functional status heart right ventricle hospitalization human male New York Heart Association class obese patient obesity pulmonary embolism response team remission survival thrombus LA - English M1 - 9 M3 - Conference Abstract N1 - L630352929 2020-01-01 PY - 2019 SN - 1535-4970 ST - The efficacy of direct oral anticoagulants on residual clot burden in obese and non-obese patients with massive and submassive pulmonary embolism T2 - American Journal of Respiratory and Critical Care Medicine TI - The efficacy of direct oral anticoagulants on residual clot burden in obese and non-obese patients with massive and submassive pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630352929&from=export VL - 199 ID - 760728 ER - TY - JOUR AB - We present a case of a 73-year-old cancer patient with low transcutaneous oxygen saturation who was transferred to the intensive care unit after deployment of the rapid response team. Differential diagnosis remained broad until methemoglobinemia (MetHb) was detected. MetHb was induced by administration of rasburicase, which was given to prevent tumor lysis syndrome. In a follow-up examination, glucose-6-phosphate dehydrogenase deficiency was found to be the cause of MetHb after rasburicase exposure. Diagnosis was made by either measuring arterial MetHb or CO oximeter. Treatment options involve transfusion and methylene blue, if glucose-6-phosphate dehydrogenase deficiency is not present. AD - K.F. Bachmann, Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland AU - Bachmann, K. F. AU - Nebiker, M. AU - Johner, C. AU - Bregy, R. AU - Schaller, A. AU - Novak, U. AU - Jakob, S. M. DB - Embase Medline DO - 10.1213/XAA.0000000000000855 KW - oximeter cytarabine methotrexate methylene blue rasburicase rituximab aged article blood gas analysis cancer patient case report clinical article diagnostic approach route differential diagnosis follow up glucose 6 phosphate dehydrogenase deficiency heart right left shunt human intensive care unit lung edema lung embolism lymphoma male methemoglobinemia noninvasive ventilation oxygen desaturation oxygen saturation pneumonia priority journal recurrence risk transfusion tumor lysis syndrome LA - English M1 - 4 M3 - Article N1 - L631117994 2020-03-11 2020-03-13 PY - 2019 SN - 2575-3126 SP - 96-98 ST - Rare Case of Transcutaneous Oxygen Desaturation in a Cancer Patient: A Case Report and Diagnostic Approach for a Recurrent Problem T2 - A and A Practice TI - Rare Case of Transcutaneous Oxygen Desaturation in a Cancer Patient: A Case Report and Diagnostic Approach for a Recurrent Problem UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631117994&from=export http://dx.doi.org/10.1213/XAA.0000000000000855 VL - 12 ID - 760746 ER - TY - JOUR AB - Introduction: Vascular Ehlers-Danlos syndrome (vEDS) is a monogenetic disease caused by a mutation in procollagen 3A1. Clinical manifestations are arterial ruptures and dissections, as well as spontaneous ruptures of the colon, oesophagus and uterus. Expected survival is short, in historical cohorts approximately 50 years. In 2010 a French-Belgian randomized controlled trial (RCT), including 53 patients, reported a hazard ratio of only 0.36 of arterial events if patients were treated with the betablocker celiprolol [1], combining β1-adrenoceptor antagonist and β2-adrenoceptor agonist actions. The aim of this study is to report the feasibility and early outcome of celiprolol treatment in a cohort of patients with vEDS. Methods: This is a single centre series, although patients were referred from the entire country (with a population of 10 million) for assessment of a multidisciplinary team including vascular surgeons, angiologists and clinical geneticists. A prospective database was created with data on family history, previous and future clinical events, medication and side-effects. Celiprolol was administered twice daily, and titrated up by 100 mg steps every 6 months to a maximum of 400 mg per day, according to the same protocol as in the RCT. Logistic regression was used to analyse predictors of vascular events after the start of the treatment. Results: Thirty-three patients were offered treatment with celiprolol, 2011-2018. Median follow up time was 44 (range 1-78) months. Thirty-one patients had a verified mutation on COL3A1 gene. The treatment was initiated in 31 patients, while two patients abstained. Twelve patients have reached the target dose of 400 mg daily, during follow-up, and in seven patients dose uptitration is ongoing. Eleven patients experienced one or more side effects, preventing them from reaching the target dose, and two terminated the treatment for that reason. Five cases of major vascular events occurred during the time of the treatment. The following four were fatal: 1) Rupture of the ascending aorta with cardiac tamponade, 2) Aortic rupture after type B dissection, 3) Rupture of a cerebral aneurysm with subarachnoidal bleeding, and 4) Rupture of a pulmonary artery. The fifth patient (with a major vascular event) had a rupture of the splenic artery that was treated successfully with an endovascular Amplatzer plug. The two patients who were offered treatment but decided to wait, both developed severe complications: colonic perforation in one, and type B dissection in the other. The yearly risk of a major vascular event was 5% in this cohort, quite similar to that observed in the treatment-arm in the RCT (5%), but significantly lower than in the control-arm (12%). No significant predictor of vascular events was identified by logistic regression analysis. Conclusion: Treatment with celiprolol is tolerated in most vEDS patients, but less than half achieved the target dosage of 400 mg daily, during the observation period. Despite fatal vascular events, these observations suggest that celiprolol has a protective effect in vEDS. The number of patients in the cohort, and the length of follow up, is increasing. Thus, we will be able to report more definite results in the near future. Disclosure: Nothing to disclose AU - Baderkhan, H. AU - Stenborg, A. AU - Hägg, A. AU - Wanhainen, A. AU - Björck, M. DB - Embase DO - 10.1016/j.ejvs.2019.09.115 KW - beta 1 adrenergic receptor celiprolol collagen type 3 endogenous compound adult adverse drug reaction aortic rupture artery rupture ascending aorta brain artery aneurysm cohort analysis colon perforation complication conference abstract dissection drug combination drug dose titration drug therapy Ehlers Danlos syndrome esophagus rupture family history feasibility study female follow up heart tamponade human major clinical study male medical geneticist multidisciplinary team prospective study pulmonary artery randomized controlled trial side effect sizing balloon catheter spleen rupture subarachnoid hemorrhage surgery uterus rupture vascular surgeon LA - English M1 - 6 M3 - Conference Abstract N1 - L2003904097 2019-12-12 PY - 2019 SN - 1532-2165 1078-5884 SP - e627 ST - Celiprolol Treatment of Patients With Vascular Ehlers-Danlos Syndrome T2 - European Journal of Vascular and Endovascular Surgery TI - Celiprolol Treatment of Patients With Vascular Ehlers-Danlos Syndrome UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003904097&from=export http://dx.doi.org/10.1016/j.ejvs.2019.09.115 VL - 58 ID - 760644 ER - TY - JOUR AB - Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (>= 4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion) (C) 2017 by The Society of Thoracic Surgeons AD - [Badhwar, Vinay; Rankin, J. Scott; Ad, Niv] West Virginia Univ, Div Cardiothorac Surg, Morgantown, WV USA. [Damiano, Ralph J., Jr.] Washington Univ, Div Cardiothorac Surg, St Louis, MO USA. [Gillinov, A. Marc; Bakaeen, Faisal G.; Suri, Rakesh M.] Cleveland Clin, Div Thorac & Cardiovasc Surg, Cleveland, OH 44106 USA. [Edgerton, James R.] Baylor Plano Heart Hosp, Dept Cardiothorac Surg, Plano, TX USA. [Philpott, Jonathan M.] Sentara Heart Hosp, Dept Cardiothorac Surg, Norfolk, VA USA. [McCarthy, Patrick M.] Northwestern Univ, Div Cardiac Surg, Feinberg Sch Med, Chicago, IL 60611 USA. [Bolling, Steven F.] Univ Michigan, Dept Cardiac Surg, Ann Arbor, MI 48109 USA. [Roberts, Harold G.] Florida Heart & Vasc Care Aventura, Dept Cardiovasc Serv, Aventura, FL USA. [Thourani, Vinod H.] Emory Univ, Div Cardiothorac Surg, Atlanta, GA 30322 USA. [Shemin, Richard J.] Univ Calif Los Angeles, David Geffen Sch Med, Div Cardiothorac Surg, Los Angeles, CA 90095 USA. [Firestone, Scott] Soc Thorac Surg, Chicago, IL USA. Badhwar, V (corresponding author), West Virginia Univ, 1 Med Ctr Dr, Morgantown, WV 26506 USA. vinay.badhwar@wvumedicine.org AN - WOS:000396527700086 AU - Badhwar, V. AU - Rankin, J. S. AU - Damiano, R. J. AU - Gillinov, A. M. AU - Bakaeen, F. G. AU - Edgerton, J. R. AU - Philpott, J. M. AU - McCarthy, P. M. AU - Bolling, S. F. AU - Roberts, H. G. AU - Thourani, V. H. AU - Suri, R. M. AU - Shemin, R. J. AU - Firestone, S. AU - Ad, N. DA - Jan DO - 10.1016/j.athoracsur.2016.10.076 J2 - Ann. Thorac. Surg. KW - COX-MAZE PROCEDURE BIPOLAR RADIOFREQUENCY ABLATION PULMONARY VEIN ISOLATION MITRAL-VALVE DISEASE VALVULAR HEART-DISEASE CARDIAC-SURGERY III PROCEDURE IV PROCEDURE MICROWAVE ABLATION SINUS RHYTHM Cardiac & Cardiovascular Systems Respiratory System Surgery LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: EO2LJ Times Cited: 126 Cited Reference Count: 126 Badhwar, Vinay Rankin, J. Scott Damiano, Ralph J., Jr. Gillinov, A. Marc Bakaeen, Faisal G. Edgerton, James R. Philpott, Jonathan M. McCarthy, Patrick M. Bolling, Steven F. Roberts, Harold G. Thourani, Vinod H. Suri, Rakesh M. Shemin, Richard J. Firestone, Scott Ad, Niv thourani, vinod/AAP-5968-2020 NHLBI NIH HHSUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [R01 HL032257] Funding Source: Medline 135 4 13 ELSEVIER SCIENCE INC NEW YORK ANN THORAC SURG PY - 2017 SN - 0003-4975 SP - 329-341 ST - The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation T2 - Annals of Thoracic Surgery TI - The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation UR - ://WOS:000396527700086 VL - 103 ID - 761674 ER - TY - JOUR AB - Introduction - A 22-year-old male presented to our hospital with a history of an unrestrained high-speed motor vehicle accident. On presentation he was hemodynamically stable with a right humerus fracture and facial injuries. Trauma CT protocol revealed a grade-3 aortic tear of the descending thoracic aorta with an anomalous origin of left vertebral artery (VA) distal to the left subclavian artery. At a multidisciplinary team meeting it was noted that the left VA was dominant and the right VA was stenosed in part of its course. CT angiography suggested that the direct re-implantation of left vertebral artery onto the left carotid artery was not possible due to the unusually short cervical portion of the pre-foraminal VA due to its early entry into foramen transversarium of C7 instead of C6. It was therefore decided to proceed with left carotid to left vertebral artery and left carotico-subclavian artery bypass prior to TEVAR of the descending aorta. Methods - Using a transverse left cervical approach the left VA was dissected out as it ascended towards the foramen transversarium of C7. Using the great saphenous vein an interposition graft was raised between the left common carotid and left VA using 7/0 prolene. Intraoperative Doppler assessment confirmed satisfactory flow. An ipsilateral carotico-subclavian bypass was then performed with Dacron graft using 6/0 prolene. TEVAR was then performed with a 26 mm x100 mm C-Tag ® stent. Results - CT angiography on the 2nd postoperative day confirmed patency of both carotico-vertebral and carotico-subclavian grafts and satisfactory placement of the TEVAR stent. The patient was noted to have a left Horner’s syndrome but otherwise made an uneventful recovery. He was discharged on the 3rd postoperative day. At follow up one month later he remained well with no complications and complete resolution of Horner’s syndrome. [Formula presented] Conclusion - Patients with traumatic Aortic tears undergoing emergency TEVAR and in whom a proximal landing zone will seal the origin of an aberrant dominant left vertebral artery arising from aortic arch (proximal or distal to the LSA) should have vertebral artery revascularization prior to deployment of the TEVAR. References 1. Clancy TV, Gary Maxwell J, Covington DL, Brinker CC, Blackman D. A statewide analysis of level I and II trauma centers for patients with major injuries. J Trauma 2001; 51:346-51. 2. Richens D, Field M, Neale M, and Oakley C. The mechanism of injury in blunt traumatic rupture of the aorta. Eur J Cardiothoracic Surg 2002;21:288-93.Debakey ME, Henly WS, Cooley DA, et al. Surgical management of dissecting aneurysms of the aorta. J Thoracic Cardiovasc Surg 1965;49:130-49 3. Lee WA, Matsumura JS, Mitchell RS, Farber MA, Greenberg RK, Azizzadeh A et al. Endovascular repair of traumatic thoracic aortic injury: Clinical practice guidelines of the Society for Vascular Surgery. Journal of Vascular Surgery. 2011 Jan; 53(1):187-192. Available from, DOI: 4. Yuan SM; Aberrant origin of vertebral artery and its clinical implications. Braz J Cardiovasc Surg 31(1):52–59(2016) 5. Lacout A, Khalil A, Figl A, Liloku R, Marcy PY. Vertebral arteria lusoria: a life-threatening condition for oesophageal surgery. Surg Radiol Anat. 2012; 34(4):381-3. 6. Uchino A, Saito N, Takahashi M, Okada Y, Kozawa E, Nishi N, et al. Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography; Neuroradiology. 2013;55(5):585-94 7. Rangel-Castilla, L., Kalani, M.Y., Cronk, K., Zabramski, J.M., Russin, J.J., Spetzler, R.F. Vertebral artery transposition for revascularization of the posterior circulation: a critical assessment of temporary and permanent complications and outcomes. J Neurosurg. 2015;122:671–677 8. Bartel T, Eggebrecht H, Müller S, et al. Comparison of diagnostic and therapeutic value of transesophageal echocardiography, intravascular ultrasonic imaging, and intraluminal phased-array imaging in aortic dissection with tear in the descending thoracic aorta (type B). Am J C rdiol 2007; 99: 270–274 9. Matsumura JS, Lee WA, Mitchell RS, et al. The Society for Vascular Surgery Practice Guidelines: management of the left subclavian artery with thoracic endovascular aortic repair. J Vasc Surg. 2009;50:1155–1158 10. Rizvi AZ, Murad MH, Fairman RM, Erwin PJ, Montori VM. The effect of left subclavian artery coverage on morbidity and mortality in patients undergoing endovascular thoracic aortic interventions: a systematic review and meta-analysis. J Vasc Surg 2009; 50:1159-69. 11. Azizzadeh A, Keyhani K, Miller CC III, Coogan SM, Safi HJ, Estrera AL. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg 2009;49:1403-8 12. V. Riambau et al Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg (2017) 53, 4-52. 13. TEVAR: Endovascular Repair of the Thoracic Aorta; David A. Nation, MD Grace J. Wang, MD; Semin Intervent Radiol. 2015 Sep; 32(3): 265–271. 14. Demetriades D. Blunt thoracic aortic injuries: crossing the rubicon. J Am Coll Surg. 2011;214(3):247Y259. 15. Nabil Saouti Vikash Hindori William J. Morshuis Robin H. Heijmen; Left subclavian artery revascularization as part of thoracic stent grafting. European Journal of Cardio-Thoracic Surgery, Volume 47, Issue 1, 1 January 2015, Pages 120–125 AD - M.A.A. Baig, Vascular & Endovascular Surgery, King Saud Medical City, Riyadh, Saudi Arabia AU - Baig, M. A. A. AU - Al Fozan, A. AU - Guzman, T. AU - Basahai, I. A. AU - Osman, I. S. DB - Embase DO - 10.1016/j.ejvs.2019.06.1014 KW - endogenous compound adult aortic aneurysm endovascular graft aortic arch aortic dissection aortic trauma artery bypass artery formation (physiology) carotid artery complication computed tomographic angiography conference abstract dacron implant descending aorta dissecting aortic aneurysm emergency health service endovascular aneurysm repair esophagus surgery face injury female follow up Horner syndrome human humerus fracture left subclavian artery male morbidity mortality multidisciplinary team neuroradiology practice guideline reimplantation remission revascularization rupture saphenous vein surgery systematic review thoracic aorta traffic accident transesophageal echocardiography ultrasound vascular ring velocity vertebral artery young adult LA - English M1 - 6 M3 - Conference Abstract N1 - L2004128690 2019-12-12 PY - 2019 SN - 1532-2165 1078-5884 SP - e381-e382 ST - Thoracic Endovascular Aortic Repair (TEVAR) in a Case of Grade 3 Blunt Aortic Injury with an Aberrant Vertebral Artery Origin T2 - European Journal of Vascular and Endovascular Surgery TI - Thoracic Endovascular Aortic Repair (TEVAR) in a Case of Grade 3 Blunt Aortic Injury with an Aberrant Vertebral Artery Origin UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004128690&from=export http://dx.doi.org/10.1016/j.ejvs.2019.06.1014 VL - 58 ID - 760649 ER - TY - JOUR AB - Impending paradoxical embolism (IPE) also described in the literature as thrombus straddling a patent foramen ovale (PFO) or paradoxical embolus in transit is a rare condition when thrombus (originating mostly in deep veins of lower extremities) embolized to the heart gets caught in PFO or in atrial septal defect without systemic embolization. We present a case of a 39-year-old female on oral contraceptive pills who presented to the emergency department with chief complaint of dyspnea and chest pain. She was found to have saddle pulmonary embolus (PE) extending through PFO to left atrium and into the left ventricle. Patient underwent emergent open pulmonary embolectomy, removal of right and left atrial thrombi, and closure of patent foramen ovale. She tolerated the surgery well and was discharged home on chronic anticoagulation therapy. PMID:31186976 AU - Bailuc, Stefania AU - Abicht, Travis AU - Barsamyan, Sergey AU - Gizaw, Yonatan DA - 2019/05/02 05/02 DB - PubMed Central DO - 10.1155/2019/5747598 PY - 2019 SN - 2090-6846 ST - Saddle Pulmonary Embolus Caught in Transit across a Patent Foramen Ovale T2 - Case Reports in Pulmonology TI - Saddle Pulmonary Embolus Caught in Transit across a Patent Foramen Ovale UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6521405&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6521405 VL - 2019 ID - 762079 ER - TY - JOUR AB - Endovascular mechanical thrombectomy (MT) for the treatment of acute stroke due to large vessel occlusion has evolved significantly with the publication of multiple positive thrombectomy trials. MT is now a recommended treatment for acute ischemic stroke. Mechanical thrombectomy is associated with a number of intra-procedural or post-operative complications, which need to be minimized and effectively managed to maximize the benefits of thrombectomy. Procedural complications include: access-site problems (vessel/nerve injury, access-site hematoma and groin infection); device-related complications (vasospasm, arterial perforation and dissection, device detachment/misplacement); symptomatic intracerebral hemorrhage; subarachnoid hemorrhage; embolization to new or target vessel territory. Other complications include: anesthetic/contrast-related, post-operative hemorrhage, extra-cranial hemorrhage and pseudoaneurysm. Some complications are life-threatening and many lead to increased length of stay in intensive care and stroke units. Complications increase costs and delay the commencement of rehabilitation. Some may be preventable; the impact of others can be minimized with early detection and appropriate management. Both neurointerventionists and stroke specialists need to be aware of the risk factors, strategies for prevention, and management of these complications. With the increasing use of mechanical thrombectomy for the treatment of acute ischemic stroke, incidence and outcome of complications will need to be carefully monitored by stroke teams. In this narrative review, we examine the frequency of complications of MT in the treatment of acute ischemic stroke with an emphasis on periprocedural complications. Overall, from recent randomized controlled trials, the risk of complications with sequelae for patient from mechanical thrombectomy is approximate to 15%. We discuss the management of complications and identify areas with limited evidence, which need further research. Search strategy and selection criteria Relevant evidence was found by searches of Medline and Cochrane Library, reference list, cross-referencing and main journal content pages. Search terms included brain ischemia, acute ischemic stroke, cerebral infarction AND mechanical thrombectomy, endovascular therapy, endovascular treatment, endovascular embolectomy, intra-arterial AND randomized controlled trial, non-randomised trials, observational studies AND complications, procedural complications, peri-procedural complications, device-related complications, management, treatment, outcome. The search included only human studies, and was limited to studies published in English between January 2014 and November 2016. The final reference list was selected on the basis of relevance to the topics covered in the Review. Guidelines for management of acute ischaemic stroke by the American Heart Association, the European Stroke Organisation, multi-disciplinary guidelines and the National Institute for Health and Care Excellence (NICE) were also reviewed. AD - [Balami, Joyce S.] Univ Oxford, Ctr Evidence Based Med, Oxford, England. [Balami, Joyce S.] Norfolk & Norwich Univ Teaching Hosp NHS Trust, Norwich, Norfolk, England. [White, Philip M.] Newcastle Univ, Inst Neurosci, Stroke Res Grp, Newcastle Upon Tyne, Tyne & Wear, England. [McMeekin, Peter J.] Northumbria Univ, Sch Hlth Community & Educ Studies, London, England. [Ford, Gary A.] Oxford Univ Hosp NHS Trust, John Radcliffe Hosp, Oxford, England. [Ford, Gary A.] Univ Oxford, Radcliffe Dept Med, Oxford, England. [Buchan, Alastair M.] Univ Oxford, Radcliffe Dept Med, Acute Stroke Programme, Oxford, England. [Buchan, Alastair M.] Univ Oxford, John Radcliffe Hosp, Acute Vasc Imaging Ctr, Oxford, England. Buchan, AM (corresponding author), Univ Oxford, John Radcliffe Hosp, Oxford OX3 9DU, England. alastair.buchan@medsci.ox.ac.uk AN - WOS:000432079700006 AU - Balami, J. S. AU - White, P. M. AU - McMeekin, P. J. AU - Ford, G. A. AU - Buchan, A. M. DA - Jun DO - 10.1177/1747493017743051 J2 - Int. J. Stroke KW - Acute ischemic stroke acute stroke therapy complications of endovascular mechanical thrombectomy endovascular mechanical thrombectomy management of complications prevention of complications STENT-RETRIEVER THROMBECTOMY LARGE VESSEL OCCLUSION RANDOMIZED CONTROLLED-TRIAL HEALTH-CARE PROFESSIONALS BALLOON GUIDE CATHETER MECHANICAL THROMBECTOMY SUBARACHNOID HEMORRHAGE SINGLE-CENTER INTRAVENOUS ALTEPLASE DISTAL EMBOLIZATION Clinical Neurology Peripheral Vascular Disease LA - English M1 - 4 M3 - Review N1 - ISI Document Delivery No.: GF6LW Times Cited: 32 Cited Reference Count: 85 Balami, Joyce S. White, Philip M. McMeekin, Peter J. Ford, Gary A. Buchan, Alastair M. Ford, Gary/AAY-6405-2020 Ford, Gary/0000-0001-8719-4968; McMeekin, Peter/0000-0003-0946-7224; White, Philip/0000-0001-6007-6013 NIHR Senior Investigator award; NIHR PEARS (Promoting Effective and Rapid Stroke Care) Programme Grant; Medical Research CouncilMedical Research Council UK (MRC); Oxford Biomedical Research Centre (BRC); NIHRNational Institute for Health Research (NIHR) The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: GAF is supported by an NIHR Senior Investigator award.; PMW and PM are supported by NIHR PEARS (Promoting Effective and Rapid Stroke Care) Programme Grant. AMB is supported by funding from the Medical Research Council, Senior NIHR fellow and Oxford Biomedical Research Centre (BRC). 32 5 17 SAGE PUBLICATIONS LTD LONDON INT J STROKE PY - 2018 SN - 1747-4930 SP - 348-361 ST - Complications of endovascular treatment for acute ischemic stroke: Prevention and management T2 - International Journal of Stroke TI - Complications of endovascular treatment for acute ischemic stroke: Prevention and management UR - ://WOS:000432079700006 VL - 13 ID - 761583 ER - TY - JOUR AB - BACKGROUND: Aeromedical transfer can reduce transfer times for primary percutaneous coronary intervention (PPCI). Delays in dispatch of the helicopter and landing-reperfusion can reduce the benefits of air travel. The ad hoc nature of these transfers may compound delays. A formal aeromedical transfer service, with rapid dispatch protocols and rapid landing to balloon times could significantly reduce reperfusion times. METHODS: A standard operating procedure (SOP) was developed using a field assessment team (doctor, aircrew paramedic) and a cardiologist-led multidisciplinary team meeting the incoming aircraft. The aeromedical SOP for STEMI care was implemented when anticipated land journey >30 min to the nearest PPCI centre. Reperfusion times for actual air travel and estimated virtual land journeys from the same location were compared. RESULTS: Between April and December 2009, 8 patients were managed according to the aeromedical SOP. Median air distance 49 miles and road, 40 miles. All subsequent data shown in median minutes (range). Call-balloon time 109 (97-116). Call-aeromedical activation 13 (9-26). Aeromedical activation-arrive scene 12 (9-16). Time at scene 29 (24-52). Call-depart scene 57 (45-75). Air journey 25 (18-30) and landing-balloon 21 (8-22). Call-arrive at PPCI centre for air 85 (70-95); estimated virtual road call-arrive at PPCI centre 102 (85-104). CONCLUSIONS: This SOP delivered sub 120 min call-balloon times in all cases undergoing PPCI from difficult locations where anticipated land journeys were >30 min. With longer anticipated land journeys (or more remote locations) the proportional gains with air transfer will be greater. Subject to a formal SOP and very rapid landing-balloon times, aeromedical transfer can significantly reduce the number of patients suffering long reperfusion delays in acute myocardial infarction. AD - Harefield Hospital, Hill End Road, Harefield, London, UB96JH, United Kingdom. AN - 21458139 AU - Balerdi, M. AU - Ellis, D. Y. AU - Grieve, P. AU - Murray, P. AU - Dalby, M. DA - Jul DO - 10.1016/j.resuscitation.2011.02.031 DP - NLM ET - 2011/04/05 J2 - Resuscitation KW - *Air Ambulances *Angioplasty, Balloon, Coronary Humans Myocardial Infarction/*therapy Retrospective Studies Time Factors Transportation of Patients/methods/*standards LA - eng M1 - 7 N1 - 1873-1570 Balerdi, Matthew Ellis, Daniel Y Grieve, Philip Murray, Paul Dalby, Miles Comparative Study Journal Article Ireland Resuscitation. 2011 Jul;82(7):947-50. doi: 10.1016/j.resuscitation.2011.02.031. Epub 2011 Apr 1. PY - 2011 SN - 0300-9572 SP - 947-50 ST - Aeromedical transfer to reduce delay in primary angioplasty T2 - Resuscitation TI - Aeromedical transfer to reduce delay in primary angioplasty VL - 82 ID - 760474 ER - TY - JOUR AB - Study Objective: Electronic health record systems with computerized physician order entry and condition-specific order sets are intended to standardize patient management and minimize errors of omission. However, the effect of these systems on disease-specific process measures and patient outcomes is not well established. We seek to evaluate the effect of computerized physician order entry electronic health record implementation on process measures and short-term health outcomes for patients hospitalized with acute ischemic stroke.Methods: We conducted a quasi-experimental cohort study of patients hospitalized for acute ischemic stroke with concurrent controls that took advantage of the staggered implementation of a comprehensive computerized physician order entry electronic health record across 16 medical centers within an integrated health care delivery system from 2007 to 2012. The study population included all patients admitted to the hospital from the emergency department (ED) for acute ischemic stroke, with an initial neuroimaging study within 2.5 hours of ED arrival. We evaluated the association between the availability of a computerized physician order entry electronic health record and the rates of ED intravenous tissue plasminogen activator administration, hospital-acquired pneumonia, and inhospital and 90-day mortality, using doubly robust estimation models to adjust for demographics, comorbidities, secular trends, and concurrent primary stroke center certification status at each center.Results: Of 10,081 eligible patients, 6,686 (66.3%) were treated in centers after the computerized physician order entry electronic health record had been implemented. Computerized physician order entry was associated with significantly higher rates of intravenous tissue plasminogen activator administration (rate difference 3.4%; 95% confidence interval 0.8% to 6.0%) but not with significant rate differences in pneumonia or mortality.Conclusion: For patients hospitalized for acute ischemic stroke, computerized physician order entry use was associated with increased use of intravenous tissue plasminogen activator. AD - Kaiser Permanente San Rafael Medical Center, San Rafael, CA Kaiser Permanente Division of Research, Oakland, CA Department of Neurology, University of California at San Francisco, San Francisco, CA Kaiser Permanente San Leandro Medical Center, San Leandro, CA Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA Mongan Institute for Health Policy, Massachusetts General Hospital, Department of Health Care Policy, Harvard Medical School, Boston, MA Kaiser Permanente Roseville Medical Center, Roseville, CA Kaiser Permanente Oakland Medical Center, Oakland, CA AN - 111055384. Corporate Author: KP CREST Network Investigators. Language: English. Entry Date: 20160303. Revision Date: 20191121. Publication Type: journal article AU - Ballard, Dustin W. AU - Kim, Anthony S. AU - Huang, Jie AU - Park, David K. AU - Kene, Mamata V. AU - Chettipally, Uli K. AU - Iskin, Hilary R. AU - Hsu, John AU - Vinson, David R. AU - Mark, Dustin G. AU - Reed, Mary E. DB - CINAHL DO - 10.1016/j.annemergmed.2015.07.018 DP - EBSCOhost KW - Emergency Service -- Statistics and Numerical Data Fibrinolytic Agents -- Therapeutic Use Electronic Order Entry Stroke -- Drug Therapy Tissue Plasminogen Activator -- Therapeutic Use Pneumonia, Bacterial -- Epidemiology Female Hospital Mortality Male Quality Improvement Electronic Health Records Aged Cross Infection -- Epidemiology Stroke -- Mortality Funding Source Human M1 - 6 N1 - research. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. Grant Information: R01 DK085070/DK/NIDDK NIH HHS/United States. NLM UID: 8002646. PMID: NLM26362574. PY - 2015 SN - 0196-0644 SP - 601-610 ST - Implementation of Computerized Physician Order Entry Is Associated With Increased Thrombolytic Administration for Emergency Department Patients With Acute Ischemic Stroke T2 - Annals of Emergency Medicine TI - Implementation of Computerized Physician Order Entry Is Associated With Increased Thrombolytic Administration for Emergency Department Patients With Acute Ischemic Stroke UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=111055384&site=ehost-live&scope=site VL - 66 ID - 761338 ER - TY - JOUR AB - Background: Hospitalization and early anticoagulation therapy remain standard care for patients who present to the emergency department (ED) with pulmonary embolism (PE). For PEs discovered incidentally, however, optimal therapeutic strategies are less clear-and all the more so when the patient has cancer, which is associated with a hypercoagulable state that exacerbates the threat of PE. Methods: We conducted a retrospective review of a historical cohort of patients with cancer and incidental PE who were referred for assessment to the ED in an institution whose standard of care is outpatient treatment of selected patients and use of low-molecular-weight heparin for anticoagulation. Eligible patients had received a diagnosis of incidental PE upon routine contrast enhanced chest CT for cancer staging. Survival data was collected at 30 days and 90 days from the date of ED presentation and at the end of the study. Results: We identified 193 patients, 135 (70%) of whom were discharged and 58 (30%) of whom were admitted to the hospital. The 30-day survival rate was 92% overall, 99% for the discharged patients and 76% for admitted patients. Almost all (189 patients, 98%) commenced anticoagulation therapy in the ED; 170 (90%) of these received low-molecular-weight heparin. Patients with saddle pulmonary artery incidental PEs were more likely to die within 30 days (43%) than were those with main or lobar (11%), segmental (6%), or subsegmental (5%) incidental PEs. In multivariate analysis, Charlson comorbidity index (age unadjusted), hypoxemia, and incidental PE location (P = 0.004, relative risk 33.5 (95% CI 3.1-357.4, comparing saddle versus subsegmental PE) were significantly associated with 30-day survival. Age, comorbidity, race, cancer stage, tachycardia, hypoxemia, and incidental PE location were significantly associated with hospital admission. Conclusions: Selected cancer patients presenting to the ED with incidental PE can be treated with low-molecular-weight heparin anticoagulation and safely discharged. Avoidance of unnecessary hospitalization may decrease in-hospital infections and death, reduce healthcare costs, and improve patient quality of life. Because the natural history and optimal management of this condition is not well described, information supporting the creation of straightforward evidence-based practice guidelines for ED teams treating this specialized patient population is needed. AD - [Banala, Srinivas R.; Yeung, Sai-Ching Jim; Rice, Terry W.; Reyes-Gibby, Cielito C.; Todd, Knox H.; Alagappan, Kumar] Univ Texas MD Anderson Canc Ctr, Dept Emergency Med, 1515 Holcombe Blvd,Unit 1468, Houston, TX 77030 USA. [Banala, Srinivas R.] Caboolture Hosp, Emergency Dept, McKean St, Caboolture, Qld 4510, Australia. [Wu, Carol C.] Univ Texas MD Anderson Canc Ctr, Dept Diagnost Radiol Thorac Imaging, 1515 Holcombe Blvd,Unit 1478, Houston, TX 77030 USA. [Todd, Knox H.] EMLine Org, Mendoza, Argentina. [Peacock, W. Frank] Baylor Coll Med, Dept Emergency Med, Houston, TX 77030 USA. Alagappan, K (corresponding author), Univ Texas MD Anderson Canc Ctr, Dept Emergency Med, 1515 Holcombe Blvd,Unit 1468, Houston, TX 77030 USA. kalagappan@mdanderson.org AN - WOS:000403111100001 AU - Banala, S. R. AU - Yeung, S. C. J. AU - Rice, T. W. AU - Reyes-Gibby, C. C. AU - Wu, C. C. AU - Todd, K. H. AU - Peacock, W. F. AU - Alagappan, K. C7 - 19 DA - Jun DO - 10.1186/s12245-017-0144-9 J2 - Int. J. Emergency Medicine KW - Incidental pulmonary embolism Cancer Emergency Outpatient VENOUS THROMBOEMBOLISM OUTPATIENT TREATMENT CLINICAL CHARACTERISTICS AMERICAN-COLLEGE PHYSICIANS THROMBOSIS GUIDELINE PROGNOSIS THERAPY DISEASE Emergency Medicine LA - English M3 - Article N1 - ISI Document Delivery No.: EX3DB Times Cited: 6 Cited Reference Count: 36 Banala, Srinivas R. Yeung, Sai-Ching Jim Rice, Terry W. Reyes-Gibby, Cielito C. Wu, Carol C. Todd, Knox H. Peacock, W. Frank Alagappan, Kumar Yeung, Sai-Ching/AAP-8079-2020 National Institutes of Health (NIH) through the Cancer Center Support GrantUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [NCI P30 CA016672] The University of Texas MD Anderson Cancer Center is supported in part by the National Institutes of Health (NIH) through the Cancer Center Support Grant NCI P30 CA016672. The NIH had no role in the conduct or reporting of the study; the content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. 6 0 14 BMC LONDON INT J EMERG MED PY - 2017 SN - 1865-1372 SP - 10 ST - Discharge or admit? Emergency department management of incidental pulmonary embolism in patients with cancer: a retrospective study T2 - International Journal of Emergency Medicine TI - Discharge or admit? Emergency department management of incidental pulmonary embolism in patients with cancer: a retrospective study UR - ://WOS:000403111100001 VL - 10 ID - 761651 ER - TY - JOUR AB - Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has recently emerged as a viable management option for peritoneal surface malignancy (PSM). However, review of literature reveals a steep learning curve and high morbidity and mortality. We present our experience of first 100 cases of CRS and HIPEC. Methods: All patients PSM undergoing CRS & HIPEC between January, 2015 to June, 2018 were identified from a prospectively maintained surgical oncology database and analyzed for clinical spectrum, surgical morbidity and peri-operative mortality. Results: A total of 102 cases of PSM were identified from the database. 77.5% of the patients were females. Epithelial ovarian carcinoma (56.9%) was the most common pathology, followed by colorectal carcinoma (15.7%), pseudomyxoma peritonei (14.7%), malignant mesothelioma (7.84%). Total peritonectomy was performed in 50.9% of cases and disease specific peritonectomy in 49.1%. Optimal CRS could be achieved in 90.2% of patients. Cisplatin and mitomycin were the most common drugs used. A total of 35% of patients had morbidity including deep vein thrombosis (7.8%), sub-acute intestinal obstruction (5.9%), wound dehiscence (3.9%), lymphocele (3.9%), ureteric injury (3.9%), acute renal failure (3.9%), entero-cutaneous fistula (3.9%). The overall treatment related mortality was 2.9% (3/102). The incidence of major morbidities was relatively less and there was no mortality in last 50 cases in comparison to first 50 cases. Conclusions: The most common indication for CRS and HIPEC was carcinoma ovary followed by colorectal and appendicular neoplasms with PMP. Overall morbidity and mortality of the current series are comparable to global rates reported from high volume centers. A protocol based multidisciplinary team approach plays an important role for successful outcome in executing complex treatments like CRS and HIPEC. AD - B. Bansal, All India Institute of Medical Sciences., India AU - Bansal, B. DB - Embase DO - 10.1245/s10434-019-07174-5 KW - cisplatin mitomycin acute kidney failure adult cancer patient cancer surgery colorectal carcinoma conference abstract cytoreductive surgery deep vein thrombosis enterocutaneous fistula female human hyperthermic intraperitoneal chemotherapy intestine obstruction lymphocele major clinical study mesothelioma morbidity multidisciplinary team ovary carcinoma peritoneum pseudomyxoma prospective study surgery surgical mortality surgical oncology wound dehiscence LA - English M3 - Conference Abstract N1 - L626915351 2019-03-29 PY - 2019 SN - 1534-4681 SP - S206 ST - Cytoreductive surgery & HIPEC for peritoneal surface malignancy: Clinical spectrum, morbidity and mortality in 102 cases T2 - Annals of Surgical Oncology TI - Cytoreductive surgery & HIPEC for peritoneal surface malignancy: Clinical spectrum, morbidity and mortality in 102 cases UR - https://www.embase.com/search/results?subaction=viewrecord&id=L626915351&from=export http://dx.doi.org/10.1245/s10434-019-07174-5 VL - 26 ID - 760749 ER - TY - JOUR AU - Baram, M. AU - Awsare, B. AU - Merli, G. DA - 2020/06/02 06/02 DB - Europe PubMed Central DO - 10.1016/j.ccc.2020.02.001 M1 - 3 PY - 2020 SN - 0749-0704 SP - 427-435 ST - Pulmonary Embolism in Intensive Care Unit T2 - Crit Care Clin TI - Pulmonary Embolism in Intensive Care Unit UR - http://europepmc.org/article/MED/32473689 VL - 36 ID - 762047 ER - TY - JOUR AU - Barbaryan, A. AU - Bailuc, S. AU - Abicht, T. AU - Barsamyan, S. AU - Gizaw, Y. AU - Mirrakhimov, A. E. DA - 2019/06/13 06/13 DB - Europe PubMed Central DO - 10.1155/2019/5747598 PY - 2019 SN - 2090-6846 ST - Saddle Pulmonary Embolus Caught in Transit across a Patent Foramen Ovale T2 - Case Rep Pulmonol TI - Saddle Pulmonary Embolus Caught in Transit across a Patent Foramen Ovale UR - http://europepmc.org/article/MED/31186976 VL - 2019 ID - 762077 ER - TY - JOUR AB - Background: A meta-analysis was performed to evaluate the use of clinical pathways for hip and knee joint replacements when compared with standard medical care. The impact of clinical pathways was evaluated assessing the major outcomes of in-hospital hip and knee joint replacement processes: postoperative complications, number of patients discharged at home, length of in-hospital stay and direct costs. Methods: Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched. The search was performed from 1975 to 2007. Each study was assessed independently by two reviewers. The assessment of methodological quality of the included studies was based on the Jadad methodological approach and on the New Castle Ottawa Scale. Data analysis abided by the guidelines set out by The Cochrane Collaboration regarding statistical methods. Meta-analyses were performed using RevMan software, version 4.2. Results: Twenty-two studies met the study inclusion criteria and were included in the meta-analysis for a total sample of 6,316 patients. The aggregate overall results showed significantly fewer patients suffering postoperative complications in the clinical pathways group when compared with the standard care group. A shorter length of stay in the clinical pathway group was also observed and lower costs during hospital stay were associated with the use of the clinical pathways. No significant differences were found in the rates of discharge to home. Conclusion: The results of this meta-analysis show that clinical pathways can significantly improve the quality of care even if it is not possible to conclude that the implementation of clinical pathways is a cost-effective process, because none of the included studies analysed the cost of the development and implementation of the pathways. Based on the results we assume that pathways have impact on the organisation of care if the care process is structured in a standardised way, teams critically analyse the actual organisation of the process and the multidisciplinary team is highly involved in the re-organisation. Further studies should focus on the evaluation of pathways as complex interventions to help to understand which mechanisms within the clinical pathways can really improve the quality of care. With the need for knee and hip joint replacement on the rise, the use of clinical pathways might contribute to better quality of care and cost-effectiveness. © 2009 Barbieri et al.; licensee BioMed Central Ltd. AD - M. Panella, Department of Clinical and Experimental Medicine, University of Eastern Piedmont 'A. Avogadro', Novara, Italy AU - Barbieri, A. AU - Vanhaecht, K. AU - Van Herck, P. AU - Sermeus, W. AU - Faggiano, F. AU - Marchisio, S. AU - Panella, M. DB - Embase Medline DO - 10.1186/1741-7015-7-32 KW - article clinical effectiveness clinical evaluation clinical trial cost effectiveness analysis decubitus deep vein thrombosis health care quality hip arthroplasty hospital cost human intermethod comparison joint prosthesis knee arthroplasty length of stay lung embolism meta analysis postoperative complication postoperative infection LA - English M3 - Article N1 - L355058049 2009-09-07 PY - 2009 SN - 1741-7015 ST - Effects of clinical pathways in the joint replacement: A meta-analysis T2 - BMC Medicine TI - Effects of clinical pathways in the joint replacement: A meta-analysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L355058049&from=export http://dx.doi.org/10.1186/1741-7015-7-32 VL - 7 ID - 761272 ER - TY - JOUR AU - Barnes, Geoffrey AU - Giri, Jay AU - Courtney, D. Mark DA - 2017 DB - German National Library of Science and Technology (TIB) PY - 2017 ST - Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the National PERT™ Consortium members T2 - Taylor & Francis Verlag TI - Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the National PERT™ Consortium members UR - https://www.tib.eu/en/search/id/tandf:doi~10.1080%252F21548331.2017.1309954/Nuts-and-bolts-of-running-a-pulmonary-embolism?cHash=91577ab9d6d5d591b68e60efd00fa6e6 ID - 761957 ER - TY - JOUR AB - OBJECTIVES: Pulmonary embolism response teams (PERT) are developing rapidly to operationalize multi-disciplinary care for acute pulmonary embolism patients. Our objective is to describe the core components of PERT necessary for newly developing programs. METHODS: An online organizational survey of active National PERT™ Consortium members was performed between April and June 2016. Analysis, including descriptive statistics and Kruskal-Wallis tests, was performed on centers self-reporting a fully operational PERT program. RESULTS: The survey response rate was 80%. Of the 31 institutions that responded (71% academic), 19 had fully functioning PERT programs. These programs were run by steering committees (17/19, 89%) more often than individual physicians (2/19, 11%). Most PERT programs involved 3-5 different specialties (14/19, 74%), which did not vary based on hospital size or academic affiliation. Of programs using multidisciplinary discussions, these occurred via phone or conference call (12/18, 67%), with a minority of these utilizing 'virtual meeting' software (2/12, 17%). Guidelines for appropriate activations were provided at 16/19 (84%) hospitals. Most PERT programs offered around-the-clock catheter-based or surgical care (17/19, 89%). Outpatient follow up usually occurred in personal physician clinics (15/19, 79%) or dedicated PERT clinics (9/19, 47%), which were only available at academic institutions. CONCLUSIONS: PERT programs can be implemented, with similar structures, at small and large, community and academic medical centers. While all PERT programs incorporate team-based multi-disciplinary care into their core structure, several different models exist with varying personnel and resource utilization. Understanding how different PERT programs impact clinical care remains to be investigated. AD - a Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, Department of Internal Medicine , University of Michigan Medical School , Ann Arbor , MI , USA. b Penn Cardiovascular Outcomes, Quality and Evaluative Research Center , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA. c Department of Emergency Medicine , Northwestern University Feinberg School of Medicine , Chicago , IL , USA. d Division of Pulmonary Critical Care and Sleep Medicine , Saint Louis University School of Medicine , Saint Louis , MO , USA. e Division of Cardiology, Lancaster General Health , University of Pennsylvania Medicine , Lancaster , PA , USA. f Division of Hematology and Oncology, Department of Medicine , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA. g Division of Cardiology, Section of Vascular Medicine, Department of Medicine , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA. h Center for Vascular Emergencies, Department of Emergency Medicine , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA. AN - 28325091 AU - Barnes, G. AU - Giri, J. AU - Courtney, D. M. AU - Naydenov, S. AU - Wood, T. AU - Rosovsky, R. AU - Rosenfield, K. AU - Kabrhel, C. DA - Aug DO - 10.1080/21548331.2017.1309954 DP - NLM ET - 2017/03/23 J2 - Hospital practice (1995) KW - Academic Medical Centers/organization & administration Fibrinolytic Agents/administration & dosage Hospital Bed Capacity Humans Medicine Patient Care Team/*organization & administration Pulmonary Embolism/*drug therapy Thrombectomy/methods Thrombolytic Therapy/*methods Vena Cava Filters Pulmonary Embolism anticoagulation deep vein thrombosis thrombolysis LA - eng M1 - 3 N1 - Barnes, Geoffrey Giri, Jay Courtney, D Mark Naydenov, Soophia Wood, Todd Rosovsky, Rachel Rosenfield, Kenneth Kabrhel, Christopher National PERT™ Consortium Research Committee Journal Article England Hosp Pract (1995). 2017 Aug;45(3):76-80. doi: 10.1080/21548331.2017.1309954. Epub 2017 Mar 31. PY - 2017 SN - 2154-8331 (Print) 2154-8331 SP - 76-80 ST - Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the National PERT™ Consortium members T2 - Hosp Pract (1995) TI - Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the National PERT™ Consortium members VL - 45 ID - 760197 ER - TY - JOUR AU - Barnes, G. AU - Giri, J. AU - Courtney, D. M. AU - Naydenov, S. AU - Wood, T. AU - Rosovsky, R. AU - Rosenfield, K. AU - Kabrhel, C. AU - National, Pert™ Consortium Research Committee DA - 2017/03/22 03/22 DB - Europe PubMed Central DO - 10.1080/21548331.2017.1309954 M1 - 3 PY - 2017 SN - 2154-8331 SP - 76-80 ST - Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the National PERT™ Consortium members T2 - Hosp Pract (1995) TI - Nuts and bolts of running a pulmonary embolism response team: results from an organizational survey of the National PERT™ Consortium members UR - http://europepmc.org/article/MED/28325091 VL - 45 ID - 761958 ER - TY - JOUR AD - Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI. Electronic address: gbarnes@umich.edu. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. Division of Pulmonary Critical Care and Sleep Medicine, St. Louis University School of Medicine, St. Louis, MO. Division of Cardiology, Lancaster General Health, University of Pennsylvania Medicine, Lancaster, PA. Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Division of Cardiology, Section of Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. AN - 27938758 AU - Barnes, G. D. AU - Kabrhel, C. AU - Courtney, D. M. AU - Naydenov, S. AU - Wood, T. AU - Rosovsky, R. AU - Rosenfield, K. AU - Giri, J. DA - Dec DO - 10.1016/j.chest.2016.09.034 DP - NLM ET - 2016/12/13 J2 - Chest KW - Humans Interdisciplinary Communication Models, Organizational Patient Care Team/*organization & administration Pulmonary Embolism/*therapy United States LA - eng M1 - 6 N1 - 1931-3543 Barnes, Geoffrey D Kabrhel, Christopher Courtney, D Mark Naydenov, Soophia Wood, Todd Rosovsky, Rachel Rosenfield, Kenneth Giri, Jay National PERT Consortium Research Committee Letter United States Chest. 2016 Dec;150(6):1414-1417. doi: 10.1016/j.chest.2016.09.034. PY - 2016 SN - 0012-3692 SP - 1414-1417 ST - Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members T2 - Chest TI - Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members VL - 150 ID - 760268 ER - TY - JOUR AD - G.D. Barnes, Frankel Cardiovascular Center, University of Michigan, 2800 Plymouth Rd, Bldg 14-G101, Ann Arbor, MI, United States AU - Barnes, G. D. AU - Kabrhel, C. AU - Courtney, D. M. AU - Naydenov, S. AU - Wood, T. AU - Rosovsky, R. AU - Rosenfield, K. AU - Giri, J. AU - Balan, P. AU - Courtney, M. AU - Drooz, A. AU - Froehlich, J. AU - George, P. AU - Green, P. AU - Giordano, N. AU - Gundert, E. AU - Gupta, R. AU - Hariharan, P. AU - Harshbarger, S. AU - Hazarika, S. AU - Heresi, G. AU - Horowitz, J. AU - Jaber, W. AU - Khandhar, S. AU - Kline, J. AU - Parry, B. AU - Selim, S. AU - Sista, A. AU - Smyth, S. AU - Todoran, T. AU - Tucker, A. AU - Weinberg, M. AU - Witkin, A. DB - Embase Medline DO - 10.1016/j.chest.2016.09.034 KW - clinical protocol consultation coronary care unit Delphi study disease registry emergency medicine health care organization health program health survey hospital service human intensive care interventional cardiovascular procedure letter lung embolism medical care medical specialist online system patient care practice guideline priority journal United States LA - English M1 - 6 M3 - Letter N1 - L613605931 2016-12-14 2018-08-07 PY - 2016 SN - 1931-3543 0012-3692 SP - 1414-1417 ST - Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members T2 - Chest TI - Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613605931&from=export http://dx.doi.org/10.1016/j.chest.2016.09.034 VL - 150 ID - 760984 ER - TY - JOUR AU - Barnes, G. D. AU - Kabrhel, C. AU - Courtney, D. M. AU - Naydenov, S. AU - Wood, T. AU - Rosovsky, R. AU - Rosenfield, K. AU - Giri, J. AU - National, Pert Consortium Research Committee DA - 2016/12/13 12/13 DB - Europe PubMed Central DO - 10.1016/j.chest.2016.09.034 M1 - 6 PY - 2016 SN - 0012-3692 SP - 1414-1417 ST - Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members T2 - Chest TI - Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members UR - http://europepmc.org/article/MED/27938758 VL - 150 ID - 761932 ER - TY - JOUR AD - [Barnes, Geoffrey D.] Univ Michigan, Sch Med, Frankel Cardiovasc Ctr, Ann Arbor, MI 48109 USA. [Barnes, Geoffrey D.] Univ Michigan, Sch Med, Dept Internal Med, Inst Healthcare Policy & Innovat, Ann Arbor, MI USA. [Kabrhel, Christopher] Harvard Med Sch, Massachusetts Gen Hosp, Ctr Vasc Emergencies, Dept Emergency Med, Boston, MA USA. [Courtney, D. Mark] Northwestern Univ, Feinberg Sch Med, Dept Emergency Med, Chicago, IL 60611 USA. [Naydenov, Soophia] St Louis Univ, Sch Med, Div Pulm Crit Care & Sleep Med, St Louis, MO 63103 USA. [Wood, Todd] Univ Penn Med, Lancaster Gen Hlth, Div Cardiol, Lancaster, PA USA. [Rosovsky, Rachel] Harvard Med Sch, Massachusetts Gen Hosp, Div Hematol & Oncol, Dept Med, Boston, MA USA. [Rosenfield, Kenneth] Harvard Med Sch, Massachusetts Gen Hosp, Div Cardiol, Sect Vasc Med,Dept Med, Boston, MA USA. [Giri, Jay] Univ Penn, Perelman Sch Med, Penn Cardiovasc Outcomes Qual & Evaluat Res Ctr, Philadelphia, PA 19104 USA. Barnes, GD (corresponding author), Univ Michigan, Frankel Cardiovasc Ctr, 2800 Plymouth Rd,Bldg 14-G101, Ann Arbor, MI 48109 USA. gbarnes@umich.edu AN - WOS:000392274600051 AU - Barnes, G. D. AU - Kabrhel, C. AU - Courtney, D. M. AU - Naydenov, S. AU - Wood, T. AU - Rosovsky, R. AU - Rosenfield, K. AU - Giri, J. AU - Natl, Pert Consortium Res Comm DA - Dec DO - 10.1016/j.chest.2016.09.034 J2 - Chest KW - Critical Care Medicine Respiratory System LA - English M1 - 6 M3 - Letter N1 - ISI Document Delivery No.: EI1VQ Times Cited: 31 Cited Reference Count: 4 Barnes, Geoffrey D. Kabrhel, Christopher Courtney, D. Mark Naydenov, Soophia Wood, Todd Rosovsky, Rachel Rosenfield, Kenneth Giri, Jay Barnes, Geoffrey/AAK-1780-2020 Barnes, Geoffrey/0000-0002-6532-8440 NHLBIUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [T32-HL007853]; St. Jude MedicalSt. Jude Medical The authors have reported to CHEST the following: G. D. B. received support from NHLBI [grant T32-HL007853]. J. G. received modest research funds to the institution from St. Jude Medical. None declared (C. K., D. M. C., S. N., T. W., R. R., K. R.). 31 0 2 ELSEVIER SCIENCE BV AMSTERDAM CHEST PY - 2016 SN - 0012-3692 SP - 1414-1417 ST - Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members T2 - Chest TI - Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members UR - ://WOS:000392274600051 VL - 150 ID - 761682 ER - TY - JOUR AB - IMPORTANCE: The risk of death from acute pulmonary embolism can range as high as 15%, depending on patient factors at initial presentation. Acute treatment decisions are largely based on an estimate of this mortality risk. OBJECTIVE: To assess the performance of risk assessment scores in a modern, US cohort of patients with acute pulmonary embolism. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study was conducted between October 2016 and October 2017 at 8 hospitals participating in the Pulmonary Embolism Response Team (PERT) Consortium registry. Included patients were adults who presented with acute pulmonary embolism and had sufficient information in the medical record to calculate risk scores. Data analysis was performed from March to May 2020. MAIN OUTCOMES AND MEASURES: All-cause mortality (7- and 30-day) and associated discrimination were assessed by the area under the receiver operator curve (AUC). RESULTS: Among 416 patients with acute pulmonary embolism (mean [SD] age, 61.3 [17.6] years; 207 men [49.8%]), 7-day mortality in the low-risk groups ranged from 1.3% (1 patient) to 3.1% (4 patients), whereas 30-day mortality ranged from 2.6% (1 patient) to 10.2% (13 patients). Among patients in the highest-risk groups, the 7-day mortality ranged from 7.0% (18 patients) to 16.3% (7 patients), whereas 30-day mortality ranged from 14.4% (37 patients) to 26.3% (26 patients). Each of the risk stratification tools had modest discrimination for 7-day mortality (AUC range, 0.616-0.666) with slightly lower discrimination for 30-day mortality (AUC range, 0.550-0.694). CONCLUSIONS AND RELEVANCE: These findings suggest that commonly used risk tools for acute pulmonary embolism have modest estimating ability. Future studies to develop and validate better risk assessment tools are needed. AD - Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor. Biostatistics Center, Massachusetts General Hospital, Boston. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Department of Internal Medicine, University of Pennsylvania, Philadelphia. Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio. Division of Cardiology, Department of Internal Medicine, Emory University, Atlanta, Georgia. Division of Cardiology, Department of Internal Medicine, Lancaster General Hospital, Lancaster, Pennsylvania. Division of Cardiovascular Medicine, Department of Internal Medicine, Medical University of South Carolina, Charleston. Department of Emergency Medicine, University of Texas Southwestern, Dallas. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Cedars-Sinai Hospital, Los Angeles, California. Department of Emergency Medicine, Massachusetts General Hospital, Boston. AN - 32845326 AU - Barnes, G. D. AU - Muzikansky, A. AU - Cameron, S. AU - Giri, J. AU - Heresi, G. A. AU - Jaber, W. AU - Wood, T. AU - Todoran, T. M. AU - Courtney, D. M. AU - Tapson, V. AU - Kabrhel, C. C2 - PMC7450352 fees from Pfizer/Bristol-Myers Squib and personal fees from Janssen, Portola, and AMAG Pharmaceuticals during the conduct of the study. Dr Giri reported receiving nonfinancial support from the US PE Response Team (PERT) Consortium; personal fees from Inari Medical, Astra Zeneca, and New England Research Institute; and grants from Recor Medical and St Jude Medical outside the submitted work. Dr Jaber reported receiving personal fees from Inari Medical outside the submitted work. Dr Courtney reported receiving grants from Stago outside the submitted work. Dr Tapson reported receiving grants from BMS, Daiichi, Inari, Penumbra, and Bayer and personal fees from Janssen during the conduct of the study; he also reported being immediate past president of the PERT Consortium. Dr Kabrhel reported receiving grants from Diagnostica Stago, Siemens Healthcare Diagnostics, and Janssen and personal fees from Boston Scientific/EKOS Corp outside the submitted work. No other disclosures were reported. DA - Aug 3 DO - 10.1001/jamanetworkopen.2020.10779 DP - NLM ET - 2020/08/28 J2 - JAMA network open LA - eng M1 - 8 N1 - 2574-3805 Barnes, Geoffrey D Muzikansky, Alona Cameron, Scott Giri, Jay Heresi, Gustavo A Jaber, Wissam Wood, Todd Todoran, Thomas M Courtney, D Mark Tapson, Victor Kabrhel, Christopher Journal Article JAMA Netw Open. 2020 Aug 3;3(8):e2010779. doi: 10.1001/jamanetworkopen.2020.10779. PY - 2020 SN - 2574-3805 SP - e2010779 ST - Comparison of 4 Acute Pulmonary Embolism Mortality Risk Scores in Patients Evaluated by Pulmonary Embolism Response Teams T2 - JAMA Netw Open TI - Comparison of 4 Acute Pulmonary Embolism Mortality Risk Scores in Patients Evaluated by Pulmonary Embolism Response Teams VL - 3 ID - 760348 ER - TY - JOUR AB - National standards for physical education (PE) encompass five principles for the purpose of defining what high school students should recognize and be able to perform as a result of a quality PE program. The expectation is that youth will develop an active, healthy lifestyle into adulthood from activities and skills taught in PE. Researchers from the United Kingdom and the United States have identified team sports as the primary curricular design in high school PE. However, it has been suggested the use of team sports is not an effective way to encourage students to be physically active throughout their lives. Participants for this study were 1,034 college-aged students from a private university located in the western United States. Responses from the questionnaire (Questions 9, 12, and 14) indicated a significant difference at the p < 0.05 level when gender was compared. Cohen's d for statistically significant values indicated low to moderate practical significance. Seven open-ended questions were used to investigate in which activities students enjoyed participating during high school PE. A majority of college students reflected the desire of being taught or exposed to lifetime activities during their high school PE class. College students who were surveyed tended to want to attain skills in high school that they could use throughout their lives. Study results indicate that some college students' reflections on past PE exposure were not beneficial. AD - [Barney, David; Wilkinson, Carol; Prusak, Keven A.] Brigham Young Univ, Teacher Educ Dept, Provo, UT 84602 USA. [Pleban, Francis T.] Murray State Univ, Dept Appl Hlth Sci, Murray, KY 42071 USA. Barney, D (corresponding author), Brigham Young Univ, 249 G Smith Field House, Provo, UT 84602 USA. david_barney@byu.edu AN - WOS:000438798000007 AU - Barney, D. AU - Pleban, F. T. AU - Wilkinson, C. AU - Prusak, K. A. DA - Spr J2 - Phys. Educ.-US KW - Education & Educational Research LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: VE2KX Times Cited: 4 Cited Reference Count: 23 Barney, David Pleban, Francis T. Wilkinson, Carol Prusak, Keven A. 4 0 1 SAGAMORE PUBL LLC URBANA PHYS EDUC-US PY - 2015 SN - 2160-1682 SP - 278-293 ST - Identifying High School Physical Education Physical Activity Patterns After High School T2 - Physical Educator-Us TI - Identifying High School Physical Education Physical Activity Patterns After High School UR - ://WOS:000438798000007 VL - 72 ID - 761761 ER - TY - JOUR AB - Background: Like adults, most children have lifelong morbidity after stroke. Revascularization therapies such as intravenous tissue plasminogen activator and mechanical thrombectomy may be options to decrease this morbidity in selected children, although currently there are no evidence-based recommendations to guide treatment. The utility and safety of mechanical thrombectomy in childhood stroke is unknown because of the lack of safety trials, case-controlled trials, and comprehensive retrospective studies. As such, the current rationale for the use of mechanical thrombectomy in childhood is based on extrapolation from adult experience, as well as consensus at individual institutions with many centers deciding care on a case-by-case basis. Nevertheless, the increasing use of recanalization therapies in appropriately selected adults with acute arterial ischemic stroke has led to an increase in consideration and use in childhood, and there are enough case reports and series, as well as experience, to suggest that some children with large vessel occlusion will likely benefit. Methods: We reviewed current literature regarding mechanical thrombectomy in childhood. Results: There are differences between pediatric and adult stroke which may impact safety, efficacy, and individual decision-making, including patient size, pathophysiology of stroke, deficit, experience, and lack of data regarding natural history of stroke in children. Conclusions: Hospitals planning to perform mechanical thrombectomy in children should establish local procedures and guidelines for considering thrombectomy. In our experience, care is best provided through multidisciplinary teams including a pediatric vascular neurologist, neurointerventionalist with pediatric experience, and pediatric neurocritical care. (C) 2019 Elsevier Inc. All rights reserved. AD - [Barry, Megan; Bernard, Timothy J.] Univ Colorado, Dept Pediat, Sect Pediat Neurol, Denver, CO 80202 USA. [Hallam, Danial K.] Univ Washington, Dept Radiol, Seattle, WA 98195 USA. [Hallam, Danial K.] Univ Washington, Dept Neurol Surg, Seattle, WA 98195 USA. [Bernard, Timothy J.] Univ Colorado, Hemophilia & Thrombosis Ctr, Denver, CO 80202 USA. [Amlie-Lefond, Catherine] Univ Washington, Dept Neurol, Seattle, WA 98195 USA. Amlie-Lefond, C (corresponding author), Seattle Childrens Hosp, MB 7-420,POB 5371, Seattle, WA 98145 USA. calefond@seattlechildrens.org AN - WOS:000470803600005 AU - Barry, M. AU - Hallam, D. K. AU - Bernard, T. J. AU - Amlie-Lefond, C. DA - Jun DO - 10.1016/j.pediatrneurol.2019.01.009 J2 - Pediatr. Neurol. KW - Childhood stroke Arterial ischemic stroke Mechanical thrombectomy Recanalization therapy ACUTE ISCHEMIC-STROKE HEALTH-CARE PROFESSIONALS LARGE-VESSEL OCCLUSIONS EARLY MANAGEMENT ENDOVASCULAR TREATMENT STENT-RETRIEVER CONSCIOUS SEDATION GENERAL-ANESTHESIA RANDOMIZED-TRIAL 2018 GUIDELINES Clinical Neurology Pediatrics LA - English M3 - Review N1 - ISI Document Delivery No.: IC2QA Times Cited: 4 Cited Reference Count: 47 Barry, Megan Hallam, Danial K. Bernard, Timothy J. Amlie-Lefond, Catherine Hospital for Sick ChildrenUniversity of Toronto; Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services(HHS), Mountain States Hemophilia Network [2H30MC24049] This article is based on a presentation at the Pediatric Stroke Symposium at the Hospital for Sick Children on April 4, 2018, in honor of Dr. Gabrielle deVeber, funded by the Hospital for Sick Children. There was no other funding for this article. The authors thank Julia Lefond for editorial review. T.J.B. is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services(HHS) under grant number 2H30MC24049, Mountain States Hemophilia Network. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. 4 1 2 ELSEVIER SCIENCE INC NEW YORK PEDIATR NEUROL PY - 2019 SN - 0887-8994 SP - 19-25 ST - What is the Role of Mechanical Thrombectomy in Childhood Stroke? T2 - Pediatric Neurology TI - What is the Role of Mechanical Thrombectomy in Childhood Stroke? UR - ://WOS:000470803600005 VL - 95 ID - 761520 ER - TY - JOUR AB - Purpose of the study: The Center for Medicare and Medicaid Services recently proposed to restrict reimbursement for left atrial appendage occlusion (LAAO) to certain patient-and process-specific criteria. In 2014, NHS England imposed similar criteria limiting LAAO reimbursement to 10 selected sites as part of the Commissioning through Evaluation (CtE) process. We aimed to assess the impact of CtE on procedural and patient outcomes. Method used: To comply with stringent CtE requirements, our institution developed a multidisciplinary team (MDT) process including stroke physicians and non-invasive cardiologists to assess eligibility for LAAO. LAAO implants were co-performed by an electrophysiologist and an interventional cardiologist. Procedural and follow-up data were prospectively entered into a central NHS database. Summary of results: Between Aug 2014 and Nov 2015, 77cases were referred to MDT (age 75 + 9 yrs, 48 males). The MDT approved LAAO for 53/77 (69%) patients; 42 underwent the procedure, 8 are pendingand3 declined. Thirteen of 77 (17%) patients were started on a novel oral anticoagulant, 4/77 (5%) weremaintained on watchful waiting, and 3/77 (4%) are undergoing further tests, while4/77 (5%) referrals were deemed inappropriate. 42 patients (mean age 75 + 9 years, 25 males, median CHA2DS2VASc 4, median HASBLED 2) underwent LAAO under TEE guidance. The Amplatzer Cardiac Plug was used in 3 (7%) cases and Amplatzer Amulet in 39 (93%). Procedural success rate was 100% (procedure time 93 + 29 min, fluoro time 14 + 8 min). Hemorrhage requiring blood transfusion occurred in 2 (5%) cases;no device-related complications were seen. Clinical follow-up beyond 6 weeks is available for 36patients so far. At a median follow-up of 122 days [IQR 81-293], 31patients (86%) are free of haemorrhagic or thromboembolic events, 1 (3%) suffered a stroke 12 months post-LAAO, 3 (8%) had bleeding events, and 1 (3%) died. Of the 32 patients who have undergone follow-up imaging at 6-8 weeks, good LAA seal without any residual leak was seen in 28 (88%) and 4 (12%) patients had a small ,5 mm leak. Conclusion: The CtE process has changed our clinical practice. Careful patient selection resulted in high LAAO implant procedural success, a low complication rate and high rate of appendage seal on follow-up imaging. AD - S. Bartoletti, Liverpool, United Kingdom AU - Bartoletti, S. AU - Velavan, P. AU - Barclay, J. AU - Khalatbari, A. AU - Sharma, N. AU - Morrison, L. AU - Fairbarn, T. AU - Gupta, D. DB - Embase DO - 10.1093/europace/euw158 KW - anticoagulant agent aged atrial fibrillation bleeding blood transfusion cardiologist cerebrovascular accident clinical practice complication data base drug therapy England follow up heart atrium appendage human imaging implant major clinical study male medicaid medicare occlusion patient selection prevention reimbursement thromboembolism watchful waiting LA - English M3 - Conference Abstract N1 - L617786436 2017-08-21 PY - 2016 SN - 1532-2092 SP - i38 ST - Left atrial appendage occlusion for stroke prevention in atrial appendage occlusion for stroke prevention in atrial fibrillation: Contemporary commissioning through evaluation experience from the united kingdom T2 - Europace TI - Left atrial appendage occlusion for stroke prevention in atrial appendage occlusion for stroke prevention in atrial fibrillation: Contemporary commissioning through evaluation experience from the united kingdom UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617786436&from=export http://dx.doi.org/10.1093/europace/euw158 VL - 18 ID - 761017 ER - TY - JOUR AB - Background Since October 2014, NHS England has approved funding for left atrial appendage occlusion (LAAO) for stroke prevention in patients with atrial fibrillation in 10 UK sites as part of Commissioning through Evaluation (CtE) process. There are no data available on contemporary LAAO practice in the CtE era. Methods In July 2014, we instituted several processes to ensure compliance with stringent CtE requirements. These included creation of a multidisciplinary team (MDT) that included stroke physicians and non-invasive cardiologists with interest in cardiac imaging, agreement on objective inclusion and exclusion criteria, wide dissemination of these criteria across the cardiac/stroke network, and instituting a dedicated LAAO clinic for patient assessment pre- and post-implant. Results Between August 2014 and November 2015, 74 LAAO referrals were reviewed at MDT. LAAO was offered to 52/74 (70.3%) patients, of which 42 (56.8%) underwent the procedure, 8 (10.8%) are awaiting it, while 2 (2.7%) declined consent. A decision was taken to treat 14 (18.9%) patients with a novel oral anticoagulant (NOAC) and to maintain watchful waiting in 5 (6.8%). 3 (4.1%) referrals were felt to be inappropriate. 42 patients (mean age 75 ± 9 years, 25 males, median CHA2DS2VASc score 4, median HAS-BLED score 2) underwent LAAO under GA and TOE guidance. The Amplatzer Cardiac Plug was used in the initial 3 cases and Amplatzer Amulet in the remaining 39. Implant was successful in all cases. Mean procedure time was 93 ± 229 min and mean flouro time was 14 ± 88 min. Periprocedural haemorrhage requiring blood transfusion occurred in 2 (4.8%) cases: no other complications were observed. Patients were discharged on a 6-week course of dual antiplatelet therapy, followed by therapy with a single antiplatelet agent. To date, clinical follow-up is available for 27 patients, while most recent 14 patients are awaiting their first follow up; 1 patient has been lost to follow-up. At mean follow-up of 189 ± 119 days, 25/27 patients (92.6%) are free of haemorrhage or thromboembolic events, 1 patient suffered stroke at 12 months post-LAAO, and 1 patient died 3 weeks after the procedure. 24 patients to date have undergone follow-up imaging, 16 patients are awaiting it, and 1 patient could not tolerate TOE and is awaiting CT. 22 of these 24 (91.6%) patients imaged had good LAA seal with no residual leak, while 2 (8%) had small (<5 mm) leak. 1 patient had evidence of a laminar clot on the device and was started on a NOAC. Conclusions Contemporary LAAO implant is associated with 100% procedural success, a very low rate of complications and a high rate of LAA seal on follow up imaging. At our centre, the CtE process has been a catalyst for change and has led to streamlining processes along the entire patient journey. With good clinician engagement, it should provide informative real-life data on patient outcomes that could be used to make funding decisions for the wider NHS. AD - S. Bartoletti, Liverpool Heart and Chest Hospital, NHS Foundation Trust, United Kingdom AU - Bartoletti, S. AU - Velavan, P. AU - Barclay, J. AU - Morrison, L. AU - Khalatbari, A. AU - Fairbairn, T. AU - Sharma, N. AU - Gupta, D. DB - Embase DO - 10.1136/heartjnl-2016-309890.62 KW - antithrombocytic agent aged atrial fibrillation bleeding blood transfusion cardiac imaging cardiologist catalyst cerebrovascular accident clinical article controlled study doctor patient relationship drug therapy female follow up funding heart atrium appendage human implant male occlusion patient assessment prevention thromboembolism toe watchful waiting LA - English M3 - Conference Abstract N1 - L611887935 2016-09-02 PY - 2016 SN - 1468-201X SP - A45-A46 ST - Left atrial appendage occlusion for stroke prevention in atrial fibrillation: contemporary experience from a commissioning through evaluation site T2 - Heart TI - Left atrial appendage occlusion for stroke prevention in atrial fibrillation: contemporary experience from a commissioning through evaluation site UR - https://www.embase.com/search/results?subaction=viewrecord&id=L611887935&from=export http://dx.doi.org/10.1136/heartjnl-2016-309890.62 VL - 102 ID - 761014 ER - TY - JOUR AB - Background: The role of the pharmacist has expanded to a more clinically oriented practice in a variety of healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes. Methods: Study abstracts and full-text articles evaluating the impact of any pharmacist intervention on outcomes in patients with an acute stroke/TIA or a history of an acute stroke/ TIA were identified. A meta-analysis was not performed. Results: Twenty-six abstracts and full-text studies were included. The included studies provided evidence supporting pharmacist interventions in multiple settings including: emergency departments, inpatient, outpatient, community pharmacy, and long-term care settings. In the majority of the studies, pharmacist care was collaborative with other healthcare professionals. Some of the pharmacist interventions included participation in a stroke response team, assessment for thrombolytic use, medication reconciliation, participation in patient rounds, identification and resolution of drug therapy problems, risk factor reduction, and patient education. Examples of outcomes include a reduction in time to thrombolytic administration, increased medication adherence, patient satisfaction, and blood pressure and/or lipid control. Conclusions: The available evidence suggests that a variety of pharmacist interventions can have a positive impact on stroke patient outcomes. Further research should be conducted to add to the current body of literature. AD - J. Basaraba, Alberta Health Services, Edmonton, AB, Canada AU - Basaraba, J. AU - George-Phillips, K. AU - Mysak, T. DB - Embase KW - lipid human systematic review stroke patient cerebrovascular accident pharmacist hospital patient patient emergency ward risk factor medication compliance medication therapy management meta analysis health care personnel long term care blood pressure drug therapy pharmacy (shop) patient education patient satisfaction community outpatient health care LA - English M1 - 12 M3 - Conference Abstract N1 - L71267495 2013-12-27 PY - 2013 SN - 0039-2499 SP - e201 ST - Pharmacists as care providers for stroke patients: A systematic review T2 - Stroke TI - Pharmacists as care providers for stroke patients: A systematic review UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71267495&from=export VL - 44 ID - 761146 ER - TY - JOUR AB - BACKGROUND: Pharmacists have become an integral member of the multidisciplinary team providing clinical patient care in various healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well-established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes. METHODS: Study abstracts and full-text articles evaluating the impact of a pharmacist intervention on outcomes in patients with an acute stroke/transient ischemic attack (TIA) or a history of an acute stroke/TIA were identified and a qualitative analysis performed. RESULTS: A total of 20 abstracts and full-text studies were included. The included studies provided evidence supporting pharmacist interventions in multiple settings, including emergency departments, inpatient, outpatient, and community pharmacy settings. In a significant proportion of the studies, pharmacist care was collaborative with other healthcare professionals. Some of the pharmacist interventions included participation in a stroke response team, assessment for thrombolytic use, medication reconciliation, participation in patient rounds, identification and resolution of drug therapy problems, risk-factor reduction, and patient education. Pharmacist involvement was associated with increased use of evidence-based therapies, medication adherence, risk-factor target achievement, and maintenance of health-related quality of life. CONCLUSIONS: Available evidence suggests that a variety of pharmacist interventions can have a positive impact on stroke patient outcomes. Pharmacists should be considered an integral member of the stroke patient care team. AD - 1Faculty of Pharmacy and Pharmaceutical Sciences,University of Alberta,Edmonton,Alberta,Canada. AN - 28929979 AU - Basaraba, J. E. AU - Picard, M. AU - George-Phillips, K. AU - Mysak, T. DA - Jan DO - 10.1017/cjn.2017.233 DP - NLM ET - 2017/09/21 J2 - The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques KW - Humans *Pharmacists Pharmacy Service, Hospital/*methods Stroke/*drug therapy/psychology *Pharmacist interventions *multidisciplinary team *pharmacist *stroke LA - eng M1 - 1 N1 - Basaraba, Jade E Picard, Michelle George-Phillips, Kirsten Mysak, Tania Journal Article Systematic Review England Can J Neurol Sci. 2018 Jan;45(1):49-55. doi: 10.1017/cjn.2017.233. Epub 2017 Sep 20. PY - 2018 SN - 0317-1671 (Print) 0317-1671 SP - 49-55 ST - Pharmacists as Care Providers for Stroke Patients: A Systematic Review T2 - Can J Neurol Sci TI - Pharmacists as Care Providers for Stroke Patients: A Systematic Review VL - 45 ID - 760403 ER - TY - JOUR AB - INTRODUCTION: Inferior vena cava (IVC) filters are used to reduce the risk of thromboembolic events in subjects who are either not a candidate for anticoagulant therapy (ACT) or have failed ACT. Complications of IVC filters could be either early (bleeding, infection, acute venous thrombosis, hematoma and arteriovenous fistula formation) or late (filter migration and chronic thrombosis/recurrent thromboembolism). IVC filter penetration of the surrounding structures including bowel (duodenum), is a known although rare complication which can manifest as abdominal pain, gastrointestinal bleeding, cava-duodenal fistula, or small bowel obstruction. We present a rare case of asymptomatic duodenal penetration by IVC filter which was managed conservatively. CASE REPORT A 64-year-old male with history of multiple, recurrent DVTs and pulmonary embolism secondary to heterozygous MTHFR gene mutation presented to our facility 3 years ago for progressively worsening dysphagia. He had Greenfield IVC filter placed a few years back and was on long term ACT. Esophagogastroduodenoscopy(EGD) incidentally revealed a piece of metal protruding from the second portion of the duodenal wall, as shown in figure 1.CT scan of the abdomen and pelvis showed multiple IVC filter struts extending beyond the IVC wall with one of the struts extending anteriorly to penetrate the duodenal wall, as in figure 2. IVC venography confirmed CT scan findings, showing four struts of a patent IVC filter extending beyond the IVC wall. Vascular surgery (VS) and interventional radiology (IR) recommended conservative management in the absence of any symptoms. He remained asymptomatic for the next three years. Repeat EGD performed 3 years later revealed unchanged IVC filter strut in the duodenum, as shown in figure 3. DISCUSSION IVC filter migration into the GI tract is extremely rare and patients are usually symptomatic. Duodenum is the most common extra-caval involved organ. Current literature directs surgical treatment of patients with symptomatic duodenal perforation, however, there are no consensus guidelines for management of asymptomatic IVC filter penetrations in GI tract. Such cases should be managed by a multidisciplinary team of IR, VS and gastroenterologist. CONCLUSION Our patient was managed successfully with a non-surgical approach and remained asymptomatic during next 3 years. (Figure Presented). AD - S.A. Basit, University of Nevada, School of Medicine, Las Vegas, NV, United States AU - Basit, S. A. AU - Shah, S. R. DB - Embase DO - 10.1038/ajg.2017.325 KW - endogenous compound methylenetetrahydrofolate reductase (NADPH2) abdomen adult anticoagulant therapy case report clinical article conference abstract consensus conservative treatment duodenum perforation dysphagia esophagogastroduodenoscopy follow up gastroenterologist gastrointestinal tract gene mutation genetic association heterozygosity human interventional radiology lung embolism male middle aged patent pelvis phlebography practice guideline surgery vascular surgery vena cava filter x-ray computed tomography LA - English M3 - Conference Abstract N1 - L620840144 2018-03-01 PY - 2017 SN - 1572-0241 SP - S1353-S1354 ST - Asymptomatic duodenal penetration by inferior vena cava filter: 3-year follow-up T2 - American Journal of Gastroenterology TI - Asymptomatic duodenal penetration by inferior vena cava filter: 3-year follow-up UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620840144&from=export http://dx.doi.org/10.1038/ajg.2017.325 VL - 112 ID - 760908 ER - TY - JOUR AB - Aim of The Study: A totally implantable venous access port (TIVAP) has become an essential prerequisite for many chemotherapy protocols. It is serving its purpose very well, but its use is not without complications. We are presenting our experience with these devices (TIVAPs). Subjects and Methods: We retrospectively reviewed the totally implantable venous access ports in 81 patients at our hospital between January 2009 and March 2011 for long-term problems which include postoperative and follow-up problems, excluding the immediate complications which occur at the time of insertion. Results: Catheter malfunction was the most common complication (9.87, 0.40/1000 device-days of use/observation). Catheter-related bloodstream infections were present in 5 (6.17) patients (0.25/1000 device-days of use/observation). The mean life of the catheter was 246 days. Only 11.1 ports required removal during the treatment period. Overall, patients either completed treatment (82.8) or died (6.1) while receiving treatment. Conclusion: TIVAPs provide safe and reliable vascular access for patients on chemotherapy but require utmost care by a dedicated team of trained medical professionals and paramedics experienced with the use of such ports, in order to minimize the complications and their continued use while administering treatment. AD - [Bassi, K. K.; Giri, A. K.; Pattanayak, M.; Abraham, S. W.; Pandey, K. K.] Rockland Hosp, Dept Surg Oncol, Qutab Inst Area, New Delhi, India. Bassi, KK (corresponding author), Rockland Hosp, Dept Surg Oncol, Qutab Inst Area, New Delhi, India. bassi_kuldeep@rediffmail.com AN - WOS:000307449800019 AU - Bassi, K. K. AU - Giri, A. K. AU - Pattanayak, M. AU - Abraham, S. W. AU - Pandey, K. K. DA - Jan-Mar DO - 10.4103/0019-509x.98934 J2 - Indian J. Cancer KW - Catheter-related infections totally implantable venous access port complications of totally implantable venous access port pocket infection thrombosis of catheter RARE COMPLICATION CATHETER FRACTURE RANDOMIZED-TRIAL A-CATH DEVICES CHEMOTHERAPY EXPERIENCE GUIDELINES MANAGEMENT INFECTION Oncology LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 987WY Times Cited: 22 Cited Reference Count: 20 Bassi, K. K. Giri, A. K. Pattanayak, M. Abraham, S. W. Pandey, K. K. Pattanayak, Manisa/0000-0003-2843-9106; Bassi, Kuldeep Kumar/0000-0002-0388-1929 26 3 9 WOLTERS KLUWER MEDKNOW PUBLICATIONS MUMBAI INDIAN J CANCER PY - 2012 SN - 0019-509X SP - 114-118 ST - Totally implantable venous access ports: Retrospective review of long-term complications in 81 patients T2 - Indian Journal of Cancer TI - Totally implantable venous access ports: Retrospective review of long-term complications in 81 patients UR - ://WOS:000307449800019 VL - 49 ID - 761836 ER - TY - JOUR AB - Background: Acquired hemophilia A (AHA) is a rare bleeding disease caused by autoantibodies against factor VIII. Spontaneous bleeding symptoms usually affect the skin and muscle, while pericardial effusion is an extremely rare manifestation. In the elderly, anticoagulant treatment is frequent and bleeding symptoms are usually associated with this. Clinical findings: We report a hemorrhagic pericardial effusion as the AHA debut in a patient with untreated chronic lymphocytic leukemia and anticoagulated with apixaban for atrial fibrillation and chronic arterial ischemia. The patient was treated with recombinant activated factor VII to control the active bleeding and corticosteroids and cyclophosphamide to eradicate the inhibitor. In addition, a briefly review of hematological malignancies associated to acquired hemophilia was performed. Particularities: a) anticoagulant treatment may confuse the suspicion of AHA and its diagnosis; b) hemorrhagic pericardial effusion is an extremely rare presentation; c) bypassing agents raise the risk of thromboembolism; d) hematological malignancies rarely cause AHA (<20% of cases). Conclusion: A multidisciplinary team is needed to diagnose and manage AHA effectively. The use of anticoagulants may lead to the misdiagnosis of clinical symptoms. Chronic lymphocytic leukemia is one of the main causes of hematological malignancies associated. The specific treatment of CLL is still recommended in the event of active disease. AD - J.M. Bastida, Department of Hematology, Hospital Universitario de Salamanca-IBSAL, Paseo de San Vicente 58-182, Salamanca, Spain AU - Bastida, J. M. AU - Cano-Mozo, M. T. AU - Lopez-Cadenas, F. AU - Vallejo, V. E. AU - Merchán, S. AU - Santos-Montón, C. AU - González-Calle, D. AU - Carrillo, J. AU - Martín, A. A. AU - Torres-Hernández, J. A. AU - González, M. AU - Martín-Herrero, F. AU - Pabón, P. AU - González-Porras, J. R. DB - Embase Medline DO - 10.1097/MD.0000000000008669 KW - apixaban blood clotting factor 8 corticosteroid cyclophosphamide prednisone recombinant blood clotting factor 7a acquired hemophilia a aged anticoagulant therapy atrial fibrillation cancer patient cardiovascular risk case report chronic arterial ischemia chronic lymphatic leukemia clinical article community acquired pneumonia computer assisted tomography diagnostic error echocardiography follow up heart atrium appendage hematologic malignancy hemolytic anemia hemophilia A hemorrhagic pericardial effusion human international normalized ratio ischemia laboratory test male medical history pericardial effusion physical examination priority journal review risk factor thorax radiography thromboembolism LA - English M1 - 47 M3 - Review N1 - L619527889 2017-12-08 2017-12-13 PY - 2017 SN - 1536-5964 0025-7974 ST - Hemorrhagic pericardial effusion as the debut of acquired hemophilia in a chronic lymphocytic leukemia patient: A case report, and a review of acquired hemophilia A-related hematological malignancies T2 - Medicine (United States) TI - Hemorrhagic pericardial effusion as the debut of acquired hemophilia in a chronic lymphocytic leukemia patient: A case report, and a review of acquired hemophilia A-related hematological malignancies UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619527889&from=export http://dx.doi.org/10.1097/MD.0000000000008669 VL - 96 ID - 760895 ER - TY - JOUR AB - Introduction: A hybrid operating room (OR) is a surgical OR with integrated imaging equipment and the possibility to serve both open surgery and image-guided interventions. Aim: This study aimed to investigate the work processes and types of collaboration in a hybrid OR during endovascular aortic repair (EVAR). Methods: Data consisted of video recordings from nine procedures, with a total recording time of 48 hrs 39 mins. The procedures were divided into four episodes (Acts). A qualitative cross-case analysis was conducted, resulting in a typical case. The type of collaboration during specific tasks was discussed and determined based on Thylefors' team typology. Results: An extensive amount of safety activities occurred in the preparation phase (Acts 1 and 2), involving a number of staff categories. After the skin incision (Act 3), the main activities were performed by fewer staff categories, while some persons had a standby position and there were persons who were not at all involved in the procedure. Discussion: The different specialist staff in the hybrid OR worked through different types of collaboration: multi-, inter- and transprofessional. The level of needed collaboration depended on the activity performed, but it was largely multiprofessional and took place largely in separate groups of specialties: anesthesiology, surgery and radiology. Waiting time and overlapping tasks indicate that the procedures could be more efficient and safe for the patient. Conclusion: This study highlights that the three expertise specialties were required for safe treatment in the hybrid OR, but the extent of interprofessional activities was limited. Our results provide a basis for the development of more effective procedures with closer and more efficient interprofessional collaboration and reduction of overlapping roles. Considerable waiting times, traffic flow and presence of people who were not involved in the patient care are areas of further investigation. AD - [Bazzi, May; Lundgren, Solveig M.; Ahlberg, Karin; Bergbom, Ingegerd] Gothenburg Univ, Inst Hlth & Care Sci, Sahlgrenska Acad, Box 457, S-40530 Gothenburg, Sweden. [Hellstrom, Mikael] Gothenburg Univ, Dept Radiol, Sahlgrenska Univ Hosp, Gothenburg, Sweden. [Hellstrom, Mikael] Gothenburg Univ, Sahlgrenska Acad, Gothenburg, Sweden. [Fridh, Isabell] Univ Boras, Fac Caring Sci Work Life & Social Welf, Boras, Sweden. Bazzi, M (corresponding author), Gothenburg Univ, Inst Hlth & Care Sci, Sahlgrenska Acad, Box 457, S-40530 Gothenburg, Sweden. may.bazzi@gu.se AN - WOS:000472771300001 AU - Bazzi, M. AU - Lundgren, S. M. AU - Hellstrom, M. AU - Fridh, I. AU - Ahlberg, K. AU - Bergbom, I. DO - 10.2147/jmdh.s197727 J2 - J. Multidiscip. Healthc. KW - hybrid operating room work processes collaboration tasks video recording cross case analysis OPERATING-ROOM SURGERY Health Care Sciences & Services LA - English M3 - Article N1 - ISI Document Delivery No.: IF0MM Times Cited: 0 Cited Reference Count: 36 Bazzi, May Lundgren, Solveig M. Hellstrom, Mikael Fridh, Isabell Ahlberg, Karin Bergbom, Ingegerd Fridh, Isabell/R-8117-2018 Fridh, Isabell/0000-0002-9828-961X; Hellstrom, Mikael/0000-0003-4031-332X 0 DOVE MEDICAL PRESS LTD ALBANY J MULTIDISCIP HEALTH PY - 2019 SN - 1178-2390 SP - 453-464 ST - The drama in the hybrid OR: video observations of work processes and staff collaboration during endovascular aortic repair T2 - Journal of Multidisciplinary Healthcare TI - The drama in the hybrid OR: video observations of work processes and staff collaboration during endovascular aortic repair UR - ://WOS:000472771300001 VL - 12 ID - 761545 ER - TY - JOUR AB - Background The weekend effect describes a phenomenon whereby patients admitted to hospitals on weekends are at higher risk of complications compared to those admitted during weekdays. However, if a weekend effect exists in orthotopic liver transplantation (oLT). Methods We analyzed oLT between 2006 and 2016 and stratified patients into weekday (Monday to Friday) and weekend (Saturday, Sunday) groups. Primary outcome measures were one-year patient and graft survival. Results 364 deceased donor livers were transplanted into 329 patients with 246 weekday (74.77%) and 83 weekend (25.23%) patients. Potential confounders (e.g. age, ischemia time, MELD score) were comparable. One-year patient and graft survival were similar. Frequencies of rejections, primary-non function or re-transplantation were not different. The day of transplantation was not associated with one-year patient and graft survival in multivariate analysis. Conclusions We provide the first data for the Eurotransplant region on oLT stratified for weekend and weekday procedures and our findings suggest there was no weekend effect on oLT. While we hypothesize that the absent weekend effect is due to standardized transplant procedures and specialized multidisciplinary transplant teams, our results are encouraging showing oLT is a safe and successful procedure, independent from the day of the week. AD - [Becker, Felix; Vogel, Thomas; Voss, Thekla; Mehdorn, Anne-Sophie; Mohr, Annika; Vowinkel, Thorsten; Palmes, Daniel; Senninger, Norbert; Bahde, Ralf; Kebschull, Linus] Univ Hosp Munster, Dept Gen Visceral & Transplant Surg, Munster, Germany. [Schuette-Nuetgen, Katharina; Reuter, Stefan] Univ Hosp Munster, Div Gen Internal Med Nephrol & Rheumatol, Dept Internal Med D, Munster, Germany. [Kabar, Iyad] Univ Hosp Munster, Dept Internal Med Gastroenterol & Hepatol B, Munster, Germany. [Bormann, Eike] Univ Hosp Munster, Inst Biostat & Clin Res, Munster, Germany. Becker, F (corresponding author), Univ Hosp Munster, Dept Gen Visceral & Transplant Surg, Munster, Germany. felix.becker@ukmuenster.de AN - WOS:000433084300118 AU - Becker, F. AU - Vogel, T. AU - Voss, T. AU - Mehdorn, A. S. AU - Schutte-Nutgen, K. AU - Reuter, S. AU - Mohr, A. AU - Kabar, I. AU - Bormann, E. AU - Vowinkel, T. AU - Palmes, D. AU - Senninger, N. AU - Bahde, R. AU - Kebschull, L. C7 - e0198035 DA - May DO - 10.1371/journal.pone.0198035 J2 - PLoS One KW - IN-HOSPITAL MORTALITY PULMONARY-EMBOLISM WEEKDAY ADMISSIONS UNITED-STATES OUTCOMES GRAFT ASSOCIATION SURVIVAL STROKE DONORS Multidisciplinary Sciences LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: GH0HY Times Cited: 4 Cited Reference Count: 28 Becker, Felix Vogel, Thomas Voss, Thekla Mehdorn, Anne-Sophie Schuette-Nuetgen, Katharina Reuter, Stefan Mohr, Annika Kabar, Iyad Bormann, Eike Vowinkel, Thorsten Palmes, Daniel Senninger, Norbert Bahde, Ralf Kebschull, Linus Open Access Publication Fund of University of Munster We acknowledge support by Open Access Publication Fund of University of Munster. There was no additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 4 0 3 PUBLIC LIBRARY SCIENCE SAN FRANCISCO PLOS ONE PY - 2018 SN - 1932-6203 SP - 14 ST - The weekend effect in liver transplantation T2 - Plos One TI - The weekend effect in liver transplantation UR - ://WOS:000433084300118 VL - 13 ID - 761588 ER - TY - JOUR AB - Full Text Available The purpose is to investigate how the outcomes of a randomized controlled trial (RCT) of catheter-directed thrombolysis (CDT) versus anticoagulation alone for acute submassive PE would affect clinical decision-making. An online survey was sent to the Pulmonary Embolism Response Team Consortium members and the North American Thrombosis Forum members. Participants rated their preference for CDT on a 5-point scale in 5 RCT outcome scenarios. In all scenarios, subjects in the CDT group walked farther at 1-year than those in the anticoagulation group. A total of 83.3% of patients and 67.1% of physicians preferred CDT (score > 3) if it improved exercise capacity and did not increase bleeding. In every scenario, patients scored CDT higher than physicians (p 60 years, 65.5% < 60 years, 57.1% of men, and 66.3% of women preferred CDT across scenarios. In conclusion, the majority of respondents would choose CDT if it improves long-term exercise capacity and does not increase bleeding. Patients appear to accept a higher bleeding risk than physicians if CDT improves long-term exercise capacity. AU - Bedros, Taslakian AU - Clayton, Li AU - Samuel, Z. Goldhaber AU - Kathryn, Z. Mikkelsen AU - James, M. Horowitz AU - Christopher, Kabrhel AU - Geoffrey, D. Barnes AU - Akhilesh, K. Sista DA - 2019/02 02 DB - Directory of Open Access Journals (Sweden) DO - 10.3390/jcm8020215 KW - pulmonary embolism submassive survey M1 - 2 PY - 2019 SN - 2077-0383 ST - How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey T2 - Journal of Clinical Medicine TI - How the Results of a Randomized Trial of Catheter-Directed Thrombolysis versus Anticoagulation Alone for Submassive Pulmonary Embolism Would Affect Patient and Physician Decision Making: Report of an Online Survey UR - https://www.mdpi.com/2077-0383/8/2/215 VL - 8 ID - 762004 ER - TY - JOUR AB - This study was performed to evaluate the incidence and outcome of patients with ventricular assist devices (VADs) undergoing abdominal surgery at our institution. A total of 604 adult patients who underwent VAD implantation between February 2004 and February 2018 were analyzed retrospectively with a median follow-up time of 66 (6-174) months. Thirty-nine patients (6.5%) underwent abdominal surgery. Elective surgical procedures were performed in 22 patients (56.4%), mainly for abdominal wall hernia repairs, partial colectomies, and cholecystectomies. Early after elective abdominal surgery no patient died, resulting in a median survival of 23 (1-78) months. Emergency surgery was performed in 17 patients (43.6%). The most common emergency indications were intestinal ischemia and/or perforation. Eight patients undergoing emergent surgery (44.4%) died within the first 30 days after primary abdominal operation, mainly due to sepsis and consecutive multiple organ failure, resulting in a dismal median survival of one month (0-52). Patients undergoing abdominal surgery had significantly lower rates of realized heart-transplantation (p = 0.031) and a significantly higher rate of VAD exchange, before or after abdominal surgery, due to thromboses or infections (p = 0.037). Nonetheless, overall survival after primary VAD implantation in these patients (median 38 months; 0-107) was not significantly impaired when compared to all other patients undergoing VAD implantation (median 30 months; 0-171). In summary, elective abdominal surgery can be performed safely when well planned by an experienced multidisciplinary team. Abdominal complications in VAD patients requiring emergent surgery, however, lead to a significant increase in short-term morbidity and a high 30-day mortality rate. AD - From the Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany. Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany. AN - 32740349 AU - Beetz, O. AU - Bajunaid, A. AU - Meißler, L. AU - Vondran, F. W. R. AU - Kleine, M. AU - Cammann, S. AU - Hanke, J. S. AU - Schmitto, J. D. AU - Haverich, A. AU - Klempnauer, J. AU - Ringe, K. I. AU - Oldhafer, F. AU - Timrott, K. DA - Aug DO - 10.1097/mat.0000000000001085 DP - NLM ET - 2020/08/03 J2 - ASAIO journal (American Society for Artificial Internal Organs : 1992) LA - eng M1 - 8 N1 - 1538-943x Beetz, Oliver Bajunaid, Anwar Meißler, Luise Vondran, Florian W R Kleine, Moritz Cammann, Sebastian Hanke, Jasmin S Schmitto, Jan D Haverich, Axel Klempnauer, Jürgen Ringe, Kristina I Oldhafer, Felix Timrott, Kai Journal Article United States ASAIO J. 2020 Aug;66(8):890-898. doi: 10.1097/MAT.0000000000001085. PY - 2020 SN - 1058-2916 SP - 890-898 ST - Abdominal Surgery in Patients with Ventricular Assist Devices: a Single-Center Report T2 - Asaio j TI - Abdominal Surgery in Patients with Ventricular Assist Devices: a Single-Center Report VL - 66 ID - 760467 ER - TY - JOUR AB - This study was performed to evaluate the incidence and outcome of patients with ventricular assist devices (VADs) undergoing abdominal surgery at our institution. A total of 604 adult patients who underwent VAD implantation between February 2004 and February 2018 were analyzed retrospectively with a median follow-up time of 66 (6-174) months. Thirty-nine patients (6.5%) underwent abdominal surgery. Elective surgical procedures were performed in 22 patients (56.4%), mainly for abdominal wall hernia repairs, partial colectomies, and cholecystectomies. Early after elective abdominal surgery no patient died, resulting in a median survival of 23 (1-78) months. Emergency surgery was performed in 17 patients (43.6%). The most common emergency indications were intestinal ischemia and/or perforation. Eight patients undergoing emergent surgery (44.4%) died within the first 30 days after primary abdominal operation, mainly due to sepsis and consecutive multiple organ failure, resulting in a dismal median survival of one month (0-52). Patients undergoing abdominal surgery had significantly lower rates of realized heart-transplantation (p= 0.031) and a significantly higher rate of VAD exchange, before or after abdominal surgery, due to thromboses or infections (p= 0.037). Nonetheless, overall survival after primary VAD implantation in these patients (median 38 months; 0-107) was not significantly impaired when compared to all other patients undergoing VAD implantation (median 30 months; 0-171). In summary, elective abdominal surgery can be performed safely when well planned by an experienced multidisciplinary team. Abdominal complications in VAD patients requiring emergent surgery, however, lead to a significant increase in short-term morbidity and a high 30-day mortality rate. AD - [Beetz, Oliver; Bajunaid, Anwar; Vondran, Florian W. R.; Kleine, Moritz; Cammann, Sebastian; Klempnauer, Juergen; Oldhafer, Felix; Timrott, Kai] Hannover Med Sch, Dept Gen Visceral & Transplant Surg, Carl Neuberg Str 1, D-30625 Hannover, Germany. [Meissler, Luise; Hanke, Jasmin S.; Schmitto, Jan D.; Haverich, Axel] Hannover Med Sch, Dept Cardiothorac Transplant & Vasc Surg, Hannover, Germany. [Ringe, Kristina, I] Hannover Med Sch, Dept Diagnost & Intervent Radiol, Hannover, Germany. Beetz, O (corresponding author), Hannover Med Sch, Dept Gen Visceral & Transplant Surg, Carl Neuberg Str 1, D-30625 Hannover, Germany. Beetz.Oliver@mh-hannover.de AN - WOS:000559082900016 AU - Beetz, O. AU - Bajunaid, A. AU - Meissler, L. AU - Vondran, F. W. R. AU - Kleine, M. AU - Cammann, S. AU - Hanke, J. S. AU - Schmitto, J. D. AU - Haverich, A. AU - Klempnauer, J. AU - Ringe, K. I. AU - Oldhafer, F. AU - Timrott, K. DA - Aug DO - 10.1097/mat.0000000000001085 J2 - Asaio J. KW - abdominal complications driveline placement intestinal ischemia ventricular assist device NONCARDIAC SURGERY DRIVELINE INFECTIONS SURGICAL-PROCEDURES COMPLICATIONS REDUCTION IMPACT Engineering, Biomedical Transplantation LA - English M1 - 8 M3 - Article N1 - ISI Document Delivery No.: MZ4HL Times Cited: 0 Cited Reference Count: 38 Beetz, Oliver Bajunaid, Anwar Meissler, Luise Vondran, Florian W. R. Kleine, Moritz Cammann, Sebastian Hanke, Jasmin S. Schmitto, Jan D. Haverich, Axel Klempnauer, Juergen Ringe, Kristina, I Oldhafer, Felix Timrott, Kai 0 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA ASAIO J PY - 2020 SN - 1058-2916 SP - 890-898 ST - Abdominal Surgery in Patients with Ventricular Assist Devices: a Single-Center Report T2 - Asaio Journal TI - Abdominal Surgery in Patients with Ventricular Assist Devices: a Single-Center Report UR - ://WOS:000559082900016 VL - 66 ID - 761422 ER - TY - JOUR AB - Background and importance Midlines, peripheral venous catheters, allow prolonged administration of intravenous therapy to patients with low venous capital. It is essential to test them to limit further misuse or complications as part of the tendering procedure. Aim and objectives To assess if two midlines met the expectations of medical teams and improved patient care. Material and methods A prospective evaluation was done with Smartmidline (Vygon, G1) and ArrowMidline (Teleflex, G2) for 4 months. Midlines are given by name and placed in the operating room using a Seldinger technique. Information to nurse care services was delivered by a pharmacy intern and a public health nurse after each insertion and during changes in dressings. Medical criteria (indications, complications, catheter operating times and removal reasons) and handling criteria (evaluation sheet by installers) were listed. Results Mean age was 74±15 years (G1) and 70±17 years (G2). There were seven successful insertions and three failures due to venous access difficulties in G1; there were eight insertions in G2. Midlines were placed by anaesthetist (94% of cases) for antibiotic therapy or nutrition. Median catheter use duration was 7 (2-24) days for G1 and 15.5 (1-65) days for G2. The reasons for withdrawal were: end of treatment (28.6% G1, 37.5% G2), accidental withdrawal by the patient (28.6% G1, 12.5% G2), thrombosis (14.3% G1), clogged catheter (12.5% G2), death (12.5% G2) and worsening of health (14.3% G1). Positive opinions were expressed regarding the length of the catheter (100% G1 vs 33% G2) and ease of installation (86% G1 vs 67% G2). Comments were made for G1 ("rigid guide") and for G2 ("complexity of handling a peel-away sheath"); 80% of installers who tested both devices preferred the Smartmidline. Conclusion and relevance The various clinical situations and small number of patients made the medical criteria not relevant to make a choice. The handling criteria and practicality of the Smartmidline, as evaluated by caregivers, led to its recommendation. To secure its use, a hygiene protocol has been implemented in the hospital. To facilitate the interface between hospital and community carers, instructions for patients, doctors and pharmacists have to be reinforced. AD - P. Behague, Hôpital Saint Philibert, Service Pharmacie, Lomme, France AU - Behague, P. AU - Debailleul, M. AU - Lampe, L. AU - Garnier, N. AU - Colas, V. AU - Raoult, M. AU - Cathelineau, F. AU - Guenault, N. AU - Leclercq, V. AU - Canevet, C. AU - Floret, E. DB - Embase DO - 10.1136/ejhpharm-2020-eahpconf.47 KW - aged antibiotic therapy caregiver catheter complication conference abstract expectation female human hygiene male nurse nutrition operating room operation duration patient care pharmacist pharmacy (shop) prospective study thrombosis LA - English M1 - SUPPL 1 M3 - Conference Abstract N1 - L633108280 2020-10-21 PY - 2020 SN - 2047-9964 SP - A21-A22 ST - Referencing a midline: How to make a choice? T2 - European Journal of Hospital Pharmacy TI - Referencing a midline: How to make a choice? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633108280&from=export http://dx.doi.org/10.1136/ejhpharm-2020-eahpconf.47 VL - 27 ID - 760600 ER - TY - JOUR AB - Background: Worldwide prevalence of peripheral artery disease (PAD) is increasing and peripheral vascular intervention (PVI) has become the primary invasive treatment. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to depict practice patterns and time changes regarding MTD of different medical specialties. Methods: This is a retrospective cross-sectional study design. 20,748 invasive, percutaneous PVI of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2014. Results: MTD prior to PVI was associated with lower odds of early unsuccessful termination of the procedures (Odds Ratio 0.662, p < 0.001). The proportion of MTD decreased over the study period (30.9 % until 2009 vs. 16.6 % from 2010, p < 0.001) while rates of critical limb-threatening ischemia (34.5 % vs. 42.1 %), patients age (70 vs. 72 years), PVI below-the-knee (BTK) (13.2 % vs. 22.4 %), and rates of severe TASC C/D lesions BTK (43.2 % vs. 54.2 %) increased (all p < 0.001). Utilization of MTD was different between medical specialties with lowest frequency in procedures performed by internists when compared to other medical specialties (7.1 % vs. 25.7 %, p < 0.001). Conclusions: MTD prior to PVI is associated with technical success of the procedure. Nonetheless, rates of MTD prior to PVI are decreasing during the study period. Future studies should address the impact of multidisciplinary vascular teams on long-term outcomes. AD - C.-A. Behrendt, Department of Vascular Medicine, Working Group GermanVasc, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany AU - Behrendt, C. A. AU - Klbel, T. AU - Schwaneberg, T. AU - Diener, H. AU - Hohnhold, R. AU - Debus, E. S. AU - Rieb, H. C. DB - Embase DO - 10.1024/0301-1526/a000771 KW - adult article clinical decision making controlled study cross-sectional study endovascular surgery female Germany human interdisciplinary communication internist ischemia knee male multidisciplinary team peripheral occlusive artery disease retrospective study LA - English M1 - 3 M3 - Article N1 - L631535488 2020-04-28 PY - 2019 SN - 1664-2872 0301-1526 SP - 262-269 ST - Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes T2 - Vasa - European Journal of Vascular Medicine TI - Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631535488&from=export http://dx.doi.org/10.1024/0301-1526/a000771 VL - 48 ID - 760778 ER - TY - JOUR AB - Background: Worldwide prevalence of peripheral artery disease (PAD) is increasing and peripheral vascular intervention (PVI) has become the primary invasive treatment. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to depict practice patterns and time changes regarding MTD of different medical specialties. Methods: This is a retrospective cross-sectional study design. 20,748 invasive, percutaneous PVI of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2014. Results: MTD prior to PVI was associated with lower odds of early unsuccessful termination of the procedures (Odds Ratio 0.662, p < 0.001). The proportion of MTD decreased over the study period (30.9 % until 2009 vs. 16.6 % from 2010, p < 0.001) while rates of critical limb-threatening ischemia (34.5 % vs. 42.1 %), patients' age (70 vs. 72 years), PVI below-the-knee (BTK) (13.2 % vs. 22.4 %), and rates of severe TASC C/D lesions BTK (43.2 % vs. 54.2 %) increased (all p < 0.001). Utilization of MTD was different between medical specialties with lowest frequency in procedures performed by internists when compared to other medical specialties (7.1 % vs. 25.7 %, p < 0.001). Conclusions: MTD prior to PVI is associated with technical success of the procedure. Nonetheless, rates of MTD prior to PVI are decreasing during the study period. Future studies should address the impact of multidisciplinary vascular teams on long-term outcomes. AD - [Behrendt, Christian-Alexander; Koelbel, Tilo; Schwaneberg, Thea; Diener, Holger; Debus, Eike Sebastian; Riess, Henrik Christian] Univ Med Ctr Hamburg Eppendorf, Univ Heart Ctr Hamburg, Dept Vasc Med, Working Grp GermanVasc, Martinistr 52, D-20246 Hamburg, Germany. [Hohnhold, Ralf] EQS Hamburg, Dept Qual Assurance, Hamburg, Germany. Behrendt, CA (corresponding author), Univ Med Ctr Hamburg Eppendorf, Univ Heart Ctr Hamburg, Dept Vasc Med, Working Grp GermanVasc, Martinistr 52, D-20246 Hamburg, Germany. behrendt@hamburg.de AN - WOS:000466117900010 AU - Behrendt, C. A. AU - Kolbel, T. AU - Schwaneberg, T. AU - Diener, H. AU - Hohnhold, R. AU - Debus, E. S. AU - Riess, H. C. DA - May DO - 10.1024/0301-1526/a000771 J2 - Vasa KW - Peripheral arterial disease interdisciplinary communication registries quality of health care clinical decision making endovascular technique MANAGEMENT SURGERY DISEASE RISK Peripheral Vascular Disease LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: HV6UI Times Cited: 1 Cited Reference Count: 24 Behrendt, Christian-Alexander Koelbel, Tilo Schwaneberg, Thea Diener, Holger Hohnhold, Ralf Debus, Eike Sebastian Riess, Henrik Christian ; Behrendt, Christian-Alexander/M-2952-2017 Kreutzburg, Thea/0000-0001-7476-778X; Behrendt, Christian-Alexander/0000-0003-0406-3319 German Stifterverband; CORONA foundation The authors are grateful to all the surgeons, radiologists, internists, and colleagues from other special disciplines who registered patients in the EQS registry. The authors are grateful to the EQS-Hamburg Federal Office for Quality Insurance for supporting this quality improvement project. The authors thank the German Stifterverband and the CORONA foundation for financial support in the organization and publication of this study. E. Sebastian Debus and Henrik C. Riess contributed equally to this work. The authors would like to thank Ms. Priscilla Robinson for proof-reading and editing. 1 4 VERLAG HANS HUBER HOGREFE AG BERN 9 VASA PY - 2019 SN - 0301-1526 SP - 262-269 ST - Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes T2 - Vasa-European Journal of Vascular Medicine TI - Multidisciplinary team decision is rare and decreasing in percutaneous vascular interventions despite positive impact on in-hospital outcomes UR - ://WOS:000466117900010 VL - 48 ID - 761528 ER - TY - JOUR AB - Introduction - Worldwide prevalence of peripheral artery disease (PAD) has evolved to an intervention as the primary treatment option. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to describe practice patterns and time changes in MTD between different health-care disciplines prior to endovascular percutaneous revascularizations. Methods - Prospective, mandatory population based cross-sectional registry study design. 24,000 invasive percutaneous endovascular treatments of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2015. MTD was analyzed in relation to different sub-cohorts, health-care disciplines and relevant outcome parameters. Results - Statistically significant differences in prior MTD were found between health-care disciplines. The lowest rates of MTD were observed in procedures conducted by angiologists, internists, or cardiologists (63 vs. 97%, p <.001). The rate of MTD is decreasing during the study period, while the rate of critical limb ischemia is increasing in the same time. Considering in-hospital outcomes, significantly more procedures were aborted if no MTD was achieved, prior to intervention for either IC (4.2 vs. 2.5%, p <.001) and CLI (5.1 vs. 4.2%, p <.334). Additionally, MTD had an independent protective effect on early termination of the procedure, equivalent to technical failure (OR.660, p <.001). [Formula presented] Conclusion - This is the first large population based study on MTD during ER for PAD. Several significant differences in MTD between health-care disciplines were observed, although patient stratification was comparable. References 1. Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;382(9901):1329-40. 2. Malyar N, Fürstenberg T, Wellmann J, Meyborg M, Lüders F, Gebauer K, et al. Recent trends in morbidity and in-hospital outcomes of in-patients with peripheral arterial disease: a nationwide population-based analysis. European heart journal. 2013;34(34):2706-14. 3. Behrendt CA, Heidemann F, Haustein K, Grundmann RT, Debus ES. Gefässchirurgie. 2016. 4. Krankenhausdiagnosestatistik [Internet]. Statistisches Bundesamt DeStatis. 2014. 5. Behrendt CA, Riess HC, Heidemann F, Diener H, Rohlffs F, Hohnhold R, et al. Radiation dosage for percutaneous PAD treatment is different in cardiovascular disciplines: Results from a 11-year population based registry in the metropolitan area of Hamburg. Eur J Vasc Endovasc Surg. 2017. 6. Gouveia J, Coleman MP, Haward R, Zanetti R, Hakama M, Borras JM, et al. Improving cancer control in the European Union: conclusions from the Lisbon round-table under the Portuguese EU Presidency, 2007. Eur J Cancer. 2008;44(10):1457-62. 7. Chang JH, Vines E, Bertsch H, Fraker DL, Czerniecki BJ, Rosato EF, et al. Cancer. 2001;91(7):1231-7. 8. MRI identified prognostic features of tumors in distal sigmoid, rectosigmoid, and upper rectum: treatment with radiotherapy and chemotherapy. International journal of radiation oncology, biology, physics. 2006;65(2):445-51. 9. Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. Dis Esophagus. 2006;19(3):164-71. 1. Kim MM, Barnato AE, Angus DC, Fleisher LA, Kahn JM. Arch Intern Med. 2010;170(4):369-76. 2. Journal of the American College of Cardiology. 2004;44(4):810-9. 3. Mitchell GK, Brown RM, Erikssen L, Tieman JJ. BMC Fam Pract. 2008;9:44. AD - C.-A. Behrendt, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany AU - Behrendt, C. A. AU - Rieß, H. C. AU - Debus, E. S. DB - Embase DO - 10.1016/j.ejvs.2019.06.548 KW - adult cancer control cancer patient cancer prognosis cancer radiotherapy cancer surgery cardiologist cardiology chemotherapy conference abstract critical limb ischemia decision making esophagus cancer European Union female Germany heart hospital patient human Internet internist male morbidity multidisciplinary team nuclear magnetic resonance imaging peripheral occlusive artery disease physics prevalence prospective study radiation dose radiation oncology radiotherapy rectum revascularization risk assessment risk factor sigmoid surgery systematic review LA - English M1 - 6 M3 - Conference Abstract N1 - L2003796812 2019-12-05 PY - 2019 SN - 1532-2165 1078-5884 SP - e37-e38 ST - Do We Need Multidisciplinary Team Decisions in Vascular Care: An Insight in Endovascular Pad Treatment? T2 - European Journal of Vascular and Endovascular Surgery TI - Do We Need Multidisciplinary Team Decisions in Vascular Care: An Insight in Endovascular Pad Treatment? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003796812&from=export http://dx.doi.org/10.1016/j.ejvs.2019.06.548 VL - 58 ID - 760642 ER - TY - JOUR AB - Objectives Rapid response teams ( RRTs) respond to signs of deterioration to avoid morbidity and mortality. Early RRT activation ( eRRT) in patients admitted from the emergency department ( ED) is associated with significantly increased mortality. Predicting these events may represent an opportunity to identify patients who would benefit from further resuscitation, aid disposition decision-making, or improve communication between ED and inpatient providers. We aimed to create a clinical prediction instrument to quantify the risk of eRRT. Methods We performed an observational cohort study of patients admitted to a non-intensive care unit ( ICU) setting who triggered eRRT from January 2009 to December of 2012 compared to those who did not trigger eRRT. Age, sex, ED vital sign measurements, and final ED diagnosis by ICD-9 code were evaluated in a multivariable logistic regression model. The performance of prediction models was assessed using discrimination summarized by area under a receiver operating curve ( AUC) and calibration with the Hosmer and Lemeshow goodness-of-fit test. The final model was used to create a simplified scoring system. Results The eRRT group consisted of 474 patients who were compared to 2,575 patients in the reference group. Age and sex did not add significant discrimination to the model and were eliminated from the simplified, final model. This model, which included vital signs and diagnosis category, was found to have an AUC of 0.754 (95% confidence interval [ CI] = 0.730 to 0.778) and was used to create a simplified scoring system. The odds ratio for the association of a 1-unit increase in risk score with eRRT was 1.37 (95% CI = 1.32 to 1.41; p < 0.001). When internally validated, the score was found to have an AUC of 0.759 (95% CI = 0.735 to 0.753). Calculated scores ranged from −3 to 18, which corresponded to predicted probabilities of eRRT ranging from 5.1% to 72.2%. Conclusions In summary, the Pe RRT score is a simple tool that can be referenced by emergency providers at the bedside to quantify the risk of early RRT activation and potential deterioration, helping to answer the question, 'How likely is my patient to trigger an RRT activation in the next twelve hours?' Given that patients who trigger eRRT have an elevated risk of morbidity and mortality, higher scores should result in resuscitative intervention, further observation in the ED, consideration of ICU admission, or direct enhanced communication between ED and inpatient providers. A prospective multicenter study is required to further validate this instrument. AD - Department of Emergency Medicine, Mayo Clinic, Rochester MN Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester MN Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester MN AN - 121235413. Language: English. Entry Date: 20170215. Revision Date: 20180516. Publication Type: Article AU - Bellew, Shawna D. AU - Cabrera, Daniel AU - Lohse, Christine M. AU - Bellolio, M. Fernanda AU - Ufberg, Jacob W. DB - CINAHL DO - 10.1111/acem.13077 DP - EBSCOhost KW - Emergency Service Hospitalization Rapid Response Team Apache Hospital Mortality Human Intensive Care Units International Classification of Diseases Length of Stay Logistic Regression Probability Prospective Studies ROC Curve Severity of Illness Indices Male Female Adult Time Factors Middle Age Aged Aged, 80 and Over M1 - 2 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. PY - 2017 SN - 1069-6563 SP - 216-225 ST - Predicting Early Rapid Response Team Activation in Patients Admitted From the Emergency Department: The PeRRT Score T2 - Academic Emergency Medicine TI - Predicting Early Rapid Response Team Activation in Patients Admitted From the Emergency Department: The PeRRT Score UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=121235413&site=ehost-live&scope=site VL - 24 ID - 761364 ER - TY - JOUR AB - OBJECTIVES: Deteriorating ward patients are at increased risk. Electronic automated advisory vital signs monitors may help identify such patients and improve their outcomes. SETTING: A total of 349 beds, in 12 general wards in ten hospitals in the United States, Europe, and Australia. PATIENTS: Cohort of 18,305 patients. DESIGN: Before-and-after controlled trial. INTERVENTION: We deployed electronic automated advisory vital signs monitors to assist in the acquisition of vital signs and calculation of early warning scores. We assessed their effect on frequency, type, and treatment of rapid response team calls; survival to hospital discharge or to 90 days for rapid response team call patients; overall type and number of serious adverse events and length of hospital stay. MEASUREMENTS AND MAIN RESULTS: We studied 9,617 patients before (control) and 8,688 after (intervention) deployment of electronic automated advisory vital signs monitors. Among rapid response team call patients, intervention was associated with an increased proportion of calls secondary to abnormal respiratory vital signs (from 21% to 31%; difference [95% confidence interval] 9.9 [0.1-18.5]; p = .029). Survival immediately after rapid response team treatment and survival to hospital discharge or 90 days increased from 86% to 92% (difference [95% confidence interval] 6.3 [0.0-12.6]; p = .04). Intervention was also associated with a decrease in median length of hospital stay in all patients (unadjusted p < .0001; adjusted p = .09) and more so in U.S. patients (from 3.4 to 3.0 days; unadjusted p < .0001; adjusted ratio [95% confidence interval] 1.03 [1.00-1.06]; p = .026). The time required to complete and record a set of vital signs decreased from 4.1 ± 1.3 mins to 2.5 ± 0.5 mins (difference [95% confidence interval] 1.6 [1.4-1.8]; p < .0001). CONCLUSIONS: Deployment of electronic automated advisory vital signs monitors was associated with an improvement in the proportion of rapid response team-calls triggered by respiratory criteria, increased survival of patients receiving rapid response team calls, and decreased time required for vital signs measurement and recording (NCT01197326). Copyright © 2012 by the Society of Critical Care. AD - R. Bellomo, Department of Intensive Care (RB), Austin Health, Melbourne, Australia AU - Bellomo, R. AU - Ackerman, M. AU - Bailey, M. AU - Beale, R. AU - Clancy, G. AU - Danesh, V. AU - Hvarfner, A. AU - Jimenez, E. AU - Konrad, D. AU - Lecardo, M. AU - Pattee, K. S. AU - Ritchie, J. AU - Sherman, K. AU - Tangkau, P. DB - Embase Medline DO - 10.1097/CCM.0b013e318255d9a0 KW - NCT01197326 acute heart infarction adult article artificial ventilation blood pressure breathing rate clinical trial consciousness controlled study electrocardiogram electronics female heart arrest heart rate hospital discharge human intensive care unit kidney failure length of stay lung edema lung embolism major clinical study male monitor mortality outcome assessment patient care patient monitoring priority journal pulse oximetry sepsis cerebrovascular accident survival rate temperature measurement vital sign ward IntelliVue MP5SC LA - English M1 - 8 M3 - Article N1 - L365313237 2012-08-01 2012-08-07 PY - 2012 SN - 0090-3493 1530-0293 SP - 2349-2361 ST - A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards T2 - Critical Care Medicine TI - A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards UR - https://www.embase.com/search/results?subaction=viewrecord&id=L365313237&from=export http://dx.doi.org/10.1097/CCM.0b013e318255d9a0 VL - 40 ID - 761192 ER - TY - GEN AB - Background A relatively high mortality of severe coronavirus disease 2019 (COVID-19) is worrying, and the application of heparin in COVID-19 has been recommended by some expert consensus because of the risk of disseminated intravascular coagulation and venous thromboembolism. However, its efficacy remains to be validated. Methods Coagulation results, medications, and outcomes of consecutive patients being classified as having severe COVID-19 in Tongji hospital were retrospectively analyzed. The 28-day mortality between heparin users and nonusers were compared, as was a different risk of coagulopathy, which was stratified by the sepsis-induced coagulopathy (SIC) score or D-dimer result. Results There were 449 patients with severe COVID-19 enrolled into the study, 99 of them received heparin (mainly with low molecular weight heparin) for 7 days or longer. D-dimer, prothrombin time, and age were positively, and platelet count was negatively, correlated with 28-day mortality in multivariate analysis. No difference in 28-day mortality was found between heparin users and nonusers (30.3% vs 29.7%, P = .910). But the 28-day mortality of heparin users was lower than nonusers in patients with SIC score ≥4 (40.0% vs 64.2%, P = .029), or D-dimer >6-fold of upper limit of normal (32.8% vs 52.4%, P = .017). Conclusions Anticoagulant therapy mainly with low molecular weight heparin appears to be associated with better prognosis in severe COVID-19 patients meeting SIC criteria or with markedly elevated D-dimer. AU - Benjamin, Kwok AU - Shari, B. Brosnahan AU - Nancy, E. Amoroso AU - Ronald, M. Goldenberg AU - Brooke, Heyman AU - James, M. Horowitz AU - Catherine, Jamin AU - Akhilesh, K. Sista AU - Deane, E. Smith AU - Eugene, Yuriditsky AU - Thomas, S. Maldonado DA - 2020/10/02 DB - OpenAIRE PY - 2020 ST - Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy TI - Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy UR - https://explore.openaire.eu/search/publication?articleId=dedup_wf_001::25867fce874eebf85f7592f9e8626bbb ID - 762013 ER - TY - JOUR AB - OBJECT.: As more pediatric neurosurgeons become involved with fetal myelomeningocele closure efforts, examining refined techniques in the overall surgical approach that could maximize beneficial outcomes becomes critical. The authors compared outcomes for patients who had undergone a modified technique with those for patients who had undergone fetal repair as part of the earlier Management of Myelomeningocele Study (MOMS). METHODS: Demographic and outcomes data were collected for a series of 43 delivered patients who had undergone in utero myelomeningocele closure at the Fetal Center at Vanderbilt from March 2011 through January 2013 (the study cohort) and were compared with data for 78 patients who had undergone fetal repair as part of MOMS (the MOMS cohort). For the study cohort, no uterine trocar was used, and uterine entry, manipulation, and closure were modified to minimize separation of the amniotic membrane. Weekly ultrasound reports were obtained from primary maternal-fetal medicine providers and reviewed. A test for normality revealed that distribution for the study cohort was normal; therefore, parametric statistics were used for comparisons. RESULTS: The incidence of premature rupture of membranes (22% vs 46%, p = 0.011) and chorioamnion separation (0% vs 26%, p < 0.001) were lower for the study cohort than for the MOMS cohort. Incidence of oligohydramnios did not differ between the cohorts. The mean (± SD) gestational age of 34.4 (± 6.6) weeks for the study cohort was similar to that for the MOMS cohort (34.1 ± 3.1 weeks). However, the proportion of infants born at term (37 weeks or greater) was significantly higher for the study cohort (16 of 41; 39%) than for the MOMS cohort (16 of 78; 21%) (p = 0.030). Compared with 10 (13%) of 78 patients in the MOMS cohort, only 2 (4%) of 41 infants in the study cohort were delivered earlier than 30 weeks of gestation (p = 0.084, approaching significance). For the study cohort, 2 fetal deaths were attributed to the intervention, and both were believed to be associated with placental disruption; one of these mothers had previously unidentified thrombophilia. Mortality rates did not statistically differ between the cohorts. CONCLUSIONS: These early results suggest that careful attention to uterine entry, manipulation, and closure by the surgical team can result in a decreased rate of premature rupture of membranes and chorioamnion separation and can reduce early preterm delivery. Although these results are promising, their confirmation will require further study of a larger series of patients. AD - Department of Obstetrics and Gynecology. AN - 24784979 AU - Bennett, K. A. AU - Carroll, M. A. AU - Shannon, C. N. AU - Braun, S. A. AU - Dabrowiak, M. E. AU - Crum, A. K. AU - Paschall, R. L. AU - Kavanaugh-McHugh, A. L. AU - Wellons, J. C., 3rd AU - Tulipan, N. B. DA - Jul DO - 10.3171/2014.3.peds13266 DP - NLM ET - 2014/05/03 J2 - Journal of neurosurgery. Pediatrics KW - Adult Cesarean Section Female Fetal Diseases/*surgery Fetal Membranes, Premature Rupture/*prevention & control Fetus/pathology/*surgery Gestational Age Humans Interdisciplinary Communication Meningomyelocele/*surgery Microsurgery Neurosurgical Procedures/*adverse effects/*methods *Patient Care Team Pregnancy Pregnancy Outcome Premature Birth/*prevention & control Prospective Studies Treatment Outcome Ultrasonography, Prenatal Uterus/surgery MOMS = Management of Myelomeningocele Study fetal surgery in utero fetal repair of myelomeningocele spina bifida repair technique LA - eng M1 - 1 N1 - 1933-0715 Bennett, Kelly A Carroll, Mary Anne Shannon, Chevis N Braun, Stephane A Dabrowiak, Mary E Crum, Alicia K Paschall, Ray L Kavanaugh-McHugh, Ann L Wellons, John C 3rd Tulipan, Noel B 1 UL1 TR000445/TR/NCATS NIH HHS/United States 1 UL1RR024975/RR/NCRR NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Video-Audio Media United States J Neurosurg Pediatr. 2014 Jul;14(1):108-14. doi: 10.3171/2014.3.PEDS13266. Epub 2014 May 2. PY - 2014 SN - 1933-0707 SP - 108-14 ST - Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique T2 - J Neurosurg Pediatr TI - Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique VL - 14 ID - 760464 ER - TY - JOUR AB - Object. As more pediatric neurosurgeons become involved with fetal myelomeningocele closure efforts, examining refined techniques in the overall surgical approach that could maximize beneficial outcomes becomes critical. The authors compared outcomes for patients who had undergone a modified technique with those for patients who had undergone fetal repair as part of the earlier Management of Myelomeningocele Study (MOMS). Methods. Demographic and outcomes data were collected for a series of 43 delivered patients who had undergone in utero myelomeningocele closure at the Fetal Center at Vanderbilt from March 2011 through January 2013 (the study cohort) and were compared with data for 78 patients who had undergone fetal repair as part of MOMS (the MOMS cohort). For the study cohort, no uterine trocar was used, and uterine entry, manipulation, and closure were modified to minimize separation of the amniotic membrane. Weekly ultrasound reports were obtained from primary maternal-fetal medicine providers and reviewed. A test for normality revealed that distribution for the study cohort was normal; therefore, parametric statistics were used for comparisons. Results. The incidence of premature rupture of membranes (22% vs 46%, p = 0.011) and chorioamnion separation (0% vs 26%, p < 0.001) were lower for the study cohort than for the MOMS cohort. Incidence of oligohydramnios did not differ between the cohorts. The mean (+/- SD) gestational age of 34.4 (+/- 6.6) weeks for the study cohort was similar to that for the MOMS cohort (34.1 +/- 3.1 weeks). However, the proportion of infants born at term (37 weeks or greater) was significantly higher for the study cohort (16 of 41; 39%) than for the MOMS cohort (16 of 78; 21%) (p = 0.030). Compared with 10 (13%) of 78 patients in the MOMS cohort, only 2 (4%) of 41 infants in the study cohort were delivered earlier than 30 weeks of gestation (p = 0.084, approaching significance). For the study cohort, 2 fetal deaths were attributed to the intervention, and both were believed to be associated with placental disruption; one of these mothers had previously unidentified thrombophilia. Mortality rates did not statistically differ between the cohorts. Conclusions. These early results suggest that careful attention to uterine entry, manipulation, and closure by the surgical team can result in a decreased rate of premature rupture of membranes and chorioamnion separation and can reduce early preterm delivery. Although these results are promising, their confirmation will require further study of a larger series of patients. AD - [Bennett, Kelly A.; Carroll, Mary Anne] Vanderbilt Univ, Sch Med, Monroe Carell Jr Childrens Hosp Vanderbilt, Dept Obstet & Gynecol, Nashville, TN 37232 USA. [Bennett, Kelly A.; Carroll, Mary Anne; Dabrowiak, Mary E.; Crum, Alicia K.] Vanderbilt Univ, Sch Med, Monroe Carell Jr Childrens Hosp Vanderbilt, Fetal Ctr Vanderbilt, Nashville, TN 37232 USA. [Shannon, Chevis N.; Wellons, John C., III; Tulipan, Noel B.] Vanderbilt Univ, Sch Med, Monroe Carell Jr Childrens Hosp Vanderbilt, Dept Neurosurg, Nashville, TN 37232 USA. [Braun, Stephane A.] Vanderbilt Univ, Sch Med, Monroe Carell Jr Childrens Hosp Vanderbilt, Dept Plast Surg, Nashville, TN 37232 USA. [Paschall, Ray L.] Vanderbilt Univ, Sch Med, Monroe Carell Jr Childrens Hosp Vanderbilt, Dept Anesthesiol, Nashville, TN 37232 USA. [Kavanaugh-McHugh, L.] Vanderbilt Univ, Sch Med, Monroe Carell Jr Childrens Hosp Vanderbilt, Dept Pediat,Div Pediat Cardiol, Nashville, TN 37232 USA. Wellons, JC (corresponding author), Vanderbilt Univ, Sch Med, Dept Neurosurg, 9226 Doctors Off Tower,2200 Childrens Way, Nashville, TN 37232 USA. john.wellons@vanderbilt.edu AN - WOS:000337935500016 AU - Bennett, K. A. AU - Carroll, M. A. AU - Shannon, C. N. AU - Braun, S. A. AU - Dabrowiak, M. E. AU - Crum, A. K. AU - Paschall, R. L. AU - Kavanaugh-McHugh, L. AU - Wellons, J. C. AU - Tulipan, N. B. DA - Jul DO - 10.3171/2014.3.peds13266 J2 - J. Neurosurg.-Pediatr. KW - fetal surgery in utero fetal repair of myelomeningocele spina bifida repair technique SHUNT-DEPENDENT HYDROCEPHALUS SPINA-BIFIDA SURGERY EXPERIENCE COVERAGE REPAIR Clinical Neurology Pediatrics Surgery LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: AJ8EM Times Cited: 34 Cited Reference Count: 15 Bennett, Kelly A. Carroll, Mary Anne Shannon, Chevis N. Braun, Stephane A. Dabrowiak, Mary E. Crum, Alicia K. Paschall, Ray L. Kavanaugh-McHugh, L. Wellons, John C., III Tulipan, Noel B. National Center for Research Resources/National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Research Resources (NCRR) [1 UL1 RR024975]; National Center for Advancing Translational Sciences/National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Advancing Translational Sciences (NCATS) [1 UL1 TR000445] The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Clinical Translational Scientific Award assistance (1 UL1 RR024975) was received from the National Center for Research Resources/National Institutes of Health for support of a patient database (by Dr. Kelly Bennett). In addition, 1 UL1 TR000445 received from the National Center for Advancing Translational Sciences/National Institutes of Health is referenced because of the use of REDCap. 35 0 AMER ASSOC NEUROLOGICAL SURGEONS ROLLING MEADOWS J NEUROSURG-PEDIATR PY - 2014 SN - 1933-0707 SP - 108-114 ST - Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique Clinical article T2 - Journal of Neurosurgery-Pediatrics TI - Reducing perinatal complications and preterm delivery for patients undergoing in utero closure of fetal myelomeningocele: further modifications to the multidisciplinary surgical technique Clinical article UR - ://WOS:000337935500016 VL - 14 ID - 761776 ER - TY - JOUR AB - Learning Objectives: During 2016, CCHS discharged 717 patients with a Pulmonary Embolism (PE) diagnosis with a Mortality Index of 1.13 and Percent Early Death rate of 2.51%. 26.4% were admitted to the ICU, with a mean stay of 5.01 days. The length of stay (LOS) O/E ratio is 1.35. PE is a commonly under-diagnosed and lethal entity. The medical community is increasingly aware of the category of submassive PE depicted by clinical markers, imaging, and biomarkers. Clot burden, laboratory data, and clinical picture are utilized for decision making, treatment and disposition. In response, Christiana Care joined the PERT Consortium and implemented a multi-disciplinary Pulmonary Embolism Response Team (PERT) to make rapid clinical assessments and consistently provide the full range of therapeutic options for massive and sub-massive PE's. Methods: Following review of literature, clinical leadership defined the clinical criteria (lab/test results, heart rate, SBP, SaO2) that are required to call a PERT Alert. Utilizing Vocera, a PERT Alert brings together the initiating provider, Pulmonary Intensivist and VIR physician on a 24/7 dedicated conference line within 15 minutes to review the patient's clinical status, labs and test results to collaboratively determine the best treatment plan, timing and disposition. A PERT Alert template was established containing pertinent patient demographic information and required communication elements. PERT Alert go live was January 23, 2017. Case reviews are conducted during monthly team meetings to assess and monitor the appropriateness of PERT Alerts. Results: 239 PERT Alerts have been initiated. Utilizing a PERT log, the process is monitored for continuous performance improvement and assists with data collection. Comparison of Vizient data 2016 to 2017 shows reductions in % ICU, Mean ICU Days, % Deaths OBS, Mortality Index, % Early Death and Mean Length of Stay. Data comparing PERT Alert patients who received catheter directed PE lysis to 2016 catheter directed PE lysis patients shows a positive trend with a 7% reduction in ICU LOS and a 67% decrease (33% annualized) in the number of patients who transferred to an ICU. Conclusions: The PERT Alert brings together a multidisciplinary team to assess and coordinate the treatment of submassive and massive PE patients in a rapid, collaborative manner. Path forward includes the creation of a PERT Alert progress note template, joining the PERT Consortium database, continuing post discharge follow up, and quality/safety. AD - M. Benninghoff, Coatesville, PA, United States AU - Benninghoff, M. AU - Gajera, M. AU - Gaskill, N. AU - Burgess, B. AU - Graif, A. AU - Kimbiris, G. DB - Embase KW - biological marker adult arterial oxygen saturation case study catheter clinical assessment conference abstract congenital central hypoventilation syndrome decision making female follow up heart rate human intensivist laboratory test leadership learning length of stay literature male mortality rate pulmonary embolism response team systematic review systolic blood pressure LA - English M1 - 1 M3 - Conference Abstract N1 - L629630267 2019-10-23 PY - 2019 SN - 1530-0293 ST - Be on the alert with pert: One year in T2 - Critical Care Medicine TI - Be on the alert with pert: One year in UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629630267&from=export VL - 47 ID - 760772 ER - TY - JOUR AB - Key Points: Question: How closely does documentation in electronic health records match the review of systems and physical examination performed by emergency physicians? Findings: In this case series of 9 licensed emergency physician trainees and 12 observers of 180 patient encounters, 38.5% of the review of systems groups and 53.2% of the physical examination systems documented in the electronic health record were corroborated by direct audiovisual or reviewed audio observation. Meaning: These findings raise the possibility that some physician documentation may not accurately represent actions taken, but further research is needed to assess this in more detail. This case series study examines how closely documentation in electronic health records matches the review of systems and physical examination performed by emergency physicians. Importance: Following the adoption of electronic health records into a regulatory environment designed for paper records, there has been little investigation into the accuracy of physician documentation. Objective: To quantify the percentage of emergency physician documentation of the review of systems (ROS) and physical examination (PE) that observers can confirm. Design, Setting, and Participants: This case series took place at emergency departments in 2 academic medical centers between 2016 and 2018. Participants' patient encounters were observed to compare real-time performance with clinical documentation. Exposures: Resident physicians were shadowed by trained observers for 20 encounters (10 encounters per physician per site) to obtain real-time observational data; associated electronic health record data were subsequently reviewed. Main Outcomes and Measures: Number of confirmed ROS systems (range, 0-14) divided by the number of documented ROS systems (range, 0-14), and number of confirmed PE systems (range, 0-14) divided by the number of documented PE systems (range, 0-14). Results: The final study cohort included 9 licensed emergency medicine residents who evaluated a total of 180 patients (mean [SD] age, 48.7 [20.0] years; 91 [50.5%] women). For ROS, physicians documented a median (interquartile range [IQR]) of 14 (8-14) systems, while audio recordings confirmed a median (IQR) of 5 (3-6) systems. Overall, 755 of 1961 documented ROS systems (38.5%) were confirmed by audio recording data. For PE, resident physicians documented a median (IQR) of 8 (7-9) verifiable systems, while observers confirmed a median (IQR) of 5.5 (3-6) systems. Overall, 760 of 1429 verifiable documented PE systems (53.2%) were confirmed by concurrent observation. Interrater reliability for rating of ROS and PE was more than 90% for all measures. Conclusions and Relevance: In this study of 9 licensed year emergency medicine residents, there were inconsistencies between the documentation of ROS and PE findings in the electronic health record and observational reports. These findings raise the possibility that some documentation may not accurately represent physician actions. Further studies should be undertaken to determine whether this occurrence is widespread. However, because such studies are unlikely to be performed owing to institution-level barriers that exist nationwide, payers should consider removing financial incentives to generate lengthy documentation. AD - National Clinician Scholars Program, University of California, Los Angeles Olive View, Department of Emergency Medicine, University of California, Los Angeles Alameda Health System, Department of Emergency Medicine, Highland Hospital, Oakland, California University of California, Santa Cruz University of California, Los Angeles Department of Radiological Sciences, Stanford University, Stanford, California Department of Emergency Medicine, University of California, Los Angeles AN - 138731745. Language: English. Entry Date: 20190926. Revision Date: 20191018. Publication Type: Article AU - Berdahl, Carl T. AU - Moran, Gregory J. AU - McBride, Owen AU - Santini, Alexandra M. AU - Verzhbinsky, Ilya A. AU - Schriger, David L. DB - CINAHL DO - 10.1001/jamanetworkopen.2019.11390 DP - EBSCOhost KW - Documentation -- Standards Physicians, Emergency -- Psychosocial Factors Physical Examination Human Male Female Adult Middle Age Aged Academic Medical Centers Electronic Health Records Audiorecording Outcome Assessment Descriptive Statistics Interrater Reliability Data Analysis Software M1 - 9 N1 - research; tables/charts. PY - 2019 SP - e1911390-e1911390 ST - Concordance Between Electronic Clinical Documentation and Physicians' Observed Behavior T2 - JAMA Network Open TI - Concordance Between Electronic Clinical Documentation and Physicians' Observed Behavior UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=138731745&site=ehost-live&scope=site VL - 2 ID - 761312 ER - TY - JOUR AB - Physical examination (PE) is a core clinical competency, and the internal medicine clerkship is a premiere venue for students to develop PE skills. However, clinical rotations often lack opportunities for real-time instruction. We sought to measure the frequency, content, and factors affecting PE instruction during the internal medicine clerkship. We conducted a prospective mixed-methods study at a single academic center. Data were gathered by a student researcher who directly observed inpatient teams over 3 months. We quantified the frequency of PE teaching activities and analyzed daily written observations using qualitative content analysis. PE was most frequently discussed during bedside rounds and least often during workroom rounds. Direct observation of students' examinations rarely occurred. Multiple factors in the learning environment were posited to affect PE instruction. In brief, we found that residents and attending physicians who are part of internal medicine teaching services do not routinely emphasize PE instruction. AD - Medical College of Wisconsin Affiliated Hospitals, Milwaukee, Wisconsin, USA. pbergl@mcw.edu. Medical College of Wisconsin, Milwaukee, Wisconsin, USA. AN - 29858550 AU - Bergl, P. A. AU - Taylor, A. C. AU - Klumb, J. AU - Quirk, K. AU - Muntz, M. D. AU - Fletcher, K. E. DA - Jun DO - 10.12788/jhm.2972 DP - NLM ET - 2018/06/03 J2 - Journal of hospital medicine KW - Clinical Clerkship/*standards Clinical Competence/standards Hospitals Humans Inpatients Internal Medicine/education Patient Care Team/standards Physical Examination/*methods Prospective Studies *Students, Medical *Teaching Rounds LA - eng M1 - 6 N1 - 1553-5606 Bergl, Paul A Taylor, Allison C Klumb, Jennifer Quirk, Kerrie Muntz, Martin D Fletcher, Kathlyn E Journal Article Research Support, Non-U.S. Gov't United States J Hosp Med. 2018 Jun;13(6):399-402. doi: 10.12788/jhm.2972. PY - 2018 SN - 1553-5592 SP - 399-402 ST - Teaching Physical Examination to Medical Students on Inpatient Medicine Teams: A Prospective, Mixed-Methods Descriptive Study T2 - J Hosp Med TI - Teaching Physical Examination to Medical Students on Inpatient Medicine Teams: A Prospective, Mixed-Methods Descriptive Study VL - 13 ID - 760277 ER - TY - JOUR AB - BACKGROUND: To compare modern endovascular therapies in the acute ischemic stroke patients leading to more comprehensive acute stroke algorithm. METHODS: A 2-year retrospective nonrandomized study on 76 patients who were placed into 5 different treatment groups for acute ischemic stroke. These groups included: group 1 (no treatment) (n = 24), group 2 (intravenous tissue plasminogen activator [tPA] only) (n = 18), group 3 (intra-arterial [IA] tPA) (n = 9), group 4 (Mechanical Embolus Removal in Cerebral Ischemia [MERCI]; retrieval only) (n = 17), and group 5 (combined IA/MERCI) (n = 8). Age range for all groups was 29-92 years. There were 39 women (51.3%) and 37 men (48.7%). The mean age for all patients was 70.1 years. The pre- and post-National Institutes of Health Stroke Scale (NIHSS) values were obtained for each group on arrival and discharge from the hospital. The results of the 4 treatment cohorts were compared with the no treatment group, providing the relative efficacy of these procedures compared with conservative medical therapy alone. RESULTS: Group 1 presented with an admission NIHSS value of 11.1 and 8.9 on discharge from the hospital. There was a NIHSS reduction of 2.2 without treatment. Group 2 had an admission NIHSS value of 11.8 and a discharge value of 4.7, resulting in an NIHSS reduction of 7.1. Group 3 had an admission NIHSS value of 16.1 and 7.4 at discharge, resulting in an NIHSS reduction of 8.7. Group 4 had an admission NIHSS value of 15.9 and discharge NIHSS value of 3.1, with an NIHSS reduction of 12.8. Group 5 had an admission NIHSS score of 15.7 and 10.6 at discharge, with an NIHSS reduction of 5.1. Four patients expired during their admission, 2 from group 1 (control group) and 2 from group 5 (combined IA/MERCI group). There was a statistically significant difference for the 5 groups at the P < .05 level in change in NIHSS scores: F (4, 24) = 9.10, P = .000. CONCLUSIONS: Modern endovascular therapies for acute ischemic stroke do improve clinical outcomes when implemented in the setting of a dedicated comprehensive stroke team. AD - Department of Neurointerventional Radiology and Neuroscience Center, St. Joseph's Hospital and Medical Center, Tampa, Florida. Electronic address: mberlet@tampabay.rr.com. Department of Neurointerventional Radiology and Neuroscience Center, St. Joseph's Hospital and Medical Center, Tampa, Florida. AN - 24011839 AU - Berlet, M. H. AU - Stambo, G. W. AU - Kelley, M. AU - Van Epps, K. AU - Woeste, T. AU - Steffen, D. DA - May-Jun DO - 10.1016/j.jstrokecerebrovasdis.2013.07.016 DP - NLM ET - 2013/09/10 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Adult Aged Aged, 80 and over Algorithms Brain Ischemia/diagnosis/mortality/*therapy Combined Modality Therapy *Community Health Services Critical Pathways Disability Evaluation *Endovascular Procedures/adverse effects/mortality Female Fibrinolytic Agents/administration & dosage Hospital Mortality Humans Infusions, Intra-Arterial Infusions, Intravenous Male Middle Aged *Outcome and Process Assessment, Health Care Patient Care Team Quality Improvement Quality Indicators, Health Care Retrospective Studies Severity of Illness Index Stroke/diagnosis/mortality/*therapy *Thrombolytic Therapy/adverse effects/methods/mortality Time Factors Tissue Plasminogen Activator/administration & dosage Treatment Outcome CT perfusion Merci Nihss penumbra tPA LA - eng M1 - 5 N1 - 1532-8511 Berlet, Matthew H Stambo, Glenn W Kelley, Merle Van Epps, Kelly Woeste, Troy Steffen, Diana Comparative Study Journal Article United States J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):869-78. doi: 10.1016/j.jstrokecerebrovasdis.2013.07.016. Epub 2013 Sep 5. PY - 2014 SN - 1052-3057 SP - 869-78 ST - Does modern ischemic stroke therapy in a large community-based dedicated stroke center improve clinical outcomes? A two-year retrospective study T2 - J Stroke Cerebrovasc Dis TI - Does modern ischemic stroke therapy in a large community-based dedicated stroke center improve clinical outcomes? A two-year retrospective study VL - 23 ID - 760490 ER - TY - JOUR AB - OBJECTIVES: There is a significant global burden of preventable morbidity and mortality after surgery caused by avoidable adverse events. Venous thromboembolism (VTE) prophylaxis, despite evidence for its efficacy, is not reliably and consistently prescribed, and is currently a serious concern for patient safety. The aim of this study was to prospectively audit errors captured by an extended surgical time out checklist and relate them to the introduction of a safety culture. METHODS: The use of an extended surgical time out checklist was prospectively audited, in consecutive patients in one operating theatre over a period of two years. Errors captured were analysed and related to other improvements to safety culture; human factors training, debriefing and regular departmental meetings. RESULTS: Time out was performed in 959 patients of 990 (96.8%) undergoing thoracic surgery. Performance was consistent over time. Errors were categorized as VTE prophylaxis (n = 53, 6%), blood products (n = 11), clerical (n = 5), imaging (n = 2) and miscellaneous (n = 2). After a lag period of 15 months, during which the team underwent human factors training, introduced debriefing and escalated VTE prophylaxis to regular departmental meetings, VTE prophylaxis errors were substantially reduced. The temporal relationship between error capture and error elimination is explored. CONCLUSIONS: Use of checklists alongside appropriate human factors training, debriefing and regular multidisciplinary communication can substantially improve VTE prophylaxis in patients undergoing surgery. AD - Department of Thoracic Surgery, Royal Devon and Exeter NHS Foundation Trust, Devon, UK. richard.berrisford@nhs.net AN - 22219459 AU - Berrisford, R. G. AU - Wilson, I. H. AU - Davidge, M. AU - Sanders, D. DA - Jun DO - 10.1093/ejcts/ezr179 DP - NLM ET - 2012/01/06 J2 - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery KW - *Checklist England *Feedback Guideline Adherence Humans Medical Audit Medical Errors/classification/prevention & control Patient Care Team/organization & administration Prospective Studies Safety Management/organization & administration Thoracic Surgical Procedures/*adverse effects Venous Thromboembolism/etiology/*prevention & control LA - eng M1 - 6 N1 - 1873-734x Berrisford, Richard G Wilson, Iain H Davidge, Mike Sanders, David Journal Article Germany Eur J Cardiothorac Surg. 2012 Jun;41(6):1326-9. doi: 10.1093/ejcts/ezr179. Epub 2011 Dec 26. PY - 2012 SN - 1010-7940 SP - 1326-9 ST - Surgical time out checklist with debriefing and multidisciplinary feedback improves venous thromboembolism prophylaxis in thoracic surgery: a prospective audit T2 - Eur J Cardiothorac Surg TI - Surgical time out checklist with debriefing and multidisciplinary feedback improves venous thromboembolism prophylaxis in thoracic surgery: a prospective audit VL - 41 ID - 760215 ER - TY - JOUR AB - Introduction: Catastrophic antiphospholipid syndrome (CAPS) is a rapidly progressive life-threatening disease characterized by multiple organ failure in presence of antiphospholipid antibodies. Therapy is based on anticoagulation with intravenous (IV) heparin, immunosuppressors, IV immunoglobulins, and plasmapheresis. Nevertheless, the course of the disease is sometimes hyperacute and the high mortality rate is primarily due to acute cardiopulmonary failure. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may effectively support cardiorespiratory function and acts as a bridge to recovery. Description: A 29-year-old woman with history of Antiphospholipid Syndrome (APS), past pulmonary, cerebral and skin vasculitis, presented to our hospital with epigastric pain and fever. After 7 days she had chest pain with ECG sinus tachycardia, anterolateral ST segment depression, serum Troponin T elevation and global hypokinesis with 40% left ventricular ejection fraction (LVEF) on echocardiography. The clinical scenario rapidly deteriorated with severe acute respiratory failure with cardiogenic shock (LVEF 20%) and acute kidney injury with anuria, refractory to mechanical ventilation, inotropes, and diuretics. Coronary angiography yielded normal results and myocardial biopsy was performed. Femoro-femoral VA-ECMO was initiated. Blood flow was 2.5 L/min/m2. After initial hemodynamic stabilization, we tried to identify the heart failure (HF) etiology. Differential diagnosis included lupus myocarditis, infective and Libman-Sacks endocarditis, thrombotic thrombocytopenic purpura and CAPS. We diagnosed CAPS on the basis of the following criteria: evidence of involvement of 3 or more organs, systems, and/or tissues (pulmonary, cardiac and kidney); development of manifestations simultaneously in a week; confirmation by histopathology of small vessel occlusion in myocardial biopsy; and laboratory confirmation of the antiphospholipid antibodies presence. Pulse steroid therapy with intravenous (IV) methylprednisolone, 1 g daily for 3 days, and IV immunoglobulin 1 mg/kg/d, for 3 days were given. She also underwent 3 plasmapheresis cycles. Heparin infusion, started before ECMO administration, was continued tomaintain constant anticoagulation. The patient progressively recovered and ECMO was stopped 10 days later. Steroid therapy was tapered to 120 mg daily associated to immunosuppression with mycophenolate mofetil 1 g twice/daily. Warfarin was started for oral anticoagulation. The patient was discharged 4 weeks after ECMO interruption with specialistic follow-up from cardiologists and rheumatologists. Conclusion: CAPS has a hight mortality rate, requiring early aggressive treatment manage by a multidisciplinary team. In this case, ECMO device played a key role as a bridge to recovery of cardiac function in a heart failure rare etiology. AD - F. Bevilacqua, Catholic University of the Sacred Heart, Cardiovascular Department, Rome, Italy AU - Bevilacqua, F. AU - Maria Enrica Antoniucci, M. E. AU - Calabrese, M. AU - Arlotta, G. AU - Scapigliati, A. AU - Guarneri, S. AU - Cavaliere, F. DB - Embase DO - 10.1002/ejhf.539 KW - heparin phospholipid antibody immunoglobulin methylprednisolone inotropic agent diuretic agent troponin T immunoglobulin G1 mycophenolate mofetil warfarin heart failure acute heart failure antiphospholipid syndrome human anticoagulation steroid therapy heart muscle biopsy plasmapheresis mortality patient etiology thorax pain multiple organ failure epigastric pain hospital vasculitis therapy fever cardiogenic shock angiocardiography skin echocardiography female heart left ventricle ejection fraction laboratory acute respiratory failure infusion acute kidney failure anuria artificial ventilation tissues hypokinesia extracorporeal oxygenation thrombotic thrombocytopenic purpura serum endocarditis myocarditis ST segment depression differential diagnosis kidney histopathology occlusion blood flow pulse rate sinus tachycardia immunosuppressive treatment follow up cardiologist rheumatology devices heart function electrocardiogram LA - English M3 - Conference Abstract N1 - L72305904 2016-06-29 PY - 2016 SN - 1879-0844 SP - 14 ST - Life-saving role of ECMO in aggressive multidisciplinary treatment strategy for catastrophic antiphospholipid syndrome T2 - European Journal of Heart Failure TI - Life-saving role of ECMO in aggressive multidisciplinary treatment strategy for catastrophic antiphospholipid syndrome UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72305904&from=export http://dx.doi.org/10.1002/ejhf.539 VL - 18 ID - 761024 ER - TY - JOUR AU - Bhamani, A. AU - Pepke-Zaba, J. AU - Sheares, K. DA - 2019/04/15 04/15 DB - Europe PubMed Central DO - 10.12688/f1000research.17861.1 PY - 2019 SN - 2046-1402 ST - Lifting the fog in intermediate-risk (submassive) PE: full dose, low dose, or no thrombolysis? T2 - F1000Res TI - Lifting the fog in intermediate-risk (submassive) PE: full dose, low dose, or no thrombolysis? UR - http://europepmc.org/article/MED/30984375 VL - 8 ID - 762080 ER - TY - JOUR AB - Introduction: Stringent donor selection ensures donor safety and good recipient outcomes in right lobe living donor liver transplantation (RLLDLT). A high rejection rate is inevitable, this further reduces donor pool. Methods: We use a detailed 4-Phase donor evaluation protocol including blood investigations/CT liver attenuation index [Phase1], CT volumetry/MRCP [Phase2], systemic evaluation [Phase3], and multidisciplinary team clearance [Phase4].MR fat estimation, and liver biopsy are performed as indicated.Chief donor rejection criteria include expected GRWR < 0.65, future donor liver remnant (FLR) < 30%, macrovesicular steatosis >20%. Results: For 1709 LDLT's (Jan 2011-Dec 2017),2640 prospective RL donors were evaluated,of these 931 (35%) were rejected;most common reasons being steatosis (57%), low GRWR (11%), and low FLR (20%).Complex bilio-vascular anatomy was present in 236/2640 (9%). Most of these (222/236, 94%) were accepted, and underwent right donor hepatectomy, 14 were rejected (6%,1.4% of all rejected donors,0.5% of all screened donors). Accepted donors had ≥3 right hepatic arteries (RHA) (overlapping supply)[6], Type C (Nakamura Classification) portal vein (PV) alone[27] or with 2 RHA's[14], ≥ 2 right inferior hepatic veins (RIHV) requiring reconstruction[54],or ≥3 right hepatic ducts (RHD's)[120].None of the 222 accepted developed ≥Grade III Clavien complications. Two recipients (0.9%) developed hepatic artery thrombosis,there was no PVT or RIHV thrombosis. Recipient biliary complication rate was 10% (vs.13.5% in our overall series, p=0.14).Complex bilio-vascular anatomy which precluded safe donation[n=14] included: (A) vascular anomalies: (i) arterial-intraparenchymal origin of principal segment 8 artery (A8) from A4(1), intraparenchymal A4 from A8(1), and 4 RHA's [all end arteries](1); (ii) PV-Type E PV(2), segment 8 PV crossover from LPV(1); (iii) hepatic vein-atretic RHV with 6 RIHV's draining RL(1), MHV ostial narrowing(1), (B)-biliary anomalies: (i) left sided gall bladder(4), (ii) >3 anticipated RL bile ducts {single LHD,adequate GRWR left lobe preferred}(2). Conclusion: Most RL donors with complex bilio-vascular anatomy can undergo safe RL donor hepatectomy with good recipient outcomes at experienced LDLT centers. AD - P. Bhangui, Medanta-The Medicity, Medanta Institute of Liver Transplantation and Regenerative Medicine, Delhi NCR, India AU - Bhangui, P. AU - Saha, S. AU - Piplani, T. AU - Srinivasan, T. AU - Rastogi, A. AU - Soin, A. S. DB - Embase DO - 10.1097/01.tp.0000580472.17422.db KW - adult common hepatic duct complication conference abstract congenital blood vessel malformation female gallbladder hepatic artery thrombosis hepatic portal vein human human cell liver biopsy liver resection living donor major clinical study male multidisciplinary team outcome assessment RL cell line steatosis surgery volumetry LA - English M1 - 8 M3 - Conference Abstract N1 - L629264336 2019-09-13 PY - 2019 SN - 0041-1337 SP - 96 ST - Complex anatomy precluding right lobe live donor hepatectomy: Is there any? T2 - Transplantation TI - Complex anatomy precluding right lobe live donor hepatectomy: Is there any? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629264336&from=export http://dx.doi.org/10.1097/01.tp.0000580472.17422.db VL - 103 ID - 760687 ER - TY - JOUR AB - Learning Objectives: Mortality associated with untreated massive PE is high. From anti-coagulation, systemic or catheter directed thrombolysis to ECMO and surgical intervention, the clinician at bedside is often left with complex and time sensitive decisions. We present a case of prompt activation of Pulmonary Embolism Response Team (PERT) leading to streamlined management of a patient with cardiac arrest secondary to PE. Methods: 30 y.o. F with no known medical condition was brought to the ED with CPR in progress. Per medics, patient was seen walking unsteadily and falling on to the ground. Upon EMS arrival, she was diaphoretic and vomiting but awake, protecting her airway and conversant. She reported left leg pain and denied drug use. En-route to the hospital, patient had a tonic clonic seizure for which she was given 3 mg of versed. Shortly after, she lost her pulse. CPR was initiated immediately for the PEA arrest and patient was intubated. In the ED, ACLS was continued. She required multiple cycles of CPR with intermittent ROSC. EKG showed right axis deviation and incomplete RBBB. TTE was concerning for PE but due to possibility of ICH from fall tPA was held. PERT was consulted and after review of the case, decision was made to cannulate for VA ECMO and perform catheter directed thrombolysis. Her chest CTA showed massive saddle PE with extension into the lobar and segmental pulmonary arteries bilaterally. Doppler revealed acute DVT in the left posterior tibial vein, gastrocnemius vein, extending into the popliteal vein above the knee. Patient received 2 rounds of CDT and was decannulated from ECMO within 4 days. She had an IVC filter placed. Her hospital stay was complicated by acute cor pormonale and cardiogenic shock, MSSA PNA, VDRF and b/l foot drop. Patient was also intermittently febrile with fevers of up 107 F raising concern for autonomic storming. She was treated per TBI storming protocol with bromocriptine, amantadine, propranolol and gabapentin. After 13 days on a ventilator and 23 days in the hospital, she was discharged to a rehab, neurologically intact. Recently, at 5 months follow up, patient continues to do well and is eager to go back t Results: Our case highlights the value of PERT in resuscitation of a cardiac arrest patient. Other institutes with PERT have reported a significant decrease in mortality from PE. We recommend that all hospitals should consider forming PERT to pool the collective expertise in providing evidence based care to improve outcome of PE. AD - A. Bhardwaj, University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, PA, United States AU - Bhardwaj, A. AU - Pasricha, V. AU - Talebi, F. AU - Diamond, C. AU - Fritz, J. AU - Palevsky, H. DB - Embase KW - amantadine bromocriptine endogenous compound gabapentin propranolol tissue plasminogen activator adult airway artificial ventilation blood clot lysis cardiogenic shock case report catheter clinical article conference abstract electrocardiogram female fever filter follow up foot gastrocnemius muscle heart arrest heart right bundle branch block hospital patient hospitalization human knee leg pain mortality popliteal vein pulmonary artery pulmonary embolism response team resuscitation return of spontaneous circulation tonic clonic seizure ventilator vomiting wakefulness walking LA - English M1 - 1 M3 - Conference Abstract N1 - L629630570 2019-10-23 PY - 2019 SN - 1530-0293 ST - Pulmonary embolism response team activation and survival after perelated cardiac arrest T2 - Critical Care Medicine TI - Pulmonary embolism response team activation and survival after perelated cardiac arrest UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629630570&from=export VL - 47 ID - 760773 ER - TY - JOUR AB - A 29-year-old woman with known ulcerative colitis developed a right-sided abdominal pain a day after preterm vaginal delivery at 30 weeks. She did not have any nausea, vomiting and had normal bowel movements. The observations were within normal limits and white cell counts were marginally elevated with a normal C reactive protein. A large ovarian vein thrombosis on the left side was an incidental finding on a CT of the abdomen and pelvis undertaken to establish the cause for abdominal pain. The patient was managed by a multidisciplinary team and was treated with anticoagulants for 6 months. This case illustrates that the incidence of pelvic venous thrombosis may be higher in pregnancy and puerperium. AD - H.M. Bhari, University Hospitals of Coventry, Warwickshire NHS Trust, Coventry, United Kingdom AU - Bhari, H. M. AU - Jeevan, D. AU - Slinn, J. AU - Goswami, K. DB - Embase Medline DO - 10.1136/bcr-2014-206452 KW - antibiotic agent anticoagulant agent C reactive protein hemoglobin low molecular weight heparin abdominal pain adult article bacterium identification case report clinical effectiveness clinical feature compression stocking computer assisted tomography differential diagnosis disease association drug efficacy drug response enterococcal infection Enterococcus female follow up human leukocyte count medical history outcome assessment pain assessment patient assessment postoperative ovarian vein thrombosis postpartum ovarian vein thrombosis protein determination protein function platelet count treatment duration ulcerative colitis urinary tract infection vein thrombosis LA - English M3 - Article N1 - L600803152 2014-12-25 2015-01-07 PY - 2014 SN - 1757-790X ST - Postpartum ovarian vein thrombosis in a 29-year-old woman with ulcerative colitis T2 - BMJ Case Reports TI - Postpartum ovarian vein thrombosis in a 29-year-old woman with ulcerative colitis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L600803152&from=export http://dx.doi.org/10.1136/bcr-2014-206452 VL - 2014 ID - 761095 ER - TY - JOUR AB - INTRODUCTION: Patients with premature ejaculation (PE) often complain of difficulty in having second erection, which is not yet investigated using scientific methodology. AIM: Evaluation of the association between post-ejaculation refractory time (PERT) with PE by comparing PERT in premature ejaculators with their age-matched control subjects. METHODS: After ethical committee approval and written informed consent from the participants were obtained, men in a monogamous stable sexual relationship and reporting PE were recruited into the study. Sexually active, matched control subjects were recruited for comparison. Exclusion criteria were erectile dysfunction, diabetes mellitus, cardiovascular diseases, hypogonadism, psychiatric conditions, instrumentation of the genitourinary tract, genitourinary anomalies, and genitourinary infections. Both the premature ejaculators and their control subjects were evaluated with the PE diagnostic tool before initiation of the study. They were asked to record their IELT and PERT over 4 weeks. The statistical analysis was done to obtain descriptive statistics, namely, mean and SD, paired t-tests, and logistic regression analysis. P < .001 was considered significant. MAIN OUTCOME MEASURE: There was a statistically significant association between prolonged PERT and PE in patients with PE compared with their age-matched control subjects. RESULTS: 102 premature ejaculators and an equal number of matched control subjects were evaluated from January 2016-December 2017. The average PERT in premature ejaculators and control subjects was 330 ± 296.63 minutes and 105.64 ± 98.59 minutes, respectively (P < .0001). Increasing age was associated with increasing PERT. PE was more common in patients when PERT exceeded a threshold of 590 minutes. CLINICAL IMPLICATIONS: Until now, the association between PE and PERT with matched-pair analysis was not reported. Our study addresses this association, which can add a new paradigm in the evaluation and management of PE. STRENGTH & LIMITATIONS: The association between PE and prolonged PERT using a statistically appropriate, adequately powered methodology is the strength of the study. The inability to address the causal association between prolonged PERT and PE because of the paucity of evidence at present is the limitation of the study. We believe that the results of this study could trigger further research into such an association, so the mystery of such an association can be unraveled. CONCLUSIONS: The association between prolonged PERT and PE, as seen in our study, is a finding, that needs further research to establish a causal association. However, reporting such an association is necessary because it is contrary to the present understanding. Bhat GS, Shastry A. Association Between Post-Ejaculatory Refractory Time (PERT) and Premature Ejaculation (PE). J Sex Med 2019;16:1364-1370. AD - Department of Urology, Andrology and Sexual Medicine, TSS Shripad Hegde Kadave Institute of Medical Sciences, Sirsi, Uttara Kannada District, Karnataka State, India. Electronic address: gajubhatru@gmail.com. Department of Urology, Andrology and Sexual Medicine, TSS Shripad Hegde Kadave Institute of Medical Sciences, Sirsi, Uttara Kannada District, Karnataka State, India. AN - 31405769 AU - Bhat, G. S. AU - Shastry, A. DA - Sep DO - 10.1016/j.jsxm.2019.06.016 DP - NLM ET - 2019/08/14 J2 - The journal of sexual medicine KW - Adult Case-Control Studies Dopamine/blood Ejaculation/*physiology Erectile Dysfunction/blood/*physiopathology/psychology Humans Male Marriage Middle Aged Premature Ejaculation/blood/*physiopathology/psychology Time Factors *Post-Ejaculatory Refractory Time *Premature Ejaculation *Premature Ejaculation Diagnostic Tool LA - eng M1 - 9 N1 - 1743-6109 Bhat, Gajanan S Shastry, Anuradha Journal Article Netherlands J Sex Med. 2019 Sep;16(9):1364-1370. doi: 10.1016/j.jsxm.2019.06.016. Epub 2019 Aug 9. PY - 2019 SN - 1743-6095 SP - 1364-1370 ST - Association Between Post-Ejaculatory Refractory Time (PERT) and Premature Ejaculation (PE) T2 - J Sex Med TI - Association Between Post-Ejaculatory Refractory Time (PERT) and Premature Ejaculation (PE) VL - 16 ID - 760226 ER - TY - JOUR AB - Racial differences in stroke risk and risk factor prevalence are well established. The present study explored racial differences in the delivery of care to patients with acute stroke between Joint Commission (JC)-certified hospitals and noncertified hospitals. A retrospective chart review was conducted in patients sustaining ischemic stroke admitted to 5 JC-certified centers and 5 noncertified hospitals. Demographic data, risk factors, utilization of acute stroke therapies, and compliance with core measures were recorded. Racial disparities were investigated in the entire group as well as for JC-certified and noncertified hospitals separately. A total of 574 patients (25.1% African Americans) were included. African Americans were significantly younger and more likely to have previous stroke, whereas Caucasians were more likely to have coronary disease and atrial fibrillation. There were no racial differences in other risk factors or baseline functions. Median National Institutes of Health Stroke Scale scores were similar in African Americans and Caucasians, as were proportions receiving intravenous tissue plasminogen activator (tPA) therapy (2.1% in African Americans, 3.5% in Caucasians; P = .40) and intervention (4.2% in African Americans, 6.8% in Caucasians; P = .26). Caucasians were more likely to arrive by emergency medical services (65.5% vs 51.5%; P = .004), to be evaluated by a stroke team (19.1% vs 7.7%; P = .001), and to have a documented National Institutes of Health Stroke Scale score (40.2% vs 29.9%; P = .03). African Americans often did not receive intravenous tPA because of a delay in arrival. African Americans performed better on virtually all stroke care variables in JC-certified centers. JC certification reduced disparity in certain variables, including tPA and deep venous thrombosis prophylaxis administration. Important racial disparities exist in the delivery of several acute stroke care variables. Efforts must be focused on eliminating disparities in prehospital delays. Guideline-based care tendered at JC-certified centers might help narrow disparities in acute stroke care delivery. AD - Department of Neurology and Stroke Program, Wayne State University School of Medicine, Detroit, Michigan 48201, USA. pdbhatta@med.wayne.edu AN - 22078781 AU - Bhattacharya, P. AU - Mada, F. AU - Salowich-Palm, L. AU - Hinton, S. AU - Millis, S. AU - Watson, S. R. AU - Chaturvedi, S. AU - Rajamani, K. DA - May DO - 10.1016/j.jstrokecerebrovasdis.2011.09.018 DP - NLM ET - 2011/11/15 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - *African Americans Aged *Delivery of Health Care, Integrated/standards Emergency Medical Services Endovascular Procedures *European Continental Ancestry Group Female Guideline Adherence *Health Services Accessibility/standards Healthcare Disparities/*ethnology/standards Humans *Joint Commission on Accreditation of Healthcare Organizations Logistic Models Male Middle Aged Multivariate Analysis Odds Ratio Patient Care Team Practice Guidelines as Topic Practice Patterns, Physicians' Prevalence *Quality of Health Care/standards Retrospective Studies Risk Factors Stroke/diagnosis/ethnology/*therapy Thrombolytic Therapy United States/epidemiology LA - eng M1 - 4 N1 - 1532-8511 Bhattacharya, Pratik Mada, Flicia Salowich-Palm, Leeza Hinton, Sabrina Millis, Scott Watson, Sam R Chaturvedi, Seemant Rajamani, Kumar Comparative Study Journal Article Multicenter Study Research Support, Non-U.S. Gov't United States J Stroke Cerebrovasc Dis. 2013 May;22(4):383-8. doi: 10.1016/j.jstrokecerebrovasdis.2011.09.018. Epub 2011 Nov 10. PY - 2013 SN - 1052-3057 SP - 383-8 ST - Are racial disparities in stroke care still prevalent in certified stroke centers? T2 - J Stroke Cerebrovasc Dis TI - Are racial disparities in stroke care still prevalent in certified stroke centers? VL - 22 ID - 760346 ER - TY - JOUR AB - SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Cardiac myxoma in pregnancy is extremely rare. In a non-pregnant patient, surgical resection is recommended if there is a potential risk for embolization or hemodynamic compromise. In the pregnant patient, however, the risks of embolization must be balanced against the risk of cardiopulmonary bypass to the mother and the fetus. CASE PRESENTATION: 33-year-old pregnant woman with a history of deep venous thrombosis, sickle cell anemia and thalassemia trait who previously underwent infusion port placement due to need of frequent transfusions presented at 31 weeks of gestation with chest pain and hemoglobin of 4.6 g/dL. On admission, a transthoracic echocardiogram showed a 2.2 cm × 1.8 cm mobile irregular shaped pedunculated mass is in the right atrium. The patient was transfused and anticoagulated with heparin. A subsequent cardiac MRI without gadolinium confirmed presence of mass, but was unable to further characterize it. Based on the history of prior deep venous thrombosis and presence of an infusion catheter, decision was made to empirically continue the patient on anticoagulation until delivery. The patient subsequently underwent a c-section at 34 weeks gestation that was complicated by internal bleeding. Anticoagulation was subsequently stopped and a follow up trans-esophageal echocardiogram revealed that the mass was discretely attached to the atrial free wall, suggestive of a right atrial myxoma. The patient was discharged with plans for surgical excision in the near future. DISCUSSION: Primary tumors of the heart are relatively rare. Among them, atrial myxomas are most frequent, accounting for 50% of all primary cardiac tumors. The management of atrial myxoma in pregnancy is complicated. Strategies include termination of pregnancy, tumor resection during pregnancy, delay in resection until the 3rd trimester is reached, and delaying cardiac surgery until after delivery. Yuan suggested attempting delivery ahead of surgery or to defer surgery till late pregnancy [1]. However, cardiac myxoma is associated with a risk of embolism especially in the hypercoagulable condition of pregnancy. Therefore, John et al. suggested that a surgical excision be performed in all pregnant women [2]. Our patient had no hemodynamic compromise or evidence of embolism from the mass. For these reasons, our multidisciplinary team decided on empiric anti-coagulation and delaying the operation until after delivery. She will now follow up as an outpatient for surgical evaluation for removal of her myxoma. CONCLUSIONS: In conclusion, the overall management of cardiac masses in pregnancy is complex. Embolic potential and hemodynamic deterioration are indications for an urgent resection. Otherwise, cardiac surgery may be avoided postponed until fetal pulmonary maturation or delivery. Anticoagulation should also be considered. Individual multidisciplinary assessment and management strategies are essential. Reference #1: S.-M. Yuan, “Indications for cardiopulmonary bypass during pregnancy and impact on fetal outcomes,” Geburtshilfe und Frauenheilkunde, vol. 74, no. 1, pp. 55–62, 2014. Reference #2: A. S. John, H. M. Connolly, H. V. Schaff, and K. Klarich, “Management of cardiac myxoma during pregnancy: a case series and review of the literature,” International Journal of Cardiology, vol. 155, no. 2, pp. 177–180, 2012. DISCLOSURES: No relevant relationships by Zabeer Bhatti, source=Web Response No relevant relationships by Alexander Volodarskiy, source=Web Response AU - Bhatti, Z. AU - Volodarskiy, A. DB - Embase DO - 10.1016/j.chest.2019.08.1562 KW - endogenous compound gadolinium hemoglobin heparin adult anticoagulation bleeding body weight cancer patient cancer surgery cardiology cardiopulmonary bypass cardiovascular magnetic resonance case report case study catheter clinical article complication conference abstract deep vein thrombosis deterioration embolism esophagus female fetus fetus outcome follow up heart atrium myxoma heart surgery hemodynamics hospital discharge human multidisciplinary team obstetric delivery outpatient pregnant woman primary tumor sickle cell anemia surgery thalassemia third trimester pregnancy thorax pain transthoracic echocardiography LA - English M1 - 4 M3 - Conference Abstract N1 - L2002983199 2019-10-02 PY - 2019 SN - 1931-3543 0012-3692 SP - A1799 ST - RIGHT ATRIAL MYXOMA IN PREGNANCY T2 - Chest TI - RIGHT ATRIAL MYXOMA IN PREGNANCY UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002983199&from=export http://dx.doi.org/10.1016/j.chest.2019.08.1562 VL - 156 ID - 760660 ER - TY - JOUR AB - "Home" is where one has a sense of belonging and feels secure, but it can also be a risky place for people with Parkinson's disease (PD). PD patients need assistance making adjustments to their physical environment to maintain appropriate care and provide a safe environment. This relationship is called the "person-environmental fit" (P-E fit). While most PD patients remain in their own homes, little is known about the specific challenges that PD patients and their caregivers encounter in the routine activities of daily living. The aim of our study was to identify the existing evidence on the issue of housing environmental adaptation in PD by performing a systematic review with a proposal of development strategies to integrate a multidisciplinary team into a home environmental research. MEDLINE, and life science journals were searched by querying appropriate key words, but revealed very few publications in this area. However, early evidence suggested that PD patients do not enjoy an adequate P-E fit in their own homes and face more functional limitations compared to matched controls. We concluded that we need to develop research-based evaluation strategies that can provide us with a theoretical and conceptual basis as well as tools for analysis of the P-E fit for PD patients and caregivers. We recommend that individual members of the multidisciplinary team including patients, caregivers, physicians, rehabilitation specialists, and social workers use a team approach to identify the key indicators and solutions for the development of PD-specific solutions for improving the P-E fit. AD - Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand; Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan. Electronic address: rbh@chulapd.org. Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand. Pacific Parkinson's Research Center, University of British Columbia, Vancouver, Canada. Department of Neurology, Juntendo University, Tokyo, Japan. Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan. AN - 26365779 AU - Bhidayasiri, R. AU - Jitkritsadakul, O. AU - Boonrod, N. AU - Sringean, J. AU - Calne, S. M. AU - Hattori, N. AU - Hayashi, A. DA - Oct DO - 10.1016/j.parkreldis.2015.08.025 DP - NLM ET - 2015/09/15 J2 - Parkinsonism & related disorders KW - Accidental Falls/*prevention & control Accidents, Home/*prevention & control Activities of Daily Living Aged Female Housing Humans Male Middle Aged Parkinson Disease/*complications/*rehabilitation *Self-Help Devices Accessibility Activities of daily livings Activity Falls Home environmental adjustment Housing adaptation Parkinson's disease Person-environmental fit Rehabilitation Safety Usability LA - eng M1 - 10 N1 - 1873-5126 Bhidayasiri, Roongroj Jitkritsadakul, Onanong Boonrod, Nonglak Sringean, Jirada Calne, Susan M Hattori, Nobutaka Hayashi, Akito Journal Article Research Support, Non-U.S. Gov't Review Systematic Review England Parkinsonism Relat Disord. 2015 Oct;21(10):1127-32. doi: 10.1016/j.parkreldis.2015.08.025. Epub 2015 Aug 25. PY - 2015 SN - 1353-8020 SP - 1127-32 ST - What is the evidence to support home environmental adaptation in Parkinson's disease? A call for multidisciplinary interventions T2 - Parkinsonism Relat Disord TI - What is the evidence to support home environmental adaptation in Parkinson's disease? A call for multidisciplinary interventions VL - 21 ID - 760299 ER - TY - JOUR AB - Background: In outpatient settings, diagnostic errors are estimated to occur in 1 in 20 adults annually and involve common conditions. However, there are very few studies of diagnostic errors in inpatient settings. Using electronic health record (EHR) data, we explored the use of a trigger «unexpected escalation to a higher level of care» to study inpatient diagnostic errors. Methods: We used a clinical data repository at a large academic medical center to identify all instances of escalation of inpatient care among patients with low baseline risk of inpatient mortality. Within a 3-year study period (2011-2013), we used an algorithm to select a cohort of adult patients below 65 years with minimal comorbid conditions (Charlson Comorbidity Index < 2), and less than 3 prior hospitalizations over the past year that were admitted to a medical service. Within this cohort, we identified escalation of care as transfer to the intensive care unit (ICU) or initiation of rapid response team (RRT) within 15 days of admission. A physician reviewed the record (notes, tests and consultations) to evaluate for diagnostic and other medical errors during the inpatient stay. We defined diagnostic errors as missed opportunities to make an earlier diagnosis based on retrospective review, irrespective of harm. Five process dimensions described in a previous framework (patient factors, patient-physician encounter, test performance and interpretation, test follow-up and tracking, or the referral process) were used to understand care breakdowns. Anticipated severity and duration of harm were recorded. Results: Of the 41, 950 admissions during the 3-year period, 52 (0.1%) unique patients encountered an unexpected escalation of care during their inpatient stay. Of these, 4 (7.7%) experienced diagnostic errors and 7 (13.5%) encountered medication errors. Other preventable adverse events recorded were patient falls (4, 7.7%), procedure-related complications (2, 3.8%) and hospital associated infections (2, 3.8%). Diagnostic errors included missed diagnoses of deep vein thrombosis, hemothorax and alcohol withdrawal. Contributing factors included breakdowns in the patient-provider encounter (n=3, 75%) involving failures in information gathering and interpretation (e.g. history of alcohol use was missed, and leg pain in an immobilized patient was not evaluated during patient assessment), and delays in test follow-up and tracking (n=1, 25%). Potential for harm was temporary (one year or less), however, the magnitude of harm was serious in all four cases of diagnostic error. Conclusion: Our preliminary evaluation suggests that electronic trigger tools could be useful to study inpatient diagnostic errors and warrant further exploration. AD - V. Bhise, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, TX, United States AU - Bhise, V. AU - Sittig, D. F. AU - Wei, L. AU - Singh, H. DB - Embase DO - 10.1515/dx-2016-0037 KW - adult adverse event alcohol consumption alcohol withdrawal syndrome case report Charlson Comorbidity Index clinical data repository clinical evaluation cohort analysis deep vein thrombosis diagnosis diagnostic error drug withdrawal electronic health record female follow up hematothorax hospital mortality hospitalization human infection intensive care unit leg pain male medical service medication error patient assessment patient referral peroperative complication rapid response team retrospective study risk assessment task performance university hospital LA - English M1 - 1 M3 - Conference Abstract N1 - L620120992 2018-01-10 PY - 2017 SN - 2194-802X SP - eA16 ST - Measuring diagnostic safety of inpatients using trigger tools T2 - Diagnosis TI - Measuring diagnostic safety of inpatients using trigger tools UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620120992&from=export http://dx.doi.org/10.1515/dx-2016-0037 VL - 4 ID - 760956 ER - TY - JOUR AB - Transfusion and patient blood management (PBM) processes are complex; while transfusions can be lifesaving, equally there may be associated morbidity and mortality. The safety and PBM culture in Australia is propelled by obligations to comply with mandatory governance frameworks. These frameworks support appropriate use of blood/blood products, and that there are adequate levels of safety at all points on the vein to vein journey. A key to the success of blood management governance is the health service multidisciplinary Blood Management team/Governance Committee (BMC). Their structure depends on the size of the health service. Importantly, representation includes healthcare executive, clinical governance, and consumer/s, with the transfusion practitioner (TP) as a key resource. Other members include staff (medical/laboratory/nursing) from areas that regularly undertake transfusion and PBM activities, such as: Perioperative suites, emergency departments, clinical wards, infusion centres, general practices, and laboratories. Engagement with relevant healthcare stakeholders is important. The TPs skillset focuses on 'staff and patient education, adverse events, transfusion governance and monitoring of transfusion practices within organisations..to ensure current clinical practices align with state, national, and international guidelines and standards.' (Miller 2012) Benchmarking through key performance monitoring, and sharing of ideas at both a local and international level allows for system improvements, and ensures efficiency and safety is maintained. The TP, working in a multidisciplinary capacity across the clinical spectrum at all levels and specialties, is often seen as the driving force for change within the healthcare system in areas affecting blood transfusion and PBM. In Australia, the TPs influence can be within an individual organization, across multiple sites, or health networks, in metropolitan or rural/regional areas. The TP con-ducts a critical role pulling together resources, promoting exchange of information, encouraging engagement and empowering colleagues to facilitate change. Highly developed communication skills assist the TP to engage the many different stakeholders and clinical environments. Successful PBM requires a coordinated approach to care across many specialities. Each clinical discipline has a role to play in the assessment and management of: pre-operative anaemia, bleeding and thrombosis risk, and tolerance of anaemia. The TP is often the key link between these clinicians, the patient, and the planning process. For any multidisciplinary team to function effectively, collaboration is essential. Highly functional teams recognize knowledge and experience, and utilize each member's skills to work together to deliver the best possible outcome for patients. Examples of working together include the development of protocols, education, auditing and review of compliance and patient outcome. TPs often undertake haemovigilance activities, and work together to follow-up reactions, and act on any recommendations with support of the BMC. There is growing body of literature available supporting multidisciplinary teams, and the TP role, in the implementation of PBM, and reducing unnecessary transfusions, and thus improving patient outcomes. Conclusion: Effective transfusion and PBM practice requires a systematic cross-specialty approach to ensure success. The TP are the essential link in the multidisci-plinary chain. However, they require strong support and leadership to potently effect change and enhance practice. AD - L. Bielby, Department of Health and Human Services, Victoria and Australian Red Cross Blood Service, Blood Matters, West Melbourne, Australia AU - Bielby, L. AU - Kelsey, G. AU - Haberfield, A. AU - Kay, S. DB - Embase DO - 10.1111/vox.12601/full KW - adult adverse event anemia Australia benchmarking bleeding blood safety blood transfusion communication skill consumer emergency ward female follow up general practice health care system human leadership male monitoring morbidity mortality nursing patient education practice guideline risk assessment staff surgery thrombosis vein LA - English M3 - Conference Abstract N1 - L619350268 2017-11-27 PY - 2017 SN - 1423-0410 SP - 28 ST - The role of the transfusion practitioner in the multidisciplinary team T2 - Vox Sanguinis TI - The role of the transfusion practitioner in the multidisciplinary team UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619350268&from=export http://dx.doi.org/10.1111/vox.12601/full VL - 112 ID - 760894 ER - TY - JOUR AB - Objectives To evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality. Design Multinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018. Setting 353 hospitals in 16 countries. Participants 39 257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism. Main outcome measure Pulmonary embolism related mortality within 30 days after diagnosis of the condition. Results Patients with acute symptomatic pulmonary embolism admitted to high volume hospitals (>40 pulmonary embolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonary embolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonary embolisms per year) was associated with a 44% reduction in the adjusted odds of pulmonary embolism related mortality at 30 days compared with admission to hospitals in the lowest quarter (<15 pulmonary embolisms per year; adjusted risk 1.3% v 2.3%; adjusted odds ratio 0.56 (95% confidence interval 0.33 to 0.95); P=0.03). Results were consistent in all sensitivity analyses. All cause mortality at 30 days was not significantly reduced between the two quarters (adjusted odds ratio 0.78 (0.50 to 1.22); P=0.28). Survivors showed little change in the odds of recurrent venous thromboembolism (odds ratio 0.76 (0.49 to 1.19)) or major bleeding (1.07 (0.77 to 1.47)) between the low and high volume hospitals. Conclusions In patients with acute symptomatic pulmonary embolism, admission to high volume hospitals was associated with significant reductions in adjusted pulmonary embolism related mortality at 30 days. These findings could have implications for management strategies. PMID:31358508 AU - Bikdeli, Behnood AU - Quezada, Andrés AU - Muriel, Alfonso AU - Lobo, José Luis AU - de Miguel-Diez, Javier AU - Jara-Palomares, Luis AU - Ruiz-Artacho, Pedro AU - Yusen, Roger D. AU - Monreal, Manuel DA - 2019/07/29 07/29 DB - PubMed Central DO - 10.1136/bmj.l4416 PY - 2019 SN - 0959-8138 ST - Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study T2 - The BMJ TI - Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6661688&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6661688 VL - 366 ID - 762073 ER - TY - JOUR AB - BACKGROUND: Bloodstream infections from central venous catheters (CVC-BSIs) increase morbidity and costs in intensive care units (ICUs). Substantial reductions in CVC-BSI rates have been reported using a combination of technical and non-technical interventions. METHODS: We conducted a 2-year, four-cluster, stepped non-randomised study of technical and non-technical (behavioural) interventions to prevent CVC-BSIs in adult and paediatric ICUs in England. Random-effects Poisson regression modelling was used to compare infection rates. A sample of ICUs participated in data verification. RESULTS: Of 223 ICUs in England, 215 (196 adult, 19 paediatric) submitted data on 2479 of 2787 possible months and 147 (66%) provided complete data. The exposure rate was 438 887 (404 252 adult and 34 635 paediatric) CVC-patient days. Over 20 months, 1092 CVC-BSIs were reported. Of these, 884 (81%) were ICU acquired. For adult ICUs, the mean CVC-BSI rate decreased over 20 months from 3.7 in the first cluster to 1.48 CVC-BSIs/1000 CVC-patient days (p<0.0001) for all clusters combined, and for paediatric ICUs from 5.65 to 2.89 (p=0.625). The trend for infection rate reduction did not accelerate following interventions training. CVC utilisation rates remained stable. Pre-ICU infections declined in parallel with ICU-acquired infections. Criterion-referenced case note review showed high agreement between adjudicators (κ 0.706) but wide variation in blood culture sampling rates and CVC utilisation. Generic infection control practices varied widely. CONCLUSIONS: The marked reduction in CVC-BSI rates in English ICUs found in this study is likely part of a wider secular trend for a system-wide improvement in healthcare-associated infections. Opportunities exist for greater harmonisation of infection control practices. Future studies should investigate causal mechanisms and contextual factors influencing the impact of interventions directed at improving patient care. AD - University of Birmingham, N5 Queen Elizabeth Hospital, Birmingham, UK. AN - 22996571 AU - Bion, J. AU - Richardson, A. AU - Hibbert, P. AU - Beer, J. AU - Abrusci, T. AU - McCutcheon, M. AU - Cassidy, J. AU - Eddleston, J. AU - Gunning, K. AU - Bellingan, G. AU - Patten, M. AU - Harrison, D. C2 - Pmc3585494 DA - Feb DO - 10.1136/bmjqs-2012-001325 DP - NLM ET - 2012/09/22 J2 - BMJ quality & safety KW - Adult *Benchmarking Catheter-Related Infections/classification/epidemiology/*prevention & control Catheterization, Central Venous/adverse effects/*statistics & numerical data Child Cluster Analysis Cross Infection/classification/epidemiology/prevention & control England/epidemiology Humans Infection Control/*methods Inservice Training Intensive Care Units/*statistics & numerical data Intensive Care Units, Pediatric/*statistics & numerical data Length of Stay Longitudinal Studies Patient Care Team/standards Poisson Distribution Prospective Studies Regression Analysis LA - eng M1 - 2 N1 - 2044-5423 Bion, Julian Richardson, Annette Hibbert, Peter Beer, Jeanette Abrusci, Tracy McCutcheon, Martin Cassidy, Jane Eddleston, Jane Gunning, Kevin Bellingan, Geoff Patten, Mark Harrison, David Matching Michigan Collaboration & Writing Committee Journal Article Multicenter Study BMJ Qual Saf. 2013 Feb;22(2):110-23. doi: 10.1136/bmjqs-2012-001325. Epub 2012 Sep 20. PY - 2013 SN - 2044-5415 (Print) 2044-5415 SP - 110-23 ST - 'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England T2 - BMJ Qual Saf TI - 'Matching Michigan': a 2-year stepped interventional programme to minimise central venous catheter-blood stream infections in intensive care units in England VL - 22 ID - 760323 ER - TY - JOUR AB - The aim of this study was to evaluate the outcome and treatment quality of transfer percutaneous coronary intervention (PCI) in older patients with acute STEMI. In this prospective study all patients with diagnosed acute (pain-to-balloon≤12 h) STEMI transferred to our institution for primary PCI (n=400) between January 2005 and October 2007 were under investigation. Overall 125 older patients with age ≥70 years were included (mean age 77.5±4.9 years; 77 males). Pre-hospital delays were more common in older patients with longer pain-to-balloon: median (range)=85 (5-629) vs. 66 (1-688) p=0.031, and pain-to-first medical-contact-times: median: 206 (84-711) vs. 172 (45-720); p=0.001. A trend towards a higher (non-significant) rate of major 5/125 (5%) vs. 5/275 (1.8%), p=0.195 and minor 10/125 (8%) vs. 14/275 (5.1%). p=0.256 bleeding complications in older patients was evident. In-hospital mortality was significantly higher in older patients compared to the younger patients group: 13/125, 10.4% vs. 8/275, 2.9%, p=0.002). Overall mortality at 30-day follow-up was 11.2% in older and 3.3% in younger patients: 14/125 vs. 9/275, p=0.002. Transfer PCI is an effective treatment strategy for older patients with acute ST-elevation myocardial infarction. Overall-30-day mortality in older STEMI-patients transferred for primary PCI is comparably low. AD - Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Academic Hospital of the University of Freiburg, Department of Cardiology, Vöhrenbacherstr. 23-27, D-78050 Villingen-Schwenningen, Germany. AN - 21146233 AU - Birkemeyer, R. AU - Rillig, A. AU - Treusch, F. AU - Kunze, M. AU - Meyerfeldt, U. AU - Miljak, T. AU - Kostin, D. AU - Koch, A. AU - Jung, W. AU - Oster, P. AU - Bahrmann, A. DA - Nov-Dec DO - 10.1016/j.archger.2010.11.015 DP - NLM ET - 2010/12/15 J2 - Archives of gerontology and geriatrics KW - Age Factors Aged Aged, 80 and over Angioplasty, Balloon, Coronary/*methods Electrocardiography/methods Female Follow-Up Studies Germany/epidemiology Hospital Communication Systems/organization & administration Hospital Mortality Humans Male Middle Aged Myocardial Infarction/complications/*mortality/*therapy Patient Care Team Patient Transfer/organization & administration/*statistics & numerical data Prospective Studies Quality of Health Care Time Factors Treatment Outcome LA - eng M1 - 3 N1 - 1872-6976 Birkemeyer, Ralf Rillig, Andreas Treusch, Fabian Kunze, Markus Meyerfeldt, Udo Miljak, Tomislav Kostin, Daniel Koch, Annette Jung, Werner Oster, Peter Bahrmann, Anke Evaluation Study Journal Article Netherlands Arch Gerontol Geriatr. 2011 Nov-Dec;53(3):e259-62. doi: 10.1016/j.archger.2010.11.015. Epub 2010 Dec 10. PY - 2011 SN - 0167-4943 SP - e259-62 ST - Outcome and treatment quality of transfer primary percutaneous intervention in older patients with acute ST-elevation myocardial infarction (STEMI) T2 - Arch Gerontol Geriatr TI - Outcome and treatment quality of transfer primary percutaneous intervention in older patients with acute ST-elevation myocardial infarction (STEMI) VL - 53 ID - 760519 ER - TY - JOUR AU - Bishop, G. J. AU - Gorski, J. AU - Lachant, D. AU - Cameron, S. J. DA - 2019/10/30 10/30 DB - Europe PubMed Central DO - 10.1016/j.jvscit.2019.07.004 M1 - 4 PY - 2019 SN - 2468-4287 SP - 402-405 ST - Chronic thromboembolic pulmonary hypertension is a clot you cannot swat T2 - J Vasc Surg Cases Innov Tech TI - Chronic thromboembolic pulmonary hypertension is a clot you cannot swat UR - http://europepmc.org/article/MED/31660459 VL - 5 ID - 762069 ER - TY - JOUR AB - Increasing attention has been placed on providing higher quality and safer patient care. This requires the development of a new set of competencies to better understand and navigate the system and lead the orthopaedic team. While still trying to learn and develop these competencies, the academic orthopaedist is also expected to model and teach them. The orthopaedic surgeon must understand what is being measured and why, both for purposes of providing better care and to eliminate unnecessary expense in the system. Metrics currently include hospital-acquired conditions, "never events," and thirty-day readmission rates. More will undoubtedly follow. Although commitment and excellence at the individual level are essential, the orthopaedist must think at the systems level to provide the highest value of care. A work culture characterized by respect and trust is essential to improved communication, teamwork, and confidential peer review. An increasing number of resources, both in print and electronic format, are available for us to understand what we can do now to improve quality and safety. Resident education in quality and safety is a fundamental component of the systems-based practice competency, the Next Accreditation System, and the Clinical Learning Environment Review. This needs to be longitudinally integrated into the curriculum and applied parallel to the development of resident knowledge and skill, and will be best learned if resident learning is experiential and taught within a genuine culture of quality and safety. AD - [Black, Kevin P.; Armstrong, April D.] Penn State Milton S Hershey Med Ctr, Dept Orthopaed & Rehabil, Hershey, PA 17033 USA. Black, KP (corresponding author), Penn State Milton S Hershey Med Ctr, Dept Orthopaed & Rehabil, 30 Hope Dr,EC089, Hershey, PA 17033 USA. kblack@hmc.psu.edu; aarmstrong@hmc.psu.edu; Lorraine.hutzler@nyumc.org; kenneth.egol@nyumc.org AN - WOS:000366399700012 AU - Black, K. P. AU - Armstrong, A. D. AU - Hutzler, L. AU - Egol, K. A. DA - Nov DO - 10.2106/jbjs.o.00020 J2 - J. Bone Joint Surg.-Am. Vol. KW - SYSTEMS-BASED PRACTICE DEEP VENOUS THROMBOSIS HEALTH-CARE THROMBOEMBOLIC COMPLICATIONS WRONG-SITE PERIOPERATIVE COMPLICATIONS ANTIMICROBIAL PROPHYLAXIS VEIN THROMBOSIS SPINAL SURGERY HOUSE STAFF Orthopedics Surgery LA - English M1 - 21 M3 - Article N1 - ISI Document Delivery No.: CY4SX Times Cited: 2 Cited Reference Count: 72 Black, Kevin P. Armstrong, April D. Hutzler, Lorraine Egol, Kenneth A. Armstrong, April/0000-0003-3729-9811 2 0 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J BONE JOINT SURG AM PY - 2015 SN - 0021-9355 SP - 1809-1815 ST - Quality and Safety in Orthopaedics: Learning and Teaching at the Same Time AOA Critical Issues T2 - Journal of Bone and Joint Surgery-American Volume TI - Quality and Safety in Orthopaedics: Learning and Teaching at the Same Time AOA Critical Issues UR - ://WOS:000366399700012 VL - 97A ID - 761736 ER - TY - JOUR AB - The aim of this manuscript was to establish a consensus for the management of acute and chronic venous obstruction among specialists in the UK. Specialist physicians representing vascular surgery, interventional radiology and hematology were invited to 3 meetings to discuss management of acute and chronic iliofemoral obstruction. The meetings outlined controversial areas, included a topic-by-topic review; and on completion reached a consensus when greater than 80% agreement was reached on each topic. Physicians from 19 UK hospitals agreed on treatment protocols and highlighted areas that need development. Potential standard treatment algorithms were created. It was decided to establish a national registry of venous patients led by representatives from the treating multidisciplinary teams. Technical improvements have facilitated invasive treatment of patients with acute and chronic venous obstruction; however, the evidence guiding treatment is weak. Treatment should be conducted in centers with multi-disciplinary input; robust, coordinated data collection; and regular outcome analysis to ensure safe and effective treatment and a basis for future evolvement. AD - [Black, Stephen A.; Breen, Karen; Saha, Prakash] Guys & St Thomas NHS Fdn Trust, London, England. [Alvi, Abdulrahman] Barking Havering & Redbridge Univ Hosp NHS Trust, London, England. [Baker, Sara J.; Metcalfe, James; Tippett, Richard; Ward, Robert; Watts, Christopher] Dorset & Wiltshire Vasc Network, London, England. [Beckett, David; Burfitt, Nicholas J.; Davies, Alun H.] Imperial Coll London, London, England. [Burfitt, Nicholas J.; Davies, Alun H.] Imperial Healthcare NHS Trust, London, England. [Coles, Simon] Portsmouth Hosp NHS Fdn Trust, London, England. [Davies, Neil; Drebes, Anja; Quigley, Shaun; Woodward, Nick; Lim, Chung S.] Royal Free London NHS Fdn Trust, London, England. [Diwakar, Previn; Scurr, James; Shaikh, Usman] Royal Liverpool & Broadgreen Univ NHS Trust, London, England. [Fortin, Kim; Hague, Julian; Richards, Toby; Vrebac, Sally] Univ Coll London Hosp NHS Fdn Trust, London, England. [Gohel, Manjit] Cambridge Univ Hosp NHS Fdn Trust, London, England. [Hammond, Christopher J.; Lenton, James] Leeds Teaching Hosp NHS Trust, London, England. [Haslam, Liz; Odedra, Bhim J.] Gloucestershire Hosp NHS Fdn Trust, London, England. [Jones, Robert G.; Willis, Andrew P.] Queen Elizabeth Hosp Birmingham, London, England. [Kearney, Tanya; Wigham, Andrew] Oxford Univ Hosp NHS Trust, London, England. [Lehmann, Eldon D.; Moore, Hayley; Schnatterbeck, Peter] West London Vasc & Intervent Ctr, London, England. [Low, Deborah] Barts Hlth NHS Trust London, London, England. [Prabhudesai, Shirish] Ashford & St Peters NHS Fdn Trust, London, England. [Ratnam, Lakshmi] St Georges Hosp Univ NHS Fdn Trust, London, England. [Shaikh, Shoaib] Bradford Teaching Hosp NHS Fdn Trust, London, England. [Shawyer, Andrew] Royal Bournemouth & Christchurch NHS Trust, London, England. Black, SA (corresponding author), St Thomas Hosp, Dept Vasc Surg, Westminster Bridge Rd, London SE1 7EH, England. Stephen.Black@gstt.nhs.uk AN - WOS:000550122800002 AU - Black, S. A. AU - Alvi, A. AU - Baker, S. J. AU - Beckett, D. AU - Breen, K. AU - Burfitt, N. J. AU - Coles, S. AU - Davies, A. H. AU - Davies, N. AU - Diwakar, P. AU - Drebes, A. AU - Fortin, K. AU - Gohel, M. AU - Hague, J. AU - Hammond, C. J. AU - Haslam, L. AU - Jones, R. G. AU - Kearney, T. AU - Lehmann, E. D. AU - Lenton, J. AU - Low, D. AU - Metcalfe, J. AU - Moore, H. AU - Odedra, B. J. AU - Prabhudesai, S. AU - Quigley, S. AU - Ratnam, L. AU - Richards, T. AU - Saha, P. AU - Schnatterbeck, P. AU - Scurr, J. AU - Shaikh, U. AU - Shaikh, S. AU - Shawyer, A. AU - Tippett, R. AU - Vrebac, S. AU - Ward, R. AU - Watts, C. AU - Wigham, A. AU - Willis, A. P. AU - Woodward, N. AU - Lim, C. S. DA - Feb DO - 10.23736/s0392-9590.19.04278-0 J2 - Int. Angiol. KW - Venous thrombosis Mechanical thrombolysis Stents Post-thrombotic syndrome May - Thurner syndrome CATHETER-DIRECTED THROMBOLYSIS DEEP-VEIN THROMBOSIS CLINICAL-PRACTICE-GUIDELINES QUALITY-OF-LIFE POSTTHROMBOTIC-SYNDROME VASCULAR-SURGERY EDITORS CHOICE DISEASE STENT COMPRESSION Peripheral Vascular Disease LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: MM4IR Times Cited: 1 Cited Reference Count: 75 Black, Stephen A. Alvi, Abdulrahman Baker, Sara J. Beckett, David Breen, Karen Burfitt, Nicholas J. Coles, Simon Davies, Alun H. Davies, Neil Diwakar, Previn Drebes, Anja Fortin, Kim Gohel, Manjit Hague, Julian Hammond, Christopher J. Haslam, Liz Jones, Robert G. Kearney, Tanya Lehmann, Eldon D. Lenton, James Low, Deborah Metcalfe, James Moore, Hayley Odedra, Bhim J. Prabhudesai, Shirish Quigley, Shaun Ratnam, Lakshmi Richards, Toby Saha, Prakash Schnatterbeck, Peter Scurr, James Shaikh, Usman Shaikh, Shoaib Shawyer, Andrew Tippett, Richard Vrebac, Sally Ward, Robert Watts, Christopher Wigham, Andrew Willis, Andrew P. Woodward, Nick Lim, Chung S. Hammond, Christopher/0000-0001-9435-5678 VENITI, Inc. This Consensus was supported with an unconditional educational grant from VENITI, Inc. 1 EDIZIONI MINERVA MEDICA TURIN INT ANGIOL PY - 2020 SN - 0392-9590 SP - 3-16 ST - Management of acute and chronic iliofemoral venous outflow obstruction: a multidisciplinary team consensus T2 - International Angiology TI - Management of acute and chronic iliofemoral venous outflow obstruction: a multidisciplinary team consensus UR - ://WOS:000550122800002 VL - 39 ID - 761462 ER - TY - JOUR AB - Background/Purpose: Acute valve thrombosis is a rare but serious complication of mechanical valve replacement surgery and is associated with high rates of morbidity and mortality. Acute valve thrombosis causes partial or complete obstruction of the valve area leading to valve dysfunction. This is characterized by abnormally high gradients across the valve on echocardiogram. Clinical manifestations depend on the severity of obstruction. Urgent diagnosis is essential to facilitate timely treatment and prevent patient deterioration. Treatment options include surgical intervention, anticoagulation and thrombolytic therapy (TT). Current guidelines recommend surgery for patients who are hemodynamically unstable or with contraindications to TT. Alternatively, TT, administered slowly, with treatment cycles guided by echo, has shown favourable outcomes with low risk for major complications when compared to other treatment modalities. The purpose is to discuss the implementation of a protocol using slow TT for patients presenting with acute valve thrombosis at Kingston Health Sciences Centre. Methods/Results: A retrospective chart review will be conducted to present the details of patients who underwent slow TT using a cyclical treatment of alteplase (TPA) and heparin infusions under echo guidance. The review will include patient selection criteria, implementation of the protocol and an overview of patient outcomes. Conclusion/Implications for Practice: Raising awareness and education of the multidisciplinary team regarding TT for acute valve thrombosis is essential to ensure favourable patient outcomes. Cardiovascular nurses play a pivotal role in the safe implementation and patient monitoring during TT. AU - Blakely, C. AU - Smith, L. AU - Hart, R. AU - Branscombe, P. AU - Campbell, D. AU - Shi, M. AU - Thakrar, A. AU - Al Turki, M. DB - Embase DO - 10.1016/j.cjca.2019.07.383 KW - alteplase heparin adult anticoagulation awareness complication conference abstract contraindication controlled study deterioration drug combination education female fibrinolytic therapy human male medical record review multidisciplinary team nurse obstruction patient monitoring patient selection practice guideline prevention prosthetic valve thrombosis retrospective study LA - English M1 - 10 M3 - Conference Abstract N1 - L2003291391 2019-10-14 PY - 2019 SN - 0828-282X SP - S203 ST - BUSTING THE CLOT BURDEN: THE IMPLEMENTATION OF A SLOW THROMBOLYTIC THERAPY PROTOCOL IN THE TREATMENT OF ACUTE MECHANICAL VALVE THROMBOSIS T2 - Canadian Journal of Cardiology TI - BUSTING THE CLOT BURDEN: THE IMPLEMENTATION OF A SLOW THROMBOLYTIC THERAPY PROTOCOL IN THE TREATMENT OF ACUTE MECHANICAL VALVE THROMBOSIS UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003291391&from=export http://dx.doi.org/10.1016/j.cjca.2019.07.383 VL - 35 ID - 760668 ER - TY - JOUR AB - The rise of endovascular techniques has improved the outcome of mesenteric ischemia. Key principle in reduction of morbidity and mortality is “revascularization first, resection later”. We believe that mesenteric ischemia is a clinical challenge demanding 24/7 multidisciplinary team availability. This article describes the current insights into treatment of mesenteric ischemia. AD - J.T.M. Blauw, Hollanderstraat 2, Den Haag, Netherlands AU - Blauw, J. T. M. AU - Bulut, T. AU - Oderich, G. S. AU - Geelkerken, B. R. H. DB - Embase Medline DO - 10.1016/j.bpg.2017.01.002 KW - celiac artery comparative study disease association endovascular revascularization endovascular surgery follow up human inferior mesenteric artery intestine infarction laparotomy medical history mesenteric ischemia morbidity outcome assessment postoperative care preoperative evaluation revascularization review superior mesenteric artery surgical mortality surgical patient vascularization LA - English M1 - 1 M3 - Review N1 - L614894958 2017-03-23 2019-10-31 PY - 2017 SN - 1532-1916 1521-6918 SP - 75-84 ST - Mesenteric vascular treatment 2016: from open surgical repair to endovascular revascularization T2 - Best Practice and Research: Clinical Gastroenterology TI - Mesenteric vascular treatment 2016: from open surgical repair to endovascular revascularization UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614894958&from=export http://dx.doi.org/10.1016/j.bpg.2017.01.002 VL - 31 ID - 760959 ER - TY - JOUR AB - Background: FOLFIRINOX exhibits a meaningful improvement in outcome measures in metastatic pancreatic cancer, making it an interesting regimen for BRPC and LAURPC. However, its use remains prohibitive due to toxicity. In this study, we examine the outcomes of mFOLFIRINOX as a neoadjuvant strategy for patients with BRPC and LAURPC. Methods: This is a retrospective analysis of a prospectively maintained database of patients who received mFOLFIRINOX for BRPC or LAURPC at Ohio State University. mFOLFIRINOX is as follows: irinotecan at 165 mg/m2; oxaliplatin at 85 mg/m2; 5-fluorouracil (5FU) at 2,400 mg/m2 over 46 hours and pegfilgrastim on day 4 of each 2-week cycle. Cases were thoroughly reviewed by a multidisciplinary team prior to initiation of therapy and at each restaging scan. The primary outcomes of this analysis were resection rate and grade 3/4 (G3/4) toxicities. Results: Since 1/1/2011, 43 patients (20 BRPC; 23 LAURPC) have received mFOLFIRINOX. Patients received gemcitabine-based chemoradiation (36 Gy in 15 fractions) only if their best response was stable disease after 4 months of mFOLFIRINOX. At the time of this abstract, 39 patients are evaluable for primary outcome. Overall resection rate was 53.8% including 45% of patients with initially unresectable disease. R0 resection was achieved in 85.7% of the surgeries. See table for more results. The rate of G3/4 toxicity was remarkably low with no episodes of febrile neutropenia, G3/4 neutropenia or thrombocytopenia. Toxicities lead to dose reductions in 46% of patients. Conclusions: Neoadjuvant mFOLFIRINOX is an effective, well-tolerated regimen as part of an integrated, multimodality strategy in BRPC and LAURPC leading to high resection rates and high R0 resection frequency. (Table Presented). AD - M.A. Blazer AU - Blazer, M. A. AU - Wu, C. S. Y. AU - Goldberg, R. M. AU - Phillips, G. S. AU - Schmidt, C. R. AU - Muscarella, P. AU - El-Dika, S. S. AU - Walker, J. P. AU - Krishna, S. G. AU - Groce, J. R. AU - Wuthrick, E. J. AU - Williams, T. M. AU - Efries, D. AU - Smith, Y. T. AU - Mathey, K. AU - Wagner, M. AU - Reardon, J. AU - Ellison, E. C. AU - Bloomston, M. AU - Bekaii-Saab, T. S. DB - Embase KW - fluorouracil oxaliplatin gemcitabine irinotecan recombinant granulocyte colony stimulating factor pancreas cancer human digestive system cancer patient surgery toxicity therapy university United States drug dose reduction thrombocytopenia neutropenia febrile neutropenia chemoradiotherapy data base L1 - http://meeting.ascopubs.org/cgi/content/abstract/32/3_suppl/275?sid=b2e14bc4-3de9-46cd-8373-1cf8057175bf LA - English M1 - 3 M3 - Conference Abstract N1 - L71324501 2014-02-21 PY - 2014 SN - 0732-183X ST - Tolerability and efficacy of modified FOLFIRINOX (mFOLFIRINOX) in patients with borderline-resectable pancreatic cancer (BRPC) and locally advanced unresectable pancreatic cancer (LAURPC) T2 - Journal of Clinical Oncology TI - Tolerability and efficacy of modified FOLFIRINOX (mFOLFIRINOX) in patients with borderline-resectable pancreatic cancer (BRPC) and locally advanced unresectable pancreatic cancer (LAURPC) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71324501&from=export VL - 32 ID - 761129 ER - TY - JOUR AB - BACKGROUND There has been a recent surge in the use of catheterdirected thrombolytic therapy (CDT) in patients with high risk pulmonary embolism (PE). While recent trials have shown low complication rates, the safety and outcomes of CDT during routine use in the community is not well elucidated. METHODS A total of 137 patients with high-risk PE (hypotensive [massive] or normotensive with right ventricular strain [submassive]) at 2 academic centers undergoing CDT from December 2012 until April 2016 were entered into a prospective database. The decision for CDT was made by a multidisciplinary PE response team. In hospital complications and outcomes were recorded. RESULTS All submassive patients survived (see table). Major complications included: 2 intracranial bleeds, 2 hematomas requiring evacuation, 2 access site complications requiring surgery, 2 pseudoaneurysms treated successfully with thrombin injection, 6 hematomas requiring transfusion, and 2 self-limiting GI bleeds requiring transfusion. Factors associated with complications were advanced age (p<0.01), massive PE presentation (p=0.02), and IVC filter placement (p<0.01), but not total thrombolytic dose administered. CONCLUSION CDT, while effective at acutely reducing pulmonary arterial pressures and possibly safer than systemic thrombolytics, is associated with serious bleeding complications and should be reserved for patients who are at a significantly elevated risk. (Table Presented). AD - T. Bloomer, Vanderbilt University Medical Center, Nashville, TN, United States AU - Bloomer, T. AU - Fong, P. AU - McDaniel, M. AU - Sandvall, B. AU - Liberman, H. AU - Devireddy, C. AU - Jaber, W. DB - Embase KW - antihypertensive agent endogenous compound fibrinolytic agent thrombin adverse drug reaction brain hemorrhage catheter complication controlled study data base false aneurysm fibrinolytic therapy filter gastrointestinal hemorrhage heart right ventricle hematoma hospital human injection lung artery pressure lung embolism major clinical study safety side effect surgery LA - English M1 - 18 M3 - Conference Abstract N1 - L614161221 2017-01-26 PY - 2016 SN - 1558-3597 SP - B315-B316 ST - Safety and outcomes of catheter-directed thrombolytic therapy in high-risk pulmonary embolism T2 - Journal of the American College of Cardiology TI - Safety and outcomes of catheter-directed thrombolytic therapy in high-risk pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614161221&from=export VL - 68 ID - 760992 ER - TY - JOUR AB - Learning Objectives: The landscape for pulmonary embolism (PE) treatment is rapidly changing. Pulmonary Embolism Response Teams (PERT) have been implemented with the goal of improving care through rapid risk stratification and multidisciplinary initiation of care, leading to a reduction in mortality and length of stay (LOS). The 2014 ESC guidelines propose a risk-based algorithm to guide this management. While overall length of stay has been shown to decrease with implementation of PERT, there is little data on the relationship between PERTdriven risk stratification and length of stay. Methods: PERT was implemented at a tertiary care center and all patients with PE present on admission (POA) were evaluated with clinical risk stratification based on the 2014 ESC PE Guidelines. Risk strata included high, high-intermediate, low-intermediate, and low-risk based on the simplified pulmonary embolism severity index (sPESI) score and presence of RV dysfunction, troponin elevation, or both. LOS for all patients with PE present on admission from 2014-2017 was collected from the Vizient database and was compared with the internal post-PERT implementation database from August 2017 to mid-May 2018. Statistical analysis of LOS by risk stratification in the post-PERT cohort was performed. Patient-level data from Vizient was not available and thus retrospective risk-stratification of these patients was not analyzed. Results: Overall mean length of stay for patients with pulmonary embolism POA decreased from 7.46 to 5.43 days. After risk stratification, mean LOS was significantly lower between high-intermediate and low-intermediate risk (8.21 vs. 5.01 days, p=0.008), and significantly lower between low-intermediate and low risk patients (5.01 vs. 3.45 days, p=0.005). Patients in shock accounted for <4% of the population and were excluded from analysis. Conclusions: These data demonstrate risk stratification in patients with PE present on admission at a tertiary care institution is associated with a reduction in mean length of stay, driven by the low-intermediate and low-risk populations. Risk stratification is an essential step for institutions planning to pursue outpatient treatment of low risk PE. AD - R. Bloomingdale, William Beaumont Hospital, Grosse Pointe, MI, United States AU - Bloomingdale, R. AU - Goldstein, J. AU - McNally, V. AU - Berger, D. AU - Swor, R. AU - Rothschild, D. AU - Bowers, T. DB - Embase KW - endogenous compound troponin adult clinical evaluation conference abstract controlled study human length of stay low risk patient low risk population outpatient pulmonary embolism response team risk assessment tertiary care center LA - English M1 - 1 M3 - Conference Abstract N1 - L629628884 2019-10-23 PY - 2019 SN - 1530-0293 ST - Length of stay reduction for pulmonary embolism patients with pert-driven risk stratification T2 - Critical Care Medicine TI - Length of stay reduction for pulmonary embolism patients with pert-driven risk stratification UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629628884&from=export VL - 47 ID - 760771 ER - TY - JOUR AB - Adherence to guidelines to avoid complications associated with mechanical ventilation is often incomplete. The goal of this study was to assess whether staff training in pre-defined interventions (bundle) improves the quality of care in mechanically ventilated patients. This study was performed on a 50-bed intensive care unit of a tertiary care university hospital. Application of a ventilator bundle consisting of semirecumbent positioning, lung protective ventilation in patients with acute lung injury (ALI), ulcer prophylaxis, and deep vein thrombosis prophylaxis (DVTP) was assessed before and after staff training in post-surgical patients requiring mechanical ventilation for at least 24 h. A total of 133 patients before and 141 patients after staff training were included. Overall bundle adherence increased from 15 to 33.8% (P < 0.001). Semirecumbent position was achieved in 24.9% of patient days before and 46.9% of patient days after staff training (P < 0.001). Administration of DVTP increased from 89.5 to 91.5% (P=0.048). Ulcer prophylaxis of > 90% was achieved in both groups. Median tidal volume in patients with ALI remained unaltered. Days on mechanical ventilation were reduced from 6 (interquartile range 2.0-15.0) to 4 (2.0-9.0) (P=0.017). Rate of ventilator-associated pneumonia (VAP), ICU length of stay, and ICU mortality remained unaffected. In patients with VAP, the median ICU length of stay was reduced by 9 days (P=0.04). Staff training by an ICU change team improved compliance to a pre-defined ventilator bundle. This led to a reduction in the days spent on mechanical ventilation, despite incomplete bundle implementation. AD - [Bloos, F.; Mueller, S.; Harz, A.; Gugel, M.; Geil, D.; Egerland, K.; Reinhart, K.; Marx, G.] Univ Hosp Jena, Dept Anaesthesiol & Intens Care Med, D-07747 Jena, Germany. [Marx, G.] Rhein Westfal TH Aachen, Fac Med, Dept Surg Intens Care Med, D-52074 Aachen, Germany. Bloos, F (corresponding author), Univ Hosp Jena, Dept Anaesthesiol & Intens Care Med, Erlanger Allee 101, D-07747 Jena, Germany. frank.bloos@med.uni-jena.de AN - WOS:000268107800013 AU - Bloos, F. AU - Muller, S. AU - Harz, A. AU - Gugel, M. AU - Geil, D. AU - Egerland, K. AU - Reinhart, K. AU - Marx, G. DA - Aug DO - 10.1093/bja/aep114 J2 - Br. J. Anaesth. KW - audit trainings complications respiratory intensive care pulmonary ventilation mechanical ACUTE LUNG INJURY PNEUMONIA POSITION THERAPY BUNDLE Anesthesiology LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 472CW Times Cited: 40 Cited Reference Count: 20 Bloos, F. Mueller, S. Harz, A. Gugel, M. Geil, D. Egerland, K. Reinhart, K. Marx, G. Bloos, Frank/AAY-8265-2020 Bloos, Frank/0000-0002-0767-7941 43 0 4 ELSEVIER SCI LTD OXFORD BRIT J ANAESTH PY - 2009 SN - 0007-0912 SP - 232-237 ST - Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study T2 - British Journal of Anaesthesia TI - Effects of staff training on the care of mechanically ventilated patients: a prospective cohort study UR - ://WOS:000268107800013 VL - 103 ID - 761892 ER - TY - JOUR AB - Galectin-3 (Gal-3), a β-galactoside-binding lectin, has been implicated in myocardial fibrosis, development of left ventricular (LV) dysfunction and transition from compensated LV hypertrophy to overt heart failure (HF), being a novel prognostic marker in HF. Risk stratification is crucial for the choice of the optimal therapy in degenerative aortic stenosis (AS), affecting elderly subjects with coexistent diseases. Our aim was to assess correlates and prognostic value of circulating Gal-3 in real-world patients with degenerative AS referred for invasive treatment. Gal-3 levels were measured at admission in 80 consecutive patients with symptomatic degenerative AS (mean age: 79 ± 8 years; aortic valve area (AVA) index: 0.4 ± 0.1 cm²/m²). The therapeutic strategy was chosen following a dedicated multidisciplinary team-oriented approach, including surgical valve replacement (n = 11), transcatheter valve implantation (n = 19), balloon aortic valvuloplasty (BAV) (n = 25) and optimal medical therapy (n = 25). Besides routine echocardiographic indices, valvulo-arterial impedance (Zva), an index of global LV afterload, was computed. There were 22 deaths over a median follow-up of 523 days. Baseline Gal-3 correlated negatively with estimated glomerular filtration rate (eGFR) (r = -0.61, p < 0.001) and was unrelated to age, symptomatic status, AVA index, LV ejection fraction, LV mass index or Zva. For the study group as a whole, Gal-3 tended to predict mortality (Gal-3 >17.8 vs. Gal-3 <17.8 ng/mL; hazard ratio (HR): 2.03 (95% confidence interval, 0.88-4.69), p = 0.09), which was abolished upon adjustment for eGFR (HR: 1.70 (0.61-4.73), p = 0.3). However, in post-BAV patients multivariate-adjusted pre-procedural Gal-3 was associated with worse survival (HR: 7.41 (1.52-36.1), p = 0.01) regardless of eGFR. In conclusion, the inverse eGFR-Gal-3 relationship underlies a weak association between Gal-3 and adverse outcome in patients with degenerative AS referred for invasive therapy irrespective of type of treatment employed. In contrast, pre-procedural Gal-3 appears an independent mortality predictor in high-risk AS patients undergoing BAV. AD - Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 17 Kopernika Street, 31-501 Cracow, Poland. bobrowska.beata@gmail.com. Second Department of Cardiology and Cardiovascular Interventions, University Hospital, 17 Kopernika Street, 31-501 Cracow, Poland. bobrowska.beata@gmail.com. Department of Nephrology, University Hospital, 15C Kopernika Street, 31-501 Cracow, Poland. esurdacka@gmail.com. Department of Coronary Artery Disease and Heart Failure, John Paul II Hospital, 80 Prądnicka Street, 31-202 Cracow, Poland. olga.kruszelnicka@onet.pl. Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 17 Kopernika Street, 31-501 Cracow, Poland. chyrchelb@gmail.com. Second Department of Cardiology and Cardiovascular Interventions, University Hospital, 17 Kopernika Street, 31-501 Cracow, Poland. chyrchelb@gmail.com. Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 17 Kopernika Street, 31-501 Cracow, Poland. surdacki.andreas@gmx.net. Second Department of Cardiology and Cardiovascular Interventions, University Hospital, 17 Kopernika Street, 31-501 Cracow, Poland. surdacki.andreas@gmx.net. Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 17 Kopernika Street, 31-501 Cracow, Poland. mcdudek@cyfromet.pl. Second Department of Cardiology and Cardiovascular Interventions, University Hospital, 17 Kopernika Street, 31-501 Cracow, Poland. mcdudek@cyfromet.pl. AN - 28468272 AU - Bobrowska, B. AU - Wieczorek-Surdacka, E. AU - Kruszelnicka, O. AU - Chyrchel, B. AU - Surdacki, A. AU - Dudek, D. C2 - Pmc5454860 DA - Apr 29 DO - 10.3390/ijms18050947 DP - NLM ET - 2017/05/05 J2 - International journal of molecular sciences KW - Aged Aged, 80 and over Angioplasty, Balloon Aortic Valve/surgery Aortic Valve Stenosis/*blood/*diagnosis/surgery/therapy Female Galectin 3/*blood Glomerular Filtration Rate Humans Male Prognosis Prospective Studies Treatment Outcome balloon aortic valvuloplasty degenerative aortic stenosis galectin-3 invasive treatment mortality prognostic value the design of the study in the collection, analyses, or interpretation of data in the writing of the manuscript, and in the decision to publish the results. LA - eng M1 - 5 N1 - 1422-0067 Bobrowska, Beata Wieczorek-Surdacka, Ewa Kruszelnicka, Olga Chyrchel, Bernadeta Surdacki, Andrzej Dudek, Dariusz Journal Article Int J Mol Sci. 2017 Apr 29;18(5):947. doi: 10.3390/ijms18050947. PY - 2017 SN - 1422-0067 ST - Clinical Correlates and Prognostic Value of Plasma Galectin-3 Levels in Degenerative Aortic Stenosis: A Single-Center Prospective Study of Patients Referred for Invasive Treatment T2 - Int J Mol Sci TI - Clinical Correlates and Prognostic Value of Plasma Galectin-3 Levels in Degenerative Aortic Stenosis: A Single-Center Prospective Study of Patients Referred for Invasive Treatment VL - 18 ID - 760388 ER - TY - JOUR AB - Introduction: Acute stroke care delivered by interdisciplinary teams is time-sensitive. Simulation-based team training is a promising tool to improve team performance in medical operations. It has the potential to improve process times, team communication, patient safety, and staff satisfaction. We aim to assess whether a multi-level approach consisting of a stringent workflow revision based on peer-to-peer review and 2-3 one-day in situ simulation trainings can improve acute stroke care processing times in high volume neurocenters within a 6 months period. Methods and Analysis: The trial is being carried out in a pre-test-post-test design at 7 tertiary care university hospital neurocenters in Germany. The intervention is directed at the interdisciplinary multiprofessional stroke teams. Before and after the intervention, process times of all direct-to-center stroke patients receiving IV thrombolysis (IVT) and/or endovascular therapy (EVT) will be recorded. The primary outcome measure will be the "door-to-needle" time of all consecutive stroke patients directly admitted to the neurocenters who receive IVT. Secondary outcome measures will be intervention-related process times of the fraction of patients undergoing EVT and effects on team communication, perceived patient safety, and staff satisfaction via a staff questionnaire. Interventions: We are applying a multi-level intervention in cooperation with three "STREAM multipliers" from each center. First step is a central meeting of the multipliers at the sponsor's institution with the purposes of algorithm review in a peer-to-peer process that is recorded in a protocol and an introduction to the principles of simulation training and debriefing as well as crew resource management and team communication. Thereafter, the multipliers cooperate with the stroke team trainers from the sponsor's institution to plan and execute 2-3 one-day simulation courses in situ in the emergency department and CT room of the trial centers whereupon they receive teaching materials to perpetuate the trainings. AD - [Bohmann, Ferdinand O.; Kurka, Natalia; Gruber, Katharina; Rai, Heike; Pfeilschifter, Waltraud; Alotaibi, Mohammad; Batarfi, AbdulAziz; Brandhofe, Annemarie; Kestner, Roxane-Isabelle; Schaefer, Jan Hendrik; Schaller, Martin Alexander; Seiler, Alexander; Wallenwein, Stephanie; Willems, Laurent M.; Steinmetz, Helmuth] Univ Hosp Frankfurt, Dept Neurol, Theodor Stern Kai 7, D-60590 Frankfurt, Germany. [de Rochemont, Richard du Mesnil; Hattingen, Elke] Univ Hosp Frankfurt, Inst Diagnost & Intervent Neuroradiol, Theodor Stern Kai 7, D-60590 Frankfurt, Germany. [Guenther, Joachim] Klinikum Hanau, Dept Neurol, Hanau, Germany. [Rostek, Peter] Univ Hosp Frankfurt, NICU Nursing Staff, Frankfurt, Germany. [Zickler, Philipp; Ertl, Michael] Univ Klinikum Augsburg, Dept Neurol & Clin Neurophysiol, Augsburg, Germany. [Berlis, Ansgar] Univ Klinikum Augsburg, Dept Diagnost & Intervent Radiol & Neuroradiol, Augsburg, Germany. [Poli, Sven; Mengel, Annerose; Blum, Corinna; Bombach, Paula; Zeller, Julia] Univ Hosp Tubingen, Dept Neurol Focus Neurovasc Dis & Neurooncol, Hoppe Seyler Str 3, D-72076 Tubingen, Germany. [Poli, Sven; Mengel, Annerose; Zeller, Julia] Univ Tubingen, Hertie Inst Clin Brain Res, Tubingen, Germany. [Ringleb, Peter; Nagel, Simon; Gumbinger, Christoph; Regula, Jens; Horstmann, Solveig; Heyse, Miriam; Dorozewski, Eva; Lamentner, Christian, I; Tilman, Reiff; Schieber, Simon; Mundiyanapurath, Sibu; Schoenenberger, Silvia; Mokli, Yahia] Univ Hosp Heidelberg, Dept Neurol, Neuenheimer Feld 400, D-69120 Heidelberg, Germany. [Pfaff, Johannes; Moehlenbruch, Markus] Univ Hosp Heidelberg, Dept Neuroradiol, Neuenheimer Feld 400, D-69120 Heidelberg, Germany. [Wollenweber, Frank A.; Kellert, Lars; Bewersdorf, Jan; Einhaeupl, Maximilian; Feil, Katharina; Klein, Matthias; Moehwald, Ken; Mulazzani, Mathias; Rohrer, Guido; Schoenedcer, Sonja] Ludwig Maximilians Univ Munchen, Dept Neurol, Marchioninistr 15, D-81377 Munich, Germany. [Herzberg, Moriz] Ludwig Maximilians Univ Munchen, Dept Diagnost & Intervent Neuroradiol, Munich, Germany. [Koehler, Luzie] Univ Hosp Leipzig, Dept Neurol, Leipzig, Germany. [Haeusler, Karl Georg] Charite Univ Med Berlin, Ctr Stroke Res Berlin, Berlin, Germany. [Haeusler, Karl Georg] Univ Klinikum Wurzburg, Dept Neurol, Wurzburg, Germany. [Alegiani, Anna; Schubert, Charlotte; Prilop, Lisa; Roesner, Sabine; Guder, Stephanie; Lange, Carmen; Higgen, Focko L.; Thomalla, Goetz] Univ Med Ctr Hamburg Eppendorf, Dept Neurol, Martinistr 52, D-20246 Hamburg, Germany. [Brekenfeld, Caspar; Bester, Maxim; Schoenfeld, Michael H.; Flottmann, Fabian; Leischner, Iannes; Froelich, Andreas Maximilian; Broocks, Gabriel; Hanning, Uta; Bechstein, Matthias; Kautz, Sebastian; Fiehler, Jens] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Martinistr 52, D-20246 Hamburg, Germany. [Doppler, Christopher E. J.; Onur, Oezguer A.; Fink, Gereon Rudolf; Bonkhoff, Anna; Dronse, Julian; Kirsch, Katharina; Laurent, Sarah; von Reutern, Boris; Rosen, Jurij; Volz, Lukas; Werner, Jan-Michael; Woking, Michael; Seliger, Robert; Yildirim, Abdulkadir] Univ Hosp Cologne, Dept Neurol, Kerpener Str 62, D-50937 Cologne, Germany. [Kabbasch, Christoph; Schlamann, Marc; Borggrefe, Jan] Univ Hosp Cologne, Dept Neuroradiol, Kerpener Str 62, D-50937 Cologne, Germany. [Manser, Tanja] FHNW Univ Appl Sci & Arts Northwestern Switzerlan, Sch Appl Psychol, Olten, Switzerland. [Kos, Zeljko; Naumann, Markus] Klinikum Augsburg, Dept Neurol & Clin Neurophysiol, Stenglinstr 2, D-86156 Augsburg, Germany. [Muehlbauer, Konstanze] Ludwig Maximilians Univ Munchen, Dept Anesthesiol, Marchioninistr 15, D-81377 Munich, Germany. [Dorn, Franziska; Mennemeyer, Philipp; Sandner, Torleif] Univ Munich LMU, Dept Diagnost & Intervent Neuroradiol, Campus Grosshadern, Munich, Germany. [Huber, Brigitte; Hill, Julia] Ludwig Maximilians Univ Munchen, Inst Stroke & Dementia Res, Marchioninistr 15, D-81377 Munich, Germany. [Gavran, Jela] Ludwig Maximilians Univ Munchen, Emergency Dept, Klinikum Grosshadern, Marchioninistr 15, D-81377 Munich, Germany. [Geran, Rohat; Schurig, Johannes; Lerm, Juliane, I; Kleefeld, Felix; Schoknecht, Karl; Jadranka, Denes; Brade, Kirsten; Wittenberg, Tatjana] Charite, Ctr Stroke Res Berlin CSB, Hindenburgdamm 30, D-12203 Berlin, Germany. [Audebert, Heinrich] Charite, Dept Neurol, Hindenburgdamm 30, D-12203 Berlin, Germany. [Mayer-Runge, Ulrich] Univ Med Ctr Hamburg Eppendorf, Cent Emergency Dept, Martinistr 52, D-20246 Hamburg, Germany. [Kyselyova, Anna] Univ Med Ctr Hamburg Eppendorf, Dept Neuroradiol Diag & Intervent, Martinistr 52, D-20246 Hamburg, Germany. Pfeilschifter, W (corresponding author), Univ Hosp Frankfurt, Dept Neurol, Theodor Stern Kai 7, D-60590 Frankfurt, Germany. waltraud.pfeilschifter@kgu.de AN - WOS:000485185200001 AU - Bohmann, F. O. AU - Kurka, N. AU - de Rochemont, R. D. AU - Gruber, K. AU - Guenther, J. AU - Rostek, P. AU - Rai, H. K. AU - Zickler, P. AU - Ertl, M. AU - Berlis, A. AU - Poli, S. AU - Mengel, A. AU - Ringleb, P. AU - Nagel, S. AU - Pfaff, J. AU - Wollenweber, F. A. AU - Kellert, L. AU - Herzberg, M. AU - Koehler, L. AU - Haeusler, K. G. AU - Alegiani, A. AU - Schubert, C. AU - Brekenfeld, C. AU - Doppler, C. E. J. AU - Onur, O. A. AU - Kabbasch, C. AU - Manser, T. AU - Pfeilschifter, W. AU - Alotaibi, M. AU - Batarfi, A. AU - Brandhofe, A. AU - Kestner, R. I. AU - Schaefer, J. H. AU - Schaller, M. A. AU - Seiler, A. AU - Wallenwein, S. AU - Willems, L. M. AU - Steinmetz, H. AU - Hattingen, E. AU - Kos, Z. AU - Naumann, M. AU - Blum, C. AU - Bombach, P. AU - Zeller, J. AU - Gumbinger, C. AU - Regula, J. AU - Horstmann, S. AU - Heyse, M. AU - Dorozewski, E. AU - Lamentner, C. I. AU - Tilman, R. AU - Schieber, S. AU - Mundiyanapurath, S. AU - Schonenberger, S. AU - Mokli, Y. AU - Mohlenbruch, M. AU - Bewersdorf, J. AU - Einhaupl, M. AU - Feil, K. AU - Klein, M. AU - Mohwald, K. AU - Muhlbauer, K. AU - Mulazzani, M. AU - Rohrer, G. AU - Schonedcer, S. AU - Dorn, F. AU - Mennemeyer, P. AU - Sandner, T. AU - Huber, B. AU - Hill, J. AU - Gavran, J. AU - Audebert, H. AU - Geran, R. AU - Schurig, J. AU - Lerm, J. I. AU - Kleefeld, F. AU - Schoknecht, K. AU - Jadranka, D. AU - Brade, K. AU - Wittenberg, T. AU - Mayer-Runge, U. AU - Bester, M. AU - Schonfeld, M. H. AU - Flottmann, F. AU - Prilop, L. AU - Leischner, I. AU - Frolich, A. M. AU - Roesner, S. AU - Broocks, G. AU - Hanning, U. AU - Guder, S. AU - Bechstein, M. AU - Lange, C. AU - Kautz, S. AU - Higgen, F. L. AU - Kyselyova, A. AU - Thomalla, G. AU - Fiehler, J. AU - Fink, G. R. AU - Bonkhoff, A. AU - Dronse, J. AU - Kirsch, K. AU - Laurent, S. AU - von Reutern, B. AU - Rosen, J. AU - Volz, L. AU - Werner, J. M. AU - Woking, M. AU - Seliger, R. AU - Yildirim, A. AU - Schlamann, M. AU - Borggrefe, J. AU - Investigators, Stream Trial C7 - 969 DA - Sep DO - 10.3389/fneur.2019.00969 J2 - Front. Neurol. KW - CRM thrombolysis (tPA) stroke emergency care simulation training TO-NEEDLE TIMES RESOURCE-MANAGEMENT ISCHEMIC-STROKE IMPLEMENTATION OUTCOMES MINUTES THERAPY PROGRAM SAFETY TRENDS Clinical Neurology Neurosciences LA - English M3 - Article N1 - ISI Document Delivery No.: IW7PF Times Cited: 1 Cited Reference Count: 25 Bohmann, Ferdinand O. Kurka, Natalia de Rochemont, Richard du Mesnil Gruber, Katharina Guenther, Joachim Rostek, Peter Rai, Heike Zickler, Philipp Ertl, Michael Berlis, Ansgar Poli, Sven Mengel, Annerose Ringleb, Peter Nagel, Simon Pfaff, Johannes Wollenweber, Frank A. Kellert, Lars Herzberg, Moriz Koehler, Luzie Haeusler, Karl Georg Alegiani, Anna Schubert, Charlotte Brekenfeld, Caspar Doppler, Christopher E. J. Onur, Oezguer A. Kabbasch, Christoph Manser, Tanja Pfeilschifter, Waltraud Alotaibi, Mohammad Batarfi, AbdulAziz Brandhofe, Annemarie Kestner, Roxane-Isabelle Schaefer, Jan Hendrik Schaller, Martin Alexander Seiler, Alexander Wallenwein, Stephanie Willems, Laurent M. Steinmetz, Helmuth Hattingen, Elke Kos, Zeljko Naumann, Markus Blum, Corinna Bombach, Paula Zeller, Julia Gumbinger, Christoph Regula, Jens Horstmann, Solveig Heyse, Miriam Dorozewski, Eva Lamentner, Christian, I Tilman, Reiff Schieber, Simon Mundiyanapurath, Sibu Schoenenberger, Silvia Mokli, Yahia Moehlenbruch, Markus Bewersdorf, Jan Einhaeupl, Maximilian Feil, Katharina Klein, Matthias Moehwald, Ken Muehlbauer, Konstanze Mulazzani, Mathias Rohrer, Guido Schoenedcer, Sonja Dorn, Franziska Mennemeyer, Philipp Sandner, Torleif Huber, Brigitte Hill, Julia Gavran, Jela Audebert, Heinrich Geran, Rohat Schurig, Johannes Lerm, Juliane, I Kleefeld, Felix Schoknecht, Karl Jadranka, Denes Brade, Kirsten Wittenberg, Tatjana Mayer-Runge, Ulrich Bester, Maxim Schoenfeld, Michael H. Flottmann, Fabian Prilop, Lisa Leischner, Iannes Froelich, Andreas Maximilian Roesner, Sabine Broocks, Gabriel Hanning, Uta Guder, Stephanie Bechstein, Matthias Lange, Carmen Kautz, Sebastian Higgen, Focko L. Kyselyova, Anna Thomalla, Goetz Fiehler, Jens Fink, Gereon Rudolf Bonkhoff, Anna Dronse, Julian Kirsch, Katharina Laurent, Sarah von Reutern, Boris Rosen, Jurij Volz, Lukas Werner, Jan-Michael Woking, Michael Seliger, Robert Yildirim, Abdulkadir Schlamann, Marc Borggrefe, Jan Berlis, Ansgar/AAN-9734-2020; Bewersdorf, Jan Philipp/AAK-6186-2020; Borggrefe, Jan/N-6549-2018; Pfaff, Johannes Alex Rolf/P-6272-2019; Dorn, Franziska/AAA-7754-2020; Klein, Matthias/F-4118-2017; Doppler, Christopher/AAD-4253-2020; Fink, Gereon R./E-1616-2012 Bewersdorf, Jan Philipp/0000-0003-3352-0902; Borggrefe, Jan/0000-0003-2908-7560; Pfaff, Johannes Alex Rolf/0000-0003-0672-5718; Dorn, Franziska/0000-0001-9093-8307; Klein, Matthias/0000-0001-9064-6865; Fink, Gereon R./0000-0002-8230-1856; Zickler, Philipp/0000-0002-2852-7360; Onur, Oezguer/0000-0001-8336-7075; Hattingen, Elke/0000-0002-8392-9004 Stryker Neurovascular The study was funded by Stryker Neurovascular. The funding source was not involved in study design, monitoring, data collection, statistical analyses, interpretation of results, or manuscript writing. 1 0 3 FRONTIERS MEDIA SA LAUSANNE FRONT NEUROL PY - 2019 SN - 1664-2295 SP - 9 ST - Simulation-Based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM)-A Prospective Single-Arm Multicenter Trial T2 - Frontiers in Neurology TI - Simulation-Based Training of the Rapid Evaluation and Management of Acute Stroke (STREAM)-A Prospective Single-Arm Multicenter Trial UR - ://WOS:000485185200001 VL - 10 ID - 761495 ER - TY - JOUR AB - BACKGROUND AND PURPOSE: Driven by the positive results of randomized, controlled trials of endovascular stroke therapies (EVT) in stroke patients with large vessel occlusion, different approaches to speed up the workflow for EVT candidates are currently being implemented worldwide. We aimed to assess the effect of a simple stroke network-wide workflow improvement project, primarily focusing on i.v. thrombolysis, on process times for patients undergoing EVT. METHODS: In 2015, we conducted a network-wide, peer-to-peer acute stroke workflow improvement program for i.v. thrombolysis with the main components of implementing a binding team-based algorithm at every stroke unit of the regional network, educating all stroke teams about non-technical skills and providing a stroke-specific simulation training. Before and after the intervention we recorded periprocedural process times, including patients undergoing EVT at the 3 EVT-capable centers (January - June 2015, n = 80 vs. July 2015 - June 2016, n = 184). RESULTS: In this multi-centric evaluation of 268 patients receiving EVT, we observed a relevant shortening of the median time from symptom onset to EVT specifically in patients requiring secondary transfer by almost an hour (300 min, 25-75% interquartile range [IQR] 231-381 min to 254 min, IQR 215.25-341 min; p = 0.117), including a reduction of the median door-to-groin time at the EVT-capable center in this patient group by 15.5 min (59 min, IQR 35-102 min to 43.5 min, IQR 27.75-81.25 min; p = 0.063). In patients directly admitted to an EVT-capable center, the median door-to-groin interval was reduced by 10.5 min (125 min, IQR 83.5-170.5 min to 114.5 min, IQR 66.5-151 min; p = 0.167), but a considerable heterogeneity between the centers was observed (p < 0.001). CONCLUSIONS: We show that a simple network-wide workflow improvement program primarily directed at fast i.v. thrombolysis also accelerates process times for EVT candidates and is a promising measure to improve the performance of an entire stroke network. AD - Department of Neurology, Frankfurt University Hospital, Frankfurt am Main, Germany. Institute of Neuroradiology, Frankfurt University Hospital, Frankfurt am Main, Germany. Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany. Department of Neuroradiology, Krankenhaus Nordwest, Frankfurt am Main, Germany. Department of Neurology, HELIOS HSK Wiesbaden, Wiesbaden, Germany. Institute of Neuroradiology, HELIOS HSK Wiesbaden, Wiesbaden, Germany. AN - 29587257 AU - Bohmann, F. O. AU - Tahtali, D. AU - Kurka, N. AU - Wagner, M. AU - You, S. J. AU - du Mesnil de Rochemont, R. AU - Berkefeld, J. AU - Hartmetz, A. K. AU - Kuhlmann, A. AU - Lorenz, M. W. AU - Schütz, A. AU - Kress, B. AU - Henke, C. AU - Tritt, S. AU - Meyding-Lamadé, U. AU - Steinmetz, H. AU - Pfeilschifter, W. DO - 10.1159/000487965 DP - NLM ET - 2018/03/28 J2 - Cerebrovascular diseases (Basel, Switzerland) KW - Adult Aged Aged, 80 and over Critical Pathways/organization & administration Delivery of Health Care, Integrated/*organization & administration *Efficiency, Organizational *Endovascular Procedures Female Fibrinolytic Agents/*administration & dosage Germany Humans Infusions, Intravenous Male Middle Aged Patient Care Team/*organization & administration Patient Transfer/organization & administration Program Evaluation Quality Improvement/organization & administration Quality Indicators, Health Care/organization & administration Regional Health Planning/*organization & administration Retrospective Studies Stroke/diagnostic imaging/physiopathology/*therapy *Thrombolytic Therapy Time Factors Time-to-Treatment/*organization & administration Workflow *Crew resource management *Endovascular stroke therapy *Non-technical skills *Simulation *Stroke *Thrombolysis LA - eng M1 - 3-4 N1 - 1421-9786 Bohmann, Ferdinand O Tahtali, Damla Kurka, Natalia Wagner, Marlies You, Se-Jong du Mesnil de Rochemont, Richard Berkefeld, Joachim Hartmetz, Ann-Kathrin Kuhlmann, Andrea Lorenz, Matthias W Schütz, Ansgar Kress, Bodo Henke, Christian Tritt, Stephanie Meyding-Lamadé, Uta Steinmetz, Helmuth Pfeilschifter, Waltraud Journal Article Multicenter Study Research Support, Non-U.S. Gov't Switzerland Cerebrovasc Dis. 2018;45(3-4):141-148. doi: 10.1159/000487965. Epub 2018 Mar 27. PY - 2018 SN - 1015-9770 SP - 141-148 ST - A Network-Wide Stroke Team Program Reduces Time to Treatment for Endovascular Stroke Therapy in a Regional Stroke-Network T2 - Cerebrovasc Dis TI - A Network-Wide Stroke Team Program Reduces Time to Treatment for Endovascular Stroke Therapy in a Regional Stroke-Network VL - 45 ID - 760206 ER - TY - JOUR AB - Patients with abdominal aortic aneurysm (AAA) frequently have other abdominal pathologies of surgical interest (other diseases, OD). Out of 1,375 elective open aortic replacements for AAA, 315 cases with OD were subdivided in Group 1 (82 patients with "clean wound" OD) and Group 2 (233 patients with "clean-contaminated wound" OD). The results of the sub-groups in which OD was treated at the same time as AAA were analysed (1a, 66 cases and 2a, 86 cases) and compared with OD not treated at the same time as AAA (1b, 16 cases and 2b, 147 cases). EVAR was done in 12 patients with a infrarenal AAA and concomitant abdominal disease. In this group post-operative complications occurred in two patients (endoleaks) and no sign of endograft infection was developed. Mean follow-up was 36 months. Mortality was 0% in Group 1a, 1b, 2b and 5.8% in Group 2a. In Group 1a there were one haemoperitoneum, one ischaemic colitis and one graft infection. In Group 1b there were 4 nefrectomies for renal carcinoma and three emergency hernia repairs within 18 months from AAA operation. In Group 2a the follow-up was uneventful. In Group 2b there was no acute complication of OD and 57.2% of patients were subsequently operated for OD. In the EVAR group the 30-day and late mortality rates were 0 and 25%, respectively and all deaths were cancer-related. Contemporary correction of OD in open surgery for AAA should be performed in clean wound cases, while clean-contaminated operations can be done only in selected cases. EVAR is a valid alternative technique to open vascular surgery for the concomitant treatment of aortic aneurysms and abdominal pathologies. AD - Department of Medical and Surgical Sciences, Universita` degli Studi, A.O. Spedali Civili Brescia, Brescia, Italy. AN - 22407592 AU - Bonardelli, S. AU - Cervi, E. AU - Nodari, F. AU - Guadrini, C. AU - Zanotti, C. AU - Giulini, S. M. C2 - Pmc3360141 DA - Jun DO - 10.1007/s13304-012-0137-4 DP - NLM ET - 2012/03/13 J2 - Updates in surgery KW - Abdomen, Acute/mortality/*surgery Algorithms Aortic Aneurysm, Abdominal/mortality/*surgery Bacterial Infections/mortality/prevention & control Blood Vessel Prosthesis Implantation/methods Comorbidity Elective Surgical Procedures Endovascular Procedures/methods Female Follow-Up Studies Humans Italy/epidemiology Male *Patient Care Team Renal Artery/surgery Surgical Wound Infection/mortality/prevention & control Survival Rate Time Factors Treatment Outcome Vascular Surgical Procedures/*methods LA - eng M1 - 2 N1 - 2038-3312 Bonardelli, Stefano Cervi, Edoardo Nodari, Franco Guadrini, Cristina Zanotti, Camilla Giulini, Stefano Maria Comparative Study Journal Article Updates Surg. 2012 Jun;64(2):125-30. doi: 10.1007/s13304-012-0137-4. Epub 2012 Mar 11. PY - 2012 SN - 2038-131X (Print) 2038-131x SP - 125-30 ST - Lesson learned from early and long-term results of 327 cases of coexisting surgical abdominal diseases and aortic aneurysms treated in open and endovascular surgery T2 - Updates Surg TI - Lesson learned from early and long-term results of 327 cases of coexisting surgical abdominal diseases and aortic aneurysms treated in open and endovascular surgery VL - 64 ID - 760258 ER - TY - JOUR AB - Background: A key component of modern analgesics is the use of multimodal opioid-sparing analgesia (MOSA). In the past, our analgesic regime after autologous breast reconstruction (ABR) included either NSAID or a selective cyclooxygenase-2 (COX-2) inhibitor. COX-2 inhibitors are superior to NSAIDs because of the well-known side effects of NSAID treatment (bleeding/gastrointestinal ulcers). However, COX-2 inhibitors have been suggested to increase flap failure rates. We report our experience in using COX-2 inhibitors as part of our post-operative MOSA after ABR using free flaps. Materials and methods: A total of 132 unilateral secondary ABR were performed (DIEP or MSTRAM) in the NSAID period (2007-2011) and 128 in the COX-2 inhibitor period (2006, 2012-2014). The same surgical team operated all patients. Data were collected prospectively and reviewed to compare the two periods, with special focus on reoperations due to bleeding/haematomas and flap thrombosis/failure. Comparisons between the COX-2 inhibitor and NSAID were made. Results: Median age, ischaemia time, blood loss and operating time were similar in the two periods. Significantly, more patients were re-operated because of post-operative haematoma in the NSAID group (n = 13/132, 9.8%) than in the COX-2 inhibitor group (n = 4/128, 3.1%) (p = 0.02). We found no difference in flap loss rates between the NSAID (n = 2/132, 1.5%) and the COX-2 inhibitor groups (n = 3/128, 2.3%) (p = 0.63). No patients suffered from thromboembolic complications or gastrointestinal bleeding. Conclusions: Multimodal analgesia using a COX-2 inhibitor is safe in ABR with free flaps and does not increase flap failure. COX-2 inhibitors seem superior to NSAID with reduced risk of post-operative haematomas. (C) 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. AD - [Bonde, Christian; Khorasani, Hoda; Hoejvig, Jens] Dept Plast Surg Breast Surg & Burns, Sect 2102, Copenhagen, Denmark. [Kehlet, Henrik] Copenhagen Univ Hosp, Sect Surg Pathophysiol, Rigshosp, Copenhagen, Denmark. Bonde, C (corresponding author), Dept Plast Surg Breast Surg & Burns, Sect 2102, Copenhagen, Denmark. bonde@rh.dk AN - WOS:000415188100007 AU - Bonde, C. AU - Khorasani, H. AU - Hoejvig, J. AU - Kehlet, H. DA - Nov DO - 10.1016/j.bjps.2017.06.007 J2 - J. Plast. Reconstr. Aesthet. Surg. KW - Free flaps Microsurgery Breast reconstruction Analgesia Complications Multimodal analgesia FAST-TRACK SURGERY COX-2 INHIBITORS CELECOXIB PRINCIPLES ROFECOXIB PARECOXIB RESECTION CARE Surgery LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: FM6SL Times Cited: 3 Cited Reference Count: 17 Bonde, Christian Khorasani, Hoda Hoejvig, Jens Kehlet, Henrik Kehlet, Henrik/0000-0002-2209-1711 3 0 ELSEVIER SCI LTD OXFORD J PLAST RECONSTR AES PY - 2017 SN - 1748-6815 SP - 1543-1546 ST - Cyclooxygenase-2 inhibitors and free flap complications after autologous breast reconstruction: A retrospective cohort study T2 - Journal of Plastic Reconstructive and Aesthetic Surgery TI - Cyclooxygenase-2 inhibitors and free flap complications after autologous breast reconstruction: A retrospective cohort study UR - ://WOS:000415188100007 VL - 70 ID - 761628 ER - TY - JOUR AB - Background: In fetal/neonatal alloimmune thrombocytopenia (FNAIT), platelets (PLT) are destroyed by maternal antibodies directed against fetal antigens. Thrombocytopenia may be severe and lead to intracranial hemorrhage in about 10% of cases. FNAIT is estimated to be markedly underdiagnosed, partly due to the fact that complete blood count (CBC) is not routinely done in all neonates. Aims: To evaluate the degree of awareness of FNAIT in an attempt to decrease the risk of this devastating condition. Methods: A retrospective analysis. Results: A retrospective analysis of 322 suspected FNAIT cases sent over the past 4 years to our reference laboratory from the majority of medical centers in the country revealed a low referral rate of 39%. In addition, 50% of the families with a thrombocytopenic newborn were referred for evaluation weeks after discharge, when the antibody titer could already be below the detection level and 27% of the mothers with a previously suspected FNAIT pregnancy were referred for such evaluation only during a subsequent pregnancy. A supplementary retrospective analysis performed at our center between 2010-2015 showed that a CBC test was done for various clinical reasons only in 7370 (23. 1%) of 31952 newborns. Thrombocytopenia (< 150x109 PLT/L) was found in 2505 (34%) of these babies, being severe (< 50x109 PLT/L) in 220 (2. 98%) of them. Extended evaluation of the latter subgroup demonstrated that 45 newborns were term and had no other possible causes for the low PLT count. Yet, only 7 babies were referred for FNAIT assessment: 4 of them were found positive for PLT antibodies. Thus, in the current analysis, 84% of the newborns with severe thrombocytopenia were not assessed for FNAIT. Conclusions: Awareness of physicians and cooperation of the multidisciplinary team (neonatologists, pediatric hematologists and gynecologists) involved are crucial for FNAIT diagnosis. Development of uniform guidelines for the evaluation of this life-threatening clinical condition is warranted. AD - L. Bonstein, Rambam Health Care Campus, Blood Bank and Platelet Immunology Laboratories, Haifa, Israel AU - Bonstein, L. AU - Lauterbach, R. AU - Atweh, N. AU - Abu-Rumi, A. AU - Haddad, N. DB - Embase DO - 10.1002/rth2.12012 KW - antibody titer awareness blood cell count child conference abstract controlled study diagnosis female gynecologist hematologist human human cell infant major clinical study mother multidisciplinary team neonatal alloimmune thrombocytopenia neonatologist newborn patient referral pregnancy retrospective study thrombocytopenia LA - English M3 - Conference Abstract N1 - L624159082 2018-10-09 PY - 2017 SN - 2475-0379 SP - 1375 ST - Fetal/neonatal alloimmune thrombocytopenia-an underestimated lifethreatening clinical condition T2 - Research and Practice in Thrombosis and Haemostasis TI - Fetal/neonatal alloimmune thrombocytopenia-an underestimated lifethreatening clinical condition UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624159082&from=export http://dx.doi.org/10.1002/rth2.12012 VL - 1 ID - 760932 ER - TY - JOUR AB - OBJECTIVE AND BACKGROUND: We present a first description of a Heart Team (HT)-guided approach to coronary revascularization and its long-term effect on clinical events after percutaneous coronary intervention (PCI). The HT approach is a structured process to decide for coronary bypass grafting (CABG), PCI or conservative therapy in ad hoc situations as well as in HT conferences. As a hypothesis, during the long-term course after a PCI performed according to HT rules, a low number of late revascularizations, especially CABGs, are expected (F-PCI study). METHODS: In this monocentric study, the HT approach to an all-comer population was first analyzed and described in general with the help of a database. Next the use of a HT approach was described for a more homogeneous subgroup with newly detected CAD (1.CAD). Those patients in whom the HT decision was PCI (which was a 1.PCI) were then studied with the help of questionnaires for clinical events during a very long-term follow-up. Events were CABG, PCI, diagnostic catheterization (DCath) and death. RESULTS: A significant number of patients were presented to HT conferences: 22 % out of all 11,174 catheterizations, 24 % out of all 7867 CAD cases and 35 % out of 3408 1.CAD cases. Most of these patients had multi-vessel disease (MVD). Conference decisions were isolated CABG in 46-66 %, PCI in 10-14 %, valvular surgery in 9-16 %, HTx in 10-21 % (Endstage heart failure candidates for surgery) and conservative therapy (Medical or no therapy, additional diagnostic procedures or no adherence to recommended therapy) in 2-3 %. However, most PCIs, ad hoc and elective, were performed under Heart Team rules, but without conference. During follow-up of 1.PCI patients (Kaplan-Meier analysis), CABG occurred in only 15 % of patients, PCI in 37 % and DCath in 65 %; mortality of any course was 51 %. Mortalities were similar in one-vessel disease and in a population of the same year, matched for age and sex (p < 0.057), but mortality was higher in 1.PCI patients with MVD (p < 0.001). Beyond 2 years, Kaplan-Meier curves were linear. CONCLUSION: The structured Heart Team approach is an effective tool for ad hoc and conference-based clinical decision-making with a sustained clinical benefit. This is demonstrated in low late CABG (and PCI) rates after a 1.PCI, without elevated mortality. The all-comer population supports the universal value of these data. Stable annual event rates late after PCI suggest a conversion to stable CAD. Heart Team conferences are also important tools in cases of valvular and end-stage heart disease. AD - Medical Clinic I, Cardio-Thoracic Center, Klinikum Fulda, Pacelliallee 4, 36043, Fulda, Germany. tassilo@bonzel.de. Medical Clinic I, Cardio-Thoracic Center, Klinikum Fulda, Pacelliallee 4, 36043, Fulda, Germany. Clinic for Cardiothoracic Surgery, Cardio-Thoracic Center, Klinikum Fulda, Fulda, Germany. AN - 26508415 AU - Bonzel, T. AU - Schächinger, V. AU - Dörge, H. DA - May DO - 10.1007/s00392-015-0932-2 DP - NLM ET - 2015/10/29 J2 - Clinical research in cardiology : official journal of the German Cardiac Society KW - Aged Cardiovascular Agents/*therapeutic use Choice Behavior Cooperative Behavior *Coronary Artery Bypass/adverse effects/mortality Coronary Artery Disease/diagnosis/mortality/*therapy Databases, Factual Decision Support Techniques Female Germany Humans Interdisciplinary Communication Kaplan-Meier Estimate Linear Models Male Middle Aged *Patient Care Team Patient Selection *Percutaneous Coronary Intervention/adverse effects/mortality Retrospective Studies Risk Assessment Risk Factors Surveys and Questionnaires Time Factors Treatment Outcome Cabg Coronary artery disease Heart Team Long-term follow-up Pci LA - eng M1 - 5 N1 - 1861-0692 Bonzel, Tassilo Orcid: 0000-0003-4325-8696 Schächinger, Volker Dörge, Hilmar Journal Article Observational Study Germany Clin Res Cardiol. 2016 May;105(5):388-400. doi: 10.1007/s00392-015-0932-2. Epub 2015 Oct 27. PY - 2016 SN - 1861-0684 SP - 388-400 ST - Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI T2 - Clin Res Cardiol TI - Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI VL - 105 ID - 760427 ER - TY - JOUR AB - Objective The objective was to evaluate the impact of evidence-based clinical decision support tools integrated directly into provider workflow in the electronic health record on utilization of computed tomography ( CT) brain, C-spine, and pulmonary embolism ( PE). Methods Validated, well-accepted scoring tools for head injury, C-spine injury, and PE were embedded into the electronic health record in a manner minimally disruptive to provider workflow. This was a longitudinal, before/after study in five emergency departments ( EDs) in a healthcare system with a common electronic health record. Attending ED physicians practicing during the entire study period were included. The main outcome measure was proportion of CTs ordered by provider (total number of CT scans of a given type divided by total patients seen by that provider) in aggregate in the pre- and post intervention period. Results There were 235,858 total patient visits analyzed in this study with an absolute decrease of 6,106 CT scan ordering for the three studies. Across all sites, there was greater than 6% decrease in utilization of CT brain and CT C-spine (-10%, 95% CI = -13% to -7%, p < 0.001; and -6%, 95% CI =-11% to -1%, p = 0.03, respectively). The use of CT PE also decreased but was not significant (-2%, 95% CI = -9% to +5%, p = 0.42). For all CT types, high utilizers in the pre-intervention period decreased usage over 14% in the post-intervention period with CT brain (-18%, 95% CI = -22% to -15%, p < 0.001), CT C-spine (-14%, 95% CI = -20% to -8%, p = 0.001), and CT PE (-23%, 95% CI = -31% to -14%, p < 0.001). For all three studies, the average utilizers did not change their usage practices. For CT brain, the low utilizers also did not increase usage but for CT C-spine and CT PE usage was increased (+29%, 95% CI = 10% to 52%, p = 0.003; and +46%, 95% CI = 26% to 70%, p < 0.001, respectively). Conclusion Embedded clinical decision support is associated with decreased overall utilization of high-cost imaging, especially among higher utilizers. It also affected low utilizers, increasing their usage consistent with improved adherence to guidelines, but this effect did not offset the overall decreased utilization for CT brain or CT C-spine. Thus, integrating clinical decision support into the provider workflow promotes usage of validated tools across providers, which can standardize the delivery of care and improve compliance with evidence-based guidelines. AD - Department of Emergency Medicine, University of Colorado School of Medicine, Aurora CO Department of Surgery, University of Colorado School of Medicine, Aurora CO University of Colorado School of Public Health, Aurora CO Department of Emergency Medicine, Memorial Hospital, Colorado Springs CO Department of Emergency Medicine, Poudre Valley Hospital, Fort Collins CO AN - 124050553. Language: English. Entry Date: 20170715. Revision Date: 20180711. Publication Type: Article AU - Bookman, Kelly AU - West, David AU - Ginde, Adit AU - Wiler, Jennifer AU - McIntyre, Robert AU - Hammes, Andrew AU - Carlson, Nichole AU - Steinbruner, David AU - Solley, Matthew AU - Zane, Richard AU - Kline, Jeffrey A. DB - CINAHL DO - 10.1111/acem.13195 DP - EBSCOhost KW - Decision Support Systems, Clinical Electronic Health Records Diagnostic Imaging Emergency Service Medical Practice, Evidence-Based Human Workflow Physicians, Emergency Brain Spine Education, Continuing (Credit) M1 - 7 N1 - CEU; research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. PY - 2017 SN - 1069-6563 SP - 839-845 ST - Embedded Clinical Decision Support in Electronic Health Record Decreases Use of High-cost Imaging in the Emergency Department: Emb ED study T2 - Academic Emergency Medicine TI - Embedded Clinical Decision Support in Electronic Health Record Decreases Use of High-cost Imaging in the Emergency Department: Emb ED study UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=124050553&site=ehost-live&scope=site VL - 24 ID - 761324 ER - TY - JOUR AB - Background: Observational studies continue to report thromboprophylaxis underuse for postoperative pulmonary embolism/deep vein thrombosis (pPE/DVT) despite the long-standing existence of prevention guidelines. However, data are limited on whether thromboprophylaxis use differs between patients developing pPE/DVT versus those who do not or on why prophylaxis is withheld. Methods:Administrative data (2002-2007) from 28 Veterans Health Administration hospitals were screened for discharges with (1) pPE/DVT as flagged by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator software and (2) pharmacoprophylaxis-recommended procedures, and the medical records were reviewed to ascertain true pPE/DVT cases. Controls were selected by matching cases by hospital, age, sex, diagnosis-related group, and predicted probability for developing pPE/DVT, and who underwent a pharmacoprophylaxis-recommended procedure. Records were assessed for 'appropriate pharmacoprophylaxis use,' defined primarily per American College of Chest Physicians (ACCP) guidelines, and reasons for anticoagulant nonuse. Results: The 116 case-control pairs were similar in terms of demographics, surgery type, ACCP risk category, and appropriate pharmacoprophylaxis rates overall. Of the highest-risk patients, respective pharmacoprophylaxis rates among cases and controls were 88% versus 92% among hip/knee replacements and 31% versus 48% among cancer patients. Of the cases and controls who did not receive appropriate pharmacoprophylaxis, only about 25% had documented contraindications. Reviewers identified contraindications in 14% of cases and 9% of controls. Conclusions: Similarities in preventive pPE/DVT practice between cases and controls suggest that pPE/DVTs occur despite implementation of guideline-adherent practices. AN - 108138155. Language: English. Entry Date: 20120831. Revision Date: 20200706. Publication Type: Journal Article AU - Borzecki, Ann M. AU - Cowan, Andrew J. AU - Cevasco, Marisa AU - Shin, Marlena H. AU - Shwartz, Michael AU - Itani, Kamal AU - Rosen, Amy K. DB - CINAHL DO - 10.1016/s1553-7250(12)38045-8 DP - EBSCOhost KW - Chemoprevention -- Utilization Postoperative Complications -- Etiology Postoperative Complications -- Prevention and Control Venous Thromboembolism -- Etiology Venous Thromboembolism -- Prevention and Control Aged Anticoagulants -- Contraindications Anticoagulants -- Therapeutic Use Case Control Studies Chemoprevention -- Contraindications Chi Square Test Electronic Health Records Confidence Intervals Data Analysis Software Effect Size Female Hospitals, Veterans Human Inpatients Male Middle Age Outcomes (Health Care) Post Hoc Analysis Process Assessment (Health Care) Pulmonary Embolism -- Epidemiology Quality Improvement Record Review Retrospective Design Stratified Random Sample T-Tests United States Venous Thromboembolism -- Risk Factors Venous Thrombosis -- Epidemiology Wilcoxon Rank Sum Test M1 - 8 N1 - algorithm; research; tables/charts. Journal Subset: Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. Special Interest: Patient Safety; Perioperative Care; Quality Assurance. NLM UID: 101238023. PMID: NLM22946252. PY - 2012 SN - 1553-7250 SP - 348-357 ST - Is Development of Postoperative Venous Thromboembolism Related to Thromboprophylaxis Use? A Case-Control Study in the Veterans Health Administration T2 - Joint Commission Journal on Quality & Patient Safety TI - Is Development of Postoperative Venous Thromboembolism Related to Thromboprophylaxis Use? A Case-Control Study in the Veterans Health Administration UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=108138155&site=ehost-live&scope=site VL - 38 ID - 761343 ER - TY - JOUR AB - Background and Objectives: Reports on acute pulmonary embolism (PE) severity and outcomes use different biomarker thresholds and combinations of imaging parameters. It is unclear if these parameters are interchangeable for determining degree of right ventricular dysfunction (RVD) severity in PE. Primary objective: Determine correlation between cardiac biomarkers and echocardiographic indices for right ventricular systolic pressure (RVSP), RV size, and RV systolic function (including tricuspid annular planar systolic excursion [TAPSE] and peak systolic excursion velocity [S']) Secondary objective: Determine the agreement between echocardiographic RV indices Methods: Prospective observational study at six regional EDs with PE response team for submassive PE patients with urgent echocardiography performed per protocol. We used Spearman's rank analyses for the correlation of measurements for pairs of independent cardiac biomarkers and echocardiographic indices Results: We enrolled 133 patients. Correlation values for variable pairs were: BNP with troponin 0.3 (0.12 to 0.45), RVSP, 0.36 (0.2 to 0.5), RV basal diameter 0.3 (0.1 to 0.45), RV:LV ratio 0.2 (0.02 to 0.36), TAPSE -0.4 (-0.6 to -0.27), S' -0.34 (-0.5 to -0.16), and TAPSE/RVSP -0.48 (-0.62 to -0.32). Troponin with RVSP 0.05 (-0.13 to 0.23), RV basal diameter 0.25 (0.08 to 0.4), RV:LV ratio 0.39 (0.23 to 0.52), TAPSE -0.37(-0.51 to -0.21), S' -0.31 (-0.47 to -0.14), and TAPSE/RVSP 0.29 ( -0.43 to -0.08). RVSP with RV basal diameter 0.39 (0.22 to 0.53), RV:LV ratio 0.4 (0.24 to 0.55), TAPSE -0.33 (-0.49 to -0.16), and S' - 0.26 (-0.43 to -0.07). RV basal diameter with TAPSE -0.26 (-0.42 to -0.09), S' -0.23 (-0.39 to -0.04), and TAPSE/RVSP -0.42 (-0.56 to -0.26). RV:LV with TAPSE -0.40 (-0.54 to -0.24), S' -0.31(-0.47 to -0.13) and TAPSE/RVSP -0.52 (-0.65 to -0.37). S' with TAPSE 0.71 (0.61 to 0.79) and TAPSE/RVSP 0.59 (0.45 to 0.70) Conclusion: Although most biomarkers and echocardiography indices are not interchangeable for gauging severity of RV in PE, RV systolic function indices had strong relationships with each other. TAPSE/RVSP had a moderate relationship with RV:LV ratio. AD - W. Bost, Carolinas Medical Center AU - Bost, W. AU - Gardner, C. AU - Fraga, D. N. AU - Belyshev, V. AU - Hogg, M. AU - Troha, D. AU - Raper, J. D. AU - Runyon, M. S. AU - Weekes, A. J. DB - Embase DO - 10.1111/acem.13961 KW - biological marker endogenous compound troponin adult conference abstract controlled study echocardiography female heart right ventricle failure human major clinical study male observational study prospective study pulmonary embolism response team systolic blood pressure tricuspid annular plane systolic excursion tricuspid valve LA - English M3 - Conference Abstract N1 - L632417864 2020-07-30 PY - 2020 SN - 1553-2712 SP - S239 ST - Correlation of right ventricular dysfunction indices in pulmonary embolism T2 - Academic Emergency Medicine TI - Correlation of right ventricular dysfunction indices in pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632417864&from=export http://dx.doi.org/10.1111/acem.13961 VL - 27 ID - 760572 ER - TY - JOUR AB - Background Maternal mortality is an important health indicator for the overall health of a population. This study assessed the causes and contributing factors to maternal mortality that occurred in the Gaza-Strip between July 2014 and June 2015. Methods This is a retrospective study that used both quantitative and qualitative data. The data were collected from available medical records, investigation reports, death certificates, and field interviews with healthcare professionals as well as families. Results A total of 18 maternal mortalities occurred in Gaza between 1st July 2014 and June 30th 2015. Age at time of death ranged from 18 to 44years, with 44.4% occurring before the age of 35years. About 22.2% were primiparous, while 55.6% were grand multiparous women. The most common causes of death were sepsis, postpartum haemorrhage, and pulmonary embolism.The most striking deficiency was very poor medical documentation which was observed in 17 cases (94%). In addition, poor communication between doctors and women and their families or among healthcare teams was noticed in nine cases (50%). These were repeatedly described by families during interviews. Further aspects surfacing in many interviews were distrust by families towards clinicians and poor understanding of health conditions by women. Other factors included socioeconomic conditions, poor antenatal attendance and the impact of the 2014 war.Low morale among medical staff was expressed by most interviewed clinicians, as well as the fear of being blamed by families and management in case of adverse events. Substandard care and lack of appropriate supervision were also found in some cases. Conclusions This study revealed deficiencies in maternity care, some of which were linked to the socioeconomic situation and the 2014 war. Others show poor implementation of clinical guidelines and lack of professional skills in communication and teamwork. Specialised training should be offered for clinicians in order to improve these aspects. However, the most striking deficiency was the extremely poor documentation, reflecting a lack of awareness among clinicians regarding its importance. Local policymakers should focus on systematic application of quality improvement strategies in order to achieve greater patient safety and further reductions in the maternal mortality rate. AD - [Bottcher, Bettina; Aldabbour, Belal; Naim, Fadel Naim] Islamic Univ Gaza, Fac Med, POB 108, Gaza Strip, Gaza, Palestine. [Abu-El-Noor, Nasser; Aljeesh, Yousef] Islamic Univ Gaza, Fac Nursing, POB 108, Gaza Strip, Gaza, Palestine. Bottcher, B (corresponding author), Islamic Univ Gaza, Fac Med, POB 108, Gaza Strip, Gaza, Palestine. Bettina.bottcher@yahoo.co.uk AN - WOS:000447197400004 AU - Bottcher, B. AU - Abu-El-Noor, N. AU - Aldabbour, B. AU - Naim, F. N. AU - Aljeesh, Y. C7 - 396 DA - Oct DO - 10.1186/s12884-018-2037-1 J2 - BMC Pregnancy Childbirth KW - Gaza-strip Maternal mortality Quality improvement Medical documentation Patient safety Clinical audit Palestine COMMUNICATION-SKILLS PATIENT CARE Obstetrics & Gynecology LA - English M3 - Article N1 - ISI Document Delivery No.: GW8BL Times Cited: 6 Cited Reference Count: 29 Bottcher, Bettina Abu-El-Noor, Nasser Aldabbour, Belal Naim, Fadel Naim Aljeesh, Yousef Abu-El-Noor, Nasser/AAF-4371-2020; Aldabbour, Belal/AAH-7766-2020; Bottcher, Bettina/AAN-1708-2020 Abu-El-Noor, Nasser/0000-0001-7991-6924; Aldabbour, Belal/0000-0001-9186-4039; UNDP [Limited funding was received only for transport costs] Funding Source: Medline 6 0 4 BMC LONDON BMC PREGNANCY CHILDB PY - 2018 SN - 1471-2393 SP - 8 ST - Maternal mortality in theGaza strip: a look at causes and solutions T2 - Bmc Pregnancy and Childbirth TI - Maternal mortality in theGaza strip: a look at causes and solutions UR - ://WOS:000447197400004 VL - 18 ID - 761564 ER - TY - JOUR AB - Portal vein thrombosis (PVT) is common complication in the setting of end stage liver disease. The presence of PVT in the setting of orthotopic liver transplantation (OLT) can be associated with the need for additional anastomoses and potentially reduced survival. The goal of anticoagulation is to achieve partial recanalization to allow end-to-end portal vein anastomosis. Our AIM was to determine the impact of anticoagulation for PVT when indicated on recanalization of the portal vein at the time of OLT and on post OLT outcomes. Methods : This is a single center retrospective study of all patients who underwent OLT who were previously diagnosed with PVT between March 2011 and July 2014. The study included all patients over age 18 with PVT diagnosed by CT or MRI and who subsequently underwent OLT. Data abstracted included demographic data, anatomic extent of PVT, presence/type of anticoagulation, effect on PVT, complications of anticoagulation, and outcomes after transplant including use of jump graft and survival. PVT was classified as occlusive or non-occlusive involving portal vein with or without extension. The decision to anticoagulate was made by a multidisciplinary team at selection conference. Results: 43/333 (13%) patients were diagnosed with PVT before OLT by axial imaging. Median age was 59 years (IQR= 52-63), 27/43 male, median BMI 28 (IQR= 25.7-33), median MELD score 20 (IQR= 17-25). PVT was diagnosed at median of 338 days prior to OLT. In 30/43 patients anticoagulation was initiated (27 warfarin, 3 enoxaparin) prior to OLT for median duration of 9 months (IQR 5- 17). The median time to demonstrated improvement or resolution of PVT was 5 months (IQR 3- 7.2). 19/30(63%) of anticoagulated patients achieved partial to full PVT resolution at time of OLT compared to 8/14 patients (57%) in whom no anticoagulation was initiated. 3 patients with partial or full resolution of PVT had recurrent thrombosis post OLT. 3 patients required jump grafts due to thrombosis. In the entire PVT cohort, there were 5 deaths post OLT (2 no anticoagulation, 1 warfarin, 2 enoxaparin). 1 month survival (no anti-coagulation 86% ;warfarin 100%;enoxaparin 67%), 6 month survival (no anti-coagulation 86% ;warfarin 96%%;enoxaparin 33%)and 1 year survival (no anti-coagulation 85% ;warfarin 94%;enoxaparin 0%) were superior in the warfarin treated group compared to enoxaparin or no anticoagulation (p<0.05). Bleeding complications were rare with no difference noted between the anticoagulated and non-anticoagulated groups. Conclusion: Anticoagulation for PVT prior to OLT is safe, and lead to partial or complete resolution in 19/30 patients. Improved survival was noted in the PVT cohort who received anticoagulation with warfarin prior to OLT. Data collection is ongoing to better refine which PVT patients derive benefit with this strategy. AD - N.K. Bozanich AU - Bozanich, N. K. AU - Ghabril, M. AU - Agrawal, S. AU - Lacerda, M. A. AU - Tector, J. AU - Fridell, J. A. AU - Mangus, R. S. AU - Kubal, C. A. AU - Kwo, P. Y. DB - Embase KW - warfarin enoxaparin anticoagulation portal vein thrombosis liver transplantation gastrointestinal disease human patient survival hepatic portal vein recanalization thrombosis male retrospective study vein anastomosis anastomosis information processing death end stage liver disease imaging transplantation bleeding nuclear magnetic resonance imaging LA - English M1 - 4 M3 - Conference Abstract N1 - L71887910 2015-05-23 PY - 2015 SN - 0016-5085 SP - S1040 ST - The role of anticoagulation for portal vein thrombosis prior to orthotopic liver transplantation T2 - Gastroenterology TI - The role of anticoagulation for portal vein thrombosis prior to orthotopic liver transplantation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71887910&from=export VL - 148 ID - 761073 ER - TY - JOUR AB - OBJECTIVES: To assess: (1) lower limb primary lymphedema or post-thrombotic syndrome patient's pathway in terms of health care professional use and (2) if aetiology of edema has an impact on this pathway. METHODS: Ancillary survey of the transversal prospective CHROEDEM pilot study. Forty patients with either lower limb primary lymphedema or post-thrombotic syndrome were invited to participate. RESULTS: Seventy-five percent of primary lymphedema patients and 50% of post-thrombotic patients benefited from a multidisciplinary management (P=0.10) including the general practitioner, the vascular medicine physician and either a physiotherapist (particularly in case of primary lymphedema), a registered nurse (particularly in case of post-thrombotic syndrome). Main ambulatory health care professionals' correspondent of hospital-based vascular medicine physicians were general practitioners (80%) in post-thrombotic patients, and general practitioners (60%) and physiotherapists (45%) in primary lymphedema patients. Pharmacists were also involved in patient education. CONCLUSION: Management of primary lymphedema and post-thrombotic related chronic edema is usually multidisciplinary. General practitioners and vascular medicine physicians are the cornerstones of this management, that also involves the physiotherapist in case of primary lymphedema and in a lesser extent the registered nurse and the pharmacist. This suggests that these five healthcare professional should play a key role in case of development of standardized patient pathways for primary lymphedema and post-thrombotic syndrome. AD - Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France. Electronic address: g-bozon@chu-montpellier.fr. Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France; EA 2992, Montpellier 1 university, 34000 Montpellier, France. Département de l'information médicale, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France. Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France. Department of vascular medicine, CHU Montpellier, Saint-Eloi hospital, 80, avenue Augustin-Fliche, 34090 Montpellier, France; EA 2992, Montpellier 1 university, 34000 Montpellier, France; Department of medicine, Sunnybrook Health Sciences Centre, université de Toronto, 2075, Bayview avenue, M4N 3M5 Toronto, ON, Canada. AN - 32265015 AU - Bozon, G. AU - Mestre Godin, S. AU - Chorron, G. AU - Nou Howaldt, M. AU - Laroche, J. P. AU - LeCollen, L. AU - Calais, C. AU - Quéré, I. AU - Galanaud, J. P. DA - Apr DO - 10.1016/j.jdmv.2020.01.186 DP - NLM ET - 2020/04/09 J2 - Journal de medecine vasculaire KW - Adult Aged Chronic Disease Combined Modality Therapy *Critical Pathways Female France/epidemiology Health Care Surveys Humans Lower Extremity Lymphedema/diagnosis/epidemiology/physiopathology/*therapy Male Middle Aged *Patient Care Team Postthrombotic Syndrome/diagnosis/epidemiology/physiopathology/*therapy Prognosis Risk Factors Chronic edema Post-thrombotic syndrome Primary lymphedema LA - eng M1 - 2 N1 - Bozon, G Mestre Godin, S Chorron, G Nou Howaldt, M Laroche, J P LeCollen, L Calais, C Quéré, I Galanaud, J P Journal Article Multicenter Study France J Med Vasc. 2020 Apr;45(2):55-61. doi: 10.1016/j.jdmv.2020.01.186. Epub 2020 Mar 11. PY - 2020 SN - 2542-4513 (Print) 2542-4513 SP - 55-61 ST - Assessment of primary lymphedema and post-thrombotic lower limb edema patient's pathway T2 - J Med Vasc TI - Assessment of primary lymphedema and post-thrombotic lower limb edema patient's pathway VL - 45 ID - 760349 ER - TY - JOUR AB - BACKGROUND: The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded on October 1, 2018, to enhance cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic arteriopathy has been selected as the very first topic to be investigated by the federation. METHODS: MeFAVS members were asked to reply to a questionnaire on the management of diabetic ischemic foot. Results were collected and analyzed statistically. The questionnaire consisted of 15 multiple choice answers regarding diabetic foot (DF) diagnosis and treatment. The questionnaire was submitted to 21 centers on April 20, 2019. RESULTS: Response rate was 62%. The survey revealed that vascular surgeons, diabetologists, and wound care nurses made-up the core of the diabetic teams present in 76.9%, 69.3%, and 92.3% of the centers, respectively. Diabetic teams were most often led by vascular surgeons (53.8%) and diabetologists (42.2%), but only in 7.9% of cases by nurses. Duplex ultrasonography and computed tomographic angiography were the most commonly available tools used to assess diabetic peripheral arterial disease (PAD). Surgical wound care was undertaken by vascular surgeons in the majority of cases, and only in 46.2% of the cases to orthopedic or plastic surgeons, while nonsurgical wound care was handled by specialized nurses (76.6%) and diabetologists (53.8%). First-line revascularization was preferred over conservative treatment (61.5% vs 53.8%) and endovascular strategy (45.3%) over open (33.7%) or hybrid (21.0%) surgery. Vascular surgeons and interventional radiologists were found to be the most common performers of endovascular revascularization (92.3% and 53.8%, respectively). Amputations had an overall rate of 16.6% (range 4-30%) and a mean reintervention rate of 22.5%, and were usually performed by vascular surgeons for both minor and major interventions (84.6%) followed by orthopedic surgeons (15.4% minor and 30.8% major). The availability of a DF clinic (84.6%) and endovascular (53.8%) and open surgery (46.2%) capabilities were considered fundamental to reduce amputation rates. CONCLUSIONS: Especially since the introduction and spreading of new endovascular techniques for the treatment of DF, it is a common consensus amongst vascular surgeons that a standardized approach to the discipline is necessary in order to improve outcomes such as amputation-free survival and mortality and it is with this perspective and purpose that transnational cooperation amongst vascular professionals and residents in training are aiming for greater proficiency in endovascular and open surgery. AD - Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy. Electronic address: umbertomarcello.bracale@unina.it. Vascular and Endovascular Surgery Unit, Department of Public Health, University Federico II of Naples, Naples, Italy. Department of Vascular Surgery, Ain Shams University, Cairo, Egypt. Department of General Surgery, American University of Beirut Medical Center, Beirut, Lebanon. Department of Vascular Surgery, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France; Faculté de Médecine Paris Ile-de-France Ouest, Paris, France. Unit of Vascular Surgery, Department of Clinical and Molecular Medicine, "Sapienza", University of Rome, Sant'Andrea Hospital, Rome, Italy. Vascular and Endovascular Surgery Unit, Department of Medicine, Surgery and Neurological Sciences, Policlinico S. Maria alle Scotte, University of Siena, Siena, Italy. Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Vascular Surgery Unit, Palermo, Italy. AN - 31629843 AU - Bracale, U. M. AU - Ammollo, R. P. AU - Hussein, E. A. AU - Hoballah, J. J. AU - Goeau-Brissonniere, O. AU - Taurino, M. AU - Setacci, C. AU - Pecoraro, F. AU - Bracale, G. DA - Apr DO - 10.1016/j.avsg.2019.09.013 DP - NLM ET - 2019/10/21 J2 - Annals of vascular surgery KW - Amputation/adverse effects/*trends Diabetic Foot/diagnostic imaging/epidemiology/*surgery Endovascular Procedures/adverse effects/*trends Health Care Surveys Healthcare Disparities/*trends Humans Ischemia/diagnostic imaging/epidemiology/*therapy Mediterranean Region/epidemiology Nurse's Role Patient Care Team/trends Peripheral Arterial Disease/diagnostic imaging/epidemiology/*therapy Physician's Role Practice Patterns, Nurses'/*trends Practice Patterns, Physicians'/*trends Reoperation/trends Specialization/trends Treatment Outcome Vascular Surgical Procedures/adverse effects/*trends Wound Healing LA - eng N1 - 1615-5947 Bracale, Umberto Marcello Ammollo, Raffaele Pio Hussein, Emad A Hoballah, Jamal J Goeau-Brissonniere, Olivier Taurino, Maurizio Setacci, Carlo Pecoraro, Felice Bracale, Giancarlo Collaborators Journal Article Multicenter Study Netherlands Ann Vasc Surg. 2020 Apr;64:239-245. doi: 10.1016/j.avsg.2019.09.013. Epub 2019 Oct 17. PY - 2020 SN - 0890-5096 SP - 239-245 ST - Managing Peripheral Artery Disease in Diabetic Patients: A Questionnaire Survey from Vascular Centers of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) T2 - Ann Vasc Surg TI - Managing Peripheral Artery Disease in Diabetic Patients: A Questionnaire Survey from Vascular Centers of the Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) VL - 64 ID - 760219 ER - TY - JOUR AB - Study Objectives: The treatment of submassive pulmonary embolisms with systemic thrombolytics, catheter directed thrombolytics or mechanical thrombectomy (ie escalation of care) is controversial but in select patients with moderate to high risk submassive pulmonary embolisms, escalating care beyond systemic anticoagulation has been shown to be beneficial in multiple study, albeit with a potential increased risk of bleeding. The entire clinical picture, and not just one isolated vital sign or test, should be used to guide the decision to escalate care for patients with submassive pulmonary embolisms. A pulmonary embolism response team, consisting of cardiologists, interventional radiologists and emergency physicians, was developed at our institution as a multidisciplinary approach to decide on the best treatment for these patients. The ratio of the right ventricle to the left ventricle on computed tomography (CT) scan is used as a part of the criteria to decide if a patient would benefit from escalation of care. Many of these patients also receive a bedside cardiac ultrasound to evaluate for the same ratio and other signs of right ventricle dysfunction. We postulate that bedside cardiac ultrasound is a better predictor of right ventricular strain and the need for escalation of care in patients with pulmonary embolisms in comparison to CT. Methods: This was a retrospective case review of patients who had a CT diagnosis of pulmonary embolism in the emergency department and who also had a bedside cardiac ultrasound performed and interpreted by an emergency physician (attending or resident) to compare which imaging modality better correlated with the need for escalation of care as decided by our pulmonary embolism response team. Escalation of care could include full or half dose systemic tissue plasminogen activator (TPA), catheter directed TPA, or mechanical thrombectomy. All bedside cardiac ultrasound images were archived in Q-path and were reviewed by an ultrasound fellowship trained emergency physician for quality assurance. Results: 61 patients were included in the study, 4 were excluded from analysis,3 were not candidates for escalation of care given recent neurosurgical intervention or brain metastases, and 1 had incomplete data. CT had a sensitivity of 95.45% (CI 77.16-99.88%) and a specificity of 42.86% (CI 26.32-60.65%) for predicting the need to escalate care, with a positive predictive value of 51.22 and a negative predictive value of 93.75. Bedside cardiac ultrasound had a sensitive and specificity of 90.91% (CI 70.84-98.88%) and 82.86% (CI 66.35-93.44) respectively and a PPV of 76.92 and a NPV of 93.55. Conclusion: CT was slightly more sensitive for predicting the need to escalate care in patients with pulmonary embolisms however bedside ultrasound was more specific as CT frequency over estimated the size the right ventricle which could lead to patients receiving systemic thrombolytics or procedures unnecessarily. Patients with submassive pulmonary embolisms in the emergency department, who are being considered for escalation of care, should have an echo or bedside cardiac ultrasound done by an emergency physician to evaluate the right heart prior to escalation of care. AU - Brackney, A. AU - Berger, D. AU - Shook, D. DB - Embase DO - 10.1016/j.annemergmed.2019.08.330 KW - endogenous compound tissue plasminogen activator adult bleeding brain metastasis cancer patient case study catheter computer assisted tomography conference abstract diagnostic test accuracy study drug therapy emergency physician emergency ward female heart left ventricle heart right ventricle human major clinical study male mechanical thrombectomy predictive value pulmonary embolism response team quality control resident retrospective study sensitivity and specificity ultrasound LA - English M1 - 4 M3 - Conference Abstract N1 - L2003124577 2019-10-04 PY - 2019 SN - 1097-6760 0196-0644 SP - S145 ST - 369 Can Bedside Cardiac Ultrasound Better Predict the Need for Escalation of Care Compared to Computed Tomography in Patients With Pulmonary Embolisms? T2 - Annals of Emergency Medicine TI - 369 Can Bedside Cardiac Ultrasound Better Predict the Need for Escalation of Care Compared to Computed Tomography in Patients With Pulmonary Embolisms? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003124577&from=export http://dx.doi.org/10.1016/j.annemergmed.2019.08.330 VL - 74 ID - 760667 ER - TY - JOUR AB - Background: Pulmonary embolism (PE) is associated with significant acute morbidity, mortality, and chronic functional limitations. In Submassive PE, use of catheter directed thrombolysis (CDT) has been shown to improve acute right ventricular (RV) function, however its effect on short and long term functional capacity has not been reported. Methods: We retrospectively analyzed patients who underwent evaluation by the Pulmonary Embolism Response Team (PERT) at single center from 2015 - 2017. We included patients with submassive PE who underwent CDT followed by a six minute walk test (6MWT) prior to discharge and in follow up 2-4 weeks post-discharge. We evaluated echocardiographic parameters of RV function before and after CDT and functional status via 6MWT. Results: Among a total of 129 patients evaluated by PERT, 83 (64%) were classified as submassive PE, and 27 (21%) underwent CDT, out of those, 12 (9.3%) had 6MWT at baseline and follow up. Mean age was 62.9+10.5, 66% were white, 42% were females, mean BMI was 38+11.3, mean PE Severity Index score was 90.5+31. CDT led to improvement in RV/LV ratio (1.5 to 1.0, p<0.01). Median baseline 6MWD was 522 feet (IQR 348-1262), which improved to 955 (IQR 596-1318) feet (p<0.01). There were no major bleeding complications, intracranial hemorrhage or in-hospital mortality. Conclusion: CDT led to significant improvement in RV: LV ratio acutely, which was associated with improvement in functional capacity measured by six minute walk distance. AD - Y. Brailovsky, Loyola University Medical Center, United States AU - Brailovsky, Y. AU - Doukas, D. AU - Porcaro, K. AU - Lopez, J. AU - Mathew, V. AU - Darki, A. DB - Embase DO - 10.1002/ccd.27553 KW - antithrombin adult blood clot lysis body mass brain hemorrhage carotid artery catheter complication conference abstract controlled study female follow up foot functional status heart right ventricle heart ventricle function hospital mortality human lung embolism major clinical study male middle aged retrospective study six minute walk test thrombosis vein disease LA - English M3 - Conference Abstract N1 - L622145849 2018-05-21 PY - 2018 SN - 1522-726X SP - S83 ST - Functional improvement after catheter directed thrombolysis in submassive pulmonary embolism category: Endovascular and peripheral interventions (including neurovascular and carotid) T2 - Catheterization and Cardiovascular Interventions TI - Functional improvement after catheter directed thrombolysis in submassive pulmonary embolism category: Endovascular and peripheral interventions (including neurovascular and carotid) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622145849&from=export http://dx.doi.org/10.1002/ccd.27553 VL - 91 ID - 760833 ER - TY - JOUR AB - Background Acute pulmonary embolism (PE) patients are at variable risk of morbidity, mortality, and response to therapy. Patients often present at various time points from the symptom onset. Several factors may shed light into the state of endogenous thrombotic and fibrinolytic system at the time of presentation. Factor XIIIa plays a critical role in clot stabilization and may impact clot dissolution. Relation of Factor XIIIa activity and symptom duration is not known. Methods We prospectively collected blood samples from patients evaluated by Pulmonary Embolism Response Team at a tertiary care center. Blood was centrifuged, and plasma collected for analysis. We used ELISA method utilizing a commercially available kit from Hyphen, BioMed (Neuville-sur-Oise France), specific for measurement of Factor XIIIa, D-dimer, and Pro-TAFI antigens. Baseline clinical characteristics were collected from electronic medical record. Symptom duration was gathered from patient subjective assessment. Additional workup included radiographic and echocardiographic evaluation. We performed correlation analysis to test the association between symptom duration and Factor XIIIa activity, D-dimer, and Pro-TAFI antigen. Additionally we performed linear regression analyses to quantify the degree of association of symptom duration and Factor XIIIa activity. Results ±±9.8, 8 patients were treated with catheter directed thrombolysis, while the rest were treated with anticoagulation alone. Symptom duration was positively correlated with Factor XIIIa activity (r =0.227). More so, for every one day increase in symptom duration the Factor XIIIa activity was increased by 2.2%. (p=0.014). We demonstrated no correlation between symptom duration and D-Dimer (p=0.58) or symptom duration and Pro-TAFI antigen (p=0.84). Conclusion In patients with acute PE, symptom duration positively correlated with Factor XIIIa activity, for every one day increase in symptom duration the Factor XIIIa activity was increased by 2.2%. Future studies are needed to ascertain the impact of Factor XIIIa activity and clot dissolution as well as functional outcomes. AD - Y. Brailovsky, Medicine, Loyola University Medical Center, Maywood, IL, United States AU - Brailovsky, Y. AU - Hoppensteadt, D. AU - Iqbal, O. AU - Simpson, K. AU - McClane, N. AU - Fareed, J. AU - Darki, A. DB - Embase DO - 10.1182/blood-2018-99-119733 KW - antigen blood clotting factor 13a D dimer endogenous compound adult anticoagulation blood clot lysis catheter clinical article clinical assessment clinical feature conference abstract controlled study correlation analysis electronic medical record enzyme linked immunosorbent assay female France human human tissue linear regression analysis male plasma prospective study protein function pulmonary embolism response team quantitative analysis rest tertiary care center LA - English M3 - Conference Abstract N1 - L626461134 2019-02-26 PY - 2018 SN - 0006-4971 ST - Symptom duration is positively correlated with factor XIIIa activity in acute pulmonary embolism T2 - Blood TI - Symptom duration is positively correlated with factor XIIIa activity in acute pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L626461134&from=export http://dx.doi.org/10.1182/blood-2018-99-119733 VL - 132 ID - 760790 ER - TY - JOUR AU - Brailovsky, Y. AU - Kunchakarra, S. AU - Lakhter, V. AU - Barnes, G. AU - Masic, D. AU - Mancl, E. AU - Porcaro, K. AU - Bechara, C. F. AU - Lopez, J. J. AU - Simpson, K. AU - Mathew, V. AU - Fareed, J. AU - Darki, A. DA - 2019/08/10 08/10 DB - Europe PubMed Central DO - 10.1007/s11239-019-01927-5 M1 - 1 PY - 2019 SN - 0929-5305 SP - 54-58 ST - Pulmonary embolism response team implementation improves awareness and education among the house staff and faculty T2 - J Thromb Thrombolysis TI - Pulmonary embolism response team implementation improves awareness and education among the house staff and faculty UR - http://europepmc.org/article/MED/31396791 VL - 49 ID - 761915 ER - TY - JOUR AB - A subset of high-risk pulmonary embolism (PE) patients requires advanced therapy beyond anticoagulation. Significant variation in delivery of care has led institutions to standardize their approach by developing Pulmonary Embolism Response Team (PERT). We sought to assess the impact of PERT implementation on house staff and faculty education. After implementation of PERT, we employed a targeted educational intervention aimed to improve PERT awareness, familiarity with treatment options, role of echocardiogram and Doppler ultrasound, and knowledge of acute PE risk stratification tools. We conducted an anonymous survey among the house staff and faculty before and after intervention to assess the impact of PERT implementation on educational objectives among clinicians. Initial and follow up samples included 115 and 109 responses. The samples were well represented across the subspecialties and all levels of training, as well as junior and senior faculty. Following the educational campaign, awareness of the program increased (72.2-92.6%, p < 0.01). Proportion of clinicians with reported comfort level of managing PE increased (82.4-90.8%, p = 0.07). Proportion of clinicians with self-reported comfort with explaining all available treatment modalities to patients increased (49.1-67.9%, p = 0.005). Proportions of responders who correctly identified the role of echocardiography in risk stratification of patients with known PE increased (73.9-84.4%, p = 0.07). Accurate clinical risk stratification of acute PE increased (60.2-73.8%, p = 0.03). The implementation of a targeted educational program at a tertiary care center increased awareness of PERT among house staff and faculty and improved physician's accuracy of clinical risk stratification and comfort level with management of acute PE. AD - Division of Cardiology, Loyola University Chicago, Stritch School of Medicine, 2160 South First Ave, Maywood, IL, USA. braeuge@gmail.com. Division of Cardiology, Cardiovascular Research Institute, Loyola University Chicago, Stritch School of Medicine, 2160 South First Ave, Maywood, IL, USA. braeuge@gmail.com. Division of Cardiology, Loyola University Chicago, Stritch School of Medicine, 2160 South First Ave, Maywood, IL, USA. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Division of Cardiovascular Disease, Department of Medicine, University of Michigan, Ann Arbor, MI, USA. Division of Pharmacology, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave, Maywood, IL, USA. Division of Vascular Surgery, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave, Maywood, IL, USA. Department of Medicine, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave, Maywood, IL, USA. Department of Pathology, Loyola University Chicago Stritch School of Medicine, 2160 South First Ave, Maywood, IL, USA. AN - 31396791 AU - Brailovsky, Y. AU - Kunchakarra, S. AU - Lakhter, V. AU - Barnes, G. AU - Masic, D. AU - Mancl, E. AU - Porcaro, K. AU - Bechara, C. F. AU - Lopez, J. J. AU - Simpson, K. AU - Mathew, V. AU - Fareed, J. AU - Darki, A. DA - Jan DO - 10.1007/s11239-019-01927-5 DP - NLM ET - 2019/08/10 J2 - Journal of thrombosis and thrombolysis KW - *Education, Medical, Continuing *Faculty, Medical Female Humans *Internship and Residency Male *Patient Care Team Pulmonary Embolism/*therapy Clinical decision making Education Pulmonary embolism Pulmonary embolism response team Thrombolysis LA - eng M1 - 1 N1 - 1573-742x Brailovsky, Yevgeniy Orcid: 0000-0002-4811-5267 Kunchakarra, Siri Lakhter, Vladimir Barnes, Geoffrey Masic, Dalila Mancl, Erin Porcaro, Katerina Bechara, Carlos F Lopez, John J Simpson, Kevin Mathew, Verghese Fareed, Jawed Darki, Amir CVRI Research Grant/Loyola University Chicago Stritch School of Medicine (US)/ Journal Article Netherlands J Thromb Thrombolysis. 2020 Jan;49(1):54-58. doi: 10.1007/s11239-019-01927-5. PY - 2020 SN - 0929-5305 SP - 54-58 ST - Pulmonary embolism response team implementation improves awareness and education among the house staff and faculty T2 - J Thromb Thrombolysis TI - Pulmonary embolism response team implementation improves awareness and education among the house staff and faculty VL - 49 ID - 760373 ER - TY - JOUR AB - Introduction: Pulmonary embolism (PE) is associated with significant acute morbidity, mortality, and long term functional limitations. There is paucity of data on acute and short term functional assessment after acute PE. Hypothesis: Functional capacity will improve from baseline to follow up among patients with acute PE. Methods: We prospectively analyzed patients who underwent evaluation by the pulmonary embolism response team (PERT) at Loyola University Medical Center between 2016 and 2018. We included patients with acute PE who underwent six-minute walk test (6MWT) at discharge and during outpatient follow up (50±72 days post discharge). We collected demographic and clinical characteristics. We used paired sampled t-test to compare continuous variables. Results: Among the 204 patients evaluated by PERT, 38 patients (18.6%) underwent 6MWT at baseline and follow up. Patients were classified as low risk (6 patients), submassive (29 patients), and massive (3 patients). Mean age was 61.3±14.2, 50% were female, 60.5% were white, 26.3% were black, 29% had cancer, and 68.4% had concomitant DVT, mean BMI 36.4±10.3, and mean PESI score was 96.8+44.4. Overall the mean 6MWT distance increased significantly from a baseline of 726.9±73.7 feet to 1042±72.8 feet at follow up (p<0.001). Low risk (786±204 to 1115.8+177.6 p=0.63), Submassive (700.2±85 to 995.6±82.8 p<0.001), and Massive PE (859±261.7 to 1343.3±307 p=0.168) groups all demonstrated improvement in 6MWT distance. Conclusions: Functional capacity as measured by 6MWT significantly improved during follow up after acute PE. Future studies are needed to determine predictors of favorable functional outcome and best treatment strategies. AD - Y. Brailovsky AU - Brailovsky, Y. AU - Kunchakarra, S. AU - Porcaro, K. AU - Doukas, D. AU - Stiff, A. AU - Bechara, C. AU - Lopez, J. AU - Mathew, V. AU - Fareed, J. AU - Darki, A. DB - Embase KW - adult body mass cancer patient clinical feature conference abstract controlled study female follow up foot functional status genetic susceptibility human major clinical study male malignant neoplasm middle aged outpatient prospective study pulmonary embolism response team risk assessment six minute walk test university hospital LA - English M3 - Conference Abstract N1 - L627102342 2019-04-11 PY - 2018 SN - 1524-4539 ST - Functional outcomes after acute pulmonary embolism T2 - Circulation TI - Functional outcomes after acute pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627102342&from=export VL - 138 ID - 760792 ER - TY - GEN AB -... PE.MethodsWe prospectively analyzed patients who underwent evaluation by the pulmonary embolism response team (PERT... AU - Brailovsky, Yevgeniy AU - Kunchakarra, Siri AU - Porcaro, Katerina AU - Doukas, Demetrios AU - Stiff, Andrew AU - Bechara, Carlos AU - Lopez, John AU - Mathew, Verghese AU - Fareed, Jawed AU - Darki, Amir DA - 2018/01/01 DB - Federal Science Library - Canada PY - 2018 SN - 0009-7322 ST - Abstract 17293: Functional Outcomes After Acute Pulmonary Embolism TI - Abstract 17293: Functional Outcomes After Acute Pulmonary Embolism UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1bb9MwFLbYJBACIdhAjKufxkOVqYntJEbiIYVOQxU3dRXwNDmxDVEvkdJ2iH_POa6TtGgP44GXqHIi17G_HJ_z-VwIYdFJP_hLJiiwg4qCh2DH5VYpViSgmXDNlI6MFe4wfTJhw2_84xfM_dyUT-va_uvCQxssPQbS_sPit51CA_wGCMAVQADXa8Egy5HLKFY9UCEkQ_v_FHYyTwB-Wq_gP82yl7lK4VmBTgOf1zMYHTrTDed5NWtSDDbZDMq68BW_rirks0UsDGpVzqpLT85-N5cwxrIl8Ecwip9qqmpX56g3LuuyldJVjcWEvK8Hhie2Wweo-9NNBNo7M8daYNUObRGmLn4v7miLK9JPONqinE090f515EOxduS3DBK2iWQ-MV5kRzzgYpMSqZXpLN0C7_gi7Lkiqb1wS1ZnbuK7fbA5-x-Mz7yZvZuIO8OwXec3dIxp2ee6LFZvzCKYjPfIHohK1Mjfj1o1IGaJaMr44ZDbPf_urwodIZZTFwdxBzd9v1uf3yf3vB1Csw1iHpAbZnFADrOFWlXz3_SYOs9gd-RyQG598A4Yh2TQ4Im613pNOzTRBk3UoYk6NNEWTbRB00MyOR2evz0LfBmO4AeYCyIwits44oUAWyLKc5taq2MTKRNKm3K4K5kBVUuElmmlk7jQ0qSKCRkJraQ27BHZX1QL85hQLXQkRSFTlWvOeC65FWk_ljoXuerL5Ii8xDm62MQAt9_fRTf1R-SVewK_QHxd5aNIoH9MZLbzZLAz0b5T9LZAGiAJEJUhMiJBnyWJeHLtnp-S2x2in5H9Vb02z8lNu5wF-dK-cDD4A6ojlEY VL - 138 ID - 761986 ER - TY - JOUR AB - Background: Acute pulmonary embolism (PE) is a heterogenous group, who present a diagnostic and therapeutic dilemma. Pulmonary Embolism Response Team (PERT) was established to standardize care of acute PE. The impact of PERT on house staff education is not known Methods: We conducted an anonymous survey among the house staff to assess awareness of PERT, clinicians’ comfort level with risk stratification and management of acute PE. We then implemented an intervention aimed at raising program awareness and addressing gaps in knowledge. Intervention consisted of lecture presentations, informational pocket cards, and “smart notes” in the electronic medical record. We then conducted a follow up survey to assess the impact of the intervention Results: Initial and follow up samples included 115 and 109 responses (13.2% and 12.5% response rate). The sample was well represented across subspecialties and different levels of training. Awareness of the program increased from 72.2% to 92.6% (p<0.01). The proportion of clinicians with reported comfort level of managing PE and explaining all the treatment modalities increased from 82.4% to 90.8% (p=0.067) and 49.1% to 67.9% (p=0.0045), respectively. Accurate risk stratification of acute PE increased from 60.2% to 73.8% (p=0.0316) Conclusion: Implementation of PERT resulted in increased awareness of the program. The educational initiative was associated with increased comfort level and improvement in accurate risk stratification of acute PE among the house staff [Figure presented] AU - Brailovsky, Y. AU - Kunchakarra, S. AU - Porcaro, K. AU - Masic, D. AU - Mancl, E. AU - Doukas, D. AU - Bechara, C. AU - Lopez, J. J. AU - Simpson, K. AU - Mathew, V. AU - Fareed, J. AU - Darki, A. DB - Embase DO - 10.1016/S0735-1097(19)33656-3 KW - awareness clinician comfort conference abstract controlled study electronic medical record follow up human pulmonary embolism response team risk assessment staff training stratification LA - English M1 - 9 Supplement 1 M3 - Conference Abstract N1 - L2001642126 2019-04-16 PY - 2019 SN - 1558-3597 0735-1097 SP - 3050 ST - PULMONARY EMBOLISM RESPONSE TEAM IMPLEMENTATION IMPROVES AWARENESS AND EDUCATION AMONG THE HOUSE STAFF T2 - Journal of the American College of Cardiology TI - PULMONARY EMBOLISM RESPONSE TEAM IMPLEMENTATION IMPROVES AWARENESS AND EDUCATION AMONG THE HOUSE STAFF UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001642126&from=export http://dx.doi.org/10.1016/S0735-1097(19)33656-3 VL - 73 ID - 760738 ER - TY - JOUR AB - Background: Pulmonary embolism (PE) is associated with significant morbidity, mortality and long term functional limitation. Determinants of functional limitation after PE are unknown. Methods: From a single center tertiary care PE database, we retrospectively analyzed patients who underwent evaluation by the pulmonary embolism response team (PERT) from 2015-2017. PE patients who underwent 6-minute-walk test (6MWT) prior to discharge were included. Pulmonary Embolism Severity Index (PESI) score was calculated using baseline clinical and demographic characteristics. Results: Among a total of 129 patients evaluated by PERT, 39 (30%) underwent 6MWT. Of those, 15.4%, 82.1%, and 2.6% of patents were classified as low risk PE, submassive PE, and massive PE, respectively. Thirty-three precent underwent catheter-directed thrombolysis. Mean age was 57.9 ± 12.9 years, 56.4% were white, 43.6% were female, mean BMI was 35.2 ± 9.4kg/m2, and mean PESI score was 92.6 ± 32.5. Rising PESI score was significantly associated with decrease in 6MWT distance. For each 10-point rise in PESI score, 6MWT distance decreased by 41.7 ft (p = 0.056), r = 0.31. See P29 Figure. Conclusion: After acute PE, an increase in PESI score is associated with substantial decrease in functional capacity as measured by 6MWT distance. Future studies evaluating efficacy of therapies for PE should incorporate baseline PESI scores when assessing functional outcomes. AD - Y. Brailovsky, Loyola University, Medical Center, Maywood, IL, United States AU - Brailovsky, Y. AU - Porcaro, K. AU - Doukas, D. AU - Steen, L. AU - Leya, F. AU - Lewis, B. AU - Mathew, V. AU - Lopez, J. AU - Darki, A. DB - Embase DO - 10.1177/1358863X18767198 KW - adult blood clot lysis body mass catheter clinical assessment comparative effectiveness conference abstract controlled study female functional status human lung embolism major clinical study male middle aged patent retrospective study six minute walk test tertiary health care LA - English M1 - 3 M3 - Conference Abstract N1 - L622669643 2018-06-26 PY - 2018 SN - 1477-0377 SP - 322-323 ST - Pulmonary embolism severity index predicts six minute walk distance after pulmonary embolism T2 - Vascular Medicine TI - Pulmonary embolism severity index predicts six minute walk distance after pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622669643&from=export http://dx.doi.org/10.1177/1358863X18767198 VL - 23 ID - 760816 ER - TY - JOUR AB - Rendu-Osler-Weber (ROW) syndrome or hereditary hemorrhagic telangiectasia is a rare autossomic dominant disease characterized by vascular dysplasia involving multiple systems and associated with an increased bleeding risk. The presence of atrial fibrillation in this population becomes a challenge, regarding the evaluation of bleeding and thrombotic risks and the best approach for the patient management. A 72 years-old female with ROW syndrome, atrial fibrillation and a CHA2DS2-VASc risk score of four, was admitted to our hospital for left atrial appendage (LAA) closure after a period of novel oral anticoagulation crowed with multiple haemorrhagic events and blood transfusions. After the implantation of a Watchman LAA number 33 closure device (Image 1A), and because of the concomitant diagnose of chronic pulmonary embolism, she was restarted on anticoagulation therapy in lower doses, with initial tolerance. For evaluation of LAA closure device during follow-up, after an unsuccessful attempt of transoesophageal echocardiography (TEE) because of severe epistaxis subsequent to oropharyngeal anaesthesia, the patient underwent a Cardiac Computed Tomography (CT) that showed a moderate peri-device leak (4.4x11mm, 0.73cm2) - (Image 1B). For better characterization, the patient underwent a new attempt of TEE with the support of an anaesthesiologist and the need of local vasoconstrictor agents and tranexamic acid for epistaxis and oropharyngeal bleeding control. TEE confirmed a moderate posterior device-leak (7.1mm) with absence of cavitary thrombus (Image 1C). After a year of anticoagulation with new significant bleeding events, TEE was repeated with the anaesthetic and pharmacologic preparation. This TEE showed a decrease in peridevice leak (<5mm wide - Image 1D), which was fundamental for supporting the multidisciplinary team decision of interruption of anticoagulation therapy. With this case we want to highlight the challenging decisions regarding patients with ROW syndrome and atrial fibrillation. Specifically, we must be alert about possible complications in trying to perform TEE in this population, once the frequent occurrence of telangiectasias in the oropharynges that may occur, as in this patient.(Figure Presented). AD - T. Branco Mano, Hospital de Santa Marta, Lisbon, Portugal AU - Branco Mano, T. AU - Moura Branco, L. AU - Ramos, R. AU - Fiarresga, A. AU - Timoteo, A. T. AU - Galrinho, A. AU - Abreu, J. AU - Castro, L. AU - Duarte Silva, N. AU - Ilhao Moreira, R. AU - Valentim Goncalves, A. AU - Cruz Ferreira, R. DB - Embase DO - 10.1093/ehjci/jez319.052 KW - tranexamic acid vasoconstrictor agent aged anesthesia anesthesiologist anticoagulant therapy atrial fibrillation blood transfusion CHA2DS2-VASc score complication computer assisted tomography conference abstract controlled study dysplasia epistaxis female follow up human implantation left atrial appendage closure device low drug dose lung embolism multidisciplinary team patient care Rendu Osler Weber disease thrombus transesophageal echocardiography LA - English M3 - Conference Abstract N1 - L631349791 2020-04-07 PY - 2020 SN - 2047-2412 SP - i56 ST - Bleeding complications in a rendu-osler-weber syndrome patient with atrial fibrillation-challenging serial transoesophageal echocardiography T2 - European Heart Journal Cardiovascular Imaging TI - Bleeding complications in a rendu-osler-weber syndrome patient with atrial fibrillation-challenging serial transoesophageal echocardiography UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631349791&from=export http://dx.doi.org/10.1093/ehjci/jez319.052 VL - 21 ID - 760629 ER - TY - JOUR AB - Background: Peritoneal mesothelioma (PM) is a rare primary neoplasm of the peritoneum with an increasing incidence worldwide. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown promise as a treatment strategy. A national PM multidisciplinary team (national PM MDT) video-conference meeting was established in the UK and Ireland in March 2016, aiming to plan optimal treatment, record outcomes and provide evidence for the benefits of centralization. This article reports on the activities and outcomes of the first 2·5 years. Methods: Between March 2016 and December 2018, patients with PM, referred to peritoneal malignancy centres in Basingstoke, Birmingham, Manchester and Dublin, were discussed by the national PM MDT via video-conference. The MDT was composed of surgeons, radiologists, specialist nurses and pathologists. Patients were considered for CRS and HIPEC if considered fit for surgery and if radiological imaging suggested that complete surgical cytoreduction could be achieved. Morbidity and mortality following surgery were analysed. Survival analysis following MDT discussion was conducted. Results: A total of 155 patients (M : F ratio 0·96) with a mean(s.d.) age of 57(17) years were discussed. To date, 22 (14·2 per cent) have had CRS and HIPEC; the median Peritoneal Cancer Index for the surgical group was 17·0. Complete cytoreduction was achieved in 19 patients. Clavien–Dindo grade I–II complications occurred in 16 patients; there was no grade III–IV morbidity or 30-day in-hospital mortality. The median follow-up for the whole cohort was 18·7 months, and the 2-year survival rate from time of first review at the national PM MDT was 68·3 per cent. Conclusion: The centralized national PM MDT was effective at selecting patients suitable for CRS and HIPEC, reporting a good outcome from patient selection. AD - T. Cecil, Peritoneal Malignancy Institute, Basingstoke and North Hampshire Hospital, Basingstoke, United Kingdom AU - Brandl, A. AU - Westbrook, S. AU - Nunn, S. AU - Arbuthnot-Smith, E. AU - Mulsow, J. AU - Youssef, H. AU - Carr, N. AU - Tzivanakis, A. AU - Dayal, S. AU - Mohamed, F. AU - Moran, B. J. AU - Cecil, T. DB - Embase Medline DO - 10.1002/bjs5.50256 KW - adult article bleeding cancer chemotherapy cancer prognosis cancer staging cancer surgery cancer survival cohort analysis colloid carcinoma cytoreductive surgery experimental renal failure female follow up hallucination histology human lung embolism major clinical study male middle aged morbidity mortality multidisciplinary team outcome assessment overall survival pancreas fistula patient selection peritoneum mesothelioma pleura mesothelioma pneumonia pneumothorax postoperative complication priority journal statistical analysis surgical patient survival analysis survival rate treatment outcome tumor volume urinary tract infection videoconferencing wound infection LA - English M1 - 2 M3 - Article N1 - L2004179645 2020-02-10 2020-04-23 PY - 2020 SN - 2474-9842 SP - 260-267 ST - Clinical and surgical outcomes of patients with peritoneal mesothelioma discussed at a monthly national multidisciplinary team video-conference meeting T2 - BJS Open TI - Clinical and surgical outcomes of patients with peritoneal mesothelioma discussed at a monthly national multidisciplinary team video-conference meeting UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004179645&from=export http://dx.doi.org/10.1002/bjs5.50256 VL - 4 ID - 760579 ER - TY - JOUR AB - Background: Current stroke management emphasizes rapid detection and diagnosis and reduction of long term morbidity and mortality through timely thrombolysis where appropriate and Stroke Unit (SU) care. This study aimed to re-evaluate current stroke management in a university teaching hospital and compare to previous audits in 2011 (1, 2). Methods: Retrospective cross-sectional analysis of 140 admissions between May and November 2013 was conducted. Results: Admissions reviewed included: 115 (82 %) ischemic strokes 10 (7 %) intracranial haemorrhages and 15 (11 %) transient ischemic attacks (TIAs). 82 (59 %) were male and mean age was 72.1. Of 140 admissions, 53 (38 %) patients presented within 4.5 hours of symptom onset (17 in 2011) and 12 (9 %) were thrombolysed. Mean time to thrombolysis from onset was 196 minutes (153 in 2011). Average time from arrival to CT Brain was 39 minutes; with mean door-toneedle- time of 82 minutes (72 in 2011). All patients had CT Brain within 24 hours of admission. 108 (77 %) were admitted directly to the stroke unit (67 % 2011). Of ischemic strokes 108 (94 %) received antiplatelet therapy within 48 hours. Of 58 diagnosed with atrial fibrillation (AF), 45 (78 %) had known AF, of whom 20 % were not anti-coagulated. Multidisciplinary team (MDT) assessment within appropriate time frames has improved since 2011. 81 % of appropriate patients had speech and language assessment within 48 hours (41 % in 2011). 86 % of stroke patients received stroke nurse practitioner consultation which has enhanced MDT assessment. Of discharges, 107 (77 %) went home and 9 (6 %) went to long term care (85 and 13 % respectively in 2011). Conclusion: More stroke patients are presenting within the thrombolysis window but onset-to-needle and door-to-needle times have increased. We need more efficiency in the in-hospital thrombolysis process to improve outcomes. Direct access to SU care has improved but more beds are needed to provide SU care to all stroke patients. AD - L. Brandon, University College Hospital, Galway, Ireland AU - Brandon, L. AU - Canavan, M. AU - Robinson, S. AU - Griffin, T. AU - Khan, A. AU - Galvin, P. AU - O'Keeffe, S. AU - O'Donnell, M. AU - Mulkerrin, E. AU - Walsh, T. DB - Embase DO - 10.1007/s11845-014-1177-1 KW - human clinical audit cerebrovascular accident university teaching hospital society blood clot lysis patient stroke patient implantable cardioverter defibrillator brain ischemia brain stroke unit needle transient ischemic attack hospital long term care consultation nurse practitioner speech and language assessment mortality atrial fibrillation therapy male morbidity diagnosis LA - English M1 - 7 M3 - Conference Abstract N1 - L71611204 2014-09-13 PY - 2014 SN - 0021-1265 SP - S329-S330 ST - Audit of stroke management at a university teaching hospital T2 - Irish Journal of Medical Science TI - Audit of stroke management at a university teaching hospital UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71611204&from=export http://dx.doi.org/10.1007/s11845-014-1177-1 VL - 183 ID - 761102 ER - TY - JOUR AB - Background Endovenous stenting is a method to overcome venous outflow obstruction in the treatment of patients with acute iliofemoral deep vein thrombosis (DVT) or in those with symptomatic post-thrombotic syndrome (PTS). These treatments allow maximal luminal expansion of the caval and/or iliac venous segment leading to a reduction in venous hypertension. While there is growing enthusiasm for their use, particularly as conventional treatments usually with anticoagulation are not always effective there is however little clinical data regarding efficacy in improving clinical outcome. Objectives To determine the outcomes in patients following placement of venous stents for treatment of obstruction in acute venous thrombotic and postthrombotic syndrome. Methods Consecutive patients with a history of DVT in whom a venous stent was inserted at two UK specialist tertiary referral centres between 2012-2015 were included. 'Acute' patients consisted of those with a fresh symptomatic iliofemoral DVT; chronic patients were those with recalcitrant PTS unresponsive to conventional therapy. Patients planned for intervention were discussed by a multidisciplinary team made up from Haematology, Interventional Radiology and Vascular Surgery. Stents were placed under general anaesthesia. Venous access was obtained using ultrasound guidance. Intravascular ultrasound (IVUS) was used to size the stent and to ensure it was fully expanded. Endophlebectomy with arterio-venous fistula formation was carried out in selected patients. All patients were given therapeutic dose low molecular weight heparin (LMWH) post procedure before transition to oral anticoagulation. Ultrasound surveillance commenced the day after the procedure and at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and annually thereafter. Clinical follow-up was at 6 weeks, 6 monthly thereafter. Primary patency was defined as a patent stent with <50% diameter reduction. Primaryassisted patency was defined as a stent that had not occluded, but had required a re-intervention to maintain patency, based on imaging findings and/or symptoms. Secondary patency included stents that had blocked and were successfully re-opened. Ulcer healing or changes in Villalta Score were used as measures of clinical outcome following intervention. Results 379 venous stents were placed in 148 patients. The median age of patients was 42yrs (range: 18-81yrs), and 86 (58%) patients were female. Symptoms in the left leg were most common (116 patients, 78%). There were 60 (41%) patients who had a venous stent placed to treat an underlying stenosis following catheter directed thrombolysis of an acute iliofemoral DVT. 88 (58%) patients had stent placement to treat a post-thrombotic obstruction considered pathological for PTS. Primary, primary-assisted and secondary patency was 67%, 85% and 88% respectively at one-year in the acute DVT group (figure 1) and 64%, 86% and 86% respectively for the PTS group (figure 2). The median Villata score was 0 (range 0-14), 12 months after stenting, though new ulceration was noted in three patients in the acute DVT group. Median Villalta scores in patients without ulceration decreased from 15 (range 6-23) to 5 (range 1- 22) one-year following the procedure (P<0.0001) in the PTS group with the greatest improvement in Villalta score in patients with a patent stent (P<0.0001). Ulcer healing occurred in 6 of 13 patients during follow-up. Four patients with severe pre-operative PTS developed an ulcer six-months following intervention. There was one death from cancer during follow-up, but no stent related mortality or major bleeding complications. Conclusions This is the largest reported series of outcomes of venous stents placed in patients with acute iliofemoral venous thrombosis or severe postthrombotic syndrome. Patients had a minimum follow-up of one year Venous stenting offer potential for the treatment of patients with obstruction related to thrombotic venous disease with good clinical outcomes at one year. Further study on patient selection, outcomes and optimal anticoagula ion is required. AD - K. Breen, Guys and St Thomas; NHS Foundation Trust, London, United Kingdom AU - Breen, K. AU - Saha, P. AU - Karanunithy, N. AU - Hunt, B. AU - Cohen, A. AU - Uprichard, J. AU - McDonald, V. AU - Fay, M. AU - Black, S. DB - Embase KW - low molecular weight heparin adult aged anticoagulation arteriovenous fistula bleeding blood clot lysis cancer surgery catheter chronic patient clinical outcome complication conference abstract controlled study death deep vein thrombosis drug therapy female follow up general anesthesia hematology human interventional radiology intravascular ultrasound leg major clinical study male mortality obstruction patent patient selection postthrombosis syndrome stenosis surgery tertiary care center ulcer healing vascular surgery venous stent LA - English M3 - Conference Abstract N1 - L620311055 2018-01-26 PY - 2017 SN - 1528-0020 ST - Outcomes following placement of venous stents for treatment of thrombotic venous disease T2 - Blood TI - Outcomes following placement of venous stents for treatment of thrombotic venous disease UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620311055&from=export VL - 130 ID - 760887 ER - TY - JOUR AB - Pulmonary embolism is a common cause of morbidity and mortality which continues to increase in overall incidence. Because it can occur with a wide range of clinical presentations, different guidelines have been developed for appropriate risk stratification of patients; interventional radiology plays a vital role in the management of both massive and submassive pulmonary embolism. Catheter-directed therapy, including mechanical and aspiration thrombectomy, standard catheter-directed thrombolysis, and ultrasound-accelerated thrombolysis, has many benefits, including lower thrombolytic doses and intraclot administration of thrombolytic therapy. While the role of catheter-directed therapy is still being developed, four important prospective studies have demonstrated its safety and efficacy. Additional studies comparing short- and long-term clinical outcomes in patients treated with catheter-directed therapy versus anticoagulation are the next step in understanding its role within the management of submassive pulmonary embolism. Furthermore, multidisciplinary pulmonary embolism response teams, in which interventional radiology plays a crucial role, are becoming essential to appropriately managing pulmonary embolism patients, including selection of those who may benefit from catheter-directed therapy. AD - University of Illinois Hospital and Health Sciences System, Chicago, Illinois. Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois. AN - 32139972 AU - Bremer, W. AU - Ray, C. E., Jr. AU - Shah, K. Y. C2 - Pmc7056338 DA - Mar DO - 10.1055/s-0039-3401841 DP - NLM ET - 2020/03/07 J2 - Seminars in interventional radiology KW - catheter-directed therapy catheter-directed thrombolysis interventional radiology pulmonary embolism pulmonary embolism response team submassive pulmonary embolism LA - eng M1 - 1 N1 - 1098-8963 Bremer, William Ray, Charles E Jr Shah, Ketan Y Journal Article Review Semin Intervent Radiol. 2020 Mar;37(1):62-73. doi: 10.1055/s-0039-3401841. Epub 2020 Mar 4. PY - 2020 SN - 0739-9529 (Print) 0739-9529 SP - 62-73 ST - Role of Interventional Radiologist in the Management of Acute Pulmonary Embolism T2 - Semin Intervent Radiol TI - Role of Interventional Radiologist in the Management of Acute Pulmonary Embolism VL - 37 ID - 760426 ER - TY - JOUR AB - Issue: Hilton Head Hospital is a 93-bed community hospital that provides a broad range of services, including cardiac surgery. Historically Ventilator Associated Pneumonia (VAP) has been part of the hospital surveillance program. The rates for VAP remained constant for the years 2007 at 5.84 and 2008 at 5.18 with a slight decline to 2.84 in 2009. While standing physician orders and the IHI care bundle for VAP prevention were in place for the ventilated patient, we continued to experience VAP. As a result, a project was initiated, in collaboration with the pulmonologist, in an attempt to identify improvement opportunities. Project: A comprehensive retrospective patient chart review was completed to assess compliance with the key VAP bundle components: head of bed (HOB) at 30 degrees, daily sedation reduction, peptic ulcer disease (PUD) prevention, and deep vein thrombosis (DVT) prevention. To be included in the review, patientswere to have been on the ventilator for greater than 72 hours. After compiling and analyzing the data, sedation vacation was the one component identified as being missed most often. Sixty-four total observations of charts yielded only 47% positive observation for sedation vacation whereas we achieved better than 90% in the other three key bundle (Figure presented) components. This finding led to the realization there was no standardized protocol in place to assess a patient response to a decrease in sedation. Therefore, a multidisciplinary team was convened to develop an improvement plan. Through its work, the team determined a need to develop a formal sedation reduction protocol. The protocol was subsequently developed, implemented, and staff was educated on its use. The ultimate project objective was to eliminate VAP occurrences by decreasing the number of days a patient required ventilation thus reducing their exposure risk. Key project goals included: Standardization of the ordering of sedation agents and titration parameters Appropriate sedation utilization and initiation of daily sedation holds Development of weaning parameters and initiation of breathing trials Daily assessment of sedation levels using the standardized Ramsay Scale Results: Through the development of a formal protocol, we ensured sedation reduction was incorporated into the routine care of the ventilated patient. Since implementation of the protocol, we have not experienced a VAP. Lesson Learned: Everyone who participated in this project learned something new and contributed to the improvement effort. The following provides a summary of key lessons learned: Increased clinician awareness about the need and benefit of formal protocols for complex and critically ill patients. Enabled the Quality and Infection Control Departments to partner with the Medical and Clinical Staff in a successful quality improvement effort. Demonstrated that with interest and staff engagement, patient care improvement is possible. Identifying just one area for improvement can lead to important gains. AD - J. Briggs, Hilton Head Hospital, United States AU - Briggs, J. AU - Arashin, K. AU - Ross, L. AU - Burnaugh, R. AU - Genone, J. DB - Embase DO - 10.1016/j.ajic.2012.04.083 KW - sedation ventilator associated pneumonia infection control epidemiology human compliance (physical) patient prevention leisure parameters ventilated patient hospital deep vein thrombosis weaning physician total quality management patient care peptic ulcer standardization heart surgery exposure air conditioning ventilator risk titrimetry medical record review breathing critically ill patient community hospital prophylaxis thrombosis prevention LA - English M1 - 5 M3 - Conference Abstract N1 - L70811547 2012-07-23 PY - 2012 SN - 0196-6553 SP - e47-e48 ST - Sedation reduction leads to reduction in ventilator associated pneumonia T2 - American Journal of Infection Control TI - Sedation reduction leads to reduction in ventilator associated pneumonia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70811547&from=export http://dx.doi.org/10.1016/j.ajic.2012.04.083 VL - 40 ID - 761199 ER - TY - JOUR AB - BACKGROUND: Pediatric hospital-acquired (HA) venous thromboembolism (VTE) is a vexing problem with improvement efforts hampered by lack of robust surveillance methods to establish accurate rates of HA-VTE. METHODS: At a freestanding children's hospital, a multidisciplinary team worked to develop a comprehensive surveillance strategy for HA-VTE. Starting with diagnosis codes, we implemented complementary detection methods, including clinical and radiology data, to develop a robust surveillance system. HA-VTE events were tracked by using descriptive statistics and a statistical process control chart. Detection methods were evaluated via retrospective application of each method to every identified HA-VTE. Initial detection method was tracked. RESULTS: A total of 68 HA-VTE events were identified and the median number of events per 1000 patient days increased from 0.18 to 0.34. No single detection method would have identified all events. Each detection method initially identified HA-VTE events. CONCLUSIONS: Implementation of multiple detection methods has optimized timely detection of HA-VTE. This allows the establishment of a reliable baseline rate, enabling quality improvement efforts to address HA-VTE. AD - Divisions of Hospital Medicine and. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. Divisions of Hospital Medicine and eshaughnessy@phoenixchildrens.com. AN - 28899859 AU - Brower, L. H. AU - Shaughnessy, E. E. AU - Chima, R. S. DA - Oct DO - 10.1542/hpeds.2016-0220 DP - NLM ET - 2017/09/14 J2 - Hospital pediatrics KW - Child Cross-Sectional Studies *Hospitals, Pediatric Humans Population Surveillance/*methods United States Venous Thromboembolism/*diagnosis conflicts of interest to disclose. LA - eng M1 - 10 N1 - Brower, Laura H Shaughnessy, Erin E Chima, Ranjit S Journal Article United States Hosp Pediatr. 2017 Oct;7(10):610-614. doi: 10.1542/hpeds.2016-0220. Epub 2017 Sep 12. PY - 2017 SN - 2154-1663 (Print) 2154-1671 SP - 610-614 ST - Development of a Surveillance System for Pediatric Hospital-Acquired Venous Thromboembolism T2 - Hosp Pediatr TI - Development of a Surveillance System for Pediatric Hospital-Acquired Venous Thromboembolism VL - 7 ID - 760278 ER - TY - JOUR AB - Background: The exact relation among patient prefracture characteristics such as age, American Society of Anesthesiologists (ASA) class, fracture type, and prefracture mobility status with perioperative complications in elderly adult patients with hip fracture is still unclear. The aim of the study was to assess the relations among patient prefracture characteristics and perioperative complications. Methods: Patients 65 years old and older admitted to our institution between January 2006 and May 2010 with the diagnosis of a low-energy hip fracture were retrospectively reviewed. A total of 389 patients met the inclusion criteria and were analyzed in this investigation. Patient prefracture characteristics, comorbidities, and surgical and hospital courses were reviewed. Results: Using logistic regression analysis, ASA class was found to be the only significant predictor of a patient having at least one or more perioperative complications (odds ratio [OR] 2.007). In addition to ASA class, prefracture mobility status was a significant predictor of delirium (OR 1.39) and pneumonia (OR 1.77), advanced age was a significant predictor of congestive heart failure (OR 1.73), and fracture type was a significant predictor of pneumonia (OR 1.6). None of the examined prefracture characteristics was found to be a significant predictor of pulmonary embolus, deep venous thrombosis, surgical wounds, transfusions, urinary tract infection, or death. Conclusions: At our institution, certain patient prefracture characteristics, particularly high ASA class, are related to certain perioperative complications. Recognition of patients who possess these risk factors can be used to alert the caregiving team about a potentially complicated hospital course. AD - Duke Univ, Med Ctr, Dept Orthoped, Durham, NC USA. Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA. Duke Univ, Sch Nursing, Durham, NC USA. Brown, CA (corresponding author), Stanford Univ, Dept Orthopaed Surg, Sch Med, 450 Broadway St,MC 6342, Redwood City, CA 94063 USA. cbrown025@gmail.com AN - WOS:000304916400005 AU - Brown, C. A. AU - Boling, J. AU - Manson, M. AU - Owens, T. AU - Zura, R. DA - Jun DO - 10.1097/SMJ.0b013e3182574bfd J2 - South.Med.J. KW - At our institution certain patient prefracture characteristics particularly high ASA class are related to certain perioperative CONTROLLED-TRIAL OSTEOPOROTIC FRACTURES MEDICAL COMORBIDITIES HOSPITALIST MODEL OLDER PATIENTS MORTALITY OUTCOMES CARE SURVIVAL SURGERY Medicine, General & Internal LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: 954AQ Times Cited: 15 Cited Reference Count: 43 Brown, Christopher A. Boling, John Manson, Maria Owens, Thomas Zura, Robert Sythes R.Z. is a consultant for Smith&Nephew Orthopedics and has received institutional funds from Sythes for research and fellowship. The other authors have no financial relationships to disclose and no conflicts of interest to report. 18 1 5 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA SOUTH MED J PY - 2012 SN - 0038-4348 SP - 306-310 ST - Relation Between Prefracture Characteristics and Perioperative Complications in the Elderly Adult Patient with Hip Fracture T2 - Southern Medical Journal TI - Relation Between Prefracture Characteristics and Perioperative Complications in the Elderly Adult Patient with Hip Fracture UR - ://WOS:000304916400005 VL - 105 ID - 761824 ER - TY - JOUR AB - BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is associated with increased morbidity and mortality after percutaneous coronary interventions and is a patient safety objective of the National Quality Forum. However, no formal quality improvement program to prevent CI-AKI has been conducted. Therefore, we sought to determine whether a 6-year regional multicenter quality improvement intervention could reduce CI-AKI after percutaneous coronary interventions. METHODS AND RESULTS: We conducted a prospective multicenter quality improvement study to prevent CI-AKI (serum creatinine increase ≥0.3 mg/dL within 48 hours or ≥50% during hospitalization) among 21 067 nonemergent patients undergoing percutaneous coronary interventions at 10 hospitals between 2007 and 2012. Six intervention hospitals participated in the quality improvement intervention. Two hospitals with significantly lower baseline rates of CI-AKI, which served as benchmark sites and were used to develop the intervention, and 2 hospitals not receiving the intervention were used as controls. Using time series analysis and multilevel poisson regression clustering to the hospital level, we calculated adjusted risk ratios for CI-AKI comparing the intervention period to baseline. Adjusted rates of CI-AKI were significantly reduced in hospitals receiving the intervention by 21% (risk ratio, 0.79; 95% confidence interval: 0.67-0.93; P=0.005) for all patients and by 28% in patients with baseline estimated glomerular filtration rate <60 mL/min per 1.73 m(2) (risk ratio, 0.72; 95% confidence interval: 0.56-0.91; P=0.007). Benchmark hospitals had no significant changes in CI-AKI. Key qualitative system factors associated with improvement included multidisciplinary teams, limiting contrast volume, standardized fluid orders, intravenous fluid bolus, and patient education about oral hydration. CONCLUSIONS: Simple cost-effective quality improvement interventions can prevent ≤1 in 5 CI-AKI events in patients with undergoing nonemergent percutaneous coronary interventions. AD - From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.). jbrown@dartmouth.edu. From The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (J.R.B., M.E.S., C.S.R.); Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (J.R.B., J.L.S., S.M.C., J.F.R., D.J.M.); Department of Community and Family Medicine, Lebanon, NH (J.R.B., T.A.M.); Fletcher Allen Health Care, Burlington, VT (R.J.S., H.L.D.); Tufts Medical Center, Boston, MA (M.J.S.); Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX (P.A.M.); The Heart Hospital, Plano, TX (P.A.M.); Department of Veterans Affairs Medical Center, White River Junction, VT (L.D.); Concord Hospital, Concord, NH (K.C.); Catholic Medical Center, Manchester, NH (P.L., D.J.G.); Portsmouth Regional Hospital, Portsmouth, NH (D.L., F.A.F.); Maine Medical Center, Portland, ME (M.A.K.); Central Maine Medical Center, Lewiston, ME (S.H., W.J.P.); and Eastern Maine Medical Center, Bangor, ME (C.D., A.W.). AN - 25074372 AU - Brown, J. R. AU - Solomon, R. J. AU - Sarnak, M. J. AU - McCullough, P. A. AU - Splaine, M. E. AU - Davies, L. AU - Ross, C. S. AU - Dauerman, H. L. AU - Stender, J. L. AU - Conley, S. M. AU - Robb, J. F. AU - Chaisson, K. AU - Boss, R. AU - Lambert, P. AU - Goldberg, D. J. AU - Lucier, D. AU - Fedele, F. A. AU - Kellett, M. A. AU - Horton, S. AU - Phillips, W. J. AU - Downs, C. AU - Wiseman, A. AU - MacKenzie, T. A. AU - Malenka, D. J. C2 - Pmc4869689 C6 - Nihms783464 DA - Sep DO - 10.1161/circoutcomes.114.000903 DP - NLM ET - 2014/07/31 J2 - Circulation. Cardiovascular quality and outcomes KW - Acute Kidney Injury/chemically induced/*prevention & control Aged Benchmarking/*methods Contrast Media/adverse effects/therapeutic use Cost-Benefit Analysis Creatinine/blood Female Humans Interdisciplinary Communication Male Middle Aged Patient Education as Topic *Percutaneous Coronary Intervention Postoperative Complications/*prevention & control Prospective Studies Quality Improvement Regional Medical Programs Rehydration Solutions/*administration & dosage acute kidney injury contrast media percutaneous coronary intervention quality improvement information to disclose in relation to this research. LA - eng M1 - 5 N1 - 1941-7705 Brown, Jeremiah R Solomon, Richard J Sarnak, Mark J McCullough, Peter A Splaine, Mark E Davies, Louise Ross, Cathy S Dauerman, Harold L Stender, Janette L Conley, Sheila M Robb, John F Chaisson, Kristine Boss, Richard Lambert, Peggy Goldberg, David J Lucier, Deborah Fedele, Frank A Kellett, Mirle A Horton, Susan Phillips, William J Downs, Cynthia Wiseman, Alan MacKenzie, Todd A Malenka, David J Northern New England Cardiovascular Disease Study Group K01 HS018443/HS/AHRQ HHS/United States K24 DK078204/DK/NIDDK NIH HHS/United States Journal Article Multicenter Study Research Support, N.I.H., Extramural Research Support, U.S. Gov't, P.H.S. Circ Cardiovasc Qual Outcomes. 2014 Sep;7(5):693-700. doi: 10.1161/CIRCOUTCOMES.114.000903. Epub 2014 Jul 29. PY - 2014 SN - 1941-7713 (Print) 1941-7713 SP - 693-700 ST - Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention T2 - Circ Cardiovasc Qual Outcomes TI - Reducing contrast-induced acute kidney injury using a regional multicenter quality improvement intervention VL - 7 ID - 760315 ER - TY - JOUR AB - BACKGROUND: Revascularization decisions can profoundly impact patient survival, quality of life, and procedural risk. Although use of Heart Teams to make revascularization decisions is growing, data on their implementation in the real-world are limited. Our objective was to assess the prevalence of Heart Teams and their association with collaboration in routine practice. METHODS: A survey of cardiologists and cardiac surgeons at 31 hospitals in Michigan was performed in May, 2011--prior to the recommendation for using Heart Teams in national guidelines. This survey included all percutaneous coronary intervention-performing hospitals in Michigan participating in the Blue Cross/Blue Shield of Michigan Cardiovascular Consortium and Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. It targeted both the use of Heart Teams and multidisciplinary Case Conferences. RESULTS: There were 53 physician survey respondents from 27 hospitals with 4 hospitals not responding. Among respondents, 11 (40.7%) hospitals reported no Heart Teams or Case Conferences while 7 (25.9%) hospitals reported either a Heart Team or Case Conference. However, there was disagreement about the presence of a Heart Team at seven hospitals, and about Case Conferences at nine hospitals. Hospitals with definite Heart Teams reported significantly greater levels of collaboration between cardiologists and cardiac surgeons. CONCLUSION: The overall presence of Heart Teams prior to their recommendation in national guidelines was limited. Even among hospitals with a potential Heart Team, there was substantial disagreement between respondents about their presence. Further refinement of the definition of a Heart Team and measures of successful implementation are needed. AD - Massachusetts General Hospital, Edward P. Lawrence Center for Quality and Safety, Boston, MA, United States of America. University of Michigan Health System, Division of Cardiovascular Medicine, Ann Arbor, MI, United States of America, Blue Cross Blue Shield of Michigan Cardiovascular Consortium, Ann Arbor, MI, United States of America, University of Michigan Health System, Ann Arbor, MI, United States of America. Blue Cross Blue Shield of Michigan Cardiovascular Consortium, Ann Arbor, MI, United States of America. University of Michigan Health System,Department of Cardiac Surgery, Ann Arbor, MI, United States of America, Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, MI, United States of America. University of Michigan Health System, Division of Cardiovascular Medicine, Ann Arbor, MI, United States of America, Ann Arbor VA Center for Clinical Management and Research, Ann Arbor, MI, United States of America. AN - 25415332 AU - Bruckel, J. T. AU - Gurm, H. S. AU - Seth, M. AU - Prager, R. L. AU - Jensen, A. AU - Nallamothu, B. K. C2 - Pmc4240646 DO - 10.1371/journal.pone.0113241 DP - NLM ET - 2014/11/22 J2 - PloS one KW - Analysis of Variance Blue Cross Blue Shield Insurance Plans Coronary Disease/*surgery Data Collection/methods/statistics & numerical data *Decision Making Hospitals/statistics & numerical data Humans Michigan *Patient Care Team Percutaneous Coronary Intervention/*methods Physicians/statistics & numerical data Practice Guidelines as Topic Surveys and Questionnaires Thoracic Surgery/organization & administration/statistics & numerical data LA - eng M1 - 11 N1 - 1932-6203 Bruckel, Jeffrey T Gurm, Hitinder S Seth, Milan Prager, Richard L Jensen, Andrea Nallamothu, Brahmajee K Journal Article Research Support, Non-U.S. Gov't PLoS One. 2014 Nov 21;9(11):e113241. doi: 10.1371/journal.pone.0113241. eCollection 2014. PY - 2014 SN - 1932-6203 SP - e113241 ST - Use of a heart team in decision-making for patients with complex coronary disease at hospitals in Michigan prior to guideline endorsement T2 - PLoS One TI - Use of a heart team in decision-making for patients with complex coronary disease at hospitals in Michigan prior to guideline endorsement VL - 9 ID - 760343 ER - TY - JOUR AB - OBJECTIVES: Heart transplantation (HTx) is still one of the most effective therapies for end-stage heart disease for patients with no other medical or surgical therapy. We report the results of our 25-year orthotropic HTx single-centre experience. METHODS: From November 1985, 905 orthotopic heart transplants have been performed at our centre. We exclude from the present analysis 13 patients who underwent re-transplantation and 14 pediatric cases (age at HTx <15 years). RESULTS: The present study collected the data of 878 primary adult orthotopic HTx performed at our centre. Mean age at HTx was of 49.6 ± 11.6 years. Mean donor age was 36.9 ± 14.8 years. Hospital mortality was 11.6% (102 patients), early graft failure was the principal cause of death (58 patients) followed by infections (18 cases) and acute rejection (7 patients). Overall actuarial survival was 78.1% at 5 years and 63.8% and 47.5%, respectively, at 10 and 15 years from HTx. Mean survival was 10.74 years; 257 late deaths were reported (33.1%); main causes were neoplasm in 83 patients, and cardiac causes included coronary allograft vasculopathy in 78 patients. Freedom from any infection at 5, 10 and 15 years was 52.2, 44.1 and 40.1%, respectively. Freedom from rejection at 5 years was 36.2%, with 493 patients experiencing at last one episode of rejection, the majority occurring during the first 2 months after transplantation. The long-term survival of HTx recipients is limited in large part by the development of coronary artery vasculopathy and malignancies. In our experience freedom from coronary allograft vasculopathy at 10 years was 66.9%, and 85 patients underwent percutaneous coronary revascularization. In our study population, 44 patients experienced posttransplant lymphoproliferative disorder and 91 patients experienced a solid neoplasm, mean survival free from neoplasm was 12.23 years. CONCLUSION: Over the past four decades the field of HTx has evolved considerably, with improvements in surgical techniques and postoperative patients' care. A careful patient selection and treatment of candidates for transplantation as well as accurate clinical follow-up combined with real multidisciplinary teamwork that involved different heart failure specialists, allowed us to obtain our excellent long-term results. AD - Cardiology and Cardiac Surgery Department bCardiothoracic Anesthesia and Intensive-care, Niguarda Ca' Granda Hospital, Milan, Italy. giuseppe.bruschi@fastwebnet.it AN - 23340045 AU - Bruschi, G. AU - Colombo, T. AU - Oliva, F. AU - Botta, L. AU - Morici, N. AU - Cannata, A. AU - Vittori, C. AU - Turazza, F. AU - Garascia, A. AU - Pedrazzini, G. AU - Frigerio, M. AU - Martinelli, L. DA - Sep DO - 10.2459/JCM.0b013e32835dbd74 DP - NLM ET - 2013/01/24 J2 - Journal of cardiovascular medicine (Hagerstown, Md.) KW - Adolescent Adult Age Distribution Age Factors Aged Blood Transfusion/statistics & numerical data Cardio-Renal Syndrome/epidemiology Cause of Death Child Coronary Artery Disease/mortality Female Graft Rejection/epidemiology Graft Survival Heart Transplantation/*statistics & numerical data Hospital Mortality Humans Immunosuppressive Agents/therapeutic use Infections/epidemiology Italy/epidemiology Kaplan-Meier Estimate Length of Stay/statistics & numerical data Lymphoproliferative Disorders/mortality Male Middle Aged Multivariate Analysis Neoplasms/mortality Operative Time Percutaneous Coronary Intervention/statistics & numerical data Reoperation/statistics & numerical data Respiration, Artificial/statistics & numerical data Sex Distribution Survival Analysis Young Adult LA - eng M1 - 9 N1 - 1558-2035 Bruschi, Giuseppe Colombo, Tiziano Oliva, Fabrizio Botta, Luca Morici, Nuccia Cannata, Aldo Vittori, Claudia Turazza, Fabio Garascia, Andrea Pedrazzini, Giovanna Frigerio, Maria Martinelli, Luigi Journal Article United States J Cardiovasc Med (Hagerstown). 2013 Sep;14(9):637-47. doi: 10.2459/JCM.0b013e32835dbd74. PY - 2013 SN - 1558-2027 SP - 637-47 ST - Heart transplantation: 25 years' single-centre experience T2 - J Cardiovasc Med (Hagerstown) TI - Heart transplantation: 25 years' single-centre experience VL - 14 ID - 760341 ER - TY - JOUR AB - PURPOSE: To improve the quality of care for STEMI patients in a low volume rural Nova Scotian emergency department (ED). A multidisciplinary team was formed to examine and investigate process delays related to achieving door to ECG and door to thrombolytic benchmarks.BACKGROUND: Historically, rural, low volume EDs have difficulty in achieving STEMI benchmarks of a door to ECG time [10 minutes] and a door to thrombolytic time [30mins]. Delays in reperfusion result in increased morbidity and mortality. Evidence exists that demonstrate positive improvements in STEMI benchmarks post intervention, however, there is still a lack of team process descriptions concerning identification and development of fundamental process change needed to remediate the gaps in attaining STEMI benchmarks. PROGRAM DESCRIPTION: Using the Collaborative Care Model adopted by the Nova Scotia Health Authority, a multidisciplinary team approach was adopted to examine and investigate care-related process delays. The approach used included: A retrospective STEMI patient chart review (n=6), group brainstorming sessions with strategic partners, knowledge dissemination of related literature review, and generation of recommendations to the employer to improve processes. CONCLUSIONS: The potential for treatment delays were attributed to Infrastructure deficits/restrictions related to technology, communication barriers, limitations in physical ED space and staff knowledge gaps. SIGNIFICANCE/IMPLICATIONS FOR PRACTICE: Our collaborative multidisciplinary approach provides a valuable template for other rural EDs sites to investigate process delays and develop interventions for process improvement. Adoption of a collaborative multidisciplinary approach to investigating process delays may assist other similar rural EDs to achieve targeted provincial STEMI benchmarks. AD - A. Buckle, Nova Scotia Health Authority, Lunenburg, NS, Canada AU - Buckle, A. AU - Lewis-Demone, D. AU - Atkinson, S. AU - Griffiths, B. AU - Jenkins, J. AU - O'Keefe-McCarthy, S. DB - Embase KW - adoption adult brainstorming clinical article communication barrier conference abstract controlled study electrocardiogram emergency ward employer female human male medical record review morbidity mortality Nova Scotia reperfusion retrospective study ST segment elevation myocardial infarction therapy delay LA - English M1 - 10 M3 - Conference Abstract N1 - L622993229 2018-07-17 PY - 2017 SN - 0828-282X SP - S227 ST - Investigation of provincial stemi benchmarks in a rural Nova Scotia emergency department: A collaborative multidisciplinary approach T2 - Canadian Journal of Cardiology TI - Investigation of provincial stemi benchmarks in a rural Nova Scotia emergency department: A collaborative multidisciplinary approach UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622993229&from=export VL - 33 ID - 760909 ER - TY - JOUR AB - Introduction - Decision to intervene once an AAA has reached the threshold size for repair relies on a careful balancing of risks and benefits. Advances in endovascular treatment have made it possible to intervene in patients that were previously considered unfit for open surgery. Despite this, there will always be patients in whom the survival benefit will not prevail the risks of AAA repair. Our study aims to determine the outcome of AAA patients turned down for non-emergency open and endovascular (including fenestrated or parallel stent graft) treatment as well as the factors involved in the decision-making process. Methods - All patients deemed unfit for open/endovascular AAA repair following multidisciplinary team (MDT) discussion at a tertiary referral hospital from 1st of January to 31st of December 2015 were included. Data was retrospectively analysed from the MDT database and the follow-up period extended until the 1st of June 2017. Reasons for not intervening were recorded using both MDT discussion outcomes and pre-operative assessments. AAAs were stratified according to size at the time of MDT discussion. Cause of death was accepted as “ruptured AAA’’ in those proven on CT scan. Survival was calculated from the date of the MDT discussion and the end point was either death or the close of the study. Results - 118 patients met the study inclusion criteria. 89 (75%) were men and the median age was 77 years. Median survival was 29 months. 77 (65%) patients were dead at the end of the study. Median survival according to AAA sizes were: 36 months (5.5-5.9 cm), 26 months (6.0-6.9 cm). 23 months (7.0-7.9 cm), 8 months (≥ 8.0 cm) (p<0.05, Log Rank test). 16 (14%) patients died of rupture - one patient had open surgery and another one underwent endovascular treatment but unfortunately both died. Cardiopulmonary exercise test (CPEX) was performed in 52% of cases and considered inappropriate in frail patients. Mortality rates were comparable in patients who had (65%) and had not (64%) undergone CPEX (p = 0.94, Chi square test) with a median survival 32 vs 28 months respectively (p = 0.001, Mann-Whitney U test). Median survival was similar for anaerobic threshold: 5-7.9 (32 months) and 8-11(31 months) (p = 0.42 Mann-Whitney U test). The reasons for not intervening included: patient choice (19%), cardiovascular, (67%) respiratory (48%), dementia (14%), malignancy (19%), renal failure (36%), poor CPEX (15%), frailty/not suitable for endovascular intervention (66%). Conclusion - It is reasonable to turn down patients based on their fitness, since they appeared to have a correlated poor life expectancy. 86% of patients turned down for non-emergency AAA repair died of unrelated illness within 2.5 years. 14% of patients during the study period had a documented AAA rupture. None of the patients who underwent emergency repair survived. AD - A.-M. Budacan, Vascular Surgery, James Cook University Hospital, Middlesbrough, United Kingdom AU - Budacan, A. M. AU - Tan, G. AU - Cheeseman, M. AU - Mofidi, R. AU - Wong, P. DB - Embase DO - 10.1016/j.ejvs.2019.06.898 KW - abdominal aortic aneurysm aged anaerobic threshold aneurysm size cancer patient cancer survival cardiopulmonary exercise test cause of death conference abstract controlled study decision making dementia endovascular aneurysm repair female follow up frailty human kidney failure life expectancy log rank test major clinical study male malignant neoplasm median survival time mortality rate multidisciplinary team open surgery preoperative evaluation rank sum test retrospective study stent graft surgery tertiary care center x-ray computed tomography LA - English M1 - 6 M3 - Conference Abstract N1 - L2004128529 2019-12-13 PY - 2019 SN - 1532-2165 1078-5884 SP - e292-e293 ST - Patients Turned Down for Non-Emergency Abdominal Aortic Aneurysm (AAA) Surgery: Are We Doing The Right Thing? Factors that Influence Decision Making and the Long-term outcome – A Single Centre Experience T2 - European Journal of Vascular and Endovascular Surgery TI - Patients Turned Down for Non-Emergency Abdominal Aortic Aneurysm (AAA) Surgery: Are We Doing The Right Thing? Factors that Influence Decision Making and the Long-term outcome – A Single Centre Experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004128529&from=export http://dx.doi.org/10.1016/j.ejvs.2019.06.898 VL - 58 ID - 760647 ER - TY - JOUR AB - BACKGROUND: The 10-year overall survival with adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after resection of colorectal liver metastases (CRLMs) was 61% in clinical trials from Memorial Sloan Kettering Cancer Center. A pilot study was performed to evaluate the safety and feasibility of adjuvant HAIP chemotherapy in patients with resectable CRLMs. STUDY DESIGN: A phase II study was performed in two centers in The Netherlands. Patients with resectable CRLM without extrahepatic disease were eligible. All patients underwent complete resection and/or ablation of CRLMs and pump implantation. Safety was determined by the 90-day HAIP-related postoperative complications from the day of pump placement (Clavien-Dindo classification, grade III or higher) and feasibility by the successful administration of the first cycle of HAIP chemotherapy. RESULTS: A total of 20 patients, with a median age of 57 years (interquartile range [IQR] 51-64) were included. Grade III or higher HAIP-related postoperative complications were found in two patients (10%), both of whom had a reoperation (without laparotomy) to replace a pump with a slow flow rate or to reposition a flipped pump. No arterial bleeding, arterial dissection, arterial thrombosis, extrahepatic perfusion, pump pocket hematoma, or pump pocket infections were found within 90 days after surgery. After a median of 43 days (IQR 29-52) following surgery, all patients received the first dose of HAIP chemotherapy, which was completed uneventfully in all patients. CONCLUSION: Pump implantation is safe, and administration of HAIP chemotherapy is feasible, in patients with resectable CRLMs, after training of a dedicated multidisciplinary team. AD - Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands. Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands. Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Department of Radiology and Nuclear Medicine, Erasmus MC, Erasmus University, Rotterdam, The Netherlands. Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Department of Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Department of Surgery, Erasmus MC Cancer Institute, Erasmus University, Rotterdam, The Netherlands. b.grootkoerkamp@erasmusmc.nl. AN - 31641947 AU - Buisman, F. E. AU - Grünhagen, D. J. AU - Homs, M. Y. V. AU - Grootscholten, C. AU - Filipe, W. F. AU - Kemeny, N. E. AU - Cercek, A. AU - D'Angelica, M. I. AU - Donswijk, M. L. AU - van Doorn, L. AU - Emmering, J. AU - Jarnagin, W. R. AU - Kingham, T. P. AU - Klompenhouwer, E. G. AU - Kok, N. F. M. AU - Kuiper, M. C. AU - Moelker, A. AU - Prevoo, W. AU - Versleijen, M. W. J. AU - Verhoef, C. AU - Kuhlmann, K. F. D. AU - Groot Koerkamp, B. C2 - PMC6863781 Wills F. Filipe, Nancy E. Kemeny, Andrea Cercek, Micheal I. D’Angelica, Maarten L. Donswijk, Leni van Doorn, Jasper Emmering, William R. Jarnagin, T. Peter Kingham, Elisabeth G. Klompenhouwer, Niels F. M. Kok, Maria C. Kuiper, Adriaan Moelker, Warner Prevoo, Michelle W. J. Versleijen, Cornelis Verhoef, Koert F. D. Kuhlmann, and Bas Groot Koerkamp have no conflicts of interest to declare. DA - Dec DO - 10.1245/s10434-019-07973-w DP - NLM ET - 2019/10/24 J2 - Annals of surgical oncology KW - Adult Aged Antineoplastic Combined Chemotherapy Protocols/*therapeutic use Chemotherapy, Adjuvant/*mortality Colorectal Neoplasms/*drug therapy/pathology/surgery Combined Modality Therapy Feasibility Studies Female Follow-Up Studies Hepatectomy/*mortality *Hepatic Artery Humans *Infusion Pumps, Implantable Infusions, Intra-Arterial Liver Neoplasms/*drug therapy/secondary/surgery Male Middle Aged Netherlands Pilot Projects Prognosis Survival Rate LA - eng M1 - 13 N1 - 1534-4681 Buisman, Florian E Grünhagen, Dirk J Homs, Marjolein Y V Grootscholten, Cecile Filipe, Wills F Kemeny, Nancy E Cercek, Andrea D'Angelica, Micheal I Donswijk, Maarten L van Doorn, Leni Emmering, Jasper Jarnagin, William R Kingham, T Peter Klompenhouwer, Elisabeth G Kok, Niels F M Kuiper, Maria C Moelker, Adriaan Prevoo, Warner Versleijen, Michelle W J Verhoef, Cornelis Kuhlmann, Koert F D Groot Koerkamp, Bas P30 CA008748/CA/NCI NIH HHS/United States Erasmus MC Fellowship/Erasmus MC Foundation/ In kind contribution of materials/Tricumed GmbH/ Mrace Efficiency/Erasmus Medisch Centrum/ Clinical Trial, Phase II Journal Article Multicenter Study Ann Surg Oncol. 2019 Dec;26(13):4599-4607. doi: 10.1245/s10434-019-07973-w. Epub 2019 Oct 22. PY - 2019 SN - 1068-9265 (Print) 1068-9265 SP - 4599-4607 ST - Adjuvant Hepatic Arterial Infusion Pump Chemotherapy After Resection of Colorectal Liver Metastases: Results of a Safety and Feasibility Study in The Netherlands T2 - Ann Surg Oncol TI - Adjuvant Hepatic Arterial Infusion Pump Chemotherapy After Resection of Colorectal Liver Metastases: Results of a Safety and Feasibility Study in The Netherlands VL - 26 ID - 760160 ER - TY - JOUR AB - One of the most common venous access devices used in patients with cancer is the implanted venous access port. Although incidences of infection and thrombosis are the most commonly reported complications, erosion rates of venous access ports are estimated at almost 1%. This article describes how evidence-based interdisciplinary interventions decreased port erosions for a regional health center from 3.2% to less than 1%. AD - Medicine Care Center, St. Cloud Hospital in Minnesota. Coborn Cancer Center, St. Cloud Hospital in Minnesota. AN - 25095292 AU - Burris, J. AU - Weis, M. DA - Aug DO - 10.1188/14.cjon.403-405 DP - NLM ET - 2014/08/06 J2 - Clinical journal of oncology nursing KW - Adult Antineoplastic Agents/administration & dosage Bandages Catheters, Indwelling/*adverse effects Equipment Design Humans Patient Care Team Retrospective Studies Skin/*injuries Wounds and Injuries/*prevention & control implanted venous access ports port erosions power port LA - eng M1 - 4 N1 - 1538-067x Burris, Jennifer Weis, Mary Journal Article United States Clin J Oncol Nurs. 2014 Aug;18(4):403-5. doi: 10.1188/14.CJON.403-405. PY - 2014 SN - 1092-1095 SP - 403-5 ST - Reduction of erosion risk in adult patients with implanted venous access ports T2 - Clin J Oncol Nurs TI - Reduction of erosion risk in adult patients with implanted venous access ports VL - 18 ID - 760521 ER - TY - JOUR AB - Introduction: Intestinal failure (IF) requires a multidisciplinary approach to ensure better results, mainly, intestinal rehabilitation (IR). We hypothesize that patients referred early have better outcomes than those who come late. Aim: To compare the outcome of pediatric patients with IF referred early versus late to a multidisciplinary IR and Transplantation Program (IRTP). Material and Methods: Retrospective, descriptive analysis of medical records of pediatric patients with parenteral nutrition (PN) dependency greater than 3 months, who were referred to a multidisciplinary IRTP. Evaluated variables were: percentage of IR, PN complications, need for Intestinal transplantation (IT) and mortality. IF associated liver disease (IFALD) was defined as persistent elevation of liver function tests, 1.5 times above normal reference range. Main venous thrombosis were stratified according to Miami classification (1: no thrombosis, 2: one thrombosis, 3: 2 or more, 4: all thrombosed). Patients with history of more than 2 catheter related bloodstream infections (CRBI) per year were considered. Statistical analysis was performed with chi-square test. Results: Between 2008 and 2016, 106 patients with IF were evaluated. 12 patients with less than 6 months of follow-up were excluded, the rest (94) were divided according to time of disease at the moment of first consultation. Group 1 (G1) included patients referred within 6 months of IF diagnosis (53/94) with a median age 0.25 y (0-14y) and group 2 (G2) patients who were first evaluated after 6 months from IF diagnosis (41/94) with a median age 2.5 y (0.6-14y). IR was accomplished in 31/53 (58%) from G1 versus 15/41 (36.5%) from G2 (p= 0.035). IFALD didn't show statistical significance during follow-up according to referral time: G1 24/53 (45%) versus 20/41 (49%) in G2 (p = 0.73). Advanced liver disease was present in 1/24 from G1 and 3/20 in G2. Miami 1-2 was described in 38/53 (72%) in G1 versus 20/41 (49%) in G2 and Miami 3-4 was described in G1: 15/53 (28%) versus 21/41 (51%) in G2 (p= 0.023). Two or more episodes of CRBI were present in 22/53 (41.5%) from G1 and in 27/41 (66%) from G2 (p= 0.019). Transplantation was performed in 6/94 (6%), 3 in G1 and 3 in G2 and 7/94 are still on the waiting list, 3 in G1 and 4 in G2. Mortality in G1 was 6/53 (11%) and 12/41 (29%) in G2 (p =0.028). Conclusion: To improve IR chances, survival and decrease PN complications in pediatric patients with IF, early referral to a multidisciplinary IRTP is mandatory. Working on prevention of PN complications is also essential to have better results and to avoid the need for transplantation. AD - V.B. Busoni, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina AU - Busoni, V. B. AU - Lobos, P. A. AU - Ussher, F. AU - Izquierdo, C. AU - Frangi, F. AU - Claria, R. S. AU - D'Agostino, D. AU - Orsi, M. DB - Embase DO - 10.1097/01.mpg.0000503536.79797.66 KW - adolescent adverse device effect catheter infection chi square test child classification complication controlled study diagnosis doctor patient relationship follow up hospital admission human human tissue intestinal failure intestine liver disease liver function test major clinical study medical record mortality parenteral nutrition patient referral rehabilitation rest statistical significance survival transplantation vein thrombosis LA - English M3 - Conference Abstract N1 - L612891221 2016-11-10 PY - 2016 SN - 1536-4801 SP - S119 ST - Improved outcome of pediatric intestinal failure with early referral to a multidisciplinary team T2 - Journal of Pediatric Gastroenterology and Nutrition TI - Improved outcome of pediatric intestinal failure with early referral to a multidisciplinary team UR - https://www.embase.com/search/results?subaction=viewrecord&id=L612891221&from=export http://dx.doi.org/10.1097/01.mpg.0000503536.79797.66 VL - 63 ID - 760995 ER - TY - JOUR AB - Background HELLP syndrome accounts for 0.2-0.6% of all pregnancies. It is characterised by haemolysis, raised liver enzymes, and low platelet count, which could lead to high maternal morbidity and mortality. Thrombotic thrombocytopenic purpura (TTP) is an another acute life-threatening disorder associated with thrombocytopenia, MAHA (micro angiopathic haemolytic anaemia) and symptoms related to microvascular thrombosis. It accounts for 5-10% are females. In some cases, HELLP syndrome may evolve into TTP. Case Presentation We are presenting a case report of 37-year-old G3P1+1 who has a past history of second-trimester miscarriage at 22 weeks due to oligohydramnios and pre-eclampsia followed by an intrauterine fetal death at 26 weeks with severe Pre-eclampsia. She was on low-dose aspirin in this pregnancy. Her blood pressure and urine analysis has been normal until 36 weeks with normal growth ultrasounds. She was admitted at 36 weeks with significantly raised blood pressure of 170/110 and two plus proteinuria, low platelet count of 56 and raised ALT, and uric acid. A diagnosis of HELLP syndrome was made. Haematologist was involved. She was stabilized on MGS04 and labetalol infusion and induction was started. She had vaginal delivery 3 hours of admission. Her platelet count dropped further to 20, and haematologist decided for plasma exchange, which showed good response in platelet count from 18 to 237. Conclusion We describe a case report with HELLP syndrome and superimposed TTP, which is rare. It requires multidisciplinary team effort and timely management. AD - A. Butt, Sulaiman AlHabib Hospital, Riyadh, Saudi Arabia AU - Butt, A. AU - Aziz, R. DB - Embase DO - 10.1111/1471-0528.15633 KW - acetylsalicylic acid labetalol uric acid adult blood pressure case report clinical article conference abstract diagnosis female fetus death HELLP syndrome hematologist human human cell infusion low drug dose male multidisciplinary team oligohydramnios plasma exchange preeclampsia proteinuria second trimester pregnancy spontaneous abortion thrombosis thrombotic thrombocytopenic purpura ultrasound urinalysis vaginal delivery LA - English M3 - Conference Abstract N1 - L627142745 2019-04-16 PY - 2019 SN - 1471-0528 SP - 59 ST - A rare case of HELLP (Heamolysis, elevated liver enzymes and low platelets) syndrome with superimposed TTP (Thrombotic thrombocytopenia Purpra) at 35 weeks of pregnancy T2 - BJOG: An International Journal of Obstetrics and Gynaecology TI - A rare case of HELLP (Heamolysis, elevated liver enzymes and low platelets) syndrome with superimposed TTP (Thrombotic thrombocytopenia Purpra) at 35 weeks of pregnancy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627142745&from=export http://dx.doi.org/10.1111/1471-0528.15633 VL - 126 ID - 760742 ER - TY - JOUR AB - BACKGROUND: Maternal mortality is an important health indicator for the overall health of a population. This study assessed the causes and contributing factors to maternal mortality that occurred in the Gaza-Strip between July 2014 and June 2015. METHODS: This is a retrospective study that used both quantitative and qualitative data. The data were collected from available medical records, investigation reports, death certificates, and field interviews with healthcare professionals as well as families. RESULTS: A total of 18 maternal mortalities occurred in Gaza between 1st July 2014 and June 30th 2015. Age at time of death ranged from 18 to 44 years, with 44.4% occurring before the age of 35 years. About 22.2% were primiparous, while 55.6% were grand multiparous women. The most common causes of death were sepsis, postpartum haemorrhage, and pulmonary embolism. The most striking deficiency was very poor medical documentation which was observed in 17 cases (94%). In addition, poor communication between doctors and women and their families or among healthcare teams was noticed in nine cases (50%). These were repeatedly described by families during interviews. Further aspects surfacing in many interviews were distrust by families towards clinicians and poor understanding of health conditions by women. Other factors included socioeconomic conditions, poor antenatal attendance and the impact of the 2014 war. Low morale among medical staff was expressed by most interviewed clinicians, as well as the fear of being blamed by families and management in case of adverse events. Substandard care and lack of appropriate supervision were also found in some cases. CONCLUSIONS: This study revealed deficiencies in maternity care, some of which were linked to the socioeconomic situation and the 2014 war. Others show poor implementation of clinical guidelines and lack of professional skills in communication and teamwork. Specialised training should be offered for clinicians in order to improve these aspects. However, the most striking deficiency was the extremely poor documentation, reflecting a lack of awareness among clinicians regarding its importance. Local policymakers should focus on systematic application of quality improvement strategies in order to achieve greater patient safety and further reductions in the maternal mortality rate. AD - Faculty of Medicine, Islamic University of Gaza, P. O. Box 108, Gaza strip, Gaza, Palestine. Bettina.bottcher@yahoo.co.uk. Faculty of Nursing, Islamic University of Gaza, P. O. Box 108, Gaza Strip, Gaza, Palestine. Faculty of Medicine, Islamic University of Gaza, P. O. Box 108, Gaza strip, Gaza, Palestine. AN - 30305058 AU - Bӧttcher, B. AU - Abu-El-Noor, N. AU - Aldabbour, B. AU - Naim, F. N. AU - Aljeesh, Y. C2 - Pmc6180491 DA - Oct 11 DO - 10.1186/s12884-018-2037-1 DP - NLM ET - 2018/10/12 J2 - BMC pregnancy and childbirth KW - Adolescent Adult Armed Conflicts Communication Documentation/standards Female Humans Maternal Mortality Medical Audit Medical Staff, Hospital/organization & administration/psychology Middle East Morale Patient Care Team/organization & administration Postpartum Hemorrhage/*mortality Pregnancy Prenatal Care Professional-Family Relations Pulmonary Embolism/*mortality *Quality of Health Care Retrospective Studies Sepsis/*mortality Socioeconomic Factors Young Adult Clinical audit Gaza-strip Medical documentation Palestine Patient safety Quality improvement exists at the Palestinian Ministry of Health (MoH) in the Gaza-Strip, which retains jurisdiction over providing approvals for access to medical records and medical databases owned by each individual hospital. The authorized body to provide approvals for studies that involve secondary health data as well as collection and analysis of primary data from both healthcare providers and patients is provided by the Human Resources Department at the MoH in the Gaza-Strip. Therefore, ethical approval for this study was obtained from the Human Resources Department at the MoH in the Gaza-Strip, which issues ethical and administrative approvals for studies involving patients and their families. The approvals were then presented to the administrative bodies of the local hospitals in the Gaza-Strip, which in turn gave their approval and provided the research team with access to medical records housed by the individual hospitals and the available contact information for the families of deceased women who were identified to be part of the potential sample for this study. The procedure, followed in Gaza at the time of this study, did not require approval by relatives to view the medical documentation of the deceased women. The hospitals included in this study were Al-Shifa Hospital in Gaza-City, Shuhada Al-Aqsa Hospital in Deir Al-Balah, Nasser Hopsital in Khan Younis, Al-Helal Al-Emirati Hospital in Rafah and Al-Awda Hospital in Jabalia Refugee Camp, which was the only private hospital. All approvals for this study had been obtained prior to data collection. In addition, and before conducting the interviews with family members or healthcare providers, written consent was obtained from those who were interviewed in person, whereas verbal consent was obtained from participants who were interviewed over the phone due to family preference. This had been agreed to by the Human Resources Department of the MoH. Prior to obtaining consent, the aims of the study were explained to the participants, and they were informed that they had the right to refuse participation in the study, or to withdraw at any time without being penalized. The collected data were kept under high confidentiality and anonymity as each case was assigned a code number. The women’s confidentiality was preserved throughout the study. It was explained to participants that the data collected might be published after having been analysed at the aggregate level. CONSENT FOR PUBLICATION: All patients’ data were kept strictly confidential and anonymity was preserved throughout the research process. Consent for publication was obtained from the interviewees and the Human Resources Department at the Ministry of Health. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. LA - eng M1 - 1 N1 - 1471-2393 Bӧttcher, Bettina Orcid: 0000-0001-7457-7265 Abu-El-Noor, Nasser Aldabbour, Belal Naim, Fadel Naim Aljeesh, Yousef Limited funding was received only for transport costs/UNDP/ Journal Article BMC Pregnancy Childbirth. 2018 Oct 11;18(1):396. doi: 10.1186/s12884-018-2037-1. PY - 2018 SN - 1471-2393 SP - 396 ST - Maternal mortality in the Gaza strip: a look at causes and solutions T2 - BMC Pregnancy Childbirth TI - Maternal mortality in the Gaza strip: a look at causes and solutions VL - 18 ID - 760173 ER - TY - JOUR AB - Background. Sickle cell disease (SCD) encompasses inherited anemias due to beta globin mutations that result in the formation of sickled red cells and increased red cell turnover. The complications of SCD are both acute and chronic, and this combination results in significant morbidity, high healthcare utilization over the lifespan, and increased premature death. Whereas many avenues have been explored to manage complications of SCD as they arise, renewed attention has been focused on pregnancy management because during pregnancy the risk for preeclampsia and deep venous thrombosis is increased and occlusion of placenta blood vessels with rigid deformed erythrocytes can cause repeated miscarriages and intra-uterine fetal death. Blood exchange transfusion can prevent these complications by reducing the concentration of abnormal hemoglobin S. Aims. To describe perinatal and maternal outcomes for pregnant women with sickle cell disease (SCD) receiving prophylactic blood exchange transfusions. Methods. This was a retrospective cohort study, covering the period from January 2001 to December 2011, which included all pregnant women with SCD followed up at our institution inSicily. We managed 12 pregnancies in 10 patients (7 SS, 3 S/b-thalassemia) that were in care because of a history of severe sickling complications. 3 Patients had a history of one or more pregnancies with severe maternofetal complications when treated in other institutions without receiving prophylactic blood exchange transfusion. In our institution all the patients received manually or automated Red cell exchange using a Spectra-Cobe blood cell separator when the haemoglobin S (HbS) was more than >50% and the aim was to achieve a proportion of HbS below 30% and a hemoglobin level between 9 and 11 g/dL. The maternal and perinatal outcomes were compared to those of the same pregnant women when treated in other institutions not receiving prophylactic blood exchange transfusion. Results. We performed 40 automated and 24 manually red cell exchange. No serious maternal complication was observed, no fetal or perinatal death occurred and no low birth weight. Summary and Conclusions. Our study suggests that women with severe sickle cell disease, even if they have a serious obstetrical history, can carry their pregnancy to term, without major obstetric complications, through a combination of early management (first trimester) by a multidisciplinary team and a suitable policy of prophylactic manually or automated red cell exchange transfusion. AD - S. Cabibbo, Uos Ematologia Asp 7, Ragusa, Italy AU - Cabibbo, S. AU - Fidone, C. AU - Spadola, V. AU - Bonomo, P. DB - Embase KW - hemoglobin beta chain hemoglobin variant hemoglobin S female sickle cell anemia patient fetus outcome human exchange blood transfusion European hematology pregnancy erythrocyte pregnant woman mutation deep vein thrombosis preeclampsia death anemia cohort analysis risk thalassemia blood cell lifespan health care utilization uterus morbidity spontaneous abortion blood vessel fetus death placenta occlusion low birth weight hemoglobin blood level perinatal death first trimester pregnancy policy turnover rate L1 - http://www.haematologica.org/content/haematol/97/supplement_1/haematol_97_s1.full.pdf LA - English M3 - Conference Abstract N1 - L71725446 2015-02-02 PY - 2012 SN - 0390-6078 SP - 737 ST - Pregnancy in sickle cell disease: Maternal and fetal outcomes in our patients receiving prophylactic blood exchange transfusions T2 - Haematologica TI - Pregnancy in sickle cell disease: Maternal and fetal outcomes in our patients receiving prophylactic blood exchange transfusions UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71725446&from=export VL - 97 ID - 761201 ER - TY - JOUR AB - Background: Establishing a stroke unit (SU) in every hospital may be infeasible because of limited resources. In Australia, it is recommended that hospitals that admit >= 100 strokes per year should have a SU. We aimed to describe differences in processes of care and outcomes among hospitals with and without SUs admitting at least 100 patients/year. Methods: National stroke audit data of 40 consecutive patients per hospital admitted between 1/7/2010-31/12/2010 and organizational survey for annual admissions were used. Descriptive analyses and multilevel regression were used to compare patient outcomes. Sensitivity analysis including only hospitals meeting all of the Australian SU criteria (e.g.,co-location of beds; inter-professional team; weekly meetings; regular training) was performed. Results: Two thousand eight hundred ninety-eight patients from 72/108 eligible hospitals completing the audit (SU = 60; patients: 2,481 [mean age 76 years; 55% male] and non-SU patients: 417 [ mean age 77; 53% male]). Hospitals with SUs had greater adherence to recommended care processes than non-SU hospitals. Patients treated in a SU hospital had fewer new strokes while in hospital (OR: 0.20; 95% CI 0.06, 0.61) and there was a borderline reduction in the odds of dying in hospital compared to patients in non-SU hospitals (OR 0.57 95% CI 0.33, 1.00). Among SU hospitals meeting all SU criteria (n = 59; 91%) the adjusted odds of having a poor outcome was further reduced compared with patients attending non-SU hospitals. Conclusion: Hospitals annually admitting >= 100 patients with acute stroke should be prioritized for establishment of a SU that meet all recommended criteria to ensure better outcomes. AD - [Cadilhac, Dominique A.; Kilkenny, Monique F.; Andrew, Nadine E.] Monash Univ, Sch Clin Sci Monash Hlth, Dept Med, Stroke & Ageing Res, Clayton, Vic 3168, Australia. [Cadilhac, Dominique A.; Kilkenny, Monique F.] Florey Inst Neurosci & Mental Hlth, Stroke Div, Heidelberg, Vic 3081, Australia. [Ritchie, Elizabeth; Hill, Kelvin; Lalor, Erin] Stroke Fdn, Melbourne, Vic 3000, Australia. Cadilhac, DA (corresponding author), Monash Univ, Sch Clin Sci Monash Hlth, Dept Med, Stroke & Ageing Res, Clayton, Vic 3168, Australia.; Cadilhac, DA (corresponding author), Florey Inst Neurosci & Mental Hlth, Stroke Div, Heidelberg, Vic 3081, Australia. dominique.cadilhac@monash.edu AN - WOS:000397164900002 AU - Cadilhac, D. A. AU - Kilkenny, M. F. AU - Andrew, N. E. AU - Ritchie, E. AU - Hill, K. AU - Lalor, E. AU - Stroke Fdn Natl Advisory, Comm AU - Natl Stroke Audit, Collaborative C7 - 212 DA - Mar DO - 10.1186/s12913-017-2150-2 J2 - BMC Health Serv. Res. KW - Audit Stroke Stroke unit Processes of care Thrombolysis ACUTE ISCHEMIC-STROKE CARE VOLUME SERVICES MULTICENTER GUIDELINES OUTCOMES Health Care Sciences & Services LA - English M3 - Article N1 - ISI Document Delivery No.: EP1SP Times Cited: 3 Cited Reference Count: 30 Cadilhac, Dominique A. Kilkenny, Monique F. Andrew, Nadine E. Ritchie, Elizabeth Hill, Kelvin Lalor, Erin National Health and Medical Research CouncilNational Health and Medical Research Council of Australia [1063761]; MFK [1109426, 1072053]; Heart Foundation; NHMRC Early Career FellowshipsNational Health and Medical Research Council of Australia DAC holds a National Health and Medical Research Council (NHMRC) Research Fellowship (1063761; co-funded Heart Foundation), MFK (1109426) and NA (1072053) are supported by NHMRC Early Career Fellowships. 3 0 BMC LONDON BMC HEALTH SERV RES PY - 2017 SP - 9 ST - Hospitals admitting at least 100 patients with stroke a year should have a stroke unit: a case study from Australia T2 - Bmc Health Services Research TI - Hospitals admitting at least 100 patients with stroke a year should have a stroke unit: a case study from Australia UR - ://WOS:000397164900002 VL - 17 ID - 761664 ER - TY - JOUR AB - Introduction: Pregnancy is possible in all stages of Chronic Kidney Disease (CKD), with an estimated prevalence around 3%. There are some important aspects, which should be taken into account during the follow-up of these patients, especially if they reached the end-stage of renal disease (ESRD) and are undergoing dialysis. In the past, according to the literature, peritoneal dialysis could be maintained for ESRD pregnant up to the beginning of the third semester, when the uterine volume would start to make PD uncomfortable to these patients and could compromise dialysis efficacy. However, in some cases, the woman can carry on the pregnancy for more than 36 weeks on PD. A good residual renal function (RRF) allows greater reduction in the fill volume making PD possible until the neonate birth. The study aims to report the case of an ESRD patient which got pregnant after 9 months of PD initiation and had a 39 weeks successful delivery. Methods: Patient's records since the beginning of her follow-up at the service were reviewed and the informations structured in the case report below. Results: Case report: A.R, 37 years old, white, with arterial hypertension since 30 years old, past obstetric history includes 2 prior spontaneous vaginal deliveries and 1 abortion in 2016 when she was admitted to the hospital due to pulmonary sepsis with nephrotic syndrome and renal dysfunction associated. Three months later, a kidney biopsy was performed and Focal Segmental Glomerulosclerosis (FSGS) was diagnosed. Methylprednisolone pulse therapy had no success, with the worsening in kidney function and need of renal replacement therapy (RRT) initiation. Hemodialysis through a central venous catheter was started. The 3 arterial-venous fistulas made, developed thrombosis. Patient was transferred to PD in April/2017, as an urgent start initiation due to vascular access dysfunction. During PD follow-up patient maintained good RRF (mean 1,200mL/day), clinical and laboratorial parameters adequate (Kt/V=2.2). In January 2018 she got pregnant. PD prescription was adjusted according to the patients tolerance and laboratorial parameters along the pregnancy weeks. No complications occurred during the first and second trimester. Towards her last trimester, an antihypertensive drug was initiated for maintenance of optimal blood pressure. She delivered a healthy baby girl (2,800 g) via spontaneous vaginal at 39 weeks. Birth was induced due to the advanced pregnancy time and the risk of worsening of the arterial pressure levels. [Figure presented] Conclusions: Our experience with this patient shows that peritoneal dialysis is a viable RRT option during pregnancy according to the patient’s RRF and promotes a successful pregnancy period with the correct adaptations on PD prescription. Adequate collaboration and support amongst family, nephrologist and gynaecologist doctors, multidisciplinary team and the patient is crucial to ensure treatment quality during this process. AU - Calice-Silva PhD, V. AU - Ferreira, H. AU - Baggio Nerbass, F. DB - Embase DO - 10.1016/j.ekir.2019.05.870 KW - antihypertensive agent methylprednisolone abortion adult arterial pressure blood pressure monitoring case report central venous catheter child chronic kidney failure clinical article complication conference abstract drug therapy end stage renal disease female fistula focal glomerulosclerosis follow up girl gynecologist hemodialysis human infant kidney biopsy kidney dysfunction multidisciplinary team nephrologist nephrotic syndrome newborn peritoneal dialysis prescription second trimester pregnancy sepsis thrombosis vagina vaginal delivery vascular access LA - English M1 - 7 M3 - Conference Abstract N1 - L2002179632 2019-07-02 PY - 2019 SN - 2468-0249 SP - S337 ST - MON-081 PERITONEAL DIALYSIS AND PREGNANCY: A CASE OF SUCCESS T2 - Kidney International Reports TI - MON-081 PERITONEAL DIALYSIS AND PREGNANCY: A CASE OF SUCCESS UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002179632&from=export http://dx.doi.org/10.1016/j.ekir.2019.05.870 VL - 4 ID - 760690 ER - TY - JOUR AB - Background: The major cause of death in the city of Sao Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15% and 20% due to difficulties inherent in large metropoles. Objective: To describe in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) of patients admitted via ambulance or peripheral hospitals, which are part of a structured training network (STEMI Network). Methods: Health care teams of four emergency services (Ermelino Matarazzo, Campo Limpo, Tatuape and Saboya) of the periphery of the city of Sao Paulo and advanced ambulances of the Emergency Mobile Health Care Service (abbreviation in Portuguese, SAMU) were trained to use tenecteplase or to refer for primary angioplasty. A central office for electrocardiogram reading was used. After thrombolysis, the patient was sent to a tertiary reference hospital to undergo cardiac catheterization immediately (in case of failed thrombolysis) or in 6 to 24 hours, if the patient was stable. Quantitative and qualitative variables were assessed by use of uni- and multivariate analysis. Results: From January 2010 to June 2011, 205 consecutive patients used the STEMI Network, and the findings were as follows: 87 anterior wall infarctions; 11 left bundle-branch blocks; 14 complete atrioventricular blocks; and 14 resuscitations after initial cardiorespiratory arrest. In-hospital mortality was 6.8% (14 patients), most of which due to cardiogenic shock, one hemorrhagic cerebrovascular accident, and one bleeding. Conclusion: The organization in the public health care system of a network for the treatment of STEMI, involving diagnosis, reperfusion, immediate transfer, and tertiary reference hospital, resulted in immediate improvement of STEMI outcomes. (Arq Bras Cardiol 2012; 99(5):1040-1048) AD - [Vellozo Caluza, Ana Christina; Barbosa, Adriano H.; Goncalves, Iran; de Oliveira, Carlos Alexandre L.; de Matos, Livia Nascimento; Alves, Claudia Maria R.; Carvalho, Antonio Carlos] Univ Fed Sao Paulo, Escola Paulista Med, Disciplina Cardiol, Sao Paulo, Brazil. [Zeefried, Claus] SAMU, Serv Atendimento Movel Urgencia, Sao Paulo, Brazil. [Moreno, Antonio Celio C.] Secretaria Saude Prefeitura Municipal Sao Paulo, Sao Paulo, Brazil. [Tarkieltaub, Elcio] Hosp Municipal Prof Dr Alipio Correa Netto, Sao Paulo, Brazil. Caluza, ACV (corresponding author), Rua Pedro Toledo 544, BR-04039001 Sao Paulo, Brazil. acvcaluza@cardiol.br AN - WOS:000311520600013 AU - Caluza, A. C. V. AU - Barbosa, A. H. AU - Goncalves, I. AU - de Oliveira, C. A. L. AU - de Matos, L. N. AU - Zeefried, C. AU - Moreno, A. C. C. AU - Tarkieltaub, E. AU - Alves, C. M. R. AU - Carvalho, A. C. DA - Nov DO - 10.1590/s0066-782x2012005000100 J2 - Arq. Bras. Cardiol. KW - Myocardial infarction guidelines emergencies quality of health care PERCUTANEOUS CORONARY INTERVENTION ISCHEMIA-GUIDED MANAGEMENT REPERFUSION THERAPY IMMEDIATE ANGIOPLASTY THROMBOLYSIS FIBRINOLYSIS STRATEGIES GUIDELINES STANDARD REGISTRY Cardiac & Cardiovascular Systems LA - Portuguese M1 - 5 M3 - Article N1 - ISI Document Delivery No.: 043CN Times Cited: 20 Cited Reference Count: 35 Vellozo Caluza, Ana Christina Barbosa, Adriano H. Goncalves, Iran de Oliveira, Carlos Alexandre L. de Matos, Livia Nascimento Zeefried, Claus Moreno, Antonio Celio C. Tarkieltaub, Elcio Alves, Claudia Maria R. Carvalho, Antonio Carlos Matos, Livia/D-1100-2012; Alves, Claudia MC/H-2194-2016 27 1 13 ARQUIVOS BRASILEIROS CARDIOLOGIA RIO DE JANEIRO ARQ BRAS CARDIOL PY - 2012 SN - 0066-782X SP - 1040-1048 ST - ST-Elevation Myocardial Infarction Network: Systematization in 205 Cases Reduced Clinical Events in the Public Health Care System T2 - Arquivos Brasileiros De Cardiologia TI - ST-Elevation Myocardial Infarction Network: Systematization in 205 Cases Reduced Clinical Events in the Public Health Care System UR - ://WOS:000311520600013 VL - 99 ID - 761818 ER - TY - JOUR AB - Objective: To estimate the prognostic value of point-of-care measurement of biomarkers related to dyspnea in patients receiving a medical emergency team (MET) review. Design: Prospective observational study. Setting: University affiliated hospital. Patients: Cohort of 95 patients receiving MET review over a six month period. Methods: We used a commercial multi-biomarker panel for shortness-of-breath (SOB panel) (Biosite Triage Profiler, Biosite Incorporated (R), 9975 Summers Ridge Road, San Diego, CA 92121, USA) including Brain natriuretic peptide (BNP), D-dimer, myoglobin (Myo), creatine kinase MB isoenzyme (CK-MB) and troponin I (Tn-I). We recorded information about demographics, MET review triggers, and MET procedures and patient outcome. Results: Mean age was 70.5 (+/- 15) years, 38 (41%) patients had a history of chronic heart failure (CHF) and 67 (70%) chronic kidney disease (CKD). At MET activation, 42 (44%) patients were dyspneic. The multi-biomarker panel was positive for at least one marker in 48 (51%) cases. BNP and D-dimer had a sensitivity of 0.79 and 0.93 for ICU admission with a negative predictive value (NPV) of 0.89 and 0.92 respectively. Thirty-five (37%) patients died. BNP was positive in 85% of such cases with sensitivity and NPV of 0.86 and 0.82, respectively. D-dimer was positive in 77% of non-survivors with a sensitivity and NPV of 0.94 and 0.88, respectively. BNP (area under the curve of receiver operating characteristic curve -AUC-ROC: 0.638) and D-dimer (AUC-ROC: 0.574) achieved poor discrimination of subsequent death. Similar findings applied to ICU admission. The combination of normal BNP and D-dimer levels completely ruled out ICU admission or death. The cardiac part of the panel was not useful in predicting ICU admission or mortality. Conclusions: Although, BNP and D-dimer are poor discriminants of ICU admission and hospital mortality, normal BNP and D-dimer levels practically exclude subsequent need for ICU admission and hospital mortality. (C) 2012 Elsevier Ireland Ltd. All rights reserved. AD - [Calzavaccaa, P.; Licari, E.; Tee, A.; Bellomo, R.] Austin Hosp, Dept Intens Care, Melbourne, Vic 3084, Australia. [Calzavaccaa, P.; Licari, E.; Tee, A.; Bellomo, R.] Austin Hosp, Dept Med, Melbourne, Vic 3084, Australia. Bellomo, R (corresponding author), Austin Hosp, Dept Med, Studley Rd, Heidelberg, Vic 3084, Australia. rinaldo.bellomo@austin.org.au AN - WOS:000309048600021 AU - Calzavaccaa, P. AU - Licari, E. AU - Tee, A. AU - Bellomo, R. DA - Sep DO - 10.1016/j.resuscitation.2012.02.012 J2 - Resuscitation KW - Medical emergency team Rapid response system Critical illness D dimer Brain natriuretic peptide Myoglobin Creatinine kinase Troponin I Mortality CRITICALLY-ILL PATIENTS DISSEMINATED INTRAVASCULAR COAGULATION INTENSIVE-CARE NATRIURETIC PEPTIDE D-DIMER HEART-FAILURE PULMONARY-DISEASE VENOUS THROMBOEMBOLISM MYOCARDIAL-INFARCTION CONSENSUS CONFERENCE Critical Care Medicine Emergency Medicine LA - English M1 - 9 M3 - Article N1 - ISI Document Delivery No.: 009TR Times Cited: 5 Cited Reference Count: 45 Calzavaccaa, P. Licari, E. Tee, A. Bellomo, R. Calzavacca, Paolo/AAN-1225-2020 Calzavacca, Paolo/0000-0001-8175-3693; Bellomo, Rinaldo/0000-0002-1650-8939 6 0 10 ELSEVIER IRELAND LTD CLARE RESUSCITATION PY - 2012 SN - 0300-9572 SP - 1119-1123 ST - Point-of-care testing during medical emergency team activations: A pilot study T2 - Resuscitation TI - Point-of-care testing during medical emergency team activations: A pilot study UR - ://WOS:000309048600021 VL - 83 ID - 761820 ER - TY - JOUR AB - Introduction Management of massive blood loss requires a multidisciplinary team approach. Current guidelines are varied and generic with a lack of adherence when it comes to management of massive haemorrhage. The aim of our survey was to assess the transfusion practice in the management of massive haemorrhage in a busy district general hospital with a tertiary neurosurgical centre and the busiest obstetric unit in London. Methods A retrospective analysis of cases requiring transfusion of more than 6 units of red blood cells (RBC), between January 2009 and January 2010. Sixty-eight cases of massive transfusion were identified, and data collected included causes of the haemorrhage, patient's demographics and past medical background, investigations (FBC, clotting), use of blood products and patient outcome. Results There were 21 gastrointestinal, 17 vascular, 12 general surgical, seven trauma, six obstetric, and five haematology-oncology patients. Thirty-one per cent of patients were 61 to 80 years old. Overall mortality was 35%, highest mortality among vascular patients. Average blood products per patient: RBC 9 units, fresh frozen plasma (FFP) 4 units, platelets (PLT) 1.2 units, cryoprecipitate 0.67 units. Tranexamic acid was used in eight cases and factor VII in one case. At the time of haemorrhage, FBC, clotting screen and fibrinogen levels were requested in 56% of patients. In this group, FFP, PLTs and cryoprecipitate were used more frequently with mean use of blood products: RBC 9 units, FFP 5 units, PLT 1.5 units, and cryoprecipitate 1 unit. Conclusion Blood product use varied widely irrespective of speciality, the dependent factor being individual doctors involved in patient management. Due to difficulty of accessing and their complexity in emergency situations, it was noted that hospital guidelines were disregarded. FFP was the commonly used blood product while cryoprecipitate and tranexamic acid were underused. Only 56% of patients had FBC and clotting screen to guide transfusion management. In these patients the ratio of cryoprecipitate and PLTs to RBCs was higher. This survey showed the need for revised, easily accessible and user-friendly guidelines for the management of massive haemorrhages. The results of this survey helped to establish pointof- care testing (thromboelastography) to provide a target controlled therapy and make the use of blood and blood products cost-effective. AD - M. Campbell, BHR NHS Trust, London, United Kingdom AU - Campbell, M. AU - Yakandawala, G. AU - Liddle, S. AU - Mehta, K. AU - Chooi, J. DB - Embase DO - 10.1186/cc11052 KW - tranexamic acid blood clotting factor 7 fibrinogen fresh frozen plasma intensive care emergency medicine transfusion human patient blood cryoprecipitate bleeding erythrocyte mortality oncology hematology injury thrombocyte United Kingdom therapy general hospital emergency patient care hospital patient physician hospital thromboelastography LA - English M3 - Conference Abstract N1 - L70735385 2012-05-11 PY - 2012 SN - 1364-8535 SP - S159 ST - Massive transfusion practice T2 - Critical Care TI - Massive transfusion practice UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70735385&from=export http://dx.doi.org/10.1186/cc11052 VL - 16 ID - 761210 ER - TY - JOUR AB - Background: Pulmonary embolism response teams (PERT) rapidly engage multiple specialists in an effort to deliver coordinated and evidence-based care to acute PE patients. We aimed to describe temporal trends in treatment patterns and outcomes since the implementation of a PERT at our medical center. Methods: We performed a longitudinal analysis, by time period (year 1-4), of patients cared for by the PERT at our academic center. Results: From September 2014 to August 2018, our PERT was activated for 300 PE patients. Mean age was 61 years and 56.3% of patients were women. A total of 81 patients (27%) had low-risk PE, 195 (65%) had submassive PE, and 24 (8%) had massive PE. Advanced therapy utilization was similar over time (Poster 17 Figure). Overall rates of 30-day all-cause mortality, recurrent venous thromboembolism, and any bleeding were 8.6%, 3.3%, and 5.7%, respectively. Multivariate analysis showed a similar rate of adverse outcomes including 30-day all-cause death, recurrent VTE, and any bleeding across time. We observed a consistent reduction in all-cause rehospitalization from year 1 to year 4 after controlling for clinical covariates (OR, 0.01; 95% CI, 0.02-0.42). Conclusion: Since implementation of our PERT, we have observed consistent and modest utilization of advanced therapies, low rates of adverse outcomes, and decreased rates of rehospitalization. AD - U. Campia, Brigham and Women's Hospital, Boston, MA, United States AU - Campia, U. AU - Chopard, R. AU - Piazza, G. AU - Goldhaber, S. Z. DB - Embase DO - 10.1177/1358863X19843803 KW - adult adverse outcome all cause mortality bleeding conference abstract female hospital readmission human major clinical study middle aged pulmonary embolism response team LA - English M1 - 3 M3 - Conference Abstract N1 - L628261255 2019-07-01 PY - 2019 SN - 1477-0377 SP - 284 ST - Management and outcomes of pulmonary embolism patients cared for by a multidisci-plinary rapid response team: A trend-based analysis T2 - Vascular Medicine TI - Management and outcomes of pulmonary embolism patients cared for by a multidisci-plinary rapid response team: A trend-based analysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628261255&from=export http://dx.doi.org/10.1177/1358863X19843803 VL - 24 ID - 760703 ER - TY - JOUR AD - [Campia, Umberto; Chopard, Romain; Piazza, Gregory; Goldhaber, Samuel Z.] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA. AN - WOS:000469356500038 AU - Campia, U. AU - Chopard, R. AU - Piazza, G. AU - Goldhaber, S. Z. DA - Jun J2 - Vasc. Med. KW - Peripheral Vascular Disease LA - English M1 - 3 M3 - Meeting Abstract N1 - ISI Document Delivery No.: IA1XT Times Cited: 0 Cited Reference Count: 0 Campia, Umberto Chopard, Romain Piazza, Gregory Goldhaber, Samuel Z. 0 SAGE PUBLICATIONS LTD LONDON VASC MED PY - 2019 SN - 1358-863X SP - 284-284 ST - Management and outcomes of pulmonary embolism patients cared for by a multidisciplinary rapid response team: a trend-based analysis T2 - Vascular Medicine TI - Management and outcomes of pulmonary embolism patients cared for by a multidisciplinary rapid response team: a trend-based analysis UR - ://WOS:000469356500038 VL - 24 ID - 761523 ER - TY - JOUR AB - BACKGROUND: Heart Team (HT) and the SYNTAX Score II (SSII) have been integrated to the contemporary guidelines with the aim to provide a multidisciplinary decision-making process between coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). AIMS: To prospectively assess the agreement between the HT decision and the SSII recommendation regarding the revascularization strategy in patients with 3-vessel coronary artery disease (CAD) of the SYNTAX II trial. METHODS: The SSII predicts the 4-year mortality of an individual patient both after PCI and after CABG. Patients were treated by PCI when the SSII predicted a mortality risk favoring PCI or when risk predictions were equipoise between PCI and CABG. However, the HT could overrule the SSII and recommend either CABG or PCI. RESULTS: A total of 202 patients have been screened and 24 did not fulfill inclusion criteria. The median age was 67.0 (IQR 59.0-73.3), and 167 (82.7%) were male. The HT endorsed SSII treatment recommendation, for CABG or PCI, in 152 patients (85.4%). Three patients had preference for PCI, irrespective of the HT decision. The main reason for the HT to overrule the SSII and recommend CABG was the prospect of a more complete revascularization (21 of 25 patients). Patients recommended for CABG by the HT had significantly higher anatomical SYNTAX score (P = 0.03) and higher predicted mortality risk for PCI (P = 0.04) when compared with patients that were enrolled in the trial. CONCLUSION: The SYNTAX score II showed to be a suitable tool for guiding treatment decisions of patients with 3-vessel coronary artery disease being endorsed by the HT in the vast majority of the patients that have been enrolled in the SYNTAX II trial. AD - Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands. Department of Interventional Cardiology, Heart Institute, Medical School, University of Sao Paulo, Sao Paulo, Brazil. Department of Interventonal Cardiology, University Hospital Clinical Centre Banja Luka, Banja Luka, Bosnia and Herzegovina. Department of Intervenional Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom. Belfast Health & Social Care Trust, Belfast, United Kingdom. Cardiovascular Institute, Hospital Clinico San Carlos and Centro Nacional De Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain. Department of Interventional Cardiology, Oxford University Hospitals, Oxford, United Kingdom. International Centre for Circulatory Health, NHLI, Imperial College London, London, United Kingdom. AN - 25946686 AU - Campos, C. M. AU - Stanetic, B. M. AU - Farooq, V. AU - Walsh, S. AU - Ishibashi, Y. AU - Onuma, Y. AU - Garcia-Garcia, H. M. AU - Escaned, J. AU - Banning, A. AU - Serruys, P. W. DA - Nov 15 DO - 10.1002/ccd.25907 DP - NLM ET - 2015/05/07 J2 - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions KW - Adult Aged Angioplasty, Balloon, Coronary/*methods/mortality Coronary Angiography/methods Coronary Artery Bypass/*methods/mortality Coronary Artery Disease/*diagnostic imaging/mortality/*therapy Coronary Restenosis/epidemiology/pathology Decision Making Decision Making, Computer-Assisted *Drug-Eluting Stents Female Follow-Up Studies Humans Male Middle Aged Patient Care Team Patient Selection Predictive Value of Tests Prospective Studies Risk Assessment Severity of Illness Index Single-Blind Method Survival Rate Time Factors Treatment Outcome coronary artery disease drug eluting risk stratification stent LA - eng M1 - 6 N1 - 1522-726x Campos, Carlos M Stanetic, Bojan M Farooq, Vasim Walsh, Simon Ishibashi, Yuki Onuma, Yoshinobu Garcia-Garcia, Hector M Escaned, Javier Banning, Adrian Serruys, Patrick W SYNTAX II Study Group Comparative Study Journal Article Multicenter Study Randomized Controlled Trial United States Catheter Cardiovasc Interv. 2015 Nov 15;86(6):E229-38. doi: 10.1002/ccd.25907. Epub 2015 May 6. PY - 2015 SN - 1522-1946 SP - E229-38 ST - Risk stratification in 3-vessel coronary artery disease: Applying the SYNTAX Score II in the Heart Team Discussion of the SYNTAX II trial T2 - Catheter Cardiovasc Interv TI - Risk stratification in 3-vessel coronary artery disease: Applying the SYNTAX Score II in the Heart Team Discussion of the SYNTAX II trial VL - 86 ID - 760300 ER - TY - JOUR AB - Background: 90Y Ibritumomab tiuxetan (90Y-IT) has become an efficient option to therapy in B-cell non-Hodgkin Lymphoma (NHL). Aims: To analyse our updated information of patients treated with 90YIbritumomab/ tiuxetan in a prospective study according clinical practice setting and to analyse treatment outcome in elderly patients. Methods: A total of 39 B cell NHL patients were included in a clinical protocol conducted by a multidisciplinary team and treated in the same centre. According to the inclusion criteria: patients over 65 years old diagnosed as CD20+ NHL with neutrophils ≥1,5 x 109/L, platelets ≥ 100 x 109/L, bone marrow lymphocytes CD20+ ≤ 25%. All patients received 0,3 or 0,4 mCi /kg IV (88%) of 90YIbritumomab/ tiuxetan and response evaluation was performed 12 weeks after. Period of study: September 2005/February 2013. The 90Y-IT was administered as consolidation of first line therapy (Rituximab alone, R-COP, R-CHOP21) or in relapsed/refractory status. Endpoints: objective response rate (ORR), time to relapse (PFS) overall survival (OS) and safety. Other clinical prognostic factors were observed to assess their possible influence upon treatment value. Results: At the end of February 2013, 39 patients over 65 years old, had received treatment with 90YIbritumomab/tiuxetan and completed the evaluation protocol and were considered to analysis; M/F: 18/21, mean age 72.8 years (65- 87); ECOG 0-1 92.3%. According OMS classification: NHL-follicular 27 (69.2%), mantle cell Lymphoma 7 (17.9%), DLBCL 4 (10.3%) and 1MALT (2.6%). Score distribution: low risk 19 (48.7%), intermediate 12 (30.8.2%) and advanced 8 (20.5%). Previous therapy schedules ≤2 (66.7%), >2 (33.3%). The median follow- up time: 46.0 months (95% CI: 4.0; 88.0), mean PFS: 39.5 months (95% CI: 32.2; 46.8) median NR (see Fig 1.). 13 patients received 90Y-IT as consolidation of first line therapy (33.3%) and 26 relapsed/refractory (66.6%). ORR was 84.6 % CR: 29 (74.3%); PR 4 (10.2%) and 6 failures (15.4%) in relapsed/refractory disease. Mean estimated OS since 90Y-IT: 63.1 months (95% CI: 51.7; 74.4) and mean estimated OS since diagnosis 158 months. Median PFS was NR. The mean PFS for patients in consolidation therapy was 52.1 months (95% CI: 44.4; 59.7), but any NHL-follicular patients in consolidation (11) have been relapsed even dead. Safety: thrombocytopenia being the most frequent, G3-4 (35.9%), median time to developed haematological toxicity: fourth week, and neutropenia G3-4 (41.0%), the median time to recover normal values was 4.2 and 2.6 weeks respectively. In 5 (12.9%) of patients red blood cell transfusion was required, and 10 platelet transfusions (25.6%). The most frequent non haematological toxicity was asthenia. One patient developed a severe mucositis. Four patients have concomitant associated tumours (colon, breast, lung and prostate) and two patients over 77 years developed a rectum carcinoma after 18 months of 90Y-IT and another prostate and renal tumour after 8 years. Non-mortality related therapy was registered, at the end of study 10 patients have died, 6 of them in relapse. Summary / Conclusion: In our experience 90Y Ibritumomab tiuxetan is a safety and effective therapy in patients with NHL over 65 years. According to obtained PFS results, it seems like the use of this kind of therapy as used in early part of therapy offers good and maintained response rate with lower toxicity in this fragile population. The OS in this population was not inferior to observed in younger NHL patients. (Figure Presented). AD - M. Campos, Department of Haematology and Hemotherapy, Zaragoza, Spain AU - Campos, M. AU - Limon, A. AU - Florez, I. AU - Grasa, J. AU - Baringo, T. AU - Giraldo, P. DB - Embase KW - yttrium 90 ibritumomab tiuxetan rituximab human therapy B lymphocyte patient hematology safety male toxicity relapse population prostate clinical protocol thrombocytopenia follow up aged treatment outcome mantle cell lymphoma classification overall survival clinical practice prospective study nonhodgkin lymphoma mortality risk diagnosis thrombocyte neutropenia rectum carcinoma lung breast neutrophil mucosa inflammation asthenia thrombocyte transfusion neoplasm erythrocyte transfusion normal value large cell lymphoma electrocorticography L1 - www.haematologica.org/content/98/supplement_2/1.full-text.pdf+html LA - English M3 - Conference Abstract N1 - L71697833 2014-12-09 PY - 2013 SN - 0390-6078 SP - 767 ST - Efficacy and safety of therapy with 90Y ibritumomab tiuxetan, in b cell NHL patients over 65 years old T2 - Haematologica TI - Efficacy and safety of therapy with 90Y ibritumomab tiuxetan, in b cell NHL patients over 65 years old UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71697833&from=export VL - 98 ID - 761166 ER - TY - JOUR AB - Background: Splanchnic venous thrombosis (SVT) encompasses thrombosis in the mesenteric, splenic or portal veins (with or without hepatic veins involvement). Little is known about appropriate therapeutic interventions and long-term clinical outcome of SVT patients. Aim of this study was to identify the correct management of SVT and encourage a multidisciplinary approach by a team composed of hematologists, hepatologists, and infectivologists. Methods:We analyzed clinical, laboratory, therapeutic and outcome data of 127 patients with SVT that were recruited from 2000 to 2016. In patients with no active bleeding, anticoagulation treatment was started as soon as possible, according to platelet count. We administered intermediate or full therapeutic dose low-molecular-weight heparin (LMWH) and early initiation of vitamin-K antagonist (VKA; INR range 2-3 or 1.8-2.5 in patients with high bleeding risk) for a platelet count >50.000/μl, only half or prophylactic dose of LMWH for a platelet count >30.000 and < 50.000/μl and no treatment for a platelet count <30.000/μl. Indefinite duration treatment was used for patients with persistent or permanent risk (i.e. cirrhosis, active solid cancer and hematological cancer). Moreover, an appropriate prophylaxis with beta-blockers and endoscopic therapies were applied in cirrhotic SVT. The quality of VKA treatment was assessed by the time in therapeutic range (TTR). The number of vascular complications was expressed as incidence rate, calculated by the number of events per 100 patients-year of observation. The Kaplan-Meier method was performed to estimate the time to reach vessel recanalization. Cox regression analysis was used to identify independent predictors of vascular events or recanalization. Results: Overall, 127 patients were included (median age 58 years; 74% males). The median follow-up of all patients was 11 months (1-212). Portal vein thrombosis was the most common site of thrombosis (50%), followed by multiple venous involvement (37%). Liver cirrhosis and solid neoplasms were the common underlying disease (72% and 36% respectively) while myeloproliferative neoplasms were identified in 8 patients (6.2%). Eighty-nine patients (70%) had esophageal varices (grade >2 in 55 patients) and 81 (64%) had thrombocytopenia (mean 72.000/ μl range 28.000/μl-148.000/μl). Ninety-nine patients (78%) were treated with anticoagulant therapy: 36% with intermediate or full dose of LMWH, 40% with half or prophylactic dose of LMWH and 24% with VKA (TTR 76%). During a median duration therapy of 7 months, the incidence rate of thrombotic events was 1.1 per 100 pt-y while the incidence rate of major bleeding was 1.6 per 100 pt-y. At univariate analysis, esophageal varices (p=0.030), renal failure (p=0.001) and liver cirrhosis (p=0.05) significantly increased the risk of bleeding events. Moreover VKA exposure was associated with a significantly lower risk of bleeding events compared to LMWH (p=0.042). Fifty-six patients (44%) obtained vessel recanalization and the probability of recanalization of the occluded vessels was 50% at 18 months. At univariate analysis, factors associated with a lack of recanalization included liver cirrhosis (p=0.004) and solid tumor (p=0.010). Only one death was attributed to fatal bleeding whereas 31 patients died for causes not related to anticoagulation (cirrhosis, cancer). Conclusions: Our study suggests the effectiveness of anticoagulant therapy (especially VKA), leading to thrombus recanalization in 44% of patients with SVT. Notably, the anticoagulant treatment was associated with a very low bleeding incidence also in patients with major risk factors for bleeding (i.e. liver cirrhosis, cancer or esophageal varices). Treatment algorithm and therapeutic decisions were taken as a multidisciplinary team, able to adapt the individual approach and avoid fatal complications. AD - L. Canafoglia AU - Canafoglia, L. AU - Rupoli, S. AU - Baroni, G. S. AU - Gironella, M. AU - Micucci, G. AU - Federici, I. AU - Offidani, M. AU - Fiorentini, A. AU - Riva, A. AU - Da Lio, L. AU - Scortechini, A. R. AU - Honorati, E. AU - Leoni, P. DB - Embase KW - antivitamin K beta adrenergic receptor blocking agent low molecular weight heparin adult anticoagulant therapy bleeding cancer susceptibility clinical laboratory clinical outcome clinical trial controlled study death drug fatality drug therapy endoscopic therapy esophagus cancer esophagus varices exposure female fibrosis follow up hematologist human incidence international normalized ratio Kaplan Meier method kidney failure liver cirrhosis major clinical study male middle aged myeloproliferative neoplasm portal vein thrombosis probability prophylaxis proportional hazards model recanalization risk factor solid malignant neoplasm platelet count thrombocytopenia treatment duration univariate analysis LA - English M1 - 22 M3 - Conference Abstract N1 - L614247735 2017-02-03 PY - 2016 SN - 1528-0020 ST - Clinical outcome of 127 cases of splanchnic venous thrombosis: Benefit of anticoagulant therapy T2 - Blood TI - Clinical outcome of 127 cases of splanchnic venous thrombosis: Benefit of anticoagulant therapy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614247735&from=export VL - 128 ID - 760978 ER - TY - JOUR AB - Aims Anti-cancer agents with cardiovascular side effects multiply, often interfering with effective oncology treatments, and thus the relationship between cardiologists and oncologists should be closer. We carried out a regional-based survey on behalf of Associazione Nazionale Medici Cardiologi Ospedalieri to analyse the status of cardio-oncology in Tuscany. Methods A short questionnaire was sent out to all cardiology divisions across Tuscany (n = 36). The questionnaire was made up of 13 questions divided into four blocks: cardio-oncology census and inner organization; multidisciplinary team and specific training; oncology-related workload; need for and availability of cardiac MRI. Results Twenty-five centres out of 36 sent back the completed questionnaire and so were included in the survey. An inadequacy of cardio-oncology services surfaced, with only 20% of institutions offering a cardio-oncology service and 28% possessing a trained cardiology team. The majority of cardiologists regarded as useful a specific training (72%), and the foundation of a distinct service (55%), and 68% assumed cooperation with oncologists as a way to improve performance. The majority of the workload involves ECGs and echocardiograms with a mean monthly number of requests ranging between 10 and 40. Cardiac MRI and computed tomography scans are used in selected cases, but all cardiologists consider them useful. Conclusion To date, cardio-oncology in Tuscany can be considered as an unmet need. We should improve dedicated services by means of specific training and multidisciplinary teams. The definition of a regional task force and appointed centres with known expertise could also help. To make this upgrade possible, a financial effort is vital. AD - [Canale, Maria Laura; Magnacca, Massimo; Casolo, Giancarlo] Versilia Hosp, Dept Cardiol, Lido Di Camaiore, Lucca, Italy. [Camerini, Andrea] Versilia Hosp, Dept Med Oncol, Lido Di Camaiore, Lucca, Italy. [Camerini, Andrea] Versilia Hosp, Ist Toscano Tumori, Lido Di Camaiore, Lucca, Italy. Canale, ML (corresponding author), Versilia Hosp, Via Aurelia 335, I-55043 Lido Di Camaiore, LU, Italy. marialauracanale@katamail.com AN - WOS:000333386300008 AU - Canale, M. L. AU - Camerini, A. AU - Magnacca, M. AU - Casolo, G. AU - Assoc Nazl Med Cardiologi, Osped DA - Feb DO - 10.2459/JCM.0b013e328363805b J2 - J. Cardiovasc. Med. KW - cardiotoxicity cardio-oncology anthracyclines VENOUS THROMBOSIS HODGKIN-LYMPHOMA CARDIOTOXICITY CANCER DYSFUNCTION MECHANISMS TRIALS DRUGS Cardiac & Cardiovascular Systems LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: AD6QQ Times Cited: 4 Cited Reference Count: 18 Canale, Maria Laura Camerini, Andrea Magnacca, Massimo Casolo, Giancarlo Casolo, Giancarlo/0000-0003-3094-9391 4 0 2 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J CARDIOVASC MED PY - 2014 SN - 1558-2027 SP - 135-140 ST - A cardio-oncology experience in Italy: results of a Tuscany regional-based survey T2 - Journal of Cardiovascular Medicine TI - A cardio-oncology experience in Italy: results of a Tuscany regional-based survey UR - ://WOS:000333386300008 VL - 15 ID - 761786 ER - TY - JOUR AB - Timely treatment is essential in acute ischemic stroke as the chances of recovery diminish over time, so efforts are necessary to streamline in-hospital pathways and reduce delays. Here, we analyse the interventions to reduce door-to-needle time in stroke patients suitable for intravenous thrombolysis at the Emergency Department of San Carlo Borromeo Hospital, Milan, Italy. All stroke patients consecutively treated with intravenous thrombolysis at our centre from January 1, 2013 to December 31, 2015 were included in this analysis. The main interventions adopted were (1) continuous education of personnel, (2) reconsideration of blood tests and identify the ones really affecting treatment decision, (3) approval of a new high-urgency Stroke Code activated as soon as the triage nurse comes to know of a potential thrombolysis candidate. Median door-to-needle time progressively decreased from 103 min (iqr 78-120) in 2013, to 92 min (iqr 72-112) in 2014, and to 37 min (iqr 27-58) with the new Stroke Code (p < 0.001) in 2015. Simultaneously, median onset-to-treatment time decreased from 177 min (iqr 142-188) in 2013, to 155 min (iqr 141-198) in 2014, and to 114 min (iqr 86-160) with the new Stroke Code (p < 0.001 and p 0.005, respectively). We did not observe any significant difference in bleeding risks or deaths, whereas the likelihood of favourable outcome (mRS 0-2) increased. Streamlining in-hospital pathways with progressive interventions significantly decreases door-to-needle time and onset-to-treatment time and may contribute to improve stroke outcomes. AD - [Candelaresi, Paolo; Dacco, R.; Fontana, G.] San Carlo Borromeo Hosp, Dept Emergency Med, Via Pio 2 3, I-20147 Milan, Italy. [Candelaresi, Paolo; Lattuada, P.; Frediani, F.] San Carlo Borromeo Hosp, Div Neurol & Stroke Unit, Milan, Italy. [Uggetti, C.] San Carlo Borromeo Hosp, Unit Neuroradiol, Dept Radiol, Milan, Italy. Candelaresi, P (corresponding author), San Carlo Borromeo Hosp, Dept Emergency Med, Via Pio 2 3, I-20147 Milan, Italy.; Candelaresi, P (corresponding author), San Carlo Borromeo Hosp, Div Neurol & Stroke Unit, Milan, Italy. paolocandelaresi@gmail.com AN - WOS:000409295900015 AU - Candelaresi, P. AU - Lattuada, P. AU - Uggetti, C. AU - Dacco, R. AU - Fontana, G. AU - Frediani, F. DA - Sep DO - 10.1007/s10072-017-3046-y J2 - Neurol. Sci. KW - Stroke Thrombolysis Stroke management Stroke team In-hospital delay CARE THROMBOLYSIS MINUTES TIME Clinical Neurology Neurosciences LA - English M1 - 9 M3 - Article N1 - ISI Document Delivery No.: FF8VM Times Cited: 6 Cited Reference Count: 11 Candelaresi, Paolo Lattuada, P. Uggetti, C. Dacco, R. Fontana, G. Frediani, F. candelaresi, paolo/AAF-1690-2019 Uggetti, Carla/0000-0002-6717-1280 6 0 2 SPRINGER-VERLAG ITALIA SRL MILAN NEUROL SCI PY - 2017 SN - 1590-1874 SP - 1671-1676 ST - A high-urgency stroke code reduces in-hospital delays in acute ischemic stroke: a single-centre experience T2 - Neurological Sciences TI - A high-urgency stroke code reduces in-hospital delays in acute ischemic stroke: a single-centre experience UR - ://WOS:000409295900015 VL - 38 ID - 761637 ER - TY - JOUR AB - BACKGROUND: Cardiac telemetry monitoring is widely utilized for a variety of clinical indications, yet indication-specific event rates for monitored patients are seldomly reported. HYPOTHESIS: High-risk hospitalized patients for clinical deterioration can be identified using standardized telemetry monitoring indications. METHODS: Adjudicated data from events triggering emergency response team (ERT) activation were systematically characterized at the Cleveland Clinic from among standardized telemetry indications ordered over a 13-month period. RESULTS: Among 72 199 orders created for telemetry monitored patients, ERT activation occurred in 2677 patients (3.7%), of which 1326 (49.5%) were cardiac-related. Patients with deep venous thrombosis or pulmonary embolism (DVT/PE) demonstrated the highest overall event rate (ERT: n = 41 of 593 pts [6.9%]; 25/41 cardiac related [61%]). Cardiac-related events were proportionally highest among patients with coronary disease awaiting revascularization (ERT: n = 19 of 847 patients [2.2%]; 13/19 cardiac-related [68.4%]). Arrhythmia-specific events were highest among patients who underwent cardiac surgery (n = 78 of 193 cardiac-related ERT [40.4%]), and patients with known or suspected tachyarrhythmias (n = 318 of 788 cardiac-related ERT [40.4%]). Bubble plot analysis identified patients hospitalized with DVT/PE, drug or alcohol exposures, and acute coronary syndrome as among the highest overall and cardiac-related events while identifying patients with respiratory disorder monitoring indications as carrying the highest noncardiac event rate. CONCLUSION: High-risk hospitalized patients can be identified by telemetry indication and prioritized according to concerns for cardiac, arrhythmia-specific and noncardiac clinical deterioration. This is particularly useful when monitored bed resources are constrained. AD - Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Nursing Institute, Cleveland Clinic, Cleveland, Ohio. Internal Medicine/Hospital Medicine, Cleveland Clinic, Cleveland, Ohio. Lerner Research Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio. Community Medicine/Hospital Medicine, Cleveland Clinic, Cleveland, Ohio. Clinical Engineering, Cleveland Clinic, Cleveland, Ohio. AN - 31407351 AU - Cantillon, D. J. AU - Burkle, A. AU - Kirkwood, D. AU - Loy, M. AU - Amuthan, R. AU - Pengel, S. AU - Tote, J. AU - Morris, W. AU - Houghtaling, P. L. AU - Hamilton, A. C. AU - Petre, M. AU - Khot, U. N. AU - Lindsay, B. D. C2 - Pmc6788477 DA - Oct DO - 10.1002/clc.23244 DP - NLM ET - 2019/08/14 J2 - Clinical cardiology KW - Cardiovascular Diseases/*diagnosis/epidemiology *Emergency Service, Hospital Follow-Up Studies Humans Incidence Monitoring, Physiologic/*methods Ohio/epidemiology Retrospective Studies Telemetry/*methods alarm fatigue arrhythmias cardiac telemetry monitoring LA - eng M1 - 10 N1 - 1932-8737 Cantillon, Daniel J Orcid: 0000-0002-5823-5588 Burkle, Alicia Kirkwood, Desiree Loy, Molly Amuthan, Ram Pengel, Shannon Tote, John Morris, William Houghtaling, Penny L Hamilton, Aaron C Petre, Marc Khot, Umesh N Lindsay, Bruce D Journal Article Clin Cardiol. 2019 Oct;42(10):952-957. doi: 10.1002/clc.23244. Epub 2019 Aug 12. PY - 2019 SN - 0160-9289 (Print) 0160-9289 SP - 952-957 ST - Indication-specific event rates among hospitalized patients undergoing continuous cardiac monitoring T2 - Clin Cardiol TI - Indication-specific event rates among hospitalized patients undergoing continuous cardiac monitoring VL - 42 ID - 760134 ER - TY - JOUR AB - Background: Cardiac telemetry is widely utilized for many indications, yet the relationship with cardiovascular and non-cardiovascular events is poorly established. Objective: To characterize telemetry indication-specific event rates as defined by requiring urgent evaluation or treatment by an emergency response team (ERT). Methods: ERT activations for hospitalized patients at the Cleveland Clinic were systematically adjudicated by telemetry indication over 13 months for total, cardiac, non-cardiac and arrhythmia-specific events. Results: Among 72,199 telemetry monitored patients, ERT activation occurred in 2,677 pts(3.7%), of which 1,326 (49.5%) were cardiac-related. Patients with deep venous thrombosis or pulmonary embolism (DVT / PE) showed the highest event rate (ERT: n=41/593 pts [6.9%]; 25/41 cardiac related [61%]). The highest cardiac event rate occurred in patients awaiting coronary revascularization (ERT: n=19/847 pts [2.2%]; 13/19 cardiac-related [68.4%]). The highest arrhythmia-specific event rate occurred in post cardiac surgery pts (n=78/193 cardiac-related ERT [40.4%]), and those with known or suspected tachyarrhythmias (n=318/788 cardiac-related ERT [40.4%]). Bubble plot analysis identified DVT/PE, drug or alcohol exposures and acute coronary syndrome as among the highest ERT and cardiac-related events, and respiratory disorders as carrying the highest non cardiac event rate, Figure. Conclusion: High risk hospitalized patients can be identified by telemetry indication, and thereby prioritized when monitored bed resources are constrained according to concerns for cardiac, arrhythmia-specific and non-cardiac clinical deterioration. [Figure presented] AU - Cantillon, D. J. AU - Burkle, A. AU - Kirkwood, D. AU - Loy, M. A. AU - Amuthan, R. AU - Pengel, S. AU - Tote, J. AU - Morris, W. AU - Houghtaling, P. L. AU - Hamilton, A. C. AU - Petre, M. AU - Khot, U. N. AU - Lindsay, B. D. DB - Embase DO - 10.1016/j.hrthm.2019.04.014 KW - alcohol acute coronary syndrome adult conference abstract controlled study deep vein thrombosis deterioration drug exposure female heart arrhythmia heart muscle revascularization hospital patient human lung embolism major clinical study male monitoring risk assessment surgery tachycardia telemetry LA - English M1 - 5 M3 - Conference Abstract N1 - L2002273526 2019-07-16 PY - 2019 SN - 1556-3871 1547-5271 SP - 129-130 ST - INDICATION-SPECIFIC EVENT RATES AMONG HOSPITALIZED PATIENTS UNDERGOING CONTINUOUS CARDIAC RHYTHM MONITORING T2 - Heart Rhythm TI - INDICATION-SPECIFIC EVENT RATES AMONG HOSPITALIZED PATIENTS UNDERGOING CONTINUOUS CARDIAC RHYTHM MONITORING UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002273526&from=export http://dx.doi.org/10.1016/j.hrthm.2019.04.014 VL - 16 ID - 760716 ER - TY - JOUR AB - Background: Hepatocellular carcinoma (HCC) was the most common primary malignant liver tumor. The portal vein thrombosis (PVTT) of 10-40% were detected when HCC is exactly diagnosed. The patients whose PVTT existed in main branch of portal vein had poor prognosis. Whether hepatectomy could improve the survival rate of patients of HCC with PVTT was currently unknown. This study was to explore the prognosis and affecting factors of HCC with PVTT after liver resection. Methods: The clinical data of 81 patients who were performed surgical treatment because of HCC with PVTT were analyzed retrospectively. All patients were followed up. Kaplan-Meier curve (log rank test) was used to survival analysis. The factor of P < 0.05 is entered into the model of Cox's proportional hazards regression to multivariate analyze the prognostic factors of HCC with PVTT after hepatectomy. Results: The median survival time of HCC with PVTT after hepatectomy was 11.0 months, and the disease-free survival (DFS) time of HCC with PVTT after hepatectomy was 4.2 months. During follow-up, HCC recurrence and metastasis were happened in 78 patients while intrahepatic recurrence and metastasis were happened in 56 patients (71.8%). The 2-year overall survival (OS) rates of patients who received the treatment of Sorafenib and transcatheter arterial chemoembolization (TACE) and symptomatic treatment after recurrence were 50.0%, 18.5% and 0% (P=0.000), respectively. Multivariate analysis showed that surgical margins and Cheng's classification for PVTT were independent factors on the DFS time for patients of the HCC with PVVT, while histological differentiation, Cheng's classification for PVTT and the modalities were independent factors on the OS time. Subgroup analysis revealed that there were not statistically significant difference (P > 0.05) for the DFS and OS time of patients between the type I and II of the Cheng's classification for PVTT. However, there were significantly difference (P < 0.05) for the DFS and OS time of patients between of the type I and type II and between of type II and type III of the Cheng's classification for PVTT, respectively. Conclusions: Cheng's classification for PVTT and the mode of treatments after the recurrence were independent factors on the survival of patients of HCC with PVTT. The individual treatments based on multidisciplinary team (MDT) could effectively extend the survival time of patients of HCC with PVTT. AD - L. Wu, Department of Hepatobiliary and Pancreatic, The Affiliated Hospital, Qingdao University, Qingdao, China AU - Cao, J. AU - Wang, Z. AU - Wu, S. AU - Yu, Y. AU - Zhu, C. AU - Wu, L. DB - Embase DO - 10.21037/tcr.2016.11.78 KW - iodinated poppyseed oil sorafenib adult aged article cancer prognosis cancer recurrence cancer surgery chemoembolization disease classification disease free survival female human liver cell carcinoma liver resection major clinical study male median survival time metastasis overall survival portal vein thrombosis survival analysis survival rate tumor thrombus LA - English M1 - 1 M3 - Article N1 - L614601612 2017-03-03 2017-03-09 PY - 2017 SN - 2219-6803 2218-676X SP - 247-253 ST - Analysis of surgical treatment and prognostic factors for hepatocellular carcinoma with portal vein tumor thrombus T2 - Translational Cancer Research TI - Analysis of surgical treatment and prognostic factors for hepatocellular carcinoma with portal vein tumor thrombus UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614601612&from=export http://dx.doi.org/10.21037/tcr.2016.11.78 VL - 6 ID - 760963 ER - TY - JOUR AB - Background and Aims: Vertebral artery compression by a cervical osteophyte is known to lead to transient haemodynamic posterior circulation symptoms following head movements. Our case illustrates recurrent embolic strokes as a result of this phenomenon and a novel treatment strategy to prevent future events. Methods: Case report A 73-year-old man presented with 3-hour history of dizziness and slurred speech. Examination showed right facial droop, dysarthria, right hemiparesis and ataxia. Past history included 3 posterior circulation infarcts over the preceding six months due to recurrent right vertebral artery (RVA) dissection secondary to a C4-C5 osteophyte protrusion, confirmed on CTA. He was taking dual antiplatelets. Urgent imaging showed a non-occlusive distal basilar artery thrombus and occluded RVA. Intravenous thrombolysis led to decrease in NIHSS from 8 to zero at 24 hours. Repeat CTA six weeks after discharge showed RVA markedly narrowed by the osteophyte but fully patent, supporting the diagnosis of dissection. Due to the risk of recurrent dissections as a result of extrinsic pressure and as unsteadiness and tinnitus continued to impair the patient's quality of life, occlusion of the RVA was decided by the multidisciplinary team as a therapeutic intervention. After initial test occlusion, endovascular embolisation with a detachable balloon was performed without complications. The patient has been asymptomatic at six month follow-up. Results: N/A Conclusions: Vertebral artery dissection secondary to osteophyte compression is an uncommon cause of recurrent posterior circulation embolic strokes refractory to medical treatment and management can be challenging. Occluding the artery by endovascular embolisation can be effective for preventing further strokes. (Figure Presented). AD - J.J.L. Cao, Addenbrooke's Hospital, Stroke Medicine, Cambridge, United Kingdom AU - Cao, J. J. L. AU - Brown, R. AU - Joshi, Y. AU - Hannon, N. AU - Khadjooi, K. DB - Embase DO - 10.1177/2396987319845581 KW - aged artery dissection artificial embolization ataxia basilar artery blood clot lysis case report cerebrovascular accident clinical article complication compression conference abstract detachable balloon dizziness dysarthria facial droop follow up hemiparesis human human cell infarction male multidisciplinary team National Institutes of Health Stroke Scale osteophyte patent prevention quality of life slurred speech surgery thrombocyte tinnitus trinucleotide repeat unsteadiness vertebral artery stenosis LA - English M3 - Conference Abstract N1 - L628558089 2019-07-23 PY - 2019 SN - 2396-9881 SP - 214 ST - Therapeutic vertebral artery occlusion in a patient with an unusual cause of recurrent posterior circulation stroke T2 - European Stroke Journal TI - Therapeutic vertebral artery occlusion in a patient with an unusual cause of recurrent posterior circulation stroke UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628558089&from=export http://dx.doi.org/10.1177/2396987319845581 VL - 4 ID - 760720 ER - TY - JOUR AB - Background: Hepatocellular carcinoma (HCC) was the most common primary malignant liver tumor. The portal vein thrombosis (PVTT) of 10-40% were detected when HCC is exactly diagnosed. The patients whose PVTT existed in main branch of portal vein had poor prognosis. Whether hepatectomy could improve the survival rate of patients of HCC with PVTT was currently unknown. This study was to explore the prognosis and affecting factors of HCC with PVTT after liver resection. Methods: The clinical data of 81 patients who were performed surgical treatment because of HCC with PVTT were analyzed retrospectively. All patients were followed up. Kaplan-Meier curve (log rank test) was used to survival analysis. The factor of P< 0.05 is entered into the model of Cox's proportional hazards regression to multivariate analyze the prognostic factors of HCC with PVTT after hepatectomy. Results: The median survival time of HCC with PVTT after hepatectomy was 11.0 months, and the disease-free survival (DFS) time of HCC with PVTT after hepatectomy was 4.2 months. During follow-up, HCC recurrence and metastasis were happened in 78 patients while intrahepatic recurrence and metastasis were happened in 56 patients (71.8%). The 2-year overall survival (OS) rates of patients who received the treatment of Sorafenib and transcatheter arterial chemoembolization (TACE) and symptomatic treatment after recurrence were 50.0%, 18.5% and 0% (P = 0.000), respectively. Multivariate analysis showed that surgical margins and Cheng's classification for PVTT were independent factors on the DFS time for patients of the HCC with PVVT, while histological differentiation, Cheng's classification for PVTT and the modalities were independent factors on the OS time. Subgroup analysis revealed that there were not statistically significant difference (P> 0.05) for the DFS and OS time of patients between the type I and II of the Cheng's classification for PVTT. However, there were significantly difference (P< 0.05) for the DFS and OS time of patients between of the type I and type II and between of type II and type III of the Cheng's classification for PVTT, respectively. Conclusions: Cheng's classification for PVTT and the mode of treatments after the recurrence were independent factors on the survival of patients of HCC with PVTT. The individual treatments based on multidisciplinary team (MDT) could effectively extend the survival time of patients of HCC with PVTT. AD - [Cao, Jingyu; Wang, Zusen; Wu, Shengkun; Yu, Yao; Zhu, Chengzhan; Wu, Liqun] Qingdao Univ, Affiliated Hosp, Dept Hepatobiliary & Pancreat, Qingdao 266003, Peoples R China. Wu, LQ (corresponding author), Qingdao Univ, Affiliated Hosp, Dept Hepatobiliary & Pancreat, Qingdao 266003, Peoples R China. wulq5810@126.com AN - WOS:000397238200026 AU - Cao, J. Y. AU - Wang, Z. S. AU - Wu, S. K. AU - Yu, Y. AU - Zhu, C. Z. AU - Wu, L. Q. DA - Feb DO - 10.21037/tcr.2016.11.78 J2 - Transl. Cancer Res. KW - Hepatocellular carcinoma (HCC) portal vein thrombosis (PVTT) prognosis HEPATECTOMY SORAFENIB Oncology LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: EP2UF Times Cited: 1 Cited Reference Count: 16 Cao, Jingyu Wang, Zusen Wu, Shengkun Yu, Yao Zhu, Chengzhan Wu, Liqun 4 0 3 AME PUBL CO SHEUNG WAN TRANSL CANCER RES PY - 2017 SN - 2218-676X SP - 247-253 ST - Analysis of surgical treatment and prognostic factors for hepatocellular carcinoma with portal vein tumor thrombus T2 - Translational Cancer Research TI - Analysis of surgical treatment and prognostic factors for hepatocellular carcinoma with portal vein tumor thrombus UR - ://WOS:000397238200026 VL - 6 ID - 761668 ER - TY - JOUR AB - INTRODUCTION: Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed. OBJECTIVE: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital. PATIENTS AND METHODS: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel-Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05. RESULTS: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033). CONCLUSION: The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records. AD - Sírio Libanês Hospital, São Paulo, Brazil. AN - 28003757 AU - Cardoso, L. F. AU - Krokoscz, D. V. AU - de Paiva, E. F. AU - Furtado, I. S. AU - Mattar, J., Jr. AU - de Souza, E. Sá M. M. AU - de Lira, A. C. C2 - Pmc5161397 DO - 10.2147/vhrm.s101880 DP - NLM ET - 2016/12/23 J2 - Vascular health and risk management KW - Adult Aged Brazil/epidemiology Chi-Square Distribution Critical Pathways Female Guideline Adherence *Hospitalization Hospitals, General Humans Linear Models Male Middle Aged Patient Care Team Patient Discharge Summaries Practice Guidelines as Topic Prevalence *Preventive Health Services/standards Program Evaluation Prospective Studies Pulmonary Embolism/diagnosis/epidemiology/*prevention & control Risk Factors Time Factors Treatment Outcome Venous Thromboembolism/diagnosis/epidemiology/*prevention & control Venous Thrombosis/diagnosis/epidemiology/*prevention & control deep venous thrombosis patient safety prevention and control pulmonary embolism quality control LA - eng N1 - 1178-2048 Cardoso, Luiz Francisco Krokoscz, Daniella Vianna C de Paiva, Edison Ferreira Furtado, Ilka Spinola Mattar, Jorge Jr de Souza E Sá, Marcia Martiniano de Lira, Antonio Carlos Onofre Journal Article Observational Study Vasc Health Risk Manag. 2016 Dec 12;12:491-496. doi: 10.2147/VHRM.S101880. eCollection 2016. PY - 2016 SN - 1176-6344 (Print) 1176-6344 SP - 491-496 ST - Results of a venous thromboembolism prophylaxis program for hospitalized patients T2 - Vasc Health Risk Manag TI - Results of a venous thromboembolism prophylaxis program for hospitalized patients VL - 12 ID - 760297 ER - TY - JOUR AB - Introduction: Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed. Objective: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital. Patients and methods: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel-Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P0.05. Results: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P0.033). Conclusion: The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records. AD - L.F. Cardoso, Sírio Libanês Hospital, Rua Dona Adma Jafet, 91, Bela Vista, São Paulo, Brazil AU - Cardoso, L. F. AU - Krokoscz, D. V. C. AU - de Paiva, E. F. AU - Furtado, I. S. AU - Mattar, J. AU - de Souza e Sá, M. M. AU - de Lira, A. C. O. DB - Embase Medline DO - 10.2147/VHRM.S101880 KW - adult aged article clinical protocol female high risk patient hospital admission hospital discharge hospital patient human male medical patient patient protocol compliance risk assessment surgical patient thrombosis prevention venous thromboembolism LA - English M3 - Article N1 - L613895259 2017-01-09 2017-02-07 PY - 2016 SN - 1178-2048 1176-6344 SP - 491-496 ST - Results of a venous thromboembolism prophylaxis program for hospitalized patients T2 - Vascular Health and Risk Management TI - Results of a venous thromboembolism prophylaxis program for hospitalized patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613895259&from=export http://dx.doi.org/10.2147/VHRM.S101880 VL - 12 ID - 760975 ER - TY - JOUR AB - Introduction: Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed. Objective: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital. Patients and methods: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel-Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05. Results: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033). Conclusion: The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records. AD - [Cardoso, Luiz Francisco; Krokoscz, Daniella Vianna C.; de Paiva, Edison Ferreira; Furtado, Ilka Spinola; Mattar, Jorge, Jr.; de Souza e Sa, Marcia Martiniano; Onofre de Lira, Antonio Carlos] Sirio Libanes Hosp, Rua Dona Adma Jafet 91, BR-01308050 Sao Paulo, Brazil. Cardoso, LF (corresponding author), Sirio Libanes Hosp, Rua Dona Adma Jafet 91, BR-01308050 Sao Paulo, Brazil. luiz.cardoso@hsl.org.br AN - WOS:000390607300005 AU - Cardoso, L. F. AU - Krokoscz, D. V. C. AU - de Paiva, E. F. AU - Furtado, I. S. AU - Mattar, J. AU - Sa, Mmde AU - de Lira, A. C. O. DO - 10.2147/vhrm.s101880 J2 - Vasc. Health Risk Manag. KW - deep venous thrombosis pulmonary embolism prevention and control patient safety quality control PREVENTION Peripheral Vascular Disease LA - English M3 - Article N1 - ISI Document Delivery No.: EF8VC Times Cited: 8 Cited Reference Count: 14 Cardoso, Luiz Francisco Krokoscz, Daniella Vianna C. de Paiva, Edison Ferreira Furtado, Ilka Spinola Mattar, Jorge, Jr. de Souza e Sa, Marcia Martiniano Onofre de Lira, Antonio Carlos 8 0 4 DOVE MEDICAL PRESS LTD ALBANY VASC HEALTH RISK MAN PY - 2016 SN - 1176-6344 SP - 491-496 ST - Results of a venous thromboembolism prophylaxis program for hospitalized patients T2 - Vascular Health and Risk Management TI - Results of a venous thromboembolism prophylaxis program for hospitalized patients UR - ://WOS:000390607300005 VL - 12 ID - 761724 ER - TY - JOUR AB - Introduction: Venous thromboembolism (VTE) is the leading cause of preventable death in hospitalized patients. However, existing prophylaxis guidelines are rarely followed.Objective: The aim of the study was to present and discuss implementation strategies and the results of a VTE prophylaxis program for medical and surgical patients admitted to a large general hospital.Patients and Methods: This prospective observational study was conducted to describe the strategy used to implement a VTE prophylaxis program in hospitalized medical and surgical patients and to analyze the results in terms of the risk assessment rate within the first 24 hours after admission, adequacy of the prophylaxis prescription, and prevalence of VTE in the discharge records before and after program implementation. We used the Mantel-Haenszel chi-square test for the linear trend of the data analysis and set the significance level to P<0.05.Results: With the support of an institutional VTE prophylaxis committee, a multiple-strategy approach was used in the implementation of the protocol, which included continuing education, complete data recording using computerized systems, and continuous auditing of and feedback to the medical staff and multidisciplinary teams. Approximately 90% of patients were evaluated within the first 24 hours after admission, and no significant difference in this percentage was observed among the years analyzed. A progressive increase in adherence to protocol recommendations, from 63.8% in 2010 to 75.0% in 2014 (P<0.001), was noted. The prevalence of symptomatic VTE in the discharge records of patients decreased from 2.03% in 2009 to 1.69% in 2014 (P=0.033).Conclusion: The implementation of a VTE prophylaxis program targeting adult patients admitted to a large hospital employing a multiple-strategy approach achieved high rates of risk assessment within 24 hours of admission, improved the adherence to prophylaxis recommendations in high-risk patients, and reduced the rate of VTE events in the discharge records. AD - Sírio Libanês Hospital, São Paulo, Brazil AN - 120636100. Language: English. Entry Date: 20180730. Revision Date: 20190516. Publication Type: journal article AU - Cardoso, Luiz Francisco AU - Krokoscz, Daniella Vianna C. AU - de Paiva, Edison Ferreira AU - Furtado, Ilka Spinola AU - Mattar Jr, Jorge AU - de Souza e. Sá, Marcia Martiniano AU - Onofre de Lira, Antonio Carlos AU - Mattar, Jorge, Jr. AU - de Lira, Antonio Carlos Onofre DB - CINAHL DO - 10.2147/VHRM.S101880 DP - EBSCOhost KW - Hospitalization Preventive Health Care -- Standards Venous Thrombosis -- Prevention and Control Pulmonary Embolism -- Prevention and Control Venous Thromboembolism -- Prevention and Control Male Adult Program Evaluation Brazil Practice Guidelines Prevalence Venous Thromboembolism -- Epidemiology Critical Path Treatment Outcomes Venous Thrombosis -- Diagnosis Venous Thromboembolism -- Diagnosis Chi Square Test Venous Thrombosis -- Epidemiology Pulmonary Embolism -- Diagnosis Patient Discharge Summaries Pulmonary Embolism -- Epidemiology Risk Factors Female Hospitals Prospective Studies Guideline Adherence Time Factors Aged Middle Age Linear Regression Multidisciplinary Care Team Human N1 - research; tables/charts. Journal Subset: Australia & New Zealand; Biomedical; Peer Reviewed. NLM UID: 101273479. PMID: NLM28003757. PY - 2016 SN - 1176-6344 SP - 491-496 ST - Results of a venous thromboembolism prophylaxis program for hospitalized patients T2 - Vascular Health & Risk Management TI - Results of a venous thromboembolism prophylaxis program for hospitalized patients UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=120636100&site=ehost-live&scope=site VL - 12 ID - 761378 ER - TY - JOUR AB - BACKGROUND: Endovascular mechanical revascularization has become the mainstay acute stroke management secondary to emergent large vessel occlusions. In patients who can benefit from mechanical revascularization, the ability to intervene in a timely manner directly correlates with improved outcomes. The field assessment for stroke triage (FAST-ED) prehospital triage tool, is one of many stroke severity scales designed to decrease time to diagnosis in the field and optimize patient triage to comprehensive stroke centers. It is however unclear what impact if any, this tool has on time to activation of hospital stroke intervention teams. We set out to assess the impact of the implementation of the FAST-ED triage tool on the activation of the stroke intervention team in a community stroke treatment practice. METHODS: We retrospectively reviewed institutional records for consecutive admissions with reported stroke alerts between March 2017 and September 2018, and selected patients who presented via Emergency Medical Services (EMS). The association between FAST-ED scores and impact on time to revascularization as well as the association between FAST-ED scores and the presence of emergent large vessel occlusion were analyzed. RESULTS: There was a statistically significant improvement in interventional team activation times in favor of the FAST-ED cohort, (P < .05). CONCLUSIONS: FAST-ED implementation demonstrates a statistically significant improvement on stroke team activation times for patients who are candidates for mechanical revascularization. Larger cohort analysis is needed to fully evaluate the magnitude of this effect. AD - Department of Radiology, Aventura Hospital and Medical Center, Aventura, Florida. Electronic address: krcarr85@gmail.com. Department of Radiology, Aventura Hospital and Medical Center, Aventura, Florida. Herbert Wertheim College of Medicine, Florida International University, Miami, Florida. AN - 31699574 AU - Carr, K. AU - Yang, Y. AU - Roach, A. AU - Shivashankar, R. AU - Pasquale, D. AU - Serulle, Y. DA - Jan DO - 10.1016/j.jstrokecerebrovasdis.2019.104472 DP - NLM ET - 2019/11/09 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Aged Aged, 80 and over *Cerebral Revascularization/adverse effects/methods Decision Support Techniques Delivery of Health Care, Integrated *Emergency Medical Services *Emergency Service, Hospital *Endovascular Procedures/adverse effects/methods Female Humans Male Middle Aged Patient Care Team Predictive Value of Tests Quality Improvement Quality Indicators, Health Care Retrospective Studies Risk Factors Severity of Illness Index Stroke/diagnosis/physiopathology/*therapy Time Factors *Time-to-Treatment *Transportation of Patients Treatment Outcome *Triage Acute ischemic stroke community stroke mechanical revascularization stroke triage thrombectomy LA - eng M1 - 1 N1 - 1532-8511 Carr, Kevin Yang, Yi Roach, Allison Shivashankar, Ravishankar Pasquale, David Serulle, Yafell Journal Article United States J Stroke Cerebrovasc Dis. 2020 Jan;29(1):104472. doi: 10.1016/j.jstrokecerebrovasdis.2019.104472. Epub 2019 Nov 4. PY - 2020 SN - 1052-3057 SP - 104472 ST - Mechanical Revascularization in the Era of the Field Assessment Stroke Triage for Emergency Destination (FAST-ED): A Retrospective Cohort Assessment in a Community Stroke Practice T2 - J Stroke Cerebrovasc Dis TI - Mechanical Revascularization in the Era of the Field Assessment Stroke Triage for Emergency Destination (FAST-ED): A Retrospective Cohort Assessment in a Community Stroke Practice VL - 29 ID - 760177 ER - TY - JOUR AB - Learning Objectives: 1. To discuss indications and contraindications of interventional treatment 2. To analyse results of clinical trials 3. To understand the role of interventional therapies in the management of lung cancer The evolving field of pulmonary interventional oncology can be considered as a small integrative part in the complex area of oncology. The development of image-guided percutaneous techniques for local tumor ablation has been one of the major advances in the treatment of solid tumors. In patients who are deemed not to be candidates for surgery, various treatment strategies are available, including observation, conventional fractionated radiotherapy, stereotactic body radiotherapy and RF ablation. While it is generally accepted that observation and conventional radiotherapies offer survival rates that are inferior to the other therapeutic strategies, respectively - 5-year survival rates in the range of 6-14% and 10-27% - there is no standardized, clearly established therapy to offer patients in this situation (1,2,3,4). According to the American College of Chest Physician (ACCP) either stereotactic radiation therapy or percutaneous thermal ablation should be offered to patients who are medically inoperable (5). For selected patients, these technologies offer an optimal treatment option given their availability in the outpatient setting and low associated morbidity and mortality. In the category “thermal ablation” all energy sources that destroy a tumor with thermal energy are included, either by heat (hyperthermal ablation) which include radiofrequency (RF), laser and microwave (MW) or by cold (cryoablation or hypothermal ablation). The main objectives of pulmonary tumor ablation therapy (and other malignancies) are: 1) to eradicate all viable malignant cells in the target volume, with a safety margin to ensure complete eradication, 2) minimizing the damage to certain targeted volume will provide a good functioning reserve of the rest of the lung. This is particularly important for patient with limited pulmonary functions due to extensive underlying emphysema and fibrosis (6,7). The potential advantages of local tumor ablation therapy over surgical resection might include: 1) selective damage, 2) minimal treatment morbidity and mortality, 3) less breathing impairment in patients with borderline lung function through sparing healthy lung tissue, 4) repeatability, 5) fairly low costs, 6) excellent imaging during the procedure and for follow-up and last but not least, 7) the gain in quality of life with less pain, much shorter hospitalization times with the interventions performed on an outpatient base or with overnight stays and thus a quicker re-access to social life (8,9). Lung ablation can be a reasonable therapy even for selected patients with more advanced cancer. Such patients would include those with stage IIIb disease (based on a second nodule within the same tumor lobe) or stage IV disease based on a satellite nodule within another lobe. In addition, patients with advanced stage disease who may be treated with RF ablation include those who have responded to definitive radiation and chemotherapy but have a persistent solitary peripheral focus of cancer, and those who present with a recurrent isolated cancer after previous lung resection (10). Percutaneous thermal ablation is generally indicated for nonsurgical patients with metastatic cancer limited pulmonary metastatic burden. Approximately 30% of patients with colorectal cancer have pulmonary metastases, and in about 2-4%, these metastases are isolated (11). The number of lesions should not be considered an absolute contraindication to RF ablation if successful treatment of all metastatic deposits can be accomplished. Nevertheless, most centres preferentially treat patients with five or fewer lesions (12). The target tumor should not exceed 3-3.5 cm in longest axis to achieve best rates of complete ablation with most of the currently available devices 6. Radiofrequency ablation is considered contraindicated in the presence of tumors l cated <1cm main bronchi and when tumors are associated with atelectasis or obstructive pneumonitis (12,6). Thermal injury of hilar structures must be avoided because of the risk of a severe hemopthysis (13). In experienced hands, thermal ablation of tumors located in the vicinity of major vessels, like the aorta, and the heart has been shown to be feasible. In these cases, however, the risk of incomplete treatment of the neoplastic tissue close to the vessel may increase because of the heat loss by convection (14). In contrast to existing thermo-ablative technologies, however, microwave treatment offers several key theoretical advantages in this and in similar situations. These include efficacy on lesions with a cystic component and/or in proximity to vascular structures >3 mm in diameter with a reduction in the heatsink effect, a larger volume of cellular necrosis, reduction in procedure times, greater temperatures delivered to the target lesion, the possibility of using multiple antennae simultaneously and less intraprocedural pain (15,16,17). In addition, MWA does not require placement of grounding pads (15). Patients with untreatable or unmanageable coagulopathy or with performance status >2 are not candidates for thermal ablation of lung tumors. The treatment is possible but at a higher risk of complication and should be performed by an experienced operator in patients that have undergone previous pneumonectomy or when lesions are adjacent to major vessels or to the heart (18,14). Patient records, complete history, physical examination, and prior imaging studies should be evaluated to determine the indication and the feasibility of RF ablation. Biopsy should be performed before RF ablation in patients suspected to have a NSCLC, to confirm the diagnosis of cancer; however, in some highrisk patients, it is better that the patient undergo the risk of the biopsy and RF ablation in one setting (19). In case of lung metastases, histopathologic or cytologic confirmation should be obtained whenever there is atypical presentation or very late presentation after the primary tumor (20,21). Pretreatment imaging must carefully define the location of each lesion with respect to surrounding structures. Lesions located near or adjacent to pleura can be treated with RF ablation, although their treatment may be associated with pleural effusion caused by pleurisy brought on by the heat conducted. However, pleural effusion is usually small in amount, asymptomatic, and thus clinically insignificant (22). Treatment of subpleural lesions may be also more painful, and an adequate pain relief strategy must be foreseen (22,23). Pretreatment imaging is also aimed in evaluating the planned trajectory and the conditions of pulmonary parenchyma. In fact, it has been shown that the length of needle trajectory through aerated lung and the presence of severe emphysema represent important factors for the development of peri and postprocedural pneumothorax (22,24). Therefore, the electrode trajectory should be chosen to avoid fissures, to minimize the amount of aerate lung that needs to be traversed, avoid larger vessels and bullae (12). Preprocedural laboratory tests should include carcinoembryonic antigen (CEA) in patient with colorectal lung metastases and a careful patient's coagulation status. This includes measurement of the complete blood count, including platelet count, prothrombin time (PT)/international normalized ratio (INR). In some institutions the activated partial thromboplastin time, and/or cutaneous bleeding time are requested. An important issue surrounds management of antiplatelet (i.e., aspirin, ticlodipine, clopidogrel, IIb/IIIa receptor antagonists, nonsteroidal anti-inflammatory drugs) and/or anticoagulant drugs (i.e., warfarin) before and after the time of RF ablation. Antiplatelet medications should be discontinued several to 10 days before RF ablation. Antiplatelet therapy may be restarted 48-72 h after RF ablation. Even anticoagulant medications should be discontinued prior to RF ablation. Warfarin should generally be disco tinued at least 5 days prior to RF ablation. Heparin and related products should be discontinued 12-24 h prior to RF ablation. Warfarin may be restarted the day following RF ablation. Clinical and imaging findings associated with a multidisciplinary team evaluation are the most important features to obtain high clinical efficacy and to avoid complications. AD - G. Carrafiello, Radiology, University of Insubria, Varese, Italy AU - Carrafiello, G. AU - Ierardi, A. M. AU - Fugazzola, C. DB - Embase DO - 10.1007/s00270-011-0216-9 KW - warfarin anticoagulant agent heparin carcinoembryonic antigen acetylsalicylic acid clopidogrel receptor nonsteroid antiinflammatory agent human patient imaging Europe society neoplasm risk therapy lung tumor ablation radiotherapy lung metastasis lung tumor ablation therapy lung function emphysema lung parenchyma pain metastasis heart biopsy pleura effusion drug therapy oncology surgery lung resection technology outpatient morbidity mortality heat survival rate physical examination diagnosis pleura pleurisy analgesia needle pneumothorax electrode blister laboratory test hospital patient blood cell count platelet count physician prothrombin time international normalized ratio partial thromboplastin time bleeding time energy resource thorax radiofrequency laser microwave radiation cryoablation cancer cell safety college fibrosis breathing follow up quality of life hospitalization social life advanced cancer radiation chemotherapy stereotactic body radiation therapy lung lobectomy lung cancer clinical trial (topic) colorectal cancer solid malignant neoplasm devices radiofrequency ablation bronchus atelectasis pneumonia thermal injury aorta learning tissues heat loss thermodynamics microwave irradiation necrosis temperature blood clotting disorder medical record primary tumor LA - English M3 - Conference Abstract N1 - L70623989 2011-12-30 PY - 2011 SN - 0174-1551 SP - 401-402 ST - Clinical and imaging indications: How to select the patient T2 - CardioVascular and Interventional Radiology TI - Clinical and imaging indications: How to select the patient UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70623989&from=export http://dx.doi.org/10.1007/s00270-011-0216-9 VL - 34 ID - 761225 ER - TY - JOUR AU - Carretero Gomez, Stephanie AU - Kucsera, Csaba DA - 2015/01/01 01/01 DB - Joint Research Centre Publications Repository PY - 2015 ST - Report on case studies of the technology-based services for independent living for older people T2 - Joint Research Centre Publications Repository TI - Report on case studies of the technology-based services for independent living for older people UR - http://publications.jrc.ec.europa.eu/repository/handle/JRC94633 ID - 762132 ER - TY - JOUR AB - Abnormal invasion of placenta or placenta accreta spectrum disorders refer to the penetration of the trophoblastic tissue through the decidua basalis into the underlying uterine myometrium, the uterine serosa or even beyond, extending to pelvic organs. It is classified depending on the degree of invasion into placenta accreta (invasion <50% of the myometrium), increta (invasion >50% of the myometrium) and percreta (invading the serosa and adjacent pelvic organs). Clinical diagnosis is made intra-operatively; however, the confirmative diagnosis can only be made after a histopathological examination. The incidence of abnormal invasion of placenta has increased worldwide, mostly as a consequence of the rise in caesarean section rates, from 1 in 2500 pregnancies to 1 in 500 pregnancies. The importance of the disease is due to the increased maternal and foetal morbidity and mortality. Foetal implications are mainly due to iatrogenic prematurity, while maternal implications are mostly the increased risk of obstetric haemorrhage and surgical complications. The average blood loss is 3000-5000 mL, and up to 90% of the patients require a blood transfusion. An accurate and timely antenatal diagnosis is essential to improve outcomes. The traditional management of abnormal invasion of placenta has been a peripartum hysterectomy; however, the increased incidence and the short- and long-term consequences of a radical approach have led to the development of more conservative techniques, such as the intentional retention of the placenta, partial myometrial excision and the 'Triple P procedure'. Irrespective of the surgical technique of choice, women with a high suspicion or confirmed abnormally invasive placenta should be managed in a specialist centre with surgical expertise with a multi-disciplinary team who is experienced in managing these complex cases with an immediate availability of blood products, interventional radiology service, an intensive care unit and a neonatal intensive care unit to optimize the outcomes. AD - [Carrillo, Ana Pinas; Chandraharan, Edwin] St Georges Univ Hosp NHS Fdn Trust, Blackshaw Rd, London SW17 0QT, England. [Chandraharan, Edwin] St Georges Univ London, Blackshaw Rd, London SW17 0QT, England. Chandraharan, E (corresponding author), St Georges Univ Hosp NHS Fdn Trust, Blackshaw Rd, London SW17 0QT, England.; Chandraharan, E (corresponding author), St Georges Univ London, Blackshaw Rd, London SW17 0QT, England. edwin.c@sky.com AN - WOS:000488970500001 AU - Carrillo, A. P. AU - Chandraharan, E. C7 - 1745506519878081 DA - Oct DO - 10.1177/1745506519878081 J2 - Womens Health KW - intentional retention of placenta peripartum hysterectomy placenta accreta spectrum disorders placenta percreta prophylactive endovascular occlusive balloons the 'smudged egg' sign Triple P procedure PERIPARTUM HYSTERECTOMY PERCRETA OUTCOMES COHORT UK Obstetrics & Gynecology LA - English M3 - Review N1 - ISI Document Delivery No.: JC0LM Times Cited: 1 Cited Reference Count: 34 Carrillo, Ana Pinas Chandraharan, Edwin Chandraharan, Edwin/0000-0002-5711-8515 1 0 SAGE PUBLICATIONS LTD LONDON WOMENS HEALTH PY - 2019 SN - 1745-5057 SP - 8 ST - Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure T2 - Womens Health TI - Placenta accreta spectrum: Risk factors, diagnosis and management with special reference to the Triple P procedure UR - ://WOS:000488970500001 VL - 15 ID - 761492 ER - TY - GEN AU - Carroll, B. AU - Kabrhel, C. AU - Baker, J. AU - Dudzinski, D. M. AU - Jaff, M. R. AU - McClintic, J. AU - Rosovsky, R. AU - Rosenfield, K. AU - Sundt, T. AU - Weinberg, I. AU - Channick, R. N. DA - 2014/01/01 DB - Federal Science Library - Canada PY - 2014 SN - 1073-449X ST - A56 PULMONARY EMBOLISM: ACUTE AND CHRONIC: A Multi-Disciplinary Pulmonary Embolism Response Team (pert) For The Management Of Pulmonary Emboli: Initial Experience TI - A56 PULMONARY EMBOLISM: ACUTE AND CHRONIC: A Multi-Disciplinary Pulmonary Embolism Response Team (pert) For The Management Of Pulmonary Emboli: Initial Experience UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV3dS-NAEF9OwcMX8dTDO71j4OBQQs42HyYV76C2EavWam1An0o32aDYjyO1L_6h_j03s81uUgtyPvgS0ilstju_zs5sfjPDmG39KpkvbILncdtyrTii-Nn1eCTcXinxMFYQfhzHlKschnZw41xcUe1n1cM0l72r4lGGqqdE2jcoXw-KArxHCOAVQYDX_4JB1d03LsNzXKVq-9YImket88Z1Ux4H1sJOIKtL1U7arYtGbZqkLjNyzXoxWfdy0sf50l0w4KM-tdVoT6m1gipCD8hL_StzfyrG8SiVLI6cVmO0krkR6FENoi1RVWNdbLnoKOs3SYXSFmmBFiDT8VSbBklfm2MJEJklHfU1hYSoIzy9E1pwahz1HnJ2ct1oGvVJ_CR7eRdPQ8rOi9MQPbnOHf6DovtIkV8LJh6Nmuk4soEv7oDK7LvUa680uy9UCpa9nG-YmsaIoZuPHiA6PT-pUPsAf-bjbzE0w-sFtoDGk3z0xpl-qWX5WXGMbAJz27_cqjurbCULRqA6hc0n9kEM19jHZraQ6-wZ0QMaPaDQcwASO4DYgQw7KIJ55MDhoJc-_NHaP9yTnzOxAtOsVCFrVkowU5IdwtouINIAkQY50qCVgH4WTIc_gAxnkONsg_04Djq1E1OtSzcD2bhLfuW-72AAbH9mi8PRUGwyQP-4F3tObNkJHQxwXsHwGV1iXnYiXvLFF7b92khfX_96iy3nENtmi4_pRHxjS8m4b_Jx8l0q9x9ESJKd VL - 189 ID - 761980 ER - TY - GEN AU - Carroll, B. AU - Kabrhel, C. AU - Channick, R. N. AU - Dudzinski, D. M. AU - Jaff, M. R. AU - Rosenfield, K. AU - Baker, J. DA - 2014/01/01 DB - Federal Science Library - Canada PY - 2014 SN - 1073-449X ST - C56 CLINICAL CASES IN PULMONARY VASCULAR MEDICINE: Survival In A 45 Year Old Male With Massive Pulmonary Embolism And Cardiac Arrest With Treatment Utilizing Novel Technology After Activation Of A Multi-Disciplinary Pulmonary Embolism Response Team (pert) TI - C56 CLINICAL CASES IN PULMONARY VASCULAR MEDICINE: Survival In A 45 Year Old Male With Massive Pulmonary Embolism And Cardiac Arrest With Treatment Utilizing Novel Technology After Activation Of A Multi-Disciplinary Pulmonary Embolism Response Team (pert) UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtZ1bi9NAFIDH7YLii3jFyyoHBFGGaJvLppVVCNmKwW5a20bcp6VJprRsmkov-7C_3nMmmUm6K4s--BLSE5JMJl9nzpmcC2OW-b5pXBkTXDe2TMdME7KfHTdOhDNpTl20FUQ7TVOKVY4iq_vTDr-bg72GqvBXyf7ri0cZvnoKpP2Hl68vigLcRwRwixDg9q8w8J1D7veCUKY98D3sKR6EfBD1sN-84Sn_4Y38qOcNizyPQdilJYLRFgeQC5mFAwcO2-GnlO6nn5FLRiZwJNnMcG8tPd8H2wwfhnzvuot4mVHNDS9PyZEEyUu4J4t_FKeMtVN7tJln80tapQiXFyKrLfBzTxYt9xJVdo33UVXmMk7YOK6HEP_hxsPC4VdQnuoF6c6_ZERSp66B609UtZwZq5q_gYzzU_UfpF_cNfcDerjVMtO-KeSTEq9mQguGPJRhG7kqOUCWAj_hx9v0UlYKr6-1tOwray26heMZ_j-TeaJca2sTCA6Zhm3L8sA4v6pJxaFKfs3dWadTmzda1XSsnSTRMERjkrLpvKE08At81s0nkRvRqMEaODSTBRB805_MzHaZeqNswK5yYZaKwPg-u1eaOuAVUD5geyJ_yO6clL356JaFbIJiEySbEISg2QTFJig2P4IiE4IcPLAdIDIByQQiEwgzKMkEDQgoQADJhJJMKMgsTtFkgiYTJJlQkQmSTKjIhP4U23CdTDhaTFbnn_Xtjz7I36VYtWVXqsjdlRLGSvKWWH73mL3-0h37Xw3V6WclxuszUoldNC1QuX_C9vNlLp4yQNV-krp2alpTWtOI4w5a_qjNxy07iZtt8Ywd3HSl5zcffsHuVvwesP3NaitestvTdWbE6-krSc5vhrjTYg VL - 189 ID - 761970 ER - TY - JOUR AB - Introduction: There has been a rapid increase in the development pulmonary embolism response teams (PERT). Advocates suggest PERTs are the new standard of care for patients with complex PE; however, little data exist comparing outcomes before and after creation of a PERT. Hypothesis: A PERT will reduce mortality for patients with complex PE. Methods: This was a retrospective analysis of all patients with acute PE at an academic, tertiary care medical center for the 3 years prior to the development of a PERT (August 2012 through July 2015) and 3 years after establishment of a PERT (August 2015 through July 2018). We evaluated differences in outcomes (mortality and readmission) and practice patterns between groups. The primary outcome was PE-related mortality in patients cared for in an intensive care unit with intermediate or high-risk PE. Results: In the pre-PERT era, 890 patients were hospitalized with acute PE, of which 194 (22%) patients were cared for in an ICU with an intermediate or high-risk PE compared to 272 of 1163 (23%) in the PERT era. PERT consultation was performed in 164 patients in the PERT era (14%), including 115 of the 272 patients admitted to an ICU with elevated-risk PE. Demographics and comorbidities did not differ significantly eras. Utilization of advanced therapies were similar between eras, yet catheter-directed therapy accounted for a greater proportion in the PERT era (Figure 1). In addition, IVC filters were less frequently utilized in the PERT era. There was a non-significant trend toward a decrease in PE-related mortality in the PERT era (13.4% vs 8.8%; p=0.13). In-hospital mortality and 30-day readmissions were similar. Conclusions: Presence of a PERT was associated with similar use of advanced therapies and lower use of IVC filters among patients with elevated-risk PE. There is a suggestion that PE-related mortality decreased in the post-PERT era, but further analyses are needed to confirm this finding. AD - B. Carroll AU - Carroll, B. AU - Mehegan, T. AU - Weinstein, J. J. AU - Bauer, K. AU - Hayes, M. AU - Chu, L. M. AU - Locke, A. AU - Godishala, A. AU - Dicks, A. AU - Soriano, K. AU - Kanduri, J. AU - Sack, K. AU - Marcus, M. AU - Wiest, C. AU - Pribish, A. AU - Secemsky, E. A. AU - Pinto, D. S. DB - Embase DO - 10.1161/circ.140.suppl_1.15600 KW - adult catheter comorbidity conference abstract consultation controlled study demography female filter hospital mortality hospital readmission human intensive care unit major clinical study male pulmonary embolism response team retrospective study risk assessment tertiary health care LA - English M3 - Conference Abstract N1 - L630925083 2020-02-18 PY - 2019 SN - 1524-4539 ST - Effect of a multidisciplinary pulmonary embolism response team on outcomes in elevated-risk acute pulmonary embolism T2 - Circulation TI - Effect of a multidisciplinary pulmonary embolism response team on outcomes in elevated-risk acute pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630925083&from=export http://dx.doi.org/10.1161/circ.140.suppl_1.15600 VL - 140 ID - 760777 ER - TY - JOUR AU - Carroll, B. J. AU - Beyer, S. E. AU - Mehegan, T. AU - Dicks, A. AU - Pribish, A. AU - Locke, A. AU - Godishala, A. AU - Soriano, K. AU - Kanduri, J. AU - Sack, K. AU - Raber, I. AU - Wiest, C. AU - Balachandran, I. AU - Marcus, M. AU - Chu, L. AU - Hayes, M. M. AU - Weinstein, J. L. AU - Bauer, K. A. AU - Secemsky, E. A. AU - Pinto, D. S. DA - 2020/05/17 05/17 DB - Europe PubMed Central DO - 10.1016/j.amjmed.2020.03.058 PY - 2020 SN - 0002-9343 ST - Changes in Care for Acute Pulmonary Embolism Through A Multidisciplinary Pulmonary Embolism Response Team T2 - Am J Med TI - Changes in Care for Acute Pulmonary Embolism Through A Multidisciplinary Pulmonary Embolism Response Team UR - http://europepmc.org/article/MED/32416175 ID - 761923 ER - TY - JOUR AB - Pulmonary embolism (PE) can result in rapid clinical decompensation in many patients. With increasing patient complexity and advanced treatment options for PE, multidisciplinary, rapid response teams can optimize risk stratification and expedite management strategies. The Massive And Submassive Clot On-call Team (MASCOT) was created at our institution, which comprised specialists from cardiology, pulmonology, hematology, interventional radiology, and cardiac surgery. MASCOT offers rapid consultation 24 hours a day with a web-based conference call to review patient data and discuss management of patients with high-risk PE. We reviewed patient data collected from MASCOT's registry to analyze patient clinical characteristics and outcomes and describe the composition and operation of the team. Between August 2015 and September 2016, MASCOT evaluated 72 patients. Seventy of the 72 patients were admitted to our institution, accounting for 32% of all patients discharged with a primary diagnosis of PE. Average age was 62 ± 17 years with a female predominance (63%). Active malignancy (31%), recent surgery or trauma (21%), and recent hospitalization (24%) were common. PE clinical severity was massive in 16% and submassive in 83%. Patients were managed with anticoagulation alone in 65% (n = 46), systemic fibrinolysis in 11% (n = 8), catheter-directed therapy in 18% (n = 13), extracorporeal membrane oxygenation in 3% (n = 2), and an inferior vena cava filter was placed in 15% (n = 11). Thirteen percent (n = 9) experienced a major bleed with no intracranial hemorrhage. Survival to discharge was 89% (64% with massive PE and 93% with submassive PE). In conclusion, multidisciplinary, rapid response PE teams offer a unique coordinated approach to patient care. AD - Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Division of Interventional Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Division of Pulmonology and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: dpinto@bidmc.harvard.edu. AN - 28807405 AU - Carroll, B. J. AU - Pemberton, H. AU - Bauer, K. A. AU - Chu, L. M. AU - Weinstein, J. L. AU - Levarge, B. L. AU - Pinto, D. S. DA - Oct 15 DO - 10.1016/j.amjcard.2017.07.033 DP - NLM ET - 2017/08/16 J2 - The American journal of cardiology KW - Anticoagulants/*therapeutic use Extracorporeal Membrane Oxygenation/*methods Female Follow-Up Studies Humans Male Massachusetts/epidemiology Middle Aged Patient Care Team/*standards Pulmonary Embolism/mortality/*therapy Retrospective Studies Survival Rate/trends Thrombectomy/*methods Thrombolytic Therapy/*methods Treatment Outcome *Vena Cava Filters LA - eng M1 - 8 N1 - 1879-1913 Carroll, Brett J Pemberton, Heather Bauer, Kenneth A Chu, Louis M Weinstein, Jeffrey L Levarge, Barbara L Pinto, Duane S Journal Article United States Am J Cardiol. 2017 Oct 15;120(8):1393-1398. doi: 10.1016/j.amjcard.2017.07.033. Epub 2017 Jul 26. PY - 2017 SN - 0002-9149 SP - 1393-1398 ST - Initiation of a Multidisciplinary, Rapid Response Team to Massive and Submassive Pulmonary Embolism T2 - Am J Cardiol TI - Initiation of a Multidisciplinary, Rapid Response Team to Massive and Submassive Pulmonary Embolism VL - 120 ID - 760187 ER - TY - JOUR AB - Background Until few decades ago, the orthopaedic treatment of haemophilic arthropathy in subjects with inhibitors was considered at risk of severe complications and poor outcomes, mostly related to septic loosening and postoperative bleedings. These fact, in combination to the usually worse target joint conditions with respect to subjects without inhibitors, induced for many years orthopaedic surgeons to discourage such patients from surgery. Thus, the quality of life of subjects with inhibitors has been referred as rather poor. It is the reason why few papers deal with this topic, in a low number of patients and limited series compared to subjects without inhibitors. The aim of the present study is the analysis of the long-term outcomes of joint arthroplasties performed in a population of Persons with Haemophilia (PWH) with inhibitors, the more consistent to date reported at a single Haemophilia Centre. Methods Eighteen PWH and inhibitors were treated by 26 joint replacement procedures. Thirteen patients were treated by a primary joint replacement (18 Total Knee Arthroplasties-TKA, and 2 Total Hip Arthroplasties-THA). Five patients underwent a revision arthroplasty. In 3 cases, a revision of a knee arthroplasty (rTKA) was performed, while in 2 cases a revision of a hip arthroplasty (rTHA) was made. From the haematological point of view, all patients were managed by the use of recombinant factor VII depending on the pharmacokinetics. Clinical and radiographic parameters were evaluated preoperatively and after surgery at specific intervals. Results No patient was lost at follow-up. The mean follow-up was of 7.6 years (range: 3-13). No early mechanical complications were reported in both groups. Two complications were reported in 2 PWH undergone a TKA: a case of non-fatal pulmonary embolism managed by intensive therapy unit monitoring, and a case of postoperative bleeding managed by increased doses of rFVIIa administration until clinical resolution. A single case operated at the authors' Institution for TKA failed 4 years after the index operation: he underwent a rTKA with global satisfaction. All functional scores improved after surgery. Conclusions Surgical treatments in PWH with inhibitors have been associated to high risk of postoperative complications, mainly bleedings and infections Key improvements in the multidisciplinary management of these patients now safely allow to perform several procedures with efficacy and safety. Primary TKA or THA with modern implants may now ensure the resolution of pain, restoration of static and dynamic function, and a longer survivorship with respect to the early generation of implants also in patients with inhibitors. Also revisions, even if usually technically demanding (sometimes close to 'limb salvage' surgery), had outcomes more than acceptable. The orthopaedic management of arthropathy in PWH and inhibitors may be considered safe and effective if performed in dedicated facilities with multidisciplinary teams. AD - C. Carulli, Orthopaedic Clinic, University of Florence, Careggi University Hospital, Florence, Italy AU - Carulli, C. AU - Rizzo, A. R. AU - Linari, S. AU - Zago, M. AU - Pieri, L. AU - Castaman, G. AU - Innocenti, M. DB - Embase DO - 10.2450/2017.S4 KW - blood clotting factor 7 endogenous compound recombinant blood clotting factor 7a adult clinical article complication controlled study drug therapy follow up hemophilia hemophilic arthropathy human infection intensive care unit limb salvage lung embolism male monitoring pain pharmacokinetics postoperative hemorrhage revision arthroplasty satisfaction surgery total hip prosthesis total knee arthroplasty LA - English M3 - Conference Abstract N1 - L619752553 2017-12-20 PY - 2017 SN - 1723-2007 SP - s546 ST - Joint replacements for severe haemophilic arthropathy in patients with inhibitors: A long-term experience at a single institution T2 - Blood Transfusion TI - Joint replacements for severe haemophilic arthropathy in patients with inhibitors: A long-term experience at a single institution UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619752553&from=export http://dx.doi.org/10.2450/2017.S4 VL - 15 ID - 760897 ER - TY - JOUR AB - OBJECTIVE: To evaluate placenta accreta spectrum with and without placenta previa with regard to risk factors, antepartum diagnosis, and maternal morbidity. METHODS: We conducted a retrospective cohort study of pathology-confirmed placenta accreta spectrum deliveries with hysterectomy from two U.S. referral centers from January 2010-June 2019. Maternal, pregnancy, and delivery characteristics were compared among placenta accreta spectrum cases with (previa PAS group) and without (nonprevia PAS group) placenta previa. Surgical outcomes and a composite of severe maternal morbidities were evaluated, including eight or more blood cell units transfused, reoperation, pulmonary edema, acute kidney injury, thromboembolism, or death. Logistic regression was used with all analyses controlled for delivery location. RESULTS: Of 351 deliveries, 106 (30%) had no placenta previa at delivery. When compared with the previa group, nonprevia placenta accreta spectrum was less likely to be identified antepartum (38%, 95% CI 28-48% vs 87%, 82-91%), less likely to receive care from a multidisciplinary team (41%, 31-51% vs 86%, 81-90%), and less likely to have invasive placenta increta or percreta (51% 41-61% vs 80%, 74-84%). The nonprevia group had more operative hysteroscopy (24%, 16-33% vs 6%, 3-9%) or in vitro fertilization (31%, 22-41% vs 9%, 6-13%) and was less likely to have had a prior cesarean delivery (64%, 54-73% vs 93%, 89-96%) compared with the previa group, though the majority in each group had a prior cesarean delivery. Rates of severe maternal morbidity were similar in the two groups, at 19% (nonprevia) and 20% (previa), even after controlling for confounders (adjusted odds ratio for the nonprevia group 0.59, 95% CI 0.30-1.17). CONCLUSION: Placenta accreta spectrum without previa is less likely to be diagnosed antepartum, potentially missing the opportunity for multidisciplinary team management. Despite the absence of placenta previa and less placental invasion, severe maternal morbidity at delivery was not lower. Broader recognition of patients at risk for placenta accreta spectrum may improve early clinical diagnosis and patient outcomes. AD - Harvard Medical School, Boston, Massachusetts; Baylor College of Medicine, Houston, Texas; Stanford University, Stanford, California; University of Utah, Salt Lake City, Utah; and the Pan-American Society for Placenta Accreta Spectrum, Houston, Texas. AN - 32769646 AU - Carusi, D. A. AU - Fox, K. A. AU - Lyell, D. J. AU - Perlman, N. C. AU - Aalipour, S. AU - Einerson, B. D. AU - Belfort, M. A. AU - Silver, R. M. AU - Shamshirsaz, A. A. DA - Sep DO - 10.1097/aog.0000000000003970 DP - NLM ET - 2020/08/10 J2 - Obstetrics and gynecology LA - eng M1 - 3 N1 - 1873-233x Carusi, Daniela A Fox, Karin A Lyell, Deirdre J Perlman, Nicola C Aalipour, Soroush Einerson, Brett D Belfort, Michael A Silver, Robert M Shamshirsaz, Alireza A Journal Article United States Obstet Gynecol. 2020 Sep;136(3):458-465. doi: 10.1097/AOG.0000000000003970. PY - 2020 SN - 0029-7844 SP - 458-465 ST - Placenta Accreta Spectrum Without Placenta Previa T2 - Obstet Gynecol TI - Placenta Accreta Spectrum Without Placenta Previa VL - 136 ID - 760422 ER - TY - JOUR AB - The objective of this prospective cohort study was to see the effect of the implementation of a Sepsis Intervention Program on the standard processes of patient care using a collaborative approach between the Emergency Department (ED) and Medical Intensive Care Unit (MICU). This was performed in a large urban tertiary-care hospital, with no previous experience utilizing a specific intervention program as routine care for septic shock and which has services and resources commonly available in most hospitals. The study included 106 patients who presented to the ED with severe sepsis or septic shock. Eighty-seven of those patients met the inclusion criteria for complete data analysis. The ED and MICU staff underwent a 3-month training period followed by implementation of a protocol for sepsis intervention program over 6 months. In the first 6 months of the program's implementation, 106 patients were admitted to the ED with severe sepsis and septic shock. During this time, the ED attempted to initiate the sepsis intervention protocol in 76% of the 87 septic patients who met the inclusion criteria. This was assessed by documentation of a central venous catheter insertion for continuous SvO(2) monitoring in a patient with sepsis or septic shock. However, only 48% of the eligible patients completed the early goal-directed therapy (EGDT) protocol. Our data showed that the in-hospital mortality rate was 30.5% for the 87 septic shock patients with a mean APACHE II score of 29. This was very similar to a landmark study of EGDT (30.5% mortality with mean APACHE II of 21.5). Data collected on processes of care showed improvements in time to fluid administration, central venous access insertion, antibiotic administration, vasopressor administration, and time to MICU transfer from ED arrival in our patients enrolled in the protocol versus those who were not. Further review of our performance data showed that processes of care improved steadily the longer the protocol was in effect, although this was not statistically significant. There was no improvement in secondary outcomes, including total length of hospital stay, MICU days, and mortality. Implementation of a sepsis intervention program as a standard of care in a typical hospital protocol leads to improvements in processes of care. However, despite a collaborative approach, the sepsis intervention program was underutilized with only 48% of the patients completing the sepsis intervention protocol. AD - Memorial Hospital of Rhode Island, Brown University, 111 Brewster Street, Pawtucket, RI 02860, USA. brian_casserly@brown.edu AN - 21080182 AU - Casserly, B. AU - Baram, M. AU - Walsh, P. AU - Sucov, A. AU - Ward, N. S. AU - Levy, M. M. DA - Feb DO - 10.1007/s00408-010-9266-z DP - NLM ET - 2010/11/17 J2 - Lung KW - Apache Aged Aged, 80 and over Anti-Bacterial Agents/therapeutic use Catheterization, Central Venous *Clinical Protocols Combined Modality Therapy *Cooperative Behavior Critical Care/*organization & administration/statistics & numerical data Emergency Service, Hospital/*organization & administration/statistics & numerical data Female Fluid Therapy Hospital Mortality Humans Intensive Care Units/*organization & administration/statistics & numerical data Length of Stay Male Middle Aged Organizational Objectives *Outcome and Process Assessment, Health Care Patient Care Team/*organization & administration/statistics & numerical data Patient Transfer Program Development Program Evaluation Prospective Studies Resuscitation Rhode Island Sepsis/diagnosis/mortality/*therapy Shock, Septic/diagnosis/mortality/*therapy Time Factors Treatment Outcome Vasoconstrictor Agents/administration & dosage LA - eng M1 - 1 N1 - 1432-1750 Casserly, Brian Baram, Michael Walsh, Patricia Sucov, Andrew Ward, Nicholas S Levy, Mitchell M Journal Article United States Lung. 2011 Feb;189(1):11-9. doi: 10.1007/s00408-010-9266-z. Epub 2010 Nov 16. PY - 2011 SN - 0341-2040 SP - 11-9 ST - Implementing a collaborative protocol in a sepsis intervention program: lessons learned T2 - Lung TI - Implementing a collaborative protocol in a sepsis intervention program: lessons learned VL - 189 ID - 760473 ER - TY - JOUR AB - Objectives and Study: Vascular disorders of the liver might be caused by congenital anomalies, coagulopathies and by chronic liver disease (CLD). They are associated with severe complications. Children with prehepatic portal vein obstruction are recommended MesoRex bypass (MRB) for prophylaxis of variceal bleeding and other complications. Partial splenic embolization is an adjunctive treatment option in portal hypertension with hypersplenism. Transjugular intrahepatic portosystemic shunt (TIPS) may be a treatment option in children with gastrointestinal haemorrhage and ascites unresponsive to other treatment. Closure of congenital portosystemic shunts (CPSS) should be considered early to prevent development of hepatopulmonary syndrome, pulmonary hypertension and chronic hyperammonemia. Vascular complications after liver transplantation (LT), especially in small children, may require interventions. To improve our evaluation, management and follow up of this patient group; a multidisciplinary team was set up at our tertiary center for pediatric hepatology. The aim of this study was to evaluate the results of first two years with this team. Method: The team consists of paediatric hepatologists, paediatric coagulation specialist, interventional radiologist, paediatric radiologist, paediatric hepatology nurse and patient coordinator. The team collaborates with a paediatric abdominal-and transplant surgeon, with expertise in the MRB, at another center. Charts of all patients evaluated by the team January 2015-November 2017 were reviewed. In case of intervention platelet count, ammonium level and spleen size, before and after the procedure, were recorded. Results: 28 patients (10 girls, 18 boys), median age 8.9 yrs. (23 days-17.4 years) were evaluated. Diagnoses were CPSS (8 patients), chronic prehepatic portal vein thrombosis/obliteration (8), CLD (6), vascular complication post liver transplantation (5), Budd Chiari (1).15 patients underwent vascular interventions, see table below. One patient had a TIPS followed by partial spleen embolization (included in two groups). The results of the procedures on mean platelet count, ammonium level and spleen size are included in the table. Increase in mean platelet count, reduction in mean ammonium level and decrease in mean spleen size were seen to various extent in the MRB-, splenic embolization-and TIPS-groups. Plug occlusion of CPSS resulted in lower ammonium levels. Statistics not calculated due to limited number of patients. The patients who developed MRB stenosis and TIPS occlusion could be successfully treated with stent placement and TIPS revision, respectively. Conclusion: A multidisciplinary team for vascular liver disease can be an efficient way to structure the evaluation and treatment of patients with hepatic vascular disorders and optimize care and outcome. AD - T. Casswall, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden AU - Casswall, T. AU - Delle, M. AU - Sund, M. AU - Beijer, E. AU - Hallberg, L. AU - Seidel, A. AU - De Ville De Goyet, J. AU - Németh, A. AU - Magnusson, M. DB - Embase KW - ammonia artificial embolization ascites Budd Chiari syndrome child chronic liver disease clinical article complication conference abstract congenital portosystemic shunt controlled study diagnosis female follow up gastrointestinal hemorrhage girl hepatopulmonary syndrome human hyperammonemia hypersplenism interventional radiologist liver transplantation male nurse pediatric radiologist platelet count portal vein thrombosis prevention pulmonary hypertension school child spleen size statistics stenosis transjugular intrahepatic portosystemic shunt transplant surgeon LA - English M3 - Conference Abstract N1 - L622344213 2018-06-01 PY - 2018 SN - 1536-4801 SP - 724-725 ST - Multidisciplinary team for paediatric vascular disorders of the liver T2 - Journal of Pediatric Gastroenterology and Nutrition TI - Multidisciplinary team for paediatric vascular disorders of the liver UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622344213&from=export VL - 66 ID - 760835 ER - TY - JOUR AB - National Quality Improvement Project (NSQIP) semiannual reports (SARs) revealed high observed to expected ratios for venous thromboembolic events (VTEs) on the surgical service. Press Ganey scores identified an area of particular weakness in shared decision-making in patient care. Patients reported little to no participation in shared decision-making. A performance improvement project was developed with a 2-fold objective: decrease the percentages of patients sustaining VTE through adequate screening and prophylaxis (VTEP) and to engage patients in shared decision-making to accept VTEP through enhanced patient-centered discussions and education on the risks and benefits of VTEP. A clinical pathway was developed to implement VTEP using a standardized risk assessment tool. Patient-centered discussion introduced VTEP and impact on perioperative safety. Results included telephone survey, NSQIP SARs, and Press Ganey patient experience survey. Using NSQIP data and a pathway developed for both VTE risk assessment and patient engagement, the authors observe immediate improvements in patient experience and decreased rates of VTE. AD - [Castaldi, Maria] Jacobi Med Ctr, Surg Qual, Bronx, NY USA. [Turner, Pamela] Jacobi Med Ctr, Nursing Perioperat Serv & Intervent Radiol, Bronx, NY USA. [McNelis, John] Jacobi Med Ctr, Dept Surg, Bronx, NY USA. [Castaldi, Maria; George, Geena] Westchester Med Ctr, Dept Surg, Clincial Res Unit, Valhalla, NY USA. Castaldi, M (corresponding author), Westchester Med Ctr, Dept Surg, 100 Woods Rd,Taylor Pavil D344, Valhalla, NY 10595 USA. maria.castaldi@wmchealth.org AN - WOS:000515038200015 AU - Castaldi, M. AU - George, G. AU - Turner, P. AU - McNelis, J. DA - Feb DO - 10.1177/2374373518817081 J2 - J. Patient Experience KW - communication outpatient satisfaction data patient engagement patient safety physician engagement quality improvement team communication VENOUS THROMBOEMBOLISM RISK HOSPITAL-CARE SATISFACTION Health Care Sciences & Services LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: KN7SO Times Cited: 0 Cited Reference Count: 15 Castaldi, Maria George, Geena Turner, Pamela McNelis, John George, Geena/0000-0001-9701-334X 0 1 SAGE PUBLICATIONS INC THOUSAND OAKS J PATIENT EXPERIENCE PY - 2020 SN - 2374-3743 SP - 89-95 ST - NSQIP Impacts Patient Experience T2 - Journal of Patient Experience TI - NSQIP Impacts Patient Experience UR - ://WOS:000515038200015 VL - 7 ID - 761464 ER - TY - JOUR AB - Sticky platelet syndrome is an entity where patients have platelet hiperaggregability and thrombotic clinical manifestations. It was observed more than 30 years ago in young people with occlusive arterial, venous, myocardial infarctions, stroke, and later it was reported in women with recurrent pregnancy loss and obstetric complication events. The treatment of choice is aspirin which reverted platelet hyperaggregability. We present a pregnant woman diagnosed with type II sticky platelets syndrome with a history of two pregnancy loss. During this pregnancy, she received antiplatelet therapy and molecular weight heparin. Despite this therapy, complications arose in the third quarter that led to the early termination of pregnancy, but we obtained an alive underweight newborn without any perinatal complications. Currently, the patient maintains aspirin and she has no occlusive events. These results demonstrate that the care of these patients by a multidisciplinary team has successful outcome. AD - D. Castillo-González, Instituto de Hematología e Inmunología, Apartado 8070, La Habana, CP, Cuba AU - Castillo-González, D. AU - Rodríguez-Pérez, L. AU - Rodríguez-López, R. AU - García del Collado, A. AU - Tejeda-González, M. DB - Embase KW - acetylsalicylic acid antithrombocytic agent low molecular weight heparin artery occlusion article case report cerebrovascular accident Cuba female follow up gestation period heart infarction human low birth weight platelet hyperaggregability pregnancy termination pregnant woman sticky platelet syndrome thrombocyte disorder vein occlusion LA - Spanish M1 - 4 M3 - Article N1 - L607871086 2016-01-27 2016-02-02 PY - 2015 SN - 1561-2996 0864-0289 SP - 452-458 ST - Gestational follow-up of pregnant woman with sticky platelets syndrome: First patient reported in Cuba T2 - Revista Cubana de Hematologia, Inmunologia y Hemoterapia TI - Gestational follow-up of pregnant woman with sticky platelets syndrome: First patient reported in Cuba UR - https://www.embase.com/search/results?subaction=viewrecord&id=L607871086&from=export VL - 31 ID - 761055 ER - TY - JOUR AB - BACKGROUND Staff in the surgical intensive care unit (SICU) had several concerns about mobilizing patients receiving mechanical ventilation. OBJECTIVE To assess and improve the mindset of SICU staff toward early mobilization of patients receiving mechanical ventilation before, 6 months after, and 1 year after implementation of early mobilization. METHODS The Plan-Do-Study-Act model was used to guide the planning, implementation, evaluation, and interventions to change the mindset and practice of SICU staff in mobilizing patients receiving mechanical ventilation. Interventions to overcome barriers to early mobilization included interdisciplinary collaboration, multimodal education, and operational changes. The mindset of the SICU staff toward early mobilization of patients receiving mechanical ventilation was assessed by using a survey questionnaire distributed 2 weeks before, 6 months after, and 1 year after implementation of early mobilization. RESULTS The median score on 6 of 7 survey questions changed significantly from before, to 6 months after, to 1 year after implementation, indicating a change in the mindset of SICU staff toward early mobilization of patients receiving mechanical ventilation. The SICU staff agreed that most patients receiving mechanical ventilation are able to get out of bed safely with coordination among personnel and that early mobilization of intubated patients decreases length of stay and decreases occurrence of ventilator-associated pneumonia, deep vein thrombosis, and skin breakdown. CONCLUSIONS SICU interdisciplinary team collaboration, multimodal education, and operational support contribute to removing staff bias against mobilizing patients receiving mechanical ventilation. AD - [Castro, Emily; Turcinovic, Michael] N Shore Univ Hosp, Manhasset, NY 11030 USA. [Platz, John] N Shore Univ Hosp, Long Isl Jewish Med Ctr New Hyde Pk, Surg Intens Care Unit, Manhasset, NY 11030 USA. [Platz, John] N Shore Univ Hosp, Long Isl Jewish Med Ctr New Hyde Pk, Trauma Serv, Manhasset, NY 11030 USA. [Platz, John] SouthSide Hosp, Bay Shore, NY USA. [Law, Isabel] N Shore Univ Hosp, Early Mobilizat Qual Improvement Project, Manhasset, NY 11030 USA. Castro, E (corresponding author), N Shore Univ Hosp, 300 Community Dr, Manhasset, NY 11030 USA. ecastro@nshs.edu AN - WOS:000360574100001 AU - Castro, E. AU - Turcinovic, M. AU - Platz, J. AU - Law, I. DA - Aug DO - 10.4037/ccn2015512 J2 - Crit. Care Nurse KW - INTENSIVE-CARE-UNIT RESPIRATORY-DISTRESS-SYNDROME CRITICALLY-ILL PATIENTS QUALITY IMPROVEMENT MOBILITY REHABILITATION FAILURE MEDICINE Critical Care Medicine Nursing LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: CQ4KR Times Cited: 22 Cited Reference Count: 20 Castro, Emily Turcinovic, Michael Platz, John Law, Isabel 27 0 14 AMER ASSOC CRITICAL CARE NURSES ALISO VIEJO CRIT CARE NURSE PY - 2015 SN - 0279-5442 SP - E1-E7 ST - Early Mobilization: Changing the Mindset T2 - Critical Care Nurse TI - Early Mobilization: Changing the Mindset UR - ://WOS:000360574100001 VL - 35 ID - 761744 ER - TY - JOUR AB - Arthrogryposis multiplex congenita refers to a clinical condition or syndrome characterised by multiple congenital contractures that affect two or more different areas of the body. Of the cases reported so far, an important percentage had to be terminated before pregnancy term, predominantly by caesarean section. We describe a 36 year-old woman who wanted to conceive. A multidisciplinary approach was set from the preconceptional period and special attention was given to respiratory function, potential anaesthetic difficulties and thromboembolic risks. She delivered by caesarean section at 38 weeks. This case emphasises the possibility of achieving a term delivery in these patients and points out the importance of a multidisciplinary team, specially of obstetricians and anaesthesiologists. Copyright 2013 BMJ Publishing Group. All rights reserved. AD - J. Castro, Department of Gynecology/Obstretrics, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal AU - Castro, J. AU - Abreu-Silva, J. AU - Godinho, C. AU - Valente, F. DB - Embase Medline DO - 10.1136/bcr-2013-201621 KW - adult arthrogryposis article case report cesarean section crutch female fetus echography first trimester pregnancy follow up genetic counseling human joint limitation maternal attitude orthopedic surgery patient referral pregnancy priority journal scoliosis smoking cessation L1 - http://casereports.bmj.com/content/2013/bcr-2013-201621.full.pdf+html?sid=99294f2f-1a2a-4a04-9252-355231b046d7 LA - English M3 - Article N1 - L370471249 2013-12-21 2014-01-15 PY - 2013 SN - 1757-790X ST - Successful pregnancy in a woman with arthrogryposis multiplex congenita T2 - BMJ Case Reports TI - Successful pregnancy in a woman with arthrogryposis multiplex congenita UR - https://www.embase.com/search/results?subaction=viewrecord&id=L370471249&from=export http://dx.doi.org/10.1136/bcr-2013-201621 ID - 761143 ER - TY - JOUR AB - Context: Signal transducer and activator of transcription 3 (STAT3) deficiency is the main cause of hyper-IgE syndrom. These patients present with a diversity of manifestations including immunodeficiency on an atopic background with rhumatologic, cutaneous, cardio-vascular and respiratory disorders. Pulmonary manifestations have a major impact on their prognosis but data are scarce because of its low prevalence and high clinical heterogeneity. Objective: To describe acute and chronic pulmonary events in the French national cohort of adults patients with proven STAT3 deficiency. Secondary objectives are to identify risk factors of severe respiratory complications and to help improve clinical management. Method: Collection of acute and chronic pulmonary events in patients registered in CEREDIH national registry and aged above 16 was performed from may 2015 to Dec. 2015. Clinical, biological and radiologic findings were analyzed by a multidisciplinary team of specialists of lung diseases, immunodeficiency, haematology and lung imaging. Results: 56 patients (44% women) from 23 centers were included. Age ranged from 16 to 51. 12 patients (21%) were diagnosed after 18. Infectious respiratory events were the most frequent at all ages, seen in 95% of patients; mainly bacterial lower respiratory tract infections (30% documented with S. aureus), and fungal lung infections due to A. fumigatus (32 events in 19 patients). Vascular events were frequently seen: 7 venous thrombo-embolic events and one case of severe pulmonary arterial hypertension. Imaging analysis showed that 42 patients (75%) presented bronchiectasis or pneumatocele and 19 patients before the age of 16. Conclusion: To our knowledge, this is the only adult cohort studying respiratory involvements in STAT3 deficiency. It will help understanding and managing of this challenging disease and raise awareness of adult pulmonologists about an alternative diagnosis for bronchiectasis. AD - C. Givel, Hopital FOCH, Suresnes, France AU - Catherinot, E. AU - Givel, C. AU - Chandesris, O. AU - Mahlaoui, N. AU - Tcherakian, C. AU - Picard, C. AU - Salvator, H. AU - Rivaud, E. AU - Moshous, D. AU - Lortholary, O. AU - Blanche, S. AU - Lanternier, F. AU - Neven, B. AU - Fischer, A. AU - Hermine, O. AU - Dureault, A. AU - Poiree, S. AU - Couderc, L. J. DB - Embase DO - 10.1164/ajrccm-conference.2017.B103 KW - endogenous compound STAT3 protein adolescent adult awareness bronchiectasis cohort analysis complication diagnosis disease course female hematology human imaging immune deficiency lung infection major clinical study male pneumatocele pulmonary hypertension pulmonologist register risk factor vein embolism LA - English M3 - Conference Abstract N1 - L617708656 2017-08-15 PY - 2017 SN - 1535-4970 ST - Pulmonary manifestations in adult patients with STAT3 deficiency: A french nationwide registry-based cohort study T2 - American Journal of Respiratory and Critical Care Medicine TI - Pulmonary manifestations in adult patients with STAT3 deficiency: A french nationwide registry-based cohort study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617708656&from=export http://dx.doi.org/10.1164/ajrccm-conference.2017.B103 VL - 195 ID - 760968 ER - TY - JOUR AB - Objective: Clinical decision making and accurate outcomes comparisons in advanced limb ischemia require improved staging systems. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System (Wound extent, Ischemia, and foot Infection [WIfI]) was designed to stratify limb outcomes based on three major factors-wound extent, ischemia, and foot infection. The Project or Ex-Vivo vein graft Engineering via Transfection III (PREVENT) III (PIII) risk score was developed to stratify patients by expected amputation-free survival (AFS) after surgical revascularization. This study was designed to prospectively assess limb and patient-based staging for predicting outcomes of hospitalized patients in an amputation prevention program. Methods: This study undertook a retrospective analysis of prospectively gathered registry data of consecutive patients with limb-threatening conditions admitted to a fully integrated vascular/podiatry service over a 16-month period. Upon admission, limb risk was stratified using the WIfI system and patient risk was categorized using PIII classification. Patients were assessed for perioperative and postdischarge outcomes, and their relationship to staging at admission was analyzed. Results: There were 174 threatened limbs (143 hospitalized patients) stratified by WIfI stage (1%-12%, 2%-28%, 3%-24%, 4%-28%, 5%-3%, unstaged-5%) and PIII risk (34% low, 49% moderate, and 17% high risk). Diabetes and end-stage renal disease were associated with WIfI stage (P = .006 and P = .018) and PIII risk (P = .003 and P < .001). Perioperative (30-day) events included 3% mortality, 8% major adverse cardiovascular events and 2.4% major amputation. There were 119 limbs (71%) that underwent revascularization, including 108 infrainguinal reconstructions (endovascular or open revascularization). Rate of revascularization increased with WIfI stage (P < .001), concomitant with the number of podiatric procedures, minor amputations, and initial hospital duration of stay (all P < .001). Increased WIfI stage was associated with major adverse limb events (P = .018), reduced limb salvage (P = .037), and decreased AFS (P = .048). In contrast, PIII risk category was associated with mortality (P < .001) and AFS (P < .001). Among infrainguinal reconstruction procedures, there was a similar distribution of endovascular (46%) and surgical (54%) interventions. Freedom from major adverse limb events was best for autogenous vein bypass (P = .025), and surgical revascularization was associated with improved limb salvage among the most severely threatened limbs (WIfI stage 4: 95% limb salvage for open bypass vs 68% limb salvage for endovascular; P = .026). Conclusions: Among patients hospitalized with limb-threatening conditions and treated by a multidisciplinary amputation prevention team, PIII risk correlates with mortality whereas WIfI stage strongly predicts initial hospital duration of stay, and key mid-term limb outcomes. Surgical revascularization performed best in the limbs at greatest risk (WIfI stage 4), and autogenous vein bypass was the preferred conduit for open bypass. These data support the use of WIfI and PIII as complementary staging tools in the management of chronic limb-threatening ischemia. AD - [Causey, Marlin W.; Ahmed, Ayman; Wu, Bian; Gasper, Warren J.; Reyzelman, Alex; Vartanian, Shant M.; Hiramoto, Jade S.; Conte, Michael S.] Univ Calif San Francisco, Div Vasc & Endovasc Surg, Ctr Limb Preservat, San Francisco, CA 94143 USA. Conte, MS (corresponding author), Univ Calif San Francisco, Div Vasc & Endovasc Surg, 400 Parnassus Ave, San Francisco, CA 94143 USA. michael.conte2@ucsf.edu AN - WOS:000376231200020 AU - Causey, M. W. AU - Ahmed, A. AU - Wu, B. AU - Gasper, W. J. AU - Reyzelman, A. AU - Vartanian, S. M. AU - Hiramoto, J. S. AU - Conte, M. S. DA - Jun DO - 10.1016/j.jvs.2016.01.011 J2 - J. Vasc. Surg. KW - OBJECTIVE PERFORMANCE GOALS GRADING SYSTEM LEGS SCORE ISCHEMIA VALIDATION REVASCULARIZATION FINNVASC PREDICTION MODEL Surgery Peripheral Vascular Disease LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: DM3FC Times Cited: 34 Cited Reference Count: 20 Causey, Marlin W. Ahmed, Ayman Wu, Bian Gasper, Warren J. Reyzelman, Alex Vartanian, Shant M. Hiramoto, Jade S. Conte, Michael S. 35 1 3 MOSBY-ELSEVIER NEW YORK J VASC SURG PY - 2016 SN - 0741-5214 SP - 1563-+ ST - Society for Vascular Surgery limb stage and patient risk correlate with outcomes in an amputation prevention program T2 - Journal of Vascular Surgery TI - Society for Vascular Surgery limb stage and patient risk correlate with outcomes in an amputation prevention program UR - ://WOS:000376231200020 VL - 63 ID - 761707 ER - TY - JOUR AB - IMPORTANCE The effectiveness of checklists, daily goal assessments, and clinician prompts as quality improvement interventions in intensive care units (ICUs) is uncertain. OBJECTIVE To determine whether a multifaceted quality improvement intervention reduces the mortality of critically ill adults. DESIGN, SETTING, AND PARTICIPANTS This study had 2 phases. Phase 1 was an observational study to assess baseline data on work climate, care processes, and clinical outcomes, conducted between August 2013 and March 2014 in 118 Brazilian ICUs. Phase 2 was a cluster randomized trial conducted between April and November 2014 with the same ICUs. The first 60 admissions of longer than 48 hours per ICU were enrolled in each phase. INTERVENTIONS Intensive care units were randomized to a quality improvement intervention, including a daily checklist and goal setting during multidisciplinary rounds with follow-up clinician prompting for 11 care processes, or to routine care. MAIN OUTCOMES AND MEASURES In-hospital mortality truncated at 60 days (primary outcome) was analyzed using a random-effects logistic regression model, adjusted for patients' severity and the ICU's baseline standardized mortality ratio. Exploratory secondary outcomes included adherence to care processes, safety climate, and clinical events. RESULTS A total of 6877 patients (mean age, 59.7 years; 3218 [46.8%] women) were enrolled in the baseline (observational) phase and 6761 (mean age, 59.6 years; 3098 [45.8%] women) in the randomized phase, with 3327 patients enrolled in ICUs (n = 59) assigned to the intervention group and 3434 patients in ICUs (n = 59) assigned to routine care. There was no significant difference in in-hospital mortality between the intervention group and the usual care group, with 1096 deaths (32.9%) and 1196 deaths (34.8%), respectively (odds ratio, 1.02; 95% CI, 0.82-1.26; P = .88). Among 20 prespecified secondary outcomes not adjusted for multiple comparisons, 6 were significantly improved in the intervention group (use of low tidal volumes, avoidance of heavy sedation, use of central venous catheters, use of urinary catheters, perception of team work, and perception of patient safety climate), whereas there were no significant differences between the intervention group and the control group for 14 outcomes (ICU mortality, central line-associated bloodstream infection, ventilator-associated pneumonia, urinary tract infection, mean ventilator-free days, mean ICU length of stay, mean hospital length of stay, bed elevation to >= 30 degrees, venous thromboembolism prophylaxis, diet administration, job satisfaction, stress reduction, perception of management, and perception of working conditions). CONCLUSIONS AND RELEVANCE Among critically ill patients treated in ICUs in Brazil, implementation of a multifaceted quality improvement intervention with daily checklists, goal setting, and clinician prompting did not reduce in-hospital mortality. AD - [Cavalcanti, Alexandre B.; Guimaraes, Helio Penna; Normilio-Silva, Karina; Damiani, Lucas Petri; Romano, Edson; Berwanger, Otavio] HCor Hosp Coracao, Res Inst, Rua Abilio Soares 250,12th Floor, BR-04005000 Sao Paulo, SP, Brazil. [Bozza, Fernando Augusto; Salluh, Jorge I. F.; Silva, Aline Reis; Ramos, Grazielle Viana] DOr Inst Res & Educ, Rio De Janeiro, Brazil. [Bozza, Fernando Augusto] Fundacao Oswaldo Cruz, Rio De Janeiro, Brazil. [Machado, Flavia R.; Carrara, Fernanda; Diniz de Souza, Juliana Lubarino] Latin Amer Sepsis Inst, Sao Paulo, Brazil. [Campagnucci, Valquiria Pelisser; Vendramim, Patricia] Hosp Samaritano, Sao Paulo, Brazil. [Teixeira, Cassiano; da Silva, Nilton Brandao] Hosp Moinhos Vento, Porto Alegre, RS, Brazil. [Chang, Chung-Chou H.; Angus, Derek C.] Univ Pittsburgh, Pittsburgh, PA USA. Cavalcanti, AB (corresponding author), HCor Hosp Coracao, Res Inst, Rua Abilio Soares 250,12th Floor, BR-04005000 Sao Paulo, SP, Brazil. abiasi@hcor.com.br AN - WOS:000373873800014 AU - Cavalcanti, A. B. AU - Bozza, F. A. AU - Machado, F. R. AU - Salluh, J. I. F. AU - Campagnucci, V. P. AU - Vendramim, P. AU - Guimaraes, H. P. AU - Normilio-Silva, K. AU - Damiani, L. P. AU - Romano, E. AU - Carrara, F. AU - de Souza, J. L. D. AU - Silva, A. R. AU - Ramos, G. V. AU - Teixeira, C. AU - da Silva, N. B. AU - Chang, C. C. H. AU - Angus, D. C. AU - Berwanger, O. AU - Writing Grp, Checklist-Icu AU - Brazilian Res Intensive, Care DA - Apr DO - 10.1001/jama.2016.3463 J2 - JAMA-J. Am. Med. Assoc. KW - BLOOD-STREAM INFECTIONS INTENSIVE-CARE UNITS SAFETY CHECKLISTS SEVERE SEPSIS GUIDELINES CRITERIA OUTCOMES Medicine, General & Internal LA - English M1 - 14 M3 - Article N1 - ISI Document Delivery No.: DJ0EE Times Cited: 64 Cited Reference Count: 37 Cavalcanti, Alexandre B. Bozza, Fernando Augusto Machado, Flavia R. Salluh, Jorge I. F. Campagnucci, Valquiria Pelisser Vendramim, Patricia Guimaraes, Helio Penna Normilio-Silva, Karina Damiani, Lucas Petri Romano, Edson Carrara, Fernanda Diniz de Souza, Juliana Lubarino Silva, Aline Reis Ramos, Grazielle Viana Teixeira, Cassiano da Silva, Nilton Brandao Chang, Chung-Chou H. Angus, Derek C. Berwanger, Otavio Guimaraes, Helio Penna/AAD-8681-2019; Bozza, Fernando A/A-2618-2013; Teixeira, Cassiano/V-8764-2019; Angus, Derek C/E-9671-2012; dantas, vicente c souza/L-2648-2013; Borges, Marcos Carvalho/A-3585-2014; Cavalcanti, Alexandre/K-5529-2013; Damiani, Lucas/F-8576-2015 Bozza, Fernando A/0000-0003-4878-0256; Borges, Marcos Carvalho/0000-0001-6280-0714; Cavalcanti, Alexandre/0000-0003-2798-6263; Damiani, Lucas/0000-0002-5836-3379; Pereira da Silva, Eliane/0000-0002-3364-5046 Brazilian Health Surveillance Agency (ANVISA); PROADI; Brazilian Development Bank (BNDES); D'Or Institute for Research and Education This study was conducted as part of the Program to Support Institutional Development of Universal Health System (PROADI) from the Brazilian Ministry of Health. It was funded mainly by the Brazilian Health Surveillance Agency (ANVISA), PROADI, and Brazilian Development Bank (BNDES). D'Or Institute for Research and Education also contributed with additional funding. 66 1 27 AMER MEDICAL ASSOC CHICAGO JAMA-J AM MED ASSOC PY - 2016 SN - 0098-7484 SP - 1480-1490 ST - Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients A Randomized Clinical Trial T2 - Jama-Journal of the American Medical Association TI - Effect of a Quality Improvement Intervention With Daily Round Checklists, Goal Setting, and Clinician Prompting on Mortality of Critically Ill Patients A Randomized Clinical Trial UR - ://WOS:000373873800014 VL - 315 ID - 761709 ER - TY - JOUR AB - Aggressive pituitary adenomas (PAs) are clinically challenging for endocrinologists and neurosurgeons due to their locally invasive nature and resistance to standard treatment (surgery, medical or radiotherapy). Two pituitary-directed drugs have recently been proposed: temozolomide (TMZ) for aggressive PA, and pasireotide for ACTH-secreting PA. We describe the experience of our multidisciplinary team of endocrinologists, neurosurgeons, neuroradiologists, oncologists, otolaryngologists and pathologists with TMZ and pasireotide treatment for aggressive PAs in terms of their radiological shrinkage and genetic features. We considered five patients with aggressive PA, three of them non-secreting (two ACTH-silent and one becoming ACTH secreting), and two secreting (one GH and one ACTH). TMZ was administrated orally at 150–200 mg/m2 daily for 5 days every 28 days to all 5 patients, and 2 of them also received pasireotide 600–900 µg bid sc. We assessed the MRI at the baseline and during TMZ or pasireotide treatment. We also checked for MGMT promoter methylation and IDH, BRAF and kRAS mutations. Considering TMZ, two patients showed PA progression, one stable disease and two achieved radiological and clinical response. Pasireotide was effective in reducing hypercortisolism and mass volume, combined with TMZ in one case. Both treatments were generally well tolerated; one patient developed a grade 2 TMZ-induced thrombocytopenia. None of patients developed hypopituitarism while taking TMZ or pasireotide treatment. No genetic anomalies were identified in the adenoma tissue. TMZ and pasireotide may be important therapies for aggressive PA, alone or in combination. AD - F. Ceccato, Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, Padua, Italy AU - Ceccato, F. AU - Lombardi, G. AU - Manara, R. AU - Emanuelli, E. AU - Denaro, L. AU - Milanese, L. AU - Gardiman, M. P. AU - Bertorelle, R. AU - Scanarini, M. AU - D’Avella, D. AU - Occhi, G. AU - Boscaro, M. AU - Zagonel, V. AU - Scaroni, C. DB - Embase Medline DO - 10.1007/s11060-014-1702-0 KW - B Raf kinase corticotropin isocitrate dehydrogenase K ras protein methylated DNA protein cysteine methyltransferase octreotide pasireotide temozolomide ACTH secreting adenoma adult aged aggressive pituitary adenoma article cancer genetics clinical article DNA methylation drug efficacy drug tolerability endocrinologist female gene mutation human hypercortisolism hypophysis adenoma male neuroradiologist neurosurgeon nuclear magnetic resonance imaging oncologist otolaryngologist pathologist promoter region retrospective study tertiary care center thrombocytopenia treatment response tumor growth tumor regression tumor volume LA - English M1 - 1 M3 - Article N1 - L601160756 2015-01-14 2015-04-21 PY - 2015 SN - 1573-7373 0167-594X SP - 189-196 ST - Temozolomide and pasireotide treatment for aggressive pituitary adenoma: expertise at a tertiary care center T2 - Journal of Neuro-Oncology TI - Temozolomide and pasireotide treatment for aggressive pituitary adenoma: expertise at a tertiary care center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L601160756&from=export http://dx.doi.org/10.1007/s11060-014-1702-0 VL - 122 ID - 761083 ER - TY - JOUR AB - Aggressive pituitary adenomas (PAs) are clinically challenging for endocrinologists and neurosurgeons due to their locally invasive nature and resistance to standard treatment (surgery, medical or radiotherapy). Two pituitary-directed drugs have recently been proposed: temozolomide (TMZ) for aggressive PA, and pasireotide for ACTH-secreting PA. We describe the experience of our multidisciplinary team of endocrinologists, neurosurgeons, neuroradiologists, oncologists, otolaryngologists and pathologists with TMZ and pasireotide treatment for aggressive PAs in terms of their radiological shrinkage and genetic features. We considered five patients with aggressive PA, three of them non-secreting (two ACTH-silent and one becoming ACTH secreting), and two secreting (one GH and one ACTH). TMZ was administrated orally at 150-200 mg/m(2) daily for 5 days every 28 days to all 5 patients, and 2 of them also received pasireotide 600-900 µg bid sc. We assessed the MRI at the baseline and during TMZ or pasireotide treatment. We also checked for MGMT promoter methylation and IDH, BRAF and kRAS mutations. Considering TMZ, two patients showed PA progression, one stable disease and two achieved radiological and clinical response. Pasireotide was effective in reducing hypercortisolism and mass volume, combined with TMZ in one case. Both treatments were generally well tolerated; one patient developed a grade 2 TMZ-induced thrombocytopenia. None of patients developed hypopituitarism while taking TMZ or pasireotide treatment. No genetic anomalies were identified in the adenoma tissue. TMZ and pasireotide may be important therapies for aggressive PA, alone or in combination. AD - Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy, ceccato.filippo@gmail.com. AN - 25555563 AU - Ceccato, F. AU - Lombardi, G. AU - Manara, R. AU - Emanuelli, E. AU - Denaro, L. AU - Milanese, L. AU - Gardiman, M. P. AU - Bertorelle, R. AU - Scanarini, M. AU - D'Avella, D. AU - Occhi, G. AU - Boscaro, M. AU - Zagonel, V. AU - Scaroni, C. DA - Mar DO - 10.1007/s11060-014-1702-0 DP - NLM ET - 2015/01/04 J2 - Journal of neuro-oncology KW - Adenoma/*drug therapy/mortality/pathology Adult Aged Antineoplastic Agents, Alkylating/*therapeutic use Dacarbazine/*analogs & derivatives/therapeutic use Drug Therapy, Combination Female Follow-Up Studies Humans Male Middle Aged Neoplasm Staging Pituitary Neoplasms/*drug therapy/mortality/pathology Prognosis Retrospective Studies Somatostatin/*analogs & derivatives/therapeutic use Survival Rate Temozolomide Tertiary Care Centers LA - eng M1 - 1 N1 - 1573-7373 Ceccato, Filippo Lombardi, Giuseppe Manara, Renzo Emanuelli, Enzo Denaro, Luca Milanese, Laura Gardiman, Marina Paola Bertorelle, Roberta Scanarini, Massimo D'Avella, Domenico Occhi, Gianluca Boscaro, Marco Zagonel, Vittorina Scaroni, Carla Journal Article United States J Neurooncol. 2015 Mar;122(1):189-96. doi: 10.1007/s11060-014-1702-0. Epub 2015 Jan 3. PY - 2015 SN - 0167-594x SP - 189-96 ST - Temozolomide and pasireotide treatment for aggressive pituitary adenoma: expertise at a tertiary care center T2 - J Neurooncol TI - Temozolomide and pasireotide treatment for aggressive pituitary adenoma: expertise at a tertiary care center VL - 122 ID - 760364 ER - TY - JOUR AB - In December of 2016, a Consensus Conference on unruptured AVM treatment, involving 24 members of the three European societies dealing with the treatment of cerebral AVMs (EANS, ESMINT, and EGKS) was held in Milan, Italy. The panel made the following statements and general recommendations: (1) Brain arteriovenous malformation (AVM) is a complex disease associated with potentially severe natural history; (2) The results of a randomized trial (ARUBA) cannot be applied equally for all unruptured brain arteriovenous malformation (uBAVM) and for all treatment modalities; (3) Considering the multiple treatment modalities available, patients with uBAVMs should be evaluated by an interdisciplinary neurovascular team consisting of neurosurgeons, neurointerventionalists, radiosurgeons, and neurologists experienced in the diagnosis and treatment of brain AVM; (4) Balancing the risk of hemorrhage and the associated restrictions of everyday activities related to untreated unruptured AVMs against the risk of treatment, there are sufficient indications to treat unruptured AVMs grade 1 and 2 (Spetzler–Martin); (5) There may be indications for treating patients with higher grades, based on a case-to-case consensus decision of the experienced team; (6) If treatment is indicated, the primary strategy should be defined by the multidisciplinary team prior to the beginning of the treatment and should aim at complete eradication of the uBAVM; (7) After having considered the pros and cons of a randomized trial vs. a registry, the panel proposed a prospective European Multidisciplinary Registry. AD - M. Cenzato, Neurosurgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy AU - Cenzato, M. AU - Boccardi, E. AU - Beghi, E. AU - Vajkoczy, P. AU - Szikora, I. AU - Motti, E. AU - Regli, L. AU - Raabe, A. AU - Eliava, S. AU - Gruber, A. AU - Meling, T. R. AU - Niemela, M. AU - Pasqualin, A. AU - Golanov, A. AU - Karlsson, B. AU - Kemeny, A. AU - Liscak, R. AU - Lippitz, B. AU - Radatz, M. AU - La Camera, A. AU - Chapot, R. AU - Islak, C. AU - Spelle, L. AU - Debernardi, A. AU - Agostoni, E. AU - Revay, M. AU - Morgan, M. K. DB - Embase Medline DO - 10.1007/s00701-017-3154-8 KW - brain arteriovenous malformation brain hemorrhage conference paper consensus development daily life activity endovascular surgery European human neurologist neurosurgeon neurosurgery patient care priority journal radiosurgery register risk factor senescence treatment contraindication treatment indication unruptured brain arteriovenous malformation LA - English M1 - 6 M3 - Conference Paper N1 - L615270428 2017-04-13 2017-05-23 PY - 2017 SN - 0942-0940 0001-6268 SP - 1059-1064 ST - European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH) T2 - Acta Neurochirurgica TI - European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615270428&from=export http://dx.doi.org/10.1007/s00701-017-3154-8 VL - 159 ID - 760935 ER - TY - JOUR AB - Purpose: To access the safety and retrieval rate of early inferior vena cava (IVC) filter retrieval strategy based on preretrieval contrast-enhanced computed tomographic (CT) findings. And to compare the outcomes before and after active filter retrieval strategy set up in a single tertiary referral hospital. Materials: All patients underwent contrast-enhanced prefilter retrieval venous thromboembolism (VTE) CT. And active IVC filter retrieval strategy was established on March 2017 which was early IVC filter retrieval within hospital stay after major surgery who eligible with anticoagulation therapy. Risk of early filter retrieval was evaluated with multidisciplinary team based on VTE CT findings. Overall VTE CT findings, retrieval rate, indwelling time, anticoagulation therapy, and recurrence of venous thromboembolic events were reviewed. Subgroup analyses were also performed before and after the active filter retrieval strategy establishment from 2010 to 2018. Results: One-hundred-seventy-seven IVC filter insertion was performed in trauma patient during study period. VTE CT findings were as follows: completely resolved VTE; n = 108 (61%), partially improved; n = 58 (33%), no change; n = 8 (5%), aggravated; n = 3 (2%). Overall retrieval rate was 84% with mean indwelling time of 32 days. In subgroup analyses, 95 (53%) were prior to strategy establishment (PSE) group and 82 (47%) were after strategy establishment (ASE) group. Retrieval rate was significantly higher in ASE than PSE 81/82 (99%) Vs. 68/95 (72%) (P <0.001). Anticoagulation therapy was applied in 63/95 (63%) of PSE group and in 67/82 (82%) of ASE group. Duration of anticoagulation was significantly reduced in completely resolved VTE group (mean, 78 days ± 126) than residual VTE group (mean, 133 ± 271) (P <0.001). There was no recurrent VTE evidence during mean clinical follow-up period of 24 month in PSE group and 10 months in ASE group. Conclusions: This study showed overall 84% IVC filter retrieval rate in trauma patients. After active filter retrieval strategy setup, 99% of filters were safely retrieved in trauma patients. Preretrieval VTE CT can help decision making of early filter retrieval and planning to proper anticoagulation therapy. AU - Cha, J. AU - Lee, S. AU - Hong, J. DB - Embase DO - 10.1016/j.jvir.2019.12.334 KW - active filter adult anticoagulant therapy computer assisted tomography conference abstract contrast enhancement controlled study decision making female follow up hospitalization human information retrieval injury major clinical study major surgery male multidisciplinary team vein embolism vena cava filter venous thromboembolism LA - English M1 - 3 M3 - Conference Abstract N1 - L2004990352 2020-02-26 PY - 2020 SN - 1535-7732 1051-0443 SP - S128 ST - 3:18 PM Abstract No. 284 Early inferior vena cava filter retrieval in trauma patients: roles of preretrieval contrast-enhanced computed tomography and active filter retrieval protocol T2 - Journal of Vascular and Interventional Radiology TI - 3:18 PM Abstract No. 284 Early inferior vena cava filter retrieval in trauma patients: roles of preretrieval contrast-enhanced computed tomography and active filter retrieval protocol UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004990352&from=export http://dx.doi.org/10.1016/j.jvir.2019.12.334 VL - 31 ID - 760595 ER - TY - JOUR AB - Mechanical thrombectomy (MT), associated with intravenous thrombolysis if possible, is recommended since 2015 in proximal anterior circulation acute ischemic stroke in selected patients. The procedure is beneficial whatever the age of the patient, but requires urgent medical attention in specialised centres. Strict patient selection with scanners evaluating perfusion mismatch can prolong delay up to 24 hours post stroke symptoms. Peri-interventional procedure, notably anaesthesia, is important. The aim is to secure MT for the patient and the operator related to airway management, comfort, analgesia and movements control. Also, protection of the ischemic penumbra needs maintenance of blood pressure, oxygenation and other determinants of cerebral metabolism. General anaesthesia (GA) or procedural sedation (conscious sedation (CS)), if not local anaesthesia, could be used. For many years, it was assumed that GA altered outcome. Nevertheless, study results were impacted by consequent selection bias. Recent data found at least equipoise between GA and CS. Some randomised trials and one meta-analysis on individual patient data found better outcomes associated with GA. However, multicentric trials are urgently needed. One thing is for certain: coordination and organisation of emergency medicine, vascular neurology, interventional neuroradiology and anaesthesia-perioperative medicine teams are truly essential. AD - [Chabanne, Russell; Begard, Marc] CHU Clermont Ferrand, Hop Gabriel Montpied, Pole Med Perioperatoire, F-63000 Clermont Ferrand, France. [Mazighi, Mikael; Maier, Benjamin] Fdn Ophtalmol Adolphe de Rothschild, Serv Neuroradiol Intervent, F-75019 Paris, France. [Mazighi, Mikael] Hop Lariboisiere, Unite Soins Intensifs Neurovasc, F-75010 Paris, France. [Mazighi, Mikael] Hop Bichat Claude Bernard, Lab Vasc Translat Sci, Unite Inserm 1148, F-7518 Paris, France. Chabanne, R (corresponding author), CHU Clermont Ferrand, Hop Gabriel Montpied, Pole Med Perioperatoire, F-63000 Clermont Ferrand, France. rchabanne@chu-clermontferrand.fr AN - WOS:000507233800018 AU - Chabanne, R. AU - Begard, M. AU - Mazighi, M. AU - Maier, B. DA - Jan DO - 10.1016/j.anrea.2019.11.015 J2 - Anesth. Reanim. KW - Stroke Anterior Circulation Brain Infarction Thrombectomy General Anaesthesia Procedural Sedation Conscious Sedation HEALTH-CARE PROFESSIONALS THERAPY ESMINT GUIDELINES GENERAL-ANESTHESIA CONSCIOUS SEDATION BLOOD-PRESSURE LOCAL-ANESTHESIA STENT-RETRIEVER ASSOCIATION OCCLUSION THROMBOLYSIS Anesthesiology LA - French M1 - 1 M3 - Review N1 - ISI Document Delivery No.: KC5RE Times Cited: 0 Cited Reference Count: 45 Chabanne, Russell Begard, Marc Mazighi, Mikael Maier, Benjamin 0 1 2 ELSEVIER MASSON, CORP OFF PARIS ANESTH REANIM PY - 2020 SN - 2352-5800 SP - 96-102 ST - Anterior circulation acute ischemic stroke: Endovascular mechanical thrombectomy indications and perioperative anaesthetic management T2 - Anesthesie & Reanimation TI - Anterior circulation acute ischemic stroke: Endovascular mechanical thrombectomy indications and perioperative anaesthetic management UR - ://WOS:000507233800018 VL - 6 ID - 761471 ER - TY - JOUR AB - BACKGROUND: - Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE: - To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS: - A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS: - There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION: - The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system. AD - Departamento de Cirurgia, Faculdade de Ciências Médicas, UNICAMP, Campinas, SP, Brasil. AN - 28079244 AU - Chaim, E. A. AU - Pareja, J. C. AU - Gestic, M. A. AU - Utrini, M. P. AU - Cazzo, E. DA - Jan-Mar DO - 10.1590/S0004-2803.2017v54n1-14 DP - NLM ET - 2017/01/13 J2 - Arquivos de gastroenterologia KW - Adult Bariatric Surgery/adverse effects/*methods Brazil Female Hospitals, Public Humans Male Obesity, Morbid/*surgery *Patient Care Team Postoperative Complications Preoperative Care/*methods Prospective Studies Treatment Outcome LA - eng M1 - 1 N1 - 1678-4219 Chaim, Elinton Adami Pareja, José Carlos Gestic, Martinho Antonio Utrini, Murillo Pimentel Cazzo, Everton Journal Article Brazil Arq Gastroenterol. 2017 Jan-Mar;54(1):70-74. doi: 10.1590/S0004-2803.2017v54n1-14. PY - 2017 SN - 0004-2803 SP - 70-74 ST - Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System T2 - Arq Gastroenterol TI - Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System VL - 54 ID - 760313 ER - TY - JOUR AB - Objective Descending thoracic endovascular aneurysm repair (D-TEVAR) is often performed by vascular surgeons. At many institutions, cardiothoracic surgery support is required for an elective TEVAR to take place. Oftentimes, this means a dedicated cardiopulmonary bypass team must be available. This study aims to investigate that TEVAR is a safe procedure that does not require such a resource-intensive "back-up plan." Methods This is a retrospective analysis of data collected from March 2014 to January 2018 of 18 patients who underwent TEVAR at a tertiary care facility with a level I trauma center. There were 11 males and 7 females with an average age of 68.8 years old (range 19-97; SD +/- 19.52). The average body mass index (BMI) was 24.7 kg/m(2) (range 16.8-35; SD +/- 4.67). Nine were never smokers, four were former smokers, and five were currently smoking at the time of the procedure. The most common presenting symptom prior to intervention was chest pain (n = 10), followed by cough/dyspnea (n = 5), back pain (n = 3), and trauma (n = 2). Results The average maximum diameter of the thoracic aortic aneurysms (TAA) treated with TEVAR was 5.49 cm (n = 7; range 4.3-6.7; SD +/- 0.855). Six patients had Stanford Type B aortic dissections. Two patients with TAAs had concomitant, rapidly expanding aortic ulcers. Two patients had traumatic pseudoaneurysms, one of which ruptured prior to TEVAR. One patient had an expanding 1.9 x 1.8 cm saccular pseudoaneurysm of the aortic arch. The mean follow-up time was 69.2 weeks (n = 17; range 3-166; SD +/- 62.67), and one patient did not follow up following their initial TEVAR procedure. Of the 18 patients who received TEVAR, there were no major complications. Two patients experienced a type II endoleak. No patients required conversion to an open procedure, nor did any patients necessitate intervention by cardiothoracic surgery or cardiopulmonary bypass support. Conclusion These data suggest that cardiothoracic surgery support is not required for descending thoracic endovascular aneurysm repair (D-TEVAR). Further research is warranted on the risk factors associated with open conversion during these procedures. AD - [Chait, Jesse; Kibrik, Pavel; Alsheekh, Ahmad; Marks, Natalie; Rajaee, Sareh; Hingorani, Anil; Ascher, Enrico] NYU, Langone Hosp Brooklyn, Div Vasc Surg, 150 55th St, Brooklyn, NY 11220 USA. Chait, J (corresponding author), NYU, Langone Hosp Brooklyn, Div Vasc Surg, 150 55th St, Brooklyn, NY 11220 USA. jesse.chait@gmail.com AN - WOS:000476526100015 AU - Chait, J. AU - Kibrik, P. AU - Alsheekh, A. AU - Marks, N. AU - Rajaee, S. AU - Hingorani, A. AU - Ascher, E. DA - Aug DO - 10.1177/1708538119836331 J2 - Vascular KW - Aortic disease thoracic aneurysm type b aortic dissection thoracic endovascular aortic repair cardiopulmonary bypass endovascular surgery PRACTICE GUIDELINES MANAGEMENT SOCIETY Peripheral Vascular Disease LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: IK3ZE Times Cited: 0 Cited Reference Count: 12 Chait, Jesse Kibrik, Pavel Alsheekh, Ahmad Marks, Natalie Rajaee, Sareh Hingorani, Anil Ascher, Enrico Alsheekh, Ahmad/Q-5665-2018 Alsheekh, Ahmad/0000-0002-2597-339X; Kibrik, Pavel/0000-0002-7850-8539; Chait, Jesse/0000-0002-4755-2596; hingorani, anil/0000-0001-6934-5232 0 1 SAGE PUBLICATIONS LTD LONDON VASCULAR PY - 2019 SN - 1708-5381 SP - 448-450 ST - Descending thoracic endovascular aortic repair does not require cardiothoracic surgery support T2 - Vascular TI - Descending thoracic endovascular aortic repair does not require cardiothoracic surgery support UR - ://WOS:000476526100015 VL - 27 ID - 761507 ER - TY - JOUR AB - Background: Pregnancy in rheumatic diseases is a process that requires careful handling, beginning with proper planning. Infertility and chronic use of teratogenic drugs are some common situations in these patients, giving them a high-risk obstetrics. Objectives: To established a protocol for planning and monitoring pregnancies in patients with rheumatic diseases Methods: Retrospective review of a follow-up protocol for patients with rheumatic diseases and pregnancy wishes. This protocol includes: preconception consultation to asses fertility of the couple, as well as pregnancy couselling and establishment of a appropriate pharmacological treatment; after pregnancy period start, monthly consultations by a multidisciplinary team; and finally, a postpartum consultation after delivery Results: A total of 51 patient with different rheumatic diseases were included: Sistemic Lupus Erythematosus (8 patients), Sjogren'S Syndrom (10 patients), Rheumatoid arthritis (13 patients), Psoriatic arthritis (5 patients), Behcet's disease (3 patients), Spondiloarthritis (2 patients), Familial Mediterranean Fever (2 patients), Conective mixed Tissues Disease (1 patient), Primary Antiphospholipi Syndrom (2 patient) an Hyper IgD Syndrome (1 patient). The results were: Infertility was detected in 8 couples and assisted reproductive techniques was requieres in 7 (6 IVF and 1 insemination). Safe Pharmacological treatments were used: sulfasalazine (4), hydroxychloroquine (13), azathioprine (2). Biological DMARDs in 3 patients (1 infliximab and Certlizumab in 2). Other treatments were: steroids (12) and intravenosus immunoglobulins for fetal heart block (2). All patients with thrombophilia have been treated with LMWH alone or plus aspirin. The course of pregnancy was: delivery at term (28), delivery pre-term (3)∗ ∗, miscariages (3) ∗, pregnancy on course (7), neonatal death (1) and 8 patients are plannig the pregnancy. The abortions have occurred in 2 patients with lupus erythematosus and in 1 patient with rheumatoid arthritis. Postpartum care of newborns with mothers with positivity anti-Ro has objectified a neonatal transfer of Acs in 100% of cases;only 8 of them developed neonatal SLE. Conclusions: A satisfactory evolution of pregnancy was observed in 87% of our patients, a fact that supports our impression that this process should be approached in a multidisciplinary team. Infertility is a situation that should be considered and treated at an early stage in this patients, preferably before preconceptional period. AD - I.C. Chalmeta, Rheumatology, Valencia, Spain AU - Chalmeta, I. C. AU - Ivorra, J. AU - Marcos, B. AU - Diaz, C. AU - Beltran, E. AU - Negueroles, R. AU - Valero, J. L. AU - Feced, C. AU - Ortiz, F. AU - Gonazlez, L. AU - Martinez, I. AU - Labrador, E. AU - Arevalo, K. AU - Grau, E. AU - Alcañiz, C. AU - Fragio, J. AU - Roman, J. DB - Embase DO - 10.1136/annrheumdis-2016-eular.6064 KW - acetylsalicylic acid azathioprine disease modifying antirheumatic drug endogenous compound hydroxychloroquine immunoglobulin infliximab salazosulfapyridine steroid abortion Behcet disease clinical trial consultation doctor patient relationship drug therapy familial Mediterranean fever female fetus heart follow up human hyperimmunoglobulinemia D and periodic fever syndrome infertility therapy insemination lupus erythematosus major clinical study mixed cell culture monitoring mother newborn newborn death obstetric delivery pregnancy psoriatic arthritis puerperium retrospective study thrombophilia LA - English M3 - Conference Abstract N1 - L612779012 2016-10-21 PY - 2016 SN - 1468-2060 SP - 616 ST - Infertility and pregnancy in rheumatic diseases: The utility of a multidisciplinary protocol for the management of these patients T2 - Annals of the Rheumatic Diseases TI - Infertility and pregnancy in rheumatic diseases: The utility of a multidisciplinary protocol for the management of these patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L612779012&from=export http://dx.doi.org/10.1136/annrheumdis-2016-eular.6064 VL - 75 ID - 761015 ER - TY - JOUR AB - Background The difference in managing myxoma and pulmonary embolism (PE) emphasizes the importance of prompt diagnosis of left atrial masses. Diagnosis requires a systematic and multidisciplinary approach to treatment. Case 47 year old healthy woman presented with acute onset left lower abdominal pain and pre-syncope. Computer tomography revealed bilateral renal infarcts and bilateral PEs with a right to left ventricular (RV) ratio greater than 2.8 (Fig. 1A-B). Transthoracic echo demonstrated a reduced tricuspid annular plane systolic excursion and RV outflow tract velocity time integral (Fig. 1D-E). Transesophageal echo revealed a large serpiginous left atrial mass (Fig. 1C) traversing a patent foramen ovale (PFO). Due to complexity, the patient was transferred to our institution. Decision-making On arrival, the pulmonary embolism response team (PERT) evaluated the case. Upon further review, the mass was thought to be clot in transit rather than myxoma. Given further risk of paradoxical embolization, surgical embolectomy (Fig. 1G-H) was preferred over an endovascular approach. Conclusion Our case demonstrates the importance of establishing a prompt diagnosis for left atrial mass as treatment varies widely for each diagnosis. A multidisciplinary PERT expedites diagnosis and treatment. Embolectomy occurred within 12 hours of admission. Patient was discharged and will follow up in PERT clinic in 1 month. [Figure presented] AU - Chan, L. AU - Morris, S. AU - Haines, J. F. AU - Allen, S. AU - Porcaro, K. AU - Chowdhury, I. AU - Manshad, A. S. AU - Marginean, A. AU - Kuhrau, S. AU - Masic, D. AU - Brailovsky, Y. AU - Fareed, J. AU - Ali, S. AU - Darki, A. DB - Embase DO - 10.1016/S0735-1097(20)33684-6 KW - adult artificial embolization case report clinical article computer assisted tomography conference abstract decision making embolectomy female follow up heart left atrium heart left ventricle outflow tract hospital discharge human kidney infarction lower abdominal pain male middle aged myxoma patent foramen ovale presyncope pulmonary embolism response team transesophageal echocardiography tricuspid annular plane systolic excursion velocity LA - English M1 - 11 M3 - Conference Abstract N1 - L2005041278 2020-04-07 PY - 2020 SN - 1558-3597 0735-1097 SP - 3057 ST - DIAGNOSTIC COMPLEXITIES OF LEFT ATRIAL MASSES AND THE VALUE OF A PULMONARY EMBOLISM RESPONSE TEAM T2 - Journal of the American College of Cardiology TI - DIAGNOSTIC COMPLEXITIES OF LEFT ATRIAL MASSES AND THE VALUE OF A PULMONARY EMBOLISM RESPONSE TEAM UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005041278&from=export http://dx.doi.org/10.1016/S0735-1097(20)33684-6 VL - 75 ID - 760587 ER - TY - JOUR AB - Introduction: Hepatitis C virus (HCV) is now curable with nationally funded direct-acting antivirals; however, its eradication faces many barriers as HCV commonly occurs in difficult-to-access populations (DTAPs), including those with active drug misuse and psychiatric comorbidities. Project ECHO (PE) is a novel “hub and spoke” tele-mentoring program that originated in New Mexico, USA, and was adopted by Liverpool Hospital in July 2016 to empower local clinicians and target DTAPs. Aim: To examine if the PE model can more effectively identify and treat DTAPs with HCV in comparison to a patient cohort treated in an outpatient liver clinic. Methods: This prospective study was approved by the Sydney South West Area Health Service ethics committee. Weekly PE video conference meetings were conducted with local clinicians, including drug and alcohol physicians, sexual health physicians, private methadone prescribers, and community general practitioners. Deidentified HCV cases were presented to a multidisciplinary team of gastroenterologists, nurses, and allied health staff. Information discussed and collected during PE meetings broadly encompassed relevant clinical and biochemical data for formulating treatment plans, psychosocial, and drug-related elements that were considered potential barriers, and treatment outcomes. PE patients were then retrospectively compared with 99 consecutive new HCV patients seen in Liverpool Hospital Liver Clinic since July 2016. Results: Between July 2016 and April 2017, 99 cases of HCV were presented at the PE meetings by local clinicians in the South Western Sydney Local Health District. Thirteen were referred from a sexual health clinic, 68 from various drug health facilities, four from private methadone prescribers, and 14 from GPs. The PE cohort had a greater proportion of female patients (33.3% vs 25.3%) and were younger (median age, 45 years) compared with the liver clinic cohort (median age, 50 years). There were more Indigenous patients in the PE (n = 15) compared with the liver clinic cohort (n = 5). Ongoing substance misuse was prevalent in 43 of 99 PE patients, of whom 31 were active intravenous drug users and 25 had polysubstance misuse, compared with 17 of 99, 12 and 7, respectively, in the liver clinic. Of the 99 PE patients, 73 used opioid substitution therapy, of whom 38 (52.1%) required daily pickups (an indirect indicator of instability), while only 20 clinic patients used opioid substitution therapy, six of whom (30%) required daily pickups. Of the PE patients, 49 have a background of psychiatric illness, with 41 using psychotropic medications, compared with 44 clinic patients who have psychiatric comorbidities, 29 of whom are pharmacologically treated. Cirrhosis was present similarly in PE (13.1%) and liver clinic (18.1%) cohorts. Most were treatment-naive (95.0% and 90.9%, respectively). Genotypes 1, 2, and 3 proportions were similar between PE (44.4%, 6%, and 47.5%, respectively) and liver clinic (39.3%, 6%, and 37.3%, respectively) patients. Genotype 6 was not seen in PE patients, while it comprised 11.1% of liver clinic patients. As of May 2017, 18 of 18 patients in the PE cohort have completed therapy and achieved sustained virological response (SVR), while 46 patients are awaiting completion of treatment. Thirty-two patients did not initiate therapy (13 due to conflicting priorities and 19 were lost to follow-up), and three had treatment ceased early. In contrast, 34/35 liver clinic patients achieved SVR (one relapsed), 44 patients are awaiting completion, and 20 did not initiate therapy (six due to conflicting priorities, eight lost to followup, six awaiting future therapies). Conclusion: PE provides an innovative model that facilitates community treatment of HCV in DTAPs who are cared for by other services and differ markedly from those who would attend liver clinics. Furthermore, the teaching approach of PE teleconferencing sessions effectively empowers referring clinicians to become independent prescribers. AD - P.P.Y. Chan, Liverpool Hospital, Sydney, NSW, Australia AU - Chan, P. P. Y. AU - Mohsen, W. AU - Whelan, M. AU - Glass, A. AU - Ladera, A. AU - Mouton, M. AU - Yeung, E. AU - Tran, Q. AU - Arora, S. AU - Davison, S. AU - Levy, M. T. DB - Embase DO - 10.1111/jgh.13892 KW - alcohol methadone psychotropic agent adult clinical trial comorbidity controlled study drug therapy ethics female follow up gastroenterologist general practitioner genotype group therapy health care facility hepatitis C Hepatitis C virus human intravenous drug abuse liver cirrhosis major clinical study mental disease mentoring middle aged nonhuman nurse opiate substitution treatment outpatient population model prospective study sexual health staff sustained virologic response teaching teleconference videoconferencing LA - English M3 - Conference Abstract N1 - L618006287 2017-08-31 PY - 2017 SN - 1440-1746 SP - 67 ST - Project ECHO: A novel tele-mentoring service to aid hepatitis C treatment in difficult-to-access populations T2 - Journal of Gastroenterology and Hepatology (Australia) TI - Project ECHO: A novel tele-mentoring service to aid hepatitis C treatment in difficult-to-access populations UR - https://www.embase.com/search/results?subaction=viewrecord&id=L618006287&from=export http://dx.doi.org/10.1111/jgh.13892 VL - 32 ID - 760919 ER - TY - JOUR AB - Introduction: Developing structured online educational curricula that meet learner needs is challenging. Thrombosis and bleeding are areas of innovation and change in emergency medicine. We aimed to determine the learning needs of the Free Open Access Medical education (FOAM) community with the subsequent goal of developing structured curricula to meet them. Methods: A Massive Online Needs Assessment (MONA) was conducted to determine the perceived and unperceived educational needs in thrombosis and bleeding. The survey was designed by a multidisciplinary team of experts and was open from September 20 to December 10, 2016. The survey requested limited demographic information and contained questions to identify topics of interest. Respondents' baseline knowledge and unperceived needs were assessed using 5 case scenarios containing 3 questions each. Knowledge gaps were defined a priori as topics where <50% of participants answered correctly. Results: We received 198 complete responses by staff physicians (n = 109), residents (n = 46), medical students (n = 29) and allied health professionals (n = 14) from 20 countries. 116/198 responses were from people working in emergency medicine. Topics of interest to participants included choice of anticoagulants, interruption of anticoagulation, management of bleeding and monitoring anticoagulation. Knowledge gaps were identified in 4 main areas including interruption of anticoagulation, management of bleeding (including reversal of anticoagulation and massive transfusion), inherited thrombophilia, and screening for malignancy in acute thrombosis. Conclusion: We have identified six priority topics to cover in our future online Thrombosis and Bleeding curriculum by surveying the online medical community. Although perceived and unperceived needs showed high congruence, two priority topics were only identified by assessing unperceived needs. AD - T.M. Chan, McMaster University, Hamilton, ON, Canada AU - Chan, T. M. AU - Jo, D. AU - Shih, A. AU - Bhagirath, V. AU - Yeh, C. AU - Castellucci, L. AU - Thoma, B. AU - De Wit, K. DB - Embase DO - 10.1017/cem.2017.234 KW - anticoagulant agent anticoagulation bleeding cancer epidemiology education program emergency medicine female human learning major clinical study male medical education medical student needs assessment remission resident screening staff thrombophilia thrombosis LA - English M3 - Conference Abstract N1 - L616679055 2017-06-13 PY - 2017 SN - 1481-8043 SP - S88-S89 ST - Identifying the bleeding and thrombosis learning needs of the Free Open Access Medical education (FOAM) community T2 - Canadian Journal of Emergency Medicine TI - Identifying the bleeding and thrombosis learning needs of the Free Open Access Medical education (FOAM) community UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616679055&from=export http://dx.doi.org/10.1017/cem.2017.234 VL - 19 ID - 760965 ER - TY - JOUR AB - OBJECTIVE: Central line-associated bloodstream infections (CLABSIs) in NICU result in increased mortality, morbidity, and length of stay. Our NICU experienced an increase in the number of CLABSIs over a 2-year period. We sought to reduce risks for CLABSIs using health care failure mode and effect analysis (HFMEA) by analyzing central line insertion, maintenance, and removal practices. METHODS: A multidisciplinary team was assembled that included clinicians from nursing, neonatology, surgery, infection prevention, pharmacy, and quality management. Between March and October 2011, the team completed the HFMEA process and implemented action plans that included reeducation, practice changes, auditing, and outcome measures. RESULTS: The HFMEA identified 5 common failure modes that contribute to the development of CLABSIs. These included contamination, suboptimal environment of care, improper documentation and evaluation of central venous catheter dressing integrity, issues with equipment and suppliers, and lack of knowledge. Since implementing the appropriate action plans, the NICU has experienced a significant decrease in CLABSIs from 2.6 to 0.8 CLABSIs per 1000 line days. CONCLUSIONS: The process of HFMEA helped reduce the CLABSI rate and reinforce the culture of continuous quality improvement and safety in the NICU. AD - Children's Hospital, Boston, MA 02115, USA. AN - 23690523 AU - Chandonnet, C. J. AU - Kahlon, P. S. AU - Rachh, P. AU - Degrazia, M. AU - Dewitt, E. C. AU - Flaherty, K. A. AU - Spigel, N. AU - Packard, S. AU - Casey, D. AU - Rachwal, C. AU - Agrawal, P. B. DA - Jun DO - 10.1542/peds.2012-3293 DP - NLM ET - 2013/05/22 J2 - Pediatrics KW - Catheter-Related Infections/*epidemiology/prevention & control Catheterization, Central Venous/*adverse effects Delivery of Health Care Humans Infant, Newborn Intensive Care Units, Neonatal/*statistics & numerical data Treatment Failure Nicu central line–associated blood stream infections health care failure mode and effect analysis LA - eng M1 - 6 N1 - 1098-4275 Chandonnet, Celeste J Kahlon, Prerna S Rachh, Pratik Degrazia, Michele Dewitt, Eileen C Flaherty, Kathleen A Spigel, Nadine Packard, Stephanie Casey, Denise Rachwal, Christine Agrawal, Pankaj B Journal Article United States Pediatrics. 2013 Jun;131(6):e1961-9. doi: 10.1542/peds.2012-3293. Epub 2013 May 20. PY - 2013 SN - 0031-4005 SP - e1961-9 ST - Health care failure mode and effect analysis to reduce NICU line-associated bloodstream infections T2 - Pediatrics TI - Health care failure mode and effect analysis to reduce NICU line-associated bloodstream infections VL - 131 ID - 760210 ER - TY - JOUR AB - The objective of this review was to determine whether patients undergoing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) (1) understand the aims of the proposed intervention, and (2) whether they are offered alternative and potentially more effective therapies, as required for the process of informed consent. We performed a systematic review of Medline for observational studies of patient understanding and perceptions of coronary revascularization and of the consent process. Data extraction was of patient perceptions of expected symptomatic and prognostic benefits of PCI and CABG, and the proportion of patients offered potential alternative treatments. Eight studies were identified, of which seven were relevant to PCI and three to CABG. On average, 55% of patients correctly believed that PCI would improve symptoms, while 78% erroneously believed that PCI would extend life expectancy and 71% erroneously believed PCI would prevent future myocardial infarction. On average, over 80% of patients correctly identified that CABG would improve symptoms, reduce the risk of myocardial infarction and extend life expectancy. In the three studies that examined whether alternative therapies were discussed, 68% of PCI patients and 59% of CABG patients reported no such discussion. In conclusion, a large proportion of patients undergoing coronary interventions do not appear to understand the rationale for treatment and have erroneous perceptions regarding expected benefits. Moreover, patients are frequently not offered potentially more effective alternative therapies. This raises important questions about the adequacy of the current informed consent process. We recommend a multidisciplinary team approach as the most obvious way to remedy current practice. AD - Nuffield Department of Surgery, Oxford University, John Radcliffe Hospital, Oxford, OX3 9DU, UK. AN - 20934881 AU - Chandrasekharan, D. P. AU - Taggart, D. P. DA - Jun DO - 10.1016/j.ejcts.2010.08.033 DP - NLM ET - 2010/10/12 J2 - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery KW - Adult Aged Aged, 80 and over Angioplasty, Balloon, Coronary/ethics Coronary Artery Bypass/ethics Coronary Artery Disease/surgery/*therapy Health Knowledge, Attitudes, Practice Humans *Informed Consent Middle Aged LA - eng M1 - 6 N1 - 1873-734x Chandrasekharan, Deepak P Taggart, David P Journal Article Review Systematic Review Germany Eur J Cardiothorac Surg. 2011 Jun;39(6):912-7. doi: 10.1016/j.ejcts.2010.08.033. Epub 2010 Oct 8. PY - 2011 SN - 1010-7940 SP - 912-7 ST - Informed consent for interventions in stable coronary artery disease: problems, etiologies, and solutions T2 - Eur J Cardiothorac Surg TI - Informed consent for interventions in stable coronary artery disease: problems, etiologies, and solutions VL - 39 ID - 760287 ER - TY - JOUR AU - Chang DA - 2015/01/01 01/01 DB - Institute of Scientific and Technical Information of China (English) M1 - 3 PY - 2015 ST - Deep venous thrombosis and pulmonary embolism Response T2 - Journal of neurosurgery. TI - Deep venous thrombosis and pulmonary embolism Response UR - https://netl.istic.ac.cn/site/link?cdoi=8cfac8edad6963e03ffefba633ebdaa8&mid=466496091303411EB27FB4298C9BA46C VL - 122 ID - 762133 ER - TY - JOUR AB - With the advancement of computed tomography pulmonary angiography, differentiating between acute and chronic thrombus in pulmonary embolism has become more feasible. However, whether pulmonary embolism with chronic thrombus contributes to a higher mortality than pulmonary embolism with acute thrombus remains undetermined. Additionally, the clinical features of patients with chronic thrombus are largely unknown. Herein, we aimed to investigate the incidence and outcomes of patients with pulmonary embolism and chronic thrombus. This retrospective study included patients with pulmonary embolism from 2008 to 2016 at National Cheng Kung University Hospital. After excluding patients with tumor emboli or other etiologies and a lack of computed tomography images, we identified 205 patients with acute thrombus and 58 patients with chronic thrombus. Patients with chronic thrombus initially presented mainly with dyspnea, and the etiology was not related to recent surgery. Patients with chronic thrombus had a significantly higher incidence of elevated right ventricular systolic pressure detected by echocardiography and a higher incidence of subsequent events due to residual pulmonary embolism. Despite no differences in clinically recurrent pulmonary embolism, patients with chronic thrombus presented with a higher risk of all-cause and pulmonary embolism-related mortality than patients with acute thrombus. Chronic thrombus (hazard ratio: 2.03, p = 0.03), simplified pulmonary embolism severity index, anticoagulant use, and body mass index were the independent factors for all-cause mortality. Our findings suggest that using computed tomography pulmonary angiography for identifying patients with pulmonary embolism and chronic thrombus, which was associated with a higher risk of mortality, is pivotal for early intervention in addition to anticoagulant use. PMID:32426110 AU - Chang, Hsien-Yuan AU - Chang, Wei-Ting AU - Chen, Po-Wei AU - Lin, Chih-Chan AU - Hsu, Chih-Hsin DA - 2020/05/01 05/01 DB - PubMed Central DO - 10.1177/20458940