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 - 10.1177/2045894020905510 KW - chronic pulmonary thromboembolism chronic pulmonary embolism (PE) computed tomography (CT) M1 - 2 PY - 2020 SN - 2045-8932 ST - Pulmonary thromboembolism with computed tomography defined chronic thrombus is associated with higher mortality T2 - Pulmonary Circulation TI - Pulmonary thromboembolism with computed tomography defined chronic thrombus is associated with higher mortality UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7222268 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7222268&rendertype=abstract VL - 10 ID - 762052 ER - TY - JOUR AB - Background: Venous Thromboembolism (VTE) is a cause of hospital mortality and managing its morbidity is associated with significant expenditure. Uptake of evidenced based guideline recommendations intended to prevent VTE in hospital settings is sub-optimal. This study was conducted to explore clinicians' attitudes and the clinical environment in which they work to understand their reluctance to adopt VTE prophylaxis guidelines. Methods: Between February and November 2009, 40 hospital employed doctors from 2 Australian metropolitan hospitals were interviewed in depth. Qualitative data were analysed according to thematic methodology. Results: Analysis of interviews revealed that barriers to evidence based practice include i) the fragmented system of care delivery where multiple members of teams and multiple teams are responsible for each patient's care, and in the case of VTE, where everyone shares responsibility and no-one in particular is responsible; ii) the culture of practice where team practice is tailored to that of the team head, and where medicine is considered an 'art' in which guidelines should be adapted to each patient rather than applied universally. Interviewees recommend clear allocation of responsibility and reminders to counteract VTE risk assessment being overlooked. Conclusions: Senior clinicians are the key enablers for practice change. They will need to be convinced that guideline compliance adds value to their patient care. Then with the support of systems in the organisation designed to minimize the effects of care fragmentation, they will drive practice changes in their teams. We believe that evidence based practice is only possible with a coordinated program that addresses individual, cultural and organisational constraints. AD - [Chapman, Nicola H.; Fry, Margaret; Lassere, Marissa N.; Chong, Beng H.] St George Publ Hosp, Kogarah, NSW, Australia. [Chapman, Nicola H.; Lazar, Steven P.; Lassere, Marissa N.; Chong, Beng H.] Univ New S Wales, St George Clin Sch, Sydney, NSW, Australia. [Fry, Margaret] Univ Technol Sydney, Fac Nursing, Sydney, NSW 2007, Australia. [Fry, Margaret] Univ Technol Sydney, Fac Midwifery, Sydney, NSW 2007, Australia. Chong, BH (corresponding author), St George Publ Hosp, Kogarah, NSW, Australia. beng.chong@unsw.edu.au AN - WOS:000296338000001 AU - Chapman, N. H. AU - Lazar, S. P. AU - Fry, M. AU - Lassere, M. N. AU - Chong, B. H. C7 - 240 DA - Sep DO - 10.1186/1472-6963-11-240 J2 - BMC Health Serv. Res. KW - EVALUATING COMPLEX INTERVENTIONS HOSPITALIZED MEDICAL PATIENTS VENOUS THROMBOEMBOLISM PROPHYLAXIS PREVENTION TRIALS IMPLEMENTATION CONTRAST VTE Health Care Sciences & Services LA - English M3 - Article N1 - ISI Document Delivery No.: 839AY Times Cited: 10 Cited Reference Count: 40 Chapman, Nicola H. Lazar, Steven P. Fry, Margaret Lassere, Marissa N. Chong, Beng H. Chong, Beng/AAE-2617-2019; Fry, Margaret/F-8082-2017 Fry, Margaret/0000-0003-1265-7096 10 0 6 BMC LONDON BMC HEALTH SERV RES PY - 2011 SP - 11 ST - Clinicians adopting evidence based guidelines: a case study with thromboprophylaxis T2 - Bmc Health Services Research TI - Clinicians adopting evidence based guidelines: a case study with thromboprophylaxis UR - ://WOS:000296338000001 VL - 11 ID - 761845 ER - TY - JOUR AB - Background: Ischemic stroke is a risk associated with atrial fibrillation (AF) and is estimated to occur five times more often in afflicted patients than in those without AF. Anti-thrombotic therapy is recommended for the prevention of ischemic stroke. Risk stratification tools, such as the CHADS(2), and more recently the CHA(2)DS(2)-VASc, for predicting stroke in patients with AF have been developed to determine the level of stroke risk and assist clinicians in the selection of antithrombotic therapy. Warfarin, for stroke prevention in AF, is the most commonly prescribed anticoagulant in North America. The purpose of this study was to examine the utility of using the CHADS(2) score levels (low and high) in contrast to the CHA(2)DS(2)-VASc when examining the outcome of warfarin prescriptions for adult patients with AF. The CHA(2)DS(2)-VASc tool was not widely used in 2010, when the data analyzed were collected. It has only been since 2014 that CHA(2)DS(2)-VASc criteria has been recommended to guide anticoagulant treatment in updated AF treatment guidelines. Methods: Bivariate and multivariate data analysis strategies were used to analyze 2010 National Ambulatory Care Survey (NAMCS) data. NAMCS is designed to collect data on the use and provision of ambulatory care services nationwide. The study population for this research was US adults with a diagnosis of AF. Warfarin prescription was the dependent variable for this study. The study population was 7,669,844 AF patients. Results: Bivariate analysis revealed that of those AF patients with a high CHADS(2) score, 25.1% had received a warfarin prescription and 18.8 for those with a high CHA(2)DS(2)-VASc score. Logistic regression analysis yielded that patients with AF had higher odds of having a warfarin prescription if they had a high CHADS(2) score, were Caucasian, lived in a zip code where < 20% of the population had a university education, and lived in a zip code where < 10% of the population were living in households with incomes below the federal poverty level. Further, the analysis yielded that patients with AF had lesser odds of having a warfarin prescription if they were >= 65 years of age, female, or had health insurance. Conclusions: Overall, warfarin appears to be under-prescribed for patients with AF regardless of the risk stratification system used. Based on the key findings of our study opportunities for interventions are present to improve guideline adherence in alignment with risk stratification for stroke prevention. Interprofessional health care teams can provide improved medical management of stroke prevention for patients with AF. These interprofessional health care teams should be constituted of primary care providers (physicians, physician assistants, and nurse practitioners), nurses (RN, LPN), and pharmacists (PharmD, RPh). AD - [Chapman, Scott A.; St Hill, Catherine A.; Scheiner, Shellina R.] Univ Minnesota, Coll Pharm, Dept Expt & Clin Pharmacol, Minneapolis, MN 55455 USA. [Little, Meg M.; Swanoski, Michael T.; Lutfiyya, M. Nawal] Univ Minnesota, Coll Pharm, Dept Pharm Practice & Pharmaceut Sci, Minneapolis, MN 55455 USA. [Ware, Kenric B.] South Univ, Dept Pharm Practice, Coll Pharm, Columbia, SC 29203 USA. [Lutfiyya, M. Nawal] Univ Minnesota, Natl Ctr Interprofess Educ & Practice, Childrens Rehabil Ctr R685, 426 Church St SE, Minneapolis, MN 55455 USA. Lutfiyya, MN (corresponding author), Univ Minnesota, Coll Pharm, Dept Pharm Practice & Pharmaceut Sci, Minneapolis, MN 55455 USA.; Lutfiyya, MN (corresponding author), Univ Minnesota, Natl Ctr Interprofess Educ & Practice, Childrens Rehabil Ctr R685, 426 Church St SE, Minneapolis, MN 55455 USA. nlutfiyy@umn.edu AN - WOS:000394109800001 AU - Chapman, S. A. AU - St Hill, C. A. AU - Little, M. M. AU - Swanoski, M. T. AU - Scheiner, S. R. AU - Ware, K. B. AU - Lutfiyya, M. N. C7 - 127 DA - Feb DO - 10.1186/s12913-017-2025-6 J2 - BMC Health Serv. Res. KW - Warfarin CHADS(2) CHA(2)DS(2)-VASc Atrial fibrillation Stroke Guideline Adherence Anti-coagulation Interprofessional health care teams HEALTH-CARE ANTITHROMBOTIC THERAPY UNITED-STATES ANTICOAGULATION PREVENTION MANAGEMENT US RECOMMENDATIONS POPULATION PREVALENCE Health Care Sciences & Services LA - English M3 - Article N1 - ISI Document Delivery No.: EK7ML Times Cited: 8 Cited Reference Count: 40 Chapman, Scott A. St Hill, Catherine A. Little, Meg M. Swanoski, Michael T. Scheiner, Shellina R. Ware, Kenric B. Lutfiyya, M. Nawal Little, Meg/0000-0001-6572-178X; Lutfiyya, May Nawal/0000-0001-8856-6970 9 0 8 BIOMED CENTRAL LTD LONDON BMC HEALTH SERV RES PY - 2017 SN - 1472-6963 SP - 8 ST - Adherence to treatment guidelines: the association between stroke risk stratified comparing CHADS(2) and CHA(2)DS(2)-VASc score levels and warfarin prescription for adult patients with atrial fibrillation T2 - Bmc Health Services Research TI - Adherence to treatment guidelines: the association between stroke risk stratified comparing CHADS(2) and CHA(2)DS(2)-VASc score levels and warfarin prescription for adult patients with atrial fibrillation UR - ://WOS:000394109800001 VL - 17 ID - 761667 ER - TY - JOUR AB - Background: Considering new guidelines for retrievable inferior vena cava filters (IVCFs), we examine our initial experience after establishing a comprehensive filter removal program in our level 1 trauma center. We evaluated the technical and financial feasibility of this program and barriers to IVCF retrieval, including insurance status and costs, in trauma patients. Methods: Trauma patients receiving IVCFs from May 2011 to 2013 were consented and prospectively enrolled in the study program. Retrieval rates were assessed for the years before study initiation. Primary outcome was IVCF retrieval. Hospital financial data for retrieval were examined and univariate analysis performed. Hospital cost-to-charge and payment-to-charge ratios were assessed. Results: Before study initiation from April 2009 to 2011, 66 IVCFs were placed in trauma patients with only 2 retrievals in 2 years. During the study period, 247 trauma patients had IVCF placement of which 111 (45%) were enrolled. The main reason for nonenrollment was lack of referral by the implanting team. Retrieval was attempted in 100 outpatients with success in 85 (85%). Patients enrolled in the program were more likely to have their filters removed (73% vs. 18%; odds ratio, 12.6; 95% confidence interval, 6.6-24.3; P < 0.001). Mean time from placement to attempt was 6.2 +/- 4.0 months (range, 0.5-31.8). Of the total attempts, 29% were nonresource patients, 11% had Medicaid, and 60% had commercial insurance including Medicare patients. Chances of successful retrieval were higher if performed later during the study (P = 0.03). Successful retrieval was not related to insurance status (P = not significant). The mean total hospital charges related to retrieval were $4,493 (range, $2,510-$9,106). Successful retrieval contributed to lower total charges (P < 0.01). Factors contributing to higher total charges were retrieval attempt later in study period (P = 0.01) and commercial insurance status (P = 0.04). Conclusions: The rate of IVCF placement in trauma patients increased 4-fold over 4 years. The rate of IVCF retrieval increased more than 14-fold during the same period after establishment of the retrieval program. Elective outpatient retrieval of IVCFs in all eligible trauma patients is financially feasible without loss to the health care system even in regions with high rates of uninsured. A major barrier to successful filter retrieval was lack of patient referral into the program by implanting physicians. Hospital administration and physician outreach are important determinants of successful IVCF retrieval in trauma patients. AD - [Charlton-Ouw, Kristofer M.; Leake, Samuel S.; Sola, Cristina N.; Sandhu, Harleen K.; Miller, Charles C., III; Safi, Hazim J.; Azizzadeh, Ali] Univ Texas Med Sch Houston, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA. [Charlton-Ouw, Kristofer M.; Albarado, Rondel; Holcomb, John B.; Miller, Charles C., III; Safi, Hazim J.; Azizzadeh, Ali] Mem Hermann Hosp, Texas Med Ctr, Houston, TX USA. [Albarado, Rondel; Holcomb, John B.] Univ Texas Med Sch Houston, Dept Surg, Div Acute Care Surg, Houston, TX 77030 USA. Charlton-Ouw, KM (corresponding author), Univ Texas Med Sch Houston, Dept Cardiothorac & Vasc Surg, 6400 Fannin St,Suite 2850, Houston, TX 77030 USA. Kristofer.CharltonOuw@uth.tmc.edu AN - WOS:000346239900013 AU - Charlton-Ouw, K. M. AU - Leake, S. S. AU - Sola, C. N. AU - Sandhu, H. K. AU - Albarado, R. AU - Holcomb, J. B. AU - Miller, C. C. AU - Safi, H. J. AU - Azizzadeh, A. DA - Jan DO - 10.1016/j.avsg.2014.05.018 J2 - Ann. Vasc. Surg. KW - PULMONARY-EMBOLISM FOLLOW-UP VENOUS THROMBOEMBOLISM Surgery Peripheral Vascular Disease LA - English M1 - 1 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: AW4GS Times Cited: 12 Cited Reference Count: 18 Charlton-Ouw, Kristofer M. Leake, Samuel S. Sola, Cristina N. Sandhu, Harleen K. Albarado, Rondel Holcomb, John B. Miller, Charles C., III Safi, Hazim J. Azizzadeh, Ali Winter Meeting of the Peripheral-Vascular-Surgery-Society JAN 30-FEB 02, 2014 Steamboat Springs, CO Peripheral Vasc Surg Soc sandhu, harleen k/H-2959-2019; Charlton-Ouw, Kristofer/AAU-1554-2020 sandhu, harleen k/0000-0001-6960-4345; Charlton-Ouw, Kristofer/0000-0003-3354-1527; holcomb, john/0000-0001-8312-9157 12 0 3 ELSEVIER SCIENCE INC NEW YORK ANN VASC SURG PY - 2015 SN - 0890-5096 SP - 84-89 ST - Technical and Financial Feasibility of an Inferior Vena Cava Filter Retrieval Program at a Level One Trauma Center T2 - Annals of Vascular Surgery TI - Technical and Financial Feasibility of an Inferior Vena Cava Filter Retrieval Program at a Level One Trauma Center UR - ://WOS:000346239900013 VL - 29 ID - 761765 ER - TY - JOUR AB - PURPOSE: The purpose of this study was to evaluate a cooperation program in order to compare incidence of complications after peripherally inserted central catheter (PICC) placement between radiologists and technicians. MATERIALS AND METHODS: PICC placement technique was standardized with ultrasound-guided puncture and fluoroscopic guidance. Numbers of PICC delegated to technicians, and PICC placement difficulties, were prospectively recorded for the whole study population whereas complications such as PICC infection, deep venous thrombosis and catheter occlusion were prospectively recorded until PICC removal for a subgroup of patients included during one month. RESULTS: A total of 722 patients had PICC placement. There were 382 men and 340 women with a mean age of 66.8±15.8 (SD) years (range: 18-94years); of these, 442/722 patients (61.22%) were included in the cooperation program with 433/722 patients (59.97%) who effectively had PICC placement by technicians and 289/722 (40.03%) by radiologists. Technicians needed radiologists' help for 23/442 patients (5.20%) including 6 failed PICC placement subsequently performed by radiologists. Twenty complications (20/77; 26%) were recorded in the subgroup of 77 patients studied for complications. No differences in complications rate were found between the 33 patients who underwent PICC placement by radiologists (6/33; 18%) and the 44 patients who underwent PICC placement by technicians (14/44; 32%) (P=0.296). Complications included 8 PICC-related infections (8/77; 10.4%), 3 deep venous thromboses (3/77; 3.9%) and 9 catheter occlusions (9/77; 11.7%). CONCLUSION: PICC placement led by technicians is feasible and safe without statistical difference in terms of complications compared to PICC placement made by radiologists. AD - Department of Pharmacy, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France. Department of Radiology, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France. Department of Radiology, CHU de Nîmes, University of Montpellier, 30000 Nîmes, France. Electronic address: julien.frandon@chu-nimes.fr. AN - 31324590 AU - Chasseigne, V. AU - Larbi, A. AU - Goupil, J. AU - Bouassida, I. AU - Buisson, M. AU - Beregi, J. P. AU - Frandon, J. DA - Jan DO - 10.1016/j.diii.2019.06.010 DP - NLM ET - 2019/07/22 J2 - Diagnostic and interventional imaging KW - Adolescent Adult Aged Aged, 80 and over Allied Health Personnel Catheterization, Peripheral/adverse effects/*standards Female Humans Incidence Male Middle Aged Patient Care Team Postoperative Complications/*epidemiology/etiology Prospective Studies Radiology Young Adult Complication Cooperation program Peripherally inserted central catheter (PICC) Safety Venous access LA - eng M1 - 1 N1 - 2211-5684 Chasseigne, V Larbi, A Goupil, J Bouassida, I Buisson, M Beregi, J P Frandon, J Comparative Study Journal Article France Diagn Interv Imaging. 2020 Jan;101(1):7-14. doi: 10.1016/j.diii.2019.06.010. Epub 2019 Jul 16. PY - 2020 SN - 2211-5684 SP - 7-14 ST - PICC management led by technicians: Establishment of a cooperation program with radiologists and evaluation of complications T2 - Diagn Interv Imaging TI - PICC management led by technicians: Establishment of a cooperation program with radiologists and evaluation of complications VL - 101 ID - 760169 ER - TY - JOUR AB - Background and Purpose-Emergency department (ED) crowding occurs when demands for ED care exceed the supply of available resources. Prior studies have shown that ED crowding is associated with a delay in provision of critical ED services, but the impact of ED crowding on acute stroke care has not been extensively studied. Methods-We conducted a retrospective study of patients who presented to the ED with acute stroke symptoms (ischemic stroke, transient ischemic attack, intracerebral hemorrhage) at 2 hospitals. All patients with active stroke symptoms who presented within 3 hours were included and a random sample of patients with symptoms >3 hours was used for comparison. The association between ED crowding measures (waiting room number, ED occupancy, number of admitted patients, and total patient hours) and time to head CT order, completion, and interpretation, and time to administration of thrombolysis was determined. Results-Of 253 patients presenting with acute stroke symptoms <= 3 hours from symptom onset, 52 (21%) received thrombolysis. A random comparison group of 253 patients with symptoms >3 hours was identified. There was no significant association between ED crowding and delays in CT timing or thrombolysis in patients with symptoms <= 3 hours. Several measures of ED crowding were associated with prolonged times to CT order and completion in patients with symptoms >3 hours. Conclusions-ED crowding was not associated with care delays in thrombolysis-eligible patients with stroke. However, those with symptoms >3 hours do experience CT delays at higher levels of ED crowding. (Stroke. 2011;42:1074-1080.) AD - [Chatterjee, Pia] SUNY Hlth Sci Ctr, Kings Cty Hosp, Brooklyn, NY 11203 USA. [Cucchiara, Brett L.] Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA. [Lazarciuc, Nicole] Hosp Univ Penn, Dept Emergency Med, Philadelphia, PA 19104 USA. [Shofer, Frances S.] Univ N Carolina, Dept Emergency Med, Durham, NC USA. [Pines, Jesse M.] George Washington Univ, Dept Emergency Med, Washington, DC USA. [Pines, Jesse M.] George Washington Univ, Dept Hlth Policy, Washington, DC USA. Pines, JM (corresponding author), Ctr Hlth Care Qual, 2121 K St NW,Suite 200, Washington, DC 20037 USA. jesse.pines@gwumc.edu AN - WOS:000288857200046 AU - Chatterjee, P. AU - Cucchiara, B. L. AU - Lazarciuc, N. AU - Shofer, F. S. AU - Pines, J. M. DA - Apr DO - 10.1161/strokeaha.110.586610 J2 - Stroke KW - crowing emergency overcrowding quality stroke time to care IN-HOSPITAL DELAYS ASSOCIATION THROMBOLYSIS IMPACT INTERVENTION ANALGESIA OUTCOMES ARRIVAL TEAM PAIN Clinical Neurology Peripheral Vascular Disease LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: 741IK Times Cited: 36 Cited Reference Count: 27 Chatterjee, Pia Cucchiara, Brett L. Lazarciuc, Nicole Shofer, Frances S. Pines, Jesse M. 37 0 8 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA STROKE PY - 2011 SN - 0039-2499 SP - 1074-1080 ST - Emergency Department Crowding and Time to Care in Patients With Acute Stroke T2 - Stroke TI - Emergency Department Crowding and Time to Care in Patients With Acute Stroke UR - ://WOS:000288857200046 VL - 42 ID - 761855 ER - TY - JOUR AB - Introduction: Pulmonary embolism response team (PERT) is a multidisciplinary unit designed to deliver rapid, evidence-based and individualized care to critically ill patients with acute pulmonary embolism (PE). Despite the increasing emergence of PERTs, their impact on patient outcomes like mortality have not been studied. We studied the impact of PERT at Cleveland Clinic (CCF) since its launch in July 2014. Methods: In a retrospective review of our health records, we identified all patients diagnosed with PE on a contrast CT scan one year before and after institution of PERT (Pre-PERT: Jul 2013-Jun 2014, PERT: Jan-Dec 2015). Data from July to Dec 2014 was excluded allowing for dissemination of information regarding PERT availability. Charts were reviewed to obtain demographics, serology, simplified PE severity index (sPESI) variables and echocardiogram results. Patients with normal cardiac markers, no RV dysfunction and sPESI of 0 or 1 were classified as low risk and excluded. Results: We identified 158, 172 and 38 patients in the Pre-PERT, PERT era without activation (PERT-) and PERT era with activation (PERT+) groups respectively. Of note, since 42% (28/66) of all CCF-PERT activations in the study-period were PEs diagnosed on non-CCF studies/non-CT modalities, these patients did not get included in any group. When comparing PERT+ with Pre-PERT or PERT- patients, no significant differences were noted in average age (55.8yr v 59.9yr or 60.6yr, p=0.3 or 0.5), gender (males 57.9% v 50% or 58.7%, p=0.4 or 0.9) or sPESI (2.3 in all groups, p=0.7 or 0.3). There was a significant difference in 30-day/inpatient mortality between PERT+ and Pre-PERT groups (0% v 11.4%, p=0.02). Mortality difference approached statistical significance when comparing PERT+ and PERT- groups (0% v 8.1%, p=0.06). Finally, there was a trend towards significance when comparing Pre-PERT and all PERT era patients irrespective of PERT activation (11.4% v 6.7%, p=0.1). Conclusions: Our study revealed that patients who had involvement of PERT in the management of intermediate or high risk PE had lower mortality. Although not statistically significant given the small sample size, this data suggests that availability PERT may impart a survival benefit for all patients. with intermediate or high risk PE. AD - P. Chaudhury, Vascular Medicine, Cleveland Clinic, Cleveland, OH, United States AU - Chaudhury, P. AU - Gadre, S. AU - Bartholomew, J. R. DB - Embase KW - adult clinical article controlled study diagnosis echocardiography female gender hospital mortality human information processing lung embolism male retrospective study sample size serology statistical significance survival x-ray computed tomography LA - English M3 - Conference Abstract N1 - L619985844 2018-01-02 PY - 2017 SN - 1524-4539 ST - Impact of pulmonary embolism response team on outcomes of patients with intermediate or high risk pulmonary emboli T2 - Circulation TI - Impact of pulmonary embolism response team on outcomes of patients with intermediate or high risk pulmonary emboli UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619985844&from=export VL - 136 ID - 760899 ER - TY - JOUR AB - Treatment strategies for complex patients with pulmonary embolism (PE) are often debated given patient heterogeneity, multitude of available treatment modalities, and lack of consensus guidelines. Although multidisciplinary Pulmonary Embolism Response Teams (PERT) are emerging to address this lack of consensus, their impact on patient outcomes is not entirely clear. This analysis was conducted to compare outcomes of all patients with PE before and after PERT availability. We analyzed all adult patients admitted with acute PE diagnosed on computed tomography scans in the 18 months before and after the institution of PERT at a large tertiary care hospital. Among 769 consecutive inpatients with PE, PERT era patients had lower rates of major or clinically relevant nonmajor bleeding (17.0% vs 8.3%, p = 0.002), shorter time-to-therapeutic anticoagulation (16.3 hour vs 12.6 hour, p = 0.009) and decreased use of inferior vena cava filters (22.2% vs 16.4%, p = 0.004). There was an increase in the use of thrombolytics/catheter-based strategies, however, this did not achieve statistical significance (p = 0.07). There was a significant decrease in 30-day/inpatient mortality (8.5% vs 4.7%, p = 0.03). These differences in outcomes were more pronounced in intermediate and high-risk patients (mortality 10.0% vs 5.3%, p = 0.02). The availability of multidisciplinary PERT was associated with improved outcomes including 30-day mortality. Patients with higher severity of PE seemed to derive most benefit from PERT availability. AD - P. Chaudhury, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, IA, United States AU - Chaudhury, P. AU - Gadre, S. AU - Schneider, E. AU - Renapurkar, R. AU - Gomes, M. AU - Haddadin, I. AU - Heresi, G. AU - Tong, M. Z. AU - Bartholomew, J. R. DB - Embase Medline DO - 10.1016/j.amjcard.2019.07.043 KW - vena cava filter bivalirudin enoxaparin fibrinolytic agent fondaparinux heparin rivaroxaban adult anticoagulant therapy article bleeding cohort analysis computer assisted tomography controlled study female fibrinolytic therapy health care availability high risk patient hospital patient human intermediate risk patient lung embolism major clinical study male middle aged mortality priority journal pulmonary embolism response team retrospective study tertiary care center time to treatment treatment outcome LA - English M1 - 9 M3 - Article N1 - L2002792202 2019-09-10 2019-10-21 PY - 2019 SN - 1879-1913 0002-9149 SP - 1465-1469 ST - Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes T2 - American Journal of Cardiology TI - Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002792202&from=export http://dx.doi.org/10.1016/j.amjcard.2019.07.043 VL - 124 ID - 760653 ER - TY - JOUR AB - Treatment strategies for complex patients with pulmonary embolism (PE) are often debated given patient heterogeneity, multitude of available treatment modalities, and lack of consensus guidelines. Although multidisciplinary Pulmonary Embolism Response Teams (PERT) are emerging to address this lack of consensus, their impact on patient outcomes is not entirely clear. This analysis was conducted to compare outcomes of all patients with PE before and after PERT availability. We analyzed all adult patients admitted with acute PE diagnosed on computed tomography scans in the 18 months before and after the institution of PERT at a large tertiary care hospital. Among 769 consecutive inpatients with PE, PERT era patients had lower rates of major or clinically relevant non-major bleeding (17.0% vs 8.3 %, p = 0.002), shorter time-to-therapeutic anticoagulation (16.3 hour vs 12.6 hour, p = 0.009) and decreased use of inferior vena cava filters (22.2% vs 16.4%, p = 0.004). There was an increase in the use of thrombolytics/catheter-based strategies, however, this did not achieve statistical significance (p = 0.07). There was a significant decrease in 30-day/inpatient mortality (8.5% vs 4.7 %, p = 0.03). These differences in outcomes were more pronounced in intermediate and high-risk patients (mortality 10.0% vs 5.3%, p = 0.02). The availability of multidisciplinary PERT was associated with improved outcomes including 30-day mortality. Patients with higher severity of PE seemed to derive most benefit from PERT availability. (C) 2019 Elsevier Inc. All rights reserved. AD - [Chaudhury, Pulkit] Univ Iowa, Dept Internal Med, Div Cardiovasc Med, Iowa City, IA 52242 USA. [Chaudhury, Pulkit; Gomes, Marcelo; Bartholomew, John R.] Cleveland Clin, Sect Vasc Med, Dept Cardiovasc Med, Cleveland, OH 44106 USA. [Gadre, Shruti; Heresi, Gustavo] Cleveland Clin, Dept Pulm Med, Cleveland, OH 44106 USA. [Schneider, Erika; Renapurkar, Rahul; Haddadin, Ihab] Cleveland Clin, Dept Radiol, Cleveland, OH 44106 USA. [Tong, Michael Z. Y.] Cleveland Clin, Dept Thorac & Cardiovasc Surg, Cleveland, OH 44106 USA. Chaudhury, P (corresponding author), Univ Iowa, Dept Internal Med, Div Cardiovasc Med, Iowa City, IA 52242 USA.; Chaudhury, P (corresponding author), Cleveland Clin, Sect Vasc Med, Dept Cardiovasc Med, Cleveland, OH 44106 USA. Pulkit.chaudhury@gmail.com AN - WOS:000496035800021 AU - Chaudhury, P. AU - Gadre, S. AU - Schneider, E. AU - Renapurkar, R. AU - Gomes, M. AU - Haddadin, I. AU - Heresi, G. AU - Tong, M. Z. Y. AU - Bartholomew, J. R. DA - Nov DO - 10.1016/j.amjcard.2019.07.043 J2 - Am. J. Cardiol. KW - ANTICOAGULATION EXPERIENCE DISEASE CARE Cardiac & Cardiovascular Systems LA - English M1 - 9 M3 - Article N1 - ISI Document Delivery No.: JM2FI Times Cited: 9 Cited Reference Count: 20 Chaudhury, Pulkit Gadre, Shruti Schneider, Erika Renapurkar, Rahul Gomes, Marcelo Haddadin, Ihab Heresi, Gustavo Tong, Michael Z. Y. Bartholomew, John R. chaudhury, pulkit/AAL-7207-2020 Chaudhury, Pulkit/0000-0002-8210-8394 10 1 3 EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC BRIDGEWATER AM J CARDIOL PY - 2019 SN - 0002-9149 SP - 1465-1469 ST - Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes T2 - American Journal of Cardiology TI - Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes UR - ://WOS:000496035800021 VL - 124 ID - 761478 ER - TY - JOUR AB - Treatment strategies for complex patients with pulmonary embolism (PE) are often debated given patient heterogeneity, multitude of available treatment modalities, and lack of consensus guidelines. Although multidisciplinary Pulmonary Embolism Response Teams (PERT) are emerging to address this lack of consensus, their impact on patient outcomes is not entirely clear. This analysis was conducted to compare outcomes of all patients with PE before and after PERT availability. We analyzed all adult patients admitted with acute PE diagnosed on computed tomography scans in the 18 months before and after the institution of PERT at a large tertiary care hospital. Among 769 consecutive inpatients with PE, PERT era patients had lower rates of major or clinically relevant nonmajor bleeding (17.0% vs 8.3%, p = 0.002), shorter time-to-therapeutic anticoagulation (16.3 hour vs 12.6 hour, p = 0.009) and decreased use of inferior vena cava filters (22.2% vs 16.4%, p = 0.004). There was an increase in the use of thrombolytics/catheter-based strategies, however, this did not achieve statistical significance (p = 0.07). There was a significant decrease in 30-day/inpatient mortality (8.5% vs 4.7%, p = 0.03). These differences in outcomes were more pronounced in intermediate and high-risk patients (mortality 10.0% vs 5.3%, p = 0.02). The availability of multidisciplinary PERT was associated with improved outcomes including 30-day mortality. Patients with higher severity of PE seemed to derive most benefit from PERT availability. AD - Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa, Iowa City, Iowa; Section of Vascular Medicine, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: Pulkit.chaudhury@gmail.com. Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio. Department of Radiology, Cleveland Clinic, Cleveland, Ohio. Section of Vascular Medicine, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. AN - 31495443 AU - Chaudhury, P. AU - Gadre, S. K. AU - Schneider, E. AU - Renapurkar, R. D. AU - Gomes, M. AU - Haddadin, I. AU - Heresi, G. A. AU - Tong, M. Z. AU - Bartholomew, J. R. DA - Nov 1 DO - 10.1016/j.amjcard.2019.07.043 DP - NLM ET - 2019/09/10 J2 - The American journal of cardiology KW - Adult Aged Anticoagulants/*therapeutic use Delivery of Health Care Embolectomy/methods/statistics & numerical data Endovascular Procedures/methods/statistics & numerical data Extracorporeal Membrane Oxygenation/methods/statistics & numerical data Female Hemorrhage/chemically induced/*epidemiology Hospitalization Humans Male Middle Aged Patient Care Team/*organization & administration Pulmonary Embolism/*therapy Thrombolytic Therapy/methods/statistics & numerical data Tomography, X-Ray Computed Vena Cava Filters/statistics & numerical data LA - eng M1 - 9 N1 - 1879-1913 Chaudhury, Pulkit Gadre, Shruti Kumar Schneider, Erika Renapurkar, Rahul D Gomes, Marcelo Haddadin, Ihab Heresi, Gustavo A Tong, Michael Z Bartholomew, John R Journal Article United States Am J Cardiol. 2019 Nov 1;124(9):1465-1469. doi: 10.1016/j.amjcard.2019.07.043. Epub 2019 Aug 7. PY - 2019 SN - 0002-9149 SP - 1465-1469 ST - Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes T2 - Am J Cardiol TI - Impact of Multidisciplinary Pulmonary Embolism Response Team Availability on Management and Outcomes VL - 124 ID - 760112 ER - TY - JOUR AB - Abstract: Background: Linezolid (LZD), an oxazolidinone antibiotic agent, has excellent activity and bioavailability against most methicillin-sensitive and methicillin-resistant gram-positive bacteria. Although LZD is generally well tolerated, several studies have found adverse hematologic effects, of which thrombocytopenia is of most concern. Objective: To investigate the risk factors for thrombocytopenia in patients who received oral or parenteral LZD therapy between February 1 and November 30, 2010. Methods: Data were extracted retrospectively from the electronic medical records in our hospital information system. Thrombocytopenia was defined as either a final platelet count of <100 × 109/L (criterion 1) or a 25% reduction from the baseline platelet count (criterion 2). Risk factors were determined using logistic regression analysis, and clinical features were predicted using receiver operating characteristic curves. Results: The study included 254 patients, with mean (SD) age of 59 (17.66) years. The duration of LZD therapy was 9.43 (5.63) days. Thrombocytopenia developed in 69 patients (27.2%), as defined by criterion 1, and in 127 patients (50%), as defined by criterion 2. At univariate analysis, age, weight, creatinine clearance, serum albumin concentration, baseline platelet count, daily dosage, and concomitant use of caspofungin, levofloxacin, and meropenem were significant risk factors for thrombocytopenia. At multivariate analysis and using ROC curves, daily dose ≥18.75 mg/kg, baseline platelet count ≤181 × 109/L, duration of LZD therapy ≥10 days, and concomitant use of caspofungin and levofloxacin were independent risk factors for thrombocytopenia as defined by criterion 1, whereas creatinine clearance ≤88.39 mL/min/1.73 m2, serum albumin concentration ≤33.5 g/L, daily dose ≥18.46 mg/kg, and caspofungin were independent risk factors for thrombocytopenia as defined by criterion 2. Conclusions: The incidence of LZD-related thrombocytopenia in the Chinese population is much higher than that suggested by the drug instructions. Low pretreatment platelet count, low body weight, low serum albumin concentration, long-term drug administration, advanced age, renal insufficiency, and concomitant use of caspofungin, levofloxacin, and meropenem have been identified as risk factors. Although predictors have been proposed for use in clinical practice to screen for patients at high risk who require intensified monitoring, further research on the dosage-based pharmacokinetics and pharmacodynamics of LZD are urgently needed. AD - Department of Pharmacy, Chinese PLA General Hospital, Beijing, China Department of Medical Statistics, Chinese PLA General Hospital, Beijing, China AN - 104395372. Language: English. Entry Date: 20121212. Revision Date: 20200708. Publication Type: Journal Article AU - Chen, Chao AU - Guo, Dai-Hong AU - Cao, Xiutang AU - Cai, Yun AU - Xu, Yuanjie AU - Zhu, Man AU - Ma, Liang DB - CINAHL DO - 10.1016/j.curtheres.2012.07.002 DP - EBSCOhost KW - Thrombocytopenia -- Risk Factors Linezolid -- Adverse Effects Human China Retrospective Design Electronic Health Records Hematologic Tests Multivariate Analysis ROC Curve M1 - 6 N1 - research. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Public Health. NLM UID: 0372621. PMID: NLM24653521. PY - 2012 SN - 0011-393X SP - 195-206 ST - Risk Factors for Thrombocytopenia in Adult Chinese Patients Receiving Linezolid Therapy T2 - Current Therapeutic Research TI - Risk Factors for Thrombocytopenia in Adult Chinese Patients Receiving Linezolid Therapy UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=104395372&site=ehost-live&scope=site VL - 73 ID - 761381 ER - TY - JOUR AB - Objective: To examine the relationship between early emergency team calls and the incidence of serious adverse events-cardiac arrests, deaths, and unplanned admissions to an intensive care unit-in a cluster randomized controlled trial of medical emergency team implementation (the MERIT study). Design: Post hoc analysis of data from cluster randomized controlled trial. Setting and Participants. Twenty-three public hospitals in Australia and 741,744 patents admitted during the conduct of the study. Interventions. Attendance by a rapid response system team or cardiac arrest team. Main Outcome Measures, The relationship between the proportion of rapid response system team calls that were early emergency team calls (defined as calls not associated with cardiac arrest or death) and the rate (events/1000 admissions) of the adverse events. Results: We analyzed 11,242 serious adverse events and 3700 emergency team calls. For every 10% of increase in the proportion of early emergency team calls there was a 2.0 reduction per 10,000 admissions in unexpected cardiac arrests (95% confidence interval [CI] -2.6 to -1.4), a 2.2 reduction in overall cardiac arrests (95% CI -2.9 to -1.6), and a 0.94 reduction in unexpected deaths (95% CI -1.4 to -0.5). We found no such relationship for unplanned intensive care unit admissions or for the aggregate of unexpected cardiac arrests, unplanned intensive care unit admissions, and unexpected deaths. Conclusions. As the proportion of early emergency team calls increases, the rate of cardiac arrests and unexpected deaths decreases. This inverse relationship provides support for the notion that early review of acutely ill ward patents by an emergency team is desirable. (Crit Care Med 2009; 37:148-153) AD - [Chen, Jack; Hillman, Ken] Univ New S Wales, Simpson Ctr Hlth Serv Res, Sydney, NSW, Australia. [Bellomo, Rinaldo] Austin Med Ctr, Intens Care Unit, Melbourne, Vic, Australia. [Flabouris, Arthas] Royal Adelaide Hosp, Intens Care Unit, Aldelaide, SA, Australia. [Finfer, Simon] Royal N Shore Hosp, Intens Care Unit, Sydney, NSW, Australia. Chen, J (corresponding author), Univ New S Wales, Simpson Ctr Hlth Serv Res, Sydney, NSW, Australia. jackchen@unsw.edu.au AN - WOS:000262269900020 AU - Chen, J. AU - Bellomo, R. AU - Flabouris, A. AU - Hillman, K. AU - Finfer, S. AU - Simpson, Merit Study Investigators AU - Grp, Anzics Clinical Trials DA - Jan DO - 10.1097/CCM.0b013e3181928ce3 J2 - Crit. Care Med. KW - medical emergency team rapid response team health services research cluster randomized controlled trial dose-response CONTROLLED-TRIAL RATES THROMBOLYSIS MORTALITY ARRESTS Critical Care Medicine LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 391YK Times Cited: 163 Cited Reference Count: 20 Chen, Jack Bellomo, Rinaldo Flabouris, Arthas Hillman, Ken Finfer, Simon Chen, Jack/AAR-7346-2020; Flabouris, Arthas/L-1347-2019; Flabouris, Arthas/AAF-9477-2019 Flabouris, Arthas/0000-0002-1535-9441; /0000-0002-4157-5148; Parr, Michael/0000-0003-3507-474X; Chen, Jack/0000-0003-4693-5234; Bellomo, Rinaldo/0000-0002-1650-8939; SHEHABI, Yahya/0000-0003-4707-7462; Doig, Gordon/0000-0003-2141-7000 National Health and Medical Research Council of AustraliaNational Health and Medical Research Council of Australia; Australian Council for Safety and Quality in Health Care; Australian and New Zealand Intensive Care Foundation Supported by grants from the National Health and Medical Research Council of Australia, the Australian Council for Safety and Quality in Health Care, and the Australian and New Zealand Intensive Care Foundation as part of the MERIT study. 167 0 13 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CRIT CARE MED PY - 2009 SN - 0090-3493 SP - 148-153 ST - The relationship between early emergency team calls and serious adverse events T2 - Critical Care Medicine TI - The relationship between early emergency team calls and serious adverse events UR - ://WOS:000262269900020 VL - 37 ID - 761903 ER - TY - JOUR AB - Objectives: Generalizable, high-throughput phenotyping methods based on supervised machine learning (ML) algorithms could significantly accelerate the use of electronic health records data for clinical and translational research. However, they often require large numbers of annotated samples, which are costly and time-consuming to review. We investigated the use of active learning (AL) in ML-based phenotyping algorithms.Methods: We integrated an uncertainty sampling AL approach with support vector machines-based phenotyping algorithms and evaluated its performance using three annotated disease cohorts including rheumatoid arthritis (RA), colorectal cancer (CRC), and venous thromboembolism (VTE). We investigated performance using two types of feature sets: unrefined features, which contained at least all clinical concepts extracted from notes and billing codes; and a smaller set of refined features selected by domain experts. The performance of the AL was compared with a passive learning (PL) approach based on random sampling.Results: Our evaluation showed that AL outperformed PL on three phenotyping tasks. When unrefined features were used in the RA and CRC tasks, AL reduced the number of annotated samples required to achieve an area under the curve (AUC) score of 0.95 by 68% and 23%, respectively. AL also achieved a reduction of 68% for VTE with an optimal AUC of 0.70 using refined features. As expected, refined features improved the performance of phenotyping classifiers and required fewer annotated samples.Conclusions: This study demonstrated that AL can be useful in ML-based phenotyping methods. Moreover, AL and feature engineering based on domain knowledge could be combined to develop efficient and generalizable phenotyping methods. AD - Department of Biomedical Informatics, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA. AN - 104121829. Language: English. Entry Date: 20140207. Revision Date: 20200708. Publication Type: journal article AU - Chen, Yukun AU - Carroll, Robert J. AU - Hinz, Eugenia R. McPeek AU - Shah, Anushi AU - Eyler, Anne E. AU - Denny, Joshua C. AU - Xu, Hua DB - CINAHL DO - 10.1136/amiajnl-2013-001945 DP - EBSCOhost KW - Algorithms Artificial Intelligence Electronic Health Records Phenotype Genetic Techniques Human M1 - e2 N1 - research. Journal Subset: Blind Peer Reviewed; Computer/Information Science; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Informatics. Grant Information: R01 CA141307/CA/NCI NIH HHS/United States. NLM UID: 9430800. PMID: NLM23851443. PY - 2013 SN - 1067-5027 SP - e253-9 ST - Applying active learning to high-throughput phenotyping algorithms for electronic health records data T2 - Journal of the American Medical Informatics Association TI - Applying active learning to high-throughput phenotyping algorithms for electronic health records data UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=104121829&site=ehost-live&scope=site VL - 20 ID - 761294 ER - TY - JOUR AU - Chen, Y. L. AU - Wright, C. AU - Pietropaoli, A. P. AU - Elbadawi, A. AU - Delehanty, J. AU - Barrus, B. AU - Gosev, I. AU - Trawick, D. AU - Patel, D. AU - Cameron, S. J. DA - 2019/08/05 08/05 DB - Europe PubMed Central DO - 10.1007/s11239-019-01922-w M1 - 1 PY - 2019 SN - 1573-742x SP - 34-41 ST - Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team T2 - J Thromb Thrombolysis TI - Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team UR - http://europepmc.org/article/MED/31375993 VL - 49 ID - 761930 ER - TY - JOUR AB - Several risk stratification tools are available to predict short-term mortality in patients with acute pulmonary embolism (PE). The presence of right ventricular (RV) dysfunction is an independent predictor of mortality and may be a more efficient way to stratify risk for patients assessed by a Pulmonary Embolism Response Team (PERT). We evaluated 571 patients presenting with acute PE, then stratified them by the pulmonary embolism severity index (PESI), by the BOVA score, or categorically as low risk (no RV dysfunction by imaging), intermediate risk/submassive (RV dysfunction by imaging), or high risk/massive PE (RV dysfunction with sustained hypotension). Using imaging data to firstly define the presence of RV strain, and plasma cardiac biomarkers as additional evidence for myocardial dysfunction, we evaluated whether PESI, BOVA, or RV strain by imaging were more appropriate for determining patient risk by a PERT where rapid decision making is important. Cardiac biomarkers poorly distinguished between PESI classes and BOVA stages in patients with acute PE. Cardiac TnT and NT-proBNP easily distinguished low risk from submassive PE with an area under the curve (AUC) of 0.84 (95% CI 0.73-0.95, p < 0.0001), and 0.88 (95% CI 0.79-0.97, p < 0.0001), respectively. Cardiac TnT and NT-proBNP easily distinguished low risk from massive PE with an area under the curve (AUC) of 0.89 (95% CI 0.78-1.00, p < 0.0001), and 0.89 (95% CI 0.82-0.95, p < 0.0001), respectively. In patients with RV dysfunction, the predicted short-term mortality by PESI score or BOVA stage was lower than the observed mortality by a two-fold order of magnitude. The presence of RV dysfunction alone in the context of acute PE is sufficient for the purposes of risk stratification. More complicated risk stratification tools which require the consideration of multiple clinical variables may under-estimate short-term mortality risk. AD - Department of Medicine, University of Rochester, Rochester, USA. Yulin_Chen@urmc.rochester.edu. Department of General Medicine, University of Rochester, Rochester, USA. Yulin_Chen@urmc.rochester.edu. Department of Medicine, University of Rochester, Rochester, USA. Department of Cardiology, University of Rochester, Aab CVRI, Box CVRI, Box 601 Elmwood Ave, Rochester, NY, 14624, USA. Pulmonary Medicine and Critical Care, University of Rochester, Rochester, USA. Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA. Department of Surgery, Cardiac Surgery, University of Rochester, Rochster, USA. Department of General Medicine, University of Rochester, Rochester, USA. AN - 31375993 AU - Chen, Y. L. AU - Wright, C. AU - Pietropaoli, A. P. AU - Elbadawi, A. AU - Delehanty, J. AU - Barrus, B. AU - Gosev, I. AU - Trawick, D. AU - Patel, D. AU - Cameron, S. J. C2 - Pmc6954969 C6 - Nihms1536452 DA - Jan DO - 10.1007/s11239-019-01922-w DP - NLM ET - 2019/08/04 J2 - Journal of thrombosis and thrombolysis KW - Aged Biomarkers/blood Female Humans Male Middle Aged Natriuretic Peptide, Brain/*blood Peptide Fragments/*blood Pulmonary Embolism/blood/diagnosis/physiopathology Retrospective Studies Risk Assessment *Severity of Illness Index Troponin T/*blood *Ventricular Dysfunction, Right/blood/diagnosis/physiopathology BOVA score Biomarker Pulmonary Embolism Response Team (PERT) Pulmonary Embolism Severity Index (PESI) Pulmonary embolism (PE) Right ventricle (RV) LA - eng M1 - 1 N1 - 1573-742x Chen, Yu Lin Wright, Colin Pietropaoli, Anthony P Elbadawi, Ayman Delehanty, Joseph Barrus, Bryan Gosev, Igor Trawick, David Patel, Dhwani Cameron, Scott J Orcid: 0000-0002-9616-1540 K08 HL128856/HL/NHLBI NIH HHS/United States 3K08HL128856/HL/NHLBI NIH HHS/United States HL12020/HL/NHLBI NIH HHS/United States Clinical Trial Journal Article J Thromb Thrombolysis. 2020 Jan;49(1):34-41. doi: 10.1007/s11239-019-01922-w. PY - 2020 SN - 0929-5305 (Print) 0929-5305 SP - 34-41 ST - Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team T2 - J Thromb Thrombolysis TI - Right ventricular dysfunction is superior and sufficient for risk stratification by a pulmonary embolism response team VL - 49 ID - 760284 ER - TY - JOUR AB - AIM: To critically appraise short-term outcomes in patients treated in a new Pelvic Exenteration (PE) Unit. METHODS: This retrospective observational study was conducted by analysing prospectively collected data for the first 25 patients (16 males, 9 females) who underwent PE for advanced pelvic tumours in our PE Unit between January 2012 and October 2016. Data evaluated included age, co-morbidities, American Society of Anesthesiologists (ASA) score, Eastern Cooperative Oncology Group (ECOG) status, preoperative adjuvant treatment, intra-operative blood loss, procedural duration, perioperative adverse event, lengths of intensive care unit (ICU) stay and hospital stay, and oncological outcome. Quantitative data were summarized as percentage or median and range, and statistically assessed by the χ(2) test or Fisher's exact test, as applicable. RESULTS: All 25 patients received comprehensive preoperative assessment via our dedicated multidisciplinary team approach. Long-course neoadjuvant chemoradiotherapy was provided, if indicated. The median age of the patients was 61.9-year-old. The median ASA and ECOG scores were 2 and 0, respectively. The indications for PE were locally invasive rectal adenocarcinoma (n = 13), advanced colonic adenocarcinoma (n = 5), recurrent cervical carcinoma (n = 3) and malignant sacral chordoma (n = 3). The procedures comprised 10 total PEs, 4 anterior PEs, 7 posterior PEs and 4 isolated lateral PEs. The median follow-up period was 17.6 mo. The median operative time was 11.5 h. The median volume of blood loss was 3306 mL, and the median volume of red cell transfusion was 1475 mL. The median lengths of ICU stay and of hospital stay were 1 d and 21 d, respectively. There was no case of mortality related to surgery. There were a total of 20 surgical morbidities, which occurred in 12 patients. The majority of the complications were grade 2 Clavien-Dindo. Only 2 patients experienced grade 3 Clavien-Dindo complications, and both required procedural interventions. One patient experienced grade 4a Clavien-Dindo complication, requiring temporary renal dialysis without long-term disability. The R0 resection rate was 64%. There were 7 post-exenteration recurrences during the follow-up period. No statistically significant relationship was found among histological origin of tumour, microscopic resection margin status and postoperative recurrence (P = 0.67). Four patients died from sequelae of recurrent disease during follow-up. CONCLUSION: By utilizing modern assessment and surgical techniques, our PE Unit can manage complex pelvic cancers with acceptable morbidities, zero-rate mortality and equivalent oncologic outcomes. AD - Min Hoe Chew, Yu-Ting Yeh, Ee-Lin Toh, Stephen Aditya Sumarli, Choong Leong Tang, Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore. AN - 28567186 AU - Chew, M. H. AU - Yeh, Y. T. AU - Toh, E. L. AU - Sumarli, S. A. AU - Chew, G. K. AU - Lee, L. S. AU - Tan, M. H. AU - Hennedige, T. P. AU - Ng, S. Y. AU - Lee, S. K. AU - Chong, T. T. AU - Abdullah, H. R. AU - Goh, T. L. H. AU - Rasheed, M. Z. AU - Tan, K. C. AU - Tang, C. L. C2 - Pmc5434389 DA - May 15 DO - 10.4251/wjgo.v9.i5.218 DP - NLM ET - 2017/06/02 J2 - World journal of gastrointestinal oncology KW - Advanced pelvic tumour Chordoma Colorectal cancer Oncological outcome Pelvic exenteration Sacrectomy to this research or its publication. LA - eng M1 - 5 N1 - 1948-5204 Chew, Min Hoe Yeh, Yu-Ting Toh, Ee-Lin Sumarli, Stephen Aditya Chew, Ghee Kheng Lee, Lui Shiong Tan, Mann Hong Hennedige, Tiffany Priyanthi Ng, Shin Yi Lee, Say Kiat Chong, Tze Tec Abdullah, Hairil Rizal Goh, Terence Lin Hon Rasheed, Mohamed Zulfikar Tan, Kok Chai Tang, Choong Leong Journal Article World J Gastrointest Oncol. 2017 May 15;9(5):218-227. doi: 10.4251/wjgo.v9.i5.218. PY - 2017 SN - 1948-5204 (Print) SP - 218-227 ST - Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases T2 - World J Gastrointest Oncol TI - Critical evaluation of contemporary management in a new Pelvic Exenteration Unit: The first 25 consecutive cases VL - 9 ID - 760419 ER - TY - JOUR AD - [Rodriguez Chiaradia, Diego A.] Univ Pompeu Fabra, CIBERES ISCiii, Inst Hosp del Mar Invest Med IMIM, Hosp del Mar,Pulmonol Dept, Barcelona, Spain. [Cuttica, Michael J.] Northwestern Univ, Feinberg Sch Med, Div Pulm & Crit Care Med, Chicago, IL 60611 USA. [Jimenez, David] Univ Alcala IRYCIS, Med Dept, Hosp Ramon y Cajal, Resp Dept, Alcala De Henares, Spain. Chiaradia, DAR (corresponding author), Univ Pompeu Fabra, CIBERES ISCiii, Inst Hosp del Mar Invest Med IMIM, Hosp del Mar,Pulmonol Dept, Barcelona, Spain. darodriguez@parcdesalutmar.cat AN - WOS:000456489800001 AU - Chiaradia, D. A. R. AU - Cuttica, M. J. AU - Jimenez, D. DA - Jan DO - 10.1016/j.arbres.2018.04.002 J2 - Arch. Bronconeumol. KW - ORGANIZATIONAL SURVEY MANAGEMENT THROMBOSIS Respiratory System LA - English M1 - 1 M3 - Editorial Material N1 - ISI Document Delivery No.: HI5KB Times Cited: 1 Cited Reference Count: 18 Rodriguez Chiaradia, Diego A. Cuttica, Michael J. Jimenez, David 1 0 2 ELSEVIER DOYMA SL BARCELONA ARCH BRONCONEUMOL PY - 2019 SN - 0300-2896 SP - 1-2 ST - The Role of the Pulmonologist in a Pulmonary Embolism Response Team (PERT): A Time to Come on Stage T2 - Archivos De Bronconeumologia TI - The Role of the Pulmonologist in a Pulmonary Embolism Response Team (PERT): A Time to Come on Stage UR - ://WOS:000456489800001 VL - 55 ID - 761549 ER - TY - JOUR AB - AIMS: To audit the care of a consecutive group of acute stroke patients admitted to all District Health Boards (DHBs) in New Zealand. METHODS: A clinical audit involving a review of up to 40 consecutive stroke patients treated and discharged from each DHB between 1st of June 2008 and 31st of December 2008. RESULTS: The clinical care of 832 patients [400 men; median age 77 (interquartile range 67-84) years] admitted to 20 of 21 DHBs was audited. This represents approximately 20% of all stroke patients admitted to hospital in New Zealand over this 6 month period. Most of the audited patients were independent (66%, mRS=2) and 90% lived at home prior to their strokes. At stroke onset, 40% had a known diagnosis of atrial fibrillation (AF), of whom only 24% were taking anticoagulants. Thirty-eight percent of patients arrived in hospital within 4.5 hours of stroke onset but only 3% were treated with stroke thrombolysis. Only 28% of patients were managed in a stroke unit but these patients had higher rates of thrombolysis, more rapid access to multidisciplinary team assessments and a lower rate of stroke progression (8% vs 15%, p<0.01). Only 21% of ischaemic stroke patients received aspirin within 48 hours and 35% of patients had a speech-language therapist assessment within 48 hours of admission. CONCLUSION: Access to stroke unit care and thrombolysis rates remain low in New Zealand and should be seen as the top priorities for acute stroke care improvement along with anticoagulation for stroke prevention in AF, acute aspirin use and increased speech language therapy assessments. AD - Neurology Department, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand. AN - 22864156 AU - Child, N. AU - Fink, J. AU - Jones, S. AU - Voges, K. AU - Vivian, M. AU - Barber, P. A. DA - Jul 29 DP - NLM ET - 2012/08/07 J2 - The New Zealand medical journal KW - Aged Aged, 80 and over *Clinical Audit Female Guideline Adherence *Health Services Accessibility Hospital Units/statistics & numerical data *Hospitals, District Humans Male New Zealand/epidemiology Retrospective Studies Risk Factors Stroke/diagnosis/epidemiology/*therapy Thrombolytic Therapy/statistics & numerical data LA - eng M1 - 1358 N1 - 1175-8716 Child, Nicholas Fink, John Jones, Shelley Voges, Kevin Vivian, Mark Barber, P Alan Journal Article New Zealand N Z Med J. 2012 Jul 29;125(1358):44-51. PY - 2012 SN - 0028-8446 SP - 44-51 ST - New Zealand National Acute Stroke Services Audit: acute stroke care delivery in New Zealand T2 - N Z Med J TI - New Zealand National Acute Stroke Services Audit: acute stroke care delivery in New Zealand VL - 125 ID - 760423 ER - TY - JOUR AB - We conducted an epidemiologic survey in France on the use of bicaval dual-lumen cannulas for extracorporeal membrane oxygenation (ECMO). Every service that used the Avalon (c) cannula was contacted. Practitioners answered questions concerning its practical usage and complications that were attributable to its usage. We report data for 52 instances of cannula usage. The primary indication was acute respiratory distress syndrome (ARDS) in 77% of cases. Of all of the patients who required cannulas, 46% died. The maximum flow was 2,175 +/- 556 ml/minute for 20-Fr.-diameter cannulas, 3,207 +/- 653 ml/minute for 23 Fr., 3,963 +/- 729 ml/minute for 27 Fr., and 5,490 +/- 984 ml/minute for 31 Fr. Surgeons placed the cannulas in 52% of cases, intensivists placed the cannulas in 23% of cases, and multidisciplinary teams placed the cannulas in 25% of cases. The mean insertion time was 26 +/- 13 minutes, and insertion was performed under transesophageal electrocardiography (TEE) (67%), transthoracic echocardiography (TTE) (25%), fluoroscopy (4%), or no guidance (4%). The main complication was migration into the right ventricle. Problems with hemolysis were described in 21% of cases. No case of cannula thrombosis was found. No case of infection was reported. Bleeding was noted in 17% of cases. The mean time of use was 8 +/- 7 days. Modifications to the supportive care system were required in 15% of cases. Monitoring was performed by chest x-rays (90%), TTE (42%), and TEE (46%). Five extubations occurred during the support period. Nine patients were mobilized. The use of this cannula yielded satisfactory results. We suggest placing these cannulas using TTE or TEE and recommend the use of large-caliber cannulas in hypoxemic patients. ASAIO Journal 2013;59:157-161. AD - [Chimot, Loic; Marque, Sophie; Gros, Antoine; Gacouin, Arnaud; Lavoue, Sylvain; Camus, Christophe; Le Tulzo, Yves] Univ Rennes 1, Hop Pontchaillou, Rennes, France. [Chimot, Loic] Ctr Hosp Perigueux, Intens Care Unit, F-29019 Perigueux, France. Chimot, L (corresponding author), Ctr Hosp Perigueux, Intens Care Unit, 80 Ave Georges Pompidou, F-29019 Perigueux, France. loic.chimot@ch-perigueux.fr AN - WOS:000315599400011 AU - Chimot, L. AU - Marque, S. AU - Gros, A. AU - Gacouin, A. AU - Lavoue, S. AU - Camus, C. AU - Le Tulzo, Y. DA - Mar-Apr DO - 10.1097/MAT.0b013e31827db6f3 J2 - Asaio J. KW - ECMO epidemiology ARDS echocardiography procedure database RESPIRATORY-DISTRESS-SYNDROME ACUTE LUNG INJURY INTENSIVE-CARE UNITS FAILURE EPIDEMIOLOGY MORTALITY INFLUENZA Engineering, Biomedical Transplantation LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 099DH Times Cited: 46 Cited Reference Count: 16 Chimot, Loic Marque, Sophie Gros, Antoine Gacouin, Arnaud Lavoue, Sylvain Camus, Christophe Le Tulzo, Yves 46 1 9 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA ASAIO J PY - 2013 SN - 1058-2916 SP - 157-161 ST - Avalon (c) Bicaval Dual-Lumen Cannula for Venovenous Extracorporeal Membrane Oxygenation: Survey of Cannula Use in France T2 - Asaio Journal TI - Avalon (c) Bicaval Dual-Lumen Cannula for Venovenous Extracorporeal Membrane Oxygenation: Survey of Cannula Use in France UR - ://WOS:000315599400011 VL - 59 ID - 761811 ER - TY - JOUR AB - We conducted an epidemiologic survey in France on the use of bicaval dual-lumen cannulas for extracorporeal membrane oxygenation (ECMO). Every service that used the Avalon cannula was contacted. Practitioners answered questions concerning its practical usage and complications that were attributable to its usage. We report data for 52 instances of cannula usage. The primary indication was acute respiratory distress syndrome (ARDS) in 77% of cases. Of all of the patients who required cannulas, 46% died. The maximum flow was 2,175 ± 556 ml/minute for 20-Fr.-diameter cannulas, 3,207 ± 653 ml/minute for 23 Fr., 3,963 ± 729 ml/minute for 27 Fr., and 5,490 ± 984 ml/minute for 31 Fr. Surgeons placed the cannulas in 52% of cases, intensivists placed the cannulas in 23% of cases, and multidisciplinary teams placed the cannulas in 25% of cases. The mean insertion time was 26 ± 13 minutes, and insertion was performed under transesophageal electrocardiography (TEE) (67%), transthoracic echocardiography (TTE) (25%), fluoroscopy (4%), or no guidance (4%). The main complication was migration into the right ventricle. Problems with hemolysis were described in 21% of cases. No case of cannula thrombosis was found. No case of infection was reported. Bleeding was noted in 17% of cases. The mean time of use was 8 ± 7 days. Modifications to the supportive care system were required in 15% of cases. Monitoring was performed by chest x-rays (90%), TTE (42%), and TEE (46%). Five extubations occurred during the support period. Nine patients were mobilized. The use of this cannula yielded satisfactory results. We suggest placing these cannulas using TTE or TEE and recommend the use of large-caliber cannulas in hypoxemic patients. AD - Medical Intensive Care, Hôpital Pontchaillou, Université de Rennes 1, Rennes, France. loic.chimot@ch-perigueux.fr AN - 23438779 AU - Chimot, L. AU - Marqué, S. AU - Gros, A. AU - Gacouin, A. AU - Lavoué, S. AU - Camus, C. AU - Le Tulzo, Y. DA - Mar-Apr DO - 10.1097/MAT.0b013e31827db6f3 DP - NLM ET - 2013/02/27 J2 - ASAIO journal (American Society for Artificial Internal Organs : 1992) KW - Adult Aged *Catheters/adverse effects Echocardiography Echocardiography, Transesophageal Extracorporeal Membrane Oxygenation/*instrumentation Female France Humans Male Middle Aged Respiratory Distress Syndrome, Adult/therapy LA - eng M1 - 2 N1 - 1538-943x Chimot, Loïc Marqué, Sophie Gros, Antoine Gacouin, Arnaud Lavoué, Sylvain Camus, Christophe Le Tulzo, Yves Journal Article United States ASAIO J. 2013 Mar-Apr;59(2):157-61. doi: 10.1097/MAT.0b013e31827db6f3. PY - 2013 SN - 1058-2916 SP - 157-61 ST - Avalon© bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: survey of cannula use in France T2 - Asaio j TI - Avalon© bicaval dual-lumen cannula for venovenous extracorporeal membrane oxygenation: survey of cannula use in France VL - 59 ID - 760487 ER - TY - JOUR AB - Introduction: Giant ovarian adenomas are a rare site nowadays due to detection of this type of tumors in an early state and apart from abdominal discomfort and non-specific signs their clinical presentation remains scarce. In rare cases when the tumor has time to grow abdominal distension and enlargement are primary sings and left unoperated deep vein thrombosis can install. The aim of our paper is to present a rare case of a giant ovarian cystadenofibroma that due to compression on the right ilac vessels manifested as chronic ischemia and gangrene of the right foot. Materials and methods: We present the case of a 60 year old obese female patient with a medical history of poorly controlled type II diabetes mellitus that was admitted to our department for chronic ischemia and gangrene of the right foot that. The patient accused right and mid lower abdominal pain and abdominal enlargement of those areas for 3 years. An abdominal CT scan was performed and found a 22x20 cm thick wall ovarian tumor and common iliac vein thrombosis. Results: The patient underwent surgery and bilateral salpingo-oophorectomy was performed. Although the giant right ovarian tumor was compressive on the common iliac artery and vein, distal revascularisation was impossible and a second surgery was scheduled with amputation of the 1/3 distal part of the thigh. Pathological exam revealed a giant 8 Kg ovarian cystadenofibroma. The patient made a full recovery and is scheduled for follow up visits. Conclusion: We choose to present this case to raise awareness on the rarity of this condition, the possibility of chronic lower limb ischemia, and that an experienced multidisciplinary team can minimise intra and post-operative complications. Conflict of interest: No conflict of interest. AU - Chirca, A. AU - Costea, R. V. AU - Hasouna, M. AU - Gangura, A. G. AU - Kover, Z. I. AU - Dumitrascu, I. AU - Neagu, S. DB - Embase DO - 10.1016/j.ejso.2018.10.240 KW - abdominal discomfort abdominal distension adult amputation awareness case report clinical article complication compression conference abstract conflict of interest cystadenofibroma cystadenoma deep vein thrombosis female follow up foot gangrene human iliac artery iliac vein leg ischemia lower abdominal pain medical history middle aged multidisciplinary team non insulin dependent diabetes mellitus obesity ovary tumor postoperative complication remission revascularization salpingooophorectomy surgery thigh tumor volume x-ray computed tomography LA - English M1 - 2 M3 - Conference Abstract N1 - L2001509015 2019-01-31 PY - 2019 SN - 1532-2157 0748-7983 SP - e64 ST - A 8-Kg cystadenoma of the ovary presenting with chronic lower limb ischemia T2 - European Journal of Surgical Oncology TI - A 8-Kg cystadenoma of the ovary presenting with chronic lower limb ischemia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001509015&from=export http://dx.doi.org/10.1016/j.ejso.2018.10.240 VL - 45 ID - 760747 ER - TY - JOUR AB - BACKGROUND: Pediatric hematology-oncology (PHO) patients are at significant risk for developing central line-associated bloodstream infections (CLA-BSIs) due to their prolonged dependence on such catheters. Effective strategies to eliminate these preventable infections are urgently needed. In this study, we investigated the implementation of bundled central line maintenance practices and their effect on hospital-acquired CLA-BSIs. MATERIALS AND METHODS: CLA-BSI rates were analyzed within a single-institution's PHO unit between January 2005 and June 2011. In May 2008, a multidisciplinary quality improvement team developed techniques to improve the PHO unit's safety culture and implemented the use of catheter maintenance practices tailored to PHO patients. Data analysis was performed using time-series methods to evaluate the pre- and post-intervention effect of the practice changes. RESULTS: The pre-intervention CLA-BSI incidence was 2.92 per 1,000-patient days (PD) and coagulase-negative Staphylococcus was the most prevalent pathogen (29%). In the post-intervention period, the CLA-BSI rate decreased substantially (45%) to 1.61 per 1,000-PD (P < 0.004). Early on, blood and marrow transplant (BMT) patients had a threefold higher CLA-BSI rate compared to non-BMT patients (P < 0.033). With additional infection control countermeasures added to the bundled practices, BMT patients experienced a larger CLA-BSI rate reduction such that BMT and non-BMT CLA-BSI rates were not significantly different post-intervention. CONCLUSIONS: By adopting and effectively implementing uniform maintenance catheter care practices, learning multidisciplinary teamwork, and promoting a culture of patient safety, the CLA-BSI incidence in our study population was significantly reduced and maintained. AD - Pediatric Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109-5942, USA. sungchoi@med.umich.edu AN - 22522576 AU - Choi, S. W. AU - Chang, L. AU - Hanauer, D. A. AU - Shaffer-Hartman, J. AU - Teitelbaum, D. AU - Lewis, I. AU - Blackwood, A. AU - Akcasu, N. AU - Steel, J. AU - Christensen, J. AU - Niedner, M. F. C2 - Pmc3720122 C6 - Nihms479203 DA - Feb DO - 10.1002/pbc.24187 DP - NLM ET - 2012/04/24 J2 - Pediatric blood & cancer KW - Catheter-Related Infections/*prevention & control Catheterization, Central Venous/*adverse effects Child Cross Infection/*prevention & control Hematologic Neoplasms/therapy Humans Infection Control/*methods Intensive Care Units, Pediatric Quality Improvement LA - eng M1 - 2 N1 - 1545-5017 Choi, Sung W Chang, Lawrence Hanauer, David A Shaffer-Hartman, Jacqueline Teitelbaum, Daniel Lewis, Ian Blackwood, Alex Akcasu, Nur Steel, Janell Christensen, Joy Niedner, Matthew F K23 AI091623/AI/NIAID NIH HHS/United States AI091623-01/AI/NIAID NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Pediatr Blood Cancer. 2013 Feb;60(2):262-9. doi: 10.1002/pbc.24187. Epub 2012 Apr 22. PY - 2013 SN - 1545-5009 (Print) 1545-5009 SP - 262-9 ST - Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods T2 - Pediatr Blood Cancer TI - Rapid reduction of central line infections in hospitalized pediatric oncology patients through simple quality improvement methods VL - 60 ID - 760438 ER - TY - JOUR AB - The objective of this study was to assess the impact of a community-based healthy weight intervention on child weight and fitness. Cambridge Public Schools (CPS) have monitored BMI and fitness annually since 2000. Annual increases of overweight and obesity from 2000 (37.0%) to 2004 (39.1%), triggered a multidisciplinary team of researchers, educators, health care, and public health professionals to mobilize environmental and policy interventions. Guided by the social-ecological model and community-based participatory research (CBPR) principles, the team developed and implemented Healthy Living Cambridge Kids (HLCK), a multicomponent intervention targeting community, school, family, and individuals. The intervention included city policies and community awareness campaigns; physical education (PE) enhancements, food service reforms, farm-to-school-to-home programs; and family outreach and "BMI and fitness reports". Baseline (2004) to follow-up (2007) evaluation design assessed change in children's weight and fitness status. A cohort of 1,858 K-5th grade children participated: 37.3% black, 14.0% Hispanic, 37.1% white, 10.2% Asian, 1.7% other race; 43.3% were lower income. BMI z-score (0.67-0.63 P < 0.001) and proportion obese (20.2-18.0% P < 0.05) decreased, and mean number of fitness tests (0-5) passed increased (3.7-3.9 P < 0.001). Whereas black and Hispanic children were more likely to be obese at baseline (27.0 and 28.5%, respectively) compared with white (12.6%) and Asian (14.3%) children, obesity among all race/ethnicity groups declined. Concurrent with a 3-year community intervention, modest improvements in obesity and fitness were observed among CPS children from baseline to follow-up. The CBPR approach facilitated sustaining policies and program elements postintervention in this diverse community. AD - Institute for Community Health, Cambridge Health Alliance, Cambridge, Massachusetts, USA. vchomitz@challiance.org AN - 20107461 AU - Chomitz, V. R. AU - McGowan, R. J. AU - Wendel, J. M. AU - Williams, S. A. AU - Cabral, H. J. AU - King, S. E. AU - Olcott, D. B. AU - Cappello, M. AU - Breen, S. AU - Hacker, K. A. DA - Feb DO - 10.1038/oby.2009.431 DP - NLM ET - 2010/01/29 J2 - Obesity (Silver Spring, Md.) KW - Body Mass Index Body Weight/*physiology Child Child, Preschool Cohort Studies *Community Participation *Community-Based Participatory Research Ethnic Groups Female Health Promotion/*methods/organization & administration Humans Male Massachusetts Obesity/epidemiology/prevention & control Overweight/epidemiology/*prevention & control Physical Fitness/*physiology Prevalence Program Evaluation Schools LA - eng N1 - 1930-739x Chomitz, Virginia R McGowan, Robert J Wendel, Josefine M Williams, Sandra A Cabral, Howard J King, Stacey E Olcott, Dawn B Cappello, Maryann Breen, Susan Hacker, Karen A Journal Article United States Obesity (Silver Spring). 2010 Feb;18 Suppl 1:S45-53. doi: 10.1038/oby.2009.431. PY - 2010 SN - 1930-7381 SP - S45-53 ST - Healthy Living Cambridge Kids: a community-based participatory effort to promote healthy weight and fitness T2 - Obesity (Silver Spring) TI - Healthy Living Cambridge Kids: a community-based participatory effort to promote healthy weight and fitness VL - 18 Suppl 1 ID - 760501 ER - TY - JOUR AB - The objective of this study was to assess the impact of a community-based healthy weight intervention on child weight and fitness. Cambridge Public Schools (CPS) have monitored BMI and fitness annually since 2000. Annual increases of overweight and obesity from 2000 (37.0%) to 2004 (39.1%), triggered a multidisciplinary team of researchers, educators, health care, and public health professionals to mobilize environmental and policy interventions. Guided by the social-ecological model and community-based participatory research (CBPR) principles, the team developed and implemented Healthy Living Cambridge Kids (HLCK), a multicomponent intervention targeting community, school, family, and individuals. The intervention included city policies and community awareness campaigns; physical education (PE) enhancements, food service reforms, farm-to-school-to-home programs; and family outreach and "BMI and fitness reports". Baseline (2004) to follow-up (2007) evaluation design assessed change in children's weight and fitness status. A cohort of 1,858 K-5th grade children participated: 37.3% black, 14.0% Hispanic, 37.1% white, 10.2% Asian, 1.7% other race; 43.3% were lower income. BMI z-score (0.67-0.63 P < 0.001) and proportion obese (20.2-18.0% P < 0.05) decreased, and mean number of fitness tests (0-5) passed increased (3.7-3.9 P < 0.001). Whereas black and Hispanic children were more likely to be obese at baseline (27.0 and 28.5%, respectively) compared with white (12.6%) and Asian (14.3%) children, obesity among all race/ethnicity groups declined. Concurrent with a 3-year community intervention, modest improvements in obesity and fitness were observed among CPS children from baseline to follow-up. The CBPR approach facilitated sustaining policies and program elements postintervention in this diverse community. AD - Institute for Community Health, Cambridge Health Alliance, Cambridge, Massachusetts, USA AN - 105121293. Language: English. Entry Date: 20100326. Revision Date: 20200708. Publication Type: journal article AU - Chomitz, V. R. AU - McGowan, R. J. AU - Wendel, J. M. AU - Williams, S. A. AU - Cabral, H. J. AU - King, S. E. AU - Olcott, D. B. AU - Cappello, M. AU - Breen, S. AU - Hacker, K. A. AU - Chomitz, Virginia R. AU - McGowan, Robert J. AU - Wendel, Josefine M. AU - Williams, Sandra A. AU - Cabral, Howard J. AU - King, Stacey E. AU - Olcott, Dawn B. AU - Cappello, Maryann AU - Breen, Susan AU - Hacker, Karen A. DB - CINAHL DO - 10.1038/oby.2009.431 DP - EBSCOhost KW - Body Weight -- Physiology Health Services Research Consumer Participation Health Promotion -- Methods Obesity -- Prevention and Control Physical Fitness -- Physiology Body Mass Index Child Child, Preschool Prospective Studies Ethnic Groups Female Health Promotion -- Administration Human Experimental Studies Male Massachusetts Obesity -- Epidemiology Prevalence Program Evaluation Schools N1 - research. Supplement Title: Feb2010 Supplement 1. Journal Subset: Biomedical; USA. NLM UID: 101264860. PMID: NLM20107461. PY - 2010 SN - 1930-7381 SP - S45-53 ST - Healthy Living Cambridge Kids: a community-based participatory effort to promote healthy weight and fitness T2 - Obesity (19307381) TI - Healthy Living Cambridge Kids: a community-based participatory effort to promote healthy weight and fitness UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=105121293&site=ehost-live&scope=site VL - 18 ID - 761331 ER - TY - JOUR AB - Background: While the use of technologies such as ultrasound and electrocardiographic (ECG) guidance systems to place peripherally inserted central catheters (PICCs) has grown, little is known about the clinicians who use these tools or their work settings. Methods: Using data from a national survey of vascular access specialists, we identified technology users as PICC inserters that: (a) use ultrasound to find a suitable vein for catheter placement; (b) measure catheter-to-vein ratio; and (c) use ECG for PICC placement. Individual and organizational-level characteristics between technology users versus non-users were assessed. Bivariable comparisons were made using Chi-squared or Fisher's exact tests; two-sided alpha with p<0.05 was considered statistically significant. Results: Of the 2762 PICC inserters who accessed the survey, 1518 (55%) provided information regarding technology use. Technology users reported greater experience than non-technology users, with a higher percentage stating they had placed > 1000 PICCs (55% vs. 45%, p<0.001). A significantly greater percentage of technology users also reported being certified in vascular access by an external agency than non-technology users (75% vs. 63%, p<0.001). Technology users were more often part of vascular access teams with >= 10 members compared to non-technology users (35% vs. 22%, p<0.001). Some practices also varied between the two groups: for example, use of certain securement devices and dressings differed between technology users and non-users (p<0.001). Conclusions: Technology use by vascular access clinicians while placing PICCs is associated with clinician characteristics, work setting and practice factors. Understanding whether such differences influence clinical care or patient outcomes appears necessary. AD - [Chopra, Vineet; Winter, Suzanne; Paje, David; Krein, Sarah L.] Univ Michigan Hlth Syst, Div Gen Med, Ann Arbor, MI USA. [Chopra, Vineet; Kuhn, Latoya; Ratz, David; Krein, Sarah L.] VA Ann Arbor Healthcare Syst, Ctr Clin Management Res, Ann Arbor, MI USA. [Chopra, Vineet; Kuhn, Latoya; Ratz, David; Winter, Suzanne; Paje, David; Krein, Sarah L.] Univ Michigan, VA Ann Arbor Healthcare Syst, Patient Safety Enhancement Program, Ann Arbor, MI 48109 USA. [Carr, Peter J.] Univ Western Australia, Fac Hlth & Med Sci, Sch Med, Div Emergency Med, Perth, WA, Australia. [Carr, Peter J.] Griffith Univ, Menzies Hlth Inst Queensland, Alliance Vasc Access Teaching & Res Grp, Brisbane, Qld, Australia. Chopra, V (corresponding author), 2800 Plymouth Rd,Bldg 16 432W, Ann Arbor, MI 48109 USA. vineetc@umich.edu AN - WOS:000401800700011 AU - Chopra, V. AU - Kuhn, L. AU - Ratz, D. AU - Winter, S. AU - Carr, P. J. AU - Paje, D. AU - Krein, S. L. DA - May-Jun DO - 10.5301/jva.5000711 J2 - J. Vasc. Access KW - EKG guidance Patient safety Peripherally inserted central catheter PICC Technology Vascular access INSERTED CENTRAL CATHETER CENTRAL VENOUS CATHETERS ULTRASOUND GUIDANCE THROMBOEMBOLISM METAANALYSIS PLACEMENT NURSES RATES RISK Peripheral Vascular Disease LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: EV5JK Times Cited: 0 Cited Reference Count: 23 Chopra, Vineet Kuhn, Latoya Ratz, David Winter, Suzanne Carr, Peter J. Paje, David Krein, Sarah L. Krein, Sarah L/E-2742-2014 Krein, Sarah L/0000-0003-2111-8131; Chopra, Vineet/0000-0001-8670-9376; Carr, Pete/0000-0003-4935-3256 Blue Cross Blue Shield of Michigan Foundation [2140.II]; Agency for Healthcare Research and QualityUnited States Department of Health & Human ServicesAgency for Healthcare Research & Quality; Department of Veterans AffairsUS Department of Veterans Affairs; Health Services Research and Development ServiceUS Department of Veterans Affairs; National Center for Patient Safety; VA Health Services Research and Development Research Career Scientist AwardUS Department of Veterans Affairs [RCS 11-222] This project was funded by an Investigator Initiated Research Grant from the Blue Cross Blue Shield of Michigan Foundation (Grant Number 2140.II, PI: Chopra). The funding source played no role in study design, data acquisition, analysis or decision to report these data. Dr. Chopra is supported by a career development award from the Agency for Healthcare Research and Quality. This work was also supported by the Department of Veterans Affairs, Health Services Research and Development Service and National Center for Patient Safety. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government. Dr. Krein is supported by a VA Health Services Research and Development Research Career Scientist Award (RCS 11-222). 0 13 WICHTIG PUBLISHING MILAN J VASC ACCESS PY - 2017 SN - 1129-7298 SP - 243-249 ST - Variation in use of technology among vascular access specialists: an analysis of the PICC1 survey T2 - Journal of Vascular Access TI - Variation in use of technology among vascular access specialists: an analysis of the PICC1 survey UR - ://WOS:000401800700011 VL - 18 ID - 761657 ER - TY - GEN AB - International audience; Two randomized studies of symptom monitoring during chemotherapy or during second line treatment and follow-up via web-based patient-reported outcomes (PROs) was previously demonstrated to lengthen survival. We are presenting here a patient with advanced and recurrent lung cancer who was followed for 4 years by PROs for relapse and adverse events detection. We report how the web-mediated follow-up helped to detect dangerous pulmonary embolism, relapse and pseudo-progression to immunotherapy by self-reported symptom tracking and specific algorithms triggering notifications to medical team, allowing early management of events. We particularly describe how a discordance between objective clinical improvement under immunotherapy assessed by the application allowed to detect pseudo-progression on imaging and allowed maintenance of the treatment during more than 1-year, although imaging report could have led to stop an effective therapy. The progression observed in the routine imaging was indeed in clear contradiction with improvements in patient's global status as assessed by the reduced PRO-score computed from patient self-reported symptoms. The ability of e-health tools based on symptoms reporting for tumor response assessment should be assessed in trials to help physician in decision of stopping or continuing therapy. AU - Christophe, Letellier DA - 2020/02/02 DB - OpenAIRE PY - 2020 ST - Application and Benefits of Web-Mediated Symptom Reporting for Patients Undergoing Immunotherapy: A Clinical Example TI - Application and Benefits of Web-Mediated Symptom Reporting for Patients Undergoing Immunotherapy: A Clinical Example UR - https://explore.openaire.eu/search/publication?articleId=dedup_wf_001::763666cbfbe474efc5127e06794c70ef ID - 762058 ER - TY - JOUR AU - Christopher, Kabrhel DA - 2016/01/01 01/01 DB - Institute of Scientific and Technical Information of China (English) M1 - 2 PY - 2016 ST - A Multidisciplinary Pulmonary Embolism Response Team: Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism T2 - Chest TI - A Multidisciplinary Pulmonary Embolism Response Team: Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism UR - https://netl.istic.ac.cn/site/link?cdoi=JAMA20190510181335610445&mid=466496091303411EB27FB4298C9BA46C VL - 150 ID - 761952 ER - TY - JOUR AB - IMPORTANCE: Since the advent of transcatheter aortic valve replacement, the multidisciplinary heart team (MHT) approach has rapidly become the standard of care for patients undergoing the procedure. However, little is known about the potential effect of MHT on patients with coronary artery disease (CAD). OBJECTIVE: To determine the safety and efficacy of implementing the MHT approach for patients with complex CAD. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort pilot study of 180 patients with CAD involving more than 1 vessel in a single major academic tertiary/quaternary medical center. From May 1, 2012, through May 31, 2013, MHT meetings were convened to discuss evidence-based management of CAD. All cases were reviewed by a team of interventional cardiologists and cardiac surgeons within 72 hours of angiography. All clinical data were reviewed by the team to adjudicate optimal treatment strategies. Final recommendations were based on a consensus decision. Outcome measures were tracked for all patients to determine the safety and efficacy profile of this pilot program. EXPOSURES: Multidisciplinary heart team meeting. MAIN OUTCOMES AND MEASURES: Thirty-day periprocedural mortality and rate of major adverse cardiac events. RESULTS: Most of the patients underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG); a small percentage of patients underwent a hybrid procedure or medical management. Incidence of 30-day periprocedural mortality was low across all groups of patients (PCI group, 5 of 64 [8%]; CABG group, 1 of 87 [1%]). The rate of major adverse cardiac events during a median follow-up of 12.1 months ranged from 12 of 87 patients (14%) in the CABG group to 15 of 64 (23%) in the PCI group. CONCLUSIONS AND RELEVANCE: Outcomes of patients with complex CAD undergoing the optimal treatment strategy recommended by the MHT were similar to those of published national standards. Implementation of the MHT approach for patients with complex CAD is safe and efficacious. AD - Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania2Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania3Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. AN - 25207883 AU - Chu, D. AU - Anastacio, M. M. AU - Mulukutla, S. R. AU - Lee, J. S. AU - Smith, A. J. AU - Marroquin, O. C. AU - Sanchez, C. E. AU - Morell, V. O. AU - Cook, C. C. AU - Lico, S. C. AU - Wei, L. M. AU - Badhwar, V. DA - Nov DO - 10.1001/jamasurg.2014.2059 DP - NLM ET - 2014/09/11 J2 - JAMA surgery KW - Cohort Studies Coronary Artery Bypass/adverse effects/*mortality Coronary Artery Disease/*mortality/*surgery Feasibility Studies Follow-Up Studies Humans Interdisciplinary Communication Patient Care Team Pennsylvania Percutaneous Coronary Intervention/adverse effects/*mortality Pilot Projects Precision Medicine/methods Risk Factors Treatment Outcome LA - eng M1 - 11 N1 - 2168-6262 Chu, Danny Anastacio, Melissa M Mulukutla, Suresh R Lee, Joon S Smith, A J Conrad Marroquin, Oscar C Sanchez, Carlos E Morell, Victor O Cook, Chris C Lico, Serrie C Wei, Lawrence M Badhwar, Vinay Comparative Study Journal Article Observational Study United States JAMA Surg. 2014 Nov;149(11):1109-12. doi: 10.1001/jamasurg.2014.2059. PY - 2014 SN - 2168-6254 SP - 1109-12 ST - Safety and efficacy of implementing a multidisciplinary heart team approach for revascularization in patients with complex coronary artery disease: an observational cohort pilot study T2 - JAMA Surg TI - Safety and efficacy of implementing a multidisciplinary heart team approach for revascularization in patients with complex coronary artery disease: an observational cohort pilot study VL - 149 ID - 760181 ER - TY - JOUR AB - Trauma is a leading cause of mortality and morbidity worldwide, and thus represents a great global health challenge. The World Health Organization (WHO) estimated that 9% of deaths in the world are the result of trauma.(1) In addition, approximately 100 million people are temporarily or permanently disabled every year.(2) The situation is no different in Qatar, and injury related morbidity and mortality is increasing in the entire region, with road traffic collisions (RTCs) being the most common mechanism.(1) It is well recognized now that trauma care provided in high-volume, dedicated, level-one trauma centers, improves outcome. Studies have also looked at what are the components of a trauma system that contribute to their effectiveness(2). However, in general, it usually implies a high-volume of cases, dedicated full-time trauma qualified professionals, a solid pre-hospital system, a multidisciplinary team, and excellent rehabilitation services. Similarly, critically injured trauma patients managed in a dedicated trauma intensive care unit (TICU), has been shown to improve outcomes, especially for polytrauma patients with traumatic brain injury (TBI).(3) In fact, the American College of Surgeons (ACS) Committee on Trauma requires verified trauma centers to have a designated ICU, and that a trauma surgeon be its director.(4) Furthermore, studies have shown that for TBI, it is not necessary for this ICU to be a neurocritical care unit, but rather it should be a unit that is dedicated to trauma, that has standardized protocols for TBI management.(5,6) In fact, the outcomes are better in the latter, with lower mortality in multiple-injured patients with TBI, when admitted to a TICU (versus a medical-surgical ICU or neurocritical care unit).(3) These benefits were shown to increase, with increased injury severity. The proposed reason for this is thought to be due to the associated injuries being managed better.(7) The aim of this editorial is to describe the TICU at Hamad General Hospital (HGH), at Hamad Medical Corporation (HMC), including a comparison of its data and outcomes with other similar trauma centers in the world. The Qatar Trauma Registry, as well as previous publications from our Trauma Center,(1,8) were used to obtain HGH TICU and worldwide Level-1 Trauma Center standards, respectively. With respect to HGH, the TICU is part of an integrated trauma program, the only level-1 trauma centre in Qatar. It provides the highest standard of care for critically-ill trauma patients admitted at HGH, striving to achieve the best outcomes, excellence in evidence-based patient care, up to date technology, and a high level of academics in research and teaching. This integrated program includes an excellent pre-hospital unit, emergency and trauma resuscitation unit, TICU, trauma step-down unit (TSDU), inpatient ward, and rehabilitation unit. The new TICU is a closed 19-bed unit, that was inaugurated in 2016, is managed 24/7 by highly qualified and experienced intensivists (9 senior consultants and consultants), along with 24 well-trained and experienced associate consultants or specialists, and fellows and residents in training, as well as expert nursing staff (1:1 nurse to patient ratio) and allied health professionals (respiratory therapists, pharmacists, dieticians, physiotherapists, occupational therapists, social workers, case managers, and psychologists). It is supported by all medical and surgical subspecialty services. It is equipped with the latest state-of-the-art technology and equipment, including 'intelligent ventilators", neuro-monitoring devices, ultrasound, point-of-care testing such as arterial blood gas and rotational thromboelastrometry (ROTEM), and video airway devices. The TICU is a teaching unit, linked to the HMC Medical Education department, with presence of fellows, and residents (see below for details). Medical students (Clerkship level) from Weill-Cornell Medicine Qatar also complete a one-week rotation in the TICU, as part of their exposure to critical care. The first batch of clerks from Qatar University College of Medicine are expected to start rotating in the TICU soon. The Trauma Critical Care Fellowship Program (TCCFP) is an ACGME (Accreditation Council for Graduate Medical Education) fellowship that was established over seven years ago. To date, over 40 physicians from both within, and out of, the trauma department have completed the program. Up to seven fellows, including international candidates, are trained each year. A number of physicians have succeeded in gaining the European Diploma of Intensive Care Medicine (EDIC). The program continues to attract many applicants from various specialties including surgery, anesthesia, and emergency medicine. An increasing number of international physicians from Europe and South America have expressed interest in applying for our fellowship. The first international fellows are likely to join us from early 2020. Residents (from general surgery, ER, ENT, plastics, orthopedics, and neurosurgery) rotate (one to three months' rotations) in the TICU, and are actively part of the clinical team. There were 568 admissions to the TICU in 2018. The patients admitted were either mainly polytrauma patients with varying degrees and combinations of head, chest, abdominal, pelvic, spine, and orthopedic injuries, or isolated-TBI. Of these patients, 378 were severely injured with an injury severity score (ISS)(9) greater than 16. According to previously published data from our Trauma Centre,(1,8) our mortality rates (overall approximately 6-7%, as well as when looked at in terms of early and late deaths) compare favorably with other trauma centers around the world, when looking at similarly sized retrospective studies. The TICU continues to be an active member of the Critical Care Network of HMC.(10) This network involves all of the ICU's in all the HMC facilities. The main processes that the TICU is presently involved in as part of this network are: patient flow, clinical practice guidelines, evaluation and procurement of technologies, HMC sepsis program, and in general, taking part in any process that pertains to critical care at HMC. A number of quality improvement projects are being undertaken in the TICU. Examples of such projects include: - Decreasing rates of infection in TICU- Score-guided sedation orders to decrease sedation use, ventilator days and length of stay- Reducing blood taking and associated costs- Sepsis alert response and bundle compliance- Medical and surgical management of rib fracturesA multidisciplinary team of physicians, nurses, and allied health professionals participate in these projects, and meet once a month to review all projects. Similarly, many research projects are taking place in the TICU, in coordination with the Trauma Research program, and often in collaboration with other departments (local and international). Examples of some of the research projects include: - The "POLAR" study (RCT on Hypothermia in TBI)(11)- B-blockers in TBI (RCT-ongoing)- Tranexamic acid (TXA) for bleeding in trauma (RCT-ongoing) The team is also involved in conducting systematic reviews in relation to the role of transcranial doppler in TBI,(12) sepsis in TBI patients (ongoing), self-extubation in TBI patients,(13) safety and efficacy of phenytoin in TBI (ongoing), and optic nerve diameter for predicting outcome in TBI (submitted). The TICU at HGH is a high-volume, high acuity unit that manages all the severely injured trauma patients in Qatar. It is well staffed with highly trained and qualified personnel, and utilizes the latest in technology and state-of-the-art equipment. It performs very well, when compared to other similar units in the world, and achieves a comparable, or even lower mortality rate. With continued great support from the hospital, corporation administration, and Ministry of Public Health, the future goals of the TICU will be to maintain and improve upon the high standards of clinical care it provides, as well as perform a high quality and quantity of research, quality improvement initiatives, and educational work, in order for it to be amongst the best trauma critical care units in the world. AD - Trauma Intensive Care Unit (TICU), Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. AN - 32076594 AU - Chughtai, T. AU - Parchani, A. AU - Strandvik, G. AU - Verma, V. AU - Arumugam, S. AU - El-Menyar, A. AU - Rizoli, S. AU - Al-Thani, H. C2 - Pmc7003060 DO - 10.5339/qmj.2019.qccc.5 DP - NLM ET - 2020/02/23 J2 - Qatar medical journal KW - Doha Hamad General Hospital Hamad Medical Corporation Qatar intensive care unit trauma LA - eng M1 - 2 N1 - 2227-0426 Chughtai, Talat Parchani, Ashok Strandvik, Gustav Verma, Vishy Arumugam, Suresh El-Menyar, Ayman Rizoli, Sandro Al-Thani, Hassan Editorial Qatar Med J. 2020 Feb 6;2019(2):5. doi: 10.5339/qmj.2019.qccc.5. eCollection 2019. PY - 2019 SN - 0253-8253 (Print) 0253-8253 SP - 5 ST - Trauma intensive care unit (TICU) at Hamad General Hospital T2 - Qatar Med J TI - Trauma intensive care unit (TICU) at Hamad General Hospital VL - 2019 ID - 760369 ER - TY - JOUR AB - BACKGROUND: This study was conducted to quantify the effect of multidisciplinary care (MDC) on amputation-free survival (AFS) and wound healing within a chronic critical limb ischemia (CLI) population. METHODS: We performed a retrospective, single-center cohort study of consecutive CLI patients presenting to the Vascular Surgery Service. Patients who received initial and follow-up wound care from the MDC were compared with patients who received standard wound care (SWC). The MDC team consisted of vascular, plastic, and podiatric surgeons who jointly managed wound care and directed any other consults or services as deemed necessary. SWC consisted of an inconsistent mix of providers without a defined manager, including nurses, wound care midlevel providers, general surgeons, internists, or the patients themselves. The referring physician determined the allocation of patients. The primary outcome variable was AFS, with a secondary evaluation of wound healing. The effects of baseline demographics, comorbid medical conditions, laboratory values, ischemic lesion severity and location, Rutherford classification, and participation in MDC were assessed. Significant univariate predictors (P < .10) of AFS were entered into a multivariate Cox regression model and assessed at an α = .05. RESULTS: Between August 2010 and June 2012, 146 CLI patients (91 male [63%]) were evaluated by the Vascular Surgery Service and were followed up for a median of 539 days (interquartile range 314-679 days). Ischemic tissue loss was present in 85 patients (38 at Rutherford category 5, and 47 at Rutherford category 6). Within this cohort, 51 (60%) had MDC, and 34 (40%) had SWC. Fifty-eight patients (68%) underwent revascularization (open in 17, endovascular in 35, and hybrid in 6), 14 (8%) were managed with primary major amputation, and 13 (15%) declined revascularization. AFS was superior for patients in the MDC arm vs the SWC arm (593.3 ± 53.5 days vs 281.0 ± 38.2 days; log-rank, P = .02). Wound-healing times favored the MDC arm over the SWC arm (444.5 ± 33.2 days vs 625.2 ± 126.5 days), although this was not statistically significant (log-rank, P = .74). Multivariate modelling revealed that independent predictors of major amputation or death, or both, were nonrevascularized patients (hazard ratio [HR], 3.76; 95% confidence interval [CI], 1.78-8.02; χ(2), P < .01), treatment by SWC (HR, 2.664; 95% CI, 1.23-5.77; χ(2), P = .012), and baseline nonambulatory status (HR, 1.89; 95% CI, 1.17-2.85; χ(2), P < .01). CONCLUSIONS: MDC pathways for the management of a population of CLI patients improved AFS by greater than twofold and should be the standard of care for the CLI population. Baseline nonambulatory status and unrevascularized patients also predict worse AFS. Wound healing remains prolonged regardless of preoperative or postoperative wound care. Future study is required to evaluate the costs and functional outcomes for MDC in the management of CLI. AD - Division of Vascular and Endovascular Surgery, The University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: jayer.chung@utsouthwestern.edu. Division of Vascular and Endovascular Surgery, The University of Texas Southwestern Medical Center, Dallas, Tex. AN - 25073577 AU - Chung, J. AU - Modrall, J. G. AU - Ahn, C. AU - Lavery, L. A. AU - Valentine, R. J. DA - Jan DO - 10.1016/j.jvs.2014.05.101 DP - NLM ET - 2014/07/31 J2 - Journal of vascular surgery KW - Aged *Amputation/adverse effects/mortality Chi-Square Distribution Chronic Disease Combined Modality Therapy Disease-Free Survival *Endovascular Procedures/adverse effects/mortality Female Humans Ischemia/diagnosis/mortality/*therapy Kaplan-Meier Estimate Limb Salvage Lower Extremity/*blood supply Male Middle Aged Multivariate Analysis Patient Care Team Proportional Hazards Models Retrospective Studies Risk Factors Severity of Illness Index Texas Time Factors Treatment Outcome *Vascular Surgical Procedures/adverse effects/mortality Wound Healing LA - eng M1 - 1 N1 - 1097-6809 Chung, Jayer Modrall, J Gregory Ahn, Chul Lavery, Lawrence A Valentine, R James Journal Article Observational Study United States J Vasc Surg. 2015 Jan;61(1):162-9. doi: 10.1016/j.jvs.2014.05.101. Epub 2014 Jul 26. PY - 2015 SN - 0741-5214 SP - 162-9 ST - Multidisciplinary care improves amputation-free survival in patients with chronic critical limb ischemia T2 - J Vasc Surg TI - Multidisciplinary care improves amputation-free survival in patients with chronic critical limb ischemia VL - 61 ID - 760411 ER - TY - JOUR AB - Background: Anticoagulants (ACs) are commonly used high-alert medications in the prevention and treatment of venous thromboembolism (VTE) or for stroke prevention in patients with atrial fibrillation. Yet, they are not without risk: for example, warfarin is among the medications with the most food and drug interactions, and it is also among the leading medications implicated in ER visits related to adverse drug events in older adults. More recently, new oral anticoag- ulants (NOACs) have been approved, and their safety implications are no less important given the lack of reversal agents available. It is wellknown that patient education is associated with a reduction in adverse events and improved adherence with AC treatment. Thus, nurses have an essential role to play, particularly at the time of hospital discharge Aims: To ensure safe management and follow-up for patients discharged on ACs by standardizing the process and coordination of planning and teaching. Methods: Upon clinical observation of discharge challenges and nursing staff requests for greater support with discharge planning, a multidisciplinary team (pharmacist, nurses from thrombosis, medicine, surgery and discharge-planning) was convened and an algorithm was created. Teaching sessions were provided, using a multiple-choice preand post- quiz on ACs and discharge planning as well as the new algorithm. Results: 98 nurses from medical-surgical units participated. The overall mean score pre-test was 48%. At baseline, nurses were most knowledgeable regarding which ACs require follow-up at the Anticoagulation Clinic or in the community; staff were least comfortable regarding which teaching materials were available for patients and families, and when Anticoagulation Clinic teaching session for new patients is given. Post-teaching mean scores were 82%. Conclusion: Use of the algorithm led to increased knowledge regarding safe discharges for patients on ACs. AD - S. Chung, Nursing, Montreal, Canada AU - Chung, S. AU - Strulovitch, C. AU - Emed, J. AU - Patel, H. DB - Embase DO - 10.1111/jth.12993 KW - anticoagulant agent warfarin human hospital discharge total quality management thrombosis nurse society patient hemostasis teaching algorithm drug therapy prevention follow up anticoagulation hospital adult adverse drug reaction drug interaction safety food multiple choice test surgery venous thromboembolism risk atrial fibrillation pharmacist nursing staff cerebrovascular accident clinical observation planning patient education community LA - English M3 - Conference Abstract N1 - L71944675 2015-07-21 PY - 2015 SN - 1538-7933 SP - 90-91 ST - Safe discharge planning for patients on anticoagulants: Launch of a new quality improvement tool for nurses T2 - Journal of Thrombosis and Haemostasis TI - Safe discharge planning for patients on anticoagulants: Launch of a new quality improvement tool for nurses UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71944675&from=export http://dx.doi.org/10.1111/jth.12993 VL - 13 ID - 761067 ER - TY - JOUR AB - OBJECTIVES: Few Asian studies have evaluated the risks of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in patients with SSc. We conducted a nationwide population-based cohort study to evaluate how SSc affected the incidence of DVT and PTE in Taiwan. METHODS: We identified patients with an SSc diagnosis in Taiwan between 1998 and 2010 using the Catastrophic Illness Patient Database and the National Health Insurance Research Database. Each SSc patient was frequency matched to four control patients based on age, sex and index year and all patients were observed from the index date until the appearance of a DVT or PTE event or 31 December 2010. We calculated the hazard ratios and 95% CIs of DVT and PTE in the SSc and comparison cohorts using the Cox proportional hazards regression model. RESULTS: We observed 1895 SSc patients and 7580 control patients for ∼10,128 and 46,488 person-years, respectively. The mean ages of the SSc and comparison cohorts were 50.3 and 49.9 years, respectively. After adjusting for age, sex and co-morbidities, the risks of DVT and PTE among the SSc patients were 10.5- and 7.00-fold higher than those of the control patients. The probability of developing DVT and PTE increased in the years following the SSc diagnosis. CONCLUSION: SSc patients exhibited a significantly higher risk of developing DVT and PTE compared with the general population. Thus multidisciplinary teams should guide the assessment, treatment and holistic care of SSc patients. AD - Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. d10040@mail.cmuh.org.tw. AN - 24717920 AU - Chung, W. S. AU - Lin, C. L. AU - Sung, F. C. AU - Hsu, W. H. AU - Yang, W. T. AU - Lu, C. C. AU - Kao, C. H. DA - Sep DO - 10.1093/rheumatology/keu133 DP - NLM ET - 2014/04/11 J2 - Rheumatology (Oxford, England) KW - Adult Aged Cohort Studies Comorbidity Female Humans Incidence Male Middle Aged Pulmonary Embolism/epidemiology/*etiology Retrospective Studies Risk Assessment/methods Scleroderma, Systemic/*complications/epidemiology Taiwan/epidemiology Venous Thrombosis/epidemiology/*etiology deep vein thrombosis nationwide cohort study pulmonary thromboembolism systemic sclerosis LA - eng M1 - 9 N1 - 1462-0332 Chung, Wei-Sheng Lin, Cheng-Li Sung, Fung-Chang Hsu, Wu-Huei Yang, Wen-Ta Lu, Chuan-Chin Kao, Chia-Hung Journal Article Research Support, Non-U.S. Gov't England Rheumatology (Oxford). 2014 Sep;53(9):1639-45. doi: 10.1093/rheumatology/keu133. Epub 2014 Apr 8. PY - 2014 SN - 1462-0324 SP - 1639-45 ST - Systemic sclerosis increases the risks of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study T2 - Rheumatology (Oxford) TI - Systemic sclerosis increases the risks of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study VL - 53 ID - 760209 ER - TY - JOUR AB - Objectives. Few Asian studies have evaluated the risks of deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) in patients with SSc. We conducted a nationwide population-based cohort study to evaluate how SSc affected the incidence of DVT and PTE in Taiwan.Methods. We identified patients with an SSc diagnosis in Taiwan between 1998 and 2010 using the Catastrophic Illness Patient Database and the National Health Insurance Research Database. Each SSc patient was frequency matched to four control patients based on age, sex and index year and all patients were observed from the index date until the appearance of a DVT or PTE event or 31 December 2010. We calculated the hazard ratios and 95% CIs of DVT and PTE in the SSc and comparison cohorts using the Cox proportional hazards regression model.Results. We observed 1895 SSc patients and 7580 control patients for ∼10 128 and 46 488 person-years, respectively. The mean ages of the SSc and comparison cohorts were 50.3 and 49.9 years, respectively. After adjusting for age, sex and co-morbidities, the risks of DVT and PTE among the SSc patients were 10.5- and 7.00-fold higher than those of the control patients. The probability of developing DVT and PTE increased in the years following the SSc diagnosis.Conclusion. SSc patients exhibited a significantly higher risk of developing DVT and PTE compared with the general population. Thus multidisciplinary teams should guide the assessment, treatment and holistic care of SSc patients. AD - Department of Internal Medicine, Taichung Hospital, Ministry of Health and Welfare, Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Management Office for Health Data, China Medical University Hospital, Department of Public Health, China Medical University and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. AN - 97825886. Language: English. Entry Date: 20140910. Revision Date: 20190723. Publication Type: Article AU - Chung, Wei-Sheng AU - Lin, Cheng-Li AU - Sung, Fung-Chang AU - Hsu, Wu-Huei AU - Yang, Wen-Ta AU - Lu, Chuan-Chin AU - Kao, Chia-Hung DB - CINAHL DO - 10.1093/rheumatology/keu133 DP - EBSCOhost KW - Scleroderma, Systemic -- Complications Venous Thrombosis -- Risk Factors Pulmonary Embolism -- Risk Factors Human Academic Medical Centers China Confidence Intervals -- Utilization Cox Proportional Hazards Model -- Utilization Retrospective Design Medical Records -- Utilization Data Analysis Software -- Utilization Kaplan-Meier Estimator -- Utilization Chi Square Test -- Utilization T-Tests -- Utilization Log-Rank Test -- Utilization Poisson Distribution -- Utilization Regression -- Utilization Multivariate Analysis -- Utilization Male Female Adult Middle Age Aged Descriptive Statistics -- Utilization Funding Source M1 - 9 N1 - research; tables/charts. Journal Subset: Biomedical; Europe; UK & Ireland. Special Interest: Public Health. Grant Information: This work was supported by study projects(DMR-101-036) in our hospital, the Taiwan Ministry ofHealth and Welfare Clinical Trial and Research Centerand for Excellence (DOH102-TD-B-111-004), the TaiwanMinistry of Health and Welfare Cancer Research Centerfor Excellence (MOHW103-TD-B-111-03), and theInternational Research-Intensive Centers of Excellence inTaiwan (I-RiCE) (NSC101-2911-I-002-303).. PY - 2014 SN - 1462-0324 SP - 1639-1645 ST - Systemic sclerosis increases the risks of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study T2 - Rheumatology TI - Systemic sclerosis increases the risks of deep vein thrombosis and pulmonary thromboembolism: a nationwide cohort study UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=97825886&site=ehost-live&scope=site VL - 53 ID - 761387 ER - TY - JOUR AB - BACKGROUND: The appropriateness of a software platform for rapid MRI assessment of the amount of salvageable brain tissue after stroke is critical for both the validity of the Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) Clinical Trial of stroke thrombolysis beyond 4.5 hours and for stroke patient care outcomes. AIMS: The objective of this research is to develop and implement a methodology for selecting the acute stroke imaging software platform most appropriate for the setting of a multi-centre clinical trial. METHODS: A multi-disciplinary decision making panel formulated the set of preferentially independent evaluation attributes. Alternative Multi-Attribute Value Measurement methods were used to identify the best imaging software platform followed by sensitivity analysis to ensure the validity and robustness of the proposed solution. RESULTS: Four alternative imaging software platforms were identified. RApid processing of PerfusIon and Diffusion (RAPID) software was selected as the most appropriate for the needs of the EXTEND trial. A theoretically grounded generic multi-attribute selection methodology for imaging software was developed and implemented. CONCLUSIONS: The developed methodology assured both a high quality decision outcome and a rational and transparent decision process. This development contributes to stroke literature in the area of comprehensive evaluation of MRI clinical software. At the time of evaluation, RAPID software presented the most appropriate imaging software platform for use in the EXTEND clinical trial. The proposed multi-attribute imaging software evaluation methodology is based on sound theoretical foundations of multiple criteria decision analysis and can be successfully used for choosing the most appropriate imaging software while ensuring both robust decision process and outcomes. AD - National Stroke Research Institute, Florey Neuroscience Institutes, Melbourne, Australia. lchurilov@nsri.org.au AN - 22812698 AU - Churilov, L. AU - Liu, D. AU - Ma, H. AU - Christensen, S. AU - Nagakane, Y. AU - Campbell, B. AU - Parsons, M. W. AU - Levi, C. R. AU - Davis, S. M. AU - Donnan, G. A. DA - Apr DO - 10.1111/j.1747-4949.2012.00787.x DP - NLM ET - 2012/07/21 J2 - International journal of stroke : official journal of the International Stroke Society KW - Clinical Trials as Topic Decision Making Decision Support Techniques Diagnosis, Computer-Assisted/*methods/standards Emergency Treatment/methods Humans Magnetic Resonance Angiography Multicenter Studies as Topic Patient Care Team Patient Selection Sensitivity and Specificity Software/*standards Stroke/*diagnosis/drug therapy Thrombolytic Therapy/methods Time-to-Treatment LA - eng M1 - 3 N1 - 1747-4949 Churilov, Leonid Liu, Daniel Ma, Henry Christensen, Soren Nagakane, Yoshinari Campbell, Bruce Parsons, Mark W Levi, Christopher R Davis, Stephen M Donnan, Geoffrey A Evaluation Study Journal Article Research Support, Non-U.S. Gov't United States Int J Stroke. 2013 Apr;8(3):204-10. doi: 10.1111/j.1747-4949.2012.00787.x. Epub 2012 Jul 19. PY - 2013 SN - 1747-4930 SP - 204-10 ST - Multiattribute selection of acute stroke imaging software platform for Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) clinical trial T2 - Int J Stroke TI - Multiattribute selection of acute stroke imaging software platform for Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) clinical trial VL - 8 ID - 760476 ER - TY - JOUR AB - We report on cases of life-threatening maxillomandibular arteriovenous malformations (AVM) whereby patients had successful endovascular treatment with good outcomes. Out of a total 93 facial AVMs treated endovascularly between 1991 and 2009, five patients (5.4%) had maxillomandibular AVMs. All presented with uncontrolled dental bleeding. Endovascular procedure was the primary treatment of choice in all cases, either transfemoral approach with arterial feeder embolization or transosseous puncture, depending on the accessible route in each patient. NBCA (glue) was the only embolic agent used. Tooth extraction and dental care were performed after bleeding was controlled. All five patients (8-18 years) with a mean age of 12.4 years presented with massive dental bleeding following loosening of teeth, dental extraction and/or cheek trauma. The plain films and CT scans of four patients with AVMs of mandibles and one of maxilla, revealed expansile osteolytic lesions. The mean follow-up period was 6.6 years (ranging between one and 19 years). Three cases developed recurrent bleeding between two weeks to three months after first embolization, resulting from residual AVM and infection. Late complications occurred in two patients from chronic localized infection and osteonecrosis, which were successfully eradicated with antibiotic therapy and bony curettage. Complications occurring in two patients which included soft tissue infection, osteomyelitis and osteonecrosis were successfully treated with antibiotics, curettage and bone resection. No patient had a recurrence of bleeding after the disease had cured Initial glue embolization is recommended as the effective treatment of dental AVMs for emergent bleeding control, with the aim to complete eradicate the intraosseous venous pouches either by means of transarterial superselection or direct transosseous puncture. Patient care by a multidisciplinary team approach is important for sustained treatment results. AD - D. Songsaeng, Department Radiology, Siriraj Hospital, Mahidol University, 2 Prannok Rd, Bangkok-noi Bangkok 10700, Thailand AU - Churojana, A. AU - Khumtong, R. AU - Songsaeng, D. AU - Chongkolwatana, C. AU - Suthipongchai, S. DB - Embase Medline DO - 10.1177/159101991201800107 KW - adolescent adult antibiotic therapy arteriovenous malformation article artificial embolization bleeding bone resection cheek child deciduous tooth dental procedure disease control emergency care endovascular surgery female follow up human jaw malformation jaw osteonecrosis lung edema major clinical study male mandible maxilla osteolysis osteomyelitis outcome assessment physical examination pneumothorax postoperative period recurrent disease school child soft tissue infection surgical approach therapy effect thrombocyte transfusion tooth disease tooth extraction LA - English M1 - 1 M3 - Article N1 - L364653172 2012-05-07 PY - 2012 SN - 1591-0199 SP - 49-59 ST - Life-threatening arteriovenous malformation of the maxillomandibular region and treatment outcomes T2 - Interventional Neuroradiology TI - Life-threatening arteriovenous malformation of the maxillomandibular region and treatment outcomes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L364653172&from=export http://dx.doi.org/10.1177/159101991201800107 VL - 18 ID - 761211 ER - TY - JOUR AB - Introduction: The onset of preeclampsia is related to nutritional status. Anthropometric measurements can indicate prognosis and underlie different directions. Objectives: To assess the anthropometry of preeclampsia patients with and without comorbidities. Methods: A transversal study, developed at the Guilherme Álvaro Hospital, located at Santos/Brazil. The anthropometric data from 72 women in the mediate postpartum was collected from January 2015 to May 2016. Inclusion criteria: mothers with PE according to the criteria of NHBPEP (2000). After recruitment and acceptance to participate in the study, the patients signed an informed consent. Data analyzed: body mass index (BMI-kg/m2), waist circumference (WC, cm) - with reference to the distance from the last rib to the iliac crest, divided by two, and comorbidities associated: diabetes mellitus (DM) and systemic arterial hypertension (SAH). The frequency was calculated by Fisher's exact test and comparisons between groups, by the Mann-Whitney test (significance value of p < 0.05). The analysis was performed using Graphpad Prism software, version 5.0. Results: In the table are expressed the mean values of BMI and WC after patients have been separated into groups: PE (total), PE + DM, PE + SAH, PE + DM + SAH and PE without comorbidities (pure). There was a significant difference in mean BMI when the groups were compared (PE + DMvs PE without comorbidities, p = 0.038; PE + SH vs PE without comorbidities, p = 0.027, and PE + DM + SAH vs PE without comorbidities, p = 0.012). Regarding the waist circumference values, it was only significant difference when the PE group + DM + SAH was compared with PE group without comorbidity (p = 0.007). Conclusions: It can be concluded that the more comorbidities are associated with PE, more changes are observed in anthropometric parameters. It means that a multidisciplinary team monitoring the anthropometric data of these patients is essential to an early observation of comorbidities development that compromises the health status of patients with PE. AD - S.R. Chvaicer, UNILUS, Santos, SP, Brazil AU - Chvaicer, S. R. AU - Ferraz, L. AU - De Fatima Lopes, P. AU - Rosa, N. F. AU - De Almeida Righi, A. P. AU - Battistella, M. D. B. AU - Penatti, B. S. AU - Minari, G. AU - Argentoni, J. O. AU - Dos Santos, M. R. AU - Chaiwangyen, W. AU - De Sousa, F. L. P. DB - Embase DO - 10.1016/j.preghy.2016.08.152 KW - body mass Brazil comorbidity data analysis software diabetes mellitus female health status hospital human hypertension iliac crest informed consent major clinical study monitoring mother preeclampsia rank sum test rib waist circumference LA - English M1 - 3 M3 - Conference Abstract N1 - L614983888 2017-03-28 PY - 2016 SN - 2210-7797 SP - 212 ST - Anthropometric measurements differs among preeclampsia patients with and without comorbidities T2 - Pregnancy Hypertension TI - Anthropometric measurements differs among preeclampsia patients with and without comorbidities UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614983888&from=export http://dx.doi.org/10.1016/j.preghy.2016.08.152 VL - 6 ID - 761013 ER - TY - JOUR AB - BACKGROUND: Traumatic injuries and osteoarthritis are leading causes for functional deterioration, morbidity and mortality in the older population. Following orthopedic interventions, older patients are susceptible to various medical complications-wound and systemic infections, VTE, delirium, pressure sores, and exacerbation of chronic medical conditions. Delayed identification and treatment of these complications may increase length of stay, morbidity and mortality and increases the risk for functional deterioration and unwanted institutionalization. Geriatricians are trained to perform early identification and treatment of these complications as well as to direct a multidimensional discharge plans. In the current study we made an adjustment to the standard care of older patients by employing a proactive geriatric consultation. Geriatricians served as an integral part of a multidisciplinary team providing care for older patients in the orthopedic division. The geriatricians conducted early post-operative evaluation and continued follow-up in selected patients. DESIGN: Retrospective single center cohort study. SETTING: Orthopedic division of a large tertiary academic hospital. METHODS: Retrospective data was collected for the years 2011-2015. (The intervention took place between 01.2015 and 31.12.2015). Time from operation to geriatric consultation, post-operative length of stay in the orthopedic division and perioperative mortality were compared for patients during the intervention period (n=736) and previous years (n=5786). RESULTS: Time from operation to geriatric consultation decreased (93 hours to 67 hours median time, P <0.01). Post-operative length of stay decreased (6.8 days to 5.9 days, P value <0.01). During intervention year mortality rate was reduced significantly (38 to 34 yearly death rate, P<0.001). CONCLUSIONS: Integrating geriatricians into the multidisciplinary orthopedic team and applying a proactive geriatric approach led to reduced length of stay and mortality. AD - R. Cialic, Geriatric Division, Tel Aviv Medical Center, Tel Aviv, Israel AU - Cialic, R. AU - Barak, O. AU - Berliner-Senderey, A. AU - Meilik, A. AU - Tellem, R. AU - Lerman, Y. AU - Snir, N. DB - Embase DO - 10.1111/(ISSN)1445-5994 KW - aged cohort analysis complication consultation controlled study doctor patient relationship female follow up geriatrician health care quality human length of stay major clinical study male mortality rate statistical significance surgical mortality LA - English M3 - Conference Abstract N1 - L616115833 2017-05-16 PY - 2017 SN - 0002-8614 SP - S108 ST - Proactive geriatric consultation for elderly orthopedic patients reduces mortality and length of stay T2 - Journal of the American Geriatrics Society TI - Proactive geriatric consultation for elderly orthopedic patients reduces mortality and length of stay UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616115833&from=export http://dx.doi.org/10.1111/(ISSN)1445-5994 VL - 65 ID - 760943 ER - TY - JOUR AB - BACKGROUND: Traumatic hip fractures are a significant cause for functional deterioration, morbidity, and mortality in the older population. Following hip fracture repair interventions, older patients are susceptible to various medical complications-wound and systemic infections, VTE, delirium, pressure sores, and exacerbation of chronic medical conditions. Delayed identification and treatment of these complications may increase the length of stay, morbidity, and mortality and increases the risk of functional deterioration and unwanted institutionalization. Geriatricians are trained to perform early identification and treatment of these complications as well as to direct a multidimensional discharge plan. In the current study, we made an adjustment to the standard care of older hip fracture patients by employing a proactive geriatric consultation. Geriatricians served as an integral part of a multidisciplinary team providing care for older patients in the orthopedic division. The geriatricians conducted an early post-operative evaluation and continued follow-up in selected patients. DESIGN: a Retrospective single-center cohort study. SETTING: Orthopedic division of a large tertiary academic hospital. METHODS: Retrospective data were collected for the years 2014-2017. (The intervention took place between 01.2015 and 31.12.2015). Time from operation to geriatric consultation and perioperative mortality (30 days from operation) were compared for patients during the intervention period (2015), the year before and the 2 consecutive years following the intervention. RESULTS: During the intervention period, time from operation to geriatric consultation decreased (98 hours to 74 hours median time, P <0.001). During 2016 time for consultation further decreased to raise back in 2017. During intervention year mortality rate was reduced significantly compared with the previous year (7.2% to 4.7%, P=0.03). Mortality rate was further reduced during the post-intervention years (3.8% and 4.4% for the years 2016 and 2017, respectively). CONCLUSIONS: Integrating geriatricians into the multidisci-plinary orthopedic team and applying a proactive geriatric approach led to reduced postoperative mortality rate. This trend was sustained during post-intervention years. AD - R. Cialic, Geriatric Internal Medicine Department, Tel Aviv Meidcal Center, Tel Aviv, Israel AU - Cialic, R. AU - Tellem, R. AU - Malka, R. AU - Snir, N. DB - Embase DO - 10.1111/jgs.15898 KW - aged case report clinical article cohort analysis complication conference abstract consultation decubitus delirium female follow up geriatrician health care quality hip fracture human male mortality rate multidisciplinary team retrospective study surgery surgical mortality wound infection LA - English M3 - Conference Abstract N1 - L627350656 2019-05-14 PY - 2019 SN - 1532-5415 SP - S139 ST - Proactive geriatric consultation for elderly hip fracture patients reduces perioperative mortality rate, 2 years follow up study T2 - Journal of the American Geriatrics Society TI - Proactive geriatric consultation for elderly hip fracture patients reduces perioperative mortality rate, 2 years follow up study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627350656&from=export http://dx.doi.org/10.1111/jgs.15898 VL - 67 ID - 760733 ER - TY - JOUR AB - INTRODUCTION: Orthopaedic surgeons are wary of patients with neuromuscular (NM) diseases as a result of perceived poor outcomes and lack of data regarding complication risks. We determined the prevalence of patients with NM disease undergoing total joint arthroplasty (TJA) and characterized its relationship with in-hospital complications, prolonged length of stay, and total charges. METHODS: Data from the Nationwide Inpatient Sample from 2005 to 2014 was used for this retrospective cohort study to identify 8,028,435 discharges with total joint arthroplasty. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify 91,420 patients who had discharge diagnoses for any of the NM disorders of interest: Parkinson disease, multiple sclerosis, cerebral palsy, cerebrovascular disease resulting in lower extremity paralysis, myotonic dystrophy, myasthenia gravis, myositis (dermatomyositis, polymyositis, and inclusion-body myositis), spinal muscular atrophy type III, poliomyelitis, spinal cord injury, and amyotrophic lateral sclerosis. Logistic regression was used to estimate the association between NM disease and perioperative outcomes, including inpatient adverse events, length of stay, mortality, and hospital charges adjusted for demographic, hospital, and clinical characteristics. RESULTS: NM patients undergoing TJA had increased odds of total surgical complications (odds ratio [OR] = 1.21; 95% confidence interval [CI], 1.17 to 1.25; P < 0.0001), medical complications (OR = 1.41; 95% CI, 1.36 to 1.46; P < 0.0001), and overall complications (OR = 1.32; 95% CI, 1.28 to 1.36; P < 0.0001) compared with non-NM patients. Specifically, NM patients had increased odds of prosthetic complications (OR = 1.09; 95% CI, 0.84 to 1.42; P = 0.003), wound dehiscence (OR = 5.00; 95% CI, 1.57 to 15.94; P = 0.0002), acute postoperative anemia (OR = 1.20; 95% CI, 1.16 to 1.24; P < 0.0001), altered mental status (OR = 2.59; 95% CI, 2.24 to 2.99; P < 0.0001), urinary tract infection (OR = 1.45; 95% CI, 1.34 to 1.56; P < 0.0001), and deep vein thrombosis (OR = 1.27; 95% CI, 1.02 to 1.58; P = 0.021). No difference of in-hospital mortality was observed (P = 0.155). DISCUSSION: Because more patients with NM disease become candidates of TJA, a team of neurologists, anesthesiologists, therapists, and orthopaedic surgeon is required to anticipate, prevent, and manage potential complications identified in this study. LEVEL OF EVIDENCE: Level III, retrospective cohort study. AD - From the Department of Orthopaedic Surgery, University of Alabama at Birmingham Hospital, Birmingham, AL. AN - 30285988 AU - Cichos, K. H. AU - Lehtonen, E. J. AU - McGwin, G., Jr. AU - Ponce, B. A. AU - Ghanem, E. S. DA - Jun 1 DO - 10.5435/jaaos-d-18-00312 DP - NLM ET - 2018/10/05 J2 - The Journal of the American Academy of Orthopaedic Surgeons KW - Arthritis/*etiology/*surgery *Arthroplasty, Replacement/economics/statistics & numerical data Cohort Studies Female Hospitalization/economics/*statistics & numerical data Humans Length of Stay/statistics & numerical data Male Neuromuscular Diseases/*complications Patient Care Team Postoperative Complications/*epidemiology/prevention & control Prevalence Retrospective Studies Risk Time Factors Treatment Outcome LA - eng M1 - 11 N1 - 1940-5480 Cichos, Kyle H Lehtonen, Eva J McGwin, Gerald Jr Ponce, Brent A Ghanem, Elie S Journal Article United States J Am Acad Orthop Surg. 2019 Jun 1;27(11):e535-e543. doi: 10.5435/JAAOS-D-18-00312. PY - 2019 SN - 1067-151x SP - e535-e543 ST - Inhospital Complications of Patients With Neuromuscular Disorders Undergoing Total Joint Arthroplasty T2 - J Am Acad Orthop Surg TI - Inhospital Complications of Patients With Neuromuscular Disorders Undergoing Total Joint Arthroplasty VL - 27 ID - 760339 ER - TY - JOUR AB - Background Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality. Methods/design A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs. Discussion This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020. AD - [Cid, Ximena; Canty, David; Royse, Alistair; El-Ansary, Doa; Royse, Colin] Univ Melbourne, Dept Surg, Melbourne, Vic, Australia. [Cid, Ximena; Maier, Andrea B.; Johnson, Douglas] Royal Melbourne Hosp, Dept Med & Community Care, Parkville, Vic, Australia. [Canty, David] Monash Hlth, Dept Anesthesia & Perioperat Med, Melbourne, Vic, Australia. [Canty, David; Royse, Colin] Royal Melbourne Hosp, Dept Anesthesia & Pain Management, Parkville, Vic, Australia. [Royse, Alistair] Royal Melbourne Hosp, Dept Surg, Parkville, Vic, Australia. [Maier, Andrea B.] Univ Melbourne, Royal Melbourne Hosp, Dept Med & Aged Care, AgeMelbourne, Melbourne, Vic, Australia. [Maier, Andrea B.] Vrije Universitet, Dept Human Movement Sci, Amsterdam Movement Sci, AgeAmsterdam, Amsterdam, Netherlands. [El-Ansary, Doa] Swinburne Univ Technol, Dept Hlth Profess, Melbourne, Vic, Australia. [Clarke-Errey, Sandy] Univ Melbourne, Stat Consulting Ctr, Parkville, Vic, Australia. [Fazio, Timothy] Melbourne Hlth, Business Intelligence Unit, Parkville, Vic, Australia. [Fazio, Timothy] Univ Melbourne, Melbourne Med Sch, Dept Med & Radiol, Parkville, Vic, Australia. [Royse, Colin] Cleveland Clin, Outcomes Consortium, Cleveland, OH 44106 USA. Cid, X (corresponding author), Univ Melbourne, Dept Surg, Melbourne, Vic, Australia.; Cid, X (corresponding author), Royal Melbourne Hosp, Dept Med & Community Care, Parkville, Vic, Australia. anaite.cid@gmail.com; colin.royse@heartweb.com AN - WOS:000513676700005 AU - Cid, X. AU - Canty, D. AU - Royse, A. AU - Maier, A. B. AU - Johnson, D. AU - El-Ansary, D. AU - Clarke-Errey, S. AU - Fazio, T. AU - Royse, C. C7 - 53 DA - Jan DO - 10.1186/s13063-019-4003-2 J2 - Trials KW - Randomized controlled trial Echocardiography Focused assessment sonography Lung ultrasound Internal medicine DEEP VENOUS THROMBOSIS LUNG ULTRASOUND TRANSTHORACIC ECHOCARDIOGRAPHY CARDIAC ULTRASOUND ACUTE DYSPNEA COMPRESSION ULTRASONOGRAPHY EMERGENCY PHYSICIAN HEART-FAILURE ACCURACY MANAGEMENT Medicine, Research & Experimental LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: KL8OD Times Cited: 1 Cited Reference Count: 53 Cid, Ximena Canty, David Royse, Alistair Maier, Andrea B. Johnson, Douglas El-Ansary, Doa Clarke-Errey, Sandy Fazio, Timothy Royse, Colin Royse, Alistair/A-6046-2008 Royse, Alistair/0000-0002-4449-663X; Maier, Andrea/0000-0001-7206-1724; Cid, Ximena/0000-0002-5651-5500 1 0 2 BMC LONDON TRIALS PY - 2020 SP - 15 ST - Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial-the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study T2 - Trials TI - Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial-the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study UR - ://WOS:000513676700005 VL - 21 ID - 761466 ER - TY - JOUR AB - Aim The Laparoscopic Sleeve Gastrectomy (LSG) as a single primary bariatric procedure has been performed with growing frequency in patients with morbid obesity and should be carefully evaluated. Method The study comprises an initial consecutive series of 150 patients with LSG performed by a single surgeon between 1.April 2007, and 1. December 2009. LSG was routinely done by the “posterior technique” and the staple lines was left without any over-suturing. Perioperative complications and postoperative weight loss, together with data on improvemnt in obesity related diseases and quality of life were collected and studied prospectively by a multidisciplinary team using an electronic database. Results There was no conversion, no death and no thromboembolic complication in the whole series. Seven reoperations in six patients were required, all were done by laparoscopy. Avoiding the oversuture of the staple line in LSG shortens the operation time and seems to decrease the requirement for postoperative painkillers. Conclusion The posterior technique of LSG may be beneficial as it enables the surgeon to observe the staple line for bleeding over a longer time and repeatedly . Over suturing the staple line in LSG is not neccessarily to be considered as an obligatory step. Short term LSG results show to be very promising according the weight loss, obesity related health condition deveopement and quality of life. Long term resutls of the study are not yet available. AD - M. Cierny, Hospital Breclav, Breclav, Czech Republic AU - Cierny, M. AU - Kriz, M. AU - Zeman, D. AU - Urbanek, R. DB - Embase DO - 10.1007/s11695-010-0117-z KW - sleeve gastrectomy patient obesity surgeon body weight loss quality of life bariatric surgery morbid obesity bleeding laparoscopy operation duration health data base death thromboembolism peroperative complication LA - English M1 - 6 M3 - Conference Abstract N1 - L70451015 2011-07-05 PY - 2010 SN - 0960-8923 SP - 815 ST - Evaluation of initial 150 laparoscopic sleeve gastrectomies by posterior technique with no over-suturing T2 - Obesity Surgery TI - Evaluation of initial 150 laparoscopic sleeve gastrectomies by posterior technique with no over-suturing UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70451015&from=export http://dx.doi.org/10.1007/s11695-010-0117-z VL - 20 ID - 761252 ER - TY - JOUR AB - Objective: Rare co-existance of disease or pathology Background: Heparin-induced thrombocytopenia (HIT) is a rare but life-threatening complication of heparin administration. It can present a major clinical dilemma for physicians caring for patients requiring life-saving urgent or emergent cardiac surgery. Studies have been published examining the use of alternative anticoagulants for patients undergoing cardiopulmonary bypass (CPB), however, evidence does not clearly support any particular approach. Presently, there are no large-scale, prospective randomized studies examining the impact of alternative anticoagulants on clinical outcomes for HIT-positive patients requiring cardiac surgery. Case Report: We present the case of a patient who underwent SynCardia Total Artificial Heart (TAH) implantation following a recent left ventricular assist device (LVAD) placement. The patient was receiving argatroban for type II HIT with anuric renal failure, and developed a thrombus which occluded the inflow cannula of the LVAD. Based on a published study and after establishing consensus with the surgical, anesthesiology, perfusion, and hematology teams, we decided to use tirofiban as an antiplatelet agent to inhibit the platelet aggregation induced by heparin, and ultimately used heparin as the anticoagulant for cardiopulmonary bypass. Conclusions: When selecting anticoagulation for a HIT-positive patient requiring CPB, so that benefits outweigh risks, it is of paramount importance that the decision be based on a multitude of factors. The team caring for the patient should have a shared mental model and be familiar with the pharmacology, devices used, and local practices. These three elements should be integrated with patient-specific comorbidities along with local monitoring capabilities to ensure safe, efficient patient care. AD - [Cios, Theodore J.; Salamanca-Padilla, Yuliana; Guvakov, Dmitri] Penn State Hlth Milton S Hershey Med Ctr, Dept Anesthesiol & Perioperat Med, Hershey, PA 17033 USA. Cios, TJ (corresponding author), Penn State Hlth Milton S Hershey Med Ctr, Dept Anesthesiol & Perioperat Med, Hershey, PA 17033 USA. tcios@hmc.psu.edu AN - WOS:000397655900001 AU - Cios, T. J. AU - Salamanca-Padilla, Y. AU - Guvakov, D. DA - Mar DO - 10.12659/ajcr.902320 J2 - Am. J. Case Rep. KW - Acute Kidney Injury Anticoagulants Cardiopulmonary Bypass Heart Artificial Heparin CARDIOPULMONARY BYPASS ANTICOAGULATION ARGATROBAN SURGERY TIROFIBAN Medicine, General & Internal LA - English M3 - Article N1 - ISI Document Delivery No.: EP8WQ Times Cited: 2 Cited Reference Count: 13 Cios, Theodore J. Salamanca-Padilla, Yuliana Guvakov, Dmitri 2 0 3 INT SCIENTIFIC LITERATURE, INC SMITHTOWN AM J CASE REP PY - 2017 SN - 1941-5923 SP - 294-298 ST - An Anti-Coagulation Conundrum: Implantation of Total Artificial Heart in a Patient with HeparinInduced Thrombocytopenia Type II T2 - American Journal of Case Reports TI - An Anti-Coagulation Conundrum: Implantation of Total Artificial Heart in a Patient with HeparinInduced Thrombocytopenia Type II UR - ://WOS:000397655900001 VL - 18 ID - 761663 ER - TY - JOUR AB - BACKGROUND: Recognizing the increasing age and comorbid conditions of patients admitted to our trauma service, we embedded a hospitalist on the trauma service at our Level I trauma center.This program was initiated in January 2013. This study was designed to investigate differences in outcomes between trauma patients who received care from the trauma hospitalist (THOSP) program and similarly medically complex trauma patients who did not receive THOSP care. METHODS: There were 566 patients comanaged with THOSP between December 2013 and November 2014. These patients were matched (1:2) with propensity scores to a contemporaneous control group based on age, Injury Severity Score (ISS), and comorbid conditions. Outcomes examined included mortality, trauma-related readmissions, upgrades to the intensive care unit, hospital length of stay, the development of in-hospital complications, and the frequency of obtaining medical subspecialist consultation. Differences in outcomes were compared with Mann-Whitney U-test or χ test as appropriate. RESULTS: High-quality matching resulted in the loss of 97 THOSP patients for the final analysis. Table 1 shows the balance between the two groups after matching. While there was a 1-day increase in hospital length of stay and an increase in upgrades to the intensive care unit, there was a reduction in mortality, trauma-related readmissions, and the development of renal failure after implementation of the THOSP program (Table 2). Implementation of this program made no significant difference in the frequency of cardiology, nephrology, neurology, or endocrinology consultations. There was also no difference in the development of the complications of venous thromboembolism, pneumonia, stroke, urinary tract infection, bacteremia, or alcohol withdrawal. CONCLUSION: Our study provides evidence that embedding a hospitalist on the trauma service reduces mortality and trauma-related readmissions. A reason for these improved outcomes may be related to THOSP "vigilance." LEVEL OF EVIDENCE: Therapeutic/care management study, level IV. AD - From the Department of Surgery (M.C., G.H.T.), Value Institute (B.C.I.L. C.M., A.N.), Department of Nursing (JMP), Internal Medicine (E.M.M.), Christiana Care Health System, Newark; and Internal Medicine and Value Institute (E.J.R.), Christiana Care Health System, Wilmington, Delaware. AN - 27032003 AU - Cipolle, M. D. AU - Ingraham Lopresto, B. C. AU - Pirrung, J. M. AU - Meyer, E. M. AU - Manta, C. AU - Nightingale, A. S. AU - Robinson, E. J. AU - Tinkoff, G. H. DA - Jul DO - 10.1097/ta.0000000000001062 DP - NLM ET - 2016/04/01 J2 - The journal of trauma and acute care surgery KW - Aged Comorbidity Delaware Female *Hospital Mortality *Hospitalists Humans Injury Severity Score Male Middle Aged Patient Care Team/*organization & administration Patient Readmission/*statistics & numerical data Propensity Score Retrospective Studies *Trauma Centers Workforce LA - eng M1 - 1 N1 - 2163-0763 Cipolle, Mark D Ingraham Lopresto, Bailey C Pirrung, Joan M Meyer, Erin M Manta, Christine Nightingale, Alexandra S Robinson, Edmondo J Tinkoff, Glen H Journal Article United States J Trauma Acute Care Surg. 2016 Jul;81(1):178-83. doi: 10.1097/TA.0000000000001062. PY - 2016 SN - 2163-0755 SP - 178-83 ST - Embedding a trauma hospitalist in the trauma service reduces mortality and 30-day trauma-related readmissions T2 - J Trauma Acute Care Surg TI - Embedding a trauma hospitalist in the trauma service reduces mortality and 30-day trauma-related readmissions VL - 81 ID - 760416 ER - TY - JOUR AB - Lung volume reduction surgery (LVRS) for chronic obstructive pulmonary disease (COPD) is recommended in both British and international guidelines because trials have shown improvement in survival in selected patients with poor baseline exercise capacity and upper lobe-predominant emphysema. Despite this, few procedures are carried out, possibly because of historical concerns about high levels of morbidity and mortality associated with the operation. The authors reviewed data on lung volume reduction procedures at their institution between January 2000 and September 2012. There were no deaths within 90 days of unilateral LVRS (n=81), bullectomy (n=20) or intracavity drainage procedures (n=14). These data suggest that concerns about surgical mortality should not discourage LVRS in selected patients with COPD, provided that it is undertaken within a multidisciplinary team environment involving appropriate patient selection. © Royal College of Physicians 2014. All rights reserved. AD - N.S. Hopkinson, Royal Brompton Hospital, Fulham Road, London SW3 6NP, United Kingdom AU - Clark, S. J. AU - Zoumot, Z. AU - Bamsey, O. AU - Polkey, M. I. AU - Dusmet, M. AU - Lim, E. AU - Jordan, S. AU - Hopkinson, N. S. DB - Embase Medline DO - 10.7861/clinmedicine.14-2-122 KW - adult article bullectomy catheter complication chronic obstructive lung disease debridement epidural catheter exercise female follow up forced expiratory volume heart arrhythmia heart infarction hospital readmission human length of stay lung embolism lung emphysema lung function lung resection lung volume major clinical study male mediastinitis Monaldi procedure patient selection peroperative complication pneumonia postoperative complication practice guideline reoperation residual volume sepsis sternal debridement surgical drainage surgical mortality surgical technique survival total lung capacity tracheostomy urine retention LA - English M1 - 2 M3 - Article N1 - L372814381 2014-04-22 2014-04-29 PY - 2014 SN - 1473-4893 1470-2118 SP - 122-127 ST - Surgical approaches for lung volume reduction in emphysema T2 - Clinical Medicine, Journal of the Royal College of Physicians of London TI - Surgical approaches for lung volume reduction in emphysema UR - https://www.embase.com/search/results?subaction=viewrecord&id=L372814381&from=export http://dx.doi.org/10.7861/clinmedicine.14-2-122 VL - 14 ID - 761121 ER - TY - JOUR AU - Claus, Nielsen AU - Jens, Branebjerg AU - Casper, Marcussen AU - Mette, Craggs AU - Lars, Hulbaek AU - Claus, Duedahl Pedersen AU - Fabienne, Abadie AU - Lluch, Maria AU - LupiaÑEz Villanueva, Francisco AU - Ioannis, Maghiros AU - Villalba Mora, Elena AU - Zamora Talaya Maria, Bernarda DA - 2012/01/01 01/01 DB - Joint Research Centre Publications Repository PY - 2012 ST - Strategic Intelligence Monitor on Personal Health Systems phase 2 (SIMPHS 2) Country Study: Denmark T2 - Joint Research Centre Publications Repository TI - Strategic Intelligence Monitor on Personal Health Systems phase 2 (SIMPHS 2) Country Study: Denmark UR - http://publications.jrc.ec.europa.eu/repository/handle/JRC71145 ID - 762136 ER - TY - JOUR AB - In France, one in eight patients with acute ST-segment elevation myocardial infarction (STEMI) is admitted direct to an emergency department (ED) in a hospital without percutaneous coronary intervention (PCI) facilities. Guidelines recommend transfer to a PCI center, with a door-in to door-out (DI-DO) time of <= 30min. We report DI-DO times and identify the main factors affecting them. RESURCOR is a French Northern Alps registry of patients with STEMI of <12h duration. We focused on patients admitted direct, without prehospital medical care, to EDs in 19 non-PCI centers from 2012 to 2014. We divided DI-DO time into diagnostic time (ED admission to call for transfer) and logistical time (call for transfer to ED discharge). Among 2007 patients, 240 were admitted direct to EDs in non-PCI centers; 57.9% were treated with primary angioplasty and 32.9% received thrombolysis. Median (interquartile range) DI-DO time was 92.5 (67-143) min, with a diagnostic time of 41 (23-74) min and a logistical time of 47.5 (32-69) min. Five patients (2.1%) had a DI-DO time <= 30min. Five variables were independently associated with a shorter DI-DO time: local transfer (mobile intensive care unit [MICU] team available at referring ED) (P=.017) or transfer by air ambulance (P=.004); shorter distance from referring ED to PCI center (P<.001); shorter time from symptom onset to ED admission (P=.002); thrombolysis (P=.006); and extended myocardial infarction (P=.007). In view of longer-than-recommended DI-DO times, efforts are required to promote urgent local transfer and use of thrombolysis. AD - [Clot, Sandrine; Turk, Julien; Usseglio, Pascal] Metropole Savoie Hosp, Emergency Dept, Chambery, France. [Clot, Sandrine; Turk, Julien; Usseglio, Pascal] Metropole Savoie Hosp, Emergency Med Serv, Chambery, France. [Rocher, Thomas; Savary, Dominique] Annecy Hosp, Emergency Dept, Annecy, France. [Rocher, Thomas; Savary, Dominique] Annecy Hosp, Emergency Med Serv, Annecy, France. [Morvan, Claire] RENAU Reseau Nord Alpin Urgences, Annecy, France. [Cardine, Mathieu; Debaty, Guillaume] Grenoble Univ Hosp, Emergency Dept, Grenoble, France. [Cardine, Mathieu; Debaty, Guillaume] Grenoble Univ Hosp, Emergency Med Serv, Grenoble, France. [Lotfi, Mohamed; Belle, Loic] Annecy Hosp, Dept Cardiol, Annecy, France. [Descotes-Genon, Vincent] Metropole Savoie Hosp, Dept Cardiol, Chambery, France. [Vanzetto, Gerald] Grenoble Univ Hosp, Dept Cardiol, Grenoble, France. Clot, S (corresponding author), Metropole Savoie Hosp, Emergency Dept, Chambery, France.; Clot, S (corresponding author), Metropole Savoie Hosp, Emergency Med Serv, Chambery, France. sandrine.clot@ch-metropole-savoie.fr AN - WOS:000549892300026 AU - Clot, S. AU - Rocher, T. AU - Morvan, C. AU - Cardine, M. AU - Lotfi, M. AU - Turk, J. AU - Usseglio, P. AU - Descotes-Genon, V. AU - Vanzetto, G. AU - Savary, D. AU - Debaty, G. AU - Belle, L. C7 - e20434 DA - Jun DO - 10.1097/md.0000000000020434 J2 - Medicine KW - door in door out emergency department percutaneous coronary intervention ST-elevation myocardial infarction thrombolysis PERCUTANEOUS CORONARY INTERVENTION MORTALITY OUTCOMES DELAYS CARE Medicine, General & Internal LA - English M1 - 23 M3 - Article N1 - ISI Document Delivery No.: MM1BB Times Cited: 0 Cited Reference Count: 22 Clot, Sandrine Rocher, Thomas Morvan, Claire Cardine, Mathieu Lotfi, Mohamed Turk, Julien Usseglio, Pascal Descotes-Genon, Vincent Vanzetto, Gerald Savary, Dominique Debaty, Guillaume Belle, Loic 0 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA MEDICINE Baltimore PY - 2020 SN - 0025-7974 SP - 6 ST - Door-in to door-out times in acute ST-segment elevation myocardial infarction in emergency departments of non-interventional hospitals A cohort study T2 - Medicine TI - Door-in to door-out times in acute ST-segment elevation myocardial infarction in emergency departments of non-interventional hospitals A cohort study UR - ://WOS:000549892300026 VL - 99 ID - 761437 ER - TY - JOUR AB - Background: Upshaw-Schulman Syndrome (USS) is a rarely congenital form of thrombotic thrombocytopenic purpura (TTP) that results from mutations in ADAMTS13 gene. Pregnancy can be the trigger event for approximately 5- 25% TTP cases (late-onset USS forms or acute acquired TTP). Aims: During pregnancy TTP may be particularly challenging because of difficult differential diagnosis with other thrombotic microangiopathies (TMAs), such as preeclampsia and HELPP syndrome, and its dramatic consequence on the fetus and its specific therapeutic management. Methods: ADAMTS13 activity was measured using the residual collagen binding assay (CBA). The detection limit of the assay is 6%. The inhibitor titer (BU/ml) was measured using a procedure based on the Bethesda method (values >1 BU/ml were considered high titer). Results: We report a case of a 28-year old white pregnant woman, gravida 2 para 0 at 20 weeks of gestation, who presented at our Department for worsening fatigue in the last week. Two years before she underwent an urgent cesarean section at 29 weeks of gestation for an atypical form of HELLP syndrome with perinatal death of a growth restricted fetus. Thrombophilia evaluation revealed omozygous for V Leiden mutation. In the actual pregnancy thromboprophylaxis with LMWH was adopted from the late first trimester. At hospital admission at 20 weeks laboratory data were: Hb 10.7 g/dl, platelets 73 x 109/l, schystocyte 12/1000 and LDH 265 U/L. Serum haptoglobin levels, DAT, coagulation test, transaminase, creatinine and blood pressure were normal. The patient was found to have an ADAMTS13 activity of < 6% with the presence of a weakly positivity for antibodies anti-ADAMTS13, confirmed in two following samples. She started oral prednisolone. No clinical sign of TTP or fetal compromise were noted, whereas platelets slowly decreased. Plasma ex-change (PEX) was initiated at 24 weeks' gestation for progressive worsening of laboratory data (Hb 9.5 g/dl, platelets 37 x 109/l, schystocyte 65/1000), obtaining a prompt increased of platelet count. A cesarean section was performed without complications at 30 weeks' gestation, after nine PEXs (Hb 9.3 g/dl, platelets 90 x 109/l) for progressive onset of allergic reactions to the procedures. A female neonate of 1440 grams (Apgar score 5) was born in good health condition. After the delivery, a spontaneous progressive normalization of the blood count of the patient was observed. LMWH administering was continued for six weeks postpartum. Nowadays she is in good health condition with a normal blood count. Repeated analysis of ADAMTS13 confirmed a level < 6% with no antibodies. We performed mutational analysis of the ADAMTS13 gene and Upshaw-Schulman syndrome was diagnosed. Summary / Conclusion: Diagnosis of TTP can be difficult during pregnancy for the potential overlap with other TMAs. The clinical manifestation of Upshaw- Schulman syndrome reported appeared unusual for the weakly positivity of ADAMTS13 antibodies, probably due to pregnancy-related alteration of the immunity system. Furthermore, we supposed that the atypical form of HELLP syndrome reported in her first pregnancy could be a manifestation of the Upshaw-Schulman Syndrome and its prompt recognition and treatment could have been able to avoid the perinatal death that had occurred. It is therefore critical to create a multidisciplinary team involving haematologists, obstetricians, apheresis and genetic counselling physicians to follow patients with thrombotic microangiopathies (TMAs) and to prevent unnecessary mortality both of the mother and the baby. (Figure Presented). AD - V. Coccini, Hematology, Monza, Italy AU - Coccini, V. AU - Carpenedo, M. AU - Pogliani, E. AU - Ornaghi, S. AU - Vergani, P. AU - Cecchetti, C. DB - Embase KW - antibody creatinine collagen haptoglobin aminotransferase prednisolone lactate dehydrogenase human mutation hematology patient female pregnancy thrombocyte thrombotic thrombocytopenic purpura HELLP syndrome fetus procedures blood cell count cesarean section health laboratory gene perinatal death blood pressure blood clotting test mortality non implantable urine incontinence electrical stimulator preeclampsia baby differential diagnosis serum fatigue apheresis obstetrician pregnant woman primigravida immunity diagnosis mutational analysis hospital admission assay allergic reaction first trimester pregnancy platelet count thrombophilia newborn Apgar score limit of detection plasma genetic counseling physician mother binding assay L1 - www.haematologica.org/content/98/supplement_2/1.full-text.pdf+html LA - English M3 - Conference Abstract N1 - L71697741 2014-12-09 PY - 2013 SN - 0390-6078 SP - 735-736 ST - Atypical presentation of upshaw-schulman syndrome in a pregnant patient with omozygous for v leiden mutation T2 - Haematologica TI - Atypical presentation of upshaw-schulman syndrome in a pregnant patient with omozygous for v leiden mutation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71697741&from=export VL - 98 ID - 761165 ER - TY - JOUR AB - Upshaw-Schulman Syndrome (USS) is a rarely congenital form of thrombotic thrombocytopenic purpura (TTP) that results from mutations in ADAMTS13 gene. Pregnancy can be the trigger event for 5-25% TTP cases (late-onset USS forms or acute acquired TTP). During pregnancy TTP may be particularly challenging because of its difficult differential diagnosis with other thrombotic microangiopathies (TMAs), such as preeclampsia and HELPP syndrome. We report a case of a 28-year old white pregnant woman, gravida 2 para 0, at 20 weeks of gestation, who presented at our Department for worsening fatigue in the last week. Two years before she underwent an urgent cesarean section at 29 weeks of gestation for an atypical form of HELLP syndrome with perinatal death of a growth restricted fetus. Thrombophilia evaluation revealed omozygous for V Leiden mutation. In the actual pregnancy thromboprophylaxis with LMWH was adopted. At hospital admission at 20 weeks laboratory data were: Hb 10.7 g/dl, platelets 73x109/L, schystocytes 12/1000 and LDH 265 U/L. Serum haptoglobin levels, DAT, coagulation test, transaminase, creatinine and blood pressure were normal. The patient was found to have an ADAMTS13 activity of <6% with the presence of a weakly positivity for antibodies anti- ADAMTS13. She started oral prednisone. No clinical sign of TTP or fetal compromise were noted, whereas platelets slowly decreased. Plasma ex-change (PEX) was initiated at 24 weeks' gestation for progressive worsening of laboratory data obtaining a prompt increase of platelet count. A cesarean section was performed without complications at 30 weeks' gestation, after nine PEXs, for progressive onset of allergic reactions to the procedures. A female neonate of 1440 grams was born in good health condition. After the delivery, a spontaneous progressive normalization of the blood count of the patient was observed. LMWH was continued for six weeks post-partum. Repeated analysis of ADAMTS13 confirmed level <6% with no antibodies. We performed mutational analysis of the ADAMTS13 gene and Upshaw-Schulman syndrome was diagnosed. We supposed that the atypical form of HELLP syndrome reported in her first pregnancy could be a manifestation of USS and its prompt recognition and treatment could have been able to avoid the perinatal death that had occurred. It is therefore critical to create a multidisciplinary team to follow patients with TMAs and to prevent unnecessary mortality both of the mother and the baby. (Figure Presented). AD - V. Coccini, Divisione Di Ematologia E Centro Trasfusionale, Ospedale San Gerardo Di Monza, Italy AU - Coccini, V. AU - Carpenedo, M. AU - Realini, S. AU - Pogliani, E. M. AU - Perseghin, P. AU - Borella, C. AU - Colaemma, A. DB - Embase KW - antibody creatinine aminotransferase haptoglobin prednisone lactate dehydrogenase pregnancy human case report society hematology mutation female patient cesarean section HELLP syndrome thrombocyte perinatal death thrombotic thrombocytopenic purpura laboratory gene thrombophilia pregnant woman hospital admission blood pressure fetus preeclampsia differential diagnosis blood clotting test baby mother mortality fatigue primigravida mutational analysis serum blood cell count health newborn procedures allergic reaction platelet count plasma non implantable urine incontinence electrical stimulator L1 - http://www.haematologica.org/content/98/supplement_3/1.full-text.pdf+html LA - English M3 - Conference Abstract N1 - L71693901 2014-12-01 PY - 2013 SN - 0390-6078 SP - 103 ST - Upshaw-schulman syndrome and omozygous for v leiden mutation in pregnancy: A case report T2 - Haematologica TI - Upshaw-schulman syndrome and omozygous for v leiden mutation in pregnancy: A case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71693901&from=export VL - 98 ID - 761151 ER - TY - JOUR AB - Objective Venous thromboembolism (VTE) is a recognized complication of gynecological malignancy and represents a leading cause of morbidity and mortality in these patients. The review aimed to discuss the incidence, risk factors, and clinical presentation of VTE before examining the literature on the diagnosis, prevention, and management in the context of uterine, cervical, ovarian, and vulval cancers. Methods/Materials A literature search was performed using Ovid Medline and Embase with the following words: "gynecological malignancy," "pelvic tumor," "venous thromboembolism," "deep vein thrombosis" and "pulmonary embolism." Results The incidence of VTE in patients with gynecological malignancy ranged between 3% and 25% and was affected by several patient and tumor factors. Duplex ultrasonography is currently the first-line imaging modality for deep venous thrombosis with sensitivity and specificity of up to 95% and 100%, respectively. Low-molecular-weight heparin is currently the VTE prophylaxis and treatment of choice for patients with gynecological malignancy, although warfarin and unfractionated heparin play a role in selected circumstances. The relatively new direct oral anticoagulants including factor Xa inhibitors and direct thrombin inhibitors are increasingly being used, although further evaluations are required, particularly in cancer patients. Catheter-directed thrombolysis and percutaneous mechanical and surgical thrombectomy may have a role in treating patients with severe symptomatic iliocaval or iliofemoral deep venous thrombosis. Overall, VTE is a poor prognosis marker in patients with gynecological malignancy. Conclusions Gynecological malignancy-Associated VTE is associated with significant morbidity, contributing to a large number of life years lost. Although promising new therapies are emerging, a 2-pronged approach is required to simultaneously target cancer-specific management and predict early on those who are likely to be affected. In the meantime, clinicians should continue to combine current guidelines with a multidisciplinary team approach to ensure that these complex patients receive the best evidence-based and compassionate care. AD - A.H. Davies, Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, Fulham Palace Rd, London, United Kingdom AU - Cohen, A. AU - Lim, C. S. AU - Davies, A. H. DB - Embase Medline DO - 10.1097/IGC.0000000000001111 KW - compression stocking intermittent pneumatic compression device vena cava filter antianemic agent anticoagulant agent antivitamin K apixaban bevacizumab blood clotting factor 10a inhibitor cisplatin D dimer dabigatran heparin low molecular weight heparin phospholipase A2 rivaroxaban thrombin inhibitor thromboxane warfarin anemia anticoagulant therapy article brachytherapy cancer chemotherapy cancer patient cancer radiotherapy cancer survival cohort analysis deep vein thrombosis Doppler ultrasonography drug efficacy drug safety drug withdrawal endometrium cancer endothelium injury female female genital tract cancer hemostasis high risk patient human hypercoagulability incidence laparoscopic surgery life expectancy lung embolism lung scintiscanning meta analysis (topic) mobilization nonhuman ovary cancer pelvis tumor phase 3 clinical trial (topic) postoperative care practice guideline preoperative care priority journal prognosis prospective study randomized controlled trial (topic) retrospective study risk factor systematic review thrombocyte aggregation thrombosis prevention uterine cervix cancer uterus cancer venous thromboembolism vulva cancer LA - English M1 - 9 M3 - Article N1 - L619126318 2017-11-13 2017-11-17 PY - 2017 SN - 1525-1438 1048-891X SP - 1970-1978 ST - Venous thromboembolism in gynecological malignancy T2 - International Journal of Gynecological Cancer TI - Venous thromboembolism in gynecological malignancy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619126318&from=export http://dx.doi.org/10.1097/IGC.0000000000001111 VL - 27 ID - 760893 ER - TY - JOUR AB - Introduction Excluding metastases and plasmacytomas, most bone tumours of the cervical spine are benign. The surgical treatment of bone tumours of the cervical spine, when indicated, is difficult and frequently requires multiple approaches. Intralesional surgery, combined with modern techniques of radiation therapy, or radiation alone, are frequently an option in malignant tumours. Intralesional surgery or minimally invasive techniques such as percutaneous radiofrequency ablation can also effectively replace surgical excision in some cases of benign tumours. Materials and methods Two hundreds and fifty-one patients (182 suffering from primary tumours and 69 metastases) of 1,247 were surgically treated from 1990 to 2012 (139 males, 112 females, age 18-44 years). The surgical techniques used were en bloc resection in 3 cases (2 chondrosarcoma, 1 chordoma), debulking and stabilization in 139 cases (55.5 %) and decompression + stabilization in 109 cases (43.5 %). The mean follow-up was 5 years (min 1-513 months). Results The major surgical complications (respiratory problems for glottis oedema, pulmonary embolism, dysphagias) were 28 (11 %) including 2 peri-operative deaths (1 pulmonary embolism, 1 respiratory failure). The minor surgical complications (wound dehiscence, loosening of the screws or breakdown of the rods during follow-up) were 21 (8.5 %). The local control of the disease was achieved in 90 % of cases, local recurrences in fact were 26 (10 %), 17 of which required a new surgical treatment. In the other 9 cases palliative radiotherapy was performed. In all patients, comparison between the pre-operative neurological status and the post-operative one, evaluated by Frankel classification, showed no aggravations, while a clinical improvement was observed in approximately 78 % of cases. Discussion Oncological and surgical staging are mandatory to decide about the treatment. Adjuvant therapies like radiation, embolization and chemotherapy must be considered by the multidisciplinary team. The patient has to correctly understand the purpose of the surgery-based on oncological staging-in order to accept-or not-morbidity as counterbalanced by the expected final result. Conclusions An adequate treatment for cervical spine tumours is mandatory at the first time. Incomplete or inadequate treatments that expose the patient to the risks of recurrence or, even worse, an adverse survival outcome must be avoided. On the other hand, overaggressive treatments may expose a patient at unnecessary risks without an appropriate oncological indication. Diagnosis, staging and treatment should be centralized in a referral centre where all necessary information should be obtained before any invasive intervention, including biopsy. AD - S. Colangeli, Istituto Ortopedico Rizzoli, Bologna, Italy AU - Colangeli, S. AU - Gasbarrini, A. AU - Ghermandi, R. AU - Barbanti Brodano, G. AU - Bandiera, S. AU - Terzi, S. AU - Babbi, L. AU - Boriani, S. AU - Lampner, A. DB - Embase DO - 10.1007/s10195-013-0264-9 KW - human spine tumor orthopedics patient retrospective study society traumatology surgery cervical spine staging radiation lung embolism follow up risk intralesional drug administration metastasis bone postoperative complication biopsy diagnosis survival morbidity decompression adjuvant therapy chordoma Frankel grade wound dehiscence chondrosarcoma death dysphagia surgical technique respiratory failure primary tumor palliative therapy excision radiofrequency ablation minimally invasive procedure artificial embolization chemotherapy male edema glottis radiotherapy female LA - English M1 - 1 M3 - Conference Abstract N1 - L71249605 2013-12-10 PY - 2013 SN - 1590-9921 SP - S95-S96 ST - Surgical treatment of the cervical spine tumors. A retrospective study on 251 out of 1,247 patients surgically treated from 1990 to 2012 T2 - Journal of Orthopaedics and Traumatology TI - Surgical treatment of the cervical spine tumors. A retrospective study on 251 out of 1,247 patients surgically treated from 1990 to 2012 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71249605&from=export http://dx.doi.org/10.1007/s10195-013-0264-9 VL - 14 ID - 761150 ER - TY - JOUR AB - Background A scarcity of data is available to guide pharmacologic management of acute ischemic stroke in patients with left ventricular assist devices (LVAD). LVAD patients who present with acute ischemic stroke can be challenging to manage, due to the presence of therapeutic anticoagulation and the limited availability of published data in this cohort. Case A fifty-nine-year-old female presented with complaints of left-sided weakness, left facial droop and left arm and leg hemiparesis; after further workup, the patient was diagnosed with acute ischemic stroke. Past medical history included hypertension, deep venous thrombosis, and non-ischemic cardiomyopathy with HVAD™ placement (on warfarin) four months prior. Based on hospital guideline, with INR < 1.7 and presentation within three hours of symptom onset, she was a candidate for intravenous alteplase (t-Pa) therapy. After t-Pa was administered, the patient became acutely altered, requiring emergent intubation. There were concerns that t-Pa may have interrupted a larger intra-device thrombosis, leading to development of new deficits following administration. Subsequently, a mechanical thrombectomy of the left middle cerebral artery was performed. Appropriate reperfusion was achieved and neurologic status returned to baseline with some residual gait deficits. Decision-making Multidisciplinary teams from neurocritical care, cardiology, and emergency medicine collaborated to provide care for this patient. Extensive risk-benefit conversations occurred amongst all parties regarding administration of t-Pa. As the pharmacist on the stroke response team, I was able to provide expertise on t-Pa therapy and contribute to this decision-making process. Conclusion This unique case demonstrates the importance of therapeutic anticoagulation in the LVAD patient population as well as the unknown implications of administration of intravenous t-Pa therapy in this cohort. A multidisciplinary and collaborative approach across all care teams that interact with LVAD patients is essential to provide the most optimal patient care. AU - Conroy, G. M. AU - Simone, P. DB - Embase DO - 10.1016/S0735-1097(20)32929-6 KW - alteplase warfarin adult anticoagulation brain ischemia cardiology case report clinical article cohort analysis conference abstract conversation decision making deep vein thrombosis drug therapy emergency medicine facial droop female gait hemiparesis human hypertension international normalized ratio intubation left ventricular assist device leg mechanical thrombectomy medical history middle aged middle cerebral artery multidisciplinary team nonischemic cardiomyopathy patient care pharmacist practice guideline reperfusion weakness LA - English M1 - 11 M3 - Conference Abstract N1 - L2005038760 2020-03-26 PY - 2020 SN - 1558-3597 0735-1097 SP - 2302 ST - SYSTEMIC ALTEPLASE THERAPY FOR ACUTE ISCHEMIC STROKE IN A LEFT VENTRICULAR ASSIST DEVICE PATIENT T2 - Journal of the American College of Cardiology TI - SYSTEMIC ALTEPLASE THERAPY FOR ACUTE ISCHEMIC STROKE IN A LEFT VENTRICULAR ASSIST DEVICE PATIENT UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005038760&from=export http://dx.doi.org/10.1016/S0735-1097(20)32929-6 VL - 75 ID - 760583 ER - TY - JOUR AB - SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Aortic endograft infection is one of the most rare and severe complications after endovascular aneurysm repair (EVAR) occurring in up to 4.0% of cases (1). We report this rare, delayed complication of abscess formation in an aortic aneurysm surrounding stent grafts 2 years after EVAR. We herein highlight the importance of early diagnosis and management of patients with aortic endograft infections. CASE PRESENTATION: A 53-year-old male with a history of type A aortic dissection status post EVAR with 2 Gelweave grafts placed 2 years ago and psoriasis on Dupilumab presented with fevers and substernal chest discomfort radiating to the back along with two syncopal episodes at home. On presentation his heart rate was 108 beats per minute, blood pressure was 97/54 millimeters of mercury (mmHg) and temperature was 99.3 degrees Fahrenheit. Initial work up revealed acute kidney injury and a normal white blood cell count with 37 % bandemia. Computed tomography (CT) scan of chest without contrast, ventilation perfusion scan and transthoracic echocardiogram completed within the first 24 hours were negative. The patient was empirically started on Vancomycin and Imipenem. On day 2 blood cultures were positive for methicillin resistant staphylococcus aureus (MRSA). Transesophageal echocardiogram (TEE) was subsequently performed and resulted negative for vegetation. Renal function improved and he underwent CT angiography which showed the true and false lumens of a dissection in the arch of the aorta and fluid around the aortic graft without extravasation of the dye. Surgical management included redo-sternotomy and drainage of the periaortic abscess cavity. Cultures of the abscess collection and ascending aorta perigraft tissue were positive for MRSA. He was then transferred to another facility for homograft aortic root replacement with extra-anatomic bypass and revascularization. DISCUSSION: Endograft infections are rare and threatening complications after thoracic aneurysm repair, carrying a mortality rate of up to 70% (2). As clinical manifestations are largely nonspecific, it is important to establish the diagnosis early. Treatment for infected aortic endograft is challenging and not well defined due to the rarity of this condition. Surgical excision remains the standard of care in suitable patients. A systematic review of the literature shows that patients treated surgically had higher survival rates (58%) compared to those treated conservatively with antibiotics and drainage (33%) (3). Treatment ranges from surgical removal of infected prosthetic material, regional tissue debridement and revascularization to antibiotic therapy alone. Overall surgical management offers greater likelihood of survival and long-term success. CONCLUSIONS: This case is of clinical importance as it emphasizes that early diagnosis of stent-graft infection after EVAR and prompt treatment are necessary for favorable outcomes. Reference #1: Heyer, K.S., et al. “Secondary infections of thoracic and abdominal aortic endografts.” J Vasc Interv Radiol. 2009; 20: 173–179. Reference #2: Rawson, T.M., et al. "The role of the multidisciplinary team in decision making for vascular graft infection.” J Vasc Surg. 2015; 62(6): 1686. Reference #3: Li, H.L., et al. “Current evidence on management of aortic stent-graft infections: a systematic review and meta-analysis.” Ann Vasc Surg. 2018; 51: 306–313. DISCLOSURES: No relevant relationships by Firas Ajam, source=Web Response No relevant relationships by Gabriella Conte, source=Web Response No relevant relationships by TAIMOOR KHAN, source=Web Response No relevant relationships by John Mikhail, source=Web Response No relevant relationships by Mohammed Shariff, source=Web Response AU - Conte, G. AU - Shariff, M. AU - Khan, T. AU - Ajam, F. AU - Mikhail, J. DB - Embase DO - 10.1016/j.chest.2019.08.1344 KW - dupilumab imipenem mercury vancomycin abdominal aorta abscess acute kidney failure adult antibiotic therapy aortic arch aortic dissection aortic root surgery aortic stent graft ascending aorta blood culture blood pressure complication computed tomographic angiography conference abstract debridement decision making diagnosis drug combination drug therapy early diagnosis endovascular aneurysm repair excision extravasation fever graft infection heart rate human kidney function leukocyte count male methicillin resistant Staphylococcus aureus middle aged mortality rate multidisciplinary team nonhuman prosthesis material psoriasis revascularization secondary infection sternotomy surgery survival rate systematic review thoracic aorta thoracic aorta aneurysm thorax pain transthoracic echocardiography vegetation ventilation-perfusion scan LA - English M1 - 4 M3 - Conference Abstract N1 - L2002984026 2019-10-02 PY - 2019 SN - 1931-3543 0012-3692 SP - A1521 ST - THORACIC AORTIC STENT-GRAFT INFECTION COMPLICATED BY AORTIC ABSCESS T2 - Chest TI - THORACIC AORTIC STENT-GRAFT INFECTION COMPLICATED BY AORTIC ABSCESS UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002984026&from=export http://dx.doi.org/10.1016/j.chest.2019.08.1344 VL - 156 ID - 760665 ER - TY - JOUR AB - Background: The objective of this study was to identify the self-reported barriers to and facilitators of prescribing low-molecular-weight heparin (LMWH) thromboprophylaxis in the intensive care unit (ICU). Methods: We conducted an interviewer-administered survey of 4 individuals per ICU (the ICU director, a bedside pharmacist, a thromboprophylaxis research coordinator, and physician site investigator) regarding LMWH thromboprophylaxis for medical-surgical patients in 27 ICUs in Canada and the United States. Items were generated by the research team and adapted from previous surveys, audits, qualitative studies, and quality improvement research. Respondents rated the barriers to LMWH use, facilitators (effectiveness, affordability, and acceptability thereof), and perceptions regarding LMWH use. Results: Respondents had 14.5 (SD, 7.7) years of ICU experience (response rate, 99%). The 5 most common barriers in descending order were as follows: drug acquisition cost, fear of bleeding, lack of resident education, concern about bioaccumulation in renal failure, and habit. The top 5 rated facilitators were preprinted orders, education, daily reminders, audit and feedback, and local quality improvement committee endorsement. Centers using preprinted orders (mean difference [P < .01]) and computerized physician order entry (P < .01) compared with those centers not using those tools reported higher affordability for these 2 facilitators. Compared with physicians and pharmacists, research coordinators considered ICU-specific audit and feedback of thromboprophylaxis rates to be a more effective, acceptable, and affordable facilitator (odds ratio, 6.67; 95% confidence interval, 1.97-22.53; P < .01). Facilitator acceptability ratings were similar within centers but differed across centers (P <= .01). Conclusions: This multicenter survey found several barriers to use of LMWH including cost, concern about bleeding, and lack of resident knowledge of effectiveness. The diversity of reported facilitators suggests that large scale programs may address generic barriers but also need site-specific interprofessional knowledge translation activities. (C) 2014 Elsevier Inc. All rights reserved. AD - [Cook, Deborah; Guyatt, Gordon] McMaster Univ, Dept Med, Hamilton, ON, Canada. [Cook, Deborah; Duffett, Mark; Ye, Chenglin; Kho, Michelle E.; Zytaruk, Nicole; Clarke, France; Guyatt, Gordon] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8N 3Z5, Canada. [Duffett, Mark] McMaster Univ, Dept Pediat, Hamilton, ON L8N 3Z5, Canada. [Lauzier, Francois] Univ Laval, Ctr Hosp Affilie Univ Quebec, Ctr Rech FRQS, Div Soins Intensifs Adultes,Dept Med Anesthesiol, Quebec City, PQ G1K 7P4, Canada. [Dodek, Peter] St Pauls Hosp, Div Crit Care Med, Vancouver, BC V6Z 1Y6, Canada. [Dodek, Peter] St Pauls Hosp, Ctr Hlth Evaluat & Outcome Sci, Vancouver, BC V6Z 1Y6, Canada. [Dodek, Peter] Univ British Columbia, Vancouver, BC V6Z 1Y6, Canada. [Paunovic, Bojan] Univ Manitoba, Dept Internal Med, Sect Crit Care Med, Winnipeg, MB, Canada. [Fowler, Rob; Sinuff, Taz] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med, Toronto, ON, Canada. [Fowler, Rob; Sinuff, Taz] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON, Canada. [Kho, Michelle E.] McMaster Univ, Sch Rehabil Sci, Hamilton, ON L8N 3Z5, Canada. [Foster, Denise] Vancouver Gen Hosp, Div Crit Care Med, Vancouver, BC, Canada. [Stelfox, Tom] Univ Calgary, Inst Publ Hlth, Dept Crit Care Med, Calgary, AB, Canada. [Wood, Gordon] Vancouver Isl Hlth Author, Dept Anesthesia, Victoria, BC, Canada. [Wood, Gordon] Vancouver Isl Hlth Author, Dept Crit Care, Victoria, BC, Canada. [Cox, Michael] St Johns Mercy Hosp, Dept Pulm & Crit Care, St Louis, MO USA. [Kutsiogiannis, Jim; Jacka, Michael] Univ Alberta, Fac Med & Dent, Div Crit Care Med, Edmonton, AB, Canada. [Roussos, Marios] Thunder Bay Reg Hlth Sci Ctr, Northern Ontario Sch Med, Dept Crit Care, Div Clin Sci, Thunder Bay, ON, Canada. [Roussos, Marios] Thunder Bay Reg Hlth Sci Ctr, Northern Ontario Sch Med, Dept Internal Med, Div Clin Sci, Thunder Bay, ON, Canada. [Kumar, Hari] St Johns Hosp, Dept Surg, St John, NB, Canada. [Kumar, Hari] St Johns Hosp, Dept Crit Care, St John, NB, Canada. Cook, D (corresponding author), McMaster Univ, Hlth Sci Ctr, Dept Med, Room 2C11,1200 Main St West, Hamilton, ON L8N 3Z5, Canada. debcook@mcmaster.ca AN - WOS:000335818300035 AU - Cook, D. AU - Duffett, M. AU - Lauzier, F. AU - Ye, C. AU - Dodek, P. AU - Paunovic, B. AU - Fowler, R. AU - Kho, M. E. AU - Foster, D. AU - Stelfox, T. AU - Sinuff, T. AU - Zytaruk, N. AU - Clarke, F. AU - Wood, G. AU - Cox, M. AU - Kutsiogiannis, J. AU - Jacka, M. AU - Roussos, M. AU - Kumar, H. AU - Guyatt, G. AU - o, Conecckt- T. Co Operative Network C7 - 471.e1 DA - Jun DO - 10.1016/j.jcrc.2014.01.017 J2 - J. Crit. Care KW - Thromboprophylaxis Venous thromboembolism Critical illness Survey Interview CRITICALLY-ILL PATIENTS MOLECULAR-WEIGHT HEPARIN DEEP-VEIN THROMBOSIS VENOUS THROMBOEMBOLISM PREVENTION PROPHYLAXIS VARIABILITY DALTEPARIN OMISSION Critical Care Medicine LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: AH0OA Times Cited: 8 Cited Reference Count: 35 Cook, Deborah Duffett, Mark Lauzier, Francois Ye, Chenglin Dodek, Peter Paunovic, Bojan Fowler, Rob Kho, Michelle E. Foster, Denise Stelfox, Tom Sinuff, Taz Zytaruk, Nicole Clarke, France Wood, Gordon Cox, Michael Kutsiogiannis, Jim Jacka, Michael Roussos, Marios Kumar, Hari Guyatt, Gordon Duffett, Mark/B-7524-2019; Lauzier, Francois/B-9237-2015; , Michelle/W-7414-2019 Duffett, Mark/0000-0003-1705-5422; Lauzier, Francois/0000-0002-6530-5513; Kho, Michelle/0000-0003-3170-031X Hamilton Academy of Health Sciences; Canadian Institutes of Health ResearchCanadian Institutes of Health Research (CIHR); Fonds de la recherche du Quebec-SanteFonds de la Recherche en Sante du Quebec; CIHRCanadian Institutes of Health Research (CIHR); Alberta Innovates Health Solutions This study was peer review funded by the Hamilton Academy of Health Sciences. M Duffett holds a fellowship from the Canadian Institutes of Health Research. F Lauzier is a recipient of a research career award from the Fonds de la recherche du Quebec-Sante. M Kho holds a Chair of the Canadian Institutes of Health Research. T Stelfox holds a New Investigator Award from CIHR and Population and Population Health Investigator Award from Alberta Innovates Health Solutions. D Cook holds a Chair of the Canadian Institutes of Health Research. 10 0 W B SAUNDERS CO-ELSEVIER INC PHILADELPHIA J CRIT CARE PY - 2014 SN - 0883-9441 SP - 9 ST - Barriers and facilitators of thromboprophylaxis for medical-surgical intensive care unit patients: A multicenter survey T2 - Journal of Critical Care TI - Barriers and facilitators of thromboprophylaxis for medical-surgical intensive care unit patients: A multicenter survey UR - ://WOS:000335818300035 VL - 29 ID - 761778 ER - TY - JOUR AB - Esophagectomy (EG) is a high-risk therapy for esophageal cancer and end-stage benign disease. This study compares the results of EG before and after implementation of a perioperative clinical care process including a health provider education program (EP) and institutional uncomplicated postoperative clinical pathway (POP) for purpose quality improvement. This is a single institution retrospective cohort study. The EP was provided to critical care and telemetry unit nurses and the POP was imbedded in the electronic health record. Patients undergoing elective EG with reconstruction with the stomach for benign disease or cancer were included from 2005 to 2011. Cohorts were pre- and postimplementation (PreI and PostI) of an EP and 8-day POP (August 2008). Patient, tumor and peri/postoperative-specific variables were compared between cohorts, as well as resource utilization and hospital costs. We identified 33 PreI and 41 PostI patients. Both cohorts had similar patient demographics, preoperative comorbidities, majority cancer diagnosis, and for cancer patients, majority adenocarcinoma and IIB/III pathologic stage. Both groups had one death and similar rate of discharge to home. The PostI cohort demonstrated reduced 30-day readmission rate (2.4% vs 24.2%); P < 0.05. In regard to clinical outcomes, the PostI group exhibited reduced deep venous thrombosis/pulmonary emboli (2.4% vs 18.2%); P < 0.05. The PostI group demonstrated significantly reduced radiographic test utilization and costs, as well as total overall 30-day readmission costs. A defined perioperative clinical process involving educating the patient care team and implementing a widely disseminated POP can reduce complications, 30-day readmission rates, and hospital costs after EG. AD - Section of General Thoracic Surgery, University of California, Davis Medical Center, Sacramento, California, USA. AN - 28234134 AU - Cooke, D. T. AU - Calhoun, R. F. AU - Kuderer, V. AU - David, E. A. DA - Jan 1 DP - NLM ET - 2017/02/25 J2 - The American surgeon KW - Adenocarcinoma/pathology/*surgery *Critical Pathways Elective Surgical Procedures Esophageal Diseases/surgery Esophageal Neoplasms/pathology/*surgery *Esophagectomy/economics Hospital Costs Humans Patient Readmission/statistics & numerical data *Quality Improvement Retrospective Studies Treatment Outcome LA - eng M1 - 1 N1 - 1555-9823 Cooke, David T Calhoun, Royce F Kuderer, Valerie David, Elizabeth A Comparative Study Journal Article United States Am Surg. 2017 Jan 1;83(1):103-111. PY - 2017 SN - 0003-1348 SP - 103-111 ST - A Defined Esophagectomy Perioperative Clinical Care Process Can Improve Outcomes and Costs T2 - Am Surg TI - A Defined Esophagectomy Perioperative Clinical Care Process Can Improve Outcomes and Costs VL - 83 ID - 760305 ER - TY - JOUR AB - Esophagectomy (EG) is a high-risk therapy for esophageal cancer and end-stage benign disease. This study compares the results of EG before and after implementation of a perioperative clinical care process including a health provider education program (EP) and institutional uncomplicated postoperative clinical pathway (POP) for purpose quality improvement. This is a single institution retrospective cohort study. The EP was provided to critical care and telemetry unit nurses and the POP was imbedded in the electronic health record. Patients undergoing elective EG with reconstruction with the stomach for benign disease or cancer were included from 2005 to 2011. Cohorts were pre- and postimplementation (PreI and PostI) of an EP and 8-day POP (August 2008). Patient, tumor and peri/postoperative-specific variables were compared between cohorts, as well as resource utilization and hospital costs. We identified 33 PreI and 41 PostI patients. Both cohorts had similar patient demographics, preoperative comorbidities, majority cancer diagnosis, and for cancer patients, majority adenocarcinoma and IIB/III pathologic stage. Both groups had one death and similar rate of discharge to home. The PostI cohort demonstrated reduced 30-day readmission rate (2.4% vs 24.2%); P < 0.05. In regard to clinical outcomes, the PostI group exhibited reduced deep venous thrombosis/pulmonary emboli (2.4% vs 18.2%); P < 0.05. The PostI group demonstrated significantly reduced radiographic test utilization and costs, as well as total overall 30-day readmission costs. A defined perioperative clinical process involving educating the patient care team and implementing a widely disseminated POP can reduce complications, 30-day readmission rates, and hospital costs after EG. AD - Section of General Thoracic Surgery, University of California, Davis Medical Center, Sacramento, California AN - 121127828. Language: English. Entry Date: 20170316. Revision Date: 20200706. Publication Type: journal article AU - Cooke, David T. AU - Calhoun, Royce F. AU - Kuderer, Valerie AU - Elizabeth, R. N. AU - David, A. AU - David, Elizabeth A. DB - CINAHL DO - 10.1177/000313481708300133 DP - EBSCOhost KW - Quality Improvement Critical Path Adenocarcinoma -- Surgery Surgery, Digestive System -- Economics Esophageal Neoplasms -- Surgery Esophageal Neoplasms -- Pathology Treatment Outcomes Health Facility Costs Adenocarcinoma -- Pathology Surgery, Elective Readmission -- Statistics and Numerical Data Esophageal Diseases -- Surgery Human Retrospective Design Validation Studies Comparative Studies Evaluation Research Multicenter Studies Critical Care Family Needs Inventory M1 - 1 N1 - research. Journal Subset: Biomedical; USA. Instrumentation: Critical Care Family Needs Inventory (CCFNI). NLM UID: 0370522. PMID: NLM28234134. PY - 2017 SN - 0003-1348 SP - 103-111 ST - A Defined Esophagectomy Perioperative Clinical Care Process Can Improve Outcomes and Costs T2 - American Surgeon TI - A Defined Esophagectomy Perioperative Clinical Care Process Can Improve Outcomes and Costs UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=121127828&site=ehost-live&scope=site VL - 83 ID - 761279 ER - TY - JOUR AB - Background: Box Hill Hospital has employed an Acute Stroke Nurse (ASN) since 2003; a role vital to the stroke team, which has previously been shown to significantly reduce thrombolysis treatment times. During an acute stroke, the ASN takes on the role of “team leader”, running the Code Stroke like a traditional code situation. Aims: To describe the ASN role with regard to stroke protocol development and implementation. Code Stroke processes review, time to thrombolysis and patient outcomes were also examined. Methods: This prospective study documented the ASN role in Code Strokes, stroke protocol development and implementation, facilitators and barriers to rapid treatment. Thrombolysis treatment times and patient outcomes (modified Rankin Scale [mRS]) were also examined. Results: During a code stroke, the ASN is the “team leader”, directing patient care from arrival to treatment decision and delivery. The ASN ensures all care processes are performed to facilitate rapid thrombolysis, allowing the medical team to assess the patient and interpret CT images in real time. Through protocol development, the ASN identifies delays and liaises with the ED and radiology teams to improve stroke services. New stroke protocols have improved median Door-to-CT time (10 mins vs. 27 mins, P < 0.001), Door-to-Needle time (33 mins vs. 75 mins, P < 0.001) and patient outcomes (discharge mRS 0-1, 46% vs. 23%, P = 0.039). Conclusion: The ASN role is vital to ensure best stroke practices are achieved, through protocol development, implementation and review. As team leader, the ASN coordinates all protocol components to ensure optimal stroke care for patients. AD - S. Coote, Eastern Health, Box Hill, VIC, Australia AU - Coote, S. AU - Frost, T. AU - Loh, P. S. AU - Bladin, C. AU - Gilligan, A. DB - Embase DO - 10.1111/ijs.12334-2 KW - cerebrovascular accident human stroke patient nursing patient care nurse health patient blood clot lysis Rankin scale prospective study needle radiology hospital LA - English M3 - Conference Abstract N1 - L71611477 2014-09-13 PY - 2014 SN - 1747-4930 SP - 32 ST - The acute stroke nurse role is vital to optimise stroke patient care T2 - International Journal of Stroke TI - The acute stroke nurse role is vital to optimise stroke patient care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71611477&from=export http://dx.doi.org/10.1111/ijs.12334-2 VL - 9 ID - 761104 ER - TY - JOUR AB - Medical readiness requires Department of Defense medical clinics to be robust to changes in patient demand. Minor fluctuations in patient demand occur on a regular basis, but major increases can also occur. Major demand increases can result from a number of occurrences, including mass military deployments, medical incidents, outbreaks, and overflow from Veterans' Affairs clinics. This research evaluates a system of clinics at Wright-Patterson Air Force Base in order to determine its ability to handle a 200% surge in patient demand. In addition, this study evaluates the relative effectiveness of six different staffing mix options to minimize patient wait times, also under the surge demand conditions. This evaluation is conducted using discrete-event simulation to estimate patient wait times and includes a sensitivity analysis of the increased patient demand, as well as a cost-benefit analysis to determine the most cost-effective alternative scenario. The study finds that adjustments to staffing mix enable cost savings while meeting current demands. In addition, the study finds that adjusting the staffing mix will not have a negative impact on patient wait time in the surge conditions, relative to the current staffing mix. AD - [Corpuz, Michael Q.; Valencia, Vhance V.] Air Force Inst Technol, Dept Syst Engn & Management, Wright Patterson AFB, OH 45433 USA. [Rusnock, Christina F.; Oyama, Kyle] Air Force Inst Technol, Dept Syst Engn & Management, Syst Engn, Wright Patterson AFB, OH 45433 USA. Rusnock, CF (corresponding author), Air Force Inst Technol, 2950 Hobson Way, Wright Patterson AFB, OH 45433 USA. christina.rusnock@afit.edu AN - WOS:000412669300008 AU - Corpuz, M. Q. AU - Rusnock, C. F. AU - Valencia, V. V. AU - Oyama, K. DA - Oct DO - 10.1177/1548512916650996 J2 - J. Def. Model. Simul.-Appl. Methodol. Technol.-JDMS KW - Discrete-event simulation sensitivity analysis cost-benefit analysis military healthcare robustness DISCRETE-EVENT SIMULATION COST-BENEFIT-ANALYSIS HEALTH-CARE THROMBOLYSIS SYSTEMS TEAMS TIMES MODEL SIZE Engineering, Multidisciplinary LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: FJ3YP Times Cited: 0 Cited Reference Count: 25 Corpuz, Michael Q. Rusnock, Christina F. Valencia, Vhance V. Oyama, Kyle 88th Aerospace Medicine Squadron, Wright-Patterson AIR FORCE BASE, OH This work was supported in part by the 88th Aerospace Medicine Squadron, Wright-Patterson AIR FORCE BASE, OH. 0 2 SAGE PUBLICATIONS INC THOUSAND OAKS J DEF MODEL SIMUL-AP SI PY - 2017 SN - 1548-5129 SP - 407-419 ST - Medical readiness: evaluating the robustness of medical clinic staffing solutions T2 - Journal of Defense Modeling and Simulation-Applications Methodology Technology-Jdms TI - Medical readiness: evaluating the robustness of medical clinic staffing solutions UR - ://WOS:000412669300008 VL - 14 ID - 761633 ER - TY - JOUR AB - The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis. In recent years, several advances in treatment have also emerged. Novel, direct-acting oral anticoagulants make the outpatient treatment of low risk PE easier than before. However, the spectrum of PE severity varies widely, so emergency physicians must be able to risk-stratify patients to ensure the appropriate disposition. Finally, PE response teams have been developed to facilitate rapid access to advanced therapies (e.g., catheter directed thrombolysis) for patients with high-risk PE. This review will discuss the clinical challenges of PE diagnosis, risk stratification and treatment that emergency physicians face every day. PMID:27752629 AU - Corrigan, Daniel AU - Prucnal, Christiana AU - Kabrhel, Christopher DA - 2016/09/30 09/30 DB - PubMed Central DO - 10.15441/ceem.16.146 KW - Pulmonary embolism Venous thrombosis Risk stratification Thrombolysis Hospital rapid response team M1 - 3 PY - 2016 SN - 2383-4625 SP - 117-117 ST - Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients T2 - Clinical and Experimental Emergency Medicine TI - Pulmonary embolism: the diagnosis, risk-stratification, treatment and disposition of emergency department patients UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5065342&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5065342 VL - 3 ID - 762123 ER - TY - JOUR AB - Background: African Americans are under-represented in trials evaluating oral anticoagulants for the treatment of acute venous thromboembolism (VTE). The aim of this study was to evaluate the effectiveness and safety of rivaroxaban versus warfarin for the treatment of VTE in African Americans. Methods: We utilized Optum® De-Identified Electronic Health Record data from 11/1/2012–9/30/2018. We included African Americans experiencing an acute VTE during a hospital or emergency department visit, who received rivaroxaban or warfarin as their first oral anticoagulant within 7-days of the acute VTE event and had ≥1 provider visit in the prior 12-months. Differences in baseline characteristics between cohorts were adjusted using inverse probability-of-treatment weighting based on propensity scores (standard differences < 0.10 were achieved for all covariates). Our primary endpoint was the composite of recurrent VTE or major bleeding at 6-months. Three- and 12-month timepoints were also assessed. Secondary endpoints included recurrent VTE and major bleeding as individual endpoints. Cohort risk was compared using Cox regression and reported as hazard ratios (HRs) with 95% confidence intervals (CIs). Results: We identified 2097 rivaroxaban and 2842 warfarin users with incident VTE. At 6-months, no significant differences in the composite endpoint (HR = 0.96, 95%CI = 0.75–1.24), recurrent VTE (HR = 1.02, 95%CI = 0.76–1.36) or major bleeding alone (HR = 0.93, 95%CI = 0.59–1.47) were observed between cohorts. Analysis at 3- and 12-months provided consistent findings for these endpoints. Conclusions: In African Americans experiencing an acute VTE, no significant difference in the incidence of recurrent VTE or major bleeding was observed between patients receiving rivaroxaban or warfarin. AD - Department of Pharmacy Practice, University of Connecticut School of Pharmacy, 69 North Eagleville Road, Unit 3092, 06269, Storrs, CT, USA Evidence-Based Practice Center, Hartford Hospital, Hartford, CT, USA TeamHealth LifePoint Group, Southaven, MS, USA Real World Value and Evidence, Janssen Scientific Affairs LLC, Titusville, NJ, USA Medical Affairs, Janssen Pharmaceuticals Inc., Titusville, NJ, USA Department of Pharmacoepidemiology, New England Health Analytics LLC, Granby, CT, USA AN - 142611320. Language: English. Entry Date: 20200410. Revision Date: 20200410. Publication Type: Article AU - Costa, Olivia S. AU - Thompson, Stanley AU - Ashton, Veronica AU - Palladino, Michael AU - Bunz, Thomas J. AU - Coleman, Craig I. DB - CINAHL DO - 10.1186/s12959-020-00219-w DP - EBSCOhost KW - Rivaroxaban -- Administration and Dosage Warfarin -- Administration and Dosage Black Persons Recurrence -- Prevention and Control Venous Thromboembolism -- Drug Therapy Treatment Outcomes Human Retrospective Design Prospective Studies Electronic Health Records Emergency Service Anticoagulants -- Administration and Dosage Administration, Oral Probability Time Factors Cox Proportional Hazards Model Regression Odds Ratio Confidence Intervals M1 - 1 N1 - research; tables/charts. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 101170542. PY - 2020 SN - 1477-9560 SP - 1-9 ST - Rivaroxaban versus warfarin for treatment and prevention of recurrence of venous thromboembolism in African American patients: a retrospective cohort analysis T2 - Thrombosis Journal TI - Rivaroxaban versus warfarin for treatment and prevention of recurrence of venous thromboembolism in African American patients: a retrospective cohort analysis UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=142611320&site=ehost-live&scope=site VL - 18 ID - 761382 ER - TY - JOUR AB - BACKGROUND: : Recognition of trauma-induced coagulopathy by conventional coagulation testing (CCT) is limited by their slow results, incomplete characterization, and their poor predictive nature. Rapid thrombelastography (r-TEG) delivers a more comprehensive assessment of the coagulation system but has not been prospectively validated in trauma patients. The purpose of this pilot study was to evaluate the timeliness of r-TEG results, their correlation with CCTs, and the ability of r-TEG to predict early blood transfusion. METHODS: : Over a 5-month period, 583 consecutive major trauma activations were prospectively entered into a database, of which 272 met entry criteria. r-TEG and CCTs (prothrombin time, international normalized ratio, partial thromboplastin time, and platelet count) were obtained on all patients. Graphical results for r-TEG were displayed 'real time' in the trauma bay. Spearman's correlation and regression models were used to compare r-TEG and CCTs. RESULTS: : Early r-TEG values (activated clotting time [ACT], k-time, and r-value) were available within 5 minutes, late r-TEG values (maximal amplitude and [alpha]-angle) within 15 minutes, and CCTs within 48 minutes (p < 0.001). ACT, r-value, and k-time showed strong correlation with prothrombin time, international normalized ratio, and partial thromboplastin time (all r >0.70; p < 0.001), whereas maximal amplitude (r = -0.49) and [alpha]-angle (r = 0.40) correlated with platelet count (both p < 0.001). Linear regression demonstrated ACT predicted red blood cells (coef. 0.05; 95% confidence interval [CI], 0.04-0.06; p < 0.001), plasma (coef. 0.03; 95% CI, 0.02-0.04; p < 0.001), and platelet (coef. 0.06; 95% CI, 0.04-0.07; p < 0.001) transfusions within the first 2 hours of arrival. Controlling for all demographics and Emergency Department vitals, ACT >128 predicted massive transfusion (>=10 U) in the first 6 hours (odds ratio, 5.15; 95% CI, 1.36-19.49; p = 0.01). In addition, ACT <105 predicted patients who did not receive any transfusions in the first 24 hours (odds ratio, 2.80; CI, 1.02-7.07; p = 0.04). CONCLUSIONS: : Graphical r-TEG results are available within minutes, correlate with conventional coagulation test that are not as rapidly available, and are predictive of early transfusions of packed red blood cells, plasma, and platelets. AD - From the Department of Surgery (B.A.C., C.W., R.A.K., J.B.H.) and the Center for Translational Injury Research (B.A.C., G.F., Q.M.H., Z.A.R., J.P., C.W., J.B.H.), The University of Texas Health Science Center, Houston, Texas. AN - 108249298. Language: English. Entry Date: 20111021. Revision Date: 20200708. Publication Type: Journal Article AU - Cotton, B. A. AU - Faz, G. AU - Hatch, Q. M. AU - Radwan, Z. A. AU - Podbielski, J. AU - Wade, C. AU - Kozar, R. A. AU - Holcomb, J. B. DB - CINAHL DO - 10.1097/TA.0b013e31821e1bf0 DP - EBSCOhost KW - Blood Coagulation Disorders -- Diagnosis Blood Transfusion -- Statistics and Numerical Data Thrombelastography -- Methods Adult Blood Component Transfusion Electronic Health Records Female Hospitalization Trauma Severity Indices Linear Regression Male Middle Age Multivariate Analysis Pilot Studies Specimen Handling Time Factors Wounds and Injuries -- Complications Young Adult M1 - 2 N1 - research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Critical Care; Emergency Care. NLM UID: 0376373. PMID: NLM21825945. PY - 2011 SN - 0022-5282 SP - 407-417 ST - Rapid thrombelastography delivers real-time results that predict transfusion within 1 hour of admission T2 - Journal of Trauma TI - Rapid thrombelastography delivers real-time results that predict transfusion within 1 hour of admission UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=108249298&site=ehost-live&scope=site VL - 71 ID - 761375 ER - TY - JOUR AB - Introduction: Marfan syndrome is a connective tissue disorder caused by mutations in the fibrillar FBN-1 gene. Aortic dissection and rupture are major causes of morbidity and mortality and are of special concern during pregnancy. Materials and Methods: The authors report four cases of aortic root repair with preservation of the native aortic valve that have has created a discussion between cardiothoracic surgeons, obstetricians, and gynecologists regarding the best care for Marfan syndrome patients. We present these cases here with a review of the literature. Results: Surgery of the aorta and valves in Marfan syndrome is less risky than in previous eras and surgical management guidelines are generally accepted. Yet, we may be unnecessarily referring women to terminate pregnancies or to avoid pregnancy. We believe there may be alternative options for these patients. Conclusions: Marfan syndrome during pregnancy can be navigated with preconception counseling, antepartum care, and close postpartum follow-up involving an appropriate multidisciplinary team. AD - H. Copeland, Department of Surgery, University of Mississippi Medical Center, Jackson, MS, United States AU - Cottrell, J. AU - Calhoun, J. AU - Szczepanski, J. AU - Corvera, J. AU - Creswell, L. L. AU - Kogon, B. AU - Hasaniya, N. AU - Copeland, H. DB - Embase Medline DO - 10.1111/jocs.14592 KW - dabigatran adult aortic dissection aortic reconstruction aortic regurgitation aortic root aortic valve article ascending aorta atrial fibrillation cardiovascular magnetic resonance case report case study cesarean section clinical article conservative treatment disease severity dyspnea echocardiography female forceps delivery gestation period heart left ventricle hypertrophy heart surgery hospital discharge human induced abortion leg edema lung embolism Marfan syndrome nuclear magnetic resonance imaging obstetric procedure postoperative period prenatal care retrospective study return to work right coronary artery thoracic aorta thorax pain transthoracic echocardiography vaginal delivery LA - English M1 - 7 M3 - Article N1 - L2004838212 2020-05-26 2020-07-23 PY - 2020 SN - 1540-8191 0886-0440 SP - 1439-1443 ST - Aortic root valve-sparing repair and dissections in Marfans syndrome during pregnancy: A case series T2 - Journal of Cardiac Surgery TI - Aortic root valve-sparing repair and dissections in Marfans syndrome during pregnancy: A case series UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004838212&from=export http://dx.doi.org/10.1111/jocs.14592 VL - 35 ID - 760558 ER - TY - JOUR AB - An analysis of outcomes, quality, and survey data was carried out to evaluate the impact of surgical multidisciplinary rounds (SMDR) at a community teaching hospital. Surgical inpatients were reviewed over a 4-year period. Real-time changes to clinical care, documentation, and programs were enacted during the rounds. SMDR contributed to reductions in length of stay (6.1 to 5.1 days), postoperative respiratory failure (15.5% to 6.8%), deep venous thrombosis/pulmonary embolism (2.8% to 2.3%), cardiac complications (7.0% to 1.6%), and catheter-associated urinary tract infection (5.2% to 1.5%), and increased Surgical Care Improvement Program All-or-None compliance (95.6% to 98.7%). Additionally, SMDR increased awareness of Accreditation Council for Graduate Medical Education core competencies among surgical residents and was associated with enhanced job satisfaction among participants. Twice-weekly SMDR is an effective care paradigm that has changed culture, improved care coordination, and facilitated rapid, sustained process improvement along multiple patient safety indicators and core measures. AD - Berkshire Medical Center, Pittsfield, MA tcounihan@bhs1.org. Berkshire Medical Center, Pittsfield, MA. AN - 25210093 AU - Counihan, T. AU - Gary, M. AU - Lopez, E. AU - Tutela, S. AU - Ellrodt, G. AU - Glasener, R. DA - Jan-Feb DO - 10.1177/1062860614549761 DP - NLM ET - 2014/09/12 J2 - American journal of medical quality : the official journal of the American College of Medical Quality KW - Awareness Catheter-Related Infections/prevention & control Hospitals, Teaching/organization & administration Humans Patient Care Team/*organization & administration Postoperative Complications/prevention & control Quality Assurance, Health Care/organization & administration Quality Improvement/*organization & administration Quality Indicators, Health Care/statistics & numerical data *Surgical Procedures, Operative Teaching Rounds/*organization & administration Acs-nsqip quality improvement surgical multidisciplinary rounds LA - eng M1 - 1 N1 - 1555-824x Counihan, Timothy Gary, Monique Lopez, Enrique Tutela, Sharyl Ellrodt, Gray Glasener, Richard Journal Article United States Am J Med Qual. 2016 Jan-Feb;31(1):31-7. doi: 10.1177/1062860614549761. Epub 2014 Sep 10. PY - 2016 SN - 1062-8606 SP - 31-7 ST - Surgical Multidisciplinary Rounds: An Effective Tool for Comprehensive Surgical Quality Improvement T2 - Am J Med Qual TI - Surgical Multidisciplinary Rounds: An Effective Tool for Comprehensive Surgical Quality Improvement VL - 31 ID - 760242 ER - TY - JOUR AB - A Bosnian woman at 20 weeks’ gestation presented with dyspnea and hypoxia. She was diagnosed with Eisenmenger physiology with severe pulmonary hypertension, ventricular septal defect, and patent ductus arteriosus. Given high maternal mortality, coordination of care with a multidisciplinary team approach may allow for best possible outcomes. (Level of Difficulty: Intermediate.) AD - M.E. Countouris, Heart and Vascular Institute, University of Pittsburgh, B-571.3 Scaife Hall, 200 Lothrop Street, Pittsburgh, PA, United States AU - Countouris, M. E. AU - Jeyabalan, A. AU - Caldwell, J. C. AU - Lee, J. E. AU - Hickey, G. W. DB - Embase DO - 10.1016/j.jaccas.2019.11.056 KW - bicarbonate calcium chloride epinephrine prostacyclin vasopressin adult anesthesiological procedure anticoagulant therapy article Bosnian (citizen) case report clinical article clinical outcome color Doppler flowmetry computed tomographic angiography congestive heart failure differential diagnosis disease severity drug dose titration dyspnea Eisenmenger complex extracorporeal oxygenation female fetus fetus mortality fluid resuscitation follow up gestational age heart catheterization heart ventricle septum defect human hypoxia intubation lung embolism maternal mortality medical decision making multidisciplinary team patent ductus arteriosus perinatal period pregnant woman priority journal puerperium pulmonary hypertension therapeutic abortion transesophageal echocardiography transthoracic echocardiography LA - English M1 - 1 M3 - Article N1 - L2004558260 2020-01-31 2020-02-04 A Bosnian woman at 20 weeks’ gestation presented with dyspnea and hypoxia. She was diagnosed with Eisenmenger physiology with severe pulmonary… PY - 2020 SN - 2666-0849 SP - 125-130 ST - Primary Presentation of Pulmonary Hypertension in the Peripartum: Preparing for Patients With Eisenmenger Physiology T2 - JACC: Case Reports TI - Primary Presentation of Pulmonary Hypertension in the Peripartum: Preparing for Patients With Eisenmenger Physiology UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004558260&from=export http://dx.doi.org/10.1016/j.jaccas.2019.11.056 VL - 2 ID - 760614 ER - TY - JOUR AB - Learning Objectives: Venous thromboembolism (VTE) events in children have increased. Our preventable harm index showed that VTE was a significant source of harm at our institution. We wanted to understand these events and target strategies to decrease VTEs. We also wanted to determine if current guidelines for risk assessment and prevention were being consistently followed. Methods: A multidisciplinary team reviewed the literature for current best practice for VTE prevention in children. A risk screening tool was already in place. Retrospectively each VTE was reviewed for age, risk factors, and presence of a central venous catheter (CVC). In addition, the reviewer completed a risk assessment score based on information in the medical record. This score was compared to the risk assessment documented on admission and the date of diagnosis of the VTE. Results: A total of 21 VTEs in children 6 months-21 years over an 18 month period were identified. Nineteen (91%) occurred in patients with CVCs. Seventeen (81%) in an upper extremity, and 2 (9%) in a lower extremity. All patients had a second significant risk factor for VTE in addition to the CVC. Co-morbidities: sepsis 7/21 (33%), cystic fibrosis 5/21 (24%), previous VTE 3/21 (14%), inflammatory bowel disease 3/21 (14%), malignancy 2/21 (10%), and head trauma 1/21 (5%). Admission risk assessment: 9 patients low risk, 6 moderate risk, and 2 high risk. The documented risk score agreed with the reviewer's assessment only 41% of the time. Reviewer's risk scores were consistently higher than documented in the medical record. Patients in the high risk category received appropriate prevention, including SCD's, and enoxaparin, or heparin. Patients with moderate risk received no additional interventions. Conclusions: Most VTEs occurred in patients with CVCs. These patients all had an additional co-morbidity that increased their risk of VTE. There may be opportunity to improve prevention strategies in children with moderate risk. Training is required to improve reliability of risk assessment for VTE. More study is needed to determine effective prevention strategies in children.. AD - V. Craig AU - Craig, V. AU - Puthenpura, V. AU - Lewis, J. DB - Embase DO - 10.1097/01.ccm.0000509931.11458.f3 KW - endogenous compound enoxaparin heparin central venous catheter child clinical article clinical trial comorbidity controlled study cystic fibrosis diagnosis head injury human inflammatory bowel disease lower limb malignant neoplasm medical record practice guideline prevention reliability risk assessment risk factor screening sepsis upper limb venous thromboembolism LA - English M1 - 12 M3 - Conference Abstract N1 - L613520999 2016-12-08 PY - 2016 SN - 1530-0293 SP - 390 ST - Associated comorbidity is common in children with hospital-acquired venous thromboembolism T2 - Critical Care Medicine TI - Associated comorbidity is common in children with hospital-acquired venous thromboembolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613520999&from=export http://dx.doi.org/10.1097/01.ccm.0000509931.11458.f3 VL - 44 ID - 760981 ER - TY - JOUR AD - Klinik für Herz- und Gefässchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, 24105 Kiel. JCremer@kielheart.uni-kiel.de AN - 20333601 AU - Cremer, J. DA - Apr DO - 10.1055/s-0030-1251910 DP - NLM ET - 2010/03/25 J2 - Deutsche medizinische Wochenschrift (1946) KW - Angioplasty, Balloon, Coronary Coronary Artery Bypass/*methods Coronary Artery Bypass, Off-Pump/methods Coronary Stenosis/*surgery Drug-Eluting Stents Evidence-Based Medicine Follow-Up Studies Germany Humans Minimally Invasive Surgical Procedures/*methods Patient Care Team Postoperative Complications/mortality Practice Guidelines as Topic Registries Survival Rate United States LA - ger M1 - 13 N1 - 1439-4413 Cremer, J Comparative Study Journal Article Germany Dtsch Med Wochenschr. 2010 Apr;135(13):627-8. doi: 10.1055/s-0030-1251910. Epub 2010 Mar 23. OP - Chronische koronare Mehrgefässerkrankung mit linker Hauptstammstenose - Pro Bypasschirurgie. PY - 2010 SN - 0012-0472 SP - 627-8 ST - [Chronic coronary multi-vessel disease with left main artery stenosis: For coronary artery bypass graft] T2 - Dtsch Med Wochenschr TI - [Chronic coronary multi-vessel disease with left main artery stenosis: For coronary artery bypass graft] VL - 135 ID - 760530 ER - TY - JOUR AB - Introduction: Haemolytic uremic syndrome (HUS) is a systemic disease and one of the most frequent causes of acute kidney failure (AKF) in children. It was described for the first time in 1955 and it is represented by the triad: acute kidney failure, haemolytic anemia and thrombocytopenia. Despite the decrease in mortality caused by sepsis, in the latest years, this pathology still remains a major cause of morbidity and mortality for the children younger than five years old. In Romania, most cases are due to infection with Shiga toxin-producing Escherichia coli (STEC). Alarming for us was the rapid increasing of case numbers in the last 6 months. It was gathered an international multidisciplinary team with the participation of European Programme for Intervention Epidemiology Training (EPIET), European Centre Control (ECDC) in Stockholm, Sweden and Istituto Superiore di Sanità (ISS) in Rome, Italy testing the antibodies to the lipopolysaccharide (LPS) of six major STEC serogroups (O157, O26, O103, O111, O145, and O55) by ELISA. Purpose: To understand and recognize early the first symptoms and prevent the possible complications during the evolution and the treatment of the disease. Materials and Methods: A retrospective study of 26 cases of haemolytic uremic syndrome treated in the first 6 months of this year in the Nephrology Department of the “Marie Curie” Emergency Children's Hospital, Bucharest, Romania. Results: The age of studied patients was between 5 months and 3 years. All the patients presented at the beginning diarrhea. Some of them experienced important melenic stool, neurologic disorders of consciousness, dizziness and tonic-clonic seizures due to electrolyte imbalances. 19 children needed peritoneal dialysis between 3 and 21 days. In more than 50% of the cases the pathogen was E. Coli (most frequent serogroup O26), 1 case was diagnosed with Salmonella. Geographical distribution of the 26 cases: most of the patients were located Arges- Pitesti, but also in: Bucharest, Constanta, Craiova. Evolution: 3 cases died and the global evolution of the other 23 patients was favorable. Conclusion: In the great majority of the presented cases, HUS is due to STEC infections. It is a severe, life-threatening disease, but in most cases it is self-limiting with complete resolution. The treatment is supportive and aims not only AKF but also extrarenal involvement of the disease (multiple renal failure), neurological, intestinal, pancreatic, hypertension, cardiac or pulmonary impairment. The rapid and accurate diagnosis and correct supportive treatment is the key of a good outcome and evolution in HUS in children. AD - A. Croitoru, Emergency Hospital for Children Marie Sklodowska Curie, Bucharest, Romania AU - Croitoru, A. AU - Tieranu, I. AU - Costin, M. AU - Costache, D. AU - Grigore, M. AU - Balgradean, M. DB - Embase DO - 10.1080/2331205X.2016.1265203 KW - antibody lipopolysaccharide acute kidney failure child clinical article consciousness diagnosis diarrhea dizziness electrolyte disturbance enzyme linked immunosorbent assay Escherichia coli infection feces geographic distribution heart failure hemolytic uremic syndrome hospital human hypertension intestine Italy lung nephrology neurologic disease nonhuman pancreas peritoneal dialysis remission retrospective study Romania Salmonella serotype Shiga toxin producing Escherichia coli Sweden tonic clonic seizure LA - English M1 - 1 M3 - Conference Abstract N1 - L614265559 2017-02-06 PY - 2016 SN - 2331-205X ST - Haemolytic uremic syndrome : Current issue for small pediatric age group-outbreak 26 cases in six months T2 - Cogent Medicine TI - Haemolytic uremic syndrome : Current issue for small pediatric age group-outbreak 26 cases in six months UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614265559&from=export http://dx.doi.org/10.1080/2331205X.2016.1265203 VL - 3 ID - 761046 ER - TY - JOUR AB - OBJECTIVE: Venous thromboembolism remains one of the leading causes of maternal mortality in the developed world. Retrievable inferior vena cava (IVC) filters have a role in the prevention of lethal pulmonary emboli when anticoagulation is contraindicated or has failed [1]. It is unclear whether or not the physiological changes in pregnancy influence efficacy and complications of these devices. The decision to place an IVC filter in pregnancy is complex and there is limited information in terms of benefit and risk to the mother. The objective of this study was to determine the efficacy and safety of these devices in pregnancy and to compare these with rates reported in the general population. STUDY DESIGN: The aim of this study was report three recent cases of retrievable IVC filter use in pregnant women in our department and to perform a systematic review of the literature to identify published cases of filters in pregnancy. The efficacy and complication rates of these devices in pregnancy were estimated and compared to rates reported in the general population in a recent review [2]. Fisher's exact test was used for statistical analysis. RESULTS: In addition to our three cases, 16 publications were identified with retrievable IVC filter use in 40 pregnant women resulting in a total of 43 cases. There was no pulmonary embolus in the pregnant group (0/43) compared to 57/6291 (0.9%) in the general population. Thrombosis of the filter (2.3% vs. 0.9%, p = 0.33) and perforation of the IVC (7.0% vs 4.4%, p = 0.44) were more common in pregnancy compared to the general population but the difference was not statistically significant. Failure to retrieve the filter is more likely to occur in pregnancy (26% vs. 11%, p = 0.006) but this did not correlate with the type of device (p = 0.61), duration of insertion (p = 0.58) or mode of delivery (p = 0.37). CONCLUSION: Data for retrievable IVC filters in pregnancy is limited and there may be a publication bias towards complicated cases. This study shows that the filter appears to protect against PE in pregnancy but the numbers are small. Complications such as filter thrombosis and IVC penetration appear to be higher in pregnancy but this difference is not statistically significant. It is not possible to retrieve the device in one out of every four pregnant women. This has implications in terms of long term risk of lower limb thrombosis and post thrombotic syndrome. The decision to use an IVC filter in pregnancy needs careful consideration by a multidisciplinary team. The benefit and risk assessment should be individualised and clearly outlined to the patient. AD - Maternal Medicine Service, Coombe Women and Infants University Hospital, Dublin 8, Ireland. National Centre of Hereditary Coagulation Disorders, Ireland. Department of Radiology, St. James Hospital, Dublin 8, Ireland. Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland. Maternal Medicine Service, Coombe Women and Infants University Hospital, Dublin 8, Ireland. Electronic address: bbyrne@coombe.ie. AN - 29331855 AU - Crosby, D. A. AU - Ryan, K. AU - McEniff, N. AU - Dicker, P. AU - Regan, C. AU - Lynch, C. AU - Byrne, B. DA - Mar DO - 10.1016/j.ejogrb.2017.12.035 DP - NLM ET - 2018/01/15 J2 - European journal of obstetrics, gynecology, and reproductive biology KW - Adult Device Removal/*adverse effects Female Humans Patient Care Team *Precision Medicine Pregnancy Pregnancy Complications, Cardiovascular/etiology/physiopathology/prevention & control/*therapy Pulmonary Embolism/epidemiology/etiology/*prevention & control Risk Risk Assessment Vena Cava Filters/*adverse effects Vena Cava, Inferior Venous Thromboembolism/physiopathology/*therapy Venous Thrombosis/epidemiology/etiology/prevention & control Retrievable IVC filter Venous thromboembolism LA - eng N1 - 1872-7654 Crosby, David A Ryan, Kevin McEniff, Niall Dicker, Patrick Regan, Carmen Lynch, Caoimhe Byrne, Bridgette Journal Article Review Systematic Review Ireland Eur J Obstet Gynecol Reprod Biol. 2018 Mar;222:25-30. doi: 10.1016/j.ejogrb.2017.12.035. Epub 2017 Dec 21. PY - 2018 SN - 0301-2115 SP - 25-30 ST - Retrievable Inferior vena cava filters in pregnancy: Risk versus benefit? T2 - Eur J Obstet Gynecol Reprod Biol TI - Retrievable Inferior vena cava filters in pregnancy: Risk versus benefit? VL - 222 ID - 760306 ER - TY - JOUR AB - BACKGROUND AND PURPOSE: The PED is an FDS designed for the treatment of intracranial aneurysms. Data regarding the use of this device in acute or subacute aSAH is limited to a few case reports or small series. We aimed to demonstrate the feasibility of using an FDS, the PED, for the treatment of ruptured intracranial aneurysms with challenging morphologies. MATERIALS AND METHODS: We conducted a retrospective review of all known patients treated with the PED for aSAH at 4 institutions between June 2008 and January 2012. Pertinent clinical and radiologic information was submitted by individual centers for central collation. The decision to treat with the PED was made on a case-by-case basis by a multidisciplinary team under compassionate use. RESULTS: Twenty patients (15 women; median age, 54.5 years; IQR, 8.0 years) were found. There were 8 blister, 8 dissecting or dysplastic, 2 saccular, and 2 giant aneurysms. Median time to treatment was 4 days (range, 1-90 days; IQR, 12.75 days) from rupture. Three patients had previous failed treatment. Procedure-related symptomatic morbidity and mortality were 15%, with 1 (5%) procedure-related death. Two patients died relative to medical complications, and 1 patient was lost to follow-up. Sixteen patients were available for follow-up, 81% had a GOS of 5, and 13% had a GOS of 4 attributed to a poorer initial clinical presentation. One patient died of urosepsis at 4 months. Occlusion rates were 75% and 94% at 6 months and 12 months, respectively. There were 3 delayed complications (1 silent perforator infarct, 2 moderate asymptomatic in-stent stenoses). No symptomatic delayed complications or rehemorrhages occurred. CONCLUSIONS: The FDS may be a feasible treatment option in the acute or subacute setting of selected ruptured aneurysms, especially blister aneurysms. Ruptured giant aneurysms remain challenging for both surgical and endovascular techniques; at this stage, FDSs should be used with caution in this aneurysm subtype. AD - [Cruz, J. P.; Spears, J.; Marotta, T. R.] Univ Toronto, St Michaels Hosp, Div Neuroradiol, Dept Med Imaging, Toronto, ON, Canada. [Martin, A.; Spears, J.] Univ Toronto, Dept Surg, Div Neurosurg, Toronto, ON, Canada. [O'Kelly, C.; Alshaya, W.] Univ Edmonton, Dept Surg, Div Neurosurg, Edmonton, AB, Canada. [Kelly, M.] Univ Saskatchewan, Div Neurosurg, Dept Surg, Saskatoon, SK, Canada. [Wong, J. H.] Univ Calgary, Dept Clin Neurosci, Div Neurosurg, Calgary, AB, Canada. Marotta, TR (corresponding author), St Michaels Hosp, 30 Bond St, Toronto, ON M5B 1W8, Canada. marottat@smh.ca AN - WOS:000329210300008 AU - Cruz, J. P. AU - O'Kelly, C. AU - Kelly, M. AU - Wong, J. H. AU - Alshaya, W. AU - Martin, A. AU - Spears, J. AU - Marotta, T. R. DA - Feb DO - 10.3174/ajnr.A3380 J2 - Am. J. Neuroradiol. KW - INTERNAL CAROTID-ARTERY RUPTURED INTRACRANIAL ANEURYSMS FLOW-DISRUPTING DEVICE BLISTER-LIKE ANEURYSMS ENDOVASCULAR TREATMENT PART I STENT DIVERSION DISSECTION THROMBOSIS Clinical Neurology Neuroimaging Radiology, Nuclear Medicine & Medical Imaging LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 282YH Times Cited: 57 Cited Reference Count: 53 Cruz, J. P. O'Kelly, C. Kelly, M. Wong, J. H. Alshaya, W. Martin, A. Spears, J. Marotta, T. R. Cruz, Juan Pablo/AAQ-5640-2020 Cruz, Juan Pablo/0000-0002-7524-7273; Kelly, Michael/0000-0002-3278-2620 63 0 5 AMER SOC NEURORADIOLOGY DENVILLE AM J NEURORADIOL PY - 2013 SN - 0195-6108 SP - 271-276 ST - Pipeline Embolization Device in Aneurysmal Subarachnoid Hemorrhage T2 - American Journal of Neuroradiology TI - Pipeline Embolization Device in Aneurysmal Subarachnoid Hemorrhage UR - ://WOS:000329210300008 VL - 34 ID - 761813 ER - TY - JOUR AB - Introduction: Population ageing, the rising demand for healthcare, and the establishment of acute stroke treatment programs have given rise to increases in the number and complexity of neurological emergency cases. Nevertheless, many centres in Spain still lack on-call emergency neurologists. Methods: We conducted a retrospective study to describe the role of on-call neurologists at Hospital General Universitario Gregorio Maranon, a tertiary care centre in Madrid, Spain. Socio-demographic characteristics, most common pathologies, diagnostic tests, and destination of the patients attended were recorded daily using a computer database. Results were compared with the general care data from the emergency department. Results: The team attended 3234 patients (3.48% of the emergency department total). The mean number of patients seen per day was 11.15. The most frequent pathologies were stroke (34%), epilepsy (16%) and headache (8%). The mean stay in the emergency department was 7.17 hours. Hospital admission rate was 40% (7.38% of emergency hospital admissions). The main destinations for admitted patients were the stroke unit (39.5%) and the neurology department (33%). Endovascular or thrombolytic therapies were performed on 76 occasions. Doctors attended 70% of the patients during on-call hours. Conclusions: Emergency neurological care is varied, complex, and frequently necessary. Neurological cases account for a sizeable percentage of both patient visits to the emergency room and the total number of emergency admissions. The current data confirm that on-call neurologists available on a 24-hour basis are needed in emergency departments. (C) 2013 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved. AD - [Rodriguez Cruz, P. M.; Perez Sanchez, J. R.; Cuello, J. P.; Sobrino Garcia, P.; Vicente Peracho, G.; Garcia Arratibel, A.; Sanchez Guzman, D.; Bravo Quelle, N.; Gutierrez Ruano, B.; Cordido Henriquez, F.; Romero Delgado, F.; Munoz Gonzalez, A.; Dominguez Rubio, R.; Iglesias Mohedano, A. M.; Martin Barriga, M. L.; de la Casa Fages, B.; Diaz Otero, F.; Garcia Pastor, A.; Gil Nunez, A.] Univ Gregorio Maranon, Gen Hosp, Serv Neurol, Madrid, Spain. [Alarcon Morcillo, C.] Hosp La Zarzuela, Serv Neurol, Madrid, Spain. [Diaz Otero, F.; Garcia Pastor, A.] Univ Gregorio Maranon, Gen Hosp, Unidad Ictus, Madrid, Spain. [Ezpeleta, D.] Hosp Univ Quiron, Serv Neurol, Madrid, Spain. Cruz, PMR (corresponding author), Univ Gregorio Maranon, Gen Hosp, Serv Neurol, Madrid, Spain. rodriguezcruzpm@gmail.com AN - WOS:000336076700001 AU - Cruz, P. M. R. AU - Sanchez, J. R. P. AU - Cuello, J. P. AU - Garcia, P. S. AU - Peracho, G. V. AU - Arratibel, A. G. AU - Guzman, D. S. AU - Quelle, N. B. AU - Ruano, B. G. AU - Morcillo, C. A. AU - Henriquez, F. C. AU - Delgado, F. R. AU - Gonzalez, A. M. AU - Rubio, R. D. AU - Mohedano, A. M. I. AU - Barriga, M. L. M. AU - Fages, B. D. AU - Otero, F. D. AU - Ezpeleta, D. AU - Pastor, A. G. AU - Nunez, A. G. DA - May DO - 10.1016/j.nrl.2013.04.009 J2 - Neurologia KW - Emergency neurology Neurology on-call Workload Emergency department Admissions and discharges Organisation models Spain NEUROCRITICAL CARE ISCHEMIC-STROKE IMPLEMENTATION QUALITY BENEFIT IMPACT SPAIN Clinical Neurology LA - Spanish M1 - 4 M3 - Article N1 - ISI Document Delivery No.: AH4DJ Times Cited: 9 Cited Reference Count: 32 Rodriguez Cruz, P. M. Perez Sanchez, J. R. Cuello, J. P. Sobrino Garcia, P. Vicente Peracho, G. Garcia Arratibel, A. Sanchez Guzman, D. Bravo Quelle, N. Gutierrez Ruano, B. Alarcon Morcillo, C. Cordido Henriquez, F. Romero Delgado, F. Munoz Gonzalez, A. Dominguez Rubio, R. Iglesias Mohedano, A. M. Martin Barriga, M. L. de la Casa Fages, B. Diaz Otero, F. Ezpeleta, D. Garcia Pastor, A. Gil Nunez, A. Sanchez, Javier Ricardo Perez/AAD-2866-2019; Garcia-Pastor, Andres/AAQ-1060-2020; Mohedano, Ana Iglesias/AAQ-6071-2020 Sanchez, Javier Ricardo Perez/0000-0001-9292-9471; Garcia-Pastor, Andres/0000-0002-0090-8807; De la Casa-Fages, Beatriz/0000-0003-0486-3308 9 0 8 ELSEVIER ESPANA SLU BARCELONA NEUROLOGIA PY - 2014 SN - 0213-4853 SP - 193-199 ST - Workload of on-call emergency room neurologists in a Spanish tertiary care centre. A one-year prospective study T2 - Neurologia TI - Workload of on-call emergency room neurologists in a Spanish tertiary care centre. A one-year prospective study UR - ://WOS:000336076700001 VL - 29 ID - 761779 ER - TY - JOUR AB - Introduction: Chronic thromboembolic disease is a major cause of severe pulmonary hypertension and disabling right ventricular dysfunction. Pulmonary endarterectomy (PE) is currently considered a therapeutic option that can cure these patients. Objective: The aim of this study was to review the experience at a Colombian PE cardiovascular center, the outcomes and most frequent complications. Materials and methods: A retrospective review of PEs performed from 2009 through 2017 was conducted, which form an e-database developed for cardiovascular surgery in 2009. All intra and postoperative events were recorded, as well as the major outcomes, including mortality. Results: Twenty-one patients (12 females and 9 males) were identified, with a mean age of 48 years [interquartile range (IQR): 30–70]; 76.2% had a New York Heart Association (NYHA) functional class category III or IV, and the mean intensive care unit stay was 179hours (IQR 27–528). The most frequent perioperative complications were cardiac (right ventricular dysfunction, and biventricular dysfunction) and pulmonary (pulmonary edema and severe dysfunction disorders), with an overall mortality of 9.5%. Conclusion: Although the reported survival in this paper is similar to recently published trials, our work suggests that it is appropriate to foresee the possibility of postoperative cardiopulmonary support in these patients and to have a multidisciplinary team available, trained in caring for these events that have a negative impact on outcomes and survival of this surgical population. AD - J.A. Castro-Pérez, Clínica Cardiovascular Cardio VID, Oficina de Anestesiología, Calle 78 B 75 – 21, Medellín, Colombia AU - Cruz-Suárez, G. A. AU - Castro-Pérez, J. A. AU - Echavarría-Vásquez, J. D. AU - Bolivar-Giraldo, I. C. AU - Echeverri-Saldarriaga, S. AU - Ariza, F. DB - Embase DO - 10.1097/CJ9.0000000000000020 KW - adult all cause mortality anesthesia article care behavior clinical article complication controlled study endarterectomy female heart right ventricle failure human intensive care unit lung edema lung embolism male middle aged multidisciplinary team New York Heart Association class peroperative complication pulmonary hypertension retrospective study survival LA - English M1 - 2 M3 - Article N1 - L626534584 2019-09-13 PY - 2018 SN - 2422-0248 2256-2087 SP - 98-102 ST - Pulmonary endarterectomy in a Colombian cardiovascular center: Experience and main outcomes T2 - Colombian Journal of Anesthesiology TI - Pulmonary endarterectomy in a Colombian cardiovascular center: Experience and main outcomes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L626534584&from=export http://dx.doi.org/10.1097/CJ9.0000000000000020 VL - 46 ID - 760850 ER - TY - JOUR AB - SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Given the growing complexities with the management of acute pulmonary embolism (PE) patients, several academic medical centers have established Pulmonary Embolism Response Teams (PERT). This allows for an expedited evaluation and multidisciplinary treatment approach for these patients, most often those with intermediate to high-risk PEs. Smaller, community-based hospital systems, however, may not have the resources to initiate such a multidisciplinary program. The following report demonstrates a successfully initiated single-consultant, tiered-approach PERT program within a community setting, which was led by intensivists. Other consultants, including vascular surgery or interventional radiology, were consulted when specific interventions were needed. METHODS: This was a single-center, retrospective evaluation of all hospitalized patients with a PERT activation from February 2018 to February 2019. RESULTS: There were a total of 75 PERT activations (38 males, mean age 62) with 71 patients having confirmed PEs. Of those with a confirmed PE, 65 (91.5%) patients were considered to have intermediate-risk PEs, while 1 (1.4%) patient had a high-risk PE. This is a significant underestimate of total number of high-risk PE patients during this period, as most were direct ICU consultations. Approximately 87% of all PERT activations originated from within our Emergency Department. The majority of patients (78%) were treated with standard anticoagulation. Of the intermediate-risk patients, 14 (21.5%) underwent catheter-directed thrombolysis [CDT], while the 1 high-risk patient was given systemic thrombolysis. The 30-day mortality was 14% for patients with confirmed PE. Average hospital length of stay (LOS) was 6.6 days, with no significant difference in LOS between each treatment group. Specifically, CDT was not associated with reduced hospital LOS compared to standard anticoagulation for patients with intermediate risk PEs (6.8 days vs 6.6 days, p=0.93). CDT was associated with 20.4% improvement in mean pulmonary artery pressure. There was only 1 (1.4%) significant extracranial bleeding event associated with CDT. CONCLUSIONS: The following describes outcomes related to a tiered-approach PERT program in a community hospital setting. This model may be a feasible option for similar settings or those with limited resources. CLINICAL IMPLICATIONS: Further investigation is warranted to determine whether a tiered-approach PERT program has comparable outcomes to the more traditional, multidisciplinary PERT program. DISCLOSURES: No relevant relationships by Anthony Cucci, source=Web Response No relevant relationships by Ahmad JABRI, source=Web Response No relevant relationships by Loren Masterson, source=Web Response No relevant relationships by Rachel Powers, source=Web Response No relevant relationships by Lokesh Venkateshaiah, source=Web Response No relevant relationships by Elizabeth Verghese, source=Web Response No relevant relationships by Naga Venkata Rama Krishna Vura, source=Web Response AU - Cucci, A. AU - Venkateshaiah, L. AU - Masterson, L. AU - Verghese, E. AU - Jabri, A. AU - Powers, R. AU - Rama Krishna Vura, N. V. DB - Embase DO - 10.1016/j.chest.2019.08.439 KW - adult anticoagulation bleeding blood clot lysis catheter clinical evaluation community hospital conference abstract consultation controlled study emergency ward high risk patient hospital patient human intensivist intermediate risk patient interventional radiology length of stay lung artery pressure major clinical study male middle aged mortality pulmonary embolism response team retrospective study risk assessment vascular surgery LA - English M1 - 4 M3 - Conference Abstract N1 - L2002983322 2019-10-02 PY - 2019 SN - 1931-3543 0012-3692 SP - A402 ST - OUTCOMES OF A NEWLY ESTABLISHED PULMONARY EMBOLISM RESPONSE TEAM IN A COMMUNITY SETTING: A TIERED-APPROACH T2 - Chest TI - OUTCOMES OF A NEWLY ESTABLISHED PULMONARY EMBOLISM RESPONSE TEAM IN A COMMUNITY SETTING: A TIERED-APPROACH UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002983322&from=export http://dx.doi.org/10.1016/j.chest.2019.08.439 VL - 156 ID - 760662 ER - TY - JOUR AB - Gastrointestinal stromal tumors are the commonest stromal tumors of the digestive tract. Even though, the incidence is aproximately 10 to 20 cases per million people and year. More than 90% of these tumors take place in patients over 40, and the median age is 63. Its diagnosis during pregnancy is extremely rare. There are less than 10 cases reported in literature about gastrointestinal stromal tumors diagnosed during pregnancy. We describe the case of a patient who was diagnosed of gastrointestinal stromal tumor during her first pregnancy due to massive lower digestive bleeding and the fetus died. She underwent a small bowel resection and cesarean section delivery. Afterwards, she was controlled by obstetricians, digestive surgeons and oncologists. The following two pregnancies were normal, and six years since the diagnosis she is asymptomatic. Even if they are extremely rare tumors during pregnancy, it is very important knowing their diagnosis and multidisciplinary treatment; also very important is knowing their prognostic factors and the different possible treatments. AD - Departamento de Ginecología y Obstetricia, Hospital Universitario La Paz, Madrid, España. marxichos@hotmail.com AN - 21961377 AU - Cuerva-González, M. J. AU - Lacoponi, S. AU - de la Calle-Fernández, M. AU - Pozo-Krielinger, J. DA - Dec DP - NLM ET - 2011/10/04 J2 - Ginecologia y obstetricia de Mexico KW - Adult Anticoagulants/therapeutic use Cesarean Section Embolism, Amniotic Fluid/etiology Emergencies Enoxaparin/therapeutic use Female Fertilization in Vitro Fetal Death/*etiology Follow-Up Studies Gastrointestinal Hemorrhage/*etiology/surgery Gastrointestinal Stromal Tumors/*complications/diagnosis/pathology/surgery Humans Ileal Neoplasms/*complications/diagnosis/pathology/surgery Patient Care Team Postoperative Complications/etiology Pregnancy *Pregnancy Complications, Neoplastic/diagnosis/pathology/surgery Pregnancy, High-Risk Puerperal Disorders/etiology Pulmonary Embolism/etiology Remission Induction Thrombophilia/drug therapy/etiology Venous Thrombosis/etiology LA - spa M1 - 12 N1 - Cuerva-González, Marcos Javier Lacoponi, Sara de la Calle-Fernández, Maria Pozo-Krielinger, Juan Case Reports English Abstract Journal Article Mexico Ginecol Obstet Mex. 2010 Dec;78(12):697-702. OP - Tumor del estroma gastrointestinal en el embarazo y control posterior. caso clínico. PY - 2010 SN - 0300-9041 (Print) 0300-9041 SP - 697-702 ST - [Gastrointestinal stromal tumor in pregnancy and control. Case report] T2 - Ginecol Obstet Mex TI - [Gastrointestinal stromal tumor in pregnancy and control. Case report] VL - 78 ID - 760523 ER - TY - JOUR AB - Introduction: Acute mesenteric venous thrombosis is a rare but potentially fatal condition with superior mesenteric vein being the most common site of thrombosis development [1]. It is more common in patients with underlying disorders which cause disruptions to Virchow's Triad of hypercoagulability, stasis and endothelial injury. The disease is often associated with intestinal ischemia in its acute form, further complicating its management. Presentation of case: We present a case of acute superior mesenteric venous thrombosis resulting in jejunal ischemia in a 60-year-old Caucasian male with possible ulcerative colitis. A computed tomography (CT) scan demonstrated features of intestinal infarction. However, the patient was stable after initial resuscitation with a non-peritonitic abdomen and was subsequently managed with conservative measures. Discussion: We have illustrated a case of a patient with acute mesenteric venous thrombosis with potential bowel compromise. Despite concerning CT features, the patient was clinically stable and responded to conservative management. We hope to emphasise that although radiology plays a crucial role in modern medicine, it is important to make therapeutic decisions based on clinical findings. Conclusion: Acute mesenteric venous thrombosis is a complex entity. It requires a multidisciplinary team approach to plan for the most appropriate treatment strategy suitable for each patient as all options are associated with significant risks. The underlying cause should be established as this will determine any long-term management necessary to prevent recurrence. AD - J. Cui, Ward 2A, Caboolture Hospital, 120 McKean St, Caboolture, QLD, Australia AU - Cui, J. AU - Kirkby, B. DB - Embase DO - 10.1016/j.ijscr.2018.10.039 KW - central venous catheter nasogastric tube urinary catheter hemoglobin heparin lactic acid steroid warfarin abdominal tenderness adult anticoagulant therapy arterial gas article blood pressure breathing rate case report clinical article colonoscopy conservative treatment dehydration dietary intake fluid resuscitation follow up Glasgow coma scale heart rate hemoglobin blood level hepatic portal vein human intensive care unit intestine ischemia intestine perforation lactate blood level male melena mesenteric vein thrombosis metabolic acidosis middle aged oxygen saturation polycythemia priority journal radiodiagnosis resuscitation steroid therapy superior mesenteric vein total parenteral nutrition ulcerative colitis upper abdominal pain x-ray computed tomography LA - English M3 - Article N1 - L2001231820 2018-11-06 2018-11-12 PY - 2018 SN - 2210-2612 SP - 96-98 ST - Intestinal ischemia secondary to superior mesenteric venous thrombosis—A case report T2 - International Journal of Surgery Case Reports TI - Intestinal ischemia secondary to superior mesenteric venous thrombosis—A case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001231820&from=export http://dx.doi.org/10.1016/j.ijscr.2018.10.039 VL - 53 ID - 760856 ER - TY - JOUR AB - Between 2.2% and 17% of all strokes have symptom onset during hospitalization in a patient originally admitted for another diagnosis or procedure. A response system to rapidly evaluate inpatients with acute neurologic symptoms facilitates evaluation and treatment of stroke developing during hospitalization. The National Stroke Association implemented an in-hospital stroke quality-improvement initiative from July 2010 to June 2011 in 6 certified stroke centers from Michigan, South Carolina, Pennsylvania, Colorado, Washington, and North Carolina. Three hundred ninety-three in-hospital stroke alerts were examined over a 1-year period. Of the alerts, 42.5% were for ischemic stroke, 8.7% probable or possible TIA, 2.8% intracranial hemorrhage, and 46.1% were stroke mimics. The most common stroke mimics were seizure, hypotension, and delirium. Participating hospitals had an alarm rate for diagnoses other than acute cerebrovascular events ranging from 28.0% to 66.7%. Of 194 in-hospital stroke/transient ischemic attack cases, 8.2% received intravenous thrombolysis alone, 10.3% received intra-arterial/mechanical thrombolysis alone, and 1% received both. No patient with a stroke mimic received thrombolysis. Our findings suggest that in-hospital response teams need to be prepared to respond to a range of acute medical conditions other than ischemic stroke. AD - E. Cumbler, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, 12401 E. 17th Ave. Mail Stop F782, Aurora, CO, United States AU - Cumbler, E. AU - Simpson, J. DB - Embase Medline DO - 10.1002/jhm.2311 KW - fibrinolytic agent aged article blood clot lysis brain hemorrhage brain ischemia cerebrovascular accident controlled study delirium female fibrinolysis fibrinolytic therapy hospital patient human hypotension major clinical study male multicenter study priority journal prospective study rapid response team seizure stroke patient total quality management transient ischemic attack LA - English M1 - 3 M3 - Article N1 - L602631078 2015-03-06 2015-03-12 PY - 2015 SN - 1553-5606 1553-5592 SP - 179-183 ST - Code stroke: Multicenter experience with in-hospital stroke alerts T2 - Journal of Hospital Medicine TI - Code stroke: Multicenter experience with in-hospital stroke alerts UR - https://www.embase.com/search/results?subaction=viewrecord&id=L602631078&from=export http://dx.doi.org/10.1002/jhm.2311 VL - 10 ID - 761085 ER - TY - JOUR AB - Introduction: Stroke continues to have a devastating impact on public health, and it remains a leading cause of death and disability. Unfortunately, it is possible to find prehospital and hospital approaches that do not treat this pathology as a true medical emergency. Hospitals providing care for patients with acute stroke should organize clinical protocols and pathways for effective implementation of acute therapies. Methods: The survey was conducted in a new secondary hospital in São Paulo, Brazil from May 2008 to December 2008. A retrospective study of the medical records of patients with stroke diagnosis analyzing clinical treatment given before and after a training course (administered in August 2008) provided to medical staff and nurses that work in the Accident and Emergency Department. Median times from admission to head CT, prescription of aspirin, statins and deep venous thrombosis prophylaxis were the indicators evaluated. Results: Before the training, the median time between admission and the first CT scan was 3 hours; aspirin was prescribed for 63.3% of the patients and statins for 5.3%. Deep venous thrombosis prophylaxis was used only in 36.3% of eligible patients. After theoretical and practical training administered in the Albert Einstein Realistic Simulation Center, the timing for brain imaging had decreased to 1.33 hours, 85.9% of patients had received aspirin and 28.6% had taken statin. Deep venous thrombosis prophylaxis had been provided to 45.88% of eligible patients. Conclusions: The present study shows that training and monitoring are important for efficiency and the best results for stroke. We conclude that continuous education involving multidisciplinary teams improves the quality of care for patients. AD - F.C.P. Cunha, Hospital M'Boi Mirim, São Paulo, SP, Brazil AU - Cunha, F. C. P. AU - Coelho, F. M. S. AU - Pedott, M. S. AU - Borgerth, M. AU - Engelsmann, C. AU - Bueno, M. A. DB - Embase DO - 10.1186/cc7851 KW - acetylsalicylic acid hydroxymethylglutaryl coenzyme A reductase inhibitor statin (protein) cerebrovascular accident South and Central America emergency medicine intensive care patient deep vein thrombosis thrombosis prevention hospital disability pathology emergency clinical protocol therapy Brazil retrospective study medical record diagnosis training medical staff nurse simulation prescription computer assisted tomography emergency ward brain imaging monitoring education public health cause of death accident LA - English M3 - Conference Abstract N1 - L70339965 2011-02-14 PY - 2009 SN - 1364-8535 ST - Improved quality of stroke care after multidisciplinary training T2 - Critical Care TI - Improved quality of stroke care after multidisciplinary training UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70339965&from=export http://dx.doi.org/10.1186/cc7851 VL - 13 ID - 761278 ER - TY - JOUR AB - CONTEXT: Nutritional complications may occur after bariatric surgery, due to restriction of food intake and impaired digestion or absorption of nutrients. CASE REPORT: After undergoing vertical gastroplasty and jejunoileal bypass, a female patient presented marked weight loss and protein deficiency. Seven months after the bariatric surgery, she presented dermatological features compatible with acrodermatitis enteropathica, as seen from the plasma zinc levels, which were below the reference values (34.4 mg%). The skin lesions improved significantly after 1,000 mg/day of zinc sulfate supplementation for one week. CONCLUSIONS: The patient's evolution shows that the multidisciplinary team involved in surgical treatment of obesity should take nutritional deficiencies into consideration in the differential diagnosis of skin diseases, in order to institute early treatment. AD - S. F. C. Cunha, Divisão de Nutrologia, Departamento de Clínica Médica, Universidade de São Paulo, Av. Bandeirantes, 3.900, Monte Alegre - Ribeirão Preto (SP), CEP 14048-900, Brazil AU - Cunha, S. F. C. AU - Gonçalves, G. A. P. AU - Marchini, J. S. AU - Roselino, A. M. F. DB - Embase Medline DO - 10.1590/S1516-31802012000500010 KW - antiallergic agent antidepressant agent cyanocobalamin multivitamin thiamine zinc zinc sulfate acrodermatitis enteropathica adult article case report clinical feature diet restriction digestive system function disorder enterocutaneous fistula erythema female follow up food intake gastroplasty human human tissue jejunoileal bypass laboratory diagnosis lung embolism postoperative period protein deficiency pruritus reference value skin biopsy skin exfoliation subphrenic abscess surgical infection treatment duration treatment response vitamin supplementation body weight loss xerosis zinc blood level zinc deficiency L1 - http://www.scielo.br/pdf/spmj/v130n5/10.pdf LA - English Portuguese M1 - 5 M3 - Article N1 - L366207780 2012-12-14 2012-12-19 PY - 2012 SN - 1516-3180 SP - 330-335 ST - Acrodermatitis due to zinc deficiency after combined vertical gastroplasty with jejunoileal bypass: Case report T2 - Sao Paulo Medical Journal TI - Acrodermatitis due to zinc deficiency after combined vertical gastroplasty with jejunoileal bypass: Case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L366207780&from=export http://dx.doi.org/10.1590/S1516-31802012000500010 VL - 130 ID - 761183 ER - TY - JOUR AB - Background: Whereas the need for urgent thromboysis for acute ischaemic stroke is well known and encouraged, the need for urgent (less than two weeks) carotid endarterectomy for patients with symptomatic carotid stenosis > 50% is perhaps less appreciated. There are numerous stages for potential delays in carotid endarterectomy for symptomatic carotid stenosis from symptom onset to surgery for these patients. We assessed delays for such patients in a general hospital within the UK. Methods: Retrospective review of delays in carotid endarterectomy in symptomatic patients between 2004 and 2008 at in a general hospital. Results: 25 patients (20 men and 5 women, mean age 63 years) had carotid endarterectomy for symptomatic carotid stenosis. Median delays were recorded as follows: from symptom onset to stroke physician assessment was 3 days; from stroke physician assessment to carotid Doppler was 8 days; and vascular surgery referral to surgical assessment was 21 days. Median delay from symptom onset to carotid endarterectomy was 129 days for the entire group. Two patients (8%) had surgery within 14 days and eight (32%) had surgery within 12 weeks. Conclusions: Our study demonstrates that like the UK in general the benefit of carotid endarterectomy is not being fully realised in our hospital. More awareness of the emergency issues surrounding TIA/minor stroke is required to enhance the timeliness of comprehensive assessments and treatment. A multidisciplinary team service has to better co-ordinate emergent access to necessary investigations to help deliver the target of endarterctomy within two weeks of symptom onset. AD - E. Cunningham, Royal Victoria Hospital, Belfast, United Kingdom AU - Cunningham, E. AU - McCarron, M. O. DB - Embase DO - 10.1159/000321266 KW - carotid endarterectomy patient cerebrovascular accident general hospital carotid artery obstruction surgery physician United Kingdom female brain ischemia hospital carotid artery emergency vascular surgery LA - English M3 - Conference Abstract N1 - L70330336 2011-01-29 PY - 2010 SN - 1015-9770 SP - 327 ST - Delays to carotid endarterectomy for symptomatic patients in a general hospital T2 - Cerebrovascular Diseases TI - Delays to carotid endarterectomy for symptomatic patients in a general hospital UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70330336&from=export http://dx.doi.org/10.1159/000321266 VL - 29 ID - 761255 ER - TY - JOUR AB - Use of peripherally inserted central catheters (PICCs) has markedly increased during the last decade. However, there are few studies on use of PICCs in patients with haematological malignancies (HM) receiving intensive chemotherapy. Preliminary data suggest a higher rate of PICC-related complications in these high-risk patients. This prospective observational single-centre study aimed to investigate PICC-related complications after implementation of a multidisciplinary approach to PICC care and compared it with previous literature. A total of 44 PICCs were inserted in 36 patients (27.3 %, thrombocytopenia < 50 x 10(9)/L at insertion) over 5045 PICC days (median duration, 114.5 days). No major insertion-related complications were observed. Major late complications were obstruction in 13.6 % (1.19/1000 PICC days) of patients, catheter-related bloodstream infection in 6.8 % (0.59/1000 PICC days), and catheter-related thrombosis in 4.5 % (0.39/1000 PICC days). Premature PICC removal occurred in 34 % (2.97/1000 PICC days) of patients. The overall rate of potentially major dangerous complications was particularly low (11.36 %, 0.99/1000 PICC days) compared with previous studies. This study highlights the utility of a multidisciplinary approach for PICC care in adults with HM receiving intensive chemotherapy. We provide further data to support use of PICCs in such patient populations. AD - [Curto-Garcia, Natalia; Garcia-Suarez, Julio; Callejas Chavarria, Marta; Gil Fernandez, Juan Jose; Martin Guerrero, Yolanda; Magro Mazo, Elena; Marcellini Antonio, Shelly; Miguel Juarez, Luis; Gutierrez, Isabel; Burgaleta, Carmen] Univ Hosp Principe Asturias, Dept Haematol, Madrid, Spain. [Jose Arranz, Juan; Montalvo, Irene; Elvira, Carmen; Dominguez, Pilar; Teresa Diaz, Maria] Univ Hosp Principe Asturias, Nursing Staff Haematol Unit, Madrid, Spain. Curto-Garcia, N (corresponding author), Univ Hosp Principe Asturias, Dept Haematol, Carretera Alcala Meco S-N, Madrid, Spain. natcurto@gmail.com AN - WOS:000365817800014 AU - Curto-Garcia, N. AU - Garcia-Suarez, J. AU - Chavarria, M. C. AU - Fernandez, J. J. G. AU - Guerrero, Y. M. AU - Mazo, E. M. AU - Antonio, S. M. AU - Juarez, L. M. AU - Gutierrez, I. AU - Arranz, J. J. AU - Montalvo, I. AU - Elvira, C. AU - Dominguez, P. AU - Diaz, M. T. AU - Burgaleta, C. DA - Jan DO - 10.1007/s00520-015-2754-1 J2 - Support. Care Cancer KW - Peripherally inserted central catheters Haematological malignancies PICC-related bloodstream infection PICC-related thrombosis CENTRAL VENOUS CATHETERS BLOOD-STREAM INFECTIONS ACUTE MYELOID-LEUKEMIA INDUCTION CHEMOTHERAPY VASCULAR ACCESS TIP POSITION PREVENTION GUIDELINES RATES Oncology Health Care Sciences & Services Rehabilitation LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: CX6NM Times Cited: 12 Cited Reference Count: 28 Curto-Garcia, Natalia Garcia-Suarez, Julio Callejas Chavarria, Marta Gil Fernandez, Juan Jose Martin Guerrero, Yolanda Magro Mazo, Elena Marcellini Antonio, Shelly Miguel Juarez, Luis Gutierrez, Isabel Jose Arranz, Juan Montalvo, Irene Elvira, Carmen Dominguez, Pilar Teresa Diaz, Maria Burgaleta, Carmen JUAREZ SALCEDO, LUIS MIGUEL/0000-0003-1448-8601 15 1 27 SPRINGER NEW YORK SUPPORT CARE CANCER PY - 2016 SN - 0941-4355 SP - 93-101 ST - A team-based multidisciplinary approach to managing peripherally inserted central catheter complications in high-risk haematological patients: a prospective study T2 - Supportive Care in Cancer TI - A team-based multidisciplinary approach to managing peripherally inserted central catheter complications in high-risk haematological patients: a prospective study UR - ://WOS:000365817800014 VL - 24 ID - 761730 ER - TY - JOUR AB - Venous thromboembolism is a major cause of morbidity and mortality. The impact of the US Surgeon General's The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism in 2008 has been lower than expected given the public health impact of this disease. This scientific statement highlights future research priorities in venous thromboembolism, developed by experts and a crowdsourcing survey across 16 scientific organizations. At the fundamental research level (T0), researchers need to identify pathobiological causative mechanisms for the 50% of patients with unprovoked venous thromboembolism and to better understand mechanisms that differentiate hemostasis from thrombosis. At the human level (T1), new methods for diagnosing, treating, and preventing venous thromboembolism will allow tailoring of diagnostic and therapeutic approaches to individuals. At the patient level (T2), research efforts are required to understand how foundational evidence impacts care of patients (eg, biomarkers). New treatments, such as catheter-based therapies, require further testing to identify which patients are most likely to experience benefit. At the practice level (T3), translating evidence into practice remains challenging. Areas of overuse and underuse will require evidence-based tools to improve care delivery. At the community and population level (T4), public awareness campaigns need thorough impact assessment. Large population-based cohort studies can elucidate the biological and environmental underpinnings of venous thromboembolism and its complications. To achieve these goals, funding agencies and training programs must support a new generation of scientists and clinicians who work in multidisciplinary teams to solve the pressing public health problem of venous thromboembolism. AN - 32776842 AU - Cushman, M. AU - Barnes, G. D. AU - Creager, M. A. AU - Diaz, J. A. AU - Henke, P. K. AU - Machlus, K. R. AU - Nieman, M. T. AU - Wolberg, A. S. DA - Aug 11 DO - 10.1161/cir.0000000000000818 DP - NLM ET - 2020/08/11 J2 - Circulation KW - AHA Scientific Statements hemostasis postthrombotic syndrome pulmonary embolism research priorities thrombosis venous thromboembolism venous thrombosis LA - eng M1 - 6 N1 - 1524-4539 Cushman, Mary Barnes, Geoffrey D Creager, Mark A Diaz, Jose A Henke, Peter K Machlus, Kellie R Nieman, Marvin T Wolberg, Alisa S American Heart Association Council on Peripheral Vascular Disease; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and the International Society on Thrombosis and Haemostasis Journal Article United States Circulation. 2020 Aug 11;142(6):e85-e94. doi: 10.1161/CIR.0000000000000818. Epub 2020 Jul 8. PY - 2020 SN - 0009-7322 SP - e85-e94 ST - Venous Thromboembolism Research Priorities: A Scientific Statement From the American Heart Association and the International Society on Thrombosis and Haemostasis T2 - Circulation TI - Venous Thromboembolism Research Priorities: A Scientific Statement From the American Heart Association and the International Society on Thrombosis and Haemostasis VL - 142 ID - 760415 ER - TY - JOUR AB - Venous thromboembolism (VTE) is a major cause of morbidity and mortality. The impact of the Surgeon General's Call to Action in 2008 has been lower than expected given the public health impact of this disease. This scientific statement highlights future research priorities in VTE, developed by experts and a crowdsourcing survey across 16 scientific organizations. At the fundamental research level (T0), researchers need to identify pathobiologic causative mechanisms for the 50% of patients with unprovoked VTE and better understand mechanisms that differentiate hemostasis from thrombosis. At the human level (T1), new methods for diagnosing, treating, and preventing VTE will allow tailoring of diagnostic and therapeutic approaches to individuals. At the patient level (T2), research efforts are required to understand how foundational evidence impacts care of patients (eg, biomarkers). New treatments, such as catheter-based therapies, require further testing to identify which patients are most likely to experience benefit. At the practice level (T3), translating evidence into practice remains challenging. Areas of overuse and underuse will require evidence-based tools to improve care delivery. At the community and population level (T4), public awareness campaigns need thorough impact assessment. Large population-based cohort studies can elucidate the biologic and environmental underpinings of VTE and its complications. To achieve these goals, funding agencies and training programs must support a new generation of scientists and clinicians who work in multidisciplinary teams to solve the pressing public health problem of VTE. AD - [Cushman, Mary] Univ Vermont, Larner Coll Med, Dept Pathol & Lab Med, Dept Med, Burlington, VT USA. [Barnes, Geoffrey D.] Univ Michigan, Frankel Cardiovasc Ctr, Ann Arbor, MI 48109 USA. [Creager, Mark A.] Dartmouth Hitchcock Med Ctr, Geisel Sch Med Dartmouth, Heart & Vasc Ctr, Lebanon, NH 03766 USA. [Diaz, Jose A.] Vanderbilt Univ, Med Ctr, Div Surg Res, Nashville, TN USA. [Henke, Peter K.] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA. [Machlus, Kellie R.] Harvard Med Sch, Dept Med, Boston, MA 02115 USA. [Nieman, Marvin T.] Case Western Reserve Univ, Dept Pharmacol, Cleveland, OH 44106 USA. [Wolberg, Alisa S.] Univ N Carolina, UNC Blood Res Ctr, Dept Pathol & Lab Med, Chapel Hill, NC 27515 USA. Cushman, M (corresponding author), Univ Vermont, Dept Med, 360 South Pk Dr, Colchester, VT 05446 USA. mary.cushman@uvm.edu AN - WOS:000547905100001 AU - Cushman, M. AU - Barnes, G. D. AU - Creager, M. A. AU - Diaz, J. A. AU - Henke, P. K. AU - Machlus, K. R. AU - Nieman, M. T. AU - Wolberg, A. S. AU - Amer Heart, Assoc AU - Council Peripheral Vasc, Dis AU - Council Arteriosclerosis, Thrombosi AU - Council Cardiovasc Stroke, Nursing AU - Council Clinical, Cardiology AU - Council Epidemiology, Prevention AU - Int Soc Thrombosis, Haemostasis DA - Jul DO - 10.1002/rth2.12373 J2 - Res. Pract. Thromb. Haemost. KW - hemostasis postthrombotic syndrome pulmonary embolism thrombosis venous thromboembolism venous thrombosis research priorities DEEP-VEIN THROMBOSIS QUALITY-OF-LIFE HEMATOLOGY 2018 GUIDELINES PULMONARY-EMBOLISM POSTTHROMBOTIC SYNDROME RISK ANTICOAGULANTS THROMBOLYSIS PROPHYLAXIS VALIDATION Hematology LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: NE8GD Times Cited: 0 Cited Reference Count: 47 Cushman, Mary Barnes, Geoffrey D. Creager, Mark A. Diaz, Jose A. Henke, Peter K. Machlus, Kellie R. Nieman, Marvin T. Wolberg, Alisa S. Barnes, Geoffrey/AAK-1780-2020 Barnes, Geoffrey/0000-0002-6532-8440; Diaz, MD, Jose Antonio/0000-0001-5205-2118; Wolberg, Alisa/0000-0002-2845-2303; Machlus, Kellie/0000-0002-2155-1050 0 WILEY HOBOKEN RES PRACT THROMB HAE PY - 2020 SP - 714-721 ST - Venous thromboembolism research priorities: A scientific statement from the American Heart Association and the International Society on Thrombosis and Haemostasis T2 - Research and Practice in Thrombosis and Haemostasis TI - Venous thromboembolism research priorities: A scientific statement from the American Heart Association and the International Society on Thrombosis and Haemostasis UR - ://WOS:000547905100001 VL - 4 ID - 761426 ER - TY - JOUR AB - Venous thromboembolism is a major cause of morbidity and mortality. The impact of the US Surgeon General'sThe Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolismin 2008 has been lower than expected given the public health impact of this disease. This scientific statement highlights future research priorities in venous thromboembolism, developed by experts and a crowdsourcing survey across 16 scientific organizations. At the fundamental research level (T0), researchers need to identify pathobiological causative mechanisms for the 50% of patients with unprovoked venous thromboembolism and to better understand mechanisms that differentiate hemostasis from thrombosis. At the human level (T1), new methods for diagnosing, treating, and preventing venous thromboembolism will allow tailoring of diagnostic and therapeutic approaches to individuals. At the patient level (T2), research efforts are required to understand how foundational evidence impacts care of patients (eg, biomarkers). New treatments, such as catheter-based therapies, require further testing to identify which patients are most likely to experience benefit. At the practice level (T3), translating evidence into practice remains challenging. Areas of overuse and underuse will require evidence-based tools to improve care delivery. At the community and population level (T4), public awareness campaigns need thorough impact assessment. Large population-based cohort studies can elucidate the biological and environmental underpinnings of venous thromboembolism and its complications. To achieve these goals, funding agencies and training programs must support a new generation of scientists and clinicians who work in multidisciplinary teams to solve the pressing public health problem of venous thromboembolism. AN - WOS:000562734100007 AU - Cushman, M. AU - Barnes, G. D. AU - Creager, M. A. AU - Diaz, J. A. AU - Henke, P. K. AU - Machlus, K. R. AU - Nieman, M. T. AU - Wolberg, A. S. AU - Amer Heart Assoc, Council AU - Council, Arteriosclerosis AU - Council Cardiovasc Stroke, Nursing AU - Council Clinical, Cardiology AU - Council Epidemiology, Prevention AU - Int Soc Thrombosis, Haemostasis DA - Aug DO - 10.1161/cir.0000000000000818 J2 - Circulation KW - AHA Scientific Statements hemostasis postthrombotic syndrome pulmonary embolism research priorities thrombosis venous thromboembolism venous thrombosis DEEP-VEIN THROMBOSIS QUALITY-OF-LIFE HEMATOLOGY 2018 GUIDELINES PULMONARY-EMBOLISM POSTTHROMBOTIC SYNDROME RISK ANTICOAGULANTS THROMBOLYSIS PROPHYLAXIS VALIDATION Cardiac & Cardiovascular Systems Peripheral Vascular Disease LA - English M1 - 6 M3 - Editorial Material N1 - ISI Document Delivery No.: NE6TP Times Cited: 0 Cited Reference Count: 47 Cushman, Mary Barnes, Geoffrey D. Creager, Mark A. Diaz, Jose A. Henke, Peter K. Machlus, Kellie R. Nieman, Marvin T. Wolberg, Alisa S. Barnes, Geoffrey/AAK-1780-2020 Barnes, Geoffrey/0000-0002-6532-8440; Machlus, Kellie/0000-0002-2155-1050 0 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CIRCULATION PY - 2020 SN - 0009-7322 SP - E85-E94 ST - Venous Thromboembolism Research Priorities: A Scientific Statement From the American Heart Association and the International Society on Thrombosis and Haemostasis T2 - Circulation TI - Venous Thromboembolism Research Priorities: A Scientific Statement From the American Heart Association and the International Society on Thrombosis and Haemostasis UR - ://WOS:000562734100007 VL - 142 ID - 761419 ER - TY - JOUR AB - Objectives: The awareness of stroke risks, warning signs and effective ways of early treatment is very important for stroke prevention. The aim of this study was to understand the knowledge of stroke of medical staff in Yunnan province, analyze the differences between urban and rural areas and the differences among west, central and east areas in Yunnan Province. Methods: We adopted the convenient sampling method to conduct a questionnaire survey on the medical staff of an urban hospital and a rural hospital in west, central, east Yunnan province. Chi-square test determined the statistical difference between urban and rural medical staff in the various types of knowledge of stroke. Regional differences in the knowledge of stroke of medical staff were assessed by logistic regression, estimating odds ratios (OR) and 95% confidence intervals (95% CIs) and adjusting for age, gender, income, education. Results: In total, 983 medical staff (mean age 34.1 ± 8.4 years, 79.76% women) were included. The knowledge of stroke of medical staff in Yunnan province was not comprehensive enough, with the low awareness rate of Thrombolysis-Time (about 55%) and the high awareness rate of Early-Symptoms (94%). There were statistically significant differences in the following knowledge between urban and rural medical staff: Thrombolysis-Qualification (χ2= 9.447, P = 0.002), Green-Channel (χ2= 3.993, P = 0.046), Referral-Service (χ2= 40.072, P < 0.001). Meanwhile, the knowledge of stroke of medical staff in central Yunnan province was higher than that in west in the terms of Thrombolysis-Qualification (OR: 2.123, 95% CI: 1.509-2.986), Thrombolysis-Examination (OR: 1.655, 95% CI: 1.088-2.519), Referral-Service (OR: 5.712, 95% CI: 2.673-12.207). Conclusions: The knowledge of stroke of medical staff in Yunnan province was not comprehensive and there were significant differences between urban and rural medical staff. We suggest that interactive stroke education and training should be provided to ensure that medical staff have the knowledge and skills at all stages of the stroke course. We support that establishing a multidisciplinary team to provide stroke service design and setting up stroke specialist nurses to coordinate related processes among various departments and to conduct public education training of medical staff will improve high-quality stroke care and outcomes for people who have experienced a stroke. Health resources input should be increased in rural and underdeveloped areas and technical cooperation ought to be strengthened between primary hospitals and higher-level hospitals to promote the level of primary health care effectively. AD - K. Zheng, Department of Neurology, First People's Hospital of Yunnan Province, Kunming, China AU - Dai, J. AU - Wang, X. AU - Zheng, K. AU - Yang, Y. AU - Zhu, X. AU - Gong, Y. DB - Embase DO - 10.1111/bcpt.13301 KW - adult awareness blood clot lysis cerebrovascular accident conference abstract controlled study education female gender health care planning human male medical staff multidisciplinary team nurse patient referral primary health care questionnaire rural hospital skill urban hospital LA - English M3 - Conference Abstract N1 - L631570271 2020-04-30 PY - 2019 SN - 1742-7843 SP - 4 ST - A study on the knowledge of stroke of medical staff in Yunnan province T2 - Basic and Clinical Pharmacology and Toxicology TI - A study on the knowledge of stroke of medical staff in Yunnan province UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631570271&from=export http://dx.doi.org/10.1111/bcpt.13301 VL - 125 ID - 760652 ER - TY - JOUR AB - BackgroundTakayasu arteritis-induced renal arteritis (TARA), commonly seen in Takayasu arteritis (TA), has become one of the main causes of poor prognosis and early mortality in patients with TA. TARA progressing into Takayasu arteritis-induced renal artery stenosis (TARAS), could lead to severe complications including malignant hypertension, cardiac-cerebral vascular disease, and ischemic nephropathy. Since there existed no guidelines on treatments, this study aimed to review the comprehensive treatments for TARA.MethodsWe searched systematically in databases including PubMed, Ovid-Medline, EMBASE, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed, from inception to May 2018. Literature selection, data extraction, and statistical analysis were performed.ResultsEighty-two literatures were recruited focusing on medical treatments (n = 34) and surgical treatments (n = 48). We found that combined medical treatments of glucocorticoids and conventional synthetic disease-modifying anti-rheumatic drugs could reach high rates of remission in patients with TARA, and biological disease-modifying anti-rheumatic drugs were preferred for refractory patients. After remission induction, surgical treatment could help reconstruct renal artery and recover renal function partly. Percutaneous transluminal angioplasty was the first choice for patients with TARAS, while open surgery showed a good long-term survival.ConclusionsPatients with TARA should benefit both from medical treatments and from surgical treatments comprehensively and sequentially. Multidisciplinary team coordination is recommended especially in patients with severe complications. AD - L.-D. Jiang, Department of Rheumatology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, China AU - Dai, X. M. AU - Yin, M. M. AU - Liu, Y. AU - Ma, L. L. AU - Ying, J. AU - Jiang, L. D. DB - Embase Medline DO - 10.1097/CM9.0000000000000704 KW - disease modifying antirheumatic drug aortic arch syndrome arteritis artery constriction clinical effectiveness endovascular surgery human incidence kidney artery kidney disease kidney function long term survival open surgery percutaneous transluminal angioplasty remission renal arteritis review risk factor systematic review treatment outcome LA - English M1 - 8 M3 - Review N1 - L632684244 2020-09-01 2020-10-08 PY - 2020 SN - 2542-5641 0366-6999 SP - 975-981 ST - Advancements in medical and surgical treatments of Takayasu arteritis-induced renal arteritis: A systematic review T2 - Chinese Medical Journal TI - Advancements in medical and surgical treatments of Takayasu arteritis-induced renal arteritis: A systematic review UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632684244&from=export http://dx.doi.org/10.1097/CM9.0000000000000704 VL - 133 ID - 760637 ER - TY - JOUR AB - Background and objective: Anticoagulation (AC) for prevention of cardio-embolism is most frequently indicated but largely underused in frail older patients with atrial fibrillation (AF). The objective of this study was to identify patient subgroups in whom AC is frequently underused Setting and methods: Retrospective study of 629 patients aged C75 years with AF and clear AC indication (CHADS2 ≥ 2/6) upon hospital admission. A comprehensive assessment was performed by a geriatric multidisciplinary team. Risks of AF-associated stroke and AC-associated bleeding were predicted using CHADS21 and HEMORR2HAGES2 scores, respectively. Main outcome measure: Underuse of anticoagulation (vitamin K antagonist or low molecular weight heparin at therapeutic dose) upon admission. Bivariate analyses were performed to investigate the association between AC underuse and patient's characteristics (i.e. socio-demographics, geriatric syndromes, and risk factors for cardioembolism (CHADS2) and bleeding (HEMORR2HAGES)). Results: Of 629 geriatric patients (85 ± 5 years; female 55 %, malnutrition 51 %, recent falls 41 %, cognitive impairment 36 %, nursing home 23 %), 316 did not receiveAC(underuse: 50 %). Patients with no AC, as compared to those on AC, were more frequently aged above 85 years (61 vs. 50 %, p<0.01), at risk for fall (69 vs. 58 %, p<0.01) and in nursing home (27 vs. 19 %, p = 0.02). No difference was observed with regard to gender, malnutrition, history of recent falls or cognitive impairment. Patients with no AC had a higher bleeding risk (HEMORR2HAGES: 4.0 ± 2.2 vs. 3.6 ± 2.8) and a lower cardioembolism risk (CHADS2: 3.1 ± 2.1 vs. 3.4 ± 2.1). AC underuse was larger in the 181 patients with CHADS2 = 2/6 (58 vs. 47 %; OR = 1.5[1.1-2.2]) and in the 271 patients with HEMORR2HAGES ≤ 3/12 (58 vs. 40 %; OR = 2.2[1.5-2.8]). Surprisingly, AC underuse was not much lower in patients with a previous stroke (84/201: 42 %). AC underuse was higher in the 250 patients on anti-thrombotic agent (56 vs. 23 %, OR = 4.1[2.9-5.7], p<0.001). Conclusions: Anticoagulation underuse remains too frequent (50 %) in frail older patients with AF despite clear anticoagulation indication. Risk factors for AC underuse in geriatric patients were older age, fall risk, aspirin use and high bleeding risk. These findings suggest that physician's choices are based on fear of major bleeding, some being justified (high bleeding risk), others not (older age, risk for fall). AD - O. Dalleur, Pharmacy, Cliniques Universitaires Saint-Luc, Brussels, Belgium AU - Dalleur, O. AU - Maes, F. AU - Henrard, S. AU - Wouters, D. AU - Scavée, C. AU - Spinewine, A. AU - Boland, B. DB - Embase DO - 10.1007/s11096-013-9801-0 KW - low molecular weight heparin antivitamin K acetylsalicylic acid anticoagulation frail elderly aged human atrial fibrillation clinical pharmacy therapy risk factor patient risk bleeding geriatric patient nursing home cerebrovascular accident cognitive defect malnutrition female bivariate analysis embolism fear physician prevention hospital admission fall risk gender retrospective study LA - English M1 - 5 M3 - Conference Abstract N1 - L71239467 2013-12-03 PY - 2013 SN - 2210-7703 SP - 875 ST - Risk factors for underuse of anticoagulation in frail elderly patients with atrial fibrillation T2 - International Journal of Clinical Pharmacy TI - Risk factors for underuse of anticoagulation in frail elderly patients with atrial fibrillation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71239467&from=export http://dx.doi.org/10.1007/s11096-013-9801-0 VL - 35 ID - 761149 ER - TY - JOUR AB - BACKGROUND: Intravenous rt-PA is effective in hyperacute ischemic stroke (HAIS) but is administered only in few patients. OBJECTIVES: To report the thrombolysis rate in our stroke unit using a stroke code (SC) protocol with a prenotification system and to analyze the SC impact on the thrombolysis rate in a systematic review. METHODS: We report, from 2005 to 2009, the intravenous rt-PA rate in our prospective registry of hyperacute strokes suspicions. The systematic review was conducted in searching PubMed and EMBASE for prospective studies reporting thrombolysis rates and their use of a SC. We categorized SC between those with a prenotification by the Emergency Medical Services and those with only an in-hospital SC system. RESULTS: Among the 1450 stroke patients hospitalized in our stroke unit, 349 were admitted via the SC protocol as suspicions of hyperacute strokes. Intravenous rt-PA rates were: 12.9% of the ischemic strokes, 36% of the suspicions of hyperacute strokes and 59.6% of the HAIS. We found 23 studies reporting thrombolysis rates ranging from 10.3% to 58% of HAIS. Ten studies gave data concerning the use of a SC in case of HAIS. Thrombolysis rate was higher in hospitals with a prenotification system (54.7%) compared with both those with no specific organization (18.2%) (OR=5.43, 95% CI: 3.84-7.73) and those with an in-hospital restricted SC (37.9%) (OR=1.97, 95% CI: 1.53-2.54). CONCLUSIONS: Thrombolysis rate of HAIS is improved by a SC, especially when a prenotification system of thrombolysis candidates by Emergency Medical Services to the stroke unit is used. AD - Department of Neurology, Tenon University Hospital, AP-HP, F-75020, Paris, France. AN - 22050950 AU - Dalloz, M. A. AU - Bottin, L. AU - Muresan, I. P. AU - Favrole, P. AU - Foulon, S. AU - Levy, P. AU - Drouet, T. AU - Marro, B. AU - Alamowitch, S. DA - Mar 15 DO - 10.1016/j.jns.2011.10.009 DP - NLM ET - 2011/11/05 J2 - Journal of the neurological sciences KW - Age Factors Aged Brain Ischemia/drug therapy *Clinical Protocols Drug Utilization Emergency Medical Services/statistics & numerical data Female Fibrinolytic Agents/therapeutic use France/epidemiology Hospitals Humans Male Middle Aged Paris/epidemiology Patient Care Team Prospective Studies Registries Stroke/*diagnosis/*drug therapy/epidemiology Thrombolytic Therapy/*statistics & numerical data Tissue Plasminogen Activator/therapeutic use LA - eng M1 - 1-2 N1 - 1878-5883 Dalloz, M A Bottin, L Muresan, I P Favrole, P Foulon, S Levy, P Drouet, T Marro, B Alamowitch, S Journal Article Meta-Analysis Systematic Review Netherlands J Neurol Sci. 2012 Mar 15;314(1-2):120-5. doi: 10.1016/j.jns.2011.10.009. Epub 2011 Nov 1. PY - 2012 SN - 0022-510x SP - 120-5 ST - Thrombolysis rate and impact of a stroke code: a French hospital experience and a systematic review T2 - J Neurol Sci TI - Thrombolysis rate and impact of a stroke code: a French hospital experience and a systematic review VL - 314 ID - 760398 ER - TY - JOUR AB - Purpose: To assess the prevalence of the ocular manifestations related to the disease and/or ascribable to the administration of potentially toxic drugs in a cohort of 98 patients with systemic lupus erythematosus (SLE). Methods: Retrospective, observational study reporting the experience of two tertiary referral centers. Results: Overall, an ocular involvement was detected in 29 patients (29.6%), sometimes preceding of months the diagnosis of SLE, more often revealed at diagnosis or throughout its course. More than a single ocular manifestation was found in 20 of the 29 patients with ophthalmological findings (68.9%). The array of ocular morbidity included, in a decreasing order of frequency, cataracts, keratoconjunctivitis sicca, glaucoma, discoid lesions of eyelids, episcleritis, retinopathy, vortex keratopathy, choroidopathy and retinal detachment, central retinal vein occlusion, and hydroxychloroquine-induced toxic maculopathy. Conclusions: It is advised that a multidisciplinary team for the diagnosis and treatment of SLE should regularly include the presence of an ophthalmologist. AD - F. Dammacco, Unità Operativa G. Baccelli, Policlinico, Piazza G. Cesare, 11, Bari, Italy AU - Dammacco, R. AU - Procaccio, P. AU - Racanelli, V. AU - Vacca, A. AU - Dammacco, F. DB - Embase Medline DO - 10.1080/09273948.2018.1501495 KW - cyclophosphamide glucocorticoid hydroxychloroquine mycophenolate mofetil prednisone adolescent adult alopecia anorexia arthritis article ascites body weight loss brain disease cataract central retina vein occlusion chorioretinopathy cognitive defect cohort analysis disease activity drug induced disease electroretinography endocarditis episcleritis eye disease eye fundus eye toxicity eyelid disease fatigue fever fluorescence angiography follow up functional status fundus fluorescein angiography glaucoma glomerulonephritis heart infarction human interstitial pneumonia keratoconjunctivitis sicca keratopathy kidney failure Kikuchi disease livedo reticularis lung embolism lung hemorrhage lymphadenopathy major clinical study malaise mouth ulcer myalgia myositis nephrotic syndrome observational study ophthalmology optical coherence tomography pericarditis photosensitivity pleurisy polyneuropathy prevalence purpuric rash rash Raynaud phenomenon retina detachment retina maculopathy retinopathy retrospective study seizure Sjoegren syndrome SLEDAI spleen thrombosis systemic lupus erythematosus tertiary care center thrombosis visual disorder cornea verticillata LA - English M1 - 8 M3 - Article N1 - L623610249 2018-08-30 2018-12-27 PY - 2018 SN - 1744-5078 0927-3948 SP - 1154-1165 ST - Ocular Involvement in Systemic Lupus Erythematosus: The Experience of Two Tertiary Referral Centers T2 - Ocular Immunology and Inflammation TI - Ocular Involvement in Systemic Lupus Erythematosus: The Experience of Two Tertiary Referral Centers UR - https://www.embase.com/search/results?subaction=viewrecord&id=L623610249&from=export http://dx.doi.org/10.1080/09273948.2018.1501495 VL - 26 ID - 760787 ER - TY - JOUR AB - INTRODUCTION: We observed pulmonary hypertension (PH), pericardial effusions, and left ventricular systolic dysfunction (LVSD) in multiple critically ill hematopoietic stem cell transplant (HSCT) recipients. We implemented routine structured echocardiography screening for HSCT recipients admitted to the pediatric intensive care unit (PICU) using a standardized multidisciplinary process. METHODS: HSCT recipients admitted to the PICU with respiratory distress, hypoxia, shock, and complications related to transplant-associated thrombotic microangiopathy were screened on admission and every 1-2 weeks thereafter. Echocardiography findings requiring intervention and/or further screening included elevated right ventricular pressure, LVSD, and moderate to large pericardial effusions. All echocardiograms were compared to the patient's routine pretransplant echocardiogram. RESULTS: Seventy HSCT recipients required echocardiography screening over a 3-year period. Echo abnormalities requiring intervention and/or further screening were found in 35 (50%) patients. Twenty-four (34%) patients were noted to have elevated right ventricular pressure; 14 (20%) were at risk for PH, while 10 (14%) had PH. All patients with PH were treated with pulmonary vasodilators. LVSD was noted in 22 (31%) patients; 15/22 (68%) received inotropic support. Moderate to large pericardial effusions were present in nine (13%) patients, with six needing pericardial drain placement. DISCUSSION: Echocardiographic abnormalities are common in critically ill HSCT recipients. Utilization of echocardiogram screening may allow for early detection and timely intervention for cardiac complications in this high-risk cohort. AD - Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. AN - 28271596 AU - Dandoy, C. E. AU - Jodele, S. AU - Paff, Z. AU - Hirsch, R. AU - Ryan, T. D. AU - Jefferies, J. L. AU - Cash, M. AU - Rotz, S. AU - Pate, A. AU - Taylor, M. D. AU - El-Bietar, J. AU - Myers, K. C. AU - Wallace, G. AU - Nelson, A. AU - Grimley, M. AU - Pfeiffer, T. AU - Lane, A. AU - Davies, S. M. AU - Chima, R. S. DA - Oct DO - 10.1002/pbc.26513 DP - NLM ET - 2017/03/09 J2 - Pediatric blood & cancer KW - Adolescent Allografts Child Child, Preschool Critical Illness Electrocardiography Female *Hematopoietic Stem Cell Transplantation Humans *Hypertension, Pulmonary/etiology/physiopathology/therapy Intensive Care Units Male Patient Care Team *Pericardial Effusion/etiology/physiopathology/therapy *Ventricular Dysfunction, Left/etiology/physiopathology/therapy critical care echocardiography pericardial effusion pulmonary hypertension stem cell transplant thrombotic microangiopathy LA - eng M1 - 10 N1 - 1545-5017 Dandoy, Christopher E Jodele, Sonata Paff, Zachary Hirsch, Russel Ryan, Thomas D Jefferies, John L Cash, Michelle Rotz, Seth Pate, Abigail Taylor, Michael D El-Bietar, Javier Myers, Kasiani C Wallace, Gregory Nelson, Adam Grimley, Michael Pfeiffer, Thomas Lane, Adam Davies, Stella M Chima, Ranjit S Journal Article United States Pediatr Blood Cancer. 2017 Oct;64(10). doi: 10.1002/pbc.26513. Epub 2017 Mar 8. PY - 2017 SN - 1545-5009 ST - Team-based approach to identify cardiac toxicity in critically ill hematopoietic stem cell transplant recipients T2 - Pediatr Blood Cancer TI - Team-based approach to identify cardiac toxicity in critically ill hematopoietic stem cell transplant recipients VL - 64 ID - 760253 ER - TY - JOUR AB - Background Transanal total mesorectal excision (taTME) is a surgical approach for low rectal cancer with a learning curve estimated at 40-50 cases. The experience among taTME surgeons beyond their learning curve is limited. Methods A retrospective analysis of all taTME cases performed for rectal cancer at two tertiary care hospitals from 2014 to 2019 was conducted. Transanal surgeons had previously performed > 50 taTME cases. Demographic, perioperative, and short-term outcomes were analyzed. Results Among 54 taTME patients, 74.1% were male and 27.8% had a BMI >= 30. Tumors were stage I (8), II (13), III (29), and IV (4). Complex cases included 4 local recurrences, 4 prior liver resections, and 2 with prior prostate cancer. Thirty tumors were located <= 6 cm from the anal verge. On staging MRI, 12 had a positive predicted circumferential radial margin (+CRM), and 4 had internal anal sphincter involvement (+IAS). Forty-seven patients received neoadjuvant therapy. A 2-team approach was used in 51 patients with laparoscopic (83.3%) or robotic (16.7%) abdominal assistance with a 9.2% conversion rate. Low anterior resection with sphincter salvage was achieved in 87% with 8 patients requiring intersphincteric resection. Anastomoses were hand-sewn in 57.4% and all patients were diverted. Median LOS was 5 days with a 42.6% 30-day morbidity rate and 3 postoperative mortalities (ARDS, pulmonary embolism and pseudomembranous colitis). Complete and near complete TME grade was achieved in 94.4% with a 3.7% rate of +CRM. At a median follow-up of 28 months, local and distant recurrence rates were 3.9% and 17.6%, respectively, with no cancer-related mortality. Conclusion Indications for taTME at experienced centers have expanded to include complex reoperative cases, local recurrences, metastatic cancer, and tumors with threatened CRM or IAS with evidence of post-treatment tumor regression. In the latter cases, taTME achieves good short-term outcomes and may facilitate R0 resection. AD - [D'Andrea, Anthony P.; Bonaccorso, Antoinette; Cuevas, Jordan M.; Bhasin, Deepika; Sylla, Patricia] Icahn Sch Med Mt Sinai, Dept Surg, Div Colon & Rectal Surg, 5 East 98th St,Box 1259, New York, NY 10029 USA. [McLemore, Elisabeth C.; Basam, Motahar; Tsay, Anna T.; Attaluri, Vikram] Southern Calif Kaiser Permanente Med Grp, Dept Surg, Los Angeles Med Ctr, Los Angeles, CA USA. Sylla, P (corresponding author), Icahn Sch Med Mt Sinai, Dept Surg, Div Colon & Rectal Surg, 5 East 98th St,Box 1259, New York, NY 10029 USA. patricia.sylla@mountsinai.org AN - WOS:000541638000001 AU - D'Andrea, A. P. AU - McLemore, E. C. AU - Bonaccorso, A. AU - Cuevas, J. M. AU - Basam, M. AU - Tsay, A. T. AU - Bhasin, D. AU - Attaluri, V. AU - Sylla, P. DA - Sep DO - 10.1007/s00464-019-07172-4 J2 - Surg. Endosc. KW - Transanal total mesorectal excision (taTME) Rectal cancer Learning curve Proctectomy Survival Oncologic outcomes LAPAROSCOPIC-ASSISTED RESECTION SHORT-TERM OUTCOMES MRC CLASICC TRIAL PATHOLOGICAL OUTCOMES RANDOMIZED-TRIAL LOCAL RECURRENCE OPEN SURGERY OPEN-LABEL MULTICENTER CARCINOMA Surgery LA - English M1 - 9 M3 - Article N1 - ISI Document Delivery No.: MT2PF Times Cited: 3 Cited Reference Count: 43 D'Andrea, Anthony P. McLemore, Elisabeth C. Bonaccorso, Antoinette Cuevas, Jordan M. Basam, Motahar Tsay, Anna T. Bhasin, Deepika Attaluri, Vikram Sylla, Patricia D'Andrea, Anthony/0000-0002-9855-2457 2 0 1 SPRINGER NEW YORK SURG ENDOSC PY - 2020 SN - 0930-2794 SP - 4101-4109 ST - Transanal total mesorectal excision (taTME) for rectal cancer: beyond the learning curve T2 - Surgical Endoscopy and Other Interventional Techniques TI - Transanal total mesorectal excision (taTME) for rectal cancer: beyond the learning curve UR - ://WOS:000541638000001 VL - 34 ID - 761485 ER - TY - JOUR AB - INTRODUCTION: Safe management of warfarin in the inpatient setting can be challenging. At the Mayo Clinic hospitals in Rochester, Minnesota, we set out to improve the safety of warfarin management among surgical and non-surgical inpatients. METHODS: A multidisciplinary team designed a pharmacist-managed warfarin protocol (PMWP) which designated warfarin dosing to inpatient pharmacists with guidance from computerised dosing algorithms. Ordering this protocol was ultimately designed as an 'opt out' practice. The primary improvement measure was frequency of international normalised ratio (INR) greater than 5; secondary measures included adoption rate of the protocol, a counterbalance INR metric (INR <1.7 three days after first inpatient warfarin dose), and complication rates, including bleeding and thrombosis events. An interrupted time series analysis was conducted to compare outcomes. RESULTS: Among over 50 000 inpatient warfarin recipients, the PMWP was adopted for the majority of both surgical and non-surgical inpatients during the study period (1 January 2005 to 31 December 2011). The primary improvement measure decreased from 5.6% to 3.4% for medical patients and from 5.2% to 2.4% for surgical patients during the preimplementation and postimplementation periods, respectively. The INR counterbalance measure did not change. Postoperative bleeding decreased from 13.5% to 11.1% among surgical patients, but bleeding was unchanged among medical patients. CONCLUSION: Our PMWP led to achievement of improved INR control for inpatient warfarin recipients and to less near-term bleeding among higher risk, surgical patients. AD - Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA. Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA. Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA. AN - 29713691 AU - Daniels, P. R. AU - Manning, D. M. AU - Moriarty, J. P. AU - Bingener-Casey, J. AU - Ou, N. N. AU - O'Meara, J. G. AU - Roellinger, D. L. AU - Naessens, J. M. C2 - Pmc5922568 DO - 10.1136/bmjoq-2017-000290 DP - NLM ET - 2018/05/02 J2 - BMJ open quality KW - hospital medicine medication safety patient safety pharmacists quality improvement LA - eng M1 - 2 N1 - 2399-6641 Daniels, Paul R Manning, Dennis M Moriarty, James P Bingener-Casey, Juliane Ou, Narith N O'Meara, John G Roellinger, Daniel L Naessens, James M Journal Article BMJ Open Qual. 2018 Apr 20;7(2):e000290. doi: 10.1136/bmjoq-2017-000290. eCollection 2018. PY - 2018 SN - 2399-6641 SP - e000290 ST - Improving inpatient warfarin therapy safety using a pharmacist-managed protocol T2 - BMJ Open Qual TI - Improving inpatient warfarin therapy safety using a pharmacist-managed protocol VL - 7 ID - 760295 ER - TY - JOUR AB - Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare life-threatening form of pulmonary artery hypertension. CTEPH is potentially curable by performing surgical operation - pulmonary thrombendarteriectomy. Unfortunately, about 36% of patients with CTEPH are considered as inoperable because of different conditions including left main coronary artery compression syndrome (LMCS), caused by compression with delated pulmonary artery. Appropriate management of patients with CTEPH and LMCS remains unknown. Case report: We report for the first time a case of a successful hybrid treatment of patient with CTEPH and LMCS. Due to high pulmonary vascular resistance (PVR) and LMCS (90% stenosis) the risk for pulmonary thrombendarteriectomy for patient was considered as high. The multidisciplinary team decided to start treatment with new method of treatment for patients with CTEPH - balloon pulmonary angioplasty. In 5 months 4 sessions of balloon pulmonary angioplasty were successfully performed. In a follow-up mean pulmonary artery pressure decreased from 57 to 37 mm Hg, PVR decreased from 20 to 7 WU. Coronary angiography showed no compression of left main coronary artery. The diameter of pulmonary artery decreased from 4.2 to 3.6 cm. Patient was reconsidered as operable and transferred to a surgical unit for pulmonary thrombendarteriectomy. Conclusion: Effective balloon pulmonary angioplasty can lead to regression of left main compression syndrome in CTEPH patients. Balloon pulmonary angioplasty can be a "bridge-treatment" to pulmonary thrombendarteriectomy in patients with high operation risk. AD - M.B. Karabasheva, National Medical Research Center of Cardiology, Moscow, Russian Federation AU - Danilov, N. M. AU - Karabasheva, M. B. AU - Sagaydak, O. V. AU - Matchin, Y. G. AU - Mershin, K. V. AU - Chazova, I. E. DB - Embase DO - 10.15275/rusomj.2019.0407 KW - cholesterol creatinine D dimer diuretic agent hemoglobin warfarin adult artery compression article blood oxygen tension cardiac index case report chronic thromboembolic pulmonary hypertension clinical article computer assisted tomography coronary angiography echography electrocardiogram female follow up heart output human hypothermia inferior cava vein intravascular ultrasound left coronary artery lung angiography lung artery pressure lung vascular resistance middle aged mortality risk risk factor tachycardia transthoracic echocardiography tricuspid annular plane systolic excursion LA - English M1 - 4 M3 - Article N1 - L630486042 2020-01-10 2020-01-14 PY - 2019 SN - 2304-3415 ST - Hybrid approach for treating patient with chronic thromboembolic pulmonary hypertension and extrinsic compression of left main coronary artery T2 - Russian Open Medical Journal TI - Hybrid approach for treating patient with chronic thromboembolic pulmonary hypertension and extrinsic compression of left main coronary artery UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630486042&from=export http://dx.doi.org/10.15275/rusomj.2019.0407 VL - 8 ID - 760775 ER - TY - JOUR AB - The objective of this study was to report and discuss the incidence, clinical characteristics and outcomes of emergency peripartum hysterectomies (EPH) performed at a tertiary referral hospital in Ankara, Turkey. The labour and delivery unit database was retrospectively analysed for emergency peripartum hysterectomies (EPH) performed between January 2008 and January 2013, at the Zekai Tahir Burak Women's Health Training and Research Hospital. A total of 92,887 deliveries were accomplished within the study period. EPH was performed in 48 cases, and the incidence was 0.51 in 1,000. Abnormal placentation was the most common indication for EPH. Most common complications were blood product transfusion and postoperative fever. None of the cases resulted in maternal mortality. Serious maternal complication rates were relatively low in our study. In cases that are unresponsive to initial conservative measures, EPH should be performed without delay and a multidisciplinary team approach should be conducted whenever possible. AD - E. Baser, Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Training and Research Hospital, Ankara, Turkey AU - Danisman, N. AU - Baser, E. AU - Togrul, C. AU - Kaymak, O. AU - Tandogan, M. AU - Gungor, T. DB - Embase DO - 10.3109/01443615.2014.935712 KW - adult Apgar score article bladder injury blood cephalopelvic disproportion cesarean section comorbidity obstetric delivery disseminated intravascular clotting emergency peripartum hysterectomy emergency surgery female fetus distress fever follow up human hysterectomy incidence intestine injury lung embolism newborn death perinatal period peroperative complication placenta accreta placenta previa postoperative complication postoperative ileus pregnancy risk factor surgical infection tertiary care center Turkey (republic) twin pregnancy uterine atony uterus bleeding uterus rupture vaginal delivery LA - English M1 - 1 M3 - Article N1 - L600991143 2014-12-26 2015-01-05 PY - 2015 SN - 1364-6893 0144-3615 SP - 19-21 ST - Emergency peripartum hysterectomy: Experience of a major referral hospital in Ankara, Turkey T2 - Journal of Obstetrics and Gynaecology TI - Emergency peripartum hysterectomy: Experience of a major referral hospital in Ankara, Turkey UR - https://www.embase.com/search/results?subaction=viewrecord&id=L600991143&from=export http://dx.doi.org/10.3109/01443615.2014.935712 VL - 35 ID - 761081 ER - TY - JOUR AB - A 60-year-old man was found unconscious at work, without any signs of trauma. At the site, he presented with tonic-clonic seizures, central facial palsy and eye deviation. A CT scan of the cerebrum did not find bleeding or thrombosis, but contrast enhancement at the superior sagittal sinus and pathological cervical lymph nodes. The MRI demonstrated multiple intracerebral metastases, while a supplementary fluoro-deoxy-glucose positron emission tomography scan revealed metastatic lesions above and below the diaphragm, without signs of a primary tumour. An ear, nose and throat examination found a small supraglottic tumour and cervical lymph node metastases. Following a multidisciplinary team discussion, biopsies from the duodenal mucosa and an inguinal lymph node were performed, showing squamous cell carcinoma with its origin in the head and neck. The patient was diagnosed with a T1N2cM1 supraglottic laryngeal cancer, receiving palliative whole brain radiation therapy but died 11 weeks after the debut of symptoms. AD - C. Danstrup, Department of Otorhinolaryngology - Head and Neck Surgery, Aalborg Universitetshospital, Aalborg, Denmark AU - Danstrup, C. AU - Andersen, M. DB - Embase Medline DO - 10.1136/bcr-2019-233584 KW - diazepam floxuridine fluorodeoxyglucose midazolam morphine valproic acid adult alcohol consumption article bone atrophy brain metastasis cancer staging case report cervical lymph node metastasis cervical lymphadenopathy clinical article computer assisted tomography contrast enhancement death facial nerve paralysis fine needle aspiration biopsy follow up Glasgow coma scale hospital discharge human human tissue intensive care unit laryngoscopy larynx cancer lymphoma male multidisciplinary team nuclear magnetic resonance imaging patient referral positron emission tomography priority journal squamous cell carcinoma symptomatology tobacco consumption tonic clonic seizure unconsciousness whole brain radiotherapy LA - English M1 - 3 M3 - Article N1 - L631337156 2020-04-07 2020-04-10 PY - 2020 SN - 1757-790X ST - Tonic-clonic seizures as first symptom of a disseminated supraglottic laryngeal cancer T2 - BMJ Case Reports TI - Tonic-clonic seizures as first symptom of a disseminated supraglottic laryngeal cancer UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631337156&from=export http://dx.doi.org/10.1136/bcr-2019-233584 VL - 13 ID - 760589 ER - TY - JOUR AB - Background/rationale Romiplostim is a thrombopoietin receptor agonist recommended as a second-line therapy for immune thrombocytopenia. An initial dose of 1 mcg/kg/week subcutaneously with weekly 1 mcg/kg dose escalation is recommended per package labeling. Optimizing romiplostim dosing for hospitalized, corticosteroid- and intravenous immunoglobulin-refractory patients with severe thrombocytopenia secondary to immune thrombocytopenia may be critical for improving platelet responses, reducing the risk of bleeding, and decreasing hospital length of stay. Limited data are available evaluating the efficacy and safety of higher initial doses. Objective The primary objective of this study was to compare the time to platelet ≥ 10 × 109/L between patients who received an initial romiplostim dose of ≥2 mcg/kg/week compared to the standard initial dose of 1 mcg/kg/week. Secondary objectives included time to platelet response ≥ 30 × 109/L and ≥50 × 109/L, percentage of patients achieving platelet responses, hospital length of stay, and incidence of adverse events and bleeding complications. Methods This was a retrospective, single-center, cohort study including hospitalized adults with corticosteroid- and intravenous immunoglobulin-refractory immune thrombocytopenia. A baseline platelet < 10 × 109/L was required. Patients were stratified by their initial romiplostim dose into Cohort 1 (1 mcg/kg/week) and Cohort 2 (≥2 mcg/kg/week). A review of electronic medical records and descriptive statistics generated findings. Results A total of 18 patients were included, 4 in Cohort 1 and 14 in Cohort 2. Patients in Cohort 2 had a median initial dose of 4.5 mcg/kg/week. Patients in Cohort 2 achieved a platelet ≥ 10 × 109/L in a median of 2 days versus 4.5 days for Cohort 1. More patients in Cohort 2 achieved a platelet ≥ 30 × 109/L (42.9% vs. 25%) and platelet ≥ 50 × 109/L (28.6% vs. 25%). The median hospital length of stay was shorter in Cohort 2 (13.5 vs. 20 days). Clinically relevant nonmajor bleeding was noted less frequently in Cohort 2 (28.6% vs. 75%), while major bleeding was more frequent in Cohort 2 (14.3% vs. 0%). No thrombotic events occurred. Conclusion Our study suggests that higher initial romiplostim doses may be safe for hospitalized patients with treatment-refractory immune thrombocytopenia. Compared to Food and Drug Administration-approved dosing, higher initial doses may shorten time to platelet responses and hospital length of stay. Further large-scale studies are needed to confirm these findings. AD - Department of Pharmacy, The Ohio State University James Cancer Hospital, Columbus, OH, USA Department of Pharmaceutical Services, Vanderbilt-Ingram Cancer Center, Nashville, TN, USA The Ohio State University James Cancer Hospital, Columbus, OH, USA Division of Hematology & Oncology AN - 135207524. Language: English. Entry Date: 20190320. Revision Date: 20190320. Publication Type: Article AU - DasGupta, Ryan K. AU - Levine, Lauren AU - Wiczer, Tracy AU - Cataland, Spero DB - CINAHL DO - 10.1177/1078155217748470 DP - EBSCOhost KW - Thrombocytopenia -- Immunology Thrombocytopenia -- Drug Therapy Thrombocytopenia -- Chemically Induced Recombinant Proteins -- Administration and Dosage Recombinant Proteins -- Therapeutic Use Blood Platelets Human Adult Female Male Retrospective Design Prospective Studies Stratified Random Sample Electronic Health Records Descriptive Statistics Adverse Drug Event Length of Stay Hemorrhage M1 - 3 N1 - research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 9511372. PY - 2019 SN - 1078-1552 SP - 567-576 ST - Initial romiplostim dosing and time to platelet response in patients with treatment refractory immune thrombocytopenia T2 - Journal of Oncology Pharmacy Practice TI - Initial romiplostim dosing and time to platelet response in patients with treatment refractory immune thrombocytopenia UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=135207524&site=ehost-live&scope=site VL - 25 ID - 761342 ER - TY - JOUR AB - INTRODUCTION: This is an analysis of adult Behcet's disease (BD) in Iran, from the Iran Registry of 7187 BD patients, gathered from 1975 to 2014, among which 6075 were adults (84.5%). PATIENTS: Patients were seen by a multidisciplinary team of experts. The diagnosis was by expert opinion, not by any specific classification/diagnosis criteria. However, 96.8% of them were classified by the International Criteria for Behcet's Disease (ICBD). Adult BDs were patients who had their first manifestation at the age of 16 or later. RESULTS: Males constituted 56% (male/female ratio 1.3/1). The mean age at onset was 28.3 ± 8.7, mean duration 10.8 ± 8.2, and mean follow-up 5.0 ± 6.3. Oral aphthosis was seen in 97.5%, genital aphthosis 65.7%, skin manifestations 64.6% (pseudofolliculitis 53.2%, erythema nodosum 23.9%), ocular manifestations 58.1% (anterior uveitis 41.1%, posterior uveitis 45%, retinal vasculitis 33.6%, cataract 24.4%), joint manifestations 39.4% (arthralgia 18.9%, monoarthritis 9.1%, oligoarthritis 17.8%, ankyloing spondylitis 2%), gastrointestinal manifestations 7% (gastroduodenitis 2.3%, peptic ulcer 1.2%, diarrhea 2.1%, rectorrhagia 1.0%, abdominal pain-nausea 1.8%), neurological manifestations 10.6% (central 3.7%, peripheral 0.3%, headache 7.6%), vessel involvement (large vessel 1.7% with large vein thrombosis 1.1% and arterial involvement 0.7%, phlebitis 6.6%, superficial phlebitis 2.3%), epididymitis 4.6%, pulmonary manifestations 1% and cardiac manifestations 0.6%. Positive pathergy test was seen in 52.3%, human leukocyte antigen (HLA)-B5 in 54%, HLA-B51 in 48.9%, and high erythrocyte sedimentation rate in 52.8% of patients. By International Study Group (ISG) criteria 77.9% were classified, compared to ICBD revised criteria with 96.9%. The specificity of ISG was 99.2% and ICBD 97.2%. CONCLUSION: Results are near the nationwide surveys from Japan, China, Korea and Germany. AD - Behcet's Disease Unit, Rheumatology Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran. AN - 26258691 AU - Davatchi, F. AU - Chams-Davatchi, C. AU - Shams, H. AU - Nadji, A. AU - Faezi, T. AU - Akhlaghi, M. AU - Sadeghi Abdollahi, B. AU - Ashofteh, F. AU - Ghodsi, Z. AU - Mohtasham, N. AU - Shahram, F. DA - Jan DO - 10.1111/1756-185x.12691 DP - NLM ET - 2015/08/11 J2 - International journal of rheumatic diseases KW - Adolescent Adult Age Factors Behcet Syndrome/diagnosis/*epidemiology Disease Progression Female Humans Iran/epidemiology Male Predictive Value of Tests Prognosis Registries Risk Factors Sex Factors Time Factors Young Adult Behcet's disease LA - eng M1 - 1 N1 - 1756-185x Davatchi, Fereydoun Chams-Davatchi, Cheyda Shams, Hormoz Nadji, Abdolhadi Faezi, Tahereh Akhlaghi, Massoomeh Sadeghi Abdollahi, Bahar Ashofteh, Farimah Ghodsi, Zahra Mohtasham, Negin Shahram, Farhad Journal Article England Int J Rheum Dis. 2016 Jan;19(1):95-103. doi: 10.1111/1756-185X.12691. Epub 2015 Aug 10. PY - 2016 SN - 1756-1841 SP - 95-103 ST - Adult Behcet's disease in Iran: analysis of 6075 patients T2 - Int J Rheum Dis TI - Adult Behcet's disease in Iran: analysis of 6075 patients VL - 19 ID - 760397 ER - TY - JOUR AB - OBJECTIVE: To identify the clinical picture of Behcet's disease in a large cohort of patients (6500) in Iran, over a period of 35 years, and compare them with other large series from around the world. METHODS: Patients with Behcet's disease from all over Iran were seen in the Behcet's Disease Research Unit by a multidisciplinary team (rheumatologists, dermatologists, and ophthalmologists). Diagnosis was based on 'expert opinion'. Data were collected on a standardized data sheet (105 items), and stored in an electronic database. Data were updated at each follow-up. RESULTS: Male to female ratio was 1.22 :  .00. The mean age at onset was 26 years ± 11.3. The frequency of symptoms were: oral aphthosis 97.3%, genital aphthosis 64.6%, skin manifestations 64.9% (pseudofolliculitis 54.5%, erythema nodosum 22.5%, other lesions 7%), pathergy phenomenon 52.5%, ophthalmologic manifes-tations 56.8% (anterior uveitis 41.2%, posterior uveitis 44.9%, retinal vasculitis 32.1%), joint manifestations 37.4% (arthralgia 17.2%, monoarticular arthritis 7.6%, oligoarthritis 16.8%, ankylosing spondylitis 2%), neurological manifestations 3.8% (central manifestations 3.5%, mononeuritis multiplex 0.3%), gastrointestinal manifestations 7.4%, vascular involvement 8.3% (phlebitis 5.7%, superficial phlebitis 2.2%, large vein thrombosis 1.1%, arterial thrombosis 0.154%, aneurysm 0.5%), epididymitis 4.7%, cardiac involvement 0.6%, and pulmonary involvement 0.9%. Sedimentation rate was normal in 46.5% of patients. Abnormal urine sediment was detected in 12.2%. HLA-B5 was present in 53.3% and HLA-B51 in 47.9% of patients. CONCLUSION: Behcet's disease is mainly seen in young people. The most frequent symptoms are mucocutaneous, ocular and joint manifestations. Comparison with large series did not show major differences. AD - Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Avenue, Tehran, Iran. fddh@davatchi.net AN - 21199472 AU - Davatchi, F. AU - Shahram, F. AU - Chams-Davatchi, C. AU - Shams, H. AU - Nadji, A. AU - Akhlaghi, M. AU - Faezi, T. AU - Ghodsi, Z. AU - Larimi, R. AU - Ashofteh, F. AU - Abdollahi, B. S. DA - Oct DO - 10.1111/j.1756-185X.2010.01549.x DP - NLM ET - 2011/01/05 J2 - International journal of rheumatic diseases KW - Adolescent Adult Age Distribution Age of Onset Aged Behcet Syndrome/classification/complications/diagnosis/*epidemiology Child Child, Preschool Female Health Surveys Humans Infant Iran/epidemiology Male Middle Aged Prevalence Sex Distribution Time Factors Young Adult LA - eng M1 - 4 N1 - 1756-185x Davatchi, Fereydoun Shahram, Farhad Chams-Davatchi, Cheyda Shams, Hormoz Nadji, Abdolhadi Akhlaghi, Massoomeh Faezi, Tahereh Ghodsi, Zahra Larimi, Roghieh Ashofteh, Farima Abdollahi, Bahar Sadeghi Journal Article England Int J Rheum Dis. 2010 Oct;13(4):367-73. doi: 10.1111/j.1756-185X.2010.01549.x. PY - 2010 SN - 1756-1841 SP - 367-73 ST - Behcet's disease in Iran: analysis of 6500 cases T2 - Int J Rheum Dis TI - Behcet's disease in Iran: analysis of 6500 cases VL - 13 ID - 760405 ER - TY - JOUR AB - Objective: To identify the clinical picture of Behcet's disease in a large cohort of patients (6500) in Iran, over a period of 35 years, and compare them with other large series from around the world. Methods: Patients with Behcet's disease from all over Iran were seen in the Behcet's Disease Research Unit by a multidisciplinary team (rheumatologists, dermatologists, and ophthalmologists). Diagnosis was based on 'expert opinion'. Data were collected on a standardized data sheet (105 items), and stored in an electronic database. Data were updated at each follow-up. Results: Male to female ratio was 1.22 1.00. The mean age at onset was 26 years ± 11.3. The frequency of symptoms were: oral aphthosis 97.3%, genital aphthosis 64.6%, skin manifestations 64.9% (pseudofolliculitis 54.5%, erythema nodosum 22.5%, other lesions 7%), pathergy phenomenon 52.5%, ophthalmologic manifes-tations 56.8% (anterior uveitis 41.2%, posterior uveitis 44.9%, retinal vasculitis 32.1%), joint manifestations 37.4% (arthralgia 17.2%, monoarticular arthritis 7.6%, oligoarthritis 16.8%, ankylosing spondylitis 2%), neurological manifestations 3.8% (central manifestations 3.5%, mononeuritis multiplex 0.3%), gastrointestinal manifestations 7.4%, vascular involvement 8.3% (phlebitis 5.7%, superficial phlebitis 2.2%, large vein thrombosis 1.1%, arterial thrombosis 0.154%, aneurysm 0.5%), epididymitis 4.7%, cardiac involvement 0.6%, and pulmonary involvement 0.9%. Sedimentation rate was normal in 46.5% of patients. Abnormal urine sediment was detected in 12.2%. HLA-B5 was present in 53.3% and HLA-B51 in 47.9% of patients. Conclusion: Behcet's disease is mainly seen in young people. The most frequent symptoms are mucocutaneous, ocular and joint manifestations. Comparison with large series did not show major differences. © 2010 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd. AD - F. Davatchi, Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Avenue, Tehran, 14114, Iran AU - Davatchi, F. AU - Shahram, F. AU - Chams-Davatchi, C. AU - Shams, H. AU - Nadji, A. AU - Akhlaghi, M. AU - Faezi, T. AU - Ghodsi, Z. AU - Larimi, R. AU - Ashofteh, F. AU - Abdollahi, S. DB - Embase Medline DO - 10.1111/j.1756-185X.2010.01549.x KW - adult arthropathy article Behcet disease clinical feature demography disease classification epididymitis eye disease female gastrointestinal symptom genital ulcer geographic distribution heart disease human Iran laboratory test lung disease major clinical study male mouth ulcer neurologic disease onset age priority journal sedimentation rate sex ratio skin manifestation vascular disease LA - English M1 - 4 M3 - Article N1 - L359797849 2010-10-28 2010-11-02 PY - 2010 SN - 1756-1841 1756-185X SP - 367-373 ST - Behcet's disease in Iran: analysis of 6500 cases T2 - International Journal of Rheumatic Diseases TI - Behcet's disease in Iran: analysis of 6500 cases UR - https://www.embase.com/search/results?subaction=viewrecord&id=L359797849&from=export http://dx.doi.org/10.1111/j.1756-185X.2010.01549.x VL - 13 ID - 761243 ER - TY - JOUR AB - Objective: To report the clinical picture of Behcet's Disease in a large cohort of patients (7227) in Iran, over a period of 40 years, and compare results with other nationwide surveys, and some large cohorts (more than 500 patients). Methods: Patients with Behcet's Disease from all over Iran were seen in the Behcet's Disease Research Unit by a multidisciplinary team (Rheumatologists, Dermatologists, and Ophthalmologists). Diagnosis was based on “Expert Opinion”. Data were collected on a standardized data sheet (105 items), and stored in an electronic database. Data were updated at each follow- up. Due to patients large number, confidence Intervals are very short (1.15 at 50%, 0.7% at 10% and 90%). Results: Male to female ratio was 1.24 to 1. The mean age at the onset was 25.8 years ± 10.3. The frequency of symptoms were: Oral aphthosis 97.5%, genital aphthosis 64.8%, skin manifestations 63.8% (pseudofolliculitis 52.8%, erythema nodosum 23%, other skin lesions 7.3%), ophthalmologic manifestations 55.2% (anterior uveitis 41.5%, posterior uveitis 45.3%, retinal vasculitis 33.4%), joint manifestations 39.1% (arthralgia 19%, monoarthritis 9.2%, oligoarthritis 17.4%, ankylosing spondylitis 2.2%), neurological manifestations 4% (central manifestations 3.7%, peripheral Manifestations 0.3%), GI manifestations 7.1%, vascular involvement 8.7% (phlebitis 6.3%, superficial phlebitis 2.3%, large vein thrombosis 1.2%, arterial thrombosis 0.2%, aneurysm 0.5%), epididymitis 4.5%, cardiac involvement 0.6%, and pulmonary involvement 0.9%. Positive pathergy test was seen in 52.5%. Sedimentation rate was normal in 49.1% of patients. Abnormal urine sediment was detected in 13.4%. HLA-B5 was present in 53.2% and HLA-B51 in 47.2% of patients. Comparison: Data from Japan, Turkey, China, Korea, Morocco, Germany, and Tunisia will be given accordingly. Oral aphthosis was seen in 98%, 100%, 98%, 99%,100%, 98.5%, 100%. Genital aphthosis 73/88/76/83/86/64/87.5. Skin 87/-/69/84/-/81/68. Eye 69/29/35/51/65/ 58/32. Joint 57/12/30/38/52/53/55. CNS 11/2.2/6.5/4.6/17/11/12. Gastrointestinal 16/1.4/ 8.87.3/-/12/-. Phlebitis 9/11/5.3/1.8/16/13/25. Conclusion: Comparison with large series did not show major differences. AD - F. Davatchi, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran AU - Davatchi, F. AU - Shahram, F. AU - Sadeghi Abdollahi, B. AU - Chams-Davatchi, C. AU - Nadji, A. AU - Ghodsi, Z. AU - Akhlaghi, M. AU - Faezi, S. T. AU - Ashofteh, F. AU - Mohtasham, N. DB - Embase KW - Behcet disease Iran patient human Asia rheumatology phlebitis Turkey (republic) follow up monarthritis arthritis data base diagnosis ophthalmologist retina vasculitis uveitis dermatologist female sedimentation rate epididymitis iridocyclitis Japan Morocco Tunisia eye arthralgia aneurysm ankylosing spondylitis artery thrombosis skin defect vein thrombosis erythema nodosum skin manifestation confidence interval urine sediment China Korea Germany skin male central nervous system LA - English M3 - Conference Abstract N1 - L72004618 2015-09-12 PY - 2015 SN - 1756-1841 SP - 14 ST - Behcets disease in Iran, analysis of 7227 patients T2 - International Journal of Rheumatic Diseases TI - Behcets disease in Iran, analysis of 7227 patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72004618&from=export VL - 18 ID - 761061 ER - TY - JOUR AB - Objective: To identify an appropriate diagnostic tool for the early diagnosis of acute traumatic coagulopathy and validate this modality through prediction of transfusion requirements in trauma hemorrhage. Design: Prospective observational cohort study. Setting: Level 1 trauma center. Patients: Adult trauma patients who met the local criteria for full trauma team activation. Exclusion criteria included emergency department arrival >2 hrs after injury, >2000 mL of intravenous fluid before emergency department arrival, or transfer from another hospital. I nterventions: None. Measurements: Blood was collected on arrival in the emergency department and analyzed with laboratory prothrombin time, point-of-care prothrombin time, and rotational thromboelastometry. Prothrombin time ratio was calculated and acute traumatic coagulopathy defined as laboratory prothrombin time ratio >1.2. Transfusion requirements were recorded for the first 12 hrs following admission. Main Results: Three hundred patients were included in the study. Laboratory prothrombin time results were available at a median of 78 (62-103) mins. Point-of-care prothrombin time ratio had reduced agreement with laboratory prothrombin time ratio in patients with acute traumatic coagulopathy, with 29% falsenegative results. In acute traumatic coagulopathy, the rotational thromboelastometry clot amplitude at 5 mins was diminished by 42%, and this persisted throughout clot maturation. Rotational thromboelastometry clotting time was not significantly prolonged. Clot amplitude at a 5-min threshold of <= 35 mm had a detection rate of 77% for acute traumatic coagulopathy with a false-positive rate of 13%. Patients with clot amplitude at 5 mins <= 35 mm were more likely to receive red cell (46% vs. 17%, p < .001) and plasma (37% vs. 11%, p < .001) transfusions. The clot amplitude at 5 mins could identify patients who would require massive transfusion (detection rate of 71%, vs. 43% for prothrombin time ratio >1.2, p < .001). Conclusions: In trauma hemorrhage, prothrombin time ratio is not rapidly available from the laboratory and point-of-care devices can be inaccurate. Acute traumatic coagulopathy is functionally characterized by a reduction in clot strength. With a threshold of clot amplitude at 5 mins of <= 35 mm, rotational thromboelastometry can identify acute traumatic coagulopathy at 5 mins and predict the need for massive transfusion. (Crit Care Med 2011; 39:2652-2658) AD - [Pearse, Rupert; Brohi, Karim] Queen Mary Univ London, Barts & London Sch Med & Dent, William Harvey Res Inst, London, England. [Pasi, K. John] Queen Mary Univ London, Barts & London Sch Med & Dent, Pathol Grp, Blizard Inst Cell & Mol Sci, London, England. [Platton, Sean; Allard, Shubha; Hart, Daniel; MacCallum, Peter] Barts & London NHS Trust, Dept Haematol, London, England. [Stanworth, Simon] John Radcliffe Hosp, NHS Blood & Transplant, Oxford OX3 9DU, England. Brohi, K (corresponding author), Queen Mary Univ London, Barts & London Sch Med & Dent, William Harvey Res Inst, London, England. k.brohi@qmul.ac.uk AN - WOS:000297254000009 AU - Davenport, R. AU - Manson, J. AU - De'Ath, H. AU - Platton, S. AU - Coates, A. AU - Allard, S. AU - Hart, D. AU - Pearse, R. AU - Pasi, K. J. AU - MacCallum, P. AU - Stanworth, S. AU - Brohi, K. DA - Dec DO - 10.1097/CCM.0b013e3182281af5 J2 - Crit. Care Med. KW - coagulopathy diagnosis hemorrhage rotational thromboelastometry transfusion trauma DAMAGE CONTROL RESUSCITATION RED-BLOOD-CELL MASSIVE TRANSFUSION MORTALITY INJURY THROMBELASTOGRAPHY HYPERFIBRINOLYSIS MANAGEMENT PLASMA CARE Critical Care Medicine LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: 851FO Times Cited: 300 Cited Reference Count: 37 Davenport, Ross Manson, Joanna De'Ath, Henry Platton, Sean Coates, Amy Allard, Shubha Hart, Daniel Pearse, Rupert Pasi, K. John MacCallum, Peter Stanworth, Simon Brohi, Karim Pearse, Rupert/H-5426-2011; Platton, Sean/AAG-5019-2019; Platton, Sean/L-5315-2019 Pearse, Rupert/0000-0002-4373-5934; Platton, Sean/0000-0002-5466-0448; Davenport, Ross/0000-0002-8593-6582 National Institute for Health ResearchNational Institute for Health Research (NIHR) [RP-PG-0407-10036]; ROTEM Supported, in part, by the National Institute for Health Research: Programme Grant for Applied Research (RP-PG-0407-10036). Rupert Pearse is a National Institute for Health Research (UK) Clinician Scientist. Pentapharm GmbH (Munich, Germany) provided ROTEM reagent and equipment on an unrestricted basis.; Dr. Davenport and Dr. Brohi received unrestricted reagent/equipment grants from ROTEM. The remaining authors have not disclosed any potential conflicts of interest. 312 1 21 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CRIT CARE MED PY - 2011 SN - 0090-3493 SP - 2652-2658 ST - Functional definition and characterization of acute traumatic coagulopathy T2 - Critical Care Medicine TI - Functional definition and characterization of acute traumatic coagulopathy UR - ://WOS:000297254000009 VL - 39 ID - 761838 ER - TY - JOUR AB - OBJECTIVE: To assess results of open repair (OR) of AAA in a single high volume center. METHODS: We analyzed prospectively collected data of 450 patients who underwent elective OR of AAA at the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre in the period between January 2013 and September 2014. RESULTS: Postoperative death occurred in seven patients (1. 55%) during the first 30 postoperative days. The mortality was caused by: uncontrolled bleeding-1, acute myocardial infarction-1, ischemic colitis-2, MOFS-2, sepsis due to infection and dehiscence of laparotomy wound-1. Coronary artery disease (OR 3.89; CI 0.85-17.7; p = 0.0058), postoperative acute myocardial infarction (OR 29.9; CI 2.56-334.95; p = 0.0053), chronic renal failure (OR 7.5; CI 1.35-8.5; p = 0.0073), colonic necrosis (OR 88.2; CI 4.77-1629.69; p = 0.0026), occlusion of the both hypogastric arteries and the inability to preserve at least one hypogastric artery (OR 17.4; CI 1.99-178.33; p = 0.0230), aortobifemoral reconstruction (OR 9.06; CI 1.76-46.49; p = 0.016), significant perioperative bleeding (>2 L) (OR 7.32; CI 1.31-10.79; p = 0.0001), hostile abdomen (OR 5.25; CI 1.3-21.1; p = 0.0055), inflammatory aneurysm (OR 13.99; CI 2.88-65.09; p = 0.0002), supraceliac aortic cross-clamping (OR 18.7; CI 3.8-90.6; p = 0.0003), prolonged aortic cross-clamping (>60 min) (OR 14.25; CI 2.75-64.5; p = 0.0003), the intraoperative hypotension (OR 6.61; CI 0.71-61.07; p = 0.0545), the prolonged operation (>240 min) (OR 8.66; CI 0.91-81.56; p = 0.0585) and complete dehiscence of the laparotomy (OR 44.1; CI 3.39-572.78; p = 0.0396) increased the 30-day mortality in our study. CONCLUSIONS: Early mortality after open repair of AAA in high volume center might be very low due to experienced multidisciplinary team. Centralized open aortic surgery might be solution for effective treatment of patients with unsuitable anatomy or for young patients with long life expectancy. AU - Davidovic, L. B. AU - Maksic, M. AU - Koncar, I. AU - Ilic, N. AU - Dragas, M. AU - Fatic, N. AU - Markovic, M. AU - Banzic, I. AU - Mutavdzic, P. DB - Medline DO - 10.1007/s00268-016-3788-3 KW - adult aged aorta abdominal aortic aneurysm comorbidity elective surgery female high volume hospital human male middle aged mortality postoperative complication retrospective study vascular surgery very elderly LA - English M1 - 3 M3 - Article N1 - L618972532 2017-10-31 PY - 2017 SN - 1432-2323 SP - 884-891 ST - Open Repair of AAA in a High Volume Center T2 - World journal of surgery TI - Open Repair of AAA in a High Volume Center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L618972532&from=export http://dx.doi.org/10.1007/s00268-016-3788-3 VL - 41 ID - 760955 ER - TY - JOUR AB - Training and learning in the field of access for dialysis, including peritoneal and hemodialysis and access for oncologic patients, is well suited for the use of simulators, simulated case learning, and root cause analysis of adverse outcomes and team training. Simulators range over a wide spectrum from simple suture learning devices, inexpensive systems for venous puncture simulation, such as a turkey breast or leg with a pressurized tunneled rubber or graft conduit, to sophisticated computer designed simulators to teach interventional procedures such as vascular access angiogram, balloon angioplasty and stent placing. Team training capitalizes on the principles used in aviation, known as Crew Resource Management (CRM) or Human Factor (HF). The objectives of team training are to improve communication and leadership skills, to use checklists to prevent errors, to promote a change in the attitudes towards vascular access from learning through mistakes in a non-punitive environment, to impacting positively the employee performance and to increase staff retention by making the workplace safer, more efficient and user-friendly. AD - Department of Surgery, University of Texas Southwestern Medical Center, Parkland Memorial Hospital, 5939 Harry Hines Blvd., Dallas, TX 75390-8567, USA. ingemar.davidson@UTSouthwestern.edu AN - 21240863 AU - Davidson, I. J. AU - Yoo, M. C. AU - Biasucci, D. G. AU - Browne, P. AU - Dees, C. AU - Dolmatch, B. AU - Gallieni, M. AU - La Greca, A. AU - Korndorffer, J. R. AU - Nolen, B. AU - O'Rear, S. AU - Peden, E. AU - Pittiruti, M. AU - Reed, G. AU - Scott, D. AU - Slakey, D. DA - Jul-Sep DO - 10.5301/jva.2010.5826 DP - NLM ET - 2011/01/18 J2 - The journal of vascular access KW - Attitude of Health Personnel Clinical Competence Communication *Computer Simulation/standards *Computer-Assisted Instruction/standards Education, Medical, Graduate/*methods/standards Endovascular Procedures/*education/standards Health Knowledge, Attitudes, Practice Humans Kidney Failure, Chronic/*therapy Leadership Learning *Models, Cardiovascular Patient Care Team Quality Improvement *Renal Dialysis/standards Vascular Surgical Procedures/*education/standards LA - eng M1 - 3 N1 - 1724-6032 Davidson, Ingemar J A Yoo, Min C Biasucci, Daniel G Browne, Patrick Dees, Cathy Dolmatch, Bart Gallieni, Maurizio La Greca, Antonio Korndorffer, James R Nolen, Billy O'Rear, Sandy Peden, Eric Pittiruti, Mauro Reed, Gary Scott, Daniel Slakey, Douglas Journal Article Review United States J Vasc Access. 2010 Jul-Sep;11(3):181-90. doi: 10.5301/jva.2010.5826. PY - 2010 SN - 1129-7298 SP - 181-90 ST - Simulation training for vascular access interventions T2 - J Vasc Access TI - Simulation training for vascular access interventions VL - 11 ID - 760255 ER - TY - JOUR AB - Methods: Our observational study involved a multidisciplinary surgical team that performed laparoscopy on 154 patients suffering from pelvic pain. Surgical complications occurring up to the 30th postoperative day were recorded. Results: Mean age patient age was 34.1 years. Infertility was present in 69 (45%) although 31% had not attempted to get pregnant. Dysmenorrhea was the most frequent symptom (79.3%) followed by chronic pelvic pain (59.7%) and deep dyspareunia (48,7%). Most cases required extensive surgery as the majority (n=117; 76.9%) were classified as severe endometriosis (ASRM grade IV). The most frequent surgical procedures were: 136 adhesiolysis, 100 intestinal surgeries (85 retosigmoidectomies), 92 peritonal lesion excision, 39 vaginal resections, 19 myomectomies, 21 hysterectomies and 5 partial bladder resections. Postoperative complications were recorded in 14 (9.59%) patients: 8 (5.48%) major complications and 6 (4.11%) minor. Major complications included blood transfusion (n=2) retosigmoid anastomosis dehiscence (1), rectovaginal fistula (n=1), urinary fistula (n=1), deep vein thrombosis (n=1), lower limb compartment syndrome with motor deficit (n=1) and one intestinal obstruction (n=1). Minor complications were abdominal wall infection (n=3), peripheral neuropathy (n=3), bladder atony (n=1) and bladder perforation (n=1). No deaths were observed. All major complication cases underwent retosigmoidectomy associated with vaginal resection (n=6), uterosacral ligament excision (n=5) or hysterectomy (n=3). Objective: Evaluate the type and incidence of postoperative complications after surgery for deep infiltrative endometriosis at Biocor Hospital. Conclusion: The surgical treatment of DIE is complex and subject to complications. The surgical expertise of a multidisciplinary team plays a vital role in this setting. AD - M.M. Carneiro, Department of Obstetrics and Gynecology, Federal University of Minas Gerais (UFMG), Rua Antonio Torres, 186, Belo Horizonte, MG, Brazil AU - de Ávila, I. AU - Costa, L. M. P. AU - Soto, M. AU - Filogônio, I. D. S. AU - Carneiro, M. M. DB - Embase DO - 10.5935/1518-0557.20140020 KW - adult anastomosis dehiscence article bladder perforation compartment syndrome deep vein thrombosis dysmenorrhea dyspareunia endometriosis female human hypotonic bladder incidence infection intestine obstruction laparoscopy major clinical study middle aged observational study pelvic pain peripheral neuropathy urinary tract fistula LA - English M1 - 4 M3 - Article N1 - L600574351 2014-12-02 2014-12-05 PY - 2014 SN - 1518-0557 1517-5693 SP - 139-143 ST - Safe multidisciplinary approach in deeply infiltrating endometriosis (DIE): Is it feasible? T2 - Jornal Brasileiro de Reproducao Assistida TI - Safe multidisciplinary approach in deeply infiltrating endometriosis (DIE): Is it feasible? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L600574351&from=export http://dx.doi.org/10.5935/1518-0557.20140020 VL - 18 ID - 761139 ER - TY - JOUR AB - Background: The patient’s refusal to accept blood transfusions during major abdominal surgery forces the surgeon to face an ethical challenge and raises doubts about the appropriate perioperative management of these patients. The aim of this study is to present our experience and assess the safety of bloodless major pancreatic surgery Methods: We retrospectively analysed perioperative outcomes of 25 unselected Jehovah's witness who underwent surgery for pancreatic and periampullary tumors between 2010 and 2016. In collaboration of a multidisciplinary team, we treated perioperative anaemia with drugs stimulating erythropoiesis (erythropoietin, iron and folic acid) Results: 18 patients underwent pancreaticoduodenectomy, 3 spleen-preserving left pancreatectomy, 3 distal splenopancreatectomy, 1 total pancreatectomy. Median estimated intraoperative blood loss was 400mL (300 to 700mL). Median preoperative and postoperative day 1 values of Hb was 14g/dL (12 to 16) and 12g/dL (9 to 15), respectively. 10 (40%) patients had Clavien-Dindo < 3 complications: 6 pancreatic fistula (5 grade A and 1 grade B), 3 delayed gastric emptying, 1 abdominal collection, 1 biliary fistula, and 1 pulmonary thromboembolism. Only 1 patient had an abdominal fluid collection that required percutaneous drainage (Clavien-Dindo >3). In hospital mortality was 0%. Median length of stay was 16 days (8 to 30) Conclusion: Multidisciplinary approach and specific perioperative management permit safe pancreatic resections in Jehovah’s Witness patients AU - De Bellis, M. AU - Ruzzenente, A. AU - Bagante, F. AU - Conci, S. AU - Campagnaro, T. AU - Lazzari, G. AU - Lombardo, E. AU - Guglielmi, A. AU - Iacono, C. DB - Embase DO - 10.1016/j.hpb.2019.10.1110 KW - endogenous compound erythropoietin folic acid iron adult anemia bile duct fistula clinical article complication conference abstract controlled study drug therapy erythropoiesis female hospital mortality human infarction Jehovah's witness length of stay lung embolism male multidisciplinary team neoplasm operative blood loss pancreas fistula pancreatectomy pancreaticoduodenectomy percutaneous drainage preoperative evaluation retrospective study spleen stomach paresis surgery LA - English M3 - Conference Abstract N1 - L2004367949 2020-01-01 PY - 2019 SN - 1477-2574 1365-182X SP - S919 ST - Major pancreatic resection in Jehovah's witness patients: a single institute experience T2 - HPB TI - Major pancreatic resection in Jehovah's witness patients: a single institute experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004367949&from=export http://dx.doi.org/10.1016/j.hpb.2019.10.1110 VL - 21 ID - 760763 ER - TY - JOUR AB - Purpose A clinical pathway for patients with acute ischemic stroke was implemented in 2014 by one Italian teaching hospital multidisciplinary team. The purpose of this paper is to determine whether this clinical pathway had a positive effect on patient management by comparing performance data. Design/methodology/approach Volume, process and outcome indicators were analyzed in a pre-post retrospective observational study. Patients' (admitted in 2013 and 2015) medical records with International Classification of Diseases, ICD-9 code 433.x (precerebral artery occlusion and stenosis), 434.x (cerebral artery occlusion) and 435.x (transient cerebral ischemia) and registered correctly according to hospital guidelines were included. Findings An increase context-sensitive in-patient numbers with more severe cerebrovascular events and an increase in patient transfers from the Stroke to Neurology Unit within three days (70 percent, p=0.25) were noted. Clinical pathway implementation led to an increase in patient flow from the Emergency Department to dedicated specialized wards such as the Stroke and Neurology Unit (23.7 percent, p<0.001). Results revealed no statistically significant decrease in readmission rates within 30 days (5.7 percent, p=0.85) and no statistically significant differences in 30-day mortality. Research limitations/implications - The pre-post retrospective observational study design was considered suitable to evaluate likely changes in patient flow after clinical pathway implementation, even though this design comes with limitations, describing only associations between exposure and outcome. Originality/value Clinical pathway implementation showed an overall positive effect on patient management and service efficiency owing to the standardized application in time-dependent protocols and multidisciplinary/integrated care implementation, which improved all phases in acute ischemic stroke care. AD - [de Belvis, Antonio Giulio; Angioletti, Carmen] Fdn Policlin Univ A Gemelli IRCCS, Dept Evaluat Clin Pathways & Outcomes, Rome, Italy. [de Belvis, Antonio Giulio; Frisullo, Giovanni] Univ Cattolica Sacro Cuore, Rome, Italy. [Lohmeyer, Franziska Michaela; Barbara, Andrea; Giubbini, Gabriele; Ricciardi, Walter; Specchia, Maria Lucia] Univ Cattolica Sacro Cuore, Inst Publ Hlth, Hyg Sect, Rome, Italy. [Frisullo, Giovanni] Fdn Policlin Univ A Gemelli IRCCS, Dept Neurosci, Rome, Italy. [Ricciardi, Walter] Fdn Policlin Univ A Gemelli IRCCS, Rome, Italy. [Ricciardi, Walter] Italian Natl Hlth Inst, Rome, Italy. Lohmeyer, FM (corresponding author), Univ Cattolica Sacro Cuore, Inst Publ Hlth, Hyg Sect, Rome, Italy. franziskamichaela.lohmeyer@policlinicogemelli.it AN - WOS:000465587100004 AU - de Belvis, A. G. AU - Lohmeyer, F. M. AU - Barbara, A. AU - Giubbini, G. AU - Angioletti, C. AU - Frisullo, G. AU - Ricciardi, W. AU - Specchia, M. L. DA - Apr DO - 10.1108/ijhcqa-05-2018-0111 J2 - Int. J. Health Care Qual. Assur. KW - Stroke Clinical governance Clinical pathway Appropriateness LENGTH-OF-STAY QUALITY MANAGEMENT LEAN TECHNIQUES CARE PATHWAYS THROMBOLYSIS EPIDEMIOLOGY ASSOCIATIONS FLOW Health Policy & Services LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: HU9BF Times Cited: 2 Cited Reference Count: 34 de Belvis, Antonio Giulio Lohmeyer, Franziska Michaela Barbara, Andrea Giubbini, Gabriele Angioletti, Carmen Frisullo, Giovanni Ricciardi, Walter Specchia, Maria Lucia Ricciardi, Walter/AAB-2056-2019; Barbara, Andrea/J-3954-2018 Ricciardi, Walter/0000-0002-5655-688X; LOHMEYER, Franziska Michaela/0000-0003-4004-7201; Barbara, Andrea/0000-0001-5321-4537; Frisullo, Giovanni/0000-0002-1604-6594 2 3 EMERALD GROUP PUBLISHING LTD BINGLEY INT J HEALTH CARE Q PY - 2019 SN - 0952-6862 SP - 588-598 ST - Ischemic stroke: clinical pathway impact T2 - International Journal of Health Care Quality Assurance TI - Ischemic stroke: clinical pathway impact UR - ://WOS:000465587100004 VL - 32 ID - 761531 ER - TY - JOUR AB - Background:Equality in healthcare between urban and rural areas is problematic in France. Telemedicine networks are expected to improve equality in expertise assessment. We aimed to evaluate the use and impact of a regional rural French telemedicine network, dedicated to medical and surgical neurological emergencies, on interhospital patient transfers.Methods:Eight community hospital emergency departments were remotely connected to the only university hospital in Franche-Comte, France. We prospectively obtained data from all patients consecutively admitted to emergency care departments in the region and who received medical or neurosurgical expertise by telemedicine from January 2002 to December 2015. The reasons for requesting expertise, number of requested neurological opinions, and interhospital patient transfers were analyzed. Economic savings were determined by estimating the cost of avoided transfers.Results:A total of 23,710 patients had telemedicine consultations in the region. The network was used by every community hospital (independently of the existence of local neurological teams). These consultations were overwhelmingly for cases of stroke (30%) and head or spinal injuries (36%). Cerebral tumors represented 9% of teleconsultations. In 2015, 75% of patients admitted to the remote hospitals that did not have onsite neurological expertise nevertheless received neurovascular tele-expertise. The rate of thrombolyzed patients dramatically increased within 13 years regionally (9.9%) and 33.5% of thrombolyses were performed by telemedicine. The number of patients examined by telemedicine and admitted for head or spinal injuries also increased over the 13-year period (12% vs. 21%). Secondary interhospital transfers were halved for both pathologies. The estimated saving is approximate to Euro3.5 million.Conclusion:Telemedicine networks facilitate acute-phase neurological assessment and prevent unnecessary secondary interhospital transfers. AD - [de Bustos, Elisabeth Medeiros; Bouamra, Benjamin; Moulin, Thierry] Univ Bourgogne Franche Comte, Dept Neurol 2, CHRU, Besancon EA 481, Besancon, France. [Berthier, Eric] Jura Sud Hosp, Dept Neurol, Lons, France. [Chavot, Didier] Nord Franche Comte Hosp, Dept Neurol, Trevenans, France. de Bustos, EM (corresponding author), CHRU Jean Minjoz, Dept Neurol 2, 2 Blvd Flemming, F-25033 Besancon, France. edebustosmedeiros@chu-besancon.fr AN - WOS:000424477600009 AU - de Bustos, E. M. AU - Berthier, E. AU - Chavot, D. AU - Bouamra, B. AU - Moulin, T. DA - Feb DO - 10.1089/tmj.2017.0035 J2 - Telemed. e-Health KW - healthcare telemedicine telestroke stroke head and spinal injury NEUROSURGICAL REFERRAL CENTER INTEGRATIVE STROKE CARE HEAD-INJURED PATIENTS GLOBAL BURDEN PILOT PROJECT TELEMERGENCY TELESTROKE HOSPITALS IMPLEMENTATION TELERADIOLOGY Health Care Sciences & Services LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: FV3OL Times Cited: 7 Cited Reference Count: 29 de Bustos, Elisabeth Medeiros Berthier, Eric Chavot, Didier Bouamra, Benjamin Moulin, Thierry healthcare system The telemedicine system was funded by the healthcare system. There is no other specific funding for this study. 7 0 6 MARY ANN LIEBERT, INC NEW ROCHELLE TELEMED E-HEALTH PY - 2018 SN - 1530-5627 SP - 155-160 ST - Evaluation of a French Regional Telemedicine Network Dedicated to Neurological Emergencies: A 14-Year Study T2 - Telemedicine and E-Health TI - Evaluation of a French Regional Telemedicine Network Dedicated to Neurological Emergencies: A 14-Year Study UR - ://WOS:000424477600009 VL - 24 ID - 761605 ER - TY - JOUR AD - Hospital Ramon y Cajal, Madrid, Espana. AN - 25059270 AU - de Felipe, A. AU - Alonso-Cánovas, A. AU - Vera, R. AU - Cruz-Culebras, A. AU - Alonso de Leciñana-Cases, M. AU - Sainz-De la Maza, S. AU - Bragado, D. AU - Aguado, A. AU - González-Gómez, F. J. AU - Masjuán, J. DA - Aug 16 DP - NLM ET - 2014/07/26 J2 - Revista de neurologia KW - Brain Death/diagnostic imaging Endovascular Procedures/statistics & numerical data Hospital Units/*organization & administration/statistics & numerical data Hospitals, University/*organization & administration/statistics & numerical data Humans Internship and Residency Medical Staff, Hospital Neurology/*organization & administration Night Care/organization & administration Patient Care Team Patient Selection Prospective Studies Registries/statistics & numerical data Stroke/diagnosis/drug therapy/surgery/*therapy Tertiary Care Centers/*organization & administration/statistics & numerical data Thrombectomy/statistics & numerical data Thrombolytic Therapy/statistics & numerical data Time-to-Treatment Tissue and Organ Procurement/organization & administration Ultrasonography, Doppler, Transcranial LA - spa M1 - 4 N1 - 1576-6578 de Felipe, Alicia Alonso-Cánovas, Araceli Vera, Rocío Cruz-Culebras, Antonio Alonso de Leciñana-Cases, María Sainz-De la Maza, Susana Bragado, Diana Aguado, Alba González-Gómez, Francisco J Masjuán, Jaime Letter Spain Rev Neurol. 2014 Aug 16;59(4):190-1. OP - ¿Es útil una guardia específica de ictus? PY - 2014 SN - 0210-0010 SP - 190-1 ST - [Is a specific on-call stroke service useful?] T2 - Rev Neurol TI - [Is a specific on-call stroke service useful?] VL - 59 ID - 760524 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). Copyright (C) 2009 S. Karger AG, Basel AD - [Alonso de Lecinana-Cases, Maria] Hosp Univ Ramon & Cajal, Serv Neurol, Unidad Ictus, Dept Neurol,Stroke Unit, ES-28034 Madrid, Spain. [Gil-Nunez, Antonio] Gregorio Maranon Univ Hosp, Madrid, Spain. [Diez-Tejedor, Exuperio] La Paz Univ Hosp, Madrid, Spain. de Lecinana-Cases, M (corresponding author), Hosp Univ Ramon & Cajal, Serv Neurol, Unidad Ictus, Dept Neurol,Stroke Unit, Ctra Colmenar Km 9 100, ES-28034 Madrid, Spain. mariaalonsoleci@telefonica.net AN - WOS:000271586600018 AU - de Lecinana-Cases, M. AU - Gil-Nunez, A. AU - Diez-Tejedor, E. DO - 10.1159/000200452 J2 - Cerebrovasc. Dis. KW - Acute stroke Stroke network Medical care Attention chain Stroke code Care resources Stroke management FOCAL CEREBRAL-ISCHEMIA THROMBOLYTIC TREATMENT PLASMINOGEN-ACTIVATOR 1ST YEAR COST ALTEPLASE PATHOPHYSIOLOGY ASSOCIATION EXPERIENCE MANAGEMENT Clinical Neurology Peripheral Vascular Disease LA - English M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: 517BB Times Cited: 28 Cited Reference Count: 55 Alonso de Lecinana-Cases, Maria Gil-Nunez, Antonio Diez-Tejedor, Exuperio 5th International Workshop on Ischemic Stroke APR 03-04, 2008 Madrid, SPAIN Bristol Myers Squibb de Lecinana, Maria Alonso/C-1464-2017 de Lecinana, Maria Alonso/0000-0002-4302-6580; Diez Tejedor, Exuperio/0000-0003-2295-1707 29 0 6 KARGER BASEL CEREBROVASC DIS 1 PY - 2009 SN - 1015-9770 SP - 140-147 ST - Relevance of Stroke Code, Stroke Unit and Stroke Networks in Organization of Acute Stroke Care - The Madrid Acute Stroke Care Program T2 - Cerebrovascular Diseases TI - Relevance of Stroke Code, Stroke Unit and Stroke Networks in Organization of Acute Stroke Care - The Madrid Acute Stroke Care Program UR - ://WOS:000271586600018 VL - 27 ID - 761902 ER - TY - JOUR AB - Background: Multidisciplinary Team (MDT) meetings are the current “gold standard” in interstitial lung disease (ILD) diagnosis. Requisite participants are respiratory physicians, radiologists and pathologists. A rheumatologist physician is not routinary involved in MDT even if up to 20% of ILD are related to connective tissue disease, rheumatoid arthritis or systemic vasculitis. Objectives: The aim of this study is to evaluate the prevalence and predictors of systemic rheumatological diseases in a cohort of patients with ILD, evaluated by a rheumatology specialist on the advice of MDT in a university hospital. Methods: Thirty-two patients with ILD, evaluated at dedicated MDT were referred to a rheumatologist in 2018, usually for autoantibodies positivity or clinical history suspected for a rheumatological disorder. Rheumatologic evaluation included physical examination, routinary blood and urine tests, serum levels of C3 and C4, ANA, Rheumatoid Factor (RF), ANCAs, anti- Sm, anti-RNP, anti-Ro/SSA, anti-La/SSB, anti-Sm, anti-Jo1, anti-dsDNA and anti-CCP antibodies. Family history of autoimmune diseases, presence of rheumatologic red flags (Raynaud's phenomenon, photosensitivity, inflammatory skin manifestations, sicca syndrome, recurrent fever, inflammatory arthralgias, paresthesias, oral or genital aphthosis, thrombosis and recurrent miscarriages), respiratory symptoms and pulmonary function test were also evaluated. When indicated, capillaroscopy, joint imaging and salivary gland biopsy were performed. Results: Twenty-one patients (65.6%) were female. At the time of rheumatological evaluation, the patients had a mean age of 64.4±12.6 years with a mean period of 21.1±39.6 months since the first identification of ILD on a CT scan. Twenty-five (78.1%) and 18 (56.3%) patients respectively complained exertional dyspnea and cough, 6 patients (18.8%) were on oxygen therapy and 13 (40.6%) had a FVC<80%. The pattern on CT scan suggested a UIP, NSIP and OP respectively in 18 (56.3%), 6 (18.8%) and 2 (6.3%) patients. Ten patients (31.3%) were diagnosed with a defined rheumatological condition (4 with Sjogren Syndrome, 3 with scleroderma, 1 with Rheumatoid Arthritis, 1 with Mixed Connective Tissue Disease and 1 with Granulomatosis with Polyangiitis); 7 (21.9%) were diagnosed with Interstitial Pneumonia with autoimmune feature (IPAF). A rheumatological diagnosis was not statistically associated with any specific rheumatologic red flag, routine laboratory abnormalities or family history of systemic autoimmune disease. Three out of 13 capillaroscopies and 3 out of 9 salivary glands biopsies performed had diagnostic findings. The only immunologic abnormalities associated to a rheumatologic diagnosis were RF positivity (20.0%vs54.5%, p=0.024) and p-ANCA positivity (10.0%vs40.9%, p=0.042), both with low specificity (respectively 15.0% and 5.0%) and sensitivity (respectively 55.6% and 42.9.0%). After diagnosis, 11 patients (34.4%) started immunosuppressive therapy and 7 (21.9%) started antifibrotic therapy. Conclusion: Single clinical or laboratory abnormalities are not strongly associated to a rheumatological diagnosis in patients with ILD, suggesting that only a comprehensive rheumatological evaluation allows correct classification of the disease associated with ILD and is mandatory to make or exclude a diagnosis. In this study, we evaluated only preselected patients by ILD-MDT, but the results indirectly suggest that direct participation of rheumatologist to MDT is advisable to increase accuracy and reduce delay in diagnosis and treatment. AD - E. De Lorenzis, Catholic University of the Sacred Heart, Institute of Rheumatology, Rome, Italy AU - De Lorenzis, E. AU - Natalello, G. AU - Verardi, L. AU - Bosello, S. L. AU - Gremese, E. DB - Embase DO - 10.1136/annrheumdis-2019-eular.6364 KW - cyclic citrullinated peptide antibody endogenous compound Jo 1 antibody La antibody neutrophil cytoplasmic antibody rheumatoid factor ribonucleoprotein antibody Ro antibody Sm antibody adult arthralgia capillaroscopy clinical article clinical evaluation conference abstract congenital malformation controlled study coughing dyspnea family history female foot and mouth disease forced vital capacity human human tissue immunosuppressive treatment interstitial pneumonia lung function test male middle aged mixed connective tissue disease multidisciplinary team oxygen therapy paresthesia photosensitivity physical examination prevalence Raynaud phenomenon recurrent abortion recurrent fever rheumatoid arthritis rheumatologist rheumatology salivary gland biopsy scleroderma sensitivity and specificity Sjoegren syndrome skin manifestation systemic vasculitis thrombosis university hospital urinalysis Wegener granulomatosis x-ray computed tomography LA - English M3 - Conference Abstract N1 - L628807800 2019-08-09 PY - 2019 SN - 1468-2060 SP - 2030 ST - The management of interstitial lung diseases: The importance of the rheumatologic expertise in multidisciplinary meetings T2 - Annals of the Rheumatic Diseases TI - The management of interstitial lung diseases: The importance of the rheumatologic expertise in multidisciplinary meetings UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628807800&from=export http://dx.doi.org/10.1136/annrheumdis-2019-eular.6364 VL - 78 ID - 760706 ER - TY - JOUR AB - Pulmonary embolism (PE) is a common disease resulting in significant morbidity and mortality. High-risk features of PE are hypotension or shock, and early reperfusion is warranted to unload the strained right ventricle and improve clinical outcomes. Currently, systemic thrombolysis (ST) is the standard of care but is associated with bleeding complications. Catheter-based therapies (CDT) have emerged as a promising alternative having demonstrated to be equally effective while having a lower risk of bleeding. Several CDT are currently available, some combining mechanical properties with low-dose thrombolytics. Recent guidelines suggest that CDT may be considered in patients with high-risk PE who have high bleeding risk, after failed ST, or in patients with rapid haemodynamic deterioration as bail-out before ST can be effective, depending on local availability and expertise. In haemodynamically stable patients with right ventricular (RV) dysfunction (intermediate-risk PE), CDT may be considered if clinical deterioration occurs after starting anticoagulation and relative contraindications for ST due to bleeding risk exist. Decision on treatment modality should follow a risk-benefit analysis on a case by case base, weighing the risk of PE-related complications; i.e. haemodynamic deterioration vs. bleeding. As timely initiation of treatment is warranted to prevent early mortality, bleeding risk factors should be assessed at an early stage in all patients with acute PE and signs of RV dysfunction. To ensure optimal management of complex cases of PE and assess a potential CDT strategy, a multidisciplinary approach is recommended. A dedicated Pulmonary Embolism Response Team may optimize this process. AD - Department of Internal Medicine, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. Department of Cardiology, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. Department of Pulmonology, UMC Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands. AN - 31777453 AU - de Winter, M. A. AU - Vlachojannis, G. J. AU - Ruigrok, D. AU - Nijkeuter, M. AU - Kraaijeveld, A. O. C2 - Pmc6868359 DA - Nov DO - 10.1093/eurheartj/suz223 DP - NLM ET - 2019/11/30 J2 - European heart journal supplements : journal of the European Society of Cardiology KW - Catheter-directed thrombolysis Emergency care Pulmonary embolism Thrombolytic therapy LA - eng M1 - Suppl I N1 - 1554-2815 de Winter, M A Vlachojannis, G J Ruigrok, D Nijkeuter, M Kraaijeveld, A O Journal Article Eur Heart J Suppl. 2019 Nov;21(Suppl I):I16-I22. doi: 10.1093/eurheartj/suz223. Epub 2019 Nov 21. PY - 2019 SN - 1520-765X (Print) 1520-765x SP - I16-i22 ST - Rationale for catheter-based therapies in acute pulmonary embolism T2 - Eur Heart J Suppl TI - Rationale for catheter-based therapies in acute pulmonary embolism VL - 21 ID - 760182 ER - TY - JOUR AB - Background: Pulmonary Embolism Response Teams (PERTs) that provide multidisciplinary care to patients with severe PE are increasingly common. Most PERT activations originate from the Emergency Department (ED). Aims: To describe how PERT activations originating from the ED differ from those originating from inpatient floors or intensive care units (ICU). Methods: We enrolled a consecutive cohort of patients for whom PERT was activated at an urban teaching hospital. We compared PERT activations based on whether the activation originated from the ED, ICU or an inpatient floor. We compared groups in terms of the proportion of PERT activations that occurred during day, evening or weekend hours, and the proportion of confirmed PE. We compared PE severity, treatment and outcomes across locations. We tested differences using Fisher exact tests, with a two-tailed p-value < .05 considered significant. Results: We enrolled 565 patients; including 449 (79%) with confirmed PE. The mean age was 61±16 years, and 241 (54%) were male. Activations from the ED (n=286, 89%) or floor (n=100, 75%) were more likely to be for confirmed PE than activations from the ICU (n=63, 58%), p< 0.0001. There were no statistical differences in the time of day of PERT activation based on location. Most activations for massive PE originated from the ICU (n=41, 65.1%), followed by the ED (n=82, 28.7%) and inpatient floors (n=22, 22.0%), p< 0.0001. Most activations from the ED (n=157, 54.9%) and floors (n=55, 55.0%) were for submassive PE. The use of thrombolysis or thrombectomy was most common among ICU patients (n=18, 31.6%), and more common among ED patients (n=52, 18.4%) than floor patients (n=6, 6.0%). Mortality and major bleeding events were most common among ICU patients, and similar among ED and floor patients. Conclusions: PERT activations from different clinical locations differ in terms of patient presentation, PE confirmation, treatments and outcomes. PERTs should be designed and prepared to support the different needs of each clinical area. AD - E. Deadmon, Massachusetts General Hospital, Center for Vascular Emergencies, Department of Emergency Medicine, Boston, United States AU - Deadmon, E. AU - Giordano, N. AU - Rosenfield, K. AU - Rosovsky, R. AU - Parry, B. AU - Al-Bawardi, R. AU - Kabrhel, C. DB - Embase DO - 10.1002/rth2.12012 KW - adult bleeding blood clot lysis cohort analysis conference abstract controlled study emergency ward female Fisher exact test hospital patient human intensive care unit major clinical study male middle aged mortality pulmonary embolism response team statistical significance teaching hospital thrombectomy LA - English M3 - Conference Abstract N1 - L624155735 2018-10-09 PY - 2017 SN - 2475-0379 SP - 634 ST - Comparing emergency department patients to inpatients receiving a pulmonary embolism response team (PERT) activation T2 - Research and Practice in Thrombosis and Haemostasis TI - Comparing emergency department patients to inpatients receiving a pulmonary embolism response team (PERT) activation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624155735&from=export http://dx.doi.org/10.1002/rth2.12012 VL - 1 ID - 760926 ER - TY - JOUR AU - Deadmon, E. K. AU - Giordano, N. J. AU - Rosenfield, K. DA - 2017 DB - German National Library of Science and Technology (TIB) PY - 2017 ST - Comparison of Emergency Department Patients to Inpatients Receiving a Pulmonary Embolism Response Team (PERT) Activation T2 - British Library Online Contents TI - Comparison of Emergency Department Patients to Inpatients Receiving a Pulmonary Embolism Response Team (PERT) Activation UR - https://www.tib.eu/en/search/id/BLSE:RN385692923/Comparison-of-Emergency-Department-Patients-to?cHash=d1392f105d6d98891c52ed2fd223651b ID - 761962 ER - TY - JOUR AB - OBJECTIVES: The development of pulmonary embolism response teams (PERTs) has been widely adopted nationally with the goal of providing multidisciplinary care to patients with high-risk PE. Most PERT activations originate from the emergency department (ED), while others are from the intensive care unit (ICU) or inpatient floors. It is unclear if ED PERT activations differ from non-ED PERT activation in terms of presentation, management, and outcome. METHODS: We enrolled a consecutive cohort of patients for whom PERT was activated at an urban academic medical center. We compared three groups of PERT activations based on whether the activation originated from the ED, ICU, or a non-ICU inpatient floor. We compared these groups in terms of the proportion of PERT activations that occurred during day, evening, or weekend hours and the proportion of confirmed PE. We also compared PE severity, treatment, and outcomes across locations. We tested differences using chi-square tests, with a two-tailed p-value of <0.05 considered statistically significant. RESULTS: We enrolled 561 patients, of whom 449 (79.5%) had confirmed PE. The mean ± SD age of patients with confirmed PE was 61 ± 17 years, and 300 (53.5%) were male. Activations from the ED (n = 283, 88.4%) or floor (n = 100, 74.6%) were more likely to be for confirmed PE than activations from the ICU (n = 63, 58.9%; p < 0.0001). There was a statistical difference in the time of day of PERT activation with the ED having more activations during night hours than the ICU or floors (p = 0.004). Most activations for confirmed, massive PE originated from the ICU (n = 41, 65.1%), followed by the ED (n = 82, 29%) and inpatient floors (n = 22, 22%; p < 0.0001). Most activations from the ED (n = 155, 54.8%) and floors (n = 55, 55%) were for submassive PE. The use of thrombolysis or thrombectomy was more common among ICU patients (n = 18, 33.3%), followed by ED patients (n = 53, 19.6%) and then floor patients (n = 8, 8.2%). Mortality and major bleeding events were most common among ICU patients and similar among ED and floor patients. CONCLUSIONS: Pulmonary embolism response team activations from different clinical locations differ in terms of patient presentation, PE confirmation, treatments, and outcomes. PERTs should be customized to support the different needs of each clinical area. AD - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Division of Cardiology and Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. AN - 28419620 AU - Deadmon, E. K. AU - Giordano, N. J. AU - Rosenfield, K. AU - Rosovsky, R. AU - Parry, B. A. AU - Al-Bawardy, R. F. AU - Chang, Y. AU - Kabrhel, C. DA - Jul DO - 10.1111/acem.13199 DP - NLM ET - 2017/04/19 J2 - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine KW - Academic Medical Centers Adult Aged Emergency Service, Hospital/*statistics & numerical data Emergency Treatment/*methods Female Hemorrhage Hospital Rapid Response Team/*statistics & numerical data Hospitalization/*statistics & numerical data Humans Intensive Care Units/*statistics & numerical data Male Middle Aged Pulmonary Embolism/mortality/*therapy Treatment Outcome LA - eng M1 - 7 N1 - 1553-2712 Deadmon, Erin K Giordano, Nicholas J Rosenfield, Kenneth Rosovsky, Rachel Parry, Blair Alden Al-Bawardy, Rasha Fahad Chang, Yuchiao Kabrhel, Christopher Comparative Study Journal Article United States Acad Emerg Med. 2017 Jul;24(7):814-821. doi: 10.1111/acem.13199. Epub 2017 May 11. PY - 2017 SN - 1069-6563 SP - 814-821 ST - Comparison of Emergency Department Patients to Inpatients Receiving a Pulmonary Embolism Response Team (PERT) Activation T2 - Acad Emerg Med TI - Comparison of Emergency Department Patients to Inpatients Receiving a Pulmonary Embolism Response Team (PERT) Activation VL - 24 ID - 760184 ER - TY - JOUR AB - Objectives The development of pulmonary embolism response teams ( PERTs) has been widely adopted nationally with the goal of providing multidisciplinary care to patients with high-risk PE. Most PERT activations originate from the emergency department ( ED), while others are from the intensive care unit ( ICU) or inpatient floors. It is unclear if ED PERT activations differ from non- ED PERT activation in terms of presentation, management, and outcome. Methods We enrolled a consecutive cohort of patients for whom PERT was activated at an urban academic medical center. We compared three groups of PERT activations based on whether the activation originated from the ED, ICU, or a non- ICU inpatient floor. We compared these groups in terms of the proportion of PERT activations that occurred during day, evening, or weekend hours and the proportion of confirmed PE. We also compared PE severity, treatment, and outcomes across locations. We tested differences using chi-square tests, with a two-tailed p-value of <0.05 considered statistically significant. Results We enrolled 561 patients, of whom 449 (79.5%) had confirmed PE. The mean ± SD age of patients with confirmed PE was 61 ± 17 years, and 300 (53.5%) were male. Activations from the ED ( n = 283, 88.4%) or floor ( n = 100, 74.6%) were more likely to be for confirmed PE than activations from the ICU ( n = 63, 58.9%; p < 0.0001). There was a statistical difference in the time of day of PERT activation with the ED having more activations during night hours than the ICU or floors (p = 0.004). Most activations for confirmed, massive PE originated from the ICU ( n = 41, 65.1%), followed by the ED ( n = 82, 29%) and inpatient floors ( n = 22, 22%; p < 0.0001). Most activations from the ED ( n = 155, 54.8%) and floors ( n = 55, 55%) were for submassive PE. The use of thrombolysis or thrombectomy was more common among ICU patients ( n = 18, 33.3%), followed by ED patients ( n = 53, 19.6%) and then floor patients ( n = 8, 8.2%). Mortality and major bleeding events were most common among ICU patients and similar among ED and floor patients. Conclusions Pulmonary embolism response team activations from different clinical locations differ in terms of patient presentation, PE confirmation, treatments, and outcomes. PERTs should be customized to support the different needs of each clinical area. AD - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA Division of Cardiology and Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA AN - 124050550. Language: English. Entry Date: 20170715. Revision Date: 20180711. Publication Type: Article AU - Deadmon, Erin K. AU - Giordano, Nicholas J. AU - Rosenfield, Kenneth AU - Rosovsky, Rachel AU - Parry, Blair Alden AU - Al‐Bawardy, Rasha Fahad AU - Chang, Yuchiao AU - Kabrhel, Christopher AU - Runyon, Michael S. DB - CINAHL DO - 10.1111/acem.13199 DP - EBSCOhost KW - Emergency Patients Inpatients Pulmonary Embolism Multidisciplinary Care Team Human Prospective Studies Chi Square Test Thrombectomy Hemorrhage M1 - 7 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. PY - 2017 SN - 1069-6563 SP - 814-821 ST - Comparison of Emergency Department Patients to Inpatients Receiving a Pulmonary Embolism Response Team ( PERT) Activation T2 - Academic Emergency Medicine TI - Comparison of Emergency Department Patients to Inpatients Receiving a Pulmonary Embolism Response Team ( PERT) Activation UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=124050550&site=ehost-live&scope=site VL - 24 ID - 761310 ER - TY - JOUR AB - Objectives: The development of pulmonary embolism response teams (PERTs) has been widely adopted nationally with the goal of providing multidisciplinary care to patients with high-risk PE. Most PERT activations originate from the emergency department (ED), while others are from the intensive care unit (ICU) or inpatient floors. It is unclear if ED PERT activations differ from non-ED PERT activation in terms of presentation, management, and outcome. Methods: We enrolled a consecutive cohort of patients for whom PERT was activated at an urban academic medical center. We compared three groups of PERT activations based on whether the activation originated from the ED, ICU, or a non-ICU inpatient floor. We compared these groups in terms of the proportion of PERT activations that occurred during day, evening, or weekend hours and the proportion of confirmed PE. We also compared PE severity, treatment, and outcomes across locations. We tested differences using chi-square tests, with a two-tailed p-value of <0.05 considered statistically significant. Results: We enrolled 561 patients, of whom 449 (79.5%) had confirmed PE. The mean +/- SD age of patients with confirmed PE was 61 +/- 17 years, and 300 (53.5%) were male. Activations from the ED (n = 283, 88.4%) or floor (n = 100, 74.6%) were more likely to be for confirmed PE than activations from the ICU (n = 63, 58.9%; p < 0.0001). There was a statistical difference in the time of day of PERT activation with the ED having more activations during night hours than the ICU or floors (p = 0.004). Most activations for confirmed, massive PE originated from the ICU (n = 41, 65.1%), followed by the ED (n = 82, 29%) and inpatient floors (n = 22, 22%; p < 0.0001). Most activations from the ED (n = 155, 54.8%) and floors (n = 55, 55%) were for submassive PE. The use of thrombolysis or thrombectomy was more common among ICU patients (n = 18, 33.3%), followed by ED patients (n = 53, 19.6%) and then floor patients (n = 8, 8.2%). Mortality and major bleeding events were most common among ICU patients and similar among ED and floor patients. Conclusions: Pulmonary embolism response team activations from different clinical locations differ in terms of patient presentation, PE confirmation, treatments, and outcomes. PERTs should be customized to support the different needs of each clinical area. AD - [Deadmon, Erin K.; Giordano, Nicholas J.; Parry, Blair Alden; Kabrhel, Christopher] Harvard Med Sch, Massachusetts Gen Hosp, Dept Emergency Med, Ctr Vasc Emergencies, Boston, MA 02115 USA. [Rosenfield, Kenneth; Al-Bawardy, Rasha Fahad] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Div Cardiol & Vasc Med, Boston, MA USA. [Rosovsky, Rachel] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Div Hematol & Oncol, Boston, MA USA. [Chang, Yuchiao] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Boston, MA USA. Kabrhel, C (corresponding author), Harvard Med Sch, Massachusetts Gen Hosp, Dept Emergency Med, Ctr Vasc Emergencies, Boston, MA 02115 USA. ckabrhel@mgh.harvard.edu AN - WOS:000407135100004 AU - Deadmon, E. K. AU - Giordano, N. J. AU - Rosenfield, K. AU - Rosovsky, R. AU - Parry, B. A. AU - Al-Bawardy, R. F. AU - Chang, Y. C. AU - Kabrhel, C. DA - Jul DO - 10.1111/acem.13199 J2 - Acad. Emerg. Med. KW - DEEP-VEIN THROMBOSIS VENOUS THROMBOEMBOLISM MANAGEMENT OUTCOMES REGISTRY RISK THROMBOLYSIS PRESSURE TRENDS Emergency Medicine LA - English M1 - 7 M3 - Article N1 - ISI Document Delivery No.: FC9BF Times Cited: 6 Cited Reference Count: 26 Deadmon, Erin K. Giordano, Nicholas J. Rosenfield, Kenneth Rosovsky, Rachel Parry, Blair Alden Al-Bawardy, Rasha Fahad Chang, Yuchiao Kabrhel, Christopher Janssen PharmaceuticalsJohnson & Johnson USAJanssen Biotech Inc; Siemens Healthcare; Diagnostica Stago; Boehringer-IngelheimBoehringer Ingelheim CK has a grant and consulting agreement with Janssen Pharmaceuticals, Siemens Healthcare, and Diagnostica Stago, and a grant with Boehringer-Ingelheim. 7 0 WILEY HOBOKEN ACAD EMERG MED PY - 2017 SN - 1069-6563 SP - 814-821 ST - Comparison of Emergency Department Patients to Inpatients Receiving a Pulmonary Embolism Response Team (PERT) Activation T2 - Academic Emergency Medicine TI - Comparison of Emergency Department Patients to Inpatients Receiving a Pulmonary Embolism Response Team (PERT) Activation UR - ://WOS:000407135100004 VL - 24 ID - 761646 ER - TY - JOUR AB - Background- National guidelines endorse recombinant tissue-type plasminogen activator (r-tPA) in eligible patients with acute ischemic stroke to improve patients' functional recovery. However, 23% to 40% of ideal candidates with acute ischemic stroke for reperfusion are not treated, perhaps because of the difficulty in explaining the benefits and risks of r-tPA within the frenetic pace of emergency department care. To support better knowledge transfer and creation of a shared decision-making tool, we conducted qualitative interviews to define the information needs and preferred presentation format for stroke survivors, caregivers, and clinicians considering r-tPA treatment. Methods and Results- A multidisciplinary team used qualitative research methods to identify informational needs and strategies for describing the benefits and risks of r-tPA in a clinical setting. Through focus groups (n=10) of stroke survivors (n=39) and caregivers (n=24) and individual interviews with emergency physicians (n=23) and advanced practice nurses (n=20), several themes emerged. Survivors and caregivers preferred a broader definition of a good outcome (independence, rather than no significant disability), simpler graphs as compared with detailed pictographs, and presentation of both population and individualized benefits (framed positively) and risk of receiving r-tPA. Some physicians expressed skepticism with the data and the ability to present risk/benefit information emergently, whereas other physicians and most advanced practice nurses thought such information would improve care. Physicians stressed the importance of presenting the risk of thrombolytic-related intracranial hemorrhage. Conclusions- This study suggests that a positively framed risk-benefit tool with graphical presentations of general and patient-specific risk estimates could support patients and providers in considering r-tPA for acute ischemic stroke. Clinical Trial Registration- URL: [GRAPHICS] . Unique identifier: NCT01864928. AD - [Decker, Carole] Univ Missouri Kansas City, Sch Nursing, Kansas City, MO USA. [Spertus, John A.] Univ Missouri Kansas City, Sch Med, Dept Biomed & Hlth Informat, Kansas City, MO USA. [Decker, Carole; Chhatriwalla, Emily; Gialde, Elizabeth; Garavalia, Brian; Summers, Debbie; Spertus, John A.] St Lukes Hosp Kansas City, Cardiovasc Outcomes Res, Kansas City, MO USA. [Quinlan, Miriam E.; Cheng, Eric] Univ Calif Los Angeles, David Geffen Sch Med, Dept Neurol, Los Angeles, CA 90024 USA. [Saver, Jeffrey L.] Univ Calif Los Angeles, Comprehens Stroke Ctr, Los Angeles, CA 90024 USA. [Rymer, Marilyn] Univ Kansas Hosp, Ctr Adv Brain & Neurol Care, Kansas City, MO USA. [Cheng, Eric] Genentech Inc, US Med Affairs Cardiometab Neurosci, San Francisco, CA USA. [Kent, David M.] Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Predict Analyt & Comparat Effectiveness PACE Ctr, Boston, MA USA. Decker, C (corresponding author), St Lukes Mid Amer Heart Inst, Cardiovasc Outcomes Res, Kansas City, MO 64111 USA. c1decker@saint-lukes.org AN - WOS:000371333600008 AU - Decker, C. AU - Chhatriwalla, E. AU - Gialde, E. AU - Garavalia, B. AU - Summers, D. AU - Quinlan, M. E. AU - Cheng, E. AU - Rymer, M. AU - Saver, J. L. AU - Chen, E. AU - Kent, D. M. AU - Spertus, J. A. DA - Oct DO - 10.1161/circoutcomes.115.002003 J2 - Circ.-Cardiovasc. Qual. Outcomes KW - caregivers stroke treatment outcome intracranial hemorrhage survivors TISSUE-PLASMINOGEN ACTIVATOR INTRAVENOUS THROMBOLYSIS INTRACRANIAL HEMORRHAGE POOLED ANALYSIS ALTEPLASE RISK TIME GUIDELINES FRAMEWORK ATLANTIS Cardiac & Cardiovascular Systems LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: DF4QD Times Cited: 16 Cited Reference Count: 47 Decker, Carole Chhatriwalla, Emily Gialde, Elizabeth Garavalia, Brian Summers, Debbie Quinlan, Miriam E. Cheng, Eric Rymer, Marilyn Saver, Jeffrey L. Chen, Er Kent, David M. Spertus, John A. American Heart Association/Spina Outcomes Research Center grant [0875149 N]; GenentechRoche HoldingGenentech This study was partially funded by grants from the American Heart Association/Spina Outcomes Research Center grant (0875149 N) and Genentech. 17 0 6 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CIRC-CARDIOVASC QUAL 3 PY - 2015 SN - 1941-7705 SP - S109-S116 ST - Patient-Centered Decision Support in Acute Ischemic Stroke Qualitative Study of Patients' and Providers' Perspectives T2 - Circulation-Cardiovascular Quality and Outcomes TI - Patient-Centered Decision Support in Acute Ischemic Stroke Qualitative Study of Patients' and Providers' Perspectives UR - ://WOS:000371333600008 VL - 8 ID - 761739 ER - TY - JOUR AB - PMID:33104984 AU - Dehghan, Houman DA - 2020/10/26 10/26 DB - PubMed Central DO - 10.1007/s12574-020-00500-x PY - 2020 SN - 1349-0222 SP - 1-1 ST - Pulmonary thromboembolism with multiple right heart mural thrombus in a patient with COVID-19 T2 - Journal of Echocardiography TI - Pulmonary thromboembolism with multiple right heart mural thrombus in a patient with COVID-19 UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7587169&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7587169 ID - 762007 ER - TY - JOUR AU - Dehghan, H. AU - Soleimani, A. DA - 2020/10/28 10/28 DB - Europe PubMed Central DO - 10.1007/s12574-020-00500-x PY - 2020 SN - 1349-0222 ST - Pulmonary thromboembolism with multiple right heart mural thrombus in a patient with COVID-19 T2 - J Echocardiogr TI - Pulmonary thromboembolism with multiple right heart mural thrombus in a patient with COVID-19 UR - http://europepmc.org/article/MED/33104984 ID - 762006 ER - TY - JOUR AB - BACKGROUND: Cardiologists may prescribe antithrombotic therapy to patients with atrial fibrillation (AF), but prescription application mostly depends on general practitioners. The present study aims to assess frequency and appropriateness of antithrombotic therapy in general practice, as a function of thromboembolic risk factors, using the CHADS2 score. METHODS: The computer records of 39 general practitioners were evaluated in order to identify patients with non-valvular AF; therapy and thromboembolic risk factors were recorded. RESULTS: AF was documented in 951 patients; 96 (10.1%) had contraindications to oral anticoagulants. Among the remaining 850 patients, 292 (34.4%) did not receive antithrombotic therapy according to guidelines. In particular, 102 (12.0%) did not receive any antithrombotic treatment. CONCLUSIONS: Among general practitioners of the Veneto region (Italy), the application of guidelines on antithrombotic therapy in non-valvular AF is comparable, or even slightly better than that reported in published cohort studies, but it deserves further improvement. There is a need for targeted educational interventions and a better coordination between cardiologists and general practitioners. AD - Divisione Clinicizzata di Cardiologia, A.O. Istituti Ospitalieri, Verona. AN - 20677578 AU - Del Zotti, F. AU - Gottardi, G. AU - Frapporti, G. AU - Micchi, A. AU - Zanolla, L. DA - Apr DP - NLM ET - 2010/08/04 J2 - Giornale italiano di cardiologia (2006) KW - Aged Aged, 80 and over Anticoagulants/therapeutic use Atrial Fibrillation/*complications Cardiology Cohort Studies Comorbidity Drug Utilization Family Practice Female Fibrinolytic Agents/therapeutic use Guideline Adherence Humans Italy/epidemiology Male Middle Aged Patient Care Team Patient Education as Topic Practice Guidelines as Topic Risk Factors Severity of Illness Index Thromboembolism/*epidemiology/etiology/prevention & control Thrombophilia/drug therapy/*etiology LA - ita M1 - 4 N1 - Del Zotti, Francesco Gottardi, Giobatta Frapporti, Guglielmo Micchi, Alessio Zanolla, Luisa English Abstract Journal Article Italy G Ital Cardiol (Rome). 2010 Apr;11(4):313-7. OP - Fibrillazione atriale non valvolare: valutazione del rischio tromboembolico e del trattamento antitrombotico in una popolazione di pazienti in medicina generale. PY - 2010 SN - 1827-6806 (Print) 1827-6806 SP - 313-7 ST - [Nonvalvular atrial fibrillation: thromboembolic risk assessment and therapy in a general practice population] T2 - G Ital Cardiol (Rome) TI - [Nonvalvular atrial fibrillation: thromboembolic risk assessment and therapy in a general practice population] VL - 11 ID - 760451 ER - TY - JOUR AB - Objective. - The objective of our study was to compare treatment-based obstetrical outcomes in women with either thrombotic or obstetrical antiphospholipid syndrome (APS). Materials and methods. - This was a historical cohort study conducted between 1998 and 2009 in 23 patients who had a total of 83 pregnancies. The syndrome was diagnosed using the 2006 Sapporo criteria. Results. - Thirty-one of these 83 pregnancies were valid before the diagnosis was made. A live infant was born in 22% of them, the infant being small for gestational age in 26% of cases. The fetus died in utero in a further 26% of cases. Pregnancies were subdivided into 2 groups depending on whether the initial event leading to APS diagnosis was obstetrical or thrombotic. Treatment (aspirin and low molecular weight heparin) was based on this classification: the latter was given in a curative dose for thrombotic events, in a preventive dose for obstetrical events. No fetal loss was observed when treatment was administered according to the protocol. Nevertheless, 20% of the pregnancies with obstetrical APS were complicated by smallness for gestational age and only 38% of the infants were live births. More than 87% of the thrombotic forms treated were free of complications and led to birth of a living child. Conclusion. - Appropriate treatment appears to improve the prognosis for pregnancies in patients with APS. These patients are nevertheless at increased risk of an obstetrical event and require close monitoring, especially in obstetrical manifestations, which appear to have a poorer prognosis. Multidisciplinary follow-up by an experienced team is essential. (C) 2014 Elsevier Masson SAS. All rights reserved. AD - [Delesalle, C.; de Vienne, C.; Dreyfus, M.] CHU Caen, Pole Femme Enfant, Serv & Dept Gynecol Obstet & Med Reprod, F-14033 Caen 9, France. [Delesalle, C.; Dreyfus, M.] Univ Caen Basse Normandie, F-14032 Caen 5, France. [Le Hello, C.] CHU Caen, Dept Med Vasc, F-14000 Caen, France. [Verspyck, E.] CHU Charles Nicolle, Pole Gynecol & Obstet, F-76031 Rouen, France. [Verspyck, E.] Univ Rouen, F-76000 Rouen, France. Delesalle, C (corresponding author), CHU Caen, Pole Femme Enfant, Serv & Dept Gynecol Obstet & Med Reprod, Ave Cote de Nacre, F-14033 Caen 9, France. delesalle-c@chu-caen.fr AN - WOS:000356566300010 AU - Delesalle, C. AU - de Vienne, C. AU - Le Hello, C. AU - Verspyck, E. AU - Dreyfus, M. DA - May DO - 10.1016/j.jgyn.2014.06.002 J2 - J. Gynecol. Obstet. Biol. Reprod. KW - Antiphospholipid syndrome Management Pregnancy LOW-DOSE ASPIRIN CONTROLLED-TRIAL ANTIBODIES WOMEN AUTOANTIBODIES PREECLAMPSIA ASSOCIATION PREVENTION MANAGEMENT HEPARIN Obstetrics & Gynecology LA - French M1 - 5 M3 - Article N1 - ISI Document Delivery No.: CK9NH Times Cited: 1 Cited Reference Count: 37 Delesalle, C. de Vienne, C. Le Hello, C. Verspyck, E. Dreyfus, M. 2 0 5 ELSEVIER MASSON, CORP OFF PARIS J GYNECOL OBST BIO R PY - 2015 SN - 0368-2315 SP - 463-470 ST - Antiphospholipid syndrome and pregnancy: Obstetrical prognosis according to the type of APS T2 - Journal De Gynecologie Obstetrique Et Biologie De La Reproduction TI - Antiphospholipid syndrome and pregnancy: Obstetrical prognosis according to the type of APS UR - ://WOS:000356566300010 VL - 44 ID - 761753 ER - TY - JOUR AB - Background and Purpose-Telemedicine techniques can be used to address the rural-metropolitan disparity in acute stroke care. The Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC) trial reported more accurate decision making for telemedicine consultations compared with telephone-only and that the California-based research network facilitated a high rate of thrombolysis use, improved data collection, low risk of complications, low technical complications, and favorable assessment times. The main objective of the STRokE DOC Arizona TIME (The Initial Mayo Clinic Experience) trial was to determine the feasibility of establishing, de novo, a single-hub, multirural spoke hospital telestroke research network across a large geographical area in Arizona by replicating the STRokE DOC protocol. Methods-Methods included prospective, single-hub, 2-spoke, randomized, blinded, controlled trial of a 2-way, site-independent, audiovisual telemedicine system designed for remote examination of adult patients with acute stroke versus telephone consultation to assess eligibility for treatment with intravenous thrombolysis. The primary outcome measure was whether the decision to give thrombolysis was correct. Secondary outcomes were rate of thrombolytic use, 90-day functional outcomes, incidence of intracerebral hemorrhages, and technical observations. Results-From December 2007 to October 2008, 54 patients were assessed, 27 of whom were randomized to each arm. Mean National Institutes of Health Stroke Scale score at presentation was 7.3 (SD 6.2) points. No consultations were aborted; however, technical problems (74%) were prevalent in the telemedicine arm. Overall, the correct treatment decision was established in 87% of the consultations. Both modalities, telephone (89% correct) and telemedicine (85% correct), performed well. Intravenous thrombolytic treatment was used in 30% of the telemedicine and telephone consultations. Good functional outcomes at 90 days were not significantly different. There were no statistically significant differences in mortality (4% in telemedicine and 11% in telephone) or rates of intracerebral hemorrhage (4% in telemedicine and 0% in telephone). Conclusions-It is feasible to extend the original STRokE DOC trial protocol to a new state and establish an operational single-hub, multispoke rural hospital telestroke research network in Arizona. The trial was not designed to have sufficient power to detect a difference between the 2 consultative modes: telemedicine and telephone-only. Whether by telemedicine or telephone consultative modalities, there were appropriate treatment decisions, high rates of thrombolysis use, improved data collection, low rates of intracerebral hemorrhage, and equally favorable time requirements. The learning curve was steep for the hub and spoke personnel of the new telestroke network, as reflected by frequent technical problems. Overall, the results support the effectiveness of highly organized and structured stroke telemedicine networks for extending expert stroke care into rural remote communities lacking sufficient neurological expertise. (Stroke. 2010; 41: 1251-1258.) AD - [Demaerschalk, Bart M.; Kiernan, Terri-Ellen J.; Aguilar, Maria I.; Ingall, Timothy J.; Dodick, David W.; Snyder, Charlene R. Hoffman] Mayo Clin Arizona, Dept Neurol, Phoenix, AZ USA. [Brazdys, Karina] Mayo Clin Arizona, Div Clin Res Serv, Phoenix, AZ USA. [Corday, Doren A.] Mayo Clin Arizona, Div Informat Technol, Phoenix, AZ USA. Arizona Dept Hlth Serv, Bur Emergency Med Serv & Trauma Syst & Maricopa M, Phoenix, AZ 85007 USA. [Raman, Rema; Meyer, Brett C.] Univ Calif San Diego, Sch Med, Dept Neurosci, La Jolla, CA 92093 USA. [Ward, Michael P.] Kingman Reg Med Ctr, Dept Emergency Med, Kingman, AZ USA. [Richemont, Phillip C.] Yuma Reg Med Ctr, Dept Emergency Med, Yuma, AZ USA. [Koch, Tiffany C.] Arizona Res Ctr, Phoenix, AZ USA. [Miley, Madeline L.] Loyola Univ, Dept Neurosci, Chicago, IL 60611 USA. Demaerschalk, BM (corresponding author), Mayo Clin Hosp, Cerebrovasc Dis Ctr, 5777 Mayo Blvd, Phoenix, AZ 85054 USA. demaerschalk.bart@mayo.edu AN - WOS:000278019400030 AU - Demaerschalk, B. M. AU - Bobrow, B. J. AU - Raman, R. AU - Kiernan, T. E. J. AU - Aguilar, M. I. AU - Ingall, T. J. AU - Dodick, D. W. AU - Ward, M. P. AU - Richemont, P. C. AU - Brazdys, K. AU - Koch, T. C. AU - Miley, M. L. AU - Snyder, C. R. H. AU - Corday, D. A. AU - Meyer, B. C. AU - Investigators, S. TRokE DOC AZ TIME DA - Jun DO - 10.1161/strokeaha.109.574509 J2 - Stroke KW - stroke telemedicine rural hospitals rural health state government randomized controlled trials DOC TRIAL TELEMEDICINE ASSOCIATION CARE STATEMENT SYSTEMS Clinical Neurology Peripheral Vascular Disease LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: 600WK Times Cited: 81 Cited Reference Count: 12 Demaerschalk, Bart M. Bobrow, Bentley J. Raman, Rema Kiernan, Terri-Ellen J. Aguilar, Maria I. Ingall, Timothy J. Dodick, David W. Ward, Michael P. Richemont, Phillip C. Brazdys, Karina Koch, Tiffany C. Miley, Madeline L. Snyder, Charlene R. Hoffman Corday, Doren A. Meyer, Brett C. SALAZAR, ANTONIO/A-5806-2013 SALAZAR, ANTONIO/0000-0003-2639-2340 Arizona Department of Health Services; Mayo Clinic This work was supported by an Arizona Department of Health Services research grant and a Mayo Clinic research grant. The telemedicine application (Accessvideo) was purchased from BF Technologies. 81 0 8 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA STROKE PY - 2010 SN - 0039-2499 SP - 1251-1258 ST - Stroke Team Remote Evaluation Using a Digital Observation Camera in Arizona The Initial Mayo Clinic Experience Trial T2 - Stroke TI - Stroke Team Remote Evaluation Using a Digital Observation Camera in Arizona The Initial Mayo Clinic Experience Trial UR - ://WOS:000278019400030 VL - 41 ID - 761873 ER - TY - JOUR AB - Stroke telemedicine is a consultative modality that facilitates care of patients with acute stroke at underserviced hospitals by specialists at stroke centers. The design and Implementation of a hub-and-spoke telestroke network are complex. This review describes the technology that makes stroke telemedicine possible, the members that should be Included In a telestroke team, the hub-and-spoke characteristics of a telestroke network, and the format of a typical consultation. Common obstacles to the practice of telestroke medicine are explored, such as medicolegal, economic, and market Issues. An example of a state-based telestroke network Is thoroughly described, and established International telestroke networks are presented and compared. The opportunities for future advances In telestroke practice, research, and education are considered. AD - [Demaerschalk, Bart M.; Miley, Madeline L.; Kiernan, Terri-Ellen J.; Aguilar, Maria I.; Ingall, Timothy J.; Dodick, David W.] Mayo Clin Hosp, Dept Neurol, Phoenix, AZ 85054 USA. [Bobrow, Bentley J.] Mayo Clin Hosp, Dept Emergency Med, Phoenix, AZ 85054 USA. [Corday, Doren A.] Mayo Clin Hosp, Div Informat Technol, Phoenix, AZ 85054 USA. [Wellik, Kay E.] Mayo Clin Hosp, Lib Serv, Div Educ Adm, Phoenix, AZ 85054 USA. [Koch, Tiffany C.] Mayo Clin Hosp, Div Res Adm Serv, Phoenix, AZ 85054 USA. [Miley, Madeline L.] Loyola Univ, Dept Biol, Chicago, IL 60626 USA. [Bobrow, Bentley J.] Arizona Dept Hlth Serv, Bur EMS & Trauma Syst, Phoenix, AZ 85007 USA. [Ward, Michael P.] Kingman Reg Med Ctr, Dept Emergency Med, Kingman, AZ USA. [Richemont, Phillip C.] Yuma Reg Med Ctr, Dept Emergency Med, Yuma, AZ USA. Demaerschalk, BM (corresponding author), Mayo Clin Hosp, Dept Neurol, 5777 E Mayo Blvd, Phoenix, AZ 85054 USA. demaerschalk.bart@mayo.edu AN - WOS:000262032400011 AU - Demaerschalk, B. M. AU - Miley, M. L. AU - Kiernan, T. E. J. AU - Bobrow, B. J. AU - Corday, D. A. AU - Wellik, K. E. AU - Aguilar, M. I. AU - Ingall, T. J. AU - Dodick, D. W. AU - Brazdys, K. AU - Koch, T. C. AU - Ward, M. P. AU - Richemont, P. C. AU - Coinvestigators, Starr DA - Jan DO - 10.4065/84.1.53 J2 - Mayo Clin. Proc. KW - ACUTE ISCHEMIC-STROKE TISSUE-PLASMINOGEN ACTIVATOR PILOT PROJECT CARE TEMPIS PROSPECTIVE RELIABILITY EMERGENCY PHYSICIANS METROPOLITAN MATRIX REMOTE EVALUATION TELESTROKE THROMBOLYSIS Medicine, General & Internal LA - English M1 - 1 M3 - Review N1 - ISI Document Delivery No.: 388PT Times Cited: 114 Cited Reference Count: 65 Demaerschalk, Bart M. Miley, Madeline L. Kiernan, Terri-Ellen J. Bobrow, Bentley J. Corday, Doren A. Wellik, Kay E. Aguilar, Maria I. Ingall, Timothy J. Dodick, David W. Brazdys, Karina Koch, Tiffany C. Ward, Michael P. Richemont, Phillip C. Arizona Department of Health Services [HI754123]; Mayo Clinic research [90256993]; Stroke Telemedicine for Arizona Rural Residents (STARR) Registry; STRokE DOC Arizona-The Initial Mayo Experience (TIME) trial [NCT00623350] This study was funded by an Arizona Department of Health Services research grant (HI754123), a Mayo Clinic research grant (90256993), the STRokE DOC Arizona-The Initial Mayo Experience (TIME) trial (clinicaltrials.gov identifier: NCT00623350), and the Stroke Telemedicine for Arizona Rural Residents (STARR) Registry. 116 0 18 ELSEVIER SCIENCE INC NEW YORK MAYO CLIN PROC PY - 2009 SN - 0025-6196 SP - 53-64 ST - Stroke Telemedicine T2 - Mayo Clinic Proceedings TI - Stroke Telemedicine UR - ://WOS:000262032400011 VL - 84 ID - 761904 ER - TY - JOUR AB - Key-Words: Metastatic-Spinal-Cord-Compression, Rehabilitation, Oncological-Emergency Purpose: Metastatic spinal cord compression (MSCC) is an oncological emergency that requires efficient and effective diagnosis, treatment and rehabilitation (NICE 2008). The current MSCC quality standards for adults highlight the need for: Early detection of MSCC through appropriate assessment by MSCC Co-ordinator, spinal surgeon and clinical oncologist, and imaging within 24 hours. Treatment (dexamethasone, radiotherapy, surgery) commencement within 24 hours of confirmed diagnosis Timely rehabilitation and discharge planning with patient and family input The aim of this audit is to: Determine whether the multidisciplinary team (MDT) management of patients admitted with MSCC meets national and local guidelines at Guy's and St Thomas’ Hospital (GSTT). Identify what changes need to be met in order to meet national (NICE 2008, 2014) and local Kings Health Partners guidelines (KHP 2015). Methods: NICE guidelines (2008) and the updated local (KHP) guidelines (2015) were reviewed and an agreed local audit tool was developed by an expert panel of physiotherapists and Doctors. The audit tool highlighted the key components to benchmark all patients admitted with a suspected and/or confirmed MSCC. A list of all suspected and confirmed MSCC patients admitted to Guys hospital within GSTT April 2017-April 2018 was compiled from physiotherapy and oncology records. Medical notes were retrospectively analysed using the audit tool and results compiled. Results: 80 Patients were admitted to GSTT oncology wards with suspected MSCC between April 2017-April 2018. Of these patients, 40 had confirmed MSCC, 24 Impending and 16 suspected but no MSCC identified. 87.5% of patients were commenced on dexamethasone and 95% venous thromboembolism prophylaxis immediately on suspicion of MSCC. 70% of individuals had a MRI scan within 24 hours and 46.7% of patients commenced oncological treatment (radiotherapy, surgery or chemotherapy) within 24 hours of confirmed MSCC. Spinal stability was documented for 73% and a formal ASIA assessment was completed in 34.4% of cases on admission and 3% of cases on discharge. Examination of the rehabilitation pathway for individuals with confirmed MSCC demonstrated that 98% of individuals had rehab commenced within 24 hours of referral. A total of 17.17 hours was spent per patient during their admission (average length of stay 21.21 days) with an average of 49.9 minutes direct rehab provided per session. Conclusion(s): MSCC is an oncological emergency which requires clear and effective pathways for diagnosis, treatment and onward rehabilitation. This audit demonstrates good compliance with national and local standards in some areas of care. However, highlights the need for improvements in key areas such as MRI scan within 24 hours, time to commence oncological treatment, documentation of spinal stability and record of formal neurological assessment. Thus the need for a more streamlined pathway is still evident. Implications: Early detection and timely management is vital for individuals with MSCC and can significantly improve patient outcomes. This project has identified the need for improved education and development of the MSCC pathway within GSTT. Collaborative working between the Rehabilitation, Oncology and Surgical services is vital to implement changes to improve MSCC pathways and ensure quality care for patients with suspected and or confirmed MSCC. Funding acknowledgements: Unfunded. AD - K. Denaro, Guys and St Thomas NHS Foundation Trust, Physiotherapy, London, United Kingdom AU - Denaro, K. AU - Peat, N. AU - George, R. AU - Earnshaw, I. DB - Embase DO - 10.1016/j.physio.2020.03.074 KW - dexamethasone adult cancer patient cancer radiotherapy cancer surgery chemotherapy conference abstract controlled study diagnosis documentation drug therapy education female funding hematology hospital discharge human length of stay major clinical study male multidisciplinary team nervous system nuclear magnetic resonance imaging oncology ward patient referral physiotherapist physiotherapy practice guideline prophylaxis radiotherapy rehabilitation retrospective study spinal cord metastasis venous thromboembolism LA - English M3 - Conference Abstract N1 - L2006783557 2020-06-25 PY - 2020 SN - 1873-1465 0031-9406 SP - e54 ST - Metastatic spinal cord compression - a retrospective audit of current practice on medical oncology and haematology wards at GSTT T2 - Physiotherapy (United Kingdom) TI - Metastatic spinal cord compression - a retrospective audit of current practice on medical oncology and haematology wards at GSTT UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2006783557&from=export http://dx.doi.org/10.1016/j.physio.2020.03.074 VL - 107 ID - 760569 ER - TY - JOUR AB - Salvage surgery is usually the only treatment for recurrent head and neck tumors but often poses a challenge to surgeons due to post-resected defects at 2 or more sites. Here we present the outcomes and rationale for reconstruction by a double-island anterolateral thigh (ALT) free flap following the salvage surgery.Patients treated with double-island ALT free flaps in salvage surgery between September 2012 and January 2017 at West China Hospital, Sichuan University were retrospectively viewed.A total of 18 patients (15 males) underwent reconstruction with double-island ALT free flaps (range from 40 to 77 years old). All patients had recurrent tumors after surgery and/or chemoradiotherapy and were selected for salvage surgery by a multidisciplinary team. The flaps were initially harvested as 7 cm × 7 cm to 16 cm × 10 cm single blocks and then divided into double-island flaps with each individual paddle ranging from5 cm × 3 cm to 10 cm × 8 cm. The average flap thickness was 3.5 cm (range from 2 to 6 cm), and the average pedicle length was 8 cm (range from 6 to 10 cm). A total of 18 arteries and 32 veins were anastomosed. Three patients developed fistula, 1 developed flap failure due to thrombosis and was re-operated with a pedicle flap. One patient died of pulmonary infection 6 months after the operation.Flap reconstruction for complex head and neck defects after salvage surgery remains challenging, but double-island ALT free flap reconstruction conducted by a multidisciplinary team and experienced surgeons would have a role in this setting. AD - Department of Otorhinolaryngology Head and Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China. AN - 30313121 AU - Deng, D. AU - Liu, J. AU - Chen, F. AU - Lv, D. AU - Gan, W. AU - Li, L. AU - Wang, J. C2 - Pmc6203530 DA - Oct DO - 10.1097/md.0000000000012839 DP - NLM ET - 2018/10/14 J2 - Medicine KW - Adult Aged China Female *Free Tissue Flaps Head and Neck Neoplasms/*surgery Humans Male Middle Aged Reconstructive Surgical Procedures/*methods Salvage Therapy LA - eng M1 - 41 N1 - 1536-5964 Deng, Di Liu, Jun Chen, Fei Lv, Dan Gan, Weigang Li, Linke Wang, Ji Journal Article Observational Study Medicine (Baltimore). 2018 Oct;97(41):e12839. doi: 10.1097/MD.0000000000012839. PY - 2018 SN - 0025-7974 (Print) 0025-7974 SP - e12839 ST - Double-island anterolateral thigh free flap used in reconstruction for salvage surgery for locally recurrent head and neck carcinoma T2 - Medicine (Baltimore) TI - Double-island anterolateral thigh free flap used in reconstruction for salvage surgery for locally recurrent head and neck carcinoma VL - 97 ID - 760243 ER - TY - JOUR AB - Salvage surgery is usually the only treatment for recurrent head and neck tumors but often poses a challenge to surgeons due to post-resected defects at 2 or more sites. Here we present the outcomes and rationale for reconstruction by a double-island anterolateral thigh (ALT) free flap following the salvage surgery. Patients treated with double-island ALT free flaps in salvage surgery between September 2012 and January 2017 at West China Hospital, Sichuan University were retrospectively viewed. A total of 18 patients (15 males) underwent reconstruction with double-island ALT free flaps (range from 40 to 77 years old). All patients had recurrent tumors after surgery and/or chemoradiotherapy and were selected for salvage surgery by a multidisciplinary team. The flaps were initially harvested as 7cm x 7cm to 16cm x 10cm single blocks and then divided into double-island flaps with each individual paddle ranging from 5cm x 3cm to 10cm x 8cm. The average flap thickness was 3.5cm (range from 2 to 6cm), and the average pedicle length was 8cm (range from 6 to 10cm). A total of 18 arteries and 32 veins were anastomosed. Three patients developed fistula, 1 developed flap failure due to thrombosis and was re-operated with a pedicle flap. One patient died of pulmonary infection 6 months after the operation. Flap reconstruction for complex head and neck defects after salvage surgery remains challenging, but double-island ALT free flap reconstruction conducted by a multidisciplinary team and experienced surgeons would have a role in this setting. AD - [Deng, Di; Liu, Jun; Chen, Fei; Lv, Dan; Gan, Weigang; Li, Linke; Wang, Ji] Sichuan Univ, West China Hosp, Dept Otorhinolaryngol Head & Neck Surg, 37 Guo Xue Lane, Chengdu 610041, Sichuan, Peoples R China. Chen, F (corresponding author), Sichuan Univ, West China Hosp, Dept Otorhinolaryngol Head & Neck Surg, 37 Guo Xue Lane, Chengdu 610041, Sichuan, Peoples R China. 375572059@qq.com AN - WOS:000452234800103 AU - Deng, D. AU - Liu, J. AU - Chen, F. AU - Lv, D. AU - Gan, W. G. AU - Li, L. K. AU - Wang, J. C7 - e12839 DA - Oct DO - 10.1097/md.0000000000012839 J2 - Medicine KW - double-island anterolateral thigh free flap head and neck carcinoma multidisciplinary team reconstruction salvage surgery SQUAMOUS-CELL CARCINOMA LARYNGECTOMY FISTULA Medicine, General & Internal LA - English M1 - 41 M3 - Article N1 - ISI Document Delivery No.: HD0YG Times Cited: 0 Cited Reference Count: 29 Deng, Di Liu, Jun Chen, Fei Lv, Dan Gan, Weigang Li, Linke Wang, Ji Liu, Jun/0000-0003-4800-7749 Science and Technology department of Sichuan Province [2018SZ0133]; Science and Technology department of Chengdu [2016-HM01-00210-SF, 2016-HM01-00167-SF] This work was partly supported by the Science and Technology department of Sichuan Province (NO. 2018SZ0133; F Chen), the Science and Technology department of Chengdu (NO.2016-HM01-00167-SF; F Chen) and (NO. 2016-HM01-00210-SF;J Liu). 1 3 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA MEDICINE Baltimore PY - 2018 SN - 0025-7974 SP - 5 ST - Double-island anterolateral thigh free flap used in reconstruction for salvage surgery for locally recurrent head and neck carcinoma T2 - Medicine TI - Double-island anterolateral thigh free flap used in reconstruction for salvage surgery for locally recurrent head and neck carcinoma UR - ://WOS:000452234800103 VL - 97 ID - 761566 ER - TY - JOUR AB - Objectives. - Giant intracranial aneurysms represent a major therapeutic challenge for each surgical team. The aim of our study was to extensively review the French contemporary experience in treating giant intracranial aneurysms in order to assess the current management. Patients and methods. - This retrospective multicenter study concerned consecutive patients treated for giant intracranial aneurysms (2004-2008) in different French university hospitals (Bordeaux, Caen, Clermont-Ferrand, Lille, Lyon, Nice, Paris-Lariboisiere, Rouen et Toulouse). Different variables were analyzed: the diagnostic circumstances, the initial clinical status based on the WFNS scale, aneurysmal features and exclusion procedure. At 6 months, the outcome was evaluated according to the modified Rankin Scale (mRS): favorable (mRS 0-2) and unfavorable (mRS 3-6). A multivariate logistic regression model included all the independent variables with P < 0.25 in the univariate analysis (P < 0.05). Results. - A total of 79 patients with a mean age of 51.5 +/- 1.6 years (median: 52 years; range: 16-79) were divided into two groups, with the ruptured group (n = 26, 32.9%) significantly younger (P<0.05, Student's-t-test) than the unruptured group (n = 53, 67.1%). After SAH, the initial clinical status was good in 12 patients (46.2%), and in the unruptured group, the predominant diagnosis circumstance was a pseudo-tumor syndrome occurring in 22 (41.5%). The first procedure of aneurysm treatment in the global population was endovascular in 42 patients (53.1%), microsurgical in 29 (36.7%) and conservative in 8 (10.2). An immediate neurological deterioration was reported in 38 patients (48.1%) after endovascular treatment in 19 (45.2% of endovascular procedures), after miscrosurgical in 15 (51.7% of microsurgical procedures) and after conservative in 4 (the half). At 6 months, the outcome was favorable in 45 patients (57%) and after multivariate analysis, the predictive factors of favorable outcome after management of giant cerebral aneurysm were the initial good clinical status in cases of SAH (P<0.002), the endovascular treatment (P<0.005), and the absence of neurological deterioration (P<0.006). The endovascular procedure was obtained as a predictive factor because of the low risk efficacy of indirect procedures, in particular a parent vessel occlusion. Conclusion. - The overall favorable outcome rate concerned 57% of patients at 6 months despite 53.8% of poor initial clinical status in cases of rupture. The predictive factors for favorable outcome were good clinical status, endovascular treatment and the absence of postoperative neurological deterioration. Endovascular treatment should be integrated into the therapeutic armenmatarium against giant cerebral aneurysms but the durability of exclusion should be taken into account during the multidisciplinary discussion by the neurovascular team. (C) 2014 Elsevier Masson SAS. All rights reserved. AD - [Derrey, S.; Penchet, G.; Thines, L.; Lonjon, M.; David, P.; Bataille, B.; Emery, E.; Lubrano, V.; Laguarrigue, J.; Bresson, D.; Pelissou, I.; Irthum, B.; Lejeune, J. -P.; Proust, F.] Rouen Univ Hosp, Dept Neurosurg, 1 Rue Germont, F-76031 Rouen, France. Proust, F (corresponding author), Rouen Univ Hosp, Dept Neurosurg, 1 Rue Germont, F-76031 Rouen, France. Francois.Proust@chu-rouen.fr AN - WOS:000369348300004 AU - Derrey, S. AU - Penchet, G. AU - Thines, L. AU - Lonjon, M. AU - David, P. AU - Bataille, B. AU - Emery, E. AU - Lubrano, V. AU - Laguarrigue, J. AU - Bresson, D. AU - Pelissou, I. AU - Irthum, B. AU - Lejeune, J. P. AU - Proust, F. DA - Dec DO - 10.1016/j.neuchi.2013.11.006 J2 - Neurochirurgie KW - Giant cerebral aneurysm Microsurgical clipping Endovascular coiling Predictive factors Outcome Management Pseudo-tumor syndrome QUALITY-OF-LIFE SUBARACHNOID HEMORRHAGE ENDOVASCULAR COILING TRIAL ISAT RECONSTRUCTION EMBOLIZATION SURVIVAL SURGERY Clinical Neurology Surgery LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: DC6RW Times Cited: 5 Cited Reference Count: 46 Derrey, S. Penchet, G. Thines, L. Lonjon, M. David, P. Bataille, B. Emery, E. Lubrano, V. Laguarrigue, J. Bresson, D. Pelissou, I. Irthum, B. Lejeune, J. -P. Proust, F. 5 0 3 MASSON EDITEUR MOULINEAUX CEDEX 9 NEUROCHIRURGIE PY - 2015 SN - 0028-3770 SP - 371-377 ST - French collaborative group series on giant intracranial aneurysms: Current management T2 - Neurochirurgie TI - French collaborative group series on giant intracranial aneurysms: Current management UR - ://WOS:000369348300004 VL - 61 ID - 761733 ER - TY - JOUR AB - OBJECTIVE: Patient specific rehearsal (PsR) prior to endovascular aneurysm repair (EVAR) enables the endovascular team to practice and evaluate the procedure prior to treating the real patient. This multicentre trial aimed to evaluate the utility of PsR prior to EVAR as a pre-operative planning and briefing tool. MATERIAL AND METHODS: Patients with an aneurysm suitable for EVAR were randomised to pre-operative or post-operative PsR. Before and after the PsR, the lead implanter completed a questionnaire to identify any deviation from the initial treatment plan. All team members completed a questionnaire evaluating realism, technical issues, and human factor aspects pertinent to PsR. Technical and human factor skills, and technical and clinical success rates were compared between the randomised groups. RESULTS: 100 patients were enrolled between September 2012 and June 2014. The plan to visualise proximal and distal landing zones was adapted in 27/50 (54%) and 38/50 (76%) cases, respectively. The choice of the main body, contralateral limb, or iliac extensions was adjusted in 8/50 (16%), 17/50 (34%), and 14/50 (28%) cases, respectively. At least one of the abovementioned parameters was changed in 44/50 (88%) cases. For 100 EVAR cases, 199 subjective questionnaires post-PsR were completed. PsR was considered to be useful for selecting the optimal C-arm angulation (median 4, IQR 4-5) and was recognised as a helpful tool for team preparation (median 4, IQR 4-4), to improve communication (median 4, IQR 3-4), and encourage confidence (median 4, IQR 3-4). Technical and human factor skills and technical and initial clinical success rates were similar between the randomisation groups. CONCLUSION: PsR prior to EVAR has a significant impact on the treatment plan and may be useful as a pre-operative planning and briefing tool. Subjective ratings indicate that this technology may facilitate planning of optimal C-arm angulation and improve non-technical skills. TRIAL REGISTRATION: URL://www.clinicaltrials.gov. Unique identifier: NCT01632631. AD - Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. Electronic address: liesbeth.desender@ugent.be. Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. Department of Vascular Surgery, Zurich University Hospital, Zurich, Switzerland. Department of Vascular and Thoracic Surgery, St. Maarten Hospital, Duffel, Belgium. Department of Surgery and Cancer, Imperial College London, UK. Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands. Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands. AN - 28117241 AU - Desender, L. AU - Van Herzeele, I. AU - Lachat, M. AU - Duchateau, J. AU - Bicknell, C. AU - Teijink, J. AU - Heyligers, J. AU - Vermassen, F. DA - Mar DO - 10.1016/j.ejvs.2016.12.018 DP - NLM ET - 2017/01/25 J2 - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery KW - Aortic Aneurysm, Abdominal/diagnostic imaging/*surgery Aortography/methods Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation/adverse effects/instrumentation/*methods Clinical Competence Computed Tomography Angiography Endovascular Procedures/adverse effects/instrumentation/*methods *High Fidelity Simulation Training Humans Netherlands Patient Care Team Patient Safety *Patient-Specific Modeling Prospective Studies Prosthesis Design Risk Factors Stents Surgery, Computer-Assisted/adverse effects/instrumentation/*methods Surveys and Questionnaires Time Factors Treatment Outcome *Aneurysm *Endovascular procedures *Patient simulation *Team performance *Teamwork LA - eng M1 - 3 N1 - 1532-2165 Desender, L Van Herzeele, I Lachat, M Duchateau, J Bicknell, C Teijink, J Heyligers, J Vermassen, F PAVLOV Study Group Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't England Eur J Vasc Endovasc Surg. 2017 Mar;53(3):354-361. doi: 10.1016/j.ejvs.2016.12.018. Epub 2017 Jan 20. PY - 2017 SN - 1078-5884 SP - 354-361 ST - A Multicentre Trial of Patient specific Rehearsal Prior to EVAR: Impact on Procedural Planning and Team Performance T2 - Eur J Vasc Endovasc Surg TI - A Multicentre Trial of Patient specific Rehearsal Prior to EVAR: Impact on Procedural Planning and Team Performance VL - 53 ID - 760264 ER - TY - JOUR AB - Objective:To assess the effect of patient-specific virtual reality rehearsal (PsR) before endovascular infrarenal aneurysm repair (EVAR) on technical performance and procedural errors.Background:Endovascular procedures, including EVAR, are executed in a complex multidisciplinary environment, often treating high-risk patients. Consequently, this may lead to patient harm and procedural inefficiency. PsR enables the endovascular team to evaluate and practice the case in a virtual environment before treating the real patient.Methods:A multicenter, prospective, randomized controlled trial recruited 100 patients with a nonruptured infrarenal aortic or iliac aneurysm between September 2012 and June 2014. Cases were randomized to preoperative PsR or standard care (no PsR). Primary outcome measures were errors during the real procedure and technical operative metrics (total endovascular and fluoroscopy time, contrast volume, number of angiograms, and radiation dose).Results:There was a 26% [95% confidence interval (CI) 9%-40%, P = 0.004) reduction in minor errors, a 76% (95% CI 30%-92%, P = 0.009) reduction in major errors, and a 27% (95% CI 8.2%-42%, P = 0.007) reduction in errors causing procedural delay in the PsR group. The number of angiograms performed to visualize proximal and distal landing zones was 23% (95% CI 8%-36%, P = 0.005) and 21% (95% CI 7%-32%, P = 0.004) lower in the PsR group.Conclusions:PsR before EVAR can be used in different hospital settings by teams with various EVAR experience. It reduces perioperative errors and the number of angiograms required to deploy the stent graft, thereby reducing delays. Ultimately, it may improve patient safety and procedural efficiency. AD - [Desender, Liesbeth M.; Van Herzeele, Isabelle; Vermassen, Frank E.] Ghent Univ Hosp, Dept Thorac & Vasc Surg, 2K12D,De Pintelaan 185, B-9000 Ghent, Belgium. [Lachat, Mario L.; Rancic, Zoran] Univ Zurich Hosp, Dept Vasc Surg, Zurich, Switzerland. [Duchateau, Johan] St Maarten Hosp, Dept Vasc & Thorac Surg, Duffel, Belgium. [Rudarakanchana, Nung; Bicknell, Colin D.] Imperial Coll London, Dept Surg & Canc, London, England. [Heyligers, Jan M. M.] St Elizabeth Hosp, Dept Vasc Surg, Tilburg, Netherlands. [Teijink, Joep A. W.] Catharina Hosp, Dept Vasc Surg, Eindhoven, Netherlands. Desender, LM (corresponding author), Ghent Univ Hosp, Dept Thorac & Vasc Surg, 2K12D,De Pintelaan 185, B-9000 Ghent, Belgium. liesbeth.desender@ugent.be AN - WOS:000386353600003 AU - Desender, L. M. AU - Van Herzeele, I. AU - Lachat, M. L. AU - Rancic, Z. AU - Duchateau, J. AU - Rudarakanchana, N. AU - Bicknell, C. D. AU - Heyligers, J. M. M. AU - Teijink, J. A. W. AU - Vermassen, F. E. AU - Grp, Pavlov Study DA - Nov DO - 10.1097/sla.0000000000001871 J2 - Ann. Surg. KW - endovascular team error EVAR patient safety patient-specific simulation ENDOVASCULAR ANEURYSM REPAIR SIMULATION IMPLEMENTATION OUTCOMES ERROR Surgery LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: EA1LL Times Cited: 26 Cited Reference Count: 24 Desender, Liesbeth M. Van Herzeele, Isabelle Lachat, Mario L. Rancic, Zoran Duchateau, Johan Rudarakanchana, Nung Bicknell, Colin D. Heyligers, Jan M. M. Teijink, Joep A. W. Vermassen, Frank E. Lachat, Mario/G-4826-2011 Lachat, Mario/0000-0001-7812-2110; Van Herzeele, Isabelle/0000-0002-1754-7390 W.L. Gore & Associates Inc, Flagstaff, Arizona, USA; Medtronic Inc., Santa Rosa, California, USAMedtronic; National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London This trial was supported by Simbionix USA Corp, Cleveland, OH, USA (technical support), W.L. Gore & Associates Inc, Flagstaff, Arizona, USA (research grant), and Medtronic Inc., Santa Rosa, California, USA (research grant). For Imperial College Staff, the research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. 26 1 4 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA ANN SURG PY - 2016 SN - 0003-4932 SP - 703-709 ST - Patient-specific Rehearsal Before EVAR: Influence on Technical and Nontechnical Operative Performance. A Randomized Controlled Trial T2 - Annals of Surgery TI - Patient-specific Rehearsal Before EVAR: Influence on Technical and Nontechnical Operative Performance. A Randomized Controlled Trial UR - ://WOS:000386353600003 VL - 264 ID - 761691 ER - TY - JOUR AB - OBJECTIVES: To report the technical success and clinical outcomes of catheter-based therapy (CBT) for acute ischemic stroke in patients ineligible for intravenous thrombolysis. BACKGROUND: Acute ischemic stroke is common but undertreated. CBT for acute ischemic stroke is a therapeutic option in selected patients who are not candidates for intravenous thrombolysis. METHODS: Consecutive stroke patients who were ineligible for intravenous thrombolysis and underwent CBT were identified by retrospective chart review. Demographic information, National Institutes of Health Stroke Scale (NIHSS), procedural characteristics, and clinical outcomes during hospitalization and at 90 days follow up were collected. Experienced interventional cardiologists with the consultative support of stroke neurologists were on call for acute strokes. RESULTS: A total of 33 acute ischemic stroke patients underwent emergency cerebral angiography, with 26 patients undergoing CBT. Successful "culprit" artery recanalization was achieved in 23 (88%) of the 26 patients. In-hospital adverse events occurred in 4 (15%) patients, with intracerebral hemorrhage (ICH) (12%) representing the most common adverse event. The baseline NIHSS for patients who underwent intervention was 16.5 +/- 9.9 (median 16) and improved significantly to 9.9 +/- 8.7 (median 9) (P < 0.001) at hospital discharge. A modified Rankin score of two or less (indicating mild disability) was achieved in half (n = 13) of the CBT treated patients. All cause mortality at 90 days was 8% (2/26). CONCLUSIONS: In selected patients, CBT provided by qualified interventional cardiologists supported by stroke neurologists, offers a safe and effective option for patients with acute stroke who are not eligible for intravenous thrombolysis. AD - Department of Cardiovascular Diseases, The Ochsner Heart and Vascular Institute, Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA. AN - 19198006 AU - DeVries, J. T. AU - White, C. J. AU - Collins, T. J. AU - Jenkins, J. S. AU - Reilly, J. P. AU - Grise, M. A. AU - McMullan, P. W. AU - Badawi, R. A. AU - Ramee, S. R. DA - Apr 1 DO - 10.1002/ccd.21927 DP - NLM ET - 2009/02/07 J2 - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions KW - Aged *Angioplasty, Balloon/adverse effects/instrumentation Brain Ischemia/*complications/diagnostic imaging/mortality/therapy Cardiology/*methods *Cerebral Angiography Cooperative Behavior Disability Evaluation Embolectomy Female Humans Intracranial Hemorrhages/etiology/mortality Male Middle Aged Neurology Patient Care Team Personnel Staffing and Scheduling *Radiography, Interventional Radiology, Interventional/*methods Referral and Consultation Retrospective Studies Severity of Illness Index Stents Stroke/diagnostic imaging/etiology/mortality/*therapy Thrombolytic Therapy/adverse effects Time Factors Treatment Outcome LA - eng M1 - 5 N1 - 1522-726x DeVries, James T White, Christopher J Collins, Tyrone J Jenkins, J Stephen Reilly, John P Grise, Mark A McMullan, Paul W Badawi, Ramy A Ramee, Stephen R Journal Article United States Catheter Cardiovasc Interv. 2009 Apr 1;73(5):692-8. doi: 10.1002/ccd.21927. PY - 2009 SN - 1522-1946 SP - 692-8 ST - Acute stroke intervention by interventional cardiologists T2 - Catheter Cardiovasc Interv TI - Acute stroke intervention by interventional cardiologists VL - 73 ID - 760370 ER - TY - JOUR AB - Study Design. Retrospective cohort (case only). Objective. To evaluate the results and survival determinants of 21 patients with sacral chordomas treated with en bloc resection and adjuvant radiotherapy. Summary of Background Data. There are few long-term studies on treatment of sacral chordomas with more than 20 patients, and factors related to survival are not fully understood. Methods. Demographics, treatment, complications, and oncological outcomes were analyzed with summary statistics, hypothesis testing with Mantel-Haenszel-Cox analysis, log-rank test, Cox proportional hazard model, and Kaplan-Meier survival estimates as applicable. Results. There were 12 males and 9 females with mean age of 61 years (16-79) and mean follow-up of 5.8 years (2-19.2). Tumor stage was IB in 20 and IIIB in one; mean tumor size was 10.5 cm. Fourteen patients underwent combined anterior-posterior resection and 7 posterior resection alone; 18 received adjuvant radiotherapy. After treatment, bowel and bladder control were present in 4 and 5 patients, respectively. Complications included: wound infection (4), other wound complications (9), fistula (2), deep vein thrombosis (1), and pulmonary embolism (1). Median survival was 7.2 years. Eight (40%) had local recurrence and 4 (19%) metastatic disease. Mean disease-free interval before recurrence was 2.5 years (1-5). No patient (n = 8) treated in the past 9 years has had local or distant disease. Patients treated for recurrent tumor survived 5.7 years on average (range, 0.8-9) after the first recurrence. The only risk factor for tumor recurrence was proximal tumor extent (P = 0.05) There was a statistically significant association between recurrence and survival (RR = 3.8; 95% confidence interval, 1.0-15.3; P = 0.04). Conclusion. Despite the complications, increased long-term survival can be achieved with treatment. Proximal tumor extent may be related to recurrence and survival. Recurrence rates have diminished over time, emphasizing the importance of an experienced multidisciplinary surgical team. AD - [Dhawale, Arjun A.; Gjolaj, Joseph P.; Temple, H. Thomas; Eismont, Frank J.] Univ Miami, Miller Sch Med, Dept Orthopaed, Miami, FL 33136 USA. [Holmes, Laurens, Jr.] Univ Delaware, Dept Epidemiol, Newark, DE USA. [Sands, Laurence R.] Univ Miami, Miller Sch Med, Dept Surg, Miami, FL 33136 USA. Eismont, FJ (corresponding author), Univ Miami, Miller Sch Med, JMH Rehab Ctr, Dept Orthopaed, R303T,1611 NW 12th Ave, Miami, FL 33136 USA. feismont@med.miami.edu AN - WOS:000337390700009 AU - Dhawale, A. A. AU - Gjolaj, J. P. AU - Holmes, L. AU - Sands, L. R. AU - Temple, H. T. AU - Eismont, F. J. DA - Mar DO - 10.1097/brs.0000000000000173 J2 - Spine KW - sacrum chordoma en bloc resection radiotherapy survival recurrence complications tumor oncological outcomes RECONSTRUCTION MANAGEMENT RESECTION Clinical Neurology Orthopedics LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: AJ1BN Times Cited: 16 Cited Reference Count: 19 Dhawale, Arjun A. Gjolaj, Joseph P. Holmes, Laurens, Jr. Sands, Laurence R. Temple, H. Thomas Eismont, Frank J. 16 0 1 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA SPINE PY - 2014 SN - 0362-2436 SP - E353-E359 ST - Sacrectomy and Adjuvant Radiotherapy for the Treatment of Sacral Chordomas T2 - Spine TI - Sacrectomy and Adjuvant Radiotherapy for the Treatment of Sacral Chordomas UR - ://WOS:000337390700009 VL - 39 ID - 761782 ER - TY - JOUR AB - Surgery plays an important role in the treatment of Crohn's Disease (CD) and the timing of surgical treatment is crucial in order to prevent complications, need for further surgeries and occurrence of disabling events. The need for surgical treatment should be discussed with patient in a multidisciplinary team including surgeon and gastroenterologist, during which patient should be extensively informed about clinical situation, therapeutic options, type of surgical intervention and its possible consequences and complications. The aim of the article is to analyze pre-operative risk factors in CD patients and how they could be optimized. Assessment of pre-operative risk factors should include radiological imaging, evaluation of current medical therapies, nutritional status, presence of abdominal sepsis, thromboembolic prophylaxis, cessation of smoking and patient counselling. We discuss different therapeutic agents for CD, with relative impact on post-operative outcomes and their possible pre-operative wash-out. Optimisation of nutritional status is also discussed, with reference to different types of nutrition and their influence on the post-operative course. Each factor has been discussed in order to define a standard pre-operative strategy and achieve the best outcomes also in patients with depleted resources. (C) 2020 Elsevier Inc. All rights reserved. AD - [Di Candido, Francesca; Spinelli, Antonino] IRCCS, Humanitas Clin & Res Ctr, Colon & Rectal Surg Div, Via Manzoni 56, I-20089 Rozzano, MI, Italy. [Moggia, Elisabetta] Osped Infermi, Div Gen Surg, Turin, Italy. [Spinelli, Antonino] Humanitas Univ, Dept Biomed Sci, Via Rita Levi Montalcini 4, I-20090 Milan, Italy. Spinelli, A (corresponding author), IRCCS, Humanitas Clin & Res Ctr, Colon & Rectal Surg Div, Via Manzoni 56, I-20089 Rozzano, MI, Italy. antonino.spinelli@hunimed.eu AN - WOS:000541482500002 AU - Di Candido, F. AU - Moggia, E. AU - Spinelli, A. C7 - Unsp 100742 DA - Jun DO - 10.1016/j.scrs.2020.100742 J2 - Semin. Colon Rectal Surg. KW - INFLAMMATORY-BOWEL-DISEASE EARLY POSTOPERATIVE COMPLICATIONS INTRAABDOMINAL SEPTIC COMPLICATIONS RECEIVING IMMUNOMODULATOR THERAPY SURGERY ENHANCED RECOVERY MAJOR COLORECTAL SURGERY RISK-FACTORS VENOUS THROMBOEMBOLISM MULTIVARIATE-ANALYSIS NUTRITIONAL-STATUS Surgery LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: LZ8PK Times Cited: 0 Cited Reference Count: 95 Di Candido, Francesca Moggia, Elisabetta Spinelli, Antonino 0 1 W B SAUNDERS CO-ELSEVIER INC PHILADELPHIA SEMIN COLON RECTAL S PY - 2020 SN - 1043-1489 SP - 7 ST - Pre-operative optimisation in Crohn's Disease T2 - Seminars in Colon and Rectal Surgery TI - Pre-operative optimisation in Crohn's Disease UR - ://WOS:000541482500002 VL - 31 ID - 761439 ER - TY - JOUR AB - Placenta accreta spectrum (PAS) disorders is a multifactorial process that encompasses a heterogeneous group of conditions characterized by an abnormal invasion of trophoblastic tissue through the myometrium and uterine serosa. PAS is associated with a high burden of adverse maternal outcomes including severe life-threatening hemorrhage, need for blood transfusion, damage to adjacent organs, and death. Prenatal screening of PAS is mandatory so that women may be counselled about the severity of this condition to plan management with a multidisciplinary team and delivery in a specialized center. Ultrasound during the second and third trimester is the primary tool in diagnosing PAS, while magnetic resonance imaging is generally performed to confirm the diagnosis and to delineate the topography of placental invasion. Cesarean hysterectomy with placenta left in situ between 34 and 35 weeks of gestation is currently the gold standard surgical management of PAS disorders. Conservative management, such as uterine conservation with the placenta left in situ, or “Triple-P” procedure, should be restricted to a limited number of patients who desire to preserve fertility, after an extensive counselling regarding the high maternal morbidity and mortality risks. Finally, endovascular interventional radiology has been suggested to reduce the amount of blood loss, improve visualization of the operative field and reduce surgical complications, and its use is increasing in specialized centers. AD - F. D’Antonio, Women’s Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway AU - Di Mascio, D. AU - Calì, G. AU - D’Antonio, F. DB - Embase Medline DO - 10.23736/S0026-4784.18.04333-2 KW - angiogenesis cesarean section color Doppler echocardiography conservative treatment devascularization diagnostic accuracy disease classification endovascular surgery first trimester pregnancy follow up hysterectomy interventional radiology meta analysis (topic) nuclear magnetic resonance imaging placenta accreta placenta previa pregnancy outcome prenatal screening review risk factor second trimester pregnancy third trimester pregnancy trophoblast vascularization LA - English M1 - 2 M3 - Review N1 - L2001726981 2019-03-29 2019-04-02 PY - 2019 SN - 1827-1650 0026-4784 SP - 113-120 ST - Updates on the management of placenta accreta spectrum T2 - Minerva Ginecologica TI - Updates on the management of placenta accreta spectrum UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001726981&from=export http://dx.doi.org/10.23736/S0026-4784.18.04333-2 VL - 71 ID - 760732 ER - TY - JOUR AB - PURPOSE: To report the initial clinical experience with fully endovascular extra-anatomic femoro-popliteal bypass (FPB) for limb salvage in patients with critical limb ischemia (CLI) and no traditional endovascular or surgical revascularization options. METHODS: Between June 2013 and May 2018, endovascular procedure was proposed for limb salvage during multidisciplinary team meeting in fifteen hospitalized patients (median age 67 years; 73% men) with CLI and a high risk of major amputation. Primary outcome was amputation-free survival at 1 year. Secondary outcomes included mortality, cardiovascular (CV) events and major limb amputation at 1 year, primary/secondary bypass patency and wound healing at the last follow-up visit. Procedure-related complications (deaths, CV events, hemorrhages) were recorded through 30 days. RESULTS: Technical procedure success rate was 100%. Major peri-procedural outcomes occurred in two patients (13%): One patient died secondary to cardiogenic shock; one patient suffered acute coronary syndrome associated with iliopsoas bleeding. No major amputation occurred through 30 days. Median follow-up period was 21.5 (18.25-45.5) months (last follow-up visits on April 2019). Amputation-free survival at 1-year and at the last follow-up visit was 80% and 53%, respectively. Cumulative mortality at 1-year and at the last follow-up visit was 13% and 33%, respectively. Primary and secondary bypass patency was 27% and 60%, respectively. Complete wound healing was achieved in 11 patients (73%). CONCLUSION: Endovascular extra-anatomic FPB represents an innovative approach for limb salvage in CLI with no traditional endovascular or surgical revascularization options. Our clinical experience highlights that this technique remains challenging because of frequent comorbidities and fragility of this patient population. LEVEL OF EVIDENCE: Level 4, Case series. AD - Interventional Radiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014, Paris, France. massimiliano.di.primio@gmail.com. Interventional Radiology, Hôpital Privé de Parly 2, 21 Rue Moxouris, 78150, Le Chesnay, France. massimiliano.di.primio@gmail.com. Interventional Radiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014, Paris, France. Interventional Radiology, Hôpital Privé de Parly 2, 21 Rue Moxouris, 78150, Le Chesnay, France. Vascular Medicine Department, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014, Paris, France. Medical Information Department, Groupe Hospitalier Paris Saint-Joseph, 185, rue Raymond Losserand, 75014, Paris, France. Interventional Radiology Department, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France. Université Paris Descartes, Sorbonne Paris Cité, Paris, France. INSERM U970, Paris, France. INSERM UMR 1153-CRESS, Paris, France. AN - 31214761 AU - Di Primio, M. AU - Angelopoulos, G. AU - Lazareth, I. AU - Lin, F. AU - Petit, A. AU - Priollet, P. AU - Sapoval, M. AU - Emmerich, J. AU - Yannoutsos, A. DA - Sep DO - 10.1007/s00270-019-02253-2 DP - NLM ET - 2019/06/20 J2 - Cardiovascular and interventional radiology KW - Aged Chronic Disease Endovascular Procedures/*methods Female Follow-Up Studies Humans Ischemia/*surgery Limb Salvage/*methods Lower Extremity/*blood supply/*surgery Male Middle Aged Retrospective Studies Risk Factors Survival Analysis Time Factors Treatment Outcome Vascular Patency Wound Healing Critical limb ischemia Endovascular revascularization Femoro-popliteal bypass Limb salvage LA - eng M1 - 9 N1 - 1432-086x Di Primio, M Angelopoulos, G Lazareth, I Lin, F Petit, A Priollet, P Sapoval, M Emmerich, J Yannoutsos, A Orcid: 0000-0002-8858-8253 Journal Article United States Cardiovasc Intervent Radiol. 2019 Sep;42(9):1279-1292. doi: 10.1007/s00270-019-02253-2. Epub 2019 Jun 18. PY - 2019 SN - 0174-1551 SP - 1279-1292 ST - Endovascular Extra-Anatomic Femoro-Popliteal Bypass for Limb Salvage in Chronic Critical Limb Ischemia T2 - Cardiovasc Intervent Radiol TI - Endovascular Extra-Anatomic Femoro-Popliteal Bypass for Limb Salvage in Chronic Critical Limb Ischemia VL - 42 ID - 760303 ER - TY - JOUR AB - BACKGROUND: The objective of our study was to evaluate the effect of the Pulsara Stop Stroke© medical application on door-to-needle (DTN) time in patients presenting to our emergency department with acute ischemic stroke (AIS). The secondary objective was to evaluate the DTN performance of dedicated neurohospitalists versus private practice neurologists covering emergency department stroke call. METHODS: We conducted a retrospective cohort study of the Good Shepherd Health System stroke quality improvement dashboard for an 18-month period. The primary outcome was mean DTN time performance in cases with and without Stop Stroke© usage. Secondary outcome was mean DTN time between neurohospitalist and private neurologists with and without use of Stop Stroke©. RESULTS: During the study period, there were 85 stroke activations receiving tissue plasminogen activator (63 with Stop Stroke©, 22 without Stop Stroke©). In cases where the app was used, we observed a reduction in mean DTN time of 40 minutes (87-47 minutes), a 46% reduction. There was no significant difference in DTN time observed between the neurohospitalist and private neurologist performance independent of app usage. Mean DTN less than 60 minutes improved with app use from 18% to 85% with Stop Stroke©. CONCLUSIONS: In patients arriving to our primary stroke center with AIS, use of Pulsara Stop Stroke© acute care coordination app decreased mean DTN time by 40 minutes, a significant 46% improvement in this metric and is consistent with other studies of the app. We further observed a 3.7× improvement in DTN less than 60 minutes with use of the app. AD - Baylor College of Medicine, Houston, Texas. Electronic address: Rob.dickson@mchd-tx.org. Palmerston North Hospital, Palmerston North, New Zealand. Good Shepherd Medical Center, Longview, Texas. AN - 26971040 AU - Dickson, R. L. AU - Sumathipala, D. AU - Reeves, J. DA - May DO - 10.1016/j.jstrokecerebrovasdis.2015.12.001 DP - NLM ET - 2016/03/14 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Academic Medical Centers/*organization & administration Delivery of Health Care, Integrated/*organization & administration Emergency Medical Services/*organization & administration Fibrinolytic Agents/*administration & dosage Humans Interdisciplinary Communication *Mobile Applications Patient Care Team/*organization & administration Program Evaluation Quality Improvement/organization & administration Quality Indicators, Health Care/organization & administration Retrospective Studies Stroke/diagnosis/*drug therapy Texas *Thrombolytic Therapy Time Factors Time-to-Treatment/*organization & administration Tissue Plasminogen Activator/*administration & dosage Treatment Outcome Stroke acute care coordination emergency medical service medical application therapy time to therapy tissue plasminogen activator LA - eng M1 - 5 N1 - 1532-8511 Dickson, Robert L Sumathipala, Dineth Reeves, Jennifer Journal Article United States J Stroke Cerebrovasc Dis. 2016 May;25(5):1275-1279. doi: 10.1016/j.jstrokecerebrovasdis.2015.12.001. Epub 2016 Mar 9. PY - 2016 SN - 1052-3057 SP - 1275-1279 ST - Stop Stroke© Acute Care Coordination Medical Application: A Brief Report on Postimplementation Performance at a Primary Stroke Center T2 - J Stroke Cerebrovasc Dis TI - Stop Stroke© Acute Care Coordination Medical Application: A Brief Report on Postimplementation Performance at a Primary Stroke Center VL - 25 ID - 760439 ER - TY - JOUR AB - OBJECTIVES: We sought to study the impact of direct referral to an intervention center after pre-hospital diagnosis of ST-segment elevation myocardial infarction (STEMI) on treatment intervals and outcome. BACKGROUND: Primary angioplasty has become the preferred reperfusion strategy in STEMI. Ambulance diagnosis and direct referral to an intervention center is an attractive treatment option that has not been studied extensively. METHODS: Consecutive pre-hospital patients with STEMI, who were referred to our intervention center for primary angioplasty between 2005 and 2007, were studied. After pre-hospital diagnosis, patients were either directly transported to our center or referred through a nonintervention center. The catheterization laboratory was activated before transport to the intervention center. RESULTS: Of the 581 patients referred, 454 (78%) came with direct transport and 127 (22%) through a nonintervention center. Direct transport was associated with a higher proportion of patients treated within the 90-min time window of the STEMI guidelines: 82% versus 23% (p < 0.01). Patients directly transported had a significantly shorter median symptom-to-balloon time of 149 min (Interquartile range: 118 to 197 min) versus 219 min (interquartile range: 178 to 315 min), p < 0.01, a higher post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 rate (92% vs. 84%; p = 0.03), and a lower 1-year mortality rate (7% vs. 13%; p = 0.03). Direct transport to the intervention center was independently associated with the symptom-to-balloon time, which in turn was an independent predictor of post-procedural TIMI flow grade 3, a strong prognosticator of outcome. CONCLUSIONS: After ambulance-based diagnosis of STEMI, direct transport to an intervention center with pre-hospital notification of the catheterization laboratory more than triples the proportion of patients treated within the time window of the guidelines. Time to balloon was an independent predictor of post-procedural TIMI flow grade 3, which underscores the need to reduce treatment delays. AD - Department of Cardiology, Heart Lung Center, Radboud University Medical Center, Nijmegen, the Netherlands. h.dieker@cardio.umcn.nl AN - 20650431 AU - Dieker, H. J. AU - Liem, S. S. AU - El Aidi, H. AU - van Grunsven, P. AU - Aengevaeren, W. R. AU - Brouwer, M. A. AU - Verheugt, F. W. DA - Jul DO - 10.1016/j.jcin.2010.04.010 DP - NLM ET - 2010/07/24 J2 - JACC. Cardiovascular interventions KW - Aged *Ambulances *Angioplasty, Balloon, Coronary/adverse effects/mortality Chi-Square Distribution *Emergency Medical Services Female Guideline Adherence *Health Services Accessibility Humans Kaplan-Meier Estimate Logistic Models Male Middle Aged Myocardial Infarction/diagnosis/mortality/*therapy Netherlands Patient Care Team *Patient Transfer Practice Guidelines as Topic Proportional Hazards Models Prospective Studies *Referral and Consultation Residence Characteristics Risk Assessment Risk Factors Time Factors Treatment Outcome *Triage LA - eng M1 - 7 N1 - 1876-7605 Dieker, Hendrik-Jan Liem, Stephan S B El Aidi, Hamza van Grunsven, Pierre Aengevaeren, Wim R M Brouwer, Marc A Verheugt, Freek W A Comparative Study Journal Article United States JACC Cardiovasc Interv. 2010 Jul;3(7):705-11. doi: 10.1016/j.jcin.2010.04.010. PY - 2010 SN - 1936-8798 SP - 705-11 ST - Pre-hospital triage for primary angioplasty: direct referral to the intervention center versus interhospital transport T2 - JACC Cardiovasc Interv TI - Pre-hospital triage for primary angioplasty: direct referral to the intervention center versus interhospital transport VL - 3 ID - 760514 ER - TY - JOUR AB - Introduction Fracture neck of femur is the commonest reason for surgery in sick, elderly patients. For many of them, hip fracture is said to be the beginning of the end of their journey of life. Early surgery may lead to better outcomes. The aim of this audit was to study current practice and adherence to safety guidelines published by the AAGBI (Association of Anaesthetists of Great Britain and Ireland) UK, as no local guidelines are available at present. Method A retrospective audit was carried out at Colombo North Teaching Hospital Ragama in 10 wards on all patients above 60 years (n=41) and had surgery for fracture neck of femur from 15(th) January to 15 th June 2014. Data were extracted from patient records using a data collection form. Results Mean age of the population was 75.8 years and72.9% were females and 27% were males. Only four patients (11%) had surgery within the recommended period of 48 hours after admission. 50% of patients had surgery only after 7-8 days. Delays were compounded by late admission to hospital following injury. One patient died of a probable acute coronary event or pulmonary embolism. Lack of close monitoring of these patients due to inadequate intensive care beds, complicates the postoperative management. None of these patients received thrombo-prophylaxis despite current guidelines. Conclusions and Recommendations Adherence to standard practice guidelines for management of patients with fracture neck of femur is found to be unsatisfactory at CNTH, Ragama. The delays are due to late admission, late referral to orthopaedic team and anaesthetists and lack of dedicated theatre time and intensive care beds. Thromboprophylaxis in this high risk category of patients is not carried out. There is an urgent need to address these issues and plan perioperative management of these patients according to available standard practice guidelines. AD - [Dissanayake, M.; Wijesuriya, N.] North Colombo Teaching Hosp, Ragama, Sri Lanka. Dissanayake, M (corresponding author), North Colombo Teaching Hosp, Ragama, Sri Lanka. mihiri.dissanayake@gmail.com AN - WOS:000421597200004 AU - Dissanayake, M. AU - Wijesuriya, N. J2 - Sri Lankan J. Anaesthesiol. KW - fracture neck of femur delay in surgery safety standards Anesthesiology LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: V8F8J Times Cited: 0 Cited Reference Count: 10 Dissanayake, M. Wijesuriya, N. 0 COLL ANAESTHESIOLOGISTS SRI LANKA COLOMBO SRI LANKAN J ANAESTH PY - 2015 SN - 1391-8834 SP - 17-21 ST - Audit of perioperative management of patients with fracture neck of femur T2 - Sri Lankan Journal of Anaesthesiology TI - Audit of perioperative management of patients with fracture neck of femur UR - ://WOS:000421597200004 VL - 23 ID - 761768 ER - TY - JOUR AB - Background and Aims: Successful liver transplantation can lead to restoration of fertility in women. Studies have shown largely favourable pregnancy outcomes in liver transplant recipients, however, concern remains regarding maternal and foetal complications and optimal management of these high risk patients. We sought to evaluate the maternal and foetal outcomes of pregnancy, post liver transplant over a 14 year period in the National Liver Transplant Unit (NLTU). Methods: We conducted a retrospective study of all self-reported pregnancies in patients transplanted in the NLTU 1992 to 2016. Information was collected regarding the following parameters: transplant indication, gestational age, number of pregnancies, immunosuppression, pregnancy induced hypertension (PIH), preeclampsia, infections, venous thrombosis (VT), re-transplant, miscarriages, caesarean section, prematurity, birth weights and congenital anomalies. Results: 31 pregnancies were reported in 13 women. Median age at delivery 28.5 years (18-38). Live birth rate 67.7% (n = 21). Maternal complications: PIH (14.3%), pre-eclampsia (4.8%), VT (4.8%), liver decompensation post-partum (9.5%) and infections (14.3%). Retransplant occurred in 3 (14.3%) patients, one within a year of delivery. Mortality amongst this cohort was 30.77% (n = 4). Deaths occurred from 8-96 months post-delivery. No patient died as a direct result of pregnancy. Foetal complications: miscarriage in 10 (32.3%), prematurity in 9 (42.9%) and low birth weight in 6 (28.6%). 16 (76.2%) were delivered by caesarean section. NICU admissions in 5 (23.8%). No congenital abnormalities occurred. One child born premature had respiratory distress syndrome. All patients with PIHand pre-eclampsiawere on tacrolimus (P = 0.583). Patients on cyclosporinewere more likely to get infections (P = 0.055); have a higher chance of re-transplant post-pregnancy (P = 0.055) and higher mortality (P = 0.055). Six miscarriage occurred on tacrolimus (P = 0.014, LR 10.38). C-section was overall more prevalent in this cohort and more likely on cyclosporine (P = 0.04). Conclusions: Our study showed high rates of maternal and foetal complications in transplant recipients with a significantly higher rate of miscarriage and incidence of C-section than the general population. This highlights the importance of adequate pre-conception counselling, including optimal timing of pregnancy and appropriate management by a multidisciplinary team including a high risk obstetrician and transplant hepatologist. AD - J. Doherty, National Liver Tranpslant Unit, St Vincent's University Hospital, Ireland AU - Doherty, J. AU - Jones, F. AU - Cormick, A. M. AU - McAuliffe, F. DB - Embase KW - cyclosporine tacrolimus adult cesarean section child clinical article cohort analysis complication conception conference abstract congenital malformation controlled study counseling death decompensated liver cirrhosis female fetus fetus outcome gestational age graft recipient human immunosuppressive treatment incidence infection live birth liver graft low birth weight maternal hypertension mortality obstetrician outcome assessment population preeclampsia pregnancy outcome prematurity respiratory distress syndrome retrospective study spontaneous abortion vein thrombosis LA - English M1 - 1 M3 - Conference Abstract N1 - L621223262 2018-03-19 PY - 2017 SN - 1600-0641 SP - S185 ST - Pregnancy outcomes in the post liver transplant setting: The Irish experience T2 - Journal of Hepatology TI - Pregnancy outcomes in the post liver transplant setting: The Irish experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621223262&from=export VL - 66 ID - 760973 ER - TY - JOUR AB - OBJECTIVES: The Heart Team has been recommended as standard care for patients with coronary artery disease (CAD). However, little is known about the real benefits, potential treatment delays and late outcomes of this approach. Our goal was to determine the safety and feasibility of multidisciplinary Heart Team decision making for patients with CAD. METHODS: We retrospectively assessed 1000 consecutive cases discussed by the Heart Team between November 2010 and January 2012. We assessed (i) time intervals between different care steps involving the Heart Team; (ii) the distribution of patients according to the complexity of their CAD; and (iii) the 5-year survival as estimated from Kaplan-Meier curves. RESULTS: Of 1000 case discussions, 40 were repeat cases, resulting in 960 unique cases. The mean age was 65 years, 73% were men, and 29% had diabetes. Native vessel disease was present in 86.4%, of which 69% had simple 1-vessel disease (1VD) or 2-vessel disease (2VD), and 31% had complex left main (LM) or 3-vessel disease (3VD). The time interval between referral by a community hospital and final treatment was less than 6 weeks for 90% of cases. Treatment decisions were delayed in 35% of cases due to a need for additional diagnostic information. For simple 1- or 2VD with or without proximal left anterior descending artery involvement, treatment was medical therapy in 6% and 12%, respectively; percutaneous coronary intervention (PCI) in 88% and 85%, respectively; and coronary artery bypass grafting (CABG) in 6% and 3%, respectively. For 3VD disease, treatment was equally split between CABG and PCI (46% for both). PCI was preferred for isolated LM or LM with 1VD (81% vs CABG 16%), whereas CABG was preferred in LM with 2- or 3VD (71% vs PCI 19%). The 5-year mortality rate was 16% for 1- or 2VD, 17% for 3VD, 3% for isolated LM or with 1VD and 27% for LM with 2- or 3VD. CONCLUSIONS: In this single-centre analysis, the Heart Team approach was feasible, with decision making and treatment by the Heart Team following within a short time after referral. However, the timing of treatment could be further optimized if adequate information and imaging were available at the time of the Heart Team meeting. The final treatment recommendation by the Heart Team was largely in accordance with clinical guidelines. AD - Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands. Department of Cardiology, Erasmus University Medical Center, Netherlands. AN - 30101313 AU - Domingues, C. T. AU - Milojevic, M. AU - Thuijs, Djfm AU - van Mieghem, N. M. AU - Daemen, J. AU - van Domburg, R. T. AU - Kappetein, A. P. AU - Head, S. J. DA - Feb 1 DO - 10.1093/icvts/ivy237 DP - NLM ET - 2018/08/14 J2 - Interactive cardiovascular and thoracic surgery KW - Aged Coronary Artery Bypass/*methods Coronary Artery Disease/*surgery *Decision Making Female Follow-Up Studies Humans Male *Patient Care Team Percutaneous Coronary Intervention/*methods Retrospective Studies *Surgeons Time Factors Treatment Outcome LA - eng M1 - 2 N1 - 1569-9285 Domingues, Carina T Milojevic, Milan Thuijs, Daniel J F M van Mieghem, Nicolas M Daemen, Joost van Domburg, Ron T Kappetein, A Pieter Head, Stuart J Journal Article Observational Study England Interact Cardiovasc Thorac Surg. 2019 Feb 1;28(2):206-213. doi: 10.1093/icvts/ivy237. PY - 2019 SN - 1569-9285 SP - 206-213 ST - Heart Team decision making and long-term outcomes for 1000 consecutive cases of coronary artery disease T2 - Interact Cardiovasc Thorac Surg TI - Heart Team decision making and long-term outcomes for 1000 consecutive cases of coronary artery disease VL - 28 ID - 760378 ER - TY - JOUR AB - A 21-year-old man, born in Cape Verde but living in Europe for 4 years. He had been healthy with no relevant medical history up to one year before, when he felt intense precordial pain and syncope after exertion. Since then he developed fatigability, dyspnea, chest discomfort and palpitations on exertion, as well as progressive involuntary weight loss and decubitus cough. Initial investigations carried out by his GP revealed atrial flutter with periods of very rapid (250 bpm) ventricular response on Holter monitoring, reason for the referral to the emergency where he was hospitalized. On physical examination he had tachycardia, jaundice, cachexia, elevated jugular venous pressure, hepatomegaly and ascites. The electrocardiogram showed prominent P waves and chest X-ray showed bilateral pulmonary interstitial infiltrates and enlargement of the right cavities. Analytically, he had elevated bilirubin, leukopenia and thrombocytopenia. Echocardiography revealed findings compatible with constrictive pericarditis (CP): pericardial thickening and typical constrictive physiology (ventricular interdependence and respiratory variation of flow)including less common signs such as annulus reversus and annulus paradoxus. There was also significant bi-ventricular dysfunction, bi-atrial dilation and very low cardiac output, with abundant intra-cardiac spontaneous echo contrast. The thoraco-abdomino-pelvic CT revealed chronic liver disease with congestion, pleural effusions, pericardial calcifications, ascites and massive mediastinal and abdominal adenopathies. Cardiac MR was not possible due to claustrophobia. Blood cultures and IGRA test were negative. However, given the presumptive diagnosis of tuberculosis (TB), anti-TB therapy was started. Despite the diagnosis of “end-stage” chronic CP with very high operative risk (including a Child Pugh B score-8 points), multidisciplinary team decided, after clinical stabilization, to perform total anterior pericardiectomy, without complications. Pericardial and mediastinal biopsies, pericardial/pleural fluid cultures/ immune-phenotyping were inconclusive. Anti-tuberculosis therapy was maintained. After surgery, the patient had a remarkable clinical improvement (NYHA I). The echocardiogram after 4 months showed significant improvement, with normalization of left ventricular ejection fraction and increase of cardiac output, despite persistence of posterior calcifications. CP is a rare entity. Tuberculosis remains the leading cause in developing countries. Echocardiography and Doppler in particular are critical for the noninvasive demonstration of the physiology of constriction. If the diagnosis remains uncertain or surgical intervention is planned, multimodality imaging is often required. Pericardiectomy is the only definitive treatment option for patients with chronic CP. Although in “end-stage” cases the operative risk is markedly elevated, the young age and absence of other effective therapeutical options in our patient, dictated the decision to move forward with the procedure. Close follow-up is necessary, as recovery of cardiac function is usually slow and may be only partial (Figure presented). AD - K. Domingues, Hospital of Santarem, Cardiology, Santarem, Portugal AU - Domingues, K. AU - De Oliveira, A. F. AU - Braga, A. AU - Goncalves, M. AU - Reis, C. AU - Horta, E. AU - Andrade, M. J. AU - Trabulo, M. AU - Mendes, M. AU - Neves, J. P. DB - Embase DO - 10.1093/ehjci/jex266 KW - bilirubin adult ascites biopsy blood culture cachexia calcification Cape Verde case report central venous pressure Child Pugh score chronic liver disease claustrophobia complication constrictive pericarditis coughing developing country diagnosis dyspnea echocardiography emergency Europe faintness follow up forward heart failure heart atrium enlargement heart atrium flutter heart left ventricle ejection fraction heart palpitation heart ventricle function hepatomegaly Holter monitoring human human tissue jaundice leukopenia lymphadenopathy male mediastinum medical history P wave patient referral pericardial effusion pericardiectomy phenotype physical examination physiology pleura effusion pleura fluid precordial pain surgery surgical risk tachycardia thorax radiography thrombocytopenia tuberculosis body weight loss young adult LA - English M3 - Conference Abstract N1 - L620122323 2018-01-10 PY - 2017 SN - 2047-2412 SP - iii177-iii178 ST - Chronic constrictive pericarditis: An 'end-stage' case with all ingredients, treated successfully T2 - European Heart Journal Cardiovascular Imaging TI - Chronic constrictive pericarditis: An 'end-stage' case with all ingredients, treated successfully UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620122323&from=export http://dx.doi.org/10.1093/ehjci/jex266 VL - 18 ID - 760886 ER - TY - JOUR AB - Introduction: Patient blood management (PBM) represents a shift towards a patient-centred evidenced-based reduction in transfusion with the aim of improving outcomes and appropriately utilising a scarce and costly resource. Three pillars are considered: optimisation of anaemia, minimising blood loss and improving tolerance to anaemia before, during and after a surgical procedure or delivery. Minimising allogenic transfusion and loss of future blood donors is a particularly compelling argument for a robust PBM programme in the young obstetric population. In our institution, snapshot audits of antenatal, perinatal and postnatal bloodmanagement revealed room for improvement and prompted a multipronged quality improvement initiative. Methods: Retrospective data was collected pertaining to each PBM pillar 1. Prevalence and management of antenatal anaemia: 50 consecutive patient snapshot 2. Management of massive obstetric haemorrhage (MOH) in a 2-year time period 3. Transfusion in stable women post delivery: 50 patients over 6-month period Quality improvement methodology has been employed to drive change in each domain. Results: 1. Prevalence of antenatal anaemia was 16% in the 1st trimester increasing to 28% by the 2nd trimester. 85% of anaemic women were prescribed oral iron, but only 50% were successfully optimised by their 2nd trimester check. Compliance and tolerance with oral iron was poor (31%). No patients received IV iron. 2. 18 patients had a declared MOH over a 2-year time period in our institution. Only one third of patients had fibrinogen measured. No patients received cryoprecipitate or fibrinogen concentrate. Thromboelastography (TEG) was performed in 11% cases. Cell salvage was not utilised in any of the cases. 3. 47 stable postpartum women were transfused in a 6-month period. Median number of units transfused was 2 [2-2]. 36 RBC units were transfused in patients with trigger Hb >70 g/L. Discussion: Identifying shortfalls in each PBMdomain led to an ambitious multidisciplinary team approach to quality service improvement. An antenatal anaemia pathway with timely recheck of Hb and access to outpatient IV iron infusions was developed. Measurement of fibrinogen is now standard at declaration of MOH with an emphasis on early replacement with cryoprecipitate or fibrinogen concentrate if <2-3 g/L in the context of ongoing bleeding. Use of TEG to monitor and individualise haemostatic response will be facilitated with acquisition of the new TEG 6s on the labour ward. Discussion about use of cell salvage is encouraged for all high-risk cases at morning brief. Implementation of restrictive transfusion triggers, targets and a single-unit policy is being supported with introduction of electronic prescribing with clinical decision tool. Driving change requires multidisciplinary buy in with education to inform and support clinicians. “PBM lessons of the week” have helped disseminate knowledge. We are collecting data prospectively to chart change in transfusion practice over time. AD - C. Donohue, Royal Free London NHS Trust, London, United Kingdom AU - Donohue, C. AU - Morkane, C. AU - Abeysundara, L. AU - Carpenter, E. AU - Abdul-Kadir, R. AU - Mallett, S. V. DB - Embase DO - 10.1111/tme.12417 KW - endogenous compound fibrinogen fibrinogen concentrate iron anemia clinical article clinical trial cryoprecipitate doctor patient relationship drug therapy education electronic prescribing female first trimester pregnancy human infusion male obstetric hemorrhage obstetrics outpatient prevalence second trimester pregnancy thromboelastography total quality management LA - English M3 - Conference Abstract N1 - L615441264 2017-04-24 PY - 2017 SN - 1365-3148 SP - 35 ST - Identifying and tackling the pillars of PBM in obstetrics T2 - Transfusion Medicine TI - Identifying and tackling the pillars of PBM in obstetrics UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615441264&from=export http://dx.doi.org/10.1111/tme.12417 VL - 27 ID - 760951 ER - TY - JOUR AB - Introduction: Patient and team safety are paramount in healthcare, but medical errors remain the third leading cause of death. In laparoscopy, a surgical black box, based on aviation industry principles, provides valuable information about events occurring during these procedures.1 The system collects and synchronizes audio-visual and patient-related data for semi-automatic evaluation of technical- and non-technical skills (NTS) and environmental factors. In endovascular surgery, this technology may also provide useful knowledge about type, cause and frequency of perioperative events. Yet, high reliance on multidisciplinary teams and high equipment demands including radiation and a mobile C-arm pose additional challenges to transfer the black box technology in this field. We present our experience to adapt a black box system for evaluation of endovascular surgical procedures. Methods: Prior to installation, approval was obtained from all relevant hospital parties. Together with the original black box team and partners from biomedical, infrastructural and IT departments, an implementation plan was created for adapting the black box to our hybrid angiosuite, equipped with a Philips Allura Xper FD20 system. Video-evaluation frameworks were chosen with the black box research team. Technical skill evaluation tools were chosen after a non-structured analysis of the literature. NTS and environmental factor evaluation frameworks were already available in the system. A framework for radiation safety evaluation has been self-developed and is currently being validated. Results: Ethics approval took 54 days and approval of juridical and financial agreement took 252 days. All team members (surgeons, nurses, anaesthesiologists) were informed during informative sessions and informed consent was collected. Site assessment and hardware installation both required two days. Four ceiling-mounted cameras were used to capture team movement and activity in the angiosuite, which were sometimes blocked by the C-arm. Three multidirectional ceiling microphones were installed to capture team conversations and environmental noise. A direct connection with the C-arm system captures the fluoroscopy image and radiation safety parameters. Patient hemodynamic monitoring is captured through the anaesthesia monitor and provides information about event severity and physiologic consequences. Surgical technical performance is assessed with the 'Global Rating Scale of Endovascular Performance' and the 'Examiner's Checklist' frameworks. The NOTSS, SPLINTS and ANTS frameworks were picked to assess non-technical skills of surgical, nursing and anaesthesiology teams, respectively. The 'Disruption in Surgery Index' framework assesses disruptive and environmental factors. A pilot study of 20 elective endovascular treatments of symptomatic iliac and femoropopliteal atherosclerotic disease to assess feasibility and reliability of black box-driven analysis is in progress. Data will be available at the annual meeting. Conclusion: To our knowledge, this innovative black box technology is the first to be installed in a hybrid angiosuite worldwide. Ultimately, this may help identify the number of errors or near-misses occurring in a hybrid angiosuite. This may allow each centre to identify safety risks and map operational sequences leading to adverse events in endovascular surgery, ultimately leading to educational interventions based on real situations so that every error or near-miss remains unique. Disclosure: Nothing to disclose AU - Doyen, B. AU - Gordon, L. AU - Vermassen, F. AU - Grantcharov, T. AU - Van Herzeele, I. DB - Embase DO - 10.1016/j.ejvs.2019.09.247 KW - adult anesthesia anesthesiologist atherosclerosis checklist computer conference abstract conversation drug safety endovascular surgery environmental factor feasibility study female fluoroscopy hemodynamic monitoring human iliac bone informed consent male microphone multidisciplinary team noise nurse pilot study radiation safety rating scale reliability skill splint surgeon surgical nursing surgical technique videorecording X ray system LA - English M1 - 6 M3 - Conference Abstract N1 - L2003904147 2019-12-12 PY - 2019 SN - 1532-2165 1078-5884 SP - e713-e714 ST - Introduction of a Surgical Black Box System in a Hybrid Angiosuite: Challenges and Opportunities T2 - European Journal of Vascular and Endovascular Surgery TI - Introduction of a Surgical Black Box System in a Hybrid Angiosuite: Challenges and Opportunities UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003904147&from=export http://dx.doi.org/10.1016/j.ejvs.2019.09.247 VL - 58 ID - 760645 ER - TY - JOUR AB - Objectives: Radiation protection training courses currently focus on broad knowledge topics which may not always be relevant in daily practice. The goal of this study was to determine the key competencies in radiation protection that every endovascular team member should possess and apply routinely, through multispecialty clinical content expert consensus. Methods: Consensus was obtained through a two round modified Delphi methodology. The expert panel consisted of European vascular surgeons, interventional radiologists, and interventional cardiologists/angiologists experienced in endovascular procedures. An initial list of statements, covering knowledge skills, technical skills and attitudes was created, based on a literature search. Additional statements could be suggested by the experts in the first Delphi round. Each of the statements had to be rated on a 5-point Likert scale. A statement was considered to be a key competency when the internal consistency was greater than alpha = 0.80 and at least 80% of the experts agreed (rating 4/5) or strongly agreed (rating 5/5) with the statement. Questionnaires were emailed to panel members using the Surveymonkey service. Results: Forty-one of 65 (63.1%) invited experts agreed to participate in the study. The response rates were 36 out of 41 (87.8%): overall 38 out of 41(92.6%) in the first round and 36 out of 38 (94.7%) in the second round. The 71 primary statements were supplemented with nine items suggested by the panel. The results showed excellent consensus among responders (Cronbach's alpha = 0.937 first round; 0.958 s round). Experts achieved a consensus that 30 of 33 knowledge skills (90.9%), 23 of 27 technical skills (82.1%), and 15 of 20 attitudes (75.0%) should be considered as key competencies. Conclusions: A multispecialty European endovascular expert panel reached consensus about the key competencies in radiation protection. These results may serve to create practical and relevant radiation protection training courses in the future, enhancing radiation safety for both patients and the entire endovascular team. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. AD - [Doyen, Bart; Maertens, Heidi; Van Herzeele, Isabelle] Ghent Univ Hosp, Dept Thorac & Vasc Surg, 2K12D,Pintelaan 185, B-9000 Ghent, Belgium. [Maurel, Blandine] Univ Hosp Ctr Nantes, Dept Vasc Surg, Nantes, France. [Cole, Jonathan] Royal Free London NHS Fdn Trust, Radiol Phys & Radiat Safety, London, England. [Mastracci, Tara] Royal Free London NHS Fdn Trust, Dept Vasc Surg, London, England. Doyen, B (corresponding author), Ghent Univ Hosp, Dept Thorac & Vasc Surg, 2K12D,Pintelaan 185, B-9000 Ghent, Belgium. bart.doyen@ugent.be AN - WOS:000426344500024 AU - Doyen, B. AU - Maurel, B. AU - Cole, J. AU - Maertens, H. AU - Mastracci, T. AU - Van Herzeele, I. AU - prot, Pret Principles Radiation DA - Feb DO - 10.1016/j.ejvs.2017.11.020 J2 - Eur. J. Vasc. Endovasc. Surg. KW - Radiation protection Delphi consensus Education Multispecialty Endovascular INTERVENTIONAL RADIOLOGY JOINT GUIDELINE EXPOSURE EDUCATION KNOWLEDGE FRAMEWORK CRITERIA SOCIETY EUROPE IMPACT Surgery Peripheral Vascular Disease LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: FX8LC Times Cited: 5 Cited Reference Count: 29 Doyen, Bart Maurel, Blandine Cole, Jonathan Maertens, Heidi Mastracci, Tara Van Herzeele, Isabelle Bertoglio, Luca/N-2092-2019; Melissano, Germano/AAN-4259-2020; Lachat, Mario/G-4826-2011 Bertoglio, Luca/0000-0001-6871-2176; Melissano, Germano/0000-0002-4168-1792; Lachat, Mario/0000-0001-7812-2110; Doyen, Bart/0000-0002-9573-7632; VERZINI, Fabio/0000-0003-4453-1949; Dick, Florian/0000-0003-1561-2619; Maurel, Blandine/0000-0001-8957-6951; FERRARESI, Roberto/0000-0002-6185-6510; Cole, Jonathan/0000-0002-3012-4392; Van Herzeele, Isabelle/0000-0002-1754-7390 Senior Clinical Fellowship of the Fund for Scientific Research - Flanders, Belgium I. Van Herzeele is supported by a Senior Clinical Fellowship of the Fund for Scientific Research - Flanders, Belgium. 5 0 6 W B SAUNDERS CO LTD LONDON EUR J VASC ENDOVASC PY - 2018 SN - 1078-5884 SP - 281-287 ST - Defining the Key Competencies in Radiation Protection for Endovascular Procedures: A Multispecialty Delphi Consensus Study T2 - European Journal of Vascular and Endovascular Surgery TI - Defining the Key Competencies in Radiation Protection for Endovascular Procedures: A Multispecialty Delphi Consensus Study UR - ://WOS:000426344500024 VL - 55 ID - 761603 ER - TY - JOUR AB - Optimal pulmonary hypertension (PH) management relies on a timely, accurate diagnosis and follow-up in specialized clinics by multidisciplinary teams that have clearly defined responsibilities and protocols. Internationally agreed criteria for expert center staff are lacking, particularly with respect to nurses, who often act as a central component of the team. This survey aimed to evaluate the current organization of PH clinics and the role of nurses. The survey (35 questions) was online February-December 2015 and was advertised at international PH nurse meetings and through international PH organizations to their corresponding clinics. In total, 126 healthcare professionals from 32 countries responded. According to respondents, 54% of clinics managed >200 patients, of whom 49% had a pulmonary arterial hypertension (PAH) diagnosis, on average. In terms of staff, 66% had a dedicated program administrator, 35% had one full-time nurse coordinator/practitioner/specialist, and 57% had a nurse attend outpatient clinic alongside a physician. Crucially, not all centers had a nurse in their team. The role of a nurse coordinator/practitioner/specialist varied with 51% taking patient histories/examinations and 66% managing outpatients. In 34% of clinics, nurses were involved in their own research. Protocols were available for PH therapies (81%), management of heart failure (37%) and pain (26%), and referring patients who did not have PAH/chronic thromboembolic PH back to their specialist (62%). Not all clinics are meeting all of the standards outlined in the latest guidelines with key areas of improvement being level of support from/for nurses, clear protocols, and referral pathways. AD - 1 University of Ottawa Heart Institute, Ottawa, ON, Canada. 2 Alberta Health Services, Calgary, AB, Canada. 3 Heart and Vascular Center, University of Iowa, Iowa City, IA, USA. 4 Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK. AN - 31106660 AU - Doyle-Cox, C. AU - Nicholson, G. AU - Stewart, T. AU - Gin-Sing, W. C2 - Pmc6557030 DA - Apr-Jun DO - 10.1177/2045894019855611 DP - NLM ET - 2019/05/21 J2 - Pulmonary circulation KW - and organization financing health education/disease prevention/patient education health policy pulmonary arterial hypertension LA - eng M1 - 2 N1 - 2045-8940 Doyle-Cox, Carolyn Nicholson, Gail Stewart, Traci Gin-Sing, Wendy Journal Article Pulm Circ. 2019 Apr-Jun;9(2):2045894019855611. doi: 10.1177/2045894019855611. PY - 2019 SN - 2045-8932 (Print) 2045-8932 SP - 2045894019855611 ST - Current organization of specialist pulmonary hypertension clinics: results of an international survey T2 - Pulm Circ TI - Current organization of specialist pulmonary hypertension clinics: results of an international survey VL - 9 ID - 760201 ER - TY - JOUR AB - Background: Although the benefits of antithrombotic drugs are indisputable, they carry a high risk for patient safety. Studies on the implementation and effectiveness of a hospital-based multidisciplinary antithrombotic team on bleeding and thrombotic outcomes are scarce. Aims: Main aim is to investigate the effect of implementing a hospital- based multidisciplinary antithrombotic team on the efficacy and safety of antithrombotic therapy during and after hospitalization. Secondary aims are to determine the effect of the multidisciplinary team on severity of bleeding, all-cause mortality and length of hospitalization. Methods: Design: Prospective, observational multicenter cohort study. Setting: Patients admitted to Erasmus University Medical Center and Reinier de Graaf Hospital between October 2015 and December 2017, using one or more therapeutically dosed anticoagulants. Intervention: Implementation of a hospital-based multidisciplinary antithrombotic team. Primary outcome: proportion of patients with a composite end point consisting of ≥1 bleeding or ≥1 thrombotic event from hospitalization until 3 months after hospitalization. Secondary outcomes: proportion of patients with a major and non-major bleeding event, all-cause mortality and length of hospitalization before and after implementation of the multidisciplinary antithrombotic team. Statistical analysis: For analysis of the primary outcome we used segmented regression analysis for the interrupted time series data. For the secondary outcomes logistic regression analysis was used. T-test analysis was performed for the length of hospitalization. Results: 941 patients were included in the usual care period and 945 patients in the intervention period. Introduction of the multidisciplinary antithrombotic team led to a significant reduction in the proportion of patients with the primary outcome (-1.83% (95% CI: -2.58%; -1.08%). Lower all-cause mortality (odds ratio [OR] 0.71, 95% confidence interval [95% CI] 0.53-0.95) was observed after introduction of the multidisciplinary antithrombotic team. No significant effect of the intervention was found for the severity of bleeding and mean length of hospital stay. Summary/Conclusion: Introducing a multidisciplinary antithrombotic team contributes to patient safety. AD - A. Dreijer, Hospital Pharmacy, Reinier De Graaf ziekenhuis, Delft, Netherlands AU - Dreijer, A. AU - Kruip, M. AU - Diepstraten, J. AU - Brouwer, R. AU - Croles, N. AU - Kragten, E. AU - Leebeek, F. AU - Van Den Bemt, P. DB - Embase KW - anticoagulant agent adult all cause mortality bleeding cohort analysis conference abstract controlled study drug safety drug therapy female hospitalization human major clinical study male multicenter study multidisciplinary team outcome assessment patient safety pharmacokinetics prospective study thrombosis time series analysis university hospital LA - English M3 - Conference Abstract N1 - L629912055 2019-11-26 PY - 2019 SN - 2572-9241 SP - 118 ST - The effect of antithrombotic stewardship on the efficacy and safety of antithrombotic therapy during and after hospitalization in two dutch hospitals T2 - HemaSphere TI - The effect of antithrombotic stewardship on the efficacy and safety of antithrombotic therapy during and after hospitalization in two dutch hospitals UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629912055&from=export VL - 3 ID - 760712 ER - TY - JOUR AB - Background: Although the benefits of antithrombotic drugs are indisputable, they carry a high risk for patient safety. Studies on the implementation and (cost-) effectiveness of a hospital-based multidisciplinary antithrombotic team on bleeding and thrombotic outcomes are scarce. Objectives: Main aim is to investigate the effect of implementing a hospital-based multidisciplinary antithrombotic team on the efficacy and safety of antithrombotic therapy during and after hospitalization. Secondary aims are to determine the effect of the multidisciplinary team on severity of bleeding, all-cause mortality and length of hospitalization. Methods: Design: Prospective, observational multicenter cohort study. Setting: Patients admitted to Erasmus University Medical Center and Reinier de Graaf Hospital between October 2015 and December 2017, using one or more therapeutically dosed anticoagulants. Intervention: Implementation of a hospital-based multidisciplinary antithrombotic team. Primary outcome: proportion of patients with a composite end point consisting of ≥1 bleeding or ≥ 1 thrombotic event from hospitalization until 3 months after hospitalization. Secondary outcomes: proportion of patients with a major and non-major bleeding event, all-cause mortality and length of hospitalization before and after implementation of the multidisciplinary antithrombotic team. Statistical analysis: For analysis of the primary outcome we used segmented regression analysis for the interrupted time series data. For the secondary outcomes logistic regression analysis was used. T-Test analysis was performed for the length of hospitalization. Results: 941 patients were included in the usual care period and 945 patients in the intervention period. Introduction of the multidisciplinary antithrombotic team led to a significant reduction in the proportion of patients with the primary outcome (-1.83% (95% CI: -2.58%; -1.08%). Lower all-cause mortality (odds ratio [OR] 0.71, 95% confidence interval [95% CI] 0.53-0.95) was observed after introduction of the multidisciplinary antithrombotic team. No significant effect of the intervention was found for the severity of bleeding and mean length of hospital stay. Conclusions: Introducing a multidisciplinary antithrombotic team contributes to patient safety. AD - A. Dreijer, Erasmus University Medical Center, Rotterdam, Netherlands AU - Dreijer, A. AU - Kruip, M. J. H. A. AU - Diepstraten, J. AU - Polinder, S. AU - Brouwer, R. AU - Croles, N. AU - Kragten, E. AU - Leebeek, F. W. G. AU - Van Den Bemt, P. DB - Embase DO - 10.1002/pds.4864 KW - anticoagulant agent adult all cause mortality bleeding cohort analysis conference abstract controlled study drug safety drug therapy female hospitalization human major clinical study male multicenter study multidisciplinary team outcome assessment patient safety pharmacokinetics prospective study thrombosis time series analysis university hospital LA - English M3 - Conference Abstract N1 - L629264302 2019-09-13 PY - 2019 SN - 1099-1557 SP - 9-10 ST - Antithrombotic stewardship T2 - Pharmacoepidemiology and Drug Safety TI - Antithrombotic stewardship UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629264302&from=export http://dx.doi.org/10.1002/pds.4864 VL - 28 ID - 760686 ER - TY - JOUR AB - Introduction: Antithrombotic therapy carries high risks for patient safety. Antithrombotics belong to the top 5 medications involved in potentially preventable hospital admissions related to medication. To provide a standard for antithrombotic therapy and stress the importance of providing optimal care to patients on antithrombotic therapy, the Landelijke Standaard Ketenzorg Antistolling (LSKA; Dutch guideline on integrated antithrombotic care) was drafted. However, the mere publication of this guideline does not guarantee its implementation. This may require a multidisciplinary team effort. Therefore, we designed a study aiming to determine the influence of hospital-based antithrombotic stewardship on the effect and safety of antithrombotic therapy outcomes during and after hospitalisation. Methods and analysis: In this study, the effect of the implementation of a multidisciplinary antithrombotic team is compared with usual care using a pre-post study design. The study is performed at the Erasmus University Medical Center Rotterdam and the Reinier de Graaf Hospital Delft. Patients who are or will be treated with antithrombotics are included in the study. We aim to include 1900 patients, 950 in each hospital. Primary outcome is the proportion of patients with a composite end point consisting of >= 1 bleeding or >= 1 thrombotic event from the beginning of antithrombotic therapy (or hospitalisation) until 3 months after hospitalisation. Bleeding is defined according to the International Society of Thrombosis and Haemostasis (ISTH) classification. A thrombotic event is defined as any objectively confirmed arterial or venous thrombosis, including acute myocardial infarction or stroke for arterial thrombosis and deep venous thrombosis or pulmonary embolism or venous thrombosis. An economic evaluation is performed to determine whether the implementation of the multidisciplinary antithrombotic team will be cost-effective. Ethics and dissemination: This protocol was approved by the Medical Ethical Committee of the Erasmus University Medical Center. The findings of the study will be disseminated through peer-reviewed journals and presented at relevant conferences. AD - [Dreijer, Albert R.; Vulto, Arnold G.; van den Bemt, Patricia M. L. A.] Erasmus Univ, Med Ctr, Dept Hosp Pharm, Rotterdam, Netherlands. [Dreijer, Albert R.; Diepstraten, Jeroen] Reinier de Graaf Hosp, Dept Hosp Pharm, Delft, Netherlands. [Kruip, Marieke J. H. A.; Leebeek, Frank W. G.] Erasmus Univ, Dept Hematol, Med Ctr, Rotterdam, Netherlands. [Polinder, Suzanne] Erasmus Univ, Dept Publ Hlth, Med Ctr, Rotterdam, Netherlands. [Brouwer, Rolf] Reinier de Graaf Hosp, Dept Hematol, Delft, Netherlands. van den Bemt, PMLA (corresponding author), Erasmus Univ, Med Ctr, Dept Hosp Pharm, Rotterdam, Netherlands. p.vandenbemt@erasmusmc.nl AN - WOS:000391303600039 AU - Dreijer, A. R. AU - Kruip, Mjha AU - Diepstraten, J. AU - Polinder, S. AU - Brouwer, R. AU - Leebeek, F. W. G. AU - Vulto, A. G. AU - van den Bemt, Pmla C7 - e011537 DO - 10.1136/bmjopen-2016-011537 J2 - BMJ Open KW - ATRIAL-FIBRILLATION MEDICATION ADHERENCE DEFINITION POPULATION ADMISSIONS WARFARIN EVENTS Medicine, General & Internal LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: EG8JS Times Cited: 6 Cited Reference Count: 38 Dreijer, Albert R. Kruip, Marieke J. H. A. Diepstraten, Jeroen Polinder, Suzanne Brouwer, Rolf Leebeek, Frank W. G. Vulto, Arnold G. van den Bemt, Patricia M. L. A. Van den Bemt, Patricia/0000-0003-1418-5520 Dutch health insurance company Stichting Phoenix; Daiichi SankyoDaiichi Sankyo Company Limited; Boehringer IngelheimBoehringer Ingelheim; BayerBayer AG; PfizerPfizer; Scientific Committee Reinier de Graaf Hospital The Dutch health insurance company Stichting Phoenix, the pharmaceutical companies (Daiichi Sankyo, Boehringer Ingelheim, Bayer and Pfizer) and the Scientific Committee Reinier de Graaf Hospital provided financial support for this study in the form of unrestricted grants. 7 0 2 BMJ PUBLISHING GROUP LONDON BMJ OPEN PY - 2016 SN - 2044-6055 SP - 9 ST - Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol T2 - Bmj Open TI - Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol UR - ://WOS:000391303600039 VL - 6 ID - 761723 ER - TY - JOUR AB - Background Although the benefits of antithrombotic drugs are indisputable to reduce thrombotic events, they carry a high risk of compromising patient safety. No previous studies investigated the implementation and (cost-) effectiveness of a hospital-based multidisciplinary antithrombotic team on bleeding and thrombotic outcomes. The primary aim of this study was to compare the proportion of patients with a composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization. Methods and findings A prospective, multicenter before-after intervention study was conducted in two Dutch hospitals. Adult patients hospitalized between October 2015 and December 2017 treated with anticoagulant therapy were included. The primary aim was to estimate the proportion of patients with a composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization. The intervention was the implementation of a multidisciplinary antithrombotic team focusing on education, medication reviews by pharmacists, implementing of local anticoagulant therapy guidelines based on national guidelines, patient counselling and medication reconciliation at admission and discharge. The primary endpoint was analysed using segmented linear regression. We obtained data for 1,886 patients: 941 patients were included in the usual care period and 945 patients in the intervention period. The S-team study showed that implementation of a multidisciplinary antithrombotic team over time significantly reduced the composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization in patients using anticoagulant drugs (-1.83% (-2.58% to -1.08%) per 2 month period). Conclusions This study shows that implementation of a multidisciplinary antithrombotic team over time significantly reduces the composite end point consisting of one or more bleeding episodes or one or more thrombotic event from hospitalization until three months after hospitalization in patients using anticoagulant drugs. AD - [Dreijer, Albert R.] Erasmus MC, Dept Hosp Pharm, Rotterdam, Netherlands. [Dreijer, Albert R.; Diepstraten, Jeroen] Reinier Graaf Hosp, Dept Hosp Pharm, Delft, Netherlands. [Kruip, Marieke J. H. A.; Croles, F. Nanne; Leebeek, Frank W. G.] Erasmus MC, Dept Hematol, Rotterdam, Netherlands. [Kruip, Marieke J. H. A.] Thrombosis Serv STAR SHL, Rotterdam, Netherlands. [Polinder, Suzanne] Erasmus MC, Dept Publ Hlth, Rotterdam, Netherlands. [Brouwer, Rolf; Kragten, Esther] Reinier Graaf Hosp, Dept Hematol, Delft, Netherlands. [Mol, Peter G. M.; van den Bemt, Patricia M. L. A.] Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharmacol, Groningen, Netherlands. Dreijer, AR (corresponding author), Erasmus MC, Dept Hosp Pharm, Rotterdam, Netherlands.; Dreijer, AR (corresponding author), Reinier Graaf Hosp, Dept Hosp Pharm, Delft, Netherlands. a.dreijer@treant.nl AN - WOS:000545747200069 AU - Dreijer, A. R. AU - Kruip, Mjha AU - Diepstraten, J. AU - Polinder, S. AU - Brouwer, R. AU - Mol, P. G. M. AU - Croles, F. N. AU - Kragten, E. AU - Leebeek, F. W. G. AU - van den Bemt, Pmla C7 - e0235048 DA - Jun DO - 10.1371/journal.pone.0235048 J2 - PLoS One KW - ATRIAL-FIBRILLATION BLEEDING COMPLICATIONS VENOUS THROMBOEMBOLISM WARFARIN ANTICOAGULATION DEFINITION MANAGEMENT APIXABAN COST Multidisciplinary Sciences LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: MG0TI Times Cited: 0 Cited Reference Count: 33 Dreijer, Albert R. Kruip, Marieke J. H. A. Diepstraten, Jeroen Polinder, Suzanne Brouwer, Rolf Mol, Peter G. M. Croles, F. Nanne Kragten, Esther Leebeek, Frank W. G. van den Bemt, Patricia M. L. A. Stichting Phoenix Schiedam; Daiichi SankyoDaiichi Sankyo Company Limited; Boehringer IngelheimBoehringer Ingelheim; BayerBayer AG; PfizerPfizer; Scientific Committee Reinier de Graaf Gasthuis Stichting Phoenix Schiedam, the pharmaceutical companies (Daiichi Sankyo, Boehringer Ingelheim, Bayer and Pfizer) and the Scientific Committee Reinier de Graaf Gasthuis provided financial support for this study in the form of unrestricted grants. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 0 PUBLIC LIBRARY SCIENCE SAN FRANCISCO PLOS ONE PY - 2020 SN - 1932-6203 SP - 16 ST - Effect of antithrombotic stewardship on the efficacy and safety of antithrombotic therapy during and after hospitalization T2 - Plos One TI - Effect of antithrombotic stewardship on the efficacy and safety of antithrombotic therapy during and after hospitalization UR - ://WOS:000545747200069 VL - 15 ID - 761430 ER - TY - JOUR AB - INTRODUCTION: Antithrombotic therapy carries high risks for patient safety. Antithrombotics belong to the top 5 medications involved in potentially preventable hospital admissions related to medication. To provide a standard for antithrombotic therapy and stress the importance of providing optimal care to patients on antithrombotic therapy, the Landelijke Standaard Ketenzorg Antistolling (LSKA; Dutch guideline on integrated antithrombotic care) was drafted. However, the mere publication of this guideline does not guarantee its implementation. This may require a multidisciplinary team effort. Therefore, we designed a study aiming to determine the influence of hospital-based antithrombotic stewardship on the effect and safety of antithrombotic therapy outcomes during and after hospitalisation. METHODS AND ANALYSIS: In this study, the effect of the implementation of a multidisciplinary antithrombotic team is compared with usual care using a pre-post study design. The study is performed at the Erasmus University Medical Center Rotterdam and the Reinier de Graaf Hospital Delft. Patients who are or will be treated with antithrombotics are included in the study. We aim to include 1900 patients, 950 in each hospital. Primary outcome is the proportion of patients with a composite end point consisting of ≥1 bleeding or ≥1 thrombotic event from the beginning of antithrombotic therapy (or hospitalisation) until 3 months after hospitalisation. Bleeding is defined according to the International Society of Thrombosis and Haemostasis (ISTH) classification. A thrombotic event is defined as any objectively confirmed arterial or venous thrombosis, including acute myocardial infarction or stroke for arterial thrombosis and deep venous thrombosis or pulmonary embolism or venous thrombosis. An economic evaluation is performed to determine whether the implementation of the multidisciplinary antithrombotic team will be cost-effective. ETHICS AND DISSEMINATION: This protocol was approved by the Medical Ethical Committee of the Erasmus University Medical Center. The findings of the study will be disseminated through peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER: NTR4887; pre-results. AD - Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands. Department of Hospital Pharmacy, Reinier de Graaf Hospital, Delft, The Netherlands. Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands. Department of Hematology, Reinier de Graaf Hospital, Delft, The Netherlands. AN - 27998897 AU - Dreijer, A. R. AU - Kruip, M. J. AU - Diepstraten, J. AU - Polinder, S. AU - Brouwer, R. AU - Leebeek, F. W. AU - Vulto, A. G. AU - van den Bemt, P. M. C2 - Pmc5223636 DA - Dec 20 DO - 10.1136/bmjopen-2016-011537 DP - NLM ET - 2016/12/22 J2 - BMJ open KW - Academic Medical Centers Anticoagulants/*therapeutic use Arteries/pathology Cost-Benefit Analysis Female Fibrinolytic Agents/*therapeutic use Hemorrhage/etiology *Hospitalization Hospitals Humans Male Myocardial Infarction/drug therapy Netherlands *Patient Care Team Pulmonary Embolism/drug therapy Research Design Stroke Thrombosis/*drug therapy Veins/pathology Venous Thrombosis/drug therapy *Epidemiology LA - eng M1 - 12 N1 - 2044-6055 Dreijer, Albert R Kruip, Marieke J H A Diepstraten, Jeroen Polinder, Suzanne Brouwer, Rolf Leebeek, Frank W G Vulto, Arnold G van den Bemt, Patricia M L A Journal Article Research Support, Non-U.S. Gov't BMJ Open. 2016 Dec 20;6(12):e011537. doi: 10.1136/bmjopen-2016-011537. PY - 2016 SN - 2044-6055 SP - e011537 ST - Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol T2 - BMJ Open TI - Antithrombotic stewardship: a multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: a study protocol VL - 6 ID - 760191 ER - TY - JOUR AB - Introduction: Antithrombotic therapy carries high risks for patient safety. Antithrombotics belong to the top 5 medications involved in potentially preventable hospital admissions related to medication. To provide a standard for antithrombotic therapy and stress the importance of providing optimal care to patients on antithrombotic therapy, the Landelijke Standaard Ketenzorg Antistolling (LSKA; Dutch guideline on integrated antithrombotic care) was drafted. However, the mere publication of this guideline does not guarantee its implementation. This may require a multidisciplinary team effort. Therefore, we designed a study aiming to determine the influence of hospital-based antithrombotic stewardship on the effect and safety of antithrombotic therapy outcomes during and after hospitalisation. Methods and analysis: In this study, the effect of the implementation of a multidisciplinary antithrombotic team is compared with usual care using a pre-post study design. The study is performed at the Erasmus University Medical Center Rotterdam and the Reinier de Graaf Hospital Delft. Patients who are or will be treated with antithrombotics are included in the study. We aim to include 1900 patients, 950 in each hospital. Primary outcome is the proportion of patients with a composite end point consisting of ≥1 bleeding or ≥1 thrombotic event from the beginning of antithrombotic therapy (or hospitalisation) until 3 months after hospitalisation. Bleeding is defined according to the International Society of Thrombosis and Haemostasis (ISTH) classification. A thrombotic event is defined as any objectively confirmed arterial or venous thrombosis, including acute myocardial infarction or stroke for arterial thrombosis and deep venous thrombosis or pulmonary embolism or venous thrombosis. An economic evaluation is performed to determine whether the implementation of the multidisciplinary antithrombotic team will be cost-effective. Ethics and dissemination: This protocol was approved by the Medical Ethical Committee of the Erasmus University Medical Center. The findings of the study will be disseminated through peer-reviewed journals and presented at relevant conferences. AD - P.M.L.A. Van Den Bemt, Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Netherlands AU - Dreijer, A. R. AU - Kruip, M. J. H. A. AU - Diepstraten, J. AU - Polinder, S. AU - Brouwer, R. AU - Leebeek, F. W. G. AU - Vulto, A. G. AU - Van Den Bemt, P. M. L. A. DB - Embase Medline DO - 10.1136/bmjopen-2016-011537 KW - acenocoumarol activated prothrombin complex anticoagulant agent antithrombin III apixaban bivalirudin dabigatran etexilate dalteparin danaparoid enoxaparin fibrinogen fondaparinux nadroparin phenprocoumon phytomenadione protamine prothrombin complex rivaroxaban taneptacogin alfa tinzaparin tranexamic acid acute heart infarction anticoagulant therapy artery thrombosis article bleeding cerebrovascular accident deep vein thrombosis hospitalization human lung embolism major clinical study patient care study design treatment outcome vein thrombosis LA - English M1 - 12 M3 - Article N1 - L613801322 2017-01-02 2017-03-24 PY - 2016 SN - 2044-6055 ST - Antithrombotic stewardship: A multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: A study protocol T2 - BMJ Open TI - Antithrombotic stewardship: A multidisciplinary team approach towards improving antithrombotic therapy outcomes during and after hospitalisation: A study protocol UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613801322&from=export http://dx.doi.org/10.1136/bmjopen-2016-011537 VL - 6 ID - 760986 ER - TY - JOUR AB - BACKGROUND:The incidence rate of stroke in hospitalized patients ranges between 2% and 17% of all strokes-a higher rate than in the community. Delays in recognition and management of stroke in hospitalized patients lead to worse outcomes. At our hospital, the existing in-hospital stroke (IHS) code showed low usage and effectiveness. In a quality improvement (QI) project, we aimed to improve the identification of and the quality of care for inpatient strokes.METHODS:A nurse-driven IHS protocol was implemented, which alerted a specialized stroke team and cleared the computed tomography (CT) scanner. The protocol focused on prioritizing staff education, simplifying the process, empowering staff to activate an IHS code, ensuring adequate support and teamwork, identifying well-defined quality metrics (eg, time to CT and documentation tool use), and providing feedback communication. We analyzed 2 years of postimplementation IHS data for impact on stroke detection and outcomes.RESULTS:In the 2 years post QI, there was a more than 10-fold increase in IHS (pre-QI, n = 8; first year post QI, n = 94; second year post QI, n = 123). In the post-QI cohort, after excluding patients with missing information (n = 26), 69 cases had new stroke diagnoses (63 ischemic, 6 hemorrhagic), and 148 were stroke mimics. The mean (SD) time from IHS to CT was 18.7 (7.0) minutes. Of the 63 new ischemic stroke cases, 25 (39.7%) were treated with thrombolytic therapy and/or mechanical thrombectomy.CONCLUSION:The new IHS protocol has led to a marked increase in cases identified, rapid evaluation, and high utilization rate of acute stroke therapies. AD - [Droegemueller, Carol J.; Wagner, Roberta L. Huna; Shibeshi, Hannah] Reg Hosp Comprehens Stroke Ctr, St Paul, MN 55101 USA. [Kashyap, Bhavani] HealthPartners Inst, HealthPartners Neurosci Ctr, Bloomington, MN USA. [Clayton, Mitchell W.; Fennig, Mary W.] HealthPartners Neurosci Ctr, St Paul, MN USA. [Hussein, Haitham M.] HealthPartners Inst, Reg Hosp Comprehens Stroke Ctr, HealthPartners Neurosci Ctr, Bloomington, MN USA. Droegemueller, CJ (corresponding author), Reg Hosp Comprehens Stroke Ctr, St Paul, MN 55101 USA. carol.j.droegemueller@healthpartners.com AN - WOS:000552072300010 AU - Droegemueller, C. J. AU - Kashyap, B. AU - Wagner, R. L. H. AU - Shibeshi, H. AU - Clayton, M. W. AU - Fennig, M. W. AU - Hussein, H. M. DA - Aug DO - 10.1097/jnn.0000000000000517 J2 - J. Neurosci. Nurs. KW - in-hospital improvement inpatient outcomes process quality stroke stroke code CARE Clinical Neurology Nursing LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: MP2XQ Times Cited: 0 Cited Reference Count: 17 Droegemueller, Carol J. Kashyap, Bhavani Wagner, Roberta L. Huna Shibeshi, Hannah Clayton, Mitchell W. Fennig, Mary W. Hussein, Haitham M. Kashyap, Bhavani/0000-0003-4823-9638 0 2 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J NEUROSCI NURS PY - 2020 SN - 0888-0395 SP - 186-191 ST - A Successful Quality Improvement Project for Detection and Management of Acute Stroke in Hospitalized Patients T2 - Journal of Neuroscience Nursing TI - A Successful Quality Improvement Project for Detection and Management of Acute Stroke in Hospitalized Patients UR - ://WOS:000552072300010 VL - 52 ID - 761424 ER - TY - JOUR AB - The prothrombotic state of pregnancy increases the risk of thromboembolic complications and death in women with mechanical heart valves (MHVs). Although it is accepted that these women must be on therapeutic anticoagulation throughout pregnancy, competing maternal and fetal risks, as well as the lack of high-quality data from prospective studies, make the choice of the optimal method of anticoagulation challenging. Vitamin K antagonists (VKAs) are associated with fewer maternal complications, but conversely also the lowest live birth rates as well as warfarin-related embryopathy and fetopathy. Low-molecular-weight heparin (LMWH) does not cross the placenta and is associated with fewer fetal risks but more maternal complications. Sequential treatment involving VKAs in the second and third trimesters and either low-molecular-weight or unfractionated heparin in the first trimester, although appealing is still associated with maternal complications, especially around the time of bridging. As absolute equipoise of maternal versus fetal wellbeing is unlikely, patient preferences should be considered in decision making. A multidisciplinary team including hematologists, cardiologists, obstetric physicians, and high-risk obstetricians with expertise in the management of pregnant women with cardiac disease is required to optimize outcomes. Prospective studies are needed to determine the anticoagulant regimen for women with MHVs that provides optimal and acceptable maternal and fetal outcomes. AD - Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. Division of Cardiology, Pregnancy and Heart Disease Program, Mount Sinai Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. Division of Maternal-Fetal Medicine, National Women's Health, Auckland City Hospital, Auckland, New Zealand. AN - 27706532 AU - D'Souza, R. AU - Silversides, C. K. AU - McLintock, C. DA - Oct DO - 10.1055/s-0036-1593418 DP - NLM ET - 2016/10/25 J2 - Seminars in thrombosis and hemostasis KW - Anticoagulants/adverse effects/*therapeutic use Female *Heart Valve Prosthesis Heparin, Low-Molecular-Weight/adverse effects/*therapeutic use Humans Pregnancy Pregnancy Complications, Cardiovascular/blood/*drug therapy/physiopathology Vitamin K/antagonists & inhibitors LA - eng M1 - 7 N1 - 1098-9064 D'Souza, Rohan Silversides, Candice K McLintock, Claire Journal Article Review United States Semin Thromb Hemost. 2016 Oct;42(7):798-804. doi: 10.1055/s-0036-1593418. Epub 2016 Oct 5. PY - 2016 SN - 0094-6176 SP - 798-804 ST - Optimal Anticoagulation for Pregnant Women with Mechanical Heart Valves T2 - Semin Thromb Hemost TI - Optimal Anticoagulation for Pregnant Women with Mechanical Heart Valves VL - 42 ID - 760291 ER - TY - JOUR AB - We report a five year military experience with anterior retroperitoneal spine exposure combining vascular and neurosurgical spine teams. From August 2005 through April 2010 (56 months), hospital records from a single institution were retrospectively reviewed. Complications, estimated blood loss, transfusions, operative time and length of stay were documented. Eighty-four patients with lumbar spondylosis underwent primary (63, 75%) or secondary exposure (21, 25%) of a single- (66, 79%) or multilevel disc space (18, 21%). Median operative time and estimated blood loss were 127 minutes (range, 30-331 minutes) and 350 mL (range, 0-2940 mL). The overall complication rate was 23.8%. Postoperative complications included six blood transfusions (7%), three patients with retrograde ejaculation (3.57%) or surgical site infection; two with a prolonged ileus (2.38%) or ventral hernia and one each with a bowel obstruction (1, 1.19%), deep venous thrombosis or lymphocele. All-cause mortality was 1%. In conclusion, a team approach can minimize complications while offering the technical benefits and durability of an anterior approach to the lumbar spine. AD - Department of Surgery, Medical College of Wisconsin, Milwaukee, WI; Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas-Houston. Department of Surgery, Division of Vascular Surgery. Department of Surgery, Neurosurgery Service, Walter Reed National Military Medical Center Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Department of Surgery, Division of Vascular Surgery Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA foxvascular@gmail.com. AN - 23493280 AU - Dua, A. AU - Fox, J. AU - Patel, B. AU - Martin, E. AU - Rosner, M. AU - Fox, C. J. DA - Aug DO - 10.1177/1708538113478757 DP - NLM ET - 2013/03/16 J2 - Vascular KW - Adult Aged Cooperative Behavior Female Humans Interdisciplinary Communication Length of Stay Lumbar Vertebrae/*surgery Male Middle Aged Military Medicine/*methods Neurosurgical Procedures/adverse effects/*methods/mortality Orthopedic Procedures/adverse effects/*methods/mortality *Patient Care Team Postoperative Complications/diagnosis/therapy Retrospective Studies Spinal Diseases/mortality/*surgery Time Factors Treatment Outcome United States Vascular Surgical Procedures/adverse effects/*methods/mortality Young Adult anterior retroperitoneal approach spinal fusion spine surgery vascular trauma LA - eng M1 - 4 N1 - Dua, Anahita Fox, Jennifer Patel, Bhavin Martin, Eric Rosner, Michael Fox, Charles J Journal Article England Vascular. 2014 Aug;22(4):246-51. doi: 10.1177/1708538113478757. Epub 2013 May 7. PY - 2014 SN - 1708-5381 (Print) 1708-5381 SP - 246-51 ST - A team approach to anterior lumbar spine surgery in the military T2 - Vascular TI - A team approach to anterior lumbar spine surgery in the military VL - 22 ID - 760450 ER - TY - JOUR AB - BACKGROUND: We have previously demonstrated that the use of a daily "Quality Rounds Checklist" (QRC) can increase compliance with evidence-based prophylactic measures and decrease complications in a busy trauma intensive care unit (ICU) over a 3-month period. This study was designed to determine the sustainability of QRC use over 1 year and examine the relationship between compliance and outcome improvement. METHODS: A prospective before-after design was used to examine the effectiveness of the QRC tool in documenting compliance with 16 prophylactic measures for ventilator-associated pneumonia (VAP), deep venous thrombosis, pulmonary embolism, catheter-related bloodstream infection, and other ICU complications. The QRC was implemented on a daily basis for a 1-year period by the ICU fellow on duty. Monthly compliance rates were assessed by a multidisciplinary team for development of strategies for real-time improvement. Compliance and outcomes were captured over 1 year of QRC use. RESULTS: QRC use was associated with a sustained improvement of VAP bundle and other compliance measures over a year of use. After multivariable analysis adjusting for age (> 55), injury mechanism, Glasgow Coma Scale score (≤ 8), and Injury Severity Score (> 20), the rate of VAP was significantly lower after QRC use, with an adjusted mean difference of -6.65 (per 1,000 device days; 95% confidence interval, -9.27 to -4.04; p = 0.008). During the year of QRC use, 3% of patients developed a VAP if all four daily bundle measures were met for the duration of ICU stay versus 14% in those with partial compliance (p = 0.04). The overall VAP rate with full compliance was 5.29 versus 9.23 (per 1,000 device days) with partial compliance. Compared with the previous year, a 24% decrease in the number of pneumonias was recorded for the year of QRC use, representing an estimated cost savings of approximately $400,000. CONCLUSION: The use of a QRC facilitates sustainable improvement in compliance rates for clinically significant prophylactic measures in a busy Level I trauma ICU. The daily use of the QRC, requiring just a few minutes per patient to complete, equates to cost-effective improvement in patient outcomes. AD - Division of Trauma and Critical Care at the Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA. jjd3c@yahoo.com AN - 20032792 AU - Dubose, J. AU - Teixeira, P. G. AU - Inaba, K. AU - Lam, L. AU - Talving, P. AU - Putty, B. AU - Plurad, D. AU - Green, D. J. AU - Demetriades, D. AU - Belzberg, H. DA - Oct DO - 10.1097/TA.0b013e3181c4526f DP - NLM ET - 2009/12/25 J2 - The Journal of trauma KW - Academic Medical Centers Adolescent Adult Aged California *Checklist Cross Infection/mortality/prevention & control Evidence-Based Medicine/*standards Female Guideline Adherence/standards Hospital Mortality Humans Intensive Care Units/*standards Male Middle Aged Pneumonia, Ventilator-Associated/*mortality/*prevention & control Prospective Studies Quality Assurance, Health Care/standards Quality Indicators, Health Care/*standards Wounds and Injuries/*mortality/therapy Young Adult LA - eng M1 - 4 N1 - 1529-8809 Dubose, Joseph Teixeira, Pedro G R Inaba, Kenji Lam, Lydia Talving, Peep Putty, Brad Plurad, David Green, Donald J Demetriades, Demetrios Belzberg, Howard Journal Article United States J Trauma. 2010 Oct;69(4):855-60. doi: 10.1097/TA.0b013e3181c4526f. PY - 2010 SN - 0022-5282 SP - 855-60 ST - Measurable outcomes of quality improvement using a daily quality rounds checklist: one-year analysis in a trauma intensive care unit with sustained ventilator-associated pneumonia reduction T2 - J Trauma TI - Measurable outcomes of quality improvement using a daily quality rounds checklist: one-year analysis in a trauma intensive care unit with sustained ventilator-associated pneumonia reduction VL - 69 ID - 760374 ER - TY - JOUR AB - Background: We have previously demonstrated that the use of a daily "Quality Rounds Checklist" (QRC) can increase compliance with evidence-based prophylactic measures and decrease complications in a busy trauma intensive care unit (ICU) over a 3-month period. This study was designed to determine the sustainability of QRC use over 1 year and examine the relationship between compliance and outcome improvement. Methods: A prospective before-after design was used to examine the effectiveness of the QRC tool in documenting compliance with 16 prophylactic measures for ventilator-associated pneumonia (VAP), deep venous thrombosis, pulmonary embolism, catheter-related bloodstream infection, and other ICU complications. The QRC was implemented on a daily basis for a 1-year period by the ICU fellow on duty. Monthly compliance rates were assessed by a multidisciplinary team for development of strategies for real-time improvement. Compliance and outcomes were captured over 1 year of QRC use. Results: QRC use was associated with a sustained improvement of VAP bundle and other compliance measures over a year of use. After multivariable analysis adjusting for age (>55), injury mechanism, Glasgow Coma Scale score (≤8), and Injury Severity Score (>20), the rate of VAP was significantly lower after QRC use, with an adjusted mean difference of -6.65 (per 1,000 device days; 95% confidence interval, -9.27 to -4.04; p = 0.008). During the year of QRC use, 3% of patients developed a VAP if all four daily bundle measures were met for the duration of ICU stay versus 14% in those with partial compliance (p = 0.04). The overall VAP rate with full compliance was 5.29 versus 9.23 (per 1,000 device days) with partial compliance. Compared with the previous year, a 24% decrease in the number of pneumonias was recorded for the year of QRC use, representing an estimated cost savings of approximately $400,000. Conclusion: The use of a QRC facilitates sustainable improvement in compliance rates for clinically significant prophylactic measures in a busy Level I trauma ICU. The daily use of the QRC, requiring just a few minutes per patient to complete, equates to cost-effective improvement in patient outcomes. © 2010 Lippincott Williams & Wilkins. AD - J. Dubose, Inpt Tower 2LC100, 1200 North State Street, Los Angeles, CA 90033-4525, United States AU - Dubose, J. AU - Teixeira, P. G. R. AU - Inaba, K. AU - Lam, L. AU - Talving, P. AU - Putty, B. AU - Plurad, D. AU - Green, D. J. AU - Demetriades, D. AU - Belzberg, H. DB - Embase Medline DO - 10.1097/TA.0b013e3181c4526f KW - adult article catheter infection clinical trial deep vein thrombosis female human injury intensive care unit lung embolism major clinical study male patient compliance priority journal prophylaxis sepsis total quality management ventilator associated pneumonia LA - English M1 - 4 M3 - Article N1 - L359814602 2010-11-01 2010-11-11 PY - 2010 SN - 0022-5282 1529-8809 SP - 855-860 ST - Measurable outcomes of quality improvement using a daily quality rounds checklist: One-year analysis in a trauma intensive care unit with sustained ventilator-associated pneumonia reduction T2 - Journal of Trauma - Injury, Infection and Critical Care TI - Measurable outcomes of quality improvement using a daily quality rounds checklist: One-year analysis in a trauma intensive care unit with sustained ventilator-associated pneumonia reduction UR - https://www.embase.com/search/results?subaction=viewrecord&id=L359814602&from=export http://dx.doi.org/10.1097/TA.0b013e3181c4526f VL - 69 ID - 761244 ER - TY - JOUR AU - Dudzinski DA - 2016/01/01 01/01 DB - Institute of Scientific and Technical Information of China (English) M1 - 1 PY - 2016 ST - Multidisciplinary Pulmonary Embolism Response Teams T2 - Circulation: An Official Journal of the American Heart Association TI - Multidisciplinary Pulmonary Embolism Response Teams UR - https://netl.istic.ac.cn/site/link?cdoi=095ca8f4839534f091e03b0de3466aad&mid=466496091303411EB27FB4298C9BA46C VL - 133 ID - 762124 ER - TY - JOUR AU - Dudzinski, D. M. AU - Giri, J. AU - Rosenfield, K. DA - 2017/02/19 02/19 DB - Europe PubMed Central DO - 10.1161/circinterventions.116.004345 M1 - 2 PY - 2017 SN - 1941-7640 ST - Interventional Treatment of Pulmonary Embolism T2 - Circ Cardiovasc Interv TI - Interventional Treatment of Pulmonary Embolism UR - http://europepmc.org/article/MED/28213377 VL - 10 ID - 762117 ER - TY - JOUR AU - Dudzinski, D. M. AU - Horowitz, J. M. DA - 2016/09/03 09/03 DB - Europe PubMed Central DO - 10.1016/j.rec.2016.05.025 M1 - 1 PY - 2016 SN - 1885-5857 SP - 9-13 ST - Start-up, Organization and Performance of a Multidisciplinary Pulmonary Embolism Response Team for the Diagnosis and Treatment of Acute Pulmonary Embolism T2 - Rev Esp Cardiol (Engl Ed) TI - Start-up, Organization and Performance of a Multidisciplinary Pulmonary Embolism Response Team for the Diagnosis and Treatment of Acute Pulmonary Embolism UR - http://europepmc.org/article/MED/27567494 VL - 70 ID - 761979 ER - TY - JOUR AB - This study examined the nature of cognitive, metacognitive, and affective processes among a medical team experiencing difficulty managing a challenging simulated medical emergency case by conducting in-depth analysis of process data. Medical residents participated in a simulation exercise designed to help trainees to develop medical expertise, effective leadership, and team management skills. Purposive sampling was used to select one team for case study based on overall performance. Video and audio data were collected from the simulation and debriefing session and a follow-up interview was conducted with the team leader. Performance measures were also collected from expert raters (i.e., experienced staff physicians). Video data were reviewed and coded for cognitive, metacognitive, and emotional events exhibited by team members during the simulation. Interview and debriefing transcripts were coded for themes related to these regulatory processes. Results from quantitative and qualitative analyses revealed that the team exhibited lower-order cognitive and metacognitive process (e.g., summarizing, providing information) more often than higher-order processes (e.g., evaluation, reasoning). Furthermore, team members expressed negative emotions (e.g., anxiety) more often than positive emotions (e.g., enjoyment). Chi square analyses of the team leader revealed that negative emotions were significantly more frequently preceded by lower-order processes compared to higher-order processes. Qualitative thematic analyses provided further corroboration of these findings. The findings suggest that medical trainees (particularly teams experiencing difficulty managing a challenging case) may require further scaffolding in their use of regulatory processes within medical emergencies. The results from this study are discussed in terms of implications for theories of self-regulation, methodological advances, and instructional design for medical education. AD - [Duffy, Melissa C.; Griscom, Sophia E.; Stead, Victoria] McGill Univ, Dept Educ & Counselling Psychol, Fac Educ, Montreal, PQ H3A 1Y2, Canada. [Azevedo, Roger] N Carolina State Univ, Dept Psychol, Raleigh, NC 27695 USA. [Sun, Ning-Zi; Wiseman, Jeffrey; Maniatis, Thomas] McGill Univ, Div Gen Internal Med, Montreal, PQ H3A 1Y2, Canada. [Crelinsten, Linda; Lachapelle, Kevin] McGill Univ, Arnold & Blema Steinberg Med Simulat Ctr, Montreal, PQ H3A 1Y2, Canada. [Lachapelle, Kevin] McGill Univ, Div Cardiac Surg, Montreal, PQ H3A 1Y2, Canada. Duffy, MC (corresponding author), McGill Univ, Dept Educ & Counselling Psychol, Fac Educ, 3700 McTavish St, Montreal, PQ H3A 1Y2, Canada. melissa.duffy@mail.mcgill.ca AN - WOS:000352972500005 AU - Duffy, M. C. AU - Azevedo, R. AU - Sun, N. Z. AU - Griscom, S. E. AU - Stead, V. AU - Crelinsten, L. AU - Wiseman, J. AU - Maniatis, T. AU - Lachapelle, K. DA - May DO - 10.1007/s11251-014-9333-6 J2 - Instr. Sci. KW - Emotion Cognition Metacognition Regulation Medicine Simulation training CRISIS-RESOURCE-MANAGEMENT CRITICALLY-ILL PATIENTS CRITICAL-CARE MEDICINE SELF-REGULATION EMOTION REGULATION PULMONARY-EMBOLISM TEMPORAL CHARACTERISTICS EDUCATION RESEARCH ADVERSE EVENTS ACHIEVEMENT Education & Educational Research Psychology, Educational LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: CG0QV Times Cited: 14 Cited Reference Count: 88 Duffy, Melissa C. Azevedo, Roger Sun, Ning-Zi Griscom, Sophia E. Stead, Victoria Crelinsten, Linda Wiseman, Jeffrey Maniatis, Thomas Lachapelle, Kevin Sun, Ning-Zi/0000-0002-9751-1135 McGill University Collaborative Research Grant; Canada Research Chairs programCanada Research Chairs This research was supported by funding from a McGill University Collaborative Research Grant and the Canada Research Chairs program awarded to the second author. We would like to acknowledge the Arnold and Blema Steinberg Medical Simulation Centre for supporting this research. We would also like to thank Inderpal Dhillon for his assistance with data entry and coding. 14 0 43 SPRINGER DORDRECHT INSTR SCI PY - 2015 SN - 0020-4277 SP - 401-426 ST - Team regulation in a simulated medical emergency: An in-depth analysis of cognitive, metacognitive, and affective processes T2 - Instructional Science TI - Team regulation in a simulated medical emergency: An in-depth analysis of cognitive, metacognitive, and affective processes UR - ://WOS:000352972500005 VL - 43 ID - 761754 ER - TY - JOUR AB - BACKGROUND: One of the mandates of the Canadian Society of Nephrology's (CSN) Vascular Access Working Group (VAWG) is to inform the nephrology community of the current status of vascular access (VA) practice within Canada. To better understand VA practice patterns across Canada, the CSN VAWG conducted a national survey. OBJECTIVES: (1) To inform on VA practice patterns, including fistula creation and maintenance, within Canada. (2) To determine the degree of consensus among Canadian clinicians regarding patient suitability for fistula creation and to assess barriers to and facilitators of fistula creation in Canada. DESIGN: Development and implementation of a survey. SETTING: Community and academic VA programs. PARTICIPANTS: Nephrologists, surgeons, and nurses who are involved in VA programs across Canada. MEASUREMENTS: Practice patterns regarding access creation and maintenance, including indications and contraindications to fistula creation, as well as program-wide facilitators of and barriers to VA. METHODS: A small group of CSN VAWG members determined the scope and created several VA questions which were then reviewed by 5 additional VAWG members (4 nephrologists and 1 VA nurse) to ensure that questions were clear and relevant. The survey was then tested by the remaining members of the VAWG and refinements were made. The final survey version was submitted electronically to relevant clinicians (nephrologists, surgeons, and nurses) involved or interested in VA across Canada. Questions centered around 4 major themes: (1) Practice patterns regarding access creation (preoperative assessment and maturation assessment), (2) Practice patterns regarding access maintenance (surveillance and salvage), (3) Indications and contraindications for arteriovenous (AV) access creation, and (4) Facilitators of and barriers to fistula creation and utilization. RESULTS: Eighty-two percent (84 of 102) of invited participants completed the survey; the majority were nurses or VA coordinators (55%) with the remainder consisting of nephrologists (21%) and surgeons (20%). Variation in practice was noted in utility of preoperative Doppler ultrasound, interventions to assist nonmaturing fistulas, and procedures to salvage failing or thrombosed AV-access. Little consensus was seen regarding potential contraindications to AV-access creation (with the exception of limited life expectancy and poor vasculature on preoperative imaging, which had high agreement). Frequent barriers to fistula utilization were primary failure (77% of respondents) and long maturation times (73%). Respondents from centers with low fistula prevalence also cited long surgical wait times as an important barrier to fistula creation, whereas those from centers with high fistula prevalence cited access to multidisciplinary teams and interventional radiology as keys to successful fistula creation and utilization. CONCLUSIONS: There is significant variation in VA practice across Canada and little consensus among Canadian clinicians regarding contraindications to fistula creation. Further high-quality studies are needed with regard to appropriate fistula placement to help guide clinical practice. AD - Division of Nephrology, Department of Medicine, University of Calgary, Alberta, Canada. Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, Canada. Division of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada. Division of Nephrology, Schulich School of Medicine and Dentistry, Department of Medicine, Western University, London, Ontario, Canada. Department of Medicine, University of Toronto, Ontario, Canada. Faculty of Medicine, University Health Network, University of Toronto, Ontario, Canada. Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada. AN - 29511569 AU - Dumaine, C. AU - Kiaii, M. AU - Miller, L. AU - Moist, L. AU - Oliver, M. J. AU - Lok, C. E. AU - Hiremath, S. AU - MacRae, J. M. C2 - Pmc5833215 DO - 10.1177/2054358118759675 DP - NLM ET - 2018/03/08 J2 - Canadian journal of kidney health and disease KW - arteriovenous fistula hemodialysis vascular access of interest with respect to the research, authorship, and/or publication of this article. LA - eng N1 - 2054-3581 Dumaine, Chance Kiaii, Mercedeh Miller, Lisa Moist, Louise Oliver, Matthew J Lok, Charmaine E Hiremath, Swapnil MacRae, Jennifer M Journal Article Can J Kidney Health Dis. 2018 Feb 28;5:2054358118759675. doi: 10.1177/2054358118759675. eCollection 2018. PY - 2018 SN - 2054-3581 (Print) 2054-3581 SP - 2054358118759675 ST - Vascular Access Practice Patterns in Canada: A National Survey T2 - Can J Kidney Health Dis TI - Vascular Access Practice Patterns in Canada: A National Survey VL - 5 ID - 760342 ER - TY - JOUR AB - Background: Though intestinal failure (IF) after bariatric surgery (BS) is uncommon, its prevalence is increasing. However, data on the outcomes for these patients are limited. Objectives: To analyze the outcomes of treatment for patients with IF after BS. Setting: University hospital. Methods: A single-center analysis (1991–2016) of outcomes according to treatment arms established by a multidisciplinary team. Results: Twenty-five IF patients were identified (median age 45 yr). BS was 92% Roux-en-Y gastric bypass. The major cause of IF was volvulus/internal hernia (72%). Median time from BS to IF was 48 months. Treatment arms were intestinal rehabilitation (IR, n = 15), transplantation (TXP, n = 5), and parenteral nutrition (PN, n = 5). For IR, median bowel length was 60 cm. Forty-six percent ultimately discontinued PN. Twenty-seven percent were partially weaned PN and 27% failed IR. Common surgical rehabilitation was Roux-en-Y gastric bypass reversal and restoration of gastrointestinal continuity. The 5-year overall survival was 74%. For TXP, 7 patients were listed for TXP (5 initially and 2 after failed IR). Three underwent TXP, 2 isolated intestine and 1 isolated liver. Three were delisted (1 improvement and 2 death). For PN, 6 patients required long-term PN (5 initially and 1 after failed IR). Four patients are alive currently. Conclusions: IF after BS is an increasing problem facing IR centers. Internal hernia is the major cause. Surgical IR is the first-line therapy and affords the best outcome. TXP is reserved for rescuing patients who failed IR or develop PN complications. Long-term PN is suitable for patients in whom IR or TXP is impractical. AD - D.G. Farmer, 8501e Westwood Plaza, RRUCLA Medical Center, Los Angeles, CA, United States AU - Dumronggittigule, W. AU - Marcus, E. A. AU - DuBray, B. J. AU - Venick, R. S. AU - Dutson, E. AU - Farmer, D. G. DB - Embase Medline DO - 10.1016/j.soard.2018.10.014 KW - acute kidney failure adult article chronic graft rejection clinical article comorbidity cytomegalovirus infection deep vein thrombosis depression digestive system fistula enterocutaneous fistula fatty liver female gangrene gastric banding graft failure graft survival heart arrest human hypertension internal hernia intestinal failure intestine obstruction intestine transplantation intestine volvulus liver transplantation lung embolism malabsorption male multiple organ failure non insulin dependent diabetes mellitus overall survival parenteral nutrition priority journal reoperation respiratory failure retrospective study Roux-en-Y gastric bypass sepsis septic shock tracheostomy university hospital LA - English M1 - 1 M3 - Article N1 - L2001460065 2019-01-17 2019-04-03 PY - 2019 SN - 1878-7533 1550-7289 SP - 98-108 ST - Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center T2 - Surgery for Obesity and Related Diseases TI - Intestinal failure after bariatric surgery: Treatment and outcome at a single-intestinal rehabilitation and transplant center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001460065&from=export http://dx.doi.org/10.1016/j.soard.2018.10.014 VL - 15 ID - 760758 ER - TY - JOUR AB - Objective: Pancreatic cancer is a leading cause of cancer death; it represents the ninth and tenth most common cancers in women and men, respectively, with only a 9% 5-year survival rate. Surgery remains the only potential curative therapy, but most patients present with advanced stage disease at the time of diagnosis. Patients with tumors that involve the superior mesenteric vein-portal vein (SMV-PV) confluence are considered “borderline resectable” and are at higher risk for perioperative complications and margin-positive resection. Regularly, neoadjuvant chemotherapy can be used to evaluate tumor behavior, to downstage tumors, to facilitate margin-negative resection, and to minimize the risk of recurrence. We present our single-institutional experience in the utility of adjunctive SMV-PV reconstruction for these tumors to assess viability and survival. Methods: A retrospective single-institution review identifying all patients who had a pancreaticoduodenectomy or total pancreatectomy during a 5-year period from January 2014 to December 2018 was completed. Multiplanar computed tomography angiography imaging was used to stage the tumors by objective radiologic classification determining extent of disease. Cases were presented preoperatively at a multidisciplinary tumor board. All vascular surgical reconstructions were performed by a multidisciplinary team approach with experienced hepatobiliary and vascular surgeons. Results: During the 5-year period, 160 pancreatic resections (152 pancreaticoduodenectomies [95.0%] and 8 total pancreatectomies [(5.0%]) were performed, of which 85 (53.1%) were for pancreatic adenocarcinoma. The average age was 69.2 years (60.3% male, 39.7% female). Of the 85 operations for pancreatic adenocarcinoma, 35 (41.2%) underwent vascular reconstructions. Of these, 22 (62.9%) received neoadjuvant chemotherapy. Vascular reconstructions of the portal vein consisted of 16 (45.7%) primary repairs, 9 (25.7%) resections with cryopreserved vein allograft interposition grafting, 5 (14.3%) resections with primary end-to-end anastomosis, and 3 (8.6%) lateral venorrhaphy with patch angioplasty. There were also two (5.7%) concomitant arterial reconstructions (common hepatic artery). In the patients who underwent vascular reconstruction, margin-negative resection was achieved in 29 (85.3%). There were no in-hospital deaths; there was one (2.9%) 30-day death from a car accident. The 1-year survival was 74.3%. There were three (8.6%) thromboses requiring reintervention. Conclusions: This study validates a multidisciplinary surgical approach to the treatment of borderline resectable pancreatic cancers. When surgical treatment is deemed appropriate, adjunctive SMV-PV resection may further extend opportunity for a tumor-free margin (R0) of resection with comparable survival for stage II tumors. Vascular surgeons are being consulted to participate in these advanced vascular reconstructions with increased frequency and should be familiar with the various reconstruction techniques. AU - Duong, W. Q. AU - Fujitani, R. AU - Tohmasi, S. AU - Kabutey, N. K. AU - Maithel, S. AU - Farzaneh, C. AU - Jutric, Z. AU - Imagawa, D. DB - Embase DO - 10.1016/j.jvs.2020.04.126 KW - advanced cancer aged allograft artery reconstruction cancer chemotherapy cancer patient cancer recurrence cancer staging cancer surgery cancer survival computed tomographic angiography conference abstract controlled study end to end anastomosis female hepatic artery hepatic portal vein hospital mortality human male mesentery multidisciplinary team neoadjuvant chemotherapy pancreas adenocarcinoma pancreatectomy pancreaticoduodenectomy patch angioplasty retrospective study superior mesenteric vein surgery surgical approach surgical margin survival thrombosis traffic accident vascular surgeon vein reconstruction LA - English M1 - 1 M3 - Conference Abstract N1 - L2006737687 2020-07-15 PY - 2020 SN - 1097-6809 0741-5214 SP - e68 ST - Adjunctive Superior Mesenteric-Portal Venous Reconstruction in the Treatment of Borderline Resectable Pancreatic Adenocarcinoma T2 - Journal of Vascular Surgery TI - Adjunctive Superior Mesenteric-Portal Venous Reconstruction in the Treatment of Borderline Resectable Pancreatic Adenocarcinoma UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2006737687&from=export http://dx.doi.org/10.1016/j.jvs.2020.04.126 VL - 72 ID - 760562 ER - TY - JOUR AB - Objective No studies to date have focused on the safety of coloanal/ileoanal anastomosis (CAIAA) in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC), which is associated with severe morbidity and mortality. We herein present the outcomes of patients with peritoneal carcinomatosis (PC) who underwent CAIAA. Methods We evaluated the prospectively collected data from 20 patients with PC who underwent CRS + HIPEC with respect to the primary disease, synchronous resections, intraoperative chemotherapy regimen, timing of protective ileostomy closure, and overall postoperative complications. Results Most patients underwent CRS + HIPEC and CAIAA for PC due to colorectal cancer. Coloanal anastomosis was performed in 15 (75%) patients, and J-pouch ileoanal anastomosis was performed in 5 (25%) patients. No anastomosis-related complications occurred in any patients who underwent CAIAA; however, one patient died of pulmonary embolism on postoperative day 7. Conclusions CAIAA is associated with serious complications even after performing benign colorectal surgery. However, it may be challenging for surgeons to simultaneously perform CAIAA in patients with PC who undergo CRS + HIPEC. We emphasize that this procedure can be safely performed with experienced surgical teams by using a multidisciplinary approach. AD - [Duzgun, Ozgul; Kalin, Murat] Hlth Sci Univ, Umraniye Training & Res Hosp, Dept Gen Surg, Istanbul, Turkey. Duzgun, O (corresponding author), Hlth Sci Univ, Umraniye Training & Res Hosp, Dept Surg Oncol, Floor 3,St 1, TR-34764 Umraniye Istanbul, Turkey. ozgulduzgun@gmail.com AN - WOS:000487161400001 AU - Duzgun, O. AU - Kalin, M. C7 - Unsp 0300060519872618 DA - Oct DO - 10.1177/0300060519872618 J2 - J. Int. Med. Res. KW - Cytoreductive surgery hyperthermic intraperitoneal chemotherapy peritoneal carcinomatosis coloanal ileoanal anastomosis colorectal cancer safety COLOANAL ANASTOMOSIS HAND-SEWN RESECTION LEAKAGE Medicine, Research & Experimental Pharmacology & Pharmacy LA - English M1 - 10 M3 - Article N1 - ISI Document Delivery No.: JG3AA Times Cited: 1 Cited Reference Count: 22 Duzgun, Ozgul Kalin, Murat Duzgun, Ozgul/0000-0001-7214-2276 1 0 SAGE PUBLICATIONS LTD LONDON J INT MED RES PY - 2019 SN - 0300-0605 SP - 4911-4919 ST - Safety of coloanal/ileoanal anastomosis during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: results of 20 consecutive patients T2 - Journal of International Medical Research TI - Safety of coloanal/ileoanal anastomosis during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: results of 20 consecutive patients UR - ://WOS:000487161400001 VL - 47 ID - 761496 ER - TY - JOUR AB - OBJECTIVES: The purpose of the study is to evaluate the influence of a multidisciplinary model of care on the incidence of postoperative complications after a hip fracture. DESIGN: Retrospective cohort series. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Three hundred six patients with pertrochanteric femur fracture (OTA classification: 31-B1, 31-B2, 31-B3, 31-A1, 31-A2, 31-B3, 32-A1, and 32-A2). INTERVENTION: A multidisciplinary, collaborative model of perioperative care: the Medical Orthopaedic Trauma Service (MOTS). MAIN OUTCOME MEASURES: Incidence of in-patient complications, length of in-patient hospitalization, readmission rate after hospital discharge, and postdischarge mortality at 90 days and 1 year. RESULTS: Although there was no change in length of hospitalization, there was a significantly decreased overall incidence of in-patient complications and a decreased incidences of new-onset urinary tract infection and arrhythmias in the MOTS cohort. These differences persisted after controlling for age, comorbidity, gender, ethnicity, type of fracture, and number of days from admission to surgery with a logistic regression model. Subgroup analysis of patients with an American Society of Anesthesiologists physical status classification of 1 or 2 revealed a significantly decreased 90 day readmission rate with the MOTS model, but this did not persist in a regression model (P = 0.07). CONCLUSIONS: A multidisciplinary, collaborative model of care for patients with hip fractures decreases the incidence of postoperative in-patient complications and may influence hospital readmission rates. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2012 by Lippincott Williams &Wilkins. AD - C.J. Dy, Hospital for Special Surgery, Office of Academic Training, 525 East 70th Street, New York, NY 10021, United States AU - Dy, C. J. AU - Dossous, P. M. AU - Ton, Q. V. AU - Hollenberg, J. P. AU - Lorich, D. G. AU - Lane, J. M. DB - Embase Medline DO - 10.1097/BOT.0b013e3182242678 KW - aged article cohort analysis controlled study decubitus deep vein thrombosis delirium ethnicity female femoral neck fracture femur pertrochanteric fracture femur subtrochanteric fracture heart arrhythmia heart infarction hip fracture hospital patient hospital readmission hospitalization human length of stay logistic regression analysis lung embolism major clinical study male mortality perioperative period postoperative complication priority journal retrospective study surgical infection traumatology urinary tract infection LA - English M1 - 6 M3 - Article N1 - L51602325 2011-09-07 2012-06-01 PY - 2012 SN - 0890-5339 1531-2291 SP - 379-383 ST - The medical orthopaedic trauma service: An innovative multidisciplinary team model that decreases in-hospital complications in patients with hip fractures T2 - Journal of Orthopaedic Trauma TI - The medical orthopaedic trauma service: An innovative multidisciplinary team model that decreases in-hospital complications in patients with hip fractures UR - https://www.embase.com/search/results?subaction=viewrecord&id=L51602325&from=export http://dx.doi.org/10.1097/BOT.0b013e3182242678 VL - 26 ID - 761197 ER - TY - JOUR AB - Objective: To describe histopathologic observations in eyes enucleated after intra-arterial chemotherapy (IAC) for retinoblastoma (Rb). Methods: Retrospective histopathologic analysis of 8 eyes. Results: The eyes were enucleated for tumor viability (n = 4), neovascular glaucoma (n = 2), anaphylactic reaction from IAC (n = 1), and persistent retinal detachment with poor visualization of the tumor (n = 1). Of the 2 eyes judged clinically with complete tumor regression and the 5 with viable tumor, the findings were confirmed on histopathology. The Rb response ranged from minimal (n = 1) to moderate (n = 1) to extensive (n = 4) to complete regression (n = 2). Viable vitreous seeds (n = 4 eyes), invasion into the optic nerve (n = 3), reaching the lamina cribrosa in 2 cases, and invasion into the choroid (n = 1) were observed. Histopathologic evidence of ischemic atrophy involving the outer retina and choroid was found in 4 eyes. One eye treated at another center with IAC and enucleated by our team for recurrence was observed to have extensive choroidal and outer retinal atrophy. This case showed orbital vascular occlusion and subendothelial smooth muscle hyperplasia. Intravascular birefringent foreign material was observed in 5 cases within occluded vessels, stimulating a granulomatous inflammatory response. The foreign material comprised cellulose fibers (n = 3), synthetic fabric fibers (n = 1), or unknown composition (n = 2). Thrombosed blood vessels were identified in 5 eyes and involved ciliary arteries in the retrobulbar orbit (n = 5), scleral emissarial canals (n = 1), small choroidal vessels (n = 1), and central retinal artery (n = 1). Conclusion: Retinoblastoma can be controlled with IAC, but histopathology of enucleated eyes reveals that ocular complications including thromboembolic events can occur. AD - [Eagle, Ralph C., Jr.] Thomas Jefferson Univ, Ophthalm Pathol Lab, Wills Eye Inst, Philadelphia, PA 19107 USA. [Shields, Carol L.; Shields, Jerry A.] Thomas Jefferson Univ, Ocular Oncol Serv, Wills Eye Inst, Philadelphia, PA 19107 USA. [Jabbour, Pascal] Thomas Jefferson Univ, Dept Endovasc Neurosurg, Philadelphia, PA 19107 USA. Eagle, RC (corresponding author), Thomas Jefferson Univ, Ophthalm Pathol Lab, Wills Eye Inst, 840 Walnut St,14th Floor, Philadelphia, PA 19107 USA. reagle@willseye.org AN - WOS:000297047600003 AU - Eagle, R. C. AU - Shields, C. L. AU - Bianciotto, C. AU - Jabbour, P. AU - Shields, J. A. DA - Nov DO - 10.1001/archophthalmol.2011.223 J2 - Arch. Ophthalmol. KW - CEREBRAL-ANGIOGRAPHY OPHTHALMIC ARTERY INTRAOCULAR RETINOBLASTOMA ENUCLEATED EYES RISK CHEMOREDUCTION MELPHALAN Ophthalmology LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: 848JK Times Cited: 44 Cited Reference Count: 25 Eagle, Ralph C., Jr. Shields, Carol L. Bianciotto, Carlos Jabbour, Pascal Shields, Jerry A. Noel T. and Sara L. Simmonds Endowment for Ophthalmic Pathology; Wills Eye Institute; Eye Tumor Research Foundation, Philadelphia, Pennsylvania This study was supported by the Noel T. and Sara L. Simmonds Endowment for Ophthalmic Pathology, Wills Eye Institute, and the Eye Tumor Research Foundation, Philadelphia, Pennsylvania ( C. L. Shields and J. A. Shields). 47 0 4 AMER MEDICAL ASSOC CHICAGO ARCH OPHTHALMOL-CHIC PY - 2011 SN - 0003-9950 SP - 1416-1421 ST - Histopathologic Observations After Intra-arterial Chemotherapy for Retinoblastoma T2 - Archives of Ophthalmology TI - Histopathologic Observations After Intra-arterial Chemotherapy for Retinoblastoma UR - ://WOS:000297047600003 VL - 129 ID - 761840 ER - TY - JOUR AB - BACKGROUND AND OBJECTIVE: Transbronchial cryobiopsy (TBCB) is a technique in which frozen samples of lung are obtained using a probe inserted through a bronchoscope. We performed a retrospective study to assess the performance of the TBCB procedure complemented by segmental bronchial blockade using an angioplasty balloon, in terms of diagnostic yield and safety in diffuse parenchymal lung disease (DPLD). METHODS: Data from 100 patients with suspected DPLD (clinical and radiological findings), who underwent TBCB in our institution to establish a definitive diagnosis, were reviewed. In our institution, TBCB is monitored with fluoroscopy and performed under general anaesthesia by a multidisciplinary team (an anaesthesiologist, a pulmonologist and an interventional radiologist). In each patient, four samples were collected using a 2.4-mm distal diameter cryoprobe. To control bleeding, the biopsied segmental bronchus was blocked with a 6-mm diameter angioplasty balloon, inserted over a 0.035-inch angled hydrophilic guidewire. After the cryoextraction, the balloon was inflated for 3 min intervals until bleeding stopped. RESULTS: Overall, 98% of samples had diagnostic value. In 85% of cases, DPLD was confirmed, while in 7%, cancer was diagnosed. Complications were observed in 16% of the patients: 13 patients developed moderate haemorrhage, and 3 developed pneumothorax. CONCLUSION: Transbronchial cryobiopsy had a high diagnostic yield for DPLD. Performing the procedure under fluoroscopy guidance and using angioplasty balloon for selective bronchial blockade achieved a low rate of iatrogenic complications directly associated with the technique. AD - Department of Radiology, Hospital Galdakao Usansolo, Basque Country, Spain. Department of Pulmonology, Hospital Galdakao Usansolo, Basque Country, Spain. Department of Anesthesiology, Hospital Galdakao Usansolo, Basque Country, Spain. AN - 27254138 AU - Echevarria-Uraga, J. J. AU - Pérez-Izquierdo, J. AU - García-Garai, N. AU - Gómez-Jiménez, E. AU - Aramburu-Ojembarrena, A. AU - Tena-Tudanca, L. AU - Miguélez-Vidales, J. L. AU - Capelastegui-Saiz, A. DA - Aug DO - 10.1111/resp.12827 DP - NLM ET - 2016/06/03 J2 - Respirology (Carlton, Vic.) KW - Adult Aged Angioplasty, Balloon/*methods Bronchoscopy/*methods Cryopreservation/methods Female Fluoroscopy/methods Humans *Image-Guided Biopsy/adverse effects/methods Lung/*pathology Lung Diseases, Interstitial/*diagnosis Male Middle Aged Postoperative Hemorrhage/*prevention & control Retrospective Studies Spain *Specimen Handling/adverse effects/methods *angioplasty balloon *bronchoscopy *cryoablation *diffuse parenchymal lung diseases *image-guided biopsy LA - eng M1 - 6 N1 - 1440-1843 Echevarria-Uraga, José Javier Orcid: 0000-0003-1399-7447 Pérez-Izquierdo, Julio García-Garai, Nerea Gómez-Jiménez, Estíbaliz Aramburu-Ojembarrena, Amaia Tena-Tudanca, Luis Miguélez-Vidales, José L Capelastegui-Saiz, Alberto Journal Article Australia Respirology. 2016 Aug;21(6):1094-9. doi: 10.1111/resp.12827. Epub 2016 Jun 2. PY - 2016 SN - 1323-7799 SP - 1094-9 ST - Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy T2 - Respirology TI - Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy VL - 21 ID - 760449 ER - TY - JOUR AB - BACKGROUND: Permanent and reliable vascular access is of utmost importance for patients (with chronic renal failure) in need of haemodialysis. Autogenous arteriovenous fistula (AVF) on the forearm are robust and have the benefits of providing long-term access with relatively few complications. The main problem is insufficient blood flow due to stenoses requiring early intervention. The AVF therefore needs surveillance with regular clinical examination supplemented with imaging. In recent years Doppler sonography has gained an increasingly important role in the assessment of AVFs. This paper discusses AVFs and frequent complications and stresses the benefit of Doppler sonography in the planning and surveillance of AVFs. MATERIAL AND METHODS: The survey is based on literature retrieved from a PubMed search, and our experience from sonographic examinations of AVFs in the Central Hospital of Lillehammer, Norway. RESULTS: Doppler sonography is a non-invasive imaging modality without discomfort for the patient, and well suited for examination of AVFs. The method has a high sensitivity for detection of stenoses and other AVF-related problems, and can provide a detailed image of the course and diameter of blood vessels, with quantitative measurement of blood flow. Indications for Doppler sonography are preoperative mapping, assessment of fistula problems and maturity; it is also a useful method for continuous surveillance of fistulas. INTERPRETATION: Doppler sonography can be used for immediate treatment of patients with sudden AVF problems; and if necessary endovascular intervention or surgery can follow. Recent European guidelines recommend the method as a standard procedure before and after creation of an AVF. Doppler sonography should have a central position in a multidisciplinary teamwork on surveillance of patients with AVFs in need of haemodialysis. AD - J. Edenberg, Radiologisk avdeling, Sykehuset Innlandet Lillehammer, 2629 Lillehammer, Norway. AU - Edenberg, J. AU - Benschop, P. AU - Høgåsen, K. DB - Medline KW - arteriovenous shunt Doppler flowmetry echography human methodology kidney artery renal replacement therapy review sensitivity and specificity stenosis, occlusion and obstruction thrombosis LA - Norwegian M1 - 16 M3 - Review N1 - L355249167 2009-09-21 PY - 2009 SN - 0807-7096 SP - 1635-1638 ST - Doppler sonography of arteriovenous fistulas for haemodialysis T2 - Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række TI - Doppler sonography of arteriovenous fistulas for haemodialysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L355249167&from=export VL - 129 ID - 761269 ER - TY - JOUR AB - Background: Increasing demand for peripheral inserted central lines. A prospective audit was conducted for 3 consecutive months to include all non-tunnelled peripheral inserted central lines (PICC lines). Objectives: Quantify, analyse the documentation process, analyse the post insertion care, identify complications and issues. Results: 19 PICC line requests, 18 insertions, success 100 % (75-95 % normal), 16 patients, 2 patients had 2 PICC lines (reinsertion post infection, reinsertion post removal), M:F = 4:12, AGE average 58 (range 26-92), 5 patients on OPAT. Post insertion care oncology: structured service, local guidelines, experience and educated staff, excellent follow up and documentation. Surgical/ medical and orthopaedic lack of all above. Complications local infection x1, thrombosis x2, bleeding from site x1, line blockage x1. Conclusions: Successful insertion 100 % using ultrasound. Inadequate documentation of line insertion and removal. Excellent care of line on oncology ward. Inadequate care of line on general wards. Implications: Multidisciplinary team anaesthesia, clinical teams, infection control, radiology and OPAT liaison agreed care bundle published on hospital home page. New PICC insertion pack, new PICC lines single and double lumen lines purchased. Dedicated theatre time anaesthetic and nursing staff for PICC line insertion. AD - C. Efrimescu, Tullamore General Hospital, Ireland AU - Efrimescu, C. AU - Straub, B. AU - O'Mahony, E. DB - Embase DO - 10.1007/s11845-015-1396-0 KW - anesthetic agent ultrasound human peripherally inserted central venous catheter documentation patient infection central venous catheter anesthesia ward oncology ward thrombosis clinical audit follow up bleeding nursing staff infection control hospital care bundle radiology oncology LA - English M1 - 2 M3 - Conference Abstract N1 - L72312876 2016-06-29 PY - 2016 SN - 1863-4362 SP - S133 ST - Using ultra sound for peripheral central venous access T2 - Irish Journal of Medical Science TI - Using ultra sound for peripheral central venous access UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72312876&from=export http://dx.doi.org/10.1007/s11845-015-1396-0 VL - 185 ID - 761037 ER - TY - JOUR AB - BACKGROUND: Abdominothoracic oesophageal resections, also known as Ivor Lewis procedures, are complex visceral surgery procedures. In recent years, substeps have increasingly been performed using minimally invasive techniques. However, intrathoracic anastomosis is still a challenge given the instrumental and technological possibilities available to date. This article provides a detailed description of the use of the Da Vinci robotic system and our techniques in oesophageal surgery. METHODS: In a prospective data collection, we analysed the robotic-assisted oesophageal surgeries performed at the University Hospital of Schleswig-Holstein, Campus Kiel, between November 2013 and November 2015. RESULTS: A total of 56 patients underwent robotic-assisted oesophageal surgery, with 43 patients undergoing the Ivor Lewis technique, 10 patients undergoing the McKeown procedure and 3 patients undergoing enucleation of a leiomyoma. A complete tumour resection (R0 margin) was achieved in 53 patients (93.4%); the mean number of resected lymph nodes was 23 (14-75). Forty-five (80.5%) patients received an induction therapy. Mean operative time was 412 min (120-610); mean hospital stay was 19 days (4-145). A conversion to open surgery was necessary in 19 (34.1%) cases, most notably in the thoracic part of the surgical procedure (17 patients). Forty-three patients received intrathoracic oesophagogastrostomy; 4 out of 5 patients with an initial side-to-side anastomosis developed a leakage, whereupon the technique was switched to a hand-sewn procedure (leakage in 3 out of 20 patients). Other major morbidities included leakage of the gastric conduit in 2 patients (3.6%), airway fistula in 2 patients (3.6%), mesenteric ischaemia in one patient (1.8%), and peritonitis due to a dislocated feeding tube in one other patient. Pulmonary complications occurred in 19 patients (34%). Four patients (7.1%) died of pulmonary embolism, heart attack, and septic organ failure. CONCLUSION: Robotic-assisted, minimally invasive oesophagectomy is a feasible and useful approach for oncological surgery. This technique should be implemented in a structured program with an extensive and critical evaluation of the users' own results and an exchange with other experienced work teams. This helps to avoid pitfalls and to speed up the learning curve. Further technological developments and increasing experience might lead to a more widespread use of this technique. AD - Klinik für Allgemeine-, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland. Klinik für Anästhesie und Schmerztherapie, imland Klinik Rendsburg, Deutschland. Klinik für Anästhesie und operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Deutschland. AN - 27074211 AU - Egberts, J. H. AU - Aselmann, H. AU - Hauser, C. AU - Bernsmeier, A. AU - Carstens, A. AU - Hoecker, J. AU - Becker, T. DA - Apr DO - 10.1055/s-0042-104196 DP - NLM ET - 2016/04/14 J2 - Zentralblatt fur Chirurgie KW - Adenocarcinoma/*surgery Anastomosis, Surgical/instrumentation/methods Carcinoma, Squamous Cell/surgery Esophageal Neoplasms/*surgery Esophagectomy/*instrumentation/*methods Esophagus/surgery Gastroplasty/instrumentation/methods Humans Laparoscopy/*instrumentation/*methods Patient Care Team Patient Positioning Robotic Surgical Procedures/*instrumentation/*methods Surgical Equipment Surgical Instruments LA - ger M1 - 2 N1 - 1438-9592 Egberts, J-H Aselmann, H Hauser, C Bernsmeier, A Carstens, A Hoecker, J Becker, T Journal Article Review Germany Zentralbl Chir. 2016 Apr;141(2):145-53. doi: 10.1055/s-0042-104196. Epub 2016 Apr 13. OP - Roboterchirurgie am Ösophagus. PY - 2016 SN - 0044-409x SP - 145-53 ST - [Robotic-Assisted Oesophageal Surgery] T2 - Zentralbl Chir TI - [Robotic-Assisted Oesophageal Surgery] VL - 141 ID - 760146 ER - TY - JOUR AB - Background: Stroke is a devastating disease with increasing incidence and prevalence due to population aging. Even with the best care, a proportion of patients dies or is left with significant neurological and cognitive disability. Organization of stroke centers markedly improved outcomes worldwide. We initiated a 'lysis alarm' program in September 2013 at our medical center. Methods: This is a retrospective review of electronic data from patients with acute ischemic stroke before (October 2012-June 2013) and after (October 2013-June 2014) the 'lysis alarm' program was introduced at our medical center. Results: Prior to the introduction of the stroke program, there were only 19 thrombolysis procedures in 777 acute stroke patients in 9 months, while this figure rose to 32 thrombolysis procedures in 737 acute stroke patients after the initiation of the program. The 'door-to-needle' time decreased from 88 to 71 min when the two study periods were compared. These changes were associated with decreased stroke mortality in patients receiving thrombolytic treatment (16% prior to the program and 9% during the program). In 2013, there were 1,439 thrombolysis procedures, representing 3.2% of all stroke cases throughout Hungary. After the introduction of the 'lysis alarm' program, we have reached a 4% thrombolysis rate at our medical center. Conclusions: Our thrombolysis rate is higher than the national average, but still low compared to the rates of Western European countries. We are continuously working to enhance our stroke program. Here, we discuss those components that need to be further refined in order to improve stroke intervention and outcome. (C) 2015 The Author(s) Published by S. Karger AG, Basel AD - [Egi, Csilla; Horvath, Julia; Hahn, Katalin; Kalman, Bernadette; Betlehem, Jozsef; Nagy, Lajos] Univ Pecs, Markusovszky Univ Teaching Hosp, Markusovszky St 5, HU-9700 Szombathely, Hungary. Egi, C (corresponding author), Univ Pecs, Markusovszky Univ Teaching Hosp, Markusovszky St 5, HU-9700 Szombathely, Hungary. egi.csilla@gmail.com AN - WOS:000216895700008 AU - Egi, C. AU - Horvath, J. AU - Hahn, K. AU - Kalman, B. AU - Betlehem, J. AU - Nagy, L. DO - 10.1159/000441479 J2 - Cerebrovasc. Dis. Extra KW - Stroke Thrombolysis Stroke team Stroke center Public education Peripheral Vascular Disease LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: V1H0C Times Cited: 2 Cited Reference Count: 24 Egi, Csilla Horvath, Julia Hahn, Katalin Kalman, Bernadette Betlehem, Jozsef Nagy, Lajos Markusovszky University Teaching Hospital; University of Pecs The authors received salary support from the Markusovszky University Teaching Hospital and the University of Pecs. 2 0 KARGER BASEL CEREBROVASC DIS EXTR PY - 2015 SN - 1664-5456 SP - 132-138 ST - Improving Outcomes Achieved by a New Stroke Program in Hungary T2 - Cerebrovascular Diseases Extra TI - Improving Outcomes Achieved by a New Stroke Program in Hungary UR - ://WOS:000216895700008 VL - 5 ID - 761767 ER - TY - JOUR AB - Since the 1970s, specialized hemophilia centers have been established to optimize the complex and costly treatment of patients with severe bleeding disorders. The focus is on longterm patient care through a multidisciplinary team of medical and non-medical specialists working in a hemophilia center. Such an optimized treatment has been shown to increase both the life expectancyand the qualityof life ofhemophilia patients. This guideline of the Society for Thrombosis and Hemostasis Research (GTH) defines both the structure and process quality of hemophilia centers to achieve the following goals: • Definition of a transparent criteria catalog by the GTH for the required structure and process quality of hemophilia centers. • Ability to classify hemophilia centers based on these criteria. • To create the prerequisite for starting a certification process of hemophilia centers under the auspices of GTH. AD - H. Eichler, Institut für Klinische Hämostaseologie und Transfusionsmedizin, Universitätsklinikum des Saarlandes, Kirrbergerstrabe, Homburg/Saar, Germany AU - Eichler, H. AU - Pedroni, M. A. AU - Halimeh, S. AU - Königs, C. AU - Langer, F. AU - Miesbach, W. AU - Oldenburg, J. AU - Scholz, U. AU - Streif, W. AU - Klamroth, R. DB - Embase Medline DO - 10.1055/s-0039-1688450 KW - adenosine diphosphate adenosine triphosphate CD63 antigen mepacrine adolescent adult article assay bleeding tendency child clinical article cohort analysis controlled study correlational study disease classification drug uptake feasibility study female flow cytometry human laboratory test male scoring system thrombocyte disorder thrombocyte release reaction LA - German M1 - 4 M3 - Article N1 - L629980690 2019-12-10 2019-12-16 PY - 2019 SN - 2567-5761 0720-9355 SP - 311-321 ST - Guideline of the Society for Thrombosis and Hemostasis Research (GTH) on the structure and process quality of hemophilia centers T2 - Hamostaseologie TI - Guideline of the Society for Thrombosis and Hemostasis Research (GTH) on the structure and process quality of hemophilia centers UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629980690&from=export http://dx.doi.org/10.1055/s-0039-1688450 VL - 39 ID - 760774 ER - TY - JOUR AB - Introduction: Acute pulmonary embolism (PE) with hemodynamic stability and right ventricular(RV) dysfunction carries a high risk of mortality and is classified as submassive PE(SMPE). We report the results of a multidisciplinary PE team approach for treatment of SMPE with surgical pulmonary embolectomy(SPE) and catheter-directed thrombolysis(CDT). Methods: Data were collected for patients who underwent SPE or CDT for SMPE from January 2002-May 2015. Our multidisciplinary team consists of cardiologists, cardiac surgeons, and interventional cardiologists who determine on a case-by-case basis the optimal advanced treatment strategy. The EkoSonic ultrasound-assisted system was used for CDT. Results: 135 patients underwent treatment for SMPE; 71 underwent SPE, and 64 had CDT. Mean age was 57.3±14 years, and 49/135(36.3% were female. Identified risk factors for PE included DVT 59/135(43.7%), immobility 48/135(35.8%), and cancer 31/135(23.2%). In patients with prohibitive risk for surgery(58/64; 91%) or distal/diffuse clot(6/64; 9.4%), CDT was utilized. For SPE patients, 2.8%(2/71) had clot-in-transit, and 47%(33/71) had contraindications to thrombolysis such as recent surgery 17/71(24%), active bleeding 6/71 (8.5%), or intracranial pathology 10/71(14%). Overall operative mortality was 5.2%(SPE 7.0% vs CDT 3.1%, p=0.44). Bleeding complications were observed in 6 CPT patients(9.4%) and none in SPE(p=0.010). Postoperative stroke rate was 1.5%(2/135), all in SPE group(p=0.50). CDT patients had shorter ICU(20hrs vs 70hrs, p<0.001) and hospital LOS(3d vs 8d, p<0.001). Four-year survival was 85% for the entire cohort(Figure). Conclusion: Management of acute submassive PE by a multidisciplinary PE team results in low mortality and complication rates. SPE and CDT are two important advanced treatment options for these high risk patients. Careful multidisciplinary evaluation and selection maximizes clinical benefit. AD - J.I. Ejiofor, Cardiac Surgery, Brigham and Women's Hosp, Boston, MA, United States AU - Ejiofor, J. I. AU - Piazza, G. AU - Norman, A. V. AU - Yammine, M. AU - McGurk, S. AU - McCabe, J. M. AU - Goldhaber, S. Z. AU - Aranki, S. F. AU - Shekar, P. S. AU - Sobieszczyk, P. AU - Kaneko, T. DB - Embase KW - adult bleeding blood clot lysis cancer surgery cardiac surgeon cardiologist cerebrovascular accident clinical evaluation cohort analysis complication controlled study embolectomy female flush catheter high risk patient human immobility lung embolism major clinical study male middle aged pathology risk assessment risk factor skull surgery surgical mortality survival ultrasound LA - English M3 - Conference Abstract N1 - L619219930 2017-11-17 PY - 2016 SN - 1524-4539 ST - Advanced treatment of submassive pulmonary embolism in 135 patients triaged by a multidisciplinary pulmonary embolism response team T2 - Circulation TI - Advanced treatment of submassive pulmonary embolism in 135 patients triaged by a multidisciplinary pulmonary embolism response team UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619219930&from=export VL - 134 ID - 760993 ER - TY - GEN AB - IntroductionAcute pulmonary embolism (PE) with hemodynamic stability and right ventricular(RV) dysfunction carries a high risk of mortality and is classified... AU - Ejiofor, Julius I. AU - Piazza, Gregory AU - Norman, Anthony V. AU - Yammine, Maroun AU - McGurk, Siobhan AU - McCabe, James M. AU - Goldhaber, Samuel Z. AU - Aranki, Sary F. AU - Shekar, Prem S. AU - Sobieszczyk, Piotr AU - Kaneko, Tsuyoshi DA - 2016/01/01 DB - Federal Science Library - Canada PY - 2016 SN - 0009-7322 ST - Abstract 18040: Advanced Treatment of Submassive Pulmonary Embolism in 135 Patients Triaged by a Multidisciplinary Pulmonary Embolism Response Team TI - Abstract 18040: Advanced Treatment of Submassive Pulmonary Embolism in 135 Patients Triaged by a Multidisciplinary Pulmonary Embolism Response Team UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1Rb9MwELbWSSDGhGBjGgyQn_YSZdRJmq5oIFVV0RAaKtBK8FQ5sYOyNYnUpkLbH-RvcWfHicOGRB94SZpTayXxZ_vz9b47QnzvpOv-MSd4A9EVEuYFzw9h-yZkKGLBkxjogRhEAl28s5k__hZ8-uxNtjqmDmBj-68dDzboehTSbtD5daNggM8AATgCCOD4TzAYRujLiEuHncJAUm5A86__tI4xR-EKrIvAozGOaLJewO1hNN04i4oFVtFIc4f5PcznnypF3BTu_IfmrtxRGt6WuveOFr7oWFyJKaQzmxGP0mVclRC7qzKQ5akYX6ZFor0LqOperxqP7yTlNzfc1twYH7cSRVhZEpqg3u88y1Ltz73gS5j0bAcIC1EJyBoHCLL0RoST2w6XkQrpVamsmiJVdWRq_YtzgFZpD4dbYajIRN2-rxXUJ7JaKrzADXo6FVO9llSeWT1oVGHWOXPU2WHWOjFUnW6xDtvQSv_d1bvWvouPjusbc3FbGB5javhMpHH5Vubu7GuHdGC6xl3Bh481FQn9fs-UEsTb3yG7PwuMwlhdKRHGQ2QcFZeaPiaPqk0QHWq4PiFbMt8j-8Ocl0V2TY-pCktWb3SP3L-ooj_2yS8DZqoe4w01UKY1lGmR0AbKtAYiNUCkaU4BytRAmVZQptE15fQWlOlZxpdX7-p2zl6r68psGm1bDdTbVsR9ZXlKgvfj6ejcbb2luZYkz__WFf4B2c6LXB4SGsQhi5DCnzIe9GU8iCIJJF8wFvsCTs_IZk0_3_D7R-RBM0RekO1yuZYvyb1ktXCjVfJKoeM3vxvNLw VL - 134 ID - 761947 ER - TY - JOUR AB - Introduction: Idiopathic thrombocytopenic purpura (ITP) is estimated to occur in 1 per 1000 pregnancies and can be associated with adverse maternal or neonatal outcome. We present a case where the treatment of the patient's ITP and post-partum haemorrhage (PPH)was handled by a multidisciplinary team, guided by aggregometry and thromboelastography (TEG). Case: A 29-year old woman with almost refractory ITP presented with PPH and evacuation of retained placental fragments after her third vaginal delivery. Prior to delivery a detailed plan to control her haemostasis was outlined in collaboration with the transfusion medical expert, the obstetrician, and the haematologist. Tranexamic acid and desmopressin were planned to be administrated directly prior to delivery, followed by platelets. Misoprostol and oxytocin was to be administrated immediately after delivery. Point of Care Testing (POCTs), i.e. TEG, functional fibrinogen assay (ReoPro®) and aggregometry analysis (Multiplate®) was performed, together with standard laboratory tests throughout the delivery, operation and afterwards. Few minutes after uncomplicated vaginal delivery of a baby girl, heavy vaginal bleeding started. The patient was immediate-ly transferred to the operation theatre for manual placenta removal. The total bleeding during labour and placenta removal was estimated to 2000 ml. After 3 hours the bleeding started again. During the first 24 hours after delivery her PPH was estimated to minimum 3000 ml and she received 15 pools of platelets, 4 pools of fresh frozen plasma and 6 packed red blood cells. In addition to 25 mg of desmopressin, and 1 g of fibrinogen, she had received 1 g tranexamic acid every 4th hour. The patient was hemodynamic stable pre-, per- and post-operative. On day 5 an ultrasound scan identified additional retained placental tissue. Evacuation was performed after another set of POCTs, and administration of platelets and 2 g tranexamic acid, and with 25 mg desmopressin during this operation. She was discharged at day 20, wellbeing without symptoms. Conclusion: Each patient should be assessed individually and a plan for management of labour, delivery and potential bleeding should be made. Management of pregnant women with ITP requires a multidisciplinary approach. POCTs present easy accessible and useful results that enable the clinicians to rapid evaluate goal directed therapeutic intervention. AD - K. Ekelund, Rigshospitalet, Department of anesthesiology, Juliane Marie Centre, Copenhagen, Denmark AU - Ekelund, K. AU - Pinborg, A. AU - Bjerrum, O. W. AU - Stensballe, J. DB - Embase DO - 10.1111/aas.12153 KW - desmopressin tranexamic acid fibrinogen misoprostol fresh frozen plasma abciximab oxytocin thromboelastography human patient idiopathic thrombocytopenic purpura postpartum hemorrhage society anesthesiology intensive care brain female bleeding thrombocyte vaginal delivery placental delivery manual placental delivery pregnancy erythrocyte ultrasound vagina bleeding girl baby laboratory test assay medical expert point of care testing transfusion pregnant woman labor management tissues wellbeing hemostasis LA - English M3 - Conference Abstract N1 - L71131814 2013-08-16 PY - 2013 SN - 0515-2720 SP - 16-17 ST - Thromboelastography and aggregometry guided treatment in a patient with idiopathic thrombocytopenic purpura and postpartum hemorrhage T2 - Acta Anaesthesiologica Scandinavica, Supplement TI - Thromboelastography and aggregometry guided treatment in a patient with idiopathic thrombocytopenic purpura and postpartum hemorrhage UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71131814&from=export http://dx.doi.org/10.1111/aas.12153 VL - 57 ID - 761154 ER - TY - JOUR AB - Stroke rapid-response ("code stroke") teams facilitate the evaluation and treatment of patients presenting to emergency departments (EDs). Little is known about the usefulness of code stroke systems for patients hospitalized primarily for other conditions. We hypothesized that the yield of code stroke evaluations would be lower in hospitalized than in ED patients, and sought to identify potential targets for quality improvement efforts. Diagnoses and management of in-hospital and ED code stroke patients were assessed retrospectively in a Joint Commission-certified primary stroke center over a 1-year period. A total of 93 in-hospital and 204 ED code strokes were identified during this period. Compared with the ED patients, the hospitalized patients were less likely to have had a stroke/transient ischemic attack (26.8% vs 51.4%; P < .0001) and less likely to have been treated with a thrombolytic agent (odds ratio, 0.27; 95% confidence interval, 0.07-0.97: P = .03). Conditions not necessitating immediate neurologic care accounted for 63.4% of in-hospital strokes, compared with 31.3% of ED code strokes (P < .0001). "Altered mental status" was the sole presenting symptom in 48% of the hospitalized patients, compared with only 10% of ED patients (P < .0001), and was the only clinical feature independently associated with a stroke mimic in the hospitalized patients (odds ratio, 63.52; 95% confidence interval, 7.37-547.69; P = .0002). There was no association between a final diagnosis of a stroke mimic and patient age, sex or race-ethnicity or nursing shift. The proportions of patients with acute ischemic stroke and patients treated with thrombolytics after activation of in-hospital code stroke were small, and were lower than those of patients with ED code stroke in the same hospital over the same time period. Developing a standardized assessment protocol for hospitalized patients with altered mental status may improve the efficacy of care. AD - Department of Medicine, Duke Stroke Center, Duke University, Durham, North Carolina 27710, USA. AN - 22206693 AU - El Husseini, N. AU - Goldstein, L. B. DA - May DO - 10.1016/j.jstrokecerebrovasdis.2011.09.012 DP - NLM ET - 2011/12/31 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Aged Aged, 80 and over Chi-Square Distribution Critical Pathways Diagnosis, Differential *Emergency Service, Hospital Female Health Services Accessibility *Hospital Rapid Response Team *Hospitalization Humans Logistic Models Male Middle Aged Odds Ratio Predictive Value of Tests Prognosis Psychiatric Status Rating Scales Retrospective Studies Stroke/*diagnosis/psychology/*therapy *Thrombolytic Therapy Time Factors *Time-to-Treatment LA - eng M1 - 4 N1 - 1532-8511 El Husseini, Nada Goldstein, Larry B Comparative Study Journal Article Research Support, Non-U.S. Gov't United States J Stroke Cerebrovasc Dis. 2013 May;22(4):345-8. doi: 10.1016/j.jstrokecerebrovasdis.2011.09.012. Epub 2011 Dec 28. PY - 2013 SN - 1052-3057 SP - 345-8 ST - "Code stroke": hospitalized versus emergency department patients T2 - J Stroke Cerebrovasc Dis TI - "Code stroke": hospitalized versus emergency department patients VL - 22 ID - 760376 ER - TY - JOUR AB - Background: Pulmonary embolism (PE) management often involves multiple specialties that differ in clinical knowledge, expertise, and comfort in managing PE. Coincident with a reported improvement in patient outcomes with the Pulmonary Embolism Response Team (PERT) model, the impact of a PERT on trainee physician education and autonomy are unknown. Cardiologists are comfortable with acute care, hemodynamics, managing right ventricular failure, and thrombolytic agents, so lead a PERT initiative at the University of Rochester Medical Center. Methods: A resident and fellow questionnaire and short multiple choice quiz were administered in the following departments: internal medicine, emergency medicine, cardiology, cardiothoracic and vascular surgery, pulmonology, and critical care, with emphasis on the educational outcomes since PERT implementation. Results: 73 physicians responded to the survey (88% MD/12% DO). 49% of respondents underestimated 3-month mortality for submassive and massive PE, and 44% were unaware of a common physical exam finding for PE. Comparing before and after PERT implementation, physicians perceived increased confdence in identifying (p<0.001), and managing (P=0.003) high risk PE; enhanced confdence in treating patients appropriately with systemic thrombolysis (P=0.04) and increased knowledge of indications for systemic thrombolysis and surgical embolectomy (P=0.04 and p<0.001, respectively). Respondents perceived no change in awareness of contraindications for thrombolysis (P=0.15) or indications for Extra-Corporeal Membrane Oxygenation (ECMO, P=0.06). Respondents perceived no loss of patient autonomy since PERT (P=1.0), but an increased fund of knowledge (77%, P<0.001), and a perception that PERT improves care of patients with high risk PE (89%, P<0.001). 71% of respondents indicated that every institution should have a PERT functioning like an acute myocardial infarction team (P<0.001). Conclusion: While PERT may be perceived as superfuous or unnecessary, trainee physicians in a large institution perceived an enhanced educational and patient management experience for high risk PE without a loss of autonomy. AD - A. Elbadawi AU - Elbadawi, A. AU - Wright, C. AU - Patel, D. AU - Chen, Y. L. AU - Cameron, S. DB - Embase DO - 10.1016/S0735-1097(18)32483-5 KW - acute heart infarction adult awareness blood clot lysis cardiology conference abstract contraindication controlled study education embolectomy emergency medicine extracorporeal oxygenation human intensive care lung embolism mortality patient autonomy patient care perception physical examination pulmonology questionnaire resident risk assessment student surgery LA - English M1 - 11 M3 - Conference Abstract N1 - L621786472 2018-04-27 PY - 2018 SN - 1558-3597 ST - The impact of multi-specialty team for high risk pulmonary embolism on resident and fellow education T2 - Journal of the American College of Cardiology TI - The impact of multi-specialty team for high risk pulmonary embolism on resident and fellow education UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621786472&from=export http://dx.doi.org/10.1016/S0735-1097(18)32483-5 VL - 71 ID - 760845 ER - TY - JOUR 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. AD - 1 Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA. 2 Department of Internal Medicine, Division of Cardiology; University of Rochester Medical Center, Rochester, NY, USA. 3 Department of Internal Medicine; University of Rochester Medical Center, Rochester, NY, USA. 4 Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA. 5 Novo Science Ltd, Edinburgh, UK. 6 Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 7 Department of Surgery, Cardiac Surgery, University of Rochester Medical Center, Rochester, NY, USA. 8 Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. AN - 29786477 AU - Elbadawi, A. AU - Wright, C. AU - Patel, D. AU - Chen, Y. L. AU - Mazzillo, J. AU - Cameron, P. AU - Barnes, G. D. AU - Cameron, S. J. C2 - Pmc6525006 C6 - Nihms1015668 DA - Aug DO - 10.1177/1358863x18767753 DP - NLM ET - 2018/05/23 J2 - Vascular medicine (London, England) KW - Adult Attitude of Health Personnel Curriculum Education, Medical, Graduate/*methods Female Health Knowledge, Attitudes, Practice Humans *Interdisciplinary Communication *Internship and Residency Male Middle Aged *Patient Care Team Professional Autonomy Pulmonary Embolism/diagnosis/mortality/*therapy Risk Assessment Risk Factors Specialization Surveys and Questionnaires Young Adult *autonomy *education *massive PE *pulmonary embolism (PE) *pulmonary embolism response team (PERT) *sub-massive PE *thrombolysis interest with respect to the research, authorship, and/or publication of this article. LA - eng M1 - 4 N1 - 1477-0377 Elbadawi, Ayman Orcid: 0000-0002-4248-781x Wright, Colin Patel, Dhwani Chen, Yu Lin Mazzillo, Justin Cameron, Pamela Barnes, Geoffrey D Cameron, Scott J Orcid: 0000-0002-9616-1540 K08 HL128856/HL/NHLBI NIH HHS/United States L30 HL120200/HL/NHLBI NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Vasc Med. 2018 Aug;23(4):372-376. doi: 10.1177/1358863X18767753. Epub 2018 May 22. PY - 2018 SN - 1358-863X (Print) 1358-863x SP - 372-376 ST - The impact of a multi-specialty team for high risk pulmonary embolism on resident and fellow education T2 - Vasc Med TI - The impact of a multi-specialty team for high risk pulmonary embolism on resident and fellow education VL - 23 ID - 760178 ER - TY - GEN AB -.... Coincident with a reported improvement in patient outcomes with the Pulmonary Embolism Response Team (PERT) model, the impact of a PERT on trainee physician education... AU - Elbadawi, Ayman AU - Wright, Colin AU - Patel, Dhwani AU - Lin Chen, Yu AU - Cameron, Scott DA - 2018/01/01 DB - Federal Science Library - Canada PY - 2018 SN - 0735-1097 ST - THE IMPACT OF MULTI-SPECIALTY TEAM FOR HIGH RISK PULMONARY EMBOLISM ON RESIDENT AND FELLOW EDUCATION TI - THE IMPACT OF MULTI-SPECIALTY TEAM FOR HIGH RISK PULMONARY EMBOLISM ON RESIDENT AND FELLOW EDUCATION UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1dS8MwFA06UUTwW5xf5FEfOps0bdPHunU2rN3m1qE-lbRJnmSK0_9v-rENZAr60rdbwkm494Sbcw8AFm6ZxrecwIXjmtLMKdX1RyAXcUxygZWj6ThCeaEbnkys4In0HwppzO0PDf1S2utaxexMz71G9EbTAWoZ9jrYKMbKFA4GDmstMrFDS2OPRcRSwbP6N6tr084yrXb3_ry0fbBbU0voV2fhAKzJ6SHYiuvm-REQSRhAFg_9dgIHXRhPooQZ42HQZn6UPMMk8GOo74QwZPchHLFxDw4nkYbXHz3DIL4bRGwcw0Ef6j1jnaCfQL_fgd0gigaPcGHgcwySbpC0Q6M2WTAKo3FsEJc4GUHC9LBAHscYZTTzJKamyIgrichkphDOOTFFTnmuXC6VIxwilGV5mXUCGtPXqTwFUHmOZ0vNd_QViFDpco6wtE1lexa3ucqboDVHN32rRmmkyzdmGrqqG45oWkKX2k1A53uQ1nygqvOpRv730LP_h56DbU2KSt0hMi9A4-P9U16CTTV7MbKZuipPmP52WO8LeKTAyA VL - 71 ID - 761984 ER - TY - JOUR AB - PURPOSE: Children receiving treatment in the hospital frequently require intravenous (IV) access. Placement of short peripheral catheters can be painful and challenging especially in those children who have difficult access. Many children's hospitals have teams of specialized vascular access nurses experienced in peripheral catheter insertion, and at times use vein visualization devices, including ultrasound (US), to assist in peripheral IV placement. Our objectives were to describe the prevalence and success rate of US-guided peripheral IV placement by vascular access team nurses at a single tertiary children's hospital. METHODS: We retrospectively reviewed quality assurance data kept by our institution's vascular access team between February, 2014 and March, 2014. Data extracted included: age, gender, number of attempts, if difficult, if ultimately successful and modality used to aid IV placement. Descriptive statistics and chi-square tests were used to analyze and report data. RESULTS: There were 1111 patient-nurse encounters reported for peripheral IV placement over a six-week period, and a total of 1579 attempts. Ultimately 84% of the patients had successful IV placement. Overall, visualization and palpation was the most frequently used technique (50.1%), followed by near-infrared light (40.6%), US (8.0%), and transillumination (1.3%). The success rate of US (60% overall and 59.2% difficult) was not significantly different from other advanced visualization techniques. CONCLUSIONS: Vascular access team nurses use US infrequently for peripheral IV placement, including in children with difficult access. Methods to increase its skillful use in difficult access patients and improve successful IV placements should be explored. AD - Children's Hospital Los Angeles, Los Angeles, California - USA. University of Southern California, Los Angeles, California - USA. LAC+USC Medical Center, Los Angeles, California - USA. AN - 27886365 AU - Elkhunovich, M. AU - Barreras, J. AU - Bock Pinero, V. AU - Ziv, N. AU - Vaiyani, A. AU - Mailhot, T. DA - Jan 18 DO - 10.5301/jva.5000615 DP - NLM ET - 2016/11/26 J2 - The journal of vascular access KW - Catheterization, Peripheral/adverse effects/instrumentation/*nursing Chi-Square Distribution Child Child, Preschool *Hospitals, Pediatric Humans Infant Infant, Newborn Infrared Rays *Nursing Staff, Hospital Palpation/nursing Patient Care Team Retrospective Studies Risk Factors *Tertiary Care Centers Transillumination/nursing Treatment Outcome Ultrasonography, Interventional/*nursing Vascular Access Devices LA - eng M1 - 1 N1 - 1724-6032 Elkhunovich, Marsha Barreras, Joanna Bock Pinero, Valerie Ziv, Nurit Vaiyani, Aisha Mailhot, Thomas Comparative Study Journal Article United States J Vasc Access. 2017 Jan 18;18(1):57-63. doi: 10.5301/jva.5000615. Epub 2016 Nov 15. PY - 2017 SN - 1129-7298 SP - 57-63 ST - The use of ultrasound for peripheral IV placement by vascular access team nurses at a tertiary children's hospital T2 - J Vasc Access TI - The use of ultrasound for peripheral IV placement by vascular access team nurses at a tertiary children's hospital VL - 18 ID - 760164 ER - TY - JOUR AB - Rationale: Ensuring accurate communication of patient care goals in the intensive care unit (ICU) is essential. This can be challenging as the patients in this setting are medically complex and require the coordination of large multidisciplinary teams which requires staff time and effort. The purpose of this pilot study was to determine whether the use of a 24-hour communication tool during daily interprofessional ICU rounds improved satisfaction regarding communication, understanding, and implementation of patient care goals. Methods: This pilot study was done at our institution in a closed 18-bed combined medical and surgical ICU. The 24-hour communication tool included specific management plans regarding ventilator weaning, deep vein thrombosis prophylaxis, stress ulcer prophylaxis, nutrition, antibiotics, fluid status, line placement, pain management, physical and occupational therapy, swallow evaluation, lab results and requests, and nursing concerns. During the intervention period, the communication tool was completed by nursing staff and subsequently used by resident physicians during daily rounds for a two-week period. We created a 15-question survey that assessed the degree of satisfaction with communication, understanding, and achieving patient care goals with a 5-level Likert scale. This survey was completed by multidisciplinary ICU staff before and after implementation of the communication tool. Results: We collected 16 surveys prior to implementation of the communication tool and 6 surveys after the implementation of the communication tool. Multidisciplinary team members that completed the survey included medical students, nurses, respiratory therapists, residents, fellows, and attending physicians. Prior to implementation of the communication tool, 27% of all survey responses reflected some level of dissatisfaction. Post implementation, we observed a 100% rate with some level of satisfaction across all survey domains. We observed the most significant positive change in survey domains gauging satisfaction with end of life communications and achieving patient care goals. For the domain in end of life communication, 75% of survey respondents expressed dissatisfaction prior to implementation, with post-implementation results indicating 100% satisfaction. For the domain of achieving patient care goals, 50% were dissatisfied prior to implementation, and 100% were satisfied post implementation of the communication tool. Conclusions: Our data suggests that the use of a 24-hour communication tool to facilitate interprofessional ICU rounds improves staff satisfaction and achievement of patient care goals. AD - M.K. Ellis, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States AU - Ellis, M. K. AU - Mathew, A. B. DB - Embase KW - antibiotic agent achievement adult analgesia clinical article conference abstract controlled study deep vein thrombosis female human Likert scale male medical student nursing staff nutrition occupational therapy patient care pilot study resident respiratory therapist satisfaction stress ulcer surgical intensive care unit thrombosis prevention total quality management ventilator weaning LA - English M1 - MeetingAbstracts M3 - Conference Abstract N1 - L622966040 2018-07-16 PY - 2018 SN - 1535-4970 ST - Quality improvement project assessing multidisciplinary team satisfaction before and after utilization of a communication tool T2 - American Journal of Respiratory and Critical Care Medicine TI - Quality improvement project assessing multidisciplinary team satisfaction before and after utilization of a communication tool UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622966040&from=export VL - 197 ID - 760870 ER - TY - JOUR AB - Case Report: Case Report: 41 yr old African American female presented to the hospital with bilateral lower extremities and mesenteric ischemia due to extensive thrombosis of the abdominal aorta (AA). Computer topographic angiography showed an isolated patent segment of the AA at the level of renal arteries. The patient underwent a complex thoraco-abdominal bypass surgery with a four-limb graft; 1st limb to the superior mesenteric artery, 2nd limb to the isolated patent segment of AA, and 3rd and 4th limbs to femoral arteries. Further work up revealed low levels of protein C, protein S and antithrombin III. Patient was discharged on long-term anticoagulation, but unfortunately she lost follow up and stopped her anticoagulation. Two years later she presented to the hospital with acute kidney injury (AKI) and volume overload that required intermittent hemodialysis (HD). Her blood pressure (BP) remained elevated despite ultrafiltration and multiple antihypertensive medication use. Extensive work up without use of contrast revealed inoperable occluded graft limb to AA and a non-functional atrophic left kidney with inadequate blood flow to the right kidney. Renal biopsy of the right kidney showed severe tubular necrosis and viable tissue. Based on the tissue viability, she underwent renal autotransplantation of the right kidney. Following her procedure, she recovered from AKI and had BP well controlled on a single agent. Her creatinine was 0.75 mg/dl 3 months post RAT. Conclusions: In conclusion renal autotransplantation is a rare procedure that is technically demanding with several potentially serious complications. The procedure is underutilized and in the correct settings, it may be of great utility. It should be considered as alternative to dialysis in patients with severe peripheral artery disease. Our case illustrates an alternative therapeutic approach to lifelong HD commitment and to resistant hypertension in a patient with solitary kidney and inoperable renal vascular perfusion disorder. Multidisciplinary team approach is the key factor for such a challenging surgery. AD - N. Elmahi, University of Mississippi Medical Center, Jackson, MS, United States AU - Elmahi, N. AU - Kokko, K. AU - Fulop, T. AU - Hamrahian, S. DB - Embase DO - 10.231/JIM.0b013e3182820c55 KW - protein C antithrombin III protein S creatinine antihypertensive agent solitary kidney kidney autotransplantation dialysis patient human vascular disease medical research limb kidney procedures tissues anticoagulation hospital patent case report African American computer abdominal aorta hemodialysis angiography follow up thrombosis mesenteric ischemia femoral artery resistant hypertension superior mesenteric artery acute kidney failure blood pressure ultrafiltration drug therapy kidney tubule necrosis bypass surgery kidney biopsy kidney artery blood flow peripheral occlusive artery disease perfusion diseases surgery leg female LA - English M1 - 2 M3 - Conference Abstract N1 - L70993183 2013-02-21 PY - 2013 SN - 1081-5589 SP - 443 ST - Solitary kidney autotransplantation; an alternative to dialysis commitment in a patient with significant vascular disease T2 - Journal of Investigative Medicine TI - Solitary kidney autotransplantation; an alternative to dialysis commitment in a patient with significant vascular disease UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70993183&from=export http://dx.doi.org/10.231/JIM.0b013e3182820c55 VL - 61 ID - 761178 ER - TY - JOUR AB - Objective: The use of left ventricular assist devices (LVADs) by non transplantation mechanical circulatory support (MCS) centers has garnered some controversy due to concerns about maintaining outcomes, gaining appropriate experience, and the availability of necessary resources. Our goal was therefore to report outcome data for patients who underwent LVAD implantation as a bridge to transplant (BTT) or destination therapy (DT) at a non transplantation MCS center. (FIGURE PRESERNTED) Methods: A retrospective review was performed of all patients who underwent implantation of the HeartMate II LVAD (Thoratec Corporation, Pleasanton, CA USA) as BTT or DT at our non transplantation MCS center between January 2016 and June 2017. Results: A total of 30 patients underwent LVAD implantation during the study period: 70% as DTand 30% as BTT. Most patients were Inter-agency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 1 (40.7%) or level 2 (51.9%). The overall 30-day mortality rate was 0% and the mortality rate at 1 year was 4.8%. The stroke rate was 0% at last follow-up. The median length of stay was 22 days and the rate of 30-day readmissions was 20%. Two patients (6.7%) required mediastinal reexploration for bleeding. There were no device exchanges for thrombosis in this cohort. Three patients underwent concomitant placement of a right ventricular assist device; 2 of these patients survived to RVAD explant and 1 survived to transplant. Conclusions: With the appropriate multidisciplinary teams, collaboration with transplant centers, and center commitment, LVAD therapy can be disseminated to non transplantation MCS centers with acceptable outcomes that are comparable with results from the INTERMACS registry. AD - A. Elmously, New York-Presbyterian, Weill Cornell Medical Center, New York, NY, United States AU - Elmously, A. AU - Worku, B. AU - Guy, T. S. AU - Girardi, L. N. AU - Salemi, A. DB - Embase KW - adult assisted circulation bleeding case report cerebrovascular accident clinical article conference abstract explant female follow up hospital readmission human human tissue implantation left ventricular assist device length of stay male mediastinum mortality rate retrospective study right ventricular assist device thrombosis transplantation LA - English M3 - Conference Abstract N1 - L622328196 2018-05-31 PY - 2018 SN - 1559-0879 SP - S30-S31 ST - Outcomes of left ventricular assist device implantation in a real life non-transplant mechanical circulatory support center during the era of commercialization T2 - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery TI - Outcomes of left ventricular assist device implantation in a real life non-transplant mechanical circulatory support center during the era of commercialization UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622328196&from=export VL - 13 ID - 760834 ER - TY - JOUR AB - Objective: To assess the benefit of the recombinant human interleukin‐1 receptor antagonist anakinra in treating pediatric patients with secondary hemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS) associated with rheumatic and nonrheumatic conditions. Methods: A retrospective chart review of all anakinra‐treated patients with secondary HLH/MAS was performed at Children's of Alabama from January 2008 through December 2016. Demographic, clinical, laboratory, and genetic characteristics, outcomes data, and information on concurrent treatments were collected from the records and analyzed using appropriate univariate statistical approaches to assess changes following treatment and associations between patient variables and outcomes. Results: Forty‐four patients with secondary HLH/MAS being treated with anakinra were identified in the electronic medical records. The median duration of hospitalization was 15 days. The mean pretreatment serum ferritin level was 33,316 ng/ml and dropped to 14,435 ng/ml (57% decrease) within 15 days of the start of anakinra treatment. The overall mortality rate in the cohort was 27%. Earlier initiation of anakinra (within 5 days of hospitalization) was associated with reduced mortality (P = 0.046), whereas thrombocytopenia (platelet count <100,000/μl) and STXBP2 mutations were both associated with increased mortality (P = 0.008 and P = 0.012, respectively). In considering patients according to their underlying diagnosis, those with systemic juvenile idiopathic arthritis (JIA) had the lowest mortality rate, with no deaths among the 13 systemic JIA patients included in the study (P = 0.006). In contrast, those with an underlying hematologic malignancy had the highest mortality rate, at 100% (n = 3). Conclusion: These findings suggest that anakinra appears to be effective in treating pediatric patients with non–malignancy‐associated secondary HLH/MAS, especially when it is given early in the disease course and when administered to patients who have an underlying rheumatic disease. AD - University of Alabama at Birmingham School of Medicine and Assiut University Children's Hospital, Assiut Egypt University of Alabama at Birmingham School of Medicine AN - 141451158. Language: English. Entry Date: 20200203. Revision Date: 20200203. Publication Type: Article AU - Eloseily, Esraa M. AU - Weiser, Peter AU - Crayne, Courtney B. AU - Haines, Hilary AU - Mannion, Melissa L. AU - Stoll, Matthew L. AU - Beukelman, Timothy AU - Atkinson, T. Prescott AU - Cron, Randy Q. DB - CINAHL DO - 10.1002/art.41103 DP - EBSCOhost KW - Recombinant Proteins -- Therapeutic Use -- In Infancy and Childhood Antirheumatic Agents -- Therapeutic Use -- In Infancy and Childhood Histiocytosis -- Drug Therapy -- In Infancy and Childhood Interleukin 1 Receptors, Cell Surface -- Antagonists and Inhibitors -- In Infancy and Childhood Macrophage Activation Syndrome -- Drug Therapy -- In Infancy and Childhood Rheumatic Diseases Human Child Retrospective Design Alabama Electronic Health Records Univariate Statistics Length of Stay Ferritin -- Blood Ferritin -- Drug Effects Descriptive Statistics Thrombocytopenia -- Mortality Arthritis, Juvenile Rheumatoid -- Mortality Histiocytosis -- Mortality Mutation -- Drug Effects Treatment Outcomes Child, Preschool Adolescence M1 - 2 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 101623795. PY - 2020 SN - 2326-5191 SP - 326-334 ST - Benefit of Anakinra in Treating Pediatric Secondary Hemophagocytic Lymphohistiocytosis T2 - Arthritis & Rheumatology TI - Benefit of Anakinra in Treating Pediatric Secondary Hemophagocytic Lymphohistiocytosis UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=141451158&site=ehost-live&scope=site VL - 72 ID - 761300 ER - TY - JOUR AB - Objective: This study explores the link between neurologic deficit as measured by the National Institutes of Health Stroke Scale (NIHSS), and its relationship to length of stay (LOS) and discharge destination. Design: A retrospective chart review was completed of 54 patients admitted for rehabilitation after experiencing a cerebrovascular accident. Setting: The study was completed in an acute inpatient rehabilitation stroke unit in a large urban tertiary care medical center. Participants: Patients were included in this analysis if their record contained an NIHSS score on both admission and discharge, if they had neuroimaging documentation of an acute hemorrhagic or ischemic stroke, and if they were not transferred away from the rehabilitation unit during their stay. Of 54 cases reviewed, 47 were ultimately included. Main Outcome Measurements: Independent variables included were NIHSS admission and discharge scores, change in score from admission to discharge, discharge destination, age, gender, type of stroke, and use of tissue plasminogen activator. These were examined against the dependent variable, LOS. Results: Greater admission NIHSS scores predicted longer hospital stays. Mean admission and discharge scores were significantly greater for patients discharged to subacute facilities, and LOS was also longer for these patients compared with those discharged to the community. Surprisingly, age was inversely related to LOS, admission score, and discharge score. Conclusion: Stroke remains one of the most common reasons for admission to acute care hospitals. The authors know of no studies that have examined the rehabilitation aspect of care incorporating the NIHSS in this manner. This study draws a connection between neurologic impairment by using the NIHSS and LOS and discharge destination in an acute inpatient rehabilitation stroke unit. In the future, multidisciplinary rehabilitation teams may consider using this measure to predict LOS and disposition at discharge from inpatient rehabilitation. AD - [Elwood, Douglas; Rashbaum, Ira; Bonder, Jaclyn; Berliner, Jeffrey; Yoon, Steve; Ben-Roohi, Moshe; Bansal, Amit] NYU, Dept Phys Med & Rehabil, New York, NY 10016 USA. [Pantel, Austin; Purvin, Mike] NYU, Sch Med, New York, NY 10016 USA. Elwood, D (corresponding author), NYU, Dept Phys Med & Rehabil, Suite 600,400 E 34th St, New York, NY 10016 USA. elwood01@nyumc.org AN - WOS:000208411100008 AU - Elwood, D. AU - Rashbaum, I. AU - Bonder, J. AU - Pantel, A. AU - Berliner, J. AU - Yoon, S. AU - Purvin, M. AU - Ben-Roohi, M. AU - Bansal, A. DA - Feb DO - 10.1016/j.pmrj.2008.10.010 J2 - Pm&R KW - NIH STROKE SCALE ACUTE ISCHEMIC-STROKE RELIABILITY SCORE THROMBOLYSIS PREDICTION MANAGEMENT OCCLUSION TRIAL Rehabilitation Sport Sciences LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: V24LE Times Cited: 20 Cited Reference Count: 28 Elwood, Douglas Rashbaum, Ira Bonder, Jaclyn Pantel, Austin Berliner, Jeffrey Yoon, Steve Purvin, Mike Ben-Roohi, Moshe Bansal, Amit 21 0 4 WILEY HOBOKEN PM&R PY - 2009 SN - 1934-1482 SP - 147-151 ST - Length of Stay in Rehabilitation is Associated with Admission Neurologic Deficit and Discharge Destination T2 - Pm&R TI - Length of Stay in Rehabilitation is Associated with Admission Neurologic Deficit and Discharge Destination UR - ://WOS:000208411100008 VL - 1 ID - 761897 ER - TY - JOUR AB - Background HER2-positive metastatic breast cancer is incurable and new treatments are needed. Addition of atezolizumab to trastuzumab emtansine might potentiate anticancer immunity and enhance the HER2-targeted cytotoxic activity of trastuzumab emtansine. We aimed to test this combination in HER2-positive advanced breast cancer that had progressed after previous treatment with trastuzumab and a taxane. Methods The KATE2 study is a randomised, double-blind, placebo-controlled, phase 2 study at 68 centres from nine countries across Asia, Australia, North America, and western Europe. Eligible patients were adults (aged >= 18 years) with an Eastern Cooperative Oncology Group performance status of 0 or 1 and centrally confirmed, measurable, HER2-positive advanced breast cancer previously treated with trastuzumab and a taxane. Patients were randomly assigned (2:1) either trastuzumab emtansine (3.6 mg/kg of bodyweight) plus atezolizumab (1200 mg) or trastuzumab emtansine plus placebo; all study drugs were administered by intravenous infusion every 3 weeks. Randomisation was done via an interactive voice and web response system using a permuted block scheme (block size of six) and was stratified by PD-L1 status, world region, and liver metastases. Patients, investigators, and study team members were masked to treatment allocation. The primary endpoint was investigator-assessed progression-free survival in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02924883, and the study has been completed. Findings Between Sept 26, 2016, and Aug 7, 2017, 330 patients were screened for the study, of whom 202 were randomly allocated either atezolizumab (n=133) or placebo (n=69). At the recommendation of the independent data monitoring committee, treatment assignment was unmasked on Dec 11, 2017, due to futility and the numerically higher frequency of adverse events among patients assigned atezolizumab. This date was set as the clinical cutoff for the primary analysis. Median follow-up was 8.5 months (IQR 6.1-11.5) for patients assigned atezolizumab and 8.4 months (5.3-11.1) for those assigned placebo. Median progression-free survival was 8.2 months (95% CI 5.8-10.7) for patients assigned atezolizumab versus 6.8 months (4.0-11.1) for those assigned placebo (stratified hazard ratio 0.82, 95% CI 0.55-1.23; p=0.33). The most common grade 3 or worse adverse events were thrombocytopenia (17 [13%] among 132 patients who received atezolizumab vs three [4%] among 68 who received placebo), increased aspartate aminotransferase (11 [8%] vs two [3%]), anaemia (seven [5%] vs 0), neutropenia (six [5%] vs three [4%]), and increased alanine aminotransferase (six [5%] vs two [3%]). Serious adverse events occurred in 43 (33%) of 132 patients who received atezolizumab and 13 (19%) of 68 patients who received placebo. One patient who received atezolizumab died due to a treatment-related adverse event (haemophagocytic syndrome). Interpretation Addition of atezolizumab to trastuzumab emtansine did not show a clinically meaningful improvement in progression-free survival and was associated with more adverse events. Further study of trastuzumab emtansine plus atezolizumab is warranted in a subpopulation of patients with PD-L1-positive, HER2-positive advanced breast cancer. Copyright (C) 2020 Elsevier Ltd. All rights reserved. AD - [Emens, Leisha A.] Univ Pittsburgh, Med Ctr, Hillman Canc Ctr, Pittsburgh, PA 15213 USA. [Esteva, Francisce J.] New York Univ Langone Hlth, Perlmutter Canc Ctr, New York, NY USA. [Beresford, Mark] Royal United Hosp, Bath, Avon, England. [Saura, Cristina] Vall dHebron Univ Hosp, Vall dHebron Inst Oncol, Barcelona, Spain. [De Laurentiis, Michelin] Ist Ricovero & Cura Carattere Sci Ist Natl Tumori, Naples, Italy. [Kim, Sung-Bae] Univ Ulsan, Asan Med Ctr, Coll Med, Seoul, South Korea. [Im, Seock-Ah] Seoul Natl Univ, Seoul Natl Univ Hosp, Canc Res Inst, Coll Med, Seoul, South Korea. [Wang, Yifan] Roche China Holding, Shanghai, Peoples R China. [Salgado, Roberto] Ziekenhuis Netwerk Antwerpen Hosp, Dept Pathol, Gasthuis Zusters Antwerpen, Antwerp, Belgium. [Mani, Aruna; Shah, Jigna; Liu, Haiying] Genentech Inc, San Francisco, CA USA. [Lambertini, Chiara; de Haas, Sanne L.; Patre, Monika] F Hoffmann La Roche, Basel, Switzerland. [Loi, Sherene] Peter MacCallum Canc Ctr, Div Res, Melbourne, Vic, Australia. Emens, LA (corresponding author), Univ Pittsburgh, Med Ctr, Hillman Canc Ctr, Pittsburgh, PA 15213 USA. emensla@upmc.edu; sherene.loi@petermac.org AN - WOS:000576153400022 AU - Emens, L. A. AU - Esteva, F. J. AU - Beresford, M. AU - Saura, C. AU - De Laurentiis, M. AU - Kim, S. B. AU - Im, S. A. AU - Wang, Y. F. AU - Salgado, R. AU - Mani, A. AU - Shah, J. AU - Lambertini, C. AU - Liu, H. Y. AU - de Haas, S. L. AU - Patre, M. AU - Loi, S. DA - Oct J2 - Lancet Oncol. KW - OPEN-LABEL PHYSICIANS CHOICE TH3RESA SAFETY Oncology LA - English M1 - 10 M3 - Article N1 - ISI Document Delivery No.: NY1JC Times Cited: 0 Cited Reference Count: 18 Emens, Leisha A. Esteva, Francisce J. Beresford, Mark Saura, Cristina De Laurentiis, Michelin Kim, Sung-Bae Im, Seock-Ah Wang, Yifan Salgado, Roberto Mani, Aruna Shah, Jigna Lambertini, Chiara Liu, Haiying de Haas, Sanne L. Patre, Monika Loi, Sherene Saura, Cristina/0000-0001-8296-5065; Esteva, Francisco/0000-0003-2437-3920 F Hoffman-La Roche F Hoffman-La Roche. 0 1 ELSEVIER SCIENCE INC NEW YORK LANCET ONCOL PY - 2020 SN - 1470-2045 SP - 1283-1295 ST - Trastuzumab emtansine plus atezolizumab versus trastuzumab emtansine plus placebo in previously treated, HER2-positive advanced breast cancer (KATE2): a phase 2, multicentre, randomised, double-blind trial T2 - Lancet Oncology TI - Trastuzumab emtansine plus atezolizumab versus trastuzumab emtansine plus placebo in previously treated, HER2-positive advanced breast cancer (KATE2): a phase 2, multicentre, randomised, double-blind trial UR - ://WOS:000576153400022 VL - 21 ID - 761406 ER - TY - JOUR AB - BACKGROUND: Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with thrombotic events, myocardial infarction, and valvular heart disease. During valvular replacement surgery, the high risk of thrombosis combined with the operative risks in these specific groups of patients poses a challenge to the medical team. CASE PRESENTATION: We present a case of a female patient with APS and mixed aortic valve disease. During surgery, she suddenly developed complete cardiac arrest. Three months later, after she recovered, and while she was still on close follow up, a thrombotic event caused myocardial infarction. After prompt and precise treatment, the patient successfully recovered; one year after surgery patient is doing well. CONCLUSION: Adequate surgical technique along with optimal anticoagulation strategies and long term follow up are of paramount importance to ensure an uneventful recovery. A multidisciplinary team is required to manage these complex scenarios and high-risk patients. AU - Endara, S. A. AU - Dávalos, G. A. AU - Fierro, C. H. AU - Ullauri, V. E. AU - Molina, G. A. DB - Medline DO - 10.1186/s13019-020-01330-9 KW - adult anticoagulation antiphospholipid syndrome aortic valve disease aortic valve replacement artery article case report clinical article female follow up heart arrest heart infarction high risk patient human multidisciplinary team risk assessment surgical patient surgical technique thrombus LA - English M1 - 1 M3 - Article N1 - L633080613 2020-10-19 PY - 2020 SN - 1749-8090 SP - 275 ST - Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report T2 - Journal of cardiothoracic surgery TI - Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633080613&from=export http://dx.doi.org/10.1186/s13019-020-01330-9 VL - 15 ID - 760543 ER - TY - JOUR AB - Plain Language Summary This study looked at people with cancer who received chemotherapy and developed a condition where their bone marrow activity was reduced, called myelosuppression. This meant they had fewer red blood cells that carry oxygen around the body, white blood cells that help fight infections, and platelets that help the blood to clot. The researchers wanted to understand how chemotherapy-induced myelosuppression affects peoples' lives and their cancer treatment, and people's experiences of treatment for myelosuppression. Overall, 301 people in the USA with breast, lung, or large bowel (colorectal) cancer completed an online survey. They had all received chemotherapy in the last year, and had myelosuppression at least once during their treatment. The survey showed that around 8 in 10 people (79%) had to be treated for myelosuppression, and around 7 in 10 people (73%) felt they received treatment for myelosuppression quickly. Chemotherapy was delayed, reduced, or stopped because of myelosuppression in around 6 in 10 people (64%). Around 3 in 10 people (30%) felt their oncologist did not understand the discomfort that myelosuppression caused them, and around 9 in 10 people (88%) felt that myelosuppression made their quality of life worse. The researchers concluded that because myelosuppression impacts peoples' lives and their ability to keep receiving chemotherapy to treat their cancer, effective prevention and treatment for this condition are important. Better communication between people and their health care teams could help them to understand how people experience myelosuppression and make plans for treatment together. Introduction Chemotherapy-induced myelosuppression (CIM) is one of the most common dose-limiting complications of cancer treatment, and is associated with a range of debilitating symptoms that can significantly impact patients' quality of life. The purpose of this study was to understand patients' perspectives on how the side effects of CIM are managed in routine clinical practice. Methods An online survey was conducted of participants with breast, lung, or colorectal cancer who had received chemotherapy treatment within the past 12 months, and had experienced at least one episode of myelosuppression in the past year. The survey was administered with predominantly close-ended questions, and lay definitions of key terms were provided to aid response selection. Results Of 301 participants who completed the online survey, 153 (51%) had breast cancer, 100 (33%) had lung cancer, and 48 (16%) had colorectal cancer. Anemia, neutropenia, lymphopenia, and thrombocytopenia were reported by 61%, 59%, 37%, and 34% of participants, respectively. Most participants (79%) reported having received treatment for CIM, and 64% of participants recalled chemotherapy dose modifications as a result of CIM. Although most participants believed their oncologist was aware of the side effects of CIM, and treated them quickly, 30% of participants felt their oncologists did not understand how uncomfortable they were due to the side effects of CIM. Overall, 88% of participants considered CIM to have a moderate or major impact on their lives. Conclusion The data highlight that despite the various methods used to address CIM, and the patient-focused approach of oncologists, the real-world impact of CIM on patients is substantial. Improving communication between patients and health care providers may help improve patients' understanding of CIM, and foster shared decision-making in terms of treatment. Additional insights from patients should be obtained to further elucidate the totality of life burden associated with CIM. AD - [Epstein, Robert S.; Krenitsky, JoAnn] Epstein Hlth LLC, Woodcliff Lake, NJ 07677 USA. [Aapro, Matti S.] Clin Genolier, Genolier, Switzerland. [Roy, Upal K. Basu] LUNGev Fdn, Bethesda, MD USA. [Salimi, Tehseen] G1 Therapeut Inc, Res Triangle Pk, NC USA. [Leone-Perkins, Megan L.] Corrona LLC, HealthiVibe, Arlington, VA USA. [Girman, Cynthia] CERobs Consulting LLC, Chapel Hill, NC USA. [Girman, Cynthia; Schlusser, Courtney] UNC Gillings Sch Global Publ Hlth, Chapel Hill, NC USA. [Crawford, Jeffrey] Duke Univ, Med Ctr, Durham, NC USA. Epstein, RS (corresponding author), Epstein Hlth LLC, Woodcliff Lake, NJ 07677 USA. repstein@epsteinhealth.com AN - WOS:000546497600001 AU - Epstein, R. S. AU - Aapro, M. S. AU - Roy, U. K. B. AU - Salimi, T. AU - Krenitsky, J. AU - Leone-Perkins, M. L. AU - Girman, C. AU - Schlusser, C. AU - Crawford, J. DA - Aug DO - 10.1007/s12325-020-01419-6 J2 - Adv. Ther. KW - Anemia Chemotherapy Myelosuppression Neutropenia Oncology Online survey Patient burden Real-world Symptom management Thrombocytopenia CANCER PERCEPTIONS FATIGUE AGENTS CARE Medicine, Research & Experimental Pharmacology & Pharmacy LA - English M1 - 8 M3 - Article N1 - ISI Document Delivery No.: ML6SL Times Cited: 0 Cited Reference Count: 40 Epstein, Robert S. Aapro, Matti S. Roy, Upal K. Basu Salimi, Tehseen Krenitsky, JoAnn Leone-Perkins, Megan L. Girman, Cynthia Schlusser, Courtney Crawford, Jeffrey Rapid Service; G1 Therapeutics, Inc. (Research Triangle Park, NC, USA) Sponsorship for this study, the Rapid Service and Open Access Fees were funded by G1 Therapeutics, Inc. (Research Triangle Park, NC, USA). 0 1 SPRINGER NEW YORK ADV THER PY - 2020 SN - 0741-238X SP - 3606-3618 ST - Patient Burden and Real-World Management of Chemotherapy-Induced Myelosuppression: Results from an Online Survey of Patients with Solid Tumors T2 - Advances in Therapy TI - Patient Burden and Real-World Management of Chemotherapy-Induced Myelosuppression: Results from an Online Survey of Patients with Solid Tumors UR - ://WOS:000546497600001 VL - 37 ID - 761427 ER - TY - JOUR AB - Patient presentation A 33-year-old man was referred to our hospital suffering fever with shivers, dyspnea, dry cough, and weakness. Initial work up Symptoms appeared three weeks until hospitalization. Laboratory results showed leukocytosis and high levels of inflammatory markers. Haematological diseases were excluded, a chest x-ray showed infiltration in the lower lobe of the right lung, antibiotics were prescribed. Diagnosis and management When clinical and laboratory results showed no signs of improvement, chest computed tomography (CT) scan was performed and bilateral pulmonary artery thromboembolism with right lung infarct-pneumonia was diagnosed (Figure 1, 2). Treatment was supplemented with intravenous anticoagulants. In the course of treatment patient's status worsened, respiratory failure progressed, so CT scan was performed again and showed massive pulmonary artery thromboembolism without the effect of treatment. Transthoracic 2D echocardiography showed dilated right heart chambers, relative severe tricuspid valve regurgitation, increased systolic pulmonary artery pressure (Video 1, figure 3), pulmonary artery valve masses in the stem which caused obstruction with maximum gradient about 50 mmHg(Video 2, figure 4). For a detailed workup, magnetic resonance imaging (MRI) was done, that revealed tumorous masses from pulmonary artery valve to the pulmonary trunk and right pulmonary branch (Figure 5, 6, 7). The patient underwent pulmoangiography and biopsy was taken out of the masses that suspected sarcoma. The multidisciplinary team came to a conclusion to perform surgery considering worsening patient's status. The patient underwent pulmonary artery prosthesis implantation and right pneumonectomy (Figure 8). Masses from pulmonary artery valve were examined by pathologists, surgical specimen results showed high grade poorly differentiated pulmonary artery intimal sarcoma (Figure 9, 10). Follow up Early postoperative period was complicated with cardiogenic shock and respiratory failure. Despite extracorporeal membrane oxygenation (ECMO) and high doses of vasopressors patient did not survive the 2nd postoperative day. Conclusions: Pulmonary artery sarcoma (PAS) frequently can be misdiagnosed as thromboembolism. Multimodality imaging should be considered pulmonary artery filling defects persist despite proper anticoagulation therapy for early diagnosis and better survival. AD - R. Ereminiene, Hospital of Lithuanian, University of Health Sciences, Department of Cardiology, Kaunas, Lithuania AU - Ereminiene, R. AU - Sakaviciute, E. AU - Ereminas, R. AU - Jankauskas, A. AU - Poskiene, L. AU - Ruminaite, A. AU - Miliauskas, S. AU - Benetis, R. AU - Ereminiene, E. DB - Embase DO - 10.1093/ehjci/jez319.878 KW - antibiotic agent anticoagulant agent adult anticoagulant therapy artery prosthesis cancer patient cancer size cancer surgery cancer survival cardiogenic shock case report clinical article complication computer assisted tomography conference abstract coughing diagnosis diagnostic error drug megadose drug therapy dyspnea early diagnosis extracorporeal oxygenation fever follow up hospitalization human human tissue implantation infarction leukocytosis lung artery pressure lung embolism lung resection male multidisciplinary team nuclear magnetic resonance imaging obstruction pathologist pneumonia postoperative period respiratory failure right lung sarcoma shivering surgery thorax radiography tricuspid valve regurgitation two dimensional echocardiography videorecording weakness LA - English M3 - Conference Abstract N1 - L631350411 2020-04-07 PY - 2020 SN - 2047-2412 SP - i928 ST - Pulmonary artery sarcoma mimicking as pulmonary thromboembolism for a young man: The role of multimodality imaging for diagnosis T2 - European Heart Journal Cardiovascular Imaging TI - Pulmonary artery sarcoma mimicking as pulmonary thromboembolism for a young man: The role of multimodality imaging for diagnosis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631350411&from=export http://dx.doi.org/10.1093/ehjci/jez319.878 VL - 21 ID - 760631 ER - TY - JOUR AB - Prosthetic valve thrombosis is a rare and severe complication of the mechanical prosthetic valve. Management can be challenging due to varying clinical presentation, overlapping features of differential diagnosis, and lack of randomized controlled trials on the therapeutic options. In this article, we report the case of a patient with a mechanical prosthetic mitral valve presented with symptoms of heart failure, and an echocardiography showing increased mean pressure gradient across the prosthesis along with a fixed posterior leaflet and a partially restricted anterior leaflet with no visible mass. That raised the concern for an obstructed prosthesis. After multimodality imaging and multidisciplinary team discussions, prosthetic valve thrombosis diagnosis was favored over other different diagnoses that included but not limited to pannus ingrowth. Fibrinolytic therapy was administrated, and the patient was discharged on optimal anticoagulation. Repeated echocardiography a month later showed normal mean gradient and normal functioning prosthetic mitral valve without the need for repeat mitral valve surgery. AD - A. Essa, Creighton University, Omaha, NE, United States AU - Essa, A. AU - Haddad, T. AU - Slattery, T. DB - Embase Medline DO - 10.1177/2324709620921078 KW - echocardiograph heart valve prosthesis mitral valve prosthesis acetylsalicylic acid alteplase heparin warfarin aged article case report clinical article computer assisted tomography female follow up half life time human international normalized ratio oxygen saturation pleura effusion priority journal prosthetic valve thrombosis thorax radiography transesophageal echocardiography LA - English M3 - Article N1 - L2005015777 2020-05-28 2020-07-03 PY - 2020 SN - 2324-7096 ST - Successful Fibrinolytic Therapy in a Challenging Obstructive Prosthetic Mitral Valve Thrombosis T2 - Journal of Investigative Medicine High Impact Case Reports TI - Successful Fibrinolytic Therapy in a Challenging Obstructive Prosthetic Mitral Valve Thrombosis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005015777&from=export http://dx.doi.org/10.1177/2324709620921078 VL - 8 ID - 760615 ER - TY - JOUR AB - Pulmonary embolism (PE) is the 3rd leading cause of mortality in hospitalized patients. There are differences in classification of PE severity in societal guidelines. PE severity classification stresses an importance on right ventricular dysfunction (RVD). Except ESC guidelines which use sPESI (Simplified PE Severity score), other guidelines do not include hypoxia as a marker of PE severity classification. Therefore, we aimed to identify how patients who present with hypoxia differ from patients without hypoxia. We performed retrospective chart review on patients who presented to the emergency department and were diagnosed with PE within 24 hours of admission between 2017-2018. A total of 89 patients were included in analyses. Patients who developed PE during their hospitalization were excluded. Hypoxia was defined as oxygen saturation less than 90%. The mean age of the sample was 56 years (SD 17.6) and about more than half of them were female (58%). The median length of stay (LOS) was 3 days (IQR 2.4-7). Patients who presented with hypoxia had more RVD (elevated troponin and BNP) compared to patients without hypoxia. (p = 0.004) Hypoxic PE patients had double the length of stay (LOS) (Mdn 6.8 Vs 3.4, Z= -2.36, p=0.018) compared to patients without. Patients with hypoxia correlated with higher PE severity classification (based on ESC guidelines) compared to those without (OR 6.6, 95% 1.99-21.94, p = 0.002). We did not find any statistically significant difference between groups on imaging based RVD (Echo-cardiogram or Computed Tomographic Pulmonary Angiography) parameters. Hypoxia (SpO2 less than 90%) is very easy to identify in the emergency room and can be used to as a marker of PE severity (higher ESC classification, positive co-relation to biomarker) and morbidity (increased LOS). Based on our findings, hypoxic patients would classify into at least the sub-massive category based on AHA/ACCP classification (given strong co-relation with biomarker positivity). Hypoxia in PE can be used as a single and also an easy check point to trigger activation of multi-disciplinary PE response teams (PERT) based on our analyses given its strong correlation with biomarkers and higher PE severity across all classifications. Findings from our study may provide an avenue in the future to study the role of catheter directed thrombolysis (CDT) and half dose thrombolysis in reducing LOS in hypoxic sub-massive PE patients after adjusting for bleeding risk. AD - E. Essien, Internal Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States AU - Essien, E. AU - Alashram, R. AU - Male, E. AU - Pettigrew, S. AU - Carabelli, E. AU - Gupta, R. AU - Zhao, H. AU - Panaro, J. AU - Cohen, G. AU - Bashir, R. AU - Criner, G. J. AU - Rali, P. DB - Embase KW - biological marker endogenous compound troponin adult attention bleeding blood clot lysis catheter conference abstract controlled study diagnosis echocardiography emergency ward female heart right ventricle failure hospitalization human hypoxia length of stay lung angiography major clinical study medical record review middle aged morbidity oxygen saturation practice guideline pulmonary embolism response team retrospective study LA - English M1 - 9 M3 - Conference Abstract N1 - L630347814 2020-01-01 PY - 2019 SN - 1535-4970 ST - Call for attention: Hypoxia from acute pulmonary embolism T2 - American Journal of Respiratory and Critical Care Medicine TI - Call for attention: Hypoxia from acute pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630347814&from=export VL - 199 ID - 760726 ER - TY - JOUR AB - Venous thromboembolism (VTE) includes pulmonary embolism (PE) and deep vein thrombosis. PE is the third most common cause of cardiovascular death worldwide after stroke and heart attack. Management of PE has evolved recently with the availability of local thrombolysis; mechanical extraction devices; hemodynamic support devices, like extracorporeal membrane oxygenation; and surgical embolectomy. There has been development of multidisciplinary PE response teams nationwide to optimize the care of patients with VTE. This review describes the epidemiology of PE, discusses diagnostic strategies and current and emerging treatments for VTE, and considers post-PE follow-up care. AD - P. Rali, Division of Thoracic Surgery and Medicine, Pulmonary Embolism Response Team (PERT), Temple University Hospital, 3401 North Broad Street, Philadelphia, PA, United States AU - Essien, E. O. AU - Rali, P. AU - Mathai, S. C. DB - Embase Medline DO - 10.1016/j.mcna.2018.12.013 KW - vena cava filter anticoagulant agent brain natriuretic peptide D dimer troponin clinical evaluation computed tomographic angiography deep vein thrombosis diagnostic accuracy disease classification follow up genetic analysis genetic risk gold standard human laboratory test low risk patient lung angiography lung embolism morbidity mortality rate pathophysiology patient care prediction priority journal review risk factor transthoracic echocardiography venous thromboembolism ventilation-perfusion scan LA - English M1 - 3 M3 - Review N1 - L2001776359 2019-04-10 2019-04-18 PY - 2019 SN - 1557-9859 0025-7125 SP - 549-564 ST - Pulmonary Embolism T2 - Medical Clinics of North America TI - Pulmonary Embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001776359&from=export http://dx.doi.org/10.1016/j.mcna.2018.12.013 VL - 103 ID - 760713 ER - TY - JOUR AB - OBJECTIVES: Thrombolysis in stroke remains underutilized in daily practice. We analyzed the impact of a multimodal strategy on the rate of thrombolysis and specific procedure times during the implementation of a community hospital stroke unit. MATERIAL AND METHODS: During a period of 2 years before and after implementation of a stroke unit, we prospectively recorded all patients with thrombolysis and specific procedure times. Calculated door-to-needle time (DNT), door-to-CT time (DCT) and CT-to-needle time (CNT) were analyzed. All structural changes before and after the implementation were analyzed. RESULTS: The number of patients with thrombolysis increased from 24 in 2005-2006 (4.8% of all admitted patients with ischemic stroke) to 95 in 2007-2008 (12.8%). DNT was significantly reduced from 62.2±36.1 to 38.5±22.2 min (P<0.001). DCT remained unchanged at 10.3±9.5 to 10.4±13.9 min (P=0.974), whereas CNT improved from 45.7±23.1 to 28.3±20.3 min (P=0.001). Several structural changes concerning staff, logistics, procedures and laboratory were identified which contributed to decreasing DNT. CONCLUSIONS: A multimodal strategy including several structural changes enables the successful implementation of a community hospital stroke unit offering rapid access to thrombolysis with a very short DNT. AD - Department of Neurology, Klinikum Traunstein, Cuno-Niggl-Strasse 3, Traunstein,Germany. thorleif.etgen@klinikum-traunstein.de AN - 20704572 AU - Etgen, T. AU - Freudenberger, T. AU - Schwahn, M. AU - Rieder, G. AU - Sander, D. DA - Jun DO - 10.1111/j.1600-0404.2010.01413.x DP - NLM ET - 2010/08/14 J2 - Acta neurologica Scandinavica KW - Adolescent Adult Age Factors Aged Aged, 80 and over Cerebral Hemorrhage/etiology/mortality/prevention & control Cohort Studies Combined Modality Therapy/*methods/statistics & numerical data Emergency Medical Services/*methods/statistics & numerical data Emergency Service, Hospital Female Fibrinolytic Agents/therapeutic use Germany Health Care Surveys/methods Hospitals, Community/*methods/statistics & numerical data Humans Male Medicine/statistics & numerical data/trends Middle Aged Neurology/statistics & numerical data/trends Patient Care Team/standards/statistics & numerical data/trends Prospective Studies Quality Assurance, Health Care/methods Quality of Health Care/statistics & numerical data Stroke/diagnosis/*drug therapy/mortality Thrombolytic Therapy/*methods/statistics & numerical data Time Factors Tissue Plasminogen Activator/therapeutic use Tomography, X-Ray Computed/statistics & numerical data Transportation of Patients Treatment Outcome Young Adult LA - eng M1 - 6 N1 - 1600-0404 Etgen, T Freudenberger, T Schwahn, M Rieder, G Sander, D Journal Article Denmark Acta Neurol Scand. 2011 Jun;123(6):390-5. doi: 10.1111/j.1600-0404.2010.01413.x. Epub 2010 Aug 12. PY - 2011 SN - 0001-6314 SP - 390-5 ST - Multimodal strategy in the successful implementation of a stroke unit in a community hospital T2 - Acta Neurol Scand TI - Multimodal strategy in the successful implementation of a stroke unit in a community hospital VL - 123 ID - 760489 ER - TY - JOUR AB - Background: Previous studies undertaken to identify risk factors for peripherally inserted central catheter (PICC)-associated DVT have yielded conflicting results. PICC insertion teams and other health-care providers need to understand the risk factors so that they can develop methods to prevent DVT. Methods: A 1-year prospective observational study of PICC insertions was conducted at a 456-bed, level I trauma center and tertiary referral hospital affiliated with a medical school. All patients with one or more PICC insertions were included to identify the incidence and risk factors for symptomatic DVT associated with catheters inserted by a facility-certified PICC team using a consistent and replicated approach for vein selection and insertion. Results: A total of 2,014 PICCs were inserted during 1,879 distinct hospitalizations in 1,728 distinct patients for a total of 15,115 days of PICC placement. Most PICCs were placed in the right arm (76.9%) and basilic vein (74%) and were double-lumen 5F (75.3%). Of the 2,014 PICC insertions, 60 (3.0%) in 57 distinct patients developed DVT in the cannulated or adjacent veins. The best-performing predictive model for DVT (area under the curve, 0.83) was prior DVT (odds ratio [OR], 9.92; P < .001), use of double-lumen 5F (OR, 7.54; P < .05) or triple-lumen 6F (OR, 19.50; P < .01) PICCs, and prior surgery duration of > 1 h (OR, 1.66; P = .10). Conclusions: Prior DVT and surgery lasting > 1 h identify patients at increased risk for PICC-associated DVT. More importantly, increasing catheter size also is significantly associated with increased risk. Rates of PICC-associated DVT may be reduced by improved selection of patients and catheter size. CHEST 2010; 138(4):803-810 AD - [Woller, Scott C.; Stevens, Scott M.; Elliott, C. Gregory; Weaver, Lindell K.] Univ Utah, Sch Med, Dept Med, Salt Lake City, UT USA. Evans, RS (corresponding author), LDS Hosp, Dept Med Informat, 8th Ave & C St, Salt Lake City, UT 84143 USA. rscott.evans@imail.org AN - WOS:000283000500012 AU - Evans, R. S. AU - Sharp, J. H. AU - Linford, L. H. AU - Lloyd, J. F. AU - Tripp, J. S. AU - Jones, J. P. AU - Woller, S. C. AU - Stevens, S. M. AU - Elliott, C. G. AU - Weaver, L. K. DA - Oct DO - 10.1378/chest.10-0154 J2 - Chest KW - CENTRAL VENOUS CATHETERS POSTTHROMBOTIC SYNDROME RETROSPECTIVE ANALYSIS HOSPITALIZED-PATIENTS THROMBOSIS PICC CARE THROMBOEMBOLISM Critical Care Medicine Respiratory System LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: 664YQ Times Cited: 136 Cited Reference Count: 29 Evans, R. Scott Sharp, Jamie H. Linford, Lorraine H. Lloyd, James F. Tripp, Jacob S. Jones, Jason P. Woller, Scott C. Stevens, Scott M. Elliott, C. Gregory Weaver, Lindell K. Intermountain Healthcare This work was performed at Intermountain Medical Center and supported by Intermountain Healthcare. 157 2 29 ELSEVIER SCIENCE BV AMSTERDAM CHEST PY - 2010 SN - 0012-3692 SP - 803-810 ST - Risk of Symptomatic DVT Associated With Peripherally Inserted Central Catheters T2 - Chest TI - Risk of Symptomatic DVT Associated With Peripherally Inserted Central Catheters UR - ://WOS:000283000500012 VL - 138 ID - 761866 ER - TY - JOUR AB - INTRODUCTION: We set a goal to reduce the incidence rate of catheter-related bloodstream infections to rate of <1 per 1,000 central line days in a two-year period. METHODS: This is an observational cohort study with historical controls in a 25-bed intensive care unit at a tertiary academic hospital. All patients admitted to the unit from January 2008 to December 2011 (31,931 patient days) were included. A multidisciplinary team consisting of hospital epidemiologist/infectious diseases physician, infection preventionist, unit physician and nursing leadership was convened. Interventions included: central line insertion checklist, demonstration of competencies for line maintenance and access, daily line necessity checklist, and quality rounds by nursing leadership, heightened staff accountability, follow-up surveillance by epidemiology with timely unit feedback and case reviews, and identification of noncompliance with evidence-based guidelines. Molecular epidemiologic investigation of a cluster of vancomycin-resistant Enterococcus faecium (VRE) was undertaken resulting in staff education for proper acquisition of blood cultures, environmental decontamination and daily chlorhexidine gluconate (CHG) bathing for patients. RESULTS: Center for Disease Control/National Health Safety Network (CDC/NHSN) definition was used to measure central line-associated bloodstream infection (CLA-BSI) rates during the following time periods: baseline (January 2008 to December 2009), intervention year (IY) 1 (January to December 2010), and IY 2 (January to December 2011). Infection rates were as follows: baseline: 2.65 infections per 1,000 catheter days; IY1: 1.97 per 1,000 catheter days; the incidence rate ratio (IRR) was 0.74 (95% CI=0.37 to 1.65, P=0.398); residual seven CLA-BSIs during IY1 were VRE faecium blood cultures positive from central line alone in the setting of findings explicable by noninfectious conditions. Following staff education, environmental decontamination and CHG bathing (IY2): 0.53 per 1,000 catheter days; the IRR was 0.20 (95% CI=0.06 to 0.65, P=0.008) with 80% reduction compared to the baseline. Over the two-year intervention period, the overall rate decreased by 53% to 1.24 per 1,000 catheter-days (IRR of 0.47 (95% CI=0.25 to 0.88, P=0.019) with zero CLA-BSI for a total of 15 months. CONCLUSIONS: Residual CLA-BSIs, despite strict adherence to central line bundle, may be related to blood culture contamination categorized as CLA-BSIs per CDC/NHSN definition. Efforts to reduce residual CLA-BSIs require a strategic multidisciplinary team approach focused on epidemiologic investigations of practitioner- or unit-specific etiologies. AN - 23497591 AU - Exline, M. C. AU - Ali, N. A. AU - Zikri, N. AU - Mangino, J. E. AU - Torrence, K. AU - Vermillion, B. AU - St Clair, J. AU - Lustberg, M. E. AU - Pancholi, P. AU - Sopirala, M. M. C2 - Pmc3733431 DA - Mar 4 DO - 10.1186/cc12551 DP - NLM ET - 2013/03/19 J2 - Critical care (London, England) KW - Catheter-Related Infections/*epidemiology/*prevention & control Catheterization, Central Venous/standards/trends Cohort Studies Cross Infection/*epidemiology/*prevention & control Female Humans Intensive Care Units/*standards/trends Male Tertiary Healthcare/*standards/trends LA - eng M1 - 2 N1 - 1466-609x Exline, Matthew C Ali, Naeem A Zikri, Nancy Mangino, Julie E Torrence, Kelly Vermillion, Brenda St Clair, Jamie Lustberg, Mark E Pancholi, Preeti Sopirala, Madhuri M HL095772/HL/NHLBI NIH HHS/United States Journal Article Observational Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Crit Care. 2013 Mar 4;17(2):R41. doi: 10.1186/cc12551. PY - 2013 SN - 1364-8535 (Print) 1364-8535 SP - R41 ST - Beyond the bundle--journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections T2 - Crit Care TI - Beyond the bundle--journey of a tertiary care medical intensive care unit to zero central line-associated bloodstream infections VL - 17 ID - 760409 ER - TY - JOUR AB - Background: Thrombosis of a dialysis access, both in native and in prosthetic one, is the most serious and complex event that may occur because, if untreated, leads to loss of vascular access (VA). Aim of our study is to report our experience in the treatment of vascular access thrombosis using dedicated endovascular devices. Materials and methods: We retrospectively evaluated our series of 45 patients of the last 24 months (25 males, 20 females) with a thrombosis of the outflow vein or of the prosthetic side of the VA. A preliminary Echo-color-doppler (ECD) was performed in all patients to evaluate the state of venous outflow side, indications and to perform treatment planning. The devices used were: maual thromboaspiration with a guide catheter of 6 or 7 F diameter, Trerotola Device (Arrow) and Angiojet (Boston Scientific). Stenosis below thrombosis evaluated at the diagnostic angiography was always treated with progressives angioplasty (PTA) with ballon catheters of growing diameters. In any selected cases it was necessary to place an endoprosthesis of a proper diameter (Gore Viabahn). We evaluate immediate technical success at the post-treatment angiography, primary patency (PP), and clinical success defined as the possibility to perform an adequate hemodialytic session with g ood flow-volume. Results: Immediate postprocedural technical success was 84%, while PP at 2 months was 77%. Conclusions: Thrombosis should be treated within 48 hours whenever possible to increase the possiblity of the access salvage. The possibility to perform a treatment of thrombosis of a FAV should be evaluated by a multidisciplinary team considering the patient's medical history to assess the best choice between an endovascular treatment rather than surgical treatment or access abandonment. The availability of mechanical thrombolysis and pharmacological thrombolysis significantly increases the chance of salvage of the vascular access and minimizes the duration of the treatment. AD - G. Failla, Department of Diagnostic and Interventional Radiology, Azienda Ospedaliera Per L'Emergenza Cannizzaro, Catania, Italy AU - Failla, G. AU - Calcara, G. AU - Morale, W. AU - Coniglio, G. AU - Bisceglie, P. AU - Rastelli, S. AU - Malfa, P. AU - Seminara, G. AU - Patané, D. DB - Embase DO - 10.5301/jva.5000726 KW - adult angiography angioplasty artery prosthesis clinical article color Doppler flowmetry conference abstract dialysis endoprosthesis female guiding catheter human male Massachusetts mechanical thrombectomy medical history retrospective study stenosis thrombectomy catheter thrombosis thrombus aspiration treatment planning vascular access vein blood flow LA - English M3 - Conference Abstract N1 - L620524334 2018-02-08 PY - 2017 SN - 1129-7298 SP - S54 ST - Thrombosis in native and prosthetic dialysis access: Our experience with dedicated endovascular devices T2 - Journal of Vascular Access TI - Thrombosis in native and prosthetic dialysis access: Our experience with dedicated endovascular devices UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620524334&from=export http://dx.doi.org/10.5301/jva.5000726 VL - 18 ID - 760972 ER - TY - JOUR AB - INTRODUCTION: Over the past several decades, checklists have emerged in a variety of different patient care settings to help reduce medical errors and ensure patient safety. To date, there have been no published accounts demonstrating the effectiveness of checklists designed specifically for the unique demands of neurointerventional procedures. METHODS: A three-part, 20-item checklist was developed specific to neurointerventional procedures using the WHO surgical checklist as a template. Staff members (nurses, radiation technologists and physicians) were surveyed regarding near-miss adverse events and the quality of communication immediately following each neurointerventional procedure for 4 weeks prior to implementation of the checklist and again for 4 weeks after using the checklist. Staff members were asked to complete final surveys at the end of the study period. RESULTS: 71 procedures were performed during the 4 weeks prior to checklist implementation and 60 procedures were performed during the 4 weeks after institution of the checklist. Post-checklist surveys indicated significantly improved communication compared with pre-checklist surveys (χ(2) 29.4, p<0.001). The number of adverse events was lower after checklist implementation for eight of the nine adverse event types (not individually significant), but the total number of adverse events was significantly lower after checklist implementation (χ(2) 11.4, p=0.001). Final staff surveys were uniformly positive with 95% of individuals indicating that the checklist should be continued in the department. CONCLUSIONS: Use of a neurointerventional procedural checklist resulted in statistically significant improvements in team communication and a significant reduction in total adverse events, with uniformly positive staff feedback. AD - Department of Neurosurgery, University of Florida, Gainesville, FL 32610, USA. kyle.fargen@neurosurgery.ufl.edu AN - 22773334 AU - Fargen, K. M. AU - Velat, G. J. AU - Lawson, M. F. AU - Firment, C. S. AU - Mocco, J. AU - Hoh, B. L. DA - Sep 1 DO - 10.1136/neurintsurg-2012-010430 DP - NLM ET - 2012/07/10 J2 - Journal of neurointerventional surgery KW - Checklist/*methods Data Collection Endovascular Procedures/adverse effects Feedback Humans *Interdisciplinary Communication Laboratory Personnel Medical Errors/*prevention & control Neurosurgical Procedures/*adverse effects Nurses Patient Care Team Patient Safety Personnel, Hospital Physicians Quality Improvement Risk Assessment LA - eng M1 - 5 N1 - 1759-8486 Fargen, Kyle M Velat, Gregory J Lawson, Matthew F Firment, Christopher S Mocco, J Hoh, Brian L Journal Article England J Neurointerv Surg. 2013 Sep 1;5(5):497-500. doi: 10.1136/neurintsurg-2012-010430. Epub 2012 Jul 6. PY - 2013 SN - 1759-8478 SP - 497-500 ST - Enhanced staff communication and reduced near-miss errors with a neurointerventional procedural checklist T2 - J Neurointerv Surg TI - Enhanced staff communication and reduced near-miss errors with a neurointerventional procedural checklist VL - 5 ID - 760389 ER - TY - JOUR AB - Background/Case Studies: Four-factor Prothrombin Complex Concentrate (4F-PCC) is FDA approved for the urgent reversal of warfarin. The package insert is based on INR value and the patient's weight. In July 2014, based on previous evidence of lower dose non-weight-based (fixed) efficacy of 3-factor Prothrombin Complex, a protocol was instituted by a multidisciplinary team at our institution to provide an immediate release of fixed non-weight-based low dose of 4F-PCC prior to the initial INR result to minimize delays in treatment: initial INR drawn at time of patient presentation, release initial fixed dose of 4F-PCC without waiting for INR results (1500 IU Intracranial hemorrhage (ICH) patients, 1000 IU non-ICH patients), vitamin K administered, repeat INR within 30 min after initial fixed dose, review initial INR result and 30 min INR if available, administer additional dose if needed (pre and post PCC INR results and clinical status). Study Design/Methods: Retrospective analysis of our of blood bank data of patients who presented to the ED and who were enrolled in the 4F-PCC protocol to reverse warfarin. Data was collected by Transfusion Safety Officer (TSO) to monitor and track the derivate usage, protocol adherence, and reconcile it with finance. The effectiveness was evaluated by post-PCC INR and patient clinical status. Results/Findings: From June 2014 -April 2016, 149 patients received 4F-PCC in our institute. 79 presented with gastrointestinal (GI) bleed, 37 with intracranial hemorrhage (ICH), and 33 with other (eminent surgery, MTP, ret-roperitoneal bleed and hematuria). Data are summarized in Table 1. 10(12.6%) patients in GI bleed group received more than 2 vials at presentation. 3(9%) patients in ICH group received more than 3 vials at presentation. Total of 7 Patients (3 in GI and 4 in ICH group) received a second dose of 4F-PCC. 13(8.6%) patients had presenting INR<2. No adverse consequences were observed. Conclusion: The optimal dose of 4F-PCC that controls hemorrhage but does not significantly increase the risk of thrombosis needs further study. Our protocol of immediate release of a fixed lower dose 4F-PCC is effective in reversing warfarin and eliminates the delays caused by weight and INR measurements. Using a lower dosing may also offer benefits in cost savings. AD - K. Fayyaz, LIJ MC Northwell Health, Great Neck, NY, United States AU - Fayyaz, K. DB - Embase DO - 10.1111/trf.13807 KW - prothrombin complex vitamin K group warfarin blood bank brain hemorrhage clinical trial controlled study cost control drug therapy female finance gastrointestinal hemorrhage hematuria human international normalized ratio low drug dose major clinical study male protocol compliance retrospective study safety study design surgery thrombosis LA - English M3 - Conference Abstract N1 - L617344216 2017-07-20 PY - 2016 SN - 1537-2995 SP - 174A ST - Rapid reversal of warfarin using immediate release of fixed low-dose four-factor prothrombin complex concentrate T2 - Transfusion TI - Rapid reversal of warfarin using immediate release of fixed low-dose four-factor prothrombin complex concentrate UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617344216&from=export http://dx.doi.org/10.1111/trf.13807 VL - 56 ID - 761006 ER - TY - JOUR AB - Acute promyelocytic leukemia (APL) manifesting during pregnancy is a very rare but highly challenging gestational complication in part due to its associated profound coagulopathy. We present the case of a 23-year-old Gravida 3 Para 2002 woman admitted to our hospital at 26 weeks of gestation for severe pre-eclampsia with documentation of intrauterine fetal demise (IUFD), thrombocytopenia, and placental abruption. A peripheral blood smear revealed promyelocytes with azure granules, highly concerning for APL. Additional peripheral blood studies confirmed APL. Placental examination also revealed circulating blasts in decidual vessels and scattered blast entrapment in diffuse perivillous fibrinoid deposits, but none in the chorionic villi. Treatment for APL was initiated immediately and she is in complete molecular remission. Our case underscores the importance of close collaboration among obstetric, hematology, and pathology teams in the care of patients with pre-eclampsia, thrombocytopenia, and postpartum coagulopathy. We also describe five additional cases of gestations complicated by hematologic malignancies identified upon a 10-year institutional retrospective review. AD - [Fei, Fei; Faye-Petersen, Ona M.; Reddy, Vishnu V.] Univ Alabama Birmingham, Dept Pathol, Div Anat, Birmingham, AL 35249 USA. [Fei, Fei; Faye-Petersen, Ona M.; Reddy, Vishnu V.] Univ Alabama Birmingham, Dept Pathol, Div Clin Pathol, Birmingham, AL 35249 USA. [Vachhani, Pankit; Jamy, Omer] Univ Alabama Birmingham, Dept Med, Div Hematol Oncol, Birmingham, AL 35249 USA. Reddy, VV (corresponding author), Univ Alabama Birmingham, Dept Pathol, Birmingham, AL 35249 USA. vreddy@uabmc.edu AN - WOS:000512485400035 AU - Fei, F. AU - Faye-Petersen, O. M. AU - Vachhani, P. AU - Jamy, O. AU - Reddy, V. V. C7 - 152672 DO - 10.1016/j.prp.2019.152672 J2 - Pathol. Res. Pract. KW - Acute promyelocytic leukemia Pregnancy Disseminated intravascular coagulation BREAST-CANCER PATIENT RISK Pathology LA - English M1 - 12 M3 - Review N1 - ISI Document Delivery No.: KK1BP Times Cited: 2 Cited Reference Count: 20 Fei, Fei Faye-Petersen, Ona M. Vachhani, Pankit Jamy, Omer Reddy, Vishnu V. 2 0 1 ELSEVIER GMBH MUNICH PATHOL RES PRACT PY - 2019 SN - 0344-0338 SP - 5 ST - Acute promyelocytic leukemia during pregnancy: A case report and 10-year institutional review of hematologic malignancies during pregnancy T2 - Pathology Research and Practice TI - Acute promyelocytic leukemia during pregnancy: A case report and 10-year institutional review of hematologic malignancies during pregnancy UR - ://WOS:000512485400035 VL - 215 ID - 761543 ER - TY - JOUR AB - Background: This study was designed to explore the prevalence and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods: From January 1, 2012, to December 31, 2018, 273 elderly patients over 70 years old with elective hip surgery were collected from the electronic medical records. Collected data included demographic characteristics, comorbidities, ASA classification, types of previous operations, types of anesthesia, operation time, fracture to operation time, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, whether transfusion, preoperative hospitalization, postoperative hospitalization, electrocardiograph, lower limb venous ultrasonography and total hospitalization time. Results: In these 273 patients, 15(5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement preoperatively. Fracture to surgery time, preoperative hemoglobin level, anemia, preoperative hospitalization, pulmonary disease and total hospitalization time were statistically different between DVT group and non-DVT group (P < 0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026–0.799, P = 0.027) and total hospitalization time (OR: 1.135; 95%CI: 1.023–1.259, P = 0.017) were the two independent risk factors for preoperative DVT. Conclusion: Preoperative anemia and total hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture. AD - Medicine School of Chinese PLA, No.28, Fuxing Road, 100853, Beijing, China Department of Anesthesia, Hainan Hospital of Chinese PLA General Hospital, No.80, Jianglin Road, 572000, Sanya, China Department of Anesthesia Operation Center, Chinese PLA General Hospital, No.28, Fuxing Road, 100853, Beijing, China AN - 142533853. Language: English. Entry Date: 20200406. Revision Date: 20200417. Publication Type: Article AU - Feng, Long AU - Xu, Longhe AU - Yuan, Weixiu AU - Xu, Zhipeng AU - Feng, Zeguo AU - Zhang, Hong DB - CINAHL DO - 10.1186/s12871-020-00983-2 DP - EBSCOhost KW - Preoperative Period Anemia -- Complications Length of Stay -- Evaluation Venous Thromboembolism -- Epidemiology Venous Thromboembolism -- Risk Factors Risk Assessment Chinese Hip Fractures -- Surgery Human Prevalence Aged Aged, 80 and Over Surgery, Elective -- Methods Hip Surgery -- Methods Electronic Health Records Comorbidity Anesthesia Treatment Duration Hemoglobins -- Blood Blood Gas Analysis Cardiovascular System Physiology Blood Transfusion Electrocardiography Lower Extremity -- Blood Supply Lower Extremity -- Ultrasonography Venous Thromboembolism -- Ultrasonography Vena Cava Filters Odds Ratio Confidence Intervals M1 - 1 N1 - research; tables/charts. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 100968535. PY - 2020 SN - 1471-2253 SP - 1-6 ST - Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery T2 - BMC Anesthesiology TI - Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=142533853&site=ehost-live&scope=site VL - 20 ID - 761368 ER - TY - JOUR AB - Background Since 2011, a pharmacist has been part of the multidisciplinary team for critically ill patients in an eight bed polyvalent intensive care unit (ICU). Daily tasks include team ward round and in ward evaluation of all patient therapeutic profiles. Pharmacist interventions (PI) have to take into account the specific characteristics of the critically ill patients and address virtually all pharmaceutical problems. The post implementation evaluation showed a rate of 3.5 interventions/patient and an acceptance rate of around 70%. In order to assess the evolution of the pharmacist role, the same evaluation was conducted in 2015. Purpose To characterise the evolution of PI and identify major contribution areas for a clinical pharmacist in a polyvalent ICU. Material and methods PI were registered from March to June 2015 on a daily bases using the formulary developed and used in 2011. The information collected included patient process number, drug intervened, PI cause, expected results and outcomes. A descriptive statistical analysis and association of variables were performed and compared with the results obtained in 2011. Results 217 interventions were registered, resulting in an average of 2.24 interventions/patient. The acceptance rate was 82% and the medical specialties with more interventions were internal medicine, cardiac surgery and general surgery. The most frequent causes of intervention were 'potential adverse reaction/toxicity' (18%), including vancomycin pharmacokinetic monitoring; and 'drug absence' (14%), primarily antiplatelet therapy and venous thromboembolism prophylaxis. The most prevalent outcomes were 'prevented problem' (52%) and 'cost savings associated with therapy' (24%). The drug classes with more interventions were proton pump inhibitors, antibacterials and heparins. Compared with the 2011 results, there was a higher acceptance rate and a greater dispersion of intervention causes, mostly with respect to the suggestion of outpatient therapy introduction or events related to hospital admission prophylaxis. Conclusion The results suggest good pharmacist integration into the clinical team, as seen by the number of interventions and the high acceptance rate. Moreover, the spectrum of the PI areas increased which helps to define the role of the pharmacist in this setting. Assessing pharmacist impact on patient outcomes remains however the biggest challenge for future work. AD - L. Fernandes, Hospital Da Luz, Pharmacy, Lisbon, Portugal AU - Fernandes, L. AU - Melo, H. AU - Rei, M. J. AU - Duarte, A. AU - Santos, C. AU - Andrade Gomes, J. DB - Embase DO - 10.1136/ejhpharm-2016-000875.160 KW - antithrombocytic agent proton pump inhibitor vancomycin adverse drug reaction clinical trial controlled study cost control doctor patient relationship drug therapy general surgery heart surgery hospital admission human intensive care unit internal medicine monitoring outpatient care pharmacist pharmacokinetics prophylaxis publication side effect statistical analysis suggestion toxicity venous thromboembolism LA - English M3 - Conference Abstract N1 - L614324305 2017-02-10 PY - 2016 SN - 2047-9964 SP - A71 ST - Clinical pharmacist interventions in the critical patient: Evolution of a 4 year project T2 - European Journal of Hospital Pharmacy TI - Clinical pharmacist interventions in the critical patient: Evolution of a 4 year project UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614324305&from=export http://dx.doi.org/10.1136/ejhpharm-2016-000875.160 VL - 23 ID - 761034 ER - TY - JOUR AB - INTRODUCTION: Cystic fibrosis (CF) is an autosomal recessive disease caused by a mutation in the gene encoding the CF transmembrane conductance regulator protein (CFTR). Early diagnosis and adequate management have considerably improved the survival rate until adulthood, therefore opening the possibility for pregnancy for these patients. Nevertheless, pregnancy has a negative impact on the pulmonary function of the patient with CF due to the size of the uterus, the relative immunosuppression and the increase in nutritional requirements. Risk factors that influence pregnancy are the basal pulmonary function, the nutritional state, pancreatic insufficiency, bacterial colonization, diabetes and the presence of pulmonary hypertension. Most of the labors result in a living newborn, with premature birth presenting as the main complication. There are very few reports of CF associated with twin pregnancy and its outcomes in the literature. CASE REPORT A 21-year-old female with a history of CF with secondary chronic respiratory failure with permanent oxygen requirement and moderate malnutrition, in addition to chronic airway P. areuginosa colonization, is admitted with a 27-week dichorionic diamniotic twin pregnancy. Upon consult she refers a history of progressive dyspnea, worsening cough with purulent sputum, no fever, associated with risk of preterm labor and discordant fetal growth. Cardiac ultrasound showed severe pulmonary hypertension without right cardiac insufficiency. CT-angiogram reported disseminated bronchiectases without sings of pulmonary embolism. Treatment with tobramycin, bronchodilators, pancreatic enzymes, steroids for fetal lung maturation and intensive nutritional support was initiated. At 31 weeks, functional class deterioration is evidenced; cesarean labor is performed obtaining two males of 1342 and 1299 grams. They evolve favorably without mayor complications regarding the previous basal state of the mother and the newborns. DISCUSSION: Pregnancy in patients with CF can have a normal evolution and come to a good resolution for the mother and the fetus if treated by a multidisciplinary team in reference centers involved in the follow-up before, during and after the pregnancy, especially in twin pregnancies that entail greater risks of complications and overall morbimortality. Most patients carry out their pregnancies without significantly compromising their pulmonary function. In our case the main morbidity was derived from the secondary pulmonary hypertension. AD - L. Fernandez, Interventional Pulmonology, Fundacion Valle del Lili, Universidad Icesi, Cali, Colombia AU - Fernandez, L. AU - Angel, A. M. AU - Martinez, W. AU - Sanabria, F. AU - Leib, C. S. DB - Embase KW - bronchodilating agent oxygen pancreas enzyme steroid tobramycin adult airway bacterial colonization bronchiectasis case report chronic respiratory failure clinical article complication conference abstract coughing cystic fibrosis deterioration diabetes mellitus dyspnea female fetus fetus growth fetus lung maturation fever follow up heart failure human lung embolism lung function male malnutrition morbidity newborn nutritional status nutritional support pancreatic insufficiency premature labor pulmonary hypertension risk factor sputum twin pregnancy ultrasound young adult LA - English M1 - MeetingAbstracts M3 - Conference Abstract N1 - L622965807 2018-07-16 PY - 2018 SN - 1535-4970 ST - Cystic fibrosis and twin pregnancy, the challenge of multidisciplinary care: A case report T2 - American Journal of Respiratory and Critical Care Medicine TI - Cystic fibrosis and twin pregnancy, the challenge of multidisciplinary care: A case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622965807&from=export VL - 197 ID - 760869 ER - TY - JOUR AB - Introduction: The theme of safe surgery is relevant to the prevention of errors related to health care and should always be valued and reason of attention of professionals of the surgery block. Objective: To identify the knowledge, attitudes and practices of the multidisciplinary team of surgery block about safe surgery based on the use of the checklist. Methods: This was a cross-sectional and descriptive study, developed from the investigation called CAP (Knowledge, Attitudes and Practices in health), with quantitative analysis of data. The sample was composed of 117 professionals, including physicians, nurses and nursing technicians working in the block period of 3 hospitals in the city of Recife/PE. Data were collected through a semi-structured form. Results: The knowledge, attitudes and practices of professionals were similar among the three hospitals investigated. It showed good results, in spite of the hospital C presents inferior results to hospitals A and B. Conclusion: The professionals of the hospitals analyzed presented positively regarding the understanding and the importance of safe surgery; however, there was an omission on the part of some professionals of technical level regarding some questions about the protocol, showing the need for professional training and breadth of knowledge on the subject. Introducción: El tema de la cirugía segura es relevante para la prevención de errores relacionados con el cuidado de la salud y siempre debe ser valorada y motivo de atención de profesionales del bloque quirúrgico. Objetivo: Identificar los conocimientos, actitudes y prácticas del equipo multidisciplinario de bloque quirúrgico acerca de la cirugía segura basada en la utilización de la lista. Métodos: Este fue un estudio transversal, descriptivo, característicos de la investigación desarrollada llamado CAP (Conocimientos, actitudes y Prácticas en salud), con el análisis cuantitativo de los datos. La muestra se compone de 117 profesionales, entre ellos médicos, enfermeras y técnicos que trabajan en el período de bloqueo de tres hospitales en la ciudad de Recife/PE. Los datos fueron recolectados a través de un formulario semi-estructurado. Resultados: Los conocimientos, actitudes y prácticas de los profesionales fueron similares entre los tres hospitales investigados, que mostró buenos resultados, a pesar de que el hospital C presenta resultados inferiores a los hospitales A y B. Conclusión: Los profesionales de los hospitales analizados presentaron positivamente con respecto a la comprensión y la importancia de la seguridad de la cirugía, sin embargo, hubo una omisión por parte de algunos profesionales de nivel técnico acerca de algunas preguntas en el protocolo, mostrando la necesidad de la formación profesional y la amplitud de los conocimientos acerca de este tema. Introdução: A temática da cirurgia segura é relevante para a prevenção de erros relacionados à assistência à saúde e deve ser sempre valorizada e motivo de atenção dos profissionais do bloco operatório. Objetivo: Identificar o conhecimento, atitudes e práticas da equipe multidisciplinar do bloco operatório sobre cirurgia segura baseada no uso da lista de verificação. Métodos: Trata-se de um estudo transversal, de característica descritiva, desenvolvido a partir do inquérito denominado CAP (Conhecimentos, Atitudes e Práticas em saúde), com análise quantitativa dos dados. A amostra foi composta por 117 profissionais, entre médicos, enfermeiros e técnicos de enfermagem, que atuam no bloco operatório de três hospitais da cidade de Recife/PE. Os dados foram coletados por meio de um formulário semiestruturado. Resultados: O conhecimento, atitudes e práticas dos profissionais foram semelhantes nos três hospitais estudados, que apresentaram bons resultados, apesar do hospital C apresentar resultados inferiores aos hospitais A e B. Conclusão: Os profissionais dos hospitais analisados apresentaram-se de forma positiva quanto à compreensão e importância da cirurgia segura, porém observou-se uma omissão por parte de alguns profissionais do nível técnico quanto a algumas questões sobre o protocolo, apresentando a necessidade de uma capacitação profissional e abrangência do conhecimento sobre o tema. AD - Enfermeira, Professora Adjunta da Faculdade de Enfermagem Nossa Senhora das Graças (FENSG) da Universidade de Pernambuco (UPE), Recife/PE Acadêmica de Enfermagem pela Faculdade de Enfermagem Nossa Senhora das Graças (FENSG) da Universidade de Pernambuco (UPE), Recife/PE Enfermeira, Doutoranda em Enfermagem pela Universidade de Pernambuco, Recife/PE Enfermeira, Professora Assistente da Faculdade de Enfermagem Nossa Senhora das Graças (FENSG) da Universidade de Pernambuco (UPE), Recife/PE AN - 138997805. Language: Portuguese. Entry Date: 20191029. Revision Date: 20191102. Publication Type: Article AU - Ferreira e Pereira, Emanuela Batista AU - Gomes Brito, Priscilla Renata do Nascimento AU - Gonçalves Ferreira, Ranna Carinny AU - Vasconcelos Silva, Fernanda da Mata AU - Chagas da Costa, Vânia AU - Perrelli Valença, Marília DB - CINAHL DO - 10.33233/eb.v18i4.2826 DP - EBSCOhost KW - Surgery, Operative Multidisciplinary Care Team Operating Room Personnel -- Psychosocial Factors Professional Knowledge Patient Safety Human Checklists Cross Sectional Studies Descriptive Research RN First Assistants -- Psychosocial Factors Quantitative Studies Physician Attitudes Nurse Attitudes M1 - 4 N1 - research; tables/charts. Journal Subset: Mexico & Central/South America; Nursing; Peer Reviewed. NLM UID: 101187838. PY - 2019 SN - 1678-2410 SP - 561-569 ST - Conhecimentos, atitudes e práticas sobre cirurgia segura entre profissionais do bloco operatório T2 - Enfermagem Brasil TI - Conhecimentos, atitudes e práticas sobre cirurgia segura entre profissionais do bloco operatório UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=138997805&site=ehost-live&scope=site VL - 18 ID - 761313 ER - TY - JOUR AB - PURPOSE: To report an initial experience of concomitant endovascular repair of abdominal aortic aneurysms (AAA) and cardiac surgery. METHODS: Records for 10 consecutive patients (all men; median age 68 years, range 60-79) with AAA treated by a multidisciplinary team at a tertiary specialist center were retrospectively reviewed. Each patient had independent indications for surgical correction of their cardiac disease and AAAs. The patients underwent endovascular aneurysm repair (EVAR) followed by cardiac surgery under the same anesthesia. Eight patients had concomitant coronary artery bypass grafting (CABG; 4 off-pump), 1 patient had CABG and left ventricular aneurysmectomy, and 1 patient required aortic root replacement. RESULTS: All combined procedures were performed successfully under a single general anesthesia and took a median of 508 minutes (range 425-625). Median intensive care stay was 3 days (range 2-4), while hospital stay was 8 days (range 7-21) days. There were no deaths in-hospital or within 30 days. Complications were minor and self-limiting; there were no instances of renal failure. At a median follow-up of 29 months (range 14-38), no EVAR-related secondary interventions were required. CONCLUSION: Concomitant EVAR and cardiac surgery delivered by a multidisciplinary team is feasible, appears safe, and eliminates the risk associated with staged operations. Improved patient satisfaction and efficient use of resources are potential advantages. AD - Liverpool Heart and Chest Hospital, Liverpool, UK. AN - 23731307 AU - Field, M. L. AU - Vallabhaneni, S. R. AU - Kuduvalli, M. AU - Brennan, J. A. AU - Torella, F. AU - McWilliams, R. G. AU - Oo, A. DA - Jun DO - 10.1583/12-3966r.1 DP - NLM ET - 2013/06/05 J2 - Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists KW - Aged Aortic Aneurysm, Abdominal/*complications/*surgery *Coronary Artery Bypass Coronary Artery Disease/*complications/*surgery *Endovascular Procedures Humans Male Middle Aged Retrospective Studies LA - eng M1 - 3 N1 - 1545-1550 Field, Mark L Vallabhaneni, S Rao Kuduvalli, Manoj Brennan, John A Torella, Francesco McWilliams, Richard G Oo, Aung Journal Article United States J Endovasc Ther. 2013 Jun;20(3):345-9. doi: 10.1583/12-3966R.1. PY - 2013 SN - 1526-6028 SP - 345-9 ST - Combined cardiac surgery and endovascular repair of abdominal aortic aneurysms T2 - J Endovasc Ther TI - Combined cardiac surgery and endovascular repair of abdominal aortic aneurysms VL - 20 ID - 760293 ER - TY - JOUR AB - Purpose: Acute pulmonary embolism (PE) is a life-threatening event, accounting for over 300 deaths a year in Australia.1 PE is stratified into massive, submassive and low risk.2 Massive PE is defined as PE with sustained hypotension or requiring vasopressor support. Submassive PE is defined as PE in a normotensive patient with right heart dysfunction or elevated troponin levels. Low risk PE is defined as PE having no hypotension or right heart dysfunction. Treatment options for massive and submassive PE include systemic anticoagulation, systemic thrombolysis, surgical embolectomy, and catheter directed therapies.3-6 Systemic thrombolysis is associated with up to a 20% major bleeding risk and a 2-5% risk of intracranial haemorrhage.7-8 In the case of submassive PE, low-dose systemic thrombolysis has been shown to be a safe and effective alternative, dramatically reducing the bleeding risk.5 Surgical embolectomy has historically high mortality rates, although this is improving to around 10% for massive PE with earlier surgical intervention.3 There is growing utilisation of catheter directed therapies (CDT), including localised thrombolysis and mechanical embolectomy, for massive and submassive PE.9-12 Recently, two multicentre, prospective trials have shown efficacy of CDT for massive and submassive PE, without any major bleeding complications.8,13 In Australia, there is scarce literature on the application of CDT to massive and submassive PE and its associated outcomes. Methods and Materials: A retrospective audit was conducted on all CT pulmonary angiograms requested during 1 October 2017 to 31 March 2018 at the Royal Brisbane and Women's Hospital, Herston, Queensland, Australia (RBWH). Data analysed included: a Patient demographics; b Pulmonary embolism type; c Evidence of right heart dysfunction (CT, echocardiogram); d Cardiac biochemistry; e Treatment (systemic anticoagulation, systemic thrombolysis, surgical embolectomy, CDT); f Time between symptom onset and treatment; and g Outcome (post-angiographic, 3 month clinical). Results: 703 CT pulmonary angiograms were performed for suspected PE during the study period. Of these, 84 studies were positive for PE (11.94%). Preliminary results indicate that these comprised of 6 massive PEs, 25 submassive PEs, and 53 low-risk PEs. CDT was utilised in 5 patients (4 massive, 1 submassive). Average time from symptom onset to CDT treatment was 27.4 hours. 3 patients had excellent angiographic improvement. The remaining 2 patients died. Conclusion: Our audit will contribute to the growing literature on the application of CDT to massive and submassive PE. This data will also be used by our newly formed Pulmonary Embolism Response Team to monitor and improve outcomes.6. AD - M. Fielder, Royal Brisbane and Women's Hospital, Herston, QLD, Australia AU - Fielder, M. AU - Van Den Heuvel, J. AU - McNiff, M. AU - Markwell, A. AU - Cullen, L. AU - Pincus, J. AU - Davis, S. AU - Bain, R. AU - Stewart, P. AU - Zappala, C. AU - Coulthard, A. AU - Clouston, J. DB - Embase DO - 10.1111/(ISSN)1754-9485 KW - adult anticoagulation biochemistry brain hemorrhage catheter complication conference abstract echocardiography female heart disease human low drug dose lung angiography major clinical study mechanical thrombectomy mortality rate multicenter study preliminary data prospective study pulmonary embolism response team Queensland retrospective study surgery LA - English M3 - Conference Abstract N1 - L624942366 2018-11-20 PY - 2018 SN - 1754-9485 SP - 11 ST - Catheter directed therapy for massive and submassive pulmonary embolism: A single centre Australian experience T2 - Journal of Medical Imaging and Radiation Oncology TI - Catheter directed therapy for massive and submassive pulmonary embolism: A single centre Australian experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624942366&from=export http://dx.doi.org/10.1111/(ISSN)1754-9485 VL - 62 ID - 760796 ER - TY - JOUR AB - Introduction: Complex management of JIA comprises of drug treatment, physiotherapy/occupational therapy, education and counselling. It should be provided by a trained multidisciplinary team of physicians and allied health professionals (AHP). In the traditional model, nursing and physiotherapy staff competencies are limited by the leading role of physicians and support of an equally important role of AHP is not automatically provided. A case for the importance of AHP needs to be presented to the healthcare providers and hospital managers. Objectives: The project has 2 parts: 1.To develop a comprehensive system of therapeutic interventions provided by AHP to paediatric patients with JIA (a subject to this report). 2.To prospectively test performance of these interventions in a cohort of JIA patients with active disease requiring new drug treatment. Methods: Two trained rheumatology nurses and a physiotherapist contributed to the development of an AHP intervention plans as an addon to the routine clinical care. Apart from the published literature the main resources included observations made by the team during their educational visits to the 2 European paediatric rheumatology services (Utrecht, NL, and Birmingham, UK). For the 2nd part of the study patient inclusion criteria were: 1. Active JIA (at least 1 joint with active synovitis). 2. Newly diagnosed, untreated JIA or JIA relapse requiring medical intervention. Performance of interventions was tested by standardized quality of life assessments (CHAQ, parent/patient global assessment, SMILY-illness, JAMAR) along physician-derived disease activity measures (physician global, active joint count, ESR/CRP, JADAS71). Consecutive patients have been randomised into 3 groups according to the frequency of AHP interventions (3 or 6-monthly or no extra AHP intervention). Results: AHP intervention had 2 parts: an interview (about 30-45 min) and a practical session. Nurse interview covered 3 main areas: Introduction of the rheumatology team, patient history (schooling, (Table presented) relationships, hobbies and psychosocial aspects) and education (disease, its treatment, monitoring and parent/patient assessments). Where eligible, practical training in injection technique and drug safety/handling issues was provided. Physiotherapy (PT) interview covered history of pain, functional limitation, school PE, sporting, vocational issues and education on PT management. Practical input included full PT assessment, complex evaluation of physical function and establishment of the PT treatment plan. From November 2013 to May 2014 total of 41 consecutive patients were eligible from which one family refused participation. Polyarticular JIA was present in 19 children, oligoarthritis in 14, psoriatic, enthesitis-related or systemic JIA in 7 patients. There were 24 patients with the new diagnosis of JIA, 16 had JIA relapse. Median age at study entry was 6.5 years (3.7-10.1), prior disease duration was 1.0 year (0.2-3.7). Median active joint count at study entry was 3 (1-6.5), JADAS 71 was 9 (6-18). From 21 patients in whom the first F/U assessment was available, 10 received intraarticular triamcinolone-hexacetonide (in 2 cases with methotrexate, MTX), 6 received s.c. MTX and in 5 patients biologic therapy was added to MTX. Conclusion: With this study we aim to accumulate better evidence on the importance of the trained nursing and physiotherapy staff in the multidisciplinary team caring for rheumatology patients in the country where such an approach is not fully supported by the existing system. Evaluation of the performance of interventions provided by AHP is a subject of ongoing study. AD - S. Fingerhutova, Paediatric Rheumatology Unit, General University Hospital in Prague, Prague, Czech Republic AU - Fingerhutova, S. AU - Saifridova, M. AU - Vranova, M. AU - Dolezalova, P. AU - Sebkova, S. AU - Bohm, M. AU - Nemcova, D. AU - Obrsalova, J. DB - Embase KW - enalapril maleate methotrexate new drug triamcinolone hexacetonide juvenile rheumatoid arthritis rheumatology human patient physician physiotherapy interview education relapse nursing drug therapy school nurse enthesitis counseling pain task performance monitoring diagnosis disease duration social psychology manager health care personnel therapy diseases quality of life model disease activity synovitis medical history leisure health practitioner injection United Kingdom vocation child arthritis physiotherapist intraarticular drug administration biological therapy LA - English M3 - Conference Abstract N1 - L71686879 2014-11-22 PY - 2014 SN - 1546-0096 ST - Is there an evidence for the role of multidisciplinary team in the management of active juvenile idiopathic arthritis? T2 - Pediatric Rheumatology TI - Is there an evidence for the role of multidisciplinary team in the management of active juvenile idiopathic arthritis? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71686879&from=export VL - 12 ID - 761101 ER - TY - JOUR AB - OBJECTIVE: Central lines in NICUs have long dwell times. Success in reducing central line-associated bloodstream infections (CLABSIs) requires a multidisciplinary team approach to line maintenance and insertion. The Perinatal Quality Collaborative of North Carolina (PQCNC) CLABSI project supported the development of NICU teams including parents, the implementation of an action plan with unique bundle elements and a rigorous reporting schedule. The goal was to reduce CLABSI rates by 75%. METHODS: Thirteen NICUs participated in an initiative developed over 3 months and deployed over 9 months. Teams participated in monthly webinars and quarterly face-to-face learning sessions. NICUs reported on bundle compliance and National Health Surveillance Network infection rates at baseline, during the intervention, and 3 and 12 months after the intervention. Process and outcome indicators were analyzed using statistical process control methods (SPC). RESULTS: Near-daily maintenance observations were requested for all lines with a 68% response rate. SPC analysis revealed a trend to an increase in bundle compliance. We also report significant adoption of a new maintenance bundle element, central line removal when enteral feedings reached 120 ml/kg per day. The PQCNC CLABSI rate decreased 71%, from 3.94 infections per 1000 line days to 1.16 infections per 1000 line days with sustainment 1 year later (P = .01). CONCLUSIONS: A collaborative structure targeting team development, family partnership, unique bundle elements and strict reporting on line care produced the largest reduction in CLABSI rates for any multiinstitutional NICU collaborative. AD - CAPT USN (Ret), Division of Neonatal-Perinatal Medicine, Department of Pediatrics, CB 7596, 4th Floor, UNC Hospitals, Chapel Hill, NC 27599-7596. martin_mccaffrey@med.unc.edu. AN - 24249819 AU - Fisher, D. AU - Cochran, K. M. AU - Provost, L. P. AU - Patterson, J. AU - Bristol, T. AU - Metzguer, K. AU - Smith, B. AU - Testoni, D. AU - McCaffrey, M. J. DA - Dec DO - 10.1542/peds.2013-2000 DP - NLM ET - 2013/11/20 J2 - Pediatrics KW - Catheter-Related Infections/epidemiology/*prevention & control Catheterization, Central Venous/adverse effects/methods/*standards Checklist Cross Infection/epidemiology/*prevention & control Guideline Adherence Humans Infant, Newborn Intensive Care Units, Neonatal/organization & administration/*standards Intensive Care, Neonatal/methods/*standards North Carolina Outcome and Process Assessment, Health Care Patient Care Team Practice Guidelines as Topic Quality Assurance, Health Care/*methods/organization & administration Quality Improvement/*organization & administration Clabsi central line–associated bloodstream infection enteral feeding family-centered care infant quality improvement LA - eng M1 - 6 N1 - 1098-4275 Fisher, David Cochran, Keith M Provost, Lloyd P Patterson, Jacquelyn Bristol, Tara Metzguer, Karen Smith, Brian Testoni, Daniela McCaffrey, Martin J Clinical Trial Journal Article Multicenter Study Research Support, Non-U.S. Gov't United States Pediatrics. 2013 Dec;132(6):e1664-71. doi: 10.1542/peds.2013-2000. Epub 2013 Nov 18. PY - 2013 SN - 0031-4005 SP - e1664-71 ST - Reducing central line-associated bloodstream infections in North Carolina NICUs T2 - Pediatrics TI - Reducing central line-associated bloodstream infections in North Carolina NICUs VL - 132 ID - 760440 ER - TY - JOUR AB - Objectives: Wounds of the lower limb in patients with diabetes are frequently difficult to heal. Some wounds fail to heal despite optimal medical and surgical care. This review examines the evidence for whether free tissue transfer techniques may reduce the requirement of amputation in these patients. Design: A systematic review. Materials & Methods: Pubmed, Embase, AMED, SCOPUS and CINAHL and Cochrane Library were searched for all articles on free tissue transfer in lower limb wounds in patients with diabetes (September 2010). Current experience, indications and outcomes were analysed. Results: 528 patients from 18 studies were included in the systematic review. 66% of patients had concomitant revascularisation with bypass surgery. 63% of flaps were muscle based, 35% fasciocutaneous and 1.7% omental. Pooled in-hospital mortality rate was 4.4%, flap survival was 92% and limb salvage rate of 83.4% over a 28 months average follow-up time. Conclusions: In conclusion free tissue transfer achieves successful wound healing in selected patients with diabetes and difficult to heal wounds that would have required amputation. Pre-operative optimisation of vascular supply and eradication of infection is key to success. Objective wound assessment scores and a clear multidisciplinary team (MDT) approach would improve patient care. © 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. AD - R. J. Hinchliffe, St Georges Vascular Institute, St Georges Healthcare NHS Trust, London SW17 0QT, United Kingdom AU - Fitzgerald Oconnor, E. J. AU - Vesely, M. AU - Holt, P. J. AU - Jones, K. G. AU - Thompson, M. M. AU - Hinchliffe, R. J. DB - Embase Medline DO - 10.1016/j.ejvs.2010.11.013 KW - bypass surgery diabetes mellitus fasciocutaneous flap follow up free tissue graft graft survival human leg amputation leg injury leg revascularization limb injury limb salvage major clinical study mortality preoperative evaluation priority journal revascularization review systematic review treatment outcome LA - English M1 - 3 M3 - Review N1 - L361328790 2011-03-07 2011-03-11 PY - 2011 SN - 1078-5884 1532-2165 SP - 391-399 ST - A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes T2 - European Journal of Vascular and Endovascular Surgery TI - A systematic review of free tissue transfer in the management of non-traumatic lower extremity wounds in patients with diabetes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L361328790&from=export http://dx.doi.org/10.1016/j.ejvs.2010.11.013 VL - 41 ID - 761238 ER - TY - JOUR AB - PMID:32938471 AU - Flaczyk, Adam AU - Reed, Clay T. AU - Bankhead-Kendall, Brittany K. AU - Bittner, Edward A. DA - 2020/09/16 09/16 DB - PubMed Central DO - 10.1186/s13054-020-03273-y PY - 2020 SN - 1364-8535 ST - Comparison of published guidelines for management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and future investigations T2 - Critical Care TI - Comparison of published guidelines for management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and future investigations UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7492793&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7492793 VL - 24 ID - 762022 ER - TY - JOUR AU - Flaczyk, A. AU - Rosovsky, R. P. AU - Reed, C. T. AU - Bankhead-Kendall, B. K. AU - Bittner, E. A. AU - Chang, M. G. DA - 2020/09/23 09/23 DB - Europe PubMed Central DO - 10.1186/s13054-020-03273-y M1 - 1 PY - 2020 SN - 1364-8535 ST - Comparison of published guidelines for management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and future investigations T2 - Crit Care TI - Comparison of published guidelines for management of coagulopathy and thrombosis in critically ill patients with COVID 19: implications for clinical practice and future investigations UR - http://europepmc.org/article/MED/32938471 VL - 24 ID - 762019 ER - TY - JOUR AB - OBJECTIVE: Multidisciplinary care is recommended for the treatment of patients with ischemic and diabetic wounds. In addition to integrating care from multiple specialties, outpatient wound care centers provide an opportunity for continuity and organization of care after revascularization or hospitalization. The purpose of this study was to assess changes in the practice patterns and outcomes of patients treated by a tertiary care vascular surgery practice after the introduction of an affiliated outpatient wound care center. METHODS: A prospective institutional database was used to identify patients who underwent lower-extremity revascularization, amputation, or surgical debridement during consecutive 3-year periods before (BWC; n = 735) and after (AWC; n = 1503) the opening of an affiliated wound care center. Patients were included if they underwent intervention for atherosclerotic peripheral arterial disease or diabetic foot ulcers (DFUs). Changes in case volume, surgical indication, and procedural characteristics were assessed. Clinical outcomes included freedom from lower-extremity amputations and mortality. RESULTS: We identified a total of 1751 procedures performed in 1249 limbs that met inclusion criteria. After the opening of the wound clinic, procedures related to limb salvage represented a greater proportion of overall cases performed by the vascular service (19% vs 26%; P < .0001). The volume of lower-extremity interventions increased by 64%, from 662 procedures in the BWC period to 1085 procedures in the AWC period. There was no difference in type of revascularization performed between the two study periods, although surgical debridements (from 8.9% to 13%; P = .01) and infrapopliteal endovascular interventions (from 21% to 28%; P = .04) significantly increased. Compared with BWC patients, AWC patients more frequently presented with DFUs (7.3% vs 13%; P = .002) and chronic wounds (39% vs 45%; P = .05). At 1 year of follow-up, major amputation rates were significantly lower in the AWC group than in the BWC cohort (5.5% vs 8.8%; P = .04). Treatment during the AWC period was associated with a reduced risk of major amputation (adjusted hazard ratio, 0.41; 95% confidence interval, 0.27-0.62; P < .001), but no difference in all-cause mortality. CONCLUSIONS: The opening of an outpatient wound center affiliated with a tertiary vascular surgical practice was associated with a higher volume of limb salvage patients and procedures. The risk of major amputation decreased following the opening of the wound care center. Integrating vascular surgeons into wound centers may result in a synergistic system that promotes more aggressive and effective limb salvage. AD - Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif; Geisel School of Medicine at Dartmouth, Hanover, NH. Division of Vascular and Endovascular Surgery, University of California Davis Medical Center, Sacramento, Calif. Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif. Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif. Electronic address: vchandra@stanford.edu. AN - 31153696 AU - Flores, A. M. AU - Mell, M. W. AU - Dalman, R. L. AU - Chandra, V. DA - Nov DO - 10.1016/j.jvs.2019.01.087 DP - NLM ET - 2019/06/04 J2 - Journal of vascular surgery KW - Aged Amputation/statistics & numerical data Endovascular Procedures/adverse effects/*methods/statistics & numerical data Female Health Plan Implementation Humans Ischemia/etiology/mortality/*surgery Kaplan-Meier Estimate Limb Salvage/methods/*statistics & numerical data Lower Extremity/blood supply/surgery Male Outpatient Clinics, Hospital/*organization & administration/statistics & numerical data Patient Care Team/*organization & administration Peripheral Arterial Disease/complications/mortality/*surgery Practice Patterns, Physicians'/organization & administration/statistics & numerical data Program Evaluation Prospective Studies Tertiary Care Centers/organization & administration/statistics & numerical data Treatment Outcome Workload/statistics & numerical data Wound Healing *Amputation *Limb salvage *Wound care LA - eng M1 - 5 N1 - 1097-6809 Flores, Alyssa M Mell, Matthew W Dalman, Ronald L Chandra, Venita UL1 TR001085/TR/NCATS NIH HHS/United States Journal Article Research Support, N.I.H., Extramural United States J Vasc Surg. 2019 Nov;70(5):1612-1619. doi: 10.1016/j.jvs.2019.01.087. Epub 2019 May 29. PY - 2019 SN - 0741-5214 SP - 1612-1619 ST - Benefit of multidisciplinary wound care center on the volume and outcomes of a vascular surgery practice T2 - J Vasc Surg TI - Benefit of multidisciplinary wound care center on the volume and outcomes of a vascular surgery practice VL - 70 ID - 760200 ER - TY - JOUR AB - BACKGROUND: We assessed cardiac adverse events (AEs) after primary lower extremity arterial revascularization (LEAR) for critical lower limb ischemia (CLI) in order to evaluate the impact of cardiac AEs on the clinical outcome. We created an optimized care protocol concerning CLI patients' preoperative work-up as well as intra- and postoperative surveillance according to recent important literature and guidelines. METHODS: We conducted a prospective analysis of clinical outcome after LEAR using patient-related risk factors, comorbidity, surgical therapy, and AEs. This cohort was divided into patients with and without AEs. AEs were categorized according to predefined standards: minor, surgical, failed revascularization, and systemic. The consequences of AEs were reoperation, additional medication, irreversible physical damage, and early death. RESULTS: There were 106 patients (Fontaine III n=49, 46%, and Fontaine IV n=57, 56%) who underwent primary revascularization by bypass graft procedure (n=67, 63%) or balloon angioplasty (n=39, 37%). No difference in comorbidity was registered between the two groups. Eighty-four AEs were registered in 34 patients (32%). Patients experiencing AEs had significantly less antiplatelet agents (without AEs n=63, 88%, vs. with AEs n=18, 53%; p=0.000) and/or beta-blockers (without AEs n=66, 92%, vs. with AEs n=16, 47%; p=0.000) compared to patients without AEs. The two most harmful consequences of AEs were irreversible physical damage (n=3) and early death (n=8). Sixty percent (n=9) of systemic AEs were heart-related. The postprocedural mortality rate was 7.5%, with a 75% (n=6) heart-related cause of death. CONCLUSION: AEs occur in >30% of CLI patients after LEAR. The most harmful AEs on the clinical outcome of CLI patients were heart-related, causing increased morbidity and death. Significant correlations between prescription of beta-blockers and antiplatelet agents and prevention of AEs were observed. A persistent focus on the prevention of systemic AEs in order to ameliorate the outcome after LEAR for limb salvage remains of utmost importance. Therefore, we advise the implementation of an optimized care protocol by discussing patients in a strict manner according to a predetermined protocol, to optimize and standardize the preoperative work-up as well as intra- and postoperative patient surveillance. AD - Department of Vascular Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands. AN - 19747609 AU - Flu, H. C. AU - Lardenoye, J. H. AU - Veen, E. J. AU - Aquarius, A. E. AU - Van Berge Henegouwen, D. P. AU - Hamming, J. F. DA - Sep-Oct DO - 10.1016/j.avsg.2009.06.012 DP - NLM ET - 2009/09/15 J2 - Annals of vascular surgery KW - Adrenergic beta-Antagonists/therapeutic use Aged Aged, 80 and over Amputation Angioplasty, Balloon/*adverse effects/mortality Arterial Occlusive Diseases/complications/mortality/surgery/*therapy Clinical Protocols Critical Illness Female Heart Diseases/*etiology/mortality/prevention & control Humans Interdisciplinary Communication Ischemia/etiology/mortality/surgery/*therapy Limb Salvage Lower Extremity/*blood supply Male Middle Aged Patient Care Team Patient Selection Platelet Aggregation Inhibitors/therapeutic use Prospective Studies Registries Reoperation Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome Vascular Surgical Procedures/*adverse effects/mortality LA - eng M1 - 5 N1 - 1615-5947 Flu, H C Lardenoye, J H P Veen, E J Aquarius, A E Van Berge Henegouwen, D P Hamming, J F Journal Article Netherlands Ann Vasc Surg. 2009 Sep-Oct;23(5):583-97. doi: 10.1016/j.avsg.2009.06.012. PY - 2009 SN - 0890-5096 SP - 583-97 ST - Morbidity and mortality caused by cardiac adverse events after revascularization for critical limb ischemia T2 - Ann Vasc Surg TI - Morbidity and mortality caused by cardiac adverse events after revascularization for critical limb ischemia VL - 23 ID - 760508 ER - TY - JOUR AB - Purpose: Evaluate national variation in structure and care processes for critically injured children. Methods: Institutions with pediatric intensive care units (PICUs) that treat trauma patients were identified through the Virtual Pediatric Systems (n = 72). Prospective survey data were obtained from PICU and Trauma Directors (n = 69, 96% response). Inquiries related to structure and care processes in the PICU and emergency department included infrastructure, physician staffing, team composition, decision making, and protocol/checklist use. Results: About one-third of the 69 institutions were ACS-verified Level-1 Pediatric Trauma Centers (32%); 36 (52%) were state-designated Level 1. The surgeon was the primary decision maker in the trauma bay at 88% of sites, and in the PICU at 44%. The intensivist was primary in the PICU at 30% of sites and intensivist consultation was elective at 11%. Free-standing pediatric centers used checklists more often than adult/pediatric centers for DVT prophylaxis (75% vs. 50%, p = 0.039), cervical spine clearance (75% vs. 44%, p = 0.011), and pain control (63% vs. 34%, p = 0.024). Otherwise, protocols/checklists were infrequently utilized by either center type. Conclusion: Variability exists in structure and care processes for critically injured children. Further investigation of variation and its causal relationship to outcomes is warranted to provide optimal care. (C) 2016 Elsevier Inc. All rights reserved. AD - [Flynn-O'Brien, Katherine T.; Thompson, Leah L.; Rivara, Frederick P.] Harborview Injury Prevent & Res Ctr, Box 359960,325 Ninth Ave, Seattle, WA 98104 USA. [Flynn-O'Brien, Katherine T.] Univ Washington, Dept Surg, Box 356410,1959 NE Pacific St, Seattle, WA 98195 USA. [Gall, Christine M.; Rice, Tom B.] Virtual Pediat Syst LLC, 470 W Sunset Blvd 440, Los Angeles, CA 90027 USA. [Fallat, Mary E.] Univ Louisville, Dept Surg, 315 E Broadway,Suite 565, Louisville, KY 40202 USA. [Fallat, Mary E.] Kosair Childrens Hosp, 315 E Broadway,Suite 565, Louisville, KY 40202 USA. [Rice, Tom B.] Med Coll Wisconsin, Dept Pediat, 9000 W Wisconsin Ave,MS 681, Milwaukee, WI 53226 USA. [Rivara, Frederick P.] Univ Washington, Dept Pediat, Box 359774,325 Ninth Ave, Seattle, WA 98104 USA. [Thompson, Leah L.] Seattle Childrens Hosp Res Inst, 4800 Sand Point Way NE, Seattle, WA 98105 USA. [Gall, Christine M.] SCL Hlth, 2480 W 26th Ave,Suite 60B, Denver, CO 90211 USA. Flynn-O'Brien, KT (corresponding author), Box 359960,325 Ninth Ave, Seattle, WA 98104 USA. flynnobr@uw.edu AN - WOS:000372012800029 AU - Flynn-O'Brien, K. T. AU - Thompson, L. L. AU - Gall, C. M. AU - Fallat, M. E. AU - Rice, T. B. AU - Rivara, F. P. DA - Mar DO - 10.1016/j.jpedsurg.2015.09.006 J2 - J. Pediatr. Surg. KW - Trauma Critical care Pediatrics Patient care Quality Outcome and process assessment AMERICAN-COLLEGE PEDIATRIC TRAUMA SAFETY CHECKLIST MEDICAL ERRORS SURGEONS OUTCOMES MORTALITY PROTOCOL IMPACT IMPLEMENTATION Pediatrics Surgery LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: DG4AR Times Cited: 2 Cited Reference Count: 52 Flynn-O'Brien, Katherine T. Thompson, Leah L. Gall, Christine M. Fallat, Mary E. Rice, Tom B. Rivara, Frederick P. Childress Foundation grant; NCRR/NIHUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Research Resources (NCRR) [UL1TR000423]; National Institute of Child Health and Human DevelopmentUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) [T32-HD057822] This project was, in part, supported by the 2014 Childress Foundation grant. The Institute of Translational Health Sciences (ITHS), which assisted in the creation and administration of the electronic data capture survey instrument, received grant support (UL1TR000423) from NCRR/NIH. Dr. Flynn-O'Brien received fellowship support from the National Institute of Child Health and Human Development (T32-HD057822) during the preparation of this paper. Virtual Pediatric ICU Systems (VPS), LLC site coordinators assisted with the study however no VPS patient data were provided or utilized. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Childress Institute, or VPS, LLC. There are no conflicts of interest to declare. 2 0 1 W B SAUNDERS CO-ELSEVIER INC PHILADELPHIA J PEDIATR SURG PY - 2016 SN - 0022-3468 SP - 490-498 ST - Variability in the structure and care processes for critically injured children: A multicenter survey of trauma bay and intensive care units T2 - Journal of Pediatric Surgery TI - Variability in the structure and care processes for critically injured children: A multicenter survey of trauma bay and intensive care units UR - ://WOS:000372012800029 VL - 51 ID - 761716 ER - TY - JOUR AB - Thrombotic complications in pregnancy represent a major cause of morbidity and mortality. Pregnancy is a primary hypercoagulable state due to enhanced production of clotting factors, a decrease in protein S activity, and inhibition of fibrinolysis. These physiologic changes will yield a collective rate of venous thromboembolism (VTE) of about 1-2 in 1000 pregnancies for the general obstetric population, which represents a five- to tenfold increased risk in pregnancy compared to age-matched non-pregnant peers. A select group of women, however, will carry a significantly higher rate of thrombosis due to primary thrombophilia, either inherited or acquired. This introduces a population of women who may benefit from prophylactic anticoagulation, either antepartum or postpartum. The coagulation changes that occur in preparation for the hemostatic challenges of delivery endure for several weeks postpartum. In fact, daily risk for pulmonary embolism (PE) is the highest postpartum. Use of anticoagulation in pregnancy introduces particular risk at the time of delivery, where bleeding and clotting risk collide. Altered metabolism rates of anticoagulants in pregnant women often necessitate closer monitoring than is required outside of pregnancy in order to ensure efficacy and safety. Heparin products are the mainstay of treating VTE in pregnancy, chiefly because they do not cross the placenta. In women with mechanical heart valves, the ideal anticoagulation regimen remains controversial as heparin use has shown inferior outcomes for preventing thromboembolic complications compared to warfarin, but warfarin carries risk for fetal embryopathy. Other populations where a heparin alternative is necessary include women with a history of heparin-associated thrombocytopenia (HIT) or other heparin intolerance. Further challenging the management of anticoagulation in pregnancy is the dearth of randomized clinical trials. The evidence governing treatment recommendations is largely based on expert guidelines, observational studies, or extrapolation from non-pregnant cohorts. A careful critique of a woman's history, as well as the available data, is essential for optimal management of anticoagulation in pregnancy. Such decisions should involve a multidisciplinary team involving obstetrics, hematology, cardiology, and anesthesia. AD - Massachusetts General Hospital, 55 Fruit Street, POB 224, Boston, MA, 02114, USA. afogerty@partners.org. AN - 28913590 AU - Fogerty, A. E. DA - Sep 14 DO - 10.1007/s11936-017-0575-x DP - NLM ET - 2017/09/16 J2 - Current treatment options in cardiovascular medicine KW - Anticoagulation Neuraxial anesthesia Pregnancy Thromboprophylaxis LA - eng M1 - 10 N1 - Fogerty, Annemarie E Journal Article Review United States Curr Treat Options Cardiovasc Med. 2017 Sep 14;19(10):76. doi: 10.1007/s11936-017-0575-x. PY - 2017 SN - 1092-8464 (Print) 1092-8464 SP - 76 ST - Challenges of Anticoagulation Therapy in Pregnancy T2 - Curr Treat Options Cardiovasc Med TI - Challenges of Anticoagulation Therapy in Pregnancy VL - 19 ID - 760216 ER - TY - JOUR AB - PURPOSE OF REVIEW: This manuscript addresses the risks for venous thromboembolism (VTE) during pregnancy and the associated challenges of both diagnosis and treatment. RECENT FINDINGS: The obstacles to diagnosis given lack of specificity of typical biomarkers to predict VTE in pregnancy, as well as the unique fetal and bleeding risks introduced by managing massive pulmonary embolism (PE) with thrombolytics or thrombectomy are highlighted. VTE during pregnancy and the postpartum window occurs at a 6-10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality. Hypercoagulability persists for 6-8 weeks after delivery with the highest risk of PE being postpartum. The lack of randomized trials in pregnant women leads to variability in practice, which are largely based on expert consensus or extrapolation from non-pregnant cohorts. The standard treatment of VTE in pregnancy is anticoagulation with low molecular weight heparin (LMWH), which like unfractionated heparin does not cross the placenta and is not teratogenic. LMWH is preferred given the negligible risk for heparin-induced thrombocytopenia and osteoporosis, better bioavailability, and a predictive dose response. Depending on the severity of the VTE, additional treatments including thrombolysis, thrombectomy, inferior vena cava filter placement, or venous stenting may be used. Management requires balancing the competing bleeding and thrombotic risks during labor and delivery and factoring the impact of treatment on the fetus. A multidisciplinary team involving hematology, obstetrics, anesthesia, vascular medicine, and cardiology is critical for safe and timely management. The design and execution of prospective, randomized trials to specifically address optimal diagnosis and management are a top priority in obstetric hematology. AD - Massachusetts General Hospital, 55 Fruit Street, Yawkey 7B, Boston, MA, 02114, USA. afogerty@partners.org. AN - 30039233 AU - Fogerty, A. E. DA - Jul 23 DO - 10.1007/s11936-018-0658-3 DP - NLM ET - 2018/07/25 J2 - Current treatment options in cardiovascular medicine KW - Anticoagulation Deep venous thrombosis Diagnosis Pregnancy Pulmonary embolism Thrombosis LA - eng M1 - 8 N1 - Fogerty, Annemarie E Journal Article Review United States Curr Treat Options Cardiovasc Med. 2018 Jul 23;20(8):69. doi: 10.1007/s11936-018-0658-3. PY - 2018 SN - 1092-8464 (Print) 1092-8464 SP - 69 ST - Management of Venous Thromboembolism in Pregnancy T2 - Curr Treat Options Cardiovasc Med TI - Management of Venous Thromboembolism in Pregnancy VL - 20 ID - 760129 ER - TY - JOUR AB - INTRODUCTION: This study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome in those patients, we examined the association between baseline patient characteristics and a complicated course. METHODS: We included patients aged 70 years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at Ziekenhuisgroep Twente (ZGT) Almelo, the Netherlands between April 2011 and October 2013. Data registration was carried out using the clinical pathways of the CvGT database. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high-risk (HR, ASA 3 ≥, n = 341) and low-risk (LR, ASA 1-2, n = 111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course. RESULTS: The analysis demonstrated that 49.6% (n = 224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (n = 17). In 57.5% (n = 196) of the HR patients, a complicated course was seen compared to 25.2% (n = 28) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p ≤ 0.001), anemia (HR 19.4% vs. LR 6.3%, p = 0.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%, p = 0.301) and pneumonia (HR 10.9% vs. LR 5.4%, p = 0.089). Independent risk factors for a complicated course were increasing age (OR 1.04, 95% CI 1.01-1.07, p = 0.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04-2.37, p = 0.031) and ASA score ≥3 (OR 3.62, 95% CI 2.22-5.91, p ≤ 0.001). CONCLUSIONS: After integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients with a hip fracture. The in-hospital mortality rate was 3.8%. Important risk factors for a complicated course were increasing age, poor medical condition and delirium risk VMS Frailty score. Awareness of risk factors that affect the course during admission can be useful in optimizing care and outcomes. In the search for possible areas for improvement in care, targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs), such as CAUTIs and pneumonia are important. AD - Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands. e.folbert@zgt.nl. Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands. Department of Finance and Organization, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands. ZGT Academy, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands. Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands. Department of Geriatric Medicine, University Medical Centre Groningen, Goningen, Leydenacademy on Vitality and Aging, Leiden, The Netherlands. AN - 28233062 AU - Folbert, E. C. AU - Hegeman, J. H. AU - Gierveld, R. AU - van Netten, J. J. AU - Velde, D. V. AU - Ten Duis, H. J. AU - Slaets, J. P. DA - Apr DO - 10.1007/s00402-017-2646-6 DP - NLM ET - 2017/02/25 J2 - Archives of orthopaedic and trauma surgery KW - Aged Aged, 80 and over Anemia/*epidemiology Arrhythmias, Cardiac/epidemiology Catheter-Related Infections/*epidemiology Delirium/*epidemiology Female Geriatrics Heart Failure/epidemiology Hip Fractures/*surgery *Hospital Mortality Hospitalization Humans Incidence Logistic Models Male Multivariate Analysis Myocardial Infarction Netherlands/epidemiology Orthopedics Patient Care Team Pneumonia/epidemiology Postoperative Complications/*epidemiology Pulmonary Embolism/epidemiology Renal Insufficiency/epidemiology Risk Factors Stroke/epidemiology Surgical Wound Infection/epidemiology Urinary Tract Infections/*epidemiology Asa Adverse outcomes Hip fracture Learning healthcare system Orthogeriatric care Quality improvement LA - eng M1 - 4 N1 - 1434-3916 Folbert, E C Hegeman, J H Gierveld, R van Netten, J J Velde, D van der Ten Duis, H J Slaets, J P Journal Article Germany Arch Orthop Trauma Surg. 2017 Apr;137(4):507-515. doi: 10.1007/s00402-017-2646-6. Epub 2017 Feb 23. PY - 2017 SN - 0936-8051 SP - 507-515 ST - Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment T2 - Arch Orthop Trauma Surg TI - Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment VL - 137 ID - 760123 ER - TY - JOUR AB - Background Neoadjuvant chemotherapy for unresectable colorectal liver metastases can downsize tumours for curative resection. We assessed the effectiveness of cetuximab combined with chemotherapy in this setting. Methods Between Dec 2, 2004, and March 27, 2008, 114 patients were enrolled from 17 centres in Germany and Austria; three patients receiving FOLFOX6 alone were excluded from the analysis. Patients with non-resectable liver metastases (technically non-resectable or >= 5 metastases) were randomly assigned to receive cetuximab with either FOLFOX6 (oxaliplatin, fluorouracil, and folinic acid; group A) or FOLFIRI (irinotecan, fluorouracil, and folinic acid; group B). Randomisation was not blinded, and was stratified by technical resectability and number of metastases, use of PET staging, and EGFR expression status. They were assessed for response every 8 weeks by CT or MRI. A local multidisciplinary team reassessed resectability after 16 weeks, and then every 2 months up to 2 years. Patients with resectable disease were offered liver surgery within 4-6 weeks of the last treatment cycle. The primary endpoint was tumour response assessed by Response Evaluation Criteria In Solid Tumours (RECIST), analysed by modified intention to treat. A retrospective, blinded surgical review of patients with radiological images at both baseline and during treatment was done to assess objectively any changes in resectability. The study is registered with ClinicalTrials. gov, number NCT00153998. Findings 56 patients were randomly assigned to group A and 55 to group B. One patient in each group were excluded from the analysis of the primary endpoint because they discontinued treatment before first full dose, one patient in group B was excluded because of early pulmonary embolism. A confirmed partial or complete response was noted in 36 (68%) of 53 patients in group A, and 30 (57%) of 53 patients in group B (difference 11%, 95% CI -8 to 30; odds ratio [OR] 1.62, 0.74-3-59; p=0.23). The most frequent grade 3 and 4 toxicities were skin toxicity (15 of 54 patients in group A, and 22 of 55 patients in group B), and neutropenia (13 of 54 patients in group A and 12 of 55 patients in group B). R0 resection was done in 20 (38%) of 53 patients in group A and 16 (30%) of 53 of patients in group B. In a retrospective analysis of response by KRAS status, a partial or complete response was noted in 47 (70%) of 67 patients with KRAS wild-type tumours versus 11 (41%) of 27 patients with KRAS-mutated tumours (OR 3.42, 1.35-8-66; p=0.0080). According to the retrospective review, resectability rates increased from 32% (22 of 68 patients) at baseline to 60% (41 of 68) after chemotherapy (p<0.0001). Interpretation Chemotherapy with cetuximab yields high response rates compared with historical controls, and leads to significantly increased resectability. AD - [Folprecht, Gunnar; Stoehlmacher, Jan; Goekkurt, Eray] Univ Hosp Carl Gustav Carus, Univ Canc Ctr, Dept Med 1, D-01307 Dresden, Germany. [Gruenberger, Thomas] Univ Hosp Vienna, Hepatobiliary Serv, Dept Gen Surg, Vienna, Austria. [Bechstein, Wolf O.] Goethe Univ Frankfurt, Dept Surg, Frankfurt, Germany. [Raab, Hans-Rudolf] Klinikum Oldenburg, Dept Surg, Oldenburg, Germany. [Lordick, Florian] Tech Univ Munich, Klinikum Rechts Isar, Dept Med 3, D-8000 Munich, Germany. [Hartmann, Joerg T.] Univ Tubingen Hosp, Dept Med, Tubingen, Germany. [Lang, Hauke] Univ Hosp Mainz, Dept Surg, Mainz, Germany. [Frilling, Andrea] Univ Hosp Essen, Dept Gen Visceral & Transplantat Surg, Essen, Germany. [Weitz, Juergen] Univ Heidelberg Hosp, Dept Surg, Heidelberg, Germany. [Konopke, Ralf] Univ Hosp Carl Gustav Carus, Dept Surg, Univ Canc Ctr, D-01307 Dresden, Germany. [Stroszczynski, Christian] Univ Hosp Carl Gustav Carus, Dept Radiol, D-01307 Dresden, Germany. [Liersch, Torsten] Univ Hosp Gottingen, Dept Surg, Gottingen, Germany. [Ockert, Detlev] Univ Heidelberg Hosp, Natl Ctr Tumor Dis, Heidelberg, Germany. [Herrmann, Thomas] Krankenhaus Barmherzigen Bruder, Trier, Germany. [Parisi, Fabio] NYU, Inst Canc, New York, NY 10003 USA. [Koehne, Claus-Henning] Klinikum Oldenburg, Dept Hematol & Oncol, Oldenburg, Germany. Folprecht, G (corresponding author), Univ Hosp Carl Gustav Carus, Univ Canc Ctr, Dept Med 1, Fetscherstr 74, D-01307 Dresden, Germany. Gunnar.Folprecht@uniklinikum-dresden.de AN - WOS:000273874100020 AU - Folprecht, G. AU - Gruenberger, T. AU - Bechstein, W. O. AU - Raab, H. R. AU - Lordick, F. AU - Hartmann, J. T. AU - Lang, H. AU - Frilling, A. AU - Stoehlmacher, J. AU - Weitz, J. AU - Konopke, R. AU - Stroszczynski, C. AU - Liersch, T. AU - Ockert, D. AU - Herrmann, T. AU - Goekkurt, E. AU - Parisi, F. AU - Kohne, C. H. DA - Jan DO - 10.1016/s1470-2045(09)70330-4 J2 - Lancet Oncol. KW - 1ST-LINE TREATMENT HEPATIC RESECTION PLUS IRINOTECAN CANCER OXALIPLATIN FLUOROURACIL LEUCOVORIN BEVACIZUMAB COMBINATION GUIDELINES Oncology LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 547GH Times Cited: 631 Cited Reference Count: 33 Folprecht, Gunnar Gruenberger, Thomas Bechstein, Wolf O. Raab, Hans-Rudolf Lordick, Florian Hartmann, Joerg T. Lang, Hauke Frilling, Andrea Stoehlmacher, Jan Weitz, Juergen Konopke, Ralf Stroszczynski, Christian Liersch, Torsten Ockert, Detlev Herrmann, Thomas Goekkurt, Eray Parisi, Fabio Koehne, Claus-Henning Bechstein, Wolf/H-5457-2019; Folprecht, Gunnar/F-8638-2011; Hartmann, Joerg Thomas/E-3369-2010; Gruenberger, Thomas/ABA-1661-2020; Weitz, Juergen/L-7136-2018 Bechstein, Wolf/0000-0002-3267-8145; Folprecht, Gunnar/0000-0002-9321-9911; Gruenberger, Thomas/0000-0002-2671-0540 Merck-SeronoMerck SeronoMerck & Company; Sanofi AventisSanofi-Aventis; PfizerPfizer We thank all patients who consented to enter the study, all investigators from the participating study sites, and the data managers (especially Ute Schubert and Evelyn Franke) for their great support. We acknowledge support from Merck-Serono, Sanofi Aventis, and Pfizer, and also thank Paul Hoban for medical writing support. 660 0 42 ELSEVIER SCIENCE INC NEW YORK LANCET ONCOL PY - 2010 SN - 1470-2045 SP - 38-47 ST - Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial T2 - Lancet Oncology TI - Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial UR - ://WOS:000273874100020 VL - 11 ID - 761884 ER - TY - JOUR AB - BACKGROUND: Neoadjuvant chemotherapy for unresectable colorectal liver metastases can downsize tumours for curative resection. We assessed the effectiveness of cetuximab combined with chemotherapy in this setting. METHODS: Between Dec 2, 2004, and March 27, 2008, 114 patients were enrolled from 17 centres in Germany and Austria; three patients receiving FOLFOX6 alone were excluded from the analysis. Patients with non-resectable liver metastases (technically non-resectable or > or =5 metastases) were randomly assigned to receive cetuximab with either FOLFOX6 (oxaliplatin, fluorouracil, and folinic acid; group A) or FOLFIRI (irinotecan, fluorouracil, and folinic acid; group B). Randomisation was not blinded, and was stratified by technical resectability and number of metastases, use of PET staging, and EGFR expression status. They were assessed for response every 8 weeks by CT or MRI. A local multidisciplinary team reassessed resectability after 16 weeks, and then every 2 months up to 2 years. Patients with resectable disease were offered liver surgery within 4-6 weeks of the last treatment cycle. The primary endpoint was tumour response assessed by Response Evaluation Criteria In Solid Tumours (RECIST), analysed by modified intention to treat. A retrospective, blinded surgical review of patients with radiological images at both baseline and during treatment was done to assess objectively any changes in resectability. The study is registered with ClinicalTrials.gov, number NCT00153998. FINDINGS: 56 patients were randomly assigned to group A and 55 to group B. One patient in each group were excluded from the analysis of the primary endpoint because they discontinued treatment before first full dose, one patient in group B was excluded because of early pulmonary embolism. A confirmed partial or complete response was noted in 36 (68%) of 53 patients in group A, and 30 (57%) of 53 patients in group B (difference 11%, 95% CI -8 to 30; odds ratio [OR] 1.62, 0.74-3.59; p=0.23). The most frequent grade 3 and 4 toxicities were skin toxicity (15 of 54 patients in group A, and 22 of 55 patients in group B), and neutropenia (13 of 54 patients in group A and 12 of 55 patients in group B). R0 resection was done in 20 (38%) of 53 patients in group A and 16 (30%) of 53 of patients in group B. In a retrospective analysis of response by KRAS status, a partial or complete response was noted in 47 (70%) of 67 patients with KRAS wild-type tumours versus 11 (41%) of 27 patients with KRAS-mutated tumours (OR 3.42, 1.35-8.66; p=0.0080). According to the retrospective review, resectability rates increased from 32% (22 of 68 patients) at baseline to 60% (41 of 68) after chemotherapy (p<0.0001). INTERPRETATION: Chemotherapy with cetuximab yields high response rates compared with historical controls, and leads to significantly increased resectability. FUNDING: Merck-Serono, Sanofi-Aventis, and Pfizer. AD - University Hospital Carl Gustav Carus, Medical Department I/University Cancer Center, Dresden, Germany. Gunnar.Folprecht@uniklinikum-dresden.de AN - 19942479 AU - Folprecht, G. AU - Gruenberger, T. AU - Bechstein, W. O. AU - Raab, H. R. AU - Lordick, F. AU - Hartmann, J. T. AU - Lang, H. AU - Frilling, A. AU - Stoehlmacher, J. AU - Weitz, J. AU - Konopke, R. AU - Stroszczynski, C. AU - Liersch, T. AU - Ockert, D. AU - Herrmann, T. AU - Goekkurt, E. AU - Parisi, F. AU - Köhne, C. H. DA - Jan DO - 10.1016/s1470-2045(09)70330-4 DP - NLM ET - 2009/11/28 J2 - The Lancet. Oncology KW - Aged Antibodies, Monoclonal/adverse effects/*therapeutic use Antibodies, Monoclonal, Humanized Antineoplastic Agents/adverse effects/*therapeutic use Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use Austria Camptothecin/adverse effects/analogs & derivatives/therapeutic use Cetuximab Chemotherapy, Adjuvant Colorectal Neoplasms/*pathology ErbB Receptors/analysis Female Fluorouracil/adverse effects/therapeutic use Germany *Hepatectomy Humans Leucovorin/adverse effects/therapeutic use Linear Models Liver Neoplasms/chemistry/*drug therapy/genetics/secondary/*surgery Magnetic Resonance Imaging Male Middle Aged Mutation Neoadjuvant Therapy Odds Ratio Organoplatinum Compounds/adverse effects/therapeutic use Proto-Oncogene Proteins/genetics Proto-Oncogene Proteins B-raf/genetics Proto-Oncogene Proteins p21(ras) Retrospective Studies Risk Assessment Time Factors Tomography, Spiral Computed Treatment Outcome ras Proteins/genetics LA - eng M1 - 1 N1 - 1474-5488 Folprecht, Gunnar Gruenberger, Thomas Bechstein, Wolf O Raab, Hans-Rudolf Lordick, Florian Hartmann, Jörg T Lang, Hauke Frilling, Andrea Stoehlmacher, Jan Weitz, Jürgen Konopke, Ralf Stroszczynski, Christian Liersch, Torsten Ockert, Detlev Herrmann, Thomas Goekkurt, Eray Parisi, Fabio Köhne, Claus-Henning Clinical Trial, Phase II Journal Article Multicenter Study Randomized Controlled Trial England Lancet Oncol. 2010 Jan;11(1):38-47. doi: 10.1016/S1470-2045(09)70330-4. Epub 2009 Nov 26. PY - 2010 SN - 1470-2045 SP - 38-47 ST - Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial T2 - Lancet Oncol TI - Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial VL - 11 ID - 760152 ER - TY - JOUR AB - Background: Neoadjuvant chemotherapy for unresectable colorectal liver metastases can downsize tumours for curative resection. We assessed the effectiveness of cetuximab combined with chemotherapy in this setting.Methods: Between Dec 2, 2004, and March 27, 2008, 114 patients were enrolled from 17 centres in Germany and Austria; three patients receiving FOLFOX6 alone were excluded from the analysis. Patients with non-resectable liver metastases (technically non-resectable or > or =5 metastases) were randomly assigned to receive cetuximab with either FOLFOX6 (oxaliplatin, fluorouracil, and folinic acid; group A) or FOLFIRI (irinotecan, fluorouracil, and folinic acid; group B). Randomisation was not blinded, and was stratified by technical resectability and number of metastases, use of PET staging, and EGFR expression status. They were assessed for response every 8 weeks by CT or MRI. A local multidisciplinary team reassessed resectability after 16 weeks, and then every 2 months up to 2 years. Patients with resectable disease were offered liver surgery within 4-6 weeks of the last treatment cycle. The primary endpoint was tumour response assessed by Response Evaluation Criteria In Solid Tumours (RECIST), analysed by modified intention to treat. A retrospective, blinded surgical review of patients with radiological images at both baseline and during treatment was done to assess objectively any changes in resectability. The study is registered with ClinicalTrials.gov, number NCT00153998.Findings: 56 patients were randomly assigned to group A and 55 to group B. One patient in each group were excluded from the analysis of the primary endpoint because they discontinued treatment before first full dose, one patient in group B was excluded because of early pulmonary embolism. A confirmed partial or complete response was noted in 36 (68%) of 53 patients in group A, and 30 (57%) of 53 patients in group B (difference 11%, 95% CI -8 to 30; odds ratio [OR] 1.62, 0.74-3.59; p=0.23). The most frequent grade 3 and 4 toxicities were skin toxicity (15 of 54 patients in group A, and 22 of 55 patients in group B), and neutropenia (13 of 54 patients in group A and 12 of 55 patients in group B). R0 resection was done in 20 (38%) of 53 patients in group A and 16 (30%) of 53 of patients in group B. In a retrospective analysis of response by KRAS status, a partial or complete response was noted in 47 (70%) of 67 patients with KRAS wild-type tumours versus 11 (41%) of 27 patients with KRAS-mutated tumours (OR 3.42, 1.35-8.66; p=0.0080). According to the retrospective review, resectability rates increased from 32% (22 of 68 patients) at baseline to 60% (41 of 68) after chemotherapy (p<0.0001).Interpretation: Chemotherapy with cetuximab yields high response rates compared with historical controls, and leads to significantly increased resectability.Funding: Merck-Serono, Sanofi-Aventis, and Pfizer. AD - University Hospital Carl Gustav Carus, Medical Department I/University Cancer Center, Dresden, Germany AN - 105128059. Language: English. Entry Date: 20100326. Revision Date: 20200708. Publication Type: journal article AU - Folprecht, G. AU - Gruenberger, T. AU - Bechstein, W. O. AU - Raab, H. R. AU - Lordick, F. AU - Hartmann, J. T. AU - Lang, H. AU - Frilling, A. AU - Stoehlmacher, J. AU - Weitz, J. AU - Konopke, R. AU - Stroszczynski, C. AU - Liersch, T. AU - Ockert, D. AU - Herrmann, T. AU - Goekkurt, E. AU - Parisi, F. AU - Köhne, C. H. AU - Folprecht, Gunnar AU - Gruenberger, Thomas DB - CINAHL DO - 10.1016/S1470-2045(09)70330-4 DP - EBSCOhost KW - Antibodies, Monoclonal -- Therapeutic Use Antineoplastic Agents -- Therapeutic Use Antineoplastic Agents, Combined -- Therapeutic Use Colorectal Neoplasms -- Pathology Surgery, Digestive System Liver Neoplasms -- Drug Therapy Liver Neoplasms -- Surgery Aged Antibodies, Monoclonal -- Adverse Effects Antineoplastic Agents -- Adverse Effects Antineoplastic Agents, Combined -- Adverse Effects Austria Camptothecin -- Adverse Effects Camptothecin -- Analogs and Derivatives Camptothecin -- Therapeutic Use Chemotherapy, Adjuvant Female Fluorouracil -- Adverse Effects Fluorouracil -- Therapeutic Use Germany Human Leucovorin -- Adverse Effects Leucovorin -- Therapeutic Use Linear Regression Liver Neoplasms Magnetic Resonance Imaging Male Middle Age Mutation Neoadjuvant Therapy Odds Ratio Organoplatinum Compounds -- Adverse Effects Organoplatinum Compounds -- Therapeutic Use Proteins Transferases Epidermal Growth Factors -- Analysis Retrospective Design Risk Assessment Time Factors Tomography, X-Ray Computed Treatment Outcomes Clinical Trials M1 - 1 N1 - clinical trial; research. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 100957246. PMID: NLM19942479. PY - 2010 SN - 1470-2045 SP - 38-47 ST - Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial T2 - Lancet Oncology TI - Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=105128059&site=ehost-live&scope=site VL - 11 ID - 761397 ER - TY - JOUR AB - Background and Purpose-The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time-dependent, and guidelines recommend a door-to-needle time of <= 60 minutes. However, fewer than one third of acute ischemic stroke patients who receive tPA are treated within guideline-recommended door-to-needle times. This article describes the design and rationale of Target: Stroke, a national initiative organized by the American Heart Association/American Stroke Association in partnership with other organizations to assist hospitals in increasing the proportion of tPA-treated patients who achieve guideline-recommended door-to-needle times. Methods-The initial program goal is to achieve a door-to-needle time <60 minutes for at least 50% of acute ischemic stroke patients. Key best practice strategies previously associated with achieving faster door-to-needle times in acute ischemic stroke were identified. Results-The 10 key strategies chosen by Target: Stroke include emergency medical service prenotification, activating the stroke team with a single call, rapid acquisition and interpretation of brain imaging, use of specific protocols and tools, premixing tPA, a team-based approach, and rapid data feedback. The program includes many approaches intended to promote hospital participation, implement effective strategies, share best practices, foster collaboration, and achieve stated goals. A detailed program evaluation is also included. In the first year, Target: Stroke has enrolled over 1200 United States hospitals. Conclusions-Target: Stroke, a multidimensional initiative to improve the timeliness of tPA administration, aims to elevate clinical performance in the care of acute ischemic stroke, facilitate the more rapid integration of evidence into clinical practice, and improve outcomes. (Stroke. 2011;42:2983-2989.) AD - [Fonarow, Gregg C.] Univ Calif Los Angeles, Div Cardiol, Los Angeles, CA USA. [Smith, Eric E.] Univ Calgary, Dept Clin Neurosci, Hotchkiss Brain Inst, Calgary, AB T2N 1N4, Canada. [Saver, Jeffrey L.] Univ Calif Los Angeles, Dept Neurol, Los Angeles, CA 90024 USA. [Reeves, Mathew J.] Michigan State Univ, Dept Epidemiol, E Lansing, MI 48824 USA. [Hernandez, Adrian F.; Peterson, Eric D.] Duke Clin Res Ctr, Durham, NC USA. [Sacco, Ralph L.] Univ Miami, Miller Sch Med, Miami, FL 33136 USA. [Schwamm, Lee H.] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA. Fonarow, GC (corresponding author), Ronald Reagan UCLA Med Ctr, Ahmanson UCLA Cardiomyopathy Ctr, 10833 LeConte Ave,Room 47-123 CHS, Los Angeles, CA 90095 USA. gfonarow@mednet.ucla.edu AN - WOS:000295217100066 AU - Fonarow, G. C. AU - Smith, E. E. AU - Saver, J. L. AU - Reeves, M. J. AU - Hernandez, A. F. AU - Peterson, E. D. AU - Sacco, R. L. AU - Schwamm, L. H. DA - Oct DO - 10.1161/strokeaha.111.621342 J2 - Stroke KW - acute stroke thrombolytics quality of care quality improvement PLASMINOGEN-ACTIVATOR QUALITY IMPROVEMENT POOLED ANALYSIS CARE THROMBOLYSIS ALTEPLASE BALLOON DELAYS NINDS GUIDELINES Clinical Neurology Peripheral Vascular Disease LA - English M1 - 10 M3 - Article N1 - ISI Document Delivery No.: 824QM Times Cited: 203 Cited Reference Count: 31 Fonarow, Gregg C. Smith, Eric E. Saver, Jeffrey L. Reeves, Mathew J. Hernandez, Adrian F. Peterson, Eric D. Sacco, Ralph L. Schwamm, Lee H. Smith, Eric E/C-5443-2012; Fonarow, Gregg C/D-5988-2014; Demchuk, Andrew M/E-1103-2012; Hernandez, Adrian F/A-7818-2016; Sacco, Ralph/Y-9278-2019 Smith, Eric E/0000-0003-3956-1668; Fonarow, Gregg C/0000-0002-3192-8093; Demchuk, Andrew M/0000-0002-4930-7789; Hernandez, Adrian F/0000-0003-3387-9616; Saver, Jeffrey/0000-0001-9141-2251; Schwamm, Lee/0000-0003-0592-9145 National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA; Michigan Stroke Registry; AHAAmerican Heart Association [0675060N]; Johnson JohnsonJohnson & Johnson USA; LillyEli Lilly; Bristol-Myers SquibbBristol-Myers Squibb; Sanofi-AventisSanofi-Aventis; Merck-Schering Plough partnershipMerck & Company G.C.F. serves a member of the GWTG Steering Committee, receives research support from the National Institutes of Health (significant), served as a consultant to Pfizer (modest); and is an employee of the University of California, which holds a patent on retriever devices for stroke (significant). E. E. S. serves as a member of the GWTG Steering Subcommittee and has served on an advisory board for Genentech (modest). J.L.S. serves as a member of the GWTG Science Subcommittee, as a scientific consultant regarding trial design and conduct to CoAxia, Concentric Medical, Talacris, Ferrer, Photothera, Brainsgate, Sygnis, and Ev3; received lecture honoraria from Ferrer; is an employee of the University of California, which holds a patent on retriever devices for stroke. M.J.R. receives salary support from the Michigan Stroke Registry and serves as a member of several AHA GWTG Subcommittees. A. F. H. is a member of the Duke Clinical Research Institute, which serves as the AHA/ASA GWTG data coordinating center; is a recipient of an AHA Pharmaceutical Roundtable grant (0675060N) and has received a research grant from Johnson & Johnson; has received honorarium from AstraZeneca and Amgen. E. D. P. has received research grants from Lilly, Johnson & Johnson, and Bristol-Myers Squibb, Sanofi-Aventis, and Merck-Schering Plough partnership. Dr Peterson serves as Principle investigator of the Data Analytic Center for AHA/ASA's GWTG. R. L. S. is president of the AHA/ASA. L. H. S. serves as chair of the AHA/ASA's GWTG Steering Committee; serves as a consultant to the Research Triangle Institute and to the Massachusetts Department of Public Health, and serves on the Steering Committee for Lundbeck's DIAS4 clinical trial. 213 0 12 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA STROKE PY - 2011 SN - 0039-2499 SP - 2983-U493 ST - Improving Door-to-Needle Times in Acute Ischemic Stroke The Design and Rationale for the American Heart Association/American Stroke Association's Target: Stroke Initiative T2 - Stroke TI - Improving Door-to-Needle Times in Acute Ischemic Stroke The Design and Rationale for the American Heart Association/American Stroke Association's Target: Stroke Initiative UR - ://WOS:000295217100066 VL - 42 ID - 761844 ER - TY - JOUR AB - Background and Purpose-Earlier tissue-type plasminogen activator (tPA) treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times. We used lean process improvement methodology to develop a streamlined intravenous tPA protocol. Methods-In early 2011, a multidisciplinary team analyzed the steps required to treat patients with acute ischemic stroke with intravenous tPA using value stream analysis (VSA). We directly compared the-tPA--treated patients in the "pre-VSA" epoch with the "post-VSA" epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. Results-The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to the room; serial processing of workflow; and delays in waiting for laboratory results. On March 1, 2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT before the patient room, using parallel process workflow, and implementing point-of-care laboratories. In the pre- and post-VSA epochs, 132 and 87 patients were treated with intravenous tPA, respectively. Compared with pre-VSA, door-to-needle times and percent of patients treated <= 60 minutes from hospital arrival were improved in the post-VSA epoch: 60 minutes versus 39 minutes (P<0.0001) and 52% versus 78% (P<0.0001), respectively, with no change in symptomatic hemorrhage rate. Conclusions-Lean process improvement methodology can expedite-time-dependent stroke care without compromising safety. (Stroke. 2012;43:3395-3398.) AD - [Ford, Andria L.; Khoury, Naim; Sampson, Tomoko R.; Panagos, Peter; Lee, Jin-Moo] Washington Univ, Sch Med, Dept Neurol, St Louis, MO 63110 USA. [Panagos, Peter] Washington Univ, Sch Med, Dept Emergency Med, St Louis, MO 63110 USA. [Lee, Jin-Moo] Washington Univ, Sch Med, Dept Radiol, St Louis, MO 63110 USA. [Williams, Jennifer A.] Barnes Jewish Hosp, Emergency Dept, St Louis, MO 63110 USA. [Spencer, Mary] Barnes Jewish Hosp, Neurol & Neurosurg Ctr, St Louis, MO 63110 USA. Lee, JM (corresponding author), Washington Univ, Sch Med, Dept Neurol, 600 S Euclid Ave,Box 8111, St Louis, MO 63110 USA. leejm@neuro.wustl.edu AN - WOS:000311497600052 AU - Ford, A. L. AU - Williams, J. A. AU - Spencer, M. AU - McCammon, C. AU - Khoury, N. AU - Sampson, T. R. AU - Panagos, P. AU - Lee, J. M. DA - Dec DO - 10.1161/strokeaha.112.670687 J2 - Stroke KW - acute stroke protocol door-to-needle time lean manufacturing thrombolytic tPA value stream analysis STROKE MIMICS THROMBOLYSIS ASSOCIATION ISCHEMIA Clinical Neurology Peripheral Vascular Disease LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: 042UU Times Cited: 92 Cited Reference Count: 12 Ford, Andria L. Williams, Jennifer A. Spencer, Mary McCammon, Craig Khoury, Naim Sampson, Tomoko R. Panagos, Peter Lee, Jin-Moo Lee, Jin-Moo/K-2024-2015 Lee, Jin-Moo/0000-0002-3979-0906; Williams, Jennifer/0000-0001-9248-3959; Panagos, Peter/0000-0003-1464-0167 Specialized Programs of Translational Research in Acute Stroke (SPOTRIAS) grant [NIH5P50NS055977]; Institute of Clinical and Translational Sciences at Washington University [UL1 TR000448]; [NIHK23NS069807] This study was supported by NIHK23NS069807 to Dr Ford, the Specialized Programs of Translational Research in Acute Stroke (SPOTRIAS) grant, NIH5P50NS055977, to Dr Lee and Dr Panagos and the Institute of Clinical and Translational Sciences at Washington University, UL1 TR000448. 105 0 49 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA STROKE PY - 2012 SN - 0039-2499 SP - 3395-+ ST - Reducing Door-to-Needle Times Using Toyota's Lean Manufacturing Principles and Value Stream Analysis T2 - Stroke TI - Reducing Door-to-Needle Times Using Toyota's Lean Manufacturing Principles and Value Stream Analysis UR - ://WOS:000311497600052 VL - 43 ID - 761817 ER - TY - JOUR AB - INTRODUCTION: Implementing patient education (PE) in a defined geographic area, based on a population-based approach, implies using community resources according to a logic of complementarity, in order to mitigate the risk of rupture in patient care. METHODS: The PE Resource Centre for the Ile-de-France Region convened a multidisciplinary and multi-setting meeting attended by 45 participants in order to define the ways to improve the complementarity of all available PE resources, while taking into account the diversity of patients' needs. Three working groups successively explored three dimensions: structure, processes and outcomes, in order to assess this complementarity. RESULTS: Each group worked on three aspects: PE resources; patient's health trajectory in a defined geographic area, and a multidisciplinary team approach.Participants identified various deficits: clustering and lack of visibility for PE resources, programme framing constraints and difficulties of access for patients. Nevertheless, they highlighted several positive elements emerging from their shared experience. They recommend: 1) sharing of the available resources by developing communication and multidisciplinary training and more flexible programme formats; 2) building links between stakeholders, by promoting local PE programmes, and by encouraging coordination and practice analysis; 3) using and articulating a diversity of evaluation approaches, while reinforcing the multidimensional nature of PE contributions, not only for patients but also for professionals and the healthcare system. DISCUSSION: PE Resource Centres may facilitate implementation of these recommendations by supporting a collective and dynamic approach, contributing to a reduction of social inequalities in PE access. AN - 30541259 AU - Fournier, C. AU - Cittée, J. AU - Brugerolles, H. AU - Faury, E. AU - Bourgeois, I. AU - Le Bel, J. AU - Dorsa Figueiredo, M. AU - Traynard, P. Y. DA - May-June DO - 10.3917/spub.183.0307 DP - NLM ET - 2018/12/14 J2 - Sante publique (Vandoeuvre-les-Nancy, France) KW - Formative Feedback Guidelines as Topic Humans Patient Education as Topic/*methods/*organization & administration LA - fre M1 - 3 N1 - Fournier, Cécile Cittée, Jacques Brugerolles, Héléna Faury, Evelyne Bourgeois, Isabelle Le Bel, Josselin Dorsa Figueiredo, Mariana Traynard, Pierre-Yves Journal Article France Sante Publique. 2018 May-June;30(3):307-311. doi: 10.3917/spub.183.0307. OP - Améliorer la complémentarité des offres d'éducation thérapeutique du patient : retour d'expérience et recommandations. PY - 2018 SN - 0995-3914 (Print) 0995-3914 SP - 307-311 ST - [Improving the complementarity of patient education proposals: Experience feedback and recommendations] T2 - Sante Publique TI - [Improving the complementarity of patient education proposals: Experience feedback and recommendations] VL - 30 ID - 760271 ER - TY - JOUR AB - Introduction: Implementing patient education (PE) in a defined geographic area, based on a population-based approach, implies using community resources according to a logic of complementarity, in order to mitigate the risk of rupture in patient care. Methods: The PE Resource Centre for the Ile-de-France Region convened a multidisciplinary and multi-setting meeting attended by 45 participants in order to define the ways to improve the complementarity of all available PE resources, while taking into account the diversity of patients' needs. Three working groups successively explored three dimensions: structure, processes and outcomes, in order to assess this complementarity. Results: Each group worked on three aspects: PE resources; patient's health trajectory in a defined geographic area, and a multidisciplinary team approach. Participants identified various deficits: clustering and lack of visibility for PE resources, programme framing constraints and difficulties of access for patients. Nevertheless, they highlighted several positive elements emerging from their shared experience. They recommend: 1) sharing of the available resources by developing communication and multidisciplinary training and more flexible programme formats; 2) building links between stake-holders, by promoting local PE programmes, and by encouraging coordination and practice analysis; 3) using and articulating a diversity of evaluation approaches, while reinforcing the multidimensional nature of PE contributions, not only for patients but also for professionals and the healthcare system. Discussion: PE Resource Centres may facilitate implementation of these recommendations by supporting a collective and dynamic approach, contributing to a reduction of social inequalities in PE access. AD - [Fournier, Cecile; Cittee, Jacques; Brugerolles, Helena; Le Bel, Josselin; Figueiredo, Mariana Dorsa; Traynard, Pierre-Yves] Conseil Sci Pole Res, ETP, 34 Rue Villiers de Lisle Adam, F-75020 Paris, France. [Fournier, Cecile] IRDES, 117 Bis Rue Manin, F-75019 Paris, France. [Cittee, Jacques] FEMASIF Federat Maisons & Poles Sante Ile de Fran, 9 Rue St Bruno, F-75018 Paris, France. [Faury, Evelyne] Agence Reg Ile de France, 35 Rue Gare, F-75019 Paris, France. [Bourgeois, Isabelle] Icone Mediat Sante, 83 Blvd Voltaire, F-35000 Rennes, France. [Le Bel, Josselin] Univ Paris Diderot, Dept Med Gen, Sorbonne Paris Cite, F-75018 Paris, France. [Traynard, Pierre-Yves] IAME, INSERM, UMR 1137, Paris, France. Traynard, PY (corresponding author), Conseil Sci Pole Res, ETP, 34 Rue Villiers de Lisle Adam, F-75020 Paris, France. traynard2@wanadoo.fr AN - WOS:000445130900003 AU - Fournier, C. AU - Cittee, J. AU - Brugerolles, H. AU - Faury, E. AU - Bourgeois, I. AU - Le Bel, J. AU - Figueiredo, M. D. AU - Traynard, P. Y. DA - May-Jun DO - 10.3917/spub.183.0307 J2 - Sante Publique KW - Patient education complementarity of health services Interprofessional relations Territorial network Public, Environmental & Occupational Health LA - French M1 - 3 M3 - Article N1 - ISI Document Delivery No.: GU2WA Times Cited: 0 Cited Reference Count: 9 Fournier, Cecile Cittee, Jacques Brugerolles, Helena Faury, Evelyne Bourgeois, Isabelle Le Bel, Josselin Figueiredo, Mariana Dorsa Traynard, Pierre-Yves 0 3 SOC FRANCAISE SANTE PUBLIQUE VANDOEUVRE-LES-NANCY CEDEX SANTE PUBLIQUE PY - 2018 SN - 0995-3914 SP - 307-311 ST - Improving the complementarity of patient education proposals: experience feedback and recommendations T2 - Sante Publique TI - Improving the complementarity of patient education proposals: experience feedback and recommendations UR - ://WOS:000445130900003 VL - 30 ID - 761589 ER - TY - JOUR AB - Introduction: Surgical treatment for chronic thromboembolic pulmonary hypertension (CTEPH) is challenging. Most Portuguese patients with CTEPH have been referred to foreign institutions for treatment, with significant social and economic costs. To meet this emerging need, the cardiothoracic surgery department of Hospital de Santa Marta, Lisbon, has developed a dedicated program for pulmonary thromboendarterectomy (PTE). We hereby present the results for the first 19 patients treated. Methods: We conducted a retrospective analysis of all 19 patients who underwent PTE at Hospital de Santa Marta between 2008 and April 2019. Results: Since 2008, a total of 19 patients have undergone PTE in our department. The procedure was performed with good outcomes in both survival and functional recovery. At the very beginning of the series two patients died perioperatively, before all the team underwent formal training at the Royal Papworth Hospital, UK, with no early deaths since. Postoperative complications were similar to other published series. During 11 years of follow-up, there were three late deaths, all in patients with residual pulmonary arterial hypertension. At the latest follow-up (October 2019), all surviving patients showed significant functional recovery, all in NYHA class I or II, with only one patient on vasodilator therapy with sildenafil (the first in the series, operated in 2008). Conclusions: PTE is a demanding procedure, in which outcomes are related to volume and accumulated experience, however it can be performed safely and with reproducible results by a properly prepared dedicated team with a well -controlled learning curve. More patients and multidisciplinary experience will be needed to further improve and streamline results. (C) 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U. AD - [Fragata, Jose; Telles, Helena] Ctr Hosp & Univ Lisboa Cent CHULC, Hosp Santa Marta, Nova Med Sch, Serv Cirurgia Cardiotorac, Lisbon, Portugal. Telles, H (corresponding author), Ctr Hosp & Univ Lisboa Cent CHULC, Hosp Santa Marta, Nova Med Sch, Serv Cirurgia Cardiotorac, Lisbon, Portugal. htellesa@gmail.com AN - WOS:000572678000005 AU - Fragata, J. AU - Telles, H. DA - Sep DO - 10.1016/j.repc.2020.05.006 J2 - Rev. Port. Cardiol. KW - Chronic thromboembolic pulrnonary hypertension Pulmonary thromboendarterectomy Single-center report results Cardiothoracic surgery Pulplonary hypertension Treatment Cardiac & Cardiovascular Systems LA - English M1 - 9 M3 - Article N1 - ISI Document Delivery No.: NT0YR Times Cited: 1 Cited Reference Count: 12 Fragata, Jose Telles, Helena 1 0 ELSEVIER ESPANA SLU BARCELONA REV PORT CARDIOL PY - 2020 SN - 0870-2551 SP - 505-512 ST - Pulmonary thromboendarterectomy in Portugal: Initial experience T2 - Revista Portuguesa De Cardiologia TI - Pulmonary thromboendarterectomy in Portugal: Initial experience UR - ://WOS:000572678000005 VL - 39 ID - 761411 ER - TY - JOUR AB - Background: Behçet's disease (BD) is a systemic vasculitis which ethiopathogenesis still poorly understood. Vascular involvement is one of the major causes of mortality and morbidity in this disease. It occupies a special place in the cardiovascular pathologies because of its venous and arterial tropism all confounded caliber but also because of its pejorative prognosis as well on the functional level as vital. Objectives: Our goal was to present the various venous and arterial manifestations of BD, their epidemiological, clinical, evolutionary and therapeutic characteristics. Methods: This is a retrospective study over a period of 9 years [2009-2018] that enrolled 87 patients who met the international criteria for Behçet's disease. The characteristics of vascular involvement were studied. Results: Twenty-two patients had vascular involvement (25%). There are 17 men and 5 women (sex ratio H/F=3,4), mean age at diagnosis of angina Behçet 39 years [22 years-63 years]. The vascular lesions were indicative of the disease in 17 cases (77%), and for the other 5 patients, the mean time to onset of vascular disease compared with the diagnosis of BD was 2 years. Venous thrombosis involved 20 patients (90%). They were deep in 16 patients, superficial in one patient and superficial and deep in 3 patients. It was recurrent in 14 patients. The most common site of deep vein thrombosis was the lower limbs (n=17). The others had unusual sites: inferior vena cava thrombosis (n = 3), superior vena cava thrombosis (n = 2), sus-hepatic vein (n=1) and upper limb thrombosis (n = 1). Pulmonary embolism was noted in one case. Arterial damage involved 4 patients (20%) divided into arterial aneurysms (3 cases) and arterial thromboses (2 cases). The locations were divided as follows: lower extremity arteries in 2 cases, upper limb arteries in one case, pulmonary artery in 2 cases and abdominal aorta in one case. Lower limb ischemia had occurred in one patient. Two patients (10%) had mixed vascular, arterial and venous involvement, confirming the multiple and ubiquitous nature of angio-Behçet. The treatment was based on colchicine, anticoagulants and corticosteroids in venous thromboses. Immunosuppressive therapy was started in 4 patients in front of the unusual site. In arterial cases, corticosteroids in combination with immunosuppressant were prescribed. Flattening of the aneurysm was indicated in 2 cases with simple operative follow-up. Conclusion: Behçet disease (BD) is very common in the Mediterranean basin, mainly affects the 30-year-old man. This systemic disease is characterized by oral aphthosis, genital ulcers and systemic involvement including occular, gastrointestinal, neurological, and vessels that make the severity of the disease. All types of vessels, regardless of size and seat, may be affected, with venous tropism. Our study has just supported current literature data regarding the extensive and recurrent venous thrombosis during MB. The seriousness of this venous involvement lies in the involvement of the cavernous veins and in pulmonary embolism. Arterial damage, such as thrombosis and/or aneurysm, is rare but maybe life-threatening. Early diagnosis, intensive and appropriate treatment, regular follow-up and the involvement of a multidisciplinary team including internists, vascular surgeons and radiologists are key to better management of patients with angio -Behçet. Our study illustrates the frequency and significance of vascular involvement in BD. AD - A. Fraj, Mohamed Taher Maamouri Hospital, Internal Medicine Department, Nabeul, Tunisia AU - Fraj, A. AU - Elamri, R. AU - Garbouj, W. AU - Alaya, Z. AU - Khalfallah, R. AU - Tounsi, H. AU - Chaabane, I. DB - Embase DO - 10.1136/annrheumdis-2019-eular.5414 KW - anticoagulant agent colchicine corticosteroid immunosuppressive agent abdominal aorta adult aneurysm angina pectoris artery thrombosis conference abstract deep vein thrombosis diagnosis drug combination drug therapy early diagnosis female follow up foot and mouth disease genital ulcer human immunosuppressive treatment inferior cava vein internist leg ischemia liver vein lung embolism major clinical study male multidisciplinary team nervous system pulmonary artery radiologist retrospective study sex ratio superior cava vein systemic disease systemic vasculitis tropism upper limb vascular lesion vascular surgeon LA - English M3 - Conference Abstract N1 - L628808117 2019-08-09 PY - 2019 SN - 1468-2060 SP - 2094-2095 ST - Vascular involvement in behçet's disease : About 87 cases T2 - Annals of the Rheumatic Diseases TI - Vascular involvement in behçet's disease : About 87 cases UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628808117&from=export http://dx.doi.org/10.1136/annrheumdis-2019-eular.5414 VL - 78 ID - 760707 ER - TY - JOUR AB - Polycythaemia Vera (PV) is a clonal haematopoietic disorder characterised by an elevated haematocrit in association with either the JAK2 V617F or JAK12 exon 12 mutation. The BSH guidelines for the investigation, diagnosis and management of Polycythaemia Vera (PV) were published in November 2018. The guidelines suggest consideration of a red cell mass study (RCM) in males if the haematocrit is between 0.48-0.52 in JAK2 Essential thrombocythaemia. This will confirm whether erythrocytosis is present. The risk stratification for PV into high and low risk is based upon age > 65 and previous thrombotic episodes. High risk patients require cytoreduction. Patients categorised as low risk but with certain features such as White cell count > 15, cardiovascular risk factors, extreme thrombocytosis or uncontrolled venesection can be considered at higher risk. A retrospective review of PV patients diagnosed at the Royal Hallamshire Hospital and Barnsley District General Hospital from 2013- 2018 was analysed to determine if clinical management needs to be changed. The list of PV patients was identified from the Haematology Multidisciplinary Team discussions. There were 97 patients diagnosed with PV between 2013-2018. The mean age was 69.3 years. Sixty patients were male. The mean White cell count at diagnosis was 9.8 (5.2-31.9). Seven patients (7%) had a WCC > 15. The mean erythropoietin level was 2.9. Cytoreduction was used in 56 patients (57%), and venesection in the remaining patients. At present, 70 patients (72%) were categorised as high risk (as per BSH 2018) of which 28 patients were treated with venesection. Twenty seven patients categorised as low risk, of these 10 patients had either cardiovascular risk factors, high WCC or extreme thrombocytosis. A review of JAK2 positive essential thrombocythaemia patients, revealed 5 patients had a haematocrit between 0.48-0.52. The BSH guidelines have risk stratified patients with PV into high and low risk, in an attempt to reduce complications such as thrombosis or MPN related bleeding. The use of red cell mass studies in male patients with Essential thrombocythaemia can lead to change in management if a raised red cell mass is identified. At present, we have identified 38 patients (39%) who need their management changing from venesection to cytoreduction. Twenty eight high risk patients will need to be switched to cytoreductive treatment, while 10 patients cardiovascular risk, raised WCC and extreme thrombocytosis will need cytoreductive treatment. This has implications for the haematology day unit activity, which will reduce substantially. More patients will be treated with either hydroxycarbamide or interferon. The 5 patients with essential thrombocythaemia with haematocrit between 0.48-0.52, will need RCM studies. This will increase the requesting of nuclear medicine investigations. Implementation of BSH 2018 PV will potentially increase the patients on cytoreductive treatment. AD - S. Francis, Haematology Department, Haematology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom AU - Francis, S. AU - Sorour, Y. AU - Keat, S. DB - Embase DO - 10.1111/bjh.15854 KW - endogenous compound erythropoietin hydroxyurea interferon Janus kinase 2 aged bleeding cardiovascular risk catchment area (hydrology) complication conference abstract gene expression general hospital hematocrit hematology high risk patient human leukocyte count major clinical study male multidisciplinary team nuclear medicine phlebotomy polycythemia vera protein expression retrospective study risk assessment stratification thrombocythemia thrombocytosis thrombosis LA - English M3 - Conference Abstract N1 - L627190505 2019-04-17 PY - 2019 SN - 1365-2141 SP - 161 ST - The impact of the BSH 2018 polycythaemia vera guidelines on clinical management in the sheffield and barnsley catchment area T2 - British Journal of Haematology TI - The impact of the BSH 2018 polycythaemia vera guidelines on clinical management in the sheffield and barnsley catchment area UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627190505&from=export http://dx.doi.org/10.1111/bjh.15854 VL - 185 ID - 760744 ER - TY - JOUR AB - Background: The purpose of this study was to review the management of lower extremity arterial injuries to determine incidence, assess the current management strategy, and evaluate hospital outcome. Methods:This was a retrospective review, including trauma database query, and medical records review set in an urban level I trauma center. Sixty-five patients with 75 lower extremity arterial injuries were admitted between April 2005 and April 2010. The interventions were primary amputation, medical management, vascular surgical intervention, and subsequent amputation. The main outcome measures were age, gender, race, mechanism of injury, type of injury, associated lower extremity injuries, concomitant injuries, Injury Severity Score, Abbreviated Injury Scale, surgical procedures and interventions, limb salvage rate, mortality, length of stay, and discharge disposition. Results: During a 5-year period, 65 patients with 75 lower extremity arterial injuries were admitted to the hospital, yielding an incidence of 0.39% among trauma admissions. The study population was comprised primarily of young men, with a mean Injury Severity Score of 15.2 and a mean Abbreviated Injury Scale of 2.7 (moderate to severe injuries). The majority of patients (78.4%) suffered concomitant lower extremity injuries, most frequently bony or venous injuries, whereas 35.4% experienced associated injuries to other body regions. The most common injury mechanism was a gunshot wound (46.7%). Arterial injuries were categorized into 42 penetrating (56.0%) and 33 blunt mechanisms (44.0%). Involved arterial distribution was as follows: 4 common femoral (5.3%), 4 profunda femoris (5.3%), 24 superficial femoral (32.0%), 16 popliteal (21.3%), and 27 tibial (36.0%) arteries. The types of arterial injuries were as follows: 28 occlusion (37.3%), 23 transection (30.7%), 16 laceration (21.3%), and 8 dissection (10.7%). Orthopedic surgeons performed amputations as primary procedures in 3 patients (4.6%). The majority (76.8%) of injuries receiving vascular management underwent surgical intervention, with procedure distribution as follows: 26 bypass (49.1%); 13 primary repair (24.5%); 7 ligation (13.2%); 4 endovascular (7.5%); and 3 isolated thrombectomy (5.7%) procedures. Concomitant venous repair and fasciotomy were performed in 22.4% and 38.2% of cases, respectively. Medication was the primary strategy for 16 arterial injuries (23.2%). Subsequent major amputation was required for 3 patients (4.8%) who initially received vascular management. Three patients (4.6%) died during hospitalization. Conclusion: The current multidisciplinary team management approach, including use of computed tomographic or conventional angiography and prompt surgical management, resulted in successful outcomes after lower extremity arterial injuries and will continue to be utilized. (J Vasc Surg 2011;53:1604-10.) AD - [Franz, Randall W.; Shah, Kaushal J.; Franz, Evan T.] Grant Med Ctr, Vasc & Vein Ctr, Columbus, OH 43215 USA. [Halaharvi, Deepa] Doctors Hosp, Columbus, OH USA. [Hartman, Jodi F.; Wright, Michelle L.] Orthopaed Res & Reporting Ltd, Gahanna, OH USA. Franz, RW (corresponding author), Grant Med Ctr, Vasc & Vein Ctr, 285 E State St,Suite 260, Columbus, OH 43215 USA. rfranz2@ohiohealth.com AN - WOS:000291410600022 AU - Franz, R. W. AU - Shah, K. J. AU - Halaharvi, D. AU - Franz, E. T. AU - Hartman, J. F. AU - Wright, M. L. DA - Jun DO - 10.1016/j.jvs.2011.01.052 J2 - J. Vasc. Surg. KW - VASCULAR INJURIES ENDOVASCULAR TREATMENT DIAGNOSIS FRACTURES Surgery Peripheral Vascular Disease LA - English M1 - 6 M3 - Review N1 - ISI Document Delivery No.: 774TX Times Cited: 55 Cited Reference Count: 37 Franz, Randall W. Shah, Kaushal J. Halaharvi, Deepa Franz, Evan T. Hartman, Jodi F. Wright, Michelle L. 58 0 1 MOSBY-ELSEVIER NEW YORK J VASC SURG PY - 2011 SN - 0741-5214 SP - 1604-1610 ST - A 5-year review of management of lower extremity arterial injuries at an urban level I trauma center T2 - Journal of Vascular Surgery TI - A 5-year review of management of lower extremity arterial injuries at an urban level I trauma center UR - ://WOS:000291410600022 VL - 53 ID - 761849 ER - TY - JOUR AB - Background: Upper-extremity arterial injuries are relatively uncommon, but they may significantly impact patient outcome. Management of these injuries was reviewed to determine incidence, assess the current management strategy, and evaluate hospital outcome. Methods: Upper-extremity trauma patients presenting with arterial injury between January 2005 and July 2010 were included in this retrospective review. Descriptive statistics were used to describe demographic, injury, treatment, and outcome data. These variables also were compared between blunt and penetrating arterial injuries and between proximal and distal arterial injuries. Results: During a 5.6-year period, 135 patients with 159 upper-extremity arterial injuries were admitted, yielding an incidence of 0.74% among trauma admissions. The majority of patients (78.5%) suffered concomitant upper-extremity injuries. The most common injury mechanism was laceration by glass (26.4%). Arterial injuries were categorized into 116 penetrating (73.0%) and 43 blunt (27.0%) mechanisms. Arterial distribution involved was as follows: 13 axillary (8.2%), 40 brachial (25.2%), 52 radial (32.7%), 51 ulnar (32.1%), and 3 other (1.9%). The types of arterial injuries were as follows: 69 transection (43.4%), 68 laceration (42.8%), 16 occlusion (10.1%), 3 avulsion (1.9%), and 3 entrapment (1.9%). One patient (0.7%) required a primary above-elbow amputation. The majority of injuries (96.8%) receiving vascular management underwent surgical intervention - 76 primary repair (49.7%), 41 ligation (26.8%), 31 bypass (20.3%), and 5 endovascular (3.3%). Conservative treatment was the primary strategy for five arterial injuries (3.3%). Of the patients receiving vascular intervention, three (2.2%) required major and three (2.2%) required minor amputations during hospitalization and no patients expired. Conclusion: The current multidisciplinary team management approach with prompt surgical management resulted in successful outcomes after upper-extremity arterial injuries. No outcome differences between penetrating and blunt or between proximal and distal arterial injuries were calculated. This management approach will continue to be used. © Annals of Vascular Surgery Inc. AD - R.W. Franz, Vascular and Vein Center, Grant Medical Center, 285 East State Street, Columbus, OH, United States AU - Franz, R. W. AU - Skytta, C. K. AU - Shah, K. J. AU - Hartman, J. F. AU - Wright, M. L. DB - Embase Medline DO - 10.1016/j.avsg.2011.11.010 KW - arm amputation arm injury artery bypass artery entrapment artery injury artery ligation artery occlusion artery transection avulsion injury axillary artery blunt trauma brachial artery endovascular surgery hospital admission hospitalization human laceration medical record review penetrating trauma priority journal radial artery retrospective study review treatment outcome ulnar artery LA - English M1 - 5 M3 - Review N1 - L51852561 2012-02-13 2012-06-19 PY - 2012 SN - 0890-5096 1615-5947 SP - 655-664 ST - A five-year review of management of upper-extremity arterial injuries at an urban level I trauma center T2 - Annals of Vascular Surgery TI - A five-year review of management of upper-extremity arterial injuries at an urban level I trauma center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L51852561&from=export http://dx.doi.org/10.1016/j.avsg.2011.11.010 VL - 26 ID - 761196 ER - TY - JOUR AU - Freeland, Z. K. AU - Clayton, J. T. AU - Rosenblatt, R. L. DA - 2019/04/11 04/11 DB - Europe PubMed Central DO - 10.1080/08998280.2018.1503476 M1 - 1 PY - 2019 SN - 0899-8280 SP - 9-13 ST - Management of pulmonary embolism at a large academic hospital T2 - Proc (Bayl Univ Med Cent) TI - Management of pulmonary embolism at a large academic hospital UR - http://europepmc.org/article/MED/30956571 VL - 32 ID - 762082 ER - TY - JOUR AB - OBJECTIVE: To describe the epidemiology of infections related to the use of implantable central venous access devices (CVADs) in cancer patients and to evaluate measures aimed at reducing the rates of such infections. DESIGN: Prospective cohort study. SETTING: Referral hospital for cancer in São Paulo, Brazil. PATIENTS: We prospectively evaluated all implantable CVADs employed between January 2009 and December 2011. Inpatients and outpatients were followed until catheter removal, transfer to another facility, or death. METHODS: Outcome measures were bloodstream infection and pocket infection. We also evaluated the effects that the creation of a multidisciplinary team for CVAD care, avoiding in-hospital implantation of CVADs, and limiting CVAD insertion in neutropenic patients have on the rates of such infections. RESULTS: During the study period, 966 CVADs (mostly venous ports) were implanted in 933 patients, for a combined total of 243,792 catheter-days. We identified 184 episodes of infection: 154 (84%) were bloodstream infections, 21 (11%) were pocket infections, and 9 (5%) were surgical site infections. During the study period, the rate of CVAD-related infection dropped from 2.2 to 0.24 per 1,000 catheter-days ([Formula: see text]). Multivariate analysis revealed that relevant risk factors for such infection include surgical reintervention, implantation in a neutropenic patient, in-hospital implantation, use of a cuffed catheter, and nonchemotherapy indication for catheter use. CONCLUSIONS: Establishing a multidisciplinary team specifically focused on CVAD care, together with systematic reporting of infections, appears to reduce the rates of infection related to the use of these devices. AD - Infection Control Service, Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil. maristelapf@uol.com.br AN - 23739070 AU - Freire, M. P. AU - Pierrotti, L. C. AU - Zerati, A. E. AU - Araújo, P. H. AU - Motta-Leal-Filho, J. M. AU - Duarte, L. P. AU - Ibrahim, K. Y. AU - Souza, A. A. AU - Diz, M. P. AU - Pereira, J. AU - Hoff, P. M. AU - Abdala, E. DA - Jul DO - 10.1086/671006 DP - NLM ET - 2013/06/07 J2 - Infection control and hospital epidemiology KW - Brazil/epidemiology Cancer Care Facilities/statistics & numerical data Catheter-Related Infections/*epidemiology/etiology/microbiology Catheterization, Central Venous/*adverse effects Female Humans Male Middle Aged Neoplasms/complications/*therapy Prospective Studies Risk Factors LA - eng M1 - 7 N1 - 1559-6834 Freire, Maristela P Pierrotti, Ligia C Zerati, Antônio E Araújo, Pedro H X N Motta-Leal-Filho, J M Duarte, Laiane P G Ibrahim, Karim Y Souza, Antonia A L Diz, Maria P E Pereira, Juliana Hoff, Paulo M Abdala, Edson Journal Article United States Infect Control Hosp Epidemiol. 2013 Jul;34(7):671-7. doi: 10.1086/671006. Epub 2013 May 21. PY - 2013 SN - 0899-823x SP - 671-7 ST - Infection related to implantable central venous access devices in cancer patients: epidemiology and risk factors T2 - Infect Control Hosp Epidemiol TI - Infection related to implantable central venous access devices in cancer patients: epidemiology and risk factors VL - 34 ID - 760312 ER - TY - JOUR AB - Pyoderma gangrenosum (PG) is a rare, noninfectious, inflammatory disease characterized by neutrophilic infiltration of the dermis and destruction of tissue. PG is a diagnostic challenge, which can lead to late diagnosis, delayed treatment and detrimental surgical interventions. We describe a presentation not previously reported, affecting deep muscle and tendon leading to tendon rupture. Furthermore, we show the multidisciplinary team approach to management of a patient with PG and the reconstructive surgical element. A 31-year-old woman presented with a rapid onset painful, tender, left calf and ankle, which was associated with a mild flare of ulcerative colitis. Investigations revealed a white cell count of 26 × 109 cells L-1, a C-reactive protein count of 226 mg L-1, no deep vein thrombosis on ultrasound, no bone or joint involvement on X-ray and no organisms on joint aspirate. Debridement was undertaken after the left ankle developed a foul-smelling discharging wound. Repeat debridement led to worsening of the condition (pathergy). Intraoperative tissue cultures and microscopy showed no evidence of fungi, bacteria or mycobacteria. Histology showed granulation, inflammatory infiltrate, abscess formation and focal necrotizing vasculitis. Dermatology opinion confirmed PG. Awareness of the diagnosis of PG, and early involvement of dermatology, in a rapidly progressing wound is essential to avoid delayed treatment and prevent worsening through pathergy. AD - G.A. Fremlin, Department of Medicine, University Hospitals Bristol, Bristol, Avon, United Kingdom AU - Fremlin, G. A. AU - Rawlings, C. AU - Livingstone, J. A. AU - Bray, A. P. J. J. DB - Embase Medline DO - 10.1111/bjd.13264 KW - amoxicillin plus clavulanic acid balsalazide C reactive protein cyclosporine flucloxacillin prednisolone abscess achilles tendon rupture adult ankle pain antibiotic therapy arthralgia article bacterium culture case report cellulitis coagulase negative Staphylococcus debridement disease duration disease severity drug dose reduction drug substitution drug withdrawal erythema female fever follow up histopathology hospital admission human human tissue immunosuppressive treatment inflammatory infiltrate intraoperative period leukocyte count medical history microscopy necrotizing arteritis nuclear magnetic resonance imaging pain severity patent ductus arteriosus physiotherapy preoperative period priority journal protein blood level pyoderma gangrenosum range of motion rheumatoid arthritis scapular flap tendon reconstruction tissue culture ulcerative colitis walking weight bearing wound healing LA - English M1 - 2 M3 - Article N1 - L601050780 2014-12-30 2015-02-25 PY - 2015 SN - 1365-2133 0007-0963 SP - 522-526 ST - An unusual case of bilateral pyoderma gangrenosum with Achilles tendon rupture T2 - British Journal of Dermatology TI - An unusual case of bilateral pyoderma gangrenosum with Achilles tendon rupture UR - https://www.embase.com/search/results?subaction=viewrecord&id=L601050780&from=export http://dx.doi.org/10.1111/bjd.13264 VL - 172 ID - 761079 ER - TY - JOUR AB - Inherited platelet disorders (IPDs) comprise a heterogeneous group of disorders with a complex genetic etiology, characterized by impairments in platelet formation, morphology and function. Since the implementation of next generation sequencing (NGS) in 2009, the gene list for diagnosis of IPDs rapidly expanded from 39 to 53 genes. A diagnostic high-throughput targeted NGS platform (referred to as ThromboGenomics; www.thrombogenomics.org.uk) was very recently described as an affordable DNA-based test of 76 genes to diagnose patients 'suspected of having a known inherited platelet, thrombotic or bleeding disorder' (BPD). When the phenotype is strongly indicative of the presence of a particular disease etiology but the Variants are unknown, sensitivity remains high (>90% based on 61 samples) while patients included with an uncertain disease such as delta storage pool disease, mostly receive no genetic diagnosis (only 10% a genetic diagnosis was obtained). Such IPDs should be included in gene discovery NGS programs such as the BRIDGE-BPD2 study. For this study, whole genome sequencing results of the DNA samples of nearly 1000 probands with uncharacterized IPDs, analyzed using assigned Human Phenotype Ontology (HPO) terms have helped to identify pathogenic Variants in almost 20% of cases. New clustering algorithms to group cases with similar phenotypes have been used to identify two novel IPD genes (DIAPH1 and SRC2) and several putative ones. Still many IPD patients don't receive a genetic diagnosis. A majority of cases either harbor pathogenic Variants in unknown genes or in regulatory regions or are the result of a digenic mode of inheritance. NGS combined with data from RNA-seq, ChIP-seq, gene regulatory network analysis, epigenome, proteomics and mouse knock-out studies amongst others will also help explore the non-coding regulatory space and gene-gene interactions. Given the existence of many non-pathogenic Variants in any individual's genome, the main challenge faced by researchers when interpreting NGS data of an IPD case is determining which Variants are causing the disorder.3Interpreting the functional consequences of novel rare Variants is not easy and it is extremely important to apply rigorous standards when assigning pathogenicity. Clinical genomic data are the same as other complex medical data and should be interpreted by a multidisciplinary team comprising typically a statistical geneticist, clinical geneticist, and genetic counselors, who have the skills to interpret these results in the context of the test methodology, the theoretical background of genetics, Bayesian reasoning, and a myriad of other factors. Simeoni I, Stephens JC, Hu F, et al. A comprehensive high-throughput sequencing test for the diagnosis of inherited bleeding, thrombotic and platelet disorders. Blood. 2016; 127: 279. Turro E, Greene D, Wijgaerts A, et al. A dominant gain-of-function mutation in universal tyrosine kinase SRC causes thrombocytopenia, myelofibrosis, bleeding, and bone pathologies. Sci Transl Med. 2016;8:328. Lentaigne C, Freson K, Laffan MA, et al. Inherited platelet disorders: towards DNA-based diagnosis. Blood. 2016; 127: 2814. AD - K. Freson AU - Freson, K. DB - Embase KW - endogenous compound protein kinase p60 animal model animal tissue bleeding bone disease chromatin immunoprecipitation counselor diagnosis epigenetics gain of function mutation gene disruption gene interaction gene regulatory network genetics high throughput sequencing human inheritance knockout gene major clinical study myelofibrosis ontology pathogenicity phenotype proteomics scientist skill theoretical model thrombocyte disorder thrombosis whole genome sequencing LA - English M1 - 22 M3 - Conference Abstract N1 - L614309131 2017-02-09 PY - 2016 SN - 1528-0020 ST - Clinical next generation sequencing to identify novel platelet disorders T2 - Blood TI - Clinical next generation sequencing to identify novel platelet disorders UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614309131&from=export VL - 128 ID - 760979 ER - TY - JOUR AB - Background and Purpose-A survey of graduating neurology residents conducted in 2000 showed that many residents had limited experience and comfort treating with tissue-type plasminogen activator (tPA). We examined changes in residents' experience during the past decade. Methods-A 12-item survey was sent to US neurology residents in their final year of training. Items examined residents' experience and confidence with assessment of the acute stroke patient and use of tPA for treatment. Questions were worded identically in the 2000 and 2010 surveys, and responses were compared between the two. Results-Of 491 residents, 286 (58%) responded. There was a significant increase from 2000 to 2010 in the percentage of residents who felt comfortable independently treating with tPA (73% versus 94%, P<0.001), who had observed administration of tPA (88% versus 99%, P<0.001), who had personally treated with tPA (80% versus 95%, P<0.001), and who had been involved in post-tPA care (89% versus 98%, P<0.001). There was a substantial increase in residents with formal training in using the National Institutes of Health Stroke Scale (65% versus 92%, P<0.001) and who had dedicated stroke teams at their institution (84% versus 93%, P=0.001). Conclusions-Neurology residents' experience and comfort treating acute ischemic stroke with tPA increased significantly between 2000 and 2010, as did resident exposure to stroke teams and formal training in the National Institutes of Health Stroke Scale. (Stroke. 2011;42:2963-2965.) AD - [Raser, Jonathan; Brizzi, Kate; Cucchiara, Brett] Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA. [Fridman, Vera] Brigham & Womens Hosp, Dept Neurol, Boston, MA 02115 USA. Cucchiara, B (corresponding author), Univ Penn, Dept Neurol, 3400 Spruce St, Philadelphia, PA 19104 USA. cucchiar@mail.med.upenn.edu AN - WOS:000295217100061 AU - Fridman, V. AU - Raser, J. AU - Brizzi, K. AU - Cucchiara, B. DA - Oct DO - 10.1161/strokeaha.111.621839 J2 - Stroke KW - tPA thrombolysis acute stroke CARE Clinical Neurology Peripheral Vascular Disease LA - English M1 - 10 M3 - Article N1 - ISI Document Delivery No.: 824QM Times Cited: 1 Cited Reference Count: 5 Fridman, Vera Raser, Jonathan Brizzi, Kate Cucchiara, Brett 1 0 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA STROKE PY - 2011 SN - 0039-2499 SP - 2963-2965 ST - Graduating US Neurology Residents' Experience With Tissue-Type Plasminogen Activator for Acute Stroke A 10-Year Comparison T2 - Stroke TI - Graduating US Neurology Residents' Experience With Tissue-Type Plasminogen Activator for Acute Stroke A 10-Year Comparison UR - ://WOS:000295217100061 VL - 42 ID - 761843 ER - TY - JOUR AB - BACKGROUND: Hip fractures are associated with substantial morbidity and mortality for older adults. Patients sustaining hip fractures usually have comorbid conditions that may benefit from comanagement by geriatricians and orthopedic surgeons. METHODS: The Geriatric Fracture Center (GFC) is part of a community teaching hospital. Patients are comanaged daily by a geriatrician and orthopedic surgeon, emphasizing total quality management, timely treatment, and standardized care. We reviewed medical records to compare process and outcome measures in the GFC with a local institution that did not have a fracture management service. Patients 60 years or older admitted for a proximal femur fracture from May 1, 2005, to April 30, 2006, were included; pathological, recurrent, high-energy, periprosthetic, and nonoperative fractures were excluded. RESULTS: Geriatric Fracture Center patients (n = 193) were significantly older, were less likely to reside in the community, and had more comorbid conditions and dementia than usual care patients (n = 121). Despite baseline differences, GFC patients, compared with usual care patients, had shorter times to surgery (24.1 vs 37.4 hours), fewer postoperative infections (2.3% vs 19.8%), fewer complications overall (30.6% vs 46.3%), and shorter length of stay (4.6 vs 8.3 days). Compared with GFC patients, physical restraint use was significantly higher in usual care patients (0% vs 14.1%). After we adjusted for baseline characteristics, patients treated in the GFC had shorter times to surgery, shorter length of stay, fewer cardiac complications, and fewer cases of thromboembolism, delirium, and infection. There was no difference in in-hospital mortality or 30-day readmission rate. CONCLUSION: Comanagement by geriatricians and orthopedic surgeons, combined with standardized care, leads to improved processes and outcomes for patients with hip fractures. AD - Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14620, USA. Susan_Friedman@urmc.rochester.edu AN - 19822829 AU - Friedman, S. M. AU - Mendelson, D. A. AU - Bingham, K. W. AU - Kates, S. L. DA - Oct 12 DO - 10.1001/archinternmed.2009.321 DP - NLM ET - 2009/10/14 J2 - Archives of internal medicine KW - Aged Aged, 80 and over Female Geriatrics/organization & administration Hip Fractures/*surgery Hospital Units/*organization & administration Hospitals, Community/organization & administration Hospitals, Teaching/organization & administration Humans Length of Stay Male Models, Organizational Outcome Assessment, Health Care Patient Care Team/*organization & administration Retrospective Studies LA - eng M1 - 18 N1 - 1538-3679 Friedman, Susan M Mendelson, Daniel A Bingham, Karilee W Kates, Stephen L Journal Article Research Support, Non-U.S. Gov't United States Arch Intern Med. 2009 Oct 12;169(18):1712-7. doi: 10.1001/archinternmed.2009.321. PY - 2009 SN - 0003-9926 SP - 1712-7 ST - Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes T2 - Arch Intern Med TI - Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes VL - 169 ID - 760280 ER - TY - JOUR AU - Friedman, Tamir AU - Winokur, Ronald S. AU - Quencer, Keith B. DA - 2018 DB - German National Library of Science and Technology (TIB) PY - 2018 ST - Patient Assessment: Clinical Presentation, Imaging Diagnosis, Risk Stratification, and the Role of Pulmonary Embolism Response Team T2 - Thieme Verlag TI - Patient Assessment: Clinical Presentation, Imaging Diagnosis, Risk Stratification, and the Role of Pulmonary Embolism Response Team UR - https://www.tib.eu/en/search/id/thieme:10.1055-s-0038-1642040/Patient-Assessment-Clinical-Presentation-Imaging?cHash=78ac5be8baec5d75811b6731d45c1426 ID - 761937 ER - TY - JOUR AU - Friedman, T. AU - Winokur, R. S. AU - Quencer, K. B. AU - Madoff, D. C. DA - 2018/06/07 06/07 DB - Europe PubMed Central DO - 10.1055/s-0038-1642040 M1 - 2 PY - 2018 SN - 0739-9529 SP - 116-121 ST - Patient Assessment: Clinical Presentation, Imaging Diagnosis, Risk Stratification, and the Role of Pulmonary Embolism Response Team T2 - Semin Intervent Radiol TI - Patient Assessment: Clinical Presentation, Imaging Diagnosis, Risk Stratification, and the Role of Pulmonary Embolism Response Team UR - http://europepmc.org/article/MED/29872247 VL - 35 ID - 761935 ER - TY - GEN AB - Pulmonary embolism (PE) is currently the third leading cause of death and moreover is likely underdiagnosed. PE remains the most common preventable cause of hospital deaths in the United States, which may be attributable to its diagnostic challenges. Although difficult to diagnose, patient mortality rates are time-dependent, and thus, the suspicion and diagnosis of PE in a timely manner is imperative. Diagnosis based on several criteria which may dictate imaging workup as well as laboratory tests and clinical parameters are discussed. The evolution of treatment guidelines via various clinical trials and recommendations is outlined, setting the stage for the use of fibrinolytics, whether systemic or catheter directed. Treatment, including fibrinolytics, is predicated on patient triage into three large categories—massive, submassive, or low-risk PE. Additionally, a relatively new concept of a multidisciplinary team composed of several subspecialty experts known as the PE response team (PERT) is discussed. PERT's timely and unified recommendations have been shown to optimize care and decrease mortality while tailoring treatment to each individual afflicted by PE. AU - Friedman, Tamir AU - Winokur, Ronald S. AU - Quencer, Keith B. AU - Madoff, David C. DA - 2020/08/03 DB - OpenAIRE PY - 2020 ST - Patient Assessment: Clinical Presentation, Imaging Diagnosis, Risk Stratification, and the Role of Pulmonary Embolism Response Team TI - Patient Assessment: Clinical Presentation, Imaging Diagnosis, Risk Stratification, and the Role of Pulmonary Embolism Response Team UR - https://explore.openaire.eu/search/publication?articleId=od_______267::a86b480ef60b0f86679eb548f0db56c6 ID - 761933 ER - TY - JOUR AB - BACKGROUND: Thoracic endovascular aortic repair has become the preferred treatment for a variety of descending thoracic aortic pathologies. However, there are unresolved issues such as morphologic appearance of chronic dissection, persistent false lumen perfusion, and adequacy of landing zone. Enthusiasm for improving the technique of open aortic repair and perioperative management is fading. In this study, we would like to demonstrate how we improve our surgical outcomes by establishing a dedicated aortic multidisciplinary team at the Kawasaki Aortic Center. METHOD: We performed a single-center retrospective study from January 2015 to December 2016. All patients with open descending thoracic aortic replacement were recruited. Preoperative patient demographic data, bypass strategies, operative details, and postoperative outcomes were reviewed. RESULT: From January 2015 to December 2016, we treated 168 cases of descending thoracic aortic repair using a left thoracotomy. Median age was 69.0 ± 21.8 years old, and 63.1% were aortic dissection (acute, 4.8%; chronic, 58.3%); 81.3% patients underwent elective operations. Left heart bypass, deep hypothermic circulatory arrest, and partial cardiopulmonary bypass were performed in 88.6%, 9.0%, and 2.4% of patients, respectively. Mean operative time was 312 ± 94 minutes. In-hospital mortality in total was 0.6%. The rate of transient spinal cord injury was 4.7%. CONCLUSIONS: Under a dedicated aortic multidisciplinary team, we demonstrated that open descending thoracic aorta replacement can be performed with excellent early outcomes with low reintervention rates, regardless of the nature of the aortic pathologies. AD - Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan; Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan. Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China. Electronic address: wonhl1@surgery.cuhk.edu.hk. AN - 30448162 AU - Fujikawa, T. AU - Yamamoto, S. AU - Oshima, S. AU - Ozaki, K. AU - Shimamura, J. AU - Asada, H. AU - Wong, R. H. L. DA - Jun DO - 10.1016/j.jtcvs.2018.08.094 DP - NLM ET - 2018/11/19 J2 - The Journal of thoracic and cardiovascular surgery KW - Aged Aneurysm, Dissecting/surgery Aorta, Thoracic/*surgery Aortic Aneurysm, Thoracic/surgery Aortic Diseases/mortality/surgery *Endovascular Procedures/methods/mortality Female Humans Male Operative Time Retrospective Studies Thoracotomy Vascular Surgical Procedures/methods/mortality *descending thoracic aortic replacement *open aortic surgery LA - eng M1 - 6 N1 - 1097-685x Fujikawa, Takuya Yamamoto, Shin Oshima, Susumu Ozaki, Kensuke Shimamura, Junichi Asada, Hiroaki Wong, Randolph H L Journal Article United States J Thorac Cardiovasc Surg. 2019 Jun;157(6):2168-2174. doi: 10.1016/j.jtcvs.2018.08.094. Epub 2018 Sep 29. PY - 2019 SN - 0022-5223 SP - 2168-2174 ST - Open surgery for descending thoracic aorta in an endovascular era T2 - J Thorac Cardiovasc Surg TI - Open surgery for descending thoracic aorta in an endovascular era VL - 157 ID - 760220 ER - TY - JOUR AB - OBJECTIVE: Ophthalmic aneurysms present unique challenges to a vascular team. This study reviews the 16-year experience of a multidisciplinary neurovascular service in the treatment, complications, outcomes, and follow-up of patients with ophthalmic aneurysms from 1990 to 2005. METHODS: A retrospective analysis of prospectively collected data of 134 patients with 157 ophthalmic aneurysms is presented. Subgroup analysis is performed based on treatment and clinical presentation of the patients. RESULTS: Clinical outcomes are reported using the Glasgow Outcome Scale. A "good" outcome is defined as a Glasgow Outcome Scale score of 4 or 5, and a "poor" outcome is defined as a Glasgow Outcome Scale score of 1 to 3. Outcome was related to patient age (P = 0.0002) and aneurysm size (P = 0.046). Outcomes for patients with ruptured aneurysms were related to hypertension (P<0.0001) and clinical admission grade (P= 0.001). In patients with unruptured aneurysms, a good clinical outcome was noted in 103 (92.7%) of 111 patients at discharge and 83 (94.3%) of 88 patients at the time of the 1-year follow-up evaluation. Complete clipping was attained in 89 (79.5%) of 112 patients with angiographic follow-up. Patients with aneurysm remnants from both coiling and clipping had a low risk of regrowth, and there were no rehem-orrhages. One of 25 patients with angiographic follow-up (average, 4.3 ± 4.1 years) after "complete" clipping showed recurrence of the aneurysm. CONCLUSION: Despite the difficulties presented by ophthalmic aneurysms, these lesions can be successfully managed by a multidisciplinary team. Imaging follow-up of patients is important, as there is a risk of aneurysm regrowth after either coiling or clipping. Copyright © 2009 by the Congress of Neurological Surgeons. AD - D. H. Fulkerson, Department of Neurosurgery, School of Medicine, Indiana University, 545 Barnhill Drive, Indianapolis, IN 46202 AU - Fulkerson, D. H. AU - Horner, T. C. AU - Payner, T. D. AU - Leipzig, T. J. AU - Scott, J. A. AU - Denardo, A. J. AU - Redelman, K. AU - Goodman, J. M. DB - Embase Medline DO - 10.1227/01.NEU.0000337127.73667.80 KW - adult age aneurysm clip aneurysm rupture aneurysm surgery article carotid arteriography coil embolization endovascular surgery female follow up Glasgow coma scale human hypertension internal carotid artery aneurysm major clinical study male ophthalmic artery ophthalmic artery aneurysm outcome assessment priority journal recurrence risk LA - English M1 - 2 M3 - Article N1 - L354249911 2009-03-23 PY - 2009 SN - 0148-396X SP - 218-229 ST - Results, outcomes, and follow-up of remnants in the treatment of ophthalmic aneurysms: A 16-year experience of a combined neurosurgical and endovascular team T2 - Neurosurgery TI - Results, outcomes, and follow-up of remnants in the treatment of ophthalmic aneurysms: A 16-year experience of a combined neurosurgical and endovascular team UR - https://www.embase.com/search/results?subaction=viewrecord&id=L354249911&from=export http://dx.doi.org/10.1227/01.NEU.0000337127.73667.80 VL - 64 ID - 761276 ER - TY - JOUR AB - The age of patients presenting with complex arrhythmias is increasing. Frailty is a multifaceted syndrome characterized by an increased vulnerability to stressors and a decreased ability to maintain homeostasis. The prevalence of frailty is associated with age. The aims of this European Heart Rhythm Association (EHRA) EP Wire survey were to evaluate the proportion of patients with frailty and its influence on the clinical management of arrhythmias. A total of 41 centres-members of the EHRA Electrophysiology Research Network-in 14 European countries completed the web-based questionnaire in June 2017. Patients over 70 years represented 53% of the total treated population, with the proportion of frail elderly individuals reaching approximately 10%; 91.7% of the responding centres reported treating frail subjects in the previous year. The respondents usually recognized frailty based on the presence of problems of mobility, nutrition, and cognition and inappropriate loss of body weight and muscle mass. Renal failure, dementia, disability, atrial fibrillation, heart failure, falls, and cancer were reported to characterize the elderly frail individuals. Atrial fibrillation was considered the prevalent arrhythmia associated with frailty by 72% of the responding centres, and for stroke prevention, non-vitamin K antagonist oral anticoagulants were preferred. None of the respondents considered withholding the prevention of thrombo-embolic events in subjects with a history of falls. All participants have agreed that cardiac resynchronization therapy exerts positive effects including improvement in cardiac, physical, and cognitive performance and quality of life. The majority of respondents preferred an Arrhythmia Team to manage this special population of elderly patients, and many would like having a simple tool to quickly assess the presence of frailty to guide their decisions, particularly on the use of complex cardiac implantable electrical devices (CIEDs). In conclusion, the complex clinical condition in frail patients presenting with arrhythmias warrants an integrated multidisciplinary approach both for the management of rhythm disturbances and for the decision on using CIEDs. AD - Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence and AOU Careggi, Viale Pieraccini 6, 50139 Florence, Italy. School of Medicine, Cardiology Clinic, Clinical Centre of Serbia, University of Belgrade, Visegradska 26, Belgrade 11000, Serbia. Department of Cardiology, Cardiovascular Research Centre, Aalborg University Hospital, Søndre Skovvej 15, DK-9100 Aalborg, Denmark. Department of Cardiology, Institute for Surgical Research, Institute for Clinical Medicine, Center for Cardiological Innovation, Oslo University Hospital, University of Oslo, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway. Cardiology Clinic, Emergency Institute for Cardiovascular Diseases and Transplant, University of Medicine and Pharmacy, 540136 Tirgu Mures, Romania. Cardiology Division, University Hospital S. Maria della Misericordia, P.le Santa Maria della Misericordia 15, 33100 Udine, Italy. Department of Electrophysiology, Leipzig University - Heart Centre, 04289 Leipzig, Germany. AN - 29040554 AU - Fumagalli, S. AU - Potpara, T. S. AU - Bjerregaard Larsen, T. AU - Haugaa, K. H. AU - Dobreanu, D. AU - Proclemer, A. AU - Dagres, N. DA - Nov 1 DO - 10.1093/europace/eux288 DP - NLM ET - 2017/10/19 J2 - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology KW - Age Factors Aged Aged, 80 and over Arrhythmias, Cardiac/diagnosis/epidemiology/physiopathology/*therapy Clinical Decision-Making Comorbidity Decision Support Techniques Europe/epidemiology Female Frail Elderly Frailty/diagnosis/epidemiology/physiopathology/*therapy Geriatric Assessment Health Care Surveys Humans Male Patient Care Team Prevalence Quality of Life Risk Factors Treatment Outcome Anticoagulants Arrhythmia team Atrial fibrillation Cardiac implantable electrical devices EHRA survey EP wire Elderly Frailty LA - eng M1 - 11 N1 - 1532-2092 Fumagalli, Stefano Potpara, Tatjana S Bjerregaard Larsen, Torben Haugaa, Kristina H Dobreanu, Dan Proclemer, Alessandro Dagres, Nikolaos Journal Article England Europace. 2017 Nov 1;19(11):1896-1902. doi: 10.1093/europace/eux288. PY - 2017 SN - 1099-5129 SP - 1896-1902 ST - Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey T2 - Europace TI - Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey VL - 19 ID - 760432 ER - TY - JOUR AB - The age of patients presenting with complex arrhythmias is increasing. Frailty is a multifaceted syndrome characterized by an increased vulnerability to stressors and a decreased ability to maintain homeostasis. The prevalence of frailty is associated with age. The aims of this European Heart Rhythm Association (EHRA) EP Wire survey were to evaluate the proportion of patients with frailty and its influence on the clinical management of arrhythmias. A total of 41 centres-members of the EHRA Electrophysiology Research Network-in 14 European countries completed the web-based questionnaire in June 2017. Patients over 70 years represented 53% of the total treated population, with the proportion of frail elderly individuals reaching approximately 10%; 91.7% of the responding centres reported treating frail subjects in the previous year. The respondents usually recognized frailty based on the presence of problems of mobility, nutrition, and cognition and inappropriate loss of body weight and muscle mass. Renal failure, dementia, disability, atrial fibrillation, heart failure, falls, and cancer were reported to characterize the elderly frail individuals. Atrial fibrillation was considered the prevalent arrhythmia associated with frailty by 72% of the responding centres, and for stroke prevention, non-vitamin K antagonist oral anticoagulants were preferred. None of the respondents considered withholding the prevention of thrombo-embolic events in subjects with a history of falls. All participants have agreed that cardiac resynchronization therapy exerts positive effects including improvement in cardiac, physical, and cognitive performance and quality of life. The majority of respondents preferred an Arrhythmia Team to manage this special population of elderly patients, and many would like having a simple tool to quickly assess the presence of frailty to guide their decisions, particularly on the use of complex cardiac implantable electrical devices (CIEDs). In conclusion, the complex clinical condition in frail patients presenting with arrhythmias warrants an integrated multidisciplinary approach both for the management of rhythm disturbances and for the decision on using CIEDs. AD - [Fumagalli, Stefano] Univ Florence, Dept Expt & Clin Med, Geriatr Intens Care Unit, Viale Pieraccini 6, I-50139 Florence, Italy. [Fumagalli, Stefano] AOU Careggi, Viale Pieraccini 6, I-50139 Florence, Italy. [Potpara, Tatjana S.] Univ Belgrade, Clin Ctr Serbia, Cardiol Clin, Sch Med, Visegradska 26, Belgrade 11000, Serbia. [Larsen, Torben Bjerregaard] Aalborg Univ Hosp, Cardiovasc Res Ctr, Dept Cardiol, Sondre Skovvej 15, DK-9100 Aalborg, Denmark. [Haugaa, Kristina H.] Univ Oslo, Oslo Univ Hosp, Ctr Cardiol Innovat, Rikshosp,Dept Cardiol,Inst Surg Res,Inst Clin Med, Sognsvannsveien 20, N-0372 Oslo, Norway. [Dobreanu, Dan] Univ Med & Pharm, Emergency Inst Cardiovasc Dis & Transplant, Cardiol Clin, Targu Mures 540136, Romania. [Proclemer, Alessandro] Univ Hosp S Maria Misericordia, Cardiol Div, Ple Santa Maria Della Misericordia 15, I-33100 Udine, Italy. [Dagres, Nikolaos] Univ Leipzig, Heart Ctr, Dept Electrophysiol, D-04289 Leipzig, Germany. Fumagalli, S (corresponding author), Univ Florence, Dept Expt & Clin Med, Geriatr Intens Care Unit, Viale Pieraccini 6, I-50139 Florence, Italy.; Fumagalli, S (corresponding author), AOU Careggi, Viale Pieraccini 6, I-50139 Florence, Italy. stefano.fumagalli@unifi.it AN - WOS:000414367100025 AU - Fumagalli, S. AU - Potpara, T. S. AU - Larsen, T. B. AU - Haugaa, K. H. AU - Dobreanu, D. AU - Proclemer, A. AU - Dagres, N. DA - Nov DO - 10.1093/europace/eux288 J2 - Europace KW - Anticoagulants Arrhythmia team Atrial fibrillation Cardiac implantable electrical devices Elderly Frailty EHRA survey EP wire CARDIAC RESYNCHRONIZATION THERAPY IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR ATRIAL-FIBRILLATION ELDERLY-PATIENTS AGE-GROUPS DISABILITY PREVENTION WARFARIN DEATH Cardiac & Cardiovascular Systems LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: FL6PE Times Cited: 29 Cited Reference Count: 24 Fumagalli, Stefano Potpara, Tatjana S. Larsen, Torben Bjerregaard Haugaa, Kristina H. Dobreanu, Dan Proclemer, Alessandro Dagres, Nikolaos Haugaa, Kristina/S-8023-2019; Fumagalli, Stefano/AAR-3393-2020 Haugaa, Kristina/0000-0002-4900-0453 29 0 5 OXFORD UNIV PRESS OXFORD EUROPACE PY - 2017 SN - 1099-5129 SP - 1896-1902 ST - Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey T2 - Europace TI - Frailty syndrome: an emerging clinical problem in the everyday management of clinical arrhythmias. The results of the European Heart Rhythm Association survey UR - ://WOS:000414367100025 VL - 19 ID - 761630 ER - TY - JOUR AB - PURPOSE: The Pulmonary Embolism Severity Index (PESI) is validated to predict 30-day mortality in acute pulmonary embolism (PE). Heart rate, systolic blood pressure, respiratory rate and oxygen saturation are key components of the PESI that can vary over time, especially after initial resuscitation of the patient. The most appropriate timing of vital signs for calculation of PESI score is not well established. Risk scoring can help the Pulmonary Embolism Response Team (PERT) in deciding choice of therapy. Objective of this study was to investigate the optimal timing of vital signs for calculation of the PESI score. METHODS: Retrospective review of prospective PERT registry at Cleveland Clinic from 2014 to 2016. 70 consecutive patients were studied. Vital signs were collected in 4 different time points for each acute event: 1st at 0 hour (closest to the time of acute PE), 2nd at 2 hours (from the time of acute PE), 3rd was lowest possible score in 0-6 hours (using best vital signs), 4th was highest possible score in 0-6 hours (using worst vital signs). Four unique PESI scores were calculated for each event, using vitals from 4 different timings. C-statistic was used to compare predictive strengths for 30-day mortality. RESULTS: 66 patients were included in final analysis. The average PESI score using 4 methods was: 104 (at 0 hour), 102(at 2 hours), 93 (lowest possible score in 0-6 hours), 126 (highest possible score in 0-6 hours), p <0.0001. The variation in PESI score was attributed to variation in blood pressure, heart rate and respiratory rate at various time points. The area under ROC for prediction of 30-day mortality using 4 methods of PESI calculation was: 0.77 (at 0 hour), 0.79 (at 2 hours), 0.75 (lowest possible score in 0-6 hours), 0.80 (highest possible score in 0-6 hours), p = 0.41. CONCLUSIONS: Timing of vitals can significantly affect the PESI score calculation. The PE mortality risk class can vary from Class 3 (based on best vitals) to Class 5 (based on worst vitals). Although not statistically significant, the PESI score calculated at 2 hours and the highest possible PESI score in 0-6 hours offered the highest discrimination to predict 30-day mortality in acute pulmonary embolism. AD - A. Gadre, Cleveland Clinic, Cleveland, OH, United States AU - Gadre, A. AU - Deshwal, H. AU - Mahar, J. AU - Sadana, D. AU - Shishehbor, M. AU - Haddadin, I. AU - Tong, M. Z. Y. AU - Bartholomew, J. AU - Heresi, G. DB - Embase DO - 10.1016/j.chest.2017.08.1076 KW - blood pressure breathing rate calculation female heart rate human lung embolism major clinical study male mortality risk prediction prospective study register retrospective study vital sign LA - English M1 - 4 M3 - Conference Abstract N1 - L619297382 2017-11-22 PY - 2017 SN - 1931-3543 SP - A1043 ST - Predictive scoring for severity of acute pulmonary embolism: Does timing matter? T2 - Chest TI - Predictive scoring for severity of acute pulmonary embolism: Does timing matter? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619297382&from=export http://dx.doi.org/10.1016/j.chest.2017.08.1076 VL - 152 ID - 760905 ER - TY - JOUR AB - Treatment recommendations for submassive pulmonary embolus (SMPE), defined as pulmonary embolus (PE) resulting in right ventricular dysfunction and/or myocardial necrosis, vary. The objective of this study was to develop an investigative protocol at our tertiary care hospital to standardise the approach to patients with SMPE and to evaluate the effect of the protocol on process measures including consultation with cardiology and critical care physicians and time to echocardiogram and treatment. Triggered by right ventricle/left ventricle ratios >0.9, the protocol standardised ancillary studies and immediate consultation with critical care and cardiology. Post-protocol implementation, the percent of patients with SMPE evaluated by critical care specialists increased from 26% (19/74) to 93% (41/44) (p<0.001) and cardiology consultations increased from 35% (26/74) to 89% (39/44) (p<0.001). Patient arrival to echocardiogram was reduced from 15 hours to 5 hours post-protocol implementation. In addition, average time to anticoagulation was reduced from greater than 7 hours to 3 hours 27 min post-protocol implementation. The protocol has helped to identify patients with SMPE and standardise the care they receive after diagnosis. PMID:30057955 AU - Galanos, Kelly AU - Coakley, Kevin AU - White, Peter AU - Griffen, David DA - 2018/07/21 07/21 DB - PubMed Central DO - 10.1136/bmjoq-2017-000279 KW - emergency department healthcare quality improvement shared decision making M1 - 3 PY - 2018 SN - 2399-6641 ST - Effectiveness of a submassive pulmonary embolism protocol to standardise patient evaluation and treatment T2 - BMJ Open Quality TI - Effectiveness of a submassive pulmonary embolism protocol to standardise patient evaluation and treatment UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6059323 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6059323&rendertype=abstract VL - 7 ID - 762098 ER - TY - JOUR AU - Galanos, K. AU - Jaeger, C. AU - Coakley, K. AU - White, P. AU - Griffen, D. DA - 2018/07/31 07/31 DB - Europe PubMed Central DO - 10.1136/bmjoq-2017-000279 M1 - 3 PY - 2018 SN - 2399-6641 ST - Effectiveness of a submassive pulmonary embolism protocol to standardise patient evaluation and treatment T2 - BMJ Open Qual TI - Effectiveness of a submassive pulmonary embolism protocol to standardise patient evaluation and treatment UR - http://europepmc.org/article/MED/30057955 VL - 7 ID - 762097 ER - TY - JOUR AB - Introduction: Hospital-acquired venous thromboembolism (VTE) is a potentially fatal complication of hospitalisation, with meta-analyses and guidelines supporting the use of proven prophylactic measures (graduated compression stockings (GCS) and anticoagulants). Despite this, prophylaxis is underutilised and represents one of the largest gaps between evidence and current clinical practice. Methods: All episodes of VTE complicating hospitalisation were ascertained prospectively as part of a quality improvement programme over 3.5 years with a view to designing interventions to improve the use of prophylaxis and reduce the rate of VTE. Interventions initially centred upon highlighting the burden of VTE, the extent of failure to apply guideline evidence into practice, and the development and application of a hospital-wide risk assessment tool. Later interventions sought to build the risk-assessment tool into routine clinical care and enhanced feedback on VTE to clinical teams. Results: The annual rate of VTE fell in all the years following the intervention (2001), from 2.57 per 1000 cost-weighted separations to a nadir of 1.87 in 2003, with the difference being statistically significant (RR 0.68, 0.47 to 0.99, p = 0.04). The proportion of patients receiving anticoagulant prophylaxis increased (48% to 74%, p = 0.01) but there was no change in the measured use of GCS. There was a marked increase in the use of risk assessment for VTE in the ward setting (7.7% to 100%, p<0.001) during the programme. Conclusion: Affordable and accessible interventions can improve the application of VTE prophylaxis guidelines into daily hospital care and are associated with reductions in this potentially life-threatening complication. AD - [Gallagher, M.] George Inst Int Hlth, Camperdown, NSW 2050, Australia. [Oliver, K.; Hurwitz, M.] Canberra Hosp, Woden, ACT, Australia. Gallagher, M (corresponding author), George Inst Int Hlth, POB M201,Missenden Rd, Camperdown, NSW 2050, Australia. mgallagher@george.org.au AN - WOS:000270515300017 AU - Gallagher, M. AU - Oliver, K. AU - Hurwitz, M. DA - Oct DO - 10.1136/qshc.2007.024778 J2 - Qual. Saf. Health Care KW - DEEP-VEIN THROMBOSIS PULMONARY-EMBOLISM PREVENTION POPULATION GUIDELINES AUTOPSY Health Care Sciences & Services LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: 503EI Times Cited: 21 Cited Reference Count: 21 Gallagher, M. Oliver, K. Hurwitz, M. Oliver, Kathryn/I-9905-2019 Oliver, Kathryn/0000-0002-4326-5258 21 0 2 B M J PUBLISHING GROUP LONDON QUAL SAF HEALTH CARE PY - 2009 SN - 1475-3898 SP - 408-412 ST - Improving the use of venous thromboembolism prophylaxis in an Australian teaching hospital T2 - Quality & Safety in Health Care TI - Improving the use of venous thromboembolism prophylaxis in an Australian teaching hospital UR - ://WOS:000270515300017 VL - 18 ID - 761889 ER - TY - JOUR AB - The risk of hemorrhage after therapeutic administration of tissue plasminogen activator (tPA) is well known. Cases of postadministration hemorrhage have been reported within many organ systems. We present a case of a 62-year-old female with undiagnosed thyroid goiter who received tPA for acute ischemic stroke and developed acute airway compromise. The surgical airway response team was called due to inability to ventilate or intubate. An incision into the mass during attempted tracheotomy released colloid and blood, decompressing the airway and facilitating ventilation and intubation. Hemithyroidectomy for mass removal was delayed for 3 days to allow normalization of post-tPA coagulopathy. AD - Department of Otolaryngology, New York University, New York, New York, U.S.A. AN - 25043767 AU - Gallant, S. C. AU - Fritz, M. A. AU - Paul, B. C. AU - Costantino, P. D. DA - Mar DO - 10.1002/lary.24841 DP - NLM ET - 2014/07/22 J2 - The Laryngoscope KW - Airway Obstruction/chemically induced/*surgery Brain Ischemia/complications/*drug therapy Female Fibrinolytic Agents/adverse effects/therapeutic use Follow-Up Studies Goiter, Nodular/*complications/surgery Hematoma/*complications/surgery Humans Middle Aged Thrombolytic Therapy/*adverse effects Thyroidectomy/*methods Tissue Plasminogen Activator/*adverse effects/therapeutic use Tracheotomy/methods airway goiter hemorrhage tPA thyroid LA - eng M1 - 3 N1 - 1531-4995 Gallant, Sara C Fritz, Mark A Paul, Benjamin C Costantino, Peter D Case Reports Journal Article United States Laryngoscope. 2015 Mar;125(3):604-7. doi: 10.1002/lary.24841. Epub 2014 Jul 14. PY - 2015 SN - 0023-852x SP - 604-7 ST - Management of airway compromise following thyroid cyst hemorrhage after thrombolytic therapy T2 - Laryngoscope TI - Management of airway compromise following thyroid cyst hemorrhage after thrombolytic therapy VL - 125 ID - 760518 ER - TY - JOUR AB - Pulmonary embolism response teams (PERTs) are multidisciplinary response teams aimed at delivering a range of diagnostic and therapeutic modalities to patients with pulmonary embolism. These teams have gained traction on a national scale. However, despite sharing a common goal, individual PERT programs are quite individualized-varying in their methods of operation, team structures, and practice patterns. The tendency of such response teams is to become intensely structured, algorithmic, and inflexible. However, in their current form, PERT programs are quite the opposite. They are being creatively customized to meet the needs of the individual institution based on available resources, skills, personnel, and institutional goals. After a review of the essential core elements needed to create and operate a PERT team in any form, this article will discuss the more flexible feature development of the nascent PERT team. These include team planning, member composition, operational structure, benchmarking, market analysis, and rudimentary financial operations. AD - Department of Cardiology, Vascular Medicine and Peripheral Vascular Intervention Program, Hofstra Northwell School of Medicine, Northwell Health, Manhasset, NY, USA. Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA. Department of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. Department of Cardiology, Vascular Medicine and Peripheral Vascular Intervention Program, Hofstra Northwell School of Medicine, Northwell Health, Manhasset, NY, USA. Electronic address: Mweinberg4@northwell.edu. AN - 29029717 AU - Galmer, A. AU - Weinberg, I. AU - Giri, J. AU - Jaff, M. AU - Weinberg, M. DA - Sep DO - 10.1053/j.tvir.2017.07.012 DP - NLM ET - 2017/10/17 J2 - Techniques in vascular and interventional radiology KW - *Algorithms Cooperative Behavior Delivery of Health Care, Integrated/*organization & administration Humans Interdisciplinary Communication Models, Organizational Organizational Objectives Patient Care Team/*organization & administration Process Assessment, Health Care/*organization & administration Pulmonary Embolism/diagnosis/physiopathology/*therapy Pert Pulmonary embolism response team pulmonary embolism LA - eng M1 - 3 N1 - 1557-9808 Galmer, Andrew Weinberg, Ido Giri, Jay Jaff, Michael Weinberg, Mitchell Journal Article United States Tech Vasc Interv Radiol. 2017 Sep;20(3):216-223. doi: 10.1053/j.tvir.2017.07.012. Epub 2017 Jul 5. PY - 2017 SN - 1557-9808 SP - 216-223 ST - The Role of the Pulmonary Embolism Response Team: How to Build One, Who to Include, Scenarios, Organization, and Algorithms T2 - Tech Vasc Interv Radiol TI - The Role of the Pulmonary Embolism Response Team: How to Build One, Who to Include, Scenarios, Organization, and Algorithms VL - 20 ID - 760144 ER - TY - JOUR AB - Fractures of the pelvis and acetabulum, although uncommon in the pediatric cohort, represent a range of injuries with similarities to those seen in the adult cohort but with key differences that are important for the treating physician to be aware of to allow for systematic evaluation and management of these potentially life-threatening injuries. As the pediatric skeleton matures, changes in anatomy and physiology influence injury pattern, diagnosis, treatment, and complications. High-energy fractures of the pediatric pelvis are particularly concerning given the reported mortality rates ranging from 3.2% to 18%, with severe fracture patterns being associated with visceral injury in up to 60% of patients. The unique complexity of pediatric patients requires a multidisciplinary team to fully address their care. A systematic approach to the initial evaluation and diagnosis of pediatric patients with fractures of the acetabulum or pelvic ring aids in choosing between surgical and nonsurgical management of these fractures and avoiding complications unique to the maturing skeleton. We present such an approach to assist the practitioner who infrequently treats these uncommon injuries. AD - [Doering, Travis A.] Northwell Hlth, Dept Orthopaed Surg, New Hyde Pk, NY USA. [Galos, David] Nassau Univ, Med Ctr, Dept Orthopaed Surg, E Meadow, NY 11554 USA. Galos, D (corresponding author), Nassau Univ, Med Ctr, Dept Orthopaed Surg, E Meadow, NY 11554 USA. AN - WOS:000532489000008 AU - Galos, D. AU - Doering, T. A. DA - May DO - 10.5435/jaaos-d-19-00082 J2 - J. Am. Acad. Orthop. Surg. KW - VENOUS THROMBOEMBOLISM RISK-FACTORS CHILDREN TRAUMA RING MORTALITY DISRUPTION OUTCOMES PACKING INJURY Orthopedics Surgery LA - English M1 - 9 M3 - Review N1 - ISI Document Delivery No.: LM8HI Times Cited: 0 Cited Reference Count: 38 Galos, David Doering, Travis A. 0 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J AM ACAD ORTHOP SUR PY - 2020 SN - 1067-151X SP - 353-362 ST - High-Energy Fractures of the Pelvis and Acetabulum in Pediatric Patients T2 - Journal of the American Academy of Orthopaedic Surgeons TI - High-Energy Fractures of the Pelvis and Acetabulum in Pediatric Patients UR - ://WOS:000532489000008 VL - 28 ID - 761447 ER - TY - JOUR AB - Introduction Cardiac disease in pregnancy is the leading cause for maternal mortality in developed countries and the second commonest cause in Sri Lanka; its burden continues to rise due to surviving congenital heart disease and acquired heard disease like myocardial infarction. Modified WHO category 4 cardiac diseases are advocated for therapeutic termination of pregnancy; owing to high maternal mortality. Pre-conceptional counselling, appropriate contraception and early termination of unplanned pregnancies are life saving in severe cardiac disease. We report a series of 10 cases, underwent therapeutic termination of pregnancy between 2014 to 2016, owing to high cardiac risk, in the university unit of a tertiary care teaching hospital in Sri Lanka; De Soysa Hospital for Women. Clinical description Median age of mothers was 27 years (range 16-42), representing all regions, all religions (Buddhists 7, Islam 1, Hindu 1, Christian 1) and races. All mothers were unemployed and only 2 had school education up to ordinary level. All spouses except 1 navy officer had been manual laborers resembling most were from lower social strata. Eight were married, of two unmarried, one was living with the partner. Except one diagnosed first during pregnancy, all were unplanned pregnancies. Four were primies, while 5 had living children. Median (range) gestational age (POA) of admission was 11 weeks (7 to 18), and termination was 13 weeks (ra8-20) delays were mainly due to referrals. The outline of the cases are as follows. Case 1: large PDA, sub aortic VSD, with a severe pulmonary hypertension. Case 2: teenager with pre-regnancy primary pulmonary hypertention. Case 3: cyanotic heart disease, tetralogy of fallot with, severe VSD and pulmonary atresia. Case 4: VSD with Eisenmengers disease. Case 5: ACS (NSTEMI) underwent PCI. Case 6: Mitral valve replaced with grade 3 MR and AR. Case 7 and 9: large osteum secondum ASD with severe pulmonary hypertension. Case 8: ACS STEMI, following PCI. Case 10: Tight MS, failed PTMC, Mitral valve replaced with severe bi-ventricular ventricular dysfunction. Means of termination were; using mifepriston followed by misoprostol; 3 occasions requiring more than 1 cycle and 3 occasions leading to surgical evacuation following failed medical induction. All the terminations were done with involvement of multidisciplinary team, in ICU setup; recovery had been uneventful exept for fever and vomiting (each 2 cases). Median hospital, ICU stay (range) had been 18 days (7-36) and 6 days (3-11) respectively. All received DVT prophylaxis, antibiotics and opioids analgesia, all were offered progesterone implants immediately and interval permanent contraception then, referred for cardiology follow-up. AD - W. Gankanda, Obstetrics and Gyneacology, De Soysa Hospital for Women, Colombo, Sri Lanka AU - Gankanda, W. AU - Kaluarachchi, A. AU - Maggonage, C. G. AU - Samsudeen, M. F. AU - Rajendraseelan, T. DB - Embase DO - 10.1111/1471-0528.15132 KW - antibiotic agent misoprostol progesterone adolescent adult analgesia aorta Buddhist cardiology case study child clinical article conference abstract contraception cyanotic heart disease diagnosis education Fallot tetralogy female fever follow up gestational age heart ventricle function high risk pregnancy Hindu human implant Islam male married person mitral valve mother non ST segment elevation myocardial infarction pulmonary hypertension pulmonary valve atresia race single (marital status) spouse Sri Lanka surgery teaching hospital tertiary health care treatment failure unemployment unplanned pregnancy vomiting LA - English M3 - Conference Abstract N1 - L621569836 2018-04-11 PY - 2018 SN - 1471-0528 SP - 110-111 ST - Therapeutic termination of pregnancies with high risk cardiac disease: A case series T2 - BJOG: An International Journal of Obstetrics and Gynaecology TI - Therapeutic termination of pregnancies with high risk cardiac disease: A case series UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621569836&from=export http://dx.doi.org/10.1111/1471-0528.15132 VL - 125 ID - 760842 ER - TY - JOUR AB - Background & aims: Chronic intestinal failure (CIF) requires long term parenteral nutrition (PN) and, in some patients, intestinal transplantation (ITx). Indications and timing for ITx remain poorly defined. In the present study we aimed to analyze causes and outcome of children with CIF. Methods: 118 consecutive patients referred to our institution were assessed by a multidisciplinary team and four different categories were defined retrospectively based on their clinical course: Group 1: patients with reversible intestinal failure; group 2: patients unsuitable for ITx, group 3: patients listed for ITx; group 4: patients stable under PN. Analysis involved comparison between groups for nutritional status, central venous catheter (CVC) related complications, liver disease, and outcome after transplantation by using non parametric tests, Mann Whitney tests, Kruskal Wallis, Wilcoxon signed rank tests and chi square distribution for percentage. Results: 118 children (72 boys) with a median age of 15 months at referral (2 months-16 years) were assessed. Etiology of IF was short bowel syndrome [n = 47], intractable diarrhea of infancy En = 37], total intestinal aganglionosis [n = 18], and chronic intestinal pseudoobstruction [n = 17]. Most patients (89.8%) were totally PN dependent, with 48 children (40.7%) on home-PN prior to admission. Nutritional status was poor with a median body weight at -1.5 z-score (ranges: -5 to +2.5) and median length at -2.0 z-score (ranges: -5.5 to +2.3). The mean number of CVC inserted per patient was 5.2 (range 1-20) and the mean number of CRS per patient was 5.5 (median: 5; range 0-12) Fifty-five patients (46.6%) had thrombosis of >= 2 main venous axis. At admission 34.7% of patients had elevated bilirubin (>= 50 mu mol/l), and 19.5% had platelets <100,000/ml, and 15% had both. Liver biopsy performed in 79 children was normal (n = 4), or showed F1 or F2 fibrosis (n = 29), bridging fibrosis F3 (n = 20), or cirrhosis (n = 26). Group 1 included 10 children finally weaned from PN (7-years survival: 100%). Group 2 included 12 children with severe liver disease and associated disorders unsuitable for transplantation (7-years survival: 16.6%). Group 3 included 66 patients (56%) who were listed for small bowel or liver-small bowel transplantation, 62/66 have been transplanted (7years survival: 74.6%). Factors influencing outcome after liver-ITx were body weight (p < .004), length (p < .001), pre-Tx bilirubin plasma level (p < .001) and thrombosis (p < .01) for isolated ITx, Group 4 included 30 children (25.4%) with irreversible IF considered as potential candidates for isolated ITx. Four children were lost from follow up and 3 died within 2 years (survival 88.5%). Among potential candidates, the following parameters improved significantly during the first 12 months of follow up: Body weight (p.0001), length (p < .0001) and bilirubin (p < .0001). Conclusions: many patients had a poor nutritional status with severe complications especially liver disease. PN related complications were the most relevant indication for ITx, but also a negative predictor for outcome. Early patient referral for Tx-assessment might help to identify and separate children with irreversible IF from children with transient IF or uncomplicated long-term PN, allowing to adapt a patient-based treatment strategy including or not ITx. (C) 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. AD - [Ganousse-Mazeron, S.; Lacaille, F.; Colomb-Jung, V.; Talbotec, C.; Ruemmele, F.; Goulet, O.] Univ Paris 05, Hop Necker Enfants Malad, Reference Ctr Rare Digest Dis, Dept Pediat Gastroenterol Hepatol & Nutr, F-75015 Paris, France. [Sauvat, F.; Chardot, C.; Jan, D.; Revillon, Y.] Univ Paris 05, Hop Necker Enfants Malad, Dept Pediat Surg, F-75015 Paris, France. [Canion, D.] Univ Paris 05, Hop Necker Enfants Malad, Dept Pathol, F-75015 Paris, France. Goulet, O (corresponding author), Univ Paris 05, Hop Necker Enfants Malad, 149 Rue Sevres, F-75015 Paris, France. olivier.goulet@nck.aphp.fr AN - WOS:000355034900014 AU - Ganousse-Mazeron, S. AU - Lacaille, F. AU - Colomb-Jung, V. AU - Talbotec, C. AU - Ruemmele, F. AU - Sauvat, F. AU - Chardot, C. AU - Canion, D. AU - Jan, D. AU - Revillon, Y. AU - Goulet, O. DA - Jun DO - 10.1016/j.clnu.2014.04.015 J2 - Clin. Nutr. KW - Cholestasis Intestinal failure Intestinal rehabilitation Intestinal transplantation Parenteral nutrition Short bowel syndrome SHORT-BOWEL SYNDROME HOME PARENTERAL-NUTRITION SERIAL TRANSVERSE ENTEROPLASTY BLOOD-STREAM INFECTIONS TOLL-LIKE RECEPTORS LIVER-DISEASE PROGNOSTIC-FACTORS PEDIATRIC-PATIENTS CLINICAL-OUTCOMES MANAGEMENT Nutrition & Dietetics LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: CI8PT Times Cited: 44 Cited Reference Count: 54 Ganousse-Mazeron, S. Lacaille, F. Colomb-Jung, V. Talbotec, C. Ruemmele, F. Sauvat, F. Chardot, C. Canion, D. Jan, D. Revillon, Y. Goulet, O. 43 0 6 CHURCHILL LIVINGSTONE EDINBURGH CLIN NUTR PY - 2015 SN - 0261-5614 SP - 428-435 ST - Assessment and outcome of children with intestinal failure referred for intestinal transplantation T2 - Clinical Nutrition TI - Assessment and outcome of children with intestinal failure referred for intestinal transplantation UR - ://WOS:000355034900014 VL - 34 ID - 761749 ER - TY - JOUR AB - BACKGROUND & AIMS: Chronic intestinal failure (CIF) requires long term parenteral nutrition (PN) and, in some patients, intestinal transplantation (ITx). Indications and timing for ITx remain poorly defined. In the present study we aimed to analyze causes and outcome of children with CIF. METHODS: 118 consecutive patients referred to our institution were assessed by a multidisciplinary team and four different categories were defined retrospectively based on their clinical course: Group 1: patients with reversible intestinal failure; group 2: patients unsuitable for ITx, group 3: patients listed for ITx; group 4: patients stable under PN. Analysis involved comparison between groups for nutritional status, central venous catheter (CVC) related complications, liver disease, and outcome after transplantation by using non parametric tests, Mann-Whitney tests, Kruskal-Wallis, Wilcoxon signed rank tests and chi square distribution for percentage. RESULTS: 118 children (72 boys) with a median age of 15 months at referral (2 months-16 years) were assessed. Etiology of IF was short bowel syndrome [n = 47], intractable diarrhea of infancy [n = 37], total intestinal aganglionosis [n = 18], and chronic intestinal pseudoobstruction [n = 17]. Most patients (89.8%) were totally PN dependent, with 48 children (40.7%) on home-PN prior to admission. Nutritional status was poor with a median body weight at -1.5 z-score (ranges: -5 to +2.5) and median length at -2.0 z-score (ranges: -5.5 to +2.3). The mean number of CVC inserted per patient was 5.2 (range 1-20) and the mean number of CRS per patient was 5.5 (median: 5; range 0-12) Fifty-five patients (46.6%) had thrombosis of ≥2 main venous axis. At admission 34.7% of patients had elevated bilirubin (≥50 μmol/l), and 19.5% had platelets <100,000/ml, and 15% had both. Liver biopsy performed in 79 children was normal (n = 4), or showed F1 or F2 fibrosis (n = 29), bridging fibrosis F3 (n = 20), or cirrhosis (n = 26). Group 1 included 10 children finally weaned from PN (7-years survival: 100%). Group 2 included 12 children with severe liver disease and associated disorders unsuitable for transplantation (7-years survival: 16.6%). Group 3 included 66 patients (56%) who were listed for small bowel or liver-small bowel transplantation, 62/66 have been transplanted (7 years survival: 74.6%). Factors influencing outcome after liver-ITx were body weight (p < .004), length (p < .001), pre-Tx bilirubin plasma level (p < .001) and thrombosis (p < .01) for isolated ITx, Group 4 included 30 children (25.4%) with irreversible IF considered as potential candidates for isolated ITx. Four children were lost from follow up and 3 died within 2 years (survival 88.5%). Among potential candidates, the following parameters improved significantly during the first 12 months of follow up: Body weight (p.0001), length (p < .0001) and bilirubin (p < .0001). CONCLUSIONS: many patients had a poor nutritional status with severe complications especially liver disease. PN related complications were the most relevant indication for ITx, but also a negative predictor for outcome. Early patient referral for Tx-assessment might help to identify and separate children with irreversible IF from children with transient IF or uncomplicated long-term PN, allowing to adapt a patient-based treatment strategy including or not ITx. AD - Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France. Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France. Department of Pathology, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France. Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France. Electronic address: olivier.goulet@nck.aphp.fr. AN - 25015836 AU - Ganousse-Mazeron, S. AU - Lacaille, F. AU - Colomb-Jung, V. AU - Talbotec, C. AU - Ruemmele, F. AU - Sauvat, F. AU - Chardot, C. AU - Canioni, D. AU - Jan, D. AU - Revillon, Y. AU - Goulet, O. DA - Jun DO - 10.1016/j.clnu.2014.04.015 DP - NLM ET - 2014/07/13 J2 - Clinical nutrition (Edinburgh, Scotland) KW - Adolescent Bilirubin/blood Central Venous Catheters/adverse effects Child Child, Preschool Female Follow-Up Studies Humans Infant Intestinal Diseases/*surgery Intestines/*physiopathology/*transplantation Liver Diseases/complications/pathology Male Nutritional Status Parenteral Nutrition, Total/adverse effects/methods Retrospective Studies Short Bowel Syndrome/surgery Treatment Outcome Cholestasis Intestinal failure Intestinal rehabilitation Intestinal transplantation Parenteral nutrition Short bowel syndrome LA - eng M1 - 3 N1 - 1532-1983 Ganousse-Mazeron, S Lacaille, F Colomb-Jung, V Talbotec, C Ruemmele, F Sauvat, F Chardot, C Canioni, D Jan, D Revillon, Y Goulet, O Journal Article England Clin Nutr. 2015 Jun;34(3):428-35. doi: 10.1016/j.clnu.2014.04.015. Epub 2014 Apr 30. PY - 2015 SN - 0261-5614 SP - 428-35 ST - Assessment and outcome of children with intestinal failure referred for intestinal transplantation T2 - Clin Nutr TI - Assessment and outcome of children with intestinal failure referred for intestinal transplantation VL - 34 ID - 760491 ER - TY - JOUR AB - Pulmonary embolism (PE) is a common condition seen regularly by emergency physicians. The authors describe a patient who presented with shortness of breath and syncope. He also experienced drowsy, clammy and sweaty episodes. He was tachycardic, tachypnoeic and saturating at 92% on air. A chest X-ray was normal but an ECG showed S1Q3T3. ACT pulmonary angiography performed showed bilateral pulmonary emboli with a large inferior vena cava (IVC) thrombus. Echocardiography revealed severely dilated right ventricle and atrium, severe right ventricular impairment, pulmonary hypertension, large mobile friable clots seen extending into the tricuspid valve. A multidisciplinary team decided the safest management approach was intravenous heparin. The patient recovered and repeat echocardiography 5 days later showed significantly smaller clots. The extension of an IVC thrombus into the heart and prolapsing into the tricuspid valve is an extremely rare presentation. Furthermore this case demonstrates the importance of echocardiography when diagnosing and generating bespoke management plans for PE. AD - K. Garala, University Hospitals Leicester, Glenfield Hospital, Leicester, United Kingdom AU - Garala, K. AU - Chelliah, R. AU - Hudson, I. DB - Embase Medline DO - 10.1136/bcr-2013-010341 KW - heparin warfarin adult arterial oxygen saturation article blood clot lysis case report clinical feature cold clammy skin cold sweat computed tomographic angiography drowsiness dyspnea ECG abnormality echocardiography faintness follow up heart atrium enlargement heart dilatation heart right ventricle failure heart ventricle dilatation human inferior cava vein obstruction lung embolism male outcome assessment priority journal pulmonary hypertension tachycardia tachypnea vein thrombosis L1 - http://casereports.bmj.com/content/2013/bcr-2013-010341.full.pdf+html?sid=8ee52613-d2b0-497b-b5cd-ece36de34af4 LA - English M3 - Article N1 - L369408588 2013-08-03 2013-08-14 PY - 2013 SN - 1757-790X ST - Massive Pulmonary embolus and a precariously positioned thrombus: Teetering on a knife edge! T2 - BMJ Case Reports TI - Massive Pulmonary embolus and a precariously positioned thrombus: Teetering on a knife edge! UR - https://www.embase.com/search/results?subaction=viewrecord&id=L369408588&from=export http://dx.doi.org/10.1136/bcr-2013-010341 ID - 761160 ER - TY - JOUR AB - Objectives: Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy caused by complement dysregulation. The aim of this study was to establish the efficacy and safety of eculizumab in patients with aHUS in clinical practice and to describe different individualization strategies. Methods: Authors performed an observational, longitudinal, and ambispective study at a tertiary care center. Clinical histories of patients in treatment with eculizumab were reviewed. Effectiveness and safety were assessed with the evolution of analytical parameters, symptoms and concomitant therapies required. Results: Authors included five patients (two children). The patients were followed up from diagnosis and first administration of eculizumab. Four patients discontinued eculizumab: one because he had anti-factor H autoantibodies that could be managed with immunosuppressive therapy, another because of non-response, and the other two because of clinical stabilization, resolution of TMA, and no findings of high-risk mutations in complement factors. Therapy was tapered in the remaining patients in aHUS remission. No adverse events were identified during or after treatment. Conclusion: Eculizumab is an effective and safe treatment for patients diagnosed with primary or secondary aHUS. Personalized treatment, tapering or discontinuation should be taken on an individual basis by a multidisciplinary team in order to increase the cost-effectiveness of this therapy. AD - [Garcia-Martin, Estela; Manrique-Rodriguez, Silvia; Martinez Fernandez-Llamazares, Cecilia; Sanjurjo-Saez, Maria] Hosp Gen Univ Gregorio Maranon, Pharm Dept, Inst Invest Sanitaria Gregorio Maranon IiSGM, Madrid, Spain. [Goicoechea-Diezhondino, Marian] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon IiSGM, Nephrol Dept, Madrid, Spain. [Alvarez-Blanco, Olalla] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon IiSGM, Pediat Nephrol Dept, Madrid, Spain. [Garcia-Morin, Marina] Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon IiSGM, Pediat Oncohematol Dept, Madrid, Spain. Garcia-Martin, E (corresponding author), Pharm Dept, 28007 Dr Esquerdo,46, Madrid, Spain. egarciamartin@salud.madrid.org AN - WOS:000503699300001 AU - Garcia-Martin, E. AU - Manrique-Rodriguez, S. AU - Fernandez-Llamazares, C. M. AU - Goicoechea-Diezhondino, M. AU - Alvarez-Blanco, O. AU - Garcia-Morin, M. AU - Sanjurjo-Saez, M. DA - Dec DO - 10.1080/21678707.2019.1703108 J2 - Exp. Opin. Orphan Drugs KW - Eculizumab atypical hemolytic uremic syndrome thrombotic microangiopathy individualization tapering and discontinuation COMPLEMENT INHIBITOR ECULIZUMAB THROMBOTIC MICROANGIOPATHY PLASMA EXCHANGES ADULT PATIENTS TRANSPLANTATION DISCONTINUATION DIAGNOSIS PATHOPHYSIOLOGY REMISSION Pharmacology & Pharmacy LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: KA0ER Times Cited: 0 Cited Reference Count: 50 Garcia-Martin, Estela Manrique-Rodriguez, Silvia Martinez Fernandez-Llamazares, Cecilia Goicoechea-Diezhondino, Marian Alvarez-Blanco, Olalla Garcia-Morin, Marina Sanjurjo-Saez, Maria Fernandez-Llamazares, Cecilia M/T-4736-2017 Fernandez-Llamazares, Cecilia M/0000-0001-6254-8715 0 3 TAYLOR & FRANCIS LTD ABINGDON EXPERT OPIN ORPHAN D PY - 2019 SN - 2167-8707 SP - 525-533 ST - Variability in management and outcomes of therapy with eculizumab in atypical hemolytic uremic syndrome T2 - Expert Opinion on Orphan Drugs TI - Variability in management and outcomes of therapy with eculizumab in atypical hemolytic uremic syndrome UR - ://WOS:000503699300001 VL - 7 ID - 761472 ER - TY - JOUR AB - Objectives: Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy caused by complement dysregulation. The aim of this study was to establish the efficacy and safety of eculizumab in patients with aHUS in clinical practice and to describe different individualization strategies. Methods: Authors performed an observational, longitudinal, and ambispective study at a tertiary care center. Clinical histories of patients in treatment with eculizumab were reviewed. Effectiveness and safety were assessed with the evolution of analytical parameters, symptoms and concomitant therapies required. Results: Authors included five patients (two children). The patients were followed up from diagnosis and first administration of eculizumab. Four patients discontinued eculizumab: one because he had anti-factor H autoantibodies that could be managed with immunosuppressive therapy, another because of non-response, and the other two because of clinical stabilization, resolution of TMA, and no findings of high-risk mutations in complement factors. Therapy was tapered in the remaining patients in aHUS remission. No adverse events were identified during or after treatment. Conclusion: Eculizumab is an effective and safe treatment for patients diagnosed with primary or secondary aHUS. Personalized treatment, tapering or discontinuation should be taken on an individual basis by a multidisciplinary team in order to increase the cost-effectiveness of this therapy. AD - E. García-Martín, Pharmacy Department, 28007 Dr. Esquerdo, 46, Madrid, Spain AU - García-Martín, E. AU - Manrique-Rodríguez, S. AU - Martínez Fernández-Llamazares, C. AU - Goicoechea-Diezhondino, M. AU - Álvarez-Blanco, O. AU - García-Morín, M. AU - Sanjurjo-Sáez, M. DB - Embase DO - 10.1080/21678707.2019.1703108 KW - amoxicillin autoantibody complement factor H autoantibody corticosteroid eculizumab Meningococcus vaccine unclassified drug adult article child clinical article drug withdrawal female hemolytic uremic syndrome human immunosuppressive treatment longitudinal study male middle aged observational study priority journal school child tertiary care center treatment outcome LA - English M1 - 12 M3 - Article N1 - L2003921244 2019-12-31 2020-02-10 PY - 2019 SN - 2167-8707 SP - 525-533 ST - Variability in management and outcomes of therapy with eculizumab in atypical hemolytic uremic syndrome T2 - Expert Opinion on Orphan Drugs TI - Variability in management and outcomes of therapy with eculizumab in atypical hemolytic uremic syndrome UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003921244&from=export http://dx.doi.org/10.1080/21678707.2019.1703108 VL - 7 ID - 760640 ER - TY - JOUR AB - Background and Objectives: Biomarker and echocardiographic values of RV pressure dilatation and systolic dysfunction, which may inform clinicians of pulmonary embolism (PE) severity and prognosis for clinical deterioration, are not yet defined. Primary objective: Determine echocardiographic measurements in PE patients with RV dysfunction (RVD) by CT or biomarkers. Secondary objective: Determine differences of biomarkers and echocardiographic measurements between outcome groups, with primary outcome predefined as composite of death, respiratory failure, hypotension, dysrhythmias or reperfusion intervention within five days. Methods: Prospective observational study at six regional EDs with PE response team for submassive PE patients, who had urgent echocardiography performed per protocol. Extractors reviewed EMR for predefined outcomes within subsequent five days of hospitalization. We used descriptive univariate analyses for the cohort and Mann Whitney for outcome group differences. Results: In eight months, we enrolled 138 patients (goal 280). Echocardiography was performed 7.5 hours (mean) after PE. Forty-nine of 133 (37%) patients had primary outcome. Cohort medians: BNP 132 pg/ml (44-306); troponin 0.06 ng/mL (0.03-0.17); RV base 4.3 cm (3.8-4.8); LV basal diameter 4.2 (3.7-4.6); RV:LV ratio 1.0 (0.9-1.2); RV systolic pressure 47 mmHg (36-56); TAPSE 1.6 cm (1.4-2.0); systolic excursion velocity (S') 11 cm/s (8.0-13.4); TAPSE/RVSP ratio 0.04 (0.02-0.05). Differences in median measurements between outcome positive vs outcome negative groups: BNP 97.5 (23 to 216) p = 0.004; troponin 0.03 (0.01 to 0.06) p = 0.01; RV base 0.2 (-0.1 to 0.5) p = 0.15; LV base -0.3 (-0.5 to 0) p = 0.06; RV:LV ratio 0.1 (0 to 0.2) p = 0.02; RVSP 2 (-4.2 to 7) p = 0.55; TAPSE -0.2 (-0.3 to 0) p = 0.06; S' -1.5 (-3 to 0) p = 0.05; TASPE/RVSP ratio -0.01 (-0.01 to 0) p = 0.11. Conclusion: We present RV measurements for ED patients with acute PE and signs of RVD. Those with subsequent clinical deterioration within five days had significant differences in BNP, troponin, and RV:LV ratio. TAPSE and S' trended toward significance. AD - C. Gardner, Carolinas Medical Center AU - Gardner, C. AU - Bost, W. AU - Fraga, D. N. AU - Belyshev, V. AU - Hogg, M. AU - Runyon, M. S. AU - Raper, J. D. AU - Troha, D. AU - Weekes, A. J. DB - Embase DO - 10.1111/acem.13961 KW - endogenous compound troponin adult conference abstract controlled study deterioration echocardiography female heart right ventricle failure hospitalization human major clinical study male observational study prospective study pulmonary embolism response team systolic blood pressure tricuspid annular plane systolic excursion univariate analysis LA - English M3 - Conference Abstract N1 - L632418160 2020-07-30 PY - 2020 SN - 1553-2712 SP - S64 ST - Right ventricular dysfunction measurements in pulmonary embolism with subsequent acute clinical deterioration T2 - Academic Emergency Medicine TI - Right ventricular dysfunction measurements in pulmonary embolism with subsequent acute clinical deterioration UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632418160&from=export http://dx.doi.org/10.1111/acem.13961 VL - 27 ID - 760573 ER - TY - JOUR AB - BackgroundPhysicians spend significant time outside of regular office visits caring for complex patients, and this work is often uncompensated. In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a billing code for care coordination between office visits for beneficiaries with multiple chronic conditions.ObjectiveCharacterize use of the Chronic Care Management (CCM) code in New England in 2015.DesignRetrospective observational analysis.ParticipantsAll Medicare fee-for-service beneficiaries in New England continuously enrolled in Parts A and B in 2015.InterventionNone.Main measuresThe primary outcome was the number of beneficiaries with a CCM claim per 1000 eligible beneficiaries. Secondary outcomes included the total number of CCM claims, total reimbursement, mean number of claims per beneficiary, and beneficiary characteristics independently associated with receiving CCM services.Key resultsOf the more than two million Medicare fee-for-service beneficiaries in New England, almost 1.7 million were potentially eligible for CCM services. Among eligible beneficiaries, 10,951 (0.65%) had a CCM claim in 2015. Massachusetts had the highest penetration of CCM use (9.40 claims per 1000 eligible beneficiaries); Vermont had the lowest (0.54 claims per 1000 eligible beneficiaries). Mean reimbursement per physician was $1745.98. Age, race/ethnicity, dual-eligible status, income, number of chronic conditions, and state of residence were associated with receiving CCM services in an adjusted model.ConclusionsThe CCM code is likely underutilized in New England; the program may therefore not be achieving its intended goal of encouraging consistent, team-based chronic care management for Medicare's most complex beneficiaries. Or practices may be foregoing reimbursement for care coordination that they are already providing. Recently implemented revisions may improve uptake of CCM services; it will be important to compare our results with future utilization. AD - [Gardner, Rebekah L.] Brown Univ, Alpert Med Sch, Dept Med, Providence, RI 02912 USA. [Gardner, Rebekah L.; Youssef, Rouba; Morphis, Blake; DaCunha, Alyssa; Pelland, Kimberly; Cooper, Emily] Healthcentr Advisors, Providence, RI USA. Gardner, RL (corresponding author), Brown Univ, Alpert Med Sch, Dept Med, Providence, RI 02912 USA. Rebekah_Gardner@Brown.edu AN - WOS:000450752600020 AU - Gardner, R. L. AU - Youssef, R. AU - Morphis, B. AU - DaCunha, A. AU - Pelland, K. AU - Cooper, E. DA - Nov DO - 10.1007/s11606-018-4562-z J2 - J. Gen. Intern. Med. KW - chronic care management Medicare primary care care coordination UNITED-STATES HEPATITIS SCHIZOPHRENIA TIME SEX THROMBOLYSIS PREDICTORS DISORDERS MORTALITY DISEASE Health Care Sciences & Services Medicine, General & Internal LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: HB1BC Times Cited: 5 Cited Reference Count: 45 Gardner, Rebekah L. Youssef, Rouba Morphis, Blake DaCunha, Alyssa Pelland, Kimberly Cooper, Emily Excellence in Operations and Quality Improvement - Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services [HHSM-500-2014-QIN014I] This study was funded by Contract Number HHSM-500-2014-QIN014I, titled Excellence in Operations and Quality Improvement, sponsored by the Centers for Medicare & Medicaid Services (CMS), an agency of the US Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government. CMS reviewed the manuscript and provided comments, but did not have any role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation or approval of the manuscript. The authors assume full responsibility for the accuracy and completeness of the ideas presented. 5 0 8 SPRINGER NEW YORK J GEN INTERN MED PY - 2018 SN - 0884-8734 SP - 1892-1898 ST - Use of Chronic Care Management Codes for Medicare Beneficiaries: a Missed Opportunity? T2 - Journal of General Internal Medicine TI - Use of Chronic Care Management Codes for Medicare Beneficiaries: a Missed Opportunity? UR - ://WOS:000450752600020 VL - 33 ID - 761562 ER - TY - JOUR AB - Rationale Access to intravenous thrombolysis for acute ischaemic stroke is limited worldwide, particularly in regional and rural areas including in Australia. We are testing the effectiveness of a new rural Prehospital Acute Stroke Triage protocol that includes prehospital assessment and rapid transport of patients from a rural catchment to the major stroke centre in Newcastle, NSW, Australia. The local district hospitals within the rural catchment do not have the capability or infrastructure to deliver acute stroke thrombolysis. The trial has relevance to stroke clinicians, health service managers and planners responsible for rural populations. Aims To implement a system of rapid prehospital assessment and facilitated transport that will significantly increase stroke thrombolysis rates to 10% of ischaemic stroke cases in the rural catchment. Validate an eight-point modified National Institutes of Health Stroke Scale for use by paramedics in the prehospital setting to assess patients' potential eligibility for stroke thrombolysis. Design The joint project between the John Hunter Hospital Acute Stroke Team and the Ambulance Service of NSW will use a prospective cohort with an historical control group. Tools and protocols have been developed and education undertaken for ambulance field and operations centre personnel. These include a cut-down eight-item National Institutes of Health Stroke Scale (Hunter NIHSS-8) score to be used in the field by paramedics and a transport decision matrix to expedite transport for a suspected stroke patient (road or road plus air transport). Outcomes The primary outcome measure will be the rate of intravenous tissue plasminogen activator delivery for those who suffer an ischaemic stroke following protocol implementation, in comparison with historical rates over a corresponding period prior to implementation, for residents within the catchment. Sixty cases are required in the postimplementation time epoch to demonstrate a statistically significant absolute increase in thrombolysis rates for ischaemic strokes from <1% to 10%, (power of 80%, alpha error of 0.05). The major secondary outcome will be inter-rater reliability of the Hunter NIHSS-8. AD - [Levi, Christopher R.] Univ Newcastle, John Hunter Hosp, Dept Neurol,Acute Stroke Serv, Stroke Program,Ctr Brain & Mental Hlth Res, New Lambton Hts, NSW 2305, Australia. [Garnett, Ashley R.; Marsden, Dianne L.; Parsons, Mark W.; Quain, Debbie A.; Spratt, Neil J.; Levi, Christopher R.] Hunter Med Res Inst, New Lambton Hts, NSW 2305, Australia. [Marsden, Dianne L.; Parsons, Mark W.; Spratt, Neil J.; Levi, Christopher R.] Hunter New England Hlth, Hunter Stroke Serv, New Lambton Hts, NSW 2305, Australia. [Loudfoot, Allan R.; Middleton, Paul M.] New S Wales Ambulance Serv, Rozelle, NSW 2039, Australia. [Loudfoot, Allan R.; Middleton, Paul M.] Ambulance Res Inst, Rozelle, NSW 2039, Australia. Levi, CR (corresponding author), Univ Newcastle, John Hunter Hosp, Dept Neurol,Acute Stroke Serv, Stroke Program,Ctr Brain & Mental Hlth Res, Lookout Rd, New Lambton Hts, NSW 2305, Australia. christopher.levi@hnehealth.nsw.gov.au AN - WOS:000283949400016 AU - Garnett, A. R. AU - Marsden, D. L. AU - Parsons, M. W. AU - Quain, D. A. AU - Spratt, N. J. AU - Loudfoot, A. R. AU - Middleton, P. M. AU - Levi, C. R. AU - Rural, Past Protocol Steering Grp DA - Dec DO - 10.1111/j.1747-4949.2010.00522.x J2 - Int. J. Stroke KW - acute stroke ambulance protocol rural stroke thrombolysis TISSUE-PLASMINOGEN ACTIVATOR ACUTE ISCHEMIC-STROKE COST-EFFECTIVENESS CLINICAL-TRIALS SCALE CARE IMPLEMENTATION THROMBOLYSIS RELIABILITY VALIDATION Clinical Neurology Peripheral Vascular Disease LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: 676WM Times Cited: 13 Cited Reference Count: 35 Garnett, Ashley R. Marsden, Dianne L. Parsons, Mark W. Quain, Debbie A. Spratt, Neil J. Loudfoot, Allan R. Middleton, Paul M. Levi, Christopher R. Parsons, Mark W./G-3750-2014; bladin, chris/B-9136-2013; Spratt, Neil J/K-4208-2012; Middleton, Paul M/A-9084-2012 Spratt, Neil J/0000-0002-9023-6177; Middleton, Paul M/0000-0003-0760-1098; Levi, Christopher/0000-0002-9474-796X; Marsden, Dianne/0000-0002-6943-8428 13 0 11 SAGE PUBLICATIONS LTD LONDON INT J STROKE PY - 2010 SN - 1747-4930 SP - 506-513 ST - The rural Prehospital Acute Stroke Triage (PAST) trial protocol: a controlled trial for rapid facilitated transport of rural acute stroke patients to a regional stroke centre T2 - International Journal of Stroke TI - The rural Prehospital Acute Stroke Triage (PAST) trial protocol: a controlled trial for rapid facilitated transport of rural acute stroke patients to a regional stroke centre UR - ://WOS:000283949400016 VL - 5 ID - 761864 ER - TY - JOUR AB - OBJECTIVES: Clot in transit (CIT) represents a rare and life-threatening manifestation of venous thromboembolism of which we have limited understanding. This study describes the risk factors, clinical characteristics, and outcomes associated with the development of CIT as well as death following CIT diagnosis. METHODS: We analyzed patients enrolled in our institutional Pulmonary Embolism Response Team (PERT) registry and compared 57 patients who had a CIT to 608 pulmonary embolism (PE) patients who did not have a CIT. We performed univariate and multivariate logistic regression to identify factors associated with CIT (vs PE without CIT) among patients who had an echocardiogram, as well as factors associated with 7-day death after CIT diagnosis. RESULTS: CIT was present in (57) 8.6% of patients who had an echocardiogram. Multivariate analysis showed heart failure (OR 2.8, 95% CI 1.2-6.5, P = 0.01), a pre-existing central venous catheter (OR 2.5, 95% CI 1.1-5.7, P = 0.03), and hypotension (OR 2.1, 95% CI 1.1-3.7, P = 0.02) to be independently associated with CIT. All-cause mortality by 7 days was higher in CIT patients (12.5% vs 5.1%, P = 0.02). CIT patients who died were more likely to have presented with hemodynamic collapse (57.1% vs 14.0%, P = 0.02), mental status change (100% vs 22.0%, P < 0.001), and to be intubated (100% vs 36.0%, P = 0.001). CONCLUSIONS: The presence of heart failure, a central venous catheter, and hypotension should alert physicians to patients who may require an echocardiogram to diagnose CIT. The mortality of CIT is high, even relative to a population with severe PE. AD - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States. Department of Cardiology, Massachusetts General Hospital, Boston, MA, United States. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States. Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States. Electronic address: ckabrhel@partners.org. AN - 31991381 AU - Garvey, S. AU - Dudzinski, D. M. AU - Giordano, N. AU - Torrey, J. AU - Zheng, H. AU - Kabrhel, C. DA - Mar DO - 10.1016/j.thromres.2020.01.006 DP - NLM ET - 2020/01/29 J2 - Thrombosis research KW - *Clot in transit *Pulmonary embolism in transit *Pulmonary embolism response team *Right heart thromboembolism *Right heart thrombus *Thrombus in transit LA - eng N1 - 1879-2472 Garvey, Shannon Dudzinski, David M Giordano, Nicholas Torrey, Jasmine Zheng, Hui Kabrhel, Christopher Journal Article United States Thromb Res. 2020 Mar;187:139-147. doi: 10.1016/j.thromres.2020.01.006. Epub 2020 Jan 10. PY - 2020 SN - 0049-3848 SP - 139-147 ST - Pulmonary embolism with clot in transit: An analysis of risk factors and outcomes T2 - Thromb Res TI - Pulmonary embolism with clot in transit: An analysis of risk factors and outcomes VL - 187 ID - 760224 ER - TY - JOUR AB - Background: Most PERT team algorithms for evaluation of intermediate and high-risk pulmonary embolism (PE) do not include evaluation for a patent foramen ovale (PFO). Yet 3 prior prospective studies concerning the detection of a PFO in intermediate and high-risk PE have found the prevalence to be approximately 35% with evidence of paradoxical embolism and stroke to be as high as 17% (1-3). A PFO in the face of PE has also been associated with increased mortality to as high as 33% (3). In our PERT team experience 6 out of 160 activations were associated with a clinically significant event leading to PFO detection and consideration for closure. Over the past 4 years we have witnessed 4 different ways paradoxical embolism may present and highlight them in case series. Case Descriptions: Case #1: Intermediate risk PE treated with catheter-directed thrombolysis and stabilization of hemodynamics. Hospital day 4, experienced acute embolic occlusion of left carotid artery leading to large CVA and ultimately brain death. Case #2: Intermediate risk PE with subsequent acute myocardial infarction with embolic occlusion of the RCA requiring thrombectomy and PFO closure. Case #3: High risk saddle PE simultaneously found to have extensive right upper extremity arterial and right common carotid artery thromboembolism requiring extensive embolectomy and PFO closure. Case #4: Intermediate risk PE presented with severe hypoxemia requiring high flow oxygen. Hypoxemia from shunt across moderate-sized PFO resolved as pulmonary hypertension improved. Conclusions: PFOs significantly add to morbidity and mortality especially when PE is intermediate and high risk as elevated pulmonary artery pressures can promote shunting of blood across the defect and risk paradoxical embolism. Systemic embolism may lead to stroke, myocardial infarction, vascular ischemic injury, or renal and splenic infarcts. Evaluation for PFO by trans-thoracic echocardiogram is safe and capable of recognizing larger PFOs that may require closure. Finding a PFO may also influence the long-term recommendations for anticoagulation for unprovoked PE. We suggest that the detection of PFO with bubble study should be considered as part of PERT team evaluation. AD - P.J. Gary, Pulmonary and Critical Care Medicine, Lankenau Medical Center, Wynnewood, PA, United States AU - Gary, P. J. AU - Whealon, S. AU - Greenspon, L. W. DB - Embase KW - oxygen acute heart infarction anticoagulation blood clot lysis brain death case study catheter cerebrovascular accident complication conference abstract echocardiography embolectomy human hypoxemia kidney infarction lung artery pressure morbidity mortality occlusion paradoxical embolism patent foramen ovale prevalence prospective study pulmonary embolism response team pulmonary hypertension right common carotid artery shunting spleen infarction surgery thrombectomy upper limb LA - English M1 - 9 M3 - Conference Abstract N1 - L630347654 2020-01-01 PY - 2019 SN - 1535-4970 ST - Complications associated with a patent foramen ovale in intermediate and high risk pulmonary embolism: A 4-year PERT team experience T2 - American Journal of Respiratory and Critical Care Medicine TI - Complications associated with a patent foramen ovale in intermediate and high risk pulmonary embolism: A 4-year PERT team experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630347654&from=export VL - 199 ID - 760725 ER - TY - JOUR AB - Objective: To report our initial experience with intra-arterial thrombectomy (IAT) with stent retriever for acute ischemic stroke. Methods: We conducted a retrospective review of patients with acute ischemic stroke who underwent IAT from September 2010 to August 2016. Results: Forty-one patients were included; mean age was 57 years (range: 29-85), and 54% were women. There were 32 anterior circulation occlusions, and 11 posterior circulation occlusions. The mean value of the National Institutes of Health Stroke Scale (NIHSS) upon admission (available in 9/41 patients) was 14 (range: 6-20). Nineteen patients had favorable outcomes (modified Rankin Scale [mRS]: 0-2 at 6 months), and 22 had unfavorable outcomes (mRS: 3-6 at 6 months). The mortality rate was 37% (15/41). Favorable outcomes were associated with revascularization within the first 360 minutes of the onset of symptoms (p=0.000001), and satisfactory revascularization (thrombolysis in cerebral infarction [TICI] scale: 2b or 3) (p=0.0018). Conclusion: It is of paramount importance to educate stroke teams on the benefits of IAT for acute ischemic stroke and the population on identifying stroke and seeking immediate care following symptom onset. AD - [Maranha Gatto, Luana Antunes; Demartini Junior, Zeferino] Hosp Univ Cajuru, Dept Neurosurg & Intervent Neuroradiol, Rua Sao Jose 300, BR-80050350 Curitiba, Parana, Brazil. [Zetola, Viviane de Hiroki F.] Univ Fed Parana, Hosp Clin, Dept Neurol, Curitiba, Parana, Brazil. [Nascimento, Fabio A.] Baylor Coll Med, Dept Neurol, Houston, TX 77030 USA. [Koppe, Gelson Luis] Hosp Univ Cajuru, Dept Neuroradiol, Curitiba, Parana, Brazil. Gatto, LAM (corresponding author), Hosp Univ Cajuru, Dept Neurosurg & Intervent Neuroradiol, Rua Sao Jose 300, BR-80050350 Curitiba, Parana, Brazil. luanamaranha@yahoo.com.br AN - WOS:000418561300003 AU - Gatto, L. A. M. AU - Zetola, V. D. F. AU - Demartini, Z. AU - Nascimento, F. A. AU - Koppe, G. L. DA - Dec DO - 10.1055/s-0037-1607062 J2 - Braz. Neurosurg. KW - endovascular treatment intra-arterial thrombectomy mechanical thrombectomy ischemic stroke INTRAVENOUS T-PA ENDOVASCULAR TREATMENT IMAGING SELECTION TRIAL THERAPY Surgery LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: FQ7RX Times Cited: 0 Cited Reference Count: 12 Maranha Gatto, Luana Antunes Zetola, Viviane de Hiroki F. Demartini Junior, Zeferino Nascimento, Fabio A. Koppe, Gelson Luis Nascimento, Fabio A./W-8395-2019; Demartini, Zeferino/H-4978-2015 Nascimento, Fabio A./0000-0002-7161-6385; Demartini, Zeferino/0000-0002-0683-5418 0 1 GEORG THIEME VERLAG KG STUTTGART BRAZ NEUROSURG PY - 2017 SN - 0103-5355 SP - 213-216 ST - Intra-arterial Thrombectomy with Stent Retriever for Acute Ischemic Stroke - a Retrospective, Single-centered Study from Brazil T2 - Brazilian Neurosurgery-Arquivos Brasileiros De Neurocirurgia TI - Intra-arterial Thrombectomy with Stent Retriever for Acute Ischemic Stroke - a Retrospective, Single-centered Study from Brazil UR - ://WOS:000418561300003 VL - 36 ID - 761619 ER - TY - JOUR AB - Introduction: It is a challenge to ensure transferability of successful integrated care services to a new healthcare setting. The ACT@Scale program aims to identify, transfer and scale-up mature integrated care and telehealth practices in different regions in Europe. Patient empowerment PE, representing the process through which greater control over health is gained, is one of the target areas for successful integrated care deployment. In ACT@Scale, five integrated care programs, represented by a local multidisciplinary team, identified the key issues related to PE and required changes to improve the program in order to scale it up. Short description of practice change implemented: During the ACT@Scale project, programs apply collaborative methodologies CM to stimulate rapid process improvement. It encompasses routine data collection and assessment, provision of training material and communication channels. Regions develop and apply changes to improve the level of patient empowerment in their programs. Various surveys that measure PE level are used patient activation PAM[1]; psycho-social profile MAY[2]; program satisfaction NPS[3]; and staff attitude on PE CSPAM[2]. Aim and theory of change: Regions use CM to apply process improvements while learning cycles are managed by Plan-Do-Study-Act PDSA cycles. Evidence from the data is used to start subsequent improvement cycles. We monitor PE during the upscaling process. Targeted population and stakeholders: Implemented changes target patients of five integrated care programs, healthcare providers and program managers. Timeline: Total project duration is three years. Two full one-year PDSA cycles will be completed by participating programs. Highlights: The approach is complemented by an ICT solution for data collection and visualization to support decision-making. ICT data management allows distributed analysis of patient outcomes and resource utilization. This data remains in the regions, while a central engine runs remote analysis and displays aggregated results across regions. Comments on sustainability: The ACT@Scale program has a dedicated work package to address sustainability. Some participating programs are addressing this topic by applying changes in this area. Comments on transferability: Sharing of good practices within the consortium is part of collaborative methodology. During the final phase of ACT@Scale, specific local and international activities on dissemination and knowledge transferability will be organized. Conclusions: By using surveys, we can measure patient empowerment level in the program staff and patients and the regional level of adoption. Tools for monitoring progress of these levels and impact on outcomes during process improvement are essential to support the decision making process. Discussions: The data collection and regional implementation of the ICT technology are in progress. When completed, it will allow a more detailed analysis of patient empowerment levels into integrated care programs. Lessons learned: Distributed analysis can be a solution when data sharing is not allowed. AD - Philips Research, The Netherlands Laboratory of Computing, Medical Informatics and Medical Imaging Technologies, Aristotle University of Thessaloniki, Greece AN - 138001726. Language: English. Entry Date: In Process. Revision Date: 20190813. Publication Type: Article. Supplement Title: 2018 Supplement2. Journal Subset: Europe AU - Gaveikaite, Violeta AU - Filos, Dimitris AU - Schonenberg, Helen AU - Maglaveras, Nicos AU - Chouvarda, Ioanna DB - CINAHL DO - 10.5334/ijic.s2238 DP - EBSCOhost N1 - Health Services Administration; UK & Ireland. NLM UID: 101214424. PY - 2018 SN - 1568-4156 SP - 1-2 ST - How can patient empowerment be integrated into change management while scaling-up an integrated care program? T2 - International Journal of Integrated Care (IJIC) TI - How can patient empowerment be integrated into change management while scaling-up an integrated care program? UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=138001726&site=ehost-live&scope=site VL - 18 ID - 761333 ER - TY - JOUR AB - Introduction: Systemic lupus erythematosus (SLE) is an idiopathic connective tissue disease, characterized with multiorgan involvement. Central nervous system (CNS) involvement is one of the most frequent manifestation of SLE and is termed as neuropsychiatric SLE (NPSLE) Prevalence of NPSLE varies between 12% and 95% among SLE patients. cerebrovascular accidents (CVA) and/or transient ischemic attack (TIA) represents one of the most frequent neuropsychiatric manifestation in SLE patients. Cerebral embolism may have cardioembolic source. Purpose: we described one case of SLE patient with NPSLE diagnosis and concomitant nonsignificant size of ASD II and tried to find its possible association with cerebrovascular accident. Method: We performed retrospective analysis of SLE (NPSLE) patient who had undergone echocardiographic and brain MRI evaluation. Case-Results: A 63 years old women was diagnosed with SLE in 1996 based on positive ANF, positive anti-cardiolipin IGg , arthritis, discoid lupus, positive coombs test and neurological manifestations (hemiplegia and aphasia). Echocardiographic evaluation showed pericarditis and nonsignificant ASD II (<3mm). Ischemic changes were observed on Brain MRI study. Two years later in 1998 brain MRI showed a white matter defect (suspected vascular nature). Patient received 6 standard course of treatment with Cyclophosphamide ,Prednisone (from 60 mg gradually decreased to 10 mg) and oral anticoagulation drugs. After 9 years from the first diagnosis of SLE patient achieved complete remission, but soon in 2006 patient developed TIA and in 2013 developed lacunar infarct. Cardiac source of embolism was excluded according to performed analysis. In addition myocardial infarction was excluded based on Single-photon emission computed tomography (SPECT) perfusion scan. Since then patient remained under the observation of multidisciplinary team. Conclusion: We demonstrated one case of SLE patient with life threating neurological manifestations developed several times. Transthoracic echocardiographic examination showed small ASD II which was not considered as source of embolism, but we believe that in SLE patients with PFO/ASD, even though the size of defect is not large, cerebrovascular accidents may develop due to underlying inflammatory mechanism predisposing possible thromboembolism and early diagnosis, follow-up and management can be paramount to avoid future complications. AD - M. Gegenava, Leiden University Medical Centre, Leiden, Netherlands AU - Gegenava, M. AU - Gegenava, T. AU - Huizinga, T. DB - Embase DO - 10.1093/ehjci/jez319.899 KW - anticoagulant agent cardiolipin antibody cyclophosphamide endogenous compound prednisone adult aphasia arthritis case report clinical article complication conference abstract Coombs test diagnosis discoid lupus erythematosus drug therapy early diagnosis female follow up heart infarction hemiplegia human lacunar stroke middle aged multidisciplinary team nuclear magnetic resonance imaging perfusion pericarditis prevalence remission retrospective study single photon emission computed tomography systemic lupus erythematosus thromboembolism white matter LA - English M3 - Conference Abstract N1 - L631350196 2020-04-07 PY - 2020 SN - 2047-2412 SP - i950 ST - Detection of cardiac sources of cerebrovascular events in patient with systemic lupus erythematosus with neuropsychiatric manifestations T2 - European Heart Journal Cardiovascular Imaging TI - Detection of cardiac sources of cerebrovascular events in patient with systemic lupus erythematosus with neuropsychiatric manifestations UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631350196&from=export http://dx.doi.org/10.1093/ehjci/jez319.899 VL - 21 ID - 760630 ER - TY - JOUR AB - Introduction: Cardiac involvement in Systemic Lupus Erythematosus (SLE) may lead to left ventricular (LV) hypertrophy with possible impairment of LV diastolic function and left atrial (LA) function, particularly in patients with severe forms of SLE with neuropsychiatric manifestations (NPSLE) and can also be associated with cardiovascular outcome. Purpose: We evaluated the prevalence of LV diastolic dysfunction and LA dysfunction in a large cohort of SLE patients including also NPSLE patients, and their association with the occurrence of cardiovascular events (cerebrovascular accidents, lung-embolism, coronary revascularisation, heart failure hospitalisations and development of supraventricular arrhythmias). Methods: A total of 102 SLE patients (87% female, 42±15 years) were included, of which 43 (42%) with NPSLE according to a multidisciplinary team assessment. All patients fulfilled the American College of Rheumatology (ACR 1997) and Systemic Lupus Erythematosus International Collaborating Clinics (SLICC 2012) classification criteria for SLE. Echocardiography was performed at the first visit: LV diastolic function was assessed according to current recommendations and including Tissue Doppler Imaging measures; LA volume (LAVI) was also measured and LA function was assessed by LA reservoir strain using 2D speckle tracking imaging. Results: In the SLE patients, mean LV mass index was 82±32 g/m2, 29% of patients showed an e'septal <10, 7% an E/e'>14, 16% a LAVI>34 ml/m2 and 5% a tricuspid velocity >2.8m/s. When applying the currently recommended multiparametric approach, only 4% of SLE patients showed LV diastolic dysfunction. In NPSLE patients, the prevalence of LV diastolic dysfunction was not significantly higher (5%). However, an impaired LA reservoir strain (based on the median value of 25%) was observed in 54% of the total SLE population and in 77% of NPSLE patients suggesting higher sensitivity of this parameter to detect impaired LA function and LV diastolic function. During a median follow up of 11 years (Interquartile range: 4-19 years), 43 (42%) patients developed a cardiovascular event. Kaplan-Meier curve analysis showed that SLE patients with impaired LA strain <25% experienced higher cumulative rates of cardiovascular events, as compared to SLE patients with LA strain≥25% (Chi-square 4.350; Log rank p=0.037). At the uni- and multivariate Cox-regression models, LA strain showed significant association with cardiovascular events (hazard ratio [HR]:0.944; 95% confidence interval [CI]: 0.893-0.997; p=0.039) together with age (HR: 1.030; 95% CI: 1.002-1.059; p=0.039) after correcting for LV mass index and LV diastolic dysfunction. Conclusions: LA dysfunction as assessed by LA reservoir strain is significantly impaired in SLE and particularly in NPSLE patients and improve detection of myocardial involvement in these patients. Furthermore, LA reservoir strain is independently associated with the development of cardiovascular events. (Figure Presented) . AD - T. Gegenava, Leiden University Medical Center, Leiden, Netherlands AU - Gegenava, T. AU - Gegenava, M. AU - Steup-Beekman, M. AU - Huizinga, T. AU - Bax, J. AU - Delgado, V. AU - Ajmone-Marsan, N. DB - Embase DO - 10.1093/eurheartj/ehz745.0841 KW - adult cerebrovascular accident cohort analysis conference abstract controlled study female follow up heart atrium function heart left atrium heart left ventricle hypertrophy heart left ventricle mass heart muscle revascularization heart supraventricular arrhythmia hospitalization human Kaplan Meier method left ventricular diastolic dysfunction lung embolism major clinical study male mental disease multidisciplinary team prevalence rheumatology systemic lupus erythematosus tissue Doppler imaging tricuspid valve LA - English M3 - Conference Abstract N1 - L630049273 2019-12-12 PY - 2019 SN - 0195-668X SP - 2669 ST - Assessment of left atrial function in patients with systemic lupus erythematosus with and without neuropsychiatric manifestations: Association with cardiovascular events T2 - European Heart Journal TI - Assessment of left atrial function in patients with systemic lupus erythematosus with and without neuropsychiatric manifestations: Association with cardiovascular events UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630049273&from=export http://dx.doi.org/10.1093/eurheartj/ehz745.0841 VL - 40 ID - 760672 ER - TY - JOUR AB - INTRODUCTION: In-hospital stroke alerts are typically activated by nurses or physicians when a patient's neurological status acutely changes from baseline. It is unclear if knowledge of stroke symptoms translates to accurate activation of the acute stroke team. We hypothesized that nurses who activate the stroke alert system would correctly identify as great a proportion of acute strokes as physicians. We also investigated the time to activation of these in-hospital stroke alerts. METHODS: We retrospectively reviewed consecutive inpatient stroke team calls over a 12-month period at a single, tertiary care center. Calls and exact times were identified from the acute stroke pager log. The type of provider who called the stroke alert, patient characteristics, last known well time, and acute stroke symptoms was prospectively collected and retrospectively verified through electronic medical record review. Patients with definite stroke then were retrospectively identified by World Health Organization Monitoring of Trends and Determinants in Cardiovascular Disease (WHO MONICA) criterion. RESULTS: A total of 93 calls were analyzed. Nurses and physicians/midlevel providers activated the in-hospital stroke alert with a similar percentage of correct stroke diagnosis (62.7% versus 58.8%, P = .82). Nurses activated stroke alerts significantly earlier than physicians/midlevel providers (median 2 hours [IQR .5-6 hours] versus 4.9 hours [IQR 1.3-21.3 hours], P = .0096) from last known well time. CONCLUSIONS: Nurses identify in-hospital ischemic events with a similar percentage as physicians, and they activate the stroke alerts significantly earlier. The median nursing activation time fell within a 3-hour window for potential systemic thrombolytic or early endovascular therapy. An intensive, focused, collaborative education of nursing staff may further improve inpatient stroke outcomes. AD - Department of Neurology, Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio. Electronic address: georgep@ccf.org. Department of Neurology, Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio. Akron General Hospital, Akron, Ohio. Department of Neurology, Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio; Department of Neurology, University of Missouri, Columbia, Missouri. AN - 28342656 AU - George, P. AU - Wisco, D. R. AU - Gebel, J. AU - Uchino, K. AU - Newey, C. R. DA - May DO - 10.1016/j.jstrokecerebrovasdis.2016.10.003 DP - NLM ET - 2017/03/28 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Aged Attitude of Health Personnel Clinical Competence *Critical Pathways Early Diagnosis Female Health Knowledge, Attitudes, Practice *Hospitalists Humans Male *Nursing Staff, Hospital Patient Care Team Retrospective Studies Stroke/*diagnosis/physiopathology/psychology/therapy Time Factors Time-to-Treatment In-hospital stroke epidemiology inpatient nursing stroke management LA - eng M1 - 5 N1 - 1532-8511 George, Pravin Wisco, Dolora R Gebel, James Uchino, Ken Newey, Christopher R Comparative Study Journal Article United States J Stroke Cerebrovasc Dis. 2017 May;26(5):917-921. doi: 10.1016/j.jstrokecerebrovasdis.2016.10.003. Epub 2017 Mar 22. PY - 2017 SN - 1052-3057 SP - 917-921 ST - Nurses Are as Specific and Are Earlier in Calling In-Hospital Stroke Alerts Compared to Physicians T2 - J Stroke Cerebrovasc Dis TI - Nurses Are as Specific and Are Earlier in Calling In-Hospital Stroke Alerts Compared to Physicians VL - 26 ID - 760296 ER - TY - JOUR AB - Background: The management of intracranial aneurysms in the pediatric population presents unique challenges. Cases are rare and tend to be of higher complexity compared with aneurysms in adults. Outcomes in long-term follow-up are not well-characterized. Here we present illustrative case examples to demonstrate key concepts in managing these lesions in the context of the modern neurovascular era. Methods: Four institutional databases of neurovascular procedures from 2012 to 2017 were reviewed. Patients <18 years old who underwent treatment for intracranial aneurysms were included. Patient characteristics, aneurysm details, treatment information, and angiographic and clinical outcomes were recorded. Results: Ten cases of intracranial aneurysms in 9 children were identified. Management included direct clipping, trapping and bypass, endovascular coil embolization, endovascular vessel sacrifice, and flow diversion. Conclusions: The management of intracranial aneurysms in pediatric patients requires special considerations, from the diagnostic phase to treatment methods and follow-up regimen. These are ideally considered by a multidisciplinary team, with expertise from pediatric neurosurgeons, cerebrovascular neurosurgeons, and neurointerventionalists. AD - P. Kan, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States AU - Ghali, M. G. Z. AU - Srinivasan, V. M. AU - Cherian, J. AU - Wagner, K. M. AU - Chen, S. R. AU - Johnson, J. AU - Lam, S. K. AU - Kan, P. DB - Embase Medline DO - 10.1016/j.wneu.2017.12.057 KW - pipeline embolization device stent adolescent aneurysm clipping angiography article bypass surgery case report child clinical article clinical outcome coil embolization endovascular aneurysm repair female follow up human intracranial aneurysm male microsurgery nuclear magnetic resonance imaging preschool child recurrent disease risk factor school child vascular surgery x-ray computed tomography LA - English M3 - Article N1 - L620397837 2018-02-02 2018-03-12 PY - 2018 SN - 1878-8769 1878-8750 SP - e294-e307 ST - Multimodal Treatment of Intracranial Aneurysms in Children: Clinical Case Series and Review of the Literature T2 - World Neurosurgery TI - Multimodal Treatment of Intracranial Aneurysms in Children: Clinical Case Series and Review of the Literature UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620397837&from=export http://dx.doi.org/10.1016/j.wneu.2017.12.057 VL - 111 ID - 760839 ER - TY - JOUR AB - Objective: To determine the proportion of computed tomography pulmonary angiograms (CTPAs), performed after medical emergency team (MET) calls, that are positive for pulmonary embolism (PE), and whether there are useful clinical predictors of positive CTPA results. Design: All patients from a tertiary referral hospital in Melbourne who had an MET response and an associated CTPA within 6 hours, from 2009 to 2013, were included. We reviewed medical records to assess indications for CTPA, including MET clinical triggers, time of day of the MET (implying the seniority of decision making), chest x-ray results and Wells scores as a clinical decision rule for PE. Results: There were 4578 MET responses (in 3136 patients) over the 5-year study period, from which 70 CTPAs were ordered (2.2% of all patients). A PE was identified in 12 patients (17.1%). The median age of CTPA patients was 70 years (interquartile range, 60-76 years) and most were surgical patients (80%). The major MET triggers for CTPA were hypoxia (42.9%) and hypotension (28.6%). An abnormal chest x-ray was associated with a low likelihood of PE. The Wells scores and MET indications of hypoxia, hypotension and tachycardia were not accurate in predicting the presence or extent of PE. Conclusion: Clinical decision rules and MET indications were not significantly associated with the presence of PE on CTPA. However, an abnormal chest x-ray has a high negative predictive value and therefore may be helpful in preventing unnecessary CTPAs. AD - [Ghani, Manisa; Tobin, Antony] St Vincents Hosp, Dept Crit Care Med, Melbourne, Vic, Australia. Ghani, M (corresponding author), St Vincents Hosp, Dept Crit Care Med, Melbourne, Vic, Australia. manisa.ghani@svhm.org.au AN - WOS:000344977900008 AU - Ghani, M. AU - Tobin, A. DA - Dec J2 - Crit Care Resusc. KW - EMBOLISM MANAGEMENT DIAGNOSIS RISK Critical Care Medicine LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: AT5IU Times Cited: 1 Cited Reference Count: 19 Ghani, Manisa Tobin, Antony Tobin, Antony/R-7863-2019 Tobin, Antony/0000-0003-4301-7841 1 0 AUSTRALASIAN MED PUBL CO LTD PYRMONT CRIT CARE RESUSC PY - 2014 SN - 1441-2772 SP - 280-284 ST - Computed tomography pulmonary angiogram as a result of medical emergency team calls: a 5-year retrospective audit T2 - Critical Care and Resuscitation TI - Computed tomography pulmonary angiogram as a result of medical emergency team calls: a 5-year retrospective audit UR - ://WOS:000344977900008 VL - 16 ID - 761771 ER - TY - JOUR AB - Background There are limited data on outcomes for patients with peripheral artery disease undergoing endovascular revascularization by multi-disciplinary teams in a community hospital setting. Methods From January 2015 through December 2015, we assembled a multi-disciplinary program comprised of cardiologists, surgeons, radiologists, nurses, and administrative staff for managing patients with peripheral artery disease undergoing endovascular revascularization. Demographic, procedural, and outcomes data were collected with use of a template from the Society for Vascular Surgery Vascular Quality Initiative database. We compared characteristics and outcomes of patients with intermittent claudication and critical limb ischemia. We used Kaplan-Meier methods to estimate the rate of overall survival and freedom from rehospitalization between groups. Results After excluding patients with acute limb ischemia (n = 5), peripheral intervention to the upper extremity (n = 6), or abdominal aorta (n = 11), there were 82 patients in the study cohort; 45 had intermittent claudication and 37 had critical limb ischemia. Baseline and procedural characteristics were similar between groups, although critical limb ischemia patients were more likely to have hyperlipidemia (75.7% vs. 53.3%,P = .42). Procedural success was achieved in 91.3% of cases. Actionable access site bleeding occurred in 2.4% of patients. High rates of aspirin (91.5%) and statin (87.8%) were noted at discharge. After two years of post endovascular revascularization, survival was 57.5% for critical limb ischemia patients and 94.4% for intermittent claudication patients (P < .001). Freedom from rehospitalization was 32.7% for critical limb ischemia patients and 83.5% for intermittent claudication patients (P < .001). Conclusions We found that favorable outcomes may be achieved with a multi-disciplinary peripheral artery disease program at community hospitals. The incorporation of quality improvement practices may further help to develop standardized and regionalized approaches to care delivery for patients with peripheral artery disease. AD - [Michael Gharacholou, S.; Gutierrez, Jorge F. Trejo] Mayo Clin Florida, Dept Cardiovasc Med, Jacksonville, FL 32224 USA. [Li, Zhuo] Mayo Clin Florida, Dept Biostat, Jacksonville, FL USA. [Uy, Jonathan J.; Eckstein, Lee H.] Mayo Clin Hlth Syst, Dept Radiol, La Crosse, WI USA. [Flock, Carolyn R.] Mayo Clin Hlth Syst, Dept Clin Res, La Crosse, WI USA. [Senger, Joshua L.] Mayo Clin Hlth Syst, Dept Cardiol, La Crosse, WI USA. [Chapman, Scott C.] Univ Pittsburgh, Dept Vasc Surg, Med Ctr, Pittsburgh, PA USA. Gharacholou, SM (corresponding author), Mayo Clin Florida, Dept Cardiovasc Med, Jacksonville, FL 32224 USA. gharacholou.shahyar@mayo.edu AN - WOS:000571799000001 AU - Gharacholou, S. M. AU - Li, Z. AU - Uy, J. J. AU - Eckstein, L. H. AU - Flock, C. R. AU - Senger, J. L. AU - Gutierrez, J. F. T. AU - Chapman, S. C. C7 - 1708538120958858 DO - 10.1177/1708538120958858 J2 - Vascular KW - Multidisciplinary outcomes peripheral artery disease AMPUTATION-FREE SURVIVAL SMOKING-CESSATION INTERVENTIONS PREVENTION CORONARY ASPIRIN EVENTS VOLUME Peripheral Vascular Disease LA - English M3 - Article; Early Access N1 - ISI Document Delivery No.: NR8GV Times Cited: 0 Cited Reference Count: 14 Michael Gharacholou, S. Li, Zhuo Uy, Jonathan J. Eckstein, Lee H. Flock, Carolyn R. Senger, Joshua L. Gutierrez, Jorge F. Trejo Chapman, Scott C. 0 SAGE PUBLICATIONS LTD LONDON VASCULAR SN - 1708-5381 SP - 8 ST - Characteristics and outcomes of patients with peripheral artery disease undergoing endovascular revascularization: A community hospital perspective T2 - Vascular TI - Characteristics and outcomes of patients with peripheral artery disease undergoing endovascular revascularization: A community hospital perspective UR - ://WOS:000571799000001 ID - 761408 ER - TY - JOUR AB - Objectives The aim of this study was to evaluate the early and mid-term clinical results, the device performance, and the mid-term re-intervention rates of patients suffering blunt thoracic aortic injury (BTAI) managed by a multidisciplinary team in a low-volume BTAI centre. Methods This was a retrospective observational study in a tertiary hospital setting. From December 2005 to March 2016, all patients over 18 years old admitted with BTAI were included in the study. No exclusion criteria were applied. The study data were collected and analysed retrospectively. Follow-up of survivors included computed tomography imaging 3 and 9 months post-procedure, then annually. Results Twenty-eight patients were included in the study. Their mean age was 42 ± 16 years and 89% were male. A contained aortic rupture was diagnosed in 20 patients, a Stanford type B dissection in six, and intramural haematoma in two patients. Multidisciplinary evaluations were performed and an intervention was indicated in 25 patients (89%), four of whom died before the intervention. Nineteen patients underwent thoracic endovascular aortic repair of the descending thoracic aorta and two patients underwent a frozen elephant trunk procedure. The procedures were performed 0.7 ± 1.2 days after injury. All procedures were successful. There were no device related complications. The post-operative 30 day mortality was 5%, with one patient dying on the day of operation from other vascular injuries. The 30 day mortality of all patients was 18%. The median mid-term follow-up period was 786 days. All 30 day survivors survived the follow-up period. The mid-term imaging showed stable results in 19 patients. Two patients required frozen elephant trunk procedures after 240 and 681 days and both procedures were successful. Conclusions In a low volume centre, a multidisciplinary team using a standardised protocol with the endovascular first approach demonstrated excellent outcomes, similar to those of large centres. If the aortic trauma is adequately managed, the patient's outcome is closely related to the additional trauma. AD - T. Ghazy, Herzzentrum Dresden Universitätsklinik, Fetscherstrasse 76, Dresden, Germany AU - Ghazy, T. AU - Mikulasch, S. AU - Reeps, C. AU - Hoffmann, R. T. AU - Wijatkowska, K. AU - Diab, A. H. AU - Kappert, U. AU - Matschke, K. AU - Weiss, N. AU - Mahlmann, A. DB - Embase Medline DO - 10.1016/j.ejvs.2017.08.009 KW - angiotensin receptor antagonist beta adrenergic receptor blocking agent catecholamine dipeptidyl carboxypeptidase inhibitor hydroxymethylglutaryl coenzyme A reductase inhibitor adolescent adult aged aortic trauma article blunt thoracic aortic injury cardiovascular mortality clinical article clinical decision making computer assisted tomography emergency health service endovascular aneurysm repair female follow up hematoma hemiplegia human low volume hospital male middle aged observational study outcome assessment paraplegia priority journal retrospective study shock survivor tertiary care center transesophageal echocardiography young adult LA - English M1 - 5 M3 - Article N1 - L618470944 2017-09-29 2018-07-02 PY - 2017 SN - 1532-2165 1078-5884 SP - 604-612 ST - Experts' Results in Blunt Thoracic Aortic Injury are Reproducible in Lower Volume Tertiary Institutions. Early and Mid-term Results of an Observational Study T2 - European Journal of Vascular and Endovascular Surgery TI - Experts' Results in Blunt Thoracic Aortic Injury are Reproducible in Lower Volume Tertiary Institutions. Early and Mid-term Results of an Observational Study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L618470944&from=export http://dx.doi.org/10.1016/j.ejvs.2017.08.009 VL - 54 ID - 760891 ER - TY - JOUR AB - Background: Thrombolysis and endovascular treatment for patients with ischaemic stroke is a time critical therapy. Radiographer engagement is key to early acquisition and interpretation of brain imaging and rapid treatment of the acute stroke patients. As part of an ongoing initiative to reduce the door-to-needle times, we implemented a 'stroke team page' that involved early notification of the radiographers for rapid imaging of patients screened for Hyperacute treatment. Methods: The 'stroke team page' was implemented in April 2016 to improve the thrombolysis service. Stroke imaging pathway was improved by implementing changes in processes that ensured the stroke patient journey is efficient. The radiology team reviewed all processes to identify time critical points and streamlined processes accordingly. Prospective data collected pre and post intervention. Statistical methods were applied to analyse the data. Results: Prior to implementation of this initiative, 152 patients received thrombolysis from July 2014 to March 2016. In the 21 months after implementation, 209 patients received thrombolysis (April 2016 to December 2017). Our thrombolysis rate increased from 25.8% prior to 28.8% after the intervention (P=0.22). Stroke onset to-needle-time did not differ significantly between the groups (83 minutes vs. 88 minutes, P=0.30) but door-to-CT time and door-to-needle time were significantly reduced (31 minutes vs 18 minutes, P<0.001, and 65 minutes vs 47 minutes, P<0.001, respectively). Conclusion: By having an inclusive multidisciplinary team simultaneously notified with the addition of a radiographer in the acute stroke team, we improved the thrombolysis rates and door-to-CT time which led to significantly reduced door-to-needle times. AD - J. Gibbs, Royal North Shore Hospital, St Leonards, NSW, Australia AU - Gibbs, J. DB - Embase DO - 10.1177/1747493019858233 KW - adult blood clot lysis brain ischemia conference abstract controlled study female human major clinical study male multidisciplinary team prospective study radiographer radiology statistical analysis stroke patient LA - English M1 - 1 M3 - Conference Abstract N1 - L629009713 2019-08-28 PY - 2019 SN - 1747-4949 SP - 3 ST - Improving the thrombolysis rates and door to needle times-the Radiographer's role T2 - International Journal of Stroke TI - Improving the thrombolysis rates and door to needle times-the Radiographer's role UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629009713&from=export http://dx.doi.org/10.1177/1747493019858233 VL - 14 ID - 760683 ER - TY - JOUR AB - BackgroundTelemedicine can facilitate delivery of thrombolysis in acute stroke. The aim of this qualitative study was to explore patients' and carers' views of their experiences of using a stroke telemedicine system in order to contribute to the development of reliable and acceptable telemedicine systems and training for health-care staff. MethodWe recruited patients who had, and carers who were present at, recent telemedicine consultations for acute stroke in three hospitals in NW England. Semi-structured interviews were conducted using an interview guide based on normalization process theory (NPT). Thematic analysis was undertaken. ResultsWe conducted 24 interviews with 29 participants (16 patients; 13 carers). Eleven interviews pertained to live' telemedicine assessments (at the time of admission); nine had mock-up telemedicine assessments (within 48h of admission); four had both assessments. Using the NPT domains as a framework for analysis, factors relating to coherence (sense making) included people's knowledge and understanding of telemedicine. Cognitive participation (relational work) included interaction between staff and with patients and carers. Issues relating to collective action (operational work) included information exchange and support, and technical matters. Findings relating to reflexive monitoring (appraisal) included positive and negative impressions of the telemedicine process, and emotional reactions. ConclusionAlthough telemedicine was well accepted by many participants, its use added an additional layer of complexity to the acute stroke consultation. The remote' nature of the consultationposed challenges for some patients. These issues may be ameliorated by clear information for patients and carers, staff interpersonal skills, and teamworking. AD - [Gibson, Josephine; Lightbody, Elizabeth; McAdam, Joanna; Gibson, Alison; Fitzgerald, Jane; Watkins, Caroline] Univ Cent Lancashire, Clin Practice Res Unit, Brook Bldg 425, Preston PR1 2HE, Lancs, England. [McLoughlin, Alison; Emsley, Hedley] Lancashire Teaching Hosp NHS Fdn Trust, Preston, Lancs, England. [Day, Elaine] Cardiac & Stroke Networks Lancashire & Cumbria, Preston, Lancs, England. [May, Carl] Univ Southampton, Southampton, NY USA. [Price, Chris] Northumbria Healthcare NHS Fdn Trust, Preston, Lancs, England. [Ford, Gary A.] Newcastle Univ, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England. Gibson, J (corresponding author), Univ Cent Lancashire, Clin Practice Res Unit, Brook Bldg 425, Preston PR1 2HE, Lancs, England. Jgibson4@uclan.ac.uk AN - WOS:000368936100009 AU - Gibson, J. AU - Lightbody, E. AU - McLoughlin, A. AU - McAdam, J. AU - Gibson, A. AU - Day, E. AU - Fitzgerald, J. AU - May, C. AU - Price, C. AU - Emsley, H. AU - Ford, G. A. AU - Watkins, C. DA - Feb DO - 10.1111/hex.12333 J2 - Health Expect. KW - acute stroke telemedicine remote consultation thrombolysis patient satisfaction carer satisfaction NORMALIZATION PROCESS THEORY QUALITATIVE EVALUATION THROMBOLYSIS Health Care Sciences & Services Health Policy & Services Public, Environmental & Occupational Health LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: DC0VO Times Cited: 7 Cited Reference Count: 24 Gibson, Josephine Lightbody, Elizabeth McLoughlin, Alison McAdam, Joanna Gibson, Alison Day, Elaine Fitzgerald, Jane May, Carl Price, Chris Emsley, Hedley Ford, Gary A. Watkins, Caroline Gibson, Josephine/H-8375-2019; McLoughlin, Alison/L-3049-2016; Ford, Gary/AAY-6405-2020; Watkins, Caroline/E-6898-2013 Gibson, Josephine/0000-0002-3051-1237; McLoughlin, Alison/0000-0001-5298-9306; Ford, Gary/0000-0001-8719-4968; Emsley, Hedley/0000-0003-0129-4488; Fitzgerald, Jane/0000-0002-5929-8652; Price, Christopher/0000-0003-3566-3157; Watkins, Caroline/0000-0002-9403-3772; Lightbody, Elizabeth/0000-0001-5016-3471; Harrison, Joanna/0000-0001-8963-7240; May, Carl/0000-0002-0451-2690 National Institute for Health Research (NIHR)National Institute for Health Research (NIHR) [PB-PG-1208-18280]; National Institute for Health ResearchNational Institute for Health Research (NIHR) [NF-SI-0515-10116, PB-PG-1208-18280] Funding Source: Researchfish; Stroke Association [TSA PMF 2013/02] Funding Source: Researchfish This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit Programme (Grant reference number PB-PG-1208-18280). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. 7 1 16 WILEY-BLACKWELL HOBOKEN HEALTH EXPECT PY - 2016 SN - 1369-6513 SP - 98-111 ST - "It was like he was in the room with us': patients' and carers' perspectives of telemedicine in acute stroke T2 - Health Expectations TI - "It was like he was in the room with us': patients' and carers' perspectives of telemedicine in acute stroke UR - ://WOS:000368936100009 VL - 19 ID - 761720 ER - TY - JOUR AB - Background: Team-based group communications using checklists are widely advocated to achieve shared understandings and improve patient safety. Despite the positive effect checklists have on collaborations and reduced postoperative complications, their use has not been straightforward. Previous research has described contextual factors that impact on the implementation of checklists, however there is limited understanding of the issues that impede team participation in checklist use in surgery. The aim of this prospective study was to identify and describe factors that drive team participation in safety checks in surgery. Methods: We observed ten surgical teams and conducted 33 semi-structured interviews with 70 participants from nursing, surgery and anaesthetics, and the community. Constant comparative methods were used to analyse textual data derived from field notes and interviews. Observational and interview data were collected during 2014-15. Results: Analysis of the textual data generated from the field notes and interviews revealed the extent to which members of the surgical team participated in using the surgical safety checklist during each phase of patient care. These three categories included: 'using the checklist'; 'working independently'; and, 'communicating checks with others'. The phases in the checking process most vulnerable to information loss or omission were sign in and sign out. Conclusions: Team participation in safety checks depends on a convergence of intertwined factors; namely, team attributes, communication strategies and checking processes. A whole-of-team approach to participation in surgical safety checks is far more complex when considering the factors that drive participation. Strategies to increase participation in safety checks need to target professional communication practices and work processes such as workflow which curtail team members' ability to participate. AD - [Gillespie, Brigid M.; Marshall, Andrea P.] Griffith Univ, Ctr Hlth Practice Innovat HPI, NHMRC Ctr Res Excellence Nursing NCREN, MHIQ, Parklands Dr,Gold Coast Campus, Gold Coast, Qld 4222, Australia. [Withers, Teresa K.; Lavin, Joanne; Gardiner, Therese; Marshall, Andrea P.] Gold Coast Univ Hosp, Gold Coast Hosp & Hlth Serv, 1 Hosp Blvd, Southport, Qld 4215, Australia. [Marshall, Andrea P.] Griffith Univ, Sch Nursing & Midwifery, Gold Coast Campus, Nathan, Qld 4222, Australia. Gillespie, BM (corresponding author), Griffith Univ, Ctr Hlth Practice Innovat HPI, NHMRC Ctr Res Excellence Nursing NCREN, MHIQ, Parklands Dr,Gold Coast Campus, Gold Coast, Qld 4222, Australia. b.gillespie@griffith.edu.au AN - WOS:000378152100001 AU - Gillespie, B. M. AU - Withers, T. K. AU - Lavin, J. AU - Gardiner, T. AU - Marshall, A. P. C7 - 3 DA - Jan DO - 10.1186/s13037-015-0090-5 J2 - Patient Saf. Surg. KW - VENOUS THROMBOEMBOLISM PROPHYLAXIS ADVERSE EVENTS IMPLEMENTATION SURGERY CHECKLISTS HOSPITALS BARRIERS FAILURES QUALITY TIME Surgery LA - English M3 - Article N1 - ISI Document Delivery No.: DP0BH Times Cited: 9 Cited Reference Count: 51 Gillespie, Brigid M. Withers, Teresa K. Lavin, Joanne Gardiner, Therese Marshall, Andrea P. Gillespie, Brigid/0000-0003-3186-5691; Marshall, Andrea/0000-0001-7692-403X; Gardiner, Therese/0000-0001-6731-8361 9 0 8 BMC LONDON PATIENT SAF SURG PY - 2016 SN - 1754-9493 SP - 9 ST - Factors that drive team participation in surgical safety checks: a prospective study T2 - Patient Safety in Surgery TI - Factors that drive team participation in surgical safety checks: a prospective study UR - ://WOS:000378152100001 VL - 10 ID - 761722 ER - TY - JOUR AB - BACKGROUND: The Italian Registry of Thrombosis in Children (RITI) was established by a multidisciplinary team with the aims of improving knowledge about neonatal and paediatric thrombotic events in Italy and providing a preliminary source of data for the future development of specific clinical trials and diagnostic-therapeutic protocols. MATERIALS AND METHODS: We analysed the subset of RITI data concerning paediatric systemic venous thromboembolic events that occurred between January 2007 and June 2013. RESULTS: Eighty-five deep venous thromboses and seven pulmonary emboli were registered in the RITI. A prevalence peak was observed in children aged 10 to 18 years and, unexpectedly, in children aged 1 to 5 years. A central venous line was the main risk factor (55% of venous thromboembolic events); surgery (not cardiac) (25%), concomitant infections (23%) and malignancy (22%) were the clinical conditions most often associated with the onset of venous thromboembolism. There was a diagnostic delay of more than 24 hours in 37% of the venous thromboembolic events. Doppler ultrasound was the most widely used test for the objective diagnosis of deep venous thrombosis (87%). Antithrombotic therapy was administered in 96% of venous thromboembolic events, mainly low molecular weight heparin (60%). In 2% of cases recurrences occurred, while post-thrombotic syndrome developed in 8.5% of cases. DISCUSSION: Although the data from the RITI are largely in agreement with published data, peaks of prevalence of thrombosis, risk factors and objective tests used for the diagnosis showed some peculiarities which may deserve attention. AD - Paediatric Haematology and Oncology Unit, University Hospital of Bari, Bari, Italy. Paediatric Haematology, Department of Paediatric Sciences, University Hospital "Città della Salute e della Scienza", Turin, Italy. Thrombosis and Haemostasis Unit, "Giannina Gaslini" Children's Hospital, Genoa, Italy. Department of Paediatrics, "Dell'Angelo" Hospital, Venice, Italy. Paediatric Neurology Unit, Paediatric University Hospital of Padua, Padua, Italy. Department of Paediatrics, "Anna Meyer" Children's Hospital, Florence, Italy. Department of Haematology and Oncology and Transfusion Medicine, IRCCS Paediatric Hospital "Bambino Gesù", Rome, Italy. Neonatology Unit, IRCCS Paediatric Hospital "Bambino Gesù", Rome, Italy. Department of Oncology and Haematology, University Hospital of Padua, Padua, Italy. Cardiovascular Prevention Centre, Humanitas Research Hospital, Milan, Italy. Department of Medicine, Thrombotic and Haemorrhagic Diseases Unit, University of Padua Medical School, Padua, Italy. AN - 28686155 AU - Giordano, P. AU - Grassi, M. AU - Saracco, P. AU - Molinari, A. C. AU - Gentilomo, C. AU - Suppiej, A. AU - Indolfi, G. AU - Lasagni, D. AU - Luciani, M. AU - Piersigilli, F. AU - Putti, M. C. AU - Rota, L. L. AU - Sartori, S. AU - Simioni, P. C2 - Pmc6034769 DA - Jul DO - 10.2450/2017.0075-17 DP - NLM ET - 2017/07/08 J2 - Blood transfusion = Trasfusione del sangue KW - Adolescent Age Factors Child Child, Preschool Female Humans Infant Italy/epidemiology Male Prevalence *Registries Retrospective Studies Risk Factors *Ultrasonography, Doppler Venous Thromboembolism/*diagnostic imaging/*epidemiology Young Adult LA - eng M1 - 4 N1 - 2385-2070 Giordano, Paola Grassi, Massimo Saracco, Paola Molinari, Angelo C Gentilomo, Chiara Suppiej, Agnese Indolfi, Giuseppe Lasagni, Donatella Luciani, Matteo Piersigilli, Fiammetta Putti, Maria C Rota, Lidia L Sartori, Stefano Simioni, Paolo Paediatric Thrombosis Working Group of the RITI (see Appendix I) Clinical Trial Journal Article Multicenter Study Blood Transfus. 2018 Jul;16(4):363-370. doi: 10.2450/2017.0075-17. Epub 2017 Jun 3. PY - 2018 SN - 1723-2007 (Print) 1723-2007 SP - 363-370 ST - Paediatric venous thromboembolism: a report from the Italian Registry of Thrombosis in Children (RITI) T2 - Blood Transfus TI - Paediatric venous thromboembolism: a report from the Italian Registry of Thrombosis in Children (RITI) VL - 16 ID - 760195 ER - TY - JOUR AB - Introduction. Add-on treatment of follicular non-Hodgkin's lymphoma (NHL) with 90Y Ibritumomab tiuxetan (Zevalin®) has become an efficient alternative. The aim of this study is to analyze our updated information of patients treated with 90YIbritumomab/tiuxetan in a prospective study according clinical practice setting and to analyze treatment outcome. Subjets and Methods. 87 relapsed/refractory lymphoma patients were included in a clinical protocol conducted by a multidisciplinary team and treated in the same centre. According the inclusion criteria: found relapsed/refractory CD20+ NHL patients 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/September 2010. Endpoints: objective response rate (ORR), time to relapse (TTR) overall survival (OS) and safety. Other clinical prognostic factors were observed to assess their possible influence upon treatment value. Results. Until September 2010, 87 patients had received treatment with 90YIbritumomab/ tiuxetan, and were considered to analysis; M/F 52.6%/47.4%; mean age 61.88 years (30-86); ECOG 0-1 96.2%; 68 follicular NHL (63.8%), 8 mantle cell NHL (13.8%), 9 BDLG NHL (15.5%) and 2 Hodgkin Lymphoma (6.9%). According FLIPI score distribution: (0-1) 70.2%, FLIPI (>1) 29.8%, ECOG 0-1 96.2%, Previous therapy schedules 1-2 (44.8%), >2 (55.2%). The median follow-up time: 30.23 months, medianTTP: 34.4 months (95% CI: 29.7; 39.0). Mean OS 46.0 months (95% CI: 38.0; 53.9), median: NA for FNHL. Completed response (CR) was different according lymphoma subtype: 58 (CR) follicular NHL, 7 (CR) mantle cell NHL and 6 (CR) NHL BDLG. ORR: 76.8%. Complete response 73.4%, partial response 3.4% and relapsed 23.1%, 11.3% patients have died or withdraw. Median TTR was 42 months for follicular NHL vs 15 months for other NHL subtypes. Safety: thrombocytopenia being the most frequent (27.6%) haematological toxicity, median time to G3-4: fourth week, and neutropenia (22.4%), the median time to recover normal values was 4.2 and 2.6 weeks respectively. In 10.3% of patients red blood cell transfusion was required, and platelet transfusions in 27.6%. The most frequent non haematological toxicity was asthenia. One patient developed a severe mucositis. Two patients have concomitant associated tumours (colon and prostate) and two patients developed secondary malignancies (skin and lung tumours). Comments. In our experience 90Y Ibritumomab tiuxetan (Zevalin®) is a safety and effective therapy in relapsed NHL, especially in patients with follicular non- Hodgkin's lymphoma that can obtain higher complete response than other types of lymphoma and prolonged median survival time. AD - P. Giraldo, Miguel Servet University Hospital, Zaragoza, Spain AU - Giraldo, P. AU - Andrade, M. AU - Rubio-Martinez, A. AU - Grasa, J. AU - Lievano, P. AU - Baringo, T. AU - Lopez-Gomez, L. AU - Navarro, P. AU - Arroyo, E. AU - Arroyo, E. AU - Cueva De La, L. AU - Abos, D. DB - Embase KW - yttrium 90 ibritumomab tiuxetan nonhodgkin lymphoma hematology therapy human male patient lymphoma safety toxicity neutrophil follow up thrombocytopenia neutropenia thrombocyte clinical protocol Hodgkin disease overall survival relapse treatment outcome B lymphocyte electrocorticography skin normal value erythrocyte transfusion thrombocyte transfusion prostate mucosa inflammation asthenia lung survival time clinical practice prospective study L1 - http://www.haematologica.org/content/96/supplement_2/1.full-text.pdf+html LA - English M3 - Conference Abstract N1 - L71698791 2014-12-09 PY - 2011 SN - 0390-6078 SP - 400-401 ST - Therapy with 90y ibritumomab tiuxetan in relapsed/refractory non-hodgkin lymphoma. Analysis of recent outcomes T2 - Haematologica TI - Therapy with 90y ibritumomab tiuxetan in relapsed/refractory non-hodgkin lymphoma. Analysis of recent outcomes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71698791&from=export VL - 96 ID - 761231 ER - TY - JOUR AB - While systemic intravenous thrombolysis decreases mortality in patients with high-risk pulmonary embolism (PE), it clearly increases haemorrhagic risk. There are many contraindications to thrombolysis, and efforts should aim at selecting those patients who will benefit most, without suffering complications. The current review summarises the evidence for the use of thrombolytic therapy in PE. It clarifies the pathophysiological mechanisms in PE and acute cor pulmonale that increase the risk of bleeding following thrombolysis. It discusses future management challenges, namely tailored drug administration, new treatment monitoring techniques and catheter-directed thrombolysis. PMID:29531763 AU - Giraud, Raphael AU - Bounameaux, Henri AU - Bendjelid, Karim DA - 2018/02/26 02/26 DB - PubMed Central DO - 10.1136/openhrt-2017-000735 KW - myocardial ischaemia and infarction (ihd) pulmonary embolism thrombolytic therapy M1 - 1 PY - 2018 SN - 2053-3624 ST - Understanding haemorrhagic risk following thrombolytic therapy in patients with intermediate-risk and high-risk pulmonary embolism: a hypothesis paper T2 - Open Heart TI - Understanding haemorrhagic risk following thrombolytic therapy in patients with intermediate-risk and high-risk pulmonary embolism: a hypothesis paper UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5845427 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5845427&rendertype=abstract VL - 5 ID - 762104 ER - TY - GEN AU - Giri, Jay S. AU - Piazza, Gregory DA - 2018/01/01 DB - Federal Science Library - Canada KW - Index Medicus PY - 2018 SN - 1358-863X ST - A midterm report card for pulmonary embolism response teams TI - A midterm report card for pulmonary embolism response teams UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV3da9swEBdbx0Zfxr6Xdh3eS2EUr5Yl2RK0hbClbKzrGItH3oxkSTCWOCVp_v-dLCnB6Qbdw16MfRjL1u98H7rTHUIkf5elWzJBgh_UNBSDH6eslKQpwTKhmkidG8u6YHpVkdGEXn5ztZ9jt8sN7b8CDzSA3m2k_Qfw1w8FApwDC8ARmACOt2KD4dHsp3biN0QHXClq3eUWXq2m8BbdZtyZmk9ds4yFT5g1R4B8qGIe7NYfMWE1xuL_2AokLiuEVQTMY-KxUwJe8tGyTDMSeqoE0ei3AvdYwMs5324naEzfZuemLO6iwZgwzgsygStwhn2Bl37Z68uv9Xl1cVGPR5PxoSt4PoMPuT41bVp9v4vu5WBQuFzND58-r1VsWQi8iTkfb4_RtzFuOA69pL1OTY4foYfBAUiGHqrH6I5pn6AHX8K0PkXzYRIQSzxiiUMsAcSSk5lc_Dpb43Zy3F0HcgSxT42I9qkdvIH0DFXno_H7j2noipFikpc4ZVYw2TRaFrwEW7JgKsulAsuZ4szqEkupjWTSMsM03MKpzTOJuck0mP7USvIc7bTz1rxEiWY6F6wRXCpNCVWCWsazQmjFlMxEOUBv4zzWV774SY1DffjtOR-gN3Gia5BQLuwkWzNfLWsMRjy4DaA-BuiFR2D9tFxkhJZcDNChg6QOf87yr8Ps3WKYfbS7YfFXaOd6sTIH6L5dTlO1tK87VvoN3PFtyA VL - 23 ID - 762107 ER - TY - JOUR AB - Background: In December 2012, a multidisciplinary pulmonary embolism response team (PERT) was created at Emory University Midtown Hospital to provide consultation for patients with pulmonary embolism (PE), including inferior vena cava filter placement. The Food and Drug Administration (FDA) currently recommends retrieving all filters when no longer clinically needed. We sought to determine the impact of PERT on filter retrieval. Methods: Retrospective chart review of filters (n = 212) placed between July 2011 and December 2013 at a single hospital, analyzed pre (n = 155) and post (n = 57) PERT formation. Results: Median age of patients was 66, 44% male, 67% African American. The most frequent indications for insertion were inability to anticoagulate (44%), acute PE with poor reserve (22%), and a history of PE with a planned surgery (22%), with no difference pre and post PERT. A total of 19 filters had a retrieval attempt (17 successful, no complications), which was 8% of the total population or 12% of the eligible patients (excluding deaths and ongoing filter indication.) Eight retrieved filters were pre PERT, or 7% of eligible patients, versus 11 post PERT, or 23% of eligible patients (p = .008). Reasons for lack of retrieval were loss to follow up (35%), poor prognosis or death (25%), ongoing indication (10%), and no discussion of filter at follow up with provider (23%). Other factors associated with lack of retrieval were older age, African American race, and history of bleeding (p<0.05 for all). PERT involvement at the index hospitalization and outpatient follow up with a PERT specialist were associated with increased filter removal rates (30% and 74%, respectively, p<0.01 vs no PERT.) Conclusion: Despite FDA advisory, current filter retrieval rate remains very low. Involvement of a dedicated pulmonary embolism response team, especially outpatient follow up, may increase the rate of filter retrieval. AD - L. Glade, Emory University, School of Medicine, United States AU - Glade, L. AU - Devireddy, C. AU - Leeper Jr, K. AU - Liberman, H. A. AU - McDaniel, M. AU - Wells, B. AU - Jaber, W. A. DB - Embase DO - 10.1002/ccd.25910 KW - filter vena cava filter lung embolism society angiography fishing human patient follow up death African American outpatient hospital Food and Drug Administration population surgery medical record review medical specialist hospitalization male consultation bleeding prognosis university LA - English M3 - Conference Abstract N1 - L71873648 2015-05-13 PY - 2015 SN - 1522-1946 SP - S121-S122 ST - Fishing for filters: A retrospective analysis on inferior vena cava filter placement and removal pre and post creation of a pulmonary embolism response team T2 - Catheterization and Cardiovascular Interventions TI - Fishing for filters: A retrospective analysis on inferior vena cava filter placement and removal pre and post creation of a pulmonary embolism response team UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71873648&from=export http://dx.doi.org/10.1002/ccd.25910 VL - 85 ID - 761069 ER - TY - JOUR AB - BACKGROUND: Despite Food and Drug Administration approval of 2 new drugs for idiopathic pulmonary fibrosis (IPF), curative therapies remain elusive and mortality remains high. Preclinical and clinical data support the safety of human mesenchymal stem cells as a potential novel therapy for this fatal condition. The Allogeneic Human Cells (hMSC) in patients with Idiopathic Pulmonary Fibrosis via Intravenous Delivery (AETHER) trial was the first study designed to evaluate the safety of a single infusion of bone marrow-derived mesenchymal stem cells in patients with idiopathic pulmonary fibrosis. METHODS: Nine patients with mild to moderate IPF were sequentially assigned to 1 of 3 cohorts and dosed with a single IV infusion of 20, 100, or 200 x 10(6) human bone marrowderived mesenchymal stem cells per infusion from young, unrelated, men. All baseline patient data were reviewed by a multidisciplinary study team to ensure accurate diagnosis. The primary end point was the incidence (at week 4 postinfusion) of treatment-emergent serious adverse events, defined as the composite of death, nonfatal pulmonary embolism, stroke, hospitalization for worsening dyspnea, and clinically significant laboratory test abnormalities. Safety was assessed until week 60 and additionally 28 days thereafter. Secondary efficacy end points were exploratory and measured disease progression. RESULTS: No treatment-emergent serious adverse events were reported. Two nontreatmentrelated deaths occurred because of progression of IPF (disease worsening and/or acute exacerbation). By 60 weeks postinfusion, there was a 3.0% mean decline in % predicted FVC and 5.4% mean decline in % predicted diffusing capacity of the lungs for carbon monoxide. CONCLUSIONS: Data from this trial support the safety of a single infusion of human mesenchymal stem cells in patients with mild-moderate IPF. AD - [Glassberg, Marilyn K.; Minkiewicz, Julia; Simonet, Emmanuelle S.; DiFede, Darcy; Shafazand, Shirin; Khan, Aisha; Pujol, Marietsy V.; Fishman, Joel; Hare, Joshua M.] Univ Miami, Dept Med, M Miller Sch Med, 1600 NW 10th Ave RMSB 7056 D-60, Miami, FL 33136 USA. [Glassberg, Marilyn K.; Rubio, Gustavo A.] Univ Miami, Dept Surg, M Miller Sch Med, 1600 NW 10th Ave RMSB 7056 D-60, Miami, FL 33136 USA. [Glassberg, Marilyn K.] Univ Miami, Dept Pediat, M Miller Sch Med, 1600 NW 10th Ave RMSB 7056 D-60, Miami, FL 33136 USA. [Toonkel, Rebecca L.] Florida Int Univ, Dept Med, Herbert Wertheim Coll Med, Miami, FL 33199 USA. [DiFede, Darcy; Khan, Aisha; Pujol, Marietsy V.; Hare, Joshua M.] Univ Miami, Interdisciplinary Stem Cell Inst, 1600 NW 10th Ave RMSB 7056 D-60, Miami, FL 33136 USA. [LaRussa, Vincent F.] Univ Louisville, Dept Cardiol, Louisville, KY 40292 USA. [Lancaster, Lisa H.] Vanderbilt Univ, Med Ctr, Dept Med, Nashville, TN USA. [Rosen, Glenn D.] Bristol Myers Squibb, Lawrenceville, NJ USA. [Mageto, Yolanda N.] Univ Vermont, Coll Med, Dept Med, Burlington, VT 05405 USA. [Mendizabal, Adam] EMMES Corp, Rockville, MD USA. Glassberg, MK (corresponding author), Univ Miami, Miller Sch Med, Dept Med, Interstitial Lung Dis Program, 1600 NW 10th Ave RMSB 7056 D-60, Miami, FL 33136 USA. mglassbe@med.miami.edu AN - WOS:000402798000015 AU - Glassberg, M. K. AU - Minkiewicz, J. AU - Toonkel, R. L. AU - Simonet, E. S. AU - Rubio, G. A. AU - DiFede, D. AU - Shafazand, S. AU - Khan, A. AU - Pujol, M. V. AU - LaRussa, V. F. AU - Lancaster, L. H. AU - Rosen, G. D. AU - Fishman, J. AU - Mageto, Y. N. AU - Mendizabal, A. AU - Hare, J. M. DA - May DO - 10.1016/j.chest.2016.10.061 J2 - Chest KW - bone marrow idiopathic pulmonary fibrosis mesenchymal stem cells safety trial MARROW PROGENITOR CELLS BONE-MARROW RANDOMIZED-TRIAL STROMAL CELLS TRANSENDOCARDIAL INJECTION ISCHEMIC CARDIOMYOPATHY INTERSTITIAL PNEUMONIA MYOCARDIAL-INFARCTION DOUBLE-BLIND RAT MODEL Critical Care Medicine Respiratory System LA - English M1 - 5 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: EW8WE Times Cited: 72 Cited Reference Count: 32 Glassberg, Marilyn K. Minkiewicz, Julia Toonkel, Rebecca L. Simonet, Emmanuelle S. Rubio, Gustavo A. DiFede, Darcy Shafazand, Shirin Khan, Aisha Pujol, Marietsy V. LaRussa, Vincent F. Lancaster, Lisa H. Rosen, Glenn D. Fishman, Joel Mageto, Yolanda N. Mendizabal, Adam Hare, Joshua M. International Conference of the American-Thoracic-Society (ATS) MAY 13-18, 2016 San Francisco, CA Amer Thorac Soc Lester and Sue Smith Foundation Financial support for the AETHER trial came from the Lester and Sue Smith Foundation. 75 2 17 ELSEVIER SCIENCE BV AMSTERDAM CHEST PY - 2017 SN - 0012-3692 SP - 971-981 ST - Allogeneic Human Mesenchymal Stem Cells in Patients With Idiopathic Pulmonary Fibrosis via Intravenous Delivery (AETHER) A Phase I Safety Clinical Trial T2 - Chest TI - Allogeneic Human Mesenchymal Stem Cells in Patients With Idiopathic Pulmonary Fibrosis via Intravenous Delivery (AETHER) A Phase I Safety Clinical Trial UR - ://WOS:000402798000015 VL - 151 ID - 761660 ER - TY - JOUR AB - Peripherally inserted central catheter (PICC) use continues to increase, leading to the development of a blind bedside technique (BST) for placement. The aim of our study was to compare the BST with the fluoroscopically guided technique (FGT), with specific regard to catheter tip position (CTP). One hundred eighty patients were randomized to either the BST or the FGT. All procedures were done by the same interventional team and included postprocedural chest X-ray to assess CTP. Depending on the international guidelines for optimal CTP, patients were classified in three types: optimal, suboptimal not needing repositioning, and nonoptimal requiring additional repositioning procedures. Fisher's test was used for comparisons. One hundred seventy-one PICCs were successful inserted. In the BST groups, 23.3% of placements were suboptimal and 30% nonoptimal, requiring repositioning. In the FGT group, 5.6% were suboptimal and 1.1% nonoptimal. Thus, suboptimal and nonoptimal CTP were significantly lower in the FGT group (p < 0.001). Tip malposition rates are high when using blind BST, exposing the patient to an increased risk of deep venous thrombosis and catheter malfunction. Using the FGT or emerging technologies that could help tip positioning are recommended, especially for long-term indications. aEuro cent Bedside and fluoroscopy guided techniques are commonly used for PICC placement. aEuro cent Catheter malposition is the major technical issue with the bedside technique. aEuro cent Catheter malposition occurred in 53% of patients with the bedside technique. AD - [Glauser, Frederic] Univ Hosp Lausanne, Dept Angiol, Rue Bugon 46, CH-1011 Lausanne, Switzerland. [Breault, Stephane; Sotiriadis, Charalampos; Jouannic, Anne-Marie; Qanadli, Salah D.] Univ Hosp Lausanne, Dept Radiol, Cardiothorac & Vasc Unit, Rue Bugnon 46, CH-1011 Lausanne, Switzerland. [Rigamonti, Fabio] Geneva Univ Hosp, Div Cardiol, Rue Gabrielle Perret Gentil 4, CH-1211 Geneva, Switzerland. Qanadli, SD (corresponding author), Univ Hosp Lausanne, Dept Radiol, Cardiothorac & Vasc Unit, Rue Bugnon 46, CH-1011 Lausanne, Switzerland. Charalampos.sotiriadis@chuv.ch; salah.qanadli@chuv.ch AN - WOS:000403366700022 AU - Glauser, F. AU - Breault, S. AU - Rigamonti, F. AU - Sotiriadis, C. AU - Jouannic, A. M. AU - Qanadli, S. D. DA - Jul DO - 10.1007/s00330-016-4666-y J2 - Eur. Radiol. KW - Peripherally inserted central catheters Tip malposition Fluoroscopically guided technique Blind bedside technique Intensive care unit CENTRAL VENOUS CATHETER POSITION SYSTEM RISK Radiology, Nuclear Medicine & Medical Imaging LA - English M1 - 7 M3 - Article N1 - ISI Document Delivery No.: EX6QI Times Cited: 9 Cited Reference Count: 26 Glauser, Frederic Breault, Stephane Rigamonti, Fabio Sotiriadis, Charalampos Jouannic, Anne-Marie Qanadli, Salah D. 9 0 1 SPRINGER NEW YORK EUR RADIOL PY - 2017 SN - 0938-7994 SP - 2843-2849 ST - Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement T2 - European Radiology TI - Tip malposition of peripherally inserted central catheters: a prospective randomized controlled trial to compare bedside insertion to fluoroscopically guided placement UR - ://WOS:000403366700022 VL - 27 ID - 761648 ER - TY - JOUR AB - Introduction: Valvular heart disease continues to be the most common cardiac disease associated with pregnancy in Indian population. Advanced surgical techniques and prosthetic valve design entwined with adequate anticoagulation has now made increased feasibility of pregnancy in women with prosthetic valves. Objectives: The objective of this study is to assess the outcomes of pregnancy in women with heart valve prostheses and to enlighten the challenges in the management of prosthetic valve during pregnancy. Methods: Our institution screened an estimated 6500 antenatal mothers for cardiac evaluation through January 2016 to January 2018 of which 29 patients had prosthetic valve implantation done prior to the present conception. We carried out a prospective analysis of prosthetic valve hemodyanamics in these prosthetic antenatal mothers. Results: Most common indication for valve replacement was Rheumatic heart disease. All the patients had mechanical valve replacement done with 24(82.7%) of them in mitral position. Nine (23.6%) of the patients were on warfarin and the reminder on acenocoumaral. 17 of these 29 patients had a higher pre pregnancy dose of oral anticoagulants [>2 mg acenocoumaral-13; >5 mg warfarin in 4]. First trimester Heparin switch over was done in 13 (44.8%) patients. Maternal outcome: Successful pregnancy rate was 60.7%. Maternal complications encountered were antepartum prosthetic valve thrombosis in 5 patients, post partum prosthetic valve thrombosis in 4 patients, embolic stroke in two patients, TIA in one patient, ICH in one patient and one mortality. Recurrent antepartum PVT occurred in one patient who had redo MVR done antenatally. Postpartum hemorrhage was encountered in 2 patients necessitating uterine artery ligation. Fetal outcome: Fetal outcome: 8 patients (27.5%) had fetal abortion; 8 patients had intrauterine growth retardation with intrauterine death in 3 patients. Warfarin embryopathy in the form of occipital meningomyelocele occurred in one patient. [Figure presented] [Figure presented] Conclusion: Women who have prosthetic heart valves and are of childbearing age should be counseled (ideally before conception) about the potential issues that might arise during pregnancy. Management of complications is more challenging during the pregnancy and close monitoring of valve hemodyanamics is required throughout pregnancy in a specialized program for these high-risk mothers by a multidisciplinary team. Disclosure of Interest: None declared AU - Gnanaraj, J. P. AU - Princy, A. AU - Majella, C. M. AU - Srinivasan, K. AU - S, V. AU - N, S. AU - David, P. E. J. AU - Gunasingh, S. AU - P, P. AU - Susikar, A. AU - Rangarajan, J. DB - Embase DO - 10.1016/j.gheart.2018.09.250 KW - heparin warfarin abortion artery ligation cerebrovascular accident clinical assessment complication conception conference abstract drug megadose drug therapy embryopathy female fetus fetus death fetus outcome first trimester pregnancy heart valve replacement human intrauterine growth retardation major clinical study meningomyelocele monitoring mortality mother multidisciplinary team postpartum hemorrhage pregnancy rate prospective study prosthetic valve thrombosis rheumatic heart disease uterine artery LA - English M1 - 4 M3 - Conference Abstract N1 - L2001223872 2018-11-02 PY - 2018 SN - 2211-8179 2211-8160 SP - 447 ST - Sailing Through Pregnancy With a Prosthetic Heart Valve T2 - Global Heart TI - Sailing Through Pregnancy With a Prosthetic Heart Valve UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001223872&from=export http://dx.doi.org/10.1016/j.gheart.2018.09.250 VL - 13 ID - 760783 ER - TY - JOUR AB - BACKGROUND: Cardiopulmonary exercise testing (CPET) is frequently used for the evaluation of patients with pulmonary hypertension (PH). Non-operable distal chronic thromboembolic pulmonary hypertension (CTEPH) represents a unique subgroup of PH where microvascular disease resembling pulmonary arterial hypertension (PAH) may predominate and efficacious medical therapy is now available. However, little is known regarding the detailed CPET profile of patients with distal CTEPH, and whether ventilation and gas exchange responses are different from PAH. METHODS: Forty-nine consecutive patients with non-operable distal CTEPH according to multidisciplinary team assessment and 45 PAH patients underwent CPET and right heart catheterization. Patients were followed up for a median of 3.2 years (interquartile range: 1.8 to 4.4). RESULTS: Pulmonary hemodynamics were similar in distal CTEPH and PAH groups, but patients with distal CTEPH achieved a lower percent predicted peak oxygen consumption (59 ± 13% vs 66 ± 14%, p < 0.05). At peak exercise, higher physiologic dead-space fraction (VD/VT) (0.45 ± 0.07 vs 0.35 ± 0.07, p < 0.0001) and higher arterial-to-end-tidal carbon dioxide gradient (9 ± 3 vs 5 ± 3 mm Hg, p < 0.0001) were observed in distal CTEPH compared with PAH. Ventilatory efficiency, expressed as VE/VCO(2) slope, was also more impaired in distal CTEPH (52.2 ± 10.1 vs 43.8 ± 8.4 liters/min, p < 0.0001). In the distal CTEPH group only, higher VD/VT was associated with lower peak oxygen consumption (r = -0.46, p = 0.003) and worse survival. CONCLUSIONS: Compared with PAH, a distinct pattern of response to exercise was observed in distal CTEPH, characterized by increased dead-space ventilation that resulted in worse ventilatory efficiency and greater impairment of exercise capacity. In distal CTEPH, dead-space ventilation correlated with exercise capacity and was associated with survival. AD - Université Paris-Sud, Le Kremlin-Bicêtre, France; AP-HP, Service de Pneumologie, Centre de Référence de l׳Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; CHU UCL Namur, Université Catholique de Louvain, Département de Pneumologie, Yvoir, Belgium. Electronic address: laurent.godinas@uclouvain.be. Université Paris-Sud, Le Kremlin-Bicêtre, France; AP-HP, Service de Pneumologie, Centre de Référence de l׳Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France. Université Paris-Sud, Le Kremlin-Bicêtre, France; AP-HP, Service de Pneumologie, Centre de Référence de l׳Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. Université Paris-Sud, Le Kremlin-Bicêtre, France; AP-HP, Service de Pneumologie, Centre de Référence de l׳Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France; Department of Medicine, Division of Respirology University of Calgary, Calgary, Alberta, Canada. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l׳Exercice et de la Dyspnée, Paris, France; Sorbonne Universités, UPMC Université Paris 06, UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France. AN - 28666570 AU - Godinas, L. AU - Sattler, C. AU - Lau, E. M. AU - Jaïs, X. AU - Taniguchi, Y. AU - Jevnikar, M. AU - Weatherald, J. AU - Sitbon, O. AU - Savale, L. AU - Montani, D. AU - Simonneau, G. AU - Humbert, M. AU - Laveneziana, P. AU - Garcia, G. DA - Nov DO - 10.1016/j.healun.2017.05.024 DP - NLM ET - 2017/07/02 J2 - The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation KW - Chronic Disease Exercise Test Exercise Tolerance/*physiology Female Follow-Up Studies France/epidemiology Humans Hypertension, Pulmonary/etiology/physiopathology/*therapy Male Middle Aged Pulmonary Embolism/*complications/mortality Respiration, Artificial/*methods Respiratory Dead Space/*physiology Retrospective Studies Survival Rate/trends cardiopulmonary exercise test chronic thromboembolic disease gas exchange physiologic dead space pulmonary artery hypertension ventilatory efficiency LA - eng M1 - 11 N1 - 1557-3117 Godinas, Laurent Sattler, Caroline Lau, Edmund M Jaïs, Xavier Taniguchi, Yu Jevnikar, Mitja Weatherald, Jason Sitbon, Olivier Savale, Laurent Montani, David Simonneau, Gérald Humbert, Marc Laveneziana, Pierantonio Garcia, Gilles Journal Article United States J Heart Lung Transplant. 2017 Nov;36(11):1234-1242. doi: 10.1016/j.healun.2017.05.024. Epub 2017 May 22. PY - 2017 SN - 1053-2498 SP - 1234-1242 ST - Dead-space ventilation is linked to exercise capacity and survival in distal chronic thromboembolic pulmonary hypertension T2 - J Heart Lung Transplant TI - Dead-space ventilation is linked to exercise capacity and survival in distal chronic thromboembolic pulmonary hypertension VL - 36 ID - 760239 ER - TY - JOUR AB - SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: To report safety and efficacy of catheter directed thrombolysis (CDT) for sub-massive pulmonary embolism (sPE) in a community hospital setting utilizing a new process based upon multidisciplinary assessment and decision making. METHODS: We performed a retrospective chart review of 176 patients between May 2017 to December 2018 with a primary diagnosis of PE. This time frame was selected to reflect the start an active multidisciplinary process for sPE management at our institution. RESULTS: Of 176 patients, 9% (n=18) who had evidence of right ventricular (RV) strain or compromise detected on computed tomography (CT), echocardiogram and elevated cardiac biomarkers (troponin and brain naturetic peptide) were evaluated for CDT. CDT was performed 10 times in 9 patients (mean age 51.8 years, mean BMI 33.6 kg/m2). Time from diagnosis to CDT time was 1-3 days. Venous access sites used were femoral (n=5), internal jugular (n=3), brachial (n=1) and basilic (n=1). The majority of cases were done by interventional cardiology with Cragg-McNamara catheters (n=7); the remainder were done by interventional radiology with Grollman (n=2) or 5F pigtail catheters (n=1). Duration of alteplase (tPA) infusion ranged from 6 to 24 hours and the mean dose was 25 mg (range 16-34 mg). Objective evidence of decreased RV strain was found among 60% (n=6) patients (2 on right heart catheterization and 4 on echocardiogram. Following CDT, 1 patient had worsened heart failure and one developed basilic vein thrombosis. Post CDT, 75% (n=6/8) patients were found to have decreased oxygen requirements at discharge among the ones that required oxygen at admission. Average length of hospital stay was 5 days. Through January 2019, two patients had readmissions (one with a recurrent PE due to non-compliance and the other required readmission due to drug-drug interactions) and no reported mortality. Eight patients were denied CDT for either low platelets, presence of pulmonary infarct, evidence of concomitant infection, significant co-morbidities. They were treated with conventional anticoagulation. CONCLUSIONS: This case series demonstrates that CDT may be a useful and safe modality for sPE when performed in a community hospital setting. CLINICAL IMPLICATIONS: sPE can be effectively managed by a multidisciplinary team in a community hospital setting utilizing catheter directed therapy. DISCLOSURES: No relevant relationships by John Finley, source=Web Response No relevant relationships by Reshma Golamari, source=Web Response No relevant relationships by shambo guha roy, source=Web Response No relevant relationships by Dominic Valentino, source=Web Response AU - Golamari, R. AU - Guha Roy, S. AU - Valentino, D. AU - Finley, J. DB - Embase DO - 10.1016/j.chest.2019.08.432 KW - alteplase biological marker endogenous compound oxygen tissue plasminogen activator troponin adult anticoagulation blood clot lysis body mass brain cardiology case study community hospital comorbidity computer assisted tomography concurrent infection conference abstract diagnosis drainage catheter echocardiography female heart catheterization heart failure heart right ventricle hospital readmission hospitalization human human cell interventional radiology lung embolism lung infarction major clinical study male medical record review middle aged mortality multidisciplinary team peripheral infusion catheter retrospective study thrombocyte vein thrombosis LA - English M1 - 4 M3 - Conference Abstract N1 - L2002983294 2019-10-02 PY - 2019 SN - 1931-3543 0012-3692 SP - A395 ST - CATHETER DIRECTED THROMBOLYSIS IN SUBMASSIVE PULMONARY EMBOLISM: EXPERIENCE IN A COMMUNITY HOSPITAL SETTING T2 - Chest TI - CATHETER DIRECTED THROMBOLYSIS IN SUBMASSIVE PULMONARY EMBOLISM: EXPERIENCE IN A COMMUNITY HOSPITAL SETTING UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002983294&from=export http://dx.doi.org/10.1016/j.chest.2019.08.432 VL - 156 ID - 760661 ER - TY - JOUR AB - Background According to the U.S. Surgeon General, venous thromboembolism (VTE) affects 350,000 to 600,000 Americans each year and is implicated in over 100,000 deaths. Noting that only half of eligible patients in our inpatient medical service were receiving VTE prophylaxis (VTEP), our hospital instituted an intervention to improve performance on this critical measure. Objectives We seek to evaluate the four-year sustainability of a computerized prompt guiding medical residents to order VTEP. The goal of the intervention is to increase the percentage of VTEP-eligible patients who are prescribed VTEP. Methods This is a retrospective cohort study evaluating the effectiveness of an intervention designed to increase the percentage of VTEP-eligible patients receiving VTEP. Our intervention centered around an automated prompt in the electronic medical record (EMR) system. The prompt guides residents in the process of admitting patients to a “hard stop” screen entreating them to identify VTE risk factors in the patient and to choose from a list of evidence-based VTEP order options (including but not limited to heparin, sequential compression devices, and an option to not order VTEP if not indicated). Concurrently, an educational presentation was offered to residents explaining the intervention and re-educating them on evidence-based VTEP guidelines. The computerized prompt remains in use today. Results Data covering all patients admitted to the hospital one month prior to the implementation of the VTEP prompt in January 2011 were collected. Of these patients, 49.0% were found to have received VTEP therapy (n = 964). Four years later, the percentage of patients receiving VTEP rose 53% to 74% (n = 572). Conclusions As advances in medical technology continue to improve patient care, optimization of medication utilization becomes increasingly important. With underuse of critical medications raising the risk of iatrogenic illness, it remains the responsibility of the patient care team to engage in best practices to minimize these risks. Our intervention has demonstrated that VTEP utilization may be optimized by the use of a low-cost, easily implementable, and easily replicable intervention that effectively leverages the EMR system. AD - U. Goldberg, Kingsbrook Jewish Medical Center, Brooklyn, NY, United States AU - Goldberg, U. AU - Jean, H. AU - Pasco, N. AU - Belfer, A. AU - Kalavar, M. DB - Embase DO - 10.1002/ajh.24471 KW - heparin American clinical trial cohort analysis comparative effectiveness compression instrument consensus development death electronic medical record system hospital patient human iatrogenic disease major clinical study medical service medical technology patient care prevention prophylaxis resident responsibility risk factor teaching hospital venous thromboembolism LA - English M1 - 9 M3 - Conference Abstract N1 - L611870299 2016-09-01 PY - 2016 SN - 1096-8652 SP - E392 ST - Sustainability of an intervention to optimize venous thromboembolism prevention in a community teaching hospital T2 - American Journal of Hematology TI - Sustainability of an intervention to optimize venous thromboembolism prevention in a community teaching hospital UR - https://www.embase.com/search/results?subaction=viewrecord&id=L611870299&from=export http://dx.doi.org/10.1002/ajh.24471 VL - 91 ID - 761003 ER - TY - JOUR AB - Background: Venous thromboembolism (VTE) includes pulmonary embolism (PE) and deep vein thrombosis (DVT), and results in 100,000 deaths annually in the United States. There is low global VTE awareness, including limited data regarding difficulties patients encounter during their management. This study aims to identify a patient's perspective on VTE gaps of care. Methods: This is a qualitative study using semi-structured interviews with VTE patients, who had been previously diagnosed and treated for at least one VTE event in their lifetime. Participants were separated in five focused groups; sample size was defined by data saturation. Interviews were audio recorded, transcribed verbatim, and analyzed thematically using framework analysis based on data saturation evaluation. The study was approved by a local institutional review board. We used inductive framework analysis to interpret the data. Results: Twenty participants were included in the analysis. Ten participants (50%) were men. Three major themes were identified: 1) concerned about limited disease knowledge; 2) VTE awareness in healthcare system; 3) incomplete communication during transitional and follow-up care. Conclusions: Findings suggest that gaps of VTE care extend in different levels of the medical system, including: the patient, physicians, and medical teams. Patients were sensitive to a lack of disease awareness among healthcare providers. There was appreciation for subspecialty care recommended for VTE. In a qualitative study, using the patient perspective, we have detected frustrations and perceived areas of improvement of the care of the patient with VTE. These gaps are anchored in perceived lack of disease awareness and difficult transitional care. AD - [Golemi, Iva; Salazar Adum, Juan P.; Diaz Quintero, Luis] NorthShore Univ Hlth Syst, Dept Internal Med, 2650 Ridge Ave, Evanston, IL 60201 USA. [Paz, Luis H.] Northshore Univ Hlth Syst, Dept Cardiovasc Med, Evanston, IL USA. [Fuentes, Harry E.] Mayo Clin, Dept Hematol Oncol, Rochester, MN USA. [Schmitt, Natalie] NorthShore Univ Hlth Syst, Dept Psychiat & Behav Sci, Evanston, IL USA. [Tafur, Alfonso J.] NorthShore Univ Hlth Syst, Div Cardiovasc Med, Dept Med, Evanston, IL USA. Golemi, I (corresponding author), NorthShore Univ Hlth Syst, Dept Internal Med, 2650 Ridge Ave, Evanston, IL 60201 USA. igolemi@northshore.org AN - WOS:000486608100002 AU - Golemi, I. AU - Salazar Adum, J. P. AU - Diaz Quintero, L. AU - Paz, L. H. AU - Fuentes, H. E. AU - Schmitt, N. AU - Tafur, A. J. DA - Aug DO - 10.23736/s0392-9590.19.04130-0 J2 - Int. Angiol. KW - Venous thromboembolism Venous thrombosis Pulmonary embolism PULMONARY-EMBOLISM THROMBOEMBOLISM PREVENTION PROPHYLAXIS GUIDELINES KNOWLEDGE TOOL Peripheral Vascular Disease LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: IY7XI Times Cited: 2 Cited Reference Count: 28 Golemi, Iva Salazar Adum, Juan P. Diaz Quintero, Luis Paz, Luis H. Fuentes, Harry E. Schmitt, Natalie Tafur, Alfonso J. Tafur, Alfonso/AAN-7950-2020 Paz Rios, Luis/0000-0001-7024-8990; Diaz Quintero, Luis/0000-0002-5637-1324 2 0 1 EDIZIONI MINERVA MEDICA TURIN INT ANGIOL PY - 2019 SN - 0392-9590 SP - 284-290 ST - Gaps of care in patients with venous thrombotic embolism: a qualitative study T2 - International Angiology TI - Gaps of care in patients with venous thrombotic embolism: a qualitative study UR - ://WOS:000486608100002 VL - 38 ID - 761503 ER - TY - JOUR AB - Purpose: Many patients receiving left ventricular assist device(LVAD)s as destination therapy (DT) have significant psychosocial issues (poor social support, substance abuse, personality disorders, smoking etc). The effect that these have on their outcome after implantation is poorly understood and can make implant decisions difficult and controversial. To study the impact of psychosocial factors, we compared the outcome of patients receiving LVADs as DT with psychosocial issues to patients receiving LVADs as DT for other reasons. Methods: We studied 77 consecutive patients who received LVADs as DT at our institution from Jan 2010- June 2012. 26 (34%) of these patients were considered to have significant psychosocial issues (P) by the multidisciplinary team at the time of implant whereas 51 (66%) had no psychosocial issues (NP). Results: Pre-implant, the patients with psychosocial issues were younger (51 ± 13 vs. 65 ± 10 yrs, P< 0.001) and had better renal function (eGFR: 72 ± 18 vs. 51 ± 21 ml/min, p< 0.0001). Other baseline demographics were similar between the groups except there were more smokers in the P group. Actuarial survival at 1 and 2 years was 88.5% vs 67.7% and 74.3% vs 51.2% in the psychosocial vs non psychosocial groups, p = 0.07. At a mean follow up of 33 months, the number of patients in the psychosocial vs non psychosocial groups who had driveline infections (27% vs 29%), stroke (23% vs 23.5%), gastrointestinal bleeding (27% vs 37%), pump exchange (4% vs 6%) and pump thrombosis {TPA/Integrelin or pump exchange}(23% vs 17%), was not different. The number of re-hospitalizations also did not differ (4.3+4.1 pyschosocial vs 4.5+4.7 non psychosocial group). Conclusion: Our data suggests that, possibly due to their younger age and better renal function, even though they may be difficult to manage, patients with psychosocial problems receiving DT LVADs have outcomes that are as good as those receiving DT LVADs for other reasons with even a trend towards better survival. (Figure Presented). AD - H. Golwala, Cardiovascular Medicine, University of Louisville, Rudd Heart and Lung Institute, Louisville, KY, United States AU - Golwala, H. AU - Rawasia, W. F. AU - Vessels, K. AU - McCants, K. AU - Slaughter, M. S. AU - Lenneman, A. AU - Birks, E. J. DB - Embase DO - 10.1016/j.healun.2014.01.274 KW - survival left ventricular assist device implantation society heart lung transplantation social psychology human patient implant pump smoking kidney function thrombosis personality disorder gastrointestinal hemorrhage cerebrovascular accident substance abuse social support infection follow up psychosocial disorder hospitalization therapy LA - English M1 - 4 M3 - Conference Abstract N1 - L71404938 2014-04-11 PY - 2014 SN - 1053-2498 SP - S89 ST - Psychosocial factors do not influence survival or the development of complications after left ventricular assist device implantation T2 - Journal of Heart and Lung Transplantation TI - Psychosocial factors do not influence survival or the development of complications after left ventricular assist device implantation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71404938&from=export http://dx.doi.org/10.1016/j.healun.2014.01.274 VL - 33 ID - 761117 ER - TY - JOUR AB - Background/Case Studies: Cardiovascular surgery (CVS) requires a significant blood transfusion support and consequently patients (PTS) are at risk of adverse events associated with allogenic transfusion. Patient blood management (PBM) consists of a number of evidence-based measures taken by a multidisciplinary team in order to optimize patient care. Purpose: The present retrospective study analyses the effect of implementing PBM criteria on blood transfusion therapy during CVS. Study Design/Methods: The 76 first-time CVS PTS with a cardiopulmonary bypass (CBP) were allotted to either Group A or B. Group A (pre-PBM): 37 PTS with a coronary disease diagnosis treated between Jan. 2013 and July 2014, before our nstitution incorporated a PBM protocol. 29 PTS underwent myocardial revascularization surgery (MRS); 7 had a valve replacement (VR) and 1 underwent both procedures, MRS 1 VR. Group B (post-PBM): 39 PTS treated between Aug. 2014 and March 2016 by the same professional team as Group A. 24 underwent MRS; 11 had a VR and 4 were subject to both treatment, MRS 1 VR. Patients' admittance was programmed and routine pre-surgical studies were complied with. Pre-surgical hemostasis control was made by conventional coagulogram (CC) in both groups and by CC with Fibrinogen (F1) dosage by Clauss method and platelet count during peri-surgical period. Group B control also included rotational thromboelastometry (TEM) with activators (ROTEM). Hemostasis monitoring was performed in both groups at pump exit and in the ICU until parameters were normal and/ or bleeding stopped. Group B also underwent a TEM study during CBP. Both Groups were administered antifibrinolytic agents: Tranexamic acid (TXA), (Arotran)(average dose) and F1 (Haemocomplettan-Behring), (aver-age dose 4g). Statistical analysis used: Statistic 7.0 Results/Findings: FFP: 95% consumption difference (IC 95%:1.7 a 2.8 - p<0.01). PLT: 93% consumption difference (IC 95% 4 a 9.5 - p<0.001). Conclusion: Implementation of PBM criteria in CVS patients significantly reduced risk and FFP (95%) and PLT (93%), while it increased blood components stock, usually scarce, in other patients. Greater efforts will be necessary to reduce RBC consumption. The PBM implementation meant our institution managed to reduce costs and legal contingencies and improved its position in the accreditation process. Results:. AD - G.N. Gôngora Falero, Transfusional Medicine, San Camilo Clinica, Ciudad Autbnoma de BA, Argentina AU - Gôngora Falero, G. N. AU - Canle, O. AU - Begue, G. AU - Pastoriza, S. AU - Romano, F. AU - Vidmar, L. AU - Vilaseca, A. DB - Embase DO - 10.1111/trf.13807 KW - endogenous compound fibrinogen fibrinogen concentrate tranexamic acid accreditation bleeding blood component cardiopulmonary bypass child controlled study diagnosis female heart muscle revascularization heart valve replacement hemostasis human major clinical study male monitoring preschool child statistical analysis study design surgery platelet count LA - English M3 - Conference Abstract N1 - L617344208 2017-07-20 PY - 2016 SN - 1537-2995 SP - 107A ST - Patient blood management program assessment in cardiovacular surgery T2 - Transfusion TI - Patient blood management program assessment in cardiovacular surgery UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617344208&from=export http://dx.doi.org/10.1111/trf.13807 VL - 56 ID - 761005 ER - TY - JOUR AB - Background: Enhanced Recovery after Surgery (ERAS) protocols have changed the approach of perioperative care toward many major surgical procedures performed today. Strong evidence of consistent benefits of ERAS exist for colorectal, thoracic, and urological surgery. Introduction: Our evidence-based clinical pathways focused on prehabilitation and included interventions like aggressive preoperative optimization of medical comorbidities, familiarizing with perioperative protocols, thromboprophylaxis, opioid free multimodal analgesia, and early ambulation. Objectives: Analyze the feasibility and safety of the MERABS protocol in patients after bariatric surgery. Methods: Prospective and descriptive study. Patients undergoing a surgical procedure as a treatment for obesity were included. The protocol was adapted and approved by the members of the multidisciplinary team. The protocol was divided into 3 stages; Preoperative, intraoperative, and postoperative. Specific measures and goals were established that were evaluated by the patient and by members of the multidisciplinary team. Results: We included 103 patients. 79 women and 24 men. The mean age: 37.2 years (20-56). BMI: 45.3 KG/M2 (35-69). Co-morbidities: Hypertension 39%, Dyslipidemia 38%, Diabetes mellitus type 2 (30%) and Obstructive sleep apnea syndrome 14%. Surgeries: RYGB 72%, SG 19%, MGB 8%, and SADI-S 1.0%. The mean surgical time was 105.6 (±21.7) minutes. Time to ambulate: 6.18 hrs on average. Length of stay 26.4 hours on average. Major complications: 4(3.8%). Reoperations 2 (1.9%) for bleeding and stenosis of the jejunum-jejunum anastomosis. Readmissions: 2 (1.9%) for GJ Leak and urological problem. Conclusion: The MERABS protocol in patients after bariatric surgery is feasible and safe, allowed for reduced hospitalization times without increased rate of complications or readmissions. AD - I. González, General Hospital Dr. Ruben Leñero, Mexico, Mexico AU - González, I. AU - Gutiérrez, L. AU - Campos, F. AU - Apaez, N. AU - Marín, R. AU - Guzmán, R. AU - Sanchez, R. AU - Ramírez, C. AU - Romero, G. AU - Zurita, L. DB - Embase DO - 10.1007/s11695-017-2774-7 KW - adult anastomosis bariatric surgery bleeding clinical evaluation clinical outcome comorbidity complication conference abstract dyslipidemia feasibility study female hospital readmission hospitalization human hypertension jejunum length of stay major clinical study male non insulin dependent diabetes mellitus obesity outcome assessment patient referral prospective study reoperation sleep disordered breathing stenosis surgery LA - English M1 - 1 M3 - Conference Abstract N1 - L620637903 2018-02-15 PY - 2017 SN - 1708-0428 SP - 518 ST - Mexican enhanced recovery after bariatric surgery (m.e.r.a.b.s.) protocol. initial experience and clinical outcomes from a mexican referral bariatric centre enhanced recovery in bariatric surgery T2 - Obesity Surgery TI - Mexican enhanced recovery after bariatric surgery (m.e.r.a.b.s.) protocol. initial experience and clinical outcomes from a mexican referral bariatric centre enhanced recovery in bariatric surgery UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620637903&from=export http://dx.doi.org/10.1007/s11695-017-2774-7 VL - 27 ID - 760924 ER - TY - JOUR AB - BACKGROUND: The frequency of ad hoc percutaneous coronary intervention (PCI) varies among institutions and regions of the country. It is unclear what factors limit use of the ad hoc strategy. OBJECTIVE: To define factors which limit the use of the ad hoc strategy. METHODS: All patients who underwent PCI at our center in 2004 were reviewed. Patients who had emergent PCI for ST-elevation myocardial infarction (n = 188), those who had undergone diagnostic coronary angiography at a referring facility (n = 54), and those who had a repeat PCI after a previous ad hoc PCI (n = 19) were excluded. PCIs performed the same day as diagnostic angiography were considered "ad hoc"; all others were designated "staged". Demographic and procedural factors through hospital discharge were prospectively recorded. Logistic regression analysis was performed to identify correlates of ad hoc PCI, PCI success, and PCI complications. RESULTS: Of the 580 PCI procedures eligible for analysis, 557 (96%) were ad hoc and 23 (4%) were staged. Patients undergoing staged PCI had more lesions treated, a higher rate of no-reflow and periprocedural myocardial infarction, and higher contrast volumes and fluoroscopic times. Logistic regression analysis revealed that patients with history of heart failure, renal insufficiency and a recent myocardial infarction were more likely to undergo a staged PCI. Patients undergoing a staged PCI and those who had previous bypass surgery were more likely to have an unsuccessful PCI procedure. CONCLUSION: Most PCI procedures can be performed safely and effectively on the same day as diagnostic coronary angiography. AD - Department of Cardiology, Geisinger Medical Center, Danville, PA 17822, USA. AN - 19411717 AU - Good, C. W. AU - Blankenship, J. C. AU - Scott, T. D. AU - Skelding, K. A. AU - Berger, P. B. AU - Wood, G. C. DA - May DP - NLM ET - 2009/05/05 J2 - The Journal of invasive cardiology KW - Aged Angioplasty, Balloon, Coronary/adverse effects/*methods Cardiac Catheterization Comorbidity Coronary Angiography Coronary Artery Bypass Drug-Eluting Stents Feasibility Studies Female Health Status Indicators Heart Failure/diagnostic imaging/therapy Humans Male Middle Aged Myocardial Infarction/diagnostic imaging/*therapy Outcome and Process Assessment, Health Care Patient Care Team Postoperative Complications/therapy Recurrence Retrospective Studies LA - eng M1 - 5 N1 - 1557-2501 Good, Christopher W Blankenship, James C Scott, Thomas D Skelding, Kimberly A Berger, Peter B Wood, G Craig Journal Article United States J Invasive Cardiol. 2009 May;21(5):194-200. PY - 2009 SN - 1042-3931 SP - 194-200 ST - Feasibility and safety of ad hoc percutaneous coronary intervention in the modern era T2 - J Invasive Cardiol TI - Feasibility and safety of ad hoc percutaneous coronary intervention in the modern era VL - 21 ID - 760485 ER - TY - JOUR AB - PURPOSE: Our aim is to describe the number and distribution of requests addressed to an Advanced Practice Nursing team for functional problems of totally implantable venous access devices (TIVADs) and to describe, in detail, the malfunction management by the type and number of additional investigations and treatment modalities. METHOD: The Advanced Practice Nursing team recorded data about all requests for support as part of the standard care. A specific protocol, the Leuven Malfunction Management Protocol was used for troubleshooting. In this descriptive, retrospective study, data of 3950 consecutive requests for TIVAD-related functional problems in 2019 patients were analyzed. Data collection included (1) demographic information, (2) device-related details, and (3) malfunction and follow-up details. RESULTS: 'Easy injection, impossible aspiration' was the most frequently documented functional problem (66.9%) for all requests for help. Of all malfunctions, catheter tip was in an optimal position in 73.4%, thrombolytics were administered in 59.0%, and a linogram was performed in 4.9%. TIVAD removal/exchange was advised in 4.4% of the requests. CONCLUSIONS: TIVAD malfunction-defined operationally in terms of injection and/or aspiration problems-reflect all functional complications encountered in practice. Adherence to the Leuven Malfunction Management Protocol can ensure that, in most cases, catheter patency can be fully restored without removing or replacing the TIVAD. The Advanced Practice Nursing team coordinates the following treatments, investigations, and procedures: radiological catheter tip verification; thrombolytic agent administration and, if necessary, subsequent injection of solutions to dissolve drug precipitates or lipid deposits; linogram; percutaneous sleeve stripping; and TIVAD removal/replacement. AD - Department of Surgical Oncology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. godelieve.goossens@uzleuven.be AN - 22265937 AU - Goossens, G. A. AU - Stas, M. AU - Moons, P. DA - Dec DO - 10.1016/j.ejon.2011.11.006 DP - NLM ET - 2012/01/24 J2 - European journal of oncology nursing : the official journal of European Oncology Nursing Society KW - Adolescent Adult Advanced Practice Nursing/*organization & administration Aged Antineoplastic Agents/*administration & dosage Catheterization, Central Venous/*adverse effects/*nursing Catheters, Indwelling/*adverse effects Chi-Square Distribution Child Child, Preschool Female Humans Infant Infusion Pumps, Implantable/*adverse effects Male Middle Aged Neoplasms/*drug therapy/*nursing Patient Care Team/organization & administration Retrospective Studies LA - eng M1 - 5 N1 - 1532-2122 Goossens, Godelieve Alice Stas, Marguerite Moons, Philip Journal Article Scotland Eur J Oncol Nurs. 2012 Dec;16(5):465-71. doi: 10.1016/j.ejon.2011.11.006. Epub 2012 Jan 21. PY - 2012 SN - 1462-3889 SP - 465-71 ST - Management of functional complications of totally implantable venous access devices by an advanced practice nursing team: 5 years of clinical experience T2 - Eur J Oncol Nurs TI - Management of functional complications of totally implantable venous access devices by an advanced practice nursing team: 5 years of clinical experience VL - 16 ID - 760362 ER - TY - JOUR AB - Purpose: To evaluate the disease profile in patients admitted to the CICU in a multiprofile teaching hospital without invasive cardiology and cardiac surgery, and to determine the association of cardiovascular and noncardiovascular illnesses with the length of stay (LOS) and in-hospital mortality. Methods: We studied 950 admissions between June 1, 2016 and May 31, 2017. Through retrospective systematic review of the electronic database we collected data about the leading and concomitant diagnoses, demographic and clinical data, LOS and causes of death. Results: The leading diagnosis was cardiovascular in 72% of patients-decompensated heart failure (33%), atrial fibrillation (15%), stroke (11%), acute coronary syndrome without ST elevation (6%), pulmonary embolism (3%), infective endocarditis (1%), pericarditis (2%), other arrhythmias (1%). Pneumonia, exacerbated chronic obstructive pulmonary disease (COPD) with respiratory failure (6%), exacerbated chronic kidney failure (4%), diabetes mellitus (4%), gastrointestinal diseases (3%) and sepsis (2%) were the most frequent noncardiovascular leading diagnosis. A respiratory and kidney failure and sepsis were found in 10% of all patients as secondary diagnosis. The median LOS was 6 days cardiovascular and 10 days in non-cardiovascular patients. In-hospital mortality was 13% and stroke was the most common cause (40%). The other cardiovascular diseases were 28% of the in-hospital mortality. Acute and exacerbated respiratory and kidney failure, gastrointestinal bleeding, decompensated diabetes mellitus and sepsis accounted for 32% of in-hospital mortality. Conclusion: A significant number of patients with acute or exacerbated non-cardiovascular diseases as a leading or concomitant diagnosis were treated in the CICU. These patients, as well as patients with severely decompensated heart failure and stroke had prolonged LOS and increased in-hospital mortality. The diversity of diseases treated in CICU necessitates more complex management by a multidisciplinary team. AD - M. Gospodinova, Military Medical Academy of Sofia, Department of Internal Medicine, Clinic of Cardiology, Sofia, Bulgaria AU - Gospodinova, M. AU - Cherneva, Z. H. AU - Peichev, I. AU - Denchev, S. DB - Embase DO - 10.1177/2048872617751067 KW - acute coronary syndrome adult atrial fibrillation bacterial endocarditis cardiovascular system cause of death cerebrovascular accident chronic kidney failure chronic obstructive lung disease conference abstract coronary care unit diabetes mellitus diagnosis female gastrointestinal disease gastrointestinal hemorrhage heart failure hospital mortality human length of stay lung embolism male pericarditis pneumonia respiratory failure retrospective study sepsis ST segment elevation systematic review LA - English M1 - 1 M3 - Conference Abstract N1 - L621353638 2018-03-27 PY - 2018 SN - 2048-8734 SP - 53 ST - Disease profile, length of stay and in-hospital mortality in the cardiac intensive care unit T2 - European Heart Journal: Acute Cardiovascular Care TI - Disease profile, length of stay and in-hospital mortality in the cardiac intensive care unit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621353638&from=export http://dx.doi.org/10.1177/2048872617751067 VL - 7 ID - 760840 ER - TY - JOUR AB - BACKGROUND: Surgical management of advanced-stage ovarian cancer (ASOC) can require diaphragmatic surgery (DS) to achieve complete cytoreduction. The aim of this study was to evaluate modalities and morbidities of DS at the time of initial surgery (INS) and interval debulking surgery (IDS; performed after neoadjuvant chemotherapy). STUDY DESIGN: Retrospective review of patients undergoing (unilateral or bilateral) DS at the time of INS or IDS for ASOC. RESULTS: Between 2005 and 2008, 63 patients were studied. Treatment of the diaphragm was unilateral in 31 patients and bilateral in 32 patients. DS was performed respectively at the time of INS in 22 patients (35%) and IDS in 41 (65%) patients. Complete cytoreductive surgery was achieved in 95% (21 of 22 in the INS group and 39 of 41 in the IDS group). Surgical procedures used during DS were (in the INS and IDS groups, respectively) stripping in 14 (64%) and 16 (39%), coagulation in 2 (9%) and 10 (24%), and both procedures in 6 (27%) and 15 (37%). An intraoperative chest tube was placed in 14% of patients in each group. Postoperative chest complications requiring treatment occurred in 6 cases: pulmonary embolism (3 cases), symptomatic pleural effusion requiring chest drainage (1 case), and pneumothorax necessitating chest drainage (2 cases). CONCLUSIONS: Rate of overall morbidity related to DS was not statistically different in patients undergoing INS and IDS. Surgical treatment of this upper part of the abdomen is key to achieving complete cytoreductive surgery in ASOC. AD - Institut Gustave Roussy, Villejuif, France. AN - 20347745 AU - Gouy, S. AU - Chereau, E. AU - Custodio, A. S. AU - Uzan, C. AU - Pautier, P. AU - Haie-Meder, C. AU - Duvillard, P. AU - Morice, P. DA - Apr DO - 10.1016/j.jamcollsurg.2010.01.011 DP - NLM ET - 2010/03/30 J2 - Journal of the American College of Surgeons KW - Abdominal Abscess/etiology Adult Aged Antineoplastic Combined Chemotherapy Protocols/*therapeutic use Biomarkers, Tumor/blood CA-125 Antigen/blood Chemotherapy, Adjuvant Chest Tubes/adverse effects Clinical Competence Diaphragm/*pathology/*surgery Digestive System Fistula/etiology Female Hematoma/etiology Humans Middle Aged Neoadjuvant Therapy/methods Neoplasm Staging Ovarian Neoplasms/drug therapy/*pathology/*surgery *Ovariectomy/adverse effects Patient Care Team Peritoneal Neoplasms/secondary/*surgery Pleural Effusion/etiology Pneumothorax/etiology Predictive Value of Tests Prognosis Pulmonary Embolism/etiology Reoperation/adverse effects/methods Retrospective Studies *Second-Look Surgery/adverse effects/methods Surgical Wound Dehiscence/etiology LA - eng M1 - 4 N1 - 1879-1190 Gouy, Sebastien Chereau, Elisabeth Custodio, Ana Sofia Uzan, Catherine Pautier, Patricia Haie-Meder, Christine Duvillard, Pierre Morice, Philippe Journal Article United States J Am Coll Surg. 2010 Apr;210(4):509-14. doi: 10.1016/j.jamcollsurg.2010.01.011. PY - 2010 SN - 1072-7515 SP - 509-14 ST - Surgical procedures and morbidities of diaphragmatic surgery in patients undergoing initial or interval debulking surgery for advanced-stage ovarian cancer T2 - J Am Coll Surg TI - Surgical procedures and morbidities of diaphragmatic surgery in patients undergoing initial or interval debulking surgery for advanced-stage ovarian cancer VL - 210 ID - 760237 ER - TY - JOUR AB - Importance: Intravenous alteplase is an effective treatment for acute ischemic stroke and is significantly underutilized. It is known that stroke centers with accreditation are more likely to provide intravenous alteplase treatment, and therefore, policies that increase the number of certified stroke centers and the number of acute ischemic stroke patients routed to these centers may be beneficial. Objective: To determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Design: An observational, longitudinal study to examine treatment trends with log-link binomial regression modeling to compare pre-post policy implementation changes in the proportions of patients treated with intravenous alteplase in two counties. Setting: Two urban counties, Santa Clara and San Mateo, in the western region of US that regionalized acute stroke care between 2005 and 2010. Participants: Patients with primary or secondary diagnosis of stroke were identified from the statewide patient discharge database by International Classification of Diseases (ICD-9) codes. We linked ambulance and hospital data to create complete patient care records. Main outcomes and measures: Stroke treatment, defined as a documented primary procedure code for intravenous alteplase administration (ICD-9: 99.10). Results: In Santa Clara County, intravenous alteplase was administered to 35 patients (1.7%) in the pre-regionalization period and 240 patients (2.1%) in the post-regionalization period. In San Mateo County, intravenous alteplase was administered to 29 patients (1.3%) in the pre-policy period and 135 patients (3.2%) in the post-policy period. After regionalization of stroke care, intravenous alteplase increased two-fold in San Mateo County [adjusted RR 2.20, p = 0.003, 95% CI (1.31, 3.69)] but did not show any statistically significant change in Santa Clara County [adjusted RR 1.10, p = 0.55, 95% CI (0.80, 1.51)]. In the post-regionalization phase, when compared with Santa Clara County, we found that San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers and more frequent use of intravenous alteplase at stroke centers. Conclusions: Our findings suggest that greater post-regionalization improvements in San Mateo County contributed to significantly better county-level thrombolysis use than Santa Clara County. AN - 144636948. Language: English. Entry Date: 20200729. Revision Date: 20200729. Publication Type: Article AU - Govindarajan, Prasanthi AU - Shiboski, Stephen AU - Grimes, Barbara AU - Cook, Lawrence J. AU - Ghilarducci, David AU - Meng, Tong AU - Trickey, Amber W. DB - CINAHL DO - 10.1080/10903127.2019.1679303 DP - EBSCOhost KW - Stroke -- Drug Therapy Stroke Units Tissue Plasminogen Activator -- Administration and Dosage Administration, Intravenous Urban Areas -- United States Treatment Outcomes Health Services Accessibility Human Male Female Adult Middle Age Aged Aged, 80 and Over Transportation of Patients Ambulances Electronic Health Records Descriptive Statistics Chi Square Test Fisher's Exact Test Linear Regression Funding Source M1 - 4 N1 - research; tables/charts. Journal Subset: Allied Health; Blind Peer Reviewed; Peer Reviewed; USA. Grant Information: Funding was provided by Agency of Healthcare Research and Quality Career Development Award (K08 HS 17965) and National Center for Advancing Translational Sciences, National Institute of Health through UCSF-CTSI Grant number KL2 RR024130.. NLM UID: 9703530. PY - 2020 SN - 1090-3127 SP - 505-514 ST - Effect of Acute Stroke Care Regionalization on Intravenous Alteplase Use in Two Urban Counties T2 - Prehospital Emergency Care TI - Effect of Acute Stroke Care Regionalization on Intravenous Alteplase Use in Two Urban Counties UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=144636948&site=ehost-live&scope=site VL - 24 ID - 761321 ER - TY - JOUR AB - Background Inserting a transjugular intrahepatic portosystemic shunt by means of interventional radiology has become the procedure of choice for decompression of portal hypertension The indications and criteria for patient selection have been expanded and refined accordingly Objectives To review our experience with TIPS and analyze the results with emphasis on patient selection and indication (conventional vs atypical) Methods In this retrospective analysis in a single center all cases were managed by a multidisciplinary team (comprising liver surgery and transplantation, hepatology, imaging, interventional radiology and intensive care) Results Between August 2003 and December 2009, 34 patients (mean age 51, range 27-76 years) were treated with TIPS The cause of portal hypertension was cirrhosis (23 cases), hypercoagulability complicated by Budd Chiari syndrome (n=6), and acute portal vein thrombosis (n=5) Clinical indications for TIPS included treatment or secondary prevention of variceal bleeding (10 cases), refractory ascites (n=18), mesenteric ischemia due to acute portal vein thrombosis (n=5), and acute liver failure (n=1) TIPS was urgent in 18 cases (53%) and elective in 16 Three deaths occurred following urgent TIPS The overall related complication rate was 32% transient encephalopathy (6 cases), ischemic hepatitis (n=2), acute renal failure (n=2) and bleeding (n=1) Long term results of TIPS were defined as good in 25 cases (73%), fair in 4(12%) and failure in 5(15%) In three of five patients with mesenteric ischemia following acute portal vein thrombosis, surgery was obviated Revision of TIPS due to stenosis or thrombosis was needed in 7 cases (20%) Conclusions TIPS is safe and effective While its benefit for patients with portal hypertension is clear, the role of TIPS in treatment of portal mesenteric venous thrombosis needs further evaluation Patient selection, establishing the indication and performing TIPS should be done by a multidisciplinary dedicated team IMAJ 2010 12 687-691 AD - [Goykhman, Yaacov; Ben Haim, Menahem; Nakache, Richard; Szold, Oded; Klausner, Joseph] Tel Aviv Sourasky Med Ctr, Dept Surg B, IL-64239 Tel Aviv, Israel. [Ben Haim, Menahem] Tel Aviv Sourasky Med Ctr, Dept Liver Surg, IL-64239 Tel Aviv, Israel. [Rosen, Galia; Kori, Isaac] Tel Aviv Sourasky Med Ctr, Dept Intervent Radiol, IL-64239 Tel Aviv, Israel. [Haggai, Michal Carmiel; Oren, Ran] Tel Aviv Sourasky Med Ctr, Dept Hepatol, IL-64239 Tel Aviv, Israel. [Haggai, Michal Carmiel; Nakache, Richard] Tel Aviv Sourasky Med Ctr, Dept Transplantat, IL-64239 Tel Aviv, Israel. [Szold, Oded] Tel Aviv Sourasky Med Ctr, Surg Intens Care Units, IL-64239 Tel Aviv, Israel. Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel. Ben Haim, M (corresponding author), Tel Aviv Sourasky Med Ctr, Dept Surg B, 6 Weizmann St, IL-64239 Tel Aviv, Israel. AN - WOS:000285078000009 AU - Goykhman, Y. AU - Ben Haim, M. AU - Rosen, G. AU - Haggai, M. C. AU - Oren, R. AU - Nakache, R. AU - Szold, O. AU - Klausner, J. AU - Kori, I. DA - Nov J2 - Isr. Med. Assoc. J. KW - transjugular intrahepatic portosystemic shunt (TIPS) portal hypertension cirrhosis Budd Chiari syndrome portal vein thrombosis PORTAL-VEIN THROMBOSIS ADVANCED CIRRHOSIS RANDOMIZED-TRIAL HYPERTENSION MANAGEMENT TIPS SURVIVAL ASCITES Medicine, General & Internal LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: 691KF Times Cited: 15 Cited Reference Count: 24 Goykhman, Yaacov Ben Haim, Menahem Rosen, Galia Haggai, Michal Carmiel Oren, Ran Nakache, Richard Szold, Oded Klausner, Joseph Kori, Isaac 16 0 ISRAEL MEDICAL ASSOC JOURNAL RAMAT GAN ISR MED ASSOC J PY - 2010 SN - 1565-1088 SP - 687-691 ST - Transjugular Intrahepatic Portosystemic Shunt: Current Indications, Patient Selection and Results T2 - Israel Medical Association Journal TI - Transjugular Intrahepatic Portosystemic Shunt: Current Indications, Patient Selection and Results UR - ://WOS:000285078000009 VL - 12 ID - 761865 ER - TY - JOUR AB - BACKGROUND: Inserting a transjugular intrahepatic portosystemic shunt by means of interventional radiology has become the procedure of choice for decompression of portal hypertension. The indications and criteria for patient selection have been expanded and refined accordingly. OBJECTIVES: To review our experience with TIPS and analyze the results with emphasis on patient selection and indication (conventional vs. atypical). METHODS: In this retrospective analysis in a single center all cases were managed by a multidisciplinary team (comprising liver surgery and transplantation, hepatology, imaging, interventional radiology and intensive care). RESULTS: Between August 2003 and December 2009, 34 patients (mean age 51, range 27-76 years) were treated with TIPS. The cause of portal hypertension was cirrhosis (23 cases), hypercoagulability complicated by Budd-Chiari syndrome (n=6), and acute portal vein thrombosis (n=5). Clinical indications for TIPS included treatment or secondary prevention of variceal bleeding (10 cases), refractory ascites (n=18), mesenteric ischemia due to acute portal vein thrombosis (n=5), and acute liver failure (n=1). TIPS was urgent in 18 cases (53%) and elective in 16. Three deaths occurred following urgent TIPS. The overall related complication rate was 32%: trasient encephalopathy (6 cases), ischemic hepatitis (n=2), acute renal failure (n=2) and bleeding (n=1). Long-term results of TIPS were defined as good in 25 cases (73%), fair in 4 (12%) and failure in 5 (15%). In three of five patients with mesenteric ischemia following acute portal vein thrombosis, surgery was obviated. Revision of TIPS due to stenosis or thrombosis was needed in 7 cases (20%). CONCLUSIONS: TIPS is safe and effective. While its benefit for patients with portal hypertension is clear, the role of TIPS in treatment of portal-mesenteric venous thrombosis needs further evaluation. Patient selection, establishing the indication and performing TIPS should be done by a multidisciplinary dedicated team. AD - Department of Surgery B, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. AN - 21243870 AU - Goykhman, Y. AU - Ben-Haim, M. AU - Rosen, G. AU - Carmiel-Haggai, M. AU - Oren, R. AU - Nakache, R. AU - Szold, O. AU - Klausner, J. AU - Kori, I. DA - Nov DP - NLM ET - 2011/01/20 J2 - The Israel Medical Association journal : IMAJ KW - Acute Kidney Injury/etiology Adult Aged Budd-Chiari Syndrome/complications Fibrosis/complications Hemorrhage/etiology Humans Hypertension, Portal/etiology/surgery Liver Diseases/etiology Middle Aged *Patient Selection Portasystemic Shunt, Transjugular Intrahepatic/adverse effects/*methods/*statistics & numerical data Postoperative Complications Retrospective Studies Survival Analysis Treatment Outcome Venous Thrombosis/complications LA - eng M1 - 11 N1 - Goykhman, Yaacov Ben-Haim, Menahem Rosen, Galia Carmiel-Haggai, Michal Oren, Ran Nakache, Richard Szold, Oded Klausner, Joseph Kori, Isaac Journal Article Israel Isr Med Assoc J. 2010 Nov;12(11):687-91. PY - 2010 SN - 1565-1088 (Print) SP - 687-91 ST - Transjugular intrahepatic portosystemic shunt: current indications, patient selection and results T2 - Isr Med Assoc J TI - Transjugular intrahepatic portosystemic shunt: current indications, patient selection and results VL - 12 ID - 760430 ER - TY - JOUR AB - BACKGROUND: Although cardiac rehabilitation (CR) has been shown to reduce mortality and is a recommended component in clinical practice guidelines, CR referral and utilization rates remain low. Referral strategies have been implemented to increase CR use but have yet to be compared concurrently. To determine the optimal strategy to maximize CR referral, enrollment, and participation, we evaluated 3 referral strategies compared with usual care: "automatic" only via discharge order or electronic record, health care provider liaison only, or a combined approach. METHODS: In this prospective controlled study, 2635 inpatients with coronary artery disease from 11 Ontario, Canada, hospitals using 1 of the 4 referral strategies completed a sociodemographic survey, and clinical data were extracted from medical charts. One year later, 1809 participants completed a mailed survey that assessed CR utilization. Referral strategies were compared using generalized estimating equations to control for effect of hospital. RESULTS: Adjusted analyses revealed referral strategy was significantly related to CR referral and enrollment (P<.001). Combined automatic and liaison referral resulted in the greatest CR use (odds ratio [OR], 8.41; 85.8% referral, 73.5% enrollment), followed by automatic only (OR, 3.27; 70.2% referral, 60.0% enrollment), and liaison only (OR, 3.35; 59.0% referral, 50.6% enrollment), compared with usual referral (32.2% referral, 29.0% enrollment). The degree of CR participation did not differ by referral strategy among referred participants (mean [SD] percentage of classes attended, 82.87% [27.20%]; P=.88). CONCLUSIONS: Automatic referral combined with a patient discussion can achieve among the highest rates of CR referral reported. Wider adoption of such strategies could ensure that 45% more patients being treated for cardiac disease would have access to and realize the benefits of CR. AD - School of Kinesiology and Health Sciences, Faculty of Health, York University, 368 Bethune, 4700 Keele St, Toronto, ON M3J 1P3, Canada. sgrace@yorku.ca AN - 21325114 AU - Grace, S. L. AU - Russell, K. L. AU - Reid, R. D. AU - Oh, P. AU - Anand, S. AU - Rush, J. AU - Williamson, K. AU - Gupta, M. AU - Alter, D. A. AU - Stewart, D. E. DA - Feb 14 DO - 10.1001/archinternmed.2010.501 DP - NLM ET - 2011/02/18 J2 - Archives of internal medicine KW - Acute Coronary Syndrome/*rehabilitation Aged Angioplasty, Balloon, Coronary/*rehabilitation Cooperative Behavior Female Health Services Accessibility/statistics & numerical data Humans Interdisciplinary Communication Male Medical Records Systems, Computerized/statistics & numerical data Middle Aged Odds Ratio Ontario Patient Acceptance of Health Care/statistics & numerical data Patient Care Team Patient Discharge/statistics & numerical data Pilot Projects Prospective Studies Referral and Consultation/*statistics & numerical data Rehabilitation Centers/*statistics & numerical data Telephone Utilization Review/statistics & numerical data LA - eng M1 - 3 N1 - 1538-3679 Grace, Sherry L Russell, Kelly L Reid, Robert D Oh, Paul Anand, Sonia Rush, James Williamson, Karen Gupta, Milan Alter, David A Stewart, Donna E Cardiac Rehabilitation Care Continuity Through Automatic Referral Evaluation (CRCARE) Investigators HOA-80676/Canadian Institutes of Health Research/Canada MSH-80489/Canadian Institutes of Health Research/Canada Journal Article Research Support, Non-U.S. Gov't United States Arch Intern Med. 2011 Feb 14;171(3):235-41. doi: 10.1001/archinternmed.2010.501. PY - 2011 SN - 0003-9926 SP - 235-41 ST - Effect of cardiac rehabilitation referral strategies on utilization rates: a prospective, controlled study T2 - Arch Intern Med TI - Effect of cardiac rehabilitation referral strategies on utilization rates: a prospective, controlled study VL - 171 ID - 760375 ER - TY - JOUR AB - Introduction: Aortic graft infection is fatal without device removal, but explantation is challenging as no device is designed to be removed. Like others, we previously reported 30% 30-day mortality with explantation and extra-anatomical reconstruction. Here we report early results from a specialist team of explantation of abdominal grafts/endografts, and treatment of mycotic aneurysms, with in-situ reconstruction using biological conduits. Methods: We report 19 consecutive patients with infected abdominal aortic grafts/endografts (16) or primary mycotic aneurysms (3) who presented between May 2015 and March 2018. Diagnosis was made via standardised criteria within a vascular infection MDM and all patients had follow-up (mean 13 months) within a dedicated clinic with data being prospectively collected. Results: This series consists of 19 consecutive patients (mean age 69 (56-84), 15 men): 16 with aortic grafts and 3 with primary mycotic aortic pseudoaneurysms. 9 patients had previous EVAR and 7 had previous open repairs. 4 patients (21%) presented with aorto-enteric fistulae. All were treated with in-situ reconstruction using bovine pericardium (5/19), femoral veins (13/19) or composite biological conduits (1/19). There were 9 bifurcated grafts, 9 tube grafts and 1 composite uni-iliac conduit. Highest clamp position was supra-coeliac (N=8), supra-renal (4) and inter/infrarenal (7). Median blood loss was 3.5 L, operative time 8 hours, and transfusion requirement 8 units packed red cells. Median postoperative ITU/HDU stay was 8 days, with a median length of hospital stay of 23 days. Mortality was 0 at 30 days, 1 at 6 months (5%) and 2/19 (11%) at 13 months. Both deaths were due to recurrent secondary aortic-enteric fistulae. Postoperative complications included acute kidney injury in 10 patients with only 4 requiring temporary renal dialysis; drainage of chest/abdominal collections (N=3); pneumonia (3), MI (1), DVT/PE (1). 2 patients required reoperation for bleeding or anastomotic pseudoaneurysm formation. All 17 survivors underwent a standardized antimicrobial course, following which the median CRP was 5 and WCC 8, and antimicrobials were stopped. All survivors had post-operative follow-up 18F-FDG PET-CT scans which showed resolved or significantly improved uptake around the neo-aorta. Conclusion: Abdominal endograft explantation and in-situ biological conduit reconstruction is feasible and may prove curative, allowing termination of antimicrobial therapy. Long-term follow-up and ongoing multidisciplinary care is essential. AD - G. Gradinariu, Department of Vascular Surgery, St. Thomas' Hospital, Guy's and St. Thomas' NHS Trust, London, United Kingdom AU - Gradinariu, G. AU - Lyons, O. AU - Donati, T. AU - Sandford, B. AU - Taylor, D. AU - Price, N. AU - Sallam, M. AU - Bell, R. DB - Embase DO - 10.1016/j.ejvs.2019.06.1217 KW - antiinfective agent abdominal aorta acute kidney failure aged antimicrobial therapy aortic graft bleeding bovine clamp clinical article complication conference abstract controlled study erythrocyte concentrate explant false aneurysm femoral vein fistula follow up graft infection hemodialysis hospitalization human human cell iliac bone male mortality multidisciplinary team mycotic aneurysm nonhuman pericardium pneumonia positron emission tomography-computed tomography prospective study reoperation surgery survivor thorax LA - English M1 - 6 M3 - Conference Abstract N1 - L2004128667 2019-12-12 PY - 2019 SN - 1532-2165 1078-5884 SP - e528 ST - Management of Aortic Graft Infections and Mycotic Aneurysms: Improved Outcomes and Promising Early Results Through a Multidisciplinary Team Approach and In-situ Reconstruction Using Biological Conduits T2 - European Journal of Vascular and Endovascular Surgery TI - Management of Aortic Graft Infections and Mycotic Aneurysms: Improved Outcomes and Promising Early Results Through a Multidisciplinary Team Approach and In-situ Reconstruction Using Biological Conduits UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004128667&from=export http://dx.doi.org/10.1016/j.ejvs.2019.06.1217 VL - 58 ID - 760648 ER - TY - JOUR AB - A 64-year-old man, with no history of trauma, presented with transient visual loss. He was diagnosed with amaurosis fugax and started on dipyridamole and simvastatin. An inconclusive ultrasound (US) Doppler was followed by CT angiogram (CTA) and MRI, which demonstrated free floating intraluminal thrombus in the distal right common carotid artery. ECG showed sinus rhythm and an echocardiogram showed no cardiac thrombus. Following discussion at the vascular multidisciplinary team the decision was made to treat with intravenous heparin followed by warfarin. He has been regularly followed up with CTA/USS, the most recent (Oct 2012) showing no evidence of thrombus. He has had no further symptoms. Despite no initial aetiology being found we suggest that his undiagnosed oesophageal carcinoma (diagnosed 5 months after initial presentation) could have been responsible for a hypercoagulability state giving an increased risk of thrombosis and leading to the thrombus in the common carotid artery. Copyright 2013 BMJ Publishing Group. All rights reserved. AD - R. Graham, Department of General Surgery, West Wales General Hospital, Carmarthen, United Kingdom AU - Graham, R. AU - Blaszczynski, M. DB - Embase Medline DO - 10.1136/bcr-2013-008710 KW - dipyridamole heparin simvastatin warfarin adult anticoagulant therapy article carotid artery injury carotid artery thrombosis carotid atherosclerosis case report computed tomographic angiography differential diagnosis Doppler ultrasonography electrocardiogram follow up free floating carotid artery thrombosis hematologic disease human magnetic resonance angiography male malignant neoplasm medical history priority journal transitional blindness treatment outcome L1 - http://casereports.bmj.com/content/2013/bcr-2013-008710.full.pdf+html?sid=d920a186-26ff-464a-ab7d-461cfc64279d LA - English M3 - Article N1 - L369267137 2013-07-16 2013-07-29 PY - 2013 SN - 1757-790X ST - Spontaneous free floating carotid artery thrombosis T2 - BMJ Case Reports TI - Spontaneous free floating carotid artery thrombosis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L369267137&from=export http://dx.doi.org/10.1136/bcr-2013-008710 ID - 761161 ER - TY - JOUR AB - Purpose: Comparing the outcome measures and safety of endovascular therapy (EVT) with anticoagulation (AC) in the treatment of acute pulmonary embolism (PE) utilizing a Pulmonary Embolism Response Team (PERT). Materials: Retrospective review of medical records between January 2017 and August 2018 was performed to identify patients with acute massive or submassive PE who were evaluated by the PERT. Included were patients who received AC with or without EVT. Excluded were patients who were treated with IVC filter only. Analysis was performed comparing patients who received AC alone and those who received AC and EVT. A subgroup analysis was performed for patients who were initially admitted to the ICU comparing AC with or without EVT. Results: A total of 207 patients were identified, 4 were excluded as they did not receive AC and were treated only with IVC filters. There were 153 patients in the AC group and 50 in the EVT group. The AC group was significantly older (64.7 ± 16.4 vs. 58.2 ± 16.2 years, P = 0.02) and had a shorter ICU stay (0.97 ± 2.6 vs. 1.4 ± 1.5 days, P <0.001), although only 35.9% (n = 55) of the AC group were admitted to the ICU (compared to 70% (n = 35) in the EVT group, P <0.001). The rate for initial admission to a stepdown unit was 45.8% for the AC group and 16% for the EVT group (P <0.001). There was a 7.2% major hemorrhagic complication rate in the AC group and 6% in the EVT group (P = 1). The minor hemorrhagic complication rate was 1.3% for the AC group and 0% for the EVT (P = 1). When comparing patients who were initially admitted to the ICU, age (61.7 ± 16.7 vs. 57.7 ± 16.9 years, P = 0.2) and ICU stay (2 ± 2.2 vs. 1.9 ± 1.5 days, P = 0.15) were not significantly different between the AC and EVT groups, respectively. The total hospital stay for the AC group in the subgroup analysis was 7.7 ± 10.2 days while the EVT group stay was 6.3 ± 7.4 (P = 0.2). Conclusions: For patients evaluated by the PERT, major hemorrhagic complication rates were not significantly different between AC and EVT, and for patients initially admitted to the ICU, the ICU length of stay was not significantly different. AU - Graif, A. AU - Kornblum, J. AU - McNinch, J. AU - Putnam, S. AU - Paik, H. AU - Grilli, C. AU - Kimbiris, G. AU - Agriantonis, D. AU - Leung, D. DB - Embase DO - 10.1016/j.jvir.2019.12.303 KW - adult anticoagulation complication conference abstract controlled study female filter hospitalization human length of stay major clinical study male medical record non invasive procedure pulmonary embolism response team retrospective study LA - English M1 - 3 M3 - Conference Abstract N1 - L2004990731 2020-02-26 PY - 2020 SN - 1535-7732 1051-0443 SP - S114-S115 ST - 3:09 PM Abstract No. 256 Comparison of endovascular and noninvasive therapies in acute pulmonary embolism: a PERT experience T2 - Journal of Vascular and Interventional Radiology TI - 3:09 PM Abstract No. 256 Comparison of endovascular and noninvasive therapies in acute pulmonary embolism: a PERT experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004990731&from=export http://dx.doi.org/10.1016/j.jvir.2019.12.303 VL - 31 ID - 760596 ER - TY - JOUR AB - Background: The use of anticoagulants in pregnancy (pg) is challenging. Most decisions are based on the recommendations of observational studies and personal experience together with women's preferences. High risk thrombotic situations for ante-natal VTE and/or the need to prolong postpartum prophylaxis are important issues to be considered (Group 4). Objective: Retrospective evaluation of antithrombotic treatment in pregnancy and puerperium (2 years). Methods: Patients were managed in a multidisciplinary team. Gestational complications were excluded. They were divided in 4 groups Table. Anticoagulants: Oral anticoagulation with acenocumarol (OAC); unfractionated heparin (UH) or low-molecular-weight heparin (LMWH) enoxaparin. Enoxaparin was stopped 12-24 hs before delivery and restarted 8-12 hs after; UH during the peri-delivery period: 4pts. Results: There were not bleeding complications during the ante-natal period; one pt with prophylaxis developed a VTE and another with full dose heparin hematuria and gynecological hemorrhage. Comments: In pg the management of anticoagulant treatment in a multidisciplinary team is important to establish different strategies according to patient's risks. AD - B. Grand, Department of Maternal and Perinatal Medicine, Hospital Juan A. Fernández, Buenos Aires, Argentina AU - Grand, B. AU - González Alcántara, M. AU - Voto, G. AU - Orti, J. AU - Lapidus, A. AU - Voto, L. S. DB - Embase DO - 10.1016/S0049-3848(13)70140-3 KW - anticoagulant agent heparin enoxaparin low molecular weight heparin acenocoumarol female human pregnant woman thrombosis risk health prophylaxis pregnancy patient bleeding puerperium hematuria personal experience anticoagulation anticoagulant therapy pregnancy complication observational study LA - English M3 - Conference Abstract N1 - L71021604 2013-04-12 PY - 2013 SN - 0049-3848 SP - S101 ST - Antithrombotic treatment in pregnant women with high thrombotic risk situations T2 - Thrombosis Research TI - Antithrombotic treatment in pregnant women with high thrombotic risk situations UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71021604&from=export http://dx.doi.org/10.1016/S0049-3848(13)70140-3 VL - 131 ID - 761181 ER - TY - JOUR AB - In June 2016, an advanced extracorporeal membrane oxygenation (ECMO) program consisting of a multidisciplinary team was initiated at a large level-one trauma center. The program was created to standardize management for patients with a wide variety of pathologies, including trauma. This study evaluated the impact of the advanced ECMO program on the outcomes of traumatically injured patients undergoing ECMO. A retrospective cohort study was performed on all patients sustaining traumatic injury who required ECMO support from January 2014 to September 2017. The primary outcome was to determine survival in trauma ECMO patients in the two timeframes, before and after initiation of the advanced ECMO program. Secondary outcomes included complication rates, length of stay, ventilator usage, and ECMO days. One hundred and thirty eight patients were treated with ECMO during the study period. Of the 138 patients, 22 sustained traumatic injury. Seven patients were treated in our pre-group and 15 in our post-group. The majority of patients were treated with VV ECMO. Our post group VV ECMO extracorporeal survival rate was 64% and our survival to discharge was 55%. This study demonstrated an improvement in survival after implementation of our advanced ECMO program. The implementation of a multidisciplinary trauma ECMO team dedicated to the rescue of critically ill patients is the key for achieving excellent outcomes in the trauma population. AD - Dewitt Daughtry Family Department of Surgery, Division of Trauma, Surgical Critical Care and Burns, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA. Division of Trauma and Acute Care Surgery, Jackson Health System & Ryder Trauma Center, Miami, FL, USA. Dewitt Daughtry Family Department of Surgery, Division of Cardiothoracic Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA. Division of Liver, Intestinal and Multivisceral Transplant, Miami Transplant Institute, Miami, FL, USA. Dewitt Daughtry Family Department of Surgery, Division of Liver, Intestinal and Multivisceral Transplant, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA. Department of Pharmacy, Jackson Health System, Miami, FL, USA. Division of Thoracic Transplantation and Mechanical Circulatory Support, Miami Transplant Institute, Miami, FL, USA. AN - 30039876 AU - Grant, A. A. AU - Hart, V. J. AU - Lineen, E. B. AU - Lai, C. AU - Ginzburg, E. AU - Houghton, D. AU - Schulman, C. I. AU - Vianna, R. AU - Patel, A. N. AU - Casalenuovo, A. AU - Loebe, M. AU - Ghodsizad, A. DA - Nov DO - 10.1111/aor.13152 DP - NLM ET - 2018/07/25 J2 - Artificial organs KW - Adult Anticoagulants/therapeutic use Blood Transfusion Extracorporeal Membrane Oxygenation/adverse effects/*methods Female Hemorrhage/etiology/therapy Humans Length of Stay Male Survival Analysis Thrombosis/etiology/therapy Treatment Outcome Wounds and Injuries/epidemiology/*therapy Extracorporeal membrane oxygenation Hemorrhage Thrombosis Trauma Weaning protocol LA - eng M1 - 11 N1 - 1525-1594 Grant, April A Orcid: 0000-0001-7275-4088 Hart, Valerie J Lineen, Edward B Lai, Cynthia Ginzburg, Enrique Houghton, Douglas Schulman, Carl I Vianna, Rodrigo Patel, Amit N Casalenuovo, Amelia Orcid: 0000-0003-1587-5283 Loebe, Matthias Ghodsizad, Ali Journal Article United States Artif Organs. 2018 Nov;42(11):1043-1051. doi: 10.1111/aor.13152. Epub 2018 Jul 24. PY - 2018 SN - 0160-564x SP - 1043-1051 ST - The Impact of an Advanced ECMO Program on Traumatically Injured Patients T2 - Artif Organs TI - The Impact of an Advanced ECMO Program on Traumatically Injured Patients VL - 42 ID - 760229 ER - TY - JOUR AB - In June 2016, an advanced extracorporeal membrane oxygenation (ECMO) program consisting of a multidisciplinary team was initiated at a large level-one trauma center. The program was created to standardize management for patients with a wide variety of pathologies, including trauma. This study evaluated the impact of the advanced ECMO program on the outcomes of traumatically injured patients undergoing ECMO. A retrospective cohort study was performed on all patients sustaining traumatic injury who required ECMO support from January 2014 to September 2017. The primary outcome was to determine survival in trauma ECMO patients in the two timeframes, before and after initiation of the advanced ECMO program. Secondary outcomes included complication rates, length of stay, ventilator usage, and ECMO days. One hundred and thirty eight patients were treated with ECMO during the study period. Of the 138 patients, 22 sustained traumatic injury. Seven patients were treated in our pre-group and 15 in our post-group. The majority of patients were treated with VV ECMO. Our post group VV ECMO extracorporeal survival rate was 64% and our survival to discharge was 55%. This study demonstrated an improvement in survival after implementation of our advanced ECMO program. The implementation of a multidisciplinary trauma ECMO team dedicated to the rescue of critically ill patients is the key for achieving excellent outcomes in the trauma population. AD - [Grant, April A.; Hart, Valerie J.; Lineen, Edward B.; Ginzburg, Enrique; Houghton, Douglas; Schulman, Carl I.] Univ Miami, Leonard M Miller Sch Med, Div Trauma Surg Crit Care & Burns, Dewitt Daughtry Family Dept Surg, Coral Gables, FL 33124 USA. [Grant, April A.; Hart, Valerie J.; Lineen, Edward B.; Ginzburg, Enrique; Houghton, Douglas; Schulman, Carl I.] Jackson Hlth Syst, Div Trauma & Acute Care Surg, Miami, FL USA. [Grant, April A.; Hart, Valerie J.; Lineen, Edward B.; Ginzburg, Enrique; Houghton, Douglas; Schulman, Carl I.] Ryder Trauma Ctr, Miami, FL USA. [Lai, Cynthia; Patel, Amit N.; Loebe, Matthias; Ghodsizad, Ali] Univ Miami, Leonard M Miller Sch Med, Div Cardiothorac Surg, Dewitt Daughtry Family Dept Surg, Coral Gables, FL 33124 USA. [Vianna, Rodrigo] Miami Transplant Inst, Div Liver Intestinal & Multivisceral Transplant, Miami, FL USA. [Vianna, Rodrigo] Univ Miami, Leonard M Miller Sch Med, Div Liver Intestinal & Multivisceral Transplant, Dewitt Daughtry Family Dept Surg, Coral Gables, FL 33124 USA. [Casalenuovo, Kamelia] Jackson Hlth Syst, Dept Pharm, Miami, FL USA. [Loebe, Matthias; Ghodsizad, Ali] Miami Transplant Inst, Div Thorac Transplantat & Mech Circulatory Suppor, Miami, FL USA. Ghodsizad, A (corresponding author), Univ Miami, Leonard M Miller Sch Med, Div Cardiothorac Surg, ECMO Program, 1801 NW 9th Ave,6th Floor, Miami, FL 33136 USA. axg1433@miami.edu AN - WOS:000451135800010 AU - Grant, A. A. AU - Hart, V. J. AU - Lineen, E. B. AU - Lai, C. AU - Ginzburg, E. AU - Houghton, D. AU - Schulman, C. I. AU - Vianna, R. AU - Patel, A. N. AU - Casalenuovo, K. AU - Loebe, M. AU - Ghodsizad, A. DA - Nov DO - 10.1111/aor.13152 J2 - Artif. Organs KW - Extracorporeal membrane oxygenation Trauma Weaning protocol Thrombosis Hemorrhage EXTRACORPOREAL MEMBRANE-OXYGENATION RESPIRATORY-DISTRESS-SYNDROME ADULT TRAUMA PATIENTS LIFE-SUPPORT IMPROVES SURVIVAL FAILURE Engineering, Biomedical Transplantation LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: HB5XB Times Cited: 7 Cited Reference Count: 15 Grant, April A. Hart, Valerie J. Lineen, Edward B. Lai, Cynthia Ginzburg, Enrique Houghton, Douglas Schulman, Carl I. Vianna, Rodrigo Patel, Amit N. Casalenuovo, Kamelia Loebe, Matthias Ghodsizad, Ali 7 0 1 WILEY HOBOKEN ARTIF ORGANS PY - 2018 SN - 0160-564X SP - 1043-1051 ST - The Impact of an Advanced ECMO Program on Traumatically Injured Patients T2 - Artificial Organs TI - The Impact of an Advanced ECMO Program on Traumatically Injured Patients UR - ://WOS:000451135800010 VL - 42 ID - 761559 ER - TY - JOUR AB - Background: A number of factors can lead to adverse events (AE) in patients taking warfarin. Performing a root cause analysis (RCA) of serious adverse events is one systematic way of determining these causes. Methods: Multidisciplinary teams were formed at three participating MAQI2 high volume sites with organized anticoagulation services. Medical records from patients who suffered serious adverse events (major bleeds, embolic stroke, venous thromboembolism) were reviewed to determine the root cause. More than 200 patients had an AE and underwent screening by trained RNs. Of these, 48 required full review. All potential contributing factors (co-morbidities, patient physical limitations, concurrent meds, current protocols) were assessed to determine the main factor that caused the AE. Results: Full RCA was completed in 48 cases from 3 sites. The main contributing factor was identified in 42/48 (88 %) cases. Most AEs, 31/42 (78 %), were due to patient-specific factors such as co-morbidities, patient physical limitations, or language barriers. Patient to provider and provider to provider communication accounted for 10/42 (24 %) of events and was the second most common cause. Other causes included protocol non-adherence and technology/equipment issues. After each detailed review, the multidisciplinary team recommended changes that addressed the primary cause. Conclusions: The majority of severe adverse events for patients taking warfarin were related to non-modifiable patient related issues. The remaining adverse events were primarily due to patient to provider and provider to provider communication issues. Methods for improving communication need to be addressed and studied, and methods for more effective patient education should be investigated. AD - C.M. Graves, University of Michigan, Ann Arbor, MI, United States AU - Graves, C. M. AU - Gu, X. AU - Haymart, B. AU - Almany, S. L. AU - Krol, G. D. AU - Kaatz, S. AU - Froehlich, J. B. AU - Barnes, G. D. AU - Kline-Rogers, E. DB - Embase DO - 10.1007/s11239-015-1193-7 KW - warfarin anticoagulation human anticoagulant therapy United States total quality management patient root cause analysis interpersonal communication morbidity language screening medical record venous thromboembolism cerebrovascular accident patient education LA - English M1 - 3 M3 - Conference Abstract N1 - L71890986 2015-05-29 PY - 2015 SN - 0929-5305 SP - 418 ST - Initial findings of a root cause analysis of adverse events in anticoagulation patients: Results from the Michigan anticoagulation quality improvement initiative (MAQI2) T2 - Journal of Thrombosis and Thrombolysis TI - Initial findings of a root cause analysis of adverse events in anticoagulation patients: Results from the Michigan anticoagulation quality improvement initiative (MAQI2) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71890986&from=export http://dx.doi.org/10.1007/s11239-015-1193-7 VL - 39 ID - 761074 ER - TY - JOUR AB - BACKGROUND: A number of factors can lead to adverse events (AEs) in patients taking warfarin. Performing a root cause analysis (RCA) of serious AEs is one systematic way of determining the causes of these events. METHODS: Multidisciplinary teams were formed at Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)) sites with organized anticoagulation management services (AMS). Medical records from patients who suffered serious AEs (major bleed, embolic stroke, venous thromboembolism) were reviewed, and AMS staff were interviewed to determine the root cause using the "5 Whys" technique. More than 600 patients had an AE and underwent screening by trained RNs. Of these, 79 required full review by a multidisciplinary panel. All potential contributing factors (comorbidities, concurrent medications, current protocols) were assessed to determine the main factor that caused the AE. RESULTS: Full RCA was completed in 79 cases. The main contributing factor was identified in 69/79 (87%) cases. Most identified AEs, 55/69 (80%), were due to patient-specific factors such as comorbidities. Patient-to-provider and provider-to-provider communication accounted for 16/69 (23%) of events and was the second most common cause. Other causes included protocol non-adherence and technology/equipment issues. After each detailed review, the multidisciplinary panel recommended system changes that addressed the primary cause. CONCLUSION: The majority of severe AEs for patients taking warfarin were related to nonmodifiable patient-related issues. The remaining AEs were primarily due to patient-to-provider and provider-to-provider communication issues. Methods for improving communication need to be addressed, and methods for more effective patient education should be investigated. AN - 28528624 AU - Graves, C. M. AU - Haymart, B. AU - Kline-Rogers, E. AU - Barnes, G. D. AU - Perry, L. K. AU - Pluhatsch, D. AU - Gearhart, N. AU - Gikas, H. AU - Ryan, N. AU - Kurtz, B. DA - Jun DO - 10.1016/j.jcjq.2017.03.007 DP - NLM ET - 2017/05/23 J2 - Joint Commission journal on quality and patient safety KW - Anticoagulants/*adverse effects Clinical Protocols Communication Comorbidity Hemorrhage/chemically induced/mortality Humans *Outpatients Patient Safety Professional-Patient Relations Quality Improvement/*organization & administration *Root Cause Analysis Stroke/prevention & control Venous Thromboembolism/prevention & control Warfarin/*adverse effects LA - eng M1 - 6 N1 - Graves, Christopher M Haymart, Brian Kline-Rogers, Eva Barnes, Geoffrey D Perry, Linda K Pluhatsch, Denise Gearhart, Nannette Gikas, Helen Ryan, Noelle Kurtz, Brian Journal Article Research Support, Non-U.S. Gov't Netherlands Jt Comm J Qual Patient Saf. 2017 Jun;43(6):299-307. doi: 10.1016/j.jcjq.2017.03.007. Epub 2017 Apr 19. PY - 2017 SN - 1553-7250 (Print) 1553-7250 SP - 299-307 ST - Root Cause Analysis of Adverse Events in an Outpatient Anticoagulation Management Consortium T2 - Jt Comm J Qual Patient Saf TI - Root Cause Analysis of Adverse Events in an Outpatient Anticoagulation Management Consortium VL - 43 ID - 760274 ER - TY - JOUR AB - Purpose: Infective endocarditis (IE) is widely underdiagnosed or diagnosed after a major delay. The diagnosis is currently based on the modified DUKE criteria, where the only validated imaging technique is echocardiography, and remains challenging especially in patients with an implantable cardiac device. The aim of this study was to assess the incremental diagnostic role of 18F-FDG PET/CT in patients with an implanted cardiac device and suspected IE. Methods: We prospectively analysed 27 consecutive patients with an implantable device evaluated for suspected device-related IE between January 2011 and June 2013. The diagnostic probability of IE was defined at presentation according to the modified DUKE criteria. PET/CT was performed as soon as possible following the clinical suspicion of IE. Patients then underwent medical or surgical treatment based on the overall clinical evaluation. During follow-up, we considered: lead cultures in patients who underwent extraction, direct inspection and lead cultures in those who underwent surgery, and a clinical/instrumental reevaluation after at least 6 months in patients who received antimicrobial treatment or had an alternative diagnosis and were not treated for IE. After the follow-up period, the diagnosis was systematically reviewed by the multidisciplinary team using the modified DUKE criteria and considering the new findings. Results: Among the ten patients with a positive PET/CT scan, seven received a final diagnosis of "definite IE", one of "possible IE" and two of "IE rejected". Among the 17 patients with a negative PET/CT scan, four were false-negative and received a final diagnosis of definite IE. These patients underwent PET/CT after having started antibiotic therapy (≥48 h) or had a technically suboptimal examination. Conclusion: In patients with a cardiac device, PET/CT increases the diagnostic accuracy of the modified Duke criteria for IE, particularly in the subset of patients with possible IE in whom it may help the clinician manage a challenging situation. © 2014 Springer-Verlag. AD - C. Rapezzi, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater-University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy AU - Graziosi, M. AU - Nanni, C. AU - Lorenzini, M. AU - Diemberger, I. AU - Bonfiglioli, R. AU - Pasquale, F. AU - Ziacchi, M. AU - Biffi, M. AU - Martignani, C. AU - Bartoletti, M. AU - Tumietto, F. AU - Boriani, G. AU - Viale, P. L. AU - Fanti, S. AU - Rapezzi, C. DB - Embase Medline DO - 10.1007/s00259-014-2773-z KW - antibiotic agent fluorodeoxyglucose f 18 adult aged antibiotic therapy article bacterial endocarditis blood culture clinical article clinical evaluation coagulase negative Staphylococcus computer assisted emission tomography defibrillator diagnostic accuracy diagnostic test accuracy study echocardiography Enterococcus false negative result false positive result female follow up human lung embolism methicillin resistant Staphylococcus aureus methicillin susceptible Staphylococcus aureus prospective study radiodiagnosis sensitivity and specificity Streptococcus group D LA - English M1 - 8 M3 - Article N1 - L53175060 2014-07-21 2014-08-22 PY - 2014 SN - 1619-7089 1619-7070 SP - 1617-1623 ST - Role of 18F-FDG PET/CT in the diagnosis of infective endocarditis in patients with an implanted cardiac device: A prospective study T2 - European Journal of Nuclear Medicine and Molecular Imaging TI - Role of 18F-FDG PET/CT in the diagnosis of infective endocarditis in patients with an implanted cardiac device: A prospective study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L53175060&from=export http://dx.doi.org/10.1007/s00259-014-2773-z VL - 41 ID - 761137 ER - TY - JOUR AB - Before December 2014, the only proven effective treatment for acute ischemic stroke was recombinant tissue-type plasminogen activator (r-tPA). This has now changed with the publication of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE), Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial (EXTEND IA), Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment Trial (SWIFT PRIME), and Randomized Trial of Revascularization With the Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset (REVASCAT) studies. We review the main results of these studies and how they inform stroke patient management going forward. The main take home points for neurologists are (1) intra-arterial thrombectomy is a potently effective treatment and should be offered to patients who have documented occlusion in the distal internal carotid or the proximal middle cerebral artery, have a relatively normal noncontrast head computed tomographic scan, severe neurological deficit, and can have intra-arterial thrombectomy within 6 hours of last seen normal; (2) benefits are clear in patients receiving r-tPA before intra-arterial thrombectomy; r-tPA should not be withheld if the patient meets criteria, and benefit in patients who do not receive r-tPA or have r-tPA exclusions requires further study; and (3) these favorable results occur when intra-arterial thrombectomy is performed in an endovascular stroke center by a coordinated multidisciplinary team that extends from the prehospital stage to the endovascular suite, minimizes time to recanalization, uses stent-retriever devices, and avoids general anesthesia. In conclusion, stroke teams, including practicing neurologists caring for patients with stroke should now provide the option for intra-arterial thrombectomy for a subset of patients with acute stroke. AD - [Grotta, James C.] Mem Hermann Hosp, Clin Innovat & Res Inst, Houston, TX USA. [Hacke, Werner] Heidelberg Univ, Univ Heidelberg Hosp, Dept Neurol, Heidelberg, Germany. Grotta, JC (corresponding author), 6410 Fannin St,Ste 1423, Houston, TX 77030 USA. james.c.grotta@uth.tmc.edu AN - WOS:000354941800020 AU - Grotta, J. C. AU - Hacke, W. DA - Jun DO - 10.1161/strokeaha.115.008384 J2 - Stroke KW - cerebral infarction clinical trials, randomized thrombolytic therapy ACUTE ISCHEMIC-STROKE THROMBOLYTIC THERAPY 1ST-LINE TREATMENT POOLED ANALYSIS T-PA ALTEPLASE ATLANTIS NINDS ECASS Clinical Neurology Peripheral Vascular Disease LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: CI7KI Times Cited: 73 Cited Reference Count: 18 Grotta, James C. Hacke, Werner GenentechRoche HoldingGenentech; Covidien; Frazer Ltd; Boehringer IngelheimBoehringer Ingelheim; Specialists on Call (modest); Stryker (modest) Dr Grotta receives research support from Genentech, Covidien, and Frazer Ltd, and consulting fees from Specialists on Call (modest) and Stryker (modest). Dr Hacke receives honoraria (modest) as a member of the SWIFT PRIME steering committee and a unrestricted grant by Boehringer Ingelheim to perform the European Cooperative Acute Stroke Study 4 (ECASS 4) Study. 77 0 21 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA STROKE PY - 2015 SN - 0039-2499 SP - 1447-1452 ST - Stroke Neurologist's Perspective on the New Endovascular Trials T2 - Stroke TI - Stroke Neurologist's Perspective on the New Endovascular Trials UR - ://WOS:000354941800020 VL - 46 ID - 761748 ER - TY - JOUR AB - Background: Recently, a mobile stroke unit (MSU) was shown to facilitate acute stroke treatment directly at the emergency site. The neuroradiological expertise of the MSU is improved by its ability to detect early ischemic damage via automatic electronic (e) evaluation of CT scans using a novel software program that calculates the electronic Alberta Stroke Program Early CT Score (e-ASPECTS). Methods: The feasibility of integrating e-ASPECTS into an ambulance was examined, and the clinical integration and utility of the software in 15 consecutive cases evaluated. Results: Implementation of e-ASPECTS onto the MSU and into the prehospital stroke management was feasible. The values of e-ASPECTS matched with the results of conventional neuroradiologic analysis by the MSU team. The potential benefits of e-ASPECTS were illustrated by three cases. In case 1, excluding early infarct signs supported the decision to directly perform prehospital thrombolysis. In case 2, in which stroke was caused by large-vessel occlusion, the high e-ASPECTS value supported the decision to initiate intra-arterial treatment and triage the patient to a comprehensive stroke center. In case 3, the e-ASPECTS value was 10, indicating the absence of early infarct signs despite pre-existing cerebral microangiopathy and macroangiopathy, a finding indicating the program's robustness against artefacts. Conclusions: This study on the integration of e-ASPECTS into the prehospital stroke management via a MSU showed for the first time that such integration is feasible, and aids both decision regarding the treatment option and the triage regarding the most appropriate target hospital. (C) 2016 S. Karger AG, Basel AD - [Grunwald, Iris Quasar] Anglia Ruskin Univ, Dept Neurosci, Chelmsford, Essex, England. [Grunwald, Iris Quasar; Greveson, Eric] Brainomix Ltd, Oxford, England. [Ragoschke-Schumm, Andreas; Schwindling, Lenka; Helwig, Stefan; Manitz, Matthias; Walter, Silke; Yilmaz, Umut; Lesmeister, Martin; Fassbender, Klaus] Univ Saarland, Med Ctr, Dept Neurol, Kirrberger Str 1, DE-66421 Homburg, Germany. [Kettner, Michael; Roumia, Safwan; Reith, Wolfgang] Univ Saarland, Med Ctr, Inst Neuroradiol, Homburg, Germany. Fassbender, K (corresponding author), Univ Saarland, Med Ctr, Dept Neurol, Kirrberger Str 1, DE-66421 Homburg, Germany. Klaus.Fassbender@uks.eu AN - WOS:000390030800003 AU - Grunwald, I. Q. AU - Ragoschke-Schumm, A. AU - Kettner, M. AU - Schwindling, L. AU - Roumia, S. AU - Helwig, S. AU - Manitz, M. AU - Walter, S. AU - Yilmaz, U. AU - Greveson, E. AU - Lesmeister, M. AU - Reith, W. AU - Fassbender, K. DA - Dec DO - 10.1159/000446861 J2 - Cerebrovasc. Dis. KW - Alberta Stroke Program Early CT Score Electronic ASPECTS Computed tomography Mobile stroke unit Stroke Pre-hospital care ACUTE ISCHEMIC-STROKE COMPUTED-TOMOGRAPHY HYPERACUTE STROKE THROMBOLYSIS THROMBECTOMY THERAPY TRIAL CARE STANDARD TIME Clinical Neurology Peripheral Vascular Disease LA - English M1 - 5-6 M3 - Article N1 - ISI Document Delivery No.: EF0QL Times Cited: 14 Cited Reference Count: 35 Grunwald, Iris Quasar Ragoschke-Schumm, Andreas Kettner, Michael Schwindling, Lenka Roumia, Safwan Helwig, Stefan Manitz, Matthias Walter, Silke Yilmaz, Umut Greveson, Eric Lesmeister, Martin Reith, Wolfgang Fassbender, Klaus Fassbender, Klaus/0000-0003-3596-868X; Kettner, Michael/0000-0002-6743-0705; Lesmeister, Martin/0000-0001-5228-6483; Walter, Silke/0000-0002-1176-2911 14 1 7 KARGER BASEL CEREBROVASC DIS PY - 2016 SN - 1015-9770 SP - 332-338 ST - First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit T2 - Cerebrovascular Diseases TI - First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit UR - ://WOS:000390030800003 VL - 42 ID - 761683 ER - TY - JOUR AB - BACKGROUND CONTEXT: Elective posterior lumbar fusion is a common surgical procedure, but reported length of hospital stay is variable (usually 3-7 days). The effect of a limited number of factors on length of stay (LOS) has previously been evaluated. However, multivariate analysis using LOS as a dependent variable to separate potentially confounding variables has not been performed. PURPOSE: To facilitate setting of realistic expectations and considering the significant costs of hospitalization, it would be ideal to have a clear understanding of the variables affecting LOS for this surgery. STUDY DESIGN/SETTING: This is a retrospective case series at a tertiary care center. PATIENT SAMPLE: One hundred three patients undergoing elective, open, one-to three-level posterior lumbar instrumented fusion (with or without decompression) by the orthopedic spine service at our institution between January 2010 and June 2012 were included in the study. OUTCOME MEASURES: LOS was determined from the date of surgery to the date of discharge. METHODS: Preoperative factors (patient demographics, previous surgery, levels instrumented, American Society of Anesthesiologists [ASA] score, and major medical comorbidities including diabetes, hypertension, malignancy, pulmonary disease, or heart disease), intraoperative factors (complications, drain placement, estimated blood loss, blood transfusion, fluids administered, operating room time, and surgery time), and postoperative factors (drain removal, blood transfusion, complications, and discharge destination) were collected and analyzed with multivariate stepwise regression to determine predictors of LOS. "Postoperative complications'' were excluded as an independent variable from the regression analysis because of its close relationship with LOS. No funding was received for the completion of this study, and there are no potential conflicts of interests. RESULTS: Our sample included 70 one-level, 26 two-level, and 7 three-level operations. Average LOS was 3.6 +/- 1.8 days (mean +/- SD) with the range 0 to 12 days. Of this cohort, 79% (81 of 103) had a stay of 4 days or less. The only preoperative variables associated with LOS in the multivariate model were age (p=.038) and ASA score (p=.001). History of heart disease (p=.005) was significantly associated with a decreased hospital stay. Intraoperative complications included six dural tears and one pedicle fracture. No intraoperative factors were found to be associated with a longer LOS. Postoperative complications occurred in 32% of patients (33 of 103). Common complications included anemia requiring transfusion (11), altered mental status (8), pneumonia (4), hardware complications requiring reoperation (3). Only one serious complication, renal failure, occurred. Average LOS for patients with a postoperative complication was 5.1 +/- 2.3 vs. 2.9 +/- 0.9 days for patients with no complication (p<.001). Discharge to a subacute or nursing facility (p<.001) was significantly associated with increased LOS. Levels fused were not predictive of LOS, possibly due to the skew toward one-level cases in our sample. CONCLUSION: Patients who are older and have widespread systemic disease tend to stay in the hospital longer after surgery. Contrary to our expectations, no single comorbidity was predictive of longer hospital stays. Heart disease was associated with a shorter LOS, but this may have been due to a more extensive preoperative workup and closer medical management. Intraoperative events did not affect LOS; however, postoperative events did. These data should prove useful for counseling patients and setting expectations of patients and the health care team. (C) 2015 Elsevier Inc. All rights reserved. AD - [Gruskay, Jordan A.; Fu, Michael; Bohl, Daniel D.; Webb, Matthew L.; Grauer, Jonathan N.] Yale Univ, Sch Med, Dept Orthoped & Rehabil, New Haven, CT 06510 USA. Grauer, JN (corresponding author), Yale Univ, Sch Med, Dept Orthoped & Rehabil, 800 Howard Ave, New Haven, CT 06510 USA. jonathan.grauer@yale.edu AN - WOS:000354875700014 AU - Gruskay, J. A. AU - Fu, M. AU - Bohl, D. D. AU - Webb, M. L. AU - Grauer, J. N. DA - Jun DO - 10.1016/j.spinee.2013.10.022 J2 - Spine Journal KW - Fusion Lumbar Posterior Length of stay Complications Comorbidities HOSPITAL STAY COMPLICATION RATES KNEE ARTHROPLASTY INTERBODY FUSION OUTCOMES COSTS HIP INSTRUMENTATION ARTHRODESIS THROMBOSIS Clinical Neurology Orthopedics LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: CI6NF Times Cited: 75 Cited Reference Count: 27 Gruskay, Jordan A. Fu, Michael Bohl, Daniel D. Webb, Matthew L. Grauer, Jonathan N. Bohl, Daniel D/AAI-6828-2020 Bohl, Daniel D/0000-0002-7599-4244; Fu, Michael/0000-0002-4623-1491 76 0 12 ELSEVIER SCIENCE INC NEW YORK SPINE J PY - 2015 SN - 1529-9430 SP - 1188-1195 ST - Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysis T2 - Spine Journal TI - Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysis UR - ://WOS:000354875700014 VL - 15 ID - 761750 ER - TY - JOUR AB - Abstract: Background: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and cardiovascular events. In New Zealand (NZ), Māori (indigenous New Zealanders) and Pacific people experience higher rates of AF compared with non‐Māori/non‐Pacific people. Aim: To describe a primary care population with AF in NZ. Stroke risk and medication adherence according to ethnicity are also detailed. Methods: Electronic medical records for adults (≥20 years, n = 135 840, including 19 918 Māori and 43 634 Pacific people) enrolled at 37 NZ general practices were analysed for AF diagnosis and associated medication prescription information. Results: The overall prevalence of non‐valvular AF (NVAF) in this population was 1.3% (1769), and increased with age (4.4% in people ≥55 years). Māori aged ≥55 years were more likely to be diagnosed with NVAF (7.3%) than Pacific (4.0%) and non‐Māori/non‐Pacific people (4.1%, P < 0.001). Māori and Pacific NVAF patients were diagnosed with AF 10 years earlier than non‐Māori/non‐Pacific patients (median age of diagnosis: Māori = 60 years, Pacific = 61 years, non‐Māori/non‐Pacific = 71 years, P < 0.001). Overall, 67% of NVAF patients were at high risk for stroke (CHA2DS2‐VASc ≥ 2) at the time of AF diagnosis. Almost half (48%) of Māori and Pacific NVAF patients aged <65 years were at high risk for stroke, compared with 22% of non‐Māori/non‐Pacific (P < 0.001). Irrespective of ethnic group, adherence to AF medication was suboptimal in those NVAF patients with a high risk of stroke or with stroke history. Conclusion: AF screening and stroke thromboprophylaxis in Māori and Pacific people could start below the age of 65 years in NZ. AD - School of Health Sciences, Stockton University, Galloway, New Jersey, USA Department of Medicine, The University of Auckland, Auckland, New Zealand Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Heart Research Institute, Charles Perkins Centre, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia Department of Cardiology and Anzac Research Institute, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand Department of Computer Science, The University of Auckland, Auckland, New Zealand Te Kupenga Hauora Māori (Department of Māori Health), The University of Auckland, Auckland, New Zealand East Tamaki Healthcare, Auckland, New Zealand Wai Health, Auckland, New Zealand National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand AN - 128361547. Language: English. Entry Date: 20180331. Revision Date: 20190418. Publication Type: Article AU - Gu, Yulong AU - Doughty, Robert N. AU - Freedman, Ben AU - Kennelly, John AU - Warren, Jim AU - Harwood, Matire AU - Hulme, Richard AU - Paltridge, Chris AU - Teh, Ruth AU - Rolleston, Anna AU - Walker, Natalie DB - CINAHL DO - 10.1111/imj.13648 DP - EBSCOhost KW - Atrial Fibrillation -- Epidemiology -- New Zealand Maori Persons -- New Zealand Asians -- New Zealand Primary Health Care -- New Zealand Stroke -- Risk Factors Medication Compliance -- Ethnology New Zealand Prospective Studies Human Prevalence Middle Age Atrial Fibrillation -- Diagnosis Electronic Health Records Young Adult Adult Aged Medication Compliance M1 - 3 N1 - research; tables/charts. Journal Subset: Australia & New Zealand; Biomedical; Peer Reviewed. NLM UID: 101092952. PY - 2018 SN - 1444-0903 SP - 301-309 ST - Burden of atrial fibrillation in Māori and Pacific people in New Zealand: a cohort study T2 - Internal Medicine Journal TI - Burden of atrial fibrillation in Māori and Pacific people in New Zealand: a cohort study UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=128361547&site=ehost-live&scope=site VL - 48 ID - 761302 ER - TY - JOUR AB - Purpose To assess outcomes and predictors of early and long-term remission in patients with Cushing's disease (CD) due to ACTH-secreting adenomas treated via endoscopic endonasal approach (EEA). Methods This is a retrospective study. Consecutive patients operated for CD from 1998 to 2017 in an Italian referral Pituitary Center were enrolled. Clinical, radiological, and histological data at enrollment and follow-up were collected. Results 151 patients (107 F) were included; 88.7% were naive for treatment, 11.3% had been treated surgically and 11.2% medically. At pre-operative magnetic resonance imaging (MRI), 35 had a macroadenoma and 80 a microadenoma, while tumor was undetectable in 36 patients. Mean age at surgery was 41.1 +/- 16.6 years. Diagnosis was confirmed histologically in 82.4% of the cases. Patients with disease persistence underwent second surgery and/or medical and/or radiation therapy. Mean follow-up was 92.3 +/- 12.0 (range 12-237.4) and median 88.2 months. Remission rate was 88.1% after the first surgery and 90.7% at last follow-up. One patient died of pituitary carcinoma. Post-surgical cortisol drop (p = 0.004), tumor detection at MRI (p = 0.03) and size < 1 cm (p = 0.045) increased the chance of disease remission; cavernous sinus invasion was a negative predictor of outcome (p = 0.002). Twenty-seven patients developed diabetes insipidus and 18 hypopituitarism. Surgery repetition increased the risk of hypopituitarism (p = 0.03), but not of other complications, which included epistaxis (N = 2), cerebrospinal fluid leakage (1), pneumonia (3), myocardial infarction (1), and pulmonary embolisms (2). Conclusions Selective adenomectomy via EEA performed by experienced surgeons, supported by a multidisciplinary dedicated team, allows long-term remission in the vast majority of CD patients with low complication rate. AD - [Guaraldi, F.; Zoli, M.; Mazzatenta, D.] IRCCS Ist Sci Neurol Bologna, Bologna, Italy. [Guaraldi, F.; Zoli, M.; Gori, D.; Friso, F.; Mazzatenta, D.] Univ Bologna, Dept Biomed & Neuromotor Sci DIBINEM, Via Altura 3, I-40139 Bologna, Italy. [Asioli, S.] Univ Bologna, Sect Anat Pathol M Malpighiat, Dept Biomed & Neuromuscular Sci, Bellaria Hosp, Bologna, Italy. [Corona, G.; Sforza, A.] Osped Maggiore Bologna, Div Endocrinol, Bologna, Italy. [Pasquini, E.] Bellaria Hosp, ENT Div, Bologna, Italy. [Bacci, A.] IRCCS Inst Neurol Sci Bologna, Div Neuroradiol, Bologna, Italy. Guaraldi, F (corresponding author), IRCCS Ist Sci Neurol Bologna, Bologna, Italy.; Guaraldi, F (corresponding author), Univ Bologna, Dept Biomed & Neuromotor Sci DIBINEM, Via Altura 3, I-40139 Bologna, Italy. federica.guaraldi@yahoo.it AN - WOS:000521767600001 AU - Guaraldi, F. AU - Zoli, M. AU - Asioli, S. AU - Corona, G. AU - Gori, D. AU - Friso, F. AU - Pasquini, E. AU - Bacci, A. AU - Sforza, A. AU - Mazzatenta, D. DA - Oct DO - 10.1007/s40618-020-01225-5 J2 - J. Endocrinol. Invest. KW - Cushing's disease ACTH-secreting pituitary adenoma Transsphenoidal surgery Outcome Cortisol Predictor Pituitary unit TRANSSPHENOIDAL SURGERY REMISSION RATES ADENOMAS DIAGNOSIS INVASION Endocrinology & Metabolism LA - English M1 - 10 M3 - Article N1 - ISI Document Delivery No.: NL6EM Times Cited: 0 Cited Reference Count: 35 Guaraldi, F. Zoli, M. Asioli, S. Corona, G. Gori, D. Friso, F. Pasquini, E. Bacci, A. Sforza, A. Mazzatenta, D. Asioli, Sofia/0000-0002-5035-2448 0 SPRINGER NEW YORK J ENDOCRINOL INVEST PY - 2020 SN - 0391-4097 SP - 1463-1471 ST - Results and predictors of outcome of endoscopic endonasal surgery in Cushing's disease: 20-year experience of an Italian referral Pituitary Center T2 - Journal of Endocrinological Investigation TI - Results and predictors of outcome of endoscopic endonasal surgery in Cushing's disease: 20-year experience of an Italian referral Pituitary Center UR - ://WOS:000521767600001 VL - 43 ID - 761451 ER - TY - JOUR AB - OBJECTIVES: The aim of this study was to determine the feasibility of establishing a mechanical thrombectomy (MT) program for acute ischemic stroke in a community hospital using interventional cardiologists working closely with neurologists. BACKGROUND: American Heart Association/American Stroke Association 2018 guidelines give a Class I (Level of Evidence: A) recommendation for MT in eligible patients with large vessel occlusion stroke. Improvement in neurological outcomes with MT is highly time sensitive. Most hospitals do not have trained neurointerventionalists to perform MT, leading to treatment delays that reduce the benefit of reperfusion therapy. METHODS: An MT program based in the cardiac catheterization laboratory was developed using interventional cardiologists with ST-segment elevation myocardial infarction teams. RESULTS: Forty patients underwent attempted MT for acute ischemic stroke. An additional 5 patients who underwent angiography did not undergo attempted thrombectomy, because of absence of target thrombus (n = 4) or unsuitable anatomy (n = 1). Median National Institutes of Health Stroke Scale score prior to MT was 19 and at discharge was 7. TICI (Thrombolysis In Cerebral Infarction) grade 2b or 3 flow was restored in 80% of patients (32 of 40). At 90 days, 55% of patients (22 of 40) were functionally independent (modified Rankin score ≤2). In-hospital mortality was 13% (5 of 40). Symptomatic intracranial hemorrhage occurred in 15% of patients (6 of 40). Major vascular complications occurred in 5% of patients (2 of 40). CONCLUSIONS: MT can be successfully performed by interventional cardiologists with carotid stenting experience working closely with neurologists in hospitals lacking formally trained neurointerventionists. This model has the potential to increase access to timely care for patients with acute ischemic stroke. AD - Division of Cardiology, Doylestown Health, Doylestown Hospital, Doylestown, Pennsylvania. Electronic address: guidera5@verizon.net. Division of Neurology, Doylestown Health, Doylestown Hospital, Doylestown, Pennsylvania. Division of Cardiology, Doylestown Health, Doylestown Hospital, Doylestown, Pennsylvania. Department of Radiology, Lehigh Valley Hospital, Allentown, Pennsylvania. AN - 32273100 AU - Guidera, S. A. AU - Aggarwal, S. AU - Walton, J. D. AU - Boland, D. AU - Jackel, R. AU - Gould, J. D. AU - Kearins, B. AU - McGarvey, J., Jr. AU - Qi, Y. AU - Furlong, B. DA - Apr 13 DO - 10.1016/j.jcin.2020.01.232 DP - NLM ET - 2020/04/11 J2 - JACC. Cardiovascular interventions KW - Aged Aged, 80 and over Brain Ischemia/diagnostic imaging/mortality/*therapy *Cardiac Catheterization *Cardiologists Clinical Competence *Endovascular Procedures/adverse effects/mortality Female Hospital Mortality Humans Male Middle Aged *Neurologists *Patient Care Team Recovery of Function Registries Retrospective Studies Risk Factors Specialization Stroke/diagnostic imaging/mortality/*therapy *Thrombectomy/adverse effects/mortality Time Factors Treatment Outcome *acute ischemic stroke *mechanical thrombectomy LA - eng M1 - 7 N1 - 1876-7605 Guidera, Steven A Aggarwal, Sudhir Walton, J Doyle Boland, David Jackel, Roy Gould, Jeffrey D Kearins, Brooke McGarvey, Joseph Jr Qi, Yan Furlong, Brian Journal Article United States JACC Cardiovasc Interv. 2020 Apr 13;13(7):884-891. doi: 10.1016/j.jcin.2020.01.232. PY - 2020 SN - 1936-8798 SP - 884-891 ST - Mechanical Thrombectomy for Acute Ischemic Stroke in the Cardiac Catheterization Laboratory T2 - JACC Cardiovasc Interv TI - Mechanical Thrombectomy for Acute Ischemic Stroke in the Cardiac Catheterization Laboratory VL - 13 ID - 760528 ER - TY - JOUR AB - The Stroke Units (SUs) have been demonstrated to be efficient and cost effective for acute stroke care. Nevertheless, the level of stroke unit implementation in Italy does not correspond to expectations yet. This study is a survey, which aims at assessing the current status of in-hospital stroke care in the Italian regions and at updating SUs. The survey was conducted by means of a semi-structured questionnaire, based on 18 stroke care "quality indicators", submitted to all the Italian centres that had taken part in the SITS-MOST study, and to other centres advised by the coordinator of SITS studies and by regional opinion leaders of stroke. SUs were defined as acute wards, with stroke-dedicated beds and dedicated teams that had been formally authorised to administer rt-PA. A statistical analysis was performed by a descriptive statistics and logistic regression model. The study was carried out from November 2009 to September 2010. A total of 168 forms were sent out and 153 replies received. Seven centres, which had not performed any thrombolytic treatment, and 16 which did not fulfil the criteria for the definition of SU were excluded from the study. Most of the centres reported more than 100 stroke patient admissions per year, i.e., 122 (84 %) from 100 to 500, 18 (12 %) more than 500. The 19 % of the centres admitted more than 30 % of patients within 3 h from the symptom onset and only 30 % admitted more than 30 % of patients within 4.5 h. The mean number of thrombolyses performed in the last 6 months was 10 for centres with a doctor on duty 24 h a day, 6 for those that have a doctor on duty from 8 a.m. to 8 p.m. and a doctor on call for night, and 5 for centres with a doctor on call 24 h a day. The territorial distribution of the SUs is remarkably heterogeneous: 87 SUs (67 %) are located in the North of Italy, 28 (22 %) in the central part of Italy and only 15 (11 %) in the South. The last few years have witnessed a rise in both the diffusion of SUs and access to thrombolytic therapy in Italy. Despite this, there are a few large areas, mostly in the south, where the requirements of healthcare legislation are not met, and access to a dedicated SU and thrombolytic treatment is still limited and poor. AD - [Guidetti, D.; Spallazzi, M.; Rota, E.; Morelli, N.; Immovilli, P.] Guglielmo da Saliceto Hosp, Dept Neurol, I-29100 Piacenza, Italy. [Toni, D.] Univ Rome, Emergency Dept, Stroke Unit Sapienza, Rome, Italy. [Baldereschi, M.] Italian Natl Res Council, Inst Neurosci, Florence, Italy. [Polizzi, B. M.] Minist Hlth, Ctr Dis Control, Rome, Italy. [Ferro, S.] Agenzia Sanit Emilia Romagna, Bologna, Italy. [Inzitari, D.] Univ Florence, Dept Neurosci & Pharmacol, Florence, Italy. Guidetti, D (corresponding author), Guglielmo da Saliceto Hosp, Dept Neurol, Via Cantone Cristo, I-29100 Piacenza, Italy. d.guidetti@ausl.pc.it AN - WOS:000322140400007 AU - Guidetti, D. AU - Spallazzi, M. AU - Toni, D. AU - Rota, E. AU - Morelli, N. AU - Immovilli, P. AU - Baldereschi, M. AU - Polizzi, B. M. AU - Ferro, S. AU - Inzitari, D. AU - Promotion Implementation, Stroke DA - Jul DO - 10.1007/s10072-012-1226-3 J2 - Neurol. Sci. KW - Stroke unit Stroke care Acute wards Stroke Clinical Neurology Neurosciences LA - English M1 - 7 M3 - Article N1 - ISI Document Delivery No.: 187SS Times Cited: 3 Cited Reference Count: 8 Guidetti, D. Spallazzi, M. Toni, D. Rota, E. Morelli, N. Immovilli, P. Baldereschi, M. Polizzi, B. M. Ferro, S. Inzitari, D. Inzitari, Domenico/AAH-8722-2020; Morelli, Nicola/AAN-7876-2020; Spallazzi, Marco/K-5946-2016; Baldereschi, Marzia/AAF-9989-2019; Baldereschi, Marzia/J-4765-2013; Toni, Danilo/K-3151-2016 Morelli, Nicola/0000-0003-3787-2243; Spallazzi, Marco/0000-0002-8091-2063; Baldereschi, Marzia/0000-0001-7703-4987; immovilli, paolo/0000-0001-9417-3903; Toni, Danilo/0000-0003-2735-8427 3 0 4 SPRINGER-VERLAG ITALIA SRL MILAN NEUROL SCI PY - 2013 SN - 1590-1874 SP - 1087-1092 ST - Updating on Italian Stroke Units: the "CCM study" T2 - Neurological Sciences TI - Updating on Italian Stroke Units: the "CCM study" UR - ://WOS:000322140400007 VL - 34 ID - 761802 ER - TY - JOUR AB - Thrombotic occlusion of saphenous vein grafts (SVG), the conduits most commonly used in coronary artery bypass grafting (CABG) surgery, causes significant morbidity and mortality. There is class 1A evidence that early aspirin administration following CABG reduces thrombotic SVG occlusion, as well as overall morbidity and mortality. The American Heart Association/American College of Cardiology and the European Association of Cardiothoracic Surgeons have issued guidelines recommending that 150 to 325 mg aspirin be administered within 6 hours following CABG. We carried out a clinical audit of our practice to identify any reasons for deviation from these standards of care and to implement any corrective measures. We prospectively collected data on 200 consecutive patients who underwent CABG to assess both the compliance in prescribing and administering aspirin and the effect on blood loss and transfusion requirements. Sixty-nine percent of patients received an aspirin loading dose 6 hours postoperatively. The reasons for nonadministration of aspirin were postoperative bleeding (10%), lack of a prescription despite aspirin being clinically indicated (13%), and a prescription for aspirin but no administration (9%). Reasons included inadequate handover between clinical teams (4%), aspirin loading <= 24 hours preoperatively (2%), and administration after the first 6 hours (3%). Our audit showed that early aspirin administration did not cause further bleeding or increase blood or blood product transfusion. We followed the recommendations in the majority of cases, but there is scope for improvement in this practice and a need to address "gray areas" not covered by the guidelines. AD - [Gukop, Philemon; Kakouros, Nicholaos; Hosseini, Morteza Tavakkoli; Valencia, Oswaldo; Kourliouros, Antonios; Sarsam, Mazin; Chandrasekaran, Venkatachalam] St George Hosp, Dept Cardiothorac Surg, London SW17 0QT, England. Chandrasekaran, V (corresponding author), St George Hosp, Dept Cardiothorac Surg, Blackshaw Rd, London SW17 0QT, England. v.chandrasekaran@stgeorges.nhs.uk AN - WOS:000287699600002 AU - Gukop, P. AU - Kakouros, N. AU - Hosseini, M. T. AU - Valencia, O. AU - Kourliouros, A. AU - Sarsam, M. AU - Chandrasekaran, V. DA - Feb DO - 10.1532/hsf98.20101087 J2 - Heart Surg. Forum KW - VEIN GRAFT PATENCY SAPHENOUS-VEIN ANTITHROMBOTIC THERAPY ANTIPLATELET MANAGEMENT Cardiac & Cardiovascular Systems Surgery LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 726DS Times Cited: 3 Cited Reference Count: 12 Gukop, Philemon Kakouros, Nicholaos Hosseini, Morteza Tavakkoli Valencia, Oswaldo Kourliouros, Antonios Sarsam, Mazin Chandrasekaran, Venkatachalam Gukop, Philemon/H-9732-2019 Gukop, Philemon/0000-0002-5768-1973; Kakouros, Nikolaos/0000-0002-2289-7598 4 0 6 FORUM MULTIMEDIA PUBLISHING, LLC CHARLOTTESVILLE HEART SURG FORUM PY - 2011 SN - 1098-3511 SP - E7-E11 ST - Practice Considerations of Early Aspirin Administration following Coronary Artery Bypass Surgery T2 - Heart Surgery Forum TI - Practice Considerations of Early Aspirin Administration following Coronary Artery Bypass Surgery UR - ://WOS:000287699600002 VL - 14 ID - 761860 ER - TY - JOUR AB - OBJECTIVE: Treatment of massive pulmonary embolism (MPE) is controversial, with mortality rates ranging from 25% to 65%. Patients commonly present with profound shock or cardiac arrest. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly being used as a form of acute cardiopulmonary support in critically ill patients. We reviewed our institution's pulmonary embolism response team experience using VA-ECMO for patients presenting with advanced shock and/or cardiac arrest from MPE. METHODS: From March 2017 to July 2019 we retrospectively reviewed 17 consecutive patients at our institution with MPE who were placed on VA-ECMO for initial hemodynamic stabilization. RESULTS: The mean patient age and body mass index was 55.8 years and 31.8, respectively. Ten of 17 patients (59%) required cardiopulmonary resuscitation before or during VA-ECMO cannulation. All patients had evidence of profound shock with a mean initial lactate of 8.95 mmol/L, a mean pH of 7.10, and a mean serum creatinine of 1.78 mg/dL. Seventeen of 17 cannulations (100%) were performed percutaneously, with 41% (n = 7) of patients placed on VA-ECMO while awake and using local analgesia. Five of 17 patients (29%) required reperfusion cannulas, with 0% incidence of limb loss. Overall survival was 13 of 17 patients (76%), with causes of death resulting from anoxic brain injury (n = 2), septic shock (n = 1), and cardiopulmonary resuscitation-induced hemorrhage from liver laceration (n = 1). In survivors, 12 of 13 patients (92%) were discharged without evidence of neurologic insult. The median duration of the VA-ECMO run for survivors was 86 hours (range, 45-218 hours). In survivors, the median length of time from ECMO cannulation to lactate clearance (<2.0 mmol/L) was 10 hours and the median length of time from ECMO cannulation to freedom from vasopressors was 6 hours. Three of 13 patients (23%) required concomitant percutaneous thrombectomy and catheter-directed thrombolysis to address persistent right heart dysfunction, with the remaining survivors (77%) receiving VA-ECMO and anticoagulation alone as definitive therapy for their MPE. The median intensive care and hospital length of stay for survivors was 9 and 13 days, respectively. CONCLUSIONS: VA-ECMO was effective at salvaging highly unstable patients with MPE. Survivors had rapid reversal of multiple organ failure with ECMO as their primary therapy. The majority of survivors required ECMO and anticoagulation alone for definitive therapy of their MPE. AD - Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM; Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM; Department of Critical Care, University of New Mexico School of Medicine, Albuquerque, NM. Electronic address: sguliani@salud.unm.edu. Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM. Department of Critical Care, University of New Mexico School of Medicine, Albuquerque, NM. Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM; Division of Vascular Surgery, University of New Mexico School of Medicine, Albuquerque, NM. AN - 32505687 AU - Guliani, S. AU - Das Gupta, J. AU - Osofsky, R. AU - Kraai, E. P. AU - Mitchell, J. A. AU - Dettmer, T. S. AU - Wray, T. C. AU - Tawil, I. AU - Rana, M. A. AU - Marinaro, J. DA - Jun 4 DO - 10.1016/j.jvsv.2020.04.033 DP - NLM ET - 2020/06/09 J2 - Journal of vascular surgery. Venous and lymphatic disorders KW - Catheter-directed thrombolysis (CDT) Massive pulmonary embolism (MPE) Pulmonary embolism response teams (PERTs) Reperfusion cannulas Venoarterial extracorporeal membrane oxygenation (VA-ECMO) LA - eng N1 - 2213-3348 Guliani, Sundeep Das Gupta, Jaideep Osofsky, Robin Kraai, Erik P Mitchell, Jessica A Dettmer, Todd S Wray, Trenton C Tawil, Isaac Rana, Muhammad Ali Marinaro, Jon Journal Article United States J Vasc Surg Venous Lymphat Disord. 2020 Jun 4:S2213-333X(20)30321-8. doi: 10.1016/j.jvsv.2020.04.033. PY - 2020 ST - Venoarterial extracorporeal membrane oxygenation is an effective management strategy for massive pulmonary embolism patients T2 - J Vasc Surg Venous Lymphat Disord TI - Venoarterial extracorporeal membrane oxygenation is an effective management strategy for massive pulmonary embolism patients ID - 760516 ER - TY - JOUR AB - Introduction: Acute ischemic stroke management saw a paradigm shift in 1995 when the National Institute of Neurological Disorders and Stroke (NINDS) USA confirmed significant short and long term benefits of IV recombinant tissue plasminogen activator (rt-PA) therapy in treatment of acute ischemic stroke. Though the NINDS study protocol was CT based, subsequent studies have shown that MRI in acute stroke settings, has higher sensitivity and specificity. We studied the feasibility and effectiveness of a MRI based protocol for acute stroke thrombolysis at a tertiary care centre. Methods: Data of patients who underwent thrombolysis and/or interventional therapy at our centre for acute stroke between April 2013 to August 2014 under FAST (Fortis Acute Stroke Treatment) protocol was retrospectively analyzed. Patients who presented within 6 hours of onset of stroke like symptoms were included in the protocol. Inclusion and exclusion criteria for thrombolysis was as per AHA stroke guidelines. Parameters studied were door to needle time, stroke subtype, modality of treatment, cause(s) for non thrombolysis, cause(s) of delay in execution of protocol. Tabulated results were analyzed. Results: In the present study FAST code was activated in a total of 86 cases, of which 63.95% (n=55) had acute ischemic stroke, 18.60% (n=16) hemorrhagic stroke and 17.44% (n=15) had normal imaging study. Due to various contraindications for MRI, CT was done in 9 cases. Out of total 86 cases, 18.60% (n=16) underwent active intervention (Intravenous (IV) and/or endovascular therapy). In acute ischemic stroke category a total of 29.09% (n=16) had active intervention of which 75% (n=12) was IV rt-PA therapy, 18.75% (n=3) was endovascular therapy (intra-arterial (IA) and mechanical therapy) and 6.25% (n=1) was bridge therapy (IV, IA and mechanical therapy).Target time of 15 minutes for shifting to MRI was achieved in 88.37% (n=76) cases. In 11.63% (n=10) cases, delay in shifting was due to need for initial intubation and stabilization. In 100% cases MRI reporting was achieved in target time of 25 minutes. Target door to needle time of 60 minutes was achieved in 87.5% (n=14) cases. In 12.5% (n=2) cases this target was missed due to delay in getting consent for thrombolysis. Discussion: We conclude that a MRI based protocol for acute stroke thrombolysis is feasible with proactive coordinated efforts of a multidisciplinary team. Faster MRI reporting time also makes it effective, in providing time sensitive therapy to a larger number of potentially eligible patients. The results of the present study is based on a small sample size and single centre experience and requires revalidation in a multi centre study for its widespread applicability. AD - G. Gupta, Fortis Escorts Heart Institute, India AU - Gupta, G. AU - Bag, P. AU - Goyal, V. AU - Varma, A. DB - Embase KW - alteplase adult blood clot lysis brain hemorrhage brain ischemia conference abstract contraindication controlled study drug therapy feasibility study female human intubation major clinical study male multidisciplinary team nuclear magnetic resonance imaging retrospective study sample size tertiary care center LA - English M1 - 13 M3 - Conference Abstract N1 - L624508626 2018-10-26 PY - 2015 SN - 1998-359X SP - S25-S26 ST - Feasibility and effectiveness of a MRI based protocol for acute stroke thrombolysis and intervention: Experience of a Tertiary Care Centre T2 - Indian Journal of Critical Care Medicine TI - Feasibility and effectiveness of a MRI based protocol for acute stroke thrombolysis and intervention: Experience of a Tertiary Care Centre UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624508626&from=export VL - 19 ID - 761078 ER - TY - JOUR AB - OBJECTIVE: "Stroke code" (SC) implementation in hospitals can improve the rate of thrombolysis and the timeline in care of stroke patient. MATERIALS AND METHODS: A prospective data of patients treated for acute ischemic stroke (AIS) after implementation of "SC" (post-SC era) were analyzed (2015-2016) and compared with the retrospective data of patients treated in the "pre-SC era." Parameters such as symptom-to-door, door-to-physician, door-to-imaging, door-to-needle (DTN), and symptom-to-needle time were calculated. The severity of stroke was calculated using the National Institutes of Health Stroke Score (NIHSS) before and after treatment. RESULTS: Patients presented with stroke symptoms in pre- and post-SC era (695 vs. 610) and, out of these, patients who came in window period constituted 148 (21%) and 210 (34%), respectively. Patients thrombolyzed in pre- and post-SC era were 44 (29.7%) and 65 (44.52%), respectively. Average DTN time was 104.95 min in pre-SC era and reduced to 67.28 min (P < 0.001) post-SC implementation. Percentage of patients thrombolyzed within DTN time ≤60 min in pre-SC era and SC era was 15.90% and 55.38%, respectively. CONCLUSION: Implementation of SC helped us to increase thrombolysis rate in AIS and decrease DTN time. AD - Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India. Department of Neurology, Ruby Hall Clinic, Pune, Maharashtra, India. Deapartment of Medicine, BJMC, Pune, Maharashtra, India. Department of Radiology, Ruby Hall Clinic, Pune, Maharashtra, India. Resident General Medicine, Ruby Hall Clinic, Pune, Maharashtra, India. Department of Accident and Emergency, Ruby Hall Clinic, Pune, Maharashtra, India. AN - 29743763 AU - Gurav, S. K. AU - Zirpe, K. G. AU - Wadia, R. S. AU - Naniwadekar, A. AU - Pote, P. U. AU - Tungenwar, A. AU - Deshmukh, A. M. AU - Mohopatra, S. AU - Nimavat, B. AU - Surywanshi, P. C2 - Pmc5930528 DA - Apr DO - 10.4103/ijccm.IJCCM_504_17 DP - NLM ET - 2018/05/11 J2 - Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine KW - Acute ischemic stroke door to needle time stroke code LA - eng M1 - 4 N1 - 1998-359x Gurav, Sushma K Zirpe, Kapil G Wadia, R S Naniwadekar, Avinash Pote, Prajakta U Tungenwar, Amit Deshmukh, Abhijeet M Mohopatra, Srikanta Nimavat, Balakrishna Surywanshi, Prasad Journal Article Indian J Crit Care Med. 2018 Apr;22(4):243-248. doi: 10.4103/ijccm.IJCCM_504_17. PY - 2018 SN - 0972-5229 (Print) 0972-5229 SP - 243-248 ST - Impact of "Stroke Code"-Rapid Response Team: An Attempt to Improve Intravenous Thrombolysis Rate and to Shorten Door-to-Needle Time in Acute Ischemic Stroke T2 - Indian J Crit Care Med TI - Impact of "Stroke Code"-Rapid Response Team: An Attempt to Improve Intravenous Thrombolysis Rate and to Shorten Door-to-Needle Time in Acute Ischemic Stroke VL - 22 ID - 760193 ER - TY - JOUR AB - Aim: (1) To evaluate the number of patients thrombolysed within 1 h of arrival to emergency room (ER) (2) To identify reasons for delay in thrombolysis of acute stroke patients. Materials and Methods: All patients admitted to ER with symptoms suggestive of stroke from January 2011 to November 2013 were studied. Retrospective data were collected to evaluate ER to needle (door to needle time [DTNt]) time and reasons for delay in thrombolysis. The parameters studied (1) onset of symptoms to ER time, (2) ER to imaging time (door to imaging time [DTIt]), (4) ER to needle time (door to needle) and (5) contraindications for thrombolysis. Results: A total of 695 patients with suspected stroke were admitted during study period. 547 (78%) patients were out of window period. 148 patients (21%, M = 104, F = 44) arrived within window period (< 4.5 h.). 104 (70.27%) were contraindicated for thrombolysis. Majority were intracerebral bleeds. 44 (29.7%) were eligible for thrombolysis. 7 (15.9%) were thrombolysed within 1 h. The mean time for arrival of patients from onset of symptoms to hospital (symptom to door) 83 min (median -47). The mean door to neuro-physician time (DTPt) was 32 min (median -15 min). The mean DTIt was 58 min (median -50 min). The mean DTNt 104 (median -100 min). Conclusion: Reasons for delay in thrombolysis are: Absence of stroke education program for common people. Lack of priority for triage and imaging for stroke patients. AD - [Gurav, Sushma K.; Zirpe, Kapil G.; Pathak, Manishprasad K.; Deshmukh, Abhijeet M.] Ruby Hall Cln, Neurotrauma Unit, Pune 411001, Maharashtra, India. [Wadia, R. S.] Ruby Hall Cln, Neurosci, Pune, Maharashtra, India. [Sonawane, Rahul V.; Goli, Nikhil] Ruby Hall Cln, Med, Pune, Maharashtra, India. Gurav, SK (corresponding author), Ruby Hall Cln, Neurotrauma Unit, Pune 411001, Maharashtra, India. kirtisush_gurav@yahoo.co.in AN - WOS:000218221100003 AU - Gurav, S. K. AU - Zirpe, K. G. AU - Wadia, R. S. AU - Pathak, M. K. AU - Deshmukh, A. M. AU - Sonawane, R. V. AU - Goli, N. DA - May DO - 10.4103/0972-5229.156468 J2 - Indian J. Crit. Care Med. KW - Acute ischemic stroke window period thrombolysis triage and stroke code team Critical Care Medicine LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: V3F9W Times Cited: 7 Cited Reference Count: 10 Gurav, Sushma K. Zirpe, Kapil G. Wadia, R. S. Pathak, Manishprasad K. Deshmukh, Abhijeet M. Sonawane, Rahul V. Goli, Nikhil 11 0 MEDKNOW PUBLICATIONS & MEDIA PVT LTD MUMBAI INDIAN J CRIT CARE M PY - 2015 SN - 0972-5229 SP - 265-269 ST - Problems and limitations in thrombolysis of acute stroke patients at a tertiary care center T2 - Indian Journal of Critical Care Medicine TI - Problems and limitations in thrombolysis of acute stroke patients at a tertiary care center UR - ://WOS:000218221100003 VL - 19 ID - 761755 ER - TY - JOUR AB - INTRODUCTION: Current research within other surgical specialties suggests that a co-surgeon approach may reduce operative times and complications associated with complex bilateral procedures, possibly leading to improved patient and surgical outcomes. We sought to evaluate the role of the co-surgery team and its development in free flap breast reconstruction. METHODS: A retrospective review of free-flap breast reconstruction by two surgeons from 2011 to 2016 was conducted. We analyzed 128 patients who underwent bilateral-DIEP breast. Surgical groups were: single-surgeon reconstruction (SSR; 35 patients), co-surgery where both surgeons are present for entire reconstruction (CSR-I; 69 patients), and co-surgery reconstruction where co-surgeons appropriately assist in two concurrent or staggered cases (CSR-II; 24 patients). Efficiency data collected was OR time and patient length-of-stay (LOS). The rate of flap-failure, return to OR, infection, wound breakdown, seroma, hematoma, and PE/DVT were compared. RESULTS: Single-surgeon reconstruction had significantly longer OR time (678 vs. 485 min, P < .0001), LOS (5 vs. 3.9 days, P < .001), higher wound occurrences of the umbilical site that required surgical correction [11.4 percent (n = 4) vs. 1.5% (n = 1); P < .043] compared to CSR-I. Similarly, SSR had significantly longer average OR time (678 vs. 527 min P < .0001), average LOS (5 vs. 4 days, P = .0005) when compared with CSR-II. There were no total increased patient related complications associated with co-surgery (CSR-I or II). CONCLUSION: The addition of a co-surgeon, even with concurrent surgery, reduces operative time, average patient LOS, and postoperative complications. This work lends a strong credence that co-surgery model is associated with increased operative efficiency. AD - Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. AN - 28695998 AU - Haddock, N. T. AU - Kayfan, S. AU - Pezeshk, R. A. AU - Teotia, S. S. DA - Jan DO - 10.1002/micr.30191 DP - NLM ET - 2017/07/12 J2 - Microsurgery KW - Adult Aged Female Free Tissue Flaps/*transplantation Humans Length of Stay/statistics & numerical data Mammaplasty/*methods Microsurgery/*methods Middle Aged Operative Time Outcome Assessment, Health Care Patient Care Team/*organization & administration Postoperative Complications/epidemiology/prevention & control Retrospective Studies Surgeons/*organization & administration LA - eng M1 - 1 N1 - 1098-2752 Haddock, Nicholas T Kayfan, Samar Orcid: 0000-0002-6166-1000 Pezeshk, Ronnie A Teotia, Sumeet S Journal Article United States Microsurgery. 2018 Jan;38(1):14-20. doi: 10.1002/micr.30191. Epub 2017 Jul 11. PY - 2018 SN - 0738-1085 SP - 14-20 ST - Co-surgeons in breast reconstructive microsurgery: What do they bring to the table? T2 - Microsurgery TI - Co-surgeons in breast reconstructive microsurgery: What do they bring to the table? VL - 38 ID - 760192 ER - TY - JOUR AB - OBJECTIVE: The aim was to review a pathway of care for diabetic patients found to have retinal artery emboli detected by retinal screening. DESIGN: This was a retrospective review of a pathway agreed in 2001 by a multidisciplinary team. MATERIALS AND METHODS: The prospectively collected Gloucestershire Diabetic Retinal Screening Programme database was reviewed; patients sent for carotid duplex imaging underwent review of their scan results and their casenotes. RESULTS: The prevalence of retinal emboli was 214 out of 25,299 diabetic patients who had retinal screening (0.85%). Some 200 diabetic patients underwent carotid duplex imaging; 23 had ipsilateral and 2 had contralateral carotid stenosis > 70%. Of these, ten patients underwent carotid endarterectomy without any major morbidity. CONCLUSIONS: [corrected] A pathway was established for the small number of patients with retinal emboli, and could be tested in other populations. AD - English National Diabetic Retinopathy Screening Programme, UK. AN - 21616692 AU - Hadley, G. AU - Earnshaw, J. J. AU - Stratton, I. AU - Sykes, J. AU - Scanlon, P. H. DA - Aug DO - 10.1016/j.ejvs.2011.04.031 DP - NLM ET - 2011/05/28 J2 - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery KW - Aged Aged, 80 and over Angioplasty Asymptomatic Diseases Carotid Stenosis/*diagnostic imaging/epidemiology/surgery *Critical Pathways Diabetic Retinopathy/*diagnosis/epidemiology Endarterectomy, Carotid England/epidemiology Female *Fluorescein Angiography Humans Interdisciplinary Communication Male Mass Screening/*methods Middle Aged Patient Care Team Predictive Value of Tests Prevalence Retinal Artery Occlusion/*diagnosis/epidemiology Retrospective Studies Severity of Illness Index Treatment Outcome *Ultrasonography, Doppler, Duplex LA - eng M1 - 2 N1 - 1532-2165 Hadley, G Earnshaw, J J Stratton, I Sykes, J Scanlon, P H Journal Article England Eur J Vasc Endovasc Surg. 2011 Aug;42(2):153-7. doi: 10.1016/j.ejvs.2011.04.031. Epub 2011 May 25. PY - 2011 SN - 1078-5884 SP - 153-7 ST - A potential pathway for managing diabetic patients with arterial emboli detected by retinal screening T2 - Eur J Vasc Endovasc Surg TI - A potential pathway for managing diabetic patients with arterial emboli detected by retinal screening VL - 42 ID - 760526 ER - TY - JOUR AB - Introduction: Pulmonary hypertension (PH) is a rare disease and when associated with pregnancy can be devastating. In the developed world, maternal mortality from PH has decreased from 56% in the 1970s to 16% as of 2014. In the developing world, there are still many challenges in the management of these cases. Objective: to review the management of such patients in a resource limited setting from September 2016 to September 2017. Methods: Cases with severe PH were identified from high risk antenatal care follow up, cardiology clinic and wards. Severity and type of pulmonary hypertension, NYHA functional status, mode of delivery and anesthesia as well as neonatal and maternal outcomes were noted. Results: 20 cases of severe PH were reviewed. Seventeen of the patients had chronic rheumatic valvular heart disease (RHD) as the cause of PH (81% Group 2 PH, with average mitral valve area was 0.9sqcm) and 3 had combined RHD and Congenital Heart Defects (CHD) and one isolated CHD. The average pulmonary arterial pressure as measured on Echocardiography was 102.9 mmHg (SD 16.9). Fourteen of the patients had NYHA functional class III or more (66.7%), 10 patients underwent cesarean deliveries, 5 underwent vaginal deliveries with assisted second stage Two patients underwent termination of pregnancy at 16 & 19 weeks and are alive. There were 4 maternal deaths (19.1%) with a mean age at death of 28 years (SD 5.3). Death was caused by pulmonary edema in 2 cases and pulmonary venous thromboembolism in 2 cases. 76.2% of pregnancies resulted in live birth. Conclusion: Group 2 PH caused by mitral stenosis complicating pregnancy continues to be a significant contributor in our set up. Although these cases were managed in a low resource setting, the outcomes are comparable to studies from the developed world. Multidisciplinary team treatment including cardiology, anesthesia, and obstetrics is important to improve maternal and fetal outcomes. AD - A. Hailu, Mekelle University, College of Health Sciences, Department of Internal Medicine, Ethiopia AU - Hailu, A. AU - Yeman, A. AU - Abate, E. AU - Berhe, H. AU - Whelan, A. AU - Briller, J. AU - Nixon, H. AU - Goba, G. DB - Embase KW - adult anesthesia cardiology case report cesarean section clinical article conference abstract congenital heart malformation echocardiography Ethiopia female fetus fetus outcome follow up functional status human live birth lung artery pressure lung edema maternal death mitral valve stenosis New York Heart Association class newborn obstetrics pregnancy prenatal care pulmonary hypertension pulmonary vein thromboembolism university hospital vaginal delivery LA - English M3 - Conference Abstract N1 - L623056796 2018-07-20 PY - 2018 SN - 1995-1892 SP - 10-11 ST - Outcome of pulmonary hypertension in pregnancy: Experience from resource limited setting in a university hospital in Northern Ethiopia T2 - Cardiovascular Journal of Africa TI - Outcome of pulmonary hypertension in pregnancy: Experience from resource limited setting in a university hospital in Northern Ethiopia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L623056796&from=export VL - 29 ID - 760836 ER - TY - JOUR AB - Background: Patient education is an integral part of management of acute Pulmonary Embolism (PE). We aim to assess the impact of supplemental PE education packet on patient's comprehension of acute PE pathophysiology and treatment options. Methods: Acute PE patients managed by pulmonary embolism response team (PERT) received a 14-question multiple choice survey during admission. Patients received supplemental education materials prior to discharge and completed a follow up survey in post-PE clinic. The survey included questions on presenting signs/symptoms of acute PE, diagnostic tests, anticoagulation regimens, and other management. We compared the proportion of patients who correctly answered each question at baseline and follow up. Results: Forty-two patients completed baseline and follow-up surveys. Median time to follow up was thirty-six days. The change in overall survey score pre- vs post-educational material was 1.57 points (p=0.000258). The educational packet was associated with improvement in patient comprehension about PE and available treatment modalities. (Figure 1)Conclusions: Patient education is an integral part of management of Pulmonary embolism. There are substantial gaps between what clinicians convey to the patient and what they comprehend. Educational pamphlets may be useful tool to address some of those gaps. AD - J.F. Haines, Loyola University Medical Center, United States AU - Haines, J. F. AU - Morris, S. AU - Chan, L. AU - Porcaro, K. AU - Allen, S. AU - Masic, D. AU - Mancl, E. AU - Brailovsky, Y. AU - Darki, A. DB - Embase DO - 10.1002/ccd.28864 KW - adult anticoagulation awareness clinical article comprehension conference abstract controlled study diagnosis female follow up human male patient education pulmonary embolism response team LA - English M3 - Conference Abstract N1 - L632520608 2020-08-11 PY - 2020 SN - 1522-726X SP - S85 ST - Effect of supplemental education materials on patient awareness and understanding of pulmonary embolism T2 - Catheterization and Cardiovascular Interventions TI - Effect of supplemental education materials on patient awareness and understanding of pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632520608&from=export http://dx.doi.org/10.1002/ccd.28864 VL - 95 ID - 760575 ER - TY - JOUR AB - Background: Pulmonary embolism (PE) is associated with morbidity and mortality and may require fibrinolysis. Some patients have contraindications to fibrinolytic therapy and require urgent surgical pulmonary embolectomy (SPE). We sought to investigate clinical characteristics and outcomes of patients requiring urgent SPE. Methods: We retrospectively analyzed patients who underwent evaluation by pulmonary embolism response team (PERT) at a tertiary care center from 2016 to 2019. We included patients with massive and submassive PE who underwent urgent SPE. Results: Among 370 consecutive patients evaluated by PERT, 9 (2.43%) patients underwent urgent SPE; 6 (66%) male. 4 patients had submassive PE and 5 had massive PE. Indications for embolectomy were recent surgery (n=5), recent CVA (n=1), intracardiac tumor/thrombus (n=1), large patent foramen ovale (n=1), and clot in transit (n=1). Mean length of stay was 13.8 days. Mean PESI score 119.3 (+/- 52.4). Average time from PERT activation to surgical embolectomy was 13.4 hours. 1 patient who died had a delay in diagnosis of 9 hours and thus 22-hour delay from time of diagnosis to PERT activation, with resultant delay of surgery. Conclusions: In a tertiary referral center, need for urgent surgical pulmonary embolectomy is relatively low. Rapid evaluation by the multidisciplinary PERT and early surgical embolectomy is associated with low operative mortality and excellent short- and long-term outcomes. (Figure Presented) . AD - J.F. Haines, Loyola University Medical Center, United States AU - Haines, J. F. AU - Morris, S. AU - Porcaro, K. AU - Brailovsky, Y. AU - Perez-Tamayo, R. A. AU - Frazier, J. AU - Schwartz, J. AU - McGee, E. AU - Bakhos, M. AU - Allen, S. AU - Chan, L. AU - Masic, D. AU - Mancl, E. AU - Darki, A. DB - Embase DO - 10.1002/ccd.28864 KW - adult clinical feature conference abstract embolectomy female human length of stay major clinical study male patent foramen ovale pulmonary embolism response team retrospective study surgical mortality tertiary care center tumor thrombus LA - English M3 - Conference Abstract N1 - L632520606 2020-08-11 PY - 2020 SN - 1522-726X SP - S84-S85 ST - Surgical embolectomy for management of acute submassive and massive pulmonary embolism T2 - Catheterization and Cardiovascular Interventions TI - Surgical embolectomy for management of acute submassive and massive pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632520606&from=export http://dx.doi.org/10.1002/ccd.28864 VL - 95 ID - 760574 ER - TY - JOUR AB - Objective: To report a case of refractory idiopathic thrombocytopenic purpura (ITP) in a pregnant patient with known chronic ITP in her second pregnancy who underwent an elective caesarean section at 36 weeks of gestation. She delivered a baby with severe neonatal thrombocytopenia requiring intravenous immunoglobulin and platelet transfusions due to antiplatelet antibody placental transfer. Methods: This rare case was identified at a tertiary General Hospital in England. The case note was retrieved retrospectively from the medical records library and studied in detail. Literature was reviewed. Results: We report a case of a 22 year old, gravida 2 para1, who presented at 10 weeks of gestation to the haematology clinic with an intrauterine pregnancy on scan and normal booking bloods except a low platelet count of 42 × 109/L. Her obstetric history revealed gestational diabetes and ITP confirmed on bone marrow biopsy. She obtained a partial platelet response with intravenous immunoglobulin infusions. She was induced at 36 weeks of gestation and had a normal vaginal delivery. She had blood transfusion due to postpartum haemorrhage. The baby developed ITP secondary to antibody transfer through the placenta. In this pregnancy she attended the joint obstetric-haematology clinic. Fetal cordocentesis was not performed. At 35 weeks of gestation she had a platelet count of 19 × 109. A multidisciplinary team meeting was held and the mode and timing of delivery was discussed to optimise the outcomes for the patient and baby. She received intravenous immunoglobulin prior to the delivery. At 36 weeks of gestation, she underwent an elective caesarean section, delivered a male baby weighing 2415 g (25th percentile) with an apgar of 8 and 9 at 1 and 5 min respectively. The neonate had a platelet count of 27 ×109/L, few petechiae on chest, mild respiratory distress, jaundiced and was slightly floppy. The neonate received intravenous immunoglobulin and platelet transfusion for neonatal thrombocytopenia, phototherapy for jaundice and intravenous antibiotics for chest infection in the neonatal unit. Neonatal alloimmune thrombocytopenia was ruled out. Immunophenotypic analysis of platelets was done and platelet antigens were negative. This case was purely due to placental transfer of antibody which does not occur frequently in two subsequent pregnancies, although in this patient it occurred in both pregnancies. Conclusions: Refractory ITP and anti-platelet antibody placental transfer in the same patient in two subsequent pregnancies is rare. A multidisciplinary approach should be warranted in all cases of pregnant patients with ITP as it has implications on subsequent pregnancies and future treatment. AD - F.S.A. Hakim, Sandwell and West Birmingham Hospitals NHS Trust, Women's and Child Health Services, Birmingham, West Midlands, United Kingdom AU - Hakim, F. S. A. AU - Sinha, A. AU - Murrin, R. DB - Embase DO - 10.1111/j.1471-0528.2012.03376.x KW - immunoglobulin G thrombocyte antibody immunoglobulin antibody thrombocyte antigen antibiotic agent idiopathic thrombocytopenic purpura pregnancy placental transfer newborn jaundice college female human patient baby platelet count neonatal thrombocytopenia thrombocyte hematology cesarean section hospital newborn thrombocyte transfusion placenta passive immunization postpartum hemorrhage general hospital vaginal delivery infusion bone marrow biopsy pregnancy diabetes mellitus blood transfusion neonatal alloimmune thrombocytopenia blood chest infection cordocentesis jaundice phototherapy library respiratory distress thorax medical record petechia male United Kingdom LA - English M3 - Conference Abstract N1 - L70780948 2012-06-22 PY - 2012 SN - 1470-0328 SP - 100 ST - Severe idiopathic thrombocytopenic purpura in pregnancy: A rare case of IgG anti-platelet antibody placental transfer resulting in neonatal jaundice T2 - BJOG: An International Journal of Obstetrics and Gynaecology TI - Severe idiopathic thrombocytopenic purpura in pregnancy: A rare case of IgG anti-platelet antibody placental transfer resulting in neonatal jaundice UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70780948&from=export http://dx.doi.org/10.1111/j.1471-0528.2012.03376.x VL - 119 ID - 761198 ER - TY - JOUR AB - SUMMARY: Background: Arteriovenous dialysis access, fistulae (AVF) or grafts (AVG), are associated with significant rates of thrombosis. Timely thrombectomy may have a significant impact on immediate and long‐term access survival. However, switching to a catheter is associated with higher rates of morbidity and mortality compared with those who have an AVF or AVG. Objectives: The goal of this study was to evaluate whether time to thrombectomy increases the risk for loss of dialysis access and subsequent placement of a dialysis catheter at hospital discharge, at 6 months, 12 months, and data at any time after discharge. Methods: Using retrospective data, 444 patients were identified as having undergone thrombectomy for dialysis access dysfunction between January 2008 and April 2015, with 122 hospital admissions primarily for thrombectomy. Results: The mean age was 60.4 years, 65% were male, and 44.3% had an arteriovenous fistula as their dialysis access. The mean time to thrombectomy was 10.8 hours, and 14 patients utilised a catheter for haemodialysis as primary access upon discharge. After adjustment for prior access intervention, access type, and time to thrombectomy, the adjusted odds ratios (AOR) of a one‐day delay in thrombectomy was associated with a twofold increase in requirement for catheter at discharge and at 6 months. This association remained present at any time after discharge. Conclusion: In this study of patients cared for within an academic health system, a single day delay in thrombectomy nearly doubled the risk of needing a dialysis catheter at hospital discharge, 6 months, or any time after discharge. AD - Department of Medicine, University of Minnesota, Minneapolis Minnesota, USA University of Minnesota School of Public Health (SPH), University of Minnesota, Minneapolis Minnesota, USA AN - 139475953. Language: English. Entry Date: 20191109. Revision Date: 20191109. Publication Type: Article AU - Hall, Damian AU - Shaughnessy, Daniel AU - Drawz, Paul AU - Akkina, Sunil AU - Esten, Andrew AU - Foley, Robert N. AU - Reule, Scott DB - CINAHL DO - 10.1111/jorc.12295 DP - EBSCOhost KW - Treatment Delay -- Risk Factors Thrombectomy Catheters, Dialysis Time Factors Patient Admission Human Retrospective Design Electronic Health Records T-Tests Chi Square Test Data Analysis, Statistical Adult Middle Age Aged Confidence Intervals Vascular Patency -- Evaluation Renal Replacement Therapy M1 - 4 N1 - research; tables/charts. Journal Subset: Blind Peer Reviewed; Continental Europe; Core Nursing; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Nursing; Peer Reviewed. NLM UID: 101392167. PY - 2019 SN - 1755-6678 SP - 232-238 ST - Time to thrombectomy is associated with increased risk for dialysis catheter placement T2 - Journal of Renal Care TI - Time to thrombectomy is associated with increased risk for dialysis catheter placement UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=139475953&site=ehost-live&scope=site VL - 45 ID - 761396 ER - TY - JOUR AB - Background: Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. Methods: A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/ 7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). Results: Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n = 43) and BSNR members (86%, n = 21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. Conclusions: The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is investigating suspected acute stroke patients by CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience (thrombectomy) centre. AD - [Halvorsrud, Kristoffer; Flynn, Darren; Craig, Dawn] Newcastle Univ, Inst Hlth & Soc, Newcastle Upon Tyne, Tyne & Wear, England. [Ford, Gary A.; White, Phil] Newcastle Univ, Inst Neurosci, 3-4 Claremont Terrace, Newcastle Upon Tyne NE2 4AX, Tyne & Wear, England. [McMeekin, Peter] Northumbria Univ, Sch Hlth Community & Educ Studies, Newcastle Upon Tyne, Tyne & Wear, England. [Bhalla, Ajay] Guys & St Thomas NHS Fdn Trust, London, England. [White, Phil] Newcastle Upon Tyne Hosp NHS Fdn Trust, Newcastle Upon Tyne, Tyne & Wear, England. [Balami, Joyce] Univ Oxford, Ctr Evidence Based Med, Oxford, England. [Ford, Gary A.] Oxford Univ Hosp NHS Trust, Oxford, England. [Ford, Gary A.] Univ Oxford, Oxford, England. [Halvorsrud, Kristoffer] Queen Mary Univ London, Barts & London Sch Med & Dent, London, England. White, P (corresponding author), Newcastle Univ, Inst Neurosci, 3-4 Claremont Terrace, Newcastle Upon Tyne NE2 4AX, Tyne & Wear, England.; White, P (corresponding author), Newcastle Upon Tyne Hosp NHS Fdn Trust, Newcastle Upon Tyne, Tyne & Wear, England. phil.white@ncl.ac.uk AN - WOS:000426502500002 AU - Halvorsrud, K. AU - Flynn, D. AU - Ford, G. A. AU - McMeekin, P. AU - Bhalla, A. AU - Balami, J. AU - Craig, D. AU - White, P. C7 - 135 DA - Feb DO - 10.1186/s12913-018-2922-3 J2 - BMC Health Serv. Res. KW - Delphi exercise Service organisation Consensus Neurointervention Intra-arterial thrombectomy ACUTE ISCHEMIC-STROKE TISSUE-PLASMINOGEN ACTIVATOR ENDOVASCULAR THROMBECTOMY MECHANICAL THROMBECTOMY INTRAVENOUS ALTEPLASE CARE METAANALYSIS THERAPY Health Care Sciences & Services LA - English M3 - Article N1 - ISI Document Delivery No.: FY0LJ Times Cited: 5 Cited Reference Count: 40 Halvorsrud, Kristoffer Flynn, Darren Ford, Gary A. McMeekin, Peter Bhalla, Ajay Balami, Joyce Craig, Dawn White, Phil Ford, Gary/AAY-6405-2020 Ford, Gary/0000-0001-8719-4968; White, Philip/0000-0001-6007-6013; Flynn, Darren/0000-0001-7390-632X; Halvorsrud, Kristoffer/0000-0002-8813-0939; McMeekin, Peter/0000-0003-0946-7224 National Institute for Health Research (NIHR) under its Programme Grant for Applied Research Programme [RP-PG-1211-20012] This paper summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research Programme (RP-PG-1211-20012). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. 5 0 1 BMC LONDON BMC HEALTH SERV RES PY - 2018 SN - 1472-6963 SP - 10 ST - A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England T2 - Bmc Health Services Research TI - A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England UR - ://WOS:000426502500002 VL - 18 ID - 761601 ER - TY - JOUR AB - Among patients with proximal iliofemoral deep vein thrombosis (DVT) and an elevated Villalta score, anticoagulation therapy alone may not be a sufficient management strategy in select cases. In this article, we report a case of severe bilateral iliofemoral DVT that resisted the standard treatment for DVT, requiring catheter-directed thrombolysis and subsequent mechanical thrombectomy. AD - A.T. Lanfear, Baylor Scott and White, The Heart Hospital, Plano, TX, United States AU - Hamandi, M. AU - Lanfear, A. T. AU - Woolbert, S. AU - Bolin, M. L. AU - Fan, J. AU - William, M. AU - Khan, Z. AU - DiMaio, J. M. AU - Dib, C. DB - Embase Medline DO - 10.1177/2324709620910288 KW - Indigo robotic catheter system thrombectomy catheter anticoagulant agent enoxaparin rivaroxaban adult anticoagulant therapy article augmentation index blood clot lysis case report clinical article clot burden compression computed tomographic angiography deep vein thrombosis disease burden drug withdrawal echography femoral vein follow up hemochromatosis high frequency ultrasound His Villalta score hospital discharge human inferior cava vein international normalized ratio limb swelling lung embolism male mechanical thrombectomy middle aged pain patient compliance phlebography priority journal pulmonary embolism response team scoring system vein compression vein injury venous circulation walking difficulty weeping lesion LA - English M3 - Article N1 - L2004399914 2020-03-17 2020-03-20 PY - 2020 SN - 2324-7096 ST - Challenging Management of a Patient With Severe Bilateral Deep Vein Thrombosis T2 - Journal of Investigative Medicine High Impact Case Reports TI - Challenging Management of a Patient With Severe Bilateral Deep Vein Thrombosis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004399914&from=export http://dx.doi.org/10.1177/2324709620910288 VL - 8 ID - 760611 ER - TY - JOUR AB - Background: Malaria is an endemic parasitic disease in Jizan region due to tropical climate, which leads to morbidity and probable mortality. The majority of cases are caused by Plasmodium Falciparum which has high severity and complications including thrombocytopenia, hypoglycemia, hepatic, renal impairment and cerebral malaria. Since 2016 thousands of the Armed Forces Personnel were exposed to malaria disease without enough vector control due to war situation, 181 cases were reported among military personnel at that year of. Estimated malaria prevalence was 9.05/1000 per year. Most of the solders come from non endemic areas and not aware by malaria disease symptoms, vector or preventive measures. This research aims to evaluate, is health education program will decrease malaria disease prevalence among military personnel? Methods: a cross sectional comparative prospective study aimed to evaluate the effect of health education in decreasing malaria disease prevalence among military personnel in Jizan region in 3 years. Intensive Health Education in the field and hospital for Military personnel using flyers, media, lectures and field visit workshops. This was assessed by measuring compliance for oral chemo-prophylaxis and local malaria repellent cream. Annual prevalence, field surveys and run charts over time were used; negative correlation was tested using Spearman method. Results: Increased awareness for Malaria disease transmission, complications and prevention from 36% to 87%, increased compliance for oral chemo prophylaxis from 15% to 53% for front-line personnel, increased compliance for local repellent cream from 25% to 85% and sustained decrease in malaria prevalence from 9.05 case/1000/year(2016) to 1.06(2017) which maintained at 1.14 in 2018; negative correlation. Conclusions: This study found that health education program led to decrease malaria prevalence from 9.05 case/1000/year(2016) to 1.06(2017) among military personnel. Health education and personal protection is the best way to decrease disease prevalence, multidisciplinary team is essential for sustained improvement. AU - Hamdi, A. A. AU - Behiry, A. AU - Elzubeir, A. AU - Alfageeh, A. AU - Al shahrani, T. AU - Darbashi, M. AU - tutiyyah, H. DB - Embase DO - 10.1016/j.ajic.2020.06.070 KW - awareness chemoprophylaxis complication conference abstract controlled study field study health education human major clinical study malaria military personnel multidisciplinary team prevalence prospective study LA - English M1 - 8 M3 - Conference Abstract N1 - L2007233928 2020-08-12 PY - 2020 SN - 1527-3296 0196-6553 SP - S36-S37 ST - Does Health Education Program Improve Malaria Prevalence Among Military Personnel in Endemic Area? T2 - American Journal of Infection Control TI - Does Health Education Program Improve Malaria Prevalence Among Military Personnel in Endemic Area? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2007233928&from=export http://dx.doi.org/10.1016/j.ajic.2020.06.070 VL - 48 ID - 760554 ER - TY - JOUR AB - Background Ventricular assist devices (VAD) are increasingly used as long-term treatment for advanced heart failure. However, survival after VAD implantation is still unsatisfactory, and no specific outpatient follow-up algorithms have been formally established. Here, we evaluate the effect of an intensified follow-up protocol (IFUP) on survival rates and VAD-associated complications. Methods and results This is a retrospective study of 57 patients who received a VAD at our center between February 2013 and December 2017. Inclusion criteria were discharge home after VAD implantation and follow-up in our VAD outpatient clinic. Patients implanted after October 2015 (n = 30) were monitored according to IFUP. This protocol embodied formalized, multi-disciplinary clinical visits every 4-8 weeks including a cardiologist, a cardiothoracic surgeon and a VAD-coordinator and was characterized by optimized anticoagulation and wound management as well as guideline-directed medical therapy. One-year survival in the IFUP patients was 97%, compared to 74% in the pre-IFUP era (p = 0.01). Implementation of IFUP was associated with a 90% risk-reduction for 1-year mortality (relative risk 0.099; p = 0.048). The rate of complications, e.g., device thrombosis and major bleeding, was significantly reduced, resulting in superior event-free survival in the IFUP group (p = 0.003). Furthermore, by implementation of IFUP, a more stable anticoagulation adjustment was achieved as well as an improved adherence to guideline-directed medical therapy. Conclusion Implementation of an IFUP for VAD patients is associated with a significant decrease in 1-year all-cause mortality. This emphasizes the need for more vigilance in the management of VAD patients by a dedicated multi-disciplinary team. AD - [Hamed, Sonja; Mueller, Florian; Ehlermann, Philipp; Hittmann, Davina; Katus, Hugo A.; Raake, Philip W.; Kreusser, Michael M.] Heidelberg Univ, Div Cardiol, Dept Internal Med 6, Neuenheimer Feld 410, D-69120 Heidelberg, Germany. [Schmack, Bastian; Mueller, Florian; Ruhparwar, Arjang; Katus, Hugo A.] Heidelberg Univ, Dept Cardiac Surg, Neuenheimer Feld 110, D-69120 Heidelberg, Germany. [Ruhparwar, Arjang; Raake, Philip W.; Kreusser, Michael M.] DZHK German Ctr Cardiovasc Res, Partner Site Heidelberg Mannheim, Heidelberg, Germany. Kreusser, MM (corresponding author), Heidelberg Univ, Div Cardiol, Dept Internal Med 6, Neuenheimer Feld 410, D-69120 Heidelberg, Germany.; Kreusser, MM (corresponding author), DZHK German Ctr Cardiovasc Res, Partner Site Heidelberg Mannheim, Heidelberg, Germany. michael.kreusser@med.uni-heidelberg.de AN - WOS:000491598600002 AU - Hamed, S. AU - Schmack, B. AU - Mueller, F. AU - Ehlermann, P. AU - Hittmann, D. AU - Ruhparwar, A. AU - Katus, H. A. AU - Raake, P. W. AU - Kreusser, M. M. DA - Nov DO - 10.1007/s00392-019-01451-9 J2 - Clin. Res. Cardiol. KW - Advanced heart failure Ventricular assist devices Mechanical circulatory support Outpatient care Follow-up protocol ADVANCED HEART-FAILURE CIRCULATORY SUPPORT THERAPY IMPLANTATION GUIDELINES MANAGEMENT REGISTRY Cardiac & Cardiovascular Systems LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: JF7XD Times Cited: 2 Cited Reference Count: 42 Hamed, Sonja Schmack, Bastian Mueller, Florian Ehlermann, Philipp Hittmann, Davina Ruhparwar, Arjang Katus, Hugo A. Raake, Philip W. Kreusser, Michael M. 2 0 1 SPRINGER HEIDELBERG HEIDELBERG CLIN RES CARDIOL PY - 2019 SN - 1861-0684 SP - 1197-1207 ST - Implementation of an intensified outpatient follow-up protocol improves outcomes in patients with ventricular assist devices T2 - Clinical Research in Cardiology TI - Implementation of an intensified outpatient follow-up protocol improves outcomes in patients with ventricular assist devices UR - ://WOS:000491598600002 VL - 108 ID - 761481 ER - TY - JOUR AB - Continuous infusions of unfractionated heparin (UFH) are still commonly used in the initial treatment of venous thromboembolism (VTE). As a result of UFH's high risk profile and common usage, weight-based UFH nomograms were developed more than two decades ago to standardize its dosing. Since that time, there has been scant literature on improving UFH administration. Specifically, upgrading current UFH nomograms, improving therapeutic monitoring, and exploring and expanding the role of Computerized Physician Order Entry (CPOE) and the Electronic Health Record (EHR) to achieve optimal delivery methods have little published research or quality improvement work. Several factors previously identified contributing to sub-optimal UFH therapy at our institution include timing of aPTT lab ordering and reporting, errors in dose adjustments, lack of boluses when clinically indicated, pharmacy and nursing administration errors, and suboptimal design and use of CPOE order sets. A multidisciplinary team at this academic medical center designed an intervention to improve the quality and safety of continuous UFH infusions in hospitalized patients. The aims were two-fold: reduce the time to initial therapeutic aPTT values and increase the overall time patients spent in therapeutic range without increasing time supra-therapeutic. To determine the percent time spent in different therapeutic ranges, linear averaging was used between aPTT values over time. As UFH is given continuously and monitoring aPTT values has inherent variability, we proposed that looking at time spent in therapeutic ranges gives a more realistic and meaningful clinical picture than current accepted metrics that look at single point-in-time aPTT values. We feel that these historic metrics, which focus on the percentage of patients with a therapeutic aPTT at 24 hours and time to therapeutic aPTT, do not provide sufficient information to impact optimal therapeutic dosing. The intervention involved four core changes to our existing UFH nomogram: Dedicated UFH order set for treatment of VTE incorporating weight-based initial and subsequent boluses, and further dosage adjustments. Built-in online weight-based dosing calculator. Development of a new lab order aPTTAC (activated partial thromboplastin time anticoagulant) which prompted a priority lab draw and lab processing. Nursing dual sign-off on all dosage adjustments. We extracted data from the EHR of 8629 patients that were on continuous infusion UFH for VTE from January 2010 through February 2012. There were 5759 patients in the pre-intervention group and 2870 patients in the post-intervention group. All patients on therapy for greater than 8 hours who had at least one aPTT were included in the analysis. Post-intervention, the proportion of patients who were therapeutic within 24 hours increased 16% (67% to 78%, p value <0.0001), and time to therapeutic aPTT decreased by 18% (13.9 hours to 11.4 hours, p value <0.0001). (Figure 1) Additionally, post-intervention, the proportion of time spent inside the therapeutic range increased from 47% to 53% (p value <0.0001). There was a small increase in percentage time supra-therapeutic from 20% to 21%, (p value <0.0001), however, this was not associated with increased bleeding events. Safety analysis, which involved the manual review of 131 pre-intervention and 127 post-intervention charts revealed a trend towards lower bleeding rates with the new UFH nomogram. The rate of major bleeding was 3.9% post intervention compared to 6.9% before the upgrade (p value 0.4116). This safety initiative demonstrates a significant improvement in the safe and effective use of continuous UFH infusion in the treatment of VTE. Through creative utilization of technology and improved process of care we have brought high reliability to this high-risk medication. To our knowledge, this is the largest cohort of patients evaluated for safe VTE treatment with a UFH nomogram. Further retrospective analysis of this data evaluating patient specific characteristics should shed light on opportunities to mprove the UFH nomogram and further leverage the EHR and CPOE to improve patient care. While our evaluation looks at a single center, these interventions could easily be implemented in other hospital systems with EHR and CPOE capabilities. (Figure presented) . AD - A.C. Hamilton, Department of Hospital Medicine, Cleveland Clinic, Cleveland, OH, United States AU - Hamilton, A. C. AU - Bartholomew, J. R. AU - Militello, M. AU - Patrick, R. AU - Kandpal, S. AU - Bulgar, A. AU - Bixler, S. AU - Klein, D. AU - Skowronsky, C. AU - Li, I. AU - Rosenbaum, K. AU - Gomez, E. AU - Goodman, J. AU - Sakenes, S. AU - Marchant, K. AU - Phillips, S. DB - Embase KW - heparin anticoagulant agent nomogram technology society hematology human patient statistical significance safety weight bleeding computerized provider order entry therapy infusion continuous infusion monitoring risk nursing management pharmacy (shop) total quality management hospital planning patient care venous thromboembolism electronic medical record reliability book nursing processing partial thromboplastin time drug therapy hospital patient university hospital L1 - http://abstracts.hematologylibrary.org/cgi/content/abstract/120/21/1168?maxtoshow=&hits=80&RESULTFORMAT=&searchid=1&FIRSTINDEX=2000&displaysectionid=Poster+Session&fdate=1/1/2012&tdate=12/31/2012&resourcetype=HWCIT LA - English M1 - 21 M3 - Conference Abstract N1 - L70963959 2013-01-17 PY - 2012 SN - 0006-4971 ST - Revisiting the heparin nomogram: Leveraging technology to improve quality T2 - Blood TI - Revisiting the heparin nomogram: Leveraging technology to improve quality UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70963959&from=export VL - 120 ID - 761186 ER - TY - JOUR AB - OBJECTIVE: Intracranial infectious aneurysms (IIAs) are a rare clinical entity without a definitive treatment guideline. In this study, we evaluate the treatment options of these lesions based on our own clinical experience and review the current knowledge of therapy as portrayed in the literature. METHODS: We conducted a single-center retrospective analysis of all patients with an IIA and performed a systematic review of the literature using the MEDLINE database. We undertook a comprehensive literature search using the OVID gateway of the MEDLINE database (1950-October 2015) using the following keywords (in combination): 'infectious', 'mycotic', 'cerebral aneurysm', 'intracranial aneurysm'. 1,721 potentially relevant abstracts were identified and 63 studies were selected for full review. The studies were analysed regarding ruptured versus unruptured aneurysms, aneurysm localization and treatment, as well as clinical and radiological outcome. RESULTS: Our institutional series consisted of 6 patients (median age 57 [32-76]) treated between 2011 and 2015. All patients presented with ruptured IIAs located on the middle cerebral artery (MCA, 5 patients) and anterior cerebral artery (ACA, 1 patient). Five patients were treated by clipping and resecting the aneurysm, 1 patient underwent coiling. All patients received antibiotic therapy and 1 patient died. We further identified 814 patients (median age 35.5 [0-81]) in 63 studies. Locations of the aneurysms were mentioned in 55 studies. The most frequent locations of the aneurysms were: MCA (63.5%), posterior cerebral artery (14%), ACA (9.0%) and others (13.5%). Treatment for IIAs was described in 62 studies: antibiotic treatment (56.1%), a combination of antibiotics and surgery (20.9%) or antibiotics and endovascular treatment (23.0%). Outcome was mentioned in 82.4% of the patients with a mortality rate of 16.8%. An evaluation of treatment outcome was limited due to the heterogeneity of patients in the published case series. CONCLUSION: Antibiotic therapy of patients with IIA is mandatory. However, due to the complexity of the disease and its accompanying comorbidities, a general treatment algorithm could not be defined. Analogous to non-mycotic aneurysms, further treatment decisions require an interdisciplinary approach involving neurosurgeons, interventionists and infectious disease specialists. AD - Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany. AN - 27598469 AU - Hamisch, C. A. AU - Mpotsaris, A. AU - Timmer, M. AU - Reiner, M. AU - Stavrinou, P. AU - Brinker, G. AU - Goldbrunner, R. AU - Krischek, B. DO - 10.1159/000448406 DP - NLM ET - 2016/09/07 J2 - Cerebrovascular diseases (Basel, Switzerland) KW - Adolescent Adult Aged Aged, 80 and over Aneurysm, Infected/diagnostic imaging/microbiology/*therapy Aneurysm, Ruptured/diagnostic imaging/microbiology/*therapy Anti-Bacterial Agents/*therapeutic use Cerebral Angiography/methods Child Child, Preschool Combined Modality Therapy Computed Tomography Angiography *Endovascular Procedures Female Humans Infant Infant, Newborn Interdisciplinary Communication Intracranial Aneurysm/diagnostic imaging/microbiology/*therapy Male Middle Aged *Patient Care Team Retrospective Studies Risk Factors Time Factors Treatment Outcome *Vascular Surgical Procedures Young Adult LA - eng M1 - 5-6 N1 - 1421-9786 Hamisch, Christina A Mpotsaris, Anastasios Timmer, Marco Reiner, Michael Stavrinou, Pantelis Brinker, Gerrit Goldbrunner, Roland Krischek, Boris Case Reports Journal Article Review Systematic Review Switzerland Cerebrovasc Dis. 2016;42(5-6):493-505. doi: 10.1159/000448406. Epub 2016 Sep 7. PY - 2016 SN - 1015-9770 SP - 493-505 ST - Interdisciplinary Treatment of Intracranial Infectious Aneurysms T2 - Cerebrovasc Dis TI - Interdisciplinary Treatment of Intracranial Infectious Aneurysms VL - 42 ID - 760347 ER - TY - JOUR AB - BACKGROUND: Few data are available on hospital-wide incidence of central line-associated bloodstream infection (CLABSI) rates in patients with central venous catheter (CVC) in China, where many systemic obstacles holding back evidence-based guidelines implementation exist. METHODS: This study was conducted prospectively in 2 phases. The baseline and intervention phases were performed in a teaching hospital in China, between January 2017 and October 2018. A systematic quality improvement (SQI) and multidisciplinary teamwork (MDT) CLABSI infection control program was introduced in the intervention phase. In the intensive care units (ICUs) and non-ICUs, CLABSIs were continuously monitored, data collected, then analyzed. RESULTS: After intervention, the CLABSI rate decreased from 2.84-0.56 per 1,000 CVC days in ICUs (P < .001), and from 0.82-0.47 per 1,000 CVC days in non-ICUs (P = .003). The length of time until CLABSI occurrence increased from 8.72-13.60 days in ICUs (P = .046), and from 10.00-12.00 days in non-ICUs (P = .048). The number of multidrug-resistant bacteria isolated from CLABSI episodes decreased both in ICUs and in non-ICUs. CONCLUSIONS: The SQI and MDT CLABSI infection control program is effective in reducing hospital-wide CLABSI in patients with CVC, both in ICUs and in non-ICUs. AD - Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, China. Department of Cardiology Medicine, Renmin Hospital of Wuhan University, Wuhan, China. Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China. Department of Infection Control, Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, China. Department of Medicine, Renmin Hospital of Wuhan University, Wuhan, China. Department of Infection Control, Department of Respiratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: 894069719@qq.com. AN - 31277999 AU - Han, J. AU - Wan, J. AU - Cheng, Y. AU - Li, D. AU - Deng, M. AU - Wang, X. AU - Feng, J. AU - He, Y. AU - Ye, Q. AU - Wang, L. AU - Lei, Y. AU - Wang, J. DA - Nov DO - 10.1016/j.ajic.2019.05.008 DP - NLM ET - 2019/07/07 J2 - American journal of infection control KW - Catheter-Related Infections/*prevention & control Catheterization, Central Venous Central Venous Catheters/*adverse effects Equipment and Supplies, Hospital Hand Hygiene Hospital Administration Hospitals/*standards Humans Infection Control/*organization & administration/standards Inservice Training Intensive Care Units/standards Organizational Policy *Patient Care Team Product Packaging *Quality Improvement *Central venous catheter *Infection control program *Intervention study LA - eng M1 - 11 N1 - 1527-3296 Han, Jingjing Wan, Jun Cheng, Yujia Li, Dan Deng, Min Wang, Xuefen Feng, Jiarui He, Yuhong Ye, Qing Wang, Li Lei, Yourong Wang, Jianmiao Journal Article United States Am J Infect Control. 2019 Nov;47(11):1358-1364. doi: 10.1016/j.ajic.2019.05.008. Epub 2019 Jul 2. PY - 2019 SN - 0196-6553 SP - 1358-1364 ST - A hospital-wide reduction in central line-associated bloodstream infections through systematic quality improvement initiative and multidisciplinary teamwork T2 - Am J Infect Control TI - A hospital-wide reduction in central line-associated bloodstream infections through systematic quality improvement initiative and multidisciplinary teamwork VL - 47 ID - 760153 ER - TY - JOUR AB - Our objective was to determine the relative merits of intervention or observation of type II endoleaks (T2Ls). A retrospective analysis was performed on 386 infra-renal endovascular aneurysm repair (IR-EVAR) patients from 2006 to 2015. Annual surveillance imaging of patients undergoing EVAR at our centre were analysed, and all endoleaks were subjected to a multidisciplinary team meeting for consideration and treatment. In the 10-year time frame, 386 patients (79.5±8.7 years) underwent an IR-EVAR. Eighty-one patients (21.0%) developed a T2L and intervention was undertaken in 28 (34.6%): 17 (60.7%) were treated via a transarterial approach (TA) and 11 (39.3%) using the translumbar approach (TL). Fifty-three patients (65.4%) with T2Ls were managed conservatively. Patients who received T2L treatment had a greater proportion of recurrent T2Ls than patients who were conservatively managed ( p=0.032). T2Ls associated with aneurysmal growth were more resistant to treatment than those where there was no change or a decrease in aneurysm size during follow-up (0.033). There was no significant difference in the TA and TL approach with respect to endoleak repair success ( p=0.525). Treatment of a T2L did not confer a survival advantage compared to conservative management ( p=0.449) nor did the choice of either the TA or TL approach ( p=0.148). Our study suggests the development of a T2L associated with aneurysm growth may represent an aggressive phenotype that is resistant to treatment. However, this did not lead to an increased risk of mortality over follow-up. Neither a transarterial nor a translumbar approach to treating a T2L conferred superiority. AD - 1 Imperial College School of Medicine, London, UK. 2 Aortic Team, Royal Free London, London, UK. 3 Division of Radiology, University College Hospital, London, UK. AN - 28436300 AU - Haq, I. U. AU - Kelay, A. AU - Davis, M. AU - Brookes, J. AU - Mastracci, T. M. AU - Constantinou, J. DA - Aug DO - 10.1177/1358863x17704315 DP - NLM ET - 2017/04/25 J2 - Vascular medicine (London, England) KW - Aged Aged, 80 and over Aortic Aneurysm, Abdominal/*surgery Blood Vessel Prosthesis Implantation/*adverse effects *Embolization, Therapeutic/adverse effects Endoleak/diagnostic imaging/etiology/*therapy *Endovascular Procedures/adverse effects Female Humans Kaplan-Meier Estimate London Male Phenotype Predictive Value of Tests Registries Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome *Watchful Waiting *abdominal aortic aneurysm (AAA) *embolization *endovascular aneurysm repair *interventional *type II endoleak *vascular LA - eng M1 - 4 N1 - 1477-0377 Haq, Ikram-Ul Kelay, Arun Davis, Meryl Brookes, Jocelyn Mastracci, Tara M Constantinou, Jason Comparative Study Journal Article England Vasc Med. 2017 Aug;22(4):316-323. doi: 10.1177/1358863X17704315. Epub 2017 Apr 24. PY - 2017 SN - 1358-863x SP - 316-323 ST - Ten-year single-centre experience with type II endoleaks: Intervention versus observation T2 - Vasc Med TI - Ten-year single-centre experience with type II endoleaks: Intervention versus observation VL - 22 ID - 760336 ER - TY - JOUR AD - [Haque, I; Metti, F.; Roy, B.; Cho, J.; Chien, J.] Westmead Hosp, Dept Resp & Sleep Med, Westmead, NSW, Australia. [Cho, J.; Chien, J.] Westmead Inst Med Res, Ludwig Engel Ctr Resp Res, Westmead, NSW, Australia. [Cho, J.; Chien, J.] Univ Sydney, Westmead Hosp, Sydney, NSW, Australia. AN - WOS:000538684200378 AU - Haque, I. AU - Metti, F. AU - Roy, B. AU - Cho, J. AU - Chien, J. DA - Jun J2 - Respirology KW - Respiratory System LA - English M3 - Meeting Abstract N1 - ISI Document Delivery No.: LV8JS Times Cited: 0 Cited Reference Count: 0 Haque, I Metti, F. Roy, B. Cho, J. Chien, J. 0 WILEY HOBOKEN RESPIROLOGY 1 SI PY - 2020 SN - 1323-7799 SP - 195-195 ST - OUTCOMES OF A NEW PULMONARY EMBOLISM RESPONSE TEAM (PERT) MODEL OF CARE FOR INTERMEDIATE TO HIGH RISK PULMONARY EMBOLISM IN AN AUSTRALIAN TERTIARY REFERRAL HOSPITAL: A 12 MONTH RETROSPECTIVE STUDY T2 - Respirology TI - OUTCOMES OF A NEW PULMONARY EMBOLISM RESPONSE TEAM (PERT) MODEL OF CARE FOR INTERMEDIATE TO HIGH RISK PULMONARY EMBOLISM IN AN AUSTRALIAN TERTIARY REFERRAL HOSPITAL: A 12 MONTH RETROSPECTIVE STUDY UR - ://WOS:000538684200378 VL - 25 ID - 761440 ER - TY - JOUR AB - OBJECTIVE: The logistics involved in administration of IV tPA for acute ischemic stroke patients are complex, and may contribute to variability in door-to-needle times between different hospitals. We sought to identify practice patterns in stroke centers related to IV tPA use. We hypothesized that there would be significant variability in logistics related to ancillary staff (i.e. nursing, pharmacists) processes in the emergency room setting. METHODS: A 21 question survey was distributed to attendees of the AHA/ASA Southwest Affiliate Stroke Coordinators Conference to evaluate potential barriers and delays with regards to thrombolysis for acute strokes patients in the Emergency Department setting. Answers were anonymous and aggregated to examine trends in responses. RESULTS: Responses were obtained from 37 of 67 (55%) stroke centers, which were located mainly in the Southwest United States. Logistical processes differed between facilities. Nursing and pharmacy carried stroke pagers in only 19% of the centers, and pharmacy responded to stroke alerts only one-third of centers. Insertion of Foley catheters and nasogastric tubes prior to tPA was routine in some of the sites. Other barriers to IV tPA administration included physician reluctance and inadequate communication between health care providers. CONCLUSION: Practices regarding logistics for giving IV tPA may be variable amongst different stroke centers. Given this potential variability, prospective evaluation to confirm these preliminary findings is warranted. AD - Washington University School of Medicine, Saint Louis, USA. Johns Hopkins University, Baltimore, USA. Baylor College of Medicine, Houston, USA. Baylor College of Medicine, Houston, USA. Electronic address: bershad@bcm.edu. AN - 26047090 AU - Hargis, M. AU - Shah, J. N. AU - Mazabob, J. AU - Rao, C. V. AU - Suarez, J. I. AU - Bershad, E. M. DA - Aug DO - 10.1016/j.clineuro.2015.04.027 DP - NLM ET - 2015/06/06 J2 - Clinical neurology and neurosurgery KW - Administration, Intravenous Brain Ischemia/complications/*drug therapy Cross-Sectional Studies Emergency Medicine *Emergency Service, Hospital Fibrinolytic Agents/*therapeutic use Hospitals, Special Humans Neurology Neuroscience Nursing *Patient Care Team Pharmacy Service, Hospital Stroke/*drug therapy/etiology Thrombolytic Therapy/*methods *Time-to-Treatment Tissue Plasminogen Activator/*therapeutic use Acute ischemic stroke Barriers Emergency department IV tPA Stroke centers LA - eng N1 - 1872-6968 Hargis, Mitch Shah, Jharna N Mazabob, Janine Rao, Chethan Venkatasubba Suarez, Jose I Bershad, Eric M Journal Article Netherlands Clin Neurol Neurosurg. 2015 Aug;135:79-84. doi: 10.1016/j.clineuro.2015.04.027. Epub 2015 May 22. PY - 2015 SN - 0303-8467 SP - 79-84 ST - Barriers to administering intravenous tissue plasminogen activator (tPA) for acute ischemic stroke in the emergency department: A cross-sectional survey of stroke centers T2 - Clin Neurol Neurosurg TI - Barriers to administering intravenous tissue plasminogen activator (tPA) for acute ischemic stroke in the emergency department: A cross-sectional survey of stroke centers VL - 135 ID - 760510 ER - TY - JOUR AB - Background : Acute pulmonary embolism (PE) presentation varies from no symptoms and little cardiopulmonary consequence, to shock with evidence of cardiopulmonary failure i.e massive PE. Subjects often have multiple and/or overlapping risks and co- morbidity relevant to presentation. Aims : We sought to determine the association of multiple clinical risk factors in massive PE as compared to nonmassive PE subjects, enrolled longitudinally at Massachusetts General Hospital PE Response Team. In addition, we investigated this association in cancer associated PE. Methods : We performed a retrospective cohort study of consecutive acute PE subjects between 2012- 2015. We collected PE risk factors and other host factors, variables related to prognostic risk stratification and outcomes. We defined massive PE as acute central (clot proximal to lobar artery) PE with lowest systolic blood pressure ≤90 mg or presenting with hemodynamic collapse associated with right heart strain defined by Echocardiogram or Computed Tomography and/or presence of Troponin ≥0.1 ng/ml. A priori level of significance for univariate and multivariate analysis was determined at p ≤0.1 and p ≤0.05, respectively. Results : We included 364 (figure 1) subjects with 13% presenting as massive PE and 28% having active cancer. In univariate analysis, history of cerebrovascular disease (CVD), recent invasive procedure, recent hospitalization and active cancer treatment was noted to statistically significant. In subanalysis, contrary to active cancer subjects, history of vasculothrombotic disease likely coronary and/or peripheral artery disease or CVD remained significant in non cancer subjects apart from recent hospitalization or procedure. In multivariate histogram analysis, the group with history of CVD, recent hospitalization or procedure, active cancer treatment had a population attributable fraction of 48% for massive PE (absolute risk 19% vs 7.0%, p=0.002, figure 2) Conclusions : A group with CVD, recent hospitalization/procedure or cancer treatment presents with more likely as massive PE as compared to nonmassive PE, with differential effects in cancer associated PE. (Figure Presented) . AD - P. Hariharan, Massachusetts General Hospital, VA Boston Health Care System, Center for Vascular Emergencies, Boston, United States AU - Hariharan, P. AU - Giordano, N. AU - Muzikansky, A. AU - Kabrhel, C. DB - Embase DO - 10.1002/rth2.12229 KW - endogenous compound host factor troponin adult cancer prognosis cancer therapy cardiopulmonary insufficiency cerebrovascular disease cohort analysis computer assisted tomography conference abstract controlled study echocardiography female general hospital histogram hospitalization human invasive procedure male Massachusetts peripheral occlusive artery disease pulmonary embolism response team retrospective study risk factor stratification systolic blood pressure univariate analysis LA - English M3 - Conference Abstract N1 - L628814635 2019-08-09 PY - 2019 SN - 2475-0379 SP - 788-789 ST - Risk factors associated with massive PE T2 - Research and Practice in Thrombosis and Haemostasis TI - Risk factors associated with massive PE UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628814635&from=export http://dx.doi.org/10.1002/rth2.12229 VL - 3 ID - 760695 ER - TY - JOUR AB - Objective: The purpose of this study was to describe the demographics, training, and practice characteristics of consultant vascular surgeons across the UK to provide an assessment of current, and inform future prediction of workforce needs. Methods: A questionnaire was developed using a modified Delphi process to generate questionnaire items. The questionnaire was emailed to all consultant vascular surgeons (n = 450) in the UK who were members of the Vascular Society of Great Britain & Ireland. Results: 352 consultant vascular surgeons from 95 hospital trusts across the UK completed the survey (78% response rate). The mean age was 50.6 years old, the majority (62%) were mid-career, but 24% were above the age of 55. Currently, 92% are men and only 8% women. 93% work full-time, with 60% working >50 hours, and 21% working >60 hours per week. The average team was 5 to 6 (range 2-10) vascular surgeons; with 23% working in a large team of >8. 17% still work in small teams of <3. Over 90% of consultant vascular surgeons perform the major index vascular surgery procedures (aneurysm repair, carotid endarterectomy, infra-inguinal bypass, amputation). While 84% perform standard endovascular abdominal aortic aneurysm repair (EVAR), <50% perform more complex endovascular aortic therapy. The majority of vascular surgeons "like their job" (85%) and are "satisfied" (69%) with their job. 34% of consultant vascular surgeons indicated they were "extremely likely" to retire within the next 10 years. Conclusions: This study provides the first detailed analysis of the new specialty of vascular surgery as practiced in the UK. There is a need to plan for a significant expansion in the consultant vascular surgeon workforce in the UK over the next 10 years to maintain the status quo. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. AD - [Harkin, D. W.] Royal Victoria Hosp Belfast, Belfast Vasc Ctr, Belfast, Antrim, North Ireland. [Beard, J. D.] No Gen Hosp, Sheffield Vasc Inst, Sheffield S5 7AU, S Yorkshire, England. [Shearman, C. P.] Univ Hosp Southampton NHS Fdn Trust, Dept Vasc Surg, Southampton, Hants, England. [Wyatt, M. G.] Freeman Rd Hosp, Northern Vasc Ctr, Newcastle Upon Tyne, Tyne & Wear, England. Harkin, DW (corresponding author), Belfast Hlth & Social Care Trust, Belfast Vasc Ctr, Royal Victoria Hosp, Belfast, Antrim, North Ireland. denis.harkin@belfasttrust.hscni.net AN - WOS:000352662200016 AU - Harkin, D. W. AU - Beard, J. D. AU - Shearman, C. P. AU - Wyatt, M. G. AU - Royal Coll, Surg DA - Apr DO - 10.1016/j.ejvs.2014.11.008 J2 - Eur. J. Vasc. Endovasc. Surg. KW - Vascular surgery Workforce planning UK Training Healthcare planning Healthcare assessment SURGICAL WORKFORCE Surgery Peripheral Vascular Disease LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: CF6JE Times Cited: 7 Cited Reference Count: 8 Harkin, D. W. Beard, J. D. Shearman, C. P. Wyatt, M. G. 7 0 W B SAUNDERS CO LTD LONDON EUR J VASC ENDOVASC PY - 2015 SN - 1078-5884 SP - 448-454 ST - The Vascular Surgery Workforce: A Survey of Consultant Vascular Surgeons in the UK, 2014 T2 - European Journal of Vascular and Endovascular Surgery TI - The Vascular Surgery Workforce: A Survey of Consultant Vascular Surgeons in the UK, 2014 UR - ://WOS:000352662200016 VL - 49 ID - 761757 ER - TY - JOUR AB - BACKGROUND: Healthcare teams that frequently follow a bundle of evidence-based processes provide care with lower rates of morbidity. Few process bundles to improve surgical outcomes in hysterectomy have been identified. OBJECTIVE: The purpose of this study was to investigate whether a bundle of 4 perioperative care processes is associated with fewer postoperative complications and readmissions for hysterectomies in the Michigan Surgical Quality Collaborative. STUDY DESIGN: A bundle of perioperative care process goals was developed retrospectively with 30-day peri-and postoperative outcome data from the Hysterectomy Initiative in Michigan Surgical Quality Collaborative. All benign hysterectomies that had been performed between January 2013 and January 2015 were included. Based on evidence of lower complication rates after benign hysterectomy, the following processes were considered to be the "bundle": use of guideline-appropriate preoperative antibiotics, a minimally invasive surgical approach, operative duration <120 minutes, and avoidance of intraoperative hemostatic agent use. Each process was considered present or absent, and the number of processes was summed for a bundle score that ranged from 0-4. Cases with a score of zero were excluded. Outcomes measured were rates of complications (any and major) and hospital readmissions, all within 30 days of surgery. Postoperative events that were considered a "major complication" included acute renal failure, cardiac arrest that required cardiopulmonary resuscitation, central line infection, cerebral vascular accident, death, deep vein thrombosis, intestinal obstruction, myocardial infarction, pelvic abscess, pulmonary embolism, rectovaginal fistula, sepsis, surgical site infection (deep and organ-space), unplanned intubation, ureteral obstruction, and ureterovaginal and vesicovaginal fistula. The outcome "any complication" included all those events already described in addition to blood transfusion within 72 hours of surgery, urinary tract infection, and superficial surgical site infection. Outcomes were adjusted for patient demographics, surgical factors, and hospitallevel clustering effects. RESULTS: There were 16,286 benign hysterectomies available for analysis. Among all hysterectomies that were reviewed, 33.6% met criteria for all bundle processes; however, there was wide variation in the rate among the 56 hospitals in the study sample with 9.1% of cases at the lowest quartile and 60.4% at the highest quartile of hospitals that met criteria for all bundle processes. Overall, the rate of any complication was 6.8% and of any major complication was 2.3%. The rate of hospital readmissions was 3.6%. After adjustment for confounders, in cases in which all bundle criterion were met compared with cases in which all bundle criterion were not met, the rate of any complications increased from 4.3-7.8% (P<.001); major complications increased from 1.7-2.6% (P<.001), and readmissions increased from 2.6-4.1% (P<.001). After adjustment for confounders, hospitals with greater rates of meeting all 4 criteria were associated significantly with lower hospital-level rates of postoperative complications (P<.001) and readmissions (P<.001). CONCLUSIONS: This multiinstitutional evaluation reveals that reduced morbidity and readmission are associated with rates of bundle compliance. The proposed bundle is a surgical goal, which is not possible in every case, and there is significant variation in the proportion of cases meeting all 4 bundle processes in Michigan hospitals. Implementation of evidence-based process bundles at a healthcare system level are worthy of prospective study to determine whether improvements in patient outcomes are possible. AD - [Harris, John A.; Sammarco, Anne G.; Swenson, Carolyn W.; Uppal, Shitanshu; Kamdar, Neil; DeLancey, John O.; Morgan, Daniel M.] Univ Michigan, Dept Obstet & Gynecol, Ann Arbor, MI 48109 USA. [Campbell, Darrel] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA. [Evilsizer, Sarah] Michigan Surg Qual Collaborat, Ann Arbor, MI USA. [Harris, John A.] Univ Pittsburgh, Pittsburgh, PA 15260 USA. Harris, JA (corresponding author), Univ Michigan, Dept Obstet & Gynecol, Ann Arbor, MI 48109 USA.; Harris, JA (corresponding author), Univ Pittsburgh, Pittsburgh, PA 15260 USA. harrisja@mail.magee.edu AN - WOS:000402492100014 AU - Harris, J. A. AU - Sammarco, A. G. AU - Swenson, C. W. AU - Uppal, S. AU - Kamdar, N. AU - Campbell, D. AU - Evilsizer, S. AU - DeLancey, J. O. AU - Morgan, D. M. C7 - 502.e1-e11 DA - May DO - 10.1016/j.ajog.2016.12.173 J2 - Am. J. Obstet. Gynecol. KW - bundle hysterectomy morbidity SURGICAL SITE INFECTION COLORECTAL SURGERY SAFETY CHECKLIST LEARNING-CURVE OPERATIVE TIME PELVIC ABSCESS INTERVENTIONS MORTALITY ARGUMENT IMPACT Obstetrics & Gynecology LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: EW4SV Times Cited: 8 Cited Reference Count: 26 Harris, John A. Sammarco, Anne G. Swenson, Carolyn W. Uppal, Shitanshu Kamdar, Neil Campbell, Darrel Evilsizer, Sarah DeLancey, John O. Morgan, Daniel M. Uppal, Shitanshu/D-9374-2015 Uppal, Shitanshu/0000-0002-8329-6948; Sammarco, Anne/0000-0003-4926-4560; Harris, John/0000-0002-7907-8139 Blue Cross and Blue Shield of Michigan/Blue Care Network; National Institute of Child Health and Human Development WRHR Career Development Award [K12 HD063087, K12 HD065257]; Office of Research on Women's HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH Office of Research on Women's Health (ORWH) [P50 HD044406]; National Institute of Child Health and Human DevelopmentUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) [R01 HD038665]; Michigan Surgical Quality Collaborative The Michigan Surgical Quality Collaborative database is funded by Blue Cross and Blue Shield of Michigan/Blue Care Network. Investigator support for J.A.H. included the Robert Wood Johnson Foundation as a Clinical Scholar at the University of Michigan and National Institute of Child Health and Human Development WRHR Career Development Award K12 HD063087 at the University of Pittsburgh (The Robert Wood Johnson Foundation was not directly involved in study design, data acquisition and interpretation, manuscript preparation or review. Any opinions expressed herein do not necessarily reflect the opinions of the Robert Wood Johnson Foundation.) Investigator support for C.W.S. was provided by the National Institute of Child Health and Human Development WRHR Career Development Award K12 HD065257. Investigator support for J.O.D. was provided by Office of Research on Women's Health P50 HD044406 and the National Institute of Child Health and Human Development R01 HD038665. D.M.M. and S.E. receive salary support from the Michigan Surgical Quality Collaborative. 8 3 7 MOSBY-ELSEVIER NEW YORK AM J OBSTET GYNECOL PY - 2017 SN - 0002-9378 SP - 11 ST - Are perioperative bundles associated with reduced postoperative morbidity in women undergoing benign hysterectomy? Retrospective cohort analysis of 16,286 cases in Michigan T2 - American Journal of Obstetrics and Gynecology TI - Are perioperative bundles associated with reduced postoperative morbidity in women undergoing benign hysterectomy? Retrospective cohort analysis of 16,286 cases in Michigan UR - ://WOS:000402492100014 VL - 216 ID - 761655 ER - TY - JOUR AB - This study reports on 15 years of experience, in a single haemophilia care centre in France, with central venous access devices (VADs) in children with haemophilia. Following the insertion of a central VAD, patients were requested to return to the hospital on a quarterly basis for a multidisciplinary appointment which included clinical examination, chest X-ray, cardiac and major vessels ultrasound and preventive fibrinolysis. The family was urged to return to the Haemophilia Care Centre if complications or problems occurred. The follow-up comprised 50 patients. Data were collected prospectively. The total number of days with a VAD was 86 461 days and the total number of times the VAD was used was 41 192 (approximately every other day). Mean duration of VAD placement was 1269 days (range 113-2794 days). There were 25 complications, of which 9 haematomas and 5 systemic infections. Two VADs, infected with Staphylococcus aureus, had to be replaced. The infection rate was calculated as 0.0578 infections/1000 catheter days. There were no cases of thrombosis. This study concluded that most VAD infections in children can be avoided, even in patients requiring intense, prolonged treatment. The very low infection rate was achieved through the efforts of a multidisciplinary team, combined with extensive training for all individuals involved, adherence to written protocols and specific monitoring measures. AD - Department of Haematology, Haemophilia Care Centre, Universitaire Necker-Enfants Malades, Paris, France. Department of Anaesthesia, Universitaire Necker-Enfants Malades, Paris, France. Home Care Education Centre for Children, Universitaire Necker-Enfants Malades, Paris, France. AN - 25623936 AU - Harroche, A. AU - Merckx, J. AU - Salvi, N. AU - Faivre, J. AU - Jacqmarcq, O. AU - Dazet, D. AU - Makhloufi, M. AU - Clairicia, M. AU - Torchet, M. F. AU - Aouba, A. AU - Rothschild, C. DA - Jul DO - 10.1111/hae.12638 DP - NLM ET - 2015/01/28 J2 - Haemophilia : the official journal of the World Federation of Hemophilia KW - Bacterial Infections/etiology/microbiology Blood Coagulation Disorders, Inherited/*drug therapy Central Venous Catheters/*adverse effects/microbiology Child Factor IX/therapeutic use Factor VIII/therapeutic use Factor VIIa/therapeutic use Female Follow-Up Studies Hematoma/etiology Humans Male Recombinant Proteins/therapeutic use Staphylococcus aureus/isolation & purification central venous access devices complications haemophilia infection paediatrics LA - eng M1 - 4 N1 - 1365-2516 Harroche, A Merckx, J Salvi, N Faivre, J Jacqmarcq, O Dazet, D Makhloufi, M Clairicia, M Torchet, M-F Aouba, A Rothschild, C Journal Article England Haemophilia. 2015 Jul;21(4):465-8. doi: 10.1111/hae.12638. Epub 2015 Jan 27. PY - 2015 SN - 1351-8216 SP - 465-8 ST - Long-term follow-up of children with haemophilia - low incidence of infections with central venous access devices T2 - Haemophilia TI - Long-term follow-up of children with haemophilia - low incidence of infections with central venous access devices VL - 21 ID - 760222 ER - TY - JOUR AB - AIMS: A major proportion of patients with diabetic foot syndrome are older than 65 years. Little is known about outcomes of these elderly patients. METHODS: We analysed 245 treatment cases in an observational single-centre study for comorbidities and outcomes over a 6-month period. RESULTS: In all, 122 patients had peripheral arterial disease which was significantly increasing with age (n = 245, df = 1, χ(2) = 23.06, p ⩽ 0.0001). Increasing age correlated positively with decreasing rate of revascularisations (n = 122, df = 1, χ(2) = 4.23, p = 0.039). In total, 23 (9.3%) patients died in the observation period. In-hospital mortality was 2.8%, percentage of major amputations 2.8%. In the invasively treated subgroup, 13 out of 67 patients died within the observation period. Death after revascularisation was independent of age (n = 67, df = 1, χ(2) = 2.05, p = 0.153). Mobility decreased in the whole study group with increasing age. The risk of decrease with age was not influenced by revascularisation status. CONCLUSION: With careful interdisciplinary evaluation, elderly patients with diabetic foot syndrome can be treated with favourable outcome. Mobility before and after treatment deserves more attention as a predictor of treatment success and outcome parameter. AD - Department of Gastroenterology and Diabetology, Klinikum Ludwigshafen, Ludwigshafen, Germany hartmanb@klilu.de. I. Medical Clinic, Department of Endocrinology and Metabolism, University of Mainz, Mainz, Germany. Department of Gastroenterology and Diabetology, Klinikum Ludwigshafen, Ludwigshafen, Germany. Stiftung IHF, Institut für Herzinfarktforschung, Ludwigshafen, Germany. Department of Gastroenterology and Diabetology, Klinikum Worms, Worms, Germany. AN - 27941057 AU - Hartmann, B. AU - Fottner, C. AU - Herrmann, K. AU - Limbourg, T. AU - Weber, M. M. AU - Beckh, K. DA - Jan DO - 10.1177/1479164116666477 DP - NLM ET - 2016/12/13 J2 - Diabetes & vascular disease research KW - Adult Age Factors Aged Aged, 80 and over *Amputation/adverse effects/mortality Comorbidity Diabetic Foot/diagnosis/mortality/physiopathology/*therapy *Endovascular Procedures/adverse effects/mortality Female Germany Hospital Mortality Humans Limb Salvage Male Middle Aged *Mobility Limitation Patient Care Team *Quality of Life Recovery of Function Retrospective Studies Risk Factors Time Factors Treatment Outcome *Vascular Surgical Procedures/adverse effects/mortality *Wound Healing *Diabetic foot syndrome *elderly patients *mobility *revascularisation LA - eng M1 - 1 N1 - 1752-8984 Hartmann, Bettina Fottner, Christian Herrmann, Karin Limbourg, Tobias Weber, Matthias M Beckh, Karlheinz Journal Article Observational Study England Diab Vasc Dis Res. 2017 Jan;14(1):55-58. doi: 10.1177/1479164116666477. Epub 2016 Oct 20. PY - 2017 SN - 1479-1641 SP - 55-58 ST - Interdisciplinary treatment of diabetic foot wounds in the elderly: Low risk of amputations and mortality and good chance of being mobile with good quality of life T2 - Diab Vasc Dis Res TI - Interdisciplinary treatment of diabetic foot wounds in the elderly: Low risk of amputations and mortality and good chance of being mobile with good quality of life VL - 14 ID - 760503 ER - TY - JOUR AB - Background and Objective: Intravenous thrombolysis service for stroke was introduced at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009, based on the recommendations of a multidisciplinary team of clinicians. We report the experience at our center in establishing a stroke protocol incorporating computed tomography perfusion (CTP) of the brain, to assess the feasibility of incorporating CTP in the stroke protocol. Methods: A retrospective review of all patients who had a CTP between January 2010 and December 2011 was performed. Results: Of 272 patients who were admitted with acute ischemic stroke, 44 (16.2%) arrived within 4.5 hours from symptom onset and had a CTP performed with the intention to treat. The median time for symptom-to-door, symptom-to-scan and door-to-scan was 90.0 minutes (62.5 - 146.3), 211.0 minutes (165.5 - 273.5) and 85.0 minutes (48.0 - 144.8) respectively. Eight patients (2.9%) were thrombolysed of whom five received IV thrombolysis and three underwent mechanical thrombolysis. The median symptom-to-needle and door-to-needle times were 290.5 minutes (261.3 - 405.0) and 225.0 minutes (172.5 - 316.8) respectively. Four patients were thrombolysed despite being outside the window of treatment based on the CTP findings. Six of the thrombolysed patients had a Modified Rankin Score (MRS) of 1-2 at 5 months post procedure. Conclusions: CTP provides a benefit to management decisions and subsequent patient outcome. It is feasible to incorporate CTP as a standard imaging modality in a stroke protocol. The delays in the time-dependent pathways are due to our work flow and organisational process rather than performing the CTP per se. AD - R. Sahathevan, Department of Medicine, UKM Medical Center, jalan yaacob Latiff, Bandar Tun Razak 56000 Kuala Lumpur, Malaysia AU - Hashim, H. AU - Hassan, R. AU - Sharis, S. AU - Azmin, S. AU - Remli, R. AU - Mukari, S. A. AU - Yahya, N. AU - Tan, H. J. AU - Mohamed Ibrahim, N. AU - Ismail, M. S. AU - Muda, S. AU - Sahathevan, R. DB - Embase KW - alteplase adult aged article brain ischemia brain perfusion clinical protocol computer assisted tomography disease duration feasibility study female fibrinolytic therapy hospital admission human major clinical study male mechanical thrombectomy middle aged Modified Rankin Score needle retrospective study scoring system symptom tertiary care center time L1 - http://www.neurology-asia.org/articles/neuroasia-2013-18(4)-355.pdf LA - English M1 - 4 M3 - Article N1 - L370572590 2014-01-02 2014-01-20 PY - 2013 SN - 1823-6138 SP - 355-360 ST - Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion: A tertiary referral center experience T2 - Neurology Asia TI - Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion: A tertiary referral center experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L370572590&from=export VL - 18 ID - 761145 ER - TY - JOUR AB - Background and Objective: Intravenous thrombolysis service for stroke was introduced at the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2009, based on the recommendations of a multidisciplinary team of clinicians. We report the experience at our center in establishing a stroke protocol incorporating computed tomography perfusion (CTP) of the brain, to assess the feasibility of incorporating CTP in the stroke protocol. Methods: A retrospective review of all patients who had a CTP between January 2010 and December 2011 was performed. Results: Of 272 patients who were admitted with acute ischemic stroke, 44 (16.2%) arrived within 4.5 hours from symptom onset and had a CTP performed with the intention to treat. The median time for symptom-to-door, symptom-to-scan and door-to-scan was 90.0 minutes (62.5 - 146.3), 211.0 minutes (165.5 - 273.5) and 85.0 minutes (48.0 - 144.8) respectively. Eight patients (2.9%) were thrombolysed of whom five received IV thrombolysis and three underwent mechanical thrombolysis. The median symptom-to-needle and door-to-needle times were 290.5 minutes (261.3 - 405.0) and 225.0 minutes (172.5 - 316.8) respectively. Four patients were thrombolysed despite being outside the window of treatment based on the CTP findings. Six of the thrombolysed patients had a Modified Rankin Score (MRS) of 1-2 at 5 months post procedure. Conclusions: CTP provides a benefit to management decisions and subsequent patient outcome. It is feasible to incorporate CTP as a standard imaging modality in a stroke protocol. The delays in the time-dependent pathways are due to our work flow and organisational process rather than performing the CTP per se. AD - [Hassan, Radhiana] Int Islam Univ, Dept Radiol, Kuala Lumpur, Malaysia. [Sharis, Syazarina; Mukari, Shahizon Azura; Muda, Sobri] Univ Kebangsaan Malaysia, Med Ctr, Dept Radiol, Bangi 43600, Malaysia. [Azmin, Shahrul; Remli, Rabani; Yahya, Nafisah; Tan, Hui Jan; Mohamed Ibrahim, Norlinah; Sahathevan, Ramesh] Univ Kebangsaan Malaysia, Med Ctr, Dept Med, Bangi 43600, Malaysia. [Ismail, Mohd Saiboon] Univ Kebangsaan Malaysia, Med Ctr, Dept Emergency Med, Bangi 43600, Malaysia. Sahathevan, R (corresponding author), UKM Med Ctr, Dept Med, Jalan Yaacob Latiff, Kuala Lumpur 56000, Malaysia. ramesh@ppukm.edu.my AN - WOS:000328858700003 AU - Hashim, H. AU - Hassan, R. AU - Sharis, S. AU - Azmin, S. AU - Remli, R. AU - Mukari, S. A. AU - Yahya, N. AU - Tan, H. J. AU - Mohamed Ibrahim, N. AU - Ismail, M. S. AU - Muda, S. AU - Sahathevan, R. AU - Kuala Lumpur Regionalised, Intergra DA - Dec J2 - Neurol. Asia KW - INTRAVENOUS THROMBOLYSIS ALTEPLASE REGISTRY THERAPY ECASS Clinical Neurology LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: 277ZV Times Cited: 1 Cited Reference Count: 19 Hashim, Hilwati Hassan, Radhiana Sharis, Syazarina Azmin, Shahrul Remli, Rabani Mukari, Shahizon Azura Yahya, Nafisah Tan, Hui Jan Mohamed Ibrahim, Norlinah Ismail, Mohd Saiboon Muda, Sobri Sahathevan, Ramesh Saiboon, Ismail Mohd/W-8428-2019; Hashim, Hilwati/M-8163-2016; Mohamed Ibrahim, Norlinah/H-3847-2016 Saiboon, Ismail Mohd/0000-0003-3972-9803; Hashim, Hilwati/0000-0003-4057-0000; HASSAN, RADHIANA/0000-0002-2144-8416; Remli, Rabani/0000-0003-3988-7609; Mohamed Ibrahim, Norlinah/0000-0002-6684-7488 1 0 ASEAN NEUROLOGICAL ASSOC KUALA LUMPUR NEUROL ASIA PY - 2013 SN - 1823-6138 SP - 355-360 ST - Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion: A tertiary referral center experience T2 - Neurology Asia TI - Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion: A tertiary referral center experience UR - ://WOS:000328858700003 VL - 18 ID - 761793 ER - TY - JOUR AB - Study objective: We evaluate the extent and nature of treatment delays and the contributing factors influencing them for patients with acute ischemic stroke, as well as main barriers to stroke care in an Iranian emergency department (ED). Methods: A retrospective chart review was conducted on 394 patients with acute ischemic stroke who were referred to the ED of a tertiary academic medical center in northwest Iran from March 21 to June 21, 2017. The steps of this review process included instrument development, medical records retrieval, data extraction, and data verification. Primary outcomes were identified treatment delays and causes of loss of eligibility for intravenous recombinant tissue plasminogen activator (r-tPA). Results: Of patients with acute ischemic stroke, 80.2% did not meet intravenous r-tPA eligibility; the most common cause was delayed (> 4.5 hours) ED arrival after symptom onset (71.82%; n = 283). Of 19.8% of subjects for whom the stroke code was activated, intravenous r-tPA was administered in only 5.3%. The average time from patients' arrival to first emergency medicine resident visit, notification of acute stroke team, presence of neurology resident, and computed tomography scan interpretation was lower for patients who met criteria of intravenous r-tPA than for those who lost eligibility for fibrinolytic therapy. The average door-to-needle time was 69 minutes (interquartile range 46 to 91 minutes). Conclusion: Our ED and acute stroke team had a favorable clinical performance meeting established critical time goals of inhospital care for potentially eligible patients, but a poor clinical performance for the majority of patients who were not candidates for fibrinolytic therapy. AD - [Hassankhani, Hadi] Tabriz Univ Med Sci, Sch Nursing & Midwifery, Dept Med Surg Nursing, Res Ctr Evidence Based Med, Tabriz, Iran. [Soheili, Amin] Tabriz Univ Med Sci, Sch Nursing & Midwifery, Dept Med Surg Nursing, Student Res Comm, Tabriz, Iran. [Vahdati, Samad S.] Tabriz Univ Med Sci, Sch Med, Dept Emergency Med, Neurosci Res Ctr, Tabriz, Iran. [Gilani, Neda] Tabriz Univ Med Sci, Sch Hlth, Dept Stat & Epidemiol, Rd Traff Injury Res Ctr, Tabriz, Iran. [Mozaffari, Farough A.] Univ Tabriz, Sch Law & Social Sci, Dept Social Sci, Tabriz, Iran. [Fraser, Justin F.] Univ Kentucky, Dept Neurol Surg Neurol Radiol & Neurosci, Lexington, KY USA. Soheili, A (corresponding author), Tabriz Univ Med Sci, Sch Nursing & Midwifery, Dept Med Surg Nursing, Student Res Comm, Tabriz, Iran. soheili.a1991@gmail.com AN - WOS:000456007300008 AU - Hassankhani, H. AU - Soheili, A. AU - Vahdati, S. S. AU - Mozaffari, F. A. AU - Fraser, J. F. AU - Gilani, N. DA - Feb DO - 10.1016/j.annemergmed.2018.08.435 J2 - Ann. Emerg. Med. KW - TISSUE-PLASMINOGEN ACTIVATOR HEALTH-CARE PROFESSIONALS MEDICAL ADVICE INTRAVENOUS THROMBOLYSIS EARLY MANAGEMENT HEART-DISEASE GUIDELINES DISCHARGE TIMES HOSPITALS Emergency Medicine LA - English M1 - 2 M3 - Review N1 - ISI Document Delivery No.: HH8UA Times Cited: 0 Cited Reference Count: 49 Hassankhani, Hadi Soheili, Amin Vahdati, Samad S. Mozaffari, Farough A. Fraser, Justin F. Gilani, Neda Gilani, Neda/D-7715-2017; Vahdati, Samad Shams/L-7332-2017; Vahdati, Samad Shams/AAY-2932-2020; Gilani, Neda/AAC-8293-2020; Mozaffari, Farough Amin/AAK-3053-2020 Gilani, Neda/0000-0002-5399-0277; Vahdati, Samad Shams/0000-0002-4831-6691; Gilani, Neda/0000-0002-5399-0277; Soheili, Amin/0000-0003-4237-8944 Tabriz University of Medical Sciences [729] By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org).The authors have stated that no such relationships exist. This study was extracted from Dr. Soheili's PhD dissertation, and commissioned and granted by the research deputy of Tabriz University of Medical Sciences (project no. 729). 0 1 4 MOSBY-ELSEVIER NEW YORK ANN EMERG MED PY - 2019 SN - 0196-0644 SP - 118-129 ST - Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review T2 - Annals of Emergency Medicine TI - Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review UR - ://WOS:000456007300008 VL - 73 ID - 761542 ER - TY - JOUR AB - Background: Therapy of severe pulmonary embolism (PE) in patients immediately after surgery poses a difficult challenge with regard to bleeding complications. Ultrasound-accelerated thrombolysis (USAT) has proven to be an effective therapy for severe PE using a fraction of conventional lysis doses. In this case series, we present 3 cases with severe PE immediately after surgery treated by ultra-low-dose USAT. Methods: Between June and October 2017, 3 patients (2 male, 60 and 61 years old; 1 female, 16 years old) with symptomatic massive PE early after surgery were presented to our interdisciplinary PE response team where ultra-low-dose USAT was decided to be applied due to the extent of PE and previous surgery in all patients. The patients were fitted with 2 EKOS® 12 cm devices (BTG Ltd, Surrey, UK) in each respective pulmonary artery across the occlusive thrombi for 6 hours receiving 1 mg rt-PA/h/catheter. Transthoracic echograms and computed tomography (CT) scans were performed before and within 48 hours of therapy initiation. Results: All 3 patients survived USAT uneventful with minor bleeding receiving a total dose of 12 mg rt-PA per patient. Within the first hours of therapy significant reduction of RV/LV ratio (1.3 ± 0.2 vs. 0.7 ± 0.08, p: 0.043) and mean pulmonary arterial pressure (33.4 ± 6.1 mmHg vs. 21.7 ± 3.2 mmHg, p: 0.021) as well as significant increase of oxygen saturation on room air (O2 sat, 83.6 ± 4.1 vs. 99.3 ± 1.1, p: 0.012) and right ventricular peak systolic strain rate (-1.12 ± 0.07 s-1 vs. -1.37 ± 0.05 s-1, p: 0.011) was observed. Notable reduction of heart rate, systolic pulmonary arterial pressure, and longitudinal peak systolic strain, and an increase in tricuspid annular plane systolic excursion and tricuspid annular systolic velocity were also documented (Table PC20-1). Follow-up CT scans revealed only minor remaining nonobstructive thrombi. Conclusion: In this case series, ultra-low-dose USAT resulted in nearly complete resolution of thrombus within 6 hours of therapy with very rapid recovery of hemodynamics in these highly symptomatic patients. Thus, ultra-low-dose USAT appears to be a safe and reasonable therapy option for early postoperative PE. (Table Presented). AD - N. Hatam, University Hospital RWTH Aachen, Aachen, Germany AU - Hatam, N. AU - Spetsotaki, K. AU - Steffen, H. AU - Zayat, R. AU - Spillner, J. DB - Embase KW - alteplase oxygen adolescent ambient air bleeding case report case study catheter clinical article computer assisted tomography conference abstract drug therapy echography female follow up heart rate heart right ventricle human low drug dose lung artery pressure male oxygen saturation patient history of surgery pulmonary embolism response team remission sonothrombolysis surgery thrombus tricuspid annular plane systolic excursion tricuspid valve LA - English M1 - 2 M3 - Conference Abstract N1 - L631723211 2020-05-18 PY - 2019 SN - 1559-0879 SP - 76S-77S ST - Low-dose ultrasound-accelerated thrombolysis in early postoperative massive pulmonary embolism T2 - Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery TI - Low-dose ultrasound-accelerated thrombolysis in early postoperative massive pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631723211&from=export VL - 14 ID - 760781 ER - TY - JOUR AB - Introduction Care for stroke patients has improved steadily in southern Vietnam. Medical treatments such as thrombolytic therapy have been implemented at several hospitals, and stroke-care units composed of a team of various health professionals have been created. However, little attention has been focused on providing support to caregivers of stroke patients. This study aimed to characterize the caregivers of stroke patients who were treated in state-owned acute-care hospitals and to learn about their needs when patients are discharged. Such information can be used to enhance the caregiver's support system. Methods We used questionnaires to conduct a descriptive study in 2011 at a state-owned acute-care hospital in southern Vietnam. We recruited study participants from among caregivers of stroke patients who had been informed of their hospital discharge date. We assessed 8 caregiver characteristics, and caregiver participants selected their needs from the survey's list of 15 possible needs. We analyzed the data by using the independent sample t test and logistic regression. Results Of the 93 caregivers who consented to participate, 86 (92.5%) completed the survey and indicated their concerns at discharge. The most frequently cited need was information on how to prevent stroke recurrence (72, 83.7%), followed by which drugs are most effective in preventing a relapse (62, 72.1%), how long recovery would take (61, 70.9%), and availability of hospitals in the patient's hometown (60, 69.8%). A little over half of caregivers indicated financial concerns. A caregiver's need for information on diet for a stroke survivor increased with the caregiver's education level. Conclusions This study revealed several needs among caregivers of stroke survivors in southern Vietnam that are similar to those found by studies of caregivers of stroke survivors in high-income countries. Our findings suggest that comprehensive stroke care that includes caregiver education about healthful diets and prevention of stroke recurrence is needed at state-owned acute-care hospitals in southern Vietnam. AD - [Hayashi, Yumiko] Becamex Int Hosp, Rehabil Dept, Thu Dau Mot City, Binh Duong Prov, Vietnam. [Hoang Hoa Hai] Becamex Int Hosp, Thu Dau Mot City, Binh Duong Prov, Vietnam. [Nguyen Anh Tai] Cho Ray Hosp, Ho Chi Minh City, Vietnam. Hayashi, Y (corresponding author), Becamex Int Hosp, Rehabil Dept, Becamex Tower,230 Binh Duong Ave,Phu Hoa Ward, Thu Dau Mot City, Binh Duong Prov, Vietnam. yumiko.hayashi@bih.vn AN - WOS:000329392600013 AU - Hayashi, Y. AU - Hai, H. H. AU - Tai, N. A. C7 - 130023 DA - Aug DO - 10.5888/pcd10.130023 J2 - Prev. Chronic Dis. KW - FAMILY CAREGIVERS SUPPORT NEEDS SURVIVORS REHABILITATION BURDEN Public, Environmental & Occupational Health LA - English M3 - Article N1 - ISI Document Delivery No.: 285KJ Times Cited: 5 Cited Reference Count: 24 Hayashi, Yumiko Hoang Hoa Hai Nguyen Anh Tai 5 0 10 CENTERS DISEASE CONTROL & PREVENTION ATLANTA PREV CHRONIC DIS PY - 2013 SN - 1545-1151 SP - 8 ST - Assessment of the Needs of Caregivers of Stroke Patients at State-Owned Acute-Care Hospitals in Southern Vietnam, 2011 T2 - Preventing Chronic Disease TI - Assessment of the Needs of Caregivers of Stroke Patients at State-Owned Acute-Care Hospitals in Southern Vietnam, 2011 UR - ://WOS:000329392600013 VL - 10 ID - 761801 ER - TY - JOUR AB - Introduction/objective. - The benefits of thrombolysis in patients presenting with acute ischemic stroke (IS) are highly time-dependent. The aim of our study was to evaluate the clinical benefit, after 3 months, of an intrahospital mobile thrombolysis team (MTT) for thrombolysis in IS. Patients and methods. - A total of 95 consecutive patients treated with IV tPA for acute IS at the neurology department of Rouen University Hospital between 1 January and 31 December 2015 were retrospectively identified. Patients who had benefited from mechanical thrombectomy or hemicraniectomy were excluded. The study compared 33 patients who had benefited from our MTT (thrombolysis whatever the location and as soon as possible by a specific nurse) with 62 patients treated in the usual way (thrombolysis only at the stroke unit). Management timescales, inhospital and 3-month clinical outcomes, and imaging data were also compared between the two groups. Results. - Demographic data and factors known to influence the clinical course after thrombolysis were similar between the two groups (P > 0.05). However, use of the MTT allowed significant decreases in the median onset-to-treatment (OTT) time of 26 min and median door-to-needle (DTN) time of 27 min (P < 0.001). The proportion of patients with a DTN time < 60 min was higher in the MTT group than in the usual care (UC) group: 64% vs. 14%, respectively (P < 0.001), according to American Heart Association/American Stroke Association guidelines. Although there was a smaller proportion of negative 3-month outcomes (modified Rankin Scale score: 6; 6% vs. 16%) and a larger proportion of highly favorable 3-month outcomes (mRS score: 0-1; 79% vs. 64%) in the MTT vs. UC groups, respectively, these differences were not statistically significant (P > 0.05). Discussion/conclusion. - Use of an MTT is a simple way to reduce thrombolysis delays, and the present results encourage us to improve the system to make it even more effective and available for all patients. (C) 2017 Elsevier Masson SAS. All rights reserved. AD - [Hebant, B.; Triquenot-Bagan, A.; Guegan-Massardier, E.; Ozkul-Wermester, O.; Grangeon, L.; Maltete, D.] Rouen Univ Hosp, Dept Neurol, 1 Rue Germont, F-76000 Rouen, France. [Maltete, D.] Rouen Fac Med, INSERM, U1073, 22 Blvd Gambetta, F-76000 Rouen, France. Maltete, D (corresponding author), Rouen Univ Hosp, Dept Neurol, 1 Rue Germont, F-76000 Rouen, France. David.Maltete@chu-rouen.fr AN - WOS:000401104000007 AU - Hebant, B. AU - Triquenot-Bagan, A. AU - Guegan-Massardier, E. AU - Ozkul-Wermester, O. AU - Grangeon, L. AU - Maltete, D. DA - Mar DO - 10.1016/j.neurol.2017.02.003 J2 - Rev. Neurol. KW - Stroke Thrombolysis Management timescales Onset-to-treatment time Door-to-needle time TISSUE-PLASMINOGEN ACTIVATOR CONTROLLED-TRIAL EARLY MANAGEMENT ASSOCIATION CARE PREDICTORS THERAPY TIME IMPROVEMENT VALIDATION Clinical Neurology LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: EU5WE Times Cited: 2 Cited Reference Count: 32 Hebant, B. Triquenot-Bagan, A. Guegan-Massardier, E. Ozkul-Wermester, O. Grangeon, L. Maltete, D. 2 0 3 MASSON EDITEUR MOULINEAUX CEDEX 9 REV NEUROL-FRANCE PY - 2017 SN - 0035-3787 SP - 152-158 ST - Impact of an intrahospital mobile thrombolysis team on 3-month clinical outcomes in patients benefiting from intravenous thrombolysis for acute ischemic stroke T2 - Revue Neurologique TI - Impact of an intrahospital mobile thrombolysis team on 3-month clinical outcomes in patients benefiting from intravenous thrombolysis for acute ischemic stroke UR - ://WOS:000401104000007 VL - 173 ID - 761665 ER - TY - JOUR AB - INTRODUCTION/OBJECTIVE: The benefits of thrombolysis in patients presenting with acute ischemic stroke (IS) are highly time-dependent. The aim of our study was to evaluate the clinical benefit, after 3 months, of an intrahospital mobile thrombolysis team (MTT) for thrombolysis in IS. PATIENTS AND METHODS: A total of 95 consecutive patients treated with IV tPA for acute IS at the neurology department of Rouen University Hospital between 1 January and 31 December 2015 were retrospectively identified. Patients who had benefited from mechanical thrombectomy or hemicraniectomy were excluded. The study compared 33 patients who had benefited from our MTT (thrombolysis whatever the location and as soon as possible by a specific nurse) with 62 patients treated in the usual way (thrombolysis only at the stroke unit). Management timescales, inhospital and 3-month clinical outcomes, and imaging data were also compared between the two groups. RESULTS: Demographic data and factors known to influence the clinical course after thrombolysis were similar between the two groups (P>0.05). However, use of the MTT allowed significant decreases in the median onset-to-treatment (OTT) time of 26min and median door-to-needle (DTN) time of 27min (P<0.001). The proportion of patients with a DTN time<60min was higher in the MTT group than in the usual care (UC) group: 64% vs. 14%, respectively (P<0.001), according to American Heart Association/American Stroke Association guidelines. Although there was a smaller proportion of negative 3-month outcomes (modified Rankin Scale score: 6; 6% vs. 16%) and a larger proportion of highly favorable 3-month outcomes (mRS score: 0-1; 79% vs. 64%) in the MTT vs. UC groups, respectively, these differences were not statistically significant (P>0.05). DISCUSSION/CONCLUSION: Use of an MTT is a simple way to reduce thrombolysis delays, and the present results encourage us to improve the system to make it even more effective and available for all patients. AD - Department of Neurology, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France. Department of Neurology, Rouen University Hospital, 1 Rue de Germont, 76000 Rouen, France; INSERM U1073, Rouen Faculty of Medicine, 22 Boulevard Gambetta, 76000 Rouen, France. Electronic address: David.Maltete@chu-rouen.fr. AN - 28314516 AU - Hebant, B. AU - Triquenot-Bagan, A. AU - Guegan-Massardier, E. AU - Ozkul-Wermester, O. AU - Grangeon, L. AU - Maltête, D. DA - Mar DO - 10.1016/j.neurol.2017.02.003 DP - NLM ET - 2017/03/21 J2 - Revue neurologique KW - Administration, Intravenous Aged Aged, 80 and over Brain Ischemia/complications/*drug therapy Female Fibrinolytic Agents/*administration & dosage Hospitals Humans Male Middle Aged *Mobile Health Units/organization & administration *Patient Care Team/organization & administration Retrospective Studies Stroke/complications/*drug therapy Thrombolytic Therapy/*methods Treatment Outcome Door-to-needle time Management timescales Onset-to-treatment time Stroke Thrombolysis LA - eng M1 - 3 N1 - Hebant, B Triquenot-Bagan, A Guegan-Massardier, E Ozkul-Wermester, O Grangeon, L Maltête, D Journal Article France Rev Neurol (Paris). 2017 Mar;173(3):152-158. doi: 10.1016/j.neurol.2017.02.003. Epub 2017 Mar 15. PY - 2017 SN - 0035-3787 (Print) 0035-3787 SP - 152-158 ST - Impact of an intrahospital mobile thrombolysis team on 3-month clinical outcomes in patients benefiting from intravenous thrombolysis for acute ischemic stroke T2 - Rev Neurol (Paris) TI - Impact of an intrahospital mobile thrombolysis team on 3-month clinical outcomes in patients benefiting from intravenous thrombolysis for acute ischemic stroke VL - 173 ID - 760445 ER - TY - JOUR AB - Background: The main aim of this study was to evaluate the impact of the implementation of a mobile thrombolysis team (MTT) on time to thrombolysis treatment depending on patient admission time: regular hours (RH) or out of hours (OH). Methods: 504 consecutive patients treated with IV tPA or with combined IV tPA and mechanical thrombectomy for acute ischemic stroke were retrospectively included between 1st January 2013 and 31st December 2017. Three sub-periods were identified: 2013-2014, 2015-2016, and 2017 during which patients were treated with the usual care (UC), by the MIT or with UC according to their time of admission, or by the MTT, in the three time periods respectively. We compared in-hospital delays according to patient admission time. Results: In 2013-2014, 133 patients were included. Both median door-to-needle (DTN) and imaging to needle (ITN) times were shorter for patients admitted during RH than OH, respectively 75 min versus 85 min and 52 min versus 57 min (P < 0.05), and the proportion of patients with DTN <= 60 min was 23% versus 9% (P < 0.05), respectively. In 2015-2016, 223 patients were included. DTN and ITN times were shorter for patients admitted during RH and treated by the MIT than during OH with UC, respectively 54 min versus 78 min and 24 min versus 47 min (P < 0.001), and the proportion of patients with DTN <= 60 min was 64% versus 21% (P < 0.001), respectively. In 2017, there was no difference concerning in-hospital delays regardless of patient admission time (P > 0.05). Discussion: DTN time was significantly longer for patients admitted OH. We suggest that the implementation of an around-the-clock MTT would allow a reduction of in-hospital delays and similar times to thrombolysis treatment regardless of admission time. AD - [Hebant, Benjamin; Triquenot-Bagan, Aude; Guegan-Massardier, Evelyne; Ozkul-Wermester, Ozlem; Maltete, David] Rouen Univ Hosp, Dept Neurol, Rouen, France. [Maltete, David] Univ Rouen, Inst Res & Innovat Biomed, Lab Neuronal & Neuroendocrine Differentiat & Comm, INSERM U1239, F-76821 Mont St Aignan, France. [Maltete, David] Normandy Univ, Normandy, France. Hebant, B (corresponding author), Rouen Univ Hosp, Dept Neurol, Rouen, France. benjamin.hebant@gmail.com AN - WOS:000445169300010 AU - Hebant, B. AU - Triquenot-Bagan, A. AU - Guegan-Massardier, E. AU - Ozkul-Wermester, O. AU - Maltete, D. DA - Sep DO - 10.1016/j.jns.2018.07.009 J2 - J. Neurol. Sci. KW - Stroke Thrombolysis Time management Door-To-Needle time Regular hours Out of hours ACUTE ISCHEMIC-STROKE TISSUE-PLASMINOGEN ACTIVATOR TO-NEEDLE TIMES SAFE IMPLEMENTATION CLINICAL-OUTCOMES IMPACT NINDS CARE Clinical Neurology Neurosciences LA - English M3 - Article N1 - ISI Document Delivery No.: GU3IH Times Cited: 1 Cited Reference Count: 22 Hebant, Benjamin Triquenot-Bagan, Aude Guegan-Massardier, Evelyne Ozkul-Wermester, Ozlem Maltete, David 1 0 2 ELSEVIER SCIENCE BV AMSTERDAM J NEUROL SCI PY - 2018 SN - 0022-510X SP - 46-50 ST - In-hospital delays to stroke thrombolysis: Out of hours versus regular hours and reduction in treatment times through the creation of a 24/7 mobile thrombolysis team T2 - Journal of the Neurological Sciences TI - In-hospital delays to stroke thrombolysis: Out of hours versus regular hours and reduction in treatment times through the creation of a 24/7 mobile thrombolysis team UR - ://WOS:000445169300010 VL - 392 ID - 761569 ER - TY - JOUR AB - Background: Treatment with checkpoint inhibitors such as anti-programmed death-1 (anti-PD-1), anti-PD-ligand 1 (anti-PD-L1), and anti-cytotoxic T-Iymphocyte antigen-4 (anti-CTLA-4) antibodies can prolong the survival of cancer patients, but it also induces autoimmune side effects in 86-96% of patients by activating the immune system. In 17-59% of patients, these are severe or even life-threatening. Methods: This review is based on pertinent articles retrieved by a search in PubMed and on an evaluation of a side-effect registry. Results: Checkpoint-inhtritor-induced autoimmune side effects manifest themselves in all organ systems, most commonly as skin lesions (46-62%), autoimmune colitis (22-48%), autoimmune hepatitis (7-33%), and endocrinopathies (thyroiditis, hypophysitis, adrenalitis, diabetes mellitus; 12-34%). Rarer side effects include pneumonitis (3-8%), nephritis (1-7%), cardiac side effects including cardiomyositis (5%), and neurological side effects (1-5%). Severe (sometimes lethal) side effects arise in 17-21%, 20-28%, and 59% of patients undergoing anti-PD-1 and a ntiCTLA-4 antibody treatment and the approved combination therapy, respectively. With proper monitoring, however, these side effects can be recognized early and, usually, treated with success. Endocrine side effects generally require long-term hormone substitution. Patients who have stopped taking checkpoint inhibitors because of side effects do not show a poorer response of their melanoma or shorter survival in comparison to patients who continue to take checkpoint inhibitors. Conclusion: The complex management of checkpoint-inhibitor-induced side effects should be coordinated in experienced centers. The creation of an interdisciplinary lox team" with designated experts for organ-specific side effects has proven useful. Prospective registry studies based on structured documentation of side effects in routine clinical practice are currently lacking and urgently needed. AD - [Heinzerling, Lucie] Univ Hosp Erlangen Nurnberg, Dept Dermatol, Erlangen, Germany. [de Toni, Enrico N.] Ludwig Maximilians Univ Munchen, Univ Hosp, Dept Internal Med 2, Munich, Germany. [Schett, Georg] Univ Hosp Erlangen Nurnberg, Dept Med 3, Erlangen, Germany. [Hundorfean, Gheorghe] Univ Hosp Erlangen Nurnberg, Dept Med 1, Erlangen, Germany. [Zimmer, Lisa] Univ Duisburg Essen, Clin Dermatol, Essen Univ Hosp, Duisburg, Germany. Heinzerling, L (corresponding author), Univ Klinikum Erlangen, Hautklin, Ulmenweg 18, D-91054 Erlangen, Germany. Lucie.Heinzerling@uk-erlangen.de AN - WOS:000463028700001 AU - Heinzerling, L. AU - de Toni, E. N. AU - Schett, G. AU - Hundorfean, G. AU - Zimmer, L. DA - Feb DO - 10.3238/arztebl.2019.0119 J2 - Dtsch. Arztebl. Int. KW - ADVERSE DRUG-REACTIONS MERKEL CELL-CARCINOMA ADVANCED MELANOMA OPEN-LABEL METASTATIC MELANOMA IPILIMUMAB THERAPY ANTI-PD-1 ANTIBODY ORGAN TRANSPLANT IMMUNE THROMBOCYTOPENIA PERICARDIAL TAMPONADE Medicine, General & Internal LA - English M1 - 8 M3 - Review N1 - ISI Document Delivery No.: HR3HZ Times Cited: 25 Cited Reference Count: 159 Heinzerling, Lucie de Toni, Enrico N. Schett, Georg Hundorfean, Gheorghe Zimmer, Lisa 25 0 12 DEUTSCHER AERZTE-VERLAG GMBH COLOGNE DTSCH ARZTEBL INT PY - 2019 SN - 1866-0452 SP - 119-+ ST - Checkpoint Inhibitors The Diagnosis and Treatment of Side Effects T2 - Deutsches Arzteblatt International TI - Checkpoint Inhibitors The Diagnosis and Treatment of Side Effects UR - ://WOS:000463028700001 VL - 116 ID - 761536 ER - TY - JOUR AU - Henke, P. AU - Obi, A. DA - 2020/06/05 06/05 DB - Europe PubMed Central DO - 10.1016/j.jvsv.2020.05.014 M1 - 5 PY - 2020 SN - 2213-333x SP - 899-900 ST - Reply T2 - J Vasc Surg Venous Lymphat Disord TI - Reply UR - http://europepmc.org/article/MED/32497627 VL - 8 ID - 762046 ER - TY - JOUR AB - PURPOSE: Pulmonary hypertension due to unresolved pulmonary emboli that narrow pulmonary arteries , known as chronic thromboembolic pulmonary hypertension (CTEPH), is a deadly disease that can be effectively treated with a complex surgical procedure called pulmonary thromboendarterectomy (PTE). The Cleveland Clinic has a multidisciplinary team dedicated to the evaluation and treatment of CTEPH patients. Here, we report our PTE experience. METHODS: Retrospective review of all patients who underwent PTE at the Cleveland Clinic. We report surgical volumes and hospital mortality. For recent cohorts, we report detailed demographic, clinical and hemodynamic data before and after PTE, as well as long term survival. RESULTS: Between 1995 and 2014, a total of 150 PTE surgeries were performed at the Cleveland Clinic. Between 1995 and 2010, there were a total of 86 PTEs with a hospital mortality rate of 11.6%. Between 2011 and 2014, we performed 64 PTE surgeries with a hospital mortality rate of 4.7%. Patients operated between 2011 and 2014 had the following baseline characteristics: median age 51 (range 21-81); 61% male; NYHA functional class II 18%, III 64% and IV 18%; median body mass index 31 (range 22 - 54); median six-minute walk distance 291 meters (interquartile range [IQR] 221, 384), median NT-proBNP 764 pg/mL (interquartile range 180, 2132). Pre and post PTE invasive hemodynamics were as follows: mean PAP 45 (IQR 39, 55) and 25 (IQR 22, 31) mmHg, cardiac index 2.2 (IQR 1.8, 2.6) and 2.9 (IQR 2.6, 3.3) L/min/m2, pulmonary vascular resistance 6.2 (IQR 4.9, 10.1) and 2.4 (IQR 1.8, 3.1) Wood units, respectively. For 70 CTEPH patients treated with PTE between 2009 and 2014, 5 -year survival was 87.4%, compared to 63.3% for 31 contemporary CTEPH patients treated medically (log-rank p = 0.04). CONCLUSIONS: PTE is the treatment of choice for CTEPH as it is associated with low operative mortality; dramatic improvements right heart hemodynamics and excellent long-term outcomes, even in patients with severe disease and co-morbidities such as obesity. CLINICAL IMPLICATIONS: There is a need for emerging centers with a dedicated team of specialists to effectively evaluate and treat patients with CTEPH. AD - G. Heresi, Cleveland Clinic, Cleveland, Ohio, Cleveland, OH, United States AU - Heresi, G. AU - Smedira, N. DB - Embase DO - 10.1378/chest.2281888 KW - hospital endarterectomy human patient mortality chronic thromboembolic pulmonary hypertension surgery lung embolism pulmonary artery cardiac index long term survival pulmonary hypertension obesity male body mass hemodynamics heart hemodynamics lung vascular resistance surgical mortality survival morbidity surgical technique medical specialist New York Heart Association class L1 - http://journal.publications.chestnet.org/article.aspx?articleID=2457267 LA - English M1 - 4 M3 - Conference Abstract N1 - L72132870 2016-01-15 PY - 2015 SN - 0012-3692 ST - Pulmonary thromboendarterectomy experience at the cleveland clinic T2 - Chest TI - Pulmonary thromboendarterectomy experience at the cleveland clinic UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72132870&from=export http://dx.doi.org/10.1378/chest.2281888 VL - 148 ID - 761057 ER - TY - JOUR AB - Introduction: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a leading cause of pulmonary hypertension. Pulmonary Endarterectomy (PEA) is the treatment of choice. Medical Therapy (MT) and Balloon Pulmonary Angioplasty (BAP) should be considered in technically non-operable patients Purpose: The aim of this study was to analyse the improvement in survival benefit of TEA over years in a national CTEPH expert center. Methods: We included all patients evaluated by a CTEPH multidisciplinary team from 1st January 1996 to 31st December 2015. The assessment of operability was made by a multidisciplinary team. We defined learning curve as the period of time when less than 10 TEA procedure were performed yearly (1996-2010). We analysed survival benefit of TEA comparing TEA and MT before and after finishing the learning curve period. BAP are performed in our center since 2013, so this group was excluded for the analysis. Results: In this period of time, 292 patients were evaluated by a multidisciplinary team. 153 patients (52.4%) were referred to surgery (142 operated before 31st December 2015). Of the 139 non-operable patients, 23 were good candidates for BAP (7.9%) and 116 patients (39.7%) received only MT. In the learning curve period, 46 patients were operated and 41 received MT. When comparing baseline characteristics of both groups, significant differences between surgical and medical group were found in the age at diagnosis (53.62±14.29 vs. 64.02±15.33), proportion of women (43.7% vs. 61.2%), BMI (27.03±4,18 vs. 28,46±4.68), 6MWT (391±117 vs. 354±117) and mPAP (48,62±12,03 vs. 44,57±11,83). In the surgical group, 8 patients died in the perioperative period and other 7 during the follow-up. In the medical group, 2 patients underwent lung transplantation y 29 died during follow up. In a multivariate analysis, factors related with mortality were: surgery (RR 0,37; 95% CI 0,19-0,72), lower pulmonary vascular resistance (RR 1,19; 95% CI 1,02-1,39), higher distance in 6MWT (RR 0,79, 95% CI 0,73-0,85), previous history of acute pulmonary embolism (RR 0,50; 95% CI 0,27-0,92), and the lack of cancer (RR 2,57; 95% CI 1,22-5,43)). In the survival analysis, we obtained a significant improvement in mortality in the TEA group. This benefit was already present in the learning curve period. Conclusion: In our experience TEA surgery is a safe and effective procedure for patients with CTEPH even in early stages of the development of a multidisciplinary group. Operability should be assessed in all patients, being good candidates more than half of them in our center. (Figure Presented). AD - I. Hernandez Gonzalez, University Hospital 12 De Octubre, Cardiology, Madrid, Spain AU - Hernandez Gonzalez, I. AU - Lopez Gude, M. J. AU - Velazquez Martin, M. T. AU - Revilla Ostolaza, Y. AU - Alonso Charterina, S. AU - Perez Nunez, M. AU - Morales Ruiz, R. AU - Perez Vela, J. L. AU - Albarran Gonzalez-Trevilla, A. AU - Quezada Loaiza, C. A. AU - Ortiz Bautista, C. AU - Ochoa Parra, N. AU - Ponz De Antonio, I. AU - Cortina Romero, J. M. AU - Escribano Subias, P. DB - Embase DO - 10.1093/eurheartj/ehx502.P2596 KW - adult angioplasty balloon body mass cancer staging cancer surgery cancer survival chronic thromboembolic pulmonary hypertension conference abstract controlled study diagnosis endarterectomy female follow up human learning curve lung embolism lung transplantation lung vascular resistance major clinical study mortality multivariate analysis perioperative period surgery survival analysis LA - English M3 - Conference Abstract N1 - L621235487 2018-03-20 PY - 2017 SN - 1522-9645 SP - 548-549 ST - Survival benefit improvement of Pulmonary Endarterectomy with experience gained in a national expert center T2 - European Heart Journal TI - Survival benefit improvement of Pulmonary Endarterectomy with experience gained in a national expert center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621235487&from=export http://dx.doi.org/10.1093/eurheartj/ehx502.P2596 VL - 38 ID - 760920 ER - TY - JOUR AB - In 1967, Thomas Starzl performed the first successful liver transplantation (LTX) in a 1 1/2-year-old child. This operation represented a medical milestone and true pioneer ship, but the treatment was still highly experimental often offering no long-time cure. At present, approximately 25000 transplantations are performed worldwide in children and adults each year. LTX is considered an established treatment for end-stage liver disease and some metabolic disorders with long-term survival rates > 85%. Optimized care is achieved by multidisciplinary teams in which radiology plays an important role. Intra-operative ultrasound with b-mode and vascular imaging techniques are used to control the quality of the vascular anastomosis. As post-operative complications can be relatively frequently encountered in children and an intensified imaging regime is advocated to timely detect and manage these problems. Post-operative imaging is mainly based on protocol ultrasound examinations, which are frequently scheduled at fixed intervals post-operatively and at larger intervals during the follow-up period. Cross-sectional imaging (CT / MRI) is usually reserved for unclear cases. Early surgical complications include bleeding, vascular stenosis/thrombosis, bile leakage and bile duct stenosis. The main non-surgical postoperative complications are infections and acute rejection. Late complications after transplantation occur less frequently and include vascular problems (stenosis, thrombosis), bile duct dilatation (stenosis, ischemic type lesions), rejection, infections and post-transplant lymphoma. A limitation for long-time graft survival can be the development of liver fibrosis. Protocol biopsies have shown relevant liver fibrosis in a relatively large proportion of patients 5 to 10 years after transplantation. Elastography represents an alternative non-invasive method to detect fibrosis and may be useful guide treatment modifications. Available data in pediatric patients are presented. AD - J. Herrmann, Hamburg, Germany AU - Herrmann, J. AU - Herden, U. AU - Grabhorn, E. AU - Fischer, L. DB - Embase DO - 10.1007/s00247-019-04365-w KW - acute graft rejection bile duct dilatation bile leakage biopsy bleeding blood vessel shunt cancer surgery child cholestasis clinical assessment complication conference abstract elastography end stage liver disease female follow up graft survival human human tissue infection liver fibrosis liver transplantation long term survival lymphoma major clinical study male metabolic disorder multidisciplinary team non invasive procedure nuclear magnetic resonance imaging pediatric patient peroperative complication peroperative echography preschool child radiology surgery thrombosis LA - English M3 - Conference Abstract N1 - L627463831 2019-05-14 PY - 2019 SN - 1432-1998 SP - S276 ST - Radiological follow-up of transplanted liver T2 - Pediatric Radiology TI - Radiological follow-up of transplanted liver UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627463831&from=export http://dx.doi.org/10.1007/s00247-019-04365-w VL - 49 ID - 760717 ER - TY - JOUR AB - BACKGROUND: Randomized studies suggest that open lower extremity revascularization procedures are associated with improved outcomes compared with endovascular peripheral vascular interventions (PVIs). However, advances in endovascular technologies and treatment by multidisciplinary limb preservation teams have shown improved outcomes. The aim of our study was to compare perioperative and long-term outcomes after open versus PVI procedures in diabetic patients with chronic limb-threatening ischemia (CLTI) treated in a multidisciplinary setting. METHODS: All patients presenting to our multidisciplinary diabetic limb-preservation service from 6/2012 to 07/2018 were enrolled in a prospective database. Patients who underwent either an open lower extremity bypass (LEB) or a PVI for CLTI were included in the analysis. Perioperative (30-day) complications and 4-year patency and limb salvage rates were compared between PVI and LEB using chi-squared tests, Kaplan-Meier curve analyses, and stepwise multivariable Cox proportional hazards models. RESULTS: A total of 195 lower extremity revascularization procedures were performed in 120 patients (mean age: 65.0 ± 1.0 years, 61.7% male, 63.3% black), including 53 (27.2%) open procedures and 142 (72.8%) PVIs. Nearly two-thirds of procedures (65.6%) treated multilevel diseases, while 27.2% treated isolated tibial disease and 7.2% treated isolated femoropopliteal disease. More than half of the procedures (53.3%) were performed for Wound, Ischemia, and foot Infection (WIfI) classification stage 4 limbs, 25.1% for stage 3, and 21.6% for stage 1/2. In the LEB group, 67.9% of targets were infrapopliteal. In the PVI group, 63.4% of procedures were isolated tibial interventions or were multilevel interventions including the tibial segment. Perioperative complications occurred in 52.8% of LEB versus 12.0% of PVI (P < 0.001). At 4 years postoperatively, there was no significant difference in crude (unadjusted) primary patency for PVI versus LEB (34.5 ± 6.6% vs. 49.6 ± 8.1, P = 0.89). Secondary patency was better for the LEB group (50.3 ± 7.4% vs. 55.4 ± 7.5%; P = 0.04), but amputation-free survival was similar (65.1 ± 6.7% vs. 60.9 ± 9.7%; P = 0.79). After adjusting for baseline differences between groups, primary patency (hazard ratio [HR]: 0.61; 95% confidence interval [CI]: 0.34 to 1.10) and amputation-free survival (HR: 1.51; 95% CI: 0.71 to 2.34) remained similar for PVI versus LEB, but secondary patency was persistently lower for PVI (HR: 0.35; 95% CI: 0.14 to 0.90). CONCLUSIONS: In this cohort of diabetic patients with CLTI undergoing predominantly tibial interventions, open revascularization was associated with a higher risk of perioperative complications than PVIs. While secondary patency rates were better after LEBs, our data suggest that an endovascular-first approach results in equivalent long-term amputation-free survival for diabetic patients treated in a multidisciplinary setting. AD - Diabetic Foot and Wound Service, The Johns Hopkins Hospital, Baltimore, MD; Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD. Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD. Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD. Diabetic Foot and Wound Service, The Johns Hopkins Hospital, Baltimore, MD; Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: cabular1@jhmi.edu. AN - 31200047 AU - Hicks, C. W. AU - Canner, J. K. AU - Lum, Y. W. AU - Black, J. H., 3rd AU - Abularrage, C. J. DA - Oct DO - 10.1016/j.avsg.2019.04.001 DP - NLM ET - 2019/06/15 J2 - Annals of vascular surgery KW - Aged Amputation Chronic Disease Databases, Factual Diabetic Angiopathies/diagnostic imaging/physiopathology/*therapy *Endovascular Procedures/adverse effects Female Humans Interdisciplinary Communication Ischemia/diagnostic imaging/physiopathology/*therapy Limb Salvage Male Middle Aged *Patient Care Team Peripheral Arterial Disease/diagnostic imaging/physiopathology/*therapy Progression-Free Survival Risk Factors *Tibial Arteries/diagnostic imaging/physiopathology Time Factors *Vascular Grafting/adverse effects Vascular Patency LA - eng N1 - 1615-5947 Hicks, Caitlin W Canner, Joseph K Lum, Ying W Black, James H 3rd Abularrage, Christopher J Comparative Study Journal Article Netherlands Ann Vasc Surg. 2019 Oct;60:315-326.e2. doi: 10.1016/j.avsg.2019.04.001. Epub 2019 Jun 12. PY - 2019 SN - 0890-5096 SP - 315-326.e2 ST - Long-term Outcomes of an Endovascular-First Approach for Diabetic Patients With Predominantly Tibial Disease Treated in a Multidisciplinary Setting T2 - Ann Vasc Surg TI - Long-term Outcomes of an Endovascular-First Approach for Diabetic Patients With Predominantly Tibial Disease Treated in a Multidisciplinary Setting VL - 60 ID - 760225 ER - TY - JOUR AB - Rationale The incidence of acute pulmonary embolism (APE) is estimated at 1-2 per 1,000 persons with VTE responsible for 60,000-100,000 deaths annually. This is likely an underestimate given 10-30% will die within one month of diagnosis. Catheter directed thrombolysis (CDT) has been shown to improve right ventricular (RV) function, however it is unknown if clot distribution is a predictor of RV recovery. Additionally, it is unknown if thrombolytic bolus dosing impacts RV recovery after CDT. Methods We conducted a retrospective review of patients in our Pulmonary Embolism Response Team (PERT) database from May 2017 to present who had undergone CDT due to RV strain on either chest computed tomography (CT) or echocardiogram RV strain on CT was defined as RV/LV ratio > 0.9, flattening of the interventricular septum, and reflux of contrast into the venous circulation (Dudzinski et. al 2016). RV strain on echo was defined as RV dilation > 1:1 and tricuspid annular plane systolic excursion (TAPSE) < 1.8 (Roberts et. al 2011). Clot burden was defined by the Miller score (Ouriel et. al 2017) and most central location of the embolism. The primary endpoint of RV recovery was defined as no RV dilation and TAPSE > 1.8 post CDT. Results 101 patients underwent CDT with a mean age of 57; 51% were male. The proportion of patients with main pulmonary artery and saddle APE were 91% and 36% respectively. Univariate associations with RV recovery were carried out using chisquared or Fisher's exact tests for categorical variables and analysis of variance for continuous variables (statistical significance p < 0.05). At 24-72 hours and 3 months, 12/48 (25%) and 34/48 (71%) patients respectively had RV recovery. Clot distribution was not significantly associated with RV recovery, nor was the Miller score. Higher dose lytic bolus was associated with increased RV recovery (p=0.016) and more significant non-fatal bleeding events. Elevated heart rate (HR) initially was associated with inability to recover RV function (HR 99.7 ± 14.3 without RV recovery; and 92.2 ± 13.6 with RV recovery) (p=0.028). Conclusions Distribution of APE does not appear to influence RV recovery after CDT. As expected, 100% of patients with echocardiographic data at 3 months recovered RV function. Bolus dose of lytic and HR prior to CDT appear to be associated with RV recovery. To our knowledge, this is the first study to indicate that higher dose lytic bolus during CDT is associated with RV recovery. AD - J. Hines, Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI, United States AU - Hines, J. AU - Floyd, M. AU - Ismail, R. AU - Le, P. AU - Grafton, G. AU - Kelly, B. AU - Hegab, S. AU - Awdish, R. L. DB - Embase KW - adult analysis of variance bleeding catheter directed thrombolysis computer assisted tomography conference abstract controlled study drug megadose echocardiography female heart rate heart right ventricle heart ventricle function human incidence interventricular septum major clinical study male middle aged pulmonary artery pulmonary embolism response team remission retrospective study statistical significance thorax tricuspid annular plane systolic excursion venous circulation LA - English M1 - 1 M3 - Conference Abstract N1 - L632376126 2020-07-27 PY - 2020 SN - 1535-4970 ST - Clot distribution in pulmonary embolism does not influence right ventricular recovery T2 - American Journal of Respiratory and Critical Care Medicine TI - Clot distribution in pulmonary embolism does not influence right ventricular recovery UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632376126&from=export VL - 201 ID - 760633 ER - TY - JOUR AB - Venous thromboembolism (VTE) is a preventable and potentially life-threatening complication of hospital admission. VTE can be prevented by effective screening of patients for VTE risk and prescribing pharmacological or mechanical prophylaxis. National Institute for Health and Care Excellence (NICE) guidelines recommend that all patients admitted to hospital should be assessed for VTE risk and assigned VTE prophylaxis accordingly1. The NHS standard contract reflects this guidance, mandating that hospitals should aim for at least 95% of patients to have a VTE risk assessment on admission, with financial penalties for those that fail to comply2. In our trust, a small district general hospital, we had failed to meet this target since April 2016 and VTE risk assessment had dropped to below 50% by June 2017. Our aim was to achieve 95% VTE risk assessment and improve VTE risk management in general. We set up a multidisciplinary task force of junior doctors and clerical staff to champion VTE risk management through quality improvement (QI) methodology, aiming to improve practice by using multiple plan-do-study-act (PDSA) cycles. Our task force was supported by senior management and co-ordinated through our hos-pital's QI 'hub'. In our first PDSA cycle, we researched our task using a driver diagram based approach and surveyed junior doctors to identify the main barriers to VTE risk assessment. To monitor our performance a clerk was employed to audit monthly data on compliance with VTE risk assessment. Our primary intervention was education through a series of semi-nars and bulletins aimed at informing and empowering junior doctors. Awareness was further raised by a poster campaign highlighting the importance of VTE risk assessment. During our second PDSA cycle, we widened the spectrum of our approach to include other members of the multidisciplinary team: Senior nurses and clerical staff on admission wards were recruited as 'VTE champions'. The 'VTE champions' role was to identify outstanding VTE risk assessments and prompt junior doctors to complete them. Our driver diagram and junior doctor survey highlighted the main barriers to VTE risk assessment as education and awareness, having results available and having the support of senior colleagues for decision making. VTE risk assessment completion rose from 50% in June 2017 to 88% in September 2017 following our first PDSA cycle and 94% in November 2017 following our second PDSA cycle. We aim to achieve above 95% in the near future. By championing VTE and flattening hierarchy using QI methodology and education our task force has helped to drastically improve VTE risk assessment completion rates. We have helped to raise awareness of the importance of VTE risk management through a multidisciplinary approach. Our intervention has helped ensure the trust avoids financial sanction of up to £2million, which is vital for the ongoing success of our small trust. More importantly, we have helped to improve patient safety through better VTE risk management. The success of our task force highlights what can be achieved by empowering junior doctors to partake in QI, with the support of a QI 'hub' and senior management. AD - R. Hinton, Weston Area Health NHS Trust, Weston Super Mare, United Kingdom AU - Hinton, R. AU - China, Z. AU - Brammar, L. AU - Burrows, A. AU - Collins, P. DB - Embase DO - 10.1111/bjh.15226 KW - adult awareness conference abstract decision making driver education general hospital human nurse patient safety prophylaxis punishment risk assessment risk management staff total quality management trust venous thromboembolism LA - English M3 - Conference Abstract N1 - L622079019 2018-05-16 PY - 2018 SN - 1365-2141 SP - 55 ST - Championing venous thromboembolism (VTE): Empowering junior doctors to improve vte prophylaxis T2 - British Journal of Haematology TI - Championing venous thromboembolism (VTE): Empowering junior doctors to improve vte prophylaxis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622079019&from=export http://dx.doi.org/10.1111/bjh.15226 VL - 181 ID - 760832 ER - TY - JOUR AB - Background: Both incidence and prevalence of stroke will increase in the coming decades, due to demographic changes with a more aged population and increased stroke survival. An optimized rehabilitation outcome is therefore essential from both the individual and societal point of view. Early discharge from hospital is cost-effective. In Early Supported Discharge (ESD) stroke patients are discharged home as soon as possible, but with support from a multidisciplinary team and rehabilitative treatment in the community. Studies conducted 10-15 years ago indicate that this is equal to or better than traditional in-hospital treatment, but the essential components are mostly unclarified. Methods: We conducted an RCT with 306 acute stroke patients randomized into one of two different ESD arms or a control arm. The ESD arms differed in the location for the rehabilitative treatment after discharge: either in a day unit or in the patients' homes. The control patients were treated according to ordinary procedures. The main outcome was modified Rankin Scale (mRS), in addition to several secondary outcomes. Patient data were collected at 0, 3 and 6 months after stroke and analysed using regression statistics. Results: Baseline characteristics were not different between the groups. 55.2 % of the patients were male and 44.8 % female, with a mean age of 69.8 years (males) and 75.5 years (females). On follow-up all the groups performed well with mean mRS of 2.36/2.32 (3/6 months), mean Barthel Index of 86.7/87.5, and mean NIHSS of 3.05/2.55. There were only minor differences between the groups, but the home treatment-group did a little better at both time points. Detailed results will be presented at the conference. Interpretation: Although differences between groups did not reach statistical significance, ESD performed at least as well as ordinary treatment and best with the home rehabilitation group. This demonstrates that early discharge is safe in the present context. Most previous studies were conducted 1-2 decades ago when thrombolysis had not been introduced and prophylactic treatment was less developed than today, and this may partly explain the more uniformly good results now. AD - H. Hofstad, Haukeland Univ Hosp, Bergen, Norway AU - Hofstad, H. AU - Eide, G. E. AU - Moe-Nilssen, R. AU - Næss, H. AU - Skouen, J. S. DB - Embase KW - cerebrovascular accident hospital patient Norway nursing human home rehabilitation rehabilitation heart arm patient stroke patient hospital female male prevalence Rankin scale prophylaxis procedures blood clot lysis home care Barthel index community survival follow up statistical significance statistics patient coding population National Institutes of Health Stroke Scale LA - English M1 - 2 M3 - Conference Abstract N1 - L71144145 2013-08-26 PY - 2013 SN - 0039-2499 ST - Early supported discharge after stroke in bergen, norway: No significant difference from in-patient treatment, but home rehabilitation may be better T2 - Stroke TI - Early supported discharge after stroke in bergen, norway: No significant difference from in-patient treatment, but home rehabilitation may be better UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71144145&from=export VL - 44 ID - 761179 ER - TY - JOUR AB - The department of trauma at a Level 1 trauma center sought to improve outcomes by enhancing the continuity of care for patients admitted to trauma services. Departmental leadership explored opportunities to improve this aspect of patient care through expansion of existing trauma nurse practitioner (NP) services. The restructured trauma NP service model was implemented in September 2013. A retrospective study was conducted with patients who presented at the trauma center between September 2012 and August 2015. Patients with at least a 24-hr hospital length of stay (LOS) were separated into 3 comparator groups by 12-month increments: 12 months pre-, 12 months during, and 12 months postimplementation. Data revealed improvement in hospital LOS, intensive care unit LOS, time to place rehabilitation consultation, and placement of discharge orders before noon. A significant decline in the rate of complications including pneumonia and deep vein thrombosis (DVT) was also noted. Accordingly, expansion of the trauma NP model resulted in significant improvements in patient and process of care outcomes. This model for NP services may prove to be beneficial for acute care settings at other hospitals with high volume trauma services. AD - Center for Health Services and Outcomes Research, Charleston Area Medical Center, Charleston, West Virginia (Ms Samanta and Dr Bethea); Charleston Area Medical Center, Charleston, West Virginia (Mss Holliday, Budinger, and Hardway). AN - 29117053 AU - Holliday, A. AU - Samanta, D. AU - Budinger, J. AU - Hardway, J. AU - Bethea, A. C2 - Pmc5929127 C6 - NIHMS904567 Samanta has no conflict of interest to report. Julie Budinger has no conflict of interest to report. Jessica Hardway has no conflict of interest to report. Audis Bethea has no conflict of interest to report. DA - Nov/Dec DO - 10.1097/jtn.0000000000000327 DP - NLM ET - 2017/11/09 J2 - Journal of trauma nursing : the official journal of the Society of Trauma Nurses KW - Academic Medical Centers Adult Aged Cohort Studies Critical Care/*methods Critical Care Nursing/organization & administration Female Humans Length of Stay Male Middle Aged Nurse Practitioners/*organization & administration Nurse's Role Organizational Innovation *Outcome Assessment, Health Care Patient Admission/statistics & numerical data Patient Care Team/organization & administration Patient Discharge/statistics & numerical data Patient Readmission/statistics & numerical data Quality Improvement Retrospective Studies Trauma Centers/*organization & administration Wounds and Injuries/diagnosis/*nursing Young Adult LA - eng M1 - 6 N1 - Holliday, Anna Samanta, Damayanti Budinger, Julie Hardway, Jessica Bethea, Audis U54 GM104942/GM/NIGMS NIH HHS/United States Evaluation Study Journal Article J Trauma Nurs. 2017 Nov/Dec;24(6):365-370. doi: 10.1097/JTN.0000000000000327. PY - 2017 SN - 1078-7496 (Print) 1078-7496 SP - 365-370 ST - An Outcome Analysis of Nurse Practitioners in Acute Care Trauma Services T2 - J Trauma Nurs TI - An Outcome Analysis of Nurse Practitioners in Acute Care Trauma Services VL - 24 ID - 760118 ER - TY - JOUR AB - Background: Select patients with rectal adenocarcinoma with metastatic disease at presentation can be cured with multimodality management. However, the optimal components and sequencing of therapy is unknown. The aim of this study is to evaluate outcomes for patients treated with chemotherapy, short course radiation therapy (SCRT) and surgical resection. Methods: Patients with newly diagnosed metastatic rectal adenocarcinoma who received SCRT from 2010-2016 were identified. All patients were evaluated by a multidisciplinary team and deemed candidates for treatment with curative intent. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Patient, tumor and treatment characteristics were evaluated as prognostic factors using a Cox proportional hazards model. Results: Thirty-four patients were included with a median [interquartile range (IQR)] follow-up of 25 (14.75-42.25) months; 26 patients (76.5%) received definitive surgery for their rectal tumor, and 24 patients (70.6%) received definitive local management of metastatic disease. One-, 2- and 3-year OS were 97%, 86.2% and 76.0%, respectively, and 1-, 2-, and 3-year PFS were 52.1%, 22.7% and 17%, respectively. On multivariate analysis, definitive management of metastases was associated with improved OS [hazard ratio (HR) 0.03, 95% confidence interval (CI): 0.01-0.33]; P=0.003, and =≤ months of neoadjuvant chemotherapy was associated with decreased OS (HR 11.7, 95% CI: 2.11-106; P=0.004). Conclusions: These findings suggest that SCRT can be successfully integrated into a definitive, multidisciplinary approach to metastatic rectal adenocarcinoma. Benefits to this approach include decreased time off systemic therapy as compared to standard course RT. Further study is needed to determine the optimum interval between SCRT and surgery. AD - E.B. Holliday, Division of Radiation Oncology, MD Anderson Cancer Center, The University of Texas, 1515 Holcombe Blvd. Unit 97, Houston, TX, United States AU - Holliday, E. B. AU - Hunt, A. AU - Nancy You, Y. AU - Chang, G. J. AU - Skibber, J. M. AU - Rodriguez-Bigas, M. A. AU - Bednarski, B. K. AU - Eng, C. AU - Koay, E. J. AU - Minsky, B. D. AU - Taniguchi, C. AU - Krishnan, S. AU - Herman, J. M. AU - Das, P. DB - Embase DO - 10.21037/jgo.2017.09.02 KW - bevacizumab capecitabine fluorouracil folinic acid irinotecan oxaliplatin adult anastomosis leakage article cancer prognosis cancer radiotherapy cancer surgery clinical article controlled study dehydration diarrhea female heart infarction human intensity modulated radiation therapy lung embolism male nausea overall survival pelvis abscess postoperative complication progression free survival radiation dose radiation injury radiation safety radiofrequency ablation rectum carcinoma rectum surgery small intestine obstruction surgical infection treatment duration treatment response LA - English M1 - 6 M3 - Article N1 - L619509843 2017-12-07 2017-12-12 PY - 2017 SN - 2219-679X 2078-6891 SP - 990-997 ST - Short course radiation as a component of definitive multidisciplinary treatment for select patients with metastatic rectal adenocarcinoma T2 - Journal of Gastrointestinal Oncology TI - Short course radiation as a component of definitive multidisciplinary treatment for select patients with metastatic rectal adenocarcinoma UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619509843&from=export http://dx.doi.org/10.21037/jgo.2017.09.02 VL - 8 ID - 760885 ER - TY - JOUR AB - OBJECTIVE: To determine the association of a central-line maintenance team on the incidence of central-line-associated bloodstream infections (CLABSIs) in the neonatal intensive care unit (NICU). STUDY DESIGN: Central line maintenance in the NICU was limited to a line team starting in March 2008. CLABSI rates were determined before (December 2006 to February 2008) and after implementation of the line team ( March 2008 to August 2010) utilizing consistent National Healthcare Safety Network definitions. Rates were calculated by birth weight categories and overall. Data analysis was performed by two-proportion t test using Minitab. RESULT: Overall CLABSI decreased by 65% after implementation of the line team. Pre intervention, mean overall CLABSI rate was 11.6 /1000, as compared with 4.0/1000 after intervention (P<0.001). Birth-weight-specific CLABSI rates also decreased significantly. Decreased infection rates were sustained over time. CONCLUSION: A line team provided for standardized, consistent central-line maintenance care leading to a significant, sustained decrease in CLABSI in a NICU. AD - Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA. Holzmann-Pazgal@uth.tmc.edu AN - 22011970 AU - Holzmann-Pazgal, G. AU - Kubanda, A. AU - Davis, K. AU - Khan, A. M. AU - Brumley, K. AU - Denson, S. E. DA - Apr DO - 10.1038/jp.2011.91 DP - NLM ET - 2011/10/21 J2 - Journal of perinatology : official journal of the California Perinatal Association KW - Bacteremia/epidemiology/etiology/nursing/*prevention & control Birth Weight Catheter-Related Infections/epidemiology/etiology/nursing/*prevention & control Catheterization, Central Venous/*adverse effects/*nursing Catheters, Indwelling/*microbiology Checklist Cross Infection/epidemiology/etiology/nursing/*prevention & control Cross-Sectional Studies Humans Infant, Newborn *Intensive Care Units, Neonatal *Nursing, Team Risk Factors Sepsis/epidemiology/etiology/nursing/*prevention & control Texas LA - eng M1 - 4 N1 - 1476-5543 Holzmann-Pazgal, G Kubanda, A Davis, K Khan, A M Brumley, K Denson, S E Journal Article United States J Perinatol. 2012 Apr;32(4):281-6. doi: 10.1038/jp.2011.91. Epub 2011 Oct 20. PY - 2012 SN - 0743-8346 SP - 281-6 ST - Utilizing a line maintenance team to reduce central-line-associated bloodstream infections in a neonatal intensive care unit T2 - J Perinatol TI - Utilizing a line maintenance team to reduce central-line-associated bloodstream infections in a neonatal intensive care unit VL - 32 ID - 760436 ER - TY - JOUR AU - Hooks, B. AU - Sharma, V. AU - Taylor, G. AU - Wadhwani, S. AU - Ehtesham, M. DA - 2019/11/27 11/27 DB - Europe PubMed Central DO - 10.1177/1538574419885275 M1 - 2 PY - 2019 SN - 1538-5744 SP - 135-140 ST - Outcome Measures for Acute Submassive Pulmonary Embolisms at a Community-Based Hospital Using Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis T2 - Vasc Endovascular Surg TI - Outcome Measures for Acute Submassive Pulmonary Embolisms at a Community-Based Hospital Using Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis UR - http://europepmc.org/article/MED/31769352 VL - 54 ID - 762067 ER - TY - JOUR AB - PURPOSE: Ultrasound-facilitated, catheter-directed, low-dose fibrinolysis (USAT) appears to provide promising results for the management of acute submassive pulmonary embolisms (ASMPEs) at tertiary care centers. This study assessed outcome measures at a community-based hospital systems and compared results to known studies. MATERIALS AND METHODS: This is a single-center, retrospective study assessing clinical outcomes of the EkoSonic Endovascular System intervention for ASMPEs performed by three surgical 3 subspecialties (interventional radiology, interventional cardiology, and vascular surgery) part of a pulmonary embolism response team (PERT). We reviewed 146 PERT activations from June 2013 to December 2017. Eighty-three patients with ASMPEs underwent USAT. RESULTS: Our study showed greater differences (P = .01) between baseline and follow-up pulmonary artery systolic pressures (20.9 ± 9.8 mm Hg [n = 14]) compared to the ULTIMA study (12.3 ± 10 mm Hg [n = 30]). Our length-of-stay measures were shorter (6.1 ± 5.1 [n = 83]; P = .0001) compared to the SEATTLE II study (8.8 ± 5.0 [n = 150]). Preprocedure transthoracic echocardiograms (TTEs) were performed for 54 (65%) of 83 patients. Postprocedure TTEs at 48 hours was performed for 52 (62%) of 83 patients. Use of TTEs before and after intervention did not change outcomes. Intracranial hemorrhage was not observed in our patient population. There was no difference in outcomes between the three subspecialties in our study. CONCLUSIONS: Use of USAT in a community-based hospital PERT has similar outcomes to tertiary care centers. Furthermore, similar outcomes were observed between the three subspecialties suggesting development of a comprehensive care team for management of ASMPEs. AD - Division of Pulmonary and Critical Care Medicine, Ascension Providence-Providence Park Hospital, Novi, MI, USA. Michigan State University College of Human Medicine, East Lansing, MI, USA. Department of Internal Medicine, Ascension Providence-Providence Park Hospital, Novi, MI, USA. AN - 31769352 AU - Hooks, B. AU - Sharma, V. AU - Taylor, G. AU - Wadhwani, S. AU - Ehtesham, M. DA - Feb DO - 10.1177/1538574419885275 DP - NLM ET - 2019/11/27 J2 - Vascular and endovascular surgery KW - Acute Disease Adult Aged Cardiologists *Catheterization, Peripheral/adverse effects Female Fibrinolytic Agents/*administration & dosage/adverse effects *Hospitals, Community Humans Infusions, Intra-Arterial Male Michigan Middle Aged Pulmonary Embolism/diagnostic imaging/physiopathology/*therapy Radiologists Retrospective Studies Specialization Surgeons Thrombolytic Therapy/adverse effects/*methods Time Factors Treatment Outcome *Ultrasonic Therapy/adverse effects catheter-directed therapy pulmonary embolism ultrasound-facilitated LA - eng M1 - 2 N1 - 1938-9116 Hooks, Brandon Orcid: 0000-0001-7322-250x Sharma, Vinay Taylor, Gavin Wadhwani, Sumeet Ehtesham, Muhammad Comparative Study Journal Article United States Vasc Endovascular Surg. 2020 Feb;54(2):135-140. doi: 10.1177/1538574419885275. Epub 2019 Nov 26. PY - 2020 SN - 1538-5744 SP - 135-140 ST - Outcome Measures for Acute Submassive Pulmonary Embolisms at a Community-Based Hospital Using Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis T2 - Vasc Endovascular Surg TI - Outcome Measures for Acute Submassive Pulmonary Embolisms at a Community-Based Hospital Using Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis VL - 54 ID - 760180 ER - TY - JOUR AB - The aim of this study was to investigate the utility of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) to predict all-cause mortality in patients presenting with acute pulmonary embolism (PE). Three hundred consecutive patients with acute PE between March 2016 and December 2018 were retrospectively analyzed. We identified 191 patients who met the study inclusion criteria. Twenty-eight patients died during the study period. There was a significant difference in PLR, but not NLR, between patients with low risk, submassive, and massive risk PE (P = .02 and P = .58, respectively, by the Kruskal-Wallis test). Elevated NLR and PLR were associated with all-cause mortality (P < .01 and P < .01, respectively). Neutrophil-to-lymphocyte ratio of 5.46 was associated with all-cause mortality with sensitivity of 75.0% and specificity of 66.9% (area under the curve [AUC]: 0.692 [95% confidence interval, CI]: 0.568-0.816); P < .01). Platelet-to-lymphocyte ratio of 256.6 was associated with all-cause mortality with sensitivity of 53.6% and specificity of 82.2% (AUC: 0.693 [95% CI: 0.580-0.805]; P < .01). Neutrophil-to-lymphocyte ratio and PLR are simple biomarkers that are readily available from routine laboratory values and may be useful components of PE risk prediction models. PMID:31960711 AU - Hoppensteadt, Debra AU - Iqbal, Omer AU - Darki, Amir DA - 2020/01/21 01/21 DB - PubMed Central DO - 10.1177/1076029619900549 KW - acute pulmonary embolism neutrophil-to-lymphocyte ratio platelet-to-lymphocyte ratio NLR PLR inflammation PY - 2020 SN - 1076-0296 ST - Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict All-Cause Mortality in Acute Pulmonary Embolism T2 - Clinical and Applied Thrombosis/Hemostasis TI - Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict All-Cause Mortality in Acute Pulmonary Embolism UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7098206&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7098206 VL - 26 ID - 762061 ER - TY - JOUR AB - Background: Stroke is a leading cause of disability in Ireland. The objectives of this project were to analyse the current access to in-patient stroke services and multidisciplinary team (MDT) rehabilitation in an acute stroke centre. Methods: A retrospective analysis was carried out on all patients admitted to Beaumont hospital with acute stroke over a three-month period (March-May 2012). Time to referral and assessment, time spent in rehabilitation and the interventions implemented by the medical and MDT were evaluated. Demographic information was also recorded. Results: There were 73 patients (male=40, 54.8%), mean age was 68 (s.d.= 15.1). Patients were discharged from the stroke service after a mean length of stay of 20.2 days (s.d.= 19.3). Over three quarters (76.7%, N=56) of patients were admitted to the acute stroke unit (ASU). Length of stay in the ASU was 14.6 days (s.d.=15.1). The majority (97.3%, N=71) had a brain scan and 13.7% (n=10) received thrombolysis. The mean length of time from admission to general MDT referral was 2 days (s.d.=2.16), mean length of time from referral to first assessment was 1.49 days (s.d.=1.64), with length of treatment 17.9 days (s.d.=24.1). Patients received approximately 23-47 minutes per discipline per day, by up to four disciplines (Physiotherapy, Occupational Therapy, Speech and Language Therapy and Dietetics and Nutrition). Conclusion: Nearly a quarter (23.3%, N=17) of stroke patients were not treated in the ASU. There was on average a two-day delay in referral to the various MDT services, the national guidelines recommend that all stroke patients should receive a full MDT assessment within 24 hours. However, once referred patients were generally reviewed within a 24-hour window. These findings describe current demands on a stroke service in one clinical site and give an insight into inpatient service capacity issues which can impact on meeting standards of stroke care. AD - N.F. Horgan, Royal College of Surgeons in Ireland, Dublin, Ireland AU - Horgan, N. F. AU - O'Sullivan, E. AU - Shanahan, J. AU - Kirrane, K. AU - Armitage, D. AU - Leahy, W. AU - O'Flaherty, E. AU - Williams, D. DB - Embase KW - aged blood clot lysis brain scintiscanning dietetics hospital patient human length of stay major clinical study male nutrition occupational therapy patient referral physiotherapy practice guideline rehabilitation retrospective study speech and language rehabilitation stroke patient stroke unit treatment duration LA - English M3 - Conference Abstract N1 - L614325612 2017-02-10 PY - 2014 SN - 1421-9786 SP - 312 ST - Access to in-patient stroke services and multidisciplinary team (MDT) rehabilitation: Current demands and capacity T2 - Cerebrovascular Diseases TI - Access to in-patient stroke services and multidisciplinary team (MDT) rehabilitation: Current demands and capacity UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614325612&from=export VL - 37 ID - 761112 ER - TY - JOUR AB - Objectives: This survey sought to characterize the national prescribing patterns and barriers to the use of thrombolytic agents in the treatment of pulmonary embolism, with a specific focus on treatment during actual or imminent cardiac arrest. Design: A 19-question international, cross-sectional survey on thrombolytic use in pulmonary embolism was developed, validated, and administered. A multivariable logistic regression was conducted to determine factors predictive of utilization of thrombolytics in the setting of cardiac arrest secondary to pulmonary embolism. Setting: International survey study. Subjects: Physicians, pharmacists, nurses, and other healthcare professionals who were members of the Society of Critical Care Medicine. Interventions: None. Measurements and Main Results: Thrombolytic users were compared with nonusers. Respondents (n = 272) predominately were physicians (62.1%) or pharmacists (30.5%) practicing in an academic medical center (54.8%) or community teaching setting (24.6%). Thrombolytic users (n = 177; 66.8%) were compared with nonusers (n = 88; 33.2%) Thrombolytic users were more likely to work in pulmonary/critical care (80.2% thrombolytic use vs 59.8%; p < 0.01) and emergency medicine (6.8% vs 3.5%; p < 0.01). Users were more likely to have an institutional guideline or policy in place pertaining to the use of thrombolytics in cardiac arrest (27.8% vs 13.6%; p < 0.01) or have a pulmonary embolism response team (38.6% vs 19.3%; p < 0.01). Lack of evidence supporting use and the risk of adverse outcomes were barriers to thrombolytic use. Working in a pulmonary/critical care environment (odds ratio, 2.36; 95% CI, 1.24–4.52) and comfort level (odds ratio, 2.77; 95% CI, 1.7–4.53) were predictive of thrombolytic use in the multivariable analysis. Conclusions: Most survey respondents used thrombolytics in the setting of cardiac arrest secondary to known or suspected pulmonary embolism. This survey study adds important data to the literature surrounding thrombolytics for pulmonary embolism as it describes thrombolytic user characteristic, barriers to use, and common prescribing practices internationally. AU - Horng, Michelle AU - Holzhausen, Jenna M. AU - Van Berkel, Megan A. AU - Sokol, Sarah S. AU - Peppard, Sarah AU - Hammond, Drayton A. DA - 2020/06/09 06/09 DB - PubMed Central DO - 10.1097/CCE.0000000000000132 KW - cardiac arrest massive pulmonary embolism pulmonary embolism thrombolytic M1 - 6 PY - 2020 SN - 2639-8028 ST - International Survey of Thrombolytic Use for Treatment of Cardiac Arrest Due to Massive Pulmonary Embolism T2 - Critical Care Explorations TI - International Survey of Thrombolytic Use for Treatment of Cardiac Arrest Due to Massive Pulmonary Embolism UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7314323&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7314323 VL - 2 ID - 762001 ER - TY - JOUR AB - Background Primary percutaneous coronary intervention (PPCI) has led to improved mortality, reduced rates of recurrent ischaemia and shorter hospital stays compared to thrombolysis. Data from our centre published previously show that in low-risk patients very early discharge at 48 h is feasible and safe. We investigated whether in a group of low risk patients stratified to 48-h discharge, 24-h discharge would be potentially feasible. Methods We undertook an observational study at an interventional cardiology centre involving 2980 patients who underwent Primary PCI from January 2004 to July 2011. Patients with TIMI 3 flow, ST segment resolution, good or moderate left ventricular function, and no dysrhythmia post-PPCI were discharged at 2 days. Remaining higher risk patients were discharged when judged clinically fit. All patients were offered outpatient review by a multidisciplinary team. Follow-up was collected for a median of 2.8 years (IQR 1.3-4.4 years). Results Of the 2980 patients, 1174 (39.4%) were judged suitable for 48-h discharge. Of these, 964 patients (82.1%) were discharged at 48 h, with 210 discharged after longer inpatient stays. Of these 210 patients discharged after 2 days, 150 were delayed due to timing issues (admission at unsociable hours, eg, 01:00). 60 (5.1%) patients fitting criteria had their planned 48-h discharge delayed due to a clinical complication, of which 53 occurred within the first 24 h (including six MACE events and seven arrhythmias, there were no deaths) (Abstract 048 table 1). Only seven patients (0.60%) developed complications after 24 h, of which only 1 (0.09%) suffered a MACE event (target vessel revascularisation), with the remaining complications being abnormal blood tests (renal/liver function) or drug reactions (eg, rash). There were no in-hospital deaths in the 48-h group Conclusion Simple clinical criteria can be used to identify low-risk patients suitable for very early discharge 48 h following uncomplicated successful primary PPCI. With only a small percentage of complications occurring after the first 24 h, discharge after 24 h may be safe and warrants further study. AD - J.P. Howar, Barts and the London NHS Trust, United Kingdom AU - Howar, J. P. AU - Jone, D. A. AU - Gallaghe, S. AU - Ratho, K. AU - Jai, A. AU - Mohiddi, S. AU - Knigh, C. AU - Mathu, A. AU - Smit, E. J. AU - Wra, A. DB - Embase DO - 10.1136/heartjnl-2012-301877b.48 KW - human percutaneous coronary intervention society patient risk death observational study blood clot lysis mortality follow up hospital patient revascularization hospitalization heart left ventricle function ST segment rash high risk patient outpatient heart arrhythmia cardiology ischemia blood hospital LA - English M3 - Conference Abstract N1 - L70975024 2013-01-30 PY - 2012 SN - 1355-6037 SP - A26-A27 ST - Is it safe to discharge patients 24 h after uncomplicated successful primary percutaneous coronary intervention T2 - Heart TI - Is it safe to discharge patients 24 h after uncomplicated successful primary percutaneous coronary intervention UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70975024&from=export http://dx.doi.org/10.1136/heartjnl-2012-301877b.48 VL - 98 ID - 761204 ER - TY - JOUR AB - Pulmonary embolism, despite being common, often remains elusive as a diagnosis, and clinical suspicion needs to remain high when seeing a patient with cardiopulmonary symptoms. Once suspected, diagnosis is usually straightforward; however, optimal treatment can be difficult. Risk stratification with clinical scores, biomarkers and imaging helps to refine the best treatment strategy, but the position of thrombolysis in intermediate risk (submassive) pulmonary embolism remains a grey area. Pulmonary embolism response teams are on the increase to provide advice in such cases. Direct oral anticoagulants have been a major advance in treatment this decade, but are not appropriate for all patients. Follow-up of patients with pulmonary embolism should be mandatory to determine duration of anticoagulation and to assess for serious long-term complications. AD - L. Howard, National Pulmonary Hypertension Service, Dept of Cardiology, Hammersmith Hospital, Imperial College Healthcare, NHS Trust, Du Cane Road, London, United Kingdom AU - Howard, L. DB - Embase Medline DO - 10.7861/clinmedicine.19-3-247 KW - amino terminal pro brain natriuretic peptide apixaban D dimer dabigatran edoxaban low molecular weight heparin rivaroxaban troponin warfarin acute pulmonary embolism age anticoagulant therapy article breathing rate computer assisted tomography disease severity assessment Doppler flowmetry echocardiography follow up heart failure heart right ventricle failure high risk patient hospital admission human intermediate risk patient intracardiac thrombosis low risk patient lung angiography lung embolism malignant neoplasm mortality risk pregnancy pulmonary embolism response team Pulmonary Embolism Severity Index pulmonary hypertension right heart thrombus scoring system simplified Pulmonary Embolism Severity Index systolic blood pressure ventilation-perfusion scan Wells score LA - English M1 - 3 M3 - Article N1 - L2002092570 2019-06-25 2019-07-01 PY - 2019 SN - 1473-4893 1470-2118 SP - 243-247 ST - Acute pulmonary embolism T2 - Clinical Medicine, Journal of the Royal College of Physicians of London TI - Acute pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002092570&from=export http://dx.doi.org/10.7861/clinmedicine.19-3-247 VL - 19 ID - 760715 ER - TY - JOUR AB - BACKGROUND AND PURPOSE: Anecdotal evidence suggests that the coronavirus disease 2019 (COVID-19) pandemic mitigation efforts may inadvertently discourage patients from seeking treatment for stroke with resultant increased morbidity and mortality. Analysis of regional data, while hospital capacities for acute stroke care remained fully available, offers an opportunity to assess this. We report regional Stroke Team acute activations and reperfusion treatments during COVID-19 mitigation activities. METHODS: Using case log data prospectively collected by a Stroke Team exclusively serving ≈2 million inhabitants and 30 healthcare facilities, we retrospectively reviewed volumes of consultations and reperfusion treatments for acute ischemic stroke. We compared volumes before and after announcements of COVID-19 mitigation measures and the prior calendar year. RESULTS: Compared with the 10 weeks prior, stroke consultations declined by 39% (95% CI, 32%-46%) in the 5 weeks after announcement of statewide school and restaurant closures in Ohio, Kentucky, and Indiana. Results compared with the prior year and time trend analyses were consistent. Reperfusion treatments also appeared to decline by 31% (95% CI, 3%-51%), and specifically thrombolysis by 33% (95% CI, 4%-55%), but this finding had less precision. CONCLUSIONS: Upon the announcement of measures to mitigate COVID-19, regional acute stroke consultations declined significantly. Reperfusion treatment rates, particularly thrombolysis, also appeared to decline qualitatively, and this finding requires further study. Urgent public education is necessary to mitigate a possible crisis of avoiding essential emergency care due to COVID-19. AD - Department of Neurology (J.H., E.S., E.A., R. J. S., J.P.B., S. L. D., M.L.F., A. W. G., P.S., P.K.), University of Cincinnati, OH. Division of Biostatistics (H.S.), Cincinnati Children's Hospital Medical Center, OH. Department of Emergency Medicine (C.K., N.K., K.B.W., O.A.), University of Cincinnati, OH. Division of Neurology (K.P.), Cincinnati Children's Hospital Medical Center, OH. Department of Neurosurgery (C. J. P.), University of Cincinnati, OH. Department of Communications, Hamilton County, Cincinnati, OH (H.L.). AN - 32639860 AU - Hsiao, J. AU - Sayles, E. AU - Antzoulatos, E. AU - Stanton, R. J. AU - Sucharew, H. AU - Broderick, J. P. AU - Demel, S. L. AU - Flaherty, M. L. AU - Grossman, A. W. AU - Kircher, C. AU - Kreitzer, N. AU - Peariso, K. AU - Prestigiacomo, C. J. AU - Shirani, P. AU - Walsh, K. B. AU - Lampton, H. AU - Adeoye, O. AU - Khatri, P. C2 - Pmc7359904 DA - Sep DO - 10.1161/strokeaha.120.030499 DP - NLM ET - 2020/07/09 J2 - Stroke KW - Coronavirus Infections/*complications/epidemiology/*therapy Humans Indiana/epidemiology Kentucky/epidemiology Ohio/epidemiology Pandemics Patient Care Team Pneumonia, Viral/*complications/epidemiology/*therapy Prospective Studies Referral and Consultation/statistics & numerical data Reperfusion Stroke/*complications/epidemiology/*therapy Thrombectomy Thrombolytic Therapy/statistics & numerical data Time-to-Treatment Treatment Outcome *pandemics *reperfusion *restaurants *stroke *viruses LA - eng M1 - 9 N1 - 1524-4628 Hsiao, Jessica Sayles, Emily Antzoulatos, Eleni Stanton, Robert J Sucharew, Heidi Broderick, Joseph P Demel, Stacie L Flaherty, Matthew L Grossman, Aaron W Kircher, Charles Kreitzer, Natalie Peariso, Katrina Prestigiacomo, Charles J Shirani, Peyman Walsh, Kyle B Lampton, Holly Adeoye, Opeolu Khatri, Pooja U24 NS107241/NS/NINDS NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Stroke. 2020 Sep;51(9):e2111-e2114. doi: 10.1161/STROKEAHA.120.030499. Epub 2020 Jul 8. PY - 2020 SN - 0039-2499 (Print) 0039-2499 SP - e2111-e2114 ST - Effect of COVID-19 on Emergent Stroke Care: A Regional Experience T2 - Stroke TI - Effect of COVID-19 on Emergent Stroke Care: A Regional Experience VL - 51 ID - 760311 ER - TY - JOUR AB - Objectives: To define the early and midterm outcomes after thoracic endovascular aortic repair (TEVAR) of blunt thoracic aortic injury (BTAI). Methods: Clinical data of consecutive patients who underwent TEVAR (2006-2017) for BTAI were retrospectively reviewed. Primary end points were major adverse events and mortality; secondary end points were complications and reinterventions. Results: Eighteen patients underwent TEVAR for BTAI (female, 11, 61%; median age, 29 years, range, 16-85 years). Cause of trauma included motor vehicle accident (n = 15, 83%), motorcycle accident (n = 1, 5.6%), and fall (n = 2, 11%); median injury severity score was 36 (range: 4-59). Aortic injuries involved zones 2 to 3 (n = 1), zone 3 (n = 12), zones 3 to 4 (n = 3), and zone 5 (n = 2). TEVAR was performed at a median of 1 day (range: 0-6 days) from aortic injury, devices from 3 manufacturers were used (Gore: 15, Medtronic: 2, Cook 1). Left subclavian artery was partially covered in 2 patients (11%), and completely covered in 2 patients (11%) with reconstruction using chimney technique. Seven patients (39%) had concomitant surgeries (orthopedic: five; abdominal: three) and seven (39%) had staged orthopedic surgeries after TEVAR. Technical success was 100%. No intraoperative death occurred. Thirty-day mortality was 11% (n = 2), major adverse event rate was 33% (n = 6). Rates of respiratory failure, stroke, deep venous thrombosis (DVT) and pulmonary embolism were 17% (n = 3), 11% (n = 2), 22% (n = 4), and 11% (n = 2), respectively. Temporary IVC filter was placed in seven patients (39%, preoperative: 1; postoperative: 6). Median follow-up was 3.1 years (range: 2 days to 0.5 years). There were no TEVAR-related or device-related complications or reinterventions. There were two late deaths, nonaortic related. Three-year survival was 89%. Conclusions: BTAI patients were young and usually polytraumatic requiring healthcare by a multidisciplinary team. TEVAR/device-related complications and reinterventions were low in our series; however, data on device-related long-term outcomes and aortic remodeling in particular for younger patients are needed. AD - Y. Huang, Mayo Clinic, Rochester, MN, United States AU - Huang, Y. AU - Weiss, S. AU - Oderich, G. S. AU - Kalra, M. AU - Johnstone, J. K. AU - Shuja, F. AU - Bower, T. AU - DeMartino, R. DB - Embase KW - adolescent adult adverse event aged aortic trauma case report cerebrovascular accident chimney clinical article complication conference abstract death deep vein thrombosis endovascular aneurysm repair female filter follow up human injury scale left subclavian artery lung embolism mortality orthopedic surgery respiratory failure retrospective study surgery thoracic aorta traffic accident LA - English M1 - 6 M3 - Conference Abstract N1 - L623020632 2018-07-18 PY - 2018 SN - 2213-3348 SP - e228 ST - Midtermoutcomes after thoracic endovascular aortic repair of blunt traumatic thoracic aortic injury T2 - Journal of Vascular Surgery TI - Midtermoutcomes after thoracic endovascular aortic repair of blunt traumatic thoracic aortic injury UR - https://www.embase.com/search/results?subaction=viewrecord&id=L623020632&from=export VL - 67 ID - 760818 ER - TY - JOUR AB - Objective: Acute superior mesenteric artery (SMA) thrombosis is a life-threatening and challenging emergency condition. Our study was designed to evaluate the safety and efficacy of percutaneous vacuum-assisted aspiration thrombectomy using the Indigo device (Penumbra, Alameda, Calif) in the first instance and, later, other devices available on the market that can safely aspirate the clot. Methods: This study included retrospective multinational registry data from 11 international centers that consisted of 93 consecutive patients (43 male, 50 female; age range, 55-93 years). The study was conducted from 2016 to 2018. Symptom onset to treatment time ranged from 8 hours to 7 days. All 93 cases were of the native SMA vessel (not in-stent thrombosis). Mean length of lesions was 18 ± 22 cm. Access site was mostly common femoral artery in the groin (radial and brachial also used). Technical success was defined as restoration of antegrade blood flow without the need of lysis or alternative thrombectomy or other revascularization strategies, such as vascular surgery or bypass. Safety end points considered were any in-hospital major adverse events. Results: A total of 93 cases of acute SMA thrombosis were managed with manual aspiration using long Terumo destination sheath 6F and 8F (Terumo, Shibuya, Tokyo, Japan). Indigo and ACE mechanical aspiration catheters from Penumbra were employed. Aspirex mechanical aspiration catheters and Rotarex atherectomy catheter (Straub Medical, Wangs, Switzerland) and Sofia Plus catheter (MicroVention/Terumo, Aliso Viejo, Calif) were used. Access was obtained through a transfemoral, brachial, or radial endovascular approach under local anesthesia. Technical success was recorded as 100% by all methods. All cases successfully removed all or enough clot to allow flow, and no death in the first 24 hours was reported. Two deaths were reported on day 27 and day 28 after cardiac arrest from other comorbidities. The remaining patients are alive at present. Follow-up range considered was 3 to 16 months (ongoing). No cases of intraprocedural dissection or rupture were reported. No intraprocedural distal embolizations were noted. No distal filters were used. Additional stenting was required in five cases to treat underlying stenosis. Conclusions: Endovascular management using thrombectomy and some atherectomy systems offers an effective option for successful percutaneous recanalization of acute thrombotic SMA occlusion, which can be performed under local anesthesia alone. It must remain a multidisciplinary team approach, with team members consisting of emergency department/accident and emergency physicians, gastrointestinal surgeons, vascular surgeons, interventional radiologists, and anesthetists. Further collaborative research is required to improve our understanding and management of such cases. AU - Huasen, B. AU - Massmann, A. AU - Bisdas, T. AU - Gelabert, M. AU - Sponza, M. AU - Maurizio, C. AU - Del Giudice, C. AU - Nguyen, L. D. DB - Embase DO - 10.1016/j.jvs.2019.08.158 KW - dipeptidyl carboxypeptidase endogenous compound unclassified drug accident adult adverse device effect aged anesthesist artificial embolization aspiration catheter atherectomy catheter blood flow catheter sheath comorbidity conference abstract controlled study dissection drug safety emergency physician emergency ward female femoral artery filter follow up heart arrest human inguinal region interventional radiologist Japan local anesthesia major clinical study male middle aged multicenter study multidisciplinary team recanalization retrospective study revascularization rupture stent thrombosis superior mesenteric artery obstruction surgery Switzerland thrombectomy catheter thrombus aspiration time to treatment vacuum vascular surgeon LA - English M1 - 5 M3 - Conference Abstract N1 - L2003356341 2019-10-21 PY - 2019 SN - 1097-6809 0741-5214 SP - e176 ST - Superior Mesenteric Artery Thrombosis: International Endovascular Treatment Team Approach T2 - Journal of Vascular Surgery TI - Superior Mesenteric Artery Thrombosis: International Endovascular Treatment Team Approach UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003356341&from=export http://dx.doi.org/10.1016/j.jvs.2019.08.158 VL - 70 ID - 760654 ER - TY - JOUR AU - Huber, T. AU - Sharma, A. AU - Uflacker, A. DA - 2016 DB - German National Library of Science and Technology (TIB) PY - 2016 ST - Pulmonary embolism response team: what an interventional radiologist should know T2 - British Library Online Contents TI - Pulmonary embolism response team: what an interventional radiologist should know UR - https://www.tib.eu/en/search/id/BLSE:RN376288870/Pulmonary-embolism-response-team-what-an-interventional?cHash=e0915065c919bfa5d07395725537c394 ID - 761909 ER - TY - JOUR AB - Background: There are several well established scores for the assessment of the prognosis of major trauma patients that all have in common that they can be calculated at the earliest rioting intensive care unit stay. We intended to develop a sequential trauma score (STS) that allows prognosis at several early stages based on the information that is available at a particular time. Study Design: In a retrospective, multicenter study using data derived from the Trauma Registry of the German Trauma Society (2002-2006), we identified the most relevant prognostic factors from the patients basic data (B), prehospital phase (A), early (B1), and late (B2) trauma room phase. Univariate and logistic regression models as well as score quality criteria and the explanatory power have been calculated. Results: A total of 2,354 patients with complete data were identified. From the patients basic data (P), logistic regression showed that age was a significant predictor of survival (AUC(model) (P), area under the curve = 0.63). Logistic regression of the prehospital data (A) showed that blood pressure, pulse rate, Glasgow coma scale (GCS), and anisocoria were significant predictors (AUC(model A) = 0.76; AUC(model) (P + A) = 0.82). Logistic regression of the early trauma room phase (B1) showed that peripheral oxygen saturation, GCS, anisocoria, base excess, and thromboplastin time to be significant predictors of survival (AUC(model) (B1) = 0.78; AUC(model P + A + B1) = 0.85). Multivariate analysis of the late trauma room phase (132) detected cardiac massage, abbreviated injury score (AIS) of the head >= 3, the maximum MS, the need for transfusion or massive blood transfusion, to be the most important predictors (AUC(model B2) = 0.84; AUC(final model P + A + B1 + B2) = 0.90). The explanatory power - a tool for the assessment of the relative impact of each segment to mortality - is 25% for P, 7% for A, 17% for B1 and 51% for B2. A spreadsheet for the easy calculation of the sequential trauma score is available at: www.sequential-trauma-score.com Conclusions: This score is the first sequential, dynamic score to provide a prognosis for patients with blunt major trauma at several points in time. With every additional piece of information the precision increases. The medical team has a simple, useful tool to identify patients at high risk and to predict the prognosis of an individual patient with major trauma very early, quickly and precisely. AD - [Huber-Wagner, S.; Stegmaier, J.; Mathonia, P.; Euler, E.; Mutschler, W.; Kanz, K. -G.] Univ Munich, Munich Univ Dept Trauma Surg, Munich, Germany. [Paffrath, T.] Univ Witten Herdecke, Cologne Merheim Med Ctr, Dept Trauma & Orthoped Surg, Cologne, Germany. [Lefering, R.] Univ Witten Herdecke, Cologne Merheim Med Ctr, IFOM Inst Res Operat Med, Cologne, Germany. Huber-Wagner, S (corresponding author), Munich Univ Hosp LMU, Dept Trauma Surg, Campus Innenstadt,Nussbaumstr 20, D-80336 Munich, Germany. stefan.huber@med.uni-muenchen.de AN - WOS:000278825300001 AU - Huber-Wagner, S. AU - Stegmaier, J. AU - Mathonia, P. AU - Paffrath, T. AU - Euler, E. AU - Mutschler, W. AU - Kanz, K. G. AU - Lefering, R. AU - German Trauma Soc, D. G. U. DA - May DO - 10.1186/2047-783x-15-5-185 J2 - Eur. J. Med. Res. KW - Major trauma outcome prognosis scoring score severely injured patients polytrauma dynamic score ISS TRISS RISC STS INJURY SEVERITY SCORE BRAIN-INJURY IMPROVES ACCURACY GERMAN SOCIETY CARE REGISTRY HYPOTHERMIA VALIDATION SURGERY SYSTEMS Medicine, Research & Experimental LA - English M1 - 5 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: 611OF Times Cited: 26 Cited Reference Count: 40 Huber-Wagner, S. Stegmaier, J. Mathonia, P. Paffrath, T. Euler, E. Mutschler, W. Kanz, K. -G. Lefering, R. Annual Meeting of the German-Trauma-Society OCT 22-25, 2008 Berlin, GERMANY German Trauma Soc 27 0 4 I HOLZAPFEL VERLAG GMBH MUNICH EUR J MED RES PY - 2010 SN - 0949-2321 SP - 185-195 ST - THE SEQUENTIAL TRAUMA SCORE - A NEW INSTRUMENT FOR THE SEQUENTIAL MORTALITY PREDICTION IN MAJOR TRAUMA T2 - European Journal of Medical Research TI - THE SEQUENTIAL TRAUMA SCORE - A NEW INSTRUMENT FOR THE SEQUENTIAL MORTALITY PREDICTION IN MAJOR TRAUMA UR - ://WOS:000278825300001 VL - 15 ID - 761875 ER - TY - JOUR AB - Introduction Pregnancy creates a hypercoagulable state and results in increased haemodynamic load. While anti-coagulation is mandatory for pregnant women with mechanical prosthetic heart valves, a standardized anticoagulation regime is challenged by the contradictory issues in the maternal and fetal safety profiles and efficacy between oral anticoagulants such as warfarin and the heparin derivatives. The aim of this study was to review the perinatal and maternal outcomes of pregnancies in which the mothers had mechanical prosthetic heart valves. Methods This was a retrospective descriptive cohort study. Relevant demographic, treatment and outcome data from the case notes of mothers with mechanical heart valves in pregnancy from 1999 to 2012 were recorded. Results We identified 14 pregnancies in 7 patients with mechanical prosthetic heart valves. The age at time of conceiving ranged from 25 to 36 years, with a mean of 30.6 years. 5 women were of Chinese ethnicity and 2 were of Malay ethnicity. 5 had acquired valvular heart disease and 2 had congenital heart disease requiring valve replacement. Mitral valve was the most common valve replaced. Of the 14 pregnancies, 11 (78.6%) conceived on warfarin and 3 (21.4%) on low-molecular weight heparin (LMWH). All the pregnancies were co-managed with a hematologist and cardiologist. 4 pregnancies were maintained on low dose warfarin (between 2 to 5 mg) until 34-36 weeks before conversion to LMWH and 10 were maintained on LMWH throughout. 9 out of 14 pregnancies resulted in live birth. Although no maternal deaths or thrombotic events were noted, there were significant bleeding events among mothers who had live births, including 3 episodes of threatened miscarriage in the first and second trimesters and 4 haemorrhagic episodes postpartum, of whom 3 were secondary postpartum haemorrhage and 2 required transfusion. In our series, there was one fetus with isolated mild ventriculomegaly. No warfarin embryopathies were reported, possibly due to the low dosages of warfarin used. Comparing the warfarin and LMWH groups yielded no significant differences for both maternal and fetal outcomes. Conclusion While mothers with mechanical prosthetic heart valves can have successful pregnancy outcomes, these remain high risk and should be managed by the appropriate multidisciplinary team to oversee the manipulation of the anticoagulation and surveillance of both antepartum and postpartum complications. AD - C. Hui, Obstetrics and Gynaecology, Singapore General Hospital, Singapore AU - Hui, C. AU - Tan, P. S. AU - Mok, Z. W. AU - Tan, L. K. DB - Embase DO - 10.1111/1471-0528.15132 KW - low molecular weight heparin warfarin adult anticoagulation cardiologist clinical article cohort analysis complication conference abstract congenital heart disease embryopathy ethnicity female fetus fetus outcome heart valve replacement hematologist human imminent abortion live birth low drug dose maternal death mechanical heart valve mitral valve mother postpartum hemorrhage pregnancy outcome retrospective study second trimester pregnancy Singapore thrombosis valvular heart disease LA - English M3 - Conference Abstract N1 - L621570030 2018-04-11 PY - 2018 SN - 1471-0528 SP - 118 ST - Mechanical prosthetic heart valves in pregnancy - The Singapore experience T2 - BJOG: An International Journal of Obstetrics and Gynaecology TI - Mechanical prosthetic heart valves in pregnancy - The Singapore experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621570030&from=export http://dx.doi.org/10.1111/1471-0528.15132 VL - 125 ID - 760843 ER - TY - JOUR AB - Objective/Background: To modify, content validate, and evaluate a teamwork assessment tool for use in endovascular surgery. Methods: A multistage, multimethod study was conducted. Stage 1 included expert review and modification of the existing Observational Teamwork Assessment for Surgery (OTAS) tool. Stage 2 included identification of additional exemplar behaviours contributing to effective teamwork and enhanced patient safety in endovascular surgery (using real-time observation, focus groups, and semistructured interviews of multidisciplinary teams). Stage 3 included content validation of exemplar behaviours using expert consensus according to established psychometric recommendations and evaluation of structure, content, feasibility, and usability of the Endovascular Observational Teamwork Assessment Tool (Endo-OTAS) by an expert multidisciplinary panel. Stage 4 included final team expert review of exemplars. Results: OTAS core team behaviours were maintained (communication, coordination, cooperation, leadership team monitoring). Of the 114 OTAS behavioural exemplars, 19 were modified, four removed, and 39 additional endovascular-specific behaviours identified. Content validation of these 153 exemplar behaviours showed that 113/153 (73.9%) reached the predetermined Item-Content Validity Index rating for teamwork and/or patient safety. After expert team review, 140/153 (91.5%) exemplars were deemed to warrant inclusion in the tool. More than 90% of the expert panel agreed that Endo-OTAS is an appropriate teamwork assessment tool with observable behaviours. Some concerns were noted about the time required to conduct observations and provide performance feedback. Conclusion: Endo-OTAS is a novel teamwork assessment tool, with evidence for content validity and relevance to endovascular teams. Endo-OTAS enables systematic objective assessment of the quality of team performance during endovascular procedures. (C) 2016 Published by Elsevier Ltd on behalf of European Society for Vascular Surgery. AD - [Hull, L.] Imperial Coll London, Imperial Patient Safety Translat Res Ctr, London, England. [Bicknell, C.; Patel, K.; Vyas, R.; Rudarakanchana, N.] Imperial Coll London, Dept Surg & Canc, London, England. [Bicknell, C.; Rudarakanchana, N.] Imperial Healthcare NHS Trust, Vasc Unit, London, England. [Van Herzeele, I.] Ghent Univ Hosp, Dept Thorac & Vasc Surg, Ghent, Belgium. [Sevdalis, N.] Kings Coll London, Hlth Serv & Populat Res Dept, Ctr Implementat Sci, London, England. Hull, L (corresponding author), Imperial Coll London, Imperial Patient Safety Translat Res Ctr, London, England. louise.hull@klc.ac.uk AN - WOS:000379631900004 AU - Hull, L. AU - Bicknell, C. AU - Patel, K. AU - Vyas, R. AU - Van Herzeele, I. AU - Sevdalis, N. AU - Rudarakanchana, N. DA - Jul DO - 10.1016/j.ejvs.2015.12.044 J2 - Eur. J. Vasc. Endovasc. Surg. KW - Assessment Endovascular surgery Evaluation Team performance Teamwork NONTECHNICAL SKILLS PATIENT SAFETY SYSTEM IMPLEMENTATION REHEARSAL PROGRAM CARE Surgery Peripheral Vascular Disease LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: DR0YD Times Cited: 12 Cited Reference Count: 22 Hull, L. Bicknell, C. Patel, K. Vyas, R. Van Herzeele, I. Sevdalis, N. Rudarakanchana, N. Sevdalis, Nick/AAJ-6280-2020; Sevdalis, Nick/O-1419-2017 Sevdalis, Nick/0000-0001-7560-8924; Sevdalis, Nick/0000-0001-7560-8924; , Kirtan/0000-0002-2298-224X National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust; King's Health Partners; Guy's and St Thomas' NHS Foundation Trust; King's College Hospital NHS Foundation Trust; King's College London and South London and Maudsley NHS Foundation Trust; Guy's and St Thomas' Charity; Maudsley Charity and Health Foundation Sevdalis' research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London at King's College Hospital NHS Foundation Trust. NS is a member of King's Improvement Science, which is part of the NIHR CLAHRC South London and comprises a specialist team of improvement scientists and senior researchers based at King's College London. Its work is funded by King's Health Partners (Guy's and St Thomas' NHS Foundation Trust, King's College Hospital NHS Foundation Trust, King's College London and South London and Maudsley. NHS Foundation Trust), Guy's and St Thomas' Charity, the Maudsley Charity and the Health Foundation. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. 12 0 5 W B SAUNDERS CO LTD LONDON EUR J VASC ENDOVASC PY - 2016 SN - 1078-5884 SP - 11-20 ST - Content Validation and Evaluation of an Endovascular Teamwork Assessment Tool T2 - European Journal of Vascular and Endovascular Surgery TI - Content Validation and Evaluation of an Endovascular Teamwork Assessment Tool UR - ://WOS:000379631900004 VL - 52 ID - 761703 ER - TY - JOUR AB - Increasing process complexity in the pediatric intensive care unit (PICU) can lead to information overload resulting in missing pertinent information and potential errors during morning rounds. An efficient model using a novel electronic rounding tool was designed as part of a broader critical care decision support system-checklist for early recognition and treatment of acute illness and injury in pediatrics (CERTAINp). We aimed to evaluate its impact on improving the process of care during rounding. Prospective pre-and post-interventional data included: team performance baseline assessment, patient safety discussion, guideline adherence, rounding time, and a survey of Residents' and Nurses' perception using a Likert scale. Attending physicians were blinded to the components of the assessment. A total of 113 pre-intervention and 114 post-intervention roundings were recorded by direct observation. Pre-intervention (108) and post-intervention staff surveys (80) were obtained. Adherence to standard of care guidelines improved to > 97 % in all data points, with maximum increase seen in discussions of ulcer prophylaxis, bowel protocol, DVT prophylaxis, skin care, glucose control and head of bed elevation (2-28 % pre-vs. 100 % for all post-intervention, p < 0.01). Significant improvement was noticed in spontaneous breathing trials, sedation breaks and need for devices (45-57 % pre-vs. 100 % for all post-intervention, p < 0.01). Rounding time (mean +/- SD) increased by 2 min/patient (8.0 +/- 5.8 min pre-intervention vs. 9.9 +/- 5.7 min post-intervention, p = 0.002). Staff reported improved perception of all aspects of rounding. Utilization of the CERTAINp rounding tool led to perfect compliance to the discussion of best practice guidelines; had minimal impact on rounding time and improved PICU staff satisfaction. AD - [Hulyalkar, Manasi; Gleich, Stephen J.; Kaur, Harsheen; Arteaga, Grace M.; Tripathi, Sandeep] Mayo Clin, Dept Pediat & Adolescent Med, Rochester, MN USA. [Kashyap, Rahul; Barwise, Amelia; Dong, Yue; Fan, Lei] Mayo Clin, METRIC Multidisciplinary Epidemiol & Translat Res, Rochester, MN USA. [Murthy, Srinivas] Univ British Columbia, Div Crit Care, Dept Pediat, Vancouver, BC, Canada. [Tripathi, Sandeep] Univ Illinois, Coll Med, Dept Pediat, Peoria, IL 61656 USA. Tripathi, S (corresponding author), Mayo Clin, Dept Pediat & Adolescent Med, Rochester, MN USA.; Tripathi, S (corresponding author), Univ Illinois, Coll Med, Dept Pediat, Peoria, IL 61656 USA. Sandeep.tripathi@osfhealthcare.org AN - WOS:000413761000025 AU - Hulyalkar, M. AU - Gleich, S. J. AU - Kashyap, R. AU - Barwise, A. AU - Kaur, H. AU - Dong, Y. AU - Fan, L. AU - Murthy, S. AU - Arteaga, G. M. AU - Tripathi, S. DA - Dec DO - 10.1007/s10877-016-9946-1 J2 - J. Clin. Monitor. Comp. KW - Electronic checklist Intensive care unit (ICU) ICU rounds Pediatrics MEASURABLE OUTCOMES CHECKLIST SAFETY Anesthesiology LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: FK8LU Times Cited: 3 Cited Reference Count: 23 Hulyalkar, Manasi Gleich, Stephen J. Kashyap, Rahul Barwise, Amelia Kaur, Harsheen Dong, Yue Fan, Lei Murthy, Srinivas Arteaga, Grace M. Tripathi, Sandeep tripathi, sandeep/AAF-9232-2020; Dong, Yue/B-7597-2008; Murthy, Srinivas/AAS-7243-2020 Dong, Yue/0000-0002-1737-6536; Murthy, Srinivas/0000-0002-9476-839X National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Advancing Translational Sciences (NCATS) [UL1 TR000135] We appreciate Professor Ognjen Gajic's advice and mentorship for this study. His leadership in adult CERTAIN project has inspired this current study. This publication was made possible by CTSA Grant No. UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. 3 0 12 SPRINGER HEIDELBERG HEIDELBERG J CLIN MONIT COMPUT PY - 2017 SN - 1387-1307 SP - 1313-1320 ST - Design and alpha-testing of an electronic rounding tool (CERTAINp) to improve process of care in pediatric intensive care unit T2 - Journal of Clinical Monitoring and Computing TI - Design and alpha-testing of an electronic rounding tool (CERTAINp) to improve process of care in pediatric intensive care unit UR - ://WOS:000413761000025 VL - 31 ID - 761623 ER - TY - JOUR AB - The Surgical Care Improvement Project (SCIP) is a national program aimed at reducing perioperative complications and is a quality benchmark metric for Centers for Medicare and Medicaid Services. This study evaluates whether a multidisciplinary program improved an institution's compliance with SCIP measures. Analysis of the facility's performance data identified three key areas of SCIP noncompliance: 1) timely discontinuation of perioperative antibiotics and urinary catheters, 2) initiation of venous thromboembolism prophylaxis, and 3) perioperative beta blocker administration. Multidisciplinary teams collaborated with providers and department chairs in reviewing and enable SCIP compliance. Anesthesia staff managed preoperative antibiotics. SCIP-compliant order sets, venous thromboembolism pop-up alerts, and progress note templates were added to the electronic medical record. Standardized education was provided to explain SCIP requirements, review noncompliant cases, and update teams on SCIP performance. Data were captured from January 2009 to March 2014. Ten SCIP fallouts were reported for general surgery specialties in January 2013, when the SCIP compliance project launched. Specifically, colon-related surgery achieved 100 per cent compliance. Six months after implementation, overall SCIP compliance at our institution improved by 65 per cent (from 90.7-98.6% compliance). AD - Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA. AN - 26140888 AU - Huntington, C. R. AU - Strayer, M. AU - Huynh, T. AU - Green, J. M. DA - Jul DP - NLM ET - 2015/07/05 J2 - The American surgeon KW - Adrenergic beta-Agonists/therapeutic use Antibiotic Prophylaxis/standards Benchmarking/*organization & administration Colonic Diseases/surgery Digestive System Surgical Procedures/standards Guideline Adherence/*statistics & numerical data Humans Perioperative Care/*standards Practice Guidelines as Topic/*standards Process Assessment, Health Care United States Venous Thromboembolism/prevention & control LA - eng M1 - 7 N1 - 1555-9823 Huntington, Ciara R Strayer, Melissa Huynh, Toan Green, John M Journal Article Observational Study United States Am Surg. 2015 Jul;81(7):687-92. PY - 2015 SN - 0003-1348 SP - 687-92 ST - A Multidisciplinary Approach to Improving SCIP Compliance T2 - Am Surg TI - A Multidisciplinary Approach to Improving SCIP Compliance VL - 81 ID - 760377 ER - TY - JOUR AB - The Surgical Care Improvement Project (SCIP) is a national program aimed at reducing perioperative complications and is a quality benchmark metric for Centers for Medicare and Medicaid Services. This study evaluates whether a multidisciplinary program improved an institution's compliance with SCIP measures. Analysis of the facility's performance data identified three key areas of SCIP noncompliance: 1) timely discontinuation of perioperative antibiotics and urinary catheters, 2) initiation of venous thromboembolism prophylaxis, and 3) perioperative beta blocker administration. Multidisciplinary teams collaborated with providers and department chairs in reviewing and enable SCIP compliance. Anesthesia staff managed preoperative antibiotics. SCIP-compliant order sets, venous thromboembolism pop-up alerts, and progress note templates were added to the electronic medical record. Standardized education was provided to explain SCIP requirements, review noncompliant cases, and update teams on SCIP performance. Data were captured from January 2009 to March 2014. Ten SCIP fallouts were reported for general surgery specialties in January 2013, when the SCIP compliance project launched. Specifically, colon-related surgery achieved 100 per cent compliance. Six months after implementation, overall SCIP compliance at our institution improved by 65 per cent (from 90.7-98.6% compliance). AD - Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina AN - 103543016. Language: English. Entry Date: 20150923. Revision Date: 20200623. Publication Type: journal article. Journal Subset: Biomedical AU - Huntington, Ciara R. AU - Strayer, Melissa AU - Toan, Huynh AU - Green, John M. AU - Huynh, Toan DB - CINAHL DO - 10.1177/000313481508100717 DP - EBSCOhost KW - Benchmarking -- Administration Perioperative Care -- Standards Practice Guidelines -- Standards Guideline Adherence -- Statistics and Numerical Data Antibiotic Prophylaxis -- Standards Colonic Diseases -- Surgery United States Venous Thromboembolism -- Prevention and Control Adrenergic Beta-Agonists -- Therapeutic Use Surgery, Digestive System -- Standards Process Assessment (Health Care) Ferrans and Powers Quality of Life Index Questionnaires M1 - 7 N1 - USA. NLM UID: 0370522. PMID: NLM26140888. PY - 2015 SN - 0003-1348 SP - 687-692 ST - A Multidisciplinary Approach to Improving SCIP Compliance T2 - American Surgeon TI - A Multidisciplinary Approach to Improving SCIP Compliance UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=103543016&site=ehost-live&scope=site VL - 81 ID - 761281 ER - TY - JOUR AB - BACKGROUND: American College of Cardiology/American Heart Association guidelines recommend >75% of patients with an ST-elevation myocardial infarction receive primary percutaneous coronary interventions (PPCI) within 90 minutes. Despite these recommendations, this goal has been difficult to achieve. METHODS AND RESULTS: We conducted a prospective interventional study involving 349 patients undergoing PPCI at a single tertiary referral institution to determine the impact of prehospital 12-lead ECG triage and emergency department activation of the infarct team on door-to-balloon time (D2BT). The median D2BT of all patients (n=107) who underwent PPCI after field ECG and emergency department activation of the infarct team (MonashHEART Acute Myocardial Infarction [MonAMI] group) was 56 minutes (interquartile range, 36.5 to 70) compared with the median time of a contemporary group (n=122) undergoing PPCI during the same period but not receiving field triage (non-MonAMI group) of 98 minutes (73 to 126.45). The median D2BT time of 120 consecutive patients who underwent PPCI before initiation of the project (pre-MonAMI group) was 101.5 minutes (72.5 to 134; P<0.001). The proportion of patients who achieved a D2BT of < or = 90 minutes increased from 39% in the pre-MonAMI group and 45% in the non-MonAMI group to 93% in the MonAMI group (P<0.001). CONCLUSIONS: The performance of prehospital 12-lead ECG triage and emergency department activation of the infarct team significantly improves D2BT and results in a greater proportion of patients achieving guideline recommendations. AD - Monash Cardiovascular Research Centre, Monash University, Australia. AN - 20031770 AU - Hutchison, A. W. AU - Malaiapan, Y. AU - Jarvie, I. AU - Barger, B. AU - Watkins, E. AU - Braitberg, G. AU - Kambourakis, T. AU - Cameron, J. D. AU - Meredith, I. T. DA - Dec DO - 10.1161/circinterventions.109.892372 DP - NLM ET - 2009/12/25 J2 - Circulation. Cardiovascular interventions KW - Aged Ambulances/*organization & administration *Angioplasty, Balloon, Coronary Australia *Electrocardiography *Emergency Medical Services/organization & administration *Emergency Service, Hospital/organization & administration Female Guideline Adherence *Health Services Accessibility/organization & administration Humans Male Middle Aged Myocardial Infarction/*diagnosis/therapy *Patient Care Team/organization & administration Pilot Projects Practice Guidelines as Topic Predictive Value of Tests Program Evaluation Prospective Studies Time Factors *Triage/organization & administration LA - eng M1 - 6 N1 - 1941-7632 Hutchison, Adam W Malaiapan, Yuvaraj Jarvie, Ian Barger, Bill Watkins, Edward Braitberg, George Kambourakis, Tony Cameron, James D Meredith, Ian T Journal Article Multicenter Study Research Support, Non-U.S. Gov't United States Circ Cardiovasc Interv. 2009 Dec;2(6):528-34. doi: 10.1161/CIRCINTERVENTIONS.109.892372. Epub 2009 Dec 1. PY - 2009 SN - 1941-7640 SP - 528-34 ST - Prehospital 12-lead ECG to triage ST-elevation myocardial infarction and emergency department activation of the infarct team significantly improves door-to-balloon times: ambulance Victoria and MonashHEART Acute Myocardial Infarction (MonAMI) 12-lead ECG project T2 - Circ Cardiovasc Interv TI - Prehospital 12-lead ECG to triage ST-elevation myocardial infarction and emergency department activation of the infarct team significantly improves door-to-balloon times: ambulance Victoria and MonashHEART Acute Myocardial Infarction (MonAMI) 12-lead ECG project VL - 2 ID - 760340 ER - TY - JOUR AB - Background: Utilization of endovascular procedures in the perioperative management of patients undergoing transsphenoidal surgery is uncommon but plays a critical role in preventing and treating potentially life-threatening vascular complications. Methods: We performed a retrospective review of all patients over a 10-year period who underwent transsphenoidal surgery at two tertiary-care institutions and identified all pre-operative and post-operative endovascular procedures performed. Results: 18 perioperative endovascular procedures were performed including 9 pre- and 9 post-operative. Preoperative procedures included balloon-test occlusion (n=4), aneurysm coiling (n=4), and parent artery occlusion (n=1). One aneurysm coiling was complicated by coil migration requiring coil retrieval with a snare device and one balloon-test occlusion was complicated by pituitary apoplexy. Pituitary apoplexy following balloon-test occlusion has not been reported and the potential pathophysiology is reviewed. Post-operative procedures included embolization for epistaxis (n=2) and embolization with or without parent artery sacrifice for carotid and anterior cerebral artery vascular injury (n=7). Arterial vascular injury was managed with coil embolization and/or with detachable balloons. Review of anatomical features predisposing to vascular injury are discussed. Conclusions: Patients undergoing transsphenoidal surgery should be managed with a multidisciplinary team ensuring that endovascular treatment options are made available during the perioperative period. AD - T.J. Huynh, Halifax, Canada AU - Huynh, T. J. AU - Cusimano, M. AU - Clarke, D. B. AU - Weeks, A. AU - Marotta, T. R. AU - Maloney, W. J. AU - Aldakkan, A. AU - Bharatha, A. DB - Embase DO - 10.1017/cjn.2019.182 KW - adult adverse device effect anterior cerebral artery artery occlusion blood vessel injury carotid artery clinical article coil embolization coil migration complication conference abstract controlled study detachable balloon endovascular surgery epistaxis female human hypophysis apoplexy information retrieval male multidisciplinary team perioperative period preoperative evaluation retrospective study surgery tertiary health care transsphenoidal surgery LA - English M3 - Conference Abstract N1 - L629427875 2019-10-01 PY - 2019 SN - 0317-1671 SP - S36 ST - Perioperative endovascular procedure utilization in transsphenoidal surgery patients at two tertiary-care academic centres T2 - Canadian Journal of Neurological Sciences TI - Perioperative endovascular procedure utilization in transsphenoidal surgery patients at two tertiary-care academic centres UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629427875&from=export http://dx.doi.org/10.1017/cjn.2019.182 VL - 46 ID - 760711 ER - TY - JOUR AB - Rationale, aims and objectivesPrescribing errors (PE) are frequent, cause significant harm to patients and prove costly. Few studies demonstrate the impact of pharmacist interventions. The objectives of this study were to characterize the severity and cost of the potential outcome of PE that pharmacists can prevent and to develop an economic analysis. MethodWe performed a non-randomized, prospective, observational study of all prescriptions made to adult patients admitted to a 1300-bed tertiary teaching hospital in Madrid (Spain) by means of a computerized physician order entry tool combined with a clinical decision support system. We analysed PE intercepted through the pharmacist validation process between January and June 2013. An independent team determined the severity of the potential adverse drug event (ADE) and the probability of causing an ADE (PAE). We estimated the cost avoidance and performed an economic analysis. A kappa statistic was used to verify inter-observer agreement. Results484 PE were intercepted: 36.2% of PE were classified as being of minor severity, 59.1% as moderate and 4.7% as serious. The most common type of moderate-serious PE found was excessive dose (30%, 94/309), followed by insufficient dose (20%, 62/309), and omission (19%, 58/309). The most frequent families of drugs involved in moderate-serious PE were antineoplastic agents (22.3%, 69/309) and antimicrobials (17.2%, 53/309). The PAE was higher than 40% in 49% of PE. We estimated a cost avoidance of Euro291,422 and a return on investment of Euro1.7 for each Euro1 spent on a pharmacist's salary. The overall inter-rater agreement for the participants was moderate for severity (=0.57; P<0.005) and strong for the PAE (=0.77; P<0.005). ConclusionsPharmacists add important value in preventing PE, and their interventions are financially beneficial for the institution. AD - [Ibanez-Garcia, Sara; Guadalupe Rodriguez-Gonzalez, Carmen; Luisa Martin-Barbero, Maria; Sanjurjo-Saez, Maria; Herranz-Alonso, Ana] Hosp Gen Univ Gregorio Maranon, Hosp Gregorio Maranon, Inst Invest Sanitaria, Dept Hosp Pharm, Madrid 28007, Spain. Rodriguez-Gonzalez, CG (corresponding author), Hosp Gen Univ Gregorio Maranon, C Doctor Esquerdo 46, Madrid 28007, Spain. crgonzalez@salud.madrid.org AN - WOS:000373135400015 AU - Ibanez-Garcia, S. AU - Rodriguez-Gonzalez, C. G. AU - Martin-Barbero, M. L. AU - Sanjurjo-Saez, M. AU - Herranz-Alonso, A. AU - iPharma DA - Apr DO - 10.1111/jep.12466 J2 - J. Eval. Clin. Pract. KW - adverse drug event clinical pharmacists economic analysis interventions medication errors severity ADVERSE DRUG EVENTS INTENSIVE-CARE-UNIT IN-HOSPITAL INPATIENTS PHYSICIAN ORDER ENTRY PRESCRIBING ERRORS CLINICAL PHARMACIST ECONOMIC OUTCOMES MEDICATION ERRORS IMPACT THERAPY Health Care Sciences & Services Medical Informatics Medicine, General & Internal LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: DH9SF Times Cited: 6 Cited Reference Count: 49 Ibanez-Garcia, Sara Guadalupe Rodriguez-Gonzalez, Carmen Luisa Martin-Barbero, Maria Sanjurjo-Saez, Maria Herranz-Alonso, Ana ALONSO, ANA HERRANZ/E-9456-2018; IBAA‘EZ GARCAA, SARA/T-4668-2017 ALONSO, ANA HERRANZ/0000-0002-5517-0248; IBAA‘EZ GARCAA, SARA/0000-0003-4686-8537 iPharma (Pharmacy Innovation Center of the Hospital General Universitario Gregorio Maranon) [PI12/02883] The authors thank Thomas O'Boyle and Jose Maria Bellon Cano for their help in the preparation of the manuscript. This project was supported by iPharma (Pharmacy Innovation Center of the Hospital General Universitario Gregorio Maranon) through funding received with project PI12/02883. 6 0 8 WILEY HOBOKEN J EVAL CLIN PRACT PY - 2016 SN - 1356-1294 SP - 253-260 ST - Adding value through pharmacy validation: a safety and cost perspective T2 - Journal of Evaluation in Clinical Practice TI - Adding value through pharmacy validation: a safety and cost perspective UR - ://WOS:000373135400015 VL - 22 ID - 761713 ER - TY - JOUR AB - Introduction and Aims: Strategies to prevent vascular access (VA) thrombosis include mapping, early stenosis diagnosis and preventive treatment. Ultrasound (US) use by nephrologist may substantially change practice to intervene in all steps. The aim is present the results after creation and consolidation of a Vascular Access Unit based on the US use by nephrology in a multidisciplinary approach. Methods: 1. Prospective cohorts study. Reference University Hospital. 2005-2011 2. Multidisciplinary team: nephrologist, vascular surgeon, interventional radiologist and nursing. 3. Protocol: 3.1. VA surveillance: by US, in outpatient nephrology consult and in dialysis unit 3.2. Mapping and treatment. 2 periods: initial and consolidation 1st) Physical exploration and image study on demand by surgeon 2nd) US routinely by joint nephro-surgeon consult and angiogram on demand 4. Treatment: By protocol. Surgery or angioplasty depending stenosis location. Surgery prioritized by Glomerular Filtration Rate, VA dysfunction level or if catheter carrier 5. Outcomes: Patency, thrombosis, patients starting hemodialysis (HD) by AVF, patients in HD with AV reconstruction without requiring catheter, maturation failure and need for angiogram in mapping 6. Data Record: Smart Network Vascular Access Sofware (AcVasSoft). Results: 1. VA: n=506 2. Age: 64.8±15, 58% M, 42% F, Charlson Index = 7.8 3. Assisted primary patency: 1, 2 and 3 years: 74, 70 and 67%. Higher patency in humeral AV and males ( p<0.05). No differences between resident and staff 4. Thrombosis: 0.01-0.05/ VA/year 5. Start HD with VA >80% and HD reconstructions without catheter >90% 6. Maturation failure: 20% (12% immediate) 7. Mapping: need angiogram <5%. After mapping, sex and gender differences corrected. Conclusions: 1. US by nephrologist make the multidisciplinary approach more efficient, so provide the team of an integrated decision in mapping, diagnosis, treatment and prioritization. This may low VA morbidity in high comorbidity patients 2. It should be part of the armamentarium in nephrology and include their learning in the specialty training. AD - J. Ibeas, Nephrology, University Hospital Parc Taulí Sabadell, Barcelona, Spain AU - Ibeas, J. AU - Valeriano, J. AU - Vallespin, J. AU - Fortuño, J. AU - Rodriguez-Jornet, A. AU - Cabré, C. AU - Merino, J. AU - Vinuesa, X. AU - Bolos, M. AU - Branera, J. AU - Mateos, A. AU - Jimeno, V. AU - Grau, C. AU - Criado, E. AU - Moya, C. AU - Ramirez, J. AU - Gimenez, A. AU - Garcia, M. DB - Embase DO - 10.1093/ndt/gft118 KW - edetic acid nephrology vascular access human prospective study ultrasound thrombosis nephrologist catheter surgeon patient surgery stenosis maturation diagnosis glomerulus filtration rate angioplasty dialysis outpatient nursing prophylaxis comorbidity radiologist morbidity sex difference male Charlson Comorbidity Index hemodialysis university hospital learning LA - English M3 - Conference Abstract N1 - L71075691 2013-06-08 PY - 2013 SN - 0931-0509 SP - i231 ST - Vascular access ultrasound by nephrology: From routine mapping to surveillance under protocol. Prospective study of 500 cases T2 - Nephrology Dialysis Transplantation TI - Vascular access ultrasound by nephrology: From routine mapping to surveillance under protocol. Prospective study of 500 cases UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71075691&from=export http://dx.doi.org/10.1093/ndt/gft118 VL - 28 ID - 761170 ER - TY - JOUR AB - Introduction and Aims: Strategies to prevent vascular access (VA) thrombosis include mapping and early stenosis diagnosis. Ultrasound (US) use can substantially change the practice given that intervene in these steps. It has been suggested the usefulness of mapping for prevention of immediate failure in patients with higher risk but recommendation is not well established. On the other hand, the role of surveillance in arteriovenous fistula (AVF) remains controversial. The aim of the study is to evaluate the usefulness of ultrasound mapping in AVF patency in high risk patients for fistula failure. Methods: 1. Prospective cohorts study. Reference University Hospital. 2. Multidisciplinary team: nephrologist, vascular surgeon, interventional radiologist and nursing. 3. Mapping: 2 groups 3.1. Control Group. Preoperative physical examination by a specific vascular surgeon 3.2. Study Group. Preoperative ultrasound examination by a nephro-surgical team. The election of the location for AVF creation was decided as distal as possible, taking into account the Glomerular Filtration to avoid the risk of fistula failure and catheter placement in patients closer to dialysis starting. 3.3. VA Surveillance Protocol (both groups): by US in outpatient nephrology clinic & dialysis unit 4. Treatment: By protocol. Surgery/angioplasty depending stenosis location. In juxtaanastomotic area: surgery; rest of the territory: angioplasty. 5. Outcomes: Secondary Patency. Kaplan-Meier (Log-Rank test)6. Data Record: NephroCloud® Results: 1. n = 334. Control Group: 77; Ultrasound Group 2572. Age: 64.2 ± 15, Gender: 56% Male, 44% female 3. AVF location: radial 50%, braquial 50%4. After stratifying by risk factors for fistula failure, the patency to 1, 2, 3, 4 and 5 years was: 4.1. >;75 y.o. Control: 45%, 45%, 45%, 45%, 45%; US: 76%, 65%, 65%, 65%, 65% (p = 0.08) 4.2. Sex = female. Control: 51%, 47%, 41%, 41%,41%; US: 69%, 63%, 63%, 63%, 63%, (p = 0.06) 4.3.Radial artery: Control: 55%, 48%, 48%,48%,48%; US: 66%, 59%, 59%, 59%, 59% (p = 0.2) 4.4. Combination >;75 y.o. + female: Control: 28%, 28%,28%,28%,28%; US: 74%, 61%, 61%, 61%, 61% ( p<0.05) 4.5. Combination: >;75 y.o. + female + radial: Control: 20%; US: 81%, 62%, 62%, 62%, 62% ( p<0.005). Conclusions: - US mapping can be helpful for AVF planning in high risk patients for fistula failure. - The results of secondary patency in patients with the combination of older age, female sex and distal vessels can be comparables to general dialysis population. AD - J. Ibeas, Parc Taulí Sabadell, Hospital Universitari, Nephrology, Sabadell, Barcelona, Spain AU - Ibeas, J. AU - Vallespin, J. AU - Rioja, S. AU - Cordoba, N. AU - Merino, J. AU - Fortuño, J. R. AU - Vinuesa, X. AU - Mateo, A. AU - Rodriguez-Jornet, A. DB - Embase DO - 10.1093/ndt/gfw173.45 KW - edetic acid human ultrasound patient risk fistula female dialysis high risk patient control group vascular surgeon stenosis thrombosis interventional radiologist nephrologist male population university hospital risk factor log rank test nursing vascular access angioplasty hospital arteriovenous fistula nephrology outpatient catheter prevention surgery glomerulus filtration election gender examination radial artery planning physical examination diagnosis LA - English M3 - Conference Abstract N1 - L72326643 2016-07-23 PY - 2016 SN - 1460-2385 SP - i272-i273 ST - Prospective controled study of systematic ultrasound mapping in patients with high risk of failure in fistula creation T2 - Nephrology Dialysis Transplantation TI - Prospective controled study of systematic ultrasound mapping in patients with high risk of failure in fistula creation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72326643&from=export http://dx.doi.org/10.1093/ndt/gfw173.45 VL - 31 ID - 761025 ER - TY - JOUR AB - Case report A 62 year old African American male with history of coronary artery disease (CAD) with severe 3 vessel disease with in-stent restenosis of his proximal left anterior descending artery (LAD), mid left circumflex artery (LCx), and severe diffuse disease of right coronary artery, decompensated chronic liver disease (DCLD) from hepatitis c cirrhosis (status post curative hepatitis treatment) with ascites, splenomegaly, and thrombocytopenia, history of cerebrovascular accident, hypertension, chronic non occlusive portal thrombosis, presented with nausea, vomiting, chest pain and elevated troponin from known DCLD and CAD. Patient with recent multiple admissions for hepatic and/or cardiac complications and could not undergo coronary artery bypass graft (CABG) due to high perioperative mortality from DCLD at same time could not undergo liver transplantation due to significant CAD. Initial option was to refer him for non-intervention measures with a dim prognosis, but patient was upbeat with wanted all measures to be done to improve his independence. A multidisciplinary team decision was taken for patient to undergo percutaneous coronary intervention with placement of bare-metal stent to his proximal LAD and mid LCx. He was optimized and had procedure without complications with plan for liver transplant followed by CABG and close follow-up to modify his antiplatelet regimen when his platelet count returns to a value of less than 50 000. AD - I. Ifedili, University of Tennessee, Health Science Center, Memphis, TN, United States AU - Ifedili, I. AU - Salem, S. AU - Christian, E. A. AU - Askari, R. AU - Khouzam, R. N. DB - Embase DO - 10.1136/jim-2018-000974.98 KW - endogenous compound troponin adult adverse device effect African American ascites bare metal stent case report cerebrovascular accident chronic liver disease clinical article complication conference abstract coronary artery bypass graft coronary artery circumflex branch coronary artery disease follow up hepatitis C human human cell hypertension in-stent restenosis left anterior descending coronary artery liver cirrhosis liver graft male middle aged multidisciplinary team nausea and vomiting percutaneous coronary intervention platelet count portal vein thrombosis prognosis right coronary artery splenomegaly surgery surgical mortality thorax pain thrombocytopenia LA - English M1 - 2 M3 - Conference Abstract N1 - L626929650 2019-04-01 PY - 2019 SN - 1708-8267 SP - 392 ST - Management dilemma for a patient in need of coronary artery bypass graft and hepatic transplant where one indication makes the other treatment a high risk surgery T2 - Journal of Investigative Medicine TI - Management dilemma for a patient in need of coronary artery bypass graft and hepatic transplant where one indication makes the other treatment a high risk surgery UR - https://www.embase.com/search/results?subaction=viewrecord&id=L626929650&from=export http://dx.doi.org/10.1136/jim-2018-000974.98 VL - 67 ID - 760750 ER - TY - JOUR AB - Introduction: Pulmonary Embolism Response Team (PERT) protocols are used to expedite risk stratification and management of complex acute pulmonary embolisms (PE). The process varies by institution. Objective: To quantify mortality outcomes after implementing PERT at our practice (Figure 1). Methods: 58 patients in our PERT registry were analyzed for parameters seen on table 1. Quantitative data is presented as median and qualitative data as percentages. Results: Median age was 70.5, with female predominance 65.5% (38 out of 58), PE severity index (PESI) of 101.6, and cancer in 33% (19 out of 58) [Table 1]. 10%(6 out of 58) received thrombolysis and 14%(8 out of 58) received IVC filter. 5 deaths occurred of which 60% (3 patients) were due to cancer progression. Conclusion: Our PERT algorithm is anchored in right ventricle to left ventricle (RV/LV) ratio on CT reading and does successfully select high risk PE patients. Mortality is similar to that expected by PESI stratification. Prospective comparative evaluation of PERT is needed to see if it affects early mortality. AD - O. Iftikhar, Northshore Univ HealthSystems, Evanston, IL, United States AU - Iftikhar, O. AU - Smart, K. AU - Ahsan, A. AU - Tafur, A. DB - Embase KW - aged blood clot lysis cancer growth death female filter heart left ventricle heart right ventricle human lung embolism major clinical study mortality register risk assessment stratification LA - English M3 - Conference Abstract N1 - L619084240 2017-11-09 PY - 2017 SN - 1524-4636 ST - Pulmonary embolism response team: Implementation and outcomes at Northshore university healthsystems T2 - Arteriosclerosis, Thrombosis, and Vascular Biology TI - Pulmonary embolism response team: Implementation and outcomes at Northshore university healthsystems UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619084240&from=export VL - 37 ID - 760949 ER - TY - JOUR AB - BACKGROUND: Time to treatment remains the most important factor in acute ischemic stroke prognosis. We quantified the effect of new interventions reducing in-hospital delays in acute stroke management and assessed its repercussion on door-to-imaging (DTI), imaging-to-needle (ITN), and door-to-needle (DTN) times. METHODS: Prospective registry of consecutive stroke patients who were candidates for reperfusion therapy attended in a tertiary care hospital from February 1 to December 31, 2014. A series of measures aimed at reducing in-hospital delays were implemented. We compared DTI, ITN, and DTN times between patients who underwent the interventions and those who did not. RESULTS: 231 patients. DTI time was lower when personal history was reviewed and tests were ordered before patient arrival (2.5 minutes saved, P = .016) and when electrocardiogram was not made (5.4 minutes saved, P < .001). Not performing a computed tomography angiography and not waiting for coagulation results from laboratory before intravenous thrombolysis (25.5%) reduced ITN time significantly (14 and 12 minutes saved, respectively, P < .001). These interventions remained as independent predictors of a shorter ITN and DTN time. Completing all steps resulted in the lowest DTI and ITN times (13 and 19 minutes, respectively). CONCLUSIONS: Every measure is an important part of a chain focused on saving time in acute stroke: the lowest DTI and ITN times were obtained when all steps were completed. Measures shortening ITN time produced a greater impact on DTN time reduction; therefore, ITN interventions should be considered a critical part of new protocols and guidelines. AD - Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: a.iglesiasmohedano@gmail.com. Neurology Department-Vascular Neurology Section, Hospital General Universitario Gregorio Marañón, Madrid, Spain. AN - 28522232 AU - Iglesias Mohedano, A. M. AU - García Pastor, A. AU - Díaz Otero, F. AU - Vázquez Alen, P. AU - Vales Montero, M. AU - Luque Buzo, E. AU - Redondo Ráfales, N. AU - Chavarria Cano, B. AU - Fernández Bullido, Y. AU - Villanueva Osorio, J. A. AU - Gil Núñez, A. DA - Aug DO - 10.1016/j.jstrokecerebrovasdis.2017.04.015 DP - NLM ET - 2017/05/20 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Administration, Intravenous Aged Aged, 80 and over Brain Ischemia/diagnostic imaging/physiopathology/*therapy Cerebral Angiography/methods Computed Tomography Angiography Critical Pathways/*organization & administration Delivery of Health Care, Integrated/*organization & administration Efficiency, Organizational Electrocardiography Female Fibrinolytic Agents/*administration & dosage Humans Male Middle Aged Models, Organizational Patient Care Team/organization & administration Process Assessment, Health Care/*organization & administration Registries Stroke/diagnostic imaging/physiopathology/*therapy Tertiary Care Centers *Thrombolytic Therapy Time Factors Time and Motion Studies Time-to-Treatment/*organization & administration Treatment Outcome *Workflow Door-to-needle time door-to-imaging imaging-to-needle intravenous thrombolysis ischemic stroke treatment LA - eng M1 - 8 N1 - 1532-8511 Iglesias Mohedano, Ana María García Pastor, Andrés Díaz Otero, Fernando Vázquez Alen, Pilar Vales Montero, Marta Luque Buzo, Elisa Redondo Ráfales, Nuria Chavarria Cano, Beatriz Fernández Bullido, Yolanda Villanueva Osorio, Jose Antonio Gil Núñez, Antonio Journal Article Observational Study United States J Stroke Cerebrovasc Dis. 2017 Aug;26(8):1817-1823. doi: 10.1016/j.jstrokecerebrovasdis.2017.04.015. Epub 2017 May 15. PY - 2017 SN - 1052-3057 SP - 1817-1823 ST - Efficacy of New Measures Saving Time in Acute Stroke Management: A Quantified Analysis T2 - J Stroke Cerebrovasc Dis TI - Efficacy of New Measures Saving Time in Acute Stroke Management: A Quantified Analysis VL - 26 ID - 760211 ER - TY - JOUR AB - Purpose: There is considerable clinical equipoise surrounding the triage, risk stratification and correct treatment protocols for patients with acute pulmonary embolism (PE). A multidisciplinary UCLA pulmonary embolism response team (UPERT) was established as an interdisciplinary approach to the assessment and management of acute PE. Materials: UPERT is activated for patients who meet criteria for submassive or massive PE. The attending multidisciplinary on-call team reviews the patient data. Consensus opinion on patient risk and treatment option is reached. Results: From 2/23/17 to 9/12/17, UPERT was activated for a total of 20 patients (11 male, 9 female), mean age 48.5 (range, 11-87). Median time from UPERT activation to completion of consultation note was 195 minutes (range, 49-1475). 20/20 patients received transthoracic echocardiogram. 17/20 patients received CT pulmonary angiography, with 2 patients excluded secondary to age (11 years) and hemodynamic instability, and 1 patient who received a V/Q scan due to poor renal function. 20/20 patients treated with heparin intravenous anti-coagulation. 14/20 patients bridged to novel oral anti-coagulation before discharge. 1/20 patient bridged to Coumadin before discharge. 4/20 patients received systemic thrombolysis with tissue plasminogen activator (tPA) (dose range, 25-100 mg). 8/20 patients underwent intervention. All 8 underwent IVC filter placement; 3 underwent catheter-directed thrombolysis. No patient underwent catheter embolectomy, or surgical embolectomy. 14/20 patients were admitted to ICU. Mean ICU length of stay was 6 days (range, 1-16). 1/20 patient experienced an adverse event (major bleed secondary to failed CVC placement prior to tPA). No patient experienced intracranial hemorrhage. 2/20 patients expired during hospitalization, with UPERT activated from the ICU. 17/20 patients discharged without post-UPERT adverse event. Conclusions: UPERT offers expeditious input and clinical judgment from multiple specialties to optimize therapy. The majority of UPERT patients are managed with medical treatment alone with minimal adverse events thus far. Longitudinal data acquisition will provide comparative outcome evaluation. AD - E. Ihenachor, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States AU - Ihenachor, E. AU - Wang, T. AU - Chang, S. AU - Calfon-Press, M. AU - Moriarty, J. DB - Embase KW - endogenous compound heparin tissue plasminogen activator warfarin adult adverse event anticoagulation blood clot lysis brain hemorrhage catheter clinical article conference abstract consensus consultation decision making drug combination drug therapy embolectomy female filter hemodynamics hospitalization human information processing kidney function length of stay lung angiography lung embolism male middle aged outcome assessment patient coding patient risk risk assessment surgery transthoracic echocardiography treatment failure LA - English M1 - 4 M3 - Conference Abstract N1 - L621353089 2018-03-27 PY - 2018 SN - 1535-7732 SP - S273-S274 ST - UCLA pulmonary embolism response team: Initial experience T2 - Journal of Vascular and Interventional Radiology TI - UCLA pulmonary embolism response team: Initial experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621353089&from=export VL - 29 ID - 760829 ER - TY - JOUR AB - BACKGROUND: The association between comprehensive stroke care capacity and hospital volume of stroke interventions remains uncertain. We performed a nationwide survey in Japan to examine the impact of comprehensive stroke care capacity on the hospital volume of stroke interventions. METHODS: A questionnaire on hospital characteristics, having tissue plasminogen activator (t-PA) protocols, and 25 items regarding personnel, diagnostic, specific expertise, infrastructure, and educational components recommended for comprehensive stroke centers (CSCs) was sent to 1369 professional training institutions. We examined the effect of hospital characteristics, having a t-PA protocol, and the number of fulfilled CSC items (total CSC score) on the hospital volume of t-PA infusion, removal of intracerebral hemorrhage, and coiling and clipping of intracranial aneurysms performed in 2009. RESULTS: Approximately 55% of hospitals responded to the survey. Facilities with t-PA protocols (85%) had a significantly higher likelihood of having 23 CSC items, for example, personnel (eg, neurosurgeons: 97.3% versus 66.1% and neurologists: 51.3% versus 27.7%), diagnostic (eg, digital cerebral angiography: 87.4% versus 43.2%), specific expertise (eg, clipping and coiling: 97.2% and 54% versus 58.9% and 14.3%, respectively), infrastructure (eg, intensive care unit: 63.9% versus 33.9%), and education (eg, professional education: 65.2% versus 20.7%). On multivariate analysis adjusted for hospital characteristics, total CSC score, but not having a t-PA protocol, was associated with the volume of all types of interventions with a clear increasing trend (P for trend < .001). CONCLUSION: We demonstrated a significant association between comprehensive stroke care capacity and the hospital volume of stroke interventions in Japan. AD - Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan. Electronic address: kiihara@hsp.ncvc.go.jp. Department of Preventive Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. Advanced Medical Technology Development, National Cerebral and Cardiovascular Center, Osaka, Japan. Integrative Stroke Imaging Center, National Cerebral and Cardiovascular Center, Osaka, Japan. Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan. Department of Neurosurgery, Iwate Medical University, Iwate, Japan. Chiba Cardiovascular Center, Chiba, Japan. Department of Neurosurgery, Kyorin University, Tokyo, Japan. Showa University Hospital, Tokyo, Japan. Department of Neurosurgery, Nagoya University, Nagoya, Japan. Department of Neurosurgery, Nagasaki University, Nagasaki, Japan. Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan. Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan. Research Institute for Brain and Blood Vessels, Akita, Japan. Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan. Department of Healthcare Epidemiology, Faculty of Medicine, Kyoto University, Kyoto, Japan. AN - 24103675 AU - Iihara, K. AU - Nishimura, K. AU - Kada, A. AU - Nakagawara, J. AU - Toyoda, K. AU - Ogasawara, K. AU - Ono, J. AU - Shiokawa, Y. AU - Aruga, T. AU - Miyachi, S. AU - Nagata, I. AU - Matsuda, S. AU - Ishikawa, K. B. AU - Suzuki, A. AU - Mori, H. AU - Nakamura, F. DA - May-Jun DO - 10.1016/j.jstrokecerebrovasdis.2013.08.016 DP - NLM ET - 2013/10/10 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Comprehensive Health Care/*trends Delivery of Health Care, Integrated/trends Embolization, Therapeutic/trends Fibrinolytic Agents/administration & dosage Health Care Surveys Health Services Accessibility/trends Healthcare Disparities/trends Hospitals, High-Volume/*trends Hospitals, Low-Volume/*trends Humans Japan Linear Models Multivariate Analysis Neurosurgical Procedures/trends Outcome and Process Assessment, Health Care/*trends Patient Care Team/trends Stroke/diagnosis/*therapy Surveys and Questionnaires Thrombolytic Therapy/trends Tissue Plasminogen Activator/administration & dosage Treatment Outcome Stroke facilities acute stroke therapy intracerebral hemorrhage ischemic stroke stroke units subarachnoid hemorrhage LA - eng M1 - 5 N1 - 1532-8511 Iihara, Koji Nishimura, Kunihiro Kada, Akiko Nakagawara, Jyoji Toyoda, Kazunori Ogasawara, Kuniaki Ono, Junichi Shiokawa, Yoshiaki Aruga, Toru Miyachi, Shigeru Nagata, Izumi Matsuda, Shinya Ishikawa, Koichi B Suzuki, Akifumi Mori, Hisae Nakamura, Fumiaki J-ASPECT Study Collaborators Journal Article Multicenter Study United States J Stroke Cerebrovasc Dis. 2014 May-Jun;23(5):1001-18. doi: 10.1016/j.jstrokecerebrovasdis.2013.08.016. Epub 2013 Oct 6. PY - 2014 SN - 1052-3057 SP - 1001-18 ST - The impact of comprehensive stroke care capacity on the hospital volume of stroke interventions: a nationwide study in Japan: J-ASPECT study T2 - J Stroke Cerebrovasc Dis TI - The impact of comprehensive stroke care capacity on the hospital volume of stroke interventions: a nationwide study in Japan: J-ASPECT study VL - 23 ID - 760383 ER - TY - JOUR AB - Despite the availability of updated guidelines for the diagnosis and treatment of venous thromboembolism (VTE), the management of this disorder in clinical practice is often not standardized, given the different degree of compliance with official recommendations by the various involved specialists. The aim of this consensus paper, as a result of a board of experts in thromboembolism, is to define strategies to improve the quality of patients' care and the efficiency of healthcare resources utilization, by means of: (a) analysis of the guidelines for diagnosis and treatment of VTE; (b) analysis of diagnostic and therapeutic algorithms currently used in clinical practice by different specialists; (c) agreement on a common algorithm for diagnosis and treatment of VTE in different clinical settings; (d) definition of the possible role of the new oral anticoagulant agents (NOAC), such as rivaroxaban, based on their potential benefits for both acute and chronic therapy. The so-called "single drug approach" (as opposed to the traditional heparin/VKA combination), which can be adopted with these drugs, makes anticoagulation more convenient for both patients and healthcare providers, without the need for a close monitoring of the hemocoagulative status, and with a concomitant reduction of length of hospitalization and treatment costs. Among NOACs, in this paper we focused on rivaroxaban only because it was the unique available NOAC in Italy for the treatment of VTE at the time the manuscript was written. Concerning rivaroxaban, the results of two phase III, randomized and controlled trials confirm the non-inferiority of this drug compared to standard therapy (enoxaparin/warfarin) for the treatment of patients with pulmonary embolism (EINSTEIN PE Study) or deep vein thrombosis (EINSTEIN DVT Study) in terms of both efficacy and safety, supporting its use as an effective therapeutic option for these disorders. AD - Center for Haemostasis and Thrombosis, Hospital "G. da Saliceto" of Piacenza, Piacenza, Italy. D.Imberti@ausl.pc.it. University of Perugia, Perugia, Italy. General Hospital of Conegliano and Vittorio Veneto, Vittorio Veneto, Italy. Angiology Operating Unit, Azienda Ospedaliera of Padova, Padua, Italy. Fondazione Poliambulanza of Brescia, Brescia, Italy. University of Insubria, Varese, Italy. SIMG, Florence, Italy. AN - 29520700 AU - Imberti, D. AU - Becattini, C. AU - Bernardi, E. AU - Camporese, G. AU - Cuccia, C. AU - Dentali, F. AU - Paretti, D. DA - Oct DO - 10.1007/s11739-018-1802-5 DP - NLM ET - 2018/03/10 J2 - Internal and emergency medicine KW - Biomarkers/analysis/blood Consensus Disease Management Factor Xa Inhibitors/therapeutic use Fibrin Fibrinogen Degradation Products/analysis Heparin, Low-Molecular-Weight/pharmacology/therapeutic use Humans Interdisciplinary Communication Italy Patient Care Team/*trends Pulmonary Embolism/*drug therapy/etiology Rivaroxaban/therapeutic use Treatment Outcome Ultrasonography/methods Venous Thrombosis/complications/*drug therapy Anticoagulation EINSTEIN DVT Study EINSTEIN PE Study Pulmonary embolism Venous thromboembolism LA - eng M1 - 7 N1 - 1970-9366 Imberti, Davide Orcid: 0000-0001-7546-7949 Becattini, Cecilia Bernardi, Enrico Camporese, Giuseppe Cuccia, Claudio Dentali, Francesco Paretti, Damiano Journal Article Italy Intern Emerg Med. 2018 Oct;13(7):1037-1049. doi: 10.1007/s11739-018-1802-5. Epub 2018 Mar 8. PY - 2018 SN - 1828-0447 SP - 1037-1049 ST - Multidisciplinary approach to the management of patients with pulmonary embolism and deep vein thrombosis: a consensus on diagnosis, traditional therapy and therapy with rivaroxaban T2 - Intern Emerg Med TI - Multidisciplinary approach to the management of patients with pulmonary embolism and deep vein thrombosis: a consensus on diagnosis, traditional therapy and therapy with rivaroxaban VL - 13 ID - 760122 ER - TY - JOUR AB - Objective The option to retrieve inferior vena cava (IVC) filters has resulted in an increase in the utilization of these devices as stopgap measures in patients with relative contraindications to anticoagulation. These retrievable IVC filters, however, are often not retrieved and become permanent. Recent data from our institution confirmed a historically low retrieval rate. Therefore, we hypothesized that the implementation of a new IVC filter retrieval protocol would increase the retrieval rate of appropriate IVC filters at our institution. Methods All consecutive patients who underwent an IVC filter placement at our institution between September 2003 and July 2012 were retrospectively reviewed. In August 2012, a multidisciplinary task force was established, and a new IVC filter retrieval protocol was implemented. Prospective data were collected using a centralized interdepartmental IVC filter registry for all consecutive patients who underwent an IVC filter placement between August 2012 and September 2014. Patients were chronologically categorized into preimplementation (PRE) and postimplementation (POST) groups. Comparisons of outcome measures, including the retrieval rate of IVC filters along with rates of retrieval attempt and technical failure, were made between the two groups. Results In the PRE and POST groups, a total of 720 and 74 retrievable IVC filters were implanted, respectively. In the POST group, 40 of 74 filters (54%) were successfully retrieved compared with 82 of 720 filters (11%) in the PRE group (P <.001). Furthermore, a greater number of IVC filter retrievals were attempted in the POST group than in the PRE group (66% vs 14%; P <.001). No significant difference was observed between the PRE and POST groups for technical failure (17% vs 18%; P =.9). Conclusions The retrieval rate of retrievable IVC filters at our institution was significantly increased with the implementation of a new IVC filter retrieval protocol with a multidisciplinary team approach. This improved retrieval rate is possible with minimal dedication of resources and can potentially lead to a decrease in IVC filter-related complications in the future. AD - J. Kalish, Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, 88 E Newton St, Collamore 5, Boston, MA, United States AU - Inagaki, E. AU - Farber, A. AU - Eslami, M. H. AU - Siracuse, J. J. AU - Rybin, D. V. AU - Sarosiek, S. AU - Sloan, J. M. AU - Kalish, J. DB - Embase Medline DO - 10.1016/j.jvsv.2015.11.002 KW - adult blood clotting disorder conference paper controlled study deep vein thrombosis device removal equipment design human lung embolism major clinical study outcome assessment postoperative period practice guideline preoperative period priority journal prospective study protocol compliance retrospective study treatment indication treatment outcome vena cava filter Bird's Nest Denali Eclipse G2X Gunther-Tulip Optease Option Trapease LA - English M1 - 3 M3 - Conference Paper N1 - L608674238 2016-03-04 2016-06-28 PY - 2016 SN - 2213-3348 2213-333X SP - 276-282 ST - Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach Presented at the Twenty-sixth Annual Meeting of the American Venous Forum, New Orleans, La, February 19-22, 2014 T2 - Journal of Vascular Surgery: Venous and Lymphatic Disorders TI - Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach Presented at the Twenty-sixth Annual Meeting of the American Venous Forum, New Orleans, La, February 19-22, 2014 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L608674238&from=export http://dx.doi.org/10.1016/j.jvsv.2015.11.002 VL - 4 ID - 761011 ER - TY - JOUR AB - Objective: The option to retrieve inferior vena cava (IVC) filters has resulted in an increase in the utilization of these devices as stopgap measures in patients with relative contraindications to anticoagulation. These retrievable IVC filters, however, are often not retrieved and become permanent. Recent data from our institution confirmed a historically low retrieval rate. Therefore, we hypothesized that the implementation of a new IVC filter retrieval protocol would increase the retrieval rate of appropriate IVC filters at our institution. Methods: All consecutive patients who underwent an IVC filter placement at our institution between September 2003 and July 2012 were retrospectively reviewed. In August 2012, a multidisciplinary task force was established, and a new IVC filter retrieval protocol was implemented. Prospective data were collected using a centralized interdepartmental IVC filter registry for all consecutive patients who underwent an IVC filter placement between August 2012 and September 2014. Patients were chronologically categorized into preimplementation (PRE) and postimplementation (POST) groups. Comparisons of outcome measures, including the retrieval rate of IVC filters along with rates of retrieval attempt and technical failure, were made between the two groups. Results: In the PRE and POST groups, a total of 720 and 74 retrievable IVC filters were implanted, respectively. In the POST group, 40 of 74 filters (54%) were successfully retrieved compared with 82 of 720 filters (11%) in the PRE group (P < .001). Furthermore, a greater number of IVC filter retrievals were attempted in the POST group than in the PRE group (66% vs 14%; P < .001). No significant difference was observed between the PRE and POST groups for technical failure (17% vs 18%; P = .9). Conclusions: The retrieval rate of retrievable IVC filters at our institution was significantly increased with the implementation of a new IVC filter retrieval protocol with a multidisciplinary team approach. This improved retrieval rate is possible with minimal dedication of resources and can potentially lead to a decrease in IVC filter-related complications in the future. AD - [Inagaki, Elica] Boston Med Ctr, Dept Surg, Boston, MA USA. [Farber, Alik; Eslami, Mohammad H.; Siracuse, Jeffrey J.; Kalish, Jeffrey] Boston Med Ctr, Dept Surg, Div Vasc & Endovasc Surg, Boston, MA USA. [Rybin, Denis V.] Boston Univ, Sch Publ Hlth, Dept Biostat, Boston, MA USA. [Sarosiek, Shayna; Sloan, J. Mark] Boston Univ, Dept Med, Sect Hematol & Oncol, Boston, MA 02215 USA. [Sarosiek, Shayna; Sloan, J. Mark] Boston Med Ctr, Boston, MA USA. Kalish, J (corresponding author), Boston Med Ctr, Endovasc Surg, 88 E Newton St,Collamore 5,D-506, Boston, MA 02118 USA. jeffrey.kalish@bmc.org AN - WOS:000389013200004 AU - Inagaki, E. AU - Farber, A. AU - Eslami, M. H. AU - Siracuse, J. J. AU - Rybin, D. V. AU - Sarosiek, S. AU - Sloan, J. M. AU - Kalish, J. DA - Jul DO - 10.1016/j.jvsv.2015.11.002 J2 - J. Vasc. Surg.-Venous Lymphat. Dis. KW - FOLLOW-UP IMPROVES PULMONARY-EMBOLISM AMERICAN-COLLEGE INCREASING USE REMOVAL RATES TRAUMA COMPLICATIONS POPULATION PREVENTION Surgery Peripheral Vascular Disease LA - English M1 - 3 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: ED7CL Times Cited: 20 Cited Reference Count: 28 Inagaki, Elica Farber, Alik Eslami, Mohammad H. Siracuse, Jeffrey J. Rybin, Denis V. Sarosiek, Shayna Sloan, J. Mark Kalish, Jeffrey 26th Annual Meeting of the American-Venous-Forum FEB 19-22, 2014 New Orleans, LA Amer Venous Forum Siracuse, Jeffrey/AAN-2987-2020 Inagaki, Elica/0000-0002-9066-9044; eslami, mohammad/0000-0001-5490-3131; Sarosiek, Shayna/0000-0002-0075-6735 NIGMS NIH HHSUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of General Medical Sciences (NIGMS) [T32 GM086308] Funding Source: Medline 20 0 1 ELSEVIER SCIENCE BV AMSTERDAM J VASC SURG-VENOUS L PY - 2016 SN - 2213-333X SP - 276-282 ST - Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach T2 - Journal of Vascular Surgery-Venous and Lymphatic Disorders TI - Improving the retrieval rate of inferior vena cava filters with a multidisciplinary team approach UR - ://WOS:000389013200004 VL - 4 ID - 761702 ER - TY - JOUR AB - Objective: Studies have shown that language discordance between treatment teams and patients leads to worse patient outcomes, including longer hospital stays, higher rates of readmission, impaired comprehension of discharge instructions, and lower treatment adherence. Yet, there is a paucity of data evaluating the effects of language discordance on postoperative outcomes among vascular surgery patients. This study compared 30-day postoperative complications and readmissions after nonemergent infrainguinal bypass between non-English-speaking (NES) and English-speaking (ES) patients. Methods: Consecutive patients who underwent nonemergent infrainguinal bypass for claudication, ischemic rest pain, and tissue loss at an urban, academic medical center between 2007 and 2014 were identified. Patients were stratified into NES or ES groups by their self-identified primary language. Crude comparisons and multivariable analyses were performed to assess the association of primary language status with 30-day wound infections, adverse graft events (wound infections, graft thromboses, or hematomas), readmissions, and Emergency Department return visits. Results: The study included 261 patients who underwent an infrainguinal bypass: 51 NES and 210 ES patients. The NES patients were older (67.4 +/- 6 9.8 vs 63.1 +/- 6 9.9 years; P = .005) and had a higher rate of diabetes (78.4% vs 58.6%; P = .009) and a lower rate of chronic obstructive pulmonary disease (5.9% vs 28.6%; P = .001). Other comorbidities were comparable between the two groups. The NES patients were more likely to be Medicaid beneficiaries (51.0% vs 21.4%; P < .001). Across all outcomes compared, crude analyses showed no significant difference between NES and ES patients. Adjusted analysis revealed that language discordance did not affect the odds of adverse outcomes of wound infections (odds ratio [OR], 1.87; 95% confidence interval [CI], 0.90-3.88; P = .095), adverse graft events (OR, 1.23; 95% CI, 0.62-2.45; P = .556), readmissions (OR, 1.51; 95% CI, 0.77-2.95; P = .478), or Emergency Department return visits (OR, 1.28; 95% CI, 0.58-2.83; P = .546). Conclusions: Our study suggests that language discordance does not affect 30-day complication and readmission rates after infrainguinal bypass. AD - [Inagaki, Elica] Boston Univ, Sch Med, Boston Med Ctr, Dept Surg, Boston, MA 02118 USA. [Farber, Alik; Kalish, Jeffrey; Siracuse, Jeffrey J.; Zhu, Clara] Boston Univ, Sch Med, Boston Med Ctr, Div Vasc & Endovasc Surg,Dept Surg, Boston, MA 02118 USA. [Rybin, Denis V.; Doros, Gheorghe] Boston Univ, Sch Publ Hlth, Dept Biostat, Boston, MA USA. [Eslami, Mohammad H.] Univ Pittsburgh, Med Ctr, Dept Surg, Div Vasc Surg, Pittsburgh, PA USA. Eslami, MH (corresponding author), Univ Pittsburgh, Med Ctr, Div Vasc Surg, 200 Lathrop St,PUH Ste 1010-A, Pittsburgh, PA 15213 USA. eslamimh@upmc.edu AN - WOS:000415129100024 AU - Inagaki, E. AU - Farber, A. AU - Kalish, J. AU - Siracuse, J. J. AU - Zhu, C. AU - Rybin, D. V. AU - Doros, G. AU - Eslami, M. H. DA - Nov DO - 10.1016/j.jvs.2017.03.453 J2 - J. Vasc. Surg. KW - LENGTH-OF-STAY PEDIATRIC EMERGENCY-DEPARTMENT LIMITED ENGLISH PROFICIENCY HEALTH-CARE FOLLOW-UP BARRIERS OUTCOMES INTERPRETERS IMPACT Surgery Peripheral Vascular Disease LA - English M1 - 5 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: FM6BB Times Cited: 4 Cited Reference Count: 24 Inagaki, Elica Farber, Alik Kalish, Jeffrey Siracuse, Jeffrey J. Zhu, Clara Rybin, Denis V. Doros, Gheorghe Eslami, Mohammad H. Vascular Annual Meeting of the Society-for-Vascular-Surgery JUN 08-11, 2016 National Harbor, MD Soc Vasc Surg Siracuse, Jeffrey/AAN-2987-2020 , Gheorghe/0000-0001-5524-4721; eslami, mohammad/0000-0001-5490-3131 4 0 3 MOSBY-ELSEVIER NEW YORK J VASC SURG PY - 2017 SN - 0741-5214 SP - 1473-1478 ST - Role of language discordance in complication and readmission rate after infrainguinal bypass T2 - Journal of Vascular Surgery TI - Role of language discordance in complication and readmission rate after infrainguinal bypass UR - ://WOS:000415129100024 VL - 66 ID - 761629 ER - TY - JOUR AB - Objective. The objective of this medication utilization evaluation (MUE) was to determine the appropriateness of dabigatran and rivaroxaban while also reviewing outcomes for safety and effectiveness within a large, multi-center health system. Methods. A retrospective chart review was performed using the system's electronic medical record. A data inquiry was requested and generated for dabigatran usage from July 28, 2011 through July 28, 2012 and for rivaroxaban from March 1, 2012 to July 31, 2012 at eight health system hospitals. All patients receiving at least one dose were eligible for inclusion in the MUE. Results. For dabigatran, 78 of 390 unique patient encounters were analyzed (20%). All 62 rivaroxaban encounters were included in the analysis. Dabigatran was used for appropriate indications in 94% of encounters and 82% for rivaroxaban. Based on indication and renal function, 87% of dabigatran patients and 92% of rivaroxaban patients received correct dosing. For patients transitioning to or from another anticoagulant, appropriate transitions occurred in 44% of dabigatran transitions and 48% of rivaroxaban transitions. At discharge, 83% of dabigatran and 86% of rivaroxaban therapy was continued. There were no reported strokes or systemic embolism with dabigatran, but one reported deep vein thrombosis occurred during hospitalization with rivaroxaban therapy. Documented bleeds in 5% of dabigatran and 3% of rivaroxaban patients. Patient education was documented for 37% of dabigatran and 26% of rivaroxaban patients receiving therapeutic anticoagulation. Conclusion. This MUE revealed the appropriate use of dabigatran and rivaroxaban therapy with few safety outcomes within a large, multi-center health system. AD - PGY-2 Pharmacotherapy Resident, Indiana University Health, Indianapolis, IN Butler University College of Pharmacy and Health Sciences, Indianapolis, IN Clinical Pharmacy Specialist-Internal Medicine, Indiana University Health, Indianapolis, IN AN - 113282277. Language: English. Entry Date: 20160301. Revision Date: 20191111. Publication Type: Article AU - Isaacs, Alex N. AU - Doolin, Meagan AU - Morse, Courtney AU - Shiltz, Erin AU - Nisly, Sarah A. DB - CINAHL DO - 10.2146/sp150031 DP - EBSCOhost KW - Drug Utilization -- Evaluation Rivaroxaban -- Administration and Dosage Hospitals Anticoagulants -- Administration and Dosage Pharmacy and Pharmacology Rivaroxaban -- Therapeutic Use Retrospective Design Anticoagulants -- Therapeutic Use Discharge Planning Drug Evaluation Record Review Electronic Health Records Protocols M1 - 5 N1 - research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. PY - 2016 SN - 1079-2082 SP - S35-S41 ST - Medication utilization evaluation of dabigatran and rivaroxaban within a large, multi-center health system T2 - American Journal of Health-System Pharmacy TI - Medication utilization evaluation of dabigatran and rivaroxaban within a large, multi-center health system UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=113282277&site=ehost-live&scope=site VL - 73 ID - 761349 ER - TY - JOUR AB - Introduction: Caesarean section is major abdominal procedure. We perform approximately 700 cases per year in our district general hospital which is about 20% of the total births. Like any procedure there are risks and benefits. When it is indicated we need to ensure clinical effectiveness, safety and maximise patient experience. We standardise our perioperative care in comparison to national (NICE clinical guideline132) and local guidelines. We completed an audit cycle regarding our caesarean section perioperative care in 2013 and 2014. Materials and methods: In this audit and re-audit cycle, 50 cases were collected on two occasions, prospectively covering both emergency and elective caesarean sections over two sets period of 3 months in 2013 and 2014. We assessed following criteria: consenting, administering pre-incision antibiotics, completing a theatre WHO check list, duration of hospital stays, thromboprophylaxis, patient and theatre team debriefing. Clinical cases and summary results: We noted our good practice of consenting in providing adequate verbal and written information for women's informed choice with 100% compliance to standards. Patients received pre- incision in 95% of elective caesarean section (ELCS) and 93% emergency caesarean sections (EMCS) in 2013. In 2014 100% patient had pre-incision antibiotics. VTE prophylaxis improved from 86% and 89% to 96% and 93% respectively in ELCS and EMCS. Most patients had early post-operative enhanced discharge, only 8-9% patients stayed in the hospital for 3-4 days. A culture of patient debriefing had been gradually developing from only 0 to 5% in 2013 to 55-65% in 2014. Significant improvement was noted in theatre WHO check list completion, from 10% to 96% for ELCS and from 0 to 52% for EMCS. In both the years there was lack of documental evidence of theatre team briefing which obviously needs further attention. Though we tried to avoid verbal consenting, still were happening in up to 12 to 15% of category 1 caesarean sections. Conclusion: The audits demonstrated that with a dedicated multidisciplinary team approach and commitment it is possible to consistently improve quality of perioperative care for women having caesarean sections. Patient and staff debriefing are gradually becoming part of our routine practice to ensure women are having high satisfaction while going through a stressful life event and that the caring team members also feel well engaged and satisfied for their role and contribution. AD - S. Islam, Department of Obstetrics and Gynaecology, University Hospital of North Tees, Stockton-On-Tees, United Kingdom AU - Islam, S. AU - Bodnar, S. DB - Embase DO - 10.1080/14767058.2016.1191212 KW - antibiotic agent attention cesarean section checklist controlled study female general hospital hospitalization human incision life event major clinical study perioperative period practice guideline prophylaxis safety satisfaction staff LA - English M3 - Conference Abstract N1 - L611870258 2016-09-07 PY - 2016 SN - 1476-4954 SP - 83 ST - Assessing quality of care for women having caesarean sections in a district general hospital in the UK T2 - Journal of Maternal-Fetal and Neonatal Medicine TI - Assessing quality of care for women having caesarean sections in a district general hospital in the UK UR - https://www.embase.com/search/results?subaction=viewrecord&id=L611870258&from=export http://dx.doi.org/10.1080/14767058.2016.1191212 VL - 29 ID - 761045 ER - TY - JOUR AB - IMPORTANCE Mobile stroke treatment units (MSTUs) with on-site treatment teams that include a vascular neurologist can provide thrombolysis in the prehospital setting faster than treatment in the hospital. These units can be made more resource efficient if the need for an on-site neurologist can be eliminated by relying solely on telemedicine for physician presence. OBJECTIVE To test whether telemedicine is reliable and remote physician presence is adequate for acute stroke treatment using an MSTU. DESIGN, SETTING, AND PARTICIPANTS Prospective observational study conducted between July 18 and November 1, 2014. The dates of the study analysis were November 1, 2014, to March 30, 2015. The setting was a community-based study assessing telemedicine success of the MSTU in Cleveland, Ohio. Participants were the first 100 residents of Cleveland who had an acute onset of stroke-like symptoms between 8 AM and 8 PM and were evaluated by the MSTU after the implementation of the MSTU program at the Cleveland Clinic. A vascular neurologist evaluated the first 100 patients via telemedicine, and a neuroradiologist remotely assessed images obtained by mobile computed tomography (CT). Data were entered into the medical record and a prospective registry. MAIN OUTCOMES AND MEASURES The study compared the evaluation and treatment of patients on the MSTU with a control group of patients brought to the emergency department via ambulance during the same year. Process times were measured from the time the patient entered the door of the MSTU or emergency department, and any problems encountered during his or her evaluation were recorded. RESULTS Ninety-nine of 100 patients were evaluated successfully. The median duration of telemedicine evaluation was 20 minutes (interquartile range [IQR], 14-27 minutes). One connection failure was due to crew error, and the patient was transported to the nearest emergency department. There were 6 telemedicine disconnections, none of which lasted longer than 60 seconds or affected clinical care. Times from the door to CT completion (13 minutes [IQR, 9-21 minutes]) and from the door to intravenous thrombolysis (32 minutes [IQR, 24-47 minutes]) were significantly shorter in the MSTU group compared with the control group (18 minutes [IQR, 12-26 minutes] and 58 minutes [IQR, 53-68 minutes], respectively). Times to CT interpretation did not differ significantly between the groups. CONCLUSIONS AND RELEVANCE An MSTU using telemedicine is feasible, with a low rate of technical failure, and may provide an avenue for reducing the high cost of such systems. AD - [Itrat, Ahmed; Taqui, Ather; Cerejo, Russell; Winners, Stacey; Rasmussen, Peter; Hussain, Muhammad S.; Uchino, Ken] Cleveland Clin, Cerebrovasc Ctr, 9500 Euclid Ave,S80, Cleveland, OH 44195 USA. [Briggs, Farren] Case Western Reserve Univ, Sch Med, Dept Epidemiol & Biostat, Cleveland, OH 44106 USA. [Cho, Sung-Min; Organek, Natalie] Cleveland Clin, Dept Neurol, Cleveland, OH 44106 USA. [Reimer, Andrew P.] Cleveland Clin, Crit Care Transport Team, Cleveland, OH 44106 USA. [Reimer, Andrew P.] Case Western Reserve Univ, Frances Payne Bolton Sch Nursing, Cleveland, OH 44106 USA. Uchino, K (corresponding author), Cleveland Clin, Cerebrovasc Ctr, 9500 Euclid Ave,S80, Cleveland, OH 44195 USA. uchinok@ccf.org AN - WOS:000385845500006 AU - Itrat, A. AU - Taqui, A. AU - Cerejo, R. AU - Briggs, F. AU - Cho, S. M. AU - Organek, N. AU - Reimer, A. P. AU - Winners, S. AU - Rasmussen, P. AU - Hussain, M. S. AU - Uchino, K. AU - Cleveland Prehosp Acute Stroke, Tre DA - Feb DO - 10.1001/jamaneurol.2015.3849 J2 - JAMA Neurol. KW - MOBILE STROKE PILOT FEASIBILITY TELESTROKE TRIAL MANAGEMENT UNIT DIAGNOSIS Clinical Neurology LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: DZ4QY Times Cited: 68 Cited Reference Count: 25 Itrat, Ahmed Taqui, Ather Cerejo, Russell Briggs, Farren Cho, Sung-Min Organek, Natalie Reimer, Andrew P. Winners, Stacey Rasmussen, Peter Hussain, Muhammad S. Uchino, Ken Briggs, Farren/Q-2164-2019; Cho, Sung-Min/V-1841-2019 Briggs, Farren/0000-0003-0903-1359; Cho, Sung-Min/0000-0002-5132-0958; Reimer, Andrew/0000-0002-6425-4101; Uchino, Ken/0000-0001-9468-4172 Milton and Tamar Maltz Family Foundation; Cleveland Clinic The Cleveland Clinic mobile stroke treatment unit was jointly funded by The Milton and Tamar Maltz Family Foundation and the Cleveland Clinic. 71 3 10 AMER MEDICAL ASSOC CHICAGO JAMA NEUROL PY - 2016 SN - 2168-6149 SP - 162-168 ST - Telemedicine in Prehospital Stroke Evaluation and Thrombolysis Taking Stroke Treatment to the Doorstep T2 - Jama Neurology TI - Telemedicine in Prehospital Stroke Evaluation and Thrombolysis Taking Stroke Treatment to the Doorstep UR - ://WOS:000385845500006 VL - 73 ID - 761721 ER - TY - GEN AB - Trombos móveis no átrio direito são raros e associados a altas taxas de embolia pulmonar e de mortalidade. Neste relato é apresentado um caso de trombo em trânsito nas câmaras direitas, com suspeita clínica de tromboembolismo pulmonar, diagnosticado por ecocardiografia transesofágica, com boa evolução após anticoagulação. São também discutidas suas formas de apresentação, tratamento e evolução.Emboli in transit in right atrium are rare. When they occur, they are associated to high rate of pulmonary embolism and mortality. This is a case report on an embolus in transit in right chambers, with clinical suspicion of pulmonary thromboembolism. Diagnosis was obtained through transesophageal echocardiography. The patient had a positive response post-anticoagulation. The team discussed presentation forms, treatment and condition development. AU - Ivan Romero, Rivera AU - Maria Alayde Mendonça da, Silva AU - Ricardo César, Cavalcanti AU - Edmilton Wanderley, Cavalcante AU - Roberto Lúcio de Gusmão, Verçosa DA - 2020/02/13 DB - OpenAIRE PY - 2020 ST - Trombo em trânsito no interior do átrio direito: relato de caso e revisão da literatura Right heart emboli-in-transit: case report and literature review TI - Trombo em trânsito no interior do átrio direito: relato de caso e revisão da literatura Right heart emboli-in-transit: case report and literature review UR - https://explore.openaire.eu/search/publication?articleId=dedup_wf_001::ae6a3d8cad08988a27a8d47f3f334558 ID - 762057 ER - TY - JOUR AB - Background As pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are debilitating and fatal diseases it is essential to increase the understanding of patients' experience of support. The aim was to describe patients' experiences of support while living with PAH or CTEPH. Methods Seventeen patients (13 women and four men) aged 28-73 years were strategically selected from a regional PAH centre and individually interviewed. The answers were analysed using qualitative content analysis. Results Three categories that describe patients' experiences of support emerged: Support linked to the healthcare; support linked to the private sphere; and support linked to persons outside the private sphere. Conclusion Healthcare practitioners must work more in collaboration to detect patients' need for support and to develop the patient's own skills to manage daily life. The PAH teams should tailor interventions to provide emotional, informational and instrumental support and guidance to patients and their families. AD - [Ivarsson, Bodil; Sjoberg, Trygve] Lund Univ, Dept Cardiothorac Surg, S-22100 Lund, Sweden. [Ivarsson, Bodil; Sjoberg, Trygve] Skane Univ Hosp, SE-22185 Lund, Sweden. [Ivarsson, Bodil] Reg Skane, Med Serv, Lund, Sweden. [Ekmehag, Bjorn] Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden. [Ekmehag, Bjorn] Univ Uppsala Hosp, Uppsala, Sweden. Ivarsson, B (corresponding author), Skane Univ Hosp, Dept Cardiothorac Surg, SE-22185 Lund, Sweden. bodil.ivarsson@med.lu.se AN - WOS:000366319400011 AU - Ivarsson, B. AU - Ekmehag, B. AU - Sjoberg, T. DA - Jan DO - 10.1016/j.hlc.2015.03.026 J2 - Heart Lung Circ. KW - Chronic disease Peer support Relationship Social support Supportive care SURVIVAL CARE MANAGEMENT DIAGNOSIS Cardiac & Cardiovascular Systems LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: CY3OP Times Cited: 6 Cited Reference Count: 27 Ivarsson, Bodil Ekmehag, Bjorn Sjoberg, Trygve Skane University Hospital; Swedish Society of Pulmonary Hypertension; Actelion Pharmaceuticals Sverige AB This study was supported by Skane University Hospital and by an unrestricted research grant from the Swedish Society of Pulmonary Hypertension and Actelion Pharmaceuticals Sverige AB. 6 0 4 ELSEVIER SCIENCE INC NEW YORK HEART LUNG CIRC PY - 2016 SN - 1443-9506 SP - 35-40 ST - Support Experienced by Patients Living with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension T2 - Heart Lung and Circulation TI - Support Experienced by Patients Living with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension UR - ://WOS:000366319400011 VL - 25 ID - 761732 ER - TY - JOUR AB - BackgroundPulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare diseases with a gradual decline in physical health. Adherence to treatment is crucial in these very symptomatic and life threatening diseases. ObjectiveTo describe PAH and CTEPH patients experience of their self-reported medication adherence, beliefs about medicines and information about treatment. MethodsA quantitative, descriptive, national cohort survey that included adult patients from all PAH-centres in Sweden. All patients received questionnaires by mail: The Morisky Medication Adherence Scale (MMAS-8) assesses treatment-related attitudes and behaviour problems, the Beliefs about Medicines Questionnaire-Specific scale (BMQ-S) assesses the patient's perception of drug intake and the QLQ-INFO25 multi-item scale about medical treatment information. ResultsThe response rate was 74% (n=325), mean age 6614 years, 58% were female and 69% were diagnosed with PAH and 31% with CTEPH. Time from diagnosis was 4.7 +/- 4.2 years. More than half of the patients (57%) reported a high level of adherence. There was no difference in the patients' beliefs of the necessity of the medications to control their illness when comparing those with high, medium or low adherence. Despite high satisfaction with the information, concerns about potential adverse effects of taking the medication were significantly related to adherence. ConclusionsTreatment adherence is relatively high but still needs improvement. The multi-disciplinary PAH team should, together with the patient, seek strategies to improve adherence and prevent concern. AD - [Ivarsson, Bodil] Skane Univ Hosp, Dept Cardiothorac Surg, Lund, Sweden. [Ivarsson, Bodil; Hesselstrand, Roger; Radegran, Goran] Lund Univ, Clin Sci Lund, Lund, Sweden. [Hesselstrand, Roger] Skane Univ Hosp, Dept Rheumatol, Lund, Sweden. [Radegran, Goran] Skane Univ Hosp, Sect Heart Failure & Valvular Dis, Lund, Sweden. [Kjellstrom, Barbro] Karolinska Inst, Dept Med, Cardiol Unit, Stockholm, Sweden. [Kjellstrom, Barbro] Karolinska Univ Hosp, Stockholm, Sweden. Ivarsson, B (corresponding author), Skane Univ Hosp, Dept Cardiothorac Surg THAI, SE-22185 Lund, Sweden. bodil.ivarsson@med.lu.se AN - WOS:000437844500005 AU - Ivarsson, B. AU - Hesselstrand, R. AU - Radegran, G. AU - Kjellstrom, B. DA - Jun DO - 10.1111/crj.12770 J2 - Clin. Respir. J. KW - chronic disease communication compliance gender health behaviour information pulmonary hypertension SOCIAL SUPPORT CARE Respiratory System LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: GM1QJ Times Cited: 2 Cited Reference Count: 28 Ivarsson, Bodil Hesselstrand, Roger Radegran, Goran Kjellstrom, Barbro Kjellstrom, Barbro/AAR-3484-2020 Kjellstrom, Barbro/0000-0002-7936-1209; Ivarsson, Bodil/0000-0002-5647-3929 Medicine Service University Trust; Region Skane; Swedish Society of Pulmonary Hypertension (Bayer AB); Actelion Pharmaceuticals Sverige AB; Swedish Heart and Lung AssociationSwedish Heart-Lung Foundation Medicine Service University Trust; Region Skane and by unrestricted research grants from the Swedish Society of Pulmonary Hypertension (Bayer AB); Actelion Pharmaceuticals Sverige AB and The Swedish Heart and Lung Association 3 0 4 WILEY HOBOKEN CLIN RESPIR J PY - 2018 SN - 1752-6981 SP - 2029-2035 ST - Adherence and medication belief in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: A nationwide population-based cohort survey T2 - Clinical Respiratory Journal TI - Adherence and medication belief in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: A nationwide population-based cohort survey UR - ://WOS:000437844500005 VL - 12 ID - 761584 ER - TY - JOUR AB - Outpatient pulmonary hypertension (PH) specialist centers have an important role in the optimal management of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). The aim of the present study was to gain an understanding of the work facing nurses at the outpatient PH specialist centers in Sweden. All nurses (n= 14) working at the outpatient PH specialist centers in Sweden were included. Qualitative content analysis was employed to analyze the interviews, wherein an overarching theme emerged: "Build and maintain a relationship with the patient". Three categories described the nurses' experiences: "Ambiguous satisfaction regarding information and communication", "Acting as a coordinator" and "Professional and personal development". To provide good patient care, the nurses described the key components as the ability to give information on all aspects of the disease and their availability by phone for patients, their relatives, and other healthcare resources. This requires evidence-based, specialist knowledge about the disease, its care, and treatments as well as experience. In conclusion, working as a nurse at the outpatient PH specialist centers highlight the advantages, expectations, and difficulties in working with patients with a rare and life-threatening illness. The overall knowledge and skills were high, but the nurses expressed a need for in-depth and continued training. AD - [Ivarsson, Bodil] Univ Trust, Off Med Serv, SE-22185 Lund, Region Skane, Sweden. [Ivarsson, Bodil] Lund Univ, Clin Sci, Dept Cardiothorac Surg, SE-22185 Lund, Sweden. [Kjellstrom, Barbro] Karolinska Inst, Dept Med, SE-17176 Stockholm, Sweden. [Kjellstrom, Barbro] Lund Univ, Clin Sci, Dept Clin Physiol, SE-22185 Lund, Sweden. [Kjellstrom, Barbro] Skane Univ Hosp, Dept Clin Physiol, SE-22185 Lund, Sweden. Ivarsson, B (corresponding author), Univ Trust, Off Med Serv, SE-22185 Lund, Region Skane, Sweden.; Ivarsson, B (corresponding author), Lund Univ, Clin Sci, Dept Cardiothorac Surg, SE-22185 Lund, Sweden. Bodil.ivarsson@med.lu.se; barbro.kjellstrom@ki.se AN - WOS:000548056900078 AU - Ivarsson, B. AU - Kjellstrom, B. C7 - 180 DA - Jun DO - 10.3390/healthcare8020180 J2 - Healthcare KW - advocacy allied health occupations health information management clinical decision-making communication chronic disease holistic care professionals-patient relations significant others team care PULMONARY ARTERIAL-HYPERTENSION MANAGEMENT SUPPORT IMPACT Health Care Sciences & Services Health Policy & Services LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: MJ4KA Times Cited: 0 Cited Reference Count: 24 Ivarsson, Bodil Kjellstrom, Barbro Ivarsson, Bodil/0000-0002-5647-3929 0 1 MDPI BASEL HEALTHCARE-BASEL PY - 2020 SP - 10 ST - Novel Insight into How Nurses Working at PH Specialist Clinics in Sweden Perceive Their Work T2 - Healthcare TI - Novel Insight into How Nurses Working at PH Specialist Clinics in Sweden Perceive Their Work UR - ://WOS:000548056900078 VL - 8 ID - 761438 ER - TY - JOUR AB - Objectives: Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension are severe diseases with complicated treatment that need care at specialist clinics. The aim was to investigate changes in the patients' perceptions on coping, social support and received information when attending a newly started nurse-coordinated pulmonary arterial hypertension-outpatient clinic. Methods: The present study was a descriptive, questionnaire-based cohort study including 42 adult patients. To evaluate coping, the Pearlin Mastery Scale was used. Social support, information and health-related quality of life were measured using Social Network and Support Scale, QLQ-INFO25 and the EQ-5D. Results: Attending the pulmonary arterial hypertension-outpatient clinic increased coping ability (Mastery Scale) significantly (baseline 16.0 +/- 3.3 points vs 2-year follow-up 19.6 +/- 5.2 points, p < 0.001) while there was no difference in social network and support or in perception of received information after. Patients who improved their coping ability (67%) were younger, had better exercise capacity, experienced better health-related quality of life and were more satisfied with received information about treatment and medical tests than those who reduced the coping ability. There was no difference in gender, diagnosis, time since diagnose, pulmonary arterial hypertension-specific treatment, education level or civil status between the two groups. Conclusion: This study suggests that the pulmonary arterial hypertension-team, in partnership with the patient, can support patients to take control of their disease and increase their health-related quality of life. AD - [Ivarsson, Bodil] Lund Univ, Div Cardiothorac Surg, Dept Clin Sci Lund, SE-22185 Lund, Sweden. [Ivarsson, Bodil; Radegran, Goran; Hesselstrand, Roger] Skane Univ Hosp, SE-22185 Lund, Sweden. [Ivarsson, Bodil] Med Serv Univ Trust, Lund, Region Skane, Sweden. [Radegran, Goran] Lund Univ, Dept Clin Sci Lund, Sect Heart Failure & Valvular Dis, Div Cardiol, Lund, Sweden. [Hesselstrand, Roger] Lund Univ, Rheumatol, Dept Clin Sci Lund, Lund, Sweden. [Kjellstrom, Barbro] Karolinska Inst, Dept Med, Stockholm, Sweden. Ivarsson, B (corresponding author), Lund Univ, Div Cardiothorac Surg, Dept Clin Sci Lund, SE-22185 Lund, Sweden.; Ivarsson, B (corresponding author), Skane Univ Hosp, SE-22185 Lund, Sweden. bodil.ivarsson@med.lu.se AN - WOS:000463093100001 AU - Ivarsson, B. AU - Radegran, G. AU - Hesselstrand, R. AU - Kjellstrom, B. C7 - Unsp 2050312117749159 DA - Jan DO - 10.1177/2050312117749159 J2 - SAGE Open Med. KW - Communication chronic disease health-related quality of life mastery professionals-patient relations patient preference TEAMWORK CARE Medicine, General & Internal LA - English M3 - Article N1 - ISI Document Delivery No.: HR4CY Times Cited: 4 Cited Reference Count: 23 Ivarsson, Bodil Radegran, Goran Hesselstrand, Roger Kjellstrom, Barbro Kjellstrom, Barbro/AAR-3484-2020 Kjellstrom, Barbro/0000-0002-7936-1209 Medicine Service University Trust; Region Skane; Swedish Society of Pulmonary Hypertension; Swedish Heart and Lung AssociationSwedish Heart-Lung Foundation; Bayer AB; Actelion Pharmaceuticals Sverige AB The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by Medicine Service University Trust, Region Skane and by unrestricted research grants from the Swedish Society of Pulmonary Hypertension (Bayer AB, Actelion Pharmaceuticals Sverige AB) and The Swedish Heart and Lung Association. 4 0 1 SAGE PUBLICATIONS INC THOUSAND OAKS SAGE OPEN MED PY - 2018 SN - 2050-3121 SP - 6 ST - Coping, social support and information in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: A 2-year retrospective cohort study T2 - Sage Open Medicine TI - Coping, social support and information in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension: A 2-year retrospective cohort study UR - ://WOS:000463093100001 VL - 6 ID - 761608 ER - TY - JOUR AB - Introduction: Spouses play a crucial role, both physically and psychologically, for patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Our aim was to investigate the spouse's experiences when living with a partner diagnosed with PAH or CTEPH. Methods: We used a qualitative interview study design based on open-ended questions analysed using qualitative content analysis. Results: 14 spouses were interviewed. Two categories that describe spouses' experiences of dealing with everyday life were identified: "Living in an insecure life situation" and "Providing and receiving information and support". The experiences reported by the spouses were that their life situation was insecure, and that they had challenges in providing and receiving information and support. Most spouses also wanted and felt a need to be more involved in the care. Conclusion: The spouses were only partly satisfied with their life situation. To support the spouse's participation, the PAH/CTEPH team should encourage the patient to bring their spouse along, and offer them the opportunity to participate in the contacts with healthcare and provide information on an individual family perspective. AD - [Ivarsson, Bodil; Sjoberg, Trygve] Skane Univ Hosp, Dept Cardiothorac Surg, Lund, Sweden. [Ivarsson, Bodil; Sjoberg, Trygve; Hesselstrand, Roger; Radegran, Goran] Lund Univ, Clin Sci Lund, Lund, Sweden. [Hesselstrand, Roger] Skane Univ Hosp, Dept Rheumatol, Lund, Sweden. [Radegran, Goran] Skane Univ Hosp, Sect Heart Failure & Valvular Dis, Lund, Sweden. [Kjellstrom, Barbro] Karolinska Inst, Dept Med, Cardiol Unit, Stockholm, Sweden. Ivarsson, B (corresponding author), Skane Univ Hosp, Dept Cardiothorac Surg THAI, Klinikgatan 11, S-22185 Lund, Sweden. bodil.ivarsson@med.lu.se AN - WOS:000532535900040 AU - Ivarsson, B. AU - Sjoberg, T. AU - Hesselstrand, R. AU - Radegran, G. AU - Kjellstrom, B. C7 - 218 DA - Feb DO - 10.1183/23120541.00218-2018 J2 - ERJ Open Res. KW - SUPPORT MANAGEMENT Respiratory System LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: LM8YX Times Cited: 1 Cited Reference Count: 20 Ivarsson, Bodil Sjoberg, Trygve Hesselstrand, Roger Radegran, Goran Kjellstrom, Barbro Kjellstrom, Barbro/AAR-3484-2020 Kjellstrom, Barbro/0000-0002-7936-1209; Ivarsson, Bodil/0000-0002-5647-3929 Actelion Pharmaceuticals Sverige AB This study was supported by unrestricted research grants from Actelion Pharmaceuticals Sverige AB. The sponsor did not have any role in study design, data collection, analysis or interpretation of data, nor in writing the manuscript or the decision to submit the paper for publication. Funding information for this article has been deposited with the Crossref Funder Registry. 1 0 EUROPEAN RESPIRATORY SOC JOURNALS LTD SHEFFIELD ERJ OPEN RES PY - 2019 SP - 7 ST - Everyday life experiences of spouses of patients who suffer from pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension T2 - Erj Open Research TI - Everyday life experiences of spouses of patients who suffer from pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension UR - ://WOS:000532535900040 VL - 5 ID - 761541 ER - TY - JOUR AB - Background Linezolid is an antibiotic used for the treatment of serious infections caused by gram positive bacteria. Although first approved for skin infections, its use includes empiric treatment of infections usually caused by linezolid sensitive bacteria. Purpose To describe, analyse and optimise the use of linezolid in a university hospital. To study new susceptible optimisation points. Material and methods This was a retrospective observational study (February-March 2016). Patient demographics and treatment related data were obtained from electronic clinical records. All linezolid prescriptions were reviewed, carrying out and registering pharmacy interventions. The results were compared with evidence observed in published guidelines and the literature. Results 53 patients treated with linezolid were found (66 years (30-95)), 60% were men. Average treatment duration was 10.4 days (median 8 days, treatments longer than 90 days excluded). Indications were: 30% skin infections, 22.6% peritonitis, 18.8% pneumonia, 7.5% prosthesis infections and 7.5% meningitis. 51% of cases were unlabelled indications. 26.4% were empiric treatments (<5 days), and 28.3% longer than 14 days (labelled treatment duration). Infectious diseases (32%) and critical care units (34%) were the most prescriber services. Microbiological samples were obtained in 90.6% of patients (39.5% Staphylococcus spp, 18.7% Enterococcus spp). Only gram negative bacteria were isolated in 6 patients (3 following treatment). 3 patients treated for more than 7 days had no samples. Adverse drug reactions did not lead to drug withdrawal in any patient. 7 patients (13%) developed thrombocytopenia (average 15.7 days of linezolid (5-35)), 2 anaemia and 1 liver enzyme elevations. 15 drug interactions were detected and followed clinically. Conclusion Most uses of linezolid in our hospital were according to the hospital protocols and were highly supported by bibliography and clinical evidence, although they were not authorised by the drug data file or FDA. The issues identified for future pharmacy interventions were intravenous to oral switch (although not registered, it was considered too long), and treatment de-escalation (microorganisms sensitive to other drugs were isolated without antibiotic change). Pharmacists have contributed in a multidisciplinary team to optimise linezolid use, especially in the detection of drug interactions, drug adverse effects and validation of prescriptions of linezolid, in each case considering infection and causal microorganism. AD - I.I. Izquierdo, Hospital Basurto, Department of Pharmacy, Bilbao, Spain AU - Izquierdo, I. I. AU - España, Z. P. AU - Barrenechea, M. L. M. AU - Aguirre, I. M. AU - Santos, P. N. M. AU - Urtizberea, U. B. AU - Diaz, L. I. AU - Muzas, E. O. AU - Armada, A. L. AU - Ibarreche, Y. M. J. DB - Embase DO - 10.1136/ejhpharm-2017-000640.318 KW - linezolid liver enzyme adverse device effect adverse drug reaction anemia clinical trial communicable disease drug therapy drug withdrawal Enterococcus female Gram negative bacterium human human tissue information processing intensive care unit major clinical study male meningitis nonhuman observational study peritonitis pharmacist pharmacy (shop) pneumonia practice guideline prescription prosthesis infection publication side effect skin infection Staphylococcus thrombocytopenia treatment duration validation process LA - English M3 - Conference Abstract N1 - L617772345 2017-08-18 PY - 2017 SN - 2047-9964 SP - A145 ST - Linezolid use evaluation, pharmacy interventions and study of new optimisation points T2 - European Journal of Hospital Pharmacy TI - Linezolid use evaluation, pharmacy interventions and study of new optimisation points UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617772345&from=export http://dx.doi.org/10.1136/ejhpharm-2017-000640.318 VL - 24 ID - 760954 ER - TY - GEN AB - Abstract Compared with recent advances in treatment of serious cardiovascular diseases, such as myocardial infarction and stroke, the treatment and outcome of... AU - Jaber, Wissam A. M. D. AU - Fong, Pete P. M. D. AU - Weisz, Giora M. D. AU - Lattouf, Omar M. D. AU - Jenkins, James M. D. AU - Rosenfield, Kenneth M. D. Mhcds AU - Rab, Tanveer M. D. AU - Ramee, Stephen M. D. DA - 2016/01/01 DB - Federal Science Library - Canada KW - Cardiovascular Internal Medicine fibrinolysis pulmonary artery embolectomy interventional management Pulmonary embolism Stroke (Disease) Anticoagulants (Medicine) Cardiology Heart diseases PY - 2016 SN - 0735-1097 ST - Acute Pulmonary Embolism TI - Acute Pulmonary Embolism UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnR3JSsNAdNCK4sVdWjdy86ApmZkkkxyLtlhEUbTgbZgtYOkiTXvw730vSw9iBb0EAplM3v5e5i2EcNYO_G86QbAkS60wzlhHtYG4iDoTKGYstzyxGDcOBrz7Fj4-Y2nM9YoD_SIxa6gM9h6kUfEfj4XrZAN7yuD4grjfXqrhOCmmegALY6vNVFQVMz-_Y5VVatQpcpV-7e3-7dv2yE7lWHqdkhP2yZqbHJCth-ro_JA0O2Yxd97TYgSMp2afXnesp6P3fHxEBr3u682dX41F8A34J6lvAp5maKepcRy8M2YhZtCIxkhwZphOrOEmEC6NBM20VZyqSNtEKRBPF3J-TBqT6cQ1iZfy2FEqYggystBaqoPIaRXiPCsdJ0HUIlc1WuRH2f1C1mlhQ4nASgRWUiYB2BYRNeZkXdcJmsjllVjkksocnpQvSBSkCXqjabEyWq6sLH9p0SWg-NcdL5FAEoVxPlNGVTUFAB22tZKdELwPEQIkJ__c4ZRsw11cZp2dkcZ8tnDnZDPLR77Os4uC5eB627__Ajv80jE VL - 67 ID - 762128 ER - TY - JOUR AB - Full Text Available Background We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions ( P  = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions ( P  = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability. AU - Jacob, Schultz AU - Nicholas, Giordano AU - Hui, Zheng AU - Blair, A. Parry AU - Geoffrey, D. Barnes AU - Gustavo, A. Heresi AU - Wissam, Jaber AU - Todd, Wood AU - Thomas, Todoran AU - Courtney, D. Mark AU - Soophia, Naydenov AU - Sameer, Khandhar AU - Philip, Green AU - Christopher, Kabrhel DA - 2019/08 08 DB - Directory of Open Access Journals (Sweden) DO - 10.1177/2045894018824563 PY - 2019 SN - 2045-8940 ST - A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium T2 - Pulmonary Circulation TI - A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium UR - https://doi.org/10.1177/2045894018824563 VL - 9 ID - 761940 ER - TY - JOUR AB - In this presentation, the focus is on type B dissection, indicating that the entry tear is localized at the level or distal to the origin of the left subclavian artery. In uncomplicated acute type B aortic dissection, conservative management is indicated and concentrates on blood pressure measurement and intensive observation. In complicated type B dissection, endovascular coverage of the entry tear aims for restoring flow to obstructed side branches. In general, open surgery has hardly any place in the decision tree in patients with acute type B dissection. In patients who develop post dissection descending thoracic or thoraco abdominal aortic aneurysms, open surgical repair is still the treatment of choice, despite the rapid evolving endovascular solutions. Aneurysms involving the thoracic and abdominal aorta constitute an enormous challenge for the patient and the team managing this complex pathology. Especially in extensive thoraco abdominal aortic aneurysms (TAAA), the surgical trauma and associated potential adverse events are massive threats for our patients. Surgical results have significantly improved over time, especially in experienced and high-volume centers, however, mortality and morbidity rates remain high. Endovascular strategies are increasingly performed in TAAA patients, both in degenerative and post dissection aneurysms, showing encouraging results. This presentation addresses some important differences between degenerative and post dissection aneurysm. Degenerative versus post dissection aneurysms: Degenerative aneurysms are the most common type of descending and thoraco-abdominal aortic aneurysms and occur as the result of breakdown of the connective tissue and muscular layer. The main causing factors are hypertension, cigarette smoking, genetic conditions, affecting patients at higher age. Post dissection aneurysms develop after a type A or type B dissection over time. These post dissection aneurysms can also occur in elderly patients but the larger group of affected patients are those with severe hypertension or syndromic aortic conditions. For therapeutic purposes it is relevant to understand the differences between degenerative and post dissection aneurysms. In general, the indication for treatment depends of the maximal diameter of the aneurysm and no difference is made between degenerative and post dissection aneurysm: larger than 6 cm is accepted as a threshold for intervention. In connective tissue disease patients this threshold is 5 cm. The open surgical techniques do not differ in degenerative and post dissection aneurysms. Post dissection thoracoabdominal aneurysms can develop following extensive Stanford type A or Stanford type B aortic dissection in which the longitudinal extension of the dissection involved the descending thoracic and abdominal aorta, most often including the iliac arteries as well. Such late aneurysmal degeneration of the outer wall of the false lumen occurs in 30-40 % One of the main differences between degenerative and post dissection aneurysms is patency of intercostal and lumbar arteries: in the latter group almost all segmental arteries are patent whereas in atherosclerotic aneurysms the majority of segmental vessels is occluded. In post dissection aneurysms, the important segmental vessels most often originate from the true lumen, which is technically an advantage for revascularization since the quality of tissue is better than in the false lumen. Moving from open to endovascular TAAA repair? Open surgical repair of degenerative and post dissection TAAA is still the gold standard in patients 'fit' for surgery. However, the majority of patients are not fit enough for this huge surgical trauma. The best results obtained with open repair are obtained in patients with Marfan syndrome who most often have a TAAA following type A or B dissection. These patients are significantly younger than patients with degenerative aneurysms, contributing to lower mortality rates. They frequently have undergone multiple aortic procedures of the ascending and/or aortic arch al eady. The surgical trauma in isolated descending thoracic aortic aneurysm repair is significantly lower than in open thoraco abdominal aortic repair. In intact descending thoracic aneurysms, surgical mortality is approximately 7% and comparable to mortality rates after TEVAR. Studies have shown 30-day mortality, long-term survival (5 years) and aortic-related interventions and found similar short-term mortality after open and endovascular repair in a large group with degenerative descending thoracic aortic aneurysms. However, 5-year survival was significantly worse after TEVAR. Open TAAA repair in the elderly patient is associated with higher mortality and major adverse events, both for degenerative and post dissection aneurysms. Therefore it is encouraging that endovascular solutions with branched and fenestrated grafts provide acceptable outcomes and that results are improving over time. Even post dissection thoraco-abdominal aneurysms are currently treated by endovascular means, however, experience is still limited and results are reported by highly experienced and high-volume centers. These complex procedures, either open surgical or endovascular, should therefore be centralized in centers of excellence with the full infrastructure and multidisciplinary teams to master the procedures and handle adverse events. AD - M. Jacobs, European Vascular Center Aachen-Maastricht, Maastricht University Medical Center, Netherlands AU - Jacobs, M. DB - Embase KW - aged aortic arch aortic dissection blood pressure measurement cigarette smoking conference abstract connective tissue disease conservative treatment decision tree descending aortic aneurysm descending aortic surgery dissecting aneurysm endovascular aneurysm repair gold standard human hypertension iliac artery intersegmental vessel left subclavian artery long term survival lumbar artery Marfan syndrome morbidity mortality rate multidisciplinary team open surgery patent revascularization surgery surgical injury surgical mortality thoracoabdominal aorta aneurysm LA - English M1 - 3 M3 - Conference Abstract N1 - L632172029 2020-07-09 PY - 2019 SN - 1644-3276 SP - 190-191 ST - Open repair of aortic dissection T2 - Acta Angiologica TI - Open repair of aortic dissection UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632172029&from=export VL - 25 ID - 760782 ER - TY - JOUR AB - Purpose: The purpose of this retrospective study was to investigate the effect of revised cardiac rehabilitation Clinical Pathways (CPs) on the Cardiac Rehabilitation (CR) participation rate of patients with Myocardial Infarction (MI) undergoing Percutaneous Coronary Intervention (PCI). Methods: We reviewed the electronic medical record of patients who were referred for CR after MI from July 2015 to December 2016. In April 2016, the patient groups were divided into 9-month periods: pre- and post-CP revision. We reduced the mean number of hospital visits for CR and the wait times before starting CR and the first Cardio Pulmonary Exercise (CPX) test. We added a home-based CR program and reinforced the CR liaison nurse's role. The changes in the CR wait time, mean number of hospital visits post-discharge, and participation rates at 1 and 3 months were investigated. Results: Ninety-two patients were recruited from July 2015 to March 2016. Twenty-four (26.1%) participated in CR at 1 month, and 11 (12.0%) were maintained up to 3 months. From April 2016 to December 2016, 107 patients were recruited. Sixty-five (60.7%) participated at 1 month, and 38 (35.5%) were maintained up to 3 months. The mean number of hospital visits was 3.5±0.8 versus 1.9±0.9 in the previous and revised CP groups. The average number of days to the first CPX test after MI was 43.4±17.6 versus 26.3±10.6. Conclusion: Following CP revision, the CR participation rate significantly improved among patients with PCI post-MI. CP revision in terms of inter-physician communication and additional nursing interventions should be considered. AD - Resident, Department of Rehabilitation Medicine, Chungbuk National University Hospital, Cheongju, Korea Assistant Professor, Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk Regional Cardiocerebrovascular Center, Cheongju, Korea Educational Nurse, Chungbuk Regional Cardiocerebrovascular Center, Cheongju, Korea Professor, Department of Rehabilitation Medicine, Chungbuk National University College of Medicine, Chungbuk Regional Cardiocerebrovascular Center, Cheongju, Korea AN - 132598008. Language: English. Entry Date: 20181029. Revision Date: 20181029. Publication Type: Article AU - Jae Ung, Ko AU - Goo Joo, Lee AU - Han Mi, kim AU - Heui Je, Bang DB - CINAHL DO - 10.7475/kjan.2018.30.5.536 DP - EBSCOhost KW - Myocardial Infarction -- Rehabilitation Critical Path Consumer Participation Rehabilitation, Cardiac Treatment Outcomes Human Retrospective Design Electronic Health Records Academic Medical Centers South Korea Exercise Test, Cardiopulmonary Waiting Lists Percutaneous Coronary Intervention Hospitalization Nurse Liaison Nursing Role Home Rehabilitation Descriptive Statistics Pearson's Correlation Coefficient Chi Square Test Fisher's Exact Test T-Tests Mann-Whitney U Test Data Analysis Software Male Female Adult Middle Age Aged Funding Source M1 - 5 N1 - research; tables/charts. Journal Subset: Asia; Nursing; Peer Reviewed. Grant Information: Chungbuk Regional Cardiocerebrovascular Center is received a installation support national subsidy (emergency medical fund), budgetary line-item (090-091-2800-2833-321-320-01).. PY - 2018 SN - 1225-4886 SP - 536-545 ST - The Effect of the Revised Clinical Pathway of Cardiac Rehabilitation on Participation Rates in Patients with Myocardial Infarction: A Retrospective T2 - Korean Journal of Adult Nursing TI - The Effect of the Revised Clinical Pathway of Cardiac Rehabilitation on Participation Rates in Patients with Myocardial Infarction: A Retrospective UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=132598008&site=ehost-live&scope=site VL - 30 ID - 761390 ER - TY - JOUR AB - INTRODUCTION: Telestroke has increased access to acute management of ischemic stroke in areas that lack stroke care expertise, yet delays persist in evaluation and treatment. We describe variation in time to alert a telestroke physician of suspected acute ischemic stroke patients potentially eligible for acute stroke therapies among community hospitals in our telestroke network, and explore demographic and spoke-related characteristics associated with delays. METHODS: From our telestroke registry, we identified suspected acute ischemic stroke patients who arrived within 6 hours of symptom onset and underwent video consultation at 1 of 17 community hospitals in our hub-and-spoke network. We compared time between patient arrival to telestroke alert (door-to-page-time) and to tissue plasminogen activator (tPA) administration for eligible patients (door-to-needle-time). We identified factors associated with prolonged metrics. RESULTS: Of 1020 cases between 9/2015 and 3/2017, 47% received tPA. Sixty percent had door-to-page-time more than 15 minutes (median 19.5; IQR, 11-34). Door-to-page-time more than 15 minutes was associated with an 8-fold increase in likelihood of door-to-needle-time more than 60 minutes. Patients with severe stroke experienced faster door-to-page-times. Hospitals with more beds had prolonged door-to-page-time. Full time in-house neurology presence, even when not covering emergent consultations, was associated with faster door-to-page-time over telestroke. Seventy-one percent of patients underwent CT brain prior to the telestroke physician alert; this scenario delayed door-to-page and door-to-needle times. CONCLUSIONS: Door-to-page-time varied considerably among spokes. Awaiting CT scan prior to alerting the telestroke consultant of a stroke code delayed metrics. Telestroke physician alert standards are needed, as are educational initiatives on acute ischemic stroke management and workflow. AD - Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas. Electronic address: amanda.l.jagolino@uth.tmc.edu. Department of Neurology, University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas. Institute for Stroke and Cerebrovascular Disease, Department of Neurology, Houston, Texas; University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas. AN - 31439524 AU - Jagolino-Cole, A. L. AU - Bozorgui, S. AU - Ankrom, C. M. AU - Vahidy, F. AU - Bambhroliya, A. B. AU - Randhawa, J. AU - Trevino, A. D. AU - Cossey, T. C. AU - Savitz, S. I. AU - Wu, T. C. DA - Nov DO - 10.1016/j.jstrokecerebrovasdis.2019.104332 DP - NLM ET - 2019/08/24 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Administration, Intravenous Aged Benchmarking/*standards Brain Ischemia/diagnosis/physiopathology/*therapy Delivery of Health Care, Integrated/*standards Female Fibrinolytic Agents/administration & dosage Humans Male Middle Aged Outcome and Process Assessment, Health Care/*standards Patient Care Team/*standards Practice Patterns, Physicians'/*standards Registries Remote Consultation/*standards Retrospective Studies Stroke/diagnosis/physiopathology/*therapy Thrombolytic Therapy/*standards Time Factors Time-to-Treatment/*standards Tissue Plasminogen Activator/administration & dosage Tomography, X-Ray Computed/standards Treatment Outcome Videoconferencing/standards Workflow Telemedicine acute stroke care healthcare delivery systems ischemic stroke metrics telestroke LA - eng M1 - 11 N1 - 1532-8511 Jagolino-Cole, Amanda L Bozorgui, Shima Ankrom, Christy M Vahidy, Farhaan Bambhroliya, Arvind B Randhawa, Jaskaren Trevino, Alyssa D Cossey, T C Savitz, Sean I Wu, Tzu-Ching Journal Article United States J Stroke Cerebrovasc Dis. 2019 Nov;28(11):104332. doi: 10.1016/j.jstrokecerebrovasdis.2019.104332. Epub 2019 Aug 19. PY - 2019 SN - 1052-3057 SP - 104332 ST - Variability and Delay in Telestroke Physician Alert among Spokes in a Telestroke Network: A Need for Metric Benchmarks T2 - J Stroke Cerebrovasc Dis TI - Variability and Delay in Telestroke Physician Alert among Spokes in a Telestroke Network: A Need for Metric Benchmarks VL - 28 ID - 760331 ER - TY - JOUR AB - Insufficient response to oxidative stress in placenta is proposed as a contributing factor for preeclampsia (PE) development. Glutathione S-transferases (GST) have significant role in detoxification processes. Conflicting results were published by several research groups regarding GST T1 and GST M1 deletion polymorphism as risk factors for PE. The aim of the present meta-analysis was to get a better understanding of the impact of these polymorphisms in preeclampsia development. To identify relevant case-control studies, the author team searched Clarivate Analytics Web of Science, Scopus, PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, major subject journals, and gray literature. Pooled odds ratios and 95% confidence intervals for GST M1 and GST T1 deletion polymorphism and preeclampsia were derived from random effects models. This meta-analysis included 10 eligible studies. The pooled analyses showed no association between GST M1/GST T1 deletion polymorphisms and susceptibility to PE. Even though high heterogeneity was founded among results for GST M1 and double null genotypes, Egger's and Begg's tests (0.17 and 0.18, respectively) revealed no statistical evidence of publication bias among included studies. The present updated systematic review and meta-analysis found no association between GST M1 and GST T1 deletion polymorphism and PE risk. AD - [Jakovljevic, Tamara Sljivancanin] Obstet & Gynecol Clin Narodni Front, Dept Neonatol, Belgrade, Serbia. [Jacimovic, Jelena] Univ Belgrade, Sch Dent Med, Cent Lib, Belgrade, Serbia. [Nikolic, Nadja; Milasin, Jelena] Univ Belgrade, Sch Dent Med, Dept Human Genet, Belgrade, Serbia. Jakovljevic, TS (corresponding author), Obstet & Gynecol Clin Narodni Front, Dept Neonatol, Belgrade, Serbia. tamaricasljiva@hotmail.com AN - WOS:000554354000001 AU - Jakovljevic, T. S. AU - Jacimovic, J. AU - Nikolic, N. AU - Milasin, J. C7 - e13303 DO - 10.1111/aji.13303 J2 - Am. J. Reprod. Immunol. KW - gene glutathione S-transferase M1 glutathione S-transferase T1 meta-analysis polymorphism preeclampsia CIRCULATING ANGIOGENIC FACTORS OXIDATIVE STRESS RISK GSTM1 GSTT1 ENZYME HYPERTENSION ANTIOXIDANTS POPULATION CANCER Immunology Reproductive Biology LA - English M3 - Review; Early Access N1 - ISI Document Delivery No.: MS5ZP Times Cited: 0 Cited Reference Count: 52 Jakovljevic, Tamara Sljivancanin Jacimovic, Jelena Nikolic, Nadja Milasin, Jelena Jacimovic, Jelena/B-8563-2011 Jacimovic, Jelena/0000-0002-6537-7269; Sljivancanin Jakovljevic, Tamara/0000-0003-2622-8284; Nikolic, Nadja/0000-0002-8513-9313 Ministarstvo Prosvete, Nauke i Tehnoloskog Razvoja [175075] Ministarstvo Prosvete, Nauke i Tehnoloskog Razvoja, Grant/Award Number: 175075 0 1 WILEY HOBOKEN AM J REPROD IMMUNOL SN - 1046-7408 SP - 11 ST - Lack of association between glutathione S-transferase M1 and T1 gene polymorphisms and susceptibility to preeclampsia: An updated systematic review and meta-analysis T2 - American Journal of Reproductive Immunology TI - Lack of association between glutathione S-transferase M1 and T1 gene polymorphisms and susceptibility to preeclampsia: An updated systematic review and meta-analysis UR - ://WOS:000554354000001 ID - 761423 ER - TY - JOUR AB - What is known and objective: The aim of this study was to evaluate the appropriateness and clinical outcomes of edoxaban use, and to determine the role of clinical pharmacists in improving the efficacy and safety of edoxaban use. Methods: A retrospective study was performed by using an electronic medical record and anticoagulation clinical data from 600 patients who received edoxaban from 1 March 2016 to 16 July 2017 at a tertiary teaching university hospital. The appropriateness of edoxaban use was assessed using eight criteria based on drug use evaluation criteria developed by the American Society of Health‐System Pharmacists drug use evaluation guidelines, details in Korea Food and Drug Administration approval of edoxaban. Clinical outcomes were evaluated between the appropriately prescribed and inappropriately prescribed groups regarding the incidence of thrombosis and bleeding episodes. Results and discussion: After excluding 86 patients due to the inability to assess renal function, 514 were eligible. Appropriate use was found in 294 patients (57.2%). The most frequent inappropriate use of edoxaban was dose adjustment (60.8%) in accordance with the dosing recommendation in patients with renal insufficiency (creatinine clearance [CrCl] of 15‐50 mL/min) and a low body weight of <60 kg. Moreover, there were three cases of edoxaban use in patients with prosthetic heart valves and moderate‐to‐severe mitral stenosis, and 15 cases of non‐valvular atrial fibrillation in patients with CrCl >95 mL/min in whom edoxaban use is not recommended. Furthermore, we found that the factors related to the appropriateness of edoxaban use were <60 kg body weight (adjusted odds ratio [OR]: 0.310; confidence interval [CI]: 0.197‐0.488) and CrCl <50 mL/min (adjusted OR: 0.629; CI: 0.404‐0.980). There were 45 events (8.75%) of any bleeding, 9 (1.8%) of stroke/transient ischaemic attack (TIA) and four events (0.8%) of deep vein thrombosis (DVT)/pulmonary embolism (PE). However, there was no difference between the appropriately prescribed group (294 patients) and inappropriately prescribed group (220 patients) in the incidence of bleeding events (27 [9.2%] vs 18 [8.2%]), stroke/TIA (7 [2.4%] vs 2 [0.9%]) and DVT/PE (2 [0.7%] vs 2 [0.9%]), respectively. What is new and conclusion: Although edoxaban has a broad therapeutic window that does not require routine monitoring, it should be cautiously used in patients with renal insufficiency (CrCl <50 mL/min) and body weight <60 kg. AD - Department of Pharmacy, Seoul National University Hospital, Seoul Korea College of Pharmacy, Chungbuk National University, Cheongju Korea Division of Life and Pharmaceutical Service, Ewha Womans University, Seoul Korea College of Pharmacy, Ewha Womans University, Seoul Korea AN - 138441646. Language: English. Entry Date: 20190907. Revision Date: 20200930. Publication Type: Article AU - Jang, Bo Min AU - Lee, Ok Sang AU - Shin, Eun Jeong AU - Cho, Eun Jeong AU - Suh, Sung Yeon AU - Cho, Yoon Sook AU - Koo Lee, Myung AU - Rhie, Sandy Jeong DB - CINAHL DO - 10.1111/jcpt.12999 DP - EBSCOhost KW - Drug Utilization -- Evaluation Outcome Assessment Anticoagulants -- Adverse Effects Professional Role Pharmacists Human Retrospective Design Electronic Health Records Academic Medical Centers Tertiary Health Care Inappropriate Prescribing Incidence Thrombosis Hemorrhage Adverse Drug Event Descriptive Statistics Dosage Calculation Body Weight Creatinine -- Metabolism Odds Ratio Confidence Intervals M1 - 5 N1 - practice guidelines; research; tables/charts. Journal Subset: Biomedical; Europe; Peer Reviewed; UK & Ireland. NLM UID: 8704308. PY - 2019 SN - 0269-4727 SP - 760-767 ST - Factors related to inappropriate edoxaban use T2 - Journal of Clinical Pharmacy & Therapeutics TI - Factors related to inappropriate edoxaban use UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=138441646&site=ehost-live&scope=site VL - 44 ID - 761330 ER - TY - JOUR AB - Objectives We sought to assess the technical and clinical feasibility of continuous aspiration catheter-directed mechanical thrombectomy (CDT) in patients with high- or intermediate-high-risk pulmonary embolism (PE). Methods and Results Fourteen patients (eight women and six men; age range: 29–71 years) with high- or intermediate-high-risk PE and contraindications to or ineffective systemic thrombolysis were prospectively enrolled between October 2018 and February 2020. The Indigo Mechanical Thrombectomy System (Penumbra, Inc., Alameda, California) was used as CDT device. Low-dose local thrombolysis (alteplase, 3–12 mg) was additionally applied in three patients. Technical and procedural success was achieved in 14 patients (100%). Complete or nearly complete clearance of pulmonary arteries was achieved in nine patients (64.3%), whereas partial clearance was achieved in five (35.7%). A significant improvement in the pre- and postprocedural patients' clinical status was observed in the following fields (median; interquartile range): heart rate (110; 100–120/min vs. 85; 80–90/min; p < 0.0001), systolic blood pressure (106; 90–127 mmHg vs. 123; 110–133 mmHg; p = 0.049), arterial oxygen saturation (88.5; 84.2–93% vs. 95.0; 93.8–95%, p = 0.0051), pulmonary artery systolic pressure (55; 44–66 mmHg vs. 42; 34–53 mmHg; p = 0.0015), Miller index score (21.5; 20–23 vs. 9.5; 8–13; p < 0.0001) and right ventricular/left ventricular ratio (1.3; 1.3–1.5 vs. 1.0; 0.9–1.0; p < 0.0001). No major periprocedural bleeding was detected. Conclusions CDT is a feasible and promising technique for management of high- or intermediate-high-risk PE to decrease thrombus burden, reduce right heart strain, and improve hemodynamic and clinical status. Some patients may benefit from simultaneous local low-dose thrombolytic therapy. Nevertheless, its criteria and role in CTD-managed patients require further elucidation. PMID:32904502 AU - Jankiewicz, Stanisław AU - Żabicki, Bartosz AU - Grygier, Marek AU - Mularek-Kubzdela, Tatiana AU - Krasiński, Zbigniew AU - Lesiak, Maciej DA - 2020/08/21 08/21 DB - 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 - Journal of Interventional Cardiology TI - Continuous Aspiration Thrombectomy in High- and Intermediate-High-Risk Pulmonary Embolism in Real-World Clinical Practice UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7456496&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7456496 VL - 2020 ID - 762034 ER - TY - JOUR AB - Purpose: To evaluate the safety and efficacy of the microvascular plug (MVP) for selective renal artery embolization. Methods: Retrospective review was performed on a cohort of 6 patients undergoing renal artery embolization using the MVP between July 2015 and August 2018. Patients' demographics, indication for embolization, technical details of the embolization procedure, and clinical events were gathered from the patients' electronic medical records. Results: The patients underwent selective renal artery embolization with a MVP for iatrogenic vascular injuries (n = 3), traumatic vascular injuries (n = 2), and for elective embolization of an angiomyolipoma (n = 1), in native kidneys (n = 4) or in renal allografts (n = 2). Immediate occlusion of the feeding artery was achieved with 1 MVP device in 4 patients. In 1 patient, a second MVP was needed, and in another patient, additional 0.018-inch microcoils were used to completely occlude the injured artery. Technical success was achieved in all patients. The volume of the resulting renal infarction was estimated less than 5% of the renal volume. No other procedure-related complications occurred. Conclusion: The MVP is a safe and effective device allowing superselective renal artery embolization. Therefore, we recommend the MVP as a valuable embolic in superselective renal artery embolization. Additionally, a single device is sufficient in most cases, potentially reducing the cost, duration, and radiation exposure of the procedure. AD - Department of Radiology, University Hospitals Leuven, Leuven, Belgium AN - 141717809. Language: English. Entry Date: 20200218. Revision Date: 20200219. Publication Type: Article AU - Jardinet, Thomas AU - Bonne, Lawrence AU - Oyen, Raymond AU - Maleux, Geert DB - CINAHL DO - 10.1177/1538574419897500 DP - EBSCOhost KW - Renal Artery -- Pathology Embolization, Therapeutic -- Methods Endovascular Procedures -- Methods Human Retrospective Design Record Review Blood Vessels -- Injuries Angiomyolipoma -- Surgery Electronic Health Records Treatment Outcomes Female Male Middle Age Aged M1 - 3 N1 - case study; diagnostic images; pictorial; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 101136421. PY - 2020 SN - 1538-5744 SP - 240-246 ST - Initial Experience With the Microvascular Plug in Selective Renal Artery Embolization T2 - Vascular & Endovascular Surgery TI - Initial Experience With the Microvascular Plug in Selective Renal Artery Embolization UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=141717809&site=ehost-live&scope=site VL - 54 ID - 761341 ER - TY - JOUR AU - Jen, W. Y. AU - Kristanto, W. AU - Teo, L. AU - Phua, J. AU - Yip, H. S. AU - MacLaren, G. AU - Teoh, K. AU - Sim, T. B. AU - Loh, J. AU - Ong, C. C. AU - Chee, Y. L. AU - Kojodjojo, P. DA - 2019/03/27 03/27 DB - Europe PubMed Central DO - 10.1016/j.hlc.2019.02.190 M1 - 3 PY - 2019 SN - 1443-9506 SP - 345-353 ST - Assessing the Impact of a Pulmonary Embolism Response Team and Treatment Protocol on Patients Presenting With Acute Pulmonary Embolism T2 - Heart Lung Circ TI - Assessing the Impact of a Pulmonary Embolism Response Team and Treatment Protocol on Patients Presenting With Acute Pulmonary Embolism UR - http://europepmc.org/article/MED/30910512 VL - 29 ID - 761955 ER - TY - JOUR AB - Background: Pulmonary embolism (PE) care has traditionally been fragmented. The newly introduced Pulmonary Embolism Response Team (PERT) model provides streamlined care based on expedient, multi-disciplinary decision-making. This study aimed to quantify the impact of PERT, as part of a hospital-wide PE treatment protocol, on clinical outcomes. Methods: Consecutive adult patients with acute PE diagnosed via computed tomography pulmonary angiogram (CTPA) were included. The PERT and treatment protocol were introduced in January 2015. Patient characteristics, therapies, quality measures of CTPA reporting, and clinical outcomes of PE patients treated for 2 years before and after implementation of these changes were evaluated. Primary endpoints were median length of stay in intensive care (ICU) and survival to discharge. Results: A total of 321 consecutive PE patients were enrolled, of which 154 (treated in 2013-2014) and 167 (2015-2016) patients formed the historical control and study groups, respectively. Implementation of the algorithm was associated with less variance in anticoagulation and improved reporting of right heart strain parameters on CTPA. The ICU stay was reduced from a median of 5 to 2 days (p < 0.01). Eligible massive PE patients receiving reperfusion increased from 30% to 92% (p = 0.01), with mean delay from diagnosis to reperfusion decreasing from 763 to 181 minutes (p < 0.01). Bleeding complications were not increased, but overall survival to discharge remained unchanged. Conclusions: Introducing a PERT and treatment protocol reduced ICU stay, enhanced quality measures, and improved access of massive PE patients to reperfusion therapies, without increasing bleeding complications or health care costs. AD - P. Kojodjojo, Department of Cardiology, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore AU - Jen, W. Y. AU - Kristanto, W. AU - Teo, L. AU - Phua, J. AU - Yip, H. S. AU - MacLaren, G. AU - Teoh, K. AU - Sim, T. B. AU - Loh, J. AU - Ong, C. C. AU - Chee, Y. L. AU - Kojodjojo, P. DB - Embase Medline DO - 10.1016/j.hlc.2019.02.190 KW - acute disease adult anticoagulant therapy article bleeding clinical assessment clinical outcome cohort analysis computed tomographic angiography controlled study delayed diagnosis female health care planning high risk patient hospital discharge human length of stay lung embolism major clinical study male middle aged priority journal protocol compliance pulmonary embolism response team retrospective study LA - English M1 - 3 M3 - Article N1 - L2001724178 2019-03-28 2020-03-06 PY - 2020 SN - 1444-2892 1443-9506 SP - 345-353 ST - Assessing the Impact of a Pulmonary Embolism Response Team and Treatment Protocol on Patients Presenting With Acute Pulmonary Embolism T2 - Heart Lung and Circulation TI - Assessing the Impact of a Pulmonary Embolism Response Team and Treatment Protocol on Patients Presenting With Acute Pulmonary Embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001724178&from=export http://dx.doi.org/10.1016/j.hlc.2019.02.190 VL - 29 ID - 760590 ER - TY - JOUR AB - Purpose: To study a more real-life outcome of patients with critical limb ischemia (CLI) in an institution with a multidisciplinary team (MDT) approach with a preference toward endovascular intervention first. Material and Methods: A prospective observational cohort study was conducted between May 2007 and May 2010 on patients presenting with CLI. At baseline, MDT selected the optimal treatment, with a preference towards endovascular intervention first. Patients received endovascular treatment, surgical revascularization, primary major amputation, or conservative treatment. Primary endpoints were the quality of life and functional status 6 and 12 months after the initial intervention assessed by the VascuQol and ALDS questionnaire, respectively. Results: Overall, 150 patients were included; 98 had endovascular intervention, 36, surgery, 5, major amputation, and 11, conservative treatment. During follow-up, 40% underwent an additional ipsilateral revascularization procedure. For the total population and endovascular and surgery subgroups, VascuQol sum scores improved after 6 and 12 months (p<0.0001 for all outcomes) compared with baseline. The functional status improved (p=0.014) after 12 months compared with that of baseline for the total population. The functional status of the surgery subgroup improved after 6 (p=0.003) and 12 (p=0.011) months compared with baseline. The other subgroups did not show significant changes. Conclusion: Overall, the strategy of using MDT with a preference toward endovascular treatment first has comparable or even slightly better results than those of other cohorts. All vascular groups should consider implementing MDT to optimize patient outcomes, and discuss whether their treatment strategy should be aimed at treating CLI patients, preferably endovascular first. AD - S. Jens, Radiology, Academic Medical Center, Amsterdam, Netherlands AU - Jens, S. AU - Conijn, A. P. AU - Frans, F. AU - Nieuwenhuis, M. B. B. AU - Met, R. AU - Koelemay, M. J. W. AU - Legemate, D. A. AU - Bipat, S. AU - Reekers, J. A. DB - Embase KW - society Europe critical limb ischemia human patient functional status surgery revascularization population amputation conservative treatment cohort analysis follow up questionnaire procedures quality of life LA - English M1 - 2 M3 - Conference Abstract N1 - L71617934 2014-09-20 PY - 2014 SN - 0174-1551 SP - S232 ST - Outcomes of endovascular first strategy in critical limb ischemia T2 - CardioVascular and Interventional Radiology TI - Outcomes of endovascular first strategy in critical limb ischemia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71617934&from=export VL - 37 ID - 761103 ER - TY - JOUR AB - PURPOSE: This study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age. METHODS: A prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively. RESULTS: In total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup. CONCLUSIONS: Overall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes. AD - Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, s.jens@amc.uva.nl. AN - 25112882 AU - Jens, S. AU - Conijn, A. P. AU - Frans, F. A. AU - Nieuwenhuis, M. B. AU - Met, R. AU - Koelemay, M. J. AU - Legemate, D. A. AU - Bipat, S. AU - Reekers, J. A. DA - Jun DO - 10.1007/s00270-014-0955-5 DP - NLM ET - 2014/08/13 J2 - Cardiovascular and interventional radiology KW - Activities of Daily Living Aged Amputation/statistics & numerical data *Angioplasty, Balloon Cohort Studies Disease-Free Survival Female Follow-Up Studies Humans Ischemia/physiopathology/surgery/*therapy Lower Extremity/*blood supply/physiopathology/surgery Male Middle Aged Prospective Studies Quality of Life Risk Factors Surveys and Questionnaires Treatment Outcome Vascular Patency/*physiology LA - eng M1 - 3 N1 - 1432-086x Jens, Sjoerd Conijn, Anne P Frans, Franceline A Nieuwenhuis, Marieke B B Met, Rosemarie Koelemay, Mark J W Legemate, Dink A Bipat, Shandra Reekers, Jim A Journal Article Observational Study Research Support, Non-U.S. Gov't United States Cardiovasc Intervent Radiol. 2015 Jun;38(3):552-9. doi: 10.1007/s00270-014-0955-5. Epub 2014 Aug 12. PY - 2015 SN - 0174-1551 SP - 552-9 ST - Outcomes of infrainguinal revascularizations with endovascular first strategy in critical limb ischemia T2 - Cardiovasc Intervent Radiol TI - Outcomes of infrainguinal revascularizations with endovascular first strategy in critical limb ischemia VL - 38 ID - 760408 ER - TY - JOUR AB - Methods: A prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively. Results: In total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup. Conclusions: Overall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes. Purpose: This study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age. AD - S. Jens, Department of Radiology, Academic Medical Center, Meibergdreef 9, Amsterdam, Netherlands AU - Jens, S. AU - Conijn, A. P. AU - Frans, F. A. AU - Nieuwenhuis, M. B. B. AU - Met, R. AU - Koelemay, M. J. W. AU - Legemate, D. A. AU - Bipat, S. AU - Reekers, J. A. DB - Embase Medline DO - 10.1007/s00270-014-0955-5 KW - artery cohort analysis critical limb ischemia disability follow up functional status human ischemia patient peripheral vascular disease population procedures quality of life questionnaire revascularization senescence surgery LA - English M1 - 3 M3 - Article N1 - L53287528 2014-08-14 PY - 2015 SN - 1432-086X 0174-1551 SP - 552-559 ST - Outcomes of Infrainguinal Revascularizations with Endovascular First Strategy in Critical Limb Ischemia T2 - CardioVascular and Interventional Radiology TI - Outcomes of Infrainguinal Revascularizations with Endovascular First Strategy in Critical Limb Ischemia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L53287528&from=export http://dx.doi.org/10.1007/s00270-014-0955-5 VL - 38 ID - 761065 ER - TY - GEN AB - PURPOSE: To describe controlled ovarian stimulation (COS) in a population of women with GATA2 deficiency, a genetic bone marrow failure syndrome, prior to allogeneic hematopoietic stem cell transplant METHODS: This is a retrospective case series of nine women with GATA2 deficiency who underwent oocyte preservation at a research institution. Main outcomes measured include baseline fertility characteristics ((antimullerian hormone (AMH) and day 3 follicle-stimulating hormone (FSH) and estradiol (E2)) and total doses of FSH and human menopausal gonadotropins (HMG), E2 on day of trigger, and total number of metaphase II oocytes retrieved. RESULTS: The mean age was 24 years [16–32], mean AMH was 5.2 ng/mL [0.7–10], and day 3 mean FSH was 5.1 U/L [0.7–8.1], and E2 was 31.5 pg/mL [< 5–45]. The mean dose of FSH was 1774 IU [675–4035], and HMG was 1412 IU [375–2925] with a mean E2 of 2267 pg/mL [60.7–4030] on day of trigger. The mean total of metaphase II oocytes was 7.7 [0–15]. One patient was diagnosed with a deep vein thrombosis (DVT) with pulmonary embolism (PE) during COS. CONCLUSION: This study is the first to analyze the outcomes of COS in women with GATA2 deficiency. The response to ovarian stimulation suggests that oocyte cryopreservation should be considered prior to gonadotoxic therapy. However, due to the risk of potentially life-threatening complications, it is prudent that patients are properly counseled of the risks and are evaluated by a multi-disciplinary medical team prior to COS. AU - Jessica, R. Zolton AU - Toral, P. Parikh AU - Dennis, D. Hickstein AU - Steven, M. Holland AU - Micah, J. Hill AU - Alan, H. DeCherney AU - Erin, F. Wolff DA - 2020/08/03 DB - OpenAIRE PY - 2020 ST - Oocyte cryopreservation for women with GATA2 deficiency TI - Oocyte cryopreservation for women with GATA2 deficiency UR - https://explore.openaire.eu/search/publication?articleId=dedup_wf_001::4a00b03af7182fd3aea00f0e41eec480 ID - 762036 ER - TY - JOUR AB - BACKGROUND: The treatment of acute ischemic stroke in Ontario is coordinated through a network of stroke centers, supplemented by emergency telemedicine consultations to nonstroke centers through the Ontario Telemedicine Network's province-wide Telestroke program. Using geoinformatics, we sought to evaluate the overall impact of Telestroke on access to stroke thrombolysis in Ontario. METHODS: Ontario population data (census) were used to overlay polygons created by Service Area Analysis using ArcGIS 10.1. Service areas were divided into predefined driving times toward the nearest stroke center. Centers were compared after they were categorized as being able to administer stroke thrombolysis either independently or through the Telestroke program. RESULTS: Of the 12,857,821 people living in Ontario in 2011, 99.83% had timely access to stroke thrombolysis, leaving 21,829 people, exclusively within Northern Ontario, without access. Of the population, 71.86% was within a 30-minute drive of a regional or district stroke center, increasing to 91.28% when the Telestroke program was included, for an additional 2,501,121 people. Of the population, 1.85% had access to stroke thrombolysis only through the extended time window (between 3 and 4.5 hours), increasing to 3.86% with Telestroke, for an additional 258,618 people. CONCLUSION: The vast majority of people in Ontario have access to stroke thrombolysis. The provincial Telestroke program improves timeliness of access for those living in Southern Ontario, although some remote rural and Northern communities remain without access. Geoinformatics may likewise prove useful in coordinating provincial access to endovascular thrombectomy. AD - Department of Geography, University of Calgary, Calgary, Alberta, Canada. McMaster University, Hamilton, Ontario, Canada. Hamilton Health Sciences, Hamilton, Ontario, Canada. Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Hamilton Health Sciences, Hamilton, Ontario, Canada; Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Electronic address: sahlas@mcmaster.ca. AN - 28478980 AU - Jewett, L. AU - Mirian, A. AU - Connolly, B. AU - Silver, F. L. AU - Sahlas, D. J. DA - Jul DO - 10.1016/j.jstrokecerebrovasdis.2017.03.023 DP - NLM ET - 2017/05/10 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - *Catchment Area, Health *Delivery of Health Care, Integrated *Geographic Information Systems *Health Services Accessibility Health Services Needs and Demand Humans *Models, Theoretical Needs Assessment Ontario Patient Care Team Program Evaluation Stroke/diagnosis/*drug therapy Telemedicine/*methods Thrombolytic Therapy/*methods Time Factors *Time-to-Treatment Treatment Outcome Stroke geospatial telestroke thrombolysis LA - eng M1 - 7 N1 - 1532-8511 Jewett, Lauren Mirian, Ario Connolly, Ben Silver, Frank L Sahlas, Demetrios J Comparative Study Journal Article United States J Stroke Cerebrovasc Dis. 2017 Jul;26(7):1400-1406. doi: 10.1016/j.jstrokecerebrovasdis.2017.03.023. Epub 2017 May 3. PY - 2017 SN - 1052-3057 SP - 1400-1406 ST - Use of Geospatial Modeling to Evaluate the Impact of Telestroke on Access to Stroke Thrombolysis in Ontario T2 - J Stroke Cerebrovasc Dis TI - Use of Geospatial Modeling to Evaluate the Impact of Telestroke on Access to Stroke Thrombolysis in Ontario VL - 26 ID - 760505 ER - TY - GEN AB - Pulmonary embolism (PE) remains largely underdiagnosed due to nonspecific symptoms. This study aims to evaluate typical symptoms of PE patients, their related... AU - Ji, Qiao-Ying AU - Wang, Mao-Feng AU - Su, Cai-Min AU - Yang, Qiong-Fang AU - Feng, Lan-Fang AU - Zhao, Lan-Yan AU - Fang, Shuang-Yan AU - Zhao, Fen-Hua AU - Li, Wei-Min DA - 2017/01/01 DB - Federal Science Library - Canada KW - Dyspnea - complications Humans Middle Aged Risk Factors Tachypnea - complications Logistic Models Male Pulmonary Embolism - diagnosis Cough - complications Pulmonary Embolism - etiology Aged, 80 and over Female Aged Retrospective Studies Principal Component Analysis Cluster Analysis Dyspnea Embolisms Pulmonary arteries Regression analysis Respiration Health risk assessment Embolism Cough Principal components analysis Index Medicus PY - 2017 SN - 2045-2322 ST - Clinical symptoms and related risk factors in pulmonary embolism patients and cluster analysis based on these symptoms TI - Clinical symptoms and related risk factors in pulmonary embolism patients and cluster analysis based on these symptoms UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwrV1La9wwEBYlEOilNH1ukgb1XLaRJcuWjklIaCkUCl3oTch6wFKvvUTZwv77zliKaUqgl55sLNmWRqPRN5bnG0IE_8iWf9mElquofeuC86HqHPhFVXDMcueFF8qj37haiesf9ddvGBozZ_7CX8QyW3CW43kMtY41C6KyTS0lt02oKgcwR3gvonaTMRbqD98qk3xzXVe6BM0woc4TLFwYXAY2GhwC0Jb2wcI08fc_DjrBRhdje_OcPCuwkV7k9h2RJ2F4QQ5zIsn9S_Kr0Hv2NO0327txk6gdPJ0CVQIc1-knLZl16Hqg210P2mdv9zRsurFfpw0t_Kr5PtfvkD8BzjNjCcW1ztNxoAAXU5hf8oqsbq6_X31alowK0EkAPksXuIxeutYqZ6HXvgOp2YbVERyZoLkNAOekBHe5lV4FiwReESGfZrVXTovX5GAYh_CWUC1Q8m0D_kmsva86JkNna0yF1TWKyQX5cC9Os83EGWba8BbKZOEbEL6ZhG_aBblEic81kfR6ugBjb8rYm3-N_YKc3o-XKTMxGSTPAQwEwPfRYiS4h660Eprwfi6GKYb7JnYI4w4f0TQcd4ChzpusBnNDuWaIoMXx_-jACXnKJ43ELzyn5ODudhfekcOY-mWX4hno9OcvZ5Nm_wa9Ef-c VL - 7 ID - 762122 ER - TY - JOUR AB - BACKGROUND: Kaposiform lymphangiomatosis (KLA) and kaposiform hemangioendothelioma (KHE) are rare and aggressive vascular disorders. The aim of this study was to examine the clinical features and prognosis of KLA and KHE involving the thorax. METHODS: The clinical features, imaging and pathological findings, treatments and outcome were retrospectively reviewed for 6 patients with KLA and 7 patients with KHE involving the thorax. RESULTS: The mean ages at the time of the presentation of signs/symptoms were 26.7 months and 4.1 months for KLA and KHE, respectively. Respiratory symptoms, pericardial and pleural effusion, thrombocytopenia and coagulopathy were common in both KLA and KHE. Diffuse lesions involving the lung and extrathoracic sites were observed in KLA but not in KHE. Histopathologically, all lesions had spindled tumor cells, which were immunoreactive for CD31 and D2-40. In KLA, the spindle cells were distributed in sparse and poorly marginated clusters, whereas the spindle cells formed more defined and confluent vascularized nodules in KHE. Unlike the refractory behavior of KLA, the majority of patients with KHE responded to medical treatments with regression of the lesion and normalization of the hematologic parameters. CONCLUSIONS: The presenting and histological characteristics of KLA can overlap with those of KHE. The presence of diffuse vascular lesions in the mediastinum and lung with refractory thrombocytopenia and coagulopathy should suggest the diagnosis of KLA. Given the rarity and high morbidity and mortality of these disorders, the diagnostic process and therapeutic approach should include a multidisciplinary team review and consensus. AD - Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China. jijiyuanyuan@163.com. Pediatric Intensive Care Unit, Department of Critical Care Medicine, West China Hospital of Sichuan University, #37# Guo-Xue-Xiang, Chengdu, 610041, China. siy_chen@163.com. Division of Oncology, Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China. Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, China. Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, 610041, China. AN - 31277673 AU - Ji, Y. AU - Chen, S. AU - Peng, S. AU - Xia, C. AU - Li, L. C2 - Pmc6612206 DA - Jul 5 DO - 10.1186/s13023-019-1147-9 DP - NLM ET - 2019/07/07 J2 - Orphanet journal of rare diseases KW - Diagnosis, Differential Female Hemangioendothelioma/*diagnosis/*diagnostic imaging Humans Infant Infant, Newborn Kasabach-Merritt Syndrome/*diagnosis/*diagnostic imaging Lymphangiectasis/*diagnosis/*diagnostic imaging Magnetic Resonance Imaging Male Prognosis Retrospective Studies Sarcoma, Kaposi/*diagnosis/*diagnostic imaging *Coagulopathy *Kaposiform hemangioendothelioma *Kaposiform lymphangiomatosis *Thorax *Thrombocytopenia non-financial, that could be perceived as prejudicing the impartiality of the research reported. LA - eng M1 - 1 N1 - 1750-1172 Ji, Yi Orcid: 0000-0002-9289-9660 Chen, Siyuan Peng, Suhua Xia, Chunchao Li, Li Journal Article Research Support, Non-U.S. Gov't Orphanet J Rare Dis. 2019 Jul 5;14(1):165. doi: 10.1186/s13023-019-1147-9. PY - 2019 SN - 1750-1172 SP - 165 ST - Kaposiform lymphangiomatosis and kaposiform hemangioendothelioma: similarities and differences T2 - Orphanet J Rare Dis TI - Kaposiform lymphangiomatosis and kaposiform hemangioendothelioma: similarities and differences VL - 14 ID - 760166 ER - TY - JOUR AB - BackgroundKaposiform lymphangiomatosis (KLA) and kaposiform hemangioendothelioma (KHE) are rare and aggressive vascular disorders. The aim of this study was to examine the clinical features and prognosis of KLA and KHE involving the thorax.MethodsThe clinical features, imaging and pathological findings, treatments and outcome were retrospectively reviewed for 6 patients with KLA and 7 patients with KHE involving the thorax.ResultsThe mean ages at the time of the presentation of signs/symptoms were 26.7months and 4.1months for KLA and KHE, respectively. Respiratory symptoms, pericardial and pleural effusion, thrombocytopenia and coagulopathy were common in both KLA and KHE. Diffuse lesions involving the lung and extrathoracic sites were observed in KLA but not in KHE. Histopathologically, all lesions had spindled tumor cells, which were immunoreactive for CD31 and D2-40. In KLA, the spindle cells were distributed in sparse and poorly marginated clusters, whereas the spindle cells formed more defined and confluent vascularized nodules in KHE. Unlike the refractory behavior of KLA, the majority of patients with KHE responded to medical treatments with regression of the lesion and normalization of the hematologic parameters.ConclusionsThe presenting and histological characteristics of KLA can overlap with those of KHE. The presence of diffuse vascular lesions in the mediastinum and lung with refractory thrombocytopenia and coagulopathy should suggest the diagnosis of KLA. Given the rarity and high morbidity and mortality of these disorders, the diagnostic process and therapeutic approach should include a multidisciplinary team review and consensus. AD - [Ji, Yi; Peng, Suhua] Sichuan Univ, Div Oncol, Dept Pediat Surg, West China Hosp, Chengdu 610041, Sichuan, Peoples R China. [Chen, Siyuan] Sichuan Univ, Dept Crit Care Med, Pediat Intens Care Unit, West China Hosp, 37 Guo Xue Xiang, Chengdu 610041, Sichuan, Peoples R China. [Xia, Chunchao] Sichuan Univ, Dept Radiol, West China Hosp, Chengdu 610041, Sichuan, Peoples R China. [Li, Li] Sichuan Univ, Pathol Lab, West China Hosp, Chengdu 610041, Sichuan, Peoples R China. Ji, Y (corresponding author), Sichuan Univ, Div Oncol, Dept Pediat Surg, West China Hosp, Chengdu 610041, Sichuan, Peoples R China.; Chen, SY (corresponding author), Sichuan Univ, Dept Crit Care Med, Pediat Intens Care Unit, West China Hosp, 37 Guo Xue Xiang, Chengdu 610041, Sichuan, Peoples R China. jijiyuanyuan@163.com; siy_chen@163.com AN - WOS:000474612800002 AU - Ji, Y. AU - Chen, S. Y. AU - Peng, S. H. AU - Xia, C. C. AU - Li, L. C7 - 165 DA - Jul DO - 10.1186/s13023-019-1147-9 J2 - Orphanet J. Rare Dis. KW - Kaposiform lymphangiomatosis Kaposiform hemangioendothelioma Thrombocytopenia Coagulopathy Thorax KASABACH-MERRITT PHENOMENON FEATURES Genetics & Heredity Medicine, Research & Experimental LA - English M3 - Article N1 - ISI Document Delivery No.: IH6NF Times Cited: 4 Cited Reference Count: 20 Ji, Yi Chen, Siyuan Peng, Suhua Xia, Chunchao Li, Li National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [81401606, 81400862]; Key Project in the Science & Technology Program of Sichuan Province [19ZDYF1454]; Science Foundation for Excellent Youth Scholars of Sichuan University [2015SU04A15] This work was supported by grants from the National Natural Science Foundation of China (Grant No: 81401606 and 81400862), the Key Project in the Science & Technology Program of Sichuan Province (Grant No: 19ZDYF1454), and the Science Foundation for Excellent Youth Scholars of Sichuan University (Grant No: 2015SU04A15). 4 0 1 BMC LONDON ORPHANET J RARE DIS PY - 2019 SN - 1750-1172 SP - 8 ST - Kaposiform lymphangiomatosis and kaposiform hemangioendothelioma: similarities and differences T2 - Orphanet Journal of Rare Diseases TI - Kaposiform lymphangiomatosis and kaposiform hemangioendothelioma: similarities and differences UR - ://WOS:000474612800002 VL - 14 ID - 761510 ER - TY - JOUR AB - PURPOSE: This is a single-center, descriptive report of the management and complications of venous catheter use in 19 severely burned passengers from a bus fire that occurred on July 5, 2014, in Hangzhou. METHODS: We recorded the parameters of the catheters insertion and indwelling. Sampling of each removed catheter was conducted to monitor for catheter-related infections. Bedside ultrasound screening was performed for recording central venous catheter (CVC)-related complications. RESULTS: Of the 174 venous accesses placed, 108 were CVCs. 27 (25.0%) catheter tip cultures (CTC) were positive; 12 (11.1%) were catheter-related blood stream infections (CRBSI). Acinetobacter baumannii was the most prominent bacterial infection for both CTC- (55.56%) and CRBSI- (75.00%) positive catheters. CTC- and CRBSI-positive rates were higher during the emergency stage, and both dropped rapidly after reform measures (chi-square test, p = 0.003), and all were negative after the no.8 catheters. Accumulative regression results indicated that total body surface area burned (TBSA), number of catheters, days of indwelling, and bloodstream infections were independently associated with CTC results, while gender and number of catheters were independently associated with CRBSI results. 1 femur vein thrombosis was detected and cured. CONCLUSIONS: Bedside ultrasound and professional IV team for CVC management are pivotal for massive burn victims. Their intervention helps control CVC-related infections and other complications. A. baumannii was the most frequent bacterial infection found in both CTC- and CRBSI-positive catheters. Several most important factors associated with catheter-related infections were concluded. This information alerts us to watch for patients with such warning factors. AD - Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou - PR China. Department of Burns and Wound Center, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou - PR China. Professional Intravenous Team, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou - PR China. AN - 27056030 AU - Jiang, H. AU - Hu, H. AU - Ren, H. AU - Han, C. AU - Wang, X. AU - You, C. AU - Zhao, R. DA - Jul 12 DO - 10.5301/jva.5000547 DP - NLM ET - 2016/04/09 J2 - The journal of vascular access KW - Acinetobacter Infections/diagnosis/microbiology/*therapy Acinetobacter baumannii/*isolation & purification Adult Burns/diagnosis/*therapy Catheter-Related Infections/diagnosis/microbiology/*therapy Catheterization, Central Venous/adverse effects/*instrumentation *Catheters, Indwelling *Central Venous Catheters China Female *Fires Humans Male *Mass Casualty Incidents *Motor Vehicles Patient Care Team Point-of-Care Systems Retrospective Studies Risk Factors Severity of Illness Index Terrorism Time Factors Ultrasonography, Interventional LA - eng M1 - 4 N1 - 1724-6032 Jiang, Hongfei Hu, Hang Ren, Haitao Han, Chunmao Wang, Xingang You, Chuangang Zhao, Ruiyi Journal Article United States J Vasc Access. 2016 Jul 12;17(4):353-9. doi: 10.5301/jva.5000547. Epub 2016 Apr 7. PY - 2016 SN - 1129-7298 SP - 353-9 ST - Retrospective data about the catheter-related complications and management in massive bus burn casualties T2 - J Vasc Access TI - Retrospective data about the catheter-related complications and management in massive bus burn casualties VL - 17 ID - 760289 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 TromboEmbolica (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. AD - [Jimenez, David; Quezada, Andres] Ramon & Cajal Hosp, Ramon y Cajal Inst Hlth Res IRYCIS, Resp Dept, Madrid 28034, Spain. [Jimenez, David] Alcala Univ, Dept Med, Madrid, Spain. [Bikdeli, Behnood] Columbia Univ, Med Ctr, New York Presbyterian Hosp, Div Cardiol,Dept Med, New York, NY USA. [Bikdeli, Behnood] Yale Univ, Sch Med, Ctr Outcomes Res & Evaluat, New Haven, CT USA. [Bikdeli, Behnood] Cardiovasc Res Fdn, New York, NY USA. [Muriel, Alfonso] Ramon & Cajal Hosp, Ramon y Cajal Inst Hlth Res IRYCIS, Dept Biostat, CIBERESP, Madrid, Spain. [Luis Lobo, Jose] Araba Hosp, Resp Dept, Vitoria, Spain. [de Miguel-Diez, Javier] Gregorio Maranon Hosp, Resp Dept, Madrid, Spain. [Jara-Palomares, Luis] Virgen del Rocio Hosp, Resp Dept, Inst Biomed Seville, CIBERES, Seville, Spain. [Ruiz-Artacho, Pedro] Clin Univ Navarra, Dept Internal Med, Madrid, Spain. [Yusen, Roger D.] Washington Univ, Sch Med, Div Pulm & Crit Care Med, St Louis, MO USA. [Yusen, Roger D.] Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO USA. [Monreal, Manuel] Germans Trias & Pujol Univ Hosp, Dept Internal Med, Badalona, Spain. [Monreal, Manuel] Catholic Univ Murcia, Murcia, Spain. Jimenez, D (corresponding author), Ramon & Cajal Hosp, Ramon y Cajal Inst Hlth Res IRYCIS, Resp Dept, Madrid 28034, Spain.; Jimenez, D (corresponding author), Alcala Univ, Dept Med, Madrid, Spain. djimenez.hrc@gmail.com AN - WOS:000479162000001 AU - Jimenez, D. AU - Bikdeli, B. AU - Quezada, A. AU - Muriel, A. AU - Lobo, J. L. AU - de Miguel-Diez, J. AU - Jara-Palomares, L. AU - Ruiz-Artacho, P. AU - Yusen, R. D. AU - Monreal, M. AU - Investigators, Riete C7 - l4416 DA - Jul DO - 10.1136/bmj.l4416 J2 - BMJ-British Medical Journal KW - VENOUS THROMBOEMBOLISM RESPONSE TEAM DIAGNOSIS MULTIDISCIPLINARY THROMBOLYSIS EPIDEMIOLOGY CARE Medicine, General & Internal LA - English M3 - Article N1 - ISI Document Delivery No.: IO1SK Times Cited: 5 Cited Reference Count: 26 Jimenez, David Bikdeli, Behnood Quezada, Andres Muriel, Alfonso Luis Lobo, Jose de Miguel-Diez, Javier Jara-Palomares, Luis Ruiz-Artacho, Pedro Yusen, Roger D. Monreal, Manuel Muriel, Alfonso AM/F-9948-2015; Jimenez, David/G-1627-2015; Jara-Palomares, Luis/A-4090-2017; RUIZ-ARTACHO, PEDRO/I-3100-2018 Muriel, Alfonso AM/0000-0002-4805-4011; Jimenez, David/0000-0002-4571-7721; de Miguel-Diez, Javier/0000-0003-4543-573X; Jara-Palomares, Luis/0000-0002-4125-3376; RUIZ-ARTACHO, PEDRO/0000-0002-5680-9883 5 1 BMJ PUBLISHING GROUP LONDON BMJ-BRIT MED J PY - 2019 SN - 1756-1833 SP - 8 ST - Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study T2 - Bmj-British Medical Journal TI - Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study UR - ://WOS:000479162000001 VL - 366 ID - 761509 ER - TY - JOUR AB - PURPOSE: Top analize the clinic results of the implantation of a multidisciplinary protocol to maintain permeability of the arteriovenous hemodialysis grafts (AVG). METHOD: Prospective recording of all interventions (radiological and surgical) on AVG dysfunction in the 1999-2007 period. The AVG stenosis were always treated by percutaneous angioplasty (PA) except stenosis recurrence in less than three months or persistence after PA. The AVG thromboses were always treated by surgical thrombectomy plus PTFE bridge if necessary. Complications, primary and secondary AVG patency were reviewed. RESULTS: Ninety six dysfunction AVG were collected for study. All of them were 6x40 mm standard wall PTFE (Gore-Tex®). Thirty six of them were humero-basilic antebraquial loop and sixty were humero-axillary upper arm curve configuration. During the study, 52 PTFE bridges, 109 surgical thrombectomies, 131 PA, and 15 stents were needed to maintain FAVP permeability. Primay patency was 73.68%, 60.21% and 37.52% at one, two and three years respectively. Secondary patency was 89.49%, 84.07% and 66.84% at one, two and three years respectively. We avoid a central venous catheter (CVC) in the 80% of intervention for thrombosis dysfunction. No surgical or radiological related deaths occurred. Median hospital admission related with AVG thrombosis was 0.03/patient/year. CONCLUSION: The application of a combined protocol for the treatment of AVG dysfunction and thrombosis, according to DOQI recomendations obtains good results in AVG patency in our experience. AN - 24089161 AU - Jiménez-Almonacid, P. AU - Gruss, E. AU - Jiménez-Toscano, M. AU - Lasala, M. AU - Rueda, J. A. AU - Vega, L. AU - Rodríguez, G. AU - de La Cruz, R. AU - Pardo, M. AU - Fernández, B. AU - López, P. AU - Martín-Cavana, J. AU - Quintáns, A. DO - 10.3265/Nefrologia.pre2013.Apr.11898 DP - NLM ET - 2013/10/04 J2 - Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia KW - Angioplasty Arteriovenous Shunt, Surgical/*adverse effects/instrumentation Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation Capillary Permeability Clinical Protocols Equipment Design Forearm/blood supply General Surgery Hospitalization Humans Interdisciplinary Communication Kidney Failure, Chronic/therapy Medical Records Systems, Computerized Nephrology *Patient Care Team Polytetrafluoroethylene Radiology, Interventional *Renal Dialysis Stents Thrombectomy Thrombosis/*etiology/prevention & control Vascular Access Devices/*adverse effects LA - eng spa M1 - 5 N1 - 1989-2284 Jiménez-Almonacid, Pedro Gruss, Enrique Jiménez-Toscano, Marta Lasala, Manuel Rueda, José A Vega, Laura Rodríguez, Gil de La Cruz, Raúl Pardo, Mar Fernández, Beatriz López, Paula Martín-Cavana, Jaime Quintáns, Antonio Comparative Study Journal Article Spain Nefrologia. 2013;33(5):692-8. doi: 10.3265/Nefrologia.pre2013.Apr.11898. PY - 2013 SN - 0211-6995 SP - 692-8 ST - Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis T2 - Nefrologia TI - Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis VL - 33 ID - 760357 ER - TY - JOUR AB - Introduction / Innovation Concept: The boom in online educational resources for medical education over the past decade has changed how physicians learn and keep up to date with new literature. While nearly all emergency medicine residents use online resources, few of these resources were designed to target knowledge gaps. Novel methods are required to identify learning needs to allow the targeted development of learner-centered curricula. Methods: A multidisciplinary team attempted to determine the feasibility of conducting a Massive Online Needs Assessment (MONA) to assess the perceived and unperceived educational needs in thrombosis and bleeding. An open, online survey was launched via Google Forms and disseminated using the online educational resource CanadiEM.org and social media platforms Twitter and Facebook with the goal of reaching participants of the Free Open Access Medical education (FOAM) community. Curriculum, Tool, or Material: The survey was designed to identify knowledge gaps and contained demographic, free text, and multiple choice questions. It took individuals approximately 30 minutes to complete and was incentivized with entry into a draw for one of four $250 Amazon Gift cards. Feasibility was defined a priori as 150 responses from at least 4 specialties in 4 or more countries. This sample was deemed the minimum number required to identify knowledge gaps (defined as <50% correct answers). The survey was open from September 20 to December 10, 2016. We received 198 complete responses from 20 countries. Respondents included staff physicians (n = 109), residents (n = 46), medical students (n = 29), nurses (n = 8), paramedics (n = 4), a pharmacist (n = 1) and a physician assistant (n = 1). The survey entry page hosted on CanadiEM.org received page views from 866 unique IP addresses. As such, a conservative approximation of the completion rate per unique viewer was 22% (198/866). Conclusion: It is feasible to use a MONA to collect data on the perceived and unperceived needs of an online community. Such needs assessments could be used to make online resources more learner-centered. AD - D. Jo, McMaster University, Hamilton, ON, Canada AU - Jo, D. AU - De Wit, K. AU - Bhagirath, V. AU - Castellucci, L. AU - Yeh, C. AU - Thoma, B. AU - Chan, T. M. DB - Embase DO - 10.1017/cem.2017.92 KW - bleeding curriculum development feasibility study female human major clinical study male medical education medical student multiple choice test needs assessment nurse pharmacist physician assistant resident social media staff thrombosis LA - English M3 - Conference Abstract N1 - L616679103 2017-06-13 PY - 2017 SN - 1481-8043 SP - S37-S38 ST - Using a Massive Online Needs Assessment (MONA) to develop a Free Open Access Medical education (FOAM) curriculum T2 - Canadian Journal of Emergency Medicine TI - Using a Massive Online Needs Assessment (MONA) to develop a Free Open Access Medical education (FOAM) curriculum UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616679103&from=export http://dx.doi.org/10.1017/cem.2017.92 VL - 19 ID - 760966 ER - TY - JOUR AB - Introduction: It is debated whether early trauma-induced coagulopathy (TIC) in severely injured patients reflects disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype, acute coagulopathy of trauma shock (ACoTS) or yet other entities. This study investigated the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. Methods: An observational study was carried out at a single Level I Trauma Center. Eighty adult trauma patients (>= 18 years) who met criteria for full trauma team activation and had an arterial cannula inserted were included. Blood was sampled a median of 68 minutes (IQR 48 to 88) post-injury. Data on demography, biochemistry, injury severity score (ISS) and mortality were recorded. Plasma/serum was analyzed for biomarkers reflecting tissue/endothelial cell/glycocalyx damage (histone-complexed DNA fragments, Annexin V, thrombomodulin, syndecan-1), coagulation activation/inhibition (prothrombinfragment 1+2, thrombin/antithrombin-complexes, antithrombin, protein C, activated protein C, endothelial protein C receptor, protein S, tissue factor pathway inhibitor, vWF), factor consumption (fibrinogen, FXIII), fibrinolysis (D-dimer, tissue-type plasminogen activator, plasminogen activator inhibitor-1) and inflammation (interleukin (IL)-6, terminal complement complex (sC5b-9)). Comparison of patients stratified according to the presence or absence of overt DIC (International Society of Thrombosis and Hemostasis (ISTH) criteria) or ACoTS (activated partial thromboplastin time (APTT) and/or international normalized ratio (INR) above normal reference). Results: No patients had overt DIC whereas 15% had ACoTS. ACoTS patients had higher ISS, transfusion requirements and mortality (all P < 0.01) and a biomarker profile suggestive of enhanced tissue, endothelial cell and glycocalyx damage and consumption coagulopathy with low protein C, antithrombin, fibrinogen and FXIII levels, hyperfibrinolysis and inflammation (all P < 0.05). Importantly, in non-ACoTS patients, apart from APTT/INR, higher ISS correlated with biomarkers of enhanced tissue, endothelial cell and glycocalyx damage, protein C activation, coagulation factor consumption, hyperfibrinolysis and inflammation, that is, resembling that observed in patients with ACoTS. Conclusions: ACoTS and non-ACoTS may represent a continuum of coagulopathy reflecting a progressive early evolutionarily adapted hemostatic response to the trauma hit and both are parts of TIC whereas DIC does not appear to be part of this early response. AD - [Johansson, Par I.; Ostrowski, Sisse R.] Univ Copenhagen Hosp, Capital Reg Blood Bank, Sect Transfus Med, Rigshosp, DK-2100 Copenhagen, Denmark. [Sorensen, Anne Marie] Univ Copenhagen Hosp, Dept Anesthesia, Rigshosp, DK-2100 Copenhagen, Denmark. [Sorensen, Anne Marie; Larsen, Claus F.] Univ Copenhagen Hosp, Ctr Head & Orthoped, Trauma Ctr, Rigshosp, DK-2100 Copenhagen, Denmark. [Perner, Anders] Univ Copenhagen Hosp, Dept Intens Care, Rigshosp, DK-2100 Copenhagen, Denmark. [Welling, Karen Lise] Univ Copenhagen Hosp, Dept Neurointens Care, Rigshosp, DK-2100 Copenhagen, Denmark. [Wanscher, Michael] Univ Copenhagen Hosp, Dept Cardiothorac Anesthesia, Rigshosp, DK-2100 Copenhagen, Denmark. Johansson, PI (corresponding author), Univ Copenhagen Hosp, Capital Reg Blood Bank, Sect Transfus Med, Rigshosp, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. per.johansson@rh.regionh.dk AN - WOS:000306087200066 AU - Johansson, P. I. AU - Sorensen, A. M. AU - Perner, A. AU - Welling, K. L. AU - Wanscher, M. AU - Larsen, C. F. AU - Ostrowski, S. R. C7 - R272 DO - 10.1186/cc10553 J2 - Crit. Care KW - DIC ACoTS TIC trauma coagulopathy glycocalyx protein C fibrinolysis inflammation consumption ENDOTHELIAL GLYCOCALYX WHOLE-BLOOD HYPOPERFUSION ANTICOAGULATION DEPLETION Critical Care Medicine LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: 969VJ Times Cited: 95 Cited Reference Count: 30 Johansson, Par I. Sorensen, Anne Marie Perner, Anders Welling, Karen Lise Wanscher, Michael Larsen, Claus F. Ostrowski, Sisse R. Johansson, Par/P-9283-2015; Ostrowski, Sisse R/E-7423-2011 Johansson, Par/0000-0001-9778-5964; Ostrowski, Sisse Rye/0000-0001-5288-3851; Perner, Anders/0000-0002-4668-0123 Danish Council for Independent Research (Medical Sciences)Det Frie Forskningsrad (DFF); Aase and Ejnar Danielsens Foundation; L. F. Foghts Foundation; A. P. Moller and wife Chastine Mc-Kinney Mollers Foundation (Medical Sciences) The Danish Council for Independent Research (Medical Sciences), Aase and Ejnar Danielsens Foundation, L. F. Foghts Foundation, A. P. Moller and wife Chastine Mc-Kinney Mollers Foundation (Medical Sciences) supported the study with unrestricted research grants. 96 0 8 BIOMED CENTRAL LTD LONDON CRIT CARE PY - 2011 SN - 1466-609X SP - 10 ST - Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? An observational study T2 - Critical Care TI - Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? An observational study UR - ://WOS:000306087200066 VL - 15 ID - 761863 ER - TY - JOUR AB - Objective: High patient age is a strong predictor of poor outcome in trauma patients. The present study investigated the effect of age on mortality and biomarkers of sympathoadrenal activation, tissue, endothelial, and glycocalyx damage, coagulation activation/inhibition, fibrinolysis, and inflammation in trauma patients at admission. Design: Prospective observational study. Setting: Single level I trauma center. Patients: Eighty adult trauma patients (>= 18 yrs) who met criteria for full trauma team activation and had an arterial cannula. Intervention: Blood sampling a median of 68 min (interquartile range 48-88) post injury. Measurements: Data on demography, biochemistry, Injury Severity Score, and 30-day mortality were recorded and plasma/serum was analyzed for biomarkers reflecting sympathoadrenal activation (adrenaline, noradrenaline), tissue/endothelial cell/glycocalyx damage (histone-complexed DNA fragments, annexin V, thrombomodulin, syndecan-1), platelet activation (soluble CD40 ligand), coagulation activation/inhibition (prothrombin fragment 1.2, thrombin/antithrombin complex, antithrombin, protein C, activated protein C, protein S, soluble endothelial protein C receptor, tissue factor pathway inhibitor, von Willebrand factor, fibrinogen, factor XIII), fibrinolysis (D-dimer, tissue-type plasminogen activator, plasminogen activator inhibitor-1), and inflammation (interleukin-6, terminal complement complex). Patients were stratified according to the median age (46 yrs) of the full cohort. Results: Older trauma patients had markedly higher noradrenaline (p < .001) but an attenuated increase in adrenaline with increasing Injury Severity Score and lower platelets and leukocytes (both p < .05) compared to the younger patients. Older patients displayed a biomarker profile suggestive of enhanced release, activation, and consumption of the natural anticoagulants (low antithrombin, high activated protein C, protein S, and tissue factor pathway inhibitor) and hyperfibrinolysis (high tissue-type plasminogen activator) (all p < .05 vs. younger patients). Age was an independent predictor of mortality (hazard ratio 1.04 [95% confidence interval 1.01-1.07], p = .005) after adjusting for Injury Severity Score, prehospital Glasgow Coma Scale, and plasma catecholamines. Conclusions: In trauma patients, the association between age and mortality was confirmed. Older patients had high plasma noradrenaline but attenuated adrenaline release with higher Injury Severity Score, impaired platelet and leukocyte mobilization, enhanced consumption of anticoagulants, and hyperfibrinolysis, which may all contribute to the poor outcome in these patients. (Crit Care Med 2012; 40:1844-1850) AD - [Johansson, Par I.; Ostrowski, Sisse R.] Copenhagen Univ Hosp, Ctr Head & Orthoped, Transfus Med Sect, Copenhagen, Denmark. [Sorensen, Anne Marie] Copenhagen Univ Hosp, Ctr Head & Orthoped, Capital Reg Blood Bank, Dept Anesthesia, Copenhagen, Denmark. [Perner, Anders] Copenhagen Univ Hosp, Ctr Head & Orthoped, Dept Intens Care, Copenhagen, Denmark. [Welling, Karen Lise] Copenhagen Univ Hosp, Ctr Head & Orthoped, Dept Neurointens Care, Copenhagen, Denmark. [Wanscher, Michael] Copenhagen Univ Hosp, Ctr Head & Orthoped, Dept Cardiothorac Anesthesia, Copenhagen, Denmark. [Sorensen, Anne Marie; Larsen, Claus F.] Copenhagen Univ Hosp, Ctr Head & Orthoped, Ctr Trauma, Copenhagen, Denmark. Johansson, PI (corresponding author), Copenhagen Univ Hosp, Ctr Head & Orthoped, Transfus Med Sect, Copenhagen, Denmark. per.johansson@rh.regionh.dk AN - WOS:000304335600021 AU - Johansson, P. I. AU - Sorensen, A. M. AU - Perner, A. AU - Welling, K. L. AU - Wanscher, M. AU - Larsen, C. F. AU - Ostrowski, S. R. DA - Jun DO - 10.1097/CCM.0b013e31823e9d15 J2 - Crit. Care Med. KW - adrenaline aging catecholamines coagulopathy glycocalyx inflammation noradrenaline platelets trauma MULTIPLE ORGAN FAILURE PROTEIN-C DEPLETION IMMUNE-SYSTEM ENDOTHELIAL GLYCOCALYX PLASMA-CATECHOLAMINES CRITICALLY-ILL NERVOUS-SYSTEM COAGULOPATHY MORTALITY THROMBOCYTOPENIA Critical Care Medicine LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: 946EZ Times Cited: 13 Cited Reference Count: 40 Johansson, Par I. Sorensen, Anne Marie Perner, Anders Welling, Karen Lise Wanscher, Michael Larsen, Claus F. Ostrowski, Sisse R. Ostrowski, Sisse R/E-7423-2011; Johansson, Par/P-9283-2015 Johansson, Par/0000-0001-9778-5964; Perner, Anders/0000-0002-4668-0123; Ostrowski, Sisse Rye/0000-0001-5288-3851 Danish Council for Independent Research (Medical Sciences)Det Frie Forskningsrad (DFF); Aase and Ejnar Danielsens Foundation; L. F. Foghts Foundation; A. P. Moller and wife Chastine Mc-Kinney Mollers Foundation (Medical Sciences) Supported, in part, by The Danish Council for Independent Research (Medical Sciences), Aase and Ejnar Danielsens Foundation, L. F. Foghts Foundation, and the A. P. Moller and wife Chastine Mc-Kinney Mollers Foundation (Medical Sciences). 15 0 3 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CRIT CARE MED PY - 2012 SN - 0090-3493 SP - 1844-1850 ST - Elderly trauma patients have high circulating noradrenaline levels but attenuated release of adrenaline, platelets, and leukocytes in response to increasing injury severity T2 - Critical Care Medicine TI - Elderly trauma patients have high circulating noradrenaline levels but attenuated release of adrenaline, platelets, and leukocytes in response to increasing injury severity UR - ://WOS:000304335600021 VL - 40 ID - 761826 ER - TY - GEN AB - Acute pulmonary embolism(PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic... AU - John, L. Nosher Arjun Patel Sugeet Jagpal Christopher Gribbin Vyacheslav Gendel DA - 2017/01/01 DB - Federal Science Library - Canada KW - Pulmonary embolism Thrombectomy Interventional radiology Endovascular Review Thrombolysis Fibrinolysis PY - 2017 SN - 1949-8470 ST - Endovascular treatment of pulmonary embolism: Selective review of available techniques TI - Endovascular treatment of pulmonary embolism: Selective review of available techniques UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lj9MwELbYlUBcEG_CY2Uuy4WExI7jGGkPCHUFQiAhKOIW-ckWpUlp2iL49cwkaUSXG7coGVuKx5mZLzPzmRDOkjS-ZBO0K2TqU1uW4H9cJjPNcutYKCAczzKLfcPzOZ99zT98xNaYfRUZFlkelComzeKiL7cc13Xdn7eWBMSNeMudCYmE6cXppm3rs9WyH-d_nw6CPRGRNvgTwW6OyBG4z78Afm-8AR4BsBroHXPO1Iuf39fJTiWLjCXgzZA8WHGBSWlkY7hom28_wMccerV_QtXLFZdg7YvRUp_fJDfG2JO-Gl7qFrnim9vk2vsxu36HfJk1bipNpVMJOm0DXW1r2K96_Yv6pWnrRbd8ST_1R-iAtaRD_wvK6Z1e1NiNRSdy2O4umZ_PPr9-E4_nLsQW86Sx5wZ53qzhYIGMME5zyawET2-lsCa4IF1uucyMFoBqPaBc5UvAkQ7QVm4Cv0eOm7bxDwgNqlDCQwwEsCgvvdQ6Y16kQSiuhQ42Is-nNaxWA79GVUJIWjKpBFgXmBEQbH9VijQiz_bLPEkDikE9VaCnaqcq0FMFeorI070WKvhgMAuiG99uuwqLxJAUPxcRuT9oZZprr9qIyAN9TQJIxn34BDZkT8o97ruH_z3yEbnOMGTIsF3-MTnerLf-Cbkaujo2XTiBcP_tu5N-s_4BPoQHSw VL - 9 ID - 762120 ER - TY - JOUR AB - BACKGROUND Vascular access care is a classic example of multidisciplinary team work between nephrologists, vascular surgeons, interventional radiologists, ultrasound technicians and dialysis nurses. The National Kidney Foundation (NFK) began the Dialysis Outcomes and Quality Initiative (DOQI) in 1995, now referred to as the Kidney Disease Outcomes and Quality Initiative (KDOQI), which published a large evidence-based set of clinical guidelines to help improve healthcare outcomes among patients with end-stage renal disease (ESRD). This study was conducted to determine the outcome of arteriovenous fistulae created for haemodialysis access in Christian Medical College, Ludhiana. All arteriovenous fistulae were created using 6-0 prolene and the patients were followed up for a period of 9 months. The outcome was measured in terms of primary success rate, primary failure rate and complications. MATERIALS AND METHODS This study was a one-year retrospective and one-year prospective study conducted in the Department of Surgery and Nephrology, Christian Medical College and Hospital, Ludhiana. After determination of the appropriate limb for surgery, arteriovenous fistulae were done under local anaesthesia in the operation theatre. All anastomosis were end (vein) to side (artery) and were done by using 6-0 prolene. The fistula created was monitored for a good thrill, pulse and any immediate complication such as bleeding or thrombosis. After four to six weeks, a fistula with a good thrill was considered to be mature and was subjected to cannulation and then haemodialysis. The fistula flow rate was recorded at initiation of haemodialysis and after four weeks of haemodialysis. A nine month follow-up study was done, and the final outcome of the fistula was measured in terms of duration of successful use, need for creation of a new fistula at another site and need for re-exploration. RESULTS 1. At the end of the 9-month follow-up period, 62.7% of the AVF had a successful outcome; 21.2% became non-functional. In 15.3% cases, a new fistula was made at another site. One case was lost to follow-up. 2. The primary failure rate was 4.2%. CONCLUSION This study has thus demonstrated that the vascular unit of General Surgery in Christian Medical College, Ludhiana, is making arteriovenous access for haemodialysis at a rate comparable to other centres in India and worldwide. AD - [Johny, Susan] Amala Inst Med Sci, Dept Gen Surg, Trichur, India. [Luther, Anil] Christian Med Coll & Hosp, Dept Gen Surg, Ludhiana, Punjab, India. Johny, S (corresponding author), Amala Inst Med Sci, Dept Gen Surg, Trichur, India. drsusanjohny@gmail.com AN - WOS:000428428800023 AU - Johny, S. AU - Luther, A. DA - Jan DO - 10.14260/jemds/2018/80 J2 - J. Evol. Med. Dent. Sci.-JEMDS KW - Arteriovenous Fistula Haemodialysis Primary Patency Primary Failure Rate DIALYSIS ACCESS Medicine, General & Internal LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: GA6FQ Times Cited: 1 Cited Reference Count: 10 Johny, Susan Luther, Anil 1 0 2 JOURNAL EVOLUTION MEDICAL & DENTAL SCIENCES KARNATAKA J EVOL MED DENT SCI- PY - 2018 SN - 2278-4748 SP - 361-366 ST - OUTCOME OF ARTERIOVENOUS FISTULA FOR HAEMODIALYSIS ACCESS T2 - Journal of Evolution of Medical and Dental Sciences-Jemds TI - OUTCOME OF ARTERIOVENOUS FISTULA FOR HAEMODIALYSIS ACCESS UR - ://WOS:000428428800023 VL - 7 ID - 761607 ER - TY - JOUR AB - Background-National guidelines call for participation in systems to rapidly diagnose and treat ST-segment-elevation myocardial infarction (STEMI). In order to characterize currently implemented STEMI reperfusion systems and identify practices common to system organization, the American Heart Association surveyed existing systems throughout the United States. Methods and Results-A STEMI system was defined as an integrated group of separate entities focused on reperfusion therapy for STEMI within a geographic region that included at least 1 hospital that performs percutaneous coronary intervention and at least 1 emergency medical service agency. Systems meeting this definition were invited to participate in a survey of 42 questions based on expert panel opinion and knowledge of existing systems. Data were collected through the American Heart Association Mission: Lifeline website. Between April 2008 and January 2010, 381 unique systems involving 899 percutaneous coronary intervention hospitals in 47 states responded to the survey, of which 255 systems (67%) involved urban regions. The predominant funding sources for STEMI systems were percutaneous coronary intervention hospitals (n = 320, 84%) and /or cardiology practices (n = 88, 23%). Predominant system characteristics identified by the survey included: STEMI patient acceptance at percutaneous coronary intervention hospital regardless of bed availability (N = 346, 97%); single phone call activation of catheterization laboratory (N = 335, 92%); emergency department physician activation of laboratory without cardiology consultation (N = 318, 87%); data registry participation (N = 311, 84%); and prehospital activation of the laboratory through emergency department notification without cardiology notification (N = 297, 78%). The most common barriers to system implementation were hospital (n = 139, 37%) and cardiology group competition (n = 81, 21%) and emergency medical services transport and finances (n = 99, 26%). Conclusions-This survey broadly describes the organizational characteristics of collaborative efforts by hospitals and emergency medical services to provide timely reperfusion in the United States. These findings serve as a benchmark for existing systems and should help guide healthcare teams in the process of organizing care for patients with STEMI. (Circ Cardiovasc Qual Outcomes. 2012;5:423-428.) AD - [Jollis, James G.; Granger, Christopher B.] Duke Univ, Med Ctr, Durham, NC USA. [Henry, Timothy D.] Minneapolis Heart Inst Fdn, Minneapolis, MN USA. [Antman, Elliott M.] Brigham & Womens Hosp, Boston, MA 02115 USA. [Berger, Peter B.] Geisinger Hlth Syst, Danville, PA USA. [Moyer, Peter H.] Boston Emergency Med Serv, Boston, MA USA. [Pratt, Franklin D.] Los Angeles Cty Fire Dept, Los Angeles, CA USA. [Rokos, Ivan C.] Univ Calif Los Angeles, UCLA Olive View Med Ctr, David Geffen Sch Med, Dallas, TX USA. [Acuna, Anna R.] Amer Heart Assoc, Dallas, TX USA. [Roettig, Mayme Lou] Duke Clin Res Inst, Durham, NC USA. [Jacobs, Alice K.] Boston Med Ctr, Boston, MA USA. Jollis, JG (corresponding author), Room 3347 Duke S Hosp,Box 3254 DUMC, Durham, NC 27710 USA. james.jollis@duke.edu AN - WOS:000308544500005 AU - Jollis, J. G. AU - Granger, C. B. AU - Henry, T. D. AU - Antman, E. M. AU - Berger, P. B. AU - Moyer, P. H. AU - Pratt, F. D. AU - Rokos, I. C. AU - Acuna, A. R. AU - Roettig, M. L. AU - Jacobs, A. K. DA - Jul DO - 10.1161/circoutcomes.111.964668 J2 - Circ.-Cardiovasc. Qual. Outcomes KW - delivery of health care multi-institutional systems myocardial infarction myocardial reperfusion PERCUTANEOUS CORONARY INTERVENTION INTERHOSPITAL TRANSFER PRIMARY ANGIOPLASTY TIMELY ACCESS REPERFUSION THERAPY RECOMMENDATIONS THROMBOLYSIS STRATEGIES PROTOCOL Cardiac & Cardiovascular Systems LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: 002PO Times Cited: 82 Cited Reference Count: 25 Jollis, James G. Granger, Christopher B. Henry, Timothy D. Antman, Elliott M. Berger, Peter B. Moyer, Peter H. Pratt, Franklin D. Rokos, Ivan C. Acuna, Anna R. Roettig, Mayme Lou Jacobs, Alice K. Granger, Christopher B/D-3458-2014 Granger, Christopher B/0000-0002-0045-3291; Jacobs, Alice/0000-0002-2428-2458 83 0 5 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CIRC-CARDIOVASC QUAL PY - 2012 SN - 1941-7705 SP - 423-428 ST - Systems of Care for ST-Segment-Elevation Myocardial Infarction: A Report From the American Heart Association's Mission: Lifeline T2 - Circulation-Cardiovascular Quality and Outcomes TI - Systems of Care for ST-Segment-Elevation Myocardial Infarction: A Report From the American Heart Association's Mission: Lifeline UR - ://WOS:000308544500005 VL - 5 ID - 761821 ER - TY - JOUR AB - BACKGROUND: National guidelines call for participation in systems to rapidly diagnose and treat ST-segment-elevation myocardial infarction (STEMI). In order to characterize currently implemented STEMI reperfusion systems and identify practices common to system organization, the American Heart Association surveyed existing systems throughout the United States. METHODS AND RESULTS: A STEMI system was defined as an integrated group of separate entities focused on reperfusion therapy for STEMI within a geographic region that included at least 1 hospital that performs percutaneous coronary intervention and at least 1 emergency medical service agency. Systems meeting this definition were invited to participate in a survey of 42 questions based on expert panel opinion and knowledge of existing systems. Data were collected through the American Heart Association Mission: Lifeline website. Between April 2008 and January 2010, 381 unique systems involving 899 percutaneous coronary intervention hospitals in 47 states responded to the survey, of which 255 systems (67%) involved urban regions. The predominant funding sources for STEMI systems were percutaneous coronary intervention hospitals (n = 320, 84%) and /or cardiology practices (n = 88, 23%). Predominant system characteristics identified by the survey included: STEMI patient acceptance at percutaneous coronary intervention hospital regardless of bed availability (N = 346, 97%); single phone call activation of catheterization laboratory (N = 335, 92%); emergency department physician activation of laboratory without cardiology consultation (N = 318, 87%); data registry participation (N = 311, 84%); and prehospital activation of the laboratory through emergency department notification without cardiology notification (N = 297, 78%). The most common barriers to system implementation were hospital (n = 139, 37%) and cardiology group competition (n = 81, 21%) and emergency medical services transport and finances (n = 99, 26%). CONCLUSIONS: This survey broadly describes the organizational characteristics of collaborative efforts by hospitals and emergency medical services to provide timely reperfusion in the United States. These findings serve as a benchmark for existing systems and should help guide healthcare teams in the process of organizing care for patients with STEMI. AD - Duke University Medical Center, Durham, NC, USA. james.jollis@duke.edu AN - 22619274 AU - Jollis, J. G. AU - Granger, C. B. AU - Henry, T. D. AU - Antman, E. M. AU - Berger, P. B. AU - Moyer, P. H. AU - Pratt, F. D. AU - Rokos, I. C. AU - Acuña, A. R. AU - Roettig, M. L. AU - Jacobs, A. K. DA - Jul 1 DO - 10.1161/circoutcomes.111.964668 DP - NLM ET - 2012/05/24 J2 - Circulation. Cardiovascular quality and outcomes KW - American Heart Association Angioplasty, Balloon, Coronary/economics/*standards Cardiology Service, Hospital/economics/*standards Cooperative Behavior Delivery of Health Care, Integrated/economics/*standards Emergency Medical Services/economics/*standards Health Care Surveys Health Services Accessibility/economics/*standards Health Services Research Hospital Costs Humans Interinstitutional Relations Myocardial Infarction/*diagnosis/economics/*therapy Outcome and Process Assessment, Health Care/economics/*standards Patient Admission/standards Patient Care Team/standards Practice Guidelines as Topic Practice Patterns, Physicians'/standards Regional Health Planning/economics/*standards Surveys and Questionnaires Treatment Outcome United States LA - eng M1 - 4 N1 - 1941-7705 Jollis, James G Granger, Christopher B Henry, Timothy D Antman, Elliott M Berger, Peter B Moyer, Peter H Pratt, Franklin D Rokos, Ivan C Acuña, Anna R Roettig, Mayme Lou Jacobs, Alice K Journal Article United States Circ Cardiovasc Qual Outcomes. 2012 Jul 1;5(4):423-8. doi: 10.1161/CIRCOUTCOMES.111.964668. Epub 2012 May 22. PY - 2012 SN - 1941-7713 SP - 423-8 ST - Systems of care for ST-segment-elevation myocardial infarction: a report From the American Heart Association's Mission: Lifeline T2 - Circ Cardiovasc Qual Outcomes TI - Systems of care for ST-segment-elevation myocardial infarction: a report From the American Heart Association's Mission: Lifeline VL - 5 ID - 760394 ER - TY - JOUR AB - AIM: Primary percutaneous coronary intervention (PPCI) produces more effective coronary reperfusion and allows immediate risk stratification compared with fibrinolysis. We investigated the safety and feasibility of very early discharge at 2 days following PPCI in selected low-risk cases. METHODS: This was a prospective observational cohort study of 2779 patients who underwent PPCI between 2004 and 2011. Patients meeting the following criteria were deemed suitable for very early discharge; TIMI III flow, left ventricle (LF) ejection fraction >40%, and rhythmic and haemodynamic stability out to 48 h. Higher-risk patients who did not fulfil these criteria were discharged later according to physician preference. All patients were offered outpatient review by a multidisciplinary team. Endpoints included 30 day readmission rates and major adverse cardiac events (MACE) out to a median of 2.8 years (IQR range: 1.3-4.4 years). RESULTS: 1309 (49.3%) PPCI patients met very early discharge criteria, of whom 1117 (85.3%) were actually discharged at 2 days. 620 (23.4%) were discharged at 3 days, and 916 (34.5%) >3 days after admission (median 5, IQR: 4-8) days). Patients discharged at 2 days were younger, and had lower rates of diabetes, renal dysfunction, multivessel coronary artery disease, previous myocardial infarction, and previous coronary artery bypass surgery, compared with patients discharged later. 30-day readmission rates for non-MACE events were 4.8%, 4.9% and 4.6% for patients discharged 2 days, 3 days and >3 days after admission, respectively. MACE rates were lowest in patients discharged at 2 days (9.6%, 95% CI 4.7% to 16.6%) compared with patients discharged at 3 days (12.3% 95% CI 6.0% to 19.2%) and >3 days (28.6% 95% CI 22.9% to 34.7%, p<0.0001) after admission. CONCLUSIONS: Our data suggest that discharge of low-risk patients 2 days after successful PPCI is feasible and safe. Over 40% of all patients with ST-elevation myocardial infarction may be suitable for early discharge with important implications for healthcare costs. AD - Department of Cardiology, London Chest Hospital, Bonner Road, Bethnal Green, London E2 9JX, UK. AN - 23053711 AU - Jones, D. A. AU - Rathod, K. S. AU - Howard, J. P. AU - Gallagher, S. AU - Antoniou, S. AU - De Palma, R. AU - Guttmann, O. AU - Cliffe, S. AU - Colley, J. AU - Butler, J. AU - Ferguson, E. AU - Mohiddin, S. AU - Kapur, A. AU - Knight, C. J. AU - Jain, A. K. AU - Rothman, M. T. AU - Mathur, A. AU - Timmis, A. D. AU - Smith, E. J. AU - Wragg, A. DA - Dec DO - 10.1136/heartjnl-2012-302414 DP - NLM ET - 2012/10/12 J2 - Heart (British Cardiac Society) KW - Aged Coronary Angiography *Electrocardiography Feasibility Studies Female Follow-Up Studies Hospital Mortality/trends Humans London/epidemiology Male Middle Aged Myocardial Infarction/diagnosis/epidemiology/*therapy Patient Discharge/*standards *Percutaneous Coronary Intervention Prospective Studies Survival Rate/trends Time Factors LA - eng M1 - 23 N1 - 1468-201x Jones, Daniel A Rathod, Krishnaraj S Howard, James Philip Gallagher, Sean Antoniou, Sotiris De Palma, Rodney Guttmann, Oliver Cliffe, Samantha Colley, Judith Butler, Jane Ferguson, Eileen Mohiddin, Saidi Kapur, Akhil Knight, Charles J Jain, Ajay K Rothman, Martin T Mathur, Anthony Timmis, Adam D Smith, Elliot J Wragg, Andrew Comparative Study Journal Article England Heart. 2012 Dec;98(23):1722-7. doi: 10.1136/heartjnl-2012-302414. Epub 2012 Oct 10. PY - 2012 SN - 1355-6037 SP - 1722-7 ST - Safety and feasibility of hospital discharge 2 days following primary percutaneous intervention for ST-segment elevation myocardial infarction T2 - Heart TI - Safety and feasibility of hospital discharge 2 days following primary percutaneous intervention for ST-segment elevation myocardial infarction VL - 98 ID - 760431 ER - TY - JOUR AB - SERVICE OR PROGRAM: The Clinical Orthopedic Pharmacist service at Grant Medical Center (GMC) was instated February 2016 to support the interdisciplinary team in addressing institutional outcomes opportunities in the total joint arthroplasty (TJA) patient population. The role was developed using the ACCP Standards of Practice for Clinical Pharmacists and the ASHP Pharmacy Advancement Initiative (PAI) principles, positioning the clinical pharmacist to optimize pharmacotherapy across the TJA continuum of care. Service delivery by the covering Orthopedic Clinical Pharmacist includes prospective pre-operative medication optimization, inpatient interdisciplinary rounding with the surgical team, targeted interventions to reduce post-operative complications, and discharge medication reconciliation and counseling. JUSTIFICATION/DOCUMENTATION: The implementation of the Clinical Orthopedic Pharmacist service was associated with significant improvements in TJA post-operative DVT rate (1.25% in FY15 vs. 0.66% FY16 vs. 0.16% FY17YTD) and readmission rate (3.37% vs. 4.23% vs. 1.97%). The institution has met national benchmark goals for patient outcomes and avoided significant reimbursement penalties as a result of these improvements. ADAPTABILITY: The Clinical Orthopedic Pharmacist service was developed in a step-wise fashion in concert with all interdisciplinary stakeholders in the institution's TJA patient outcomes. After thorough gap analysis and case series reviews, individual pharmacist interventions were matched to team-identified patient care opportunities to target specific quality and financial outcomes of interest. This approach represents a template that clinical pharmacists may readily apply at other institutions providing TJA and to other target populations with specific outcomes goals. SIGNIFICANCE: TJA institutions are subject to significant external outcomes accountability. We identified opportunities for clinical pharmacists to optimize pharmacotherapy for TJA patients, then developed a service that significantly contributed to improved patient outcomes and institutional revenue capture. Our results support the application of ACCP and ASHP standards to the development of novel clinical pharmacy practice models to improve outcomes in this important surgical population. AD - S. Jordan, Grant Medical Center (OhioHealth), Columbus, OH, United States AU - Jordan, S. AU - Kramer, B. DB - Embase DO - 10.1002/phar.2052 KW - adult arthroplasty case study clinical pharmacy counseling documentation health care delivery hospital patient hospital readmission human medication therapy management patient care pharmacist postoperative complication punishment reimbursement surgery LA - English M1 - 12 M3 - Conference Abstract N1 - L620235647 2018-01-23 PY - 2017 SN - 1875-9114 SP - e225 ST - Quality and economic impact of integrating clinical pharmacists into the care of orthopedic surgery patients T2 - Pharmacotherapy TI - Quality and economic impact of integrating clinical pharmacists into the care of orthopedic surgery patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620235647&from=export http://dx.doi.org/10.1002/phar.2052 VL - 37 ID - 760971 ER - TY - JOUR AB - Objective: The cost of treating diabetes-related disease in New Zealand is increasing and is expected to reach New Zealand dollars (NZD) 1.8 billion in 2021. The financial burden attached to the treatment of diabetic foot wounds is difficult to quantify and reported costs of treatment vary greatly in the literature. As of yet, no study has captured the true total cost of treating a diabetic foot wound. In this study, we investigate the total minimum cost of treating a diabetic foot ulcer at a tertiary institution. Methods: A retrospective audit of hospital and interhospital records was performed to identify adult patients with diabetes who were treated operatively for a diabetic foot wound by the department of vascular surgery at Auckland Hospital between January 2009 and June 2014. Costs from the patients' admissions and outpatient clinics from their first meeting to the achievement of a final outcome were tallied to calculate the total cost of healing the wound. The hospital's expenses were calculated using a fully absorbed activity-based costing methodology and correlated with a variety of demographic and clinical factors extracted from patients' electronic records using a general linear mixed model. Results: We identified 225 patients accounting for 265 wound episodes, 700 inpatient admissions, 815 outpatient consultations, 367 surgical procedures, and 248 endovascular procedures. The total minimum cost to the Auckland city hospital was NZD 10,217,115 (NZD 9,886,963 inpatient costs; NZD 330,152 outpatient costs). The median cost per wound episode was NZD 29,537 (NZD 28,491 inpatient costs; NZD 834 outpatient cost). Wound healing was achieved in 70% of wound episodes (average length of healing, 9 months); 19% of wounds had not healed before the patient's death. Of every 3.5 wound episodes, one required a major amputation. Wound treatment modality, particularly surgical management, was the strongest predictor of high resource utilization. Wounds treated with endovascular intervention and no surgical intervention cost less. Surgical management (indiscriminate of type) was associated with faster wound healing than wounds managed endovascularly (median duration, 140 vs 224 days). Clinical risk factors including smoking, ischemic heart disease, hypercholesterolemia, hypertension, and chronic kidney disease did not affect treatment cost significantly. Conclusions: We estimate the minimum median cost incurred by our department of vascular surgery in treating a diabetic foot wound to be NZD 30,000 and identify wound treatment modality to be a significant determinant of cost. While readily acknowledging our study's inherent limitations, we believe it provides a real-world representation of the minimum total cost involved in treating diabetic foot lesions in a tertiary center. Given the increasing rate of diabetes, we believe this high cost reinforces the need for the establishment of a multidisciplinary diabetic foot team in our region. AD - [Joret, Maximilian O.] Univ Auckland, Fac Med & Hlth Sci, Sch Med, Auckland, New Zealand. [Stewart, Joanna] Univ Auckland, Fac Med & Hlth Sci, Sch Populat Hlth, Dept Epidemiol & Biostat, Auckland, New Zealand. [Dean, Anastasia; Bhamidipaty, Venu] Auckland Hosp, Dept Vasc Surg, Pk Rd, Auckland 1010, New Zealand. [Cao, Colin] ADHB, Dept Business Intelligence, Auckland, New Zealand. Bhamidipaty, V (corresponding author), Auckland Hosp, Dept Vasc Surg, Pk Rd, Auckland 1010, New Zealand. venubham@gmail.com AN - WOS:000382224900017 AU - Joret, M. O. AU - Dean, A. AU - Cao, C. AU - Stewart, J. AU - Bhamidipaty, V. DA - Sep DO - 10.1016/j.jvs.2016.03.421 J2 - J. Vasc. Surg. KW - LOWER-EXTREMITY ULCERS COSTS CARE AMPUTATIONS Surgery Peripheral Vascular Disease LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: DU5AS Times Cited: 9 Cited Reference Count: 26 Joret, Maximilian O. Dean, Anastasia Cao, Colin Stewart, Joanna Bhamidipaty, Venu Joret, Maximilian/AAG-6305-2020 Joret, Maximilian/0000-0001-9290-2703 9 0 15 MOSBY-ELSEVIER NEW YORK J VASC SURG PY - 2016 SN - 0741-5214 SP - 648-655 ST - The financial burden of surgical and endovascular treatment of diabetic foot wounds T2 - Journal of Vascular Surgery TI - The financial burden of surgical and endovascular treatment of diabetic foot wounds UR - ://WOS:000382224900017 VL - 64 ID - 761698 ER - TY - JOUR AB - OBJECTIVE: To identify predictors of variation in colorectal cancer care and outcomes in New South Wales. DESIGN, SETTING AND PATIENTS: Multilevel logistic regression analysis using a linked population-based dataset based on the records of patients with cancer of the colon, rectosigmoid junction or rectum who were registered in 2007 and 2008 by the NSW Central Cancer Registry and treated in 105 hospitals in NSW. MAIN OUTCOME MEASURES: Six outcome measures (30-day mortality, 28-day emergency readmission, prolonged length of stay, 30-day wound infection, 90-day venous thromboembolism, 1-year mortality) and five care process measures (discussion at multidisciplinary team [MDT] meeting, documented cancer stage, recorded pathological stage, treatment within 31 days of decision to treat, treatment within 62 days of referral). RESULTS: We analysed data for 6890 people. There was wide variation between hospitals in care process measures, even after adjusting for patient and hospital factors. Older adults were less likely to be discussed at an MDT meeting and receive treatment within suggested time frames (all P < 0.001 for colon cancer). Increasing patient age, greater extent of disease, higher Charlson comorbidity score and resection after emergency admission consistently showed strong evidence of an association with poor outcomes. Much of the variation between hospitals in outcome measures was accounted for by patient characteristics. CONCLUSIONS: Patient characteristics should be included in risk-adjustment models for comparing outcomes between hospitals and for quantifying hospital variation. Further exploration of the reasons why certain hospitals and patients appear to be at risk of poorer care is needed. AD - Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. mikaela.jorgensen@sydney.edu.au. Cancer Epidemiology and Services Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. Surgical Outcomes Research Centre, Sydney Local Health District and University of Sydney, Sydney, NSW, Australia. AN - 24794673 AU - Jorgensen, M. L. AU - Young, J. M. AU - Dobbins, T. A. AU - Solomon, M. J. DA - Apr 21 DO - 10.5694/mja13.10710 DP - NLM ET - 2014/05/06 J2 - The Medical journal of Australia KW - Adolescent Adult Age Distribution Aged Aged, 80 and over Child Child, Preschool Colorectal Neoplasms/*mortality/*therapy Educational Status Female Health Care Surveys Humans Infant Infant, Newborn Inpatients/statistics & numerical data Length of Stay/*statistics & numerical data Male Middle Aged Neoplasm Staging New South Wales/epidemiology Patient Readmission/*statistics & numerical data Predictive Value of Tests Rectal Neoplasms/mortality/therapy Risk Assessment Risk Factors Surgical Wound Infection/etiology/mortality/therapy Treatment Failure Treatment Outcome Venous Thromboembolism/etiology/mortality/therapy LA - eng M1 - 7 N1 - 1326-5377 Jorgensen, Mikaela L Young, Jane M Dobbins, Timothy A Solomon, Michael J Journal Article Multicenter Study Research Support, Non-U.S. Gov't Australia Med J Aust. 2014 Apr 21;200(7):403-7. doi: 10.5694/mja13.10710. PY - 2014 SN - 0025-729x SP - 403-7 ST - Predictors of variation in colorectal cancer care and outcomes in New South Wales: a population-based health data linkage study T2 - Med J Aust TI - Predictors of variation in colorectal cancer care and outcomes in New South Wales: a population-based health data linkage study VL - 200 ID - 760235 ER - TY - JOUR AB - OBJECTIVES: Narrow therapeutic window is a major cause of thrombolysis exclusion in acute ischemic stroke. Whether prehospital medicalization increases t-PA treatment rate is investigated in the present study. PATIENTS AND METHODS: Intrahospital processing times and t-PA treatment were analyzed in stroke patients calling within 6h and admitted in our stoke unit. Patients transferred by our mobile medical team (SAMU) and by Fire Department (FD) paramedics were compared. RESULTS: 193 (61.6%) SAMU patients and 120 (38.4%) FD patients were included within 30 months. Clinical characteristics and onset-to-call intervals were similar in the two groups. Mean door-to-imaging delay was deeply reduced in the SAMU group (52 vs. 159 min, p<0.0001) and was <25 min in 50% of SAMU patients and 14% of FD patients (p<0.0001). SAMU management was the only independent factor of early imaging (p=0.0006). t-PA administration rate was higher in SAMU group than in FD group (42% vs. 28%, p=0.04). Proportion of patients with delayed therapeutic window was higher in FD group than in SAMU group (38% vs. 26%, p<0.0001). CONCLUSION: Prehospital transfer medicalization promotes emergency room bypass, direct radiology room admission and high thrombolysis rate in acute ischemic stroke. AD - Neurology and Stroke Center, University Hospital of Fort-de-France, Martinique. julien_joux@hotmail.com AN - 23489443 AU - Joux, J. AU - Olindo, S. AU - Girard-Claudon, A. AU - Chausson, N. AU - Saint-Vil, M. AU - Signate, A. AU - Edimonana, M. AU - Jeannin, S. AU - Aveillan, M. AU - Cabre, P. AU - Smadja, D. DA - Sep DO - 10.1016/j.clineuro.2013.02.010 DP - NLM ET - 2013/03/16 J2 - Clinical neurology and neurosurgery KW - Aged Ambulances Emergency Medical Services/*methods Female Fibrinolytic Agents/therapeutic use France Humans Magnetic Resonance Imaging Male *Medicalization Middle Aged Mobile Health Units Patient Care Team Patient Transfer/*methods Physicians Prospective Studies Risk Factors Stroke/diagnosis/*drug therapy *Thrombolytic Therapy Tissue Plasminogen Activator/therapeutic use Ambulance Medicalization Prehospital Stroke Thrombolysis LA - eng M1 - 9 N1 - 1872-6968 Joux, Julien Olindo, Stéphane Girard-Claudon, Annette Chausson, Nicolas Saint-Vil, Martine Signate, Aissatou Edimonana, Mireille Jeannin, Severine Aveillan, Mathieu Cabre, Philippe Smadja, Didier Journal Article Netherlands Clin Neurol Neurosurg. 2013 Sep;115(9):1583-5. doi: 10.1016/j.clineuro.2013.02.010. Epub 2013 Mar 13. PY - 2013 SN - 0303-8467 SP - 1583-5 ST - Prehospital transfer medicalization increases thrombolysis rate in acute ischemic stroke. A French stroke unit experience T2 - Clin Neurol Neurosurg TI - Prehospital transfer medicalization increases thrombolysis rate in acute ischemic stroke. A French stroke unit experience VL - 115 ID - 760493 ER - TY - JOUR AB - An increased emphasis on stroke care has led to a proliferation of specialized stroke teams despite relatively few trials demonstrating their efficacy. Our academic stroke center incorporated a unique setup allowing for the comparison between stroke teams and emergency physicians. During weekday working hours, a stroke team would respond to the emergency department for stroke activations. During all other times, the emergency physician caring for the patient would make all treatment decisions. We sought to determine whether there was any difference in treatment and outcomes between these two groups. We conducted a retrospective review of all stroke activations from January 2015 to June 2016 and compared the thrombolytic administration rates, modified Rankin Scale (mRS) at discharge, and change in National Institutes of Health Stroke Scale (NIHSS). A total of 415 stroke activations were identified. Of those, 69 of 262 patients (26.3%) seen by emergency physicians and 60 of 153 patients (39.2%) seen by neurologists received thrombolysis (P = 0.006). No significant difference was found in the discharge mRS or change in NIHSS between the two groups. Emergency physicians administered significantly less thrombolytics than did neurologists. No significant difference was observed in outcomes, including mRS and admission-to-discharge change in NIHSS. AD - Department of Emergency Medicine, Baylor Scott & White Medical Center-TempleTempleTexas. Baylor College of MedicineHoustonTexas. Department of Neurology, Baylor Scott & White Medical Center-TempleTempleTexas. Baylor Scott & White Research InstituteTempleTexas. AN - 31656402 AU - Juergens, A. L., 2nd AU - Barney, J. AU - Julakanti, M. AU - Allen, L. AU - Shaver, C. C2 - Pmc6793957 DA - Oct DO - 10.1080/08998280.2019.1632779 DP - NLM ET - 2019/10/28 J2 - Proceedings (Baylor University. Medical Center) KW - Brain infarction emergency medicine patient care team LA - eng M1 - 4 N1 - 1525-3252 Juergens, Andrew L 2nd Orcid: 0000-0002-4882-5963 Barney, Jacob Julakanti, Maneesha Orcid: 0000-0002-7817-791x Allen, Leigh Orcid: 0000-0003-3200-5917 Shaver, Courtney Orcid: 0000-0002-9936-4597 Journal Article Proc (Bayl Univ Med Cent). 2019 Jul 22;32(4):485-489. doi: 10.1080/08998280.2019.1632779. eCollection 2019 Oct. PY - 2019 SN - 0899-8280 (Print) 0899-8280 SP - 485-489 ST - Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke T2 - Proc (Bayl Univ Med Cent) TI - Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke VL - 32 ID - 760275 ER - TY - JOUR AB - OBJECTIVE. Long indwelling times for inferior vena cava (IVC) filters that are used to prevent venous thromboembolism can result in complications. To improve care for patients receiving retrievable IVC filters, we developed and evaluated an informatics-based initiative to facilitate patient tracking, clinical decision-making, and care coordination. MATERIALS AND METHODS. A semiautomated filter-tracking application was custom-built to query our radiology information system to extract and transfer key data elements related to IVC filter insertion procedures into a database. A web-based interface displayed key information and facilitated communication between the interventional radiology clinical team and referring physicians. A set of filter management options was provided depending on each patient's clinical condition. The system was launched in April 2016. Using retrospective observational cohort methods, we compared filter retrieval rates during a test period from July through December 2016 with a control period of the same 6 months in 2015. RESULTS. System development required approximately 100 hours of development time. Two hundred ninety-three IVC filter placements and 83 filter retrievals were tracked during the study periods. The overall filter retrieval rate was 23% in the control period and 34% in the test period. Mean times from filter placement to retrieval in the control and test periods were not significantly different (88.9 and 102.7 days, respectively; p = 0.32). CONCLUSION. A semiautomated approach to tracking patients with IVC filters can facilitate care coordination and clinical decision-making for a device with known potential complications. Similar applications designed to improve provider communication and documentation of filter management plans, including appropriateness for retrieval, can be replicated. AD - [Juluru, Krishna; Elnajjar, Pierre; Shih, Hao-Hsin; Hiestand, Brian; Durack, Jeremy C.] Mem Sloan Kettering Canc Ctr, Dept Radiol, 1275 York Ave, New York, NY 10065 USA. Juluru, K (corresponding author), Mem Sloan Kettering Canc Ctr, Dept Radiol, 1275 York Ave, New York, NY 10065 USA. juluruk@mskcc.org AN - WOS:000442411600007 AU - Juluru, K. AU - Elnajjar, P. AU - Shih, H. H. AU - Hiestand, B. AU - Durack, J. C. DA - Sep DO - 10.2214/ajr.18.19561 J2 - Am. J. Roentgenol. KW - filter clinic inferior vena cave (IVC) filter retrievable filter safety US Food and Drug Administration (FDA) QUALITY RATES Radiology, Nuclear Medicine & Medical Imaging LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: GR2NI Times Cited: 0 Cited Reference Count: 11 Juluru, Krishna Elnajjar, Pierre Shih, Hao-Hsin Hiestand, Brian Durack, Jeremy C. NIH/NCI Cancer Center support grant [P30 CA008748] Supported in part through an NIH/NCI Cancer Center support grant (P30 CA008748). 0 1 AMER ROENTGEN RAY SOC RESTON AM J ROENTGENOL PY - 2018 SN - 0361-803X SP - W178-W184 ST - An Informatics Approach to Facilitate Clinical Management of Patients With Retrievable Inferior Vena Cava Filters T2 - American Journal of Roentgenology TI - An Informatics Approach to Facilitate Clinical Management of Patients With Retrievable Inferior Vena Cava Filters UR - ://WOS:000442411600007 VL - 211 ID - 761573 ER - TY - JOUR AB - To the Editor: In this report, we describe the successful introduction of a novel Pulmonary Embolism Response Team (PERT) to streamline the care of patients with severe pulmonary embolism (PE). The treatment of patients with massi... AU - Kabrhel DA - 2013/01/01 01/01 DB - Institute of Scientific and Technical Information of China (English) M1 - 5 PY - 2013 ST - A multidisciplinary pulmonary embolism response team T2 - Chest: The Journal of Circulation, Respiration and Related Systems TI - A multidisciplinary pulmonary embolism response team UR - https://netl.istic.ac.cn/site/link?cdoi=6b839544e863d324a438d9f5acb4befe&mid=466496091303411EB27FB4298C9BA46C VL - 144 ID - 761908 ER - TY - JOUR AB - BACKGROUND: Integrating newly developed tests and treatments for severe pulmonary embolism (PE) into clinical care requires coordinated multispecialty collaboration. To meet this need, we developed a new paradigm: a multidisciplin... AU - Kabrhel DA - 2016/01/01 01/01 DB - Institute of Scientific and Technical Information of China (English) M1 - 2 PY - 2016 ST - A Multidisciplinary Pulmonary Embolism Response Team Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism T2 - Chest: The Journal of Circulation, Respiration and Related Systems TI - A Multidisciplinary Pulmonary Embolism Response Team Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism UR - https://netl.istic.ac.cn/site/link?cdoi=30fad88dc18f951046f21c72396a8975&mid=466496091303411EB27FB4298C9BA46C VL - 150 ID - 761954 ER - TY - JOUR AU - Kabrhel, Christopher DA - 2017 DB - German National Library of Science and Technology (TIB) PY - 2017 ST - Achieving Multidisciplinary Collaboration for the Creation of a Pulmonary Embolism Response Team: Creating a “Team of Rivals” T2 - Thieme Verlag TI - Achieving Multidisciplinary Collaboration for the Creation of a Pulmonary Embolism Response Team: Creating a “Team of Rivals” UR - https://www.tib.eu/en/search/id/thieme:10.1055-s-0036-1597760/Achieving-Multidisciplinary-Collaboration-for-the?cHash=cf7619641eb7cda4322ba7cc4a181171 ID - 761973 ER - TY - JOUR AB - base case was a 65‐year‐old patient. Additionally, we utilized preliminary data published by the Pulmonary Embolism Response Team at the ... AU - Kabrhel, Christopher AU - Ali, Ayman AU - Choi, Jin G. DA - 2017 DB - German National Library of Science and Technology (TIB) PY - 2017 ST - Systemic Thrombolysis, Catheter‐Directed Thrombolysis, and Anticoagulation for Intermediate‐risk Pulmonary Embolism: A Simulation Modeling Analysis T2 - Wiley TI - Systemic Thrombolysis, Catheter‐Directed Thrombolysis, and Anticoagulation for Intermediate‐risk Pulmonary Embolism: A Simulation Modeling Analysis UR - https://www.tib.eu/en/search/id/wiley:doi~10.1111%252FACEM.13242/Systemic-Thrombolysis-Catheter-Directed-Thrombolysis?cHash=023c70045adbd57ddab0f5feff9acae3 ID - 761983 ER - TY - JOUR AB - OBJECTIVES: Decision making around the use of thrombolysis for patients with intermediate-risk (submassive) pulmonary embolism (PE) remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (intravenous tissue plasminogen activator [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 quantitatively estimate the differences between the three strategies. METHODS: We created an individual-level state-transition model to simulate long-term outcomes of a hypothetical patient cohort treated with IV tPA, CDT, or anticoagulation alone. Our model incorporated clinical randomized controlled trial 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 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 (ICERs). RESULTS: Catheter-directed thrombolysis (mean, 95% confidence interval [CI] = 7.388 [7.381-7.396] QALYs) resulted in the most long-term utility 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, when measured by mean QALYs, 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 results in the largest number of QALYs for patients with intermediate-risk PE, although it is relatively expensive and the absolute difference in QALYs between anticoagulation alone and CDT is small. Future studies that provide data on longitudinal quality-of-life outcomes of patients treated for PE and characteristics of CDT would be beneficial to augment model inputs, inform assumptions, and validate results. AD - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA. Harvard Medical School, Boston, MA. Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA. Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA. AN - 28650086 AU - Kabrhel, C. AU - Ali, A. AU - Choi, J. G. AU - Hur, C. DA - Oct DO - 10.1111/acem.13242 DP - NLM ET - 2017/06/27 J2 - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine KW - Aged Female Fibrinolytic Agents/*administration & dosage/adverse effects Humans Intracranial Hemorrhages/*chemically induced Longitudinal Studies Male Middle Aged Pulmonary Embolism/*drug therapy Quality-Adjusted Life Years Risk Thrombolytic Therapy/economics/instrumentation/*methods Time Factors Tissue Plasminogen Activator/*administration & dosage/adverse effects Treatment Outcome LA - eng M1 - 10 N1 - 1553-2712 Kabrhel, Christopher Ali, Ayman Choi, Jin G Hur, Chin Comparative Study Journal Article United States Acad Emerg Med. 2017 Oct;24(10):1235-1243. doi: 10.1111/acem.13242. Epub 2017 Sep 13. PY - 2017 SN - 1069-6563 SP - 1235-1243 ST - Systemic Thrombolysis, Catheter-Directed Thrombolysis, and Anticoagulation for Intermediate-risk Pulmonary Embolism: A Simulation Modeling Analysis T2 - Acad Emerg Med TI - Systemic Thrombolysis, Catheter-Directed Thrombolysis, and Anticoagulation for Intermediate-risk Pulmonary Embolism: A Simulation Modeling Analysis VL - 24 ID - 760241 ER - TY - JOUR AB - Objectives Decision making around the use of thrombolysis for patients with intermediate-risk (submassive) pulmonary embolism ( PE) remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (intravenous tissue plasminogen activator [ 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 quantitatively estimate the differences between the three strategies. Methods We created an individual-level state-transition model to simulate long-term outcomes of a hypothetical patient cohort treated with IV tPA, CDT, or anticoagulation alone. Our model incorporated clinical randomized controlled trial 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 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 ( ICERs). Results Catheter-directed thrombolysis (mean, 95% confidence interval [ CI] = 7.388 [7.381-7.396] QALYs) resulted in the most long-term utility 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, when measured by mean QALYs, 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 results in the largest number of QALYs for patients with intermediate-risk PE, although it is relatively expensive and the absolute difference in QALYs between anticoagulation alone and CDT is small. Future studies that provide data on longitudinal quality-of-life outcomes of patients treated for PE and characteristics of CDT would be beneficial to augment model inputs, inform assumptions, and validate results. AD - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston MA Harvard Medical School, Boston MA Gastrointestinal Unit, Massachusetts General Hospital, Boston MA Institute for Technology Assessment, Massachusetts General Hospital, Boston MA AN - 125726000. Language: English. Entry Date: 20171020. Revision Date: 20190723. Publication Type: Article AU - Kabrhel, Christopher AU - Ali, Ayman AU - Choi, Jin G. AU - Hur, Chin AU - Mark Courtney, D. DB - CINAHL DO - 10.1111/acem.13242 DP - EBSCOhost KW - Simulations Thrombolytic Therapy Anticoagulants -- Administration and Dosage Pulmonary Embolism -- Risk Factors Human Pulmonary Embolism -- Classification Outcomes (Health Care) Plasminogen Activators -- Adverse Effects Tissue Plasminogen Activator -- Administration and Dosage Hemorrhage -- Risk Factors Stroke -- Risk Factors Drug Evaluation Catheters Data Analysis Software Patient Assessment Middle Age Hospitals, Public Sensitivity and Specificity Male Female M1 - 10 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. PY - 2017 SN - 1069-6563 SP - 1235-1243 ST - Systemic Thrombolysis, Catheter-Directed Thrombolysis, and Anticoagulation for Intermediate-risk Pulmonary Embolism: A Simulation Modeling Analysis T2 - Academic Emergency Medicine TI - Systemic Thrombolysis, Catheter-Directed Thrombolysis, and Anticoagulation for Intermediate-risk Pulmonary Embolism: A Simulation Modeling Analysis UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=125726000&site=ehost-live&scope=site VL - 24 ID - 761388 ER - TY - JOUR AB - Background: The optimal care of patients (pts) with severe pulmonary embolism (PE) involves several specialties. In order to provide timely, organized, evidence-based recommendations and therapy, a multidisciplinary team is required. We established an innovative Pulmonary Embolism Response Team (PERT), with an infrastructure for rapid, multidisciplinary consultation and to facilitate comparative-effectiveness research. Understanding the types of cases seen by our PERT will help other specialists assess the impact of creating similar teams elsewhere. Methods: The MGH PERT includes specialists in cardiology, emergency medicine, pulmonary/critical care, interventional radiology, vascular medicine and thoracic surgery. We launched the PERT Oct. 22, 2012 and asked clinicians who diagnosed massive or submassive PE to call a 24-h emergency number to activate the PERT. Upon activation, PERT members used commercially available online meeting software (GoToMeeting®) to discuss the case, view data and radiologic images and develop a treatment plan. For each case, prospective clinical data are collected in a research registry. For the current report, we describe our initial 12 week experience with team activation (10/22/12-01/12/ 13), including demographics, clinical characteristics, treatments and outcomes. Descriptive statistics (means and proportions) were analyzed using SAS v9.2. Results: Activations: In 12 weeks, there were 30 unique PERT activations, plus two duplicate activations. Twenty seven (90%) occurred during day or evening hours. Most (17, 57%) originated in the emergency department, 7 (23%) in intensive care units and 6 (20%) on hospital floors. Median time from activation to PERT meeting was 54 min. Patients: Mean age was 57 ± 17 years and 19 (63%) were male. Comorbid illness included: cardiopulmonary disease (n = 10, 33%), recent trauma or surgery (n = 8, 26%); cancer (n = 8, 26%); prior venous thromboembolism (n = 3, 10%). Twelve (40%) patients had a contraindication to thrombolysis or high-risk of bleeding. PE Severity: Twenty-five (83%) pts had diagnosed PE, 5 (17%) had suspected but unconfirmed PE. Two (6%) were in cardiac arrest. Seven (28%) PE were saddle, 8 (32%) main pulmonary artery, 9 (36%) lobar, and 1 (3%) segmental. Twenty (80%) were bilateral. Sixteen (64%) pts with PE had elevated troponin-t and 13 (52%) had elevated NT-proBNP. Twenty (80%) had right heart strain on echocardiography or computed tomography. Eight (32%) were hypotensive (< 90 mmHg) and 9 (36%) were intubated. Sixteen (64%) had concomitant deep vein thrombosis. Treatment and Outcomes: After consultation, the PERT considered 5 (20%) PE low risk, 18 (72%) submassive and 2 (8%) massive. Twentythree (92%) pts received unfractionated heparin, 1 (4%) enoxaparin, and 1 (4%) no anticoagulation. Two (8%) pts had catheter directed thrombolysis and 5 (20%) had a vena cava filter placed. One (4%) pt had hematuria after anticoagulation. Seven (23%) pts overall and 3 (12%) with confirmed PE died prior to hospital discharge. Discussion: We describe an innovative multidisciplinary Pulmonary Embolism Response Team (PERT). Our initial experience suggests that the PERT was activated frequently and appropriately. Most pts had massive or submassive PE, suggesting clinicians are highly efficient at selecting pts with severe PE. The PERT provided recommendations in < 1 h in most cases. AD - C. Kabrhel, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States AU - Kabrhel, C. AU - Jaff, M. AU - Channick, R. AU - Baker, J. N. AU - Jama, A. AU - Manthripragada, G. K. AU - Hawkins, B. AU - O'Dea, J. AU - Weinberg, I. AU - Rosenfield, K. DB - Embase KW - troponin T antihypertensive agent enoxaparin heparin lung embolism United States general hospital society thrombosis hemostasis human patient anticoagulation medical specialist risk blood clot lysis consultation clinical study software emergency echocardiography thorax surgery computer assisted tomography deep vein thrombosis register heart arrest interventional radiology male bleeding emergency medicine venous thromboembolism hospital discharge hematuria cardiology pulmonary artery neoplasm heart vena cava filter surgery injury catheter diseases comparative effectiveness hospital intensive care unit emergency ward statistics therapy evidence based practice LA - English M3 - Conference Abstract N1 - L71207801 2013-11-06 PY - 2013 SN - 1538-7933 SP - 386-387 ST - A multidisciplinary pulmonary embolism response team (PERT). Initial clinical experience at Massachusetts general hospital T2 - Journal of Thrombosis and Haemostasis TI - A multidisciplinary pulmonary embolism response team (PERT). Initial clinical experience at Massachusetts general hospital UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71207801&from=export VL - 11 ID - 761159 ER - TY - JOUR AB - Background: Our Pulmonary Embolism Response Team (PERT) provides multi-specialty collaborative care for patients with severe PE. Objectives: Describe a longitudinal analysis of treatments and outcomes among PERT patients. Methods: We recorded data on consecutive patients treated by PERT including clinical presentation, test results, treatment, and outcomes through 365 days. The Partners HealthCare IRB approved the study. We performed Fisher's exact tests and regression analysis to test for trends. Results: In 30 months, there were 394 PERT activations. Activations increased by an average of 16% per 6 month period (ptrend <0.01) (Figure 1). 227 (58%) activations came from the ED, 78 (20%) from an ICU, 56 (14%) from a medical floor, 18 (5%) from a surgical floor. The mean age was 61±16 yrs. and 212 (54%) were male (54%). The mean Charlson Comorbidity Index (CCI) score was 2.6±2.8. 216 (69%) of PE were in a main pulmonary artery (PA), saddle or intracardiac and 158 (50%) also had deep vein thrombosis (DVT). The majority of confirmed PE were submassive (n=143, 46%) or massive (n=80, 25%) and most patients (n=204, 65%) had evidence of right heart strain on echocardiography or CTPA. PERT treated (n=35, 11%), with systemic or catheter-directed thrombolysis (CDT) though the most common treatment was anticoagulation alone (n=215, 69%). Hemorrhagic complications occurred within 7 days in 25 (8%) and within 30 days in 36 (14%) patients. Bleeding was similar among patients treated with catheter directed thrombolysis (1/28 (4%) in 7 days and 3/27 (11%) in 30 days) and patients treated with anticoagulation alone (8/209 (4%) in 7 days and 17/179 (10%) in 30 days). The 30-day mortality was 12% for PE overall and 25% in patients with massive PE (p<0.01). Conclusion: The PERT approach was rapidly adopted and sustained over time and facilitated access to advanced treatments for PE, with similar bleeding in CDT and anticoagulated patients. The PERT paradigm may represent a new standard-of-care for patients with PE. (Figure Presented). AD - C. Kabrhel, Massachusetts General Hospital, Boston, MA, United States AU - Kabrhel, C. AU - Rosovsky, R. AU - Channick, R. AU - Jaff, M. AU - Weinberg, I. AU - Sundt, T. AU - Dudzinski, D. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Chang, Y. AU - Rosenfield, K. DB - Embase DO - 10.1111/acem.12974 KW - lung embolism patient human society emergency medicine blood clot lysis anticoagulation catheter bleeding deep vein thrombosis regression analysis health care intracardiac drug administration pulmonary artery mortality male Charlson Comorbidity Index echocardiography heart health care quality Fisher exact test LA - English M3 - Conference Abstract N1 - L72281286 2016-05-31 PY - 2016 SN - 1553-2712 SP - S244 ST - A multidisciplinary pulmonary embolism response team (PERT): Initial 30-month experience with a novel approach to delivery of care to patients with sub-massive and massive PE T2 - Academic Emergency Medicine TI - A multidisciplinary pulmonary embolism response team (PERT): Initial 30-month experience with a novel approach to delivery of care to patients with sub-massive and massive PE UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72281286&from=export http://dx.doi.org/10.1111/acem.12974 VL - 23 ID - 761022 ER - TY - JOUR AB - BACKGROUND: Integrating newly developed tests and treatments for severe pulmonary embolism (PE) into clinical care requires coordinated multispecialty collaboration. To meet this need, we developed a new paradigm: a multidisciplinary Pulmonary Embolism Response Team (PERT). In this report, we provide the first longitudinal analysis of patients treated by a PERT. METHODS: Our PERT includes specialists in cardiovascular medicine and surgery, emergency medicine, hematology, pulmonary/critical care, and radiology, and is organized as a rapid response team. We prospectively captured clinical, therapeutic, and outcome data at PERT activation and during follow-up periods up to 365 days. We analyzed data collectively, and as five mutually exclusive 6-month periods. We performed Fisher exact tests and regression analysis to test for trend. RESULTS: In 30 months, there were 394 unique PERT activations, 314 (80%) for confirmed PE. PERT activations increased by 16% every 6 months. Most confirmed PEs were submassive (n = 143, 46%) or massive (n = 80, 26%). The PERT treated a relatively large proportion of patients with PE and systemic or catheter-directed thrombolysis (n = 35, 11%), though the most common treatment was anticoagulation alone (n = 215, 69%). Hemorrhagic complications were rare overall, especially among patients treated with catheter-directed thrombolysis. The all-cause 30-day mortality of PERT patients with confirmed PE was 12%. CONCLUSIONS: We report our initial 30-month experience with a novel multidisciplinary PERT that rapidly engages multiple specialists to deliver efficient, organized, and evidence-based care to patients with high-risk PE. The PERT paradigm was rapidly adopted and may become a new standard of care for patients with PE. AD - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: ckabrhel@partners.org. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. AN - 27006156 AU - Kabrhel, C. AU - Rosovsky, R. AU - Channick, R. AU - Jaff, M. R. AU - Weinberg, I. AU - Sundt, T. AU - Dudzinski, D. M. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Chang, Y. AU - Rosenfield, K. DA - Aug DO - 10.1016/j.chest.2016.03.011 DP - NLM ET - 2016/03/24 J2 - Chest KW - Adult Aged Anticoagulants/*therapeutic use Cardiology Catheterization, Swan-Ganz Delivery of Health Care/*organization & administration Emergency Medicine Female Hematology Hemorrhage/chemically induced Hospitals, General Humans Longitudinal Studies Male Massachusetts Middle Aged Patient Care Team/*organization & administration Postoperative Hemorrhage/epidemiology Prospective Studies Pulmonary Embolism/*therapy Pulmonary Medicine Radiology Severity of Illness Index Thoracic Surgery *Thrombectomy *Thrombolytic Therapy *deep vein thrombosis *pulmonary embolism *rapid response team *thrombolysis *thrombosis LA - eng M1 - 2 N1 - 1931-3543 Kabrhel, Christopher Rosovsky, Rachel Channick, Richard Jaff, Michael R Weinberg, Ido Sundt, Thoralf Dudzinski, David M Rodriguez-Lopez, Josanna Parry, Blair A Harshbarger, Savanah Chang, Yuchiao Rosenfield, Kenneth Journal Article United States Chest. 2016 Aug;150(2):384-93. doi: 10.1016/j.chest.2016.03.011. Epub 2016 Mar 19. PY - 2016 SN - 0012-3692 SP - 384-93 ST - A Multidisciplinary Pulmonary Embolism Response Team: Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism T2 - Chest TI - A Multidisciplinary Pulmonary Embolism Response Team: Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism VL - 150 ID - 760199 ER - TY - JOUR AB - BACKGROUND: Integrating newly developed tests and treatments for severe pulmonary embolism (PE) into clinical care requires coordinated multispecialty collaboration. To meet this need, we developed a new paradigm: a multidisciplinary Pulmonary Embolism Response Team (PERT). In this report, we provide the first longitudinal analysis of patients treated by a PERT. METHODS: Our PERT includes specialists in cardiovascular medicine and surgery, emergency medicine, hematology, pulmonary/critical care, and radiology, and is organized as a rapid response team. We prospectively captured clinical, therapeutic, and outcome data at PERT activation and during follow-up periods up to 365 days. We analyzed data collectively, and as five mutually exclusive 6-month periods. We performed Fisher exact tests and regression analysis to test for trend. RESULTS: In 30 months, there were 394 unique PERT activations, 314 (80%) for confirmed PE. PERT activations increased by 16% every 6 months. Most confirmed PEs were submassive (n = 143, 46%) or massive (n = 80, 26%). The PERT treated a relatively large proportion of patients with PE and systemic or catheter-directed thrombolysis (n = 35, 11%), though the most common treatment was anticoagulation alone (n = 215, 69%). Hemorrhagic complications were rare overall, especially among patients treated with catheter-directed thrombolysis. The all-cause 30-day mortality of PERT patients with confirmed PE was 12%. CONCLUSIONS: We report our initial 30-month experience with a novel multidisciplinary PERT that rapidly engages multiple specialists to deliver efficient, organized, and evidence-based care to patients with high-risk PE. The PERT paradigm was rapidly adopted and may become a new standard of care for patients with PE. AD - [Kabrhel, Christopher; Rosovsky, Rachel; Dudzinski, David M.; Parry, Blair A.; Harshbarger, Savanah] Harvard Med Sch, Massachusetts Gen Hosp, Ctr Vasc Emergencies, Dept Emergency Med, Boston, MA USA. [Rosovsky, Rachel; Rodriguez-Lopez, Josanna] Harvard Med Sch, Massachusetts Gen Hosp, Div Hematol & Oncol, Dept Med, Boston, MA USA. [Channick, Richard] Harvard Med Sch, Massachusetts Gen Hosp, Div Pulm & Crit Care, Dept Med, Boston, MA USA. [Jaff, Michael R.; Weinberg, Ido] Harvard Med Sch, Massachusetts Gen Hosp, Fireman Vasc Ctr, Boston, MA USA. [Jaff, Michael R.; Weinberg, Ido; Dudzinski, David M.; Rosenfield, Kenneth] Harvard Med Sch, Massachusetts Gen Hosp, Div Cardiol, Dept Med, Boston, MA USA. [Sundt, Thoralf] Harvard Med Sch, Massachusetts Gen Hosp, Div Cardiac Surg, Dept Surg, Boston, MA USA. [Dudzinski, David M.; Chang, Yuchiao] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Boston, MA USA. Kabrhel, C (corresponding author), Massachusetts Gen Hosp, Dept Emergency Med, Ctr Vasc Emergencies, Zero Emerson Pl,Ste 3B, Boston, MA 02114 USA. ckabrhel@partners.org AN - WOS:000380934100028 AU - Kabrhel, C. AU - Rosovsky, R. AU - Channick, R. AU - Jaff, M. R. AU - Weinberg, I. AU - Sundt, T. AU - Dudzinski, D. M. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Chang, Y. C. AU - Rosenfield, K. DA - Aug DO - 10.1016/j.chest.2016.03.011 J2 - Chest KW - deep vein thrombosis pulmonary embolism rapid response team thrombolysis thrombosis VENOUS THROMBOEMBOLISM CLINICAL-OUTCOMES EMBOLECTOMY MANAGEMENT THROMBOLYSIS REGISTRY TRIAL FRAGMENTATION SUPPORT Critical Care Medicine Respiratory System LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: DS7AG Times Cited: 99 Cited Reference Count: 32 Kabrhel, Christopher Rosovsky, Rachel Channick, Richard Jaff, Michael R. Weinberg, Ido Sundt, Thoralf Dudzinski, David M. Rodriguez-Lopez, Josanna Parry, Blair A. Harshbarger, Savanah Chang, Yuchiao Rosenfield, Kenneth Kabrhel, Christopher/0000-0002-8699-7176 Diagnostica Stago; Siemens Healthcare; Janssen PharmaceuticalsJohnson & Johnson USAJanssen Biotech Inc; Boehringer-IngelheimBoehringer Ingelheim; Abbott VascularAbbott Laboratories; Atrium; Lutonix/BARD; The Medicines Company The authors have reported to CHEST the following: C. K. discloses the following relationships: consultant to Diagnostica Stago, Janssen Pharmaceuticals, Siemens, Pfizer, and Portola Pharmaceuticals; grant recipient from Diagnostica Stago, Siemens Healthcare, Janssen Pharmaceuticals, and Boehringer-Ingelheim. M. J. discloses the following relationships: consultant to Abbott Vascular, Boston Scientific, Cardinal Health, Cordis Corporation, Covidien, Ekos Corporation, Medtronic, Micell, Inc., and Primacea; equity in Access Closure, Inc., I. C. Sciences, Inc., JanaCare, Inc., MC10, Northwind Medical, Inc., PQ Bypass, Inc., Primacea, Sano V, Inc., and Vascular Therapies, Inc.; board member with VIVA Physicians and CBSET. T. S. discloses the following relationship: consultant to Thrasos Therapeutics. R. discloses the following relationships: consultant to Cardinal Health and SurModics; grants/contracts with Abbott Vascular, Atrium; Lutonix/BARD, and The Medicines Company; equity with Access Closure, Inc., and AngioDynamics/Vortex; personal compensation from Cook, HCRI, and The Medicines Company; board member with VIVA Physicians. None declared (R. R., R. C., I. W., T. S., D. D., J. R.-L., B. P., S. H., Y. C.). 100 0 4 ELSEVIER SCIENCE BV AMSTERDAM CHEST PY - 2016 SN - 0012-3692 SP - 384-393 ST - A Multidisciplinary Pulmonary Embolism Response Team Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism T2 - Chest TI - A Multidisciplinary Pulmonary Embolism Response Team Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism UR - ://WOS:000380934100028 VL - 150 ID - 761701 ER - TY - JOUR AB - Background: Integrating newly developed tests and treatments for severe pulmonary embolism (PE) into clinical care requires coordinated multispecialty collaboration. To meet this need, we developed a new paradigm: a multidisciplinary Pulmonary Embolism Response Team (PERT). In this report, we provide the first longitudinal analysis of patients treated by a PERT.Methods: Our PERT includes specialists in cardiovascular medicine and surgery, emergency medicine, hematology, pulmonary/critical care, and radiology, and is organized as a rapid response team. We prospectively captured clinical, therapeutic, and outcome data at PERT activation and during follow-up periods up to 365 days. We analyzed data collectively, and as five mutually exclusive 6-month periods. We performed Fisher exact tests and regression analysis to test for trend.Results: In 30 months, there were 394 unique PERT activations, 314 (80%) for confirmed PE. PERT activations increased by 16% every 6 months. Most confirmed PEs were submassive (n = 143, 46%) or massive (n = 80, 26%). The PERT treated a relatively large proportion of patients with PE and systemic or catheter-directed thrombolysis (n = 35, 11%), though the most common treatment was anticoagulation alone (n = 215, 69%). Hemorrhagic complications were rare overall, especially among patients treated with catheter-directed thrombolysis. The all-cause 30-day mortality of PERT patients with confirmed PE was 12%.Conclusions: We report our initial 30-month experience with a novel multidisciplinary PERT that rapidly engages multiple specialists to deliver efficient, organized, and evidence-based care to patients with high-risk PE. The PERT paradigm was rapidly adopted and may become a new standard of care for patients with PE. AD - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA AN - 117161199. Language: English. Entry Date: 20170601. Revision Date: 20191120. Publication Type: journal article. Journal Subset: Biomedical AU - Kabrhel, Christopher AU - Rosovsky, Rachel AU - Channick, Richard AU - Jaff, Michael R. AU - Weinberg, Ido AU - Sundt, Thoralf AU - Dudzinski, David M. AU - Rodriguez-Lopez, Josanna AU - Parry, Blair A. AU - Harshbarger, Savanah AU - Yuchiao, Chang AU - Rosenfield, Kenneth AU - Chang, Yuchiao DB - CINAHL DO - 10.1016/j.chest.2016.03.011 DP - EBSCOhost KW - Thrombectomy Anticoagulants -- Therapeutic Use Thrombolytic Therapy Multidisciplinary Care Team -- Administration Pulmonary Embolism -- Therapy Health Care Delivery -- Administration Aged Prospective Studies Middle Age Massachusetts Postoperative Hemorrhage -- Epidemiology Specialties, Medical Hemorrhage -- Chemically Induced Hematology Adult Internal Medicine Emergency Medicine Severity of Illness Indices Hospitals Thoracic Surgery Cardiology Swan-Ganz Catheterization Male Female Critical Care Family Needs Inventory M1 - 2 N1 - Peer Reviewed; USA. Instrumentation: Critical Care Family Needs Inventory (CCFNI). NLM UID: 0231335. PMID: NLM27006156. PY - 2016 SN - 0012-3692 SP - 384-393 ST - A Multidisciplinary Pulmonary Embolism Response Team: Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism T2 - CHEST TI - A Multidisciplinary Pulmonary Embolism Response Team: Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=117161199&site=ehost-live&scope=site VL - 150 ID - 761282 ER - TY - JOUR AB - Objective: To demonstrate the potential of de-identified clinical data from multiple healthcare systems using different electronic health records (EHR) to be efficiently used for very large retrospective cohort studies.Materials and Methods: Data of 959 030 patients, pooled from multiple different healthcare systems with distinct EHR, were obtained. Data were standardized and normalized using common ontologies, searchable through a HIPAA-compliant, patient de-identified web application (Explore; Explorys Inc). Patients were 26 years or older seen in multiple healthcare systems from 1999 to 2011 with data from EHR.Results: Comparing obese, tall subjects with normal body mass index, short subjects, the venous thromboembolic events (VTE) OR was 1.83 (95% CI 1.76 to 1.91) for women and 1.21 (1.10 to 1.32) for men. Weight had more effect then height on VTE. Compared with Caucasian, Hispanic/Latino subjects had a much lower risk of VTE (female OR 0.47, 0.41 to 0.55; male OR 0.24, 0.20 to 0.28) and African-Americans a substantially higher risk (female OR 1.83, 1.76 to 1.91; male OR 1.58, 1.50 to 1.66). This 13-year retrospective study of almost one million patients was performed over approximately 125 h in 11 weeks, part time by the five authors.Discussion: As research informatics tools develop and more clinical data become available in EHR, it is important to study and understand unique opportunities for clinical research informatics to transform the scale and resources needed to perform certain types of clinical research.Conclusions: With the right clinical research informatics tools and EHR data, some types of very large cohort studies can be completed with minimal resources. AD - Department of Information Services, The MetroHealth System, Cleveland, Ohio, USA Department of Information Services, The MetroHealth System, Cleveland, Ohio, USA. AN - 104375364. Language: English. Entry Date: 20130510. Revision Date: 20200708. Publication Type: journal article AU - Kaelber, D. C. AU - Foster, W. AU - Gilder, J. AU - Love, T. E. AU - Jain, A. K. AU - Kaelber, David C. AU - Foster, Wendy AU - Gilder, Jason AU - Love, Thomas E. AU - Jain, Anil K. DB - CINAHL DO - 10.1136/amiajnl-2011-000782 DP - EBSCOhost KW - Data Collection Methods Electronic Health Records -- Statistics and Numerical Data Venous Thromboembolism -- Prevention and Control Body Height Body Mass Index Female Human Internet Male Middle Age Retrospective Design Risk Factors Software Unified Medical Language System United States Venous Thromboembolism -- Epidemiology M1 - 6 N1 - research. Journal Subset: Blind Peer Reviewed; Computer/Information Science; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Special Interest: Informatics. Grant Information: UL1 RR024989/RR/NCRR NIH HHS/United States. NLM UID: 9430800. PMID: NLM22759621. PY - 2012 SN - 1067-5027 SP - 965-972 ST - Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data T2 - Journal of the American Medical Informatics Association TI - Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=104375364&site=ehost-live&scope=site VL - 19 ID - 761360 ER - TY - JOUR AB - PURPOSE: Until 2009 only a very small number of children (one patient a year) underwent a kidney transplantation surgery abroad Belarus. METHOD: A number of consequential steps had to be undertaken in order to successfully launch the pediatric kidney transplantation program which included multidisciplinary team training, state authorization, an expeditious method for organ distribution, protocols for recipient selection and evaluation, and perioperative and follow-up care. As a result 50 (29 male; 21 female) pediatric kidney transplantation surgeries were performed in the time period from April 2009 until September 2012. Indications included congenital abnormalities (24); chronic GN (15); metabolic disease (4); HUS (2); CTIN (2); FSGS (1); INS (1) or vasculitis (1). Mean recipient age was 13(3-17) years. 7 LRD and 43 DCD KTx. Mean CIT was LR cases 287(245 -300) min and DCD was 898(357-1085) min. Mean age of DCD was 32(9-49) years and LRD was 37(30-53) years. RESULTS: Actuarial graft survival rates were 96% and 86% at 1,3-yr respectively. (Table Presented) 1 patient underwent retransplantation. Complications (8 cases: 16%), bleeding(3), hematomas(2) and lymphoceles (3). 4 grafts failed due to vessel thrombosis (2) and acute rejection (2); patient survival 100%. CONCLUSION: The initial successful results could be received due to careful planning, institutional and state support, required and allocated resources but most importantly due to professional and dedicated team. We separately would like to express our special thanks to Oxford Transplant Center, Birmingham Children Hospital and Pittsburg Transplant Center for exceptional support and training possibility. AD - A. Kalachyk, National Transplant Center, Minsk, Belarus AU - Kalachyk, A. AU - Baiko, S. AU - Dubrou, V. AU - Valek, A. AU - Kobiak, A. AU - Barash, V. AU - Tur, N. AU - Harden, P. AU - Sukalo, A. DB - Embase DO - 10.1111/petr.12122 KW - kidney transplantation Belarus transplantation human patient recipient follow up survival rate bleeding organ distribution vasculitis pediatric hospital metabolic disorder graft survival acute graft rejection congenital disorder retransplantation thrombosis hematoma male survival planning female child LA - English M3 - Conference Abstract N1 - L71163614 2013-09-16 PY - 2013 SN - 1397-3142 SP - 91 ST - New paediatric kidney transplantation program in belarus: Outcomes and disclousers T2 - Pediatric Transplantation TI - New paediatric kidney transplantation program in belarus: Outcomes and disclousers UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71163614&from=export http://dx.doi.org/10.1111/petr.12122 VL - 17 ID - 761155 ER - TY - JOUR AB - SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Acute aortic syndrome is a life-threatening emergency that includes classic aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer (PAU). This group of conditions present with similar clinical symptoms of which chest pain and back pain are common. Early diagnosis and treatment is essential in reducing mortality from life-threatening complications. CASE PRESENTATION: An 88-year-old female with diabetes mellitus type 2 and hypertension presented to the emergency room with complaints of vomiting, pleuritic chest and left shoulder pain of one-week duration. She reported a productive cough of yellow sputum, body aches but denied any fevers or dyspnea. Her vitals on presentation were within normal limits. Pertinent examination findings were bibasilar crepitations with normal heart sounds, no murmurs or pulse deficits. Initial hemoglobin (Hb) was 12.5g/dL with elevated white blood cell count, lactate and troponin; her electrocardiogram was unremarkable. A noncontrast computed tomography (CT) scan of abdomen and pelvis showed diverticulosis, left lower lobe consolidation and small bilateral pleural effusions. She was admitted to the medical floor for sepsis secondary to community-acquired pneumonia and non-ST elevation myocardial infarction (MI). She was treated with intravenous fluids, empiric antibiotics and aspirin. Within 24 hours of admission, she had an acute worsening of her mentation associated with non-refractory hypotension and hypoxemia requiring oxygen via nonrebreather. The rapid response team was called and a noncontrast CT chest done en-route to the ICU, showed complete opacification of the left hemithorax with shift of the heart and mediastinal structures to the right, secondary to a large left hemothorax. An emergent chest tube was placed with drainage of 1000 cc of frank blood. Follow-up contrast CT chest showed a ruptured PAU of the aortic arch with surrounding periaortic hematoma/aortic dissection. Serial troponins were uptrending, however echocardiogram showed impaired left ventricular diastolic filling and was otherwise unremarkable. She was definitively treated with emergent thoracic endovascular repair (TEVAR) after transfer to another facility. DISCUSSION: Penetrating atherosclerotic ulcer is a lesion that penetrates the internal elastic lamina into the media, that usually involves the descending aorta but rarely may involve the arch or ascending aorta. It must be differentiated from more common causes of chest pain such as MI or pulmonary embolism. A contrast CT is usually required for diagnosis. If the ascending aorta is involved, surgical intervention such as TEVAR provides a safe alternative for high-risk surgical patients. CONCLUSIONS: Aortic arch PAU is a rare condition with lethal complications, such as a tension hemothorax in our index case, which must be differentiated from other causes of chest pain to facilitate lifesaving interventions. Reference #1: Baliyan, V., Parakh, A., Prabhakar, A. M., & Hedgire, S. (2018). Acute aortic syndromes and aortic emergencies. Cardiovascular diagnosis and therapy, 8(Suppl 1), S82–S96. https://doi.org/10.21037/cdt.2018.03.02 Reference #2: Jacobsen GH, Brandt B, Ellesøe SG (2017) Spontaneous Tension Hemothorax in a Young Male with a Nuss Implant. J Pulm Respir Med 6: 394. doi:10.4172/2161-105X.1000394 Reference #3: S. Kimura, M. Noda, M. Usui, M. Isobe. Diagnostic criteria for penetrating atheromatous ulcer of the thoracic aorta. Ann Thorac Surg, 78 (2004), pp. 1070-1072 https://doi.org/10.1016/S0003-4975(03)01405-XX DISCLOSURES: No relevant relationships by Sahai Donaldson, source=Web Response No relevant relationships by Ifunanya Kalu, source=Web Response No relevant relationships by Lorenzo Leys, source=Web Response No relevant relationships by Alem Mehari, source=Web Response AU - Kalu, I. AU - Leys, L. AU - Donaldson, S. AU - Mehari, A. DB - Embase DO - 10.1016/j.chest.2020.08.2120 KW - acetylsalicylic acid antibiotic agent endogenous compound hemoglobin lactic acid oxygen troponin abdomen acute aortic syndrome aged aortic arch aortic dissection ascending aorta atherosclerosis case report chest tube clinical article community acquired pneumonia computer assisted tomography conference abstract coughing crackle descending aorta diverticulosis drug combination drug fatality dyspnea echocardiography emergency ward endovascular aneurysm repair female fever follow up heart left ventricle filling heart murmur heart sound hematoma hematothorax human hypertension hypotension hypoxemia implant leukocyte count lung embolism male non insulin dependent diabetes mellitus non ST segment elevation myocardial infarction pelvis pleura effusion rapid response team risk assessment sepsis shoulder pain sputum surgical patient tension thinking thoracic aorta thorax pain ulcer very elderly vomiting LA - English M1 - 4 M3 - Conference Abstract N1 - L2008026182 2020-10-20 PY - 2020 SN - 1931-3543 0012-3692 SP - A107 ST - PENETRATING ATHEROSCLEROTIC ULCER OF THE AORTIC ARCH: A RARE CAUSE OF TENSION HEMOTHORAX T2 - Chest TI - PENETRATING ATHEROSCLEROTIC ULCER OF THE AORTIC ARCH: A RARE CAUSE OF TENSION HEMOTHORAX UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008026182&from=export http://dx.doi.org/10.1016/j.chest.2020.08.2120 VL - 158 ID - 760541 ER - TY - JOUR AB - Background and Purpose: Improving door-to-needle times (DNTs) for thrombolysis of acute ischemic stroke patients improves outcomes, but participation in DNT improvement initiatives has been mostly limited to larger, academic medical centers with an existing interest in stroke quality improvement. It is not known whether quality improvement initiatives can improve DNT at a population level, including smaller community hospitals. This study aims to determine the effect of a provincial improvement collaborative intervention on improvement of DNT and patient outcomes. Methods: A pre post cohort study was conducted over 10 years in the Canadian province of Alberta with 17 designated stroke centers. All ischemic stroke patients who received thrombolysis in the Canadian province of Alberta were included in the study. The quality improvement intervention was an improvement collaborative that involved creation of interdisciplinary teams from each stroke center, participation in 3 workshops and closing celebration, site visits, webinars, and data audit and feedback. Results: Two thousand four hundred eighty-eight ischemic stroke patients received thrombolysis in the pre- and postintervention periods (630 in the post period). The mean age was 71 years (SD, 14.6 years), and 46% were women. DNTs were reduced from a median of 70.0 minutes (interquartile range, 51-93) to 39.0 minutes (interquartile range, 27-58) for patients treated per guideline (P<0.0001). The percentage of patients discharged home from acute care increased from 45.6% to 59.5% (P<0.0001); the median 90-day home time increased from 43.3 days (interquartile range, 27.3-55.8) to 53.6 days (interquartile range, 36.8-64.6) (P=0.0015); and the in-hospital mortality decreased from 14.5% to 10.5% (P=0.0990). Conclusions: The improvement collaborative was likely the key contributing factor in reducing DNTs and improving outcomes for ischemic stroke patients across Alberta. AD - [Kamal, Noreen] Dalhousie Univ, Dept Ind Engn, Halifax, NS, Canada. [Kamal, Noreen; Smith, Eric E.; Demchuk, Andrew M.; Hill, Michael D.] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada. [Smith, Eric E.; Mrklas, Kelly J.; Hill, Michael D.] Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada. [Demchuk, Andrew M.; Hill, Michael D.] Univ Calgary, Dept Radiol, Calgary, AB, Canada. [Lang, Eddy] Univ Calgary, Dept Emergency Med, Calgary, AB, Canada. [Jeerakathil, Thomas; Siddiqui, Muzaffar] Univ Alberta, Div Neurol, Dept Med, Edmonton, AB, Canada. [Stang, Jillian; Liu, Mingfu] Alberta Hlth Serv, Data Analyt, Calgary, AB, Canada. [Rogers, Edwin] Govt Saskatchewan, Strateg Management Branch, Regina, SK, Canada. [Siddiqui, Muzaffar] Grey Nuns Community Hosp, Edmonton, AB, Canada. [Mann, Balraj; Valaire, Shelley] Alberta Hlth Serv, Cardiovasc Hlth & Stroke, Strateg Clin Network, Edmonton, AB, Canada. [Bestard, Jennifer; Shand, Elaine] Red Deer Reg Hosp Ctr, Red Deer, AB, Canada. [Benard, Magali] Westlock Healthcare Ctr, Westlock, AB, Canada. [Collins, Lisa] Alberta Hlth Serv, North Zone, Cold Lake, AB, Canada. [Martin, Kevin; Hartley, Corinna] Chinook Reg Hosp, Lethbridge, AB, Canada. [Reiber, Marnie] Lloydminster Hosp, Lloydminster, AB, Canada. [Mrklas, Kelly J.] Alberta Hlth Serv, Syst Innovat & Programs Strateg Clin Networks, Calgary, AB, Canada. Kamal, N (corresponding author), Dalhousie Univ, 5269 Morris St,Room 100,POB 15000, Halifax, NS B3H 4R2, Canada. noreen.kamal@dal.ca AN - WOS:000562751900036 AU - Kamal, N. AU - Jeerakathil, T. AU - Stang, J. AU - Liu, M. F. AU - Rogers, E. AU - Smith, E. E. AU - Demchuk, A. M. AU - Siddiqui, M. AU - Mann, B. AU - Bestard, J. AU - Lang, E. AU - Shand, E. AU - Benard, M. AU - Collins, L. AU - Martin, K. AU - Hartley, C. AU - Reiber, M. AU - Valaire, S. AU - Mrklas, K. J. AU - Hill, M. D. AU - Program, Quicr Alberta Stroke DA - Aug DO - 10.1161/strokeaha.120.029734 J2 - Stroke KW - brain ischemia cohort studies hospital mortality humans quality improvement TISSUE-PLASMINOGEN ACTIVATOR ACUTE ISCHEMIC-STROKE THROMBOLYSIS HOSPITALS TIMES Clinical Neurology Peripheral Vascular Disease LA - English M1 - 8 M3 - Article N1 - ISI Document Delivery No.: NE6ZZ Times Cited: 0 Cited Reference Count: 25 Kamal, Noreen Jeerakathil, Thomas Stang, Jillian Liu, Mingfu Rogers, Edwin Smith, Eric E. Demchuk, Andrew M. Siddiqui, Muzaffar Mann, Balraj Bestard, Jennifer Lang, Eddy Shand, Elaine Benard, Magali Collins, Lisa Martin, Kevin Hartley, Corinna Reiber, Marnie Valaire, Shelley Mrklas, Kelly J. Hill, Michael D. ; Kamal, Noreen/I-9255-2017 Zerna, Charlotte/0000-0001-5969-8990; Kamal, Noreen/0000-0001-5957-2183 Alberta Innovates CRIO (Collaborative Research and Innovation Opportunities) Grant This study was was funded by Alberta Innovates CRIO (Collaborative Research and Innovation Opportunities) Grant. Dr Michael D. Hill was the Principal Investigator for this grant. 0 1 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA STROKE PY - 2020 SN - 0039-2499 SP - 2339-2346 ST - Provincial Door-to-Needle Improvement Initiative Results in Improved Patient Outcomes Across an Entire Population T2 - Stroke TI - Provincial Door-to-Needle Improvement Initiative Results in Improved Patient Outcomes Across an Entire Population UR - ://WOS:000562751900036 VL - 51 ID - 761421 ER - TY - JOUR AB - OBJECTIVES: Vascular problems such as thrombosis and stenosis of the hepatic artery, portal vein, and hepatic vein are serious complications after living-donor liver transplant and can cause increased morbidity, graft loss, and patient death. The aim of this study was to assess the incidence, treatment, and outcome of recipient vascular complications after living-donor liver transplant in a single Egyptian center. MATERIALS AND METHODS: Between November 2006 and March 2014, we performed 226 living-donor liver transplants for 225 patients at Dar Al Fouad Hospital in 6th of October City in Egypt. Review of all patients with vascular complications was performed. RESULTS: In 20 of 225 recipients (8.9%), there were vascular complications that occurred from day 0 to 14 (mean, 5.6 ± 3.4 d). Complications included isolated hepatic artery thrombosis in 7 patients (35%), isolated portal vein thrombosis in 6 patients (30%), isolated hepatic vein stenosis in 3 patients (15%), and isolated hepatic artery stenosis in 1 patient (5%). Combined portal vein thrombosis and hepatic artery thrombosis occurred in 2 patients (10%), and combined portal vein thrombosis and hepatic vein stenosis occurred in 1 patient (5%). Complications were identified with duplex ultrasonography and confirmed with computed tomographic angiography and direct angiography when needed. Multidisciplinary treatment included percutaneous transarterial or transvenous thrombolysis with or without balloon dilation and stenting, open surgical exploration with thrombectomy, vascular revision, or retransplant. There were no intraoperative deaths, but mortality occurred in 15 of 20 patients (75%). Survival ranged from 6 days to 70 months. Preoperative portal vein thrombosis was observed in 3 of 7 patients (43%) who had postoperative portal vein thrombosis. CONCLUSIONS: Major vascular complications in living-donor liver transplant recipients have poor outcome despite early detection and prompt multidisciplinary intervention. Preoperative recipient portal vein thrombosis is a risk factor for postoperative portal vein thrombosis. AD - From the Department of Surgery, Ein Shams University, Cairo. AN - 25894130 AU - Kamel, R. AU - Hatata, Y. AU - Taha, M. AU - Hosny, K. AU - Amin, A. DA - Apr DP - NLM ET - 2015/04/22 J2 - Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation KW - Adult Aged Combined Modality Therapy Early Diagnosis Egypt/epidemiology Female Humans Incidence Liver Transplantation/*adverse effects/methods/mortality *Living Donors Male Middle Aged Patient Care Team Predictive Value of Tests Retrospective Studies Risk Factors Time Factors Tomography, X-Ray Computed Treatment Outcome Ultrasonography, Doppler, Duplex Vascular Diseases/diagnosis/*etiology/mortality/therapy LA - eng N1 - 2146-8427 Kamel, Refaat Hatata, Yasser Taha, Mohamed Hosny, Karim Amin, Ayman Journal Article Turkey Exp Clin Transplant. 2015 Apr;13 Suppl 1:64-70. PY - 2015 SN - 1304-0855 SP - 64-70 ST - Major vascular complications in living-donor liver transplant recipients: single center team experience T2 - Exp Clin Transplant TI - Major vascular complications in living-donor liver transplant recipients: single center team experience VL - 13 Suppl 1 ID - 760437 ER - TY - JOUR AB - Introduction: People who experience an ST-elevation myocardial infarction (STEMI) due to an occluded coronary artery require prompt treatment. Treatments to open a blocked artery are called reperfusion therapies (RTs) and can include intravenous pharmacological thrombolysis (TL) or primary percutaneous coronary intervention (pPCI) in a cardiac catheterisation laboratory (cath lab). Optimal RT (ORT) with pPCI or TL reduces morbidity and mortality. In remote areas, a number of geographical and organisational barriers may influence access to ORT. These are not well understood and the exact proportion of patients who receive ORT and the relationship to time of day and remoteness from the cardiac cath lab is unknown. The aim of this retrospective study was to compare the characteristics of ORT delivery in central and remote locations in the north of Scotland and to identify potential barriers to optimal care with a view to service redesign. Method: The study was set in the north of Scotland. All patients who attended hospital with a STEMI between March 2014 and April 2015 were identified from national coding data. A data collection form was developed by the research team in several iterative stages. Clinical details were collected retrospectively from patients' discharge letters. Data included treatment location, date of admission, distance of patient from the cath lab, route of access to health care, left ventricular function and RT received. Distance of patients from the cath lab was described as remote if they were more than 90 minutes of driving time from the cardiac cath lab and central if they were 90 minutes or less of driving time from the regional centre. For patients who made contact in a pre-hospital setting, ORT was defined as pre-hospital TL (PHT) or pPCI. For patients who self-presented to the hospital first, ORT was defined as in-hospital TL or pPCI. Data were described as mean (standard deviation) as appropriate. Chi-squared and student's t-test were used as appropriate. Each case was reviewed to determine if ORT was received; if ORT was not received, the reasons for this were recorded to identify potentially modifiable barriers. Results: Of 627 acute myocardial infarction patients initially identified, 131 had a STEMI, and the others were non-STEMI. From this STEMI cohort, 82 (62%) patients were classed as central and 49 (38%) were remote. In terms of initial therapy, 26 (20%) received pPCI, 19 (15%) received PHTs, 52 (40%) received in-hospital TL, while 33 (25%) received no initial RT. ORT was received by 53 (65%) central and 20 (41%) remote patients; chi(2)=7.05, degrees of freedom = 130, p<0.01).Several recurring barriers were identified. Conclusion: This study has demonstrated a significant health inequality between the treatment of STEMI in remote compared to central locations. Potential barriers identified include staffing availability and training, public awareness and inter-hospital communication. This suggests that there remain significant opportunities to improve STEMI care for people living in the north of Scotland. AD - [Kamona, Ahmad; Cunningham, Scott; Addison, Brian; Rushworth, Gordon F.] Robert Gordon Univ, Sch Pharm & Life Sci, Aberdeen AB10 7GJ, Scotland. [Call, Andrew; Bloe, Charles; Leslie, Stephen James] Raigmore Hosp, Cardiac Unit, NHS Highland, Inverness IV2 3UJ, Scotland. [Innes, Alistair] Dr MacKinnon Mem Hosp, NHS Highland, Broadford IV49 9AA, Isle of Skye, Scotland. [Bond, Raymond R.] Ulster Univ, Sch Comp & Math, Coleraine BT37 0QB, Londonderry, North Ireland. [Peace, Aaron] Altnagelvin Hosp, Cardiac Unit, Glenshane Rd, Derry BT47 6SB, North Ireland. Leslie, SJ (corresponding author), Raigmore Hosp, Cardiac Unit, NHS Highland, Inverness IV2 3UJ, Scotland. stephen.leslie@nhs.net AN - WOS:000454634900008 AU - Kamona, A. AU - Cunningham, S. AU - Addison, B. AU - Rushworth, G. F. AU - Call, A. AU - Bloe, C. AU - Innes, A. AU - Bond, R. R. AU - Peace, A. AU - Leslie, S. J. C7 - 4618 DO - 10.22605/rrh4618 J2 - Rural Remote Health KW - myocardial Infarction reperfusion therapies retrospective review Scotland STEMI thrombolysis ACUTE CORONARY SYNDROMES THROMBOLYTIC THERAPY PRIMARY ANGIOPLASTY TIME REPERFUSION MANAGEMENT MORTALITY Public, Environmental & Occupational Health LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: HG0KW Times Cited: 0 Cited Reference Count: 34 Kamona, Ahmad Cunningham, Scott Addison, Brian Rushworth, Gordon F. Call, Andrew Bloe, Charles Innes, Alistair Bond, Raymond R. Peace, Aaron Leslie, Stephen James Bond, Raymond/0000-0002-1078-2232 European Union's INTERREG VA Programme The authors would like to thank the staff of the Scottish Ambulance Service and Coronary Care Unit A. Peace, R. Bond and S. Leslie are supported by the European Union's INTERREG VA Programme, managed by the Special EU Programmes Body. 0 COLL MEDICINE & DENTISTRY JAMES COOK UNIV TOWNSVILLE DOUGLAS RURAL REMOTE HEALTH PY - 2018 SN - 1445-6354 SP - 9 ST - Comparing ST-segment elevation myocardial infarction care between patients residing in central and remote locations: a retrospective case series T2 - Rural and Remote Health TI - Comparing ST-segment elevation myocardial infarction care between patients residing in central and remote locations: a retrospective case series UR - ://WOS:000454634900008 VL - 18 ID - 761610 ER - TY - JOUR AB - Objectives: An evaluation of risk factors for adverse drug events in critically ill patients has not been previously studied. The purpose of this original study was to determine risk factors for adverse drug events in critically ill adult patients. Design: This retrospective case-control study includes patients who were admitted to the intensive care unit during a 7.5-yr period. Setting: Academic medical center with 647 beds that contains approximately 120 intensive care unit beds. Patients: Patients in the case group experienced an adverse drug event as documented in the hospital's database. The control group comprised the next two patients admitted to the same intensive care unit by the same admitting service. Interventions: None. Measurements and Main Results: Twenty-nine suspected risk factors identified from the literature were evaluated, including patient characteristics, drug characteristics, and laboratory values using a multiple logistic regression. A sample of 1101 cases and controls (54% male), with a mean age of 59.4 +/- 17.5 yrs, were identified. In 367 cases, there was a total of 499 documented adverse drug events. Patients with kidney injury, thrombocytopenia, and those admitted emergently were 16-times, 3-times, and 2-times more likely to have an adverse drug event, respectively. Patients who were administered intravenous medications had a 3% higher risk of having an adverse drug event for each drug dispensed. Overall, the case group received more drugs per intensive care unit day and more drugs per intensive care unit stay. Conclusions: Several patient and drug-related characteristics contribute to the risk of adverse drug events in critically ill patients. Diligent monitoring of factors that can influence the pharmacokinetic properties for existing drug therapies is necessary. Drug regimens should be evaluated daily for minimization. Based on previous studies, pharmacists as part of the interdisciplinary team could help to manage these risks. (Crit Care Med 2012; 40:823-828) AD - [Kane-Gill, Sandra L.] Univ Pittsburgh, Sch Pharm, Dept Pharm & Clin Translat Sci, Ctr Pharmacoinformat & Outcomes Res, Pittsburgh, PA 15260 USA. Univ Pittsburgh, Med Ctr, Dept Pharm, Pittsburgh, PA USA. [Kirisci, Levent] Univ Pittsburgh, Dept Pharmaceut Sci & Psychiat, Pittsburgh, PA USA. [Verrico, Margaret M.] Univ Pittsburgh, Sch Pharm, Dept Pharm & Therapeut, Pittsburgh, PA 15261 USA. [Rothschild, Jeffrey M.] Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Gen Med, Boston, MA 02115 USA. Kane-Gill, SL (corresponding author), Univ Pittsburgh, Sch Pharm, Dept Pharm & Clin Translat Sci, Ctr Pharmacoinformat & Outcomes Res, Pittsburgh, PA 15260 USA. SLK54@pitt.edu AN - WOS:000300532800015 AU - Kane-Gill, S. L. AU - Kirisci, L. AU - Verrico, M. M. AU - Rothschild, J. M. DA - Mar DO - 10.1097/CCM.0b013e318236f473 J2 - Crit. Care Med. KW - adverse drug event reporting system critical care intensive care unit medication error risk factor safety INTENSIVE-CARE-UNIT HOSPITALIZED-PATIENTS MEDICATION ERRORS SAFETY COSTS SURVEILLANCE TECHNOLOGY Critical Care Medicine LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: 895YO Times Cited: 65 Cited Reference Count: 34 Kane-Gill, Sandra L. Kirisci, Levent Verrico, Margaret M. Rothschild, Jeffrey M. Kane-GIll, Sandra/0000-0001-7523-4846 Society of Critical Care Medicine/TAP/Joseph F. Dasta outcomes research; National Institute on Drug AbuseUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Drug Abuse (NIDA) [K02 DA017822] Supported, in part, by the Society of Critical Care Medicine/TAP/Joseph F. Dasta outcomes research grant and by grant K02 DA017822 from National Institute on Drug Abuse awarded to Dr. Levent Kirisci. 67 0 12 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CRIT CARE MED PY - 2012 SN - 0090-3493 SP - 823-828 ST - Analysis of risk factors for adverse drug events in critically ill patients T2 - Critical Care Medicine TI - Analysis of risk factors for adverse drug events in critically ill patients UR - ://WOS:000300532800015 VL - 40 ID - 761832 ER - TY - JOUR AB - BACKGROUND AND PURPOSE: Clinical outcomes in patients with acute ischemic stroke caused by large vessel occlusion depend on the speed and quality of workflows leading to mechanical thrombectomy. In the absence of universally accepted best practices for workflow, developing stroke hospitals can benefit from improved awareness of real-world workflows in effect at experienced centers. To this end, we surveyed prethrombectomy workflow practices at stroke centers throughout the United States. MATERIALS AND METHODS: E-mail and phone interviews were conducted with neurointerventional team members at 30 experienced, endovascular-capable stroke centers. Questions were chosen to reflect workflow components of triage, team activation, transport, case setup, and anesthesia. RESULTS: There is wide variation in prethrombectomy workflows. At 53% of institutions, nonphysician staff respond to stroke alerts alongside physicians. Imaging triage involves noninvasive angiography or perfusion imaging at 97% and 63% of institutions, respectively. Neurointerventional consultation is initiated before the completion of neuroimaging at 86% of institutions, and the team is activated before a final treatment decision at 59%. The neurointerventional team most commonly arrives within 30 minutes. Patients may be transported to the neuroangiography suite before team arrival at 43% of institutions. Procedural trays are set up in advance of team arrival at 13% of centers; additional thrombectomy devices are centrally stored at 54%. A power injector for angiographic runs is consistently used at 43% of institutions. Anesthesiology routinely supports thrombectomies at 67% of institutions. CONCLUSIONS: Prethrombectomy workflows vary widely between experienced centers. Improved awareness of real-world workflows and their variations may help to guide institutions in designing their own protocols of care. AD - [Kansagra, A. P.; Cross, D. T.; Moran, C. J.] Washington Univ, Sch Med, Mallinckrodt Inst Radiol, St Louis, MO USA. [Kansagra, A. P.; Cross, D. T.; Moran, C. J.] Washington Univ, Sch Med, Dept Neurosurg, St Louis, MO USA. [Kansagra, A. P.] Washington Univ, Sch Med, Dept Neurol, St Louis, MO 63110 USA. [Meyers, G. C.; Kruzich, M. S.] Barnes Jewish Hosp, St Louis, MO 63110 USA. Kansagra, AP (corresponding author), Mallinckrodt Inst Radiol, 510 South Kingshighway Blvd,Campus Box 8131, St Louis, MO 63110 USA. apkansagra@gmail.com AN - WOS:000419258900012 AU - Kansagra, A. P. AU - Meyers, G. C. AU - Kruzich, M. S. AU - Cross, D. T. AU - Moran, C. J. DA - Dec DO - 10.3174/ajnr.A5384 J2 - Am. J. Neuroradiol. KW - ACUTE ISCHEMIC-STROKE INTRAVENOUS T-PA ENDOVASCULAR TREATMENT GENERAL-ANESTHESIA IMAGING SELECTION THERAPY TIME THROMBECTOMY TRIAL REPERFUSION Clinical Neurology Neuroimaging Radiology, Nuclear Medicine & Medical Imaging LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: FR7OD Times Cited: 6 Cited Reference Count: 28 Kansagra, A. P. Meyers, G. C. Kruzich, M. S. Cross, D. T. Moran, C. J. moran, christopher/0000-0001-5559-3390 6 0 2 AMER SOC NEURORADIOLOGY DENVILLE AM J NEURORADIOL PY - 2017 SN - 0195-6108 SP - 2238-2242 ST - Wide Variability in Prethrombectomy Workflow Practices in the United States: A Multicenter Survey T2 - American Journal of Neuroradiology TI - Wide Variability in Prethrombectomy Workflow Practices in the United States: A Multicenter Survey UR - ://WOS:000419258900012 VL - 38 ID - 761620 ER - TY - JOUR AB - Objective: Shorter time from symptom onset to treatment is associated with improved outcomes in patients who undergo mechanical thrombectomy for treatment of acute ischemic stroke due to emergent large vessel occlusion. In this work, we detail pre-thrombectomy process improvements in a multi-hospital network and report the effect on door-to-puncture time in patients undergoing mechanical thrombectomy. Patients and Methods: A streamlined workflow was adopted to minimize door-to-puncture time. Key features of this workflow included rapid and concurrent clinical and radiological evaluation with point-of-care image interpretation, pre-transfer IV thrombolysis and CTA for transferred patients, immediate transport to the angiography suite potentially before neurointerventional radiology team arrival, and minimalist room setup. Door-to puncture time was measured prospectively and analyzed retrospectively for 78 consecutive patients treated between January 2015 and December 2015. Statistical analysis was performed using the F-test on individual coefficients of a linear regression model. Results: From quarter 1 to quarter 4, the number of thrombectomies performed increased by 173% (11 patients to 30 patients, p = 0.002), and there was a significant increase in the proportion of transferred patients that underwent pre-transfer CTA (p = 0.04). During this interval, overall median door-to-puncture time decreased by 74% (147 min to 39 min, p < 0.001); this decrease was greatest in transferred patients with pre-transfer CTA (81% decrease, 129 min to 25 min, p < 0.001) and smallest in patients presenting directly to the emergency department (52% decrease, 167 min to 87 min, p < 0.001). Conclusion: Simple workflow improvements to streamline in-hospital triage and perform critical workup at transferring hospitals can produce reductions in door-to-puncture time. AD - [Kansagra, Akash P.; Wallace, Adam N.; McEachern, James D.; Moran, Christopher J.; Cross, DeWitte T., III; Goyal, Manu S.] Washington Univ, Sch Med, Mallinckrodt Inst Radiol, St Louis, MO USA. [Kansagra, Akash P.; Moran, Christopher J.; Cross, DeWitte T., III] Washington Univ, Sch Med, Dept Neurosurg, St Louis, MO USA. [Kansagra, Akash P.; Curfman, David R.; Lee, Jin-Moo; Ford, Andria L.; Panagos, Peter D.] Washington Univ, Sch Med, Dept Neurol, St Louis, MO 63110 USA. [Panagos, Peter D.] Washington Univ, Sch Med, Dept Emergency Med, St Louis, MO USA. [Derdeyn, Colin P.] Univ Iowa Hosp & Clin, Dept Radiol, Iowa City, IA 52242 USA. Kansagra, AP (corresponding author), 510 South Kingshighway Blvd,Campus Box 8131, St Louis, MO 63110 USA. kansagra@wustl.edu AN - WOS:000427666000014 AU - Kansagra, A. P. AU - Wallace, A. N. AU - Curfman, D. R. AU - McEachern, J. D. AU - Moran, C. J. AU - Cross, D. T. AU - Lee, J. M. AU - Ford, A. L. AU - Goyal, M. S. AU - Panagos, P. D. AU - Derdeyn, C. P. DA - Mar DO - 10.1016/j.clineuro.2018.01.026 J2 - Clin. Neurol. Neurosurg. KW - Ischemic stroke Angiography Thrombectomy Quality Process improvement MECHANICAL THROMBECTOMY IMAGING SELECTION NEEDLE TIMES THERAPY REPERFUSION WORKFLOW ONSET PA Clinical Neurology Surgery LA - English M3 - Article N1 - ISI Document Delivery No.: FZ5WC Times Cited: 6 Cited Reference Count: 34 Kansagra, Akash P. Wallace, Adam N. Curfman, David R. McEachern, James D. Moran, Christopher J. Cross, DeWitte T., III Lee, Jin-Moo Ford, Andria L. Goyal, Manu S. Panagos, Peter D. Derdeyn, Colin P. Goyal, Manu/N-5073-2019; Lee, Jin-Moo/K-2024-2015 Panagos, Peter/0000-0003-1464-0167; Derdeyn, Colin/0000-0002-5932-2683; Lee, Jin-Moo/0000-0002-3979-0906 6 0 7 ELSEVIER SCIENCE BV AMSTERDAM CLIN NEUROL NEUROSUR PY - 2018 SN - 0303-8467 SP - 71-75 ST - Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke T2 - Clinical Neurology and Neurosurgery TI - Streamlined triage and transfer protocols improve door-to-puncture time for endovascular thrombectomy in acute ischemic stroke UR - ://WOS:000427666000014 VL - 166 ID - 761596 ER - TY - JOUR AB - Objective: Pediatric thrombosis has unique characteristics due to its epidemiology, pathophysiology and treatment considerations. Children diagnosed with thrombosis have to be evaluated by multidisciplinary team at the level of diagnosis, treatment and follow-up. Here we present our 2-year experience of pediatric thrombosis patients with a multidisciplinary thrombosis council management. Methodology: Pediatric thrombosis cases were evaluated in a monthly council of pediatric hematology-oncology, pediatric radiology and neuroradyology in addition to other pediatric subspecialities in Istanbul University, Faculty of Medicine. We retrospectively reviewed case presentations and recommendations of the council for 61 children (95 admissions) between November 2017 and August 2019. Results: Male/female ratio was 1.54 of evaluated 61 patients. Twenty-two patients we reevaluated at follow-up for treatment management or reporting outcome. Five of the patients were newborns,10 were infants, 23 were children (2 to 12 years), 22 were adolescents (12 to 18 years) and 2 were young adults (22 and 26 years, respectively) at diagnosis. All patients were re-evaluated by the radiologist at the multidisciplinary council for primary diagnosis or ongoing management. The diagnosis of the patients was mainly brain thrombosis (arterial: 36%, sinovenous: 32%), others were portal vein thrombosis (6%), renal vein thrombosis (6.5%), deep vein thrombosis (6.5%), cardiac thrombosis (5%), hepatic vein thrombosis (3%), recurrent catheter thrombosis (3%), peripheral artery thrombosis (3%) and pulmonary embolism (1.5%). Six patients were evaluated for anticoagulation prophylaxis without personal history of previous thrombosis; 5 for pre-HRT evaluation and 1 for strong family history, respectively. Concomitant diseases were infection (27%), rheumatologic disease (10%), catheterization (10%), trauma (10%), congenital heart disease (8%), kidney disease (6.5%), malignancy (5%), hemoglobinopathy (3%) and dehydration (3%). Underlying thrombophilia factors were evaluated as high Factor VIII (27%), high homocysteine (23%), Factor V Leiden mutation (16%), protein S deficiency (13%), protein C deficiency (10%), hyperlipidemia (10%), Prothrombin 20210A mutation (6.5%) and Antithrombin III deficiency(6,5%). On the basis of patients’ clinical and radiological status, treatment and prophylaxis periods were determined. Thirty-nine patients(64%) received primary or secondary prophylaxis with vitamin K antagonists, aspirin or LMVH for different periods of time. Conclusion: Cerebral arterial and sinovenous thrombosis were more common in our pediatric thrombosis council cases. It is because pediatricians face more difficulties in the treatment of cerebral thrombosis and our center is a tertiary referral center where complicated cases were referred. Acquired risk factors for thrombosis were more common than congenital ones, infection and elevated Factor VIII were commonest, respectively. AU - Karakas, Z. AU - Tuna, R. AU - Aydinli, N. AU - Sencer, S. AU - Karaman, S. AU - Tugcu, D. AU - Unuvar, A. AU - Durmaz, O. AU - Nayır, A. AU - Nisli, K. AU - Dindar, A. AU - Omeroglu, R. AU - Darendeliler, F. AU - Bayramoglu, Z. AU - Ocak, S. DB - Embase DO - 10.1016/S0145-2126(19)30262-0 KW - acetylsalicylic acid antivitamin K blood clotting factor 5 Leiden blood clotting factor 8 endogenous compound homocysteine prothrombin adolescent adult adverse device effect anticoagulation antithrombin deficiency cancer patient cancer recurrence catheter thrombosis catheterization child clinical evaluation conference abstract congenital heart disease deep vein thrombosis dehydration drug therapy family history female follow up gene mutation hematology hemoglobinopathy human hyperlipidemia infant injury intracardiac thrombosis kidney vein thrombosis liver vein thrombosis lung embolism major clinical study male malignant neoplasm occlusive cerebrovascular disease pediatrician portal vein thrombosis prophylaxis protein C deficiency protein S deficiency radiologist radiology retrospective study risk factor tertiary care center thrombophilia Turkey (republic) young adult LA - English M3 - Conference Abstract N1 - L2004021064 2019-12-03 PY - 2019 SN - 1873-5835 0145-2126 SP - S27 ST - Two-year experience of a multidisciplinary approach for pediatric thrombosis in a tertiary referral center T2 - Leukemia Research TI - Two-year experience of a multidisciplinary approach for pediatric thrombosis in a tertiary referral center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004021064&from=export http://dx.doi.org/10.1016/S0145-2126(19)30262-0 VL - 85 ID - 760670 ER - TY - JOUR AB - Importance: In patients who undergo mechanical ventilation during surgery, the ideal tidal volume is unclear. Objective: To determine whether low-tidal-volume ventilation compared with conventional ventilation during major surgery decreases postoperative pulmonary complications. Design, Setting, and Participants: Single-center, assessor-blinded, randomized clinical trial of 1236 patients older than 40 years undergoing major noncardiothoracic, nonintracranial surgery under general anesthesia lasting more than 2 hours in a tertiary hospital in Melbourne, Australia, from February 2015 to February 2019. The last date of follow-up was February 17, 2019. Interventions: Patients were randomized to receive a tidal volume of 6 mL/kg predicted body weight (n = 614; low tidal volume group) or a tidal volume of 10 mL/kg predicted body weight (n = 592; conventional tidal volume group). All patients received positive end-expiratory pressure (PEEP) at 5 cm H2O. Main Outcomes and Measures: The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, including pneumonia, bronchospasm, atelectasis, pulmonary congestion, respiratory failure, pleural effusion, pneumothorax, or unplanned requirement for postoperative invasive or noninvasive ventilation. Secondary outcomes were postoperative pulmonary complications including development of pulmonary embolism, acute respiratory distress syndrome, systemic inflammatory response syndrome, sepsis, acute kidney injury, wound infection (superficial and deep), rate of intraoperative need for vasopressor, incidence of unplanned intensive care unit admission, rate of need for rapid response team call, intensive care unit length of stay, hospital length of stay, and in-hospital mortality. Results: Among 1236 patients who were randomized, 1206 (98.9%) completed the trial (mean age, 63.5 years; 494 [40.9%] women; 681 [56.4%] undergoing abdominal surgery). The primary outcome occurred in 231 of 608 patients (38%) in the low tidal volume group compared with 232 of 590 patients (39%) in the conventional tidal volume group (difference,-1.3% [95% CI,-6.8% to 4.2%]; risk ratio, 0.97 [95% CI, 0.84-1.11]; P =.64). There were no significant differences in any of the secondary outcomes. Conclusions and Relevance: Among adult patients undergoing major surgery, intraoperative ventilation with low tidal volume compared with conventional tidal volume, with PEEP applied equally between groups, did not significantly reduce pulmonary complications within the first 7 postoperative days. AD - D. Karalapillai, Department of Anesthesia, Austin Hospital, Melbourne, VIC, Australia D. Karalapillai, Department of Intensive Care, Austin Hospital, Studley Road, Heidelberg, VIC, Australia AU - Karalapillai, D. AU - Weinberg, L. AU - Peyton, P. AU - Ellard, L. AU - Hu, R. AU - Pearce, B. AU - Tan, C. O. AU - Story, D. AU - O'Donnell, M. AU - Hamilton, P. AU - Oughton, C. AU - Galtieri, J. AU - Wilson, A. AU - Serpa Neto, A. AU - Eastwood, G. AU - Bellomo, R. AU - Jones, D. A. DB - Embase Medline DO - 10.1001/jama.2020.12866 KW - abdominal surgery acute kidney failure adult adult respiratory distress syndrome article atelectasis Australia body weight bronchospasm comparative study controlled study conventional tidal volume female follow up general anesthesia hospital admission hospital mortality human intensive care unit intraoperative period invasive ventilation length of stay low tidal volume ventilation lung congestion lung embolism major clinical study major surgery male middle aged noninvasive ventilation pleura effusion pneumonia pneumothorax positive pressure ventilation postoperative complication prediction priority journal randomized controlled trial respiratory failure sepsis single blind procedure systemic inflammatory response syndrome tertiary care center treatment outcome volume controlled ventilation wound infection LA - English M1 - 9 M3 - Article N1 - L632977675 2020-10-02 2020-10-09 PY - 2020 SN - 1538-3598 0098-7484 SP - 848-858 ST - Effect of Intraoperative Low Tidal Volume vs Conventional Tidal Volume on Postoperative Pulmonary Complications in Patients Undergoing Major Surgery: A Randomized Clinical Trial T2 - JAMA - Journal of the American Medical Association TI - Effect of Intraoperative Low Tidal Volume vs Conventional Tidal Volume on Postoperative Pulmonary Complications in Patients Undergoing Major Surgery: A Randomized Clinical Trial UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632977675&from=export http://dx.doi.org/10.1001/jama.2020.12866 VL - 324 ID - 760547 ER - TY - JOUR AB - PURPOSE OF REVIEW: Coronary artery disease is common in patients with end-stage renal disease (ESRD) on hemodialysis. ESRD patients are prone to atherosclerosis and are likely to present with advanced CAD requiring coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). RECENT FINDINGS: Individual observational studies and aggregated results comparing PCI to CABG have shown an increased risk of early postoperative mortality in the CABG group followed by a decrease in late mortality and cardiovascular events. Drug eluting stents are preferred to bare metal stents in patients undergoing PCI. Bilateral versus single internal thoracic arterial grafting strategies showed no difference in survival, freedom from cardiac death or freedom from cardiac events. There was no clear survival advantage to off-pump CABG over on-pump CABG in ESRD patients. Evidence to support either CABG or PCI was limited to retrospective observational studies that were at risk for treatment allocation bias. SUMMARY: CABG carries an upfront risk of increased perioperative mortality while demonstrating late survival benefit compared with PCI. Thus, in the context of balancing these competing risks and benefits, deciding on the most appropriate treatment in this high-risk cohort is challenging. Comprehensive patient evaluation by a multidisciplinary team is strongly recommended. AD - Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. AN - 29965800 AU - Karkhanis, R. AU - Tam, D. Y. AU - Fremes, S. E. DA - Sep DO - 10.1097/hco.0000000000000539 DP - NLM ET - 2018/07/03 J2 - Current opinion in cardiology KW - *Coronary Artery Bypass Coronary Artery Disease/complications/*surgery Humans Kidney Failure, Chronic/*complications *Percutaneous Coronary Intervention LA - eng M1 - 5 N1 - 1531-7080 Karkhanis, Reena Tam, Derrick Y Fremes, Stephen E Comparative Study Journal Article Review United States Curr Opin Cardiol. 2018 Sep;33(5):546-550. doi: 10.1097/HCO.0000000000000539. PY - 2018 SN - 0268-4705 SP - 546-550 ST - Management of patients with end-stage renal disease: coronary artery bypass graft surgery versus percutaneous coronary intervention T2 - Curr Opin Cardiol TI - Management of patients with end-stage renal disease: coronary artery bypass graft surgery versus percutaneous coronary intervention VL - 33 ID - 760256 ER - TY - JOUR AB - Purpose: To evaluate the midterm feasibility, efficacy and safety of internal iliac artery branch grafts for endovascular repair of aortoiliac, common iliac, and internal iliac artery aneurysms. Methods: Between December 2006 and September 2008, 8 patients underwent elective endovascular repair of aortoiliac, common iliac, and internal iliac artery aneurysms. Computed tomography aortography (CTA) was used to detect postoperative endoleak, stent migration, branch patency, and aneurysm sac expansion. Results: All stent grafts were correctly implanted. However, intraoperative branch occlusion occurred in 2 of 8 cases. Both occlusions have been managed conservatively, with only 1 patient suffering detrimental symptoms. One endoleak was found. Median follow up by CT was 402 days (range 77 to 718 days). No patients died. Conclusions: Midterm results are encouraging for endovascular branch grafts to include the internal iliac artery. However, patient selection is of great importance and our series illustrates the value of caution and multidisciplinary teamwork. AD - J. R. Boyle, Consultant in Vascular Surgery, Addenbrookes Hospital, Cambridge University Hospitals, Hills Road, Cambridge CB2 2QQ, United Kingdom AU - Karthikesalingam, A. AU - Parmar, J. AU - Cousins, C. AU - Hayes, P. D. AU - Varty, K. AU - Boyle, J. R. DB - Embase Medline DO - 10.1177/1538574409352692 KW - aged aneurysm aneurysm surgery aortography aortoiliac artery aneurysm article balloon dilatation blood vessel graft buttock claudication clinical article common iliac artery aneurysm computer assisted tomography conservative treatment elective surgery endoleak endovascular surgery follow up graft patency human implantation internal iliac artery internal iliac artery aneurysm outcome assessment postoperative complication stent surgical technique vascular patency LA - English M1 - 3 M3 - Article N1 - L358518844 2010-04-01 2010-05-20 PY - 2010 SN - 1538-5744 SP - 179-183 ST - Midterm results from internal iliac artery branched endovascular stent grafts T2 - Vascular and Endovascular Surgery TI - Midterm results from internal iliac artery branched endovascular stent grafts UR - https://www.embase.com/search/results?subaction=viewrecord&id=L358518844&from=export http://dx.doi.org/10.1177/1538574409352692 VL - 44 ID - 761256 ER - TY - JOUR AB - Introduction: There is a need to improve outcomes and care in the perioperative period amongst patients who are having major lower limb amputations. The aim of this audit was to determine adherence to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) recommended standards for the management of patients undergoing major lower limb amputations. Methods: 50 patients requiring major lower limb amputation in a District General Hospital were audited, with further detailed analysis possible in 19 cases where the full records were available. The age range (median) was 49 – 93 (75). 72% were male and 28% were female. The data was collected and analysed using Microsoft Excel 2013 ™. Results: Of the 50 cases audited, 20% (10) of the amputations were performed on a planned operating list and 88% (37) of patients had their operation within normal working hours. A consultant surgeon or trainee with a Certificate of Completion of Training (CCT) performed the operation in 72% (36) of these cases. On detailed review of 19 cases, 68% (13) were reviewed by a consultant within 14 hours of arrival to hospital and 47% (9) were reviewed by a Vascular Consultant within 24 hours of admission. 68% (13) had the amputation within 48 hours and 5% (1) were elective; it is unknown if a local review took place to determine why the rest, 5 cases and all urgent, were not performed within 48 hours. There was multidisciplinary team (MDT) involvement in the decision to operate in 16% (3) of cases. In 26% (5) of the cases were an MDT was not used, this was due to urgency of the operation. There is evidence of discussion with a consultant vascular surgeon in 4 of these cases. However, we were unable to determine whether these 5 cases were reviewed by a consultant Anaesthetist. Discharge planning and rehabilitation was discussed as soon as the need for amputation was identified in 21% (4) of cases. Only 1 case had a named amputation or discharge coordinator. 21% (4) of cases had physiotherapy from the first day post-amputation. A total of 19 (38%) of patients were known to have diabetes pre-operatively. On detailed review of 10 of these patients whose notes were available, the following results were obtained; 50% (5) had both pre-operative and post-operative review, and 30% (3) only had pre-operative review. 7% (7) of the patients had their insulin prescribed according to the National Patient Safety Agency (NPSA) guidelines. It was unclear whether hospital guidelines had been used to manage uncontrolled blood glucose levels in any of these cases. There was an 80% achievement for each of the following standards; nutritional state assessment within 48 hours of hospital admission, pre-operative screening for Methicillin-resistant Staphylococcus aureus (MRSA), pre- and post-operative falls assessment and risk reduction measures. We noted a 30-day post-amputation survival rate of 80%. [Formula presented] Conclusion: There are still improvements that need to be made to help improve outcomes for patients undergoing major lower limb amputation. The key areas are early consultant review, involving an extensive MDT in the decision to operate, perioperative optimisation of patients with diabetes, and proactive discharge-planning facilitated by an amputation coordinator. References 1. National Clinical Guideline Centre. 2012. Lower limb peripheral arterial disease. Diagnosis and management (full NICE guideline). Clinical guideline 147. National Institute for Health and Clinical Excellence. 2. National Clinical Guideline Centre. 2015. Diabetic foot problems: prevention and 3. Management. NICE guideline [NG19]. National Institute for Health and Clinical Excellence. 4. National Confidential Enquiry into Patient Outcome and Death (NCEPOD). 2014. Lower Limb Amputation: Working Together. London. 5. The Vascular Society of Great Britain and Ireland. 2010. Quality improvement framework for major amputation surgery. Vascular Society of Great Britain and Ireland. AD - F.K. Kashora, Vascular Surgery, Lister Hospital, Stevenage, United Kingdom AU - Kashora, F. K. AU - Mohammadi, M. AU - Metcalfe, M. AU - Kuriakose, J. AU - Selvakumar, S. AU - Guest, M. DB - Embase DO - 10.1016/j.ejvs.2019.06.1153 KW - insulin achievement adult anesthesist case report clinical article conference abstract consultation diabetic foot diabetic patient drug safety England female general hospital glucose blood level hospital admission hospital discharge human Ireland leg amputation male methicillin resistant Staphylococcus aureus multidisciplinary team nonhuman nutritional status patient safety peripheral occlusive artery disease physiotherapy practice guideline preoperative evaluation risk reduction software surgery survival rate total quality management vascular surgeon LA - English M1 - 6 M3 - Conference Abstract N1 - L2004128805 2019-12-13 PY - 2019 SN - 1532-2165 1078-5884 SP - e480-e482 ST - Major Lower Limb Amputation: A Review of Current Standards in One Vascular Centre T2 - European Journal of Vascular and Endovascular Surgery TI - Major Lower Limb Amputation: A Review of Current Standards in One Vascular Centre UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004128805&from=export http://dx.doi.org/10.1016/j.ejvs.2019.06.1153 VL - 58 ID - 760650 ER - TY - JOUR AB - The development of a pediatric cardiac support program is a complex, multidisciplinary project. This study describes the University of Iowa Congenital Heart Program's experience from its inception to the present. In, we examine those specific factors that have led to substantial improvements in the program, additionally identifying where further gains can be made. We retrospectively reviewed all pediatric patients who received mechanical cardiac support at the University of Iowa from the inception of the program in 1991. In total, 29 patients received mechanical support between December 1991 and December 2015 and are included in the study. Twelve patients received continuous flow devices and 17 patients received pulsatile flow devices. Median age at implant was 12.8 years (range 0.1-18.2 years). Median weight at implant was 40.5 kg (3.2-123.4 kg). Factors examined included: operating room (OR) time, intensive care unit and hospital length of stay, intubation days, blood product usage, pre- and post-operative bilirubin, creatinine, natriuretic peptide B (NPPB), and device implanted. Categorical and continuous variables were compared using Chi-squared and Wilcoxon rank-sum tests, respectively. Of the 29 patients who received mechanical support, 17 (58.6%) were discharged home, 11 (37.9%) died during their hospitalization, and 1 (3.5%) remains hospitalized. Median length of ventricular assist device support was 59.5 days (range 1-653 days). Between December 1991 and December 2011, in-hospital mortality was 64.3%. Following this period, significant changes were made to patient management with in-hospital mortality decreasing to 13.3% between February 2013 and December 2015. Comparison between deceased and living patients revealed several significant factors including: median number of packed red blood cells transfused, 8 versus 4 units (P=0.048), median OR time, 396 versus 299 min (P=0.003), and device implanted. During the early stages of the mechanical support program, higher than expected mortality rates prompted changes in the management of pediatric cardiac patients, specifically, the development of a dedicated management team. These changes significantly improved outcomes and we suggest can be used as a model for similar cardiac support programs, especially in smaller volume programs. AD - [Kashyap, Abhishek; Turek, Joseph W.; Wagner, Samantha J.; Felderman, Laura; Jaggers, Elizabeth A.; Gruber, Peter J.] Univ Iowa Hosp & Clin, Dept Surg, Iowa City, IA 52242 USA. [Wagner, Samantha J.; Edens, R. Erik] Univ Iowa, Carver Coll Med, Stead Family Dept Pediat, Iowa City, IA USA. [Gruber, Peter J.] Univ Southern Calif, Dept Surg, 1450 Biggy St,4517 NRT, Los Angeles, CA 90033 USA. [Gruber, Peter J.] Univ Southern Calif, Dept Stem Cell Biol, 1450 Biggy St,4517 NRT, Los Angeles, CA 90033 USA. [Gruber, Peter J.] Univ Southern Calif, Dept Regenerat Med, 1450 Biggy St,4517 NRT, Los Angeles, CA 90033 USA. Gruber, PJ (corresponding author), Univ Southern Calif, Dept Surg, 1450 Biggy St,4517 NRT, Los Angeles, CA 90033 USA.; Gruber, PJ (corresponding author), Univ Southern Calif, Dept Stem Cell Biol, 1450 Biggy St,4517 NRT, Los Angeles, CA 90033 USA.; Gruber, PJ (corresponding author), Univ Southern Calif, Dept Regenerat Med, 1450 Biggy St,4517 NRT, Los Angeles, CA 90033 USA. peter.gruber@med.usc.edu AN - WOS:000430277400011 AU - Kashyap, A. AU - Turek, J. W. AU - Wagner, S. J. AU - Felderman, L. AU - Jaggers, E. A. AU - Gruber, P. J. AU - Edens, R. E. DA - Apr DO - 10.1111/aor.12963 J2 - Artif. Organs KW - Pediatric heart failure Ventricular assist devices Extracorporeal membrane oxygenator Heart transplantation Congenital Mechanical circulatory support Heart-assist devices VENTRICULAR ASSIST DEVICES CARE-UNIT STAY HEART-TRANSPLANTATION CIRCULATORY SUPPORT CHILDREN OUTCOMES BRIDGE PREDICTORS THROMBOSIS MORBIDITY Engineering, Biomedical Transplantation LA - English M1 - 4 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: GD1QW Times Cited: 1 Cited Reference Count: 24 Kashyap, Abhishek Turek, Joseph W. Wagner, Samantha J. Felderman, Laura Jaggers, Elizabeth A. Gruber, Peter J. Edens, R. Erik 13th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion SEP 28-30, 2017 Rome, ITALY Turek, Joseph/0000-0002-4006-7555; Gruber, Peter/0000-0002-7356-905X 1 0 WILEY HOBOKEN ARTIF ORGANS SI PY - 2018 SN - 0160-564X SP - 444-451 ST - Development of a Pediatric Cardiac Mechanical Support Program T2 - Artificial Organs TI - Development of a Pediatric Cardiac Mechanical Support Program UR - ://WOS:000430277400011 VL - 42 ID - 761595 ER - TY - JOUR AB - Background: Pulmonary Embolism Severity Index (PESI) score is a validated tool that predicts short and long-term outcomes. Recently, there has been an increasing interest in the development of institution specific, multi-disciplinary pulmonary embolism response teams (PERT). We report the impact of activating our PERT on outcomes in PE patients across various PESI classes. Methods: A multi-specialty approach to all acute PE patients was implemented in Feb 2016 at our institution. Retrospective analysis was performed to evaluate the process over a period of 11 months (Feb-Dec 2016). Results: 191 acute PEs were diagnosed in the hospital (n=248; 47 transfers from other facilities). PERT was activated for 60% (n=115/191) patients. Comparison between the baseline demographics, PESI class, length of stay for PERT activated (PERT-A) versus PERT not activated (PERT-N) is showed in Table (1). LOS for PERT-A/PERT-N group was 4.23/8.13, 4.96/9.33, 6.56/10.38, 5.74/10.47, 11.67/12.61 for PESI Class I-V, respectively. Regression showed that both PERT activation and PESI score contribute to a model of LOS (p<0.05): LOS = 4.7 + 0.052 PESI score-3.24 PERT accounting for 4% of LOS. Both groups had >90% use of anticoagulation and no difference in survival. [Table Presented] Conclusion: Our results demonstrate that PERT resulted in a lower LOS across different PESI groups, even with limited utilization of the algorithm. For 2017, we are focusing on effective utilization of evidence based interventions to manage these complex patients. AD - K. Kassar, Allegheny General Hospital, Pittsburgh, PA, United States AU - Kassar, K. AU - Veer, M. AU - Doyle, M. AU - Patel, A. AU - Bihler, E. AU - Benza, R. AU - Kanwar, M. DB - Embase DO - 10.1016/S0735-1097(18)32484-7 KW - adult anticoagulation conference abstract diagnosis female human length of stay lung embolism major clinical study male retrospective study LA - English M1 - 11 M3 - Conference Abstract N1 - L621786491 2018-04-27 PY - 2018 SN - 1558-3597 ST - Implementation and outcomes of a pulmonary embolism response team: A single center experience T2 - Journal of the American College of Cardiology TI - Implementation and outcomes of a pulmonary embolism response team: A single center experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621786491&from=export http://dx.doi.org/10.1016/S0735-1097(18)32484-7 VL - 71 ID - 760846 ER - TY - JOUR AB - Introduction: Pulmonary Embolism Severity Index (PESI) score is a validated tool which predicts short and long-term outcomes but does not include a targeted therapy approach. Recently, there has been an increasing interest in the development of institution specific, multi-disciplinary pulmonary embolism response teams (PERT) to improve outcomes and reduce morbidity and mortality of PE. We report the impact of activating our PERT team on outcomes in PE patients across various PESI classes. Methods: A multi-specialty approach to all acute PE patients was implemented in Feb 2016 at our institution (Figure 1). Retrospective analysis was done to evaluate the process, diagnostic procedures, therapy and outcomes for patients diagnosed with acute PE over a period of 11 months (February - December 2016). Results: 191 acute PEs were diagnosed in the hospital (n=248; 47 transfers from other facilities). PERT was activated for 60% (n=115/191) patients. Comparison between the baseline demographics and PESI class for PERT activated (PERT-A) versus PERT not activated (PERT-N) is presented in Table 1. Length of stay (LOS) was found to be lower in each PESI class for PERT-A vs PERT-N group (Figure 2). Regression showed that both PERT activation and PESI score contribute to a model of LOS (p<0.05): LOS = 4.7 + 0.052 PESI score - 3.24 PERT accounting for 4% of LOS. Conclusion: PERT activation is associated with shorter in-Hospital length of stay across different PESI Classes. AU - Kassar, K. AU - Veer, M. AU - Doyle, M. AU - Patel, A. AU - Bihler, E. AU - Benza, R. AU - Kanwar, M. DB - Embase DO - 10.1016/j.cardfail.2019.07.413 KW - adult conference abstract controlled study female human length of stay major clinical study male pulmonary embolism response team retrospective study LA - English M1 - 8 M3 - Conference Abstract N1 - L2002536079 2019-08-13 PY - 2019 SN - 1532-8414 1071-9164 SP - S143 ST - Implementation and Outcomes of a Pulmonary Embolism Response Team: A Single Center Experience T2 - Journal of Cardiac Failure TI - Implementation and Outcomes of a Pulmonary Embolism Response Team: A Single Center Experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002536079&from=export http://dx.doi.org/10.1016/j.cardfail.2019.07.413 VL - 25 ID - 760682 ER - TY - JOUR AB - Introduction: Scimitar syndrome is described as an abnormal connection between one pulmonary vein and the right atrium or vena cava. Case presentation: 40 year old female presented with respiratory failure and septic shock that was unresponsive to pressors and IV fluids. Transthoracic echocardiogram showed severely dilated right ventricle with severe tricuspid regurgitation. Chest computed tomography angiogram (CTA) was negative for pulmonary embolism but showed right upper pulmonary vein connecting to inferior vena cava consistent with Scimitar anomaly. (Figure 1) Invasive hemodynamic evaluation showed mixed venous saturation (SvO2) 14%, cardiac index (CI) 1.89 L/min/m2, systemic vascular resistance (SVR) 754 dynes, severely elevated filling pressures, and pulmonary artery pressure (PAP) 77/44 (57) mmHg. Dialysis, dobutamine and inhaled nitroglycerin (iNO) were added to pressors for RV support. Follow up hemodynamic profile showed SvO2 75%, CI 4.9 L/min/m2, improved filling pressures, SVR 473 dynes, PAP 79/37 (48) mmHg. However, liver/kidney function and lactic acid continued to worsen indicating inadequate organ perfusion. Inaccurate SvO2 and subsequent CI and SVR calculation in the setting of L to R shunt through the anomalous vein was suspected. Subsequently, the decision was made to titrate hemodynamic support using MAP>70 accepting the presence of shunt, after which lactic acid and liver/kidney function started improving. Unfortunately, the patient suffered hypoxemic cardiac arrest. The rate of iNO was decreased as it was thought to increase V/Q mismatch despite its hemodynamic benefit to RV. Initiation of extracorporeal membrane oxygenation was difficult because of severe vasospasm. Vegetative state was noted and care was withdrawn per family request. Discussion: The patient's hemodynamic profile was consistent with cardiogenic shock secondary to acute RV failure caused by initial IV fluid administration. RV support in the setting of pulmonary hypertension was achieved with dialysis, dobutamine and iNO. Improving hemodynamic parameters obtained by pulmonary catheter didn't correlate with worsening laboratory perfusion parameters. The availability of chest CTA showing an unexpected pulmonary venous anomaly helped our multidisciplinary team explain the inaccuracy of hemodynamic parameters. AU - Kassar, K. AU - Williams, R. AU - Manik, V. AU - Alpert, C. AU - Bajwa, O. AU - Azam, H. DB - Embase DO - 10.1016/j.cardfail.2019.07.155 KW - dobutamine glyceryl trinitrate lactic acid adult calculation cardiac index cardiogenic shock case report catheter clinical article computer assisted tomography conference abstract dialysis drug therapy drug withdrawal extracorporeal oxygenation female follow up heart arrest heart right ventricle human inferior cava vein intravenous drug administration kidney function liver function lung artery pressure lung embolism male multidisciplinary team perfusion persistent vegetative state pulmonary hypertension pulmonary vein malformation respiratory failure scimitar syndrome septic shock systemic vascular resistance thorax transthoracic echocardiography treatment failure tricuspid valve regurgitation vasospasm LA - English M1 - 8 M3 - Conference Abstract N1 - L2002535847 2019-08-13 PY - 2019 SN - 1532-8414 1071-9164 SP - S55 ST - A Stab in the Heart: Scimitar Pulmonary Venous Anomaly Complicating a Case of Cardiogenic Shock T2 - Journal of Cardiac Failure TI - A Stab in the Heart: Scimitar Pulmonary Venous Anomaly Complicating a Case of Cardiogenic Shock UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002535847&from=export http://dx.doi.org/10.1016/j.cardfail.2019.07.155 VL - 25 ID - 760681 ER - TY - JOUR AB - Stroke occurs acutely, is time-sensitive and requires well-organized services, a chain of recovery. It includes emergency call centre, stroke triage, emergency medical services, emergency room (ER), stroke unit (SU), rehabilitation hospital, and community health care. The chain is only as strong as its weakest link. Emergency call centre identifies a potential stroke patient and dispatches an ambulance staffed by trained personnel. After verifying the stroke symptoms and ensuring the patient's vital functions, the paramedics give a pre-hospital notification call to the receptive ER of the nearest hospital with appropriate resources for acute stroke management and transport the patient quickly. Acute stroke management requires parallel processes including further stabilisation of vital functions, diagnostic work-up, treatment of acute life-threatening conditions, concomitant diseases and severe abnormalities of basic physiological functions, and specific treatments including thrombolysis when appropriate. All patients with suspected stroke require immediate brain imaging. Thrombolysis with alteplase is safe and effective for selected patients with acute ischaemic stroke up to 4.5 h while SU care suits all stroke patients and improves their outcome, and the benefits of SU care are long-lasting. Acute SU care includes also secondary prevention based on the etiologic work-up and the patient's risk factors. Early rehabilitation by a multidisciplinary team is also launched at SU and continues when needed in rehabilitation hospitals or rehabilitation outpatient clinics, and later in community health services. A survey of the EUSI revealed that in Europe only 1/7 acute stroke patients are treated in SUs. This is a challenge worth undertaking. AD - M. Kaste, Department of Neurology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland AU - Kaste, M. DB - Embase DO - 10.1111/j.1747-4949.2010.00480.x KW - alteplase cerebrovascular accident stroke unit patient hospital rehabilitation stroke patient emergency health service emergency blood clot lysis community care secondary prevention risk factor personnel emergency ward diagnosis physiology outpatient department Europe brain imaging brain ischemia ambulance LA - English M3 - Conference Abstract N1 - L70334765 2011-02-04 PY - 2010 SN - 1747-4930 SP - 1 ST - How to organize acute stroke unit care T2 - International Journal of Stroke TI - How to organize acute stroke unit care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70334765&from=export http://dx.doi.org/10.1111/j.1747-4949.2010.00480.x VL - 5 ID - 761246 ER - TY - JOUR AB - Background: Patient engagement (PE) has been broadly defined as the process of actively involving and supporting patients in health care and treatment decision making activities. More engaged patients are more likely to adhere to healthier behaviors and to show improved clinical outcomes. We hypothesize that patients seen at VA primary care clinics with better team structure and organization and a more conducive environment for improving quality and safety will be more likely to use PE care practices. Methods: We performed a cross-sectional analysis of data from the 2016 Patient-Aligned Care Team (PACT) national survey, which included 4,125 direct care providers (PCPs, RN, clinical associates) in VA primary care clinics. Conceptually related PE items on the PACT survey were grouped into 3 composite variables: Patient planning and goal setting (PLAN, 5 items), motivational interviewing (MI, 2 items), and organizational strategies to promote self-management (ORG, 6 items). We used exploratory factor analysis to examine factor structure and confirmatory factor analysis to determine model fit (RMSEA=0.73, CFI=0.93). We used generalized estimating equations (GEE) with multivariable logistic regression to identify independent correlates of high performance on each PE care practice (defined as top 25th percentile). Data from the corporate data warehouse (CDW) and the Survey of Healthcare Experiences of Patients (SHEP) in 2016 were used to adjust for patient sociodemographic characteristics, medical comorbidity score, and self-reported health status (all covariates were aggregated to the clinic level). For survey respondents, PACT role and years of total experience in PACT, type of clinic (community-based vs. medical center-based), and average panel size for clinic providers (adjusted for FTE) were included in all models. Results: Estimated response rate on the PACT survey was 25%. Mean (sd) across clinics for the three PE composite scores were: PLAN 3.1 (1.1) on a 5-point scale, MI 0.9 (0.7) on a 2-point scale, and ORG 2.6 (1.0) on a 6-point scale. For PLAN, respondents at top performing clinics were more likely to report having fully staffed PACT teams: OR=2.8 (95% CI 1.8, 4.2), written role descriptions for each team member: OR=4.7 (3.1, 7), leadership structure responsible for implementing and maintaining PACT: OR=7.2 (4.3, 12), regular team meetings to discuss performance improvement: OR=6.9 (4.5, 11), working to the top of their competency: OR=10.2 for top category (4.3, 24), and less likely to report burnout: OR 0.5 for lowest category (0.3, 0.8). Results were similar for MI and ORG. No consistent association was observed for psychological safety at top versus bottom performing clinics. Conclusions: High performance of PE care practices is associated with other desirable structural and organizational attributes with regard to the VA primary care workplace. Strategies to improve the functioning of primary care teams in VA may enhance patient engagement in care. AD - D.A. Katz, University of Iowa, Iowa City, IA, United States AU - Katz, D. A. AU - Wu, C. AU - Mohr, D. AU - Stewart, G. DB - Embase KW - endogenous compound adult burnout case report clinical article comorbidity conference abstract confirmatory factor analysis cross-sectional study data warehouse drug safety exploratory factor analysis female health status human leadership male motivational interviewing primary medical care self care workplace LA - English M1 - 2 M3 - Conference Abstract N1 - L622329405 2018-05-31 PY - 2018 SN - 1525-1497 SP - 134-135 ST - Care practices to promote patient engagement in VA primary care: Medical home characteristics associated with high performance T2 - Journal of General Internal Medicine TI - Care practices to promote patient engagement in VA primary care: Medical home characteristics associated with high performance UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622329405&from=export VL - 33 ID - 760867 ER - TY - JOUR AB - Aims: In this single-centre study, we aimed to evaluate the short- and long-term efficacy and safety outcomes of ultrasound-assisted thrombolysis (USAT) performed in patients with acute pulmonary embolism (PE) at intermediate to high risk and high risk (IHR, HR). Methods and results: The study group comprised 141 retrospectively evaluated patients with PE who underwent USAT. Tissue-type plasminogen activator (t-PA) dosage was 36.1 +/- 15.3 mg, and infusion duration was 24.5 +/- 8.1 hours. USAT was associated with improvements in echocardiographic measures of right ventricle systolic function, pulmonary arterial (PA) obstruction score, right to left ventricle diameter ratio (RV/LV), right to left atrial diameter ratio and PA pressures, irrespective of the risk (p<0.0001 for all). In-hospital mortality, major and minor bleeding rates were 5.7%, 7.8% and 11.3%, respectively. Follow-up data (median 752 days) were available in all patients. Absolute and % changes in RV/LV and % changes in PA mean pressure were significantly higher in patients younger than 65 years compared with older patients, whereas bleeding, 30-day and long-term mortality were not related to age, t-PA dosage or infusion duration. HR versus IHR increased 30-day mortality. Conclusions: USAT was associated with improvements in thrombolysis and stabilisation of haemodynamics along with relatively low rates of complications in patients with PE, regardless of the risk status. However, HR still confers a higher short-term mortality. Increasing the t-PA dosage and prolongation of infusion may not offer benefit in USAT treatments. AD - [Kaymaz, Cihangir; Akbal, Ozgur Yasar; Hakgor, Aykun; Tokgoz, H. Ceren; Karagoz, Ali; Tanyeri, Seda; Keskin, Berhan; Turkday, Sevim; Demir, Durmus; Dogan, Cem; Bayram, Zubeyde; Acar, Rezzan Deniz; Guvendi, Busra; Ozdemir, Nihal] Univ Hlth Sci, Kosuyolu Heart Educ & Res Hosp, Dept Cardiol, Istanbul, Turkey. [Tanboga, Ibrahim Halil] Hisar Intercontinental Hosp, Dept Cardiol, Istanbul, Turkey. [Tanboga, Ibrahim Halil] Ataturk Univ, Dept Biostat, Erzurum, Turkey. [Tapson, Victor F.] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Konstantinides, Stavros] Democritus Univ, Med Sch, Dept Cardiol, Thrace, Greece. [Konstantinides, Stavros] Johannes Gutenberg Univ Mainz, Univ Med Ctr Mainz, Ctr Thrombosis & Haemostasis, Mainz, Germany. Kaymaz, C (corresponding author), Kosuyolu Yuksek Ihtisas Egitim & Arastirma Hastan, Denizer Caddesi Cevizli Kavsagi 2, TR-34865 Istanbul, Turkey. cihangirkaymaz2002@yahoo.com AN - WOS:000452496900014 AU - Kaymaz, C. AU - Akbal, O. Y. AU - Hakgor, A. AU - Tokgoz, H. C. AU - Karagoz, A. AU - Tanboga, I. H. AU - Tanyeri, S. AU - Keskin, B. AU - Turkday, S. AU - Demir, D. AU - Dogan, C. AU - Bayram, Z. AU - Acar, R. D. AU - Guvendi, B. AU - Ozdemir, N. AU - Tapson, V. F. AU - Konstantinides, S. DA - Nov DO - 10.4244/eij-d-18-00371 J2 - EuroIntervention KW - femoral miscellaneous multidisciplinary heart team pulmonary embolism thrombus-containing lesion ACCELERATED THROMBOLYSIS VENOUS THROMBOEMBOLISM THERAPY TRIAL FRAGMENTATION FIBRINOLYSIS OBSTRUCTION EMBOLECTOMY MANAGEMENT PRESSURE Cardiac & Cardiovascular Systems LA - English M1 - 10 M3 - Article N1 - ISI Document Delivery No.: HD4KS Times Cited: 6 Cited Reference Count: 36 Kaymaz, Cihangir Akbal, Ozgur Yasar Hakgor, Aykun Tokgoz, H. Ceren Karagoz, Ali Tanboga, Ibrahim Halil Tanyeri, Seda Keskin, Berhan Turkday, Sevim Demir, Durmus Dogan, Cem Bayram, Zubeyde Acar, Rezzan Deniz Guvendi, Busra Ozdemir, Nihal Tapson, Victor F. Konstantinides, Stavros karagoz, ali/Q-6665-2019 Konstantinides, Stavros/0000-0001-6359-7279 6 0 1 EUROPA EDITION TOULOUSE CEDEX 6 EUROINTERVENTION PY - 2018 SN - 1774-024X SP - 1136-1143 ST - A five-year, single-centre experience on ultrasound-assisted, catheter-directed thrombolysis in patients with pulmonary embolism at high risk and intermediate to high risk T2 - Eurointervention TI - A five-year, single-centre experience on ultrasound-assisted, catheter-directed thrombolysis in patients with pulmonary embolism at high risk and intermediate to high risk UR - ://WOS:000452496900014 VL - 14 ID - 761560 ER - TY - JOUR AB - OBJECTIVE: Acute limb ischemia (ALI) in pediatric patients is rare but may lead to limb loss and life-long complications. This study reviewed the experience of a Canadian tertiary pediatric center with the medical and operative management of ALI. METHODS: The medical records of inpatients diagnosed with ALI of the upper or lower limb between 1999 and 2012 were reviewed. Patient demographics, arterial clot site and etiology, intervention, anticoagulation type and duration, and short-term and long-term complications were analyzed. RESULTS: A total of 151 patients (45% female) presented with signs of limb ischemia, of whom 38% were aged <30 days, 46% were between 1 and 12 months, and 16% were between 1 and 18 years. Ninety-four percent of those injuries involved the lower limbs. Ninety-one percent were due to vessel catheterization, 5% were idiopathic, 1% were congenital, and 4% traumatic. Ninety-four percent were managed nonoperatively. Patients were treated with a combination of thrombolysis, unfractionated or low-molecular-weight heparin, aspirin or warfarin, or both (duration, 1 day-13 years). All patients were monitored after discharge at our institution or at their referring hospital (average, 3.4 ± 2.8 years). Fifteen percent had complications related to ALI or anticoagulation (most commonly limb length or thigh circumference discrepancy, or intracranial hemorrhage). Nineteen percent of patients died of unrelated causes (sepsis, multiorgan dysfunction, or cardiac failure). CONCLUSIONS: In contrast with adults, ALI in children can generally be managed nonoperatively with anticoagulation, likely because of their greater ability to develop arterial collaterals. Long-term follow-up by a multidisciplinary team of pediatric and surgical specialists and allied health professionals is integral to achieving a successful outcome in children with ALI. AD - Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Division of Vascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: barry.rubin@uhn.on.ca. AN - 24657296 AU - Kayssi, A. AU - Shaikh, F. AU - Roche-Nagle, G. AU - Brandao, L. R. AU - Williams, S. A. AU - Rubin, B. B. DA - Jul DO - 10.1016/j.jvs.2014.01.051 DP - NLM ET - 2014/03/25 J2 - Journal of vascular surgery KW - Acute Disease Adolescent Anticoagulants/adverse effects/*therapeutic use Aspirin/therapeutic use Canada Catheterization, Peripheral/adverse effects Child Child, Preschool Female Fibrinolytic Agents/*therapeutic use Heparin, Low-Molecular-Weight/therapeutic use Hospitals, Pediatric Humans Infant Intracranial Hemorrhages/chemically induced Ischemia/complications/*therapy Lower Extremity/*blood supply/injuries Male Organ Size Retrospective Studies Tertiary Care Centers Upper Extremity/*blood supply/injuries Warfarin/therapeutic use LA - eng M1 - 1 N1 - 1097-6809 Kayssi, Ahmed Shaikh, Furqan Roche-Nagle, Graham Brandao, Leonardo R Williams, Suzan A Rubin, Barry B Journal Article United States J Vasc Surg. 2014 Jul;60(1):106-10. doi: 10.1016/j.jvs.2014.01.051. Epub 2014 Mar 20. PY - 2014 SN - 0741-5214 SP - 106-10 ST - Management of acute limb ischemia in the pediatric population T2 - J Vasc Surg TI - Management of acute limb ischemia in the pediatric population VL - 60 ID - 760456 ER - TY - JOUR AB - Objectives: Acute limb ischemia (ALI) in pediatric patients is rare but may lead to limb loss and life-long complications. The aim of this study was to review the experience of a Canadian tertiary pediatric center with the medical and operative management of ALI. Methods: The charts of in-patients diagnosed with acute upper or lower limb ischemia between 1999-2012 were reviewed. Patient demographics, arterial clot site and etiology, intervention, anticoagulation type and duration, and short and long-term complications were analyzed. Results: 136 patients presented with signs of limb ischemia (46% female, 34% younger than 30 days, 51% between 1-12 months, and 15% between 1-18 years). 95% involved the lower limbs. 85% of arterial clots were totally occlusive. 92% were due to vessel catheterization, 5% were idiopathic, and 2% were due to hereditary hypercoagulable states. 96% were managed nonoperatively. Patients were treated with a combination of thrombolysis, unfractionated or low molecular-weight heparin, aspirin and/or warfarin (duration, 1 day-13 years). All patients were followed postdischarge at our institution or at their referring hospital (average, 3.5 years). 13% had complications related toALI or anticoagulation (limb length or thigh circumference discrepancy, or intracranial hemorrhage). 25 patients died of unrelated causes (sepsis, multi-organ dysfunction, or cardiac failure). Conclusions: In contrast with adults, ALI in children can generally be managed nonoperatively with anticoagulation, likely because of their greater ability to develop arterial collaterals. Long-term follow-up by a multidisciplinary team of pediatric and surgical specialists and allied health professionals is integral to achieving a successful outcome. AD - A. Kayssi, Division of Vascular Surgery, University Health Network, University of Toronto, Toronto, ON, Canada AU - Kayssi, A. AU - Shaikh, F. AU - Roche-Nagle, G. AU - Rubin, B. AU - Brandao, L. R. AU - Williams, S. A. DB - Embase DO - 10.1016/j.jvs.2013.02.151 KW - acetylsalicylic acid warfarin low molecular weight heparin population society vascular surgery limb ischemia human patient anticoagulation limb leg etiology hospital thigh circumference leg ischemia follow up heart failure blood clot lysis sepsis brain hemorrhage catheterization adult child pediatric hospital medical specialist health practitioner female LA - English M1 - 5 M3 - Conference Abstract N1 - L71055763 2013-05-13 PY - 2013 SN - 0741-5214 SP - 34S ST - Management of acute limb ischemia in the pediatric population T2 - Journal of Vascular Surgery TI - Management of acute limb ischemia in the pediatric population UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71055763&from=export http://dx.doi.org/10.1016/j.jvs.2013.02.151 VL - 57 ID - 761169 ER - TY - JOUR AB - Background: Over the past several decades, laparoscopic Roux-en-Y gastric bypass and vertical sleeve gastrectomy offer excellent surgical options in the management of obesity as well as diabetes mellitus type 2. As the popularity of these procedures increase, it becomes necessary to determine the risk-benefit when selecting patients for these surgeries. The purpose of this study is to analyze the effect of elevated pre-operative HbA1c within the patient population undergoing these procedures and how it affects post-operative success, recovery, and complications. Methods: This is a retrospective cohort study with patients recruited from the Loma Linda University Healthcare Bariatric Surgery database. Data was collected from patients that received either the gastric sleeve or bypass procedure from July 2012 to July 2015. Inclusion criteria are patients above the age of 18 who underwent laparoscopic vertical sleeve gastrectomy or laparo-scopic Roux-en-Y gastric bypass. Patients were excluded if younger than 18 years, lost to follow-up within 30 days after surgery, or did not have any recorded HbA1c values within 6 months prior to surgery. Patients were separated into 3 groups determined by their HbA1c level, either below 6.5 mg/dL (Group A), between 6.5-8.0 mg/dL (Group B), and above 8.0 mg/dL (Group C). Follow-up was continued on all groups for a minimum of 1 year. The 3 groups were then analyzed using the Chi-Square method for complication rates, operative success, and postoperative HbA1c changes. Complications were graded as either early (within 30 days) or late (after 30 days), as well as major or minor. Major complications were assessed as reoperation, wound infection, leak, venous thrombosis, or death. All other complications were deemed minor. Results: A total of 192 pts were collected, 138 in Group A, 33 in Group B, and 21 in Group C. Group A demonstrated a 22/138 (15.9%) complication rate, Group B had 6/33 (18.2%), and Group C had 3/21 (14.3%). The overall complication rate from the procedures was 31/192 (18.2%). 10 (5.2%) of the complications were major complications, including 6 wound infections, 1 DVT, 1 leak, and 2 anastomotic strictures, there were no deaths. 21 (10.9%) of the complications were minor, including dehydration, nausea, emesis, and diarrhea. 21 of the complications were early, and 14 were late. The chi-square statistic for the study is 0.2216, with a p-value of 0.895106. This shows no significance in the results between the groups. Conclusion: Our study showed no significant difference in morbidity outcomes major or minor in patients with poorly controlled diabetes versus patients with either well controlled diabetes or none at all. This indicates that patients with HbA1c 4 8.0 mg/dL can safely undergo these surgical procedures without any increased risk in morbidity or mortality. The lack of significance indicates that weight loss surgery should not be unnecessarily delayed for patients with poorly controlled diabetes, as the long term efficacy of the surgery has proven benefits. The study can be strengthened by factoring in long term efficacy of weight loss surgery and its effect on diabetes management. Limitations of this study include short duration of follow-up (1 year), small sample size, as well as its retrospective nature. Patients with poorly controlled diabetes with a multidisciplinary team approach including endocrinologists can safely and effec-tively undergo bariatric surgery. AD - A. Kazi, Loma Linda University Health, Loma Linda, CA, United States AU - Kazi, A. AU - Scharf, K. AU - Michelotti, M. AU - Wu, E. AU - Srikureja, D. AU - Garberoglio, R. AU - Keeth, S. AU - Luo-Owen, X. DB - Embase KW - hemoglobin A1c adult cohort analysis complication controlled study death dehydration diabetes mellitus diarrhea endocrinologist female follow up gastric sleeve human major clinical study male morbidity mortality nausea remission reoperation retrospective study Roux-en-Y gastric bypass sample size sleeve gastrectomy statistical significance stenosis surgery vein thrombosis vomiting body weight loss wound infection young adult LA - English M1 - 7 M3 - Conference Abstract N1 - L619777713 2017-12-21 PY - 2016 SN - 1878-7533 SP - S69 ST - Morbidity and mortality of gastric sleeve and bypass patients with elevated hba1c levels T2 - Surgery for Obesity and Related Diseases TI - Morbidity and mortality of gastric sleeve and bypass patients with elevated hba1c levels UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619777713&from=export VL - 12 ID - 761010 ER - TY - JOUR AB - PMID:30652953 AU - Kelly, Bryan A. DA - 2019/02/07 02/07 DB - PubMed Central DO - 10.1177/2045894019829071 M1 - 1 PY - 2019 SN - 2045-8932 ST - Multidisciplinary pulmonary embolism care: an exciting time to join the team T2 - Pulmonary Circulation TI - Multidisciplinary pulmonary embolism care: an exciting time to join the team UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6378440&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6378440 VL - 9 ID - 761985 ER - TY - JOUR AB - BACKGROUND: Rapid reperfusion in patients with ST-elevation myocardial infarction (STEMI) is associated with lower mortality. Reduction in door-to-balloon (D2B) time for percutaneous coronary intervention requires multidisciplinary cooperation, process analysis, and quality improvement methodology. METHODS: Six Sigma methodology was used to reduce D2B times in STEMI patients presenting to a tertiary care center. Specific steps in STEMI care were determined, time goals were established, and processes were changed to reduce each step's duration. Outcomes were tracked, and timely feedback was given to providers. RESULTS: After process analysis and implementation of improvements, mean D2B times decreased from 128 to 90 minutes. Improvement has been sustained; as of June 2010, the mean D2B was 56 minutes, with 100% of patients meeting the 90-minute window for the year. CONCLUSION: Six Sigma methodology and immediate provider feedback result in significant reductions in D2B times. The lessons learned may be extrapolated to other primary percutaneous coronary intervention centers. AD - Department of Emergency Medicine, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA. ekelly@wfubmc.edu AN - 21130919 AU - Kelly, E. W. AU - Kelly, J. D. AU - Hiestand, B. AU - Wells-Kiser, K. AU - Starling, S. AU - Hoekstra, J. W. DA - Nov-Dec DO - 10.1016/j.pcad.2010.08.002 DP - NLM ET - 2010/12/07 J2 - Progress in cardiovascular diseases KW - *Academic Medical Centers *Angioplasty, Balloon, Coronary Critical Pathways/*organization & administration Delivery of Health Care, Integrated/*organization & administration Health Services Accessibility/*organization & administration Humans Myocardial Infarction/mortality/*therapy North Carolina Organizational Innovation Outcome and Process Assessment, Health Care/*organization & administration Patient Care Team/organization & administration Practice Guidelines as Topic Program Development Program Evaluation Quality of Health Care/organization & administration Regional Health Planning/organization & administration Time Factors Transportation of Patients/*organization & administration Treatment Outcome LA - eng M1 - 3 N1 - 1873-1740 Kelly, Elizabeth W Kelly, Jonathan D Hiestand, Brian Wells-Kiser, Kathy Starling, Stephanie Hoekstra, James W Journal Article United States Prog Cardiovasc Dis. 2010 Nov-Dec;53(3):219-26. doi: 10.1016/j.pcad.2010.08.002. PY - 2010 SN - 0033-0620 SP - 219-26 ST - Six Sigma process utilization in reducing door-to-balloon time at a single academic tertiary care center T2 - Prog Cardiovasc Dis TI - Six Sigma process utilization in reducing door-to-balloon time at a single academic tertiary care center VL - 53 ID - 760469 ER - TY - JOUR AB - BACKGROUND: Patients with massive and submassive pulmonary embolism (PE) require rapid identification, triage, and consideration for reperfusion therapy. Use of an existing ST-segment elevation myocardial infarction (STEMI) team and activation protocol may be an effective means to care for these patients. OBJECTIVE: The objective of this analysis was to evaluate a pilot study using the STEMI team and a dedicated PE protocol for treatment of patients with massive and submassive PE. METHODS: From June 2014 to April 2016, a total of 40 patients with massive and submassive PE were evaluated. Baseline demographics, mode of hospital entry (transfer-in, in-hospital, and emergency department [ED] arrival), treatment time intervals (door to computed tomography PE protocol [CTPE], CTPE to invasive pulmonary angiogram, door to treatment time), procedures performed, and in-hospital clinical events were collected. RESULTS: Mean age was 56 ± 14 years, 17 (42%) were male, and 12 (30%) had a prior history of deep venous thrombosis or PE. Twenty-three patients (57%) had massive PE and 17 patients (43%) had submassive PE. Mode of hospital entry was transfer-in (38%), in-hospital (20%), and ED arrival (42%). Four patients (10%) presented with cardiac arrest, 8 patients (20%) required intubation, and 5 patients (12%) required extracorporeal membrane oxygenation. Ten patients (25%) received anticoagulation therapy or placement of inferior vena cava filter, 3 patients (7.5%) received diagnostic pulmonary angiography alone, and 27 patients (67.5%) received endovascular treatment. For patients arriving via the ED, door to CTPE was 4.9 ± 3.6 hours, CTPE to diagnostic pulmonary angiography was 7.8 ± 8.5 hours, and door to treatment time was 10.2 ± 9.0 hours. Endovascular devices utilized included combinations of rheolytic and other thrombectomy devices as well as catheter-directed fibrinolysis. Length of hospital stay was 15 ± 15 days and in-hospital survival rate was 90%. CONCLUSIONS: Use of an existing STEMI team and activation protocol is a feasible method to care for patients with massive and submassive PE. This pilot study demonstrated rapid treatment times with low in-hospital mortality. AD - Division of Cardiovascular Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033 USA. shavelle@usc.edu. AN - 30279292 AU - Kendall, M. R. AU - Swadron, S. AU - Clavijo, L. C. AU - Mehra, A. K. AU - Hindoyan, A. AU - Matthews, R. V. AU - Shavelle, D. M. DA - Oct DP - NLM ET - 2018/10/04 J2 - The Journal of invasive cardiology KW - *Cardiologists Emergency Service, Hospital Female Fibrinolytic Agents/therapeutic use Humans Male Middle Aged *Patient Care Team Pilot Projects Pulmonary Embolism/*therapy Retrospective Studies ST Elevation Myocardial Infarction Thrombectomy/*methods Thrombolytic Therapy/methods *catheter-directed thrombolytic therapy *percutaneous mechanical thrombectomy *pulmonary embolism *pulmonary embolism response team LA - eng M1 - 10 N1 - 1557-2501 Kendall, Michael R Swadron, Stuart Clavijo, Leonardo C Mehra, Anilkumar K Hindoyan, Antotreas Matthews, Ray V Shavelle, David M Journal Article United States J Invasive Cardiol. 2018 Oct;30(10):367-371. PY - 2018 SN - 1042-3931 SP - 367-371 ST - Use of the STEMI Team for Treatment of Patients With Pulmonary Embolism: A Pilot Study T2 - J Invasive Cardiol TI - Use of the STEMI Team for Treatment of Patients With Pulmonary Embolism: A Pilot Study VL - 30 ID - 760203 ER - TY - JOUR AB - Background. Patients with massive and submassive pulmonary embolism (PE) require rapid identification, triage, and consideration for reperfusion therapy. Use of an existing ST-segment elevation myocardial infarction (STEMI) team and activation protocol may be an effective means to care for these patients.Objective. The objective of this analysis was to evaluate a pilot study using the STEMI team and a dedicated PE protocol for treatment of patients with massive and submassive PE. Methods. From June 2014 to April 2016, a total of 40 patients with massive and submassive PE were evaluated. Baseline demographics, mode of hospital entry (transfer-in, in-hospital, and emergency department [ED] arrival), treatment time intervals (door to computed tomography PE protocol [CTPE], CTPE to invasive pulmonary angiogram, door to treatment time), procedures performed, and in-hospital clinical events were collected. Results. Mean age was 56 +/- 14 years, 17 (42%) were male, and 12 (30%) had a prior history of deep venous thrombosis or PE. Twenty-three patients (57%) had massive PE and 17 patients (43%) had submassive PE. Mode of hospital entry was transfer-in (38%), in-hospital (20%), and ED arrival (42%). Four patients (10%) presented with cardiac arrest, 8 patients (20%) required intubation, and 5 patients (12%) required extracorporeal membrane oxygenation. Ten patients (25%) received anticoagulation therapy or placement of inferior vena cava filter, 3 patients (7.5%) received diagnostic pulmonary angiography alone, and 27 patients (67.5%) received endovascular treatment. For patients arriving via the ED, door to CTPE was 4.9 +/- 3.6 hours, CTPE to diagnostic pulmonary angiography was 7.8 +/- 8.5 hours, and door to treatment time was 10.2 +/- 9.0 hours. Endovascular devices utilized included combinations of rheolytic and other thrombectomy devices as well as catheter-directed fibrinolysis. Length of hospital stay was 15 +/- 15 days and in-hospital survival rate was 90%. Conclusions. Use of an existing STEMI team and activation protocol is a feasible method to care for patients with massive and submassive PE. This pilot study demonstrated rapid treatment times with low in-hospital mortality. AD - [Kendall, Michael R.; Clavijo, Leonardo C.; Mehra, Anilkumar K.; Hindoyan, Antotreas; Matthews, Ray V.; Shavelle, David M.] Univ Southern Calif, Div Cardiovasc Med, 1510 San Pablo St,Suite 322, Los Angeles, CA 90033 USA. [Swadron, Stuart] Univ Southern Calif, Dept Emergency Med, Los Angeles, CA USA. Shavelle, DM (corresponding author), Univ Southern Calif, Div Cardiovasc Med, 1510 San Pablo St,Suite 322, Los Angeles, CA 90033 USA. shavelle@usc.edu AN - WOS:000455648300010 AU - Kendall, M. R. AU - Swadron, S. AU - Clavijo, L. C. AU - Mehra, A. K. AU - Hindoyan, A. AU - Matthews, R. V. AU - Shavelle, D. M. DA - Oct J2 - J. Invasive Cardiol. KW - catheter-directed thrombolytic therapy percutaneous mechanical thrombectomy pulmonary embolism pulmonary embolism response team RESPONSE TEAM OUTCOMES THERAPY THROMBOLYSIS FIBRINOLYSIS PREDICTORS HEMORRHAGE CARE Cardiac & Cardiovascular Systems LA - English M1 - 10 M3 - Article N1 - ISI Document Delivery No.: HH3VO Times Cited: 0 Cited Reference Count: 19 Kendall, Michael R. Swadron, Stuart Clavijo, Leonardo C. Mehra, Anilkumar K. Hindoyan, Antotreas Matthews, Ray V. Shavelle, David M. 0 H M P COMMUNICATIONS MALVERN J INVASIVE CARDIOL PY - 2018 SN - 1042-3931 SP - 367-371 ST - Us of the STEMI Team for Treatment of Patients With Pulmonary Embolism: A Pilot Study T2 - Journal of Invasive Cardiology TI - Us of the STEMI Team for Treatment of Patients With Pulmonary Embolism: A Pilot Study UR - ://WOS:000455648300010 VL - 30 ID - 761565 ER - TY - JOUR AB - BACKGROUND: The hemodialysis reliable outflow (HeRO) access device is a permanent dialysis graft used in patients with central venous obstruction. Given the complexity of care related to end-stage dialysis access (ESDA) patients, a multidisciplinary approach has been used to achieve operative success of HeRO graft placement. METHODS: The single-center retrospective review included adult patients that were seen in ESDA clinic who underwent a HeRO graft placement from September 2010-September 2014 under the care of a team consisting of a nephrologist, an interventional radiologist, and a surgeon. The effectiveness of the multidisciplinary approach was evaluated using outcome variables including successful HeRO graft placement, operative complications, the rate of obtaining central venous access, and advanced endovascular maneuvers performed by interventional radiology to obtain central venous access. RESULTS: A multidisciplinary approach has been used in 33 ESDA patients. Access to the right atrium was achieved in 100% of cases. Fifty-eight percent of patients required advanced endovascular maneuvers in the interventional radiology suite to obtain central venous access. Successful HeRO graft placement was achieved in 94% (31 of 33) of the study population. No intraoperative complications were encountered. Median primary and secondary patency rates were 83 d (interquartile range: 45-170) and 345 d (interquartile range: 146-579) per HeRO graft placement, respectively. Primary and secondary patency rates at 60 d were 70% (23 of 33) and 79% (26 of 33), respectively. CONCLUSIONS: In this difficult patient population, a multidisciplinary team can provide a unique and collaborative approach to HeRO graft placement in patients with complex central venous outflow obstruction. AD - Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: clark.d.kensinger@vanderbilt.edu. Department of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Division of Interventional and Vascular Radiology, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee. AN - 26022998 AU - Kensinger, C. AU - Brownie, E. AU - Bream, P., Jr. AU - Moore, D. C2 - Pmc4604008 C6 - Nihms694453 DA - Nov DO - 10.1016/j.jss.2015.04.088 DP - NLM ET - 2015/05/30 J2 - The Journal of surgical research KW - Adult Aged Arteriovenous Shunt, Surgical/instrumentation/*methods Endovascular Procedures/instrumentation/*methods Female Humans Kidney Failure, Chronic/*surgery Male Middle Aged Outcome and Process Assessment, Health Care *Patient Care Team Renal Dialysis/instrumentation/*methods Retrospective Studies Dialysis access HeRO graft Hemodialysis reliable outflow dialysis device Venous outflow obstruction including financial interests, activities, relationships, and affiliations. LA - eng M1 - 1 N1 - 1095-8673 Kensinger, Clark Brownie, Evan Bream, Peter Jr Moore, Derek T32 DK007569/DK/NIDDK NIH HHS/United States 5T32DK007569/DK/NIDDK NIH HHS/United States Evaluation Study Journal Article Research Support, N.I.H., Extramural J Surg Res. 2015 Nov;199(1):259-65. doi: 10.1016/j.jss.2015.04.088. Epub 2015 May 6. PY - 2015 SN - 0022-4804 (Print) 0022-4804 SP - 259-65 ST - Multidisciplinary team approach to end-stage dialysis access patients T2 - J Surg Res TI - Multidisciplinary team approach to end-stage dialysis access patients VL - 199 ID - 760233 ER - TY - JOUR AB - Objectives: The Pulmonary Embolism Response Team (PERT) model is now widely adopted in many AU - Khaing, Phue AU - Paruchuri, Arpana AU - Eisenbrey, John R. DA - 2020 DB - German National Library of Science and Technology (TIB) PY - 2020 ST - First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation T2 - Taylor & Francis Verlag TI - First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation UR - https://www.tib.eu/en/search/id/tandf:doi~10.1080%252F21548331.2020.1706315/First-year-experience-of-a-pulmonary-embolism-response?cHash=13ebee1b5d7f41fd17b374e697885777 ID - 761961 ER - TY - JOUR AU - Khaing, P. AU - Paruchuri, A. AU - Eisenbrey, J. R. AU - Merli, G. J. AU - Gonsalves, C. F. AU - West, F. M. AU - Awsare, B. K. DA - 2019/12/28 12/28 DB - Europe PubMed Central DO - 10.1080/21548331.2020.1706315 M1 - 1 PY - 2019 SN - 2154-8331 SP - 23-28 ST - First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation T2 - Hosp Pract (1995) TI - First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation UR - http://europepmc.org/article/MED/31847615 VL - 48 ID - 761960 ER - TY - JOUR AB - Objectives: The Pulmonary Embolism Response Team (PERT) model is now widely adopted in many institutions to provide multidisciplinary care for patients with acute pulmonary embolism (PE). However, descriptive experiences of PERT operations and studies on clinical outcomes remain limited.Methods: We performed a retrospective review of PERT activations at an academic tertiary care center, with secondary aims to study outcomes associated with performing catheter directed therapies (CDT).Results: The intermediate high-risk PE category was most frequent (n = 40, 76.9%) among the 52 total cases evaluated during the study period. There was one in-hospital mortality, associated with hospice admission for a non-PE diagnosis. Six patients (11.5%) experienced a bleeding complication of any severity. Anticoagulation (AC) alone was recommended in 30 patients (57.7%) and CDT was performed in 16 patients (30.8%). There were no significant differences in patient characteristics or disease severity between patients in the AC group versus the CDT group, except for a higher prevalence of malignancy in the AC group (p = 0.037). Patients who underwent CDT demonstrated a lower, albeit non-significant, median intensive care unit (ICU) length of stay (LOS) (3 vs. 4 days, p = 0.34) and hospital LOS (4 vs. 5 days, p = 0.25), as compared to patients receiving AC alone. Bleeding rates were similar between the two groups (6.7% vs. 6.3%, p = 1.0).Conclusions: Adoption of the PERT model at an academic tertiary care center was associated with acceptably low rates of mortality and bleeding, similar to other published studies. Performing CDT in select patients under PERT consultation may be associated with shorter ICU and hospital LOS; however, larger studies are needed to validate this finding. AD - Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA. Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA. Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA. Jefferson Vascular Center, Department of Medicine, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA. Division of Interventional Radiology, Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University Hospital, Philadelphia, PA, USA. AN - 31847615 AU - Khaing, P. AU - Paruchuri, A. AU - Eisenbrey, J. R. AU - Merli, G. J. AU - Gonsalves, C. F. AU - West, F. M. AU - Awsare, B. K. DA - Feb DO - 10.1080/21548331.2020.1706315 DP - NLM ET - 2019/12/19 J2 - Hospital practice (1995) KW - Acute Disease Adult Aged Anticoagulants/administration & dosage/*therapeutic use Catheter Ablation/adverse effects/*methods Female Hemorrhage/etiology Hospital Mortality Humans Length of Stay Male Middle Aged Palliative Care/statistics & numerical data Patient Care Team/*organization & administration Pulmonary Embolism/drug therapy/*surgery Retrospective Studies Severity of Illness Index Socioeconomic Factors Tertiary Care Centers Thrombolytic Therapy/adverse effects/*methods Pulmonary embolism anticoagulation catheter directed thrombolysis pulmonary embolism response team LA - eng M1 - 1 N1 - Khaing, Phue Orcid: 0000-0002-1286-5111 Paruchuri, Arpana Eisenbrey, John R Merli, Geno J Gonsalves, Carin F West, Frances M Awsare, Bharat K Journal Article England Hosp Pract (1995). 2020 Feb;48(1):23-28. doi: 10.1080/21548331.2020.1706315. Epub 2020 Jan 3. PY - 2020 SN - 2154-8331 (Print) 2154-8331 SP - 23-28 ST - First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation T2 - Hosp Pract (1995) TI - First year experience of a pulmonary embolism response team with comparisons of outcomes between catheter directed therapy versus standard anticoagulation VL - 48 ID - 760230 ER - TY - JOUR AB - Rationale: The management of patients with pulmonary embolism (PE) has become complex due to a proliferation of new therapeutic options, a deficiency of robust evidence-based treatment algorithms, and the necessity for multispecialty coordination of care. As a result, many healthcare institutions have developed Pulmonary Embolism Response Teams (PERT) that provide a teambased, expedited, and efficient means of evaluating and treating PE patients. However, the actual benefits of PERT are difficult to measure and are still being explored in the literature. Methods: In this study, the first year experience of a PERT program at a large, urban, tertiary referral center was retrospectively reviewed from July 2017 to July 2018. Baseline characteristics and overall outcomes of patients recommended to receive anticoagulation (AC) alone versus AC plus catheter-directed therapies (CDT) were compared. Multivariable linear regression analyses were performed. Results: A total of 52 patients were evaluated by activation of the PERT during its first year. These patients on average were 55.8 years old, and were predominantly Caucasian (51.9%) and female (55.8%). There were 46 submassive (88.5%) and 6 massive (11.5%) PE cases. Most patients (71.2%) were admitted to the intensive care unit (ICU) specifically for the PE diagnosis. The all-cause in-hospital mortality rate was 1.9%; the PE-attributable mortality was 0%. Of the study group, 57.7% (n=30) were observed on AC alone and 30.8% (n=16) underwent CDT. There was a significantly increased proportion of patients with known malignancy in the AC group, as compared to the CDT group (26.7% vs. 0%, p <0.05). No significant differences were observed in other characteristics between the two groups. As compared to AC, CDT was significantly associated with shorter ICU length of stay (LOS), after adjusting for potential confounders including co-morbidities, severity of PE presentation, and anticoagulation agent used (β = -0.402, p <0.05). There was also a trend towards an association between CDT and shorter hospital LOS; however, this did not reach statistical significance. There was a similar rate of bleeding complications between the two groups (AC 6.7% vs. CDT 6.3%, p >0.05). Conclusions: In this study, CDT was associated with a shorter ICU LOS as compared to AC alone after adjusting for potential confounders. Bleeding complication rates were similar. More studies from other institutions are needed to validate our findings that performing CDT in the appropriate setting may lead to shorter ICU LOS, without an associated increase in bleeding complications. AD - P. Khaing, Division of Pulmonary and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University Hospital, Philadelphia, PA, United States AU - Khaing, P. AU - Paruchuri, A. AU - West, F. M. AU - Merli, G. J. AU - Gonsalves, C. AU - Awsare, B. K. DB - Embase KW - anticoagulant agent adult anticoagulation bleeding cancer patient catheter Caucasian comorbidity complication conference abstract controlled study female hospital mortality human intensive care unit length of stay linear regression analysis major clinical study male malignant neoplasm middle aged pulmonary embolism response team retrospective study statistical significance tertiary care center LA - English M1 - 9 M3 - Conference Abstract N1 - L630352977 2020-01-01 PY - 2019 SN - 1535-4970 ST - First year experience of a pulmonary embolism response team: A comparison of catheter directed therapies and anticoagulation T2 - American Journal of Respiratory and Critical Care Medicine TI - First year experience of a pulmonary embolism response team: A comparison of catheter directed therapies and anticoagulation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630352977&from=export VL - 199 ID - 760729 ER - TY - JOUR AB - Rationale: Catheter-directed therapy (CDT) is increasingly used in the treatment algorithm for intermediate-risk pulmonary embolism (PE). In several prospective studies, CDT has been shown to be associated with early improvement in echocardiographic parameters when compared to anticoagulation (AC) alone. It remains unknown whether these endovascular reperfusion strategies impact hospital length of stay (LOS). Methods: In this retrospective study involving patients from two large academic medical centers, we examined hospital LOS among intermediate-risk PE patients undergoing CDT versus those on AC alone. All intermediate-risk PE patients evaluated by the respective Pulmonary Embolism Response Teams (PERT) between 7/2017 and 6/2019 were considered for inclusion. Patients whose PE diagnosis was made more than 3 calendar days from date of hospital admission were excluded. The following parameters were collected: age, medical comorbidities, worst vital signs within 24 hours of PE diagnosis, Bova score stage, treatment modality (CDT vs. AC), and hospital LOS. Statistical analysis was performed with two-sample t-testing for continuous variables and chi-square testing for categorical variables between groups. Propensity score matching of CDT patients and AC patients were performed to evaluate hospital LOS. Results: There were 242 patients included in the study, of which 58 underwent CDT and 184 received AC alone Patients undergoing CDT had a higher proportion of higher Bova score stages (p=0.0003) and a lower proportion of malignancy (p=0.0007) than patients receiving AC alone. There was also a trend towards a lower proportion of cardiopulmonary disease in the CDT group (p=0.078). After matching 58 CDT patients to 58 AC patients, there were no residual significant differences between the two groups, suggesting adequate matching (Table 1). There was no significant difference in overall hospital LOS between CDT patients and AC patients (5.8 versus 5.0 days, respectively; p=0.301) Conclusion: The use of CDT in intermediate-risk PE patients at two large academic medical centers was found to be associated with no significant differences in hospital LOS. Multiple factors, such as differences in duration of thrombolytic infusion (e.g., 6 hours versus prolonged) and variability in ancillary staff involvement in discharge planning, may have affected overall hospital LOS in this study. Additionally, because CDT is a relatively new therapeutic modality, treating clinicians may have been inclined to observe these patients longer post-procedurally. Our study provides a current state on hospital LOS in regards to use of CDT and may present an opportunity for PERT programs to influence modifiable factors that can shorten hospital LOS (Table Presented). AD - P. Khaing, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University Hospital, Philadelphia, PA, United States AU - Khaing, P. AU - Vien, L. P. AU - Uricheck, J. AU - Alashram, R. AU - Gonsalves, C. AU - Eisenbrey, J. AU - Lu, X. AU - Zhao, H. AU - Rali, P. AU - Awsare, B. K. DB - Embase KW - adult algorithm anticoagulation cancer patient cancer staging catheter comorbidity conference abstract controlled study cor pulmonale diagnosis female hospital admission hospital discharge human length of stay major clinical study male multicenter study propensity score prospective study pulmonary embolism response team retrospective study risk assessment university hospital vital sign LA - English M1 - 1 M3 - Conference Abstract N1 - L632376174 2020-07-27 PY - 2020 SN - 1535-4970 ST - Hospital length of stay among intermediate-risk pulmonary embolism patients undergoing catheter-directed therapy versus anticoagulation alone T2 - American Journal of Respiratory and Critical Care Medicine TI - Hospital length of stay among intermediate-risk pulmonary embolism patients undergoing catheter-directed therapy versus anticoagulation alone UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632376174&from=export VL - 201 ID - 760635 ER - TY - JOUR AB - Objective: To assess patients' experiences and satisfaction following AAA repair. Methods: A study specific questionnaire was developed with collaboration of a multidisciplinary team. List of patients who underwent elective open AAA repair and EVAR (endovascular aneurysm repair) between January 2006 and December 2008 was obtained from departmental database and cross checked against hospital database for survival status. Emergency AAA repairs were excluded. Study questionnaires were posted to 138 patients (Open 113, EVAR 25) with self-addressed stamped return envelopes. Statistical analysis was performed using SPSS 16.0. Results: Response rate was 89% (n=123; Open 121, EVAR 21). Patients' experiences: 71% (n=88) were unaware of this condition prior to diagnosis, 97% (n=120) indicated their understanding of need for surgery, 92% (n=113) stated that the operation was adequately explained to them, 54% (n=67) were provided with written information while 12% (n=15) used the internet for further information. Sixteen percent (n=20) were in active employment before surgery which reduced to 9% (n=11) after surgery, 90% (n=111) reported full recovery following surgery with 60% (n=74) recovering within six months. Satisfaction: 42% (n=52) reported that operation was bigger than their expectation. Eighty-seven percent (n=108) were satisfied with the overall experience and 85% (n=105) stated that they would recommend the operation to family/friends if required. Inter-group analysis: Statistically significant difference was observed between open and EVAR patients for mean age Open 74 years (SD7), EVAR 78 years (SD7), P=0.01 and median length of hospital stay Open 9 days (range 2-46), EVAR 6 days (range 4-15), P=0.01. However, no difference was observed in awareness, functional outcome or satisfaction. Conclusions: There is lack of awareness regarding AAA in elderly population. However, once diagnosed patients understand the implications and are satisfied with the overall results and would recommend it if required. AD - J.A. Khan, Academic Vascular Surgical Unit, University of Hull, Hull, United Kingdom AU - Khan, J. A. AU - Mazari, F. AU - Abdulrahman, M. N. AU - Mockford, K. AU - Chetter, I. AU - McCollum, P. DB - Embase DO - 10.1510/icvts.2010.0000S1 KW - nitrogen 15 patient human satisfaction abdominal aortic aneurysm society cardiovascular surgery questionnaire surgery data base hospital Internet employment survival endovascular aneurysm repair statistical analysis diagnosis emergency population hospitalization aged data analysis software LA - English M3 - Conference Abstract N1 - L71661318 2014-10-31 PY - 2010 SN - 1569-9293 SP - S68 ST - A questionnaire survey to assess patients' experiences and satisfaction following elective abdominal aortic aneurysm (AAA) repair T2 - Interactive Cardiovascular and Thoracic Surgery TI - A questionnaire survey to assess patients' experiences and satisfaction following elective abdominal aortic aneurysm (AAA) repair UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71661318&from=export http://dx.doi.org/10.1510/icvts.2010.0000S1 VL - 10 ID - 761259 ER - TY - JOUR AB - BACKGROUND: To evaluate patients' awareness, functional outcome, and satisfaction after abdominal aortic aneurysm (AAA) repair. METHODS: A study-specific questionnaire was developed with collaboration of a multidisciplinary team. Lists of patients who underwent elective open AAA repair and endovascular aneurysm repair (EVAR) between January 2006 and December 2008 were obtained from the departmental database and cross-checked against hospital database for survival status. Emergency AAA repairs were excluded. Study questionnaires were posted to 138 patients (113 open, 25 EVAR) with self-addressed stamped return envelopes. Statistical analysis was performed using SPSS v16.0. RESULTS: Response rate was 89% (n = 123; 102 open, 21 EVAR). Seventy-one percent (n = 88) were unaware of this condition before diagnosis. Ninety-seven percent (n = 120) indicated their understanding of the need for surgery. Ninety-two percent (n = 113) stated that the operation was adequately explained to them. Ninety percent (n = 111) reported full recovery after surgery, with 60% (n = 74) recovering within 6 months. Eighty-seven percent (n = 108) were satisfied with the overall experience, and 85% (n = 105) stated that they would recommend the operation to family and/or friends if required. CONCLUSIONS: There is a lack of awareness regarding AAA in elderly population. However, after being diagnosed, patients understand the implications and are satisfied with the overall results and would recommend AAA repair to family and/or friends if required. AD - Academic Vascular Surgical Unit, University of Hull, Hull, United Kingdom. junaid.khan@hey.nhs.uk AN - 21802257 AU - Khan, J. A. AU - Mazari, F. A. AU - Abdul Rahman, M. N. AU - Mockford, K. AU - Chetter, I. C. AU - McCollum, P. T. DA - Oct DO - 10.1016/j.avsg.2011.05.013 DP - NLM ET - 2011/08/02 J2 - Annals of vascular surgery KW - Aged Aged, 80 and over Aortic Aneurysm, Abdominal/physiopathology/psychology/*surgery Awareness Blood Vessel Prosthesis Implantation/*psychology Comprehension Elective Surgical Procedures Endovascular Procedures/*psychology Female Health Care Surveys *Health Knowledge, Attitudes, Practice Humans Male Patient Education as Topic Patient Satisfaction Patients/*psychology Prospective Studies Recovery of Function Surveys and Questionnaires Time Factors Treatment Outcome United Kingdom LA - eng M1 - 7 N1 - 1615-5947 Khan, Junaid A Mazari, Fayyaz A Abdul Rahman, M N A Mockford, Katherine Chetter, Ian C McCollum, Peter T Journal Article Netherlands Ann Vasc Surg. 2011 Oct;25(7):878-86. doi: 10.1016/j.avsg.2011.05.013. Epub 2011 Jul 28. PY - 2011 SN - 0890-5096 SP - 878-86 ST - Patients' perspective of functional outcome after elective abdominal aortic aneurysm repair: a questionnaire survey T2 - Ann Vasc Surg TI - Patients' perspective of functional outcome after elective abdominal aortic aneurysm repair: a questionnaire survey VL - 25 ID - 760402 ER - TY - JOUR AB - Background: To evaluate patients' awareness, functional outcome, and satisfaction after abdominal aortic aneurysm (AAA) repair. Methods: A study-specific questionnaire was developed with collaboration of a multidisciplinary team. Lists of patients who underwent elective open AAA repair and endovascular aneurysm repair (EVAR) between January 2006 and December 2008 were obtained from the departmental database and cross-checked against hospital database for survival status. Emergency AAA repairs were excluded. Study questionnaires were posted to 138 patients (113 open, 25 EVAR) with self-addressed stamped return envelopes. Statistical analysis was performed using SPSS v16.0. Results: Response rate was 89% (n = 123; 102 open, 21 EVAR). Seventy-one percent (n = 88) were unaware of this condition before diagnosis. Ninety-seven percent (n = 120) indicated their understanding of the need for surgery. Ninety-two percent (n = 113) stated that the operation was adequately explained to them. Ninety percent (n = 111) reported full recovery after surgery, with 60% (n = 74) recovering within 6 months. Eighty-seven percent (n = 108) were satisfied with the overall experience, and 85% (n = 105) stated that they would recommend the operation to family and/or friends if required. Conclusions: There is a lack of awareness regarding AAA in elderly population. However, after being diagnosed, patients understand the implications and are satisfied with the overall results and would recommend AAA repair to family and/or friends if required. © 2011 Annals of Vascular Surgery Inc. AD - J.A. Khan, Academic Vascular Surgical Unit, University of Hull, Hull Royal Infirmary, Anlaby Road, Hull HU3 2JZ, United Kingdom AU - Khan, J. A. AU - Mazari, F. A. AU - Abdul Rahman, M. N. A. AU - Mockford, K. AU - Chetter, I. C. AU - McCollum, P. T. DB - Embase Medline DO - 10.1016/j.avsg.2011.05.013 KW - abdominal aortic aneurysm aged aneurysm surgery aortic surgery article attitude to health elective surgery endovascular aneurysm repair female functional assessment human major clinical study male outcome assessment patient satisfaction priority journal prospective study questionnaire LA - English M1 - 7 M3 - Article N1 - L51544788 2011-07-29 2011-09-28 PY - 2011 SN - 0890-5096 1615-5947 SP - 878-886 ST - Patients' perspective of functional outcome after elective abdominal aortic aneurysm repair: A questionnaire survey T2 - Annals of Vascular Surgery TI - Patients' perspective of functional outcome after elective abdominal aortic aneurysm repair: A questionnaire survey UR - https://www.embase.com/search/results?subaction=viewrecord&id=L51544788&from=export http://dx.doi.org/10.1016/j.avsg.2011.05.013 VL - 25 ID - 761221 ER - TY - JOUR AB - Background Advanced practice providers (APPs) are important members of stroke teams. Stroke code simulations offer valuable experience in the evaluation and treatment of stroke patients without compromising patient care. We hypothesized that simulation training would increase APP confidence, comfort level, and preparedness in leading a stroke code similar to neurology residents. Methods This is a prospective quasi-experimental, pretest/posttest study. Nine APPs and 9 neurology residents participated in 3 standardized simulated cases to determine need for IV thrombolysis, thrombectomy, and blood pressure management for intracerebral hemorrhage. Emergency medicine physicians and neurologists were preceptors. APPs and residents completed a survey before and after the simulation. Generalized mixed modeling assuming a binomial distribution was used to evaluate change. Results On a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree), confidence in leading a stroke code increased from 2.4 to 4.2 (p < 0.05) among APPs. APPs reported improved comfort level in rapidly assessing a stroke patient for thrombolytics (3.1-4.2; p < 0.05), making the decision to give thrombolytics (2.8 vs 4.2; p < 0.05), and assessing a patient for embolectomy (2.4-4.0; p < 0.05). There was no difference in the improvement observed in all the survey questions as compared to neurology residents. Conclusion Simulation training is a beneficial part of medical education for APPs and should be considered in addition to traditional didactics and clinical training. Further research is needed to determine whether simulation education of APPs results in improved treatment times and outcomes of acute stroke patients. AD - [Khan, Muhib; Kaskar, Omran; De Jesus, Michelle; Zachariah, Joseph; Coleman, Robert R.; Sherman, Wendy; Hingtgen, Cynthia; Abdelhak, Tamer; Smith, Brien] Spectrum Hlth, Neurosci Inst, Div Neurol, Grand Rapids, MI USA. [Price, Theresa] Spectrum Hlth, Dept Accreditat & Regulat, Grand Rapids, MI USA. [Tubergen, Tricia] Spectrum Hlth, Nursing Adm, Grand Rapids, MI USA. [Oostema, Adam] Michigan State Univ, Dept Emergency Med, E Lansing, MI 48824 USA. [Khan, Muhib; Kaskar, Omran; De Jesus, Michelle; Zachariah, Joseph; Coleman, Robert R.; Sherman, Wendy; Hingtgen, Cynthia; Abdelhak, Tamer; Smith, Brien] Michigan State Univ, Dept Clin Neurosci, Coll Human Med, E Lansing, MI 48824 USA. [Baird, Grayson L.] Rhode Isl Hosp, Lifespan Biostat Core, Providence, RI 02903 USA. [Baird, Grayson L.] Brown Univ, Warren Alpert Sch Med, Dept Diagnost Imaging, Providence, RI 02912 USA. [Scurek, Raymond] Emergency Care Specialists, Grand Rapids, MI USA. [Silver, Brian] Univ Massachusetts, Med Sch, Dept Neurol, Worcester, MA USA. Khan, M (corresponding author), Spectrum Hlth, Neurosci Inst, Div Neurol, Grand Rapids, MI USA.; Khan, M (corresponding author), Michigan State Univ, Dept Clin Neurosci, Coll Human Med, E Lansing, MI 48824 USA. muhib.khan@spectrumhealth.org AN - WOS:000441722500007 AU - Khan, M. AU - Baird, G. L. AU - Price, T. AU - Tubergen, T. AU - Kaskar, O. AU - De Jesus, M. AU - Zachariah, J. AU - Oostema, A. AU - Scurek, R. AU - Coleman, R. R. AU - Sherman, W. AU - Hingtgen, C. AU - Abdelhak, T. AU - Smith, B. AU - Silver, B. DA - Apr DO - 10.1212/cpj.0000000000000435 J2 - Neurol.-Clin. Pract. KW - NURSE INITIATED THROMBOLYSIS ADVANCED PRACTICE CLINICIAN QUALITY IMPROVEMENT NEEDLE TIMES THROMBECTOMY THERAPY DOOR Clinical Neurology LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: GQ5KS Times Cited: 4 Cited Reference Count: 19 Khan, Muhib Baird, Grayson L. Price, Theresa Tubergen, Tricia Kaskar, Omran De Jesus, Michelle Zachariah, Joseph Oostema, Adam Scurek, Raymond Coleman, Robert R. Sherman, Wendy Hingtgen, Cynthia Abdelhak, Tamer Smith, Brien Silver, Brian Silver, Brian/A-2204-2010 4 0 5 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA NEUROL-CLIN PRACT PY - 2018 SN - 2163-0402 SP - 116-119 ST - Stroke code simulation benefits advanced practice providers similar to neurology residents T2 - Neurology-Clinical Practice TI - Stroke code simulation benefits advanced practice providers similar to neurology residents UR - ://WOS:000441722500007 VL - 8 ID - 761593 ER - TY - JOUR AB - BACKGROUND: Ventilator-associated pneumonia (VAP) is a frequent hospital acquired infections among intensive care unit patients. The Institute for Healthcare Improvement has suggested a "care bundle" approach for the prevention of VAP. This report describes the effects of implementing this strategy on VAP rates. METHODS: All mechanically ventilated patients admitted to the intensive care unit between 2008 and 2013 were prospectively followed for VAP development according to the National Healthcare Safety Network criteria. In 2011, a 7-element care bundle was implemented, including head-of-bed elevation 30°-45°, daily sedation vacation and assessment for extubation, peptic ulcer disease prophylaxis, deep vein thrombosis prophylaxis, oral care with chlorhexidine, endotracheal intubation with in-line suction and subglottic suctioning, and maintenance of endotracheal tube cuff pressure at 20-30 mmHg. The bundle compliance and VAP rates were then followed. RESULTS: A total of 3665 patients received mechanical ventilation, and there were 9445 monitored observations for bundle compliance. The total bundle compliance before and after initiation of the VAP team was 90.7% and 94.2%, respectively (P < .001). The number of VAP episodes decreased from 144 during 2008-2010 to only 14 during 2011-2013 (P < .0001). The rate of VAP decreased from 8.6 per 1000 ventilator-days to 2.0 per 1000 ventilator-days (P < .0001) after implementation of the care bundle. CONCLUSIONS: This study suggests that systematic implementation of a multidisciplinary team approach can reduce the incidence of VAP. Further sustained improvement requires persistent vigilant inspections. AD - Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Electronic address: raymondkhan@yahoo.com. Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Anaesthesia Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Quality Management Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Infection Prevention and Control Program, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Infection Prevention and Control Program, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Epidemiology and Biostatistics, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Respiratory Services, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. AN - 26940595 AU - Khan, R. AU - Al-Dorzi, H. M. AU - Al-Attas, K. AU - Ahmed, F. W. AU - Marini, A. M. AU - Mundekkadan, S. AU - Balkhy, H. H. AU - Tannous, J. AU - Almesnad, A. AU - Mannion, D. AU - Tamim, H. M. AU - Arabi, Y. M. DA - Mar 1 DO - 10.1016/j.ajic.2015.09.025 DP - NLM ET - 2016/03/05 J2 - American journal of infection control KW - Adult Aged Aged, 80 and over Female Humans Incidence Infection Control/*methods Intensive Care Units Male Middle Aged *Patient Care Bundles Pneumonia, Ventilator-Associated/epidemiology/*prevention & control Care bundles Infection control Quality improvement Ventilator-associated pneumonia LA - eng M1 - 3 N1 - 1527-3296 Khan, Raymond Al-Dorzi, Hasan M Al-Attas, Khalid Ahmed, Faisal Wali Marini, Abdellatif M Mundekkadan, Shihab Balkhy, Hanan H Tannous, Joseph Almesnad, Adel Mannion, Dianne Tamim, Hani M Arabi, Yaseen M Journal Article United States Am J Infect Control. 2016 Mar 1;44(3):320-6. doi: 10.1016/j.ajic.2015.09.025. PY - 2016 SN - 0196-6553 SP - 320-6 ST - The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia T2 - Am J Infect Control TI - The impact of implementing multifaceted interventions on the prevention of ventilator-associated pneumonia VL - 44 ID - 760141 ER - TY - JOUR AB - Case summary: Mrs EP, 31 y/o, initially presented at 20 wks of pregnancy with severe pain, swelling and numbness in the right arm. On examination the right arm was swollen, dusky in colour with normal peripheral pulses. Duplex scan showed some narrowing and obstruction in the axillary vein as it crossed the 1st rib; intraluminal small vein thrombosis could not be ruled out. A diagnosis of upper extremity DVT and Thoracic outlet syndrome (TOS) was made and therapeutic dose of clexane and Aspirin were started. Thrombophyllia screen was negative. The vascular surgeon, haematologist and obstetrician managed her jointly. She was referred to the vascular unit in a tertiary center when she continued to have persistent pain in the right arm. The x-ray of the cervical spine showed no evidence of bony cervical rib or anatomic anomaly of the first rib. Repeat duplex USG demonstrated severe venous compression at the thoracic operculum with a residual subclavian channel only 1.8mm on abduction. Although there was no thrombosis at that time the patient was at risk of acute thrombosis with a 10% risk of pulmonary embolism. A decision was taken to treat her surgically and right transaxillary 1st rib resection and subclavian venolysis of the subclavian vein was performed at 32 weeks of gestation. The clexane was stopped after surgery. Her symptoms improved initially followed by recurrence and balloon angioplasty was done at 38 wks gestation. Clexane was restarted in prophylactic dose. She was symptom free after angioplasty and had a spontaneous vertex delivery of a healthy female infant at 39 wks 6 days. Prophylactic clexane and aspirin were continued for 6 wks post partum. On follow-up she did not have any residual neurological or vascular problem in the right arm. Discussion: Thoracic outlet syndrome (TOS) is usually caused by compression of the brachial plexus elements or the subclavian vessels in their passage from the cervical area towards the axilla and proximal arm either at the interscalene triangle, costoclavicular triangle or subarachnoid space. Cervical ribs, anomalous muscles and fibrous bands may further constrict these areas. TOS may also be caused by upper extremity DVT. Upper extremity DVT makes up approximately 1-4% of all the episodes of DVT1. True prevalence is unknown, but has been suggested as 5/100,0000 per year. [2] Symptoms of TOS include aching pain from the scapula down the upper extremety, oedema, skin discolouration, tenderness and venous distension. In order to diagnose accurately clinical presentation may be neurogenic TOS (compression of the brachial plexus), vascular TOS (compression of the subclavian vessels) and non specific TOS. The diagnosis can be made by history, clinical examination, provocative tests, ultrasound, radiological evaluation including venogram and electro diagnostic evaluation. Normal findings of these investigations do not exclude TOS. Options of treatment include conservative and definitive. Definitive treatment include surgical decompression of the related structures i.e. transaxillary 1st rib resection (includes anterior portion of the 1st rib and cartilage, division of the costoclavicular ligament and subclavius tendon), or scalenotomy or angioplasty. [3,4] Routine use of transaxillary 1st rib resection was first described in 1973 by Charrett et al5. When there is evidence of upper extremity DVT, anticoagulation therapy should be started in therapeutic doses followed by Warfarin in non pregnant and Clexane/Heparin in pregnancy. Unexplained or hypercoagulable recurrent UEDVT should prompt a search for inherited hypercoagulable states or underlying malignancy. Because upper extremity DVT is frequently asymptomatic until complications ensue, a high index of suspiscion can prevent morbidity and mortality. Immediate thrombolytic therapy followed by early surgical decompression has been shown to be safe and efficacious. [6] Venous decompression if necessary and balloon angioplasty with stenting for the treatment of residual stricture have also been recommended. [1] Sanders and Hamm nd reported 86% improvement of symptoms and failure rate of 9% of surgical decompression. Twenty-one of 87 patients with TOS had non thormbotic obstruction. They were treated with transaxillary 1st rib resection and venolysis. [3] Altobelli et al reported more primary (46%) and secondary failure (64%) rates than Sanders and Hammond. [7] Divi et al reported their experience of thoracic outlet decompression for subclavian vein thrombosis. They concluded that patients with subclavian vein obstruction have more favourable outcome relative to those with combined neurogenic and venous pathologic features4. Complications include infection and haematoma. Our patient although no clot was found she was treated with anticoagulation for suspicion of UEDVT and conservative approach was taken to manage TOS. However, due to persistence of symptoms she was referred to tertiary care center. It was decided to treat her surgically due to a significant risk of UEDVT and PE without treatment. She underwent resection of 1st rib initially followed by balloon angioplasty. We could not find any case report of TOS in pregnancy in medline search. There are reports of UEDVT in pregnancy, none presented with s/s of TOS. Our patient was treated successfully with decompression surgery and angioplasty. There should be a high index of suspicion for TOS and patients should be managed by a multidisciplinary team and referred to a tertiary care center if needed. AD - R. Khan, Nevill Hall Hospital, Abergavenny, South Wales, United Kingdom AU - Khan, R. AU - Rich, D. AU - Dawson, A. AU - Thompson, J. DB - Embase DO - 10.1016/S0020-7292(09)61603-9 KW - enoxaparin acetylsalicylic acid warfarin pregnancy obstetrics thorax outlet syndrome gynecology case report arm patient decompression surgery rib resection compression percutaneous transluminal angioplasty angioplasty diagnosis pain risk rib subclavian vein tertiary health care vein thrombosis obstruction cervical rib thrombosis surgery brachial plexus decompression fibrinolytic therapy stent cervical spine vein occlusion first rib abduction infection hematoma X ray surgeon lung embolism axillary vein pulse rate anticoagulation color examination paresthesia female infant follow up axilla subarachnoid space muscle malformation prevalence edema skin clinical examination ultrasound swelling cartilage ligament tendon anticoagulant therapy morbidity mortality scapula LA - English M3 - Conference Abstract N1 - L70230575 2010-08-13 PY - 2009 SN - 0020-7292 SP - S443-S444 ST - Case report: A case of thoracic outlet syndrome (TOS) in pregnancy T2 - International Journal of Gynecology and Obstetrics TI - Case report: A case of thoracic outlet syndrome (TOS) in pregnancy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70230575&from=export http://dx.doi.org/10.1016/S0020-7292(09)61603-9 VL - 107 ID - 761266 ER - TY - JOUR AB - BACKGROUND AND PURPOSE: Enhanced Recovery (ER) is a well-established multidisciplinary strategy in lower limb arthroplasty and was introduced in our department in May 2008. This retrospective study reviews short-term outcomes in a consecutive unselected series of 3,000 procedures (the "ER" group), and compares them to a numerically comparable cohort that had been operated on previously using a traditional protocol (the "Trad" group). METHODS: Prospectively collected data on surgical endpoints (length of stay (LOS), return to theater (RTT), re-admission, and 30- and 90-day mortality) and medical complications (stroke, gastrointestinal bleeding, myocardial infarction, and pneumonia within 30 days; deep vein thrombosis and pulmonary embolism within 60 days) were compared. Results ER included 1,256 THR patients and 1,744 TKR patients (1,369 THRs and 1,631 TKRs in Trad). The median LOS in the ER group was reduced (3 days vs. 6 days; p = 0.01). Blood transfusion rate was also reduced (7.6% vs. 23%; p < 0.001), as was RTT rate (p = 0.05). The 30-day incidence of myocardial infarction declined (0.4% vs. 0.9%; p = 0.03) while that of stroke, gastrointestinal bleeding, pneumonia, deep vein thrombosis, and pulmonary embolism was not statistically significantly different. Mortality at 30 days and at 90 days was 0.1% and 0.5%, respectively, as compared to 0.5% and 0.8% using the traditional protocol (p = 0.03 and p = 0.1, respectively). INTERPRETATION: This is the largest study of ER arthroplasty, and provides safety data on a consecutive unselected series. The program has achieved a statistically significant reduction in LOS and in cardiac ischemic events for our patients, with a near-significant decrease in return to theater and in mortality rates. AD - Department of Trauma and Orthopaedics , Northumbria Healthcare NHS Foundation Trust, Ashington, Northumberland , UK. AN - 24359028 AU - Khan, S. K. AU - Malviya, A. AU - Muller, S. D. AU - Carluke, I. AU - Partington, P. F. AU - Emmerson, K. P. AU - Reed, M. R. C2 - Pmc3940988 DA - Feb DO - 10.3109/17453674.2013.874925 DP - NLM ET - 2013/12/24 J2 - Acta orthopaedica KW - Aged Arthroplasty, Replacement, Hip/*adverse effects/methods/mortality/rehabilitation Arthroplasty, Replacement, Knee/*adverse effects/methods/mortality/rehabilitation Cardiovascular Diseases/etiology Clinical Protocols Delivery of Health Care/*organization & administration England/epidemiology Female Humans Length of Stay/statistics & numerical data Male Middle Aged Patient Care Team/organization & administration Patient Readmission/statistics & numerical data Perioperative Care/methods Program Evaluation Reoperation/statistics & numerical data Retrospective Studies Treatment Outcome LA - eng M1 - 1 N1 - 1745-3682 Khan, Sameer K Malviya, Ajay Muller, Scott D Carluke, Ian Partington, Paul F Emmerson, Kevin P Reed, Mike R Journal Article Multicenter Study Acta Orthop. 2014 Feb;85(1):26-31. doi: 10.3109/17453674.2013.874925. Epub 2013 Dec 20. PY - 2014 SN - 1745-3674 (Print) 1745-3674 SP - 26-31 ST - Reduced short-term complications and mortality following Enhanced Recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures T2 - Acta Orthop TI - Reduced short-term complications and mortality following Enhanced Recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures VL - 85 ID - 760406 ER - TY - JOUR AB - Background: Digital subtraction angiography (DSA) is a frequently used technique in the neurodiagnosis and treatment of cerebrovascular diseases. The routine use of femoral arterial sheaths (FAS) peri-procedurally has become standard. The maintenance of a FAS post-procedure may be warranted while awaiting the normalization of coagulopathy or to reaccess emergently. We retrospectively reviewed our stroke dataset to evaluate for complications associated with the prolonged use of FAS post-procedure. Methods: A retrospective chart review was performed over a five-month period, including adult patients admitted to the neuroscience intensive care unit (NSICU) following a neuro-endovascular procedure at a tertiary healthcare facility. The patients' age and sex along with catheter size, duration of sheath placement, coagulation status, usage of heparinized-saline, reuse of FAS for angiographic interventions, and closure technique employed when sheath was removed were recorded. FAS were maintained and evaluated by the neurocritical care team for vascular complications according to protocols. Furthermore, patients were categorized as delayed extubation when they remained intubated post-procedure. A spontaneous breathing trial was performed once FAS could be removed following evaluation. Data were expressed with descriptive statistics. Results: One hundred and seventy-eight neuro-endovascular procedures were reviewed. Fourteen patients in which the sheaths were left in place for a prolonged period of time after the procedure were identified with seven (50%) having complications. The most common complication was delayed extubation, which was noted in all seven of the patients with complications. Bleeding complications were noted in four (28.6%). None had thromboembolic complications. Only one FAS was reaccessed for the evaluation of vasospasm and the introduction of intra-arterial verapamil. There was a linear increase in complications with the duration the catheter remained in place after the procedure. Conclusion: The practice of keeping FAS in for a prolonged period of time following procedures should be evaluated given the association with direct and indirect complications and minimal need to reaccess the catheter after the procedure. AD - [Khan, Zalan; Nattanamai, Premkumar; Keerthivaas, Premkumar] Univ Missouri, Neurol, Columbia, MO 65211 USA. [Newey, Christopher R.] Cleveland Clin Ohio, Neurol, Cleveland, OH USA. Khan, Z (corresponding author), Univ Missouri, Neurol, Columbia, MO 65211 USA. zalankhan@live.com AN - WOS:000450936000096 AU - Khan, Z. AU - Nattanamai, P. AU - Keerthivaas, P. AU - Newey, C. R. C7 - e2230 DA - Feb DO - 10.7759/cureus.2230 J2 - Cureus KW - femoral sheath complications mechanical ventilation RETROPERITONEAL HEMORRHAGE CATHETERIZATION HEMATOMA Medicine, General & Internal LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: HB3FO Times Cited: 0 Cited Reference Count: 15 Khan, Zalan Nattanamai, Premkumar Keerthivaas, Premkumar Newey, Christopher R. 0 CUREUS INC PALO ALTO CUREUS PY - 2018 SP - 7 ST - An Evaluation of Complications in Femoral Arterial Sheaths Maintained Post-Neuroangiographic Procedures T2 - Cureus TI - An Evaluation of Complications in Femoral Arterial Sheaths Maintained Post-Neuroangiographic Procedures UR - ://WOS:000450936000096 VL - 10 ID - 761602 ER - TY - JOUR AB - OBJECTIVES: To investigate the invasive hemodynamics in patients with intermediate-risk pulmonary embolism (PE) and the change that occurs with catheter-directed thrombolysis (CDT). BACKGROUND: Intermediate-risk PE is associated with right ventricular strain and worse outcomes yet the invasive hemodynamics have not been well described. METHODS: Ninety-two consecutive patients with intermediate-risk PE referred for CDT at two tertiary medical centers with Pulmonary Embolism Response Teams were included in this prospective cohort study. Hemodynamics at baseline and after CDT therapy was measured. Patients with cardiac index (CI) ≤1.8 L min(-1) m(-2) were compared to those without shock (CI > 1.8). Linear regression analysis was performed to study the relationship between clinical variables and low CI. RESULTS: Thirty-seven out of 92 (40%) had a CI less than 1.8 L min(-1) m(-2) . When comparing the low CI to the normal CI groups, most demographics, vital signs, biomarkers, and PE severity index (PESI) scores were similar. The low CI group had more females and slightly lower systolic blood pressures although still in the normal range (122 vs. 132 mmHg, p = .026). Treatment with CDT was associated with significant improvement in CI, heart rate, and pulmonary artery pressures in both groups. Linear regression analysis did not reveal a strong correlation between CI and noninvasive metrics such as heart rate, blood pressure, or PESI score. CONCLUSIONS: Forty percent of patients with submassive PE had a depressed CI and treatment with CDT lead to hemodynamic improvements. Invasive hemodynamics may help better identify higher risk patients and guide therapy. AD - Perelman School of Medicine, Penn-Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. AN - 31498965 AU - Khandhar, S. J. AU - Mehta, M. AU - Cilia, L. AU - Palevsky, H. AU - Matthai, W. AU - Rivera-Lebron, B. AU - Toma, C. DA - Jan DO - 10.1002/ccd.28491 DP - NLM ET - 2019/09/10 J2 - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions KW - Adult Aged *Cardiac Catheterization Female Fibrinolytic Agents/administration & dosage *Hemodynamics/drug effects Humans Male Middle Aged Philadelphia Predictive Value of Tests Prospective Studies Pulmonary Embolism/*diagnosis/drug therapy/physiopathology Recovery of Function Thrombolytic Therapy Treatment Outcome *invasive hemodynamics *low cardiac output *right heart catheterization *submassive pulmonary embolism LA - eng M1 - 1 N1 - 1522-726x Khandhar, Sameer J Orcid: 0000-0003-1272-4164 Mehta, Mili Cilia, Lindsey Palevsky, Harold Matthai, William Rivera-Lebron, Belinda Toma, Catalin Journal Article Multicenter Study United States Catheter Cardiovasc Interv. 2020 Jan;95(1):13-18. doi: 10.1002/ccd.28491. Epub 2019 Sep 9. PY - 2020 SN - 1522-1946 SP - 13-18 ST - Invasive hemodynamic assessment of patients with submassive pulmonary embolism T2 - Catheter Cardiovasc Interv TI - Invasive hemodynamic assessment of patients with submassive pulmonary embolism VL - 95 ID - 760140 ER - TY - JOUR AB - The diabetic heel ulcer (DHU) represents a reconstructive challenge to clinicians and the multidisciplinary team alike. It is traditionally viewed as a condition that is inherently difficult to treat due to the intrinsic anatomical vulnerabilities of the heel. In addition to this, several factors are associated with poorer end outcomes – namely, that of major amputation. These include peripheral vascular disease, infection/osteomyelitis and the size of the ulcer itself. In light of the significant morbidity, economic burden and mortality seen in this cohort of patients, this review aims to explore current treatment modalities that have been undertaken. Literature in this field has mostly been confined to a handful of small case studies, some of which reflect novel, multimodal approaches, and promising results. Management with osteotomy, flap reconstruction and acellular dermal matrices, amongst other options, is covered within this review. AD - R. Khoo, Department of Plastic and Reconstructive Surgery, Fiona Stanley Hospital, Perth, WA, Australia AU - Khoo, R. AU - Jansen, S. DB - Embase Medline DO - 10.1111/iwj.12839 KW - amputation article calcaneus cohort analysis diabetic foot economic aspect emotion foot ulcer health care system heel human hyperbaric oxygen therapy infection morbidity mortality osteomyelitis peripheral vascular disease priority journal risk factor social aspect LA - English M1 - 2 M3 - Article N1 - L620681580 2018-02-19 2018-10-23 PY - 2018 SN - 1742-481X 1742-4801 SP - 205-211 ST - Slow to heel: a literature review on the management of diabetic calcaneal ulceration T2 - International Wound Journal TI - Slow to heel: a literature review on the management of diabetic calcaneal ulceration UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620681580&from=export http://dx.doi.org/10.1111/iwj.12839 VL - 15 ID - 760828 ER - TY - JOUR AB - Rationale Acute pulmonary embolism (PE) is a common diagnosis with high morbidity and mortality. The management of PE remains controversial with a variety of treatment options including anticoagulation alone, catheter-directed therapy, systemic thrombolytic therapy, surgical or suction embolectomy, IVC filter (IVCF) placement, or some combination. PE Response Teams (PERTs) are multidisciplinary teams that provide rapid, individualized care for PE patients. PERTs were first introduced in large academic centers and have been welldescribed in these settings, but less has been described about PERTs in community-based hospitals. With the growing adoption of PERTs, we aim to describe the initial experience of PERT implementation in a community-based hospital. Methods This study was conducted in a 320-bed community-based teaching hospital in Norwalk, CT, with internal medicine and radiology residencies, and pulmonary/critical care, sleep medicine, and gastroenterology fellowships. Norwalk Hospital provides standard anticoagulation, systemic thrombolytic therapy, catheter directed therapy (EKOS), and IVCF placement on-site. Surgical embolectomy or ECMO requires outside referral. Due to variations in PE management at our institution, a PERT was implemented in June 2017 to augment guideline-based management of PE patients. We conducted a retrospective chart review of all PERT activations since PERT implementation. Data including patient demographics, risk stratification, cardiac biomarkers, presence of right ventricular dysfunction, lactic acid, Bova score, and outcomes were recorded and compared to other published PERT experiences. Results A total of 27 PERT activations occurred over five months. Seventeen (63%) were activations for patients with intermediate-high or high-risk PE, ten (37%) were activations for patients with intermediate-low or low-risk PE. Eighteen (67%) patients were treated with anticoagulation alone, 4 (15%) were treated with EKOS, 4 (15%) were treated with systemic tPA, 1 (4%) was treated with IVCF only. Nine (33%) patients total received IVCFs. Patients with an elevated Bova score of 5/stage III generally required advanced therapy. There were 4 in-hospital deaths; these patients had high risk PE, cardiac arrest, and elevated Bova scores. Compared to larger academic institutions, we had a similar percentage of patients treated with anticoagulation alone, but fewer patients had embolectomy, half-dose tPA, or ECMO. We experienced no major bleeding complications. Conclusions Our experience suggests that PERTs can be successfully implemented in smaller community-based hospitals with similar treatment strategies to larger academic centers without an increase in adverse events. Further research is needed to compare outcomes based on available on-site therapies, and to assess improvement in guideline-based care of PE after PERT implementation. AD - A. Khosla, Pulmonary and Critical Care Fellow, Norwalk, CT, United States AU - Khosla, A. AU - Scatena, R. AU - Ahasic, A. M. DB - Embase KW - biological marker endogenous compound lactic acid tissue plasminogen activator adoption adult adverse event anticoagulation bleeding catheter clinical article complication conference abstract controlled study embolectomy female fibrinolytic therapy filter gastroenterology heart arrest heart right ventricle failure hospital mortality human intensive care lung embolism male medical record review patient referral practice guideline radiology retrospective study sleep medicine stratification surgery teaching hospital LA - English M1 - MeetingAbstracts M3 - Conference Abstract N1 - L622969948 2018-07-16 PY - 2018 SN - 1535-4970 ST - Do pulmonary embolism response teams (perts) Have a Role in Community Based Hospitals? A Five Month Community Based PERT Experience T2 - American Journal of Respiratory and Critical Care Medicine TI - Do pulmonary embolism response teams (perts) Have a Role in Community Based Hospitals? A Five Month Community Based PERT Experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622969948&from=export VL - 197 ID - 760872 ER - TY - JOUR AB - BACKGROUND: The impact of reducing door-to-balloon time on hospital revenues, costs, and net income is unknown. METHODS: We prospectively determined the impact on hospital finances of (1) emergency department physician activation of the catheterization lab and (2) immediate transfer of the patient to an immediately available catheterization lab by an in-house transfer team consisting of an emergency department nurse, a critical care unit nurse, and a chest pain unit nurse. We collected financial data for 52 consecutive ST-elevation myocardial infarction patients undergoing emergency percutaneous intervention from October 1, 2004-August 31, 2005 and compared this group to 80 consecutive ST-elevation myocardial infarction patients from September 1, 2005-June 26, 2006 after protocol implementation. RESULTS: Per hospital admission, insurance payments (hospital revenue) decreased ($35,043 +/- $36,670 vs. $25,329 +/- $16,185, P = 0.039) along with total hospital costs ($28,082 +/- $31,453 vs. $18,195 +/- $9,242, P = 0.009). Hospital net income per admission was unchanged ($6962 vs. $7134, P = 0.95) as the drop in hospital revenue equaled the drop in costs. For every $1000 reduction in total hospital costs, insurance payments (hospital revenue) dropped $1077 for private payers and $1199 for Medicare/Medicaid. A decrease in hospital charges ($70,430 +/- $74,033 vs. $53,514 +/- $23,378, P = 0.059), diagnosis related group relative weight (3.7479 +/- 2.6731 vs. 2.9729 +/- 0.8545, P = 0.017) and outlier payments with hospital revenue>$100,000 (7.7% vs. 0%, P = 0.022) all contributed to decreasing ST-elevation myocardial infarction hospitalization revenue. One-year post-discharge financial follow-up revealed similar results: Insurance payments: $49,959 +/- $53,741 vs. $35,937 +/- $23,125, P = 0.044; Total hospital costs: $39,974 +/- $37,434 vs. $26,778 +/- $15,561, P = 0.007; Net Income: $9984 vs. $9159, P = 0.855. CONCLUSION: All of the financial benefits of reducing door-to-balloon time in ST-elevation myocardial infarction go to payers both during initial hospitalization and after one-year follow-up. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT00800163. AD - Indiana Heart Physicians, Indianapolis, Indiana, USA. khot@cvresearch.net AN - 19631001 AU - Khot, U. N. AU - Johnson-Wood, M. L. AU - Geddes, J. B. AU - Ramsey, C. AU - Khot, M. B. AU - Taillon, H. AU - Todd, R. AU - Shaikh, S. R. AU - Berg, W. J. C2 - Pmc2731056 DA - Jul 26 DO - 10.1186/1471-2261-9-32 DP - NLM ET - 2009/07/28 J2 - BMC cardiovascular disorders KW - Angioplasty, Balloon, Coronary/*economics Cost-Benefit Analysis Emergency Service, Hospital/*economics *Hospital Charges *Hospital Costs Humans Insurance, Health, Reimbursement Length of Stay/economics Medicaid/economics Medicare/economics Myocardial Infarction/*economics/*therapy Patient Admission/economics Patient Care Team/*economics Patient Transfer/*economics Prospective Studies Quality of Health Care/*economics Time Factors Treatment Outcome United States LA - eng N1 - 1471-2261 Khot, Umesh N Johnson-Wood, Michele L Geddes, Jason B Ramsey, Curtis Khot, Monica B Taillon, Heather Todd, Randall Shaikh, Saeed R Berg, William J Clinical Trial Journal Article Research Support, Non-U.S. Gov't BMC Cardiovasc Disord. 2009 Jul 26;9:32. doi: 10.1186/1471-2261-9-32. PY - 2009 SN - 1471-2261 SP - 32 ST - Financial impact of reducing door-to-balloon time in ST-elevation myocardial infarction: a single hospital experience T2 - BMC Cardiovasc Disord TI - Financial impact of reducing door-to-balloon time in ST-elevation myocardial infarction: a single hospital experience VL - 9 ID - 760434 ER - TY - JOUR AB - BACKGROUND: The use of emergency medical services (EMS) and notification to hospitals by paramedics for patients with suspected stroke are crucial determinants in reducing delay time to acute stroke treatment. The aim of this study is to investigate whether EMS use and prehospital notification (PN) can shorten the time to thrombolytic therapy in a stroke center with a systemized stroke code program. METHODS: Beginning in January 2012, stroke experts in our stroke center received direct calls via mobile phone from paramedics prenotifying the transport of patients with suspected stroke. We compared baseline characteristics and prehospital/in-hospital delay time in stroke patients treated with intravenous recombinant tissue plasminogen activator for 44 months with and without EMS use and/or PN. RESULTS: Intravenous thrombolytic therapy was performed on 274 patients. Of those patients, 215 (78.5%) were transported to the hospital via EMS and 59 (21.5%) were admitted via private modes of transportation. The patients who used EMS had shorter median onset-to-arrival times (62 minutes versus 116 minutes, P < .001). There was no difference in in-hospital delay time between the 2 groups. In 28 cases (13%) of EMS transport, EMS personnel called the clinical staff to notify the incoming patient. Prenotification by EMS was associated with shorter median door-to-imaging time (9 minutes versus 12 minutes, P = .045) and door-to-needle time (20 minutes versus 29 minutes, P = .011). CONCLUSIONS: We found that EMS use reduces prehospital delay time. However, EMS use without prenotification does not shorten in-hospital processing time in a stroke center with a systemized stroke code program. AD - Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea; Department of Neurology, College of Medicine, Dong-A University, Busan, Republic of Korea. Electronic address: kdh6542@hanmail.net. Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea; Department of Neurology, College of Medicine, Dong-A University, Busan, Republic of Korea. Busan-Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea. AN - 27067887 AU - Kim, D. H. AU - Nah, H. W. AU - Park, H. S. AU - Choi, J. H. AU - Kang, M. J. AU - Huh, J. T. AU - Cha, J. K. DA - Jul DO - 10.1016/j.jstrokecerebrovasdis.2016.02.011 DP - NLM ET - 2016/04/14 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Aged Ambulances Cell Phone *Delivery of Health Care, Integrated *Emergency Medical Services Female Fibrinolytic Agents/*administration & dosage Humans Infusions, Intravenous Male Middle Aged Patient Care Team Program Evaluation Recombinant Proteins/administration & dosage Republic of Korea Retrospective Studies Stroke/diagnosis/*drug therapy/physiopathology *Thrombolytic Therapy Time Factors *Time-to-Treatment Tissue Plasminogen Activator/*administration & dosage Treatment Outcome *Stroke *door-to-needle time *emergency medicine *prenotification *thrombolysis LA - eng M1 - 7 N1 - 1532-8511 Kim, Dae-Hyun Nah, Hyun-Wook Park, Hyun-Seok Choi, Jae-Hyung Kang, Myong-Jin Huh, Jae-Taeck Cha, Jae-Kwan Comparative Study Journal Article United States J Stroke Cerebrovasc Dis. 2016 Jul;25(7):1665-1670. doi: 10.1016/j.jstrokecerebrovasdis.2016.02.011. Epub 2016 Apr 7. PY - 2016 SN - 1052-3057 SP - 1665-1670 ST - Impact of Prehospital Intervention on Delay Time to Thrombolytic Therapy in a Stroke Center with a Systemized Stroke Code Program T2 - J Stroke Cerebrovasc Dis TI - Impact of Prehospital Intervention on Delay Time to Thrombolytic Therapy in a Stroke Center with a Systemized Stroke Code Program VL - 25 ID - 760386 ER - TY - JOUR AB - Hepatocellular carcinoma (HCC) of intermediate stage consists of diverse tumor and patient factors in terms of tumor number, size and liver function resulting in various outcomes given by transarterial chemoembolization (TACE). Transarterial radioembolization (TARE) using radioactive isotope, β-ray emitting Yttrium-90 with a short half-life and penetration depth, is an emerging intra-arterial brachytherapy characterized by potent anti-cancer effect given by radiation but minimal embolic effect. Although there is lack of study directly comparing the efficacy and safety between TACE and TARE in patients with unresectable HCC, several retrospective or small-scaled studies suggest that overall efficacy indicated by overall survival and time to progression is similar between two modalities and TARE has a superiority in the safety including postembolization syndrome, hospitalization days and outpatient-based therapy. In advanced HCC with portal vein (PV) invasion, TACE is not consistently recommended due to risk of hepatic decompensation or failure after procedure. On the contrary, available data suggest that TARE might be a promising treatment option in HCC with PV thrombosis if patient's liver function is preserved and the level of PV invasion is less than main trunk. Ongoing trials comparing TARE and sorafenib in advanced HCC would elucidate the role of this locoregional therapy. The need of a multidisciplinary team, complex steps of procedure and high cost of TARE are the hurdles to widespread recommendation of this therapy in intermediate or advanced HCC. The optimization of selection between TACE and TARE might be dependent on availability, experience, tumor factors and patient factors. AD - Department of Internal Medicine, Yonsei Liver Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. Department of Internal Medicine, Yonsei Liver Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. gihankhys@yuhs.ac. AN - 27126821 AU - Kim, D. Y. AU - Han, K. H. DA - Nov DO - 10.1007/s12072-016-9722-9 DP - NLM ET - 2016/10/28 J2 - Hepatology international KW - Brachytherapy/*methods Carcinoma, Hepatocellular/*therapy Chemoembolization, Therapeutic/*methods Clinical Trials as Topic Disease Progression Female Humans Liver Neoplasms/*therapy Male Patient Selection Retrospective Studies Treatment Outcome Yttrium Radioisotopes/*therapeutic use Hepatocellular carcinoma Transarterial chemoembolization Transarterial radioembolization LA - eng M1 - 6 N1 - 1936-0541 Kim, Do Young Han, Kwang-Hyub Comparative Study Journal Article Review United States Hepatol Int. 2016 Nov;10(6):883-892. doi: 10.1007/s12072-016-9722-9. Epub 2016 Apr 28. PY - 2016 SN - 1936-0533 SP - 883-892 ST - Transarterial chemoembolization versus transarterial radioembolization in hepatocellular carcinoma: optimization of selecting treatment modality T2 - Hepatol Int TI - Transarterial chemoembolization versus transarterial radioembolization in hepatocellular carcinoma: optimization of selecting treatment modality VL - 10 ID - 760338 ER - TY - JOUR AB - Background: Best practice recommendations are lacking. Thus far, literature has described pharmacist-led DOAC monitoring. Objective: The purpose of this study is to describe a DOAC monitoring program involving pharmacy students. Methods: This was an observational analysis of a quality improvement initiative. A clinical pharmacist preceptor identified clinic patients taking DOACs by running a report using the electronic medical record. Pharmacy students conducted chart reviews, called pharmacies for 6-month refill histories, and interviewed and educated patients. Findings were communicated to the care team and interventions were performed as applicable with the preceptor. Results: Of 90 patients included, the mean age was 63 years, 54% were female, and 65.6% were black or African American. Rivaroxaban and apixaban were used most commonly. Sixty-two percent of DOACs were prescribed for atrial fibrillation/flutter, while 32.2% for venous thromboembolism. The mean MPR was 77.1%, with 27.7% of patients having an MPR ≤60%. Of the 136 student-led interventions, 25.2% involved medication access, 24.4% adherence education, 20.7% processing refills, 14.8% laboratory monitoring recommendations, 8.9% switching or recommending switching to another anticoagulant, and 4.4% stopping a nonsteroidal anti-inflammatory drug or aspirin. Conclusion: Pharmacy students can help to ensure medication safety and effective use of DOACs. AD - Greensboro Area Health Education Center, Greensboro, NC, USA Cone Health, Greensboro, NC, USA University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA UNC School of Medicine, Chapel Hill, NC, USA AN - 131838685. Language: English. Entry Date: 20180924. Revision Date: 20191111. Publication Type: Article AU - Kim, Jennifer J. AU - Hill, Hailey L. AU - Groce, James B. AU - Granfortuna, James M. AU - Makhlouf, Tanya K. DB - CINAHL DO - 10.1177/0897190017752713 DP - EBSCOhost KW - Students, Pharmacy Anticoagulants -- Administration and Dosage Drug Monitoring Program Evaluation Human Nonexperimental Studies Quality Improvement Pharmacists Electronic Health Records Interviews Patient Education Communication Preceptorship Middle Age Female Male Black Persons Rivaroxaban -- Therapeutic Use Atrial Fibrillation -- Drug Therapy Venous Thromboembolism -- Drug Therapy Atrial Flutter -- Drug Therapy Education, Pharmacy Drug Substitution Treatment Outcomes Patient Safety Medication Compliance M1 - 5 N1 - research; tables/charts. Journal Subset: Biomedical; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 8900945. PY - 2018 SN - 0897-1900 SP - 462-468 ST - Pharmacy Student Monitoring of Direct Oral Anticoagulants T2 - Journal of Pharmacy Practice TI - Pharmacy Student Monitoring of Direct Oral Anticoagulants UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=131838685&site=ehost-live&scope=site VL - 31 ID - 761361 ER - TY - JOUR AB - OBJECTIVE: Posterior cerebral artery (PCA) aneurysms are rare and often challenging to manage. Since Drake's historical report regarding PCA aneurysms, there has been limited additional information on recent advancements in either microsurgical or endovascular tools. We report a series of 25 consecutive cases and attempt to extrapolate useful information for managing PCA aneurysms. METHODS: A total of 25 cases of PCA aneurysm that were treated either by microsurgical or endovascular methods were selected and retrospectively reviewed. The clinical data, radiographic findings, and outcomes associated with the treatment modality were analysed. RESULTS: The case series included 13 women and 12 men with a mean age of 52 years, ranging from 11 to 75 years. Fourteen aneurysms were ruptured, 7 aneurysms caused a direct mass effect, and the remaining 4 aneurysms were found incidentally. Most aneurysms were located in the P1 through P2A segment of the PCA (19 aneurysms, 76%). Seven aneurysms (28%) were large-giant in size (>20 mm), 4 of which had a thrombosed sac. Microsurgical treatment was the primary treatment in 15 aneurysms, including 9 successful direct clip ligations, 3 aneurysms that were surgically trapped without a bypass, and 2 wrapped aneurysms. One giant thrombosed aneurysm was incompletely clipped; subsequently, the large remnant was coil-embolised. Endovascular coil embolisation was performed for 6 aneurysms, stent-assisted coil embolisation was performed for 2 aneurysms, and 2 aneurysms were treated by endovascular occlusion of the parent artery. Permanent deficits acquired after treatment included limb weakness, palsy of the third cranial nerve, and hemianopsia in 5 cases (20%). There was no mortality. Overall, 22 patients (88%) showed favourable clinical outcomes according to the modified Rankin Scale Score (≤2) at the mean clinical follow-up period of 43.2 months (range: 2-130 months). CONCLUSIONS: The present case series suggests that treating PCA aneurysms with microsurgical or endovascular options can achieve a comparable outcome when a judicious decision is made. Endovascular treatment had excellent anatomical and clinical outcomes for non-mass compressing, non-giant, saccular aneurysms. Given the propensity for the large-giant, dysplastic nature of PCA aneurysms to develop in younger patients, microsurgical competence should be maintained. Along with careful evaluation of the anatomic collaterals over the PCA territory, therapeutic parent artery sacrifice may be an appropriate option without adding bypass. AD - Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea. AN - 23910998 AU - Kim, Y. B. AU - Lee, J. W. AU - Huh, S. K. AU - Kim, B. M. AU - Kim, D. J. DA - Oct DO - 10.1016/j.clineuro.2013.07.004 DP - NLM ET - 2013/08/06 J2 - Clinical neurology and neurosurgery KW - Adolescent Adult Aged Cerebral Angiography Child Embolization, Therapeutic Female Follow-Up Studies Humans Intracranial Aneurysm/surgery/*therapy Magnetic Resonance Angiography Male Microsurgery Middle Aged Neurosurgical Procedures Patient Care Team *Posterior Cerebral Artery Retrospective Studies Treatment Outcome Young Adult Cerebral aneurysm Coil embolisation Parent artery occlusion Posterior cerebral artery LA - eng M1 - 10 N1 - 1872-6968 Kim, Yong Bae Lee, Jae Whan Huh, Seung-Kon Kim, Byung Moon Kim, Dong Jun Journal Article Netherlands Clin Neurol Neurosurg. 2013 Oct;115(10):2062-8. doi: 10.1016/j.clineuro.2013.07.004. Epub 2013 Jul 30. PY - 2013 SN - 0303-8467 SP - 2062-8 ST - Outcomes of multidisciplinary treatment for posterior cerebral artery aneurysms T2 - Clin Neurol Neurosurg TI - Outcomes of multidisciplinary treatment for posterior cerebral artery aneurysms VL - 115 ID - 760285 ER - TY - JOUR AB - Restrictive transfusion thresholds are safe, reduce potentially hazardous exposure to blood and lead to significant cost savings. We have previously shown that a clinical decision support system (CDSS) aids adherence to a restrictive transfusion policy. Here, we demonstrate that daily review of transfusions flagged as inappropriate by the CDSS can be used to monitor compliance with hospital transfusion guidelines and allows real-time education of clinicians. For two months, a multidisciplinary team of transfusion specialists reviewed CDSS alerts for RBC and platelet prescriptions discordant with CDSS advice. Alerts were triggered if a clinician attempted to prescribe blood products outside nationally agreed guidelines (for example an Hb of > 70 g/L or a platelet count > 10x109/L). In order to avoid delays in blood provision, the system allows prescription of blood in any circumstance, but if an alert was triggered and overridden, clinicians had to provide written justification. For orders where there wasn't a clear rationale for transfusion, electronic patient records (EPR) were reviewed, followed by contacting of the clinician via internal email if justification could not be found. 205 Red Blood Cell (RBC) and 79 Platelet (Plt) transfusions were flagged as inappropriate in November and December, 2018. Following removal of duplicate requests and outpatient prescriptions, 104 RBC and 51 platelet transfusions required further clarification. Review of EPR and the information accompanying the request allowed 76/104 (73%) RBC transfusions to be judged as clinically necessary. Common reasons included active bleeding (35/76, 46%), a recent point of care test or laboratory test lower than the transfusion threshold (14/76, 18%), pre-operative anaemia (13/76, 17%) and a higher transfusion threshold (80 g/L) because of cardiac disease (6/ 76, 8%). 28/104 (27%) RBC transfusions appeared inappropriate after EPR review and required email clarification with clinicians. 23/ 28 (82%) of prescribing clinicians responded; this allowed 7 to be classified as clinically necessary, leaving 21/104 (20%) RBC transfusions as inappropriate, including non-respondents. These clinicians were provided with further education about good transfusion practice. Of the 51 Plt transfusions, 48/51 (94%) were judged as clinically necessary following review of EPR and information accompanying the request. Common reasons included active bleeding with a platelet count < 50x109/L (27/48, 56%), a surgical or invasive procedure with a platelet count < 50x109/L (17/48, 35%) and a venous thromboembolism requiring anticoagulation with a platelet count < 50x109/L (23%). Email clarification allowed 2/3 Plt transfusions to be judged as clinically necessary, leaving 1/51 (2%) as inappropriate. Average daily time for review and follow-up of all transfusions was typically between 30 and 60 minutes. In conclusion, we demonstrate that daily review of blood product prescriptions flagged as inappropriate by a CDSS is an efficient way of identifying inappropriate transfusions. 20% of RBC transfusions flagged by the CDSS were shown to be inappropriate after further investigation. Internal email contact to clarify clinically dubious RBC transfusion orders had a high response rate and allows targeted education. Plt transfusions at this centre are almost always indicated; this is presumably because they are either prescribed by haematologists or discussed with haematologists prior to prescription. AD - A. King, Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom AU - King, A. AU - Polzella, P. AU - Salisbury, R. AU - Staples, S. AU - Staves, J. AU - Bakhishli, G. AU - Murphy, M. DB - Embase DO - 10.1111/bjh.15854 KW - adult anemia anticoagulation bleeding clinical decision support system clinician conference abstract e-mail education electronic health record electronic patient record erythrocyte transfusion follow up heart disease hematologist hospital patient human human cell invasive procedure laboratory test monitoring multidisciplinary team outpatient platelet count practice guideline preoperative evaluation prescription surgery thrombocyte transfusion venous thromboembolism LA - English M3 - Conference Abstract N1 - L627189911 2019-04-17 PY - 2019 SN - 1365-2141 SP - 147-148 ST - A clinical decision support system allows realtime monitoring of compliance to hospital transfusion guidelines and immediate education regarding inappropriate inpatient transfusions T2 - British Journal of Haematology TI - A clinical decision support system allows realtime monitoring of compliance to hospital transfusion guidelines and immediate education regarding inappropriate inpatient transfusions UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627189911&from=export http://dx.doi.org/10.1111/bjh.15854 VL - 185 ID - 760743 ER - TY - JOUR AB - Pulmonary embolism (PE) has the potential to block the blood supply to the lungs, which results in life threatening or disabling sequelae. The high morbidity and high incidence of this disease also place a heavy economic burden on the healthcare system. Patients who develop PE require rapid diagnosis and access to providers who can identify individualized treatment plans. Thus, a multidisciplinary approach to the diagnosis and treatment of patients who present at the hospital with submassive or massive PE is needed. Massachusetts General Hospital (MGH) published a successful implementation of a multidisciplinary response team for the management of submassive and massive PE. The goal of this project was to determine the effectiveness of a such a team for PE in a large teaching hospital in the mid-Atlantic region, and a team of practitioners and support personnel developed a pulmonary embolism response team (PERT) that would become the standard of practice in the organization for all patients who presented with submassive and massive PE. A guiding team of experts was formed to customize the design of the PERT consult using current science and evidence-based practice. Clinical tools were developed to help clinicians use the guidelines successfully, and a "soft go live" of the PERT consult was initiated. Post implementation analysis indicated that the program was successful when the team used the consult and care set developed. Implementation of current science requires necessary time and resources. These processes can be customized and adopted by other organizations with appropriate guidance from experts in the field of study and effective coordination of plans. AN - 123296033. Language: English. Entry Date: 20180427. Revision Date: 20191120. Publication Type: Abstract AU - Kitts, Cheryl-Lynne DB - CINAHL DP - EBSCOhost KW - Pulmonary Embolism -- Diagnosis Pulmonary Embolism -- Therapy Multidisciplinary Care Team Venous Thromboembolism Human Mid Atlantic Region Medical Practice, Evidence-Based Clinical Assessment Tools Academic Medical Centers Practice Guidelines N1 - research; doctoral dissertation. PY - 2017 SN - 9781369435634 SP - 1-1 ST - Implementing a Pulmonary Embolism Response Team to Improve Coordination of Care for Patients with Venous Thromboembolism T2 - Implementing a Pulmonary Embolism Response Team to Improve Coordination of Care for Patients with Venous Thromboembolism TI - Implementing a Pulmonary Embolism Response Team to Improve Coordination of Care for Patients with Venous Thromboembolism UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=123296033&site=ehost-live&scope=site ID - 761339 ER - TY - JOUR AB - BACKGROUND: The outcome of stroke patients can be improved by a rapid initiation of thrombolytic therapy. Here, we sought to determine whether an additional simple but thorough case-based discussion of recent thrombolysed cases with the entire neurologic staff can improve the door-to-needle time without changes to the implemented stroke protocol. METHODS: For every performed thrombolysis, a route card, consisting of a timeline with 3 time points and target times, had to be completed by the attending neurologist. Times and reasons for delays were noted. All thrombolysed cases were then reviewed in a 14-day-rhythm with the entire neurologic staff. The responsible stroke consultant gave details and reasons for delays. Possibilities to avoid delays were then discussed with the whole team. All thrombolyses were prospectively recorded and compared with thrombolyses of the 2 preinterventional years. The primary outcome parameter was the door-to-needle time. RESULTS: The door-to-needle time decreased from 37 minutes in the preintervention period (N = 154) to 28 minutes during the intervention (N = 97; P < .001). Performance was improved for residents (<6 years of neurologic training) as well as for the specialists (>6 years of neurologic training). Improvements in the performance of specialists were significantly greater than those of residents. CONCLUSIONS: The present study demonstrates improved treatment of stroke patients by a simple, non-time-consuming intervention that combines education with a potential increase in staff motivation. This intervention is effective in a tertiary academic stroke center with a previously implemented sophisticated stroke protocol but should also improve treatment delays in primary stroke centers. AD - Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany. Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Biomagnetic Center, University Hospital, Germany. Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany; Biomagnetic Center, University Hospital, Germany. Electronic address: carsten.klingner@med.uni-jena.de. AN - 30598329 AU - Klingner, C. AU - Günther, A. AU - Brodoehl, S. AU - Witte, O. W. AU - Klingner, C. M. DA - Apr DO - 10.1016/j.jstrokecerebrovasdis.2018.12.002 DP - NLM ET - 2019/01/02 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Aged Aged, 80 and over Attitude of Health Personnel Drug Administration Schedule Education, Medical, Continuing Education, Medical, Graduate Female Fibrinolytic Agents/*administration & dosage Health Knowledge, Attitudes, Practice Humans Inservice Training Internship and Residency Interpersonal Relations Male Middle Aged Motivation *Neurologists/education Patient Care Team *Practice Patterns, Physicians' Prospective Studies Quality Improvement Stroke/diagnosis/*drug therapy/physiopathology Thrombolytic Therapy/*methods Time Factors *Time-to-Treatment Treatment Outcome Stroke management door-to-needle education t-PA thrombolysis LA - eng M1 - 4 N1 - 1532-8511 Klingner, Caroline Günther, Albrecht Brodoehl, Stefan Witte, Otto W Klingner, Carsten M Journal Article United States J Stroke Cerebrovasc Dis. 2019 Apr;28(4):876-881. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.002. Epub 2018 Dec 28. PY - 2019 SN - 1052-3057 SP - 876-881 ST - Talk About Thrombolysis. Regular Case-Based Discussions of Stroke Thrombolysis Improve Door-to-Needle Time by 20 T2 - J Stroke Cerebrovasc Dis TI - Talk About Thrombolysis. Regular Case-Based Discussions of Stroke Thrombolysis Improve Door-to-Needle Time by 20 VL - 28 ID - 760353 ER - TY - JOUR AB - Systemic lupus erythematosus (SLE) is a chronic, multisystem autoimmune disease predominantly affecting women, particularly those of childbearing age. SLE provides challenges in the prepregnancy, antenatal, intrapartum, and postpartum periods for these women, and for the medical, obstetric, and midwifery teams who provide their care. As with many medical conditions in pregnancy, the best maternal and fetal-neonatal outcomes are obtained with a planned pregnancy and a cohesive multidisciplinary approach. Effective prepregnancy risk assessment and counseling includes exploration of factors for poor pregnancy outcome, discussion of risks, and appropriate planning for pregnancy, with consideration of discussion of relative contraindications to pregnancy. In pregnancy, early referral for hospital-coordinated care, involvement of obstetricians and rheumatologists (and other specialists as required), an individual management plan, regular reviews, and early recognition of flares and complications are all important. Women are at risk of lupus flares, worsening renal impairment, onset of or worsening hypertension, preeclampsia, and/or venous thromboembolism, and miscarriage, intrauterine growth restriction, preterm delivery, and/or neonatal lupus syndrome (congenital heart block or neonatal lupus erythematosus). A cesarean section may be required in certain obstetric contexts (such as urgent preterm delivery for maternal and/or fetal well-being), but vaginal birth should be the aim for the majority of women. Postnatally, an ongoing individual management plan remains important, with neonatal management where necessary and rheumatology followup. This article explores the challenges at each stage of pregnancy, discusses the effect of SLE on pregnancy and vice versa, and reviews antirheumatic medications with the latest guidance about their use and safety in pregnancy. Such information is required to effectively and safely manage each stage of pregnancy in women with SLE. AD - [Nelson-Piercy, Catherine] Kings Coll London, Womens Hlth Acad Ctr, Div Womens Hlth, Westminster Bridge Rd, London SE1 7EH, England. [Nelson-Piercy, Catherine] St Thomas Hosp, Kings Hlth Partners, Westminster Bridge Rd, London SE1 7EH, England. Nelson-Piercy, C (corresponding author), Kings Coll London, Womens Hlth Acad Ctr, Div Womens Hlth, Westminster Bridge Rd, London SE1 7EH, England.; Nelson-Piercy, C (corresponding author), St Thomas Hosp, Kings Hlth Partners, Westminster Bridge Rd, London SE1 7EH, England. catherine.nelson-piercy@gstt.nhs.uk AN - WOS:000396559000001 AU - Knight, C. L. AU - Nelson-Piercy, C. DO - 10.2147/oarrr.s87828 J2 - Open Access Rehumatol. KW - systemic lupus erythematosus preconception counseling medication management of pregnancy pregnancy complications neonatal lupus CONGENITAL HEART-BLOCK MULTIETHNIC US COHORT NEONATAL LUPUS INTRAVENOUS IMMUNOGLOBULIN WOMEN RISK PREECLAMPSIA NEPHRITIS DISEASE FETAL Rheumatology LA - English M3 - Review N1 - ISI Document Delivery No.: EO2XJ Times Cited: 23 Cited Reference Count: 86 Knight, Caroline L. Nelson-Piercy, Catherine National Institute for Health ResearchNational Institute for Health Research (NIHR) [2927] Funding Source: Researchfish 30 2 7 DOVE MEDICAL PRESS LTD ALBANY OPEN ACCESS RHEUMATO PY - 2017 SN - 1179-156X SP - 37-53 ST - Management of systemic lupus erythematosus during pregnancy: challenges and solutions T2 - Open Access Rheumatology-Research and Reviews TI - Management of systemic lupus erythematosus during pregnancy: challenges and solutions UR - ://WOS:000396559000001 VL - 9 ID - 761679 ER - TY - JOUR AB - Learning Objectives: Failure-to-rescue (FTR) events are defined as complications leading to mortality in surgical patients and are tracked as patient safety indicators. Hospitals that utilize Rapid Response Teams (RRT) have shown decreased rates of respiratory and cardiac arrest outside ICUs but data is insufficient to show mortality reduction, particularly in post-operative patients. We analyzed clinical characteristics of surgical patients with RRT activations and subsequent FTRs, to identify potential opportunities for mortality prevention. Methods: Mortalities on patients with RRT activations within 30-days of surgery were analyzed from August 2012 to December 2014 at a large academic medical center. Data collected included demographics, type of surgery, physiologic variables, and reasons for RRT and FTR events. All cause mortality, ICU length of stay (LOS) and total hospital costs were determined. Results: 223 patients had RRT activations within 30-days of a surgical procedure. Of these, 47 had FTR events leading to mortality (21.2%). 21 were excluded due to incomplete data. The 26 patients included for analysis had procedures involving general surgery (53.8%), neurosurgery (19.2%), thoracic (11.5%), or orthopedics (7.7%). The most common reasons for RRT activations were respiratory events (34.6%), altered mental status (26.9%) and hypotension (23.1%). FTR related mortality events were associated with sepsis (61.5%), acute renal failure (50%), pneumonia (46.2%), neurologic complications (38.5%), deep vein thrombosis/pulmonary embolism (23.1%), shock/cardiac arrest (19.2%), and GI bleed (19.2%). Average ICU LOS was 16 days with an average total cost per patient of $176,021. Conclusions: FTR events leading to mortality are relatively common in surgical patients who undergo RRT activations. The majority of activations are related to respiratory events and altered mental status. Further analysis comparing survivors and non-survivors after RRT activations is recommended to better understand risk factors for deterioration and FTR. AD - A. Ko AU - Ko, A. AU - Aquino, L. AU - Seferian, E. AU - Grant, G. AU - Alban, R. DB - Embase DO - 10.1097/01.ccm.0000474659.85059.0b KW - intensive care surgical patient human rapid response team society mortality patient mental health surgery survivor hypotension university hospital orthopedics neurosurgery general surgery prevention procedures deterioration surgical technique heart arrest hospital cost vein sepsis hospital neurological complication pneumonia embolism acute kidney failure risk factor length of stay patient safety learning LA - English M1 - 12 M3 - Conference Abstract N1 - L72102351 2015-12-10 PY - 2015 SN - 0090-3493 SP - 209 ST - Failure to rescue after rapid response team activations in surgical patients T2 - Critical Care Medicine TI - Failure to rescue after rapid response team activations in surgical patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72102351&from=export http://dx.doi.org/10.1097/01.ccm.0000474659.85059.0b VL - 43 ID - 761050 ER - TY - JOUR AB - Background and PurposeExperienced multidisciplinary stroke team and well-organized hospital management are considered necessary to achieve good results after mechanical thrombectomy (MT) in acute ischemic stroke patients. We analyzed the technical results of MT performed in the Czech Republic in the year 2016 to provide relevant data for further quality improvement.Material and MethodsAll centers performing MT in the CR were called for detailed technical and clinical data from year 2016, which were anonymously analyzed and relevant technical key time intervals were compared. Clinical outcomes were assessed according to the HERMES meta-analysis.ResultsIn the 2016, 1053 MTs were performed in the CR. Of 15 dedicated centers, the data from 12 centers and from 886 (84%) patients (49.2% males, mean age 69.812.3years) were analyzed. The overall median of time from hospital arrival to groin puncture (GP) was 77min with a range from 40 to 109min among individual hospitals, from GP to first passage of stent retriever 20 (15-40) min and from GP to maximal reached recanalization 42 (33-80) min. The median of recanalization time was 240 (219-320) min. The recanalization (TICI 2b-3) was achieved in 81.7% of patients, 44.1% of patients had a good 3-month clinical outcome and 6.3% suffered from symptomatic intracerebral hemorrhage. Peri-procedural complications were recorded in 89 (10%) patients.Conclusion Despite achieved good overall results, a great variability in some of the analyzed key time intervals among individual centers performing MT warrants further quality improvement. AD - [Kocher, Martin] Palacky Univ, Med Sch & Hosp, Comprehens Stroke Ctr, Dept Radiol, Olomouc, Czech Republic. [Sanak, Daniel] Palacky Univ, Med Sch & Hosp, Comprehens Stroke Ctr, Dept Neurol, IP Pavlova 6, Olomouc 77520, Czech Republic. [Zapletalova, Jana] Palacky Univ, Med Sch, Dept Med Biophys & Stat, Olomouc, Czech Republic. [Cihlar, Filip] Masaryk Hosp Usti Nad Labem, Dept Radiol, Usti Nad Labem, Czech Republic. [Czerny, Daniel] Univ Ostrava, Fac Med, Dept Radiol, Ostrava, Czech Republic. [Czerny, Daniel] Univ Hosp, Ostrava, Czech Republic. [Cernik, David] Masaryk Hosp Usti Nad Labem, Dept Neurol, Usti Nad Labem, Czech Republic. [Duras, Petr; Rohan, Vladimir] Charles Univ Prague, Univ Hosp Plzen, Fac Med, Dept Radiol, Plzen, Czech Republic. [Endrych, Ladislav] Hosp Liberec, Dept Radiol, Liberec, Czech Republic. [Herzig, Roman; Lojik, Miroslav] Charles Univ Prague, Fac Med, Dept Neurol, Hradec Kralove, Czech Republic. [Herzig, Roman; Lojik, Miroslav] Univ Hosp, Hradec Kralove, Czech Republic. [Lacman, Jiri; Sramek, Martin] Cent Mil Univ Hosp Prague, Dept Radiol, Prague, Czech Republic. [Rohan, Vladimir] Charles Univ Prague, Univ Hosp Plzen, Fac Med, Dept Neurol, Plzen, Czech Republic. [Ostry, Svatopluk] Hosp Ceske Budejovice, Dept Neurol, Ceske Budejovice, Czech Republic. [Padr, Radek] Charles Univ Prague, Univ Hosp Motol Prague, Fac Med 2, Dept Radiol, Prague, Czech Republic. [Sramek, Martin] Cent Mil Univ Hosp Prague, Dept Neurol, Prague, Czech Republic. [Skorna, Miroslav] Masaryk Univ, Univ Hosp Brno, Fac Med, Dept Neurol, Brno, Czech Republic. [Sterba, Ludek] Hosp Ceske Budejovice, Dept Radiol, Ceske Budejovice, Czech Republic. [Vaclavik, Daniel] Ostrava Vitkovice Hosp, AGEL Res & Training Inst, Dept Neurol, Ostrava, Czech Republic. [Vanicek, Jiri] Masaryk Univ, Fac Med, Dept Diagnost Imaging, Brno, Czech Republic. [Vanicek, Jiri; Volny, Ondrej] St Annes Hosp Brno, Brno, Czech Republic. [Vanicek, Jiri; Volny, Ondrej] Int Clin Res Ctr, Brno, Czech Republic. [Volny, Ondrej] Masaryk Univ, Fac Med, Dept Neurol, Brno, Czech Republic. [Tomek, Ales] Charles Univ Prague, Univ Hosp Motol Prague, Fac Med 2, Dept Neurol, Prague, Czech Republic. Sanak, D (corresponding author), Palacky Univ, Med Sch & Hosp, Comprehens Stroke Ctr, Dept Neurol, IP Pavlova 6, Olomouc 77520, Czech Republic. daniel.sanak@centrum.cz AN - WOS:000451931100010 AU - Kocher, M. AU - Sanak, D. AU - Zapletalova, J. AU - Cihlar, F. AU - Czerny, D. AU - Cernik, D. AU - Duras, P. AU - Endrych, L. AU - Herzig, R. AU - Lacman, J. AU - Lojik, M. AU - Ostry, S. AU - Padr, R. AU - Rohan, V. AU - Skorna, M. AU - Sramek, M. AU - Sterba, L. AU - Vaclavik, D. AU - Vanicek, J. AU - Volny, O. AU - Tomek, A. DA - Dec DO - 10.1007/s00270-018-2068-z J2 - Cardiovasc. Interv. Radiol. KW - Acute ischemic stroke Mechanical thrombectomy Technical results Complications Time intervals 1ST PASS TECHNIQUE ENDOVASCULAR TREATMENT CONSENSUS STATEMENT DIRECT ASPIRATION THERAPY THROMBOLYSIS UPDATE TRIAL ADAPT Cardiac & Cardiovascular Systems Radiology, Nuclear Medicine & Medical Imaging LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: HC6SF Times Cited: 1 Cited Reference Count: 21 Kocher, Martin Sanak, Daniel Zapletalova, Jana Cihlar, Filip Czerny, Daniel Cernik, David Duras, Petr Endrych, Ladislav Herzig, Roman Lacman, Jiri Lojik, Miroslav Ostry, Svatopluk Padr, Radek Rohan, Vladimir Skorna, Miroslav Sramek, Martin Sterba, Ludek Vaclavik, Daniel Vanicek, Jiri Volny, Ondrej Tomek, Ales Volny, Ondrej/AAR-7620-2020; Sramek, Martin/O-2603-2017 Volny, Ondrej/0000-0002-0546-6921; Sramek, Martin/0000-0002-5519-9876; Sanak, Daniel/0000-0001-5426-1810; Tomek, Ales/0000-0002-7468-499X 1 0 8 SPRINGER NEW YORK CARDIOVASC INTER RAD PY - 2018 SN - 0174-1551 SP - 1901-1908 ST - Mechanical Thrombectomy for Acute Ischemic Stroke in Czech Republic: Technical Results from the Year 2016 T2 - Cardiovascular and Interventional Radiology TI - Mechanical Thrombectomy for Acute Ischemic Stroke in Czech Republic: Technical Results from the Year 2016 UR - ://WOS:000451931100010 VL - 41 ID - 761557 ER - TY - JOUR AB - Objectives In Asian countries, Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is widely used in gastric cancer patients with peritoneal dissemination. This is not the case in Europe. Its efficacy remains to be established, and more data are needed on the associated postoperative complication risk. A prospective dose escalation trial (PERISCOPE I) was conducted to assess the feasibility of HIPEC with oxaliplatin and docetaxel in gastric cancer patients with synchronous peritoneal carcinomatosis. Postoperative complications were systematically recorded. Methods In two experienced HIPEC centres, patients with limited peritoneal dissemination of a locally advanced, resectable gastric adenocarcinoma were treated with (sub)total gastrectomy, cytoreductive surgery and HIPEC provided that preoperative systemic chemotherapy was without disease progression. Intraoperative intraperitoneal chemotherapy consisted of oxaliplatin (460 mg/m2) for 30 minutes at 41-42°C, followed by docetaxel in escalating dosages (0, 50, 75 mg/m2) for 90 minutes at 37°C. Complications were scored using Common Toxicity Criteria version 4.03. Results In total, 25 patients underwent the full study procedure. Re-admission rate at the intensive care unit was 32% (n = 8). Two patients (8%) died due to a complicated postoperative course: one patient after reanimation following aspiration; another patient from the sequelae of a duodenal stump leakage. Four patients (16%) needed one or more re-operations, firstly because of small bowel ischaemia (n = 2), duodenal stump leakage (n = 1), or colonic perforation (n = 1). Nonsurgical re-interventions involved coil embolization of a mesenteric artery bleeding (n = 1), percutaneous abdominal drainage (n = 5), percutaneous thoracic drainage (n = 3), and endoscopic stent placement for an anastomotic leakage (n = 2). Other serious adverse events were infectious, gastro-intestinal, neurologic, thromboembolic, and haematologic complications. Median postoperative hospital stay was 24 (IQR: 13-32) days. Conclusion In the PERISCOPE I study, including gastric cancer patients with synchronous peritoneal carcinomatosis, postoperative complications after HIPEC with oxaliplatin and docetaxel were common and diverse. Postoperative management required a broad multidisciplinary team of various medical and interventional specialists. AD - W.J. Koemans, Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands AU - Koemans, W. J. AU - Van Der Kaaij, R. T. AU - Wassenaar, E. C. E. AU - Sikorska, K. AU - Boot, H. AU - Grootscholten, C. AU - Los, M. AU - Hartemink, K. J. AU - Veenhof, A. A. F. A. AU - Hahn, C. P. AU - Houwink, A. P. I. AU - Boerma, D. AU - Ramshorst, B. AU - Sandick, J. W. DB - Embase DO - 10.1515/pap-2018-7018 KW - docetaxel oxaliplatin abdominal drainage adult advanced cancer adverse drug reaction anastomosis leakage aspiration bleeding cancer patient cancer surgery carcinomatous peritonitis clinical article coil embolization colon perforation complication conference abstract controlled study cytoreductive surgery disease exacerbation drug therapy feasibility study female hospital readmission hospitalization human hyperthermic intraperitoneal chemotherapy intensive care unit ischemia male mesenteric artery multidisciplinary team postoperative care prospective study reoperation resuscitation side effect small intestine stomach adenocarcinoma surgery thorax drainage thromboembolism total stomach resection LA - English M3 - Conference Abstract N1 - L627103740 2019-04-11 PY - 2018 SN - 2364-768X SP - sA248-sA249 ST - Postoperative complications after HIPEC with oxaliplatin and docetaxel in gastric cancer patients with peritoneal dissemination T2 - Pleura and Peritoneum TI - Postoperative complications after HIPEC with oxaliplatin and docetaxel in gastric cancer patients with peritoneal dissemination UR - https://www.embase.com/search/results?subaction=viewrecord&id=L627103740&from=export http://dx.doi.org/10.1515/pap-2018-7018 VL - 3 ID - 760811 ER - TY - JOUR AB - Background Despite significant advances in imaging and endoscopic diagnostic techniques, adequate localization of gastrointestinal bleeding (GIB) can be challenging. Provocative angiography (PROVANGIO) has not been part of the standard diagnostic algorithms yet. We sought to examine the ability of PROVANGIO to identify the bleeding source when conventional radiography fails. Methods Patients undergoing PROVANGIO for GIB during 2008-2014 were retrospectively included. Demographics and periprocedural patient characteristics were recorded. PROVANGIO was performed in a multidisciplinary setting, involving interventional radiology, surgery and anesthesiology teams, ready to intervene in case of uncontrolled bleeding. The procedure included conventional angiography of the celiac, superior and inferior mesenteric arteries (SMA, IMA) followed by a stepwise bleeding provocation with anticoagulating, vasodilating and/or thrombolytic agent administration, combined with angiography. Results Twenty-three PROVANGIO were performed. Patients were predominantly male (15, 65.2%), and hematochezia was the most common presenting symptom (12, 52.2%). Patients with a positive PROVANGIO had lower Charlson comorbidity index (1 vs. 7, p = 0.009) and were less likely to have a prior history of GIB (14.3% vs. 87.5%, p = 0.001). PROVANGIO localized bleeding in 7 (30%) patients. In 6 out of 7 patients, the bleeding source was identified in the SMA and, in one case, in the IMA distribution. The bleeding was controlled angiographically in four cases, endoscopically in one case and surgically in the remaining two. No complications related to PROVANGIO were detected. Conclusions In our series, PROVANGIO safely identified the bleeding source, and provided that necessary safeguards are put into place, we recommend incorporating it in the diagnostic algorithms for GIB management. AD - [Kokoroskos, Nikolaos; Naar, Leon; Peponis, Thomas; Martinez, Myriam; El Moheb, Mohamad; El Hechi, Majed; Alser, Osaid; Fuentes, Eva; Velmahos, George] Harvard Med Sch, Massachusetts Gen Hosp, Dept Surg Emergency Surg & Surg Crit Care, Div Trauma, 165 Cambridge St,Suite 810, Boston, MA 02114 USA. Kokoroskos, N (corresponding author), Harvard Med Sch, Massachusetts Gen Hosp, Dept Surg Emergency Surg & Surg Crit Care, Div Trauma, 165 Cambridge St,Suite 810, Boston, MA 02114 USA. nickkokordoc@gmail.com AN - WOS:000532609600001 AU - Kokoroskos, N. AU - Naar, L. AU - Peponis, T. AU - Martinez, M. AU - El Moheb, M. AU - El Hechi, M. AU - Alser, O. AU - Fuentes, E. AU - Velmahos, G. DA - Sep DO - 10.1007/s00268-020-05545-8 J2 - World J.Surg. KW - HEMORRHAGE HEPARIN Surgery LA - English M1 - 9 M3 - Article N1 - ISI Document Delivery No.: MQ2JH Times Cited: 0 Cited Reference Count: 20 Kokoroskos, Nikolaos Naar, Leon Peponis, Thomas Martinez, Myriam El Moheb, Mohamad El Hechi, Majed Alser, Osaid Fuentes, Eva Velmahos, George Alser, Osaid/P-5509-2017 Alser, Osaid/0000-0001-6743-803X 0 SPRINGER NEW YORK WORLD J SURG PY - 2020 SN - 0364-2313 SP - 2944-2949 ST - Provocative Angiography, Followed by Therapeutic Interventions, in the Management of Hard-To-Diagnose Gastrointestinal Bleeding T2 - World Journal of Surgery TI - Provocative Angiography, Followed by Therapeutic Interventions, in the Management of Hard-To-Diagnose Gastrointestinal Bleeding UR - ://WOS:000532609600001 VL - 44 ID - 761445 ER - TY - JOUR AB - Background: Acute pulmonary embolism (PE) with preserved hemodynamics but right ventricular dysfunction, classified as submassive PE, carries a high risk of mortality. We report the results for patients who did not qualify for medical therapy and required treatment of submassive PE with surgical pulmonary embolectomy and catheter-directed thrombolysis (CDT). Methods: Between October 1999 and May 2015, 133 submassive PE patients underwent treatment with pulmonary embolectomy (71) and CDT (62). A multidisciplinary PE response team helped to determine the most appropriate treatment strategy on a case-by-case basis. The EkoSonic ultrasound-facilitated thrombolysis system (EKOS) was used for CDT, which was introduced in 2010. Results: The mean age of submassive PE patients was 57.3 years, which included 36.8% females. PE risk factors included previous deep venous thrombosis (46.6%), immobility (36.1%), recent surgery (30.8%), and cancer (22.6%), P < 0.05. The most common indication for advanced treatment was right ventricular strain (42.9%), P = 0.03. The frequency of surgical pulmonary embolectomy remained stable even after incorporating the EKOS procedure into our treatment algorithm, with statistically similar operative mortality. Bleeding was observed in six CDT patients and one pulmonary embolectomy patient (P < 0.05). Follow-up echocardiography was available for 61% of the overall cohort, of whom 76.5% had no residualmoderate or severe right ventricular dysfunction. Conclusions: Pulmonary embolectomy and CDT are important contemporary advanced treatment options for selected high-risk patients with submassive PE, who do not qualify for medical therapy. AD - [Kolkailah, Ahmed A.; Hirji, Sameer; Ejiofor, Julius I.; Del Val, Fernando Ramirez; Lee, Jiyae; McGurk, Siobhan; Aranki, Sary F.; Shekar, Prem S.; Kaneko, Tsuyoshi] Harvard Med Sch, Brigham & Womens Hosp, Div Cardiac Surg, 75 Francis St, Boston, MA 02115 USA. [Piazza, Gregory] Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA. Hirji, S (corresponding author), Harvard Med Sch, Brigham & Womens Hosp, Div Cardiac Surg, 75 Francis St, Boston, MA 02115 USA. shirji@partners.org AN - WOS:000435738400009 AU - Kolkailah, A. A. AU - Hirji, S. AU - Piazza, G. AU - Ejiofor, J. I. AU - Del Val, F. R. AU - Lee, J. AU - McGurk, S. AU - Aranki, S. F. AU - Shekar, P. S. AU - Kaneko, T. DA - May DO - 10.1111/jocs.13576 J2 - J. Card. Surg. KW - clinical outcomes multidisciplinary heart team pulmonary embolectomy pulmonary embolism resource utilization thrombolysis HEMODYNAMICALLY STABLE PATIENTS PLASMINOGEN-ACTIVATOR HOSPITAL STAY RISK TRIAL METAANALYSIS MANAGEMENT REGISTRY INTERVENTION FIBRINOLYSIS Cardiac & Cardiovascular Systems Surgery LA - English M1 - 5 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: GJ9QK Times Cited: 7 Cited Reference Count: 35 Kolkailah, Ahmed A. Hirji, Sameer Piazza, Gregory Ejiofor, Julius I. Del Val, Fernando Ramirez Lee, Jiyae McGurk, Siobhan Aranki, Sary F. Shekar, Prem S. Kaneko, Tsuyoshi International Coronary Congress AUG 18-20, 2017 New York, NY hirji, sameer/AAF-7691-2019 hirji, sameer/0000-0002-5032-675X 7 0 3 WILEY HOBOKEN J CARDIAC SURG PY - 2018 SN - 0886-0440 SP - 252-259 ST - Surgical pulmonary embolectomy and catheter-directed thrombolysis for treatment of submassive pulmonary embolism T2 - Journal of Cardiac Surgery TI - Surgical pulmonary embolectomy and catheter-directed thrombolysis for treatment of submassive pulmonary embolism UR - ://WOS:000435738400009 VL - 33 ID - 761590 ER - TY - JOUR AB - BACKGROUND: Acute pulmonary embolism (PE) with preserved hemodynamics but right ventricular dysfunction, classified as submassive PE, carries a high risk of mortality. We report the results for patients who did not qualify for medical therapy and required treatment of submassive PE with surgical pulmonary embolectomy and catheter-directed thrombolysis (CDT). METHODS: Between October 1999 and May 2015, 133 submassive PE patients underwent treatment with pulmonary embolectomy (71) and CDT (62). A multidisciplinary PE response team helped to determine the most appropriate treatment strategy on a case-by-case basis. The EkoSonic ultrasound-facilitated thrombolysis system (EKOS) was used for CDT, which was introduced in 2010. RESULTS: The mean age of submassive PE patients was 57.3 years, which included 36.8% females. PE risk factors included previous deep venous thrombosis (46.6%), immobility (36.1%), recent surgery (30.8%), and cancer (22.6%), P < 0.05. The most common indication for advanced treatment was right ventricular strain (42.9%), P = 0.03. The frequency of surgical pulmonary embolectomy remained stable even after incorporating the EKOS procedure into our treatment algorithm, with statistically similar operative mortality. Bleeding was observed in six CDT patients and one pulmonary embolectomy patient (P < 0.05). Follow-up echocardiography was available for 61% of the overall cohort, of whom 76.5% had no residual moderate or severe right ventricular dysfunction. CONCLUSIONS: Pulmonary embolectomy and CDT are important contemporary advanced treatment options for selected high-risk patients with submassive PE, who do not qualify for medical therapy. AD - Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. AN - 29659045 AU - Kolkailah, A. A. AU - Hirji, S. AU - Piazza, G. AU - Ejiofor, J. I. AU - Ramirez Del Val, F. AU - Lee, J. AU - McGurk, S. AU - Aranki, S. F. AU - Shekar, P. S. AU - Kaneko, T. DA - May DO - 10.1111/jocs.13576 DP - NLM ET - 2018/04/17 J2 - Journal of cardiac surgery KW - Acute Disease Adult Aged Echocardiography Embolectomy/*methods Female Humans Male Middle Aged Neoplasms Pulmonary Embolism/complications/diagnostic imaging/*therapy Restraint, Physical Risk Risk Factors Thrombolytic Therapy/*methods Treatment Outcome Venous Thrombosis Ventricular Dysfunction, Right/complications clinical outcomes multidisciplinary heart team pulmonary embolectomy pulmonary embolism resource utilization thrombolysis LA - eng M1 - 5 N1 - 1540-8191 Kolkailah, Ahmed A Hirji, Sameer Orcid: 0000-0002-5032-675x Piazza, Gregory Ejiofor, Julius I Ramirez Del Val, Fernando Lee, Jiyae McGurk, Siobhan Aranki, Sary F Shekar, Prem S Kaneko, Tsuyoshi Journal Article United States J Card Surg. 2018 May;33(5):252-259. doi: 10.1111/jocs.13576. Epub 2018 Apr 16. PY - 2018 SN - 0886-0440 SP - 252-259 ST - Surgical pulmonary embolectomy and catheter-directed thrombolysis for treatment of submassive pulmonary embolism T2 - J Card Surg TI - Surgical pulmonary embolectomy and catheter-directed thrombolysis for treatment of submassive pulmonary embolism VL - 33 ID - 760116 ER - TY - JOUR AB - Peripheral vascular disease affects millions of individuals worldwide, and results in significant morbidity and mortality. The complex nature of the disease, the presence of multiple comorbidities, and the existence of a wide variety of therapeutic options suggests that a multidisciplinary approach to treatment has the potential to improve care of these patients. The success of the heart team for complex coronary artery and structural heart disease could serve as a model for the efficient and effective management of patients with peripheral vascular disease. In this paper, the authors propose a multidisciplinary vascular team approach for the treatment of critical limb ischemia, pulmonary embolism, acute ischemic stroke, and acute aortic syndromes. The successful implementation of such vascular teams has the potential to significantly enhance quality of care, improve clinical outcomes, and reduce costs. Prospective evaluation is warranted to determine how to best integrate this approach into routine clinical care. AD - Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Division of Cardiology, New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Division of Cardiovascular Medicine, University Hospitals, Case Western Reserve University, Cleveland, Ohio. Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Department of Cardiovascular Diseases, Ochsner Medical Center, New Orleans, Louisiana. Division of Cardiology, Newton-Wellesley Hospital, Newton, Massachusetts. Department of Surgery, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Department of Cardiothoracic and Vascular Surgery, Memorial Hermann Hospital, University of Texas Health Science Center, Houston, Texas. Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan. Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts. Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: Herbert.Aronow@Lifespan.org. AN - 31097169 AU - Kolte, D. AU - Parikh, S. A. AU - Piazza, G. AU - Shishehbor, M. H. AU - Beckman, J. A. AU - White, C. J. AU - Jaff, M. R. AU - Iribarne, A. AU - Nguyen, T. C. AU - Froehlich, J. B. AU - Rosenfield, K. AU - Aronow, H. D. DA - May 21 DO - 10.1016/j.jacc.2019.03.463 DP - NLM ET - 2019/05/18 J2 - Journal of the American College of Cardiology KW - Aortic Diseases/therapy Brain Ischemia/therapy Cardiovascular Diseases/*therapy Extremities/*blood supply Humans Ischemia/*therapy *Patient Care Team Pulmonary Embolism/therapy Stroke/therapy *aortic dissection *critical limb ischemia *multidisciplinary team *peripheral artery disease *pulmonary embolism *stroke LA - eng M1 - 19 N1 - 1558-3597 Kolte, Dhaval Parikh, Sahil A Piazza, Gregory Shishehbor, Mehdi H Beckman, Joshua A White, Christopher J Jaff, Michael R Iribarne, Alexander Nguyen, Tom C Froehlich, James B Rosenfield, Kenneth Aronow, Herbert D ACC Peripheral Vascular Disease Council Journal Article Review United States J Am Coll Cardiol. 2019 May 21;73(19):2477-2486. doi: 10.1016/j.jacc.2019.03.463. PY - 2019 SN - 0735-1097 SP - 2477-2486 ST - Vascular Teams in Peripheral Vascular Disease T2 - J Am Coll Cardiol TI - Vascular Teams in Peripheral Vascular Disease VL - 73 ID - 760125 ER - TY - JOUR AB - Peripheral vascular disease affects millions of individuals worldwide, and results in significant morbidity and mortality. The complex nature of the disease, the presence of multiple comorbidities, and the existence of a wide variety of therapeutic options suggests that a multidisciplinary approach to treatment has the potential to improve care of these patients. The success of the heart team for complex coronary artery and structural heart disease could serve as a model for the efficient and effective management of patients with peripheral vascular disease. In this paper, the authors propose a multidisciplinary vascular team approach for the treatment of critical limb ischemia, pulmonary embolism, acute ischemic stroke, and acute aortic syndromes. The successful implementation of such vascular teams has the potential to significantly enhance quality of care, improve clinical outcomes, and reduce costs. Prospective evaluation is warranted to determine how to best integrate this approach into routine clinical care. (c) 2019 by the American College of Cardiology Foundation. AD - [Kolte, Dhaval; Aronow, Herbert D.] Brown Univ, Warren Alpert Med Sch, Div Cardiol, Providence, RI 02903 USA. [Parikh, Sahil A.] Columbia Univ, Med Ctr, New York Presbyterian Hosp, Div Cardiol, New York, NY USA. [Piazza, Gregory] Harvard Med Sch, Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02115 USA. [Shishehbor, Mehdi H.] Case Western Reserve Univ, Univ Hosp, Div Cardiovasc Med, Cleveland, OH 44106 USA. [Beckman, Joshua A.] Vanderbilt Univ, Med Ctr, Div Cardiovasc Med, Nashville, TN USA. [White, Christopher J.] Ochsner Med Ctr, Dept Cardiovasc Dis, New Orleans, LA USA. [Jaff, Michael R.] Newton Wellesley Hosp, Div Cardiol, Newton, MA USA. [Iribarne, Alexander] Dartmouth Hitchcock Med Ctr, Dept Surg, Sect Cardiac Surg, Lebanon, NH 03766 USA. [Nguyen, Tom C.] Univ Texas Hlth Sci Ctr Houston, Mem Hermann Hosp, Dept Cardiothorac & Vasc Surg, Houston, TX 77030 USA. [Froehlich, James B.] Univ Michigan, Div Cardiovasc Med, Ann Arbor, MI 48109 USA. [Rosenfield, Kenneth] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA. Aronow, HD (corresponding author), Brown Univ, Warren Alpert Med Sch, Lifespan Cardiovasc Inst, 593 Eddy St,RIH APC 730, Providence, RI 02903 USA. Herbert.Aronow@Lifespan.org AN - WOS:000467710400015 AU - Kolte, D. AU - Parikh, S. A. AU - Piazza, G. AU - Shishehbor, M. H. AU - Beckman, J. A. AU - White, C. J. AU - Jaff, M. R. AU - Iribarne, A. AU - Nguyen, T. C. AU - Froehlich, J. B. AU - Rosenfield, K. AU - Aronow, H. D. AU - Council, A. C. C. Peripheral Vasc Dis DA - May DO - 10.1016/j.jacc.2019.03.463 J2 - J. Am. Coll. Cardiol. KW - aortic dissection critical limb ischemia multidisciplinary team peripheral artery disease pulmonary embolism stroke ABDOMINAL AORTIC-ANEURYSMS CRITICAL LIMB ISCHEMIA MULTIDISCIPLINARY PULMONARY-EMBOLISM HEALTH-CARE PROFESSIONALS ENDOVASCULAR TREATMENT RESPONSE TEAM EARLY MANAGEMENT RISK-FACTORS TASK-FORCE HEART TEAM Cardiac & Cardiovascular Systems LA - English M1 - 19 M3 - Article N1 - ISI Document Delivery No.: HX9ES Times Cited: 4 Cited Reference Count: 70 Kolte, Dhaval Parikh, Sahil A. Piazza, Gregory Shishehbor, Mehdi H. Beckman, Joshua A. White, Christopher J. Jaff, Michael R. Iribarne, Alexander Nguyen, Tom C. Froehlich, James B. Rosenfield, Kenneth Aronow, Herbert D. Kolte, Dhaval/AAL-4032-2020 4 2 ELSEVIER SCIENCE INC NEW YORK J AM COLL CARDIOL PY - 2019 SN - 0735-1097 SP - 2477-2486 ST - Vascular Teams in Peripheral Vascular Disease T2 - Journal of the American College of Cardiology TI - Vascular Teams in Peripheral Vascular Disease UR - ://WOS:000467710400015 VL - 73 ID - 761525 ER - TY - JOUR AB - PURPOSE: To compare radiation exposure of nurses when performing nursing tasks associated with interventional procedures depending on whether or not the nurses called out to the operator before approaching the patient. MATERIALS AND METHODS: In a prospective study, 93 interventional radiology procedures were randomly divided into a call group and a no-call group; there were 50 procedures in the call group and 43 procedures in the no-call group. Two monitoring badges were used to calculate effective dose of nurses. In the call group, the nurse first told the operator she was going to approach the patient each time she was about to do so. In the no-call group, the nurse did not say anything to the operator when she was about to approach the patient. RESULTS: In all the nursing tasks, the equivalent dose at the umbilical level inside the lead apron was below the detectable limit. The equivalent dose at the sternal level outside the lead apron was 0.16 μSv ± 0.41 per procedure in the call group and 0.51 μSv ± 1.17 per procedure in the no-call group. The effective dose was 0.018 μSv ± 0.04 per procedure in the call group and 0.056 μSv ± 0.129 per procedure in the no-call group. The call group had a significantly lower radiation dose (P = .034). CONCLUSIONS: Radiation doses of nurses were lower in the group in which the nurse called to the operator before she approached the patient. AD - Department of Radiology, Kansai Medical University, 10-15, Fumizono, Moriguchi, Osaka, 570-8507 Japan. Electronic address: kome64@yo.rim.or.jp. Department of Radiology, Kansai Medical University, 10-15, Fumizono, Moriguchi, Osaka, 570-8507 Japan. Graduate School of Engineering, Osaka City University, Osaka, Japan. AN - 24813167 AU - Komemushi, A. AU - Suzuki, S. AU - Sano, A. AU - Kanno, S. AU - Kariya, S. AU - Nakatani, M. AU - Yoshida, R. AU - Kono, Y. AU - Ikeda, K. AU - Utsunomiya, K. AU - Harima, Y. AU - Komemushi, S. AU - Tanigawa, N. DA - Aug DO - 10.1016/j.jvir.2014.03.021 DP - NLM ET - 2014/05/13 J2 - Journal of vascular and interventional radiology : JVIR KW - Angiography/adverse effects/*nursing *Communication Endovascular Procedures/adverse effects/*nursing Female Humans Japan *Nursing Staff, Hospital Occupational Exposure/adverse effects/*prevention & control *Occupational Health Patient Care Team Prospective Studies Protective Clothing *Radiation Dosage Radiation Monitoring Radiation Protection Radiography, Interventional/adverse effects/*nursing Risk Assessment Risk Factors LA - eng M1 - 8 N1 - 1535-7732 Komemushi, Atsushi Suzuki, Satoshi Sano, Akira Kanno, Shohei Kariya, Shuji Nakatani, Miyuki Yoshida, Rie Kono, Yumiko Ikeda, Koshi Utsunomiya, Keita Harima, Yoko Komemushi, Sadao Tanigawa, Noboru Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't United States J Vasc Interv Radiol. 2014 Aug;25(8):1195-9. doi: 10.1016/j.jvir.2014.03.021. Epub 2014 May 9. PY - 2014 SN - 1051-0443 SP - 1195-9 ST - Radiation dose of nurses during IR procedures: a controlled trial evaluating operator alerts before nursing tasks T2 - J Vasc Interv Radiol TI - Radiation dose of nurses during IR procedures: a controlled trial evaluating operator alerts before nursing tasks VL - 25 ID - 760359 ER - TY - JOUR AB - Pulmonary embolism (PE) is the third most frequent acute cardiovascular syndrome. Annual PE incidence and PE-related mortality rates rise exponentially with age, and consequently, the disease burden imposed by PE on the society continues to rise as the population ages worldwide. Recently published landmark trials provided the basis for new or changed recommendations included in the 2019 update of the European Society of Cardiology Guidelines (developed in cooperation with the European Respiratory Society). Refinements in diagnostic algorithms were proposed and validated, increasing the specificity of pre-test clinical probability and D-dimer testing, and thus helping to avoid unnecessary pulmonary angiograms. Improved diagnostic strategies were also successfully tested in pregnant women with suspected PE. Non-vitamin K antagonist oral anticoagulants (NOACs) are now the preferred agents for treating the majority of patients with PE, both in the acute phase (with or without a brief lead-in period of parenteral heparin or fondaparinux) and over the long term. Primary reperfusion is reserved for haemodynamically unstable patients. Besides, the 2019 Guidelines endorse multidisciplinary teams for coordinating the acute-phase management of high-risk and (in selected cases) intermediate-risk PE. For normotensive patients, physicians are advised to include the assessment of the right ventricle on top of clinical severity scores in further risk stratification, especially if early discharge of the patient is envisaged. Further important updates include guidance (1) on extended anticoagulation after PE, taking into account the improved safety profile of NOACs; and (2) on the overall care and follow-up of patients who have suffered PE, with the aim to prevent, detect and treat late sequelae of venous thromboembolism. AU - Konstantinides, S. AU - Meyer, G. DB - Medline DO - 10.1007/s11739-020-02340-0 KW - adult anticoagulation cardiology complication diagnosis diagnostic test accuracy study disease burden drug safety drug therapy female follow up heart right ventricle human incidence lung angiography lung embolism mortality rate multidisciplinary team pharmacokinetics physician pregnant woman pretest posttest design probability reperfusion review risk assessment D dimer fondaparinux heparin LA - English M1 - 6 M3 - Review N1 - L631912332 2020-06-03 PY - 2020 SN - 1970-9366 SP - 957-966 ST - Management of acute pulmonary embolism 2019: what is new in the updated European guidelines? T2 - Internal and emergency medicine TI - Management of acute pulmonary embolism 2019: what is new in the updated European guidelines? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631912332&from=export http://dx.doi.org/10.1007/s11739-020-02340-0 VL - 15 ID - 760545 ER - TY - JOUR AU - Konstantinides, S. V. DA - 2020/08/26 08/26 DB - Europe PubMed Central DO - 10.1016/j.jaccas.2020.05.016 M1 - 9 PY - 2020 SN - 2666-0849 SP - 1388-1390 ST - Thrombosis and Thromboembolism Related to COVID-19: Increase the Level of Awareness, Lower the Threshold of Suspicion, and Keep Following the Guidelines T2 - JACC Case Rep TI - Thrombosis and Thromboembolism Related to COVID-19: Increase the Level of Awareness, Lower the Threshold of Suspicion, and Keep Following the Guidelines UR - http://europepmc.org/article/MED/32840252 VL - 2 ID - 762032 ER - TY - JOUR AB - Pulmonary hypertension has been recognized as a contraindication to pregnancy. Recently, several groups have shown promising results with the use of balloon pulmonary angioplasty (BPA) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) patients with distally located organized thrombi who were not candidates for pulmonary endarterectomy. We present the case report of a 26-year-old woman who became pregnant after successful treatment of severe CTEPH with the use of BPA. We conclude that patients undergoing effective BPA for CTEPH can consider becoming pregnant if followed closely by a multidisciplinary team, including experts in thrombosis, pulmonary hypertension, and obstetrics. AD - G. Kopeć, Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital Krakow, Ul Prądnicka 80, Kraków, Poland AU - Kopeć, G. AU - Magoń, W. AU - Stępniewski, J. AU - Waligóra, M. AU - Jonas, K. AU - Podolec, P. DB - Embase Medline DO - 10.1016/j.cjca.2019.10.029 KW - enoxaparin adult Apgar score article balloon pulmonary angioplasty cardiac index case report chronic thromboembolic pulmonary hypertension clinical article clinical effectiveness disease severity dyspnea electrocardiography endarterectomy female follow up gestational age heart catheterization hemodynamics human labor management lung artery pressure lung function test lung vascular resistance maternity ward medical history multidisciplinary team percutaneous transluminal angioplasty physical examination pregnancy outcome puerperium pulmonary artery six minute walk test transesophageal echocardiography tricuspid valve regurgitation LA - English M1 - 4 M3 - Article N1 - L2005090784 2020-03-05 PY - 2020 SN - 0828-282X SP - 589.e13-589.e16 ST - Pregnancy in a Patient With Chronic Thromboembolic Pulmonary Hypertension After Successful Treatment with Balloon Pulmonary Angioplasty T2 - Canadian Journal of Cardiology TI - Pregnancy in a Patient With Chronic Thromboembolic Pulmonary Hypertension After Successful Treatment with Balloon Pulmonary Angioplasty UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005090784&from=export http://dx.doi.org/10.1016/j.cjca.2019.10.029 VL - 36 ID - 760580 ER - TY - JOUR AB - Background: The aim of this retrospective study was to evaluate the efficacy and safety of weekly high-dose 5-fluorouracil (5-FU)/folinic acid (FA) as 24-h infusion (AIO regimen) plus irinotecan in patients with histologically proven metastatic gastroesophageal adenocarcinoma (UICC stage IV). Material/Methods: From 08/1999 to 12/2008, 76 registered, previously untreated patients were evaluable. Treatment regimen: irinotecan (80 mg/m(2)) as 1-h infusion followed by 5-FU (2000 mg/m(2)) combined with FA (500 mg/m(2)) as 24-h infusion (d1, 8, 15, 22, 29, 36, qd 57). Results: Median age: 59 years; male/female: 74%/26%; ECOG <= 1: 83%; response: CR: 1%, PR: 16%, SD: 61%, PD: 17%, not evaluable in terms of response: 5%; tumor control: 78%; median OS: 11.2 months; median time-to-progression: 5.3 months; 1-year survival rate: 49%; 2-year survival rate: 17%; no evidence of disease: 6.6%; higher grade toxicities (grade 3/4): anemia: 7%, leucopenia: 1%, ascites: 3%, nausea: 3%, infections: 12%, vomiting: 9%, GI bleeding of the primary tumor: 4%, diarrhea: 17%, thromboembolic events: 4%; secondary metastatic resection after downsizing: 16 patients (21%), R-classification of secondary resections: R0/R1/R2: 81%/6%/13%, median survival of the 16 patients with secondary resection: 23.7 months. Conclusions: Combined 5-FU/FA as 24-h infusion plus irinotecan may be considered as an active palliative first-line treatment accompanied by tolerable toxicity; thus offering an alternative to cisplatin-based treatment regimens. Thanks to efficient interdisciplinary teamwork, secondary metastatic resections could be performed in 16 patients. In total, the patients who had undergone secondary resection had a median survival of 23.7 months, whereas the median survival of patients without secondary resection was 10.1 months (p <= 0.001). AD - [Koucky, Kathrin; Wein, Axel; Albrecht, Heinz; Maennlein, Gudrun; Wolff, Kerstin; Ostermeier, Nicola; Busse, Dagmar; Siebler, Juergen; Neurath, Markus F.; Boxberger, Frank] Univ Erlangen Nurnberg, Dept Internal Med 1, D-91054 Erlangen, Germany. [Konturek, Peter C.] Thuringia Clin Saalfeld, Dept Internal Med, Saalfeld, Germany. [Reulbach, Udo] Trin Coll Ctr Hlth Sci, Dept Publ Hlth & Primary Care, Dublin, Ireland. [Golcher, Henriette; Schildberg, Claus; Hohenberger, Werner] Univ Erlangen Nurnberg, Dept Surg, D-91054 Erlangen, Germany. [Janka, Rolf] Univ Erlangen Nurnberg, Dept Radiol, D-91054 Erlangen, Germany. [Hahnd, Eckhart G.] Univ Witten Herdecke, Fac Hlth, Erlangen, Germany. Boxberger, F (corresponding author), Univ Erlangen Nurnberg, Dept Internal Med 1, Ulmenweg 18, D-91054 Erlangen, Germany. frank.boxberger@uk-erlangen.de AN - WOS:000291104100016 AU - Koucky, K. AU - Wein, A. AU - Konturek, P. C. AU - Albrecht, H. AU - Reulbach, U. AU - Mannlein, G. AU - Wolff, K. AU - Ostermeier, N. AU - Busse, D. AU - Golcher, H. AU - Schildberg, C. AU - Janka, R. AU - Hohenberger, W. AU - Hahnd, E. G. AU - Siebler, J. AU - Neurath, M. F. AU - Boxberger, F. DA - May DO - 10.12659/msm.881764 J2 - Med. Sci. Monitor KW - gastroesophageal cancer palliative chemotherapy irinotecan 5-fluorouracil PHASE-II TRIAL ADVANCED GASTRIC-CANCER COLORECTAL-CANCER HEPATIC RESECTION PLUS IRINOTECAN GASTROESOPHAGEAL ADENOCARCINOMA EUROPEAN-ORGANIZATION ADVANCED ESOPHAGEAL LIVER METASTASES SUPPORTIVE CARE Medicine, Research & Experimental LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: 770QR Times Cited: 4 Cited Reference Count: 54 Koucky, Kathrin Wein, Axel Konturek, Peter C. Albrecht, Heinz Reulbach, Udo Maennlein, Gudrun Wolff, Kerstin Ostermeier, Nicola Busse, Dagmar Golcher, Henriette Schildberg, Claus Janka, Rolf Hohenberger, Werner Hahnd, Eckhart G. Siebler, Juergen Neurath, Markus F. Boxberger, Frank Reulbach, Udo/F-4239-2012 Reulbach, Udo/0000-0002-9527-157X; Janka, Rolf/0000-0003-1698-9741 Pfizer Pharma GmbH, Germany This study was partially supported by a grant from Pfizer Pharma GmbH, Germany 4 0 INT SCIENTIFIC INFORMATION, INC MELVILLE MED SCI MONITOR PY - 2011 SN - 1643-3750 SP - CR248-CR258 ST - Palliative first-line therapy with weekly high-dose 5-fluorouracil and sodium folinic acid as a 24-hour infusion (AIO regimen) combined with weekly irinotecan in patients with metastatic adenocarcinoma of the stomach or esophagogastric junction followed by secondary metastatic resection after downsizing T2 - Medical Science Monitor TI - Palliative first-line therapy with weekly high-dose 5-fluorouracil and sodium folinic acid as a 24-hour infusion (AIO regimen) combined with weekly irinotecan in patients with metastatic adenocarcinoma of the stomach or esophagogastric junction followed by secondary metastatic resection after downsizing UR - ://WOS:000291104100016 VL - 17 ID - 761854 ER - TY - JOUR AB - Polyethylene of Raised Temperature resistance (PE-RT) nanocomposites with graphene nanoplatelets (GNPs) were prepared in order to investigate the effect of the nanofiller on the thermal stability of the polymer. PE-RT is a new type of polyethylene with improved mechanical and thermal properties and is commonly used as a piping material1. Various types of graphene are often used as a reinforcement filler material to improve electrical, thermal and mechanical properties of the polymeric matrix2. In the present work, PERT/ GNPs nanocomposites were prepared by the melt mixing method using GNPs with 5μm diameter and 6nm thickness at different filler concentration (0.5, 1, 2.5% wt.). The characterization of neat PE-RT and the corresponding nanocomposites was achieved by X-Ray Diffraction (XRD). The effect of GNPs on the thermal properties of PE-RT nanocomposites was studied by using Differential Scanning Calorimetry (DSC) and Thermogravimetric Analysis (TGA). It was found that the presence of GNPs affected the crystalline structure of the PE-RT matrix. TGA results also showed that the nanocomposites exhibited better thermal stability than neat PE-RT. The nanocomposites with 2.5%wt. filler content exhibited the most improved thermal stability compared to the ones with lower filler content (0.5, 1%wt.). AD - D. Kourtidou, X-ray, Optical Characterization and Thermal Analysis Laboratory, Physics Department, Aristotle University of Thessaloniki, Greece AU - Kourtidou, D. AU - Tarani, E. AU - Bikiaris, D. N. AU - Vourlias, G. AU - Chrissafis, K. DB - Embase KW - analytical equipment nanofiller spectrometer Ultima graphene graphene nanoplatelet nanocomposite nitrogen polyethylene polymer unclassified drug article crystallinity crystallization differential scanning calorimetry diffraction peak enthalpy environmental temperature flow rate mass mechanics melt mixing method melting point physical mobility synthesis temperature resistance thermal analysis thermal conductivity thermogravimetry thermostability X ray diffraction LA - English M1 - 4 M3 - Article N1 - L2002506493 2019-10-29 2019-11-26 PY - 2018 SN - 2241-3081 1105-4999 SP - 154-160 ST - Synthesis, characterization and thermal analysis of PE-RT/graphene nanocomposites T2 - Pharmakeftiki TI - Synthesis, characterization and thermal analysis of PE-RT/graphene nanocomposites UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002506493&from=export VL - 30 ID - 760857 ER - TY - JOUR AB - The prevalence of concomitant abdominal aortic aneurysm (AAA) and severe aortic stenosis (AS) has been increasing in the elderly population. Both conditions have adverse outcomes, if not adequately managed. No clear recommendations are available in the literature until today, in regards of the management sequence making thus the decision-making challenging. We report 2 cases of AAA and significant AS treated with endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI) during the same procedure and a review of the literature on this topic. Based on our experience, the combined procedure with TAVI followed by EVAR seems to be feasible, safe, and effective while detailed preoperative planning and a carefully tailored management strategy by a multidisciplinary team are essential. AD - G.I. Karaolanis, Vascular Unit, Department of Surgery, Medical School, University of Ioannina, Ioannina, Greece AU - Koutsias, S. AU - Karaolanis, G. I. AU - Papafaklis, M. I. AU - Peroulis, M. AU - Tzimas, P. AU - Lakkas, L. AU - Mitsis, M. AU - Naka, K. K. AU - Michalis, L. K. DB - Embase Medline DO - 10.1177/1538574420927864 KW - percutaneous aortic valve bioprosthesis endoprosthesis Excluder contrast medium abdominal aortic aneurysm aged angiography aortic stenosis artery graft article balloon dilatation case report chronic obstructive lung disease clinical article comorbidity assessment computed tomographic angiography computer assisted tomography coronary angiography coronary artery bypass graft coronary artery circumflex branch Doppler flowmetry dyspnea echography endovascular aneurysm repair femoral access fluoroscopy time follow up graft anastomosis heart ejection fraction heart failure heart left ventricle hypertrophy hospitalization human hypertension left anterior descending coronary artery left ventricular systolic dysfunction male mammary artery marginal artery New York Heart Association class pacemaker implantation peak transvalvular pressure percutaneous coronary intervention peripheral edema procedure time prostate surgery right coronary artery saphenous vein graft surgical mortality transcatheter aortic valve implantation transthoracic echocardiography transvalvular pressure gradient vascular surgery very elderly CoreValve Evolut R LA - English M1 - 6 M3 - Article N1 - L2005089166 2020-06-02 PY - 2020 SN - 1938-9116 1538-5744 SP - 544-548 ST - Simultaneous Transcatheter Aortic Valve Implantation and Infrarenal Aortic Aneurysm Repair for Severe Aortic Stenosis and Abdominal Aortic Aneurysm: Report of 2 Cases and Literature Review T2 - Vascular and Endovascular Surgery TI - Simultaneous Transcatheter Aortic Valve Implantation and Infrarenal Aortic Aneurysm Repair for Severe Aortic Stenosis and Abdominal Aortic Aneurysm: Report of 2 Cases and Literature Review UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005089166&from=export http://dx.doi.org/10.1177/1538574420927864 VL - 54 ID - 760553 ER - TY - JOUR AB - Abstract: Background: The assessment of clinical guideline adherence for the evaluation of pulmonary embolism (PE) via computed tomography pulmonary angiography (CTPA) currently requires either labor‐intensive, retrospective chart review or prospective collection of PE risk scores at the time of CTPA order. The recording of clinical data in a structured manner in the electronic health record (EHR) may make it possible to automate the calculation of a patient's PE risk classification and determine whether the CTPA order was guideline concordant. Objectives: The objective of this study was to measure the performance of automated, structured data–only versions of the Wells and revised Geneva risk scores in emergency department (ED) encounters during which a CTPA was ordered. The hypothesis was that such an automated method would classify a patient's PE risk with high accuracy compared to manual chart review. Methods: We developed automated, structured data–only versions of the Wells and revised Geneva risk scores to classify 212 ED encounters during which a CTPA was performed as “PE likely” or “PE unlikely.” We then combined these classifications with D‐dimer ordering data to assess each encounter as guideline concordant or discordant. The accuracy of these automated classifications and assessments of guideline concordance were determined by comparing them to classifications and concordance based on the complete Wells and revised Geneva scores derived via abstractor manual chart review. Results: The automatically derived Wells and revised Geneva risk classifications were 91.5 and 92% accurate compared to the manually determined classifications, respectively. There was no statistically significant difference between guideline adherence calculated by the automated scores compared to manual chart review (Wells, 70.8% vs. 75%, p = 0.33; revised Geneva, 65.6% vs. 66%, p = 0.92). Conclusion: The Wells and revised Geneva score risk classifications can be approximated with high accuracy using automated extraction of structured EHR data elements in patients who received a CTPA. Combining these automated scores with D‐dimer ordering data allows for the automated assessment of clinical guideline adherence for CTPA ordering in the ED, without the burden of manual chart review. AD - Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY Department of Population Health, NYU School of Medicine, New York, NY Center for Healthcare Innovation and Delivery Science, NYU School of Medicine, New York, NY Department of Medicine, NYU School of Medicine, New York, NY Department of Urology, NYU School of Medicine, New York, NY Department of Radiology, NYU School of Medicine, New York, NY AN - 132091326. Language: English. Entry Date: 20181004. Revision Date: 20190902. Publication Type: Article AU - Koziatek, Christian A. AU - Simon, Emma AU - Horwitz, Leora I. AU - Makarov, Danil V. AU - Smith, Silas W. AU - Jones, Simon AU - Gyftopoulos, Soterios AU - Swartz, Jordan L. DB - CINAHL DO - 10.1111/acem.13442 DP - EBSCOhost KW - Pulmonary Embolism -- Risk Factors Pulmonary Embolism -- Classification Guideline Adherence -- Evaluation Computed Tomography Angiography -- Methods Automation Pulmonary Embolism -- Radiography Emergency Service Risk Assessment Clinical Assessment Tools Human Validity Record Review Electronic Health Records M1 - 9 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. PY - 2018 SN - 1069-6563 SP - 1053-1061 ST - Automated Pulmonary Embolism Risk Classification and Guideline Adherence for Computed Tomography Pulmonary Angiography Ordering T2 - Academic Emergency Medicine TI - Automated Pulmonary Embolism Risk Classification and Guideline Adherence for Computed Tomography Pulmonary Angiography Ordering UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=132091326&site=ehost-live&scope=site VL - 25 ID - 761298 ER - TY - JOUR AB - Selection of the optimal pert- and postprocedural antithrombotic regimen in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) is a common clinical problem which may pose a challenge to medical practitioners. This systematic review summarizes the updated evidence on this topic. Non-vitamin K oral anticoagulants (NOACs) at standard doses are the preferred option in most of post PCI patients with AF, except those few with a clear indication for a vitamin K antagonist (VKA). Reduced NOAC doses should be considered in dabigatran- or rivaroxaban-treated patients with a high bleeding risk, which prevail over concerns about stent thrombosis or ischemic stroke. There is insufficient evidence to favor one NOAC over another in this setting. In the early post stenting period, triple therapy comprising a NOAC, clopidogrel and aspirin is recommended. Timing of post PCI aspirin cessation should be based on a careful analysis of the bleeding and ischemic risk. There is only low quality evidence regarding the optimal approach to elective or urgent/emergency PCI procedures in patients requiring oral anticoagulation. It is suggested that there is no need of interruption of VKA and PCI procedure should be performed via radial artery access with a lower dose of unfractionated heparin. On the other hand, NOACs are usually stopped before elective PCIs, while urgent/emergency procedures may be performed with the addition of low-dose parenteral anticoagulation. AD - [Kozinski, Marek; Rejszel-Baranowska, Joanna] Med Univ Gdansk, Dept Cardiol & Internal Med, 9b Powstania Styczniowego St, PL-81519 Gdynia, Poland. [Mlodawska, Elzbieta; Tomaszuk-Kazberuk, Anna] Med Univ Bialystok, Dept Cardiol, Bialystok, Poland. [Siller-Matula, Jolanta M.] Med Univ Vienna, Dept Cardiol, Vienna, Austria. [Siller-Matula, Jolanta M.] Med Univ Warsaw, Ctr Preclin Res & Technol CEPT, Dept Expt & Clin Pharmacol, Warsaw, Poland. Kozinski, M (corresponding author), Med Univ Gdansk, Dept Cardiol & Internal Med, 9b Powstania Styczniowego St, PL-81519 Gdynia, Poland. marek.kozinski@gumed.edu.pl AN - WOS:000543377400003 AU - Kozinski, M. AU - Rejszel-Baranowska, J. AU - Mlodawska, E. AU - Siller-Matula, J. M. AU - Tomaszuk-Kazberuk, A. DO - 10.5114/aic.2020.96055 J2 - Postep. Kardiol. Interwencyjnej KW - atrial fibrillation percutaneous coronary intervention non-vitamin K oral anticoagulants vitamin K antagonist anticoagulation ELUTING STENT IMPLANTATION ORAL ANTICOAGULATION ARTERY-DISEASE TRIPLE THERAPY MANAGEMENT METAANALYSIS GUIDELINES DABIGATRAN ASPIRIN HEPARIN Cardiac & Cardiovascular Systems LA - English M1 - 2 M3 - Review N1 - ISI Document Delivery No.: MC6EJ Times Cited: 0 Cited Reference Count: 27 Kozinski, Marek Rejszel-Baranowska, Joanna Mlodawska, Elzbieta Siller-Matula, Jolanta M. Tomaszuk-Kazberuk, Anna Jolanta Siller-Matula, PD/J-8992-2015 Jolanta Siller-Matula, PD/0000-0001-6041-1635 0 1 TERMEDIA PUBLISHING HOUSE LTD POZNAN POSTEP KARDIOL INTER PY - 2020 SN - 1734-9338 SP - 127-137 ST - Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention T2 - Postepy W Kardiologii Interwencyjnej TI - Updated overview of evidence on optimal antithrombotic therapy in patients with atrial fibrillation undergoing percutanous coronary intervention UR - ://WOS:000543377400003 VL - 16 ID - 761467 ER - TY - JOUR AB - PURPOSE: As part of an initiative to revolutionize the curriculum of the NYU School of Medicine, we hypothesized that a simulation-based workshop, structured to engage learners in many facets of cardiac pathophysiology and the approach to patients with cardiac disease, would improve medical student education both in learner satisfaction and in measurable improvements in knowledge. METHODS: The second year medical school class was divided into small groups who rotated between two stations. The students worked together to obtain a history, perform a physical exam, interpret EKG and rhythm strips, and administer treatments with a facilitator from the division of cardiology. One case involved a man who developed in-stent thrombosis and ventricular fibrillation. The other case involved a woman with mitral stenosis who developed atrial fibrillation with rapid ventricular response and congestive heart failure. Discussion points included mechanisms of disease and medication action, differential diagnosis of chest pain and dyspnea, the cardiovascular physical exam, and elements of professionalism involved with treating acutely ill patients and working within a multidisciplinary team. The simulations were followed by a debriefing led by a cardiology attending and/or fellow. The students scored and commented on the experience. The students took a multiple choice exam, similar to exams given in previous years. The exams and scores on the individual test questions the year of the intervention and the year prior were obtained. Two critical care physicians (BK and VK), who were not involved in development of the test, reviewed the test questions and divided them into three categories based upon how related the item content was to the simulation content - very related, moderately related, and not related. RESULTS: The overall percentage correct increased from 81.5% to 84.85%; this was not statistically significant by a Mann- Whitney analysis (p = 0.202). However, when focusing on the items that were either very or moderately related (22 and 17 questions on respective exams), there was a statistically significant improvement from 83.81% to 94.94% (p=0.02). The scores for the unrelated questions (52 and 53 questions on respective exams) went down from 82.43% to 81.62%; this was not statistically significant (p=0.92). The cardiology pathophysiology course received the highest rating for any pathophysiology course over the prior two years, higher than the score from the prior year. CONCLUSIONS: Simulation-based medical education in the area of cardiac pathophysiology and clinical approach enhances knowledge as measured by a multiple choice exam. That there was a difference in the improvement between simulation sensitive and simulation insensitive test items suggests that this improvement was due to simulation rather than the quantity of education. Future efforts would include identifying other clinically relevant endpoints beyond multiple choice exams. The cardiology simulation workshop has been added permanently to the medical school curriculum. AD - V. Kramer, Monmouth Pulmonary Consultants, Eatontown, NJ, United States AU - Kramer, V. AU - Skolnick, A. H. AU - Felner, K. AU - Kaufman, B. DB - Embase DO - 10.1016/j.chest.2016.08.722 KW - atrial fibrillation cardiology clinical study congestive heart failure curriculum differential diagnosis disease simulation dyspnea electrocardiogram female heart ventricle fibrillation human intensive care male medical decision making medical school medical student mitral valve stenosis physician professionalism rhythm satisfaction stent thrombosis thorax pain LA - English M1 - 4 M3 - Conference Abstract N1 - L613469030 2016-12-05 PY - 2016 SN - 1931-3543 SP - 630A ST - Simulation-enhanced second-year medical student cardiology curriculum T2 - Chest TI - Simulation-enhanced second-year medical student cardiology curriculum UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613469030&from=export http://dx.doi.org/10.1016/j.chest.2016.08.722 VL - 150 ID - 761000 ER - TY - JOUR AB - Catherizations in the early period after congenital heart surgery (CHS) are considered to be associated with an elevated rate of morbidity and mortality due to the hemodynamic instability and vulnerability of these patients. Therefore, they are often avoided or delayed. The purpose of our study was to evaluate the feasibility and safety of diagnostic and interventional percutaneous procedures in this critical period (≤30 days) after CHS in children. Method: Retrospective evaluation of all early postoperative catheterizations in our institution between 01/2001 and 12/2009. Patients: We performed in total 140 catheterizations - 134 diagnostic and 66 interventional procedures. Patients age ranged from 1 day to 18.8(median 0.3)years, their weight from 2.5 to 70(median 4.7)kg. 80 patients (57%) were male. Catheterizations were performed between 0 and 30(median 11)days after CHS. Previous surgery was partial/total cavopulmonaryanastomosis (33.6%), shunt- or Norwood/hybrid procedures (18.6%), implantation of a pulmonary graft (12.9%), arterial switch-operation (8.6%), repair of coarctation (5.7%), and others. Results: Indications for catheterization were prolonged postoperative course (25%), decrease of saturation (22.1%), ECGchanges (13.5%), elevated pulmonary-arterial pressure (12.1%), assumed re-coarcations (5%), and others. 4 patients were catheterized under extracorporeal mechanical support. 81 diagnostic procedures (60.4%) revealed a significant pathology leading to a direct catheter-intervention (n=60) or early redosurgery (n=21). Interventions (n=86, 66 patients) included stent-implantations/balloon-dilatations in pulmonary arteries (25.6%) or (re-)coarctations (10.5%) or restrictive ASDs (10.5%), coil-embolizations of aortopulmonary (11.6%) and venovenous collaterals (9.3%), manipulations of shunts and fenestrations (12.8%), and others. Immediate success rate was high (97%). Complications (arrhythmias, vessel thrombosis, pneumothorax, intracerebral bleeding) occurred in 12 patients (8.6%). 30-day survival rate after catheterization was 95%. Conclusion: If indicated, diagnostic catheterizations can be performed safely and with a high diagnostic value in the early postoperative course. Postoperative decrease of saturation had the highest predictive value for a postoperative problem needing acute treatment (68%). Transcatheter interventions can be successfully performed leading to a significant and lasting improvement of these critically ill patients. Therefore, diagnostic and interventional catheterizations should not be withheld from the patients at any time after CHS. An experienced multidisciplinary team approach is needed to ensure the successful realization of these procedures. AD - O. Kretschmar, University Children's Hospital Zurich, Department of Pediatric Cardiology, Australia AU - Kretschmar, O. AU - Balmer, C. AU - Prětre, R. AU - Dave, H. AU - Knirsch, W. DB - Embase DO - 10.1017/S1047951110000478 KW - catheterization Japanese (people) diagnosis heart surgery pediatric cardiology society postoperative period child cardiology patient pulmonary artery fenestration heart arrhythmia thrombosis pneumothorax brain hemorrhage survival rate diagnostic value critically ill patient morbidity safety weight male surgery implantation lung artery pressure diagnostic procedure pathology catheter stent dilatation mortality LA - English M3 - Conference Abstract N1 - L70221191 2010-08-11 PY - 2010 SN - 1047-9511 SP - S40 ST - Diagnostic and interventional percutaneous catheterization in the early postoperative period (≥30 days) after congenital heart surgery in children - A single-centre experience T2 - Cardiology in the Young TI - Diagnostic and interventional percutaneous catheterization in the early postoperative period (≥30 days) after congenital heart surgery in children - A single-centre experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70221191&from=export http://dx.doi.org/10.1017/S1047951110000478 VL - 20 ID - 761257 ER - TY - JOUR AB - Mechanical circulatory support (MCS) is the overarching term that encompasses the temporary and durable devices used in patients with severe heart failure. MCS disturbs the hematologic and coagulation system, leading to platelet activation, activation of the contact pathway of coagulation, and acquired von Willebrand syndrome. Ischemic stroke and major hemorrhage occur in up to 30% of patients. Hematologists are an essential part of the MCS team because they understand the delicate balance between bleeding and clotting and alteration of hemostasis with antithrombotic therapy. However, prior to this important collaborative role, learning the terminology used in the field and types of MCS devices allows improved communication with the MCS team and best patient care. Understanding which antithromobotic therapies are used at baseline is also required to provide recommendations if hemorrhage or thrombosis occurs. Additional challenging consultations in MCS patients include the influence of thrombophilia on the risk for thrombosis and management of heparin-induced thrombocytopenia. This narrative review will provide a foundation to understand MCS devices how to prevent, diagnose, and manage MCS thrombosis for the practicing hematologist. AD - [Kreuziger, Lisa Baumann] Med Coll Wisconsin, Dept Med, Div Hematol, BloodCtr Wisconsin, Milwaukee, WI 53226 USA. [Massicotte, M. Patricia] Univ Alberta, Dept Pediat, Edmonton, AB, Canada. Kreuziger, LB (corresponding author), Med Coll Wisconsin, Blood Res Inst, BloodCtr Wisconsin, 8733 Watertown Plank Rd, Milwaukee, WI 53226 USA.; Kreuziger, LB (corresponding author), Med Coll Wisconsin, Div Hematol & Oncol, 8733 Watertown Plank Rd, Milwaukee, WI 53226 USA. Lisa.BaumannKreuziger@bcw.edu AN - WOS:000451862100066 AU - Kreuziger, L. B. AU - Massicotte, M. P. DA - Nov DO - 10.1182/asheducation-2018.1.507 J2 - Hematol.-Am. Soc. Hematol. Educ. Program KW - VENTRICULAR ASSIST DEVICES EXTRACORPOREAL MEMBRANE-OXYGENATION INTRAAORTIC BALLOON PUMP TOTAL ARTIFICIAL-HEART VON-WILLEBRAND-FACTOR CONTINUOUS-FLOW ANTITHROMBOTIC THERAPY CARDIOGENIC-SHOCK PROSPECTIVE TRIAL SUPPORT Education, Scientific Disciplines Hematology LA - English M3 - Article N1 - ISI Document Delivery No.: HC5SG Times Cited: 4 Cited Reference Count: 50 Kreuziger, Lisa Baumann Massicotte, M. Patricia 4 0 3 AMER SOC HEMATOLOGY WASHINGTON HEMATOL-AM SOC HEMAT PY - 2018 SN - 1520-4391 SP - 507-515 ST - Adult and pediatric mechanical circulation: a guide for the hematologist T2 - Hematology-American Society of Hematology Education Program TI - Adult and pediatric mechanical circulation: a guide for the hematologist UR - ://WOS:000451862100066 ID - 761561 ER - TY - JOUR AB - Introduction: Patients undergoing peripheral vascular surgery (PVS) have increased risk of post-op myocardial infarction (MI) and death due to coronary artery disease (CAD). Functionally significant coronary ischemia is often unrecognized since guidelines recommend no cardiac testing in patients with no CAD symptoms. A new non-invasive cardiac test, coronary CT angiography (CTA)-derived fractional flow reserve (FFRCT), reliably identifies ischemia-producing coronary stenosis in chest pain patients but its value in peripheral vascular patients is unknown. We sought to determine whether pre-op diagnosis of silent coronary ischemia using FFRct can reduce post-op MI and cardiovascular death in patients undergoing PVS. Methods: Patients with no cardiac symptoms admitted for elective PVS underwent pre-op CTA-FFRCT evaluation in a prospective, open-label, IRB-approved Study and were compared to matched consecutive Control patients with no cardiac symptoms who underwent elective PVS with standard pre-op cardiac evaluation during the 18 months before the Study began. CTA-FFRCT results were available to treating physicians with guidance by a multidisciplinary team of surgery, cardiology and anaesthesiology. Ischemia-producing coronary stenosis was defined as FFRCT ≤0.80 distal to stenosis in >2mm vessels. Primary endpoint was major adverse cardiac event (MACE= cardiovascular (CV) death, MI or urgent coronary revascularization) at 30 days, with follow up at 6 and 12 months. Results: Study patients (n=127) were similar to Controls (n=130) with regard to age (66±8 v. 66±8 years), gender (80% v. 82% male), cardiac risk factors, pre-op ABI and surgery performed. CTA in Study patients revealed extensive coronary calcification (mean Agatston score 1135±1018) with ≥50% coronary stenosis in 72% of patients including 7% with left main stenosis. FFRCT analysis in118 patients (93%) revealed significant coronary ischemia in 82 patients (65%) with multivessel ischemia in 57%. PVS was performed as scheduled in 120 Study patients (94%) and postponed in 7(coronary revasc in 1, medical therapy in 6). PVS was performed in all Controls. There were no post-op deaths in Study vs 5 deaths from MI in Control; one patient in Study had post op MI on day 3 with successful emergent coronary stenting. Primary outcome, MACE at 30 days, in Study was 1/127 (0.8%) vs. 7/130 (5.4%) inControl (p=0.066). Elective coronary angiography was performed 1-3 months post-op in 72 Study patients with left main, severe or multivessel ischemia with coronary revascularization in 50 (45 stents; 5 CABG). MACE at 6 months was reduced in Study (2/124, 1.6%) compared to Control (9/130, 6.9%, P=0.034).Cumulative events during 12 month follow up (Kaplan Meier analysis) showed that compared to Controls, Study patients had significant reduction in MACE (3.7% vs 8.5%, P=0.031), CV death (0% vs 5.4%, p=0.014) and MI (3.7% vs 8.5%, p=0.031). There was no difference in all-cause mortality. Conclusion: Patients undergoing peripheral vascular surgery have high prevalence (65%) of unsuspected silent coronary ischemia. Pre-op diagnosis of silent ischemia using CTA-FFRCTcan help guide multidisciplinary team approach to reduce post-operative death and MI. Favorable one year results of staged peripheral and coronary revascularization suggest the need for further controlled outcome studies. Disclosure: Research grant from HeartFlow Inc. AU - Krievins, D. AU - Zellans, E. AU - Latkovskis, G. AU - Zvaigzne, L. AU - Erglis, A. AU - Kumsars, I. AU - Rumba, R. AU - Kaufmanis, K. AU - Zarins, C. DB - Embase DO - 10.1016/j.ejvs.2019.09.261 KW - desulfatohirudin adult Agatston score all cause mortality anesthesiology cardiology clinical evaluation computed tomographic angiography conference abstract controlled study coronary angiography coronary artery calcification coronary artery obstruction coronary stenting female follow up fractional flow reserve gender heart muscle revascularization human Kaplan Meier method lower limb major adverse cardiac event major clinical study male multidisciplinary team physician preoperative evaluation prevalence prospective study risk factor silent myocardial ischemia surgery thorax pain LA - English M1 - 6 M3 - Conference Abstract N1 - L2003903990 2019-12-12 PY - 2019 SN - 1532-2165 1078-5884 SP - e723 ST - Preoperative Testing for Silent Coronary Ischemia Using Coronary CT Angiography-derived Fractional Flow Reserve (FFRct) May Reduce Postoperative Myocardial Infarction and Cardiovascular Death in Patients Needing Lower-extremity Revascularization Compared to Standard Pre-operative Evaluation of Patients With no Cardiac Symptoms Undergoing Peripheral Vascular Surgery T2 - European Journal of Vascular and Endovascular Surgery TI - Preoperative Testing for Silent Coronary Ischemia Using Coronary CT Angiography-derived Fractional Flow Reserve (FFRct) May Reduce Postoperative Myocardial Infarction and Cardiovascular Death in Patients Needing Lower-extremity Revascularization Compared to Standard Pre-operative Evaluation of Patients With no Cardiac Symptoms Undergoing Peripheral Vascular Surgery UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003903990&from=export http://dx.doi.org/10.1016/j.ejvs.2019.09.261 VL - 58 ID - 760643 ER - TY - JOUR AB - Introduction and Objectives: Circumcision is a traditional and religious ceremony in Algeria as in other Muslim countries. It is one of the most frequent surgical procedure but no Algerian guidelines have been established for its management. The aim of this study was to analyse outcomes of circumcision and to provide guidelines for its management. Materials and Methods: We retrospectively reviewed medical records of nine patients who had been circumcised between 2009-2013. Factor concentrates were given before and after circumcision for 10 days (for circumcision done before 2011) and 5 days (for circumcision done after 2011); the doses had been adjusted according to the severity of hemophilia and bleeding phenotype. Results: We studied nine patients (Hemophilia A = 5, Hemophilia B = 4). In five patients factor activities were < 1%, 3/9 were between 1 and 5% and 1/9 was >5%. The ages of circumcision ranged from 2 to 18 years (median 8 years). All indications for circumcision were parental request. The patients with hemophilia < 15 years were circumcised in the pediatric surgery department with the collaboration of surgeons, anesthesiologists and hematologists. All circumcisions were done under general anesthesia. Two patients had mild bleeding. Transfusion was not needed. Thrombotic events were not observed and antibody occurrence was not detected in these patients. Conclusion: Our experience showed that circumcision should be performed under appropriate conditions by a multidisciplinary team in a specialized centre. It allowed us to reduce the consumption of clotting factor concentrate and to establish a protocol to manage circumcision but the number of patients is small and we should apply our protocol on a larger patient sample to have convincing conclusions, and in order to provide Algerian guidelines for the management of circumcision. AD - A. Krim, CHU IBN Badis, Constantine, Argentina AU - Krim, A. AU - Mezhoud, F. AU - Salhi, N. AU - Bouabellou, F. AU - Mansour, N. E. S. AU - Khellaf, M. AU - Meskaldji, L. DB - Embase DO - 10.1111/hae.12400 KW - blood clotting factor concentrate antibody hemophilia patient Algeria human circumcision bleeding hemophilia B surgical technique medical record hemophilia A Muslim ceremony transfusion pediatric surgery surgeon hematologist phenotype anesthesist general anesthesia LA - English M3 - Conference Abstract N1 - L71475594 2014-06-04 PY - 2014 SN - 1351-8216 SP - 80 ST - Circumcision in hemophilia patients in eastern Algeria: A single centre experience T2 - Haemophilia TI - Circumcision in hemophilia patients in eastern Algeria: A single centre experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71475594&from=export http://dx.doi.org/10.1111/hae.12400 VL - 20 ID - 761113 ER - TY - JOUR AB - BACKGROUND: Few published data exist with respect to current implementation of interventions that increase patient safety in intensive care units (ICUs) Furthermore, even less published data exist that address implementation of outcome-related methodologies of patient safety interventions in ICUs. OBJECTIVE: The purpose of this study was threefold: (1) to increase implementation rates of known, evidence-based interventions in the Dartmouth Hitchcock Medical Center (DHMC) ICU that have been demonstrated to reduce morbidity and mortality in critically ill patients; (2) to develop a durable and reproducible intervention model that can be applied not only to various aspects of ICU medicine but to any healthcare microsystem that is process oriented; and (3) to design an "ICU-specific" value compass. DESIGN: Using a before/after study design, the interventions involved: (1) establishing a systematic approach to integrate the delivery of proven ICU safety measures; (2) using the design of the various tools to develop a method for team communication and team building; (3) incorporating prompts into a ICU progress note for the healthcare team to address three evidence-based measures on a daily basis; and (4) using a data wall to demonstrate progress and to provide "real-time" feedback for error correction. SETTING AND PARTICIPANTS: In the before and after study, two groups of 40 consecutive patients admitted to DHMC's Intensive Care Unit were evaluated. The first group of patients was admitted between April and May of 2003. The second group of 40 patients was admitted between May and June of 2004. To ensure process stability, control data were also collected on patients at an interval time point between these two groups. MAIN OUTCOME MEASURES: Three evidence-based interventions were identified that reduce the likelihood of adverse events resulting simply from an ICU stay: (1) prophylaxis against venous thrombo-embolic disease (venous thromboembolism or deep vein thrombosis); (2) prophylaxis against ventilator-associated pneumonia (VAP); and (3) prophylaxis against stress-ulcers (SU). Two data points were obtained per patient per day corresponding to the work shift schedule in the ICU. The unit of measure was patient-shift observation. A limited data set was collected before implementing the change package to ensure system stability. RESULTS: Both traditional statistical analysis and statistical process control (SPC) were used to evaluate the results. For each metric, it was possible to demonstrate an increase in the measure of the mean, reduced point-to-point variation as well as a substantial narrowing of the control limits indicating improved process control. LIMITATIONS: By virtue of the involvement of the researcher in the data collection for the control group, the potential existed for methodological bias by acting on the information collected. There was also the lack of a cohesive data structure from which to collect information (ie, the hospital computer speaks one language, the ventilator a second and the monitoring systems a third). CONCLUSIONS: A model for changing the ICU microsystem at DHMC was created that enabled successful implementation of evidence-based measures by maximising the natural flow of work and fostering a team-based culture to improve patient safety. Unique to this method and unlike currently available methods that define only the delivery of the appropriate intervention as success, system success was defined in terms of both true positives, namely delivering care when it is indicated, as well as true negatives, not delivering care when there is none indicated, to offer a more comprehensive system review. Additionally, the method of data collection allowed simplified defect analysis, thereby eliminating a resource-consuming audit of data after the fact. This approach, therefore, provides a basis for adapting and redesigning the PDSA cycle so as to specifically apply this type of "disciplinary" work. AD - Critical Care Medicine, Franklin Square Hospital, Baltimore, Maryland 21237, USA. william.krimsky@medstar.net AN - 19204137 AU - Krimsky, W. S. AU - Mroz, I. B. AU - McIlwaine, J. K. AU - Surgenor, S. D. AU - Christian, D. AU - Corwin, H. L. AU - Houston, D. AU - Robison, C. AU - Malayaman, N. DA - Feb DO - 10.1136/qshc.2007.024844 DP - NLM ET - 2009/02/11 J2 - Quality & safety in health care KW - Critical Care/*standards *Guideline Adherence Health Plan Implementation Humans Intensive Care Units/*organization & administration/standards Models, Organizational New Hampshire Patient Care Team/organization & administration Pilot Projects *Safety Management LA - eng M1 - 1 N1 - 1475-3901 Krimsky, W S Mroz, I B McIlwaine, J K Surgenor, S D Christian, D Corwin, H L Houston, D Robison, C Malayaman, N Journal Article Research Support, Non-U.S. Gov't England Qual Saf Health Care. 2009 Feb;18(1):74-80. doi: 10.1136/qshc.2007.024844. PY - 2009 SN - 1475-3898 SP - 74-80 ST - A model for increasing patient safety in the intensive care unit: increasing the implementation rates of proven safety measures T2 - Qual Saf Health Care TI - A model for increasing patient safety in the intensive care unit: increasing the implementation rates of proven safety measures VL - 18 ID - 760481 ER - TY - JOUR AB - Introduction: The study was conducted to understand the clinical algorithm of spinal meningioma. Correlation was done by clinical presentation with radiological features and histopathology. The stress on to understand the necessity for a team-approach between clinician, radiologist and pathologist and vice versa is emphasized. Aim: The aim of the study is to correlate histopathology of spinal meningioma with the radiological features. Materials and Methods: This is a retrospective study of spinal tumors, diagnosed by histopathology as various types of meningioma. All the relevant clinical data of the patients were searched from the ward records. The various radiological features were collected. Results: The total number of spinal tumors studied during the 8 years period was 86 cases among which 25 cases were diagnosed by histopathology as various types of meningioma conclusively. Spectroscopy provides molecular information with regard to meningiomas and potentially aid in biopsy planning. Surgical resections were done as follows: 20 cases resected as Simpson Grade 1, 5 cases resected as Simpson Grade 2. Venous thromboembolism was seen in 1 patient. Four cases underwent follow-up adjuvant external beam radiotherapy. Conclusion: The Simpson grading of resection of meningioma correlated the degree of surgical resection completeness with symptomatic recurrence. Four cases underwent follow-up adjuvant external beam radiotherapy with good results. Spinal meningioma needs correlation between radiologist, pathologist and clinician. AD - [Krishnaveni, A. G.; Kannan, P.] Thoothukudi Med Coll, Dept Pathol, Thoothukudi, Tamil Nadu, India. [Anandan, Heber] Dr Agarwals Healthcare Ltd, Dept Clin Res, Tirunelveli, Tamil Nadu, India. Kannan, P (corresponding author), Thoothukudi Med Coll, Dept Pathol, Thoothukudi, Tamil Nadu, India. drkannanpathology1967@gmail.com AN - WOS:000414568900024 AU - Krishnaveni, A. G. AU - Kannan, P. AU - Anandan, H. DA - Jul DO - 10.17354/ijss/2017/346 J2 - Int. J. Sci. Study KW - Adjuvant external beam radiotherapy Computed tomography Hematoxylin-eosin stain Magnetic resonance imaging Radiograph Simpson grading of resection RESECTION FEATURES Medicine, Research & Experimental LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: FL9JE Times Cited: 0 Cited Reference Count: 25 Krishnaveni, A. G. Kannan, P. Anandan, Heber Anandan, Heber/S-4379-2019; David, Heber A/AAD-5191-2020 Anandan, Heber/0000-0002-5850-301X; 0 INT JOURNAL SCIENTIFIC STUDY-IJSS MAHARASHTRA INT J SCI STUDY PY - 2017 SN - 2321-6379 SP - 108-118 ST - A Radiology-pathological Correlation of Spinal Meningioma in a Tertiary Care Hospital - A Retrospective Study T2 - International Journal of Scientific Study TI - A Radiology-pathological Correlation of Spinal Meningioma in a Tertiary Care Hospital - A Retrospective Study UR - ://WOS:000414568900024 VL - 5 ID - 761644 ER - TY - JOUR AB - SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Limited data exist on the optimal timing of factor Xa (fXa) inhibitor initiation for acute pulmonary embolism (PE) after catheter-directed thrombolysis (CDT). The objective of this study was to determine the average time to initiation of apixaban and rivaroxaban after completion of CDT and to analyze the effect of timing on clinical markers and safety. METHODS: A retrospective review of patients who underwent CDT from our Pulmonary Embolism Response Team registry was conducted from 2016 to 2020. Patients who received apixaban were compared to those who received rivaroxaban after CDT. The primary outcome was time to fXa inhibitor initiation from the completion of CDT. Secondary outcomes include GUSTO bleeding, CDT characteristics, hemodynamics, echocardiographic parameters, and length of stay. RESULTS: Of the 46 CDT procedures performed during the study period, 38 patients were transitioned to a fXa inhibitor (apixaban n=17, rivaroxaban n=21) before discharge. There were no differences in baseline characteristics, CDT dose or duration, hemodynamic parameters, or change in RV:LV ratio among groups. Unfractionated heparin was started shortly after completion of CDT (4.1 hrs for apixaban vs. 5.1 hrs for rivaroxaban; p=0.86). More patients who received apixaban had a massive PE (23% vs. 5%, p=0.08), were hypotensive on admission (35% vs 5%, p=0.02), and required vasopressor support (18% vs 0%, p=0.04). The average time to apixaban initiation was significantly longer than rivaroxaban (66 hrs vs. 42 hrs, p=0.041). There were no differences in GUSTO bleeding (12% vs. 10%; p=0.82) or length of stay (9.1 vs. 8.2 days; p=0.35) among groups. CONCLUSIONS: The average time to initiation of a fXa inhibitor after completion of CDT was 42 to 66 hours. Timing varied based on initial patient presentation as more patients in the apixaban group presented with a massive PE and experienced subsequent hemodynamic instability. Despite differences in timing of fXa inhibitor initiation, no difference in any type of GUSTO bleeding occurred. Further studies are warranted to determine the optimal time to initiation of fXa inhibitors. CLINICAL IMPLICATIONS: While CDT has become a more widely used treatment option for acute PE, initiation of maintenance anticoagulation post procedure is largely unknown. This study demonstrates when fXa inhibitors can be administered safely and effectively after CDT. DISCLOSURES: No relevant relationships by Sorcha Allen, source=Web Response No relevant relationships by Nathalie Antonios, source=Web Response No relevant relationships by Yevgeniy Brailovsky, source=Web Response No relevant relationships by Lucas Chan, source=Web Response No relevant relationships by Ibrahim Chowdhury, source=Web Response No relevant relationships by Amir Darki, source=Web Response No relevant relationships by Jawed Fareed, source=Web Response No relevant relationships by Jeremiah Haines, source=Web Response No relevant relationships by Shannon Kuhrau, source=Web Response No relevant relationships by Ahmad Manshad, source=Web Response No relevant relationships by Alexandru Marginean, source=Web Response No relevant relationships by Dalila Masic, source=Web Response No relevant relationships by Karim Merchant, source=Web Response No relevant relationships by Stephen Morris, source=Web Response No relevant relationships by Katerina Porcaro, source=Web Response AU - Kuhrau, S. AU - Masic, D. AU - Chowdhury, I. AU - Antonios, N. AU - Brailovsky, Y. AU - Allen, S. AU - Merchant, K. AU - Marginean, A. AU - Manshad, A. AU - Chan, L. AU - Porcaro, K. AU - Morris, S. AU - Haines, J. AU - Fareed, J. AU - Darki, A. DB - Embase DO - 10.1016/j.chest.2020.08.1924 KW - antihypertensive agent apixaban heparin hypertensive factor rivaroxaban adult anticoagulation bleeding catheter directed thrombolysis clinical article conference abstract controlled study drug safety drug therapy female hemodynamic parameters hemodynamics human length of stay male outcome assessment pharmacokinetics pulmonary embolism response team retrospective study LA - English M1 - 4 M3 - Conference Abstract N1 - L2008026083 2020-10-19 PY - 2020 SN - 1931-3543 0012-3692 SP - A2266-A2267 ST - TIMING OF FACTOR XA INHIBITORS AFTER CATHETER-DIRECTED THROMBOLYSIS IN PATIENTS WITH ACUTE PULMONARY EMBOLISM T2 - Chest TI - TIMING OF FACTOR XA INHIBITORS AFTER CATHETER-DIRECTED THROMBOLYSIS IN PATIENTS WITH ACUTE PULMONARY EMBOLISM UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008026083&from=export http://dx.doi.org/10.1016/j.chest.2020.08.1924 VL - 158 ID - 760540 ER - TY - JOUR AB - Introduction: Anticoagulation remains the mainstay pharmacotherapy for acute pulmonary embolism (PE), but multiple treatment options exist. The Pulmonary Embolism Response Team (PERT) is a multidisciplinary group that evaluates patients, formulates evidence-based treatment plans, and mobilizes resources. The objective of this study was to characterize the anticoagulation prescribing patterns made by PERT and to determine the clinical impact of anticoagulant selection. Materials and Methods: This was a retrospective analysis of patients evaluated by PERT from 2016 to 2018. Multivariable linear regression was conducted to determine predictors of length of stay (LOS). Results: A total of 209 patients were evaluated by PERT and received anticoagulation on discharge. Of those, 47% received a non-vitamin K oral anticoagulant (NOAC), 29% received warfarin, and 23% received low-molecular-weight heparin. Patient preferences and comorbidities were the most common reasons for NOAC omission. Patients who received NOACs had a shorter median LOS than warfarin (6.1 [4.6-7.6] days vs 10.9 [8.4-13.4] days;P< .05). Selection of NOAC upon discharge was the only factor independently associated with reduced LOS (beta coefficient: -0.6; 95% CI: -1.01 to -0.18;P< .01). Conclusion: The most common recommendation made by PERT was to initiate a NOAC upon discharge, resulting in shorter hospital LOS compared to patients who received warfarin. AD - [Kuhrau, Shannon; Masic, Dalila; Mancl, Erin] Loyola Univ Med Ctr, Dept Pharm, 2160 S First Ave, Maywood, IL 60153 USA. [Brailovsky, Yevgeniy; Porcaro, Katerina; Darki, Amir] Loyola Univ Med Ctr, Div Cardiol, Maywood, IL 60153 USA. [Morris, Stephen; Haines, Jeremiah] Loyola Univ Med Ctr, Dept Internal Med, Maywood, IL 60153 USA. [Charo, Kim] Gottlieb Mem Hosp, Dept Internal Med, Melrose Pk, IL USA. [Fareed, Jawed] Loyola Univ, Dept Pathol, Med Ctr Hosp, Maywood, IL USA. Kuhrau, S (corresponding author), Loyola Univ Med Ctr, Dept Pharm, 2160 S First Ave, Maywood, IL 60153 USA. srkuhrau@gmail.com AN - WOS:000548869600001 AU - Kuhrau, S. AU - Masic, D. AU - Mancl, E. AU - Brailovsky, Y. AU - Porcaro, K. AU - Morris, S. AU - Haines, J. AU - Charo, K. AU - Fareed, J. AU - Darki, A. C7 - 0897190020940125 DO - 10.1177/0897190020940125 J2 - J. Pharm. Pract. KW - pulmonary embolism anticoagulation thrombosis WARFARIN RIVAROXABAN MANAGEMENT EDOXABAN THERAPY DISEASE RISK Pharmacology & Pharmacy LA - English M3 - Article; Early Access N1 - ISI Document Delivery No.: MK6AV Times Cited: 0 Cited Reference Count: 22 Kuhrau, Shannon Masic, Dalila Mancl, Erin Brailovsky, Yevgeniy Porcaro, Katerina Morris, Stephen Haines, Jeremiah Charo, Kim Fareed, Jawed Darki, Amir Masic, Dalila/0000-0002-1621-9571; Brailovsky, Yevgeniy/0000-0002-4811-5267 0 SAGE PUBLICATIONS INC THOUSAND OAKS J PHARM PRACT SN - 0897-1900 SP - 6 ST - Impact of Pulmonary Embolism Response Team on Anticoagulation Prescribing Patterns in Patients With Acute Pulmonary Embolism T2 - Journal of Pharmacy Practice TI - Impact of Pulmonary Embolism Response Team on Anticoagulation Prescribing Patterns in Patients With Acute Pulmonary Embolism UR - ://WOS:000548869600001 ID - 761425 ER - TY - JOUR AB - INTRODUCTION: Anticoagulation remains the mainstay pharmacotherapy for acute pulmonary embolism (PE), but multiple treatment options exist. The Pulmonary Embolism Response Team (PERT) is a multidisciplinary group that evaluates patients, formulates evidence-based treatment plans, and mobilizes resources. The objective of this study was to characterize the anticoagulation prescribing patterns made by PERT and to determine the clinical impact of anticoagulant selection. MATERIALS AND METHODS: This was a retrospective analysis of patients evaluated by PERT from 2016 to 2018. Multivariable linear regression was conducted to determine predictors of length of stay (LOS). RESULTS: A total of 209 patients were evaluated by PERT and received anticoagulation on discharge. Of those, 47% received a non-vitamin K oral anticoagulant (NOAC), 29% received warfarin, and 23% received low-molecular-weight heparin. Patient preferences and comorbidities were the most common reasons for NOAC omission. Patients who received NOACs had a shorter median LOS than warfarin (6.1 [4.6-7.6] days vs 10.9 [8.4-13.4] days; P < .05). Selection of NOAC upon discharge was the only factor independently associated with reduced LOS (β coefficient: -0.6; 95% CI: -1.01 to -0.18; P < .01). CONCLUSION: The most common recommendation made by PERT was to initiate a NOAC upon discharge, resulting in shorter hospital LOS compared to patients who received warfarin. AD - Department of Pharmacy, Loyola University Medical Center, Maywood, IL, USA. Division of Cardiology, Loyola University Medical Center, Maywood, IL, USA. Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA. Department of Internal Medicine, Gottlieb Memorial Hospital, Melrose Park, IL, USA. Department of Pathology, Loyola University Medical Center Hospital, Maywood, IL, USA. AN - 32666864 AU - Kuhrau, S. AU - Masic, D. AU - Mancl, E. AU - Brailovsky, Y. AU - Porcaro, K. AU - Morris, S. AU - Haines, J. AU - Charo, K. AU - Fareed, J. AU - Darki, A. DA - Jul 15 DO - 10.1177/0897190020940125 DP - NLM ET - 2020/07/16 J2 - Journal of pharmacy practice KW - anticoagulation pulmonary embolism thrombosis LA - eng N1 - 1531-1937 Kuhrau, Shannon Orcid: 0000-0002-5066-293x Masic, Dalila Mancl, Erin Brailovsky, Yevgeniy Orcid: 0000-0002-4811-5267 Porcaro, Katerina Morris, Stephen Haines, Jeremiah Charo, Kim Fareed, Jawed Darki, Amir Journal Article United States J Pharm Pract. 2020 Jul 15:897190020940125. doi: 10.1177/0897190020940125. PY - 2020 SN - 0897-1900 SP - 897190020940125 ST - Impact of Pulmonary Embolism Response Team on Anticoagulation Prescribing Patterns in Patients With Acute Pulmonary Embolism T2 - J Pharm Pract TI - Impact of Pulmonary Embolism Response Team on Anticoagulation Prescribing Patterns in Patients With Acute Pulmonary Embolism ID - 760240 ER - TY - JOUR AB - Aim: Due to a hypercoagulable state, cancer increases the risk of venous thromboembolism (VTE) in the postoperative period. NICE guidelines recommend extended VTE prophylaxis to 28 days post-operatively after major abdominal cancer surgery [NG89]. We analysed our compliance with NICE guidelines and reviewed the reasons for non-compliance. Method: In this retrospective study, patients with colorectal cancer who had undergone surgery over a 4 month period were reviewed. Factors including demographics, type of surgery, complications, dose and course duration of medications were identified. Results: Between April 2018 to July 2018 in a Teaching Hospital, 48 patients had a major colorectal resection. Only 30 (63%) patients received the recommended 28 days of Enoxaparin. 11 (23%) patients received enoxaparin for an inappropriate duration. The duration of VTE prophylaxis ranged from 19-39 days. Conclusion: Lack of awareness of multidisciplinary teams about duration and dosage of Enoxaparin along with lack of appropriate checks at the time of discharge led to substandard VTE prophylaxis. We intend to address this by appropriate training and checklists. AD - S. Kulkarni, University Hospital of North Durham, NHS, Durham, United Kingdom AU - Kulkarni, S. AU - Rantos, I. AU - Green, S. DB - Embase KW - enoxaparin abdominal cancer adult awareness cancer patient cancer surgery checklist clinical article colorectal cancer complication conference abstract demography drug therapy female human hypercoagulability male multidisciplinary team peroperative complication postoperative period proctocolectomy prophylaxis retrospective study surgery teaching hospital venous thromboembolism LA - English M3 - Conference Abstract N1 - L631603208 2020-05-04 PY - 2019 SN - 1463-1318 SP - 93 ST - Increasing awareness in health-care professionals of the correct VTE prophylaxis in patients with Colorectal Cancer T2 - Colorectal Disease TI - Increasing awareness in health-care professionals of the correct VTE prophylaxis in patients with Colorectal Cancer UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631603208&from=export VL - 21 ID - 760679 ER - TY - JOUR AB - INTRODUCTION Computed Tomographic Pulmonary Angiograms (CTPAs) are used in the investigation of suspected pulmonary emboli (PE). Incidental findings of lung lesions are common. The outcomes of these incidental lesions are not clear. We present our experience in the management of incidental lung lesions over a five year period in a UK district general hospital. METHOD We identified patients retrospectively by analyzing all CTPAs from 2008 to 2012. We used Picture Archiving and Communication System for reports. Biopsy results and treatment outcomes were obtained from our in house pathology reporting system and cancer multidisciplinary database. Patients' medical records were used to confirm clinical outcomes. RESULTS Our study showed a two-thirds rise in the number of CTPAs requested over five years. Incidental lung lesions on CTPAs increased from 13% in 2008 to 19% in 2012. Patients that had CTPAs with a prior diagnosis of cancer increased from 1.7% to 2.7%. Patients with lung lesions suspicious for lung malignancy were referred to the Lung Multidisciplinary Team (MDT) for a decision on either serial imaging [positron emission tomography (PET) or CT] or tissue biopsy. Incidental lung lesions on CTPAs that required discussion at the Lung MDT decreased by half from 40/86 (46.5%) in 2008 to 49/204 (24%) in 2012. Patients referred for lung biopsy decreased from 12/86 (14%) to 22/204 (11%) over five years. Patients referred for monitoring with follow up imaging dropped significantly from 15/86 (17.4%) in 2008 to 11/204 (5.4%) in 2012. Over five years, 0.6% to 1.4% of patients with incidentalomas had histologically proven lung cancer mainly of advanced stage. Patients who required palliative treatment increased from 6/9 (67%) in 2008 to 18/19 (95%) in 2012, compared to radical treatment which decreased from 33% to 5%. CONCLUSIONS The rate of incidental lung lesions on CTPAs has risen due to the increased demand of CTPAs for investigation of PE in clinical practice. Lung MDT discussion of incidentalomas has halved over five years due to greater accountability of respiratory physician-led monitoring and urgent referral for biopsy. Less than 20% of all incidental lung lesions on CTPAs proved to be lung cancer. Patients with positive histology in our series had advanced stage lung cancer. A diagnosis of malignancy from incidental lung lesions was associated with a poor prognosis. We advise a standardized management pathway to reduce the delay in diagnosis and treatment of lung cancer from incidental lung lesions on CTPAs. (Table Presented). AD - A. Kumar, Princess Alexandra Hospital, Harlow, United Kingdom AU - Kumar, A. AU - Sallehuddin, S. AU - Isse, S. AU - Sundaram, S. AU - Sikdar, T. AU - Russell, P. DB - Embase KW - computer assisted tomography American society lung lesion human patient lung cancer lung diagnosis biopsy monitoring incidentaloma neoplasm imaging lung embolism incidental finding palliative therapy pathology data base medical record United Kingdom treatment outcome follow up picture archiving and communication system lung biopsy tissues positron emission tomography general hospital clinical practice physician histology prognosis L1 - http://www.atsjournals.org/doi/pdf/10.1164/ajrccm-conference.2014.189.1_MeetingAbstracts.A2253 LA - English M3 - Conference Abstract N1 - L72044684 2015-11-05 PY - 2014 SN - 1073-449X ST - Outcomes over five years in the identification of incidental pulmonary lesions on computed tomography pulmonary angiograms T2 - American Journal of Respiratory and Critical Care Medicine TI - Outcomes over five years in the identification of incidental pulmonary lesions on computed tomography pulmonary angiograms UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72044684&from=export VL - 189 ID - 761100 ER - TY - JOUR AB - Introduction: Metastases to the spine occur from a variety of primary malignancies. Surgery on these patients can be challenging with a substantial risk of complications. We present a single-center experience of 189 consecutive patients who underwent surgery for spinal metastases, and share our insights regarding complications. Methods: Charts of 189 patients who underwent surgery for spinal metastases over 5 years from October 2011 through February 2017 were reviewed for complications and possible contributing factors. A multivariate analysis was performed for patient demographic and surgical parameters that predict complications. Results: Complications were identified in 20% of all patients who underwent surgery for spine metastases. Medical complications included: urinary tract infection, 10%; deep vein thrombosis/pulmonary embolism, 5%; pneumonia, 3% and myocardial infarction, 1%. Surgical complications included: wound infection, 3%; and new neurologic deficit, 2%. Average thirty-day survival was 87%. Average ninety-day survival was 65%. Age > 65, prior radiation, and multiple metastases were all predictive of complications at a statistically significant threshold of p < 0.05. Conclusions: Surgery for spinal metastases is associated with a relatively high complication rate. Medical complications are more common than surgical complications. Age > 65, prior radiation, and multiple metastases were all predictive of complications. Optimization of co-morbid conditions by a multidisciplinary team may help reduce medical complications associated with surgery for spinal metastases. AD - J. Kumar, Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States AU - Kumar, J. AU - Yanamadala, V. AU - Shankar, G. AU - Choi, B. AU - Shin, J. DB - Embase DO - 10.1177/2192568218771030 KW - adult cancer patient cancer surgery cancer survival complication conference abstract controlled study deep vein thrombosis female heart infarction human lung embolism major clinical study male peroperative complication pneumonia radiation spine metastasis surgery urinary tract infection wound infection LA - English M1 - 1 M3 - Conference Abstract N1 - L622331049 2018-05-31 PY - 2018 SN - 2192-5690 SP - 118S ST - Complications associated with surgery for spinal metastases: A multivariable analysis T2 - Global Spine Journal TI - Complications associated with surgery for spinal metastases: A multivariable analysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622331049&from=export http://dx.doi.org/10.1177/2192568218771030 VL - 8 ID - 760821 ER - TY - JOUR AB - Background: Glanzmann thrombasthenia (GT) due to mutations that affect the αIIbβ3 integrin. Platelets (PLT) have been suggested to play a role in the early development of atherosclerosis. As one test of this hypothesis that GT may have a protective effect from atherothrombosis. Aims: We report a Coronary Artery Bypass Graft Surgery (CABG) and right Carotid endarterectomy (CEA) in a 57-year-old Tunisian man with GT type I disease (no platelet αIIbβ3 expression). Methods: The patient showed typical signs of GT with no PLT aggregation in response to physiological agonists. He presented a low PLT count (80 G/l). GT was diagnosed at 5 years old; He suffered from repeated epistaxis and gingivorrhagia but never required transfusion. He received blood transfusions only for his circumcision at 11 years old. He presented recently unstable angina, atrial fibrillation and right carotid atherosclerosis which first treated by Aspirin. These lesions were deemed inaccessible to percutaneous therapy. Therefore, CABG and CEA were recommended. Results: A multidisciplinary team was established to optimize perioperative management. The research of anti-HLA and anti-integrin αIIbβ3 allo-antibodies was negative. Prophylactic HLA-matched PLT administration was continued before and through the immediate postoperative period and no bleeding complications occurred. PLT transfusion recovery was confirmed by the percentage of αIIbβ3 expression on PLT surface (expression of αIIbβ3 increased from 0 to 55%). The PLT function analysis by aggregation and function tests was not normalized. The patient was discharged under a treatment of VKA in the reason of his atrial fibrillation chads2. His screening tests for risk factors for thrombosis revealed presence of FII G20210A mutation. Conclusions: This observation suggests that atherosclerosis can develop despite the lack of αIIbβ3 integrin and that cautious administration of aspirin or VKA is possible in patients with congenital hemostatic disorder in event of severe thrombotic complication. AD - M. Kurdi, University Hospital Pitié Salpêtrière, Paris, France AU - Kurdi, M. AU - Ankri, A. AU - Amour, J. AU - Brumpt, C. AU - Delort, J. AU - Lebreton, G. AU - Croisille, L. AU - D'Orion, R. AU - Martin-Toutain, I. DB - Embase DO - 10.1002/rth2.12012 KW - acetylsalicylic acid alloantibody endogenous compound fibrinogen receptor adult agonist atrial fibrillation blood transfusion carotid atherosclerosis carotid endarterectomy case report CHADS2 score child circumcision clinical article complication conference abstract coronary artery bypass graft diagnosis drug therapy epistaxis Glanzmann disease hospital discharge human human cell male middle aged multidisciplinary team mutation postoperative period preschool child protein expression risk factor school child screening test surgery thrombocyte thrombosis Tunisian unstable angina pectoris LA - English M3 - Conference Abstract N1 - L624158973 2018-10-09 PY - 2017 SN - 2475-0379 SP - 1321-1322 ST - Management of a patient with glanzmann thrombasthenia during a coronary artery bypass graft surgery: A case study T2 - Research and Practice in Thrombosis and Haemostasis TI - Management of a patient with glanzmann thrombasthenia during a coronary artery bypass graft surgery: A case study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624158973&from=export http://dx.doi.org/10.1002/rth2.12012 VL - 1 ID - 760931 ER - TY - JOUR AB - Background: Living donor liver transplantation is a safe method to expand the organ donation pool. In order to prevent postoperative morbidity and mortality, preoperative evalutation of the potential donors should be made meticulously by a multidisciplinary team. Despite this preperation process, some of the donor operations are aborted due to encountered situations of donor or recipient. In this study we analyzed the, aborted donor hepatectomies at different stages of the operation retrospectively. Materials and Methods: In our liver transplantation institute, 1304 living donor candidates underwent surgical exploration for donor hepatectomy from September 2005 until October 2015. Among these candidates explorations, 50 (3.8%) of them were aborted due to various reasons. These abortion indications are analyzed retrospectively. Results: Among the hepatectomy abortions, 33 (66%) were due to donor related, 13 (26%) were due to recipient related and 4 (8%) were due to surgical condition. Donor related conditions were: histopathologically diagnosis of hepatosteatosis 18, Diagnosis of graft hepatitis and fibrosis 6, remnant volume insufficiency 4, vasculary conditions 3, biliary abnormalities 2. Recipient related conditions were: Diagnosis of peritoneal carcinomatosis 4, extreme intraabdominal adhesions related bleeding 2, diagnosis non-cirrhotic portal hypertension 3, haemodynamically instability 2, switching treatment option to resection 1 and providing sufficient portal drainage during exploration for portal vein thrombosis 1. Surgical conditions related aborted cases were present during initial phases of LDLT program in our institution. Among these cases, 2 were due to dissection of donor right hepatic artery, 1 were due to dissection of segment 4 artery of donor for left lobe hepatectomy and in one case remaining of the middle hepatic vein in graft although planned not to be removed, Conclusions: In terms of donor safety, abortion of donor hepatectomy should be considered during every stage of the procedure. Limiting this event may be provided by preooperative evaluation of the potential donors and recipients by a well-cooperating multidisciplinary team. Also we think, increasing surgical experience, will decrease the number of aborted donor hepatectomies. AD - K. Kutlutürk, Department of Surgery, Liver Transplantation Institute, Inonu Universty, Malatya, Turkey AU - Kutlutürk, K. AU - Otan, E. AU - Dirican, A. AU - Yilmaz, M. AU - Isik, B. AU - Özdemir, F. AU - Ince, V. AU - Akbulut, S. AU - Barut, B. AU - Ersan, V. AU - Baskiran, A. AU - Yilmaz, S. DB - Embase DO - 10.1097/01.tp.0000483259.57907.d4 KW - abortion adhesion bleeding congenital malformation diagnosis dissection fatty liver fibrosis hepatic artery hepatitis human human experiment liver resection liver transplantation liver vein living donor peritoneum cancer portal hypertension portal vein thrombosis recipient safety surgery LA - English M1 - 5 M3 - Conference Abstract N1 - L614324955 2017-02-10 PY - 2016 SN - 0041-1337 SP - S230 ST - Aborted donor hepatectomies for living donor liver transplantation: A single center experience T2 - Transplantation TI - Aborted donor hepatectomies for living donor liver transplantation: A single center experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614324955&from=export http://dx.doi.org/10.1097/01.tp.0000483259.57907.d4 VL - 100 ID - 761020 ER - TY - JOUR AD - Department of Pharmacy, Jackson Memorial Hospital, Jackson Health System, Miami, FL, United States. Miami Transplant Institute, Miami, FL, United States. Department of Medicine, University of Miami, Miami, FL, United States. Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, United States. Department of Pharmacy, New York Presbyterian Columbia University Medical Center, New York, NY, United States. Electronic address: doug.jennings.pharmd@gmail.com. AN - 27232922 AU - Kuyumjian, Y. M. AU - Miyares, M. A. AU - Leverock, J. AU - Chaparro, S. AU - Baker, W. L. AU - Jennings, D. L. DA - Sep 1 DO - 10.1016/j.ijcard.2016.05.030 DP - NLM ET - 2016/05/28 J2 - International journal of cardiology KW - Anticoagulants/*pharmacology Blood Coagulation/*drug effects/physiology Cohort Studies Female Heart-Assist Devices/*standards/trends Humans International Normalized Ratio/methods Male Middle Aged Patient Care Team/*standards/trends Retrospective Studies Bleeding Lvad Thrombosis Time in therapeutic range Warfarin LA - eng N1 - 1874-1754 Kuyumjian, Yara M Miyares, Marta A Leverock, Jaime Chaparro, Sandra Baker, William L Jennings, Douglas L Letter Netherlands Int J Cardiol. 2016 Sep 1;218:118-119. doi: 10.1016/j.ijcard.2016.05.030. Epub 2016 May 13. PY - 2016 SN - 0167-5273 SP - 118-119 ST - A multidisciplinary team-based process improves outpatient anticoagulation quality with continuous-flow left-ventricular assist devices T2 - Int J Cardiol TI - A multidisciplinary team-based process improves outpatient anticoagulation quality with continuous-flow left-ventricular assist devices VL - 218 ID - 760482 ER - TY - JOUR AB - Optimizing the time it takes to get a potential stroke patient to imaging is essential in a rapid stroke response. At our hospital, door-to-imaging time is comprised of 2 time periods: the time before a stroke is recognized, followed by the period after the stroke code is called during which the stroke team assesses and brings the patient to the computed tomography scanner. To control for delays due to triage, we isolated the time period after a potential stroke has been recognized, as few studies have examined the biases of stroke code responders. This code-to-imaging time (CIT) encompassed the time from stroke code activation to initial imaging, and we hypothesized that perception of stroke severity would affect how quickly stroke code responders act. In consecutively admitted ischemic stroke patients at The Mount Sinai Hospital emergency department, we tested associations between National Institutes of Health Stroke Scale scores (NIHSS), continuously and at different cutoffs, and CIT using spline regression, t tests for univariate analysis, and multivariable linear regression adjusting for age, sex, and race/ethnicity. In our study population, mean CIT was 26 minutes, and mean presentation NIHSS was 8. In univariate and multivariate analyses comparing CIT between mild and severe strokes, stroke scale scores <4 were associated with longer response times. Milder strokes are associated with a longer CIT with a threshold effect at a NIHSS of 4. AD - [Kwei, Kimberly T.; Liang, John; Wilson, Natalie; Tuhrim, Stanley; Dhamoon, Mandip] Icahn Sch Med Mt Sinai, Dept Neurol, One Gustave L Levy Pl,POB 1137, New York, NY 10029 USA. [Liang, John] Thomas Jefferson Univ Hosp, Dept Neurocrit Care, Philadelphia, PA 19107 USA. Kwei, KT (corresponding author), Icahn Sch Med Mt Sinai, Dept Neurol, One Gustave L Levy Pl,POB 1137, New York, NY 10029 USA. kimberly.kwei@mssm.edu AN - WOS:000432189900002 AU - Kwei, K. T. AU - Liang, J. AU - Wilson, N. AU - Tuhrim, S. AU - Dhamoon, M. DA - May DO - 10.1097/nrl.0000000000000157 J2 - Neurologist KW - acute stroke acute stroke diagnosis acute stroke management cerebral ischemia stroke severity mild stroke ACUTE ISCHEMIC-STROKE THROMBOLYSIS Clinical Neurology LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: GF8AO Times Cited: 3 Cited Reference Count: 11 Kwei, Kimberly T. Liang, John Wilson, Natalie Tuhrim, Stanley Dhamoon, Mandip 4 0 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA NEUROLOGIST PY - 2018 SN - 1074-7931 SP - 79-82 ST - Stroke Severity Affects Timing Time From Stroke Code Activation to Initial Imaging is Longer in Patients With Milder Strokes T2 - Neurologist TI - Stroke Severity Affects Timing Time From Stroke Code Activation to Initial Imaging is Longer in Patients With Milder Strokes UR - ://WOS:000432189900002 VL - 23 ID - 761591 ER - TY - JOUR AB - Coronavirus disease 2019 (COVID-19) is associated with increased rates of deep vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary Embolism Response Teams (PERT) have previously been associated with improved outcomes. We aimed to investigate whether PERT utilization, recommendations, and outcomes for patients diagnosed with acute PE changed during the COVID-19 pandemic. This is a retrospective cohort study of all adult patients with acute PE who received care at an academic hospital system in New York City between March 1st and April 30th, 2020. These patients were compared against historic controls between March 1st and April 30th, 2019. PE severity, PERT utilization, initial management, PERT recommendations, and outcomes were compared. There were more cases of PE during the pandemic (82 vs. 59), but less PERT activations (26.8% vs. 64.4%,p < 0.001) despite similar markers of PE severity. PERT recommendations were similar before and during the pandemic; anticoagulation was most recommended (89.5% vs. 86.4%,p = 0.70). During the pandemic, those with PERT activations were more likely to be female (63.6% vs. 31.7%,p = 0.01), have a history of DVT/PE (22.7% vs. 1.7%,p = 0.01), and to be SARS-CoV-2 PCR negative (68.2% vs. 38.3%p = 0.02). PERT activation during the pandemic is associated with decreased length of stay (7.7 +/- 7.7 vs. 13.2 +/- 12.7 days,p = 0.02). PERT utilization decreased during the COVID-19 pandemic and its activation was associated with different biases. PERT recommendations and outcomes were similar before and during the pandemic, and led to decreased length of stay during the pandemic. AD - [Kwok, Benjamin; Brosnahan, Shari B.; Amoroso, Nancy E.; Goldenberg, Ronald M.; Heyman, Brooke] New York Univ Langone Hlth, Div Pulm Crit Care & Sleep Med, New York, NY USA. [Horowitz, James M.; Yuriditsky, Eugene] New York Univ Langone Hlth, Leon H Charney Div Cardiol, New York, NY USA. [Jamin, Catherine] New York Univ Langone Hlth, Ronald O Perelman Dept Emergency Med, New York, NY USA. [Sista, Akhilesh K.] New York Univ Langone Hlth, Div Vasc & Intervent Radiol, New York, NY USA. [Smith, Deane E.] New York Univ Langone Hlth, Dept Cardiothorac Surg, New York, NY USA. [Maldonado, Thomas S.] New York Univ Langone Hlth, Div Vasc & Endovasc Surg, New York, NY USA. Kwok, B (corresponding author), New York Univ Langone Hlth, Div Pulm Crit Care & Sleep Med, New York, NY USA. benjamin.kwok@nyulangone.org AN - WOS:000568744400002 AU - Kwok, B. AU - Brosnahan, S. B. AU - Amoroso, N. E. AU - Goldenberg, R. M. AU - Heyman, B. AU - Horowitz, J. M. AU - Jamin, C. AU - Sista, A. K. AU - Smith, D. E. AU - Yuriditsky, E. AU - Maldonado, T. S. DO - 10.1007/s11239-020-02264-8 J2 - J. Thromb. Thrombolysis KW - Venous thromboembolism Pulmonary embolism Pulmonary Embolism Response Team COVID-19 SARS-CoV-2 Cardiac & Cardiovascular Systems Hematology Peripheral Vascular Disease LA - English M3 - Article; Early Access N1 - ISI Document Delivery No.: NN4FD Times Cited: 0 Cited Reference Count: 18 Kwok, Benjamin Brosnahan, Shari B. Amoroso, Nancy E. Goldenberg, Ronald M. Heyman, Brooke Horowitz, James M. Jamin, Catherine Sista, Akhilesh K. Smith, Deane E. Yuriditsky, Eugene Maldonado, Thomas S. Sista, Akhilesh/0000-0001-5582-796X; goldenberg, ron/0000-0002-0717-7250; Reis, AlessanRSS/0000-0001-8486-7469 0 SPRINGER DORDRECHT J THROMB THROMBOLYS SN - 0929-5305 SP - 9 ST - Pulmonary Embolism Response Team activation during the COVID-19 pandemic in a New York City Academic Hospital: a retrospective cohort analysis T2 - Journal of Thrombosis and Thrombolysis TI - Pulmonary Embolism Response Team activation during the COVID-19 pandemic in a New York City Academic Hospital: a retrospective cohort analysis UR - ://WOS:000568744400002 ID - 761410 ER - TY - JOUR AB - Coronavirus disease 2019 (COVID-19) is associated with increased rates of deep vein thrombosis (DVT) and pulmonary embolism (PE). Pulmonary Embolism Response Teams (PERT) have previously been associated with improved outcomes. We aimed to investigate whether PERT utilization, recommendations, and outcomes for patients diagnosed with acute PE changed during the COVID-19 pandemic. This is a retrospective cohort study of all adult patients with acute PE who received care at an academic hospital system in New York City between March 1st and April 30th, 2020. These patients were compared against historic controls between March 1st and April 30th, 2019. PE severity, PERT utilization, initial management, PERT recommendations, and outcomes were compared. There were more cases of PE during the pandemic (82 vs. 59), but less PERT activations (26.8% vs. 64.4%, p < 0.001) despite similar markers of PE severity. PERT recommendations were similar before and during the pandemic; anticoagulation was most recommended (89.5% vs. 86.4%, p = 0.70). During the pandemic, those with PERT activations were more likely to be female (63.6% vs. 31.7%, p = 0.01), have a history of DVT/PE (22.7% vs. 1.7%, p = 0.01), and to be SARS-CoV-2 PCR negative (68.2% vs. 38.3% p = 0.02). PERT activation during the pandemic is associated with decreased length of stay (7.7 ± 7.7 vs. 13.2 ± 12.7 days, p = 0.02). PERT utilization decreased during the COVID-19 pandemic and its activation was associated with different biases. PERT recommendations and outcomes were similar before and during the pandemic, and led to decreased length of stay during the pandemic. AD - Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA. benjamin.kwok@nyulangone.org. Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA. Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA. Ronald O. Perelman Department of Emergency Medicine, New York University Langone Health, New York, NY, USA. Division of Vascular and Interventional Radiology, New York University Langone Health, New York, NY, USA. Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA. Division of Vascular and Endovascular Surgery, New York University Langone Health, New York, NY, USA. AN - 32910409 AU - Kwok, B. AU - Brosnahan, S. B. AU - Amoroso, N. E. AU - Goldenberg, R. M. AU - Heyman, B. AU - Horowitz, J. M. AU - Jamin, C. AU - Sista, A. K. AU - Smith, D. E. AU - Yuriditsky, E. AU - Maldonado, T. S. C2 - Pmc7482370 DA - Sep 10 DO - 10.1007/s11239-020-02264-8 DP - NLM ET - 2020/09/11 J2 - Journal of thrombosis and thrombolysis KW - Covid-19 Pulmonary Embolism Response Team Pulmonary embolism SARS-CoV-2 Venous thromboembolism CJ, AKS, DES, EY, and TSM have no conflicts of interest to disclose. LA - eng N1 - 1573-742x Kwok, Benjamin Orcid: 0000-0002-6331-2779 Brosnahan, Shari B Amoroso, Nancy E Goldenberg, Ronald M Heyman, Brooke Horowitz, James M Jamin, Catherine Sista, Akhilesh K Smith, Deane E Yuriditsky, Eugene Maldonado, Thomas S Journal Article J Thromb Thrombolysis. 2020 Sep 10:1-9. doi: 10.1007/s11239-020-02264-8. PY - 2020 SN - 0929-5305 (Print) 0929-5305 SP - 1-9 ST - Pulmonary Embolism Response Team activation during the COVID-19 pandemic in a New York City Academic Hospital: a retrospective cohort analysis T2 - J Thromb Thrombolysis TI - Pulmonary Embolism Response Team activation during the COVID-19 pandemic in a New York City Academic Hospital: a retrospective cohort analysis ID - 760380 ER - TY - JOUR AB - Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling disease characterized by unexplained incapacitating fatigue, accompanied by variable multi-systemic symptoms. ME/CFS causes a significant personal and public health burden, and urgently requires the coordination of research efforts to investigate its etiology and pathophysiology and to develop and validate sensitive and specific biomarkers to confirm diagnosis. This narrative paper describes how people with ME/CFS, together with a multidisciplinary team of researchers, have established the UK ME/CFS Biobank (UKMEB), a unique research infrastructure specifically designed to expedite biomedical research into ME/CFS. We describe the journey that led to its conceptualization and operation, and how the resource has served as a model disease-specific biobank, aggregating human biospecimens alongside comprehensive health information on participants. The UKMEB currently has data and samples from 600 donors including people with ME/CFS and a comparison group with multiple sclerosis and healthy controls. A longitudinal sub-cohort has been established of participants having follow-up assessments at multiple time-points. As an open resource for quality and ethical research into ME/CFS, biological samples and data have not only been analyzed within our research team but have also been shared with researchers across Europe, America and the Middle East. We continue to encourage researchers from academic and commercial sectors to access the UKMEB. Major steps have been taken and challenges remain; these include sustainability and expansion, and harmonization of processes to facilitate integration with other bioresources and databanks internationally. AD - Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom. AN - 30564186 AU - Lacerda, E. M. AU - Mudie, K. AU - Kingdon, C. C. AU - Butterworth, J. D. AU - O'Boyle, S. AU - Nacul, L. C2 - Pmc6288193 DO - 10.3389/fneur.2018.01026 DP - NLM ET - 2018/12/20 J2 - Frontiers in neurology KW - Me/cfs biobank partnership patient engagement PE research infrastructure LA - eng N1 - 1664-2295 Lacerda, Eliana M Mudie, Kathleen Kingdon, Caroline C Butterworth, Jack D O'Boyle, Shennae Nacul, Luis R01 AI103629/AI/NIAID NIH HHS/United States Journal Article Front Neurol. 2018 Dec 4;9:1026. doi: 10.3389/fneur.2018.01026. eCollection 2018. PY - 2018 SN - 1664-2295 (Print) 1664-2295 SP - 1026 ST - The UK ME/CFS Biobank: A Disease-Specific Biobank for Advancing Clinical Research Into Myalgic Encephalomyelitis/Chronic Fatigue Syndrome T2 - Front Neurol TI - The UK ME/CFS Biobank: A Disease-Specific Biobank for Advancing Clinical Research Into Myalgic Encephalomyelitis/Chronic Fatigue Syndrome VL - 9 ID - 760344 ER - TY - JOUR AB - Background Pulmonary Embolism (PE) is associated with high morbidity and mortality; however, with the advent of multidisciplinary Pulmonary Embolism Response Teams (PERT) and advanced therapies, those may be preventable. We evaluated the treatment and 30-day outcomes of all PE admitted to our hospital. Methods We prospectively studied 191 patients with CT-confirmed PE between 01/2019 and 07/2019. Baseline characteristics, as well as, medical, interventional, and operational care were captured. Outcomes of interest included 30-day mortality, length of stay (LOS), readmission rate and new O2 therapy according to PERT activation. Safety outcomes were death and bleeding. Results The average age was 54, 54% were female, 61% presented with dyspnea, and 55% had either cancer or prior PE. Majority (79%) received anticoagulation as a monotherapy, despite having massive or submassive PE (75%). PERT activation was low (23%) and did not correlate with PE severity. PERT resulted in lower rates of death (2% vs. 12%), readmission (9% vs. 22%) and new O2 therapy (7% vs 12%), while LOS rate was comparable to those without PERT. Only 12 (6.3%) patients received advanced therapies (EKOS or FlowTriever), all of whom survived with one minor bleed. Conclusion PERT use was variable, independent of PE severity, and expanded the very limited use of advanced therapies. PERT was associated with lower morbidity and mortality underscoring the importance of a multidisciplinary approach and appropriate use of advanced therapies. [Figure presented] AU - Lacey, M. J. AU - Hammad, T. AU - Li, J. AU - Tefera, L. AU - Schilz, R. AU - Carman, T. AU - Kahl, R. AU - Zemko, A. AU - Shishehbor, M. DB - Embase DO - 10.1016/S0735-1097(20)31792-7 KW - adult advanced cancer anticoagulation bleeding cancer patient cancer survival conference abstract controlled study dyspnea female hospital readmission human length of stay major clinical study male malignant neoplasm middle aged monotherapy morbidity mortality oxygen therapy prospective study pulmonary embolism response team thrombectomy device LA - English M1 - 11 M3 - Conference Abstract N1 - L2005038046 2020-03-26 PY - 2020 SN - 1558-3597 0735-1097 SP - 1165 ST - PROSPECTIVE SINGLE CENTER EXPERIENCE OF PULMONARY EMBOLISM MANAGEMENT AND OUTCOMES IN THE ERA OF PULMONARY EMBOLISM RESPONSE TEAMS T2 - Journal of the American College of Cardiology TI - PROSPECTIVE SINGLE CENTER EXPERIENCE OF PULMONARY EMBOLISM MANAGEMENT AND OUTCOMES IN THE ERA OF PULMONARY EMBOLISM RESPONSE TEAMS UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005038046&from=export http://dx.doi.org/10.1016/S0735-1097(20)31792-7 VL - 75 ID - 760582 ER - TY - JOUR AU - Lachant, D. AU - Bach, C. AU - Wilson, B. AU - Chengazi, V. AU - Goldman, B. AU - Lachant, N. AU - Pietropaoli, A. AU - Cameron, S. AU - James White, R. DA - 2020/10/11 10/11 DB - Europe PubMed Central M1 - 3 PY - 2020 SN - 2045-8932 ST - Clinical and imaging outcomes after intermediate- or high-risk pulmonary embolus T2 - Pulm Circ TI - Clinical and imaging outcomes after intermediate- or high-risk pulmonary embolus UR - http://europepmc.org/article/PMC/PMC7509735 VL - 10 ID - 762012 ER - TY - JOUR AB - Introduction: Differentiated thyroid carcinoma with an extensive intravenous tumor thrombus which is extending into internal jugular vein (IJV), superior vena cava (SVC) and right atrium (RA) is a rare clinical finding. We report a multimodal staged surgical approach for this life threatening complicated case. Presentation of case: A 52 year old female, presented with diffuse thyroid swelling, FNAC revealed it as follicular thyroid neoplasm. Computed tomography (CT) scan showed tumor thrombus extending into IJV, SVC and right atrium (RA). We planned complete resection of tumor in two stage operation. Initially in first stage, cardio-thoracic surgery was done to remove SVC and RA thrombus to eliminate the immediate risk of pulmonary embolism. In the second stage, neck surgery was performed to resect thyroid tumor and to perform extensive thrombectomy in the cervical veins. This patient has been followed for one year after successful surgery without recurrence. Discussion: Venous involvement by follicular thyroid carcinoma reaching to RA is a rare life threatening condition. Though there is no standard guidelines available, treatment strategies should be discussed and planned among multidisciplinary team. Intraluminal extension is not a contraindication for aggressive surgical management. It will avoid fatal pulmonary embolism, as well as improve overall survival of the patient. Conclusion: Invasion of the great vessels by thyroid carcinoma is usually associated with early relapse and poor prognosis, but if tumor in the blood vessel is resected completely, a better prognosis is possible. Two staged surgical approach is safe and gives a predictable outcome. AD - P.P. Lad, Department of Surgical Oncology, Om Sai Onco-Surgery Center, R/S no 457/10, Sugar Mill Corner, Main Road, Kasaba Bawada, Kolhapur, Maharashtra, India AU - Lad, P. P. AU - Kumar, J. AU - Sarvadnya, J. AU - Powar, A. S. DB - Embase DO - 10.1016/j.ijscr.2019.10.050 KW - iodine 131 thyroglobulin adult article brachiocephalic vein cancer staging cancer surgery cardioplegia cardiopulmonary bypass case report clinical article computer assisted tomography distant metastasis echocardiography female fine needle aspiration biopsy follow up heart right atrium human inferior cava vein internal jugular vein lung embolism middle aged physical examination priority journal superior cava vein surgical approach thoracic surgeon thorax surgery thrombectomy thyroglobulin blood level thyroid follicular carcinoma thyroidectomy tumor thrombus x-ray computed tomography LA - English M3 - Article N1 - L2004062043 2019-12-04 2019-12-11 PY - 2020 SN - 2210-2612 SP - 48-52 ST - Staged surgical management of follicular thyroid carcinoma with extensive thrombus reaching up to right atrium – A case report T2 - International Journal of Surgery Case Reports TI - Staged surgical management of follicular thyroid carcinoma with extensive thrombus reaching up to right atrium – A case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004062043&from=export http://dx.doi.org/10.1016/j.ijscr.2019.10.050 VL - 66 ID - 760610 ER - TY - JOUR AB - Obesity, with its comorbidities, is a major public health problem. Population-based surveys estimate 2 of every 3 U.S. adults are overweight or obese. Despite billions of dollars spent annually on weight loss attempts, recidivism is high and long-term results are disappointing. In simplest terms, weight loss and maintenance depend on energy balance, and a combination of increased energy expenditure by exercise and decreased energy intake through caloric restriction is the mainstay of behavioral interventions. Many individuals successfully lose 5%-10% of body weight through behavioral approaches and thereby significantly improve health. Similar success occurs with some weight loss prescriptions, although evidence for successful weight loss with over-the-counter medications and supplements is weak. Commercial weight loss programs have helped many individuals achieve their goals, although few programs have been carefully evaluated and compared, limiting recommendations of one program over another. For the very obese, bariatric surgery is an option that leads to significant weight loss and improved health, although risks must be carefully weighed. Lifestyle changes, including regular physical activity, healthy food choices, and portion control, must be adopted, regardless of the weight loss approach, which requires ongoing support. Patients can best decide the appropriate approach working with a multidisciplinary team, including their health care provider and experts in nutrition, exercise, and behavioral intervention. © 2011 The American Society for Parenteral and Enteral Nutrition. AD - S. Going, Department of Nutritional Sciences, University of Arizona, 1713 E. University Blvd #93, Tucson, AZ 85721-0093, United States AU - Laddu, D. AU - Dow, C. AU - Hingle, M. AU - Thomson, C. AU - Going, S. C1 - accomplia adipex alli bontril dexatrim didrex ionamine meridia prelu 2 reducti tenuate xenical(Hoffmann La Roche,United States) DB - Embase Medline DO - 10.1177/0884533611418335 KW - albumin amfepramone anorexigenic agent anorexin derivative benzphetamine caffeine feces lipid ghrelin insulin leptin methamphetamine phendimetrazine phendimetrazine tartrate phentermine phentermine resin phenylpropanolamine transthyretin reducti rimonabant sibutramine tetrahydrolipstatin unclassified drug aerobic exercise albumin blood level anastomosis leakage anxiety arteriosclerosis bariatric surgery behavior therapy biliopancreatic bypass body image body mass caloric intake caloric restriction carbohydrate metabolism cardiovascular disease clinical effectiveness cognitive therapy constipation cost death deep vein thrombosis depression diarrhea diet supplementation digestive system ulcer dizziness drug efficacy drug safety eating habit energy balance energy expenditure Ephedra evidence based practice exercise exercise intensity flatulence follow up Food and Drug Administration fruit gallstone formation gastric banding gastrointestinal disease gastrointestinal hemorrhage gastrointestinal obstruction gastrointestinal pain gastrointestinal symptom gastroplasty glaucoma glucose homeostasis heart palpitation human hypertension hyperthyroidism insomnia insulin blood level internal hernia Internet intestine stenosis irritability jejunoileal bypass lifestyle modification lip disease lipid metabolism low calorie diet low carbohydrate diet low fat diet lung embolism macronutrient Mediterranean diet mental disease meta analysis motivation nausea neurological complication non insulin dependent diabetes mellitus obesity patient counseling patient participation physical activity protein diet protein intake randomized controlled trial (topic) restlessness review Roux Y anastomosis satiety self concept sepsis side effect social status steatorrhea surgical mortality surgical risk swelling tachycardia throat tightness United States urticaria valvular heart disease vegetable vertical banded gastroplasty vomiting body weight loss xerostomia accomplia adipex alli bontril dexatrim didrex ionamine meridia prelu 2 tenuate xenical LA - English M1 - 5 M3 - Review N1 - L362646473 2011-10-05 2011-10-12 PY - 2011 SN - 0884-5336 1941-2452 SP - 512-525 ST - A review of evidence-based strategies to treat obesity in adults T2 - Nutrition in Clinical Practice TI - A review of evidence-based strategies to treat obesity in adults UR - https://www.embase.com/search/results?subaction=viewrecord&id=L362646473&from=export http://dx.doi.org/10.1177/0884533611418335 VL - 26 ID - 761220 ER - TY - JOUR AB - BACKGROUNDS: Glioblastoma multiforme is the most common malignant primary tumor of the brain in adults. Standard therapy consists in maximal surgical resection and adjuvant concurrent chemoradiotherapy and adjuvant therapy with temozolomid. This approach improves survival in comparison with postsurgical radiotherapy alone. PATIENTS AND METHODS: Consecutive patients with histologically confirmed glioblastoma multiforme in the period from January 2003 to December 2009 underwent postoperative radiotherapy (1.8-2.0 Gy/d, total of 60 Gy) plus concurrent daily chemotherapy (temozolomide 75 mg/m2/d), followed by 6 cycles of temozolomide (150 to 200 mg/m2 for 5 days, every 28 days) and were analyzed retrospectively. The primary end point was to describe the correlation between known clinical factors, treatment and progression free survival (PFS) and overall survival (OS). We assessed the toxicity and safety of the chemoradiotherapy. RESULTS: Eighty-six patients (median age, 56 years; 60% male) were included. Most of them (> 80%) were of performance status (PS) 0-1 at the beginning of chemoradiotherapy. Total macroscopic resection was performed in 20% of the patients, subtotal in 65%, partial in 9%, and just biopsy in 6%. Median PFS was 7.0 months (2.0-35.5), median OS was 13.0 months (2.5-70). Postoperative performance status (PS), the extent of resection, and administration of planned treatment without reduction had statistically significant influences on PFS and OS. Median PFS and OS were 22.0, 7.0 and 6.0 months for PFS (p = 0.0018) in patients with PS O, 1 and 2 respectively and 32.0, 13.0 and 9.0 months for OS (p = 0.0023). Patients with total removal of tumor had longer PFS (14.0 vs 6.0 months, HR = 0.5688; p = 0.0301) and OS (23.0 vs 12.0 months, HR 0.4977; p = 0.0093), as did patients without dose reduction of radiotherapy and/or chemotherapy. Patients with radiotherapy dose of over 54 Gy had PFS 8.0 vs 3.0 months (HR = 0.3313; p = 0.0001) and OS 15.0 vs 5.0 months (HR = 0.1730; p < 0.0001). Similarly, treatment with concurrent chemotherapy for more than 40 days was also important: PFS 8.0 vs 5.0 months (HR = 0.5300; p = 0.0023) and OS 17.0 vs 9.5 months (HR = 0.5943; p = 0.0175). Age, gender and position of tumor had no significant influence. Treatment-related hematology toxicity grades 3 and 4 occurred relatively often: thrombocytopenia (9%), leukopenia (6%), neutropenia (6%) and lymphopenia (25%). Thrombo-embolic events were dominant in non-hematology toxicity. Serious toxicity occurred mainly in the subgroup of patients with PS 2. Treatment of progression was useful in selected patients. Second surgery was of the most benefit (OS 24.0 vs 12.5 months, HR = 0.5325; p = 0.0111). CONCLUSION: Postoperative performance status, extent of resection, successful administration of the majority of planned concurrent chemoradiotherapy and possibility of surgical treatment at the time of recurrence correlate with better prognosis for our patients with glioblastoma. Our experience indicates that performance status should be the main factor in decisions about treatment intensity. Treatment of malignant glioma requires a multidisciplinary team. AD - Masarykův onkologický ústav, Brno. AN - 21644366 AU - Lakomý, R. AU - Fadrus, P. AU - Slampa, P. AU - Svoboda, T. AU - Kren, L. AU - Lzicarová, E. AU - Belanová, R. AU - Siková, I. AU - Poprach, A. AU - Schneiderová, M. AU - Procházková, M. AU - Sána, J. AU - Slabý, O. AU - Smrcka, M. AU - Vyzula, R. AU - Svoboda, M. DP - NLM ET - 2011/06/08 J2 - Klinicka onkologie : casopis Ceske a Slovenske onkologicke spolecnosti KW - Adult Aged Brain Neoplasms/mortality/*therapy Combined Modality Therapy Female Glioblastoma/mortality/*therapy Humans Karnofsky Performance Status Male Middle Aged Survival Rate Young Adult LA - cze M1 - 2 N1 - Lakomý, R Fadrus, P Slampa, P Svoboda, T Kren, L Lzicarová, E Belanová, R Siková, I Poprach, A Schneiderová, M Procházková, M Sána, J Slabý, O Smrcka, M Vyzula, R Svoboda, M English Abstract Journal Article Research Support, Non-U.S. Gov't Czech Republic Klin Onkol. 2011;24(2):112-20. OP - Výsledky multimodální lécby glioblastoma multiforme: Konsekutivní série 86 pacientů diagnostikovaných v letech 2003-2009. PY - 2011 SN - 0862-495X (Print) 0862-495x SP - 112-20 ST - [Multimodal treatment of glioblastoma multiforme: results of 86 consecutive patients diagnosed in period 2003-2009] T2 - Klin Onkol TI - [Multimodal treatment of glioblastoma multiforme: results of 86 consecutive patients diagnosed in period 2003-2009] VL - 24 ID - 760520 ER - TY - JOUR AB - Backgrounds: Glioblastoma multiforme is the most common malignant primary tumor of the brain in adults. Standard therapy consists in maximal surgical resection and adjuvant concurrent chemoradiotherapy and adjuvant therapy with temozolomid. This approach improves survival in comparison with postsurgical radiotherapy alone. Patients and Methods: Consecutive patients with histologically confirmed glioblastoma multiforme in the period from January 2003 to December 2009 underwent postoperative radiotherapy (1.8-2.0 Gy/d, total of 60 Gy) plus concurrent daily chemotherapy (temozolomide 75 mg/m2/d), followed by 6 cycles of temozolomide (150 to 200 mg/m2 for 5 days, every 28 days) and were analyzed retrospectively. The primary end point was to describe the correlation between known clinical factors, treatment and progression free survival (PFS) and overall survival (OS). We assessed the toxicity and safety of the hemoradiotherapy. Results: Eighty-six patients (median age, 56 years; 60% male) were included. Most of them (> 80%) were of performance status (PS) 0-1 at the beginning of chemoradiotherapy. Total macroscopic resection was performed in 20% of the patients, subtotal in 65%, partial in 9%, and just biopsy in 6%. Median PFS was 7.0 months (2.0-35.5), median OS was 13.0 months (2.5-70). Postoperative performance status (PS), the extent of resection, and administration of planned treatment without reduction had statistically significant influences on PFS and OS. Median PFS and OS were 22.0, 7.0 and 6.0 months for PFS (p = 0.0018) in patients with PS 0, 1 and 2 respectively and 32.0, 13.0 and 9.0 months for OS (p = 0.0023). Patients with total removal of tumor had longer PFS (14.0 vs 6.0 months, HR = 0.5688; p = 0.0301) and OS (23.0 vs 12.0 months, HR 0.4977; p = 0.0093), as did patients without dose reduction of radiotherapy and/or chemotherapy. Patients with radiotherapy dose of over 54 Gy had PFS 8.0 vs 3.0 months (HR = 0.3313; p = 0.0001) and OS 15.0 vs 5.0 months (HR = 0.1730; p < 0.0001). Similarly, treatment with concurrent hemotherapy for more than 40 days was also important: PFS 8.0 vs 5.0 months (HR = 0.5300; p = 0.0023) and OS 17.0 vs 9.5 months (HR = 0.5943; p = 0.0175). Age, gender and position of tumor had no significant influence. Treatment-related hematology toxicity grades 3 and 4 occurred relatively often: thrombocytopenia (9%), leukopenia (6%), neutropenia (6%) and lymphopenia (25%). Thrombo-embolic events were dominant in non-hematology toxicity. Serious toxicity occurred mainly in the subgroup of patients with PS 2. Treatment of progression was useful in selected patients. Second surgery was of the most benefit (OS 24.0 vs 12.5 months, HR = 0.5325; p = 0.0111). Conclusion: Postoperative performance status, extent of resection, successful administration of the majority of planned concurrent chemoradiotherapy and possibility of surgical treatment at the time of recurrence correlate with better prognosis for our patients with glioblastoma. Our experience indicates that performance status should be the main factor in decisions about treatment intensity. Treatment of malignant glioma requires a multidisciplinary team. AD - M. Svoboda, Klinika Komplexní Onkologické Péče, Masarykův Onkologický Ústav, Žlutý kopec 7, 656 53 Brno, Czech Republic AU - Lakomý, R. AU - Fadrus, P. AU - Šlampa, P. AU - Svoboda, T. AU - Křen, L. AU - Lžičařová, E. AU - Belanová, R. AU - Šiková, I. AU - Poprach, A. AU - Schneiderová, M. AU - Procházková, M. AU - Šána, J. AU - Slabý, O. AU - Smrčka, M. AU - Vyzula, R. AU - Svoboda, M. DB - Embase Medline KW - temozolomide age distribution article blood toxicity cancer adjuvant therapy cancer patient cancer radiotherapy cancer recurrence cancer surgery cancer survival chemoradiotherapy comparative study controlled study correlation analysis drug safety female gender glioblastoma histology human leukopenia lymphocytopenia major clinical study male multimodality cancer therapy multiple cycle treatment neutropenia overall survival pathological anatomy postoperative care prognosis progression free survival radiation injury reoperation retrospective study thrombocytopenia thromboembolism treatment planning tumor biopsy LA - Czech M1 - 2 M3 - Article N1 - L361690766 2011-05-10 2011-05-16 PY - 2011 SN - 0862-495X 1802-5307 SP - 112-120 ST - Multimodal treatment of glioblastoma multiforme: Results of 86 consecutive patients diagnosed in period 2003-2009 T2 - Klinicka Onkologie TI - Multimodal treatment of glioblastoma multiforme: Results of 86 consecutive patients diagnosed in period 2003-2009 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L361690766&from=export VL - 24 ID - 761233 ER - TY - JOUR AB - Background Intravenous thrombolysis is a key element of emergency treatment for acute ischaemic stroke, but hospital service delivery is variable. The Paramedic Acute Stroke Treatment Assessment (PASTA) multicentre cluster randomised controlled trial evaluated whether an enhanced paramedic-initiated stroke assessment pathway could improve thrombolysis volume. This paper reports the findings of a parallel process evaluation which explored intervention paramedics' experience of delivering the enhanced assessment. Methods Interviewees were recruited from 453 trained intervention paramedics across three UK ambulance services hosting the trial: North East, North West and Welsh Ambulance Services. A semistructured interview guide aimed to (1) explore the stroke-specific assessment and handover procedures which were part of the PASTA pathway and (2) enable paramedics to share relevant views about expanding their role and any barriers/enablers they encountered. Interviews were audiorecorded, transcribed verbatim and analysed following the principles of the constant comparative method. Results Twenty-six interviews were conducted (11 North East, 10 North West and 5 Wales). Iterative data analysis identified four key themes, which reflected paramedics' experiences at different stages of the care pathway: (1) Enhanced assessment at scene: paramedics felt this improved their skillset and confidence. (2) Prealert to hospital: a mixed experience dependent on receiving hospital staff. (3) Handover to hospital team: standardisation of format was viewed as the primary benefit of the PASTA pathway. (4) Assisting in hospital and feedback: due to professional boundaries, paramedics found these aspects harder to achieve, although feedback from the clinical team was valued when available. Conclusion Paramedics believed that the PASTA pathway enhanced their skills and the emergency care of stroke patients, but a continuing clinical role postadmission was challenging. Future studies should consider whether interdisciplinary training is needed to enable more radical extension of professional boundaries for paramedics. AD - [Lally, Joanne; Vaittinen, Anu; Flynn, Darren; Exley, Catherine] Newcastle Univ, Populat Hlth Sci Inst, Newcastle Upon Tyne, Tyne & Wear, England. [McClelland, Graham] North East Ambulance Serv NHS Fdn Trust, Res & Dev, Newcastle Upon Tyne, Tyne & Wear, England. [Price, Christopher, I; Shaw, Lisa] Newcastle Univ, Populat Hlth Sci Inst, Stroke Res Grp, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England. [Ford, Gary A.] Univ Oxford, Med Sci Div, Oxford, England. [Ford, Gary A.] Oxford Univ Hosp NHS Fdn Trust, Oxford, England. Price, CI (corresponding author), Newcastle Univ, Populat Hlth Sci Inst, Stroke Res Grp, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England. c.i.m.price@ncl.ac.uk AN - WOS:000562772400009 AU - Lally, J. AU - Vaittinen, A. AU - McClelland, G. AU - Price, C. I. AU - Shaw, L. AU - Ford, G. A. AU - Flynn, D. AU - Exley, C. DA - Aug DO - 10.1136/emermed-2019-209392 J2 - Emerg. Med. J. KW - paramedics qualitative research stroke AMBULANCE EMERGENCY Emergency Medicine LA - English M1 - 8 M3 - Article N1 - ISI Document Delivery No.: NE7HP Times Cited: 0 Cited Reference Count: 25 Lally, Joanne Vaittinen, Anu McClelland, Graham Price, Christopher, I Shaw, Lisa Ford, Gary A. Flynn, Darren Exley, Catherine Exley, Catherine/0000-0002-3570-7503; Shaw, Lisa/0000-0002-3435-9519; McClelland, Graham/0000-0002-4502-5821; Flynn, Darren/0000-0001-7390-632X National Institute for Health ResearchNational Institute for Health Research (NIHR) [RP-PG-1211-20012] The work was funded by the National Institute for Health Research (Programme Grants for Applied Research, title: Promoting Effective and Rapid Stroke care (PEARS), project number: RP-PG-1211-20012). 0 BMJ PUBLISHING GROUP LONDON EMERG MED J PY - 2020 SN - 1472-0205 SP - 480-485 ST - Paramedic experiences of using an enhanced stroke assessment during a cluster randomised trial: a qualitative thematic analysis T2 - Emergency Medicine Journal TI - Paramedic experiences of using an enhanced stroke assessment during a cluster randomised trial: a qualitative thematic analysis UR - ://WOS:000562772400009 VL - 37 ID - 761420 ER - TY - JOUR AB - BACKGROUND: Acute kidney injury due to contrast material occurs in 3% to 15% of the 2 million cardiac catheterizations done in the United States each year. OBJECTIVE: To reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. METHODS: Nurse leaders in the Northern New England Cardiovascular Disease Study Group, a 10-center quality improvement consortium in Maine, New Hampshire, and Vermont, formed a nursing task force to reduce acute kidney injury due to contrast material after cardiovascular interventional procedures. Data were prospectively collected January 1, 2007, through June 30, 2012, on consecutive nonemergent patients (n = 20 147) undergoing percutaneous coronary interventions. RESULTS: Compared with baseline rates, adjusted rates of acute kidney injury among the 10 centers were significantly reduced by 21% and by 28% in patients with baseline estimated glomerular filtration rate less than 60 mL/min per 1.73 m(2). Key qualitative system factors associated with improvement included use of multidisciplinary teams, standardized fluid orders, use of an intravenous fluid bolus, patient education about oral hydration, and limiting the volume of contrast material. CONCLUSIONS: Standardization of evidence-based best practices in nursing care may reduce the incidence of acute kidney injury due to contrast material. AD - Peggy Lambert is executive director of critical care services, Sue Bowden is a nurse, and Carmen Petrin and Lynn Scott are nurse practitioners at Catholic Medical Center, Manchester, New Hampshire. Kristine Chaisson is a nurse and executive director of the Central Maine Heart and Vascular Center, Central Maine Medical Center, Lewiston, Maine. Susan Horton is a nurse and cardiac director and Nancy Roy is the nurse manager of the cardiac intensive care unit, Central Maine Medical Center. Sheila Conley is a nurse database manager and Janette Stender is a cardiovascular medicine nurse practitioner at Dartmouth-Hitchcock Medical Center. Ellen Hopkins and Gertrude Kent are ambulatory cardiac care nurses, Maine Medical Center, Portland, Maine. Anita Nicholson is a cardiac catheterization nurse and Brian Smith is a cardiac catheterization technician, Wentworth Douglass Hospital, Dover, New Hampshire. Cindy Downs and Brenda Homsted are nurses, Eastern Maine Medical Center, Bangor, Maine. Cathy S. Ross is administrative director, Northern New England Cardiovascular Disease Study Group and manager of research projects at Dartmouth-Hitchcock Medical Center. Jeremiah Brown is an associate professor and Emily Marshall is a research assistant, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, the Department of Medicine, and the Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. He is the principal investigator of the quality improvement project. AN - 28148611 AU - Lambert, P. AU - Chaisson, K. AU - Horton, S. AU - Petrin, C. AU - Marshall, E. AU - Bowden, S. AU - Scott, L. AU - Conley, S. AU - Stender, J. AU - Kent, G. AU - Hopkins, E. AU - Smith, B. AU - Nicholson, A. AU - Roy, N. AU - Homsted, B. AU - Downs, C. AU - Ross, C. S. AU - Brown, J. C2 - Pmc5557383 C6 - Nihms885803 DA - Feb DO - 10.4037/ccn2017178 DP - NLM ET - 2017/02/06 J2 - Critical care nurse KW - Acute Kidney Injury/*chemically induced/nursing/*prevention & control Aged Contrast Media/*adverse effects Female Humans Male Middle Aged New England Nurse's Role Patient Education as Topic/methods *Patient Safety Percutaneous Coronary Intervention/*adverse effects/methods Qualitative Research Quality Improvement Risk Assessment LA - eng M1 - 1 N1 - 1940-8250 Lambert, Peggy Chaisson, Kristine Horton, Susan Petrin, Carmen Marshall, Emily Bowden, Sue Scott, Lynn Conley, Sheila Stender, Janette Kent, Gertrude Hopkins, Ellen Smith, Brian Nicholson, Anita Roy, Nancy Homsted, Brenda Downs, Cindy Ross, Cathy S Brown, Jeremiah Northern New England Cardiovascular Disease Study Group K01 HS018443/HS/AHRQ HHS/United States Journal Article Crit Care Nurse. 2017 Feb;37(1):13-26. doi: 10.4037/ccn2017178. PY - 2017 SN - 0279-5442 (Print) 0279-5442 SP - 13-26 ST - Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety T2 - Crit Care Nurse TI - Reducing Acute Kidney Injury Due to Contrast Material: How Nurses Can Improve Patient Safety VL - 37 ID - 760496 ER - TY - JOUR AB - BACKGROUND: The use of inappropriate elective Percutaneous Coronary Intervention (PCI) has decreased over time, but hospital-level variation in the use of inappropriate PCI persists. Understanding the barriers and facilitators to the implementation of Appropriate Use Criteria (AUC) guidelines may inform efforts to improve elective PCI appropriateness. METHODS: All hospitals performing PCI in Washington State were categorized by their use of inappropriate elective PCI in 2010 to 2013. Semi-structured, qualitative telephone interviews were then conducted with 17 individual interviews at 13 sites in Washington State to identify barriers and facilitators to the implementation of the AUC guidelines. An inductive and deductive, team-based analytical approach, drawing primarily on Matrix analysis was performed to identify factors affecting implementation of the AUC. RESULTS: Specific facilitators were identified that supported successful implementation of the AUC. These included collaborative catheterization laboratory environments that allow all staff to participate with questions and opinions; ongoing AUC education with catheterization laboratory teams and referring providers; internal AUC peer review processes; interventional cardiologist be directly involved with the pre-procedural review process; checklist-based algorithms for pre-procedural documentation; systems redesign to include insurance companies; and AUC educational information with patients. Barriers to implementation of the AUC included external pressures, such as competition for patients, and the lack of shared medical records with sites that referred patients for coronary angiography. CONCLUSIONS: The identified facilitators enabled sites to successfully implement the AUC. Catheterization laboratories struggling to successfully implement the AUC may consider utilizing these strategies to improve their processes to improve patient selection for elective PCI. AD - VA Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA. Anne.Lambert-Kerzner@ucdenver.edu. Minneapolis Heart Institute, Minneapolis, MN, USA. Anne.Lambert-Kerzner@ucdenver.edu. VA Eastern Colorado Health Care System, Department of Veterans Affairs Medical Center, Denver, CO, USA. School of Public Health, University of Colorado, Aurora, CO, USA. Foundation for Health Care Quality Clinical Outcomes Assessment Program, Seattle, WA, USA. Minneapolis Heart Institute, Minneapolis, MN, USA. AN - 30103677 AU - Lambert-Kerzner, A. AU - Maynard, C. AU - McCreight, M. AU - Ladebue, A. AU - Williams, K. M. AU - Fehling, K. B. AU - Bradley, S. M. C2 - Pmc6205154 DA - Aug 13 DO - 10.1186/s12872-018-0901-6 DP - NLM ET - 2018/08/15 J2 - BMC cardiovascular disorders KW - Cardiology Service, Hospital/standards Education, Medical, Continuing/standards Elective Surgical Procedures Guideline Adherence/*standards Health Care Surveys Hospitals, High-Volume/standards Hospitals, Low-Volume/standards Humans Inservice Training/standards Myocardial Ischemia/diagnosis/*surgery Patient Care Team/standards Percutaneous Coronary Intervention/*standards Practice Guidelines as Topic/*standards Practice Patterns, Physicians'/*standards Qualitative Research Referral and Consultation/standards Washington *Appropriate use criteria *Ischemic heart disease *Percutaneous coronary intervention *Qualitative Review Board approved this study (#14–0282) and a waiver of informed consent was granted. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors report no conflicts. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. LA - eng M1 - 1 N1 - 1471-2261 Lambert-Kerzner, Anne Orcid: 0000-0002-9224-287x Maynard, Charles McCreight, Marina Ladebue, Amy Williams, Katherine M Fehling, Kelty B Bradley, Steven M Journal Article Research Support, Non-U.S. Gov't BMC Cardiovasc Disord. 2018 Aug 13;18(1):164. doi: 10.1186/s12872-018-0901-6. PY - 2018 SN - 1471-2261 SP - 164 ST - Assessment of barriers and facilitators in the implementation of appropriate use criteria for elective percutaneous coronary interventions: a qualitative study T2 - BMC Cardiovasc Disord TI - Assessment of barriers and facilitators in the implementation of appropriate use criteria for elective percutaneous coronary interventions: a qualitative study VL - 18 ID - 760324 ER - TY - JOUR AB - Ventilator-associated events (VAEs) are associated with increased risk of poor outcomes, including death. Bundle practices including thromboembolism prophylaxis, stress ulcer prophylaxis, oral care, and daily sedation breaks and spontaneous breathing trials aim to reduce rates of VAEs and are endorsed as quality metrics in the intensive care units. We sought to create electronic search algorithms (digital signatures) to evaluate compliance with ventilator bundle components as the first step in a larger project evaluating the ventilator bundle effect on VAE. We developed digital signatures of bundle compliance using a retrospective cohort of 542 ICU patients from 2010 for derivation and validation and testing of signature accuracy from a cohort of random 100 patients from 2012. Accuracy was evaluated against manual chart review. Overall, digital signatures performed well, with median sensitivity of 100% (range, 94.4%–100%) and median specificity of 100% (range, 100%–99.8%). Automated ascertainment from electronic medical records accurately assesses ventilator bundle compliance and can be used for quality reporting and research in VAE. AD - Guang’anmen Hospital, China Academy of Chinese Medicine Sciences, Beijing 100053, China Multidisciplinary Epidemiology and Translational Research in Critical Care, Perioperative and Emergency Medicine (METRIC-PM) Group, USA Mayo Clinic, Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA North Central Texas Medical Foundation, Wichita Falls Family Practice Residency Program, Wichita Falls, TX 76301, USA Mayo Clinic, Department of Anesthesiology, Division Critical Care Medicine, Rochester, MN 55905, USA Mayo Clinic, Department of Medicine, Division of Infectious Diseases, Rochester, MN 55905, USA AN - 109274521. Language: English. Entry Date: 20151027. Revision Date: 20151027. Publication Type: Article AU - Lan, Haitao AU - Thongprayoon, Charat AU - Ahmed, Adil AU - Herasevich, Vitaly AU - Sampathkumar, Priya AU - Gajic, Ognjen AU - O’Horo, John C. DB - CINAHL DO - 10.1155/2015/396508 DP - EBSCOhost KW - Electronic Health Records Electronic Signature Respiration, Artificial -- Adverse Effects Quality of Health Care Quality Assurance Human Intensive Care Units Guideline Adherence Retrospective Design Prospective Studies Reference Values Adult Middle Age Aged Descriptive Statistics Male Female Sensitivity and Specificity Confidence Intervals Data Analysis Software N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Critical Care. NLM UID: 101600173. PY - 2015 SN - 2314-6133 SP - 1-6 ST - Automating Quality Metrics in the Era of Electronic Medical Records: Digital Signatures for Ventilator Bundle Compliance T2 - BioMed Research International TI - Automating Quality Metrics in the Era of Electronic Medical Records: Digital Signatures for Ventilator Bundle Compliance UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=109274521&site=ehost-live&scope=site VL - 2015 ID - 761299 ER - TY - JOUR AB - urpose: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease leading to worsening cardiopulmonary function and reduced survival for those patients non-eligible for pulmonary endarterectomy (PEA). The current diagnosis procedure and management of patients with CTEPH was investigated. Methods: Newly (≤ 6 months) diagnosed consecutive patients with CTEPH were included in a prospective registry between February 2007 and January 2009. Results: 679 patients with CTEPH were enrolled in 26 European and 1 Canadian centres (50.1% male, mean age ± SD: 60.4±14.5 years). The median time from symptoms to diagnosis was 14 months (0.1-441 months). Symptoms included dyspnoea (99.1%), fatigue (31.5%), and chest pain (15.3%); 12.8% of patients experienced syncopes. Most patients were in NYHA functional class III (68.5%) or IV (12.8%). Right heart catheterization indicated elevated mean pulmonary artery pressure (47±12 mmHg) and pulmonary vascular resistance (790±462 dyn.sec.cm-5); cardiac index was 2.3±0.7 L.min-1.m-2. On echocardiography, an enlarged right ventricle was observed in 86.6% of patients with available data and abnormal right ventricular contractility in 66.6%. Perfusion and ventilation scans were abnormal in 98.5% and 19.0% of patients, respectively. Angiography demonstrated proximal lesions of the pulmonary artery in 63.0% of patients (70.8% operable, 48.4% non-operable patients), which was confirmed by computed tomography. Dilatation of main pulmonary arteries was reported in 68.4% of patients (75.1% operable, 56.7% non-operable patients), and mosaic perfusion pattern for 76.6% (82.4% operable, 66.9% non-operable patients). At diagnosis, 37.7% of patients initiated at least one PH-specific therapy including phosphodiesterase type V inhibitor, endothelin receptor antagonist or prostacyclin analogue (28.3% operable, 54.1% non-operable patients). Non-operability was due to technical reasons, age or comorbidities, while 63.5% of patients were considered operable. PEA was performed in 381 patients (56.1%) after a median period of 78 days (0-588 days) following diagnosis. At the end of enrolment, 57 patients had died, mostly from right heart failure (n=16) and perioperative complications (n=17). Conclusions: Perfusion scintigraphy and pulmonary angiography are main tools to diagnose CTEPH. Despite the lack of approved medical treatments for CTEPH, a significant number of patients receive off-label treatments. Patients should be referred for evaluation to a multidisciplinary team experienced in PEA with the goal to perform surgery in all operable patients. AD - I.M. Lang, Medical University of Vienna, Vienna, Austria AU - Lang, I. M. AU - Simonneau, G. AU - Pepke-Zaba, J. AU - Mayer, E. AU - Delcroix, M. DB - Embase DO - 10.1093/eurheartj/ehq290 KW - phosphodiesterase V inhibitor endothelin receptor antagonist prostacyclin diagnosis cardiology society pulmonary hypertension thromboembolism patient therapy pulmonary artery perfusion angiography computer assisted tomography mosaicism pH heart right ventricle failure peroperative complication dilatation scintigraphy lung angiography surgery cardiopulmonary function survival endarterectomy register male dyspnea thorax pain heart catheterization fatigue lung artery pressure lung vascular resistance cardiac index echocardiography heart right ventricle heart ventricle contractility air conditioning faintness LA - English M3 - Conference Abstract N1 - L70283018 2010-10-26 PY - 2010 SN - 0195-668X SP - 916 ST - Current diagnosis and management of chronic thromboembolic pulmonary hypertension T2 - European Heart Journal TI - Current diagnosis and management of chronic thromboembolic pulmonary hypertension UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70283018&from=export http://dx.doi.org/10.1093/eurheartj/ehq290 VL - 31 ID - 761248 ER - TY - JOUR AB - Background and objective: Good practice about medicines imposes to Health Institutions a close monitoring of prescriptions, especially off-label prescriptions. Patient care should take into account clinical profile, respect of guidelines and health expense control. We report here a case highlighting the significant role of the clinical pharmacist in care units to ensure medication good use in a Castleman syndrome, a rare disease due to Human Herpesvirus 8 (HHV-8) and associated with human immunodeficiency virus (HIV) infection. Design: Case report. Results: Our patient, a 49 years old man (creatinine clearance rate (CrCl): 95 mL/min), was diagnosed with HIV infection in February 2016 (CD4 at 160UI/L), leading to introduce a therapy by Emtricitabine- Tenofovir, Darunavir, and Ritonavir. The evolution was hampered by repeated episodes of acute renal failure (ARF; CrCl: 21 mL/min) and pancytopenia (hemoglobinemia at 8.6 g/dL, leucopoenia at 3.3G/L, and thrombopenia at 55G/L). Because of HHV8 blood PCR at 30 000copies/mL, transient crises with pancytopenia, ARF, and HIV infection, a diagnostic of Kaposi Sarcoma Herpesvirus (KICS), an atypical Castleman syndrome, was retained. Given the lake of data in literature for this rare disease, a multidisciplinary team (medical specialists and clinical pharmacists) was gathered to choose an appropriate therapeutic strategy. Treatment regimen consisted of: Day 1, intravenous etoposide at 250 mg; Day 4, rituximab at 375 mg/ m2; following one week later by rituximab 1 day and oral etoposide at 250 mg the day after. Good communication between medical specialists and pharmacists enables the patient to get an optimal and personal treatment. Relaying the information by clinical pharmacists in care units to pharmacists in charge of Good Practice facilitate the reimbursement. Conclusion: Clinical pharmacists in care unit help to optimize therapeutic strategies according to their experiences and scientific works. Cooperation with physicians is improved, as well as prescriptions follow-up of off-label drugs, and health patients fully respected. Quality and relevance of prescriptions are strengthened, with a better control of economic expenses. AD - V. Larbre, Pharmacy, Grenoble, France AU - Larbre, V. AU - Chanoine, S. AU - Henard, J. AU - Dentan, C. AU - Bedouch, P. AU - Pavese, P. DB - Embase DO - 10.1007/s11096-016-0404-4 KW - CD4 antigen darunavir emtricitabine plus tenofovir disoproxil endogenous compound etoposide ritonavir rituximab acute kidney failure adult blood case report controlled study creatinine clearance diagnosis doctor patient relationship follow up human Human herpesvirus 8 Human immunodeficiency virus infection Kaposi sarcoma male medical specialist middle aged nonhuman off label drug use pancytopenia pharmacist polymerase chain reaction rare disease reimbursement syndrome thrombocytopenia LA - English M1 - 1 M3 - Conference Abstract N1 - L614479126 2017-02-22 PY - 2017 SN - 2210-7711 SP - 317 ST - Clinical pharmacist and good practice: About a case report of a Castelman syndrome T2 - International Journal of Clinical Pharmacy TI - Clinical pharmacist and good practice: About a case report of a Castelman syndrome UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614479126&from=export http://dx.doi.org/10.1007/s11096-016-0404-4 VL - 39 ID - 760957 ER - TY - JOUR AB - Background: Studies on heteronormativity in PE either appear to have explored the experiences of and conditions for non-heterosexual students,or adopt a retrospective point of view. Further, the relation between heteronormativity and movement and how movement activities embody social norms and values related to gender and sexuality has not been explored in depth. Purpose: To explore the relation between movement and heteronormativity in PE as experienced by the students. Participants, setting and research design: The study is based on interviews with 24 students, aged 15 and 16 years and living in a big city area in Sweden. Each student was interviewed on three occasions, immediately following PE lessons visited by the researchers. Data collection: The interviews revolved around: (1) the students' social situation; (2) their sporting habits and interests; (3) their views about PE (aims, content, teaching methods, learning, assessment and grading); (4) their views of girls' and boys' conditions in PE; and (5) their views about body and movement. Data analysis: A discourse analysis was conducted, based on the interview as a whole, namely the interviewer's questions and comments and the interviewees' responses and possible counter-questions. Particular interest was directed towards linguistic regularities relating to norms and ideas about gender and sexuality. Findings: Heteronormativity conditions the way in which girls and boys (feel they can appropriately) engage in a certain movement activity and still be viewed as 'normal'. In the PE classes we visited, being recognised as a 'normal' or straight girl presupposed a feminine appearance, a good coordinative and rhythmic ability, self-confidence in relation to partner dancing, and conversely, a lack of self-confidence and are reluctance to appear aggressive and competitive in connection with ball games. Boys who adopt that position might be apprehended as 'effeminate' or 'poofs' - unless they have some kind of status marker that can serve as a heterosexual alibi, like being popular and athletic. Being recognised as a 'normal' or straight boy presupposed a masculine appearance and confidence, i.e. aggressive and competitive behaviour, in team ball games. Girls who occupy that position might be perceived as 'butch' or 'manly' (perhaps as lesbians?) if they do not, correspondingly, have some kind of marker that can serve as a heterosexual alibi. This might include having a feminine appearance. Conclusions: Since heteronorms are embodied in and through movement, any attempt to challenge the heteronormative culture of PE teaching would have to carefully consider which kinds of activities to include in the PE curriculum, and to make it possible for the students to move in new ways. Such a strategy would include a critically reflexive approach among PE teachers towards the conventional endeavour to make the teaching 'work' without too much emphasis on exploring how students experience different physical activities. AD - [Larsson, Hakan; Redelius, Karin; Fagrell, Birgitta] Swedish Sch Sport & Hlth Sci, Dept Sport & Hlth Sci, Stockholm, Sweden. Larsson, H (corresponding author), Swedish Sch Sport & Hlth Sci, Dept Sport & Hlth Sci, Stockholm, Sweden. hakan.larsson@utep.su.se AN - WOS:000308136500005 AU - Larsson, H. AU - Redelius, K. AU - Fagrell, B. DA - Jan DO - 10.1080/17408989.2010.491819 J2 - Phys. Educ. Sport Pedag. KW - physical education gender heteronormativity student perceptions PARTICIPATION DANCE Education & Educational Research LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 997AO Times Cited: 35 Cited Reference Count: 34 Larsson, Hakan Redelius, Karin Fagrell, Birgitta 35 1 27 ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD ABINGDON PHYS EDUC SPORT PEDA PY - 2011 SN - 1740-8989 SP - 67-81 ST - Moving (in) the heterosexual matrix. On heteronormativity in secondary school physical education T2 - Physical Education and Sport Pedagogy TI - Moving (in) the heterosexual matrix. On heteronormativity in secondary school physical education UR - ://WOS:000308136500005 VL - 16 ID - 761862 ER - TY - JOUR AB - Purpose: Prolonged central vascular access is a source of significant morbidity in children with intestinal failure (IF). In an effort to decrease morbidity, our multidisciplinary IF team has primarily used peripherally inserted central catheters (PICCs) for these patients. We compared outcomes of PICCs to Broviacs (R). Methods: A review of children with IF (2006-2018) at an academic children's hospital was conducted. Inclusion criteria: total parenteral nutrition duration >42 days or small bowel length < 25% of total for gestational age. Complications/1000 catheter days were extracted, and a Poisson model was used to compare complications between PICCs and Broviacs (R). Results: Thirty-seven patients with IF were included, accounting for 19,452 catheter days. There were 209 PICCs (1.2-4F) and 39 Broviacs (R) (2.7-7F). The median duration of overall PICC access/patient was 166 days (range: 35 days-8 years). Incidences of central line associated blood stream infection and venous thrombosis were 3.95 and 0.55 per 1000 catheter days, respectively. There were no significant differences in complication rates per line per catheter day between PICCs and Broviacs (R) on multivariate analysis. Broviacs (R) showed a trend towards increased of catheter-related hospital admissions when compared to PICCs. Conclusions: PICCs in children with intestinal failure have similar complication rates to Broviacs (R) but may reduce catheter-related hospital admissions. Use of tunneled PICCs and increasing experience with this vascular access method may allow it to realize its potential advantages. (C) 2019 Elsevier Inc. All rights reserved. AD - [LaRusso, Kathryn; Fung, Tiffany; Long, Justin; Attari, Zahia; Yousef, Yasmine; Girgis, Hidy; Raghunathan, Rajam; Emil, Sherif] McGill Univ, Montreal Childrens Hosp, Hlth Ctr, Div Pediat Gen & Thorac Surg, Montreal, PQ, Canada. [Schaack, Geraldine; Dumas, Marie-Pier] McGill Univ, Montreal Childrens Hosp, Hlth Ctr, Nursing Educ, Montreal, PQ, Canada. [McGregor, Kevin] McGill Univ, Dept Epidemiol Biostat & Occupat Hlth, Montreal, PQ, Canada. [Sant'Anna, Ana] McGill Univ, Montreal Childrens Hosp, Hlth Ctr, Div Pediat Gastroenterol & Nutr, Montreal, PQ, Canada. Emil, S (corresponding author), Montreal Childrens Hosp, Div Pediat Gen & Thorac Surg, 1001 Decarie, Montreal, PQ H4A 3J1, Canada. Sherif.Emil@mcgill.ca AN - WOS:000467080000025 AU - LaRusso, K. AU - Schaack, G. AU - Fung, T. AU - McGregor, K. AU - Long, J. AU - Dumas, M. P. AU - Attari, Z. AU - Yousef, Y. AU - Girgis, H. AU - Raghunathan, R. AU - Sant'Anna, A. AU - Emil, S. DA - May DO - 10.1016/j.jpedsurg.2019.01.052 J2 - J. Pediatr. Surg. KW - Intestinal failure Central venous catheter Peripherally inserted central catheter Broviac SHORT-BOWEL-SYNDROME PARENTERAL-NUTRITION COMPLICATIONS LENGTH RISK Pediatrics Surgery LA - English M1 - 5 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: HX0LA Times Cited: 3 Cited Reference Count: 24 LaRusso, Kathryn Schaack, Geraldine Fung, Tiffany McGregor, Kevin Long, Justin Dumas, Marie-Pier Attari, Zahia Yousef, Yasmine Girgis, Hidy Raghunathan, Rajam Sant'Anna, Ana Emil, Sherif 50th Annual Meeting of the Canadian-Association-of-Pediatric-Surgeons (CAPS) SEP 26-28, 2018 Toronto, CANADA Canadian Assoc Pediat Surg 3 1 5 W B SAUNDERS CO-ELSEVIER INC PHILADELPHIA J PEDIATR SURG PY - 2019 SN - 0022-3468 SP - 999-1004 ST - Should you pick the PICC? Prolonged use of peripherally inserted central venous catheters in children with intestinal failure T2 - Journal of Pediatric Surgery TI - Should you pick the PICC? Prolonged use of peripherally inserted central venous catheters in children with intestinal failure UR - ://WOS:000467080000025 VL - 54 ID - 761526 ER - TY - JOUR AB - The objective of this retrospective study was to investigate the indications, interventions and clinical outcome of pregnant and newly delivered women admitted to the multidisciplinary intensive care unit at the King Abdullah University Hospital in Jordan over a 7-year period from January 2002 to December 2008. The collected data included demographic characteristics of the patients, mode of delivery, pre-existing medical conditions, reason for admission, specific intervention, length of stay and maternal outcome. A total of 43 women required admission to the intensive care unit (ICU), which represented 0.37% of all deliveries. The majority (95.3%) of patients were admitted to the ICU postpartum. The most common reasons for admissions were (pre)eclampsia (48.8%) and obstetric haemorrhage (37.2). The remainder included adult respiratory distress syndrome (6.9%), pulmonary embolism (2.3%) and neurological disorders (4.6%). Mechanical ventilation was required to support 18.6% of patients and transfusion of red blood cells was needed for 48.8% of patients. There were three maternal deaths (6.9%). A multidisciplinary team approach is essential to improve the management of hypertensive disorders and postpartum haemorrhage to achieve significant improvements in maternal outcome. A large, prospective study to know which women are at high risk of admission to the intensive care units and to prevent serious maternal morbidity and mortality is warranted. AD - Department of Obstetrics and Gynaecology, Jordan University of Science and Technology, Irbid, Jordan. isam_l@yahoo.com AN - 20455722 AU - Lataifeh, I. AU - Amarin, Z. AU - Zayed, F. AU - Al-Mehaisen, L. AU - Alchalabi, H. AU - Khader, Y. DA - May DO - 10.3109/01443611003646298 DP - NLM ET - 2010/05/12 J2 - Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology KW - Adult Female Humans Intensive Care Units/*statistics & numerical data Jordan/epidemiology Middle Aged Obstetric Labor Complications/*mortality/therapy Patient Admission Pregnancy Retrospective Studies Young Adult LA - eng M1 - 4 N1 - 1364-6893 Lataifeh, I Amarin, Z Zayed, F Al-Mehaisen, L Alchalabi, H Khader, Y Journal Article England J Obstet Gynaecol. 2010 May;30(4):378-82. doi: 10.3109/01443611003646298. PY - 2010 SN - 0144-3615 SP - 378-82 ST - Indications and outcome for obstetric patients' admission to intensive care unit: a 7-year review T2 - J Obstet Gynaecol TI - Indications and outcome for obstetric patients' admission to intensive care unit: a 7-year review VL - 30 ID - 760288 ER - TY - JOUR AB - Background. The Meridional Hospital Liver transplant unit is the only one active in all Espirito Santo State, Brazil, since 2004. Objective. The aim is to analyze data of the first 250 transplants performed by the team. Methods. This retrospective study reviewed files from patients transplanted in the Meridional Hospital from January 2005 to December 2015. Results. There were 250 liver transplants in 236 patients and 14 retransplants. 72.4% were male recipients, with average age of 51.1 years (1-70 years), and the main etiology was alcoholic cirrhosis (33.6% of the cases). Surgical reintervention occurred in 58 patients (include retransplantations) during the same hospitalization, with revision of homeostasis and retransplant as main indications. In the retransplant group, 73.3% of patients died within 2 months. Thrombosis of the hepatic artery was responsible for 40% of the indications for retransplant. The average time between first and second transplant was 223 days (median 14 days). Currently 152 of 236 patients are living, with 1-year life expectancy of approximately 71%. The mortality peak occurred from the immediate postoperative period to 2 months post-transplant (63.8% of the deaths). 32% of subjects did not need intraoperative blood transfusion. The average time of intensive care unit stay was of 8.52 days, and overall hospital stay was 21.7 (median 15 days). Conclusion. Despite the logistic difficulties and lack of donors our unit, keep in advance with survival comparable to other national centers (68% to 74% in 1-year). AD - [Lauer, S. S.] Cassiano Antonio de Moraes Hosp, Digest Syst Surg, Vitoria, ES, Brazil. [Miguel, G. P. S.] Merid Hosp, Liver Transplantat Serv, Cariacica, ES, Brazil. [Miguel, G. P. S.] Merid Hosp, Med Residency Serv Surg, Cariacica, ES, Brazil. [Miguel, G. P. S.; de Abreu, I. W.; Stein, A. B.] Merid Hosp, Digest Surg & Surg Liver Transplant, Cariacica, Brazil. Lauer, SS (corresponding author), Cassiano Antonio de Moraes Hosp, Surg Digest Surg, Ave Mal Campos 1355,Second Floor,Surg Wing, BR-29043260 Vitoria, ES, Brazil. dra.ssl612@gmail.com AN - WOS:000400954100051 AU - Lauer, S. S. AU - Miguel, G. P. S. AU - de Abreu, I. AU - Stein, A. B. DA - May DO - 10.1016/j.transproceed.2017.01.060 J2 - Transplant. Proc. KW - Immunology Surgery Transplantation LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: EU3TO Times Cited: 1 Cited Reference Count: 8 Lauer, S. S. Miguel, G. P. S. de Abreu, I. W. Stein, A. B. abreu, Isaac/0000-0002-5036-8714 1 0 ELSEVIER SCIENCE INC NEW YORK TRANSPL P PY - 2017 SN - 0041-1345 SP - 841-847 ST - Hepatic Transplants in Espirito Santo State, Brazil T2 - Transplantation Proceedings TI - Hepatic Transplants in Espirito Santo State, Brazil UR - ://WOS:000400954100051 VL - 49 ID - 761659 ER - TY - JOUR AB - Background: We aimed to compare effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin-K antagonists (VKA) in atrial fibrillation (AF) patients with chronic kidney disease (CKD) not receiving dialysis. Methods: By using personal identification numbers, we cross-linked individual-level data from Danish administrative registries. We identified every citizen with a prior diagnosis of AF and CKD who initiated NOAC or VKA (2011–2017). An external analysis of 727 AF patients with CKD (no dialysis) was performed to demonstrate level of kidney function in a comparable population. Study outcomes included incidents of stroke/thromboembolisms (TEs), major bleedings, myocardial infarctions (MIs), and all-cause mortality. We used Cox proportional hazards models to determine associations between oral anticoagulant treatment and outcomes. Results: Of 1560 patients included, 1008 (64.6%) initiated VKA and 552 (35.4%) initiated NOAC. In a comparable population we found that 95.3% of the patients had an estimated glomerular filtration rate (eGFR) < 59 mL/min. Patients treated with NOAC had a significantly decreased risk of major bleeding (hazard ratio (HR): 0.47, 95% confidence interval (CI): 0.26–0.84) compared to VKA. There was not found a significant association between type of anticoagulant and risk of stroke/TE (HR: 0.83, 95% CI: 0.39–1.78), MI (HR: 0.45, 95% CI: 0.18–1.11), or all-cause mortality (HR: 0.99, 95% CI: 0.77–1.26). Conclusion: NOAC was associated with a lower risk of major bleeding in patients with AF and CKD compared to VKA. No difference was found in risk of stroke/TE, MI, and all-cause mortality. AD - Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Kildegaardsvej 28, 2900, Hellerup, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark The Danish Heart Foundation, Vognmagergade 7, 1120, Copenhagen, Denmark Department of Nephrology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark Department of Health Science and Technology, Aalborg University, Fredrik Bajers vej 5, 9100, Aalborg, Denmark The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark AN - 139599362. Language: English. Entry Date: 20191118. Revision Date: 20191118. Publication Type: Article AU - Laugesen, Emma Kirstine AU - Staerk, Laila AU - Carlson, Nicholas AU - Kamper, Anne-Lise AU - Olesen, Jonas Bjerring AU - Torp-Pedersen, Christian AU - Gislason, Gunnar AU - Bonde, Anders Nissen DB - CINAHL DO - 10.1186/s12959-019-0211-y DP - EBSCOhost KW - Atrial Fibrillation -- Drug Therapy Anticoagulants -- Administration and Dosage Vitamin K -- Antagonists and Inhibitors Patient Safety -- Evaluation Cardiac Patients Kidney Failure, Chronic Human Prospective Studies Comparative Studies Patient Identification Electronic Health Records Clinical Trial Registry Treatment Outcomes -- Evaluation Kidney -- Physiology Adverse Drug Event -- Evaluation Stroke Thromboembolism Hemorrhage Myocardial Infarction Cause of Death Cox Proportional Hazards Model Descriptive Statistics Glomerular Filtration Rate Confidence Intervals M1 - 1 N1 - research; tables/charts. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 101170542. PY - 2019 SN - 1477-9560 SP - N.PAG-N.PAG ST - Non-vitamin K antagonist oral anticoagulants vs. vitamin-K antagonists in patients with atrial fibrillation and chronic kidney disease: a nationwide cohort study T2 - Thrombosis Journal TI - Non-vitamin K antagonist oral anticoagulants vs. vitamin-K antagonists in patients with atrial fibrillation and chronic kidney disease: a nationwide cohort study UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=139599362&site=ehost-live&scope=site VL - 17 ID - 761354 ER - TY - JOUR AU - Lavender, Z. AU - MacNabb, M. DA - 2019/11/27 11/27 DB - Europe PubMed Central DO - 10.1097/01.jaa.0000604872.64196.31 M1 - 12 PY - 2019 SN - 1547-1896 SP - 52-53 ST - Pulmonary embolism response team T2 - JAAPA TI - Pulmonary embolism response team UR - http://europepmc.org/article/MED/31770307 VL - 32 ID - 761905 ER - TY - JOUR AB - Objective: Dialysis patients historically have had poor pregnancy outcomes, but these have improved over the years with better delivery of dialysis care. The purpose of our study is to describe baseline characteristics and pregnancy outcomes among women with end stage renal disease (ESRD) on hemodialysis (HD). Study Design: We carried out a cohort study on all births using the United States’ Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database between 2005 and 2015. Descriptive statistics were used to measure baseline characteristics and maternal and neonatal outcomes of women with ESRD under HD treatment. We created a composite measure of vascular mediated adverse pregnancy outcomes which included intrauterine growth restriction (IUGR), preeclampsia and intrauterine fetal death (IUFD). Then, using this composite measure, multivariate logistic regression analyses were used to identify risk factors for the development of vascular mediated adverse outcomes of pregnancy among women with ESRD who were on HD. Results: We identified 307 birth records to women with ESRD on HD among 8,765,973 births. There was an increase in the number of patients with ESRD on HD over the 10-year study period. None of the baseline characteristics of the patients were found to be significantly correlated to the occurrence of the composite outcome. Maternal outcomes included need for blood transfusions (28%), placental abruption (8%), sepsis (6%), thromboembolic event (6%), preeclampsia (28%), length of admission >6 days (57%) and maternal death (3%). Neonatal outcomes included congenital anomalies (5%), IUGR (14%), IUFD (7%) and preterm labor < 37 weeks (45%). Conclusion: The incidence of pregnant women with ESRD on HD in the US is rising, with adverse pregnancy complications for both the mother and fetus. Since no specific predictors for the adverse outcomes were found, this entire group of patients should be considered at high risk, strengthening the need for an early multidisciplinary team management. AU - Lavie, A. AU - Czuzoj-Shulman, N. AU - Spence, A. R. AU - Abenhaim, H. A. DB - Embase DO - 10.1016/j.ajog.2019.11.523 KW - adult adverse outcome blood transfusion cohort analysis complication conference abstract congenital malformation controlled study end stage renal disease female fetus fetus death health care cost hemodialysis hospital patient human incidence intrauterine growth retardation major clinical study maternal death multidisciplinary team preeclampsia pregnancy complication pregnancy outcome pregnant woman premature labor risk factor sepsis solutio placentae thromboembolism United States LA - English M1 - 1 M3 - Conference Abstract N1 - L2004455949 2020-01-06 PY - 2020 SN - 1097-6868 0002-9378 SP - S329-S330 ST - 507: Characteristics and outcomes among pregnant women with end-stage renal disease on hemodialysis: a population-based study T2 - American Journal of Obstetrics and Gynecology TI - 507: Characteristics and outcomes among pregnant women with end-stage renal disease on hemodialysis: a population-based study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004455949&from=export http://dx.doi.org/10.1016/j.ajog.2019.11.523 VL - 222 ID - 760612 ER - TY - JOUR AB - BACKGROUND: Historically, pregnancies among women with prosthetic heart valves have been associated with an increased incidence of adverse outcomes. OBJECTIVES: Systematic review to assess risk of adverse pregnancy outcomes among women with a prosthetic heart valve(s) over the last 20 years. SEARCH STRATEGY: Electronic literature search of Medline, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature and Embase to find recent studies. SELECTION CRITERIA: Studies of pregnant women with heart valve prostheses including trials, cohort studies and unselected case series. DATA COLLECTION AND ANALYSIS: Primary analysis calculated absolute risks and 95% confidence intervals (CI) for pregnancy outcomes using a random effects model. The Freeman-Tukey transformation was utilised in secondary analysis due to the large number of individual study outcomes with zero events. MAIN RESULTS: Eleven studies capturing 499 pregnancies among women with heart valve prostheses, including 256 mechanical and 59 bioprosthetic, were eligible for inclusion. Pooled estimate of maternal mortality was 1.2/100 pregnancies (95% CI 0.5-2.2), for mechanical valves subgroup 1.8/100 (95% CI 0.5-3.7) and bioprosthetic subgroup 0.7/100 (95% CI 0.1-4.5), overall pregnancy loss 20.8/100 pregnancies (95% CI 9.5-35.1), perinatal mortality 5.0/100 births (95%CI 1.8-9.8) and thromboembolism 9.3/100 pregnancies (95% CI 4.0-16.5). CONCLUSIONS: Women with heart valve prostheses experienced higher rates of adverse outcomes than expected in a general obstetric population; however, lower than previously reported. Women with bioprostheses had significantly fewer thromboembolic events compared to women with mechanical valves. Women should be counselled pre-pregnancy about risk of maternal death and pregnancy loss. Vigilant surveillance by a multidisciplinary team throughout the perinatal period remains warranted for these women and their infants. TWEETABLE ABSTRACT: Metaanalysis suggests improvement in #pregnancy outcomes among women with #heartvalveprostheses. AD - Clinical Population Perinatal Health Research, Kolling Institute, University of Sydney, Sydney, NSW, Australia. Department of Cardiology, Royal North Shore Hospital, St Leonards, NSW, Australia. AN - 26119028 AU - Lawley, C. M. AU - Lain, S. J. AU - Algert, C. S. AU - Ford, J. B. AU - Figtree, G. A. AU - Roberts, C. L. DA - Oct DO - 10.1111/1471-0528.13491 DP - NLM ET - 2015/06/30 J2 - BJOG : an international journal of obstetrics and gynaecology KW - Bioprosthesis Female Fetal Death Fetal Mortality *Heart Valve Prosthesis Humans Infant, Newborn Maternal Mortality Perinatal Mortality Pregnancy Pregnancy Complications, Cardiovascular/*epidemiology *Pregnancy Outcome Thromboembolism/epidemiology Cardiovascular diseases heart valve prosthesis LA - eng M1 - 11 N1 - 1471-0528 Lawley, C M Lain, S J Algert, C S Ford, J B Figtree, G A Roberts, C L Journal Article Meta-Analysis Research Support, Non-U.S. Gov't Review Systematic Review England BJOG. 2015 Oct;122(11):1446-55. doi: 10.1111/1471-0528.13491. Epub 2015 Jun 29. PY - 2015 SN - 1470-0328 SP - 1446-55 ST - Prosthetic heart valves in pregnancy, outcomes for women and their babies: a systematic review and meta-analysis T2 - Bjog TI - Prosthetic heart valves in pregnancy, outcomes for women and their babies: a systematic review and meta-analysis VL - 122 ID - 760250 ER - TY - JOUR AB - Background: Antiphospholipid antibodies (aPL) are risk factors for adverse pregnancy outcome (APO). Still debated is the prognostic role of the aPL profile, defined as the combination of the 3 criteria tests for aPL (LA: Lupus Anticoagulant; aCL: anti-cardiolipin; aB2GPI: anti-beta2glycoprotein I) and the antibody titer (low vs. medium-high) of aCL and aB2GPI. Objectives: To determine the association between the aPL profile and the occurrence of APO in prospectively followed, treated pregnancies. Methods: 217 pregnancies in 154 women were prospectively followed by a multidisciplinary team of rheumatologists and obstetricians in a single center between 1985 and 2014. Patients were classified as Primary Antiphospholipid Syndrome (PAPS) according to the revised criteria. Patients not fulfilling the criteria, were defined as either non-criteria PAPS or aPL carriers, according to their clinical history and/or aPL status. Patients with concomitant systemic autoimmune diseases were excluded. Data were retrospectively collected and analyzed by aPL profile categories. APO was defined as at least one of the following: miscarriage (before 10th week), fetal death (beyond 10th week), severe preterm delivery (before 34th week) with or without preeclampsia (PE), HELLP syndrome or perinatal death. Statistical analysis was performed with Chi-square with Yates' correction (p-value significant <0.05). Results: The serological profile (triple, double, single aPL positivity) and diagnostic classification of the 217 pregnancies is shown in Table 1. APO occurred in 33 (15%) pregnancies: 14 (42%) in triple positive, 5 (15%) in double positive, and 14 (42%) in single positive patients. Fifteen APO (45%) occurred in LA negative pregnancies. Triple aPL positivity was significantly associated with APO in comparison with double + single positivity (χ2=5.61, p=0.006). In order to assess the role of antibody titers, the analysis was restricted to pregnancies positive for each single aPL test (IgG/IgM aCL, IgG/IgM aB2GPI). No difference in the frequency of APO was observed between pregnancies with low vs. medium-high titer for IgG aCL, IgM aCL, and IgM aB2GPI. Medium-high titers of IgG aB2GPI were associated with APO in comparison with low titers, respectively 17 pregnancies (27%) vs 4 pregnancies (8%) (χ2=5.20, p=0.02). Among these 17 pregnancies with medium/high titers, 13 (76%) were triple aPL positive. Conclusions: Patients with triple aPL positivity seem to be at higher risk for APO despite conventional treatment. aCL and aBGPI titers do not seem to be associated with APO, therefore patients in our cohort with low titers cannot be considered at “low risk” for obstetric events, although being treated. (Table Presented). AD - M.G. Lazzaroni, Rheumatology and Clinical Immunology Unit, Brescia, Italy AU - Lazzaroni, M. G. AU - Lupoli, F. AU - Aggogeri, E. AU - Bettiga, E. AU - Andreoli, L. AU - Fredi, M. AU - Reggia, R. AU - Lojacono, A. AU - Zatti, S. AU - Taglietti, M. AU - Gorla, R. AU - Filippini, M. AU - Tincani, A. DB - Embase DO - 10.1136/annrheumdis-2015-eular.3474 KW - phospholipid antibody chorionic gonadotropin immunoglobulin G immunoglobulin M cardiolipin lupus anticoagulant adenosine 3' phosphate 5' phosphosulfate European pregnancy outcome pregnancy rheumatology rheumatic disease female human patient antibody titer risk perinatal death HELLP syndrome preeclampsia statistical analysis risk factor premature labor fetus death spontaneous abortion diagnosis autoimmune disease statistical significance Yates continuity correction classification antiphospholipid syndrome obstetrician L1 - http://ard.bmj.com/content/74/Suppl_2/574.3.abstract?sid=7b6751bb-7573-4876-9f4e-e69ac416d72a LA - English M3 - Conference Abstract N1 - L72152580 2016-01-16 PY - 2015 SN - 0003-4967 SP - 574-575 ST - The association between antiphospholipid antibody profile and adverse pregnancy outcome in 217 prospectively followed, treated pregnancies in a single center over 30 years of experience T2 - Annals of the Rheumatic Diseases TI - The association between antiphospholipid antibody profile and adverse pregnancy outcome in 217 prospectively followed, treated pregnancies in a single center over 30 years of experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72152580&from=export http://dx.doi.org/10.1136/annrheumdis-2015-eular.3474 VL - 74 ID - 761068 ER - TY - JOUR AB - INTRODUCTION: The technique and preliminary outcomes are reported for laser fenestrated endografting (LfEVAR), developed as an alternative procedure for endovascular repair of thoraco-abdominal aortic aneurysms (TAAAs), type IA endoleaks (T1AELs), and pararenal aortic aneurysms (PAAAs). METHODS: Patients with TAAA, T1AEL, and PAAA considered unfit for open repair by a multidisciplinary team and who could not benefit from a custom made device were selected. LfEVAR is a physician modified technique requiring sequential steps. After preliminary stenting of each target artery, a standard stent graft was deployed in the aorta. Laser fenestration was performed using a steerable sheath positioned in the stent graft lumen in front of each target artery ostium. After progressive dilation of the laser fenestration, bridging stents were placed and flared to insure accurate perfusion of the visceral arteries. RESULTS: Between August 2015 and March 2017, 16 consecutive patients were treated using LfEVAR including two TAAAs, four T1AELs, and 10 PAAAs. Thirty-three laser fenestrations were performed with a 94.3% success rate for visceral artery fenestration. The median ischaemic was 7.5 minutes for the superior mesenteric artery, 48 and 50 minutes for the left and right renal arteries, and 125 minutes for the coeliac trunk. Four secondary procedures were required: two endoleaks (type II and III), and two related to fenestrations: one renal stent dislocation, and one renal artery stent stenosis. During a mean follow up of 17 months, no deaths occurred. Follow up computed tomography (CT) scans performed at 30 days, 6, 12, and 18 months were satisfactory (4 endoleaks and two aneurysm enlargements were observed). The follow up CT scan imaging demonstrated 97% primary patency. CONCLUSION: In situ antegrade LfEVAR is feasible and a safe alternative option for high risk inoperable patients or for those not eligible for custom made device endografting, particularly in emergency cases. AD - Department of Vascular Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson, Paris-Sud University, Paris Saclay, France. Department of Vascular Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson, Paris-Sud University, Paris Saclay, France. Electronic address: d.fabre@ccml.fr. AN - 30196815 AU - Le Houérou, T. AU - Fabre, D. AU - Alonso, C. G. AU - Brenot, P. AU - Bourkaib, R. AU - Angel, C. AU - Amsallem, M. AU - Haulon, S. DA - Sep DO - 10.1016/j.ejvs.2018.05.014 DP - NLM ET - 2018/09/11 J2 - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery KW - Aged Aged, 80 and over Aortic Aneurysm, Abdominal/diagnostic imaging/*surgery Aortic Aneurysm, Thoracic/diagnostic imaging/*surgery Aortography/methods Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation/adverse effects/instrumentation/*methods Computed Tomography Angiography Endoleak/diagnostic imaging/*surgery Endovascular Procedures/adverse effects/*instrumentation/methods Feasibility Studies Female Humans *Laser Therapy/adverse effects Male Operative Time Proof of Concept Study Prospective Studies Prosthesis Design Stents Time Factors Treatment Outcome *Endoleak *Endovascular aneurysm repair *Fenestration *Laser *Thoraco-abdominal aortic aneurysm LA - eng M1 - 3 N1 - 1532-2165 Le Houérou, Thomas Fabre, Dominique Alonso, Carlos G Brenot, Philippe Bourkaib, Ryiad Angel, Claude Amsallem, Myriam Haulon, Stephan Journal Article England Eur J Vasc Endovasc Surg. 2018 Sep;56(3):356-362. doi: 10.1016/j.ejvs.2018.05.014. Epub 2018 Jun 30. PY - 2018 SN - 1078-5884 SP - 356-362 ST - In Situ Antegrade Laser Fenestrations During Endovascular Aortic Repair T2 - Eur J Vasc Endovasc Surg TI - In Situ Antegrade Laser Fenestrations During Endovascular Aortic Repair VL - 56 ID - 760245 ER - TY - JOUR AB - Object: Anticoagulation during pregnancy is challenging because of the potential for maternal complications. We aimed to describe management of anticoagulation for the treatment of acute venous thromboembolism (VTE) during pregnancy and to compare delivery and post-partum outcomes in pregnant women with or without anticoagulant therapy. Method: We studied clinical characteristics of all women included between 1992 and 2012 in the EDITH study for pregnancy-associated VTE. For each case, two controls were retrospectively matched for age, date and place of delivery. Results: We included 31 women with acute VTE during pregnancy (24 with deep vein thrombosis and 7 with pulmonary embolism). Weight adjusted-dose subcutaneous low-molecular-weight-heparin was used for initial treatment in 71% of cases. Management of anticoagulation in peripartum was documented for 23 women: for 18, (78.3%), anticoagulation was held at least 24 hours prior to delivery. We observed no recurrence of VTE and 9 bleeding events (4 before delivery, 1 early post-partum hemorrhage, 4 after discharge). When compared to controls, women receiving anticoagulation had less obstetrical anaesthesia (66.7% versus 93.3% p=0.002), longer hospitalisation after delivery (6.93±2.23 days versus 5.60±1.56 days, p=0.002) and lower breastfeeding rate (40% versus 68.9%, p=0.013). Conclusions: Management of peripartum in women receiving anticoagulation for acute VTE during pregnancy was not in line with evidence-based clinical practice guidelines and should better be considered by a multidisciplinary team. We observed unexpected late postpartum bleedings when resuming oral anticoagulants. Ultrasound control of uterine vacuity before discharge could be useful for bleeding prevention. AD - E. Le Moigne, EA 3878 and Department of Internal Medicine and Chest Diseases, Brest, France AU - Le Moigne, E. AU - Georget, S. AU - Collet, M. AU - Jacquot, M. AU - Tromeur, C. AU - Mottier, D. AU - Delluc, A. DB - Embase KW - low molecular weight heparin anticoagulant agent human venous thromboembolism female pregnancy case control study thrombosis health hemostasis anticoagulant therapy anticoagulation bleeding lung embolism pregnant woman deep vein thrombosis practice guideline ultrasound prevention obstetric anesthesia postpartum hemorrhage weight evidence based practice uterus LA - English M3 - Conference Abstract N1 - L71848290 2015-04-24 PY - 2015 SN - 0049-3848 SP - S72 ST - Anticoagulant therapy for acute venous thromboembolism during pregnancy: Case-control study of delivery and post-partum T2 - Thrombosis Research TI - Anticoagulant therapy for acute venous thromboembolism during pregnancy: Case-control study of delivery and post-partum UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71848290&from=export VL - 135 ID - 761080 ER - TY - JOUR AB - Background: System factors contributing to preventable harm in vascular patients have not been previously reported in detail. The aim of this exploratory mixed-methods study was to describe vascular surgeons' perceptions of factors contributing to adverse events (AEs) in arterial surgery. A secondary aim was to report recommendations to improve patient safety. Methods: Vascular consultants/registrars working in the British National Health Service were questioned about the causes of preventable AEs through survey and semi- structured interview (response rates 77% and 83%, respectively). Survey respondents considered a recent AE, indicating on a 5 point Likert scale the extent to which various factors from a validated framework contributed toward the incident. Semi-structured interviews were conducted to obtain detailed accounts of contributory factors, and to elicit recommendations to improve safety. Results: Seventy-seven surgeons completed the survey on 77 separate AEs occurring during open surgery (n = 41) and in endovascular procedures (n = 36). Ten interviewees described 15 AEs. The causes of AEs were multifactorial (median number of factors/ AE = 5, IQR 3-9, range 0-25). Factors frequently reported by survey respondents were communication failures (36.4%; n = 28/77); inadequate staffing levels/skill mix (32.5%; n = 25/77); lack of knowledge/skill (37.3%; n = 28/75). Themes emerging from interviews were team factors (communication failure, lack of team continuity, lack of clarity over roles/responsibilities); work environment factors (poor staffing levels, equipment problems, distractions); inadequate training/supervision. Knowledge/skill (p = .034) and competence (p = .018) appeared to be more prominent in causing AEs in open procedures compared with endovascular procedures; organisational structure was more frequently implicated in AEs occurring in endovascular procedures (p = .017). To improve safety, interviewees proposed team training programmes (5/10 interviewees); additional protocols/checklists (4/10); improved escalation procedures (3/10). Conclusion: Vascular surgeons believe that AEs in arterial operations are caused by multiple, modifiable system factors. Larger studies are needed to establish the relative importance of these factors and to determine strategies that can effectively address system failures. (C) 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. AD - [Lear, Rachael; Godfrey, Anthony D.; Riga, Celia; Bicknell, Colin D.] Imperial Coll London, Dept Surg & Canc, London, England. [Lear, Rachael] Kingston Univ, Fac Hlth Social Care & Educ, London, England. [Lear, Rachael] St Georges Univ London, 6th Floor Hunter Wing,Cranmer Terrace, London SW17 0RE, England. [Riga, Celia; Bicknell, Colin D.] Imperial Coll Healthcare Natl Hlth Serv Trust, Imperial Vasc Unit, London, England. [Norton, Christine] Kings Coll London, Fac Nursing & Midwifery, London, England. [Vincent, Charles] Univ Oxford, Med Sci Div, Dept Expt Psychol, Oxford, England. [Bicknell, Colin D.] Imperial Coll London, Ctr Hlth Policy, London, England. [Lear, Rachael] Kingston Univ, Fac Hlth Social Care & Educ, St Georges Hosp, 6th Floor Hunter Wing,Cranmer Terrace, London SW17 ORE, England. Lear, R (corresponding author), Imperial Coll London, Dept Surg & Canc, Div Surg, St Marys Campus, London W2 1NY, England. r.lear12@imperial.ac.uk AN - WOS:000419053800021 AU - Lear, R. AU - Godfrey, A. D. AU - Riga, C. AU - Norton, C. AU - Vincent, C. AU - Bicknell, C. D. DA - Dec DO - 10.1016/j.ejvs.2017.10.003 J2 - Eur. J. Vasc. Endovasc. Surg. KW - Patient safety Communication Endovascular procedures CARDIAC-SURGERY ADVERSE EVENTS OPERATING-ROOM REHEARSAL MORTALITY SAFETY COMPLICATIONS FAILURES OUTCOMES QUALITY Surgery Peripheral Vascular Disease LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: FR4RQ Times Cited: 0 Cited Reference Count: 27 Lear, Rachael Godfrey, Anthony D. Riga, Celia Norton, Christine Vincent, Charles Bicknell, Colin D. National Institute for Health ResearchNational Institute for Health Research (NIHR) [CDRF-2012-03-040]; Circulation Foundation; National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust; Imperial College London This research was supported by the National Institute for Health Research (Rachael Lear, Clinical Doctoral Research Fellowship, CDRF-2012-03-040), the Circulation Foundation, and by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. The views expressed in this publication are those of the author(s) and not necessarily those of the funders, the NHS, the National Institute for Health Research or the Department of Health. 0 2 W B SAUNDERS CO LTD LONDON EUR J VASC ENDOVASC PY - 2017 SN - 1078-5884 SP - 778-786 ST - Surgeons' Perceptions of the Causes of Preventable Harm in Arterial Surgery: A Mixed-Methods Study T2 - European Journal of Vascular and Endovascular Surgery TI - Surgeons' Perceptions of the Causes of Preventable Harm in Arterial Surgery: A Mixed-Methods Study UR - ://WOS:000419053800021 VL - 54 ID - 761618 ER - TY - JOUR AB - BackgroundVascular surgical care has changed dramatically in recent years with little knowledge of the impact of system failures on patient safety. The primary aim of this multicentre observational study was to define the landscape of surgical system failures, errors and inefficiency (collectively termed failures) in aortic surgery. Secondary aims were to investigate determinants of these failures and their relationship with patient outcomes. MethodsTwenty vascular teams at ten English hospitals trained in structured self-reporting of intraoperative failures (phase I). Failures occurring in open and endovascular aortic procedures were reported in phase II. Failure details (category, delay, consequence), demographic information (patient, procedure, team experience) and outcomes were reported. ResultsThere were strong correlations between the trainer and teams for the number and type of failures recorded during 88 procedures in phase I. In 185 aortic procedures, teams reported a median of 3 (i.q.r. 2-6) failures per procedure. Most frequent failures related to equipment (unavailability, failure, configuration, desterilization). Most major failures related to communication. Fourteen failures directly harmed 12 patients. Significant predictors of an increased failure rate were: endovascular compared with open repair (incidence rate ratio (IRR) for open repair 071, 95 per cent c.i. 057 to 088; P=0002), thoracic aneurysms compared with other aortic pathologies (IRR 207, 139 to 308; P<0001) and unfamiliarity with equipment (IRR 152, 120 to 191; P<0001). The major failure total was associated with reoperation (P=0011), major complications (P=0029) and death (P=0027). ConclusionFailure in aortic procedures is frequently caused by issues with team-working and equipment, and is associated with patient harm. Multidisciplinary team training, effective use of technology and new-device accreditation may improve patient outcomes. Towards safer surgery AD - [Lear, R.; Riga, C.; Godfrey, A. D.; Cheshire, N. J.; Darzi, A. W.; Bicknell, C. D.] Imperial Coll London, Dept Surg & Canc, London, England. [Falaschetti, E.] Imperial Coll London, Clin Trials Unit, London, England. [Darzi, A. W.; Bicknell, C. D.] Imperial Coll London, Ctr Hlth Policy, London, England. [Lear, R.; Riga, C.; Norton, C.; Bicknell, C. D.] Imperial Coll Healthcare NHS Trust, London, England. [Norton, C.] Kings Coll London, Fac Nursing & Midwifery, London, England. [Vincent, C.] Univ Oxford, Div Med Sci, Dept Expt Psychol, Oxford, England. [Van Herzeele, I.] Ghent Univ Hosp, Dept Thorac & Vasc Surg, Ghent, Belgium. Lear, R (corresponding author), Imperial Coll London, Dept Surg & Canc, Div Surg, St Marys Campus, London W2 1NY, England. r.lear12@imperial.ac.uk AN - WOS:000384671500010 AU - Lear, R. AU - Riga, C. AU - Godfrey, A. D. AU - Falaschetti, E. AU - Cheshire, N. J. AU - Van Herzeele, I. AU - Norton, C. AU - Vincent, C. AU - Darzi, A. W. AU - Bicknell, C. D. AU - Collaborators, Leap Study DA - Oct DO - 10.1002/bjs.10275 J2 - Br. J. Surg. KW - ADVERSE EVENTS MORTALITY Surgery LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: DX8WL Times Cited: 11 Cited Reference Count: 14 Lear, R. Riga, C. Godfrey, A. D. Falaschetti, E. Cheshire, N. J. Van Herzeele, I. Norton, C. Vincent, C. Darzi, A. W. Bicknell, C. D. Lear, Rachael/0000-0002-8670-3799; Falaschetti, Emanuela/0000-0001-6964-2042 Circulation Foundation; NIHRNational Institute for Health Research (NIHR) [CDRF-2012-03-040]; NIHR Biomedical Research CentreNational Institute for Health Research (NIHR); British Heart FoundationBritish Heart Foundation [FS/11/37/28819] Funding Source: Researchfish; National Institute for Health ResearchNational Institute for Health Research (NIHR) [CDRF-2012-03-040] Funding Source: Researchfish This work was supported by the Circulation Foundation (President's Early Career Award to C.D.B.); the NIHR (CDRF-2012-03-040 to R.L.); and the NIHR Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. The views expressed in this publication are those of the author(s) and not necessarily those of the funders, the National Health Service, the NIHR or the Department of Health. 11 0 1 WILEY-BLACKWELL HOBOKEN BRIT J SURG PY - 2016 SN - 0007-1323 SP - 1467-1475 ST - Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes T2 - British Journal of Surgery TI - Multicentre observational study of surgical system failures in aortic procedures and their effect on patient outcomes UR - ://WOS:000384671500010 VL - 103 ID - 761695 ER - TY - JOUR AB - IMPORTANCE: Prevention strategies for heart failure are needed. OBJECTIVE: To determine the efficacy of a screening program using brain-type natriuretic peptide (BNP) and collaborative care in an at-risk population in reducing newly diagnosed heart failure and prevalence of significant left ventricular (LV) systolic and/or diastolic dysfunction. DESIGN, SETTING, AND PARTICIPANTS: The St Vincent's Screening to Prevent Heart Failure Study, a parallel-group randomized trial involving 1374 participants with cardiovascular risk factors (mean age, 64.8 [SD, 10.2] years) recruited from 39 primary care practices in Ireland between January 2005 and December 2009 and followed up until December 2011 (mean follow-up, 4.2 [SD, 1.2] years). INTERVENTION: Patients were randomly assigned to receive usual primary care (control condition; n=677) or screening with BNP testing (n=697). Intervention-group participants with BNP levels of 50 pg/mL or higher underwent echocardiography and collaborative care between their primary care physician and specialist cardiovascular service. MAIN OUTCOMES AND MEASURES: The primary end point was prevalence of asymptomatic LV dysfunction with or without newly diagnosed heart failure. Secondary end points included emergency hospitalization for arrhythmia, transient ischemic attack, stroke, myocardial infarction, peripheral or pulmonary thrombosis/embolus, or heart failure. RESULTS: A total of 263 patients (41.6%) in the intervention group had at least 1 BNP reading of 50 pg/mL or higher. The intervention group underwent more cardiovascular investigations (control, 496 per 1000 patient-years vs intervention, 850 per 1000 patient-years; incidence rate ratio, 1.71; 95% CI, 1.61-1.83; P<.001) and received more renin-angiotensin-aldosterone system-based therapy at follow-up (control, 49.6%; intervention, 56.5%; P=.01). The primary end point of LV dysfunction with or without heart failure was met in 59 (8.7%) of 677 in the control group and 37 (5.3%) of 697 in the intervention group (odds ratio [OR], 0.55; 95% CI, 0.37-0.82; P = .003). Asymptomatic LV dysfunction was found in 45 (6.6%) of 677 control-group patients and 30 (4.3%) of 697 intervention-group patients (OR, 0.57; 95% CI, 0.37-0.88; P = .01). Heart failure occurred in 14 (2.1%) of 677 control-group patients and 7 (1.0%) of 697 intervention-group patients (OR, 0.48; 95% CI, 0.20-1.20; P = .12). The incidence rates of emergency hospitalization for major cardiovascular events were 40.4 per 1000 patient-years in the control group vs 22.3 per 1000 patient-years in the intervention group (incidence rate ratio, 0.60; 95% CI, 0.45-0.81; P = .002). CONCLUSION AND RELEVANCE: Among patients at risk of heart failure, BNP-based screening and collaborative care reduced the combined rates of LV systolic dysfunction, diastolic dysfunction, and heart failure. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00921960. AD - Chronic Cardiovascular Disease Management Unit, St Vincent's Healthcare Group/St Michael's Hospital, Dublin, Ireland. AN - 23821090 AU - Ledwidge, M. AU - Gallagher, J. AU - Conlon, C. AU - Tallon, E. AU - O'Connell, E. AU - Dawkins, I. AU - Watson, C. AU - O'Hanlon, R. AU - Bermingham, M. AU - Patle, A. AU - Badabhagni, M. R. AU - Murtagh, G. AU - Voon, V. AU - Tilson, L. AU - Barry, M. AU - McDonald, L. AU - Maurer, B. AU - McDonald, K. DA - Jul 3 DO - 10.1001/jama.2013.7588 DP - NLM ET - 2013/07/04 J2 - Jama KW - Aged Biomarkers/blood Cardiology Cardiovascular Diseases/epidemiology Diastole Echocardiography Emergency Medical Services/statistics & numerical data Female Heart Failure/*diagnosis/*prevention & control Hospitalization/statistics & numerical data Humans Male *Mass Screening Middle Aged Natriuretic Peptide, Brain/*blood *Patient Care Team Prevalence Primary Health Care Prospective Studies Risk Factors Ventricular Dysfunction, Left/*epidemiology LA - eng M1 - 1 N1 - 1538-3598 Ledwidge, Mark Gallagher, Joseph Conlon, Carmel Tallon, Elaine O'Connell, Eoin Dawkins, Ian Watson, Chris O'Hanlon, Rory Bermingham, Margaret Patle, Anil Badabhagni, Mallikarjuna R Murtagh, Gillian Voon, Victor Tilson, Leslie Barry, Michael McDonald, Laura Maurer, Brian McDonald, Kenneth Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't United States JAMA. 2013 Jul 3;310(1):66-74. doi: 10.1001/jama.2013.7588. PY - 2013 SN - 0098-7484 SP - 66-74 ST - Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial T2 - Jama TI - Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial VL - 310 ID - 760136 ER - TY - JOUR AB - Introduction: A major drawback to microvascular free flap breast reconstruction is the length of operation-up to 9 hours or more for bilateral reconstruction. This takes a significant mental and physical toll on the surgical team, producing fatigue that may compromise surgical outcome. To facilitate the operation we have incorporated a period of cold ischemia of the flaps such that members of the surgical team can alternate a brief respite during the operation. Methods: We retrospectively reviewed our series of microvascular free flap breast reconstructions performed over a four-year period in which cold ischemia of the flaps were induced. Results: Seventy patients underwent free flap breast reconstruction with 104 flaps. Mean cold ischemia time for all flaps was 2 hours 36 min. Average rest time per surgeon per case was 35 min. Complications included two total flap losses (1.9%), one partial flap loss (1.0%), one anastomotic thrombosis (1.0%), two hematomas (1.9%), three fat necrosis (2.9%), and two delayed healing (1.9%). Statistical analysis revealed that the probability of complications is inversely related to cold ischemia time (P = 0.0163). Conclusion: Cold ischemia facilitates breast reconstruction by allowing the surgical team to alternate breaks during the operation. This helps reduce surgeon fatigue and is well tolerated by the flap. Thus, we believe that the use of cold ischemia is safe and advantageous in microvascular breast reconstruction. (C) 2010 Wiley-Liss, Inc. Microsurgery 30:361-367, 2010. AD - [Lee, David T.; Lee, Gordon] Stanford Univ, Palo Alto, CA 94304 USA. Lee, G (corresponding author), Stanford Plast & Reconstruct Surg, 770 Welch Rd,Suite 400,MC 5715, Palo Alto, CA 94304 USA. glee@stanford.edu AN - WOS:000280085900004 AU - Lee, D. T. AU - Lee, G. DO - 10.1002/micr.20739 J2 - Microsurgery KW - DUTY HOURS SURGERY FATIGUE TIME FLAP CARE Surgery LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: 628AI Times Cited: 8 Cited Reference Count: 12 Lee, David T. Lee, Gordon 8 0 1 WILEY HOBOKEN MICROSURG PY - 2010 SN - 0738-1085 SP - 361-367 ST - COLD ISCHEMIA IN MICROVASCULAR BREAST RECONSTRUCTION T2 - Microsurgery TI - COLD ISCHEMIA IN MICROVASCULAR BREAST RECONSTRUCTION UR - ://WOS:000280085900004 VL - 30 ID - 761885 ER - TY - JOUR AB - BACKGROUND: Primary abdominal wall reconstruction after liver transplantation presents a challenge in patients with size mismatch, multivisceral transplants, and prior recipient abdominal surgery. The authors report their experience with a novel technique for abdominal wall reconstruction with a new vascular composite allotransplant. METHODS: Five posterior rectus sheath-liver composite vascular allotransplants were procured by a multidisciplinary team and transplanted into four patients over the course of 2 years. Liver transplantation was performed in the standard manner, and the posterior rectus sheath was inset as an inlay flap. RESULTS: Abdominal wall integrity was reestablished with vascularized fascia in all five cases. In two cases, the fascia was closed immediately at the time of initial transplantation. In three cases, the abdomen was left open for a planned second look and closed definitively when the liver appeared satisfactory. In one patient, hepatic artery thrombosis was detected 11 days after transplantation, requiring a second posterior rectus sheath-liver transplant. Skin closure was performed for all transplants in either an immediate or a delayed fashion. Reoperation requiring elevation of the posterior rectus sheath flap for a suprahepatic vena cava stenosis was performed in one patient. CONCLUSIONS: Closure of the abdominal cavity is critical to the success of liver transplantation for organ survival and overall patient morbidity and mortality. The authors describe their institutional experience with a novel method of concurrent abdominal wall reconstruction and liver transplantation using the posterior rectus sheath-liver vascular composite allotransplant in situations of size mismatch, multivisceral transplants, and compromised abdominal wall of the recipient. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V. AD - Sections of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, Ill, USA. AN - 23358016 AU - Lee, J. C. AU - Olaitan, O. K. AU - Lopez-Soler, R. AU - Renz, J. F. AU - Millis, J. M. AU - Gottlieb, L. J. DA - Feb DO - 10.1097/PRS.0b013e3182789c28 DP - NLM ET - 2013/01/30 J2 - Plastic and reconstructive surgery KW - Abdominal Wall/*surgery Adolescent Adult Child Child, Preschool Female Humans Infant Liver Transplantation/*methods Male Reconstructive Surgical Procedures/*methods Rectus Abdominis/*blood supply/*transplantation Retrospective Studies Surgical Flaps/*blood supply Young Adult LA - eng M1 - 2 N1 - 1529-4242 Lee, Justine C Olaitan, Oyedolamu K Lopez-Soler, Reynold Renz, John F Millis, J Michael Gottlieb, Lawrence J Case Reports Journal Article United States Plast Reconstr Surg. 2013 Feb;131(2):209e-218e. doi: 10.1097/PRS.0b013e3182789c28. PY - 2013 SN - 0032-1052 SP - 209e-218e ST - Expanding the envelope: the posterior rectus sheath-liver vascular composite allotransplant T2 - Plast Reconstr Surg TI - Expanding the envelope: the posterior rectus sheath-liver vascular composite allotransplant VL - 131 ID - 760507 ER - TY - JOUR AB - Background: Warfarin requires individualized dosing and monitoring in the ambulatory setting for protection against thromboembolic disease. Yet in multiple settings, patients spend upwards of 30% of time outside the therapeutic range, subjecting them to an increased risk of adverse events. At an urban, publicly funded clinic, the electronic health record (EHR) would not support integration with extant warfarin management software, which led to the creation and implementation of an electronic patient registry and a complementary team-based work flow to provide real-time health-system-level data for warfarin patients. Methods: Creation of the registry, which began in August 2014, entailed use of an existing platform, which could interface with the outpatient EHR. The registry was designed to help ensure regular testing and monitoring of patients while enabling identification of patients and subpopulations with suboptimal management. The work flow used for the clinic's warfarin patients was also redesigned. An assessment indicated that the registry identified 341 (96%) of 357 patients actively seen in the clinic. Results: For the cohort of the 357 patients in the registry, the no-show rate decreased from 31% (preimplementation, August 2014-December 2014) to 21% (postimplementation, January 2015-November 2015). The ratio of visits to no-shows increased from 2.3 to 4.0 visits. Conclusion: Design and implementation of an electronic registry in conjunction with a complementary work flow established an active tracking system that improved treatment monitoring for patients on anticoagulation therapy. Registry creation also facilitated assessment of the quality of care and laid the groundwork for ongoing evaluation and quality improvement efforts. AD - [Lee, Shin-Yu] Zuckerberg San Francisco Gen Hosp & Trauma Ctr ZS, San Francisco Hlth Network, Richard H Fine Peoples Clin, San Francisco, CA 94110 USA. [Cherian, Roy; Salley, Alaya Levi] ZSFG, San Francisco, CA USA. [Ly, Irene; Horton, Claire; Sarkar, Urmimala] Richard H Fine Peoples Clin, San Francisco, CA USA. [Ly, Irene] Univ Calif Davis, Davis, CA 95616 USA. [Horton, Claire] Univ Calif San Francisco, Residence, San Francisco, CA 94143 USA. [Salley, Alaya Levi] Kaiser Permanente, Oakland, CA USA. [Sarkar, Urmimala] UCSF, San Francisco, CA USA. Lee, SY (corresponding author), Zuckerberg San Francisco Gen Hosp & Trauma Ctr ZS, San Francisco Hlth Network, Richard H Fine Peoples Clin, San Francisco, CA 94110 USA. shin-yu.lee@sfdph.org AN - WOS:000424164300006 AU - Lee, S. Y. AU - Cherian, R. AU - Ly, I. AU - Horton, C. AU - Salley, A. L. AU - Sarkar, U. DA - Jul DO - 10.1016/j.jcjq.2017.03.006 J2 - Jt. Comm. J. Qual. Patient Saf. KW - ATRIAL-FIBRILLATION ANTICOAGULATION CONTROL INFORMATION-TECHNOLOGY MEDICATION SCHEDULE ORAL ANTICOAGULANTS DIABETES CARE HEALTH MANAGEMENT STROKE DISPARITIES Health Care Sciences & Services LA - English M1 - 7 M3 - Article N1 - ISI Document Delivery No.: FU9GP Times Cited: 2 Cited Reference Count: 28 Lee, Shin-Yu Cherian, Roy Ly, Irene Horton, Claire Salley, Alaya Levi Sarkar, Urmimala Agency for Healthcare Research and Quality (AHRQ)United States Department of Health & Human ServicesAgency for Healthcare Research & Quality [R21HS021322, P30HS023558] The information contained in this article note is supported through two grants from the Agency for Healthcare Research and Quality (AHRQ): R21HS021322 and P30HS023558. 2 0 ACADEMIC PRESS INC ELSEVIER SCIENCE SAN DIEGO JT COMM J QUAL PATIE PY - 2017 SN - 1553-7250 SP - 353-360 ST - Designing and Implementing an Electronic Patient Registry to Improve Warfarin Monitoring in the Ambulatory Setting T2 - Joint Commission Journal on Quality and Patient Safety TI - Designing and Implementing an Electronic Patient Registry to Improve Warfarin Monitoring in the Ambulatory Setting UR - ://WOS:000424164300006 VL - 43 ID - 761643 ER - TY - JOUR AB - BACKGROUND: Quality improvement (QI) initiatives characterised by iterative cycles of quantitative data analysis do not readily explain the organisational determinants of change. However, the integration of sociotechnical theory can inform more effective strategies. Our specific aims were to (1) describe a computerised decision support intervention intended to improve adherence with deep venous thrombosis (DVT) prophylaxis recommendations; and (2) show how sociotechnical theory expressed in 'Fit between Individuals, Task and Technology' framework (FITT) can identify and clarify the facilitators and barriers to QI work. METHODS: A multidisciplinary team developed and implemented electronic menus with DVT prophylaxis recommendations. Stakeholders were interviewed and human factors were analysed to optimise integration. Menu exposure, order placement and clinical performance were measured. Vista tool extraction and chart review were used. Performance compliance pre-implementation was 77%. RESULTS: There were 80-110 eligible cases per month. Initial menu use rate was 20%. After barriers were classified and addressed using the FITT framework, use improved 50% to 90%. Tasks, users and technology issues in the FITT model and their interfaces were identified and addressed. Workflow styles, concerns about validity of guidelines, cycle times and perceived ambiguity of risk were issues identified. CONCLUSIONS: DVT prophylaxis in a surgical setting is fraught with socio-political agendas, cognitive dissonance and misaligned expectations. These must be sought and articulated if organisations are to respond to internal resistance to change. This case study demonstrates that QI teams using information technology must understand the clinical context, even in mature electronic health record environments, in order to implement sustainable systems. AD - Portland Oregon VA Medical Center, Oregon Health and Sciences University, Portland, Oregon, USA. blake.lesselroth@va.gov AN - 21209144 AU - Lesselroth, B. J. AU - Yang, J. AU - McConnachie, J. AU - Brenk, T. AU - Winterbottom, L. C2 - Pmc3088464 DA - May DO - 10.1136/bmjqs.2010.042689 DP - NLM ET - 2011/01/07 J2 - BMJ quality & safety KW - *Decision Support Systems, Clinical Guideline Adherence/statistics & numerical data Humans Postoperative Care/*standards Practice Guidelines as Topic *Quality Improvement Venous Thrombosis/*prevention & control LA - eng M1 - 5 N1 - 2044-5423 Lesselroth, Blake J Yang, Jianji McConnachie, Judy Brenk, Thomas Winterbottom, Lisa Journal Article Research Support, Non-U.S. Gov't BMJ Qual Saf. 2011 May;20(5):381-9. doi: 10.1136/bmjqs.2010.042689. Epub 2011 Jan 5. PY - 2011 SN - 2044-5415 (Print) 2044-5415 SP - 381-9 ST - Addressing the sociotechnical drivers of quality improvement: a case study of post-operative DVT prophylaxis computerised decision support T2 - BMJ Qual Saf TI - Addressing the sociotechnical drivers of quality improvement: a case study of post-operative DVT prophylaxis computerised decision support VL - 20 ID - 760412 ER - TY - JOUR AB - Background In our large teaching hospital, Pre-Operative Assessments (POA) for general surgery patients are completed in a single visit by a multidisciplinary team comprising trained nurses, anaesthetist and junior doctors. Medicines reconciliation and completion of thromboprophylaxis risk assessment (TRA) are completed by junior doctors. For orthopaedic patients, these are completed by trained pharmacists. Missed doses as a result of incomplete POA for general surgery patients were identified as a major risk at our institution. Purpose We carried out a prospective study comparing the reliability of medicines reconciliation performed by junior doctors compared to pharmacists, before and after implementation of three interventions that are listed below. Materials and methods We collected data on completion rate of prescription charts and TRAs of all patients who attended POA for general surgery and orthopaedic for 2 weeks, and the number of missed doses for 2 weeks. Following that, the completion rate of all patients attending POA for general surgery was continuously monitored over a period of 22 weeks. A fishbone diagram was used to analyse the POA process and to identify possible targets for interventions. We implemented three interventions: • All junior doctors receive a mandatory medicines reconciliation and TRA teaching session. • Junior doctors to complete all prescription charts as a batch at the end of POA clinic. • Patients were not permitted to be transferred to theatre without a complete prescription chart. Data were plotted in a run-chart for analysis. The attendance rate and reasons for nonattendance of junior doctors at POA were also recorded. Results The completion rate of prescription charts and TRA for general surgery and orthopaedic patients was 43% and 94% respectively. Over a period of one week, 18 cases of missed doses were recorded. Following the first two interventions, the completion rate of prescription charts for general surgery patients increased to 45% and to 51% after the third intervention. Junior doctors attended only 44% of POA clinics, with the majority being kept away by other clinical commitments. Conclusions Preventing medicines errors in elective surgical patients begins with accurate medicines reconciliation and completion of prescription charts at POA clinic. Our data revealed that junior doctors were not as reliable as trained pharmacists in completing prescription charts. Despite three interventions, the completion rate of prescription charts by junior doctors could not be raised to meet the standard of trained pharmacists. We therefore support the introduction of trained pharmacists to the POA clinics to manage medicines reconciliation and reduce medicines-related incidents. AD - C. Leung, Norfolk and Norwich University Hospital, NHS Foundation Trust, Department of General Surgery, Norwich, United Kingdom AU - Leung, C. AU - Brunswicker, A. AU - Yogarajah, A. AU - Sparrow, S. AU - Webdale, M. AU - Irving, S. AU - Lipp, A. DB - Embase DO - 10.1136/ejhpharm-2013-000436.399 KW - clinical article controlled study error general surgery hospital human pharmacist preoperative evaluation prescription prospective study reliability risk assessment surgery surgical patient teaching LA - English M3 - Conference Abstract N1 - L611785043 2016-08-29 PY - 2014 SN - 2047-9964 SP - A163 ST - Improving medicines reconciliation in pre-operative assessment of surgical patients T2 - European Journal of Hospital Pharmacy TI - Improving medicines reconciliation in pre-operative assessment of surgical patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L611785043&from=export http://dx.doi.org/10.1136/ejhpharm-2013-000436.399 VL - 21 ID - 761123 ER - TY - JOUR AB - Public engagement (PE) involves multidisciplinary stakeholders contributing their perspectives to a project in order to achieve a common goal. However, it is not easy to take the needs and wishes of stakeholders into account while balancing their diverse power and interests in the engagement process. The unbalanced distribution of power and interests inevitably causes conflict during engagement with multiple stakeholders. Research on how to improve PE performance from a stakeholder's perspective is still in its infancy. This study used a survey to investigate the complicated relationships between stakeholder's power, interests, conflict, and project satisfaction. The results showed that different forms of power and interest influenced final satisfaction with PE projects either directly or indirectly, through conflict. The PE organizers are encouraged to include more representatives from different groups of stakeholders in the team decision-making process to enable active engagement with their interests and to establish a systematic and logical team-decision-making process to decrease task conflict. The findings of this study will contribute to balancing stakeholder's power and interests, managing conflict effectively, improving PE performance for construction development projects, and, finally, to maximizing public value. AD - [Leung, Mei-yung; Yu, Jingyu; Liang, Qi] City Univ Hong Kong, Dept Civil & Architectural Engn, Kowloon Tong, Hong Kong, Peoples R China. Leung, MY (corresponding author), City Univ Hong Kong, Dept Civil & Architectural Engn, Tat Chee Ave, Kowloon Tong, Hong Kong, Peoples R China. bcmei@cityu.edu.hk; jingyuyu-c@my.cityu.edu.hk; qiliang3-c@student.cityu.edu.hk AN - WOS:000325773100011 AU - Leung, M. Y. AU - Yu, J. Y. AU - Liang, Q. C7 - 40130190 DA - Nov DO - 10.1061/(asce)co.1943-7862.0000754 J2 - J. Constr. Eng. Manage. KW - Conflict Construction management Public participation Conflict Interests Power Public engagement Stakeholder POWER SOURCES CONFLICT PARTICIPATION MANAGEMENT DELIBERATION INFORMATION INNOVATION FRAMEWORK JUSTICE BASES Construction & Building Technology Engineering, Industrial Engineering, Civil LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: 236DB Times Cited: 22 Cited Reference Count: 80 Leung, Mei-yung Yu, Jingyu Liang, Qi Leung, Mei-yung/K-4075-2015 Leung, Mei-yung/0000-0003-4186-2347 Hong Kong Institute of Surveyors (Planning and Development Division) [NP022075-02] The work described in this paper was fully supported by a grant from the Hong Kong Institute of Surveyors (Planning and Development Division, Project No. NP022075-02). 22 3 56 ASCE-AMER SOC CIVIL ENGINEERS RESTON J CONSTR ENG M PY - 2013 SN - 0733-9364 SP - 11 ST - Improving Public Engagement in Construction Development Projects from a Stakeholder's Perspective T2 - Journal of Construction Engineering and Management TI - Improving Public Engagement in Construction Development Projects from a Stakeholder's Perspective UR - ://WOS:000325773100011 VL - 139 ID - 761796 ER - TY - JOUR AB - Aims Tranexamic acid (TXA) has been shown to reduce blood loss and transfusion requirements in patients undergoing orthopaedic surgery. There remains a lack of prospective evidence for the use of TXA in patients undergoing periacetabular osteotomy (PAO). The purpose of this study was to determine if intravenous (IV) TXA is effective in reducing calculated blood loss and transfusions after PAO. Methods This was a single-centre prospective double-blind placebo-controlled randomized trial of 81 patients aged 12 to 45 years undergoing elective PAO by a single surgeon. The intervention group in = 40) received two doses of IV TXA of a maximum 1 g in each dose; the control group (n = 41) received two doses of 50 ml 0.9% saline IV. The primary outcome was pert-operative calculated blood loss. Secondary outcomes included allogenic transfusions and six-week postoperative complications. Results There were no differences in demographics or intraoperative variables between study groups. The TXA group demonstrated lower mean calculated blood loss (1,265 ml, (SD 321) vs 1,515 ml, (SD 394); p = 0.002) and lower frequency of allogenic transfusion (10%/n = 4 vs 37%/n = 15; p = 0.008). Regression analyses associated TXA use with significant reductions in calculated blood loss (p < 0.001) and transfusion (p = 0.007) after adjusting for age, sex, body mass index, preoperative haemoglobin, cell-saver volume, intraoperative mean arterial blood pressure, and operating time. No patients suffered venous thromboembolic complications. Conclusion In this trial, IV TXA decreased postoperative calculated blood loss by 293 ml and reduced the frequency of allogenic transfusions by 73% (37% vs 10%) following PAO. TXA may be safe and effective for reducing blood loss in patients undergoing PAO. AD - [Levack, A. E.; McLawhorn, A. S.; Dodwell, E.; DelPizzo, K.; Nguyen, J.; Sink, E.] Hosp Special Surg, 535 E 70th St, New York, NY 10021 USA. Levack, AE (corresponding author), Hosp Special Surg, 535 E 70th St, New York, NY 10021 USA. Alevack@gmail.com AN - WOS:000564463400008 AU - Levack, A. E. AU - McLawhorn, A. S. AU - Dodwell, E. AU - DelPizzo, K. AU - Nguyen, J. AU - Sink, E. DA - Sep DO - 10.1302/0301-620x.102b9.bjj-2019-1777.r1 J2 - Bone Joint J. KW - TOTAL HIP SURGERY RISK Orthopedics Surgery LA - English M1 - 9 M3 - Article N1 - ISI Document Delivery No.: NH1UZ Times Cited: 0 Cited Reference Count: 33 Levack, A. E. McLawhorn, A. S. Dodwell, E. DelPizzo, K. Nguyen, J. Sink, E. Orthopaedic Research and Education Fund [15 to 007]; National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Arthritis & Musculoskeletal & Skin Diseases (NIAMS) [T32 AR007281] This publication was supported by the Orthopaedic Research and Education Fund under award number 15 to 007 and the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH) under award number T32 AR007281. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. 0 BRITISH EDITORIAL SOC BONE & JOINT SURGERY LONDON BONE JOINT J PY - 2020 SN - 2049-4394 SP - 1151-1157 ST - Intravenous tranexamic acid reduces blood loss and transfusion requirements after periacetabular osteotomy A PLACEBO-CONTROLLED, DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL T2 - Bone & Joint Journal TI - Intravenous tranexamic acid reduces blood loss and transfusion requirements after periacetabular osteotomy A PLACEBO-CONTROLLED, DOUBLE-BLIND RANDOMIZED CLINICAL TRIAL UR - ://WOS:000564463400008 VL - 102B ID - 761414 ER - TY - JOUR AB - Proliferative sickle cell retinopathy (PSCR) is the most frequent vision-threatening complication of sickle cell disease (SCD). We investigated the relationship between the severity of sickle cell retinopathy in heterozygous (SC) or homozygous (SS) adult SCD patients and the clinical and laboratory data obtained during visits to a national SCD referral center. This retrospective longitudinal analysis included 942 SCD patients (313 patients with SC and 629 with SS disease) with ophthalmologic evaluations who were followed over a 19-year period by a multidisciplinary team in a referral center. PSCR was graded using the Goldberg classification. We identified patient and SCD characteristics associated with sickle cell retinopathy severity using multinomial logistic-regression models. Multivariate analysis associated severe PSCR forms (stages III-V) with older age (p = 0.032), pulmonary involvement (documented pulmonary hypertension with pulmonary arterial pressure >= 40 mm Hg, restrictive syndrome >20%, or previous history of pulmonary embolism diagnosed by vascular imaging) (p = 0.029), deafness or tinnitus (p = 0.026), and no history of osteomyelitis (p = 0.013) for SC patients; and with older age (p < 0.001), male sex (p = 0.003), and acute pyelonephritis (p = 0.04) for SS patients. The model of severe PSCR versus no PSCR showed good calibration and discrimination for SC and SS patients. Awareness of the clinical and laboratory factors significantly associated with severe PSCR in patients with SC or SS SCD may contribute to improved preventive strategies. (Medicine 2011;90: 372-378) AD - [Leveziel, Nicolas; Lalloum, Franck; Querques, Giuseppe; Binaghi, Michel; Coscas, Gabriel; Soubrane, Gisele; Souied, Eric H.] UPEC, Fac Med Henri Mondor, Dept Ophthalmol, Creteil, France. [Bastuji-Garin, Sylvie] Hop Henri Mondor, AP HP, Dept Clin Res & Publ Hlth, F-94010 Creteil, France. [Bastuji-Garin, Sylvie] UPEC, EA4393, Lab Clin Invest, Creteil, France. [Benlian, Pascale] Univ Paris 06, Dept Biochem & Mol Biol, Fac Med Pierre & Marie Curie, Paris, France. [Bachir, Dora; Galacteros, Frederic] Hop Henri Mondor, AP HP, Natl Referral Ctr Adult Sickle Cell Dis, Red Cell Genet Dis Unit,UPEC, F-94010 Creteil, France. Leveziel, N (corresponding author), Hop Henri Mondor, Serv Ophtalmol, 51 Ave Marechal de Lattre de Tassigny, F-94010 Creteil, France. nicolas.leveziel@chicreteil.fr AN - WOS:000296724100002 AU - Leveziel, N. AU - Bastuji-Garin, S. AU - Lalloum, F. AU - Querques, G. AU - Benlian, P. AU - Binaghi, M. AU - Coscas, G. AU - Soubrane, G. AU - Bachir, D. AU - Galacteros, F. AU - Souied, E. H. DA - Nov DO - 10.1097/MD.0b013e3182364cba J2 - Medicine KW - FETAL HEMOGLOBIN NATURAL-HISTORY HYDROXYUREA MANIFESTATIONS HEMOLYSIS GENDER ANEMIA COHORT Medicine, General & Internal LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: 844CB Times Cited: 18 Cited Reference Count: 24 Leveziel, Nicolas Bastuji-Garin, Sylvie Lalloum, Franck Querques, Giuseppe Benlian, Pascale Binaghi, Michel Coscas, Gabriel Soubrane, Gisele Bachir, Dora Galacteros, Frederic Souied, Eric H. Bastuji-Garin, Sylvie/R-3479-2018; Benlian, Pascale/I-7964-2016 Bastuji-Garin, Sylvie/0000-0001-9855-5183; Querques, Giuseppe/0000-0002-3292-9581; Benlian, Pascale/0000-0002-3423-8979; Nicolas, Leveziel/0000-0001-8533-9457 19 0 1 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA MEDICINE Baltimore PY - 2011 SN - 0025-7974 SP - 372-378 ST - Clinical and Laboratory Factors Associated With the Severity of Proliferative Sickle Cell Retinopathy in Patients With Sickle Cell Hemoglobin C (SC) and Homozygous Sickle Cell (SS) Disease T2 - Medicine TI - Clinical and Laboratory Factors Associated With the Severity of Proliferative Sickle Cell Retinopathy in Patients With Sickle Cell Hemoglobin C (SC) and Homozygous Sickle Cell (SS) Disease UR - ://WOS:000296724100002 VL - 90 ID - 761842 ER - TY - JOUR AB - Proliferative sickle cell retinopathy (PSCR) is the most frequent vision-threatening complication of sickle cell disease (SCD). We investigated the relationship between the severity of sickle cell retinopathy in heterozygous (SC) or homozygous (SS) adult SCD patients and the clinical and laboratory data obtained during visits to a national SCD referral center. This retrospective longitudinal analysis included 942 SCD patients (313 patients with SC and 629 with SS disease) with ophthalmologic evaluations who were followed over a 19-year period by a multidisciplinary team in a referral center. PSCR was graded using the Goldberg classification. We identified patient and SCD characteristics associated with sickle cell retinopathy severity using multinomial logistic-regression models. Multivariate analysis associated severe PSCR forms (stages III-V) with older age (p=0.032), pulmonary involvement (documented pulmonary hypertension with pulmonary arterial pressure≥40 mm Hg, restrictive syndrome>20%, or previous history of pulmonary embolism diagnosed by vascular imaging) (p=0.029), deafness or tinnitus (p=0.026), and no history of osteomyelitis (p=0.013) for SC patients; and with older age (p<0.001), male sex (p=0.003), and acute pyelonephritis (p=0.04) for SS patients. The model of severe PSCR versus no PSCR showed good calibration and discrimination for SC and SS patients. Awareness of the clinical and laboratory factors significantly associated with severe PSCR in patients with SC or SS SCD may contribute to improved preventive strategies. AD - Faculté de Médecine Henri-Mondor, Department of Ophthalmology, Université Paris Est Créteil (UPEC), and AP-HP, Hôpital Henri-Mondor, Department of Clinical Research and Public Health, Créteil, France. nicolas.leveziel@chicreteil.fr AN - 22033449 AU - Leveziel, N. AU - Bastuji-Garin, S. AU - Lalloum, F. AU - Querques, G. AU - Benlian, P. AU - Binaghi, M. AU - Coscas, G. AU - Soubrane, G. AU - Bachir, D. AU - Galactéros, F. AU - Souied, E. H. DA - Nov DO - 10.1097/MD.0b013e3182364cba DP - NLM ET - 2011/10/29 J2 - Medicine KW - Adolescent Adult Aged Child Female Hemoglobin SC Disease/*complications Humans Logistic Models Longitudinal Studies Male Middle Aged Multivariate Analysis Retinal Diseases/*etiology Retrospective Studies Young Adult LA - eng M1 - 6 N1 - 1536-5964 Leveziel, Nicolas Bastuji-Garin, Sylvie Lalloum, Franck Querques, Giuseppe Benlian, Pascale Binaghi, Michel Coscas, Gabriel Soubrane, Gisèle Bachir, Dora Galactéros, Frédéric Souied, Eric H Journal Article United States Medicine (Baltimore). 2011 Nov;90(6):372-8. doi: 10.1097/MD.0b013e3182364cba. PY - 2011 SN - 0025-7974 SP - 372-8 ST - Clinical and laboratory factors associated with the severity of proliferative sickle cell retinopathy in patients with sickle cell hemoglobin C (SC) and homozygous sickle cell (SS) disease T2 - Medicine (Baltimore) TI - Clinical and laboratory factors associated with the severity of proliferative sickle cell retinopathy in patients with sickle cell hemoglobin C (SC) and homozygous sickle cell (SS) disease VL - 90 ID - 760495 ER - TY - JOUR AB - Objective: We sought to determine the effectiveness of mock rapid-response simulation scenarios in gynecologic oncology inpatient emergencies to improve team confidence, knowledge, and responsiveness to improve patient outcomes. Method: A prospective pre- and post-educational study was performed with 3 simulated scenarios of inpatient gynecologic oncologic emergencies: hypotension due to postoperative hemorrhage, pulmonary embolism, and neutropenic sepsis. Participants included multidisciplinary staff working on medical-surgical gynecologic oncology inpatient wards in a large northern Virginia hospital system. A moulaged manikin with high-fidelity vital signs was used for mock rapid-response in situ simulations. Participant data were statistically compared for pre- and post-curriculum differences including knowledge test, confidence survey, and team performance assessments based on validated checklists. Clinical impacts were measured through hospital patient safety data before and after the curriculum was initiated. Results: Seventeen multidisciplinary participants participated in 4 mock rapid-response events over 3 months. In each scenario, statistically significant improvement was found in knowledge, confidence, and team performance (Table 1). The most significant team improvements were seen with the sepsis scenario. During the study period hospital-wide patient safety data demonstrated a reduction in both intensive care unit (ICU) stays and mortality rates for sepsis. Course evaluations were overwhelmingly positive, and team members thought the mock codes were very valuable. Conclusion: Simulation is an effective method for preparing multidisciplinary teams to respond to gynecologic oncology inpatient emergencies. This is an ongoing study, and initial results indicate that mock codes may result in earlier recognition and management of inpatient gynecologic oncology emergencies resulting in reduced morbidity and mortality. [Figure presented] AD - C. Lewis, Inova Fairfax Hospital, Falls Church, VA, United States AU - Lewis, C. AU - Archer, V. AU - Proctor, C. AU - Marko, E. DB - Embase DO - 10.1016/j.ygyno.2019.04.671 KW - adult checklist clinical article conference abstract controlled study curriculum drug safety female gynecology hospital patient hospital planning human hypotension intensive care unit lung embolism manikin morbidity mortality rate multidisciplinary team oncology patient safety postoperative hemorrhage prospective study sepsis simulation staff surgery vital sign LA - English M3 - Conference Abstract N1 - L2002078436 2019-07-10 PY - 2019 SN - 1095-6859 0090-8258 SP - 285 ST - Gynecology oncology inpatient emergency simulations to improve patient outcomes T2 - Gynecologic Oncology TI - Gynecology oncology inpatient emergency simulations to improve patient outcomes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002078436&from=export http://dx.doi.org/10.1016/j.ygyno.2019.04.671 VL - 154 ID - 760701 ER - TY - JOUR AB - An exclusive right thoracic approach for esophagus surgery is rarely used, with few reports of its use in China. We retrospectively reviewed the data of 21 esophageal cancer patients from January 2010 to January 2015. Their age ranged from 74-83years (average 76.6). All of the patients had lower pulmonary function. After multidisciplinary team discussion, sufficient preoperative preparation, and assessment of cardiopulmonary reserve, an exclusive right thoracic approach for esophageal cancer resection was performed. The esophagus was dissected in the right chest and the stomach was separated through the esophageal hiatus. The tube stomach and the esophageal remnant were anastomosed with a stapling device at the top of the right side of the thoracic cavity. All operations were successfully completed; however, there were two early postoperative deaths resulting from pulmonary infection and pulmonary artery embolism. The one-year postoperative survival rate was 66.7%. An exclusive right thoracic approach could be selectively used for elderly patients with poor pulmonary function. AD - [Li, Chuan; Ge, Nan; Shen, Yi; Jiao, Wenjie] Qingdao Univ, Dept Thorac Surg, Affiliat Hosp, 16 Jiangsu Rd, Qingdao 266003, Shandong, Peoples R China. Jiao, WJ (corresponding author), Qingdao Univ, Dept Thorac Surg, Affiliat Hosp, 16 Jiangsu Rd, Qingdao 266003, Shandong, Peoples R China. jiaowenjie@163.com AN - WOS:000409189100025 AU - Li, C. AU - Ge, N. AU - Shen, Y. AU - Jiao, W. J. DA - Sep DO - 10.1111/1759-7714.12459 J2 - Thorac. Cancer KW - Esophagus right thoracic approach surgery Oncology Respiratory System LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: FF7IG Times Cited: 0 Cited Reference Count: 7 Li, Chuan Ge, Nan Shen, Yi Jiao, Wenjie 0 1 WILEY HOBOKEN THORAC CANCER PY - 2017 SN - 1759-7706 SP - 543-545 ST - Exclusive right thoracic approach for esophagus surgery T2 - Thoracic Cancer TI - Exclusive right thoracic approach for esophagus surgery UR - ://WOS:000409189100025 VL - 8 ID - 761638 ER - TY - JOUR AB - Objective. Most patients of acute ischemic stroke (AIS) receive treatments in the department of emergency in China. We aimed to examine the status of AIS diagnosis and treatment and the impact of green pathway operation in different regions of China. Methods. In this nationwide survey, information regarding the emergency care of AIS was collected from 451 hospitals in different regions of China, by interviewing 484 physicians from these hospitals. Structured questionnaire was used to explore the status of AIS care and impact of the green pathway. Results. 445 hospitals from 18 provinces, 4 municipalities, and 3 ethnic autonomous regions in China were included in the present study. Overall, the proportion of door-to-needle time (DNT) less than 60 min was 66.08% in the enrolled hospitals (n=298). Stratified by regions, the results suggested that hospitals located in East regions had shorter DNT time (P=0.036), and more proportion of rtPA (P<0.001) than those in West regions. Further analysis suggested that hospitals with a green channel were more likely to shorten DNT and improve the proportion of rtPA (P<0.01). Conclusion. Considerable regional differences were observed in terms of DNT time and thrombolysis rates in the departments of emergency in China. Further studies are required to confirm the regional differences in AIS care in China. AD - [Li, Jianguo; Liu, Jingming; Guo, Wei] Capital Med Univ, Beijing Tiantan Hosp, Emergency Dept, Beijing 100070, Peoples R China. [Ma, Yuefeng; He, Xiaojun] Zhejiang Univ, Hosp 2, Med Coll, Dept Chinese Journal Emergency Med, Hangzhou 310009, Zhejiang, Peoples R China. [Peng, Peng] Xinjiang Med Univ, Affiliated Hosp 1, Urumqi 830001, Peoples R China. Guo, W (corresponding author), Capital Med Univ, Beijing Tiantan Hosp, Emergency Dept, Beijing 100070, Peoples R China. guowei1010@163.com AN - WOS:000481829500001 AU - Li, J. G. AU - Liu, J. M. AU - Ma, Y. F. AU - Peng, P. AU - He, X. J. AU - Guo, W. C7 - 3747910 DA - Aug DO - 10.1155/2019/3747910 J2 - Emerg. Med. Int. KW - TISSUE-PLASMINOGEN ACTIVATOR THROMBOLYSIS GUIDELINES MANAGEMENT PERFORMANCE EFFICACY REGISTRY SAFETY TEAM TIME Emergency Medicine LA - English M3 - Article N1 - ISI Document Delivery No.: IS0HK Times Cited: 1 Cited Reference Count: 27 Li, Jianguo Liu, Jingming Ma, Yuefeng Peng, Peng He, Xiaojun Guo, Wei Stroke Group, Emergency Medicine Branch of the Chinese Medical Association This study was supported by the Stroke Group, Emergency Medicine Branch of the Chinese Medical Association: Peng Peng, Wei Guo, Hai Kang, Jun Zhang, Xincai Ji, Chao Lan, Yunxia Zhang, Zhenying Chen, Qiang Zan, Guangjun Meng, Yingjie Li, Xi He, Xuemei Zong, Jingyu Li, Yu Zhang, Weibo Gao, Qiang Zhao, Wenqiang Jiang, Yecheng Liu, Feng Li, Hongyu Zhao, Junyi Niu, Guiyun Li, Tao Xu, Yongsheng Han, Li Li, Min Deng, Wei Gu, Dongfeng Guo, Zhigang Yu, Guoping Wu, Jining Liu, Jianzhong Yang, Chongyang Zhang, Lida Zhi, Hongsheng Liu, Ning Ding, Bin Gu, Qinzhong Zhu, Wangxiang Jiang, and Yun Li. 1 0 HINDAWI LTD LONDON EMERG MED INT PY - 2019 SN - 2090-2840 SP - 7 ST - Imbalanced Regional Development of Acute Ischemic Stroke Care in Emergency Departments in China T2 - Emergency Medicine International TI - Imbalanced Regional Development of Acute Ischemic Stroke Care in Emergency Departments in China UR - ://WOS:000481829500001 VL - 2019 ID - 761502 ER - TY - JOUR AB - In this study, failure mode and effect analysis (FMEA), a proactive tool, was applied to reduce errors associated with the process which begins with assessment of patient and ends with treatment of complications. The aim of this study is to assess whether FMEA implementation will significantly reduce the incidence of catheter-related bloodstream infections (CRBSIs) in intensive care unit.The FMEA team was constructed. A team of 15 medical staff from different departments were recruited and trained. Their main responsibility was to analyze and score all possible processes of central venous catheterization failures. Failure modes with risk priority number (RPN) ≥100 (top 10 RPN scores) were deemed as high-priority-risks, meaning that they needed immediate corrective action. After modifications were put, the resulting RPN was compared with the previous one. A centralized nursing care system was designed.A total of 25 failure modes were identified. High-priority risks were "Unqualified medical device sterilization" (RPN, 337), "leukopenia, very low immunity" (RPN, 222), and "Poor hand hygiene Basic diseases" (RPN, 160). The corrective measures that we took allowed a decrease in the RPNs, especially for the high-priority risks. The maximum reduction was approximately 80%, as observed for the failure mode "Not creating the maximal barrier for patient." The averaged incidence of CRBSIs was reduced from 5.19% to 1.45%, with 3 months of 0 infection rate.The FMEA can effectively reduce incidence of CRBSIs, improve the security of central venous catheterization technology, decrease overall medical expenses, and improve nursing quality. AN - 29390515 AU - Li, X. AU - He, M. AU - Wang, H. C2 - Pmc5758217 DA - Dec DO - 10.1097/md.0000000000009339 DP - NLM ET - 2018/02/03 J2 - Medicine KW - Academic Medical Centers Bacteremia/diagnosis/*therapy Blood-Borne Pathogens/*isolation & purification Catheter-Related Infections/*diagnosis/*therapy Catheterization, Central Venous/*adverse effects/methods Critical Care/methods Cross Infection/microbiology/therapy Female Healthcare Failure Mode and Effect Analysis/*methods Humans Intensive Care Units Interdisciplinary Communication Male Patient Care Team/organization & administration Quality Improvement Treatment Outcome LA - eng M1 - 51 N1 - 1536-5964 Li, Xixi He, Mei Wang, Haiyan Journal Article Medicine (Baltimore). 2017 Dec;96(51):e9339. doi: 10.1097/MD.0000000000009339. PY - 2017 SN - 0025-7974 (Print) 0025-7974 SP - e9339 ST - Application of failure mode and effect analysis in managing catheter-related blood stream infection in intensive care unit T2 - Medicine (Baltimore) TI - Application of failure mode and effect analysis in managing catheter-related blood stream infection in intensive care unit VL - 96 ID - 760183 ER - TY - JOUR AB - The purpose of this study is to assess clinical efficacy and safety of sorafenib combined with transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) on patients with unresectable hepatocellular carcinoma (HCC). Efficacy and safety profiles of sorafenib in combination with TACE and RFA were evaluated based on retrospective data for thirty patients with unresectable HCC. Patients were treated with TACE initially when admitted to hospital, followed by RFA 3 days after TACE. All TACE and RFA were performed by the same team of doctors. Seven days after the first TACE, patients started taking continuous sorafenib 400 mg bid without breaks until unacceptable toxicities or disease progression. The response to treatment, overall survival (OS), time to progression (TTP), and adverse effects were evaluated. The disease control rate was 33.3 % by RECIST criteria. The median TTP was 15.3 months (95 % CI 4.8-23.5). The median OS was 28.8 months (95 % CI 12.8-39.6). At the time of data record, 13 patients (43.3 %) were dead. Median OS in patients with or without portal vein thrombosis was 12.3 months (95 % CI 7.6-14.5) and 30.2 months (95 % CI 24.2-34.5), respectively, P = 0.018. The most common adverse events related to sorafenib were hand-foot skin reaction (53.3 %) and diarrhea (33.3 %). The combination of sorafenib, TACE, and RFA proved both safe and effective in the treatment for unresectable hepatocellular carcinoma patients. AD - [Li, Yong; Zheng, You-Bing; Zhao, Wei; Liu, Bing; Hu, Bao-Shan; He, Xu; Huang, Jian-Wen; Lu, Li-Gong] Guangdong Gen Hosp, Guangdong Acad Med Sci, Dept Intervent Radiol, Ctr Canc, Guangzhou 510080, Guangdong, Peoples R China. Lu, LG (corresponding author), Guangdong Gen Hosp, Guangdong Acad Med Sci, Dept Intervent Radiol, Ctr Canc, 106 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, Peoples R China. luligong1969@163.com AN - WOS:000327858800033 AU - Li, Y. AU - Zheng, Y. B. AU - Zhao, W. AU - Liu, B. AU - Hu, B. S. AU - He, X. AU - Huang, J. W. AU - Lu, L. G. C7 - 730 DA - Dec DO - 10.1007/s12032-013-0730-5 J2 - Med. Oncol. KW - Hepatocellular carcinoma Transarterial chemoembolization Ablation Sorafenib Therapy TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION ENDOTHELIAL GROWTH-FACTOR RANDOMIZED-TRIALS ANGIOGENESIS EXPRESSION IMPROVES THERAPY Oncology LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: 264EC Times Cited: 11 Cited Reference Count: 23 Li, Yong Zheng, You-Bing Zhao, Wei Liu, Bing Hu, Bao-Shan He, Xu Huang, Jian-Wen Lu, Li-Gong Science and Technology Foundation of Guangdong Province, China [2011A030400009]; Natural Science Foundation of Guangdong Province, ChinaNational Natural Science Foundation of Guangdong Province [S2012010010569] Science and Technology Foundation of Guangdong Province, China (Grant No. 2011A030400009); Natural Science Foundation of Guangdong Province, China (Grant No. S2012010010569). 13 2 14 HUMANA PRESS INC TOTOWA MED ONCOL PY - 2013 SN - 1357-0560 SP - 6 ST - Sorafenib in combination with transarterial chemoembolization and radiofrequency ablation in the treatment for unresectable hepatocellular carcinoma T2 - Medical Oncology TI - Sorafenib in combination with transarterial chemoembolization and radiofrequency ablation in the treatment for unresectable hepatocellular carcinoma UR - ://WOS:000327858800033 VL - 30 ID - 761794 ER - TY - JOUR AB - Background: Unfractionated heparin (UFH), despite its limitations, has been used as the primary anticoagulant alternative during the percutaneous coronary intervention (PCI). Some studies indicated that intravenous enoxaparin could be an effective and safe option. Our team used enoxaparin alone at one time according to the guidelines (Class IIA) and found a little catheter thrombosis during PCI. We recommend a new anticoagulation strategy using enoxaparin in combination with UFH. Enoxaparin has a more predictable anticoagulant response with no need of repeatedly monitoring anticoagulation during PCI. This retrospective study aimed to evaluate the efficacy and safety of using enoxaparin in combination with UFH in PCI patients with complex coronary artery disease. Methods: Between January 2015 and April 2017, 600 PCI patients who received intravenous UFH at an initial dose of 3000 U plus intravenous enoxaparin at a dose of 0.75 mg/kg (observation group) and 600 PCI patients who received UFH at a dose of 100 U/kg (control group) were consecutively included in this retrospective study. The endpoints were postoperative 48-h thrombolysis in myocardial infarction (TIMI) bleeding and transfusion and 30-day and 1-year major adverse cardio-cerebrovascular events (MACCE). Results: Baseline clinical, angiographic, and procedural characteristics were similar between groups, except there was less stent implantation per patient in the observation group (2.13 vs. 2.25 in the control group, P = 0.002). TIMI bleeding (3.3% vs. 4.7%) showed no significant difference between the observation group and control group. During the 30-day follow-up, the rate of MACCE was 0.9% in the observation group and 1.5% in the control group. There was no significant difference in the rates of MACCE, death, myocardial infarction, target vessel revascularization, cerebrovascular event, and angina within 30 days and 1 year after PCI between groups as well as in the subgroup analysis of transfemoral approach. Conclusions: UFH with sequential enoxaparin has similar anticoagulant effect and safety as UFH in PCI of complex coronary artery disease. AD - [Li, Zhi-Zhong; Tao, Ying; Wang, Su; Yin, Cheng-Qian; Gao, Yu-Long; Cheng, Yu-Tong; Li, Zhao; Ma, Chang-Sheng] Capital Med Univ, Dept Cardiol, Beijing Anzhen Hosp, Beijing Inst Heart Lung & Blood Vessel Dis, Beijing 100029, Peoples R China. Ma, CS (corresponding author), Capital Med Univ, Dept Cardiol, Beijing Anzhen Hosp, Beijing Inst Heart Lung & Blood Vessel Dis, Beijing 100029, Peoples R China. chshma@vip.sina.com AN - WOS:000447840700004 AU - Li, Z. Z. AU - Tao, Y. AU - Wang, S. AU - Yin, C. Q. AU - Gao, Y. L. AU - Cheng, Y. T. AU - Li, Z. AU - Ma, C. S. C7 - Pmid 30334526 DA - Oct DO - 10.4103/0366-6999.243559 J2 - Chin. Med. J. KW - Complex Coronary Heart Disease Enoxaparin Percutaneous Coronary Intervention Unfractionated Heparin ASSOCIATION TASK-FORCE ELEVATION MYOCARDIAL-INFARCTION VON-WILLEBRAND-FACTOR AMERICAN-COLLEGE CARDIOVASCULAR ANGIOGRAPHY PRACTICE GUIDELINES REVASCULARIZATION MANAGEMENT OUTCOMES THERAPY Medicine, General & Internal LA - English M1 - 20 M3 - Article N1 - ISI Document Delivery No.: GX6BE Times Cited: 0 Cited Reference Count: 22 Li, Zhi-Zhong Tao, Ying Wang, Su Yin, Cheng-Qian Gao, Yu-Long Cheng, Yu-Tong Li, Zhao Ma, Chang-Sheng Capital Characteristic Clinic Project of Beijing [Z131107002213042] This work was supported by a grant from the Capital Characteristic Clinic Project of Beijing (No. Z131107002213042). 0 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CHINESE MED J-PEKING PY - 2018 SN - 0366-6999 SP - 2417-2423 ST - Unfractionated Heparin with Sequential Enoxaparin in Patients with Complex Coronary Artery Lesions during Percutaneous Coronary Intervention T2 - Chinese Medical Journal TI - Unfractionated Heparin with Sequential Enoxaparin in Patients with Complex Coronary Artery Lesions during Percutaneous Coronary Intervention UR - ://WOS:000447840700004 VL - 131 ID - 761563 ER - TY - JOUR AB - IO Progression vs Pseudoprogression: The patterns of response to treatment with immunotherapy differ from those with molecularly targeted agents or cytotoxic chemotherapy where responses can take appreciably longer to become apparent. In addition, a unique response pattern termed “pseudoprogression” may be encountered with immunotherapy with checkpoint inhibitors in which patients appear to have a transient worsening of disease, manifested either by progression of known lesions or the appearance of new lesions, before disease stabilizes or regresses. While pseudoprogression is rare in lung cancer with reported rates of < 5%, it is a worrying situation for both clinicians and patients on immunotherapy.1,2 It can be difficult to differentiate pseudo-progression from true disease progression, but close monitoring of the following clinical features may help identify pseudoprogression - Pseudoprogression is often asymptomatic, whereas true progression is more likely to be associated with clinical decline. - The patient's performance status remains stable or improves if it is pseudoprogression while the performance status may deteriorate in true disease progression - Systemic symptoms may or may not improve in pseudoprogression while systemic symptoms often worsen in disease progression - Symptoms of tumour enlargement may or may not be present in pseudoprogression whereas true progression may be associated with symptoms of tumour enlargement - There is an initial increase in baseline tumour burden followed by a response in pseudoprogression while there is an increase in baseline tumour burden in true progression. New lesions that appear in pseudoprogression remain stable and/or subsequently respond while in true progression, new lesions appear and increase in size. Biopsy may reveal evidence of immune cell infiltration in pseudoprogression3,4 and evidence of tumour growth in true progression. However, histological confirmation is not always possible. Smaller deposits of tumour may continue to grow or new lesions appear in the first few months of effective immunotherapy during this period of immune priming and appear as progressive disease on restaging scans. These areas of apparent pseudoprogression should be carefully followed to distinguish nonresponding patients with progressive disease from those with delayed response. Distinguishing treatment-induced imaging changes from progressive disease has important implications to avoid premature and inappropriate discontinuation of a treatment regimen. Radiation Fibrosis vs Recurrence: Stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiation therapy (SBRT), is a recommended treatment for stage 1 non–small-cell lung cancer (NSCLC) in patients who are medically inoperable or refuse surgery. Most patients treated for NSCLC with SABR develop post-treatment radiographic changes due to radiation-induced lung injury (RILI) which can occur in the acute phase (within six months) as radiation pneumonitis and in the late phase (after six months) as radiation fibrosis. With SABR, the incidence of acute- and late-onset RILI is high with acute benign computed tomography (CT) changes in 54-79% of patients and late changes in 80–100% of patients.5 Radiation pneumonitis may appear as ground-glass opacities, consolidation or both. The late phase of radiation fibrosis frequently appears as a well-defined area of volume loss with a linear scar or consolidation, parenchymal distortion and traction bronchiectasis that conforms to the treatment portals which may either stabilize or evolve up to 24 months. Shrinkage of the region of fibrotic consolidation or a more sharply defined demarcation between normal and irradiated lung parenchyma may occur as the process progresses. Such benign CT changes can mimic tumour recurrence, especially when they develop as mass-like patterns.6 Distinguishing radiological changes due to radiation-induced fibrosis after SABR and local tumor recurrence can be quite challenging.7 A systematic review by Huang et al.7 identified severa high-risk radiologic features on CT scan to discriminate between SABR-induced fibrosis and tumor recurrence. These include an enlarging mass-like lesion at the primary site, sequential enlarging opacity, enlarging opacity after 12 months, bulging margins, disappearance (loss) of linear margins, craniocaudal growth, disappearance (loss) of air bronchograms, ipsilateral pleural effusion, or lymph node enlargement. While some sources caution against the use of PET scans to differentiate between post-SBRT fibrosis and recurrence, others have postulated a SUVmax of > 5 can be a useful discriminator.a,b,d Due to a high number of false-positive findings on PET, patients suitable for salvage therapy should undergo a biopsy, whenever possible.8 The optimal follow-up schedule for patients treated with SABR for early stage NSCLC is unclear, although clinical practice guidelines of the European Society for Medical Oncology recommend CT imaging every 6 months for a period for at least 3 years in those patients suitable for salvage therapy.8The timing of local recurrence after SABR, as well as a persistent risk of second primary lung cancer with an annual rate of 2% to 5%, suggests that long-term radiological follow-up using CT scans is needed, especially in patients fit enough to undergo any radical treatment. Others recommend a post SABR follow-up strategy similar to that of postsurgical cases, i.e. all patients eligible for any type of salvage undergo 6 months follow-up CT scans for a period of 3 years post-SABR, followed by annual CT scans thereafter.9,10 With suspicion of progressive disease, recommendations include a multidisciplinary team discussion with consideration for biopsy and/or surgical or nonsurgical salvage therapy if safe and when further investigations are non-reassuring.10 References: 1. Fehrenbacher L, Spira A, Ballinger M, et al. Lancet. 2016; 387(10030):1837-1846. 2. Borghaei H, Paz-Ares L, Horn L, et al. N Engl J Med. 2015; 373(17): 1627–1639. 3. Wolchok JD, Hoos A, O’Day S, et al. Clin Cancer Res. 2009; 15(23):7412-7420. 4. Ribas A, Chmielowski B, Glaspy JA. Clin Cancer Res. 2009; 15(23):7116-7118. 5. Park KJ, Chung JY, Chun MS, Suh JH. Radiographics 2000; 20:83-98. 6. Linda A, Trovo M, Bradley JD. Eur J Radiol 2011; 79(1):147-154. 7. Huang K, Dahele M, Senan S, et al. Radiother Oncol 2012; 102(3):335- 342. 8. Postmus PE, Kerr KM, Oudkerk M, et al. Annals of Oncology 2017; 28 (Supplement 4):iv1–iv21 9. Verstegen NE, Lagerwaard FJ, Hashemi SM, et al. J Thorac Oncol 2015; 10(8):1195-1200. 10. Huang K, Palma DA, et al. J Thorac Oncol. 2015; 10:412-419. AU - Liam, C. DB - Embase DO - 10.1016/j.jtho.2018.08.166 KW - glass radical unclassified drug adult biopsy body weight bronchiectasis cancer patient cancer radiotherapy cancer recurrence cancer size cancer staging cancer surgery cell infiltration clinical feature clinician conference abstract disease exacerbation female fibrosis follow up histopathology horn human human tissue immunocompetent cell immunotherapy lung injury lymph node hyperplasia male maximum standardized uptake value monitoring multidisciplinary team non small cell lung cancer oncology pleura effusion positron emission tomography practice guideline radiation pneumonia radiotherapy relapse salvage therapy scar stereotactic body radiation therapy surgery systematic review traction therapy tumor growth tumor recurrence LA - English M1 - 10 M3 - Conference Abstract N1 - L2001207126 2018-10-30 PY - 2018 SN - 1556-1380 1556-0864 SP - S282 ST - What Are the Clinical Features of IO Progression/Pseudoprogression and Radiation Fibrosis vs Recurrence T2 - Journal of Thoracic Oncology TI - What Are the Clinical Features of IO Progression/Pseudoprogression and Radiation Fibrosis vs Recurrence UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001207126&from=export http://dx.doi.org/10.1016/j.jtho.2018.08.166 VL - 13 ID - 760794 ER - TY - JOUR AB - Objectives: The objective of this study was to compare the outcomes of patients undergoing ultrasound-accelerated thrombolysis (USAT) and standard catheter-directed thrombolysis (CDT) for the treatment of acute pulmonary embolism (PE). Methods: The records of all patients in our institution having undergone CDT or USAT for massive or submassive PE from 2009 to 2014 were retrospectively reviewed. Standard statistical methods were used to compare characteristics and to assess for longitudinal change in outcomes. Results: Sixty-three patients, 27 CDT and 36 USAT, were treated for massive (12.7%) or submassive (87.3%) PE. Of which, 96.8% were treated for bilateral PE. Baseline patient characteristics did not differ between the 2 treatment groups. There was no difference in total dose of lytic administered (CDT: 23.2 ± 13.7 mg; USAT: 27.5 ± 12.9 mg; P = .2). Two patients in the CDT and 1 in the USAT groups required conversion to surgical thrombectomy (CDT: 7.4%; USAT: 2.8%; P = .6). Rates of major and minor bleeding complications (CDT: 11.0%; USAT: 13.9%; P = .8) did not differ significantly between the CDT and USAT groups. Estimated survival at 90 days was 92% for CDT and 93% for USAT and 82% at 1 year for both groups (P = .8). All echocardiographic parameters improved significantly from baseline to 1-year follow-up, but quantitative improvement did not differ between groups. Conclusion: This study suggests no statistical differences in clinical and hemodynamic outcomes or procedural complication rates between USAT and standard CDT for the treatment of acute PE. Prospective studies are needed to further evaluate comparative and cost-effectiveness of different interventions for acute massive and submassive PE. AD - Division of Vascular Surgery, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA AN - 118104369. Language: English. Entry Date: 20160920. Revision Date: 20191120. Publication Type: Article AU - Liang, Nathan L. AU - Avgerinos, Efthymios D. AU - Marone, Luke K. AU - Singh, Michael J. AU - Makaroun, Michel S. AU - Chaer, Rabih A. DB - CINAHL DO - 10.1177/1538574416666228 DP - EBSCOhost KW - Pulmonary Embolism -- Therapy Treatment Outcomes -- Evaluation Ultrasonography -- Utilization Fibrinolytic Agents -- Administration and Dosage Catheters, Vascular -- Utilization Human Retrospective Design Record Review Electronic Health Records Descriptive Research Descriptive Statistics Venous Thrombosis Academic Medical Centers -- Pennsylvania Pennsylvania Male Female Adult Middle Age Aged Fisher's Exact Test Paired T-Tests Kruskal-Wallis Test Kaplan-Meier Estimator Wilcoxon Rank Sum Test Repeated Measures Survival Echocardiography Comparative Studies M1 - 6 N1 - research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. NLM UID: 101136421. PY - 2016 SN - 1538-5744 SP - 405-410 ST - Comparative Outcomes of Ultrasound-Assisted Thrombolysis and Standard Catheter-Directed Thrombolysis in the Treatment of Acute Pulmonary Embolism T2 - Vascular & Endovascular Surgery TI - Comparative Outcomes of Ultrasound-Assisted Thrombolysis and Standard Catheter-Directed Thrombolysis in the Treatment of Acute Pulmonary Embolism UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=118104369&site=ehost-live&scope=site VL - 50 ID - 761308 ER - TY - JOUR AU - Liang, Y. AU - Nie, S. P. AU - Wang, X. AU - Thomas, A. AU - Thompson, E. AU - Zhao, G. Q. AU - Han, J. AU - Wang, J. AU - Griffiths, M. J. D. DA - 2020/09/23 09/23 DB - Europe PubMed Central DO - 10.11909/j.issn.1671-5411.2020.08.005 M1 - 8 PY - 2020 SN - 1671-5411 SP - 510-518 ST - Role of Pulmonary Embolism Response Team in patients with intermediate- and high-risk pulmonary embolism: a concise review and preliminary experience from China T2 - J Geriatr Cardiol TI - Role of Pulmonary Embolism Response Team in patients with intermediate- and high-risk pulmonary embolism: a concise review and preliminary experience from China UR - http://europepmc.org/article/MED/32952526 VL - 17 ID - 761926 ER - TY - GEN AB -.... Many of the treatment options for PE involve clinicians from multiple disciplines. Pulmonary Embolism Response Teams (PERTs... AU - Liang, Ying AU - Nie, Shao-Ping AU - Wang, Xiao AU - Thomas, Ashley AU - Thompson, Elizabeth AU - Zhao, Guan-Qi AU - Han, Jing AU - Wang, Jing AU - Griffiths, Mark J. D. DA - 2020/01/01 DB - Federal Science Library - Canada KW - Pulmonary embolism Pulmonary Embolism Response Team Review Multidisciplinary PY - 2020 SN - 1671-5411 ST - Role of Pulmonary Embolism Response Team in patients with intermediate- and high-risk pulmonary embolism: a concise review and preliminary experience from China TI - Role of Pulmonary Embolism Response Team in patients with intermediate- and high-risk pulmonary embolism: a concise review and preliminary experience from China UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb9QwELZoJSouFU9RCpU50Fu2dhwnDmqRENoKhEBQdSVuKzsei4VsEiW7B_id_CDGjnelcOQYP-QkHo9n7G--IUSkM5b8oxNyyYvKSsa08ZtGWshU8bwwDHCHdcrHDS8WYv4t-_zVh8bsUGQeZDmBKs6a1fcAt4z_tQ_51mbO-42-yF6heYwmRXq-adv6qluHfvD7fGwYiIi08YcI1eaAHOD2uXPwR-WNxnPIt4PvxhOZcX5EXgW9UrLy4kdYl7N9HXqXKQsEoExODNQpvBJVu4rq9_o-OY6GJn07fsEDcgeah-ToU7xKf0T-3LQ10NbRy7Xuf775sq1RIHX_6_IiPMfi-dq09WpYT0tvRmAtTEtvQe_brRoaGVsH6o96qael6EOYygYSqhtLPVFy4pHttNuNTSEO95pqio66z_hBx-Ca0KXroQ5ZyHzTPUcz9SEyNCQCf0wW1_Pbd--TmOIh6ThHVeuczSB3QpaaK41igdaLsYZbWTFIIbccVKm4dE464DYVmSmyMuNlpXWViVQ8IYdN28BTQg33vpa2LNcoYIqV4KrCCcuEZgLAnZCXuxla4hLy9yK6gXY7LNHCCbfDSp2QYjJ1y26k_Fh6Eu5pDQpiIOOO8vbsv3uekntejkZQ4XNyuOm38ILcdUOdmMGdoZn_4eNZENK_kNAJmw VL - 17 ID - 761929 ER - TY - JOUR AB - History and clinical findings: A 76 year-old woman with 8-year history of diabetes mellitus and hypertension was admitted with gangrene of left great toe, 3rd, 4th and 5th toes. Twenty months ago, She started to receive hemodialysis due to end-stage renal disease. She did not have any history of reactive airway disease nor bradycardia that would contraindicate the use of topical beta-blocker. The X-ray of left lower limb and foot showed calcification of left superficial femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery, dorsal foot artery and digital artery, as well as osteolytic destruction at distal end of metatarsal bone, and lateral dislocation of the 4th and 5th toes. Color Doppler ultrasound of bilateral lower extremity arteries showed obvious calcification of bilateral superficial femoral arteries, thrombosis of left popliteal artery, severe stenosis of left anterior tibial artery, occlusion of left posterior tibial artery, right anterior tibial artery and posterior tibial artery. Computed tomographic angiography (CTA) of bilateral lower limb arteries revealed moderate stenosis of left superficial femoral artery, occlusion of left popliteal artery, left posterior tibial artery and dorsal pedal artery, occulusion of right posterior tibial artery, but right dorsal pedal artery was visible. Diagnosis, treatment and follow-up: Diagnosis of diabetic foot (left, grade 4) and diabetic lower extremity arterial occlusion (left, stage 4) was made. Based on multidisciplinary team (MDT) discussion, the patient was unable to undergo vascular bypass surgery, and left lower extermity amputation also was not suitable because of right atrial thrombosis. Therefore, conservative treatment was recommended. The specific scheme used clopidogrel for antiplatelet agglutination, Low Molecular Weight Heparin (Clexane) and warfarin for anticoagulation, lipo-alprostadil for vasodilation, as well as local debridement and ultrasonic debridement. The treatments were given for up to 9 weeks, but with no significant clinical response. So the patient was treated with vacuum-assisted closure and autologous platelet-rich gel therapy for the next 7 weeks, then applied with 1 drop of timolol maleate 0.5% ophthalmic solution per cm 2 wound area every other day for another 6 weeks, the wound rapidly healed and re-epithelialized basically. The follow-up for 5 weeks showed that the wound healed completely without any discomfort. No side effect was found. AU - Liang, Y. J. AU - Chen, D. W. AU - Wen, X. R. AU - Huang, B. AU - Gao, Y. AU - Ran, X. W. DB - Medline DO - 10.12182/20200460601 KW - aged amputation anticoagulation artery occlusion article blood vessel shunt bradycardia calcification case report clinical article color Doppler flowmetry computed tomographic angiography conservative treatment debridement destruction diabetic foot digital artery dislocation drug combination drug therapy end stage renal disease female follow up gangrene hallux heart right atrium hemodialysis human human cell hypertension metatarsal bone multidisciplinary team osteolysis popliteal artery respiratory tract disease side effect superficial femoral artery surgery thrombocyte agglutination thrombosis tibial artery topical drug administration vacuum assisted closure vasodilatation X ray clopidogrel enoxaparin eye drops lipoprostaglandin E1 timolol timolol maleate warfarin LA - Chinese M1 - 4 M3 - Article N1 - L632413645 2020-07-30 PY - 2020 SN - 1672-173X SP - 582-586 ST - Successful Treatment of Refractory Ischemic Diabetic Foot Ulcers by Combination Therapy of Autologous Platelet-rich Gel and Topical β Adrenergic Receptor Blocker: a Case Report T2 - Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition TI - Successful Treatment of Refractory Ischemic Diabetic Foot Ulcers by Combination Therapy of Autologous Platelet-rich Gel and Topical β Adrenergic Receptor Blocker: a Case Report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632413645&from=export http://dx.doi.org/10.12182/20200460601 VL - 51 ID - 760563 ER - TY - JOUR AB - The efficacy of thrombolytic therapy for acute ischemic stroke (AIS) decreases when the administration of tissue plasminogen activator (tPA) is delayed. Derived from Toyota Production System, lean production aims to create top-quality products with high-efficiency procedures, a concept that easily applies to emergency medicine. In this study, we aimed to determine whether applying lean principles to flow optimization could hasten the initiation of thrombolysis. A multidisciplinary team (Stroke Team) was organized to implement an ongoing, continuous loop of lean production that contained the following steps: decomposition, recognition, intervention, reengineering and assessment. The door-to-needle time (DNT) and the percentage of patients with DNT ≤ 60 min before and after the adoption of lean principles were used to evaluate the efficiency of our flow optimization. Thirteen patients with AIS in the pre-lean period and 43 patients with AIS in the lean period (23 in lean period I and 20 patients in lean period II) were consecutively enrolled in our study. After flow optimization, we reduced DNT from 90 to 47 min (p < 0.001(¤)). In addition, the percentage of patients treated ≤60 min after hospital arrival increased from 38.46 to 75.0 % (p = 0.015(¤)). Adjusted analysis of covariance confirmed a significant influence of optimization on delay of tPA administration (p < 0.001). The patients were more likely to have a good prognosis (mRS ≤ 2 at 90 days) after the flow optimization (30.77-75.00 %, p = 0.012(¤)). Our study may offer an effective approach for optimizing the thrombolytic flow in the management of AIS. AD - Departments of Shenzhen Second People's Hospital, Graduate School of Guangzhou Medical University, Shenzhen, Guangdong Province, China. Department of Neurology, Shenzhen Second People's Hospital, Sungang West Road, Shenzhen, 518000, Guangdong Province, China. Departments of Shenzhen Second People's Hospital, Graduate School of Guangzhou Medical University, Shenzhen, Guangdong Province, China. 18825212638@163.com. Department of Neurology, Shenzhen Second People's Hospital, Sungang West Road, Shenzhen, 518000, Guangdong Province, China. 18825212638@163.com. Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China. Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China. Department of Radiology, Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, China. AN - 27094731 AU - Liang, Z. AU - Ren, L. AU - Wang, T. AU - Hu, H. AU - Li, W. AU - Wang, Y. AU - Liu, D. AU - Lie, Y. DA - Dec DO - 10.1007/s13246-016-0442-1 DP - NLM ET - 2016/04/21 J2 - Australasian physical & engineering sciences in medicine KW - Aged Brain Ischemia/*complications/*therapy Female Humans Male Middle Aged Stroke/*complications/*therapy *Thrombolytic Therapy Time Factors Treatment Outcome *Acute ischemic stroke *Cardiovascular *Lean production *Optimization *Thrombolysis LA - eng M1 - 4 N1 - 1879-5447 Liang, Zhuoyuan Ren, Lijie Wang, Ting Hu, Huoyou Li, Weiping Wang, Yaping Liu, Dehong Lie, Yi Clinical Trial Journal Article Netherlands Australas Phys Eng Sci Med. 2016 Dec;39(4):987-996. doi: 10.1007/s13246-016-0442-1. Epub 2016 Apr 19. PY - 2016 SN - 0158-9938 SP - 987-996 ST - Effective management of patients with acute ischemic stroke based on lean production on thrombolytic flow optimization T2 - Australas Phys Eng Sci Med TI - Effective management of patients with acute ischemic stroke based on lean production on thrombolytic flow optimization VL - 39 ID - 760404 ER - TY - JOUR AB - The efficacy of thrombolytic therapy for acute ischemic stroke (AIS) decreases when the administration of tissue plasminogen activator (tPA) is delayed. Derived from Toyota Production System, lean production aims to create top-quality products with high-efficiency procedures, a concept that easily applies to emergency medicine. In this study, we aimed to determine whether applying lean principles to flow optimization could hasten the initiation of thrombolysis. A multidisciplinary team (Stroke Team) was organized to implement an ongoing, continuous loop of lean production that contained the following steps: decomposition, recognition, intervention, reengineering and assessment. The door-to-needle time (DNT) and the percentage of patients with DNT ae 60 min before and after the adoption of lean principles were used to evaluate the efficiency of our flow optimization. Thirteen patients with AIS in the pre-lean period and 43 patients with AIS in the lean period (23 in lean period I and 20 patients in lean period II) were consecutively enrolled in our study. After flow optimization, we reduced DNT from 90 to 47 min (p < 0.001(A)). In addition, the percentage of patients treated ae60 min after hospital arrival increased from 38.46 to 75.0 % (p = 0.015(A)). Adjusted analysis of covariance confirmed a significant influence of optimization on delay of tPA administration (p < 0.001). The patients were more likely to have a good prognosis (mRS ae 2 at 90 days) after the flow optimization (30.77-75.00 %, p = 0.012(A)). Our study may offer an effective approach for optimizing the thrombolytic flow in the management of AIS. AD - [Liang, Zhuoyuan; Ren, Lijie; Wang, Ting] Guangzhou Med Univ, Grad Sch, Dept Shenzhen Peoples Hosp 2, Shenzhen, Guangdong, Peoples R China. [Liang, Zhuoyuan; Ren, Lijie; Wang, Ting; Hu, Huoyou; Wang, Yaping] Shenzhen Second Peoples Hosp, Dept Neurol, Sungang West Rd, Shenzhen 518000, Guangdong, Peoples R China. [Li, Weiping] Shenzhen Second Peoples Hosp, Dept Neurosurg, Shenzhen Key Lab Neurosurg, Shenzhen, Guangdong, Peoples R China. [Liu, Dehong] Shenzhen Second Peoples Hosp, Dept Emergency, Shenzhen, Guangdong, Peoples R China. [Lie, Yi] Shenzhen Second Peoples Hosp, Dept Radiol, Shenzhen, Guangdong, Peoples R China. Ren, LJ (corresponding author), Guangzhou Med Univ, Grad Sch, Dept Shenzhen Peoples Hosp 2, Shenzhen, Guangdong, Peoples R China.; Ren, LJ (corresponding author), Shenzhen Second Peoples Hosp, Dept Neurol, Sungang West Rd, Shenzhen 518000, Guangdong, Peoples R China. 18825212638@163.com AN - WOS:000392323000022 AU - Liang, Z. Y. AU - Ren, L. J. AU - Wang, T. AU - Hu, H. Y. AU - Li, W. P. AU - Wang, Y. P. AU - Liu, D. H. AU - Lie, Y. DA - Dec DO - 10.1007/s13246-016-0442-1 J2 - Australas. Phys. Eng. Sci. Med. KW - Acute ischemic stroke Thrombolysis Optimization Lean production Cardiovascular TISSUE-PLASMINOGEN ACTIVATOR HEALTH-CARE EMERGENCY THERAPY IMPROVEMENT PRINCIPLES MINUTES DELAYS TIMES Engineering, Biomedical LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: EI2NA Times Cited: 7 Cited Reference Count: 48 Liang, Zhuoyuan Ren, Lijie Wang, Ting Hu, Huoyou Li, Weiping Wang, Yaping Liu, Dehong Lie, Yi Guangdong Province Science and Technology Project [2013B021800102]; Shenzhen Knowledge Innovation Program [20130322131035]; Shenzhen-based research project [JCYJ20140414170821262]; Technology development item of Shenzhen science and technology innovation committee [CXZZ20140610151856719, JCYJ20151030151431727]; Clinical Doctor-Basic Scientist Combination Foundation of Shenzhen Second People's Hospital This work was supported in part by Guangdong Province Science and Technology Project (2013B021800102), Shenzhen Knowledge Innovation Program (20130322131035) and Shenzhen-based research project (JCYJ20140414170821262), Technology development item of Shenzhen science and technology innovation committee (CXZZ20140610151856719, JCYJ20151030151431727) and Clinical Doctor-Basic Scientist Combination Foundation of Shenzhen Second People's Hospital. 11 0 12 SPRINGER DORDRECHT AUSTRALAS PHYS ENG S PY - 2016 SN - 0158-9938 SP - 987-996 ST - Effective management of patients with acute ischemic stroke based on lean production on thrombolytic flow optimization T2 - Australasian Physical & Engineering Sciences in Medicine TI - Effective management of patients with acute ischemic stroke based on lean production on thrombolytic flow optimization UR - ://WOS:000392323000022 VL - 39 ID - 761681 ER - TY - JOUR AB - Background: Few data are available on management of very elderly colon cancer patients, especially concerning the parameters of therapeutic decisions and the role of geriatricians. Methods: We retrospectively reviewed the charts of patients over 80 years of age who underwent surgery for a localised colon cancer in a French academic hospital. Results: A total of 176 patients underwent surgery (postoperative morbidity and mortality rates: 25% and 6.7%). Adjuvant chemotherapy was discussed at a multidisciplinary team meeting for 91% of stage III patients, but only 13.5% of them were treated. Twenty-five patients relapsed: 19 were discussed at the multidisciplinary meeting and 16 were treated (5 had a metastasectomy). Despite their increase with time, geriatric assessments were infrequent, 17% (33% after 2006), and had no impact on postoperative morbi-mortality. Median overall survival and recurrence-free survival were 65.3 months and 65.1 months, respectively. Age, emergency surgery, and Charlson comorbidity index were independent prognostic factors. Conclusion: Selected elderly colon cancer patients have significant access to surgery. However, postoperative morbi-mortality rates remain high and adjuvant chemotherapy rarely prescribed. Perioperative geriatric assessment, especially before surgery, should be routinely proposed to these patients to evaluate its impact on postoperative morbi-mortality and prescription of adjuvant treatment. © 2014 Editrice Gastroenterologica Italiana S.r.l. AD - A. Lièvre, Département d'Oncologie médicale, Institut Curie-Hopital René Huguenin, 35, rue Dailly, 92210 Saint-Cloud, France AU - Lièvre, A. AU - Laurent, V. AU - Cudennec, T. AU - Peschaud, F. AU - Malafosse, R. AU - Benoist, S. AU - Penna, C. AU - Lepère, C. AU - Vaillant, J. N. AU - Julié, C. AU - Teillet, L. AU - Nordlinger, B. AU - Rougier, P. AU - Mitry, E. DB - Embase Medline DO - 10.1016/j.dld.2014.05.005 KW - capecitabine fluorouracil folinic acid oxaliplatin abdominal infection aged anastomosis leakage article cancer adjuvant therapy cancer combination chemotherapy cancer recurrence cancer staging cancer surgery cancer survival cerebrovascular accident Charlson Comorbidity Index colon cancer colon surgery emergency surgery female gastrointestinal hemorrhage geriatric assessment groups by age heart arrhythmia heart failure human ileus infectious complication kidney failure lung embolism major clinical study male mental disease mesenteric ischemia metastasis resection morbidity overall survival patient care pneumonia postoperative complication postoperative period priority journal recurrence free survival respiratory failure retrospective study septicemia surgical mortality urinary tract infection very elderly LA - English M1 - 9 M3 - Article N1 - L53176818 2014-06-13 2014-09-06 PY - 2014 SN - 1878-3562 1590-8658 SP - 838-845 ST - Management of patients over 80 years of age treated with resection for localised colon cancer: Results from a French referral centre T2 - Digestive and Liver Disease TI - Management of patients over 80 years of age treated with resection for localised colon cancer: Results from a French referral centre UR - https://www.embase.com/search/results?subaction=viewrecord&id=L53176818&from=export http://dx.doi.org/10.1016/j.dld.2014.05.005 VL - 46 ID - 761138 ER - TY - JOUR AB - CONTEXT: The association of an adult tele-intensive care unit (ICU) intervention with hospital mortality, length of stay, best practice adherence, and preventable complications for an academic medical center has not been reported. OBJECTIVE: To quantify the association of a tele-ICU intervention with hospital mortality, length of stay, and complications that are preventable by adherence to best practices. DESIGN, SETTING, AND PATIENTS: Prospective stepped-wedge clinical practice study of 6290 adults admitted to any of 7 ICUs (3 medical, 3 surgical, and 1 mixed cardiovascular) on 2 campuses of an 834-bed academic medical center that was performed from April 26, 2005, through September 30, 2007. Electronically supported and monitored processes for best practice adherence, care plan creation, and clinician response times to alarms were evaluated. MAIN OUTCOME MEASURES: Case-mix and severity-adjusted hospital mortality. Other outcomes included hospital and ICU length of stay, best practice adherence, and complication rates. RESULTS: The hospital mortality rate was 13.6% (95% confidence interval [CI], 11.9%-15.4%) during the preintervention period compared with 11.8% (95% CI, 10.9%-12.8%) during the tele-ICU intervention period (adjusted odds ratio [OR], 0.40 [95% CI, 0.31-0.52]). The tele-ICU intervention period compared with the preintervention period was associated with higher rates of best clinical practice adherence for the prevention of deep vein thrombosis (99% vs 85%, respectively; OR, 15.4 [95% CI, 11.3-21.1]) and prevention of stress ulcers (96% vs 83%, respectively; OR, 4.57 [95% CI, 3.91-5.77], best practice adherence for cardiovascular protection (99% vs 80%, respectively; OR, 30.7 [95% CI, 19.3-49.2]), prevention of ventilator-associated pneumonia (52% vs 33%, respectively; OR, 2.20 [95% CI, 1.79-2.70]), lower rates of preventable complications (1.6% vs 13%, respectively, for ventilator-associated pneumonia [OR, 0.15; 95% CI, 0.09-0.23] and 0.6% vs 1.0%, respectively, for catheter-related bloodstream infection [OR, 0.50; 95% CI, 0.27-0.93]), and shorter hospital length of stay (9.8 vs 13.3 days, respectively; hazard ratio for discharge, 1.44 [95% CI, 1.33-1.56]). The results for medical, surgical, and cardiovascular ICUs were similar. CONCLUSION: In a single academic medical center study, implementation of a tele-ICU intervention was associated with reduced adjusted odds of mortality and reduced hospital length of stay, as well as with changes in best practice adherence and lower rates of preventable complications. AD - Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA. craig.lilly@umassmed.edu AN - 21576622 AU - Lilly, C. M. AU - Cody, S. AU - Zhao, H. AU - Landry, K. AU - Baker, S. P. AU - McIlwaine, J. AU - Chandler, M. W. AU - Irwin, R. S. DA - Jun 1 DO - 10.1001/jama.2011.697 DP - NLM ET - 2011/05/18 J2 - Jama KW - Academic Medical Centers Adult Aged Critical Illness/*mortality/therapy *Critical Pathways Diagnosis-Related Groups Female *Guideline Adherence Hospital Bed Capacity, 500 and over *Hospital Mortality Humans Iatrogenic Disease/prevention & control Intensive Care Units/*standards *Length of Stay Male Middle Aged Odds Ratio Outcome Assessment, Health Care Patient Care Team Pneumonia, Ventilator-Associated Pressure Ulcer/prevention & control Prospective Studies Severity of Illness Index *Telemedicine Venous Thrombosis/prevention & control LA - eng M1 - 21 N1 - 1538-3598 Lilly, Craig M Cody, Shawn Zhao, Huifang Landry, Karen Baker, Stephen P McIlwaine, John Chandler, M Willis Irwin, Richard S University of Massachusetts Memorial Critical Care Operations Group Evaluation Study Journal Article Research Support, Non-U.S. Gov't United States JAMA. 2011 Jun 1;305(21):2175-83. doi: 10.1001/jama.2011.697. Epub 2011 May 16. PY - 2011 SN - 0098-7484 SP - 2175-83 ST - Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes T2 - Jama TI - Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes VL - 305 ID - 760372 ER - TY - JOUR AB - The aim of the study was to analyze the results of the endovascular coilng and stenting as current methods for treatment of ruptured and non-ruptured intracranial aneurysms. For a period of 4 years, 132 patients - 55 (42%) male and 77 (58%) female, at average age of 50.7 years, were diagnosed with 189 intracranial aneurysms. One hundred and sixty endovascular interventions were performed, of which 127 coil embolisations, 22 stent placements and 11 reembolisations in previously embolised patients with angiographic data for recanalisation. For evaluation of the patient's condition at admission, the Hunt & Hess scale was applied. The Fisher scale was used to classify the subarachnoid hemorrhage based on the CT-scans. Total occlusion was achieved in 93 of the 127 coiled aneurysms in our series (73.2%). Subtotal occlusion of the aneurismal sack and neck was presented in the rest 34 aneurysms (26.7%) because of their geometric characteristics. In 13 of the 55 follow-up angiographies performed, significant recanalisation was identified, which led to 11 reembolisations. We report 10 complications in the series of 160 endovascular interventions (6.25%), namely: intrainterventional aneurysm rupture - 1 case (0.63%); transient vasospasm - 3 cases (1.9%); thromboembolic complications - 5 cases (3.1%); intrainterventional in-stent thrombosis, followed by recanalisation - 1 case (0.63%). Overall mortality in our series was 3.35% (5 patients), none of the deaths directly connected to the intervention, but as a result of the poor clinical condition of the patients upon admission. Because of its minimal invasiveness and lower complication rates, the endovascular technique is gaining ground as an alternative to the surgical clipping. Nevertheless the endovascular treatment represents only a component of the healing process of patients with ruptured/unruptured cerebral aneurysms that should be carried out by a multidisciplinary team. AD - M. Lilov, Department of Radiology, Military Medical Academy, 3, Georgi Sofiiski blvd., 1606 Sofia, Bulgaria AU - Lilov, M. AU - Juszkat, R. AU - Todorov, I. AU - Eftimov, T. AU - Petkov, A. DB - Embase KW - article artificial embolization brain artery aneurysm rupture computer assisted tomography endovascular surgery female follow up human intracranial aneurysm major clinical study male mortality recanalization stent subarachnoid hemorrhage surgical technique LA - Bulgarian M1 - 2 M3 - Article N1 - L364266321 2012-02-23 2012-02-28 PY - 2011 SN - 0486-400X SP - 131-137 ST - Endovascular treatment of intracranial aneurysms T2 - Rentgenologiya i Radiologiya TI - Endovascular treatment of intracranial aneurysms UR - https://www.embase.com/search/results?subaction=viewrecord&id=L364266321&from=export VL - 50 ID - 761216 ER - TY - JOUR AB - BACKGROUND: There is a wide variability in practice patterns on the use of inferior vena cava filters (IVCFs) among institutions, which is likely due to contrasting indication guidelines published by different professional societies. The aim of the present study is to report our healthcare system use of IVCF to: 1) determine practice patterns, 2) determine factors that may predict IVCF retrieval and 3) identify areas for improvement. METHODS: A retrospective review of 180 consecutive IVCF placement performed between July 2014 and December 2015 was conducted. RESULTS: One hundred nine (60.6%) IVCFs were placed for absolute indications, 27 (15.0%) for relative indications, 26 (14.4%) prophylactically and 18 (10.0%) for unknown indications. Average age was 59.3 years. Ninety-five had active cancer. Surgical and medical services requested filter placement in 112 (62.2%) and 68 (37.8%) patients, respectively. Thirteen (7.2%) patients had a hematology consult prior to IVCF placement. Documentation of the presence of an IVCF was present in 118/127 (92.9%) discharge summaries, and outlined instructions for filter retrieval post-discharge were present in 20/124 (16.1%) cases. Only 33 (25.0%) IVCF were retrieved at a median interval of 162 days (range: 4 - 1,053 days). None of the factors of interest was found to be significantly associated with IVCF retrieval. CONCLUSION: A root cause analysis identified that the lack of a structured system for IVCF tracking resulted in poor IVCF retrieval rates. This study resulted in the development of a hospital-initiated multidisciplinary team to address these issues. AD - Department of Medicine, Division of Hematology/Oncology, Medical University of South Carolina, Charleston, SC, USA. Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, SC, USA. AN - 30214647 AU - Lim, M. Y. AU - Yamada, R. AU - Guimaraes, M. AU - Greenberg, C. S. C2 - Pmc6134999 DA - Oct DO - 10.14740/jocmr3544w DP - NLM ET - 2018/09/15 J2 - Journal of clinical medicine research KW - Clinical practice guidelines High value care Quality improvement Thromboembolism LA - eng M1 - 10 N1 - 1918-3011 Lim, Ming Y Yamada, Ricardo Guimaraes, Marcelo Greenberg, Charles S Journal Article J Clin Med Res. 2018 Oct;10(10):758-764. doi: 10.14740/jocmr3544w. Epub 2018 Sep 10. PY - 2018 SN - 1918-3003 (Print) 1918-3003 SP - 758-764 ST - Practice Patterns of Inferior Vena Cava Filter Placement and Factors That Predict Retrieval Rates: A Single-Center Institution and Review of the Literature T2 - J Clin Med Res TI - Practice Patterns of Inferior Vena Cava Filter Placement and Factors That Predict Retrieval Rates: A Single-Center Institution and Review of the Literature VL - 10 ID - 760332 ER - TY - JOUR AB - Introduction: The origins of cardiovascular disease (CVD) begin in childhood. The primary objective of this cross-sectional cohort study was to determine the prevalence of cardiovascular risk factors in patients with congenital haemophilia A or B followed at Rady Children's Hospital San Diego Hemophilia and Thrombosis Treatment Center (HTC). We hypothesized that cardiovascular risk factors could be identified as part of a comprehensive clinic visit. Materials and Methods: Standardized measurement of weight, height, waist circumference and blood pressure plus non-fasting glucose and lipid panel were performed. Participants and/ or caregivers completed questionnaires about family history, medical history and lifestyle. Clinical data were abstracted from the medical record. Descriptive statistics, Student's t test, correlation, Mann-Whitney U test and chi-square test were performed to analyse the data. Results: Forty-three males (mean 12 years, range 5-20 years) enrolled. High rates of overweight and obesity, (pre) hypertension and abnormal lipids were identified. Subjects with normal weight had more days of > 60 minutes of physical activity compared with those with overweight or obesity (5.2 +/- 2.4 vs. 3.8 +/- 2.5 day; P = 0.07). Higher weight was correlated with higher factor consumption (cor = 0.88; P < 0.001). There was no difference in target joints based on weight category (30% in normal weight vs. 25% in overweight or obese, chi(2) = 0.11, P = 0.74), which may be attributed to high rates of prophylaxis. Conclusions: Modifiable risk factors for CVD were identified as part of the study during comprehensive clinic visits. The HTC team may develop behavioural interventions to target cardiovascular risk reduction as part of the comprehensive care model. AD - [Limjoco, Jacqueline; Thornburg, Courtney D.] Rady Childrens Hosp, San Diego, CA USA. [Thornburg, Courtney D.] Univ Calif San Diego, Rady Childrens Hosp San Diego, La Jolla, CA USA. Thornburg, CD (corresponding author), Univ Calif San Diego, Rady Childrens Hosp San Diego, 3020 Childrens Way,MC 5035, San Diego, CA 92123 USA. cthornburg@rchsd.org AN - WOS:000452418900023 AU - Limjoco, J. AU - Thornburg, C. D. DA - Sep DO - 10.1111/hae.13585 J2 - Haemophilia KW - cardiovascular disease haemophilia hypertension obesity overweight HIGH BLOOD-PRESSURE PUBLIC-HEALTH UNITED-STATES OBESITY PREVALENCE HYPERTENSION PREVENTION MALES OVERWEIGHT CHILDHOOD Hematology LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: HD3LU Times Cited: 2 Cited Reference Count: 38 Limjoco, Jacqueline Thornburg, Courtney D. National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [UL1TR001442]; UC San Diego Academic Senate National Institutes of Health, Grant/Award Number: UL1TR001442; UC San Diego Academic Senate 2 0 1 WILEY HOBOKEN HAEMOPHILIA PY - 2018 SN - 1351-8216 SP - 747-754 ST - Risk factors for cardiovascular disease in children and young adults with haemophilia T2 - Haemophilia TI - Risk factors for cardiovascular disease in children and young adults with haemophilia UR - ://WOS:000452418900023 VL - 24 ID - 761571 ER - TY - JOUR AB - Background The relationship between chronic obstructive pulmonary disease (COPD) and perioperative outcomes remains incompletely understood. Our purpose is to evaluate the features of postoperative adverse outcomes for geriatric surgical patients with COPD receiving non-thoracic surgeries. Aim To evaluate the potential impact of COPD history on the outcome after general surgery. Design A retrospective cohort study with matching procedure by propensity score. Methods We conducted a nationwide study of 15 359 COPD patients aged 65 years and older who received major non-thoracic surgeries in 2008-2013 from the Taiwan National Health Insurance Research Database. Comprehensive matching procedure with propensity score were used to select 15 359 surgical patients without COPD for comparison. Major postoperative complications and 30-day in-hospital mortality were evaluated among patients with and without COPD by calculating adjusted odds ratios (ORs) and 95% CIs. Results Patients with COPD had significantly increased risk for postoperative complications, including pneumonia (OR = 90.3; 95% CI: 60.3-135), septicemia (OR = 3.11; 95% CI: 2.82-3.43), acute renal failure (OR = 2.53; 95% CI: 2.11-3.02), pulmonary embolism (OR = 2.74; 95% CI: 1.52-4.96), and 30-day postoperative mortality (adjusted OR = 2.09; 95% CI: 1.76-2.50), compared with surgical patients without COPD. Longer length of hospital stay and higher medical expenditures were also noted in COPD patients than those without COPD. Conclusions Geriatric patients with COPD showed significantly higher postoperative adverse outcome rates with risk of 30-day mortality nearly twofold when compared with patients without COPD. Our findings remind surgical care team pay more attention to this specific population. AD - [Lin, Chao-Shun; Chen, Chien-Yu; Chen, Ta-Liang; Liao, Chien-Chang] Taipei Med Univ Hosp, Dept Anesthesiol, 252 Wuxing St, Taipei 11031, Taiwan. [Lin, Chao-Shun; Chen, Chien-Yu; Chen, Ta-Liang; Liao, Chien-Chang] Taipei Med Univ Hosp, Anesthesiol & Hlth Policy Res Ctr, Taipei, Taiwan. [Lin, Chao-Shun; Chen, Chien-Yu; Chen, Ta-Liang; Liao, Chien-Chang] Taipei Med Univ, Sch Med, Dept Anesthesiol, Coll Med, Taipei, Taiwan. [Yeh, Chun-Chieh] China Med Univ Hosp, Dept Surg, Taichung, Taiwan. [Yeh, Chun-Chieh] Univ Illinois, Dept Surg, Chicago, IL 60680 USA. [Chung, Chi-Li] Taipei Med Univ Hosp, Div Pulm Med, Dept Internal Med, Taipei, Taiwan. [Liao, Chien-Chang] China Med Univ, Sch Chinese Med, Coll Chinese Med, Taichung, Taiwan. [Liao, Chien-Chang] Taipei Med Univ, Shuan Ho Hosp, Dept Anesthesiol, New Taipei, Taiwan. Liao, CC (corresponding author), Taipei Med Univ Hosp, Dept Anesthesiol, 252 Wuxing St, Taipei 11031, Taiwan. jacky48863027@yahoo.com.tw AN - WOS:000462833300005 AU - Lin, C. S. AU - Chen, C. Y. AU - Yeh, C. C. AU - Chung, C. L. AU - Chen, T. L. AU - Liao, C. C. DA - Feb DO - 10.1093/qjmed/hcy240 J2 - QJM-An Int. J. Med. KW - C-REACTIVE PROTEIN ACUTE EXACERBATIONS SURGICAL-PATIENTS ADVERSE OUTCOMES GLOBAL BURDEN UNITED-STATES COPD STROKE IMPACT COMORBIDITIES Medicine, General & Internal LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: HR0QK Times Cited: 2 Cited Reference Count: 35 Lin, Chao-Shun Chen, Chien-Yu Yeh, Chun-Chieh Chung, Chi-Li Chen, Ta-Liang Liao, Chien-Chang Yeh, Chun Chieh/Y-3304-2019 Taiwan's Ministry of Science and Technology [MOST107-2221-E-038-009, MOST106-2314-B-038-036-MY3, MOST106-2221-E-038-003] Taiwan's Ministry of Science and Technology (MOST107-2221-E-038-009; MOST106-2314-B-038-036-MY3; MOST106-2221-E-038-003). 2 0 OXFORD UNIV PRESS OXFORD QJM-INT J MED PY - 2019 SN - 1460-2725 SP - 107-113 ST - Defining risk of general surgery in patients with chronic obstructive pulmonary diseases T2 - Qjm-an International Journal of Medicine TI - Defining risk of general surgery in patients with chronic obstructive pulmonary diseases UR - ://WOS:000462833300005 VL - 112 ID - 761537 ER - TY - JOUR AB - Introduction Acute pulmonary embolism (PE) is frequently misdiagnosed and is associated with morbidity and short- and long-term mortality. As therapeutic options continue to increase, appropriate patient selection is paramount to optimize outcomes. We implemented a PE response team (PERT) at our tertiary care hospital consisting of pulmonary and critical care attendings and fellows, interventional cardiology, interventional radiology, and cardiothoracic surgery. We describe our one-year experience with a PERT. Methods Retrospective chart review of all PERT consults from 7/1/16 to 7/1/17. All patients were included in the review. Clinical parameters, treatment, survival, and discharge anticoagulation were evaluated. Results 102 patients were included. PE was present in 86/102 (84.3%) of consults. Other reasons for consultation included RA/RV clot-in-transit (5%), DVT (4%), abnormal V/Q scan (3%), clot on catheter tip (1%), PE history (1%), and hypoxemia (1%). 74% of the patients had bilateral PE. The average PESI score and BNP were 106.35 + 47.61 and 531.63 + 725.75, respectively. 65/86 (75.5%) of PE patients had a sPESI > 0. The majority of the patients diagnosed with PE were classified as intermediate-risk. There were 43% intermediate-high risk patients and 16% intermediate-low risk. 9% of patients had massive (high-risk) PE and 33% were low-risk PE. Of the 8 patients classified as massive PE, all patients received intravenous (IV) tissue-type plasminogen activator (tPA). Doses of tPA ranged from 47 mg to 100 mg. One patient diagnosed with high intermediate-risk PE progressed to massive PE and received catheter-directed therapy with 15 mg of tPA, and then 50 mg of IV tPA. 15% of patients underwent ultrasound-assisted catheter-directed thrombolysis. Dose and duration of infusion varied depending on several parameters (dose range from 6 to 24 mg with duration 4 to 24 hours). 4% of patients underwent clot extraction without lysis. One patient was placed on veno-arterial extracorporeal membrane oxygenation (ECMO). 17% received a retrievable IVC filter. Survival to hospital discharge was 90.3%. Conclusion Our study describes our 1-year experience with a PERT. The primary reason for consultation was intermediate-risk PE. Survival to hospital discharge was > 90%. We believe that improving risk-stratification, careful assessment of new technology and the utilization of a multidisciplinary PERT can ultimately improve the management of acute PE. AD - B. Lindgren, Cedars-Sinai Medical Center, Los Angeles, CA, United States AU - Lindgren, B. AU - Weinberg, A. AU - Friedman, O. AU - Dohad, S. AU - Tapson, V. F. DB - Embase KW - endogenous compound tissue plasminogen activator adult anticoagulation artery blood clot lysis catheter conference abstract consultation diagnosis extracorporeal oxygenation extraction female filter high risk patient hospital discharge human hypoxemia infusion lung embolism major clinical study male medical record review patient selection retrospective study risk assessment seashore stratification ultrasound LA - English M1 - MeetingAbstracts M3 - Conference Abstract N1 - L622965360 2018-07-16 PY - 2018 SN - 1535-4970 ST - West coast PERT: A first year experience with a multidisciplinary pulmonary embolism response team T2 - American Journal of Respiratory and Critical Care Medicine TI - West coast PERT: A first year experience with a multidisciplinary pulmonary embolism response team UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622965360&from=export VL - 197 ID - 760868 ER - TY - JOUR AB - The risk of venous thrombosis and pulmonary embolism is increased during pregnancy and the postpartum period. There is no generally accepted algorithm for the diagnosis of pregnancy-associated venous thromboembolism (VTE). Diagnostic algorithms, including clinical prediction rules and d-dimer testing, have not been established for pregnant patients. Imaging studies therefore play a major role in confirming suspected VTE in pregnant women. However, concerns have been raised against radiologic imaging because of maternal and foetal radiation exposure. There is a paucity of studies addressing the diagnostic strategies and the risks and benefits of antithrombotic therapy during pregnancy. Therefore, management strategies for pregnancy-associated VTE have been deduced from observational studies and extrapolated from recommendations for nonpregnant patients. Weight-adjusted therapeuticdose low molecular weight heparin (LMWH) is the anticoagulant treatment of choice in cases of VTE during pregnancy. Once or twice daily dosing regimens are acceptable throughout pregnancy. Management of delivery mainly depends on the time interval between the diagnosis of VTE and the expected delivery date. In particular, if VTE manifests at term, delivery should be attended by an experienced multidisciplinary team. AD - B. Linnemann, Gefäßzentrum Ostbayern - Angiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, Regensburg, Germany AU - Linnemann, B. DB - Embase KW - low molecular weight heparin article human pregnancy puerperium radiodiagnosis venous thromboembolism LA - German M1 - 4 M3 - Article N1 - L623549689 2018-08-24 2018-08-30 PY - 2018 SN - 2198-1701 0341-8677 SP - 571-587 ST - Venous thromboembolism in pregnancy and postpartum T2 - Gynakologische Praxis TI - Venous thromboembolism in pregnancy and postpartum UR - https://www.embase.com/search/results?subaction=viewrecord&id=L623549689&from=export VL - 43 ID - 760877 ER - TY - JOUR AB - Venous thromboembolism (VTE) is a major cause of maternal morbidity during pregnancy and the postpartum period. However, because there is a lack of adequate study data, management strategies for pregnancy-associated VTE must be deduced from observational stu-dies and extrapolated from recommendations for non-pregnant patients. In this review, the members of the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) have summarised the evidence that is currently available in the literature to provide a practical approach for treating pregnancy-associated VTE. Because heparins do not cross the placenta, weight-adjusted therapeutic-dose low molecular weight heparin (LMWH) is the anticoagulant treatment of choice in cases of acute VTE during pregnancy. No differences between once and twice daily LMWH dosing regimens have been reported, but twice daily dosing seems to be advisable, at least peripartally. It remains unclear whether determining dose adjustments according to factor Xa activities during pregnancy provides any benefit. Management of delivery deserves attention and mainly depends on the time interval between the diagnosis of VTE and the expected delivery date. In particular, if VTE manifests at term, delivery should be attended by an experienced multidisciplinary team. In lactating women, an overlapping switch from LMWH to warfarin is possible. Anticoagulation should be continued for at least 6 weeks postpartum or for a minimum period of 3 months. Although recommendations are provided for the treatment of pregnancy-associated VTE, there is an urgent need for well-designed prospective studies that compare different management strategies and define the optimal duration and intensity of anticoagulant treatment. AD - 1 Medical Practice of Angiology and Haemostaseology, Praxis am Grüneburgweg, Frankfurt/Main, Germany. 2 Zentrum für Blutgerinnungsstörungen, MVZ Labor Dr. Reising-Ackermann und Kollegen, Leipzig, Germany. 3 Gerinnungszentrum Rhein Ruhr, Duisburg, Germany. 4 Centrum für Blutgerinnungsstörungen und Transfusionsmedizin, Düsseldorf, Germany. 5 Blutgerinnung Ulm, Germany. 6 Gynäkologische Endokrinologie und Fertilitätsstörungen, Ruprecht-Karls-Universität Heidelberg, Germany. 7 Klinikum Darmstadt, Klinik für Gefäßmedizin - Angiologie, Darmstadt, Germany. 8 Centrum für Thrombose und Hämostase, Johannes-Gutenberg-Universität, Mainz, Germany. AN - 27058796 AU - Linnemann, B. AU - Scholz, U. AU - Rott, H. AU - Halimeh, S. AU - Zotz, R. AU - Gerhardt, A. AU - Toth, B. AU - Bauersachs, R. DO - 10.1024/0301-1526/a000504 DP - NLM ET - 2016/04/09 J2 - VASA. Zeitschrift fur Gefasskrankheiten KW - Administration, Oral Anticoagulants/*administration & dosage/adverse effects Drug Administration Schedule Drug Monitoring Female Humans Pregnancy Pregnancy Complications, Cardiovascular/blood/diagnosis/*therapy Pulmonary Embolism/blood/diagnosis/*therapy Risk Assessment Risk Factors Treatment Outcome Venous Thromboembolism/blood/diagnosis/*therapy Venous Thrombosis/blood/diagnosis/*therapy Venous thromboembolism deep vein thrombosis low molecular weight heparin postpartum pulmonary embolism LA - eng M1 - 2 N1 - Linnemann, Birgit Scholz, Ute Rott, Hannelore Halimeh, Susan Zotz, Rainer Gerhardt, Andrea Toth, Bettina Bauersachs, Rupert Working Group in Women's Health of the Society of Thrombosis and Hemostasis Journal Article Practice Guideline Review Switzerland Vasa. 2016;45(2):103-18. doi: 10.1024/0301-1526/a000504. PY - 2016 SN - 0301-1526 (Print) 0301-1526 SP - 103-18 ST - Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) T2 - Vasa TI - Treatment of pregnancy-associated venous thromboembolism - position paper from the Working Group in Women's Health of the Society of Thrombosis and Haemostasis (GTH) VL - 45 ID - 760212 ER - TY - JOUR AB - BACKGROUND: Risk stratification of patients with pulmonary embolism (PE) is essential to guide advanced interventional management and proper disposition. OBJECTIVES: In this study, we sought to assess individual echocardiographic markers of right ventricular (RV) strain and left ventricular (LV) function in patients with high-risk PE and identify their association with the need for advanced intervention (such as thrombolysis) and 30-day mortality. METHODS: This was a retrospective study of ED patients with PE who were subject to a pulmonary embolism response team activation over a 5-year period. Cardiac point-of-care ultrasound studies were performed as part of patient care and later assessed for septal bowing, RV hypokinesis, McConnell sign, RV enlargement, tricuspid annular place systolic excursion, and LV systolic dysfunction. Outcome variables included need for advanced intervention and 30-day mortality. RESULTS: The pulmonary embolism response team was activated in 893 patients, of which 718 had a confirmed PE. Of these, 90 had adequate cardiac point-of-care ultrasound images available for review. Patients who needed an advanced intervention were more likely to have septal bowing (odds ratio [OR] 8.69, 95% confidence interval [CI] 2.37-31.86), RV enlargement (OR 4.02, 95% CI 1.43-11.34), and a McConnell sign (OR 2.79, 95% CI 1.09-7.13). LV dysfunction was the only statistically significant predictor of 30-day mortality (OR 9.63, 95% CI 1.74-53.32). CONCLUSION: In patients with PE in the ED, sonographic findings of RV strain that are more commonly associated with advanced intervention included septal bowing, McConnell sign, and RV enlargement. LV dysfunction was associated with a higher 30-day mortality. These findings can help inform decisions about ED management and disposition of patients with PE. AD - Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Massachusetts General Hospital, Boston, Massachusetts. Augusta University/University of Georgia Medical Partnership, University of Georgia, Athens, Georgia. Northeastern University, Boston, Massachusetts. AN - 33127261 AU - Liteplo, A. S. AU - Huang, C. K. AU - Zheng, H. AU - Patel, R. AU - Ratanski, D. AU - Giordano, N. J. AU - Kabrhel, C. AU - Shokoohi, H. DA - Oct 27 DO - 10.1016/j.jemermed.2020.09.041 DP - NLM ET - 2020/11/01 J2 - The Journal of emergency medicine KW - left ventricular function mortality point-of-care ultrasound pulmonary embolism right ventricular strain ultrasound LA - eng N1 - Liteplo, Andrew S Huang, Calvin K Zheng, Hui Patel, Ravish Ratanski, Daniel Giordano, Nicholas J Kabrhel, Christopher Shokoohi, Hamid Journal Article United States J Emerg Med. 2020 Oct 27:S0736-4679(20)30978-1. doi: 10.1016/j.jemermed.2020.09.041. PY - 2020 SN - 0736-4679 (Print) 0736-4679 ST - Left Ventricular Dysfunction Correlates With Mortality in Pulmonary Embolism T2 - J Emerg Med TI - Left Ventricular Dysfunction Correlates With Mortality in Pulmonary Embolism ID - 760470 ER - TY - JOUR AB - Background and Objectives: Risk stratification of patients with pulmonary embolism (PE) can guide advanced interventional management and proper disposition. The presence of right ventricular strain (RVS) on point-of-care ultrasound (POCUS) is known to portend a higher morbidity and mortality. However, there are various definitions of RVS. In this study, we sought to assess individual markers of RVS in patients with PE and identify the attributed impact of each echo finding associated with the need for advanced intervention (such as thrombolysis) and 30-day mortality Methods: This was a retrospective study of ED patients with PE who were subject to a Pulmonary Embolism Response Team (PERT) activation over a 5-year time period. POCUS studies were performed by emergency providers as part of patient care. Two physicians with ultrasound fellowship training reviewed all images and assessed for septal bowing, RV hypokinesis, McConnell sign, left ventricular (LV) systolic dysfunction, RV/LV ratio, and tricuspid annular plane systolic excursion (TAPSE). In cases of disagreement, a third physician adjudicated the findings. Outcome variables included: 1) need for advanced intervention and 2) mortality. P-values were calculated by ANOVA for numerical covariates and chi-square test or Fisher's exact test for categorical covariates as appropriate Results: The PERT was activated in 893 patients. Of these, 90 had a confirmed PE and adequate POCUS images available for review. Patients who needed an advanced intervention were more likely to have septal bowing (88% vs 47%, p <.01), McConnell sign (58% vs 33%, p=0.03), and an elevated RV/LV diameter ratio (1.17 vs 0.97, p <.01). We did not find a statistically significant difference in the rate of RV hypokinesis (65% vs 47%, p=.011) or abnormal TAPSE (14.6 mm vs 15.3 mm, p=.51). LV dysfunction was the only statistically significant predictor of 30-day mortality (33% vs 5%, p=.02) Conclusion: In ED patients with PE, sonographic findings of RVS that are more commonly associated with advanced intervention included septal bowing, McConnell sign, and an elevated RVD/LVD ratio. LV dysfunction was associated with a higher 30-day mortality. These findings can help inform decisions about ED management and disposition of patients with PE. AD - A.S. Liteplo, Massachusetts General Hospital AU - Liteplo, A. S. AU - Shokoohi, H. AU - Huang, C. K. AU - Zheng, H. AU - Patel, R. AU - Ratanski, D. AU - Giordano, N. AU - Kabrhel, C. DB - Embase DO - 10.1111/acem.13961 KW - adult adverse outcome analysis of variance blood clot lysis conference abstract controlled study female heart right ventricle human hypokinesia left ventricular systolic dysfunction major clinical study male mortality outcome assessment outcome variable physician point of care ultrasound pulmonary embolism response team retrospective study tricuspid annular plane systolic excursion LA - English M3 - Conference Abstract N1 - L632417857 2020-07-30 PY - 2020 SN - 1553-2712 SP - S238-S239 ST - Predicting adverse outcomes in patients with pulmonary embolism by utilizing point-of-care cardiac ultrasound T2 - Academic Emergency Medicine TI - Predicting adverse outcomes in patients with pulmonary embolism by utilizing point-of-care cardiac ultrasound UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632417857&from=export http://dx.doi.org/10.1111/acem.13961 VL - 27 ID - 760571 ER - TY - JOUR AB - Medical advances have increased survival of patients with congenital heart disease. However, cardiac disease in pregnancy carries significant maternal and fetal risks, posing enormous challenges to obstetricians. Cyanotic congenital heart disease is associated with maternal complications such as arrhythmias, thromboembolic events and death. Fetal complications include small for gestational age, miscarriage and prematurity. Cyanotic congenital heart disease patients who continue their pregnancies require holistic multidisciplinary team care with early and coordinated planning for delivery. Management of such patients include early counseling regarding pregnancy-associated risks, close monitoring of their cardiac function and regular scanning for fetal assessment. Choice of anesthesia for these patients requires meticulous planning to achieve a favorable balance between systemic and pulmonary vascular resistance, ensuring minimal change in right-to-left shunting. We report a case of a successfully managed pregnancy in a patient with complex congenital heart disease and a single ventricle of left ventricle morphology. AD - J.Y. Liu, Singapore General Hospital, 31 Third Hospital Avenue, #03-03 Bowyer, Block C, Singapore, Singapore AU - Liu, J. Y. AU - Tan, W. K. AU - Tan, E. L. AU - Tan, J. L. AU - Tan, L. K. C1 - aspirin DB - Embase DO - 10.1177/1753495X16678487 KW - acetylsalicylic acid corticosteroid enoxaparin hemoglobin adult anemia anesthesia article birth weight case report cavopulmonary connection cesarean section Chinese congestive heart failure cyanosis cyanotic heart disease dextrocardia Doppler ultrasonography dyspnea echocardiography female fetus growth fetus lung maturity fetus monitoring follow up general anesthesia gestational age heart function heart left ventricle heart right left shunt heart single ventricle high risk pregnancy human hyaline membrane disease hypoglycemia hypoxia low drug dose lung vascular resistance male medical history newborn newborn intensive care newborn sepsis oxygen saturation patient counseling percutaneous transluminal angioplasty placenta previa pneumonia pregnant woman prematurity prenatal care primigravida priority journal pulmonary artery stenosis systemic vascular resistance thorax radiography thrombosis tricuspid valve atresia unplanned pregnancy aspirin LA - English M1 - 2 M3 - Article N1 - L616906318 2017-06-28 2017-06-30 PY - 2017 SN - 1753-4968 1753-495X SP - 88-92 ST - A case of successfully managed pregnancy in a patient with complex cyanotic congenital heart disease T2 - Obstetric Medicine TI - A case of successfully managed pregnancy in a patient with complex cyanotic congenital heart disease UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616906318&from=export http://dx.doi.org/10.1177/1753495X16678487 VL - 10 ID - 760937 ER - TY - JOUR AB - Introduction: Emergency department (ED) patients with acute pulmonary embolism (PE) despite therapeutic anticoagulation at the time of diagnosis are uncommonly encountered and present a diagnostic and management challenge. Their characterization and outcomes are poorly described. We sought to describe the prevalence and characteristics of therapeutically anticoagulated patients among a population of patients with acute PE in a community setting and to describe treatment changes and 30-day outcomes. Methods: From a large retrospective cohort of adults with acute, objectively-confirmed PE across 21 EDs between 01/2013 and 04/2015, we identified patients who arrived on direct oral or injectable anticoagulants, or warfarin with an initial ED international normalized ratio (INR) value ≥2.0. Patients were excluded from the larger cohort if they had received a diagnosis of venous thromboembolism (VTE) in the prior 30 days. We gathered demographic and clinical variables from electronic health records and structured manual chart review. We report discharge anticoagulation regimens and major 30-day adverse outcomes. Results: Among 2,996 PE patients, 36 (1.2%) met study criteria. Mean age was 63 years. Eleven patients (31%) had active cancer and 25 (69%) were high risk on the PE Severity Index (Classes III-V), comparable to the larger cohort (p>0.1). Reasons for pre-arrival anticoagulation were VTE treatment or prevention (n=21), and atrial fibrillation or flutter (n=15). All patients arrived on warfarin and one was also on enoxaparin: 32 had a therapeutic INR (2.0-3.0) and four had a supratherapeutic INR (>3.0). Fifteen patients (42%) had at least one subtherapeutic INR (<2.0) in the 14 days preceding their diagnostic visit. Two patients died during hospitalization. Of the 34 ultimately discharged, 22 underwent a change in anticoagulation drug or dosing, 19 of whom received injectables, either to replace or to supplement warfarin. Four patients also received inferior vena cava filters. Thirty-day outcomes included one major hemorrhage and one additional death. No patients experienced recurrent or worsening VTE. Conclusion: We found a low prevalence of therapeutic anticoagulation at the time of acute PE diagnosis. Most patients with breakthrough PE underwent a change in therapy, though management varied widely. Subtherapeutic anticoagulation levels in the preceding weeks were common and support the importance of anticoagulation adherence. AD - Kaiser Permanente, Division of Research, Oakland, California. Kaiser Permanente, San Rafael Medical Center, Department of Emergency Medicine, San Rafael, California. Kaiser Permanente, Walnut Creek Medical Center, Department of Emergency Medicine, Walnut Creek, California. Kaiser Permanente, Sacramento Medical Center, Department of Emergency Medicine, Sacramento, California. AN - 129439089. Language: English. Entry Date: 20180510. Revision Date: 20190516. Publication Type: Article AU - Liu, Michelle Y. AU - Ballard, Dustin W. AU - Jie, Huang AU - Rauchwerger, Adina S. AU - Reed, Mary E. AU - Bouvet, Sean C. AU - Vinson, David R. DB - CINAHL DO - 10.5811/westjem.2018.1.35586 DP - EBSCOhost KW - Pulmonary Embolism -- Drug Therapy Emergency Patients Anticoagulants -- Therapeutic Use Treatment Outcomes Community Health Centers Retrospective Design Prospective Studies Human International Normalized Ratio Warfarin -- Therapeutic Use Venous Thromboembolism -- Diagnosis Electronic Health Records Record Review Middle Age Atrial Fibrillation Heparin, Low-Molecular-Weight Hemorrhage Death Vena Cava Filters Medication Compliance Venous Thromboembolism -- Drug Therapy M1 - 3 N1 - research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Double Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 101476450. PY - 2018 SN - 1936-900X SP - 510-516 ST - Acute Pulmonary Embolism in Emergency Department Patients Despite Therapeutic Anticoagulation T2 - Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health TI - Acute Pulmonary Embolism in Emergency Department Patients Despite Therapeutic Anticoagulation UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=129439089&site=ehost-live&scope=site VL - 19 ID - 761289 ER - TY - JOUR AB - BACKGROUND: Certain pregnant women suffer from cardiac pathology,and a few of them need cardiac operations under cardiopulmonary bypass during pregnancy. Feto-neonatal and maternal outcomes have not been sufficiently described. METHODS: We conducted a retrospective review of 22 cases of women undergoing cardiac operations under cardiopulmonary bypass during pregnancy in our hospital from Jan.2014 to Mar.2019. RESULTS: All 22 patients were alive after treatment. The types of cardiac disorders included congenital heart defects, rheumatic heart disease,infective endocarditis,aortic dissection, obstruction and/or thrombosis of a prosthetic valve. Only one case was a twin pregnancy,and the other 21 cases were singletons. Four fetuses died in the utero after surgery. Three patients chose termination of the pregnancy after the cardiac operations: one fetus was detected abnormity of the brain and the other two patients abandoned pregnancy. Fourteen fetuses were alive and born without any abnormity. Two fetuses suffered from neonatal intracranial hemorrhage and died after birth. CONCLUSIONS: Cardiac operation under cardiopulmonary bypass during pregnancy is a challenge for physicians in multidisciplinary teams. Strictly evaluating the indication is vital. On the other hand, some patients can benefit from this management. AD - Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd road, Guangzhou, 510080, Guangdong, China. Department of Obstetrics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd road, Guangzhou, 510080, Guangdong, China. 13725161315@163.com. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. zhuangjian5413@tom.com. Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. Department of Anesthesia, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China. AN - 32404125 AU - Liu, Y. AU - Han, F. AU - Zhuang, J. AU - Liu, X. AU - Chen, J. AU - Huang, H. AU - Wang, S. AU - Zhou, C. C2 - Pmc7218656 DA - May 13 DO - 10.1186/s13019-020-01136-9 DP - NLM ET - 2020/05/15 J2 - Journal of cardiothoracic surgery KW - Adult Cardiac Surgical Procedures/*methods/mortality *Cardiopulmonary Bypass/mortality Female Fetal Mortality Humans Infant Infant Mortality Infant, Newborn Pregnancy Pregnancy Complications, Cardiovascular/*surgery Retrospective Studies Treatment Outcome Young Adult Cardiac operation Cardiopulmonary bypass Outcome LA - eng M1 - 1 N1 - 1749-8090 Liu, Yanli Han, Fengzhen Orcid: 0000-0001-7378-2021 Zhuang, Jian Liu, Xiaoqing Chen, Jimei Huang, Huanlei Wang, Sheng Zhou, Chengbin No. 2014A050503048, 2017A070701013, 2017B090904034 and 2017B030314109, 2019B020230003/the Science and Technology Department of Guangdong Province/ [2018YFC1002600]/the Chinese National Key Research and Development Program/ No. DFJH201802/Guangdong Peak Project/ Journal Article J Cardiothorac Surg. 2020 May 13;15(1):92. doi: 10.1186/s13019-020-01136-9. PY - 2020 SN - 1749-8090 SP - 92 ST - Cardiac operation under cardiopulmonary bypass during pregnancy T2 - J Cardiothorac Surg TI - Cardiac operation under cardiopulmonary bypass during pregnancy VL - 15 ID - 760468 ER - TY - JOUR AB - Background Certain pregnant women suffer from cardiac pathology,and a few of them need cardiac operations under cardiopulmonary bypass during pregnancy. Feto-neonatal and maternal outcomes have not been sufficiently described. Methods We conducted a retrospective review of 22 cases of women undergoing cardiac operations under cardiopulmonary bypass during pregnancy in our hospital from Jan.2014 to Mar.2019. Results All 22 patients were alive after treatment. The types of cardiac disorders included congenital heart defects, rheumatic heart disease,infective endocarditis,aortic dissection, obstruction and/or thrombosis of a prosthetic valve. Only one case was a twin pregnancy,and the other 21 cases were singletons. Four fetuses died in the utero after surgery. Three patients chose termination of the pregnancy after the cardiac operations: one fetus was detected abnormity of the brain and the other two patients abandoned pregnancy. Fourteen fetuses were alive and born without any abnormity. Two fetuses suffered from neonatal intracranial hemorrhage and died after birth. Conclusions Cardiac operation under cardiopulmonary bypass during pregnancy is a challenge for physicians in multidisciplinary teams. Strictly evaluating the indication is vital. On the other hand, some patients can benefit from this management. AD - [Liu, Yanli; Han, Fengzhen] Guangdong Acad Med Sci, Guangdong Prov Peoples Hosp, Dept Obstet, 106 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, Peoples R China. [Zhuang, Jian; Chen, Jimei; Huang, Huanlei; Zhou, Chengbin] Guangdong Acad Med Sci, Guangdong Prov Peoples Hosp, Guangdong Prov Key Lab South China Struct Heart D, Dept Cardiovasc Surg,Guangdong Cardiovasc Inst, Guangzhou, Guangdong, Peoples R China. [Liu, Xiaoqing] Guangdong Acad Med Sci, Guangdong Prov Peoples Hosp, Guangdong Cardiovasc Inst,Dept Epidemiol, Guangdong Prov Key Lab South China Struct Heart D, Guangzhou, Guangdong, Peoples R China. [Wang, Sheng] Guangdong Acad Med Sci, Guangdong Prov Peoples Hosp, Dept Anesthesia, Guangzhou, Guangdong, Peoples R China. Han, FZ (corresponding author), Guangdong Acad Med Sci, Guangdong Prov Peoples Hosp, Dept Obstet, 106 Zhongshan 2nd Rd, Guangzhou 510080, Guangdong, Peoples R China.; Zhuang, J (corresponding author), Guangdong Acad Med Sci, Guangdong Prov Peoples Hosp, Guangdong Prov Key Lab South China Struct Heart D, Dept Cardiovasc Surg,Guangdong Cardiovasc Inst, Guangzhou, Guangdong, Peoples R China. 13725161315@163.com; zhuangjian5413@tom.com AN - WOS:000536279300001 AU - Liu, Y. L. AU - Han, F. Z. AU - Zhuang, J. AU - Liu, X. Q. AU - Chen, J. M. AU - Huang, H. L. AU - Wang, S. AU - Zhou, C. B. C7 - 92 DA - May DO - 10.1186/s13019-020-01136-9 J2 - J. Cardiothorac. Surg. KW - Cardiac operation Cardiopulmonary bypass Pregnancy Outcome SURGERY Cardiac & Cardiovascular Systems Surgery LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: LS3HR Times Cited: 0 Cited Reference Count: 11 Liu, Yanli Han, Fengzhen Zhuang, Jian Liu, Xiaoqing Chen, Jimei Huang, Huanlei Wang, Sheng Zhou, Chengbin Chinese National Key Research and Development Program [2018YFC1002600]; Science and Technology Department of Guangdong Province [2014A050503048,2017A070701013,2017B090904034, 2017B030314109,2019B3020230003]; Guangdong Peak Project [DFJH201802]; Guangdong Provincial Key Laboratory of South China Structural Heart Disease This work was supported by the Chinese National Key Research and Development Program [2018YFC1002600],the Science and Technology Department of Guangdong Province [No. 2014A050503048,2017A070701013,2017B090904034 and 2017B030314109,2019B3020230003], Guangdong Peak Project [No. DFJH201802] and Guangdong Provincial Key Laboratory of South China Structural Heart Disease. 0 BMC LONDON J CARDIOTHORAC SURG PY - 2020 SP - 6 ST - Cardiac operation under cardiopulmonary bypass during pregnancy T2 - Journal of Cardiothoracic Surgery TI - Cardiac operation under cardiopulmonary bypass during pregnancy UR - ://WOS:000536279300001 VL - 15 ID - 761444 ER - TY - JOUR AB - Introduction: The association between thrombocytopenia (TP) and gastrointestinal hemorrhage was not completely understood. The purpose of this study is to evaluate the risk of gastrointestinal hemorrhage and post-hemorrhage mortality in patients with TP. Methods: Using the Taiwan National Health Insurance Research Database, we identified 1033 adults aged >= 18 years diagnosed with TP in 2000-2003. Non-TP cohort consisted of 10,330 adults randomly selected and matched by age and sex from the same dataset. Incident events of gastrointestinal hemorrhage occurring after TP from January 1, 2000, through December 31, 2008, were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of gastrointestinal hemorrhage associated with TP were calculated. Another nested cohort study consisted of 27,369 patients with hospitalization due to gastrointestinal hemorrhage between January 1, 2004, and December 31, 2010. We calculated the adjusted odds ratios (ORs) and 95% CIs of 30-day mortality after gastrointestinal hemorrhage in patients with and without TP during admission. Results: The incidences of gastrointestinal hemorrhage for people with and without TP were 14.5 and 5.07 per 1000 person-years, respectively (P < 0.0001). Compared to people without TP, patients with TP had increased risk of gastrointestinal hemorrhage (HR, 2.61; 95% CI, 2.05-3.32). In the nested cohort study, TP was associated with post-hemorrhage mortality (OR, 1.98; 95% CI, 1.09-3.59). Conclusion: Patients with TP showed higher risks of gastrointestinal hemorrhage and post-hemorrhage mortality. Our findings suggest the urgency of preventing and managing gastrointestinal hemorrhage by a multidisciplinary medical team for this specific population. (C) 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. AD - [Lo, Po-Han; Huang, Yu-Feng; Cherng, Yih-Giun] Taipei Med Univ, Shuang Ho Hosp, Dept Anesthesiol, New Taipei City, Taiwan. [Chang, Chuen-Chau; Cherng, Yih-Giun; Chen, Ta-Liang; Liao, Chien-Chang] Taipei Med Univ, Sch Med, Taipei, Taiwan. [Chang, Chuen-Chau; Chen, Ta-Liang; Liao, Chien-Chang] Taipei Med Univ Hosp, Dept Anesthesiol, 252 Wuxing St, Taipei 110, Taiwan. [Chang, Chuen-Chau; Chen, Ta-Liang; Liao, Chien-Chang] Taipei Med Univ Hosp, Ctr Hlth Policy Res, Taipei, Taiwan. [Yeh, Chun-Chieh] China Med Univ Hosp, Dept Surg, Taipei, Taiwan. [Yeh, Chun-Chieh] Univ IL, Dept Surg, Chicago, IL USA. [Chang, Chia-Yau] Taipei Med Univ Hosp, Dept Pediat, Div Pediat Hematol & Oncol, Taipei, Taiwan. [Liao, Chien-Chang] China Med Univ, Sch Chinese Med, Taichung, Taiwan. Liao, CC (corresponding author), Taipei Med Univ Hosp, Dept Anesthesiol, 252 Wuxing St, Taipei 110, Taiwan. ccliao@tmu.edu.tw AN - WOS:000370184800022 AU - Lo, P. H. AU - Huang, Y. F. AU - Chang, C. C. AU - Yeh, C. C. AU - Chang, C. Y. AU - Cherng, Y. G. AU - Chen, T. L. AU - Liao, C. C. DA - Jan DO - 10.1016/j.ejim.2015.10.007 J2 - Eur. J. Intern. Med. KW - Cohort study Gastrointestinal hemorrhage Mortality Risk Thrombocytopenia HELICOBACTER-PYLORI MANAGEMENT PURPURA EPIDEMIOLOGY PREVALENCE VARICES Medicine, General & Internal LA - English M3 - Article N1 - ISI Document Delivery No.: DD8NW Times Cited: 3 Cited Reference Count: 36 Lo, Po-Han Huang, Yu-Feng Chang, Chuen-Chau Yeh, Chun-Chieh Chang, Chia-Yau Cherng, Yih-Giun Chen, Ta-Liang Liao, Chien-Chang Yeh, Chun Chieh/I-4893-2019 Yeh, Chun Chieh/0000-0001-6753-7564; Cherng, Yih-Giun/0000-0002-0201-4380 Shuang Ho Hospital, Taipei Medical University [104TMU-SHH-23]; Taiwan Ministry of Science and Technology [NSC102-2314-B-038-021-MY3, MOST104-2314-B-038-027-MY2] This study was supported by grants from Shuang Ho Hospital, Taipei Medical University (104TMU-SHH-23) and Taiwan Ministry of Science and Technology (NSC102-2314-B-038-021-MY3; MOST104-2314-B-038-027-MY2). 3 0 ELSEVIER AMSTERDAM EUR J INTERN MED PY - 2016 SN - 0953-6205 SP - 86-90 ST - Risk and mortality of gastrointestinal hemorrhage in patients with thrombocytopenia: Two nationwide retrospective cohort studies T2 - European Journal of Internal Medicine TI - Risk and mortality of gastrointestinal hemorrhage in patients with thrombocytopenia: Two nationwide retrospective cohort studies UR - ://WOS:000370184800022 VL - 27 ID - 761727 ER - TY - JOUR AB - AIMS OF THE STUDY: In our hospital, a previous attempt to introduce peripherally inserted central catheters (PICC) was aborted after a nonsystematic approach, seemingly accompanied by high rates of complications. The goal of this new interdisciplinary project was to introduce PICCs in an academic hospital, with an embedded interdisciplinary surveillance programme for both infectious and noninfectious outcomes. METHODS: We prospectively collected data for this surveillance study from all patients who underwent PICC insertion from 1 January 2014 and had the catheter removed by 31 December 2015 in our 950-bed academic hospital (Bern University Hospital, Switzerland). Infectious complications were defined according to Centers for Disease Control and Prevention / National Healthcare Safety Network criteria. PICCs were restricted to cancer and infectious disease patients, and were followed up irrespective of the management setting (inpatient, outpatient or intermittently hospitalised after insertion). An interdisciplinary team reviewed the outcomes on a routine basis and discussed changes to the process to improve outcomes, if necessary. RESULTS: One hundred and thirty-five PICCs were inserted in 124 patients, the majority of whom were patients from the medical oncology department (n = 107, 86.3%). Indications for PICC insertion included: chemotherapy (n = 97, 71.9%), antibiotic therapy (n = 24, 17.8%), total parenteral nutrition (n = 8, 5.9%), blood product transfusion (n = 4, 3.0%) and palliative care (n = 2, 1.5%). During a total of 10 402 catheter-days (median dwell time 62 days), there were five central line-associated bloodstream infections, including one mucosal barrier injury laboratory-confirmed bloodstream infection and two exit-site infections, yielding incidence rates of 0.48 and 0.19 infections per 1000 catheter-days, respectively. Incidence rates were 0.67 per 1000 catheter-days (n = 7) for radiologically documented deep venous thrombosis, 0.96 (n = 10) for tip dislocation and 0.67 (n = 7) for catheter occlusion. The overall rate of complications was 4.5 per 1000 catheter-days. Seventeen catheters (12.6%) were removed because of any complication. CONCLUSION: We successfully introduced PICCs in an academic hospital by implementing a systematic surveillance programme for complications. Both infectious and noninfectious complications were rare. Infection prevention specialists should be actively involved during the introduction of new intravascular devices in order to provide quality indicators and assure patient safety. AD - [Lo Priore, Elia; Marschall, Jonas] Bern Univ Hosp, Dept Infect Dis, Bern, Switzerland. [Fliedner, Monika] Bern Univ Hosp, Directorate Nursing & Allied Hlth Care Profess, Bern, Switzerland. [Heverhagen, Johannes T.] Bern Univ Hosp, Dept Diagnost Intervent & Paediat Radiol, Bern, Switzerland. [Novak, Urban] Bern Univ Hosp, Dept Med Oncol, Bern, Switzerland. Lo Priore, E (corresponding author), Univ Bern, Bern Univ Hosp, Dept Infect Dis, Freiburgstr, CH-3010 Bern, Switzerland. elia.lopriore@insel.ch AN - WOS:000402286900007 AU - Lo Priore, E. AU - Fliedner, M. AU - Heverhagen, J. T. AU - Novak, U. AU - Marschall, J. C7 - w14441 DA - May DO - 10.4414/smw.2017.14441 J2 - Swiss Med. Wkly. KW - PICC surveillance introduction CLABSI infectious complications noninfectious complications BLOOD-STREAM INFECTIONS CENTRAL VENOUS CATHETERS CANCER-PATIENTS RISK-FACTORS VASCULAR ACCESS ADULT PATIENTS COMPLICATIONS METAANALYSIS PREVENTION PICCS Medicine, General & Internal LA - English M3 - Article N1 - ISI Document Delivery No.: EW1WT Times Cited: 1 Cited Reference Count: 39 Lo Priore, Elia Fliedner, Monika Heverhagen, Johannes T. Novak, Urban Marschall, Jonas Marschall, Jonas/AAF-6425-2019 Marschall, Jonas/0000-0002-0052-3210; Novak, Urban/0000-0001-7642-2101 2 1 6 E M H SWISS MEDICAL PUBLISHERS LTD MUTTENZ SWISS MED WKLY PY - 2017 SN - 1424-7860 SP - 9 ST - The role of a surveillance programme for introducing peripherally inserted central catheters: a 2-year observational study in an academic hospital T2 - Swiss Medical Weekly TI - The role of a surveillance programme for introducing peripherally inserted central catheters: a 2-year observational study in an academic hospital UR - ://WOS:000402286900007 VL - 147 ID - 761654 ER - TY - JOUR AB - BACKGROUND: Children with empyema are managed at our center using a protocol-driven clinical care pathway. Chemical fibrinolysis is deployed as first-line management for significant pleural disease. We therefore examined clinical outcome(s) to benchmark standards of care while analyzing disease severity with introduction of the pneumococcal conjugate vaccine. METHODS: Medical case-records of children managed at a UK pediatric center were surveyed from Jan 2006 to Dec 2012. Binary logistic regression was utilized to study failure of fibrinolytic therapy. The effects of age, comorbidity, number of days of intravenous antibiotics prior to drainage and whether initial imaging showed evidence of necrotizing disease were also studied. RESULTS: A total of 239 children were treated [age range 4months-19years; median 4years]. A decreasing number of patients presenting year-on-year since 2006 with complicated pleural infections was observed. The majority of children were successfully managed without surgery using antibiotics alone (27%) or a fine-bore chest-drain and urokinase (71%). Only 2% of cases required primary thoracotomy. 14.7% cases failed fibrinolysis and required a second intervention. The only factor predictive of failure and need for surgery was suspicion of necrotizing disease on initial imaging (P=0.002, OR 8.69). CONCLUSION: Pediatric patients with pleural empyema have good outcomes when clinical care is led by a multidisciplinary team and protocol driven care pathway. Using a 'less is best' approach few children require surgery. AD - Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK. Medical School University of Liverpool, Liverpool, UK. Department of Respiratory Medicine, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK. Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK; Academic Department of Paediatric Surgery, University of Liverpool, Liverpool, UK. Electronic address: paul.losty@liv.ac.uk. AN - 26382287 AU - Long, A. M. AU - Smith-Williams, J. AU - Mayell, S. AU - Couriel, J. AU - Jones, M. O. AU - Losty, P. D. DA - Apr DO - 10.1016/j.jpedsurg.2015.07.022 DP - NLM ET - 2015/09/19 J2 - Journal of pediatric surgery KW - Adolescent Child Child, Preschool Conservative Treatment/*methods *Disease Management Empyema, Pleural/*therapy Female Humans Infant Logistic Models Male Pleural Effusion/*therapy Retrospective Studies Treatment Outcome Young Adult Antibiotics Clinical trials Empyema Parapneumonic effusion Thoracic surgery Urokinase LA - eng M1 - 4 N1 - 1531-5037 Long, Anna-May Smith-Williams, Jonathan Mayell, Sarah Couriel, Jon Jones, Matthew O Losty, Paul D Journal Article United States J Pediatr Surg. 2016 Apr;51(4):588-91. doi: 10.1016/j.jpedsurg.2015.07.022. Epub 2015 Aug 12. PY - 2016 SN - 0022-3468 SP - 588-91 ST - 'Less may be best'-Pediatric parapneumonic effusion and empyema management: Lessons from a UK center T2 - J Pediatr Surg TI - 'Less may be best'-Pediatric parapneumonic effusion and empyema management: Lessons from a UK center VL - 51 ID - 760360 ER - TY - JOUR AB - Recent ESC/EACTS revascularization guidelines advocate a 'Heart Team' (HT) approach in the decision-making process when managing patients with coronary disease. We prospectively assessed HT decision-making in 150 patients analysing personnel attendance, data presented, the 'actioning' of the HT decision and, if not completed, then the reasons why. Additionally, 50 patients were specifically re-discussed after 1 year in order to assess consistency in decision-making. We have two HT meetings each week. At least one surgeon, interventional cardiologist and non-interventional cardiologist were present at all meetings. Data presented included patient demographics, symptoms, co-morbidities, coronary angiography, left ventricular function and other relevant investigations, e.g. echocardiograms. HT decisions included continued medical treatment (22%), percutaneous coronary intervention (PCI; 22%), coronary-artery bypass grafting (CABG; 34%) or further investigations such as pressure wire studies, dobutamine stress echo or cardiac magnetic resonance imaging (22%). These decisions were fully undertaken in 86% of patients. Reasons for aberration in the remaining 21 patients included patient refusal (CABG 29%, PCI 10%) and further co-morbidities (28%). On re-discussion of the same patient data (n = 50) a year later, 24% of decisions differed from the original HT recommendations reflecting the fact that, for certain coronary artery disease pattern, either CABG or PCI could be appropriate. AD - Cardiothoracic Unit, Heart & Lung Centre, New Cross Hospital, Wolverhampton, UK. AN - 22294559 AU - Long, J. AU - Luckraz, H. AU - Thekkudan, J. AU - Maher, A. AU - Norell, M. C2 - Pmc3329280 DA - May DO - 10.1093/icvts/ivr157 DP - NLM ET - 2012/02/02 J2 - Interactive cardiovascular and thoracic surgery KW - *Angioplasty, Balloon, Coronary/adverse effects Cardiovascular Agents/adverse effects/*therapeutic use Continuity of Patient Care *Cooperative Behavior *Coronary Artery Bypass/adverse effects Coronary Artery Disease/diagnosis/*therapy England Female Guideline Adherence Humans *Interdisciplinary Communication Male *Outcome and Process Assessment, Health Care *Patient Care Team Patient Selection Practice Guidelines as Topic Prospective Studies Reproducibility of Results Time Factors Treatment Outcome LA - eng M1 - 5 N1 - 1569-9285 Long, Jenny Luckraz, Heyman Thekkudan, Joyce Maher, Abdul Norell, Michael Journal Article Interact Cardiovasc Thorac Surg. 2012 May;14(5):594-8. doi: 10.1093/icvts/ivr157. Epub 2012 Jan 31. PY - 2012 SN - 1569-9293 (Print) 1569-9285 SP - 594-8 ST - Heart team discussion in managing patients with coronary artery disease: outcome and reproducibility T2 - Interact Cardiovasc Thorac Surg TI - Heart team discussion in managing patients with coronary artery disease: outcome and reproducibility VL - 14 ID - 760333 ER - TY - JOUR AB - Background: Thrombotic microangiopathy (TMA) is a rare and life-threatening condition that can arise secondary to different diseases or mechanisms. The best known is the thrombotic thrombocytopenic purpura (TTP) a severe deficiency of ADAMTS13 in which an early treatment associates good prognosis, Hemolytic uremic syndrome (HUS) and Secondary TMA were the potential multiple etiologies can further delay diagnosis and treatment. The early detection of TMA can be done by both the clinical physician and hematology laboratory. In May of 2016 we started the implementation of the multidisciplinary team (MDT) in our center, in which the laboratory screens for early detection and works with the MDT when a TMA is suspected either by clinical or laboratory findings; decreasing the time for the diagnosis and treatment. Aims: Retrospectively evaluate the improvement in the response time and detection of TMA cases with the joint effort of the MDT and the Hematology laboratory, in a single center. Methods: The MDT working group takes in physicians from Intensive care unit, Nephrology, Hematology, Farmacy, Immunology, and other services who follow the criteria for the diagnostic of TMA and discuss all potential TMA cases via a smartphone chat App, to elaborate the differential diagnoses and to recommend the best treatment option at every case. The screening evaluation is performed by a hematologist present in full time in the laboratory since 2015, either by critical results or a call from a suspected TMA case from the MDT. The laboratory screening and team workflow is described in figure 1. We report 44 cases from 2010-2017 (Including adults and children) with a median age 40-year-old. (1-76) from before and after the MDT group (table 1). The Response time (RT) was retrospectively evaluated from the laboratory records, from the first day that a TMA diagnosis was feasible up to the day it was diagnosed. Results: In the cohort of 44 cases there has been a dramatic increase in the detection of cases after the MDT group and screening was stablished, 2010 to Apr16 (15cases) versus >May16-Feb18 (29 cases) an increase of 65% of the diagnosis after the MDT. The median response time decreased from 11 days (1.5-12) before the MDT to 0 days (0-2) (P=0.03) after the MDT. (table 1). Summary/Conclusion: The MDT communication with the laboratory and vice versa increases the awareness and detection of TMA, in which is fundamental to have a hematologist present in the laboratory and a trained staff to early recognize these alterations. The implementation of the MDT has improved the probability to early detect a TMA at our center. We believe that the Increase in the number of cases is probably related to missed or not diagnosed cases in the pre MDT era. (Table Presented) . AD - B. Lopez-Andrade, Haematology, Palma Mallorca, Spain AU - Lopez-Andrade, B. AU - Ballester, M. C. AU - Duran, M. A. AU - Lo Riso, L. AU - Sanchez-Raga, J. M. AU - Perez, A. AU - Uriol, M. AU - Cabello, S. AU - Garcia-Recio, M. AU - Aspas, G. AU - Sampol, A. DB - Embase DO - 10.1097/HS9.0000000000000060 KW - adult awareness child clinical article conference abstract controlled study diagnosis differential diagnosis early diagnosis hematologist hemolytic uremic syndrome human immunology incidence intensive care unit joint male multidisciplinary team nephrology probability retrospective study smartphone son staff thrombotic thrombocytopenic purpura treatment response time workflow LA - English M3 - Conference Abstract N1 - L625922933 2019-01-18 PY - 2018 SN - 2572-9241 SP - 1041-1042 ST - Incidence of thrombotic microangiopathy in hospital universitario son espases. the role of the hematology laboratory and the multidisciplinary team in the TMA early diagnosis T2 - HemaSphere TI - Incidence of thrombotic microangiopathy in hospital universitario son espases. the role of the hematology laboratory and the multidisciplinary team in the TMA early diagnosis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L625922933&from=export http://dx.doi.org/10.1097/HS9.0000000000000060 VL - 2 ID - 760819 ER - TY - JOUR AB - The correct stratification of pulmonary embolism risk (PE) is essential for decision-making, regarding treatment and defining the patient's place of admission. In high-risk PE, urgent re-establishment of pulmonary circulation and admission to a critical unit is required. The reperfusion treatment of choice is systemic thrombolysis, although in certain situations, especially when there is a contraindication for it, we will evaluate a surgical embolectomy or one of the catheter-guided therapies. In the rest of PE, the treatment of choice will be anticoagulation. Currently, direct oral anticoagulants have become the treatment of choice for the treatment of PE, due to their better safety profile. However, low molecular weight heparins and subsequently antivitamins K, remain the most used treatment, because they are funded by the public system. In cases of PE with cardiorespiratory arrest and / or cardiogenic shock, whenever available at our center, we must consider the indication of extracorporeal membrane oxygenation. The recent creation of PE response teams (PERT team), have meant an improvement in the care of patients with intermediate-high and high risk PE. During the follow-up of patients with PE, it is essential to perform a correct screening of chronic thromboembolic pulmonary hypertension, in order to perform a correct diagnostic and therapeutic approach. AU - López-Núñez, J. J. DB - Embase DO - 10.1016/j.rce.2020.07.006 KW - adult anticoagulation blood clot lysis cardiogenic shock cardiopulmonary arrest catheter chronic thromboembolic pulmonary hypertension contraindication embolectomy extracorporeal oxygenation follow up human pharmacokinetics pulmonary embolism response team reperfusion review risk assessment surgery thrombectomy antivitamin K low molecular weight heparin LA - English Spanish M3 - Article in Press N1 - L2007806798 2020-09-16 PY - 2020 SN - 1578-1860 0014-2565 ST - Pulmonary embolism treatment. Detection of chronic thromboembolic pulmonary hypertension T2 - Revista Clinica Espanola TI - Pulmonary embolism treatment. Detection of chronic thromboembolic pulmonary hypertension UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2007806798&from=export http://dx.doi.org/10.1016/j.rce.2020.07.006 ID - 760625 ER - TY - JOUR AB - INTRODUCTION AND OBJECTIVES: To validate the axillary approach as a safe and efficient option for the transcatheter aortic valve implantation in patients who have contraindication for femoral approach at three Spanish hospitals. METHODS: We included patients with severe symptomatic aortic stenosis at very high or prohibitive surgical risk, selected by a multidisciplinary team, for transcatheter aortic valve implantation, and had contraindication to the femoral approach. RESULTS: We included 19 of 186 (10.5%) patients, who were implanted a percutaneous aortic valve, between November 2008 and March 2010. The mean age was 78.3 (standard deviation [SD]±8.65) years and 73.7% were males. The mean logistic EuroSCORE was 28.7% (SD±16.3%). The procedural success rate was 100%. After the procedure the maximum transvalve gradient decreased from 81.7 mmHg (SD±21.5) to 15.8 mmHg (SD±5.5), and no patient presented residual aortic regurgitation >2. The all-cause mortality, with a mean follow-up time of 9.2 (SD±3.2) months was 10.5%, and the in-hospital and 30-day mortality rates were 0%. The global incidence of major complications due to the procedure was 15.7%. Definitive pacemaker implantation was carried out for atrioventricular block in 8 patients (44.4%). CONCLUSIONS: The axillary approach for transcatheter aortic valve implantation using the CoreValve(®) and contraindication to the femoral approach is safe and efficient for selected patients, with excellent results in terms of success implantation and in hospital and 30-day mortality. AD - Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España. birihh@yahoo.es AN - 21208709 AU - López-Otero, D. AU - Muñoz-García, A. J. AU - Avanzas, P. AU - Lozano, I. AU - Alonso-Briales, J. H. AU - Souto-Castro, P. AU - Morís, C. AU - Hernández-García, J. M. AU - Trillo-Nouche, R. DA - Feb DO - 10.1016/j.recesp.2010.08.004 DP - NLM ET - 2011/01/07 J2 - Revista espanola de cardiologia KW - Aged Aortic Valve Stenosis/mortality/*surgery Atrioventricular Block/therapy Cardiac Catheterization/*methods Endovascular Procedures/*methods Female Femoral Vein/anatomy & histology Follow-Up Studies Heart Valve Prosthesis Implantation/*methods Humans Male Pacemaker, Artificial LA - eng spa M1 - 2 N1 - 1579-2242 López-Otero, Diego Muñoz-García, Antonio J Avanzas, Pablo Lozano, Iñigo Alonso-Briales, Juan H Souto-Castro, Pablo Morís, César Hernández-García, José M Trillo-Nouche, Ramiro Journal Article Spain Rev Esp Cardiol. 2011 Feb;64(2):121-6. doi: 10.1016/j.recesp.2010.08.004. Epub 2011 Jan 3. PY - 2011 SN - 0300-8932 SP - 121-6 ST - Axillary approach for transcatheter aortic valve implantation: optimization of the endovascular treatment for the aortic valve stenosis T2 - Rev Esp Cardiol TI - Axillary approach for transcatheter aortic valve implantation: optimization of the endovascular treatment for the aortic valve stenosis VL - 64 ID - 760401 ER - TY - JOUR AB - Background:Over the past couple decades, concerns have been raised regarding graduate student wellbeing and attrition in Canada and abroad. Although research on graduate education has increased in response to these concerns, these works are often focused upon a narrow aspect of the multifaceted reality of graduate education and have not been student-conducted. This situation is largely mirrored in the case of physical education (PE), although further complicated by the focus on the United States in which graduate programmes differ considerably from Canada, Europe, and elsewhere. Purpose/Aim:The purpose of this research was to conduct a broad investigation into our own experiences as PE graduate students in Canada. Two research questions guided our team of eight Canadian-based PE graduate students: What are our experiences as PE graduate students in Canada? How might we enhance the experience for ourselves and others like us? We hoped that if we worked together to better understand and thrive in our situations, we might develop a supportive peer community and be able to promote positive changes to PE graduate education. Design:Drawing upon the participatory research method of photovoice, we individually took photographs of our graduate experiences and then engaged in critical discussions about the meaning, conditions, and possibilities of those experiences. These discussions were analysed in an iterative process of independently and collaboratively coding, thematizing, and refining to produce themes of our experiences. Guided by the criteria of continuity and interaction in Dewey's theory of experience, we engaged in an interpretive analysis of the themes in terms of their educative and miseducative quality. Finally, we interpreted the quality of the larger experience of engaging in this participatory investigation. Findings:Thematic findings included our experience of: (a) work knowing no bounds, including the time-intensive struggle of work-life balance, dictates of funding and employment, and challenges of juggling multiple roles; (b) feeling fortunate for opportunities to grow as lifelong learners, to have support systems, and to engage with children and youths; and (c) feeling in limbo due to challenges to PE, our transient positions, and our mental health. Conclusion:We interpreted the majority of our thematic experiences to be educative and as pushing us to grow academically in constructive directions. Objective conditions such as graduate programmes, supervisors, peers, and family were primarily credited for this. We interpreted the minority of our thematic experiences as miseducative and as distorting our academic growth in unconstructive directions. This was almost exclusively attributed to internal conditions such as our failure to adapt ourselves to the environment. The larger experience of engaging in this participatory investigation was perceived as educative and due to the objective conditions of our newly formed community and Dewey's theory. Our communal reflection on our experiences via Dewey's criteria stimulated growth and the desire to continue in, rather than retreat from, PE and academia. We suggest that all PE graduate students would benefit from the opportunity to engage with a community of peers in sustained, theory-guided reflection on the quality of their graduate experiences. AD - [Lorusso, Jenna R.] Western Univ, Fac Educ, 1137 Western Rd, London, ON N6A 3K7, Canada. [Johnson, Ashley M.] Queens Univ, Sch Kinesiol & Hlth Studies, Kingston, ON, Canada. [Morrison, Hayley J.] Univ Alberta, Fac Educ, Edmonton, AB, Canada. [Stoddart, Alexandra L.; Cameron, Nicole] Univ Saskatchewan, Coll Kinesiol, Saskatoon, SK, Canada. [Borduas, Christopher] Mem Univ Newfoundland, Sch Human Kinet & Recreat, St John, NF, Canada. [Lim, Christopher] Sch Exercise Sci Phys & Hlth Educ, Victoria, BC, Canada. [Price, Caitlin] Brock Univ, Dept Kinesiol, St Catharines, ON, Canada. [Stoddart, Alexandra L.] Univ Regina, Fac Educ, Regina, SK, Canada. [Borduas, Christopher] Univ Calgary, Werklund Sch Educ, Calgary, AB, Canada. [Cameron, Nicole] Lester B Pearson Sch, Saskatoon, SK, Canada. [Lim, Christopher] Univ British Columbia, Fac Educ, Vancouver, BC, Canada. [Price, Caitlin] York Reg Dist Sch Board, Aurora, ON, Canada. Lorusso, JR (corresponding author), Western Univ, Fac Educ, 1137 Western Rd, London, ON N6A 3K7, Canada. jlorusso@uwo.ca AN - WOS:000547155800001 AU - Lorusso, J. R. AU - Johnson, A. M. AU - Morrison, H. J. AU - Stoddart, A. L. AU - Borduas, C. AU - Cameron, N. AU - Lim, C. AU - Price, C. DO - 10.1080/17408989.2020.1789572 J2 - Phys. Educ. Sport Pedag. KW - Photovoice Dewey graduate education quality of experience participatory research SPORT PEDAGOGY DOCTORAL STUDENTS SOCIALIZATION PERSPECTIVES Education & Educational Research LA - English M3 - Article; Early Access N1 - ISI Document Delivery No.: MI1DK Times Cited: 0 Cited Reference Count: 29 Lorusso, Jenna R. Johnson, Ashley M. Morrison, Hayley J. Stoddart, Alexandra L. Borduas, Christopher Cameron, Nicole Lim, Christopher Price, Caitlin Johnson, Ashley/0000-0002-4415-252X; Stoddart, Alexandra/0000-0001-7760-8418 0 1 ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD ABINGDON PHYS EDUC SPORT PEDA SN - 1740-8989 SP - 23 ST - Graduate student experience in focus: a photovoice investigation of physical and health education graduate students in Canada T2 - Physical Education and Sport Pedagogy TI - Graduate student experience in focus: a photovoice investigation of physical and health education graduate students in Canada UR - ://WOS:000547155800001 ID - 761428 ER - TY - JOUR AB - OBJECTIVES: The impact of the distance from the interventional cardiologist's home to the hospital and door to balloon time (DTBT) BACKGROUND: The importance of DTBT is highlighted by its inclusion as one of the core quality measures collected by the center for Medicare and Medicaid services and by the Joint commission on Accreditation of Healthcare organizations. We investigated the effect of time of day on the DTBT in patients having primary percutaneous coronary intervention (pPCI) and the impact of distance of the on call interventional cardiologist from the hospital on the DTBT and major adverse cardiac events (MACE) in patients undergoing pPCI during the off hours METHODS: Patients enrolled in the study presented with STEMI either in the field or to the emergency department (ED) and underwent pPCI from October 2007 to July 2009 RESULTS: Significant predictors of DTBT included a history of prior MI (P = 0.001), prior percutaneous coronary intervention (P = 0.021), prior coronary artery bypass grafting (P < 0.001), and history of diabetes mellitus (P = 0.004). The strongest predictor of DTBT was on versus off hours. Mean DTB was 18.5 min greater during off hours (72 min) compared to on-hours (53.5 min). The distance from the cardiologist's home to the hospital was not associated with DTBT on multivariable analysis (P = 0.20) CONCLUSION: When pPCI is performed in a highly organized STEMI center with broad staff support and expertise in cardiac care, the increase in the DTBT during off hours was not associated with increase MACE rates. AD - Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts. AN - 24665082 AU - Lotfi, A. AU - Alreja, G. AU - Kashef, M. A. AU - Giugliano, G. R. AU - Garb, J. AU - Schweiger, M. DA - Nov 15 DO - 10.1002/ccd.25492 DP - NLM ET - 2014/03/26 J2 - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions KW - *After-Hours Care Aged Chi-Square Distribution Female Humans Logistic Models Male Massachusetts Middle Aged Multivariate Analysis Myocardial Infarction/diagnosis/*therapy Patient Care Team *Percutaneous Coronary Intervention/adverse effects Personnel Staffing and Scheduling *Physicians *Residence Characteristics Retrospective Studies Risk Factors Time Factors *Time-to-Treatment Treatment Outcome ST segment elevation myocardial infarction door to balloon time off and on hours primary percutaneous coronary intervention LA - eng M1 - 6 N1 - 1522-726x Lotfi, Amir Alreja, Gaurav Kashef, Mohammad Amin Giugliano, Gregory R Garb, Jane Schweiger, Marc Journal Article Observational Study United States Catheter Cardiovasc Interv. 2014 Nov 15;84(6):950-4. doi: 10.1002/ccd.25492. Epub 2014 Apr 16. PY - 2014 SN - 1522-1946 SP - 950-4 ST - The impact of the distance from the interventional cardiologist's home to the hospital during off hours T2 - Catheter Cardiovasc Interv TI - The impact of the distance from the interventional cardiologist's home to the hospital during off hours VL - 84 ID - 760400 ER - TY - JOUR AB - LEARNING OBJECTIVE #1: Recognizing Lemierre's syndrome as an uncommon, but increasingly prevalent disease with significant morbidity and mortality, necessitating high clinical suspicion and rapid diagnosis LEARNING OBJECTIVE #2: Discussing the core treatment principles and management of these patients CASE: A 23 year old man with no significant medical history presented with 1 week of body aches, chills, cough, sore throat, and fevers. Initial labs were notable for a WBC count of 14.9 and lactate of 3.5. His chest x-ray revealed extensive infiltrates, and follow up CTscan showed bilateral opacities. He was started on IV vancomycin and piperacillin/ tazobactam for suspected multi-lobar pneumonia. Blood cultures from admission grew anaerobic gram negative rods, with speciation to Fusobacterium necrophorum, and his antibiotics were changed to IV ampicillin/sulbactam. Neck ultrasound and subsequent neck CT revealed non-occlusive thrombophlebitis of the right internal jugular vein (IJV) and right external jugular vein, leading to the diagnosis of Lemierre's Syndrome. His care was managed by a multidisciplinary team including infectious disease, head and neck surgery, and vascular surgery. Anticoagulation was deferred in lieu of monitoring with daily ultrasounds to track clot length. His course was complicated by hypoxic respiratory failure, requiring continuous high flow oxygen, and septic myelosuppression; both of which resolved after 1 week of IV antibiotics and supportive care. He was discharged with oral metronidazole to complete a 6 week total antibiotic course. During his follow up appointment 2 weeks later, he showed clinical improvement, with only occasional neck pain, and marked improvement on his chest x-ray. DISCUSSION: Lemierre's syndrome, also known as jugular vein suppurative thrombophlebitis, is a rare condition. It often affects previously healthy young adults and is characterized by a primary oropharyngeal infection, followed by metastatic spread and suppurative thrombophlebitis of the carotid sheath vessels, classically the IJV. Though once relatively common, the number of cases has declined since the discovery of antibiotics. However, there are now concerns about a reemergence of this condition, thought mostly due to antibiotic resistance and decreased antibiotic prescription for minor oropharyngeal conditions. This increasing prevalence, along with an unfamiliarity of many clinicians with the classical features of this “forgotten disease”, risks misdiagnosis or delay in identifying this potentially fatal illness. Lemierre's syndrome carries a mortality of over 90 % if untreated; thus, early diagnosis and prompt treatment initiation is vital. Patients typically present with acute fever, rigors, respiratory distress and localized neck and/or throat pain. Septic emboli to the lungs, as seen in our patient, occur in up to 97% of cases. Metastatic infectious seeding of the organs, soft tissue, joints, and bones is also possible. CNS involvement is uncommon, but not unheard of, and carries an even worse prognosis. Causative organisms are usually normal oropharyngeal flora, most commonly Fusobacterium necrophorum. Other etiologies include primary dental infection, infectious mononucleosis, and IV catheter insertion. The diagnosis of this condition is made with consistent microbiology and identification of jugular vein thrombophlebitis on CT scan or ultrasound. Unfortunately, given the rarity of this condition, there have been no randomized trials done to help guide management. That being said, current treatment principles include prompt IV antibiotic administration and consideration for surgical intervention and/or anticoagulation. Empiric antibiotic therapy includes a beta-lactamase resistant antibiotic for at least 4 weeks. Although ligation or resection of the IJV was common before antibiotics, surgical intervention is now generally only favored with refractory sepsis, abscess formation, rapid clot extension, or ongoing septic emboli despite antibiotic therapy. The role of anticoagulation in patients with Lemierre's syndrome remains controversial. Proponents argue that anticoagulation prevents clot extension, increases penetration of antibiotics, and hastens resolution of the thrombus. Arguments against anticoagulation cite the inherent risks of therapy, especially as sepsis related thrombocytopenia is not uncommon, as well as a potential for worsening metastatic spread of septic emboli. This case is a classic presentation of Lemierre's syndrome. It illustrates the rapidity of clinical decline seen in these patients, and therefore highlights the need for high clinical suspicion from physicians, as well as aggressive and multidisciplinary management. Lemierre's should be suspected in patients with antecedent pharyngitis, septic pulmonary emboli, and persistent fever despite antimicrobial therapy. Appropriate and prompt institution of antibiotics remains the mainstay of therapy, with surgical drainage where indicated. Though there are no clear guidelines, a review of the literature notes that there is an unofficial consensus that anticoagulation is indicated in certain circumstances, such as a lack of response despite adequate antimicrobial therapy, underlying thrombophilia, or potential for retrograde progression to the cavernous sinus. Regardless, during therapy, close observation for signs of continued sepsis, propagation of thrombus, or septic emboli is vital. AD - J.S. Louie, Kaiser Permanente San Francisco, Berkeley, CA, United States AU - Louie, J. S. DB - Embase KW - antibiotic agent tazobactam vancomycin beta lactamase sultamicillin metronidazole oxygen memory society internal medicine human anticoagulation patient thrombophlebitis embolism Lemierre syndrome ultrasound diagnosis surgery sepsis therapy fever neck sore throat risk follow up antibiotic therapy infection thrombus mortality jugular vein Fusobacterium necrophorum antimicrobial therapy monitoring lobar pneumonia abscess vascular surgery head and neck surgery computer assisted tomography microbiology head and neck disease external jugular vein internal jugular vein coughing prognosis bone soft tissue lung medical history morbidity respiratory distress thorax radiography early diagnosis flora etiology tooth infection mononucleosis catheter diagnostic error diseases ligation male prevalence prescription antibiotic resistance cavernous sinus thrombophilia carotid artery surgical drainage young adult lung embolism Gram negative bacterium leukocyte count neck pain consensus blood culture pharyngitis bone marrow suppression physician thrombocytopenia respiratory failure central nervous system LA - English M1 - 2 M3 - Conference Abstract N1 - L72289319 2016-05-31 PY - 2016 SN - 1525-1497 SP - S718 ST - Remembering a forgotten disease T2 - Journal of General Internal Medicine TI - Remembering a forgotten disease UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72289319&from=export VL - 31 ID - 761023 ER - TY - JOUR AB - BACKGROUND: Three-dimensional contrast-enhanced ultrasound (3D-CEUS) is a novel technology allowing surgeons to view duplex ultrasound images in three dimensions with ultrasound contrast highlighting blood flow in endoleaks after endovascular aneurysm repair (EVAR). It potentially reduces the need for computed tomography angiography (CTA) and catheter angiography. This study compares 3D-CEUS with both CTA and the final vascular multidisciplinary team (MDT) diagnosis using all available imaging. Interoperator variability for detection of endoleak and the influence of 3D-CEUS on patient management were studied. METHODS: A consecutive 100 patients undergoing CTA for EVAR surveillance were invited to undergo standard CEUS and 3D-CEUS on the same day, with 3D-CEUS reported independently by two blinded vascular scientists. Presence and type of endoleak were compared between CTA, standard CEUS, 3D-CEUS, and the final diagnostic decision made in the vascular MDT meeting. Interoperator reliability of 3D-CEUS was analyzed using the κ statistic. RESULTS: The 100 paired CTA, CEUS, and 3D-CEUS studies were analyzed. Compared with CTA, the sensitivity, specificity, positive predictive value, and negative predictive value of 3D-CEUS to endoleak were 96%, 91%, 90%, and 96%, respectively. Compared with the MDT decision with access to all imaging modalities, the sensitivity, specificity, positive predictive value, and negative predictive value of 3D-CEUS were 96%, 100%, 100%, and 96%. The κ statistic for interoperator agreement was 0.89. CONCLUSIONS: 3D-CEUS was more sensitive and accurate than CTA for endoleak detection and classification after EVAR. 3D-CEUS is now our initial investigation of choice in cases of sac expansion during duplex ultrasound follow-up or if there is diagnostic uncertainty on standard duplex ultrasound or CTA. AD - Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. Independent Vascular Services, University Hospital South Manchester, Manchester, United Kingdom. Department of Vascular and Endovascular Surgery, University Hospital South Manchester, Manchester, United Kingdom. Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. Electronic address: chris.lowe@doctors.org.uk. AN - 28017583 AU - Lowe, C. AU - Abbas, A. AU - Rogers, S. AU - Smith, L. AU - Ghosh, J. AU - McCollum, C. DA - May DO - 10.1016/j.jvs.2016.10.082 DP - NLM ET - 2016/12/27 J2 - Journal of vascular surgery KW - Aortic Aneurysm/diagnostic imaging/*surgery Aortography/methods Blood Vessel Prosthesis Implantation/*adverse effects Computed Tomography Angiography Contrast Media/*administration & dosage Endoleak/classification/*diagnostic imaging/etiology Endovascular Procedures/*adverse effects Humans *Image Interpretation, Computer-Assisted *Imaging, Three-Dimensional Observer Variation Predictive Value of Tests Prospective Studies Reproducibility of Results Treatment Outcome Ultrasonography, Doppler, Duplex/*methods LA - eng M1 - 5 N1 - 1097-6809 Lowe, Christopher Abbas, Abeera Rogers, Steven Smith, Lee Ghosh, Jonathan McCollum, Charles 097820/Z/11/B/Wellcome Trust/United Kingdom Comparative Study Journal Article Research Support, Non-U.S. Gov't United States J Vasc Surg. 2017 May;65(5):1453-1459. doi: 10.1016/j.jvs.2016.10.082. Epub 2016 Dec 22. PY - 2017 SN - 0741-5214 SP - 1453-1459 ST - Three-dimensional contrast-enhanced ultrasound improves endoleak detection and classification after endovascular aneurysm repair T2 - J Vasc Surg TI - Three-dimensional contrast-enhanced ultrasound improves endoleak detection and classification after endovascular aneurysm repair VL - 65 ID - 760262 ER - TY - JOUR AB - Rest pain, tissue loss, and gangrene are manifestations of critical limb ischemia caused by peripheral arterial disease and define a patient subgroup at highest risk for major limb amputation. Patients with nonhealing lower extremity wounds should be screened for the risk factors for peripheral arterial disease and offered noninvasive vascular testing. The diagnosis of critical limb ischemia mandates prompt institution of medical and surgical management to achieve the best chance of limb salvage. Surgical intervention has evolved from primary amputation to open bypass to the present era of endovascular therapy. The goals of surgical bypass and endovascular therapy are to improve perfusion sufficiently to permit healing. Despite poorer patency rates and the more frequent need for reintervention, endovascular therapy has been shown in multiple retrospective studies to achieve limb salvage similar to open bypass. Only one large, prospective, randomized controlled trial exists comparing open bypass with endovascular therapy: The Bypass versus Angioplasty in Severe Limb Ischemia of the Leg (BASIL) trial. Close clinical surveillance and serial monitoring of limb perfusion by means of noninvasive arterial studies are needed to determine the need for further vascular intervention. Limb salvage patients suffer from multiple comorbidities and benefit from a multidisciplinary, team approach to care. AD - University of Arizona Health Sciences Center, Tucson, AZ, USA. AN - 21200287 AU - Lucas, L. C. AU - Mills, J. L., Sr. DA - Jan DO - 10.1097/PRS.0b013e3182028eab DP - NLM ET - 2011/01/14 J2 - Plastic and reconstructive surgery KW - *Endovascular Procedures Humans Ischemia/diagnosis/*surgery *Limb Salvage Lower Extremity/*blood supply/surgery Patient Selection Risk Factors Treatment Outcome Vascular Surgical Procedures LA - eng N1 - 1529-4242 Lucas, Layla C Mills, Joseph L Sr Journal Article United States Plast Reconstr Surg. 2011 Jan;127 Suppl 1:163S-173S. doi: 10.1097/PRS.0b013e3182028eab. PY - 2011 SN - 0032-1052 SP - 163s-173s ST - Critical evaluation of endovascular surgery for limb salvage T2 - Plast Reconstr Surg TI - Critical evaluation of endovascular surgery for limb salvage VL - 127 Suppl 1 ID - 760345 ER - TY - JOUR AB - Rest pain, tissue loss, and gangrene are manifestations of critical limb ischemia caused by peripheral arterial disease and define a patient subgroup at highest risk for major limb amputation. Patients with nonhealing lower extremity wounds should be screened for the risk factors for peripheral arterial disease and offered noninvasive vascular testing. The diagnosis of critical limb ischemia mandates prompt institution of medical and surgical management to achieve the best chance of limb salvage. Surgical intervention has evolved from primary amputation to open bypass to the present era of endovascular therapy. The goals of surgical bypass and endovascular therapy are to improve perfusion sufficiently to permit healing. Despite poorer patency rates and the more frequent need for reintervention, endovascular therapy has been shown in multiple retrospective studies to achieve limb salvage similar to open bypass. Only one large, prospective, randomized controlled trial exists comparing open bypass with endovascular therapy: The Bypass versus Angioplasty in Severe Limb Ischemia of the Leg (BASIL) trial. Close clinical surveillance and serial monitoring of limb perfusion by means of noninvasive arterial studies are needed to determine the need for further vascular intervention. Limb salvage patients suffer from multiple comorbidities and benefit from a multidisciplinary, team approach to care. AD - L.C. Lucas, University of Arizona Health Sciences Center, Tucson, AZ, USA. AU - Lucas, L. C. AU - Mills Sr, J. L. DB - Medline KW - article endovascular surgery human ischemia leg limb salvage patient selection risk factor treatment outcome vascular surgery vascularization LA - English M3 - Article N1 - L361367925 2011-03-10 PY - 2011 SN - 1529-4242 SP - 163S-173S ST - Critical evaluation of endovascular surgery for limb salvage T2 - Plastic and reconstructive surgery TI - Critical evaluation of endovascular surgery for limb salvage UR - https://www.embase.com/search/results?subaction=viewrecord&id=L361367925&from=export VL - 127 Suppl 1 ID - 761240 ER - TY - JOUR AB - OBJECTIVE: To describe the implantation of a care quality indicator associated to the nursing diagnosis of patients at high risk of bleeding, based on the alarming results of prothrombin time (PT), partially activated thromboplastin time (aPTT) and platelets. METHODS: Retrospective experience report of multidisciplinary actions developed in a university hospital. The stages of the study involved team meetings, search for effective communication strategies and creation of a new indicator of quality of care. RESULTS: The indicator was called "Compliance of Nursing Diagnosis Risk for bleeding", monitored monthly since June 2016. The technical file includes the characteristics and attributes of the indicator. Based on the analyzes of the indicator, action plans are established for its qualification. CONCLUSION: The implementation of the quality of care indicator associated to the nursing diagnosis improved the communication process, the monitoring and the nursing care to patients at risk of bleeding. AD - Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, Porto Alegre, Rio Grande do Sul, Brasil. Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brasil. AN - 31038603 AU - Lucena, A. F. AU - Laurent, Mdcr AU - Reich, R. AU - Pinto, L. R. C. AU - Carniel, E. L. AU - Scotti, L. AU - Hemesath, M. P. DO - 10.1590/1983-1447.2019.20180322 DP - NLM ET - 2019/05/01 J2 - Revista gaucha de enfermagem KW - Adult Female Hemorrhage/prevention & control Hemorrhagic Disorders/blood/epidemiology/*nursing Hospitals, University Humans Infant, Newborn Interdisciplinary Communication Male *Nursing Diagnosis Partial Thromboplastin Time Patient Care Team *Patient Safety Platelet Count Prothrombin Time *Quality Indicators, Health Care Quality of Health Care Retrospective Studies Risk LA - por eng M1 - spe N1 - 1983-1447 Lucena, Amália de Fátima Laurent, Maria do Carmo Rocha Reich, Rejane Pinto, Luciana Ramos Correa Carniel, Elenice Lorenzi Scotti, Luciana Hemesath, Melissa Prade Journal Article Brazil Rev Gaucha Enferm. 2019;40(spe):e20180322. doi: 10.1590/1983-1447.2019.20180322. Epub 2019 Apr 29. OP - Diagnóstico de enfermagem risco de sangramento como indicador de qualidade assistencial à segurança de pacientes. PY - 2019 SN - 0102-6933 SP - e20180322 ST - Nursing diagnosis risk for bleeding as an indicator of quality of care for patient safety T2 - Rev Gaucha Enferm TI - Nursing diagnosis risk for bleeding as an indicator of quality of care for patient safety VL - 40 ID - 760328 ER - TY - JOUR AB - Background Acute pulmonary embolism remains a significant cause of mortality and morbidity worldwide. Benefit of recently developed multidisciplinary PE response teams (PERT) with higher utilization of advanced therapies has not been established. Methods To evaluate patient-centered outcomes and cost-effectiveness of a multidisciplinary PERT we performed a retrospective analysis of 554 patients with acute PE at the university of Virginia between July 2014 and June 2015 (pre-PERT era) and between April 2017 through October 2018 (PERT era). Six-month survival, hospital length-of-stay (LOS), type of PE therapy, and in-hospital bleeding were assessed upon collected data. Results 317 consecutive patients were treated for acute PE during an 18-month period following institution of a multidisciplinary PE program; for 120 patients PERT was activated (PA), the remaining 197 patients with acute PE were considered as a separate, contemporary group (NPA). The historical, comparator cohort (PP) was composed of 237 patients. These 3 groups were similar in terms of baseline demographics, comorbidities and risk, as assessed by the Pulmonary Embolism Severity Index (PESI). Patients in the historical cohort demonstrated worsened survival when compared with patients treated during the PERT era. During the PERT era no statistically significant difference in survival was observed in the PA group when compared to the NPA group despite significantly higher severity of illness among PA patients. Hospital LOS was not different in the PA group when compared to either the NPA or PP group. Hospital costs did not differ among the 3 cohorts. 30-day re-admission rates were significantly lower during the PERT era. Rates of advanced therapies were significantly higher during the PERT era (9.1% vs. 2%) and were concentrated in the PA group (21.7% vs. 1.5%) without any significant rise in in-hospital bleeding complications. Conclusions At our institution, all-cause mortality in patients with acute PE has significantly and durably decreased with the adoption of a PERT program without incurring additional hospital costs or protracting hospital LOS. Our data suggest that the adoption of a multidisciplinary approach at some institutions may provide benefit to select patients with acute PE. AU - Lukasz, A. Myc AU - Jigna, N. Solanki AU - Andrew, J. Barros AU - Nebil, Nuradin AU - Matthew, G. Nevulis AU - Kranthikiran, Earasi AU - Emily, D. Richardson AU - Shawn, C. Tsutsui AU - Kyle, B. Enfield AU - Nicholas, R. Teman AU - Ziv, J. Haskal AU - Sula, Mazimba AU - Jamie, L. W. Kennedy AU - Andrew, D. Mihalek AU - Aditya, M. Sharma AU - Alexandra, Kadl DA - 2020/06 06 DB - Directory of Open Access Journals (Sweden) DO - 10.1186/s12931-020-01422-z KW - Acute pulmonary embolism Pulmonary embolism response team PERT Acute pulmonary embolism interventions M1 - 1 PY - 2020 SN - 1465-9921 SP - 1-9 ST - Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism T2 - Respiratory Research TI - Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism UR - http://link.springer.com/article/10.1186/s12931-020-01422-z VL - 21 ID - 761999 ER - TY - JOUR AB - PURPOSE OF REVIEW: Vascular Ehlers-Danlos syndrome (EDS) results from mutations in the formation of type III collagen. This leads to various potentially lethal complications including rupture of the arterial vessels, intestinal organs, and the uterus. This review summarizes recent cohort studies that have improved our medical and surgical management of complications associated with vascular EDS. RECENT FINDINGS: Vascular EDS is associated with a shortened overall survival due to potential complications, namely loss of connective tissue integrity in blood vessels and increased risk of arterial rupture. The traditional approach has been to treat such complications conservatively unless they are life threatening. There have been challenges to this treatment paradigm based on recent reports. Treatment with the beta blocker Celiprolol was shown in a randomized study to be associated with a three-fold decrease in arterial rupture in vascular EDS patients. Furthermore, it was shown by observational studies that elective surgical repair of blood vessels at risk of rupture may be safely undertaken at tertiary referral centers that have expertise in managing connective tissue disorders. Novel approaches using endovascular therapy with coil embolization have also been attempted with good results in the treatment of ruptured pseudoaneurysms, visceral aneurysms, and carotid-cavernous fistulas. SUMMARY: New evidence-based treatments have greatly expanded the medical and surgical management options for patients with EDS. These patients are best managed by multidisciplinary teams of interventionalists, cardiologists, and geneticists in tertiary centers with expertise in managing connective tissue disorders. AD - Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland 21287-8611, USA. AN - 21852761 AU - Lum, Y. W. AU - Brooke, B. S. AU - Black, J. H., 3rd DA - Nov DO - 10.1097/HCO.0b013e32834ad55a DP - NLM ET - 2011/08/20 J2 - Current opinion in cardiology KW - Antihypertensive Agents/therapeutic use Celiprolol/therapeutic use Collagen Type III/genetics Ehlers-Danlos Syndrome/drug therapy/genetics/pathology/*surgery Embolization, Therapeutic/instrumentation/methods *Endovascular Procedures Humans Prognosis Risk Assessment LA - eng M1 - 6 N1 - 1531-7080 Lum, Ying Wei Brooke, Benjamin S Black, James H 3rd Journal Article Review United States Curr Opin Cardiol. 2011 Nov;26(6):494-501. doi: 10.1097/HCO.0b013e32834ad55a. PY - 2011 SN - 0268-4705 SP - 494-501 ST - Contemporary management of vascular Ehlers-Danlos syndrome T2 - Curr Opin Cardiol TI - Contemporary management of vascular Ehlers-Danlos syndrome VL - 26 ID - 760309 ER - TY - JOUR AB - Background : The use of inferior vena cava filters (IVCF) is controversial. However, the procedure is frequently performed for secondary prophylaxis in patients with severe pulmonary embolism (PE) treated by pulmonary embolism response teams (PERTs). Aims : To identify factors associated with placement of an IVCF and the rate of PE reoccurrence at 12 months among patients treated by a PERT. Methods : Data were collected on all patients who had a PERT activation from 10/2012- 12/2018. Data describing demographics, medical history, PE characteristics and treatment were collected at the time of PERT activation and prospectively for 12 months after PERT activation. Logistic regression analyses were performed to determine factors associated with IVCF placement. Results : We identified 1086 patients (67 [61%] male, 42 [39%] female, mean age 59 years old), of whom 109 (10%) had an IVCF placed in the first 7 days after PERT activation. Patients receiving an IVCF were more likely to have had an ED (p< 0.001) or ICU PERT referral (p< 0.001). Patients with a history of recent trauma (p< 0.001), intracranial haemorrhage (p=0.0018), recent surgery (p=0.0027), a recent invasive procedure (p=0.0162), recent hospitalization (p=0.0110) or presenting with syncope (p=0.0456), were more likely to have an IVCF placed. Patients receiving IVCF were also more likely to have evidence of right ventricular : left ventricular ratio >1 on CTPA (p< 0.001) and right ventricular dysfunction on echocardiogram (p=0.0048) and were more likely to require respiratory support (p=0.0122) through nasal cannula, nonrebreather mask, CPAP/ BIPAP or mechanical ventilation. The 30- day VTE recurrence rate was higher (10.99% vs. 0.13%) in IVCF patients (p=0.0229); with 8.26% experiencing DVT and 1.83% PE. Conclusions : Factors associated with VTE severity (e.g. ED or ICU patient location, right heart strain) and elevated bleeding risk (e.g. recent surgery or trauma) were associated with IVCF placement among PERT patients. AD - E. Lun, Massachusetts General Hospital, Emergency Medicine, Boston, United States AU - Lun, E. AU - Giordano, N. AU - Hansen, A. K. AU - Mortensen, C. S. AU - Torrey, J. AU - Zheng, H. AU - Kabrhel, C. DB - Embase DO - 10.1002/rth2.12229 KW - adult brain hemorrhage conference abstract controlled study echocardiography faintness female heart left ventricle heart right ventricle failure hospitalization human injury invasive procedure major clinical study male medical history middle aged nasal cannula non rebreathing valve patient referral positive pressure ventilation pulmonary embolism response team recurrence risk vena cava filter LA - English M3 - Conference Abstract N1 - L628813991 2019-08-09 PY - 2019 SN - 2475-0379 SP - 808 ST - Factors that influence inferior vena cava filter placement and long-term efficacy T2 - Research and Practice in Thrombosis and Haemostasis TI - Factors that influence inferior vena cava filter placement and long-term efficacy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628813991&from=export http://dx.doi.org/10.1002/rth2.12229 VL - 3 ID - 760694 ER - TY - JOUR AB - Clinical research on penetrating injury to the buttock is sparse and largely limited to case reports and clinical series. The purpose of this paper is to provide a detailed overview of literature of the topic and to propose a basic algorithm for management of penetrating gluteal injuries (PGI). MEDLINE, EMBASE, Cochran, and CINAHL databases were employed. Thirty-seven papers were selected and retrieved for overview from 1,021 records. PGI accounts for 2–3 % of all penetrating injuries, with a mortality rate up to 4 %. Most haemodynamically stable patients will benefit from traditional wound care and selective non-operative management. When gluteal fascia injury is confirmed or suspected, a contrast-enhanced CT-scan provides the most accurate injury diagnosis. CT-scan-based angiography and endovascular interventions radically supplement assessment and management of patients with penetrating injury to the major buttock and adjacent extra-buttock arteries. Immediate life-saving damage-control surgery is indicated for patients with hypovolemic shock and signs of internal bleeding. A universal basic management algorithm is proposed. This overview shows that penetrating injury to the buttock should be regarded as a potential life-threatening injury, and therefore, patients with such injuries should be managed in trauma centres equipped with hybrid operating theatres for emergency endovascular and open surgery for multidisciplinary teams operating 24/7. AD - R. Lunevicius, Emergency General Surgery and Major Trauma Units, Cheshire and Merseyside Major Trauma Centre, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, United Kingdom AU - Lunevicius, R. AU - Lewis, D. AU - Ward, R. G. AU - Chang, A. AU - Samalavicius, N. E. AU - Schulte, K. M. DB - Embase Medline DO - 10.1007/s10151-014-1168-2 KW - anatomical variation angioembolization artificial embolization buttock clinical assessment tool computer assisted tomography conservative treatment data analysis diagnostic accuracy disease control emergency surgery follow up hemodynamics human incidence intermethod comparison laparoscopic surgery morbidity mortality outcome assessment patient positioning penetrating gluteal injury penetrating trauma review scoring system selective non operative management surgical approach syndrome delineation treatment indication treatment response wound care LA - English M1 - 11 M3 - Review N1 - L53185895 2014-06-13 2015-01-07 PY - 2014 SN - 1128-045X 1123-6337 SP - 981-992 ST - Penetrating injury to the buttock: an update T2 - Techniques in Coloproctology TI - Penetrating injury to the buttock: an update UR - https://www.embase.com/search/results?subaction=viewrecord&id=L53185895&from=export http://dx.doi.org/10.1007/s10151-014-1168-2 VL - 18 ID - 761096 ER - TY - JOUR AB - BACKGROUND/PURPOSE: Pulmonary endarterectomy (PEA) is a potentially curative surgical procedure for patients with chronic thromboembolic pulmonary hypertension. The aim of this study is to review our institutional experience with this operation. METHODS: We conducted a retrospective review of PEA performed at our institution between January 2005 and December 2013. The measured outcomes were inhospital complications, improvement in cardiac function and exercise capacity, and actuarial survival after PEA. RESULTS: Ten consecutive patients (7 women, 3 men) underwent PEA with a mean age of 59.9 ± 12.9 years. The preoperative New York Heart Association functional class (NYHA FC) for these patients was either Class III (n = 6) or Class IV (n = 4). The period from symptom onset to diagnosis was 34.3 ± 37.9 months, and that from diagnosis to operation was 31.4 ± 46.8 months. After PEA, the duration of intensive care unit stay and hospital stay prior to discharge were 9.7 ± 5.7 days and 18.7 ± 7.4 days, respectively. Postoperative complications included reperfusion lung edema (n = 3) and pneumonia (n = 1), and all recovered with medical therapy. After a mean follow-up of 48.4 ± 35.1 months, all patients showed marked improvements in their clinical status and were still alive without evidence of disease recurrence. CONCLUSION: With proper patient selection, the cooperation of a multidisciplinary team, and meticulous postoperative management, PEA can be conducted safely with relatively low risk at a center with limited experience with the procedure. AD - Department of Surgery, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei, Taiwan; College of Medicine, National Taiwan University, Number 7, Chung-Shan South Road, Taipei, Taiwan. College of Medicine, National Taiwan University, Number 7, Chung-Shan South Road, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei, Taiwan. Department of Surgery, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei, Taiwan; College of Medicine, National Taiwan University, Number 7, Chung-Shan South Road, Taipei, Taiwan. Electronic address: ntuhsu@gmail.com. AN - 25267092 AU - Luo, W. C. AU - Huang, S. C. AU - Lin, Y. H. AU - Lai, H. S. AU - Kuo, S. W. AU - Pan, S. C. AU - Hsu, H. H. DA - Dec DO - 10.1016/j.jfma.2014.08.009 DP - NLM ET - 2014/10/01 J2 - Journal of the Formosan Medical Association = Taiwan yi zhi KW - Adult Aged Chronic Disease/therapy *Endarterectomy Female Follow-Up Studies Humans Hypertension, Pulmonary/*surgery Lung/*physiopathology Male Middle Aged Pneumonia/etiology *Postoperative Complications Pulmonary Artery/*surgery Pulmonary Edema/etiology Pulmonary Embolism/*surgery Retrospective Studies Taiwan Treatment Outcome chronic thromboembolic pulmonary hypertension pulmonary endarterectomy LA - eng M1 - 12 N1 - Luo, Wei-Cheng Huang, Shu-Chien Lin, Yen-Hung Lai, Hong-Shiee Kuo, Shuenn-Wen Pan, Sung-Ching Hsu, Hsao-Hsun Journal Article Singapore J Formos Med Assoc. 2015 Dec;114(12):1197-203. doi: 10.1016/j.jfma.2014.08.009. Epub 2014 Sep 26. PY - 2015 SN - 0929-6646 (Print) 0929-6646 SP - 1197-203 ST - Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension--A single-center experience in Taiwan T2 - J Formos Med Assoc TI - Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension--A single-center experience in Taiwan VL - 114 ID - 760304 ER - TY - JOUR AB - Background/Purpose: Pulmonary endarterectomy (PEA) is a potentially curative surgical procedure for patients with chronic thromboembolic pulmonary hypertension. The aim of this study is to review our institutional experience with this operation. Methods: We conducted a retrospective review of PEA performed at our institution between January 2005 and December 2013. The measured outcomes were inhospital complications, improvement in cardiac function and exercise capacity, and actuarial survival after PEA. Results: Ten consecutive patients (7 women, 3 men) underwent PEA with a mean age of 59.9 ± 12.9 years. The preoperative New York Heart Association functional class (NYHA FC) for these patients was either Class III (. n = 6) or Class IV (. n = 4). The period from symptom onset to diagnosis was 34.3 ± 37.9 months, and that from diagnosis to operation was 31.4 ± 46.8 months. After PEA, the duration of intensive care unit stay and hospital stay prior to discharge were 9.7 ± 5.7 days and 18.7 ± 7.4 days, respectively. Postoperative complications included reperfusion lung edema (. n = 3) and pneumonia (. n = 1), and all recovered with medical therapy. After a mean follow-up of 48.4 ± 35.1 months, all patients showed marked improvements in their clinical status and were still alive without evidence of disease recurrence. Conclusion: With proper patient selection, the cooperation of a multidisciplinary team, and meticulous postoperative management, PEA can be conducted safely with relatively low risk at a center with limited experience with the procedure. AD - H.-H. Hsu, Department of Surgery, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei, Taiwan AU - Luo, W. C. AU - Huang, S. C. AU - Lin, Y. H. AU - Lai, H. S. AU - Kuo, S. W. AU - Pan, S. C. AU - Hsu, H. H. C1 - viagra(Pfizer,Australia) DB - Embase Medline DO - 10.1016/j.jfma.2014.08.009 KW - sildenafil adult aged article chronic thromboembolic pulmonary hypertension clinical article endarterectomy exercise female follow up functional status heart function hospital discharge hospitalization human intensive care unit lung edema male morbidity New York Heart Association class outcome assessment pneumonia postoperative complication preoperative evaluation pulmonary endarterectomy recurrent disease reperfusion lung edema retrospective study survival symptom Taiwan treatment outcome viagra LA - English M1 - 12 M3 - Article N1 - L602682639 2015-03-10 2020-10-07 PY - 2015 SN - 1876-0821 0929-6646 SP - 1197-1203 ST - Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension-A single-center experience in Taiwan T2 - Journal of the Formosan Medical Association TI - Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension-A single-center experience in Taiwan UR - https://www.embase.com/search/results?subaction=viewrecord&id=L602682639&from=export http://dx.doi.org/10.1016/j.jfma.2014.08.009 VL - 114 ID - 761049 ER - TY - JOUR AB - Background/purpose: Pulmonary endarterectomy (PEA) is a potentially curative surgical procedure for patients with chronic thromboembolic pulmonary hypertension. The aim of this study is to review our institutional experience with this operation.Methods: We conducted a retrospective review of PEA performed at our institution between January 2005 and December 2013. The measured outcomes were inhospital complications, improvement in cardiac function and exercise capacity, and actuarial survival after PEA.Results: Ten consecutive patients (7 women, 3 men) underwent PEA with a mean age of 59.9 ± 12.9 years. The preoperative New York Heart Association functional class (NYHA FC) for these patients was either Class III (n = 6) or Class IV (n = 4). The period from symptom onset to diagnosis was 34.3 ± 37.9 months, and that from diagnosis to operation was 31.4 ± 46.8 months. After PEA, the duration of intensive care unit stay and hospital stay prior to discharge were 9.7 ± 5.7 days and 18.7 ± 7.4 days, respectively. Postoperative complications included reperfusion lung edema (n = 3) and pneumonia (n = 1), and all recovered with medical therapy. After a mean follow-up of 48.4 ± 35.1 months, all patients showed marked improvements in their clinical status and were still alive without evidence of disease recurrence.Conclusion: With proper patient selection, the cooperation of a multidisciplinary team, and meticulous postoperative management, PEA can be conducted safely with relatively low risk at a center with limited experience with the procedure. AD - Department of Surgery, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei, Taiwan College of Medicine, National Taiwan University, Number 7, Chung-Shan South Road, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, Number 7, Chung-Shan South Road, Taipei, Taiwan AN - 111892744. Language: English. Entry Date: 20161222. Revision Date: 20190516. Publication Type: journal article AU - Luo, Wei-Cheng AU - Huang, Shu-Chien AU - Lin, Yen-Hung AU - Lai, Hong-Shiee AU - Kuo, Shuenn-Wen AU - Pan, Sung-Ching AU - Hsu, Hsao-Hsun DB - CINAHL DO - 10.1016/j.jfma.2014.08.009 DP - EBSCOhost KW - Hypertension, Pulmonary -- Surgery Pulmonary Artery -- Surgery Lung -- Physiopathology Endarterectomy Postoperative Complications Pulmonary Embolism -- Surgery Chronic Disease -- Therapy Adult Aged Pneumonia -- Etiology Prospective Studies Treatment Outcomes Retrospective Design Male Pulmonary Edema -- Etiology Female Taiwan Middle Age Human M1 - 12 N1 - research. Journal Subset: Biomedical; Europe; UK & Ireland. NLM UID: 9214933. PMID: NLM25267092. PY - 2015 SN - 0929-6646 SP - 1197-1203 ST - Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension--A single-center experience in Taiwan T2 - Journal of the Formosan Medical Association TI - Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension--A single-center experience in Taiwan UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=111892744&site=ehost-live&scope=site VL - 114 ID - 761373 ER - TY - JOUR AB - This paper reports the incidence of trigeminocardiac reflex (TCR) in endovascular treatment of dural arteriovenous fistulas (DAVFs) with Onyx. The consecutive case histories of 45 patients with DAVFs, treated with Onyx transarterially and trans venously, from February 2005 to February 2008 at Beijing Tiantan Hospital, China, were retrospectively reviewed. The time period was limited as the anesthetic and intravascular procedure was performed under the same standardized anesthetic protocol and by the same team. The TCR rate was subsequently calculated. Of the 45 patients, five showed evidence of TCR during transarterial Onyx injection and transvenous DMSO injection. Their HR fell 50% during intravascular procedures compared with levels immediately before the stimulus. However, blood pressure values were stable in all cases. The TCR rate for all patients was 11.1% (95% CI, 4 to 24%), 7.7% (95% CI, 210 21%) in patients treated intraarterially and 33.3% (4 to 78%) in patients treated intravenously. Once HR has fallen, intravenous atropine is indicated to block the depressor response and prevention further TCR episodes. TCR may occur due to chemical stimulus of DMSO and Onyx cast formation under a standardized anesthetic protocol and should be blunted by atropine. AD - [Lv, X.; Li, Y.; Jiang, C.; Wu, Z.] Capital Med Univ, Beijing Tiantan Hosp, Beijing Neurosurg Inst, Beijing 100050, Peoples R China. Wu, Z (corresponding author), Capital Med Univ, Intervent Neuroradiol Dept, Beijing Neurosurg Inst, 6 Tiantan Xili, Beijing 100050, Hebei, Peoples R China. ttyyzjb@sina.com AN - WOS:000281008700007 AU - Lv, X. AU - Li, Y. AU - Jiang, C. AU - Wu, Z. DA - Mar DO - 10.1177/159101991001600107 J2 - Interv. Neuroradiol. KW - trigeminocardiac reflex dural arteriovenous fistula INTRAORBITAL FOREIGN-BODY SKULL BASE SURGERY CEREBELLOPONTINE ANGLE CARDIAC REFLEX ASYSTOLE PREVENTION RHIZOTOMY Clinical Neurology Radiology, Nuclear Medicine & Medical Imaging LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 639WW Times Cited: 25 Cited Reference Count: 26 Lv, X. Li, Y. Jiang, C. Wu, Z. 25 0 1 SAGE PUBLICATIONS INC THOUSAND OAKS INTERV NEURORADIOL PY - 2010 SN - 1591-0199 SP - 59-63 ST - The Incidence of Trigeminocardiac Reflex in Endovascular Treatment of Dural Arteriovenous Fistula with Onyx T2 - Interventional Neuroradiology TI - The Incidence of Trigeminocardiac Reflex in Endovascular Treatment of Dural Arteriovenous Fistula with Onyx UR - ://WOS:000281008700007 VL - 16 ID - 761879 ER - TY - JOUR AB - AIMS: Right ventricular (RV) failure causes death from acute pulmonary embolism (PE), due to a mismatch between RV systolic function and increased RV afterload. We hypothesized that an echocardiographic ratio of this mismatch [RV systolic function by tricuspid annular plane systolic excursion (TAPSE) divided by pulmonary arterial systolic pressure (PASP)] would predict adverse outcomes better than each measurement individually, and would be useful for risk stratification in intermediate-risk PE. METHODS AND RESULTS: This was a retrospective analysis of a single academic centre Pulmonary Embolism Response Team registry from 2012 to 2019. All patients with confirmed PE and a formal transthoracic echocardiogram performed within 2 days were included. All echocardiograms were analysed by an observer blinded to the outcome. The primary endpoint was a 7-day composite outcome of death or haemodynamic deterioration. Secondary outcomes were 7- and 30-day all-cause mortality. A total of 627 patients were included; 135 met the primary composite outcome. In univariate analysis, the TAPSE/PASP was associated with our primary outcome [odds ratio = 0.028, 95% confidence interval (CI) 0.010-0.087; P < 0.0001], which was significantly better than either TAPSE or PASP alone (P = 0.017 and P < 0.0001, respectively). A TAPSE/PASP cut-off value of 0.4 was identified as the optimal value for predicting adverse outcome in PE. TAPSE/PASP predicted both 7- and 30-day all-cause mortality, while TAPSE and PASP did not. CONCLUSION: A combined echocardiographic ratio of RV function to afterload is superior in prediction of adverse outcome in acute intermediate-risk PE. This ratio may improve risk stratification and identification of the patients that will suffer short-term deterioration after intermediate-risk PE. AD - Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, 0 Emerson Place, MA 02114, USA. Department of Cardiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark. Department of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. Biostatistics Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA. AN - 33026070 AU - Lyhne, M. D. AU - Kabrhel, C. AU - Giordano, N. AU - Andersen, A. AU - Nielsen-Kudsk, J. E. AU - Zheng, H. AU - Dudzinski, D. M. DA - Oct 7 DO - 10.1093/ehjci/jeaa243 DP - NLM ET - 2020/10/08 J2 - European heart journal cardiovascular Imaging KW - acute pulmonary embolism echocardiography right ventricular afterload right ventricular function risk stratification LA - eng N1 - 2047-2412 Lyhne, Mads D Kabrhel, Christopher Giordano, Nicholas Andersen, Asger Nielsen-Kudsk, Jens Erik Zheng, Hui Dudzinski, David M Journal Article England Eur Heart J Cardiovasc Imaging. 2020 Oct 7:jeaa243. doi: 10.1093/ehjci/jeaa243. PY - 2020 SN - 2047-2404 ST - The echocardiographic ratio tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure predicts short-term adverse outcomes in acute pulmonary embolism T2 - Eur Heart J Cardiovasc Imaging TI - The echocardiographic ratio tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure predicts short-term adverse outcomes in acute pulmonary embolism ID - 760484 ER - TY - JOUR AB - BACKGROUND: Respiratory alarm monitoring and rapid response team alerts on hospital general floors are based on detection of simple numeric threshold breaches. Although some uncontrolled observation trials in select patient populations have been encouraging, randomized controlled trials suggest that this simplistic approach may not reduce the unexpected death rate in this complex environment. The purpose of this review is to examine the history and scientific basis for threshold alarms and to compare thresholds with the actual pathophysiologic patterns of evolving death which must be timely detected. METHODS: The Pubmed database was searched for articles relating to methods for triggering rapid response teams and respiratory alarms and these were contrasted with the fundamental timed pathophysiologic patterns of death which evolve due to sepsis, congestive heart failure, pulmonary embolism, hypoventilation, narcotic overdose, and sleep apnea. RESULTS: In contrast to the simplicity of the numeric threshold breach method of generating alerts, the actual patterns of evolving death are complex and do not share common features until near death. On hospital general floors, unexpected clinical instability leading to death often progresses along three distinct patterns which can be designated as Types I, II and III. Type I is a pattern comprised of hyperventilation compensated respiratory failure typical of congestive heart failure and sepsis. Here, early hyperventilation and respiratory alkalosis can conceal the onset of instability. Type II is the pattern of classic CO2 narcosis. Type III occurs only during sleep and is a pattern of ventilation and SPO2 cycling caused by instability of ventilation and/or upper airway control followed by precipitous and fatal oxygen desaturation if arousal failure is induced by narcotics and/or sedation. CONCLUSION: The traditional threshold breach method of detecting instability on hospital wards was not scientifically derived; explaining the failure of threshold based monitoring and rapid response team activation in randomized trials. Furthermore, the thresholds themselves are arbitrary and capricious. There are three common fundamental pathophysiologic patterns of unexpected hospital death. These patterns are too complex for early detection by any unifying numeric threshold. New methods and technologies which detect and identify the actual patterns of evolving death should be investigated. AD - Department of Anesthesiology and Perioperative Care, Hoag Memorial Hospital Presbyterian, Newport Beach, CA 92658 USA. pcurry@hoaghospital.org. AN - 21314935 AU - Lynn, L. A. AU - Curry, J. P. C2 - Pmc3045877 DA - Feb 11 DO - 10.1186/1754-9493-5-3 DP - NLM ET - 2011/02/15 J2 - Patient safety in surgery LA - eng M1 - 1 N1 - 1754-9493 Lynn, Lawrence A Curry, J Paul Journal Article Patient Saf Surg. 2011 Feb 11;5(1):3. doi: 10.1186/1754-9493-5-3. PY - 2011 SN - 1754-9493 SP - 3 ST - Patterns of unexpected in-hospital deaths: a root cause analysis T2 - Patient Saf Surg TI - Patterns of unexpected in-hospital deaths: a root cause analysis VL - 5 ID - 760463 ER - TY - JOUR AB - IMPORTANCE: In 2010, national payers announced they would begin using patient satisfaction scores to adjust reimbursements for surgical care. OBJECTIVE: To determine whether patient satisfaction is independent from surgical process measures and hospital safety. DESIGN: We compared the performance of hospitals that participated in the Patient Satisfaction Survey, the Centers for Medicare & Medicaid Services Surgical Care Improvement Program, and the employee Safety Attitudes Questionnaire. SETTING: Thirty-one US hospitals. PARTICIPANTS Patients and hospital employees. INTERVENTIONS: There were no interventions for this study. MAIN OUTCOMES AND MEASURES: Hospital patient satisfaction scores were compared with hospital Surgical Care Improvement Program compliance and hospital employee safety attitudes (safety culture) scores during a 2-year period (2009-2010). Secondary outcomes were individual domains of the safety culture survey. RESULTS: Patient satisfaction was not associated with performance on process measures (antibiotic prophylaxis, R = -0.216 [P = .24]; appropriate hair removal, R = -0.012 [P = .95]; Foley catheter removal, R = -0.089 [P = .63]; deep vein thrombosis prophylaxis, R = 0.101 [P = .59]). In addition, patient satisfaction was not associated with a hospital's overall safety culture score (R = 0.295 [P = .11]). We found no association between patient satisfaction and the individual culture domains of job satisfaction (R = 0.327 [P = .07]), working conditions (R = 0.191 [P = .30]), or perceptions of management (R = 0.223 [P = .23]); however, patient satisfaction was associated with the individual culture domains of employee teamwork climate (R = 0.439 [P = .01]), safety climate (R = 0.395 [P = .03]), and stress recognition (R = -0.462 [P = .008]). CONCLUSIONS AND RELEVANCE: Patient satisfaction was independent of hospital compliance with surgical processes of quality care and with overall hospital employee safety culture, although a few individual domains of culture were associated. Patient satisfaction may provide information about a hospital's ability to provide good service as a part of the patient experience; however, further study is needed before it is applied widely to surgeons as a quality indicator. AD - Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. AN - 23715968 AU - Lyu, H. AU - Wick, E. C. AU - Housman, M. AU - Freischlag, J. A. AU - Makary, M. A. DA - Apr DO - 10.1001/2013.jamasurg.270 DP - NLM ET - 2013/05/30 J2 - JAMA surgery KW - Antibiotic Prophylaxis Attitude of Health Personnel Cohort Studies Device Removal Female Hair Removal/methods Humans Job Satisfaction Male Organizational Culture Patient Care Team/organization & administration *Patient Satisfaction *Quality Indicators, Health Care Regression Analysis Safety Management/organization & administration *Surgical Procedures, Operative Surveys and Questionnaires United States Urinary Catheterization Venous Thrombosis/prevention & control LA - eng M1 - 4 N1 - 2168-6262 Lyu, Heather Wick, Elizabeth C Housman, Michael Freischlag, Julie Ann Makary, Martin A Journal Article Multicenter Study Research Support, Non-U.S. Gov't United States JAMA Surg. 2013 Apr;148(4):362-7. doi: 10.1001/2013.jamasurg.270. PY - 2013 SN - 2168-6254 SP - 362-7 ST - Patient satisfaction as a possible indicator of quality surgical care T2 - JAMA Surg TI - Patient satisfaction as a possible indicator of quality surgical care VL - 148 ID - 760418 ER - TY - JOUR AB - Cerebral venous thrombosis is rare and often under diagnosed in children with nephrotic syndrome. MRI with venography is an essential tool in its diagnosis. Both early diagnosis and the commencement of anticoagulation are paramount for a good outcome. An 8 year old boy diagnosed with steroid dependent nephrotic syndrome with 12 relapses in the 2 years since diagnosis, presents and is admitted for another relapse following an intercurrent illness. Symptoms and signs at the time of admission are lethargy, cough, vomiting, abdominal pain, headache, generalised oedema and ascites. He is treated with high dose steroids and goes into remission within the next 3 days. However, he continues to complain of a headache not improved with analgesia. Magnetic Resonance Imaging (MRI) followed by venography are performed and the diagnosis of a dural sinus thrombosis is made. Initial neurology is intact, however, he develops signs of raised intracranial pressure and requires transfer to a tertiary centre. He is successfully treated with anticoagulants and a therapeutic lumbar puncture. The child is kept on anticoagulants and statins and is kept under follow up. Cerebral infarction is therefore avoided. This case illustrates the importance of the consideration of prothrombotic tendency in children with nephrotic syndrome and what the consequences of this can be. It also highlights an important lesson for all those who look after these children in being vigilant in considering all complications and therefore ensuring they are managed appropriately and successfully within a multidisciplinary team. (Figure Presented). AD - J. Mackintosh, Paediatric Department, Queen's University Hospital, Romford, United Kingdom AU - Mackintosh, J. AU - Solebo, J. AU - Chawda, S. DB - Embase DO - 10.1136/archdischild-2014-306237.350 KW - steroid anticoagulant agent hydroxymethylglutaryl coenzyme A reductase inhibitor cerebral sinus thrombosis child human nephrotic syndrome college pediatrics child health diagnosis relapse phlebography headache nuclear magnetic resonance imaging vomiting brain infarction abdominal pain follow up coughing lethargy diseases lumbar puncture intracranial pressure neurology analgesia boy male remission drug megadose ascites generalized edema anticoagulation early diagnosis L1 - http://adc.bmj.com/content/99/Suppl_1/A151.2.abstract?sid=a89aef74-8afc-4f62-b7c0-11cc9b60cc96 LA - English M3 - Conference Abstract N1 - L71566348 2014-08-21 PY - 2014 SN - 0003-9888 SP - A151 ST - Dural sinus thrombosis in a child with steroid dependent nephrotic syndrome: A case discussion T2 - Archives of Disease in Childhood TI - Dural sinus thrombosis in a child with steroid dependent nephrotic syndrome: A case discussion UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71566348&from=export http://dx.doi.org/10.1136/archdischild-2014-306237.350 VL - 99 ID - 761118 ER - TY - JOUR AB - Background: The inception of a Multidisciplinary Bleeding Disorders/ Obstetric clinic has led to optimal management of pregnant women with IBD as they are known to be at increased risk of bleeding complications in both mother and fetus. Aims: To report on outcomes of 142 pregnancies in 97 consecutive women with IBD who were seen in the last 5 years in our Centre, which is a tertiary referral centre. Methods: Retrospective analysis was conducted going through obstetric and hospital records of patients who were seen in the last 5 years with special attention to bleeding complications, clotting factor use, maternal and fetal outcomes. Details of any previous pregnancies were included for women who presented during this period. Results: Results are presented in the table below. The types of IBD included carriers of haemophilia A and B, VWD, FXI deficiency, platelet function defects and rare bleeding disorders. The last group included fibrinogen disorders, FVII deficiency, FV deficiency, FX deficiency, familial macro-thrombocytopenia and unclassified bleeding disorders. Antepartum haemorrhage (APH) was seen in 5 pregnancies and of these, 3 cases required clotting factor replacement (CFR) - one Haemophilia A carrier woman, one patient with type 2 VWD and one patient with type 3 VWD. Of note, these two patients with VWD had a subsequent pregnancy each and were managed with upfront CFR (three times a week) during these without any bleeding complications. In 6 pregnancies, late amniocentecis was undertaken to inform delivery plans. Significant post-partum haemorrhage was seen in 19 of 142 pregnancies with blood transfusion being required in 5 deliveries. Conclusions: Overall, the maternal and foetal outcomes were excellent in this high risk patient population. The rate of maternal complications was 3.5% for APH and 19% for PPH. No fetal complications were noted. Obstetric management of women with IBD can be optimised using a multidisciplinary team including haematologists, obstetricians and anaesthetists. (Table Presented) . AD - B. Madan, St Thomas' Hospital, Centre for Haemostasis and Thrombosis, London, United Kingdom AU - Madan, B. AU - Al-Fararjeh, F. AU - Gray, G. DB - Embase DO - 10.1002/rth2.12012 KW - blood clotting factor 11 blood clotting factor 7 endogenous compound fibrinogen anesthesist antepartum hemorrhage attention bleeding disorder blood transfusion complication conference abstract controlled study female fetus fetus outcome hematologist hemophilia A hemophilia B high risk patient human joint major clinical study medical record multidisciplinary team obstetric delivery obstetrician postpartum hemorrhage pregnancy retrospective study risk assessment tertiary care center thrombocyte function thrombocytopenia LA - English M3 - Conference Abstract N1 - L624156203 2018-10-09 PY - 2017 SN - 2475-0379 SP - 741-742 ST - Single centre experience of obstetric management of women with inherited bleeding disorders (IBD) in a multidisciplinary joint women's bleeding disorders / obstetric clinic T2 - Research and Practice in Thrombosis and Haemostasis TI - Single centre experience of obstetric management of women with inherited bleeding disorders (IBD) in a multidisciplinary joint women's bleeding disorders / obstetric clinic UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624156203&from=export http://dx.doi.org/10.1002/rth2.12012 VL - 1 ID - 760927 ER - TY - JOUR AB - Background and Purpose-In-hospital mortality is higher for certain medical conditions based on the time of presentation to the emergency department. The primary goal of this study was to determine whether patients with acute ischemic stroke who arrived to the emergency department during a nursing shift change had similar rates of thrombolytic use and functional outcomes compared with patients presenting during nonshift change hours. Methods-A retrospective review of patients with acute ischemic stroke presenting to the emergency department of a primary stroke center from 2005 through 2010. The time to notify the stroke team, perform a head CT scan, and to start intravenous or intra-arterial thrombolysis was assessed. Thrombolysis rates, mortality rate, discharge disposition, change in the National Institutes of Health Stroke Scale, and change in modified Barthel Index at 3 and 12 months were assessed. Results-Of 3133 patients with acute ischemic stroke, 917 met criteria for inclusion. Arrival during nursing shift change, weekends, and July through September had no impact on process times, thrombolysis rates, and functional outcomes. Arrival at night did result in longer time to intra-arterial but not to intravenous thrombolysis, higher mortality rate, and smaller gain in functional status as measured by the modified Barthel Index at 3 months. The degree of emergency department "busyness" also did not influence tissue-type plasminogen activator treatment times. Conclusions-Presentation during a nursing shift change, a time of transition of care, did not delay thrombolytic use in eligible patients with acute ischemic stroke. Presentation with acute ischemic stroke at night did result in delays of care for patients undergoing interventional therapies. (Stroke. 2012;43:1067-1074.) AD - [Madej-Fermo, Olga P.; McCullough, Louise D.] Univ Connecticut, Sch Med, Farmington, CT USA. [Staff, Ilene; Fortunato, Gil] Hartford Hosp, Res Program, Hartford, CT 06115 USA. [Abbott, Lincoln] Hartford Hosp, Dept Emergency Med, Hartford, CT 06115 USA. [McCullough, Louise D.] Hartford Hosp, Dept Neurol, Stroke Ctr, Hartford, CT 06115 USA. McCullough, LD (corresponding author), 263 Farmington Ave,MC 1840, Farmington, CT 06030 USA. lmccullough@uchc.edu AN - WOS:000302124200029 AU - Madej-Fermo, O. P. AU - Staff, I. AU - Fortunato, G. AU - Abbott, L. AU - McCullough, L. D. DA - Apr DO - 10.1161/strokeaha.111.643437 J2 - Stroke KW - delivery of care ischemic stroke outcome shift change thrombolysis IN-HOSPITAL DELAYS TIME MORTALITY ADMISSION WEEKENDS THERAPY CENTERS WEEKDAY ONSET Clinical Neurology Peripheral Vascular Disease LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: 916ST Times Cited: 8 Cited Reference Count: 20 Madej-Fermo, Olga P. Staff, Ilene Fortunato, Gil Abbott, Lincoln McCullough, Louise D. McCullough, Louise/R-2824-2019 Hartford Hospital This work was supported by a research grant from Hartford Hospital Research Fund. 8 0 5 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA STROKE PY - 2012 SN - 0039-2499 SP - 1067-1074 ST - Impact of Emergency Department Transitions of Care on Thrombolytic Use in Acute Ischemic Stroke T2 - Stroke TI - Impact of Emergency Department Transitions of Care on Thrombolytic Use in Acute Ischemic Stroke UR - ://WOS:000302124200029 VL - 43 ID - 761829 ER - TY - JOUR AB - Background: It is speculated that there is overlap between neurologic emergencies and trauma, yet to date there has not been a study looking at the prevalence of neurologic emergencies amongst trauma activations. Objectives: We sought to determine the prevalence of neurologic emergencies in patients presenting to a level I trauma center as trauma team activations (TTAs). We explored a subset of acute ischemic stroke patients to determine delays in management. Methods: This was a retrospective review of trauma registry data capturing all TTAs at a level I trauma and stroke center from 2011 to 2016. Neurologic emergencies were defined as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or status epilepticus. Among patients diagnosed with acute ischemic strokes, we compared stroke metrics with hospital stroke data during the same period. Results: There were 18,859 trauma activations during the study period, of which 117 (0.6%) had a neurologic emergency. There were 52 patients with ischemic stroke (45%), 39 with intracerebral hemorrhage (34%), 15 with subarachnoid hemorrhage (13%), and 10 with status epilepticus (9%). Among the 52 patients with ischemic stroke, 20 (38%) received intravenous thrombolysis. The median time to computed tomography scan was 23 min and the median time to thrombolysis (tissue plasminogen activator) was 60 min. When compared with non-TTA patients during the same time period, both median time to computed tomography scan and time to tissue plasminogen activator were similar (p = 0.16 and p = 0.6, respectively). Conclusions: Neurologic emergencies, though relatively uncommon, do exist among TTAs. Despite the TTA, eligible patients met the benchmarks for acute stroke care delivery. (C) 2019 Elsevier Inc. All rights reserved. AD - [Madhok, Debbie Y.] Univ Calif San Francisco, Dept Emergency Med, Zuckerberg San Francisco Gen Hosp, San Francisco, CA 94110 USA. [Madhok, Debbie Y.; Singh, Vineeta] Univ Calif San Francisco, Zuckerberg San Francisco Gen Hosp, Dept Neurol, San Francisco, CA 94110 USA. [Diaz, Michael A.] Univ Calif San Francisco, Dept Neurol, San Francisco, CA 94110 USA. [Darger, Bryan F.] Univ Calif San Francisco, Dept Emergency Med, San Francisco, CA 94110 USA. [Wybourn, Christopher] Univ Calif San Francisco, Dept Surg, Zuckerberg San Francisco Gen Hosp, San Francisco, CA 94110 USA. Madhok, DY (corresponding author), Univ Calif San Francisco, Zuckerberg San Francisco Gen Hosp, Dept Emergency Med & Neurol, 1001 Potrero Ave,6A, San Francisco, CA 94110 USA. AN - WOS:000496763300026 AU - Madhok, D. Y. AU - Diaz, M. A. AU - Darger, B. F. AU - Wybourn, C. AU - Singh, V. DA - Oct DO - 10.1016/j.jemermed.2019.05.025 J2 - J. Emerg. Med. KW - intracerebral hemorrhage neurologic status epilepticus stroke trauma activation PATIENT IMPACT STROKE CARE Emergency Medicine LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: JN2XH Times Cited: 0 Cited Reference Count: 15 Madhok, Debbie Y. Diaz, Michael A. Darger, Bryan F. Wybourn, Christopher Singh, Vineeta 0 ELSEVIER SCIENCE INC NEW YORK J EMERG MED PY - 2019 SN - 0736-4679 SP - 543-548 ST - NEUROLOGIC EMERGENCIES PRESENTING AS TRAUMA ACTIVATIONS TO AN URBAN LEVEL I TRAUMA CENTER T2 - Journal of Emergency Medicine TI - NEUROLOGIC EMERGENCIES PRESENTING AS TRAUMA ACTIVATIONS TO AN URBAN LEVEL I TRAUMA CENTER UR - ://WOS:000496763300026 VL - 57 ID - 761487 ER - TY - JOUR AB - Introduction: Laparoscopic adrenalectomy is a treatment option in patients with Cushing's syndrome. Preoperative comorbities as well as surgical and anesthesiological difficulties can make the procedure challenging. Presentation of the case: We present the case of a 53-year-old obese man diagnosed with Cushing's syndrome, also suffering from other endocrine pathologies, neurofibromatosis type 2, cardiomiopathy with severe hypertrophy and diastolic dysfunction, deep vein thrombosis (DVT) and obstructive sleep apnea syndrome (OSAS). After multidisciplinary team discussion of the case, the patient underwent laparoscopic synchronous bilateral adrenalectomy. The laparoscopic approach was a part of a balanced enhanced recovery program which resulted in uneventful discharge in 4 days. Conclusion: Laparoscopic synchronous bilateral adrenalectomy is feasible and effective and should be considered also in patients with wide preoperative comorbidities and challenging intraoperative management, as long as the patient is meticulously studied preoperatively. An approach including a multidisciplinary team discussion is recommended. AD - F. Ziglioli, University-Hospital of Parma, Department of Urology, Via Gramsci 14, Parma, Italy AU - Maestroni, U. AU - Cataldo, S. AU - Moretti, V. AU - Baciarello, M. AU - Maspero, G. AU - Ziglioli, F. DB - Embase DO - 10.1016/j.amsu.2018.07.015 KW - computed tomography scanner vena cava filter bilirubin cisatracurium cortisone acetate fentanyl hydrocortisone lidocaine noradrenalin propofol remifentanil sevoflurane adrenal hyperplasia adrenalectomy adult article case report clinical article computer assisted tomography coronary artery disease Cushing disease dysphonia endotracheal intubation follow up gamma knife radiosurgery histopathology hormone substitution human hypertension hypertransaminasemia laparoscopic surgery lower extremity deep vein thrombosis male middle aged morbid obesity neurilemoma neuroendocrine tumor neurofibromatosis type 2 pneumoperitoneum pons angle tumor priority journal sleep disordered breathing spinal cord tumor toxic goiter LA - English M3 - Article N1 - L2001266313 2018-11-16 2018-12-13 PY - 2018 SN - 2049-0801 SP - 261-263 ST - A challenging case of laparoscopic synchronous bilateral adrenalectomy for Cushing's disease. Case report T2 - Annals of Medicine and Surgery TI - A challenging case of laparoscopic synchronous bilateral adrenalectomy for Cushing's disease. Case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001266313&from=export http://dx.doi.org/10.1016/j.amsu.2018.07.015 VL - 36 ID - 760784 ER - TY - JOUR AB - Background: It remains unclear whether interstitial lung disease (ILD) in common variable immunodeficiency (CVID) is a consequence of chronic infection or a manifestation of dysregulated lymphoid proliferation found in those with this condition.Objective: To increase understanding of CVID-associated lung disease by comparing clinical and immunologic associations in those with bronchiectasis, ILD, or no lung disease observed on chest computerized tomography (CT).Methods: Retrospective review of electronic medical records of 61 patients with CVID was used to identify clinical and laboratory correlates of bronchiectasis, ground glass opacity, and pulmonary nodules on CT scan.Results: Significant clinical and immunologic associations were identified for common CT scan findings in CVID. Bronchiectasis was strongly correlated with a CD4+ T-cell count lower than 700 cells/μL and was associated with a history of pneumonia and older age. Pulmonary nodular disease was correlated with increased CD4+:CD8+ T-cell ratios, a history of autoimmune hemolytic anemia or immune thrombocytopenic purpura, elevated IgM, and younger age. Ground glass opacity had similar clinical and laboratory characteristics as those for nodular lung disease but was associated with elevated monocyte counts and the presence of liver disease.Conclusion: CT findings of bronchiectasis or ILD, including ground glass opacity and extensive pulmonary nodules, were correlated with selected clinical and laboratory characteristics. These results suggest divergent processes of CVID lung disease, with bronchiectasis more strongly associated with infection and T-cell lymphopenia and ILD more strongly linked with autoimmunity and lymphoproliferation. AD - Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York. Department of Health Evidence and Policy, Icahn School of Medicine at Mount Sinai, New York, New York. Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: Charlotte.Cunningham-Rundles@mssm.edu. AN - 103847587. Language: English. Entry Date: 20150424. Revision Date: 20161117. Publication Type: journal article AU - Maglione, Paul J. AU - Overbey, Jessica R. AU - Radigan, Lin AU - Bagiella, Emilia AU - Cunningham-Rundles, Charlotte DB - CINAHL DO - 10.1016/j.anai.2014.04.024 DP - EBSCOhost KW - Bronchiectasis -- Radiography Immunologic Deficiency Syndromes -- Radiography Lung Diseases, Interstitial -- Radiography Lung Neoplasms -- Radiography Adolescence Adult Aged Aged, 80 and Over Anemia, Hemolytic -- Immunology Bronchiectasis -- Immunology CD4 Lymphocyte Count T Lymphocytes -- Immunology Electronic Health Records Female Human Immunoglobulins -- Blood Lung -- Radiography Lung Diseases, Interstitial -- Diagnosis Lung Diseases, Interstitial -- Etiology Male Middle Age Lung Neoplasms -- Immunology Pneumonia -- Immunology Purpura, Thrombocytopenic -- Immunology Retrospective Design Tomography, X-Ray Computed Young Adult M1 - 4 N1 - research. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: AI 061093/AI/NIAID NIH HHS/United States. NLM UID: 9503580. PMID: NLM24880814. PY - 2014 SN - 1081-1206 SP - 452-459 ST - Pulmonary radiologic findings in common variable immunodeficiency: clinical and immunological correlations T2 - Annals of Allergy, Asthma & Immunology TI - Pulmonary radiologic findings in common variable immunodeficiency: clinical and immunological correlations UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=103847587&site=ehost-live&scope=site VL - 113 ID - 761374 ER - TY - JOUR AB - Introduction: Many authors have written about the need to treat patients closer to their beds, in order to observe them more as distinct people. The FAST HUG mnemonic, which consists of a checklist, was suggested as an idea to be employed everyday, by professionals dealing with patients who are critically ill. Minding these questions and motivated by an idea of follow patients' treatment closer, we have put into practice the instrument developed by Jean-Louis Vincent, evaluating the seven most important procedures in critically ill patients, and performed the FAST HUG. This checklist consists of seven items to be evaluated: Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control. Knowing that the pressure ulcer is one of the challenges faced by ICU nurses, related to patients' need to stay at rest, to be under rigorous control or more complex therapy, it was decided to create the eighth item on the checklist: S, for skin. It stands for skin treatment, with the techniques used in the unit (Braden Scale), monitoring and evaluating closer skin integrity, and allowing nurses to calculate the scoring average of the Braden Scale, and greater incidence of ulcer in interned patients. Objective: To expose the shortcomings found during the FAST HUG application, and to show results obtained with the eighth item of the FAST HUG mnemonic: S - Skin. Methods: A descriptive study, based on institutional data, was carried out in the adult ICU of a private hospital. It was performed from 2 to 27 June 2008, except on weekends. Three hundred and twenty-three patients were involved. The checklist was carried out during the afternoons by the head nurse, or the assistant nurse of the unit. In order to do this job, a spreadsheet was elaborated to control data, updated every week. This spreadsheet provided graphics for a more objective control of the results obtained. The idea was exposed to the team, during a training program, and so we started the activities. Results and discussion: For 20 days of the checklist, 323 patients were evaluated for the eight items. The real shortcomings most frequently found were related to thromboembolic prophylaxis (85%) and glucose control (90%). These shortcomings were immediately evaluated and, depending on this analysis, this item would go on or not, according to the patient's clinical situation. The shortcomings found were tracked just as they were detected, and their cause would be discussed in a multidisciplinary group, and a solution was found. If the item was not observed, it would be (Figure presented) written down but not treated as a real shortcoming. The changes in medial prescription were done immediately. In cases where the patient did not show a favorable situation for the utilization of thromboembolic prophylaxis (bleeding, presurgical, among others), it would be treated as a nonreal shortcoming. The same was done for glucose control. We realized that after 4 weeks using this instrument there was a small reduction of shortcomings in glucose control (Figure 1), and a discrete raise in thromboembolic prophylaxis (Figure 2). From this point we reviewed the checklist, in order to provide a field to write down real shortcomings, so that they are given more relevance and treatment, since the patients' clinical situation deserves different treatments that do not interfere in the unit's quality of service. The inclusion of skin evaluation through the Braden Scale was an opportunity to follow patients' skin, by means of risk evaluation to develop wounds, providing data on the daily scoring average of the Braden Scale and the spot where these wounds were more frequent. An average Braden score of 13.65 (Figure 3) was verified, and it was also seen that the greater incidence of pressure ulcer was in the sacral region (44.75%) (Figure 4). Conclusions: It can be concluded that FAST HUG, in addition to being a tool to evaluate assisting quality and to assure patients that their needs will be fulfilled while they remain in the ICU, may b considered a boost to overcome new challenges. Along with the (Figure presented) checklist, a reduction of shortcomings found in glucose control was observed and a rigorous multidisciplinary evaluation of patients with contraindications to the use of prophylaxis of TEV. Also, we could see a greater attention of the multidisciplinary team to the results provided by the evaluation of skin wound risk, since they offer a significant prognostic value. AD - G.B. Magnan, Santa Luzia Hospital, Brasília, DF, Brazil AU - Magnan, G. B. AU - Vargas, R. S. AU - Lins, L. F. AU - Mendonc¸a, K. R. AU - Barbosa, M. AU - Rocha, P. R. AU - Maia, M. O. DB - Embase DO - 10.1186/cc7803 KW - glucose checklist South and Central America private hospital emergency medicine intensive care patient skin prophylaxis Braden Scale thromboembolism nurse critically ill patient decubitus risk wound sedation therapy analgesia feeding monitoring ulcer adult head nurse work training prescription bleeding prevention stress ulcer skin injury LA - English M3 - Conference Abstract N1 - L70339917 2011-02-14 PY - 2009 SN - 1364-8535 ST - FAST HUG in an ICU at a private hospital in Brasília: Checklist and the eighth evaluation item T2 - Critical Care TI - FAST HUG in an ICU at a private hospital in Brasília: Checklist and the eighth evaluation item UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70339917&from=export http://dx.doi.org/10.1186/cc7803 VL - 13 ID - 761277 ER - TY - JOUR AB - Background: Heparin induced thrombocytopenia(HIT) is a rare and potentially life-or limb-threatening complication. HIT misdiagnosis may cause exposure to high-cost, unindicated anticoagulants with high bleeding risk. Anticoagulation treatment is typically initiated when a heparin induced platelet antibody(HIPAB) is ordered. Prior studies including a pharmacy/lab intervention have demonstrated a reduction in inappropriate ordering of HIT labs by utilizing the 4T score and contacting the physician for low risk patients. Aims: We hypothesized that a pharmacy-led, multidisciplinary team-based intervention with 4T pre-test probability would reduce inappropriate HIPAB tests, reduce costs, and decrease exposure to high-risk anticoagulants. A previous retrospective study of our system revealed that 81% (47/58) of patients tested in a 3 month period were low risk and unindicated. Methods: In March 2016, the laboratory began notifying the pharmacy when HIPAB tests were ordered. A pharmacist would calculate a 4T score, contact the ordering provider and suggest test cancellation if low (≤3) risk. Special coagulation pathologists provided clinical support to the pharmacist if needed. Results: After eight months, only 14. 8% (16/108) of HIPAB tests were unindicated. The intervention resulted in a decrease of inappropriate HIT testing by 66. 2% and estimated cost savings of $45,000. Average monthly tests decreased from 23 ordered and 23 processed to 14. 5 and 7. 1 per month, respectively in the same time frame, with an 86% acceptance of cancelling HIPAB for recommended patients. Overall ordered HIT labs decreased from 219 in 2015 down to 50 in 2016 increasing HIPAB yield from 10% to 44%. Conclusions: A joint multidisciplinary team based intervention with Pharmacists, Pathologists, and special coagulation technicians can result in improved patient care and cost savings. This study provides validation that a pharmacist intervention and multidisciplinary approach in multiple hospitals systems can improve patient care as related to HIT. AD - C. Mahan, University of New Mexico, Presbyterian Healthcare Services, College of Pharmacy, Albuquerque, United States AU - Mahan, C. AU - Kelly, L. AU - Pierce, A. AU - Burnett, A. AU - Haghamad, A. DB - Embase DO - 10.1002/rth2.12012 KW - endogenous compound heparin thrombocyte antibody adult anticoagulation community hospital conference abstract cost control female heparin induced thrombocytopenia human joint low risk patient major clinical study male multicenter study multidisciplinary team pathologist patient care pharmacist pharmacy (shop) probability retrospective study risk assessment validation process LA - English M3 - Conference Abstract N1 - L624157699 2018-10-09 PY - 2017 SN - 2475-0379 SP - 1355 ST - Anticoagulation stewardship program for heparin induced thrombocytopenia: A cooperative effort between a community hospital system pharmacy anticoagulation service and an associated reference laboratory T2 - Research and Practice in Thrombosis and Haemostasis TI - Anticoagulation stewardship program for heparin induced thrombocytopenia: A cooperative effort between a community hospital system pharmacy anticoagulation service and an associated reference laboratory UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624157699&from=export http://dx.doi.org/10.1002/rth2.12012 VL - 1 ID - 760928 ER - TY - JOUR AB - PURPOSE: Management of sub-massive and massive acute PE is challenging. The role of multidisciplinary teams for the care of these patients is emerging. Herein, we report our experience with a PERT comprising of members from Pulmonary/Critical Care, Vascular Medicine, Cardiology, Cardiothoracic surgery, Emergency Medicine and Interventional Radiology. METHODS: We conducted a retrospective chart review on all patients admitted to the medical ICU who required activation of the Pulmonary Embolism Response team (PERT) from January 2015- February 2016. We extracted data pertaining to clinical presentation, bleeding complications, and pre- and post-discharge imaging. Patients were classified as low risk, sub-massive or massive PE. Upon activation of the PERT, a virtual meeting was held between its members and after deliberation, patients received low-dose tPA, full dose tPA, catheter directed tPA, surgical embolectomy or anticoagulation alone. These patients were followed up after discharge in the vascular medicine clinic. Patients with incomplete follow up data were excluded from the analysis. RESULTS: 84 patients were evaluated by the team. Complete data were available in 71 patients. 8 (11.3%) patients were classified as low risk, 50(70.4%) sub-massive PE and 13(18.3%) massive PE. 52(73.2%) patients had a lower extremity DVT. 55(77.5%) had abnormal vital signs on admission to the ICU and 63(88.7%) patients had evidence of right ventricular (RV) strain on Echo or CT. 9(12.7%) patients were treated with catheter directed tPA , 3(4.2%) received full dose tPA, 11(15.5%) received low-dose tPA, 2(2.8%) underwent a surgical embolectomy and 1(1.4%) underwent suction thrombectomy(everyone received full dose anticoagulation with heparin). 29(40.8%) patients received an IVC filter. 16 patients had bleeding complications. 4 (44%) patients in the catheter directed tPA group had clinically significant bleeding. There were no bleeding complications among patients who received low-dose or full dose tPA. 12(25%) patients who received anticoagulation without tPA had documented bleeding. 5(7%) patients died while in the medical ICU. There were no deaths among patients who received any form of tPA. All 11 patients who were treated with low-dose tPA normalized their vitals and also did not show signs of RV strain on discharge and follow up Echo after three to six months compared to 2(22.2%) of the patients treated with catheter directed tPA who still had signs of RV strain. The mean reduction in RVSP on follow up was 29 ± 12 mmHg in the low-dose tPA group compared to 14 ± 15 mmHg in patients treated with catheter directed tPA and 17 ± 11 mmHg among patients who received anticoagulation only. CONCLUSIONS: A multidisciplinary approach to cases of sub-massive and massive PE can be implemented successfully. In our limited cohort, patients who received low-dose tPA had lower bleeding risk, higher resolution of RV strain and greater reduction in RVSP on follow up Echo compared to patients who received catheter directed tPA or anticoagulation alone. AD - J. Mahar, Cleveland Clinic Foundation, Cleveland, OH, United States AU - Mahar, J. AU - Sadana, D. AU - Nguyen, N. AU - Bauer, S. AU - Haddadin, I. AU - Shishehbor, M. AU - Smedira, N. AU - Erwin, P. AU - Militello, M. AU - Zhen-Yu, M. AU - Evans, N. AU - Bartholomew, J. AU - Heresi, G. DB - Embase DO - 10.1016/j.chest.2016.08.1266 KW - endogenous compound heparin tissue plasminogen activator anticoagulation bleeding cardiology catheter clinical trial complication controlled study death embolectomy emergency medicine filter follow up heart right ventricle human imaging interventional radiology low drug dose lower limb lung embolism major clinical study medical intensive care unit medical record review suction surgery thorax surgery thrombectomy vital sign LA - English M1 - 4 M3 - Conference Abstract N1 - L613468150 2016-12-05 PY - 2016 SN - 1931-3543 SP - 1157A ST - A pulmonary embolism response team (PERT) approach: Early experience from the cleveland clinic T2 - Chest TI - A pulmonary embolism response team (PERT) approach: Early experience from the cleveland clinic UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613468150&from=export http://dx.doi.org/10.1016/j.chest.2016.08.1266 VL - 150 ID - 760998 ER - TY - JOUR AB - Management of intermediate and high risk acute pulmonary embolism (PE) is challenging. The role of multidisciplinary teams for the care of these patients is emerging. Herein, we report our experience with a pulmonary embolism response team (PERT). We conducted a retrospective chart review on all patients admitted to the Cleveland Clinic main campus who required activation of the (PERT) from October 1, 2014 to September 1, 2016. We extracted data pertaining to clinical presentation, bleeding complications, and pre- and post-discharge imaging. Patients were classified as low, intermediate or high risk PE. Descriptive and continuous variables were collected and analyzed. There were 134 PERT activations. PE was confirmed by CT-PA in 118 patients. Fifteen (13%) patients were classified as low risk, 80 (68%) intermediate risk PE and 23 (19%) high risk PE. Fourteen (12%) patients were treated with catheter directed rtPA, 6 (5%) received full dose (100 mg rtPA), 16 (13%) received systemic half-dose (50 mg rtPA), 6 (5%) underwent a surgical embolectomy and 4 (3%) underwent mechanical thrombectomy. 65 (55%) patients received anticoagulation only, and 8 (7%) patients were managed conservatively without any anticoagulation or advanced therapy. 11 (9%) patients died while during the hospitalization. Fourteen patients had major bleeding events. There were no bleeding events among patients who received systemic low dose or full dose rtPA. A multidisciplinary approach to cases of intermediate risk and high risk PE can be implemented successfully. We saw a relatively low rate of bleeding events with use of rtPA. AD - Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Internal Medicine Residency Program, Cleveland Clinic Foundation, Cleveland, OH, USA. Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA. Heart & Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. Pharmacy Services, Cleveland Clinic Foundation, Cleveland, OH, USA. Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. University Hospitals, Cleveland, OH, USA. Respiratory Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A90, Cleveland, OH, 44195, USA. heresig@ccf.org. AN - 29855780 AU - Mahar, J. H. AU - Haddadin, I. AU - Sadana, D. AU - Gadre, A. AU - Evans, N. AU - Hornacek, D. AU - Mahlay, N. F. AU - Gomes, M. AU - Joseph, D. AU - Serhal, M. AU - Tong, M. Z. AU - Bauer, S. R. AU - Militello, M. AU - Silver, B. AU - Shishehbor, M. AU - Bartholomew, J. R. AU - Heresi, G. A. DA - Aug DO - 10.1007/s11239-018-1686-2 DP - NLM ET - 2018/06/02 J2 - Journal of thrombosis and thrombolysis KW - Adult Aged Anticoagulants/therapeutic use Disease Management Embolectomy Hemorrhage/chemically induced/etiology Humans Middle Aged Patient Care Team/*standards Pulmonary Embolism/complications/*therapy Retrospective Studies Risk Assessment Thrombectomy Thrombolytic Therapy Tissue Plasminogen Activator/therapeutic use Anticoagulation Pert Pulmonary embolism Thrombolysis LA - eng M1 - 2 N1 - 1573-742x Mahar, Jamal H Haddadin, Ihab Sadana, Divyajot Gadre, Abishek Evans, Natalie Hornacek, Deborah Mahlay, Natalia Fendrikova Gomes, Marcelo Joseph, Douglas Serhal, Maya Tong, Michael Zhen-Yu Bauer, Seth R Militello, Michael Silver, Bernard Shishehbor, Mehdi Bartholomew, John R Heresi, Gustavo A Journal Article Netherlands J Thromb Thrombolysis. 2018 Aug;46(2):186-192. doi: 10.1007/s11239-018-1686-2. PY - 2018 SN - 0929-5305 SP - 186-192 ST - A pulmonary embolism response team (PERT) approach: initial experience from the Cleveland Clinic T2 - J Thromb Thrombolysis TI - A pulmonary embolism response team (PERT) approach: initial experience from the Cleveland Clinic VL - 46 ID - 760115 ER - TY - JOUR AB - Management of intermediate and high risk acute pulmonary embolism (PE) is challenging. The role of multidisciplinary teams for the care of these patients is emerging. Herein, we report our experience with a pulmonary embolism response team (PERT). We conducted a retrospective chart review on all patients admitted to the Cleveland Clinic main campus who required activation of the (PERT) from October 1, 2014 to September 1, 2016. We extracted data pertaining to clinical presentation, bleeding complications, and pre- and post-discharge imaging. Patients were classified as low, intermediate or high risk PE. Descriptive and continuous variables were collected and analyzed. There were 134 PERT activations. PE was confirmed by CT-PA in 118 patients. Fifteen (13%) patients were classified as low risk, 80 (68%) intermediate risk PE and 23 (19%) high risk PE. Fourteen (12%) patients were treated with catheter directed rtPA, 6 (5%) received full dose (100 mg rtPA), 16 (13%) received systemic half-dose (50 mg rtPA), 6 (5%) underwent a surgical embolectomy and 4 (3%) underwent mechanical thrombectomy. 65 (55%) patients received anticoagulation only, and 8 (7%) patients were managed conservatively without any anticoagulation or advanced therapy. 11 (9%) patients died while during the hospitalization. Fourteen patients had major bleeding events. There were no bleeding events among patients who received systemic low dose or full dose rtPA. A multidisciplinary approach to cases of intermediate risk and high risk PE can be implemented successfully. We saw a relatively low rate of bleeding events with use of rtPA. AD - G.A. Heresi, Respiratory Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A90, Cleveland, OH, United States AU - Mahar, J. H. AU - Haddadin, I. AU - Sadana, D. AU - Gadre, A. AU - Evans, N. AU - Hornacek, D. AU - Mahlay, N. F. AU - Gomes, M. AU - Joseph, D. AU - Serhal, M. AU - Tong, M. Z. Y. AU - Bauer, S. R. AU - Militello, M. AU - Silver, B. AU - Shishehbor, M. AU - Bartholomew, J. R. AU - Heresi, G. A. DB - Embase Medline DO - 10.1007/s11239-018-1686-2 KW - extracorporeal membrane oxygenation device alteplase anticoagulant agent adult aged anticoagulant therapy article bleeding brain hemorrhage embolectomy female gastrointestinal hemorrhage hematuria hemoptysis high risk patient hospital admission hospital discharge hospitalization human low risk patient lung embolism major clinical study male mechanical thrombectomy muscle bleeding pericardial effusion priority journal rapid response team retrospective study vagina bleeding work experience LA - English M1 - 2 M3 - Article N1 - L622434458 2018-06-08 2018-11-21 PY - 2018 SN - 1573-742X 0929-5305 SP - 186-192 ST - A pulmonary embolism response team (PERT) approach: initial experience from the Cleveland Clinic T2 - Journal of Thrombosis and Thrombolysis TI - A pulmonary embolism response team (PERT) approach: initial experience from the Cleveland Clinic UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622434458&from=export http://dx.doi.org/10.1007/s11239-018-1686-2 VL - 46 ID - 760809 ER - TY - JOUR AB - Background Central venous catheter (CVC) is used for measuring hemodynamic variables, transfusion of blood, fluids and medications when peripheral vascular lack sufficiency. Unfortunately CVC is associated with many complications ranging from anxiety and discomfort for the patient to severe mechanical side effects such as arterial lacerations, pleural and pericardial injury as well as infection and thrombosis. This study aimed to survey of a practical approach to central venous catheterization in pediatric patients. Materials and Methods In this retrospective and descriptive study, rate of success and complications of central venous catheterization by the anesthesia team for the hospitalized children 0-15 years from 2009 to 2016 years at Mofid Children Hospital, Tehran-Iran, were investigated. Advancement of catheters tips in pleural space; peritoneal cavity and pericardium were recognized by rat tail blood flow as a practical approach which was proved by chest X-ray. Successful rate and complications of inserting CVC were collected by researchers using medical records of the patients. Results There were 2,385 (53%) female and 2,115 (47%) male patients. Patient's age ranged from 1 month to 10 years, mean 12.25 +/- 6.45 months. About 4,500 patients who underwent central venous catheterization were investigated that 815 patients (18%) had improper catheterization in the internal jugular and 374 patients (8%) had accidental arterial injury and 160 patients (3%) had accidental pleural injury. Accidental pleural injury were recognized by rat tail blood flow in the liquid column connected to the catheter to the patient's bedside and all of them was proven by taking control image. Conclusion Using rat tail blood flow as a practical approach to central venous catheterization in pediatric patients can be associated with prevention of the plural injury and subsequent pneumothorax and hemothorax. AD - [Mahdavi, Alireza; Sadeghi, Afsaneh] Shahid Beheshti Univ Med Sci, Anesthesiol Res Ctr, Tehran, Iran. [Panah, Ashkan] Shiraz Univ Med Sci, Shiraz, Iran. Sadeghi, A (corresponding author), Shahid Beheshti Univ Med Sci, Pediat Anaesthesiolog Mofid Hosp, Tehran, Iran.; Sadeghi, A (corresponding author), Mofid Pediat Hosp, Tehran, Iran. are20935@yahoo.com AN - WOS:000433250000014 AU - Mahdavi, A. AU - Panah, A. AU - Sadeghi, A. DA - Jun DO - 10.22038/ijp.2018.29953.2649 J2 - Int. J. Pediatr.-Masshad KW - Central Venous Catheters Pediatrics Pneumothorax INTENSIVE-CARE PATIENTS VEIN CATHETERIZATION COMPLICATIONS CHILDREN MANAGEMENT ACCESS PAIN Pediatrics LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: GH2RS Times Cited: 0 Cited Reference Count: 22 Mahdavi, Alireza Panah, Ashkan Sadeghi, Afsaneh Panah, Ashkan/O-3410-2017 Panah, Ashkan/0000-0002-2123-4127 0 4 MASHHAD UNIV MED SCIENCES MASHHAD INT J PEDIATR-MASSHA PY - 2018 SN - 2345-5047 SP - 7843-7849 ST - Survey of a Practical Approach to Central Venous Catheterization in Pediatric Patients T2 - International Journal of Pediatrics-Mashhad TI - Survey of a Practical Approach to Central Venous Catheterization in Pediatric Patients UR - ://WOS:000433250000014 VL - 6 ID - 761586 ER - TY - JOUR AB - Chronic thromboembolic pulmonary hypertension (CTEPH), a rare consequence of an acute pulmonary embolism, is a disease that is underdiagnosed, and surgical pulmonary thromboendarterectomy (PTE) remains the preferred therapy. However, determination of operability is multifactorial and can be challenging. There is growing excitement for the percutaneous treatment of inoperable CTEPH with data from multiple centers around the world showing the clinical feasibility of balloon pulmonary angioplasty. Riociguat remains the only approved medical therapy for CTEPH patients deemed inoperable or with persistent pulmonary hypertension after PTE. We recommend that expert multidisciplinary CTEPH teams be developed at individual institutions. Additionally, optimal and standardized techniques for balloon pulmonary angioplasty need to be developed along with dedicated interventional equipment and appropriate training standards. In the meantime, the percutaneous revascularization option is appropriate for patients deemed inoperable in combination with targeted medical therapy, or those who have failed to benefit fromsurgery. (C) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. AD - [Mahmud, Ehtisham; Ang, Lawrence; Behnamfar, Omid; Patel, Mitul P.] Univ Calif San Diego, Div Cardiovasc Med, La Jolla, CA 92093 USA. [Madani, Michael M.] Univ Calif San Diego, Div Cardiothorac Surg, La Jolla, CA 92093 USA. [Kim, Nick H.; Poch, David; Auger, William R.] Univ Calif San Diego, Sulpizio Cardiovasc Ctr, Div Pulm & Crit Care Med, La Jolla, CA 92093 USA. [Kim, Nick H.] Actelion, Allschwil, Switzerland. [Kim, Nick H.] Bayer, Leverkusen, Germany. [Kim, Nick H.] Merck, Hyderabad, Telangana, India. [Kim, Nick H.; Poch, David] Speakers Bur Bayer, Leverkusen, Germany. [Auger, William R.] Bayers CTEPH Image Expert Panel, Basel, Switzerland. Mahmud, E (corresponding author), Univ Calif San Diego, Sulpizio Cardiovasc Ctr, 9434 Med Ctr Dr, La Jolla, CA 92037 USA. emahmud@ucsd.edu AN - WOS:000432962100012 AU - Mahmud, E. AU - Madani, M. M. AU - Kim, N. H. AU - Poch, D. AU - Ang, L. AU - Behnamfar, O. AU - Patel, M. P. AU - Auger, W. R. DA - May DO - 10.1016/j.jacc.2018.04.009 J2 - J. Am. Coll. Cardiol. KW - INTERNATIONAL PROSPECTIVE REGISTRY BEAM COMPUTED-TOMOGRAPHY LONG-TERM OUTCOMES RISK-FACTORS ARTERIAL-HYPERTENSION ENDARTERECTOMY SURGERY CIRCULATORY ARREST IMAGING TECHNIQUES DEEP HYPOTHERMIA ANGIOPLASTY Cardiac & Cardiovascular Systems LA - English M1 - 21 M3 - Review N1 - ISI Document Delivery No.: GG8QD Times Cited: 31 Cited Reference Count: 113 Mahmud, Ehtisham Madani, Michael M. Kim, Nick H. Poch, David Ang, Lawrence Behnamfar, Omid Patel, Mitul P. Auger, William R. BayerBayer AG Dr. Kim has been a consultant for Actelion, Bayer, and Merck; and has served on the Speakers Bureau for Bayer. Dr. Poch has been a consultant; and has served on the Speakers Bureau for Bayer. Dr. Auger has served as an advisory board member (uncompensated) for Bayer's CTEPH Image Expert Panel; and has received research funding from Bayer for the CTEPH registry. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. 34 0 3 ELSEVIER SCIENCE INC NEW YORK J AM COLL CARDIOL PY - 2018 SN - 0735-1097 SP - 2468-2486 ST - Chronic Thromboembolic Pulmonary Hypertension T2 - Journal of the American College of Cardiology TI - Chronic Thromboembolic Pulmonary Hypertension UR - ://WOS:000432962100012 VL - 71 ID - 761587 ER - TY - JOUR AB - Introduction: Inappropriate prescribing leads to medication-related harm, increase in hospital admissions and healthcare costs. Due to the complexity of the prescribing process, improvements are more likely to be effective if being multidisciplinary, multifaceted and tailor-made. Therefore Participatory Action Research (PAR), a research approach that involves relevant stakeholders to improve complex problems by tailormade interventions, could be useful. Objectives: To explore if a multidisciplinary team using PAR is effective in reducing in-hospital prescribing errors (PEs). Methods: A prospective pre- and post-intervention study was performed between June 2015 and April 2018 involving 12 clinical wards of Amsterdam UMC - location VUmc. A multidisciplinary 'pharmacotherapy team' was compiled, consisting of two physicians/clinical pharmacologists, a hospital pharmacist, an internist and a quality consultant. The team identified relevant stakeholders (specialists, junior doctors and nurses) per ward and coordinated a 10-month intervention. Interventions focused on organizational (e.g. redesigning working process), disciplinal (e.g. improving guideline accessibility) and individual aspects (e.g. education). Medications orders (MOs) of patients admitted to these wards were screened for PEs using a structured medication review. Identified PEs were categorized by the team according to the NCCMERP classification. Results: 273 patients with 2683 MOs were included in the pre- and 178 patients with 2233 MOs in the post-intervention period. The total of MOs containing ≥ 1 PE decreased from 13.6% (SD 17.6) during pre-intervention period to 12.5% (SD 14.8) versus the post-intervention period, although this difference was not statistically significant (p = 0.69). There were differences in reduction between medical and surgical wards ranging from 1.0 - 6.0%. During the pre- and post-intervention period, incorrect dosage (respectively 38.3% and 53.8% of all PEs) and unknown indication (respectively 32.9% and 31.7% of all PEs) were the most common PEs. Summary / Conclusions: A multidisciplinary team using PAR was not effective in overall reduction of in-hospital PEs, although there were differences in reduction between wards. Critical success factors were dedicated on-ward stakeholders. Specific focus on high risk patients or high risk medications in future studies might possibly have more impact. AD - R.F. Mahomedradja, Section Pharmacotherapy, Dept. Internal Medicine, Amsterdam, Netherlands AU - Mahomedradja, R. F. AU - Bekema, J. K. AU - Brinkman, D. J. AU - Sigaloff, K. C. AU - Kuijvenhoven, M. A. AU - Van Agtmael, M. A. DB - Embase DO - 10.1007/s00228-019-02685-2 KW - adult conference abstract consultation controlled study doctor nurse relation education error female high risk patient hospital pharmacist human internist intervention study major clinical study male multidisciplinary team participatory action research pharmacologist practice guideline prescription prospective study risk assessment surgical ward LA - English M3 - Conference Abstract N1 - L628798070 2019-08-08 PY - 2019 SN - 1432-1041 SP - S65-S66 ST - The pharmacotherapy team: a novel multidisciplinary strategy using participatory action research to improve appropriate in-hospital prescribing T2 - European Journal of Clinical Pharmacology TI - The pharmacotherapy team: a novel multidisciplinary strategy using participatory action research to improve appropriate in-hospital prescribing UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628798070&from=export http://dx.doi.org/10.1007/s00228-019-02685-2 VL - 75 ID - 760705 ER - TY - JOUR AB - Use of peripheral venous catheters (PVCs) is very common in hospitals. According to the literature, after a visit to the emergency department >75% of hospitalised patients carry a PVC, among which almost 50% are useless. In this study, the presence and complications of PVCs in an infectious diseases (ID) unit of a French tertiary-care university hospital were monitored. A total of 614 patients were prospectively included over a 6-month period. Among the 614 patients, 509 (82.9%) arrived in the ID unit with a PVC, of which 260 (51.1%) were judged unnecessary and were removed as soon as the patients were examined by the ID team. More than one-half of PVCs were removed within 24 h in the unit (308/509; 60.5%). PVCs were complicated for 65 (12.8%) of the 509 patients, with complications including extravasation, cutaneous necrosis, lymphangitis, phlebitis, tearing off the patient, superficial venous thrombosis and arthritis. We must therefore continue to search for unjustified PVC insertion. Alternatives to the intravenous administration route must be proposed, such as subcutaneous infusion or oral antibiotic therapy. (C) 2020 Elsevier B.V. and International Society of Chemotherapy. All rights reserved. AD - [Mailhe, Morgane; Aubry, Camille; Brouqui, Philippe; Raoult, Didier; Parola, Philippe; Lagier, Jean-Christophe] IHU Mediterranee Infect, Marseille, France. [Brouqui, Philippe; Raoult, Didier; Lagier, Jean-Christophe] Aix Marseille Univ, AP HM, MEPHI, IRD, Marseille, France. [Michelet, Pierre] Aix Marseille Univ, Serv Urgences Adultes, UMR MD2, Hop Timone, Marseille, France. [Parola, Philippe] Aix Marseille Univ, AP HM, SSA, VITROME,IRD, Marseille, France. Lagier, JC (corresponding author), IHU Mediterranee Infect, Marseille, France.; Lagier, JC (corresponding author), Aix Marseille Univ, AP HM, MEPHI, IRD, Marseille, France. jean-christophe.lagier@ap-hm.fr AN - WOS:000518855500010 AU - Mailhe, M. AU - Aubry, C. AU - Brouqui, P. AU - Michelet, P. AU - Raoult, D. AU - Parola, P. AU - Lagier, J. C. C7 - 105875 DA - Mar DO - 10.1016/j.ijantimicag.2020.105875 J2 - Int. J. Antimicrob. Agents KW - Peripheral venous catheter Bloodstream infection Phlebitis BLOOD-STREAM INFECTIONS ENDOCARDITIS ANTIBIOTICS NUTRITION RISK BONE Infectious Diseases Microbiology Pharmacology & Pharmacy LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: KT2ON Times Cited: 0 Cited Reference Count: 36 Mailhe, Morgane Aubry, Camille Brouqui, Philippe Michelet, Pierre Raoult, Didier Parola, Philippe Lagier, Jean-Christophe Morgane, MAILHE/0000-0002-7173-1551 National Research Agency under the program 'Investissements d'avenir'French National Research Agency (ANR) [ANR-10-IAHU-03]; Region Provence-Alpes-Cote d'AzurRegion Provence-Alpes-Cote d'Azur; European funding FEDER PRIMI This study was supported by the National Research Agency under the program 'Investissements d'avenir' [reference ANR-10-IAHU-03]. This work was supported by the Region Provence-Alpes-Cote d'Azur and European funding FEDER PRIMI. 0 7 9 ELSEVIER AMSTERDAM INT J ANTIMICROB AG PY - 2020 SN - 0924-8579 SP - 4 ST - Complications of peripheral venous catheters: The need to propose an alternative route of administration T2 - International Journal of Antimicrobial Agents TI - Complications of peripheral venous catheters: The need to propose an alternative route of administration UR - ://WOS:000518855500010 VL - 55 ID - 761455 ER - TY - JOUR AB - Introduction: Clinical Pharmacists have been members of the multidisciplinary team providing direct patient care in Critical Care since the 1970's. Practice has grown and developed in different parts of the country independently of each other, guided by American research and position papers. An environmental scan of current practices in Canada does not currently exist in the published literature. Objectives: To describe current practices of ICU Pharmacists in Canada. Methods: An open-form survey consisting of 14 questions was distributed to all members of the Canadian Society of Hospital Pharmacists, Critical Care Practice Speciality Network via email. Follow-up telephone correspondence inviting participants working in critical care was then performed. Results: A 10% response rate included 31 respondents from across Canada 71% of those practiced within a tertiary care centre, 93% in mixed medical / surgical units. The mean size of intensive care units was 21 beds (Median 20, Range 6-44, IQR 12-27) and mean pharmacist to patient ratio was 13 to 1 (Median 12, Range 6- 23, IQR 10-17). (Table 1) A team of pharmacists shared ICU coverage in 77% of cases. Within those teams, 30% of staff have advanced training with either a Postbaccalaureate Doctor of Pharmacy (PharmD) or Masters degree, and 39% of organizations require an entry-to-practice degree and some on-the-job training as a minimum to practice in Critical Care. Advanced-degree training found more commonly in Vancouver and Toronto, where the Faculties of Pharmacy have offered PharmD degrees for more than a decade. Patient care rounds are completed in a standardized fashion in 55% of centres, with another 11% of centers reporting a similar format determined by the Attending Physicians. (Table 2) Within rounds, the Pharmacist has an allotted time to present in 52% of critical care units, with the remainder either expected to support and comment on presentations from other members of the team or as agreed upon with the Attending Physician. Clinical Pharmacists provide 8 hour/day coverage in 92% of centres, five days a week in 84%, with 4 hours (range 3-8) devoted to rounding. During rounds, pharmacists describe their contribution as most commonly reviewing current medications adjusting medication dosing for organ dysfunction reviewing antimicrobial therapy providing therapeutic drug monitoring and ensuring appropriate prophylaxis for stress ulcers, venous thromboembolism, and ventilator associated pneumonia. Pharmacists report using a checklist 33% of the time to prepare for rounds. A standardized patient monitoring form is used at 55% of sites and 80% of pharmacist documentation occurs outside the legal record on pharmacy documentation records. Pharmacists indicate that the majority of their suggestions/interventions on rounds are included in the Physician's Progress notes in 87% of centres. Supplementation of the physician progress notes occurs in 56% of centres when the Pharmacist determines greater detail is required or if the pharmacist's recommendation is discordant with the decision from rounds. Conclusion: Pharmacists' practice in critical care is variable in Canada. Higher credentialing is found in areas where a post baccalaureate PharmD program has been in existence for greater than 10 years. Documentation of interventions largely occurs within the physicians progress note and the majority of pharmacist documentation occurs outside of the legal record. (Table Presented) . AD - J.F. Mailman, Pharmacy Services, Regina Qu'Appelle Health Region, Regina, Saskatchewan, Canada AU - Mailman, J. F. AU - Semchuk, W. DB - Embase DO - 10.1007/s12630-018-1162-7 KW - accreditation adult adverse device effect antimicrobial therapy artificial ventilation Canada checklist clinical article clinical pharmacist conference abstract documentation drug monitoring e-mail female follow up hospital pharmacist human intensive care unit male patient monitoring pharmacy (shop) physician prophylaxis staff stress ulcer surgery telephone tertiary care center venous thromboembolism ventilator associated pneumonia writing LA - English M3 - Conference Abstract N1 - L624942481 2018-11-20 PY - 2018 SN - 1496-8975 SP - S89-S91 ST - Pharmacists' role in critical care: Environmental scan of current practices in Canada T2 - Canadian Journal of Anesthesia TI - Pharmacists' role in critical care: Environmental scan of current practices in Canada UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624942481&from=export http://dx.doi.org/10.1007/s12630-018-1162-7 VL - 65 ID - 760806 ER - TY - JOUR AB - BACKGROUND: Acute stroke care requires rapid assessment and intervention. Replacing traditional sequential algorithms in stroke care with parallel processing using telestroke consultation could be useful in the management of acute stroke patients. The purpose of this study was to assess the feasibility of a nurse-driven acute stroke protocol using a parallel processing model. METHODS: This is a prospective, nonrandomized, feasibility study of a quality improvement initiative. Stroke team members had a 1-month training phase, and then the protocol was implemented for 6 months and data were collected on a "run-sheet." The primary outcome of this study was to determine if a nurse-driven acute stroke protocol is feasible and assists in decreasing door to needle (intravenous tissue plasminogen activator [IV-tPA]) times. RESULTS: Of the 153 stroke patients seen during the protocol implementation phase, 57 were designated as "level 1" (symptom onset <4.5 hours) strokes requiring acute stroke management. Among these strokes, 78% were nurse-driven, and 75% of the telestroke encounters were also nurse-driven. The average door to computerized tomography time was significantly reduced in nurse-driven codes (38.9 minutes versus 24.4 minutes; P < .04). CONCLUSIONS: The use of a nurse-driven protocol is feasible and effective. When used in conjunction with a telestroke specialist, it may be of value in improving patient outcomes by decreasing the time for door to decision for IV-tPA. AD - Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas. Hospital Accreditation Services, American Heart Association, Dallas, Texas. Department of Nursing, Emergency Department, University of Texas Southwestern, Dallas, Texas. Department of Neurology, Duke University, Durham, North Carolina. Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, Texas. Electronic address: daiwai.olson@utsouthwestern.edu. AN - 28012837 AU - Mainali, S. AU - Stutzman, S. AU - Sengupta, S. AU - Dirickson, A. AU - Riise, L. AU - Jones, D. AU - Yang, J. AU - Olson, D. M. DA - May DO - 10.1016/j.jstrokecerebrovasdis.2016.11.007 DP - NLM ET - 2016/12/26 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Critical Pathways Delivery of Health Care, Integrated Feasibility Studies Fibrinolytic Agents/*administration & dosage Humans Infusions, Intravenous *Nurse's Role *Nursing Staff, Hospital Patient Care Team *Process Assessment, Health Care Prospective Studies Stroke/diagnostic imaging/*drug therapy/*nursing Teleradiology *Thrombolytic Therapy Time Factors *Time-to-Treatment Tissue Plasminogen Activator/*administration & dosage Tomography, X-Ray Computed Treatment Outcome Nursing acute ischemic stroke door to needle systems of care LA - eng M1 - 5 N1 - 1532-8511 Mainali, Shraddha Stutzman, Sonja Sengupta, Samarpita Dirickson, Amanda Riise, Laura Jones, Donald Yang, Julian Olson, DaiWai M Journal Article United States J Stroke Cerebrovasc Dis. 2017 May;26(5):987-991. doi: 10.1016/j.jstrokecerebrovasdis.2016.11.007. Epub 2016 Dec 21. PY - 2017 SN - 1052-3057 SP - 987-991 ST - Feasibility and Efficacy of Nurse-Driven Acute Stroke Care T2 - J Stroke Cerebrovasc Dis TI - Feasibility and Efficacy of Nurse-Driven Acute Stroke Care VL - 26 ID - 760143 ER - TY - JOUR AB - Background and Aims: Due to obesity epidemic, bariatric procedure number is continuous increasing, including laparoscopic sleeve gastrectomy (LSG) or laparoscopic gastric by-pass (LGB). We aim to assess complications and their risk factors in 2nd Department of General Surgery Jagniellonian University Medical College patients, basing on our six-year experience. Objectives: Assessment of bariatric procedures complication rates. Evaluation of complication risk factors. Material and Methods: Data of 408 patients, operated on morbid obesity in the 2nd Department of General Surgery JUMC since 2009 till 2015, were collected retrospectively. Patients were qualified to LSG or LGB by multidisciplinary team. Patients were divided into two groups: with and without complications in 30-days perioperative period. Analysis were conducted using Statistica 10.0 PL. Pearson's test and chi-square with corrections assessed qualitative data. T-student, Mann-Whitney's tests analyzed quantitative data. Logistic regression analysis were performed. Statistical significance was observed with p < 0.05. Results: Complication, mortality and reoperation rates were respectively 7.35%, 0.49%, 1.23%. Most frequent complication was rhabdomyolysis (2.2%). 2 deaths in LGB occurred due to pulmonary embolism and peritonitis with strangulated incision hernia and anastomosis dehiscence. According to univariate logistic regression maximal weight, maximal BMI, weight on the day of procedure and BMI on the day of procedure in LGB increased OR of complications (p = 0.011; 0.017; 0.010; 0.009), which stayed significant in multivariate logistic regression. In LSG univariate logistic regression showed statistically significant OR in maximal weight, maximal BMI, weight on the day of procedure and BMI on the day of procedure (p = 0.019; 0.017; 0.021; 0.021), as well as procedure duration (OR: 1.02; 95%CI: 1.01-1.03; p < 0.001) and number of staplers (OR: 2.40; 95%CI: 1.44-3.99; p < 0.001). However multivariate logistic regression revealed significance of only the last two parameters. Out of 12 co-morbidities none affected significantly OR of complications. Type of procedure, intraoperative adverse effects and surgical experience of operator did not affect OR of complications (p = 0.741; 0.961; 0.119). Conclusion: LSG and LGB are relatively safe procedures, even performed by surgeon on the learning curve. BMI is the most reliable risk factor for LGB complication. In LSG number of used staples and procedure duration increase complications risk. AD - P. Major, 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland AU - Major, P. AU - Matłok, M. AU - Pȩdziwiatr, M. AU - Wysocki, M. AU - Pasek, S. AU - Jabłoński, Sz AU - Stefura, T. AU - Małczak, P. AU - Budzyński, A. DB - Embase DO - 10.1159/000446744 KW - bariatric surgery European obesity risk factor procedures human logistic regression analysis weight patient general surgery epidemic rhabdomyolysis lung embolism mortality stapler statistical significance medical school morbidity reoperation learning curve death sleeve gastrectomy anastomosis dehiscence incision peritonitis university student hernia perioperative period parameters adverse drug reaction surgeon morbid obesity risk rank sum test LA - English M3 - Conference Abstract N1 - L72316263 2016-06-29 PY - 2016 SN - 1662-4033 SP - 274 ST - Risk factors for complications after bariatric surgery T2 - Obesity Facts TI - Risk factors for complications after bariatric surgery UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72316263&from=export http://dx.doi.org/10.1159/000446744 VL - 9 ID - 761018 ER - TY - JOUR AB - BACKGROUND: Stroke neurologists, vascular surgeons, interventional neuroradiologists and interventional cardiologists have embraced carotid angioplasty and stenting (CAS) because of potential advantages over carotid endarterectomy (CEA). At Austin Health, a multidisciplinary neuro-interventional group was formed to standardise indications and facilitate training. The aims of this study were to describe our organisational model and to determine whether 30-day complications and early outcomes were similar to those of major trials. METHODS: A clinical protocol was developed to ensure optimal management. CAS was performed on patients with high medical risk for CEA, with technically difficult anatomy for CEA, or who were randomised to CAS in a trial. RESULTS: From October 2003 to May 2008, 47 patients (34 male, mean age 71.5) underwent CAS of 50 carotid arteries. Forty-three cases had ipsilateral carotid territory symptoms within the previous 12 months. The main indications for CAS were high risk for CEA (n= 17) and randomised to CAS (n= 21). Interventionists were proctored in 27 cases. The procedural success rate was 94% with two cases abandoned because of anatomical problems and one because of on-table angina. Hypotension requiring vasopressor therapy occurred in 12 cases (24%). The duration of follow up was one to 44 months (mean 6.8 months). The 30-day rate of peri-procedural stroke or death was 6% and the one-year rate of peri-procedural stroke or death or subsequent ipsilateral stroke was 10.6%. Restenosis occurred in 13% (all asymptomatic). CONCLUSION: A multidisciplinary approach is a useful strategy for initiating and sustaining a CAS programme. AD - National Stroke Research Institute, Australia. AN - 20561100 AU - Mak, C. S. AU - Chambers, B. R. AU - Clark, D. J. AU - Molan, M. AU - Brooks, M. AU - Roberts, N. AU - Fell, G. AU - Roberts, A. K. AU - New, G. AU - Donnan, G. A. DA - Nov DO - 10.1111/j.1445-5994.2010.02285.x DP - NLM ET - 2010/06/22 J2 - Internal medicine journal KW - Aged Aged, 80 and over Angioplasty, Balloon/*methods Carotid Stenosis/pathology/*therapy *Clinical Protocols Endarterectomy, Carotid/methods Female Humans Interdisciplinary Communication Male Middle Aged Patient Care Team/*organization & administration Prospective Studies Randomized Controlled Trials as Topic Registries *Stents LA - eng M1 - 11 N1 - 1445-5994 Mak, C S Chambers, B R Clark, D J Molan, M Brooks, M Roberts, N Fell, G Roberts, A K New, G Donnan, G A Journal Article Australia Intern Med J. 2011 Nov;41(11):789-94. doi: 10.1111/j.1445-5994.2010.02285.x. Epub 2010 Jun 16. PY - 2011 SN - 1444-0903 SP - 789-94 ST - Multidisciplinary approach to carotid stenting T2 - Intern Med J TI - Multidisciplinary approach to carotid stenting VL - 41 ID - 760414 ER - TY - JOUR AB - Objectives Median arcuate ligament syndrome (MALS) is a vascular compression syndrome with symptoms that overlap chronic functional abdominal pain (CFAP). We report our experience treating MALS in a pediatric cohort previously diagnosed with CFAP. Patients and Methods We prospectively evaluated 46 pediatric (< 21 years of age) patients diagnosed with MALS at a tertiary care referral center from 2008 to 2012. All patients had previously been diagnosed with CFAP. Patients were evaluated for celiac artery compression by duplex ultrasound and diagnosis was confirmed by computed tomography. Quality of life (QOL) was determined by pre- and postsurgical administration of PedsQL™ questionnaire. The patients underwent laparoscopic release of the median arcuate ligament overlying the celiac artery which included surgical neurolysis. We examined the hemodynamic changes in parameters of the celiac artery and perioperative QOL outcomes to determine correlation. Results All patients had studies suggestive of MALS on duplex and computed tomography; 91% (n = 42) positive for MALS were females. All patients underwent a technically satisfactory laparoscopic surgical release resulting in a significant improvement in blood flow through the celiac artery. There were no deaths and a total of 9 complications, 8 requiring a secondary procedure; 33 patients were administered QOL surveys. 18 patients completed the survey with 15 (83%) patients reporting overall improvement in the QOL. Overall, 31/46 patients (67%) reported improvement of symptoms since the time of surgery. Conclusions MALS was found to be more common in pediatric females than males. Laparoscopic release of the celiac artery can be performed safely in the pediatric population. Surgical release of the artery and resultant neurolysis resulted in significant improvement in the blood flow, symptoms, and overall QOL in this cohort. The overall improvement in QOL outcome measures after surgery leads us to conclude that MALS might be earlier diagnosed and possibly treated in patients with CFAP. We recommend a multidisciplinary team approach to care for these complex patients. © 2013 Elsevier Inc. AD - G.Z. Mak, University of Chicago Medical Center, MC 4062, 5839 S. Maryland Ave, Chicago, IL 60637, United States AU - Mak, G. Z. AU - Speaker, C. AU - Anderson, K. AU - Stiles-Shields, C. AU - Lorenz, J. AU - Drossos, T. AU - Liu, D. C. AU - Skelly, C. L. DB - Embase Medline DO - 10.1016/j.jpedsurg.2013.03.003 KW - abdominal pain adolescent adult article blood flow celiac artery celiac artery stenosis child clinical article clinical trial computer assisted tomography Doppler ultrasonography female human male neurolysis postoperative complication priority journal quality of life school child sex difference treatment response LA - English M1 - 11 M3 - Article N1 - L370267490 2013-11-22 2013-11-27 PY - 2013 SN - 0022-3468 1531-5037 SP - 2261-2270 ST - Median arcuate ligament syndrome in the pediatric population T2 - Journal of Pediatric Surgery TI - Median arcuate ligament syndrome in the pediatric population UR - https://www.embase.com/search/results?subaction=viewrecord&id=L370267490&from=export http://dx.doi.org/10.1016/j.jpedsurg.2013.03.003 VL - 48 ID - 761148 ER - TY - JOUR AB - A high frequency of PF4-ELISA testing in patients suspected to have heparin-induced thrombocytopenia (HIT) despite low 4T scores has been observed in multiple medical centers. Education of clinicians has been suggested to reduce inappropriate testing. We determined trends of PF4-ELISA testing in our institution after the introduction of a HIT education program for clinicians. A HIT Program was developed that included ongoing education, individual feedback, and continuous clinical audit of PF4-ELISA utilization. To assess the impact of education on PF4-ELISA testing trends, we conducted a prospective cohort review of all adult patients who had a PF4-ELISA ordered over a 3month period (the last quarter of the academic year). 72 PF4-ELISA tests were ordered during the study period. Prospectively calculated 4T scores by investigators revealed 60 low-risk (83.3%), 9 intermediate-risk (12.5%), and 3 high-risk (4.16%). We observed divergent 4T scores with the ordering clinician calculating a higher 4T score compared to the Hematology Quality Improvement (QI) team. The majority of PF4-ELISA testing was ordered by the intensive care units (ICUs) (n=32, 44.44%). Our study revealed that the frequency of calculation of 4T scores remains poor with the majority inappropriately performed in the ICU setting, with ordering clinicians calculating higher 4T scores than the Hematology QI team. This suggests that clinician education alone is insufficient. Introducing mandatory 4T score calculation prior to PF4-ELISA testing may not be helpful as ordering clinicians can bypass the restriction through inaccurate 4T score calculation. AD - [Malalur, Pannaga; Greenberg, Charles; Lim, Ming Y.] Med Univ South Carolina, Div Hematol Oncol, Dept Med, 39 Sabin St,MSC 635, Charleston, SC 29425 USA. Malalur, P (corresponding author), Med Univ South Carolina, Div Hematol Oncol, Dept Med, 39 Sabin St,MSC 635, Charleston, SC 29425 USA. malalur@musc.edu AN - WOS:000459806100016 AU - Malalur, P. AU - Greenberg, C. AU - Lim, M. Y. DA - Feb DO - 10.1007/s11239-018-01803-8 J2 - J. Thromb. Thrombolysis KW - Thrombocytopenia Heparin 4T score Anticoagulation Clinician education MOLECULAR-WEIGHT HEPARIN 4TS SCORING SYSTEM CARDIAC-SURGERY DIAGNOSIS CARE PROGRAM HIT Cardiac & Cardiovascular Systems Hematology Peripheral Vascular Disease LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: HM9LN Times Cited: 0 Cited Reference Count: 32 Malalur, Pannaga Greenberg, Charles Lim, Ming Y. Lim, Ming Yeong/I-7178-2019 Lim, Ming Yeong/0000-0001-5208-3387; Malalur, Pannaga/0000-0002-9222-4321 0 SPRINGER DORDRECHT J THROMB THROMBOLYS PY - 2019 SN - 0929-5305 SP - 287-291 ST - Limited impact of clinician education on reducing inappropriate PF4 testing for heparin-induced thrombocytopenia T2 - Journal of Thrombosis and Thrombolysis TI - Limited impact of clinician education on reducing inappropriate PF4 testing for heparin-induced thrombocytopenia UR - ://WOS:000459806100016 VL - 47 ID - 761539 ER - TY - JOUR AB - Background: With advent, of Pulmonary embolism response team (PERT) across nation, identifying the patients high risk PE patient is vital. The aim of this study is to determine whether a PE could be identified and characterized accurately by internal medicine (IM) residents and pulmonary/critical care (PCC) fellows without prior training in CTA reading experience. Methods: A single 1-hour instructional session was held among IM-residents (PGY1, PGY2, PG3) and five PCC-fellows (three-PGY4s, and two-PGY5) with expert chest radiologist. CTA images of 50 patients with and without PE were assessed in a blinded fashion by IM-residents, PCC fellows, and one experienced radiologist. The cohort was instructed to measure for optimal arterial opacification which was defined as an attenuation coefficient of more than or equal to 120 Hounsfield Units (HU) using regions of interest at the level of the pulmonary trunk. The group was asked to determine if there was presence of PE. Laterality of PE was identified and location was characterized as central, proximal, or distal. Results: The kappa statistic for adequate assessment of contrast bolus among IM-residents and PCC-fellows showed slight agreement. The kappa statistics for accurate detection for presence of pulmonary embolism showed moderate to substantial agreement (0.45-0.94); and for adequate location characterization of pulmonary embolism ranged from 0.34-0.78. (Table 1) Conclusion: To our knowledge, this study is the first study evaluating the accuracy of diagnosis of PE by IM-residents and PCC fellows who did not have dedicated training or expertise in CT reading. After simple instruction, detection of PE on CTA was possible by non-radiologist. Extent of PE location identification had variability. We believe that further training to quantify PE is needed for non-radiologist. On the other end, identification of PE by non-radiologist trainees have following clinical implications: A) patient can be started on anti-coagulation while waiting for study results B) If empiric anti-coagulation was started it can be stopped. C) time to effective therapeutic anti-coagulation can be reduced d) PERT activation can be done rapidly depending on institutional protocol. AD - E. Male, Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States AU - Male, E. AU - Walshon, M. AU - Alashram, R. AU - Zheng, M. AU - Patel, M. AU - Yousef, I. AU - Pettigrew, S. AU - Essien, E. AU - Carabelli, E. AU - Heyman, B. AU - Cohen, G. AU - Panaro, J. AU - Cobb, R. AU - Zhao, H. AU - Bashir, R. AU - Gupta, R. AU - Criner, G. J. AU - Maruti, K. AU - Rali, P. DB - Embase KW - adult anticoagulation clinical article conference abstract controlled study diagnosis female hemispheric dominance human intensive care internal medicine kappa statistics male pulmonary artery pulmonary embolism response team radiologist resident thorax LA - English M1 - 9 M3 - Conference Abstract N1 - L630348607 2020-01-01 PY - 2019 SN - 1535-4970 ST - The accuracy of non-radiologist at making diagnosis of pulmonary embolism (PE) T2 - American Journal of Respiratory and Critical Care Medicine TI - The accuracy of non-radiologist at making diagnosis of pulmonary embolism (PE) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630348607&from=export VL - 199 ID - 760727 ER - TY - JOUR AB - Introduction: While the benefits of early mobility for prevention of complications such as pneumonia, thromboembolic events, and improved mortality have been well studied in postsurgical patients, it is unclear which patients may struggle to achieve full weight-bearing on the first postoperative day. Materials and Methods: The 2016 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Targeted Hip Fracture Database was queried regarding the ability to achieve weight-bearing on first postoperative day for older adults. Cases that occurred secondary to malignancy were excluded or for which weight-bearing was unachievable on the first postoperative day due to medical reasons were excluded. Results: A total of 6404 patients met inclusion and exclusion criteria for the study, with 1640 (25.6%) patients unable to bear weight on the first postoperative day. Following adjusted analysis, nonmodifiable patient factors such as dependent (partial or total) functional health status, dyspnea with moderate exertion (odds ratio [OR]: 1.31 [95% confidence interval, CI: 1.04-1.65]), ventilator dependency, and preoperative dementia on presentation to hospital were associated with lack of achievement of weight-bearing on the first postoperative day. Modifiable patient factors such as presence of systemic inflammatory response syndrome (OR: 1.35 [95% CI: 1.11-1.64]), delirium, and low preoperative hematocrit and modifiable system factors including delayed time to surgery, total postoperative time >90 minutes, and transfer from an outside emergency department were also associated with inability to achieve weight-bearing on the first postoperative day. Discussion: Medical teams can utilize the results from this study to better identify patients preoperatively who may be at risk of not achieving early mobilization and proactively employ implement strategies to encourage mobility as soon as possible for hip fracture patients. AD - [Malik, Azeem Tariq; Phieffer, Laura S.; Ly, Thuan, V; Khan, Safdar N.; Quatman, Carmen E.] Ohio State Univ, Wexner Med Ctr, Dept Orthopaed, 410 W 10th Ave, Columbus, OH 43210 USA. [Quatman-Yates, Catherine] Ohio State Univ, Wexner Med Ctr, Div Phys Therapy, Columbus, OH 43210 USA. Quatman-Yates, C (corresponding author), Ohio State Univ, Wexner Med Ctr, Dept Orthopaed, 410 W 10th Ave, Columbus, OH 43210 USA. carmen.quatman@osumc.edu AN - WOS:000489711700001 AU - Malik, A. T. AU - Quatman-Yates, C. AU - Phieffer, L. S. AU - Ly, T. V. AU - Khan, S. N. AU - Quatman, C. E. C7 - Unsp 2151459319837481 DA - Apr DO - 10.1177/2151459319837481 J2 - Geriatr. Orthop. Surg. Rehabil. KW - weight bearing WBAT mobility hip fracture surgery NSQIP ELDERLY-PATIENTS EARLY AMBULATION OLDER-ADULTS MOBILITY MOBILIZATION PREDICTORS MORTALITY PROGRAM INTERVENTIONS MANAGEMENT Geriatrics & Gerontology Orthopedics Rehabilitation Surgery LA - English M3 - Article N1 - ISI Document Delivery No.: JD1CB Times Cited: 0 Cited Reference Count: 45 Malik, Azeem Tariq Quatman-Yates, Catherine Phieffer, Laura S. Ly, Thuan, V Khan, Safdar N. Quatman, Carmen E. Ohio State University Wexner Medical Center; National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [R03AG060177] The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project is made possible through a patient safety and advancement grant funded by The Ohio State University Wexner Medical Center. Two authors have received other funding from the National Institutes of Health grant R03AG060177(CEQ), Davis Bremer Path to Pre K through The Ohio State University Wexner Medical Center (CEQ) and Simpson-Cummins Endowment (CQY), which is related to the work but not funding work presented here. Several authors disclose consulting for the Johnson and Johnson Hip Fracture Advisory Board (CEQ and CQY) and Helius Medical Technologies (CQY). 0 1 SAGE PUBLICATIONS INC THOUSAND OAKS GERIATR ORTHOP SURG PY - 2019 SN - 2151-4585 SP - 9 ST - Factors Associated With Inability to Bear Weight Following Hip Fracture Surgery: An Analysis of the ACS-NSQIP Hip Fracture Procedure Targeted Database T2 - Geriatric Orthopaedic Surgery & Rehabilitation TI - Factors Associated With Inability to Bear Weight Following Hip Fracture Surgery: An Analysis of the ACS-NSQIP Hip Fracture Procedure Targeted Database UR - ://WOS:000489711700001 VL - 10 ID - 761530 ER - TY - JOUR AB - Objectives: The aim of the study was to benchmark the quality of local stroke practice. Methods: All stroke patients admitted to Mater Dei Hospital were recruited prospectively over 6 weeks in 2008. A questionnaire based on the Royal College of Physicians (RCP) National Sentinel Stroke Audit was used. The results were compared to the RCP 2008 national sentinel stroke audit. Results: 63 patients were admitted with a diagnosis of stroke of which 42 were confirmed. 50% were male. Ages ranged between 37 and 93, with an average age of 75.7 years. 47.6% presented within 3 h. 31% were under the care of a consultant neurologist and 26.2% spent >50% of their stay in the dedicated neurology ward. The average length of stay was 9 days (range 1-30 days). 81% were discharged alive. Of these 44.1% went home, 26.5% went to a rehab unit, while 20.6% were transferred to a long-term care facility. All patients underwent CT scanning of the brain within 24 h, with 62% of scans being performed within 3 h of presentation. 85.7% had at least one co-morbidity, the commonest being hypertension (73.2%), previous CVA/TIA (43.9%), diabetes mellitus (39%) or evidence of vascular disease (39%). Concomitant past cerebrovascular events and diabetes was present in 38.1%. 94% received aspirin within 48 h. Nutrition was started within 72 h for 90.5%. At 24 h from admission, 54.7% of patients were not screened for swallowing. 47.6% of patients were not assessed by occupational therapist. 81% of patients were assessed by physiotherapy at 72 h of admission. None of the patients had rehabilitation goals agreed upon by a multi-disciplinary team. If thrombolysis was available, 16.7% would have been eligible. The commonest contraindications were: presentation > 3 h of onset of symptoms (52.4%), age>80 years (35.7%), blood pressure > 185/110 (26.2%) and significant stroke severity (19%). Conclusion: Local results compared well to the RCP 2008 results in initiation of aspirin, imaging, and nutrition. However, there is need for improvement in the assessment of swallowing, mood and cognitive function as well as involvement of a multidisciplinary team. Ways in which adherence to international guidelines can be improved include the introduction of a stroke unit, delivery of thrombolysis, a dedicated multidisciplinary service and the use of local guidelines for stroke. A follow up audit is currently underway to assess implementation of these recommendations. AD - M. Mallia, Mater Dei Hospital, B Kara, Martinique AU - Mallia, M. AU - Dingli, P. AU - Azzopardi, L. AU - Vassallo, D. AU - Aquilina, J. AU - Vella, N. AU - Galea Debono, A. DB - Embase DO - 10.1007/s00415-011-6026-9 KW - acetylsalicylic acid cerebrovascular accident society Malta patient clinical audit nutrition diabetes mellitus blood clot lysis swallowing cognition stroke unit follow up stroke patient hospital questionnaire college physician male consultation neurology ward length of stay long term care brain morbidity hypertension vascular disease computer assisted tomography occupational therapist physiotherapy rehabilitation blood pressure imaging mood diagnosis LA - English M3 - Conference Abstract N1 - L70408849 2011-05-15 PY - 2011 SN - 0340-5354 SP - S122 ST - Stroke in Malta T2 - Journal of Neurology TI - Stroke in Malta UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70408849&from=export http://dx.doi.org/10.1007/s00415-011-6026-9 VL - 258 ID - 761235 ER - TY - JOUR AB - Objectives: The aim of the study was to benchmark the quality of local stroke care in view of introduction of thrombolysis. Methods: Stroke patients admitted to Mater Dei Hospital over 6 weeks in 2008 were recruited. A questionnaire based on the 2006 Royal College of Physicians (RCP) National Sentinel Stroke Audit phase II (Clinical Audit) was used. Results were compared to the 2008 RCP National Sentinel Stroke Audit phase II (Clinical Audit) report. Results: 42 confirmed strokes were admitted. All patients underwent CT scanning within 24 hours. 97% received aspirin within 48 hours. 26.2% spent >50% of their stay in the neurology ward. 81% were discharged alive. At 24 hours from admission, 54.7% were not screened for swallowing. 47.6% were not assessed by an occupational therapist. 81% were assessed by physiotherapy at 72 hours of admission. None of the patients had documented goals set by a multi-disciplinary team. If thrombolysis were available, 16.7% would have been eligible. The commonest contraindications were late presentation (52.4%) and age >80 years (35.7%). Conclusion: Local results compared well to the RCP 2008 results in initiation of aspirin, imaging, and nutrition. However, we noted need for improvement in the assessment of swallowing, mood and cognitive function as well as involvement of a multidisciplinary team. Since then, adherence to international guidelines has improved by the introduction of thrombolysis, a dedicated multidisciplinary service and the use of local guidelines for stroke. AD - M. Mallia, Mater Dei Hospital, Msida, Malta AU - Mallia, M. AU - Dingli, P. AU - Micallef, D. AU - Azzorpardi, L. AU - Vassallo, D. AU - Aquilna, J. AU - Vella, N. AU - Debono, A. G. DB - Embase KW - acetylsalicylic acid fibrinolytic agent adult age aged article blood clot lysis cerebrovascular accident clinical article cognition computer assisted tomography diet therapy female health care quality hospital admission human male Malta mood physiotherapy practice guideline prospective study quality control rehabilitation care swallowing LA - English M1 - 1 M3 - Article N1 - L603837553 2015-04-24 PY - 2015 SN - 1813-3339 SP - 14-18 ST - Benchmarking local practice in view of introduction of thrombolysis for stroke in Malta T2 - Malta Medical Journal TI - Benchmarking local practice in view of introduction of thrombolysis for stroke in Malta UR - https://www.embase.com/search/results?subaction=viewrecord&id=L603837553&from=export VL - 27 ID - 761087 ER - TY - JOUR AB - BACKGROUND: Inhospital stroke (IHS) is associated with high morbidity and mortality, likely related to multiple factors, including delayed time to recognition, associated comorbidities, and initial care from non-stroke trained providers. We hypothesized that guided revision of a formalized 'stroke code' system can improve diagnosis and time to thrombolysis and thrombectomy. METHODS: IHS activations occurring at a comprehensive stroke center between 2013 and 2016 were retrospectively analyzed to guide revisions of an established stroke code protocol to improve provider communication and time to imaging, reduce stroke mimic rate, and improve the use of parallel processing. After protocol implementation, we prospectively collected data between 2016 and 2017 for comparison with the pre-implementation group, including diagnostic accuracy and relevant time points (code call to examination, examination to imaging, and imaging to intervention). We report descriptive statistics for comparison of patient characteristics and time metrics (time to imaging and reperfusion after IHS activation). Multivariable regression analysis was performed to identify independent predictors of stroke mimics and time metrics. RESULTS: There were 136 cases in the pre-implementation group and 69 in the post-implementation group. A reduction in stroke mimics (52% vs 33%, P=0.01) occurred after protocol initiation. Mean time to imaging after stroke code call was 7.6 min shorter (P=0.026) and mean time from imaging to acute reperfusion therapy was 45.7 vs 19.8 min (P=0.05) in the pre- versus the post-implementation group. CONCLUSION: Revision of an existing IHS protocol was associated with a lower rate of stroke mimics, and a shorter time to intravenous and intra-arterial intervention. AD - Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. AN - 31030187 AU - Manners, J. AU - Khandker, N. AU - Barron, A. AU - Aziz, Y. AU - Desai, S. M. AU - Morrow, B. AU - Delfyett, W. T. AU - Martin-Gill, C. AU - Shutter, L. AU - Jovin, T. G. AU - Jadhav, A. P. DA - Nov DO - 10.1136/neurintsurg-2019-014890 DP - NLM ET - 2019/04/29 J2 - Journal of neurointerventional surgery KW - Administration, Intravenous Adult Aged Aged, 80 and over Female Hospitalization/trends Humans Male Middle Aged *Patient Care Team Retrospective Studies Stroke/*diagnosis/*therapy Thrombectomy/*methods Thrombolytic Therapy/*methods Time Factors *Time-to-Treatment Treatment Outcome stroke thrombectomy thrombolysis LA - eng M1 - 11 N1 - 1759-8486 Manners, Jody Khandker, Namir Barron, Adam Aziz, Yasmin Desai, Shashvat M Morrow, Benjamin Delfyett, William T Martin-Gill, Christian Shutter, Lori Jovin, Tudor G Jadhav, Ashutosh P Journal Article England J Neurointerv Surg. 2019 Nov;11(11):1080-1084. doi: 10.1136/neurintsurg-2019-014890. Epub 2019 Apr 27. PY - 2019 SN - 1759-8478 SP - 1080-1084 ST - An interdisciplinary approach to inhospital stroke improves stroke detection and treatment time T2 - J Neurointerv Surg TI - An interdisciplinary approach to inhospital stroke improves stroke detection and treatment time VL - 11 ID - 760142 ER - TY - JOUR AB - Background: The incidence and the outcomes of pulmonary embolism (PE) missed during emergency department (ED) workup are largely unknown. Objectives: To describe the frequency, demographics, and outcomes of patients with delayed diagnosis of PE. Methods: We retrospectively compared patients diagnosed with PE during ED workup (early diagnosis) with patients diagnosed with PE thereafter (delayed diagnosis). Electronic health records (EHR) of 123,560 consecutive patients who attended a tertiary hospital ED were screened. Data were matched with radiology and pathology results from the EHR. Results: Of 1,119 patients presenting to the ED with early workup for PE, PE was diagnosed in 182 patients (80.5%) as early diagnosis. Delayed diagnosis was established in 44 cases (19.5%) using radiology and/or autopsy data. Median age of patients with early diagnosis was significantly lower as compared to delayed diagnosis (67 vs. 77.5 years). Main symptoms were dyspnea (109 patients [59.9%] in early, 20 patients [45.5%] in delayed diagnosis), chest pain (90 patients [49.5%] in early, 8 patients [18.2%] in delayed diagnosis), and nonspecific complaints (16 patients [8.8%] in early, 13 patients [29.5%] in delayed diagnosis). In-hospital mortality was 1.6% in early diagnosis and 43.2% in delayed diagnosis. Conclusions: Delayed diagnosis of PE carries a worse prognosis than early diagnosis. This discrepancy may arise from either delayed therapy, confounding variables (e.g., older age), or both. Possible reasons for delayed diagnoses are nonspecific presentations and symptoms overlapping with preexisting conditions. AD - Department of Emergency Medicine, University Hospital of Basel, University of Basel, Basel, Switzerland Department of Cardiology, Vienna North Hospital, Vienna, Austria Department of Pathology, University Hospital of Basel, University of Basel, Basel, Switzerland Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland AN - 145313495. Language: English. Entry Date: 20200831. Revision Date: 20201104. Publication Type: Article AU - Mansella, Gregory AU - Keil, Christoph AU - Nickel, Christian H AU - Eken, Ceylan AU - Wirth, Christian AU - Tzankov, Alexandar AU - Peterson, Caspar Joyce AU - Aujesky, Drahomir AU - Bingisser, Roland DB - CINAHL DO - 10.1159/000508396 DP - EBSCOhost KW - Pulmonary Embolism -- Diagnosis Diagnosis, Delayed Outcomes (Health Care) Emergency Service Human Descriptive Statistics Retrospective Design Comparative Studies Early Diagnosis Electronic Health Records Tertiary Health Care Pulmonary Embolism -- Radiography Autopsy Pulmonary Embolism -- Symptoms Dyspnea Chest Pain Hospital Mortality Pulmonary Embolism -- Prognosis Age Factors Incidence M1 - 7 N1 - research; tables/charts. Journal Subset: Allied Health; Biomedical; Continental Europe; Europe. NLM UID: 0137356. PY - 2020 SN - 0025-7931 SP - 589-597 ST - Delayed Diagnosis in Pulmonary Embolism: Frequency, Patient Characteristics, and Outcome T2 - Respiration TI - Delayed Diagnosis in Pulmonary Embolism: Frequency, Patient Characteristics, and Outcome UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=145313495&site=ehost-live&scope=site VL - 99 ID - 761317 ER - TY - JOUR AB - Objective To assess the outcome of patients with advanced ovarian cancer (OC) who were treated without surgery, having received upfront chemotherapy and no interval debulking surgery (IDS). Methods Retrospective analysis of medical and chemotherapy records of consecutive patients with OC between 2005 and 2013 at UCL Hospitals London, UK who received neoadjuvant chemotherapy (NACT) was then found to be unsuitable for IDS following review by the multidisciplinary team. Results Eighty-three patients (18%) out of 467 receiving NACT did not undergo IDS. Median age was 70 years (range 33–88); out of these 83 patients, 43 (51.8%) presented with stage IV disease. Forty-three of these 83 patients received carboplatin and paclitaxel (CP) (51.8%) and 37 received carboplatin alone (C) (44.6%); 3 patients (3.6%) received other platinum-based combinations. Reasons for not proceeding to surgery were: poor response to chemotherapy after 3–4 cycles of NACT (61/83, 73.5%); comorbidities (12/83, 14.5%); patient decision (4/83, 4.8%). Six patients (7.2%) received < 3 cycles of NACT due to a worsening clinical condition. The median overall survival (OS) for patients not undergoing IDS was 18 months (95% CI 10–20 months). Forty-four of 83 patients (53%) received > 2 lines of chemotherapy. In a univariate analysis CP, age < 70 years, and absence of comorbidities were factors influencing OS. In a multivariate analysis only having received CP remained independently associated with OS (HR 0.49, 95% CI 0.29–0.84). Conclusions Chemotherapy alone can provide reasonable disease control in patients unsuitable for IDS and CP should be used if possible. AD - J.A. Ledermann, UCL Cancer Institute and UCL Hospitals, 90 Tottenham Court Rd., London, United Kingdom AU - Marchetti, C. AU - Kristeleit, R. AU - McCormack, M. AU - Mould, T. AU - Olaitan, A. AU - Widschwendter, M. AU - MacDonald, N. AU - Ledermann, J. A. DB - Embase Medline DO - 10.1016/j.ygyno.2016.11.001 KW - bevacizumab carboplatin paclitaxel platinum derivative adult advanced cancer aged article cancer adjuvant therapy cancer combination chemotherapy cancer grading cancer patient cancer staging cancer surgery cancer survival cardiovascular disease cerebrovascular accident Charlson Comorbidity Index clinical outcome comorbidity cytoreductive surgery female follow up human lung embolism major clinical study medical record review middle aged multiple cycle treatment outcome assessment ovary carcinoma overall survival patient decision making priority journal treatment response LA - English M1 - 1 M3 - Article N1 - L613752502 2016-12-21 2016-12-30 PY - 2017 SN - 1095-6859 0090-8258 SP - 57-60 ST - Outcome of patients with advanced ovarian cancer who do not undergo debulking surgery: A single institution retrospective review T2 - Gynecologic Oncology TI - Outcome of patients with advanced ovarian cancer who do not undergo debulking surgery: A single institution retrospective review UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613752502&from=export http://dx.doi.org/10.1016/j.ygyno.2016.11.001 VL - 144 ID - 760962 ER - TY - JOUR AB - Right heart thrombus in transit clot (RHTT) associated with a pulmonary thromboembolism (PTE) is a rare but potentially fatal diagnosis. Early diagnosis and immediate intervention are crucial. This report describes the case of a healthy, physically active 32-year-old female who presented 19 days postoperatively, following an anterior cruciate ligament reconstruction and partial lateral meniscectomy with a saddle PE, RHTT, and right ventricular (RV) strain. The patient received half of the standard dose of intravenous tissue plasminogen activator (TPA) in combination with anticoagulation and survived. Case reports of RHTT will inform future studies designed to evaluate whether and when thrombolysis should be administered. PMID:32518563 AU - Mardinger, Cynthia AU - Boiteau, Paul J. E. DA - 2020/05/19 05/19 DB - PubMed Central DO - 10.1155/2020/7561986 PY - 2020 SN - 1687-9627 ST - Thrombolysis of Postoperative Acute Pulmonary Embolism with a Thrombus in Transit T2 - Case Reports in Medicine TI - Thrombolysis of Postoperative Acute Pulmonary Embolism with a Thrombus in Transit UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7256686 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7256686&rendertype=abstract VL - 2020 ID - 762048 ER - TY - JOUR AU - Mardinger, C. AU - Boiteau, P. J. E. AU - Kortbeek, J. B. DA - 2020/06/10 06/10 DB - Europe PubMed Central DO - 10.1155/2020/7561986 PY - 2020 SN - 1687-9627 ST - Thrombolysis of Postoperative Acute Pulmonary Embolism with a Thrombus in Transit T2 - Case Rep Med TI - Thrombolysis of Postoperative Acute Pulmonary Embolism with a Thrombus in Transit UR - http://europepmc.org/article/MED/32518563 VL - 2020 ID - 762043 ER - TY - JOUR AU - Marginean, A. AU - Masic, D. AU - Brailovsky, Y. AU - Fareed, J. AU - Darki, A. DA - 2020/08/26 08/26 DB - Europe PubMed Central DO - 10.1016/j.jaccas.2020.05.017 M1 - 9 PY - 2020 SN - 2666-0849 SP - 1383-1387 ST - Difficulties of Managing Submassive and Massive Pulmonary Embolism in the Era of COVID-19 T2 - JACC Case Rep TI - Difficulties of Managing Submassive and Massive Pulmonary Embolism in the Era of COVID-19 UR - http://europepmc.org/article/MED/32835283 VL - 2 ID - 762031 ER - TY - JOUR AB - OBJECTIVE: Congenital vascular malformations are a heterogeneous group of lesions with the potential to cause significant lifelong morbidity in children. Diagnosis and treatment of these lesions may be complex and require a multidisciplinary approach. Sclerotherapy is widely used for the treatment of low-flow vascular malformations (LFVMs) as an alternative to surgical resection in adults; however, limited data of its use in a pediatric setting are available. The purpose of this study was to evaluate the efficacy and safety of sclerotherapy for pediatric LFVMs. METHODS: In this retrospective study, we reviewed our multidisciplinary vascular malformations team database for all patients younger than 18 years treated for congenital vascular malformations from 2008 to 2017. Of these, patients with LFVM treated with foam sclerotherapy were included. Dynamic contrast-enhanced magnetic resonance imaging was used to select patients for sclerotherapy by the multidisciplinary team. Foam sclerotherapy was performed with either polidocanol or sodium tetradecyl sulfate. Patients' characteristics, including demographics, presenting symptoms, and anatomic location of malformation, were assessed. Outcomes included treatment response, number of procedures, and postprocedural complications. RESULTS: The 61 patients with 61 LFVMs included 27 boys (44.3%) and 34 girls (55.7%), with mean age of 10.3 years (standard deviation, ± 5.3 years). The cohort included 32 venous (52.5%), 16 lymphatic (26.2%), and 8 mixed venous and lymphatic (13.1%) malformations along with 5 (8.2%) associated with Klippel-Trénaunay syndrome. Primary indications for intervention included pain and swelling (n = 12 [19.6%]), pain alone (n = 23 [37.7%]), swelling alone (n = 15 [24.6%]), functional impairment (n = 8 [13.1%]), and bleeding (n = 3 [4.9%]). Anatomic distributions varied, with 13 head and neck (21.3%), 5 truncal (8.2%), 10 upper extremity (16.4%), 27 lower extremity (44.3%), and 6 diffuse (9.8%). Among the head and neck lesions, 8 (13.1%) extended to the face; and of the extremity lesions, 5 (8.2%) extended to the hand and 17 (27.9%) to the foot. Overall, sclerotherapy resulted in significant improvement or complete resolution of symptoms in 53 patients (86.9%). Complications were observed in seven patients (11.4%); six cases (9.8%) of superficial skin ulceration resolved without intervention, and one infection (1.6%) required antibiotics. No patients experienced adverse hemodynamic consequences or venous thromboembolism. CONCLUSIONS: This series of pediatric LFVMs, the largest of its kind to date, demonstrates that sclerotherapy with foam-based agents effectively reduces symptoms with an acceptable rate of complications. Further study is needed to determine the optimal sclerosing agents for individual subsets of LFVMs in the pediatric population. AD - Division of Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC. Electronic address: jovan.markovic@duke.edu. Division of Vascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC. AN - 32284312 AU - Markovic, J. N. AU - Nag, U. AU - Shortell, C. K. DA - Nov DO - 10.1016/j.jvsv.2019.11.023 DP - NLM ET - 2020/04/15 J2 - Journal of vascular surgery. Venous and lymphatic disorders KW - Congenital vascular malformations Foam sclerotherapy Low-flow vascular malformations Polidocanol Sodium tetradecyl sulfate LA - eng M1 - 6 N1 - 2213-3348 Markovic, Jovan N Nag, Uttara Shortell, Cynthia K Journal Article United States J Vasc Surg Venous Lymphat Disord. 2020 Nov;8(6):1074-1082. doi: 10.1016/j.jvsv.2019.11.023. Epub 2020 Apr 10. PY - 2020 SP - 1074-1082 ST - Safety and efficacy of foam sclerotherapy for treatment of low-flow vascular malformations in children T2 - J Vasc Surg Venous Lymphat Disord TI - Safety and efficacy of foam sclerotherapy for treatment of low-flow vascular malformations in children VL - 8 ID - 760446 ER - TY - JOUR AB - Pulmonary artery hypertension (PH) frequently affects women of childbearing age. Due to the very high maternal mortality risk, with most of the deaths occurring in the 3rd trimester and within the first 10 post-delivery days, pregnancy should generally be avoided in PH. We describe the case of a 39-year-old woman who was transferred to our department at the 25th week of pregnancy with a severe right heart failure. Since the 14th week she experienced increasing dyspnea, palpitations and generalized edema. She declined termination of the pregnancy after thorough counselling. The echocardiogram showed a dilated, hypertrophic and hypokinetic right ventricle, with a pulmonary artery (PA) systolic pressure 85 mmHg. The clinical status improved with diuretics. A team including cardiologists, obstetricians, anaesthesiologists, neonatologists and staff coordinators was made up. A complete diagnostic work-up for PH was performed: CT scan excluded pulmonary thromboembolism, no evidence of an intracardiac shunt, and blood tests were negative for vasculitis, thyroid disorder, connective tissue disease and thrombophilia. A right heart catheterization demonstrated a PA pressure of 60/42 mmHg, PCW pressure 11 mmHg, a severely elevated PVR at 16.9 WU, and significant reduction of the cardiac output, without any fall in the PA pressure or PVR after inhaled nitric oxide. A complete obstetrical and fetal evaluation excluded other relevant diagnoses. LMW heparin was prescribed. In the following days a step treatment with continuous infusion Epoprostenol and oral Sildenafil was initiated. The PDE-inhibitor was not tolerated after few weeks for flushing and hypotension. An elective caesarean section was successfully performed at the 31st week, under epidural anaesthesia. The baby demonstrated normal growth, development, and birth apgar scores. The patient was discharged from the ICU on day four. The postdelivery course was uneventful and the mother was discharged on day 30. At 6-month follow up, she was a WHO FC-II. This patient was diagnosed with severe PH in an advanced stage of pregnancy. Critical decisions, rapid escalation of the prostacyclin therapy, and the use of an experienced multidisciplinary team led to a successful delivery, with no complications for the mother or baby. The management of these infrequent, but critical situations, should be strictly handled by experienced tertiary referral centers. AD - A. Marocco, G. Brotzu Hospital, Cardiology, Cagliari, Italy AU - Marocco, A. AU - Giardina, G. AU - Corda, M. AU - Chessa, G. AU - Spanu, P. AU - Massidda, E. AU - Pibiri, L. AU - Zwicke, D. AU - Porcu, M. DB - Embase DO - 10.1002/ejhf.833 KW - diuretic agent nitric oxide prostacyclin sildenafil adult anesthesiologist Apgar score cardiologist case report cesarean section connective tissue disease counseling diagnosis drug therapy dyspnea echocardiography epidural anesthesia exposure female fetus flushing follow up generalized edema growth curve heart catheterization heart output heart palpitation heart right ventricle failure heart septum defect human hypotension infant infusion lung artery pressure lung embolism neonatologist obstetrician pregnancy pulmonary hypertension staff systolic blood pressure tertiary care center thrombophilia thyroid disease vasculitis x-ray computed tomography LA - English M3 - Conference Abstract N1 - L616173128 2017-05-18 PY - 2017 SN - 1878-1314 SP - 360 ST - A successful multidisciplinary approach to pregnancy and delivery in pulmonary artery hypertension T2 - European Journal of Heart Failure TI - A successful multidisciplinary approach to pregnancy and delivery in pulmonary artery hypertension UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616173128&from=export http://dx.doi.org/10.1002/ejhf.833 VL - 19 ID - 760944 ER - TY - JOUR AB - Background Afib is a common cardiac arrhythmia associated with substantial risk of mortality and morbidity from stroke and thromboembolism (TE). The CHA2DS2-VASc score, comprised of six components: CHF/LVEF < 40%, Hypertension, Age ≥ 75, Diabetes, Stroke/TIA/TE, Vascular Disease, Age 65-74, Sex Category, is supported by Clinical Practice Guidelines (CPG) as a quality measure for risk assessment in patients with non-valvular afib. We developed and integrated a Best Practice Alert (BPA) to appropriately capture and communicate this clinical standard across the continuum of care. Case The BPA is activated in the electronic health record (EHR) in real time by ICD-10 afib diagnosis code identification and prepopulates all risk factor fields based on discrete data located in the demographics, medical history, and problem list. Together, these factors generate a risk score which is validated and permanently filed by the clinician. To achieve compliance, daily alerts trigger until the score is addressed as part of the individualized care plan. Decision-making This multidisciplinary team's initiative highlights innovation supporting clinical needs to promote communication and collaboration in an effort to align care disciplines with afib management strategies. The BPA leverages our EHR to maintain consistency through inpatient & outpatient transitions of care across a multi-hospital network. Conclusion Leadership and our clinical teams have embraced the best practice of assessing risk factors in conjunction with CPG recommendations for individualized oral anticoagulation care plans. This BPA is endorsed as: easy, appropriate, collaborative, streamlined, and accessible. This BPA was reported as an excellent example of “IT/Clinical/Operational teamwork” and “leveraging an EHR using accurate data in, accurate data out.” This innovation is expected to continue to improve care, render external reporting less laborious, and support population level retrospective analysis including quality and research. References/Resources 2019 AHA/ACC/HRS Focused Update of the 2014 Guideline for Management of Patients with Afib; 2014 AHA/ACC/HRS Guideline for the Management of Patients with Afib AU - Marrah, K. AU - Russo, T. DB - Embase DO - 10.1016/S0735-1097(20)32926-0 KW - adult anticoagulation clinical assessment conference abstract decision making demography electronic health record female hospital patient human ICD-10 leadership male medical history multidisciplinary team outpatient practice guideline retrospective study risk factor teamwork LA - English M1 - 11 M3 - Conference Abstract N1 - L2005038847 2020-04-07 PY - 2020 SN - 1558-3597 0735-1097 SP - 2299 ST - INNOVATION (PLUS) BEST PRACTICE (EQUALS) BLUEPRINT FOR TRANSFORMING AFIB CARE ACROSS THE CONTINUUM T2 - Journal of the American College of Cardiology TI - INNOVATION (PLUS) BEST PRACTICE (EQUALS) BLUEPRINT FOR TRANSFORMING AFIB CARE ACROSS THE CONTINUUM UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005038847&from=export http://dx.doi.org/10.1016/S0735-1097(20)32926-0 VL - 75 ID - 760584 ER - TY - JOUR AB - Objective: The epidemiology of Chronic pancreatitis (CP) is unknown in Álava (Spain). PC assessment from our Pancreas Unit. Material and methods: Prospective cohort study in 319,227 people. 2011-2013 analysis. CP was defined by M-ANNHEIM, so 85 patients (pts) with CP were included, 68 men and 17 women, with 59.38 as average age. Results: 27 new diagnosis and 2 pts died during the analysis period. Etiology: alcohol-tobacco 44%, recurrent pancreatitis 30%, obstructive 5%, autoimmune 2%, metabolic 2% and idiopathic 17%. Main-symptoms: chronic abdominal pain 17%, recurrent abdominal pain 39%, diarrhea steatorrhea 18%. 82, 73 and 50 pts underwent, respectively, CT-scan, MRCP and EUS as diagnostic procedures. Calcification was found in 24 pts, with wirsung dilatation >6mm in 36 pts. Complications: pseudocyst 24pts, biliary stricture 22pts, duodenal stricture 10pts, splenic vein thrombosis 9pts, pseudoaneurysm and pancreatic fistula 4pts and 1 pancreatic neoplasm. EPI in need of PERT in 41pts(48%); Diabetes in 48pts(58%). Also, 21,2% needed opioid analgesics, 18,2% endoscopic treatment or 18,2% surgery. Conclusions: Chronic pancreatitis in Alava is not as uncommon a disease as firstly thought. Its main etiology is alcohol consumption and smoking. This series showed a significant prevalence of pain, PEI, Diabetes, complications and high resource consumption is also worth mentioning. AD - C. Marra-Lépez, Hospital Universitario Araba Txagorritxu, Spain AU - Marra-Lépez, C. AU - Marcaide, A. AU - Ramírez de la Piscina, P. AU - Duca, I. AU - Urtasun, L. AU - Ganchegi, I. AU - Estrada, S. AU - Delgado, E. AU - García-Campos, F. DB - Embase KW - alcohol narcotic analgesic agent chronic pancreatitis university hospital human abdominal pain diabetes mellitus etiology pancreas pancreatitis tobacco diarrhea female cohort analysis computer assisted tomography splenic vein vein thrombosis false aneurysm steatorrhea diagnosis diagnostic procedure calcification dilatation pseudocyst cholestasis patient pancreas tumor pancreas fistula male epidemiology surgery alcohol consumption smoking prevalence pain Spain LA - English M1 - 4 M3 - Conference Abstract N1 - L71184938 2013-10-11 PY - 2013 SN - 1424-3903 SP - e15 ST - Chronic pancreatitis study in txagorritxu-araba university hospital (Vitoria-Gasteiz, Alava, Basque-Country) T2 - Pancreatology TI - Chronic pancreatitis study in txagorritxu-araba university hospital (Vitoria-Gasteiz, Alava, Basque-Country) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71184938&from=export VL - 13 ID - 761182 ER - TY - JOUR AB - Budd-Chiari syndrome (BCS) is a rare and potentially life-threatening disorder characterized by obstruction of the hepatic outflow tract at any level between the junction of the inferior vena cava with the right atrium and the small hepatic veins. In the West, BCS is a rare hepatic manifestation of one or more underlying prothrombotic risk factors. The most common underlying prothrombotic risk factor is a myeloproliferative disorder, although it is now recognized that almost half of patients have multiple underlying prothrombotic risk factors. Clinical manifestations can be diverse, making BCS a possible differential diagnosis of many acute and chronic liver diseases. The index of suspicion should be very low if there is a known underlying prothrombotic risk factor and new onset of liver disease. Doppler ultrasound is sufficient for confirming the diagnosis, although tomographic imaging (computed tomography (CT) or magnetic resonance imaging (MRI)) is often necessary for further treatment and discussion with a multidisciplinary team. Anticoagulation is the cornerstone of the treatment. Despite the use of anticoagulation, the majority of patients need additional (more invasive) treatment strategies. Algorithms consisting of local angioplasty, TIPS and liver transplantation have been proposed, with treatment choice dictated by a lack of response to a less-invasive treatment regimen. The application of these treatment strategies allows for a five-year survival rate of 90%. In the long term the disease course of BCS can sometimes be complicated by recurrence, progression of the underlying myeloproliferative disorder, or development of post-transplant lymphoma in transplant patients. AD - F. Nevens, Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg KU Leuven, Leuven, Belgium AU - Martens, P. AU - Nevens, F. DB - Embase DO - 10.1177/2050640615582293 KW - angioplasty anticoagulation Budd Chiari syndrome chronic liver disease clinical feature computer assisted tomography differential diagnosis extrahepatic bile duct obstruction fibrinolytic therapy follow up human liver transplantation nuclear magnetic resonance imaging priority journal recurrence risk review risk factor survival rate transjugular intrahepatic portosystemic shunt treatment outcome treatment planning LA - English M1 - 6 M3 - Review N1 - L608999916 2016-03-21 2016-03-24 PY - 2015 SN - 2050-6414 2050-6406 SP - 489-500 ST - Budd-Chiari syndrome T2 - United European Gastroenterology Journal TI - Budd-Chiari syndrome UR - https://www.embase.com/search/results?subaction=viewrecord&id=L608999916&from=export http://dx.doi.org/10.1177/2050640615582293 VL - 3 ID - 761043 ER - TY - JOUR AB - Aims Aim of the study was to assess quality of life during the first year after pelvic exenteration for gynecologic malignancy performed with curative intent. Method A French multicentric prospective study was performed by including patients who underwent PE. Quality of life by measuring functional and symptom scales was assessed using the EORTC QLQ-C30 (version 3.0) and the EORTC QLQ-OV28 questionnaires prior to surgery, and at baseline, 1, 3, 6, and 12 months after the procedure Results A total of 97 patients were included. Quality of life including physical, personal, fatigue, and anorexia reported in the QLQ-C30 were significantly reduced one month postoperatively and improved at least to baseline level one year after the procedure. Body image was also significantly reduced one month postoperatively. Global health, emotional, dyspnoea, and anorexia items were significantly improved one year after surgery compared to baseline values. Unlike younger patients, elderly patients did not regain physical and social activities after PE. Conclusion Deterioration of QOL was most significant during the first three months after surgery. Elderly patients were the only group of patients with permanent decreased physical and social function. Preoperative evaluation and postoperative follow-up should include health-related QOL instruments counselling by a multidisciplinary team to cover all aspects concerning stoma care, sexual function and long-term concerns after surgery. AD - A. Martinez, Institut Claudius Regaud, Toulouse Oncopole, Surgery, Toulouse, France AU - Martinez, A. AU - Filleron, T. AU - Rouanet, P. AU - Meeus, P. AU - Lambaudie, E. AU - Classe, J. M. AU - Foucher, F. AU - Fabrice, N. AU - Sebastien, G. AU - Frederic, G. AU - Querleu, D. AU - Ferron, G. DB - Embase DO - 10.1097/01.IGC.0000527296.86225.87 KW - aged anorexia body image cancer surgery counseling deterioration dyspnea fatigue female female genital tract cancer follow up global health human major clinical study male pelvis exenteration physical activity preoperative evaluation prospective study quality of life questionnaire sexual function social behavior social status stoma surgery LA - English M3 - Conference Abstract N1 - L619744961 2017-12-20 PY - 2017 SN - 1525-1438 SP - 1977 ST - Prospective assessment of first year quality of life after pelvic exenteration for gynecologic malignancy. A french multicentric study T2 - International Journal of Gynecological Cancer TI - Prospective assessment of first year quality of life after pelvic exenteration for gynecologic malignancy. A french multicentric study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619744961&from=export http://dx.doi.org/10.1097/01.IGC.0000527296.86225.87 VL - 27 ID - 760896 ER - TY - JOUR AB - Cardiac surgery is a high-risk procedure performed by a multidisciplinary team using complex tools and technologies. Efforts to improve cardiac surgery safety have been ongoing for more than a decade, yet the literature provides little guidance regarding best practices for identifying errors and improving patient safety. This focused review of the literature was undertaken as part of the FOCUS initiative (Flawless Operative Cardiovascular Unified Systems), a multifaceted effort supported by the Society of Cardiovascular Anesthesiologists Foundation to identify hazards and develop evidence-based protocols to improve cardiac surgery safety. Hazards were defined as anything that posed a potential or real risk to the patient, including errors, near misses, and adverse events. Of the 1438 articles identified for title review, 390 underwent full abstract screening, and 69 underwent full article review, which in turn yielded 55 meeting the inclusion criteria for this review. Two key themes emerged. First, studies were predominantly reactive (responding to an event or report) instead of proactive (using prospective designs such as self-assessments and external reviewers, etc.) and very few tested interventions. Second, minor events were predictive of major problems: multiple, often minor, deviations from normal procedures caused a cascade effect, resulting in major distractions that ultimately led to major events. This review fills an important gap in the literature on cardiac surgery safety, that of systematically identifying and categorizing known hazards according to their primary systemic contributor (or contributors). We conclude with recommendations for improving patient outcomes by building a culture of safety, promoting transparency, standardizing training, increasing teamwork, and monitoring performance. Finally, there is an urgent need for studies that evaluate interventions to mitigate the inherent risks of cardiac surgery. (Anesth Analg 2011;112:1061-74) AD - [Martinez, Elizabeth A.] Harvard Univ, Massachusetts Gen Hosp, Dept Anesthesia Crit Care & Pain Med, Cambridge, MA 02138 USA. [Thompson, David A.; Bauer, Laura; Lubomski, Lisa H.; Gurses, Ayse P.; Goeschel, Christine A.; Pronovost, Peter J.] Johns Hopkins Univ, Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD 21205 USA. [Errett, Nicole A.; Gurses, Ayse P.; Marsteller, Jill A.; Mohit, Babak; Goeschel, Christine A.; Pronovost, Peter J.] Johns Hopkins Univ, Dept Hlth Policy & Management, Bloomberg Sch Publ Hlth, Baltimore, MD 21218 USA. Martinez, EA (corresponding author), Dept Anesthesia Crit Care & Pain Med, GRB 444,55 Fruit St, Boston, MA 02114 USA. emartinez10@partners.org AN - WOS:000289785100011 AU - Martinez, E. A. AU - Thompson, D. A. AU - Errett, N. A. AU - Kim, G. R. AU - Bauer, L. AU - Lubomski, L. H. AU - Gurses, A. P. AU - Marsteller, J. A. AU - Mohit, B. AU - Goeschel, C. A. AU - Pronovost, P. J. DA - May DO - 10.1213/ANE.0b013e31820bfe8e J2 - Anesth. Analg. KW - ARTERY-BYPASS-SURGERY HARVARD MEDICAL-PRACTICE CARBON-DIOXIDE EMBOLISM INTRAOPERATIVE TRANSESOPHAGEAL ECHOCARDIOGRAPHY RIGHT-VENTRICULAR PERFORATION DRUG ADMINISTRATION SYSTEM PATIENT SAFETY SURGICAL-PATIENTS PULMONARY-ARTERY ADVERSE EVENTS Anesthesiology LA - English M1 - 5 M3 - Review N1 - ISI Document Delivery No.: 753NI Times Cited: 21 Cited Reference Count: 83 Martinez, Elizabeth A. Thompson, David A. Errett, Nicole A. Kim, George R. Bauer, Laura Lubomski, Lisa H. Gurses, Ayse P. Marsteller, Jill A. Mohit, Babak Goeschel, Christine A. Pronovost, Peter J. Goeschel, Christine/AAA-6783-2020 Mohit, Babak/0000-0002-6059-6681; Errett, Nicole/0000-0002-8247-8336 Agency for Healthcare Research and QualityUnited States Department of Health & Human ServicesAgency for Healthcare Research & Quality [HS013904-02, HS018762]; Society of Cardiovascular Anesthesia (SCA) Foundation This work was completed as part of the FOCUS initiative. The FOCUS Initiative is a collaborative project of the Society of Cardiovascular Anesthesiologists (SCA), the SCA Foundation, and the Johns Hopkins University Quality and Safety Research group. FOCUS is funded exclusively by the SCA Foundation. Elizabeth A. Martinez, MD, MHS, was supported by the Agency for Healthcare Research and Quality K08 grant #HS013904-02. Ayse P. Gurses, PhD, was partially supported by the Agency for Healthcare Research and Quality K01 grant #HS018762.; This author received research funding from Society of Cardiovascular Anesthesia (SCA) Foundation. Attestation: This author approved the final manuscript. 21 0 10 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA ANESTH ANALG PY - 2011 SN - 0003-2999 SP - 1061-1074 ST - High Stakes and High Risk: A Focused Qualitative Review of Hazards During Cardiac Surgery T2 - Anesthesia and Analgesia TI - High Stakes and High Risk: A Focused Qualitative Review of Hazards During Cardiac Surgery UR - ://WOS:000289785100011 VL - 112 ID - 761853 ER - TY - JOUR AB - BACKGROUND: Older adults with hip fracture have a 5- to 8- fold increased risk for all-cause mortality and much higher risk of institutionalization. Therefore, standardized and evidence-based interventions are highly needed. In this study, we aimed to identify mortality predictors in neck of femur (NOF) fracture patients and to assess the effectiveness of an integrated model of orthogeriatrics care in this population. METHODS: Two geriatricians run the model with the assistance of a multidisciplinary team. Assessments included surgical risk, physical examination, nutrition, cognition, and blood tests (blood count, biochemistry, electrolytes, and calciotropic hormones). A comprehensive intervention plan was designed following established Guidelines (http://www.aci.health.nsw.gov.au/-data/assets/pdf-file/0013/153400/ aci-orthogeriatrics-clinical-practice-guide.pdf). Two populations of NOF fracture patients admitted before (2006) and after (Jan. 2011- June 2012) the implementation of the program were compared. Uni and multivariate regression analysis models were used to determine independent predictors of early mortality. RESULTS: Two groups of NOF fracture patients were compared: n=270 in 2006, and n=150 in 2011-12. Mean age (83±7) and gender (73% female) were similar in both groups. Low albumin (<33) was associated with cardiac events (HR 2.4, 95% CI: 1.4-4.2) whereas low lymphocyte count (<20%) was associated with deep venous thrombosis and early cardiac events (HR 1.8, 95% CI: 1.15-4.5). The orthogeriatrics group showed a significantly shorter waiting time (<48h) for surgery (from 59.7% to 21.6%, p<0.01), lower in-hospital mortality (5.4% vs. 1.9%, p<0.05) and lower rate of di novo admission to nursing homes (24% vs.17%, p<0.05), with a higher number of patients receiving rehabilitation at discharge in the orthogeriatrics group (50% vs. 61.5%, p<0.05). CONCLUSION: We have identified strong predictors of early mortality in NOF patients. In addition, our data demonstrates the effectiveness of an evidence-based standardized orthogeriatrics program run by geriatricians together with a multidisciplinary team. AD - M. Martinez-Reig, Ageing Bone Research Program, Sydney Medical School Nepean, University of Sydney, Penrith, NSW, Australia AU - Martinez-Reig, M. AU - Vignakaran, N. AU - Kurusumuthu, P. AU - Smith, J. AU - Demontiero, O. AU - Loza-Diaz, G. AU - Sardinha, L. AU - Sharma, A. AU - Duque, G. DB - Embase DO - 10.1111/jgs.12263 KW - albumin hormone electrolyte model human femur fracture neck geriatrics society patient mortality fracture population evidence based practice risk hip fracture regression analysis lymphocyte count institutionalization adult blood cell count blood clinical practice cognition gender rehabilitation nursing home deep vein thrombosis surgery surgical risk female physical examination nutrition LA - English M3 - Conference Abstract N1 - L71038479 2013-04-20 PY - 2013 SN - 0002-8614 SP - S173-S174 ST - The orthogeriatrics model: Testing the effectiveness of an integrated model of care in older patients with neck of femur fracture T2 - Journal of the American Geriatrics Society TI - The orthogeriatrics model: Testing the effectiveness of an integrated model of care in older patients with neck of femur fracture UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71038479&from=export http://dx.doi.org/10.1111/jgs.12263 VL - 61 ID - 761172 ER - TY - JOUR AB - Introduction Our objective was to compare the feasibility and safety of surgical procedures to treat gynecological pathologies with intestinal involvement performed by skilled gynecological surgeons and by a multidisciplinary team of gynecologists plus colorectal surgeons. Material and methods We performed a comparative, observational, prospective study at a tertiary referral center. The population included all women undergoing bowel surgery for gynecological pathologies over a 3-year period. Cases were analyzed by the specialty of the main surgeon performing the intestinal procedure. The main outcome measures were surgical procedure characteristics and postoperative outcomes and complications. Results A total of 65 women were included. Surgery was exclusively performed by a subspecialized gynecologist in 30.8% of the women, and undertaken by a multidisciplinary team (colorectal surgeons and gynecologists) in 69.2%. The main demographic and clinical characteristics were comparable in both groups. Main indications for bowel resection in gynecological surgery were advanced ovarian cancer and deep infiltrating endometriosis. In addition to the standard gynecological surgical procedures, a total of 135 intestinal segments were resected, with sigmoid colon the most frequent intestinal segment resected in both groups (53% in the gynecologist group and in 60% in the multidisciplinary group). No significant differences were observed between the two groups in the distribution and frequency of surgical techniques used, rate of complications, mean hospitalization time or frequency of re-intervention. Conclusion Skilled gynecological surgeons appear to be equally good at handling common intestinal problems as a team of gynecologist and colorectal surgeons. AD - F. Carmona, Clinical Institute of Gynecology, Obstetrics and Neonatology, Faculty of Medicine, Hosp. Clinic and August Pi i Sunyer Biomedical Investigation Institute, University of Barcelona, C/Villarroel 170, Barcelona, Spain AU - Martínez-Serrano, M. J. AU - Martínez-Román, S. AU - Pahisa, J. AU - Balasch, J. AU - Carmona, F. DB - Embase Medline DO - 10.1111/aogs.12698 KW - abdominal pain adult advanced cancer aged anastomosis leakage anastomosis stenosis article cancer surgery colon resection colorectal surgeon controlled study deep vein thrombosis endometriosis feasibility study female fistula gynecologic disease gynecologic surgery gynecologist hemicolectomy hemoperitoneum human ileostomy intestine resection intestine surgery lung embolism major clinical study middle aged observational study outcome assessment ovary cancer partial gastrectomy patient safety pelvis abscess pleura effusion pneumonia postoperative ileus postoperative infection postoperative pain postoperative thrombosis priority journal prospective study rectum anastomosis rectum resection reoperation sigmoid sigmoidectomy small intestine resection surgeon surgical infection urinary tract infection LA - English M1 - 9 M3 - Article N1 - L605476307 2015-08-11 2015-08-12 PY - 2015 SN - 1600-0412 0001-6349 SP - 954-959 ST - Intestinal surgery performed by gynecologists T2 - Acta Obstetricia et Gynecologica Scandinavica TI - Intestinal surgery performed by gynecologists UR - https://www.embase.com/search/results?subaction=viewrecord&id=L605476307&from=export http://dx.doi.org/10.1111/aogs.12698 VL - 94 ID - 761090 ER - TY - JOUR AB - Background: The drip-and-ship method of treating stroke patients may increase the use of tissue plasminogen activator (t-PA) in community hospitals. Objective: The safety and early outcomes of patients treated with t-PA for acute ischemic stroke (AIS) by the drip-and-ship method were compared to patients directly treated at a stroke center. Methods: The charts of all patients who were treated with intravenous (i.v.) t-PA at outside hospitals under the remote guidance of our stroke team and were then transferred to our facility were reviewed. Baseline NIHSS (National Institutes of Health Stroke Scale) scores, onset-to-treatment (OTT), and arrival-to-treatment (ATT) times were abstracted. The rates of in-hospital mortality, symptomatic hemorrhage (sICH), early excellent outcome (modified Rankin Scale [mRS] <= 1), and early good outcome (discharge home or to inpatient rehabilitation) were determined. Results: One hundred sixteen patients met inclusion criteria. Eighty-four (72.4%) were treated within 3 h of symptom onset. The median estimated NIHSS score was 9.5 (range 3-27). The median OTT time was 150 min, and the median ATT was 85 min. These patients had an in-hospital mortality rate of 10.7% and sICH rate of 6%. Thirty percent of patients had an early excellent outcome and 75% were discharged to home or inpatient rehabilitation. When these outcome rates were compared with those observed in patients treated directly at our stroke center, there were no statistical differences. Conclusions: In this small retrospective study, drip-and-ship management of delivering i.v. t-PA for AIS patients did not seem to compromise safety. However, a large prospective study comparing drip-and-ship management to routine care is needed to validate the safety of this approach to treatment. (C) 2011 Elsevier Inc. AD - [Savitz, Sean I.] Univ Texas Hlth Sci Ctr Houston, Dept Neurol, Vasc Neurol Program, Houston, TX 77030 USA. [Khaja, Aslam M.] Univ Illinois, Dept Neurol, Chicago, IL USA. Savitz, SI (corresponding author), Univ Texas Hlth Sci Ctr Houston, Dept Neurol, Vasc Neurol Program, 6431 Fannin St,MSB 7-044, Houston, TX 77030 USA. AN - WOS:000294195900004 AU - Martin-Schild, S. AU - Morales, M. M. AU - Khaja, A. M. AU - Barreto, A. D. AU - Hallevi, H. AU - Abraham, A. AU - Sline, M. R. AU - Jones, E. AU - Grotta, J. C. AU - Savitz, S. I. DA - Aug DO - 10.1016/j.jemermed.2008.10.018 J2 - J. Emerg. Med. KW - stroke thrombolysis health care safety outcomes TISSUE-PLASMINOGEN ACTIVATOR EXPERIENCE PHYSICIANS DIAGNOSIS Emergency Medicine LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 811GZ Times Cited: 27 Cited Reference Count: 16 Martin-Schild, Sheryl Morales, Miriam M. Khaja, Aslam M. Barreto, Andrew D. Hallevi, Hen Abraham, Anitha Sline, M. Rick Jones, Elizabeth Grotta, James C. Savitz, Sean I. National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [5-T32-NS007412-09] Drs. Martin-Schild, Barreto, and Abraham are supported by training grant 5-T32-NS007412-09 from the National Institutes of Health to the University of Texas-Houston Medical School Stroke Program. 29 0 2 ELSEVIER SCIENCE INC NEW YORK J EMERG MED PY - 2011 SN - 0736-4679 SP - 135-141 ST - IS THE DRIP-AND-SHIP APPROACH TO DELIVERING THROMBOLYSIS FOR ACUTE ISCHEMIC STROKE SAFE? T2 - Journal of Emergency Medicine TI - IS THE DRIP-AND-SHIP APPROACH TO DELIVERING THROMBOLYSIS FOR ACUTE ISCHEMIC STROKE SAFE? UR - ://WOS:000294195900004 VL - 41 ID - 761847 ER - TY - JOUR AB - Background: Pulmonary endarterectomy (PEA) is a surgical intervention reserved for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In some cases, temporary circulatory support [extracorporeal life support (ECLS)] is required after PEA. Rates of ECLS requirement varies between centers. Reasons for institution of ECLS include respiratory failure, cardiac failure (or both respiratory and cardiac failure), bleeding, and reperfusion edema. This article reviews the experience of ECLS after PEA from the current literature, as well as our own institution's experience as a CTEPH multidisciplinary center. Methods: A literature review was conducted along with a retrospective chart review from 15 years of our PEA program. Results: The literature demonstrates many different approaches are used for mechanically supporting patients who develop complications after PEA. Variations in approach stem from differing indications such as, respiratory failure rather than hemodynamic compromise (or vice versa), time of implantation (immediately in operating room or delayed after surgery) and many other causes. In our center, 12.3% (19/154) of patients need ECLS with extracorporeal membrane oxygenator (ECMO) after PEA procedure. Implantation was mainly in the operating room before or immediately after weaning from cardiopulmonary bypass and mostly peripheral cannulation was used. ECMO lasted an average of 11 +/- 8 days. And 52.6% (10 of 19 patients) of patients were weaned from ECLS and of this, 70% (7 of 10 patients) were discharged. Conclusions: In some cases of PEA, ECLS is needed post-operatively. Expert teams should consider this possibility pre-operatively based on predisposing characteristics. The need for ECMO shouldn't be "di per se" a contraindication to surgery but might be considered in the surgical risk estimation. The ideal setup is not fixed and depends on the center's practices as well as indication. Even though complications do occur with ECMO, in general, results are good, being a bridge to further recovery of pulmonary hypertension (PH) or also to transplantation. AD - [Martin-Suarez, Sofia; Gliozzi, Gregorio; Fiorentino, Mariafrancesca; Loforte, Antonio; Pacini, Davide] Bologna Univ, St Orsola Hosp, Cardiac Surg Dept, Padiglione CTV 23,Via Massarenti,9 CAP, I-40138 Bologna, Italy. [Ghigi, Valentina] Bologna Univ, St Orsola Hosp, Cardiac Surg Anesthesia Dept, Bologna, Italy. [Di Camillo, Marcello] Bologna Univ, St Orsola Hosp, Bologna, Italy. [Galie, Nazareno] Bologna Univ, St Orsola Hosp, Cardiol Dept, Pulm Hypertens Unit, Bologna, Italy. Martin-Suarez, S (corresponding author), Bologna Univ, St Orsola Hosp, Cardiac Surg Dept, Padiglione CTV 23,Via Massarenti,9 CAP, I-40138 Bologna, Italy. docsofi74@hotmail.com AN - WOS:000457545600010 AU - Martin-Suarez, S. AU - Gliozzi, G. AU - Fiorentino, M. AU - Loforte, A. AU - Ghigi, V. AU - Di Camillo, M. AU - Galie, N. AU - Pacini, D. DA - Jan DO - 10.21037/acs.2019.01.02 J2 - Ann. Cardiothorac. Surg. KW - Extracorporeal membrane oxygenator (ECMO) pulmonary endarterectomy (PEA) deep hypothermic arrest pulmonary hypertension (PH) MEMBRANE-OXYGENATION ENDARTERECTOMY HEMORRHAGE VENTRICLE FAILURE INDEX Cardiac & Cardiovascular Systems Surgery LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: HJ9UV Times Cited: 1 Cited Reference Count: 25 Martin-Suarez, Sofia Gliozzi, Gregorio Fiorentino, Mariafrancesca Loforte, Antonio Ghigi, Valentina Di Camillo, Marcello Galie, Nazareno Pacini, Davide Loforte, Antonio/K-4919-2018 Loforte, Antonio/0000-0002-3689-0477 1 0 AME PUBL CO SHATIN ANN CARDIOTHORAC SUR PY - 2019 SN - 2225-319X SP - 84-92 ST - Role and management of extracorporeal life support after surgery of chronic thromboembolic pulmonary hypertension T2 - Annals of Cardiothoracic Surgery TI - Role and management of extracorporeal life support after surgery of chronic thromboembolic pulmonary hypertension UR - ://WOS:000457545600010 VL - 8 ID - 761548 ER - TY - JOUR AB - Background/Purpose: Pulmonary endarterectomy (PEA) is the gold standard treatment of chronic thromboembolic pulmonary hypertension (CTEPH). High-risk patients may require postoperative establishment of extracorporeal membrane oxygenation (ECMO) support. We report our single-centre experience concerning post-PEA ECMO strategy. Methods: In our series, 159 adult patients underwent PEA. Of these, 21 patients (13.2%) required veno-arterial ECMO. In 15 cases (71.4%), ECMO indication was unsuccessful weaning from cardiopulmonary bypass because of mixed he-modynamic and respiratory reasons. Peripheral cannulation setting was accomplished in 18 patients, while centrally in 3. Data have been retrospectively collected. Post-PEA ECMO and no ECMO cohorts were compared. Results: Patients on postoperative ECMO were clinically and hemodynamically more compromised. In the univariate analysis on preoperative variables, severe PVR (>10 Woods Units) was the main risk factor for early mortality (OR 3.5 (2.4-9.9); P =.018). Other risk factors were: pulmonary vascular distal lesions (OR 4.0 (1.0-15.2); P =.044), NYHA functional classes III-IV (OR 4.7 (1.1-21.2); P =.044), high right ventricle filling pressure (OR 3.7 (1.3-10.2); P =.012), moderate to severe tricuspid valve regurgitation (OR 1.9 (1.1-3.5); P =.033), O2 therapy (OR 2.6 (1.0-6.9); P =.046), CO<4L/min (OR 3.0 (1.1-8.1); P =.027), and reoperation (OR 6.9 (1.9-25.1); P =.004). The multivariate analysis confirmed high PVR and pulmonary disease (low FEV1 and DLCO) as risk factor for early mortality and need of postoperative ECMO. Mean ECMO support time was 10.6 ± 8 days; 11 patients (52.4%) were successfully weaned. Five years survival was comparable in the two cohorts (95.1% and 83.3%, post-PEA no ECMO vs ECMO, respectively) (P =.198). Conclusions: Decision-making process of PEA in CTEPH, requires an expert multidisciplinary team discussion to properly weight all procedural risks of postoperative complications. Need of ECMO may impact negatively on outcomes but conditional mid-to-long-term survival results to be comparable with the not mechanically supported population. AD - G. Gliozzi, Cardiac Surgery Unit, Sant'Orsola Hospital, Alma Mater Studiorum-Bologna University, Bologna, Italy AU - Martin-Suarez, S. AU - Gliozzi, G. AU - Mariani, C. AU - Cavalli, G. G. AU - Galiè, N. AU - Loforte, A. AU - Pacini, D. DB - Embase DO - 10.1111/aor.13651 KW - adult cannulation cardiopulmonary bypass chronic thromboembolic pulmonary hypertension complication conference abstract controlled study decision making endarterectomy extracorporeal oxygenation forced expiratory volume heart right ventricle human long term survival lung diffusion capacity major clinical study male mortality multidisciplinary team oxygen therapy postoperative complication preoperative evaluation reoperation retrospective study risk factor tricuspid valve regurgitation univariate analysis weaning LA - English M1 - 3 M3 - Conference Abstract N1 - L631569604 2020-04-30 PY - 2020 SN - 1525-1594 SP - E121 ST - Extracorporeal membrane oxygenation support after pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension T2 - Artificial Organs TI - Extracorporeal membrane oxygenation support after pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631569604&from=export http://dx.doi.org/10.1111/aor.13651 VL - 44 ID - 760599 ER - TY - JOUR AB - Chronic thromboembolic pulmonary hypertension is considered the only type of pulmonary hypertension with a potentially curative surgical treatment. Even today it is under-diagnosed or often diagnosed late with a worsening of the prognosis. Chronic thromboembolic pulmonary hypertension presents with nonspecific symptoms and general practitioners may not be aware of the condition or potential for treatment. Current medical treatment is, at best, palliative. Pulmonary endarterectomy offers the only possibility of symptomatic and prognostic improvement, being curative in most cases in the short and long term. Not only the identification of the pathology can be difficult and delayed, moreover after the diagnosis has been established, the estimation of operability can be challenging. The operability is based on the preoperative estimation of postoperative surgical classification and probable pulmonary vascular resistance, which determine the risk of intervention and the probable outcome. This complex procedure that includes, characterization of the pathology, the surgical intervention going through the whole decision process requires a multidisciplinary collaboration of experts in pulmonary hypertension, with a dedicated surgical team, and with very precise protocols. At our center, we have built a team of dedicated specialists including radiologists, cardiologists, cardiac surgeons, anesthesiologists and physiotherapists. Together, not only we have been able to obtain surgical results comparable to higher European centers, but also, to develop and implement other therapeutic options such as pulmonary angioplasty with balloon, dedicated to patients at high risk and discarded for surgery. In the present paper, we present a review of the pathology and, as an example, our single center experience with a multidisciplinary and dedicated management of chronic thromboembolic pulmonary hypertension patients, specifically diagnosis, pulmonary endarterectomy indication, protocols and results. (C) 2017 Socialad Espanola de Cirugia Toracica-Cardiovascular. Published by Elsevier Espana, S.L.U. AD - [Martin-Suareza, Sofia; Pacini, Davide; di Bartolomeo, Roberto] Hosp Santa Orsola Malpighi, Dept Cirugia Cardiovasc, Bolonia, Italy. [Gonzalez Vargas, Teresa] Hosp Virgen de las Nieves, Dept Cirugia Cardiovasc, Granada, Spain. [Galie, Nazzareno] Hosp Santa Orsola Malpighi, Dept Cardiol, Bolonia, Italy. Martin-Suarez, S (corresponding author), Hosp Santa Orsola Malpighi, Dept Cirugia Cardiovasc, Bolonia, Italy. docsofi74@hotimail.com AN - WOS:000429591400004 AU - Martin-Suarez, S. AU - Vargas, T. G. AU - Pacini, D. AU - di Bartolomeo, R. AU - Galie, N. DA - Mar-Apr DO - 10.1016/j.circv.2017.10.004 J2 - Cir. Cardiovasc. KW - Pulmonary hypertension Deep hypothermic circulatory arrest Endarterectomy INTERNATIONAL PROSPECTIVE REGISTRY SURGICAL-MANAGEMENT CIRCULATORY ARREST CEREBRAL PERFUSION RISK-FACTORS EMBOLISM HYPOTHERMIA EXPERIENCE SURGERY ANGIOPLASTY Surgery LA - Spanish M1 - 2 M3 - Review N1 - ISI Document Delivery No.: GC2DC Times Cited: 1 Cited Reference Count: 37 Martin-Suareza, Sofia Gonzalez Vargas, Teresa Pacini, Davide di Bartolomeo, Roberto Galie, Nazzareno 1 0 ELSEVIER SCIENCE BV AMSTERDAM CIR CARDIOVASC PY - 2018 SN - 1134-0096 SP - 93-101 ST - Chronic thromboembolic pulmonary hypertension (CTEPH): Characterization, pulmonary endarterectomy (PEA) and new therapeutic options T2 - Cirugia Cardiovascular TI - Chronic thromboembolic pulmonary hypertension (CTEPH): Characterization, pulmonary endarterectomy (PEA) and new therapeutic options UR - ://WOS:000429591400004 VL - 25 ID - 761599 ER - TY - JOUR AB - Introduction: Patients with Glanzmann thrombasthenia (GT) fail to form large platelet thrombi due to mutations that affect the biosynthesis and/or function of the αIIbβ3 integrin. This results in a moderate to severe bleeding disorder. Platelets (PLT) have been suggested to play a role in the early development of atherosclerosis. As one test of this hypothesis, it has been postulated on the basis of experimental studies, that GT may have a protective effect from atherothrombosis. Methods: We now report a Coronary Artery Bypass Graft Surgery (CABG) and right Carotid endarterectomy (CEA), in a 57-year-old Tunisian man with classic GT type I disease (with no platelet αIIbβ3 expression): the patient showed all the typical signs of GT with no PLT aggregation in response to physiological agonists. Furthermore, he presented a low PLT count around 80 G/l. GT was diagnosed at 5 years old; He suffered from repeated epistaxis and gingivorrhagia but never required transfusion. He received blood transfusions only for his circumcision at 11 years old. At 57 years old, he presented unstable angina, atrial fibrillation and right carotid atherosclerosis which first treated by Aspirin. These lesions were deemed inaccessible to percutaneous therapy. Therefore, CABG and CEA were recommended. Results: A multidisciplinary team (anesthesia, hematology, cardiac surgery, and transfusion medicine) was established to optimize perioperative management. The research of anti-HLA and antiintegrin αIIbβ3 allo-antibodies was negative. Successful management was achieved during the operation by prophylactic administration of HLAmatched PLT. Prophylactic PLT administration was continued through the immediate postoperative period and no bleeding complications occurred. PLT transfusion recovery was confirmed by calculating the percentage of αIIbβ3 expression by total PLT counts (expression of αIIbβ3 increased from 0 to 55%). Whereas, the PLT function analysis by aggregation and function tests was not normalized. The patient was discharged under a treatment of VKA in the reason of his atrial fibrillation chads2. His screening tests for risk factors for thrombosis revealed presence of FII G20210A mutation. Discussion/Conclusion: This observation suggests that atherosclerosis can develop despite the lack of αIIbβ3 integrin and that cautious administration of aspirin or VKA is possible in patients with congenital hemostatic disorder in event of severe thrombotic complication. AD - I. Martin-Toutain, Biological Hematology, Paris, France AU - Martin-Toutain, I. AU - Kurdi, M. AU - Amour, J. AU - Brumpt, C. AU - Delort, J. AU - Lebreton, G. AU - Croisille, L. AU - D'Oiron, R. AU - Ankri, A. DB - Embase KW - acetylsalicylic acid alloantibody endogenous compound fibrinogen receptor adult agonist anesthesia atrial fibrillation blood transfusion carotid atherosclerosis carotid endarterectomy CHADS2 score child circumcision clinical study clinical trial complication coronary artery bypass graft diagnosis drug therapy epistaxis experimental study gene expression regulation gene inactivation Glanzmann disease human male middle aged mutation postoperative period preschool child risk factor school child screening test surgery thrombocyte thrombosis transfusion medicine Tunisian unstable angina pectoris LA - English M3 - Conference Abstract N1 - L614510954 2017-02-27 PY - 2017 SN - 1365-2516 SP - 77-78 ST - Coronary artery bypass graft surgery in a patient with glanzmann thrombasthenia T2 - Haemophilia TI - Coronary artery bypass graft surgery in a patient with glanzmann thrombasthenia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614510954&from=export VL - 23 ID - 760958 ER - TY - JOUR AB - Rationale: Home parenteral nutrition (HPN) is a safe and effective treatment for type III intestinal failure (CIF). Experiences accumulated in the US and the European Union has been published over the last years. However, HPN experience for CIF has not been properly documented in South America. This work shows the results achieved by a multidisciplinary team in the administration and management of HPN for CIF in the southern region of Argentina. Methods: The Patagonian team of Nutritional Support carried out this cases series study. Patients admitted to the HPN team with diagnosis of CIF during the period 2011–2018 were included for analysis. The information collected was stored in an electronic database and the results are expressed in average, standard deviation and percentage, according to the type of variable analyzed. All statistical analyzes were performed in the SPSS-IBM® 24 program. Results: During the study period, a total of 32 patients diagnosticated with CIF and requiring HPN were assisted by the team. Table 1 shows baseline characteristics of the patients, along with the results of the latest medical check-up. 53% of the patients were women with an average age at CIF diagnosis of 55 ± 19 years. CIF causes distributed as follows: Extensive intestinal resection due to surgical complication (44%); Postsurgery fistula (17%); Extensive intestinal resection due to intestinal ischemia (13%); Mechanical obstruction due to extrinsic compression (13%); Extensive mucosal disease (10%); and Pseudo intestinal chronic obstruction (3%). Intestinal anatomy of the patients with SBS was distributed as: Type I: 40%; Type II: 30%; and Type III: 30%; respectively. According to the ESPEN CIF Clinical Classification ESPEN, patients were assigned on admission to categories D3:40%; D2:40%; D1:7%; and C3:7%; respectively. The remaining 6% of the patients was scattered among other groups. Weekly average parenteral calories did not vary during the study: Admission: 11,300 ± 3,666 calories vs. Actual: 8,611 ± 4,509 (D = –2,689 calories; p >0.05). HPN outcomes were as follows: Intestinal sufficiency with discontinuation of HPN: 40,6% of the patients; Persistent CIF with prolonged HPN: 40,6%; and Death from the underlying disease while on HPN: 18,7%; respectively. Average HPN duration was 468 ± 440(range 2–2635) days. HPN duration differed regarding HPN outcome: Intestinal sufficiency: 332 ± 240 days; Prolonged HPN: 489 ± 400 days; and Death while on HPN: 148 ± 145 days. Catheter-related bloodstream infection incidence (CRBSI) was 0.88 cases/1000 catheter-days, venous thrombosis 0.25 cases/1000 catheter-days and catheter rupture 0.25 cases/1000 catheter-days. The number of catheter replacements was 0.94 per patient, and average catheter time of useful life was 467 ± 280 days. Conclusions: In the present study series extensive intestinal resection due to surgical complication was the most common cause of CIF. HPN improved selected nutritional markers. HPN also improved the patient‘s self-sufficiency and quality of life. Patients required lower caloric loads: a sign of better intestinal absorption probably related to rehabilitation of the gut. Almost half of the patients achieved intestinal sufficiency after almost a year on HPN. The 18.75% of mortality was in patients with a malignant cause of CIF. Finally the incidence of catheter related complications were according to international recommendations. All these results demonstrate the safety and feasibility of HPN treatment in our region. AD - A.L.N. Martinuzzi, Nutrihome-SA, Neuquen, Argentina AU - Martinuzzi, A. L. N. AU - Cascaron, F. AU - Nuñez, A. AU - Bogado, M. AU - Betancurt, C. AU - Roel, P. AU - Tonnelier, M. AU - Ocampo, L. R. AU - Carcamo, C. AU - Traverso, M. AU - Maldonado, N. DB - Embase DO - 10.1016/S0261-5614(19)32759-1 KW - adult adverse device effect Argentina calorie case study catheter complication catheter infection clinical classification complication compression conference abstract drug withdrawal feasibility study female fistula gastrointestinal tract home parenteral nutrition human incidence intestinal failure intestine absorption intestine ischemia intestine resection medical examination middle aged mortality mucosal disease multidisciplinary team nutritional support obstruction peroperative complication quality of life rupture systematic review vein thrombosis LA - English M3 - Conference Abstract N1 - L2002860065 2019-09-20 PY - 2019 SN - 1532-1983 0261-5614 SP - S105-S106 ST - HOME PARENTERAL NUTRITION IN PATIENTS WITH TYPE III INTESTINAL FAILURE. PATAGONIAN EXPERIENCE T2 - Clinical Nutrition TI - HOME PARENTERAL NUTRITION IN PATIENTS WITH TYPE III INTESTINAL FAILURE. PATAGONIAN EXPERIENCE UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002860065&from=export http://dx.doi.org/10.1016/S0261-5614(19)32759-1 VL - 38 ID - 760678 ER - TY - JOUR AB - Introduction: Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. Methods: We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Results: Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Conclusion: Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. (C) 2017 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U. AD - [Masjuan, J.; Acebron, F.] Hosp Univ Ramon & Cajal, Serv Neurol, Madrid, Spain. [Masjuan, J.] Univ Alcala De Henares, Fac Med, Dept Med, Madrid, Spain. [Masjuan, J.] Inst Invest Sanitaria IRYCIS, Madrid, Spain. [Gallego Cullere, J.] Complejo Hosp Navarra, Serv Neurol, Navarra, Spain. [Ignacio Garcia, E.] Univ Cadiz, Escuela Univ Enfermeria & Fisioterapia, Cadiz, Spain. [Mira Solves, J. J.; Navarro Soler, I. M.] Univ Miguel Hernandez, Dept Psicol Salud, Alicante, Spain. [Ollero Ortiz, A.] Hosp Serrania, Serv Neurol, Malaga, Spain. [Vidal de Francisco, D.] Complejo Hosp Jaen, Serv Neurol, Jaen, Spain. [Lopez-Mesonero, L.] Hosp Virgen de la Concha, Serv Neurol, Zamora, Spain. [Bestue, M.; Alberti, O.] Hosp San Jorge, Serv Neurol, Huesca, Spain. [Mira Solves, J. J.] Dept Salud Alicante St Joan, Alicante, Spain. Soler, IMN (corresponding author), Univ Miguel Hernandez, Dept Psicol Salud, Alicante, Spain. inavarro@umh.es AN - WOS:000520097400003 AU - Masjuan, J. AU - Cullere, J. G. AU - Garcia, E. I. AU - Solves, J. J. M. AU - Ortiz, A. O. AU - de Francisco, D. V. AU - Lopez-Mesonero, L. AU - Bestue, M. AU - Alberti, O. AU - Acebron, F. AU - Soler, I. M. N. DA - Jan-Feb DO - 10.1016/j.nrl.2017.06.001 J2 - Neurologia KW - Patient-centred care Emergency care Care quality Hospital Stroke Quality indicators CARE Clinical Neurology LA - Spanish M1 - 1 M3 - Article N1 - ISI Document Delivery No.: KV0EM Times Cited: 0 Cited Reference Count: 14 Masjuan, J. Gallego Cullere, J. Ignacio Garcia, E. Mira Solves, J. J. Ollero Ortiz, A. Vidal de Francisco, D. Lopez-Mesonero, L. Bestue, M. Alberti, O. Acebron, F. Navarro Soler, I. M. Mira, Jose Joaquin/C-8729-2017 Mira, Jose Joaquin/0000-0001-6497-083X 0 1 ELSEVIER ESPANA SLU BARCELONA NEUROLOGIA PY - 2020 SN - 0213-4853 SP - 16-23 ST - Stroke treatment outcomes in hospitals with and without Stroke Units T2 - Neurologia TI - Stroke treatment outcomes in hospitals with and without Stroke Units UR - ://WOS:000520097400003 VL - 35 ID - 761469 ER - TY - JOUR AB - Extremity vascular trauma is a challenging surgical emergency in both civilian population and combat environment. It requires vigilant diagnosis and prompt treatment to minimize limb loss and mortality. A multidisciplinary team approach is required to deal with shock states, concomitant abdominal injuries, head injuries, and fractures with significant tissue loss and psychological stress. Anticoagulation is frequently used during traumatic vascular repair to avoid repair site thrombosis, postoperative deep venous thrombosis, and pulmonary embolism (PE). In this review article, we are going to search about how frequent is the use of anticoagulation in terms of limb salvage rates, and mortality rates or side effects of anticoagulation in terms of risk of bleeding episodes, and the need for future prospective studies. Extremity vascular trauma is managed by a variety of methods including open repairs, endovascular repairs, and nonoperative management. Most of the literature demonstrates the use of systemic or regional anticoagulation in the management of vascular injuries with the improvement in limb salvage rates and reduced morbidities but confounding factors lead to variable results. Some studies show an increased risk of bleeding in trauma patients with the use of anticoagulants in trauma settings without any significant effect on repair site thrombosis. More comprehensive studies and randomized controlled trials are needed to confirm the importance of perioperative anticoagulation while avoiding the confounding factors in terms of injury severity scores, ischemia time, demographics of patients, modes of injury, comorbidities, grades of shock, concomitant injuries that need anticoagulation like venous injuries or intracranial injuries that are contraindications to the use of anticoagulation, type of anticoagulation and expertise available as well as the experience level of the operating surgeon. Literature also reveals the use of new oral anticoagulants (e.g., dabigatran) to be associated with lesser bleeding episodes when compared to warfarin, so in future, we can check the feasibility of these agents to reduce the bleeding episodes and at the same time improve the limb salvage rates. AD - General Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA. Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA. AN - 32642377 AU - Masood, A. AU - Danawar, N. A. AU - Mekaiel, A. AU - Raut, S. AU - Malik, B. H. C2 - Pmc7336685 DA - Jun 6 DO - 10.7759/cureus.8473 DP - NLM ET - 2020/07/10 J2 - Cureus KW - emergency vascular injuries extremity vascular repair extremity vascular trauma intraoperative/postoperative anticoagulation systemic anticoagulation vascular injuries vascular system injuries and anticoagulants LA - eng M1 - 6 N1 - 2168-8184 Masood, Ayesha Danawar, Nuaman A Mekaiel, Andrew Raut, Sumit Malik, Bilal Haider Journal Article Review Cureus. 2020 Jun 6;12(6):e8473. doi: 10.7759/cureus.8473. PY - 2020 SN - 2168-8184 (Print) 2168-8184 SP - e8473 ST - The Utility of Therapeutic Anticoagulation in the Perioperative Period in Patients Presenting in Emergency Surgical Department With Extremity Vascular Injuries T2 - Cureus TI - The Utility of Therapeutic Anticoagulation in the Perioperative Period in Patients Presenting in Emergency Surgical Department With Extremity Vascular Injuries VL - 12 ID - 760511 ER - TY - JOUR AB - Introduction: Patient blood management (PBM) is a multidisciplinary system based about patient's anaemia tolerance. Evaluation is very difficult when a polytrauma or an obstetric emergency with massive bleeding occurs and the time of operation is critical. In this specific setting, point-of-care (POC) testing with thromboelastometry (ROTEM®) for determination of the coagulation status in real time and intraoperative cell salvage are very important for appropriate use of blood components. In our department, there is a multidisciplinary team (nurses and technicians) working in accordance with PBM guidelines. Methods: We considered 73 cases between the years 2015-2016 who underwent to emergency surgical procedure. Of these, we considered 40 patients who underwent both perioperative cell salvage and POC testing. We analysed the data about intraoperative blood losses and use of allogeneic blood components. Results: From data analysis we observed on 73 patients, the total amount of processed blood was 90 339 mL with a volume of recovered blood of 42 153 mL, corresponding to 169 blood units. We reported two cases: the first patient (39 years old) with a diagnosis of PPE and with fibrinolytic acute pathway and coagulation system dysfunction (Figure 1). According to ROTEMresults, we administered 6 g fibrinogen + 4 FFP + 2 mg of rFVIIa, which corrected the coagulation system (Figure 2). The second patient (21 years old) with the diagnosis of trauma-induced coagulopathy and with haemoperitoneum. During perioperative cell salvage, blood loss was 2250 mL and we recovered 1400 mL, which corresponds to six red blood cell unit. ROTEM evaluations showed a serious lack of fibrinogen (Figure 3), which was corrected with 8 g of fibrinogen + 4 FFP + 2 g tranexamic acid (Figure 4). Conclusion: These data show that cell salvage the real-time coagulation monitoring represent correct application of patient blood management pathways. Intraoperative blood salvage and the early detection of acute coagulopathy decreased the use of allogeneic blood and reduced morbidity and mortality due to massive bleeding. (Figure Presented). AD - F. Massarelli, Department of Transfusion Medicine, San Camillo-Forlanini Hospital, Rome, Italy AU - Massarelli, F. AU - Scali, S. AU - Carapellotti, A. AU - Catteddu, A. AU - Maiani, L. AU - Mancusi, A. AU - Rondinelli, M. B. AU - Pierelli, L. DB - Embase DO - 10.1111/tme.12417 KW - endogenous compound fibrinogen fibrinolytic agent recombinant blood clotting factor 7a adult blood clotting disorder blood component blood salvage cell culture monitoring data analysis diagnosis emergency erythrocyte gene inactivation hemoperitoneum human injury major clinical study morbidity mortality nurse operative blood loss point of care testing practice guideline surgery thromboelastograph young adult LA - English M3 - Conference Abstract N1 - L615441320 2017-04-24 PY - 2017 SN - 1365-3148 SP - 43 ST - Thromboelastometry (ROTEM®) and intraoperative cell salvage for appropriate use of blood components T2 - Transfusion Medicine TI - Thromboelastometry (ROTEM®) and intraoperative cell salvage for appropriate use of blood components UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615441320&from=export http://dx.doi.org/10.1111/tme.12417 VL - 27 ID - 760952 ER - TY - JOUR AB - OBJECTIVES: Background: Myocarditis commonly presents as a young male with flu-like symptoms and elevated ESR, characteristics which make it easily overlooked by an obstetrician. While current incidence is unknown, myocarditis is most commonly viral and has been implicated in sudden cardiac death in young adults at rates of 8.6-12%. In early pregnancy an acute process impacting cardiac output can cause significant clinical problems. METHODS: Case: A 21-year old female who presented for shortness of breath was tachycardic with elevated D dimer. She was incidentally found to be 5 weeks pregnant. Negative influenza testing, chest x ray, lower extremity doppler studies, and CT negative for pulmonary embolus but with lower lobe intralobular septal thickening and possible edema. Transvaginal ultrasound found gestational and yolk sacs and pelvic ascites. During admission the patient had worsened tachycardia with sustained heart rate of 140-150 bpm, EKG indicating right ventricular hypertrophy and incomplete right bundle branch block, new bilateral infiltrates and effusions on chest x ray, pulmonary hypertension on echocardiogram with right ventricular systolic pressure of 42 mmg Hg and low normal ejection fraction at 50%. Elevated troponins, creatine kinase, and brain natriuretic peptide were also found. Intensive care unit admission was needed for worsening clinical condition. Laboratories ruled out HIV, hepatitis, lupus and other autoimmune conditions, cytomegalovirus, Epstein Barr virus, Legionella and numerous respiratory viruses. Positive Mycoplasma IgM pointed toward Mycoplasma pneumonia with associated myocarditis and she improved with proper therapies. At 2 week followup cardiac function was stable with resolved pulmonary hypertension. Cardiac MRI was planned for postpartum, and the intrauterine pregnancy continued to develop. RESULTS: (see next section) CONCLUSIONS: Myocarditis in early gestation should not delay appropriate medical interventions. For viral myocarditis, the steroid endocrinology of pregnancy is a known risk for worsened clinical outcome. While in this case the causative agent was an atypical bacteria, the extra risks that decreased cardiac function in pregnancy create should not be taken lightly. Coordinating with a multidisciplinary team has the potential to expedite patient care and safety. This case serves as a testament to the importance of rapid medical decision making when myocarditis is in the differential. AD - A. Massengill, University of Illinois, College of Medicine at Peoria, United States AU - Massengill, A. AU - Rodriguez, J. AU - Cotter, T. AU - Cotter, J. G. DB - Embase DO - 10.1016/j.ajog.2016.09.069 KW - brain natriuretic peptide creatine kinase D dimer endogenous compound immunoglobulin M steroid troponin adult ascites cardiovascular magnetic resonance case report clinical outcome Cytomegalovirus dyspnea echocardiography edema endocrinology Epstein Barr virus female follow up heart ejection fraction heart rate heart right bundle branch block heart right ventricle hypertrophy hepatitis human Human immunodeficiency virus influenza intensive care unit jurisprudence Legionella lower limb lung embolism medical decision making Mycoplasma pneumonia nonhuman outcome assessment patient care pregnancy pulmonary hypertension respiratory distress systemic lupus erythematosus systolic blood pressure tachycardia thorax radiography transvaginal echography virus myocarditis yolk sac young adult LA - English M1 - 6 M3 - Conference Abstract N1 - L618754857 2017-10-18 PY - 2016 SN - 1097-6868 SP - S846 ST - Infectious myocarditis in pregnancy: An unlikely cause of respiratory distress T2 - American Journal of Obstetrics and Gynecology TI - Infectious myocarditis in pregnancy: An unlikely cause of respiratory distress UR - https://www.embase.com/search/results?subaction=viewrecord&id=L618754857&from=export http://dx.doi.org/10.1016/j.ajog.2016.09.069 VL - 215 ID - 760989 ER - TY - JOUR AB - Background: Stroke is a medical emergency. In-hospital stroke (IHS) represents 6.5 - 15% of all strokes. The treatment goal for acute ischemic stroke is to reperfuse ischemic brain tissue. Delay in recognition due to comorbidities and delay in brain imaging with neurologist evaluation are common. Unlike the response for cardiac arrest, most hospitals have no organized system in place for the patient having an acute stroke while hospitalized. Purpose: The purpose was to increase recognition of IHS, develop an organized acute stroke code process with rapid brain imaging and interpretation, increasing treatment rates and improving patient outcomes. Methods: FAST test was used to teach stroke recognition to all hospital employees. An online stroke education module, in-services and dedicated stroke champions on each unit helped reinforce the teaching. The Rapid Response Team (RRT) at Hoag Hospital consists of experienced critical care RNs. Stroke symptoms, establishing a “last time seen normal”, NIH Stroke Scale, treatment options and IV tPA competencies were part of a class for all RRT RNs. A “Code 20” is called by RRT for any patient exhibiting the signs and symptoms of stroke, last time seen normal within 8 hours. This code pages Stroke Team, which provides a neurologist, Stroke Unit Charge Nurse and CT. Stroke Protocol Orders are initiated. The goal is to arrive at CT scan within 20 minutes of calling the code. The RRT RN discusses treatment plan with neurologist and transfers patient to the appropriate level of care to facilitate thrombolytic therapies as needed. Restrospective ongoing analysis of RRT Code 20 calls over the time period of 5/1/2008 - 7/31/2010 was undertaken. This includes monthly reports to committee, case studies and immediate debriefing with the RNs involved. Results: A total of 160 Code 20s have been called since program rollout. 23% (37/160) were new IHS, 13% (21/160) were TIAs. 16% (6/37) IHS received IV tPA, 2.7% (1/37) IHS received IA tPA with Penumbra thrombectomy for a total of 19% (7/37) treatment rate for IHS. 2.5% (4/160) of Code 20s were acute ICH. Conclusions: RRT Code 20 is an effective tool for the management of acute in-hospital stroke. Ongoing education with real time feedback to the nurses involved with each case is needed to decrease the false positives called as Code 20s. Several other neurological emergencies were also rapidly identified and treated. AD - D.M. Mastrolia, Hoag Hosp., Newport Beach, CA, United States AU - Mastrolia, D. M. AU - Furlong, K. DB - Embase DO - 10.1161/STR.0b013e3182074d9b KW - cerebrovascular accident hospital patient emergency brain imaging education National Institutes of Health Stroke Scale physical disease by body function stroke unit charge nurse computer assisted tomography fibrinolytic therapy case study thrombectomy brain tissue nurse heart arrest brain ischemia hospital personnel teaching intensive care feedback system LA - English M1 - 3 M3 - Conference Abstract N1 - L70363191 2011-03-16 PY - 2011 SN - 0039-2499 SP - e328 ST - Code 20 increases identification and treatment of in-hospital stroke T2 - Stroke TI - Code 20 increases identification and treatment of in-hospital stroke UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70363191&from=export http://dx.doi.org/10.1161/STR.0b013e3182074d9b VL - 42 ID - 761239 ER - TY - JOUR AB - Background: To maximize the effect of intravenous (IV) thrombolysis and/or endovascular therapy (EVT) for acute ischemic stroke (AIS), stroke centers need to establish a parallel workflow on the basis of a code stroke (CS) protocol. At Kokura Memorial Hospital (KMH), we implemented a CS system in January 2014; however, the process of information sharing within the team has occasionally been burdensome. Objective: To solve this problem using information communication technology (ICT), we developed a novel application for smart devices, named "Task Calc. Stroke" (TCS), and aimed to investigate the impact of TCS on AIS care. Methods: TCS can visualize the real-time progress of crucial tasks for AIS on a dashboard by changing color indicators. From August 2015 to March 2017, we installed TCS at KMH and recommended its use during normal business hours (NBH). We compared the door-to-computed tomography time, the door-to-complete blood count (door-to-CBC) time, the door-to-needle for IV thrombolysis time, and the door-to-puncture for EVT time among three treatment groups, one using TCS ("TCS-based CS"), one not using TCS ("phone-based CS"), and one not based on CS ("non-CS"). A questionnaire survey regarding communication problems was conducted among the CS teams at 3 months after the implementation of TCS. Results: During the study period, 74 patients with AIS were transported to KMH within 4.5 h from onset during NBH, and 53 were treated using a CS approach (phone-based CS: 26, TSC-based CS: 27). The door-to-CBC time was significantly reduced in the TCS-based CS group compared to the phone-based CS group, from 31 to 19 min (p = 0.043). Other processing times were also reduced, albeit not significantly. The rate of IV thrombosis was higher in the TCS-based CS group (78% vs. 46%, p = 0.037). The questionnaire was correctly filled in by 34/38 (89%) respondents, and 82% of the respondents felt a reduction in communication burden by using the TCS application. Conclusions: TCS is a novel approach that uses ICT to support information sharing in a parallel CS workflow in AIS care. It shortens the processing times of critical tasks and lessens the communication burden among team members. AD - [Matsumoto, Shoji; Nakahara, Ichiro; Watanabe, Sadayoshi] Fujita Hlth Univ, Dept Comprehens Strokol, Sch Med, Toyoake, Aichi, Japan. [Koyama, Hiroshi] Adv Inst Ind Technol, Aduate Sch Ind Technol, Shinagawa, Japan. [Ishii, Akira] Kyoto Univ Hosp, Dept Neurosurg, Kyoto, Japan. [Hatano, Taketo; Chihara, Hideo; Kamata, Takahiko; Kondo, Daisuke; Nagata, Izumi] Kokura Mem Hosp, Dept Neurosurg, Kitakyushu, Fukuoka, Japan. [Ohta, Tsuyoshi] Kochi Hlth Sci Ctr, Dept Neurosurg, Kochi, Japan. [Tanaka, Koji; Yamasaki, Ryo; Kira, Jun-ichi] Kyushu Univ, Grad Sch Med Sci, Neurol Inst, Dept Neurol, Fukuoka, Fukuoka, Japan. [Ando, Mitsushige] Shiga Gen Hosp, Dept Neurosurg, Moriyama, Japan. [Takita, Wataru] Natl Hosp Org Nagoya Med Ctr, Dept Neurol, Nagoya, Aichi, Japan. [Tokunaga, Keisuke] Natl Hosp Org Kyushu Med Ctr, Dept Cerebrovasc Med & Neurol, Fukuoka, Fukuoka, Japan. [Hashikawa, Takuro] St Marys Hosp, Dept Neurosurg, Kurume, Fukuoka, Japan. [Funakoshi, Yusuke] Kobe City Med Ctr Gen Hosp, Dept Neurosurg, Kobe, Hyogo, Japan. [Higashi, Eiji] Saga Med Ctr Koseikan, Dept Cerebrovasc Med, Saga, Japan. [Tsujimoto, Atsushi] Japan Community Hlth Care Org, Dept Neurol, Kyushu Hosp, Kitakyushu, Fukuoka, Japan. [Furuta, Konosuke] Kokura Mem Hosp, Dept Neurol, Kitakyushu, Fukuoka, Japan. [Ishihara, Takuma] Gifu Univ Hosp, Innovat & Clin Res Promot Ctr, Gifu, Japan. [Hashimoto, Tetsuya] Univ Calif Los Angeles, Dept Neurol, Los Angeles, CA 90024 USA. [Koge, Junpei] Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Osaka, Japan. [Sonoda, Kazutaka] Saiseikai Fukuoka Gen Hosp, Dept Neurol, Fukuoka, Fukuoka, Japan. [Torii, Takako] Nagoya City Univ, Dept Neurol & Neurosci, Grad Sch Med Sci, Nagoya, Aichi, Japan. [Nakagaki, Hideaki] Fukuoka City Hosp, Dept Neurol, Fukuoka, Fukuoka, Japan. Matsumoto, S (corresponding author), Fujita Hlth Univ, Dept Comprehens Strokol, Sch Med, Toyoake, Aichi, Japan. shoji.neuro@gmail.com AN - WOS:000497459000001 AU - Matsumoto, S. AU - Koyama, H. AU - Nakahara, I. AU - Ishii, A. AU - Hatano, T. AU - Ohta, T. AU - Tanaka, K. AU - Ando, M. AU - Chihara, H. AU - Takita, W. AU - Tokunaga, K. AU - Hashikawa, T. AU - Funakoshi, Y. AU - Kamata, T. AU - Higashi, E. AU - Watanabe, S. AU - Kondo, D. AU - Tsujimoto, A. AU - Furuta, K. AU - Ishihara, T. AU - Hashimoto, T. AU - Koge, J. AU - Sonoda, K. AU - Torii, T. AU - Nakagaki, H. AU - Yamasaki, R. AU - Nagata, I. AU - Kira, J. I. C7 - 1118 DA - Oct DO - 10.3389/fneur.2019.01118 J2 - Front. Neurol. KW - acute ischemic stroke endovascular therapy intravenous thrombolysis processing times visual task management TISSUE-PLASMINOGEN ACTIVATOR TO-NEEDLE TIMES SMARTPHONE Clinical Neurology Neurosciences LA - English M3 - Article N1 - ISI Document Delivery No.: JO3CM Times Cited: 0 Cited Reference Count: 20 Matsumoto, Shoji Koyama, Hiroshi Nakahara, Ichiro Ishii, Akira Hatano, Taketo Ohta, Tsuyoshi Tanaka, Koji Ando, Mitsushige Chihara, Hideo Takita, Wataru Tokunaga, Keisuke Hashikawa, Takuro Funakoshi, Yusuke Kamata, Takahiko Higashi, Eiji Watanabe, Sadayoshi Kondo, Daisuke Tsujimoto, Atsushi Furuta, Konosuke Ishihara, Takuma Hashimoto, Tetsuya Koge, Junpei Sonoda, Kazutaka Torii, Takako Nakagaki, Hideaki Yamasaki, Ryo Nagata, Izumi Kira, Jun-ichi Ohta, Tsuyoshi/0000-0001-9345-7701 [16K10727] This work was supported by a Grant-in-Aid for Scientific Research (16K10727). 0 FRONTIERS MEDIA SA LAUSANNE FRONT NEUROL PY - 2019 SN - 1664-2295 SP - 10 ST - A Visual Task Management Application for Acute Ischemic Stroke Care T2 - Frontiers in Neurology TI - A Visual Task Management Application for Acute Ischemic Stroke Care UR - ://WOS:000497459000001 VL - 10 ID - 761484 ER - TY - JOUR AB - PURPOSE: Acute mesenteric ischemia (AMI) is still associated with very high morbidity and mortality while the rareness and heterogeneity hamper the establishment of evidence-based guidelines. We sought to help standardize contemporary treatment by a cohort study at our tertiary center in the rising endovascular age. METHODS: A retrospective cohort study was conducted from 2005 to 2015. Patients with occlusive (OMI), non-occlusive (NOMI), and venous mesenteric ischemia (VMI) were compared with respect to clinical and treatment parameters as well as outcome. RESULTS: The study cohort consisted of 48 patients composed of 27 males and 21 females with an average age of 63 years and an average BMI of 25.1 kg/m(2). In 48% of patients (N=23), an acute arterial OMI had occurred while NOMI was present in 31% (N=15) and VMI in 21% (N=10). Interventional and intraoperative recanalizations were significantly more often required in OMI patients compared with other entities (p=0.003). Patients with venous mesenteric ischemia had a significant better overall survival than patients with OMI or NOMI in the univariate analysis (p=0.027). Patients with renal failure had a 14.7-fold higher relative risk (Cox p=0.013) and patients without bowel resection during primary surgery had a 17.8-fold higher relative risk (Cox p=0.047) to die of AMI in the postoperative course. CONCLUSIONS: AMI remains a rare but oftentimes fatal disease. Our study provides evidence that outcome may depend on the AMI subtype, presence of renal insufficiency, and early bowel resection. Further research should help individualize treatment for optimized outcomes. AD - Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany. Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany. arne.koscielny@ukbonn.de. AN - 31512020 AU - Matthaei, H. AU - Klein, A. AU - Branchi, V. AU - Kalff, J. C. AU - Koscielny, A. DA - Oct DO - 10.1007/s00384-019-03388-x DP - NLM ET - 2019/09/13 J2 - International journal of colorectal disease KW - Acute Disease Cohort Studies *Digestive System Surgical Procedures Female Humans Kaplan-Meier Estimate Male Mesenteric Ischemia/*complications Middle Aged Multivariate Analysis Patient Care Team Renal Insufficiency/*complications Risk Factors Survival Analysis Treatment Outcome Acute abdomen Mesenteric ischemia Venous thrombosis Visceral artery occlusion LA - eng M1 - 10 N1 - 1432-1262 Matthaei, Hanno Klein, Alina Branchi, Vittorio Kalff, Jörg C Koscielny, Arne Journal Article Germany Int J Colorectal Dis. 2019 Oct;34(10):1781-1790. doi: 10.1007/s00384-019-03388-x. Epub 2019 Sep 11. PY - 2019 SN - 0179-1958 SP - 1781-1790 ST - Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes T2 - Int J Colorectal Dis TI - Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes VL - 34 ID - 760158 ER - TY - JOUR AB - Introduction: In 2013 the first national guideline outlined referral criteria for pressure equalization (PE) tube insertion, the second most common operation for US children.1 National data suggests over-referral, with PE tubes suggested for targeted reduction. 2,3,4 Primary Aim: To increase by 20% the number of children (< 6 years) in a medical home appropriately referred to ENT for tube placement. Methods: • PDSA #1: A multidisciplinary team modified the 2013 national guideline1 for clarity, disseminated it to providers, developed web-based resources (tympanometry, hearing screens), and ensured access to exam equipment and patient education materials. Interventions were chosen based on factors contributing to the gap, including lack of knowledge regarding referral criteria and inaccurate diagnosis of recurrent acute otitis media (RAOM), chronic otitis media with effusion (COME), and hearing loss. • PDSA #2: A web-based care process model (available at point of ordering referral) and “Choosing Wisely”-style patient education were published and disseminated. Measurement: Baseline and post-intervention chart audits using 17 middle ear ICD-9 codes identified outpatients billed by ENT providers. Charts were audited for unique patients meeting inclusion criteria; guideline was applied to determine appropriateness of referral. Results: The percentage of appropriate referrals increased after PDSA #1 (68% to 77%) and PDSA #2 (77% to 88%) (Table 1, Figure 1); the improvement for RAOM patients was statistically significant after PDSA #1 (67% to 87%, p=.046). The percentage of appropriate referrals for COME decreased after PDSA #1 (83% to 44%) but increased after PDSA #2 (44% to 71%) (Figure 2). Table 1. Measurement Figure 1. Percentage of pts appropriately referred (total) Figure 2. Percentage of pts appropriately referred (by indication) Pre- and post- provider satisfaction surveys were obtained as counterbalance measures. Financial data (Q3 2012 - Q4 2014) suggest a downward trend in ENT visits and total cost per patient. Discussion and Conclusions: • We narrowly missed our goal of 20% improvement, but RAOM improvement was statistically significant. • Limitations included reliance on billing data, small sample sizes, variable application of referral criteria by abstractors, no control for month of ENT referrals (possible seasonal effect), and no parent satisfaction measure. • A multidisciplinary approach to improving appropriate subspecialty utilization is necessary to provide high value pediatric care; guidelines providing evidence-based criteria for appropriate referral to other subspecialties can be similarly used to improve the value of pediatric care. (Table Presented). AD - A.C. Mattke, Mayo Clinic, Rochester, MN, United States AU - Mattke, A. C. AU - Wong-Nano, G. AU - Martin, V. AU - Cofer, S. AU - Wi, C. AU - Cook, W. AU - Juhn, Y. AU - Soma, D. AU - Homme, J. AU - Starr, S. DB - Embase DO - 10.1542/peds.141.1-MeetingAbstract.83 KW - acute otitis media child chronic secretory otitis media clinical article conference abstract controlled study female hearing impairment human ICD-9 male middle ear disease multidisciplinary team outpatient patient education patient referral pediatrics practice guideline primary medical care process model sample size satisfaction tympanometry LA - English M1 - 1 M3 - Conference Abstract N1 - L630253141 2019-12-27 PY - 2018 SN - 1098-4275 ST - A primary care-ENT initiative to improve value for children with middle ear disease T2 - Pediatrics TI - A primary care-ENT initiative to improve value for children with middle ear disease UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630253141&from=export http://dx.doi.org/10.1542/peds.141.1-MeetingAbstract.83 VL - 141 ID - 760882 ER - TY - JOUR AB - OBJECTIVE: Numerous guidelines have been published on the management of venous thromboembolism (VTE). However, therapeutic decision-making may prove challenging in routine clinical practice. With this in mind, multidisciplinary team (MDT) meetings have been set up in Rennes University Hospital, France. This study sought to describe the situations discussed during MDT meetings and to assess whether the meetings bring about changes in the management of these patients. MATERIALS AND METHODS: A retrospective single-center study conducted at the Rennes University Hospital included cases presented from the beginning of the MDT meetings (February 2015) up to May 2017. RESULTS: In total, 142 cases were presented in 15 MDT meetings, corresponding to a mean of 10±4 cases per meeting. Of these, 129 related to VTE patients: 33 provoked VTEs, 22 unprovoked VTEs, 49 cancer-related VTEs, and 25 unspecified VTEs. MDT meetings led to significant changes in the anticoagulation type (therapeutic, prophylactic, or discontinuation) and duration, but not in the anticoagulant choice (direct oral anticoagulants, vitamin K antagonists, heparins, etc.). CONCLUSION: Requests for MDT meetings are made for all VTE types, and these meetings have an impact on VTE management. AD - Cardiology Department, Saint Malo Hospital, Saint Malo, France; Vascular Medicine unit, Rennes University Hospital, Rennes, France. Electronic address: chadi.mauger@gmail.com. Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France; Rennes 1 University, Rennes, France. Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France. Departement of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France. Oncology Department, Saint-Grégoire private hospital, Saint-Grégoire, France. Medical Oncology, Centre Eugène Marquis, Rennes, France. Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France; Pediatric Department, University Hospital, Rennes, France. Vascular Medicine unit, Rennes University Hospital, Rennes, France. UMR INSERM U1085, Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Rennes, France. Vascular Medicine unit, Rennes University Hospital, Rennes, France; INSERM CIC 14 14, Rennes, France. Electronic address: maheguillaume@yahoo.fr. AN - 32571559 AU - Mauger, C. AU - Gouin, I. AU - Guéret, P. AU - Gac, F. N. AU - Baillerie, A. AU - Lefeuvre, C. AU - Boutruche, B. AU - Bayard, S. AU - Jaquinandi, V. AU - Jégo, P. AU - Mahé, G. DA - Jul DO - 10.1016/j.jdmv.2020.04.011 DP - NLM ET - 2020/06/24 J2 - Journal de medecine vasculaire KW - Administration, Oral Anticoagulants/*administration & dosage/adverse effects Blood Coagulation/*drug effects *Clinical Decision-Making *Cooperative Behavior Drug Administration Schedule France Hospitals, University Humans *Interdisciplinary Communication *Patient Care Team Patient Selection Retrospective Studies Treatment Outcome Venous Thromboembolism/diagnosis/*drug therapy/etiology Anticoagulation Cancer Multidisciplinary Evaluation Consortium Venous thromboembolism disease LA - eng M1 - 4 N1 - Mauger, C Gouin, I Guéret, P Gac, F Nedelec Baillerie, A Lefeuvre, C Boutruche, B Bayard, S Jaquinandi, V Jégo, P Mahé, G Journal Article France J Med Vasc. 2020 Jul;45(4):192-197. doi: 10.1016/j.jdmv.2020.04.011. Epub 2020 May 13. PY - 2020 SN - 2542-4513 (Print) 2542-4513 SP - 192-197 ST - Impact of multidisciplinary team meetings on the management of venous thromboembolism. A clinical study of 142 cases T2 - J Med Vasc TI - Impact of multidisciplinary team meetings on the management of venous thromboembolism. A clinical study of 142 cases VL - 45 ID - 760248 ER - TY - JOUR AB - Aim: Out-of-hospital cardiac arrests (OHCAs) in pregnant women are rare events. In this study, we aimed to describe a cohort of pregnant women who experienced OHCAs in a large urban area, and received treatment by the prehospital teams in a two-tiered emergency response system. Methods: This retrospective study included pregnant women over 18 years of age who experienced OHCAs. The analysed variables included maternal age, gestational age, variables specific to the rescue system, number of shocks delivered by an automatic external defibrillator, and rates of maternal and neonatal survival. Results: Over the 5-year study period, 19,515 OHCAs occurred, 16 of which were in pregnant women. These 16 patients had a median age of 31 years [interquartile range (IQR): 28-35] and a median gestational age of 20 weeks [IQR: 10-33]. Three patients (18.8%) had an initial rhythm of ventricular fibrillation. Only one patient underwent thrombolysis. Of the 16 patients, 6 (38%) died after resuscitation on the scene. The remaining 10 were transported to the hospital, of whom 5 achieved circulation through a mechanical CPR device. Only 2 patients were alive 30 days after OHCA. Conclusions: Over half of the pregnant women who experienced OHCA were at least 20 weeks pregnant. Analysis of the prehospital medical data suggests that the current recommendations are difficult to apply in an out-of-hospital environment. Specific recommendations for this situation must be developed. AD - [Maurin, Olga; Lemoine, Sabine; Jost, Daniel; Lanoe, Vincent; Travers, Stephane; Tourtier, Jean Pierre; Paris Fire Brigade Cardiac Arrest] Paris Fire Brigade Med Emergency Dept, 1 Pl Jules Renard, F-75017 Paris, France. [Jost, Daniel] INSERM, SDEC, U970, Paris, France. [Renard, Aurelien] Mil Teaching Hosp, HIA St Anne, Emergency Dept, Toulon, France. [Lapostolle, Frederic] Avicenne Hosp, AP HP, INSERM, U942,Emergency Med Serv Dept SAMU 93, Bobigny, France. Lemoine, S (corresponding author), Paris Fire Brigade Med Emergency Dept, 1 Pl Jules Renard, F-75017 Paris, France. sabine.lemoine@pompiersparis.fr AN - WOS:000459785900029 AU - Maurin, O. AU - Lemoine, S. AU - Jost, D. AU - Lanoe, V. AU - Renard, A. AU - Travers, S. AU - Lapostolle, F. AU - Tourtier, J. P. AU - Paris Fire Brigade Cardiac, Arrest DA - Feb DO - 10.1016/j.resuscitation.2018.11.001 J2 - Resuscitation KW - Out-of-hospital cardiac arrest Pregnancy Perimortem caesarean section Extracorporeal membrane oxygenation Thrombolysis Maternofoetal outcomes PERIMORTEM CESAREAN DELIVERY LIFE-SUPPORT PREGNANCY SECTION FRANCE Critical Care Medicine Emergency Medicine LA - English M3 - Article N1 - ISI Document Delivery No.: HM9EO Times Cited: 4 Cited Reference Count: 19 Maurin, Olga Lemoine, Sabine Jost, Daniel Lanoe, Vincent Renard, Aurelien Travers, Stephane Lapostolle, Frederic Tourtier, Jean Pierre Jost, Daniel/AAD-1106-2020 Jost, Daniel/0000-0002-6046-1234; Frederic, Lemoine/0000-0003-0828-2818; Lemoine, Sabine/0000-0003-4018-0715 4 0 ELSEVIER IRELAND LTD CLARE RESUSCITATION PY - 2019 SN - 0300-9572 SP - 205-211 ST - Maternal out-of-hospital cardiac arrest: A retrospective observational study T2 - Resuscitation TI - Maternal out-of-hospital cardiac arrest: A retrospective observational study UR - ://WOS:000459785900029 VL - 135 ID - 761540 ER - TY - JOUR AB - OBJECTIVE: This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team Planning for Delivery and Postpartum Care. INTENDED USERS: All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. TARGET POPULATION: Women with obesity who are pregnant or planning pregnancies. EVIDENCE: Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetric anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS: The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committees peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS: Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affecting pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. GUIDELINE UPDATE: SOGC guideline will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. SPONSORS: This guideline was developed with resources funded by the SOGC. SUMMARY STATEMENTS: RECOMMENDATIONS. AD - Toronto, ON. Electronic address: cynthiadr.maxwell@sinaihealthsystem.ca. Ottawa, ON. Beaconsfield, QC. Vancouver, BC. Halifax, NS. Montréal, QC. AN - 31640866 AU - Maxwell, C. AU - Gaudet, L. AU - Cassir, G. AU - Nowik, C. AU - McLeod, N. L. AU - Jacob, CÉ AU - Walker, M. DA - Nov DO - 10.1016/j.jogc.2019.03.027 DP - NLM ET - 2019/10/24 J2 - Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC KW - Canada Female Humans *Obesity Patient Care Team/*standards Pregnancy *Pregnancy Complications Prenatal Care/*standards Societies, Medical Caesarean birth fetal ultrasound fetal/neonatal morbidity gestational weight gain labour and delivery maternal morbidity maternal obesity stillbirth vaginal birth vaginal birth after Caesarean venous thromboembolism weight loss surgery wound disruption LA - eng M1 - 11 N1 - Maxwell, Cynthia Gaudet, Laura Cassir, Gabrielle Nowik, Christina McLeod, N Lynne Jacob, Claude-Émilie Walker, Mark Journal Article Practice Guideline Netherlands J Obstet Gynaecol Can. 2019 Nov;41(11):1660-1675. doi: 10.1016/j.jogc.2019.03.027. PY - 2019 SN - 1701-2163 (Print) 1701-2163 SP - 1660-1675 ST - Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care T2 - J Obstet Gynaecol Can TI - Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care VL - 41 ID - 760150 ER - TY - JOUR AB - Objective: This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on pre-conception and pregnancy care. Part II will focus on team planning for delivery and Postpartum Care. Intended Users: All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. Target Population: Women with obesity who are pregnant or planning pregnancies. Evidence: Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetrical anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Validation Methods: The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committee peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings, at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. Benefits, Harms, and Costs: Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affected pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. Guideline Update: SOGC guidelines will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. Sponsors: This guideline was developed with resources funded by the SOGC. Summary Statements: 1. Maternal obesity carries both maternal and fetal risks (II-2). 2. There are limited options for weight loss and management during pregnancy (II-2). 3. Guidelines can assist with individualized recommendations regarding maternal gestational weight gain and calorie and nutrient intake during pregnancy (II-2). 4. Maternal obesity is a risk factor for fetal macrosomia (II-2). 5. The accuracy of fetal imaging for pregnancy dating, anatomical assessment, and fetal weight estimates is reduced in the setting of maternal obesity (II-2). 6. Stillbirth is more common with maternal obesity (II-1). 7. Multiple gestations carry additional risks in pregnancies complicated by maternal obesity (II-2). 8. Weight loss surgery before pregnancy, while generally conferring benefits to mother and fetus, also carries rare and serious morbidity during gestation (II-1). Recommendations: 1. Weight management strategies prior to pregnancy may include dietary, exercise, medical, and surgical approaches. When pursued before pregnancy, health benefits may carry forward into future pregnancies (III B). 2. As obesity carries many medical risks, assessment for conditions of the cardiac, pulmonary, renal, endocrine, and skin systems, as well as obstructive sleep apnea, is warranted in the pre-pregnancy period (II-3 B). 3. Folic acid supplementation in the 3 months prior to conception is warranted given the increased risks of congenital abnormalities of the fetal heart and neural tube related to maternal obesity (II-2 A). 4. It is recommended that both monitoring of gestational weight gain and approaches for gestational weight gain management be formally integrated into routine prenatal care (III A). 5. There is good evidence to support the role of exercise in pregnancy (I A). 6. There is good evidence to support supplementation with folic acid (at least 0.4 mg) and vitamin D (400 IU) during pregnancy (II-2 A). 7. Fetal macrosomia may be altered by well-controlled maternal gestational weight gain (II-2 A). 8. Increased fetal surveillance for well-being is suggested in the third trimester if the reduced fetal movements are reported, given the increased rate of stillbirth (II-3). 9. Aspirin prophylaxis can be recommended for women with obesity when other risk factors are present for the prevention of preeclampsia (I A). 10. It is recommended that delivery be considered at 39-40 weeks gestation for women with a body mass index of 40 kg/m(2) or greater given the increased rate of stillbirth (II-2 A). 11. Multiple gestations in women with obesity require increased surveillance and may benefit from consultation with a Maternal-Fetal Medicine consultant, especially in the setting of monochorionic gestations (II-2 A). 12. Pregnancy after weight loss surgery may benefit from Maternal-Fetal Medicine consultation given the potential for significant albeit rare maternal morbidity (III B). AD - cynthiadr.maxwell@sinaihealthsystem.ca AN - WOS:000491874300018 AU - Maxwell, C. AU - Gaudet, L. AU - Cassir, G. AU - Nowik, C. AU - McLeod, N. L. AU - Jacob, C. E. AU - Walker, M. DA - Nov DO - 10.1016/j.jogc.2019.03.026 J2 - J. Obstet. Gynaecol. Can. KW - Pregnancy matemal obesity labour and delivery vaginal birth Caesarean birth wound disruption venous thromboembolism maternal morbidity fetal/neonatal morbidity fetal ultrasound weight loss surgery gestational weight gain stillbirth vaginal birth after Caesarean GESTATIONAL WEIGHT-GAIN BODY-MASS INDEX ROUX-EN-Y LAPAROSCOPIC-SLEEVE-GASTRECTOMY ADVERSE PREGNANCY OUTCOMES LIFE-STYLE INTERVENTION NEURAL-TUBE DEFECTS LOW-DOSE ASPIRIN GASTRIC BYPASS RISK-FACTORS Obstetrics & Gynecology LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: JG1YU Times Cited: 3 Cited Reference Count: 178 Maxwell, Cynthia Gaudet, Laura Cassir, Gabrielle Nowik, Christina McLeod, N. Lynne Jacob, Claude-Emilie Walker, Mark Maxwell, Cynthia/0000-0003-4734-1251 4 3 17 ELSEVIER INC SAN DIEGO J OBSTET GYNAECOL CA PY - 2019 SN - 1701-2163 SP - 1623-1640 ST - Guideline No. 391-Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care T2 - Journal of Obstetrics and Gynaecology Canada TI - Guideline No. 391-Pregnancy and Maternal Obesity Part 1: Pre-conception and Prenatal Care UR - ://WOS:000491874300018 VL - 41 ID - 761482 ER - TY - JOUR AB - Objective: This guideline will review key aspects in the pregnancy care of women with obesity. Part I will focus on Preconception and Pregnancy Care. Part II will focus on Team Planning for Delivery and Postpartum Care. Intended Users: All health care providers (obstetricians, family doctors, midwives, nurses, anaesthesiologists) who provide pregnancy-related care to women with obesity. Target Population: Women with obesity who are pregnant or planning pregnancies. Evidence: Literature was retrieved through searches of Statistics Canada, Medline, and The Cochrane Library on the impact of obesity in pregnancy on antepartum and intrapartum care, maternal morbidity and mortality, obstetric anaesthesia, and perinatal morbidity and mortality. Results were restricted to systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to September 2018. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Validation Methods: The content and recommendations were drafted and agreed upon by the authors. Then the Maternal-Fetal Medicine Committees peer reviewed the content and submitted comments for consideration, and the Board of the Society of Obstetricians and Gynaecologists of Canada (SOGC) approved the final draft for publication. Areas of disagreement were discussed during meetings at which time consensus was reached. The level of evidence and quality of the recommendation made were described using the Evaluation of Evidence criteria of the Canadian Task Force on Preventive Health Care. Benefits, Harms, and Costs: Implementation of the recommendations in these guidelines may increase obstetrical provider recognition of the issues affecting pregnant individuals with obesity, including clinical prevention strategies, communication between the health care team, the patient and family as well as equipment and human resource planning. It is hoped that regional, provincial and federal agencies will assist in the education and support of coordinated care for pregnant individuals with obesity. Guideline Update: SOGC guideline will be automatically reviewed 5 years after publication. However, authors can propose another review date if they feel that 5 years is too short/long based on their expert knowledge of the subject matter. Sponsors: This guideline was developed with resources funded by the SOGC. Summary Statements: 1. Unfavourable cervix and induction of labour are more common with maternal obesity. The role of induction of labour and risk of Caesarean birth remains unclear (II-2). 2. Electronic fetal monitoring is recommended for women in active labour with a body mass index >35 kg/m(2). Cervical assessment, uterine monitoring, and fetal heart rate monitoring may be more challenging with higher degrees of maternal body mass index (III). 3. Decision-to-delivery time is increased in women with obesity (II-2). 4. Body mass index increases risk of surgical site infection and wound complications (II-2). 5. Anaesthetic risks are increased with maternal obesity (II-2). 6. Rates of successful breastfeeding are reduced for women with obesity (II-2). 7. Several effective contraceptive choices are available to women with obesity (III). 8. Women with obesity are at higher risk of postpartum depression and anxiety (II-2). 9. Antenatal, labour and delivery, and postnatal care may be more complex in women with obesity (III). Recommendations: 1. Electronic fetal monitoring is recommended for women in active labour with a body mass index >35 kg/m 2 . Intrauterine pressure catheters may assist in assessment of labour contractions. Fetal scalp electrodes may be helpful to ensure continuous fetal monitoring when indicated (III B). 2. Women with obesity may benefit from higher dosage of preoperative antibiotics for Caesarean birth (I A). 3. It is recommended to reapproximate the subcutaneous tissue layers at the time of Caesarean birth to reduce wound complications (II-2 A). 4. Antenatal assessment with obstetric anaesthesia may assist in planning for safer birth for women with obesity (III A). 5. Postoperative thromboprophylaxis is recommended, at appropriate dosing for the given body mass index, due to the greater risk of venous thromboembolism following Caesarean birth with women with obesity (II-3 A). 6. Women with obesity should be offered lactation support in the postpartum period (III C) 7. Women with obesity should be screened for postpartum depression and anxiety given that maternal obesity is a risk factor for these conditions (II-2 A). 8. Counselling regarding weight management in the postpartum period is suggested in order to minimize risks in subsequent pregnancies (II-2 A). 9. Obstetric team planning may be helpful for women with obesity to navigate the steps in antenatal, labour and delivery, and postnatal care (III-3 A). AD - cynthiadr.maxwell@sinaihealthsystem.ca AN - WOS:000491874300019 AU - Maxwell, C. AU - Gaudet, L. AU - Cassir, G. AU - Nowik, C. AU - McLeod, N. L. AU - Jacob, C. E. AU - Walker, M. DA - Nov DO - 10.1016/j.jogc.2019.03.027 J2 - J. Obstet. Gynaecol. Can. KW - Pregnancy maternal obesity labour and delivery vaginal birth Caesarean birth wound disruption venous thromboembolism maternal morbidity fetal/neonatal morbidity fetal ultrasound weight loss surgery gestational weight gain stillbirth vaginal birth after Caesarean BODY-MASS INDEX GESTATIONAL WEIGHT-GAIN RANDOMIZED CONTROLLED-TRIAL SURGICAL-SITE INFECTIONS PRESSURE WOUND THERAPY OF-THE-LITERATURE CESAREAN DELIVERY MORBIDLY OBESE VENOUS THROMBOEMBOLISM SHOULDER DYSTOCIA Obstetrics & Gynecology LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: JG1YU Times Cited: 3 Cited Reference Count: 148 Maxwell, Cynthia Gaudet, Laura Cassir, Gabrielle Nowik, Christina McLeod, N. Lynne Jacob, Claude-Emilie Walker, Mark Maxwell, Cynthia/0000-0003-4734-1251 4 1 17 ELSEVIER INC SAN DIEGO J OBSTET GYNAECOL CA PY - 2019 SN - 1701-2163 SP - 1660-1675 ST - Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care T2 - Journal of Obstetrics and Gynaecology Canada TI - Guideline No. 392-Pregnancy and Maternal Obesity Part 2: Team Planning for Delivery and Postpartum Care UR - ://WOS:000491874300019 VL - 41 ID - 761483 ER - TY - JOUR AB - Purpose. The implementation of best practices to optimize inpatient anticoagulation and venous thromboembolism (VTE) management are described. Summary. A multidisciplinary team of pharmacists, hospitalists, computer prescriber-order-entry system (CPOE) experts, and data specialists was assembled. A VTE management best-practices bundle was designed and implemented using education, CPOE upgrades, clinical decision support, triggered consultation, and checklists. Process performance data were collected from CPOE and chart review. A total of 189 patients with 211 identified VTE events were included in the analysis. Compliance with warfarin adjustment by protocol improved significantly, from 70% before the launch of the order set to 96% afterward. Heparin-warfarin overlap nearly tripled, from 26% to 74%, but still over a quarter of postimplementation cases did not meet this quality measure. While lowmolecular- weight heparin (LMWH) was used appropriately in all six postintervention cases of cancer-related VTE, the result was not a significant improvement over the 68% compliance in the period preceding the order set. The prescription rate of compression stockings after leg DVT was low in both periods. Point estimates for mean length of hospital stay improved but did not reach statistical significance. Measures of mortality and readmission rates were limited by sample size and were not significantly changed. Conclusion. Implementation by a multidisciplinary team of a VTE management bundle incorporated CPOE upgrades and other interventions. Laboratory testing before warfarin treatment, warfarin education, warfarin adjustment by protocol, and warfarin-heparin overlap improved after the interventions, but LMWH education, compression stocking use, laboratory testing before heparin treatment, and clinical outcomes did not change significantly. AD - Clinical Professor of Medicine, University of California San Diego Medical Center, San Diego Associate Clinical Professor of Pharmacy, Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California San Diego Medical Center, San Diego Associate Clinical Professor of Medicine, University of California San Diego Medical Center, San Diego AN - 104014894. Language: English. Entry Date: 20140203. Revision Date: 20200708. Publication Type: Journal Article AU - Mayard, Greg AU - Humber, Doug AU - Jenkins, Ian DB - CINAHL DO - 10.2146/ajhp130108 DP - EBSCOhost KW - Multidisciplinary Care Team Inpatients Venous Thromboembolism -- Therapy Anticoagulants -- Therapeutic Use Outcomes of Education Human Practice Guidelines Chi Square Test Yates' Continuity Correction M1 - 4 N1 - practice guidelines; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. PMID: NLM24481155. PY - 2014 SN - 1079-2082 SP - 305-310 ST - Multidisciplinary initiative to improve inpatient anticoagulation and management of venous thromboembolism T2 - American Journal of Health-System Pharmacy TI - Multidisciplinary initiative to improve inpatient anticoagulation and management of venous thromboembolism UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=104014894&site=ehost-live&scope=site VL - 71 ID - 761352 ER - TY - JOUR AB - PURPOSE: The implementation of best practices to optimize inpatient anticoagulation and venous thromboembolism (VTE) management are described. SUMMARY: A multidisciplinary team of pharmacists, hospitalists, computer prescriber-order-entry system (CPOE) experts, and data specialists was assembled. A VTE management best-practices bundle was designed and implemented using education, CPOE upgrades, clinical decision support, triggered consultation, and checklists. Process performance data were collected from CPOE and chart review. A total of 189 patients with 211 identified VTE events were included in the analysis. Compliance with warfarin adjustment by protocol improved significantly, from 70% before the launch of the order set to 96% afterward. Heparin-warfarin overlap nearly tripled, from 26% to 74%, but still over a quarter of postimplementation cases did not meet this quality measure. While low-molecular-weight heparin (LMWH) was used appropriately in all six postintervention cases of cancer-related VTE, the result was not a significant improvement over the 68% compliance in the period preceding the order set. The prescription rate of compression stockings after leg DVT was low in both periods. Point estimates for mean length of hospital stay improved but did not reach statistical significance. Measures of mortality and readmission rates were limited by sample size and were not significantly changed. CONCLUSION: Implementation by a multidisciplinary team of a VTE management bundle incorporated CPOE upgrades and other interventions. Laboratory testing before warfarin treatment, warfarin education, warfarin adjustment by protocol, and warfarin-heparin overlap improved after the interventions, but LMWH education, compression stocking use, laboratory testing before heparin treatment, and clinical outcomes did not change significantly. AD - Greg Maynard, M.D., M.S., is Clinical Professor of Medicine; Doug Humber, Pharm.D., is Associate Clinical Professor of Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences; and Ian Jenkins, M.D., is Associate Clinical Professor of Medicine, University of California San Diego Medical Center, San Diego. AN - 24481155 AU - Maynard, G. AU - Humber, D. AU - Jenkins, I. DA - Feb 15 DO - 10.2146/ajhp130108 DP - NLM ET - 2014/02/01 J2 - American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists KW - Anticoagulants/administration & dosage/*therapeutic use *Clinical Protocols Guideline Adherence Heparin, Low-Molecular-Weight/administration & dosage/therapeutic use Humans Inpatients Length of Stay Medical Order Entry Systems/standards Patient Care Team/*organization & administration Quality Indicators, Health Care Venous Thromboembolism/*drug therapy Warfarin/administration & dosage/therapeutic use LA - eng M1 - 4 N1 - 1535-2900 Maynard, Greg Humber, Doug Jenkins, Ian Journal Article Research Support, Non-U.S. Gov't England Am J Health Syst Pharm. 2014 Feb 15;71(4):305-10. doi: 10.2146/ajhp130108. PY - 2014 SN - 1079-2082 SP - 305-10 ST - Multidisciplinary initiative to improve inpatient anticoagulation and management of venous thromboembolism T2 - Am J Health Syst Pharm TI - Multidisciplinary initiative to improve inpatient anticoagulation and management of venous thromboembolism VL - 71 ID - 760270 ER - TY - JOUR AB - Background: The Society of Hospital Medicine (SHM) created 'Mentored Implementation' (MI) programs with the dual aims of educating and mentoring hospitalists and their quality improvement (QI) teams and accelerating improvement in the inpatient setting in three signature programs: Venous Thromboembolism (VTE) Prevention, Glycemic Control, and Project BOOST (Better Outcomes for Older adults through Safe Transitions). Methods: More than 300 hospital improvement teams were enrolled in SHM MI programs in a series of cohorts. Hospitalist mentors worked with individual hospitals/health systems to guide local teams through the life cycle of a QI project. Implementation Guides and comprehensive Web-based 'Resource Rooms,' as well as the mentor's own experience, provided best-practice definitions, practical implementation tips, measurement strategies, and other tools. E-mail interactions and mentoring were augmented by regularly scheduled teleconferences; group webinars; and, in some instances, a site visit. Performance was tracked in a centralized data tracking center. Results: Preliminary data on all three MI programs show significant improvement in patient outcomes, as well as enhancements of communication and leadership skills of the hospitalists and their QI teams. Conclusions: Although objective data on outcomes and process measures for the MI program's efficacy remain preliminary at this time, the maturing data tracking system, multiple awards, and early results indicate that the MI programs are successful in providing QI training and accelerating improvement efforts. AN - 108127678. Language: English. Entry Date: 20120831. Revision Date: 20200706. Publication Type: Journal Article AU - Maynard, Gregory A. AU - Budnitz, Tina L. AU - Nickel, Wendy K. AU - Greenwald, Jeffrey L. AU - Kerr, Kathleen M. AU - Miller, Joseph A. AU - Resnic, JoAnne N. AU - Rogers, Kendall M. AU - Schnipper, Jeffrey L. AU - Stein, Jason M. AU - Whitcomb, Winthrop F. AU - Williams, Mark V. DB - CINAHL DO - 10.1016/s1553-7250(12)38040-9 DP - EBSCOhost KW - Hospital Programs Hospitalists Mentorship Quality Improvement Collaboration Communication Electronic Health Records Data Security Glycemic Control Health Information Networks Health Insurance Portability and Accountability Act Human Information Technology Inpatients Leadership Outcomes (Health Care) Privacy and Confidentiality Program Implementation Prospective Studies Seminars and Workshops Surveys Teleconferencing Venous Thromboembolism -- Prevention and Control M1 - 7 N1 - pictorial; research; tables/charts. Journal Subset: Editorial Board Reviewed; Expert Peer Reviewed; Health Services Administration; Peer Reviewed; USA. Special Interest: Patient Safety; Quality Assurance. NLM UID: 101238023. PMID: NLM22852190. PY - 2012 SN - 1553-7250 SP - 301-310 ST - Mentored Implementation: Building Leaders and Achieving Results Through a Collaborative Improvement Model T2 - Joint Commission Journal on Quality & Patient Safety TI - Mentored Implementation: Building Leaders and Achieving Results Through a Collaborative Improvement Model UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=108127678&site=ehost-live&scope=site VL - 38 ID - 761350 ER - TY - JOUR AB - Background and Purpose: Stroke is the third leading cause of death and leading cause of long term disability in the USA. Intravenous administration of tissue plasminogen activator (t-PA) is the only FDA approved medical therapy for treatment of patients with acute ischemic stroke. It is recommended by the American Heart Association that earlier treatment with t-PA within 90 minutes of symptoms may result in a more favorable patient outcome. Initiating t-PA for ischemic stroke patients within 60 minutes after Emergency Department (ED) triage is an indicator tracked by the Get With The Guidelines database. The purpose of our project was to increase the number of ischemic stroke patients receiving t-PA within 60 minutes after triage. Methods: The Six Sigma® process model was applied in order to develop an understanding of variations in the times of triage to initiation of IV t-PA data. We assembled a multidisciplinary team to develop and measure aspects of our current protocols, analyze data, investigate and identify the causes of delays and form action plans to enhance our new process. We tracked the patient flow from first responder contact to thrombolysis time. As a result the team acknowledged that it was imperative to impact the early recognition of ischemic stroke patients in the field. This led to local and regional stroke educational programs. Our neuroscience team of physicians and nurses proceeded to educate over 850 emergency responders. Results: Initial analysis of the baseline data showed that 56 % (5 of 9) of the ischemic stroke patients received intravenous t-PA within 60 minutes of triage. Once the stroke code process was implemented, 79 % (15 of 19) of ischemic stroke patients received intravenous t-PA within 60 minutes after triage. These results were obtained within 9 months of process implementation. Specific process changes included the use of a standard time clock, shorter CT scan turn around times, dedicated 24/7 ED pharmacists, quicker availability of medication administration pumps and ongoing feedback by all team members on the acute stroke process. Conclusions: The stroke team was able to identify barriers, institute process changes and ensure the implementation of change from the prehospital community setting to the acute inhospital care. AD - J.M. Mazabob, St Luke's Episcopal Hosp, Houston, TX, United States AU - Mazabob, J. M. AU - Brown, G. AU - Livesay, S. AU - Freeborg, S. AU - Suarez, J. AU - Bershad, E. AU - Smirnakis, S. DB - Embase KW - tissue plasminogen activator cerebrovascular accident total quality management brain ischemia stroke patient human blood clot lysis emergency ward outcomes research cardiovascular disease emergency health service patient process model data base therapy medical society intravenous drug administration pump disability pharmacist computer assisted tomography cause of death rescue personnel nurse drug therapy feedback system community physician Food and Drug Administration LA - English M1 - 6 M3 - Conference Abstract N1 - L71256631 2013-12-17 PY - 2011 SN - 1941-7705 ST - Mind the time: A quality improvement project to increase the percent of ischemic stroke patients receiving intravenous tissue plasminogen activator within 60 minutes after arrival at the emergency department T2 - Circulation: Cardiovascular Quality and Outcomes TI - Mind the time: A quality improvement project to increase the percent of ischemic stroke patients receiving intravenous tissue plasminogen activator within 60 minutes after arrival at the emergency department UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71256631&from=export VL - 4 ID - 761219 ER - TY - JOUR AB - Background and Purpose: Stroke is the leading cause of adult disability in the United States. Compliance with the stroke quality indicators reinforces that a stroke center is adhering to the evidence based standards of care in acute stroke patients. Hardwiring a process in the delivery of care during hospitalization will ensure improved compliance of these quality indicators. Methods: A core multidisciplinary team was formed that included neurointensivists, neurologist, neurointerventional radiologist, pharmacist, emergency room and neuro intensive care staff along with neuroscience administration staff. Directors of the various services impacted by the stroke patients were invited on an ad hoc basis. Retrospective chart reviews were performed to collect data on a monthly basis for the following quality indicators: DVT prophylaxis Discharged on antithrombotics Patients with a-fib receiving anticoagulation Thrombolytic therapy administration Antithrombotic by end of day 2 Discharged on cholesterol meds Dysphagia screening Stroke education Smoking cessation education Assessed for Rehab Overall compliance with these indicators was on target but areas for improvement were noted in the following areas: stroke education, discharged on statin, thrombolytic therapy administration and patients with a-fib receiving anticoagulation. Aggressive action plans for each of these areas were developed and implemented. Initiatives included standardized electronic order sets, electronic admission, consult, history and physical templates with the quality indicators listed. Presentation of compliance results with a review of outliers were part of monthly section meetings. In order to understand process deviations further discussions with section chiefs resulted in investigation and resolution of issues that led to the variances. Hiring of a research registered nurse and a stroke coordinator were added to the existing stroke service team. Results: Dramatic improvement was achieved with no indicator falling below <85.2% (85.2 out 100) for an entire year. Gold Plus achievement level with the American Stroke Association was achieved within a three year period. Target Stroke Honor Role was also achieved during this time period. Conclusions: A cohesive project team was able to identify barriers, recommend process changes and ensure the implementation of change within the institution. Data collection and process revision is ongoing. AD - J.M. Mazabob, St Luke's Episcopal Hosp, Houston, TX, United States AU - Mazabob, J. M. AU - Brown, G. AU - Livesay, S. AU - Suarez, J. AU - Bershad, E. AU - Nguyen, T. DB - Embase KW - cholesterol anticoagulant agent statin (protein) gold cerebrovascular accident brain ischemia outcomes research evidence based practice cardiovascular disease human compliance (physical) education patient stroke patient fibrinolytic therapy anticoagulation prophylaxis medical record review United States pharmacist disability radiologist achievement emergency ward intensive care neurologist adult dysphagia hospitalization screening smoking cessation registered nurse information processing LA - English M1 - 3 M3 - Conference Abstract N1 - L71256260 2013-12-17 PY - 2012 SN - 1941-7705 ST - Acute ischemic stroke quality indicators: Implementation of evidence-based practice to improve compliance T2 - Circulation: Cardiovascular Quality and Outcomes TI - Acute ischemic stroke quality indicators: Implementation of evidence-based practice to improve compliance UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71256260&from=export VL - 5 ID - 761206 ER - TY - JOUR AB - BACKGROUND: P2Y12 inhibitors are critical following percutaneous coronary intervention (PCI) with stent placement; they reduce the risk of stent thrombosis and myocardial infarction. Despite the importance of the therapy, non-adherence is common among Veterans. METHODS AND RESULTS: Our main objective is to conduct a multi-site randomized stepped wedge trial to test the effectiveness of a multi-faceted intervention to improve adherence to P2Y12 inhibitors and PCI outcomes as well as formatively evaluate and refine the intervention implementation process. The primary outcomes of the study are the proportion of patients whose P2Y12 inhibitor prescription was filled at the time of hospital discharge following PCI with stent placement as well as the proportion of patients who were adherent based on the pharmacy refill data in the year after PCI hospital discharge. We will also assess the secondary outcomes such as bleeding, myocardial infarction, stroke, and mortality among these patients, and the cost-effectiveness of the intervention. The study was conducted at Veterans Health Administration (VA) PCI sites. At each site, we enrolled patients over a 6-month period and followed them for 12 months after PCI. Additionally, we collected qualitative data to identify contextual factors and to assess barriers and facilitators to the implementation and maintenance of the intervention. CONCLUSIONS: The study will add to the current state of knowledge on improving medication adherence in patients receiving PCI with stent implantation. Moreover, the study includes an extensive examination of the implementation process and will contribute to the field of implementation science. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01609842 https://clinicaltrials.gov/ct2/show/NCT01609842?term=clopidogrel+adherence&cntry1=NA%3AUS&rank=1. AD - VHA Eastern Colorado Health Care System, Denver, CO, United States. Electronic address: Marina.McCreight@va.gov. Colorado School of Public Health, Denver, CO, United States. VHA Eastern Colorado Health Care System, Denver, CO, United States. Department of Biostatistics and Informatics, University of Colorado Denver, Aurora, CO, United States. VHA Puget Sound Health Care System, Seattle, WA, United States. Michael E. DeBakey VA Medical Center, Houston, TX, United States. VA Medical Center, Salem, VA, United States. VA Medical Center, Ann Arbor, MI, United States. VA Medical Center, Seattle, WA, United States. VA Medical Center, Atlanta, GA, United States. VA Medical Center, Iowa City, IA, United States. AN - 30576842 AU - McCreight, M. S. AU - Lambert-Kerzner, A. AU - O'Donnell, C. I. AU - Grunwald, G. K. AU - Hebert, P. AU - Gillette, M. AU - Jneid, H. AU - Parashar, A. AU - Grossman, P. M. AU - Helfrich, C. AU - Mavromatis, K. AU - Saket, G. AU - Ho, P. M. DA - Feb DO - 10.1016/j.cct.2018.12.005 DP - NLM ET - 2018/12/24 J2 - Contemporary clinical trials KW - Humans Insurance Claim Review/statistics & numerical data Medication Adherence/*statistics & numerical data Patient Care Team/organization & administration Patient Education as Topic/economics/*methods Percutaneous Coronary Intervention/*methods Prospective Studies Purinergic P2Y Receptor Antagonists/*administration & dosage Research Design *Stents United States United States Department of Veterans Affairs LA - eng N1 - 1559-2030 McCreight, Marina S Lambert-Kerzner, Anne O'Donnell, Colin I Grunwald, Gary K Hebert, Paul Gillette, Michael Jneid, Hani Parashar, Amitabh Grossman, Paul M Helfrich, Christian Mavromatis, Kreton Saket, Girotra Ho, P Michael Clinical Trial Protocol Journal Article Multicenter Study Randomized Controlled Trial Research Support, U.S. Gov't, Non-P.H.S. United States Contemp Clin Trials. 2019 Feb;77:104-110. doi: 10.1016/j.cct.2018.12.005. Epub 2018 Dec 19. PY - 2019 SN - 1551-7144 SP - 104-110 ST - Improving anti-platelet therapy adherence in the Veterans Health Administration: A randomized multi-site hybrid effectiveness-implementation study protocol T2 - Contemp Clin Trials TI - Improving anti-platelet therapy adherence in the Veterans Health Administration: A randomized multi-site hybrid effectiveness-implementation study protocol VL - 77 ID - 760318 ER - TY - JOUR AB - Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients. PMID:31185730 AU - McDaniel, Michael AU - Ahrar, Kamran AU - Alrifai, Abdulah AU - Dudzinski, David M. AU - Fanola, Christina AU - Blais, Danielle AU - Janicke, David AU - Melamed, Roman AU - Mohrien, Kerry AU - Rozycki, Elizabeth AU - Ross, Charles B. AU - Klein, Andrew J. AU - Rali, Parth AU - Teman, Nicholas R. AU - Yarboro, Leoara AU - Ichinose, Eugene AU - Sharma, Aditya M. AU - Bartos, Jason A. AU - Elder, Mahir AU - Keeling, Brent AU - Palevsky, Harold AU - Naydenov, Soophia AU - Sen, Parijat AU - Amoroso, Nancy AU - Rodriguez-Lopez, Josanna M. AU - Davis, George A. AU - Rosovsky, Rachel AU - Rosenfield, Kenneth AU - Kabrhel, Christopher AU - Horowitz, James AU - Giri, Jay S. AU - Tapson, Victor AU - Channick, Richard DA - 2019/06/11 06/11 DB - PubMed Central DO - 10.1177/1076029619853037 KW - acute pulmonary embolism venous thromboembolism pulmonary embolism response team systemic thrombolysis catheter-directed thrombolysis embolectomy inferior vena cava filter chronic thromboembolic pulmonary hypertension PY - 2019 SN - 1076-0296 ST - Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium T2 - Clinical and Applied Thrombosis/Hemostasis TI - Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6714903&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6714903 VL - 25 ID - 761997 ER - TY - JOUR AB - Objective: Peripartum cardiomyopathy (PPCM) is an uncommon form of heart failure and a poorly understood complication of pregnancy. The incidence is variable among ethnicity and the majority of evidence to guide clinical practice is based on case reports. Methods: A case series of 6 patients diagnosed with PPCM in Tasmania over the period of 5 years was described. Results: All 6 patients identified were of Caucasian background, with an average age of 27.5 years and a BMI of 30.7 kg/m2. Five of the 6 patients presented with symptoms of heart failure during the postpartum period, averaging from day 2 to 6 months post-delivery. All patients had an initial work-up for suspected pulmonary embolism, with investigations showing signs of cardiomegaly and pulmonary oedema or pleural effusion. Serum BNP were elevated (range 1077-10800), and an echocardiogram performed for all patients confirmed left ventricular dysfunction of an average ejection fraction of 23.6% with associated pulmonary hypertension. All patients had significant medical comorbidities-including 4 patients with pre-eclampsia, 3 patients with post-partum haemorrhage, and 2 patients with insulin-dependent diabetes mellitus. Intensive care admission was required for 2 patients. There was one mortality directly related to PPCM, with the remaining patients showed improved cardiac symptoms on subsequent follow-up. Conclusion: The association of PPCM in these predominately young Australian women raises significantly concerns with regards to the associated morbidity and mortality. More importantly, this condition was poorly recognised and thus a high index of suspicion and multidisciplinary team care were required to optimise outcome. Large population studies are needed to further identify and manage pregnant women at risk. AD - C. McKenzie, Rural Clinical School, University of Tasmania, Burnie, Australia AU - McKenzie, C. AU - Turner, L. AU - Lim, W. H. AU - Adams, H. DB - Embase KW - adult Australian averaging body mass cardiomegaly case study Caucasian clinical article comorbidity diagnosis echocardiography female follow up heart ejection fraction heart left ventricle failure human human tissue insulin dependent diabetes mellitus intensive care lung edema lung embolism morbidity mortality peripartum cardiomyopathy pleura effusion population research postpartum hemorrhage preeclampsia pregnant woman pulmonary hypertension symptom Tasmania LA - English M3 - Conference Abstract N1 - L613101758 2016-11-10 PY - 2016 SN - 1479-828X SP - 47-48 ST - A Tasmanian experience of peripartum cardiomyopathy T2 - Australian and New Zealand Journal of Obstetrics and Gynaecology TI - A Tasmanian experience of peripartum cardiomyopathy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613101758&from=export VL - 56 ID - 760997 ER - TY - JOUR AB - Background: Prenotification to hospitals by emergency medical services of patients with suspected stroke is recommended to reduce delays in time-dependent therapies. We hypothesized that hospital prenotification would reduce recommended stroke time targets. Methods: We used the Robert Wood Johnson University Hospital (RWJUH) Brain Attack Database, which includes demographic and clinical data on all emergency department (ED) patients alerted as a Brain Attack between January 1, 2009 and June 30, 2010. Outcome variables included the time from door to stroke team arrival, computed tomographic (CT) scan completion, CT scan interpretation, electrocardiogram, laboratory results, treatment decision, and intravenous (IV) tissue plasminogen activator (tPA) administration. The primary independent variable was brain attack activation before arrival to the emergency department (ED; prenotification) versus on or after ED arrival (no prenotification). Analysis of covariance was used with patient predictors as covariates in addition to the one of interest (prenotification vs no prenotification). P <= .05 was considered statistically significant. Results: There were 229 patients (114 prenotification and 115 no prenotification) alerted as having a brain attack within the study period. Patients with prehospital notification were older (69.5 years vs 61.5 years; P = .0002), had more severe strokes (National Institutes of Health Stroke Scale score of 11.1 vs 6.9; P < .0001), and received IV tPA twice as often (27% vs 15%; P = .024). Prenotification resulted in a significant reduction in all stroke time targets except door to treatment decision and tPA administration. Conclusions: Prehospital notification of suspected stroke patients reduces time to stroke team arrival, CT scan completion, and CT scan interpretation. IV thrombolysis occurred twice as often in the prenotification group. AD - [McKinney, James S.; Mylavarapu, Krishna] Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Neurol, New Brunswick, NJ 08901 USA. [Lane, Judith; Roberts, Virginia] Robert Wood Johnson Univ Hosp Comprehens Stroke C, New Brunswick, NJ USA. [Ohman-Strickland, Pamela] Univ Med & Dent New Jersey, Sch Publ Hlth, Piscataway, NJ 08854 USA. [Merlin, Mark A.] New Jersey Dept Hlth & Senior Serv, Mobile Intens Care Advisory Board, Trenton, NJ USA. McKinney, JS (corresponding author), Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Dept Neurol, 125 Paterson St,6th Fl, New Brunswick, NJ 08901 USA. mckinnjs@umdnj.edu AN - WOS:000313576400004 AU - McKinney, J. S. AU - Mylavarapu, K. AU - Lane, J. AU - Roberts, V. AU - Ohman-Strickland, P. AU - Merlin, M. A. DA - Feb DO - 10.1016/j.jstrokecerebrovasdis.2011.06.018 J2 - J. Stroke Cerebrovasc. Dis. KW - Emergency medical services prehospital prenotification stroke thrombolysis CARE DELAYS NOTIFICATION OUTCOMES COUNCIL FIELD Neurosciences Peripheral Vascular Disease LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 071FZ Times Cited: 67 Cited Reference Count: 17 McKinney, James S. Mylavarapu, Krishna Lane, Judith Roberts, Virginia Ohman-Strickland, Pamela Merlin, Mark A. 67 0 12 ELSEVIER SCIENCE BV AMSTERDAM J STROKE CEREBROVASC PY - 2013 SN - 1052-3057 SP - 113-118 ST - Hospital Prenotification of Stroke Patients by Emergency Medical Services Improves Stroke Time Targets T2 - Journal of Stroke & Cerebrovascular Diseases TI - Hospital Prenotification of Stroke Patients by Emergency Medical Services Improves Stroke Time Targets UR - ://WOS:000313576400004 VL - 22 ID - 761812 ER - TY - JOUR AB - Introduction In 1998, a multidisciplinary team of investigators initiated the Research on Adverse Drug events And Reports (RADAR) project, a post-marketing surveillance effort that systematically investigates and disseminates information describing serious and previously unrecognized serious adverse drug and device reactions (sADRs). Objective Herein, we describe the findings, dissemination efforts, and lessons learned from the first decade of the RADAR project. Methods After identifying serious and unexpected clinical events suitable for further investigation, RADAR collaborators derived case information from physician queries, published and unpublished clinical trials, case reports, US FDA databases and manufacturer sales figures. Study selection All major RADAR publications from 1998 to the present are included in this analysis. Data extraction For each RADAR publication, data were abstracted on data source, correlative basic science findings, dissemination and resultant safety information. Results RADAR investigators reported 43 serious ADRs. Data sources included case reports (17 sADRs), registries (5 sADRs), referral centers (8 sADRs) and clinical trial reports (13 sADRs). Correlative basic science findings were reported for ten sADRs. Thirty-seven sADRS were described as published case reports (5 sADRs) or published case-series (32 sADRs). Related safety information was disseminated as warnings or boxed warnings in the package insert (17 sADRs) and/or 'Dear Healthcare Professional' letters (14 sADRs). Conclusion An independent National Institutes of Health-funded post-marketing surveillance programme can supplement existing regulatory and pharmaceutical manufacturer-supported drug safety initiatives. AD - [McKoy, June M.; Edwards, Beatrice J.; West, Dennis P.] Northwestern Univ, Feinberg Sch Med, Robert H Lurie Comprehens Canc Ctr, Chicago, IL 60611 USA. [McKoy, June M.; Fisher, Matthew J.; Edwards, Beatrice J.; Liebling, Dustin B.; Tulas, Katrina Marie] Northwestern Univ, Feinberg Sch Med, Dept Med, Div Gen Internal Med & Geriatr, Chicago, IL 60611 USA. [McKoy, June M.] Northwestern Univ, Feinberg Sch Med, Dept Med & Prevent Med, Chicago, IL 60611 USA. [Courtney, D. Mark] Northwestern Univ, Feinberg Sch Med, Dept Emergency Med, Chicago, IL 60611 USA. [Raisch, Dennis W.] VA Cooperat Studies Program Clin Res Pharm, Albuquerque, NM USA. [Raisch, Dennis W.] Univ New Mexico, Coll Pharm, Albuquerque, NM 87131 USA. [Scheetz, Marc H.; Trifilio, Steven M.] NW Mem Hosp, Dept Pharm, Chicago, IL 60611 USA. [Belknap, Steven M.; Samaras, Athena T.; Nardone, Beatrice; West, Dennis P.] Northwestern Univ, Feinberg Sch Med, Dept Dermatol, Chicago, IL 60611 USA. [Belknap, Steven M.] Northwestern Univ, Feinberg Sch Med, Dept Med, Chicago, IL 60611 USA. McKoy, JM (corresponding author), Northwestern Univ, Feinberg Sch Med, Dept Med & Prevent Med, 645 N Michigan,Suite 630, Chicago, IL 60611 USA. j-mckoy@northwestern.edu; draisch@salud.unm.edu AN - WOS:000318788500005 AU - McKoy, J. M. AU - Fisher, M. J. AU - Courtney, D. M. AU - Raisch, D. W. AU - Edwards, B. J. AU - Scheetz, M. H. AU - Belknap, S. M. AU - Trifilio, S. M. AU - Samaras, A. T. AU - Liebling, D. B. AU - Nardone, B. AU - Tulas, K. M. AU - West, D. P. DA - May DO - 10.1007/s40264-013-0042-x J2 - Drug Saf. KW - THROMBOTIC THROMBOCYTOPENIC PURPURA RED-CELL APLASIA ANTIERYTHROPOIETIN ANTIBODIES PHARMACOVIGILANCE NEVIRAPINE EPOETIN INDIVIDUALS PROPHYLAXIS TRANSPLANT RITUXIMAB Public, Environmental & Occupational Health Pharmacology & Pharmacy Toxicology LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: 142HR Times Cited: 12 Cited Reference Count: 47 McKoy, June M. Fisher, Matthew J. Courtney, D. Mark Raisch, Dennis W. Edwards, Beatrice J. Scheetz, Marc H. Belknap, Steven M. Trifilio, Steven M. Samaras, Athena T. Liebling, Dustin B. Nardone, Beatrice Tulas, Katrina Marie West, Dennis P. Nardone, Beatrice/G-7282-2012; Scheetz, Marc H/A-8524-2009 Nardone, Beatrice/0000-0003-1509-3791; Scheetz, Marc H/0000-0002-1091-6130; Belknap, Steven/0000-0002-3670-7409; Edwards, Beatrice/0000-0002-7900-5159; West, Dennis/0000-0002-9107-6697 National Cancer InstituteUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Cancer Institute (NCI) [P 30 CA60533, 5-K01 CA134554-05, 5-R01-CA125077-03, 3-R01CA125077-03S1, 2-R01CA 102713-03A2] Supported by a grant from the National Cancer Institute: P 30 CA60533, 5-K01 CA134554-05 (JMM), 5-R01-CA125077-03 (DPW), 3-R01CA125077-03S1 (DPW), and 2-R01CA 102713-03A2 (DPW). 12 0 ADIS INT LTD NORTHCOTE DRUG SAFETY PY - 2013 SN - 0114-5916 SP - 335-347 ST - Results from the First Decade of Research Conducted by the Research on Adverse Drug Events and Reports (RADAR) Project T2 - Drug Safety TI - Results from the First Decade of Research Conducted by the Research on Adverse Drug Events and Reports (RADAR) Project UR - ://WOS:000318788500005 VL - 36 ID - 761808 ER - TY - JOUR AB - Background: The geriatric population is amongst the fastest growing nation-wide and the care of cohorts who fall with resultant hip fracture is challenging. We thus designed a multidisciplinary geriatric fracture program (GFP) targeted at meeting the special needs of and improving outcomes for the elderly fragility hip fracture patient. Method: We established a GFP program and a related order set with input from a multidisciplinary team. The order set includes medications and dosing that meet BEERS criteria, a delirium algorithm, mobilization parameters, and pre-operative clearance modalities, among others. Patients aged 50 and older, presenting to a tertiary academic medical center post fall with sustained hip fracture, were transitioned into this program. The nurse practitioner or internist/geriatrician evaluated the patient after transition from the ED and performed rapid medical clearance. Each patient cleared was then taken to the operating room for repair. Post-operatively, the GFP order set was followed closely. If delirium occurred and was not responsive to the algorithm in the order set, a geriatric consultation was pursued for expert assistance. Results: From inception to present (4/16//2014- 11/30/2014), the program evaluated patients (n=153) who were older (≥50 years; range 55-90 years). Of that total, which included males and females, 145 patients (94.7%) had surgery and 8 (5.2%) were admitted and treated non-operatively; average time from presentation in the ED to the operating room was <24 hours; there were 2 deaths (1.3%; neither were operative candidates; 1 died as a result of complications of severe pre-morbid cardiac disease and the other from a massive pulmonary embolus); average time to disposition was approximately 3-4 days; disposition was to an acute rehabilitation facility or a skilled nursing facility (SNF). Conclusion: In our fracture program, for example, timely surgery occurred with the support of the anesthesia department, which provided operating room access and anesthesia assistance in a timely manner for our fracture patient; in concert with our team members noted herein, this resulted in a diminution in the time from ED presentation to ultimate operative treatment and discharge. These preliminary results underscore the importance of having a dedicated multidisciplinary team with pooled expertise in treating older individuals who present with a hip fracture. AD - J.M. McKoy, Medicine, Northwestern University, Chicago, IL, United States AU - McKoy, J. M. AU - Oquendo, A. AU - Merk, B. AU - Stover, M. AU - Bunta, A. DB - Embase DO - 10.1111/jgs.13439 KW - fracture American geriatrics society human patient hip fracture surgery operating room algorithm delirium parameters mobilization drug therapy anesthesia hospital department nursing home rehabilitation lung embolism population male heart disease female death consultation nurse practitioner university hospital aged LA - English M3 - Conference Abstract N1 - L71856405 2015-04-24 PY - 2015 SN - 0002-8614 SP - S234 ST - Geriatric fracture program: Moving boldly beyond the initial fall T2 - Journal of the American Geriatrics Society TI - Geriatric fracture program: Moving boldly beyond the initial fall UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71856405&from=export http://dx.doi.org/10.1111/jgs.13439 VL - 63 ID - 761072 ER - TY - JOUR AB - Warfarin remains a difficult drug to manage due to a narrow therapeutic range and wide interindividual variability in dose requirements. The relationship between warfarin sensitivity and CYP2C9 and VKORC1 variants is strong, and is the basis for several proposed dosing algorithms. Here a gene-based dosing algorithm was compared with standard of care dosing in patients receiving warfarin to prevent venous thromboembolism after joint replacement surgery. Participants (n = 229) were adults (>= 18 years) undergoing elective total hip or knee arthroplasty and receiving warfarin under the direction of a dedicated anticoagulation services team. Patients were assigned to genotype-based or standard of care dosing arms in an alternating fashion. Initial dose for patients was determined by validated algorithms from Sconce 2005 and Pendleton 2008. Management was based on INR, but dose was adjusted less aggressively for patients with CYP2C9 variants. The primary endpoint was reduction in the incidence of adverse events; additional endpoints included time to first therapeutic INR (1.8-2.9), time to first supratherapeutic INR, and percent of INR determinations that fell below, within, and above the therapeutic range. Endpoints did not achieve statistical significance, possibly due to the management of this study by a dedicated and experienced anticoagulation services team. Trends in the data suggest that patients with genetic variants progressed to a therapeutic INR faster than patients in whom genetic variants were not detected, and there were fewer adverse events in the genotype-based dosing arm. In addition, the results of this study confirm those of others demonstrating clear relationship of genotype for CYP2C9 and VKORC1 with warfarin dose requirements; as the number of variants in these genes increases, the dose requirement decreases. Of note, the gene-based algorithm utilized here significantly underpredicted the dose requirement for participants with no variants, indicating that patients with no variants should be managed with a different algorithm than patients who inherit genetic variants in CYP2C9 and/or VKORC1. In conclusion, gene-based dosing did not improve warfarin management as defined by INR dose response, using the described protocols for implementation. Findings suggest alternative strategies for dosing based on the presence or absence of genetic variants is needed. AD - [McMillin, Gwendolyn A.] Univ Utah, ARUP Labs, Dept Pathol, Inst Clin & Expt Pathol, Salt Lake City, UT 84108 USA. [Strong, Michael B.; Wanner, Nathan A.; Vinik, Russell G.] Univ Utah Hlth Sci, Dept Internal Med, Salt Lake City, UT USA. [Peters, Christopher L.; Pendleton, Robert C.] Univ Utah Hlth Sci, Dept Orthopaed, Salt Lake City, UT USA. McMillin, GA (corresponding author), Univ Utah, ARUP Labs, Dept Pathol, Inst Clin & Expt Pathol, 500 Chipeta Way, Salt Lake City, UT 84108 USA. gwen.mcmillin@aruplab.com AN - WOS:000278379400021 AU - McMillin, G. A. AU - Melis, R. AU - Wilson, A. AU - Strong, M. B. AU - Wanner, N. A. AU - Vinik, R. G. AU - Peters, C. L. AU - Pendleton, R. C. DA - Jun DO - 10.1097/FTD.0b013e3181d925bb J2 - Ther. Drug Monit. KW - algorithm anticoagulation Coumadin orthopedic surgery pharmacogenetics CYP2C9 PHARMACOGENETICS POLYMORPHISMS NOMOGRAM Medical Laboratory Technology Pharmacology & Pharmacy Toxicology LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: 605WR Times Cited: 35 Cited Reference Count: 24 McMillin, Gwendolyn A. Melis, Roberta Wilson, Andrew Strong, Michael B. Wanner, Nathan A. Vinik, Russell G. Peters, Christopher L. Pendleton, Robert C. Wilson, Andrew/0000-0003-3679-9232 ARUP Institute of Clinical and Experimental Pathology, University of Utah; Third Wave Technologies Inc Supported by ARUP Institute of Clinical and Experimental Pathology, University of Utah, and Third Wave Technologies Inc. 38 0 1 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA THER DRUG MONIT PY - 2010 SN - 0163-4356 SP - 338-345 ST - Gene-Based Warfarin Dosing Compared With Standard of Care Practices in an Orthopedic Surgery Population: A Prospective, Parallel Cohort Study T2 - Therapeutic Drug Monitoring TI - Gene-Based Warfarin Dosing Compared With Standard of Care Practices in an Orthopedic Surgery Population: A Prospective, Parallel Cohort Study UR - ://WOS:000278379400021 VL - 32 ID - 761874 ER - TY - GEN AB - Introduction: A multidisciplinary Pulmonary Embolism Response Team (PERT) has been developed to assess high risk pulmonary embolism cases and provide rapid treatment recommendations... AU - McNeill, J. N. AU - Witkin, A. AU - Chang, Y. AU - Kabrhel, C. AU - Channick, R. N. DA - 2017/01/01 DB - Federal Science Library - Canada KW - Intervention Embolisms Pulmonary arteries Mortality Catheters PY - 2017 SN - 1073-449X ST - A69 LET IT GO: CONTROVERSIES IN THROMBOEMBOLIC DISEASE: Does The Time Of Day A Pulmonary Embolism Response Team (pert) Is Activated Affect Time To Intervention Or Outcome? TI - A69 LET IT GO: CONTROVERSIES IN THROMBOEMBOLIC DISEASE: Does The Time Of Day A Pulmonary Embolism Response Team (pert) Is Activated Affect Time To Intervention Or Outcome? UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtZ1Lb9NAEIBXtBKIC-IpHgWNhIRAK4MTx3ZSFZBpTWvaeCHZVHCqbMdWqyYxspMDv5a_woy968Y5VHDgECuZRJuV5_PMPmZnGLO6b01jwyY4dsdNprZpRjE5ja5rd_sdx43NFD1s1qdzw5OJ5X_vhd8o97Muc3Al-6-KRxmqng7S_oPym0ZRgO8RAbwiBHj9Kww8Z8BPfMkDyQ8FTf_3RShH4tQfjXEgyIOQy6ORGH4SPr5OUCUHwdj3xj799CBPS66L_3CRISK_0JB8Xc2w-xRt58_jfEZVNkZ1pG1KCaLnNGj9WR0FGvCg5F5SVVDDga1XZ0quWpN5vRipwy1FwcVqmVDR9naoYbOltJbjoliLD6jO5el6DVUc22a4wBce8mFCq91NNAlZw-XlRfNg_KhPWTQbMvw4iotzdZpArYl03I01kaZn8hyfo-Qi0SGwa4YeTZvR61VlfNEPauNvU8U9s-UdBvYrysI-x64v36cLYzLeYltoGWkAHhw3O1bIc535QrXb9u2W8r_yLrujZhrg1UzcYzfSxX12a6huzgP2G9EARAMCCYdiF1pgQBBCGwxQYOwCYQGIBZAiQWSAWIAHe_OouPzQwLH3rvqsxJqUtlRj05YSQ1rymkB6A0EJDUZQY1T_u8xhHSMQBSiMPj5kLz_7cv_I0DfoTBFUnuF8w3GrSnjWI7a9yBfpYwZxh2bR0dR0IjQdfXOQZombWVPTikwrTbMnbOe6lp5e__UzdvsKoR22vSxW6XN2MytnRlxmLyot_wFD7YUi VL - 195 ID - 761981 ER - TY - JOUR AU - McNeill, J. N. AU - Witkin, A. S. AU - Chang, Y. AU - Kabrhel, C. AU - Channick, R. N. DA - 2017/12/11 12/11 DB - Europe PubMed Central DO - 10.1016/j.chest.2017.09.033 M1 - 6 PY - 2017 SN - 0012-3692 SP - 1353-1354 ST - Does the Time of Day a Pulmonary Embolism Response Team Is Activated Affect Time to Intervention or Outcome? T2 - Chest TI - Does the Time of Day a Pulmonary Embolism Response Team Is Activated Affect Time to Intervention or Outcome? UR - http://europepmc.org/article/MED/29223267 VL - 152 ID - 761943 ER - TY - JOUR AB - Objective: To describe our experience of treating children with vein of Galen aneurysmal malformation (VGM) in a single UK centre between 2003 and 2008. Method: Retrospective review of case notes and neuroimaging. Results: 33 children were seen (26 neonates, seven infants), of whom 28 underwent endovascular treatment. Four were not offered treatment as they had evidence of severe diffuse brain injury at presentation; treatment was deferred in another who subsequently died. Seven children died (two of whom had endovascular treatment). Of the survivors (all treated), 13 (39%) are neurodevelopmentally intact, seven (21%) have mild neurodevelopmental impairment and the remaining six (18%) have significant neurological impairment. The authors were not able to identify clinical or radiological parameters which strongly predicted outcome. Of note, two children with initially low Bicêtre scores were neurologically intact after successful embolisation. Conclusion: The outlook for children with VGM is significantly better since the advent of endovascular treatment. Decisions about the appropriateness and timing of treatment should be taken by an experienced multidisciplinary team. AD - V. Ganesan, Wolfson Centre, Mecklenburgh Square, London WC1N 2AP, United Kingdom AU - McSweeney, N. AU - Brew, S. AU - Bhate, S. AU - Cox, T. AU - Roebuck, D. J. AU - Ganesan, V. DB - Embase Medline DO - 10.1136/adc.2009.177584 KW - article artificial embolization brain injury clinical article clinical assessment developmental disorder disease severity endovascular surgery female human infant infant mortality male nerve cell differentiation newborn priority journal radiology scoring system treatment outcome vein of Galen malformation L1 - http://adc.bmj.com/content/95/11/903.full.pdf LA - English M1 - 11 M3 - Article N1 - L359969006 2010-11-24 2010-12-01 PY - 2010 SN - 0003-9888 1468-2044 SP - 903-909 ST - Management and outcome of vein of Galen malformation T2 - Archives of Disease in Childhood TI - Management and outcome of vein of Galen malformation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L359969006&from=export http://dx.doi.org/10.1136/adc.2009.177584 VL - 95 ID - 761241 ER - TY - JOUR AB - Background Embolectomy is the standard of care for emergent large vessel occlusion (ELVO), and needs to be done as quickly as possible for the best possible outcomes. Optimization of workflow and process is certainly paramount. One aspect of this is process improvement to standardize as much as possible the procedure in order to decrease variability among operators, which breeds familiarity for the entire team. Objective To evaluate the impact of a standardized approach to ELVO cases in decreasing times from groin puncture to first deployment of a stent-retriever and final recanalization. Methods A retrospective review of 83 consecutive patients consisting of a pre-standardization phase (group 1) and those after standardization (group 2). The standardization process involved all three neurointerventional radiologists agreeing on a standard approach to the cases and to the equipment to be used. Times from groin puncture to first deployment of the stent-retriever and from puncture to final reperfusion were evaluated. Angiographic outcomes were scored using the Modified Thrombolysis in Cerebral Ischemia (mTICI) score. Complications from intracranial catheter manipulation (such as wire perforation) were also recorded. Clinical outcomes were assessed based on admission and discharge National Institute of Health Stroke Scale score. Results There were 22 patients in group 1 and 61 patients in group 2. Mean times from groin puncture to first deployment were 39.8 min in group 1 and 20 min in group 2, a difference which was statistically significant (p<0.0001). Overall times from puncture to final recanalization were reduced from 68.2 to 37 min, also a statistically significant difference (p<0.001). There were no cases of intraprocedural complications such as wire perforation or subarachnoid hemorrhage. Conclusions A standardized approach to the equipment used and process for ELVO cases at a single institution can dramatically reduce procedure times. AD - [McTaggart, Ryan A.; Baird, Grayson; Haas, Richard A.; Jayaraman, Mahesh V.] Brown Univ, Rhode Isl Hosp, Warren Alpert Sch Med, Dept Diagnost Imaging, 593 Eddy St,Room 377, Providence, RI 02903 USA. [Yaghi, Shadi; Jayaraman, Mahesh V.] Brown Univ, Rhode Isl Hosp, Warren Alpert Sch Med, Dept Neurol, Providence, RI 02903 USA. [Haas, Richard A.; Jayaraman, Mahesh V.] Brown Univ, Rhode Isl Hosp, Warren Alpert Sch Med, Dept Neurosurg, Providence, RI 02903 USA. Jayaraman, MV (corresponding author), Brown Univ, Rhode Isl Hosp, Warren Alpert Sch Med, Dept Diagnost Imaging, 593 Eddy St,Room 377, Providence, RI 02903 USA. mjayaraman@lifespan.org AN - WOS:000394610000002 AU - McTaggart, R. A. AU - Yaghi, S. AU - Baird, G. AU - Haas, R. A. AU - Jayaraman, M. V. DA - Jan DO - 10.1136/neurintsurg-2016-012518 J2 - J. NeuroInterventional Surg. KW - ACUTE ISCHEMIC-STROKE THROMBECTOMY THERAPY TRIAL Neuroimaging Surgery LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: EL4SA Times Cited: 17 Cited Reference Count: 10 McTaggart, Ryan A. Yaghi, Shadi Baird, Grayson Haas, Richard A. Jayaraman, Mahesh V. Yaghi, Shadi/Q-8258-2019 Jayaraman, Mahesh/0000-0002-4588-5135 17 0 2 BMJ PUBLISHING GROUP LONDON J NEUROINTERV SURG PY - 2017 SN - 1759-8478 SP - 2-5 ST - Decreasing procedure times with a standardized approach to ELVO cases T2 - Journal of Neurointerventional Surgery TI - Decreasing procedure times with a standardized approach to ELVO cases UR - ://WOS:000394610000002 VL - 9 ID - 761676 ER - TY - JOUR AB - Objective: Pre-hospital, in-hospital, and patient factors are associated with variation in door to needle (DTN) time in acute ischemic stroke (AIS). Publications are usually from large single centers or multicenter registries with less reporting on national results. Materials and methods: All AIS patients treated with intravenous tissue plasminogen activator (iv-tPA) over 4 years (2013-2016) in Northern Ireland were recorded prospectively, including patient demographics, pre-hospital care, thrombolysis rate, and DTN time. Logistic regression was performed to identify factors associated with DTN time. Results: One thousand two hundred and one patients from 10,556 stroke admissions (11.4%) were treated with iv-tPA. Median NIHSS was 10 (IQR 6-17). Median DTN time was 54 min (IQR 36-77) with 61% treated < 60 min from arrival at hospital. National thrombolysis numbers increased over time with improving DTN time (P = 0.002). Arrival method at hospital (ambulance OR 2.3 CI1.4-3.8) pre-alert from ambulance (pre-alert OR = 5.3 CI3.5-8.1) and time of day (out of hours, n = 650, OR 0.20 CI 0.22-0.38) all P < 0.001, were the independent factors in determining DTN time. Variation in DTN time between centers occurred but was unrelated to volume of stroke admissions. Conclusion: Ambulance transport with pre-hospital notification and time of day are associated with shorter DTN time on a national level. Most thrombolysis was delivered outside of normal working hours but these patients are more likely to experience treatment delays. Re-organization of stroke services at a whole system level with emphasis on pre-hospital care and design of stroke teams are required to improve quality and equitable care in AIS nationally. AD - [McVerry, Ferghal; McKee, Jacqueline; McCarron, Mark O.] Altnagelvin Hosp, Stroke Unit, Derry, North Ireland. [McVerry, Ferghal; McKee, Jacqueline; McCarron, Mark O.] Altnagelvin Hosp, Neurol Dept, Derry, North Ireland. [Hunter, Annemarie; Wiggam, Ivan; Kennedy, Fiona] Royal Victoria Hosp, Neurol Dept, Belfast, Antrim, North Ireland. [Dynan, Kevin; Matthews, Maureen] Ulster Hosp, Stroke Unit, Dundonald, North Ireland. [McCormick, Michael] Craigavon Area Hosp, Stroke Unit, Portadown, North Ireland. [Vahidassr, Djamil] Antrim Area Hosp, Stroke Unit, Antrim, Antrim, North Ireland. [McErlean, Fintan] Royal Victoria Hosp, Audit Dept, Belfast, Antrim, North Ireland. [Stevenson, Mike] Queens Univ, Ctr Publ Hlth, Belfast, Antrim, North Ireland. [Hopkins, Emer] Hlth & Social Care Board, Belfast, Antrim, North Ireland. [Kelly, James] South West Acute Hosp, Stroke Unit, Enniskillen, North Ireland. McCarron, MO (corresponding author), Altnagelvin Hosp, Stroke Unit, Derry, North Ireland.; McCarron, MO (corresponding author), Altnagelvin Hosp, Neurol Dept, Derry, North Ireland. markmccarron@doctors.org.uk AN - WOS:000473114400001 AU - McVerry, F. AU - Hunter, A. AU - Dynan, K. AU - Matthews, M. AU - McCormick, M. AU - Wiggam, I. AU - Vahidassr, D. AU - McErlean, F. AU - Stevenson, M. AU - Hopkins, E. AU - McKee, J. AU - Kelly, J. AU - Kennedy, F. AU - McCarron, M. O. C7 - 676 DA - Jun DO - 10.3389/fneur.2019.00676 J2 - Front. Neurol. KW - acute ischemic stroke thrombolysis health services research patient safety critical care QUALITY IMPROVEMENT THROMBOLYSIS MANAGEMENT OUTCOMES MINUTES BRAIN DELAY Clinical Neurology Neurosciences LA - English M3 - Article N1 - ISI Document Delivery No.: IF5IL Times Cited: 1 Cited Reference Count: 26 McVerry, Ferghal Hunter, Annemarie Dynan, Kevin Matthews, Maureen McCormick, Michael Wiggam, Ivan Vahidassr, Djamil McErlean, Fintan Stevenson, Mike Hopkins, Emer McKee, Jacqueline Kelly, James Kennedy, Fiona McCarron, Mark O. regional quality improvement agency of Northern Ireland We thank all the patients and staff in Northern Ireland hospitals formaking this study possible. The regional quality improvement agency of Northern Ireland provided funds for this study. 1 0 FRONTIERS MEDIA SA LAUSANNE FRONT NEUROL PY - 2019 SN - 1664-2295 SP - 7 ST - Country-Wide Analysis of Systemic Factors Associated With Acute Ischemic Stroke Door to Needle Time T2 - Frontiers in Neurology TI - Country-Wide Analysis of Systemic Factors Associated With Acute Ischemic Stroke Door to Needle Time UR - ://WOS:000473114400001 VL - 10 ID - 761518 ER - TY - JOUR AB - BACKGROUND: Direct-acting anti-viral therapy (DAA) has transformed hepatitis C virus (HCV) care, particularly in patients with decompensated cirrhosis. However, their impact on hepatocellular carcinoma (HCC) remains unclear. AIM: To use a national registry of patients with advanced liver disease to explore the relationship between DAA therapy and HCC. METHODS: All patients with de novo HCC post DAA therapy were frequency matched with patients who did not develop HCC. Demographic, clinical and laboratory data were obtained. Cross-sectional imaging and multidisciplinary team reports were reviewed for dates of HCC diagnosis and HCC progression. Patients were categorised by treatment outcome and time of HCC development. Data were examined by multivariable analysis and Kaplan-Meier estimation. RESULTS: Eighty patients with HCC were compared with 165 patients without HCC, treated between June 2014 and September 2015. Mean follow-up from start of DAA therapy was 32.4 months. Twenty-eight patients were diagnosed with early HCC (within 6 months of therapy) and 52 presented late. Baseline nonmalignant lesions (HR: 1.99), thrombocytopaenia (HR: 1.59) and diabetes (HR: 1.68) increased likelihood of HCC. Response to therapy was reduced in patients who developed liver cancer (SVR in patients with HCC = 54/80 (68%), SVR in patients without HCC = 143/165 (87%), P < 0.001, OR: 3.13, 95% CI: 1.64-5.99). We found no difference between tumour size, progression or survival between viraemic and nonviraemic patients. CONCLUSION: There is no alteration in prognosis or cancer progression following HCC development after HCV treatment. However, baseline nonmalignant liver lesions, diabetes and thrombocytopaenia increase the risk of HCC, and HCC is associated with a decreased SVR rate. AD - Blizard Institute, Queen Mary University of London, London, UK. University of Edinburgh, Edinburgh, UK. Royal Derby Hospital, Derby, UK. Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. University of Southampton, Southampton, UK. King's College Hospital, London. University of Birmingham, Birmingham, UK. University College Hospital, London, UK. NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust and the University of Nottingham, Nottingham, UK. AN - 31149748 AU - Mecci, A. J. AU - Kemos, P. AU - Leen, C. AU - Lawson, A. AU - Richardson, P. AU - Khakoo, S. I. AU - Agarwal, K. AU - Mutimer, D. AU - Rosenberg, W. M. AU - Foster, G. R. AU - Irving, W. L. DA - Jul DO - 10.1111/apt.15296 DP - NLM ET - 2019/06/01 J2 - Alimentary pharmacology & therapeutics KW - Antiviral Agents/*therapeutic use Carcinoma, Hepatocellular/complications/*drug therapy/*epidemiology/virology Case-Control Studies Disease Progression End Stage Liver Disease/complications/drug therapy/epidemiology Female Hepacivirus/physiology Hepatitis C/complications/drug therapy/epidemiology Hepatitis C, Chronic/complications/drug therapy/epidemiology Humans Liver Cirrhosis/complications/drug therapy/*epidemiology Liver Neoplasms/complications/*drug therapy/*epidemiology/virology Male Middle Aged Retrospective Studies Sustained Virologic Response Treatment Outcome United Kingdom/epidemiology *cirrhosis *hepatitis C *hepatocellular carcinoma *liver *outcomes research LA - eng M1 - 2 N1 - 1365-2036 Mecci, Ali Jibran Orcid: 0000-0002-9495-6593 Kemos, Polychronis Leen, Clifford Lawson, Adam Richardson, Paul Khakoo, Salim I Orcid: 0000-0002-4057-9091 Agarwal, Kosh Orcid: 0000-0002-4754-828x Mutimer, David Rosenberg, William M Orcid: 0000-0002-2732-2304 Foster, Graham R Irving, William L Orcid: 0000-0002-7268-3168 HCV Research UK MR/N005953/1/MRC_/Medical Research Council/United Kingdom LAP Research UK/International C0365/Medical Research Foundation/International NHS England/International Journal Article Research Support, Non-U.S. Gov't England Aliment Pharmacol Ther. 2019 Jul;50(2):204-214. doi: 10.1111/apt.15296. Epub 2019 May 31. PY - 2019 SN - 0269-2813 SP - 204-214 ST - The association between hepatocellular carcinoma and direct-acting anti-viral treatment in patients with decompensated cirrhosis T2 - Aliment Pharmacol Ther TI - The association between hepatocellular carcinoma and direct-acting anti-viral treatment in patients with decompensated cirrhosis VL - 50 ID - 760172 ER - TY - JOUR AB - Background Direct-acting anti-viral therapy (DAA) has transformed hepatitis C virus (HCV) care, particularly in patients with decompensated cirrhosis. However, their impact on hepatocellular carcinoma (HCC) remains unclear. Aim To use a national registry of patients with advanced liver disease to explore the relationship between DAA therapy and HCC. Methods All patients with de novo HCC post DAA therapy were frequency matched with patients who did not develop HCC. Demographic, clinical and laboratory data were obtained. Cross-sectional imaging and multidisciplinary team reports were reviewed for dates of HCC diagnosis and HCC progression. Patients were categorised by treatment outcome and time of HCC development. Data were examined by multivariable analysis and Kaplan-Meier estimation. Results Eighty patients with HCC were compared with 165 patients without HCC, treated between June 2014 and September 2015. Mean follow-up from start of DAA therapy was 32.4 months. Twenty-eight patients were diagnosed with early HCC (within 6 months of therapy) and 52 presented late. Baseline nonmalignant lesions (HR: 1.99), thrombocytopaenia (HR: 1.59) and diabetes (HR: 1.68) increased likelihood of HCC. Response to therapy was reduced in patients who developed liver cancer (SVR in patients with HCC = 54/80 (68%), SVR in patients without HCC = 143/165 (87%), P < 0.001, OR: 3.13, 95% CI: 1.64-5.99). We found no difference between tumour size, progression or survival between viraemic and nonviraemic patients. Conclusion There is no alteration in prognosis or cancer progression following HCC development after HCV treatment. However, baseline nonmalignant liver lesions, diabetes and thrombocytopaenia increase the risk of HCC, and HCC is associated with a decreased SVR rate. AD - [Mecci, Ali Jibran; Kemos, Polychronis; Foster, Graham R.] Queen Mary Univ London, Blizard Inst, London, England. [Leen, Clifford] Univ Edinburgh, Edinburgh, Midlothian, Scotland. [Lawson, Adam] Royal Derby Hosp, Derby, England. [Richardson, Paul] Royal Liverpool & Broadgreen Univ Hosp NHS Trust, Liverpool, Merseyside, England. [Khakoo, Salim I.] Univ Southampton, Southampton, Hants, England. [Agarwal, Kosh] Kings Coll Hosp London, London, England. [Mutimer, David] Univ Birmingham, Birmingham, W Midlands, England. [Rosenberg, William M.] Univ Coll Hosp, London, England. [Irving, William L.] Univ Nottingham Hosp, NHS Trust, NIHR Nottingham Biomed Res Ctr, Nottingham, England. [Irving, William L.] Univ Nottingham, Nottingham, England. Foster, GR (corresponding author), Queen Mary Univ London, Blizard Inst, London, England. g.r.foster@qmul.ac.uk AN - WOS:000473873200008 AU - Mecci, A. J. AU - Kemos, P. AU - Leen, C. AU - Lawson, A. AU - Richardson, P. AU - Khakoo, S. I. AU - Agarwal, K. AU - Mutimer, D. AU - Rosenberg, W. M. AU - Foster, G. R. AU - Irving, W. L. AU - Agarwal, K. AU - Aldersley, M. AU - Ali, A. AU - Aravamuthan, S. AU - Aspinall, R. AU - Barnes, E. AU - Brown, A. AU - Ch'ng, C. AU - Corless, L. AU - Cramp, M. AU - Foster, G. R. AU - Foxton, M. AU - Gorard, D. AU - Gordon, F. AU - Lawson, A. AU - Leen, C. AU - Moreea, S. AU - Mutimer, D. AU - Richardson, P. AU - Rosenberg, W. R. AU - Ryder, S. D. AU - Stone, B. AU - Ustianowski, A. AU - Verma, S. AU - UK, H. C. V. Res DA - Jul DO - 10.1111/apt.15296 J2 - Aliment. Pharmacol. Ther. KW - cirrhosis hepatitis C hepatocellular carcinoma liver outcomes research CHRONIC HEPATITIS-C RISK THERAPY Gastroenterology & Hepatology Pharmacology & Pharmacy LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: IG5WM Times Cited: 5 Cited Reference Count: 32 Mecci, Ali Jibran Kemos, Polychronis Leen, Clifford Lawson, Adam Richardson, Paul Khakoo, Salim I. Agarwal, Kosh Mutimer, David Rosenberg, William M. Foster, Graham R. Irving, William L. Agarwal, K. Aldersley, M. Ali, A. Aravamuthan, S. Aspinall, R. Barnes, E. Brown, A. Ch'ng, C. Corless, L. Cramp, M. Foster, G. R. Foxton, M. Gorard, D. Gordon, F. Lawson, A. Leen, C. Moreea, S. Mutimer, D. Richardson, P. Rosenberg, W. R. Ryder, S. D. Stone, B. Ustianowski, A. Verma, S. Khakoo, Salim/0000-0002-4057-9091; Mecci, Ali Jibran/0000-0002-9495-6593; Rosenberg, William/0000-0002-2732-2304 NHS England; Medical Research FoundationMedical Research Council UK (MRC) [C0365]; LAP Research UK This study was supported by NHS England; Medical Research Foundation (Grant reference C0365); LAP Research UK. 5 0 WILEY HOBOKEN ALIMENT PHARM THER PY - 2019 SN - 0269-2813 SP - 204-214 ST - The association between hepatocellular carcinoma and direct-acting anti-viral treatment in patients with decompensated cirrhosis T2 - Alimentary Pharmacology & Therapeutics TI - The association between hepatocellular carcinoma and direct-acting anti-viral treatment in patients with decompensated cirrhosis UR - ://WOS:000473873200008 VL - 50 ID - 761515 ER - TY - JOUR AB - BACKGROUND: Delays to intra-arterial therapy (IAT) lead to worse outcomes in stroke patients with proximal occlusions. Little is known regarding the magnitude of, and reasons for, these delays. In a pilot quality improvement (QI) project, we sought to examine and improve our door-puncture times. METHODS AND RESULTS: For anterior-circulation stroke patients who underwent IAT, we retrospectively calculated in-hospital time delays associated with various phases from patient arrival to groin puncture. We formulated and then implemented a process change targeted to the phase with the greatest delay. We examined the impact on time to treatment by comparing the pre- and post-QI cohorts. One hundred forty-six patients (93 pre- vs. 51 post-QI) were analyzed. In the pre-QI cohort (ie, sequential process), the greatest delay occurred from imaging to the neurointerventional (NI) suite ("picture-suite": median, 62 minutes; interquartile range [IQR], 40 to 82). A QI measure was instituted so that the NI team and anesthesiologist were assembled and the suite set up in parallel with completion of imaging and decision making. The post-QI (ie, parallel process) median picture-to-suite time was 29 minutes (IQR, 21 to 41; P<0.0001). There was a 36-minute reduction in median door-to-puncture time (143 vs. 107 minutes; P<0.0001). Parallel workflow and presentation during work hours were independent predictors of shorter door-puncture times. CONCLUSIONS: In-hospital delays are a major obstacle to timely IAT. A simple approach for achieving substantial time savings is to mobilize the NI and anesthesia teams during patient evaluation and treatment decision making. This parallel workflow resulted in a >30-minute (25%) reduction in median door-to-puncture times. AD - Division of Interventional Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA (B.P.M., T.M.L.M., R.V.C., D.L.B., J.A.H., J.D.R., A.J.Y.) Department of Neurology, Massachusetts General Hospital, Boston, MA (B.P.M., T.M.L.M., N.S.R., L.H.S.). Division of Interventional Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA (B.P.M., T.M.L.M., R.V.C., D.L.B., J.A.H., J.D.R., A.J.Y.). Department of Neurology, Emory University School of Medicine, Atlanta, GA (C.H.J.S.). Department of Neurology, Massachusetts General Hospital, Boston, MA (B.P.M., T.M.L.M., N.S.R., L.H.S.). Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (J.N.G.). Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA (W.C.L.). Wellstar Neurosurgery, Kennestone Hospital, Marietta, GA (R.G.). Division of Diagnostic Neuroradiology, Massachusetts General Hospital, Boston, MA (A.J.Y.) Division of Interventional Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA (B.P.M., T.M.L.M., R.V.C., D.L.B., J.A.H., J.D.R., A.J.Y.). AN - 25389281 AU - Mehta, B. P. AU - Leslie-Mazwi, T. M. AU - Chandra, R. V. AU - Bell, D. L. AU - Sun, C. H. AU - Hirsch, J. A. AU - Rabinov, J. D. AU - Rost, N. S. AU - Schwamm, L. H. AU - Goldstein, J. N. AU - Levine, W. C. AU - Gupta, R. AU - Yoo, A. J. C2 - Pmc4338685 DA - Nov 11 DO - 10.1161/jaha.114.000963 DP - NLM ET - 2014/11/13 J2 - Journal of the American Heart Association KW - Aged Aged, 80 and over Anesthesia Department, Hospital/standards Cooperative Behavior Female Fibrinolytic Agents/*administration & dosage Humans Infusions, Intra-Arterial Interdisciplinary Communication Male Middle Aged Patient Care Team/standards Pilot Projects Process Assessment, Health Care/*standards Program Evaluation Punctures Quality Improvement/*standards Quality Indicators, Health Care/*standards Retrospective Studies Stroke/diagnosis/*therapy Thrombectomy/*standards Thrombolytic Therapy/*standards Time Factors Time and Motion Studies Time-to-Treatment/*standards Treatment Outcome Workflow acute ischemic stroke endovascular stroke thrombectomy quality improvement stroke process improvement LA - eng M1 - 6 N1 - 2047-9980 Mehta, Brijesh P Leslie-Mazwi, Thabele M Chandra, Ronil V Bell, Donnie L Sun, Chung-Huan J Hirsch, Joshua A Rabinov, James D Rost, Natalia S Schwamm, Lee H Goldstein, Joshua N Levine, Wilton C Gupta, Rishi Yoo, Albert J Journal Article Research Support, Non-U.S. Gov't J Am Heart Assoc. 2014 Nov 11;3(6):e000963. doi: 10.1161/JAHA.114.000963. PY - 2014 SN - 2047-9980 SP - e000963 ST - Reducing door-to-puncture times for intra-arterial stroke therapy: a pilot quality improvement project T2 - J Am Heart Assoc TI - Reducing door-to-puncture times for intra-arterial stroke therapy: a pilot quality improvement project VL - 3 ID - 760387 ER - TY - JOUR AB - BACKGROUND: Pediatric hospital-acquired venous thromboembolism (VTE) is an increasingly prevalent and morbid disease. A multidisciplinary team at a tertiary children's hospital sought to answer the following clinical question: "Among hospitalized adolescents, does risk assessment and stratified VTE prophylaxis compared with no prophylaxis reduce VTE occurrence without an increase in significant adverse effects?" METHODS: Serial literature searches using key terms were performed in the following databases: Medline, Cochrane Database, CINAHL (Cumulative Index to Nursing and Allied Health), Scopus, EBMR (Evidence Based Medicine Reviews). Pediatric studies were sought preferentially; when pediatric evidence was sparse, adult studies were included. Abstracts and titles were screened, and relevant full articles were reviewed. Studies were rated for quality using a standard rating system. RESULTS: Moderate evidence exists to support VTE risk assessment in adolescents. This evidence comes from pediatric studies that are primarily retrospective in design. The results of the studies are consistent and cite prominent factors such as immobilization and central venous access. There is insufficient evidence to support specific prophylactic strategies in pediatric patients because available pediatric evidence for thromboprophylaxis efficacy and safety is minimal. There is, however, high-quality, consistent evidence demonstrating efficacy and safety of thromboprophylaxis in adults. CONCLUSIONS: On the basis of the best available evidence, we propose a strategy for risk assessment and stratified VTE prophylaxis for hospitalized adolescents. This strategy involves assessing risk factors and considering prophylactic measures based on level of risk. We believe this strategy may reduce risk of VTE and appropriately balances the adverse effect profile of mechanical and pharmacologic prophylactic methods. AD - Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and. Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; erin.shaughnessy@cchmc.org. AN - 25554759 AU - Meier, K. A. AU - Clark, E. AU - Tarango, C. AU - Chima, R. S. AU - Shaughnessy, E. DA - Jan DO - 10.1542/hpeds.2014-0044 DP - NLM ET - 2015/01/03 J2 - Hospital pediatrics KW - Adolescent *Adolescent, Hospitalized Anticoagulants/*therapeutic use *Chemoprevention/methods/standards Evidence-Based Medicine Female Humans Male Prevalence Pulmonary Embolism/etiology/*prevention & control Risk Assessment Risk Factors *Venous Thromboembolism/complications/diagnosis/epidemiology health care pediatrics prevention and control pulmonary embolism quality assurance venous thromboembolism venous thrombosis LA - eng M1 - 1 N1 - Meier, Katie A Clark, Eloise Tarango, Cristina Chima, Ranjit S Shaughnessy, Erin Journal Article Review United States Hosp Pediatr. 2015 Jan;5(1):44-51. doi: 10.1542/hpeds.2014-0044. PY - 2015 SN - 2154-1663 (Print) 2154-1671 SP - 44-51 ST - Venous thromboembolism in hospitalized adolescents: an approach to risk assessment and prophylaxis T2 - Hosp Pediatr TI - Venous thromboembolism in hospitalized adolescents: an approach to risk assessment and prophylaxis VL - 5 ID - 760205 ER - TY - JOUR AB - Poor management of post-operative acute pain can contribute to medical complications including pneumonia, deep vein thrombosis, infection and delayed healing, as well as the development of chronic pain. It is therefore important that all patients undergoing surgery should receive adequate pain management. However, evidence suggests this is not currently the case; between 10% and 50% of patients develop chronic pain after various common operations, and one recent US study recorded >80% of patients experiencing post-operative pain.At the first meeting of the acute chapter of the Change Pain Advisory Board, key priorities for improving post-operative pain management were identified in four different areas. Firstly, patients should be more involved in decisions regarding their own treatment, particularly when fateful alternatives are being considered. For this to be meaningful, relevant information should be provided so they are well informed about the various options available. Good physician/patient communication is also essential. Secondly, better professional education and training of the various members of the multidisciplinary pain management team would enhance their skills and knowledge, and thereby improve patient care. Thirdly, there is scope for optimizing treatment. Examples include the use of synergistic analgesia to target pain at different points along pain pathways, more widespread adoption of patient-controlled analgesia, and the use of minimally invasive rather than open surgery. Fourthly, organizational change could provide similar benefits; introducing acute pain services and increasing their availability towards the 24 hours/day ideal, greater adherence to protocols, increased use of patient-reported outcomes, and greater receptivity to technological advances would all help to enhance performance and increase patient satisfaction. It must be acknowledged that implementing these recommendations would incur a considerable cost that purchasers of healthcare may be unwilling or unable to finance. Nevertheless, change is under way and the political will exists for it to continue. AD - [Meissner, Winfried] Univ Klinikum FSU Jena, Klin Anaesthesiol & Intens Med, Leiter Sekt Schmerz, D-07740 Jena, Germany. [Coluzzi, Flaminia] Univ Roma La Sapienza, Dept Med & Surg Sci & Biotechnol, Rome, Italy. [Fletcher, Dominique] Hop Raymond Poincare, Serv Anesthesie Reanimat, Garches, France. [Huygen, Frank] Univ Rotterdam Hosp, Rotterdam, Netherlands. [Morlion, Bart] Univ Hosp Leuven, Louvain, Belgium. [Neugebauer, Edmund] Univ Witten Herdecke, Sch Med, Fac Hlth, Cologne, Germany. [Montes Perez, Antonio] Hosp Mar Esperanza, Serv Anestesiol, Barcelona, Spain. [Pergolizzi, Joseph] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21205 USA. [Pergolizzi, Joseph] Naples Anesthesia & Pain Associates, Naples, FL USA. Meissner, W (corresponding author), Univ Klinikum FSU Jena, Klin Anaesthesiol & Intens Med, Leiter Sekt Schmerz, D-07740 Jena, Germany. winfried.meissner@med.uni-jena.de AN - WOS:000364476500001 AU - Meissner, W. AU - Coluzzi, F. AU - Fletcher, D. AU - Huygen, F. AU - Morlion, B. AU - Neugebauer, E. AU - Perez, A. M. AU - Pergolizzi, J. DA - Nov DO - 10.1185/03007995.2015.1092122 J2 - Curr. Med. Res. Opin. KW - Organizational change Patient controlled analgesia Patient involvement Post-operative acute pain Professional education Synergistic analgesia Treatment optimization PATIENT-CONTROLLED ANALGESIA CHRONIC POSTSURGICAL PAIN SHARED DECISION-MAKING MULTIMODAL ANALGESIA EPIDURAL ANALGESIA QUALITY-IMPROVEMENT RISK-FACTORS ENHANCED RECOVERY NATIONAL-SURVEY SATISFACTION Medicine, General & Internal Medicine, Research & Experimental LA - English M1 - 11 M3 - Article N1 - ISI Document Delivery No.: CV7SZ Times Cited: 69 Cited Reference Count: 115 Meissner, Winfried Coluzzi, Flaminia Fletcher, Dominique Huygen, Frank Morlion, Bart Neugebauer, Edmund Montes Perez, Antonio Pergolizzi, Joseph Grunenthal GmbH, Aachen, Germany This article was based on a meeting held in Amsterdam, The Netherlands, 23-24 January 2015, which was supported by an unrestricted educational grant from Grunenthal GmbH, Aachen, Germany. 73 0 15 TAYLOR & FRANCIS LTD ABINGDON CURR MED RES OPIN PY - 2015 SN - 0300-7995 SP - 2131-2143 ST - Improving the management of post-operative acute pain: priorities for change T2 - Current Medical Research and Opinion TI - Improving the management of post-operative acute pain: priorities for change UR - ://WOS:000364476500001 VL - 31 ID - 761737 ER - TY - JOUR AB - Pulmonary embolism (PE) treatment depends on disease severity and risk of complications. Physician and institutional expertise may influence the use of reperfusion therapy (RT) such as systemic thrombolysis (SL) and catheter-directed interventions (CDI). We aimed to investigate the effects of a consensus-based treatment algorithm (TA) and subsequent implementation of PE response team (PERT) on RT modality choices and patient outcomes. A cohort of PE patients admitted to a tertiary care hospital between 2012 and 2017 was retrospectively evaluated. Demographics, clinical variables, RT selections, and patient outcomes during 3 consecutive 2-year periods (baseline, with TA, and with TA+PERT) were compared. Descriptive statistics were used for data analysis. A total of 1105 PE patients were admitted, and 112 received RT. Use of RT increased from 4.7% at baseline to 8.2% and 16.1% during the TA and TA+PERT periods. The primary RT modality transitioned from CDI to SL, and reduced-dose SL became most common. Treatment selection patterns remained unchanged after PERT introduction. Hospital length of stay decreased from 4.78 to 2.96 and 2.81 days (P < .001). Most of the hemorrhagic complications were minor, and their rates were similar across all 3 periods and between SL and CDI. No major hemorrhages occurred in patients treated with reduced-dose SL. In conclusion, TA and PERT represent components of a decision support system facilitating treatment modality selection, contributing to improved outcomes, and limiting complications. Treatment algorithm emerged as a factor providing consistency to PERT recommendations. AD - Department of Critical Care, Abbott Northwestern Hospital, Minneapolis, MN, USA. Department of Care Delivery Research, Allina Health, Minneapolis, MN, USA. Consulting Radiologists, Ltd, Edina, MN, USA. Department of Graduate Medical Education, Abbott Northwestern Hospital, Minneapolis, MN, USA. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA. AN - 32539524 AU - Melamed, R. AU - St Hill, C. A. AU - Engstrom, B. I. AU - Tierney, D. M. AU - Smith, C. S. AU - Agboto, V. K. AU - Weise, B. E. AU - Eckman, P. M. AU - Skeik, N. C2 - Pmc7427027 DA - Jan-Dec DO - 10.1177/1076029620928420 DP - NLM ET - 2020/06/17 J2 - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis KW - catheter-directed thrombolysis hemorrhage pulmonary embolism thrombolytics conflicts of interest with respect to the research, authorship, and/or publication of this article: Bjorn I. Engstrom, MD, has been a paid speaker for Penumbra Inc, Alameda, California, USA. LA - eng N1 - 1938-2723 Melamed, Roman Orcid: 0000-0001-6187-1414 St Hill, Catherine A Engstrom, Bjorn I Tierney, David M Orcid: 0000-0003-4202-1101 Smith, Claire S Orcid: 0000-0002-4979-2104 Agboto, Vincent K Weise, Brynn E Orcid: 0000-0001-9523-4018 Eckman, Peter M Orcid: 0000-0002-8915-1942 Skeik, Nedaa Journal Article Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620928420. doi: 10.1177/1076029620928420. PY - 2020 SN - 1076-0296 (Print) 1076-0296 SP - 1076029620928420 ST - Effects of a Consensus-Based Pulmonary Embolism Treatment Algorithm and Response Team on Treatment Modality Choices, Outcomes, and Complications T2 - Clin Appl Thromb Hemost TI - Effects of a Consensus-Based Pulmonary Embolism Treatment Algorithm and Response Team on Treatment Modality Choices, Outcomes, and Complications VL - 26 ID - 760368 ER - TY - JOUR AB - Pulmonary embolism (PE) treatment depends on disease severity and risk of complications. Physician and institutional expertise may influence the use of reperfusion therapy (RT) such as systemic thrombolysis (SL) and catheter-directed interventions (CDI). We aimed to investigate the effects of a consensus-based treatment algorithm (TA) and subsequent implementation of PE response team (PERT) on RT modality choices and patient outcomes. A cohort of PE patients admitted to a tertiary care hospital between 2012 and 2017 was retrospectively evaluated. Demographics, clinical variables, RT selections, and patient outcomes during 3 consecutive 2-year periods (baseline, with TA, and with TA+PERT) were compared. Descriptive statistics were used for data analysis. A total of 1105 PE patients were admitted, and 112 received RT. Use of RT increased from 4.7% at baseline to 8.2% and 16.1% during the TA and TA+PERT periods. The primary RT modality transitioned from CDI to SL, and reduced-dose SL became most common. Treatment selection patterns remained unchanged after PERT introduction. Hospital length of stay decreased from 4.78 to 2.96 and 2.81 days (P <.001). Most of the hemorrhagic complications were minor, and their rates were similar across all 3 periods and between SL and CDI. No major hemorrhages occurred in patients treated with reduced-dose SL. In conclusion, TA and PERT represent components of a decision support system facilitating treatment modality selection, contributing to improved outcomes, and limiting complications. Treatment algorithm emerged as a factor providing consistency to PERT recommendations. AD - R. Melamed, Department of Critical Care, Abbott Northwestern Hospital, Minneapolis, MN, United States AU - Melamed, R. AU - St. Hill, C. A. AU - Engstrom, B. I. AU - Tierney, D. M. AU - Smith, C. S. AU - Agboto, V. K. AU - Weise, B. E. AU - Eckman, P. M. AU - Skeik, N. DB - Embase Medline DO - 10.1177/1076029620928420 KW - drainage catheter brain natriuretic peptide tissue plasminogen activator troponin adult algorithm article blood clot lysis cohort analysis comparative study disease assessment disease severity drug dose reduction embolectomy extracorporeal oxygenation female heart rate hemodynamics human hypertension intensive care unit length of stay low drug dose lung embolism male partial thromboplastin time priority journal pulmonary embolism response team pulmonary embolism severity index reperfusion retrospective study systolic blood pressure tertiary care center treatment outcome LA - English M3 - Article N1 - L2005237424 2020-07-02 2020-07-22 PY - 2020 SN - 1938-2723 1076-0296 ST - Effects of a Consensus-Based Pulmonary Embolism Treatment Algorithm and Response Team on Treatment Modality Choices, Outcomes, and Complications T2 - Clinical and Applied Thrombosis/Hemostasis TI - Effects of a Consensus-Based Pulmonary Embolism Treatment Algorithm and Response Team on Treatment Modality Choices, Outcomes, and Complications UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005237424&from=export http://dx.doi.org/10.1177/1076029620928420 VL - 26 ID - 760617 ER - TY - JOUR AB - Introduction: The implementation of oncology care pathways that standardize organizational procedures has improved cancer care in recent years. However, the involvement of "authentic" patients and caregivers in quality improvement of these predetermined pathways is in its in fancy, especially the scholarly reflection on this process. We, therefore, aim to explore the multidisciplinary challenges both in practice, when cancer patients, their caregivers, and a multidisciplinary team of professionals work together on quality improvement, as well as in our research team, in which a social scientist, health care professionals, health care researchers, and experience experts design a research project together. Methods and design: Experience-based co-design will be used to involve cancer patients and their caregivers in a qualitative research design. In-depth open discovery interviews with 12 colorectal cancer patients, 12 breast cancer patients, and seven patients with cancer-associated thrombosis and their caregivers, and focus group discussions with professionals from various disciplines will be conducted. During the subsequent prioritization events and various co-design quality improvement meetings, observational field notes will be made on the multidisciplinary challenges these participants face in the process of co-design, and evaluation interviews will be done afterwards. Similar data will be collected during the monthly meetings of our multidisciplinary research team. The data will be analyzed according to the constant comparative method. Discussion: This study may facilitate quality improvement programs in oncologic care pathways, by increasing our real-world knowledge about the challenges of involving "experience experts" together with a team of multidisciplinary professionals in the implementation process of quality improvement. Such co-creation might be challenging due to the traditional paternalistic relationship, actual disease-/treatment-related constraints, and a lack of shared language and culture between patients, caregivers, and professionals and between professionals from various disciplines. These challenges have to be met in order to establish equality, respect, team spirit, and eventual meaningful participation. AD - [Melchior, Inge; Jie, Kon-Siong] Zuyderland Med Ctr, Dept Internal Med, Postbus 5500, NL-6130 MB Sittard, Netherlands. [Melchior, Inge; Moser, Albine; Jie, Kon-Siong] Zuyd Univ Appl Sci, Res Ctr Auton & Participat Chron People 3, Heerlen, Netherlands. [Moser, Albine] Maastricht Univ, Dept Family Med, CAPHRI, Maastricht, Netherlands. [Veenstra, Marja Y.] Burgerkracht Limburg Citizen Power Limburg, Sittard, Netherlands. Jie, KS (corresponding author), Zuyderland Med Ctr, Dept Internal Med, Postbus 5500, NL-6130 MB Sittard, Netherlands. a.jie@zuyderland.nl AN - WOS:000450389400001 AU - Melchior, I. AU - Moser, A. AU - Veenstra, M. Y. AU - Jie, K. S. DO - 10.2147/jmdh.s177957 J2 - J. Multidiscip. Healthc. KW - cancer care pathways experience-based co-design authentic cancer patients patient involvement caregivers' involvement qualitative research HEALTH-CARE SERVICE DEVELOPMENT PUBLIC INVOLVEMENT DECISION-MAKING OLDER-PEOPLE EXPERIENCE DESIGN POLICY Health Care Sciences & Services LA - English M3 - Article N1 - ISI Document Delivery No.: HA6KW Times Cited: 0 Cited Reference Count: 38 Melchior, Inge Moser, Albine Veenstra, Marja Y. Jie, Kon-Siong Dutch Cancer Society (KWF kankerbestrijding)KWF Kankerbestrijding [ATR2013-6458]; PfizerPfizer; Leo Pharma This work was supported by The Dutch Cancer Society (KWF kankerbestrijding) grant number ATR2013-6458, Pfizer, and Leo Pharma. 0 5 DOVE MEDICAL PRESS LTD ALBANY J MULTIDISCIP HEALTH PY - 2018 SN - 1178-2390 SP - 661-671 ST - Involving "authentic" cancer patients, their caregivers, and multidisciplinary professionals in a quality improvement trajectory in a hospital cancer pathway: a study protocol T2 - Journal of Multidisciplinary Healthcare TI - Involving "authentic" cancer patients, their caregivers, and multidisciplinary professionals in a quality improvement trajectory in a hospital cancer pathway: a study protocol UR - ://WOS:000450389400001 VL - 11 ID - 761613 ER - TY - JOUR AB - Introduction: Severe hemorrhage during cesarean hysterectomy associated with abnormal placentation is a major cause of maternal morbidity and mortality in the US. Intravascular occlusive balloon catheter placement has been hypothesized to lessen blood loss during planned cesarean hysterectomy. This study explored patterns associated with balloon placement during cesarean hysterectomy Methods: We retrospectively studied women ≥18 years of age who underwent cesarean hysterectomy for abnormal placental implantation within our large, community-based hospital system during 2012-2016. Three patient groups were studied: (1) balloon not placed, (2) balloon placed but not deployed, and (3) balloon placed and deployed. Data were abstracted from the electronic medical record and compared among patient groups using basic descriptive and inferential statistics. Results: Of 17 total patients identified (mean age 37.1 years, body mass index 33.8 kg/m2, and gestational age 32.3 weeks), 11 (65%) had balloons placed and 3 (18%) had balloons deployed. Odds of balloon placement (regardless of subsequent deployment) were greater in women with placenta accreta (p=0.01), preoperative anemia (p<0.01), and larger, multidisciplinary teams of providers (p=0.02). Significant complications (thromboembolic events and/or stent place-ment) were experienced by 2 women who underwent balloon placement but no one in the balloon deployment group. No significant group differences were detected in provider characteristics or other outcomes (e.g., estimated blood loss, transfusion, surgery duration). Conclusion: In this community-based study, use of occlusive balloon catheters did not improve outcomes but rather increased complications directly related to placement. Prospective multicenter studies are needed to evaluate the efficacy of balloon placement and deployment. AD - E. Mellott, Aurora Health Care, Milwaukee, WI, United States AU - Mellott, E. AU - Kram, J. J. F. AU - Greer, D. M. AU - Michelson, E. D. DB - Embase KW - adult anemia balloon catheter bleeding body mass body weight case report clinical article comparative effectiveness complication conference abstract electronic medical record female gestational age hospital planning human hysterectomy implantation inferential statistics multicenter study operation duration placenta accreta retrospective study stent thromboembolism LA - English M3 - Conference Abstract N1 - L622555158 2018-06-19 PY - 2018 SN - 1873-233X SP - 50S ST - Cesarean hysterectomy and prophylactic occlusive balloons catheters: Is it worth the risk? T2 - Obstetrics and Gynecology TI - Cesarean hysterectomy and prophylactic occlusive balloons catheters: Is it worth the risk? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622555158&from=export VL - 131 ID - 760825 ER - TY - JOUR AB - Background: Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. Methods: The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations. Results: The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57–0.80/OR: 0.83, 95% CI: 0.60–1.15; pulmonary OR: 0.65, 95% CI: 0.52–0.80/OR: 0.69, 95% CI: 0.58–0.81; acute renal failure OR: 0.69, 95% CI: 0.59–0.81/OR: 0.73, 95% CI: 0.65–0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42–0.65/OR: 0.77, 95% CI: 0.64–0.93; infections OR: 0.73, 95% CI: 0.67–0.79/OR: 0.80, 95% CI: 0.76–0.85; and blood transfusion OR: 0.85, 95% CI: 0.82–0.89/OR: 0.84, 95% CI: 0.82–0.87. Conclusions: Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation. Recommendation: neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty. Trial registry number: PROSPERO CRD42018099935. AD - S.G. Memtsoudis, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery and Department of Anesthesiology, Weill Cornell Medical College, New York, NY, United States AU - Memtsoudis, S. G. AU - Cozowicz, C. AU - Bekeris, J. AU - Bekere, D. AU - Liu, J. AU - Soffin, E. M. AU - Mariano, E. R. AU - Johnson, R. L. AU - Hargett, M. J. AU - Lee, B. H. AU - Wendel, P. AU - Brouillette, M. AU - Go, G. AU - Kim, S. J. AU - Baaklini, L. AU - Wetmore, D. AU - Hong, G. AU - Goto, R. AU - Jivanelli, B. AU - Argyra, E. AU - Barrington, M. J. AU - Borgeat, A. AU - De Andres, J. AU - Elkassabany, N. M. AU - Gautier, P. E. AU - Gerner, P. AU - Gonzalez Della Valle, A. AU - Goytizolo, E. AU - Kessler, P. AU - Kopp, S. L. AU - Lavand'Homme, P. AU - MacLean, C. H. AU - Mantilla, C. B. AU - MacIsaac, D. AU - McLawhorn, A. AU - Neal, J. M. AU - Parks, M. AU - Parvizi, J. AU - Pichler, L. AU - Poeran, J. AU - Poultsides, L. A. AU - Sites, B. D. AU - Stundner, O. AU - Sun, E. C. AU - Viscusi, E. R. AU - Votta-Velis, E. G. AU - Wu, C. L. AU - Ya Deau, J. T. AU - Sharrock, N. E. DB - Embase Medline DO - 10.1016/j.bja.2019.05.042 KW - acute kidney failure anesthesia blood transfusion cerebrovascular accident clinical outcome consensus deep vein thrombosis evidence based practice gastrointestinal symptom general anesthesia heart infarction human lung complication meta analysis mortality nerve injury neuraxial anesthesia pneumonia postoperative care postoperative complication postoperative hemorrhage postoperative infection priority journal pulmonary embolism response team randomized controlled trial (topic) review surgical infection surgical mortality systematic review total hip replacement total knee arthroplasty urinary tract infection urine retention LA - English M1 - 3 M3 - Review N1 - L2002372581 2019-07-31 2019-08-19 PY - 2019 SN - 1471-6771 0007-0912 SP - 269-287 ST - Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis T2 - British Journal of Anaesthesia TI - Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002372581&from=export http://dx.doi.org/10.1016/j.bja.2019.05.042 VL - 123 ID - 760676 ER - TY - JOUR AB - Critical limb ischemia (CLI) is the most severe form of peripheral arterial disease and is associated with a risk of limb loss. This vascular condition is currently treated with limb revascularization by surgery or endovascular intervention performed by a variety of specialists. Because both open vascular bypass and the less invasive endovascular therapy can be performed in selected patients with CLI, there exists significant disagreement as to which therapy should be performed first and which is more successful. The paucity of comparative effectiveness data to guide treatment of CLI has prompted a multidisciplinary effort to organize the Best Endovascular Versus Best Surgical Therapy in Patients With CLI (BEST-CLI) trial. The BEST-CLI trial is a pragmatic, multicenter, open-label, randomized trial that compares best endovascular therapy with best open surgical treatment in patients eligible for both treatments. BEST-CLI aims to provide urgently needed clinical guidance for CLI management by using a pragmatic design comparing the effectiveness of established techniques while allowing for the introduction of newer therapies as they become available; a novel primary endpoint that includes limb amputation rates, repeat intervention, and mortality; a multidisciplinary structure that fosters cooperation among interventional cardiologists, interventional radiologists, vascular surgeons, and vascular medicine specialists; and novel techniques to evaluate the cost-effectiveness and quality-of-life outcomes of the two treatment strategies being tested. AD - Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA 02115. Electronic address: mmenard@partners.org. Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, MA 02118. AN - 25812762 AU - Menard, M. T. AU - Farber, A. DA - Mar DO - 10.1053/j.semvascsurg.2015.01.003 DP - NLM ET - 2015/03/31 J2 - Seminars in vascular surgery KW - Amputation *Blood Vessel Prosthesis Implantation/adverse effects/economics Clinical Protocols Cost-Benefit Analysis Critical Illness *Endovascular Procedures/adverse effects/economics Health Care Costs Humans Interdisciplinary Communication Ischemia/diagnosis/economics/surgery/*therapy Limb Salvage Lower Extremity/*blood supply North America *Patient Care Team/economics Peripheral Vascular Diseases/diagnosis/economics/surgery/*therapy Prospective Studies Quality of Life *Research Design Saphenous Vein/*transplantation Time Factors Treatment Outcome LA - eng M1 - 1 N1 - 1558-4518 Menard, Matthew T Farber, Alik Comparative Study Journal Article Multicenter Study Pragmatic Clinical Trial Randomized Controlled Trial United States Semin Vasc Surg. 2014 Mar;27(1):82-4. doi: 10.1053/j.semvascsurg.2015.01.003. Epub 2015 Jan 22. PY - 2014 SN - 0895-7967 SP - 82-4 ST - The BEST-CLI trial: a multidisciplinary effort to assess whether surgical or endovascular therapy is better for patients with critical limb ischemia T2 - Semin Vasc Surg TI - The BEST-CLI trial: a multidisciplinary effort to assess whether surgical or endovascular therapy is better for patients with critical limb ischemia VL - 27 ID - 760179 ER - TY - JOUR AB - Objective: To test the transferability of the Helsinki stroke thrombolysis model that achieved a median 20-minute door-to-needle time (DNT) to an Australian health care setting. Methods: The existing "code stroke" model at the Royal Melbourne Hospital was evaluated and restructured to include key components of the Helsinki model: 1) ambulance prenotification with patient details alerting the stroke team to meet the patient on arrival; 2) patients transferred directly from triage onto the CT table on the ambulance stretcher; and 3) tissue plasminogen activator (tPA) delivered in CT immediately after imaging. We analyzed our prospective, consecutive tPA registry for effects of these protocol changes on our DNT after implementation during business hours (8 AM to 5 PM Monday-Friday) from May 2012. Results: There were 48 patients treated with tPA in the 8 months after the protocol change. Compared with 85 patients treated in 2011, the median (interquartile range) DNT was reduced from 61 (43-75) minutes to 46 (24-79) minutes (p = 0.040). All of the effect came from the change in the in-hours DNT, down from 43 (33-59) to 25 (19-48) minutes (p = 0.009), whereas the out-of-hours delays remain unchanged, from 67 (55-82) to 62 (44-95) minutes (p = 0.835). Conclusion: We demonstrated rapid transferability of an optimized tPA protocol to a different health care setting. With the cooperation of ambulance, emergency, and stroke teams, we succeeded in the absence of a dedicated neurologic emergency department or electronic patient records, which are features of the Finnish system. The next challenge is providing the same service out-of-hours. AD - [Meretoja, Atte; Weir, Louise; Ugalde, Melissa; Yassi, Nawaf; Yan, Bernard; Hand, Peter; Davis, Stephen M.; Campbell, Bruce C. V.] Univ Melbourne, Royal Melbourne Hosp, Dept Neurol & Med, Parkville, Vic, Australia. [Weir, Louise] Univ Melbourne, Royal Melbourne Hosp, Dept Nursing, Parkville, Vic, Australia. [Truesdale, Melinda] Univ Melbourne, Royal Melbourne Hosp, Emergency Dept, Parkville, Vic, Australia. [Meretoja, Atte] Univ Helsinki, Cent Hosp, Dept Neurol, FIN-00014 Helsinki, Finland. Meretoja, A (corresponding author), Univ Melbourne, Royal Melbourne Hosp, Dept Neurol & Med, Parkville, Vic, Australia. atte.meretoja@fimnet.fi AN - WOS:000330767900012 AU - Meretoja, A. AU - Weir, L. AU - Ugalde, M. AU - Yassi, N. AU - Yan, B. AU - Hand, P. AU - Truesdale, M. AU - Davis, S. M. AU - Campbell, B. C. V. DA - Sep DO - 10.1212/WNL.0b013e3182a4a4d2 J2 - Neurology KW - CODE STROKE TIME Clinical Neurology LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: AA0EK Times Cited: 155 Cited Reference Count: 16 Meretoja, Atte Weir, Louise Ugalde, Melissa Yassi, Nawaf Yan, Bernard Hand, Peter Truesdale, Melinda Davis, Stephen M. Campbell, Bruce C. V. Campbell, Bruce/J-1220-2019; Meretoja, Atte/G-7381-2014; Meretoja, Atte/H-6531-2019 Campbell, Bruce/0000-0003-3632-9433; Meretoja, Atte/0000-0001-6433-1931; Meretoja, Atte/0000-0001-6433-1931; Yan, Bernard/0000-0001-8802-9606; Yassi, Nawaf/0000-0002-0685-0060 National Health and Medical Research Council of Australia (NHMRC) Centre for Research Excellence grantNational Health and Medical Research Council of Australia [1001216]; Finnish Medical Foundation; Biomedicum Helsinki Foundation; Sigrid Juselius FoundationSigrid Juselius Foundation; University of MelbourneUniversity of Melbourne; Neurosciences Victoria; NHMRC Early Career FellowshipNational Health and Medical Research Council of Australia [1035688]; Heart Foundation of AustraliaNational Heart Foundation of Australia; National Stroke Foundation; Cardiovascular Lipid Australia; Royal Melbourne Hospital Neurosciences Foundation Supported by the National Health and Medical Research Council of Australia (NHMRC) Centre for Research Excellence grant 1001216. The authors received additional support from Finnish Medical, Biomedicum Helsinki, and Sigrid Juselius Foundations (A. M.), University of Melbourne, and Neurosciences Victoria (N.Y.), NHMRC Early Career Fellowship 1035688, Heart Foundation of Australia, National Stroke Foundation, and Cardiovascular Lipid Australia (B. C. V. C), and The Royal Melbourne Hospital Neurosciences Foundation (N.Y., B.C.V.C). 169 1 20 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA NEUROLOGY PY - 2013 SN - 0028-3878 SP - 1071-1076 ST - Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months T2 - Neurology TI - Helsinki model cut stroke thrombolysis delays to 25 minutes in Melbourne in only 4 months UR - ://WOS:000330767900012 VL - 81 ID - 761798 ER - TY - JOUR AB - Background: Ischemic lesions of the foot can lead to loss of the limb. These lesions have little chance of healing, even when surgical or endovascular revascularization procedures are successful. This may occur because the arteries that irrigate the target areas where the lesions are located are not revascularized or there is an incorrect vascular connection between the revas-cularized artery and the local ischemic area. Aim: To deter¬mine whether direct revascularization of specific angiosomes is crucial to wound healing and pain relief. Material and Meth¬ods: Observational, transverse, descriptive, prospective study. Patients with critical ischemia, presence of distal wound, sub¬mitted to endovascular revascularization procedures in the infrapopliteal sector. Results: A total of 32 patients were eval¬uated, mean age: 68.31 years, 18 male (56.2%) and 43.8% women, and male-women relationship of 1.3:1. Comorbidities: 84.38% were diabetic and 87.5% hypertensive, 56.25% ex-smokers, 6.25% active smoking, and 43.75% (n 14) had ischemic heart disease. The limbs were classified in the 2 study groups: in group 1, 23 (72%) direct revascularization (RD) was carried out, and in the remaining 9 limbs (28%), an indirect revascularization (RI) of the ischemic angiosomes was under¬taken. Complete healing was achieved in 27 (84.37%) limbs with an average of 37.48 days, with a standard deviation of 41.51 (range: 12-150). The rate of healing (RD 100% vs 44.44% RI) by Fisher exact test and w2 was highly significant. The average time until healing (21.17 RD days vs RI 131.25 days) with a factor analysis of variance showed P 0000001. The cumulative proportion of free amputation showed P 00032. Values were obtained as z: 3.35 y; P .001 for the relationship between type of revascularization and relief of pain. Age and smoking were considered in logistic regression analysis as important risk factors in the process of healing. Conclusion: The infrapopliteal primary angioplasty is an effective and less aggressive method for revascularization. The best results regarding the healing of ischemic ulcers or limb salvage as well as pain relief depended not only on more or less successful revascularizations but also on the direct and ade¬quate treatment of the arteries that directly irrigate the lesional zone. Should optimize clinical and advanced wound care that may be the key forecast. Requires trained, experienced, and multidisciplinary teams. AD - A.A.L.F. Merida, Hospital Centro Medico Nacional 20 de Noviembre Issste, Mexico City, Mexico AU - Merida, A. A. L. F. DB - Embase DO - 10.1177/1538574418797220 KW - aged amputation analgesia angioplasty clinical article comorbidity conference abstract controlled study diabetes mellitus factor analysis female Fisher exact test human ischemic heart disease limb salvage male multidisciplinary team prospective study revascularization risk factor smoking ulcer wound healing LA - English M1 - 8 M3 - Conference Abstract N1 - L625388836 2018-12-13 PY - 2018 SN - 1938-9116 SP - S26 ST - Infrapopliteal angioplasty infrapopliteal: Relationship between the treated artery and injured T2 - Vascular and Endovascular Surgery TI - Infrapopliteal angioplasty infrapopliteal: Relationship between the treated artery and injured UR - https://www.embase.com/search/results?subaction=viewrecord&id=L625388836&from=export http://dx.doi.org/10.1177/1538574418797220 VL - 52 ID - 760789 ER - TY - JOUR AU - Merli, G. J. DA - 2017/10/15 10/15 DB - Europe PubMed Central DO - 10.1053/j.tvir.2017.07.001 M1 - 3 PY - 2017 SN - 1089-2516 SP - 128-134 ST - Pulmonary Embolism in 2017: How We Got Here and Where Are We Going? T2 - Tech Vasc Interv Radiol TI - Pulmonary Embolism in 2017: How We Got Here and Where Are We Going? UR - http://europepmc.org/article/MED/29029706 VL - 20 ID - 762112 ER - TY - JOUR AB - Objective: The main feature of Gender Identity Disorder is strong and persistent cross-gender identification and sense of inappropriateness in the gender role of that sex. The care provided to transsexual patients requires a multidisciplinary team consisting mainly of psychologist, psychiatrist, genital reconstructive surgeon, endocrinologist, and social worker. We aimed to assess demographic data of a Brazilian tertiary public center for transgender health. Material and Methods: We retrospectively evaluated the charts of patients enrolled in transsexual transition in our center from February 2003 to June 2011. The variables analyzed were: number of transsexual patients, gender, sex and non-sex reassignment surgeries, paraffinoma, HIV-positive patients, self-mutilation, prevalence of depressive symptoms, and surgical complications. Success was evaluated by the WHOQoL- bref questionnaire. Results: One-hundred and fifty six patients were evaluated (21 female to male and 135 male to female). Original sex reassignment surgeries were performed in 37 patients and 11 were secondary genital repair. Mastectomy was the most common non genital reassignment surgery. Six percent were positive for HIV and paraffinomas were found in 18%. Depressive symptoms were reported by 53% and 2.5% presented history of self-mutilation. The most common surgical complication was urethral stricture disease (10%) followed by deep vein thrombosis (6%) and neovagina stricture (4%). No regrets for changing sex were found. The main area improved during transition was the psychological domain (from 58 ± 22 to 81 ± 14 p < 0,01). Conclusion: Transgender transition is a complex condition that needs a multidisciplinary team providing integrated health care. This health care model is efficacious to improve quality of life to transgender patients. Sex reassignment surgery may be performed by surgeons experienced in genital reconstructive repair in tertiary hospitals prepared to manage severe complications. AD - E.A. Da Silva, Service of Urology, Pedro Ernesto Memorial Hospital, Rio de Janeiro State University, Brazil AU - Mesquita, B. AU - Vieira, R. M. AU - Salomão, L. AU - Awad, M. C. AU - Chalub, M. AU - Damiao, R. AU - Da Silva, E. A. DB - Embase DO - 10.1111/j.1743-6109.2012.02643.x KW - transsexualism society health human patient sex reassignment female postoperative complication Human immunodeficiency virus depression automutilation male surgeon gender health care urethra stenosis deep vein thrombosis prevalence model quality of life tertiary health care gender dysphoria sex role psychologist psychiatrist medical specialist endocrinologist social worker Human immunodeficiency virus infected patient questionnaire mastectomy surgery LA - English M3 - Conference Abstract N1 - L70692023 2012-03-23 PY - 2012 SN - 1743-6095 SP - 75 ST - The transsexual transition: The experience of a Brazilian tertiary public center for transgender health T2 - Journal of Sexual Medicine TI - The transsexual transition: The experience of a Brazilian tertiary public center for transgender health UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70692023&from=export http://dx.doi.org/10.1111/j.1743-6109.2012.02643.x VL - 9 ID - 761212 ER - TY - JOUR AB - Background Venous thromboembolism (VTE) is a common and potentially lethal complication from hospitalisation. Critically ill patients have multiple risk factors for VTE such as prolonged immobility, use of central venous catheters, mechanical ventilation complications related to comorbidities. To reduce the incidence of VTE, various pharmacologic and mechanical thromboprophylaxis (TP) regimes are available. Purpose To characterise the prophylactic strategies used in a cohort of critically ill patients during their stay in ICU length and their adherence to hospital guidelines for the prevention of VTE. Materials and methods We conducted a prospective review of all patients admitted to a traumatic and neurocritical ICU from July 2013 to September of 2013. Patients were excluded if they were being treated for VTE diagnosed before, or were therapeutically anticoagulated for other reasons prior to ICU admission. For ICU patients our guidelines recommend anticoagulant TP with low-molecular-weight heparin (LMWH) as soon as it is safe, if it is not contraindicated. However, it is more common in ICU to start TP using mechanical methods because of the high risk of bleeding for the first few days, in which LMWH are contraindicated. A high risk of bleeding was defined as symptomatic bleeding, presence of organic lesions likely to bleed, haemophiliac diseases, haemostatic abnormalities (platelet count <50000/mm3; aPTT ratio >2; prothrombin time (IQ) <40%), or severe anaemia (haemoglobin <7 g/dL) due to bleeding or unknown causes. We collected bio-demographic data and other clinical data related to VTE. Results Over the study period 34 patients were admitted to the ICU. Of these, 4 were excluded. We therefore enrolled 30 patients, with a mean age of 45.5 years; of which 86.6% were men. The median length of stay in the ICU was 17 days (3-51). The main diagnostics for ICU admission were: acute spinal cord injury (SCI) (30%), stroke (26.6%) and head injury (23.3%). Of all the patients enrolled, 26 (87.7%) received TP treatment. Of the patients who used mechanical TP (43.75%), 96.6% used intermittent pneumatic compression (IPC) and 3.3% used graduated compression stockings (GCS). The mean time to start treatment (MTS) was 1.7 days, and the mean treatment period (MTP) was 12.3 days. Of the patients treated with LMWH (always according to renal function) (84.3%): • 50% received both, first mechanical and then pharmacologic TP, with a MTS of 13.7 days and a MTP of 11.9 days. • 50% received LMWH as a first line treatment, with a MTS of 5.4 days and a MTP of 8.7 days. The main diagnostics for unsafe LMWH treatment and prolonged mechanical measures were: head injury (30.8%) and stroke (38.5%). Of all the patients, only 4 (13.3%) did not receive any TP treatment during their stay in ICU. During the study period, any occurrences of VTE were recorded but we do not know if any events occurred after the patients were discharged. Conclusions Overall, patients in this study received a high level of VTE prophylaxis (87.7%) Our ICU adheres appropriately to the hospital's guidelines for the prevention of VTE. A high percentage of the patients initially received mechanical TP on the first or second day, and started late treatment with LMWH because of the high risk of bleeding. However we believe that there was a small number of patients who should have started the TP treatment earlier, and we should evaluate the cause in order to influence policy and propose strategies for improvement. Including a pharmacist in the multidisciplinary team of critical care practitioners in the ICU is necessary to optimise treatments. AD - L. Mestre Galofré, Hospital Vall D'Hebron, Pharmacy, Barcelona, Spain AU - Mestre Galofré, L. AU - Lalueza Broto, P. AU - Robles González, A. AU - Báguena Martínez, M. DB - Embase DO - 10.1136/ejhpharm-2013-000436.411 KW - hemoglobin low molecular weight heparin adult anemia bleeding cerebrovascular accident clinical article clinical trial compression stocking congenital malformation consensus development controlled study critical illness critically ill patient diagnosis drug therapy female head injury human intensive care unit kidney function length of stay male partial thromboplastin time pharmacist physician prevention prophylaxis prothrombin time spinal cord injury platelet count venous thromboembolism LA - English M3 - Conference Abstract N1 - L611784679 2016-08-29 PY - 2014 SN - 2047-9964 SP - A168 ST - Use of venous thromboprophylaxis in critical illness in a traumatic intensive care unit (ICU) T2 - European Journal of Hospital Pharmacy TI - Use of venous thromboprophylaxis in critical illness in a traumatic intensive care unit (ICU) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L611784679&from=export http://dx.doi.org/10.1136/ejhpharm-2013-000436.411 VL - 21 ID - 761122 ER - TY - JOUR AB - Background: Building on results from the Quality in Acute Stroke Trial, this NHMRC-funded trial will rigorously implement and evaluate initiatives to improve triage, treatment and transfer of patients with stroke in Emergency Departments (EDs) in three Australian states. Aims: To evaluate a nurse-initiated multidisciplinary organisational intervention to improve the Triage, Treatment and Transfer of stroke patients in Emergency Departments (ED) Methods: Design: cluster randomised control trial Hospitals in ACT, NSW, QLD and VIC with Emergency departments, pre-existing stroke units and who currently perform thrombolysis will be randomised to receive either usual care or the T3 Intervention comprising: Ë Triage: Rapid triage Ë Treatment: Thrombolysis where appropriate; fever, hyperglycaemia and swallowing management Ë Transfer: Collaboration between ED and stroke unit staff for rapid transfer from ED to stroke units The intervention will consist of multidisciplinary team building workshops, an interactive education program and sustained engagement of ED and stroke unit champions to embed collaborations. Our primary outcome is 90-day death and dependency (modified Rankin Score). We also will measure functional dependency (Barthel Index); Health Status (SF-36) and undertake medical record audits to examine quality of care outcomes and implementation efficacy. Results: An intention-to-treat analysis will be conducted adjusting for clustering. A separate process analysis will examine contextual factors that may influence successful intervention uptake. Conclusion: We will provide evidence for the effectiveness of a behaviour change intervention in EDs to improve stroke outcomes. To improve the 'whole pathway' in stroke, care between EDs and stroke units must be more collaborative and evidence-based. AD - S. Middleton, National Centre for Clinical Outcomes Research, Australian Catholic University, Australia AU - Middleton, S. AU - Levi, C. AU - D'Este, C. AU - Grimshaw, J. AU - Cadilhac, D. AU - Considine, J. AU - Cheung, W. AU - McInnes, L. AU - Dale, S. AU - Gerraty, R. AU - Fitzgerald, M. AU - Cadigan, G. AU - Denisenko, S. AU - Longworth, M. AU - McElduff, P. AU - Quinn, C. DB - Embase DO - 10.1111/ijs.12172 KW - cerebrovascular accident patient human nursing emergency ward health emergency health service stroke unit blood clot lysis Barthel index health status death fever hospital team building intention to treat analysis workshop education program stroke patient swallowing clinical audit hyperglycemia medical record nurse behavior change evidence based practice LA - English M3 - Conference Abstract N1 - L71227177 2013-11-20 PY - 2013 SN - 1747-4930 SP - 18 ST - T3 stroke trial protocol: Triage, treatment and transfer of patients with stroke emergency departments T2 - International Journal of Stroke TI - T3 stroke trial protocol: Triage, treatment and transfer of patients with stroke emergency departments UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71227177&from=export http://dx.doi.org/10.1111/ijs.12172 VL - 8 ID - 761156 ER - TY - JOUR AB - Background: The QASC trial showed significant benefits for patients cared for in stroke units who received assistance to implement evidence-based treatment protocols to manage fever, hyperglycaemia and swallowing. Building on these results, this NHMRC-funded trial will rigorously implement and evaluate initiatives to improve triage, treatment and transfer of stroke patients in Emergency Departments (EDs). Methods: Design: cluster randomised control trial. EDs at 26 hospitals in three Australian states will be randomised to receive either usual care or the T3 intervention comprising: rapid Triage; Treatment with thrombolysis where appropriate, fever, hyperglycaemia and swallowing management; rapid Transfer from ED to stroke units. The intervention will consist of: multidisciplinary team building workshops; interactive education program; and sustained engagement of ED and stroke unit champions to embed collaborations. Our primary outcome is 90-day death and dependency (modified Rankin Score). We also will measure functional dependency (Barthel Index); Health Status (SF-36) and undertake medical record audits to examine quality of care outcomes and implementation efficacy. Results: A between-group, intention-to-treat analysis will be conducted adjusting for clustering. A separate process analysis will examine contextual factors that may influence successful intervention uptake. Conclusion: We will provide evidence for the effectiveness of a behaviour change intervention in emergency departments to improve stroke outcomes. Stroke is common and its costs large if not treated according to evidence-based guidelines during all phases of hospital admission. To improve the 'whole pathway' in stroke, care between EDs and stroke units must be more collaborative and evidence-based. AD - S. Middleton, National Centre for Clinical Outcomes Research, Australian Catholic University, Sydney, NSW, Australia AU - Middleton, S. AU - Levi, C. R. AU - D'Este, C. AU - Grimshaw, J. AU - Cadilhac, D. A. AU - Considine, J. AU - Cheung, W. AU - McInnes, L. AU - Dale, S. AU - Gerraty, R. P. AU - Fitzgerald, M. DB - Embase DO - 10.1111/ijs.12141 KW - cerebrovascular accident human stroke patient society Australia emergency health service stroke unit evidence based practice hyperglycemia emergency ward swallowing fever medical record blood clot lysis health status Barthel index hospital hospital admission behavior change death clinical audit education program workshop intention to treat analysis team building patient LA - English M3 - Conference Abstract N1 - L71565038 2014-08-21 PY - 2013 SN - 1747-4930 SP - 10 ST - T3 Trial protocol: A CRCT evaluating an organisational intervention to improve triage, treatment and transfer of stroke patients in EDs T2 - International Journal of Stroke TI - T3 Trial protocol: A CRCT evaluating an organisational intervention to improve triage, treatment and transfer of stroke patients in EDs UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71565038&from=export http://dx.doi.org/10.1111/ijs.12141 VL - 8 ID - 761157 ER - TY - JOUR AB - Background: Because HCC usually occurs in the presence of liver disease, patient (pt) evaluation and treatment are complex and require multidisciplinary care. Tumor staging and liver function scoring systems facilitate HCC research and treatment. However, specialists have varied training in these systems. We evaluated specialty-specific reporting of HCC-related staging/scoring data. Methods: GIDEON is a global, prospective, non-interventional study to evaluate sorafenib (SOR) in HCC under real-life practice conditions. Pts with unresectable HCC who were candidates for systemic therapy and for whom a decision was made to treat with SOR were eligible. Frequency of recorded Child-Pugh (CP); Barcelona Clinic Liver Cancer (BCLC); Cancer of the Liver Italian Program (CLIP); Tumor, Nodes, Metastasis (TNM); and calculated Model for End-stage Liver Disease (MELD) data were analyzed by physician specialty. Results are descriptive. Results: In the safety population (n=563), 299 pts (41%) were enrolled by medical oncology (MO), 228 (40%) by hepatology/gastroenterology (H/G), and 39 (5%) by other (23 by surgeons; 7 by interventional radiologists). 89% were treated by a multidisciplinary team. MO pts were twice as likely as H/G pts to be not evaluable (NE) for CP (table). Unknown international normalized ratio (INR) was the primary reason CP was NE. MO and H/G pts had similar % NE for BCLC stage. H/G pts were more likely to have ECOG performance status (PS) not recorded. MO pts were less likely to have CLIP or MELD data, while H/G pts were less likely to have TNM data. Portal vein thrombosis (PVT) and alpha-fetoprotein (AFP) were unknown in 17% overall. Conclusions: The elements of HCC staging systems represent factors that may influence patient management. Lack of complete data in up to 44% of pts, despite registry enrollment requiring data collection, suggests clinicians may be missing important information and the prevalence of clinicians using comprehensive HCC staging systems is variable. (Table presented). AD - R.A. Miksad AU - Miksad, R. A. AU - Lee Cohn, A. AU - El-Khoueiry, A. B. AU - Geschwind, J. F. AU - Gholam, P. M. AU - Goldenberg, A. AU - Mantry, P. AU - Martin, R. C. G. AU - McGuire, B. AU - Piperdi, B. AU - Sanyal, A. J. AU - Imperial, J. AU - Venook, A. P. DB - Embase KW - sorafenib alpha fetoprotein scoring system liver cell carcinoma United States register digestive system cancer staging human neoplasm cancer staging liver function liver cancer liver metastasis medical specialist intervention study radiologist information processing prevalence hospital child model end stage liver disease physician safety population oncology surgeon patient international normalized ratio portal vein thrombosis systemic therapy patient care liver disease electrocorticography L1 - http://meeting.ascopubs.org/cgi/content/abstract/32/3_suppl/323?sid=b2e14bc4-3de9-46cd-8373-1cf8057175bf LA - English M1 - 3 M3 - Conference Abstract N1 - L71324547 2014-02-21 PY - 2014 SN - 0732-183X ST - Use of staging and scoring systems in hepatocellular carcinoma (HCC): Lessons from U.S. Regional analysis of the GIDEON registry T2 - Journal of Clinical Oncology TI - Use of staging and scoring systems in hepatocellular carcinoma (HCC): Lessons from U.S. Regional analysis of the GIDEON registry UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71324547&from=export VL - 32 ID - 761130 ER - TY - JOUR AB - The SITS (Safe Implementation of Thrombolysis in Stroke)-EAST project was launched in 2007 to support evidence-based stroke treatments, including thrombolytic treatments (TLTs), in Central and Eastern Europe. The aim of this study was to detail the topography, efficacy, and specific characteristics of stroke centers in the Czech Republic (CZ), the country with the highest rate of TLT. The nationwide study was performed between September and November 2007 through a questionnaire sent to all centers registered in SITS. The questionnaire contained 25 questions addressing how centers met recommendations for primary and comprehensive stroke centers in 2006. Center characteristics predicting the number of TLTs were identified by multiple regression analysis. Altogether, data were obtained from 42 centers (88% response rate) with the following characteristics [median (min-max)]: catchment area population 150,000 (90,000-750,000); number of strokes/year 420 (150-1,589); number of TLTs 7.5 (2-45); number of physicians specialized in stroke 3 (1-7). Centers treated 4.3% of the patients with ischemic strokes with tissue plasminogen activator. A stroke unit was present in 32 (78%) departments. Rescue interventional therapies were performed in 11 (26%). Financial problems restricted TLT in 14 (35%) centers. Fourteen factors were associated with the number of TLTs in univariate regression analysis, but in multiple regression analysis, only the catchment area population (p < 0.001), > 3 physicians specialized in stroke (p < 0.001), and the presence of an acute interventional program (p < 0.006) remained significant. This study provides the fundamental stroke treatment network data that are essential for certification and further SITS-EAST TLT expansion. AD - [Mikulik, Robert] Masaryk Univ, Dept Neurol, St Annes Univ Hosp, Brno 65691, Czech Republic. [Vaclavik, Daniel] Vitkovice Hosp, Dept Neurol, Ostrava 70384, Czech Republic. [Sanak, Daniel] Palacky Univ Hosp, Dept Neurol, Olomouc 77520, Czech Republic. [Bar, Michal] Univ Ostrava, Dept Neurol, Univ Hosp, Ostrava 70852, Czech Republic. [Bar, Michal] Univ Ostrava, Med Social Fac, Ostrava 70852, Czech Republic. [Sevcik, Pavel] Charles Univ Prague, Dept Neurol, Univ Hosp Pilsen, Plzen 30460, Czech Republic. [Kalita, Zbynek] Tomas Bata Hosp, Dept Neurol, Zlin 76275, Czech Republic. [Wahlgren, Nils] Karolinska Univ Hosp, Karolinska Inst, Dept Neurol, S-17176 Stockholm, Sweden. Mikulik, R (corresponding author), Masaryk Univ, Dept Neurol, St Annes Univ Hosp, Pekarska 53, Brno 65691, Czech Republic. mikulik@hotmail.com; daniel.vaclavik@nemvitkovice.cz; daniel.sanak@fnol.cz; michal.bar@fno.cz; sevcik@fnplzen.cz; kalita@bnzlin.cz; nils.wahlgren@karolinska.se AN - WOS:000273033900005 AU - Mikulik, R. AU - Vaclavik, D. AU - Sanak, D. AU - Bar, M. AU - Sevcik, P. AU - Kalita, Z. AU - Wahlgren, N. DA - Jan DO - 10.1007/s00415-009-5259-3 J2 - J. Neurol. KW - Stroke units Thrombolysis rtPA Acute stroke therapy Stroke facilities Stroke teams Treatment TISSUE-PLASMINOGEN ACTIVATOR ACUTE ISCHEMIC-STROKE CENTERS CARE Clinical Neurology LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 536GW Times Cited: 14 Cited Reference Count: 17 Mikulik, Robert Vaclavik, Daniel Sanak, Daniel Bar, Michal Sevcik, Pavel Kalita, Zbynek Wahlgren, Nils Bar, Michal/I-4516-2017 Bar, Michal/0000-0002-5049-5844 European Union Public Health Executive Agency (EAHC); [IGA MH CR NS10100-4/2008] This study was supported by a grant from the European Union Public Health Executive Agency (EAHC) and from IGA MH CR NS10100-4/2008. Nils Wahlgren has received expenses from Boehringer Ingelheim for his role as member of the Steering Committee in relation to the ECASS III trial with alteplase, and has served as a consultant to Thrombogenics as chairman of the DSMB. SITS International (chaired by Nils Wahlgren) received a grant from Boehringer Ingelheim for the SITS-MOST/SITS-ISTR study with alteplase. His institution has also received grant support towards administrative expenses for coordination of the ECASS III trial. Nils Wahlgren has also received lecture fees from Boehringer Ingelheim and from Ferrer. Robert Mikulik received lecture fees from Boehringer Ingelheim. 14 0 4 SPRINGER HEIDELBERG HEIDELBERG J NEUROL PY - 2010 SN - 0340-5354 SP - 31-37 ST - A nationwide study on topography and efficacy of the stroke treatment network in the Czech republic T2 - Journal of Neurology TI - A nationwide study on topography and efficacy of the stroke treatment network in the Czech republic UR - ://WOS:000273033900005 VL - 257 ID - 761883 ER - TY - JOUR AB - BACKGROUND: The Accreditation Council for Graduate Medical Education requires residents to be trained in practice-based learning and improvement as well as systems-based practice. In an effort to establish a formal curriculum for graduate medical education, a Performance Improvement (PI) Training Program was initiated at Memorial University Medical Center. Training for the chief residents across all residency programs focused on the basic Six Sigma framework. Chief residents chose faculty sponsors and were also mentored by Six Sigma-trained staff. Faculty and physicians who participated in the initiative received PI/Continuing Medical Education credit. METHODS: A total of 17 presurveys and postsurveys were completed on 7 outcome measures. Nonparametric Wilcoxon signed rank 2-tailed tests were performed to test for significant change from presurvey to postsurvey. RESULTS: Analysis of the 2-year data (2009-2011) found statistically significant improvement for all 7 outcome measures. The surgical residents' PI Project for 2011 included the development of the Venous Thromboembolism Reassessment Tool. The project included a multidisciplinary team to develop a computer prompt that continued to trigger if the physician launched the prophylaxis or treatment form without ordering anticoagulation. The new prompt resulted in a 391% increase in anticoagulant orders. CONCLUSIONS: This study demonstrated that the resident-based PI Training Program was innovative, practical, and comprehensive. Education, tools, and skill development were provided on quality and PI theory and practice for resident physicians in support of the Accreditation Council for Graduate Medical Education core competencies of professionalism, practice-based learning and improvement, and systems-based practice. AD - Department of Surgery, Mercer University School of Medicine, Savannah Campus, Memorial University Medical Center, Savannah, Georgia. AN - 24209652 AU - Miller, N. AU - MacNew, H. AU - Nester, J. AU - Wiggins, J. B. AU - Shealy, C. AU - Senkowski, C. DA - Nov-Dec DO - 10.1016/j.jsurg.2013.06.016 DP - NLM ET - 2013/11/12 J2 - Journal of surgical education KW - Academic Medical Centers Accreditation/standards Adult *Clinical Competence Cross-Sectional Studies Education, Medical, Graduate/*standards Female General Surgery/*education/standards Hospitals, University Humans Internship and Residency/standards Male *Practice Guidelines as Topic Problem-Based Learning/standards Quality Improvement Societies, Medical/standards United States PI/CME credit Practice-Based Learning and Improvement Professionalism Six Sigma Systems-Based Practice leadership performance improvement quality surgery resident LA - eng M1 - 6 N1 - 1878-7452 Miller, Nessa MacNew, Heather Nester, Jane Wiggins, Jean B Shealy, Cynthia Senkowski, Christopher Journal Article Review United States J Surg Educ. 2013 Nov-Dec;70(6):758-68. doi: 10.1016/j.jsurg.2013.06.016. Epub 2013 Sep 13. PY - 2013 SN - 1878-7452 SP - 758-68 ST - Jump starting a quality and performance improvement initiative to meet the updated ACGME guidelines T2 - J Surg Educ TI - Jump starting a quality and performance improvement initiative to meet the updated ACGME guidelines VL - 70 ID - 760395 ER - TY - JOUR AB - Learning Objectives: Daily goals tools (DGT) are team communication aids that facilitate evidence-based quality and safety practices (QSP), and are associated with reductions in hospital acquired complications. However, their effectiveness is dependent upon implementation fidelity and adherence to process measures. We implemented a DGT utilizing standard workflows and closedloop communication strategies to promote consistent team discussion of QSPs during daily rounds in a Neurosciences Intensive Care Unit. Methods: An interprofessional team was convened to develop a DGT incorporating national, institutional and unit-specific QSPs. We defined team member roles and standardized workflows, and emphasized closed-loop communication across disciplines during rounds. Using iterative plan-do-study-act cycles, the DGT was adapted to fit with existent care processes. ICU staff were surveyed at baseline and 16 months post-intervention to assess perceived daily discussion of QSPs. DGTs were collected for 10 months and analyzed for QSP documentation; monthly performance feedback was disseminated to frontline staff. Results: Surveys were completed by 61 (85%) staff at baseline and 54 (77%) post-intervention. At baseline, less than 50% of staff reported that the majority of QSPs were always discussed during rounds. Post-intervention, there was significant improvement in perceived team discussion of QSPs, with > 95% of staff reporting that the following QSPs were always addressed: mobility goal, sedation, pain, ventilator wean, urinary catheter and central line removal, code status and DVT prophylaxis (Chi-square 16.4-68.9; p < .001). DGT audits spanning 4088 patient days demonstrated an average overall DGT completion of 82%. Notably, all key QSPs had a documented daily team discussion of > 90%. DGT user experience was favorable, with > 70% of staff reporting that it was very effective in ensuring team communication, patient care safety and quality. Conclusions: High fidelity implementation of a DGT and consistent adherence to discussion of key QSPs was achieved through interprofessional team engagement, standardized workflows and closed-loop communication during daily rounds. Future work will focus on using DGTs to improve engagement with patients and families. AD - S. Miller, University of North Carolina School of Medicine, Chapel Hill, NC, United States AU - Miller, S. AU - Tan, E. AU - Olm-Shipman, C. DB - Embase DO - 10.1097/01.ccm.0000529207.03214.ec KW - adult central venous catheter documentation female human major clinical study male pain patient care prophylaxis sedation staff urinary catheter ventilator weaning workflow LA - English M3 - Conference Abstract N1 - L620079437 2018-01-09 PY - 2018 SN - 1530-0293 SP - 585 ST - Implementation of a daily goals tool improves team discussion of quality and safety practices T2 - Critical Care Medicine TI - Implementation of a daily goals tool improves team discussion of quality and safety practices UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620079437&from=export http://dx.doi.org/10.1097/01.ccm.0000529207.03214.ec VL - 46 ID - 760858 ER - TY - JOUR AB - Objective: The Broselow Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL) (BT) is a well-established length-based tool for estimation of body weight for children during resuscitation. In view of pandemic childhood obesity, the BT may no longer accurately estimate weight. We therefore studied the BT in children from Ontario in a large recent patient cohort. Methods: Actual height and weight were obtained from an urban and a rural setting. Children were prospectively recruited between April 2007 and July 2008 from the emergency department and outpatient clinics at the London Health Science Centre. Rural children from junior kindergarten to grade 4 were also recruited in the spring of 2008 from the Avon Maitland District School Board. Data for preschool children were obtained from three daycare centres and the electronic medical record from the Maitland Valley Medical Centre. The predicted weight from the BT was compared to the actual weight using Spearman rank correlation; agreement and percent error (PE) were also calculated. Results: A total of 6,361 children (46.2% female) were included in the study. The median age was 3.9 years (interquartile range [IQR] 1.56-7.67 years), weight was 17.2 kg (IQR 11.6-25.4 kg), and height was 103.5 cm (IQR 82-124.4 cm). Although the BT weight estimate correlated with the actual weight (r = 0.95577, p < 0.0001), the BT underestimated the actual weight by 1.62 kg (7.1% ± 16.9% SD, 95% CI -26.0-40.2). The BT had an ≥ 10% PE 43.7% of the time. Conclusions: Although the BT remains an effective method for estimating pediatric weight, it was not accurate and tended to underestimate the weight of Ontario children. Until more accurate measurement tools for emergency departments are developed, physicians should be aware of this discrepancy. Objectif: L'échelle de Broselow (Broselow Tape [BT]) est un outil reconnu qui sert à estimer le poids d'un enfant en fonction de sa taille lors d'une réanimation. Compte tenu de la pandémie d'obésité infantile, l'échelle de Broselow pourrait ne plus estimer le poids de façon précise. Nous avons donc étudié l'échelle de Broselow chez l'enfant, en Ontario, dans une importante cohorte récente de patients. Méthodes: Les tailles et poids actuels ont été recueillis dans une zone urbaine et une zone rurale. Les enfants ont été recrutés de façon prospective entre avril 2007 et juillet 2008, à partir du service d'urgence et des cliniques de consultation externe du London Health Sciences Centre. Au printemps 2008, des enfants de régions rurales fréquentant les classes de prématernelle à la 4e année de la Avon Maitland District School Board ont également été recrutés. Les données des enfants d'âge préscolaire ont été obtenues de trois garderies et à partir des dossiers médicaux électroniques du Maitland Valley Medical Centre. Le poids estimé selon l'échelle de Broselow a été comparé au poids réel au moyen de la corrélation de rangs de Spearman; la concordance et le pourcentage d'erreur (PE) ont aussi été calculés. Résultats: Un total de 6,361 enfants (46,2 % de filles) ont été inclus dans l'étude. L'âge médian était de 3,9 ans (écart interquartile [EIQ] 1,56 à 7,67 ans), le poids median de 17,2 kg (EIQ de 11,6 à 25,4 kg), et la taille médiane de 103,5 cm (EIQ de 82 à 124,4 cm). Bien que les poids estimés à l'aide de l'échelle de Broselow aient été corrélés avec les poids réels (r = 0,95577, p < 0,0001), l'échelle de Broselow a sous-estimé le poids réel de 1,62 kg (7,1 % 16,9 % écart-type, IC à 95 %: 26,0 à 40,2). L'échelle de Broselow avait un ≥ 10 % PE 43,7 % du temps. Conclusions: Bien que l'échelle de Broselow reste une méthode efficace d'estimation du poids en pédiatrie, elle ne s'est pas montrée exacte et tend à sous-estimer le poids des enfants en Ontario. Tant que l'on n'aura pas développé d'outil de mesure plus précis pour les services d'urgence, les médecins doivent être conscients de cette divergence. AD - Division of Emergency Medicine, University of Western Ontario, London, ON 3Department of Pediatrics, University of Western Ontario, London, ON 4Faculty of Medicine, University of Ottawa, Ottawa, ON Maitland Valley Medical Centre, Goderich, ON AN - 108355455. Language: English. Entry Date: 20161101. Revision Date: 20190612. Publication Type: Article AU - Milne, William Ken AU - Yasin, Abeer AU - Knight, Janine AU - Noel, Daniel AU - Lubell, Richard AU - Filler, Guido DB - CINAHL DO - 10.2310/8000.2011.110523 DP - EBSCOhost KW - Broselow Pediatric Emergency Tape -- Utilization Resuscitation -- Methods Obesity -- Epidemiology Pediatrics Human Prospective Studies Body Weight Academic Medical Centers Ontario Child, Preschool Child Electronic Health Records Spearman's Rank Correlation Coefficient Female Male Descriptive Statistics Infant M1 - Supp 1 N1 - research; tables/charts. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 100893237. PY - 2012 SN - 1481-8035 SP - 25-30 ST - Ontario children have outgrown the Broselow tape T2 - CJEM: Canadian Journal of Emergency Medicine TI - Ontario children have outgrown the Broselow tape UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=108355455&site=ehost-live&scope=site VL - 14 ID - 761356 ER - TY - JOUR AB - BACKGROUND: Northwestern Memorial Hospital (NMH) was historically a poor performer on the venous thromboembolism (VTE) outcome measure. As this measure has been shown to be flawed by surveillance bias, NMH embraced process-of-care measures to ensure appropriate VTE prophylaxis to assess healthcare-associated VTE prevention efforts. OBJECTIVE: To evaluate the impact of an institution-wide project aimed at improving hospital performance on VTE prophylaxis measures. DESIGN: A retrospective observational study. SETTING: NMH, an 885-bed academic medical center in Chicago, Illinois PATIENTS: Inpatients admitted to NMH from January 1, 2013 to May 1, 2013 and from October 1, 2014 to April 1, 2015 were eligible for evaluation. INTERVENTION: Using the define-measure-analyze-improve-control (DMAIC) process-improvement methodology, a multidisciplinary team implemented and iteratively improved 15 data-driven interventions in 4 broad areas: (1) electronic medical record (EMR) alerts, (2) education initiatives, (3) new EMR order sets, and (4) other EMR changes. MEASUREMENTS: The Joint Commission's 6 core measures and the Surgical Care Improvement Project (SCIP) SCIP-VTE-2 measure. RESULTS: Based on 3103 observations (1679 from January 1, 2013 to May 1, 2013, and 1424 from October 1, 2014 to April 1, 2015), performance on the core measures improved. Performance on measure 1 (chemoprophylaxis) improved from 82.5% to 90.2% on medicine services, and from 94.4% to 97.6% on surgical services. The largest improvements were seen in measure 4 (platelet monitoring), with a performance increase from 76.7% adherence to 100%, and measure 5 (warfarin discharge instructions), with a performance increase from 27.4% to 88.8%. CONCLUSION: A systematic hospital-wide DMAIC project improved VTE prophylaxis measure performance. Sustained performance has been observed, and novel control mechanisms for continued performance surveillance have been embedded in the hospital system. Journal of Hospital Medicine 2016;11:S29-S37. © 2016 Society of Hospital Medicine. AD - Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University and Northwestern Memorial Hospital, Chicago, Illinois. Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Northwestern Memorial Hospital, Chicago, Illinois. Division of Hospital Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. AN - 27925424 AU - Minami, C. A. AU - Yang, A. D. AU - Ju, M. AU - Culver, E. AU - Seifert, K. AU - Kreutzer, L. AU - Halverson, T. AU - O'Leary, K. J. AU - Bilimoria, K. Y. DA - Dec DO - 10.1002/jhm.2663 DP - NLM ET - 2016/12/08 J2 - Journal of hospital medicine KW - Academic Medical Centers Anticoagulants/therapeutic use Chicago Hospitalization Humans Male Process Assessment, Health Care/*methods *Quality Improvement Retrospective Studies Venous Thromboembolism/*prevention & control LA - eng N1 - 1553-5606 Minami, Christina A Yang, Anthony D Ju, Mila Culver, Eckford Seifert, Kathryn Kreutzer, Lindsey Halverson, Terri O'Leary, Kevin J Bilimoria, Karl Y Evaluation Study Journal Article United States J Hosp Med. 2016 Dec;11 Suppl 2:S29-S37. doi: 10.1002/jhm.2663. PY - 2016 SN - 1553-5592 SP - S29-s37 ST - Evaluation of an institutional project to improve venous thromboembolism prevention T2 - J Hosp Med TI - Evaluation of an institutional project to improve venous thromboembolism prevention VL - 11 Suppl 2 ID - 760217 ER - TY - JOUR AB - PMID:32979557 AU - Mishkin, Aaron DA - 2020/10/05 10/05 DB - PubMed Central DO - 10.1016/j.jvsv.2020.09.006 PY - 2020 SN - 2213-333X ST - Incidence of venous thromboembolism in coronavirus disease 2019: An experience from a single large academic center T2 - Journal of Vascular Surgery. Venous and Lymphatic Disorders TI - Incidence of venous thromboembolism in coronavirus disease 2019: An experience from a single large academic center UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7535542 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7535542&rendertype=abstract ID - 762014 ER - TY - JOUR AB - BACKGROUND: Acute venous thromboembolism (VTE) is prevalent, expensive, and deadly. Published data at our institution identified significant VTE care variation based on payer source. We developed a VTE clinical pathway to standardize care, decrease hospital utilization, provide education, and mitigate disparities. METHODS: Target population for our interdisciplinary pathway was acute medical VTE patients. The intervention included order sets, system-wide education, follow-up phone calls, and coordinated posthospital care. Study data (n = 241) were compared to historical data (n = 234), evaluating outcomes of hospital admission, length of stay (LOS), and reutilization, stratified by payer source. RESULTS: A total of 241 patients entered the VTE clinical care pathway: 107 with deep venous thrombosis (44.4%) and 134 with a pulmonary embolism (55.6%). Within the pathway, uninsured VTE patients were admitted at a lower rate than insured patients (65.9 vs 79.1%; P = 0.032). LOS decreased from 4.4 to 3.1 days (P < 0.001) for admitted VTE patients and from 5.9 to 3.1 days among uninsured patients (P = 0.0006). Overall, 30-day emergency department recidivism remained 11%, but declined (17.9% to 13.6%) among uninsured patients (P = 0.593). Fewer pathway patients (5.8%) were readmitted compared to historical patients (9.4%, P = 0.254). Individual cost of care decreased from $7610 to $5295 (P < 0.005) for any VTE patient, and from $9953 to $4304 (P = 0.001) per uninsured patient. CONCLUSIONS: Implementing an interdisciplinary, clinical pathway standardized care for VTE patients and dramatically reduced hospital utilization and cost, particularly among uninsured patients. Results of this novel study demonstrate a model for improving transitional care coordination with local community health clinics and delivering care to vulnerable populations. Other disease populations may benefit from the development of a similar model. AD - Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado. AN - 24639293 AU - Misky, G. J. AU - Carlson, T. AU - Thompson, E. AU - Trujillo, T. AU - Nordenholz, K. DA - Jul DO - 10.1002/jhm.2186 DP - NLM ET - 2014/03/19 J2 - Journal of hospital medicine KW - Acute Disease Adult Aged Cohort Studies Female Healthcare Disparities/economics/*trends Humans Male Middle Aged *Patient Acceptance of Health Care Patient Care Team/economics/*trends Venous Thromboembolism/diagnosis/economics/*therapy LA - eng M1 - 7 N1 - 1553-5606 Misky, Gregory J Carlson, Todd Thompson, Elaina Trujillo, Toby Nordenholz, Kristen Journal Article Research Support, Non-U.S. Gov't United States J Hosp Med. 2014 Jul;9(7):430-5. doi: 10.1002/jhm.2186. Epub 2014 Mar 18. PY - 2014 SN - 1553-5592 SP - 430-5 ST - Implementation of an acute venous thromboembolism clinical pathway reduces healthcare utilization and mitigates health disparities T2 - J Hosp Med TI - Implementation of an acute venous thromboembolism clinical pathway reduces healthcare utilization and mitigates health disparities VL - 9 ID - 760302 ER - TY - JOUR AB - Purpose - The purpose of this paper is to examine the impact of transformational leadership (TL) on building trust and hence, its influence on the commitment level of the employees to achieve the desired work outcomes. It also examined whether transformational leaders were able to psychologically empower employees so as to increase their commitment level and thus reduce the employee turnover intentions (TIs) in the small-and medium-sized (SME) IT companies operating in Delhi NCR, India. Design/methodology/approach - Data were collected from 420 employees (168 females and 252 males) of SME IT companies operational in Delhi NCR, India. They responded to questions about their leader's TL and their own psychological empowerment (PE), commitment and trust. Findings - The findings of the study show that transformational leaders were able to create a higher level of PE and trust amongst their employees. Further, it was also found that this led to an increase in their commitment level and hence, a decrease in their TI. The findings of the study also suggest that trust, commitment and PE act as mediators. Research limitations/implications - Limited sample size is a possible limitation of the study. One more limitation of the study is the data collection method, i.e. through survey. It was self-reported, taking only the perspective of the employees; it may not be a completely accurate response. Practical implications - With TL, leaders can psychologically empower followers to do things in a better way and can develop trust in employees resulting in high commitment; highly committed employees in turn reduce the TIs. If followers do not have faith in their own capability, it may not be possible for them to complete their job effectively. Originality/value - This study adds to the existing literature; it clarifies the process by which transformational leaders enhance followers' meaning in life through PE and develop trust resulting in high commitment. AD - [Mittal, Swati] Indian Inst Technol, Dept Management Studies, Roorkee, Uttar Pradesh, India. Mittal, S (corresponding author), Indian Inst Technol, Dept Management Studies, Roorkee, Uttar Pradesh, India. swatimittal96@gmail.com AN - WOS:000387083500005 AU - Mittal, S. DO - 10.1108/ijm-10-2014-0202 J2 - Int. J. Manpow. KW - Employee behaviour Human resource management Organizational Employees Small- to medium-sized enterprises Leaders Employee turnover ORGANIZATIONAL CITIZENSHIP BEHAVIOR MEDIATING ROLE NORMATIVE COMMITMENT PSYCHOLOGICAL EMPOWERMENT TRANSACTIONAL LEADERSHIP INFORMATION-TECHNOLOGY EMPLOYEE TURNOVER TEAM EMPOWERMENT MODERATING ROLE TRUST Industrial Relations & Labor Management LA - English M1 - 8 M3 - Article N1 - ISI Document Delivery No.: EB1CH Times Cited: 2 Cited Reference Count: 97 Mittal, Swati 2 1 39 EMERALD GROUP PUBLISHING LTD BINGLEY INT J MANPOWER PY - 2016 SN - 0143-7720 SP - 1322-1346 ST - Effects of transformational leadership on turnover intentions in IT SMEs T2 - International Journal of Manpower TI - Effects of transformational leadership on turnover intentions in IT SMEs UR - ://WOS:000387083500005 VL - 37 ID - 761726 ER - TY - JOUR AB - Between vascular complications in neonatal period, arterial events count about half of all vascular events. Diagnosing and treating them is a challenging question, because literature is limited to case reports. The clinical picture is in relation with the location and the grade of occlusion and may vary from no/ discrete symptoms, to limb or life threatening. Intrauterine limb ischemia can be provoked by an external compression or thromboembolism. After birth, limb ischemia can be secondary to sepsis, coagulation disorders or intravascular devices (almost 90% of thromboembolic events are caused by intravascular devices). In their first day of life, neonates are even more prone to thromboembolic events, because of the high values of their hematocrit and because of the tendency to contract their intravascular volume. Additional risk could be maternal diabetes, asphyxia at birth, dehydration and congenital thrombophilia. Peripheral artery occlusion is suspected when we have to deal with a cold, pulse less, discolored limb. Sign of occlusion of the artery of the limb are evident at imaging explorations: Doppler ultrasonography, MRI angiography. A multidisciplinary team should establish the best treatment for the affected newborns. The individual risk and benefit have to be carefully considered when deciding the medical and/ or surgical treatment. The main benefit of medical treatment is the repermeabilisation of the obstructed vessel. The major potential risk is a hemorrhagic event (intracranial hemorrhage). If the medical management fails to improve the perfusion of the limb, operative management should be considered. Surgical treatment should be applied when medical management has failed or if the risk for bleeding because of the thrombolysis is high. Amputation, if decided, should be delayed for as long as possible, until the line of the necrosis is definitive. We present now the case of a newborn male baby delivered by C section at 37 weeks of gestation, 4700 grams and good Apgar score, who had severe clinical signs of arterial occlusion of his left popliteal artery and signs of occlusion at Doppler ultrasonography and MRI angiography. The analysis of the well-known genetic mutations associated with increased thrombotic potential where positive for Factor V H1299R, for MTHFR C677T, for PAI-1 4G/5G and for Factor XIII V34L. Despite the medical conservatory treatment, the limb perfusion did not improve, a thrombectomy was proceed, but the evolution was with necrosis of the limb, so the amputation was necessary in his 6-th day of life. AD - D. Mocuta, University of Oradea, Faculty of Medicine and Pharmacy, Romania AU - Mocuta, D. AU - Aur, C. AU - Filip, V. DB - Embase DO - 10.1515/jpm-2015-2003 KW - blood clotting factor 5 blood clotting factor 13 perinatal care peripheral occlusive artery disease limb risk occlusion thromboembolism newborn amputation magnetic resonance angiography surgery necrosis disease management Doppler flowmetry limb ischemia devices dehydration asphyxia sepsis maternal diabetes mellitus bleeding male Apgar score thrombophilia brain hemorrhage case report newborn period therapy hematocrit compression human nuclear magnetic resonance imaging imaging blood clotting disorder pulse rate perfusion blood clot lysis popliteal artery baby pregnancy artery occlusion mutation limb perfusion thrombectomy artery LA - English M3 - Conference Abstract N1 - L72185785 2016-02-19 PY - 2015 SN - 0300-5577 ST - Neonatal peripheral artery occlusion T2 - Journal of Perinatal Medicine TI - Neonatal peripheral artery occlusion UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72185785&from=export http://dx.doi.org/10.1515/jpm-2015-2003 VL - 43 ID - 761059 ER - TY - JOUR AB - Aim To assess the outcome of pediatric patients after living donor liver transplantation (LDLT). Methods Retrospective analysis of prospectively collected data of 200 LDLT in 197 pediatric patients from August 2003 to July 2016. Results Out of 200 liver transplants done on 197 patients, 120 were males (60%) with median age 60mth+/- 60.583; range 4-228 months and with median body weight of 16 kg+/- 14.983 (4.2-80 kg). Indications were chronic liver disease (CLD) in 135 out of which cholestasis was there in 92 (70.3 %) (biliary atresia 72). Fifty-seven patients presented with acute or acute on chronic liver failure (cryptogenic 13, HAV 5, Wilson disease 24, autoimmune hepatitis 8 and tyrosinemia 5, neonatal hemochromatosis 1, drug induced 1). Overall metabolic causes were there in 66 (Wilson's disease 29, tyrosinemia 13, PFIC 10, Alagille's syndrome 3, citrullinemia 3, primary hyperoxaluria 2, maple syrup urine disease 2, protein C and S deficiency 1, GSD-1, neonatal hemochromatosis 1, Factor 7 deficiency 1). Other indications were autoimmune hepatitis 13, cryptogenic cirrhosis 8, chronic hepatitis B 1, tumor -2, Re transplant-3. Parents were the donors in 141, close relatives in 50. There was 7 swap donor and 2 domino graft. The grafts included left lateral 104 (52 %) of which 26 were reduced, left lobe 68 (34 %), right lobe 26 (13 %) and whole liver in 2 cases (domino). Immediate complications included hypertension (31 %), acute rejection (25 %), hyperglycemia (22.5 %), sepsis (33.2 %), CMV hepatitis (17 %) and chylous ascites (7.5 %). Biliary complications were seen in 28 out of which 17 biliary leak and 18 biliary stricture. In biliary leak 13 had PCD, 3 re-explore 1 PTBD and biliary stricture 11 had PTBD 2, ERCP and PTBD 2, ERCP 2, re-explore 1, ERCP and re-explore 1. Portal vein thrombosis was seen in 9 (6 had re-laparotomy, 3 managed conservatively) and hepatic artery thrombosis in 9 cases (1 died, 1 re-transplanted, 1 left iliac to HA conduit, 3 arterilization of portal vein. Two re-explore and thrombectomy, 2 had both arterilzation and re-explore). Mean hospital stay was 29 days (13- 63). Six patients had chronic rejection, 4 died, 1 underwent re-transplant, others awaiting re-transplant. One year survival rate was 91 % with an overall survival of 89 % at mean follow up of 29 months (1-85). Conclusion Pediatric LDLT is well established in India with results comparable to the best centers in world. Immediate complications, although frequent, were managed successfully. Long term complications were uncommon. Transplantation in small babies is very challenging. A multidisciplinary team is the key to success. AD - N. Mohan, Institute of Liver Transplantation and Regenerative Medicine, Medanta -The Medicity, Gurgaon, India AU - Mohan, N. AU - Karkra, S. AU - Dhaliwal, M. AU - Raghunathan, V. AU - Goyal, D. AU - Bhangui, P. AU - Goja, S. AU - Kumar, P. AU - Gupta, N. AU - Jolly, A. AU - Bhalotra, S. AU - Vohra, V. AU - Baijal, S. AU - Soin, A. DB - Embase DO - 10.1007/s12664-016-0715-3 KW - endogenous compound protein C acute graft rejection acute on chronic liver failure adult Alagille syndrome autoimmune hepatitis bile duct atresia blood clotting factor 7 deficiency body weight child cholestasis chronic graft rejection chylous ascites citrullinemia complication controlled study endoscopic retrograde cholangiopancreatography female follow up hemochromatosis hepatic artery thrombosis hepatitis B hospitalization human human tissue hyperglycemia hypertension iliac bone India infant laparotomy liver graft living donor major clinical study male maple syrup urine disease middle aged neoplasm overall survival oxalosis 1 portal vein thrombosis relative sepsis survival rate thrombectomy tyrosinemia Wilson disease LA - English M1 - 1 M3 - Conference Abstract N1 - L613940933 2017-01-05 PY - 2016 SN - 0975-0711 SP - A75 ST - Pediatric living donor liver transplants in India- Experience of the first double century T2 - Indian Journal of Gastroenterology TI - Pediatric living donor liver transplants in India- Experience of the first double century UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613940933&from=export http://dx.doi.org/10.1007/s12664-016-0715-3 VL - 35 ID - 760991 ER - TY - JOUR AB - OBJECTIVE: To describe our experience of pediatric living donor liver transplantation from India over a period of 12 years. MATERIALS AND METHODS: A retrospective analysis of 200 living donor liver transplantation in children (18 years or younger) was done for demographic features, indications, donor and graft profile and outcome. RESULTS: Between September 2004 and July 2016, 200 liver transplants were performed on 197 children. Fifty transplants were done in initial 6 years and 150 in next 6 years. All donors (51% mothers) were discharged with a mean stay of 7 days. The leading indications of liver transplants were cholestatic liver disease (46%) followed by metabolic liver disease (33%) and acute liver failure/acute on chronic liver failure (28.5%). Biliary leakage (8.5%), biliary stricture (9%), hepatic artery thrombosis (4.5%) and portal vein thrombosis (4%) were the most common surgical complications; all could be managed by surgical or interventional radiological measures, except in one child who died. Sepsis, acute rejection and CMV hepatitis in first 6 months were seen in 14.5%, 25% and 17% cases, respectively. Post-transplant lymphoproliferative disease was seen in only 1.5%. Re-transplant rate was 1.5%. The overall 1 year survival rate was 94% and 5 year actuarial survival was 87% with no statistically significant difference between children weight <10 kg vs. >10 kg. Outcome in acute liver failure did not differ significantly between those with acute on chronic liver failure vs. those with chronic liver disease. CONCLUSIONS: Advances in medical and surgical techniques associated with multidisciplinary teams including skilled pediatric liver transplant surgeons, anesthetists, dedicated pediatric hepatologists, pediatric intensivists, interventional radiologists and pathologists resulted in an excellent outcome of living related liver transplants in children. Low age and weight of the baby does not seem to be a contraindication for liver transplantation as outcome were comparable in our experience. AD - Department of Pediatric Gastroenterology, Hepatology and Liver transplant, *Pediatric Intensive Care Unit, #Institute of Liver Transplant and Regenerative Medicine, and $Department of Radiology; Medanta -The Medicity, Gurgaon, Haryana, India. Correspondence to: Neelam Mohan, Department of Pediatric astroenterology, Hepatology and Liver transplant, Medanta - The Medicity, Gurgaon, Haryana, India. drneelam@yahoo.com. AN - 28849768 AU - Mohan, N. AU - Karkra, S. AU - Rastogi, A. AU - Dhaliwal, M. S. AU - Raghunathan, V. AU - Goyal, D. AU - Goja, S. AU - Bhangui, P. AU - Vohra, V. AU - Piplani, T. AU - Sharma, V. AU - Gautam, D. AU - Baijal, S. S. AU - Soin, A. S. DA - Nov 15 DO - 10.1007/s13312-017-1181-4 DP - NLM ET - 2017/08/30 J2 - Indian pediatrics KW - Child Child, Preschool Female Humans India/epidemiology Infant Liver Diseases/epidemiology/surgery *Liver Transplantation/adverse effects/methods/mortality/statistics & numerical data Living Donors/*statistics & numerical data Male Mothers Postoperative Complications/epidemiology Retrospective Studies LA - eng M1 - 11 N1 - 0974-7559 Mohan, Neelam Karkra, Sakshi Rastogi, Amit Dhaliwal, Maninder S Raghunathan, Veena Goyal, Deepak Goja, Sanjay Bhangui, Prashant Vohra, Vijay Piplani, Tarun Sharma, Vivek Gautam, Dheeraj Baijal, S S Soin, A S Journal Article India Indian Pediatr. 2017 Nov 15;54(11):913-918. doi: 10.1007/s13312-017-1181-4. Epub 2017 Aug 24. PY - 2017 SN - 0019-6061 SP - 913-918 ST - Outcome of 200 Pediatric Living Donor Liver Transplantations in India T2 - Indian Pediatr TI - Outcome of 200 Pediatric Living Donor Liver Transplantations in India VL - 54 ID - 760265 ER - TY - JOUR AB - Extracorporeal membrane oxygenation (ECMO) is a temporary mechanical circulatory assist method that offers circulatory as well as respiratory support efficiently via peripheral access; however, it is liable to complications. Limb ischemia is one of the notorious complications of ECMO but can be avoided utilizing a proper distal limb perfusion method. A retrospective study of patients undergoing peripheral venoarterial (VA) ECMO for various reasons between June 2010 and December 2012 was performed. All patients were evaluated by our multidisciplinary team for suitability as candidates for ECMO. A peripheral VA-ECMO circuit was implanted via groin: inflow cannula in the femoral vein, an outflow cannula and distal-perfusion cannula, or an introducer sheath in the femoral artery. During the study period, 83 patients underwent various types of ECMO; 45 received peripheral VA-ECMO. Distal limb perfusion was achieved with an introducer sheath (6-8 Fr) in 13 cases and with a distal-perfusion cannula (10-12 Fr) in 32 cases. Nine (20%) patients developed signs of ischemia; five (11.2%) were treated conservatively, while four (8.8%) required surgical intervention. One patient required a below-knee amputation. The incidences of limb ischemia and limb ischemia requiring surgical intervention were significantly higher for the introducer sheath compared with the cannula (30.6 vs. 15.6% and 15.4 vs. 6.25%, respectively). Moreover, the patients supported on ECMO with a distal-perfusion cannula spent a significantly longer time on ECMO compared with the ones in whom an introducer sheath was used (11.9 ± 9.1 vs. 7.7 ± 4.3 days). The mean cannula size was significantly greater than the mean introducer sheath size (11.1 ± 1.3 vs. 7.0 ± 1.1 Fr). Use of a distal-perfusion cannula is a most reliable method of limb perfusion in peripheral VA-ECMO. The cannula can ensure adequate and smooth perfusion of the limb owing to its large caliber, its less turbulent flow, the ability it provides to monitor the flow, and the option to attach a side port. AD - Department of Cardiothoracic Transplantation & Mechanical Support, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK. AN - 24788069 AU - Mohite, P. N. AU - Fatullayev, J. AU - Maunz, O. AU - Kaul, S. AU - Sabashnikov, A. AU - Weymann, A. AU - Saez, D. G. AU - Patil, N. P. AU - Zych, B. AU - Popov, A. F. AU - DeRobertis, F. AU - Bahrami, T. AU - Amrani, M. AU - Simon, A. R. DA - Nov DO - 10.1111/aor.12314 DP - NLM ET - 2014/05/03 J2 - Artificial organs KW - Adult Catheterization, Peripheral Extracorporeal Membrane Oxygenation/instrumentation/*methods Female Heart Diseases/*therapy Humans Ischemia/*etiology/prevention & control Leg/*blood supply Male Middle Aged Retrospective Studies Risk Factors Treatment Outcome Acute limb ischemia Distal-perfusion cannula Extracorporeal membrane oxygenation LA - eng M1 - 11 N1 - 1525-1594 Mohite, Prashant N Fatullayev, Javid Maunz, Olaf Kaul, Sundip Sabashnikov, Anton Weymann, Alexander Saez, Diana G Patil, Nikhil P Zych, Bartlomiej Popov, Aron F DeRobertis, Fabio Bahrami, Toufan Amrani, Mohamed Simon, Andre R Journal Article United States Artif Organs. 2014 Nov;38(11):940-4. doi: 10.1111/aor.12314. Epub 2014 May 2. PY - 2014 SN - 0160-564x SP - 940-4 ST - Distal limb perfusion: Achilles' heel in peripheral venoarterial extracorporeal membrane oxygenation T2 - Artif Organs TI - Distal limb perfusion: Achilles' heel in peripheral venoarterial extracorporeal membrane oxygenation VL - 38 ID - 760433 ER - TY - JOUR AB - Introduction: Vein of Galen malformations (VGM) are rare pediatric congenital intravascular cerebral anomalies associated with high mortality. They can manifest in adults occasionally as cerebral hemorrhage or seizure disorder. We report a very rare case of an adult patient with newly diagnosed VGM. Case Description: 31 year old African-American right handed male presented to a referring hospital with nausea, vomiting and blurred vision associated with the 'worst headache of his life'. Non-contrast CT scan of the head revealed a partially calcified mass highly suspicious for vein of Galen malformation with evidence of subarachnoid hemorrhage (SAH). At the time of admission to our unit he was alert, awake, oriented with GCS score 15, BP 156/92 mmHg and had no gross focal motor or sensory deficits. He had no family history of polycystic kidney disease any brain aneurysms, or Arterio- venous malformations (AVM's). CT angiography and MRI of brain and neck confirmed VGM. Imaging could not exclude SAH, so lumbar puncture was performed. This was complicated by dilated venous plexi overlying the spine, which resulted in a bloody tap. A subsequent cerebral angiogram revealed no flow related aneurysm within the brain structure and a large 4.5x2.5 mm thalamic/VGM with Arterio-venous fistulous component with bilateral occlusions of the deep cavernous sinus drainage system. His blood pressure was adequately controlled and he was discharged home for outpatient follow-up. We plan for a staged embolization therapy in near future for our patient with assistance of our neuro-interventional radiologist and vascular neurosurgeon. Discussion: VGMs are characterized by the presence of multiple arteriovenous shunts draining into a dilated median cerebral venous collector. They arise from persistent arteriovenous shunting from primitive choroidal vessels into the median prosencephalic vein of Markoswski, the embryonic precursor of the vein of Galen. VGMs rarely present past infancy, and their natural history in adults is unknown. If left untreated hydrocephalus, cerebral venous hypertension, cerebral calcifications, seizures and developmental delay are known to occur. Cerebral angiography is the gold standard for the diagnosis of VGM. Because of its rarity there is still insufficient information about this disease during adulthood. Use of oral contraceptives, postpartum status, sickle cell anemia and aseptic meningitis are risk factors related to thrombosis of the vein of Galen. Intracranial hemorrhage is the most feared clinical presentation of AVM's seen in more than 30% of patients. Intravascular embolization is the treatment of choice in adults, but carries a 3% risk with each procedure the risk of permanent neurological disability or death. This complication rate should be weighed against the risk of bleeding and hence we decided for conservative management in our patient, who did not have any signs of hydrocephalus, brain atrophy or aneurysmal dilatation. Conclusion: Untreated vein of Galen malformations have a very poor prognosis. The indications of treatment are based on case-specific clinical manifestations. These lesions have been termed the 'Gordian knot' of cerebrovascular surgery. Advances in imaging technology, early and appropriate diagnostic tests and multidisciplinary team of management with neurologists, neuro-interventional radiologists, vascular neurosurgeons and critical care physicians have improved clinical outcomes. Embolization and radiotherapy are evolving options while size of the lesion, type of venous drainage and the location are the prognostic indicators in clinical management. AD - M. Moizuddin, University of South Carolina, School of Medicine, Columbia, SC, United States AU - Moizuddin, M. AU - Graham, B. AU - Owens, W. DB - Embase DO - 10.1097/01.ccm.0000440360.81792.06 KW - oral contraceptive agent intensive care vein of Galen malformation adult intensive care unit society human patient artificial embolization risk neurosurgeon brain Galen vein radiologist brain hemorrhage hydrocephalus imaging seizure blurred vision aneurysm vomiting spine lumbar puncture nausea computed tomographic angiography congenital malformation hospital mortality brain artery aneurysm hypertension brain angiography adulthood neck sickle cell anemia aseptic meningitis risk factor occlusion cavernous sinus infancy vein kidney polycystic disease shunting family history arteriovenous shunt subarachnoid hemorrhage African American computer assisted tomography male choroid vascularization diseases precursor radiotherapy physician history neurologist therapy brain calcification gold standard diagnosis follow up thrombosis prognosis procedures disability headache dilatation outpatient brain atrophy blood pressure conservative treatment cerebrovascular surgery technology diagnostic test bleeding death nuclear magnetic resonance imaging LA - English M1 - 12 M3 - Conference Abstract N1 - L71534300 2014-07-22 PY - 2013 SN - 0090-3493 SP - A285 ST - Vein of galen malformation in adult-management dilemma in intensive care unit T2 - Critical Care Medicine TI - Vein of galen malformation in adult-management dilemma in intensive care unit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71534300&from=export http://dx.doi.org/10.1097/01.ccm.0000440360.81792.06 VL - 41 ID - 761147 ER - TY - JOUR AB - BACKGROUND: In patients suffering intestinal failure due to short bowel, the goal of an Intestinal Rehabilitation Program is to optimize and tailor all aspects of clinical management, and eventually, wean patients off lifelong parenteral nutrition. AIM: To report the results of our program in patients suffering intestinal failure. PATIENTS AND METHODS: A registry of all patients referred to the Intestinal Failure unit between January 2009 and December 2015 was constructed. Initial work up included prior intestinal surgery, blood tests, endoscopic and imaging studies. Also demographic data, medical and surgical management as well as clinical follow-up, were registered. RESULTS: Data from 14 consecutive patients aged 26 to 84 years (13 women) was reviewed. Mean length of remnant small bowel was 100 cm and they were on parenteral nutrition for a median of eight months. Seven of 14 patients had short bowel secondary to mesenteric vascular events (embolism/thrombosis). Medical management and autologous reconstruction of the bowel included jejuno-colic anastomosis in six, enterorraphies in three, entero-rectal anastomosis in two, lengthening procedures in two, ileo-colic anastomosis in one and reversal Roux-Y gastric bypass in one. Thirteen of 14 patients were weaned off parenteral nutrition. CONCLUSIONS: Our Multidisciplinary Intestinal Rehabilitation Program, allowed weaning most of the studied patients off parenteral nutrition. AD - Unidad de Coloproctología, Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile. Unidad de Nutrición, Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile. Unidad de Cirugía Hepato-biliopancreática y Trasplante, Departamento de Cirugía Digestiva, Pontificia Universidad Católica de Chile, Santiago, Chile. AN - 28394957 AU - Molina, M. E. AU - Bellolio, F. AU - Klaassen, J. AU - Gómez, J. AU - Villalón, C. AU - Guerra, J. F. AU - Zúñiga, Á DA - Nov DO - 10.4067/s0034-98872016001100006 DP - NLM ET - 2017/04/11 J2 - Revista medica de Chile KW - Adult Aged Aged, 80 and over Anthropometry Digestive System Surgical Procedures/methods Disease Management Female Humans Intestines/physiopathology/surgery Male Middle Aged Nutrition Assessment Parenteral Nutrition/methods *Patient Care Team Reconstructive Surgical Procedures/methods Retrospective Studies Short Bowel Syndrome/physiopathology/*rehabilitation/surgery Treatment Outcome LA - spa M1 - 11 N1 - 0717-6163 Molina, María Elena Bellolio, Felipe Klaassen, Julieta Gómez, Javier Villalón, Constanza Guerra, Juan Francisco Zúñiga, Álvaro Journal Article Chile Rev Med Chil. 2016 Nov;144(11):1410-1416. doi: 10.4067/S0034-98872016001100006. OP - Insuficiencia intestinal secundaria a síndrome de intestino corto: resultados de un programa multidisciplinario de rehabilitación intestinal. PY - 2016 SN - 0034-9887 SP - 1410-1416 ST - [Intestinal failure due to short bowel syndrome: impact of a multidisciplinary intestinal rehabilitation program] T2 - Rev Med Chil TI - [Intestinal failure due to short bowel syndrome: impact of a multidisciplinary intestinal rehabilitation program] VL - 144 ID - 760281 ER - TY - JOUR AB - Disclosures: All authors have disclosed no financial interests, arrangements or affiliations in the context of this activity. Purpose or Case Report: -Review causes of pediatric abdominal aortic aneurysm (AAA) -Optimize imaging in evaluation of pediatric AAA, including imaging of complications -Discuss medical management and definitive treatment of pediatric AAA Methods & Materials: This educational exhibit presents cases of pediatric AAA (ages 5 months to 15 years) from the author's institutions. We also discuss image optimization, management & treatment of pediatric AAA. (Figure Presented) Results: Review of selected cases of pediatric AAA 1.Massive non-mycotic infrarenal AAAwith bilateral iliac aneurysms in a 5 month old 2. Fusiform AAA in a 15 year old with DOCK8 immunodeficiency syndrome 3. Mycotic AAA in an 8 year old with hypereosinophilia 4. Post surgical aneurysm after ganglioneuroblastoma resection in a 6 year old 5. Suprarenal aneurysms in an 8 year old with vasculitis Additional discussion including: - Discussion of causes: acquired (vasculitis, connective tissue disorder, hypertension, tuberous sclerosis, iatrogenic, trauma) versus congenital -Discussion of optimal imagingmodality and optimal imaging technique: CTA, MRA, US and conventional radiography - Discussion of aneurysm characteristics: location, morphology, associated vascular abnormalities - Discussion of complications: end organ ischemia, leak/rupture, thromboembolism and growth - Discussion of medical management: anticoagulation, antihypertensives, serial imaging, treatment of underlying cause - Discussion of operative treatment: native graft, prosthetic graft, cadaveric graft Conclusions: - AAA are uncommon in the pediatric population. When they do occur they are often secondary to infection after invasive procedures. Less commonly, they are due to inflammatory diseases, connective tissue disorders, hypertension or iatrogenic trauma. Even more rare are congenital AAA. - A variety of modalities can be utilized for diagnosis and follow-up of AAA. These include CTA, MRA, US and conventional angiography. Sedation and gating should be used to decrease motion when possible. MRI and US are non-ionizing modalities, but may be limited due to artifacts. CT uses ionizing radiation, but is readily available and has higher resolution. Catheter angiography is invasive and reserved for problem solving and possible intervention. (Figure Presented) - Management of AAA involves a multidisciplinary team of pediatric specialists, pediatric radiologists, pediatric surgeons, and vascular surgeons. -Treatment includes expectant waiting, treatment of complications, treatment of the underlying cause, and/or surgical repair. AD - C. Molloy, Kaiser Permanente, Los Angeles, CA, United States AU - Molloy, C. AU - Merchant, M. AU - Chiang, M. AU - Peng, L. AU - Lew, W. AU - Shaul, D. DB - Embase DO - 10.1007/s00247-017-3809-x KW - antihypertensive agent abdominal aortic aneurysm adolescent anticoagulation artifact case report child congenital malformation connective tissue disease conventional angiography diagnosis follow up human hypereosinophilia hypertension iliac artery aneurysm immune deficiency infection inflammatory disease invasive procedure ionizing radiation ischemia morphology motion neuroblastoma nuclear magnetic resonance imaging organ pediatric radiologist pediatric surgeon preschool child problem solving school child sedation surgery thromboembolism tuberous sclerosis vascular surgeon vasculitis LA - English M3 - Conference Abstract N1 - L615734084 2017-05-04 PY - 2017 SN - 1432-1998 SP - S225-S226 ST - Pediatric abdominal aortic aneurysms: Etiologies, imaging findings, imaging optimization, medical management and definitive treatment with current literature review T2 - Pediatric Radiology TI - Pediatric abdominal aortic aneurysms: Etiologies, imaging findings, imaging optimization, medical management and definitive treatment with current literature review UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615734084&from=export http://dx.doi.org/10.1007/s00247-017-3809-x VL - 47 ID - 760942 ER - TY - JOUR AB - OBJECTIVE: To evaluate outcomes of next pregnancy (NP), according to causes/associated conditions of previous antepartum SB (IP). STUDY DESIGN: Prospective observational multicenter study involved 3 University H. Every case of SB (> 22 weeks) occurring in the period 2004-2011 undergo the same diagnostic work-up and was classified by a multidisciplinary team. In the same period, all pregnant women with a history of SB were enrolled at 9-12 weeks. Main outcomes were prevalence of SB, FGR<10th centile, early preterm birth (EPTB) <34 weeks and mode of delivery. RESULTS: Out of 305 IP, 210 women (68.8%) had a NP in the study period, 14.1%of themwithin 6months. Fourwere lost to follow-up.Out of 210 babies (in 206 NP) 1 SB occurred (4.8/1000) due to Placental Abruption. Features of population and outcomes are reported in Table 1. With respect to IP, more antenatal evaluations and ultrasound examination were performed in NP. In NP, the rate of FGR and EPTB were lower respect to IP (FGR 10%vs 40.4%, EPTB 6.3% vs 63.1%, p<0.001). In women having had a SB related to Placenta-Vascular Disorder (including FGRor PlacentaAbruption or Severe Preeclampsia orAPLAS) the risk of any adverse outcome was increased respect with those having had a SB unexplained or due to other causes (OR 3.4; 95%CI 1.55-7.46). NP had an increased risk of LBW (1.52; 1.08-2.13), labor induction (1.7; 1.3-2.4) and C-section (2.0; 1.5-2.7) respect with general multipara population. During NP, 40.3% patients received low-molecular weight heparin prophylaxis (LMWH). They had a higher risk for FGR respect with untreated women (15.6% vs 5.3%, p= 0.01), independently of thrombophilia (12%) or cause of previous SB. At multivariate analysis, FGR is also associated with smoking (p=0.01). CONCLUSION: In women with SB history, close antenatal cares together with aggressive management is associated with improved outcomes. LMWH is useless. In addition to antenatal monitoring, management of such pregnancies has to be focus avoiding unhealthy behaviors. (Table presented). AD - F. Monari, University of Modena and Reggio Emilia, Mother-Infant Department, Modena, Italy AU - Monari, F. AU - Pedrielli, G. AU - Vergani, P. AU - Pelizzoni, F. AU - Mecacci, F. AU - Serena, C. AU - Facchinetti, F. DB - Embase DO - 10.1016/j.ajog.2013.10.607 KW - low molecular weight heparin pregnancy human multicenter study society stillbirth female risk population prevalence university labor induction premature labor multivariate analysis examination pregnant woman placenta vascular disease preeclampsia monitoring adverse outcome thrombophilia multipara ultrasound prophylaxis patient baby smoking prenatal care diagnosis LA - English M1 - 1 M3 - Conference Abstract N1 - L71275951 2014-01-03 PY - 2014 SN - 0002-9378 SP - S282 ST - Management and outcomes of pregnancy after stillbirth: Prospective observational multicenter study T2 - American Journal of Obstetrics and Gynecology TI - Management and outcomes of pregnancy after stillbirth: Prospective observational multicenter study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71275951&from=export http://dx.doi.org/10.1016/j.ajog.2013.10.607 VL - 210 ID - 761142 ER - TY - JOUR AB - Very few discrete-event simulation studies follow up on recommendations with evaluation of whether modelled benefits have been realised and the extent to which modelling contributed to any change. This paper evaluates changes made to the emergency stroke care pathway at a UK hospital informed by a simulation modelling study. The aims of the study were to increase the proportion of people with strokes that undergo a time-sensitive treatment to breakdown a blood clot within the brain and decrease the time to treatment. Evaluation involved analysis of stroke treatment pre-and post-implementation, as well as a comparison of how the research team believed the intervention would aid implementation compared to what actually happened. Two years after the care pathway was changed, treatment rates had increased in line with expectations and the hospital was treating four times as many patients than before the intervention in half the time. There is evidence that the modelling process aided implementation, but not always in line with expectations of the research team. Despite user involvement throughout the study it proved difficult to involve a representative group of clinical stakeholders in conceptual modelling and this affected model credibility. The research team also found batch experimentation more useful than visual interactive simulation to structure debate and decision making. In particular, simple charts of results focused debates on the clinical effectiveness of drugs - an emergent barrier to change. Visual interactive simulation proved more useful for engaging different hospitals and initiating new projects. (C) 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license AD - [Monks, Thomas] Univ Southampton, Fac Hlth Sci, NIHR CLAHRC Wessex, Southampton SO17 1BJ, Hants, England. [Pearson, Mark; Pitt, Martin; Stein, Ken; James, Martin A.] Univ Exeter, Med Sch, NIHR CLAHRC South West Peninsula, Exeter EX1 2LU, Devon, England. Monks, T (corresponding author), Univ Southampton, Fac Hlth Sci, NIHR CLAHRC Wessex, Southampton SO17 1BJ, Hants, England. thomas.monks@soton.ac.uk AN - WOS:000422274600007 AU - Monks, T. AU - Pearson, M. AU - Pitt, M. AU - Stein, K. AU - James, M. A. DA - Sep DO - 10.1016/j.orhc.2015.09.002 J2 - Oper. Res. Health Care KW - Stroke Simulation OR in health services Implementation Evaluation DISCRETE-EVENT SIMULATION ACUTE ISCHEMIC-STROKE POPULATION BENEFIT DECISION-SUPPORT HEALTH THROMBOLYSIS IMPLEMENTATION OPERATIONS THERAPY SYSTEMS Health Care Sciences & Services LA - English M3 - Article N1 - ISI Document Delivery No.: V9F8X Times Cited: 9 Cited Reference Count: 55 Monks, Thomas Pearson, Mark Pitt, Martin Stein, Ken James, Martin A. Pearson, Mark/0000-0001-7628-7421; Monks, Thomas/0000-0003-2631-4481 National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula; NIHR CLAHRC Wessex This article presents independent research funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula. TM is funded by NIHR CLAHRC Wessex. The views expressed in this publication are those of the author(s) and not necessarily those of the National Health Service, the NIHR, or the Department of Health. 9 0 ELSEVIER SCIENCE BV AMSTERDAM OPER RES HEALTH CARE PY - 2015 SN - 2211-6923 SP - 40-49 ST - Evaluating the impact of a simulation study in emergency stroke care T2 - Operations Research for Health Care TI - Evaluating the impact of a simulation study in emergency stroke care UR - ://WOS:000422274600007 VL - 6 ID - 761743 ER - TY - GEN AB -.... Pulmonary embolism response teams (PERTs) are developing at multiple centers to improve the decision making, efficiency and orchestration of these clinical strategies... AU - Monteleone, Peter P. AU - Rosenfield, Kenneth AU - Rosovsky, Rachel P. DA - 2016/01/01 DB - Federal Science Library - Canada KW - multidisciplinary thrombosis deep vein thrombosis (DVT) catheter directed thrombolysis (CDT) Pulmonary embolism (PE) thrombolysis rapid response team pulmonary embolism response team (PERT) Case Report PY - 2016 SN - 2223-3652 ST - Multidisciplinary pulmonary embolism response teams and systems TI - Multidisciplinary pulmonary embolism response teams and systems UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1LS8NAEF5sQfEiPrE-Sk7FS2KSzeYBrSBiUURBsOAt7GZ3sZpHSdqLv97Z3VQajx4z2YVkGHbmS775BiHsO67950yIIoZ94vNM4WcSsUwQ6soIsIKIOeeqV3k2w_fvwcurao1Zs8gUybJDVXTK-YemW7Z-rfW8NUcq3KhMfAL1BFQtwWhZVflkUeh94ntkFmohIsrUR4Rs2UM9SJ8bAP_T0La8WI8hVYnTxiHxjSCQr6WAMq74l17oKOVPNfXGhwSJE9WJvZHWuvRKONqT9hie7qO9ttC0bs0bHKAtUR6inef2V_oRanTr7WZTrjUuaP11s1jlEJpwPb7W161ZFKzK503RtdaGYiu6VgicolmbaMktoxfdHKPZ9P7t7sFuJzDYHgbcbFMAazKQgOkSIgAohSxMINcJGjGXSo4FEYmAlVKESYyzADPCGYUSjgaQ9QD8nqB-WZXiFFlQylAeBdzHUmE4xhJAOlC9MC_ImBuLAbpaOzBdGKGNFACKdnsKbk-V2wGvpC4ZoKjj4N_1Siq7ewfCRUtmt1Fx9u-d52hXPYAhslyg_rJeiUu0LZvcZo0cQjH--DTUofQDnPPmLQ VL - 6 ID - 761990 ER - TY - JOUR AB - Background. Add-on standard treatment of aggressive non-Hodgkin's lymphoma (NHL) with 90Y Ibritumomab tiuxetan (90Y-IT) (Zevalin®) has become an efficient alternative. Aims. The aim of this study is to present the analyzed updated results on treatment outcome obtained from our cohort treated with 90Y-IT according to current clinical practice. Subjects and Methods. From September 2005 to February 2012, 19 aggressive lymphoma (AL) patients treated in the same center were included in a clinical protocol conducted by a multidisciplinary team. Inclusion criteria were: CD20+ LNH Mantle Cell Lymphoma (MCL) or Diffuse Large B cell Lymphoma (DLBCL) patients with neutrophils ≥ 1. 5 x109/L, platelets ≥ 100 x109/L, bone marrow lymphocytes CD20+ ≤ 25%. 7 patients were treated as consolidation of a first line chemotherapy; decision to treat was made by the multidisciplinary team according to characteristics of cases. All patients received 0. 4 mCi /kg IV of 90Y-IT and response was evaluated 12 weeks after by PET/CT. Endpoints: objective response rate (ORR), progression free survival (PFS), overall survival (OS) and safety. Other clinical prognostic factors were observed to assess their possible influence upon treatment value. Results. Until February 2012, 19 AL patients had received treatment with 90YIT; 10 MCL (52. 6%), 9 DLBCL (47. 4%), 16 completed follow-up and were taken into analysis; M/F 10/9 (73. 6%/26. 4%); mean age 66. 9 (53-79) years for MCL and 53 (35-87) years for DLBCL; ECOG 0-1 82. 35%. According IPI score distribution: 0-1: 31. 25%, >1: 69. 75%. Previous therapy schedules: 1-2 (52. 6%), >2 (47. 4%). Median follow-up time: 46. 8 months. Mean estimated OS for MCL was 67. 6 months (50-84), median OS was 62 (37-86) and mean PFS was 27 months (95% CI: 18. 42-35. 99). For DLBCL mean OS was 85 months (53. 37-118. 45), median OS was 84 months (46. 44-121. 55), mean PFS was 39 months (95% CI: 27. 11-50. 88). Status before treatment was: relapsed but Complete Response (CR) after chemotherapy: 2 patients for MCL and 6 DLBCL; relapse and refractory with active disease after chemotherapy (PR): 2 MCL and 1 DLBCL and as consolidation after first-line chemotherapy in CR: 4 MCL cases and 3 DLBC cases. 13 patients achieved CR, 8 MCL and 5 DLBCL; 2 MCL patients and 1 DLBCL only achieved PR/stabilization of the disease. Until now only 6 (40%) patients have relapsed, 4 MCL (27%). Mortality related to relapse was reported in only one MCL case that relapsed 15 months after treatment and died 3 years later. Safety: thrombocytopenia was the most frequent (42. 1%) hematological toxicity, median time to 2. 8 weeks, grade 3-4 only occurred in 21% of patients; neutropenia occurred in 31. 5%, and the median time for recovery was 3 and 2 weeks respectively. In 2 patients (10. 52%) red cell transfusion was required and 4 (21. 5%) needed platelet transfusion. The most frequent non hematological toxicity was asthenia. None secondary malignancies have been observed. Conclusions. In our experience 90Y Ibritumomab tiuxetan (Zevalin®) is a safe and effective consolidation therapy in aggressive NHL, permitting achievement of sustained CR and prolonging PFS. Further studies on the impact of outcomes in this population are needed. (Table Presented). AD - A. Montes Limon, Hospital Universitario Miguel Servet, Saragosa, Spain AU - Montes Limon, A. AU - Andrade Campos, M. AU - Murillo Flores, I. AU - Grasa Ülrich, J. M. AU - Lievano, P. AU - Baringo, T. AU - Giraldo Castellanos, P. DB - Embase KW - ibritumomab tiuxetan yttrium 90 nonhodgkin lymphoma European hematology human patient large cell lymphoma chemotherapy follow up toxicity safety relapse therapy lymphoma mortality mantle cell lymphoma overall survival progression free survival B lymphocyte clinical protocol treatment outcome thrombocyte achievement thrombocyte transfusion erythrocyte neutrophil neutropenia thrombocytopenia transfusion asthenia population clinical practice electrocorticography L1 - http://www.haematologica.org/content/haematol/97/supplement_1/haematol_97_s1.full.pdf LA - English M3 - Conference Abstract N1 - L71725235 2015-02-02 PY - 2012 SN - 0390-6078 SP - 667-668 ST - Rit with 90Y-ibritumomab tiuxetan improves the response in aggressive non-hodgkin lymphoma T2 - Haematologica TI - Rit with 90Y-ibritumomab tiuxetan improves the response in aggressive non-hodgkin lymphoma UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71725235&from=export VL - 97 ID - 761200 ER - TY - JOUR AB - Background: Thromboprophylaxis for oncologic patients represents a huge challenge. The existence of more specific guidelines for anti-thrombotic therapy in hospitalized and ambulatory oncologic patients is an unmet need. Methods: We present an observational, descriptive, retrospective and transversal study, from January 2012 to December 2016, all the oncologic patients hospitalized for any cause in the Hospital Español de México were included. We reviewed clinical files and obtained demographic and disease characteristics necessary to stratify the risk of thromboembolism using the Khorana score. A bivariate analysis was done between the risk of thromboembolism and the use of thromboprophylaxis and a multivariate analysis to identify the reproducibility of Khorana score in Mexican patients. Results: Of the 1048 patients included in the study, 65.6% (688 patients) were categorized by the Khorana score with intermediate risk of thromboembolism, 26% (273 patients) with low risk and 8.4% (87 patients) with high risk. In the low risk group 80.6% used some kind of prophylaxis, in the intermediate risk group 83.2% and in the high risk group 87%, nevertheless only 19.7% met the recommendations published by international guidelines (ASCO, ESMO) and the Khorana score and also this data confirmed the reproducibility of Khorana score in Mexican patients. Conclusions: The 80.3% of all the patients didn't obey the recommendations stablished by the American and European guidelines. We propose a digital tool to monitor and manage the risk of thrombosis as a health condition associated with cancer. This could be use in an easy way of each member of the multidisciplinary team, to stratify cancer patients by risk to receive the correct prophylactic anti-thrombotic therapy. This is nowadays an unmet need for oncologic patients, and in our country this type of tool, will help to save resources and re-direct them to patients who will actually benefit from the prophylactic treatment. AD - L.V.G. Montes, Hospital Español de México, Ciudad de México, Mexico AU - Montes, L. V. G. DB - Embase DO - 10.1200/JCO.2017.35.31_suppl.232 KW - anticoagulant agent adult bivariate analysis cancer patient conference abstract controlled study drug therapy female human intermediate risk population low risk population major clinical study male Mexican multidisciplinary team practice guideline prescription prophylaxis reproducibility retrospective study risk assessment thromboembolism LA - English M1 - 31 M3 - Conference Abstract N1 - L625817030 2019-01-11 PY - 2017 SN - 1527-7755 SP - 173 ST - Development of a digital tool to assess the risk of thromboembolic disease and prescription of prophylactic anti-thrombotic therapy in oncologic patients T2 - Journal of Clinical Oncology TI - Development of a digital tool to assess the risk of thromboembolic disease and prescription of prophylactic anti-thrombotic therapy in oncologic patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L625817030&from=export http://dx.doi.org/10.1200/JCO.2017.35.31_suppl.232 VL - 35 ID - 760900 ER - TY - JOUR AB - INTRODUCTION: Primary pulmonary lymphomas are infrequently observed malignancies of the respiratory system. Among them, mucosa-associated lymphoid tissue (MALT) and diffuse large B-cell lymphomas are the two most commonly seen primary pulmonary lymphomas [1]. Although gastric MALT lymphoma has been shown to have strong associations with Helicobacter pylori infections, the etiology of pulmonary MALT lymphoma remains unclear. Though it carries an excellent 5 year survival rate (>80%), recognition of this indolent lymphoma is essential for determining treatment options. CASE PRESENTATION: A 54 year old woman presented to the emergency department with chest pain and dyspnea. Although a full cardiac workup was unrevealing, chest computed tomography (CT) with contrast performed to address concerns for pulmonary embolism revealed scattered bilateral ground-glass opacities (Fig. 1). She received a bronchoscopy with biopsy after a follow-up CT failed to show resolution of the mass. Pathologic evaluation revealed atypical lymphoid infiltrates that were immunostain positive for B cell marker CD20 and T cell marker CD43 concerning for MALT lymphoma. Video-assisted thorascopic exploration of the left lung with excision of the opacities confirmed the diagnosis (Fig. 2). Subsequent positron emission tomography CT did not demonstrate extrapulmonary manifestations and esophagogastroduodenoscopy with biopsy confirmed the absence of concurrent Helicobacter pylori infection. She is currently followed by a multidisciplinary team of physicians and remains disease free. DISCUSSION: Primary pulmonary MALT lymphoma equally affects both genders and peaks around the 6th decade of life. Unlike primary gastric MALT lymphomas, primary pulmonary MALT lymphomas are not known to be associated with infections [2]. It is important to note that radiographs may reveal multifocal nodules and ground-glass opacities [3]. Although these findings may be mistaken for atypical pneumonia, indolent B-cell lymphomas such as pulmonary MALT lymphomas should be considered. CONCLUSIONS: Though primary pulmonary lymphomas are rare, this case demonstrates the importance of considering pulmonary MALT lymphoma as a cause of multifocal ground-glass opacities. Definitive diagnosis should be pursued promptly as treatment modalities and prognosis differs drastically between different primary pulmonary malignancies. AD - W. Moon, St Joseph Mercy Hospital, Ypsilanti, MI, United States AU - Moon, W. AU - Kakaraparthi, S. AU - Gravelyn, T. DB - Embase DO - 10.1378/chest.1989015 KW - glass cell marker leukosialin marginal zone lymphoma primary tumor lung lymphoma human diagnosis biopsy Helicobacter infection thorax lymphoid tissue mucosa follow up female lymphocytic infiltration thorax pain dyspnea bronchoscopy survival rate B lymphocyte lung embolism physician esophagogastroduodenoscopy X ray film implantable cardiac monitor virus pneumonia B cell lymphoma prognosis emergency ward etiology large cell lymphoma computer assisted tomography videorecording excision T lymphocyte positron emission tomography gender infection soft contact lens respiratory system L1 - http://journal.publications.chestnet.org/article.aspx?articleID=1912745 LA - English M1 - 4 M3 - Conference Abstract N1 - L71780780 2015-02-13 PY - 2014 SN - 0012-3692 ST - Primary pulmonary mucosa-associated lymphoid tissue lymphoma: A rarely observed primary malignancy of the lungs T2 - Chest TI - Primary pulmonary mucosa-associated lymphoid tissue lymphoma: A rarely observed primary malignancy of the lungs UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71780780&from=export http://dx.doi.org/10.1378/chest.1989015 VL - 146 ID - 761098 ER - TY - JOUR AB - Objective: Adverse drug events (ADEs) are the most common type of iatrogenic injury in hospitalized patients. However; the ability of electronic triggers to identify patients at high risk for inpatient ADEs before they occur has not been well studied. The objective of this study was to assess the positive predictive value of event triggers to detect developing ADEs. Methods: We conducted a prospective observational study in patients at a university-based teaching hospital during a 5-month period. Patients were monitored using electronic triggers designed to detect patients at increased risk for 4 types of ADEs: hypoglycemia, hypokalemia, hyperkalemia, and thrombocytopenia. Each patient for whom a trigger fired was followed to determine whether a drug-induced markedly abnormal laboratory result occurred between 1 and 72 hours after the initial trigger firing. Results: Overall, the triggers fired 611 times on 456 patients. Of the 456 patients, 101 experienced 1 or more related ADEs between 1 and 72 hours after the initial trigger firing. The positive predictive value of the triggers and median time from trigger firing to ADE was 31% and 11.6 hours for hypoglycemia, 4.0% and 17 hours for hypokalemia, 31% and 25.4 hours for hyperkalemia, and 21% and 48.4 hours for thrombocytopenia. Conclusion: Computerized triggers have sufficient predictive value to detect developing ADEs and can help clinicians avert ADEs. More research is required to determine whether real-time, primary-prevention alerts may reduce the incidence of ADEs. AD - Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, 5039 Old Clinic Bldg, CB 7110, Chapel Hill, NC 27599-7110; crmoore@med.unc.edu AN - 109851429. Language: English. Entry Date: 20100205. Revision Date: 20151008. Publication Type: Journal Article AU - Moore, C. AU - Li, J. AU - Hung, C. AU - Downs, J. AU - Nebeker, J. R. DB - CINAHL DP - EBSCOhost KW - Adverse Drug Event -- Prevention and Control Adverse Drug Event -- Risk Factors Patient Identification -- Methods Predictive Validity Academic Medical Centers -- North Carolina Chi Square Test Electronic Health Records Descriptive Statistics Diagnosis, Laboratory Drug Utilization Funding Source Hospitalization Human Hyperkalemia -- Risk Factors Hypoglycemia -- Risk Factors Hypokalemia -- Risk Factors Nonexperimental Studies North Carolina Prospective Studies T-Tests Thrombocytopenia -- Risk Factors Time Factors M1 - 4 N1 - research; tables/charts. Journal Subset: Health Services Administration; Peer Reviewed; USA. Grant Information: This study was supported, in part, by the Agency for Healthcare Research and Quality Research Triangle Institute contract 290-00-0018 task order 16. NLM UID: 101233393. PMID: NLM22130215. PY - 2009 SN - 1549-8417 SP - 223-228 ST - Predictive value of alert triggers for identification of developing adverse drug events T2 - Journal of Patient Safety TI - Predictive value of alert triggers for identification of developing adverse drug events UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=109851429&site=ehost-live&scope=site VL - 5 ID - 761365 ER - TY - JOUR AB - Approximately 40 % of ischemic strokes have no clearly definable aetiology and are termed cryptogenic strokes. Patent ForamenOvale (PFO), a small communication between the left and right atria is a possible cause of paradoxical emboli and stroke however the significance of PFO and the role of closure in cryptogenic stroke remains uncertain. We report the case of a 34-year-old Polish man who presented with acute onset of left sided weakness, facial droop and left visual field deficits. His NIHSS on admission was 6. He had a background significant for a previous ischaemic stroke in 2010, which was attributed to an identified PFO and this was subsequently closed. On this admission he underwent an urgent CT brain and angiogram, which showed no evidence of acute infarction, but did show a filling defect in the distal M1 segment of the right MCA. He received thromobolysis and as his NIHSS failed to improve he also received mechanical thrombectomy for the M1 occlusion. An MRI head showed a large recent right MCA territory infarct, it also showed recurrent occlusion of the M1 segment post thrombectomy. As his M1 was thus not fully recanalalized he had persistent deficits. Given his history of a closed PFO he had an urgent transthoracic echo with bubble study, which was negative for any significant intracardiac shunt. He was thus worked up for a cryptogenic stroke. An extended holter revealed no evidence of atrial fibrillation. Carotid and vertebral artery duplex scans were normal. Laboratory tests showed a normal FBC, CRP, Renal profile, Liver profile, ESR, HbA1c, Lipid profile. Fibrinogen, ANA, ANCA, and ENA were all normal suggesting no evidence of vasculitis. A thrombophilia screen including homocysteine, protein C & S, anti thrombin, factor V leiden, PT, and APTT were normal. His antiphospholipid screen however came back strongly positive with titres of: IgG CAR ab >418.0, IgM CAR ab 50.0 U/mL, IgG B2GP 69.0. His lupus anticoagulant came back as positive also. The diagnosis of antiphospholipid syndrome requires two positive tests at least 12 weeks apart. He was seen by Haematology who felt that the diagnosis of primary antiphospholipid syndrome explained this young man's recurrent strokes. He was commenced on warfarin indefinitely. A repeat anticardiolipin screen was again positive 12 weeks later confirming the diagnosis of primary antiphospholipid syndrome. On further investigation it was discovered that no thrombophilia screen had been taken during his original presentation in 2010 and was hence not anticoagulated. He received extensive multidisciplinary team input and is currently convalescing in the national rehabilitation hospital. He will require lifelong anticoagulation and extensive follow up. This case illustrates the thorough work up needed for cryptogenic young stroke and the significant morbidity it has. The causative role of identified PFOs and cryptogenic stroke is an uncertain area where there is essential ongoing research, this case highlights the importance of looking beyond the most obvious cause and completing the work up until the whole story emerges. AD - C. Moran, Stroke Department, Mater Misercordiae Hospital Dublin, Ireland AU - Moran, C. AU - Murphy, S. DB - Embase DO - 10.1007/s11845-014-1153-9 KW - immunoglobulin G homocysteine fibrinogen hemoglobin A1c lipid warfarin protein C immunoglobulin M blood clotting factor 5 Leiden antithrombin lupus anticoagulant alprazolam cerebrovascular accident antiphospholipid syndrome diagnosis brain ischemia occlusion infarction thrombophilia human male non implantable urine incontinence electrical stimulator thrombectomy mechanical thrombectomy embolism heart septum defect etiology heart right atrium brain patent liver rehabilitation laboratory test morbidity vertebral artery visual field vasculitis carotid artery atrial fibrillation weakness hematology interpersonal communication hospital anticoagulation follow up National Institutes of Health Stroke Scale nuclear magnetic resonance imaging LA - English M1 - 4 M3 - Conference Abstract N1 - L71608404 2014-09-13 PY - 2014 SN - 0021-1265 SP - S162-S163 ST - The 'hole' truth uncovered-a case of young cryptogenic stroke T2 - Irish Journal of Medical Science TI - The 'hole' truth uncovered-a case of young cryptogenic stroke UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71608404&from=export http://dx.doi.org/10.1007/s11845-014-1153-9 VL - 183 ID - 761105 ER - TY - JOUR AB - Objectives: Liver transplant is an established curative therapy for children with chronic end-stage liver disease or acute liver failure. In this study, we aimed to evaluate pediatric liver transplant in terms of outcomes, complications, and long-term follow-up results. Materials and Methods: Pediatric patients who had liver transplant in our institution were included. We retrospectively evaluated demographic features including body weight, Child-Pugh score, etiology of liver disease, graft source, perioperative outcomes, perioperative complications, postoperative complications, and long-term results. Outcomes of treatment of complications and revision transplant were evaluated. Results: Between September 2001 and December 2013, there were 188 pediatric liver transplants performed in our institution. Most grafts (90.9%) were obtained from living-related donors. There were 13 patients (6.9%) who had an intervention because of a hemorrhage postoperatively. Biliary leakage was observed in 33 patients (17.5%) and biliary stricture during follow-up was observed in 32 patients (17%). Thrombosis rates in the hepatic artery and portal vein were 12.3% and 0.5%. Revision transplant was performed in 11 patients (5.8%); reason for revision transplant was rejection in 50% patients. The remaining children were alive with good graft functioning after treatment of complications and revision transplant. The overall 5- and 10-year survival rates were 82.3% and 78.9%. Conclusions: The overall outcomes of pediatric liver transplant at our center are very promising. With improved care of younger children and the combined efforts of the parents and medical team, the number of the children receiving transplants will increase in the future. AD - [Moray, Gokhan; Tezcaner, Tugan; Akdur, Aydincan; Kirnap, Mahir; Yildirim, Sedat; Haberal, Mehmet] Baskent Univ, Sch Med, Dept Gen Surg, TR-06490 Ankara, Turkey. [Ozcay, Figen] Baskent Univ, Sch Med, Dept Pediat, TR-06490 Ankara, Turkey. [Sezgin, Atilla] Baskent Univ, Sch Med, Dept Cardiovasc Surg, TR-06490 Ankara, Turkey. [Arslan, Gulnaz] Baskent Univ, Sch Med, Dept Anesthesiol, TR-06490 Ankara, Turkey. [Arslan, Gulnaz] Baskent Univ, Sch Med, Dept Reanimat, TR-06490 Ankara, Turkey. Haberal, M (corresponding author), Taskent Caddesi 77, TR-06490 Ankara, Turkey. rectorate@baskent.edu.tr AN - WOS:000355058400013 AU - Moray, G. AU - Tezcaner, T. AU - Akdur, A. AU - Oozcay, F. AU - Sezgin, A. AU - Kirnap, M. AU - Yildirim, S. AU - Arslan, G. AU - Haberal, M. DA - Apr DO - 10.6002/ect.mesot2014.O3 J2 - Exp. Clin. Transplant. KW - Children End-stage liver failure Treatment HEPATIC-ARTERY THROMBOSIS RISK-FACTORS MANAGEMENT RECONSTRUCTION COMPLICATIONS OUTCOMES CHILDREN SOCIETY Transplantation LA - English M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: CI8YU Times Cited: 9 Cited Reference Count: 19 Moray, Gokhan Tezcaner, Tugan Akdur, Aydincan Ozcay, Figen Sezgin, Atilla Kirnap, Mahir Yildirim, Sedat Arslan, Gulnaz Haberal, Mehmet 14th Congress of the Middle-East-Society-for-Organ-Transplantation / 5th Middle East Transplant Games SEP 10-13, 2014 Istanbul, TURKEY Kirnap, Mahir/AAH-9198-2019; yildirim, sedat/AAF-4610-2019 Moray, Gokhan/0000-0003-2498-7287 9 1 2 BASKENT UNIV ANKARA EXP CLIN TRANSPLANT PY - 2015 SN - 1304-0855 SP - 59-63 ST - Results of Pediatric Liver Transplant: A Single-Center Experience T2 - Experimental and Clinical Transplantation TI - Results of Pediatric Liver Transplant: A Single-Center Experience UR - ://WOS:000355058400013 VL - 13 ID - 761756 ER - TY - JOUR AB - The objective of this study was to describe our experience (1373 days of support) with the Berlin Heart Excor (BH) ventricular-assist device (VAD) as bridging to cardiac transplantation in pediatric patients with end-stage cardiomyopathy. This study involved a retrospective observational cohort. Records of patients supported with the BH VAD were reviewed. Data regarding age, sex, weight, diagnosis, preoperative condition, single versus biventricular support, morbidity, and mortality were collected. Criteria for single versus biventricular support and intensive care unit management were registered. The procedure was approved by our Institutional Ethics Committee, and informed consent was obtained. Between March 2006 and March 2010, 12 patients with diagnosis of dilated (n = 10) and restrictive (n = 2) cardiomyopathy were supported. Median age was 56.6 months (range 20.1-165.9); mean weight was 18.3 kg (range 8.5-45); and nine patients were female. Every patient presented with severe heart failure refractory to pharmacological therapy. Biventricular support was necessary in four patients. Nine patients underwent heart transplantation. No child was weaned off the BH VAD because of myocardial recovery. Mean length of support was 73 days (range 3-331), and the total number of days of support was 1373. Three patients had fatal complications: 2 had thrombo-hemorrhagic stroke leading to brain death, and one had refractory vasoplegic shock. The BH VAD is a useful and reasonable safe device for cardiac transplantation bridging in children with end-stage heart failure. Team experience resulted in less morbidity and mortality, and time for implantation, surgical procedure, anticoagulation monitoring, and patient care improved. AD - [Moreno, Guillermo E.; Charroqui, Alberto; Pilan, Maria L.; Magliola, Ricardo H.; Krynski, Mariela P.; Althabe, Maria; Landry, Luis M.; Villa, Alejandra] Hosp Pediat Dr Juan P Garrahan, Cardiac Intens Care Unit, Buenos Aires, DF, Argentina. [Sciuccati, Gabriela] Hosp Pediat Dr Juan P Garrahan, Hematol Oncol Serv, Buenos Aires, DF, Argentina. [Villa, Alejandra] Hosp Pediat Dr Juan P Garrahan, Serv Cardiol, Buenos Aires, DF, Argentina. [Vogelfang, Horacio] Hosp Pediat Dr Juan P Garrahan, Cardiac Transplantat Serv, Buenos Aires, DF, Argentina. Moreno, GE (corresponding author), Beruti 3427,Dept 9 B, RA-1425 Buenos Aires, DF, Argentina. guillermo.moreno1@gmail.com AN - WOS:000290579100016 AU - Moreno, G. E. AU - Charroqui, A. AU - Pilan, M. L. AU - Magliola, R. H. AU - Krynski, M. P. AU - Althabe, M. AU - Landry, L. M. AU - Sciuccati, G. AU - Villa, A. AU - Vogelfang, H. DA - Jun DO - 10.1007/s00246-011-9949-0 J2 - Pediatr. Cardiol. KW - Mechanical assist device Pneumatically pulsatile assist device Cardiac transplantation End-stage heart failure Cardiac failure VENTRICULAR ASSIST DEVICES MECHANICAL CIRCULATORY SUPPORT CHILDREN TRANSPLANTATION INFANTS Cardiac & Cardiovascular Systems Pediatrics LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: 763SD Times Cited: 12 Cited Reference Count: 10 Moreno, Guillermo E. Charroqui, Alberto Pilan, Maria L. Magliola, Ricardo H. Krynski, Mariela P. Althabe, Maria Landry, Luis M. Sciuccati, Gabriela Villa, Alejandra Vogelfang, Horacio 13 0 2 SPRINGER NEW YORK PEDIATR CARDIOL PY - 2011 SN - 0172-0643 SP - 652-658 ST - Clinical Experience With Berlin Heart Excor in Pediatric Patients in Argentina: 1373 days of Cardiac Support T2 - Pediatric Cardiology TI - Clinical Experience With Berlin Heart Excor in Pediatric Patients in Argentina: 1373 days of Cardiac Support UR - ://WOS:000290579100016 VL - 32 ID - 761851 ER - TY - JOUR AB - Catheter directed infusion of thrombolytics, though beneficial in restoring blood flow to an ischemic limb, remains a high-risk procedure requiring vigilant, coordinated care to prevent complications. A multidisciplinary team that included staff from all care settings and disciplines was formed. This team used a continuous improvement process to identify system problems, analyze work processes and develop tools to standardize and guide care. Because catheter-directed peripheral thrombolytic infusion is a low volume, high-risk procedure, data were collected concurrently over 4 years on all patients. Concurrent data collection identified problems as they occurred, allowing problem analysis and resolution to begin immediately. The outcomes measured included time to initiation of thrombolytic (goal was 30 minutes or less) and the incidence of bleeding complications. Data from 61 cases from November 2003 through November 2007 were analyzed. Although the 30-minute goal for the initiation of the thrombolytic infusion was met for some time periods, it was difficult to sustain and required continued communication and collaboration. The incidence of bleeding complications were within an expected range. Concurrent data collection with real-time problem solving in a team setting enhanced the delivery of safe, effective care to a high-risk, low-volume population. AD - St Joseph Mercy Hospital, Ann Arbor, Michigan 48103, USA. AN - 19217539 AU - Morris, J. AU - Neaton, M. DA - Mar DO - 10.1016/j.jvn.2008.10.003 DP - NLM ET - 2009/02/17 J2 - Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing KW - Acute Disease Catheters, Indwelling/adverse effects Clinical Audit Drug Monitoring/methods/nursing Extremities/blood supply Fibrinolytic Agents/*administration & dosage/adverse effects Hemorrhage/chemically induced/prevention & control Humans Incidence Infusions, Intravenous/adverse effects/methods/*nursing Ischemia/etiology/prevention & control Outcome and Process Assessment, Health Care/organization & administration Patient Care Team/*organization & administration Peripheral Vascular Diseases/complications Practice Guidelines as Topic Professional Staff Committees/organization & administration Risk Factors Safety Management/*organization & administration Thrombolytic Therapy/adverse effects/methods/nursing Total Quality Management/*organization & administration LA - eng M1 - 1 N1 - 1532-6578 Morris, Joann Neaton, Marie Journal Article United States J Vasc Nurs. 2009 Mar;27(1):8-12. doi: 10.1016/j.jvn.2008.10.003. PY - 2009 SN - 1062-0303 SP - 8-12 ST - Continuous improvement process for a high-risk population: catheter-directed thrombolytic infusions T2 - J Vasc Nurs TI - Continuous improvement process for a high-risk population: catheter-directed thrombolytic infusions VL - 27 ID - 760454 ER - TY - JOUR AB - Introduction: Extracorporeal membrane oxygenation is associated with an increased risk of thrombosis and hemorrhage. Acquired antithrombin deficiency often occurs in patients receiving extracorporeal membrane oxygenation, necessitating supplementation to restore adequate anticoagulation. Criteria for antithrombin supplementation in adult extracorporeal membrane oxygenation patients are not well defined. Methods: In this retrospective observational study, adult patients receiving antithrombin supplementation while supported on extracorporeal membrane oxygenation were evaluated. Antithrombin was supplemented when anti-Xa levels were subtherapeutic with unfractionated heparin infusion rates of 15-20 units/kg/h and measured antithrombin activity <50%. Patients were evaluated for changes in degree of anticoagulation and signs of bleeding 24 hours pre- and post-antithrombin supplementation. Results: A total of 14 patients received antithrombin supplementation while on extracorporeal membrane oxygenation. The median percentage of time therapeutic anti-Xa levels were maintained was 0% (0-43%) and 40% (9-84%) in the pre-antithrombin and post-antithrombin groups, respectively (p = 0.13). No difference was observed in the number of patients attaining a single therapeutic anti-Xa level (pre-antithrombin = 6, post-antithrombin = 13; p = 0.37) or unfractionated heparin infusion rate (pre-antithrombin = 7.35 (1.95-10.71) units/kg/h, post-antithrombin = 6.81 (3.45-12.58) units/kg/h; p = 0.33). Thirteen patients (92%) achieved an antithrombin activity at goal following supplementation. Antithrombin activity was maintained within goal range 52% of the time during the replacement period. Four bleeding events occurred pre-antithrombin and 10 events post-antithrombin administration (p = 0.26) with significantly more platelets administered post-antithrombin (pre-antithrombin = 0.5 units, post-antithrombin = 4.5 units; p = 0.01). Conclusion: Therapeutic anticoagulation occurred more frequently following antithrombin supplementation; however, this difference was not statistically significant. More bleeding events occurred following antithrombin supplementation while observing an increase in platelet transfusions. AD - Department of Pharmacy Services, University of Virginia Health System, Charlottesville, VA, USA Department of Thoracic and Cardiovascular Perfusion, University of Virginia, Charlottesville, VA, USA AN - 140824107. Language: English. Entry Date: 20191228. Revision Date: 20200216. Publication Type: Article AU - Morrisette, Matthew J. AU - Zomp-Wiebe, Amanda AU - Bidwell, Katherine L. AU - Dunn, Steven P. AU - Gelvin, Michael G. AU - Money, Dustin T. AU - Palkimas, Surabhi DB - CINAHL DO - 10.1177/0267659119856229 DP - EBSCOhost KW - Fibrin -- Therapeutic Use -- In Adulthood Extracorporeal Membrane Oxygenation -- In Adulthood Thrombosis -- Prevention and Control Hemorrhage -- Prevention and Control Human Anticoagulants Adult Retrospective Design Nonexperimental Studies Heparin Electronic Health Records Wilcoxon Signed Rank Test Paired T-Tests Data Analysis Software Descriptive Statistics Platelet Transfusion Thrombosis -- Risk Factors Hemorrhage -- Risk Factors Fibrin -- Administration and Dosage M1 - 1 N1 - research; tables/charts. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 8700166. PY - 2020 SN - 0267-6591 SP - 66-72 ST - Antithrombin supplementation in adult patients receiving extracorporeal membrane oxygenation T2 - Perfusion TI - Antithrombin supplementation in adult patients receiving extracorporeal membrane oxygenation UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=140824107&site=ehost-live&scope=site VL - 35 ID - 761293 ER - TY - JOUR AB - Introduction: A two-year Stroke Ambulance (SA) pilot project was implemented at the University of Alberta Hospital (UAH) in February 2017. The objective is to evaluate the clinical and economic benefits of a SA for early thrombolysis in patients from rural Alberta who otherwise lack timely access. Methods: A steering committee and seven working groups were established, engaging stakeholders internal and external to Alberta Health Services (AHS). The multidisciplinary team (stroke fellow, advanced & primary care paramedics, registered nurse, CT technologist, and stroke neurologist via Telehealth) utilize a portable CT scanner, point of care laboratory, and videoconference system to enable stroke assessment and treatment in the field. When not dispatched, the team provides stroke expertise at UAH. The SA responds to suspected stroke patients presenting to non-stroke centres within a 250 km radius of UAH and to Edmonton hospitals without hyperacute stroke capability. Patients eligible for endovascular therapy are provided with expedited transport to UAH, with assessment en route. Results: Of 60 dispatches, 15 patients were thrombolyzed and 2 received EVT. Median time to CT was 10 minutes, median time to tPA was 22 minutes, median onset to tPA was 181 minutes. There were no complications. 20 non-stroke patients were repatriated back to their local community hospital. Conclusion: Preliminary results indicate the SA provides timely evaluation and treatment of suspected stroke from non-stroke centres and reduces avoidable admissions to overcapacity tertiary care ED's. SA team expertise provides added value to UAH. A comprehensive health economic analysis will determine cost-effectiveness and project spread. AD - L. Morrison, Alberta Health Services, Stroke Program Edmonton Zone, Edmonton, Canada AU - Morrison, L. AU - Amlani, S. AU - Kalashyan, H. AU - Jeerakathil, T. AU - Shuaib, A. DB - Embase DO - 10.1177/1747493018789543 KW - endogenous compound tissue plasminogen activator adult ambulance blood clot lysis clinical article clinical evaluation community hospital complication computed tomography scanner conference abstract controlled study cost effectiveness analysis feasibility study female human male multidisciplinary team neurologist preliminary data primary medical care registered nurse stroke patient telehealth tertiary health care videoconferencing LA - English M1 - 2 M3 - Conference Abstract N1 - L624946822 2018-11-20 PY - 2018 SN - 1747-4949 SP - 50 ST - Defining the feasibility and role of a stroke ambulance treating rural stroke patients T2 - International Journal of Stroke TI - Defining the feasibility and role of a stroke ambulance treating rural stroke patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624946822&from=export http://dx.doi.org/10.1177/1747493018789543 VL - 13 ID - 760797 ER - TY - JOUR AB - Statement of Problem Or Question (One Sentence): As communication among patient care team members is often dangerously fragmented and effective collaboration becomes essential to provide safe hospital care for patients, we implemented the Daily Medicine Rounding Tool (DMeRT) that improved collaboration between the physician and nurse. Objectives of Program/Intervention (No More Than Three Objectives): 1. We aimed to promote a patient-centered, highly reliable rounding tool to reduce hospital adverse events by streamlining real time communication between nurses and physicians. 2. We hypothesize that this tool will decrease the need for frequent calls throughout the day, ultimately improving team productivity and overall staff satisfaction. Description of Program/Intervention, Including Organizational Context (E.G. Inpatient Vs. Outpatient, Practice or Community Characteristics): In our institution, the Epic's default patient dashboard columns included patient name, venous thromboemboli (VTE) prophylaxis, Medical Orders for Life Sustaining Treatment (MOLST) completion, glycemic control, and medication reconciliation completion. Expanding upon these prior default columns, we partnered with information technology and nursing to create a customized dashboard that included additional informational columns extracted from the documentation in the charts, to include the administration of intravenous fluids, oxygen supplementation, last bowel movement recorded and high risk medications (anti-coagulants, anti-epileptics, furosemide, opioids, and benzo-diazepines). We then trained the physicians and nurses to discuss each patient using the customized DMeRT dashboard during interdisciplinary rounds. The average time spent on the DMeRT is 15 minutes for a total 10 patients. This helps as a reminder and the identification of potential pitfalls and safety concerns. The DMeRT was instituted on a 30 bed medical unit (5500) on June 1, 2018 with iterative improvements to content. Measures of Success (Discuss Qualitative And/Or Quantitative Metrics Which Will Be Used To Evaluate Program/Intervention): We will analyze data pre and post intervention to assess for impact on reducing medication errors during hospitalization, hospital acquired VTE events and improvement in glycemic control. Finally we will track MOLST completion, medication reconciliation compliance, constipation and fluid overload events added to the patient's problem list 48 hours prior to discharge. Findings To Date (It Is Not Sufficient To State Findings Will Be Discussed): To date, the unit which implemented the intervention had an improvement in the Quality Hyperglycemia Scores (method used to evaluate inpatient glycemic management) from 56 in 4/2018 to 95 in 12/2018. There was an improved MOLST completion from 14% in 4/2018 to 83% in 12/2018. A Preliminary survey of 15 nurses on unit 5500 showed that 80% reported that they rarely need to call house staff within 2 hours of completing the rounding tool and 66% of nurses were satisfied with the DMeRT. Key Lessons For Dissemination (What Can Others Take Away For Implementation To Their Practice Or Community?): During hospitalization, multiple aspects of patient care are overlooked while we focus on the admitting diagnosis, necessary diagnostics and treatments. Medication errors during hospitalization are commonly caused by breakdowns in communication and associated with substantial risk. This is a simple tool that utilizes information technology to efficiently and systematically review standardized aspects of care. AD - M. Moussa, NYU Langone, Staten Island, NY, United States AU - Moussa, M. AU - Schwartz, L. AU - Mansfield, L. AU - Knight, T. A. AU - Renaud, J. AU - Ferrauiola, M. AU - Thompson, S. AU - Okamura, C. AU - Volpicelli, F. DB - Embase DO - 10.1007/11606.1525-1497 KW - anticoagulant agent furosemide opiate oxygen adult adverse event conference abstract constipation controlled study defecation doctor nurse relation drug safety drug therapy female glycemic control hospitalization human hyperglycemia information technology life sustaining treatment male medical order medication error medication therapy management nurse outpatient patient care patient safety productivity prophylaxis quantitative analysis satisfaction systematic review LA - English M1 - 2 M3 - Conference Abstract N1 - L629003930 2019-08-27 PY - 2019 SN - 1525-1497 SP - S733 ST - Implementing a daily medicine rounding tool to promote patient safety and improve communication between physician and nurse during hospital-ization T2 - Journal of General Internal Medicine TI - Implementing a daily medicine rounding tool to promote patient safety and improve communication between physician and nurse during hospital-ization UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629003930&from=export http://dx.doi.org/10.1007/11606.1525-1497 VL - 34 ID - 760723 ER - TY - JOUR AB - SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Many institutions have implemented pulmonary embolism response teams (PERT) as a means to standardize approach to management and in hopes of improving outcomes. Some at our institution have also called for the development of a PERT. To explore whether there is a need for a PERT, we first wanted to review our experience in the inpatient setting, including outcomes. METHODS: A single-center retrospective observational study was conducted at the Mayo Clinic in Rochester, MN where cases of PE are managed without the use of a PERT. All adult inpatient admissions between 8/1/2018 and 8/1/2019 with an encounter diagnosis of pulmonary embolism were reviewed. Mortality was considered PE-specific if determined by autopsy or if the treating clinician deemed it definitely or probably due to PE. RESULTS: 430 inpatient cases of PE were identified. Active malignancy was present in 36.7% of cases. The mean PESI score at presentation was 112. All cause in-hospital mortality was 2.6%, 30 day mortality 7.5%, 3-month mortality 15.4%, and 6-month mortality 21.8%. Of the 88 patients dead at the 6-month point, 76% had active cancer. 47 of the 88 had elected hospice care as outpatients. Overall in-hospital PE cause-specific mortality was 0.7%. At the 6-month point, PE cause-specific mortality was 1.4%. 238 cases (55.3%) were classified as intermediate risk PE (submassive) at the time of diagnosis with a mean PESI score of 120. Nine in-hospital deaths (3.8%) occurred in this group; only one was cause-specific to PE. Six of the nine patients elected comfort care while clinically stable due to advanced cancer or advanced age with multiple comorbidities. Treatment was largely limited to anticoagulation alone in the submassive group. Only five patients (2.1%) had hemodynamic decompensation 12-34 hours after admission and received systemic alteplase with resultant improvement. Four of the five survived to discharge. Ten cases (2.3%) were classified as high risk (massive) PE at the time of diagnosis, of which two died. 90% were treated with systemic alteplase. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was used in three patients and ultrasound-assisted catheter directed thrombolysis in one patient. In-hospital mortality in this group was 20%; all deaths were cause-specific to PE. Eight of the ten survivors were alive at six months. CONCLUSIONS: Despite the high overall acuity of PE cases at our institution, in-hospital all-cause mortality was low and PE cause-specific mortality was rare. Malignancy was a major factor in the 6-month mortality of these patients. The oft-feared scenario of a patient presenting with a submassive PE and subsequently decompensating occurred in only five out of 238 cases. CLINICAL IMPLICATIONS: PE is rarely the direct cause of mortality. Hence a therapeutic strategy biased towards more aggressive intervention and greater adverse effects may not be ideal. DISCLOSURES: No relevant relationships by Sumera Ahmad, source=Web Response No relevant relationships by Sean Caples, source=Web Response No relevant relationships by Harsha Mudrakola, source=Web Response AU - Mudrakola, H. AU - Ahmad, S. AU - Caples, S. DB - Embase DO - 10.1016/j.chest.2020.08.1886 KW - alteplase adult advanced cancer all cause mortality anticoagulation autopsy cancer patient cancer survival clinical feature comfort comorbidity conference abstract drug therapy female hemodynamics hospice care hospital mortality hospital patient human major clinical study male observational study outpatient patient referral pulmonary embolism response team retrospective study survivor ultrasound assisted catheter directed thrombolysis veno-arterial ECMO LA - English M1 - 4 M3 - Conference Abstract N1 - L2008025316 2020-10-19 PY - 2020 SN - 1931-3543 0012-3692 SP - A2206 ST - INPATIENT MANAGEMENT OF PULMONARY EMBOLISM: CLINICAL CHARACTERISTICS AND MORTALITY IN A HIGH-VOLUME TERTIARY REFERRAL CARE CENTER T2 - Chest TI - INPATIENT MANAGEMENT OF PULMONARY EMBOLISM: CLINICAL CHARACTERISTICS AND MORTALITY IN A HIGH-VOLUME TERTIARY REFERRAL CARE CENTER UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008025316&from=export http://dx.doi.org/10.1016/j.chest.2020.08.1886 VL - 158 ID - 760537 ER - TY - JOUR AB - Aim: To assess indications and outcome of pediatric patients after living donor liver transplantation. Methods: Retrospective analysis of prospectively collected data of 131 living donor liver transplantation in 130 pediatric patients from September 2004 to December 2013. Results: study group included seventy-six males (58%), mean age 72 months (5 months-17years), mean weight of 20.8 Kg (4.2-66). Indications for transplantation were chronic liver disease in 80 (59%), acute/acute on chronic liver failure in 43 (34%) and others in 11 (7%) patients. Sixty out of 80 (75%) chronic liver disease cases were cholestatic (biliary atresia-46). Donors were parents' 85, close relatives 39, donor pool increased by swap donors 5, domino 2, and ABO incompatible 2. G-rafts used were left lateral 46 (35 %), left lobe 47 (35%), reduced left lateral 20 (15%), right lobe 15(11%) and whole liver in 2 cases (domino). Robotic/laparoscopic surgery was done in 3 donors. Complications included acute rejection in 36%, cytomegalovirus hepatitis (14), chylous ascites (5), biliary and vascular issues 14 (11.2%) and 11 (8.8%). All biliary and portal vein complications could be managed by interventional radiological/ endoscopy/surgical measures. Two patients with hepatic artery thrombosis died. Chronic rejection occurred in 4 [TABLE PRESENTED] (all died), post-transplant lymphoproliferative disorder occurred in 3 (2 died). Mean hospital stay was 23 days. Survival was 86.2% in biliary atresia and 90% in overall group on a mean follow up 31 months. Three months survival in acute/acute on chronic liver failure group was 92.6%. Conclusion: Pediatric living donor liver transplantation is well established in India with results comparable to the best centers in world. Donor pool can be increased by innovative techniques such as ABO incompatible/domino/ swap donors. Outcome in IEM group was better than cholestatic group and excellent in acute/acute on chronic liver failure. Survival was inferior in <10 kg group. Biliary and vascular complications could be well handled by a multidisciplinary team. AD - A. Mujeeb, Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Gurgaon, India AU - Mujeeb, A. AU - Mohan, N. AU - Karkra, S. AU - Dhaliwal, M. AU - Raghunathan, V. AU - Goyal, D. AU - Mohanka, R. AU - Rastogi, A. AU - Balachandran, M. AU - Goja, S. AU - Kolar, S. AU - Bhangui, P. AU - Vohra, V. AU - Gupta, N. AU - Jolly, A. AU - Kumar, P. AU - Soin, A. S. DB - Embase KW - acute graft rejection acute on chronic liver failure bile duct atresia child cholestasis chronic graft rejection chylous ascites complication Cytomegalovirus follow up hepatic artery thrombosis hepatitis hospitalization human human tissue India laparoscopic surgery liver graft living donor major clinical study male nonhuman hepatic portal vein posttransplant lymphoproliferative disease preschool child relative retrospective study surgery LA - English M3 - Conference Abstract N1 - L615343696 2017-04-18 PY - 2014 SN - 2213-3453 SP - S79-S80 ST - Liver transplantation in India-where are we? Single team experience of 131 pediatric living related liver transplants T2 - Journal of Clinical and Experimental Hepatology TI - Liver transplantation in India-where are we? Single team experience of 131 pediatric living related liver transplants UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615343696&from=export VL - 4 ID - 761124 ER - TY - JOUR AB - A 62-year-old woman presented with a small cyst (1 cm) for 20 years, but in the last 6 months it had enlarged, crusted and inflamed. She had attended her general practitioner recurrently, as well as the emergency department, where the cyst was treated as a secondary infection with both oral antibiotics and incision. However, the lesion continued to get bigger, to 3×4 cm. On examination it appeared as a raised indurated lesion with crusting and sparsity of hairs on the surface. Cervical lymph nodes were not palpable. This lesion was excised due to sudden changes of the pre-existing cyst, which was reported as a pilar cyst with extensive inflammatory reaction. The cyst wall exhibited a lobular proliferation of squamous epithelium. Although much of the epithelium was benign, focal areas could be seen with cellular pleomorphism, numerous mitoses and infiltrative architecture. The features were in keeping with a malignant proliferating tricholemmal tumour (MPTTT). The tumour was completely excised. Discussion with the skin cancer multidisciplinary team and follow-up in skin cancer clinics were arranged. MPTTs are rarely found. Although the presence of high mitotic activity, nuclear polymorphism, tumoral invasion to neighbouring tissues or metastasis can indicate MPTT, the clinical behaviour of the tumour may be incompatible with its histological characteristics in cases with proliferative tricholemmal tumour (PTT). Ye et al. classified PTTs into three groups, namely benign, low-grade malignant and high-grade malignant lesions, based on clinicopathological characteristics (Ye J, Nappi O, Swanson PE et al. Proliferating pilar tumors: a clinicopathologic study of 76 cases with a proposal for definition of benign and malignant variants. Am J Clin Pathol 2004; 122: 566-74). Group I PTTs are benign lesions, and recurrence is not observed in these lesions. They show histologically regular contours with surrounding tissues and mild nuclear atypia but do not involve increased mitotic activity, necrosis or lymphovascular invasion. Group II PTTs are low-grade malignant tumours. Local recurrence may be observed in these lesions. These tumours have histologically irregular and local invasive contours, and they elongate to the deep dermis and subcutaneous tissue. Group III PTTs are highgrade malignant tumours reported to exhibit a high recurrence rate, lymph node involvement and a tendency to develop distant metastasis. Remarkable nuclear pleomorphism, atypical mitosis, necrosis and lymphovascular invasion may be observed in these tumours. On the basis of this classification, our case can be classified as low-grade MPTT. We report an extremely rare case of MPTT of the scalp. We would like to highlight that clinicians should consider malignant transformation of cysts when sudden clinical changes occur rather than recurrent infections alone. AD - K. Mukkanna, University Hospital of Wales, Cardiff, United Kingdom AU - Mukkanna, K. AU - Patel, G. DB - Embase DO - 10.1111/bjd.17892 KW - antibiotic agent adult cancer recurrence cell proliferation cervical lymph node clinician conference abstract dermis distant metastasis emergency ward epidermoid cyst female follow up general practitioner genetic association histopathology human incision inflammation lymph vessel metastasis major clinical study malignant transformation middle aged mitosis rate multidisciplinary team necrosis recurrence risk recurrent infection scalp tumor secondary infection skin cancer squamous epithelium subcutaneous tissue trichilemmoma LA - English M3 - Conference Abstract N1 - L628867220 2019-08-14 PY - 2019 SN - 1365-2133 SP - 91 ST - Malignant proliferating trichilemmal tumour of the scalp T2 - British Journal of Dermatology TI - Malignant proliferating trichilemmal tumour of the scalp UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628867220&from=export http://dx.doi.org/10.1111/bjd.17892 VL - 181 ID - 760697 ER - TY - JOUR AB - Purpose of review This review provides a comprehensive overview of the management of acute stroke within the framework of telestroke services. Recent findings The remote neurological examination using high quality videoconferencing coupled with remote review of neuroimaging has gained acceptance and proved its reliability in various publications. Telestroke networks confirmed the safety and efficiency of telethrombolysis, with an increase in the rate of thrombolysis in recent years. The analysis of a telestroke network in Europe showed improved outcomes in a cohort of ischemic stroke patients. Summary At the beginning of the millennium, telestroke networks started to develop. Ten years later, there is a collection of about 40 various networks in North America and Europe performing teleconsultations on a regular basis. Telestroke is not a new therapeutic modality, but rather a set of tools to enable more efficient delivery of acute stroke care and to improve the quality of stroke care in neurologically underserved areas. Depending on the level of available regional resources, telestroke networks can support affiliated hospitals by implementing measures that improve the quality of stroke management such as regional campaigns, stroke units and stroke teams, medical education and programs encouraging the usage of guidelines. AD - [Mueller-Barna, Peter; Haberl, Roman L.] Stadt Klinikum Munchen GmbH, Dept Neurol, Klinikum Harlaching, D-81545 Munich, Germany. [Schwamm, Lee H.] Massachusetts Gen Hosp, Boston, MA 02114 USA. Muller-Barna, P (corresponding author), Stadt Klinikum Munchen GmbH, Dept Neurol, Klinikum Harlaching, Sanat Pl 2, D-81545 Munich, Germany. peter.mueller-barna@klinikum-muenchen.de AN - WOS:000299118100002 AU - Muller-Barna, P. AU - Schwamm, L. H. AU - Haberl, R. L. DA - Feb DO - 10.1097/WCO.0b013e32834d5fe4 J2 - Curr. Opin. Neurol. KW - acute stroke care stroke unit telemedicine telestroke thrombolysis TELEMEDIC PILOT PROJECT ACUTE ISCHEMIC-STROKE REMOTE EVALUATION POOLED ANALYSIS CARE TEMPIS THROMBOLYSIS RELIABILITY IMPLEMENTATION FEASIBILITY EXPERIENCE Clinical Neurology Neurosciences LA - English M1 - 1 M3 - Review N1 - ISI Document Delivery No.: 876OX Times Cited: 39 Cited Reference Count: 53 Mueller-Barna, Peter Schwamm, Lee H. Haberl, Roman L. Schwamm, Lee/0000-0003-0592-9145 39 0 6 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA CURR OPIN NEUROL PY - 2012 SN - 1350-7540 SP - 5-10 ST - Telestroke increases use of acute stroke therapy T2 - Current Opinion in Neurology TI - Telestroke increases use of acute stroke therapy UR - ://WOS:000299118100002 VL - 25 ID - 761835 ER - TY - JOUR AB - Introduction: Stroke units improve patient outcomes. A key component of these units is co-ordinated working of multidisciplinary teams (MDT). Development and maintenance of the skills and knowledge of the MDT staff is crucial to patient well-being. Stroke specific MDT training programmes traversing the whole patient pathway are not always freely available. The current educational programme was developed to address this deficiency in stroke education. Method: A Multidisciplinary Stroke Course, run by Nottingham University Hospitals (NUH) & Health Education East Midlands was targeted at MDT stroke staff and delivered throughout 2013. Education was delivered by stroke physicians, physiotherapists, occupational & speech therapists, a stroke survivor, psychologists, early supported discharge teams & palliative care staff. Topics also included anatomy, physiology, pharmacology, thrombolysis, NIHSS training, recognition and treatment of stroke complications, and the role of nurses in hyperacute & rehabilitation settings. Qualitative & quantitative evaluation was conducted throughout the programme. Results: Over 70% of respondents to a delegate questionnaire agreed the course had improved their knowledge, confidence, job satisfaction and patient, carer & MDT communication. Furthermore 94.1% agreed the course influenced their professional practice. Qualitative data from delegate feedback forms indicate that delegates valued the MDT emphasis of the course. The average number of attendees increased throughout the year. In addition, 60.9% of respondents to an NUH stroke staff survey believed there had been improvements in their workplace as a result of staff attending. Conclusions: The professional appreciation and popularity for such a stroke educational programme was demonstrated by the increasing number of attendees and the positive feedback the course received. Education of MDT has positive effects on MDT members and has the potential to improve stroke patient outcomes. AD - S. Munshi, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom AU - Munshi, S. AU - Rowley, H. AU - Sprigg, N. AU - Valand, R. AU - Shetty, A. AU - Palmer, T. AU - Padamsey, R. AU - Barringham, A. AU - Kennie, J. AU - Grace, E. DB - Embase KW - anatomy blood clot lysis clinical study doctor patient relationship education program health education human job satisfaction National Institutes of Health Stroke Scale nurse palliative therapy physiology physiotherapist positive feedback professional practice psychologist quantitative study questionnaire rehabilitation speech stroke patient survivor university workplace LA - English M3 - Conference Abstract N1 - L614324112 2017-02-10 PY - 2014 SN - 1421-9786 SP - 320 ST - The positive impact and professional appreciation of a multidisciplinary stroke education programme T2 - Cerebrovascular Diseases TI - The positive impact and professional appreciation of a multidisciplinary stroke education programme UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614324112&from=export VL - 37 ID - 761111 ER - TY - JOUR AB - Context: Currently most automated methods to identify patient safety occurrences rely on administrative data codes; however, free-text searches of electronic medical records could represent an additional surveillance approach.Objective: To evaluate a natural language processing search-approach to identify postoperative surgical complications within a comprehensive electronic medical record.Design, Setting, and Patients: Cross-sectional study involving 2974 patients undergoing inpatient surgical procedures at 6 Veterans Health Administration (VHA) medical centers from 1999 to 2006.Main Outcome Measures: Postoperative occurrences of acute renal failure requiring dialysis, deep vein thrombosis, pulmonary embolism, sepsis, pneumonia, or myocardial infarction identified through medical record review as part of the VA Surgical Quality Improvement Program. We determined the sensitivity and specificity of the natural language processing approach to identify these complications and compared its performance with patient safety indicators that use discharge coding information.Results: The proportion of postoperative events for each sample was 2% (39 of 1924) for acute renal failure requiring dialysis, 0.7% (18 of 2327) for pulmonary embolism, 1% (29 of 2327) for deep vein thrombosis, 7% (61 of 866) for sepsis, 16% (222 of 1405) for pneumonia, and 2% (35 of 1822) for myocardial infarction. Natural language processing correctly identified 82% (95% confidence interval [CI], 67%-91%) of acute renal failure cases compared with 38% (95% CI, 25%-54%) for patient safety indicators. Similar results were obtained for venous thromboembolism (59%, 95% CI, 44%-72% vs 46%, 95% CI, 32%-60%), pneumonia (64%, 95% CI, 58%-70% vs 5%, 95% CI, 3%-9%), sepsis (89%, 95% CI, 78%-94% vs 34%, 95% CI, 24%-47%), and postoperative myocardial infarction (91%, 95% CI, 78%-97%) vs 89%, 95% CI, 74%-96%). Both natural language processing and patient safety indicators were highly specific for these diagnoses.Conclusion: Among patients undergoing inpatient surgical procedures at VA medical centers, natural language processing analysis of electronic medical records to identify postoperative complications had higher sensitivity and lower specificity compared with patient safety indicators based on discharge coding. AD - Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA AN - 108254437. Language: English. Entry Date: 20110909. Revision Date: 20200708. Publication Type: journal article AU - Murff, H. J. AU - FitzHenry, F. AU - Matheny, M. E. AU - Gentry, N. AU - Kotter, K. L. AU - Crimin, K. AU - Dittus, R. S. AU - Rosen, A. K. AU - Elkin, P. L. AU - Brown, S. H. AU - Speroff, T. AU - Murff, Harvey J. AU - FitzHenry, Fern AU - Matheny, Michael E. AU - Gentry, Nancy AU - Kotter, Kristen L. AU - Crimin, Kimberly AU - Dittus, Robert S. AU - Rosen, Amy K. AU - Elkin, Peter L. DB - CINAHL DO - 10.1001/jama.2011.1204 DP - EBSCOhost KW - Electronic Health Records Information Retrieval Natural Language Processing Postoperative Complications -- Epidemiology Clinical Indicators Automation Cross Sectional Studies Diagnosis-Related Groups Hospitalization Hospitals, Veterans -- Statistics and Numerical Data Inpatients International Classification of Diseases Myocardial Infarction -- Epidemiology Patient Discharge -- Statistics and Numerical Data Pneumonia -- Epidemiology Population Surveillance Pulmonary Embolism -- Epidemiology Renal Insufficiency -- Epidemiology Safety Sensitivity and Specificity Sepsis -- Epidemiology Surgery, Operative United States Venous Thrombosis -- Epidemiology M1 - 8 N1 - research. Journal Subset: Biomedical; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. NLM UID: 7501160. PMID: NLM21862746. PY - 2011 SN - 0098-7484 SP - 848-855 ST - Automated identification of postoperative complications within an electronic medical record using natural language processing T2 - JAMA: Journal of the American Medical Association TI - Automated identification of postoperative complications within an electronic medical record using natural language processing UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=108254437&site=ehost-live&scope=site VL - 306 ID - 761297 ER - TY - JOUR AB - Background Pulmonary embolism (PE) manifests with a variety of clinical presentations. Institutions have formed Pulmonary Embolism Response Teams (PERTs) to assess PE patients in a multidisciplinary approach to target treatments appropriately. Recent literature suggests that establishment of PERTs is associated with increased patient access to advanced therapies for PE treatment, which may improve outcomes, but data are limited. Methods All intermediate- and high-risk PE patients in 2018 were retrospectively identified from an academic tertiary care center. These patients were then grouped to those referred to PERT (n=190) and those not referred to PERT (non-PERT) (n=133). Differences in advanced PE treatments, incidence of bleeding events (any), length of stay (LOS), and in-hospital mortality were assessed between the two groups. Statistical analysis was conducted by calculating odds ratios for categorical data and t-tests for continuous data. Results Average age of the overall cohort was 63 ± 17 years and 52% of patients were female. The groups exhibited similar incidence of bleeding events (18.5% vs. 17.0%, p=0.79) and in-hospital mortality (11.1% vs. 11.9%, p=0.42), but PERT patients had significantly shorter average LOS than non-PERT (13.5 days vs. 19.1, p=0.004). PERT patients were significantly more likely to receive either catheter-directed thrombolysis, catheter-based mechanical thrombectomy, or surgical thrombectomy compared to non-PERT patients (27.4% vs. 2.3%, p=0.0001). There were no differences in LOS or for the composite endpoint of bleeding and in-hospital mortality in patients who received advanced therapy compared to those that did not (13.9 days vs. 16.5, p=0.27 for LOS; 19.6% vs. 27.5%, p=0.35 for bleeding/mortality). Conclusion This analysis shows PERT referral at our institution is associated with decreased LOS and increased likelihood of PE patients receiving catheter-based or surgical procedures. While increased access to procedures alone does not appear to be associated with improved in-hospital outcomes, further research is necessary to elucidate patient-level factors that may account for these findings. AU - Murphy, A. AU - Zilinyi, R. AU - Saleem, D. AU - Madhavan, M. AU - Nouri, S. N. AU - Einstein, A. J. AU - Sreekanth, S. AU - Su, H. Q. AU - Capua, J. AU - Brodie, D. AU - Leb, J. AU - Rosenzweig, E. B. AU - Hamid, N. AU - Takeda, K. AU - Kirtane, A. AU - Parikh, S. AU - Sethi, S. S. AU - Green, P. DB - Embase DO - 10.1016/S0735-1097(20)32901-6 KW - adult bleeding catheter directed thrombolysis cohort analysis conference abstract controlled study female hospital mortality human incidence length of stay major clinical study mechanical thrombectomy middle aged pulmonary embolism response team retrospective study risk assessment surgical technique surgical thrombectomy tertiary care center LA - English M1 - 11 M3 - Conference Abstract N1 - L2005039651 2020-04-07 PY - 2020 SN - 1558-3597 0735-1097 SP - 2274 ST - THE IMPACT OF PULMONARY EMBOLISM RESPONSE TEAMS ON THE UTILIZATION OF ADVANCED THERAPIES IN INTERMEDIATE AND HIGH RISK PULMONARY EMBOLISM PATIENTS T2 - Journal of the American College of Cardiology TI - THE IMPACT OF PULMONARY EMBOLISM RESPONSE TEAMS ON THE UTILIZATION OF ADVANCED THERAPIES IN INTERMEDIATE AND HIGH RISK PULMONARY EMBOLISM PATIENTS UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005039651&from=export http://dx.doi.org/10.1016/S0735-1097(20)32901-6 VL - 75 ID - 760585 ER - TY - JOUR AB - Background Specialty societies, such as the International Society on Thrombosis and Haemostasis (ISTH), are a key source of support for clinical and scientific communities, through the provision of educational activities, tools, and resources to support evidence-based care and high-quality, relevant basic science and clinical research. Objective The aim of this study was to identify areas where the thrombosis and hemostasis (T&H) community is facing challenges and could benefit from the support of ISTH. Methods A 3-phase, mixed-methods study consisting of semistructured individual interviews (phase 1), an online survey (phase 2), and discussion groups (phase 3) was conducted on the challenges experienced by the T&H community. Participants included physicians, clinical and basic science researchers, residents, fellows, students, and industry representatives. Qualitative data were analyzed using thematic analysis. Quantitative data were analyzed using frequency tables and chi-squares. Results The study included 468 participants in interviews (n = 45), surveys (n = 404), and discussion groups (n = 19). Nine themes emerged that describe areas where the T&H community may benefit from additional support. Three areas were related to diagnosis and testing: thrombosis risk assessment, genetic testing, and diagnosis of von Willebrand disease (VWD). Another 3 were related to treatment decision making: use of anticoagulants with certain patients, preventive treatments in bleeding disorders, and VWD treatment. The remaining 3 were related to research: collaboration with/among researchers, collaboration between teams to collect data from human subjects, and promotion of basic science research. Conclusions This study provides a comprehensive picture of priorities within the T&H community, which should inform the ISTH in its future interventions, including educational offerings and networking opportunities. AD - [Murray, Suzanne] AXDEV Grp Inc, Brossard, PQ, Canada. [McLintock, Claire] Auckland City Hosp, Natl Womens Hlth, Auckland, New Zealand. [Lazure, Patrice; Peniuta, Morgan] AXDEV Grp Inc, Performance Improvement Res, Brossard, PQ, Canada. [Schulman, Sam] McMaster Univ, Dept Internal Med, Hamilton, ON, Canada. [Rezende, Suely M.] Univ Fed Minas Gerais, Fac Med, Belo Horizonte, MG, Brazil. [Morrissey, James H.] Univ Michigan, Sch Med, Dept Biol Chem, Ann Arbor, MI 48109 USA. [Reiser, Thomas] ISTH, Carrboro, NC USA. [Pabinger, Ingrid] Med Univ Vienna, Dept Haematol & Haemostaseol, Vienna, Austria. Murray, S (corresponding author), 8 Pl Commerce,Suite 210, Brossard, PQ J4W 3H2, Canada. murrays@axdevgroup.com AN - WOS:000489316800009 AU - Murray, S. AU - McLintock, C. AU - Lazure, P. AU - Peniuta, M. AU - Schulman, S. AU - Rezende, S. M. AU - Morrissey, J. H. AU - Reiser, T. AU - Pabinger, I. DA - Oct DO - 10.1002/rth2.12237 J2 - Res. Pract. Thromb. Haemost. KW - blood coagulation disorders clinical competence hemostasis medical research priorities societies thrombosis MIXED METHODS COAGULATION SYSTEM CARE Hematology LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: JC5JC Times Cited: 0 Cited Reference Count: 34 Murray, Suzanne McLintock, Claire Lazure, Patrice Peniuta, Morgan Schulman, Sam Rezende, Suely M. Morrissey, James H. Reiser, Thomas Pabinger, Ingrid Lazure, Patrice/0000-0002-9278-1718; McLintock, Claire/0000-0002-4771-8760; Morrissey, James/0000-0002-1570-1569 ISTH education research funds Funding for AXDEV Group to conduct this study came from ISTH education research funds. 0 WILEY HOBOKEN RES PRACT THROMB HAE PY - 2019 SP - 626-638 ST - Needs and challenges among physicians and researchers in thrombosis and hemostasis: Results from an international study T2 - Research and Practice in Thrombosis and Haemostasis TI - Needs and challenges among physicians and researchers in thrombosis and hemostasis: Results from an international study UR - ://WOS:000489316800009 VL - 3 ID - 761491 ER - TY - JOUR AB - BACKGROUND & AIMS: The impact of cirrhosis or prior liver transplant on maternal health during pregnancy has not been studied. We sought to characterize outcomes during labor and delivery among pregnant women with these 2 conditions. METHODS: A population-based cohort study of women admitted for labor and delivery to US hospitals between 1998 and 2005 was conducted using the Nationwide Inpatient Sample database. We compared health outcomes between pregnant women with cirrhosis or liver transplant with those without known liver disease, adjusting for potential confounders. RESULTS: The rates of cesarean section were higher among pregnant women with cirrhosis (n = 187; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.7-3.4) and those with prior liver transplant (n = 86; aOR, 1.8; 95% CI, 1.0-3.2), compared with general obstetrical patients (n = 662,408), as were the rates of preterm labor, peripartum infection, and hypertension. The rates of death (aOR, 42.5; 95% CI, 8.5-214), venous thromboembolism (aOR, 12.3; 95% CI, 4.9-31.0), and protein-calorie malnutrition (aOR, 67.4; 95% CI, 7.5-603), as well as the rates of placental abruption and peripartum blood transfusion, were specifically higher in cirrhotic women. Women with clinically apparent decompensated cirrhosis had higher rates of cesarean delivery, preterm labor, placenta previa, and peripartum blood transfusion than women with compensated cirrhosis. CONCLUSIONS: Pregnant women with cirrhosis or prior liver transplant are at higher risk of developing numerous adverse health problems than pregnant women without these conditions. Further prospective studies are warranted to assess the benefit of aggressive preventative measures and involvement of multidisciplinary health care teams. AD - [Murthy, Sanjay K.; Nguyen, Geoffrey C.] Univ Toronto, Mt Sinai Hosp, Div Gastroenterol, Toronto, ON M5G 1X5, Canada. [Heathcote, E. Jenny] Univ Toronto, Univ Hlth Network, Div Gastroenterol, Toronto, ON M5G 1X5, Canada. [Nguyen, Geoffrey C.] Johns Hopkins Sch Med, Div Gastroenterol & Hepatol, Baltimore, MD USA. Nguyen, GC (corresponding author), Univ Toronto, Mt Sinai Hosp, Div Gastroenterol, 600 Univ Ave,Suite 437, Toronto, ON M5G 1X5, Canada. geoff.nguyen@utoronto.ca AN - WOS:000277420600023 AU - Murthy, S. K. AU - Heathcote, E. J. AU - Nguyen, G. C. DA - Dec DO - 10.1016/j.cgh.2009.08.008 J2 - Clin. Gastroenterol. Hepatol. KW - PREGNANCY MANAGEMENT THROMBOSIS HEPATITIS ICD-9-CM DISEASE Gastroenterology & Hepatology LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: 592ZM Times Cited: 17 Cited Reference Count: 28 Murthy, Sanjay K. Heathcote, E. Jenny Nguyen, Geoffrey C. Nguyen, Geoffrey/C-4614-2015 Nguyen, Geoffrey/0000-0001-7083-7429; Murthy, Sanjay/0000-0002-0128-7897 Foundation for Digestive Health and Nutrition This work was supported by an AGA Research Scholar Award by the Foundation for Digestive Health and Nutrition (G.C.N.). The sponsor had no role in the study design, collection, analysis, or interpretation of data. 17 0 1 ELSEVIER SCIENCE INC NEW YORK CLIN GASTROENTEROL H PY - 2009 SN - 1542-3565 SP - 1367-1372 ST - Impact of Cirrhosis and Liver Transplant on Maternal Health During Labor and Delivery T2 - Clinical Gastroenterology and Hepatology TI - Impact of Cirrhosis and Liver Transplant on Maternal Health During Labor and Delivery UR - ://WOS:000277420600023 VL - 7 ID - 761887 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. PMID:32845326 AU - Muzikansky, Alona AU - Cameron, Scott AU - Giri, Jay AU - Heresi, Gustavo A. AU - Jaber, Wissam AU - Wood, Todd AU - Todoran, Thomas M. AU - Courtney, D. Mark AU - Tapson, Victor AU - Kabrhel, Christopher DA - 2020/08/26 08/26 DB - PubMed Central DO - 10.1001/jamanetworkopen.2020.10779 M1 - 8 PY - 2020 SN - 2574-3805 ST - Comparison of 4 Acute Pulmonary Embolism Mortality Risk Scores in Patients Evaluated by Pulmonary Embolism Response Teams T2 - JAMA Network Open TI - Comparison of 4 Acute Pulmonary Embolism Mortality Risk Scores in Patients Evaluated by Pulmonary Embolism Response Teams UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7450352&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7450352 VL - 3 ID - 762002 ER - TY - JOUR AB - SESSION TITLE: Assessment and Outcomes in Pulmonary Thromboembolism SESSION TYPE: Original Investigations PRESENTED ON: 10/20/2019 2:15 PM - 3:15 PM PURPOSE: To determine changes in utilization of advanced therapies in the management of acute intermediate and high risk PE in the PERT era compared to pre-PERT era at the University of Virginia Medical Center (UVAMC). METHODS: A protocol was developed at UVAMC for acute intermediate risk or high risk PEs. PERT is activated, the on-call physician evaluates cases via a multidisciplinary conference call and recommendations for further treatment are provided. Using the electronic health record and clinical data repository, we retrospectively collected data on 245 patients with confirmed PE between January 2014 and July 2015 that occurred prior to initiation of PERT and 113 patients with confirmed PE after initiation of PERT between April 2017 and October 2018. RESULTS: In the pre-PERT era, most patients with PE received anticoagulation alone, with a small cohort of 20% patients receiving IVC filter and an additional 2.5% of patients received advanced therapies, which included thrombolysis (n=1) and thrombectomy (n=5). In comparison, of those patients treated by the PERT, 98% received anticoagulation at some point during their hospitalization, 14% received IVC filter and 22% received advanced therapies, which included CDT (n=16), systemic thrombolysis (n=5) and ECMO (n=4). Additionally, 30-day all-cause mortality for patients managed via PERT was 7%, lower than the historical mortality at UVAMC of 15%. When taking into consideration PESI score, 69% of patients had PESI > 3 in the PERT group compared to the 68% in the pre-PERT era. CONCLUSIONS: A multidisciplinary team based approach in patients with acute PE at UVAMC shows increased use of advanced therapies and less use of IVC filters with improved mortality rates in cohorts comprised of similar risk. Whether increased use of advanced therapies improves long-term outcomes after PE such as faster recovery time, less long-term oxygen use and less occurrence of CTEPH or post PE syndrome will need to be assessed. CLINICAL IMPLICATIONS: Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States. Due to scarcity of data in managing intermediate and high-risk pulmonary embolism, guidelines do not provide clear direction in their management. Diagnosis and management spans multiple disciplines and requires prompt and definitive management. Recent modalities such as catheter directed therapies (CDT), systemic lysis, extracorporeal membrane oxygenation (ECMO) or surgical embolectomies are being used to reduce mortality and morbidity. At the University of Virginia Medical Center (UVAMC), we developed a PE response team (PERT) to allow for quick identification of intermediate and high risk PE, encourage multidisciplinary discussion and provide individualized treatment to reduce mortality and provide long term care of these patients. DISCLOSURES: No relevant relationships by Alex Kadl, source=Web Response No relevant relationships by Lukasz Myc, source=Web Response No relevant relationships by Nebil Nuradin, source=Web Response No relevant relationships by Aditya Sharma, source=Web Response No relevant relationships by Jigna Solanki, source=Web Response AU - Myc, L. AU - Solanki, J. AU - Nuradin, N. AU - Sharma, A. AU - Kadl, A. DB - Embase DO - 10.1016/j.chest.2019.08.103 KW - oxygen adult all cause mortality anticoagulation blood clot lysis catheter chronic thromboembolic pulmonary hypertension clinical data repository cohort analysis conference abstract controlled study electronic health record embolectomy extracorporeal oxygenation female filter hospitalization human long term care major clinical study male morbidity mortality rate practice guideline pulmonary embolism response team retrospective study surgery thrombectomy United States LA - English M1 - 4 M3 - Conference Abstract N1 - L2002984194 2019-10-02 PY - 2019 SN - 1931-3543 0012-3692 SP - A18 ST - THE EFFECT OF A PULMONARY EMBOLISM RESPONSE TEAM (PERT) AT UNIVERSITY OF VIRGINIA MEDICAL CENTER ON UTILIZATION OF ADVANCED THERAPIES AND PATIENT OUTCOMES T2 - Chest TI - THE EFFECT OF A PULMONARY EMBOLISM RESPONSE TEAM (PERT) AT UNIVERSITY OF VIRGINIA MEDICAL CENTER ON UTILIZATION OF ADVANCED THERAPIES AND PATIENT OUTCOMES UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002984194&from=export http://dx.doi.org/10.1016/j.chest.2019.08.103 VL - 156 ID - 760666 ER - TY - JOUR AB - BACKGROUND: Acute pulmonary embolism remains a significant cause of mortality and morbidity worldwide. Benefit of recently developed multidisciplinary PE response teams (PERT) with higher utilization of advanced therapies has not been established. METHODS: To evaluate patient-centered outcomes and cost-effectiveness of a multidisciplinary PERT we performed a retrospective analysis of 554 patients with acute PE at the university of Virginia between July 2014 and June 2015 (pre-PERT era) and between April 2017 through October 2018 (PERT era). Six-month survival, hospital length-of-stay (LOS), type of PE therapy, and in-hospital bleeding were assessed upon collected data. RESULTS: 317 consecutive patients were treated for acute PE during an 18-month period following institution of a multidisciplinary PE program; for 120 patients PERT was activated (PA), the remaining 197 patients with acute PE were considered as a separate, contemporary group (NPA). The historical, comparator cohort (PP) was composed of 237 patients. These 3 groups were similar in terms of baseline demographics, comorbidities and risk, as assessed by the Pulmonary Embolism Severity Index (PESI). Patients in the historical cohort demonstrated worsened survival when compared with patients treated during the PERT era. During the PERT era no statistically significant difference in survival was observed in the PA group when compared to the NPA group despite significantly higher severity of illness among PA patients. Hospital LOS was not different in the PA group when compared to either the NPA or PP group. Hospital costs did not differ among the 3 cohorts. 30-day re-admission rates were significantly lower during the PERT era. Rates of advanced therapies were significantly higher during the PERT era (9.1% vs. 2%) and were concentrated in the PA group (21.7% vs. 1.5%) without any significant rise in in-hospital bleeding complications. CONCLUSIONS: At our institution, all-cause mortality in patients with acute PE has significantly and durably decreased with the adoption of a PERT program without incurring additional hospital costs or protracting hospital LOS. Our data suggest that the adoption of a multidisciplinary approach at some institutions may provide benefit to select patients with acute PE. AD - Department of Medicine, Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, USA. Department of Medicine, University of Virginia, Charlottesville, USA. Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, USA. Department of Radiology and Medical Imaging, Division of Vascular and Interventional Radiology, University of Virginia, Charlottesville, USA. Department of Medicine, Division of Cardiovascular Medicine, University of Virginia, Charlottesville, USA. Department of Medicine, Division of Pulmonary and Critical Care, University of Virginia, Charlottesville, USA. ak5sc@hscmail.mcc.virginia.edu. Department of Pharmacology, University of Virginia, Charlottesville, VA, USA. ak5sc@hscmail.mcc.virginia.edu. AN - 32571318 AU - Myc, L. A. AU - Solanki, J. N. AU - Barros, A. J. AU - Nuradin, N. AU - Nevulis, M. G. AU - Earasi, K. AU - Richardson, E. D. AU - Tsutsui, S. C. AU - Enfield, K. B. AU - Teman, N. R. AU - Haskal, Z. J. AU - Mazimba, S. AU - Kennedy, J. L. W. AU - Mihalek, A. D. AU - Sharma, A. M. AU - Kadl, A. C2 - Pmc7310489 DA - Jun 22 DO - 10.1186/s12931-020-01422-z DP - NLM ET - 2020/06/24 J2 - Respiratory research KW - Acute pulmonary embolism Acute pulmonary embolism interventions Pert Pulmonary embolism response team LA - eng M1 - 1 N1 - 1465-993x Myc, Lukasz A Solanki, Jigna N Barros, Andrew J Nuradin, Nebil Nevulis, Matthew G Earasi, Kranthikiran Richardson, Emily D Tsutsui, Shawn C Enfield, Kyle B Teman, Nicholas R Haskal, Ziv J Mazimba, Sula Kennedy, Jamie L W Mihalek, Andrew D Sharma, Aditya M Kadl, Alexandra Orcid: 0000-0001-6285-574x Journal Article Respir Res. 2020 Jun 22;21(1):159. doi: 10.1186/s12931-020-01422-z. PY - 2020 SN - 1465-9921 (Print) 1465-9921 SP - 159 ST - Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism T2 - Respir Res TI - Adoption of a dedicated multidisciplinary team is associated with improved survival in acute pulmonary embolism VL - 21 ID - 760161 ER - TY - JOUR AB - Liver transplantation (LT) is the gold standard for end-stage liver disease (Prince Postgrad Med J 78:135-141, 2002). LT is a technically demanding operation. It needs experienced surgical team along with good anesthesia and critical care support (David et al. Gastroenterol Clin North Am 17:1-18, 1988). Survival after LT is approximately 90% at 1 year. Unlike other organs, 1 and 10-year survival for liver transplantation are the same (Jain and Reyes Ann Surg 232(4):490-500, 2000). Complications after LT are classified into technical, infective, and immunological (Moon and Lee Gut Liver 3(3):145-165, 2009). Re-exploratory laparotomy (REL) is one of the surgical complications of LT. Our study was aimed at analyzing the indications and impact of REL on the patient outcomes after living donor liver transplantation in our center. Retrospective analysis of all LTs done at our center by the same surgical team from January 1 2011 to June 30 2016 was included in the study. Pediatric transplants, combined liver kidney transplants, cadaveric transplants, planned REL, and re-transplantations were excluded from the study. Re-explored patients (REL) were classified as study group, and non-re-explored (NREL) patients were used as controls for statistical comparison. Twenty-five parameters (preoperative, intraoperative, and postoperative) between the two groups were studied. SPSS 22 statistical software was used for statistical analysis. The total number of LT during the study period was 1352. After exclusion, 1241 patients were in the study group. REL group had 111 patients. Out of 111 patients, 97 had one REL, 13 patients had two RELs, and 1 had three RELs. Hence, there were 126 RELs in 111 patients. NREL group had 1140 patients. REL rate in our series was 10.02%. On univariate analysis of 25 parameters analyzed between the two groups, age, graft weight, multiple bile ducts, and mortality were found to be statistically significant (P < 0.05). Preoperative total leucocyte count, model for end-stage liver disease, and warm ischemia time were statistically significant (P < 0.1). On subgroup analysis of REL, bleeding was the commonest indication followed by intraabdominal sepsis. Delayed non-function and small for size had high mortality rates. Multiple RELs were associated with higher mortality compared to single REL (P < 0.05). REL is associated with poor prognosis after adult living donor liver transplantation. AD - [Naganathan, Selvakumar; Gupta, Subash] Indraprasta Apollo Hosp, Liver Transplantat Surg, New Delhi 110074, India. [Gupta, Subash] 101 Sangam Appts,West Enclave, New Delhi 110034, India. Naganathan, S (corresponding author), Indraprasta Apollo Hosp, Liver Transplantat Surg, New Delhi 110074, India. ssnsk@ymail.com AN - WOS:000439798500007 AU - Naganathan, S. AU - Gupta, S. DA - Aug DO - 10.1007/s12262-017-1606-2 J2 - Indian J. Surg KW - Living donor liver transplantation Re-exploratory laparotomy Mortality MELD score Multiple bile ducts Graft weight Warm ischemia time Total leucocyte count Multiple re-exploratory laparotomies BILIARY COMPLICATIONS MANAGEMENT THROMBOSIS DISEASE ERA Surgery LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: GO2KE Times Cited: 0 Cited Reference Count: 19 Naganathan, Selvakumar Gupta, Subash 0 1 SPRINGER INDIA NEW DELHI INDIAN J SURG PY - 2018 SN - 0972-2068 SP - 340-346 ST - Indications and Outcomes of Re-Exploratory Laparotomy in Adult Living Donor Liver Transplantation-Single-Center Experience of 1352 Consecutive Liver Transplantations from Indian Subcontinent T2 - Indian Journal of Surgery TI - Indications and Outcomes of Re-Exploratory Laparotomy in Adult Living Donor Liver Transplantation-Single-Center Experience of 1352 Consecutive Liver Transplantations from Indian Subcontinent UR - ://WOS:000439798500007 VL - 80 ID - 761576 ER - TY - JOUR AB - Acute traumatic aortic injury (ATAI) is a life-threatening injury. CT is the imaging tool of choice, and the knowledge of direct and indirect signs of injury, grading system, and current management protocol helps the emergency radiologist to better identify and classify the injury and provide additional details that can impact management options. Newer dual-source CT technology with ultrafast acquisition speed has also influenced the appropriate protocol for imaging in patients with suspected ATAI. This review highlights the imaging protocol in patients with blunt trauma, CT appearance and grading systems of ATAI, management options, and the role of the multidisciplinary team in the management of these patients. We also briefly review the current literature on the definition, treatment, and follow-up protocol in patients with minimal aortic injury. AD - P. Nagpal, Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States AU - Nagpal, P. AU - Mullan, B. F. AU - Sen, I. AU - Saboo, S. S. AU - Khandelwal, A. DB - Embase Medline DO - 10.1007/s00270-017-1572-x KW - aortic trauma article blood pressure regulation blunt trauma cardiac imaging cardiac patient cardiopulmonary bypass cardiovascular magnetic resonance computed tomography scanner computer assisted tomography conservative treatment disease course follow up heart rate human nuclear magnetic resonance imaging practice guideline priority journal radiation dose radiologist thoracotomy thorax radiography treatment planning whole body CT LA - English M1 - 5 M3 - Article N1 - L614072261 2017-01-19 2017-04-27 PY - 2017 SN - 1432-086X 0174-1551 SP - 643-654 ST - Advances in Imaging and Management Trends of Traumatic Aortic Injuries T2 - CardioVascular and Interventional Radiology TI - Advances in Imaging and Management Trends of Traumatic Aortic Injuries UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614072261&from=export http://dx.doi.org/10.1007/s00270-017-1572-x VL - 40 ID - 760940 ER - TY - JOUR AB - Purpose. The approach and results for identifying and characterizing preventable adverse drug events (pADEs) that are key targets for pharmacist medication therapy management (MTM) are summarized. Methods. This study was part of a larger effort aimed at developing an electronic health record--based prediction model (the complexity score, or C-score) that ranks hospitalized patients according to their risk for pADEs. An environmental scan of published epidemiologic pADE studies and national patient safety priority areas was conducted. The final list of candidate pADEs was then disseminated to ASHP members and a national technical expert panel (TEP) to evaluate the importance, prevalence, severity, preventability, and measurability of these pADEs. Polychoric correlation tests were performed to evaluate and quantify associations between importance and any of the constructs' mean rankings for each individual pADE. Results. The environmental scan yielded a total of 21 candidate pADEs, including drug-induced acute kidney injury, falls, respiratory depression, altered mental status, hemorrhage, hepatic failure, hypoglycemia, seizures, hypotension and bradycardia, ileus, blood dyscrasias, severe electrolyte imbalances, prolonged hyperglycemia, uncontrolled hypertension, uncontrolled arrhythmia, stress ulcers, hospital-acquired infections, uncontrolled hospital-acquired or community-acquired infection, uncontrolled pain, and venous thromboembolism. The survey confirmed all pADEs were important. Ranking of overall importance was mainly driven by perceived pADE severity and, to a lesser extent, by preventability and prevalence ratings. Conclusion. A literature review and survey of ASHP and TEP members were used to compile a list of important hospital-acquired pADEs for incorporation into a model for prioritizing patients for MTM services. AD - Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL Pharm.D., BCPS, Department of Pharmacy Services, UF Health Shands Hospital, Gainesville, FL M.T., M.B.A., UF Health Shands Hospital, Gainesville, FL Ph.D., Department of Biostatistics, College of Public Health and Health Professions, and Department of Biostatistics, College of Medicine, University of Florida, Gainesville, FL Ph.D., Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL B.S.Pharm., Ph.D., FISPE, Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, and Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL AN - 125885795. Language: English. Entry Date: 20171027. Revision Date: 20171030. Publication Type: Article AU - Nakyung, Jeon AU - Staley, Ben AU - Johns, Thomas AU - Pflugfelder Lipori, Glori AU - Brumback, Babette AU - Segal, Richard AU - Winterstein, Almut G. DB - CINAHL DO - 10.2146/ajhp160387 DP - EBSCOhost KW - Adverse Drug Event -- Prevention and Control Pharmacists Hospitals Medication Management Electronic Health Records Models, Theoretical Patient Safety Kidney Failure, Acute -- Chemically Induced Accidental Falls Mental Status Hemorrhage -- Chemically Induced Liver Failure -- Chemically Induced Hypoglycemia -- Chemically Induced Seizures -- Chemically Induced Hypotension -- Chemically Induced Bradycardia -- Chemically Induced Intestinal Obstruction -- Chemically Induced Paraproteinemias -- Chemically Induced Fluid-Electrolyte Imbalance -- Chemically Induced Infection -- Chemically Induced Pain -- Chemically Induced Cardiovascular Diseases -- Chemically Induced M1 - 21 N1 - research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. PY - 2017 SN - 1079-2082 SP - 1774-1783 ST - Identifying and characterizing preventable adverse drug events for prioritizing pharmacist intervention in hospitals T2 - American Journal of Health-System Pharmacy TI - Identifying and characterizing preventable adverse drug events for prioritizing pharmacist intervention in hospitals UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=125885795&site=ehost-live&scope=site VL - 74 ID - 761334 ER - TY - JOUR AB - Background: Total pancreatectomy with islet autotransplantation (TP-IAT) can be performed selectively for patients with refractory chronic pancreatitis to alleviate pain, improve quality of life, and preserve endocrine function. We evaluated the short- and long-term surgical outcomes of TP-IAT. Methods: We performed a retrospective review of 82 patients who underwent TP-IAT at our institution from 2007-2019. All patients had a diagnosis of chronic pancreatitis and were evaluated by a multidisciplinary team prior to surgical intervention. Primary endpoints were morbidity and mortality. Postoperative complications during initial hospital stay were classified by Clavien-Dindo grade. They were further categorized into early (≤30 days) or late (>30 days) and compared between standard (resection of the antrum) and pylorus-preserving approaches. The rate of postoperative hemorrhage was evaluated based on the amount of heparin infused (units/kg) during islet autotransplantation. Results: All patients underwent an open technique with 55 (67%) and 57 (70%) patients undergoing a pylorus-preserving approach and concomitant splenectomy, respectively. Median follow-up was 36 months (IQR, 14-71). There was no 90-day mortality. Clavien-Dindo grade 1, 2, 3a, 3b, 4a, 4b, and 5 complications was observed in 10%, 33%, 11%, 10%, 4%, 0%, and 0%. Early and late postoperative complications were 32% and 40%, respectively. The most common early complications were intra-abdominal abscess (n=7) and postoperative hemorrhage (n=5). Overall, there were eight (10%) patients who underwent reoperation within 30-days of TP-IAT with five (6%) being related to postoperative hemorrhage. No difference was observed in the rate of postoperative hemorrhage based on amount of heparin infused during islet autotransplantation (<60 units/kg: 2% vs≥60 units/kg: 11%, p=0.12), and there was no known incidence of portal vein thrombosis. Late complications included marginal ulcer (n=9), small bowel obstruction (n=7), and incisional hernia (n=7). There were 13 (16%) operations related to a late complication, most commonly for incisional hernia repair (n=7) and small bowel obstruction (n=4). The pylorus-preserving approach had a higher rate of marginal ulcer formation compared to the standard approach (11% vs 0%, p=0.03). Conclusions: Despite the complexity of the operation and patient population, TP-IAT can be performed safely with no 90-day mortality. A pylorus-preserving approach should be universally adopted to achieve optimal outcomes, particularly to prevent the formation of marginal ulcers. When considering the risk of portal vein thrombosis versus postoperative hemorrhage, a lower heparin dose is acceptable. This study can advise surgeons on the expected morbidity and mortality after this operation and highlight potential areas for future improvement. AU - Naples, R. AU - Thomas, J. D. AU - Perlmutter, B. AU - McMichael, J. AU - Augustin, T. AU - Walsh, R. M. AU - Simon, R. DB - Embase DO - 10.1016/S0016-5085(20)34403-6 KW - heparin abdominal abscess adult autotransplantation chronic pancreatitis complication conference abstract controlled study female follow up hernioplasty hospitalization human incisional hernia jejunum ulcer low drug dose major clinical study male morbidity mortality multidisciplinary team pancreas islet pancreatectomy portal vein thrombosis postoperative hemorrhage prevention pylorus reoperation retrospective study small intestine obstruction splenectomy surgeon surgery LA - English M1 - 6 M3 - Conference Abstract N1 - L2005912292 2020-06-02 PY - 2020 SN - 1528-0012 0016-5085 SP - S-1496 ST - 176 SURGICAL OUTCOMES OF TOTAL PANCREATECTOMY WITH ISLET AUTOTRANSPLANTATION T2 - Gastroenterology TI - 176 SURGICAL OUTCOMES OF TOTAL PANCREATECTOMY WITH ISLET AUTOTRANSPLANTATION UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005912292&from=export http://dx.doi.org/10.1016/S0016-5085(20)34403-6 VL - 158 ID - 760568 ER - TY - JOUR AB - INTRODUCTION: Chest pain unit (CPU) observation with defined stress utilization protocols is a common management option for low-risk emergency department patients. We sought to evaluate the safety of a joint emergency medicine and cardiology staffed CPU. METHODS: Prospective observational trial of consecutive patients admitted to an emergency department CPU was conducted. A standard 6-hour observation protocol was followed by cardiology consultation and stress utilization largely at their discretion. Included patients were at low/intermediate risk by the American Heart Association, had nondiagnostic electrocardiograms, and a normal initial troponin. Excluded patients were those with an acute comorbidity, age >75, and a history of coronary artery disease, or had a coexistent problem restricting 24-hour observation. Primary outcome was 30-day major adverse cardiovascular events-defined as death, nonfatal acute myocardial infarction, revascularization, or out-of-hospital cardiac arrest. RESULTS: A total of 1063 patients were enrolled over 8 months. The mean age of the patients was 52.8 ± 11.8 years, and 51% (95% confidence interval [CI], 48-54) were female. The mean thrombolysis in myocardial infarction and Diamond & Forrester scores were 0.6% (95% CI, 0.51-0.62) and 33% (95% CI, 31-35), respectively. In all, 51% (95% CI, 48-54) received stress testing (52% nuclear stress, 39% stress echocardiogram, 5% exercise, 4% other). In all, 0.9% patients (n = 10, 95% CI, 0.4-1.5) were diagnosed with a non-ST elevation myocardial infarction and 2.2% (n = 23, 95% CI, 1.3-3) with acute coronary syndrome. There was 1 (95% CI, 0%-0.3%) case of a 30-day major adverse cardiovascular events. The 51% stress test utilization rate was less than the range reported in previous CPU studies (P < 0.05). CONCLUSIONS: Joint emergency medicine and cardiology management of patients within a CPU protocol is safe, efficacious, and may safely reduce stress testing rates. AD - Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA. anapoli@lifespan.org AN - 22337218 AU - Napoli, A. M. AU - Arrighi, J. A. AU - Siket, M. S. AU - Gibbs, F. J. DA - Mar DO - 10.1097/HPC.0b013e3182457bee DP - NLM ET - 2012/02/18 J2 - Critical pathways in cardiology KW - Adult Aged *Chest Pain/complications/diagnosis Clinical Protocols/standards Coronary Angiography/methods Critical Pathways/*standards Disease Management Emergency Service, Hospital/*organization & administration *Exercise Test/methods/statistics & numerical data Female Humans Male Middle Aged Myocardial Infarction/etiology/*prevention & control Outcome and Process Assessment, Health Care/methods Patient Care Team/organization & administration Prospective Studies Referral and Consultation/organization & administration *Risk Adjustment/methods/standards LA - eng M1 - 1 N1 - 1535-2811 Napoli, Anthony M Arrighi, James A Siket, Matthew S Gibbs, Frantz J Journal Article United States Crit Pathw Cardiol. 2012 Mar;11(1):26-31. doi: 10.1097/HPC.0b013e3182457bee. PY - 2012 SN - 1535-2811 SP - 26-31 ST - Physician discretion is safe and may lower stress test utilization in emergency department chest pain unit patients T2 - Crit Pathw Cardiol TI - Physician discretion is safe and may lower stress test utilization in emergency department chest pain unit patients VL - 11 ID - 760441 ER - TY - JOUR AB - Heparin‐induced thrombocytopenia (HIT) is a potentially serious adverse drug reaction that can result in lethal vascular thrombosis. Dabigatran is a direct thrombin inhibitor that might be useful in the management of HIT. This study evaluated the efficacy and safety of dabigatran in patients with HIT. We included 43 patients in the study who received dabigatran for the management of suspected HIT, based on 4Ts (thrombocytopenia, timing of platelet count drop, thrombosis or other sequelae, and other causes of thrombocytopenia) scores. Three patients were excluded because they had received dabigatran with a creatinine clearance <15 mL/min. Patients' records were analyzed longitudinally, with 12 months follow‐up from the time of initiation of dabigatran, for occurrence of thrombosis, dabigatran‐related complications, and outcome. Patients with chronic kidney disease, hepatic impairment, mechanical heart valves, active bleeding, and extremes of weights (<50 and >120 kg) were excluded from the study. Arterial thrombosis was not observed in any of our patients. The platelet counts normalized in all patients except for 2, which was attributed to the underlying comorbidities. We did not observe any hemorrhagic events or significant thrombosis during the follow‐up period. Eight patients died from nonthrombotic causes, which were unrelated to adverse effects of dabigatran. Based on our findings, dabigatran could be considered a safe and effective agent in the management of HIT, particularly in the developing countries, where there could be issues with the cost and availability of other agents recommended for this condition. Further studies are needed to validate our findings. AD - Department of Clinical Pharmacy, School of Pharmacy‐International Campus, Iran University of Medical Sciences, Tehran Iran Department of Internal Medicine, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran Iran Department of Clinical Pharmacy, Firoozgar Clinical Research Development Center, School of Pharmacy‐International Campus, Iran University of Medical Sciences, Tehran Iran Department of Cardiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran Iran Department of Nephrology, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran Iran Department of Hematology, Firoozgar Clinical Research Development Center, Iran University of Medical Sciences, Tehran Iran Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran Iran AN - 133557658. Language: English. Entry Date: 20181220. Revision Date: 20200101. Publication Type: Article AU - Nasiripour, Somayyeh AU - Saif, Maryam AU - Farasatinasab, Maryam AU - Emami, Sepide AU - Amouzegar, Atefeh AU - Basi, Ali AU - Mokhtari, Majid DB - CINAHL DO - 10.1002/jcph.1300 DP - EBSCOhost KW - Heparin -- Adverse Effects Thrombocytopenia -- Chemically Induced Dabigatran Etexilate -- Therapeutic Use Thrombocytopenia -- Drug Therapy Human Treatment Outcomes Platelet Count Thrombosis -- Etiology Thrombocytopenia -- Complications Electronic Health Records Prospective Studies Comorbidity Treatment Duration M1 - 1 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0366372. PY - 2019 SN - 0091-2700 SP - 107-111 ST - Dabigatran as a Treatment Option for Heparin‐Induced Thrombocytopenia T2 - Journal of Clinical Pharmacology TI - Dabigatran as a Treatment Option for Heparin‐Induced Thrombocytopenia UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=133557658&site=ehost-live&scope=site VL - 59 ID - 761315 ER - TY - JOUR AB - The number of patients on chronic anticoagulant or antiplatelet therapy requiring endoscopic urological surgery is increasing worldwide. Therefore, there is a strong demand to standardize the perioperative treatment of this cohort of patients, both from a surgical and cardiological point of view, balancing the risks of bleeding versus thrombosis, and the important possible clinical and medical legal repercussions therein. Although literature is scarce and the quality of evidence quite low, in line with other surgical specialties, guidelines and recommendations for the management of urological patients have begun to emerge. The aim of this review is to analyze current available literature and evidence on the most common endoscopic procedures performed in this high-risk group of patients, focusing on the perioperative management. In particular, to analyze the most frequently performed endoscopic procedures for the treatment of benign prostate enlargement (transurethral resection of the prostate, Thulium, Holmium and greenlight laser prostatectomy), bladder cancer (transurethral resection of the bladder), upper urinary tract urothelial cancer, and nephrolithiasis. Despite the lack of randomized studies, regardless of individual patient considerations, studies would support continuation of acetylsalicylic acid, which is recommended by cardiologists, in patients with intermediate/high risk of coronary thrombosis. In contrast, multiple studies found that bridging with light weight molecular weight heparin can potentially lead to more bleeding than continuation of the anticoagulant(s) and antiplatelet therapy, and caution with bridging is advised. All urologists should familiarize themselves with emerging guidelines and recommendations, and always be prepared to discuss specific cases or scenarios in a dedicated multidisciplinary team. AD - R. Naspro, Department of Urology, ASST Papa Giovanni XXIII, Piazza Oms 1, Bergamo, Italy AU - Naspro, R. AU - Lerner, L. B. AU - Rossini, R. AU - Manica, M. AU - Woo, H. H. AU - Calopedos, R. J. AU - Cracco, C. M. AU - Scoffone, C. M. AU - Herrmann, T. R. AU - De La Rosette, J. J. AU - Cornu, J. N. AU - Da Pozzo, L. F. DB - Embase Medline DO - 10.23736/S0393-2249.17.03072-7 KW - adult bladder cancer bleeding cancer patient cancer surgery cardiologist cohort analysis coronary artery thrombosis drug therapy endoscopy high risk population human human cell laser prostatectomy male molecular weight multidisciplinary team nephrolithiasis practice guideline prostate hypertrophy randomized controlled trial (topic) review risk assessment side effect stent surgery transurethral resection urologist acetylsalicylic acid heparin holmium thulium LA - English M1 - 2 M3 - Review N1 - L621868066 2019-09-13 PY - 2018 SN - 1827-1758 0393-2249 SP - 126-136 ST - Perioperative antithrombotic therapy in patients undergoing endoscopic urologic surgery: Where do we stand with current literature? T2 - Minerva Urologica e Nefrologica TI - Perioperative antithrombotic therapy in patients undergoing endoscopic urologic surgery: Where do we stand with current literature? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621868066&from=export http://dx.doi.org/10.23736/S0393-2249.17.03072-7 VL - 70 ID - 760830 ER - TY - JOUR AB - The number of patients on chronic anticoagulant or antiplatelet therapy requiring endoscopic urological surgery is increasing worldwide. Therefore, there is a strong demand to standardize the perioperative treatment of this cohort of patients, both from a surgical and cardiological point of view, balancing the risks of bleeding versus thrombosis, and the important possible clinical and medical legal repercussions therein. Although literature is scarce and the quality of evidence quite low, in line with other surgical specialties, guidelines and recommendations for the management of urological patients have begun to emerge. The aim of this review is to analyze current available literature and evidence on the most common endoscopic procedures performed in this high-risk group of patients, focusing on the perioperative management. In particular, to analyze the most frequently performed endoscopic procedures for the treatment of benign prostate enlargement (transurethral resection of the prostate, Thulium, Holmium and greenlight laser prostatectomy), bladder cancer (transurethral resection of the bladder), upper urinary tract urothelial cancer, and nephrolithiasis. Despite the lack of randomized studies, regardless of individual patient considerations, studies would support continuation of acetylsalicylic acid, which is recommended by cardiologists, in patients with intermediate/high risk of coronary thrombosis. In contrast, multiple studies found that bridging with light weight molecular weight heparin can potentially lead to more bleeding than continuation of the anticoagulant(s) and antiplatelet therapy, and caution with bridging is advised. All urologists should familiarize themselves with emerging guidelines and recommendations, and always be prepared to discuss specific cases or scenarios in a dedicated multidisciplinary team. AD - Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy - nasprorichard@gmail.com. Section of Urology, Veteran Affairs Boston Healthcare System, Boston, MA, USA. Department of Emergency and Critical Care, S. Croce e Carle Hospital, Cuneo, Italy. Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy. Sydney Adventist Hospital Clinical School, University of Sydney, Wahroonga, Australia. Department of Urology, Cottolengo Hospital, Turin, Italy. Department of Urology and Urooncology, Hannover Medical School, Hannover, Germany. Department of Urology, AMC University Hospital, Amsterdam, The Netherlands. Service of Urology, Rouen University Hospital, Rouen, France. AN - 29241314 AU - Naspro, R. AU - Lerner, L. B. AU - Rossini, R. AU - Manica, M. AU - Woo, H. H. AU - Calopedos, R. J. AU - Cracco, C. M. AU - Scoffone, C. M. AU - Herrmann, T. R. AU - de la Rosette, J. J. AU - Cornu, J. N. AU - LF, D. A. Pozzo DA - Apr DO - 10.23736/s0393-2249.17.03072-7 DP - NLM ET - 2017/12/16 J2 - Minerva urologica e nefrologica = The Italian journal of urology and nephrology KW - Endoscopy/*methods Evidence-Based Medicine Fibrinolytic Agents/*therapeutic use Humans Male Perioperative Care/*methods Postoperative Complications/prevention & control Transurethral Resection of Prostate Urologic Surgical Procedures/*methods LA - eng M1 - 2 N1 - 1827-1758 Naspro, Richard Lerner, Lori B Rossini, Roberta Manica, Michele Woo, Henry H Calopedos, Ross J Cracco, Cecilia M Scoffone, Cesare M Herrmann, Thomas R de la Rosette, Jean J Cornu, Jean-Nicolas DA Pozzo, Luigi F Journal Article Italy Minerva Urol Nefrol. 2018 Apr;70(2):126-136. doi: 10.23736/S0393-2249.17.03072-7. Epub 2017 Dec 14. PY - 2018 SN - 0393-2249 SP - 126-136 ST - Perioperative antithrombotic therapy in patients undergoing endoscopic urologic surgery: where do we stand with current literature? T2 - Minerva Urol Nefrol TI - Perioperative antithrombotic therapy in patients undergoing endoscopic urologic surgery: where do we stand with current literature? VL - 70 ID - 760261 ER - TY - JOUR AB - BACKGROUND: Combined heart and liver transplantation (CHLT) in the pediatric population involves a complex group of patients, many of whom have palliated congenital heart disease (CHD) involving single ventricle physiology. OBJECTIVE: The purpose of this study was to describe the perioperative management of pediatric patients undergoing CHLT at a single institution and to identify management strategies that may be used to optimize perioperative care. METHODS: We did a retrospective database review of all patients receiving CHLT at a children's hospital between 2006 and 2014. Information collected included preoperative characteristics, intraoperative management, blood transfusions, and postoperative morbidity and mortality. RESULTS: Five pediatric CHLTs were performed over an 8-year period. All patients had a history of complex CHD with multiple sternotomies, three of whom had failing Fontan physiology. Patient age ranged from 7 to 23 years and weight from 29.5 to 68.5 kg. All CHLTs were performed using an en-bloc technique where both the donor heart and liver were implanted together on cardiopulmonary bypass (CPB). The median operating room time was 14.25 h, median CPB time was 3.58 h, and median donor ischemia time was 4.13 h. Patients separated from CPB on dopamine, epinephrine, and milrinone infusions and two required inhaled nitric oxide. All patients received a massive intraoperative blood transfusion post CPB with amounts ranging from one to three times the patient's estimated blood volume. The patient who required the most transfusions was in decompensated heart and liver failure preoperatively. Four of the five patients received an antifibrinolytic agent as well as a procoagulant (prothrombin complex concentrate or recombinant activated Factor VII) to assist with hemostasis. There were no 30-day thromboembolic events detected. Postoperatively the median length of mechanical ventilation, ICU stay and stay to hospital discharge was 4, 8, and 37 days, respectively. All patients are alive and free from allograft rejection at this time. CONCLUSION: Combined heart and liver transplantation in the pediatric population involves a complex group of patients with unique perioperative challenges. Successful management starts with thorough preoperative planning and communication and involves strategies to deal with massive intraoperative hemorrhage and coagulopathy in addition to protecting and supporting the transplanted heart and liver and meticulous surgical technique. An integrated multidisciplinary team approach is the cornerstone for successful outcomes. AD - Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA. Department of Cardiothoracic Surgery, Stanford Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA. Department of Transplant Surgery, Stanford Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA. Division of Cardiology, Department of Pediatrics, Stanford Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA. AN - 27402424 AU - Navaratnam, M. AU - Ng, A. AU - Williams, G. D. AU - Maeda, K. AU - Mendoza, J. M. AU - Concepcion, W. AU - Hollander, S. A. AU - Ramamoorthy, C. DA - Oct DO - 10.1111/pan.12950 DP - NLM ET - 2016/07/13 J2 - Paediatric anaesthesia KW - Adolescent Adult Blood Transfusion/statistics & numerical data Child Female Heart Defects, Congenital/*surgery Heart Transplantation/*methods Humans Length of Stay/statistics & numerical data Liver Transplantation/*methods Male Operative Time Perioperative Care/*methods Postoperative Complications Retrospective Studies Time Factors Young Adult antifibrinolytic blood transfusion cardiac coagulation congenital heart disease drugs general anesthesia hematology massive transfusions transplantation LA - eng M1 - 10 N1 - 1460-9592 Navaratnam, Manchula Ng, Ann Williams, Glyn D Maeda, Katsuhide Mendoza, Julianne M Concepcion, Waldo Hollander, Seth A Ramamoorthy, Chandra Journal Article France Paediatr Anaesth. 2016 Oct;26(10):976-86. doi: 10.1111/pan.12950. Epub 2016 Jul 12. PY - 2016 SN - 1155-5645 SP - 976-86 ST - Perioperative management of pediatric en-bloc combined heart-liver transplants: a case series review T2 - Paediatr Anaesth TI - Perioperative management of pediatric en-bloc combined heart-liver transplants: a case series review VL - 26 ID - 760458 ER - TY - JOUR AB - Background: Combined heart and liver transplantation (CHLT) in the pediatric population involves a complex group of patients, many of whom have palliated congenital heart disease (CHD) involving single ventricle physiology. Objective: The purpose of this study was to describe the perioperative management of pediatric patients undergoing CHLT at a single institution and to identify management strategies that may be used to optimize perioperative care. Methods: We did a retrospective database review of all patients receiving CHLT at a children's hospital between 2006 and 2014. Information collected included preoperative characteristics, intraoperative management, blood transfusions, and postoperative morbidity and mortality. Results: Five pediatric CHLTs were performed over an 8-year period. All patients had a history of complex CHD with multiple sternotomies, three of whom had failing Fontan physiology. Patient age ranged from 7 to 23 years and weight from 29.5 to 68.5 kg. All CHLTs were performed using an en-bloc technique where both the donor heart and liver were implanted together on cardiopulmonary bypass (CPB). The median operating room time was 14.25 h, median CPB time was 3.58 h, and median donor ischemia time was 4.13 h. Patients separated from CPB on dopamine, epinephrine, and milrinone infusions and two required inhaled nitric oxide. All patients received a massive intraoperative blood transfusion post CPB with amounts ranging from one to three times the patient's estimated blood volume. The patient who required the most transfusions was in decompensated heart and liver failure preoperatively. Four of the five patients received an antifibrinolytic agent as well as a procoagulant (prothrombin complex concentrate or recombinant activated Factor VII) to assist with hemostasis. There were no 30-day thromboembolic events detected. Postoperatively the median length of mechanical ventilation, ICU stay and stay to hospital discharge was 4, 8, and 37 days, respectively. All patients are alive and free from allograft rejection at this time. Conclusion: Combined heart and liver transplantation in the pediatric population involves a complex group of patients with unique perioperative challenges. Successful management starts with thorough preoperative planning and communication and involves strategies to deal with massive intraoperative hemorrhage and coagulopathy in addition to protecting and supporting the transplanted heart and liver and meticulous surgical technique. An integrated multidisciplinary team approach is the cornerstone for successful outcomes. AD - M. Navaratnam, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford Children's Hospital, Stanford University Medical Center, Palo Alto, CA, United States AU - Navaratnam, M. AU - Ng, A. AU - Williams, G. D. AU - Maeda, K. AU - Mendoza, J. M. AU - Concepcion, W. AU - Hollander, S. A. AU - Ramamoorthy, C. DB - Embase Medline DO - 10.1111/pan.12950 KW - antifibrinolytic agent dopamine epinephrine etomidate fentanyl hydromorphone isoflurane ketamine midazolam milrinone morphine nitric oxide prothrombin complex recombinant blood clotting factor 7a rocuronium adolescent adult article artificial ventilation blood transfusion cardiopulmonary bypass child clinical article combined heart and liver transplantation congenital heart disease female Fontan procedure graft rejection heart failure heart transplantation hemostasis hospital discharge human intensive care unit ischemia liver failure liver transplantation male morbidity mortality operation duration outcome assessment pediatric hospital perioperative period preoperative period priority journal school child sternotomy surgical technique thromboembolism young adult LA - English M1 - 10 M3 - Article N1 - L611258376 2016-07-21 2016-10-31 PY - 2016 SN - 1460-9592 1155-5645 SP - 976-986 ST - Perioperative management of pediatric en-bloc combined heart–liver transplants: a case series review T2 - Paediatric Anaesthesia TI - Perioperative management of pediatric en-bloc combined heart–liver transplants: a case series review UR - https://www.embase.com/search/results?subaction=viewrecord&id=L611258376&from=export http://dx.doi.org/10.1111/pan.12950 VL - 26 ID - 761044 ER - TY - JOUR AB - Background: The Core Laboratories for investigation of failed cardiovascular implant materials, initiated by the UE grant COST Action 537, thanks to Polish grant, have been organized in Poland. Objectives: For FCSD, research centre working on heart prostheses, biomaterials and new surgery tools the goal is the improvement of medical devices in clinical practice from the analysis of implanted prostheses. Supported by a scientific multidisciplinary team, physicians can recognize the reason of the surgical intervention and exchange the prostheses. Materials and Methods: The protocol for the recovery and evaluation of the implants and surrounding tissues consists of significant information about the patient and the explanted device/biological materials. The study includes histopathology, chemical analysis, surface studies. The complex analysis of valve damage reasons & their consequences have been studied using different modeling method: physical and computer simulation. Results: Several critical outcomes were elicited by experimental analyses, such as evidences of materials preservation/degradation, surface interactions with plasma proteins, materials colonization by fibroblasts or inflammatory cells, etc. About 200 samples: heart valves and vessel prostheses and vascular stents are under investigation. Conclusions: The test of chosen samples gave interesting answers to both physicians and engineers questions. Different mechanisms were shown to occur, causing the need for devices explantation, including calcification phenomena, thrombosis and infective processes. In conclusion, the results obtained in the course of the study enhanced some of the problems concurring to the behavior of blood-contacting biomaterials and contribute to describe the complexity and variety of the phenomena occurring in vivo. Described results can be used in the diagnosing patients data analysis in case, when the reason of progressive pathology changes is well known. AD - Z. Nawrat, Foundation for Cardiac Surgery Development, Medical University of Silesia, Silesian University, CMPiW PAN, Katowice, Poland AU - Nawrat, Z. AU - Małota, Z. AU - Sliwka, J. AU - Kostka, P. AU - Nozynski, J. AU - Łachecka, L. AU - Wojnicz, R. AU - Lelatko, J. AU - Dworak, A. AU - Jakubowski, M. DB - Embase KW - biomaterial plasma protein society artificial organ prosthesis human patient implant surgery physician devices heart valve explant calcification inflammatory cell fibroblast tissues computer simulation clinical practice heart model blood stent chemical analysis thrombosis histopathology medical device Poland data analysis pathology core laboratory L1 - http://www.artificial-organs.com/public/IJAO/Issue/Article.action?cmd=navigate&urlkey=Public_Details&uid=A1C1D715-18FC-4E74-9ECA-B094C008102C&t=IJAO LA - English M3 - Conference Abstract N1 - L70869755 2012-09-19 PY - 2010 SN - 0391-3988 SP - 473 ST - The explanted prostheses study-obligation or luxury? T2 - International Journal of Artificial Organs TI - The explanted prostheses study-obligation or luxury? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70869755&from=export VL - 33 ID - 761249 ER - TY - JOUR AB - Introduction Severe acute pancreatitis is a condition with high mortality with 40% of patients requiring intervention. NCEPOD recommends that this is best managed in a multidisciplinary team with access to specialist regional services as and when required. We report our experience of the management of pancreatic fluid collections (PFC) within the region's first remote care pancreatitis network. Methods Data on patients with severe pancreatitis who were transferred to the service between June 2015 - July 2017 were analysed. The network was formally established in 2015 and serves a population of 3.5 million & 17 referring hospitals in the Northern region. All patients were discussed in the multidisciplinary meeting and only patients requiring specialist input were transferred. Baseline characteristics, aetiology, nutritional support, antibiotic treatment, intensive care unit (ITU) stay, interventions, complications, mortality and follow up of atleast one year were reported. Results 285 patients were referred during this period. 83/285 (29%; 46 male) were transferred with a mean age 56 years [range 18-85]. The commonest aetiology was gall stones(45%) & alcohol(31%). The main reason for transfer(91%) was drainage of peripancreatic collections. Patients were referred after a mean of 13.7 [1-188] days from admission locally; 26% were admitted directly to ITU. Patients were transferred 4.5 [0-16] days post-MDT discussion. Fifty-five (66%) received antibiotics; however only 17 (20%) had appropriate antibiotics based on positive blood cultures. Appropriate feeding was 98%; 70 (84%) patients were enterically fed and 12 received parenteral nutrition (PN). One patient had inappropriate PN. 21% patients had intervention prior to transfer. On transfer, 15/83(18%) did not require intervention as there was spontaneous resolution of the collections. In the remaining patients the interventions included: endoscopic drainage only = 48%, percutaneous only = 29%, endoscopic + percutaneous = 12% & others = 5%. 35%(29/83) had multiorgan failure. 31/83 (37%) had complications following intervention. These were: sepsis = 35%, bleeding = 39%, thromboembolic events = 16% & others = 10%. Twelve (14%) patients died, 10 had MOF and 2 had pulmonary embolism, 11/12 were in ITU. Mean follow up was 18.2 months (range = 14 - 35). Conclusions Majority of patients (82%) required intervention for treatment of PFCs. Endoscopic drainage was the commonest route of drainage. Inappropriate antibiotic use remains a concern however nutritional support was adequate in majority of the patients. This is the first reported data from the U.K. regarding a remote care network & the results highlight the role of regional multidisciplinary network in the management of patients with acute severe pancreatitis. AD - M. Nayar, HPB Unit, Freeman Hospital, United Kingdom AU - Nayar, M. AU - Bourne, D. AU - Charnley, R. AU - French, J. AU - Leeds, J. AU - Oppong, K. AU - Logue, J. AU - Bekkali, N. DB - Embase DO - 10.1136/gutjnl-2019-BSGAbstracts.291 KW - alcohol antibiotic agent nutrition supplement acute pancreatitis adult antibiotic therapy bleeding blood culture complication conference abstract controlled study feeding female follow up gallstone human intensive care unit lung embolism major clinical study male middle aged mortality multiple organ failure nutritional support pancreas juice remission sepsis LA - English M3 - Conference Abstract N1 - L629363033 2019-09-24 PY - 2019 SN - 1468-3288 SP - A155 ST - Management of pancreatic fluid collections within the northern region remote care pancreatitis service T2 - Gut TI - Management of pancreatic fluid collections within the northern region remote care pancreatitis service UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629363033&from=export http://dx.doi.org/10.1136/gutjnl-2019-BSGAbstracts.291 VL - 68 ID - 760710 ER - TY - JOUR AB - Objectives: To determine incidence of bleeding in thrombocytopenic patients with cancer undergoing acute inpatient rehabilitation. Design: This is an observational cross-sectional retrospective study. Setting: Acute inpatient academic rehabilitation facility. Participants: Adult patients admitted to acute inpatient rehabilitation with functional impairments secondary to cancer. Methods: Electronic records were reviewed for thrombocytopenic patients with cancer to determine platelet counts, bleeding events during rehabilitation, and anticoagulant medications prescribed. Main outcomes measurements: Type and number of bleeding events, severity of bleeding by World Health Organization criteria. Results: Of the 278 patients with cancer admitted to acute rehabilitation over a 27-month time frame, 119 had at least one platelet count <150 000/µL. In all, 37 (31.1%) had a history of a bleeding event prior to the rehabilitation admission and 34 (28.6%) had at least one bleeding complication during their stay. Most events (87.5%) were of low grade (Grade 1 and 2 World Health Organization criteria). There was no association between platelet counts <11 000 or counts 11 000 to 20 000/µL and the occurrence of bleeding (P = .106 and P = .319, respectively). Although anticoagulants were common, there was no association found with a bleeding event and either anticoagulation status (receiving or not on such agents), specific anticoagulant or antiplatelet agents, or a combination. Conclusions: Bleeding events in patients with cancer with thrombocytopenia during acute rehabilitation stay are not uncommon but are typically mild in severity and not associated with the degree of thrombocytopenia. Patients taking anticoagulants when platelet levels rose did experience bleeding events, but not at a statistically greater rate than those not taking such medications. AD - Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Physical Medicine and Rehabilitation, Jesse Brown VA Medical Center, Chicago, IL, USA Rehabilitation Institute of Chicago, Shirley Ryan AbilityLab, Chicago, IL, USA The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA AN - 134163482. Language: English. Entry Date: 20190122. Revision Date: 20190123. Publication Type: Article AU - Neal, Jacqueline AU - Shahpar, Samman AU - Spill, Gayle AU - Semik, Patrick AU - Marciniak, Christina DB - CINAHL DO - 10.1177/1179572718761379 DP - EBSCOhost KW - Cancer Patients Rehabilitation, Cancer Thrombocytopenia Hemorrhage Adverse Health Care Event Human Male Female Adult Middle Age Descriptive Statistics Pearson's Correlation Coefficient Chi Square Test Mann-Whitney U Test Data Analysis Software Nonexperimental Studies Cross Sectional Studies Retrospective Design Inpatients Electronic Health Records Anticoagulants Aged T-Tests M1 - 7 N1 - research; tables/charts. Journal Subset: Allied Health; Australia & New Zealand; Peer Reviewed. PY - 2018 SN - 1179-5727 SP - 1-1 ST - Bleeding Events in Thrombocytopenic Patients With Cancer Undergoing Acute Rehabilitation T2 - Rehabilitation Process & Outcome TI - Bleeding Events in Thrombocytopenic Patients With Cancer Undergoing Acute Rehabilitation UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=134163482&site=ehost-live&scope=site ID - 761301 ER - TY - JOUR AB - BACKGROUND Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients. METHODS Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum amplitude (CFF.MA), citrated kaolin percent clot lysis at 30 minutes (CK.LY30), citrated RapidTEG maximum amplitude (CRT.MA), and citrated kaolin maximum amplitude (CK.MA) parameters in adults meeting full or limited trauma team criteria. Blood was drawn <= 1 hour after admission. Assays were repeated in duplicate. Reliability (TEG 5000 vs. TEG 6s analyzers) and repeatability (interdevice comparison) was quantified. Linear regression was used to define the relationship between TEG 6s and TEG 5000 devices. RESULTS A total of 475 patients were enrolled. The cohort was predominantly male (68.6%) with a median age of 49 years. Regression line slope estimates (ss) and linear correlation estimates (p) were as follows: CK.R (ss = 1.05, rho = 0.9), CFF.MA (ss = 0.99, rho = 0.95), CK.LY30 (ss = 1.01, rho = 0.91), CRT.MA (TEG 6s) versus CK.MA (TEG 5000) (ss = 1.06, rho = 0.86) as well as versus CRT.MA (TEG 5000) (ss = 0.93, rho = 0.93), indicating strong reliability between the devices. Overall, within-device repeatability was better for TEG 6s versus TEG 5000, particularly for CFF.MA and CK.LY30. CONCLUSION The TEG 6s device appears to be highly reliable for use in trauma patients, with close correlation to the TEG 5000 device and equivalent/improved within-device reliability. Given the potential advantages of using the TEG 6s device at the site of care, confirmation of agreement between the devices represents an important advance in diagnostic testing. AD - [Neal, Matthew D.] Univ Pittsburgh, Dept Surg, Med Ctr, Pittsburgh, PA USA. [Neal, Matthew D.] Univ Pittsburgh, Dept Crit Care Med, Med Ctr, Pittsburgh, PA USA. [Neal, Matthew D.] Univ Pittsburgh, Med Ctr, CTSI, Pittsburgh, PA USA. [Moore, Ernest E.] Denver Hlth, Ernest E Moore Shock Trauma Ctr, Denver, CO USA. [Walsh, Mark; Thomas, Scott] Mem Hosp South Bend, South Bend, IN USA. [Callcut, Rachael A.; Kornblith, Lucy Z.] Univ Calif San Francisco, Dept Surg, Zuckerberg San Francisco Gen Hosp, San Francisco, CA USA. [Schreiber, Martin] Oregon Hlth & Sci Univ, Dept Surg, Div Trauma Crit Care & Acute Care Surg, Portland, OR 97201 USA. [Ekeh, Akpofure Peter] Wright State Univ, Dayton, OH 45435 USA. [Singer, Adam J.] SUNY Stony Brook, Stony Brook Dept Emergency Med, Stony Brook, NY 11794 USA. [Lottenberg, Lawrence] Florida Atlantic Univ, St Marys Med Ctr, Dept Surg, W Palm Beach, FL USA. [Foreman, Michael] Baylor Univ, Med Ctr, Div Trauma Acute Care & Crit Care Surg, Dallas, TX USA. [Evans, Susan] Carolinas Med Ctr, Dept Surg, Div Acute Care Surg, Charlotte, NC 28203 USA. [Winfield, Robert D.] Univ Kansas, Med Ctr, Kansas City, KS 66103 USA. [Goodman, Michael D.] Univ Cincinnati, Dept Surg, 231 Bethesda Ave, Cincinnati, OH 45267 USA. [Freeman, Carl] St Louis Univ Hosp, SSM Hlth, St Louis, MO USA. [Milia, David] Med Coll Wisconsin, Div Trauma & Acute Care Surg, Milwaukee, WI 53226 USA. [Saillant, Noelle] Massachusetts Gen Hosp, Dept Surg, Boston, MA 02114 USA. [Hartmann, Jan; Achneck, Hardean E.] Haemonetics Corp, Braintree, MA USA. Neal, MD (corresponding author), Univ Pittsburgh, Sch Med, Dept Surg, Presbyterian Hosp, F1271-2,200 Lothrop St, Pittsburgh, PA 15213 USA. nealm2@upmc.edu AN - WOS:000511958800037 AU - Neal, M. D. AU - Moore, E. E. AU - Walsh, M. AU - Thomas, S. AU - Callcut, R. A. AU - Kornblith, L. Z. AU - Schreiber, M. AU - Ekeh, A. P. AU - Singer, A. J. AU - Lottenberg, L. AU - Foreman, M. AU - Evans, S. AU - Winfield, R. D. AU - Goodman, M. D. AU - Freeman, C. AU - Milia, D. AU - Saillant, N. AU - Hartmann, J. AU - Achneck, H. E. DA - Feb DO - 10.1097/ta.0000000000002545 J2 - J. Trauma Acute Care Surg. KW - Thromboelastography TEG 5000 TEG 6s viscoelastic testing trauma-induced coagulopathy INDUCED COAGULOPATHY RESUSCITATION TRANSFUSION EVACUATION MORTALITY TESTS SIGMA Critical Care Medicine Surgery LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: KJ3LI Times Cited: 7 Cited Reference Count: 26 Neal, Matthew D. Moore, Ernest E. Walsh, Mark Thomas, Scott Callcut, Rachael A. Kornblith, Lucy Z. Schreiber, Martin Ekeh, Akpofure Peter Singer, Adam J. Lottenberg, Lawrence Foreman, Michael Evans, Susan Winfield, Robert D. Goodman, Michael D. Freeman, Carl Milia, David Saillant, Noelle Hartmann, Jan Achneck, Hardean E. Haemonetics Corporation, Braintree, USA; Haemonetics AS, Signy, Switzerland This study was funded by Haemonetics Corporation, Braintree, USA. The data analysis was supported by a third party provider (ClinStatDevice LLC), funded by Haemonetics. Neither Drs. Neal, Moore, nor any of the co-authors received payment from Haemonetics for efforts associated with the article. The manuscript was drafted by Dr Neal, with support from Dr Moore and Dr Hartmann (Haemonetics). Medical writing support was funded by Haemonetics AS, Signy, Switzerland. 7 0 1 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J TRAUMA ACUTE CARE PY - 2020 SN - 2163-0755 SP - 279-285 ST - A comparison between the TEG 6s and TEG 5000 analyzers to assess coagulation in trauma patients T2 - Journal of Trauma and Acute Care Surgery TI - A comparison between the TEG 6s and TEG 5000 analyzers to assess coagulation in trauma patients UR - ://WOS:000511958800037 VL - 88 ID - 761465 ER - TY - JOUR AB - Background/Objectives: Patients in the hospital regardless of admitting diagnosis can be at risk for acute coronary syndrome (ACS). A process was needed to address patients experiencing symptoms of chest pain while hospitalized, with a goal to protect valuable muscle by decreasing recognition to reperfusion time. Methods: Recognition is the first step in the process. With 779 beds and 9000 staff, Early Heart Attack Care education is where we begin. All staff and volunteers participate in a learning module on Early Heart Attack Care and how to recognize ACS and respond regardless of location. If an inpatient is identified as having possible signs and symptoms of ACS, the provider is notified and an electrocardiogram (ECG) performed. ECG education for the nursing and care partner staff to validate accurate lead placement and acquisition of the ECG was implemented. The Rapid Response Team (RRT ) includes a dedicated RRT nurse and a respiratory therapist to provide critical care consultation at the bedside. The RRT nurse is paged for the patient with chest pain to assist with early recognition of ACS. After assessment of the patient and review of the ECG, expert consultation is obtained through the newly developed Chest Pain Team for patients with cardiac ischemia or the Heart Alert Team for patients with a ST-segment myocardial infarction (STEMI). The Chest Pain Team includes the CICU Fellow and Cardiology Consult Fellow. If an STEMI is identified, the Heart Alert Team is paged using a virtual pager alerting the CICU Fellow and Resident, Cardiology Consult Fellow, CICU Nurse Practitioner, Catheterization Laboratory Team, and Nursing Clinical Administrator. Telepage operators were given scripting to assist with notification of the appropriate team. STEMI drill simulations were led by one of our RRT nurses and Chest Pain Coordinator throughout the organization. A mannequin was used with role playing to simulate the patient experiencing chest discomfort. Staff performed an ECG and walked through the process of early recognition and the steps to reperfusion. An on-line computer module was developed to notify staff of the new process in addition to the simulations done on the units. “Badge Buddies” including the signs and symptoms of ACS, example of ST elevation and the inpatient process were distributed. A modified process was developed for the ICU, postanesthesia care unit, and Cardiology Progressive Care Unit. For patients with symptoms of cardiac chest pain and an ECG with automated interpretation as ∗ ∗ ∗Acute MI∗ ∗ ∗, a Heart Alert was paged directly. Results: The Inpatient Chest Pain process was implemented on February 14, 2012. In the first 6 months, 165 calls were made to RRT for chest pain. Of those calls, 36 resulted in Chest Pain Alerts and 2 Heart Alerts. Comprehensive data analysis from February, 2012 to February 2013 is currently being completed. In addition to the early recognition of ACS, 2 patients were identified as having a pulmonary embolism and received rapid treatment. Data is reviewed by the Chest Pain Committee to evaluate for opportunities for improvement and to celebrate successes. Conclusions: Organization and use of currently available resources provide support to staff in the recognition of ACS in adult inpatients. Rapid treatment through early identification is beneficial to patient outcomes improving quality care. AD - K. Nelson, Virginia Commonwealth University Medical Center, Richmond, VA, United States AU - Nelson, K. AU - Kontos, M. DB - Embase DO - 10.1097/HPC.0b013e31829c0a0d KW - human pain thorax pain patient care hospital patient patient heart electrocardiogram heart infarction nurse cardiology physical disease by body function reperfusion nursing consultation education simulation respiratory therapist ST segment elevation online system rapid response team recovery room data analysis role playing drill administrative personnel laboratory muscle acute coronary syndrome nurse practitioner ST segment learning catheterization volunteer risk heart muscle ischemia ST segment elevation myocardial infarction adult lung embolism intensive care diagnosis hospital LA - English M1 - 3 M3 - Conference Abstract N1 - L71184080 2013-10-11 PY - 2013 SN - 1535-282X SP - 173-174 ST - Implementation of an inpatient chest pain response T2 - Critical Pathways in Cardiology TI - Implementation of an inpatient chest pain response UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71184080&from=export http://dx.doi.org/10.1097/HPC.0b013e31829c0a0d VL - 12 ID - 761152 ER - TY - JOUR AB - Purpose: Our Internal Medicine ward includes a Stroke Unit (SU) with 4 beds, managed by a multidisciplinary team. We retrospectively assessed the data of the patients (pts) who underwent systemic thrombolysis for ischemic stroke and admitted to our SU in the yrs 2012 and 2013. Results:We observed 34 pts (18M and 16F, 70+14.3 yrs), all treated with systemic thrombolysis in our ED. The timing of interventions were: from the onset of symptoms to thrombolysis: 139 minutes (76-276); from thrombolysis to the admission in SU: 158 minutes (60-780). Based on medical history, hypertension was present in 65%, diabetes in 15%, AF in 18%. The mean NIHSS was 11.3 (1-25) at arrival, 6 (0- 25) after thrombolysis and 6 (0-25) at discharge. The NIHSS value post- thrombolysis was improved in 18 patients, unchanged in 13 and worsened in 3. None of the 5 patients with NIHSS >18 at the admission showed improvement after thrombolysis. Four pts showed cerebral hemorrhagic evolution; no pt had other major bleeding. No pt died during hospital stay. The evaluations performed during hospitalization have suggested that 2 pts had not had an ischemic stroke. The average stay in Stroke Unit was 8.7 days (5-15). Eleven pts were discharged to a rehabilitation ward, while the others were discharged home. At discharge, single antiplatelet therapy was prescribed in 23 pts, dual antiplatelet therapy in 7 and warfarin in 1 patient. Comments: The data obtained seem to be consistent with those reported in the literature, suggesting the validity of a Stroke Unit managed by internist physicians. AD - G. Nenci, Medicina Interna, Firenze, Italy AU - Nenci, G. AU - Baruffi, C. AU - Pazzi, M. AU - Paolacci, G. AU - Giannasi, G. AU - Attanasi, F. AU - Fortini, A. DB - Embase DO - 10.4081/itjm.2014.s2 KW - warfarin human internist blood clot lysis physician patient stroke unit hospitalization ward brain ischemia therapy National Institutes of Health Stroke Scale rehabilitation bleeding diabetes mellitus hypertension validity medical history internal medicine LA - English M3 - Conference Abstract N1 - L71506367 2014-06-26 PY - 2014 SN - 1877-9344 SP - 90 ST - Stroke Unit managed by internist physicians: Experience on patients treated with systemic thrombolysis T2 - Italian Journal of Medicine TI - Stroke Unit managed by internist physicians: Experience on patients treated with systemic thrombolysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71506367&from=export http://dx.doi.org/10.4081/itjm.2014.s2 VL - 8 ID - 761114 ER - TY - JOUR AD - Departments of Emergency Medicine and Anesthesiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.. AN - 22085984 AU - Nestler, D. M. AU - White, R. D. AU - Rihal, C. S. AU - Myers, L. A. AU - Bjerke, C. M. AU - Lennon, R. J. AU - Schultz, J. L. AU - Bell, M. R. AU - Gersh, B. J. AU - Holmes, D. R., Jr. AU - Ting, H. H. DA - Nov 1 DO - 10.1161/circoutcomes.111.961433 DP - NLM ET - 2011/11/17 J2 - Circulation. Cardiovascular quality and outcomes KW - Aged Aged, 80 and over *Angioplasty *Cardiac Catheterization Diagnostic Tests, Routine Electrocardiography/methods Female Hospitalization Humans Male Middle Aged Myocardial Infarction/*diagnosis/physiopathology/*therapy Patient Care Team Prospective Studies Quality of Health Care *Time Factors Transportation of Patients LA - eng M1 - 6 N1 - 1941-7705 Nestler, David M White, Roger D Rihal, Charanjit S Myers, Lucas A Bjerke, Christine M Lennon, Ryan J Schultz, Jeffery L Bell, Malcolm R Gersh, Bernard J Holmes, David R Jr Ting, Henry H Journal Article Research Support, Non-U.S. Gov't United States Circ Cardiovasc Qual Outcomes. 2011 Nov 1;4(6):640-6. doi: 10.1161/CIRCOUTCOMES.111.961433. PY - 2011 SN - 1941-7713 SP - 640-6 ST - Impact of prehospital electrocardiogram protocol and immediate catheterization team activation for patients with ST-elevation-myocardial infarction T2 - Circ Cardiovasc Qual Outcomes TI - Impact of prehospital electrocardiogram protocol and immediate catheterization team activation for patients with ST-elevation-myocardial infarction VL - 4 ID - 760529 ER - TY - JOUR AB - Background: Women with antiphospholipid syndrome (APS) are at increased risk of recurrent miscarriage, fetal death, placental insufficiency, preeclampsia and fetal growth restriction. Although treatment improves fetal-maternal outcomes, there are still some unsuccessful pregnancies. A multidisciplinary approach with strict monitoring is essential in order to attain obstetrical success. Objectives: To assess pregnancy outcomes in portuguese women with APS who were surveilled at a multidisciplinary unit. Methods: Pregnant women fulfilling the Sydney classification criteria for definite APS, who attended our specialized Rheumatology and Obstetrics outpatient clinic between 2010 and 2018, were included in this retrospective observational study. Cases of suspected APS not meeting the classification criteria were excluded. All pregnancies were followed by a multidisciplinary team (rheumatologists, obstetricians and nurses). Data was collected from medical records. Adverse Pregnancy Outcomes (APO) were defined as: spontaneous abortion (<10w), fetal death (≥10w), neonatal death, fetal growth restriction (FGR) and delivery prior to 36 weeks of gestation with or without preeclampsia (PE). Results: A total of 35 pregnancies were identified in 25 women with APS. Twelve (48%) patients had thrombotic APS, 9 (36%) had obstetric APS and 4 (16%) had mixed APS. Primary APS was seen in 56% of patients, while systemic lupus erythematosus was found in 44%. The average maternal age at conception was 32.8 ± 5.2 years. Mean duration of disease prior to pregnancy was 6.4 ± 5.5 years. In regard to antiphospholipid antibody (APL) profile, 28.6%, 25.7% and 28.6% of patients were triple, double and single positive, respectively. Although they had fulfilled laboratorial criteria in the past, 17% of patients were negative for all APL. All patients were instructed to receive prophylactic or therapeutic low-molecular-weight heparin combined with low dose aspirin for the duration of pregnancy. Regarding fetal outcomes, there were 2 (5.7%) cases of first-trimester miscarriage, 1 (2.9%) medical abortion due to exposure to teratogenic drugs at the time of conception and 4 (11.4%) fetal deaths. Among the cases of fetal death, one concerned a patient who suspended heparin on her own initiative and another one who became pregnant under warfarin and whose fetus had trisomy 18. The other cases occurred at 11 and 18 weeks of gestation, under regular therapy. There were no cases of neonatal death or other fetal malformations. The rate of live births was 80%, with a mean gestational age of 37.3 ± 1.5 weeks and mean birth weight of 2796.4 ± 462 g. Most women delivered by cesarean section (54.3% of cases). There were 6 (17.1%) cases of preterm birth, three (8.6%) corresponding to fetus with FGR. Concerning maternal outcomes, there was one single case (2.9%) of PE. There were no cases of eclampsia or HELLP syndrome. Lupus anticoagulant (p= 0.003, OR 25, CI 95% 1.32 - 474.0) and triple APL (p= 0.045, OR 5.7, CI 95% 1.15 - 28.33) positivity were associated with adverse pregnancy outcomes. In this cohort, no association was found between poor obstetric outcomes and history of thrombosis, presence of SLE or low complement levels (table 1). Conclusion: In our study, most pregnancies were uneventful. Despite the small sample size, we reinforce the importance of a multidisciplinary evaluation and surveillance before, during and after pregnancy in women with APS in order to implement early treatment and to optimize fetal-maternal outcomes. AD - A. Neto, Reumatologia, Hospital De Egas Moniz, CHLO, Lisboa, Portugal AU - Neto, A. AU - Martins, P. AU - Capela, S. AU - Araujo, C. AU - Centeno, M. AU - Costa, M. AU - Pinto, L. DB - Embase DO - 10.1136/annrheumdis-2019-eular.1079 KW - acetylsalicylic acid chemical teratogen endogenous compound heparin low molecular weight heparin lupus anticoagulant phospholipid antibody warfarin adult antiphospholipid syndrome birth weight cesarean section clinical article clinical assessment conception conference abstract controlled study drug combination drug therapy female fetus fetus death fetus malformation fetus outcome first trimester pregnancy gestational age HELLP syndrome human intrauterine growth retardation live birth low drug dose maternal age medical abortion medical record multidisciplinary team newborn newborn death nurse observational study obstetrician obstetrics outpatient department placenta insufficiency Portuguese (citizen) preeclampsia pregnancy outcome pregnant woman prematurity recurrent abortion retrospective study rheumatologist rheumatology sample size spontaneous abortion systemic lupus erythematosus thrombosis trisomy 18 LA - English M3 - Conference Abstract N1 - L628727974 2019-08-05 PY - 2019 SN - 1468-2060 SP - 1732-1733 ST - Pregnancy outcomes in antiphospholipid syndrome: 8 year-experience from a multidisciplinary unit T2 - Annals of the Rheumatic Diseases TI - Pregnancy outcomes in antiphospholipid syndrome: 8 year-experience from a multidisciplinary unit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628727974&from=export http://dx.doi.org/10.1136/annrheumdis-2019-eular.1079 VL - 78 ID - 760704 ER - TY - JOUR AB - Background/Purpose : Women with antiphospholipid syndrome (APS) are at increased risk of recurrent miscarriage, fetal death, placental insufficiency, preeclampsia and fetal growth restriction (FGR). Although treatment improves outcomes, there are still some unsuccessful pregnancies. A multidisciplinary approach with strict monitoring is essential in order to attain obstetrical success. Our aim is to assess feto-maternal outcomes in Portuguese pregnant women with antiphospholipid syndrome (APS) who received multidisciplinary care and to determine the risk factors for adverse outcomes. Methods : Pregnant women fulfilling the Sydney classification criteria for definite APS, who attended our specialized Rheumatology and Obstetrics outpatient clinic between 2010 and 2019, were included in this retrospective observational study. Cases of suspected APS not fulfilling the classification criteria were excluded. All pregnancies were followed up by a multidisciplinary team (rheumatologists, obstetricians and nurses). Data was collected from medical records. Adverse Pregnancy Outcomes (APO) were defined as: spontaneous abortion (< 10w), fetal death (≥10w), neonatal death, FGR and delivery prior to 36 weeks of gestation with or without preeclampsia (PE). Results : A total of 41 pregnancies were identified in 31 women with APS (58% primary; 42% secondary APS). Forty-five percent had thrombotic APS, 42% obstetric APS and 13% mixed APS. Mean age at conception was 33.4 ± 5.2 years; mean disease duration was 6.3 ± 5.3 years. In regard to antiphospholipid antibody (APL) profile, 32%, 24% and 27% of patients were triple, double and single positive, respectively. Although they had fulfilled laboratorial criteria in the past, 17% of patients were negative for all APL at the time of conception. All patients were instructed to receive prophylactic or therapeutic low-molecular-weight heparin combined with low dose aspirin for the duration of pregnancy. Regarding fetal outcomes, there were 3 (7.3%) cases of first-trimester miscarriage, 1 (2.4%) medical abortion and 4 (9.8%) fetal deaths. There were no cases of neonatal death or other fetal malformations. The rate of live births was 80.5%, with a mean gestational age of 37.7 ± 1.7 weeks and mean birth weight of 2853.9 ± 466 g. Most women (64%) delivered by cesarean section. Preterm birth rate was 18% (6 cases), half corresponding to fetus with FGR. Concerning maternal outcomes, there was one single case (2.4%) of PE. There were no cases of eclampsia or HELLP syndrome. Lupus anticoagulant (p< 0.001, OR 38) and triple APL (p=0.008, OR 8.4) positivity were associated with adverse pregnancy outcomes. In this cohort, no association was found between poor obstetric outcomes and history of thrombosis, presence of SLE or low complement levels (table 1). Conclusion : In our study, most pregnancies were uneventful. The presence of lupus anticoagulant and triple APL positivity can represent risk factors for adverse outcomes, despite conventional treatment. We reinforce the importance of a multidisciplinary evaluation and surveillance before, during and after pregnancy in women with APS in order to implement early treatment and to optimize fetal-maternal outcomes. AD - A. Neto, Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental; CEDOC, Madeira., Lisbon, Portugal AU - Neto, A. AU - Martins, P. AU - Centeno, M. AU - Araújo, C. AU - Pinto, L. AU - Capela, S. DB - Embase DO - 10.1002/art.41108 KW - acetylsalicylic acid endogenous compound low molecular weight heparin lupus anticoagulant phospholipid antibody adult adverse outcome antiphospholipid syndrome birth rate birth weight cesarean section clinical article conception conference abstract controlled study drug combination drug therapy female fetus fetus death fetus malformation fetus outcome first trimester pregnancy gestational age HELLP syndrome human intrauterine growth retardation live birth low drug dose medical abortion medical record multidisciplinary team newborn newborn death nurse observational study obstetrician obstetrics outpatient department preeclampsia pregnancy outcome pregnant woman prematurity retrospective study rheumatologist rheumatology risk factor spontaneous abortion thrombosis LA - English M3 - Conference Abstract N1 - L633060795 2020-10-14 PY - 2019 SN - 2326-5205 SP - 198-199 ST - Pregnancy in antiphospholipid syndrome: Outcomes and risk factors-data from a portuguese multidisclinary unit T2 - Arthritis and Rheumatology TI - Pregnancy in antiphospholipid syndrome: Outcomes and risk factors-data from a portuguese multidisclinary unit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633060795&from=export http://dx.doi.org/10.1002/art.41108 VL - 71 ID - 760673 ER - TY - JOUR AB - Background: Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), occurs in ∼1 to 2 individuals per 1000 each year, corresponding to ∼300 000 to 600 000 events in the United States annually. Objective: These evidence-based guidelines from the American Society of Hematology (ASH) intend to support patients, clinicians, and others in decisions about treatment of VTE. Methods: ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The McMaster University GRADE Centre supported the guideline development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and adult patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations, which were subject to public comment. Results: The panel agreed on 28 recommendations for the initial management of VTE, primary treatment, secondary prevention, and treatment of recurrent VTE events. Conclusions: Strong recommendations include the use of thrombolytic therapy for patients with PE and hemodynamic compromise, use of an international normalized ratio (INR) range of 2.0 to 3.0 over a lower INR range for patients with VTE who use a vitamin K antagonist (VKA) for secondary prevention, and use of indefinite anticoagulation for patients with recurrent unprovoked VTE. Conditional recommendations include the preference for home treatment over hospital-based treatment for uncomplicated DVT and PE at low risk for complications and a preference for direct oral anticoagulants over VKA for primary treatment of VTE. PMID:33007077 AU - Neumann, Ignacio AU - Ageno, Walter AU - Schulman, Sam AU - Thurston, Caitlin AU - Vedantham, Suresh AU - Verhamme, Peter AU - Nieuwlaat, Robby AU - Ross, Stephanie AU - Zhang, Yuan AU - Zhang, Yuqing DA - 2020/10/02 10/02 DB - PubMed Central DO - 10.1182/bloodadvances.2020001830 M1 - 19 PY - 2020 SN - 2473-9529 SP - 4693-4693 ST - American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism T2 - Blood Advances TI - American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7556153&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7556153 VL - 4 ID - 762015 ER - TY - JOUR AB - Introduction: The classification, severity and acute management of a pulmonary embolus (PE) are made based on systemic blood pressure and cardiac biomarkers (or imaging). Historically pathologic specimens were rarely available from those who survived PE. In chronic thromboembolic pulmonary hypertension (CTEPH), the pathologic specimens are complex and would not likely respond to thrombolytics. We hypothesized that some patients evaluated by PERT were already evolving to CTEPH and characterized the pathologic specimens from consecutive patients that underwent acute surgical embolectomy. We also assessed treatment response to catheter-directed thrombolytics (CDT) in patients that followed up in our pulmonary hypertension (PH) clinic. Methods: This was an IRB-approved, single-center observational study of patients who followed up in our PH clinic 2-4 months after the PERT treated them for acute intermediate/high risk PE. At the time of follow up, patients were offered V/Q scan and echocardiogram; two faculty PH clinicians (DJL & RJW) evaluated all patients. Two pathologists blinded to clinical information reviewed the clot histology and graded the clots based on percent red blood cell (RBC), platelet islands, neutrophilic apoptosis, and monocyte/fibroblast presence they classified specimens as acute, subacute or chronic thrombus. These parameters were then compared to symptom duration, presentation, and follow up imaging. Results: 16 patients underwent acute embolectomy and followed up in our PH clinic. Demographics and thrombus characteristics are listed in table 1. Patients with defects on follow up perfusion imaging trended towards less thrombus RBC (area) compared to patients where perfusion defects resolved, 65% vs 43% p = 0.06. Duration of symptoms prior to presentation was not associated with percent RBC. Three patients had recanalization on thrombus, a clear indication of chronicity; the PH clinicians did not suspect CTEPH in 2 of those 3. There was not an obvious difference in thrombus characteristics for those who presented as a massive versus submassive PE. In the 6 patients that underwent CDL, two had unchanged imaging and hemodynamics despite >24 hours of thrombolytics, and both were subsequently diagnosed with CTEPH. Conclusion Based on our histologic findings in surgical thrombectomy specimens, CDL response, and clinical follow-up, many PERT evaluated patients may already have chronic thromboembolic disease that would logically be refractory to risky, advanced therapies like thrombolytics or surgical thrombectomy. Further studies are needed to help PERT clinicians identify those for whom optimal therapy is anticoagulation and subsequent evaluation for CTEPH. AD - G. Newcomb, University of Rochester, Rochester, NY, United States AU - Newcomb, G. AU - Wilson, B. AU - White, R. AU - Goldman, B. AU - Lachant, D. DB - Embase KW - fibrinolytic agent adult anticoagulation apoptosis case report catheter directed thrombolysis chronic thromboembolic pulmonary hypertension chronicity clinical article clinical evaluation conference abstract demography drug therapy echocardiography embolectomy erythrocyte female fibroblast follow up hemodynamics histology histopathology human human cell human tissue lung embolism male monocyte neutrophil observational study pathologist recanalization risk assessment scintigraphy surgical thrombectomy thrombocyte thrombus treatment response LA - English M1 - 1 M3 - Conference Abstract N1 - L632376168 2020-07-27 PY - 2020 SN - 1535-4970 ST - Pathologic characteristics of clots recovered from intermediate/high risk pulmonary embolus patients T2 - American Journal of Respiratory and Critical Care Medicine TI - Pathologic characteristics of clots recovered from intermediate/high risk pulmonary embolus patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632376168&from=export VL - 201 ID - 760634 ER - TY - JOUR AB - Introduction: Historically, surgical management of renal cell carcinomas (RCCs) with inferior vena cava (IVC) tumour thrombus oft en lead to significant morbidity and mortality. However, vast improvements have been achieved in the management of these patients in recent times. We describe the clinical outcomes of such patients and discuss critical aspects of new surgical techniques in our centre. Patients and Methods: A retrospective review of all RCC patients with IVC tumour thrombus who underwent surgery with IVC reconstruction using vascular graft s in Princess Alexandra Hospital was performed. Clinical characteristics and operative details with clinical outcomes were analysed. Results: There were 6 male patients with median age of 62 years (40-74) who underwent nephrectomy and IVC thrombectomy with vascular graft reconstruction in the last 2 years. The extent of IVC tumour thrombus (Mayo) were: level II (1/6), level III (3/6) and level IV (2/6). Following IVC thrombectomy, IVC reconstruction with vascular graft Gelsoft included patch graft (1/6) and IVC replacement (5/6). 2 patients required thoracotomy but without need for cardiopulmonary bypass (CPB) for removal of atrial tumour thrombus and liver mobilization was required for 5 patients intraoperatively. Mean length of hospital stay was 13.8 days and majority had no significant post operative complications. On follow up, all IVC graft s were patent, with no recurrence in IVC and no significant lower limb oedema. 5 patients are still alive (8 months of follow up) while one passed away 20 months following surgery due to metastatic disease. In these cases, meticulous resection of IVC wall invaded by tumour with appropriate reconstruction (patch graft or tube graft replacement) with vascular graft was paramount to ensure good surgical clearance of tumour leading to decreased risk of recurrence at IVC. So far, Gelsoft synthetic vascular graft s used in these patients did not lead to any infective or thrombotic complications with no disease recurrence and avoided the morbidity of lower limb odema. Adequate liver mobilization with proper assessment of hepatic vein involvement determined resectability with the help of hepatobiliary transplant surgeons was also important. Similarly, intra-atrial tumour thrombus were also successfully removed without the need for CPB. Conclusions: Careful pre operative planning, involvement of multidisciplinary team and modification of surgical techniques involving use of vascular graft reconstruction are critical aspects in management of IVC tumour thrombus, leading to better clinical outcomes. AD - K.L. Ng, Princess Alexandra Hospital, Brisbane, Australia AU - Ng, K. L. AU - Wood, S. DB - Embase KW - inferior cava vein neoplasm thrombus patient human kidney carcinoma society Australia and New Zealand blood vessel graft surgery mobilization follow up leg liver morbidity surgical technique thrombectomy transplant surgeon nephrectomy liver vein hospital recurrent disease risk metastasis edema mortality tube patent postoperative complication hospitalization cardiopulmonary bypass thoracotomy planning male LA - English M3 - Conference Abstract N1 - L71408767 2014-04-15 PY - 2014 SN - 1464-4096 SP - 127 ST - Outcome and important surgical considerations in the management of inferior vena cava tumour thrombus in patients with renal cell carcinomas: A single centre experience T2 - BJU International TI - Outcome and important surgical considerations in the management of inferior vena cava tumour thrombus in patients with renal cell carcinomas: A single centre experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71408767&from=export VL - 113 ID - 761126 ER - TY - JOUR AB - Background: Intergroup 0139 Trial suggests an increase in mortality after pneumonectomy in patients receiving preoperative chemotherapy and radiation. We evaluate our outcomes with pneumonectomy after neoadjuvant chemotherapy and radiation. Methods: Neoadjuvant chemotherapy and radiation consisted of cisplatin 50 mg/m2 on days 1, 8, 29, and 36 and etoposide 50 mg/m2 on days 1-5 and 29-33 given concurrently with 5,040 cGy radiation. From a prospective database, results after pneumonectomy were compared between patients receiving and not receiving neoadjuvant chemotherapy and radiation during the same time period. Results: Over 7 years, 50 pneumonectomies were performed for non-small-cell carcinoma; 18 received neoadjuvant chemotherapy and radiation (group A) and 32 did not (group B). Comparing group A with group B, there was no significant difference in patient demographics, blood loss, transfusion requirements or pneumonectomy side. Group A had more patients with stage III disease [17/18 (94%) versus 15/32 (47%), P = 0.001] and also more often had vascularized flap for bronchial stump coverage [17/18 (94%) versus 4/32 (13%), P < 0.001]. There was no significant difference in operative morbidity or mortality. Mortality for group A was 0/18 and for group B was 2/32 (6.3%) (P = 0.530). Group A patients with IIIA(N2) disease (n = 13) had median recurrence-free survival of 12.4 months, median overall survival of 25 months, and 3-year overall survival of 22.2%. Conclusions: Using a multidisciplinary team approach at a tertiary care center, pneumonectomy can be performed successfully after neoadjuvant chemotherapy and radiation for advanced-stage lung cancer. Vascularized flap for bronchial stump coverage may be important in this regard. © 2009 Society of Surgical Oncology. AD - T. Ng, Brown University Oncology Group, Warren Alpert Medical School, Brown University, Providence, RI, United States AU - Ng, T. AU - Birnbaum, A. E. AU - Fontaine, J. P. AU - Berz, D. AU - Safran, H. P. AU - Dipetrillo, T. A. DB - Embase Medline DO - 10.1245/s10434-009-0810-0 KW - cisplatin etoposide adjuvant therapy adult advanced cancer amputation stump article bleeding blood transfusion cancer adjuvant therapy cancer combination chemotherapy cancer radiotherapy cancer staging cancer surgery cancer survival cerebrovascular accident clinical article controlled study deep vein thrombosis dehydration disease free survival empyema esophagitis female fever gastrointestinal hemorrhage graft perfusion heart infarction human hypertension lung edema lung embolism non small cell lung cancer lung resection male morbidity multimodality cancer therapy neutropenia overall survival pneumonia prospective study surgical mortality LA - English M1 - 2 M3 - Article N1 - L50704563 2009-11-19 2010-03-23 PY - 2010 SN - 1068-9265 1534-4681 SP - 476-482 ST - Pneumonectomy after neoadjuvant chemotherapy and radiation for advanced-stage lung cancer T2 - Annals of Surgical Oncology TI - Pneumonectomy after neoadjuvant chemotherapy and radiation for advanced-stage lung cancer UR - https://www.embase.com/search/results?subaction=viewrecord&id=L50704563&from=export http://dx.doi.org/10.1245/s10434-009-0810-0 VL - 17 ID - 761263 ER - TY - JOUR AB - BACKGROUND: Over the last decade, significant advances in ST-elevation myocardial infarction (STEMI) workflow have resulted in most hospitals reporting door-to-balloon (D2B) times within the 90 min standard. Few programs have been enacted to systematically attempt to achieve routine D2B within 60 min. We sought to determine whether 24-hr in-house catheterization laboratory coverage via an In-House Interventional Team Program (IHIT) could achieve D2B times below 60 min for STEMI and to compare the results to the standard primary percutaneous coronary intervention (PCI) approach. METHODS: An IHIT program was established consisting of an attending interventional cardiologist, and a catheterization laboratory team present in-hospital 24 hr/day. For all consecutive STEMI patients, we compared the standard primary PCI approach during the two years prior to the program (group A) to the initial 20 months of the IHIT program (group B), and repeated this analysis for only CMS-reportable patients. The D2B process was analyzed by calculating workflow intervals. The primary endpoint was D2B process times, and secondary endpoints included in-hospital and 6-month cardiovascular outcomes and resource utilization. RESULTS: An IHIT program for STEMI resulted in significant reductions across all treatment intervals with an overall 57% reduction in D2B time, and an absolute reduction in mean D2B time of 71 min. There were no differences pre- and post-program implementation in regard to individual or composite components of in-hospital cardiovascular outcomes; however at 6 months, there was a reduction in cardiovascular rehospitalization after program implementation (30 vs. 5%, P < 0.01). The IHIT program resulted in a significant reduction in length-of-stay (LOS) (90 ± 102 vs. 197 ± 303 hr, P = 0.02), and critical care time (54 ± 97 vs. 149 ± 299 hr, P = 0.02). CONCLUSIONS: Availability of an in-house 24-hr STEMI team significantly decreased reperfusion time and led to improved clinical outcomes and a shorter LOS for PCI-treated STEMI patients. AD - Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois. AN - 25504976 AU - Nguyen, B. AU - Fennessy, M. AU - Leya, F. AU - Nowak, W. AU - Ryan, M. AU - Freeberg, S. AU - Gill, J. AU - Dieter, R. S. AU - Steen, L. AU - Lewis, B. AU - Cichon, M. AU - Probst, B. AU - Jarotkiewicz, M. AU - Wilber, D. AU - Lopez, J. J. DA - Aug DO - 10.1002/ccd.25769 DP - NLM ET - 2014/12/17 J2 - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions KW - After-Hours Care Aged *Cardiac Catheterization/adverse effects/mortality/statistics & numerical data *Delivery of Health Care Female Health Resources/statistics & numerical data Humans Illinois Length of Stay Male Middle Aged Myocardial Infarction/diagnosis/mortality/*therapy Patient Care Team *Percutaneous Coronary Intervention/adverse effects/mortality/statistics & numerical data *Process Assessment, Health Care Program Evaluation Retrospective Studies Risk Factors Time Factors *Time-to-Treatment Treatment Outcome Workflow STEMI systems acute myocardial infarction reperfusion revascularization LA - eng M1 - 2 N1 - 1522-726x Nguyen, Bryant Fennessy, Michelle Leya, Ferdinand Nowak, Wojciech Ryan, Michael Freeberg, Sheldon Gill, Jasrai Dieter, Robert S Steen, Lowell Lewis, Bruce Cichon, Mark Probst, Beatrice Jarotkiewicz, Michael Wilber, David Lopez, John J Orcid: 0000-0002-6727-3623 Comparative Study Journal Article United States Catheter Cardiovasc Interv. 2015 Aug;86(2):186-96. doi: 10.1002/ccd.25769. Epub 2015 Feb 25. PY - 2015 SN - 1522-1946 SP - 186-96 ST - Comparison of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction during and prior to availability of an in-house STEMI system: early experience and intermediate outcomes of the HARRT program for achieving routine D2B times <60 minutes T2 - Catheter Cardiovasc Interv TI - Comparison of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction during and prior to availability of an in-house STEMI system: early experience and intermediate outcomes of the HARRT program for achieving routine D2B times <60 minutes VL - 86 ID - 760352 ER - TY - JOUR AB - Background: The Patient Safety Indicators (PSIs) Composite (PSI 90) of the Agency for Healthcare Research and Quality has been found to have low positive predictive values. Because scores can affect hospital reimbursement and ranking, our institution designed a review process to ensure accurate data and incur minimal penalties under the Hospital Value-Based Purchasing Program. Methods: A multidisciplinary team was assembled to review PSI 90 within a performance period. The positive predictive value of each PSI was calculated. Weight-adjusted PSI rates were used to recalculate the PSI 90 Performance Period Index Value (PPIV). The adjusted PPIV was used to estimate what the achievement points and financial impact would have been if PSI review had not been implemented. Differences in PPIV, achievement points, and financial impact before and after PSI review were calculated. Results: A total of 1,470 cases were flagged for PSI over a 2-year period. The positive predictive value was 63.3%. Refuting 36.7% of PSIs resulted in a decrease in the PPIV from 0.696 to 0.508, an increase in achievement points from 5 to 10, resulting in a decreased net loss of $111,773. Conclusion: Multidisciplinary review processes are practical and effective in identifying false-positive patient safety events. The real-time process affects hospital performance and resultant Medicare reimbursement substantially. AD - M.C. Nguyen, Department of Surgery, Clinical Instructor—Housestaff, The OSU Medical Center, 395 W. 12th Avenue, Columbus, OH, United States AU - Nguyen, M. C. AU - Moffatt-Bruce, S. D. AU - Van Buren, A. AU - Gonsenhauser, I. AU - Eiferman, D. S. DB - Embase Medline DO - 10.1016/j.surg.2017.10.048 KW - article controlled study deep vein thrombosis false positive result health care quality hematoma hospital purchasing human lung embolism major clinical study medicare multidisciplinary team patient safety patient safety indicator performance measurement system postoperative hemorrhage predictive value priority journal reimbursement respiratory failure retrospective study LA - English M1 - 3 M3 - Article N1 - L619931977 2018-12-03 PY - 2018 SN - 1532-7361 0039-6060 SP - 542-546 ST - Daily review of AHRQ patient safety indicators has important impact on value-based purchasing, reimbursement, and performance scores T2 - Surgery (United States) TI - Daily review of AHRQ patient safety indicators has important impact on value-based purchasing, reimbursement, and performance scores UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619931977&from=export http://dx.doi.org/10.1016/j.surg.2017.10.048 VL - 163 ID - 760837 ER - TY - JOUR AB - Background : Tamoxifen, an anti-oestrogen agent, is commonly used in the treatment of breast carcinoma. Venous thromboembolism (VTE) is a well described complication, increasing the risk 2 to 3 fold. The risk is further increased by patient related risk factors. Aims : To reduce the incidence of VTE in patients on tamoxifen undergoing breast surgery by implementing a risk stratifying algorithm for the perioperative management of Tamoxifen. Methods : An ambidirectional cohort design was used to investigate if the algorithm developed by the multidisciplinary team was effective in reducing the risk of VTE while limiting the number of doses of tamoxifen missed in the perioperative period. The algorithm classified patients as low, moderate, high, or very high risk, based on patient risk factors. Tamoxifen was withheld for pre-specified periods of time in the perioperative period, based on their risk. Patients were followed for 60 days post-procedure to see if symptomatic VTE was diagnosed. Results : 446 consecutive patients were analysed between May 2015 and July 2018. In the retrospective arm of 306 cases who were not subject to the algorithm, 4.58% (14) developed a VTE. In the prospective arm of 140 cases managed with the algorithm, 0.71% (1) developed a VTE. Statistical analysis showed a significant difference (p=0.0447, CI 95%). Absolute risk reduction of 3.86% was observed but a larger cohort is needed to validate this. The average number of doses of tamoxifen withheld was: No algorithm 18.1, low risk 0.125, moderate risk 14.988, high risk 29.6, very high risk 32.5. 11.6% fewer doses in total when using the algorithm. Conclusions : The management of Tamoxifen in a standardized manner in patients with breast cancer who require surgery can significantly reduce the risk of VTE in an already high-risk population while reducing the number of doses of Tamoxifen that are withheld. AD - A. Nicola, Guy's and St. Thomas NHS Trust, Plastic Surgery, London, United Kingdom AU - Nicola, A. AU - See, M. AU - Hunt, B. J. AU - Crowley, M. DB - Embase DO - 10.1002/rth2.12229 KW - tamoxifen adult breast carcinoma breast surgery cancer patient cancer surgery cohort analysis complication conference abstract controlled study drug therapy female high risk population human incidence major clinical study multidisciplinary team patient risk perioperative period risk assessment risk reduction surgery venous thromboembolism LA - English M3 - Conference Abstract N1 - L628813506 2019-08-09 PY - 2019 SN - 2475-0379 SP - 705 ST - Thromboprophylaxis in the perioperative patient in patients with breast cancer on tamoxifen T2 - Research and Practice in Thrombosis and Haemostasis TI - Thromboprophylaxis in the perioperative patient in patients with breast cancer on tamoxifen UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628813506&from=export http://dx.doi.org/10.1002/rth2.12229 VL - 3 ID - 760693 ER - TY - JOUR AB - Donohue syndrome ([DS]; leprechaunism) describes a genetic autosomal recessive disorder that results from the presence of homozygous or compound heterozygous mutations in the insulin receptor gene (INSR; 19p13.3-p13.2).Donohue syndrome is associated with a fatal congenital form of dwarfism with features of intrauterine and postnatal growth retardation, exaggerated hyperglycemia with hyperinsulinism and dysmorphic abnormalities.We present a case of DS owing to the rarity of this syndrome (1 case in every million births). We discuss how the disease presents, its genetic underpinning, and its prevention.The case was encountered in an Arab male born on 1 September, 2014, for consanguineous parents. The delivery was via cesarean section at 37 weeks gestation due to severe intrauterine growth restriction and nonprogress labor term. The patient was admitted to the Neonatal Intensive Care Unit due to infection, and jaundice. Dysmorphic features, abnormalities of the craniofacial region, low birth weight, skin abnormalities, abdominal distension and hypertrichosis were observed. Laboratory examinations showed, hyperinsulinism, increased C-peptide, thrombocytopenia, leucopenia, and anemia.The diagnosis of DS was done based on the combinations of typical dysmorphic characteristics, clinical evaluation, supported by genetic analysis and exaggerated biochemical results. Genetic diagnosis of DS was performed through analysis of DNA via polymerase chain reaction (PCR). A qualitative real-time PCR was used, to monitor the amplification of a targeted DNA molecule during the PCR. Other technique using sequencing of the INSR gene, which permits genetic diagnosis, counseling, and antenatal diagnoses in subsequent pregnancies, were also performed.Treatment of DS is supportive and requires the combined efforts of a multidisciplinary team, which include pediatricians, endocrinologists, dermatologists, and other health care professionals. Currently, treatment with recombinant insulin-like growth factor 1 demonstrates effectiveness, and a combination treatment with insulin-like growth factor binding protein 3 resulted in an increased lifespan.There is a scarcity of genetic information on DS among the Arab population. Consanguinity is one of underlying reasons for the appearance of rare genetic disorders. Inbreeding has long been considered a controversial phenomenon. Genetic counseling and overwhelming the alertness of the negative consequences of consanguinity on public health are warranted. AD - From the Pediatric and Neonatal Department, EMMS Nazareth-The Nazareth Hospital, Galilee Medical School-Bar-Ilan University (YN); Orthopedic Medicine, Medical Consulting Center, Nazareth Towers, General Medical Services "Sheruti Briut Clalit," Galilee Medical School-Bar-Ilan University (YA); Pediatric and Neonatal Department, EMMS Nazareth-The Nazareth Hospital, Galilee Medical School, Galilee Medical School-Bar-Ilan University (AA); and Clinical Neuroscience, Neuropsychopharmacology & Population Genetics, Research Center, EMMS Hospital, Nazareth-The Nazareth Hospital (AB), Israel. AN - 26871809 AU - Nijim, Y. AU - Awni, Y. AU - Adawi, A. AU - Bowirrat, A. C2 - Pmc4753905 DA - Feb DO - 10.1097/md.0000000000002710 DP - NLM ET - 2016/02/13 J2 - Medicine KW - Consanguinity Donohue Syndrome/*diagnosis/genetics Fatal Outcome Humans Infant Infant, Newborn Male LA - eng M1 - 6 N1 - 1536-5964 Nijim, Yousif Awni, Youssef Adawi, Amin Bowirrat, Abdalla Case Reports Journal Article Medicine (Baltimore). 2016 Feb;95(6):e2710. doi: 10.1097/MD.0000000000002710. PY - 2016 SN - 0025-7974 (Print) 0025-7974 SP - e2710 ST - Classic Case Report of Donohue Syndrome (Leprechaunism; OMIM *246200): The Impact of Consanguineous Mating T2 - Medicine (Baltimore) TI - Classic Case Report of Donohue Syndrome (Leprechaunism; OMIM *246200): The Impact of Consanguineous Mating VL - 95 ID - 760488 ER - TY - JOUR AB - Donohue syndrome ([DS]; leprechaunism) describes a genetic autosomal recessive disorder that results from the presence of homozygous or compound heterozygous mutations in the insulin receptor gene (INSR; 19p13.3-p13.2). Donohue syndrome is associated with a fatal congenital form of dwarfism with features of intrauterine and postnatal growth retardation, exaggerated hyperglycemia with hyperinsulinism and dysmorphic abnormalities. We present a case of DS owing to the rarity of this syndrome (1 case in every million births). We discuss how the disease presents, its genetic underpinning, and its prevention. The case was encountered in an Arab male born on 1 September, 2014, for consanguineous parents. The delivery was via cesarean section at 37 weeks gestation due to severe intrauterine growth restriction and nonprogress labor term. The patient was admitted to the Neonatal Intensive Care Unit due to infection, and jaundice. Dysmorphic features, abnormalities of the craniofacial region, low birth weight, skin abnormalities, abdominal distension and hypertrichosis were observed. Laboratory examinations showed, hyperinsulinism, increased C-peptide, thrombocytopenia, leucopenia, and anemia. The diagnosis of DS was done based on the combinations of typical dysmorphic characteristics, clinical evaluation, supported by genetic analysis and exaggerated biochemical results. Genetic diagnosis of DS was performed through analysis of DNA via polymerase chain reaction (PCR). A qualitative real-Time PCR was used, to monitor the amplification of a targeted DNA molecule during the PCR. Other technique using sequencing of the INSR gene, which permits genetic diagnosis, counseling, and antenatal diagnoses in subsequent pregnancies, were also performed. Treatment of DS is supportive and requires the combined efforts of a multidisciplinary team, which include pediatricians, endocrinologists, dermatologists, and other health care professionals. Currently, treatment with recombinant insulin-like growth factor 1 demonstrates effectiveness, and a combination treatment with insulin-like growth factor binding protein 3 resulted in an increased lifespan. There is a scarcity of genetic information on DS among the Arab population. Consanguinity is one of underlying reasons for the appearance of rare genetic disorders. Inbreeding has long been considered a controversial phenomenon. Genetic counseling and overwhelming the alertness of the negative consequences of consanguinity on public health are warranted. AD - A. Bowirrat, Clinical Neuroscience, Neuropsychopharmacology and Population Genetics, Nazareth-The Nazareth Hospital, Israel AU - Nijim, Y. AU - Awni, Y. AU - Adawi, A. AU - Bowirrat, A. DB - Embase Medline DO - 10.1097/MD.0000000000002710 KW - antibiotic agent bilirubin C peptide DNA electrolyte insulin receptor recombinant somatomedin C abdominal distension anemia antibiotic therapy Apgar score Arab article biochemistry birth weight blood culture blood oxygen tension case report cesarean section clinical evaluation congenital skin disease counseling obstetric delivery diastolic blood pressure DNA determination emaciation Enterobacter exon fever follow up genetic analysis gestational age head circumference heart arrest hospitalization human hydrocele hydronephrosis hyperglycemia hyperinsulinism hypertrichosis hypocholesterolemia hypoglycemia hypokalemia infant infection insulin resistance intrauterine growth retardation jaundice laboratory test leprechaunism leukopenia lipoatrophy low birth weight low set ear male neonatal thrombocytopenia newborn intensive care obstructive jaundice pallor polymerase chain reaction pregnancy priority journal real time polymerase chain reaction septicemia systolic blood pressure tachycardia thrombocyte transfusion thrombocytopenia urban area urosepsis LA - English M1 - 6 M3 - Article N1 - L608489318 2016-02-24 2016-03-04 PY - 2016 SN - 1536-5964 0025-7974 ST - Classic Case Report of Donohue Syndrome (Leprechaunism; OMIM 246200) T2 - Medicine (United States) TI - Classic Case Report of Donohue Syndrome (Leprechaunism; OMIM 246200) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L608489318&from=export http://dx.doi.org/10.1097/MD.0000000000002710 VL - 95 ID - 761038 ER - TY - JOUR AB - BACKGROUND: Rural ST-segment elevation myocardial infarction (STEMI) care networks may be particularly disadvantaged in achieving a door-to-balloon time (D2B) of less than or equal to 90 minutes recommended in current guidelines. ST-ELEVATION MYOCARDIAL INFARCTION PROCESS UPGRADE PROJECT: A multidisciplinary STEMI process upgrade group at a rural percutaneous coronary intervention center implemented evidence-based strategies to reduce time to electrocardiogram (ECG) and D2B, including catheterization laboratory activation triggered by either a prehospital ECG demonstrating STEMI or an emergency department physician diagnosing STEMI, single-call catheterization laboratory activation, catheterization laboratory response time less than or equal to 30 minutes, and prompt data feedback. EVALUATING SUCCESS: An ongoing regional STEMI registry was used to collect process time intervals, including time to ECG and D2B, in a consecutive series of STEMI patients presenting before (group 1) and after (group 2) strategy implementation. Significant reductions in time to first ECG in the emergency department and D2B were seen in group 2 compared with group 1. CONCLUSIONS: Important improvement in the process of acute STEMI patient care was accomplished in the rural percutaneous coronary intervention center setting by implementing evidence-based strategies. AD - Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.nat.niles@hitchcock.org AN - 21130917 AU - Niles, N. W. AU - Conley, S. M. AU - Yang, R. C. AU - Vanichakarn, P. AU - Anderson, T. A. AU - Butterly, J. R. AU - Robb, J. F. AU - Jayne, J. E. AU - Yanofsky, N. N. AU - Proehl, J. A. AU - Guadagni, D. F. AU - Brown, J. R. DA - Nov-Dec DO - 10.1016/j.pcad.2010.08.004 DP - NLM ET - 2010/12/07 J2 - Progress in cardiovascular diseases KW - Aged *Angioplasty, Balloon, Coronary Delivery of Health Care, Integrated/*organization & administration Electrocardiography Emergency Service, Hospital/organization & administration Evidence-Based Medicine Female Health Services Accessibility/*organization & administration Humans Male Middle Aged Myocardial Infarction/diagnosis/mortality/*therapy New Hampshire Organizational Innovation Outcome and Process Assessment, Health Care/*organization & administration Patient Care Team/organization & administration Practice Guidelines as Topic Program Development Program Evaluation Prospective Studies Quality of Health Care/*organization & administration Regional Health Planning/organization & administration Registries Rural Health Services/*organization & administration Time Factors Transportation of Patients/organization & administration Treatment Outcome LA - eng M1 - 3 N1 - 1873-1740 Niles, Nathaniel W Conley, Sheila M Yang, Rayson C Vanichakarn, Pantila Anderson, Tamara A Butterly, John R Robb, John F Jayne, John E Yanofsky, Norman N Proehl, Jean A Guadagni, Donald F Brown, Jeremiah R Dartmouth-Hitchcock ST Elevation Myocardial Infarction Process Upgrade Project (STEPUP) Group Journal Article United States Prog Cardiovasc Dis. 2010 Nov-Dec;53(3):202-9. doi: 10.1016/j.pcad.2010.08.004. PY - 2010 SN - 0033-0620 SP - 202-9 ST - Primary percutaneous coronary intervention for patients presenting with ST-segment elevation myocardial infarction: process improvement in a rural ST-segment elevation myocardial infarction receiving center T2 - Prog Cardiovasc Dis TI - Primary percutaneous coronary intervention for patients presenting with ST-segment elevation myocardial infarction: process improvement in a rural ST-segment elevation myocardial infarction receiving center VL - 53 ID - 760472 ER - TY - JOUR AB - Introduction: Obesity and Type II Diabetes Mellitus are two of the most common health problems in the UAE. We report on the structure of a comprehensive bariatric surgery program led by a US fellowship trained bariatric surgeon, and the short term outcomes of our first 100 cases. Methods: Sheikh Khalifa Medical City (SKMC) is a large tertiary hospital that did not offer bariatric surgery. Hence, the hospital recruited a US fellowship trained bariatric surgeon to help establish a comprehensive bariatric surgery program. A multidisciplinary team was established (BMI Abu Dhabi team). The team meets on monthly basis, organizes a monthly public lecture, and a yearly obesity symposium. In addition, a multidisciplinary bariatric surgery clinic and a prospective database were established. Results: We retrospectively reviewed all consecutive bariatric surgery cases performed at BMI Abu Dhabi from June 2009 to November 2010. A total number of 100 cases were performed. The types of procedures performed were: 44% LGBP,36% LSG,6% LAGB and 16% revisional bariatric surgery. The mean BMI was 45.8 kg/m2 range (35-78 kg/m2). Thirty percent of our primary bariatric surgery cohort had type 2 DM. The average operating time was 132 minutes, range (55-280). The average length of stay (LOS) was 2.3 days, range (1-9). The average 6 and 12 months excess weight loss (EWL) for LGBP was 51.8% & 77%, for LSG 45% & 60%, and for LAGB 27% & 50%. The 30 day hospital readmission was 8%. Conversion to open 2%, reoperation within 90 days 2%, stenosis 1.1%, leak 0%, sepsis after surgery 0%, pneumonia 0%, DVT/PE 2%, and the 90 day mortality 0%. Conclusion: Establishing a comprehensive bariatric surgery program in the Middle East is feasible with excellent short term bariatric surgery outcomes. AD - A.A. Nimeri, SKMC Managed by Cleveland Clinic, Surgery, Abu Dhabi, United Arab Emirates AU - Nimeri, A. A. AU - Al Hadad, M. B. AU - Schauer, P. DB - Embase DO - 10.1007/s11695-011-0435-9 KW - bariatric surgery metabolic disorder obesity surgery surgeon hospital stenosis sepsis pneumonia mortality Middle East diabetes mellitus health city data base operation duration length of stay body weight loss outpatient department hospital readmission reoperation tertiary health care LA - English M1 - 8 M3 - Conference Abstract N1 - L70530245 2011-09-15 PY - 2011 SN - 0960-8923 SP - 1101-1102 ST - Short term outcomes of bariatric surgery at BMI Abu Dhabi: The first comprehensive bariatric surgery program in Abu Dhabi T2 - Obesity Surgery TI - Short term outcomes of bariatric surgery at BMI Abu Dhabi: The first comprehensive bariatric surgery program in Abu Dhabi UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70530245&from=export http://dx.doi.org/10.1007/s11695-011-0435-9 VL - 21 ID - 761227 ER - TY - JOUR AB - Background. Vascular injuries often result in life threatening hemorrhage or limb loss. When they present with a single entry or exit wound, surgery is immediately indicated. With multiple injuries, however, imaging such as CTA is necessary for diagnosis and choice of treatment. Methods. For all combat-related vascular cases admitted to our medical center during the Lebanon wars in 1982 and 2006, we compiled and compared presenting signs and symptoms, means of diagnosis, treatments, and results. Results. 126 patients with vascular injuries were admitted (87 in 1982, 39 in 2006). 90% were male; mean age of 29 years (range 20-53). All injuries were accompanied by insult to soft tissue, bones, and viscera. 75% presented with injury to arteries in the extremities. 75% of these patients presented with limb ischemia, and 25% sustained massive blood loss. Treatments included venous interposition graft, end-to-end anastomosis, venous patch, endovascular technique (only in 2006), and ligation/observation. Complications included thrombosis and wound infections. Mortality and amputations occurred only in 1982, and this may be attributed to the use of imaging, advanced technique, and shorter average time from injury to hospital (7 hours). Conclusions. We recommend CTA as the first line modality for diagnosis of vascular injuries, as its liberal use allowed for early and appropriate treatment. Treatment outcomes improved with fast and effective resuscitation, liberal use of tourniquets and fasciotomies, and meticulous treatment by a multidisciplinary team. © 2013 Samy S. Nitecki et al. AD - S.S. Nitecki, Department of Vascular Surgery, Rambam Health Care Campus and Faculty of Medicine, Technion Israel Institute of Technology, P.O. Box 9602, 31096 Haifa, Israel AU - Nitecki, S. S. AU - Karram, T. AU - Ofer, A. AU - Engel, A. AU - Hoffman, A. DB - Embase DO - 10.1155/2013/689473 KW - adult amputation artery injury artery ligation artificial embolization battle injury bleeding blood vessel injury bone injury carotid artery clinical effectiveness computed tomographic angiography end to end anastomosis endovascular surgery fasciotomy female femoral artery follow up human injury severity limb ischemia major clinical study male mortality osteomyelitis outcome assessment popliteal artery priority journal radial artery resuscitation review sciatic nerve injury skin graft soft tissue injury subclavian artery thrombosis tibial artery tourniquet ulnar artery vertebral artery wound infection LA - English M3 - Review N1 - L368272265 2013-02-13 2013-02-26 PY - 2013 SN - 2090-2840 2090-2859 ST - Management of combat vascular injuries using modern imaging: Are we getting better? T2 - Emergency Medicine International TI - Management of combat vascular injuries using modern imaging: Are we getting better? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L368272265&from=export http://dx.doi.org/10.1155/2013/689473 VL - 2013 ID - 761174 ER - TY - JOUR AB - Purpose of review At present, 85-90% of those born with congenital heart disease (CHD) grow up to become adults. With few exceptions, reparative surgery is not curative and requires long-term surveillance. Caregivers could be changed from pediatric cardiologists to adult CHD specialists (or cardiologists) during this process. This study will focus on the current practice of transition in CHD. Recent findings Residua and sequelae may progress in severity with age and induce late complications, such as arrhythmias, cardiac failure, thromboembolism, sudden cardiac death, reoperation, cardiac intervention, and arrhythmia ablation. There are other obstacles that further complicate adult CHD, including pregnancy and delivery, noncardiac surgery, psychosocial problems, health insurance coverage, and extracardiac complications, making close follow-up and proper management mandatory. Because of this, several specialized centers have been established to respond to this need, and several studies focusing on transition have been published recently. Summary Provision of comprehensive care by multidisciplinary teams including adult CHD specialists, adult and pediatric cardiologists and cardiovascular surgeons, specialized nurses, and other specific disciplines are the fundamental features in care facilities for adult CHD. Training and education should be focused on adult CHD fellows who represent the next generation that will assume responsibility for this patient population. Proper transition from pediatric cardiologists and cardiovascular surgeons to adult CHD care team, including adult CHD specialists and/or cardiologists trained in this field, is mandatory. AD - K. Niwa, Department of Cardiology, Cardiovascular Center, St Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan AU - Niwa, K. DB - Embase Medline DO - 10.1097/MOP.0000000000000270 KW - cardiologist caregiver congenital heart disease obstetric delivery disease severity education follow up health insurance heart arrhythmia heart failure heart right ventricle failure human medical practice medical specialist pregnancy priority journal psychosocial disorder reoperation review sudden cardiac death surgeon thromboembolism training transitional care LA - English M1 - 5 M3 - Review N1 - L608875550 2016-03-14 2016-03-22 PY - 2015 SN - 1531-698X 1040-8703 SP - 576-580 ST - Adults with congenital heart disease transition T2 - Current Opinion in Pediatrics TI - Adults with congenital heart disease transition UR - https://www.embase.com/search/results?subaction=viewrecord&id=L608875550&from=export http://dx.doi.org/10.1097/MOP.0000000000000270 VL - 27 ID - 761092 ER - TY - JOUR AB - OBJECTIVES: Cancer-associated thrombosis (CAT) complex condition, which may present to any healthcare professional and at any point during the cancer journey. As such, patients may be managed by a number of specialties, resulting in inconsistent practice and suboptimal care. We describe the development of a dedicated CAT service and its evaluation. SETTING: Specialist cancer centre, district general hospital and primary care. PARTICIPANTS: Patients with CAT and their referring clinicians. INTERVENTION: A cross specialty team developed a dedicated CAT service , including clear referral pathways, consistent access to medicines, patient's information and a specialist clinic. PRIMARY AND SECONDARY OUTCOME MEASURES: The service was evaluated using a mixed-methods evaluation , including audits of clinical practice, clinical outcomes, staff surveys and qualitative interviewing of patients and healthcare professionals. RESULTS: Data from 457 consecutive referrals over an 18-month period were evaluated. The CAT service has led to an 88% increase in safe and consistent community prescribing of low-molecular-weight heparin, with improved access to specialist advice and information. Patients reported improved understanding of their condition, enabling better self-management as well as better access to support and information. Referring clinicians reported better care standards for their patients with improved access to expertise and appropriate management. CONCLUSIONS: A dedicated CAT service improves overall standards of care and is viewed positively by patients and clinicians alike. Further health economic evaluation would enhance the case for establishing this as the standard model of care. AD - Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK. Velindre Cancer Centre, Cardiff, UK. Trinity College, Dublin, Ireland. Marie Curie Hospice, Penarth, UK. Department of Haematology, Neville Hall Hospital, Abergavenny, UK. Haemophilia and Thrombosis Centre, University Hospital of Wales, Cardiff, UK. AN - 27895068 AU - Noble, S. AU - Pease, N. AU - Sui, J. AU - Davies, J. AU - Lewis, S. AU - Malik, U. AU - Alikhan, R. AU - Prout, H. AU - Nelson, A. C2 - Pmc5168504 DA - Nov 28 DO - 10.1136/bmjopen-2016-013321 DP - NLM ET - 2016/11/30 J2 - BMJ open KW - Adult Aged Aged, 80 and over Ambulatory Care Facilities Attitude Attitude of Health Personnel Female *Health Services Health Services Accessibility Heparin/therapeutic use Humans Male Middle Aged Neoplasms/*complications *Patient Care Team Patient Satisfaction Primary Health Care *Quality Improvement *Referral and Consultation Self Care *Specialization Surveys and Questionnaires Thrombosis/*drug therapy/etiology Young Adult *cancer associated thrombosis *mixed methods *patient journey *quality of life *service improvement for Leo Pharma and Pfizer no honorarium was received. RA served in the advisory boards of Pfizer, Leo Pharma, Bristol Myers Squibb and Bayer and in the speakers bureau for Leo Pharma, Pfizer and Bayer. LA - eng M1 - 11 N1 - 2044-6055 Noble, Simon Pease, Nikki Sui, Jessica Davies, James Lewis, Sarah Malik, Usman Alikhan, Raza Prout, Hayley Nelson, Annmarie Evaluation Study Journal Article BMJ Open. 2016 Nov 28;6(11):e013321. doi: 10.1136/bmjopen-2016-013321. PY - 2016 SN - 2044-6055 SP - e013321 ST - Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise T2 - BMJ Open TI - Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise VL - 6 ID - 760249 ER - TY - JOUR AB - The management of acute ischemic stroke aims to verify the clinical diagnosis, to start general supportive care and to enable decision-making about specific forms of therapy. The risk-benefit ratio is time-dependent for many therapeutic options; therefore time delays are a disadvantage within the rescue chain. The trained and multidisciplinary team of the stroke unit forms the backbone of acute management. In addition, technical infrastructure influences therapeutic options and cerebral imaging is the cornerstone. The following four therapies are evidence-based: treatment on a stroke unit, thrombolysis, early administration of acetylsalicylic acid (ASS) and hemicraniectomy in patients younger than 60 years with a so-called malignant infarction. This article describes the necessary diagnostic steps and the general and specific therapeutic options that comprise acute management within the first 48 h. AD - [Nolte, C. H.; Endres, M.] Charite, Neurol Klin, D-10115 Berlin, Germany. [Nolte, C. H.; Endres, M.] Charite, CSB, D-10115 Berlin, Germany. Nolte, CH (corresponding author), Charite, Neurol Klin, Charitepl 1, D-10115 Berlin, Germany. christian.nolte@charite.de AN - WOS:000303873800007 AU - Nolte, C. H. AU - Endres, M. DA - May DO - 10.1007/s00108-011-3003-4 J2 - Internist KW - Acute ischemic stroke Cerebral infarction Emergency treatment Thrombolytic therapy Decompressive craniectomy MIDDLE CEREBRAL-ARTERY RISK-FACTORS POOLED ANALYSIS THROMBOLYSIS ALTEPLASE KNOWLEDGE INTERVENTION ASSOCIATION GLUCOSE DELAYS Medicine, General & Internal LA - German M1 - 5 M3 - Article N1 - ISI Document Delivery No.: 940EW Times Cited: 4 Cited Reference Count: 35 Nolte, C. H. Endres, M. Nolte, Christian/0000-0001-5577-1775 4 0 1 SPRINGER HEIDELBERG HEIDELBERG INTERNIST PY - 2012 SN - 0020-9554 SP - 585-592 ST - Management of acute ischemic stroke T2 - Internist TI - Management of acute ischemic stroke UR - ://WOS:000303873800007 VL - 53 ID - 761828 ER - TY - JOUR AB - In patients with acute ischemic stroke, thrombolysis offers an opportunity to effectively reduce disability and dependency. The success of this treatment is time-dependent. The crucial diagnostic step before initiation of treatment is cerebral imaging. With the aim of reducing in-hospital delays, our hospital's interdisciplinary stroke management group implemented an all-points alarm to improve in-hospital time delay (the period between arrival to the emergency department and performance of cerebral imaging). The alarm simultaneously alerted all involved staff (from the neurologist to in-hospital transport) to the arrival of a patient potentially eligible for thrombolysis. Time delay, sociodemographic, and clinical data were assessed prospectively at 4 months before and 8 months after alarm implementation. Data were examined by analysis of covariance for both the intention-to-treat and per-protocol groups. During the assessment, 689 patients with symptoms compatible with stroke arrived at our hospital. Among those, 111 patients (16%) were eligible for thrombolysis (median age, 71 years; median National Institutes of Health Stroke Scale score, 11; 44% female). Patient characteristics (ie, age, sex, insurance status, National Institutes of Health Stroke Scale score, cardiovascular risk factors, and prehospital delay) did not differ significantly before (n = 34) and after (n = 77) alarm implementation. The median "door-to-imaging time" for patients eligible for thrombolysis was significantly reduced, from 54 minutes before implementation of the alarm to 35 minutes after implementation. Adjusted analysis of covariance demonstrated a significant influence of the intervention (P = .001) on differences in time delay. The proportion of ischemic stroke patients receiving thrombolysis rose from 42% to 66% (P = .04). The per-protocol analysis confirmed these results. The implementation of an all-points alarm can result in significant reduction of the time needed for in-hospital pathways for acute stroke patients. AD - Department of Neurology, Charité University Medical Center, Berlin, Germany. christian.nolte@charite.de AN - 21903419 AU - Nolte, C. H. AU - Malzahn, U. AU - Kühnle, Y. AU - Ploner, C. J. AU - Müller-Nordhorn, J. AU - Möckel, M. DA - Feb DO - 10.1016/j.jstrokecerebrovasdis.2011.07.004 DP - NLM ET - 2011/09/10 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Acute Disease Aged Aged, 80 and over Emergency Medical Services/organization & administration/*standards Female Humans Male Middle Aged Outcome Assessment, Health Care Patient Care Team/organization & administration/standards Program Evaluation Stroke/*drug therapy/*therapy Tertiary Care Centers/organization & administration/standards Thrombolytic Therapy/*standards Time-to-Treatment/organization & administration/*standards LA - eng M1 - 2 N1 - 1532-8511 Nolte, Christian H Malzahn, Uwe Kühnle, York Ploner, Christoph J Müller-Nordhorn, Jacqueline Möckel, Martin Clinical Trial Journal Article Research Support, Non-U.S. Gov't Validation Study United States J Stroke Cerebrovasc Dis. 2013 Feb;22(2):149-53. doi: 10.1016/j.jstrokecerebrovasdis.2011.07.004. Epub 2011 Sep 8. PY - 2013 SN - 1052-3057 SP - 149-53 ST - Improvement of door-to-imaging time in acute stroke patients by implementation of an all-points alarm T2 - J Stroke Cerebrovasc Dis TI - Improvement of door-to-imaging time in acute stroke patients by implementation of an all-points alarm VL - 22 ID - 760447 ER - TY - JOUR AB - Objective: To describe the management of prenatal care and delivery in patients bearing autoimmune hepatitis associated with moderate or severe thrombocytopenia. Methods: This study was performed in a tertiary level university hospital. Thirteen pregnancies in ten patients diagnosed with autoimmune hepatitis, complicated by thrombocytopenia, were retrospectively analyzed. The inclusion criteria were as follows: clinical diagnosis of autoimmune hepatitis, moderate or severe thrombocytopenia (platelet count < 100 x 103/mm(3)), gestational age at birth over 22 weeks, and patient followed-up by a specialized team at the institution. The variables studied were: maternal age, parity, treatment regimen, platelet count, examinations for investigation of hepatic function, type of delivery, weight at birth, and gestational age at the time of delivery. Results: The average maternal age was 24.5 years (SD = 5.3) and six (50%) occurred in nulliparous women. During pregnancy, monotherapy with prednisone was adopted in 11 cases (92%). According to the autoantibody profiles, seven pregnancies (58%) had the autoimmune hepatitis type I diagnosis, two pregnancies had type II (17%), and three pregnancies (25%) had cryptogenic chronic hepatitis (undetectable titers of autoantibodies). Portal hypertension was featured in 11 pregnancies (92%). The average gestational age at delivery was 36.9 weeks (SD = 1.5 weeks), with an average weight at birth of 2,446 g (SD = 655 g). Eight infants (67%) were small for gestational age. At the time of delivery, severe thrombocytopenia was featured in four cases (33%) and cesarean surgery was performed in seven cases (58%). Complications at delivery occurred in three cases (25%), one patient presented uterine atony, and two patients presented perineal bruising. There was no perinatal or maternal death. Conclusion: The complication's of thrombocytopenic patients with autoimmune hepatitis are elevated; nevertheless, with appropriate attention and care, they can be resolved. The association between two severe pathologies appears to increase the risk of prematurity and fetal growth restriction, demanding specialized prenatal care, as well as surveillance of newborn well-being. (C) 2013 Elsevier Editora Ltda. All rights reserved. AD - [Yamamoto Nomura, Roseli Mieko; Vieira Francisco, Rossana Pulcineli; Zugaib, Marcelo] Univ Sao Paulo, Fac Med, Dept Obstet & Ginecol, BR-05403000 Sao Paulo, Brazil. [Kleine, Roololpho Truffa] Univ Sao Paulo, Fac Med, BR-05403000 Sao Paulo, Brazil. [Kondo Igai, Ana Maria] Univ Sao Paulo, Fac Med, Hosp Clin, Clin Obstet, BR-05403000 Sao Paulo, Brazil. Nomura, RMY (corresponding author), Univ Sao Paulo, Fac Med, Dept Obstet & Ginecol, Av Dr Eneas de Carvalho Aguiar 255,10 Andar,Sala, BR-05403000 Sao Paulo, Brazil. roseli.nomura@hotmail.com AN - WOS:000315305900007 AU - Nomura, R. M. Y. AU - Kleine, R. T. AU - Igai, A. M. K. AU - Francisco, R. P. V. AU - Zugaib, M. DA - Jan-Feb DO - 10.1590/s0104-42302013000100008 J2 - Rev. Assoc. Med. Bras. KW - Autoimmune hepatitis Pregnancy Thrombocytopenia Prenatal care RISK Medicine, General & Internal LA - Portuguese M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 095AC Times Cited: 1 Cited Reference Count: 17 Yamamoto Nomura, Roseli Mieko Kleine, Roololpho Truffa Kondo Igai, Ana Maria Vieira Francisco, Rossana Pulcineli Zugaib, Marcelo Francisco, Rossana Pulcineli Vieira/AAG-7461-2020; Zugaib, Marcelo/A-5724-2013; HCFMUSP, Pos-Graduacao DOG -/F-1162-2013; Francisco, Rossana PV/C-5648-2012; Nomura, Roseli M. Y./C-6521-2012 Francisco, Rossana Pulcineli Vieira/0000-0002-9981-8069; Zugaib, Marcelo/0000-0003-1155-2671; Francisco, Rossana PV/0000-0002-9981-8069; Nomura, Roseli M. Y./0000-0002-6471-2125 2 0 7 ASSOC MEDICA BRASILEIRA SAO PAULO REV ASSOC MED BRAS PY - 2013 SP - 28-34 ST - Clinical and obstetrical management of pregnant women with autoimmune hepatitis complicated by moderate or severe thrombocytopenia T2 - Revista Da Associacao Medica Brasileira TI - Clinical and obstetrical management of pregnant women with autoimmune hepatitis complicated by moderate or severe thrombocytopenia UR - ://WOS:000315305900007 VL - 59 ID - 761815 ER - TY - JOUR AB - Background: Although perfusion imaging is being evaluated as a tool to select acute ischemic stroke patients who are most likely to benefit from reperfusion therapies beyond the standard time windows, there are limited data on the utility of perfusion imaging within the intravenous (IV) thrombolytic time window. Methods: A new stroke imaging protocol was initiated at Emory University Hospital including computed tomographic angiography (CTA) and computed tomographic perfusion (CTP). All patients presenting within 4.5 hours from last known normal time with suspected stroke were prospectively identified. Impact of CTA and CTP on the clinical management was recorded prospectively by stroke team members. Results: During the study period, 87 patients met eligibility criteria for the CTA/CTP protocol, of which 83 (95%) underwent this upfront comprehensive imaging protocol and 30 (34%) received IV thrombolytics. Overall, stroke team members reported that CTA and/or CTP aided their clinical management in 39 (47%) cases, including aiding in identification of a nonstroke diagnosis (n = 18), triage to the neurologic intensive care unit (n 5 9), early triage to endovascular therapy (n 5 4), and initiation of IV thrombolytic for low National Institutes of Health Stroke Scale score with large vessel occlusion (n = 3). Door to needle time <= 60 minutes was achieved in only 18% of patients receiving IV thrombolysis during the study period, but had improved to 44% in the subsequent 6-month period. Conclusions: An upfront CTA/CTP protocol aided stroke team decision-making in nearly half of cases. Implementation of a CTA/CTP protocol was associated with a learning curve of 6 months before door to needle time <= 60 minutes returned to similar rates as the pre-CTA/CTP protocol. AD - [Noorian, Ali Reza; Bryant, Katja; Edwards, Adam B.; Markowski, Mason P.; Bouloute, Jemisha C.; Abney, Jacquelyn; Nahab, Fadi] Emory Univ, Sch Med, Dept Neurol, Atlanta, GA 30322 USA. [Aiken, Ashley; Nicholson, Andrew D.; Dehkharghani, Seena] Emory Univ, Sch Med, Dept Radiol, Atlanta, GA 30322 USA. Noorian, AR (corresponding author), Emory Univ, Sch Med, Dept Neurol, 101 Woodruff Circle,6000, Atlanta, GA 30322 USA. arnoorian@emory.edu AN - WOS:000330582500017 AU - Noorian, A. R. AU - Bryant, K. AU - Aiken, A. AU - Nicholson, A. D. AU - Edwards, A. B. AU - Markowski, M. P. AU - Dehkharghani, S. AU - Bouloute, J. C. AU - Abney, J. AU - Nahab, F. DA - Feb DO - 10.1016/j.jstrokecerebrovasdis.2012.12.008 J2 - J. Stroke Cerebrovasc. Dis. KW - Acute stroke computed tomographic perfusion tissue plasminogen activator revascularization TECHNICAL IMPLEMENTATIONS THEORETIC BASIS CT PERFUSION THROMBOLYSIS Neurosciences Peripheral Vascular Disease LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 302DT Times Cited: 5 Cited Reference Count: 21 Noorian, Ali Reza Bryant, Katja Aiken, Ashley Nicholson, Andrew D. Edwards, Adam B. Markowski, Mason P. Dehkharghani, Seena Bouloute, Jemisha C. Abney, Jacquelyn Nahab, Fadi Nicholson, Andrew/K-3447-2014 Nicholson, Andrew/0000-0002-9304-5210; Dehkharghani, Seena/0000-0002-3141-1094 5 0 4 ELSEVIER AMSTERDAM J STROKE CEREBROVASC PY - 2014 SN - 1052-3057 SP - 220-224 ST - Initial Experience with Upfront Arterial and Perfusion Imaging among Ischemic Stroke Patients Presenting within the 4.5-hour Time Window T2 - Journal of Stroke & Cerebrovascular Diseases TI - Initial Experience with Upfront Arterial and Perfusion Imaging among Ischemic Stroke Patients Presenting within the 4.5-hour Time Window UR - ://WOS:000330582500017 VL - 23 ID - 761789 ER - TY - GEN AU - Norman, Anthony V. AU - Kaneko, Tsuyoshi AU - Piazza, Gregory AU - McGurk, Siobhan AU - Ejiofor, Julius I. AU - Goldhaber, Samuel Z. AU - Yammine, Maroun AU - Sobieszczyk, Piotr AU - McCabe, James M. AU - Aranki, Sary F. AU - Shekar, Prem S. DA - 2016/01/01 DB - Federal Science Library - Canada KW - Pulmonary embolism Heart Care and treatment Usage Analysis Surgery Hemodynamics PY - 2016 SN - 0009-7322 ST - Advanced treatment of submassive pulmonary embolism in 135 patients triaged by a multidisciplinary pulmonary embolism response team TI - Advanced treatment of submassive pulmonary embolism in 135 patients triaged by a multidisciplinary pulmonary embolism response team UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV3da9swEBdrYWMMxtZutPvUU_cQ3EmWLdvQDULpPggrjCZsb0WWpdYktoedPKT_2P69nWz5I11g28NeTHKIi4l-vjud73eHEHOPiXPLJnCfBjLxCRGxcRpu4Lsh5UFMFHhYHRre8GzGzr57519N7-e2pWsv-68bDzLYekOk_YfN75SCAD4DBOAKIIDrX8Fg3L7j7yvKITyswAtC1Gyqhn6sFnAzNSc3i4uFmZmR5iPK_LblajUykz2umkhVNBWIG1zeLRrKpvJWjQBC2TD-PU1LaQeGbZsDNMhLnNd0hkF_g74cdyJyNa9TvNNqtS6q67Qz8Km4uRFD7k2Xdvy4an7mIi3ia_tI2GwH5TXtL-yzHVu6VtTZjnQxt_n5bxPL4Now-5ETsIYAfayspXc9x_ObTkqdK7CJVYv5qHeSbWHALd_ZVTSOvSgAp8OJe2R6tmdJKpfvVO7MLnbQDthRE65_nnQxAmeB3874MzdmA4IHvaeePkIP7ZkEjxv0PEZ3VL6H9se5WBbZGh_hukq4fv2yh-59scUY--hniy3cYQsXGvfYwh0ycIsMnOYYsIVbbGGLLRyvscC_YQufZKKcv-_0nLytv1txq3RT2mJvU2qAaCVP0PTD2fT0k2PngDhXAfhrOJFLqqgiYcR9-JsjKiTjTAZUxhCMeoLSRLuCSxUJokKtlIi4x11YqX0pGHuKdvMiVwcIx9Scx0VCuAAjFJJIaRlolhAmCFNKH6LXZhsuGw5y9_xf9rt7iN7UK4wFWJZCCstiAf2mkdpg5bM_6nqO7vcQf4F2l-VKvUR3dbVw4kq_qhHzC2JMtSQ VL - 134 ID - 761938 ER - TY - JOUR AB - Summary Background & aims Intestinal rehabilitation is the preferred treatment for children with short bowel syndrome (SBS) whatever the residual bowel length, and depends on the accurate management of long-term parenteral nutrition (PN). If nutritional failure develops, intestinal transplantation (ITx) should be discussed and may be life-saving. This study aimed to evaluate survival, PN dependency and nutritional status in children with neonatal very SBS on PN or after ITx, in order to define indications and timing of both treatments. Patients and methods This retrospective cross-sectional study enrolled 36 children with very SBS (<40 cm) who entered our intestinal rehabilitation program from 1987 to 2007. Results All the children on long-term PN (n = 16) survived with a follow-up of 17 years (9–20). Six of them were eventually weaned off PN. Twenty children underwent ITx: eight children died (40%) 29 months (0–127) after Tx. The others 12 patients were weaned off PN 73 days (13–330) after Tx. Follow-up after transplantation was 14 years (6–28). Seven out of 8 (88%) patients with a history of gastroschisis required ITx. Patients who required ITx had longer stoma duration. Conclusion Survival rate of children with very short bowel was excellent if no life-threatening complications requiring transplantation developed. Gastroschisis and delayed ostomy closure are confirmed as risk factor for nutritional failure. Intestinal rehabilitation may allow a total weaning of PN before adulthood. A follow-up by a multidisciplinary team is necessary to avoid PN complications in order to minimize indications for ITx. Highlights • Multiple catheter sepsis and thrombosis are risk factors for the need of intestinal transplantation. • Patients with gastroschisis or longer duration of stoma evolves more frequently to intestinal transplantation. • The survival rate of children with neonatal very short bowel syndrome is 68%: all deaths occurred after intestinal transplantation. • One third of patients on long term parenteral nutrition can be weaned. • The objective of intestinal rehabilitation should be to avoid nutritional failure requiring intestinal transplantation. AD - Department of Pediatric Gastroenterology, Hepatology and Nutrition, Intestinal Failure Rehabilitation Center, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France Faculté de Médecine, Universitè of Sorbonne-Paris-Cité, Paris Descartes, 15 Rue de l'École de Médecine, 75006 Paris, France Department of Pediatric Surgery and Transplantation, Hôpital Universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France AN - 135710222. Language: English. Entry Date: 20190406. Revision Date: 20190411. Publication Type: Article AU - Norsa, Lorenzo AU - Artru, Solene AU - Lambe, Cecile AU - Talbotec, Cecile AU - Pigneur, Benedicte AU - Ruemmele, Frank AU - Colomb, Virginie AU - Capito, Carmen AU - Chardot, Christophe AU - Lacaille, Florence AU - Goulet, Olivier DB - CINAHL DO - 10.1016/j.clnu.2018.02.004 DP - EBSCOhost KW - Short Bowel Syndrome -- Rehabilitation -- In Infancy and Childhood Short Bowel Syndrome -- Prognosis -- In Infancy and Childhood Parenteral Nutrition Intestines -- Transplantation -- In Infancy and Childhood Nutritional Status -- In Infancy and Childhood Human Infant Child Retrospective Design Cross Sectional Studies Short Bowel Syndrome -- Mortality Weaning Gastroschisis -- Rehabilitation Ostomy Multidisciplinary Care Team Risk Assessment Survival M1 - 2 N1 - research; tables/charts. Journal Subset: Allied Health; Biomedical; Continental Europe; Double Blind Peer Reviewed; Europe; Peer Reviewed. NLM UID: 8309603. PY - 2019 SN - 0261-5614 SP - 926-933 ST - Long term outcomes of intestinal rehabilitation in children with neonatal very short bowel syndrome: Parenteral nutrition or intestinal transplantation T2 - Clinical Nutrition TI - Long term outcomes of intestinal rehabilitation in children with neonatal very short bowel syndrome: Parenteral nutrition or intestinal transplantation UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=135710222&site=ehost-live&scope=site VL - 38 ID - 761346 ER - TY - JOUR AB - Background: Recent evidence has suggested that geriatric patients with osteoporotic hip fractures may benefit from comanagement with a multidisciplinary care team. We evaluated the effect that establishment of a comprehensive multidisciplinary care team had on time to surgery, length of hospital stay, postoperative complications, and morbidity on geriatric hip fracture patients. Methods: This study was a retrospective comparative cohort study of 267 patients admitted for geriatric hip fractures at an academic trauma center and a community hospital. Patients at the academic hospital were treated by a unilateral orthopaedic team, while patients at the community hospital were treated by a comprehensive multidisciplinary team (MDT), with both hospitals served by the same group of rotating physicians and ancillary staff. Outcomes included time to surgery (TTS), length of stay (LOS), postoperative complications, and mortality rates. Results: One hundred and twenty-nine hip fractures were treated by the MDT and 138 by the non-MDT. The MDT cohort was older (84.5 vs. 79.9 yr, P<0.001) and had a larger percentage of women (79.8% vs. 67.4%, P=0.03) than the non-MDT cohort. Patients in the MDT cohort experienced a shorter TTS (1.7 vs. 2.4 days, P<0.001) and LOS (8.2 vs. 10.7 days, P=0.024) than those in the non-MDT cohort. There were no differences in complication or mortality rates between the two cohorts. Conclusions: Treatment of patients with hip fractures by a comprehensive multidisciplinary team may lead to improved clinical processes shown by decreased time to surgery and shorter LOS but did not significantly decrease individual complication or mortality rates. AD - M.S. Noticewala, Columbia University, Medical Center, 622 West 168th Street PH-1130, New York, NY, United States AU - Noticewala, M. S. AU - Swart, E. AU - Shah, R. P. AU - Macaulay, W. AU - Geller, J. A. DB - Embase DO - 10.1097/BCO.0000000000000394 KW - aged article atelectasis cerebrovascular accident cohort analysis decubitus deep vein thrombosis delirium demography female geriatric patient heart arrhythmia heart infarction hip fracture hip surgery human ileus length of stay lung embolism major clinical study male mortality rate physician pneumonia postoperative complication priority journal retrospective study surgical infection urinary tract infection LA - English M1 - 4 M3 - Article N1 - L611203469 2016-07-19 2016-07-27 PY - 2016 SN - 1941-7551 1940-7041 SP - 346-350 ST - First Place Award Multidisciplinary care of the hip fracture patient: A case control analysis of differing treatment protocols T2 - Current Orthopaedic Practice TI - First Place Award Multidisciplinary care of the hip fracture patient: A case control analysis of differing treatment protocols UR - https://www.embase.com/search/results?subaction=viewrecord&id=L611203469&from=export http://dx.doi.org/10.1097/BCO.0000000000000394 VL - 27 ID - 761012 ER - TY - JOUR AB - Background: The utilization of ultrasound-assisted catheter-directed thrombolysis (USAT) has increased in cases of severe (massive and submassive) pulmonary embolism (PE). However, evidence of benefit with regard to clinical endpoints is limited. Thus, we sought to assess the impact of USAT on in-hospital mortality. Methods: We conducted a retrospective review of patients treated for severe PE at a large academic medical center between 2013 and 2016. Severe PE inclusion was contingent on hemodynamic status, cardiac biomarkers, and echocardiography. The effect of USAT use on in-hospital mortality was assessed using logistic regression. Results: A total of 257 patients were identified as having been treated for severe PE; mean age was 61.9 ± 17.6 years and the majority (58.0%) were women. Vasopressor (17.1%) and mechanical ventilation (15.2%) use was substantial. Treatment strategies included systemic anticoagulation alone (n = 180), systemic thrombolysis (n = 16), USAT (n = 47), and surgical thrombectomy (n = 12). Overall in-hospital mortality was 11.7%. Use of USAT was associated with a lower incidence of in-hospital mortality (2.1% vs. 13.8%; p = 0.024). This decrease in mortality remained significant in a logistic regression model adjusting for age, bleeding, PE response team usage, troponin level, and blood pressure (odds ratio: 0.113; 95% confidence interval: 0.014 to 0.906) (Figure). [Figure presented] Conclusion: This large, retrospective, single-center analysis of patients treated for severe PE demonstrates that the use of USAT was associated with decreased in-hospital mortality, even after adjustment for potential confounders. Categories: STRUCTURAL: Pulmonary Embolism and Pulmonary Hypertension AU - Nouri, S. N. AU - Madhavan, M. AU - Lavelle, M. AU - Lumish, H. AU - Li, J. AU - Berman-Rosenzweig, E. AU - Parikh, S. A. AU - Kirtane, A. J. AU - Garan, A. AU - Fried, J. AU - Brodie, D. AU - Agerstrand, C. AU - Sethi, S. AU - Green, P. DB - Embase DO - 10.1016/j.jacc.2019.08.167 KW - biological marker endogenous compound hypertensive factor troponin adult anticoagulation artificial ventilation bleeding blood clot lysis blood pressure monitoring catheter conference abstract controlled study echocardiography female gene expression hospital mortality human incidence major clinical study male middle aged protein expression pulmonary embolism response team pulmonary hypertension retrospective study surgical thrombectomy university hospital LA - English M1 - 13 M3 - Conference Abstract N1 - L2002925078 2019-09-27 PY - 2019 SN - 1558-3597 0735-1097 SP - B119 ST - TCT-119 Reduced Mortality in Severe PE With Ultrasound-Assisted Catheter-Directed Thrombolysis: A Single-Center Experience T2 - Journal of the American College of Cardiology TI - TCT-119 Reduced Mortality in Severe PE With Ultrasound-Assisted Catheter-Directed Thrombolysis: A Single-Center Experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002925078&from=export http://dx.doi.org/10.1016/j.jacc.2019.08.167 VL - 74 ID - 760658 ER - TY - JOUR AB - Background: Severe (massive and sub-massive) pulmonary embolism (PE) is associated with significant rates of morbidity and mortality. We sought to assess severe PE before and after the inception of a multidisciplinary PE Response Team (PERT). Methods: Acute PE patients in the pre-PERT and early-PERT years (2013-2016) were identified and studied. Severe PE inclusion was contingent on hemodynamic status, cardiac biomarkers, and echocardiographic data. Baseline characteristics and outcomes were evaluated. Results: After screening, 255 (n=130 pre-PERT, n=125 early-PERT) of the 1,234 patients with acute PE were confirmed to have severe PE. Patients had a mean age of 61.9 (±17.6) years and were more often women (58.4%). Treatments included systemic anticoagulation alone (n=180), systemic thrombolysis (n=16), ultrasound-assisted catheter-directed thrombolysis (n=45), and surgical thrombectomy (n=12). Mechanical circulatory support was employed in 8 patients. Overall in-hospital mortality was 11.8%. In-hospital mortality and moderate-to-severe GUSTO bleeding trended towards lower rates in the early-PERT era (Figure). After controlling for simplified PESI score and sex, similar relationships were observed between PERT era and these endpoints. Conclusion: This large, retrospective, single-center analysis of patients treated for severe PE demonstrates that development of a PERT was associated with a non-statistically significant improvements in mortality and GUSTO bleeding. [Figure presented] AU - Nouri, S. N. AU - Madhavan, M. AU - Lumish, H. S. AU - Lavelle, M. AU - Gavalas, M. AU - Brown, T. AU - Li, J. AU - Rosenzweig, E. B. AU - Parikh, S. AU - Kirtane, A. AU - Garan, A. AU - Brodie, D. AU - Agerstrand, C. AU - Takeda, K. AU - Sethi, S. AU - Green, P. AU - Einstein, A. DB - Embase DO - 10.1016/S0735-1097(19)32526-4 KW - biological marker adult anticoagulation assisted circulation bleeding blood clot lysis catheter clinical assessment conference abstract controlled study female hemodynamics hospital mortality human major clinical study middle aged pulmonary embolism response team retrospective study surgical thrombectomy ultrasound LA - English M1 - 9 Supplement 1 M3 - Conference Abstract N1 - L2001638564 2019-04-16 PY - 2019 SN - 1558-3597 0735-1097 SP - 1920 ST - PULMONARY EMBOLISM RESPONSE TEAMS: DO THEY RESULT IN BETTER OUTCOMES IN SEVERE PULMONARY EMBOLISM (A SINGLE CENTER RETROSPECTIVE ANALYSIS)? T2 - Journal of the American College of Cardiology TI - PULMONARY EMBOLISM RESPONSE TEAMS: DO THEY RESULT IN BETTER OUTCOMES IN SEVERE PULMONARY EMBOLISM (A SINGLE CENTER RETROSPECTIVE ANALYSIS)? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001638564&from=export http://dx.doi.org/10.1016/S0735-1097(19)32526-4 VL - 73 ID - 760736 ER - TY - JOUR AD - [Nouri, Shayan Nabavi; Madhavan, Mahesh; Lumish, Heidi S.; Lavelle, Michael; Gavalas, Michael; Brown, Tyler; Li, Jianhua; Rosenzweig, Erika Berman; Parikh, Sahil; Kirtane, Ajay; Garan, Arthur; Brodie, Daniel; Agerstrand, Cara; Takeda, Koji; Sethi, Sanjum; Green, Philip; Einstein, Andrew] Columbia Univ, Med Ctr, New York, NY USA. AN - WOS:000460565901931 AU - Nouri, S. N. AU - Madhavan, M. AU - Lumish, H. S. AU - Lavelle, M. AU - Gavalas, M. AU - Brown, T. AU - Li, J. H. AU - Rosenzweig, E. B. AU - Parikh, S. AU - Kirtane, A. AU - Garan, A. AU - Brodie, D. AU - Agerstrand, C. AU - Takeda, K. AU - Sethi, S. AU - Green, P. AU - Einstein, A. DA - Mar DO - 10.1016/s0735-1097(19)32526-4 J2 - J. Am. Coll. Cardiol. KW - Cardiac & Cardiovascular Systems LA - English M1 - 9 M3 - Meeting Abstract N1 - ISI Document Delivery No.: HO0BU Times Cited: 0 Cited Reference Count: 0 Nouri, Shayan Nabavi Madhavan, Mahesh Lumish, Heidi S. Lavelle, Michael Gavalas, Michael Brown, Tyler Li, Jianhua Rosenzweig, Erika Berman Parikh, Sahil Kirtane, Ajay Garan, Arthur Brodie, Daniel Agerstrand, Cara Takeda, Koji Sethi, Sanjum Green, Philip Einstein, Andrew 68th Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC) MAR 16-18, 2019 New Orleans, LA Amer Coll Cardiol Rosenzweig, Erika/AAC-3680-2019; Sanjum S. Sethi, MPH/AAO-2601-2020 0 ELSEVIER SCIENCE INC NEW YORK J AM COLL CARDIOL 1 PY - 2019 SN - 0735-1097 SP - 1920-1920 ST - PULMONARY EMBOLISM RESPONSE TEAMS: DO THEY RESULT IN BETTER OUTCOMES IN SEVERE PULMONARY EMBOLISM (A SINGLE CENTER RETROSPECTIVE ANALYSIS)? T2 - Journal of the American College of Cardiology TI - PULMONARY EMBOLISM RESPONSE TEAMS: DO THEY RESULT IN BETTER OUTCOMES IN SEVERE PULMONARY EMBOLISM (A SINGLE CENTER RETROSPECTIVE ANALYSIS)? UR - ://WOS:000460565901931 VL - 73 ID - 761534 ER - TY - JOUR AB - BACKGROUND: Persistent or chronic intestinal ischemic injury (i3) can lead to severe malnutrition and acute mesenteric ischemia. Although recommended, revascularization of splanchnic arteries is sometimes unrealizable. METHODS: We report a case series of iloprost use in consecutive stable patients with persistent i3 unsuitable for revascularization followed in a tertiary care center. The feasibility of revascularization was discussed and ruled out by a multidisciplinary team, and informed consent was obtained prior to consideration of a vasoactive therapy. Therapeutic response was defined at 6 months by a decrease in the use of analgesic and parenteral nutrition, and no need for intestinal resection. RESULTS: Between 2006 and 2015, 6 patients (mean age: 51) were included. Splanchnic vascular insufficiency was due to superior mesenteric artery (SMA) thrombosis (n = 4), dissection of the celiac trunk and SMA (n = 1), or repeated vasospasm resulting in chronic nonocclusive mesenteric ischemia (n = 1). Iloprost was delivered via continuous intravenous perfusion at a maximum dosage of 2 ng/kg/min for 6 hours/day on 4 consecutive days, without severe adverse events. Therapeutic response was observed in 4 patients, 3 of which completely stopped parenteral nutrition and analgesic with no need for intestinal resection. CONCLUSIONS: Our results are consistent with findings of a favorable effect of iloprost in patients with persistent splanchnic ischemia that should be confirmed in prospective trials. AD - Department of Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, France; Paris 7-Diderot University, Paris, France; Laboratory for Vascular Translational Science-Inserm U1148, Bichat Hospital, Paris, France. Electronic address: alexandre.nuzzo@aphp.fr. Department of Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, France; Paris 7-Diderot University, Paris, France. Paris 7-Diderot University, Paris, France; Department of Pharmacy, Beaujon Hospital, Clichy, France. Paris 7-Diderot University, Paris, France; Department of Colorectal Surgery, Beaujon Hospital, Clichy, France. Paris 7-Diderot University, Paris, France; Department of Radiology, Beaujon Hospital, Clichy, France. Paris 7-Diderot University, Paris, France; Department of Pharmacy, Beaujon Hospital, Clichy, France; Department of Vascular Surgery, Bichat Hospital, Paris, France. Department of Gastroenterology, IBD, Nutritional Support, Beaujon Hospital, Clichy, France; Paris 7-Diderot University, Paris, France; Laboratory for Vascular Translational Science-Inserm U1148, Bichat Hospital, Paris, France. AN - 28323233 AU - Nuzzo, A. AU - Soudan, D. AU - Billiauws, L. AU - Bataille, J. AU - Maggiori, L. AU - Ronot, M. AU - Stocco, J. AU - Bouhnik, Y. AU - Castier, Y. AU - Corcos, O. DA - Jul DO - 10.1016/j.avsg.2016.10.061 DP - NLM ET - 2017/03/23 J2 - Annals of vascular surgery KW - Analgesics/therapeutic use Databases, Factual Female Humans Iloprost/*administration & dosage/adverse effects Infusions, Intravenous Intestines/*blood supply Ischemia/diagnosis/*drug therapy/physiopathology Male Middle Aged Parenteral Nutrition Retrospective Studies Splanchnic Circulation/drug effects Tertiary Care Centers Time Factors Treatment Outcome Vasodilator Agents/*administration & dosage/adverse effects LA - eng N1 - 1615-5947 Nuzzo, Alexandre Soudan, Damien Billiauws, Lore Bataille, Julie Maggiori, Léon Ronot, Maxime Stocco, Jeanick Bouhnik, Yoram Castier, Yves Corcos, Olivier SURVI group Journal Article Netherlands Ann Vasc Surg. 2017 Jul;42:128-135. doi: 10.1016/j.avsg.2016.10.061. Epub 2017 Mar 18. PY - 2017 SN - 0890-5096 SP - 128-135 ST - Iloprost Use in Patients with Persistent Intestinal Ischemia Unsuitable for Revascularization T2 - Ann Vasc Surg TI - Iloprost Use in Patients with Persistent Intestinal Ischemia Unsuitable for Revascularization VL - 42 ID - 760371 ER - TY - JOUR AB - Background: Persistent or chronic intestinal ischemic injury (i3) can lead to severe malnutrition and acute mesenteric ischemia. Although recommended, revascularization of splanchnic arteries is sometimes unrealizable. Methods: We report a case series of iloprost use in consecutive stable patients with persistent i3 unsuitable for revascularization followed in a tertiary care center. The feasibility of revascularization was discussed and ruled out by a multidisciplinary team, and informed consent was obtained prior to consideration of a vasoactive therapy. Therapeutic response was defined at 6 months by a decrease in the use of analgesic and parenteral nutrition, and no need for intestinal resection. Results: Between 2006 and 2015, 6 patients (mean age: 51) were included. Splanchnic vascular insufficiency was due to superior mesenteric artery (SMA) thrombosis (n = 4), dissection of the celiac trunk and SMA (n = 1), or repeated vasospasm resulting in chronic nonocclusive mesenteric ischemia (n = 1). Iloprost was delivered via continuous intravenous perfusion at a maximum dosage of 2 ng/kg/min for 6 hours/day on 4 consecutive days, without severe adverse events. Therapeutic response was observed in 4 patients, 3 of which completely stopped parenteral nutrition and analgesic with no need for intestinal resection. Conclusions: Our results are consistent with findings of a favorable effect of iloprost in patients with persistent splanchnic ischemia that should be confirmed in prospective trials. AD - [Nuzzo, Alexandre; Soudan, Damien; Billiauws, Lore; Bouhnik, Yoram; Corcos, Olivier] Beaujon Hosp, IBD, Dept Gastroenterol, Nutr Support, Clichy, France. [Nuzzo, Alexandre; Soudan, Damien; Billiauws, Lore; Bataille, Julie; Maggiori, Leon; Ronot, Maxime; Stocco, Jeanick; Bouhnik, Yoram; Castier, Yves; Corcos, Olivier] Paris 7 Diderot Univ, Paris, France. [Nuzzo, Alexandre; Corcos, Olivier] Hop Xavier Bichat, INSERM, U1148, Lab Vasc Translat Sci, Paris, France. [Bataille, Julie; Stocco, Jeanick; Castier, Yves] Beaujon Hosp, Dept Pharm, Clichy, France. [Maggiori, Leon] Beaujon Hosp, Dept Colorectal Surg, Clichy, France. [Ronot, Maxime] Beaujon Hosp, Dept Radiol, Clichy, France. [Castier, Yves] Hop Xavier Bichat, Dept Vasc Surg, Paris, France. Nuzzo, A (corresponding author), Hop Beaujon, Assistance Nutr & Transplantat Intestinale, Struct URgences Vasc Intestinales SURVI, Serv Gastroenterol,MICI, 100 Blvd Gen Leclerc, F-92100 Clichy, France. alexandre.nuzzo@aphp.fr AN - WOS:000406999000022 AU - Nuzzo, A. AU - Soudan, D. AU - Billiauws, L. AU - Bataille, J. AU - Maggiori, L. AU - Ronot, M. AU - Stocco, J. AU - Bouhnik, Y. AU - Castier, Y. AU - Corcos, O. AU - Grp, Survi DA - Jul DO - 10.1016/j.avsg.2016.10.061 J2 - Ann. Vasc. Surg. KW - STABLE PROSTACYCLIN ANALOG PERIPHERAL ARTERIAL-DISEASE ACUTE MESENTERIC ISCHEMIA CRITICAL LIMB ISCHEMIA BLOOD-FLOW INTRAVENOUS ILOPROST PULMONARY-HYPERTENSION INHALED ILOPROST INJURY RATS Surgery Peripheral Vascular Disease LA - English M3 - Article N1 - ISI Document Delivery No.: FC7CR Times Cited: 1 Cited Reference Count: 36 Nuzzo, Alexandre Soudan, Damien Billiauws, Lore Bataille, Julie Maggiori, Leon Ronot, Maxime Stocco, Jeanick Bouhnik, Yoram Castier, Yves Corcos, Olivier Soubrane, Olivier/H-7799-2016; Lakkis, Zaher/H-9378-2019; Maggiori, Leon/H-8842-2017; Mordant, Pierre/J-3603-2017; PUY, HERVE/O-1785-2017; Peoc'h, Katell/V-1604-2017 Lakkis, Zaher/0000-0002-2608-5896; Maggiori, Leon/0000-0002-9957-9897; Mordant, Pierre/0000-0001-5716-4848; PUY, HERVE/0000-0003-3362-2634; Peoc'h, Katell/0000-0002-8203-1243; Rautou, Pierre-Emmanuel/0000-0001-9567-1859; Corcos, Olivier/0000-0002-9034-7053; Paugam-Burtz, Catherine/0000-0002-8168-7152; Soubrane, Olivier/0000-0002-2059-1237; Weiss, Emmanuel/0000-0002-2854-9607; Valla, Dominique/0000-0002-4460-7643; de Raucourt, Emmanuelle/0000-0001-8774-3162; SAUVANET, alain/0000-0002-7436-5999; treton, xavier/0000-0001-8123-9213 1 0 ELSEVIER SCIENCE INC NEW YORK ANN VASC SURG PY - 2017 SN - 0890-5096 SP - 128-135 ST - Iloprost Use in Patients with Persistent Intestinal Ischemia Unsuitable for Revascularization T2 - Annals of Vascular Surgery TI - Iloprost Use in Patients with Persistent Intestinal Ischemia Unsuitable for Revascularization UR - ://WOS:000406999000022 VL - 42 ID - 761649 ER - TY - JOUR AB - Background Persistent or chronic intestinal ischemic injury (i3) can lead to severe malnutrition and acute mesenteric ischemia. Although recommended, revascularization of splanchnic arteries is sometimes unrealizable. Methods We report a case series of iloprost use in consecutive stable patients with persistent i3 unsuitable for revascularization followed in a tertiary care center. The feasibility of revascularization was discussed and ruled out by a multidisciplinary team, and informed consent was obtained prior to consideration of a vasoactive therapy. Therapeutic response was defined at 6 months by a decrease in the use of analgesic and parenteral nutrition, and no need for intestinal resection. Results Between 2006 and 2015, 6 patients (mean age: 51) were included. Splanchnic vascular insufficiency was due to superior mesenteric artery (SMA) thrombosis (n = 4), dissection of the celiac trunk and SMA (n = 1), or repeated vasospasm resulting in chronic nonocclusive mesenteric ischemia (n = 1). Iloprost was delivered via continuous intravenous perfusion at a maximum dosage of 2 ng/kg/min for 6 hours/day on 4 consecutive days, without severe adverse events. Therapeutic response was observed in 4 patients, 3 of which completely stopped parenteral nutrition and analgesic with no need for intestinal resection. Conclusions Our results are consistent with findings of a favorable effect of iloprost in patients with persistent splanchnic ischemia that should be confirmed in prospective trials. AD - A. Nuzzo, Structure d'URgences Vasculaires Intestinales (SURVI), Service de Gastroentérologie, MICI, Assistance nutritive et Transplantation intestinale, Hôpital Beaujon, 100 boulevard du Général Leclerc, Clichy, France AU - Nuzzo, A. AU - Soudan, D. AU - Billiauws, L. AU - Bouhnik, Y. AU - Corcos, O. AU - Nuzzo, A. AU - Soudan, D. AU - Billiauws, L. AU - Bataille, J. AU - Maggiori, L. AU - Ronot, M. AU - Stocco, J. AU - Bouhnik, Y. AU - Castier, Y. AU - Corcos, O. AU - Nuzzo, A. AU - Corcos, O. AU - Bataille, J. AU - Stocco, J. AU - Castier, Y. AU - Maggiori, L. AU - Ronot, M. AU - Castier, Y. AU - Sibert, A. AU - Zappa, M. AU - Garcia-Alba, C. AU - Abdel-Rehim, M. AU - Vilgrain, V. AU - Bertin, C. AU - Kerbaol, A. AU - Allaham, W. AU - Lagadec, M. AU - Benzimra, J. AU - Ronot, M. AU - Paugam, C. AU - Weiss, E. AU - Abback, P. S. AU - Delefosse, D. AU - Enriquez, I. AU - Janny, S. AU - Toussaint, A. AU - Iserentant, J. AU - Bout, H. AU - Pease, S. AU - Ear, L. K. AU - Castier, Y. AU - Pellenc, Q. AU - Roussel, A. AU - Cerceau, P. AU - Mordant, P. AU - Deblic, R. AU - Boulitrop, C. AU - Curac, S. AU - Cachier, A. AU - Plessier, A. AU - Rautou, P. E. AU - Valla, D. AU - Soubrane, O. AU - Sauvanet, A. AU - Dokmak, S. AU - Dondero, F. AU - Sepulveda, A. AU - Farges, O. AU - Aussilhou, B. AU - Palazzo, M. AU - Cazals-Hatem, D. AU - De Raucourt, E. AU - Boudaoud, L. AU - Peoc'h, K. AU - Puy, H. AU - Pons-Kerjean, N. AU - Stocco, J. AU - Bataille, J. AU - Bouton, V. AU - Diop, A. AU - Gault, N. AU - Montravers, P. AU - Augustin, P. AU - Jacob, B. L. DB - Embase Medline DO - 10.1016/j.avsg.2016.10.061 KW - iloprost adult artery thrombosis article celiac artery clinical article continuous infusion duodenum biopsy endothelial progenitor cell female hemodialysis human human tissue intestine ischemia intestine resection male mesenteric ischemia microcirculation outcome assessment parenteral nutrition priority journal revascularization superior mesenteric artery tertiary care center thrombophilia treatment response vascular smooth muscle cell vasospasm LA - English M3 - Article N1 - L615827523 2017-05-05 2019-12-23 PY - 2017 SN - 1615-5947 0890-5096 SP - 128-135 ST - Iloprost Use in Patients with Persistent Intestinal Ischemia Unsuitable for Revascularization T2 - Annals of Vascular Surgery TI - Iloprost Use in Patients with Persistent Intestinal Ischemia Unsuitable for Revascularization UR - https://www.embase.com/search/results?subaction=viewrecord&id=L615827523&from=export http://dx.doi.org/10.1016/j.avsg.2016.10.061 VL - 42 ID - 760921 ER - TY - JOUR AB - Objectives: The effectiveness of intravenous thrombolysis is limited in stroke patients with proximal cerebral artery oclusion. Intra-arterial rescue therapies can be used to treat these patients with persistent occlusion (PO), but they require the rapid mobilization of complex multidisciplinary teams. We compared the value of several baseline clinical, biochemical and radiological variables in order to predict candidates for intra-arterial therapies due to PO of large vessels despite intravenous thrombolysis. Methods: Seventy consecutive patients with acute stroke in the carotid territory treated with tPA in a Comprehensive Stroke Center with a program of iv thrombolysis and rescue therapy. We measured age, time from onset, clinical severity (NIHSS), baseline glucose levels, hyperdense middle cerebral artery (MCA) sign and ASPECTS score in CT. PO was evaluated in an angio-CT obtained after 40 minutes of iv tPA perfusion and was defined as a TIMI score of 0-1 in the intracranial carotid, M1/M2 segments of the MCA and A1/A2 segments of the anterior cerebral artery. We compared the capacity (area under the ROC curve) of different logistic regression models to predict PO. We also compared the diagnostic value of different cut-off points in the NIHSS: Sensibility (Se), Specificity (Sp), Positive predictive value (PPV), Negative predictive value (NPV). Results: 30 patients (42.9%) had PO after 40 minutes of tPA treatment. NIHSS was by far the best predictor of PO (overall predictive capacity=84.1%), followed by ASPECTS score, hyperdense MCA sign, glucose levels, time from onset and age. Adding other variables to the NIHSS only marginally increased the predictive value of the models. The analysis of the ROC curve showed that a cut-off point of NIHSS of ≥12 was the most accurate (Se=80%; Sp=82.5%; PPV=77.4%; NPV=84.6%). Compared to this, the often used cut-off point of NIHSS ≥10was more sensitive but had lower specificity and lower PPV (Se=83.3%; Sp=75%; PPV=71.4%; NPV=85.7%). Conclusions: Baseline NIHSS is simple tool that allows the early identification of candidates for intra-arterial rescue therapies due to persistent occlusion after intravenous thrombolysis. Whereas the criterion of NIHSS ≥10 is sensitive and may be suitable for centers where rescue therapies are available, a cut-off point of 12 is more specific and may be preferred in centers where emergency transfer to other hospitals is required. AD - V. Obach, Hosp. Clinic Barcelona, Barcelona, Spain AU - Obach, V. AU - Urra, X. AU - Amaro, S. AU - Gomez-Choco, M. AU - Cervera, A. AU - Blasco, J. AU - Roman, L. S. AU - Capurro, S. AU - Squarcia, M. AU - Oleaga, L. AU - Macho, J. AU - Chamorro, A. DB - Embase DO - 10.1161/01.str.0000366115.56266.0a KW - glucose National Institutes of Health Stroke Scale blood clot lysis cerebrovascular accident therapy patient predictive value carotid artery receiver operating characteristic occlusion model logistic regression analysis diagnostic value sensibility hospital stroke patient brain artery mobilization middle cerebral artery perfusion anterior cerebral artery emergency LA - English M1 - 4 M3 - Conference Abstract N1 - L70429726 2011-06-04 PY - 2010 SN - 0039-2499 SP - e360 ST - High baseline nih stroke scale is the best predictor of resistance to intravenous thrombolysis T2 - Stroke TI - High baseline nih stroke scale is the best predictor of resistance to intravenous thrombolysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70429726&from=export http://dx.doi.org/10.1161/01.str.0000366115.56266.0a VL - 41 ID - 761258 ER - TY - JOUR AB - Objective In patients lacking autogenous vein suitable for infrainguinal bypass, cryopreserved saphenous vein (CSV) allograft (CryoLife, Inc, Kennesaw, Ga) may be an acceptable alternative. The purpose of this study was to examine outcomes of CSV conduit for infrainguinal revascularization. Methods Between February 2008 and August 2015, 70 patients underwent infrainguinal bypass grafts in 73 limbs using CSV. All patients lacked suitable arm or leg vein. Demographic data and patient outcomes were retrospectively collected using electronic medical records. Results The mean age of our cohort was 70 ± 14 years, and 36 (51%) were male; 47 (67%) were white, 39 (56%) had coronary artery disease, 27 (39%) had diabetes, 56 (80%) had hypertension, and 50 (71%) were former or current smokers. Median follow-up was 304 days (interquartile range, 130-991 days). Indications for the index operation included rest pain (27%), tissue loss (55%), and prosthetic graft infection (18%); 62 of 73 (85%) bypasses were performed for critical limb ischemia, and 45 of 73 (62%) were redo operations. Distal targets included superficial femoral artery or popliteal (38%), tibial (55%), and pedal (7%). All grafts had a minimum diameter of 3 mm. At 30 days, 55 of 64 grafts (86%) were patent; 9 were lost to early follow-up. The only significant risk factors associated with 30-day failure were ABO mismatch (43% vs 10%; P =.05) and donor blood type B or AB (40% vs 9%; P =.03). Estimated overall 1-year primary patency was 35%. In a multivariate analysis, nonblack race (P =.05), donor B or AB blood type (P =.01), and bypass to a tibial or pedal target (P =.05) were independently associated with loss of primary patency. There were 20 (27%) major amputations, and all grafts in these limbs had occluded at the time of amputation. Of the 33 limbs with ischemic tissue loss that had long-term follow-up, 17 of 33 (52%) went on to graft occlusion, 10 of 33 (30%) had a major amputation, and 24 of 33 (73%) had complete healing of the index wound. Conclusions In the setting of a multidisciplinary team with aggressive wound care, CSV may be a reasonable choice for infrainguinal revascularization in patients with ischemic tissue loss who lack autogenous conduit. However, poor midterm to long-term patency suggests that optimal selection of patients is needed to derive meaningful clinical benefit. AD - J.S. Hiramoto, Division of Vascular and Endovascular Surgery, 400 Parnassus Ave, A-581, San Francisco, CA, United States AU - O'Banion, L. A. AU - Wu, B. AU - Eichler, C. M. AU - Reilly, L. M. AU - Conte, M. S. AU - Hiramoto, J. S. DB - Embase Medline DO - 10.1016/j.jvs.2017.03.415 KW - aged blood donor blood group AB blood group B bypass surgery conference paper coronary artery disease critical limb ischemia cryopreservation demography diabetes mellitus female follow up graft failure graft infection graft occlusion human hypertension leg amputation leg revascularization limb salvage major clinical study male multivariate analysis popliteal artery priority journal reoperation risk factor saphenous vein graft smoking superficial femoral artery tissue necrosis treatment outcome vein diameter LA - English M1 - 3 M3 - Conference Paper N1 - L616154084 2017-05-17 2017-09-06 PY - 2017 SN - 1097-6809 0741-5214 SP - 844-849 ST - Cryopreserved saphenous vein as a last-ditch conduit for limb salvage T2 - Journal of Vascular Surgery TI - Cryopreserved saphenous vein as a last-ditch conduit for limb salvage UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616154084&from=export http://dx.doi.org/10.1016/j.jvs.2017.03.415 VL - 66 ID - 760910 ER - TY - JOUR AB - OBJECTIVE To present family physicians with the options available for diagnosing and treating a selection of common diseases in the elderly using diagnostic and interventional radiology. QUALITY OF EVIDENCE Articles providing level I or II evidence were included in our review. Most articles presented results from randomized or other case-controlled studies. MAIN MESSAGE Geriatric care has become a complicated, multidisciplinary effort, with the family physician often leading the team. The expanding cohort of patients is not only better informed than their predecessors, but also more demanding of better care through cutting-edge technology and treatment. Specifically, the role of radiology has expanded quickly in geriatric medicine. Because of complex clinical presentations and rising costs, it is essential for primary care physicians to understand the appropriate use of imaging and radiological intervention. CONCLUSION There are a number of new and innovative radiological techniques and procedures available for elderly patients. This review aims to inform primary care physicians of a selected number of these techniques. AD - [O'Brien, Jeremy] Univ Western Ontario, Schulich Sch Med & Dent, London, ON N6A 3K7, Canada. [Baerlocher, Mark O.] Univ Toronto, Radiol Residency Training Program, Toronto, ON M5S 1A1, Canada. [Asch, Murray; Myers, Andy] Lakeridge Hlth Corp, Dept Radiol, Oshawa, ON, Canada. O'Brien, J (corresponding author), 506-57 Charles St W, Toronto, ON M5S 2X1, Canada. obrien.jeremy@gmail.com AN - WOS:000265559500010 AU - O'Brien, J. AU - Baerlocher, M. O. AU - Asch, M. AU - Myers, A. DA - Jan J2 - Can. Fam. Phys. KW - ENDOVASCULAR-ANEURYSM-REPAIR CORONARY-ARTERY STENOSES ISCHEMIC-HEART-DISEASE CRITICAL LIMB ISCHEMIA VENA-CAVA FILTERS CT ANGIOGRAPHY PERCUTANEOUS VERTEBROPLASTY INTRAABDOMINAL ABSCESSES COMPUTED-TOMOGRAPHY COLORECTAL POLYPS Primary Health Care Medicine, General & Internal LA - English M1 - 1 M3 - Review N1 - ISI Document Delivery No.: 438MM Times Cited: 4 Cited Reference Count: 29 O'Brien, Jeremy Baerlocher, Mark O. Asch, Murray Myers, Andy 4 0 3 COLL FAMILY PHYSICIANS CANADA MISSISSAUGA CAN FAM PHYSICIAN PY - 2009 SN - 0008-350X SP - 32-37 ST - Role of radiology in geriatric care A primer for family physicians T2 - Canadian Family Physician TI - Role of radiology in geriatric care A primer for family physicians UR - ://WOS:000265559500010 VL - 55 ID - 761900 ER - TY - JOUR AB - Despite benefit in acute ischaemic stroke, less than 3% of patients receive tissue plasminogen activator (tPA) in Australia. The FASTER (Face, Arm, Speech, Time, Emergency Response) protocol was constructed to reduce pre-hospital and Emergency Department (ED) delays and improve access to thrombolysis. This study aimed to determine if introduction of the FASTER protocol increases use of tPA using a prospective pre- and post-intervention cohort design in a metropolitan hospital. A pre-hospital assessment tool was used by ambulance services to screen potential tPA candidates. The acute stroke team was contacted, hospital bypass allowed, triage and CT radiology alerted, and the patient rapidly assessed on arrival to ED. Data were collected prospectively during the first 6 months of the new pathway and compared to a 6-month period 12 months prior to protocol initiation. In the 6 months following protocol introduction, 115 patients presented within 24 hours of onset of an ischaemic stroke: 22 (19%) received thrombolysis, significantly greater than five (7%) of 67 patients over the control period, p = 0.03. Overall, 42 patients were referred via the FASTER pathway, with 21 of these receiving tPA (50%). One inpatient stroke was also treated. Only two referrals (<5%) were stroke mimics. Introduction of the FASTER pathway also significantly reduced time to thrombolysis and time to admission to the stroke unit. Therefore, fast-track referral of potential tPA patients involving the ambulance services and streamlined hospital assessment is effective and efficient in improving patient access to thrombolysis. Crown Copyright (C) 2011 Published by Elsevier Ltd. All rights reserved. AD - [O'Brien, W.; Crimmins, D.; Clarke, T. A.; Whyte, S.; Sturm, J.] Gosford Hosp, Dept Neurosci, Gosford, NSW 2250, Australia. [Donaldson, W.] NSW Ambulance Serv, Cent Coast Sect, Point Clare, NSW 2250, Australia. [Risti, R.] Gosford Hosp, Dept Med Imaging, Gosford, NSW 2250, Australia. O'Brien, W (corresponding author), Gosford Hosp, Dept Neurosci, Gosford, NSW 2250, Australia. billob999@gmail.com AN - WOS:000301012500010 AU - O'Brien, W. AU - Crimmins, D. AU - Donaldson, W. AU - Risti, R. AU - Clarke, T. A. AU - Whyte, S. AU - Sturm, J. DA - Feb DO - 10.1016/j.jocn.2011.06.009 J2 - J. Clin. Neurosci. KW - Acute stroke Thrombolysis pre-hospital assessment TISSUE-PLASMINOGEN ACTIVATOR ACUTE ISCHEMIC-STROKE COST-EFFECTIVENESS THERAPY CARE Clinical Neurology Neurosciences LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 902BB Times Cited: 30 Cited Reference Count: 12 O'Brien, W. Crimmins, D. Donaldson, W. Risti, R. Clarke, T. A. Whyte, S. Sturm, J. 30 2 11 ELSEVIER SCI LTD OXFORD J CLIN NEUROSCI PY - 2012 SN - 0967-5868 SP - 241-245 ST - FASTER (Face, Arm, Speech, Time, Emergency Response): Experience of Central Coast Stroke Services implementation of a pre-hospital notification system for expedient management of acute stroke T2 - Journal of Clinical Neuroscience TI - FASTER (Face, Arm, Speech, Time, Emergency Response): Experience of Central Coast Stroke Services implementation of a pre-hospital notification system for expedient management of acute stroke UR - ://WOS:000301012500010 VL - 19 ID - 761833 ER - TY - JOUR AB - Purpose: To describe levels of knowledge amongst men and women aged >40 years in an Irish semi-rural community, and to determine the impact of a single education session on stroke knowledge. Relevance: Poor knowledge of stroke risk factors and failure to recognise and act on acute symptoms hinders efforts to prevent stroke and improve clinical outcomes. Levels of stroke knowledge are poorly established within Ireland and the impact of a single stroke education session is unknown. Participants: A community dwelling convenience sample of men and women aged over 40 years was identified from two family doctor computer registers located 25 miles apart in a semi-rural area of Ireland. Participants were allocated to an education (n = 200) or control group (n = 200). Methods: Quasi-experimental study design. Participants in the intervention group attended a 90-minute education session. The multidisciplinary team members provided information on stroke risk factors, warning signs: stroke treatment and appropriate response to acute stroke symptoms. A stroke knowledge questionnaire was completed at baseline and again within 4 weeks of the education session. Analysis: Descriptive statistics were used and intention-to-treat analysis. Group comparisons were made using logistic regression analysis, Chi-square test and Fishers exact test. A negative binomial regression model investigated the effect of the intervention on the Stroke Knowledge Score. Results: There was an initial 70% (280/400) response rate. 52% knew the brain was affected by stroke; 58% could list two or more risk factors, but only 27% could list two or more warning signs; 50%would call 999 in response to stroke; 17% had heard of 'clot-bust' or thrombolytic therapy, but only 1% knew the time frame for receiving same. The response rate to re-survey following education was 57% (229/400), with 47 of 117 subjects in the intervention group (40%) attending the education session. Stroke knowledge scores improved by 50% in the intervention group (p < 0.001). Conclusions: Knowledge of stroke risk factors, warning signs and thrombolytic therapy was moderate to poor in this Irish community dwelling cohort. A single education session can improve short-term knowledge of stroke symptoms and therapy. Implications: Further studies should look at long-term maintenance of newly acquired stroke knowledge and at ways to improve the uptake of stroke education programmes in the community. AD - G. O'Callaghan, Midland Regional Hospital at Mullingar, Physiotherapy, Mullingar, Ireland AU - O'Callaghan, G. AU - Murphy, S. AU - Loane, D. AU - Farrelly, E. AU - Horgan, F. DB - Embase DO - 10.1016/j.physio.2011.04.002 KW - education cerebrovascular accident physiotherapy population human risk factor community Ireland male female fibrinolytic therapy intention to treat analysis statistics study design control group rural population Fisher exact test register computer rural area therapy quasi experimental study chi square test questionnaire logistic regression analysis general practitioner model brain convenience sample LA - English M3 - Conference Abstract N1 - L71883415 2015-05-23 PY - 2011 SN - 0031-9406 SP - eS911 ST - Impact of a single 90-minute multidisciplinary education session on stroke knowledge in a semi-rural Irish population T2 - Physiotherapy (United Kingdom) TI - Impact of a single 90-minute multidisciplinary education session on stroke knowledge in a semi-rural Irish population UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71883415&from=export http://dx.doi.org/10.1016/j.physio.2011.04.002 VL - 97 ID - 761232 ER - TY - JOUR AB - Background: Telemedicine has created access to emergency stroke care for patients in all communities, regardless of geography. We hypothesized that there is no difference in speed of assessment between vascular neurologist (VN) robotic telepresence and standard VN-supervised stroke alert patients in a metropolitan primary stroke center. Materials and Methods: A retrospective stroke alert database was used to identify all robotic telepresence and standardly supervised stroke alert patient assessments at a primary stroke center emergency department from 2009 to 2012. The primary outcome measure was the duration of assessment from stroke alert activation to treatment or downgrade. Results: The sample size was 196 subjects. The mean duration of time from stroke alert activation to initiation of intravenous (IV) thrombolytic treatment or downgrade was 8.6 min longer in the robotic group than in the standard group (p=0.03). Among the subgroup of acute ischemic stroke patients treated with IV thrombolysis, the mean duration of time from activation to treatment was 18 min longer in the robotic group than in the standard group (p=0.01). Safety outcomes including thrombolysis protocol violations (0% versus 1%), post-thrombolysis symptomatic intracranial hemorrhagic complications (3% versus 1%), and death during hospitalization (8% versus 6%) were low in the robotic group and not significantly different from that in the standard group. Conclusions: Standard VN-supervised acute stroke team assessments were swifter than those supervised by robotic telepresence. Safety outcomes of robotic telepresence-supervised stroke alerts were excellent, and this modality may be preferred in circumstances when a VN is not immediately available on-site. AD - [O'Carroll, Cumara B.; Aguilar, Maria I.; Demaerschalk, Bart M.] Mayo Clin, Dept Neurol, Phoenix, AZ 85054 USA. [Hentz, Joseph G.] Mayo Clin, Biostat Unit, Div Hlth Sci Res, Scottsdale, AZ USA. Demaerschalk, BM (corresponding author), Mayo Clin, Dept Neurol, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA. demaerschalk.bart@mayo.edu AN - WOS:000350882900003 AU - O'Carroll, C. B. AU - Hentz, J. G. AU - Aguilar, M. I. AU - Demaerschalk, B. M. DA - Mar DO - 10.1089/tmj.2014.0064 J2 - Telemed. e-Health KW - stroke management tissue plasminogen activator stroke telemedicine thrombolytic therapy remote consultation telestroke TELEMEDICINE ASSOCIATION CARE STATEMENT SYSTEMS Health Care Sciences & Services LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: CD2CZ Times Cited: 4 Cited Reference Count: 10 O'Carroll, Cumara B. Hentz, Joseph G. Aguilar, Maria I. Demaerschalk, Bart M. Mayo Clinic Center for Translational Science Activities grant (REDCap Project) [UL1 TR000135] The authors acknowledge Mayo Clinic neurology residents, vascular neurology fellows, vascular neurology consultants, and nurse practitioners for their assistance and participation. This work was supported by Mayo Clinic Center for Translational Science Activities grant support (UL1 TR000135; REDCap Project). 4 0 6 MARY ANN LIEBERT, INC NEW ROCHELLE TELEMED E-HEALTH PY - 2015 SN - 1530-5627 SP - 151-156 ST - Robotic Telepresence Versus Standardly Supervised Stroke Alert Team Assessments T2 - Telemedicine and E-Health TI - Robotic Telepresence Versus Standardly Supervised Stroke Alert Team Assessments UR - ://WOS:000350882900003 VL - 21 ID - 761759 ER - TY - JOUR AB - Introduction Intravenous leiomyomatosis is an extremely rare variant of leiomyomatosis, characterised by growth of benign leiomyomas in systemic and intra-uterine veins. Less than 150 cases of intravenous leimoyomatosis have been described worldwide. Case Report: Our case concerns a 51 year old female who presented with a three week history of dyspnoea on exertion, pleuritic chest pain, night sweats and presyncope. D-Dimer testing was positive and she went on to have a CT Pulmonary Angiogram. The CT showed a large filling defect extending from the right atrium into the right pulmonary artery, with no filling defect in the left-sided pulmonary circulation. An echocardiogram showed an intra-cardiac lesion without signs of right heart dilatation. B-type natriuretic peptide (BNP) and high-sensitivity troponin testing were normal, and she remained haemodynamically stable with no hypotension or tachycardia. After consultation with the pulmonary embolism response team in our institution, a working diagnosis of pulmonary embolism was made and she was treated conservatively with systemic anticoagulation. She was discharged home with a good exercise tolerance. Two weeks later she re-presented with worsening dsypnoea, chest pain and transient hypotension. A repeat CT Pulmonary Angiogram showed a further filling defect in the distribution of a saddle embolus, involving the left and right pulmonary circulations. At this time there was evidence of right heart dilatation on echocardiogram with a right ventricular systolic pressure of 60mmhg. At this point she was treated with systemic thrombolysis in the intensive care unit due to her intermediate-high risk status (working diagnosis of sub-massive pulmonary embolus) and failure to respond to conservative management. Post-thrombolysis, she had no resolution of the filling defect on CT. A decision was made to proceed to surgical removal of the intravenous lesion. Pulmonary embolectomy and partial IVC thrombectomy were performed. An intact extensive pale rubbery tumour was removed from the IVC, the right heart and the pulmonary arteries. Subsequent histological analysis revealed benign leiomyomatous tissue. The patient proceeded to hysterectomy which was successful and she is recovering well. Discussion: Our case highlights an extremely unusual presentation of benign intravenous leiomyomatosis masquerading as a pulmonary embolism. There are very few case reports of intravenous leiomyomatosis extending as far as the pulmonary arteries and these cases often result in mortality. We describe the successful diagnosis and treatment of a rare life-threatening condition masquerading as a common but also life-threatening condition, and highlight the need for consideration of rare diagnoses in all cases. AD - C. O'Donnell, Department of Medicine, Mater Misericordiae Hospital, Dublin, Ireland AU - O'Donnell, C. AU - Casey, M. AU - Murphy, A. AU - Andrews, C. AU - Mulligan, N. AU - Chughtai, J. Z. AU - Hastings, J. AU - Marsh, B. AU - Ní Áinle, F. AU - McGuinness, J. AU - Lawler, L. AU - Gaine, S. P. DB - Embase KW - brain natriuretic peptide D dimer endogenous compound troponin adult anticoagulation blood clot lysis conference abstract conservative treatment consultation diagnosis dyspnea echocardiography embolectomy exercise tolerance female heart dilatation heart injury heart right atrium heart right ventricle histopathology human human tissue hypotension hysterectomy intensive care unit leiomyomatosis Leriche syndrome lung angiography lung circulation lung embolism major clinical study middle aged mortality night sweat presyncope pulmonary artery surgery systolic blood pressure tachycardia thorax pain thrombectomy LA - English M1 - MeetingAbstracts M3 - Conference Abstract N1 - L622970321 2018-07-16 PY - 2018 SN - 1535-4970 ST - An unusual case of intravenous leiomyomatosis masquerading as a pulmonary embolus T2 - American Journal of Respiratory and Critical Care Medicine TI - An unusual case of intravenous leiomyomatosis masquerading as a pulmonary embolus UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622970321&from=export VL - 197 ID - 760875 ER - TY - JOUR AB - In the past 5 years, balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are deemed inoperable has undergone significant refinement. As a result, the procedure is now used worldwide and has become a promising therapeutic option for those patients. However, pulmonary endarterectomy remains the gold standard treatment for patients with CTEPH because the techniques and strategies for BPA are not yet unified. The best therapeutic option for each patient should be determined based on discussion among a multidisciplinary team of experts. For BPA to become an established treatment for CTEPH, further data are needed. This review summarizes the techniques and strategies of BPA at present and discusses the future development of the procedure. AD - H. Matsubara, Department of Clinical Science, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Kita-ku, Okayama, Japan AU - Ogawa, A. AU - Matsubara, H. DB - Embase Medline DO - 10.1253/circj.CJ-18-0258 KW - balloon catheter artificial ventilation blood flow chronic thromboembolic pulmonary hypertension echocardiography electrocardiography endarterectomy fluoroscopy follow up human lung artery pressure lung edema lung embolism lung hemorrhage lung vascular resistance overall survival percutaneous transluminal angioplasty pulmonary artery pulmonary valve stenosis review risk factor thorax radiography LA - English M1 - 5 M3 - Review N1 - L621903973 2018-05-02 2018-05-08 PY - 2018 SN - 1347-4820 1346-9843 SP - 1222-1230 ST - After the dawn: Balloon pulmonary angioplasty for patients with chronic thromboembolic pulmonary hypertension T2 - Circulation Journal TI - After the dawn: Balloon pulmonary angioplasty for patients with chronic thromboembolic pulmonary hypertension UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621903973&from=export http://dx.doi.org/10.1253/circj.CJ-18-0258 VL - 82 ID - 760865 ER - TY - JOUR AB - BACKGROUND: Although transarterial embolization (TAE) with Onyx has become popular for the treatment of dural arteriovenous fistulas (DAVFs), transvenous embolization (TVE), surgery, and radiosurgery have continued to have a role. The aim of the present study was to compare the treatment outcomes stratified by the different treatment modalities. METHODS: The data from 92 patients with DAVFs treated from January 2009 to June 2018 were retrospectively reviewed. The treatment strategies were decided by a multidisciplinary team according to the patient's clinical status and angiographic findings. The clinical and radiologic data were analyzed and correlated with the treatment modality. RESULTS: A total of 101 procedures were performed in the 92 patients. TAE, TVE, surgery, and radiosurgery were performed in 31, 49, 12, and 9 procedures, respectively. Complete and near complete occlusion was achieved in 13 cases treated with TAE (41.9%), 41 treated with TVE (83.7%), and 10 with surgery (83.3%), as shown on immediate postprocedural angiography (P < 0.001). Retreatment was needed in 9 patients in the TAE group and none in the TVE or surgery groups (P < 0.001). Surgery (n = 1), TVE (n = 3), TAE (n = 1), and radiosurgery (n = 4) were used for patients requiring retreatment. At the last follow-up examination (mean, 26.5 ± 23.9 months), 66 of 72 DAVFs (91.6%) showed angiographic complete occlusion. Clinically, the initial symptoms had disappeared or improved in 87 of 90 patients (96.7%) at the last follow-up evaluation (mean, 26.4 ± 26.8 months). CONCLUSIONS: Even in the Onyx era, other treatment modalities still have important roles, as shown in the present study. Therefore, the selection of the appropriate treatment modality should be individualized by the angiographic findings and clinical symptoms. AD - Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea. Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea. Electronic address: bivalvia@catholic.ac.kr. Department of Radiology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea. AN - 30862595 AU - Oh, S. H. AU - Choi, J. H. AU - Kim, B. S. AU - Lee, K. S. AU - Shin, Y. S. DA - Jun DO - 10.1016/j.wneu.2019.02.173 DP - NLM ET - 2019/03/14 J2 - World neurosurgery KW - Adult Aged Central Nervous System Vascular Malformations/diagnostic imaging/surgery/*therapy Cerebral Angiography *Embolization, Therapeutic Endovascular Procedures/methods Female Humans Male Middle Aged Polyvinyls/therapeutic use *Radiosurgery Retrospective Studies Treatment Outcome Dural arteriovenous fistula Embolization Radiosurgery Surgery LA - eng N1 - 1878-8769 Oh, Sol Hooy Choi, Jai Ho Kim, Bum-Soo Lee, Kwan Sung Shin, Yong Sam Journal Article United States World Neurosurg. 2019 Jun;126:e825-e834. doi: 10.1016/j.wneu.2019.02.173. Epub 2019 Mar 9. PY - 2019 SN - 1878-8750 SP - e825-e834 ST - Treatment Outcomes According to Various Treatment Modalities for Intracranial Dural Arteriovenous Fistulas in the Onyx Era: A 10-Year Single-Center Experience T2 - World Neurosurg TI - Treatment Outcomes According to Various Treatment Modalities for Intracranial Dural Arteriovenous Fistulas in the Onyx Era: A 10-Year Single-Center Experience VL - 126 ID - 760223 ER - TY - JOUR AB - No instruments are currently available to help health systems identify target areas for reducing door-to-needle times for the administration of intravenous tissue plasminogen activator to eligible patients with ischemic stroke. A 67-item Likert-scale survey was administered by telephone to stroke personnel at 252 U.S. hospitals participating in the "Get With The Guidelines-Stroke" quality improvement program. Factor analysis was used to refine the instrument to a four-factor 29-item instrument that can be used by hospitals to assess their readiness to administer intravenous tissue plasminogen activator within 60 minutes of patient hospital arrival. AD - Questions or comments about this article may be directed to DaiWai M. Olson, PhD RN CCRN, at DaiWai.Olson@UTSouthwestern.edu. He is an Associate Professor of Neurology and Neurotherapeutics at the University of Texas Southwestern Medical Center, Dallas, TX. Margueritte Cox, MS, is a Biostatistician at Duke Clinical Research Institute, Durham, NC. Mark Constable, RN, is a Stroke Coordinater at Duke Clinical Research Institute and Duke University, Durham, NC. Gavin W. Britz, MD, is a Professor of Neurosurgery and the Chairman of Neurosurgery at Methodist Hospital, Houston, TX. Cheryl B. Lin, MD, is a Medical Resident at Duke Clinical Research Institute and Duke University, Durham, NC. Louise O. Zimmer, MPH, is a Clinical Research Coordinator at University of North Carolina at Chapel Hill, Chapel Hill, NC. Gregg C. Fonarow, MD, is a Professor of Medicine and Associate Chief of Cardiology at University of California Los Angeles, Los Angeles, CA. Lee H. Schwamm, MD, is a Professor of Neurology at Harvard University and Vice Chairman of Neurology at Massachusetts General Hospital, Boston, MA. Eric D. Peterson, MD MPH, is a Professor of Medicine at Duke Clinical Research Institute and Duke University, Durham, NC. AN - 25099063 AU - Olson, D. M. AU - Cox, M. AU - Constable, M. AU - Britz, G. W. AU - Lin, C. B. AU - Zimmer, L. O. AU - Fonarow, G. C. AU - Schwamm, L. H. AU - Peterson, E. D. C2 - Pmc4165480 DA - Oct DO - 10.1097/jnn.0000000000000082 DP - NLM ET - 2014/08/08 J2 - The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses KW - Cerebral Infarction/*nursing/therapy Early Medical Intervention/*organization & administration Efficiency, Organizational *Guideline Adherence Humans Infusions, Intravenous Patient Admission Patient Care Team/organization & administration Quality Improvement Thrombolytic Therapy/*nursing Time and Motion Studies Tissue Plasminogen Activator/*administration & dosage Workflow LA - eng M1 - 5 N1 - 1945-2810 Olson, DaiWai M Cox, Margueritte Constable, Mark Britz, Gavin W Lin, Cheryl B Zimmer, Louise O Fonarow, Gregg C Schwamm, Lee H Peterson, Eric D U18 HS016964/HS/AHRQ HHS/United States U18HS016964/HS/AHRQ HHS/United States Journal Article Research Support, U.S. Gov't, P.H.S. J Neurosci Nurs. 2014 Oct;46(5):267-73. doi: 10.1097/JNN.0000000000000082. PY - 2014 SN - 0888-0395 (Print) 0888-0395 SP - 267-73 ST - Development and initial testing of the stroke rapid-treatment readiness tool T2 - J Neurosci Nurs TI - Development and initial testing of the stroke rapid-treatment readiness tool VL - 46 ID - 760527 ER - TY - JOUR AB - IMPORTANCE: The US Food and Drug Administration recently approved the use of a transcatheter aortic valve in patients for whom traditional valve replacement surgery poses a high or prohibitive risk. Our hospital was one of the first Veterans Affairs facilities to launch a transcatheter aortic valve replacement (TAVR) program. OBJECTIVE: To evaluate our early experience with transfemoral TAVR. DESIGN AND SETTING: We retrospectively reviewed the records of all patients who underwent TAVR during the first year of our program at the Department of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Medical Center. PARTICIPANTS: The mean (SD) age of the patients was 77 (9) years, and their mean (SD) Society of Thoracic Surgeons predicted risk of mortality score was 8.8 (10.7). INTERVENTIONS: All patients underwent TAVR with the SAPIEN transcutaneous valve. MAIN OUTCOME MEASURES: We evaluated operative mortality and major operative morbidity (stroke, myocardial infarction, renal failure necessitating dialysis, and requirement for mechanical circulatory support, as well as vascular complications and requirement for permanent pacemaker), in addition to length of hospital stay and discharge status. RESULTS: Between December 21, 2011, and December 13, 2012, a total of 19 transfemoral TAVR procedures were performed at our center. Implantation was successful in all cases. There were no reports of operative (30-day) mortality, prosthetic valve endocarditis, renal failure necessitating dialysis, perioperative myocardial infarction or stroke, or conversion to surgical aortic valve replacement. Seven patients (37%) had mild paravalvular leak, 3 patients (16%) had moderate paravalvular leak, 2 patients (11%) had groin wound complications, 2 patients (11%) required a permanent pacemaker, 1 patient (5%) had a vascular access complication requiring endovascular repair, and 1 patient (5%) required temporary circulatory support (with extracorporeal membrane oxygenation). The mean (SD) length of hospital stay after TAVR was 8.0 (5.9) days. All patients were discharged home. CONCLUSIONS AND RELEVANCE: Transcatheter aortic valve replacement can be performed safely and with good outcomes at a Veterans Affairs facility with a committed multidisciplinary team and substantial experience in heart valve and endovascular therapies. AD - Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas4Department of Anesthesiology, Baylor College of Medicine, Houston, Texas. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas5Division of Vascular Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas6Texas Heart Institute, Houston. Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas6Texas Heart Institute, Houston. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas6Texas Heart Institute, Houston. AN - 24048246 AU - Omer, S. AU - Kar, B. AU - Cornwell, L. D. AU - Blaustein, A. AU - Levine, G. N. AU - Ali, N. AU - Jneid, H. AU - Paniagua, D. AU - Atluri, P. V. AU - Bechara, C. F. AU - Kougias, P. AU - Ruma, M. AU - Preventza, O. AU - Bozkurt, B. AU - Carabello, B. A. AU - Bakaeen, F. G. DA - Dec DO - 10.1001/jamasurg.2013.3743 DP - NLM ET - 2013/09/21 J2 - JAMA surgery KW - Aged Aged, 80 and over Aortic Valve Stenosis/therapy *Cardiac Catheterization Cohort Studies Endovascular Procedures/*methods Follow-Up Studies *Heart Valve Prosthesis Hospital Mortality Hospitals, Veterans/organization & administration Humans Length of Stay Male Middle Aged Minimally Invasive Surgical Procedures/methods Patient Care Team/*organization & administration Patient Safety Patient Selection Patients Retrospective Studies Risk Assessment Survival Analysis Treatment Outcome United States LA - eng M1 - 12 N1 - 2168-6262 Omer, Shuab Kar, Biswajit Cornwell, Lorraine D Blaustein, Alvin Levine, Glen N Ali, Nadir Jneid, Hani Paniagua, David Atluri, Prasad V Bechara, Carlos F Kougias, Panos Ruma, Maryrose Preventza, Ourania Bozkurt, Biykem Carabello, Blase A Bakaeen, Faisal G Evaluation Study Journal Article United States JAMA Surg. 2013 Dec;148(12):1087-93. doi: 10.1001/jamasurg.2013.3743. PY - 2013 SN - 2168-6254 SP - 1087-93 ST - Early experience of a transcatheter aortic valve program at a Veterans Affairs facility T2 - JAMA Surg TI - Early experience of a transcatheter aortic valve program at a Veterans Affairs facility VL - 148 ID - 760356 ER - TY - JOUR AB - BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging option for hemorrhage control, but its use is limited in scenarios such as penetrating chest trauma. The aim of this study was to describe the use of REBOA as a resuscitative adjunct in these cases with major hemorrhage and to propose a new clinical management algorithm. METHODS: This was a prospective, observational study conducted at a single Level I trauma center in Colombia. We included all patients older than 14 years with severe trauma who underwent REBOA from January 2015 to December 2019. Patients received REBOA if they were in hemorrhagic shock and were unresponsive to resuscitation. RESULTS: A total of 56 patients underwent REBOA placement of which 37 had penetrating trauma and 23 had chest trauma. All patients were hemodynamically unstable upon arrival to the emergency department, with a median systolic blood pressure of 69 mm Hg (interquartile range [IQR], 57-90 mm Hg) and median Injury Severity Score was 25 (IQR, 25-41). All REBOAs were deployed and inflated in zone 1, median inflation time was 40 minutes (IQR, 26-55 minutes), and no adverse neurologic outcomes were observed. Fifteen patients had REBOA and a median sternotomy. Eleven patients had concomitant abdominal wounds. Overall mortality was 28.6%, and there was no significant difference between penetrating versus blunt trauma patients (21.6% vs. 42.1%, p = 0.11). The survival rate of thoracic injured patients was similar to the predicted survival (65.2% vs. 63.3%). CONCLUSION: Resuscitative endovascular balloon occlusion of the aorta can be used safely in penetrating chest trauma, and the implementation of a REBOA management algorithm is feasible with a well-trained multidisciplinary team. LEVEL OF EVIDENCE: Therapeutic, level V. AD - From the Division of Trauma and Acute Care Surgery, Department of Surgery, (C.A.O., F.R., J.J.S., A.S., A.M.d.V., A.G.), Fundación Valle del Lili, Cali, Colombia; Seccion de Cirugía de Trauma y Emergencias (C.A.O., F.R., J.J.S., A.S., J.J.M., E.A., A.G.), Universidad del Valle-Hospital Universitario del Valle, Cali, Colombia; Department of Trauma Critical Care (M.P.), Broward General Level I Trauma Center, Fort Lauderdale, Florida; Center for Surgery and Public Health, Department of Surgery (J.P.H., C.O.), Brigham & Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Centro de Investigaciones Clínicas (CIC) (M.G.-R., E.Y.C.), Fundación Valle del Lili, Cali, Colombia; and Department of Surgery (M.B.), Riverside University Health Systems, University of California, Riverside, California. AN - 32345890 AU - Ordoñez, C. A. AU - Rodríguez, F. AU - Parra, M. AU - Herrera, J. P. AU - Guzmán-Rodríguez, M. AU - Orlas, C. AU - Caicedo, E. Y. AU - Serna, J. J. AU - Salcedo, A. AU - Del Valle, A. M. AU - Meléndez, J. J. AU - Angamarca, E. AU - García, A. AU - Brenner, M. DA - Aug DO - 10.1097/ta.0000000000002773 DP - NLM ET - 2020/04/30 J2 - The journal of trauma and acute care surgery KW - Abdominal Injuries/complications Adult Algorithms Aorta/*injuries *Balloon Occlusion *Clinical Protocols Colombia Emergency Service, Hospital Endovascular Procedures/*methods Female Humans Male Middle Aged Prospective Studies Retrospective Studies Shock, Hemorrhagic/*therapy Thoracic Injuries/*complications Trauma Severity Indices Wounds, Nonpenetrating/complications Wounds, Penetrating/*complications Young Adult LA - eng M1 - 2 N1 - 2163-0763 Ordoñez, Carlos A Rodríguez, Fernando Parra, Michael Herrera, Juan Pablo Guzmán-Rodríguez, Mónica Orlas, Claudia Caicedo, Edgar Yaset Serna, José Julián Salcedo, Alexander Del Valle, Ana Milena Meléndez, Juan José Angamarca, Edison García, Alberto Brenner, Megan Journal Article Observational Study United States J Trauma Acute Care Surg. 2020 Aug;89(2):311-319. doi: 10.1097/TA.0000000000002773. PY - 2020 SN - 2163-0755 SP - 311-319 ST - Resuscitative endovascular balloon of the aorta is feasible in penetrating chest trauma with major hemorrhage: Proposal of a new institutional deployment algorithm T2 - J Trauma Acute Care Surg TI - Resuscitative endovascular balloon of the aorta is feasible in penetrating chest trauma with major hemorrhage: Proposal of a new institutional deployment algorithm VL - 89 ID - 760517 ER - TY - JOUR AB - Background: Submassive pulmonary embolism (PE) is associated with high risk of morbidity and mortality. Ultrasound-assisted catheter-directed thrombolysis (USAT) improves right ventricular function and hemodynamics without increasing the risk of life-threatening hemorrhage. However, improvement in these endpoints must be balanced against cost of care. We investigated the direct hospital costs for patients who received USAT therapy compared to those treated with anticoagulation alone. Methods: For this single-center prospective cohort analysis, we included 17 inpatients with a primary diagnosis of pulmonary embolism who were consecutively evaluated by a multidisciplinary PE response team for consideration of USAT for submassive PE. Patients who received USAT and those who were treated medically were included. All admissions occurred at University of North Carolina Hospital from December 1st, 2016 to September 30th, 2017. Hospitalization costs were obtained on all patients. Student's t-test was used to compare means, and P-values of less than 0.05 were considered signifcant. Results: Nine patients received USAT, compared with 8 patients who were medically managed. The mean procedural cost of USAT was $7,278.30 +/-$1,704.65. The mean hospitalization cost in the USAT group was $18,685.06 +/-$3,058.17 compared to $13,121.01 +/-$10,086.99 for the medically managed group (p-value = 0.13). The cost of intensive care unit (ICU) treatment was similar in both groups [USAT mean $3,884.79 +/-$1,234.19, medically managed mean $4,094.27 +/-$3,826.77, P-value = 0.42]. Noninvasive diagnostic costs were $782.29 +/-$253.77 in the USAT group and $1,459.33 +/-$1,506.36 in the medically managed group (p-value = 0.20). Conclusion: In our sample of patients with submassive PE, USAT accounts for 39% of total hospitalization cost, but does not does not signifcantly increase ICU, or noninvasive diagnostic costs. These costs do not refect total patient charges but suggest that USAT is not cost prohibitive compared to other invasive cardiac procedures. This information is important for clinicians considering the value of USAT in the treatment of submassive PE. AD - R. Orgel, University of North Carolina, Chapel Hill, NC, United States AU - Orgel, R. AU - Pauley, E. AU - Lee, D. AU - Rossi, J. DB - Embase DO - 10.1016/S0735-1097(18)32487-2 KW - adult anticoagulation blood clot lysis catheter clinical article cohort analysis conference abstract controlled study diagnosis female heart hospitalization cost human human tissue intensive care unit lung embolism male North Carolina prospective study register statistical significance student ultrasound LA - English M1 - 11 M3 - Conference Abstract N1 - L621786562 2018-04-27 PY - 2018 SN - 1558-3597 ST - Inpatient cost of ultrasound-assisted catheter-directed thrombolysis in patients with submassive pulmonary embolus: A single center registry analysis T2 - Journal of the American College of Cardiology TI - Inpatient cost of ultrasound-assisted catheter-directed thrombolysis in patients with submassive pulmonary embolus: A single center registry analysis UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621786562&from=export http://dx.doi.org/10.1016/S0735-1097(18)32487-2 VL - 71 ID - 760847 ER - TY - JOUR AB - Therapeutic advances, including the availability of oral iron chelators and new noninvasive methods for early detection and treatment of iron overload, have significantly improved the life expectancy and quality of thalassemia patients, with a consequent increase in their reproductive potential and desire to have children. Hundreds of pregnancies have been reported so far, highlighting that women carefully managed in the preconception phase usually carry out a successful gestation and labor, both in case of spontaneous conception and assisted reproductive techniques. A multidisciplinary team including a cardiologist, an endocrinologist, and a gynecologist, under the supervision of an expert in beta-thalassemia, should be involved. During pregnancy, a close follow-up of maternal disorders and of the baby's status is recommended. Hemoglobin should be maintained over 10 g/dL to allow normal fetal growth. Chelators are not recommended; nevertheless, it may be reasonable to consider restarting chelation therapy with desferrioxamine towards the end of the second trimester when the potential benefits outweigh the potential fetal risk. Women with non-transfusion-dependent thalassemia who have never previously been transfused or who have received only minimal transfusion therapy are at risk of severe alloimmune anemia if blood transfusions are required during pregnancy. Since pregnancy increases the risk of thrombosis three-fold to four-fold and thalassemia is also a hypercoagulable state, the recommendation is to keep women who are at higher risk -such as those who are not regularly transfused and those splenectomised- on prophylaxis during pregnancy and the postpartum period. AD - R. Origa, Ospedale Pediatrico Microcitemico 'A.Cao', A.O. 'G.Brotzu', via Jenner sn, Cagliari, Italy AU - Origa, R. AU - Comitini, F. DB - Embase DO - 10.4084/mjhid.2019.019 KW - deferoxamine ferritin hemoglobin iron chelating agent Muellerian inhibiting factor article beta thalassemia blood transfusion breast feeding cardiologist drug efficacy drug safety early diagnosis endocrinologist female fertility ferritin blood level fetus growth follow up gynecologist heart disease hemoglobin blood level hemoglobin h disease high risk population high risk pregnancy human hypercoagulability in vitro fertilization infertility therapy iron chelation iron overload life expectancy maternal treatment multidisciplinary team obstetric delivery outcome assessment ovarian reserve ovary function ovary hyperstimulation ovulation induction patient counseling patient monitoring pregnancy pregnancy outcome prenatal diagnosis prepregnancy care puerperium reproductive success risk benefit analysis second trimester pregnancy splenectomy thalassemia thalassemia major thrombosis LA - English M3 - Article N1 - L626588461 2019-03-12 2019-03-14 PY - 2019 SN - 2035-3006 ST - Pregnancy in thalassemia T2 - Mediterranean Journal of Hematology and Infectious Diseases TI - Pregnancy in thalassemia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L626588461&from=export http://dx.doi.org/10.4084/mjhid.2019.019 VL - 11 ID - 760769 ER - TY - JOUR AU - Ortega Hortelano, Alejandro AU - Grosso, Monica AU - Haq, Anwar AU - Tsakalidis, Anastasios AU - Gkoumas, Konstantinos AU - Van Balen, Mitchell AU - Pekar, Ferenc DA - 2019/01/01 01/01 DB - Joint Research Centre Publications Repository PY - 2019 ST - Women in European Transport with a focus on Research and Innovation T2 - Joint Research Centre Publications Repository TI - Women in European Transport with a focus on Research and Innovation UR - http://publications.jrc.ec.europa.eu/repository/handle/JRC117687 ID - 762087 ER - TY - JOUR AB - INTRODUCTION: The purpose of this study was to review recommendations made from a specialist pelvic exenteration (PE) multidisciplinary team (MDT) and to provide insights as to the impact of the MDT on patient selection and clinical decision making. MATERIALS & METHODS: A retrospective review was conducted at Royal Prince Alfred Hospital's PE MDT between June 2014 and December 2015. Data was collected from the recorded minutes of MDT meetings. Referral information and clinical data was extracted from individual patient files. Additional data including operative dates and surgical resection margins were collected from electronic medical records. RESULTS: Of the 183 patients considered for PE during the MDT meeting, 104 (57%) were recommended for surgery. Factors that influenced the recommendation in favour of surgery were referral by a surgeon (P = 0.004), referral from a rural location (P = 0.05) and having locally advanced primary cancer (P < 0.001). Patients who were seen by the unit's surgeon prior to the MDT did not impact on the MDT recommendation nor the decision for or against surgery (P = 0.771). The most common reason for recommendation against PE was unresectable distant metastatic disease (43%). CONCLUSIONS: The PE MDT meeting is a critical step in the patient care pathway and facilitates critical decision making. Anatomically-based contraindications to surgery (i.e. involvement of adjacent organs, bone and neurovascular structures) do not appear to influence MDT decision making regarding resectability. AD - Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia; RPA Institute of Academic Surgery (IAS), Sydney, Australia. Electronic address: sarah.oshannassy@health.nsw.gov.au. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia; RPA Institute of Academic Surgery (IAS), Sydney, Australia. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia; The University of Sydney, New South Wales, Australia. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia; RPA Institute of Academic Surgery (IAS), Sydney, Australia; The University of Sydney, New South Wales, Australia. AN - 32122755 AU - O'Shannassy, S. J. AU - Brown, K. G. M. AU - Steffens, D. AU - Solomon, M. J. DA - Jun DO - 10.1016/j.ejso.2020.02.031 DP - NLM ET - 2020/03/04 J2 - European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology KW - Multidisciplinary team Pelvic exenteration Surgical outcomes LA - eng M1 - 6 N1 - 1532-2157 O'Shannassy, Sarah J Brown, Kilian G M Steffens, Daniel Solomon, Michael J Journal Article England Eur J Surg Oncol. 2020 Jun;46(6):1138-1143. doi: 10.1016/j.ejso.2020.02.031. Epub 2020 Feb 21. PY - 2020 SN - 0748-7983 SP - 1138-1143 ST - Referral patterns and outcomes of a highly specialised pelvic exenteration multidisciplinary team meeting: A retrospective cohort study T2 - Eur J Surg Oncol TI - Referral patterns and outcomes of a highly specialised pelvic exenteration multidisciplinary team meeting: A retrospective cohort study VL - 46 ID - 760276 ER - TY - JOUR AB - Background Inpatients may be at risk of cardiopulmonary instability during radiologic testing. Calling the medical emergency team is one rescue intervention that brings a team of critical care providers to the unstable patient. Little is known, however, about patients' instability and activations of the medical emergency team in the radiology department (RD-MET). Objectives To describe the cause of activation of the RD-MET for hospitalized patients, temporal attributes of RD-MET involvement, characteristics of RD-MET patients, and characteristics associated with good and poor outcomes after RD-MET activation. Methods Retrospective pilot study of RD-MET calls for 64 inpatients in a tertiary care hospital during 2009. Results Reasons for RD-MET activation were 39% neurological, 38% cardiac, and 22% respiratory, and nearly half (42%) occurred during a computed tomography scan. Most RD-MET calls were made between 10 AM and noon. RD-MET patients had a mean age of 61 (SD, 19) years; 52% were female, and 89% were white. Admitting diagnoses were most commonly neurological (20%), cardiovascular (16%), and abdominal (16%). The most common comorbid conditions were chronic obstructive pulmonary disease (23%) and diabetes (20%). Half of RD-MET inpatients were from a general care unit, and 56% required preexisting oxygen support. After RD-MET involvement, 61% of patients required a higher level of care; 3% died during the MET intervention, and 19% died later in hospitalization. Patients with preexisting comorbid conditions were more likely to have poor outcomes after the RD-MET intervention (P=.001). Conclusions RD-MET patients with comorbid conditions, from a general care unit, and at risk for neurological deterioration arrive in the radiology department with potentially underestimated support needs. Greater support in specific time frames and locations may be warranted to improve outcomes. (American Journal of Critical Care. 2011; 20: 461-469) AD - [Ott, Lora K.; Hravnak, Marilyn] Univ Pittsburgh, Sch Nursing, Dept Acute & Tertiary Care, Pittsburgh, PA 15261 USA. [Clark, Sunday] Univ Pittsburgh, Div Gen Internal Med, Sch Med, Pittsburgh, PA 15261 USA. [Clark, Sunday] Univ Pittsburgh, Dept Epidemiol, Grad Sch Publ Hlth, Pittsburgh, PA 15261 USA. [Amesur, Nikhil B.] UPMC Presbyterian Hosp, Dept Radiol, Pittsburgh, PA USA. Ott, LK (corresponding author), Univ Pittsburgh, Sch Nursing, Dept Acute & Tertiary Care, 3500 Victoria St, Pittsburgh, PA 15261 USA. ottl@pitt.edu AN - WOS:000296657500016 AU - Ott, L. K. AU - Hravnak, M. AU - Clark, S. AU - Amesur, N. B. DA - Nov DO - 10.4037/ajcc2011248 J2 - Am. J. Crit. Care KW - PULMONARY-EMBOLISM CONSENSUS CONFERENCE TEAM ANTECEDENTS MANAGEMENT MORBIDITY MORTALITY CRITERIA SYSTEMS ARREST Critical Care Medicine Nursing LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: 843FK Times Cited: 6 Cited Reference Count: 26 Ott, Lora K. Hravnak, Marilyn Clark, Sunday Amesur, Nikhil B. Research in Chronic and Critical Illness [T32 NR 008857]; National Center for Research Resources (NCRR)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Center for Research Resources (NCRR) [KL2 RR024154]; National Institutes of Health (NIH)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA; NIH Roadmap for Medical ResearchUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA Dr Ott was supported by Research in Chronic and Critical Illness (T32 NR 008857). Dr Clark was supported by grant number KL2 RR024154 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp. 6 0 AMER ASSOC CRITICAL CARE NURSES ALISO VIEJO AM J CRIT CARE PY - 2011 SN - 1062-3264 SP - 461-468 ST - PATIENTS' INSTABILITY, EMERGENCY RESPONSE, AND OUTCOMES IN THE RADIOLOGY DEPARTMENT T2 - American Journal of Critical Care TI - PATIENTS' INSTABILITY, EMERGENCY RESPONSE, AND OUTCOMES IN THE RADIOLOGY DEPARTMENT UR - ://WOS:000296657500016 VL - 20 ID - 761839 ER - TY - JOUR AU - Ozcinar, E. AU - Erol, S. AU - Aliyev, A. AU - Cakici, M. AU - Baran, C. AU - Bermede, O. DA - 2017/09/23 09/23 DB - Europe PubMed Central DO - 10.1016/j.athoracsur.2017.01.003 M1 - 4 PY - 2017 SN - 0003-4975 ST - Could Surgical Pulmonary Embolectomy Be Performed With Acceptable Outcomes Without a Pulmonary Embolism Response Team? T2 - Ann Thorac Surg TI - Could Surgical Pulmonary Embolectomy Be Performed With Acceptable Outcomes Without a Pulmonary Embolism Response Team? UR - http://europepmc.org/article/MED/28935307 VL - 104 ID - 761931 ER - TY - JOUR AB - Purpose: The aim of this study was to present our experience in patients who underwent laparoscopic bariatric surgery and to discuss the current literature on the perioperative management Material and Methods: Sixty two patients with ASA risk classification II-III were evaluated retrospectively who underwent obesity surgery in our hospital. Demographic characteristics of the patients, surgical time, complications that seen in the perioperative period and the length of hospital stay were recorded Results: The age of the patients ranged from 19 to 59 years and 75.9% of them were female. Mean operation time was 167 minutes and the length of hospital stay was 5 days. Complications seen during intraoperative period were tachycardia, hypertension and arrhythmia. In the following days, 6 (9.7%) patients were re-operated and there was no mortality Conclusion: The prevention of complications that may occur in laparoscopic obesity surgery is required with a equipped team and teamwork, a good preoperative preparation, thromboembolism prophylaxis, tight hemodynamics and blood gas monitoring for safe anesthesia AD - [Oezmete, Oezlem; Bali, Cagla; Ergenoglu, Pinar; Akin, Sule; Aribogan, Anis] Baskent Univ, Tip Fak, Adana Uygulama Arastirma Merkezi, Anesteziyol Reanimasyon Anabilim Dali, Adana, Turkey. Ozmete, O (corresponding author), Baskent Univ, Tip Fak, Adana Uygulama Arastirma Merkezi, Anesteziyol Reanimasyon Anabilim Dali, Adana, Turkey. ozlemyilma@yahoo.com AN - WOS:000399405200018 AU - Ozmete, O. AU - Bali, C. AU - Ergenoglu, P. AU - Akin, S. AU - Aribogan, A. DO - 10.17826/cutf.280158 J2 - Cukurova Med. J. KW - Obesity surgery anesthesia management laparoscopy morbidity-mortality MORBIDLY OBESE-PATIENTS BODY-MASS INDEX TRACHEAL INTUBATION DIFFICULT INTUBATION SEVOFLURANE PROPOFOL LARYNGOSCOPY PRESSURE POSITION CARE Medicine, General & Internal LA - Turkish M1 - 1 M3 - Article N1 - ISI Document Delivery No.: ES3CO Times Cited: 1 Cited Reference Count: 24 Oezmete, Oezlem Bali, Cagla Ergenoglu, Pinar Akin, Sule Aribogan, Anis 1 0 CUKUROVA UNIV, FAC MEDICINE ADANA CUKUROVA MED J PY - 2017 SN - 0250-5150 SP - 126-131 ST - Anesthesia management for laparoscopic bariatric surgery: retrospective analysis of 62 patients T2 - Cukurova Medical Journal TI - Anesthesia management for laparoscopic bariatric surgery: retrospective analysis of 62 patients UR - ://WOS:000399405200018 VL - 42 ID - 761673 ER - TY - JOUR AB - Background: In patients supported with extracorporeal membrane oxygenation, and who develop heparin-induced thrombocytopenia, there is no clear evidence to support changing to a non-heparin-coated extracorporeal membrane oxygenation circuit. Our goal was to evaluate clinical outcomes of patients who were continued on heparin-bonded circuits despite diagnosed heparin-induced thrombocytopenia. Methods: We completed a single-center retrospective study of all patients who underwent extracorporeal membrane oxygenation support from July 2008 to July 2017 and were tested heparin-induced thrombocytopenia positive while on extracorporeal membrane oxygenation support. After diagnosis of heparin-induced thrombocytopenia, mean platelet count (k/µL) was measured on consecutive days for 14 days. Results: Out of 455 patients, 14 (3.1%) had a diagnosis of heparin-induced thrombocytopenia by serotonin release assay and systemic heparin treatment was discontinued in every case. In total, 11 of the heparin-induced thrombocytopenia patients (78.6%) survived to discharge. The overall survival of all 455 extracorporeal membrane oxygenation patients was 54.1%. Platelets counts after discontinuation of systemic heparin in the heparin-induced thrombocytopenia patients increased from a mean of 59.8 k/µL at time of heparin-induced thrombocytopenia diagnosis to a mean of 280.2 k/µL at 14 days after discontinuation of heparin despite continuation of the heparin-bonded circuit. Platelet count increased in heparin-induced thrombocytopenia patients on extracorporeal membrane oxygenation support after discontinuation of systemic heparin even if maintained on the heparin-bonded circuit. Conclusion: Discontinuation of systemic heparin but continuation of heparin-coated extracorporeal membrane oxygenation circuits appeared to be an appropriate response for our extracorporeal membrane oxygenation–supported patients who developed heparin-induced thrombocytopenia. Survival in this group was not significantly different to those patients on extracorporeal membrane oxygenation without heparin-induced thrombocytopenia. Larger studies should evaluate the safety of heparin-bonded extracorporeal membrane oxygenation systems in heparin-induced thrombocytopenia patients. AD - Heart and Vascular Institute, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA Center for Emergency Medicine, University Hospital Essen, Essen, Germany Bon Secours Richmond Health Systems, Richmond, VA, USA AN - 138575899. Language: English. Entry Date: 20190914. Revision Date: 20190916. Publication Type: Article AU - Pabst, Dirk AU - Boone, Jacqueline B. AU - Soleimani, Behzad AU - Brehm, Christoph E. DB - CINAHL DO - 10.1177/0267659119842056 DP - EBSCOhost KW - Thrombocytopenia -- Chemically Induced Extracorporeal Membrane Oxygenation Outcome Assessment Heparin -- Adverse Effects Platelet Count -- Evaluation Heparin -- Therapeutic Use Human Retrospective Design Immunoglobulins Patient Discharge Survival Electronic Health Records Descriptive Statistics Chi Square Test Platelet Transfusion Adult Middle Age Aged Biological Assay M1 - 7 N1 - research; tables/charts. Journal Subset: Allied Health; Double Blind Peer Reviewed; Editorial Board Reviewed; Europe; Expert Peer Reviewed; Peer Reviewed; UK & Ireland. NLM UID: 8700166. PY - 2019 SN - 0267-6591 SP - 584-589 ST - Heparin-induced thrombocytopenia in patients on extracorporeal membrane oxygenation and the role of a heparin-bonded circuit T2 - Perfusion TI - Heparin-induced thrombocytopenia in patients on extracorporeal membrane oxygenation and the role of a heparin-bonded circuit UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=138575899&site=ehost-live&scope=site VL - 34 ID - 761332 ER - TY - JOUR AB - Aim: Aneurysm surgery after endovascular treatment has several constraints. We present the case of clipping of a thrombosed enlarging aneurysm presenting with visual loss after a stenting procedure. Methods: A 70 years old woman, during investigations for migraine, was diagnosed to have an aneurysm of the ACOMA at the left A1-A2 junction, pointing antero-inferiorly, with intraluminal thrombus. Our multidisciplinary team proposed either surgically or endovascular treatment, the latter was preferred by the patient. After antiplatelet therapy, a PED was positioned at the left A1-A2 with immediate contrast stasis within the sac. AngioMR at 1 month showed no intraaneurysmal flow and the neurological examination was normal. After 3 months the patient developed progressive complete visual loss in the left eye. Visual field and optical coherence tomography (OCT) suggested a lesion of the retrobulbar, prechiasmatic left optic nerve. MRI/DSA showed normal flow in the parent vessel, exclusion of the aneurysm and paradoxical aneurysmal growth, related to intrasaccular thrombosis, worsening the mass effect on the optic nerve,. After discussion in the neurovascular board we decided to operate. The optic nerve was compressed by turgid thrombosed aneurysm with mixed components. The sac was dissected away from the nerve and excised and the aneurismal neck was clipped. Results: Vision recovered on the first postop day which was confirmed with tests of visual acuity, fields and OCT. PED for ACOMA aneurysm has a rate of immediate procedural success of 96% and complete exclusion in 86% at mean follow-up of 10.4 months1. The procedure has a 5% worsening of previous visual deficit, due to ophthalmic artery hypoperfusion 2. Certain aneurysms continue to show filling after PED, but the ideal time frame for other alternatives is under debate 3. Also, some aneurysms seems to never close even after discontinuation of the 3 months dual antiplatelet therapy. The rate of failure increases in case of big size, complicated morphology or previous endovascular treatment.3 Conclusion: We describe an unusual complication of a new and delayed neurological deficit after a successful endovascular treatment, which was then reversed by surgery. The stent renders the artery rigid and makes the clipping of the neck more difficult. This case illustrates the need to be judicious while proposing PED treatment for freshly thrombosed aneurysms exerting mass effect on critical structures such as the optic nerve. AD - M. Pacetti, CHUV Lausanne, Lausanne, Switzerland AU - Pacetti, M. AU - Mosimann, P. J. AU - Zerlauth, J. AU - Puccinelli, F. AU - Levivier, M. AU - Daniel, R. T. DB - Embase DO - 10.1055/s-0037-1603885 KW - antithrombocytic agent aged aneurysm surgery anterior communicating artery aneurysm blindness body weight case report clinical article complication conference abstract diagnosis drug withdrawal dual antiplatelet therapy female follow up human human cell migraine morphology neck neurologic examination nuclear magnetic resonance imaging ophthalmic artery optic nerve optical coherence tomography perfusion pipeline embolization device stent surgery thrombus visual acuity visual field LA - English M3 - Conference Abstract N1 - L620956639 2018-03-07 PY - 2017 SN - 2193-6323 ST - Clipping for a partially thrombosed anterior communicating artery (ACOMA) aneurysm presenting with delayed visual loss after pipeline embolization device (PED) treatment-case report T2 - Journal of Neurological Surgery, Part A: Central European Neurosurgery TI - Clipping for a partially thrombosed anterior communicating artery (ACOMA) aneurysm presenting with delayed visual loss after pipeline embolization device (PED) treatment-case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620956639&from=export http://dx.doi.org/10.1055/s-0037-1603885 VL - 78 ID - 760938 ER - TY - JOUR AB - Background Philadelphia chromosome negative myeloproliferative neoplasms (MPNs), including essential thrombocythemia, polycythemia vera, and myelofibrosis, have severe function-limiting symptom burden that is experienced by the majority of patients. Previous studies have suggested that depression may be present in over a quarter of MPN patients, but to date no studies have evaluated the relationship between depression and other variables such as symptoms. Methods A 70-item internet based survey regarding fatigue and mood symptoms was developed by a multidisciplinary team of MPN investigators, patients and patient advocates including Patient Health Questionnaire and the Myeloproliferative Neoplasm Symptom Assessment Form was completed by over 1300 patients with MPN diagnosis. Results There were 309 respondents (23%) with PHQ-2 scores >= 3. In this analysis, we found worse systemic symptom burden in individuals reporting depressive symptoms. Conclusion This analysis suggests the importance of depression in contributing to as well as confounding symptomatology in MPN patients, and suggests that this critical variable should also be addressed by clinicians and researchers alike when comprehensively assessing symptom burden etiologies. AD - [Padrnos, Leslie] Mayo Clin, Div Hematol & Med Oncol, Scottsdale, AZ USA. [Scherber, Robyn; Mesa, Ruben] UT Hlth San Antonio MD Anderson Canc Ctr, Dept Hematol & Oncol, Portland, OR USA. [Geyer, Holly] Mayo Clin, Div Hosp Med, Scottsdale, AZ USA. [Langlais, Blake T.; Dueck, Amylou C.; Kosiorek, Heidi E.] Mayo Clin, Div Biostat, Scottsdale, AZ USA. [Senyak, Zhenya; Cotter, Mary] MPN Res Fdn, MPN Forum, Chicago, IL USA. [Clark, Matthew] Mayo Clin, Dept Psychiat & Psychol, Rochester, MN USA. [Boxer, Michael] Arizona Oncol, Tucson, AZ USA. [Harrison, Claire] Guys & St Thomas NHS Fdn Trust, London, England. [Harrison, Claire] MPN Voice, London, England. [Stonnington, Cynthia; Geda, Yonas] Mayo Clin, Dept Psychiat & Psychol, Scottsdale, AZ USA. [Geda, Yonas] Arizona State Univ, Ctr Bioelect & Biosensors, Tempe, AZ USA. Padrnos, L (corresponding author), Mayo Clin, Div Hematol & Med Oncol, 5881 E Mayo Blvd, Phoenix, AZ 85054 USA. padrnos.leslie@mayo.edu AN - WOS:000572550400001 AU - Padrnos, L. AU - Scherber, R. AU - Geyer, H. AU - Langlais, B. T. AU - Dueck, A. C. AU - Kosiorek, H. E. AU - Senyak, Z. AU - Clark, M. AU - Boxer, M. AU - Cotter, M. AU - Harrison, C. AU - Stonnington, C. AU - Geda, Y. AU - Mesa, R. DO - 10.1002/cam4.3380 J2 - Cancer Med. KW - depression essential thrombocythemia myelofibrosis myeloproliferative neoplasm PHQ-2 polycythemia vera psychooncology quality of life QUALITY-OF-LIFE METAANALYSIS INFLAMMATION FATIGUE DISEASE Oncology LA - English M3 - Article; Early Access N1 - ISI Document Delivery No.: NS9BP Times Cited: 0 Cited Reference Count: 23 Padrnos, Leslie Scherber, Robyn Geyer, Holly Langlais, Blake T. Dueck, Amylou C. Kosiorek, Heidi E. Senyak, Zhenya Clark, Matthew Boxer, Michael Cotter, Mary Harrison, Claire Stonnington, Cynthia Geda, Yonas Mesa, Ruben Mayo Clinic P30 Grant Mayo Clinic P30 Grant. 0 WILEY HOBOKEN CANCER MED-US SN - 2045-7634 SP - 9 ST - Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition T2 - Cancer Medicine TI - Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition UR - ://WOS:000572550400001 ID - 761407 ER - TY - JOUR AB - BACKGROUND: Philadelphia chromosome negative myeloproliferative neoplasms (MPNs), including essential thrombocythemia, polycythemia vera, and myelofibrosis, have severe function-limiting symptom burden that is experienced by the majority of patients. Previous studies have suggested that depression may be present in over a quarter of MPN patients, but to date no studies have evaluated the relationship between depression and other variables such as symptoms. METHODS: A 70-item internet based survey regarding fatigue and mood symptoms was developed by a multidisciplinary team of MPN investigators, patients and patient advocates including Patient Health Questionnaire and the Myeloproliferative Neoplasm Symptom Assessment Form was completed by over 1300 patients with MPN diagnosis. RESULTS: There were 309 respondents (23%) with PHQ-2 scores ≥ 3. In this analysis, we found worse systemic symptom burden in individuals reporting depressive symptoms. CONCLUSION: This analysis suggests the importance of depression in contributing to as well as confounding symptomatology in MPN patients, and suggests that this critical variable should also be addressed by clinicians and researchers alike when comprehensively assessing symptom burden etiologies. AD - Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ, USA. Department of Hematology and Oncology, UT Health San Antonio MD Anderson Cancer Center, San Antonio, Portland, Texas, Oregon, USA. Division of Hospital Medicine, Mayo Clinic, Scottsdale, AZ, USA. Division of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA. MPN Forum, MPN Research Foundation, Chicago, IL, USA. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. Arizona Oncology, Tucson, AZ, USA. Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. MPN Voice, London, United Kingdom. Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, AZ, USA. Center for Bioelectronics and Biosensors, Arizona State University, Tempe, AZ, USA. AN - 32976697 AU - Padrnos, L. AU - Scherber, R. AU - Geyer, H. AU - Langlais, B. T. AU - Dueck, A. C. AU - Kosiorek, H. E. AU - Senyak, Z. AU - Clark, M. AU - Boxer, M. AU - Cotter, M. AU - Harrison, C. AU - Stonnington, C. AU - Geda, Y. AU - Mesa, R. DA - Sep 25 DO - 10.1002/cam4.3380 DP - NLM ET - 2020/09/26 J2 - Cancer medicine KW - Phq-2 depression essential thrombocythemia myelofibrosis myeloproliferative neoplasm polycythemia vera psychooncology quality of life LA - eng N1 - 2045-7634 Padrnos, Leslie Orcid: 0000-0002-1788-4944 Scherber, Robyn Geyer, Holly Langlais, Blake T Dueck, Amylou C Kosiorek, Heidi E Senyak, Zhenya Clark, Matthew Orcid: 0000-0003-3887-4419 Boxer, Michael Cotter, Mary Harrison, Claire Stonnington, Cynthia Geda, Yonas Mesa, Ruben Mayo Clinic P30 Grant/ Journal Article United States Cancer Med. 2020 Sep 25. doi: 10.1002/cam4.3380. PY - 2020 SN - 2045-7634 ST - Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition T2 - Cancer Med TI - Depressive symptoms and myeloproliferative neoplasms: Understanding the confounding factor in a complex condition ID - 760512 ER - TY - JOUR AB - Rationale Pulmonary embolism (PE) is the third most common cause of cardiovascular death in the United States. Due to scarcity of data in managing sub-massive and massive pulmonary embolism, clear guidelines do not exist. Diagnosis and management spans multiple disciplines and requires prompt and definitive management. Recent modalities such as catheter directed thrombolysis (CDT), systemic lysis, or surgical embolectomies have been used in an attempt to reduce mortality and morbidity. Multidisciplinary team based approaches have developed across the country to streamline patient care on a case-by-case basis to guide the management of submassive and massive PEs. Aim At the University Of Virginia Medical Center (UVAMC) we developed a PERT, based on previously established models at other institutions, to allow for quick identification of high risk PE patients, offer treatment guidelines, and provide long term care with the goal to improve mortality and morbidity. Methods We developed a protocol for new acute massive or sub-massive PEs. The PERT is activated, and cases are evaluated by the on-call physician via a multidisciplinary conference call and recommendations for further treatment are provided. Results 77 patients have been evaluated through the UVAMC by the PERT, 30-day mortality has been 12.9%, which is lower than the historical mortality at UVAMC of 18.9% that included all PEs. On presentation, sub-massive and massive PEs were seen in 84.4% and 11.6% with a 30-day mortality of 12% and 22% respectively, whereas epidemiological data reports mortality up to 15% and 50% respectively. 35% of our patients underwent therapies beyond anticoagulation which included CDT (n = 18), mechanical thrombectomy (n = 7), surgical embolectomy (n = 1) and extracorporeal membrane oxygenation (n = 1). In the CDT group, pulmonary systolic artery pressure (PASP) showed a 28% reduction on follow up echocardiograms. 60% of eligible patients had close follow up in an outpatient vascular or pulmonary hypertension clinic clinic, within 3 months of diagnosis for follow up of their PE. Conclusion A multidisciplinary team based approach in patients with acute PE at UVAMC shows improved patient outcome compared to historical data. This approach ensured that several patients had close follow up for their PE in an outpatient setting. There was also an improvement in PASP in a subset of patients who underwent CDT which may suggest that long term complications such as chronic thromboembolic pulmonary hypertension could be avoided in select high risk PE patients undergoing CDT. AD - K. Pal, Pulmonary and Critical Care, University of Virginia, Charlottesville, VA, United States AU - Pal, K. AU - Solanki, J. AU - Kadl, A. AU - Mihalek, A. D. AU - Mazimba, S. AU - Kennedy, J. AU - Haskal, Z. AU - Angle, J. AU - Ailawadi, G. AU - Norton, P. T. AU - Hagspiel, K. D. AU - Burt, D. AU - Sharma, A. DB - Embase KW - adult anticoagulation arterial pressure catheter chronic thromboembolic pulmonary hypertension complication conference abstract diagnosis echocardiography extracorporeal oxygenation female follow up human lung embolism major clinical study male mechanical thrombectomy morbidity mortality outpatient patient care physician practice guideline risk assessment surgery LA - English M1 - MeetingAbstracts M3 - Conference Abstract N1 - L622969977 2018-07-16 PY - 2018 SN - 1535-4970 ST - The use of a pulmonary embolism response team (PERT) at University of Virginia Medical Center to improve patient outcomes T2 - American Journal of Respiratory and Critical Care Medicine TI - The use of a pulmonary embolism response team (PERT) at University of Virginia Medical Center to improve patient outcomes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622969977&from=export VL - 197 ID - 760873 ER - TY - JOUR AB - Background: In the last ten years the availability of new biological agents introduced deep changes in the global therapeutic approach to metastatic renal cell carcinoma (mRCC). Specifically, the use of tyrosine kinase inhibitors as 1st or 2nd line treatment allows to obtain significant responses with globally manageable toxicities. We have now time and opportunities to plan an 'up-front' sequential strategy approach with several drugs and, in the good-prognosis oligo-metastatic disease, integrate the medical treatment within a network of expertise in order to achieve the best possible response. Patients and Methods: We report updated outcome of 35 consecutive metastatic renal cell carcinoma (mRCC) patients (pts) treated at our Institution with sunitinib (scheduling: 50 mg/day, 4 week on/2 off) in 1st (29 pts) 2nd (6 pts) line therapy from 2006. There were 21 males and 15 females, median age 54 years (range 48-80); the most represented metastatic sites were bone (23%), liver (26%), lung (34%), nodes (11%). Histologic subtype was clear cell carcinoma in 80%, papillary carcinoma in 12 and chromophobe in 2. Median time on treatment for all patients was 28 months (range 12-61). Overall survival (OS) and progression-free-survival (PFS) were measured from initial administration of sunitinib until death for any cause or documented disease progression, respectively. With OS data updated at December 1, 2011, the median follow-up was 36 months (range 12-61), OS and TTP were calculated according to the Kaplan-Meyer method. Univariate and multivariate analysis (Log-rank test and Cox proportional hazards model) were performed to identify factors potentially associated with the clinical outcome. Quality of life (QoL) was assessed by FACT-G score every 2 cycles of therapy. Results: Twelve partial responses (34%) and 18 stable diseases (51%) lasting >3 months were observed by RECIST criteria, for an overall global clinical benefit of 85%. Treatment-related toxicities were expected and were globally manageable: fatigue (42%), thrombocytopenia (25%), hand foot syndrome (15%), macrocytic anemia (10%) hypertension (8%) and neutropenia (5%). Hypothyroidism took place in 21 pts (60%) and was treated, when symptomatic, with levothyroxine. Dose reduction and/or scheduling modifications were performed, modulating Sunitinib treatment on toxicity degree and patient's compliance over treatment. QoL analysis showed no significant deterioration of the evaluated items. Fifteen patients (9M, 6F) with PR or SD underwent integrated locoregional procedures aiming to optimize the obtained response: thermal ablation for liver metastases in 6 patients, embolization of bone metastases in 5, stereotaxic radiosurgery on lung and brain lesions in 4; 13 of these patients are alive and disease-free at a median of 14 months from the locoregional procedure, 2 are alive with progressive disease, in 2nd line treatment for metastatic disease. Conclusion: Our data support the modern global, integrated approach to mRCC, in which the expertise of a multidisciplinary team (urologist, radiotherapist, interventional radiologist, oncologist) allows the patients 'good responders' following an active medical therapy to achieve the best outcome in terms of PFS, QoL and also OS. Another key point of our work is the possibility to modulate sunitinib doses/schedules in the different disease stages, with an easier management of the adverse events and the preservation of a good adherence to long-term therapy, without affecting the drug efficacy. An important endpoint in the global management of the patient with RCC is the achievement of long-lasting disease responses, in view of a sequential and integrated approach with the utilization of the new biological treatments available also in treatment lines following the first. AD - R. Palumbo, Oncologia Medica II, Fondazione Maugeri, IRCCS, Pavia, Italy AU - Palumbo, R. AU - Sottotetti, F. AU - Pozzi, E. AU - Tagliaferri, B. AU - Teragni, C. AU - Bernardo, A. DB - Embase KW - sunitinib biological product protein tyrosine kinase inhibitor levothyroxine kidney metastasis quality of life society oncology human patient therapy toxicity procedures metastasis lung male preservation proportional hazards model bone liver log rank test artificial embolization multivariate analysis liver metastasis follow up bone metastasis stereotactic radiosurgery brain damage urologist long term care drug efficacy diseases fatigue deterioration drug dose reduction disease course death female progression free survival hypothyroidism overall survival neutropenia prognosis hypertension papillary carcinoma macrocytic anemia hand foot syndrome clear cell carcinoma thrombocytopenia radiologist achievement patient compliance L1 - http://ar.iiarjournals.org/content/32/5/1843.full.pdf+html LA - English M1 - 5 M3 - Conference Abstract N1 - L71051044 2013-05-10 PY - 2012 SN - 0250-7005 SP - 1960 ST - The importance of integrated multidisciplinary strategy in the therapeutic approach to metastatic renal cell carcinoma: Impact on outcome and quality of life-a prospective monoinstitutional experience T2 - Anticancer Research TI - The importance of integrated multidisciplinary strategy in the therapeutic approach to metastatic renal cell carcinoma: Impact on outcome and quality of life-a prospective monoinstitutional experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71051044&from=export VL - 32 ID - 761205 ER - TY - JOUR AB - OBJECTIVEVenous thromboembolism (VTE) is a major cause of morbidity in patients undergoing neurosurgical intervention. The authors postulate that the introduction of a routine preoperative deep vein thrombosis (DVT) screening protocol for patients undergoing neurosurgical intervention for brain tumors would result in a more effective diagnosis of DVT in this high-risk subgroup, and subsequent appropriate management of the condition would reduce pulmonary embolism (PE) rates and improve patient outcomes.METHODSThe authors conducted a prospective study of 115 adult patients who were undergoing surgical intervention for a brain tumor. All patients underwent preoperative lower-limb Doppler ultrasonography scanning for DVT screening. Patients with confirmed DVT underwent a period of anticoagulation therapy, which was stopped prior to surgery. An inferior vena cava (IVC) filter was inserted to cover the perioperative period during which anticoagulation therapy was avoided due to bleeding risk before restarting the therapy at a later date. Patients underwent follow-up performed by a neurooncology multidisciplinary team, and subsequent complications and outcomes were recorded.RESULTSSeven (6%) of the 115 screened patients had DVT. Of these patients, one developed postoperative PE, and another had bilateral DVT postoperatively. None of the patients without preoperative DVT developed VTE postoperatively. Age, symptoms of DVT, and previous history of VTE were significantly higher in the group with preoperative DVT. There were no deaths and no complications from the anticoagulation or IVC filter insertion.CONCLUSIONSPreoperative screening for DVT is a worthwhile endeavor in patients undergoing neurosurgical intervention. A multidisciplinary approach in management of anticoagulation and IVC filter insertion is safe and can minimize further VTE in such patients. AD - Departments of1Neurosurgery and. 2Haematology, King's College Hospital, London, United Kingdom. AN - 29498571 AU - Pandey, A. AU - Thakur, B. AU - Hogg, F. AU - Brogna, C. AU - Logan, J. AU - Arya, R. AU - Gullan, R. AU - Bhangoo, R. AU - Ashkan, K. DA - Mar 2 DO - 10.3171/2017.9.jns17176 DP - NLM ET - 2018/03/03 J2 - Journal of neurosurgery KW - Adult Aged Anticoagulants/therapeutic use Brain Neoplasms/complications/diagnostic imaging/*surgery Female Humans Male Middle Aged Postoperative Complications/etiology/*prevention & control *Preoperative Care Prospective Studies Ultrasonography, Doppler Vena Cava Filters Venous Thromboembolism/etiology/*prevention & control Venous Thrombosis/complications/*diagnostic imaging *CCI = Charlson Comorbidity Index *DVT = deep vein thrombosis *IVC = inferior vena cava *MDT = multidisciplinary team *PE = pulmonary embolism *VTE = venous thromboembolism *brain tumor *deep vein thrombosis *neurooncology *oncology *pulmonary embolus *screening LA - eng M1 - 1 N1 - 1933-0693 Pandey, Anmol Thakur, Bhaskar Hogg, Florence Brogna, Christian Logan, Jamie Arya, Roopen Gullan, Richard Bhangoo, Ranjeev Ashkan, Keyoumars Journal Article United States J Neurosurg. 2018 Mar 2;130(1):38-43. doi: 10.3171/2017.9.JNS17176. PY - 2018 SN - 0022-3085 SP - 38-43 ST - The role of preoperative deep vein thrombosis screening in neurooncology T2 - J Neurosurg TI - The role of preoperative deep vein thrombosis screening in neurooncology VL - 130 ID - 760236 ER - TY - JOUR AB - OBJECTIVE Venous thromboembolism (VTE) is a major cause of morbidity in patients undergoing neurosurgical intervention. The authors postulate that the introduction of a routine preoperative deep vein thrombosis (DVT) screening protocol for patients undergoing neurosurgical intervention for brain tumors would result in a more effective diagnosis of DVT in this high-risk subgroup, and subsequent appropriate management of the condition would reduce pulmonary embolism (PE) rates and improve patient outcomes. METHODS The authors conducted a prospective study of 115 adult patients who were undergoing surgical intervention for a brain tumor. All patients underwent preoperative lower-limb Doppler ultrasonography scanning for DVT screening. Patients with confirmed DVT underwent a period of anticoagulation therapy, which was stopped prior to surgery. An inferior vena cava (IVC) filter was inserted to cover the perioperative period during which anticoagulation therapy was avoided due to bleeding risk before restarting the therapy at a later date. Patients underwent follow-up performed by a neurooncology multidisciplinary team, and subsequent complications and outcomes were recorded. RESULTS Seven (6%) of the 115 screened patients had DVT. Of these patients, one developed postoperative PE, and another had bilateral DVT postoperatively. None of the patients without preoperative DVT developed VTE postoperatively. Age, symptoms of DVT, and previous history of VTE were significantly higher in the group with preoperative DVT. There were no deaths and no complications from the anticoagulation or IVC filter insertion. CONCLUSIONS Preoperative screening for DVT is a worthwhile endeavor in patients undergoing neurosurgical intervention. A multidisciplinary approach in management of anticoagulation and IVC filter insertion is safe and can minimize further VTE in such patients. AD - A. Pandey, King’s College London, GKT School of Medical Education, London, United Kingdom AU - Pandey, A. AU - Thakur, B. AU - Hogg, F. AU - Brogna, C. AU - Logan, J. AU - Arya, R. AU - Gullan, R. AU - Bhangoo, R. AU - Ashkan, K. DB - Embase Medline DO - 10.3171/2017.9.JNS17176 KW - adult aged anticoagulant therapy anticoagulation article brain metastasis brain ventriculitis cancer patient Charlson Comorbidity Index comorbidity comorbidity assessment computer assisted tomography deep vein thrombosis Doppler ultrasonography erythema female follow up glioblastoma human inferior cava vein leg swelling lung embolism major clinical study male medical history medical record melanoma meningioma morbidity oligodendroglioma perioperative period postoperative complication preoperative period priority journal prospective study screening test surgical patient treatment outcome LA - English M1 - 1 M3 - Article N1 - L2001869476 2019-05-14 2019-10-23 PY - 2019 SN - 1933-0693 0022-3085 SP - 38-43 ST - The role of preoperative deep vein thrombosis screening in neurooncology T2 - Journal of Neurosurgery TI - The role of preoperative deep vein thrombosis screening in neurooncology UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001869476&from=export http://dx.doi.org/10.3171/2017.9.JNS17176 VL - 130 ID - 760760 ER - TY - JOUR AB - Background: Primary pancreatic leiomyosarcoma is an extremely rare entity that needs high clinical suspicion in order to diagnose it at an early stage. Clinical characteristics, diagnosis, and management still remain challenging and controversial, especially in advanced stages, when tumor invades adjacent vessels and organs or gives distant metastases. Case presentation: Herein, we describe a case of a 57-year-old woman suffering from advanced pancreatic leiomyosarcoma with thrombosis of the superior mesenteric vein, as well as liver lesions which were suspicious for metastasis. Multidisciplinary team decided for upfront chemotherapy to assess tumor response. Follow-up imaging after the completion of chemotherapy led tumor board to decide for subsequent surgical exploration. The patient underwent exploratory laparotomy and irreversible electroporation ablation of the pancreatic tumor. Postoperative course was uneventful, and she was discharged 10 days later with a plan to receive adjuvant therapy. To the best of our knowledge, this is the first case of pancreatic leiomyosarcoma ever reported, treated with this novel technique of irreversible electroporation that could be an alternative and feasible way for the management of these rare malignancies. Conclusions: In conclusion, primary pancreatic leiomyosarcoma is a rare and highly malignant tumor associated with poor prognosis. Nowadays, R0 surgical resection remains the cornerstone treatment, combined with adjuvant and/or neoadjuvant chemotherapy prior to resection. In the advanced setting, when major vessel invasion and distant metastases occur, chemotherapy along with irreversible electroporation ablation could be a helpful and possibly effective modality for the management of this highly aggressive tumor. AD - M.G. Vailas, 1st Surgical Department, Athens University, School of Medicine, Agiou Thoma 17, Athens, Greece AU - Papalampros, A. AU - Vailas, M. G. AU - Deladetsima, I. AU - Moris, D. AU - Sotiropoulou, M. AU - Syllaios, A. AU - Petrou, A. AU - Felekouras, E. DB - Embase Medline DO - 10.1186/s12957-018-1553-9 KW - docetaxel gemcitabine adult advanced cancer article cancer adjuvant therapy cancer prognosis case report clinical article clinical feature computer assisted tomography distant metastasis drug effect female follow up histopathology human human tissue irreversible electroporation laparotomy mesenteric vein thrombosis middle aged nuclear magnetic resonance imaging pancreas cancer pancreatic leiomyosarcoma postoperative care primary tumor treatment planning LA - English M1 - 1 M3 - Article N1 - L625757182 2019-01-23 2019-02-04 PY - 2019 SN - 1477-7819 ST - Irreversible electroporation in a case of pancreatic leiomyosarcoma: A novel weapon versus a rare malignancy? 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis 11 Medical and Health Sciences 1103 Clinical Sciences T2 - World Journal of Surgical Oncology TI - Irreversible electroporation in a case of pancreatic leiomyosarcoma: A novel weapon versus a rare malignancy? 11 Medical and Health Sciences 1112 Oncology and Carcinogenesis 11 Medical and Health Sciences 1103 Clinical Sciences UR - https://www.embase.com/search/results?subaction=viewrecord&id=L625757182&from=export http://dx.doi.org/10.1186/s12957-018-1553-9 VL - 17 ID - 760755 ER - TY - JOUR AB - Background: Graft loss requiring retransplantation (re-LT) occurs in 10-19% of liver transplant (LT) recipients. The most common indications are chronic rejection (CR), hepatic artery thrombosis (HAT) and biliary complications and in adults, recurrence of the primary disease, whereas primary graft failure is more prevalent for those requiring early re-LT. Inferior outcomes are associated with re-LT. Late graft loss (>1year) is more common in young people (YP) aged 12-25 years, suggesting that non-adherence to treatment could play a role. Methods: Retrospective review of children and YP (0-25yrs) developing late graft loss (>1year) following LT between 1984-2011. Results: Twelve percent (142/1207) of children and YP required re-LT during the study period with 84 (M36, 7%) suffering late graft loss after a median time of 8.3 (IQR 3.1-11.5) years post LT and they underwent re-LT at a median age of 17.5 (IQR 12.2-25.9) years. Biliary atresia was the most common indication for primary LT in 30% and 23% presented with acute liver failure. Leading indications for re-LT were CR (39%), HAT (20%) and biliary complications (10%). Overall 62% survived a median time of 8.2 (IQR 4.3-13.1) years with 1,5, 10 and 15 years patient and graft survival 75%,65%,63%,47% and 73%,58%,54%,36% respectively. Patient survival was inferior for those who had re-LT >16yrs (n=50) compared to the younger patients (24% vs 50%, p<0.05) with shorter follow-up (3.6 vs 7.2 years, p<0.05) and longer duration of graft survival prior to re-LT (9.9 vs 5.9 years, p<0.05) with no difference for gender, age and presentation at 1st LT and indication for re-LT. Nine (11%) required further LT, 4 greater than 1 year post previous LT. Supervision/management by the Transition service (n=16) was protective; patient survival (87% vs 56%, p<0.05), with no difference for duration of graft survival prior to re-LT or follow up. Conclusion: Late graft loss occurred in 59% of children and YP with the majority aged over 16 years (60%) at the time of re-LT. CR was the most common indication for re-LT. Being >16 years at time of re-LT was associated with inferior survival. Transition services and support from a multidisciplinary team was protective. YP and young adults in particular are at risk of late graft loss post LT and need specialist care in order to improve outcome. AD - S. Paranahewa, Hepatology, King's College Hospital NHS Foundation Trust, London, United Kingdom AU - Paranahewa, S. AU - Joshi, D. AU - Day, J. AU - McKie, P. AU - Heaton, N. AU - Heneghan, M. A. AU - Dhawan, A. AU - Samyn, M. AU - Patel, N. DB - Embase DO - 10.1002/hep.30257 KW - acute liver failure adolescent adult bile duct atresia child chronic graft rejection clinical article complication conference abstract controlled study female follow up gender graft failure graft survival hepatic artery thrombosis human male multidisciplinary team overall survival patient history of liver transplantation retransplantation retrospective study school child young adult LA - English M3 - Conference Abstract N1 - L624565663 2018-10-30 PY - 2018 SN - 1527-3350 SP - 675A ST - Late graft loss in children and young people post liver transplantation: The importance of transition services T2 - Hepatology TI - Late graft loss in children and young people post liver transplantation: The importance of transition services UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624565663&from=export http://dx.doi.org/10.1002/hep.30257 VL - 68 ID - 760795 ER - TY - JOUR AB - Purpose: The purpose of the study was to evaluate the outcomes for wedge resection (WR), WR plus brachytherapy (WRB), or stereotactic body radiation therapy (SBRT) for early stage non-small lung cancer. Methods and Materials: Retrospectively collected data of patients treated with WR, WRB, or SBRT (1993-2012). Cesium-131 (Cs131) used in WRB group in patients with close or positive margins based on surgical assessment. Kaplan-Meier survival analysis, log-rank test used to compare disease-free survival/overall survival between different groups. Multivariable analysis, using Cox proportional hazards regression analysis, was performed to evaluate the independent effect of age, gender, and treatment procedure on disease-free survival. Results: A total of 272 patients were included in the study (123 WR, 52 WR+Cs-131, 97 SBRT). Cs-131 was used with WRs that the surgeons deemed high risk. Local control (LC) was similar in the three groups and was achieved in 92.2% for WR group vs. 96.2% for WR+Cs-131 and 95.5% for SBRT (p = 0.60). On multivariate analysis, although females showed a higher LC, neither LC nor distant metastasis were associated with age or gender (p = 0.65 and p = 0.41, respectively). Five-year overall survival was 100% in the WR+B group, 97.7% in the WR group, and 89.6% in the SBRT group (p = 0.02). Toxicity was similar in the three groups. Conclusion: WR, WR+ Cs-131, or SBRT are all excellent treatment options for patients with early stage non-small cell lung cancer that are not candidates for lobectomy. For high risk WRs, we favor use of Cesim-131 brachytherapy. Until a prospective randomized comparative study is done to evaluate the best treatment approach for early stage NSCLC, treatment selection should be based on a multidisciplinary team approach. AD - B. Parashar, Department of Radiation Oncology, Weill Cornell Medical Center, New York, NY, United States AU - Parashar, B. AU - Port, J. AU - Arora, S. AU - Christos, P. AU - Trichter, S. AU - Nori, D. AU - Wernicke, A. G. DB - Embase Medline DO - 10.1016/j.brachy.2015.04.001 KW - cesium 131 adult adverse outcome article brachytherapy brachytherapy implant cancer control cancer prognosis cancer radiotherapy comparative study computer assisted tomography disease free survival distant metastasis fatigue female follow up high risk patient histology human Kaplan Meier method lung adenocarcinoma lung cancer lung embolism lung surgery major clinical study male morbidity non small cell lung cancer overall survival pneumonia postoperative complication priority journal radiation dose radiation pneumonia retrospective study sex difference small cell lung cancer squamous cell lung carcinoma stereotactic body radiation therapy surgical technique thorax pain treatment outcome wedge resection LA - English M1 - 5 M3 - Article N1 - L604469613 2015-05-27 2015-09-08 PY - 2015 SN - 1873-1449 1538-4721 SP - 648-654 ST - Analysis of stereotactic radiation vs. wedge resection vs. wedge resection plus Cesium-131 brachytherapy in early stage lung cancer T2 - Brachytherapy TI - Analysis of stereotactic radiation vs. wedge resection vs. wedge resection plus Cesium-131 brachytherapy in early stage lung cancer UR - https://www.embase.com/search/results?subaction=viewrecord&id=L604469613&from=export http://dx.doi.org/10.1016/j.brachy.2015.04.001 VL - 14 ID - 761060 ER - TY - JOUR AB - Background: Borderline personality disorder (BPD) is a serious mental disorder commonly associated with functional impairments and adverse health outcomes. Very little is known about BPD in pregnant women; hence, our study objective was to evaluate the effect of BPD on obstetrical and neonatal outcomes. Methods: We carried out a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample from 2003 to 2012. We identified births using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic and procedure codes and classified women by BPD status. Multivariate logistic regression was used to evaluate the effect of BPD on obstetrical and neonatal outcomes, adjusted for subject baseline characteristics. Findings: During the study period, there were 989 births to women with BPD with an overall incidence of 11.65 in 100,000 births. Women with BPD were more likely younger, of lower socioeconomic status, smoked or used drugs, and had an underlying mental disorder. Unadjusted models revealed that BPD was associated with an increased risk of almost all adverse maternal and fetal outcomes we examined, the exception being post partum hemorrhage and instrumental delivery, which both had a null association with BPD, and induction of labor, which was negatively associated with BPD. Upon full adjustment, BPD was found to be associated with the following obstetrical and neonatal outcomes: gestational diabetes (odds ratio [OR], 1.45; 95% CI, 1.13-1.85), premature rupture of the membranes (OR, 1.40; 95% CI, 1.07-1.83), chorioamnionitis (OR, 1.65; 95% CI, 1.14-2.39), venous thromboembolism (OR, 2.11; 95% CI, 1.12-3.96), caesarian delivery (OR, 1.44; 95% CI, 1.26-1.64), and preterm birth (OR, 1.54; 95% CI, 1.29-1.83). Conclusion: BPD is associated with several adverse obstetrical and neonatal outcomes. Hence, pregnant women who suffer from BPD should be monitored closely by a multidisciplinary health care team both before and during their pregnancies. This oversight would allow for the receipt of treatment for BPD and also interventions to help them to cease tobacco and drug use, which may ultimately decrease the incidence of poor obstetrical and neonatal outcomes. Copyright (C) 2016 by the Jacobs Institute of Women's Health. Published by Elsevier Inc. AD - [Pare-Miron, Valerie; Abenhaim, Haim Arie] McGill Univ, Jewish Gen Hosp, Dept Obstet & Gynecol, Pav H,Room 325 5790 Cote Des Neiges Rd, Montreal, PQ H3S 1Y9, Canada. [Czuzoj-Shulman, Nicholas; Oddy, Lisa; Spence, Andrea R.; Abenhaim, Haim Arie] McGill Univ, Jewish Gen Hosp, Ctr Clin Epidemiol & Community Studies, Montreal, PQ H3T 1E2, Canada. Abenhaim, HA (corresponding author), McGill Univ, Jewish Gen Hosp, Dept Obstet & Gynecol, Pav H,Room 325 5790 Cote Des Neiges Rd, Montreal, PQ H3S 1Y9, Canada. haim.abenhaim@gmail.com AN - WOS:000375058000009 AU - Pare-Miron, V. AU - Czuzoj-Shulman, N. AU - Oddy, L. AU - Spence, A. R. AU - Abenhaim, H. A. DA - Mar-Apr DO - 10.1016/j.whi.2015.11.001 J2 - Womens Health Iss. KW - SEVERE MENTAL-ILLNESS MATERNAL SMOKING PREGNANCY WOMEN RISK COMORBIDITY COHORT ASSOCIATIONS CHILDBIRTH DELIVERY Public, Environmental & Occupational Health Women's Studies LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: DK6TJ Times Cited: 9 Cited Reference Count: 40 Pare-Miron, Valerie Czuzoj-Shulman, Nicholas Oddy, Lisa Spence, Andrea R. Abenhaim, Haim Arie 9 0 6 ELSEVIER SCIENCE INC NEW YORK WOMEN HEALTH ISS PY - 2016 SN - 1049-3867 SP - 190-195 ST - Effect of Borderline Personality Disorder on Obstetrical and Neonatal Outcomes T2 - Womens Health Issues TI - Effect of Borderline Personality Disorder on Obstetrical and Neonatal Outcomes UR - ://WOS:000375058000009 VL - 26 ID - 761714 ER - TY - CHAP A2 - Adam, M. P. A2 - Ardinger, H. H. A2 - Pagon, R. A. A2 - Wallace, S. E. A2 - Bean, L. J. H. A2 - Stephens, K. A2 - Amemiya, A. AB - CLINICAL CHARACTERISTICS: Gaucher disease (GD) encompasses a continuum of clinical findings from a perinatal lethal disorder to an asymptomatic type. The identification of three major clinical types (1, 2, and 3) and two other subtypes (perinatal-lethal and cardiovascular) is useful in determining prognosis and management. GD type 1 is characterized by the presence of clinical or radiographic evidence of bone disease (osteopenia, focal lytic or sclerotic lesions, and osteonecrosis), hepatosplenomegaly, anemia and thrombocytopenia, lung disease, and the absence of primary central nervous system disease. GD types 2 and 3 are characterized by the presence of primary neurologic disease; in the past, they were distinguished by age of onset and rate of disease progression, but these distinctions are not absolute. Disease with onset before age two years, limited psychomotor development, and a rapidly progressive course with death by age two to four years is classified as GD type 2. Individuals with GD type 3 may have onset before age two years, but often have a more slowly progressive course, with survival into the third or fourth decade. The perinatal-lethal form is associated with ichthyosiform or collodion skin abnormalities or with nonimmune hydrops fetalis. The cardiovascular form is characterized by calcification of the aortic and mitral valves, mild splenomegaly, corneal opacities, and supranuclear ophthalmoplegia. Cardiopulmonary complications have been described with all the clinical subtypes, although varying in frequency and severity. DIAGNOSIS/TESTING: The diagnosis of GD relies on demonstration of deficient glucocerebrosidase (glucosylceramidase) enzyme activity in peripheral blood leukocytes or other nucleated cells or by the identification of biallelic pathogenic variants in GBA. Note: The amino acid numbering for glucocerebrosidase used in this GeneReview follows the HGVS-recommended nomenclature, which includes the first 39 amino acids, and differs from the traditional numbering system, which does not include the first 39 amino acids. Using the HGVS-recommended nomenclature, the pathogenic variant p.Asn370Ser is named p.Asn409Ser and the pathogenic variant p.Leu444Pro is named p.Leu483Pro. MANAGEMENT: Treatment of manifestations: When possible, management by a multidisciplinary team at a Comprehensive Gaucher Center. For persons not receiving enzyme replacement therapy (ERT) or substrate reduction therapy (SRT), symptomatic treatment includes partial or total splenectomy for massive splenomegaly and thrombocytopenia. Supportive care for all affected individuals may include: transfusion of blood products for severe anemia and bleeding; analgesics for bone pain; joint replacement surgery for relief from chronic pain and restoration of function; and anti-bone resorptive agents, calcium, and vitamin D for osteoporosis. Prevention of primary manifestations: ERT is usually well tolerated and provides sufficient exogenous enzyme to overcome the block in the catabolic pathway, clearing the stored substrate, GL1, and thus reversing hematologic and liver/spleen involvement. Although bone marrow transplantation (BMT) had been undertaken in individuals with severe GD, primarily those with chronic neurologic involvement (GD type 3), this procedure has been largely superseded by ERT or SRT. Miglustat may be indicated in symptomatic individuals with GD type 1 who are not able to receive ERT. Eliglustat has been shown to improve or stabilize key disease features in those naïve to or switched from enzyme replacement therapy. Prevention of secondary complications: The use of anticoagulants in individuals with severe thrombocytopenia and/or coagulopathy should be discussed with a hematologist to avoid the possibility of excessive bleeding. Surveillance: Recommendations for comprehensive serial monitoring have been published by the International Collaborative Gaucher Group Registry (ICGG) and other groups. Agents/circumstances to avoid: Nonsteroidal anti-inflammatory drugs in individuals with moderate to severe thrombocytopenia. Evaluation of relatives at risk: It is appropriate to offer testing to asymptomatic at-risk relatives so that those with glucocerebrosidase enzyme deficiency or biallelic pathogenic variants can benefit from early diagnosis and treatment if indicated. Pregnancy management: Pregnancy can exacerbate preexisting symptoms and trigger new features in affected women. Those with severe thrombocytopenia and/or clotting abnormalities are at increased risk for bleeding around the time of delivery. Evaluation by a hematologist prior to delivery is recommended. The lack of studies on the safety of eliglustat use during pregnancy and lactation has led to the recommendation that this medication be avoided during pregnancy, if possible. GENETIC COUNSELING: Gaucher disease (GD) is inherited in an autosomal recessive manner. At conception, each sib of an affected individual has a 25% chance of being affected, a 50% chance of being an asymptomatic carrier, and a 25% chance of being unaffected and not a carrier. Targeted analysis for pathogenic variants can be used to detect carriers in high-risk populations (e.g., Ashkenazi Jewish persons). Because the carrier frequency for GD in certain populations is high (e.g., 1:18 in individuals of Ashkenazi Jewish heritage) and the p.[Asn409Ser;Asn409Ser] phenotype is variable, individuals who undergo carrier testing may be identified as being homozygous. Prenatal testing for pregnancies at increased risk is possible using molecular genetic testing when both pathogenic variants in a family are known – or assay of glucocerebrosidase enzymatic activity if only one or neither pathogenic variant in the family is known. AD - Clinical Professor, Medicine (Genetics), University College, Dublin, Ireland Senior Lecturer in Haematology, Department of Academic Haematology, Royal Free and University College Medical School, London, United Kingdom AN - 20301446 AU - Pastores, G. M. AU - Hughes, D. A. CY - Seattle (WA) LA - eng N1 - Adam, Margaret P Ardinger, Holly H Pagon, Roberta A Wallace, Stephanie E Bean, Lora JH Stephens, Karen Amemiya, Anne Pastores, Gregory M Hughes, Derralynn A Review Book Chapter NBK1269 [bookaccession] PB - University of Washington, Seattle Copyright © 1993-2020, University of Washington, Seattle. GeneReviews is a registered trademark of the University of Washington, Seattle. All rights reserved. PY - 1993 ST - Gaucher Disease T2 - GeneReviews(®) TI - Gaucher Disease ID - 760221 ER - TY - JOUR AB - Some 3 million people in the United States have atrial fibrillation (AF). Without thromboprophylaxis, AF increases overall stroke risk 5-fold. Prevention is paramount as AF-related strokes tend to be severe. Thromboprophylaxis reduces the annual incidence of stroke in AF patients by 22%-62%. However, antithrombotics are prescribed for only about half of appropriate AF patients. The study team estimates the economic implications for Medicare of fewer stroke events resulting from increased thromboprophylaxis among moderate-to high-risk AF patients. The decision model used considers both reduced stroke and increased bleeding risk from thromboprophylaxis for a hypothetical cohort on no thromboprophylaxis (45%), antiplatelets (10%), and anticoagulation (45%). AF prevalence, stroke risk, and stroke risk reduction are adjusted for age, comorbidities, and anticoagulation/antiplatelet status. Health care costs are literature based. At baseline, an estimated 24,677 ischemic strokes, 9127 hemorrhagic strokes, and 9550 bleeding events generate approximately $2.63 billion in annual event-related health care costs to Medicare for every million AF patients eligible for thromboprophylaxis. A 10% increase in anticoagulant use in the untreated population would reduce stroke events by 9%, reduce stroke fatalities by 9%, increase bleed events by 5%, and reduce annual stroke/bleed-related costs to Medicare by about $187 million (7.1%) for every million eligible AF patients. A modest 10% increase in the use of thromboprophylaxis would reduce event-related costs to Medicare by 7.1%, suggesting a compelling economic motivation to improve rates of appropriate thromboprophylaxis. New oral anticoagulants offering better balance between the risks of stroke and major bleeding events may improve these clinical and economic outcomes. AD - [Patel, Aarti A.; Veerman, Mark; Mody, Samir H.; Nelson, Winnie W.] Janssen Sci Affairs LLC, Raritan, NJ USA. [Ogden, Kristine] Oxford Outcomes, San Francisco, CA USA. [Neil, Nancy] Chordata Consulting LLC, Seattle, WA USA. [Neil, Nancy] Univ Washington, Seattle, WA 98195 USA. Neil, N (corresponding author), Chordata Consulting LLC, 4809 Osprey Dr NE, Tacoma, WA 98422 USA. nneil@chordataconsulting.com AN - WOS:000337223600005 AU - Patel, A. A. AU - Ogden, K. AU - Veerman, M. AU - Mody, S. H. AU - Nelson, W. W. AU - Neil, N. DA - Jun DO - 10.1089/pop.2013.0056 J2 - Popul. Health Manag. KW - ANTITHROMBOTIC THERAPY PREVENT STROKE RISK-FACTORS ANTICOAGULATION WARFARIN PREVALENCE OUTCOMES Health Care Sciences & Services LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: AI9BZ Times Cited: 3 Cited Reference Count: 25 Patel, Aarti A. Ogden, Kristine Veerman, Mark Mody, Samir H. Nelson, Winnie W. Neil, Nancy 3 0 1 MARY ANN LIEBERT, INC NEW ROCHELLE POPUL HEALTH MANAG PY - 2014 SN - 1942-7891 SP - 159-165 ST - The Economic Burden to Medicare of Stroke Events in Atrial Fibrillation Populations With and Without Thromboprophylaxis T2 - Population Health Management TI - The Economic Burden to Medicare of Stroke Events in Atrial Fibrillation Populations With and Without Thromboprophylaxis UR - ://WOS:000337223600005 VL - 17 ID - 761777 ER - TY - JOUR AB - A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, 'What is the optimal revascularization technique for isolated disease of the left anterior descending artery (LAD) in terms of patient survival, morbidity such as myocardial infarction (MI) and need for repeat target vessel revascularization: minimally invasive direct coronary artery bypass graft (MIDCAB) or percutaneous coronary intervention (PCI)?' Altogether 504 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. Outcome parameters that were used in the assessment include the incidence of major adverse cardiovascular or cerebral events (MACCEs), mortality and the rate of repeat target vessel revascularization. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. One meta-analysis showed no significant difference in terms of individual incidences of MI, stroke or mortality, but when considered as a composite MACCE outcome, this was found to be significantly lower in the MIDCAB group. Moreover, further meta-analytical data have revealed a 5-fold increase in the need for repeat revascularization with PCI, with some centres reporting rates of up to 34%. However, retrospective data have shown that average length of hospital stay was longer in the MIDCAB group (7.4 ± 3.2 vs 3.4 ± 3.5 days; P < 0.001). We conclude that there are obvious proven benefits with MIDCAB, namely in terms of a reduced need for repeat target vessel revascularization and incidence of MACCE, and one study has even shown that there is a long-term survival benefit in 'real-world' clinical practice. However, given that there is a lack of well-powered randomized controlled trial and long-term follow-up data to prove a mortality benefit in support of MIDCAB, patients requiring revascularization of isolated proximal LAD stenosis and being considered for percutaneous coronary intervention should be discussed in a multidisciplinary team setting prior to intervention. AD - Department of Cardiac Surgery, St. George's Hospital, London, UK. Department of Cardiac Surgery, St. George's Hospital, London, UK gopal.soppa@nhs.net. AN - 24667582 AU - Patel, A. J. AU - Yates, M. T. AU - Soppa, G. K. DA - Jul DO - 10.1093/icvts/ivu076 DP - NLM ET - 2014/03/29 J2 - Interactive cardiovascular and thoracic surgery KW - Aged Benchmarking *Coronary Artery Bypass/adverse effects/mortality Coronary Artery Disease/diagnosis/mortality/surgery/*therapy Evidence-Based Medicine Female Humans Male Minimally Invasive Surgical Procedures Patient Selection *Percutaneous Coronary Intervention/adverse effects/mortality Postoperative Complications/mortality/therapy Risk Assessment Risk Factors Time Factors Treatment Outcome Left anterior descending Minimally invasive direct coronary artery bypass graft Myocardial infarction Myocardial revascularization Percutaneous coronary intervention LA - eng M1 - 1 N1 - 1569-9285 Patel, Akshay J Yates, Martin T Soppa, Gopal K R Journal Article Review England Interact Cardiovasc Thorac Surg. 2014 Jul;19(1):144-8. doi: 10.1093/icvts/ivu076. Epub 2014 Mar 25. PY - 2014 SN - 1569-9285 SP - 144-8 ST - What is the optimal revascularization technique for isolated disease of the left anterior descending artery: minimally invasive direct coronary artery bypass or percutaneous coronary intervention? T2 - Interact Cardiovasc Thorac Surg TI - What is the optimal revascularization technique for isolated disease of the left anterior descending artery: minimally invasive direct coronary artery bypass or percutaneous coronary intervention? VL - 19 ID - 760382 ER - TY - JOUR AB - SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pulmonary embolism (PE) patients have been found to have an increased prevalence and incidence of atrial fibrillation (AF). Since PE patients with comorbid AF are at an increased risk of morbidity and mortality, developing a prediction model to understand this relationship is important. We sought to investigate the role of thrombotic biomarkers in risk stratifying patients who present with acute PE. METHODS: Study participants were enrolled for a Pulmonary Embolism Response Team (PERT) registry between March 2016 and March 2019 at a two-hospital health system. This cohort was divided into three groups: PE patients with a prior diagnosis of AF (n=8), PE patients with a subsequent diagnosis of AF (n=11), and PE patients who did not develop AF (n=71). Normal plasma controls from a commercial source were obtained (n=10; George King Bio-Medical, Inc., Overland Park, KS). Plasminogen activator inhibitor-1 (PAI-1), D-dimer, thrombin activatable fibrinolysis inhibitor antigen (TAFIa), alpha2-antiplasmin, factor XIIIa, microparticle, CRP, and tissue factor pathway inhibitor (TFPI) were profiled using the ELISA method. Kruskal Wallis ANOVA tests, Dunn’s multiple comparison tests, and Mann-Whitney U-tests were done using GraphPad Prism software. RESULTS: All biomarkers were significantly different between controls and PE patients (p<0.05). PAI-1, D-dimer, CRP, and TFPI were significantly increased in all three groups compared to controls (p<0.05). Alpha2-antiplasmin and factor XIIIa were significantly decreased in all three groups compared to controls (p<0.05). TFPI was significantly elevated in PE patients with a subsequent diagnosis of AF compared to PE patients who did not develop AF (157.71±19.03 vs. 129.01±9.35, p=0.04). CONCLUSIONS: Thrombotic biomarkers such as PAI-1, D-Dimer, CRP, TFPI, TAFIa, microparticle, alpha2-antiplasmin, and factor XIIIa may be helpful in indicating an acute PE episode. Elevated TFPI levels may be associated with an increased risk of developing AF after a PE. CLINICAL IMPLICATIONS: TFPI levels may be used to risk stratify PE patients. DISCLOSURES: No relevant relationships by Yevgeniy Brailovsky, source=Web Response No relevant relationships by Amir Darki, source=Web Response No relevant relationships by Iman Darwish, source=Web Response No relevant relationships by Jawed Fareed, source=Web Response No relevant relationships by Debra Hoppensteadt, source=Web Response No relevant relationships by Dimpi Patel, source=Web Response No relevant relationships by Mushabbar Syed, source=Web Response AU - Patel, D. AU - Darki, A. AU - Hoppensteadt, D. AU - Darwish, I. AU - Fareed, J. AU - Syed, M. AU - Brailovsky, Y. DB - Embase DO - 10.1016/j.chest.2020.08.150 KW - alpha 2 antiplasmin antigen biological marker blood clotting factor 13a D dimer endogenous compound plasminogen activator inhibitor 1 thrombin activatable fibrinolysis inhibitor tissue factor pathway inhibitor adult analysis of variance cohort analysis conference abstract controlled study data analysis software diagnosis enzyme linked immunosorbent assay female gene expression human human tissue major clinical study male morbidity mortality new-onset atrial fibrillation prediction prevalence protein expression protein fingerprinting pulmonary embolism response team rank sum test risk assessment thrombosis LA - English M1 - 4 M3 - Conference Abstract N1 - L2008025742 2020-10-16 PY - 2020 SN - 1931-3543 0012-3692 SP - A128 ST - BIOMARKER PROFILING IN PULMONARY EMBOLISM PATIENTS WITH PRE-EXISTING VS NEW-ONSET ATRIAL FIBRILLATION T2 - Chest TI - BIOMARKER PROFILING IN PULMONARY EMBOLISM PATIENTS WITH PRE-EXISTING VS NEW-ONSET ATRIAL FIBRILLATION UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008025742&from=export http://dx.doi.org/10.1016/j.chest.2020.08.150 VL - 158 ID - 760538 ER - TY - JOUR AB - Objective To assess the feasibility of endovascular repair of traumatic aortic injuries performed by interventional cardiologists in collaboration with cardiothoracic surgeons. Background Traumatic aortic injury (TAI) represents a significant cause of mortality in trauma patients. Endovascular techniques have recently come into play for the management of TAI and are usually performed by a multidisciplinary team consisting of a thoracic or vascular surgeon and/or interventional radiology. With extensive expertise in catheter-based interventions, interventional cardiologists may have a pivotal role in this important procedure. Methods From January 2009 to July 2011, we reviewed the TAI endovascular repair outcomes performed by a team of interventional cardiologists in collaboration with cardiothoracic surgery at our institution. The charts of these patients were reviewed to collect desired data, which included preoperative, procedural, and follow-up details. Results Twenty patients were identified in our series. Most of these patients developed TAI from motor vehicle accidents. Technical success for endovascular repair of TAI was achieved in all patients. Two patients developed endoleak, of which one patient required subsequent open repair. Two patients expired in the hospital from coexistent injuries. Conclusions Our series of endovascular repair for TAI performed by interventional cardiologists with the collaboration of cardiothoracic surgeons showed excellent outcomes. Our experience may give further insight in the collaborative role of interventional cardiology and cardiothoracic surgery for endovascular repair of TAI. (J Interven Cardiol 2013;26:77-83) © 2012, Wiley Periodicals, Inc. AD - J.F. Saucedo, Department of Internal Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd, WP#3010, Oklahoma City, OK 73104, United States AU - Patel, J. H. AU - Wayangankar, S. A. AU - Zacharias, S. AU - Stowell, D. AU - Saucedo, J. F. DB - Embase Medline DO - 10.1111/j.1540-8183.2012.00761.x KW - adult aged aortic trauma aortic surgery article cardiologist clinical article computed tomographic angiography endovascular repair feasibility study female follow up human male medical record review outcome assessment preoperative period priority journal surgeon thorax surgery traumatic aortic injury LA - English M1 - 1 M3 - Article N1 - L52205850 2012-09-15 2013-03-20 PY - 2013 SN - 0896-4327 1540-8183 SP - 77-83 ST - Endovascular repair of traumatic aortic injury: A novel arena in interventional cardiology T2 - Journal of Interventional Cardiology TI - Endovascular repair of traumatic aortic injury: A novel arena in interventional cardiology UR - https://www.embase.com/search/results?subaction=viewrecord&id=L52205850&from=export http://dx.doi.org/10.1111/j.1540-8183.2012.00761.x VL - 26 ID - 761176 ER - TY - JOUR AB - Introduction: Adequate triaging of patients presenting with acute pulmonary embolism (PE) is essential for appropriate treatment. Pulmonary embolism response teams (PERTs) are multidisciplinary response teams aimed at optimizing care delivery to PE patients. These teams have gained traction on a national scale. At our institution we have a PERT program to evaluate these patients. Given high amount of PE burden at our tertiary care community hospital, we observed significant over-utilization of resources. We modified PERT protocol to streamline the multidisciplinary care for intermediate and high-risk patients. This retrospective project is aimed to determine if our modified PERT protocol helps expediting care of PE patients and has any impact on outcome of these patients. Method: This retrospective cohort study was aimed to assess the quality of PERT care, with data collection period from December 25, 2016 through May, 10 2017. All PE patients were identified based on DRG codes. Patients were excluded if PE was not diagnosed in emergency room at the time of hospital presentation. All included patients were divided into 2 cohorts based on activation of PERT on diagnosis: PERT versus Non-PERT. The primary objective was to compare the outcome between 2 cohorts. Measured outcomes were 30- days all cause mortality and PE related mortality. Secondary objective was to compare diagnosis to anti-coagulation time and intervention difference between 2 cohorts. Results: 219 patients with appropriate DRG code were screened and 125 patients were excluded. 94 patients were divided into 2 cohorts: PERT (n1=45) and Non-PERT (n2=49). 30-days all cause Mortality for all patients was 6 (6.4%) and PE related mortality was 5 (5.3%). 30-days all cause mortality was 1 (2.2%) in PERT cohort compared to 5 (10.2%) in non-PERT cohort. This difference was not statistically significant. (Relative risk [RR]=0.21, P=0.15). Other outcome difference between PERT versus Non-PERT cohort: 30-days PE related mortality- 4 versus 1 (RR=0.27, P=0.24), Mean duration to start heparin drip from the time of diagnosis: 74 minutes versus 155 minutes (P=0.09), Mean duration for aPTT to become therapeutic from the time of diagnosis: 518 minutes versus 611 minutes (P=0.7). Intervention difference between PERT versus non-PERT cohort: Catheter directed thrombolytic: 5 verses 1 (RR=5.4, P=0.11), Systemic thrombolytic: 2 versus 0, surgical embolectomy: 2 versus 0. Conclusion: PERT has expedited care of PE patients with reduction in “Diagnosis to Anti-coagulation Time” at our institution. Trend towards mortality improvement was noted with all cause and PE related mortality. AD - K. Patel, Pulmonary Critical Care Medicine, Allegheny General Hospital, Pittsburgh, PA, United States AU - Patel, K. AU - Sahota, E. AU - Baltaji, S. AU - Balaan, M. R. AU - Bihler, E. DB - Embase KW - heparin activated partial thromboplastin time adult all cause mortality anticoagulation catheter clinical evaluation cohort analysis community hospital conference abstract controlled study diagnosis embolectomy emergency ward female high risk patient human lung embolism major clinical study male retrospective study risk assessment risk factor surgery tertiary health care LA - English M1 - MeetingAbstracts M3 - Conference Abstract N1 - L622970024 2018-07-16 PY - 2018 SN - 1535-4970 ST - Reduction of “diagnosis to anticoagulation time” with modified pert protocol T2 - American Journal of Respiratory and Critical Care Medicine TI - Reduction of “diagnosis to anticoagulation time” with modified pert protocol UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622970024&from=export VL - 197 ID - 760874 ER - TY - JOUR AB - Background: Rapid reperfusion improves survival in a patient with ST elevation myocardial infarction (STEMI). Programs such as “Mission Life Line” by the American Heart Association (AHA) and “Door-to- Balloon Alliance” of the American College of Cardiology (ACC) have been instituted to encourage hospitals to achieve a target door-to-balloon time of less than 90 minutes. Centers for Medicare and Medicaid services have also endorsed and implemented its payment model based on fulfillment of this criterion. Various strategies have been proposed and implemented in an effort to achieve this goal including spreading awareness among public to promptly recognize symptoms and call for Emergency Medical Services (EMS), early activation of STEMI by the emergency department (ED) physicians, and early activation of STEMI by EMS. These efforts have generally succeeded but have given rise to a new issue of inappropriate activation of the STEMI emergency response team. Prior reports have suggested a ∼5-10% “false positive” STEMI activation rate in the community as well as university hospital settings. Based on our experience, we hypothesized that the current inappropriate activation rate is actually much higher than projected by previous studies due to differences in definition and parameters used. Methods: From January 2010 to December 2013, consecutive patients were retrospectively identified utilizing our STEMI activation log. Appropriateness of STEMI was defined based on ACC/AHA electrocardiographic (ECG) STEMI criteria in the clinical context consistent with myocardial ischemia confirmation by gold standard diagnostic angiography revealing total or sub-total thrombotic occlusion of a coronary artery. Biomarkers results were not taken into consideration for STEMI analyses as these could be associated with other coronary and noncoronary syndromes. Left ventricular hypertrophy was defined with the following criteria: an R wave in lead aVL plus an S wave in lead V3 more than 25 mm; an R wave in lead aVL more than 11 mm; an S wave in lead V1 plus an R wave in leads V5 or V6 more than 35 mm; an R wave in lead I plus an S wave in lead III more than 25 mm; or an R wave in leads V5 or V6 more than 25.The ECGs, based on which a STEMI response was activated by the ED physician, were reviewed by three independent readers in the cardiology section who were blinded to the outcome. Patients were divided into two groups based on presence or absence of electrocardiographic and angiographic criteria for STEMI. Results: From January 2010 to December 2013, the STEMI team was activated for 302 patients. Patients who presented with new left bundle branch block, out of hospital cardiac arrest with ventricular tachycardia or ventricular fibrillation as the presenting rhythm, even in the absence of ST elevation on the initial electrocardiogram, were taken to the cardiac catheterization laboratory under the STEMI protocol. These patients were excluded from the analyses leaving 279 patients. Consensus of ECG findings consistent with STEMI criteria was achieved in 95% of the ECG's reviewed by the three independent cardiologists. Out of 279 patients (206 male/73 female), 161(58%) patients had true STEMI by ECG criteria and 118 (42%) patients did not meet the standard ECG criteria for STEMI. Cardiologists, on the other hand, were able to identify STEMI on ECGs approximately 90% of the time without the availability of prior ECG or clinical history. The most common initial ECG findings for the inappropriate activation group were LVH, early repolarization, and bundle branch block. Among the patients that underwent cardiac catheterization the predominant culprit artery was the left anterior descending artery (46%), followed by the right coronary artery (34%), and the left circumflex arteries (17%). Other comorbid condition associated with STEMI presentation were hypertension (64%), hyperlipidemia (55%), and prior coronary artery disease (36%). Conclusion: One of the core measures of the D2B alliance is activation of the catheterization laboratory by the ED physician via a single call system. Overcall of inappropriate activation decreases the morale of the STEMI team, leads to higher economic burden associated with running a catheterization laboratory outside business hours, and increases potential of adverse outcomes associated with emergent procedures in patients without STEMI who could benefit from other treatment strategies. Our report utilized electrocardiographic data as the primary pillar of STEMI activation as this is the only data available to the ED staff at the time of catheterization laboratory activation. Net inappropriate STEMI activation incidence in our teaching institution was 42% which is higher than reported literature. False activation was primarily driven by the misinterpretation of the ECG, thus aiming for very high sensitivity at the cost of low specificity. The higher inappropriate activation is likely due to the misinterpretation of the ECG by the ED physicians and inappropriately activating the STEMI response team. Additional training in ECG interpretation with an emphasis on STEMI presentations and requiring two ED physicians to review a potential STEMI ECG may decrease inappropriate STEMI activations. (Table Presented). AD - R. Patel, University of Arizona Sarver Heart Center, United States AU - Patel, R. AU - Nguyen, T. AU - Kumar, S. AU - Kern, K. DB - Embase DO - 10.1002/ccd.25491 KW - biological marker society emergency angiography university teaching hospital ST segment elevation myocardial infarction human patient electrocardiogram physician R wave laboratory artery catheterization cardiology cardiologist heart catheterization heart left ventricle hypertrophy medical society emergency ward coronary artery emergency health service female model thrombosis medicaid hypertension survival gold standard repolarization heart muscle ischemia diagnosis hyperlipidemia adverse outcome medicare parameters implantable cardioverter defibrillator rhythm heart ventricle fibrillation ST segment elevation hospital heart ventricle tachycardia out of hospital cardiac arrest heart left bundle branch block consensus reading heart bundle branch block right coronary artery university hospital community coronary artery disease college morality commercial phenomena reperfusion procedures teaching LA - English M3 - Conference Abstract N1 - L71512082 2014-07-05 PY - 2014 SN - 1522-1946 SP - S38-S39 ST - Inappropriate activation of a STEMI emergency response team: A university teaching hospital experience T2 - Catheterization and Cardiovascular Interventions TI - Inappropriate activation of a STEMI emergency response team: A university teaching hospital experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71512082&from=export http://dx.doi.org/10.1002/ccd.25491 VL - 83 ID - 761115 ER - TY - JOUR AB - Background A transjugular intrahepatic portosystemic shunt (TIPS) is a angiographically created low resistance conduit within the liver between portal and systemic circulations. TIPS is done to treat complications of portal hypertension. Aims Review a single institution experience with TIPS with emphasis on indications, aetiology of portal hypertension, prognostic factors, complications and survival. TIPS as a bridge to Orthotopic Liver Transplant (OLT) was also analysed. Methods A retrospective analysis of all cases who underwent TIPS at Sir Charles Gairdner Hospital, a tertiary teaching hospital and the Western Australian Liver Transplant unit, over a period of 12 years. Results 53 patients underwent TIPS between August 2000 and March 2012. Multidisciplinary team comprising interventional radiologist, hepatologist and transplant surgeons managed the cases. TIPS was done electively in 49 cases (92%) and as emergency in 4 cases (8%). TIPS revision (n = 3) and reduction (n = 1). Indications for TIPS were refractory ascites and/or hydrothorax (n = 27), treatment or secondary prevention of variceal bleeding (n = 20), Budd Chiari Syndrome (n = 4), pre colorectal surgery (n = 1) and hepatopulmonary syndrome (n = 1). The cause of portal hypertension was alcohol related liver disease (n = 26), HCV (n = 8), NASH (n = 6), BCS (n = 4), NAFLD (n = 1), PSC (n = 1) and others (n = 7) Major complications post TIPS were capsular perforation (6%), injury to hepatic artery (2%), refractory encephalopathy (7.5%), medically managed encephalopathy (26%), thrombosis/stenosis (9%), multi organ failure (5%) and worsening of renal function requiring dialysis (4%). The mean age of patients was 54 years (range 17-81) with mean follow up 29 months (range 1-119). The cumulative survival at 1 month, 1 year and 5 years was 90%, 70.9% and 43.9% respectively. The good predictors of survival were indication and Model of End Stage Liver Disease score (p < 0.05). The 5-years survival of patients with pre TIPS MELD < 18 (n = 36) was 58% compared to 18% for patients with MELD ≥18 (n = 17). Patients with TIPS for varicel bleeding (n = 20) have 5-year survival of 54% compared to 31% for ascites and/or hydrothorax (n = 27). No statistically significant difference in survival based on Child-Pugh Score and the type of stent. TIPS was done as bridging therapy for OLT in 9 cases. Indications were ascites and/or hydrothorax (n = 8) and variceal bleeding (n = 1). The mean time between TIPS and OLT was 2.8 months (range 1-10) and 5-year survival (72%) is similar to overall survival of WA liver transplant unit (78%, n = 274). Conclusion TIPS is a safe and effective method of treatment for complications of portal hypertension. Indication and MELD score pre TIPS is the strongest predictor of survival. TIPS doesn't preclude patients from OLT and can be used as a bridging therapy. It is more important in Western Australia with scarcity of organ donors and geographical isolation. AD - P. Pateria, Western Australian Liver Transplantation Service, Sir Charles Gairdner Hospital, Perth, WA, Australia AU - Pateria, P. AU - Tibballs, J. AU - Ferguson, J. AU - Jeffrey, G. AU - Garas, G. AU - Adams, L. AU - Mitchell, A. AU - Delriviere, L. AU - Huang, Y. AU - Macquillan, G. DB - Embase DO - 10.1111/j.1440-1746.2011.07251-5.x KW - alcohol transjugular intrahepatic portosystemic shunt survival therapy liver graft Australia astronomy gastroenterology human patient portal hypertension hydrothorax ascites bleeding Tertiary (period) brain disease systemic circulation emergency liver hepatic artery surgeon injury follow up model secondary prevention liver disease transplantation radiologist hepatopulmonary syndrome teaching hospital perforation colorectal surgery kidney function dialysis Budd Chiari syndrome overall survival end stage liver disease child stent hospital organ donor etiology LA - English M3 - Conference Abstract N1 - L70908614 2012-11-01 PY - 2012 SN - 0815-9319 SP - 88 ST - Transjugular intrahepatic portosystemic shunt: Indications, complications, survival and its use as a bridging therapy in liver transplant in Western Australia-a lonely planet T2 - Journal of Gastroenterology and Hepatology TI - Transjugular intrahepatic portosystemic shunt: Indications, complications, survival and its use as a bridging therapy in liver transplant in Western Australia-a lonely planet UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70908614&from=export http://dx.doi.org/10.1111/j.1440-1746.2011.07251-5.x VL - 27 ID - 761188 ER - TY - JOUR AB - PURPOSE OF REVIEW: The current review outlines the challenges in managing pregnant women with sickle-cell anemia, who are at risk of becoming critically ill during pregnancy. RECENT FINDINGS: Sickle obstetric patients pose unique challenges to the anesthetist and intensivist. We discuss the role of prophylactic transfusions for specific indications like acute anemia and twin pregnancies. The management and prevention of vaso-occlusive crises and chest crisis are also outlined. The role of the multidisciplinary team cannot be overstated.Massive obstetric hemorrhage in this population is difficult, and unique considerations such as cell-saver technology and tranexamic acid usage are discussed. Secondary complications such as pulmonary hypertension and stroke are also considered, with a summary of the latest treatment guidelines. SUMMARY: This is a challenging cohort of pregnant patients who have a significantly increased morbidity and mortality. This review aims to aid management of these patients on the labor ward for both obstetric anesthetists and intensivists. AD - aDepartment of Anesthesiology, Queen's Hospital, BHR University Hospital NHS Trust, Romford bQueen Mary University of London, London cDepartment of Anesthesiology, Princess Royal Hospital, King's College Hospital NHS Trust, Farnborough dDepartment of Obstetrics and Gynecology, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK. AN - 28323673 AU - Patil, V. AU - Ratnayake, G. AU - Fastovets, G. DA - Jun DO - 10.1097/aco.0000000000000464 DP - NLM ET - 2017/03/23 J2 - Current opinion in anaesthesiology KW - Acute Chest Syndrome/diagnosis/therapy Anemia, Sickle Cell/*therapy Antifibrinolytic Agents/therapeutic use Blood Transfusion/standards/trends Critical Care/*methods Delivery, Obstetric/*adverse effects Female Humans Hypertension, Pregnancy-Induced/diagnosis/therapy Hypertension, Pulmonary/diagnosis/therapy Incidence Interdisciplinary Communication Labor, Obstetric Operative Blood Salvage Patient Care Team Postpartum Hemorrhage/epidemiology/etiology/therapy Practice Guidelines as Topic Pregnancy Pregnancy Complications, Hematologic/*therapy Pulmonary Embolism/diagnosis/therapy Stroke/diagnosis/epidemiology/therapy Tranexamic Acid/therapeutic use LA - eng M1 - 3 N1 - 1473-6500 Patil, Vinod Ratnayake, Gamunu Fastovets, Galina Journal Article Review United States Curr Opin Anaesthesiol. 2017 Jun;30(3):326-334. doi: 10.1097/ACO.0000000000000464. PY - 2017 SN - 0952-7907 SP - 326-334 ST - Clinical 'pearls' of maternal critical care Part 2: sickle-cell disease in pregnancy T2 - Curr Opin Anaesthesiol TI - Clinical 'pearls' of maternal critical care Part 2: sickle-cell disease in pregnancy VL - 30 ID - 760124 ER - TY - JOUR AB - Background The Heart Team ( HT ) comprises integrated interdisciplinary decision making. Current guidelines assign a Class Ic recommendation for an HT approach to complex coronary artery disease ( CAD ). However, there remains a paucity of data in regard to hard clinical end points. The aim was to determine characteristics and outcomes in patients with complex CAD following HT discussion. Methods and Results This observational study was conducted at St Thomas' Hospital (London, UK). Case mixture included unprotected left main, 2-vessel (including proximal left anterior descending artery) CAD , 3-vessel CAD , or anatomical and/or clinical equipoise. HT strategy was defined as optimal medical therapy ( OMT ) alone, OMT +percutaneous coronary intervention ( PCI ), or OMT +coronary artery bypass grafting. From April 2012 to 2013, 51 HT meetings were held and 398 cases were discussed. Patients tended to have multivessel CAD (74.1%), high SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) scores (median, 30; interquartile range, 23-39), and average age 69±11 years. Multinomial logistic regression analysis performed to determine variables associated with HT strategy demonstrated decreased likelihood of undergoing PCI compared with OMT in older patients with chronic kidney disease and peripheral vascular disease. The odds of undergoing coronary artery bypass grafting compared with OMT decreased in the presence of cardiogenic shock and left ventricular dysfunction and increased in younger patients with 3-vessel CAD . Three-year survival was 60.8% (84 of 137) in the OMT cohort, 84.3% (107 of 127) in the OMT + PCI cohort, and 90.2% in the OMT +coronary artery bypass grafting cohort (92 of 102). Conclusions In our experience, the HT approach involved a careful selection process resulting in appropriate patient-specific decision making and good long-term outcomes in patients with complex CAD . AD - 1 Division of Cardiovascular The Rayne Institute BHF Centre of Research Excellence King's College London St. Thomas' Hospital London United Kingdom. 2 Department of Cardiothoracic Guy's and St Thomas' NHS Foundation Trust London United Kingdom. 3 Department of Cardiology King's College Hospital NHS Foundation Trust London United Kingdom. 4 Department of Cardiology Essex Cardiothoracic Centre Basildon United Kingdom. AN - 30943827 AU - Patterson, T. AU - McConkey, H. Z. R. AU - Ahmed-Jushuf, F. AU - Moschonas, K. AU - Nguyen, H. AU - Karamasis, G. V. AU - Perera, D. AU - Clapp, B. R. AU - Roxburgh, J. AU - Blauth, C. AU - Young, C. P. AU - Redwood, S. R. AU - Pavlidis, A. N. C2 - Pmc6507188 DA - Apr 16 DO - 10.1161/jaha.118.011279 DP - NLM ET - 2019/04/05 J2 - Journal of the American Heart Association KW - Age Factors Aged Aged, 80 and over *Cardiology Cardiovascular Agents/*therapeutic use Clinical Decision-Making/*methods Cooperative Behavior *Coronary Artery Bypass Coronary Artery Disease/epidemiology/*therapy Female Humans Kaplan-Meier Estimate Male Middle Aged *Patient Care Team *Percutaneous Coronary Intervention Prospective Studies Severity of Illness Index Shock, Cardiogenic/epidemiology Survival Rate *Thoracic Surgery United Kingdom Ventricular Dysfunction, Left/epidemiology *Heart Team *coronary artery disease *health outcomes *medication therapy *revascularization LA - eng M1 - 8 N1 - 2047-9980 Patterson, Tiffany McConkey, Hannah Z R Ahmed-Jushuf, Fiyyaz Moschonas, Konstantinos Nguyen, Hanna Karamasis, Grigoris V Perera, Divaka Clapp, Brian R Roxburgh, James Blauth, Christopher Young, Christopher P Redwood, Simon R Pavlidis, Antonis N CS/16/3/32615/BHF_/British Heart Foundation/United Kingdom FS/14/11/30526/BHF_/British Heart Foundation/United Kingdom FS/16/51/32365/BHF_/British Heart Foundation/United Kingdom DH_/Department of Health/United Kingdom Journal Article Observational Study Research Support, Non-U.S. Gov't J Am Heart Assoc. 2019 Apr 16;8(8):e011279. doi: 10.1161/JAHA.118.011279. PY - 2019 SN - 2047-9980 SP - e011279 ST - Long-Term Outcomes Following Heart Team Revascularization Recommendations in Complex Coronary Artery Disease T2 - J Am Heart Assoc TI - Long-Term Outcomes Following Heart Team Revascularization Recommendations in Complex Coronary Artery Disease VL - 8 ID - 760188 ER - TY - JOUR AB - BACKGROUND: Stroke is a leading cause of death and disability internationally. One of the three effective interventions in the acute phase of stroke care is thrombolytic therapy with tissue plasminogen activator (tPA), if given within 4.5 hours of onset to appropriate cases of ischaemic stroke. OBJECTIVES: To test the effectiveness of a multi-component multidisciplinary collaborative approach compared to usual care as a strategy for increasing thrombolysis rates for all stroke patients at intervention hospitals, while maintaining accepted benchmarks for low rates of intracranial haemorrhage and high rates of functional outcomes for both groups at three months. METHODS AND DESIGN: A cluster randomised controlled trial of 20 hospitals across 3 Australian states with 2 groups: multi- component multidisciplinary collaborative intervention as the experimental group and usual care as the control group. The intervention is based on behavioural theory and analysis of the steps, roles and barriers relating to rapid assessment for thrombolysis eligibility; it involves a comprehensive range of strategies addressing individual-level and system-level change at each site. The primary outcome is the difference in tPA rates between the two groups post-intervention. The secondary outcome is the proportion of tPA treated patients in both groups with good functional outcomes (modified Rankin Score (mRS <2) and the proportion with intracranial haemorrhage (mRS ≥2), compared to international benchmarks. DISCUSSION: TIPS will trial a comprehensive, multi-component and multidisciplinary collaborative approach to improving thrombolysis rates at multiple sites. The trial has the potential to identify methods for optimal care which can be implemented for stroke patients during the acute phase. Study findings will include barriers and solutions to effective thrombolysis implementation and trial outcomes will be published whether significant or not. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12613000939796. AD - The University of Newcastle, (UoN) University Drive, Callaghan, NSW 2308, Australia. chris.paul@newcastle.edu.au. AN - 24666591 AU - Paul, C. L. AU - Levi, C. R. AU - D'Este, C. A. AU - Parsons, M. W. AU - Bladin, C. F. AU - Lindley, R. I. AU - Attia, J. R. AU - Henskens, F. AU - Lalor, E. AU - Longworth, M. AU - Middleton, S. AU - Ryan, A. AU - Kerr, E. AU - Sanson-Fisher, R. W. C2 - Pmc4016636 DA - Mar 25 DO - 10.1186/1748-5908-9-38 DP - NLM ET - 2014/03/29 J2 - Implementation science : IS KW - Aspirin/administration & dosage Australia Cooperative Behavior Diffusion of Innovation Emergency Medical Services/methods Evidence-Based Medicine Fibrinolytic Agents/administration & dosage *Guideline Adherence Humans Patient Care Team/organization & administration *Practice Guidelines as Topic Quality of Health Care/*organization & administration Research Design Stroke/*drug therapy Thrombolytic Therapy/*methods Tissue Plasminogen Activator/administration & dosage Triage/methods LA - eng N1 - 1748-5908 Paul, Christine L Levi, Christopher R D'Este, Catherine A Parsons, Mark W Bladin, Christopher F Lindley, Richard I Attia, John R Henskens, Frans Lalor, Erin Longworth, Mark Middleton, Sandy Ryan, Annika Kerr, Erin Sanson-Fisher, Robert W Thrombolysis ImPlementation in Stroke (TIPS) Study Group Journal Article Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov't Implement Sci. 2014 Mar 25;9:38. doi: 10.1186/1748-5908-9-38. PY - 2014 SN - 1748-5908 SP - 38 ST - Thrombolysis ImPlementation in Stroke (TIPS): evaluating the effectiveness of a strategy to increase the adoption of best evidence practice--protocol for a cluster randomised controlled trial in acute stroke care T2 - Implement Sci TI - Thrombolysis ImPlementation in Stroke (TIPS): evaluating the effectiveness of a strategy to increase the adoption of best evidence practice--protocol for a cluster randomised controlled trial in acute stroke care VL - 9 ID - 760310 ER - TY - JOUR AB - Background: Thrombolysis using intravenous (IV) tissue plasminogen activator (tPA) is one of few evidence-based acute stroke treatments, yet achieving high rates of IV tPA delivery has been problematic. The 4.5-h treatment window, the complexity of determining eligibility criteria and the availability of expertise and required resources may impact on treatment rates, with barriers encountered at the levels of the individual clinician, the social context and the health system itself. The review aimed to describe health system factors associated with higher rates of IV tPA administration for ischemic stroke and to identify whether system-focussed interventions increased tPA rates for ischemic stroke. Methods: Published original English-language research from four electronic databases spanning 1997-2014 was examined. Observational studies of the association between health system factors and tPA rates were described separately from studies of system-focussed intervention strategies aiming to increase tPA rates. Where study outcomes were sufficiently similar, a pooled meta-analysis of outcomes was conducted. Results: Forty-one articles met the inclusion criteria: 7 were methodologically rigorous interventions that met the Cochrane Collaboration Evidence for Practice and Organization of Care (EPOC) study design guidelines and 34 described observed associations between health system factors and rates of IV tPA. System-related factors generally associated with higher IV tPA rates were as follows: urban location, centralised or hub and spoke models, treatment by a neurologist/ stroke nurse, in a neurology department/stroke unit or teaching hospital, being admitted by ambulance or mobile team and stroke-specific protocols. Results of the intervention studies suggest that telemedicine approaches did not consistently increase IV tPA rates. Quality improvement strategies appear able to provide modest increases in stroke thrombolysis (pooled odds ratio = 2.1, p = 0.05). Conclusions: In order to improve IV tPA rates in acute stroke care, specific health system factors need to be targeted. Multi-component quality improvement approaches can improve IV tPA rates for stroke, although more thoughtfully designed and well-reported trials are required to safely increase rates of IV tPA to eligible stroke patients. AD - [Paul, Christine L.; Ryan, Annika; Rose, Shiho; Attia, John R.; Koller, Claudia; Levi, Christopher R.] Univ Newcastle, Univ Dr, Callaghan, NSW 2308, Australia. [Kerr, Erin; Levi, Christopher R.] Hunter New England Hlth, Lookout Rd, New Lambton Hts, NSW 2305, Australia. [Paul, Christine L.; Ryan, Annika; Rose, Shiho; Attia, John R.; Koller, Claudia; Levi, Christopher R.] Hunter Med Res Inst, 1 Kookaburra Circuit, New Lambton Hts, NSW 2305, Australia. Paul, CL (corresponding author), Univ Newcastle, Univ Dr, Callaghan, NSW 2308, Australia.; Paul, CL (corresponding author), Hunter Med Res Inst, 1 Kookaburra Circuit, New Lambton Hts, NSW 2305, Australia. Chris.Paul@newcastle.edu.au AN - WOS:000374524200001 AU - Paul, C. L. AU - Ryan, A. AU - Rose, S. AU - Attia, J. R. AU - Kerr, E. AU - Koller, C. AU - Levi, C. R. C7 - 51 DA - Apr DO - 10.1186/s13012-016-0414-6 J2 - Implement. Sci. KW - Ischemic stroke Thrombolysis Implementation Quality improvement Health system change Tissue plasminogen activator ACUTE ISCHEMIC-STROKE TISSUE-PLASMINOGEN ACTIVATOR NATIONWIDE INPATIENT SAMPLE AMERICAN-HEART-ASSOCIATION DIGITAL OBSERVATION CAMERA IN-HOSPITAL MORTALITY INTRAVENOUS THROMBOLYSIS UNITED-STATES EMERGENCY-DEPARTMENT GUIDELINES-STROKE Health Care Sciences & Services Health Policy & Services LA - English M3 - Review N1 - ISI Document Delivery No.: DJ9HI Times Cited: 28 Cited Reference Count: 78 Paul, Christine L. Ryan, Annika Rose, Shiho Attia, John R. Kerr, Erin Koller, Claudia Levi, Christopher R. Attia, John R/F-5376-2013 Attia, John R/0000-0001-9800-1308; Levi, Christopher/0000-0002-9474-796X National Health and Medical Research Council (NHMRC)National Health and Medical Research Council of Australia [ID569328]; TRIP fellowship; Boehringer IngelheimBoehringer Ingelheim; Hunter Medical Research Institute; University of Newcastle; NHMRC Career Development FellowshipNational Health and Medical Research Council of Australia [APP1061335] We would like to thank Ms. Debbie Booth, The University of Newcastle medical librarian, for assistance with search strategy and terminology. This work is related to a National Health and Medical Research Council (NHMRC) partnership grant (ID569328) and is part-funded by a TRIP fellowship, with collaborative funding from Boehringer Ingelheim and in-kind support from ACI Stroke Care Network/Stroke Services NSW, Victorian Stroke Clinical Network, National Stroke Foundation and NSW Cardiovascular Research Network-National Heart Foundation, with infrastructure funding from Hunter Medical Research Institute and The University of Newcastle. Christine Paul is supported by an NHMRC Career Development Fellowship (APP1061335). None of these funding sources have had any involvement whatsoever with regard to the concept, development, writing and publishing of this paper. 30 0 11 BIOMED CENTRAL LTD LONDON IMPLEMENT SCI PY - 2016 SN - 1748-5908 SP - 12 ST - How can we improve stroke thrombolysis rates? A review of health system factors and approaches associated with thrombolysis administration rates in acute stroke care T2 - Implementation Science TI - How can we improve stroke thrombolysis rates? A review of health system factors and approaches associated with thrombolysis administration rates in acute stroke care UR - ://WOS:000374524200001 VL - 11 ID - 761710 ER - TY - JOUR AB - BACKGROUND: A multidisciplinary team (MDT) approach for decision-making in patients with complex coronary artery disease (CAD) is now a class IC recommendation in the European and American guidelines for myocardial revascularisation. The aim of this study was to evaluate the implementation and consistency of Heart Team HT decision-making in complex coronary revascularisation. METHODS: We prospectively evaluated the data of 399 patients derived from 51 consecutive MDT meetings held in a tertiary cardiac centre. A subset of cases was randomly selected and re-presented with the same clinical data to a panel blinded to the initial outcome, at least 6 months after the initial discussion, in order to evaluate the reproducibility of decision-making. RESULTS: The most common decisions included continued medical management (30%), coronary artery bypass grafting (CABG) (26%) and percutaneous coronary intervention (PCI) (17%). Other decisions, such as further assessment of symptoms or evaluation with further invasive or non-invasive tests were made in 25% of the cases. Decisions were implemented in 93% of the cases. On re-discussion of the same data (n=40) within a median period of 9 months 80% of the initial HT recommendations were successfully reproduced. CONCLUSIONS: The Heart Team is a robust process in the management of patient with complex CAD and decisions are largely reproducible. Although outcomes are successfully implemented in the majority of the cases, it is important that all clinical information is available during discussion and patient preference is taken into account. AD - Department of Cardiology, St. Thomas' Hospital, London, UK. Cardiovascular Division, St. Thomas' Hospital Campus, King's College, London, UK. Department of Cardiology, St. Thomas' Hospital, London, UK; Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK. Electronic address: grigoris.karamasis@gmail.com. Department of Cardiothoracic Surgery, St. Thomas' Hospital, London, UK. AN - 26774827 AU - Pavlidis, A. N. AU - Perera, D. AU - Karamasis, G. V. AU - Bapat, V. AU - Young, C. AU - Clapp, B. R. AU - Blauth, C. AU - Roxburgh, J. AU - Thomas, M. R. AU - Redwood, S. R. DA - Mar 1 DO - 10.1016/j.ijcard.2016.01.041 DP - NLM ET - 2016/01/18 J2 - International journal of cardiology KW - Aged Coronary Artery Bypass/*methods/statistics & numerical data Coronary Artery Disease/*therapy *Decision Making Female Humans Interdisciplinary Communication Male Myocardial Revascularization/methods/statistics & numerical data *Patient Care Team Percutaneous Coronary Intervention/*methods/statistics & numerical data Practice Patterns, Physicians' Prospective Studies Reproducibility of Results Acute coronary syndromes Chronic coronary disease Coronary angioplasty Coronary artery bypass grafting LA - eng N1 - 1874-1754 Pavlidis, Antonis N Perera, Divaka Karamasis, Grigoris V Bapat, Vinayak Young, Chris Clapp, Brian R Blauth, Chris Roxburgh, James Thomas, Martyn R Redwood, Simon R Journal Article Netherlands Int J Cardiol. 2016 Mar 1;206:37-41. doi: 10.1016/j.ijcard.2016.01.041. Epub 2016 Jan 6. PY - 2016 SN - 0167-5273 SP - 37-41 ST - Implementation and consistency of Heart Team decision-making in complex coronary revascularisation T2 - Int J Cardiol TI - Implementation and consistency of Heart Team decision-making in complex coronary revascularisation VL - 206 ID - 760244 ER - TY - JOUR AB - This study describes the availability of physical activity information in the electronic health record, explores how electronic health record documentation correlates with accelerometer-derived physical activity data, and examines whether measured physical activity relates to venous thromboembolism (VTE) prophylaxis use. Prospective observational data comes from community-dwelling older adults admitted to general medicine (n = 65). Spearman correlations were used to examine association of accelerometer-based daily step count with documented walking distance and with duration of VTE prophylaxis. Only 52% of patients had documented walking in nursing and/or physical therapy/occupational therapy notes during the first three hospital days. Median daily steps recorded via accelerometer was 1,370 (interquartile range = 854, 2,387) and correlated poorly with walking distance recorded in physical therapy/occupational therapy notes (median 33 feet/day [interquartile range = 12, 100]; r =.24; p =.27). Activity measures were not associated with use or duration of VTE prophylaxis. VTE prophylaxis use does not appear to be directed by patient activity, for which there is limited documentation. AN - 142252206. Language: English. Entry Date: 20200318. Revision Date: 20200716. Publication Type: Article AU - Pavon, Juliessa M. AU - Sloane, Richard J. AU - Pieper, Carl F. AU - Colón-Emeric, Cathleen S. AU - Gallagher, David AU - Cohen, Harvey J. AU - Hall, Katherine S. AU - Morey, Miriam C. AU - McCarty, Midori AU - Ortel, Thomas L. AU - Hastings, Susan N. DB - CINAHL DO - 10.1123/japa.2018-0462 DP - EBSCOhost KW - Venous Thromboembolism -- Prevention and Control Physical Activity Electronic Health Records Documentation -- Methods Hospitalization Human Prospective Studies Community Living Spearman's Rank Correlation Coefficient Accelerometry Walking Inpatients Physical Mobility Aged M1 - 2 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9415639. PY - 2020 SN - 1063-8652 SP - 306-310 ST - Physical Activity in the Hospital: Documentation and Influence on Venous Thromboembolism Prophylaxis T2 - Journal of Aging & Physical Activity TI - Physical Activity in the Hospital: Documentation and Influence on Venous Thromboembolism Prophylaxis UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=142252206&site=ehost-live&scope=site VL - 28 ID - 761362 ER - TY - JOUR AB - AIMS OF THE STUDY: The aims of the study are to elaborate and test, in a coronary population admitted in a cardiac rehabilitation (CR) department, an evaluative method 6 months after a cardiac rehabilitation programme, with emphasis on modified cardiac risk factors. PATIENTS AND METHODS: Every coronary patient admitted in the CR department in Machecoul between 2007 October and 2009 October, who's home were not over 50 km far away and without mental inability, were included. At the start of the programme, he was suggested to complete the training course by a phone interview at 3 months and a multidisciplinary consult at 6 months. It used dietary and physical activity questionnaires, and a 6-minute walk test (6mnWT). RESULTS: Two hundred and two patients were included (mean age 63,4 ± 10 years, 93% men), 17% after an acute coronary syndrome, 23% after angioplasty and 75% after coronary artery bypass graft. The cardioprotective dietary score increased from 7.8 ± 4.3 to 12.7 ± 3 (on a scale from-17 to+19) and the physical activity score from 15.4 ± 7.7 to 19.5 ± 4.8 (on a scale from 5 to 40). The 6mnWT increased in CR (from 431 ± 90m to 511 ± 91m) and was maintained at 6 months (513 ± 88m). The European recommendation goals were achieved by 76% of patients for LDL (<1g/L), 64% for blood pressure (<140/90), 82% for a BMI less than 30 and 36% a BMI less than 25, 67% central obesity (<102cm by men and 88 cm by women) and 82% for no smoking. Four non-fatal cardiac events and seven vascular events were reported by a mean delay of 190 ± 30 days. CONCLUSION: A six monthly evaluation of CR programme can be used in a cardiac rehabilitation department routinely activity. AD - Service de réadaptation cardiovasculaire, centre hospitalier Loire-Vendée-Océan, Machecoul, France. pavy.bruno@wanadoo.fr AN - 21907321 AU - Pavy, B. AU - Tisseau, A. AU - Caillon, M. DA - Nov DO - 10.1016/j.ancard.2011.08.004 DP - NLM ET - 2011/09/13 J2 - Annales de cardiologie et d'angeiologie KW - Acute Coronary Syndrome/blood/*rehabilitation/therapy Aged Algorithms Angioplasty, Balloon, Coronary/*rehabilitation Biomarkers/blood Blood Pressure Determination Body Mass Index Cholesterol, LDL/blood Coronary Artery Bypass/*rehabilitation *Diet Therapy Exercise Test Female Follow-Up Studies Humans Male Middle Aged Obesity/prevention & control Patient Care Team Practice Guidelines as Topic Risk Factors Smoking Prevention Surveys and Questionnaires Treatment Outcome Walking LA - fre M1 - 5 N1 - 1768-3181 Pavy, B Tisseau, A Caillon, M Journal Article France Ann Cardiol Angeiol (Paris). 2011 Nov;60(5):252-8. doi: 10.1016/j.ancard.2011.08.004. Epub 2011 Aug 26. OP - Le patient coronarien six mois après la réadaptation cardiaque : recherche sur l'évaluation de la réadaptation (étude RER). PY - 2011 SN - 0003-3928 SP - 252-8 ST - [The coronary patient six months after cardiac rehabilitation: rehabilitation evaluation research (RER study)] T2 - Ann Cardiol Angeiol (Paris) TI - [The coronary patient six months after cardiac rehabilitation: rehabilitation evaluation research (RER study)] VL - 60 ID - 760391 ER - TY - JOUR AB - Objectives: Nearly all gynecologic oncology patients have risk factors for venous thromboembolism (VTE). Our institution recently observed a significantly higher rate of VTE among patients receiving continuous epidural analgesia (CEA) and responded with new guidelines for perioperative anticoagulant use. We undertook this study to determine if the change in guidelines affected VTE rate. Methods: In July 2012, a multidisciplinary team refined anticoagulation guidelines by requiring a prophylactic dose of anticoagulant within 1 h after CEA catheter placement or before skin incision regardless of anesthesia type. Institutional review board approval was obtained and retrospective data collected for women having laparotomy between July 1, 2011, and June 30, 2013. Those having surgery in the year prior to the new protocolwere used for comparison. Data included demographic and 30-day perioperative outcomes. Those with VTE identified preoperatively were excluded. The primary outcome was rate of VTE. The secondary outcome was protocol compliance. Chi-square and logistic regression were performed. Results: There were 194 women treated under the new protocol (NP) and 237 historical cases (HC).More NP patients had cancer (68% vs 58%, P=0.038), pulmonary disease (24% vs 14%, P=0.013), and nonhypertensive cardiovascular disease (10% vs 2%, P < 0.001). Other comorbidities, operative duration, estimated blood loss, and length of stay did not vary. Use of CEA increased over time (24% HC vs 34% NP, P=0.023). Compliance improved in CEA cases (12.5% HC vs 41.5% NP, P < 0.001) but remained significantly below that in non-CEA (41.5% NP [CEA] vs 91% NP [non-CEA], P < 0.001). When all cases were combined, CEA showed an association with VTE (P=0.003), but the rate of VTE differed in HC (1.7% non-CEA vs 8.9% CEA, P=0.008) compared with NP cases (0.8% non-CEA vs 4.6% CEA, P=0.076). The change in rate of VTE with CEA was not significant under the new guidelines (P=0.34). The overall rate of VTE, independent of anesthesia type, was stable (3.4% HC vs 2.1% NP, P=0.41). Conclusions: CEA is associated with a significantly increased risk of VTE, but this could be a reflection of underlying noncompliance with perioperative anticoagulation recommendations. Compliance levels N40% are likely required before an effect, if any, can be demonstrated. AD - E. Pelkofski, University of Virginia, Charlottesville, VA, United States AU - Pelkofski, E. AU - Courtney-Brooks, M. B. AU - Tanner Kurtz, C. K. AU - Rowlingson, J. AU - Smolkin, M. AU - Duska, L. DB - Embase DO - 10.1016/j.ygyno.2014.03.367 KW - carcinoembryonic antigen anticoagulant agent human oncology patient female anticoagulation epidural anesthesia neoplasm society anesthesia lung disease logistic regression analysis catheter protocol compliance venous thromboembolism cardiovascular disease surgery laparotomy institutional review risk length of stay bleeding skin incision risk factor LA - English M3 - Conference Abstract N1 - L71543360 2014-08-01 PY - 2014 SN - 0090-8258 SP - 140 ST - Use of a perioperative anticoagulation protocol in gynecologic oncology patients receiving continuous epidural analgesia T2 - Gynecologic Oncology TI - Use of a perioperative anticoagulation protocol in gynecologic oncology patients receiving continuous epidural analgesia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71543360&from=export http://dx.doi.org/10.1016/j.ygyno.2014.03.367 VL - 133 ID - 761107 ER - TY - JOUR AB - Background: Acute pulmonary embolism (PE) is a highly morbid condition. With the emergence of multidisciplinary team-based approaches, there has been an increasing focus on individualized care of these patients. Systemic or catheter-directed thrombolysis is considered first-line therapy in the majority of cases. However, traditional surgical embolectomy has also shown excellent results in retrospective studies of highly selected patients. The purpose of this study was to examine trends, outcomes and predictors of mortality among patients treated for high-risk acute PE using National Inpatient Samples. Methods and Results: The National Inpatient Sample is the largest publicly-available, all-payer inpatient database in the United States, representing close to 20% of all hospitalizations. Between 2010 and 2014, all adults who underwent systemic thrombolysis, catheter-directed thrombolysis or surgical embolectomy for a primary diagnosis of acute pulmonary embolism were included. A total of 58,974 patients met inclusion criteria. Of these, 33,553 (57%) were treated with systemic thrombolysis (ST), 22,336 (38%) underwent catheter-directed thrombolysis (CDT), and 3,085 (5%) underwent surgical embolectomy (SE). ST was the most common modality, with a substantial increase in procedure volume after 2012 (Figure A). The use of CDT increased slightly throughout the study period, while SE volumes remained stable. SE patients, compared to ST and CDT, were more likely to have a saddle embolus (22% vs. 10% vs. 10%) and were more frequently classified as having severe risk of mortality (56% vs. 41% vs. 26%, all P < 0.01). SE patients also had significantly higher in-hospital mortality (20% vs. 16% vs. 7%), stroke (7% vs. 6% vs. 3%) and blood transfusion (32% vs. 16% vs. 10%; All P < 0.01) compared to ST and CDT patients, although the rate of major bleeding was highest in the ST group (16% vs. 18% vs. 12%; P < 0.01). Average in-hospital costs were also substantially higher in the SE group (US $69,194 vs. $27,033 vs. $25,929; P < 0.01) compared to ST and CDT groups, respectively. Among the SE patients, age > 60 years, presence of atrial fibrillation and non-saddle PE were associated with increased odds of in-hospital mortality, while factors such as private insurance, hypertension and obesity were protective (Figure B). Conclusion: Acute PE requiring intervention was associated with significant morbidity across all treatment modalities, with the highest risk of mortality observed among the SE patients. Patients with acute PE should be approached in a multidisciplinary fashion and surgeons should take caution when considering SE in older patients with evidence of heart failure and non-saddle PE. [Figure presented] University of British Columbia - Clinician Investigator Program AU - Percy, E. AU - Shah, R. AU - Hirji, S. AU - Yazdchi, F. AU - Kaneko, T. AU - Pelletier, M. DB - Embase DO - 10.1016/j.cjca.2019.07.535 KW - adult atrial fibrillation bleeding blood clot lysis blood transfusion British Columbia catheter cerebrovascular accident conference abstract controlled study embolectomy female heart failure hospital cost hospital mortality hospital patient hospitalization human human tissue hypertension insurance Leriche syndrome lung embolism major clinical study male morbidity mortality risk multicenter study obesity retrospective study surgeon United States LA - English M1 - 10 M3 - Conference Abstract N1 - L2003291667 2019-10-14 PY - 2019 SN - 0828-282X SP - S126-S127 ST - SURGICAL EMBOLECTOMY FOR ACUTE PULMONARY EMBOLISM: A MULTICENTER ANALYSIS OF OVER 58,000 CASES T2 - Canadian Journal of Cardiology TI - SURGICAL EMBOLECTOMY FOR ACUTE PULMONARY EMBOLISM: A MULTICENTER ANALYSIS OF OVER 58,000 CASES UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003291667&from=export http://dx.doi.org/10.1016/j.cjca.2019.07.535 VL - 35 ID - 760669 ER - TY - JOUR AB - Aims and objectives To identify factors associated with the increased bleeding in patients during the postoperative period after cardiac surgery. Background Bleeding is among the most frequent complications that occur in the postoperative period after cardiac surgery, representing one of the major factors in morbidity and mortality. Understanding the factors associated with the increased bleeding may allow nurses to anticipate and prioritise care, thus reducing the mortality associated with this complication. Design Prospective cohort study. Methods Adult patients in a cardiac hospital who were in the postoperative period following cardiac surgery were included. Factors associated with the increased bleeding were investigated by means of linear regression, considering time intervals of 6 and 12 hr. Results The sample comprised 391 participants. The factors associated with the increased bleeding in the first 6 hr were male sex, body mass index, cardiopulmonary bypass duration, anoxia duration, metabolic acidosis, higher heart rate, platelets and the activated partial thromboplastin time in the postoperative period. Predictors in the first 12 hr were body mass index, cardiopulmonary bypass duration, metabolic acidosis, higher heart rate, platelets and the activated partial thromboplastin time in the postoperative. Conclusions This study identified factors associated with the increased postoperative bleeding from cardiac surgery that have not been reported in previous studies. The nurse is important in the vigilance, evaluation and registry of chest tube drainage and modifiable factors associated with the increased bleeding, such as metabolic acidosis and postoperative heart rate, and in discussions with the multiprofessional team. Relevance to clinical practice Knowledge of the factors associated with the increased bleeding is critical for nurses so they can provide prophylactic interventions and early postoperative treatment when needed. AD - [Pereira, Karla M. F. S. M.; de Assis, Caroline S.; Cintra, Haulcionne N. W. L.; Rodrigues, Adriano Rogerio B.; de Oliveira, Larissa B.] Univ Sao Paulo, Fac Med, Hosp Clin, Heart Inst, Sao Paulo, SP, Brazil. [Ferretti-Rebustini, Renata Eloah L.; Pueschel, Vilanice A. A.; de Oliveira, Larissa B.] Univ Sao Paulo, Escola Enfermagem, Med Surg Nursing Dept, Sao Paulo, SP, Brazil. [Santana-Santos, Eduesley] Univ Fed Sergipe, Aracaju, SE, Brazil. [de Oliveira, Larissa B.] Soc Cardiol Estado Sao Paulo, Nursing Dept, Sao Paulo, SP, Brazil. de Oliveira, LB (corresponding author), Univ Sao Paulo, Fac Med, Hosp Clin, Sao Paulo, Brazil. larissa.oliveira@hc.fm.usp.br AN - WOS:000458362400013 AU - Pereira, Kmfsm AU - de Assis, C. S. AU - Cintra, Hnwl AU - Ferretti-Rebustini, R. E. L. AU - Puschel, V. A. A. AU - Santana-Santos, E. AU - Rodrigues, A. R. B. AU - de Oliveira, L. B. DA - Mar DO - 10.1111/jocn.14670 J2 - J. Clin. Nurs. KW - bleeding cardiovascular nursing thoracic surgery CHEST TUBE DRAINAGE BODY-MASS INDEX BLOOD-LOSS INDEPENDENT PREDICTOR CARDIOPULMONARY BYPASS FIBRINOGEN LEVEL TRANSFUSION MANAGEMENT MORBIDITY MORTALITY Nursing LA - English M1 - 5-6 M3 - Article N1 - ISI Document Delivery No.: HL0CM Times Cited: 0 Cited Reference Count: 47 Pereira, Karla M. F. S. M. de Assis, Caroline S. Cintra, Haulcionne N. W. L. Ferretti-Rebustini, Renata Eloah L. Pueschel, Vilanice A. A. Santana-Santos, Eduesley Rodrigues, Adriano Rogerio B. de Oliveira, Larissa B. Santana-Santos, Eduesley/O-6109-2014; de Oliveira, Larissa Bertacchini/Y-9029-2019; de Lucena Ferretti-Rebustini, Renata Eloah/C-8126-2012; de Oliveira, Larissa Bertacchini/D-3248-2015 Santana-Santos, Eduesley/0000-0001-8545-5677; de Oliveira, Larissa Bertacchini/0000-0001-9509-4422; de Lucena Ferretti-Rebustini, Renata Eloah/0000-0002-6159-5787; 0 8 WILEY HOBOKEN J CLIN NURS PY - 2019 SN - 0962-1067 SP - 850-861 ST - Factors associated with the increased bleeding in the postoperative period of cardiac surgery: A cohort study T2 - Journal of Clinical Nursing TI - Factors associated with the increased bleeding in the postoperative period of cardiac surgery: A cohort study UR - ://WOS:000458362400013 VL - 28 ID - 761535 ER - TY - JOUR AB - Background: In PKU, transition to adult care (TAC) is challenging and information on adults follow-up is limited. We aimed to see how TAC affects metabolic control and adherence. Methods: 55 PKU patients (55% females; 5 HPA, 26 mild PKU and 24 classical PKU) in whom TAC occurred between 2011 and 2015, were analysed in two different study periods: 2 y pre and post-TAC (SP1 and SP2, respectively). Mean age at TAC was 23.3 ± 4.3 y. None of the patients received sapropterin, but there was one pregnancy in SP2. Retrospective data on metabolic control (median blood [Phe], number of blood spots and % of blood [Phe] < 8 mg/dl) and number of clinic visits was collected for SP1 and SP2. Natural protein (NP, g/kg), protein equivalent (PE, g/kg), total protein (TP, g/kg) and Phe (mg/day) intakes closest to TAC were compared with those recorded on the first appointment after SP2. Results: In SP2, 3 patients (2 females) were lost in follow-up (6%) resulting in a final sample of 52 patients. Median number of analysed blood spots significantly increased in SP2: 22 [13-30] vs. 29 [15-41]; p=0.002. Mean (SD) of the median blood [Phe] remained stable from SP1 to SP2 (8.7 ± 4.1 vs. 9.1 ± 3.7; p=0.100) while the median % of blood [Phe] < 8 mg/dl significantly decreased in SP2 (51.5 [3.7-95.7] vs. 36.5 [4.6-84.6]; p=0.041). Median number of total clinic visits significantly increased in SP2 (5 [4-6] vs. 11 [8-13]; p< 0.001). NP, PE, TP and Phe remained similar between SP1 and SP2: 0.46 [0.35-0.88] vs. 0.46 [0.28-0.94], p=0.873; 0.85 [0.47-1.10] vs. 0.83 [0.43-1.05], p=0.066; 1.51 [1.26-1.66] vs. 1.34 [1.07-1.54], p=0.194; 1210 [830-2311] vs. 1318 [763-2935], p=0.278, respectively. Discussion: TAC had limited impact on metabolic control and few patients were lost in follow-up. Maintenance of similar dietary patterns, increase of clinical visits and the inclusion of the same experienced nutritionists in paediatric and adult care multidisciplinary teams may have contributed to our results. AD - M. Peres, Centr Genet Med, CHP, Porto, Portugal AU - Peres, M. AU - Almeida, M. F. AU - Pinto, E. AU - Carmona, C. AU - Rocha, S. AU - Guimas, A. AU - Ribeiro, R. AU - Martins, E. AU - Bandeira, A. AU - MacDonald, A. AU - Rocha, J. C. DB - Embase DO - 10.1007/s10545-018-0233-9 KW - endogenous compound protein sapropterin transcription factor Sp1 adult child conference abstract controlled study dietary pattern dietitian drug therapy female follow up human human tissue major clinical study male metabolic regulation multidisciplinary team phenylketonuria pregnancy retrospective study young adult LA - English M3 - Conference Abstract N1 - L623865313 2018-09-18 PY - 2018 SN - 1573-2665 SP - S82 ST - Transition from paediatric to adult care in phenylketonuria (TRANS-PAC-PKU): The 2 year's impact on metabolic control and adherence T2 - Journal of Inherited Metabolic Disease TI - Transition from paediatric to adult care in phenylketonuria (TRANS-PAC-PKU): The 2 year's impact on metabolic control and adherence UR - https://www.embase.com/search/results?subaction=viewrecord&id=L623865313&from=export http://dx.doi.org/10.1007/s10545-018-0233-9 VL - 41 ID - 760803 ER - TY - JOUR AB - BACKGROUND: Peripherally inserted central venous catheters (PICCs) are popular for a broad range of indications. As with other forms of central access, PICC use can be associated with serious and potentially costly complications. In 2000, in response to the rising popularity of PICC use, a surgeon-led team was created to steward their placement. All requests were screened rigorously to ensure rational use. Our hypothesis was that creation of a dedicated PICC team would decrease inappropriate PICC placement, overall complication rates, and cost. METHODS: The study was a retrospective review of prospectively collected data captured in the PICC team-maintained database between 2000 and 2013. The database was reviewed for PICC indications, reasons PICC requests were denied, and septic or thrombotic complications after PICC placement. To estimate cost savings, PICC supplies and each occurrence of blood stream infection (BSI) and thrombotic complication was assigned a cost on the basis of the available literature. RESULTS: Between 2000 and 2013, 35,651 PICC placements were requested, of which 24,638 (69.1%) were approved, 22,157 (62.1%) immediately and 2,481 (6.9%) after initial refusal in view of further review of the indications. Most (95%) of the PICCs inserted were placed at the bedside within 1 d of approval. Blood stream infections occurred in 5.9% of patients and thrombosis in 2.7%. The attributable costs saved by declining placement of unnecessary PICCs, assuming the same proportions of patients would have developed a complication, could be as high as $5.4 million (M) in supplies, $7.77 M in avoided BSI and $2.25 M in avoided thrombotic complications, for a total savings of $15.44 M. CONCLUSIONS: The implementation of a surgeon-led PICC team had a significant impact on the placement rate, reducing cost by supplies foregone and complications avoided. Cost savings related to PICC placement alone should be considered as the definite cost savings because of the judicious allocation of resources. AD - 1 Department of Surgery, Brigham and Women's Hospital , Boston, Massachusetts. 2 Division of Metabolic Support, Brigham and Women's Hospital , Boston, Massachusetts. AN - 26900912 AU - Pernar, L. I. AU - Wolf, L. L. AU - Seshadri, A. AU - Patel, V. DA - Jun DO - 10.1089/sur.2015.093 DP - NLM ET - 2016/02/24 J2 - Surgical infections KW - Boston Catheter-Related Infections/economics/*prevention & control *Catheterization, Central Venous/adverse effects/economics/methods *Catheterization, Peripheral/adverse effects/economics/methods Cost Savings/*statistics & numerical data Databases, Factual Hospital Costs/*statistics & numerical data Humans Leadership Patient Care Team/*organization & administration Retrospective Studies Surgeons LA - eng M1 - 3 N1 - 1557-8674 Pernar, Luise I M Wolf, Lindsay L Seshadri, Anupamaa Patel, Vihas Journal Article United States Surg Infect (Larchmt). 2016 Jun;17(3):352-6. doi: 10.1089/sur.2015.093. Epub 2016 Feb 22. PY - 2016 SN - 1096-2964 SP - 352-6 ST - Impact of a Surgeon-Led Peripherally Inserted Central Venous Catheter Team on Peripherally Inserted Central Venous Catheter-Related Complications and Costs T2 - Surg Infect (Larchmt) TI - Impact of a Surgeon-Led Peripherally Inserted Central Venous Catheter Team on Peripherally Inserted Central Venous Catheter-Related Complications and Costs VL - 17 ID - 760204 ER - TY - JOUR AB - Background: Peripherally inserted central venous catheters (PICCs) are popular for a broad range of indications. As with other forms of central access, PICC use can be associated with serious and potentially costly complications. In 2000, in response to the rising popularity of PICC use, a surgeon-led team was created to steward their placement. All requests were screened rigorously to ensure rational use. Our hypothesis was that creation of a dedicated PICC team would decrease inappropriate PICC placement, overall complication rates, and cost. Methods: The study was a retrospective review of prospectively collected data captured in the PICC team-maintained database between 2000 and 2013. The database was reviewed for PICC indications, reasons PICC requests were denied, and septic or thrombotic complications after PICC placement. To estimate cost savings, PICC supplies and each occurrence of blood stream infection (BSI) and thrombotic complication was assigned a cost on the basis of the available literature. Results: Between 2000 and 2013, 35,651 PICC placements were requested, of which 24,638 (69.1%) were approved, 22,157 (62.1%) immediately and 2,481 (6.9%) after initial refusal in view of further review of the indications. Most (95%) of the PICCs inserted were placed at the bedside within 1 d of approval. Blood stream infections occurred in 5.9% of patients and thrombosis in 2.7%. The attributable costs saved by declining placement of unnecessary PICCs, assuming the same proportions of patients would have developed a complication, could be as high as $5.4 million (M) in supplies, $7.77M in avoided BSI and $2.25 M in avoided thrombotic complications, for a total savings of $15.44 M. Conclusions: The implementation of a surgeon-led PICC team had a significant impact on the placement rate, reducing cost by supplies foregone and complications avoided. Cost savings related to PICC placement alone should be considered as the definite cost savings because of the judicious allocation of resources. AD - [Pernar, Luise I. M.; Wolf, Lindsay L.; Seshadri, Anupamaa; Patel, Vihas] Brigham & Womens Hosp, Dept Surg, 75 Francis St, Boston, MA 02115 USA. [Patel, Vihas] Brigham & Womens Hosp, Div Metab Support, 75 Francis St, Boston, MA 02115 USA. Pernar, LIM (corresponding author), Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA. lpernar@partners.org AN - WOS:000377113200014 AU - Pernar, L. I. M. AU - Wolf, L. L. AU - Seshadri, A. AU - Patel, V. DA - Jun DO - 10.1089/sur.2015.093 J2 - Surg. Infect. KW - BLOOD-STREAM INFECTION CARE THROMBOSIS RATES LINES Infectious Diseases Surgery LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: DN5MQ Times Cited: 5 Cited Reference Count: 16 Pernar, Luise I. M. Wolf, Lindsay L. Seshadri, Anupamaa Patel, Vihas Pernar, Luise I/ABC-9742-2020 Pernar, Luise I/0000-0002-2142-7252 6 0 3 MARY ANN LIEBERT, INC NEW ROCHELLE SURG INFECT PY - 2016 SN - 1096-2964 SP - 352-356 ST - Impact of a Surgeon-Led Peripherally Inserted Central Venous Catheter Team on Peripherally Inserted Central Venous Catheter-Related Complications and Costs T2 - Surgical Infections TI - Impact of a Surgeon-Led Peripherally Inserted Central Venous Catheter Team on Peripherally Inserted Central Venous Catheter-Related Complications and Costs UR - ://WOS:000377113200014 VL - 17 ID - 761705 ER - TY - JOUR AB - OBJECTIVE: In this case report we describe a successful interdisciplinary approach (including flow redirection and endovascular occlusion) applied to a patient with a continuously growing extracranial giant aneurysm of the right internal carotid artery (ICA) due to known Ehlers-Danlos syndrome. CASE PRESENTATION: A 42-year-old man with a continuously growing extracranial giant aneurysm of the right ICA sought treatment after failed surgery of a similar lesion of the left ICA. A multidisciplinary consultation was held at the end of 2008. TREATMENT STRATEGY: The treatment strategy consisted of flow redirection in order to secure sufficient cerebral perfusion prior to surgical trapping of the carotid aneurysm. Flow redirection was achieved by placement of a double-barrel extracranial-intracranial bypass. Subsequent surgical trapping failed due to the extreme size of the aneurysm, making certain identification of surrounding structures impossible. The aneurysm was then successfully occluded by neuroradiological intervention. In a further procedure, a large intra-aneurysmal hematoma was surgically removed to reduce the remaining bulging aneurysm sac. CONCLUSIONS: This case report describes a successful interdisciplinary approach for the treatment of a rare giant extracranial ICA aneurysm in a patient with Ehlers-Danlos syndrome. Treatment options for this type are few and carry high risks. Flow redirection via extracranial-intracranial bypass followed by endovascular occlusion appears to be a good treatment approach. AD - Department of Neurosurgery, Heinrich-Heine-University, Düsseldorf, Germany. AN - 22993245 AU - Perrin, J. M. AU - Turowski, B. AU - Steiger, H. J. AU - Hänggi, D. C2 - Pmc3812853 DA - Nov DO - 10.1136/neurintsurg-2012-010428 DP - NLM ET - 2012/09/21 J2 - Journal of neurointerventional surgery KW - Adult Angiography, Digital Subtraction Balloon Occlusion/*methods Carotid Artery Diseases/etiology/*surgery Cerebral Angiography Cerebrovascular Circulation Ehlers-Danlos Syndrome/*complications Embolization, Therapeutic/methods Endovascular Procedures/*methods Follow-Up Studies Humans Intracranial Aneurysm/etiology/*surgery Magnetic Resonance Angiography Male Neurosurgical Procedures Patient Care Team Subarachnoid Hemorrhage/surgery Treatment Outcome Aneurysm Blood Flow Coil Neck Technique LA - eng M1 - 6 N1 - 1759-8486 Perrin, Jason Michael Turowski, Bernd Steiger, Hans-Jakob Hänggi, Daniel Case Reports Journal Article J Neurointerv Surg. 2013 Nov;5(6):e40. doi: 10.1136/neurintsurg-2012-010428. Epub 2012 Sep 19. PY - 2013 SN - 1759-8478 (Print) 1759-8478 SP - e40 ST - Double-barrel extracranial-intracranial bypass surgery followed by endovascular carotid artery occlusion in a patient with an extracranial giant internal carotid artery aneurysm due to Ehlers-Danlos syndrome T2 - J Neurointerv Surg TI - Double-barrel extracranial-intracranial bypass surgery followed by endovascular carotid artery occlusion in a patient with an extracranial giant internal carotid artery aneurysm due to Ehlers-Danlos syndrome VL - 5 ID - 760522 ER - TY - JOUR AB - The treatment of ST-elevation myocardial infarction with primary percutaneous coronary intervention is a time-sensitive process, with outcomes correlated with the speed with which the healthcare team can make the diagnosis, start preliminary treatment, and successfully perform the intervention. This requires multidisciplinary teamwork involving Emergency Medical Services, Emergency Medicine and Nursing, the cardiac catheterization laboratory team, and interventional cardiology. The success of effectively delivering treatment is enhanced through focused analysis of key steps within the care process to identify systems problems and implement quality improvement initiatives. This article reviews the process whereby our institution achieved top decile performance in this multidisciplinary treatment. AD - Baystate Medical Center, Springfield, MA, USA. mark.peterman@bhs.org AN - 20618567 AU - Peterman, J. M. AU - Bisgaard, S. DA - Jul-Aug DO - 10.1111/j.1945-1474.2010.00079.x DP - NLM ET - 2010/07/14 J2 - Journal for healthcare quality : official publication of the National Association for Healthcare Quality KW - Analysis of Variance *Angioplasty, Balloon, Coronary Cardiac Catheterization Electrocardiography Emergency Service, Hospital/*organization & administration Humans Myocardial Infarction/diagnosis/*therapy Patient Care Team/*organization & administration *Quality Assurance, Health Care Time Factors Treatment Outcome LA - eng M1 - 4 N1 - Peterman, J Mark Bisgaard, Soren Journal Article United States J Healthc Qual. 2010 Jul-Aug;32(4):14-23. doi: 10.1111/j.1945-1474.2010.00079.x. PY - 2010 SN - 1062-2551 (Print) 1062-2551 SP - 14-23 ST - Door-to-balloon time: performance improvement in the multidisciplinary treatment of myocardial infarction T2 - J Healthc Qual TI - Door-to-balloon time: performance improvement in the multidisciplinary treatment of myocardial infarction VL - 32 ID - 760513 ER - TY - JOUR AB - Background: In our institution, a retrospective analysis of inferior vena cava (IVC) filter usage demonstrated attempted removal in only 60% of patients. We performed a prospective cohort study to determine if an IVC filter management program (IVCFP) will improve retrieval rates. Methods: Consecutive patients receiving a retrievable IVC filter were approached for study enrollment within 48 hours of placement. Consenting patients received a visible “IVC Filter Identification Wristband” and pre-printed orders were placed in each patient's chart indicating that the wristband can only be removed by physician order if: 1) the filter has been retrieved; 2) a decision to make the filter permanent has been discussed and agreed upon with the patient; or 3) the patient has been referred to the Thrombosis Clinic for filter follow-up after hospital discharge. Educational pamphlets and Thrombosis Clinic referral information were provided to the patient and care team. All patients were followed up to time of hospital discharge and to the end of the study if the filter was still in situ. Baseline demographics, dates of filter insertion and retrieval, and data on filter indication, documentation of a follow-up plan, reasons for non-retrieval, and all-cause mortality were extracted from electronic and paper medical records using standard forms. The primary outcome was the proportion of patients who underwent attempted filter retrieval. Secondary outcomes included the proportion of patients who had a successful retrieval and documentation of a filter management plan. Results were compared with a historical cohort of 275 patients who had filters placed between Jan 2007 and Dec 2010. Group characteristics were compared using 2-sided t-tests for continuous variables and Chi-squared analysis for categorical variables. Results: Between Nov 2011 and Dec 2013, 92 of 111 eligible patients consented to participate. Mean age was 57.3 years and 67.4% were male. Compared to historical patients, IVCFP patients were more likely to be male (64.7% vs. 54.5%; p=0.03), less likely to have a prior history of venous thromboembolism (7.6% vs. 18.5%; p=0.01) and more likely to have received a filter for an acute VTE with contraindication to anticoagulation (76.1% vs. 72.4%; p=0.03) (see Table). At the end of study in June 2014, total length of follow-up for filter retrieval was 14,823 patient-days (median 48.5; range 4-956). No patient was lost to follow-up. Compared to historical data, the IVCFP significantly improved the proportion of patients with attempted retrieval (73/92 [79.3%] vs. 165/275 [60.0%]; p=0.001), documentation of an IVC filter management plan (91.3% vs. 73.8%; p<0.001) and successful retrieval (72.8% vs. 53.1%; p=0.001). Two patients in the IVCFP cohort and 28 historical controls did not have an attempted retrieval despite no clear reason for the filter to remain in situ permanently (2% vs. 10%; p=0.01). Of the 25 patients discharged with a filter in-situ, 20 were referred to our Thrombosis Clinic and 17 had a retrieval attempt post-discharge. Conclusions: Implementation of an IVCFP - consisting of a patient identification wristband, educational materials and referral for outpatient follow-up - was associated with significant increases in attempted filter retrieval and successful filter retrieval. The IVCFP represents an effective and low cost strategy to improve the follow-up and outcomes of patients receiving retrievable IVC filters. (Table Presented). AD - J.C. Kritzinger, University of British Columbia, Vancouver, Canada AU - Peterson, E. A. AU - Yenson, P. R. AU - Kritzinger, J. C. AU - Lee, L. J. AU - Chi, J. AU - Liu, D. M. AU - Lee, A. Y. Y. DB - Embase KW - human prospective study vena cava filter tertiary health care injury American society hematology filter patient follow up documentation thrombosis hospital hospital discharge male cohort analysis anticoagulation outpatient patient identification venous thromboembolism physician Student t test medical record mortality L1 - http://www.bloodjournal.org/content/124/21/685 LA - English M1 - 21 M3 - Conference Abstract N1 - L71758033 2015-02-03 PY - 2014 SN - 0006-4971 ST - Prospective study of an inferior vena cava filter management pathway in a tertiary care and trauma centre T2 - Blood TI - Prospective study of an inferior vena cava filter management pathway in a tertiary care and trauma centre UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71758033&from=export VL - 124 ID - 761093 ER - TY - JOUR AB - Background: Nonspecific subjective adverse effects (NSAE), usually considered as related to a nocebo effect (NE), have been identified as a barrier to the acceptability of switches from biologic originators (BO) to biosimilars (BS). Objectives: To assess the efficacy of a multidisciplinary team intervention to reduce the NE among inflammatory arthritis (IA) patients concerned by systematic switch from originator Infliximab (OI) to the biosimilar infliximab (BI) SB2. Methods: The intervention was part of a multidisciplinary patient education (PE) program. It was developed in 4 steps. Step 1: we conducted first semi-directive qualitative interviews with 5 patients treated by other intravenous (IV) biologics. Interviews showed: fears about efficacy and toler-ability of BSs, need for information (particularly on the difference between BSs and generics), importance of sharing their experience of adverse effects (AE) with health practitioners (HP), and having the opportunity to switch back. The wish to discuss the nurses' own experience of BSs was prominent. Step 2: a meeting with the multidisciplinary team (3 rheu-matologists, 1 resident, 1 pharmacist, 3 nurses, 1 peer-patient from a patient's association) was set up for designing the intervention based on the interviews, on non-systematic literature review about switches and on patients' perspective regarding NE. Step 3: Consensual agreement on the intervention and the chosen pieces of language to be used by all HPs. The intervention included written and oral information by the nurses; nurse-led PE; if necessary, distribution of an informative leaflet made by the team. Step 4: Implementation of the intervention. The rheumatologist had the entire appreciation for discontinuing the BS or not. Inclusion criteria were all IA patients treated with OI. The primary outcome was SB2 retention rate (RT) at 34 weeks, secondary outcomes were the number of NSAEs leading to SB2 discontinuation; the comparison of the RT and NSAE rate of the cohort with 1) RT and NSAEs rate of a systematic switch from another Infliximab BS (CT-P13) to SB2 made at the same period in the same Rheumatology department 2) RT and NSAEs rate of switches in other published European cohorts (1,2,3). Results: Fourty-five patients were included from March 12th, 2018 to May 25 th, 2018, median follow up was 34 weeks, 17 rheumatoid arthritis (RA), 23 spondylarthritis (SpA) and 5 psoriatic arthritis (PSA) patients were included. Mean OI duration before switch was 9.4 years. The switch RT from OI to SB was 41/45 (91,2%) and NSAE (1/45). RT was significantly higher than in other European cohorts (p<0.05) (table 1). Reasons for discontinuation were uveitis (1); demyelinating disorder (1) and peripheral synovitis (1) already present before the switch; 1 patient had NSAE (increased fatigue and pain). During the same period, 18 patients switched from CT-P13 to SB2 with a RT of 12/18 (66,7%) and 1 NSAE. Conclusion: An intervention based on a multidisciplinary patient education team where nurses have a prominent role is effective in reducing the NE when switching from the originator infliximab to its biosimilar. [Figure Presented]. AD - J. Petit, Rheumatology Department APHP Saint-Antoine Hospital, Sorbonne Université, INSERM, PARIS, France AU - Petit, J. AU - Antignac, M. AU - Poilverd, R. M. AU - Dartout, S. AU - Baratto, R. AU - Louati, K. AU - Deparis, N. AU - Berenbaum, F. AU - Beauvais, C. DB - Embase DO - 10.1136/annrheumdis-2019-eular.7366 KW - biosimilar agent infliximab adult adverse event conference abstract controlled study demyelinating disease drug efficacy drug therapy drug withdrawal fatigue female follow up health practitioner human interview language male multidisciplinary team nocebo effect nurse outcome assessment pain patient education pharmacist psoriatic arthritis resident rheumatologist rheumatology spondylarthritis synovitis systematic review uveitis LA - English M3 - Conference Abstract N1 - L628860373 2019-08-13 PY - 2019 SN - 1468-2060 SP - 1447-1448 ST - How to reduce the nocebo effect when switching from originator infliximab to a biosimilar: Positive results of a multidisciplinary team intervention T2 - Annals of the Rheumatic Diseases TI - How to reduce the nocebo effect when switching from originator infliximab to a biosimilar: Positive results of a multidisciplinary team intervention UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628860373&from=export http://dx.doi.org/10.1136/annrheumdis-2019-eular.7366 VL - 78 ID - 760709 ER - TY - JOUR AB - Backround: Stroke etiology in young adults and older patient differs considerably, as epidemiology and clinical features varies according to geographical criteria. To improve clinical management and diagnostic work up of young adults with acute cerebrovascular events we analyzed retrospectively data of 6 years stroke unit case series. Methods:The Stroke Unit at S Camillo - Forlanini Hospital is a Hub Stroke Center, it is a 8 bed residential facility managed by a multidisciplinary team with 24 hours access to laboratory facility, neuroimaging, neurosurgery and cardiology services. Population served is 1,2 mil-lions living in both urban and rural area. Results: we enrolled 145 patient with acute cerebrovascular event aged 16 to 49. Risk factors for stroke and the distribution of acute cerebrovascular event and stroke subtype as well as length of stay and prognosis were studied: 70% of patients were admitted for acute ischemic event (45 female-F, 57 male-M), 10,5 % intracranial hemorrhages (5 F 10 M) 2,7% subarachnoid hemorrhage (2F 2 M) , 2% venous sinus thrombosis (3F), 14,5 for acute ischemic attack (F12, M9). Among ischemic stroke patient the etiology was as follows: atherothrombosis 29.4% , cardioembolism 19,6%, arterial dyssection 13,7%, other determined causes 8,8%, lacunar stroke 5,8%, Moyamoya disease was diagnosed in one case, and undetermined causes 22,54%. Fifteen % (15) of ischemic young patients was treated with r-TPA. Stroke severity at admission was 4,9 NIHSS (5,80 man, 4,12 woman) and at discharge 2,03 (2,48 man and 1,58 woman). PFO was diagnosed in 14 patients, 5 underwent closing procedure. Patients majority returned home when discharged. Conclusion:stroke etiology in young and older adults are diverse, with a prominence of “unknown” and “other determined” causes, and an overall favorable outcome in the younger patients. In our case series we could identify stroke etiology in almost 80% patients; atherothrombosis was the most common caused this maybe due to the age-limit (49) and depend on the definition of “young”. We choose 49 as a compromise between literature data and Italian ageing life expectancy. AD - F.R. Pezzella, Stroke Unit, S Camillo Forlanini Hospital, Rome, Italy AU - Pezzella, F. R. AU - Anticoli, S. AU - Caso, V. AU - Pozzessere, C. DB - Embase DO - 10.1159/000339538 KW - cerebrovascular accident stroke unit community hospital case study young adult human patient etiology male female thrombosis diagnosis length of stay clinical feature rural area lion population epidemiology transient ischemic attack brain ischemia risk factor stroke patient prognosis cerebral sinus thrombosis cardiology sinus venosus neurosurgery neuroimaging subarachnoid hemorrhage laboratory brain hemorrhage aging procedures moyamoya disease lacunar stroke residential home hospital adult life expectancy National Institutes of Health Stroke Scale LA - English M3 - Conference Abstract N1 - L71637528 2014-10-31 PY - 2012 SN - 1015-9770 SP - 643-644 ST - Stroke in the young adult: 6 year case series of community hospital stroke unit T2 - Cerebrovascular Diseases TI - Stroke in the young adult: 6 year case series of community hospital stroke unit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71637528&from=export http://dx.doi.org/10.1159/000339538 VL - 33 ID - 761207 ER - TY - JOUR AB - Objectives. The purpose of this study was to report a series of 16 consecutive patients who underwent laparoscopic treatment of splenic artery aneurysms. Methods. Over a period of 8 years, patients were selected for the laparoscopic option by a team of specialists that included the vascular surgeon, the interventional radiologist, and the laparoscopic surgeon. The mean size of the aneurysm was 32 mm and most was located at the splenic hilum. They were twice as common in females as in males. Ultrasonography with color Doppler function was used to define intraoperative strategy. Results. The laparoscopic treatment entailed excision of the aneurysm or its exclusion, usually reserved for distally located lesions. In one patient, laparoscopic resection and robotic anastomosis of the splenic artery was performed to re-establish flow to the spleen. In two patients, the intraoperative decision was added to combine a laparoscopic splenectomy due to insufficient residual arterial flow to the spleen. There was no conversion, or need for re-operation or related mortality. Analysis of intraoperative arterial flow data avoided unnecessary splenectomy following noncritical reduction of flow to the spleen. Conclusions: The use of intraoperative color Doppler ultrasonography is essential in deciding the appropriate procedure and whether the spleen should be removed or saved. Early control of the splenic artery proximal to the aneurysm can limit the risk of conversion due to intraoperative bleeding. Distally located aneurysms are more difficult to manage and entail a higher risk of associated splenectomy. The laparoscopic option offers some advantages over the endovascular treatment in selected patients. A multidisciplinary approach is the key to a successful treatment of this uncommon disease. (J Vasc Surg 2009;50:275-9.) AD - [Pietrabissa, Andrea; Morelli, Luca; Pugliese, Luigi; Mosca, Franco] Univ Pisa, Div Chirurg Univ 1, I-56124 Pisa, Italy. [Ferrari, Mauro; Berchiolli, Raffaella] Univ Pisa, Div Chirurg Vasc, I-56124 Pisa, Italy. [Ferrari, Vincenzo] Univ Pisa, ENDOCAS, Ctr Comp Assisted Surg, I-56124 Pisa, Italy. Pietrabissa, A (corresponding author), Univ Pisa, Dipartimento Oncol Trapianti & Nuove Tecnol Med, Div Chirurg Gen & Trapianti, Sez Chirurg Mininvasiva,Osped Cisanello, Via Paradisa 2, I-56124 Pisa, Italy. apietrab@med.unipi.it AN - WOS:000268610000006 AU - Pietrabissa, A. AU - Ferrari, M. AU - Berchiolli, R. AU - Morelli, L. AU - Pugliese, L. AU - Ferrari, V. AU - Mosca, F. DA - Aug DO - 10.1016/j.jvs.2009.03.015 J2 - J. Vasc. Surg. KW - ENDOVASCULAR MANAGEMENT EMBOLIZATION PSEUDOANEURYSMS COMPLICATIONS SPLENECTOMY RESECTION LIGATION REPAIR Surgery Peripheral Vascular Disease LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 478TA Times Cited: 32 Cited Reference Count: 29 Pietrabissa, Andrea Ferrari, Mauro Berchiolli, Raffaella Morelli, Luca Pugliese, Luigi Ferrari, Vincenzo Mosca, Franco Ferrari, Mauro/K-3270-2018; Ferrari, Vincenzo/H-9908-2015; Morelli, Luca/U-7017-2019; Pugliese, Luigi/AAC-1168-2019; Pietrabissa, Andrea/AAC-9894-2019 Ferrari, Mauro/0000-0001-7042-0236; Ferrari, Vincenzo/0000-0001-9294-2828; Morelli, Luca/0000-0002-7742-9556; Pugliese, Luigi/0000-0002-0537-4787; Pietrabissa, Andrea/0000-0001-9703-7587; Berchiolli, Raffaella Nice/0000-0001-5307-7157 34 0 3 MOSBY-ELSEVIER NEW YORK J VASC SURG PY - 2009 SN - 0741-5214 SP - 275-279 ST - Laparoscopic treatment of splenic artery aneurysms T2 - Journal of Vascular Surgery TI - Laparoscopic treatment of splenic artery aneurysms UR - ://WOS:000268610000006 VL - 50 ID - 761893 ER - TY - JOUR AB - Pulmonary hypertension (PH) is responsible for substantial morbidity and mortality worldwide. It is important for the clinician to determine the cause and the severity of the PH as the treatment may vary considerably. Except when lung or heart lung transplantation is considered, chronic thromboembolic pulmonary hypertension (CTEPH) is the only form of potentially surgically curable PH, thus, its recognition is crucial. Pulmonary endarterectomy (PEA) is the treatment of choice. Careful pre-and post-operative management is essential for a successful outcome following PEA. In 1994 the 'Pavia Pulmonary Endarterectomy Program' was established at the Fondazione IRCCS Policlinico San Matteo - University of Pavia, Italy, in which members of a multidisciplinary team involving 11 units work in close interaction with the aim of increase experience in the challenging problems these patients present in the evaluative, surgical, and post-operative phases of their care. Ever since, our series has steadily grown and patients are now referred nationally and internationally. So far, 216 PEAs have been performed. Preoperatively, New York Heart Association (NYHA) class distribution was respectively 9-II, 90-III, and 117-IV; mean pulmonary artery pressure and pulmonary vascular resistances were 47 ± 13 mmHg and 1149 ± 535 dynes/sec/cm-5 respectively. The overall operative mortality has been 9.3% (in 2008 mortality rate was 2.9%). At present, 92% of the PEA patients are actively participating in the follow-up study. Follow-up visits are at 3 months after PEA, yearly for the following 5 years, and then at 7, 10, and 15 years postoperatively. Survival rate at 3 months, 1 year, and 3 years were respectively of 89.5 ± 2.7%, 87.3 ± 3.0%, and 82.7 ± 3.6%. Survival rates had not changed at 5, 7, and 10 years postoperative. Three months after PEA, 29 (58%) subjects were within NYHA class I, 18 (36%) in class II, and 3 (6%) in class III. At 1-year follow-up, 40 (80%) patients were within NYHA class I, 10 (20%) in class II. A statistically significant difference exists not only between the preoperative and the postoperative data (P < 0.0001), but also between the functional status at 3 months and the other two postoperative controls (P < 0.001). AD - F. Piovella, U.O. Angiologia - Malattie Tromboemboliche, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy AU - Piovella, F. AU - Armini, A. M. D. AU - Barone, M. AU - Emmi, V. AU - Beltrametti, C. AU - Viganó, M. DB - Embase DO - 10.1111/j.1538-7836.2009.03473-1.x KW - endarterectomy patient pulmonary hypertension thrombosis thromboembolism society hemostasis follow up mortality pH survival rate pea functional status morbidity lung heart lung transplantation university Italy United States heart lung artery pressure lung vascular resistance surgical mortality LA - English M1 - S2 M3 - Conference Abstract N1 - L70049722 2010-02-19 PY - 2009 SN - 1538-7933 SP - 7 ST - The pavia endarterectomy program for the management of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) T2 - Journal of Thrombosis and Haemostasis TI - The pavia endarterectomy program for the management of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70049722&from=export http://dx.doi.org/10.1111/j.1538-7836.2009.03473-1.x VL - 7 ID - 761274 ER - TY - JOUR AB - The HIT Expert Probability (HEP) score compared favorably with the 4Ts score in a retrospective study. We assessed the diagnostic accuracy of the HEP score compared with the 4Ts score in a prospective cohort of 310 patients with suspected heparin-induced thrombocytopenia (HIT). A member of the clinical team calculated the HEP score and 4Ts score. An independent panel adjudicated HIT status based on a clinical summary as well as the results of HIT laboratory testing. The prevalence of HIT in the study population was 14.7%. At a cutoff of >= 3 the HEP score was 95.3% sensitive (95% confidence interval [CI], 84.2-99.4) and 35.7% specific (95% CI, 29.8-42.0) for HIT. A 4Ts score of >= 4 had a sensitivity of 97.7% (95% CI, 86.2-99.8) and specificity of 32.9% (95% CI, 27.2-39.1). The areas under the receiver operating characteristic (ROC) curves (AUCs) for the HEP score and 4Ts score were similar (0.81 [95% CI, 0.74-0.87] vs 0.76 [95% CI, 0.69-0.83]; P = .12). The HEP score exhibited a significantly higher AUC than the 4Ts score in patients in the intensive care unit (ICU) (0.86 vs 0.79; P = .03). Among trainee scorers, the HEP score performed significantly better than the 4Ts score (AUC, 0.80 vs 0.73; P = .03). Our data suggest that either the 4Ts score or the HEP score may be used in clinical practice. The HEP score may be preferable in ICU patients and among less experienced clinicians. AD - [Pishko, Allyson M.; Lefler, Daniel S.; Vega, Rolando; Cines, Douglas B.; Cuker, Adam] Univ Penn, Dept Med, Perelman Sch Med, Philadelphia, PA 19104 USA. [Fardin, Sara] Jersey Shore Univ, Dept Med, Med Ctr, Neptune, NJ USA. [Paydary, Koosha] John H Stronger Jr Hosp Cook Cty, Dept Internal Med, Chicago, IL USA. [Arepally, Gowthami M.] Duke Univ, Dept Med, Div Hematol, Durham, NC USA. [Crowther, Mark] McMaster Univ, Dept Med, Hamilton, ON, Canada. [Rice, Lawrence] Weill Cornell Med Coll, Dept Med, Houston, TX USA. [Cines, Douglas B.; Cuker, Adam] Univ Penn, Dept Pathol & Lab Med, Perelman Sch Med, Philadelphia, PA USA. Cuker, A (corresponding author), Hosp Univ Penn, 3400 Spruce St, Philadelphia, PA 19104 USA. adam.cuker@uphs.upenn.edu AN - WOS:000451417500009 AU - Pishko, A. M. AU - Fardin, S. AU - Lefler, D. S. AU - Paydary, K. AU - Vega, R. AU - Arepally, G. M. AU - Crowther, M. AU - Rice, L. AU - Cines, D. B. AU - Cuker, A. DA - Nov DO - 10.1182/bloodadvances.2018023077 J2 - Blood Adv. KW - EXPERT PROBABILITY SYSTEM Hematology LA - English M1 - 22 M3 - Article N1 - ISI Document Delivery No.: HB9ND Times Cited: 9 Cited Reference Count: 18 Pishko, Allyson M. Fardin, Sara Lefler, Daniel S. Paydary, Koosha Vega, Rolando Arepally, Gowthami M. Crowther, Mark Rice, Lawrence Cines, Douglas B. Cuker, Adam Pishko, Allyson/0000-0001-9997-454X; Arepally, Gowthami/0000-0003-0496-5064 National Institutes of Health, National Heart, Lung, and Blood InstituteUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [T32-HL007971-16A1, K23-HL112903]; 2018 Hemostasis and Thrombosis Research Society (HTRS)/Novo Nordisk Clinical Fellowship Award in Hemophilia and Rare Bleeding Disorders from the HTRS; Novo Nordisk Inc.Novo Nordisk This work was supported by the National Institutes of Health, National Heart, Lung, and Blood Institute (T32-HL007971-16A1 [A.M.P.] and K23-HL112903 [A.C.]). A.M.P. was also supported by a 2018 Hemostasis and Thrombosis Research Society (HTRS)/Novo Nordisk Clinical Fellowship Award in Hemophilia and Rare Bleeding Disorders from the HTRS, which was supported by an educational grant from Novo Nordisk Inc. 9 0 AMER SOC HEMATOLOGY WASHINGTON BLOOD ADV PY - 2018 SN - 2473-9529 SP - 3155-3162 ST - Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia T2 - Blood Advances TI - Prospective comparison of the HEP score and 4Ts score for the diagnosis of heparin-induced thrombocytopenia UR - ://WOS:000451417500009 VL - 2 ID - 761558 ER - TY - JOUR AB - Objectives: Infective endocarditis (IE) and cardiac device infection (CDI) are a major complication in the growing number of patients with congenital heart disease (CHD) reaching adulthood. We aimed to evaluate the added value of F-18-FDG-PET/CT angiography (PET/CTA) in the diagnosis of IE-CDI in adults with CHD and intravascular or intracardiac prosthetic material, in whom echocardiography (ECHO) and modified Duke Criteria (DC) have limitations because of the patients' complex anatomy. Methods: A prospective study was conducted in a referral center with multidisciplinary IE and CHD Units. PET/CTA and ECHO findings were compared in consecutive adult (>= 18 years) patients with CHD who have prosthetic material and suspected IE-CDI. The initial diagnosis using the DC and the diagnosis with the additional PET/CTA data (DC + PET/CTA) were compared with the final diagnostic consensus established by an expert team at three months. Results: Between November-2012 and April-2017, 25 patients (15 men; median age 40 years) were included. Cases were initially classified as definite in 8 (32%), possible in 14 (56%) and rejected in 3 (12%). DC + PET/CTA allowed reclassification of 12/14 (86%) cases initially identified as possible IE. The sensitivity, specificity, PPV, NPV, and accuracy of DC at IE suspicion were 39.1%/83.3%/90.4%/25.5%/61.2%, respectively. The diagnostic performance increased significantly with addition of PET/CTA data: 87%/83.3%/95.4%/61.5%/85.1%, respectively. PET/CTA also provided an alternative diagnosis in 3 patients with rejected IE, and detected pulmonary embolisms in 3 patients. Conclusions: PET/CTA was a useful diagnostic tool in the complex group of adult patients with CHD who have cardiac or intravascular prosthetic material and suspected IE or CDI, providing added diagnostic value to the modified DC (increased sensitivity) and improving case classification. (C) 2017 Elsevier B.V. All rights reserved. AD - [Pizzi, Maria N.; Dos-Subira, L.; Pijuan Domenech, Antonia; Gonzalez-Alujas, Maria T.; Miranda-Barrio, B.; Ferreira-Gonzalez, Ignacio; Garcia-Dorado, David; Tornos, Pilar] Hosp Univ Vall Hebron, Dept Cardiol, Barcelona, Spain. [Roque, Albert; Cuellar-Calabria, Hug; Escobar Amores, Manuel] Hosp Univ Vall Hebron, Dept Radiol, Barcelona, Spain. [Fernandez-Hidalgo, Nuria; Almirante, Benito] Hosp Univ Vall Hebron, Dept Infect Dis, Barcelona, Spain. [Igual, Albert] Hosp Univ Vall Hebron, Dept Cardiac Surg, Barcelona, Spain. [Castell-Conesa, Joan; Aguade-Bruix, Santiago] Hosp Univ Vall Hebron, Dept Nucl Med, Barcelona, Spain. [Gonzalez-Lopez, Juan J.] Hosp Univ Vall Hebron, Dept Microbiol, Barcelona, Spain. [Gonzalez-Lopez, Juan J.; Maisterra-Santos, Olga] Hosp Univ Vall Hebron, Dept Neurol, Barcelona, Spain. [Roque, Albert; Cuellar-Calabria, Hug; Gonzalez-Lopez, Juan J.; Castell-Conesa, Joan; Escobar Amores, Manuel] IDI, Barcelona, Spain. [Pizzi, Maria N.; Dos-Subira, L.; Roque, Albert; Fernandez-Hidalgo, Nuria; Cuellar-Calabria, Hug; Subirana-Domenech, M. T.; Ferreira-Gonzalez, Ignacio; Gonzalez-Lopez, Juan J.; Garcia-Dorado, David; Castell-Conesa, Joan; Almirante, Benito; Tornos, Pilar; Aguade-Bruix, Santiago] Univ Autonoma Barcelona, Barcelona, Spain. [Fernandez-Hidalgo, Nuria; Ferreira-Gonzalez, Ignacio; Almirante, Benito] CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain. [Dos-Subira, L.; Fernandez-Hidalgo, Nuria; Pijuan Domenech, Antonia; Subirana-Domenech, M. T.; Miranda-Barrio, B.; Almirante, Benito] Vall Hebron Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain. [Dos-Subira, L.; Fernandez-Hidalgo, Nuria; Pijuan Domenech, Antonia; Subirana-Domenech, M. T.; Miranda-Barrio, B.; Almirante, Benito] St Pau Univ Hosp, Integrated Adult Congenital Cardiac Unit, Barcelona, Spain. [Dos-Subira, L.; Fernandez-Hidalgo, Nuria; Garcia-Dorado, David; Almirante, Benito] CIBERCV, Murcia, Spain. [Fernandez-Hidalgo, Nuria; Almirante, Benito] REIPI, Seville, Spain. Pizzi, MN (corresponding author), Univ Autonoma Barcelona, Dept Cardiol, Hosp Univ Vall Hebron, VHIR, Passeig Vall Hebron 119-129, Barcelona 08035, Spain. nachi_pizzi@yahoo.com.ar AN - WOS:000411439900074 AU - Pizzi, M. N. AU - Dos-Subira, L. AU - Roque, A. AU - Fernandez-Hidalgo, N. AU - Cuellar-Calabria, H. AU - Domenech, A. P. AU - Gonzalez-Alujas, M. T. AU - Subirana-Domenech, M. T. AU - Miranda-Barrio, B. AU - Ferreira-Gonzalez, I. AU - Gonzalez-Lopez, J. J. AU - Igual, A. AU - Maisterra-Santos, O. AU - Garcia-Dorado, D. AU - Castell-Conesa, J. AU - Almirante, B. AU - Amores, M. E. AU - Tornos, P. AU - Aguade-Bruix, S. DA - Dec DO - 10.1016/j.ijcard.2017.08.008 J2 - Int. J. Cardiol. KW - Congenital cardiac disease Infective endocarditis F-18-FDG-PET/CT Prosthetic material Cardiac computed tomography Adult EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY VALVE ENDOCARDITIS FOLLOW-UP ECHOCARDIOGRAPHY MORBIDITY SPECTRUM Cardiac & Cardiovascular Systems LA - English M3 - Article N1 - ISI Document Delivery No.: FH8JG Times Cited: 15 Cited Reference Count: 27 Pizzi, Maria N. Dos-Subira, L. Roque, Albert Fernandez-Hidalgo, Nuria Cuellar-Calabria, Hug Pijuan Domenech, Antonia Gonzalez-Alujas, Maria T. Subirana-Domenech, M. T. Miranda-Barrio, B. Ferreira-Gonzalez, Ignacio Gonzalez-Lopez, Juan J. Igual, Albert Maisterra-Santos, Olga Garcia-Dorado, David Castell-Conesa, Joan Almirante, Benito Escobar Amores, Manuel Tornos, Pilar Aguade-Bruix, Santiago Gonzalez-Lopez, Juanjo/C-5366-2014 Gonzalez-Lopez, Juanjo/0000-0003-2419-5909; Almirante, Benito/0000-0002-1189-2361; Cuellar-Calabria, Hug/0000-0003-2197-4990; Albert, Roque/0000-0001-9738-3850; Fernandez-Hidalgo, Nuria/0000-0002-2115-344X; Miranda, Berta/0000-0003-1617-1050 Integrated Excellence Project [PIE-0013]; Plan Nacional de I + D + i; Instituto de Salud Carlos IIIInstituto de Salud Carlos III [RECAVA RD16/0042/0021, REIPI RD16/0016/0003]; European Development Regional Fund (FEDER) This study was partially funded by the Integrated Excellence Project PIE-0013 and supported by Plan Nacional de I + D + i 2013-2016 and networks for cooperative research on cardiovascular (RECAVA RD16/0042/0021) and infectious diseases (REIPI RD16/0016/0003) of Instituto de Salud Carlos III, and co-financed by the European Development Regional Fund (FEDER) 2014-2020, "A way to achieve Europe", Operative program Intelligent Growth 2014-2020. 15 0 21 ELSEVIER IRELAND LTD CLARE INT J CARDIOL PY - 2017 SN - 0167-5273 SP - 396-402 ST - F-18-FDG-PET/CT angiography in the diagnosis of infective endocarditis and cardiac device infection in adult patients with congenital heart disease and prosthetic material T2 - International Journal of Cardiology TI - F-18-FDG-PET/CT angiography in the diagnosis of infective endocarditis and cardiac device infection in adult patients with congenital heart disease and prosthetic material UR - ://WOS:000411439900074 VL - 248 ID - 761621 ER - TY - JOUR AB - Introduction: Studies have demonstrated an increase in adverse pregnancy outcomes in women with congenital heart disease. We sought to examine the association of maternal congenital heart disease (CHD) with the risk of severe maternal morbidity and mortality (SMM) compared to women without congenital heart disease. Methods: This retrospective cross-sectional study used 2008 through 2012 New York City (NYC) birth certificates linked to hospital discharge data to identify delivery hospitalizations. Cases of SMM were identified using ICD-9 diagnosis and procedure codes based on the Center for Disease Control and Prevention criteria. Data were limited to singleton, live births. CHD included women with any vascular, septal, or valvular abnormality of the heart at birth. Multivariable logistic regression was used to evaluate SMM in women with CHD adjusting for maternal demographics, socioeconomic status, and medical comorbidities. Results: From 2008 through 2012 there were 578,840 live singleton births in NYC, 347 of these births were to women with CHD (6/10,000). Acute renal failure, adult respiratory distress syndrome, thrombotic embolism, cardiac arrest/ventricular fibrillation, pulmonary edema/heart failure, conversion of cardiac rhythm, and transfusion were all independently associated with CHD. Women who had CHD had higher adjusted odds of SMM(aOR 2.43; 95% CI 1.60-3.70) compared to women without CHD after adjusting for maternal socioeconomic status, demographics and medical comorbidities. There was one maternal death. Conclusion: SMM is increased in women with CHD, even after adjusting for co-morbid conditions. It is important that these women receive care from an identified multidisciplinary team from precon-ception to postpartum to optimize pregnancy outcomes. AD - M. Platner, Yale University School of Medicine, New Haven, CT, United States AU - Platner, M. AU - Lipkind, H. S. AU - Campbell, K. DB - Embase KW - acute kidney failure adult adult respiratory distress syndrome birth certificate comorbidity conference abstract congenital heart disease congenital heart malformation controlled study cross-sectional study diagnosis disease control embolism female heart rhythm heart ventricle fibrillation hospital discharge hospitalization human ICD-9 live birth lung edema maternal death maternal morbidity mortality New York pregnancy outcome retrospective study social status thrombosis LA - English M3 - Conference Abstract N1 - L622555293 2018-06-19 PY - 2018 SN - 1873-233X SP - 199S ST - Severe maternal morbidity and mortality in women with congenital heart disease T2 - Obstetrics and Gynecology TI - Severe maternal morbidity and mortality in women with congenital heart disease UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622555293&from=export VL - 131 ID - 760826 ER - TY - JOUR AB - Objective: Research within a multidisciplinary team (surgeon, cardiologist, engineer) in order to asses new approaches in terms of design and materials for partial ventricular assist devices (VAD) characterized by endovascular and minor surgery implantation. Materials and Methods: We designed a new device for endovascular and minor surgery implantation based upon the analysis of present VAD in terms of addressability, complexity of the intervention and postoperative evolution of the patient. Results: New approaches in design and materials seem to be the solution for the inconveniences of existing devices. The evolution of partial VAD with endovascular implantation from the classical VAD significantly increased the patient's addressability and the success of the intervention. However, the problem of infectious risk and damage of the blood cells still remain. Our experience in the fields of heart surgery, cardiology and interventional cardiology set the boundaries for designing a new VAD. Accomplishments: We have created a prototype based on an innovative design where the blood does not circulate through the space between the rotor and the stator of the motor, avoiding centrifugation and sudden changes in flow direction. New materials developed for mechanical valves will be used. Due to its minimal invasiveness this PVAD might be used in earlier stages of heart failure with a huge potential benefit in terms of survival and quality of life. (Figure Presented). AD - A.F. Plesoianu, University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania AU - Plesoianu, A. F. AU - Plesoianu, C. E. AU - Tinica, G. DB - Embase DO - 10.1177/2048872615599730 KW - ventricular assist device human implantation devices patient minor surgery cardiology quality of life survival heart failure centrifugation risk blood heart surgery donkey blood cell cardiologist surgeon LA - English M3 - Conference Abstract N1 - L72155257 2016-01-16 PY - 2015 SN - 2048-8726 SP - 36 ST - Innovation in materials and design for ventricular assist device T2 - European Heart Journal: Acute Cardiovascular Care TI - Innovation in materials and design for ventricular assist device UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72155257&from=export http://dx.doi.org/10.1177/2048872615599730 VL - 4 ID - 761058 ER - TY - JOUR AB - Learning Objectives: Pulmonary embolism (PE) is a common and potentially fatal disease. The morbidity and mortality associated with PE can be mitigated by rapid diagnosis, risk stratification, and initiation of appropriate therapy. An important step in the risk stratification of patients is making the diagnosis of right ventricular strain. This study sought to evaluate the ability of focused critical care echocardiography (FCCE) performed by critical care fellows in a tertiary care teaching hospital to diagnose RV strain in patients with sub-massive PE. Methods: A retrospective observational study of patients for whom the hospital Pulmonary Embolism Response Team was consulted from September 1, 2015 to April 30, 2016. FCCE findings, comprehensive echocardiography (CE) findings, and time from initial identification of PE to FCCE and CE results were abstracted from the medical record. Results: 37 patients were included in the study. Of these patients 12 underwent both FCCE performed by a critical care fellow and CE while 22 were evaluated by CE alone. 23 of the 34 patents who were evaluated by CE were found to have RV strain (67.6%). RV strain was correctly identified on 10 FCCE studies (PPV 90.91%; 95% CI 58.72%-99.77%). Absence of RV strain was correctly identified on one FCCE study. One FCCE study incorrectly identified RV strain (false positive). There were no false negative FCCE studies. The average time from identification of PE to CE results was 11 hours (range 0-58 hours) while the majority of FCCE studies were completed at the time of the initial ICU history and physical (range 0-4 hours). Conclusions: This study suggests that FCCE performed by critical care fellows in a teaching hospital may be an appropriate tool for the identification of RV strain in patients with submassive pulmonary embolism. FCCE can be performed at the time of diagnosis and in this study would provide crucial risk stratification information an average of 11 hours sooner than CE. Further research is needed to verify these findings and determine the negative predictive value of FCCE in this setting. AD - M. Plisco AU - Plisco, M. AU - Elkambergy, H. AU - Mickey, W. AU - Kasal, J. AU - Westfall, S. AU - Schloss, T. AU - Karpman, C. DB - Embase DO - 10.1097/01.ccm.0000508849.14617.56 KW - clinical article diagnosis diagnostic test accuracy study echocardiography heart right ventricle human intensive care lung embolism medical record observational study patent predictive value stratification teaching hospital tertiary health care LA - English M1 - 12 M3 - Conference Abstract N1 - L613522284 2016-12-08 PY - 2016 SN - 1530-0293 SP - 119 ST - Focused critical care echocardiography for the diagnosis of right ventricular strain in PE T2 - Critical Care Medicine TI - Focused critical care echocardiography for the diagnosis of right ventricular strain in PE UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613522284&from=export http://dx.doi.org/10.1097/01.ccm.0000508849.14617.56 VL - 44 ID - 760983 ER - TY - JOUR AB - Objective: Peripheral blood stem cell transplant (PBSCT) can now cure SCD in adults, but may result in a loss of future fertility. Little is documented regarding fertility preservation in women with SCD. The aim of this study was to perform fertility preservation for women with SCD scheduled for PBSCT. Design: Prospective cohort of women with SCD undergoing fertility preservation prior to PBSCT at a large research hospital. Materials and Methods: Patients underwent standard controlled ovarian hyperstimulation (COH) using an antagonist protocol cycle with leuprolide trigger under close multidisciplinary (including reproductive endocrinologists and hematologists) monitoring. All patients were continued on therapeutic or started on prophylactic anticoagulation prior to beginning COH, and maintained on hydroxyurea. Results: Nine reproductive aged women were screened; 1 declined participation, 1 was diagnosed with unrecognized premature ovarian insufficiency, 1 had her fertility preservation cycle canceled due to poor response to fertility medications and 2 patients are scheduled for upcoming cycles. The remaining four women (ages 20, 34, 24, 27) successfully underwent COH, transvaginal oocyte retrieval and cryopreservation of mature eggs (n= 8, 13, 15, 21 oocytes, respectively). The third patient underwent two cycles due to low mature oocyte yield from her initial cycle. Headaches were reported by patients 1 and 2 following gonadotropin injections, with a negative neurologic workup including MRI in patient 2. Patient 3 underwent an exchange transfusion on day 10 of stimulation, which did not adversely impact serum reproductive hormone levels. Patients 3 and 4 reported an acute exacerbation of their chronic pain during COH, which responded well to intravenous fluids, IV and oral pain medications. Therefore, despite severe SCD and co-morbid conditions, the side effects were manageable. There were no venous thrombotic events. Conclusion: These results provide support that fertility preservation can be safely performed in women with SCD under the care of a multidisciplinary team. The safest stimulation protocol (i.e. antagonist cycle with leuprolide trigger for final oocyte maturation) was successful in all patients despite multiple risk factors for failed leuprolide trigger. Fertility preservation is important not only before PBSCT to cure their underlying disease, but also because of high rates of premature ovarian insufficiency in the SCD population post-transplant. AD - T.C. Plowden, NICHD, NIH, PRAE, Bethesda, MD, United States AU - Plowden, T. C. AU - Millan, N. M. AU - Owen, C. M. AU - Healy, M. W. AU - Banks, N. K. AU - Hsieh, M. AU - Fitzhugh, C. D. AU - Witmyer, J. AU - Peak, D. AU - Frankfurter, D. AU - DeCherney, A. H. AU - Tisdale, J. F. AU - Wolff, E. F. DB - Embase KW - leuprorelin gonadotropin hydroxyurea infusion fluid female human sickle cell anemia American society hematology fertility preservation patient oocyte fertility premature ovarian failure transplantation stimulation drug therapy adult hematologist endocrinologist monitoring headache peripheral blood stem cell cryopreservation oocyte retrieval ovary hyperstimulation egg population risk factor oocyte maturation injection hospital patient exchange blood transfusion serum side effect mouth pain anticoagulation chronic pain hormone determination hospital nuclear magnetic resonance imaging L1 - http://www.bloodjournal.org/content/126/23/3408 LA - English M1 - 23 M3 - Conference Abstract N1 - L72174100 2016-02-08 PY - 2015 SN - 0006-4971 SP - 3408 ST - Fertility preservation for women with sickle cell disease (SCD) T2 - Blood TI - Fertility preservation for women with sickle cell disease (SCD) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72174100&from=export VL - 126 ID - 761048 ER - TY - JOUR AB - Introduction: Auto-FVIII antibody inhibitors may be appear in both, pregnancy and SLE. Pregnancy can worsen the lupus disease process, and in 50 to 60% of cases is associated with a clinical flare manifesting as renal or/and hematological symptoms. Methods: A 23 year old female, with an 5-year history of SLE suffered since 26 Jan 2011 from severe abdominal pain. On 28 Jan 2011 she was diagnosed as being 7 weeks pregnant. Results: The ultrasound revealed presence of three haematomas: one in the region of left kidney (120 × 77 mm), and two on both sides of uterus [on left side (59 × 53 mm) and on right side (45 × 35 mm), respectively].Laboratory tests showed: Hb 5.2 g/dL, RBC 2.09 T/L, HCT-17.4%, WBC- 8.59 G/L, PLT-255 G/L. Proteinuria-100 mg/dL. Coagulation tests revealed isolated prolongation of the activated partial thromboplastin time (aPTT) = 94 s (25-37 s). FVIII activity was found to be reduced to 1.33%. Autoantibody against FVIII has a high titre 10.24 BU/mL. As our patient had acute major bleeds and the inhibitor titer was >5 BU she was treated with “bypassing agent” recombinant factor VIIa concentrate (intravenous bolus of 90-120 lg/kg rVIIa, repeated every 2-3 h, depending on clinical response), packed red blood cells, corticosteroids, ciclosporin (CsA) 250 mg/day monitored by CsA blood level, antibiotics, antifibrinolytic agents, nonopioid plus opioid analgesics, and she was given constant psychological support. On 6 Feb 2011 the laboratory findings showed HGB was 8.8 g/dL, RBC-3.13 T/L, HCT 27%, WBC-5.86 G/L, PLT-354 G/L. APTT- 91.16 s, FVIII-0.85%, and FVIII inhibitor-7.36 BU/ mL. Induced abortion was performed on 8 Feb 201. On that day, and for next 48 h patient was infused with rVIIa concentrate (6 mg every 2 h). Thereafter her treatment was continued with rVIIA (in modified dosage), corticosteroids, CsA and chloroquine.The inhibitor level was decreased gradually: on 3 March 2011 was 2.88 BU/mL, and was resolved on 13 March 2011 with an improvement in FVIII activity up to 22%). There has been no recurrence of the disease after 20-months follow-up due to treatment with methyloprednisolon, CsA, and chloroquine. Discussion/Conclusion: Diagnosis and therapy of our patient represent one of the most challenging clinical situations as she had major bleeding due to FVIII inhibitor being pregnant in the active state of SLE. In conclusion, where intervention is necessary in patient with acquired haemophilia it required the most experienced and dedicated multidisciplinary team. AD - M. Podolak-Dawidziak, Rheumatology and Internal Medicine, Medical University, Wrocław, Poland AU - Podolak-Dawidziak, M. AU - Sebastian, A. AU - Mezdras̈, E. AU - Zborowski, M. AU - Mizerskaskóra, M. AU - Wiland, P. AU - Zimmer, M. AU - Kuliczkowski, K. DB - Embase DO - 10.1111/hae.12083 KW - corticosteroid autoantibody chloroquine narcotic analgesic agent antifibrinolytic agent antibiotic agent cyclosporine recombinant blood clotting factor 7a antibody hemophilia systemic lupus erythematosus human pregnant woman diseases female patient pregnancy erythrocyte partial thromboplastin time blood clotting test therapy hospital patient follow up proteinuria laboratory test uterus blood level kidney laboratory induced abortion ultrasound abdominal pain diagnosis bleeding LA - English M3 - Conference Abstract N1 - L70983510 2013-02-08 PY - 2013 SN - 1351-8216 SP - 82 ST - Severe haemorrhagic diathesis in pregnant woman with systemic lupus erythematosus (SLE) and acquired haemophilia (AH) T2 - Haemophilia TI - Severe haemorrhagic diathesis in pregnant woman with systemic lupus erythematosus (SLE) and acquired haemophilia (AH) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70983510&from=export http://dx.doi.org/10.1111/hae.12083 VL - 19 ID - 761177 ER - TY - JOUR AB - Introduction: Thrombocytopaenia (TCP), or low platelet count, is a haematological disorder that commonly occurs in critically ill patients and is defined as a platelet count below 100 000/?L. Patients are at higher risk of muscular atrophy and other complications after prolonged bed rest. This literature review aims to clarify the appropriateness of active exercise in critically ill adult patients with TCP. Methods: A review of the literature was conducted using the following key words that are PubMed medical subheading (MeSH) terms: 'critical illness', 'exercise therapy', 'manual therapy', 'physical therapy', 'physiotherapy', 'postoperative care', 'rehabilitation', 'thrombocytopenia', and 'thrombopenia'. The search was limited by publication date (2000 to 2013) and language (English only) in three main databases: PubMed, SCOPUS, and CINAHL. Results: The key word searches found a total of 78 citations. Of these, only those meeting the inclusion criteria were selected after reading the title and abstract. Two studies were included after reading the full-texts. Exercise is used to treat muscular atrophy in critically ill adult patients, and rehabilitation plays an important role in the care pathway. Results of our analysis do not support evidence for or against exercise in critically ill adult patients with TCP; therefore, health professionals must pay close attention to the presence of signs of bleeding in these patients when proposing exercise. Discussion: Surprisingly, no study was found that directly covered this issue. Aggressive exercise may not be appropriate in patients with very low platelet counts. On the other hand, critically ill patients are at high risk of muscular atrophy due to the forced bed rest, especially after complex surgery or in prolonged hospitalisation. Physiotherapists and those providing care must share their observations with the rest of the multidisciplinary team before treatment starts. Conclusions: Active exercise in critically ill adult patients with severe TCP must be personalised and platelet count carefully monitored before proposing physical activity. Physical recovery can be challenging in critically ill adult patients, and it can be limited by severe TCP, mostly when bleeding is present. AD - Physiotherapist, Bologna University Hospital Authority Sant¿Orsola-Malpighi, Italy; Haematologist , Bologna University Hospital Authority Sant¿Orsola-Malpighi, Italy. AN - 93646690. Language: English. Entry Date: 20140115. Revision Date: 20190102. Publication Type: Article AU - Polastri, Massimiliano AU - Vianelli, Nicola DB - CINAHL DO - 10.12968/ijtr.2014.21.1.41 DP - EBSCOhost KW - Critical Illness -- Physiopathology Thrombocytopenia Therapeutic Exercise Physical Therapy Postoperative Care Severity of Illness Acute Care Thrombocytopenia -- Complications M1 - 1 N1 - review; tables/charts. Journal Subset: Allied Health; Europe; Peer Reviewed; UK & Ireland. Special Interest: Critical Care. PY - 2014 SN - 1741-1645 SP - 41-45 ST - Active exercise in critically ill adults affected by thrombocytopaeni T2 - International Journal of Therapy & Rehabilitation TI - Active exercise in critically ill adults affected by thrombocytopaeni UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=93646690&site=ehost-live&scope=site VL - 21 ID - 761287 ER - TY - JOUR AB - Objectives Deep vein thrombosis ( DVT) is both common and serious, yet the desire to never miss the diagnosis, coupled with the low specificity of D-dimer testing, results in high imaging rates, return visits, and empirical anticoagulation. The objective of this study was to evaluate a new approach incorporating bedside limited-compression ultrasound ( LC US) by emergency physicians ( EPs) into the workup strategy for DVT. Methods This was a cross-sectional observational study of emergency department ( ED) patients with suspected DVT. Patients on anticoagulants; those with chronic DVT, leg cast, or amputation; or when the results of comprehensive imaging were already known were excluded. All patients were treated in the usual fashion based on the protocol in use at the center, including comprehensive imaging based on the modified Wells score and serum D-dimer testing. Seventeen physicians were trained and performed LC US in all subjects. The authors identified a priori an alternate workup strategy in which DVT would be ruled out in ' DVT unlikely' (Wells score < 2) patients if the LC US was negative and in ' DVT likely' (Wells score ≥ 2) patients if both the LC US and the D-dimer were negative. The criterion standard was based on comprehensive imaging interpreted by radiologists blinded to LC US findings and by structured medical record review at 6 months in patients without comprehensive imaging. Results A total of 227 patients were enrolled (47% DVT likely), of whom 24 had DVT. The LC US was positive in 27 cases (21 actually DVT positive), indeterminate in 28 (one DVT positive), and negative in 172 (two DVT positive). Of 130 patients deemed DVT negative by the new strategy, one had confirmed DVT (miss rate = 0.8%; 95% confidence interval [ CI] = 0.1% to 4.0%), but this patient had been misclassified by the treating physician as low risk by Wells criteria. The stand-alone sensitivity and specificity of LC US were 91% (95% CI = 70% to 98%) and 97% (95% CI = 92% to 99%), respectively. Incorporating LC US into the diagnostic approach would have reduced the rate of comprehensive imaging from 70% to 43%, D-dimer testing from 100% to 33%, and the mean time to diagnostic certainty by 5.0 hours and avoided 24 (11%) return visits for imaging and 10 (4.4%) cases of unnecessary anticoagulation. In 19% of cases, the treating and scanning physician disagreed whether the patient was DVT likely or DVT unlikely based on Wells score (κ = 0.62; 95% CI = 0.48 to 0.77). Conclusions Limited-compression US holds promise as one component of the diagnostic approach to DVT, but should not be used as a stand-alone test due to imperfect sensitivity. Tradeoffs in diagnostic efficiency for the sake of perfect sensitivity remain a difficult issue collectively in emergency medicine ( EM), but need to be scrutinized carefully in light of the costs of overinvestigation, delays in diagnosis, and risks of empirical anticoagulation. Resumen Objetivos La trombosis venosa profunda ( TVP) es frecuente y grave, sin embargo, el deseo de no errar el diagnóstico, junto con la baja especificidad de la prueba del dímero D, resultan en unos porcentajes altos de pruebas de imagen, revisitas y anticoagulación de forma empírica. El objetivo fue evaluar una nueva estrategia incorporando la ecografía con compresión limitada (Eco- CL) a pie de cama realizada por urgenciólogos en el diagnóstico rutinario para la TVP. Metodología Estudio observacional de corte transversal en pacientes con sospecha de TVP en el servicio de urgencias ( SU). Se excluyeron los pacientes tratados con anticoagulantes, aquéllos con TVP crónica, escayola o amputación de miembro inferior o cuando los resultados de la prueba de imagen se acababan de conocer. Se trató a todos los pacientes siguiendo el protocolo habitual en el centro, que incluía la realización de pruebas de imagen en función de la puntuación de la escala de Wells modificada y los valores del dímero-D en plasma. Se formó a 17 médicos que realizaron Eco- CL en todos los pacientes. Los autores identificaron a priori una estrategia de diagnóstico alternativa en la cual la TVP sería descartada en pacientes con 'baja probabilidad de TVP' (puntuación de Wells < 2) si la Eco- CL era negativa, y en pacientes con 'probable TVP' (puntuación de Wells ≥ 2) si tanto la Eco- CL como el dímero-D resultaban negativos. El criterio estándar se basó en la prueba de imagen interpretada por radiólogos enmascarados a los hallazgos de la Eco- CL y por la revisión estructurada de las historias clínicas a los seis meses en aquellos pacientes sin prueba de imagen. Resultados Se incluyeron 227 pacientes (47% 'probable TVP'), de los cuales 24 tuvieron una TVP. La Eco- CL fue positiva en 27 casos (21 de TVP positiva), indeterminada en 28 (1 de TVP positiva) y negativa en 172 (2 de TVP positiva). De los 130 pacientes considerados como TVP negativa por la nueva estrategia, 1 tuvo una TVP confirmada (porcentaje de error 0,8%, IC 95% = 0,1% a 4,0%), pero este paciente había sido erróneamente clasificado por el médico responsable como de bajo riesgo según los criterios de Wells. La sensibilidad y especificidad independientes de la Eco- CL fueron de un 91% ( IC 95% = 70% a 98%) y un 97% ( IC 95% = 92% a 99,5% respectivamente). La incorporación de la Eco- CL en la estrategia diagnóstica habría reducido el porcentaje de realización de pruebas de imagen de un 70% a un 43%, la petición de dímero-D de un 100% a un 33%, el tiempo medio hasta la certeza diagnóstica en 5,0 horas, habría evitado 24 (11%) revisitas para la realización de pruebas de imagen y 10 (4,4%) casos de anticoagulación innecesaria. En un 19% de los casos, el médico responsable y el observador estuvieron en desacuerdo respecto a si el paciente era 'probable TVP' o 'baja probabilidad de TVP' basándose en la escala de Wells (índice kappa 0,62; IC 95% = 0,48 a 0,77). Conclusiones La Eco- CL se muestra prometedora como uno de los componentes en la aproximación diagnóstica de la TVP, pero no debería utilizarse como una prueba diagnóstica independiente debido a su limitada sensibilidad. Las combinaciones en la eficiencia diagnóstica con el fin de una deseable sensibilidad siguen siendo un problema difícil en el colectivo de médicos de urgencias y emergencias, pero necesitan ser probadas cuidadosamente a la luz de los costes de la sobreinvestigación, los retrasos en el diagnóstico y los riesgos de la anticoagulación empírica. AD - The Department of Emergency Medicine, Queen's University, Kingston Ontario, Canada The Department of Emergency Medicine, Saint Michael's Hospital, Toronto Ontario, Canada The Department of Pharmacology and Toxicology, Queen's University, Kingston Ontario, Canada AN - 98603442. Language: English. Entry Date: 20141003. Revision Date: 20190226. Publication Type: Article AU - Poley, Rachel A. AU - Newbigging, Joseph L. AU - Sivilotti, Marco L. A. AU - Moore, Chris DB - CINAHL DO - 10.1111/acem.12459 DP - EBSCOhost KW - Education, Medical, Continuing Venous Thrombosis -- Diagnosis Ultrasonography -- Methods Emergency Medicine Human Cross Sectional Studies Patient Selection Tertiary Health Care Outcomes (Health Care) Data Analysis Fibrin Fibrinogen Degradation Products Electronic Health Records Descriptive Statistics M1 - 9 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. PY - 2014 SN - 1069-6563 SP - 971-980 ST - Estimated Effect of an Integrated Approach to Suspected Deep Venous Thrombosis Using Limited-compression Ultrasound Impacto Estimado de una Estrategia Integrada para Evaluar la Sospecha de Trombosis Venosa Profunda Usando la Ecografía con Compresión Limitada T2 - Academic Emergency Medicine TI - Estimated Effect of an Integrated Approach to Suspected Deep Venous Thrombosis Using Limited-compression Ultrasound Impacto Estimado de una Estrategia Integrada para Evaluar la Sospecha de Trombosis Venosa Profunda Usando la Ecografía con Compresión Limitada UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=98603442&site=ehost-live&scope=site VL - 21 ID - 761327 ER - TY - JOUR AB - Objectives Prescription drug monitoring programs ( PDMPs) are underutilized, despite evidence showing that they may reduce the epidemic of opioid-related addiction, diversion, and overdose. We evaluated the usability of the Massachusetts ( MA) PDMP by emergency medicine providers ( EPs), as a system's usability may affect how often it is used. Methods This was a mixed-methods study of 17 EPs. We compared the time and number of clicks required to review one patient's record in the PDMP to three other commonly performed computer-based tasks in the emergency department ( ED: ordering a computed tomography [ CT] scan, writing a prescription, and searching a medication history service integrated within the electronic medical record [ EMR]). We performed semistructured interviews and analyzed participant comments and responses regarding their experience using the MA PDMP. Results The PDMP task took a longer time to complete (mean = 4.22 minutes) and greater number of mouse clicks to complete (mean = 50.3 clicks) than the three other tasks ( CT-pulmonary embolism = 1.42 minutes, 24.8 clicks; prescription = 1.30 minutes, 19.5 clicks; SureScripts = 1.45 minutes, 9.5 clicks). Qualitative analysis yielded four main themes about PDMP usability, three negative and one positive: 1) difficulty accessing the PDMP, 2) cumbersome acquiring patient medication history information within the PDMP, 3) nonintuitive display of patient medication history information within the PDMP, and 4) overall perceived value of the PDMP despite an inefficient interface. Conclusions The complicated processes of gaining access to, logging in, and using the MA PDMP are barriers to preventing its more frequent use. All states should evaluate the PDMP usability in multiple practice settings including the ED and work to improve provider enrollment, login procedures, patient information input, prescription data display, and ultimately, PDMP data integration into EMRs. AD - Harvard Affiliated Emergency Medicine Residency, Boston MA Department of Emergency Medicine, Brigham and Women's Hospital, Boston MA Department of Emergency Medicine, Massachusetts General Hospital, Boston MA Clinical and Quality Analysis, Partners Healthcare, Wellesley MA Department of Emergency Medicine, Harvard Medical School, Boston MA AN - 114436466. Language: English. Entry Date: 20160412. Revision Date: 20180711. Publication Type: Article AU - Poon, Sabrina J. AU - Greenwood‐Ericksen, Margaret B. AU - Gish, Rebecca E. AU - Neri, Pamela M. AU - Takhar, Sukhjit S. AU - Weiner, Scott G. AU - Schuur, Jeremiah D. AU - Landman, Adam B. AU - Miner, James R. DB - CINAHL DO - 10.1111/acem.12905 DP - EBSCOhost KW - Emergency Service Drug Monitoring -- Methods Drugs, Prescription Emergency Medicine Drug Evaluation Human Massachusetts Record Review Patient Care Electronic Health Records Certification Physicians, Emergency Data Collection Semi-Structured Interview Data Analysis Quantitative Studies Qualitative Studies M1 - 4 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. PY - 2016 SN - 1069-6563 SP - 406-414 ST - Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed-methods Study T2 - Academic Emergency Medicine TI - Usability of the Massachusetts Prescription Drug Monitoring Program in the Emergency Department: A Mixed-methods Study UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=114436466&site=ehost-live&scope=site VL - 23 ID - 761398 ER - TY - JOUR AB - Purpose. Results of a study to characterize patterns of nonadministration of medication doses for venous thromboembolism (VTE) prevention among hospitalized patients are presented. Methods. The electronic records of all patients admitted to 4 floors of a medical center during a 1-month period were examined to identify patients whose records indicated at least 1 nonadministered dose of medication for VTE prophylaxis. Proportions of nonadministered doses by medication type, intended route of administration, and VTE risk categorization were compared; reasons for nonadministration were evaluated. Results. Overall, 12.7% of all medication doses prescribed to patients in the study cohort (n = 75) during the study period (857 of 6,758 doses in total) were not administered. Nonadministration of 1 or more doses of VTE prophylaxis medication was nearly twice as likely for subcutaneous anticoagulants than for all other medication types (231 of 1,112 doses [20.8%] versus 626 of 5,646 doses [11.2%], p < 0.001). For all medications prescribed, the most common reason for nonadministration was patient refusal (559 of 857 doses [65.2%]); the refusal rate was higher for subcutaneous anticoagulants than for all other medication categories (82.7% versus 58.8%, p < 0.001). Doses of antiretrovirals, immunosuppressives, antihypertensives, psychiatric medications, analgesics, and antiepileptics were less commonly missed than doses of electrolytes, vitamins, and gastrointestinal medications. Conclusion. Scheduled doses of subcutaneous anticoagulants for hospitalized patients were more likely to be missed than doses of all other medication types. AD - Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MDDivision of Health Sciences Informatics, Johns Hopkins School of Medicine, Baltimore, MD Department of Nursing, Johns Hopkins Hospital, Baltimore, MD Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MDArmstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD Division of Hematology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD Division of Acute Care Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, MDDepartment of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MDArmstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD AN - 128520434. Language: English. Entry Date: 20180321. Revision Date: 20190130. Publication Type: Article AU - Popoola, Victor O. AU - Lau, Brandyn D. AU - Tan, Esther AU - Shaffer, Dauryne L. AU - Kraus, Peggy S. AU - Farrow, Norma E. AU - Hobson, Deborah B. AU - Aboagye, Jonathan K. AU - Streiff, Michael B. AU - Haut, Elliott R. DB - CINAHL DO - 10.2146/ajhp161057 DP - EBSCOhost KW - Venous Thromboembolism -- Prevention and Control Medication Compliance Prospective Studies Inpatients Human Electronic Health Records Academic Medical Centers Drug Administration Routes Venous Thromboembolism -- Risk Factors Injections, Subcutaneous Anticoagulants -- Administration and Dosage Anticoagulants -- Therapeutic Use Treatment Refusal Anti-Retroviral Agents -- Administration and Dosage Immunosuppressive Agents -- Administration and Dosage Antihypertensive Agents -- Administration and Dosage Psychiatric Service Analgesics -- Administration and Dosage Anticonvulsants -- Administration and Dosage Electrolytes -- Administration and Dosage Vitamins -- Administration and Dosage Gastrointestinal Agents -- Administration and Dosage Drug Administration Schedule M1 - 6 N1 - research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Peer Reviewed; USA. NLM UID: 9503023. PY - 2018 SN - 1079-2082 SP - 392-397 ST - Nonadministration of medication doses for venous thromboembolism prophylaxis in a cohort of hospitalized patients T2 - American Journal of Health-System Pharmacy TI - Nonadministration of medication doses for venous thromboembolism prophylaxis in a cohort of hospitalized patients UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=128520434&site=ehost-live&scope=site VL - 75 ID - 761353 ER - TY - JOUR AB - Background: Despite normal blood pressure (BP), patients with submassive pulmonary embolism (PE) are at significant risk of morbidity and mortality. We sought to evaluate echocardiographic and invasive hemodynamic parameters to aid in risk stratification of patients with submassive PE. Methods: We retrospectively analyzed all consecutive patients with submassive PE, who underwent Catheter Directed Thrombolysis (CDT) between 2016 and 2018 in our Pulmonary Embolism Response Team database. We performed univariate and multivariate regression analyses to identify echocardiographic predictors of low CI (CI < 2.2L/min/m2). Results: 42 patients underwent CDT for management of acute submassive PE during the study period. Within this patient cohort, average MAP was 77 mmHg and average systolic BP was 101 mmHg. 43% of patients had a low CI. Univariate linear regression identified RVOT VTI, RV/LV ratio, TAPSE, and IVC diameter as significant predictors of low CI. Multivariate regression identified RVOT VTI as the only independent predictor of low CI (OR 0.11, p=0.047). RVOT VTI cut off of 9.5cm was associated with sensitivity of 72% and specificity of 80% (AUC 0.793); Figure 1. Conclusion: Substantial proportion of patients with acute submassive PE have low CI despite normal BP. RVOT VTI is a useful echocardiographic marker in identifying patients with low CI. Further studies are needed to ascertain the prognostic ability of RVOT VTI to identify high risk patients with submassive PE. [Figure presented] AU - Porcaro, K. AU - Haines, J. AU - Morris, S. AU - Doukas, D. AU - Mancl, E. AU - Masic, D. AU - Oliveros, E. AU - Lakhter, V. AU - Bechara, C. AU - Lopez, J. J. AU - Mathew, V. AU - Fareed, J. AU - Darki, A. AU - Brailovsky, Y. DB - Embase DO - 10.1016/S0735-1097(19)32717-2 KW - adult blood clot lysis blood pressure monitoring cardiac index catheter clinical article cohort analysis conference abstract controlled study diagnostic test accuracy study female high risk patient human linear regression analysis male pulmonary embolism response team retrospective study risk assessment sensitivity and specificity stratification systolic blood pressure tricuspid annular plane systolic excursion LA - English M1 - 9 Supplement 1 M3 - Conference Abstract N1 - L2001643879 2019-04-16 PY - 2019 SN - 1558-3597 0735-1097 SP - 2111 ST - PREDICTORS OF LOW CARDIAC INDEX IN SUBMASSIVE PULMONARY EMBOLISM T2 - Journal of the American College of Cardiology TI - PREDICTORS OF LOW CARDIAC INDEX IN SUBMASSIVE PULMONARY EMBOLISM UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001643879&from=export http://dx.doi.org/10.1016/S0735-1097(19)32717-2 VL - 73 ID - 760739 ER - TY - JOUR AU - Porres-Aguilar, M. AU - Anaya-Ayala, J. E. AU - Grimaldo-Gómez, F. A. AU - Santos-Martínez, L. E. AU - Jiménez, D. AU - Porres-Muñoz, M. AU - Izaguirre-Ávila, R. AU - Carrillo-Esper, R. DA - 2020/09/23 09/23 DB - Europe PubMed Central DO - 10.24875/acm.20000008 M1 - 3 PY - 2020 SN - 1405-9940 SP - 321-327 ST - Participation of pulmonary embolism response teams during the perioperative period T2 - Arch Cardiol Mex TI - Participation of pulmonary embolism response teams during the perioperative period UR - http://europepmc.org/article/MED/32952170 VL - 90 ID - 762017 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. AD - [Porres-Aguilar, Mateo] Northcent Baptist Med Ctr, Dept Internal Med, Div Hosp Med, San Antonio, TX USA. [Anaya-Ayala, Javier E.] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Sect Vasc Surg & Endovasc Therapy, Mexico City, DF, Mexico. [Heresi, Gustavo A.] Cleveland Clin, Resp Inst, Dept Pulm & Crit Care Med, Cleveland, OH 44106 USA. [Rivera-Lebron, Belinda N.] Univ Pittsburgh, Med Ctr, Div Pulm & Crit Care Med, Pittsburgh, PA USA. Rivera-Lebron, BN (corresponding author), Univ Pittsburgh, Med Ctr, 3459 Fifth Ave UPMC Montefiore,Room S6521, Pittsburgh, PA 15213 USA. riveralebronbn@upmc.edu AN - WOS:000454323500005 AU - Porres-Aguilar, M. AU - Anaya-Ayala, J. E. AU - Heresi, G. A. AU - Rivera-Lebron, B. N. DA - Dec DO - 10.1177/1076029618812954 J2 - Clin. Appl. Thromb.-Hemost. KW - high-risk pulmonary embolism intermediate-high-risk pulmonary embolism reperfusion strategies pulmonary embolism response team EXTRACORPOREAL MEMBRANE-OXYGENATION CATHETER-DIRECTED THROMBOLYSIS DEEP-VEIN THROMBOSIS ORGANIZATIONAL SURVEY MULTIDISCIPLINARY MANAGEMENT THERAPY SUPPORT TRIAL THROMBECTOMY Hematology Peripheral Vascular Disease LA - English M3 - Review N1 - ISI Document Delivery No.: HF6DB Times Cited: 7 Cited Reference Count: 46 Porres-Aguilar, Mateo Anaya-Ayala, Javier E. Heresi, Gustavo A. Rivera-Lebron, Belinda N. Anaya-Ayala, Javier E./E-7871-2019 7 0 4 SAGE PUBLICATIONS INC THOUSAND OAKS CLIN APPL THROMB-HEM 9 PY - 2018 SN - 1076-0296 SP - 48S-55S 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 - ://WOS:000454323500005 VL - 24 ID - 761556 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. AD - B.N. Rivera-Lebron, Division of Pulmonary and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States AU - Porres–Aguilar, M. AU - Anaya-Ayala, J. E. AU - Heresi, G. A. AU - Rivera-Lebron, B. N. DB - Embase Medline DO - 10.1177/1076029618812954 KW - biological marker anticoagulant therapy anticoagulation artificial ventilation bleeding blood clotting disorder brain ischemia computer assisted tomography echocardiography follow up health care quality hospitalization human intensive care unit length of stay lung embolism practice guideline priority journal pulmonary embolism response team reperfusion review risk factor LA - English M1 - 9_suppl M3 - Review N1 - L625652686 2019-01-01 2019-01-03 PY - 2018 SN - 1938-2723 1076-0296 SP - 48S-55S 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.embase.com/search/results?subaction=viewrecord&id=L625652686&from=export http://dx.doi.org/10.1177/1076029618812954 VL - 24 ID - 760786 ER - TY - JOUR AB - PMID:31624797 AU - Porres‐Aguilar, Mateo AU - Jiménez, David AU - Mukherjee, Debabrata DA - 2019/08/09 08/09 DB - PubMed Central DO - 10.1002/rth2.12249 M1 - 4 PY - 2019 SN - 2475-0379 SP - 769-769 ST - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions T2 - Research and Practice in Thrombosis and Haemostasis TI - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6781912 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6781912&rendertype=abstract VL - 3 ID - 762071 ER - TY - JOUR AU - Porres-Aguilar, M. AU - Jiménez, D. AU - Porres-Muñoz, M. AU - Mukherjee, D. DA - 2019/10/22 10/22 DB - Europe PubMed Central DO - 10.1002/rth2.12249 M1 - 4 PY - 2019 SN - 2475-0379 ST - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions T2 - Res Pract Thromb Haemost TI - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions UR - http://europepmc.org/article/MED/31624797 VL - 3 ID - 762070 ER - TY - GEN AU - Porres-Aguilar, Mateo AU - Jiménez, David AU - Porres-Muñoz, Mateo AU - Mukherjee, Debabrata DA - 2019/01/01 DB - Federal Science Library - Canada PY - 2019 SN - 2475-0379 ST - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions: Letter to the Editor TI - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions: Letter to the Editor UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1Nj9MwELVgERIXBALE58oSx266qZ2PGi1IC1oEh66KaAW3yk4cWrZJUNoc4H_wfxl7HDe75bAcuETNJG7T-MkzYz-_IYSzYRhcGRMk5EFZFo0gj1OFlDxLITKJci5zpovYLqbP5_zsa3T-yWg_e10bb_uvHQ826HqzkfYfOt9_KRjgM0AAjgACOF4LBtN2Db9lt9yWql6bkhgN0mL1APq3tIy4KbxtV2FRuyqjKAVu9CVk9rOjeKIAycAJBC0H6A_9jF-n891dRg0C3IWFfMqmhocwEijm0lLqsobgdLPycf3U1goJTr-1qzUyvycQC9ee5rMqcWG_wnnvHiHft5205pa3o_rXXvNJewEI_Y7UIxhopWpwZ56f9xgJz6BzwyOL0jgIOZaiGeq_2Nz4znswjnpjdZqIntt3Z3seBRVqm-2SDc0ipNj5zY4rcMWdepIjCkKzhWm7wLZGzr3MV9n2ta6C-eeb5BaDcMkwUb98PPdTg8zsfrblgv3_8cK67Hj3KL1QCmsKWZc_u0fuumSGniLs7pMbunpAfp-Usrl444F3cmzPKZo7FF62dpC8bLX4dKZX1IH0iHYQpQBR2kH0iAKkKAKUdgClO4A-JLP3Z7N3HwJX_COAnEMEmjEhRzpKMqWitAjDQqbpSKTZWGU8zkWhQ5WoQrAYDuCF4lDzgieJjCGhgLSAPyIHVV3px4Tmcc5EnImxVHnEIyWiIh6HichVrGQo0ifkZfcaFz9Q4mWx33dPr3XXM3Jnh9Xn5GDbtPoFuV1s1oHaFId2xufQ9vYfbx2g1Q VL - 3 ID - 762090 ER - TY - JOUR AB - Objective: The aim of our retrospective study was to assess whether a novel team Familiarity Score (FS) is associated with the length of procedure (LOP), postoperative length of stay (LOS), and complication rate after vascular procedures. Methods: We retrospectively analyzed 326 vascular procedures performed at a tertiary care vascular surgery center between April 2012 and September 2014. Data collected included patients' age, American Society of Anesthesiologists grade, LOP, type and urgency of procedure, LOS, and complications. Familiarity Score (FS) was defined as the sum of the number of times that each possible pair of the team (vascular consultant, vascular registrar, scrub nurse, anesthetic consultant) within the team had worked together during the previous 6 months, divided by the number of possible combinations of pairs in the team. Bayesian statistics was used to analyze the data. Results: FS was significantly associated with type and urgency of the procedure (Bayes factor [BF] >1000). Emergency procedures were performed by less familiar teams, and the least familiar teams were involved in the emergency aortic procedures-endovascular and open. FS was strongly associated with LOP (BF = 37) but not with LOS (BF = 4.0) and complication rate. Conclusions: FS in vascular teams was shown to be strongly associated with LOP, suggesting that more familiar teams might collaborate more efficiently. AD - [Powezka, Katarzyna; Normahani, Pasha; Standfield, Nigel J.; Jaffer, Usman] Imperial Coll Healthcare NHS Trust, Imperial Vasc Unit, London, England. Jaffer, U (corresponding author), Imperial Coll Healthcare NHS Trust, Dept Vasc Surg, London W2 1NY, England. usman.jaffer@nhs.net AN - WOS:000514846800048 AU - Powezka, K. AU - Normahani, P. AU - Standfield, N. J. AU - Jaffer, U. DA - Mar DO - 10.1016/j.jvs.2019.03.085 J2 - J. Vasc. Surg. KW - Human factors Team working Surgery TECHNICAL PERFORMANCE NONTECHNICAL SKILLS CROSS-VALIDATION EXPERIENCE IMPACT ROOM CLASSIFICATION COMPLICATIONS WORKING ERRORS Surgery Peripheral Vascular Disease LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: KN4ZJ Times Cited: 1 Cited Reference Count: 30 Powezka, Katarzyna Normahani, Pasha Standfield, Nigel J. Jaffer, Usman Normahani, Pasha/0000-0002-6362-7535 1 0 MOSBY-ELSEVIER NEW YORK J VASC SURG PY - 2020 SN - 0741-5214 SP - 959-966 ST - A novel team Familiarity Score for operating teams is a predictor of length of a procedure: A retrospective Bayesian analysis T2 - Journal of Vascular Surgery TI - A novel team Familiarity Score for operating teams is a predictor of length of a procedure: A retrospective Bayesian analysis UR - ://WOS:000514846800048 VL - 71 ID - 761458 ER - TY - JOUR AB - BACKGROUND: Although best practices have been developed for achieving door-to-needle (DTN) times ≤60 minutes for stroke thrombolysis, critical DTN process failures persist. We sought to compare these failures in the Emergency Department at an academic medical center and a community hospital. METHODS AND RESULTS: Failure modes effects and criticality analysis was used to identify system and process failures. Multidisciplinary teams involved in DTN care participated in moderated sessions at each site. As a result, DTN process maps were created and potential failures and their causes, frequency, severity, and existing safeguards were identified. For each failure, a risk priority number and criticality score were calculated; failures were then ranked, with the highest scores representing the most critical failures and targets for intervention. We detected a total of 70 failures in 50 process steps and 76 failures in 42 process steps at the community hospital and academic medical center, respectively. At the community hospital, critical failures included (1) delay in registration because of Emergency Department overcrowding, (2) incorrect triage diagnosis among walk-in patients, and (3) delay in obtaining consent for thrombolytic treatment. At the academic medical center, critical failures included (1) incorrect triage diagnosis among walk-in patients, (2) delay in stroke team activation, and (3) delay in obtaining computed tomographic imaging. CONCLUSIONS: Although the identification of common critical failures suggests opportunities for a generalizable process redesign, differences in the criticality and nature of failures must be addressed at the individual hospital level, to develop robust and sustainable solutions to reduce DTN time. AD - From the Division of Neurology (S.P.), Center for Healthcare Studies (S.P., R.K., A.B., A.P.N., J.L.H.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Private Practice, Chicago, IL (R.K.). sprabhak@nm.org. From the Division of Neurology (S.P.), Center for Healthcare Studies (S.P., R.K., A.B., A.P.N., J.L.H.), Feinberg School of Medicine, Northwestern University, Chicago, IL; and Private Practice, Chicago, IL (R.K.). AN - 26515203 AU - Prabhakaran, S. AU - Khorzad, R. AU - Brown, A. AU - Nannicelli, A. P. AU - Khare, R. AU - Holl, J. L. DA - Oct DO - 10.1161/circoutcomes.115.002085 DP - NLM ET - 2015/10/31 J2 - Circulation. Cardiovascular quality and outcomes KW - Academic Medical Centers/*statistics & numerical data Acute Disease Diagnostic Errors Diagnostic Imaging Emergency Service, Hospital Hospitals, Community/*statistics & numerical data Humans Ischemia/diagnosis/drug therapy/*epidemiology Quality Improvement Stroke/diagnosis/drug therapy/*epidemiology Thrombolytic Therapy Time-to-Treatment Tissue Plasminogen Activator/therapeutic use Treatment Outcome Triage academic medical center community hospitals patient safety stroke LA - eng M1 - 6 Suppl 3 N1 - 1941-7705 Prabhakaran, Shyam Khorzad, Rebeca Brown, Alexandra Nannicelli, Anna P Khare, Rahul Holl, Jane L Comparative Study Journal Article Research Support, Non-U.S. Gov't United States Circ Cardiovasc Qual Outcomes. 2015 Oct;8(6 Suppl 3):S148-54. doi: 10.1161/CIRCOUTCOMES.115.002085. PY - 2015 SN - 1941-7713 SP - S148-54 ST - Academic-Community Hospital Comparison of Vulnerabilities in Door-to-Needle Process for Acute Ischemic Stroke T2 - Circ Cardiovasc Qual Outcomes TI - Academic-Community Hospital Comparison of Vulnerabilities in Door-to-Needle Process for Acute Ischemic Stroke VL - 8 ID - 760322 ER - TY - JOUR AB - BACKGROUND: Reduction in door-to-needle (DTN) times in patients with acute ischemic stroke treated with tissue-type plasminogen activator is associated with improved outcomes. We hypothesized that a learning collaborative would rapidly reduce DTN times at Chicago's primary stroke centers. METHODS AND RESULTS: We analyzed data from all adult patients with out-of-hospital ischemic stroke hospitalized between January 1, 2010 and March 31, 2015 and who received tissue-type plasminogen activator in the emergency department at 15 primary stroke centers in Chicago and 15 primary stroke centers in St. Louis. We implemented a structured learning collaborative in Chicago in quarter 1 of 2013 that included (1) a quality improvement leader, (2) stroke content expert, (3) multidisciplinary teams from each site, (4) a targeted goal for the program (DTN time <60 minutes in >50% of patients treated with tissue-type plasminogen activator), and (5) face-to-face meetings with on-site visits. We used interrupted time-series analysis to compare the impact of the learning collaborative on DTN times in Chicago pre- and post implementation and also concurrently versus St. Louis. We prespecified adjustment for mode of arrival, emergency medical services prenotification, and onset-to-arrival times. P values less than 0.05 were considered significant. In adjusted analysis, the reduction in DTN time within 1 quarter of implementation was 15.5 minutes (P=0.046) at Chicago sites versus 1.17 minutes at St. Louis sites (P=0.601). CONCLUSIONS: Using a learning collaborative model at Chicago's 15 primary stroke centers, we observed major reductions in DTN times within 1 quarter of implementation. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement. AD - From the Departments of Neurology (S.P.) and Preventive Medicine-Biostatistics (J.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; and American Heart Association/American Stroke Association Midwest Affiliate, Chicago, IL (K.O.N.). sprabhak@nm.org. From the Departments of Neurology (S.P.) and Preventive Medicine-Biostatistics (J.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; and American Heart Association/American Stroke Association Midwest Affiliate, Chicago, IL (K.O.N.). AN - 27625405 AU - Prabhakaran, S. AU - Lee, J. AU - O'Neill, K. DA - Sep DO - 10.1161/circoutcomes.116.003222 DP - NLM ET - 2016/09/15 J2 - Circulation. Cardiovascular quality and outcomes KW - Aged Aged, 80 and over Brain Ischemia/diagnosis/*drug therapy/physiopathology Chicago Cooperative Behavior Education, Medical, Continuing/methods Education, Nursing, Continuing/methods Female Fibrinolytic Agents/*administration & dosage/adverse effects Humans Inservice Training/*methods Interdisciplinary Communication Learning Male Medical Staff, Hospital/education Middle Aged Missouri Nursing Staff, Hospital/education *Patient Care Team Personnel, Hospital/*education Program Evaluation *Quality Improvement *Quality Indicators, Health Care Stroke/diagnosis/*drug therapy/physiopathology Thrombolytic Therapy/adverse effects/*methods Time Factors *Time-to-Treatment Tissue Plasminogen Activator/*administration & dosage/adverse effects Treatment Outcome *Chicago *emergency medical services *stroke *thrombolysis LA - eng M1 - 5 N1 - 1941-7705 Prabhakaran, Shyam Lee, Jungwha O'Neill, Kathleen Journal Article Multicenter Study Research Support, Non-U.S. Gov't United States Circ Cardiovasc Qual Outcomes. 2016 Sep;9(5):585-92. doi: 10.1161/CIRCOUTCOMES.116.003222. Epub 2016 Sep 13. PY - 2016 SN - 1941-7713 SP - 585-92 ST - Regional Learning Collaboratives Produce Rapid and Sustainable Improvements in Stroke Thrombolysis Times T2 - Circ Cardiovasc Qual Outcomes TI - Regional Learning Collaboratives Produce Rapid and Sustainable Improvements in Stroke Thrombolysis Times VL - 9 ID - 760407 ER - TY - JOUR AU - Prabhu, W. AU - Soukas, P. A. DA - 2017/05/02 05/02 DB - Europe PubMed Central M1 - 5 PY - 2017 SN - 0363-7913 SP - 27-32 ST - Pulmonary Embolism in 2017: Increasing Options for Increasing Incidence T2 - R I Med J (2013) TI - Pulmonary Embolism in 2017: Increasing Options for Increasing Incidence UR - http://europepmc.org/article/MED/28459918 VL - 100 ID - 762115 ER - TY - JOUR AB - Deep venous thrombosis (DVT) has an incidence rate of 0.5-1.6/1000 population (Nordstrom 1992) and is a diagnosis made based on clinical and biochemical suspicion with Doppler ultrasound (DUS) imaging confirmation. Several studies have shown that the need for an ultrasound scan is negated in D-Dimer negative patients with a low probability (Wells 2005). We aim to evaluate a D-Dimer assay introduced in 2009 using Wells score and the results of DUS to see if we can relibly identify patients who do not need an ultrasound. We also aim to see if other clinical risk factors for DVT not used in the Wells score can be useful. This is a retrospective analysis of 526 outpatients presenting to the fast response team (FRT) at the Royal London Hospital with suspected lower limb DVT during March 2009-March 2010. Quantitative Immunoturbidometric Microparticle Latex assay called Innovance D-Dimer was used for D-Dimer level estimation. Patients with no D-Dimer results were excluded. D-Dimer results, Wells score and DUS results were correlated. Of 526 patients presenting to the FRT, 510 patients had both D-Dimer and DUS for their suspected lower limb DVT. Two hundred and sixty-five (51.9%) had a negative D-Dimer. Of the 265 patients with a negative D-dimer, 143 (57.2%) had low, 88 (35.2%) moderate, 19 (7.6%) high and 15 (5.6%) no result for Wells score. No patients with a negative D-Dimer, low Wells score and low clinical risk had above knee DVT on DUS (Negative predictive value 100%). 7/265 (2.6%) patients had a positive DVT, these patients had either a moderate or high Wells score or a risk factor for DVT. 2/265 patients had a below knee DVT. In our outpatients we have seen that a negative D-Dimer with no risk factors for DVT and low Wells score can reliably exclude an above knee DVT. Patients with a risk factor for DVT or a moderate Wells score, despite a negative D-Dimer still have a risk of above knee DVT and should undergo DUS. Wells score needs to be revised to incorporate other risk factors. AD - S.G. Prabhudesai, Department of Radiology, Royal London Hospital, London, United Kingdom AU - Prabhudesai, S. G. AU - Rastogi, A. AU - Platton, S. AU - Meelinton, D. AU - Norris, D. AU - Bowles, L. AU - MaeCallum, P. K. AU - Friedman, E. DB - Embase DO - 10.1111/j.1538-7836.2011.04380_3.x KW - D dimer latex outpatient human teaching hospital knee society United Kingdom deep vein thrombosis population hemostasis thrombosis patient risk factor leg assay ultrasound risk predictive value incidence Doppler flowmetry imaging hospital diagnosis LA - English M3 - Conference Abstract N1 - L70614243 2011-12-23 PY - 2011 SN - 1538-7933 SP - 613 ST - Evaluating the use of negative D-Dimer and low wells score in excluding above knee deep venous thrombosis in an outpatient population at a major London teaching hospital T2 - Journal of Thrombosis and Haemostasis TI - Evaluating the use of negative D-Dimer and low wells score in excluding above knee deep venous thrombosis in an outpatient population at a major London teaching hospital UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70614243&from=export http://dx.doi.org/10.1111/j.1538-7836.2011.04380_3.x VL - 9 ID - 761228 ER - TY - JOUR AB - BACKGROUND: The incidence of venous thromboembolism in children has increased dramatically, with most cases occurring in children with cancer, surgery, trauma, congenital heart disease, and systemic lupus erythematosus. Early assessment of risk factors present in children would minimize morbidity and mortality from these events. OBJECTIVES: To evaluate the reliability and validity of a tool for assessing risk for venous thromboembolism in children. METHODS: The tool was developed after a review of the literature with assessment of content validity by a multidisciplinary team of experts. Patients' charts were reviewed retrospectively to establish reliability and validity of the tool. A P value less than .05 was considered statistically significant. RESULTS: Thirty-five charts were assessed for tool validity and were found to be statistically significant for all 3 risk score assessment categories. Logistic regression was used to assess 1001 patients' charts for internal consistency, which was found to be high (χ(2)(5)[n = 1001] = 100.6, P < .001). Results indicated that most patients at risk for venous thromboembolism were between the ages of 13 and 17 years, with females having more than 7 times greater risk than males. CONCLUSIONS: Descriptive statistics show that the assessment tool displays strong reliability and validity. Results validated a significant relationship between the risk score and the incidence of venous thromboembolism. Findings suggest that use of the assessment tool could significantly reduce adverse outcomes associated with venous thromboembolism in children. AD - Baptist Children's Hospital in Miami, Florida 33176, USA. andreap@baptisthealth.net AN - 22549574 AU - Prentiss, A. S. DA - May DO - 10.4037/ajcc2012548 DP - NLM ET - 2012/05/03 J2 - American journal of critical care : an official publication, American Association of Critical-Care Nurses KW - Adolescent Adult Age Factors Child Child, Preschool Female Humans Incidence Infant Infant, Newborn Logistic Models Male Reproducibility of Results Retrospective Studies Risk Assessment/methods Risk Factors Sex Factors Venous Thromboembolism/*diagnosis/epidemiology LA - eng M1 - 3 N1 - 1937-710x Prentiss, Andrea S Journal Article Validation Study United States Am J Crit Care. 2012 May;21(3):178-83; quiz 184. doi: 10.4037/ajcc2012548. PY - 2012 SN - 1062-3264 SP - 178-83; quiz 184 ST - Early recognition of pediatric venous thromboembolism: a risk-assessment tool T2 - Am J Crit Care TI - Early recognition of pediatric venous thromboembolism: a risk-assessment tool VL - 21 ID - 760257 ER - TY - JOUR AB - BACKGROUND: Access to reperfusion therapies in patients with large vessel occluding acute ischemic stroke demands process reorganization and optimization. Neurovascular networks are being built up to provide 24/7 endovascular stroke therapy service. In times of an increasingly complex stroke rescue chain little is known about patients' and their relatives' treatment awareness. METHODS: All patients, who received any kind of acute reperfusion treatment between January and August 2017 in the university hospital Aachen, and their proxies, were included in the survey. Patients were either primarily or secondarily transferred. RESULTS: For all questions regarding stroke treatment patients and their caregivers provided concurring answers. 40% of both patients and caregivers did not understand the treatment that was performed. Finally, patients who perceived on their own that stroke detection was delayed had significantly longer onset to door times than patients who did not have this impression. CONCLUSIONS: This study showed that patients' and proxies' answers correlated significantly. In case of patients' unavailability extrapolation of treatment satisfaction from answers by proxies might be permitted. High percentages of patients and caregivers do not understand relevant information, possibly due to limits of communication in an emergency setting or deficits in communication during the hospital stay. More emphasis should be laid on providing further information during the hospital stay. AD - Department of Neurology, Medical Clinic, RWTH Aachen University, Aachen, Germany. Department of Neuroradiology, Medical Clinic, RWTH Aachen University, Aachen, Germany. Department of Neurology, Medical Clinic, RWTH Aachen University, Aachen, Germany. Electronic address: jbach@ukaachen.de. AN - 29970323 AU - Pressler, H. AU - Reich, A. AU - Schulz, J. B. AU - Nikoubashman, O. AU - Willmes, K. AU - Habib, P. AU - Bach, J. P. DA - Oct DO - 10.1016/j.jstrokecerebrovasdis.2018.05.029 DP - NLM ET - 2018/07/05 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Caregivers/psychology Combined Modality Therapy *Comprehension *Endovascular Procedures/adverse effects Germany *Health Knowledge, Attitudes, Practice Hospitals, University Humans Interdisciplinary Communication Patient Care Team Patient Participation Patient Satisfaction Patients/*psychology Prognosis Risk Factors Stroke/diagnosis/physiopathology/psychology/*therapy *Thrombolytic Therapy/adverse effects Time-to-Treatment Acute ischemic stroke (AIS)—neurovascular network (NVN)—endovascular stroke treatment (EST)–patient satisfaction LA - eng M1 - 10 N1 - 1532-8511 Pressler, Hannah Reich, Arno Schulz, Jörg Bernhard Nikoubashman, Omid Willmes, Klaus Habib, Pardes Bach, Jan-Philipp Journal Article United States J Stroke Cerebrovasc Dis. 2018 Oct;27(10):2669-2676. doi: 10.1016/j.jstrokecerebrovasdis.2018.05.029. Epub 2018 Jun 30. PY - 2018 SN - 1052-3057 SP - 2669-2676 ST - Modern Interdisciplinary and Interhospital Acute Stroke Therapy-What Patients Think About It and What They Really Understand T2 - J Stroke Cerebrovasc Dis TI - Modern Interdisciplinary and Interhospital Acute Stroke Therapy-What Patients Think About It and What They Really Understand VL - 27 ID - 760135 ER - TY - JOUR AB - Embolism Response Team (PERT) – which brings together multiple specialists to rapidly evaluate intermediate- and high-risk patients with PE ... AU - Provias, Tim AU - Dudzinski, David M. AU - Jaff, Michael R. DA - 2014 DB - German National Library of Science and Technology (TIB) PY - 2014 ST - The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT): Creation of a Multidisciplinary Program to Improve Care of Patients With Massive and Submassive Pulmonary Embolism T2 - Taylor & Francis Verlag TI - The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT): Creation of a Multidisciplinary Program to Improve Care of Patients With Massive and Submassive Pulmonary Embolism UR - https://www.tib.eu/en/search/id/tandf:doi~10.3810%252Fhp.2014.02.1089/The-Massachusetts-General-Hospital-Pulmonary-Embolism?cHash=f3a3771da34049c7bfcadc492a59babf ID - 761969 ER - TY - JOUR AU - Provias, T. AU - Dudzinski, D. M. AU - Jaff, M. R. AU - Rosenfield, K. AU - Channick, R. AU - Baker, J. AU - Weinberg, I. AU - Donaldson, C. AU - Narayan, R. AU - Rassi, A. N. AU - Kabrhel, C. DA - 2014/02/26 02/26 DB - Europe PubMed Central DO - 10.3810/hp.2014.02.1089 M1 - 1 PY - 2014 SN - 2154-8331 SP - 31-37 ST - The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT): creation of a multidisciplinary program to improve care of patients with massive and submassive pulmonary embolism T2 - Hosp Pract (1995) TI - The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT): creation of a multidisciplinary program to improve care of patients with massive and submassive pulmonary embolism UR - http://europepmc.org/article/MED/24566594 VL - 42 ID - 761967 ER - TY - JOUR AB - Learning Objectives: Pulmonary embolism (PE) is a common, lifethreatening problem encountered in critical care. For patients with severe PE, unfractionated heparin (UFH) infusion is often used for anticoagulation (AC), as it can be discontinued if an intervention is planned. However, response to UFH is variable, requires frequent measurement of the partial thromboplastin time (PTT) and dose adjustment to maintain a therapeutic level of AC. Subtherapeutic or supra-therapeutic dosing places patients at risk of death from progression of disease or hemorrhage, but the proportion of patients who do not achieve therapeutic AC in a timely manner is not known. We therefore sought to determine the proportion of PE patients treated with UFH who achieve a therapeutic PTT within 24 hours of UFH initiation. Methods: We analyzed prospectively collected data from our PE Response Team database. We excluded patients not treated with UFH and those who died within 8 hours of AC initiation. We analyzed all PTT values available in the electronic medical record, grouping PTT values into six-hour time-windows after the initiation of AC. A PTT of 60-80 was considered therapeutic. Percentage of time in the therapeutic range was calculated. Results: Of 172 patients analyzed, 131 were included in the final analysis. The proportion of patients who had all their PTTs within therapeutic range was: 17.3% at 6h (19 of 110), 3.3% at 12h (4 of 121), 0.8% at 18h (1 of 122), and 0.0% at 24h (0 of 123). The percentage of patients who had any of their PTTs within therapeutic range was: 17.3% at 6h (19 of 110), 28.1% at 12h (34 of 121), 41.8% at 18h (51 of 122), and 50.4% at 24h (62 of 123). Conclusions: Half of all patients with severe PE fail to achieve any therapeutic PTT level within 24 hours of UFH initiation and the majority spend most of their first 24 hours outside of a therapeutic range of AC. Many patients received a non-standard dose of heparin, which may have limited the efficacy of AC. Future work should strive to improve AC strategies and research should focus on identifying factors associated with achieving therapeutic AC with UFH. AD - C. Prucnal AU - Prucnal, C. AU - Jansson, P. AU - Deadmon, E. AU - Zheng, H. AU - Kabrhel, C. DB - Embase DO - 10.1097/01.ccm.0000528155.02947.54 KW - heparin adult anticoagulation bleeding clinical trial death disease course drug therapy electronic medical record female human lung embolism major clinical study male partial thromboplastin time prospective study risk assessment treatment failure LA - English M3 - Conference Abstract N1 - L620081001 2018-01-09 PY - 2018 SN - 1530-0293 SP - 50 ST - Partial thromboplastin times in patients with pulmonary embolism treated with unfractionated heparin T2 - Critical Care Medicine TI - Partial thromboplastin times in patients with pulmonary embolism treated with unfractionated heparin UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620081001&from=export http://dx.doi.org/10.1097/01.ccm.0000528155.02947.54 VL - 46 ID - 760859 ER - TY - JOUR AB - OBJECTIVE: The objective was to determine the proportion of patients with pulmonary embolism (PE) treated with unfractionated heparin (UFH) who achieved therapeutic activated partial thromboplastin time (aPTT) values within 48 hours of treatment. METHODS: Retrospective analysis of a PE response team (PERT) database was performed at a large, urban, academic teaching hospital. Inclusion criteria were adult patients with acute PE for whom the PERT was consulted and who received anticoagulation (AC) with UFH according to guideline standard dosing. aPTT values during 6-hour time periods during the first 48 hours of AC were collected and analyzed. RESULTS: A total of 505 patients met inclusion criteria. For patients receiving a bolus and infusion of UFH, the proportions (95% confidence interval [CI]) of patients in the therapeutic range were 19.0% (14.2% to 25.0%) at 12 hours, 26.3% (26.3% to 33.1%) at 24 hours, 28.3% (22.0% to 35.4%) at 36 hours, and 28.4% (20.8% to 37.5%) at 48 hours. For titrated infusion only, the proportions (95% CIs) of patients were 23.3% (16.2% to 32.3%) at 12 hours, 41.4% (31.6% to 51.9%) at 24 hours, 37.0% (26.8% to 48.5%) at 36 hours, and 42.1% (30.2% to 55.0%) at 48 hours. No patient had all therapeutic aPTT values. CONCLUSIONS: The majority of patients with acute PE spend most of their first 48 hours outside of the therapeutic range of AC when treated with guideline standard dosing of UFH. Over half of the patients fail to achieve any therapeutic PTT level within 24 hours of UFH initiation, and no patient had all therapeutic aPTTs. Future research should focus on identifying factors associated with achieving therapeutic AC with UFH. AD - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA. Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA. Department of Emergency Medicine, Harvard Medical School, Boston, MA. Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston, MA. Biostatistics Center, Massachusetts General Hospital, Boston, MA. Department of Medicine, Harvard Medical School, Boston, MA. AN - 31625654 AU - Prucnal, C. K. AU - Jansson, P. S. AU - Deadmon, E. AU - Rosovsky, R. P. AU - Zheng, H. AU - Kabrhel, C. DA - Feb DO - 10.1111/acem.13872 DP - NLM ET - 2019/10/19 J2 - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine KW - Acute Disease Adult Anticoagulants/*administration & dosage Drug Administration Schedule Female Heparin/*administration & dosage Humans Male Middle Aged Partial Thromboplastin Time/*statistics & numerical data Pulmonary Embolism/*drug therapy Retrospective Studies Treatment Outcome LA - eng M1 - 2 N1 - 1553-2712 Prucnal, Christiana K Jansson, Paul S Orcid: 0000-0002-9230-3249 Deadmon, Erin Rosovsky, Rachel P Zheng, Hui Kabrhel, Christopher Centers of Expertise in Healthcare Quality and Pat/Partners Healthcare/International Journal Article Research Support, Non-U.S. Gov't United States Acad Emerg Med. 2020 Feb;27(2):117-127. doi: 10.1111/acem.13872. Epub 2019 Nov 24. PY - 2020 SN - 1069-6563 SP - 117-127 ST - Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism During the First 48 Hours of Anticoagulation With Unfractionated Heparin T2 - Acad Emerg Med TI - Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism During the First 48 Hours of Anticoagulation With Unfractionated Heparin VL - 27 ID - 760119 ER - TY - JOUR AB - Objective: The objective was to determine the proportion of patients with pulmonary embolism (PE) treated with unfractionated heparin (UFH) who achieved therapeutic activated partial thromboplastin time (aPTT) values within 48 hours of treatment. Methods: Retrospective analysis of a PE response team (PERT) database was performed at a large, urban, academic teaching hospital. Inclusion criteria were adult patients with acute PE for whom the PERT was consulted and who received anticoagulation (AC) with UFH according to guideline standard dosing. aPTT values during 6‐hour time periods during the first 48 hours of AC were collected and analyzed. Results: A total of 505 patients met inclusion criteria. For patients receiving a bolus and infusion of UFH, the proportions (95% confidence interval [CI]) of patients in the therapeutic range were 19.0% (14.2% to 25.0%) at 12 hours, 26.3% (26.3% to 33.1%) at 24 hours, 28.3% (22.0% to 35.4%) at 36 hours, and 28.4% (20.8% to 37.5%) at 48 hours. For titrated infusion only, the proportions (95% CIs) of patients were 23.3% (16.2% to 32.3%) at 12 hours, 41.4% (31.6% to 51.9%) at 24 hours, 37.0% (26.8% to 48.5%) at 36 hours, and 42.1% (30.2% to 55.0%) at 48 hours. No patient had all therapeutic aPTT values. Conclusions: The majority of patients with acute PE spend most of their first 48 hours outside of the therapeutic range of AC when treated with guideline standard dosing of UFH. Over half of the patients fail to achieve any therapeutic PTT level within 24 hours of UFH initiation, and no patient had all therapeutic aPTTs. Future research should focus on identifying factors associated with achieving therapeutic AC with UFH. AD - Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Boston MA Department of Emergency Medicine, Brigham and Women's Hospital, Boston MA Department of Emergency Medicine, Harvard Medical School, Boston MA Division of Hematology, Department of Medicine, Massachusetts General Hospital, Boston MA Biostatistics Center, Massachusetts General Hospital, Boston MA Department of Medicine, Harvard Medical School, Boston MA AN - 141677274. Language: English. Entry Date: 20200214. Revision Date: 20200218. Publication Type: Article AU - Prucnal, Christiana K. AU - Jansson, Paul S. AU - Deadmon, Erin AU - Rosovsky, Rachel P. AU - Zheng, Hui AU - Kabrhel, Christopher AU - Runyon, Michael S. DB - CINAHL DO - 10.1111/acem.13872 DP - EBSCOhost KW - Partial Thromboplastin Time Pulmonary Embolism -- Drug Therapy Heparin -- Therapeutic Use Time Factors Heparin -- Administration and Dosage Human Retrospective Design Academic Medical Centers Descriptive Statistics Confidence Intervals Blood Coagulation M1 - 2 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 9418450. PY - 2020 SN - 1069-6563 SP - 117-127 ST - Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism During the First 48 Hours of Anticoagulation With Unfractionated Heparin T2 - Academic Emergency Medicine TI - Analysis of Partial Thromboplastin Times in Patients With Pulmonary Embolism During the First 48 Hours of Anticoagulation With Unfractionated Heparin UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=141677274&site=ehost-live&scope=site VL - 27 ID - 761292 ER - TY - JOUR AB - OBJECTIVE Endovascular treatment in children, especially neonates, can be more challenging than analogous procedures in adults. This study aimed to describe the clinical and radiological findings, type and timing of endovascular treatment, and early outcomes in children who present with neurovascular malformations, who are treated with embolization, and who weigh less than 5 kg. METHODS The authors carried out a retrospective review of all consecutively treated children weighing less than 5 kg with neurovascular arteriovenous malformations (AVMs) at a single institution over a 10-year period. RESULTS Fifty-two patients were included in the study. Thirty-eight had a vein of Galen aneurysmal malformation, 3 a pial AVM, 6 a pial arteriovenous fistula, and 5 a dural sinus malformation. The endovascular treatment goals were control of cardiac failure or hydrocephalus in cases of nonhemorrhagic malformations or to prevent new bleeding in cases of previous hemorrhage. A hemorrhagic complication occurred in 12 procedures and an ischemic complication in 2. Both complication types were correlated with the age of the infant (age cutoff at 3 months) (p = of 0.015 and 0.049, respectively). No correlation was found with the weight of the infant or the duration of the procedure. CONCLUSIONS The embolization of AVMs in these patients prevented adverse cardiac effects, hydrovenous disorders, and rebleeding. The risk of major cerebral complications seems mainly correlated with age, with a threshold at 3 months. A multidisciplinary team involved in the treatment of these children may help to improve treatment success and management. AD - [Puccinelli, Francesco; Saliou, Guillaume] CHU Vaudois, Neuroradiol Intervent, Lausanne, Switzerland. [Minh Ngoc Thien Kim Tran Dong] Hop Bicetre, Serv Neuroradiol, Referral Ctr Neurovasc Dis Children, Le Kremlin Bicetre, France. [Iacobucci, Marta; Saliou, Guillaume] Hop Bicetre, Serv Neuroradiol, Le Kremlin Bicetre, France. [Mazoit, Jean-Xavier] Hop Bicetre, Anesthesie Pediat, Le Kremlin Bicetre, France. [Mazoit, Jean-Xavier] Univ Paris Sud, Lab Anesthesie UMR788 Neuroprotect Regenerat Axon, Fac Med Kremlin Bicetre, Orsay, France. [Durand, Philippe; Tissieres, Pierre] Hop Bicetre, Reanimat Pediat, Le Kremlin Bicetre, France. Saliou, G (corresponding author), CHU Vaudois, Lausanne, Switzerland. guillaume.saliou@chuv.ch AN - WOS:000466439900009 AU - Puccinelli, F. AU - Dong, Mntkt AU - Iacobucci, M. AU - Mazoit, J. X. AU - Durand, P. AU - Tissieres, P. AU - Saliou, G. DA - May DO - 10.3171/2018.11.peds1865 J2 - J. Neurosurg.-Pediatr. KW - neurovascular disease newborn children embolization endovascular treatment cerebral AVM vascular disorders GALEN MALFORMATIONS VEIN MANAGEMENT PLASTICITY Clinical Neurology Pediatrics Surgery LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: HW1JT Times Cited: 3 Cited Reference Count: 24 Puccinelli, Francesco Minh Ngoc Thien Kim Tran Dong Iacobucci, Marta Mazoit, Jean-Xavier Durand, Philippe Tissieres, Pierre Saliou, Guillaume Iacobucci, Marta/AAG-3383-2019 Iacobucci, Marta/0000-0002-3911-3278; saliou, guillaume/0000-0003-3832-7976 2 0 AMER ASSOC NEUROLOGICAL SURGEONS ROLLING MEADOWS J NEUROSURG-PEDIATR PY - 2019 SN - 1933-0707 SP - 597-605 ST - Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg T2 - Journal of Neurosurgery-Pediatrics TI - Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg UR - ://WOS:000466439900009 VL - 23 ID - 761527 ER - TY - JOUR AB - OBJECTIVE Endovascular treatment in children, especially neonates, can be more challenging than analogous procedures in adults. This study aimed to describe the clinical and radiological findings, type and timing of endovascular treatment, and early outcomes in children who present with neurovascular malformations, who are treated with embolization, and who weigh less than 5 kg. METHODS The authors carried out a retrospective review of all consecutively treated children weighing less than 5 kg with neurovascular arteriovenous malformations (AVMs) at a single institution over a 10-year period. RESULTS Fifty-two patients were included in the study. Thirty-eight had a vein of Galen aneurysmal malformation, 3 a pial AVM, 6 a pial arteriovenous fistula, and 5 a dural sinus malformation. The endovascular treatment goals were control of cardiac failure or hydrocephalus in cases of nonhemorrhagic malformations or to prevent new bleeding in cases of previous hemorrhage. A hemorrhagic complication occurred in 12 procedures and an ischemic complication in 2. Both complication types were correlated with the age of the infant (age cutoff at 3 months) (p = of 0.015 and 0.049, respectively). No correlation was found with the weight of the infant or the duration of the procedure. CONCLUSIONS The embolization of AVMs in these patients prevented adverse cardiac effects, hydrovenous disorders, and rebleeding. The risk of major cerebral complications seems mainly correlated with age, with a threshold at 3 months. A multidisciplinary team involved in the treatment of these children may help to improve treatment success and management. AD - G. Saliou, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland AU - Puccinelli, F. AU - Dong, M. N. T. K. T. AU - Iacobucci, M. AU - Mazoit, J. X. AU - Durand, P. AU - Tissieres, P. AU - Saliou, G. DB - Embase DO - 10.3171/2018.11.PEDS1865 KW - anticoagulant therapy arteriovenous fistula arteriovenous malformation article body weight brain arteriovenous malformation brain hemorrhage clinical feature clinical outcome coil embolization endovascular surgery female follow up heart failure human hydrocephalus infant infant disease major clinical study male nuclear magnetic resonance imaging operative blood loss outcome assessment postoperative complication priority journal retrospective study risk factor vein of Galen malformation LA - English M1 - 5 M3 - Article N1 - L2001905646 2019-05-14 2019-05-15 PY - 2019 SN - 1933-0715 1933-0707 SP - 597-605 ST - Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg T2 - Journal of Neurosurgery: Pediatrics TI - Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001905646&from=export http://dx.doi.org/10.3171/2018.11.PEDS1865 VL - 23 ID - 760714 ER - TY - JOUR AB - Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is usually underrecognized due to nonspecific presentations. Undiagnosed CTEPH leads to unnecessary investigations for other diseases, and more importantly, increased morbidities and mortality. Objectives: The aim of this study was to define overall CTEPH incidence and the rate of CTEPH after acute pulmonary embolism (APE) in a tertiary care university hospital and to record risk factors, clinical and imaging characteristics, diagnosis assessment, and management methods. Materials and Methods: The retrospective 5-year data, between 2012 and 2016, was extracted. Out of 1751 patients, we screened, 286 had, at least, evidence of pulmonary embolism. CTEPH was diagnosed in 20 patients, and 12 in this group had characteristics of combined APE or history of APE. Results: The overall incidence of CTEPH was 37.8 cases per million patients, and the incidence of CTEPH after APE was 5.1%. The most common presentation was progressive exertional dyspnea (50%). All patients were diagnosed by computed tomography pulmonary angiography combined with echocardiogram. Surprisingly, only two patients had investigations with ventilation/perfusion lung scan. None underwent the preferred curative surgical treatment of pulmonary endarterectomy and two had balloon pulmonary angioplasty. All patients received anticoagulants, while only 5 patients were treated with pulmonary arterial hypertension-specific drugs. Conclusion: CTEPH was uncommon in our institute, with an underuse of the standard test. Suboptimal diagnosis assessment and management remain critical problems. Developing a properly trained CTEPH care team would improve patient outcomes, but cost/resources may be prohibitive for such a relatively rare disease. AD - [Puengpapat, Suphathat; Pirompanich, Pattarin] Thammasat Univ, Div Pulmonol & Crit Care, Dept Med, Pathum Thani, Thailand. Pirompanich, P (corresponding author), Thammasat Univ, Div Pulmonol & Crit Care, Dept Med, Fac Med, Pathum Thani 12120, Thailand. pirompanichp@gmail.com AN - WOS:000443061400002 AU - Puengpapat, S. AU - Pirompanich, P. DA - Sep-Oct DO - 10.4103/lungindia.lungindia_158_18 J2 - Lung India KW - Chronic thromboembolic pulmonary hypertension pulmonary embolism pulmonary hypertension thromboembolism THROMBOTIC RISK-FACTORS DIAGNOSIS GUIDELINES EMBOLISM CTEPH Respiratory System LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: GR9HH Times Cited: 0 Cited Reference Count: 31 Puengpapat, Suphathat Pirompanich, Pattarin Pirompanich, Pattarin/0000-0003-0181-5394 Faculty of Medicine, Thammasat University This study was financially supported by Faculty of Medicine, Thammasat University. 0 WOLTERS KLUWER MEDKNOW PUBLICATIONS MUMBAI LUNG INDIA PY - 2018 SN - 0970-2113 SP - 373-378 ST - Incidence of chronic thromboembolic pulmonary hypertension in Thammasat University Hospital T2 - Lung India TI - Incidence of chronic thromboembolic pulmonary hypertension in Thammasat University Hospital UR - ://WOS:000443061400002 VL - 35 ID - 761574 ER - TY - JOUR AB - Study Objective: To show the feasibility, technique, and results of laparoscopic anterior exenteration in selected patients. Design: A retrospective cohort study. Setting: Galaxy Care Laparoscopy Institute, Pune, India. Patients: Seventy-four of 85 patients who underwent laparoscopic anterior exenteration for stage IVA carcinoma of the cervix from January 2005 to January 2015 were analyzed; the median follow-up was 30 months. Contrast-enhanced computed tomographic imaging of the abdomen and pelvis was performed for all patients. Interventions: The same surgeon and team performed all the operations for uniformity in 10 operative steps. Measurements and Main Results: The mean operative time was 180 minutes, and the mean blood loss was 160 mL. The mean hospital stay was 6 days. The average number of lymph nodes removed was 21.4. Surgical margins were negative in all patients. Forty-two patients had positive lymph nodes. Chemoradiation was given to those with positive lymph nodes. Perioperative complications occurred in 15 (20.27%) patients including deep vein thrombosis, urinary tract infection, ureterosigmoid leak (n = 2/74), and so on. Positron emission tomographic imaging and computed tomographic scanning were performed at 6 months after surgery and 6 months after adjuvant therapy in those with positive lymph nodes. There was no immediate postoperative mortality. The overall survival rate at 5 years was 25%. Conclusion: Laparoscopic anterior exenteration is feasible in cases of advanced carcinoma of the cervix. Results have shown that in selected patients this procedure is associated with good long-term survival. (C) 2016 AAGL. All rights reserved. AD - [Puntambekar, Shailesh; Shama, Vikrant; Gadkari, Yamini; Joshi, Geetanjali; Puntambekar, Seema; Parikh, Hirav; Vatsal, Shivam] Galaxy Care Laparoscopy Inst, 25-A Erandwane,Karve Rd, Pune 411004, Maharashtra, India. [Jamkar, Arun V.] Maharashtra Univ Hlth Sci, Nasik, India. Puntambekar, S (corresponding author), Galaxy Care Laparoscopy Inst, 25-A Erandwane,Karve Rd, Pune 411004, Maharashtra, India. shase63@gmail.com AN - WOS:000372560200019 AU - Puntambekar, S. AU - Shama, V. AU - Jamkar, A. V. AU - Gadkari, Y. AU - Joshi, G. AU - Puntambekar, S. AU - Parikh, H. AU - Vatsal, S. DA - Mar-Apr DO - 10.1016/j.jmig.2015.12.005 J2 - J. Mimim. Invasive Gynecol. KW - Advanced carcinoma cervix Laparoscopic anterior exenteration Palliation Ureterosigmoidostomy PELVIC EXENTERATION RADICAL HYSTERECTOMY MORBIDITY MALIGNANCIES SURVIVAL SURGERY CANCERS Obstetrics & Gynecology LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: DH1QO Times Cited: 5 Cited Reference Count: 24 Puntambekar, Shailesh Shama, Vikrant Jamkar, Arun V. Gadkari, Yamini Joshi, Geetanjali Puntambekar, Seema Parikh, Hirav Vatsal, Shivam 5 0 2 ELSEVIER SCIENCE INC NEW YORK J MINIM INVAS GYN PY - 2016 SN - 1553-4650 SP - 396-403 ST - Our Experience of Laparoscopic Anterior Exenteration in Locally Advanced Cervical Carcinoma T2 - Journal of Minimally Invasive Gynecology TI - Our Experience of Laparoscopic Anterior Exenteration in Locally Advanced Cervical Carcinoma UR - ://WOS:000372560200019 VL - 23 ID - 761715 ER - TY - JOUR AB - P>Objectives: The aim was to determine if an intensive restructuring of the approach to acute stroke improved time to thrombolysis over a 3-year study period and to determine whether delay modifications correlated with increased thrombolytic intervention or functional outcome. Methods: The study examined the pretreatment process to define specific time intervals (delays) of interest in the acute management of 289 consecutive ischemic stroke patients who were transported by the emergency medical services (EMS) and received intravenous (IV) thrombolytic therapy in the emergency department (ED) of Helsinki University Central Hospital. Time interval changes of the 3-year period and use of thrombolytics was measured. Functional outcome, measured with the modified Rankin Scale (mRS) at 3 months, was assessed with multivariable statistical analysis. Results: During implementation of the restructuring program from 2003 to 2005, the median total time delay from symptom onset to drug administration dropped from 149 to 112 minutes (p < 0.0001). Prehospital delays did not change significantly during the study period. The median delay in calling an ambulance remained at 13 minutes, and the total median prehospital delay stayed at 71 minutes. In-hospital delays decreased from 67 to 34 minutes (p < 0.0001). The median call delay was 25 minutes in patients with mild symptoms (National Institute of Health Stroke Scale [NIHSS] score < 7) and 8 minutes with severe symptoms (NIHSS > 15). In the multivariate model, stroke severity (odds ratio [OR] = 0.83, 95% confidence interval [CI] = 0.78 to 0.88, p < 0.0001), age (OR = 0.57, 95% CI = 0.42 to 0.77, p < 0.0001), and in-hospital delay (OR = 0.47, 95% CI = 0.22 to 0.97, p = 0.04) were suggesting a good outcome. Conclusions: Restructuring of the teamwork between the EMS personnel and the reorganized ED significantly reduced in-hospital, but not prehospital, delays. The present data suggest that a decreased in-hospital delay improves the accessibility of the benefits of thrombolysis. AD - [Puolakka, Tuukka; Vayrynen, Taneli; Kuisma, Markku] Univ Helsinki, Cent Hosp, Emergency Med Serv, Helsinki, Finland. [Happola, Olli; Soinne, Lauri; Lindsberg, Perttu J.] Univ Helsinki, Cent Hosp, Dept Neurol, Helsinki, Finland. [Lindsberg, Perttu J.] Univ Helsinki, Program Mol Neurol, Helsinki, Finland. Puolakka, T (corresponding author), Univ Helsinki, Cent Hosp, Emergency Med Serv, Helsinki, Finland. tuukka.puolakka@hus.fi AN - WOS:000281632000008 AU - Puolakka, T. AU - Vayrynen, T. AU - Happola, O. AU - Soinne, L. AU - Kuisma, M. AU - Lindsberg, P. J. DA - Sep DO - 10.1111/j.1553-2712.2010.00828.x J2 - Acad. Emerg. Med. KW - stroke thrombolytic therapy emergency medical services time factors treatment outcome ISCHEMIC-STROKE SCALE SCORE EMERGENCY ASSOCIATION ALTEPLASE TRIALS DOOR CARE Emergency Medicine LA - English M1 - 9 M3 - Article N1 - ISI Document Delivery No.: 647PV Times Cited: 27 Cited Reference Count: 15 Puolakka, Tuukka Vayrynen, Taneli Happola, Olli Soinne, Lauri Kuisma, Markku Lindsberg, Perttu J. Soinne, Lauri/E-3703-2019; Lindsberg, Perttu J/F-1271-2010 Lindsberg, Perttu/0000-0001-7690-811X; Kuisma, Markku/0000-0002-3057-6524 Helsinki University Central Hospital (EVO); Sigrid Juselius FoundationSigrid Juselius Foundation; Academy of FinlandAcademy of Finland [111117]; University of Helsinki This work was supported by grants from Helsinki University Central Hospital (EVO), Sigrid Juselius Foundation, Academy of Finland (111117) and University of Helsinki. There was a monthly salary of 1755.97 Euros for research assistant (TP) during June-August 2008 and December 15-31, 2008. 27 0 4 WILEY-BLACKWELL PUBLISHING, INC MALDEN ACAD EMERG MED PY - 2010 SN - 1069-6563 SP - 965-969 ST - Sequential Analysis of Pretreatment Delays In Stroke Thrombolysis T2 - Academic Emergency Medicine TI - Sequential Analysis of Pretreatment Delays In Stroke Thrombolysis UR - ://WOS:000281632000008 VL - 17 ID - 761870 ER - TY - JOUR AB - Cardiac arrest is a frequent emergency for doctors and resuscitation teams. Patients displaying asystole or pulseless electrical activity are non-shockable. They have extremely poor outcomes. The use of sonographers might contribute to a better understanding of cardiac arrest (CA) etiology and facilitate its treatment. A systematic search in databases (NLM-Gateway (R), CNRS-INIST/Pascal (R), Science Direct (R), Ovid (R), and Bibliovie (R)) of primary documents and notices allowed us to select clinical trial studies. Editorials, case report and animals studies were excluded from the analysis. The various physiopathological and semiological status revealed by echocardiography are useful to detect the aetiology of cardiac arrest. In the very first minutes following the arrest, a significant increase of right ventricle (RV) volume suggests a pulmonary thromboembolism or a RV infarction. After 4 min of CA, a physiological increase of RV volume is observed, in relation with the pressure balance between high and low arteriovenous pressures. RV and/or left ventricle collapses are straightaway pathological whichever due to pericardic effusion, pneumothorax or schock. A synthesis algorithm dedicated to care of CA, including transthoracic echocardiography for search of curable causes, is proposed. This algorithm fulfills the ILCOR, ERC and AHA recommendations. The echocardiography should be part of ACLS, nevertheless clinical studies are needed to assess its impact on morbimortality. (C) 2009 Published by Elsevier Masson SAS. AD - [Querellou, E.; Leyral, J.; Brun, C.; Levy, D.; Meyran, D.; Le Dreff, P.] Smur, Bataillon Marins Pompiers Ville Marseille, F-13003 Marseille 03, France. [Bessereau, J.] Hop Enfants La Timone, Samu 13, F-13385 Marseille 05, France. Querellou, E (corresponding author), Smur, Bataillon Marins Pompiers Ville Marseille, 9 Blvd Strasbourg,BP 207, F-13003 Marseille 03, France. querellou@yahoo.fr AN - WOS:000270768700007 AU - Querellou, E. AU - Leyral, J. AU - Brun, C. AU - Levy, D. AU - Bessereau, J. AU - Meyran, D. AU - Le Dreff, P. DA - Sep DO - 10.1016/j.annfar.2009.06.020 J2 - Ann. Fr. Anest. Reanim. KW - Emergency echocardiography Cardiopulmonary resuscitation Algorithm Critical care ultrasound Advanced life support (ALS) Cardiac arrest Cardiac tamponade Hypovolemia Pulmonary embolism Pulseless electrical activity (PEA) Tension pneumothorax Ultrasound Prognostic TTE fibrillating myocardium INFERIOR VENA-CAVA PULSELESS ELECTRICAL-ACTIVITY EXTERNAL CHEST COMPRESSION MITRAL-VALVE FUNCTION CARDIOPULMONARY-RESUSCITATION TRANSESOPHAGEAL ECHOCARDIOGRAPHY PULMONARY-EMBOLISM FOCUSED ASSESSMENT BLOOD-FLOW TRANSTHORACIC ECHOCARDIOGRAPHY Anesthesiology LA - French M1 - 9 M3 - Article N1 - ISI Document Delivery No.: 506IO Times Cited: 8 Cited Reference Count: 87 Querellou, E. Leyral, J. Brun, C. Levy, D. Bessereau, J. Meyran, D. Le Dreff, P. 8 0 2 ELSEVIER FRANCE-EDITIONS SCIENTIFIQUES MEDICALES ELSEVIER ISSY-LES-MOULINEAUX ANN FR ANESTH PY - 2009 SN - 0750-7658 SP - 769-778 ST - In and Out-of-hospital cardiac arrest and echography: A review T2 - Annales Francaises D Anesthesie Et De Reanimation TI - In and Out-of-hospital cardiac arrest and echography: A review UR - ://WOS:000270768700007 VL - 28 ID - 761891 ER - TY - JOUR AB - Pulmonary embolism (PE) is a major cause of morbidity and mortality in the United States. Although new therapeutic tools and strategies have recently been developed for the diagnosis and treatment of patients with PE, the outcomes for patients who present with massive or high‐risk PE remain dismal. To address this crisis, pulmonary embolism response teams (PERTs) are being created around the world in an effort to immediately and simultaneously engage multiple specialists to determine the best course of action and coordinate the clinical care for patients with acute PE. The scope of this review is to describe the PERT model and purpose, present the structure and organization, examine the available evidence for efficacy and usefulness, and propose future directions for research that is needed to demonstrate the value of PERT and determine if this multidisciplinary approach represents a new standard of care. AU - Rachel, Rosovsky AU - Ken, Zhao AU - Akhilesh, Sista AU - Belinda, Rivera‐Lebron AU - Christopher, Kabrhel DA - 2019/07 07 DB - Directory of Open Access Journals (Sweden) DO - 10.1002/rth2.12216 KW - advanced therapies catheter‐directed thrombolysis follow‐up care multidisciplinary pulmonary embolism pulmonary embolism response team M1 - 3 PY - 2019 SN - 2475-0379 SP - 315-330 ST - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions T2 - Research and Practice in Thrombosis and Haemostasis TI - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions UR - https://doi.org/10.1002/rth2.12216 VL - 3 ID - 761992 ER - TY - JOUR AB - BACKGROUND: For patients with acute ischemic stroke, intra-arterial treatment (IAT) is considered to be an effective strategy for removing the obstructing clot. Because outcome crucially depends on time to treatment ('time-is-brain' concept), we assessed the effects of an intervention based on performing all the time-sensitive diagnostic and therapeutic procedures at a single location on the delay before intra-arterial stroke treatment. METHODS: Consecutive acute stroke patients with large vessel occlusion who obtained IAT were evaluated before and after implementation (April 26, 2010) of an intervention focused on performing all the diagnostic and therapeutic measures at a single site ('stroke room'). RESULT: After implementation of the intervention, the median intervals between admission and first angiography series were significantly shorter for 174 intervention patients (102 min, interquartile range (IQR) 85-120 min) than for 81 control patients (117 min, IQR 89-150 min; p < 0.05), as were the intervals between admission and clot removal or end of angiography (152 min, IQR 123-185 min vs. 190 min, IQR 163-227 min; p < 0.001). However, no significant differences in clinical outcome were observed. CONCLUSION: This study shows for the, to our knowledge, first time that for patients with acute ischemic stroke, stroke diagnosis and treatment at a single location ('stroke room') saves crucial time until IAT. AD - Department of Neurology, University of the Saarland, Homburg, Germany. AN - 26484754 AU - Ragoschke-Schumm, A. AU - Yilmaz, U. AU - Kostopoulos, P. AU - Lesmeister, M. AU - Manitz, M. AU - Walter, S. AU - Helwig, S. AU - Schwindling, L. AU - Fousse, M. AU - Haass, A. AU - Garner, D. AU - Körner, H. AU - Roumia, S. AU - Grunwald, I. AU - Nasreldein, A. AU - Halmer, R. AU - Liu, Y. AU - Schlechtriemen, T. AU - Reith, W. AU - Fassbender, K. DO - 10.1159/000440850 DP - NLM ET - 2015/10/21 J2 - Cerebrovascular diseases (Basel, Switzerland) KW - Acute Disease Aged Cerebral Angiography Clinical Protocols Combined Modality Therapy Female Fibrinolytic Agents/*therapeutic use Hospital Units/*organization & administration Hospitals, University/organization & administration Humans Infusions, Intra-Arterial Male Middle Aged Patient Care Team Prospective Studies Stroke/*diagnostic imaging/drug therapy/*therapy Tertiary Care Centers/organization & administration Thrombectomy *Thrombolytic Therapy Time-to-Treatment Tissue Plasminogen Activator/*therapeutic use Tomography, X-Ray Computed LA - eng M1 - 5-6 N1 - 1421-9786 Ragoschke-Schumm, Andreas Yilmaz, Umut Kostopoulos, Panagiotis Lesmeister, Martin Manitz, Matthias Walter, Silke Helwig, Stefan Schwindling, Lenka Fousse, Mathias Haass, Anton Garner, Dominique Körner, Heiko Roumia, Safwan Grunwald, Iris Nasreldein, Ali Halmer, Ramona Liu, Yang Schlechtriemen, Thomas Reith, Wolfgang Fassbender, Klaus Comparative Study Journal Article Switzerland Cerebrovasc Dis. 2015;40(5-6):251-7. doi: 10.1159/000440850. Epub 2015 Oct 21. PY - 2015 SN - 1015-9770 SP - 251-7 ST - 'Stroke Room': Diagnosis and Treatment at a Single Location for Rapid Intraarterial Stroke Treatment T2 - Cerebrovasc Dis TI - 'Stroke Room': Diagnosis and Treatment at a Single Location for Rapid Intraarterial Stroke Treatment VL - 40 ID - 760480 ER - TY - JOUR AB - Objective: To examine our institutional experiences with ultrasound-guided peripherally inserted central catheter (US-PICC) placement by a dedicated US-PICC team under the umbrella of an existing pediatric sedation service. Methods: Retrospective review of quality data examining 968 US-PICC encounters over a 5-year period from 2012 to 2016. Data for each encounter included line indications, success rate, dwelling time, need for sedation, and incidence of complications including venous thrombosis, infection, and accidental removal. Results: US-PICC lines were successfully placed in 89% of patients with an average age of 5.4 years. Extended antibiotic treatment was the most common indication for US-PICC placement and the mean dwell time was 23 days. Long-term complications were noted in 6.1% of cases, with venous thrombosis and line infection complicating 1.7% and 0.9% of encounters, respectively. Conclusion: Results suggest that our endeavor of creating a dedicated US-PICC team under an existing pediatric sedation service is successful with regard to the number of lines placed, success rates, and incidence of complications. This approach may be beneficial to other institutions seeing to maximize resource utilization and streamline patient care. AD - [Rainey, Shane C.; Deshpande, Girish; Hanson, Keith] Univ Illinois, Coll Med, Dept Pediat, Peoria, IL 61605 USA. [Rainey, Shane C.] Univ Arizona, Coll Med Phoenix, Dept Child Hlth, Phoenix, AZ USA. [Boehm, Haley; Camp, Kim; Fehr, Annette; Horack, Kimberly] OSF Healthcare Childrens Hosp Illinois, Peoria, IL USA. Rainey, SC (corresponding author), Univ Illinois, Coll Med Peoria, 1 Illini Dr, Peoria, IL 61605 USA. shane.c.rainey@osfhealthcare.org AN - WOS:000494353600001 AU - Rainey, S. C. AU - Deshpande, G. AU - Boehm, H. AU - Camp, K. AU - Fehr, A. AU - Horack, K. AU - Hanson, K. C7 - Unsp 1179556519884040 DA - Oct DO - 10.1177/1179556519884040 J2 - Clin. MED. Insights-Pediatr. KW - Instrumentation quality improvement utilization organization and administration INSERTED CENTRAL CATHETERS DEEP-VEIN THROMBOSIS CHILDREN COMPLICATIONS Pediatrics LA - English M3 - Article N1 - ISI Document Delivery No.: JJ7SK Times Cited: 0 Cited Reference Count: 15 Rainey, Shane C. Deshpande, Girish Boehm, Haley Camp, Kim Fehr, Annette Horack, Kimberly Hanson, Keith Rainey, Shane/0000-0001-9568-3008 0 1 2 SAGE PUBLICATIONS LTD LONDON CLIN MED INSIGHTS-PE PY - 2019 SN - 1179-5565 SP - 5 ST - Development of a Pediatric PICC Team Under an Existing Sedation Service: A 5-Year Experience T2 - Clinical Medicine Insights-Pediatrics TI - Development of a Pediatric PICC Team Under an Existing Sedation Service: A 5-Year Experience UR - ://WOS:000494353600001 VL - 13 ID - 761489 ER - TY - JOUR AB - A 72-year-old man was referred to our hospital as a case of postcardiac arrest following a long distance air flight. Work-up in the emergency department revealed the presence of deep vein thrombosis (DVT), bilateral pulmonary embolism, inferior STEMI (ST elevation myocardial infarction) and ischaemic stroke. He received thrombolysis by recombinant tissue plasminogen activator (tPA) following which his haemodynamic status improved, but he developed haemorrhagic transformation of the stroke as a complication. The haemorrhagic lesion gradually resolved with conservative management, leaving behind a residual neurological deficit. His haemodynamic status was stable after the management. Although a diagnosis of right-to-left shunt lesion was highly suggestive in this condition, it could not be confirmed on the transthoracic echocardiogram. Our patient had a unique presentation of multiple thrombi in different organs that caused significant morbidity and haemodynamic instability. There are no well-established guidelines that discuss the acute management of such cases. This situation requires a careful assessment and management of the patient by a multidisciplinary team. Copyright 2012 BMJ Publishing Group. All rights reserved. AD - A.R. Rajani, Department of Cardiology, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates AU - Rajani, A. R. AU - Hussain, K. AU - Baslaib, F. O. AU - Radaideh, G. A. DB - Embase Medline DO - 10.1136/bcr-2012-007221 KW - alteplase antihypertensive agent antinuclear antibody clopidogrel double stranded DNA antibody hydroxymethylglutaryl coenzyme A reductase inhibitor low molecular weight heparin pantoprazole proton pump inhibitor aged anticoagulant therapy article artificial ventilation blood clot lysis brain infarction brain ischemia brain tomography case report cerebrovascular accident clinical feature collapse computed tomographic angiography differential diagnosis dizziness Doppler ultrasonography drug withdrawal dyspnea electrocardiogram erythrocyte transfusion follow up gastrointestinal hemorrhage Glasgow coma scale heart dilatation heart ejection fraction heart right left shunt heart right ventricle pressure hemiplegia human intubation leg thrombosis lung angiography lung embolism male medical history physiotherapy priority journal resuscitation ST segment elevation myocardial infarction transthoracic echocardiography treatment outcome tricuspid valve regurgitation L1 - http://casereports.bmj.com/content/2012/bcr-2012-007221.full.pdf+html?sid=f888be2e-4850-408f-8111-9511338378a3 LA - English M3 - Article N1 - L368090919 2013-01-21 2013-01-25 PY - 2012 SN - 1757-790X ST - A unique presentation of four thrombotic events at a time T2 - BMJ Case Reports TI - A unique presentation of four thrombotic events at a time UR - https://www.embase.com/search/results?subaction=viewrecord&id=L368090919&from=export http://dx.doi.org/10.1136/bcr-2012-007221 ID - 761184 ER - TY - JOUR AB - Background Multiple myeloma is characterised by monoclonal paraprotein production and osteolytic lesions, commonly leading to skeletal-related events (spinal cord compression, pathological fracture, or surgery or radiotherapy to affected bone). Denosumab, a monoclonal antibody targeting RANKL, reduces skeletal-related events associated with bone lesions or metastases in patients with advanced solid tumours. This study aimed to assess the efficacy and safety of denosumab compared with zoledronic acid for the prevention of skeletal-related events in patients with newly diagnosed multiple myeloma. Methods In this international, double-blind, double-dummy, randomised,active-controlled, phase 3 study, patients in 259 centres and 29 countries aged 18 years or older with symptomatic newly diagnosed multiple myeloma who had at least one documented lytic bone lesion were randomly assigned (1: 1; centrally, by interactive voice response system using a fixed stratified permuted block randomisation list with a block size of four) to subcutaneous denosumab 120 mg plus intravenous placebo every 4 weeks or intravenous zoledronic acid 4 mg plus subcutaneous placebo every 4 weeks (both groups also received investigators' choice of first-line antimyeloma therapy). Stratification was by intent to undergo autologous transplantation, antimyeloma therapy, International Staging System stage, previous skeletal-related events, and region. The clinical study team and patients were masked to treatment assignments. The primary endpoint was non-inferiority of denosumab to zoledronic acid with respect to time to first skeletal-related event in the full analysis set (all randomly assigned patients). All safety endpoints were analysed in the safety analysis set, which includes all randomly assigned patients who received at least one dose of active study drug. This study is registered with ClinicalTrials. gov, number NCT01345019. Findings From May 17, 2012, to March 29, 2016, we enrolled 1718 patients and randomly assigned 859 to each treatment group. The study met the primary endpoint; denosumab was non-inferior to zoledronic acid for time to first skeletalrelated event (hazard ratio 0.98, 95% CI 0.85-1.14; p non-inferiority = 0.010). 1702 patients received at least one dose of the investigational drug and were included in the safety analysis (850 patients receiving denosumab and 852 receiving zoledronic acid). The most common grade 3 or worse treatment-emergent adverse events for denosumab and zoledronic acid were neutropenia (126 [15%] vs 125 [15%]), thrombocytopenia (120 [14%] vs 103 [12%]), anaemia (100 [12%] vs 85 [10%]), febrile neutropenia (96 [11%] vs 87 [10%]), and pneumonia (65 [8%] vs 70 [8%]). Renal toxicity was reported in 85 (10%) patients in the denosumab group versus 146 (17%) in the zoledronic acid group; hypocalcaemia adverse events were reported in 144 (17%) versus 106 (12%). Incidence of osteonecrosis of the jaw was not significantly different between the denosumab and zoledronic acid groups (35 [4%] vs 24 [3%]; p=0.147). The most common serious adverse event for both treatment groups was pneumonia (71 [8%] vs 69 [8%]). One patient in the zoledronic acid group died of cardiac arrest that was deemed treatment-related. Interpretation In patients with newly diagnosed multiple myeloma, denosumab was non-inferior to zoledronic acid for time to skeletal-related events. The results from this study suggest denosumab could be an additional option for the standard of care for patients with multiple myeloma with bone disease. AD - [Raje, Noopur] Massachusetts Gen Hosp, Ctr Canc, Ctr Multiple Myeloma, Boston, MA 02114 USA. [Terpos, Evangelos] Natl & Kapodistrian Univ Athens, Sch Med, Alexandra Gen Hosp, Athens, Greece. [Willenbacher, Wolfgang] Univ Innsbruck Hosp, Innsbruck, Austria. [Willenbacher, Wolfgang] OncoTyrol, Ctr Personalized Canc Med, Innsbruck, Austria. [Shimizu, Kazuyuki] Natl Hosp Org Higashi Nagoya Natl Hosp, Nagoya, Aichi, Japan. [Garcia-Sanz, Ramon] Hosp Univ Salamanca, Salamanca, Spain. [Durie, Brian] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA. [Legiec, Wojciech] Med Univ Lublin, Lublin, Poland. [Krejci, Marta] Univ Hosp Brno, Dept Internal Med Hematol & Oncol, Brno, Czech Republic. [Laribi, Kamel] Ctr Hosp Le Mans, Dept Hematol, Le Mans, France. [Zhu, Li; Cheng, Paul; Warner, Douglas] Amgen Inc, Thousand Oaks, CA USA. [Roodman, G. David] Indiana Univ Sch Med, Indianapolis, IN 46202 USA. Raje, N (corresponding author), Massachusetts Gen Hosp, Ctr Canc, Ctr Multiple Myeloma, Boston, MA 02114 USA. NRAJE@mgh.harvard.edu AN - WOS:000426466100052 AU - Raje, N. AU - Terpos, E. AU - Willenbacher, W. AU - Shimizu, K. AU - Garcia-Sanz, R. AU - Durie, B. AU - Legiec, W. AU - Krejci, M. AU - Laribi, K. AU - Zhu, L. AU - Cheng, P. AU - Warner, D. AU - Roodman, G. D. DA - Mar DO - 10.1016/s1470-2045(18)30072-x J2 - Lancet Oncol. KW - SURVIVAL REGRESSION CELLS BISPHOSPHONATE OSTEONECROSIS TRIAL JAW IX Oncology LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: FX9YD Times Cited: 102 Cited Reference Count: 32 Raje, Noopur Terpos, Evangelos Willenbacher, Wolfgang Shimizu, Kazuyuki Garcia-Sanz, Ramon Durie, Brian Legiec, Wojciech Krejci, Marta Laribi, Kamel Zhu, Li Cheng, Paul Warner, Douglas Roodman, G. David Terpos, Evangelos/AAD-3667-2019; Garcia-Sanz, Ramon/B-7986-2017 Garcia-Sanz, Ramon/0000-0003-4120-2787 AmgenAmgen Amgen. 101 1 28 ELSEVIER SCIENCE INC NEW YORK LANCET ONCOL PY - 2018 SN - 1470-2045 SP - 370-381 ST - Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study T2 - Lancet Oncology TI - Denosumab versus zoledronic acid in bone disease treatment of newly diagnosed multiple myeloma: an international, double-blind, double-dummy, randomised, controlled, phase 3 study UR - ://WOS:000426466100052 VL - 19 ID - 761597 ER - TY - JOUR AU - Rali, P. M. AU - Criner, G. J. DA - 2018/04/20 04/20 DB - Europe PubMed Central DO - 10.1164/rccm.201711-2302ci M1 - 5 PY - 2018 SN - 1073-449x SP - 588-598 ST - Submassive Pulmonary Embolism T2 - Am J Respir Crit Care Med TI - Submassive Pulmonary Embolism UR - http://europepmc.org/article/MED/29672125 VL - 198 ID - 762103 ER - TY - JOUR AB - BACKGROUND: The regional needs and consolidation of cardiac surgery services (CSS) result in an increased number of stand-alone interventional cardiology units. We aimed to explore the impact of a heart team on the decision making and outcomes of patients with multivessel coronary artery disease referred for coronary revascularization in stand-alone interventional cardiology units. METHODS: This prospective study included 1063 consecutive patients with multivessel disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography and percutaneous coronary intervention (PCI), with or without on-site CSS. RESULTS: Of the 1063 patients, 487 (46%) underwent coronary artery bypass grafting (CABG) and 576 (54%) underwent PCI. A higher proportion of patients underwent PCI in hospitals without on-site CSS compared with those with on-site CSS (65% vs 46%; P < .001). Furthermore, patients referred to CABG from hospitals without on-site CSS had a significantly higher mean SYNTAX score compared with those who underwent CABG in centers with on-site CSS (29 vs 26; P = .018). Multivariate logistic regression analysis consistently showed that the absence of on-site cardiac surgery and a heart team was independently associated with a 2.5-fold increased likelihood for predicting the referral of PCI rather than CABG (odds ratio, 2.54; 95% confidence interval, 1.8-3.6). CONCLUSIONS: Patients with multivessel coronary artery disease treated in centers without on-site cardiac surgery services receive a lower rate of appropriate guideline-based intervention with CABG. These findings suggest that a heart team approach should be mandatory even in centers with stand-alone interventional cardiology units. AD - Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Department of Cardiology, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: ehud.raanani@sheba.health.gov.il. AN - 29452484 AU - Ram, E. AU - Goldenberg, I. AU - Kassif, Y. AU - Segev, A. AU - Lavee, J. AU - Shlomo, N. AU - Raanani, E. DA - Mar DO - 10.1016/j.jtcvs.2017.09.144 DP - NLM ET - 2018/02/18 J2 - The Journal of thoracic and cardiovascular surgery KW - Aged Cardiology Service, Hospital/*trends Centralized Hospital Services/*trends Clinical Decision-Making Coronary Angiography/trends Coronary Artery Bypass/adverse effects/mortality/*trends Coronary Artery Disease/diagnostic imaging/mortality/physiopathology/*therapy Female Humans Israel Male Middle Aged Patient Care Team/*trends Patient Selection Percutaneous Coronary Intervention/adverse effects/mortality/*trends Practice Patterns, Physicians'/*trends Prospective Studies Referral and Consultation/*trends Registries Time Factors Treatment Outcome *adult *coronary artery bypass grafts *coronary stents *percutaneous coronary intervention LA - eng M1 - 3 N1 - 1097-685x Ram, Eilon Goldenberg, Ilan Kassif, Yigal Segev, Amit Lavee, Jakob Shlomo, Nir Raanani, Ehud Comparative Study Journal Article Multicenter Study Video-Audio Media United States J Thorac Cardiovasc Surg. 2018 Mar;155(3):865-873.e3. doi: 10.1016/j.jtcvs.2017.09.144. Epub 2017 Nov 9. PY - 2018 SN - 0022-5223 SP - 865-873.e3 ST - Comparison of patients with multivessel disease treated at centers with and without on-site cardiac surgery T2 - J Thorac Cardiovasc Surg TI - Comparison of patients with multivessel disease treated at centers with and without on-site cardiac surgery VL - 155 ID - 760366 ER - TY - JOUR AB - Introduction/Aim: Optimal management of high risk submassive and massive pulmonary emboli (PE) is unclear with treatment options including systemic anticoagulation, catheter directed lysis, systemic thrombolysis and surgery. Until evidence is available to recommend a specific therapy for each circumstance, we have taken a multidisciplinary approach. Patients who underwent pulmonary embolectomy after the introduction of a PE management pathway at a tertiary centre were audited. Methods: Retrospective review of medical records of all pulmonary embolectomies done at Sir Charles Gairdner Hospital between January 2016 and February 2017. Results: 13 pulmonary embolectomies were undertaken during audit period. Median age was 65 (37-79) and median body mass index was 34 kg/m2 Most patients had a PE severity index of 4 or 5 (n=8) and European Society of Cardiology Risk Class of Intermediate-high or High (n=11). 2 patients had surgery provoked PE, 3 had immobility provoked PE and 1 had a thrombophilia.5 required cardio-pulmonary resuscitation pre-operatively with 1 undergoing thrombolysis. 12 underwent a CT pulmonary angiogram; all showed features of right heart strain. 12 had a preoperative echocardiogram (ECHO) which showed right heart failure. Estimated pulmonary artery systolic pressure ranged from 44-105 mmHg (n=5). Median intensive care length of stay (LOS) was 5 days (2-22 days) and median hospital LOS was 20 days (7-35 days). Patients needed endotracheal intubation and an intercostal catheter for a median of 3 days and 3 had acute kidney injury post-operatively. 1 patient died during hospital stay. Of those discharged, all survived at 6 month follow up. At hospital discharge, 8 patients had normal or mild impairment of right ventricular (RV) function. 8 had ECHO at clinic follow up and all had normal RV function. Conclusion: Pulmonary embolectomy is associated with morbidity but has a clear place in the management of high-risk PE. A multidisciplinary team approach may assist in ensuring the best treatment is matched to individual patients. Comparison with a non-surgical series on RV outcomes is needed. AD - S. Ramakrishnan, Sir Charles Gairdner Hospital, Nedlands, Australia AU - Ramakrishnan, S. AU - Sanders, L. AU - Lake, F. AU - Mulrennan, S. DB - Embase DO - 10.1111/resp.13268 KW - acute kidney failure aged blood clot lysis body mass body weight cardiology case report catheter clinical article conference abstract echocardiography embolectomy endotracheal intubation female follow up heart right ventricle failure heart ventricle function hospitalization human immobility length of stay lung angiography lung embolism male medical record morbidity preoperative evaluation pulmonary artery resuscitation retrospective study surgery systolic blood pressure thrombophilia LA - English M3 - Conference Abstract N1 - L622091468 2018-05-16 PY - 2018 SN - 1440-1843 SP - 144 ST - Pulmonary embolectomy: Audit of patient characteristics and outcomes T2 - Respirology TI - Pulmonary embolectomy: Audit of patient characteristics and outcomes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622091468&from=export http://dx.doi.org/10.1111/resp.13268 VL - 23 ID - 760848 ER - TY - JOUR AB - Objective The objective of this study was to assess midterm functional status, wound healing, and in-hospital resource use among a prospective cohort of patients treated in a tertiary hospital, multidisciplinary Center for Limb Preservation. Methods Data were prospectively gathered on all consecutive admissions to the Center for Limb Preservation from July 2013 to October 2014 with follow-up data collection through January 2016. Limbs were staged using the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) threatened limb classification scheme at the time of hospital admission. Patients with nonatherosclerotic vascular disorders, acute limb ischemia, and trauma were excluded. Results The cohort included 128 patients with 157 threatened limbs; 8 limbs with unstageable disease were excluded. Mean age (±standard deviation [SD]) was 66 (±13) years, and median follow-up duration (interquartile range) was 395 (80-635) days. Fifty percent (n = 64/128) of patients were readmitted at least once, with a readmission rate of 20% within 30 days of the index admission. Mean total number of admissions per patient (±SD) was 1.9 ± 1.2, with mean (±SD) cumulative length of stay (cLOS) of 17.1 (±17.9) days. During follow-up, 25% of limbs required a vascular reintervention, and 45% developed recurrent wounds. There was no difference in the rate of readmission, vascular reintervention, or wound recurrence by initial WIfI stage (P >.05). At the end of the study period, 23 (26%) were alive and nonambulatory; in 20%, functional status was missing. On both univariate and multivariate analysis, end-stage renal disease and prior functional status predicted ability to ambulate independently (P <.05). WIfI stage was associated with major amputation (P =.01) and cLOS (P =.002) but not with time to wound healing. Direct hospital (inpatient) cost per limb saved was significantly higher in stage 4 patients (P <.05 for all time periods). WIfI stage was associated with cumulative in-hospital costs at 1 year and for the overall follow-up period. Conclusions Among a population of patients admitted to a tertiary hospital limb preservation service, WIfI stage was predictive of midterm freedom from amputation, cLOS, and hospital costs but not of ambulatory functional status, time to wound healing, or wound recurrence. Patients presenting with limb-threatening conditions require significant inpatient care, have a high frequency of repeated hospitalizations, and are at significant risk for recurrent wounds and leg symptoms at later times. Stage 4 patients require the most intensive care and have the highest initial and aggregate hospital costs per limb saved. However, limb salvage can be achieved in these patients with a dedicated multidisciplinary team approach. AD - M.S. Conte, Division of Vascular and Endovascular Surgery, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, United States AU - Ramanan, B. AU - Ahmed, A. AU - Wu, B. AU - Causey, M. W. AU - Gasper, W. J. AU - Vartanian, S. M. AU - Reyzelman, A. M. AU - Hiramoto, J. S. AU - Conte, M. S. DB - Embase Medline DO - 10.1016/j.jvs.2017.05.102 KW - aged article cohort analysis comparative study controlled study cost benefit analysis end stage renal disease endovascular surgery female follow up foot disease functional status health care cost health care utilization hospital readmission human infection length of stay limb limb amputation limb injury limb ischemia major clinical study male musculoskeletal function open surgery organ preservation patient priority journal recurrent disease reoperation retrospective study revascularization wound healing LA - English M1 - 6 M3 - Article N1 - L617848666 2017-08-23 2017-12-06 PY - 2017 SN - 1097-6809 0741-5214 SP - 1765-1774 ST - Determinants of midterm functional outcomes, wound healing, and resources used in a hospital-based limb preservation program T2 - Journal of Vascular Surgery TI - Determinants of midterm functional outcomes, wound healing, and resources used in a hospital-based limb preservation program UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617848666&from=export http://dx.doi.org/10.1016/j.jvs.2017.05.102 VL - 66 ID - 760883 ER - TY - JOUR AB - Achilles tendon (TA) rupture is increasing in prevalence as sporting and activity patterns change. The majority of ruptures occur in men between 30 and 40 years of age and at the musculotendinous junction approximately 2-6cm from the insertion. Non-operative treatment for TA rupture is possible, and demonstrates benefits in reduced treatment costs and avoidance of operative complications such as wound breakdown or sural nerve injury. However, non-operative treatment can lead to incorrect tendon lengths and high re-rupture rates if the cohort is not carefully chosen through the use of ultrasonography and clinical features. In our dedicated foot and ankle unit, we have developed a protocol for determining operative or non-operative TA rupture treatment, designed to enable speedy response to the question 'do the ends oppose in equinus?'. We present our protocol for decision-making in the acute setting and how we use real time group communication to facilitate multidisciplinary team working. Along with our departmental protocol and methods, we review the imaging findings and required diagnostic information for acute TA rupture. Features against non-operative management include a tendon gap of >1 cm in equinus on ultrasound and a presentation delay of >2 weeks. We discuss technique and examine common imaging pitfalls, including an intact plantaris tendon and symptomatic deep venous thrombosis. We also discuss what the radiologist or sonographer can do prior to review by the orthopaedic surgeons. Achilles tendon rupture is a common injury with long-term consequences to the patient's strength and function. Return to sport may be delayed significantly and gait abnormalities persist if correct treatment is not chosen. Appropriate decision-making regarding operative and non-operative treatment options can be significantly aided by careful sonography and excellent multidisciplinary team communication. AD - L. Ramsay, Royal Surrey County Hospital, United Kingdom AU - Ramsay, L. AU - Delves, N. AU - Carne, A. DB - Embase DO - 10.1177/1742271X17700304 KW - achilles tendon rupture ankle clinical feature conservative treatment decision making deep vein thrombosis diagnosis echography gait human imaging orthopedic surgeon pes equinus radiologist return to sport LA - English M1 - 2 M3 - Conference Abstract N1 - L616623253 2017-06-09 PY - 2017 SN - 1743-1344 SP - NP2 ST - Achilles tendon rupture: Do the ends oppose in equinus? Our specialist foot and ankle unit protocol and a review of the imaging findings T2 - Ultrasound TI - Achilles tendon rupture: Do the ends oppose in equinus? Our specialist foot and ankle unit protocol and a review of the imaging findings UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616623253&from=export http://dx.doi.org/10.1177/1742271X17700304 VL - 25 ID - 760947 ER - TY - JOUR AB - Background and Objective: Data on the stroke services available in Sri Lanka is limited. We sought to describe the stroke services in Sri Lankan hospitals where a neurologist was available. Methods: An email survey was conducted among neurologists attached to all the neurology units in statesector hospitals in Sri Lanka. Results: There were 38 neurologists in 22 state-sector hospitals, and data was received regarding 21 hospitals. There were no specialist stroke physicians or stroke neurologists. Nine hospitals had a stroke unit or dedicated stroke beds. CT scanning was available in 18 hospitals (85.7%), and MRI in 4 (19%). Thrombolysis was available in 14 (66.7%), and mechanical thrombectomy in one. Echocardiography was available in all hospitals, and 24-hour ECG monitoring in 19 (90.5%). Availability of multidisciplinary services was as follows: nurses trained in stroke care (12 hospitals, 57.1%); physiotherapy (21, 100%); occupational therapy (19, 90.5%); speech therapy (17, 80.9%); mental health services (19, 90.5%); social services (14, 66.7%). Multidisciplinary team meetings were conducted in eight units. On-site neurosurgical facilities were available in eight (38.1%) hospitals, and 16 (76.2%) had access to a rehabilitation hospital within the region. Availability of essential drugs for stroke prevention was rated as 'Good' as follows: antiplatelets (20 hospitals, 100%); statins (21, 100%); antidiabetics (18, 85.7%). Conclusions: This survey provides the first data on stroke services available in Sri Lankan hospitals. There is a need for more neurologists, more stroke units and for trained stroke specialists. Facilities for modern stroke treatments were limited. There was variation in availability of multidisciplinary services. Availability of essential drugs seemed acceptable. AD - U. Ranawaka, Faculty of Medicine, University of Kelaniya, Sri Lanka AU - Ranawaka, U. DB - Embase DO - 10.1159/000505285 KW - antidiabetic agent essential drug hydroxymethylglutaryl coenzyme A reductase inhibitor conference abstract e-mail echocardiography electrocardiography monitoring human human cell mechanical thrombectomy mental health service multidisciplinary team neurologist neurology nuclear magnetic resonance imaging nurse occupational therapy physiotherapy prevention public sector rehabilitation center social work speech therapy Sri Lanka stroke unit thrombocyte x-ray computed tomography LA - English M3 - Conference Abstract N1 - L630740227 2020-02-03 PY - 2019 SN - 1421-9786 SP - 35 ST - Stroke services in Sri Lanka: Results of an online survey T2 - Cerebrovascular Diseases TI - Stroke services in Sri Lanka: Results of an online survey UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630740227&from=export http://dx.doi.org/10.1159/000505285 VL - 48 ID - 760651 ER - TY - JOUR AB - Background: Unrecognized pseudohyperkalemia (PHK), defined as an artificial increase in measured potassium concentration, due to thrombocytosis and leukocytosis can lead to inappropriate patient treatment. Understanding the laboratory and patient characteristics that increase risk of PHK is key to preventing diagnostic errors. Methods: Serum/plasma potassium results collected at 2 laboratories over 4 years were selected based on blood cell counts collected within 24 h and whole blood potassium concentrations determined within 2 h of the serum/plasma sample. Differences between whole blood and serum or plasma potassium were compared as functions of platelet or leukocyte count, fit to linear models, and stratified based on leukemia diagnosis codes. Patients having a serum/plasma potassium concentration that was at least 1 mEq/mL higher than the whole blood concentration were defined as having PHK. Based on this analysis, high-risk patients were prospectively identified and PHK risk was communicated to providers. Medication administration records were queried to compare rates of kayexalate use pre- and post-intervention. Results: Approximately 14% of serum samples with platelet counts >500 x 10(9)/L had a > I mEq/L increase relative to whole blood potassium. >25% of serum and plasma samples showed a > 1 mEq/L increase relative to whole blood potassium when leukocyte counts were >50 x 10(9)/L Patients with chronic lymphocytic leukemia and high WBC count demonstrated the highest rates of PHK. The rate of kayexalate administration prior to confirmatory testing decreased from 37% to 16% after the laboratory started verbally communicating the possibility of PHK to treating providers. Conclusions: According to our data, a leukocyte count threshold for plasma samples of 50 x 10(9)/L is appropriate for indicating a high risk of PHK. Direct communication by the laboratory to the care team reduces inappropriate potassium lowering treatment in populations at high risk. (C) 2017 The Authors. Published by Elsevier Inc. on behalf of The Canadian Society of Clinical Chemists. AD - [Ranjitkar, Pratistha; Greene, Dina N.; Baird, Geoffrey S.; Hoofnagle, Andrew N.; Mathias, Patrick C.] Univ Washington, Dept Lab Med, Seattle, WA 98195 USA. [Baird, Geoffrey S.] Univ Washington, Dept Pathol, Seattle, WA 98195 USA. [Hoofnagle, Andrew N.] Univ Washington, Dept Med, Seattle, WA 98195 USA. [Ranjitkar, Pratistha] Med Coll Wisconsin, Dept Pathol, Milwaukee, WI 53226 USA. Mathias, PC (corresponding author), Univ Washington, Dept Lab Med, Seattle, WA 98195 USA. pcm10@uw.edu AN - WOS:000406086600006 AU - Ranjitkar, P. AU - Greene, D. N. AU - Baird, G. S. AU - Hoofnagle, A. N. AU - Mathias, P. C. DA - Aug DO - 10.1016/j.clinbiochem.2017.03.007 J2 - Clin. Biochem. KW - Pseudohyperkalemia Hyperkalemia Diagnostic error Leukocytosis CHRONIC LYMPHOCYTIC-LEUKEMIA HEPARIN PLASMA SAMPLES PNEUMATIC TUBE TRANSPORT REVERSE PSEUDOHYPERKALEMIA POTASSIUM HYPERLEUKOCYTOSIS THROMBOCYTOSIS PATIENT RELEASE Medical Laboratory Technology LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: FB4BN Times Cited: 10 Cited Reference Count: 32 Ranjitkar, Pratistha Greene, Dina N. Baird, Geoffrey S. Hoofnagle, Andrew N. Mathias, Patrick C. 10 0 3 PERGAMON-ELSEVIER SCIENCE LTD OXFORD CLIN BIOCHEM PY - 2017 SN - 0009-9120 SP - 663-669 ST - Establishing evidence-based thresholds and laboratory practices to reduce inappropriate treatment of pseudohyperkalemia T2 - Clinical Biochemistry TI - Establishing evidence-based thresholds and laboratory practices to reduce inappropriate treatment of pseudohyperkalemia UR - ://WOS:000406086600006 VL - 50 ID - 761642 ER - TY - JOUR AB - Learning Objectives 1. To learn the pathophysiology or venous malformation 2. To learn the endovascular technique 3. To learn the potential complications and how to manage them Venous malformations consist of communications between normal veins and abnormally developed blood vessels that contain low flowing venous blood within. The lesions are made up of a matrix of tissue with abnormal vascular lakes. The low flowing venous blood in the lesions can clot and calcify, resulting in phleboliths. Low flow venous malformations can occur anywhere in the body and are usually present from birth although may not become symptomatic or apparant until later in life. Symptoms can become exacerbated by hormonal changes during puberty or pregnancy, as well as by trauma and surgery. They can also worsen with activity, extremes of temperature and in dependent positions. On examination, the lesions are usually soft, compressible and non-pulsatile. They demonstrate filling on dependency and the larger lesions may have palpable phleboliths within. Superficial lesions can cause a bluish discoloration of the skin. They are usually best assessed with MRI scans to define the anatomical involvement of the lesion and its relationship to adjacent structures. Ultrasound is very useful to assess suitability for percutaneous sclerotherapy. The indications for treating venous malformations are usually symptoms of pain or dull aching, swelling, bleeding or functional symptoms. Sometimes treatment can be carried out for cosmetic reasons as some malformations in prominent places can cause significant distress to patients and have a serious impact on their quality of life. Various agents have been described in the treatment of vascular and lymphatic malformations by percutaneous sclerotherapy. The most common agent used to treat venous malformations with sclerotherapy is Sodium Tetradecyl Sulphate (Fibrovein) .Potential complications of the treatment are pain, swelling, infection, bleeding and skin ulceration. It is important that the management of venous malformations are carried out in a multidisciplinary team setting. Malformations that have no symptoms should not be treated. In many cases, establishing the diagnosis, providing advice on the natural history of the lesion and observation is all that is required. Conservative management with clinical follow up either during symptomatic episodes or routine monitoring is sufficient in many patients with the use of compression garments to manage symptoms. Sclerotherapy cannot cure venous malformations but can provide good symptom relief and reduce the size of the malformations. It is usually carried out as a day case procedure and requires multiple sessions of treatment to achieve results. AD - L. Ratnam AU - Ratnam, L. DB - Embase DO - 10.1007/s00270-019-02282-x KW - tetradecyl sulfate sodium adult bleeding complication compression garment conference abstract congenital blood vessel malformation conservative treatment distress syndrome drug combination endovascular surgery female follow up history human human tissue injury lake learning lymphatic malformation multidisciplinary team nuclear magnetic resonance imaging pain pregnancy puberty quality of life sclerotherapy skin discoloration skin ulcer swelling ultrasound vein malformation venous blood LA - English M1 - 3 M3 - Conference Abstract N1 - L629260171 2019-09-13 PY - 2019 SN - 1432-086X SP - S139 ST - Venous malformations T2 - CardioVascular and Interventional Radiology TI - Venous malformations UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629260171&from=export http://dx.doi.org/10.1007/s00270-019-02282-x VL - 42 ID - 760685 ER - TY - JOUR AB - BACKGROUND In the care of patients with congenital heart disease, percutaneous interventional treatments have supplanted many surgical approaches for simple lesions, such as atrial septal defect. By contrast, complex congenital heart defects continue to require open-heart surgery. In single-ventricle patients, a staged approach is employed, which requires multiple open-heart surgeries and significant attendant morbidity and mortality. A nonsurgical transcatheter alternative would be attractive. OBJECTIVES The authors sought to show the feasibility of catheter-only, closed-chest, large-vessel anastomosis (superior vena cava and pulmonary artery [PA] or bidirectional Glenn operation equivalent) in a patient. METHODS In preclinical testing over a decade, the authors developed the techniques and technology needed for nonsurgical crossing from a donor (superior vena cava) to a recipient (PA) vessel and endovascular stent-based anastomosis of those blood vessels. The authors undertook this transcatheter approach for an adult with untreated congenital heart disease with severe cyanosis and significant surgical risk. They rehearsed the procedure step by step using contrast-enhanced cardiac computed tomography and a patient-specific 3-dimensional printed heart model. RESULTS The authors describe a first-in-human, fully percutaneous superior cavopulmonary anastomosis (bidirectional Glenn operation equivalent). The patient, a 35-year-old woman, was homebound due to dyspnea and worsening cyanosis. She was diagnosed with functional single ventricle and very limited pulmonary blood flow. The heart team believed surgical palliation conferred high operative risk due to the patient's complete condition. With the percutaneous procedure, the patient recovered uneventfully and remained improved clinically after 6 months. CONCLUSIONS This procedure may provide a viable alternative to one of the foundational open-heart surgeries currently performed to treat single-ventricle congenital heart disease. (C) 2017 by the American College of Cardiology Foundation. Published by Elsevier. All rights reserved. AD - [Ratnayaka, Kanishka; Moore, John W.; Rios, Rodrigo; Hegde, Sanjeet R.; El-Said, Howaida G.] Univ Calif San Diego, Dept Pediat, Rady Childrens Hosp, Div Cardiol, San Diego, CA 92103 USA. [Ratnayaka, Kanishka; Lederman, Robert J.] NHLBI, Cardiovasc & Pulm Branch, Div Intramural Res, Bldg 10, Bethesda, MD 20892 USA. Ratnayaka, K (corresponding author), Rady Childrens Hosp, Dept Cardiol, 3020 Childrens Way,MC 5004, San Diego, CA 92123 USA. kratnayaka@rchsd.org AN - WOS:000406613900009 AU - Ratnayaka, K. AU - Moore, J. W. AU - Rios, R. AU - Lederman, R. J. AU - Hegde, S. R. AU - El-Said, H. G. DA - Aug DO - 10.1016/j.jacc.2017.06.020 J2 - J. Am. Coll. Cardiol. KW - adult congenital heart disease catheterization Glenn shunt image-guided intervention single ventricle transcatheter electrosurgery CONGENITAL HEART-DISEASE RISK-FACTOR ANALYSIS TRANSCAVAL ACCESS PULMONARY-ARTERY VENA-CAVA SHUNT FONTAN ADULT COMPLETION EXPERIENCE Cardiac & Cardiovascular Systems LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: FC1RA Times Cited: 8 Cited Reference Count: 26 Ratnayaka, Kanishka Moore, John W. Rios, Rodrigo Lederman, Robert J. Hegde, Sanjeet R. El-Said, Howaida G. El-Said, Howaida/AAT-7480-2020 El-Said, Howaida/0000-0002-3447-7398 Division of Pediatric Cardiology-Rady Children's Hospital; Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Heart Lung & Blood Institute (NHLBI) [Z01HL006040] Supported by intramural funds at the Division of Pediatric Cardiology-Rady Children's Hospital and by the Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health (Z01HL006040 to Dr. Lederman). Dr. Ratnayaka is an unpaid collaborator for Transmural Systems. Dr. Moore is a medical advisor for Transmural Systems and BioMedical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. 8 0 2 ELSEVIER SCIENCE INC NEW YORK J AM COLL CARDIOL PY - 2017 SN - 0735-1097 SP - 745-752 ST - First-in-Human Closed-Chest Transcatheter Superior Cavopulmonary Anastomosis T2 - Journal of the American College of Cardiology TI - First-in-Human Closed-Chest Transcatheter Superior Cavopulmonary Anastomosis UR - ://WOS:000406613900009 VL - 70 ID - 761641 ER - TY - JOUR AB - INTRODUCTION: Pelvic and sacral tumor surgery is traditionally characterized by several major complications. Bleeding is probably the most feared and dreadful complication. The aim of the study was to evaluate whether the intraoperative use of the intra-aortic balloon occlusion technique could decrease the perioperative blood loss. A secondary aim was to assess aortic balloon-related complications. MATERIALS AND METHODS: From January 2014 to December 2017 15 patients (Group 1) treated with intra-aortic balloon inflation were prospectively enrolled and compared to a historical control group (Group 2) of 11 patients with similar surgeries. Number of blood units transfused, perioperative hemoglobin values, hours spent in intensive care unit (ICU), length of inpatient stay, and perioperative complications were evaluated. RESULTS: Intraoperatively, a mean of 6.1 blood units per patient (BUPP) was used in Group 1 and 16.2 BUPP in Group 2. Postoperatively the averages were 2,8 and 5,4 BUPP in Group 1 and 2, respectively. Patients in Group 1 had a faster recovery in hemoglobin values, as well as a shorter length of overall inpatient stay (28,9 vs 59 days) and of ICU stay (33.9 vs 74.6 h). The most relevant complications observed in Group 1 were two thrombosis at the incannulation site that required a surgical arterial thrombectomy. CONCLUSION: The intra-aortic balloon occlusion is an effective technique to control bleeding during the resections of huge pelvic and sacral tumors. A proper training of a multidisciplinary team and an accurate patient selection are required to prevent major complications. AD - Oncologic Orthopaedic Surgery Division, CTO Hospital - AOU Città della Salute e della Scienza di Torino, Italy. Electronic address: nicolaratto@hotmail.com. Oncologic Orthopaedic Surgery Division, CTO Hospital - AOU Città della Salute e della Scienza di Torino, Italy. Clinical Research Coordinator, Fondazione per la ricerca Sui Tumori dell'apparato Muscoloscheletrico e rari Onlus, Turin, Italy. Radiology Division of San Lazzaro Hospital, Alba, Italy. Intensive Care Unit, CTO Hospital AOU Città della Salute e della Scienza di Torino, Italy. AN - 31783224 AU - Ratto, N. AU - Boffano, M. AU - Pellegrino, P. AU - Conti, A. AU - Rossi, L. AU - Verna, V. AU - Rastellino, V. AU - Berardino, M. AU - Piana, R. DA - Mar DO - 10.1016/j.suronc.2019.11.003 DP - NLM ET - 2019/11/30 J2 - Surgical oncology KW - Adult Aged Aorta Balloon Occlusion/*methods Case-Control Studies Female Follow-Up Studies Humans *Intraoperative Care Male Middle Aged Pelvic Neoplasms/pathology/*surgery Prognosis Prospective Studies Sacrum/pathology/*surgery Aortic balloon occlusion Blood loss Pelvic and sacral tumor LA - eng N1 - 1879-3320 Ratto, Nicola Boffano, Michele Pellegrino, Pietro Conti, Andrea Rossi, Laura Verna, Valter Rastellino, Valentina Berardino, Maurizio Piana, Raimondo Journal Article Netherlands Surg Oncol. 2020 Mar;32:69-74. doi: 10.1016/j.suronc.2019.11.003. Epub 2019 Nov 20. PY - 2020 SN - 0960-7404 SP - 69-74 ST - The intraoperative use of aortic balloon occlusion technique for sacral and pelvic tumor resections: A case-control study T2 - Surg Oncol TI - The intraoperative use of aortic balloon occlusion technique for sacral and pelvic tumor resections: A case-control study VL - 32 ID - 760292 ER - TY - JOUR AB - The trial on endovascular management of unruptured intracranial aneurysms (TEAM), a prospective randomized trial comparing coiling and conservative management, initiated in September 2006, was stopped in June 2009 because of poor recruitment (80 patients). Aspects of the trial design that may have contributed to this failure are reviewed in the hope of identifying better ways to successfully complete this special type of pragmatic trial which seeks to test two strategies that are in routine clinical use. Cultural, conceptual and bureaucratic hurdles and difficulties obstruct all trials. These obstacles are however particularly misplaced when the trial aims to identify what a good medical practice should be. A clean separation between research and practice, with diverging ethical and scientific requirements, has been enforced for decades, but it cannot work when care needs to be provided in the presence of pervasive uncertainty. Hence valid and robust scientific methods need to be legitimately reintegrated into clinical practice when reliable knowledge is in want. A special status should be reserved for what we would call 'clinical care trials', if we are to practice in a transparent and prospective fashion a medicine that leads to demonstrably better patient outcomes. AD - [Raymond, Jean; Darsaut, Tim E.] Notre Dame Hosp, CHUM, Dept Radiol, Montreal, PQ H2L 4M1, Canada. [Raymond, Jean; Darsaut, Tim E.] Notre Dame Hosp, CHUM, Intervent Neuroradiol Res Unit, Montreal, PQ H2L 4M1, Canada. [Molyneux, Andrew J.] John Radcliffe Hosp, Oxford Neurovasc & Neuroradiol Res Unit, Oxford OX3 9DU, England. Raymond, J (corresponding author), Notre Dame Hosp, CHUM, Dept Radiol, 1560 Sherbrooke E,Z12909, Montreal, PQ H2L 4M1, Canada. jean.raymond@umontreal.ca AN - WOS:000288564800001 AU - Raymond, J. AU - Darsaut, T. E. AU - Molyneux, A. J. AU - Grp, Team Collaborative C7 - 64 DA - Mar DO - 10.1186/1745-6215-12-64 J2 - Trials KW - RANDOMIZED CONTROLLED-TRIAL ENDOVASCULAR TREATMENT BREAST-CANCER THIGH-LENGTH SURGERY STROKE THROMBOSIS STOCKINGS EFFICACY CONSENT Medicine, Research & Experimental LA - English M3 - Article N1 - ISI Document Delivery No.: 737JJ Times Cited: 56 Cited Reference Count: 51 Raymond, Jean Darsaut, Tim E. Molyneux, Andrew J. STEFANI, MARCO ANTONIO/C-3993-2013 STEFANI, MARCO ANTONIO/0000-0002-4728-8764; Guilbert, Francois/0000-0002-7866-0493; Gevry, Guylaine/0000-0003-1982-3480; weill, alain/0000-0002-0281-6201; cognard, christophe/0000-0003-4287-2627; Zeumer, Hermann/0000-0003-4511-1225; Kulcsar, Zsolt/0000-0002-6805-5150; iancu, daniela/0000-0003-2041-9178 National Institute for Health ResearchNational Institute for Health Research (NIHR) [06/404/50] Funding Source: Researchfish; Canadian Institutes of Health ResearchCanadian Institutes of Health Research (CIHR) [80799] Funding Source: Medline 57 0 6 BIOMED CENTRAL LTD LONDON TRIALS PY - 2011 SN - 1745-6215 SP - 13 ST - A trial on unruptured intracranial aneurysms (the TEAM trial): results, lessons from a failure and the necessity for clinical care trials T2 - Trials TI - A trial on unruptured intracranial aneurysms (the TEAM trial): results, lessons from a failure and the necessity for clinical care trials UR - ://WOS:000288564800001 VL - 12 ID - 761857 ER - TY - JOUR AB - SESSION TITLE: Fellows Pulmonary Vascular Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Acute pulmonary embolism (PE) with right heart thrombi is a rare and high-risk presentation of venous thromboembolism, with an estimated incidence of 4 -18% (1) and mortality of 27.1% with treatment, 90.9-100% without treatment. There is no expert consensus regarding optimal management, with treatment decisions individualized by the managing clinician and available expertise at the treating facility. CASE PRESENTATION: A 78-year old man with non-obstructive coronary artery disease presented to a rural hospital with exertional chest pain associated with shortness of breath, dizziness, and diaphoresis. Blood pressure was 85/57mmHg, with a repeat of 106/70mmHg, pulse 116, respiratory rate 19, oxygen saturation 92% on room air. Physical examination revealed tachycardia, clear lung fields, and mild bilateral lower extremity edema without calf tenderness. Electrocardiogram showed sinus tachycardia with ST depression in lateral leads, T wave inversion with Q waves in inferior leads. Troponin I was elevated at 0.05 ng/ml, BNP 1112 pg/ml. Chest radiography was normal. Subsequent troponin was 0.07ng/ml. Echocardiography showed a dilated right ventricle with severe systolic dysfunction with a serpentine, mobile density extending from the right atria to the right ventricular apex and into the pulmonic valve, measuring 108mm x15mm (Fig 1). There was severe pulmonary hypertension with pulmonary artery pressure estimated at 80mmHg. CT pulmonary angiography showed a saddle pulmonary embolism and heavy clot burden in both main pulmonary arteries and multiple lobar branches (Fig 2). He received thrombolysis followed by unfractionated heparin infusion. Treatment was complicated by mild epistaxis. Echocardiography after 72 hours showed dissolution of the right heart thrombus, and systolic pressure significantly improved at 38mmHg. He was discharged on hospital day three on rivaroxaban. DISCUSSION: Pulmonary embolism complicated by right heart thrombi is a rare clinical entity. Thrombolytic therapy is indicated for high-risk PE, defined by persistent hypotension, and select cases of intermediate-risk PE, defined by hemodynamic stability with right ventricular dysfunction and elevated troponin levels. Thrombolysis, compared to anticoagulation with heparin, leads to a more rapid resolution of pulmonary obstruction and a reduction in pulmonary artery pressure (2,3). Small case series and case reports have reported similar success with thrombolysis and surgical embolectomy for PE with right heart thrombi. Surgical embolectomy is proposed by the pulmonary embolism response team in its 2019 recommendations for pulmonary embolism with right heart thrombi and high clot burden. CONCLUSIONS: Pulmonary embolism with right heart thrombi is a severe manifestation of venous thromboembolic disease requiring prompt and definitive therapy. Systemic thrombolytic therapy may be an acceptable option if bleeding risk is low. Reference #1: 1. Free-floating thrombi in the right heart: diagnosis, management, and prognosis in 38 consecutive cases. L, Béra J et al. Circulation: June 1, 1999; 99(21):2779-83. Reference #2: 2. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) Reference #3: 3. Comparative efficacy of different modalities for treatment of right heart thrombi in transit: a pooled analysis. Athappan G, Sengodan P, Chacko P, Gandhi S Vasc Med. 2015 Apr; 20(2):131-8. DISCLOSURES: Chair of a Committee relationship with PHA Please note: PHA Medically Led Sessions, PHA Preceptorship Added 05/22/2020 by Jean Elwing, source=Web Response Removed 05/22/2020 by Jean Elwing, source=Web Response Educator relationship with PH CME Programs - PHA, Simply Speaking, Impact PH Please note: Intermittent, O going Added 05/22/2020 by Jean Elwing, source=Web Response, value=Honoraria Principal Investigator relationship with Actelion, Arena, Reata, United Therapeutics Please note: Ongoing - University is Paid Directly Added 05/22/2020 by Jean Elwing, source=Web Response, value=Grant/Research Support Advisory Committee Member relationship with United Therapeutics Please note: $5001 - $20000 Added 06/05/2020 by Jean Elwing, source=Web Response, value=Consulting fee Principal Investigator relationship with Lung LLC, Liquidia, Phase Bio, Complexa, Gossamer Bio Please note: Ongoing - University is Paid Directly Added 05/22/2020 by Jean Elwing, source=Web Response, value=Grant/Research Support Member of a Committee relationship with PHA Please note: PHA Education Committee Added 05/22/2020 by Jean Elwing, source=Web Response Removed 05/22/2020 by Jean Elwing, source=Web Response Advisory Committee Member relationship with Liquidia, Acceleron Please note: $1001 - $5000 Added 06/05/2020 by Jean Elwing, source=Web Response, value=Consulting fee Advisory Committee Member relationship with Acceleron Please note: $5001 - $20000 Added 06/05/2020 by Jean Elwing, source=Web Response, value=Consulting fee Removed 06/05/2020 by Jean Elwing, source=Web Response No relevant relationships by ROBERT MCLOUGHLIN, source=Web Response No relevant relationships by Sharon Raymond-Forde, source=Web Response AU - Raymond-Forde, S. AU - Elwing, J. AU - McLoughlin, R. DB - Embase DO - 10.1016/j.chest.2020.08.1796 KW - endogenous compound heparin rivaroxaban troponin I advisory committee aged ambient air anticoagulation blood clot lysis breathing rate calf (mammal) cardiology case study comparative effectiveness complication conference abstract coronary artery disease diaphoresis dizziness dyspnea echocardiography edema education embolectomy epistaxis fibrinolytic therapy financial management gene expression heart atrium heart right ventricle failure human hypotension intracardiac thrombosis lower limb lung angiography lung artery pressure male meta analysis nonhuman obstruction oxygen saturation physical examination practice guideline prognosis protein expression pulmonary embolism response team pulmonary hypertension pulmonary valve Q wave rural hospital sinus tachycardia speech ST segment depression surgery systolic blood pressure systolic dysfunction T wave inversion thorax pain vein embolism LA - English M1 - 4 M3 - Conference Abstract N1 - L2008024790 2020-10-19 PY - 2020 SN - 1931-3543 0012-3692 SP - A2078-A2079 ST - WHAT IS IN HIS RIGHT VENTRICLE? AN UNUSUAL AND LIFE-THREATENING PRESENTATION OF VTE T2 - Chest TI - WHAT IS IN HIS RIGHT VENTRICLE? AN UNUSUAL AND LIFE-THREATENING PRESENTATION OF VTE UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008024790&from=export http://dx.doi.org/10.1016/j.chest.2020.08.1796 VL - 158 ID - 760536 ER - TY - JOUR AB - The objective of this study is to determine the impact of a dedicated vascular team in the early detection of complications and improvement of vascular access patency. A dedicated vascular access team comprised four dialysis nurses, a vascular access coordinator and led by a physician. They were assigned for the surveillance and care of all vascular accesses. The team presented problematic cases in the regular quality meeting with documentation of access blood flow, dynamic venous pressure, findings of hematoma, prolonged bleeding, swelling, low arterial pressures, steal syndrome, recirculation studies and dialysis adequacy. In case of failed recirculation or persistently elevated dynamic venous pressure, further evaluation was done either a fistulogram or review by a vascular surgeon. A total of 226 problematic vascular access cases were detected during the study (January 2014 to October 2017). The majority were in 41-70 years age group. A total of 248 referrals were given. Two hundred cases were referred for fistulogram, but it was performed in 188 patients. Vascular access stenosis was detected in 153 patients (81.3%) and angioplasty was performed in 137 (89.5%) of these patients. Fifteen (9.8%) patients were managed conservatively and one patient refused angioplasty. The 15 cases managed conservatively continued to work normally. One patient who refused to angioplasty later clotted his fistula during the follow-up period. Out of 41 cases who were totally noncompliant to referral, nine (22%) clotted their fistula during the follow-up period. In 12 cases in whom fistulogram was requested, but the request was declined by the primary hospital, five patients (41.6%) clotted their fistulas. Subgroup analysis showed that in patients who had both failed recirculation and high venous pressure, the prevalence of stenosis was 90% and angioplasty was performed in 94.4%. In patients who had failed recirculation and low arterial pressure, stenosis was detected in 85.7% and angioplasty was performed in 100% of cases. A dedicated vascular team approach for the care of dialysis vascular access helps in early identification of complications and improve vascular access outcome. AD - [Raza, H.; Hashmi, M. N.; Dianne, V; Hamza, M.] King Abdullah Hemodialysis Ctr, South Riyadh, Saudi Arabia. [Hejaili, F.; A-Sayyari, A.] King Abdul Aziz Med City, Riyadh, Saudi Arabia. [A-Sayyari, A.] King Saud Bin Abdul Aziz Univ Hlth Sci, Dept Med, Riyadh, Saudi Arabia. Raza, H (corresponding author), King Abdullah Hemodialysis Ctr, Riyadh 12799, Saudi Arabia. hammadraza_pk@yahoo.com AN - WOS:000460054000005 AU - Raza, H. AU - Hashmi, M. N. AU - Dianne, V. AU - Hamza, M. AU - Hejaili, F. AU - A-Sayyari, A. DA - Jan-Feb J2 - Saudi J. Kidney Dis. Transplant. KW - HEMODIALYSIS SURVEILLANCE PRESSURE STENOSIS FLOW THROMBOSIS FISTULA GRAFTS Urology & Nephrology LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: HN2ZQ Times Cited: 0 Cited Reference Count: 22 Raza, H. Hashmi, M. N. Dianne, V Hamza, M. Hejaili, F. A-Sayyari, A. Hashmi, Muhammad Nauman/0000-0001-8297-7808 0 WOLTERS KLUWER MEDKNOW PUBLICATIONS MUMBAI SAUDI J KIDNEY DIS T PY - 2019 SN - 1319-2442 SP - 39-44 ST - Vascular Access Outcome with a Dedicated Vascular Team Based Approach T2 - Saudi Journal of Kidney Diseases and Transplantation TI - Vascular Access Outcome with a Dedicated Vascular Team Based Approach UR - ://WOS:000460054000005 VL - 30 ID - 761547 ER - TY - JOUR AB - Learning Objectives: Thrombolytic agents are a mainstay of treatment of suspected or confirmed pulmonary embolism (PE) in hemodynamically unstable patients, but evidence is less clear in patients with submassive or low risk PE or in cardiac arrest. We hypothesized that international practices for thrombolytics in PE, particularly in less well-defined areas of practice (i.e., submassive PE, cardiac arrest from PE), vary among clinicians. Methods: A 19-question survey on thrombolytic use in PE was developed, validated, and administered to all SCCM members via email. Descriptive statistics were used to present survey results. Results: Respondents (n = 272) predominately were physicians (62.1%) or pharmacists (30.5%) practicing in an academic medical center (54.8%) or community teaching setting (24.6%). Institutional policies or guidelines were more commonly in place for massive PE (47%) and catheter-directed thrombolysis (39.6%) than submassive PE (32.3%) or cardiac arrest (22.9%). PE response teams were implemented in 20.6% of centers. Most clinicians were very comfortable using thrombolytics for massive PE (76.4%) and cardiac arrest secondary to known PE (73.5%) and somewhat comfortable for cardiac arrest secondary to suspected PE (47.1%) or submassive PE (34.2%). Most clinicians (73.5%) identified no barriers to using thrombolytics for massive PE; however, common barriers for thrombolytic use in both submassive and low risk PE included lack of evidence supporting use (47.4% and 61.8%) and adverse outcomes outweighing benefits (40.8% and 64.7%). Presence of right heart strain, perceived risk of bleeding, and hemodynamic instability were most commonly identified as factors that influence the decision to initiate thrombolytics in submassive PE. Dosing preference varied widely across thrombolytic agent and indication. Conclusions: While most clinicians are comfortable using thrombolytics for massive PE and cardiac arrest secondary to known PE, limited evidence and potential adverse outcomes limit use in other settings. AD - M. Rech AU - Rech, M. AU - Hammond, D. AU - Holzhausen, J. AU - Horng, M. AU - Peppard, S. AU - Sokol, S. AU - Li, C. AU - Van Berkel, M. DB - Embase DO - 10.1097/01.ccm.0000529048.74606.74 KW - fibrinolytic agent adult adverse outcome bleeding blood clot lysis catheter drug therapy e-mail female heart arrest hemodynamics human lung embolism major clinical study male organizational policy outcome assessment pharmacist physician practice guideline statistics teaching university hospital LA - English M3 - Conference Abstract N1 - L620081335 2018-01-09 PY - 2018 SN - 1530-0293 SP - 504 ST - International survey of thrombolytic use for treatment of pulmonary embolism T2 - Critical Care Medicine TI - International survey of thrombolytic use for treatment of pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620081335&from=export http://dx.doi.org/10.1097/01.ccm.0000529048.74606.74 VL - 46 ID - 760860 ER - TY - JOUR AB - BACKGROUND: Pharmacists are an important member of the stroke team and aid in obtaining medication and medical history, providing education, managing blood pressure, reviewing exclusion criteria for recombinant tissue plasminogen activator (rtPA), and facilitating reconstitution and administration of rtPA. OBJECTIVE: To determine if pharmacist presence at bedside during acute ischemic stroke resulted in a reduction in door-to-needle (DTN) times. METHODS: This was a retrospective cohort study between January 1, 2011 and December 31, 2015 of patients who received rtPA for acute ischemic stroke in either the emergency department or hospital. RESULTS: Of the 125 included patients, 45 patients (36%) had a pharmacist present (PharmD group) and 80 patients (64%) did not (no PharmD group). Median DTN time was significantly shorter in the PharmD group: 48 minutes versus 73 minutes in the no PharmD group ( P < 0.01). The goal of DTN ≤60 minutes was met in 71% of patients in the PharmD group compared to 29% ( P < 0.01). Pharmacist at the bedside was the only factor found to be independently associated with reduction DTN time (βcoefficient -23.5 minutes, 95% confidence interval [95% CI] -38.6 to -8.50 minutes). CONCLUSION: A pharmacist at the bedside of emergency department or in-patient stroke codes reduced DTN time by a median of 23.5 minutes after adjusting for confounding factors and increased the percentage of patients meeting DTN goal time of ≤60 minutes by 49%. These findings support the inclusion of a stroke-competent pharmacist in the bedside response team for acute ischemic stroke patients. AD - 1 Loyola University Medical Center, Maywood, IL, USA. AN - 28759998 AU - Rech, M. A. AU - Bennett, S. AU - Donahey, E. DA - Dec DO - 10.1177/1060028017724804 DP - NLM ET - 2017/08/02 J2 - The Annals of pharmacotherapy KW - Aged Emergency Service, Hospital/statistics & numerical data Female Fibrinolytic Agents/*therapeutic use Hospitals/statistics & numerical data Humans Male Middle Aged Pharmacists/*statistics & numerical data Retrospective Studies Stroke/*drug therapy Thrombolytic Therapy Time Factors Tissue Plasminogen Activator/*therapeutic use Treatment Outcome clinical pharmacy neuropharmacology pharmacist/physician issues stroke thrombolytics LA - eng M1 - 12 N1 - 1542-6270 Rech, Megan A Bennett, Stephanie Donahey, Elisabeth Journal Article United States Ann Pharmacother. 2017 Dec;51(12):1084-1089. doi: 10.1177/1060028017724804. Epub 2017 Jul 31. PY - 2017 SN - 1060-0280 SP - 1084-1089 ST - Pharmacist Participation in Acute Ischemic Stroke Decreases Door-to-Needle Time to Recombinant Tissue Plasminogen Activator T2 - Ann Pharmacother TI - Pharmacist Participation in Acute Ischemic Stroke Decreases Door-to-Needle Time to Recombinant Tissue Plasminogen Activator VL - 51 ID - 760260 ER - TY - JOUR AB - OBJECTIVES: This survey sought to characterize the national prescribing patterns and barriers to the use of thrombolytic agents in the treatment of pulmonary embolism, with a specific focus on treatment during actual or imminent cardiac arrest. DESIGN: A 19-question international, cross-sectional survey on thrombolytic use in pulmonary embolism was developed, validated, and administered. A multivariable logistic regression was conducted to determine factors predictive of utilization of thrombolytics in the setting of cardiac arrest secondary to pulmonary embolism. SETTING: International survey study. SUBJECTS: Physicians, pharmacists, nurses, and other healthcare professionals who were members of the Society of Critical Care Medicine. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thrombolytic users were compared with nonusers. Respondents (n = 272) predominately were physicians (62.1%) or pharmacists (30.5%) practicing in an academic medical center (54.8%) or community teaching setting (24.6%). Thrombolytic users (n = 177; 66.8%) were compared with nonusers (n = 88; 33.2%) Thrombolytic users were more likely to work in pulmonary/critical care (80.2% thrombolytic use vs 59.8%; p < 0.01) and emergency medicine (6.8% vs 3.5%; p < 0.01). Users were more likely to have an institutional guideline or policy in place pertaining to the use of thrombolytics in cardiac arrest (27.8% vs 13.6%; p < 0.01) or have a pulmonary embolism response team (38.6% vs 19.3%; p < 0.01). Lack of evidence supporting use and the risk of adverse outcomes were barriers to thrombolytic use. Working in a pulmonary/critical care environment (odds ratio, 2.36; 95% CI, 1.24-4.52) and comfort level (odds ratio, 2.77; 95% CI, 1.7-4.53) were predictive of thrombolytic use in the multivariable analysis. CONCLUSIONS: Most survey respondents used thrombolytics in the setting of cardiac arrest secondary to known or suspected pulmonary embolism. This survey study adds important data to the literature surrounding thrombolytics for pulmonary embolism as it describes thrombolytic user characteristic, barriers to use, and common prescribing practices internationally. AD - Department of Pharmacy, Loyola University Medical Center, Maywood, IL. Department of Emergency Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL. Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX. Department of Pharmacy, Beaumont Hospital, Royal Oak, MI. Department of Pharmacy, Erlanger Health System, Chattanooga, TN. Department of Pharmacy, The University of Chicago Medicine, Chicago, IL. Department of Pharmacy, Froedtert & the Medical College of Wisconsin, Milwaukee, WI. Department of Pharmacy Practice, Concordia University Wisconsin School of Pharmacy, Mequon, WI. Department of Pharmacy, Rush University Medical Center, Chicago, IL. Department of Internal Medicine, Rush Medical College, Chicago, IL. AN - 32695997 AU - Rech, M. A. AU - Horng, M. AU - Holzhausen, J. M. AU - Van Berkel, M. A. AU - Sokol, S. S. AU - Peppard, S. AU - Hammond, D. A. C2 - Pmc7314323 DA - Jun DO - 10.1097/cce.0000000000000132 DP - NLM ET - 2020/07/23 J2 - Critical care explorations KW - cardiac arrest massive pulmonary embolism pulmonary embolism thrombolytic interest. LA - eng M1 - 6 N1 - 2639-8028 Rech, Megan A Horng, Michelle Holzhausen, Jenna M Van Berkel, Megan A Sokol, Sarah S Peppard, Sarah Hammond, Drayton A Journal Article Crit Care Explor. 2020 Jun 9;2(6):e0132. doi: 10.1097/CCE.0000000000000132. eCollection 2020 Jun. PY - 2020 SN - 2639-8028 SP - e0132 ST - International Survey of Thrombolytic Use for Treatment of Cardiac Arrest Due to Massive Pulmonary Embolism T2 - Crit Care Explor TI - International Survey of Thrombolytic Use for Treatment of Cardiac Arrest Due to Massive Pulmonary Embolism VL - 2 ID - 760334 ER - TY - JOUR AB - BACKGROUND: The changing face of American health care demands careful scrutiny of resource allocation. The impact of the surgical intensivist model on general surgical quality measures has not been studied. Our objective was to investigate the relationship between surgical critical care staffing and indicators of general surgical quality measured by the National Surgical Quality Improvement Program (NSQIP). METHODS: We retrospectively examined the number of attending surgical intensivists at our tertiary care center biannually from January 2008 through June 2012. Risk-adjusted indicators of general surgical quality were captured and reported semiannually by NSQIP. Mortality, overall morbidity, patients on ventilator for more than 48 hours, unplanned intubations, and venous thromboembolism were included. Student's t test was used to compare the staffing levels and associated NSQIP odds ratios of a 3-year control period of full commitment with a 2-year period following significant provider attrition. RESULTS: The number of full-time surgical intensivists ranged from 2 to 8, with a period of rapid decline in late 2010 to early 2011 followed by slow recovery. There was a mean of 6.6 surgical intensivists during the 3 years before the decline and a mean of 4 in the 2 years after the decline and recovery (p < 0.005). This period of decline was associated with a significant increase in the odds ratio of ventilation for more than 48 hours (before, 0.936; after, 1.87;p = 0.0086) and of venous thromboembolism (before, 0.844; after 1.43; p = 0.0268). A trend in increased unplanned intubations was also observed. Overall morbidity and mortality were not affected. Notably, quality indicators seemed to rapidly approach baseline levels as new surgical intensivists were recruited. CONCLUSION: Institutional commitment to recruitment and retention of a surgical critical care team leads to improved NSQIP general surgery quality measures. Copyright (C) 2014 by Lippincott Williams & Wilkins AD - [Reed, Christopher R.; Fogel, Sandy L.; Collier, Bryan R.; Bradburn, Eric H.; Baker, Christopher C.; Hamill, Mark E.] Virginia Tech, Carillon Sch Med, Roanoke, VA USA. Hamill, ME (corresponding author), 1906 Belleview Ave, Roanoke, VA 24014 USA. mehamill@carilionclinic.org AN - WOS:000338389600022 AU - Reed, C. R. AU - Fogel, S. L. AU - Collier, B. R. AU - Bradburn, E. H. AU - Baker, C. C. AU - Hamill, M. E. DA - Jul DO - 10.1097/ta.0000000000000279 J2 - J. Trauma Acute Care Surg. KW - NSQIP Surgical critical care quality improvement intensivist model INTENSIVE-CARE RISK ADJUSTMENT OUTCOMES IMPACT COMPLICATIONS MORTALITY SURGERY SERVICE COSTS RATES Critical Care Medicine Surgery LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: AK4IY Times Cited: 3 Cited Reference Count: 20 Reed, Christopher R. Fogel, Sandy L. Collier, Bryan R. Bradburn, Eric H. Baker, Christopher C. Hamill, Mark E. Hamill, Mark/I-5919-2019 Hamill, Mark/0000-0001-9566-0009 3 0 1 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J TRAUMA ACUTE CARE PY - 2014 SN - 2163-0755 SP - 83-88 ST - Higher surgical critical care staffing levels are associated with improved National Surgical Quality Improvement Program quality measures T2 - Journal of Trauma and Acute Care Surgery TI - Higher surgical critical care staffing levels are associated with improved National Surgical Quality Improvement Program quality measures UR - ://WOS:000338389600022 VL - 77 ID - 761775 ER - TY - JOUR AB - Introduction: Venous thromboembolism (VTE) remains one of the principal causes of morbidity and death in trauma patients that survive the first 24 h. Recent literature on VTE prevention focuses on choice of chemoprophylaxis, specifically unfractionated heparin (UFH) versus low molecular weight heparin (LMWH). This singular focus on a multifactorial process may be inadequate to fully understand the optimal approach to VTE prevention. We hypothesized that variations in care between trauma centers could be used to identify key components of VTE prevention associated with better outcomes. Methods: A 50 question survey of VTE management for years 2014-2016 was sent to 15 trauma centers. The survey included: demographics of the trauma centers, type and timing of chemoprophylaxis, ambulation expectations, and complementary services (geriatric trauma service (GTS), mobility teams, physical and occupational therapy (PT/OT)). Each center submitted their American College of Surgeons Trauma Quality Improvement Program (TQIP) Benchmark Report for Spring 2017. TQIP data included: mortality, observed rates of deep vein thrombosis (DVT) and pulmonary embolus (PE), and time to VTE prophylaxis. The survey and TQIP reports were blinded for analysis; descriptive statistics were utilized. The top DVT & PE TQIP performers were used to identify potential aspects of better care on the survey responses. The institutions' DVT and PE rates were then compared for these responses using Wilcoxon-Rank-Sum test. Results: Fifteen trauma centers (13 Level-1, 2 Level-2) completed the survey; the centers admitted 1050 -7200 trauma patients per year (median 3000). The majority of centers were University-affiliated (11 of 15) with general surgery residencies (14 of 15), Acute Care Surgery or Surgical Critical Care Fellowships, (9 of 15) and critical care boarded-surgeons only on-call (9 of 15). Few have geriatric trauma services (3 of 15) or mobility teams (1 of 15). Half the trauma centers have dedicated PT/OT teams for trauma or weekend coverage. With a total of 20,878 TQIP patients analyzed, the average observed DVT and PE rates were 1.27% (range 0.1-5.2%) and 0.68% (range 0-1.6%), respectively. Weekly lower extremity surveillance duplex (2 of 15) increased DVT detection (4.15% vs 0.80%, p = 0.034) but did not decrease PE rates (1.05% vs 0.62%, p = 0.229). Great variance was seen in choice, dosing and timing of chemoprophylaxis: UFH, 4 LMWH daily,(1) LMWH twice-daily,(5) LMWH weight-based dosing,(4) and LMWH anti-Xa dosing.(1) The top 3 performers for DVT and PE all used different types of chemoprophylaxis. These top performers had a prominent culture of mobility: dedicated PT/OT teams for trauma or weekends and an expectation to ambulate 3-times per day. Weekend PT/OT teams were associated with lower DVT rates (median 0.40%, range 0.10-1.10% vs 1.30%, 0.60-5.20%, p = 0.018), and ambulation 3-times per day was associated with lower PE rates (median 0.20%, range 0.00-0.20% vs 0.80%, 0.40-1.60%, p < 0.005). Conclusions: Considerable variation in VTE chemoprophylaxis exists among trauma centers. "Best practices" in this area requires further investigation. An expectation of mobility and investment in mobility resources may serve to decrease VTE rates in trauma patients compared to a singular focus on type of chemoprophylaxis administered. Published by Elsevier Inc. AD - [Regner, Justin L.; Shaver, Courtney N.] Scott & White Med Ctr, 2401 South 31st St, Temple, TX 76508 USA. Regner, JL (corresponding author), Scott & White Med Ctr, 2401 South 31st St, Temple, TX 76508 USA. justin.regner@bswhealth.org AN - WOS:000468741300009 AU - Regner, J. L. AU - Shaver, C. N. AU - Grp, Swsc Multictr Trials DA - Jun DO - 10.1016/j.amjsurg.2018.11.005 J2 - Am. J. Surg. KW - MOLECULAR-WEIGHT-HEPARIN DEEP-VEIN THROMBOSIS PROPHYLAXIS ENOXAPARIN CHEMOPROPHYLAXIS INJURY RISK Surgery LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: HZ3II Times Cited: 2 Cited Reference Count: 27 Regner, Justin L. Shaver, Courtney N. Agrawal, Vaidehi/B-8282-2019 Agrawal, Vaidehi/0000-0002-1958-630X 2 0 1 EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC BRIDGEWATER AM J SURG PY - 2019 SN - 0002-9610 SP - 1030-1036 ST - Determining the impact of culture on venous thromboembolism prevention in trauma patients: A Southwestern Surgical Congress Multicenter trial T2 - American Journal of Surgery TI - Determining the impact of culture on venous thromboembolism prevention in trauma patients: A Southwestern Surgical Congress Multicenter trial UR - ://WOS:000468741300009 VL - 217 ID - 761524 ER - TY - JOUR AB - Objective: To assess surgical strategies and the impact of a multidisciplinary approach on patients undergoing inferior vena caval thrombectomy for renal cell carcinoma and to evaluate perioperative morbidity and mortality associated with these procedures. Methodology: A retrospective audit for all adults who underwent nephrectomy and inferior vena caval thrombectomy from January 2008 till November 2018 at a University hospital. Patients with incomplete records were excluded from the study. Results: During the study period, 21 patients underwent inferior vena caval thrombectomy as a completion of radical nephrectomy. Most were males (19 : 2) with a mean age of 54±11.3 years. The most common surgical approach was the 11th rib flank approach (n=8) followed by midline abdominal (n=6) and Mercedes-Benz (n=5). Eight patients had level 1, 10 patients had level 2, and three patients had level 3 tumour thrombus. The cavotomy was closed primarily in 20 patients; one required inferior vena cava (IVC) reconstruction with a pericardial patch. The proximal clamp was applied below the hepatic veins for most patients. Two patients required suprahepatic clamping before thrombectomy. There was no intraoperative mortality. Five patients (24%) developed complications: two required cardiopulmonary resuscitation due to severe hypotension and were revived; one developed acute renal failure; and one patient required a damage control laparotomy for excessive oozing. There was no thirty-day mortality. Conclusion: The IVC thrombectomy, along with radical nephrectomy for renal cell carcinoma for 1-3 level thrombus, can be performed with acceptable morbidity in a multidisciplinary team approach. AD - Section of Vascular Surgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. Section of Urology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. AN - 30931058 AU - Rehman, Z. U. AU - Ather, M. H. AU - Aziz, W. C2 - Pmc6434349 DA - Mar 25 DO - 10.3400/avd.oa.18-00150 DP - NLM ET - 2019/04/02 J2 - Annals of vascular diseases KW - carcinoma inferior renal cell thrombosis vena cava LA - eng M1 - 1 N1 - 1881-6428 Rehman, Zia Ur Ather, M Hammad Aziz, Wajahat Journal Article Ann Vasc Dis. 2019 Mar 25;12(1):55-59. doi: 10.3400/avd.oa.18-00150. PY - 2019 SN - 1881-641X (Print) 1881-641x SP - 55-59 ST - Surgical Interventions for Renal Cell Carcinoma with Thrombus Extending into the Inferior Vena Cava: A Multidisciplinary Approach T2 - Ann Vasc Dis TI - Surgical Interventions for Renal Cell Carcinoma with Thrombus Extending into the Inferior Vena Cava: A Multidisciplinary Approach VL - 12 ID - 760393 ER - TY - JOUR AB - BACKGROUND AND OBJECTIVES: Diagnosis-related systems (ICD-10, OPS, PCCL) are used in acute medical care as part of the multidisciplinary classification of overall care and related costs. In contrast, such systems, reflecting therapeutic requirements and distinguishing between patients according to the level of effort and costs incurred, are still not available for use in clinical rehabilitation units. METHODS: 215 consecutive patients (aged 63.8 +/- 11.1 years; 68.2% males ) were included in a single-center prospective registry during inpatient cardiac rehabilitation (CR). The following data were included: clinical condition, diagnosis of diseases, length of acute hospitalization and various parameters of physical and psychological state (Karnofsky performance score, Hospital Anxiety and Depression Scale [HADS]). Efforts out of normal care by nurses. doctors and laboratories were measured in minutes and divided into quartiles. Logistic regression models were used to estimate the odds for predictive parameters for patients requiring care and efforts above the highest quartile. RESULTS: Mean acute in-hospital stay was 14.7 +/- 14.5 days, duration of CR 21.8 +/- 3.5 days. Mean duration of nursing efforts was 221 +/- 170 min, of medical staff efforts 5564 min, of physiotherapy 174 +/- 281 min. In the multivariate model five determinants were significantly associated with increased care provision during CR: duration of hospitalization, diabetes, arterial hypertension, low exercise capacity and anxiety as measured by HADS. Increased laboratory testing was predominantly the result of diabetes mellitus and an increased Karnofsky score. CONCLUSION: Prolonged acute hospitalization, anxiety and diabetes mellitus were associated with increased nursing/medical/phyisiotherapeutic care during CR. These factors should be taken into account in any cost classification system that needs to be developed for use in rehabilitation clinics so as to provide better transparency in cost assessment. AD - Klinik am See, Kardiologie, Rehabilitationszentrum für Innere Medizin, Berlin. AN - 20391309 AU - Reibis, R. AU - Völler, H. AU - Treszl, A. AU - Langheim, E. AU - Buhlert, H. AU - Wegscheider, K. DA - Apr DO - 10.1055/s-0030-1251932 DP - NLM ET - 2010/04/15 J2 - Deutsche medizinische Wochenschrift (1946) KW - Aged Angioplasty, Balloon, Coronary/*economics/*rehabilitation Anxiety Disorders/economics/rehabilitation Body Mass Index Combined Modality Therapy/economics/statistics & numerical data Comorbidity Coronary Artery Bypass/*economics/*rehabilitation Coronary Disease/*economics/*rehabilitation Diabetes Mellitus, Type 2/economics/rehabilitation Female Germany Health Care Costs/*statistics & numerical data Heart Failure/*economics/*rehabilitation Heart Valve Diseases/*economics/*rehabilitation Heart Valve Prosthesis Implantation/*economics/*rehabilitation Humans Hypertension/economics/rehabilitation Length of Stay/economics Male Middle Aged Multivariate Analysis National Health Programs/*economics/statistics & numerical data Patient Care Team/*economics/statistics & numerical data Physical Therapy Modalities/economics/statistics & numerical data Rehabilitation Centers/economics/statistics & numerical data Sex Factors Utilization Review/statistics & numerical data LA - ger M1 - 16 N1 - 1439-4413 Reibis, R Völler, H Treszl, A Langheim, E Buhlert, H Wegscheider, K Journal Article Germany Dtsch Med Wochenschr. 2010 Apr;135(16):795-800. doi: 10.1055/s-0030-1251932. Epub 2010 Apr 13. OP - Versorgungsaufwand und Kosten während der kardiologischen Rehabilitation. PY - 2010 SN - 0012-0472 SP - 795-800 ST - [Determinants of health care expenses during cardiac rehabilitation] T2 - Dtsch Med Wochenschr TI - [Determinants of health care expenses during cardiac rehabilitation] VL - 135 ID - 760286 ER - TY - JOUR AB - Purpose: The purpose of the study is to evaluate the clinical safety and effectiveness of the Denali (Bard, Tempe, Arizona) retrievable inferior vena cava (IVC) filter. Materials and Methods: In this retrospective study, authors reviewed the data of Denali IVC filters placed at their institution between 2013 and 2015. The clinical presentation, indications, and procedure-related complications during placement and retrieval were evaluated. The frequency of post filter pulmonary embolism (PE) and filter-related complications was assessed. Results: Denali filters were placed in 87 patients (47 males; mean age: 56 years). Twenty patients presented with PE, 45 with deep vein thrombosis (DVT), and 21 with both PE and DVT, 1 filter was placed prophylactically before surgery. Indications for filter placement included contraindications to anticoagulation (AC; n = 80), failure of AC (n = 4), and complications of AC (n = 3). No patients had PE on follow-up imaging after filter placement. Retrieval was attempted in 31 patients after a mean period of 125 days (range: 34-324 days). The filter was successfully removed in 31 (100%) patients. Follow-up imaging, available in 71 (82%) patients (range: 2-538 days), demonstrated penetration of 15 legs in 5 patients, caval thrombus in 3, 1 resulting in caval occlusion, <15° filter tilt in 5, and no leg fractures or crossed legs. Conclusion: The Denali filter is safe during deployment and readily retrievable. The overall safety following deployment is similar to those reported in the literature, and the incidence of filter fractures and migration appears to be less than the previous generation of Bard devices. AD - Division of Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA AN - 118104365. Language: English. Entry Date: 20160920. Revision Date: 20191120. Publication Type: Article AU - Reis, Stephen P. AU - Kovoor, Jerry AU - Sutphin, Patrick D. AU - Toomay, Seth AU - Trimmer, Clayton AU - Pillai, Anil AU - Reddick, Mark AU - Kalva, Sanjeeva P. DB - CINAHL DO - 10.1177/1538574416666223 DP - EBSCOhost KW - Vena Cava Filters -- Adverse Effects Treatment Outcomes -- Evaluation Pulmonary Embolism -- Therapy Venous Thrombosis -- Therapy Human Tomography, X-Ray Computed Retrospective Design Record Review Electronic Health Records Descriptive Research Descriptive Statistics Male Female Middle Age Adult Aged Aged, 80 and Over After Care M1 - 6 N1 - diagnostic images; research; tables/charts. Journal Subset: Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Peer Reviewed; USA. Special Interest: Patient Safety. NLM UID: 101136421. PY - 2016 SN - 1538-5744 SP - 385-390 ST - Safety and Effectiveness of the Denali Inferior Vena Cava Filter T2 - Vascular & Endovascular Surgery TI - Safety and Effectiveness of the Denali Inferior Vena Cava Filter UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=118104365&site=ehost-live&scope=site VL - 50 ID - 761385 ER - TY - JOUR AB - Objective: To value the occurrence of infections in chronic renal failure patients with use of catheter double-lumen temporary (CDL). Methods: Prospective study and follow-up, realized in a Clinical Nephrology, in Recife (PE), Brazil, between the months of January 2009 to December 2010. In this study 88 chronic renal failure patients participated (CRF) and who are undergoing hemodyalisis. Results: the temporary double-lumen catheters enable the execution of the hemodialysis right after implantation, but it presents an inferior operational implant cost in comparison to the fully implantable ones or to the arteriovenous fistula (AVFs). Conclusion: It is prime to raise awareness of the health team regarding cares when implanting and manipulating the catheter (during the hemodialysis sessions and realization of bandages). The patient's hygiene conditions contribute with infectious processes, they need therefore to be informed about infection risks. AD - [Mota dos Santos, Emmanuela Kethully] Rua Panfilo Falcao Melo 77, BR-55700000 Pernambuco, Brazil. dos Santos, EKM (corresponding author), Rua Panfilo Falcao Melo 77, BR-55700000 Pernambuco, Brazil. manukms@hotmail.com AN - WOS:000454643400003 AU - Reisdorfer, A. S. AU - Giugliani, R. AU - Gouveia, V. D. AU - dos Santos, E. K. M. AU - da Silva, J. J. T. DA - Jan-Mar DO - 10.9789/2175-5361.2019.v11i1.34-38 J2 - Rev. Pesqui.-Cuid. Fundam. Online KW - Renal insufficiency Infection Catheters for hemodialysis Nursing LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: HG0NW Times Cited: 0 Cited Reference Count: 20 Reisdorfer, Anion Saraiva Giugliani, Roberto Gouveia, Viviane de Araujo Mota dos Santos, Emmanuela Kethully Teixeira da Silva, Jose Jairo ; Giugliani, Roberto/G-4790-2015 Gouveia, Viviane de Araujo/0000-0002-7233-5411; Giugliani, Roberto/0000-0001-9655-3686 0 1 UNIV FEDERAL ESTADO RIO DE JANEIRO, PROGRAMA POS-GRADUACAO & ENFERMAGEM RIO DE JANEIRO REV PESQUI-CUID FUND PY - 2019 SN - 2175-5361 SP - 20-24 ST - Infections in temporary access for hemodialysis in chronic renal failure patients T2 - Revista De Pesquisa-Cuidado E Fundamental Online TI - Infections in temporary access for hemodialysis in chronic renal failure patients UR - ://WOS:000454643400003 VL - 11 ID - 761552 ER - TY - JOUR AB - OBJECTIVES: : To describe nursing compliance with a computer-based pediatric thrombosis risk assessment tool; to generate an estimate of risk factors present in our population; and to explore relationships between risk factors and confirmed thrombotic events. DESIGN: : Institutional review board-approved prospective, observational cohort study. SETTING: : Pediatric intensive care unit within a tertiary care children's hospital. PATIENTS: : All infants and children admitted to the pediatric intensive care unit during a 6-month study period (January 1, 2010-June 30, 2010). MEASUREMENTS AND MAIN RESULTS: : Eight hundred admissions were enrolled, representing 742 patients. Thrombosis risk assessment scores were recorded for 707 admissions (88% of total). Mean age = 6.95 ± 6 yrs, mean weight = 28 ± 23 kg, 45% female. A total of 32 thrombi (14 prehospital and 18 in-hospital) were present in the study group. This translated to an overall occurrence rate of 4.3% (1.9% for prehospital and 2.4% for in-hospital). Logistic regression identified that for every 1-point increase in total thrombosis score, the risk of developing a symptomatic thrombus increased by 1.57-fold (95% confidence interval 0.192-5.5) to 2.12-fold (95% confidence interval 0.175-18.34), for prehospital and in-hospital thrombi, respectively (p < .05). The most important risk factors identified for development of any thrombus were thrombophilia (acquired or inherited) (p < .001), presence of a central catheter (p = .01), and age <1 or >14 yrs (p = .052). CONCLUSIONS: : Incorporation of a scoring system into the bedside nursing assessment flow sheet was successful and identified children at risk for in-hospital thrombosis. The overall score appears to be most indicative of thrombus risk. These data may serve as a platform for future development of routine screening and possible interventional trials in critically ill children. AD - From the Departments of Pharmacy (PDR), Nursing (BW), Pediatrics (ELD), and Clinical Pharmacy (RV), School of Pharmacy, Section of Pediatric Critical Care (ELD), University of Colorado at Denver, Denver, CO; and The Children's Hospital (RV), Aurora, CO. AN - 108135470. Language: English. Entry Date: 20120907. Revision Date: 20150712. Publication Type: Journal Article AU - Reiter, Pamela D. AU - Wathen, Beth AU - Valuck, Robert J. AU - Dobyns, Emily L. DB - CINAHL DP - EBSCOhost KW - Intensive Care Units, Pediatric Risk Assessment -- Evaluation -- In Infancy and Childhood Thrombosis -- Prevention and Control -- In Infancy and Childhood Thrombosis -- Risk Factors -- In Infancy and Childhood Adolescence Chi Square Test Child Child, Preschool Electronic Health Records -- Utilization Confidence Intervals Data Analysis Software Data Analysis, Statistical Descriptive Statistics Female Human Infant Logistic Regression Male Nonexperimental Studies P-Value Prospective Studies M1 - 4 N1 - research; tables/charts. Commentary: Vavilala Monica S. Adapting the electronic clinical and quality improvement toolkit for research: The case of the thrombus risk assessment tool*. (PEDIATR CRIT CARE MED) 2012 Jul; 13 (4): 481-482. Journal Subset: Biomedical; Peer Reviewed; USA. Special Interest: Critical Care; Pediatric Care. NLM UID: 100954653. PMID: NLM22198812. PY - 2012 SN - 1529-7535 SP - 381-386 ST - Thrombosis risk factor assessment and implications for prevention in critically ill children T2 - Pediatric Critical Care Medicine TI - Thrombosis risk factor assessment and implications for prevention in critically ill children UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=108135470&site=ehost-live&scope=site VL - 13 ID - 761395 ER - TY - JOUR AB - Aim: Congenital heart disease may cause embolic ischemic stroke, representing additional morbidity. Case Report: NT was born at term. Due to hypoplastic left heart syndrome Norwood operation was performed, followed with bidirectional cavo-pulmonary anastomosis at 3 months of age. He developed nicely, until at the age of 9 months became severely decompensated due to right ventricle failure. In January 2009 two thrombi were diagnosed in the R ventricle. While on enoxaparine, sudden acute left side hemiplegia occurred. Urgent CT head scan was normal. Multidisciplinary team suggested treatment of presumed embolic event with alteplaze (rt-PA) iv. The treatment plan was explained to both parents in detail with possible complications, informed consent was signed. NT received recombinant tPA, 0.7mg iv, bolus, followed by 6.7mg in 1-hour infusion (ie 0.9 mg/kg). Control head CT scan 24 hours later showed hypodense lesion involving insula, capsula interna, corona radiata and subcortical area of the R parietal region. Anticoagulation was continued (enoxaparin 800E/12 hour sc, Aspirin 50mg/day) and he started neurophysiotherapy. Spontaneous movements in his hand recovered only after 5 days. After 3 weeks mild hemiparesis persisted with full repertoire of movements on his L side. Discussion: From 2000 on several reports of successful use of rtPA emerged. The exact dosage and mode of application is, however a matter of prospective randomized trial. In our case the outcome was not optimal. As stroke in children is rare, a close contact with adult stroke unit is essential, in order to select appropriate candidates for thrombolysis. AD - Z. Rener Primec, Department of Child Neurology, University Children Hospital, Slovenia AU - Rener Primec, Z. AU - Vesel, S. AU - Škofljanec, A. AU - Švigelj, V. DB - Embase DO - 10.1016/S1090-3798(09)70294-6 KW - enoxaparin acetylsalicylic acid cerebrovascular accident society infant case report hypoplastic left heart syndrome Norwood procedure cavopulmonary connection heart right ventricle failure thrombus hemiplegia parent informed consent infusion computer assisted tomography capsula interna anticoagulation insula hemiparesis child stroke unit blood clot lysis congenital heart disease brain ischemia morbidity adult LA - English M3 - Conference Abstract N1 - L70190034 2010-07-13 PY - 2009 SN - 1090-3798 SP - S94 ST - Treatment of cardio-embolic stroke in an infant with alteplaze iv T2 - European Journal of Paediatric Neurology TI - Treatment of cardio-embolic stroke in an infant with alteplaze iv UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70190034&from=export http://dx.doi.org/10.1016/S1090-3798(09)70294-6 VL - 13 ID - 761267 ER - TY - JOUR AB - Background and Aims: Direct transfer to angio-suite (DTAS) protocols have demonstrated to achieve a significant reduction of in-hospital workflow in patients who undergo endovascular treatment. Applying DTAS protocol implies the indication of intravenous thrombolysis (IVT) and endovascular treatment based on cone-beam CT. We aimed to assess the safety of IVT following this protocol. Methods: A 1 to 3 case-control study of consecutive DTAS patients treated with IVT after cone-beam CT and matched to 48 IVT treated patients after conventional CT-scan. DTAS protocol included a cone beam CT (X-pert CT Philips) in the angio-suite to rule-out intracerebral hemorrhage or large established infarct. Cases and controls were matched by age, NIHSS score, occlusion location and time from onset to arrival. Primary safety outcome was the rate of intracranial hemorrhage and in-hospital mortality. Results: During 24 months, among 138 DTAS patients, 16 received IVT following a cone-beam CTas only imaging test. There were no differences in age, NIHSS, level of occlusion and time from onset-to-door between cases and controls. The mean door-to-needle time was similar (25.6+/- 13.2 Vs 28.5+/-18.8 minutes, p=0.1) and the mean door-to-groin time was shorter (19.8+/-8.7 Vs 83.4+/-30.8 minutes, p<0.01) in the DTAS group. There were no differences in the rate of intracranial hemorrhage (17.0% vs. 18.8%, p=0.8), symptomatical hemorrhage (6.4% vs. 0%, p=0.3) and in-hospital mortality (10.6% vs. 6.25%, p=0.5). Conclusions: DTAS seems to be a safe strategy to reduce in-hospital workflow time in acute stroke patients. Using cone-beam CT to indicate IVT does not increase the rate of complications in our cohort. AD - M. Requena, Hospital Universitari Vall D'Hebron, Stroke Unit. Department of Neurology, Barcelona, Spain AU - Requena, M. AU - Rubiera, M. AU - Muchada, M. AU - Garcia-Tornel, A. AU - Deck, M. AU - Boned, S. AU - Rodriguez-Villatoro, N. AU - Juega, J. AU - Coscojuela, P. AU - Hernandez, D. AU - Pagola, J. AU - Rodriguez-Luna, D. AU - Tomasello, A. AU - Molina, C. AU - Ribo, M. DB - Embase DO - 10.1177/2396987319845581 KW - adult blood clot lysis brain hemorrhage case control study complication cone beam computed tomography conference abstract controlled study female hospital mortality human infarction inguinal region major clinical study male National Institutes of Health Stroke Scale occlusion stroke patient workflow x-ray computed tomography LA - English M3 - Conference Abstract N1 - L628561855 2019-07-23 PY - 2019 SN - 2396-9881 SP - 747-748 ST - Intravenous TPA after cone-beam ct evaluation in direct transfer to angio suite patients T2 - European Stroke Journal TI - Intravenous TPA after cone-beam ct evaluation in direct transfer to angio suite patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628561855&from=export http://dx.doi.org/10.1177/2396987319845581 VL - 4 ID - 760721 ER - TY - JOUR AB - BACKGROUND: Severe noncompressible torso hemorrhage remains a leading cause of potentially preventable death in modern military conflicts. Resuscitative endovascular occlusion of the aorta (REBOA) has demonstrated potential as an effective adjunct to the treatment of noncompressible torso hemorrhage in the civilian early hospital and even prehospital settings-but the application of this technology for military prehospital use has not been well described. We aimed to assess the feasibility of both field and en route prehospital REBOA in the military exercise setting, simulating a modern armed conflict. METHODS: Two adult male Sus Scrofa underwent simulated junctional combat injury in the context of a planned military training exercise. Both underwent zone I REBOA in conjunction with standard tactical combat casualty care interventions-one during point of injury care and the other during en route flight care. Animals were sequentially evacuated to two separate forward surgical teams by rotary wing platform where the balloon position was confirmed by chest x-ray. Animals then underwent different damage control thoracic and abdominal procedures before euthanasia. RESULTS: The first swine underwent immediate successful REBOA at the point of injury 7 minutes and 30 seconds after the injury. It required 6 minutes total from initiation of procedure to effective aortic occlusion. Total occlusion time was 60 minutes. In the second animal, the REBOA placement procedure was initiated immediately after take off (17 minutes and 40 seconds after the injury). Although the movements and vibration of flight were not significant impediments, we only succeeded to put a 6-French (Fr) sheath into a femoral artery during the 14 minutes flight due to lighting and visualization challenges. After the sheath had been upsized in the forward surgical team, the REBOA catheter was primarily placed in zone I followed by its replacement to zone III. Both animals survived to study completion and the termination of training. No complications were observed in either animal. CONCLUSION: Our study demonstrates the potential feasibility of REBOA for use during tactical field and en route (flight) care of combat casualties. Further study is needed to determine the optimal training and utilization protocols required to facilitate the effective incorporation of REBOA into military prehospital care capabilities. (Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.) AD - [Reva, Viktor A.; Makhnovskiy, Andrey I.; Sokhranov, Mikhail V.; Samokhvalov, Igor M.] Kirov Mil Med Acad, Dept War Surg, St Petersburg, Russia. [Hoerer, Tal M.] Orebro Univ Hosp, Dept Cardiothorac & Vasc Surg, Orebro, Sweden. [DuBose, Joseph J.] Univ Calif Davis, Med Ctr, Travis Air Force Base Med Ctr, Sacramento, CA 95817 USA. Reva, VA (corresponding author), Kirov Mil Med Acad, St Petersburg, Russia. vreva@mail.ru AN - WOS:000403907300027 AU - Reva, V. A. AU - Horer, T. M. AU - Makhnovskiy, A. I. AU - Sokhranov, M. V. AU - Samokhvalov, I. M. AU - DuBose, J. J. DA - Jul DO - 10.1097/ta.0000000000001476 J2 - J. Trauma Acute Care Surg. KW - Trauma hemorrhage REBOA vascular access military BALLOON OCCLUSION HEMORRHAGIC-SHOCK TORSO HEMORRHAGE TRAUMA PATIENTS LETHAL MODEL GAP ANALYSIS SWINE MODEL REBOA CARE PLACEMENT Critical Care Medicine Surgery LA - English M3 - Article N1 - ISI Document Delivery No.: EY3XA Times Cited: 27 Cited Reference Count: 27 Reva, Viktor A. Hoerer, Tal M. Makhnovskiy, Andrey I. Sokhranov, Mikhail V. Samokhvalov, Igor M. DuBose, Joseph J. Reva, Viktor A/R-4746-2016; Sokhranov, Mikhail/B-7292-2018 Reva, Viktor A/0000-0001-6705-9849; Sokhranov, Mikhail/0000-0001-7578-6915 [MK-7508.2016.7] Viktor Reva is currently receiving a grant (MK-7508.2016.7) from the President of Russia. For the remaining authors, no conflicts were declared. The balloon catheters used in this study were given by the industry for free for the purpose of testing. 29 0 2 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J TRAUMA ACUTE CARE 1 PY - 2017 SN - 2163-0755 SP - S170-S176 ST - Field and en route resuscitative endovascular occlusion of the aorta: A feasible military reality? T2 - Journal of Trauma and Acute Care Surgery TI - Field and en route resuscitative endovascular occlusion of the aorta: A feasible military reality? UR - ://WOS:000403907300027 VL - 83 ID - 761650 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 require prompt, definitive management; however, current consensus guidelines in this domain are not supported by high-level evidence. Randomized clinical trials comparing available pharmacologic and invasive treatment modalities-including anticoagulation, thrombolysis, and embolectomy-have not been conducted and continue to be challenging to conceptualize, design, and execute. Consequently, time-sensitive therapeutic determinations are largely not standardized, and rendered on a case-by-case basis in part depending on institutional practices and expertises. Chronic sequelae of PE, such as chronic thromboembolic pulmonary hypertension and right heart failure, are increasingly identified as conditions necessitating longitudinal specialty care. These and other challenges have created a niche for a multidisciplinary team which can respond rapidly to unstable patient scenarios, appropriately deploy resources, and offer highly specialized acute and chronic management of PE. The Massachusetts General Hospital Pulmonary Embolism Response Team (PERT), modeled after existing rapid response and collaborative care teams, is a novel approach that combines this clinical service with the development of an educational and research framework to advance the care of patients with PE. AD - Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Gray 7-730, Boston, MA, 02114, USA, nreza@partners.org. AN - 25947348 AU - Reza, N. AU - Dudzinski, D. M. DA - Jun DO - 10.1007/s11936-015-0387-9 DP - NLM ET - 2015/05/08 J2 - Current treatment options in cardiovascular medicine LA - eng M1 - 6 N1 - Reza, Nosheen Dudzinski, David M Journal Article United States Curr Treat Options Cardiovasc Med. 2015 Jun;17(6):387. doi: 10.1007/s11936-015-0387-9. PY - 2015 SN - 1092-8464 (Print) 1092-8464 SP - 387 ST - Pulmonary embolism response teams T2 - Curr Treat Options Cardiovasc Med TI - Pulmonary embolism response teams VL - 17 ID - 760175 ER - TY - JOUR AB - BACKGROUND: Safe and effective patient care for ST-elevation myocardial infarction (STEMI) relies on prompt emergency medical service (EMS) and established care coordination with receiving hospitals to conduct primary percutaneous coronary intervention (PCI). Likewise, a new emphasis has been placed on first medical contact-to-balloon (E2B) times as opposed to door-to-balloon times, identifying prehospital care as an important contributing factor for high-quality STEMI care. Therefore, we evaluated EMS processes of care before and after a period of continuous quality improvement to improve E2B times in our rural tertiary care medical center. METHODS: A retrospective, consecutive cohort study was conducted on 177 patients who received primary PCI at Dartmouth-Hitchcock Medical Center, a rural hospital, from January 1, 2006 to October 31, 2009. This cohort was stratified from January 1, 2008 to May 1, 2008 (n = 88) and May 1, 2008 to October 31, 2009 (n = 89), to acknowledge periods of no improvement (pre) and continuous quality improvement (post) in STEMI care. Primary outcome measures included frequency of non-PCI-capable hospital bypass, E2B, and frequency of prehospital electrocardiogram (ECG) and cardiac catheterization laboratory (CCL) activation. Descriptive statistics and log-rank tests were used to determine whether measures differed significantly by time period. A time-to-event analysis was conducted using a Cox proportional hazards model to assess the impact of outcomes measures on E2B pre/post-May 1, 2008. RESULTS: Patients who presented before May 1, 2008 had longer E2B times compared with patients in the post-May 1, 2008 cohort (145.1 minutes vs 115.2 minutes, t test P = .01). A log-rank test confirmed this (pre: 130 minutes vs post: 106 minutes, χ(2) = 5.3, log-rank P = .02). Similarly, patients who presented before May 1, 2008 had lower percentages of prehospital ECGs (49% vs 80%, P = .001) and CCL activations (4% vs 32%, P < .001). When prehospital ECGs (140 minutes vs 106 minutes, χ(2) = 5.9, log-rank P = .01) or CCL activations (125 minutes vs 98 minutes, χ(2) = 4.2, log-rank P = .04) were conducted, E2B times were significantly reduced. Patients who received both prehospital ECGs and prehospital CCL activations had significantly reduced E2B times compared with those who did not (125 minutes vs 91 minutes, χ(2) = 4.8, P = .02). CONCLUSIONS: The time saving benefits of prehospital ECGs may not be fully realized unless prehospital CCL activations also occur. EMS providers achieved further reductions in median E2B of approximately 24 minutes when prehospital ECGs were combined with prehospital CCL activation. Every effort should be made by PCI-capable medical centers to assess prehospital STEMI care and to integrate EMS providers into regional STEMI care quality improvement initiatives and education. AD - The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03756, USA. AN - 21130918 AU - Rezaee, M. E. AU - Conley, S. M. AU - Anderson, T. A. AU - Brown, J. R. AU - Yanofsky, N. N. AU - Niles, N. W. DA - Nov-Dec DO - 10.1016/j.pcad.2010.09.003 DP - NLM ET - 2010/12/07 J2 - Progress in cardiovascular diseases KW - Aged *Angioplasty, Balloon, Coronary Chi-Square Distribution Delivery of Health Care, Integrated/*organization & administration Electrocardiography Emergency Medical Services/*organization & administration Evidence-Based Medicine Female Health Services Accessibility/*organization & administration Humans Male Middle Aged Myocardial Infarction/diagnosis/mortality/*therapy New Hampshire Organizational Innovation Outcome and Process Assessment, Health Care/*organization & administration Patient Care Team/organization & administration Practice Guidelines as Topic Program Development Program Evaluation Proportional Hazards Models Quality of Health Care/*organization & administration Regional Health Planning/organization & administration Retrospective Studies Risk Assessment Risk Factors Rural Health Services/*organization & administration Time Factors Transportation of Patients/organization & administration Treatment Outcome LA - eng M1 - 3 N1 - 1873-1740 Rezaee, Michael E Conley, Sheila M Anderson, Tamara A Brown, Jeremiah R Yanofsky, Norman N Niles, Nathaniel W Journal Article United States Prog Cardiovasc Dis. 2010 Nov-Dec;53(3):210-8. doi: 10.1016/j.pcad.2010.09.003. PY - 2010 SN - 0033-0620 SP - 210-8 ST - Primary percutaneous coronary intervention for patients presenting with ST-elevation myocardial infarction: process improvements in rural prehospital care delivered by emergency medical services T2 - Prog Cardiovasc Dis TI - Primary percutaneous coronary intervention for patients presenting with ST-elevation myocardial infarction: process improvements in rural prehospital care delivered by emergency medical services VL - 53 ID - 760483 ER - TY - JOUR AB - A 79-year-old man presented with an enlarging thoracic aneurysm on the background of superficial bladder cancer treated with intravesical bacillus Calmette-Guérin (BCG) injections. Following the injections, he developed deranged liver function tests and hepatomegaly. Liver biopsy revealed granulomatous hepatitis compatible with disseminated mycobacterial infection (BCG-osis) and was treated with anti-tuberculosis agents for 12 months. A surveillance CT scan performed as a follow-up for his bladder cancer in 2018 revealed a saccular thoracic aneurysm at the ligamentum arteriosum, which was metabolically active on positron emission tomography (PET) scan. Given the timeframe from intravesical instillation of BCG and the metabolic activity on PET scan, the lesion was consistent with a mycotic aneurysm secondary to disseminated mycobacterial infection. Following multidisciplinary team discussion, a thoracic endovascular aneurysm repair was performed. The stent grafts were placed distal to the left subclavian artery with good angiographic results and no immediate postoperative complications. He was initiated on long-term antibiotics to cover potential bacterial pathogens including mycobacterium. AD - L. Ribeiro, Vascular Surgery, St George's Hospital, London, United Kingdom AU - Ribeiro, L. AU - Rajendran, S. AU - Stenson, K. AU - Loftus, I. DB - Embase Medline DO - 10.1136/bcr-2019-231595 KW - stent graft BCG vaccine ceftriaxone ethambutol isoniazid moxifloxacin pyrazinamide rifampicin aged anemia antibiotic therapy article bladder cancer body weight loss bone marrow biopsy bovine tuberculosis case report clinical article computer assisted tomography descending aortic aneurysm drug substitution endovascular aneurysm repair erythema fever follow up granulomatous hepatitis hepatomegaly human hypertension left subclavian artery liver biopsy liver failure long term care malaise male multidisciplinary team mycobacteriosis outpatient pancytopenia positron emission tomography postoperative care postoperative period priority journal smoking transient ischemic attack transurethral resection treatment duration LA - English M1 - 12 M3 - Article N1 - L630246061 2019-12-31 2020-01-07 PY - 2019 SN - 1757-790X ST - Rare case of a proximal descending thoracic aorta mycotic aneurysm following intravesical BCG injections for the treatment of bladder cancer T2 - BMJ Case Reports TI - Rare case of a proximal descending thoracic aorta mycotic aneurysm following intravesical BCG injections for the treatment of bladder cancer UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630246061&from=export http://dx.doi.org/10.1136/bcr-2019-231595 VL - 12 ID - 760639 ER - TY - JOUR AB - BACKGROUND: Patients with glioma are at high risk for tumor and treatment related complications. Few guidelines exist to direct the management of these supportive care needs. Our prior work suggests that a standardized clinical care pathway can improve the care of patients with glioma. METHODS: We designed a quality improvement (QI) project to address the acute care needs of patients with glioma. We formed a multidisciplinary team and selected twenty best practice measures from the literature. Using a plan-do-study-act framework, we brainstormed and implemented various improvement strategies starting in October 2013. Statistical process control charts were used to assess progress. RESULTS: Retrospective data was available for 12 best practice measures. The baseline population consisted of 98 patients with gliomas. Record review suggested wide variation in performance, with compliance ranging from 30% to 100%. The team hypothesized that lack of process standardization may contribute to less-than-ideal performance. After implementing improvement strategies, we reviewed the records of 63 consecutive patients with glioma. The proportion of patients meeting criteria for 12 practice measures improved( 65% pre QI-work;76% post-QI work,p > 0.1), al though not statistically significant. Unexpectedly, a higher proportion of patients were readmitted within 30 days of hospital discharge but the proportions for preventable readmissions were similar. Post-operative urinary tract infections (UTIs), venous thromboembolic complications and outpatient falls were identified as opportunities for improvement, with a significant decrease in the incidence of UTIs after interventions were established (p < 0.01). Barriers to pathway development included difficulties with transforming manual measures into electronic data sets. CONCLUSIONS: Creating evidence based clinical care pathways for addressing the acute care needs of patients with glioma is feasible and important. Data dashboards help to inform additional improvement work. There are many challenges, however, to developing sustainable systems for measuring and reporting performance outcomes over time. AD - N. Riblet, VA Medical Center, White River Junction, VT, United States AU - Riblet, N. AU - Schlosser, E. AU - Snide, J. AU - Ronan, L. AU - Thorley, K. AU - Davis, M. AU - Hong, J. AU - Mason, L. AU - Cooney, T. AU - Jalowiec, L. AU - Kennedy, N. AU - Richie, S. AU - Nalepinski, D. AU - Fadul, C. DB - Embase DO - 10.1093/neuonc/nov216.20 KW - human emergency care society glioma patient oncology total quality management urinary tract infection hospital readmission thromboembolism hospital discharge standardization medical record review population evidence based practice book outpatient process control neoplasm risk LA - English M3 - Conference Abstract N1 - L72188557 2016-02-19 PY - 2015 SN - 1522-8517 SP - v105-v106 ST - A clinical care pathway to improve the acute care of patients with glioma T2 - Neuro-Oncology TI - A clinical care pathway to improve the acute care of patients with glioma UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72188557&from=export http://dx.doi.org/10.1093/neuonc/nov216.20 VL - 17 ID - 761052 ER - TY - JOUR AB - Background. Patients with glioma are at increased risk for tumor-related and treatment-related complications. Few guidelines exist to manage complications through supportive care. Our prior work suggests that a clinical care pathway can improve the care of patients with glioma. Methods. We designed a quality improvement (QI) project to address the acute care needs of patients with gliomas. We formed a multidisciplinary team and selected 20 best-practice measures from the literature. Using a plan-do-study-act framework, we brain-stormed and implemented various improvement strategies starting in October 2013. Statistical process control charts were used to assess progress. Results. Retrospective data were available for 12 best practice measures. The baseline population consisted of 98 patients with glioma. Record review suggested wide variation in performance, with compliance ranging from 30% to 100%. The team hypothesized that lack of process standardization may contribute to less-than-ideal performance. After implementing improvement strategies, we reviewed the records of 63 consecutive patients with glioma. The proportion of patients meeting criteria for 12 practice measures modestly improved (65% pre-QI; 76% post-QI, P >. 1). Unexpectedly, a higher proportion of patients were readmitted within 30 days of hospital discharge (pre-QI: 10%; post-QI: 17%, P >. 1). Barriers to pathway development included difficulties with transforming manual measures into electronic data sets. Conclusions. Creating evidence-based clinical care pathways for addressing the acute care needs of patients with glioma is feasible and important. There are many challenges, however, to developing sustainable systems for measuring and reporting performance outcomes overtime. AD - [Schlosser, Evelyn M.; Snide, Jennifer A.; Ronan, Lara; Thorley, Katherine; Davis, Melissa; Hong, Jennifer; Mason, Linda P.; Cooney, Tobi J.; Jalowiec, Lanelle; Kennedy, Nancy L.; Richie, Sabrina; Nalepinski, David; Fadul, Camilo E.] Dartmouth Hitchcock Med Ctr, 1 Med Ctr Dr, Lebanon, NH 03756 USA. [Snide, Jennifer A.; Ronan, Lara; Davis, Melissa; Mason, Linda P.; Jalowiec, Lanelle; Richie, Sabrina; Nalepinski, David; Fadul, Camilo E.] Norris Cotton Canc Ctr, 1 Med Ctr Dr, Lebanon, NH 03756 USA. [Riblet, Natalie B. V.; Ronan, Lara; Fadul, Camilo E.] Geisel Sch Med Dartmouth, 1 Rope Ferry Dr, Hanover, NH 03755 USA. [Riblet, Natalie B. V.] VA Med Ctr, 215 North Main St, White River Jct, VT 05009 USA. Fadul, CE (corresponding author), Univ Virginia, Dept Neurol, POB 800432, Charlottesville, VA 22908 USA. cef3w@virginia.edu AN - WOS:000439196300003 AU - Riblet, N. B. V. AU - Schlosser, E. M. AU - Snide, J. A. AU - Ronan, L. AU - Thorley, K. AU - Davis, M. AU - Hong, J. AU - Mason, L. P. AU - Cooney, T. J. AU - Jalowiec, L. AU - Kennedy, N. L. AU - Richie, S. AU - Nalepinski, D. AU - Fadul, C. E. DA - Sep DO - 10.1093/nop/npv050 J2 - Neuro-Oncol. Pract. KW - glioma outcomes quality improvement QUALITY-OF-CARE BRAIN-TUMORS VENOUS THROMBOEMBOLISM MOLECULAR PATHOLOGY GLIOBLASTOMA RADIOTHERAPY ADULTS CRANIOTOMY SURVIVAL FALLS Clinical Neurology LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: VE3RQ Times Cited: 4 Cited Reference Count: 61 Riblet, Natalie B. V. Schlosser, Evelyn M. Snide, Jennifer A. Ronan, Lara Thorley, Katherine Davis, Melissa Hong, Jennifer Mason, Linda P. Cooney, Tobi J. Jalowiec, Lanelle Kennedy, Nancy L. Richie, Sabrina Nalepinski, David Fadul, Camilo E. Norris Cotton Cancer Center We would like to acknowledge Kati Fuller, Nancy Lapoint, Mary Robinson, Carissa Thurston, Denise Preston, and Louise Meyer for their assistance in carrying out this QI initiative, as well as Dr. Christopher Dant and Dr. J. Marc Pipas for reviewing our manuscript and providing us with editing suggestions. Finally, we would like to extend our appreciation to the original sponsors to this project including Dr. Mark Israel, Director of Norris Cotton Cancer Center, and Dr. David Roberts, Section Chief of Neurosurgery. 4 0 2 OXFORD UNIV PRESS OXFORD NEURO-ONCOL PRACT PY - 2016 SN - 2054-2577 SP - 145-153 ST - A clinical care pathway to improve the acute care of patients with glioma T2 - Neuro-Oncology Practice TI - A clinical care pathway to improve the acute care of patients with glioma UR - ://WOS:000439196300003 VL - 3 ID - 761700 ER - TY - JOUR AB - ObjectivesSARS-CoV2 infection leads to a concomitant pulmonary inflammation. This inflammation is supposed to be the main driver in the pathogenesis of lung failure (Acute Respiratory Distress Syndrome) in COVID-19. Objective of this study is to evaluate the efficacy and safety of a single dose treatment with Tocilizumab in patients with severe COVID-19.We hypothesize that Tocilizumab slows down the progression of SARS-CoV-2 induced pneumonia and inflammation. We expect an improvement in pulmonary function compared to placebo-treated patients.Desirable outcomes would be that tocilizumab reduces the number of days that patients are dependent on mechanical ventilation and reduces the invasiveness of breathing assistance. Furthermore, this treatment might result in fewer admissions to intensive care units.Next to these efficacy parameters, safety of a therapy with Tocilizumab in COVID-19 patients has to be monitored closely, since immunosuppression could lead to an increased rate of bacterial infections, which could negatively influence the patient's outcome.Trial designMulticentre, prospective, 2-arm randomised (ratio 1:1), double blind, placebo-controlled trial with parallel group design. Participants: Inclusion criteria 1.Proof of SARS-CoV2 (Symptoms and positive polymerase chain reaction (PCR))Severe respiratory failure: Ambient air SpO(2) <= 92% orNeed of >= 6l O-2/min orNIV (non-invasive ventilation) orIMV (invasive mechanical ventilation)Age >= 18 yearsExclusion criteria 1. Non-invasive or invasive mechanical ventilation >= 48 hours 2. Pregnancy or breast feeding 3. Liver injury or failure (AST/ALT >= 5x ULN) 4.Leukocytes < 2 x 10(3)/mu l 5.Thrombocytes < 50 x 10(3)/mu l 6. Severe bacterial infection (PCT > 3ng/ml) 7. Acute or chronic diverticulitis 8. Immunosuppressive therapy (e.g. mycophenolate, azathioprine, methotrexate, biologicals, prednisolone >10mg/d; exceptions are: prednisolone <= 10mg/d, sulfasalazine or hydroxychloroquine) 9. Known active or chronic tuberculosis 10. Known active or chronic viral hepatitis 11. Known allergic reactions to tocilizumab or its ingredients 12. Life expectation of less than 1 year (independent of COVID-19) 13. Participation in any other interventional clinical trial within the last 30 days before the start of this trial 14. Simultaneous participation in other interventional trials (except for participation in COVID-19 trials) which could interfere with this trial; simultaneous participation in registry and diagnostic trials is allowed 15. Failure to use one of the following safe methods of contraception: female condoms, diaphragm or coil, each used in combination with spermicides; intra-uterine device; hormonal contraception in combination with a mechanical method of contraception.The data collection of the primary follow up (28 days after randomisation) takes place during the hospital stay. Subsequently, a telephone interview on the quality of life is conducted after 6 and 12 months. Participants will be recruited from inpatients at ten medical centres in Germany.Intervention and comparatorIntervention arm: Application of 8mg/kg body weight (BW) Tocilizumab i.v. once immediately after randomisation (12 mg/kg for patients with <30kg BW; total dose should not exceed 800 mg) AND conventional treatment.Control arm: Placebo (NaCl) i.v. once immediately after randomisation AND conventional treatment.Main outcomesPrimary endpoint is the number of ventilator free days (d) (VFD) in the first 28 days after randomisation. Non-invasive ventilation (NIV), Invasive mechanical ventilation (IMV) and extracorporeal membrane oxygenation (ECMO) are defined as ventilator days. VFD's are counted as zero if the patient dies within the first 28 days.RandomisationThe randomisation code will be generated by the CTU (Clinical Trials Unit, ZKS Freiburg) using the following procedure to ensure that treatment assignment is unbiased and concealed from patients and investigator staff. Randomisation will be stratified by centre and will be performed in blocks of variable length in a ratio of 1:1 within each centre. The block lengths will be documented separately and will not be disclosed to the investigators. The randomisation code will be produced by validated programs based on the Statistical Analysis System (SAS).Blinding (masking)Participants, caregivers, and the study team assessing the outcomes are blinded to group assignment.Numbers to be randomised (sample size)100 participants will be randomised to each group (thus 200 participants in total).Trial StatusProtocol Version: V 1.2, 16.04.2020. Recruitment began 27th April 2020 and is anticipated to be completed by December 2020.Trial registrationThe trial was registered before trial start in trial registries (EudraCT: No. 2020-001408-41, registered 21st April 2020, and DRKS: No. DRKS00021238, registered 22nd April 2020).Full protoco lThe full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. AD - [Rilinger, Jonathan; Duerschmied, Daniel; Supady, Alexander; Bode, Christoph; Staudacher, Dawid L.; Wengenmayer, Tobias] Univ Freiburg, Fac Med, Med Ctr, Dept Med 3,Interdisciplinary Med Intens Care, Hugstetterstr 55, D-79106 Freiburg, Germany. [Rilinger, Jonathan; Duerschmied, Daniel; Supady, Alexander; Bode, Christoph; Staudacher, Dawid L.; Wengenmayer, Tobias] Univ Freiburg, Dept Cardiol & Angiol 1, Heart Ctr Freiburg Univ, Fac Med, Freiburg, Germany. [Kern, Winfried V.] Univ Freiburg, Div Infect Dis, Dept Med 2, Med Ctr,Fac Med, Freiburg, Germany. Rilinger, J (corresponding author), Univ Freiburg, Fac Med, Med Ctr, Dept Med 3,Interdisciplinary Med Intens Care, Hugstetterstr 55, D-79106 Freiburg, Germany.; Rilinger, J (corresponding author), Univ Freiburg, Dept Cardiol & Angiol 1, Heart Ctr Freiburg Univ, Fac Med, Freiburg, Germany. jonathan.rilinger@uniklinik-freiburg.de AN - WOS:000540317300016 AU - Rilinger, J. AU - Kern, W. V. AU - Duerschmied, D. AU - Supady, A. AU - Bode, C. AU - Staudacher, D. L. AU - Wengenmayer, T. C7 - 470 DA - Jun DO - 10.1186/s13063-020-04447-3 J2 - Trials KW - COVID-19 Randomised controlled trial protocol Tocilizumab IL-6-Rezeptor blockade Ventilator free days Inflammation Pneumonia SARS-CoV2 Medicine, Research & Experimental LA - English M1 - 1 M3 - Letter N1 - ISI Document Delivery No.: LY1YM Times Cited: 8 Cited Reference Count: 0 Rilinger, Jonathan Kern, Winfried V. Duerschmied, Daniel Supady, Alexander Bode, Christoph Staudacher, Dawid L. Wengenmayer, Tobias Duerschmied, Daniel/K-8182-2015 Duerschmied, Daniel/0000-0001-5249-4012 German Federal Ministry of Education and Research (BMBF - Bundesministerium fur Bildung und Forschung)Federal Ministry of Education & Research (BMBF) Funding for this project has been requested at the German Federal Ministry of Education and Research (BMBF - Bundesministerium fur Bildung und Forschung). The funding does and will not have an influence on the design of the study, collection, analysis and interpretation of data and in writing the manuscript besides financial support. 8 3 BMC LONDON TRIALS PY - 2020 SP - 3 ST - A prospective, randomised, double blind placebo-controlled trial to evaluate the efficacy and safety of tocilizumab in patients with severe COVID-19 pneumonia (TOC-COVID): A structured summary of a study protocol for a randomised controlled trial T2 - Trials TI - A prospective, randomised, double blind placebo-controlled trial to evaluate the efficacy and safety of tocilizumab in patients with severe COVID-19 pneumonia (TOC-COVID): A structured summary of a study protocol for a randomised controlled trial UR - ://WOS:000540317300016 VL - 21 ID - 761435 ER - TY - JOUR AB - OBJECTIVE The authors sought to investigate the incidence and predictors of venous thromboembolic events (VTEs) after craniotomy for tumor resection, which are not well established, and the efficacy of and risks associated with VTE chemoprophylaxis, which remains controversial. METHODS The authors investigated the incidence of VTEs in a consecutive series of patients presenting to the authors' institution for resection of an intracranial lesion between 2012 and 2017. Information on patient and tumor characteristics was collected and independent predictors of VTEs were determined using stepwise multivariate logistic regression analysis. Review of the literature was performed by searching MEDLINE using the keywords "venous thromboembolism," "deep venous thrombosis," "pulmonary embolism," "craniotomy," and "brain neoplasms." RESULTS There were 1622 patients included for analysis. A small majority of patients were female (52.6%) and the mean age of the cohort was 52.9 years (SD 15.8 years). A majority of intracranial lesions were intraaxial (59.3%). The incidence of VTEs was 3.0% and the rates of deep venous thromboses and pulmonary emboli were 2.3% and 0.9%, respectively. On multivariate analysis, increasing patient age (unit OR 1.02, 95% CI 1.00-1.05; p = 0.018), history of VTE (OR 7.26, 95% CI 3.24-16.27; p < 0.001), presence of motor deficit (OR 2.64, 95% CI 1.43-4.88; p = 0.002), postoperative intracranial hemorrhage (OR 4.35, 95% CI 1.51-12.55; p < 0.001), and prolonged intubation or reintubation (OR 3.27, 95% CI 1.28-8.32; p < 0.001) were independently associated with increased odds of a VTE. There were 192 patients who received VTE chemoprophylaxis (11.8%); the mean postoperative day of chemoprophylaxis initiation was 4.6 (SD 3.8). The incidence of VTEs was higher in patients receiving chemoprophylaxis than in patients not receiving chemoprophylaxis (8.3% vs 2.2%; p < 0.001). There were 30 instances of clinically significant postoperative hemorrhage (1.9%), with only 1 hemorrhage occurring after initiation of VTE chemoprophylaxis (0.1%). CONCLUSIONS The study results show the incidence and predictors of VTEs after craniotomy for tumor resection in this patient population. The incidence of VTE within this cohort appears low and comparable to that observed in other institutional series, despite the lack of routine prophylactic anticoagulation in the postoperative setting. AD - I.F. Parney, Department of Neurological Surgery, Mayo Clinic, Rochester, MN, United States AU - Rinaldo, L. AU - Brown, D. A. AU - Bhargav, A. G. AU - Rusheen, A. E. AU - Naylor, R. M. AU - Gilder, H. E. AU - Monie, D. D. AU - Youssef, S. J. AU - Parney, I. F. DB - Embase Medline DO - 10.3171/2018.7.JNS181175 KW - anticoagulant agent heparin low molecular weight heparin adult aged anticoagulant therapy article cancer surgery cohort analysis craniotomy extubation female human incidence intracranial tumor length of stay major clinical study male postoperative hemorrhage priority journal pulmonary embolism response team retrospective study systematic review venous thromboembolism LA - English M1 - 1 M3 - Article N1 - L2004484985 2020-01-21 2020-01-24 PY - 2020 SN - 1933-0693 0022-3085 SP - 10-21 ST - Venous thromboembolic events in patients undergoing craniotomy for tumor resection: Incidence, predictors, and review of literature T2 - Journal of Neurosurgery TI - Venous thromboembolic events in patients undergoing craniotomy for tumor resection: Incidence, predictors, and review of literature UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004484985&from=export http://dx.doi.org/10.3171/2018.7.JNS181175 VL - 132 ID - 760613 ER - TY - JOUR AB - A Stroke Unit is a hospital infrastructure which operates as an acute and subacute therapeutic. Simultaneously, stroke units serve as logistic centers to organise stroke patient management in a chain of care. The effectiveness of stroke unit treatment has been proven by trials. The cornerstones of efficacy are the exclusive treatment of stroke patients in this unit, the treatment by a multi-professional team and the combination of peracute and acute therapy with early mobilisation and rehabilitation. A meta-analysis showed that patients treated in Stroke Units had survived significantly more often (21% less deaths) and were significantly less frequently disabled (13% less dependency) compared to patients not treated on stroke units. Ten years later, these benefits are still measurable. Stroke units provide an ideal basis for the development of expertise in performing thrombolytic therapy. There is a clear correlation between higher numbers of fibrinolytic treatment per year and better outcomes in particular lower mortality. This result was not only found in Germany but also in other countries. Improved organisation and smooth infrastructure of stroke units lead to higher numbers of patients, enhanced expertise and better treatment in general. Classical benchmarking of certified German stroke units is provided with the help of the data bank of the Cooperative of German Stroke Registries. A continuously improved quality management according to consented quality indicators is also warranted. 200 certified Stroke Units will become active in Germany in the near future. This means that actually at least 60% of all stroke patients will be treated in these Stroke Units. AD - [Ringelstein, E. B.; Busse, O.; Ritter, M. A.] Univ Klinikum Munster, Neurol Klin & Poliklin, D-48149 Munster, Germany. Ringelstein, EB (corresponding author), Univ Klinikum Munster, Neurol Klin & Poliklin, Albert Schweitzer Str 33, D-48149 Munster, Germany. ringels@uni-muenster.de AN - WOS:000285528900008 AU - Ringelstein, E. B. AU - Busse, O. AU - Ritter, M. A. J2 - Nervenheilkunde KW - Stroke Unit acute stroke chain of case clinical pathways quality management ACUTE ISCHEMIC-STROKE CARE IMPLEMENTATION COMPONENTS Clinical Neurology Psychiatry LA - German M1 - 12 M3 - Review N1 - ISI Document Delivery No.: 697QA Times Cited: 3 Cited Reference Count: 29 Ringelstein, E. B. Busse, O. Ritter, M. A. 3 0 SCHATTAUER GMBH-VERLAG MEDIZIN NATURWISSENSCHAFTEN STUTTGART NERVENHEILKUNDE PY - 2010 SN - 0722-1541 SP - 836-842 ST - Concepts of Stroke Units in Germany and Europe T2 - Nervenheilkunde TI - Concepts of Stroke Units in Germany and Europe UR - ://WOS:000285528900008 VL - 29 ID - 761886 ER - TY - JOUR AB - BACKGROUND: The aim of this nested analysis was to identify the major components of stroke centers and other facilities actually available for acute stroke patients in hospitals of Germany and Austria. METHODS: This analysis is part of a much larger European Stroke Facility Survey of 886 hospitals treating stroke patients all over Europe initiated by the European Stroke Initiative. Three levels of stroke care were predefined: comprehensive stroke centers (CSC), primary stroke centers (PSC) and a minimum level required for any hospital ward (AHW) admitting stroke patients. Hospitals providing even less than that were indicated in the 'none' category. RESULTS: The present survey was conducted in 178 (166 and 12) German and Austrian hospitals which returned the questionnaire (41% response rate). They treated a total of 54,257 acute stroke patients per year (25% of all strokes in Germany and Austria), with a mean of 376 patients per year per hospital. 2,168 patients were given recombinant tissue plasminogen activator (4.7%), a proportion much higher than the pan-European average, but strongly dependent on the level of the facility considered (range 7.5-1.3%). Criteria for CSC were met in 13 hospitals (7.3%), for PSC in 15 (8.4%) and for AHW in 85 (47.7%). The minimum level required for AHW was not met in 65 hospitals (36.5%). 15.7% of German and Austrian hospitals provide stroke center facilities at the CSC or PSC level, as compared with 8.5% in Europe. A 24-hour availability of a stroke-trained physician was met by 100% of CSC, 73% of PSC, 85% of AHW and by 62% at the 'none' level of care. At the levels of CSC and PSC, a 100% availability was achieved for multidisciplinary stroke team, stroke-trained nurses, in-house emergency department, physiotherapy and speech therapy within 2 days, 24-hour brain CT and CT or MR angiography, as well as for transesophageal echocardiography and automated 24-hour monitoring of vital parameters. Nearly all these hospitals had training programs, stroke pathways, thrombolysis protocols and prevention procedures in place for the acute care of stroke patients. CONCLUSIONS: This survey shows that the minimum level of care is met in Germany and Austria in 63% of hospitals treating stroke patients, whereas the European average is 48.6%. However, the lack of stroke center coverage should encourage health policy decision makers to further improve the infrastructure for acute stroke care in order to make stroke centers available to every stroke victim. AD - University Hospital Münster, Department of Neurology, Albert-Schweitzer-Strasse 33, Münster, Germany. ringels@uni-muenster.de AN - 19039217 AU - Ringelstein, E. B. AU - Meckes-Ferber, S. AU - Hacke, W. AU - Kaste, M. AU - Brainin, M. AU - Leys, D. DO - 10.1159/000177922 DP - NLM ET - 2008/11/29 J2 - Cerebrovascular diseases (Basel, Switzerland) KW - Austria Germany Health Services Accessibility *Health Surveys Hospital Units/*statistics & numerical data Humans Patient Care Team Stroke/*therapy LA - eng M1 - 2 N1 - 1421-9786 Ringelstein, E Bernd Meckes-Ferber, Stefanie Hacke, Werner Kaste, Markku Brainin, Michael Leys, Didier European Stroke Initiative executive committe Journal Article Multicenter Study Switzerland Cerebrovasc Dis. 2009;27(2):138-45. doi: 10.1159/000177922. Epub 2008 Nov 28. PY - 2009 SN - 1015-9770 SP - 138-45 ST - European Stroke Facilities Survey: the German and Austrian perspective T2 - Cerebrovasc Dis TI - European Stroke Facilities Survey: the German and Austrian perspective VL - 27 ID - 760453 ER - TY - JOUR AB - Background: The aim of this nested analysis was to identify the major components of stroke centers and other facilities actually available for acute stroke patients in hospitals of Germany and Austria. Methods: This analysis is part of a much larger European Stroke Facility Survey of 886 hospitals treating stroke patients all over Europe initiated by the European Stroke Initiative. Three levels of stroke care were predefined: comprehensive stroke centers (CSC), primary stroke centers (PSC) and a minimum level required for any hospital ward (AHW) admitting stroke patients. Hospitals providing even less than that were indicated in the 'none' category. Results: The present survey was conducted in 178 ( 166 and 12) German and Austrian hospitals which returned the questionnaire (41% response rate). They treated a total of 54,257 acute stroke patients per year (25% of all strokes in Germany and Austria), with a mean of 376 patients per year per hospital. 2,168 patients were given recombinant tissue plasminogen activator (4.7%), a proportion much higher than the pan-European average, but strongly dependent on the level of the facility considered (range 7.5-1.3%). Criteria for CSC were met in 13 hospitals (7.3%), for PSC in 15 (8.4%) and for AHW in 85 (47.7%). The minimum level required for AHW was not met in 65 hospitals (36.5%). 15.7% of German and Austrian hospitals provide stroke center facilities at the CSC or PSC level, as compared with 8.5% in Europe. A 24-hour availability of a stroke-trained physician was met by 100% of CSC, 73% of PSC, 85% of AHW and by 62% at the 'none' level of care. At the levels of CSC and PSC, a 100% availability was achieved for multidisciplinary stroke team, stroke-trained nurses, in-house emergency department, physiotherapy and speech therapy within 2 days, 24-hour brain CT and CT or MR angiography, as well as for transesophageal echocardiography and automated 24-hour monitoring of vital parameters. Nearly all these hospitals had training programs, stroke pathways, thrombolysis protocols and prevention procedures in place for the acute care of stroke patients. Conclusions: This survey shows that the minimum level of care is met in Germany and Austria in 63% of hospitals treating stroke patients, whereas the European average is 48.6%. However, the lack of stroke center coverage should encourage health policy decision makers to further improve the infrastructure for acute stroke care in order to make stroke centers available to every stroke victim. Copyright (C) 2008 S. Karger AG, Basel AD - [Ringelstein, E. Bernd] Univ Munster, Munster, Germany. [Meckes-Ferber, Stefanie] Novo Nordisk, Mainz, Germany. [Hacke, Werner] Heidelberg Univ, Heidelberg, Germany. [Kaste, Markku] Univ Helsinki, Helsinki, Finland. [Brainin, Michael] Danube Univ, Krems, Austria. [Leys, Didier] Univ Lille, Lille, France. Ringelstein, EB (corresponding author), Univ Hosp Munster, Dept Neurol, Albert Schweitzer Str 33, DE-48149 Munster, Germany. ringels@uni-muenster.de AN - WOS:000262547500006 AU - Ringelstein, E. B. AU - Meckes-Ferber, S. AU - Hacke, W. AU - Kaste, M. AU - Brainin, M. AU - Leys, D. AU - European Stroke Initiative, Eusi DO - 10.1159/000177922 J2 - Cerebrovasc. Dis. KW - Stroke units Organized acute stroke care European Stroke Initiative stroke facilities survey ACUTE ISCHEMIC-STROKE UNIT CARE IMPLEMENTATION QUALITY RECOMMENDATIONS MANAGEMENT COMPONENTS BRAIN COSTS LEVEL Clinical Neurology Peripheral Vascular Disease LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 395TX Times Cited: 24 Cited Reference Count: 32 Ringelstein, E. Bernd Meckes-Ferber, Stefanie Hacke, Werner Kaste, Markku Brainin, Michael Leys, Didier LEYS, Didier/G-2955-2016 LEYS, Didier/0000-0003-4408-4392; Kaste, Markku/0000-0001-6557-6412 24 0 6 KARGER BASEL CEREBROVASC DIS PY - 2009 SN - 1015-9770 SP - 138-145 ST - European Stroke Facilities Survey: The German and Austrian Perspective T2 - Cerebrovascular Diseases TI - European Stroke Facilities Survey: The German and Austrian Perspective UR - ://WOS:000262547500006 VL - 27 ID - 761901 ER - TY - JOUR AB - Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients. AD - 1 University of Pittsburgh, Pittsburgh, PA, USA. 2 Emory University, Atlanta, GA, USA. 3 The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 4 University of Miami of Palm Beach Regional Campus/JFK Hospital, Atlantis, FL, USA. 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 6 University of Minnesota, Minneapolis, MN, USA. 7 The Ohio State University Wexner Medical Center, Columbus, OH, USA. 8 University of Buffalo, Buffalo, NY, USA. 9 Abbott Northwestern Hospital, Minneapolis, MN, USA. 10 Temple University, Philadelphia, PA, USA. 11 Piedmont Heart Institute, Atlanta, GA, USA. 12 University of Virginia, Charlottesville, VA, USA. 13 Oklahoma Heart Institute, Tulsa, OK, USA. 14 Wayne State University, Detroit, MI, USA. 15 Michigan State University, East Lansing, MI, USA. 16 University of Pennsylvania, Philadelphia, PA, USA. 17 Saint Louis University, St. Louis, MO, USA. 18 Henry Ford Hospital, Detroit, MI, USA. 19 New York University, New York, NY, USA. 20 University of Kentucky, Lexington, KY, USA. 21 Cedars-Sinai Medical Center, Los Angeles, CA, USA. 22 University of California, Los Angeles, CA, USA. AN - 31185730 AU - Rivera-Lebron, B. AU - McDaniel, M. AU - Ahrar, K. AU - Alrifai, A. AU - Dudzinski, D. M. AU - Fanola, C. AU - Blais, D. AU - Janicke, D. AU - Melamed, R. AU - Mohrien, K. AU - Rozycki, E. AU - Ross, C. B. AU - Klein, A. J. AU - Rali, P. AU - Teman, N. R. AU - Yarboro, L. AU - Ichinose, E. AU - Sharma, A. M. AU - Bartos, J. A. AU - Elder, M. AU - Keeling, B. AU - Palevsky, H. AU - Naydenov, S. AU - Sen, P. AU - Amoroso, N. AU - Rodriguez-Lopez, J. M. AU - Davis, G. A. AU - Rosovsky, R. AU - Rosenfield, K. AU - Kabrhel, C. AU - Horowitz, J. AU - Giri, J. S. AU - Tapson, V. AU - Channick, R. C2 - Pmc6714903 DA - Jan-Dec DO - 10.1177/1076029619853037 DP - NLM ET - 2019/06/13 J2 - Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis KW - Acute Disease Consensus Follow-Up Studies Humans Pulmonary Embolism/*diagnosis/diagnostic imaging/*therapy Risk Assessment acute pulmonary embolism catheter-directed thrombolysis chronic thromboembolic pulmonary hypertension embolectomy inferior vena cava filter pulmonary embolism response team systemic thrombolysis venous thromboembolism of interest with respect to the research, authorship, and/or publication of this article. LA - eng N1 - 1938-2723 Rivera-Lebron, Belinda Orcid: 0000-0002-7842-671x McDaniel, Michael Ahrar, Kamran Alrifai, Abdulah Dudzinski, David M Fanola, Christina Blais, Danielle Janicke, David Melamed, Roman Mohrien, Kerry Rozycki, Elizabeth Ross, Charles B Klein, Andrew J Rali, Parth Teman, Nicholas R Yarboro, Leoara Ichinose, Eugene Sharma, Aditya M Bartos, Jason A Elder, Mahir Keeling, Brent Palevsky, Harold Naydenov, Soophia Sen, Parijat Amoroso, Nancy Rodriguez-Lopez, Josanna M Davis, George A Rosovsky, Rachel Rosenfield, Kenneth Kabrhel, Christopher Horowitz, James Giri, Jay S Tapson, Victor Channick, Richard PERT Consortium Journal Article Practice Guideline Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029619853037. doi: 10.1177/1076029619853037. PY - 2019 SN - 1076-0296 (Print) 1076-0296 SP - 1076029619853037 ST - Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium T2 - Clin Appl Thromb Hemost TI - Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium VL - 25 ID - 760111 ER - TY - JOUR AB - Pulmonary embolism (PE) is a major source of morbidity and mortality. The presentation of acute PE varies, ranging from few or no symptoms to sudden death. Patient outcome depends upon how well the right ventricle can sustain the increased afterload caused by the embolic burden. Careful risk stratification is critical and the pulmonary embolism response team (PERT) concept offers a rapid and multidisciplinary approach. Anticoagulation is essential unless contraindicated; thrombolysis, surgical embolectomy, and catheter-directed approaches are also available. Clinical consensus statements have been published which offer a guide to PE management, but areas remain for which the evidence is inadequate. While the management of low-risk and high-risk patients is more straight-forward, optimal management of intermediate-risk patients remains controversial. In this document, we offer a case-based approach to PE management, beginning with diagnosis and risk stratification, followed by therapeutic alternatives, and finishing with follow-up care. AU - Rivera-Lebron, B. N. AU - Rali, P. M. AU - Tapson, V. F. DB - Medline DO - 10.1016/j.chest.2020.07.065 KW - adult anticoagulation blood clot lysis catheter chronic thromboembolic pulmonary hypertension consensus embolectomy follow up heart afterload heart right ventricle high risk patient human intermediate risk patient morbidity mortality pulmonary embolism response team review risk assessment sudden death LA - English M3 - Article in Press N1 - L632548428 2020-08-13 PY - 2020 SN - 1931-3543 ST - How I Do It: The PERT Concept: A Step-by-Step Approach to Managing PE T2 - Chest TI - How I Do It: The PERT Concept: A Step-by-Step Approach to Managing PE UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632548428&from=export http://dx.doi.org/10.1016/j.chest.2020.07.065 ID - 760551 ER - TY - JOUR AU - Rivera-Lebron, B. N. AU - Rali, P. M. AU - Tapson, V. F. DA - 2020/08/09 08/09 DB - Europe PubMed Central DO - 10.1016/j.chest.2020.07.065 PY - 2020 SN - 0012-3692 ST - The PERT Concept: A Step-by-Step Approach to Managing Pulmonary Embolism T2 - Chest TI - The PERT Concept: A Step-by-Step Approach to Managing Pulmonary Embolism UR - http://europepmc.org/article/MED/32758561 ID - 762035 ER - TY - JOUR AB - Background: VTE is a common complication of hospitalization and is associated with significant morbidity and mortality. The use of appropriate thromboprophylaxis can significantly reduce the risk of VTE but remains underutilized. In England, a comprehensive approach to VTE prevention was launched in 2010. This study aimed to evaluate the impact of the implementation of the national program in a single center. Methods: A prospective quality improvement program was established at King's College Hospital NHS Foundation Trust in 2010. The multidisciplinary thrombosis team launched mandatory documented VTE risk assessment and updated thromboprophylaxis guidance. Root cause analysis of hospital-associated thrombosis (HAT) was implemented to identify system failures, enable outcome measurement, and facilitate learning to improve VTE prevention practice. The key outcomes were the incidence of HAT and the proportion of events preventable with appropriate thromboprophylaxis. Results: Documented VTE risk assessment improved from < 40% to > 90% in the first 9 months. Four hundred twenty-five episodes of HAT were identified over 2 years. A significant reduction in the incidence of HAT was observed following sustained achievement of 90% risk assessment (risk ratio, 0.88; 95% CI, 0.74-0.98; P = .014). The proportion of HAT attributable to inadequate thromboprophylaxis fell significantly from 37.5% to 22.4% (P = .005). Conclusions: Mandatory VTE risk assessment can significantly reduce preventable HAT and thereby improve patient safety. AD - [Roberts, Lara N.; Porter, Gayle; Bonner, Lynda; Patel, Raj K.; Arya, Roopen] Kings Coll Hosp NHS Fdn Trust, Dept Haematol Med, Kings Thrombosis Ctr, London SE5 9RS, England. [Barker, Richard D.; Yorke, Richard] Kings Coll Hosp NHS Fdn Trust, Dept Informat & Commun Technol, London SE5 9RS, England. [Barker, Richard D.] Kings Coll Hosp NHS Fdn Trust, Div Asthma Allergy & Lung Biol, London SE5 9RS, England. Roberts, LN (corresponding author), Kings Coll Hosp NHS Fdn Trust, Dept Haematol Med, Kings Thrombosis Ctr, Denmark Hill, London SE5 9RS, England. lara.roberts@nhs.net AN - WOS:000326162600033 AU - Roberts, L. N. AU - Porter, G. AU - Barker, R. D. AU - Yorke, R. AU - Bonner, L. AU - Patel, R. K. AU - Arya, R. DA - Oct DO - 10.1378/chest.13-0267 J2 - Chest KW - DEEP-VEIN THROMBOSIS VENOUS THROMBOEMBOLISM PROPHYLAXIS PULMONARY-EMBOLISM ASSESSMENT MODEL THROMBOPROPHYLAXIS POPULATION Critical Care Medicine Respiratory System LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: 241JJ Times Cited: 21 Cited Reference Count: 22 Roberts, Lara N. Porter, Gayle Barker, Richard D. Yorke, Richard Bonner, Lynda Patel, Raj K. Arya, Roopen Arya, Roopen/0000-0001-5630-7990 23 1 8 AMER COLL CHEST PHYSICIANS NORTHBROOK CHEST PY - 2013 SN - 0012-3692 SP - 1276-1281 ST - Comprehensive VTE Prevention Program Incorporating Mandatory Risk Assessment Reduces the Incidence of Hospital-Associated Thrombosis T2 - Chest TI - Comprehensive VTE Prevention Program Incorporating Mandatory Risk Assessment Reduces the Incidence of Hospital-Associated Thrombosis UR - ://WOS:000326162600033 VL - 144 ID - 761797 ER - TY - JOUR AB - OBJECTIVES: To assess public knowledge of stroke and transient ischaemic attack symptoms, and awareness of the content of a recent national health campaign. DESIGN: Interviewer-administered questionnaire. SETTING: Leicester, UK. PARTICIPANTS: 1300 members of a mixed urban/rural, multiethnic population that was sampled in public areas, places of work and schools. MAIN OUTCOME MEASURES: Knowledge of the terms 'stroke', 'stroke risk factors' and the 'FAST campaign'. Awareness of stroke symptoms, and ability to distinguish from non-stroke symptoms. RESULTS: 70% of the public surveyed were aware of the FAST campaign, with highest penetration in the female, older and white population. Overall, high levels of awareness of FAST symptoms (facial weakness 89%, arm weakness 83%, speech problems 91%) as warning signs of stroke were observed, though significantly lower levels were reported in the black and minority ethnic population. However, poor recognition of other important signs, including leg weakness (57%) and visual loss (44%) were seen, and significantly more men were likely to report non-specific symptoms as being associated with stroke. CONCLUSIONS: The survey has confirmed the effectiveness of the recent FAST campaign in raising public awareness of stroke and stroke warning signs, though poorest penetration was seen in the black and minority ethnic population. However, important stroke symptoms, including leg weakness and visual loss, were poorly recognised. This may lead to delays in presentation, specialist assessment and secondary prevention, and such stroke warning signs should be included in future public health campaigns. AD - Department of Cardiovascular Sciences, University of Leicester, Leicester, UK. AN - 22764171 AU - Robinson, T. G. AU - Reid, A. AU - Haunton, V. J. AU - Wilson, A. AU - Naylor, A. R. DA - Jun DO - 10.1136/emermed-2012-201471 DP - NLM ET - 2012/07/06 J2 - Emergency medicine journal : EMJ KW - Adolescent Adult Aged Aged, 80 and over *Awareness Child Ethnic Groups/psychology/statistics & numerical data Female Health Education *Health Knowledge, Attitudes, Practice Hospital Rapid Response Team Humans Male Middle Aged Minority Groups/psychology/statistics & numerical data Patient Education as Topic Risk Factors Stroke/*diagnosis/*psychology Surveys and Questionnaires Sweden Time Factors United Kingdom Young Adult Fast neurology nursing home care primary care stroke symptom awareness thrombolysis transient ischaemic attack LA - eng M1 - 6 N1 - 1472-0213 Robinson, Thompson G Reid, Ann Haunton, Victoria Joanna Wilson, Andrew Naylor, A Ross PB-PG-0906-10335/Department of Health/United Kingdom Journal Article Research Support, Non-U.S. Gov't England Emerg Med J. 2013 Jun;30(6):467-71. doi: 10.1136/emermed-2012-201471. Epub 2012 Jul 4. PY - 2013 SN - 1472-0205 SP - 467-71 ST - The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? T2 - Emerg Med J TI - The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms? VL - 30 ID - 760497 ER - TY - JOUR AB - Stroke units reduce death and disability through the provision of specialist multidisciplinary care for diagnosis, emergency treatments, normalisation of homeostasis, prevention of complications, rehabilitation and secondary prevention. All stroke patients can benefit from provision of high-quality basic medical care and some need high impact specific treatments, such as thrombolysis, that are often time dependent. A standard patient pathway should include assessment of neurological impairment, vascular risk factors, swallowing, fluid balance and nutrition, cognitive function, communication, mood disorders, continence, activities of daily living and rehabilitation goals. Good communication and shared decision making with patients and their families are key to high-quality stroke care. Patients with mild or moderate disability, who are medically stable, can continue rehabilitation at home with early supported discharge teams rather than needing a prolonged stay in hospital. National clinical guidelines and prospective audits are integral to monitoring and developing stroke services in the UK. AD - [Rodgers, Helen] Newcastle Univ, Stroke Care, Newcastle Upon Tyne, Tyne & Wear, England. [Rodgers, Helen; Price, Chris] Northumbria Healthcare NHS Fdn Trust, Newcastle Upon Tyne, Tyne & Wear, England. [Price, Chris] Newcastle Univ, Stroke Med, Newcastle Upon Tyne, Tyne & Wear, England. Rodgers, H (corresponding author), Newcastle Univ, Stroke Res Grp, Inst Neurosci, 3-4 Claremont Terrace, Newcastle Upon Tyne NE2 4AE, Tyne & Wear, England. helen.rodgers@newcastle.ac.uk AN - WOS:000398884700019 AU - Rodgers, H. AU - Price, C. DA - Apr DO - 10.7861/clinmedicine.17-2-173 J2 - Clin. Med. KW - Cerebrovascular disease early supported discharge multidisciplinary care rehabilitation stroke unit HYPERGLYCEMIA DYSPHAGIA SERVICES BALANCE Medicine, General & Internal LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: ER5ZP Times Cited: 7 Cited Reference Count: 33 Rodgers, Helen Price, Chris Price, Christopher/0000-0003-3566-3157 9 0 15 ROY COLL PHYS LONDON EDITORIAL OFFICE LONDON CLIN MED PY - 2017 SN - 1470-2118 SP - 173-177 ST - Stroke unit care, inpatient rehabilitation and early supported discharge T2 - Clinical Medicine TI - Stroke unit care, inpatient rehabilitation and early supported discharge UR - ://WOS:000398884700019 VL - 17 ID - 761661 ER - TY - JOUR AB - Introduction: Both patients and their families have physical, emotional, social and spiritual needs to be assessed. Such needs have to be recorded so as to be able to set the therapeutic objectives, the outcomes review, and their further reassessment. The evaluation of these needs using common tools makes it easier to communicate information among the wide range of professionals involved in the care process. Objective: To build up a consensus on tools for multidimensional assessment in advanced cancer patients to be included/used in any medical evaluation made by the Palliative Care Team of the Catalan Institute of Oncology. Materials and methods: Consensus among the participants through group discussion. The group consisted of a representative sample of the 3 participating centres: five physicians, four psycho-oncologists and four social workers. The whole group worked full-time in palliative care teams and had wide experience. The selected instruments were analysed according to the evidence and from previous literature, as well as from the team's daily experience in their use. Results and conclusions: We define a set of tools for the assessment of the 3 domains explored: physical (history, performance status, dependency, symptoms and survival), emotional (emotional symptoms and spiritual and end-of-life issues) and social; with the percentage of agreement for each of them. (C) 2010 Sociedad Espanola de Cuidados Paliativos. Published by Elsevier Espana, S.L. All rights reserved. AD - [Garzon Rodriguez, Cristina; Martinez Losada, Emilio; Julia Torras, Joaquin; Gonzalez Barboteo, Jesus; Mate Mendez, Jorge; Ochoa Arnedo, Cristian; Fuentes Sanmartin, Sonia; Riquelme Olivares, Merce; Barbero Biedma, Elisabeth; Gil Moncayo, Francisco; Trelis Navarro, Jordi; Porta-Sales, Josep] Inst Catala Oncol, Serv Cuidados Paliat, Barcelona, Spain. [Rodriguez Morera, Anna; Lluch Salas, Jun] Inst Catala Oncol, Serv Cuidados Paliat, Girona, Spain. Rodriguez, CG (corresponding author), Inst Catala Oncol, Serv Cuidados Paliat, Barcelona, Spain. cgrodriguez@iconcologia.net AN - WOS:000298712700004 AU - Rodriguez, C. G. AU - Losada, E. M. AU - Torras, J. J. AU - Barboteo, J. G. AU - Mendez, J. M. AU - Arnedo, C. O. AU - Sanmartin, S. F. AU - Morera, A. R. AU - Salas, J. L. AU - Olivares, M. R. AU - Biedma, E. B. AU - Moncayo, F. G. AU - Navarro, J. T. AU - Porta-Sales, J. DA - Jul-Sep J2 - Med. Paliativa. KW - Palliative care Assessment Neoplasm NONSTEROIDAL ANTIINFLAMMATORY DRUGS CONFUSION ASSESSMENT METHOD CANCER-PATIENTS VENOUS THROMBOEMBOLISM PROGNOSTIC SCORE PROSPECTIVE VALIDATION SURVIVAL PREDICTION CAGE QUESTIONNAIRE PERFORMANCE SCALE NEEDS-ASSESSMENT Health Care Sciences & Services LA - Spanish M1 - 3 M3 - Article N1 - ISI Document Delivery No.: 871BN Times Cited: 0 Cited Reference Count: 85 Garzon Rodriguez, Cristina Martinez Losada, Emilio Julia Torras, Joaquin Gonzalez Barboteo, Jesus Mate Mendez, Jorge Ochoa Arnedo, Cristian Fuentes Sanmartin, Sonia Rodriguez Morera, Anna Lluch Salas, Jun Riquelme Olivares, Merce Barbero Biedma, Elisabeth Gil Moncayo, Francisco Trelis Navarro, Jordi Porta-Sales, Josep Navarro, Jose Tomas/K-7069-2014; Ochoa, Cristian/I-8060-2015 Navarro, Jose Tomas/0000-0001-9101-6013; Ochoa, Cristian/0000-0002-4508-0951 0 10 ARAN EDICIONES, S A MADRID MED PALIATIVA PY - 2011 SN - 1134-248X SP - 92-104 ST - Multidimensional assessment tool kit for doctors working in palliative care: the ICO-Tool Kit Project T2 - Medicina Paliativa TI - Multidimensional assessment tool kit for doctors working in palliative care: the ICO-Tool Kit Project UR - ://WOS:000298712700004 VL - 18 ID - 761848 ER - TY - JOUR AU - Rodríguez Chiaradía, D. A. AU - Cuttica, M. J. AU - Jimenez, D. DA - 2018/05/24 05/24 DB - Europe PubMed Central DO - 10.1016/j.arbres.2018.04.002 M1 - 1 PY - 2018 SN - 1579-2129 SP - 1-2 ST - The Role of the Pulmonologist in a Pulmonary Embolism Response Team (PERT): A Time to Come on Stage T2 - Arch Bronconeumol TI - The Role of the Pulmonologist in a Pulmonary Embolism Response Team (PERT): A Time to Come on Stage UR - http://europepmc.org/article/MED/29789172 VL - 55 ID - 761963 ER - TY - JOUR AB - IMPORTANCE: The use of technically variant segmental grafts are key in offering transplantation to increase organ availability. OBJECTIVE: To describe the use of segmental allograft in the current era of donor scarcity, minimizing vascular complications using innovative surgical techniques. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study from August 2007 to August 2012 at a university hospital. A total of 218 consecutive liver transplant patients were reviewed, and 69 patients (31.6%; 38 males and 31 females; mean age, 22.5 years) received segmental grafts from living donors or split/reduced-size grafts from deceased donors. MAIN OUTCOMES AND MEASURES: Graft type, vascular and biliary complications, and patient and graft survival. RESULTS: Of 69 segmental transplants, 47 were living donor liver transplants: 13 grafts (27.7%) were right lobes, 22 (46.8%) were left lobes, and 12 (25.5%) were left lateral segments. Twenty-two patients received deceased donor segmental grafts; of these, 11 (50.0%) were extended right lobes, 9 (40.9%) were left lateral segments, 1 (4.5%) was a right lobe, and 1 (4.5%) was a left lobe. Arterial anastomoses were done using 8-0 monofilament sutures in an interrupted fashion for living donor graft recipients and for pediatric patients. Most patients received a prophylactic dose of low-molecular-weight heparin for a week and aspirin indefinitely. There was no incidence of hepatic artery or portal vein thrombosis. Two patients developed hepatic artery stenosis and were treated with balloon angioplasty by radiology. Graft and patient survivals were 96% and 98%, respectively. CONCLUSIONS AND RELEVANCE: Use of segmental allografts is essential to offer timely transplantation and decrease waiting list mortality. Living donor liver transplants and segmental grafts from deceased donors are complementary. It is possible to have excellent outcomes combining a multidisciplinary team approach, technical expertise, routine use of anticoagulation, and strict patient and donor selection. AD - Section of Transplantation and Immunology, Department of Surgery, Yale University School of Medicine, Yale-New Haven Transplantation Center, New Haven, Connecticut. AN - 24284803 AU - Rodriguez-Davalos, M. I. AU - Arvelakis, A. AU - Umman, V. AU - Tanjavur, V. AU - Yoo, P. S. AU - Kulkarni, S. AU - Luczycki, S. M. AU - Schilsky, M. AU - Emre, S. DA - Jan DO - 10.1001/jamasurg.2013.3384 DP - NLM ET - 2013/11/29 J2 - JAMA surgery KW - Adolescent Adult Aged Child Child, Preschool Female Humans Infant Liver Transplantation/*adverse effects/*methods Male Middle Aged Quality Improvement Retrospective Studies Tissue and Organ Procurement/*methods Treatment Outcome Vascular Diseases/*etiology/*prevention & control Young Adult LA - eng M1 - 1 N1 - 2168-6262 Rodriguez-Davalos, Manuel I Arvelakis, Antonios Umman, Veysel Tanjavur, Vijayakumar Yoo, Peter S Kulkarni, Sanjay Luczycki, Stephen M Schilsky, Michael Emre, Sukru Journal Article United States JAMA Surg. 2014 Jan;149(1):63-70. doi: 10.1001/jamasurg.2013.3384. PY - 2014 SN - 2168-6254 SP - 63-70 ST - Segmental grafts in adult and pediatric liver transplantation: improving outcomes by minimizing vascular complications T2 - JAMA Surg TI - Segmental grafts in adult and pediatric liver transplantation: improving outcomes by minimizing vascular complications VL - 149 ID - 760460 ER - TY - JOUR AU - Rodriguez-Lopez, J. AU - Channick, R. DA - 2017/02/18 02/18 DB - Europe PubMed Central DO - 10.1055/s-0036-1597561 M1 - 1 PY - 2017 SN - 1069-3424 SP - 51-55 ST - The Pulmonary Embolism Response Team: What Is the Ideal Model? T2 - Semin Respir Crit Care Med TI - The Pulmonary Embolism Response Team: What Is the Ideal Model? UR - http://europepmc.org/article/MED/28208198 VL - 38 ID - 761906 ER - TY - JOUR AB - BACKGROUND: Care to patients with prosthetic joint infections (PJI) is provided after pluridisciplinary collaboration, in particular for complex presentations. Therefore, to carry out an audit in PJI justifies using pluridisciplinary criteria. We report an audit for hip or knee PJI, with emphasis on care homogeneity, length of hospital stay (LOS) and mortality. PATIENTS AND METHODS: Fifteen criteria were chosen for quality of care: 5 diagnostic tools, 5 therapeutic aspects, and 5 pluridisciplinary criteria. Among these, 6 were chosen: surgical bacterial samples, surgical strategy, pluridisciplinary discussion, antibiotic treatment, monitoring of antibiotic toxicity, and prevention of thrombosis. They were scored on a scale to 20 points. We included PJI diagnosed between 2010 and 2012 from 6 different hospitals. PJI were defined as complex in case of severe comorbid conditions or multi-drug resistant bacteria, or the need for more than 1 surgery. RESULTS: Eighty-two PJI were included, 70 of which were complex (85%); the median score was 15, with a significant difference among hospitals: from 9 to 17.5 points, P < 0.001. The median LOS was 17 days, and not related to the criterion score; 16% of the patients required intensive care and 13% died. The cure rate was 41%, lost to follow-up 33%, and therapeutic failure 13%. Cure was associated with a higher score than an unfavorable outcome in the univariate analysis (median [range]): 16 [9-18] vs 13 [4-18], P = 0.002. CONCLUSIONS: Care to patients with PJI was heterogeneous, our quality criteria being correlated to the outcome. AD - Infectiologie, centre hospitalier universitaire de Nice, hôpital de l'Archet 1, université de Nice Sophia-Antipolis, BP 3079, 06202 Nice, France. Electronic address: roger.pm@chu-nice.fr. Orthopédie-traumatologie, centre hospitalier de Cannes, Cannes, France. Bactériologie, centre hospitalier d'Antibes, Antibes, France. Bactériologie, centre hospitalier de Grasse, Grasse, France. Réanimation, bactériologie, orthopédie, centre hospitalier de Draguignan, Draguignan, France. Orthopédie-traumatologie, clinique St-Michel, Toulon, France. Infectiologie, centre hospitalier universitaire de Nice, hôpital de l'Archet 1, université de Nice Sophia-Antipolis, BP 3079, 06202 Nice, France. AN - 26026224 AU - Roger, P. M. AU - Tabutin, J. AU - Blanc, V. AU - Léotard, S. AU - Brofferio, P. AU - Léculé, F. AU - Redréau, B. AU - Bernard, E. DA - Jun DO - 10.1016/j.medmal.2015.04.003 DP - NLM ET - 2015/06/01 J2 - Medecine et maladies infectieuses KW - Aged Anti-Bacterial Agents/therapeutic use Arthritis, Infectious/drug therapy/epidemiology/etiology/surgery Combined Modality Therapy Comorbidity Debridement Device Removal Drug Resistance, Multiple, Bacterial Female France/epidemiology Hip Prosthesis/*adverse effects Humans Knee Prosthesis/*adverse effects Length of Stay/statistics & numerical data Male *Medical Audit Medicine Middle Aged *Patient Care Team Prosthesis-Related Infections/drug therapy/*epidemiology/prevention & control/surgery *Quality of Health Care Surgical Wound Infection/epidemiology/prevention & control/therapy Treatment Outcome Bone and joint infection Infection ostéo-articulaire Infection sur prothèse Prosthetic joint infection LA - eng M1 - 6 N1 - 1769-6690 Roger, P-M Tabutin, J Blanc, V Léotard, S Brofferio, P Léculé, F Redréau, B Bernard, E Réso-Infectio-Paca-Est Journal Article Multicenter Study France Med Mal Infect. 2015 Jun;45(6):229-36. doi: 10.1016/j.medmal.2015.04.003. Epub 2015 May 27. PY - 2015 SN - 0399-077x SP - 229-36 ST - Prosthetic joint infection: A pluridisciplinary multi-center audit bridging quality of care and outcome T2 - Med Mal Infect TI - Prosthetic joint infection: A pluridisciplinary multi-center audit bridging quality of care and outcome VL - 45 ID - 760263 ER - TY - JOUR AU - Roik, M. AU - Wretowski, D. AU - Łabyk, A. AU - Ciurzyński, M. AU - Kurnicka, K. AU - Lichodziejewska, B. AU - Pacho, S. AU - Potępa, M. AU - Szramowska, A. AU - Trzebicki, J. AU - Gołębiowski, M. AU - Pruszczyk, P. DA - 2018/12/31 12/31 DB - Europe PubMed Central DO - 10.5603/kp.a2018.0239 M1 - 2 PY - 2018 SN - 0022-9032 SP - 228-231 ST - Initial experience of pulmonary embolism response team with percutaneous embolectomy in intermediate-high- and high-risk acute pulmonary embolism T2 - Kardiol Pol TI - Initial experience of pulmonary embolism response team with percutaneous embolectomy in intermediate-high- and high-risk acute pulmonary embolism UR - http://europepmc.org/article/MED/30566224 VL - 77 ID - 761949 ER - TY - GEN AU - Roik, Marek AU - Wretowski, Dominik AU - Łabyk, Andrzej AU - Ciurzyński, Michał AU - Kurnicka, Katarzyna AU - Lichodziejewska, Barbara AU - Pacho, Szymon AU - Potępa, Michał AU - Szramowska, Agnieszka AU - Trzebicki, Janusz AU - Gołębiowski, Marek AU - Pruszczyk, Piotr DA - 2018/01/01 DB - Federal Science Library - Canada PY - 2018 SN - 0022-9032 ST - Initial experience of pulmonary embolism response team with percutaneous embolectomy in intermediate–high- and high-risk acute pulmonary embolism TI - Initial experience of pulmonary embolism response team with percutaneous embolectomy in intermediate–high- and high-risk acute pulmonary embolism UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV1Lj9MwELZgEYgL4qnlKV_ggtJtno2lBQntLmJVgRbYCm5R_IhU2iQobYV2T_wHfhT_g1_CzMRx08JhOXBJ02nsWppP9ozzzWfGwmAw9LbmhEDooTYwLwRhAumbNolWOi8UhAdaSI1bvJNJePQ5evcetZ87dZ617b86Hmzgeiyk_Qfnu07BAPcAAbgCCOB6IRgcIzkI3GCcpDFxnFdzGAEV4paynuNBGU1LljXPwetluz0LLdQKgkeDNFl6ELf4S6oURJmJhspOlqYjTISofezR6wi6I9p6rpCJ8Ocf9qPiMZFicRbO8dSIxSwn_SgR9zcqPtTTma0uMq686FNjlvU3e_b2YY1CKe63pwcxxMm5PJt1zM1z88W9c5mumvMzeiSyzamCgCxBfy_ET4lXEvfnd0itxdDumNop2Raft6t70K452wsHxH0oYDE-GeTY7wBLftcrZMcK2Fo4HZ0REinsIBufZNQ8o-ao3V7qqVq-MJU3-XiZXQkgNkLa6eHx2G0KpInvd4r2OPJWBxa729sYTS9uglhB2ADo9Ca7YTMX_qrF2C12yVS32bW3lptxh_20UONrqPG64Ptl3sxeOv_v79F3a-7AsGntoLhpRVx2FoQn78OT9-DJpxXvw_PX9x8ERw7A5A6YnIDJ3cB4N5a7bPL66PTgjWePCfEU6gcCBnThQ6Ywikw4EjKRkIGkvpGQO0C-bVQRpAbC4DhPY6Nigec1iEhKM9JCofpheI_tVHVldhmPVOJLjMABnRE0FfAYxOja91Wo4eM-e9Y5IfvaqsFkf3X-g4s--JBdXwP5EdtZNivzmF0tFnNPLoonhJXf85GvlA ID - 761950 ER - TY - JOUR AB - Results of our analysis show as that breast reconstruction become a standard part of the care of female patients with breast cancer. We will analyse the factors that are important for the primary or secondary breast reconstruction after mastectomy, and also take a closer look on the most recent scientific advances on breast reconstruction and on the protocols regarding them. The breast is the most common site of cancer in Croatia women. Breast cancer is the first leading cause of cancer death among women today. The incidence of female breast cancer in Croatia estimates that approximately 2.200 news cases of female breast will be diagnosed every year: We retrospectively analysed data of 101 female patients undergoing reconstructive surgery for breast reconstruction after mastectomy at Division of Plastic Surgery and Burns, University Hospital Center Split and University Clinic of Plastic and Reconstructive Surgery, Innsbruck, Austria, between 1998 and 2008. For the purpose of outcome assessment, we performed the tree different type of questionnaire: (1) Personal/medical profile (Table 1), (2) Aesthetic assessment (Table 2), and (3) Psychosocial assessment (Table 3). The occurrence of main complications during breast reconstruction (partial necrosis of flap, hernia of donor site, pulmonary embolism, deep venous thrombosis, infection rate, hemathoma and seroma formation, and extrusion of expander/implant) during hospitalisation and follow up period until 6 post operatively were analysed with respect to use different type of reconstructive methods for breast reconstruction. The difference in complication between patients groups was evaluated by chi(2)-test. The level of significance was set up at p=0.05. Mann-Whitney test was used to compare the time from mastectomy to breast reconstruction, due to asymmetrical data distribution. The three main variables of this study were to identify significant risk factors, asses the aesthetic outcome, and patient satisfaction with performed different methods for breast reconstruction (LD flap with or without tissue expander and implant, pedicle and free TRAM flaps, and expander/implants only. These variables determined the current guidelines for early and late breast reconstruction after mastectomy such as patient data, age and own decision, relation ship between reconstruction and radiotherapy, and chemotherapy, and finally about breast preserving operation. The result should confirm that breast reconstruction after mastectomy is justified, especially in young women, as well as how essential is team work involved in breast cancer operation and breast reconstruction after mastectomy. AD - [Roje, Zdravko] Univ Hosp Ctr Split, Dept Surg, Div Plast Surg & Burns, Split 21000, Croatia. [Roje, Zeljka] Univ Zagreb, Univ Hosp Dubrava, Dept Surg, Zagreb, Croatia. [Jankovic, Stipan] Univ Hosp Ctr Split, Dept Radiol, Split 21000, Croatia. [Ninkovic, Milomir] Univ Clin Plast & Reconstruct Surg, Innsbruck, Austria. Roje, Z (corresponding author), Univ Hosp Ctr Split, Dept Surg, Div Plast Surg & Burns, Spinciceva 1, Split 21000, Croatia. zdravko.roje@st.t-com.hr AN - WOS:000276232100020 AU - Roje, Z. AU - Roje, Z. AU - Jankovic, S. AU - Ninkovic, M. DA - Mar J2 - Coll. Anthropol. KW - breast cancel breast surgery preserving breast operation postmastectomy radiotherapy and chemotherapy primary and secondary breast reconstruction current guidelines for breast reconstruction after mastectomy RADIOTHERAPY MANAGEMENT IMMEDIATE RISK Anthropology LA - English M3 - Article N1 - ISI Document Delivery No.: 577OB Times Cited: 18 Cited Reference Count: 37 Roje, Zdravko Roje, Zeljka Jankovic, Stipan Ninkovic, Milomir Jankovic, Stipan/E-3315-2017 18 0 4 COLLEGIUM ANTROPOLOGICUM ZAGREB COLLEGIUM ANTROPOL 1 PY - 2010 SN - 0350-6134 SP - 113-123 ST - Breast Reconstruction after Mastectomy T2 - Collegium Antropologicum TI - Breast Reconstruction after Mastectomy UR - ://WOS:000276232100020 VL - 34 ID - 761878 ER - TY - JOUR AB - Endovascular intervention has revolutionized the treatment of aortic disease, extending the cohort of patients eligible for repair. Accurate planning for endovascular aortic repair is essential. Recent advances in modern software have demonstrated potential for improving outcomes and enhancing the decision making process beyond 3D measurements and intraoperative navigation techniques. With increasing uptake and complexity of endovascular therapies requiring multidisciplinary collaborations, it has become apparent that planning must extend to the preparation of entire interventional teams and support the early identification and prevention of potentially harmful events. This paper will examine recent advances not only in morphological planning and computational modelling, but also the role of software in the preparation of teams and prevention of error. AD - [Rolls, A. E.; Riga, C. V.; Rudarakanchana, N.; Albayati, M.; Bicknell, C. D.; Cheshire, N. J.] Univ London Imperial Coll Sci Technol & Med, Div Surg & Canc, London W2 1NY, England. [Rolls, A. E.; Riga, C. V.; Rudarakanchana, N.; Albayati, M.; Hamady, M.; Bicknell, C. D.; Cheshire, N. J.] Imperial Coll Healthcare NHS Trust, Imperial Coll Reg Vasc Unit, London, England. [Lee, S-L] Univ London Imperial Coll Sci Technol & Med, Dept Comp Sci, London W2 1NY, England. Rolls, AE (corresponding author), Univ London Imperial Coll Sci Technol & Med, Imperial Coll Healthcare NHS Trust, Imperial Coll Reg Vasc Unit, Div Surg & Canc,St Marys Hosp, 10th Floor QEQM Bldg, London W2 1NY, England. Alex.rolls1981@googlemail.com AN - WOS:000331491200001 AU - Rolls, A. E. AU - Riga, C. V. AU - Rudarakanchana, N. AU - Lee, S. L. AU - Albayati, M. AU - Hamady, M. AU - Bicknell, C. D. AU - Cheshire, N. J. DA - Feb J2 - J. Cardiovasc. Surg. KW - Software Endovascular procedures Computer simulation Robotics ENDOVASCULAR ANEURYSM REPAIR COMPUTATIONAL ANALYSIS COMPUTED-TOMOGRAPHY CATHETER NAVIGATION AORTIC REPAIR INSTANTIATION ANGIOGRAPHY CENTERLINE REHEARSAL JUNCTIONS Cardiac & Cardiovascular Systems Surgery Peripheral Vascular Disease LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: AB0OE Times Cited: 4 Cited Reference Count: 35 Rolls, A. E. Riga, C. V. Rudarakanchana, N. Lee, S-L Albayati, M. Hamady, M. Bicknell, C. D. Cheshire, N. J. Albayati, Mostafa/0000-0002-4205-036X National Institute for Health ResearchNational Institute for Health Research (NIHR) [2226] Funding Source: Researchfish 4 0 8 EDIZIONI MINERVA MEDICA TURIN J CARDIOVASC SURG PY - 2014 SN - 0021-9509 SP - 1-7 ST - Planning for EVAR: the role of modern software T2 - Journal of Cardiovascular Surgery TI - Planning for EVAR: the role of modern software UR - ://WOS:000331491200001 VL - 55 ID - 761788 ER - TY - JOUR AB - Purpose Clinical equipoise exists with the use of novel reperfusion therapies such as catheter-directed thrombolysis in the management of patients presenting to hospital with high risk pulmonary embolism (PE). Therapeutic options rely on clinical presentation, patient factors, physician preference, and institutional availability. We established a Pulmonary Embolism Response Team (PERT) to provide urgent assessment and multidisciplinary care for patients presenting to our institution with high-risk PE. Methods Data were retrospectively collected from PERT activations between January 2016 and December 2018. Chi square tests were used to determine differences in mortality across the three years of study. Logistic regression was used to evaluate 30- and 90-day mortality and occurrence of major bleeds between those receiving anticoagulation alone (AC) and those receiving advanced reperfusion therapy (ART). Results There were 128 PERT activations over three years, the majority originating from the emergency department. Eighty-five percent of activations were for submassive PE, with 56% of all activations assessed as submassive-high risk. Fifteen patients (12%) presented with massive PE. Advanced reperfusion therapy was used in 29 (23%) patients, of whom 25 (20%) received catheter-directed thrombolysis. There was an increased risk of major bleeding in the ART group compared with in the AC group (odds ratio[OR], 17.9; 95% confidence interval [CI], 4.1 to 125.0;P< 0.001), but no increased risk of mortality at 30 days (OR, 2.1; 95% CI, 0.4 to 9.1;P= 0.3). The 30-day mortality rate was 7.8%. Conclusion We describe the first Canadian PERT, a multidisciplinary team aimed at providing urgent individualized care for patients with high-risk PE. Further research is necessary to determine whether a PERT improves clinical outcomes. AD - [Romano, Kali R.; Cory, Julia M.; Finlayson, Gordon N.] Vancouver Gen Hosp, Dept Anesthesiol & Perioperat Care, JPPN 2nd Floor,Room 2449 899 West 12th Ave, Vancouver, BC V5Z 1M9, Canada. [Romano, Kali R.; Ronco, Juan J.; Finlayson, Gordon N.] Vancouver Gen Hosp, Dept Crit Care Med, Vancouver, BC, Canada. [Legiehn, Gerald M.] Vancouver Gen Hosp, Dept Radiol, Div Intervent Radiol, Vancouver, BC, Canada. [Bone, Jeffrey N.] Univ British Columbia, Fac Med, Dept Obstet & Gynaecol, Vancouver, BC, Canada. Romano, KR (corresponding author), Vancouver Gen Hosp, Dept Anesthesiol & Perioperat Care, JPPN 2nd Floor,Room 2449 899 West 12th Ave, Vancouver, BC V5Z 1M9, Canada.; Romano, KR (corresponding author), Vancouver Gen Hosp, Dept Crit Care Med, Vancouver, BC, Canada. kali.romano@vch.ca AN - WOS:000560282800002 AU - Romano, K. R. AU - Cory, J. M. AU - Ronco, J. J. AU - Legiehn, G. M. AU - Bone, J. N. AU - Finlayson, G. N. DO - 10.1007/s12630-020-01790-6 J2 - Can. J. Anesth. KW - pulmonary embolism response team MANAGEMENT RATES CARE Anesthesiology LA - English M3 - Article; Early Access N1 - ISI Document Delivery No.: NB1NW Times Cited: 0 Cited Reference Count: 15 Romano, Kali R. Cory, Julia M. Ronco, Juan J. Legiehn, Gerald M. Bone, Jeffrey N. Finlayson, Gordon N. Bone, Jeffrey/0000-0001-7704-1677 0 SPRINGER NEW YORK CAN J ANESTH SN - 0832-610X SP - 8 ST - Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience T2 - Canadian Journal of Anesthesia-Journal Canadien D Anesthesie TI - Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience UR - ://WOS:000560282800002 ID - 761417 ER - TY - JOUR AB - PURPOSE: Clinical equipoise exists with the use of novel reperfusion therapies such as catheter-directed thrombolysis in the management of patients presenting to hospital with high risk pulmonary embolism (PE). Therapeutic options rely on clinical presentation, patient factors, physician preference, and institutional availability. We established a Pulmonary Embolism Response Team (PERT) to provide urgent assessment and multidisciplinary care for patients presenting to our institution with high-risk PE. METHODS: Data were retrospectively collected from PERT activations between January 2016 and December 2018. Chi square tests were used to determine differences in mortality across the three years of study. Logistic regression was used to evaluate 30- and 90-day mortality and occurrence of major bleeds between those receiving anticoagulation alone (AC) and those receiving advanced reperfusion therapy (ART). RESULTS: There were 128 PERT activations over three years, the majority originating from the emergency department. Eighty-five percent of activations were for submassive PE, with 56% of all activations assessed as submassive-high risk. Fifteen patients (12%) presented with massive PE. Advanced reperfusion therapy was used in 29 (23%) patients, of whom 25 (20%) received catheter-directed thrombolysis. There was an increased risk of major bleeding in the ART group compared with in the AC group (odds ratio [OR], 17.9; 95% confidence interval [CI], 4.1 to 125.0; P < 0.001), but no increased risk of mortality at 30 days (OR, 2.1; 95% CI, 0.4 to 9.1; P = 0.3). The 30-day mortality rate was 7.8%. CONCLUSION: We describe the first Canadian PERT, a multidisciplinary team aimed at providing urgent individualized care for patients with high-risk PE. Further research is necessary to determine whether a PERT improves clinical outcomes. AD - Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, JPPN 2nd Floor, Room 2449 899 West 12th Ave, Vancouver, BC, V5Z 1M9, Canada. kali.romano@vch.ca. Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada. kali.romano@vch.ca. Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, JPPN 2nd Floor, Room 2449 899 West 12th Ave, Vancouver, BC, V5Z 1M9, Canada. Department of Critical Care Medicine, Vancouver General Hospital, Vancouver, BC, Canada. Division of Interventional Radiology, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada. Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. AN - 32808096 AU - Romano, K. R. AU - Cory, J. M. AU - Ronco, J. J. AU - Legiehn, G. M. AU - Bone, J. N. AU - Finlayson, G. N. DA - Aug 17 DO - 10.1007/s12630-020-01790-6 DP - NLM ET - 2020/08/19 J2 - Canadian journal of anaesthesia = Journal canadien d'anesthesie KW - pulmonary embolism response team LA - eng N1 - 1496-8975 Romano, Kali R Orcid: 0000-0001-9028-7348 Cory, Julia M Ronco, Juan J Legiehn, Gerald M Bone, Jeffrey N Finlayson, Gordon N Journal Article United States Can J Anaesth. 2020 Aug 17. doi: 10.1007/s12630-020-01790-6. OP - Équipe d’intervention en cas d’embolie pulmonaire de l’Hôpital général de Vancouver (VGH PERT): expérience initiale sur trois ans. PY - 2020 SN - 0832-610x ST - Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience T2 - Can J Anaesth TI - Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience ID - 760133 ER - TY - JOUR AB - Pulmonary embolism (PE) is a potentially fatal disease with a broad range of treatment options that spans multiple specialties. The rapid evolution and expansion of novel therapies to treat PE make it a disease process that is well suited to a multidisciplinary approach. In order to facilitate a rapid, robust response to the diagnosis of PE, some hospitals have established multidisciplinary pulmonary embolism response teams (PERTs). The PERT model is based on existing multidisciplinary teams such as heart teams and rapid response teams. A PERT is composed of clinicians from the range of specialties involved in the treatment of PE, including pulmonology critical care, interventional radiology, cardiology, and cardiothoracic surgery among others. A PERT is a 24/7 consult service that is able to provide expert advice on the initial management of PE patients and convene in real time to develop a consensus treatment plan specifically tailored to the needs of a particular patient and consistent with the capabilities of the institution. In this review, we discuss the rationale for establishing a PERT and its potential benefits. We discuss considerations in forming a PERT and present case studies of several PERTs currently in operation at different institutions. We also discuss potential difficulties in forming a PERT and review evidence that has been generated by some of the PERTs that have been in operation the longest. PMID:29670358 AU - Root, Christopher W. AU - Dudzinski, David M. AU - Zakhary, Bishoy AU - Friedman, Oren A. AU - Sista, Akhilesh K. AU - Horowitz, James M. DA - 2018/04/05 04/05 DB - PubMed Central DO - 10.2147/JMDH.S151196 KW - pulmonary embolism pulmonary embolism response team thrombosis thrombolysis venous thromboembolism PY - 2018 SN - 1178-2390 SP - 187-187 ST - Multidisciplinary approach to the management of pulmonary embolism patients: the pulmonary embolism response team (PERT) T2 - Journal of Multidisciplinary Healthcare TI - Multidisciplinary approach to the management of pulmonary embolism patients: the pulmonary embolism response team (PERT) UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5896654&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=5896654 VL - 11 ID - 761942 ER - TY - JOUR AB - Paget-Schroetter syndrome (PSS) in the context of upper extremity deep venous thrombosis (DVT) is an uncommon but potentially very serious condition affecting young, healthy adults, in which secondary post-thrombotic syndrome (PTS) can be a complication with major implications. The best treatment option remains controversial, with current guidelines recommending anticoagulation for at least 3 months. However, an incidence of PTS of approximately 50% after 6 months, 30% after 1 year and 25% after 2 years has been found using this therapeutic approach. Consequently, specialized units recommend local thrombolysis and early decompressive surgery. We describe a series of eight cases treated in this way. None of the patients showed signs of complications, and an early return to regular activities with no PTS was observed in 90% of cases. AD - Unidad de Corta Estancia/Trombosis, Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Electronic address: Vladi_medico@yahoo.es. Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Unidad de Corta Estancia/Trombosis, Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. Servicio de Cirugía Torácica, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España. AN - 25446871 AU - Rosa Salazar, V. AU - Otálora Valderrama Sdel, P. AU - Hernández Contreras, M. E. AU - García Pérez, B. AU - Arroyo Tristán Adel, A. AU - García Méndez Mdel, M. DA - Aug DO - 10.1016/j.arbres.2014.09.003 DP - NLM ET - 2014/12/03 J2 - Archivos de bronconeumologia KW - Adolescent Adult Anticoagulants/administration & dosage/*therapeutic use Combined Modality Therapy Cumulative Trauma Disorders/drug therapy/etiology/surgery *Decompression, Surgical *Disease Management Disease-Free Survival Endovascular Procedures Female Heparin, Low-Molecular-Weight/administration & dosage/*therapeutic use Humans Interdisciplinary Communication Male Neck Muscles/surgery Occupational Diseases/drug therapy/etiology/surgery Patient Care Team Postthrombotic Syndrome/*prevention & control Prospective Studies Recurrence Ribs/surgery *Thrombolytic Therapy Upper Extremity Deep Vein Thrombosis/drug therapy/etiology/surgery/*therapy Weight Lifting Young Adult Effort thrombosis Paget-Schroetter syndrome Síndrome de Paget-Schroetter Síndrome de la salida del tórax Thoracic outlet syndrome Trombosis de esfuerzo Trombosis venosa profunda de extremidad superior Upper extremity deep vein thrombosis LA - eng spa M1 - 8 N1 - 1579-2129 Rosa Salazar, Vladimir Otálora Valderrama, Sonia Del Pilar Hernández Contreras, María Encarnación García Pérez, Bartolomé Arroyo Tristán, Andrés Del Amor García Méndez, María Del Mar Journal Article Spain Arch Bronconeumol. 2015 Aug;51(8):e41-3. doi: 10.1016/j.arbres.2014.09.003. PY - 2015 SN - 0300-2896 SP - e41-3 ST - Multidisciplinary management of Paget-Schroetter syndrome. A case series of eight patients T2 - Arch Bronconeumol TI - Multidisciplinary management of Paget-Schroetter syndrome. A case series of eight patients VL - 51 ID - 760444 ER - TY - JOUR AB - Objective: The objective of this study is to evaluate the performance of 5 triggers to detect adverse events (AEs) associated with outpatient surgery. Triggers use surveillance algorithms derived from clinical logic to flag cases where AEs have most likely occurred. Current efforts to detect AEs have focused primarily on the inpatient setting, despite the increase in outpatient surgery in all health care settings. Methods: Using trigger logic, we retrospectively evaluated data from 3 large health care systems' electronic medical records. Patients were eligible for inclusion if they had an outpatient (same-day) surgery in 2007 and at least 1 clinical note in the 6 months after the surgery. Two nurse abstractors reviewed a sample of trigger-flagged cases from each health care system. After reaching interrater reliability targets (? > 0.60), we calculated the positive predictive value (PPV) of each trigger and the confidence interval of the estimate. Results: The surgical triggers flagged between 1% and 22% of the outpatient surgery cases, with a wide range in PPVs (6.0%-62.0%). The pulmonary embolism and deep vein thrombosis and emergency department triggers had the lowest proportion of flagged cases along with the highest PPVs, showing the most promise for screening cases with a high probability of AE occurrence. Conclusions: Triggers may be useful in identifying a narrow set of surgeries for further review to determine if a surgical AE occurred, complementing existing tools and initiatives used to detect AEs. Improved detection of AEs in outpatient surgery should help target potential areas for quality improvement. AD - Center for Organization, Leadership, Management Research, VA Center of Excellence, VA Boston Healthcare System Boston University School of Public Health, Department of Health Policy and Management, Tufts Medical Center and Tufts University School of Medicine, Boston, MA VA Salt Lake City Geriatrics Research, Education, and Clinical Center Center for Health Quality, Outcomes and Economics Research, VA Center of Excellence, Bedford VAMC, Bedford, MA Agency for Healthcare Research and Quality, Rockville, MD Department of Surgery, VA Boston Healthcare System, West Roxbury, MA AN - 109853503. Language: English. Entry Date: 20110520. Revision Date: 20151008. Publication Type: Journal Article AU - Rosen, Amy K. AU - Mull, Hillary J. AU - Kaafarini, Haytham AU - Nebeker, Jonathan AU - Shimada, Stephanie AU - Helwig, Amy AU - Nordberg, Brian AU - Long, Brenna AU - Savitz, Lucy A. AU - Shanahan, Christopher W. AU - Itani, Kamal DB - CINAHL DO - 10.1097/PTS.0b013e31820d164b DP - EBSCOhost KW - Adverse Health Care Event Ambulatory Surgery Health Status Indicators -- Classification Population Surveillance -- Methods Algorithms -- Utilization Electronic Health Records Confidence Intervals Decision Support Systems, Clinical Delphi Technique Emergency Patients Face Validity Funding Source Human Interrater Reliability Outpatients Predictive Validity Pulmonary Embolism Record Review Retrospective Design Surgical Patients Validation Studies Venous Thrombosis M1 - 1 N1 - forms; research; tables/charts. Journal Subset: Health Services Administration; Peer Reviewed; USA. Special Interest: Informatics; Patient Safety; Perioperative Care. Grant Information: Agency for Healthcare Research and Quality. NLM UID: 101233393. PMID: NLM21921867. PY - 2011 SN - 1549-8417 SP - 45-59 ST - Applying trigger tools to detect adverse events associated with outpatient surgery T2 - Journal of Patient Safety TI - Applying trigger tools to detect adverse events associated with outpatient surgery UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=109853503&site=ehost-live&scope=site VL - 7 ID - 761295 ER - TY - JOUR AU - Rosenfeld, B. L. AU - Bashir, R. AU - Brisco-Bacik, M. A. AU - Panidis, I. P. AU - Vaidya, A. AU - Minakata, K. AU - Forfia, P. R. DA - 2020/05/05 05/05 DB - Europe PubMed Central DO - 10.12659/ajcr.921124 PY - 2020 SN - 1941-5923 ST - Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit T2 - Am J Case Rep TI - Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit UR - http://europepmc.org/article/MED/32345956 VL - 21 ID - 762050 ER - TY - JOUR AB - Traditionally, patients presenting with symptoms of coronary artery disease (CAD) were managed medically. If medical treatment proved unsuccessful, patients were referred for coronary artery bypass surgery (CABG). However, in recent years, increasing numbers of patients have received percutaneous coronary intervention (PCI), usually a coronary stent, for primary treatment. PCI is attractive because it is minimally invasive, has proven success in the immediate treatment of acute myocardial infarction and is well-accepted for poor surgical candidates in selected cases. However, evidence from emerging and ongoing clinical trials and registries suggests that compared to PCI, CABG offers superior long-term prognostic benefits in many, if not most, patients with significant CAD. We present an analysis of recent evidence showing that patients with complex atherosclerotic lesions, multivessel disease, left main stem disease, left ventricular dysfunction and diabetes mellitus derive more benefit from surgical revascularisation than from PCI. We conclude that PCI should be restricted to patient groups where superiority or equivalence to CABG has been demonstrated and that the decision-making process in allocating treatment should be made by a multidisciplinary team to ensure that every patient receives balanced advice and therapy that is most effective in the long term. AD - Department of Surgery, The University of Melbourne, Australia. f.rosenfeldt@alfred.org.au AN - 21937275 AU - Rosenfeldt, F. L. AU - Wilson, M. D. AU - Buxton, B. F. AU - Marasco, S. F. DA - Jan DO - 10.1016/j.hlc.2011.08.008 DP - NLM ET - 2011/09/23 J2 - Heart, lung & circulation KW - *Angioplasty, Balloon, Coronary/adverse effects/methods Contraindications *Coronary Artery Bypass/methods Coronary Artery Disease/complications/diagnosis/pathology/*therapy Coronary Vessels/pathology Diabetes Mellitus, Type 2/complications Disease Management Drug Therapy/*methods Humans Outcome Assessment, Health Care Patient Selection Prognosis Randomized Controlled Trials as Topic Risk Assessment Severity of Illness Index Stents Time Ventricular Dysfunction, Left/complications LA - eng M1 - 1 N1 - 1444-2892 Rosenfeldt, Franklin L Wilson, Mark D Buxton, Brian F Marasco, Silvana F Journal Article Review Australia Heart Lung Circ. 2012 Jan;21(1):1-11. doi: 10.1016/j.hlc.2011.08.008. Epub 2011 Sep 19. PY - 2012 SN - 1443-9506 SP - 1-11 ST - Coronary artery bypass surgery provides long-term results superior to percutaneous coronary intervention T2 - Heart Lung Circ TI - Coronary artery bypass surgery provides long-term results superior to percutaneous coronary intervention VL - 21 ID - 760337 ER - TY - JOUR AB - Background: Cavernous carotid aneurysms (CCA) account for 2-9% of all intracranial aneurysms. They have been considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. These aneurysms are unique, their rupture can present in many different forms, they can suffer spontaneous thrombotic changes and the symptomatology related to the mass effect involves the neuro-ophthalmologic system. In this scenario the natural history and clinical presentation are largely different from other intracranial aneurysms. Some investigators advocate treatment of both symptomatic and asymptomatic CCAs, others recommend no treatment. The reason for this controversy relates to a lack of information on the long term natural history of these aneurysms, as well as on the long term results of treatment. Methods: In this article the authors discuss their single institution experience in diagnosis, natural history and management of 123 asymptomatic and oligosympotomatic aneurysms located in the cavernous portion of internal carotid artery. Conclusions: According to our results asymptomatic or olygosymptomatic (pain) CCAs should be conservatively managed with serial images while the others presentations should be analyzed by a multidisciplinary team, involving the neuroendovascular and microsurgical services. (C) 2014 Elsevier B.V. All rights reserved. AD - [Rosi Junior, Jefferson; Welling, Leonardo C.; Yeng, Lin Tchia; Caldas, Jose Guilherme; Schafranski, Marcelo; Teixeira, Manoel Jacobsen; Figueiredo, Eberval Gadelha] Univ Sao Paulo, Fac Med, Hosp Clin, Div Neurol Surg,Sch Med, Sao Paulo, Brazil. Welling, LC (corresponding author), Univ Sao Paulo, Fac Med, Hosp Clin, Div Neurol Surg,Sch Med, Rua Eneas C Aguiar 255, Sao Paulo, Brazil. leonardowelling@yahoo.com.br AN - WOS:000343346900007 AU - Rosi, J. AU - Welling, L. C. AU - Yeng, L. T. AU - Caldas, J. G. AU - Schafranski, M. AU - Teixeira, M. J. AU - Figueiredo, E. G. DA - Oct DO - 10.1016/j.clineuro.2014.07.015 J2 - Clin. Neurol. Neurosurg. KW - Cerebral aneurysms Treatment Historical cohort study UNRUPTURED INTRACRANIAL ANEURYSMS CEREBRAL ANEURYSM ENDOVASCULAR TREATMENT BALLOON OCCLUSION SINUS ANEURYSMS RUPTURE HEMODYNAMICS EMBOLIZATION Clinical Neurology Surgery LA - English M3 - Article N1 - ISI Document Delivery No.: AR1LO Times Cited: 5 Cited Reference Count: 26 Rosi Junior, Jefferson Welling, Leonardo C. Yeng, Lin Tchia Caldas, Jose Guilherme Schafranski, Marcelo Teixeira, Manoel Jacobsen Figueiredo, Eberval Gadelha Caldas, Jose Guilherme M P/M-2554-2017; Figueiredo, Eberval Gadelha/H-3488-2012; Figueiredo, Eberval G/E-2071-2016 5 0 4 ELSEVIER SCIENCE BV AMSTERDAM CLIN NEUROL NEUROSUR PY - 2014 SN - 0303-8467 SP - 32-35 ST - Cavernous carotid artery aneurysms: Epidemiology, natural history, diagnostic and treatment. An experience of a single institution T2 - Clinical Neurology and Neurosurgery TI - Cavernous carotid artery aneurysms: Epidemiology, natural history, diagnostic and treatment. An experience of a single institution UR - ://WOS:000343346900007 VL - 125 ID - 761773 ER - TY - JOUR AB - BACKGROUND: Cavernous carotid aneurysms (CCA) account for 2-9% of all intracranial aneurysms. They have been considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. These aneurysms are unique, their rupture can present in many different forms, they can suffer spontaneous thrombotic changes and the symptomatology related to the mass effect involves the neuro-ophthalmologic system. In this scenario the natural history and clinical presentation are largely different from other intracranial aneurysms. Some investigators advocate treatment of both symptomatic and asymptomatic CCAs, others recommend no treatment. The reason for this controversy relates to a lack of information on the long term natural history of these aneurysms, as well as on the long term results of treatment. METHODS: In this article the authors discuss their single institution experience in diagnosis, natural history and management of 123 asymptomatic and oligosympotomatic aneurysms located in the cavernous portion of internal carotid artery. CONCLUSIONS: According to our results asymptomatic or olygosymptomatic (pain) CCAs should be conservatively managed with serial images while the others presentations should be analyzed by a multidisciplinary team, involving the neuroendovascular and microsurgical services. AD - Hospital das Clínicas, da Faculdade de Medicina, Division of Neurological Surgery, School of Medicine, University of Sao Paulo, Rua Eneas C Aguiar, 255, Sao Paulo, SP, Brazil. Hospital das Clínicas, da Faculdade de Medicina, Division of Neurological Surgery, School of Medicine, University of Sao Paulo, Rua Eneas C Aguiar, 255, Sao Paulo, SP, Brazil. Electronic address: leonardowelling@yahoo.com.br. AN - 25083803 AU - Rosi Junior, J. AU - Welling, L. C. AU - Yeng, L. T. AU - Caldas, J. G. AU - Schafranski, M. AU - Teixeira, M. J. AU - Figueiredo, E. G. DA - Oct DO - 10.1016/j.clineuro.2014.07.015 DP - NLM ET - 2014/08/02 J2 - Clinical neurology and neurosurgery KW - Adult Aged Aged, 80 and over *Carotid Artery Diseases/diagnosis/epidemiology/surgery Carotid Artery, Internal/pathology/*surgery Female Humans *Intracranial Aneurysm/diagnosis/epidemiology/surgery Male Middle Aged Pain/epidemiology Risk Assessment Vascular Surgical Procedures/methods Young Adult Cerebral aneurysms Historical cohort study Treatment LA - eng N1 - 1872-6968 Rosi Junior, Jefferson Welling, Leonardo C Yeng, Lin Tchia Caldas, José Guilherme Schafranski, Marcelo Teixeira, Manoel Jacobsen Figueiredo, Eberval Gadelha Journal Article Netherlands Clin Neurol Neurosurg. 2014 Oct;125:32-5. doi: 10.1016/j.clineuro.2014.07.015. Epub 2014 Jul 20. PY - 2014 SN - 0303-8467 SP - 32-5 ST - Cavernous carotid artery aneurysms: epidemiology, natural history, diagnostic and treatment. An experience of a single institution T2 - Clin Neurol Neurosurg TI - Cavernous carotid artery aneurysms: epidemiology, natural history, diagnostic and treatment. An experience of a single institution VL - 125 ID - 760499 ER - TY - JOUR AB - Background: The accuracy of patient self-report of health care utilization and complications has yet to be determined. If patients are accurate and engaged self-reporters, collecting this information in a manner that is temporally proximate to the health care utilization events themselves may prove valuable to health care organizations undertaking quality improvement initiatives for which such data are often unavailable. Objective: The objective of this study was to measure the accuracy of patient self-report of health care utilization and complications in the 90 days following orthopedic procedures using an automated digital patient engagement platform. Methods: We conducted a multicenter real-world observational cohort study across 10 orthopedic practices in California and Nevada. A total of 371 Anthem members with claims data meeting inclusion criteria who had undergone orthopedic procedures between March 1, 2015, and July 1, 2016, at participating practices already routinely using an automated digital patient engagement platform for asynchronous remote guidance and telemonitoring were sent surveys through the platform (in addition to the other materials being provided to them through the platform) regarding 90-day postencounter health care utilization and complications. Their self-reports to structured survey questions of health care utilization and complications were compared to claims data as a reference. Results: The mean age of the 371 survey recipients was 56.5 (SD 15.7) years, 48.8% (181/371) of whom were female; 285 individuals who responded to 1 or more survey questions had a mean age of 56.9 (SD 15.4) years and a 49.5% (141/285) female distribution. There were no significant differences in demographics or event prevalence rates between responders and nonresponders. With an overall survey completion rate of 76.8% (285/371), patients were found to have accuracy of self-report characterized by a kappa of 0.80 and agreement of 0.99 and a kappa of 1.00 and agreement of 1.00 for 90-day hospital admissions and pulmonary embolism, respectively. Accuracy of self-report of 90-day emergency room/urgent care visits and of surgical site infection were characterized by a kappa of 0.45 and agreement of 0.96 and a kappa of 0.53 and agreement of 0.97, respectively. Accuracy for other complications such as deep vein thrombosis, hemorrhage, severe constipation, and fracture/dislocation was lower, influenced by low event prevalence rates within our sample. Conclusions: In this multicenter observational cohort study using an automated internet-based digital patient engagement platform, we found that patients were most accurate self-reporters of 90-day hospital admissions and pulmonary embolism, followed by 90-day surgical site infection and emergency room/urgent care visits. They were less accurate for deep vein thrombosis and least accurate for hemorrhage, severe constipation, and fracture/dislocation. A total of 76.8% (285/371) of patients completed surveys without the need for clinical staff to collect responses, suggesting the acceptability to patients of internet-based survey dissemination from and collection by clinical teams. While our methods enabled detection of events outside of index institutions, assessment of accuracy of self-report for presence and absence of events and nonresponse bias analysis, low event prevalence rates, particularly for several of the complications, limit the conclusions that may be drawn for some of the findings. Nevertheless, this investigation suggests the potential that engaging patients in self-report through such survey modalities may offer for the timely and accurate measurement of matters germane to health care organizations engaged in quality improvement efforts post discharge. AD - [Rosner, Benjamin I.] HealthLoop Inc, 605 Ellis St 100, Mountain View, CA 94043 USA. [Rosner, Benjamin I.] Kaiser Permanente, Dept Hosp Med, Santa Clara, CA USA. [Gottlieb, Marc] Anthem Inc, Atlanta, GA USA. Rosner, BI (corresponding author), HealthLoop Inc, 605 Ellis St 100, Mountain View, CA 94043 USA. ben@healthloop.com AN - WOS:000439662700001 AU - Rosner, B. I. AU - Gottlieb, M. AU - Anderson, W. N. C7 - e10405 DA - Jul DO - 10.2196/10405 J2 - J. Med. Internet Res. KW - patient-generated health data patient reported outcome measures patient self-report complications utilization patient readmission emergency room hospital economics JOINT REPLACEMENT RESOURCE UTILIZATION ADMINISTRATIVE DATA AGREEMENT HIP READMISSIONS SERVICES ARTHROPLASTY ENCOUNTER DIAGNOSIS Health Care Sciences & Services Medical Informatics LA - English M1 - 7 M3 - Article N1 - ISI Document Delivery No.: GO0VQ Times Cited: 7 Cited Reference Count: 45 Rosner, Benjamin I. Gottlieb, Marc Anderson, William N. Anderson, William N./0000-0003-4204-3415 7 0 4 JMIR PUBLICATIONS, INC TORONTO J MED INTERNET RES PY - 2018 SN - 1438-8871 SP - 13 ST - Accuracy of Internet-Based Patient Self-Report of Postdischarge Health Care Utilization and Complications Following Orthopedic Procedures: Observational Cohort Study T2 - Journal of Medical Internet Research TI - Accuracy of Internet-Based Patient Self-Report of Postdischarge Health Care Utilization and Complications Following Orthopedic Procedures: Observational Cohort Study UR - ://WOS:000439662700001 VL - 20 ID - 761580 ER - TY - JOUR AB - Pulmonary Embolism Response Teams (PERTs) are being created around the United States to immediately and simultaneously bring together multiple specialists to determine the best course of action and coordinate clinical care for patients with severe pulmonary embolism (PE). The organization and structure of each PERT will depend on local clinical demands and resources. Creating a follow up clinic for PE patients after discharge from the hospital is an essential component of any PERT program. PERT programs, which have come together to form the PERT Consortium®, are changing the landscape of PE treatment and may represent a new standard of care. AD - Division of Hematology and Oncology, Department of Medicine, Massachusetts Hospital, 55 Fruit Street, Boston, MA 02114, USA. Electronic address: rprosovsky@partners.org. Division of Cardiology, Section of Vascular Medicine and Intervention, Department of Medicine, Massachusetts Hospital, 55 Fruit Street, Boston, MA 02114, USA. Department of Emergency Medicine, Center for Vascular Emergencies, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. AN - 30122185 AU - Rosovsky, R. AU - Borges, J. AU - Kabrhel, C. AU - Rosenfield, K. DA - Sep DO - 10.1016/j.ccm.2018.04.019 DP - NLM ET - 2018/08/21 J2 - Clinics in chest medicine KW - Follow-Up Studies Humans Inpatients Outpatients Patient Care Team/*standards Pulmonary Embolism/pathology/*therapy Standard of Care/*standards *Anticoagulation management *Direct oral anticoagulants (DOACs) *Follow-up clinic *Multidisciplinary care *Pulmonary embolism (PE) *Pulmonary embolism response team (PERT) LA - eng M1 - 3 N1 - 1557-8216 Rosovsky, Rachel Borges, Jorge Kabrhel, Christopher Rosenfield, Kenneth Journal Article Review United States Clin Chest Med. 2018 Sep;39(3):621-630. doi: 10.1016/j.ccm.2018.04.019. PY - 2018 SN - 0272-5231 SP - 621-630 ST - Pulmonary Embolism Response Team: Inpatient Structure, Outpatient Follow-up, and Is It the Current Standard of Care? T2 - Clin Chest Med TI - Pulmonary Embolism Response Team: Inpatient Structure, Outpatient Follow-up, and Is It the Current Standard of Care? VL - 39 ID - 760127 ER - TY - JOUR AB - Background: Multidisciplinary pulmonary embolism response teams (PERTs) are being implemented to improve care of patients (pts) with life-threatening PE. Aims: To determine how creation of PERT affects treatment and outcomes of PE pts. Methods: Study compared PE patients before and after implementation of PERT. Consecutive sample of ER patients with PE and one highrisk feature were included in pre-PERT group. Activations from ED were included in post-PERT group. Primary outcomes included types of treatment, major bleeding and 30-day mortality. Means were used to summarize continuous variables; percentages summarized categorical variables. T-tests, Chi-square tests and logistic regression compared outcomes. To further control for differences, matched subgroups of pts pre- and post-PERT were analyzed. Data were divided into mutually exclusive six-month time periods and an interrupted time-series design examined slopes and change points pre- and post-PERT. SAS® was used for analysis and two-sided p-value < 0.05 was considered significant. Results: Total of 212 pre-PERT pts and 228 post-PERT pts were analyzed. Patient demographics were generally similar, though pre-PERT, PE were more likely to be low-risk (37% vs. 19%) while post-PERT, PE were more likely to be submassive (32% vs. 49%), p< 0.0001. After adjusting for severity, more pts underwent catheter directed thrombolysis (1% vs. 14%, p=< 0.0001) post-PERT and there was trend towards use of any advanced therapy post-PERT (9% vs. 19%, p=0.011). Results of matched analysis were similar. There were no differences in major bleeding or mortality pre- and post-PERT. However, the interrupted time-series analysis suggested a downtrend in both bleeding and death post-PERT. Conclusions: Creation of PERT affects treatment and outcomes of pts with life-threatening PE. Advanced therapies, particularly catheterdirected thrombolysis, increased after creation of PERT, especially in pts with submassive PE. In contrast, PERT appears to be associated with lower bleeding and mortality. AD - R. Rosovsky, Massachusetts General Hospital, Division of Hematology and Oncology, Department of Medicine, Boston, United States AU - Rosovsky, R. AU - Chang, Y. AU - Rosenfield, K. AU - Channick, R. AU - Jaff, M. AU - Weinberg, I. AU - Sundt, T. AU - Witkin, A. AU - Rodriguez-Lopez, J. AU - Parry, B. AU - Harshbarger, S. AU - Hariharan, P. AU - Kabrhel, C. DB - Embase DO - 10.1002/rth2.12012 KW - adult bleeding blood clot lysis catheter chi square test conference abstract controlled study death female human human tissue major clinical study male mortality pulmonary embolism response team statistical significance time series analysis LA - English M3 - Conference Abstract N1 - L624155680 2018-10-09 PY - 2017 SN - 2475-0379 SP - 634 ST - Changes in treatments and outcomes after creation of a pulmonary embolism response team (PERT) T2 - Research and Practice in Thrombosis and Haemostasis TI - Changes in treatments and outcomes after creation of a pulmonary embolism response team (PERT) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624155680&from=export http://dx.doi.org/10.1002/rth2.12012 VL - 1 ID - 760925 ER - TY - JOUR AU - Rosovsky, R. AU - Chang, Y. AU - Rosenfield, K. AU - Channick, R. AU - Jaff, M. R. AU - Weinberg, I. AU - Sundt, T. AU - Witkin, A. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Hariharan, P. AU - Kabrhel, C. DA - 2018/09/22 09/22 DB - Europe PubMed Central DO - 10.1007/s11239-018-1737-8 M1 - 1 PY - 2018 SN - 0929-5305 SP - 31-40 ST - Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis T2 - J Thromb Thrombolysis TI - Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis UR - http://europepmc.org/article/MED/30242551 VL - 47 ID - 761971 ER - TY - JOUR AU - Rosovsky, R. AU - Chang, Y. AU - Rosenfield, K. AU - Channick, R. AU - Jaff, M. R. AU - Weinberg, I. AU - Sundt, T. AU - Witkin, A. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Hariharan, P. AU - Kabrhel, C. DA - 2018/12/05 12/05 DB - Europe PubMed Central DO - 10.1007/s11239-018-1787-y M1 - 1 PY - 2018 SN - 0929-5305 ST - Correction to: Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis T2 - J Thromb Thrombolysis TI - Correction to: Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis UR - http://europepmc.org/article/MED/30506351 VL - 47 ID - 761972 ER - TY - JOUR AB - Multidisciplinary pulmonary embolism response teams (PERTs) are being implemented to improve care of patients with life-threatening PE. We sought to determine how the creation of PERT affects treatment and outcomes of patients with serious PE. A pre- and post-intervention study was performed using an interrupted time series design, to compare patients with PE before (2006-2012) and after (2012-2016) implementation of PERT at a university hospital. T-tests, Chi square tests and logistic regression were used to compare outcomes, and multivariable regression were used to adjust for differences in PE severity. Two-sided p-value < 0.05 was considered significant. For the interrupted time-series analysis, data was divided into mutually exclusive 6-month time periods (11 pre- and 7 post-PERT). To examine changes in treatment and outcomes associated with PERT, slopes and change points were compared pre- and post-PERT. Two-hundred and twelve pre-PERT and 228 post-PERT patients were analyzed. Patient demographics were generally similar, though pre-PERT, PE were more likely to be low-risk (37% vs. 19%) while post-PERT, PE were more likely to be submassive (32% vs. 49%). More patients underwent catheter directed therapy (1% vs. 14%, p = < 0.0001) or any advanced therapy (19 [9%] vs. 44 [19%], p = 0.002) post PERT. Interrupted time series analysis demonstrated that this increase was sudden and coincident with implementation of PERT, and most noticeable among patients with submassive PE. There were no differences in major bleeding or mortality pre- and post-PERT. While the use of advanced therapies, particularly catheter-directed therapies, increased after creation of PERT, especially among patients with submassive PE, there was no apparent increase in bleeding. AD - Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA. rprosovsky@partners.org. Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Department of Medicine, Newton Wellesley Hospital, Newton, MA, USA. Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. AN - 30242551 AU - Rosovsky, R. AU - Chang, Y. AU - Rosenfield, K. AU - Channick, R. AU - Jaff, M. R. AU - Weinberg, I. AU - Sundt, T. AU - Witkin, A. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Hariharan, P. AU - Kabrhel, C. DA - Jan DO - 10.1007/s11239-018-1737-8 DP - NLM ET - 2018/09/23 J2 - Journal of thrombosis and thrombolysis KW - Delivery of Health Care/*organization & administration/trends Emergency Medicine/trends Female Hospitals, University Humans Longitudinal Studies Male Patient Care Team/*organization & administration/trends Pulmonary Embolism/*therapy Retrospective Studies Risk Assessment Treatment Outcome Pert Pulmonary embolism Pulmonary embolism response team Thrombolysis Treatment LA - eng M1 - 1 N1 - 1573-742x Rosovsky, Rachel Orcid: 0000-0002-2392-7365 Chang, Yuchiao Rosenfield, Kenneth Channick, Richard Jaff, Michael R Weinberg, Ido Sundt, Thoralf Witkin, Alison Rodriguez-Lopez, Josanna Parry, Blair A Harshbarger, Savannah Hariharan, Praveen Kabrhel, Christopher Journal Article Netherlands J Thromb Thrombolysis. 2019 Jan;47(1):31-40. doi: 10.1007/s11239-018-1737-8. PY - 2019 SN - 0929-5305 SP - 31-40 ST - Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis T2 - J Thromb Thrombolysis TI - Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis VL - 47 ID - 760128 ER - TY - JOUR AB - The original version of the article unfortunately contained an error in conflict of interest. This erratum is published with the correct conflict of interest. AD - Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, USA. rprosovsky@partners.org. Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Department of Medicine, Newton Wellesley Hospital, Newton, MA, USA. Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. AN - 30506351 AU - Rosovsky, R. AU - Chang, Y. AU - Rosenfield, K. AU - Channick, R. AU - Jaff, M. R. AU - Weinberg, I. AU - Sundt, T. AU - Witkin, A. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Hariharan, P. AU - Kabrhel, C. DA - Jan DO - 10.1007/s11239-018-1787-y DP - NLM ET - 2018/12/07 J2 - Journal of thrombosis and thrombolysis LA - eng M1 - 1 N1 - 1573-742x Rosovsky, Rachel Orcid: 0000-0002-2392-7365 Chang, Yuchiao Rosenfield, Kenneth Channick, Richard Jaff, Michael R Weinberg, Ido Sundt, Thoralf Witkin, Alison Rodriguez-Lopez, Josanna Parry, Blair A Harshbarger, Savannah Hariharan, Praveen Kabrhel, Christopher Published Erratum Netherlands J Thromb Thrombolysis. 2019 Jan;47(1):41. doi: 10.1007/s11239-018-1787-y. PY - 2019 SN - 0929-5305 SP - 41 ST - Correction to: Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis T2 - J Thromb Thrombolysis TI - Correction to: Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis VL - 47 ID - 760234 ER - TY - JOUR AB - The original version of the article unfortunately contained an error in conflict of interest. This erratum is published with the correct conflict of interest. Dr. Weinberg reports the following conflicts of interest: – Novate Medical—Scientific advisory board– BTG—Non-compensated advisor Dr. Jaff reports the following conflicts of interest: – Embolitech (Equity Investment Interest) – Abbott Vascular, Boston Scientific (Non-compensated advisor) – BTG, Medtronic, Philips, Sanofi (Compensated advisor) AD - R. Rosovsky, Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, United States AU - Rosovsky, R. AU - Chang, Y. AU - Rosenfield, K. AU - Channick, R. AU - Jaff, M. R. AU - Weinberg, I. AU - Sundt, T. AU - Witkin, A. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Hariharan, P. AU - Kabrhel, C. DB - Embase Medline DO - 10.1007/s11239-018-1787-y KW - erratum priority journal LA - English M1 - 1 M3 - Erratum N1 - L625313805 2018-12-07 2019-02-01 PY - 2019 SN - 1573-742X 0929-5305 SP - 41 ST - Correction to: Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis (Journal of Thrombosis and Thrombolysis, (2019), 47, 1, (31-40), 10.1007/s11239-018-1737-8) T2 - Journal of Thrombosis and Thrombolysis TI - Correction to: Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis (Journal of Thrombosis and Thrombolysis, (2019), 47, 1, (31-40), 10.1007/s11239-018-1737-8) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L625313805&from=export http://dx.doi.org/10.1007/s11239-018-1787-y VL - 47 ID - 760754 ER - TY - JOUR AB - Multidisciplinary pulmonary embolism response teams (PERTs) are being implemented to improve care of patients with life-threatening PE. We sought to determine how the creation of PERT affects treatment and outcomes of patients with serious PE. A pre- and post-intervention study was performed using an interrupted time series design, to compare patients with PE before (2006-2012) and after (2012-2016) implementation of PERT at a university hospital. T-tests, Chi square tests and logistic regression were used to compare outcomes, and multivariable regression were used to adjust for differences in PE severity. Two-sided p-value<0.05 was considered significant. For the interrupted time-series analysis, data was divided into mutually exclusive 6-month time periods (11 pre- and 7 post-PERT). To examine changes in treatment and outcomes associated with PERT, slopes and change points were compared pre- and post-PERT. Two-hundred and twelve pre-PERT and 228 post-PERT patients were analyzed. Patient demographics were generally similar, though pre-PERT, PE were more likely to be low-risk (37% vs. 19%) while post-PERT, PE were more likely to be submassive (32% vs. 49%). More patients underwent catheter directed therapy (1% vs. 14%, p=<0.0001) or any advanced therapy (19 [9%] vs. 44 [19%], p=0.002) post PERT. Interrupted time series analysis demonstrated that this increase was sudden and coincident with implementation of PERT, and most noticeable among patients with submassive PE. There were no differences in major bleeding or mortality pre- and post-PERT. While the use of advanced therapies, particularly catheter-directed therapies, increased after creation of PERT, especially among patients with submassive PE, there was no apparent increase in bleeding. AD - [Rosovsky, Rachel] Harvard Med Sch, Div Hematol & Oncol, Dept Med, Massachusetts Gen Hosp, 55 Fruit St, Boston, MA 02114 USA. [Chang, Yuchiao] Harvard Med Sch, Massachusetts Gen Hosp, Div Gen Internal Med, Dept Med, Boston, MA USA. [Rosenfield, Kenneth; Weinberg, Ido] Harvard Med Sch, Massachusetts Gen Hosp, Div Cardiol, Dept Med, Boston, MA USA. [Channick, Richard; Witkin, Alison; Rodriguez-Lopez, Josanna] Harvard Med Sch, Massachusetts Gen Hosp, Div Pulm & Crit Care, Dept Med, Boston, MA USA. [Jaff, Michael R.] Newton Wellesley Hosp, Dept Med, Newton, MA USA. [Sundt, Thoralf] Harvard Med Sch, Massachusetts Gen Hosp, Div Cardiac Surg, Dept Surg, Boston, MA USA. [Parry, Blair A.; Harshbarger, Savannah; Hariharan, Praveen; Kabrhel, Christopher] Harvard Med Sch, Massachusetts Gen Hosp, Dept Emergency Med, Ctr Vasc Emergencies, Boston, MA USA. Rosovsky, R (corresponding author), Harvard Med Sch, Div Hematol & Oncol, Dept Med, Massachusetts Gen Hosp, 55 Fruit St, Boston, MA 02114 USA. rprosovsky@partners.org AN - WOS:000456066400004 AU - Rosovsky, R. AU - Chang, Y. C. AU - Rosenfield, K. AU - Channick, R. AU - Jaff, M. R. AU - Weinberg, I. AU - Sundt, T. AU - Witkin, A. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Hariharan, P. AU - Kabrhel, C. DA - Jan DO - 10.1007/s11239-018-1737-8 J2 - J. Thromb. Thrombolysis KW - Pulmonary embolism Pulmonary embolism response team PERT Treatment Thrombolysis VENOUS THROMBOEMBOLISM THROMBOLYSIS MANAGEMENT EPIDEMIOLOGY FIBRINOLYSIS DIAGNOSIS THERAPY TRIAL CARE Cardiac & Cardiovascular Systems Hematology Peripheral Vascular Disease LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: HH9NT Times Cited: 18 Cited Reference Count: 29 Rosovsky, Rachel Chang, Yuchiao Rosenfield, Kenneth Channick, Richard Jaff, Michael R. Weinberg, Ido Sundt, Thoralf Witkin, Alison Rodriguez-Lopez, Josanna Parry, Blair A. Harshbarger, Savannah Hariharan, Praveen Kabrhel, Christopher Rosovsky, Rachel/0000-0002-2392-7365 18 0 1 SPRINGER DORDRECHT J THROMB THROMBOLYS PY - 2019 SN - 0929-5305 SP - 31-40 ST - Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis T2 - Journal of Thrombosis and Thrombolysis TI - Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis UR - ://WOS:000456066400004 VL - 47 ID - 761550 ER - TY - JOUR AD - [Rosovsky, Rachel] Harvard Med Sch, Massachusetts Gen Hosp, Div Hematol & Oncol, Dept Med, 55 Fruit St, Boston, MA 02114 USA. [Chang, Yuchiao] Harvard Med Sch, Massachusetts Gen Hosp, Div Gen Internal Med, Dept Med, Boston, MA USA. [Rosenfield, Kenneth; Weinberg, Ido] Harvard Med Sch, Massachusetts Gen Hosp, Div Cardiol, Dept Med, Boston, MA USA. [Channick, Richard; Witkin, Alison; Rodriguez-Lopez, Josanna] Harvard Med Sch, Massachusetts Gen Hosp, Div Pulm & Crit Care, Dept Med, Boston, MA USA. [Jaff, Michael R.] Newton Wellesley Hosp, Dept Med, Newton, MA USA. [Sundt, Thoralf] Harvard Med Sch, Massachusetts Gen Hosp, Div Cardiac Surg, Dept Surg, Boston, MA USA. [Parry, Blair A.; Harshbarger, Savannah; Hariharan, Praveen; Kabrhel, Christopher] Harvard Med Sch, Massachusetts Gen Hosp, Dept Emergency Med, Ctr Vasc Emergencies, Boston, MA USA. Rosovsky, R (corresponding author), Harvard Med Sch, Massachusetts Gen Hosp, Div Hematol & Oncol, Dept Med, 55 Fruit St, Boston, MA 02114 USA. rprosovsky@partners.org AN - WOS:000456066400005 AU - Rosovsky, R. AU - Chang, Y. C. AU - Rosenfield, K. AU - Channick, R. AU - Jaff, M. R. AU - Weinberg, I. AU - Sundt, T. AU - Witkin, A. AU - Rodriguez-Lopez, J. AU - Parry, B. A. AU - Harshbarger, S. AU - Hariharan, P. AU - Kabrhel, C. DA - Jan DO - 10.1007/s11239-018-1787-y J2 - J. Thromb. Thrombolysis KW - Cardiac & Cardiovascular Systems Hematology Peripheral Vascular Disease LA - English M1 - 1 M3 - Correction N1 - ISI Document Delivery No.: HH9NT Times Cited: 0 Cited Reference Count: 1 Rosovsky, Rachel Chang, Yuchiao Rosenfield, Kenneth Channick, Richard Jaff, Michael R. Weinberg, Ido Sundt, Thoralf Witkin, Alison Rodriguez-Lopez, Josanna Parry, Blair A. Harshbarger, Savannah Hariharan, Praveen Kabrhel, Christopher Rosovsky, Rachel/0000-0002-2392-7365 0 SPRINGER DORDRECHT J THROMB THROMBOLYS PY - 2019 SN - 0929-5305 SP - 41-41 ST - Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis (vol 47, pg 31, 2019) T2 - Journal of Thrombosis and Thrombolysis TI - Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis (vol 47, pg 31, 2019) UR - ://WOS:000456066400005 VL - 47 ID - 761551 ER - TY - JOUR AB - Background: Multidisciplinary teams are being developed to respond to patients with severe pulmonary embolism (PE). Objectives: We sought to determine if the implementation of a multidisciplinary pulmonary embolism response team (PERT) changes the treatment and outcomes of patients who present to the ED with severe PE. Methods: We analyzed prospectively collected data from patients with severe PE who presented to an urban teaching hospital ED. We defined severe PE as central (lobar, main pulmonary artery or saddle) PE plus one of the following: SBP ≤90 mmHg, heart rate ≥100 bpm, right heart strain on CT or echocardiogram, troponin-t ≥0.04 ng/ml or NT-proBNP ≥500 pg/ml. We used a quasi-experimental interrupted-time series design to compare matched patients with PE before (2008-11) and after (2012-14) the creation of a PERT. We compared demographics, symptoms, comorbid illnesses, treatment and outcomes using proportions and chi-squared statistics. Results: A total of 101 patients before PERT and 89 patients after PERT met criteria for severe PE. The groups were similar in terms of age, gender, comorbidities including coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, asthma, cancer, and surgery within 30 days and presenting symptoms of syncope and shortness of breath. More patients after PERT had chronic kidney disease, hypotension, chest pain and hypoxia. Deep vein thrombosis was diagnosed more frequently after PERT (57% vs 37%, p=0.003). Patients after PERT were more likely to receive catheter directed thrombolysis (18% vs 1.0%, p<0.0001) and IVC filters (32% vs. 0%, p<0.0001). Surgical thrombectomy was performed rarely (6% after PERT vs. 1% before PERT, p=0.069) with a difference that approached statistical significance. The rates of intravenous thrombolysis and 30-day mortality were not different. Conclusion: In patients with central PE and at least one additional marker of disease severity, the implementation of a multidisciplinary PERT is associated with an increased use of catheter directed thrombolysis, IVC filter and possibly surgical thrombectomy. AD - R. Rosovsky, Massachusetts General Hospital, Boston, MA, United States AU - Rosovsky, R. AU - Provias, T. AU - Weinberg, I. AU - Channick, R. AU - Rosenfield, K. AU - Jaff, M. AU - Hariharan, P. AU - Alden Parry, B. AU - Chang, Y. AU - Kabrhel, C. DB - Embase DO - 10.1111/acem.12644 KW - troponin T marker lung embolism human patient society emergency medicine blood clot lysis filter catheter surgical thrombectomy chronic obstructive lung disease coronary artery disease heart rate statistics deep vein thrombosis diseases gender congestive heart failure time series analysis pulmonary artery thorax pain hypotension chronic kidney failure dyspnea echocardiography hypoxia faintness surgery neoplasm asthma disease severity mortality statistical significance heart teaching hospital LA - English M1 - 5 M3 - Conference Abstract N1 - L71879512 2015-05-13 PY - 2015 SN - 1069-6563 SP - S380-S381 ST - The effect of a pulmonary embolus response team (PERT) on treatments and outcomes in patients with severe PE T2 - Academic Emergency Medicine TI - The effect of a pulmonary embolus response team (PERT) on treatments and outcomes in patients with severe PE UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71879512&from=export http://dx.doi.org/10.1111/acem.12644 VL - 22 ID - 761070 ER - TY - JOUR AU - Rosovsky, Rachel AU - Zhao, Ken AU - Sista, Akhilesh DA - 2019 DB - German National Library of Science and Technology (TIB) PY - 2019 ST - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions T2 - Wiley TI - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions UR - https://www.tib.eu/en/search/id/wiley:doi~10.1002%252FRTH2.12216/Pulmonary-embolism-response-teams-Purpose-evidence?cHash=76d9a954179d08ef4ad291d7ade144e7 ID - 762088 ER - TY - JOUR AB - Pulmonary embolism (PE) is a major cause of morbidity and mortality in the United States. Although new therapeutic tools and strategies have recently been developed for the diagnosis and treatment of patients with PE, the outcomes for patients who present with massive or high-risk PE remain dismal. To address this crisis, pulmonary embolism response teams (PERTs) are being created around the world in an effort to immediately and simultaneously engage multiple specialists to determine the best course of action and coordinate the clinical care for patients with acute PE. The scope of this review is to describe the PERT model and purpose, present the structure and organization, examine the available evidence for efficacy and usefulness, and propose future directions for research that is needed to demonstrate the value of PERT and determine if this multidisciplinary approach represents a new standard of care. AD - [Rosovsky, Rachel] Massachusetts Hosp, Dept Med, Div Hematol & Oncol, Boston, MA USA. [Zhao, Ken; Sista, Akhilesh] NYU, Dept Radiol, Div Pulm Allergy & Crit Care Med, Langone Med Ctr, 560 1St Ave, New York, NY 10016 USA. [Rivera-Lebron, Belinda] Univ Pittsburgh, Dept Med, Div Pulm Allergy & Crit Care Med, Pittsburgh, PA USA. [Kabrhel, Christopher] Massachusetts Gen Hosp, Dept Emergency Med, Ctr Vasc Emergencies, Boston, MA 02114 USA. Rosovsky, R (corresponding author), Massachusetts Gen Hosp, Dept Med, Div Hematol & Oncol, 55 Fruit St, Boston, MA 02114 USA. rprosovsky@mgh.harvard.edu AN - WOS:000564243500004 AU - Rosovsky, R. AU - Zhao, K. AU - Sista, A. AU - Rivera-Lebron, B. AU - Kabrhel, C. DA - Jul DO - 10.1002/rth2.12216 J2 - Res. Pract. Thromb. Haemost. KW - advanced therapies catheter-directed thrombolysis follow-up care multidisciplinary pulmonary embolism pulmonary embolism response team DIRECT ORAL ANTICOAGULANTS QUALITY-OF-LIFE VENOUS THROMBOEMBOLISM ORGANIZATIONAL SURVEY RISK-STRATIFICATION CLINICAL-OUTCOMES MULTIDISCIPLINARY THROMBOLYSIS MANAGEMENT DIAGNOSIS Hematology LA - English M1 - 3 M3 - Review N1 - ISI Document Delivery No.: NG8PZ Times Cited: 9 Cited Reference Count: 92 Rosovsky, Rachel Zhao, Ken Sista, Akhilesh Rivera-Lebron, Belinda Kabrhel, Christopher Sista, Akhilesh/0000-0001-5582-796X 9 0 WILEY HOBOKEN RES PRACT THROMB HAE PY - 2019 SP - 315-330 ST - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions T2 - Research and Practice in Thrombosis and Haemostasis TI - Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions UR - ://WOS:000564243500004 VL - 3 ID - 761517 ER - TY - JOUR AB - The co-existence of COVID-19 and PE, two life threatening illnesses, in the same patient presents a unique challenge. Recent guidelines have delineated how best to diagnose and manage patients with PE. However, the unique aspects of this virus confound both the diagnosis and treatment of PE, and thus require modification of established algorithms.1-6 Important considerations include adjustment of diagnostic modalities, incorporation of the pro-thrombotic contribution of COVID-19, management of two critical cardio-respiratory illnesses in the same patient, and protecting patients and health care workers while providing optimal care. The benefits of a team-based approach for decision-making and coordination of care, such as that offered by pulmonary embolism response teams (PERT), has become more evident in this crisis. The importance of careful followup care also is underscored for patients with these two diseases with long-term effects. This position paper from the PERT Consortium specifically addresses issues related to the diagnosis and management of PE in the COVID-19 patient. AU - Rosovsky, R. P. AU - Grodzin, C. AU - Channick, R. AU - Davis, G. A. AU - Giri, J. S. AU - Horowitz, J. AU - Kabrhel, C. AU - Lookstein, R. AU - Merli, G. AU - Morris, T. A. AU - Rivera-Lebron, B. AU - Tapson, V. AU - Todoran, T. M. AU - Weinberg, A. S. AU - Rosenfield, K. DB - Medline DO - 10.1016/j.chest.2020.08.2064 KW - adult algorithm catheter directed thrombolysis coronavirus disease 2019 decision making follow up health care personnel human nonhuman pandemic practice guideline pulmonary embolism response team review thrombosis virus LA - English M3 - Article in Press N1 - L632739534 2020-09-08 PY - 2020 SN - 1931-3543 ST - Diagnosis and Treatment of Pulmonary Embolism During the COVID-19 Pandemic: A Position Paper from the National PERT Consortium T2 - Chest TI - Diagnosis and Treatment of Pulmonary Embolism During the COVID-19 Pandemic: A Position Paper from the National PERT Consortium UR - https://www.embase.com/search/results?subaction=viewrecord&id=L632739534&from=export http://dx.doi.org/10.1016/j.chest.2020.08.2064 ID - 760548 ER - TY - JOUR AU - Rosovsky, R. P. AU - Grodzin, C. AU - Channick, R. AU - Davis, G. A. AU - Giri, J. S. AU - Horowitz, J. AU - Kabrhel, C. AU - Lookstein, R. AU - Merli, G. AU - Morris, T. A. AU - Rivera-Lebron, B. AU - Tapson, V. AU - Todoran, T. M. AU - Weinberg, A. S. AU - Rosenfield, K. AU - Consortium, Pert DA - 2020/08/31 08/31 DB - Europe 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: A Position Paper From the National PERT Consortium T2 - Chest TI - Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic: A Position Paper From the National PERT Consortium UR - http://europepmc.org/article/MED/32861692 ID - 762027 ER - TY - JOUR AB - Background: In ischemic stroke, administration of tissue plasminogen activator (tPA) within 4.5 hours from the time last known well (LKW) improves outcomes, with better outcomes seen with earlier administration. However, for patients presenting early, a perception of significant remaining time within this window may lead to delayed tPA administration. We hypothesized that cases with a shorter LKW-to-stroke team activation (code) time will have a longer "code-to-tPA" administration time. Methods: In the Mount Sinai Hospital Stroke Registry (2009-2015), 122 patients received tPA. The patients were divided by "LKW-to-code" time into 3 groups: 0-59 minutes (n = 38), 60-119 minutes (n = 49), and 120 minutes or more (n = 35). The "code-to-tPA" time was compared among these groups, adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS) score, and race-ethnicity. Results: The average "code-to-tPA" time was 80 minutes in the 0-59 minutes group, 67 minutes in the 60-119 minutes group, and 52 minutes in the 120 minutes or more group (analysis of variance P <.0001). There was an average 28-minute difference (P =.021) between the 0-59 and 120 minutes or more groups. Conclusion: There was a significant negative correlation between the LKW-to- code time and the "code-to-tPA" time that was independent of age, sex, NIHSS score, and race-ethnicity. AD - [Rossi, Kyle C.; Liang, John W.; Wilson, Natalie; Tuhrim, Stanley; Dhamoon, Mandip S.] Icahn Sch Med Mt Sinai, Dept Neurol, 1468 Madison Ave, New York, NY 10029 USA. Liang, JW (corresponding author), Icahn Sch Med Mt Sinai, Dept Neurol, 1468 Madison Ave, New York, NY 10029 USA. johnliangmd@gmail.com AN - WOS:000396430100020 AU - Rossi, K. C. AU - Liang, J. W. AU - Wilson, N. AU - Tuhrim, S. AU - Dhamoon, M. S. DA - Jan DO - 10.1016/j.jstrokecerebrovasdis.2016.08.031 J2 - J. Stroke Cerebrovasc. Dis. KW - Ischemic stroke cerebrovascular disease quality improvement tPA alteplase IN-HOSPITAL DELAYS GUIDELINES-STROKE THROMBOLYSIS CARE THERAPY DOOR Neurosciences Peripheral Vascular Disease LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: EO1AO Times Cited: 2 Cited Reference Count: 12 Rossi, Kyle C. Liang, John W. Wilson, Natalie Tuhrim, Stanley Dhamoon, Mandip S. Liang, John/I-4741-2019 Liang, John/0000-0001-6055-0918; Rossi, Kyle/0000-0003-0607-7802 2 0 ELSEVIER SCIENCE BV AMSTERDAM J STROKE CEREBROVASC PY - 2017 SN - 1052-3057 SP - 70-73 ST - More Time Is Taken to Administer Tissue Plasminogen Activator in Ischemic Stroke Patients with Earlier Presentations T2 - Journal of Stroke & Cerebrovascular Diseases TI - More Time Is Taken to Administer Tissue Plasminogen Activator in Ischemic Stroke Patients with Earlier Presentations UR - ://WOS:000396430100020 VL - 26 ID - 761677 ER - TY - JOUR AB - Objectives: The purpose of the present study is to evaluate the safety and efficacy of “low-dose” systemic thrombolytic therapy (TT) for treatment of patients with intermediate-high risk submassive pulmonary embolism (PE). Background: TT is increasingly utilized in acute submassive PE. Strategies for TT include catheter-directed administration as well as traditional IV systemic therapy. Regardless of the route, most studies document the attendant significant bleeding complication rates expected from induction of a systemic lytic state. To mitigate bleeding, “low-dose” systemic TT (Alteplase 50 mg) has been advocated, based on recent studies which demonstrated clinical efficacy with elimination of any significant bleeding complications. Methods: Over a 24-month period, our institutional PE Response Team treated 45 acute submassive PE patients with “Low Dose” IV Alteplase 50 mg. Clinical outcomes and bleeding complications were assessed. Results: Overall clinical outcome was excellent, with 97.8% of patients surviving to discharge and a 30-day, all-cause mortality of 4.4%. Despite no patients having a HAS-BLED score > 2 (average score = 0.8 +/−), ISTH major and GUSTO moderate bleeding was observed in 11% (n = 5) of cases. Conclusions: The present observations document that low-dose systemic TT is associated with excellent clinical outcome for intermediate-high risk submassive PE, but with attendant risk for bleeding. These findings are consistent with the concept that induction of a therapeutic lytic state carries inextricable bleeding risk. AD - D.P. Rothschild, Department of Cardiovascular Medicine, Diseases, Beaumont Health, Royal Oak, MI, United States AU - Rothschild, D. P. AU - Goldstein, J. A. AU - Bowers, T. R. DB - Embase Medline DO - 10.1002/ccd.28042 KW - alteplase adult all cause mortality article bleeding clinical article clinical assessment clinical outcome clinical trial cohort analysis comorbidity computed tomographic angiography disease burden drug efficacy drug safety female fibrinolytic therapy high risk patient hospital discharge human low drug dose lung embolism male middle aged risk assessment scoring system survival rate survival time systemic therapy treatment response vasodilatation LA - English M1 - 3 M3 - Article N1 - L625512525 2018-12-24 2019-03-05 PY - 2019 SN - 1522-726X 1522-1946 SP - 506-510 ST - Low-dose systemic thrombolytic therapy for treatment of submassive pulmonary embolism: Clinical efficacy but attendant hemorrhagic risks T2 - Catheterization and Cardiovascular Interventions TI - Low-dose systemic thrombolytic therapy for treatment of submassive pulmonary embolism: Clinical efficacy but attendant hemorrhagic risks UR - https://www.embase.com/search/results?subaction=viewrecord&id=L625512525&from=export http://dx.doi.org/10.1002/ccd.28042 VL - 93 ID - 760745 ER - TY - JOUR AB - Ultrasound-accelerated thrombolysis (USAT) is advocated in pulmonary embolism (PE) based on the hypothesis that adjunctive ultrasound provides superior clinical efficacy compared to standard catheter-directed thrombolysis (CDT). This retrospective study was designed to compare outcomes between the two modalities. We analyzed patients with computed tomography-diagnosed PE at our institution treated with either USAT or standard CDT. Efficacy parameters assessed included invasive pulmonary artery systolic pressure (PASP; pre- and 24 hours post-treatment), non-invasive right-to-left ventricle (RV/LV) ratio (pre- and post-treatment), and general clinical outcomes (length-of-stay, significant bleeding, and mortality). We analyzed 98 cases (62 USAT and 36 CDT), in whom massive PE was diagnosed in 7%, intermediate/high risk in 81%, and intermediate/low risk in 12%. Overall, 92% had bilateral clot and 40% saddle embolus. At 24 hours, PASP decreased similarly in both groups (CDT Δ14.7 mmHg, USAT Δ10.8 mmHg; p = 0.14). Post-treatment, CDT showed similar improvement in the RV/LV ratio (CDT Δ0.58 vs USAT Δ0.45; p = 0.07), despite the baseline ratio being greater in the CDT group, indicating more severe RV strain (1.56 ± 0.36 vs 1.40 ± 0.29; p = 0.01). Intensive care unit and hospital length-of-stays were similar in both groups. A trend toward lesser significant bleeding rates in the CDT group (8.3% vs 12.9%, p = 0.74) as well as improved survival-to-discharge (97.2% vs 91.9%, p = 0.66) was observed. Compared to USAT, standard CDT achieves similar beneficial effects on hemodynamics, RV/LV ratios, and clinical outcomes. These observations suggest that salutary clinical results may be achieved without the need for very expensive devices. AD - 1 Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI, USA. 2 Oakland University William Beaumont School of Medicine, Oakland County, MI, USA. 3 Department of Interventional Radiology, Beaumont Health, Royal Oak, MI, USA. AN - 30915912 AU - Rothschild, D. P. AU - Goldstein, J. A. AU - Ciacci, J. AU - Bowers, T. R. DA - Jun DO - 10.1177/1358863x19838350 DP - NLM ET - 2019/03/28 J2 - Vascular medicine (London, England) KW - Adult Aged *Catheterization, Peripheral/adverse effects Computed Tomography Angiography Female Fibrinolytic Agents/*administration & dosage/adverse effects Hemodynamics Humans Length of Stay Male Middle Aged Pulmonary Embolism/diagnostic imaging/physiopathology/*therapy Retrospective Studies Thrombolytic Therapy/adverse effects/*methods Time Factors Tissue Plasminogen Activator/*administration & dosage/adverse effects Treatment Outcome Ultrasonic Therapy/adverse effects/*methods *PE Response Team(PERT) *bleeding *catheter-directed thrombolysis *hospital length of stay *pulmonary embolism (PE) *thrombolytic therapy *ultrasound-accelerated thrombolysis LA - eng M1 - 3 N1 - 1477-0377 Rothschild, Daniel P Orcid: 0000-0002-7128-4739 Goldstein, James A Ciacci, Joseph Bowers, Terry R Comparative Study Journal Article England Vasc Med. 2019 Jun;24(3):234-240. doi: 10.1177/1358863X19838350. Epub 2019 Mar 27. PY - 2019 SN - 1358-863x SP - 234-240 ST - Ultrasound-accelerated thrombolysis (USAT) versus standard catheter-directed thrombolysis (CDT) for treatment of pulmonary embolism: A retrospective analysis T2 - Vasc Med TI - Ultrasound-accelerated thrombolysis (USAT) versus standard catheter-directed thrombolysis (CDT) for treatment of pulmonary embolism: A retrospective analysis VL - 24 ID - 760165 ER - TY - JOUR AB - The occurrence of transplant renal artery stenosis (TRAS) ranges from 1 to 23% and is associated with resistant hypertension, volume overload, graft dysfunction, and poor long-term graft and patient survival. Enhancing graft availability with expanded criteria donors results in the transplantation of kidneys with atherosclerotic arteries, increasing the risk of vascular complications. Although endovascular management is the first-line strategy in this context, in some patients, surgery has to be considered. We report the experience and long-term follow-up of TRAS surgery in a French kidney transplantation center. Between 2004 and 2009, 10 patients with postoperative TRAS, considered unfit for an endovascular procedure by a multidisciplinary team, were addressed for surgery. Mean time from transplantation to surgery was 139.8 ± 136.4 days. Clinical indications were oliguria, anuria, or acute decrease in urine output (n = 5), resistant hypertension (n = 4), and persistence of a decreased allograft function (n = 1). Imaging-revealed ostial stenosis is associated with external iliac artery stenosis (n = 3) or early bifurcation (n = 2), and kinking (n = 5). Revascularization techniques consisted in a great saphenous vein bypass (n = 5) and internal iliac artery anastomosis (n = 5). In the postoperative period, there was no graft loss, but 2 patients required hemodialysis during the first week. Mean follow-up was 9.8 ± 2.1 years. One patient lost his graft 10.3 years after transplantation due to chronic rejection, and 1 patient needed endovascular dilation. There was no graft loss at 5 years. Blood pressure was controlled in all patients. Surgical intervention for TRAS is safe and effective on graft survival and graft function and has to be considered for patients unsuitable for endovascular repair. AD - Department of Vascular Surgery, Rouen University Hospital, Rouen, France. Electronic address: mrouer@gmail.com. Department of Vascular Surgery, Rouen University Hospital, Rouen, France. Department of Nephrology, Rouen University Hospital, Rouen, France. AN - 30092435 AU - Rouer, M. AU - Godier, S. AU - Monnot, A. AU - Etienne, I. AU - Bertrand, D. AU - Guerrot, D. AU - Plissonnier, D. DA - Jan DO - 10.1016/j.avsg.2018.05.066 DP - NLM ET - 2018/08/10 J2 - Annals of vascular surgery KW - Adult Anastomosis, Surgical Angiography Female Follow-Up Studies Graft Survival Humans Iliac Artery/surgery *Kidney Transplantation Male Middle Aged Renal Artery Obstruction/diagnostic imaging/etiology/*surgery Retrospective Studies Saphenous Vein/surgery Treatment Outcome LA - eng N1 - 1615-5947 Rouer, Martin Godier, Sylvie Monnot, Antoine Etienne, Isabelle Bertrand, Dominique Guerrot, Dominique Plissonnier, Didier Journal Article Netherlands Ann Vasc Surg. 2019 Jan;54:261-268. doi: 10.1016/j.avsg.2018.05.066. Epub 2018 Aug 6. PY - 2019 SN - 0890-5096 SP - 261-268 ST - Long-term Outcomes after Transplant Renal Artery Stenosis Surgery T2 - Ann Vasc Surg TI - Long-term Outcomes after Transplant Renal Artery Stenosis Surgery VL - 54 ID - 760279 ER - TY - JOUR AB - OBJECTIVE: Arterial acute mesenteric ischemia (AAMI) is a vascular and gastroenterologic emergency, most often surgical, still associated with a poor prognosis and frequent short bowel syndrome in survivors. We report the results of revascularization in AAMI patients after the creation of an intestinal stroke center. METHODS: Since July 2009, we developed a multimodal and multidisciplinary management for AMI, focusing on intestinal viability and involving gastroenterologists, vascular and abdominal surgeons, radiologists, and intensive care specialists. This management was the first step to the creation of an intestinal stroke center, based on the stroke unit model. All patients received: (1) a specific medical protocol; (2) endovascular and/or open surgical revascularization whenever possible; and/or (3) resection of non-viable small bowel. We aimed to study survival, morbidity, type of revascularization, and bowel resection in patients who benefited from arterial revascularization in our intestinal stroke center. RESULTS: Eighty-three patients with AMI were prospectively enrolled in the intestinal stroke center. Among them, 29 patients with AAMI underwent revascularization. The mean age was 50.2 ± 12 years, with 41% of male gender. The mean follow-up was 22.7 ± 19 months. Overall 2-year survival was 89.2%, and 30-day operative mortality was 6.9%. Surgical revascularization included bypass grafting (65%), endarterectomy with patch angioplasty (21%) ± retrograde open mesenteric stenting of the superior mesenteric artery (7%), and endovascular revascularization as first stage procedure (38%). The 2-year primary patency rate of open revascularization was 88%. The rate and the median length of bowel resected were 24% and 43 cm (range, 36-49 cm), respectively. CONCLUSIONS: In our experience, revascularization of AAMI patients as part of a multidisciplinary and multimodal management leads to encouraging results. Vascular surgeons have a central role in a dedicated intestinal stroke center. AD - Department of Vascular and Thoracic Surgery, Groupe Hospitalier Universitaire Paris Nord Val de Seine, Faculté de médicine Denis Diderot, Paris, France. Electronic address: arnaudkiem.roussel@gmail.com. Department of Vascular and Thoracic Surgery, Groupe Hospitalier Universitaire Paris Nord Val de Seine, Faculté de médicine Denis Diderot, Paris, France. Department of Gastroenterology, Inflammatory Bowel Diseases, Nutritional Support, and Intestinal Transplantation, Groupe Hospitalier Universitaire Paris Nord Val de Seine, Faculté de médicine Denis Diderot, Paris, France. Department of Radiology, Groupe Hospitalier Universitaire Paris Nord Val de Seine, Faculté de médicine Denis Diderot, Paris, France. Department of Colorectal Surgery and Intestinal Transplantation, Groupe Hospitalier Universitaire Paris Nord Val de Seine, Faculté de médicine Denis Diderot, Paris, France. AN - 26243208 AU - Roussel, A. AU - Castier, Y. AU - Nuzzo, A. AU - Pellenc, Q. AU - Sibert, A. AU - Panis, Y. AU - Bouhnik, Y. AU - Corcos, O. DA - Nov DO - 10.1016/j.jvs.2015.06.204 DP - NLM ET - 2015/08/06 J2 - Journal of vascular surgery KW - Acute Disease Adult Cooperative Behavior Critical Pathways *Digestive System Surgical Procedures/adverse effects/mortality *Endovascular Procedures/adverse effects/mortality Female *Hospitals, University Humans *Interdisciplinary Communication Kaplan-Meier Estimate Male Mesenteric Ischemia/diagnosis/mortality/*surgery Mesenteric Vascular Occlusion/diagnosis/mortality/*surgery Middle Aged *Patient Care Team Prospective Studies Risk Factors Time Factors Treatment Outcome *Vascular Surgical Procedures/adverse effects/mortality LA - eng M1 - 5 N1 - 1097-6809 Roussel, Arnaud Castier, Yves Nuzzo, Alexandre Pellenc, Quentin Sibert, Annie Panis, Yves Bouhnik, Yoram Corcos, Olivier Journal Article United States J Vasc Surg. 2015 Nov;62(5):1251-6. doi: 10.1016/j.jvs.2015.06.204. Epub 2015 Aug 1. PY - 2015 SN - 0741-5214 SP - 1251-6 ST - Revascularization of acute mesenteric ischemia after creation of a dedicated multidisciplinary center T2 - J Vasc Surg TI - Revascularization of acute mesenteric ischemia after creation of a dedicated multidisciplinary center VL - 62 ID - 760228 ER - TY - JOUR AB - Despite clear potential benefits of outpatient care, most patients suffering from pulmonary embolism (PE) are currently hospitalized due to the fear of possible adverse events. Nevertheless, some teams have increased or envisage to increase outpatient treatment or early discharge. We performed a narrative systematic review of studies published on this topic. We identified three meta-analyses and 23 studies, which involved 3671 patients managed at home (n = 3036) or discharged early (n = 535). Two main different approaches were applied to select patients eligible for outpatient in recent prospective studies, one based on a list of pragmatic criteria as the HESTIA rule, the other adding severity criteria (i.e. risk of death) as the Pulmonary Embolism Severity Criteria (PESI) or simplified PESI. In all these studies, a specific follow-up was performed for patients managed at home involving a dedicated team. The overall early (i.e. between 1 to 3 months) complication rate was low, <2% for thromboembolic recurrences or major bleedings and <3% for deaths with no evidence in favour of one selection strategy or another. Outpatient management appears to be feasible and safe for many patients with PE. In the coming years, outpatient treatment may be considered as the first line management for hemodynamically stable PE patients, subject to the respect of simple eligibility criteria and on the condition that a specific procedure for outpatient care is developed in advance. (C) 2017 Elsevier Ltd. All rights reserved. AD - [Roy, P-M; Moumneh, T.] CHU Angers, Emergency Dept, Angers, France. [Roy, P-M; Moumneh, T.] Univ Angers, Inst MITOVASC, EA 3860, Angers, France. [Penaloza, A.] Catholic Univ Louvain, Clin Univ St Luc, Emergency Dept, Brussels, Belgium. [Sanchez, O.] Univ Paris 05, Hop Europeen Georges Pompidou, AP HP, Sorbonne Paris Cite,Dept Pneumol, Paris, France. Roy, PM (corresponding author), CHU Angers, Dept Med Urgence, Ctr Vasc & Coagulat, 4 Rue Larrey, F-49933 Angers 09, France. PMRoy@chu-angers.fr AN - WOS:000405681800017 AU - Roy, P. M. AU - Moumneh, T. AU - Penaloza, A. AU - Sanchez, O. DA - Jul DO - 10.1016/j.thromres.2017.05.001 J2 - Thromb. Res. KW - Pulmonary embolism Outpatient treatment Hospitalization Systematic review DEEP-VEIN THROMBOSIS VENOUS THROMBOEMBOLISM HOME TREATMENT INPATIENT TREATMENT EMERGENCY-DEPARTMENTS CONSECUTIVE PATIENTS ORAL ANTICOAGULANTS ADVERSE EVENTS TERM RISK THERAPY Hematology Peripheral Vascular Disease LA - English M3 - Review N1 - ISI Document Delivery No.: FA8FO Times Cited: 19 Cited Reference Count: 51 Roy, P-M Moumneh, T. Penaloza, A. Sanchez, O. SANCHEZ, Olivier/0000-0003-1633-8391 19 2 3 PERGAMON-ELSEVIER SCIENCE LTD OXFORD THROMB RES PY - 2017 SN - 0049-3848 SP - 92-100 ST - Outpatient management of pulmonary embolism T2 - Thrombosis Research TI - Outpatient management of pulmonary embolism UR - ://WOS:000405681800017 VL - 155 ID - 761647 ER - TY - JOUR AB - Objectives: To improve the financial profitability associated with the elective AAA pathway. Methods: Two clinical audits were performed. The first audit analysed a 2-year period data for patients (n = 292) undergoing AAA elective endovascular repair (EVAR). The second audit integrated a total of five clinical and financial databases during a period of 6 months (n = 109) to map the clinical pathway alongside the respective income generated and costs incurred. Both income and cost data are estimated based on patient-level data and visually depicted on a diagram using Lean-based waste identification techniques. Subsequently, based on the data provided, a multidisciplinary team engaged in a 3-month organisation-wide transformation programme to redesign the elective AAA pathway, focusing on opportunities to: i) maximise income; and ii) minimise costs incurred in the provision of care. Results: Prior to any intervention, the NHS Trust presented a total deficit of £4,936 for the elective AAA pathway (total income of £2,198,314 and £2,203,250 in costs, n = 109). This is equivalent to a mean deficit per patient of £51 (IQR -£66,738 to £36,689). An in-depth analysis highlighted the variability associated with the type of procedure, as well as the financial impact of high-dependence unit beds and moreover vascular stents (represent 52.2% and 61.6% of the income and costs, respectively). Following the redesign transformation programme, several initiatives aimed at maximising the income and/or curb the cost curve. First, a clinical coding training scheme for Vascular Surgeons (with particular emphasis in listing comorbidities), anticipated to generate an additional 2.5-5% of income. Second, the revision of the internal stent policy and enrolment in the national purchase system for high-cost devices. The latter means that, over a 3-year period, the vascular stents will have a neutral financial impact. Third, a set of localised and pathway-specific initiatives were considered. These include the: i) employment of a clinical nurse as the AAA Pathway Coordinator, responsible for setting up a telephone clinic for initial and follow-up appointments; ii) increase in the proportion of 'on the day' admissions, leading to the decrease in the overall hospital length of stay; and iii) decrease in the utilisation of high-dependence unit beds. The positive net contribution of these initiatives is estimated at £307,442- £ 362,400, or else 14.0%-16.4% of the total costs. Conclusions: The holistic redesign of clinical pathways, with particular emphasis on patient-level financial data and considering simultaneously income and costs, has the potential to substantially improve the financial sustainability of healthcare providers. AD - T. Rua, Guy's and St Thomas NHS Foundation Trust, United Kingdom AU - Rua, T. DB - Embase DO - 10.1159/000492018 KW - abdominal aortic aneurysm adult clinical audit coding comorbidity conference abstract controlled study cost effectiveness analysis employment endovascular aneurysm repair England female follow up high dependency unit human length of stay major clinical study male multidisciplinary team nurse telephone tertiary health care trust vascular stent vascular surgeon LA - English M3 - Conference Abstract N1 - L628984830 2019-08-27 PY - 2018 SN - 2504-3145 SP - 23 ST - Redesigning care to improve cost-effectiveness: the elective abdominal aortic aneurysm (AAA) pathway in a tertiary care provider in central London T2 - Portuguese Journal of Public Health TI - Redesigning care to improve cost-effectiveness: the elective abdominal aortic aneurysm (AAA) pathway in a tertiary care provider in central London UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628984830&from=export http://dx.doi.org/10.1159/000492018 VL - 36 ID - 760879 ER - TY - JOUR AB - Objectives: To investigate the uptake, safety and efficacy of docetaxel chemotherapy in hormone-naïve metastatic prostate cancer (mPC) in the first year of use outside of a clinical trial. Patients and Methods: Patients in the West of Scotland Cancer Network with newly diagnosed mPC were identified from the regional multidisciplinary team meetings and their treatment details were collected from electronic patient records. The rate of febrile neutropenia, hospitalisations, time to progression, and overall survival were compared between those patients who received docetaxel and androgen-deprivation therapy (ADT), or ADT alone using survival analysis. Results: Of the 270 eligible patients, 103 received docetaxel (38.1%). 35 patients (34%) were hospitalised and there were 17 episodes of febrile neutropenia (16.5%). Two patients (1.9%) died within 30 days of chemotherapy. Patients who received ADT alone had an increased risk of progression (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.27–3.25; log-rank test, P = 0.002) and had an increased risk of death (HR 5.88, 95% CI: 2.52–13.72; log-rank test, P = 0.001) compared to the docetaxel group. The risk of febrile neutropenia was nine-times greater if chemotherapy was started within 3 weeks of ADT initiation (95% CI: 1.22–77.72; P = 0.032). Conclusion: Docetaxel chemotherapy in hormone-naïve mPC has significant toxicities, but has a similar effect on time to progression and overall survival as seen in randomised trials. Chemotherapy should be started at ≥3 weeks after ADT. AD - R.J. Rulach, The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom AU - Rulach, R. J. AU - McKay, S. AU - Neilson, S. AU - White, L. AU - Wallace, J. AU - Carruthers, R. AU - Lamb, C. AU - Cascales, A. AU - Marashi, H. AU - Glen, H. AU - Venugopal, B. AU - Sadoyze, A. AU - Sidek, N. AU - Russell, J. M. AU - Alhasso, A. AU - Dodds, D. AU - Laskey, J. AU - Jones, R. J. AU - MacLeod, N. DB - Embase Medline DO - 10.1111/bju.14025 KW - alanine aminotransferase aspartate aminotransferase docetaxel adult aged androgen deprivation therapy article cancer chemotherapy cancer hormone therapy cohort analysis diarrhea drug efficacy drug fatality drug safety drug tolerability drug uptake drug withdrawal febrile neutropenia hospitalization human hypertransaminasemia infection interstitial pneumonia lung embolism major clinical study male metastasis multiple cycle treatment neurotoxicity overall survival priority journal prostate cancer risk factor treatment outcome LA - English M1 - 2 M3 - Article N1 - L618803118 2017-10-24 2018-02-01 PY - 2018 SN - 1464-410X 1464-4096 SP - 268-274 ST - Real-world uptake, safety profile and outcomes of docetaxel in newly diagnosed metastatic prostate cancer T2 - BJU International TI - Real-world uptake, safety profile and outcomes of docetaxel in newly diagnosed metastatic prostate cancer UR - https://www.embase.com/search/results?subaction=viewrecord&id=L618803118&from=export http://dx.doi.org/10.1111/bju.14025 VL - 121 ID - 760853 ER - TY - JOUR AB - Background: Thrombosis of the dural sinus and/or cerebral veins (CVST) is A rare but potentially devastating type of stroke that tends to occur in young adults. Aim of this study was A critical review of clinical presentation, causative factors and outcome of CVST patients attending our anticoagulation clinic until May 2016. Methods: Prospectively recorded data of Ancona Hematology and Neurology Clinic were retrospectively analyzed. All patients underwent anticoagulation therapy. The quality of oral anticoagulation was estimated by the time in therapeutic range (TTR). The response to initial anticoagulant therapy was evaluated by recanalization of vessels according to the Kaplan-Meier method. Major bleeding (ISTH definition) and vascular events (arterial and venous thrombosis) were also taken into account. results Fourteen patients (median age 39 years, range 20-64 years; 9 females) had CVST. Headache (92%) was the most common presenting symptom. Diagnosis of CVST was confirmed by computed tomography (CT; 50%) and magnetic resonance imaging (MRI; 50%). The majority of cases had multiple sinus involvement (71.4%). Of the 14 CVST patients, four cases (28.5%) had experienced A previous thrombotic episode (venous thromboembolism in 3 cases, CVST in 1 case). Four cases (28.5%) were unprovoked, six (43%) had possibly resolved provoking factors (PR; 4/6 had oral contraceptive consumption) and four (28.5%) had persistent provoking factors (PP; 4/4 with myeloproliferative neoplasm, mainly unclassified subtype). Three cases of CVST were diagnosed in the absence of overt MPN features. In seven cases (50%), the following thrombophilic defects were detected: mild hyperhomocysteinemia (n=3), double heterozygosity for factor V Leiden and prothrombin 20210A (n=1), factor V Leiden heterozygosity (n=1), deficient proteins deficiency (n = 1) and AT deficiency (n=1). All patients were managed with heparin followed by warfarin in 12 out of 14 cases in the succeeding months (INR range 2-3, median TTR 50%). Five patients remained on warfarin treatment during the whole study period. During A median treatment duration of 15 months (1-186) none of the patients experienced major bleeding and/or recurrence of venous thrombosis. After termination of warfarin two patients (one with unprovoked CVST and one with MPN) suffered CVST recurrences; thus, the incidence rate of vascular events was 13.5 per 100 pt-y. Twelve patients (85.7%) obtained vessel recanalization/resolution of thrombosis. The probability of recanalization of the occluded vessels was 50% at 30 months. The median follow-up was 37 months (1-187). No patient died during the observation period. Conclusions: CVST is A serious and potentially life threatening thrombosis. Early diagnosis by A multidisciplinary team and prompt anticoagulation are imperative in achieving an excellent functional outcome. AD - S. Rupoli, Clinica di Ematologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona, Italy AU - Rupoli, S. AU - Gironella, M. AU - Canafoglia, L. AU - Micucci, G. AU - Federici, I. AU - Offidani, M. AU - Da Lio, L. AU - Provinciali, L. AU - Scortechini, A. R. AU - Honorati, E. AU - Leoni, P. DB - Embase KW - blood clotting factor 5 Leiden endogenous compound heparin oral contraceptive agent prothrombin warfarin adult anticoagulant therapy artery thrombosis bleeding case report cerebral sinus thrombosis clinical article clinical outcome cohort analysis computer assisted tomography conference abstract diagnosis early diagnosis female follow up headache hematology heterozygosity human hyperhomocysteinemia incidence international normalized ratio Kaplan Meier method myeloproliferative neoplasm neurology nuclear magnetic resonance imaging probability prospective study recanalization relapse retrospective study thrombophilia treatment duration venous thromboembolism LA - English M3 - Conference Abstract N1 - L621219916 2018-03-19 PY - 2016 SN - 1723-2007 SP - s827 ST - Clinical outcome and management of cerebral sinus vein thrombosis: A retrospective and prospective cohort study T2 - Blood Transfusion TI - Clinical outcome and management of cerebral sinus vein thrombosis: A retrospective and prospective cohort study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621219916&from=export VL - 14 ID - 761001 ER - TY - JOUR AB - Introduction: Recent clinical trials and key opinion leaders have identified endovascular therapy as the best practice guideline for management of large ischemic strokes. The development of an interdisciplinary endovascular stroke response team has identified a gap in managing care for these patients. For optimal procedural efficiency, it was suggested that one clinical professional be required for intravenous thrombolytic management, sedation and hemodynamic monitoring. A level two intensive care nurse was identified as an excellent candidate for this role. Methods: An Ontario-wide environmental assessment exploring the composition of endovascular stroke response teams was conducted in 2015. This, in combination with a gap analysis of the competencies required led to the development of a Clot Retrieval Nurse. This role involves facilitating patient transition from the emergency department, clinically managing the patient intra-procedurally and coordinating transfer to the Level 2 Neurosciences Stepdown Unit post-procedure. Selected nurses underwent an intensive clinical and theoretical training process to gain the competence required to treat stroke patients in the Neurointerventional Radiology suite. Results: One year post-implementation, seven Clot Retrieval nurses have excelled at providing continuity of care and supporting efficiencies in workflow processes. The team provides 24/7 on-site coverage allowing opportunity to stroke endovascular candidates across the hyperacute care continuum. Conclusion: The collaborative role is an innovative integration between the neurosurgical unit and the diagnostic imaging department. The role will continue to evolve as the program expands and patient volumes increase. The role will be sustained through simulated clot retrieval cases along with supplementary education for staff. AD - S. Russell, Hamilton Health Sciences, Canada AU - Russell, S. AU - Beesley, L. AU - McNicol-Whiteman, R. AU - Vens, M. AU - Notarandrea, C. DB - Embase DO - 10.1177/1747493017726723 KW - adult diagnostic imaging education emergency ward female human information retrieval intensive care male neuroscience nurse nursing role Ontario patient care radiology simulation staff stroke patient theoretical study workflow LA - English M1 - 4 M3 - Conference Abstract N1 - L618423081 2017-09-27 PY - 2017 SN - 1747-4949 SP - 86-87 ST - Developing a clot retrieval nursing role to support stroke patients receiving endovascular therapy T2 - International Journal of Stroke TI - Developing a clot retrieval nursing role to support stroke patients receiving endovascular therapy UR - https://www.embase.com/search/results?subaction=viewrecord&id=L618423081&from=export http://dx.doi.org/10.1177/1747493017726723 VL - 12 ID - 760969 ER - TY - JOUR AB - BACKGROUND: In many clinical trials endovascular procedures are suggested as the treatment of choice for aneurysmal Subarachnoid Hemorrhage (aSAH) whenever possible. However, in clinical practice this management is often controversial. The aim of this study is to analyze factors involved in this decision. METHODS: Our study included 317 consecutive cases of aSAH between 2010 and 2016, assessing clinical and neuroradiological features to evaluate their role in this choice. RESULTS: In our series coiling was preferred in 119 (37.6%) patients, while 198 (62.4%) were treated surgically. On univariate analysis location of aneurysms (p < 0.001), GCS score on admission (p: 0.105), degree of midline shift (p:0.015), Fisher' score (p: 0.002) and presence of vessels in the aneurysmal neck (p: 0.071) proved the most relevant factors in the choice. Also multivariate analysis confirmed the location and Fisher' grade as influential factors. Conversely, other radiological parameters, such as morphology, aspect and dome-neck ratio, presence of pre-operative vasospasm or hydrocephalus were not associated with this decision. CONCLUSIONS: The decision process in aSAH requires a multidisciplinary team, to singularly evaluate each patient. We found that the location of aneurysms in Vertebro-Basilar circulation, PCoM and ICA, greater GCS score, absence of vessels in the aneurysmal neck, lower midline shift and Fisher' score are factors influencing in choosing coiling. Conversely, morphology, Aspect and Dome-Neck ratio proved not relevant to this decision, due to technological improvement and increasing skills in the endovascular treatment. AD - IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy 2 IRCCS Istituto delle Scienze Neurologiche di Bologna, Servizio di Epidemiologia e Biostatistica, Bologna, Italy. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurochirurgia, Bologna, Italy. Neuroradiologia, Alma Mater Studiorum Università di Bologna, Bologna, Italy. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neuroradiologia, Bologna, Italy 2 IRCCS Istituto delle Scienze Neurologiche di Bologna, Servizio di Epidemiologia e Biostatistica, Bologna, Italy - luigi.cirillo2@unibo.it. AN - 30311605 AU - Rustici, A. AU - Princiotta, C. AU - Zenesini, C. AU - Bortolotti, C. AU - Sturiale, C. AU - Dall'olio, M. AU - Leonardi, M. AU - Cirillo, L. DA - Oct 10 DO - 10.23736/s0390-5616.18.04430-2 DP - NLM ET - 2018/10/13 J2 - Journal of neurosurgical sciences LA - eng N1 - 1827-1855 Rustici, Arianna Princiotta, Ciro Zenesini, Corrado Bortolotti, Carlo Sturiale, Carmelo Dall'olio, Massimo Leonardi, Marco Cirillo, Luigi Journal Article Italy J Neurosurg Sci. 2018 Oct 10. doi: 10.23736/S0390-5616.18.04430-2. PY - 2018 SN - 0390-5616 ST - The influence of clinical and radiological parameters in treatment of ruptured intracranial aneurysms: a single center 7-year retrospective cohort study T2 - J Neurosurg Sci TI - The influence of clinical and radiological parameters in treatment of ruptured intracranial aneurysms: a single center 7-year retrospective cohort study ID - 760167 ER - TY - JOUR AB - Objective: Kasabach-Merritt phenomenon (KMP) can lead to life-threatening bleeding, and its optimum treatment has not been established. We review the experience of managing KMP in a single institution. Methods: A retrospective chart review on all children with KMP treated at the Hospital for Sick Children, Toronto, over an 18 yr period was carried out. Results: All 15 patients had profound thrombocytopenia and hypofibrinogenemia at presentation, half had bleeding symptoms, and three had cardiac failure. All patients received corticosteroids. Five responded to steroids alone, given for an average of 13 wk, increasing platelets to > 20 x 109/L at a mean of 6.2 d and fibrinogen > 1 g/dL at 25.6 d. Ten patients received at least one other therapeutic modality in addition to steroids, including vincristine, interferon, anti-platelet agents and pentoxifylline. Five patients received vincristine, for a mean of 6 wk, with two patients responding. Eight patients received interferon, for a mean of 4 months, with two patients responding. Overall, the mean time to increasing platelets > 20 x 109/L was 56 d, to > 150 x 109/L was 88 d and fibrinogen > 1 g/dL 49 d. Ten patients showed a partial response to embolisation, with a mean of 2.8 procedures performed. Thrombotic complications occurred in 7%. Twelve patients remain alive, with relapse in six patients, all treated successfully. One patient died, and two patients have been lost to follow-up. Conclusion: KMP is a rare condition, with significant morbidity and mortality. The therapeutic approach should include a multidisciplinary team and consensus on guidelines. AD - [Weinstein, Miriam] Hosp Sick Children, Dept Paediat, Dermatol Sect, Div Paediat Med, Toronto, ON M5G 1X8, Canada. [Ryan, Clodagh] Mercy Univ Hosp, Dept Haematol, Cork, Ireland. [Price, Vicotria] Dalhousie Univ, IWK Hlth Ctr, Dept Paediat, Div Haematol Oncol, Halifax, NS, Canada. [John, Philip] Hosp Sick Children, Div Image Guided Therapy, Toronto, ON M5G 1X8, Canada. [Mahant, Sanjay] Hosp Sick Children, Div Paediat, Toronto, ON M5G 1X8, Canada. [Baruchel, Sylvain; Brandao, Leonardo; Blanchette, Victor] Hosp Sick Children, Dept Paediat, Div Hematol Oncol, Toronto, ON M5G 1X8, Canada. Weinstein, M (corresponding author), Hosp Sick Children, Dept Paediat, Dermatol Sect, Div Paediat Med, 555 Univ Ave, Toronto, ON M5G 1X8, Canada. miriam.weinstein@sickkids.ca AN - WOS:000273301600001 AU - Ryan, C. AU - Price, V. AU - John, P. AU - Mahant, S. AU - Baruchel, S. AU - Brandao, L. AU - Blanchette, V. AU - Pope, E. AU - Weinstein, M. DA - Feb DO - 10.1111/j.1600-0609.2009.01370.x J2 - Eur. J. Haematol. KW - KMP Kasabach-Merritt phenomenon haemangioma embolisation consumptive coagulopathy INFANTILE HEMANGIOMA SPASTIC DIPLEGIA INTERFERON MANAGEMENT THERAPY INFANCY PENTOXIFYLLINE COMPLICATION EMBOLIZATION VINCRISTINE Hematology LA - English M1 - 2 M3 - Review N1 - ISI Document Delivery No.: 540AE Times Cited: 29 Cited Reference Count: 31 Ryan, Clodagh Price, Vicotria John, Philip Mahant, Sanjay Baruchel, Sylvain Brandao, Leonardo Blanchette, Victor Pope, Elena Weinstein, Miriam 41 0 2 WILEY HOBOKEN EUR J HAEMATOL PY - 2010 SN - 0902-4441 SP - 97-104 ST - Kasabach-Merritt phenomenon: a single centre experience T2 - European Journal of Haematology TI - Kasabach-Merritt phenomenon: a single centre experience UR - ://WOS:000273301600001 VL - 84 ID - 761881 ER - TY - JOUR AB - OBJECTIVE: Kasabach-Merritt phenomenon (KMP) can lead to life-threatening bleeding, and its optimum treatment has not been established. We review the experience of managing KMP in a single institution. METHODS: A retrospective chart review on all children with KMP treated at the Hospital for Sick Children, Toronto, over an 18 yr period was carried out. RESULTS: All 15 patients had profound thrombocytopenia and hypofibrinogenemia at presentation, half had bleeding symptoms, and three had cardiac failure. All patients received corticosteroids. Five responded to steroids alone, given for an average of 13 wk, increasing platelets to >20 x 10(9)/L at a mean of 6.2 d and fibrinogen >1 g/dL at 25.6 d. Ten patients received at least one other therapeutic modality in addition to steroids, including vincristine, interferon, anti-platelet agents and pentoxifylline. Five patients received vincristine, for a mean of 6 wk, with two patients responding. Eight patients received interferon, for a mean of 4 months, with two patients responding. Overall, the mean time to increasing platelets >20 x 10(9)/L was 56 d, to >150 x 10(9)/L was 88 d and fibrinogen >1 g/dL 49 d. Ten patients showed a partial response to embolisation, with a mean of 2.8 procedures performed. Thrombotic complications occurred in 7%. Twelve patients remain alive, with relapse in six patients, all treated successfully. One patient died, and two patients have been lost to follow-up. CONCLUSION: KMP is a rare condition, with significant morbidity and mortality. The therapeutic approach should include a multidisciplinary team and consensus on guidelines. AD - Department of Haematology, Mercy University Hospital, Grenville Place, Cork, Ireland. AN - 19889011 AU - Ryan, C. AU - Price, V. AU - John, P. AU - Mahant, S. AU - Baruchel, S. AU - Brandão, L. AU - Blanchette, V. AU - Pope, E. AU - Weinstein, M. DA - Feb 1 DO - 10.1111/j.1600-0609.2009.01370.x DP - NLM ET - 2009/11/06 J2 - European journal of haematology KW - Adrenal Cortex Hormones/*administration & dosage Antineoplastic Agents, Phytogenic/administration & dosage Female Hematologic Diseases/blood/*drug therapy/*mortality Humans Infant Infant, Newborn Interferons/administration & dosage Male Pentoxifylline/administration & dosage Platelet Aggregation Inhibitors/administration & dosage Platelet Count Retrospective Studies Vincristine/administration & dosage LA - eng M1 - 2 N1 - 1600-0609 Ryan, Clodagh Price, Vicotria John, Philip Mahant, Sanjay Baruchel, Sylvain Brandão, Leonardo Blanchette, Victor Pope, Elena Weinstein, Miriam Journal Article England Eur J Haematol. 2010 Feb 1;84(2):97-104. doi: 10.1111/j.1600-0609.2009.01370.x. Epub 2009 Nov 3. PY - 2010 SN - 0902-4441 SP - 97-104 ST - Kasabach-Merritt phenomenon: a single centre experience T2 - Eur J Haematol TI - Kasabach-Merritt phenomenon: a single centre experience VL - 84 ID - 760424 ER - TY - JOUR AB - Patients with gastric variceal bleeding require a multidisciplinary team approach, which includes hepatologists, endoscopists, diagnostic radiologists, and interventional radiologists. Upper gastrointestinal endoscopy is the first-line diagnosis and management tool for bleeding gastric varices (GVs) as it is with all upper gastrointestinal bleeding scenarios. Traditionally, in the United States, when endoscopy fails to control gastric variceal bleeding, a transjugular intrahepatic portosystemic shunt (TIPS) is performed along the classic teachings of decompressing the portal circulation. However, TIPS has shown inconsistent effectiveness in controlling gastric variceal bleeding. Conversely, the balloon-occluded retrograde transvenous obliteration (BRTO) procedure has become common practice in Asia for the management of GVs. The BRTO procedure is gaining popularity in the United States. BRTO has shown to be effective in controlling gastric variceal bleeding with low gastric variceal rebleed rates. Regardless of the endovascular management (TIPS vs BRTO vs both), a multidisciplinary team with adequate preprocedural clinical assessment and management and endoscopic and imaging evaluation is required before and after the endovascular procedure. The article discusses the pre- and post-BRTO clinical evaluation and management, as well as endoscopic and imaging evaluation. Moreover, the article proposes indications, contraindications, and management protocols for the management of GVs. © 2012 Elsevier Inc. AD - W.E.A. Saad, Division of Vascular Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health System, Box 800170, 1215 Lee St, Charlottesville, VA 22908, United States AU - Saad, W. E. A. AU - Al-Osaimi, A. M. S. AU - Caldwell, S. H. DB - Embase Medline DO - 10.1053/j.tvir.2012.07.003 KW - article balloon occluded retrograde transvenous obliteration balloon occlusion clinical effectiveness clinical practice clinical protocol endoscopy fluid resuscitation follow up gastric variceal bleeding gastrointestinal hemorrhage hepatic encephalopathy human hepatic portal vein portal vein blood flow radiologist stomach varices transjugular intrahepatic portosystemic shunt treatment contraindication treatment indication United States LA - English M1 - 3 M3 - Article N1 - L365742969 2012-10-09 2012-10-11 PY - 2012 SN - 1089-2516 1557-9808 SP - 165-202 ST - Pre- and Post-Balloon-Occluded Retrograde Transvenous Obliteration Clinical Evaluation, Management, and Imaging: Indications, Management Protocols, and Follow-up T2 - Techniques in Vascular and Interventional Radiology TI - Pre- and Post-Balloon-Occluded Retrograde Transvenous Obliteration Clinical Evaluation, Management, and Imaging: Indications, Management Protocols, and Follow-up UR - https://www.embase.com/search/results?subaction=viewrecord&id=L365742969&from=export http://dx.doi.org/10.1053/j.tvir.2012.07.003 VL - 15 ID - 761190 ER - TY - JOUR AB - Percutaneous vertebroplasty: percutaneous vertebroplasty is a therapeutic, image guided procedure that involves injection of radio-opaque cement into a partially collapsed vertebral body, in an effort to relieve pain and provides stability. Indications: • Painful osteoporotic VCF refractory to medical treatment.-Painful vertebrae due toaggressive primary bone tumours like hemangiomas and giant cell tumour. In hemangiomas, treatment is aimed at pain relief, strengthening of bone and devascularization. It can be used alone or in combination with sclerotherapy, especially in cases of epidural extension causing spinal cord compression. • Painful vertebrae with extensive osteolysis due to malignant infiltration by multiple myeloma, lymphoma and metastasis. Because PVP is only aimed at treating the pain and consolidating the weight bearing bone, other specific tumour treatment should be given in conjunction for tumour management. • Painful fracture associated with osteonecrosis. • Conditions in which reinforcement of the vertebral body or pedicle is desired prior to a posterior surgical stabilisation procedure. • Chronic traumatic fracture in normal bone with non-union of fracture fragments or internal cystic changes. Contraindications: ABSOLUTE: • Asymptomatic vertebral body compression fracture. • Patient improving on medical treatment. • Osteomyelitis, discitis or active systemic infection. • Uncorrectable coagulopathy. • Allergy to bone cement or opacification agents. • Prophylaxis in osteoporotic patients. RELATIVE: • Radicular pain. • Tumour extension into the vertebral canal or cord compression. • Fracture of the posterior column - increased risk of cement leak. • Vertebral collapse >70% of body height - needle placement may be difficult. • Spinal canal stenosis - asymptomatic retropulsion of a fracture fragment causing significant spinal canal compromise. • Patients with more than five metastases or diffuse metastases. • Lack of surgical backup and monitoring facilities. Patient selection: a multidisciplinary team consisting of a radiologist, spine surgeon and referring physician (rheumatologist or oncologist) must come to a consensus on which patients should undergo this procedure and to ensure appropriate adjuvant therapy and follow-up. A detailed clinical history and examination, with specific emphasis on the neurological signs and symptoms, should be performed to confirm the underlying VCF as the cause of debilitating back pain and rule out other causes like degenerative spondylosis, radiculopathy and neurological compromise. This should be correlated with the imaging findings. In osteoporosis and metastatic disease, fractures may be present at multiple levels, not all of which require treatment with PVP. Manual examination under fluoroscopy localises and identifies the painful vertebral body. Time of intervention: the ideal candidate for PVP is one who presents within four months of a fracture, has midline non-radiating back pain that increases with weight bearing and which is exacerbated by manual palpation of the spinous process of the involved vertebra. Ideally, patients should have at least 3 weeks of conservative treatment, failure of which should prompt one to consider PVP. Intervention within days of a painful VCF is considered in patients at high risk for decubitus complications like thrombophlebitis, deep vein thrombosis, pneumonia and decubitus ulcer. There is increasing clinical data now available on the usefulness of PVP in the treatment of chronic osteoporotic fractures more than a year old. Imaging: preoperative planning requires radiographic studies to identify the fracture, estimate the duration of fracture, defi ne fracture anatomy, assess posterior vertebral body wall deficiency and exclude other causes of back pain like facet arthropathy, spinal canal stenosis or disc herniation and determine the relevant level/s in cases of multiple fractures. An MRI is a must in all patients considered for PVP as it provides both functional and anatomical information. 1, T2 and STIR sequences in axial and sagittal planes are required. Bone scans are useful in determining the age of a fracture. An increased uptake of tracer “hot scan,” is highly predictive of a positive clinical response following PVP. If there is any doubt regarding the intactness of the posterior vertebral wall, a limited CT scan through the intended level/s should be performed. Technique: the procedure can be performed under local anaesthesia and sedo-analgesia or general anaesthesia. Strict asepsis is maintained. A prone position is used for the thoracic and lumbar vertebrae and a supine position for the cervical region. The classical transpedicular route is preferred in the thoracic and lumbar vertebrae as it is inherently safe. This can be performed either by a unipedicular or bipedicular approach. An intercostovertebral route is useful in the thoracic spine when the pedicle is too small or destroyed. It is associated with a higher risk of pneumothorax and paraspinal haematoma. The postero-lateral approach is an alternative in the lumbar vertebrae but is seldom used. In the cervical vertebrae, antero-lateral approach is used. The needle path should avoid the carotid jugular complex. Using dual guidance or bi-plane fluoroscopy, the needle is tapped into position using a hammer as it provides better control. Cement Injection: injection of cement is done under continuous lateral fluoroscopic control. The lateral projection is preferred as it allows for early detection of epidural leak. Intermittent AP screening should be done to rule out lateral leaks. The risk of cement leakage is particularly high at the beginning of cement injection. The cement injection is stopped when the anterior two-thirds of the vertebral body are filled and the cement is homogenously distributed on both sides and between both end plates. Post-procedure care: an immediate evaluation of the patient's condition must be undertaken if there is any increase in pain, change in vital signs or deterioration of the neurological condition. If neurological deterioration occurs, a detailed neurological examination carried out by a specialist is followed by a thin section CT scan of the level/s treated to look for spinal cord or nerve root compression by extravasated cement, which may require urgent neurosurgical decompression. Complications: published data has placed the complication rates in osteoporotic fractures treated with PVP at <1% and in malignant fractures at <10 %. Cement leakage: It is often asymptomatic. Routes of cement leakage: • Epidural space and neural foramina. • Disc space and paravertebraltissue. • Perivertebral venous plexus. Infection: it occurs in less than 1%. Fracture of ribs, posterior elements or pedicle/Risk of collapse of the adjacent vertebral body: it has a reported incidence of 12.4%. Allergic reaction: it is to the cement and is characterised by hypotension and arrhythmias. Outcome measures 1. Pain relief - Acute osteoporotic fracture (within 72 hours): 90% success rate - Chronic osteoporotic fractures (onset is delayed): 80% success rate - Malignant fractures: 60-80% success rate - Haemangiomas: 80% success rate 2. Increased mobility - Acute osteoporotic fracture: 93% success rate - Chronic osteoporotic fracture: 50% success rate 3. Reduced requirement for analgesics: 91% success rate. AD - T. Sabharwal, Department of Radiology, Consultant Interventional Radiologist, London, United Kingdom AU - Sabharwal, T. DB - Embase KW - cement povidone analgesic agent bone cement tracer percutaneous vertebroplasty Europe society fracture patient vertebra body fragility fracture injection metastasis bone risk needle analgesia pain vertebra neoplasm backache lumbar vertebra book vertebral canal therapy deterioration computer assisted tomography imaging infection epidural drug administration hemangioma vertebral canal stenosis weight bearing examination analgesia (sensory dysfunction) decubitus fluoroscopy vital sign neurologic examination medical specialist spinal cord nerve root compression decompression epidural space rib hypotension heart arrhythmia telecommunication giant cell tumor devascularization sclerotherapy spinal cord compression osteolysis multiple myeloma lymphoma bone necrosis reinforcement pseudarthrosis compression fracture osteomyelitis diskitis blood clotting disorder allergy prophylaxis radicular pain compression body height monitoring patient selection spine surgeon nuclear magnetic resonance imaging physician rheumatology consensus adjuvant therapy follow up neurologic disease physical disease by body function spondylosis radiculopathy osteoporosis palpation conservative treatment treatment failure radiologist thrombophlebitis deep vein thrombosis pneumonia clinical study planning arthropathy intervertebral disk hernia bone scintiscanning local anesthesia general anesthesia asepsis body position supine position thoracic spine pneumothorax hematoma cervical spine carotid artery screening nerve ending allergic reaction LA - English M3 - Conference Abstract N1 - L70339149 2011-02-14 PY - 2009 SN - 0174-1551 SP - 178-179 ST - Vertebroplasty for all? T2 - CardioVascular and Interventional Radiology TI - Vertebroplasty for all? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70339149&from=export VL - 32 ID - 761268 ER - TY - JOUR AB - Background: In developing countries, intravenous thrombolysis (IVT) is available at a limited number of centers. This study aimed to assess the feasibility and safety of IVT at Tabriz Imam Reza Hospital. Methods: In a prospective study, over a 55-month period, any patient at the hospital for whom stroke code had been activated was enrolled in the study. Data on demographic characteristics, stroke risk factors, admission blood pressure, blood tests, findings of brain computed tomography (CT) scans, time of symtom onset, time of arrival to the emergency department, time of stroke code activation, time of CT scan examination, and the time of recombinant tissue plasminogen activator administration were recorded. National Institutes of Health Stroke Scale assessments were performed before IVT bolus, at 36 hours, at either 7 days or discharge (which ever one was earlier), and at 3-month follow-up. Brain CT scans were done for all patients before and 24 hours after the treatment. Results: Stroke code was activated for 407 patients and IVT was done in 168 patients. The rate of functional independence (modified Rankin Scale [mRS] 0-1) at 3 months was 39.2% (62/158). The mortality rate at day 7 was 6% (10/168). Hemorrhagic transformation was noted in 16 patients (9.5%). Symptomatic intracranial hemorrhage occurred in 5 (3%), all of which were fatal. One case of severe urinary bleeding and one other fatal case of severe angioedema were observed. Conclusion: During the first 4-5 years of administration of IVT in the hospital, it was found to be feasible and safe, but to increase the efficacy, poststroke care should be more organized and a stroke center should be established. AD - [Sadeghi-Hokmabadi, Elyar; Farhoudi, Mehdi; Taheraghdam, Aliakbar; Hashemilar, Mazyar; Savadi-Osguei, Daryous; Rikhtegar, Reza; Mehrvar, Kaveh; Sharifipour, Ehsan; Youhanaee, Parisa; Mirnour, Reshad] Tabriz Univ Med Sci, Dept Neurol, Neurosci Res Ctr, Tabriz, East Azerbaijan, Iran. Sadeghi-Hokmabadi, E (corresponding author), Tabriz Univ Med Sci, Tabriz Imam Reza Hosp, Neurosci Res Ctr, Gholghasht St, Tabriz, East Azerbaijan, Iran. aeass@yahoo.com AN - WOS:000390265200001 AU - Sadeghi-Hokmabadi, E. AU - Farhoudi, M. AU - Taheraghdam, A. AU - Hashemilar, M. AU - Savadi-Osguei, D. AU - Rikhtegar, R. AU - Mehrvar, K. AU - Sharifipour, E. AU - Youhanaee, P. AU - Mirnour, R. DO - 10.2147/ijgm.s112430 J2 - Int. J. Gen. Med. KW - stroke developing countries thrombolytic therapy code team rtPA functional independence THROMBOLYTIC THERAPY POOLED ANALYSIS GUIDELINES EFFICACY ASSOCIATION ALTEPLASE ATLANTIS NINDS ECASS IRAN Medicine, General & Internal LA - English M3 - Article N1 - ISI Document Delivery No.: EF3ZX Times Cited: 4 Cited Reference Count: 43 Sadeghi-Hokmabadi, Elyar Farhoudi, Mehdi Taheraghdam, Aliakbar Hashemilar, Mazyar Savadi-Osguei, Daryous Rikhtegar, Reza Mehrvar, Kaveh Sharifipour, Ehsan Youhanaee, Parisa Mirnour, Reshad Hokmabadi, Elyar Sadeghi/L-8926-2017; Sharifipour, Ehsan/M-3282-2016; Taheraghdam, Aliakbar/D-1905-2019 Hokmabadi, Elyar Sadeghi/0000-0002-5481-6027; Farhoudi, Mehdi/0000-0002-4972-9316 Neurosciences Research Center, Tabriz University of Medical Science The authors would like to acknowledge Dr Mohammad Yazdchi and Dr Homayoun Sadeghi-Bazarghani for their outstanding help and support, which greatly assisted them in accomplishing the current study. This research was supported by the Neurosciences Research Center, Tabriz University of Medical Science. 4 0 DOVE MEDICAL PRESS LTD ALBANY INT J GEN MED PY - 2016 SN - 1178-7074 SP - 361-367 ST - Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study T2 - International Journal of General Medicine TI - Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study UR - ://WOS:000390265200001 VL - 9 ID - 761725 ER - TY - JOUR AB - Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a late sequelae of venous thromboembolism with obstruction of pulmonary arteries by fibrotic thrombus. The treatment of CTEPH by pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) or vasodilator drugs is determined by technical accessibility of thrombus, general surgical risk with overall risk-benefit ratio, and patient factors. We surveyed a CTEPH operability risk assessment in a single PEA center. Patients and Methods. Data were collected at the time of diagnosis. In addition to operability assessment by the multidisciplinary team, the European System for Cardiac Operative Risk Evaluation II (EuroScore II) was employed. Results. Since February 1992, 415 patients (mean age 59±16 years; 62% female) were diagnosed with CTEPH. Of those 255 patients (mean age 54±15 years; 58% female) were classified as technically operable. 160 patients (mean age 68±12 years; 53% female) were classified as technically non-operable. In addition, 11% of technically operable patients had an unacceptable surgical risk-benefit ratio and were classified as non-operable. Of those, 102 patients were treated with off-label vasodilators. The logistic EuroScore was 6±4% in operable patients and 18±3% (P<0.001) in non-operable patients. Sixteen patients (Table, mean age 66±13 years; 38% female; 11 technically non-operable patients; 5 patients with unacceptable surgical risk-benefit ratio) underwent BPA procedures. Conclusion. The first treatment choice in contemporary CTEPH is PEA. BPA is an emerging technique and is currently targeting the most severe patients. (Table Presented). AD - R. Sadushi-Kolici, Medical University of Vienna, Vienna, Austria AU - Sadushi-Kolici, R. AU - Skoro-Sajer, N. AU - Schemper, M. AU - Moser, B. AU - Gerges, M. AU - Gerges, C. AU - Tilea, I. AU - Pistritto, A. AU - Babayev, J. AU - Klepetko, W. AU - Lang, I. M. DB - Embase KW - vasodilator agent chronic thromboembolic pulmonary hypertension American society patient human female EuroSCORE surgical risk thrombus endarterectomy venous thromboembolism procedures diagnosis risk assessment pulmonary artery risk angioplasty obstruction L1 - http://www.atsjournals.org/doi/pdf/10.1164/ajrccm-conference.2015.191.1_MeetingAbstracts.A4832 LA - English M3 - Conference Abstract N1 - L72052704 2015-11-05 PY - 2015 SN - 1073-449X ST - Current treatment decisions in chronic thromboembolic pulmonary hypertension T2 - American Journal of Respiratory and Critical Care Medicine TI - Current treatment decisions in chronic thromboembolic pulmonary hypertension UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72052704&from=export VL - 191 ID - 761056 ER - TY - JOUR AB - Introduction: Life expectancy in haemophilia is same comparing to general population. The aging patient with haemophilia faces many challenges particularly atherosclerosis. Cardiovascular causes of mortality occur at a similar frequency as in the general population, but the contributing risk factors in haemophilia are incompletely understood. Existing literature on this issue is lacking, and there is not a guided way of appropriate treatment of these complications. Methods: Here we present three cases with haemophilia treated with the same protocol by a multidisciplinary team which facilitated successful coronary artery bypass grafting (CABG) surgery. One patient with mild haemophilia A (47 years old), one with mild haemophilia B (45 years old) and one with severe hemophilia A (49 years old) who have known coronary artery disease and identified multivessel disease, CABG was considered by multidisciplinary team. Results: All the patients were treated with bolus factor concentrates due to pharmaco-kinetic analyses could not be performed. Inhibitory antibody testing of factor 8 or 9 assessed at least 1 day prior to operation. Patients with haemophilia A and B received a factor concentrates bolus of 50 IU and 100 IU per kg, respectively within 1 hour of induction as a preoperative care plan. During operation for another bolus was given which consisted of 500 IU and 1000 IU per liter of intraoperative blood loss for haemophilia A and B respectively. Additional post-operative factor administration was performed according to 4th hour factor level for maintaining the target factor level. Bolus infusion of 500 mg tranexamic acid were administered every 8 hours for the first five days. Target FVIII activity level was 100-120 IU/dL mL for the first 48 h, followed by 80-100 IU/dL for post-operative days 2-5 and 60-80 IU/dL for post-operative days 6-10. APTT was monitored every 4 times for the operation day and then every 12 hours thereafter. No patients developed postoperative thrombotic, hemorrhagic of infective complications. Discussion/Conclusion: In this case series, CABG surgeries was managed by a protocol which quoted by Bhave P et al. (J Card. Surg. 2015;30:61-69) established to optimize perioperative management. We did not observe any adverse events during and after CABG surgeries. With attentive monitoring and appropriate follow-up patients with haemophilia can safely undergo invasive cardiac procedures. AD - F. Sahin, Hematology, Izmir, Turkey AU - Sahin, F. AU - Atilla, F. D. AU - Demirci, Z. AU - Ozturk, P. AU - Ozbaran, M. DB - Embase DO - 10.1111/hae.13666 KW - blood clotting factor 8 endogenous compound tranexamic acid activated partial thromboplastin time adult adverse event atherosclerosis case report case study clinical article complication conference abstract coronary artery bypass surgery coronary artery disease female follow up heart hemophilia A hemophilia B human infusion kinetics male middle aged monitoring multidisciplinary team operative blood loss preoperative care surgery thrombosis LA - English M3 - Conference Abstract N1 - L626415671 2019-02-22 PY - 2019 SN - 1365-2516 SP - 85 ST - Coronary artery bypass surgery in three patients with haemophilia T2 - Haemophilia TI - Coronary artery bypass surgery in three patients with haemophilia UR - https://www.embase.com/search/results?subaction=viewrecord&id=L626415671&from=export http://dx.doi.org/10.1111/hae.13666 VL - 25 ID - 760748 ER - TY - GEN AB - Total joint arthroplasty (TJA) is the gold-standard treatment for severe hip and knee osteoarthritis. In recent decades, the hospital length of stay (LOS) has reduced substantially largely due to the widespread implementation of fast track protocols. Although the results are now better than ever and most patients have joint replacement without complications, some patients experience one or several deviations from the fast track protocol. In healthcare systems similar to those in Finland, knowledge on these deviations is sparse. This doctoral thesis sought to elucidate some of the deviations in TJA in a Finnish healthcare system. The study population consisted of TJA (i.e. total hip arthroplasty [THA] and total knee arthroplasty [TKA]) patients that underwent surgery at Helsinki University Hospital between 2014 and 2017. The study aimed to identify the reasons and risk factors for delayed discharge and 90-day readmissions after primary TKA. The study also aimed to assess early postoperative emergencies by evaluating the use of an Emergency Response Team (ERT) in the arthroplasty ward. Lastly, the study aimed to evaluate a novel phone consultation service for TJA patients and thereby elucidate common post-discharge concerns. The median LOS after TKA was 3 days. The main reasons for delayed discharge were related to functional recovery and pain. Risk factors for a discharge after the third postoperative day were older age, higher American Society of Anaesthesiologists (ASA) score, shorter preoperative walking distance, general anaesthesia, longer duration of surgery, longer time spent in Post-Anaesthesia Care Unit, and surgery later in the week. The 90-day readmission rate was 8.0% after primary TKA. The most common reasons for readmission were surgical site infection and knee pain. Independent predictors of readmission were psychiatric disease, asthma, a preoperative valgus malalignment, and a preoperative knee flexion deficit. The rate of ERT calls was approximately 7 per 1000 admissions. The most common criteria that triggered the ERT call were decreased level of consciousness, hypotension, and low oxygen saturation. Half of the patients could be treated at the ward after ERT intervention, and the other half was moved to the Intensive Care Unit. Common causes of the emergency included drug-related side effects, pneumonia, and pulmonary embolism. Concerns regarding prescribed medication, wound problems, and mobilization triggered most of the phone consultation service calls. The answering nurse alone resolved two thirds of all calls. Thirteen percent of the patients received instructions to visit the Emergency Department (ED) and half of them had a condition requiring treatment. Only two patients (0.7%) that should have been directed to the ED did not receive such instructions. This study identified several new risk factors for deviations in TJA. Due to the single-payer healthcare system, the possible confounding effect of insurance status did not confound the results. Despite differences in healthcare systems, both LOS and the readmission rate were similar to those previously reported. Considering the present study, a phone consultation service seems to reduce the amount of unnecessary ED visits. Employing an ERT service likely reduces the amount of ICU admissions after TJA surgery. Tekonivelleikkaus on pitkälle edenneen polven ja lonkan nivelrikon ensisijainen hoitomuoto. Viimeisten vuosikymmenten aikana hoitoajat ovat lyhentyneet huomattavasti ns. fast track -hoitoketjun avulla. Vaikka tulokset ovat laajalti parantuneet, ja suurin osa potilaista kotiutuu viimeistään kolmantena leikkauksen jälkeisenä päivänä, ilmenee osalle potilaista yksi tai useampi poikkeama hoitoketjussa. Näistä poikkeamista tiedetään hyvin vähän Suomen kaltaisessa terveydenhuoltojärjestelmässä. Tämän tutkimuksen tarkoituksena oli selvittää syitä usealle yleiselle poikkeamalle polven ja lonkan tekonivelleikkauksen jälkeen. Tutkimus koostui vuosien 2014 ja 2017 välillä Helsingin yliopistollisessa keskussairaalassa tehdy stä polven ja lonkan tekonivelleikkauksista. Tutkimuksen tavoitteena oli selvittää syyt ja riskitekijät myöhästyneelle kotiutumiselle ja osastolle uudelleen joutumiselle. Toisena tavoitteena oli arvioida hätäryhmän (Emergency Response Team, ERT) toimintaa tekonivelosastolla. Tämän lisäksi tutkimuksessa arvioitiin tekonivelpotilaiden puhelinpalvelun toimivuutta ja selvitettiin yleisimmät huolenaiheet kotiutumisen jälkeen. Hoitojakson mediaanipituus polven ensitekonivelleikkauksen jälkeen oli kolme päivää. Yleisimmät syyt kotiutumisen viivästymiselle olivat hidas mobilisaatio ja kipu. Riskitekijöitä kotiutumisen viivästymiselle olivat korkea ikä, korkea ASA-luokka, lyhentynyt kävelymatka ennen leikkausta, yleisanestesia, pidempi leikkaus, pidempi vietetty aika heräämössä sekä leikkaus viikon loppupuolella. Kahdeksan prosenttia potilaista joutui uudelleen osastolle yhdeksänkymmenen päivän kuluessa polven tekonivelleikkauksesta. Yleisimmät syyt olivat leikkausalueen infektio ja polvikipu. Riskitekijöitä osastolle uudelleen joutumiselle olivat psyykkinen sairaus, astma, valgus-virheasento sekä polven koukistusvajaus. ERT-hälytyksiä oli noin seitsemän tuhatta potilasta kohden. Yleisimmät hälytyksen laukaisevat kriteerit olivat tajunnantason lasku, matala verenpaine ja huono hapettuminen. Puolet potilaista pystyttiin hoitamaan osastolla ERT-ryhmän intervention jälkeen, ja puolet potilaista jouduttiin siirtämään tehovalvontaosastolle. Yleisimmät syyt potilaan tilan äkilliselle romahtamiselle olivat lääkkeen sivuvaikutus, keuhkokuume ja keuhkoveritulppa. Epäselvyydet reseptilääkkeiden käytöstä, haavaongelmat ja mobilisaatioon liittyvät ongelmat olivat yleisimmät syyt, jotka johtivat yhteydenottoon tekonivelpotilaiden puhelinpalveluun. Hieman yli kahdessa kolmasosassa puheluista huolenaihe ratkesi hoitajan antamien ohjeiden avulla. Kolmetoista prosenttia potilaista ohjeistettiin käymään päivystyksessä, ja puolet heistä sai hoitoa vaativan diagnoosin. Ainoastaan kaksi potilasta (0.7%), joiden olisi pitänyt hakeutua päivystykseen, eivät saaneet ohjeita hakeutua sinne. Tässä tutkimuksessa tunnistettiin useita uusia riskitekijöitä, jotka altistavat poikkeamille tekonivelleikkauksen hoitoketjussa. Sekä hoitojakson pituus että osastolle uudelleen joutumisen riski olivat kansainvälisiin tuloksiin verrattuna samankaltaisia, vaikka terveydenhuoltojärjestelmien välillä on suuria eroja. Tämän tutkimuksen valossa tekonivelpotilaille tarkoitettu puhelinpalvelu on hyvä tapa hoitaa leikkauksen jälkeisiä huolia, ja se todennäköisesti estää turhia päivystyskäyntejä. ERT-ryhmä näyttäisi vähentävän tehohoidon tarvetta tekonivelleikkauksen jälkeen. AU - Saku, Sami DA - 2020/09/30 DB - OpenAIRE PY - 2020 ST - Deviations in Fast Track Total Joint Arthroplasty TI - Deviations in Fast Track Total Joint Arthroplasty UR - https://explore.openaire.eu/search/publication?articleId=od______1593::5ed3d628c0e5d01e917642754fddf337 ID - 762018 ER - TY - JOUR AB - Background: To evaluate the clinical profile, validity of biochemical / imaging tests, pathological findings, surgical outcome and follow-up of patients with phaeochromocytoma and paraganglionoma at a tertiary centre for adrenal disease. Methods: Patients with phaeochromocytoma and paraganglionoma 2001- 2016 were identified from departmental databases. Electronic records reviewed. Results: All patients managed within formalised multidisciplinary team Phaeochromocytoma 71 patients, 23M: 48F, age :-56 (20-88). 56% presented with typical phaeochromocytoma symptoms; 44% on radiology although one third of these were hypertensive Biochemistry diagnostic in 69, although 2 patients had false negative urine metadrenalines. Two were presumed nonsecretory (diagnosed on histology, pre-op metadrenalines normal) Cross sectional imaging characteristic in 69. MIBG undertaken in 80%, which was overall useful; confirmatory (43), clarifying (4), confused picture (7), negative (3) Recognised genetic predisposition:- (9) Mean tumour size:- 6.6cm (0.9 - 20) One case with metastasis (ribs, resected simultaneously) 68 pts underwent surgery, all managed in conjunction with experienced endocrinologist and intensivist Pre-op blockade with phenoxybenzamine (+/- betablocker) in 62 and doxazosin (+/- betablocker) in 4 Laparoscopic adrenalectomy :- 57 (2 bilateral) with 9 conversions (16%) Open adrenalectomy :- 11 (1 bilateral) Mean hospital stay:- 6.6 (2-22) days. 1 death (PE), 9 complications from surgery, no re-operations Median follow up :- 4 years (0.5 - 12). 64 / 65 patients (98%) showed biochemical normalisation and subsequent resolution of symptoms after surgery. Post-op persistently raised metanephrines :- (1). Recurrence :- (1), 7 years after surgery, medically managed. Paraganglionoma 19 patients, 5M:12 F, 6 secretory, 3 extra-adrenal Age:- 45 (16-43) 18 pts underwent surgery For peri-renal lesions: - laparoscopic adrenalectomy - 9 (1 bilateral), open resection 7 Open Resection for mesenteric (1), Thoracic (1) and pre-aortic (1) lesions Genetic predisposition: - (4) Mean tumour size: - 6.1cm (4-9) Conclusions: Multi-disciplinary approach achieved good outcomes for these high risk cases. Nearly half had atypical presentation. AD - H.E. Doran, Department of General Surgery, Salford Royal Foundation Trust, United Kingdom AU - Salazar, L. AU - Kearney, T. M. AU - Anderson, I. D. AU - Ghatamanenni, S. AU - Doran, H. E. DB - Embase DO - 10.1007/s00423-016-1510-4 KW - (3 iodobenzyl)guanidine beta adrenergic receptor blocking agent doxazosin phenoxybenzamine adrenalectomy adult aged aorta biochemistry cancer size data base death diagnosis endocrinologist female follow up genetic predisposition histology hospitalization human human tissue imaging information processing intensivist kidney injury major clinical study male metastasis middle aged observational study peroperative complication pheochromocytoma radiology relapse reoperation surgery symptom thorax trust tumor volume urine LA - English M1 - 7 M3 - Conference Abstract N1 - L614931563 2017-03-24 PY - 2016 SN - 1435-2451 SP - 1075 ST - Phaeochromocytoma and paraganglionoma: An observational study The Salford Royal Foundation Trust experience T2 - Langenbeck's Archives of Surgery TI - Phaeochromocytoma and paraganglionoma: An observational study The Salford Royal Foundation Trust experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614931563&from=export http://dx.doi.org/10.1007/s00423-016-1510-4 VL - 401 ID - 761047 ER - TY - JOUR AB - Objective: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA). Methods: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%); and January/2008 to December/2010 (CTA, n=175, 52.7%). Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. Results: Mean age was 58 +/- 14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008), which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046), major complications (20.6 vs. 33.1%, P=0.007), stroke (4.6 vs. 10.9%, P=0.045) and sepsis (1.7 vs. 9.6%, P=0.001), as compared to before-CTA. Multivariable analysis adjusted for potential counfounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 - 0.67, P=0.007). CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 - 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 - 0.99, P=0.049) and by procedure (hybrid, OR=0.07, CI 95% 0.007 - 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 - 0.904, P=0.037). Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1 - 2.6], P=0.008), urgent surgery (OR=5.0 [1.5-16.7], P=0.008) and thoracoabdominal aneurysm (OR=24.6 [3.1-194.1], P=0.002). Conclusions: Thoracic aorta surgery in specialized center was associated with lower incidence of complications and all-cause mortality as compared to usual care. AD - [Sales, Marcela da Cunha; Frota Filho, Jose Dario; Aguzzoli, Cristiane; Souza, Leonardo Dornelles; Roesler, Alvaro Machado; Lucio, Eraldo Azevedo; Leaes, Paulo Ernesto; Nunes Pontes, Mauro Ricardo; Lucchese, Fernando Antonio] Hosp Sao Francisco, Dept Cardiovasc Surg, Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, Brazil. [Nunes Pontes, Mauro Ricardo] UFCSPA, Porto Alegre, RS, Brazil. Sales, MD (corresponding author), Rua Carvalho Monteiro 252,Apto 1201, BR-90470100 Porto Alegre, RS, Brazil. mcsales@terra.com.br AN - WOS:000350904300005 AU - Sales, M. D. AU - Frota, J. D. AU - Aguzzoli, C. AU - Souza, L. D. AU - Rosler, A. M. AU - Lucio, E. A. AU - Leaes, P. E. AU - Pontes, M. R. N. AU - Lucchese, F. A. DA - Oct-Dec DO - 10.5935/1678-9741.20140122 J2 - Rev. Bras. Cir. Cardiovasc. KW - Aortic surgery Specialized care Surgical outcomes Inpatient mortality HIGH-VOLUME CENTERS FOCUSED FACTORIES ANEURYSM SURGERY HOSPITAL VOLUME CLINICAL-TRIALS UNITED-STATES REPAIR DISSECTION CANCER MANAGEMENT Cardiac & Cardiovascular Systems Surgery LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: CD2JR Times Cited: 9 Cited Reference Count: 45 Sales, Marcela da Cunha Frota Filho, Jose Dario Aguzzoli, Cristiane Souza, Leonardo Dornelles Roesler, Alvaro Machado Lucio, Eraldo Azevedo Leaes, Paulo Ernesto Nunes Pontes, Mauro Ricardo Lucchese, Fernando Antonio 9 0 SOC BRASIL CIRURGIA CARDIOVASC SAO PAULO SP REV BRAS CIR CARDIOV PY - 2014 SN - 0102-7638 SP - 494-504 ST - Aortic Center: specialized care improves outcomes and decreases mortality T2 - Revista Brasileira De Cirurgia Cardiovascular TI - Aortic Center: specialized care improves outcomes and decreases mortality UR - ://WOS:000350904300005 VL - 29 ID - 761772 ER - TY - JOUR AB - SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: The rationale for Pulmonary Embolism Response Teams (PERT) is to optimize care for patients at high risk of mortality from acute Pulmonary Embolism (PE), by providing real-time, multidisciplinary consultation. We hypothesized that a PERT-based approach would optimize PE management and decrease readmission rates. METHODS: We performed a retrospective analysis of all 54 consecutive PERT activations over 2018 from two urban tertiary academic hospitals, to determine impact of PERT-guided therapy. We analyzed patient characteristics, and focused on significant outcomes including: in-hospital mortality, major bleeding as defined by the International Society of Thrombosis and Hemostasis (2015), 30-day readmission and clinic follow up. RESULTS: Median age was 64 years. 52% were women. There were 6 in-hospital deaths (11%), all of which were High Risk (HR) based on European Society of Cardiology classification. Cause of death was PE (n=4, 7%), major bleeding (n=1, 2%) and pneumonia (n=1, 2%). Major bleeding occurred in 4 (7%) patients, which was fatal in 1 (2%). Two patients on systemic anticoagulation (AC) alone and one post-catheter directed thrombolysis (CDT) developed major bleeding, necessitating inferior vena cava (IVC) filter placement. 47 (87%) patients were discharged and 6 (12%) were re-admitted within 30-days: 1 patient expired from massive PE and one suffered anticoagulation related gastrointestinal bleed. Four (8%) Non-PE related readmissions included one each for pneumonia, urinary tract infection, seizure, and bowel obstruction. One (11%) patient who had undergone CDT was readmitted within 30-days. 33 (70%) patients were seen within a month at either Internal Medicine or Pulmonary Clinics and 2 (4%) patients were discharged to hospice. CONCLUSIONS: Our data demonstrates comparable outcomes of PERT managed acute PE patients, compared to data from other PERT centers, with minimal PE-related mortality, major bleeding, and low rate of recurrent PE and re-admissions. CLINICAL IMPLICATIONS: Longer term follow up is needed to evaluate cardiac function and possible development of chronic thromboembolic pulmonary hypertension (CTEPH), bleeding risk from extended anticoagulation, and ensure appropriate IVC filter retrieval. DISCLOSURES: No relevant relationships by Madeline Ehrlich, source=Web Response No relevant relationships by Jason Filopei, source=Web Response No relevant relationships by James Salonia, source=Web Response No relevant relationships by Janet Shapiro, source=Web Response No relevant relationships by Adil Shujaat, source=Web Response No relevant relationships by Avinash Singh, source=Web Response No relevant relationships by David Steiger, source=Web Response No relevant relationships by Sean Zajac, source=Web Response AU - Salonia, J. AU - Singh, A. AU - Steiger, D. AU - Shapiro, J. AU - Filopei, J. AU - Zajac, S. AU - Ehrlich, M. AU - Shujaat, A. DB - Embase DO - 10.1016/j.chest.2019.08.361 KW - adult anticoagulation blood clot lysis cardiology catheter cause of death chronic thromboembolic pulmonary hypertension conference abstract female follow up gastrointestinal hemorrhage heart function hemostasis hospice hospital discharge hospital mortality hospital readmission human information retrieval intestine obstruction major clinical study male middle aged multicenter study pneumonia pulmonary embolism response team retrospective study seizure thrombosis urinary tract infection vena cava filter LA - English M1 - 4 M3 - Conference Abstract N1 - L2002983659 2019-10-02 PY - 2019 SN - 1931-3543 0012-3692 SP - A311 ST - IMPACT OF PULMONARY EMBOLISM RESPONSE TEAM ON PATIENT OUTCOMES INCLUDING 30-DAY READMISSION RATES T2 - Chest TI - IMPACT OF PULMONARY EMBOLISM RESPONSE TEAM ON PATIENT OUTCOMES INCLUDING 30-DAY READMISSION RATES UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002983659&from=export http://dx.doi.org/10.1016/j.chest.2019.08.361 VL - 156 ID - 760664 ER - TY - JOUR AB - PURPOSE: Acute mesenteric ischemia (AMI) is a life-threatening disease that leads to bowel infarction and death. The optimal management of AMI remains controversial. The present meta-analysis aimed to estimate the prognostic impact of surgical (SG) versus endovascular or hybrid intervention (EV) as the first-line treatment for acute arterial occlusive mesenteric ischemia and to assess whether endovascular strategy was actually effective in reducing bowel resection. METHODS: MEDLINE, Scopus and the Cochrane Library databases were searched. There have been no randomized controlled trials comparing SG versus EV for the treatment of AMI. We undertook this systematic review and meta-analysis according to MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines, assessing the included study quality with the Newcastle-Ottawa scale. RESULTS: Seven studies comparing EV versus SG as first strategy for the treatment of AMI were selected for the analyses, reporting of 3020 patients. EV was associated with a reduced risk of in-hospital mortality (RR 0.68; 95% CI 0.59-0.79; fixed-effects analysis; p < 0.0001; I (2) = 4.9%; τ (2) = 0.025). Pooled prevalence of mortality was 19% for EV and 34% for SG. EV also showed a benefit impact on risk of bowel resection and second-look laparotomy. CONCLUSIONS: The present meta-analysis outlines that endovascular revascularization strategy seems to offer advantages in terms of in-hospital mortality and morbidity in case of arterial occlusive AMI. A multidisciplinary team consisting of radiologists, interventional radiologists, cardiovascular and general surgeons comes out to be essential to tailor the right procedure to the patient and improve the outcomes associated with AMI. AD - Department of Radiology and Interventional Radiology, IRCCS San Martino-IST University Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy. giancarlo.salsano@yahoo.it. Cardiovascular Surgery, IRCCS San Martino-IST University Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy. Department of Radiology and Interventional Radiology, IRCCS San Martino-IST University Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy. AN - 28752257 AU - Salsano, G. AU - Salsano, A. AU - Sportelli, E. AU - Petrocelli, F. AU - Dahmane, M. AU - Spinella, G. AU - Pane, B. AU - Mambrini, S. AU - Palombo, D. AU - Santini, F. DA - Jan DO - 10.1007/s00270-017-1749-3 DP - NLM ET - 2017/07/29 J2 - Cardiovascular and interventional radiology KW - Acute Disease Endovascular Procedures/methods Hospital Mortality Humans Mesenteric Ischemia/*surgery Treatment Outcome Vascular Surgical Procedures/methods Acute mesenteric ischemia First-line treatment Meta-analysis LA - eng M1 - 1 N1 - 1432-086x Salsano, Giancarlo Salsano, Antonio Sportelli, Elena Petrocelli, Francesco Dahmane, M'ahmed Spinella, Giovanni Pane, Bianca Mambrini, Simone Palombo, Domenico Santini, Francesco Journal Article Meta-Analysis Review Systematic Review United States Cardiovasc Intervent Radiol. 2018 Jan;41(1):27-36. doi: 10.1007/s00270-017-1749-3. Epub 2017 Jul 27. PY - 2018 SN - 0174-1551 SP - 27-36 ST - What is the Best Revascularization Strategy for Acute Occlusive Arterial Mesenteric Ischemia: Systematic Review and Meta-analysis T2 - Cardiovasc Intervent Radiol TI - What is the Best Revascularization Strategy for Acute Occlusive Arterial Mesenteric Ischemia: Systematic Review and Meta-analysis VL - 41 ID - 760137 ER - TY - JOUR AB - Hospitals are complex environments that rely on clinicians working together to provide appropriate care to patients. These clinical teams adapt their interactions to meet changing situational needs. Venous thromboembolism (VTE) prophylaxis is a complex process that occurs throughout a patient's hospitalisation, presenting five stages with different levels of complexity: admission, interruption, re-initiation, initiation, and transfer. The objective of our study is to understand how the VTE prophylaxis team adapts as the complexity in the process changes; we do this by using social network analysis (SNA) measures. We interviewed 45 clinicians representing 9 different cases, creating 43 role networks. The role networks were analysed using SNA measures to understand team changes between low and high complexity stages. When comparing low and high complexity stages, we found two team adaptation mechanisms: (1) relative increase in the number of people, team activities, and interactions within the team, or (2) relative increase in discussion among the team, reflected by an increase in reciprocity.   Practitioner Summary: The reason for this study was to quantify team adaptation to complexity in a process using social network analysis (SNA). The VTE prophylaxis team adapted to complexity by two different mechanisms, by increasing the roles, activities, and interactions among the team or by increasing the two-way communication and discussion throughout the team. We demonstrated the ability for SNA to identify adaptation within a team. AD - a Department of Industrial and Systems Engineering , University of Wisconsin-Madison , Madison , Wisconsin , USA. b Center for Quality and Productivity Improvement , University of Wisconsin-Madison , Madison , Wisconsin , USA. c Geisinger Health System , Danville , Virginia , USA. d School of Medicine and Public Health , University of Wisconsin-Madison , Madison , Wisconsin , USA. AN - 30943873 AU - Salwei, M. E. AU - Carayon, P. AU - Hundt, A. S. AU - Hoonakker, P. AU - Agrawal, V. AU - Kleinschmidt, P. AU - Stamm, J. AU - Wiegmann, D. AU - Patterson, B. W. C2 - Pmc7243844 C6 - Nihms1572297 DA - Jul DO - 10.1080/00140139.2019.1603402 DP - NLM ET - 2019/04/05 J2 - Ergonomics KW - *Adaptation, Psychological *Group Processes Hospitals Humans Interdisciplinary Communication *Interprofessional Relations Patient Care Team/*organization & administration *Professional Role Venous Thromboembolism/*prevention & control Team adaptation complexity patient safety social network analysis the authors. LA - eng M1 - 7 N1 - 1366-5847 Salwei, Megan E Carayon, Pascale Hundt, Ann S Hoonakker, Peter Agrawal, Vaibhav Kleinschmidt, Peter Stamm, Jason Wiegmann, Douglas Patterson, Brian W K08 HS024558/HS/AHRQ HHS/United States R01 HS022086/HS/AHRQ HHS/United States UL1 TR000427/TR/NCATS NIH HHS/United States UL1 TR002373/TR/NCATS NIH HHS/United States Journal Article Ergonomics. 2019 Jul;62(7):864-879. doi: 10.1080/00140139.2019.1603402. Epub 2019 Apr 30. PY - 2019 SN - 0014-0139 (Print) 0014-0139 SP - 864-879 ST - Role network measures to assess healthcare team adaptation to complex situations: the case of venous thromboembolism prophylaxis T2 - Ergonomics TI - Role network measures to assess healthcare team adaptation to complex situations: the case of venous thromboembolism prophylaxis VL - 62 ID - 760251 ER - TY - CHAP A2 - Bagnara, S. A2 - Tartaglia, R. A2 - Albolino, S. A2 - Alexander, T. A2 - Fujita, Y. AB - Intensive care units (ICUs) are complex environments, which rely on teams in order to coordinate patient care. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major concern for ICU patients, who are frequently immobile. VTE prophylaxis (prevention) occurs throughout different stages of a patient's stay in the ICU, which range in levels of complexity. The objective of this study is to use social network analysis to understand team adaptation in response to different levels of complexity in the VTE prophylaxis process. The more complex stages of VTE prophylaxis involve more people, more team activities, more team interactions, and more two-way communication compared to the less complex stages. Social network analysis can be used to understand team adaptation to these different levels of complexity in a patient's ICU care. AD - [Salwei, Megan E.; Carayon, Pascale; Wiegmann, Douglas] Univ Wisconsin, Dept Ind & Syst Engn, Madison, WI 53706 USA. [Salwei, Megan E.; Carayon, Pascale; Hundt, Ann Schoofs; Hoonakker, Peter; Patterson, Brian W.; Wiegmann, Douglas] Univ Wisconsin, Ctr Qual & Prod Improvement, Madison, WI 53706 USA. [Kleinschmidt, Peter; Patterson, Brian W.] Univ Wisconsin, Sch Med & Publ Hlth, Madison, WI USA. Salwei, ME (corresponding author), Univ Wisconsin, Dept Ind & Syst Engn, Madison, WI 53706 USA.; Salwei, ME (corresponding author), Univ Wisconsin, Ctr Qual & Prod Improvement, Madison, WI 53706 USA. msalwei@wisc.edu AN - WOS:000473065900032 AU - Salwei, M. E. AU - Carayon, P. AU - Hundt, A. S. AU - Kleinschmidt, P. AU - Hoonakker, P. AU - Patterson, B. W. AU - Wiegmann, D. CY - Cham DO - 10.1007/978-3-319-96098-2_32 KW - Team adaptation Social network analysis Complexity Patient safety COGNITIVE WORK ANALYSIS SOCIAL NETWORK ANALYSIS Computer Science, Artificial Intelligence Computer Science, Cybernetics LA - English N1 - ISI Document Delivery No.: BN0KI Times Cited: 0 Cited Reference Count: 16 Salwei, Megan E. Carayon, Pascale Hundt, Ann Schoofs Kleinschmidt, Peter Hoonakker, Peter Patterson, Brian W. Wiegmann, Douglas IEA 2018 Proceedings Paper 20th Congress of the International-Ergonomics-Association (IEA) AUG 26-30, 2018 Florence, ITALY Int Ergon Assoc Salwei, Megan/ABB-7727-2020; Hoonakker, Peter/K-7118-2012 Salwei, Megan/0000-0002-5457-2501; Hoonakker, Peter/0000-0002-6854-8780 Agency for Healthcare Research and QualityUnited States Department of Health & Human ServicesAgency for Healthcare Research & Quality [R01HS022086]; [UL1TR000427] This project was supported by Grant Number R01HS022086 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The project was also partially supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), Grant UL1TR000427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. 0 GEWERBESTRASSE 11, CHAM, CH-6330, SWITZERLAND PB - Springer International Publishing Ag PY - 2019 SN - 2194-5357 978-3-319-96098-2; 978-3-319-96097-5 SP - 248-254 ST - Adv intell syst T2 - Proceedings of the 20th Congress of the International Ergonomics Association T3 - Advances in Intelligent Systems and Computing TI - Team Adaptation to Complex Clinical Situations: The Case of VTE Prophylaxis in Hospitalized Patients UR - ://WOS:000473065900032 VL - 818 ID - 761544 ER - TY - JOUR AB - Ventilator-associated pneumonia (VAP) is the most prevalent infection in intensive care units (ICU). To reduce this rate, the application of bundles – groups of individual practices and adherence to the best nursing practices from Association for Professionals in Infection Control and Epidemiology (APIC) guidelines (2009) is recommended. This study aimed This study aimed to estimate the microbiology including; rate of VAP, mortality rate attributed to VAP, among (ICU) critically ill patients and evaluate the effectiveness of adherence to VAP bundle on elimination of infection, also cost effectiveness as reflection to length of stay in ICU. Subject and methods A comparative interventional design was used to achieve the aim of the study. It is conducted in 14 bedded Adult Medical-surgical ICU.VAP Bundle Program was implemented by our multidisciplinary team (pulmonologist, microbiologist, intensivist and ICU nurses). The VAP bundle team starting the program implementation in January 2014 till the end of December 2015 (follow up prospective study), all those patients underwent daily 5 items 1- bed elevation, 2- DVT prophylaxis, 3- peptic ulcer prophylaxis, 4- oral hygiene and 5- sedation break and weaning assessment. Surveillance reports from ICU for the year 2013 were reviewed (retrospective study). Data were collected and analyzed for (VAP) and compared before and after VAP bundle intervention. Results All ventilated patients who met the inclusion criteria were grouped in two groups, group A (130) patients non bundle used and group B (250) patient vap bundle used, then sub grouped to VAP and non VAP for statistical analysis, mean age in vap patients was higher in both groups, VAP incidence in group A 18.5% that decreased significantly to half of 9% in group B, p value <0.05, also VAP rate/1000 ventilated day showed a statistically significant difference between group A 25/1000 day in 2013 to VAP rate in 2014 year, 8.5/1000 ventilator days, also to VAP rate 6/1000 ventilator days in 2015, p value <0.007. Strong significant negative correlation between compliance of VAP bundle and VAP rate was found, p < 0.0001, VAP bundle compliance ranged from 94% to 100%. Male and medical patients were higher in both groups more than 62%, outcome improved after bundle as the death rate decreased in group B in both subgroups than that in group A, and length of stay in ICU was lowered significantly in group B about 2 days subsequently lowering the cost. Conclusion The application of VAP bundle is a feasible reality that produces improvement in microbiological measures and nosocomal infection rates resulting in lowering mortality, shortened lengths of hospitalization and decreased medical care costs. However, education and periodic training remain a fundamental process of improving health services. VAPs were reduced by improving bundle compliance and ensuring the same standard of care to all ICU patients. Direct, on-site observation was a more accurate method of monitoring. AD - S.R. Samra, Chest Department, Zagazige University, Faculty of Medicine, Egypt AU - Samra, S. R. AU - Sherif, D. M. AU - Elokda, S. A. DB - Embase DO - 10.1016/j.ejcdt.2016.08.010 KW - adult aged article care bundle clinical effectiveness comparative study controlled study cost control cost effectiveness analysis critically ill patient disease surveillance female follow up health care cost health service hospital infection human incidence infection rate intensive care unit intervention study length of stay major clinical study male mortality rate nursing practice outcome assessment pathogen clearance patient monitoring prospective study protocol compliance retrospective study ventilator associated pneumonia ventilator weaning LA - English M1 - 1 M3 - Article N1 - L612898568 2016-10-27 2017-04-21 PY - 2017 SN - 0422-7638 SP - 81-86 ST - Impact of VAP bundle adherence among ventilated critically ill patients and its effectiveness in adult ICU T2 - Egyptian Journal of Chest Diseases and Tuberculosis TI - Impact of VAP bundle adherence among ventilated critically ill patients and its effectiveness in adult ICU UR - https://www.embase.com/search/results?subaction=viewrecord&id=L612898568&from=export http://dx.doi.org/10.1016/j.ejcdt.2016.08.010 VL - 66 ID - 760961 ER - TY - JOUR AB - Emergency splenectomy is rarely performed since a widespread consensus exists towards conservative management of splenic injury. However, in selected conditions, mainly hematological, there is a role for emergency or urgent splenectomy. This study aims to retrospectively review these cases and discuss outcome in relation to the pre-existing splenic pathologies. Between 2000 and 2015, 12 patients, five girls, and seven boys, with a median age of six years (3 months-13.11 years), underwent emergency or urgent splenectomy for non-traumatic conditions. All patients had major associated disorders; mainly hematological (11 cases) including hemolytic anemia with pancytopenia (1), sickle cell anemia (1), AML (1), ALL (2), CML (1), T cell lymphoma (1), Burkitt lymphoma (1), and ITP (3). One patient had a microvillous inclusion disease. Indications for splenectomy included diffuse resistant splenic abscesses (4), intracranial hemorrhage (4) or hypersplenism (3) with refractory thrombocytopenia, and spontaneous splenic rapture (1). Nine patients improved following surgery but three died, owing to massive intracranial hemorrhage (1) and severe respiratory failure (2) despite aggressive management.Conclusions: Rarely, an emergency splenectomy is required in complex settings, mostly refractory hematological conditions, in a deteriorating patient when all other measurements have failed. A multidisciplinary team approach is mandatory in the treatment of these complex cases. What is known • Conservative treatment is advised for splenic injury. • Many hematological disorders are responsible of splenic pathology. What is new • Emergency splenectomy in children for reasons other than trauma is a treatment of last resort that should be performed in a multidisciplinary context. • The outcome of emergency splenectomy in children for reasons other than trauma depends on the underlying medical condition. AD - Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Kaplan St 14, 4920235, Petah Tikva, Israel. Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Kaplan St 14, 4920235, Petah Tikva, Israel. seguiere@gmail.com. Head of Hematology Unit, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel. Head of Department of Pediatric Intensive Care Unit, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel. Head of Department of Pediatric Surgery, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. Head of Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel. AN - 31312939 AU - Samuk, I. AU - Seguier-Lipszyc, E. AU - Baazov, A. AU - Tamary, H. AU - Nahum, E. AU - Steinberg, R. AU - Freud, E. DA - Sep DO - 10.1007/s00431-019-03424-6 DP - NLM ET - 2019/07/18 J2 - European journal of pediatrics KW - Adolescent Child Child, Preschool Emergencies Female Humans Infant Male Retrospective Studies *Splenectomy Splenic Diseases/etiology/*surgery Treatment Outcome Children Emergency splenectomy Non-traumatic LA - eng M1 - 9 N1 - 1432-1076 Samuk, Inbal Seguier-Lipszyc, Emmanuelle Baazov, Artur Tamary, Hannah Nahum, Elhanan Steinberg, Ran Freud, Enrique Journal Article Germany Eur J Pediatr. 2019 Sep;178(9):1363-1367. doi: 10.1007/s00431-019-03424-6. Epub 2019 Jul 16. PY - 2019 SN - 0340-6199 SP - 1363-1367 ST - Emergency or urgent splenectomy in children for non-traumatic reasons T2 - Eur J Pediatr TI - Emergency or urgent splenectomy in children for non-traumatic reasons VL - 178 ID - 760147 ER - TY - JOUR AB - Aim: to evaluate surgeons' opinions on risk factors for postoperative complications in IBD patients. Method: Descriptive study of a closed survey carried out through Twitter and email to the members of the Spanish Association of Surgeons (AEC) and the Spanish Association of Coloproctology (AECP) from January to March 2018. Results: 142 surgeons responded to the survey, 62% consultants. For 84% of responders, IBD patients have more complications than other surgical patients; anastomotic leakage and intraabdominal sepsis were considered the most dreaded complications. Preoperative steroids, immunosuppressors and anti-TNF were considered as risk factors (96, 80 and 79% respectively). 71.6% consider nutritional optimization as well as anemia and thromboembolic disease prophylaxis extremely important in these patients. Surgeons would decide not to perform an anastomosis or protect it with a stoma in emergency surgery (87.2%), malnutrition (67.7%), and steroid use (53.3%). 92% believe that the preoperative discussion and optimization of the patient by a multidisciplinary team decreases postoperative complications. Conclusion: Potentially modifiable risk factors of postoperative complications have been identified in IBD patients. The majority of respondents believe that preoperative optimization and multidisciplinary team management has a positive influence on surgical results. AD - L. Sanchez-Guillen, University Hospital Elche, Elche, Spain AU - Sanchez-Guillen, L. AU - Blanco-Antona, F. AU - Espina-Perez, B. AU - Gomez-Diaz, C. J. AU - Guasch-Marce, M. AU - Lopez-Rodriguez-Arias, F. AU - Arroyo, A. AU - Millan, M. DB - Embase DO - 10.1111/(ISSN)1463-1318 KW - endogenous compound immunosuppressive agent steroid tumor necrosis factor adult anastomosis leakage anemia complication conference abstract consultation e-mail emergency surgery human malnutrition multidisciplinary team prophylaxis risk factor sepsis stoma surgeon surgery surgical patient thromboembolism LA - English M3 - Conference Abstract N1 - L624186205 2018-10-18 PY - 2018 SN - 1463-1318 SP - 50 ST - Postoperative complications in IBD patients: What are we worried about? A national survey T2 - Colorectal Disease TI - Postoperative complications in IBD patients: What are we worried about? A national survey UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624186205&from=export http://dx.doi.org/10.1111/(ISSN)1463-1318 VL - 20 ID - 760804 ER - TY - JOUR AB - Objective. The aim of the present study was to assess the clinical safety profile of dental extractions in patients with thrombocytopenia and explore the effectiveness of platelet transfusion before dental extractions. Study Design. This is a retrospective cohort study of patients with moderate to severe (<= 100,000/mu L) thrombocytopenia who underwent dental extractions in the Oral Medicine and Dentistry Clinic at Brigham and Women's Hospital from 2003 to 2019. Patients with a platelet count <30,000/mu L received prophylactic preprocedure platelet transfusion. Risk and type of bleeding complication (prolonged postoperative bleeding requiring intervention with topical hemostatic agents and/or therapeutic platelet transfusions) was assessed. Result . Eighty-nine thrombocytopenic patients were identified. Postextraction bleeding complications occurred in 4 patients (4.4%). Surgical extractions and multiple number of extractions were significantly associated with an increased bleeding risk (P < .05), whereas prophylactic platelet transfusion and post-transfusion platelet count were not. Conclusions. Dental extractions in patients with thrombocytopenia may be performed with a positive safety profile by following a comprehensive medical evaluation, thorough treatment planning, adequate surgical management, use of local hemostatic measures, and, importantly, coordination of care with the patient's medical team. AD - [Sandhu, Shaiba; Sankar, Vidya; Villa, Alessandro] Brigham & Womens Hosp, Div Oral Med & Dent, 75 Francis St, Boston, MA 02115 USA. [Sandhu, Shaiba; Sankar, Vidya; Villa, Alessandro] Harvard Sch Dent Med, Dept Oral Med Infect & Immun, Boston, MA USA. Sandhu, S (corresponding author), 1620 Tremont St,Suite BC 3-028, Boston, MA 02120 USA. Ssandhu@bwh.harvard.edu AN - WOS:000533604300012 AU - Sandhu, S. AU - Sankar, V. AU - Villa, A. DA - May DO - 10.1016/j.oooo.2019.12.010 J2 - Oral Surg. Oral Med. Oral Pathol. Oral Radiol. KW - PLATELET TRANSFUSION MANAGEMENT HEMOSTASIS THROMBOSIS Dentistry, Oral Surgery & Medicine LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: LO4MV Times Cited: 0 Cited Reference Count: 22 Sandhu, Shaiba Sankar, Vidya Villa, Alessandro 0 ELSEVIER SCIENCE INC NEW YORK OR SURG OR MED OR PA PY - 2020 SN - 2212-4403 SP - 478-483 ST - Bleeding risk in thrombocytopenic patients after dental extractions: a retrospective single-center study T2 - Oral Surgery Oral Medicine Oral Pathology Oral Radiology TI - Bleeding risk in thrombocytopenic patients after dental extractions: a retrospective single-center study UR - ://WOS:000533604300012 VL - 129 ID - 761446 ER - TY - JOUR AB - Objective: Compare patient characteristics, adverse events (AEs), and short term functional outcomes in patients directly presenting to and transferred into a comprehensive stroke center (CSC). Background: Guidelines recommend acute ischemic stroke (AIS) patients be transported rapidly to the closest certified stroke center (SC). The impact of SC care on transfer patients who do not receive acute revascularization therapy is not well understood. Design/Methods: Retrospective review of consecutive AIS patients at our CSC from March 2014-April 2015. We excluded patients who received tPA or endovascular therapy. Demographic and clinical data were collected. We compared AEs (hemorrhagic transformation [HT], DVT, PE, urinary tract infection [UTI], pneumonia [PNA], bacteremia) and poor short term functional outcome (modified Rankin scale score 36), among direct presenters and those transferred into our CSC. Results: Of 589 patients who did not receive revascularization therapy, 24.4[percnt] were transfers. Transfers were disproportionately white (76.4 vs 57.8[percnt], p<0.001), had higher median NIHSS (5 vs 4, p=0.028), were less often privately insured (40.1 vs 46.4[percnt]), and had less desirable ASPECTS scores on initial head CT (810; 22.9 vs 44.0, p<0.001). Transfers had higher odds of having AEs (crude OR 2.134, 95[percnt] 1.353-3.365). This association remained after adjusting for age, stroke severity, and admission glucose (OR 2.103, 95[percnt] CI 1.276-3.466.004). Transfers more frequently developed HT on repeat imaging (17.5 vs 7.0[percnt], p<0.001), clinical seizure during inpatient stay (4.9 vs 1.6[percnt], p=0.024), and PNA (7.6 vs 3.8[percnt], p=0.061). However, transfer status was not associated with poor short-term functional outcome (crude OR 1.453, 95[percnt] CI 0.986-2.141; adjusted OR 1.200, 95[percnt] CI 0.703-2.046). Conclusions: Despite having more severe strokes and higher frequency of adverse events, patients transferred into our CSC did not have worse short term functional outcomes. This highlights the importance of specialized inpatient care provided in NICUs and stroke units by experienced multidisciplinary teams. AD - K. Sands AU - Sands, K. AU - Albright, K. AU - Donnelly, J. AU - Jones, B. AU - Kaur, M. AU - Sisson, A. AU - Shiue, H. AU - Lyerly, M. AU - Gropen, T. DB - Embase KW - glucose human cerebrovascular accident American neurology patient therapy revascularization hospital patient Rankin scale bacteremia pneumonia brain ischemia urinary tract infection stroke unit clinical study seizure imaging National Institutes of Health Stroke Scale stroke patient LA - English M1 - 16 M3 - Conference Abstract N1 - L72252309 2016-04-27 PY - 2016 SN - 0028-3878 ST - When non-revascularized transfer patients come a-knocking at a stroke center T2 - Neurology TI - When non-revascularized transfer patients come a-knocking at a stroke center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72252309&from=export VL - 86 ID - 761027 ER - TY - JOUR AB - Background: Guidelines recommend acute ischemic stroke (AIS) patients be transported rapidly to the closest certified stroke center (SC). The impact of SC care on transfer patients who do not receive acute revascularization therapy is not well understood. We sought to compare patient characteristics, adverse events (AEs), and short term functional outcomes in patients directly presenting to and transferred into a comprehensive stroke center (CSC). Methods: We conducted a retrospective review of consecutive AIS patients transferred to our CSC from March 2014-April 2015. We excluded patients who received tPA or endovascular therapy. Demographic and clinical data were collected. We compared AEs (hemorrhagic transformation [HT], DVT, PE, urinary tract infection [UTI], pneumonia [PNA], bacteremia) and poor short term functional outcome, as defined by modified Rankin scale (mRS) score 3-6, among patients directly admitted to our CSC and patients transferred to our CSC. Results: Of 589 patients who did not receive revascularization therapy, 24.4% were transfers. Transfers were disproportionately white (76.4 vs 57.8%, p<0.001), had higher median NIHSS (5 vs 4, p=0.028), were less often privately insured (40.1 vs 46.4%), and had less desirable ASPECTS scores on initial head CT (8-10; 22.9 vs 44.0, p<0.001). Transfers had higher odds of having AEs (crude OR 2.134, 95% 1.353-3.365). This association remained after adjusting for age, stroke severity, and admission glucose (OR 2.103, 95% CI 1.276-3.466.004). Transfers more frequently developed HT on repeat imaging (17.5 vs 7.0%, p<0.001), clinical seizure during inpatient stay (4.9 vs 1.6%, p=0.024), and PNA (7.6 vs 3.8%, p=0.061). However, transfer status was not associated with poor short-term functional outcome (crude OR 1.453, 95% CI 0.986-2.141; adjusted OR 1.200, 95% CI 0.703-2.046). Conclusion: Despite having more severe strokes and higher frequency of adverse events, patients transferred into our CSC for a higher level of care did not have worse short term functional outcomes. This highlights the importance of specialized inpatient care provided in NICUs and stroke units by experienced multidisciplinary teams. AD - K.A. Sands, Neurology, Univ of Alabama at Birmingham, Birmingham, AL, United States AU - Sands, K. A. AU - Albright, K. C. AU - Donnelly, J. P. AU - Jones, B. A. AU - Kaur, M. AU - Sisson, A. AU - Shiue, H. AU - Lyerly, M. AU - Gropen, T. DB - Embase KW - glucose cerebrovascular accident nursing human heart American patient therapy revascularization hospital patient Rankin scale bacteremia pneumonia urinary tract infection brain ischemia stroke unit seizure clinical study imaging National Institutes of Health Stroke Scale stroke patient LA - English M3 - Conference Abstract N1 - L72210741 2016-03-21 PY - 2016 SN - 0039-2499 ST - When non-revascularized transfer patients come A-knocking at a stroke center T2 - Stroke TI - When non-revascularized transfer patients come A-knocking at a stroke center UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72210741&from=export VL - 47 ID - 761040 ER - TY - JOUR AU - Santiago, M. AU - Abrams, S. AU - Truong, J. DA - 2020/08/26 08/26 DB - Europe PubMed Central DO - 10.1016/j.visj.2020.100789 PY - 2020 SN - 2405-4690 ST - Use of US to expedite diagnosis of PE in COVID-19 Patient T2 - Vis J Emerg Med TI - Use of US to expedite diagnosis of PE in COVID-19 Patient UR - http://europepmc.org/article/MED/32835114 VL - 20 ID - 762033 ER - TY - JOUR AB - Introduction Patient Blood Management (PBM) has recently become of primary medical interest, due to the need of optimizing patients' prognosis and minimizing costs and risks of allogeneic blood transfusions. The 3 recognized 'pillars' of PBM are: Implementing red blood cell (RBC) mass, i.e. reducing anemia (if present) and ensure adequate iron and vitamin reserves Minimizing hemorrhage during and after surgery Optimizing tolerance to mild/moderate grades of anemia PBM guidelines have been recently proposed by several national and international blood authorities and scientific societies such as the European Society of Anesthesia (ESA) and, in Italy, the Blood National Bank (Centro Nazionale Sangue-CNS). However, a strict application of the guideline is not easy. Indeed, each hospital must verify its feasibility considering aspects such as its logistic (e.g. the location of the operative theaters, emergency and obstetrics, presence/absence of 24h open blood bank, etc.), the experience of each surgical team and the characteristics of the patients. General and local guidelines, moreover, should not be imposed, but shared by competent multidisciplinary teams of anesthesiologists, surgeons, and transfusionists, and an adequate training of the involved personnel should be ensured before applications. Objective We report here our experience in San Raffaele hospital, with particular regard to the vascular surgery, which is a national reference center. Results The first step in PBM is the preoperatory phase (Figure 1). Depending on patient's comorbidities and/or hematologic diseases, gender, and underlying pathology, preoperative anemia may be present in up to 20-50% of cases, and represents an independent risk for morbidity and mortality (Munoz et al. Blood Transfus. 2012; Spahn et al Anesthesiology 2010), due to higher infection rate, longer recovery time, prolonged hospi-talization, and decreased quality of life. Implementing the RBC mass is the most important target of this phase. Patients at risk of massive bleeding are the ones undergoing major cardiac and vascular surgery; for those patients, the aim is to minimize the need of blood support. Our data suggest that patients with Hb 12 g/dL or above before surgery have 20% probability of not being transfused for a TAAA (thoraco-abdominal aorta aneurysm) with a median perioperative support of 3 RBC units, whereas this percentage decreases to only 2% in patients with less than 12 g/dL with a median support of 5 RBC units. Other patients undergoing liver, oncologic, or orthopedic surgery, instead, may completely avoid transfusion, if they are correctly supported before surgery. Special care must be taken to optimize anticoagulant and antiplatelet therapy. As ESA guidelines suggest, patients undergoing surgery with potential transfusion need to be evaluated 6-8 weeks before surgery, in order to have time to correct anemia and restore iron storage resources. However, in the majority of Italian hospitals, the preoperative routine tests are usually done about 3-4 weeks before surgery, while patients coming from other regions referred to larger university hospitals for second-level surgery, in spite of their complications and comorbidities, may be evaluated shortly before surgery. We are currently applying the approved CNS-suggested algorithm for patients undergoing elective major vascular, cardiac, liver, and orthopedic surgery. The hematologist works together with the anesthesiologists in the presur-gery ambulatory check for all patients undergoing elective surgery, providing iron and/or vitamin support as need. We normally suggest oral supplementation with Sucrosomial® Iron, due to its efficacy and tolerability profile, as well as its broad spectrum of efficacy in different underlying conditions such as chronic diseases and cancer (D'Amico e al. EHA 2015; Pisani et al, Barni et al, Gascon et al 3rd Mediterranean Multidisciplinary Course on Iron Anemia); our data are at the moment under evaluation. In particular situations when there is no enough time to ensure an adequate re tore of hemoglobin levels or in case of documented iron malabsorption, we prefer the use of intravenous iron administration (Pisani et al al 3rd Mediterranean Multidisciplinary Course on Iron Anemia). Even if the use of EPO is suggested in order to implement RBC mass, possible side effects and lack of patients' confidence toward this drug lead us to reserve this treatment to very selected cases. The second step of PBM is in the perioperative phase. According to the suggestion of our regional sanitary system, the above cited multidisciplinary teams have revised the data and identified for each operation the Maximum Surgical Blood Order Schedule (MSBOS). This allowed to reduce the amount of blood units preemptively brought to the operating theater. In the TAAA subset, for example, the MSBOS have been reduced from 10 to 5 or 7 according to patients' characteris-tics. In the case of cardiac surgery, 3 patient groups have been identified: only patients undergoing high-risk surgery preemptively have their RBC units brought into the theater, whereas all the others do immunohematology standard tests and receive RBC only on demand. The results of this approach are still under evaluation. However, one may speculate that a better education of sur-geons and anesthesiologists, as well the direct presence of a smaller amount of blood in the operating theater, may reduce the number of effectively transfused RBC units. The main target of PBM during this phase is to minimize hemorrhage and at San Raffaele Hospital a strong collaboration has been built up among the emergency room, the cardiac/vascular surgery and obstetrics on shared thromboe-lastometry-based management protocols. The aim of those protocols is to optimize the use of plasma and platelets units and prevent/treat massive hemorrhage with fibrinogen concentrates. Considering only the vascular surgery subset, this led to a reduction in the use of intraoperative plasma from 2000 to 1500 mL and blood from 3 to 2 units, with a significant expense decrease and no negative impact on patients' prognosis. The final, but not less important step in PBM, is the postoperative phase. Even if the intraoperative use of RBC units has been reduced, many patients are transfused during the intensive care unit stay or readmission, especially after major surgery. In some cases, this procedure is mainly preemptive, since referring patients to transfusional or to hematology unit after discharge is logistically complicated. For the TAAA subset, in our hands, 70% of patients were transfused after surgery, with median Hb level at transfusion of 8.9 g/dL, but in 7% of cases it was 10 g/dL or more. Therefore, we are currently planning a workflow in which blood test of selected patients associate to the standard postoperative surgical ambulatory controls. In the unlikely probability of transfusion need, those patients would be managed in the hospital Transfusion Center; much more frequently they would be given an appropriate oral iron and/or vitamin support plus follow-up indications for their general practitioner. AD - L. Santoleri, Center of Transfusion Medicine IRCCS San Raffaele, Milan, Italy AU - Santoleri, L. AU - Tasara, M. AU - Bellio, L. DB - Embase DO - 10.1080/17474086.2017.1399059 KW - antithrombocytic agent endogenous compound fibrinogen iron vitamin abdominal aortic aneurysm adult anemia anesthesia anesthesiologist bleeding blood bank cancer prognosis cancer surgery central nervous system clinical article clinical trial comorbidity complication controlled clinical trial controlled study drug combination drug therapy elective surgery emergency ward feasibility study female follow up gender general practitioner heart surgery hematocrit hematologist hematology hemoglobin blood level hospital readmission human human cell human tissue infection rate intensive care unit iron storage Italy liver major surgery malabsorption male malignant neoplasm morbidity mortality obstetrics operating room organization orthopedic surgery pathology postoperative period prevention probability prognosis quality of life remission risk assessment side effect surgeon surgery thrombocyte tic university hospital vascular surgery workflow LA - English M3 - Conference Abstract N1 - L619950841 2017-12-29 PY - 2017 SN - 1747-4094 SP - 2-4 ST - Patient blood management: From theory to practice T2 - Expert Review of Hematology TI - Patient blood management: From theory to practice UR - https://www.embase.com/search/results?subaction=viewrecord&id=L619950841&from=export http://dx.doi.org/10.1080/17474086.2017.1399059 VL - 10 ID - 760970 ER - TY - JOUR AB - Background and Purpose-Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age. Methods-This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay. Results-Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home. Conclusions-In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality. (Stroke. 2009;40:3328-3335.) AD - [Saposnik, Gustavo] Univ Toronto, St Michaels Hosp, Stroke Outcome Res Canada Working Grp, Stroke Res Unit,Div Neurol,Dept Med, Toronto, ON M5C 1R6, Canada. [Black, Sandra E.] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Med, Heart & Stroke Fdn Ctr Stroke Recovery,Div Neurol, Toronto, ON M5C 1R6, Canada. [Hakim, Antoine] Univ Ottawa, Ottawa Hlth Res Inst, Dept Neurosci Res, Ottawa, ON K1N 6N5, Canada. [Tu, Jack V.; Kapral, Moira K.] Univ Hlth Network, Dept Med, Div Gen Internal Med & Clin Epidemiol, Toronto, ON, Canada. [Saposnik, Gustavo; Tu, Jack V.; Kapral, Moira K.] Univ Hlth Network, Womens Hlth Program, Toronto, ON, Canada. [Saposnik, Gustavo; Tu, Jack V.; Kapral, Moira K.] Univ Toronto, Dept Hlth Policy Management & Evaluat, Toronto, ON M5C 1R6, Canada. Saposnik, G (corresponding author), Univ Toronto, St Michaels Hosp, Stroke Outcome Res Canada Working Grp, Stroke Res Unit,Div Neurol,Dept Med, 55 Queen St E,Suite 931, Toronto, ON M5C 1R6, Canada. saposnikg@smh.toronto.on.ca AN - WOS:000270229800029 AU - Saposnik, G. AU - Black, S. E. AU - Hakim, A. AU - Fang, J. M. AU - Tu, J. V. AU - Kapral, M. K. AU - Investigators, Rcsn SORCan Working DA - Oct DO - 10.1161/strokeaha.109.558759 J2 - Stroke KW - access to care health policy health services research medicine mortality occupational therapy organized care outcome research physiotherapy stroke team stroke unit SOCIOECONOMIC-STATUS ISCHEMIC-STROKE MORTALITY DISEASE GENDER ACCESS MANAGEMENT INDEX RISK Clinical Neurology Peripheral Vascular Disease LA - English M1 - 10 M3 - Article N1 - ISI Document Delivery No.: 499NV Times Cited: 88 Cited Reference Count: 29 Saposnik, Gustavo Black, Sandra E. Hakim, Antoine Fang, Jiming Tu, Jack V. Kapral, Moira K. Saposnik, Gustavo/M-3937-2017 Saposnik, Gustavo/0000-0002-5950-9886; Tu, Jack/0000-0003-0111-722X; Black, Sandra/0000-0001-7093-8289 90 0 13 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA STROKE PY - 2009 SN - 0039-2499 SP - 3328-3335 ST - Age Disparities in Stroke Quality of Care and Delivery of Health Services T2 - Stroke TI - Age Disparities in Stroke Quality of Care and Delivery of Health Services UR - ://WOS:000270229800029 VL - 40 ID - 761890 ER - TY - JOUR AB - Background. Thromboembolism (TE) in newborns and children is becoming A rapidly increasing condition burdened by mortality and high morbidity. A dramatic increase in TE (from an annual rate of 34 to one of 54 cases per 10,000 admissions) has been reported in tertiary care hospitals in US between 2001-2007. Risk factors, clinical features and prognosis are age-dependent as well as optimal treatment strategy; however, randomised controlled trials are not available and most current treatment recommendation are extrapolated by adult studies. National and international registries have been created in various countries aiming at developing clinical trials to better understand and improve outcomes in children with TE. The Italian Registry of Pediatric Thrombosis (R. I. T. I.) was established in 2007 by A multidisciplinary team, and supported by an onlus association (ALT), aiming at better understanding neonatal and paediatric thrombotic events (TE) in Italy and providing A preliminary source of data for the future development of specific clinical trials and diagnostic-therapeutic protocols. Methods. The online event-based registry was launched in 2010, enrolling both systemic and cerebral arterial and venous TE in neonates (0-28 days) and children (up to 18 years). As of december 2016 A total of 843 events (59% pediatric and 41% neonatal TE) were recorded. Results. Data analysis of cases enrolled between 2007-2013 were reported and included pediatric cerebral arterial (N=79) and venous (N=91) TE (J Thromb Hemost 2015); clinical data of neonatal non cerebral systemic (N=75) TE (J Pediatr 2016) and of pediatric venous (N=92) TE (Blood Transfus 2017); A longer time to diagnosis compared to other registries and case series, was evidenced both for cerebrovascular and systemic TE. From 2017 the Registry is built through A web platform application (REDCap) specifically geared to support online/offline data capture for research studies and operations (https://www.trombosiinfantili.info) and case enrollment is patient-based, with number approaching 900. Data analysis are ongoing on neonatal cerebral TE and hospital acquired pediatric events. Conclusions. RITI will represent an opportunity for both Italian pediatricians and investigators of other registries to collaborate on multiple studies on risk factors, diagnostic investigations, optimal treatment strategy and acute and long-term outcome of childhood TE. AD - P. Saracco, Ematologia Pediatrica, AOU Citta della Salute e della Scienza Torino, Torino, Italy AU - Saracco, P. AU - Agostini, M. AU - Bagna, R. AU - Gentilomo, C. AU - Ilardi, L. AU - Giordano, P. AU - Lasagni, D. AU - Luciani, M. AU - Magarotto, M. AU - Molinari, A. C. AU - Sartori, S. AU - Suppiej, A. AU - Simioni, P. DB - Embase DO - 10.2450/2018.S4 KW - adult arterial thromboembolism case study child childhood clinical feature conference abstract data analysis diagnosis diagnostic test accuracy study female human Italy major clinical study male multidisciplinary team newborn pediatrician prognosis randomized controlled trial risk factor tertiary care center venous thromboembolism LA - English M3 - Conference Abstract N1 - L625452647 2018-12-19 PY - 2018 SN - 1723-2007 SP - s524 ST - The new online italian registry of pediatric thrombosis (RITI) T2 - Blood Transfusion TI - The new online italian registry of pediatric thrombosis (RITI) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L625452647&from=export http://dx.doi.org/10.2450/2018.S4 VL - 16 ID - 760799 ER - TY - JOUR AB - Aim of study: To explore the incidence of complications following spinal cord injury, explore the possible relation of complication development and the time lapse from injury to admission to a spinal unit, and compare results in both centres and those in literature. Research study: Retrospective study. Material and methods: Retrospective study has been taken to determine complications following SCI during the acute phase. Random samples were collected from Stoke Mandeville (50 patients). Data collected are from patients' medical records. Data collection tool designed to explore the following aspects: completeness of the notes, referrals forms/outreach services, aetiology and level of injury, pre- and postadmission management, time between injury and admission to spinal unit, type of complications reviewed include skin, respiratory, urinary, bowels, cardiovascular/ deep vein thrombosis (DVT)/pulmonary embolism (PE), psychological, surgical, gastrointestinal (GI), pre- and postadmission complications. Results: Study suggested that early admissions to specialised spinal centres reduce the incidence of complication development. A high incidence of at least one complication on admission was documented; the most common complications detected were skin, urinary, respiratory, and psychological. The study findings highlighted the poor documentation of the multidisciplinary team. Other findings will be outline dwithin presentation. Conclusion: It is evident from the finding of the study that a uniform standard of SCI treatment will soon be provided throughout the country As a result this will serve to improve the quality of care given to SCI patient groups, This will lead to diversion of resources to improve services of SCI management further, further recommendations will be outline within poster presentation. AD - F. Sarhan, Buckinghamshire New University, Uxbridge, United Kingdom AU - Sarhan, F. AU - Saif, M. DB - Embase DO - 10.1310/sci16S1-53 KW - rehabilitation spinal cord injury human patient skin retrospective study information processing random sample spinal cord injury medical record lung embolism etiology deep vein thrombosis documentation intestine LA - English M3 - Conference Abstract N1 - L70724532 2012-04-26 PY - 2011 SN - 1082-0744 SP - 109 ST - Complications following SCI during the acute phase T2 - Topics in Spinal Cord Injury Rehabilitation TI - Complications following SCI during the acute phase UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70724532&from=export http://dx.doi.org/10.1310/sci16S1-53 VL - 16 ID - 761230 ER - TY - JOUR AB - A 33-year-old primiparous woman, 12-weeks postpartum status-post spontaneous vaginal delivery complicated by preeclampsia, presented as a hospital transfer. Initial presentation was for acute intermittent tearing, retrosternal chest pain, that started at rest. On arrival vitals were significant for blood pressure (BP) of 171/97 mmHg and pulse of 122 beats-per-minute. Initial electrocardiogram showed ST elevations in anterior leads. Troponin I drawn on arrival was <0.10. Nitroglycerin drip and IV labetolol were started for blood pressure control and she was thrombolysed with alteplase in the ER. Emergent cardiac catheterization demonstrated coronary artery dissection in the left anterior descending (LAD) artery. At that time, she was transferred to our institute for further management. She was started on aspirin 81 mg and low-dose heparin while BP was managed with carvedilol and nitroglycerin drip titration. A multidisciplinary approach with cardiology, surgery, in addition to inter-institutional conferences was implemented. With blood pressure stabilization, she was transitioned to an oral regimen of carvedilol 25mg twice daily. Follow up cardiac computerized tomography (CT) angiography at that time showed stable disease compared to initial catheterization. Significant findings showed the left main coronary artery with 20-30% luminal narrowing without active dissection, LAD with thrombosis dissection in the ostium with up to 60-70%. Additionally, CT of the neck showed mild bilateral fibromuscular dysplasia of the internal carotids. She experienced no further complications throughout her hospital course and was discharged. In conclusion, after literature review and extensive multidisciplinary discussion the management of SCAD must be managed case-by-case. Multidisciplinary teams are likely to yield more favorable outcomes by pooling collective experience. AD - A. Sarkar, Internal Medicine, University of Miami, Holy Cross Hospital, Fort Lauderdale, FL, United States AU - Sarkar, A. AU - Sennhauser, S. AU - Lee, J. AU - Llanos, A. AU - Wood, M. J. DB - Embase DO - 10.1159/000491714 KW - acetylsalicylic acid alteplase carvedilol endogenous compound glyceryl trinitrate heparin troponin I adult blood pressure regulation cardiology carotid artery case report clinical article complication computed tomographic angiography conference abstract coronary artery dissection disease course drug combination drug therapy female fibromuscular dysplasia follow up heart catheterization human left anterior descending coronary artery low drug dose neck outcome assessment preeclampsia rest ST segment elevation surgery thorax pain thrombosis titrimetry vaginal delivery LA - English M3 - Conference Abstract N1 - L623415058 2018-08-14 PY - 2018 SN - 1421-9751 SP - 240 ST - Spontaneous coronary artery dissection, a fatal disease in hiding T2 - Cardiology (Switzerland) TI - Spontaneous coronary artery dissection, a fatal disease in hiding UR - https://www.embase.com/search/results?subaction=viewrecord&id=L623415058&from=export http://dx.doi.org/10.1159/000491714 VL - 140 ID - 760876 ER - TY - JOUR AB - To ensure that experiences and lessons learned from the unprecedented 2011 Great East Japan Earthquake are used to improve future disaster planning, the Japan Diabetes Society (JDS) launched the "Research and Survey Committee for Establishing Disaster Diabetes Care Systems Based on Relevant Findings from the Great East Japan Earthquake" under the supervision of the Chairman of the JDS. The Committee conducted a questionnaire survey among patients with diabetes, physicians, disaster medical assistance teams (DMATs), nurses, pharmacists, and nutritionists in disaster areas about the events they saw happening, the situations they found difficult to handle, and the needs that they felt required to be met during the 2011 Great East Japan Earthquake. A total of 3,481 completed questionnaires were received. Based on these and other experiences and lessons reported following the 2011 Great East Japan Earthquake and the 2004 Niigata-Chuetsu Earthquakes, the current "Manual for Disaster Diabetes Care" has been developed by the members of the Committee and other invited authors from relevant specialties. To our knowledge, the current Manual is the world's first to focus on emergency diabetes care, with this digest English version translated from the Japanese original. It is sincerely hoped that patients with diabetes and healthcare providers around the world will find this manual helpful in promoting disaster preparedness and implementing disaster relief. AD - [Satoh, Jo] Tohoku Med & Pharmaceut Univ, Wakabayashi Hosp, Sendai, Miyagi, Japan. [Yokono, Koichi] Kita Harima Med Ctr, Ono, Hokkaido, Japan. [Ando, Rie] Kanagawa Univ Human Serv, Yokosuka, Kanagawa, Japan. [Asakura, Toshinari] Niigata Univ Pharm & Appl Life Sci, Fac Pharmaceut Sci, Niigata, Japan. [Hanzawa, Kazuhiko] Niigata Univ, Grad Sch Med & Dent Sci, Adv Treatment & Prevent Vasc Dis & Embolism, Niigata, Japan. [Ishigaki, Yasushi] Iwate Med Univ, Dept Internal Med, Div Diabet Metab & Endocrinol, Morioka, Iwate, Japan. [Kadowaki, Takashi] Univ Tokyo, Grad Sch Med, Dept Prevent Diabet & Lifestyle Related Dis, Tokyo, Japan. [Kadowaki, Takashi] Teikyo Univ, Mizonokuchi Hosp, Fac Med, Dept Metab & Nutr, Tokyo, Japan. [Kasuga, Masato] Asahi Life Fdn, Inst Adult Dis, Tokyo, Japan. [Katagiri, Hideki] Tohoku Univ, Grad Sch Med, Dept Metab & Diabet, Sendai, Miyagi, Japan. [Kato, Yasuhisa] Sakae Katou Clin, Nagoya, Aichi, Japan. [Kurosawa, Koreyuki; Tachi, Masahiro] Tohoku Univ, Grad Sch Med, Dept Plast & Reconstruct Surg, Sendai, Miyagi, Japan. [Miura, Masanobu; Shimokawa, Hiroaki] Tohoku Univ, Grad Sch Med, Dept Cardiovasc Med, Sendai, Miyagi, Japan. [Nakamura, Jiro] Aichi Med Univ, Sch Med, Dept Internal Med, Div Diabet, Nagakute, Aichi, Japan. [Nishitsuka, Koichi; Yamashita, Hidetoshi] Yamagata Univ, Fac Med, Dept Ophthalmol, Yamagata, Japan. [Ogawa, Susumu] Tohoku Univ Hosp, Div Nephrol Endocrinol & Vasc Med, Sendai, Miyagi, Japan. [Okamoto, Tomoko] Tohoku Univ Hosp, Sendai, Miyagi, Japan. [Sakuma, Sadanori] Hirosaka Cardiol Med Clin, Koriyama, Fukushima, Japan. [Sakurai, Shigeru] Iwate Med Univ Hosp, Dept Safety Med, Div Infect Control, Morioka, Iwate, Japan. [Satoh, Hiroaki] Juntendo Univ, Dept Metab & Endocrinol, Tokyo, Japan. [Shimauchi, Hidetoshi; Tomita, Hiroaki] Tohoku Univ, Sendai, Miyagi, Japan. [Shoji, Wataru] Tohoku Univ, Grad Sch Med, Dept Prevent Psychiat, Sendai, Miyagi, Japan. [Sugiyama, Takashi] Ehime Univ, Grad Sch Med, Dept Obstet & Gynecol, Toon, Japan. [Suwabe, Akira] Iwate Med Univ, Sch Med, Dept Lab Med, Morioka, Iwate, Japan. [Takahashi, Kazuma] Iwate Prefectural Univ, Takizawa, Japan. [Takahashi, Susumu] Nakatsugawa Hosp, Nakatsugawa, Japan. [Terayama, Yasuo] Iwate Med Univ, Sch Med, Dept Internal Med, Div Neurol & Gerontol, Morioka, Iwate, Japan. [Tsuchiya, Yoko] Hirosaki Gakuin Univ, Hirosaki, Aomori, Japan. [Waki, Hironori] Univ Tokyo, Grad Sch Med, Dept Diabet & Metab Dis, Tokyo, Japan. [Watanabe, Tsuyoshi] Fukushima Rosai Hosp, Japan Org Occupat Hlth & Safety, Iwaki, Fukushima, Japan. [Yahata, Kazuaki] Nagaoka Chuo Hosp, Nagaoka, Niigata, Japan. [Kadowaki, Takashi] Japan Diabet Soc, Tokyo, Japan. [Kasuga, Masato] Japan Diabet Soc, Acad Invest & Educ, Tokyo, Japan. Satoh, J (corresponding author), Tohoku Med & Pharmaceut Univ, Wakabayashi Hosp, Sendai, Miyagi, Japan. josatoh@hosp.tohoku-mpu.ac.jp AN - WOS:000475508500032 AU - Satoh, J. AU - Yokono, K. AU - Ando, R. AU - Asakura, T. AU - Hanzawa, K. AU - Ishigaki, Y. AU - Kadowaki, T. AU - Kasuga, M. AU - Katagiri, H. AU - Kato, Y. AU - Kurosawa, K. AU - Miura, M. AU - Nakamura, J. AU - Nishitsuka, K. AU - Ogawa, S. AU - Okamoto, T. AU - Sakuma, S. AU - Sakurai, S. AU - Satoh, H. AU - Shimauchi, H. AU - Shimokawa, H. AU - Shoji, W. AU - Sugiyama, T. AU - Suwabe, A. AU - Tachi, M. AU - Takahashi, K. AU - Takahashi, S. AU - Terayama, Y. AU - Tomita, H. AU - Tsuchiya, Y. AU - Waki, H. AU - Watanabe, T. AU - Yahata, K. AU - Yamashita, H. DA - Jul DO - 10.1111/jdi.13053 J2 - J. Diabetes Investig. KW - Diabetes Disaster Manual EAST JAPAN EARTHQUAKE HOME BLOOD-PRESSURE GLYCEMIC CONTROL THROMBOSIS TSUNAMI STRESS Endocrinology & Metabolism LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: II9HQ Times Cited: 0 Cited Reference Count: 31 Satoh, Jo Yokono, Koichi Ando, Rie Asakura, Toshinari Hanzawa, Kazuhiko Ishigaki, Yasushi Kadowaki, Takashi Kasuga, Masato Katagiri, Hideki Kato, Yasuhisa Kurosawa, Koreyuki Miura, Masanobu Nakamura, Jiro Nishitsuka, Koichi Ogawa, Susumu Okamoto, Tomoko Sakuma, Sadanori Sakurai, Shigeru Satoh, Hiroaki Shimauchi, Hidetoshi Shimokawa, Hiroaki Shoji, Wataru Sugiyama, Takashi Suwabe, Akira Tachi, Masahiro Takahashi, Kazuma Takahashi, Susumu Terayama, Yasuo Tomita, Hiroaki Tsuchiya, Yoko Waki, Hironori Watanabe, Tsuyoshi Yahata, Kazuaki Yamashita, Hidetoshi Satoh, Hiroaki/E-9096-2017 Satoh, Hiroaki/0000-0002-0353-5807; Nishitsuka, Koichi/0000-0003-2394-9561; Shimokawa, Hiroaki/0000-0001-7534-4826 0 WILEY HOBOKEN J DIABETES INVEST PY - 2019 SN - 2040-1116 SP - 1118-1142 ST - Diabetes Care Providers' Manual for Disaster Diabetes Care T2 - Journal of Diabetes Investigation TI - Diabetes Care Providers' Manual for Disaster Diabetes Care UR - ://WOS:000475508500032 VL - 10 ID - 761514 ER - TY - JOUR AB - Background: Adherence to American College of Chest Physicians (CHEST) and National Comprehensive Cancer Network (NCCN) guidelines for venous thromboembolism (VTE) prophylaxis helps avoid thromboembolic complications during hospitalization. Electronic health records (EHR) have the potential to make an impact on guideline adherence, but data are lacking. Objectives: To determine compliance with VTE prophylaxis guidelines in internal medicine and oncology populations and to determine whether EHR implementation had any effect on the rate and appropriateness of prophylaxis practices. Methods: A retrospective chart review was conducted on medical and oncology patients admitted to the hospital for a 2-month period pre-EHR and post-EHR implementation. Risk assessment tools were available pre and post, however they were not mandatory. The rate of VTE prophylaxis was compared between the 2 time periods, with appropriateness assessed in a subgroup of participants without prophylaxis. Results: A total of 2,423 patients on the oncology and internal medicine floors were identified during the pre-EHR (n = 1,171) and post-EHR (n = 1,252) time periods. Patients in the post-EHR group were less likely to be prescribed prophylaxis as compared to those in the pre-EHR group (43% vs 50%; P = .001). In the patients audited for proper prophylaxis use (n = 750), significantly more patients in the post-EHR group had risk factors (84% vs 53%; P < .001) and contraindications (23% vs 8%; P = .001) than in the pre-EHR group. Noncompliance to prophylaxis in patients who were candidates (positive risk factors without contraindications) occurred more often in the post-EHR group (51% vs 39%; P < .001). Conclusion: Implementation of an EHR was associated with an increase in the documentation of risk factors and contraindications; however, there was a significant decrease in VTE prophylaxis utilization after EHR implementation. AD - Assistant Professor of Pharmacy Practice, Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana Clinical Pharmacy Specialist Internal Medicine, Department of Pharmacy, St. Vincent Hospital, Indianapolis, Indiana Clinical Pharmacy Specialist Oncology, Department of Pharmacy, St. Vincent Hospital, Indianapolis, Indiana AN - 113400348. Language: English. Entry Date: 20170911. Revision Date: 20181205. Publication Type: Article AU - Saum, Lindsay AU - Reeves, David DB - CINAHL DO - 10.1310/hpj5102-142 DP - EBSCOhost KW - Venous Thromboembolism -- Drug Therapy Guideline Adherence -- Evaluation Electronic Health Records -- Utilization Internal Medicine Oncologic Care Human Female Male Retrospective Design Record Review Pretest-Posttest Design P-Value Hospitals -- United States United States Anticoagulants -- Contraindications M1 - 2 N1 - research; tables/charts. Journal Subset: Biomedical; Peer Reviewed; USA. NLM UID: 0043175. PY - 2016 SN - 0018-5787 SP - 142-148 ST - Venous Thromboembolism Prophylaxis Compliance Before and After Electronic Health Record Implementation T2 - Hospital Pharmacy TI - Venous Thromboembolism Prophylaxis Compliance Before and After Electronic Health Record Implementation UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=113400348&site=ehost-live&scope=site VL - 51 ID - 761399 ER - TY - JOUR AB - BACKGROUND: Timely reperfusion is critical in acute ischemic stroke (AIS) and ST-segment-elevation myocardial infarction (STEMI). The degree to which hospital performance is correlated on emergent STEMI and AIS care is unknown. Primary objective of this study was to determine whether there was a positive correlation between hospital performance on door-to-balloon (D2B) time for STEMI and door-to-needle (DTN) time for AIS, with and without controlling for patient and hospital differences. METHODS AND RESULTS: Prospective study of all hospitals in both Get With The Guidelines-Stroke and Get With The Guidelines-Coronary Artery Disease from 2006 to 2009 and treating ≥10 patients. We compared hospital-level DTN time and D2B time using Spearman rank correlation coefficients and hierarchical linear regression modeling. There were 43 hospitals with 1976 AIS and 59 823 STEMI patients. Hospitals' DTN times for AIS did not correlate with D2B times for STEMI (ρ=-0.09; P=0.55). There was no correlation between hospitals' proportion of eligible patients treated within target time windows for AIS and STEMI (median DTN time <60 minutes: 21% [interquartile range, 11-30]; median D2B time <90 minutes: 68% [interquartile range, 62-79]; ρ=-0.14; P=0.36). The lack of correlation between hospitals' DTN and D2B times persisted after risk adjustment. We also correlated hospitals' DTN time and D2B time data from 2013 to 2014 using Get With The Guidelines (DTN time) and Hospital Compare (D2B time). From 2013 to 2014, hospitals' DTN time performance in Get With The Guidelines was not correlated with D2B time performance in Hospital Compare (n=546 hospitals). CONCLUSIONS: We found no correlation between hospitals' observed or risk-adjusted DTN and D2B times. Opportunities exist to improve hospitals' performance of time-critical care processes for AIS and STEMI in a coordinated approach. AD - From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.). kzachrison@mgh.harvard.edu. From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.). AN - 28283469 AU - Sauser Zachrison, K. AU - Levine, D. A. AU - Fonarow, G. C. AU - Bhatt, D. L. AU - Cox, M. AU - Schulte, P. AU - Smith, E. E. AU - Suter, R. E. AU - Xian, Y. AU - Schwamm, L. H. C2 - Pmc5369604 C6 - Nihms851454 DA - Mar DO - 10.1161/circoutcomes.116.003148 DP - NLM ET - 2017/03/12 J2 - Circulation. Cardiovascular quality and outcomes KW - Aged Aged, 80 and over Angioplasty, Balloon, Coronary/adverse effects/*methods/standards Delivery of Health Care, Integrated/*organization & administration/standards Female Fibrinolytic Agents/*administration & dosage/adverse effects Humans Male Middle Aged Myocardial Reperfusion/adverse effects/*methods/standards Organizational Objectives Patient Care Team/organization & administration Prospective Studies Quality Improvement/*organization & administration/standards Quality Indicators, Health Care/*organization & administration/standards Registries ST Elevation Myocardial Infarction/diagnosis/*drug therapy Stroke/diagnosis/*drug therapy Thrombolytic Therapy/adverse effects/*methods/standards Time Factors Time-to-Treatment/*organization & administration/standards Tissue Plasminogen Activator/*administration & dosage/adverse effects United States *American Heart Association *fibrinolysis *myocardial infarction *stroke *tissue-type plasminogen activator LA - eng M1 - 3 N1 - 1941-7705 Sauser Zachrison, Kori Levine, Deborah A Fonarow, Gregg C Bhatt, Deepak L Cox, Margueritte Schulte, Phillip Smith, Eric E Suter, Robert E Xian, Ying Schwamm, Lee H K23 AG040278/AG/NIA NIH HHS/United States Journal Article Multicenter Study Research Support, Non-U.S. Gov't Circ Cardiovasc Qual Outcomes. 2017 Mar;10(3):e003148. doi: 10.1161/CIRCOUTCOMES.116.003148. PY - 2017 SN - 1941-7713 (Print) 1941-7713 ST - Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated: An Opportunity for Better Coordination of Acute Care T2 - Circ Cardiovasc Qual Outcomes TI - Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated: An Opportunity for Better Coordination of Acute Care VL - 10 ID - 760168 ER - TY - JOUR AB - Central line-associated bloodstream infections (CLABSIs) account for one-third of all hospital-acquired infections and can cost the health care system between $21,000 and $100,000 per infection. A dedicated vascular access team (VAT) can help develop, implement, and standardize policies and procedures for central line usage that address insertion, maintenance, and removal as well as educate nursing staff and physicians. This article presents how 1 hospital developed a VAT and implemented evidence-based guidelines. Central line utilization decreased by 45.2%, and CLABSI incidence decreased by 90%. The results of the study demonstrated that a reduced utilization of central lines minimized the risk of patients developing a CLABSI. AD - Baptist Health Paducah Hospital, Paducah, Kentucky (Mr Savage, Ms Lynch, and Mrs Oddera). Thomas J. Savage, BSN, RN, CEN, CFRN, is a member and original developer of the vascular access team (VAT) at Baptist Health Paducah in Paducah, Kentucky. He also has 10 years' emergency department, cardiac catheter laboratory, and flight nurse experience. Amanda D. Lynch, BSN, RN, VA-BC, is a member of the VAT at Baptist Health Paducah. She has 15 years of critical care and cardiac stress laboratory experience. She joined the VAT shortly after its inception. Stacey E. Oddera, BSN, RN-BC, has 26 years' medical-surgical and interventional radiology experience. Mrs Oddera is also a member and original developer of the VAT at Baptist Health Paducah. AN - 31283661 AU - Savage, T. J. AU - Lynch, A. D. AU - Oddera, S. E. DA - Jul/Aug DO - 10.1097/nan.0000000000000328 DP - NLM ET - 2019/07/10 J2 - Journal of infusion nursing : the official publication of the Infusion Nurses Society KW - Bacteremia/prevention & control Catheter-Related Infections/epidemiology/*prevention & control Catheterization, Central Venous/*adverse effects/methods/*standards Guideline Adherence Humans Infection Control/*methods Patient Care Team/*standards Retrospective Studies LA - eng M1 - 4 N1 - 1539-0667 Savage, Thomas J Lynch, Amanda D Oddera, Stacey E Journal Article United States J Infus Nurs. 2019 Jul/Aug;42(4):193-196. doi: 10.1097/NAN.0000000000000328. PY - 2019 SN - 1533-1458 SP - 193-196 ST - Implementation of a Vascular Access Team to Reduce Central Line Usage and Prevent Central Line-Associated Bloodstream Infections T2 - J Infus Nurs TI - Implementation of a Vascular Access Team to Reduce Central Line Usage and Prevent Central Line-Associated Bloodstream Infections VL - 42 ID - 760157 ER - TY - JOUR AB - BACKGROUND Pulmonary embolism (PE) is the third most common potentially life.threatening cardiovascular disease. A new approach of pulmonary embolism response teams (PERTs) has been introduced to provide rapid multidisciplinary assessment and treatment of patients with PE. However, detailed data on institutional experience and clinical outcomes from such teams are missing. AIMS The aim of this study was to report our experience with the management of PE guided by the PERT-POZ within the first year of operation. METHODS We performed a prospective study of PERT-POZ activations at a university care center between October 2018 and October 2019. Patient characteristics, therapies, and clinical outcomes were evaluated. RESULTS There were 86 unique PERT-POZ activations, and PE was confirmed in 80 patients including: 9 patients (11.25%) classified as low.risk PE, 19 (23.75%) as intermediate.low risk, 38 (47.5%) as intermediate.high, and 14 (17.5%) as high.risk. Sixty patients (75%) received anticoagulation only, 28 (35%) direct oral anticoagulant, 7 (8.75%) vitamin K antagonist, 23 (28.75%) low-molecular-weight heparin, and 2 (2.50%) unfractionated heparin. Ten patients (12.5%) were treated with catheter.directed thrombectomy, 6 (7.5%) received systemic thrombolysis, 2 (2.5%) underwent surgical embolectomy, 2 (2.5%) were on extracorporeal membrane oxygenation support, and 2 (2.5%) underwent pharmacomechanical venous thrombectomy. There were 7 (8.75%) in.hospital deaths, and 2 (2.5%) deaths during a 3.month follow.up. Bleeding complications were rare: only 3 patients (3.75%) had major bleeding events, but none after administration of systemic thrombolysis. CONCLUSIONS Our study demonstrated that after the creation of PERT.POZ with a precise activation protocol, patients with intermediate and high.risk PE received most optimal treatment strategies. AD - S. Sawek-Szmyt, Department of Cardiology, Poznan University of Medical Sciences, Pozna, Poland AU - Sawek-Szmyt, S. AU - Jankiewicz, S. A. AU - Smukowska-Gorynia, A. AU - Janus, M. AU - Klotzka, A. AU - Pu.lecki, M. AU - Jemielity, M. AU - Krasi-Ski, Z. AU - Zabicki, B. AU - Elikowski, W. AU - Grygier, M. AU - Mularek-Kubzdela, T. AU - Lesiak, M. AU - Araszkiewicz, A. DB - Embase Medline DO - 10.33963/KP.15230 KW - adult anticoagulation article bleeding blood clot lysis clinical assessment clinical outcome complication drug therapy extracorporeal oxygenation female follow up hospital mortality human major clinical study male outcome assessment percutaneous thrombectomy prospective study pulmonary embolism response team surgery antivitamin K heparin low molecular weight heparin LA - English M1 - 4 M3 - Article N1 - L2007232011 2020-10-08 PY - 2020 SN - 1897-4279 0022-9032 SP - 300-310 ST - Implementation of a regional multidisciplinary pulmonary embolism response team: PERT.POZ initial 1.year experience T2 - Kardiologia Polska TI - Implementation of a regional multidisciplinary pulmonary embolism response team: PERT.POZ initial 1.year experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2007232011&from=export http://dx.doi.org/10.33963/KP.15230 VL - 78 ID - 760577 ER - TY - JOUR AB - SNIIRAM/SNDS, the French administrative health care database, covers around 99% of the population. Its main limitation is the absence of clinical information and biological results. This report exposes the value of SNIIRAM/SNDS enrichment by external databases, and the link-age issues. It is illustrated by examples: the well-known population-based cohort CONSTANCES created to answer to epidemiological research questions with a specific interest on occupational and social factors, chronic diseases, and aging; the CANARI study, a regional-based study that collected Gleason score in all pathology laboratories in Brittany and then, linked pathology results to an ad hoc extraction from SNIIRAM database; the goal was to investigate the risk of high grade prostate cancer in patients treated by 5-alpha-reductase inhibitors for a symptomatic benign prostatic hyperplasia; the SACHA study, that identified and medically validated major bleeding event referred to emergency wards, then linked those clinical data to SNIIRAM; the goal was to minimize misclassification bias when estimating bleeding risk in patients who were prescribed antithrombotic drugs; the ISO-PSY study linked the SNIIRAM with the national cause of death registry (CepiDc) and the nationwide emergency department surveillance system (OSCOUR (R) network) to investigate the potential link between isotretinoin and suicidal risk; the EFEMERIS cohort that assesses drugs prescriptions in French pregnant women who delivered in the Haute-Garonne region; the EPI-GETB-AM study that derived a SNIIRAM/SNDS-based algorithm to identify venous thromboembolism and linked SNIIRAM/SNDS to the EPI-GETBO-III survey for validation. Another perspective of SNDS enrichment is clinical trials' data for medico-economic assessment, and extended follow-up without attrition bias. Linkage is not straightforward. Apart from regulatory approbation and authorized data center issues, which could be solved by the Health Data Hub Initiative, a multidisciplinary team with medical, pharmacological and methodological knowledge, as well as with technical skills is essential to handle the whole process.(C) 2018 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier Masson SAS. All rights reserved. AD - [Scailteux, Lucie-Marie; Oger, Emmanuel] Rennes Univ Hosp, Pharmacovigilance Pharmacoepidemiol & Drug Inform, F-35000 Rennes, France. [Scailteux, Lucie-Marie; Droitcour, Catherine; Balusson, Frederic; Kerbrat, Sandrine; Dupuy, Alain; Drezen, Erwan; Happe, Andre; Oger, Emmanuel] Univ Rennes, EA 7449, CHU Rennes, Rech Pharmacoepidemiol & Recours Soins REPERES, F-35000 Rennes, France. [Droitcour, Catherine; Dupuy, Alain] Rennes Hosp Univ, Dermatol Dept, F-35000 Rennes, France. [Nowak, Emmanuel] Univ Brest, CHRU Brest, Univ Bretagne Loire, INSERM,CIC 1412, F-29200 Brest, France. [Happe, Andre] CHRU Brest, Ctr Donnees Clin, F-29200 Brest, France. Scailteux, LM (corresponding author), CHU Rennes, CRPV Rennes, Serv Pharmacol Clin, 2 Rue Henri Le Guilloux, F-35000 Rennes, France. luciemarie.scailteux@chu-rennes.fr AN - WOS:000461944500008 AU - Scailteux, L. M. AU - Droitcour, C. AU - Balusson, F. AU - Nowak, E. AU - Kerbrat, S. AU - Dupuy, A. AU - Drezen, E. AU - Happe, A. AU - Oger, E. DA - Apr DO - 10.1016/j.therap.2018.09.072 J2 - Therapie KW - SNIIRAM SNDS Administrative database Population-based study Linkage Matching ATRIAL-FIBRILLATION PATIENTS POSITIVE PREDICTIVE VALUES POPULATION-BASED COHORT ACUTE CORONARY SYNDROME VITAMIN-K ANTAGONISTS PROSTATE-CANCER VENOUS THROMBOEMBOLISM RADICAL PROSTATECTOMY CARDIOVASCULAR RISK ORAL ANTICOAGULANTS Pharmacology & Pharmacy LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: HP8MB Times Cited: 4 Cited Reference Count: 57 Scailteux, Lucie-Marie Droitcour, Catherine Balusson, Frederic Nowak, Emmanuel Kerbrat, Sandrine Dupuy, Alain Drezen, Erwan Happe, Andre Oger, Emmanuel SCAILTEUX, Lucie-Marie/AAD-9334-2020 4 0 2 ELSEVIER SCIENCE BV AMSTERDAM THERAPIE PY - 2019 SN - 0040-5957 SP - 215-223 ST - French administrative health care database (SNDS): The value of its enrichment T2 - Therapie TI - French administrative health care database (SNDS): The value of its enrichment UR - ://WOS:000461944500008 VL - 74 ID - 761532 ER - TY - JOUR AB - SNIIRAM/SNDS, the French administrative health care database, covers around 99% of the population. Its main limitation is the absence of clinical information and biological results. This report exposes the value of SNIIRAM/SNDS enrichment by external databases, and the linkage issues. It is illustrated by examples: the well-known population-based cohort CONSTANCES created to answer to epidemiological research questions with a specific interest on occupational and social factors, chronic diseases, and aging; the CANARI study, a regional-based study that collected Gleason score in all pathology laboratories in Brittany and then, linked pathology results to an ad hoc extraction from SNIIRAM database; the goal was to investigate the risk of high grade prostate cancer in patients treated by 5-alpha-reductase inhibitors for a symptomatic benign prostatic hyperplasia; the SACHA study, that identified and medically validated major bleeding event referred to emergency wards, then linked those clinical data to SNIIRAM; the goal was to minimize misclassification bias when estimating bleeding risk in patients who were prescribed antithrombotic drugs; the ISO-PSY study linked the SNIIRAM with the national cause of death registry (CépiDc) and the nationwide emergency department surveillance system (OSCOUR(®) network) to investigate the potential link between isotretinoin and suicidal risk; the EFEMERIS cohort that assesses drugs prescriptions in French pregnant women who delivered in the Haute-Garonne region; the EPI-GETB-AM study that derived a SNIIRAM/SNDS-based algorithm to identify venous thromboembolism and linked SNIIRAM/SNDS to the EPI-GETBO-III survey for validation. Another perspective of SNDS enrichment is clinical trials' data for medico-economic assessment, and extended follow-up without attrition bias. Linkage is not straightforward. Apart from regulatory approbation and authorized data center issues, which could be solved by the Health Data Hub Initiative, a multidisciplinary team with medical, pharmacological and methodological knowledge, as well as with technical skills is essential to handle the whole process. AD - Pharmacovigilance, pharmacoepidemiology and drug information center, Rennes university hospital, 35000 Rennes, France; EA 7449, CHU Rennes, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), university Rennes, 35000 Rennes, France. Electronic address: luciemarie.scailteux@chu-rennes.fr. EA 7449, CHU Rennes, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), university Rennes, 35000 Rennes, France; Dermatology department, Rennes hospital university, 35000 Rennes, France. EA 7449, CHU Rennes, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), university Rennes, 35000 Rennes, France. Inserm CIC 1412, université de Bretagne Loire, université de Brest, CHRU de Brest, 29200 Brest, France. EA 7449, CHU Rennes, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), university Rennes, 35000 Rennes, France; Centre de données cliniques, CHRU de Brest, 29200 Brest, France. Pharmacovigilance, pharmacoepidemiology and drug information center, Rennes university hospital, 35000 Rennes, France; EA 7449, CHU Rennes, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), university Rennes, 35000 Rennes, France. AN - 30392702 AU - Scailteux, L. M. AU - Droitcourt, C. AU - Balusson, F. AU - Nowak, E. AU - Kerbrat, S. AU - Dupuy, A. AU - Drezen, E. AU - Happe, A. AU - Oger, E. DA - Apr DO - 10.1016/j.therap.2018.09.072 DP - NLM ET - 2018/11/06 J2 - Therapie KW - Algorithms Databases, Factual/*statistics & numerical data Delivery of Health Care/*statistics & numerical data Emergency Service, Hospital/statistics & numerical data *Epidemiologic Research Design France Humans Medical Record Linkage Registries Administrative database Linkage Matching Population-based study Snds Sniiram LA - eng M1 - 2 N1 - 1958-5578 Scailteux, Lucie-Marie Droitcourt, Catherine Balusson, Frédéric Nowak, Emmanuel Kerbrat, Sandrine Dupuy, Alain Drezen, Erwan Happe, André Oger, Emmanuel Journal Article France Therapie. 2019 Apr;74(2):215-223. doi: 10.1016/j.therap.2018.09.072. Epub 2018 Oct 25. PY - 2019 SN - 0040-5957 SP - 215-223 ST - French administrative health care database (SNDS): The value of its enrichment T2 - Therapie TI - French administrative health care database (SNDS): The value of its enrichment VL - 74 ID - 760139 ER - TY - JOUR AB - To evaluate the outcomes of a multidisciplinary team working on diabetic foot (DF) patients with critical limb ischemia (CLI) in a specialized center, the authors retrospectively traced all the patients admitted in their department in 3 consecutive years with a diagnosis of CLI. From January 2006 to December 2008, 245 consecutive DF patients with CLI according the TransAtlantic interSociety Consensus II criteria were included in the study. Treatment strategy was decided by a team of diabetologists, inteventional radiologists, and vascular surgeons. Technical and clinical success, mortality, and ulcer recurrence were evaluated at 6 months and at a mean follow-up of 19.5 ± 13.4 months. Percutaneous transluminal angioplasty (PTA) was performed in 189 (77%) patients, whereas medical treatment, open surgical revascularization (OSR), and primary amputation were performed in 44 (18.3%), 11 (4.3%), and 1 (0.5%) patients, respectively. Revascularization was successful in 227/233 (97.4%) patients. At follow-up, the overall clinical success rate was 60.4%; it was significantly (P = .001) higher after revascularization (75.9%) compared with medical treatment (48.3%). During follow-up, surgical interventions in the foot were 1.5 ± 0.4 in those treated with PTA, 1.6 ± 0.5 in those treated with OSR, and 0.3 ± 0.8 in those receiving medical therapy (P < .05 compared with the others). Ulcer recurrence occurred in 29 (11.8%) patients: 4 (1.6%) in PTA, 2 (0.8%) in OSR, and 23 (9.4%) in the medical therapy group (P < .05). Major amputation rate was 9.3%, being significantly (P = .04) lower after revascularization (5.2%) compared with medical therapy alone (13.8%). Cumulative mortality rate was 10.6%. In conclusion, this study confirms the positive role of a PTA-first approach for revascularizing the complex cases of DF with CLI in a teamwork management strategy. AD - Diabetic Foot Section, Department of Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. AN - 22665920 AU - Scatena, A. AU - Petruzzi, P. AU - Ferrari, M. AU - Rizzo, L. AU - Cicorelli, A. AU - Berchiolli, R. AU - Goretti, C. AU - Bargellini, I. AU - Adami, D. AU - Iacopi, E. AU - Del Corso, A. AU - Cioni, R. AU - Piaggesi, A. DA - Jun DO - 10.1177/1534734612448384 DP - NLM ET - 2012/06/06 J2 - The international journal of lower extremity wounds KW - Adult Aged Aged, 80 and over Amputation Angioplasty Diabetic Foot/surgery/*therapy Female Humans Ischemia/surgery/*therapy Limb Salvage/*methods Male Middle Aged Prognosis Retrospective Studies Statistics as Topic Time Factors Treatment Outcome Vascular Patency Vascular Surgical Procedures/methods LA - eng M1 - 2 N1 - 1552-6941 Scatena, Alessia Petruzzi, Pasquale Ferrari, Mauro Rizzo, Loredana Cicorelli, Antonello Berchiolli, Raffaella Goretti, Chiara Bargellini, Irene Adami, Daniele Iacopi, Elisabetta Del Corso, Andrea Cioni, Roberto Piaggesi, Alberto Journal Article United States Int J Low Extrem Wounds. 2012 Jun;11(2):113-9. doi: 10.1177/1534734612448384. Epub 2012 Jun 3. PY - 2012 SN - 1534-7346 SP - 113-9 ST - Outcomes of three years of teamwork on critical limb ischemia in patients with diabetes and foot lesions T2 - Int J Low Extrem Wounds TI - Outcomes of three years of teamwork on critical limb ischemia in patients with diabetes and foot lesions VL - 11 ID - 760325 ER - TY - JOUR AB - In 2008, the top priority in our division's 5-year strategic plan was "to become an internationally recognized center of excellence for the endovascular treatment of complex aortic pathology extending from the aortic valve to the external iliac artery." Five components were identified as "most critical" to achieve this strategic priority: (1) training at centers of excellence in complex endovascular repair; (2) industry partnership to improve access to developing technologies; (3) a fully integrated team approach with one leader involved in all steps of all cases; (4) prospective data collection; and (5) development and implementation of a physician-sponsored investigational device exemption for juxtarenal, pararenal, and thoracoabdominal aneurysms. We have now performed 49 repairs (16 commercially manufactured devices, 33 physician-modified devices) for 3 common iliac, 20 juxtarenal, 9 pararenal, and 17 thoracoabdominal aneurysms, using 142 fenestrations, branches, and scallops. All patients had complete 30-day follow-up for calculation of 30-day events. Kaplan-Meier analysis was used to calculate 1-year events. In 5 years, we developed a successful complex endovascular aortic program that uses fenestrated/branched repair techniques. A focused team strategic planning approach to program development is an effective way for vascular surgery divisions to gain experience and expertise with new complex technologies while ensuring acceptable patient outcomes. AD - Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass. Electronic address: andres.schanzer@umassmemorial.org. Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa. Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass. AN - 25595400 AU - Schanzer, A. AU - Baril, D. AU - Robinson, W. P., 3rd AU - Simons, J. P. AU - Aiello, F. A. AU - Messina, L. M. DA - Mar DO - 10.1016/j.jvs.2014.08.121 DP - NLM ET - 2015/01/18 J2 - Journal of vascular surgery KW - Aged Aortic Diseases/diagnosis/*surgery Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation/adverse effects/education/instrumentation/*methods/standards Clinical Competence Cooperative Behavior Education, Medical, Graduate/organization & administration Endovascular Procedures/adverse effects/education/instrumentation/*methods/standards Female Health Care Sector/organization & administration Humans Interdisciplinary Communication Interinstitutional Relations Kaplan-Meier Estimate Male Models, Organizational Organizational Objectives Patient Care Team/organization & administration Practice Management, Medical/*organization & administration/standards Program Development Program Evaluation Prosthesis Design Quality Improvement Quality Indicators, Health Care Retrospective Studies Time Factors Treatment Outcome LA - eng M1 - 3 N1 - 1097-6809 Schanzer, Andres Baril, Donald Robinson, William P 3rd Simons, Jessica P Aiello, Francesco A Messina, Louis M Journal Article United States J Vasc Surg. 2015 Mar;61(3):826-31. doi: 10.1016/j.jvs.2014.08.121. Epub 2015 Jan 13. PY - 2015 SN - 0741-5214 SP - 826-31 ST - Developing a complex endovascular fenestrated and branched aortic program T2 - J Vasc Surg TI - Developing a complex endovascular fenestrated and branched aortic program VL - 61 ID - 760335 ER - TY - JOUR AB - Background: Fatigue remains one of the most severe and disabling symptoms experienced by patients with myeloproliferative neoplasms (MPNs) resulting in impaired social, role, and physician functioning and reduced quality of life (Cancer 2007). Current NCCN Clinical Practice Guidelines in Oncology recommend consideration of use of psychostimulants (PSs) if other causes of fatigue have been ruled out. In this analysis, we evaluate the role of pharmacologic PSs in this population utilizing data from a previously conducted a survey regarding fatigue in MPN patients (Cancer 2016). Methods: A 70-item internet-based survey was developed by a multidisciplinary team of MPN investigators, patients, and patient advocates that included questions on medication PS use. The survey was promoted online via multiple MPN-related websites during late February to March of 2014. Survey data was immediately captured, downloaded, and stored on secure servers at the Mayo Clinic Survey Research Center. Success of PSs was patient-reported on a 5-level tiered response range from not at all successful to very successful. Categorical variables were compared using chisquare tests, continuous variables using T-tests, and Pearson's rho estimated correlations. P values < 0.05 were considered statistically significant. Results: Respondents : 1788 MPN patients participated in the online survey. Of these, 1748 consented to the survey and 1676 were included for completing 10 or more survey questions. 116 patients (8.4%) of the 1377 patients who responded to the question regarding PS use reported use of these medications. Use among MPN subtypes varied (9.9% of essential thrombocythemia patients, 9.1% of polycythemia vera patients, and 5.8% of myelofibrosis patients). Characteristics : Females used PSs more frequently than males (9.9% females vs 5.4% males, P= 0.006). Use of PSs was most often observed among individuals with severe fatigue (mean brief fatigue inventory (BFI) score 5.7 among those using PSs versus 4.4 among those not using, P < 0.001). Individuals who reported that fatigue impaired sleep were more often PS users (12% of users had impaired sleep versus 6% of users without impaired sleep, P < 0.001). Patients who used PSs were also more symptomatic for the 10 most MPN-specific symptoms assessed via the MPN Total Symptom Score (MPN-TSS; mean 36.3 vs 28.4, P < 0.001). Individual MPN Symptom Assessment Form (MPN-SAF) item scores are shown in Figure 1. Efficacy : We then evaluated the characteristics of PS users by their reported success in reducing fatigue (102/166). Success in reducing fatigue was reported more often in older respondents (mean age of 58.9 years in those reporting that PSs were somewhat to very helpful vs 53.9 years for not helpful, P = 0.03). Although not significant, patients who reported success in reducing fatigue tended to have a diagnosis of PV (somewhat or very successful in 34/45 for PV; 7/13 for MF, 21/42 for ET, P= 0.05) or female (somewhat or very successful in 54/80 vs 9/20 for male, P= 0.06). Correlates : Of PS users who completed the secondary portion on fatigue reduction success level (n=102), there was no apparent correlation between MPN-TSS (0-10) and reported success in reduction of fatigue (rho =-0.1; P= 0.5). Conclusions: Medication PSs are utilized in a notable proportion of MPN patients. MPN patients who use PSs often had significantly worse fatigue than their peers, which may reflects the population in which PSs are most likely to be of suspected benefit. Given the severity of fatigue in this population and the lack of effective fatigue-alleviating strategies, more studies regarding the efficacy of PSs are needed. AD - R.M. Scherber, Oregon Health and Science University, Portland, OR, United States AU - Scherber, R. M. AU - Langlais, B. T. AU - Kosiorek, H. E. AU - Dueck, A. AU - Geyer, H. AU - Senyak, Z. AU - McCallister, A. AU - Cotter, M. AU - VanHusen, B. AU - Palmer, J. AU - Padrnos, L. AU - Harrison, C. N. AU - Fleischman, A. G. AU - Mesa, R. A. DB - Embase KW - psychostimulant agent adult conference abstract controlled study diagnosis drug efficacy fatigue female human Internet major clinical study male middle aged myelofibrosis myeloproliferative neoplasm polycythemia vera sleep statistical significance symptom assessment thrombocythemia LA - English M3 - Conference Abstract N1 - L620334091 2018-01-30 PY - 2017 SN - 1528-0020 ST - Psychostimulant use among myeloproloferative neoplasm patients T2 - Blood TI - Psychostimulant use among myeloproloferative neoplasm patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620334091&from=export VL - 130 ID - 760888 ER - TY - JOUR AB - Purpose: To determine the effectiveness of MR angiography for pulmonary embolism (MRA-PE) in symptomatic patients.Materials and Methods: We retrospectively reviewed all patients whom were evaluated for possible pulmonary embolism (PE) using MRA-PE. A 3-month and 1-year from MRA-PE electronic medical record (EMR) review was performed. Evidence for venous thromboembolism (VTE) (or death from PE) within the year of follow-up was the outcome surrogate for this study.Results: There were 190 MRA-PE exams performed with 97.4% (185/190) of diagnostic quality. There were 148 patients (120 F: 28 M) that had both a diagnostic MRA-PE exam and 1 complete year of EMR follow-up. There were 167 patients (137 F: 30 M) with 3 months or greater follow-up. We found 83% (139/167) and 81% (120/148) MRA-PE exams negative for PE at 3 months and 1 year, respectively. Positive exams for PE were seen in 14% (23/167). During the 1-year follow-up period, five patients (false negative) were diagnosed with DVT (5/148 = 3.4 %), and one of these patients also experienced a non-life-threatening PE. The negative predictive value (NPV) for MRA-PE was 97% (92-99; 95% CI) at 3 months and 96% (90-98; 95% CI) with 1 year of follow-up.Conclusion: The NPV of MRA-PE, when used for the primary diagnosis of pulmonary embolism in symptomatic patients, were found to be similar to the published values for CTA-PE. In addition, the technical success rate and safety of MRA-PE were excellent. AD - Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. AN - 104104625. Language: English. Entry Date: 20140627. Revision Date: 20200708. Publication Type: journal article AU - Schiebler, Mark L. AU - Nagle, Scott K. AU - François, Christopher J. AU - Repplinger, Michael D. AU - Hamedani, Azita G. AU - Vigen, Karl K. AU - Yarlagadda, Rajkumar AU - Grist, Thomas M. AU - Reeder, Scott B. DB - CINAHL DO - 10.1002/jmri.24057 DP - EBSCOhost KW - Magnetic Resonance Angiography Pulmonary Embolism -- Diagnosis Pulmonary Embolism -- Pathology Acute Disease Adult Electronic Health Records False Negative Results Female Prospective Studies Human Male Middle Age Predictive Value of Tests Pulmonary Artery -- Pathology Retrospective Design Tomography, X-Ray Computed Treatment Outcomes Venous Thromboembolism -- Diagnosis Venous Thromboembolism -- Pathology Young Adult M1 - 4 N1 - research. Journal Subset: Biomedical; Peer Reviewed; USA. Grant Information: P30 CA014520/CA/NCI NIH HHS/United States. NLM UID: 9105850. PMID: NLM23553735. PY - 2013 SN - 1053-1807 SP - 914-925 ST - Effectiveness of MR angiography for the primary diagnosis of acute pulmonary embolism: clinical outcomes at 3 months and 1 year T2 - Journal of Magnetic Resonance Imaging TI - Effectiveness of MR angiography for the primary diagnosis of acute pulmonary embolism: clinical outcomes at 3 months and 1 year UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=104104625&site=ehost-live&scope=site VL - 38 ID - 761323 ER - TY - JOUR AB - BACKGROUND: Hospital-acquired venous thromboembolism (HA-VTE) is a potentially preventable cause of morbidity and mortality. Despite high rates of venous thromboembolism (VTE) prophylaxis in accordance with an institutional guideline, VTE remains the most common hospital-acquired condition in our institution. OBJECTIVE: To improve the safety of all hospitalized patients, examine current VTE prevention practices, identify opportunities for improvement, and decrease rates of HA-VTE. DESIGN: Pre/post assessment. SETTING/PATIENTS: Urban academic tertiary referral center, level 1 trauma center, safety net hospital; all patients. INTERVENTION: We formed a multidisciplinary VTE task force to review all HA-VTE events, assess prevention practices relative to evidence-based institutional guidelines, and identify improvement opportunities. The task force developed an electronic tool to facilitate efficient VTE event review and designed decision-support and reporting tools, now integrated into the electronic health record, to bring optimal VTE prevention practices to the point of care. Performance is shared transparently across the institution. MEASUREMENTS: Harborview benchmarks process and outcome performance, including patient safety indicators and core measures, against hospitals nationally using Hospital Compare and Vizient data. RESULTS: Our program has resulted in >90% guideline-adherent VTE prevention and zero preventable HA-VTEs. Initiatives have resulted in a 15% decrease in HA-VTE and a 21% reduction in postoperative VTE. CONCLUSIONS: Keys to success include the multidisciplinary approach, clinical roles of task force members, senior leadership support, and use of quality improvement analytics for retrospective review, prospective reporting, and performance transparency. Ongoing task force collaboration with frontline providers is critical to sustained improvements. Journal of Hospital Medicine 2016;11:S38-S43. © 2016 Society of Hospital Medicine. AD - Department of Medicine, University of Washington, Harborview Medical Center, Seattle, Washington. Department of Quality Improvement, Harborview Medical Center, Seattle, Washington. Department of Pharmacy, University of Washington, Harborview Medical Center, Seattle, Washington. Department of Surgery/Trauma Surgery, Harborview Medical Center, Seattle, Washington. Department of Patient Care Services, Harborview Medical Center, Seattle, Washington. Department of Orthopaedics, University of Washington, Harborview Medical Center, Seattle, Washington. Department of Surgery/Trauma Surgery, University of Washington, Harborview Medical Center, Seattle, Washington. AN - 27925422 AU - Schleyer, A. M. AU - Robinson, E. AU - Dumitru, R. AU - Taylor, M. AU - Hayes, K. AU - Pergamit, R. AU - Beingessner, D. M. AU - Zaros, M. C. AU - Cuschieri, J. DA - Dec DO - 10.1002/jhm.2664 DP - NLM ET - 2016/12/08 J2 - Journal of hospital medicine KW - *Benchmarking Decision Support Systems, Clinical/statistics & numerical data Guideline Adherence Humans *Patient Care Team Patient Safety/*statistics & numerical data *Quality Improvement Venous Thromboembolism/*prevention & control LA - eng N1 - 1553-5606 Schleyer, Anneliese M Robinson, Ellen Dumitru, Roxana Taylor, Mark Hayes, Kimberly Pergamit, Ronald Beingessner, Daphne M Zaros, Mark C Cuschieri, Joseph Journal Article United States J Hosp Med. 2016 Dec;11 Suppl 2:S38-S43. doi: 10.1002/jhm.2664. PY - 2016 SN - 1553-5592 SP - S38-s43 ST - Preventing hospital-acquired venous thromboembolism: Improving patient safety with interdisciplinary teamwork, quality improvement analytics, and data transparency T2 - J Hosp Med TI - Preventing hospital-acquired venous thromboembolism: Improving patient safety with interdisciplinary teamwork, quality improvement analytics, and data transparency VL - 11 Suppl 2 ID - 760247 ER - TY - JOUR AB - Molecular diagnostics examines the basic molecules of the genome for relevant aberrations, according to diagnosis, prognosis and therapy. It depends mainly on PCR-based methods (qualitative and quantitative analysis, RT-PCR, nested PCR, melting curve analysis, sequencing etc.). The general practitioner or consultant in internal medicine encounters molecular diagnostics by his evaluations of the reasons for thromboembolism (mutation of factor V Leiden or prothrombin), myeloproliferative neoplasms (JAK2V617F-mutation, BCR-ABL1) or hemochromatosis. The specialist furthermore appreciates its value in diagnosis and treatment monitoring of acute and chronic leukemia, lymphoma, familial erythrocytosis and a variety of solid tumors (especially breast cancer and colorectal carcinoma), as well as in managing refractory transfusion answers, suspected disturbances in drug metabolism and in the planning of an allogeneic stem cell transplantation. AD - Abteilung für Hämatologie und Hämatologisches Zentrallabor, Kantonsspital Luzern. adrian.schmidt@ksb.ch AN - 20859878 AU - Schmidt, A. DA - Sep 22 DO - 10.1024/1661-8157/a000234 DP - NLM ET - 2010/09/23 J2 - Praxis KW - Family Practice Genetic Markers/*genetics Hemochromatosis/diagnosis/*genetics/therapy Humans Internal Medicine Leukemia/diagnosis/*genetics/therapy Lymphoma/diagnosis/*genetics/therapy Myeloproliferative Disorders/diagnosis/*genetics/therapy Neoplasms/diagnosis/*enzymology/*genetics/therapy Patient Care Team Polymerase Chain Reaction Reverse Transcriptase Polymerase Chain Reaction Sequence Analysis, DNA Thromboembolism/diagnosis/*genetics/therapy LA - ger M1 - 19 N1 - Schmidt, Adrian English Abstract Journal Article Review Switzerland Praxis (Bern 1994). 2010 Sep 22;99(19):1143-52. doi: 10.1024/1661-8157/a000234. OP - Molekulare Marker in der Hämatologie und Onkologie. PY - 2010 SN - 1661-8157 (Print) 1661-8157 SP - 1143-52 ST - [Molecular markers in hematology and oncology] T2 - Praxis (Bern 1994) TI - [Molecular markers in hematology and oncology] VL - 99 ID - 760282 ER - TY - JOUR AB - Background: Renal access coordinators contribute specifically to dialysis access care for people with chronic and end stage renal disease. Since the introduction of renal access coordinators into Australia in the early 2000s, there have been anecdotal examples of associated improvements in patient outcomes and service delivery; however scant published quantitative evidence exists. Thus, the impact of the implementation of renal access coordinators has not undergone a rigorous review to date. Objective: The objective of this systematic review was to critically appraise and synthesize the best available evidence related to the impact of renal access coordinators on dialysis patient outcomes and associated service delivery. Inclusion criteria Types of participants: This review considered studies that included renal access coordinators (noting variations of the titles) and adult hemodialysis patients (aged 18 years and over). Types of intervention(s): This review considered studies that evaluated the effectiveness of the renal access coordinator. This role typically consists of clinical and administration duties such as providing pre dialysis access coordination, access surveillance patient education and nurse education. Types of studies: The types of studies considered within this review included experimental and epidemiological study designs. Thus randomized controlled trials (RCT), non-randomized controlled trials, and quasi-experimental, before and after studies, prospective and retrospective cohort studies were considered as were case control studies, analytical cross sectional studies and descriptive cross sectional studies. Types of outcomes: Patient outcomes considered included: days to first vascular access complication (such as stenosis or thrombosis) and/or primary intervention (such as angioplasty or surgical intervention); percentage of central line insertions (negative); rate of arteriovenous fistula (AVF)/arteriovenous graft (AVG)/central venous catheter (CVC) at start of dialysis (incidence); prevalent rate of AVF/AVG/CVC; time to occlusion of AVF and time from referral to surgery. Service outcomes included: knowledge/up skilling of renal nurses; cannulation skills, ultrasound skills, knowledge of anatomy and physiology and other access related knowledge. Search strategy: The search strategy aimed to locate published and unpublished studies, utilizing a three-step searching approach. Studies published in English from 1990 to October 2013 were considered for inclusion in this review. Methodological quality: The studies were assessed by two independent reviewers using the appropriate standardized critical appraisal instruments from the Joanna Briggs Institute. Data collection: Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute, namely JBI Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data synthesis: This review aimed to conduct meta-analyses of the findings: however, because of the limitations of the data found, this was not possible and so the findings are presented in a narrative format. Results: Five studies were identified for inclusion in the review. No RCTs were found, therefore four of the five studies were pre-post intervention cohort studies and one was a prospective quality assurance report. Data were heterogeneous and thus did not allow for meta-analysis. All studies included multidisciplinary teams with variable emphasis on the renal access coordinator role. The pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the hemodialysis population and the quality assurance report measured the difference in patency rates between AVF and AVG. All discussed the role of central coordination as a contributor to the success of vascular access care. Conclusions: This review found insufficient data to make firm conclusions about the impact that renal access coordinators have on patient outcomes. The results of this review suggest an association between r nal access coordinators and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs. © the authors 2014. AD - M. Schoch, Deakin University, VIC, Australia AU - Schoch, M. AU - Bennett, P. AU - Fiolet, R. AU - Kent, B. AU - Au, C. DB - Embase DO - 10.11124/jbisrir-2014-1359 KW - arteriovenous fistula central venous catheter clinical effectiveness end stage renal disease health care cost health care delivery hemodialysis human incidence kidney surgery medical practice meta analysis (topic) nursing education outcome assessment patient education prevalence quality control questionnaire randomized controlled trial (topic) renal access review survival rate systematic review vascular access vascular patency vein occlusion L1 - http://www.joannabriggslibrary.org/index.php/jbisrir/article/view/1359/1947 LA - English M1 - 4 M3 - Review N1 - L373182009 2014-06-06 2014-06-11 PY - 2014 SN - 2202-4433 SP - 319-353 ST - Renal access coordinators' impact on hemodialysis patient outcomes and associated service delivery: A systematic review T2 - JBI Database of Systematic Reviews and Implementation Reports TI - Renal access coordinators' impact on hemodialysis patient outcomes and associated service delivery: A systematic review UR - https://www.embase.com/search/results?subaction=viewrecord&id=L373182009&from=export http://dx.doi.org/10.11124/jbisrir-2014-1359 VL - 12 ID - 761106 ER - TY - JOUR AB - This manuscript describes a streamlined protocol for the management of patients with acute ischemic stroke, which aims at the minimization of time from hospital admission to reperfusion. Rapid restoration of cerebral blood flow is essential for the outcomes of patients with acute ischemic stroke. Endovascular treatment (EVT) has become the standard of care to accomplish this in patients with acute stroke due to large vessel occlusion (LVO). To achieve reperfusion of ischemic brain regions as fast as possible, all in-hospital time delays have to be carefully avoided. Therefore, management of patients with acute ischemic stroke was optimized with an interdisciplinary standard operating procedure (SOP). Stroke neurologists, diagnostic as well as interventional neuroradiologists, and anesthesiologists streamlined all necessary processes from patient admission and diagnosis to EVT of eligible patients. Target times for every step were established. Actually achieved times were prospectively recorded along with clinical data and imaging scores for all endovascularly treated stroke patients. These data were regularly analyzed and discussed in interdisciplinary team meetings. Potential issues were evaluated and all staff involved was trained to adhere to the SOP. This streamlined patient management approach and enhanced interdisciplinary collaboration reduced time from patient admission to reperfusion significantly and was accompanied by a beneficial effect on clinical outcomes. AD - [Schregel, Katharina; Behme, Daniel; Tsogkas, Ioannis; Knauth, Michael; Psychogios, Marios-Nikos] Univ Med Ctr Goettingen, Inst Neuroradiol, Gottingen, Germany. [Schregel, Katharina] Brigham & Womens Hosp, Dept Radiol, Boston, MA 02115 USA. [Schregel, Katharina] Harvard Med Sch, Boston, MA 02115 USA. [Maier, Ilko; Bahr, Mathias; Liman, Jan] Univ Med Ctr Goettingen, Dept Neurol, Gottingen, Germany. [Karch, Andre; Mikolajczyk, Rafael] Helmholtz Ctr Infect Res, Dept Epidemiol, Braunschweig, Germany. [Mikolajczyk, Rafael] Martin Luther Univ Halle Wittenberg, Inst Med Epidemiol Biostat & Informat, Halle, Germany. [Schaper, Jorn; Hinz, Jose] Univ Med Ctr Goettingen, Dept Anesthesiol, Gottingen, Germany. Schregel, K; Psychogios, MN (corresponding author), Univ Med Ctr Goettingen, Inst Neuroradiol, Gottingen, Germany.; Schregel, K (corresponding author), Brigham & Womens Hosp, Dept Radiol, Boston, MA 02115 USA.; Schregel, K (corresponding author), Harvard Med Sch, Boston, MA 02115 USA. katharina.schregel@med.uni-goettingen.de; m.psychogios@med.uni-goettingen.de AN - WOS:000426095700038 AU - Schregel, K. AU - Behme, D. AU - Tsogkas, I. AU - Knauth, M. AU - Maier, I. AU - Karch, A. AU - Mikolajczyk, R. AU - Bahr, M. AU - Schaper, J. AU - Hinz, J. AU - Liman, J. AU - Psychogios, M. N. C7 - e56397 DA - Jan DO - 10.3791/56397 J2 - J. Vis. Exp. KW - Neurobiology Issue 131 acute ischemic stroke endovascular treatment workflow optimization stroke management peri-procedural timing FLAT-DETECTOR CT ALBERTA STROKE THROMBECTOMY TRIAL TIME TOMOGRAPHY OUTCOMES Multidisciplinary Sciences LA - English M1 - 131 M3 - Article N1 - ISI Document Delivery No.: FX5CM Times Cited: 6 Cited Reference Count: 28 Schregel, Katharina Behme, Daniel Tsogkas, Ioannis Knauth, Michael Maier, Ilko Karch, Andre Mikolajczyk, Rafael Bahr, Mathias Schaper, Jorn Hinz, Jose Liman, Jan Psychogios, Marios-Nikos Behme, Daniel/H-4551-2019; Karch, Andre/D-6973-2017 Karch, Andre/0000-0003-3014-8543 Siemens Healthcare The Institute of Neuroradiology, University Medicine Goettingen, has a research agreement with Siemens Healthcare. M.- N. Psychogios and M. Knauth have received travel grants from Siemens Healthcare. 6 0 3 JOURNAL OF VISUALIZED EXPERIMENTS CAMBRIDGE JOVE-J VIS EXP PY - 2018 SN - 1940-087X SP - 7 ST - Optimized Management of Endovascular Treatment for Acute Ischemic Stroke T2 - Jove-Journal of Visualized Experiments TI - Optimized Management of Endovascular Treatment for Acute Ischemic Stroke UR - ://WOS:000426095700038 ID - 761614 ER - TY - JOUR AB - Endovascular treatment of acute ischemic stroke has become standard of care for patients with large artery occlusion. Early restoration of blood flow is crucial for a good clinical outcome. We introduced an interdisciplinary standard operating procedure (SOP) between neuroradiologists, neurologists and anesthesiologists in order to streamline patient management. This study analyzes the effect of optimized workflow on periprocedural timings and its potential influence on clinical outcome. Data were extracted from a prospectively maintained university hospital stroke database. The standard operating procedure was established in February 2014. Of the 368 acute stroke patients undergoing endovascular treatment between 2008 and 2015, 278 patients were treated prior to and 90 after process optimization. Outcome measures were periprocedural time intervals and residual functional impairment. After implementation of the SOP, time from symptom onset to reperfusion was significantly reduced (median 264 min prior and 211 min after SOP-introduction (IQR 228-32 min and 161-278 min, respectively); P<0.001). Especially faster supply of imaging and prompt transfer of patients to the angiography suite contributed to this effect. Time between hospital admission and groin puncture was reduced by half after process optimization (median 64 min after versus 121 min prior to SOP-introduction (IQR 54-77 min and 96-161 min, respectively); P<0.001). Clinical outcome was significantly better after workflow optimization as measured with the modified Rankin Scale (common odds ratio (OR) 0.56; 95% CI 0.32-0.98; P = 0.038). Optimization of workflow and interdisciplinary teamwork significantly improved the outcome of patients with acute ischemic stroke due to a significant reduction of in-hospital examination, transportation, imaging and treatment times. AD - [Schregel, Katharina; Behme, Daniel; Tsogkas, Ioannis; Knauth, Michael; Psychogios, Marios-Nikos] Univ Med Goettingen, Dept Neuroradiol, Gottingen, Germany. [Maier, Ilko; Liman, Jan] Univ Med Goettingen, Dept Neurol, Gottingen, Germany. [Karch, Andre; Mikolajczyk, Rafael] Helmholtz Ctr Infect Res, Dept Infectiol, Braunschweig, Germany. [Hinz, Jose] Univ Med Goettingen, Dept Anaesthesiol, Gottingen, Germany. Schregel, K (corresponding author), Univ Med Goettingen, Dept Neuroradiol, Gottingen, Germany. katharina.schregel@med.uni-goettingen.de; m.psychogios@med.uni-goettingen.de AN - WOS:000391229300064 AU - Schregel, K. AU - Behme, D. AU - Tsogkas, I. AU - Knauth, M. AU - Maier, I. AU - Karch, A. AU - Mikolajczyk, R. AU - Hinz, J. AU - Liman, J. AU - Psychogios, M. N. C7 - e0169192 DA - Dec DO - 10.1371/journal.pone.0169192 J2 - PLoS One KW - ACUTE ISCHEMIC-STROKE COMPUTED-TOMOGRAPHY SCORE INTRAVENOUS T-PA EARLY CT SCORE ALBERTA STROKE INTERVENTIONAL MANAGEMENT CLINICAL-OUTCOMES TRIAL THROMBECTOMY THERAPY Multidisciplinary Sciences LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: EG7LN Times Cited: 24 Cited Reference Count: 32 Schregel, Katharina Behme, Daniel Tsogkas, Ioannis Knauth, Michael Maier, Ilko Karch, Andre Mikolajczyk, Rafael Hinz, Jose Liman, Jan Psychogios, Marios-Nikos Karch, Andre/D-6973-2017; Behme, Daniel/H-4551-2019 Karch, Andre/0000-0003-3014-8543; German Research FoundationGerman Research Foundation (DFG); Open Access Publication Funds of the Goettingen University The authors received no specific funding for this work, but acknowledge support by the German Research Foundation and the Open Access Publication Funds of the Goettingen University. 24 0 4 PUBLIC LIBRARY SCIENCE SAN FRANCISCO PLOS ONE PY - 2016 SN - 1932-6203 SP - 12 ST - Effects of Workflow Optimization in Endovascularly Treated Stroke Patients - A Pre-Post Effectiveness Study T2 - Plos One TI - Effects of Workflow Optimization in Endovascularly Treated Stroke Patients - A Pre-Post Effectiveness Study UR - ://WOS:000391229300064 VL - 11 ID - 761680 ER - TY - JOUR AU - Schultz, J. AU - Giordano, N. AU - Zheng, H. DA - 2018 DB - German National Library of Science and Technology (TIB) PY - 2018 ST - 377 A Multidisciplinary Pulmonary Embolism Response Team: Experience From the National Pulmonary Embolism Response Team Consortium Multicenter Registry T2 - British Library Online Contents TI - 377 A Multidisciplinary Pulmonary Embolism Response Team: Experience From the National Pulmonary Embolism Response Team Consortium Multicenter Registry UR - https://www.tib.eu/en/search/id/BLSE:vdc_100069709581.0x000001/377-A-Multidisciplinary-Pulmonary-Embolism-Response?cHash=6d90884ad6e9d029f67b0b73b8581719 ID - 761916 ER - TY - JOUR AB - BACKGROUND: We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. METHODS: We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. RESULTS: There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions (P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions (P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. CONCLUSIONS: The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability. AD - Aarhus Universitetshospital. Massachusetts General Hospital. Harvard Univeristy. University of Michigan. Cleveland Clinic. Emory Clinic. Lancaster General Hospital. Medical University of South Carolina. Northwestern Medicine. Saint Louis University Care. Penn-Presbyterian Medical Center. Columbia University Medical Center. AN - 30632901 AU - Schultz, J. AU - Giordano, N. AU - Zheng, H. AU - Parry, B. A. AU - Barnes, G. D. AU - Heresi, G. A. AU - Jaber, W. AU - Wood, T. AU - Todoran, T. AU - Courtney, D. M. AU - Naydenov, S. AU - Khandhar, S. AU - Green, P. AU - Kabrhel, C. C2 - Pmc6690111 DA - Jan 11 DO - 10.1177/2045894018824563 DP - NLM ET - 2019/01/12 J2 - Pulmonary circulation LA - eng M1 - 3 N1 - 2045-8940 Schultz, Jacob Giordano, Nicholas Zheng, Hui Parry, Blair A Barnes, Geoffrey D Heresi, Gustavo A Jaber, Wissam Wood, Todd Todoran, Thomas Courtney, D Mark Naydenov, Soophia Khandhar, Sameer Green, Philip Kabrhel, Christopher Journal Article Pulm Circ. 2019 Jan 11;9(3):2045894018824563. doi: 10.1177/2045894018824563. PY - 2019 SN - 2045-8932 (Print) 2045-8932 SP - 2045894018824563 ST - EXPRESS: A Multidisciplinary Pulmonary Embolism Response Team (PERT) - Experience from a national multicenter consortium T2 - Pulm Circ TI - EXPRESS: A Multidisciplinary Pulmonary Embolism Response Team (PERT) - Experience from a national multicenter consortium VL - 9 ID - 760154 ER - TY - JOUR AB - Background: We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods: We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results: There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions (P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions (P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions: The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability. AD - C. Kabrhel, Department of Emergency Medicine, Massachusetts General Hospital, Boston, United States AU - Schultz, J. AU - Giordano, N. AU - Zheng, H. AU - Parry, B. A. AU - Barnes, G. D. AU - Heresi, G. A. AU - Jaber, W. AU - Wood, T. AU - Todoran, T. AU - Courtney, D. M. AU - Naydenov, S. AU - Khandhar, S. AU - Green, P. AU - Kabrhel, C. DB - Embase DO - 10.1177/2045894018824563 KW - adult analysis of variance anticoagulation article clinical article clinician controlled study emergency ward female high risk population human Kruskal Wallis test male mortality multicenter study pulmonary embolism response team statistical significance United States LA - English M1 - 3 M3 - Article N1 - L628852928 2019-09-02 PY - 2019 SN - 2045-8940 2045-8932 ST - A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium T2 - Pulmonary Circulation TI - A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628852928&from=export http://dx.doi.org/10.1177/2045894018824563 VL - 9 ID - 760696 ER - TY - JOUR AB - Background We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods We enrolled patients from the National PERT Consortium (TM) multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate-low (141/416, 34%) and intermediate-high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions (P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions (P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability. AD - [Schultz, Jacob] Aarhus Univ, Dept Cardiol, Aarhus, Denmark. [Giordano, Nicholas; Parry, Blair A.; Kabrhel, Christopher] Massachusetts Gen Hosp, Dept Emergency Med, Boston, MA 02114 USA. [Zheng, Hui] Massachusetts Gen Hosp, Dept Biostat, Boston, MA 02114 USA. [Barnes, Geoffrey D.] Univ Michigan, Dept Cardiovasc Med, Ann Arbor, MI 48109 USA. [Heresi, Gustavo A.] Cleveland Clin, Dept Pulm & Crit Care Med, Cleveland, OH 44106 USA. [Jaber, Wissam] Emory Clin, Dept Intervent Cardiol, Atlanta, GA 30322 USA. [Wood, Todd] Lancaster Gen Hosp, Dept Cardiol, Lancaster, PA USA. [Todoran, Thomas] Med Univ South Carolina, Dept Cardiol, Charleston, SC 29425 USA. [Courtney, D. Mark] Northwestern Med, Dept Emergency Med, Chicago, IL USA. [Naydenov, Soophia] St Louis Univ, Dept Internal Med, St Louis, MO USA. [Khandhar, Sameer] Penn Presbyterian Med Ctr, Dept Cardiol, Philadelphia, PA USA. [Green, Philip] Columbia Univ, Med Ctr, Dept Cardiol, New York, NY USA. Kabrhel, C (corresponding author), Massachusetts Gen Hosp, Ctr Vasc Emergencies, Dept Emergency Med, Zero Emerson Pl,Suite 3B, Boston, MA 02114 USA. ckabrhel@partners.org AN - WOS:000480239400001 AU - Schultz, J. AU - Giordano, N. AU - Zheng, H. AU - Parry, B. A. AU - Barnes, G. D. AU - Heresi, G. A. AU - Jaber, W. AU - Wood, T. AU - Todoran, T. AU - Courtney, D. M. AU - Naydenov, S. AU - Khandhar, S. AU - Green, P. AU - Kabrhel, C. AU - Natl Pert Consortium Res, Comm C7 - 2045894018824563 DA - Jul DO - 10.1177/2045894018824563 J2 - Pulm. Circ. KW - assessing and improving clinician behavior cardiopulmonary pharmacology and therapeutics cardiovascular diseases pulmonary embolism registries VENOUS THROMBOEMBOLISM ORGANIZATIONAL SURVEY EUROPEAN-SOCIETY MORTALITY Cardiac & Cardiovascular Systems Respiratory System LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: IP7PB Times Cited: 9 Cited Reference Count: 21 Schultz, Jacob Giordano, Nicholas Zheng, Hui Parry, Blair A. Barnes, Geoffrey D. Heresi, Gustavo A. Jaber, Wissam Wood, Todd Todoran, Thomas Courtney, D. Mark Naydenov, Soophia Khandhar, Sameer Green, Philip Kabrhel, Christopher Barnes, Geoffrey/AAK-1780-2020 Barnes, Geoffrey/0000-0002-6532-8440 9 0 SAGE PUBLICATIONS INC THOUSAND OAKS PULM CIRC PY - 2019 SN - 2045-8932 SP - 10 ST - A multidisciplinary pulmonary embolism response team (PERT)-experience from a national multicenter consortium T2 - Pulmonary Circulation TI - A multidisciplinary pulmonary embolism response team (PERT)-experience from a national multicenter consortium UR - ://WOS:000480239400001 VL - 9 ID - 761513 ER - TY - JOUR AB - Cardiovascular rehabilitation encompasses the optimization of secondary prevention to reduce morbidity and mortality, the improvement of physical fitness and quality of life as well as the reintegration into social life and employment. This requires a multifactorial intervention on the physical, psychological, educative and social level by a multidisciplinary team. In Germany, cardiac rehabilitation started early after an index event, could demonstrate a significant reduction of total mortality, myocardial infarction and hospitalization during a follow-up of 1-2 years in 4 cohort studies including 10,758 patients with myocardial infarction and bypass surgery. This reduction of clinical events was obtained in addition to rapid revascularization therapy during the acute coronary event and on top of an evidence based secondary preventive medication. By national and international medical societies, cardiac rehabilitation is recommended as well in patients with congestive heart failure, after valve replacement or valve repair, after heart transplantation and cardioverter/defibrillator implantation. In the future, cardiac rehabilitation in Germany should be evaluated by a randomized controlled trial and multifactorial interventions should be tailored individually to specific patient subgroups and medical conditions. AD - Klinik Höhenried gGmbH der DRV Bayern Süd, Rehabilitationszentrum am Starnberger See, Bernried, Deutschland. bernhard.schwaab@hoehenried.de AN - 20848073 AU - Schwaab, B. DA - Oct DO - 10.1007/s00108-010-2623-4 DP - NLM ET - 2010/09/18 J2 - Der Internist KW - Angioplasty, Balloon, Coronary/rehabilitation Combined Modality Therapy Cooperative Behavior Coronary Artery Bypass/rehabilitation Coronary Disease/mortality/rehabilitation Defibrillators, Implantable Female Germany Heart Diseases/mortality/*rehabilitation Heart Failure/mortality/rehabilitation Heart Transplantation/mortality/rehabilitation Heart Valve Prosthesis Implantation/mortality/rehabilitation Humans Interdisciplinary Communication Life Style Male Myocardial Infarction/mortality/rehabilitation *National Health Programs Patient Care Team Prognosis Quality of Life *Rehabilitation, Vocational Secondary Prevention Survival Rate LA - ger M1 - 10 N1 - 1432-1289 Schwaab, B English Abstract Journal Article Germany Internist (Berl). 2010 Oct;51(10):1231-2, 1234, 1236-8. doi: 10.1007/s00108-010-2623-4. OP - Kardiovaskuläre Rehabilitation. PY - 2010 SN - 0020-9554 SP - 1231-2, 1234, 1236-8 ST - [Cardiovascular rehabilitation] T2 - Internist (Berl) TI - [Cardiovascular rehabilitation] VL - 51 ID - 760273 ER - TY - JOUR AB - OBJECTIVE: Treatment of middle cerebral artery (MCA) aneurysms has been historically considered as the almost exclusive domain of microsurgical clipping. This retrospective single-center study assesses whether microsurgical clipping or endovascular treatment (i.e. coiling and/or stenting) for MCA aneurysms yielded better occlusion rates and clinical outcome. METHODS: We identified patients with a minimum clinical follow-up of 12 months who had undergone MCA aneurysm repair either by clipping or by endovascular treatment between 2005 and 2015. Aneurysm occlusion rates were assessed by the Raymond-Roy Occlusion Classification (RROC) and patients' clinical outcome was measured by the modified Rankin Scale (mRS). All patients had been treated in an interdisciplinary treatment concept at a large neurovascular center; both treatment modalities were available at all times. RESULTS: Ninety-two eligible patients with MCA aneurysms, of whom 21.7% patients were treated for subarachnoid hemorrhages, were included; 38 patients underwent endovascular therapy and 54 clipping. The median age at treatment was 53.5 years (range, 25-79 years) and the median clinical follow-up was 98.5 months (range, 18-213 months). Occlusion rates were significantly higher in the clipping cohort (RROC = 1: 96.3% vs 78.9%; p = 0.04), long-term clinical outcome was better in the endovascular treatment cohort (mRS ≤ 1: 100.0% vs 90.8%; p < 0.01). Permanent treatment-associated morbidity was seen more commonly in the clipping cohort (9.3% vs 0.0%). CONCLUSIONS: Both treatment modalities are associated with excellent clinical and radiological outcome if applied within an interdisciplinary treatment concept. Endovascular aneurysm repair appears to be an attractive treatment alternative compared to clipping with low complication rates for well-selected patients. AD - 1 Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria. 2 Research Institute of Neurointervention, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria. 3 Department of Neurosurgery, Geisinger Health, Danville, PA, USA. AN - 30071740 AU - Schwartz, C. AU - Aster, H. C. AU - Al-Schameri, R. AU - Müller-Thies-Broussalis, E. AU - Griessenauer, C. J. AU - Killer-Oberpfalzer, M. C2 - Pmc6259340 DA - Dec DO - 10.1177/1591019918792231 DP - NLM ET - 2018/08/04 J2 - Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences KW - Adult Aged Aneurysm, Ruptured/therapy Angiography, Digital Subtraction Cerebral Revascularization/*methods Endovascular Procedures/*methods Female Follow-Up Studies Humans Intracranial Aneurysm/diagnostic imaging/*surgery Male Middle Aged Middle Cerebral Artery/diagnostic imaging/*surgery Patient Care Team Postoperative Complications/epidemiology Retrospective Studies Subarachnoid Hemorrhage/diagnostic imaging/surgery Surgical Instruments Treatment Outcome Endovascular treatment microsurgical clipping middle cerebral artery aneurysm occlusion rate outcome LA - eng M1 - 6 N1 - 2385-2011 Schwartz, Christoph Aster, Hans-Christoph Al-Schameri, Rahman Müller-Thies-Broussalis, Erasmia Griessenauer, Christoph J Killer-Oberpfalzer, Monika Comparative Study Journal Article Interv Neuroradiol. 2018 Dec;24(6):608-614. doi: 10.1177/1591019918792231. Epub 2018 Aug 2. PY - 2018 SN - 1591-0199 (Print) 1591-0199 SP - 608-614 ST - Microsurgical clipping and endovascular treatment of middle cerebral artery aneurysms in an interdisciplinary treatment concept: Comparison of long-term results T2 - Interv Neuroradiol TI - Microsurgical clipping and endovascular treatment of middle cerebral artery aneurysms in an interdisciplinary treatment concept: Comparison of long-term results VL - 24 ID - 760185 ER - TY - JOUR AB - AIM: clinical data of a large cohort of HCC patients consecutively referred for 90Y- RE treatment at a single institution were retrospectively reviewed in order to evidence the evolving role over time of clinical indications and treatment efficacy. Material and Metods: a cohort of 370 HCC in different stage of disease were consecutively evaluated for 90Y- RE treatment at a single institution by a multidisciplinary team from the beginning of 2005 to the end of 2013. Patients considered potentially eligible underwent to 90Y RE after a baseline evaluation and diagnostic work-up procedure including hepatic angiography and 99mTc-MAA distribution. Clinical data were collected on individual patients CRF form and registered on a centralized database. Analyzed data include : - pre-therapy (performance status, liver function alpha-fetoprotein (AFP) values, Child-Pugh class, BCLC classification stage of disease, portal vein thrombosis (PVT), previous treatment); - therapy (administerd activity, lung shunt, modality of injection and post-therapy liver radioactivity distribution by Bremsstrahlung scan) and post-therapy findings (objective CT response, OS, PFS and toxicity) observed for a minimum follow-up of six month. Results: 280 patients over 370 evaluated were enrolled for treatment. More than 20% patients were excluded for lung shunt (46 patients) or for clinical status (44 patients). Objective response was 80% including patients with PVT. Overall median OS ranged from 17 - 24 months with more than 50% of patients free of recurrence at two years. About 10% of patients had a downstaging to liver resection or liver transplantation (OLT). BCLC stage of patients referred during years 2005-2009 was different from those evaluated in 2010-2013 moving from a strong prevalence of advanced BCLC stage C disease (72 %) to a more representation of BCLC Stage A and B (58%) with a correlated improvement of prognosis. Conclusions: the role of 90Y- RE treatment in HCC carcinoma is continuously evolving and specific indications are now clearly emerging. The treatment may be safely performed in advanced stages with palliative aim but it significantly impacts in natural history of disease if performed in early / intermediate stage leading to downstaging to curative treatment (resection and OLT). AD - R. Sciuto, Regina Elena National Cancer Institute, Roma, Italy AU - Sciuto, R. AU - Rea, S. AU - Annovazzi, A. AU - Romano, L. AU - Mazzone, C. AU - Bergomi, S. AU - Pasqualoni, R. AU - D'Angelo, G. AU - Pizzi, G. AU - Vallati, G. AU - Maini, C. DB - Embase DO - 10.1007/s00259-014-2901-9 KW - yttrium 90 alpha fetoprotein technetium 99m liver cell carcinoma palliative therapy nuclear medicine human patient therapy clinical study pulmonary shunt data base liver function procedures liver angiography follow up liver transplantation prevalence diagnosis Child Pugh score classification portal vein thrombosis injection liver radioactivity brems radiation toxicity history liver resection carcinoma prognosis surgery LA - English M3 - Conference Abstract N1 - L71671158 2014-11-07 PY - 2014 SN - 1619-7070 SP - S290-S291 ST - Evolving role of 90-Y radioembolization of hepatocellular carcinoma: Moving from palliation to cure T2 - European Journal of Nuclear Medicine and Molecular Imaging TI - Evolving role of 90-Y radioembolization of hepatocellular carcinoma: Moving from palliation to cure UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71671158&from=export http://dx.doi.org/10.1007/s00259-014-2901-9 VL - 41 ID - 761097 ER - TY - JOUR AB - Background-Aim: Clinical data of a large cohort of HCC patients consecutively referred for 90Y- RE treatment at a single institution were retrospectively reviewed in order to evidence the evolving role over time of clinical indications and treatment efficacy. Methods: A cohort of 370 HCC in different stage of disease were consecutively evaluated for 90Y- RE treatment at a single institution by a multidisciplinary team from the beginning of 2005 to the end of 2013. Patients considered potentially eligible underwent to 90Y RE after a baseline evaluation and diagnostic work-up procedure including hepatic angiography and 99mTc-MAA distribution. Clinical data were collected on individual patients CRF form and registered on a centralized database. Analyzed data include: pre-therapy (performance status, liver function alpha-fetoprotein (AFP) values, Child- Pugh class, BCLC classification stage of disease, portal vein thrombosis (PVT), previous treatment); therapy (administerd activity, lung shunt, modality of injection and post-therapy liver radioactivity distribution by Bremsstrahlung scan) and post-therapy findings (objective CT response, OS, PFS and toxicity) observed for a minimum follow-up of 6 month. Results: 280 patients over 370 evaluated were enrolled for treatment. More than 20 % patients were excluded for lung shunt (46 patients) or for clinical status (44 patients). Objective response was 80 % including patients with PVT. Overall median OS ranged from 17 to 24 months with more than 50 % of patients free of recurrence at 2 years. About 10 % of patients had a downstaging to liver resection or liver transplantation (OLT). BCLC stage of patients referred during years 2005-2009 was different from those evaluated in 2010-2013 moving from a strong prevalence of advanced BCLC stage C disease (72 %) to a more representation of BCLC Stage A and B (58 %) with a correlated improvement of prognosis. Conclusion: The role of 90Y-RE treatment in HCC carcinoma is continuously evolving and specific indications are now clearly emerging. The treatment may be safely performed in advanced stages with palliative aim but it significantly impacts in natural history of disease if performed in early/intermediate stage leading to downstaging to curative treatment (resection and OLT). AD - R. Sciuto AU - Sciuto, R. AU - Rea, S. AU - Annovazzi, A. AU - Romano, L. AU - Mazzone, C. AU - Bergomi, S. AU - Pasqualoni, R. AU - D'Angelo, G. AU - Pizzi, G. AU - Vallati, G. E. AU - Lucatelli, P. AU - Maini, C. L. DB - Embase DO - 10.1007/s40336-015-0114-2 KW - yttrium 90 alpha fetoprotein technetium 99m liver cell carcinoma palliative therapy nuclear medicine molecular imaging human patient therapy clinical study pulmonary shunt data base liver function procedures liver angiography follow up prevalence prognosis diagnosis classification portal vein thrombosis Child Pugh score injection liver radioactivity brems radiation toxicity surgery liver resection liver transplantation history carcinoma LA - English M3 - Conference Abstract N1 - L72168820 2016-02-01 PY - 2015 SN - 2281-5872 SP - S32-S33 ST - Evolving role of 90Y radioembolization of hepatocellular carcinoma: Moving from palliation to cure T2 - Clinical and Translational Imaging TI - Evolving role of 90Y radioembolization of hepatocellular carcinoma: Moving from palliation to cure UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72168820&from=export http://dx.doi.org/10.1007/s40336-015-0114-2 VL - 3 ID - 761077 ER - TY - JOUR AB - What is ERAS? Enhanced recovery after surgery (ERAS) is a process that shortens postoperative recovery by minimising the physical and physiological trauma of the surgery, by removing non evidence-based traditions and by encouraging early mobilisation and feeding. ERAS differs from previous 'fast track' and 'accelerated recovery' programmes in that it is not exclusive to the young, fit and healthy and is not dependent on a patient's suitability for inclusion. Programmes, if conducted properly, should benefit every patient. The overall strategy is that firstly, patients' are given partnership of and responsibility for their care, secondly, that their health is optimized prior to surgery and thirdly, that they receive evidence-based care and rehabilitation throughout their hospital stay. What are the key components? ERAS involves the use of a number of evidence-based interventions as a model of care, enabling patients to recover faster following surgery. Success requires a 'buy-in' from all professionals involved in patient care, including general practitioners, hospital consultants, allied health professionals and hospital managers (Figure 1). ERAS programmes involve changes in every step of the patient care process, from the referral from primary care through to the post-operative phases and follow-up. Successful implementation requires the formation of a multidisciplinary team that focuses on all aspects of the perioperative period and meets regularly to audit and redesign patient pathways for its own hospital. This team approach requires leadership that ensures best practice is achieved by each and every clinical department, similar to the role of the conductor of an orchestra. An autocratic approach along the traditional 'Pyramid System' with a 'closed mind' in charge is much less likely to succeed, if at all. In primary care, pre-operative optimisation should target specifically anaemia, diabetes and hypertension. In addition smoking and alcohol are both associated with adverse outcomes, warranting advice on cessation and/or consumption. Central to the whole process is empowerment of the patient by which they realize they are the 'main player' in their care with prime responsibility for their own recovery and discharge. Surgery by itself is not a disease, and therefore patients should be encouraged to feel that the operation has not made them ill. Therefore, the level of information they receive is very important as this will define their expectations and facilitate adherence to the pathway. Crucially, specific tasks and targets, e.g. postoperative oral intake or mobilisation, are given to the patient at this stage in the pathway, ideally both in verbal and written formats. Some units have prepared their own DVD's for patients. Formal preoperative assessment should occur before surgery, including further optimisation of medical problems and risk stratification that may include for example, cardiopulmonary exercise testing. Together with full information about the planned operation, this will assist in consent and informed decision processes by the patient. Patients should be given a realistic planned day of discharge based on the unit statistics. Admission before the day of surgery can be avoided if the patient has been fully prepared for surgery in the pre- hospital period of their care. Traditional pre-operative preparations, such as overnight fasting or bowel preparation, are both unnecessary and harmful, in contrast to the wide-held view of being beneficial. Both prolonged starvation and bowel preparation have adverse effects on the level of hydration and electrolyte balance and moreover this may increase morbidity especially post-operative ileus. A Cochrane review supports reducing fasting to two hours pre- operatively for clear fluids in elective surgery, although a six-hour fast is still recommended for solid food. Preoperative carbohydrate drinks should be given to minimise postoperative protein catabolism, negative nitrogen balance and insulin resistance that occurs and which results in loss of lean mus le mass. In summary ERAS involves a positive attitude by all staff together with a clear description of what is about to happen before surgery with an emphasis on early mobilisation and encouragement to the patient to be an independent, major and active participant in their own recovery 'The drip stand'. Special mention is required of the need to avoid what have become perhaps the iconic emblems of traditional perioperative care, the drip stand and the urinary catheter. The majority of drip stands are large, heavy and difficult to steer and as such may be a major reason why many patients, particularly the elderly, arthritic and/or infirm do not wish to mobilise, despite good analgesia and a successful operation. Similarly urinary catheters may be both painful and highly embarrassing for certain patients and are also associated with their own inherent morbidity. Prolonged fluid therapy is unnecessary for the majority of patients and by avoiding this, via procedurespecific goal directed therapy, the need for postoperative catheterisation can be minimized. What specialties have implemented ERAS? A literature review reveals that, although the bulk of the research data into outcomes comes from colorectal and orthopaedic surgery, ERAS programmes have in fact been implemented across almost every specialty. Colorectal surgery There is now good evidence that ERAS programmes have led to major improvements in the perioperative care of patients undergoing colorectal surgery (Lassen 2009, Eskicioglu 2009) Summarising these data, ERAS results in superior pain control, a reduction in the duration of ileus, improved pulmonary function, a trend towards reduced thrombo-embolic and cardiovascular events and does not affect anastomotic dehiscence rates. The patient's quality of life is improved in the first 6 months after surgery. The utilisation of 'minimally invasive surgery' (MIS) via laparoscopic techniques or when this is either not available or not feasible, 'maximally invasive anaesthesia' (MIA) using central neuraxial blockade, notably thoracic epidural analgesia (TEA) has led to significant reductions in the length of hospital stay, probably as a result of a reduction of the stress response. A recent study in open colorectal surgery, comparing an opioid based fast track programme with one in which opioids were avoided completely, showed significantly better analgesia, faster extubation times, less confusion, less postoperative nausea and vomiting and reduced length of hospital (Omar 2009). Orthopaedic surgery There has been a widespread acceptance of the benefits of early mobilisation in reducing the incidence of DVT and pulmonary embolism (Husted 2010). Furthermore, two recent review articles on regional anaesthesia for hip and knee surgery respectively, highlight the improvements made over the last two decades in perioperative care and emphasise that future studies should combine surgical, nursing, anaesthetic and analgesic protocols in order to deomonstrate improved perioperative outcomes [Macfarlane 2009 a) and b)]. The combination of an intraoperative spinal with either intra-articular catheters or low-dose PNB appears to provide the ''ideal'' analgesia for these procedures. In addition, by avoiding perioperative systemic and intrathecal opioids, the incidence of both urine retention requiring catheterisation and postoperative nausea and vomiting is less, thus allowing earlier ambulation and discharge. Except in rare circumstances relating to patient-specific comorbidity, there is now little justification for the avoidance of regional anaesthesia and analgesia for major joint replacement in both upper and lower limb surgery. The recent National Audit by the Royal College of Anaesthetists confirms that spinal anaesthesia, performed and managed properly, is associated with minimal morbidity in the overwhelming majority of cases (Cook 2010) The recent Musculoskeletal 'snapshot' audit commissioned by the Scottish Executive and performed during a 12- week period from June to August 2010 outlines the current position of ERAS for low r limb arthroplasty in all Scottish orthopaedic centres and the scope for its evolution and development (http://www.18weeks.scot.nhs.uk/how-to-achieve-and-maintain-18-weeks/ service-redesign-and-transformation/enhanced-recovery). An extensive perioperative database was established for all elective primary total hip and knee arthroplasties. A total of 636 THR and TKR procedures were performed. Those hospitals that had higher transfusion rates, prolonged administration of IV fluids and patient-controlled analgesia had lower early mobilisation rates and longer lengths of post-operative length of stay. These findings are very similar to the results of a recently published nationwide survey in Denmark (Husted 2010). In an ongoing prospective series beginning in January 2007 of over 5000 patients undergoing knee arthroplasty within an ERAS programme at the Golden Jubilee Hospital in Clydebank, Scotland, patients were shown to have very low morbidity and earlier discharge compared with patients prior to establishment of the programme. The success rate for the technique is 94%. Of these patients, 96% can mobilise within 24 hours of surgery with median pain score less than 3. Postoperative fluids are only required in 5% of patients and only 7% require urinary catheterisation. The median PONV score is zero and median postoperative stay has reduced from 6.5 to 3.8 days. Notably, joint infection remains low at 0.9% and the need for blood transfusion is very low - 2% for THR and 0.6% for TKR compared with the national average of 20%. Thoracic surgery Thoracotomy induces severe postoperative pain and impairment of pulmonary function. AD - N.B. Scott, Perioperative Medicine, Golden Jubilee National Hospital, Glasgow, United Kingdom AU - Scott, N. B. DB - Embase DO - 10.1097/AAP.0b013e31826a8366 KW - anesthetic agent analgesic agent opiate alcohol carbohydrate society regional anesthesia surgery human patient hospital morbidity analgesia perioperative period clinical audit liquid colorectal surgery evidence based practice postoperative nausea and vomiting patient care diet restriction primary medical care hospitalization knee arthroplasty urinary catheter lung function catheterization manager leg pain orthopedic surgery intestine preparation ileus procedures responsibility hip knee surgery follow up exercise test lung embolism stratification decision making statistics surgical nursing catheter hospital patient risk preoperative evaluation empowerment adverse outcome epidural anesthesia minimally invasive surgery quality of life model health practitioner smoking hypertension rehabilitation aged muscle fluid therapy therapy insulin resistance diabetes mellitus nitrogen balance blood transfusion anesthesia protein degradation stress anemia extubation consultation food music solid elective surgery general practitioner patient controlled analgesia transfusion conductor data base low drug dose leadership electrolyte balance anesthesist hydration college joint prosthesis adverse drug reaction starvation comorbidity spinal anesthesia arthroplasty mobilization urine retention intrathecal drug administration health length of stay Denmark United Kingdom bladder catheterization infectious arthritis feeding thorax surgery thoracotomy postoperative pain injury LA - English M1 - 5 M3 - Conference Abstract N1 - L70880747 2012-10-01 PY - 2012 SN - 1098-7339 SP - E128-E131 ST - Enhanced recovery after surgery- the way forward T2 - Regional Anesthesia and Pain Medicine TI - Enhanced recovery after surgery- the way forward UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70880747&from=export http://dx.doi.org/10.1097/AAP.0b013e31826a8366 VL - 37 ID - 761191 ER - TY - JOUR AB - Aim of the study: Several medical, mini-invasive, endoscopic or surgical options are now available for LUTS BPH-related. Among these, prostatic artery embolization (PAE) is an endovascular approach that is gaining popularity thanks to some advantages (performance under local anesthesia, fast patient discharge, no pausing of anticoagulant drugs, ejaculation maintenance). We have analyzed the results one of the largest single Centre series in the world, achieved from patients treated in our hospital with PAE. Materials and Methods: Prospective study (November 2013–April 2018). All patients had a mpMRI (or CT scan) study and a multidisciplinary team assessment to confirm indication. Inclusion criteria: patients with special risks regarding surgery/anesthesia considered unfit for surgery; patients with indwelling bladder catheter (IBC); patients refractory with BPH medication; sexually active men (keen to avoid risk of retrograde ejaculation); patients with recurrent bleeding caused by BPH. PAE is performed using hydrophillic microcatheters and polyvinyl alcohol particles. Results: 278 patients were treated, 118(42.4%) had an IBC. Median age was 73(53–93), and median Charlson CI was 5,09(2–14). Mean operation time and mean dose were 140,58 min(Stnd Dev: 39,5) and 717,4(Stnd Dev: 379,8) Gycm2, respectively. PAE was technically successful(bilateral) in 192(81,8%) patients; PAE was not possible in 5(2.1%) because of vascular issues. All patients were discharged the day after the procedure. Mean follow up was 19(range 6–54) months. No intra or peri-opertative time complications occurred. Among all patients, 197(70.8%) complained urethral burning in the first 48 hours after the procedure, 2(0.7%) rectal discomfort. Among no IBC patients, 4(1.4%) of them reported emospermia, spontaneously resolved after 2 months; no one reported erectile dysfunction; 82 (29.5%) had urgency e frequency for 10 days. Considering IBC patients, complete follow-up was achieved for 88(31.6%); 15 days after PAE, catheter was successfully removed in 67(76.1%); 12(4.3%) had UTI in the first month after catheter removal. A significant improvement in the observed endpoints compared to the baseline values was seen: the IPSS improved by −7.5 points, the QoL score (assessed with a visual scale) by −3.1 points, the maximum urine flow (Qmax) by 5.3 ml/s, postvoid residual volume by –66.9ml and the PSA value by – 2.35ng/ml. Discussion: PAE is an interesting endovascular procedure generally performed by interventional radiologist; is mandatory that urologists select and follow the patients before and after procedure. According to our experience, PAE results feasible, safe and with high success rate and improvements in quality of life, without sexual side effects. PAE can be useful both for catheter removal and in selected patient keen to preserve ejaculation, with no benefit from medical treatment or unfit for standard surgery. Comparative studies between PAE and TURP are on going; moreover, additional study data regarding the long-term efficacy of PAE can certainly soon be expected. AU - Secco, S. AU - Barbosa, F. AU - Brambillasca, P. AU - Di Trapani, D. AU - Barbieri, M. AU - Migliorisi, C. AU - Napoli, G. AU - Vercelli, R. AU - Olivero, A. AU - Solcia, M. AU - Petralia, G. AU - Strada, E. AU - Rampolidi, A. AU - Bocciardi, A. AU - Galfano, A. DB - Embase DO - 10.1016/S1569-9056(19)33503-1 KW - anticoagulant agent endogenous compound polyvinyl alcohol aged arterial embolization bleeding burn catheter removal clinical assessment comparative study complication conference abstract controlled study endovascular surgery erectile dysfunction follow up hospital discharge human hydrophilicity International Prostate Symptom Score interventional radiologist local anesthesia lower urinary tract symptom major clinical study male microcatheter micturition multidisciplinary team operation duration postvoid residual urine volume prospective study prostate hypertrophy quality of life retrograde ejaculation side effect urinary catheter urologist x-ray computed tomography LA - English M1 - 9 M3 - Conference Abstract N1 - L2004021402 2019-12-03 PY - 2019 SN - 1878-1500 1569-9056 SP - e3170 ST - Is prostate artery embolization (PAE) the future for the treatment of lower urinary tract symptoms secondary to benign prostatic hypertrophy? T2 - European Urology, Supplements TI - Is prostate artery embolization (PAE) the future for the treatment of lower urinary tract symptoms secondary to benign prostatic hypertrophy? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2004021402&from=export http://dx.doi.org/10.1016/S1569-9056(19)33503-1 VL - 18 ID - 760671 ER - TY - JOUR AB - Introduction & Objectives: Prostatic artery embolization (PAE)is an endovascular approach that is gaining popularity for treatment of LUTS BPH-related thanks to some advantages (performance under local anesthesia, fast patient discharge, no pausing of anticoagulant drugs, ejaculation maintenance). We have analyzed the results one of the largest single Centre series in the world, achieved from patients treated in our hospital with PAE. Materials & Methods: Prospective study (11/2013-04/2018), including urologic evaluation, mpMRI (or CT scan), multidisciplinary team assessment. Inclusion criteria: patients with special risks regarding surgery/anesthesia considered unfit for surgery; with indwelling bladder catheter (IBC); refractory with BPH medication; sexually active men keen to avoid risk of retrograde ejaculation; recurrent bleeding caused by BPH. PAE was performed using hydrophillic microcatheters and polyvinyl alcohol particles (Embosphere¯ 300-500)according to the PErFecTED Technique by Carnevale. Patients were follow-up every 6 months. Post procedural mpMRI was performed only in patients with PIRADS3. Medications (i.e. alpha blocker or 5-alpha reductase inhibitor)were suspended only in patients without IBC. Results: 278 patients were treated, 118(42.4%)had an IBC. Median age was 73(53-93), median Charlson CI was 5,09(2-14). Mean operation time was 140,58 min, mean dose was 717,4Gycm2. All patients were discharged the day after the procedure. Mean follow up was 19 months. No intra or peri-opertative time complications occurred. Among all patients, 197(70.8%)complained urethral burning in the first 48 hours after the procedure, 2(0.7%)rectal discomfort. Among no IBC patients, 4(1.4%)of them reported emospermia, spontaneously resolved after 2 months; no one reported erectile dysfunction; 82(29.5%)had urgency e frequency for 10 days. Considering IBC patients, complete follow-up was achieved for 88(31.6%); 15 days after PAE, catheter was successfully removed in 67(76.1%); 12(4.3%)had UTI in the first month after catheter removal. A significant improvement in the observed endpoints was seen: IPSS improved by -7.5 points, QoL score (assessed with a visual scale)by -3.1 points, maximum urine flow(Qmax)by 5.3ml/s, postvoid residual volume by –66.9ml. Conclusions: PAE is an interesting endovascular procedure generally performed by interventional radiologist, but is mandatory that urologists select and follow the patients. According to our experience, PAE results feasible, safe and with high success rate and improvements in quality of life, without sexual side effects.PAE can be useful both for catheter removal and in selected patient keen to preserve ejaculation, with no benefit from medical treatment or unfit for standard surgery. Comparative studies between PAE and TURP are on going; additional study data regarding the long-term efficacy of PAE can certainly soon be expected. AU - Secco, S. AU - Rampoldi, A. AU - Brambillasca, P. M. AU - Barbosa, F. AU - Di Trapani, D. AU - Barbieri, M. AU - Olivero, A. AU - Napoli, G. AU - Strada, E. AU - Petralia, G. AU - Migliorisi, C. AU - Vercelli, R. AU - Bocciardi, A. M. AU - Galfano, A. DB - Embase DO - 10.1016/S1569-9056(19)31074-7 KW - alpha adrenergic receptor blocking agent endogenous compound polyvinyl alcohol steroid 5alpha reductase inhibitor aged anesthesia arterial embolization bleeding burn catheter removal comparative study complication conference abstract controlled study drug therapy endovascular surgery erectile dysfunction follow up hospital discharge human hydrophilicity International Prostate Symptom Score interventional radiologist lower urinary tract symptom major clinical study male microcatheter micturition multidisciplinary team operation duration postvoid residual urine volume prospective study prostate hypertrophy quality of life retrograde ejaculation side effect urinary catheter urologist x-ray computed tomography LA - English M1 - 1 M3 - Conference Abstract N1 - L2001680318 2019-05-14 PY - 2019 SN - 1878-1500 1569-9056 SP - e1493 ST - Is prostate artery embolization (PAE)the future for the treatment of lower urinary tract symptoms secondary to benign prostatic hypertrophy? T2 - European Urology, Supplements TI - Is prostate artery embolization (PAE)the future for the treatment of lower urinary tract symptoms secondary to benign prostatic hypertrophy? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001680318&from=export http://dx.doi.org/10.1016/S1569-9056(19)31074-7 VL - 18 ID - 760740 ER - TY - JOUR AB - Background: Published data regarding presentation, therapy, and outcomes of patients with massive pulmonary embolism (PE) are outdated and may be obsolete, given advances in treatment options and intensive care. Methods: A prospective database of submassive and massive PE patients treated by a multidisciplinary team at a tertiary hospital was analyzed. We report clinical characteristics, treatments, and outcomes. Treatment beyond anticoagulation and/or an inferior vena cava (IVC) flter was considered advanced. Results: Of 337 patients, 46 had massive and 291 had submassive PE (average age 63±15 years; 49.6% female). Compared to submassive PE, massive PE was more likely to be treated with systemic thrombolysis, IVC flter, or Extra-Corporeal Membrane Oxygenation (table). Of patients with massive PE, 34.1% received systemic thrombolysis with a total 63.4% receiving any advanced therapy. At 90 days, mortality was 46.5% and 11.5% in massive and submassive PE, respectively (P<0.0001). Patients with massive PE were more likely to have had signifcant bleeding as well (38.7% vs. 15.1%, P=0.001). Multivariate analysis revealed increased mortality was associated with massive PE (OR 5.64, 95%, CI 1.11-21.08) and bleeding (OR 7.0, 95% CI 2.5-19.7), but not with advanced therapy (OR 0.6, 95% CI 0.1-2.6). Conclusion: In a modern cohort of high-risk PE patients, mortality is high and associated with hemodynamic compromise and bleeding. More data are needed to determine optimal therapies in these patients. AD - E. Secemsky AU - Secemsky, E. AU - Chang, Y. AU - Jain, C. C. AU - Beckman, J. A. AU - Giri, J. S. AU - Jaff, M. AU - Rosenfeld, K. AU - Rosovsky, R. AU - Kabrhel, C. AU - Weinberg, I. DB - Embase DO - 10.1016/S0735-1097(18)32471-9 KW - adult anticoagulation bleeding blood clot lysis cohort analysis conference abstract extracorporeal oxygenation female hemodynamics human inferior cava vein lung embolism major clinical study male middle aged mortality multivariate analysis prospective study risk assessment tertiary care center LA - English M1 - 11 M3 - Conference Abstract N1 - L621786207 2018-04-27 PY - 2018 SN - 1558-3597 ST - Presentation, therapy, and outcomes of patients with massive pulmonary embolism in the modern era T2 - Journal of the American College of Cardiology TI - Presentation, therapy, and outcomes of patients with massive pulmonary embolism in the modern era UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621786207&from=export http://dx.doi.org/10.1016/S0735-1097(18)32471-9 VL - 71 ID - 760844 ER - TY - GEN AB - Venous thromboembolism (VTE) is the third leading cause of vascular disease and accounts for $10 billion in annual US healthcare costs. The nationwide burden... AU - Secemsky, Eric A. AU - Rosenfield, Kenneth AU - Kennedy, Kevin F. AU - Jaff, Michael AU - Yeh, Robert W. DA - 2018/01/01 DB - Federal Science Library - Canada KW - United States - epidemiology Venous Thrombosis - diagnosis Acute Disease Venous Thromboembolism - mortality Venous Thrombosis - therapy Comorbidity Humans Middle Aged Risk Factors Venous Thrombosis - mortality Patient Readmission - trends Male Pulmonary Embolism - therapy Hospital Mortality - trends Pulmonary Embolism - mortality Pulmonary Embolism - diagnosis Time Factors Aged, 80 and over Female Aged Quality Indicators, Health Care - trends Venous Thromboembolism - therapy Databases, Factual Venous Thromboembolism - diagnosis Index Medicus PY - 2018 SN - 2047-9980 ST - High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States TI - High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwlV1NS8QwEA0qKF78_tYl3vRQTZq0TY9FXVZFQdkVD0KZpgm7ol1x9eDNn-Bv9Jc4abvC6h70EMghhDATJu8lbyaECP-AeT9iAuRhxAzTSuH5k_OIgy917tsQ4Tjn2uUNdzri5FZeXrnUmP3xD_qITg7PklaCPaeAjJmMJhESKSflum41v-9WXOldUf6T5rtCBMgoWF3VZ8wMoweS02VqBHvjASfG5zrANuf_scgFMlfDS5pU-2GRTJhiicxc1A_oy-TO6TpolbtA-5YK9vn-cQxv1Inp0eXu7mxAE_dxOE3064uhN2URV9ruPvcfs77B9tAbPNJeQRE60gqy0gqyrpBO86R91PLqDxY8tHoceWFkcm2thcAAt1ba2CgbysxK6YPrGEefw1wJxjRAprRUHBjEGQcuchCrZKroF2adUBuHcWAQ7CD_kcpEANw3AbNBLCAAqzfI3tDK6VNVRyMt-UfIU2ct7Km0shYOHXrh19B76MLI0N2hl1K0kXvrgMKgVVKfhUjWkIuqDbJWue97MjyBZRBzsfn3NW2RWURKqtTpim0y9fL8anbItB08eNnANhCLn543Sj7fKLfiF5fF1Yo VL - 7 ID - 762114 ER - TY - JOUR AB - AIMS: To decrease hospital-wide central line associated bacteraemia (CLAB) by spreading the prevention programme beyond the intensive care unit (ICU) in a secondary care hospital in Auckland, New Zealand. METHOD: Over 15 months, four general surgical wards, five inpatient units, and surgical theatres adopted the quality improvement initiative, and were followed for a further 15 months. The initiative included central line insertion and maintenance checklists, a central line insertion pack, training in central line care, and a dedicated database. In addition, a checklist to assess the readiness of each new area was developed; data collection and analysis processes embedded, with rapid feedback to staff and in-depth review of all CLAB events. RESULTS: Compliance measures improved significantly (compliance with insertion increased from a mean of 84% to 92% p=0.001; maintenance from 64% to 85%, p=0.002). The absolute numbers of CLAB fell hospital-wide from a mean of 2.3/month to 0.56/month. The rate of CLAB hospital-wide decreased from 7.04/1,000 line days to 1.37/1,000. CONCLUSION: We have demonstrated that the CLAB prevention work proven effective in the ICU can be successfully adapted and expanded to the rest of the hospital. As central lines are increasingly inserted in units outside the ICU, and maintained in general wards, this work provides some useful insights into tackling this larger problem. AD - Critical Care Complex, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 1640, New Zealand. Catherine.hocking@middlemore.co.nz. AN - 24929572 AU - Seddon, M. E. AU - Hocking, C. J. AU - Bryce, E. A. AU - Hillman, J. AU - McCoubrie, V. DA - May 23 DP - NLM ET - 2014/06/16 J2 - The New Zealand medical journal KW - Bacteremia/*prevention & control Catheterization, Central Venous/adverse effects/*standards Catheters, Indwelling/adverse effects/microbiology Checklist/standards Cross Infection/microbiology/*prevention & control Equipment Contamination/prevention & control Female *Guideline Adherence Hospital Units/standards Humans Infection Control/*standards Intensive Care Units/*standards Male New Zealand Patient Care Team/organization & administration Practice Guidelines as Topic Quality Improvement Risk Assessment LA - eng M1 - 1394 N1 - 1175-8716 Seddon, Mary E Hocking, Catherine J Bryce, Elizabeth A Hillman, Jackie McCoubrie, Vicki Journal Article Research Support, Non-U.S. Gov't New Zealand N Z Med J. 2014 May 23;127(1394):60-71. PY - 2014 SN - 0028-8446 SP - 60-71 ST - From ICU to hospital-wide: extending central line associated bacteraemia (CLAB) prevention T2 - N Z Med J TI - From ICU to hospital-wide: extending central line associated bacteraemia (CLAB) prevention VL - 127 ID - 760506 ER - TY - JOUR AB - BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, distinct pulmonary vascular disease, which is caused by chronic obstruction of major pulmonary arteries. CTEPH can be cured by pulmonary endarterectomy (PEA). PEA for CTEPH is a challenging procedure, and patient selection and the perioperative management are complex, requiring significant experience. OBJECTIVES: To describe the establishment of a national CTEPH-PEA center in Israel and present results of surgery. METHODS: In this study, we reviewed the outcomes of PEA in a national referral, multi-disciplinary center for CTEPH-PEA. The center was established by collaborating with a high-volume center in Europe. A multidisciplinary team from our hospital (pulmonary hypertension specialist, cardiac surgeon, cardiac anesthesiologist and cardiac surgery intensivist was trained under the guidance of an experienced team from the European center. RESULTS: A total of 38 PEA procedures were performed between 2008 and 2018. We included 28 cases in this analysis for which long-term follow-up data were available. There were two hospital deaths (7%). At follow-up, median New York Heart Association (NYHA) class improved from III to I (P < 0.0001), median systolic pulmonary pressure decreased from 64 mmHg to 26 mmHg (P < 0.0001), and significant improvements were seen in right ventricular function and exercise capacity. CONCLUSIONS: A national center for performance of a rare and complex surgical procedure can be successfully established by collaboration with a high-volume center and by training a dedicated multidisciplinary team. AD - Pulmonary Institute, Sheba Medical Center, Tel Hashomer, Israel. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel. Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Israel. Department of Clinical Immunology, Angioedema and Allergy Unit, Sheba Medical Center, Tel Hashomer, Israel. National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel. Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg Saar, Germany. AN - 31474014 AU - Segel, M. J. AU - Kogan, A. AU - Preissman, S. AU - Agmon-Levin, N. AU - Lubetsky, A. AU - Fefer, P. AU - Schaefers, H. J. AU - Raanani, E. DA - Aug DP - NLM ET - 2019/09/02 J2 - The Israel Medical Association journal : IMAJ KW - Adult Aged Aged, 80 and over Chronic Disease Endarterectomy/*methods Female Humans Hypertension, Pulmonary/*etiology/*surgery Israel Male Middle Aged Pulmonary Artery/surgery Pulmonary Embolism/*complications/*surgery Referral and Consultation Risk Factors Treatment Outcome Young Adult LA - eng M1 - 8 N1 - Segel, Michael J Kogan, Alexander Preissman, Sergey Agmon-Levin, Nancy Lubetsky, Aaron Fefer, Paul Schaefers, Hans-Joachim Raanani, Ehud Journal Article Israel Isr Med Assoc J. 2019 Aug;21(8):528-531. PY - 2019 SN - 1565-1088 (Print) SP - 528-531 ST - Pulmonary Endarterectomy Surgery for Chronic Thromboembolic Pulmonary Hypertension: A Small-Volume National Referral Center Experience T2 - Isr Med Assoc J TI - Pulmonary Endarterectomy Surgery for Chronic Thromboembolic Pulmonary Hypertension: A Small-Volume National Referral Center Experience VL - 21 ID - 760190 ER - TY - JOUR AB - Introduction: Despite demonstrable risk of venous thromboembolism(VTE), thromboprophylaxis continues to be underutilized in hospitalized cancer patients. Our study evaluated institutional VTE prophylaxis rates after devising a series of strategic interventions to longitudinally improve adherence rates over a period of eight years. Methods and materials: Between 2004 and 2012, a series of interventions were implemented to improve the thromboprophylaxis rate among patients with solid tumours hospitalized at our institution using quality improvement methodology. Interventions included development of guidelines and institutional policies coupled with educational in-services for physicians, nurses and pharmacists and engagement of the Cancer Quality Committee. Thromboprophylaxis rates were monitored to assess response to interventions. Results: At the outset in 2004, 11 of 57 (19.3%) eligible patients received appropriate pharmacological prophylaxis and formed the baseline of our analysis. Post-2009 policy implementation and educational sessions, 46.5% of an eligible 185 inpatients were administered thromboprophylaxis. Following a two-year grace period to allow for policy acceptance, three audits were conducted in 2011 for which an average prophylaxis rate of 62.3% resulted. In 2012, following another round of educational sessions, a 96.7% rate was achieved and maintained ten weeks later. Minimal bleeding risk was observed during this eight year initiative. Conclusion: A reproducible 96.7% prophylaxis uptake rate was the result of our perseverance and persistence in believing that culture change was inevitable through continuously collaborating with stakeholders at all levels. (C) 2013 Elsevier Ltd. All rights reserved. AD - [Seki, Jack T.; Vather, Triyu] Princess Margaret Canc Ctr, Dept Pharm, Toronto, ON M5G 2M9, Canada. [Seki, Jack T.; Vather, Triyu] Univ Toronto, Leslie Dan Fac Pharm, Toronto, ON M5S 1A1, Canada. [Kukreti, Vishal; Krzyzanowska, Monika K.] Princess Margaret Canc Ctr, Div Med Oncol & Hematol, Toronto, ON M5G 2M9, Canada. [Atenafu, Eshetu G.] Princess Margaret Canc Ctr, Dept Biostat, Toronto, ON M5G 2M9, Canada. Seki, JT (corresponding author), Princess Margaret Canc Ctr, 610 Univ Ave, Toronto, ON M5G 2M9, Canada. jack.seki@uhn.ca AN - WOS:000328911900008 AU - Seki, J. T. AU - Vather, T. AU - Atenafu, E. G. AU - Kukreti, V. AU - Krzyzanowska, M. K. DA - Jan DO - 10.1016/j.thromres.2013.10.025 J2 - Thromb. Res. KW - venous thromboembolism thromboprophylaxis hospitalized cancer DEEP-VEIN THROMBOSIS PULMONARY-EMBOLISM RISK-FACTORS PREVENTION ENOXAPARIN THERAPY PLACEBO DISEASE ALERTS TRIAL Hematology Peripheral Vascular Disease LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 278TF Times Cited: 4 Cited Reference Count: 40 Seki, Jack T. Vather, Triyu Atenafu, Eshetu G. Kukreti, Vishal Krzyzanowska, Monika K. Atenafu, Eshetu G./H-7520-2019 Atenafu, Eshetu G./0000-0002-4613-3680; Krzyzanowska, Monika/0000-0001-5533-7418 AstellasAstellas Pharmaceuticals; MerckMerck & Company; Leo Pharma; PfizerPfizer; SanofiSanofi-Aventis; WyethWyeth Dr. Jack T. Seki: I have received honoraria as a speaker consultant and study grants from Astellas, Merck, Leo Pharma and Pfizer. I have received study grants from Sanofi and Wyeth. 5 0 3 PERGAMON-ELSEVIER SCIENCE LTD OXFORD THROMB RES PY - 2014 SN - 0049-3848 SP - 34-41 ST - Bridging Efforts to Longitudinally Improve and Evaluate VEnous thromboembolism prophylaxis uptake in hospitalized cancer patients through Interprofessional Teamwork (BELIEVE IT): A study by Princess Margaret Cancer Centre T2 - Thrombosis Research TI - Bridging Efforts to Longitudinally Improve and Evaluate VEnous thromboembolism prophylaxis uptake in hospitalized cancer patients through Interprofessional Teamwork (BELIEVE IT): A study by Princess Margaret Cancer Centre UR - ://WOS:000328911900008 VL - 133 ID - 761791 ER - TY - JOUR AB - BACKGROUND: When symptoms of cerebral infarction are recognized in a patient, he or she should be transported to a hospital and should be started on the appropriate treatments. The effectiveness of delayed treatment of cerebral infarction with respect to the initial diagnosis or perception of the disease is still unclear. METHODS: We retrospectively investigated whether the functional outcomes would improve if patients with cerebral infarction were transported to the hospital with minimum delay. One-hundred twenty-two patients who were transported to Mishuku Hospital from January 2012 to August 2015 were included. We conducted multiple regression analyses. The criterion variable included the BI at discharge, and the explanatory variables were age, sex, days of hospital stay, the Barthel Index (BI) on admission, time from symptom onset to hospital arrival, time from emergency medical service perception to hospital arrival, recombinant tissue plasminogen activator (rt-PA) treatment, and the occluded artery type. RESULTS: In all 122 cases, the BI at the time of discharge was not related to onset time (P = .453) but was significantly related to perception time (P = .026). BI scores at discharge were high for young patients (P = .002) and for patients with short hospital stays (P <.001). In the rt-PA group (52 cases), BI scores at discharge were also high when the perception time was short (P = .036). CONCLUSIONS: A short interval between perception and hospital arrival improves the functional outcomes for patients with cerebral infarction. Thus, patients with cerebral infarctions must be treated with minimal delay after diagnosis of the condition. AD - Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan; Department of Neurology, Mishuku Hospital, Tokyo, Japan. Electronic address: res310@ndmc.ac.jp. Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan. Department of Traumatology and Critical Care Medicine, National Defense Medical College Hospital, Tokorozawa, Japan. Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan; Department of Neurology, Mishuku Hospital, Tokyo, Japan. Department of Neurology, Mishuku Hospital, Tokyo, Japan. AN - 28774793 AU - Seno, S. AU - Tomura, S. AU - Ono, K. AU - Akitomi, S. AU - Sekine, Y. AU - Yoshimura, Y. AU - Tanaka, Y. AU - Ikeuchi, H. AU - Saitoh, D. DA - Dec DO - 10.1016/j.jstrokecerebrovasdis.2017.06.059 DP - NLM ET - 2017/08/05 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Activities of Daily Living Aged Aged, 80 and over Cerebral Infarction/diagnosis/physiopathology/*therapy Disability Evaluation Early Diagnosis *Emergency Medical Services Female Fibrinolytic Agents/*administration & dosage/adverse effects Health Status Humans Japan Length of Stay Male Middle Aged Patient Care Team Patient Discharge Predictive Value of Tests Recovery of Function Retrospective Studies Risk Factors Thrombolytic Therapy/adverse effects/*methods Time Factors *Time-to-Treatment Tissue Plasminogen Activator/*administration & dosage/adverse effects Transportation of Patients Treatment Outcome Barthel Index Transportation time cerebral infarction functional outcome onset time perception time rt-PA LA - eng M1 - 12 N1 - 1532-8511 Seno, Soichiro Tomura, Satoshi Ono, Kenichiro Akitomi, Shinji Sekine, Yasumasa Yoshimura, Yuya Tanaka, Yoshihiro Ikeuchi, Hisashi Saitoh, Daizoh Journal Article United States J Stroke Cerebrovasc Dis. 2017 Dec;26(12):2800-2805. doi: 10.1016/j.jstrokecerebrovasdis.2017.06.059. Epub 2017 Jul 31. PY - 2017 SN - 1052-3057 SP - 2800-2805 ST - The Relationship between Functional Outcome and Prehospital Time Interval in Patients with Cerebral Infarction T2 - J Stroke Cerebrovasc Dis TI - The Relationship between Functional Outcome and Prehospital Time Interval in Patients with Cerebral Infarction VL - 26 ID - 760392 ER - TY - JOUR AU - Serhal, M. AU - Haddadin, I. S. AU - Heresi, G. A. AU - Hornacek, D. A. AU - Shishehbor, M. H. AU - Bartholomew, J. R. DA - 2017/04/12 04/12 DB - Europe PubMed Central DO - 10.1007/s11239-017-1498-9 M1 - 1 PY - 2017 SN - 0929-5305 SP - 19-29 ST - Pulmonary embolism response teams T2 - J Thromb Thrombolysis TI - Pulmonary embolism response teams UR - http://europepmc.org/article/MED/28401327 VL - 44 ID - 762116 ER - TY - JOUR AB - Background Infective endocarditis (IE) is an uncommon disease with an involved interplay of clinical and surgical team management. We aimed to define diagnosis parameters and delineate in-hospital management in patients with IE admitted in a tertiary hospital of Southern Italian. Materials and methods Fifty-six consecutive patients (42 males, 14 females; age range: 34-85 years) admitted for IE in the Infectious Diseases, Cardiac Surgery, and Cardiology units, between January 2011 and August 2017, were enrolled. Demographic data, mortality, comorbidities, specimen type, microscopy results, special histological staining performed, and antimicrobial therapy were collected and analyzed. Any comments at the multidisciplinary team meetings were recorded in minutes of and approved. Results We found 83.9% of patients with positive blood cultures. The four most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA: 21.3%), methicillin-sensitive Staphylococcus aureus (MSSA: 17%), Streptococci (14.9%), and Enterococci (14.9%). Both in the univariate and multivariate analysis, we observed a significant positive correlation between surgery and complications. Particularly in the univariate analysis only, surgery was positively correlated to males and C-reactive protein (CPR) at baseline. Also, considering the most common bacteria, it resulted in a positive correlation between surgery and MRSA and Streptococci spp. and between complications and MSSA. Finally, the male gender was positively correlated to MSSA and heart complications, major arterial embolism, septic pulmonary emboli, splenic infarction, and cerebral embolism. Conclusions A blood culture test remains a critical factor for the diagnosis of IE and the antibiotic treatment of susceptible and emerging resistant bacteria. Male gender and heart complications are red flags for prompt operative management. AD - [Serra, Nicola] Univ Federico Ii, Mol Technol, Neaples, Italy. [Colomba, Claudia; Di Carlo, Paola; Palermo, Gabriele; Giammanco, Anna; Novo, Giuseppina, Jr.] Univ Palermo, Dept Hlth Promot, Maternal Childhood, Internal Med Excellence G DAlessandro,Promise, Palermo, Italy. [Di Carlo, Paola] Policlin Paolo Giaccone Univ Hosp, Dept Infect Dis, Palermo, Italy. [Fasciana, Teresa] Univ Palermo, Dept Microbiol, Palermo, Italy. [Rea, Teresa] Univ Naples Federico II, Dept Publ Hlth, Naples, Italy. [Marino, Maria Michela] Univ Campania Luigi Vanvitelli, Dept Precis Med, Naples, Italy. [Argano, Vincenzo] Univ Palermo, Cardiac Surg Unit, Palermo, Italy. [Sergi, Consolato] Univ Alberta, Med & Pathol Lab, Edmonton, AB, Canada. Sergi, C (corresponding author), Univ Alberta, Med & Pathol Lab, Edmonton, AB, Canada. biotechlab@gmail.com AN - WOS:000535876200014 AU - Serra, N. AU - Colomba, C. AU - Di Carlo, P. AU - Palermo, G. AU - Fasciana, T. AU - Giammanco, A. AU - Novo, G. AU - Rea, T. AU - Marino, M. M. AU - Argano, V. AU - Sergi, C. C7 - e8338 DA - May DO - 10.7759/cureus.8338 J2 - Cureus KW - endocarditis univariate analysis matlab gender multi-drug resistant bacteria microorganisms candida endocarditis complications adult cardiac surgery multivariate analysis 2015 ESC GUIDELINES BILIARY-TRACT DIAGNOSIS BACTIBILIA MANAGEMENT DISEASES SURGERY Medicine, General & Internal LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: LR7LN Times Cited: 0 Cited Reference Count: 30 Serra, Nicola Colomba, Claudia Di Carlo, Paola Palermo, Gabriele Fasciana, Teresa Giammanco, Anna Novo, Giuseppina, Jr. Rea, Teresa Marino, Maria Michela Argano, Vincenzo Sergi, Consolato REA, TERESA/AAT-2699-2020 0 CUREUS INC PALO ALTO CUREUS PY - 2020 SP - 16 ST - Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population T2 - Cureus TI - Infective Endocarditis: Preliminary Results of a Cohort Study in the Southern Italian Population UR - ://WOS:000535876200014 VL - 12 ID - 761443 ER - TY - JOUR AB - Background A pharmacist in the intensive care unit (ICU) as a component of multi-professional staff may improve the care provided to patients, particularly by monitoring the drugs administered, reducing preventable adverse drug events (ADE) and identifying drug interactions and errors. Purpose Evaluate the interventions of a critical care pharmacist (CCP) as a component of team-based care in a Spanish neurotrauma ICU (NTICU). Material and methods Prospective observational study with patients admitted in a NTICU for 5 weeks (including only working days). CCP collaborates with a multidisciplinary team selecting the medication therapy, dosage, duration and monitoring, based on physician diagnosis and team's goals for the patient. CCP is also responsible for clinical services and electronic verification of medication orders. Results Out of 54, only 42 patients were monitored, with a mean age of 57 years (31-85), of which 31 were males (74%). Eleven patients were admitted for polytrauma (26%), eight for severe traumatic brain injury (19%), six for acute spinal cord injury (14%), three for cerebrovascular accident (7%), two for necrotising fasciitis (5%) and 12 (28%) for other causes. The median days of admission were 14. There were only five deaths during the study period. A total of 116 interventions were done, almost three interventions per patient and five per day of dedication of the CCP. The majority of interventions were related to artificial nutrition monitoring (28) and about the management of antimicrobial optimisation (27): nine discontinuations of antibiotic prophylaxis, six antibiotic dose adjustments, four recommendations to de-escalate the antibiotic and three antibiotic changes because they did not cover the pathogen. Twenty-two interventions were related to drug administration, 11 with conciliation, eight with intravenous-to-enteral conversion, five of thromboembolism prophylaxis, four drug-related questions, three discontinuations by duplications, two stopped because of ADE and one interaction. According to an internal hospital protocol, 26% of interventions were considered of high clinical impact. Conclusion As most of the interventions were related to artificial nutrition adjustments, antimicrobial optimisation management and drug administration, a checklist was designed, containing such points where the pharmacist is mostly involved, to monitor critical patients in a standardised way and to simplify the detection of discrepancies. AD - E. Serramontmany, Vall D'Hebron University Hospital, Pharmacy Service, Barcelona, Spain AU - Serramontmany, E. AU - Girona, L. AU - Juarez, J. C. AU - Robles, A. AU - Riveiro, M. AU - Betriu, L. AU - Lalueza, P. DB - Embase DO - 10.1136/ejhpharm-2018-eahpconf.301 KW - antibiotic agent adult adverse drug reaction antibiotic prophylaxis artificial feeding cerebrovascular accident checklist clinical article conference abstract death diagnosis drug therapy drug withdrawal human infectious agent intensive care unit male monitoring multiple trauma necrotizing fasciitis nonhuman observational study pharmacist physician prospective study side effect spinal cord injury thromboembolism traumatic brain injury LA - English M3 - Conference Abstract N1 - L621457876 2018-04-03 PY - 2018 SN - 2047-9964 SP - A140 ST - Evaluation of the interventions of a critical care pharmacist in addition to team-based care in an intensive care unit T2 - European Journal of Hospital Pharmacy TI - Evaluation of the interventions of a critical care pharmacist in addition to team-based care in an intensive care unit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L621457876&from=export http://dx.doi.org/10.1136/ejhpharm-2018-eahpconf.301 VL - 25 ID - 760841 ER - TY - JOUR AB - It is estimated that in Spain 13.2 persons per 1000 inhabitants received daily vitamin K antagonists as oral anticoagulant therapy risk of thromboembolic disease. Classically control Anticoagulant Therapy has been a labor of hematology through an analysis of patient's venous blood and whose treatment regimen was collected, hours later, by each person in their Health Centers. In recent years, Primary Health Care Teams, of most Spanish Health Services, have been instructed to use and interpret, independently, portable coagulometers and the use of computer programs that allow the registration in the corresponding electronic medical records and control of the data, the calculation of doses and programming citations revision. The clinical history may have different sections that allow these activities as the module for control and monitoring of patients on oral anticoagulation available on OMI-ap Aragon. This module allows tracking, within the program, and clinical audits performed by the application TAO itself, avoiding the loss of the patient's perspective, that previously happened to this system to specify other recording bases outside the program. The purpose of this paper is to present the reader with this common tool Primary Care nursing practice, describing the program as well as before and after the use of this module included in IMO-ap steps. AD - [Bimbela Serrano, Maria Teresa] Univ Zaragoza, Zaragoza, Spain. [Bimbela Serrano, Maria Teresa] Univ Zaragoza, Dept Fisiatria & Enfermeria, Serv Aragones Salud, Zaragoza, Spain. [Bimbela Serrano, Fernando] Univ Zaragoza, Zaragoza, Spain. [Bimbela Serrano, Fernando] Univ Publ Navarra, Pamplona, Spain. Serrano, MTB (corresponding author), Univ Zaragoza, Zaragoza, Spain. tbimbela@unizar.es AN - WOS:000454018500005 AU - Serrano, M. T. B. AU - Serrano, F. B. DA - Mar J2 - Rev. Rol Enferm. KW - MEDICAL RECORDS BLOOD COAGULATION TEST PRIMARY HEALTH CARE NURSING PRACTICE Nursing LA - Spanish M1 - 3 M3 - Article N1 - ISI Document Delivery No.: VH7MM Times Cited: 0 Cited Reference Count: 24 Bimbela Serrano, Maria Teresa Bimbela Serrano, Fernando 0 EDICIONES ROL S A BARCELONA REV ROL ENFERM PY - 2016 SN - 0210-5020 SP - 182-188 ST - REGISTRATION AND COMPUTER CONTROL OF ORAL ANTICOAGULANT THERAPY (OAT) IN PRIMARY HEALTH CARE T2 - Revista Rol De Enfermeria TI - REGISTRATION AND COMPUTER CONTROL OF ORAL ANTICOAGULANT THERAPY (OAT) IN PRIMARY HEALTH CARE UR - ://WOS:000454018500005 VL - 39 ID - 761718 ER - TY - JOUR AB - Background: Pulmonary Embolism Response Teams (PERT) help providers quickly determine optimal management of acute pulmonary embolism (PE). Invasive catheter directed therapy (CDT) may help quickly stabilize patients with submassive and massive PE. However, data on the long-term impact of CDT is limited. Methods: Data from 74 PERT patients admitted at our institution over 18 months was retrospectively analyzed. Renal function and hemoglobin were compared at time of PE diagnosis, on discharge, and at follow-up (defined as first available data 90-270 days after diagnosis). The ratio of right ventricular to left ventricular diameter (RV/LV) at diagnosis was measured on computed tomography. RV/LV on transthoracic echocardiograms and 6-minute walking distance (6MWD) were measured at follow-up. Results: There were no major significant differences in renal function or hemoglobin between patients treated with CDT vs. noninvasive therapy at either discharge or follow-up. Further, RV/LV ratio and 6MWD were not significantly different between CDT and noninvasively treated patients on follow-up (Table 1). Conclusion: CDT may not negatively impact renal function or hemoglobin in the long-term. Those treated with CDT had higher initial RV/LV ratios that improved on follow-up to levels similar to those who received conservative management. Follow-up 6MWDs were comparable in a small group of patients. CDT may acutely stabilize patients, leading to long-term outcomes similar to those treated conservatively. [Figure presented] AU - Serritella, A. AU - Putnam, A. AU - Marginean, A. AU - McClelland, I. AU - Friant, J. AU - Nathan, S. AU - Shah, A. AU - Blair, J. AU - Paul, J. DB - Embase DO - 10.1016/S0735-1097(19)32524-0 KW - endogenous compound hemoglobin adult catheter clinical outcome computer assisted tomography conference abstract conservative treatment controlled study female follow up heart left ventricle heart right ventricle human kidney function major clinical study male non invasive procedure pulmonary embolism response team retrospective study six minute walk test transthoracic echocardiography walking distance LA - English M1 - 9 Supplement 1 M3 - Conference Abstract N1 - L2001638388 2019-04-16 PY - 2019 SN - 1558-3597 0735-1097 SP - 1918 ST - ANALYZING THE IMPACT OF CATHETER DIRECTED THERAPY ON LONG-TERM CLINICAL OUTCOMES IN PATIENTS WITH ACUTE PULMONARY EMBOLISM T2 - Journal of the American College of Cardiology TI - ANALYZING THE IMPACT OF CATHETER DIRECTED THERAPY ON LONG-TERM CLINICAL OUTCOMES IN PATIENTS WITH ACUTE PULMONARY EMBOLISM UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2001638388&from=export http://dx.doi.org/10.1016/S0735-1097(19)32524-0 VL - 73 ID - 760735 ER - TY - JOUR AB - Background: In-hospital strokes account for 6.5%-15% of all strokes. Efficiently managing inpatient stroke alerts is a resource-intensive process involving multidisciplinary teams. Standardized emergency department (ED) stroke protocols have been shown to decrease time from stroke alert (SA) activation to neuroimaging and treatment. At our institution, stroke patients arriving to the ED were evaluated and treated faster than inpatient (IP) strokes, highlighting the need for an improved IP SA process to meet work flow benchmarks established by the American Stroke Association. Purpose: Standardizing the IP SA process will decrease time to CT imaging and neurological evaluation, reducing SA activation to treatment times for IP strokes. Methods: A revised in-hospital SA protocol was implemented 8/2016 to prioritize early neurology notification and CT imaging. A total of 332 inpatient SA cases from 1/2013-6/2018 were analyzed for: SA activation to neurology contact, SA activation to CT image scout film time, SA activation to thrombolytic (tPA) administration and/or groin puncture time in cases where a mechanical thrombectomy was performed. Results: Analysis showed significant improvements to all of the outcome measures: 35% improvement in IP SA activation to CT imaging start time (N= 167 prior to protocol revision; N=165 after protocol revision), 36% improvement in SA activation to neurology contact time, 59% improvement in SA to tPA administration time (N=7 prior to protocol revision; N=11 after protocol revision), and a 10% improvement in SA to groin puncture time for thrombectomy cases (N=6 cases prior to protocol revision; N=6 after protocol revision). A 36% increase in IP tPA administrations might be attributed to rapid consideration of eligibility within the treatment window. Conclusions: Standardizing IP SA processes to remove inefficiencies optimizes work flow across all phases of evaluation and leads to faster treatment times and increased treatment rates. These findings may serve as the basis for large-scale multicenter studies to further validate effective protocols' impact on patient outcomes. AD - J. Sessa, Memorial Hosp West, Pembroke Pines, FL, United States AU - Sessa, J. AU - Mehta, B. P. AU - Lima, A. AU - Canellas, V. DB - Embase DO - 10.1161/str.50.suppl_1.TP480 KW - endogenous compound tissue plasminogen activator adult conference abstract contact time emergency ward female hospital patient human human tissue inguinal region major clinical study male mechanical thrombectomy multicenter study nervous system neurology puncture stroke patient surgery workflow LA - English M3 - Conference Abstract N1 - L628148650 2019-06-21 PY - 2019 SN - 1524-4628 ST - Standardizing inpatient stroke alert processes yields faster treatment times in inpatient strokes T2 - Stroke TI - Standardizing inpatient stroke alert processes yields faster treatment times in inpatient strokes UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628148650&from=export http://dx.doi.org/10.1161/str.50.suppl_1.TP480 VL - 50 ID - 760752 ER - TY - JOUR AU - Sethi, S. S. AU - Zilinyi, R. AU - Green, P. AU - Eisenberger, A. AU - Brodie, D. AU - Agerstrand, C. AU - Takeda, K. AU - Kirtane, A. J. AU - Parikh, S. A. AU - Rosenzweig, E. B. DA - 2020/08/26 08/26 DB - Europe PubMed Central DO - 10.1016/j.jaccas.2020.05.034 M1 - 9 PY - 2020 SN - 2666-0849 SP - 1391-1396 ST - Right Ventricular Clot in Transit in COVID-19: Implications for the Pulmonary Embolism Response Team T2 - JACC Case Rep TI - Right Ventricular Clot in Transit in COVID-19: Implications for the Pulmonary Embolism Response Team UR - http://europepmc.org/article/MED/32835284 VL - 2 ID - 761922 ER - TY - GEN AB -... embolism response team algorithm. (Level of Difficulty: Beginner.) AU - Sethi, Sanjum S. AU - Zilinyi, Robert AU - Green, Philip AU - Eisenberger, Andrew AU - Brodie, Daniel AU - Agerstrand, Cara AU - Takeda, Koji AU - Kirtane, Ajay J. AU - Parikh, Sahil A. AU - Rosenzweig, Erika B. DA - 2020/01/01 DB - Federal Science Library - Canada KW - clot in transit right ventricle vascular disease pulmonary embolism thrombus PY - 2020 SN - 2666-0849 ST - Right Ventricular Clot in Transit in COVID-19 TI - Right Ventricular Clot in Transit in COVID-19 UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1bS8MwFA46EXzxgop3-gcycmnS9lHmhntRFDd8C0mawMbowM3_7znpCkPYg761lJRykp7v-5JzIUSKPqO_fIKtdcEC82UJ-FPzgluR-1pEDXScc495w5OJHH7mL2-YGtPfcaCfArPm1mM7MFDtLBXdlPk-OcCqMtjAQI_73XIC16zEVnUyCUIQ-DmeMwMqaaxoWnXJdDtevIVQbe_35FxHJ3_9wFNyvOGX2WO7IM7IXmjOCX1HCZ5NcSd3lgJPs8Fiuc5mTZawapYuB6_T8RPl1QWZjIYfg2e66ZNAPdZ7o3UARSyAW1Reel9HVXoltJUgbstKOO9yGyz8m8q5AI-AslntQrBBO64iq-Ul6TXLJlyRLFa6UgE4C8iYvAyFtVwExaKCMcpGf02KziBmA9Et9Bowg-kixuamNYFBEximDJjg5t8jb8kR3uGGKld3pLf--g735DCuFtSt4kOa8x9ps6j2 VL - 2 ID - 762064 ER - TY - JOUR AB - The World Health Organisation (WHO) recommends routine use of a surgical safety checklist prior to all surgical operations. The aim of this study was to prospectively audit checklist use in orthopaedic patients before and after implementation of an educational programme designed to increase use and correlate this with early complications, mortality and staff perceptions. Data was collected on 480 patients before the educational program and 485 patients after. Pre-training checklist use was 7.9%. The rates of early complications and mortality were 8.5% and 1.9%, respectively. Forty-seven percent thought the checklist improved team communication. Following an educational program, checklist use significantly increased to 96.9% (RR12.2; 95% CI 9.0-16.6). The rate of early complications and mortality was 7.6% (RR 0.89; 95% CI 0.58-1.37) and 1.6% (RR 0.88; 95% CI 0.34-2.26), respectively. Seventy-seven percent thought the checklist improved team communication. Checklist use was not associated with a significant reduction in early complications and mortality in patients undergoing orthopaedic surgery. Education programs can significantly increase accurate use and staff perceptions following implementation. AD - [Sewell, Mathew; Adebibe, Miriam; Jayakumar, Prakash; Jowett, Charlie; Kong, Kin; Vemulapalli, Krishna; Levack, Brian] King George Hosp, London, England. Sewell, M (corresponding author), King George Hosp, London, England. matbuzz1@hotmail.com AN - WOS:000291061000016 AU - Sewell, M. AU - Adebibe, M. AU - Jayakumar, P. AU - Jowett, C. AU - Kong, K. AU - Vemulapalli, K. AU - Levack, B. DA - Jun DO - 10.1007/s00264-010-1112-7 J2 - Int. Orthop. KW - DEEP-VEIN THROMBOSIS OPERATING-ROOM ADVERSE EVENTS TOTAL HIP SURGERY REPLACEMENT TEAMWORK CARE COMMUNICATION PROPHYLAXIS Orthopedics LA - English M1 - 6 M3 - Article N1 - ISI Document Delivery No.: 770BC Times Cited: 82 Cited Reference Count: 25 Sewell, Mathew Adebibe, Miriam Jayakumar, Prakash Jowett, Charlie Kong, Kin Vemulapalli, Krishna Levack, Brian 85 0 19 SPRINGER NEW YORK INT ORTHOP PY - 2011 SN - 0341-2695 SP - 897-901 ST - Use of the WHO surgical safety checklist in trauma and orthopaedic patients T2 - International Orthopaedics TI - Use of the WHO surgical safety checklist in trauma and orthopaedic patients UR - ://WOS:000291061000016 VL - 35 ID - 761850 ER - TY - JOUR AB - OBJECTIVE: The rapid processing of perfusion and diffusion (RAPID) system for automating perfusion and diffusion data from head computed tomography has improved acute ischemic stroke treatment by quickly and accurately identifying those patients who may benefit from thrombectomy. Collateral scoring (CS) of cerebral arteries using computed tomography angiography (CTA) has proven useful in predicting postintervention infarct volumes and functional outcomes in ischemic stroke patients. Here we evaluate the relationship between CS and RAPID software in an effort to augment triage and provide improved predictability of functional outcomes in ischemic stroke patients. METHODS: A retrospective review of 77 mechanical thrombectomy patients from January 2017 to October 2018 with large vessel occlusions of the anterior circulation who underwent RAPID and CTA imaging was performed. Baseline characteristics, RAPID data, CS, modified Rankin Scale score, and procedural data were collected. magnetic resonance imaging was used to calculate the postintervention stroke volume. RESULTS: CS inversely correlates with the volume of RAPID cerebral blood flow <30% (13 = -18.131, 95% confidence interval [CI] -24.384 to -11.879, P < 0.001), RAPID Tmax >6s (beta = -22.205, 95% CI -39.125 to -5.285, P = 0.011), postintervention stroke volume (beta = -30.637, 95% CI -41.554 to -19.720, P < 0.001), and discharge National Institutes of Health Stroke Scale score (beta = -1.922, 95% CI -3.575 to -0.269, P = 0.023). CONCLUSIONS: CS on CTA may be a useful way to identify patients who would benefit from mechanical thrombectomy and predict functional outcomes postintervention. CS may allow the stroke team to optimize the care of patients who may not be able to obtain RAPID analysis. AD - [Shah, Varun S.; Cua, Santino] Ohio State Univ, Coll Med, Columbus, OH 43210 USA. [Eaton, Ryan G.; Dornbos, David, III; Nguyen Hoang; Schunemann, Victoria; Nimjee, Shahid; Youssef, Patrick; Powers, Ciaran J.] Ohio State Univ, Dept Neurol Surg, Wexner Med Ctr, Columbus, OH 43210 USA. Powers, CJ (corresponding author), Ohio State Univ, Dept Neurol Surg, Wexner Med Ctr, Columbus, OH 43210 USA. Ciaran.Powers@osumc.edu AN - WOS:000517784600058 AU - Shah, V. S. AU - Eaton, R. G. AU - Cua, S. AU - Dornbos, D. AU - Hoang, N. AU - Schunemann, V. AU - Nimjee, S. AU - Youssef, P. AU - Powers, C. J. DA - Mar DO - 10.1016/j.wneu.2019.12.033 J2 - World Neurosurg. KW - Ischemic stroke MCA collateral scoring RAPID Thrombectomy AGGRESSIVE DECOMPRESSIVE SURGERY ENDOVASCULAR THERAPY SYMPTOM ONSET INFARCTION CORE Clinical Neurology Surgery LA - English M3 - Article N1 - ISI Document Delivery No.: KR7GS Times Cited: 0 Cited Reference Count: 23 Shah, Varun S. Eaton, Ryan G. Cua, Santino Dornbos, David, III Nguyen Hoang Schunemann, Victoria Nimjee, Shahid Youssef, Patrick Powers, Ciaran J. Eaton, Ryan/0000-0003-3388-9195; Nimjee, Shahid/0000-0002-0317-8731 0 2 ELSEVIER SCIENCE INC NEW YORK WORLD NEUROSURG PY - 2020 SN - 1878-8750 SP - 6 ST - Scoring of Middle Cerebral Artery Collaterals Predicts RAPID CT-Perfusion Analysis and Short-Term Outcomes in Acute Ischemic Stroke Patients Undergoing Thrombectomy T2 - World Neurosurgery TI - Scoring of Middle Cerebral Artery Collaterals Predicts RAPID CT-Perfusion Analysis and Short-Term Outcomes in Acute Ischemic Stroke Patients Undergoing Thrombectomy UR - ://WOS:000517784600058 VL - 135 ID - 761457 ER - TY - JOUR AB - BACKGROUND: Few injuries have produced as much debate with respect to management as have blunt cerebrovascular injuries (BCVIs). Without question, early anticoagulation is the mainstay of therapy for these injuries. However, the role of endovascular stenting for BCVI remains controversial. Our purpose was to examine the use of endovascular stents for BCVI and outcomes and describe which injuries are being treated with stents. METHODS: Patients with BCVI from 2011 to 2016 were identified and stratified by age, sex, and injury severity. Patients were then divided into two groups (previous study [PS] = 2011-2012 and current study [CS] = 2013-2016) based on a paradigm shift in BCVI diagnosis and treatment at our institution. Beginning in 2013, a multidisciplinary team assumed care of patients with BCVI from interventional radiology. Digital subtraction angiography was used to confirmatory injuries in both groups and heparin used for initial therapy. RESULTS: In the CS, 237 patients were diagnosed with BCVI compared with 128 patients in the PS. Both groups were clinically similar with no difference in distribution of vessels injured. Beginning in 2013, there was a significant decrease in the use of stents for these injuries. In fact, in the CS, only 21 (8.9%) patients were treated with endovascular stenting compared to 44 (34%) patients in the PS. Of patients in the CS, 14 had grade III pseudoaneurysms and seven had grade II dissections. Despite this reduction in stenting, there was no significant change in the BCVI-related stroke rate between the CS and the PS (4.2% vs. 3.9%). CONCLUSION: Anticoagulation alone is adequate therapy for the majority of BCVI. Nevertheless, there is still a role for endovascular stents in the treatment of BCVI. Their use should be reserved for enlarging carotid pseudoaneurysms and dissections with significant narrowing. The prospect of determining which injuries benefit from stent placement warrants prospective investigation. LEVEL OF EVIDENCE: Therapuetic/care management, level IV. AD - From the Department of Surgery (C.P.S., J.P.S., S.M.S., N.R.M., D.M.F., T.C.F., M.A.C., L.J.M.), University of Tennessee Health Science Center, Memphis, Tennessee. AN - 29370049 AU - Shahan, C. P. AU - Sharpe, J. P. AU - Stickley, S. M. AU - Manley, N. R. AU - Filiberto, D. M. AU - Fabian, T. C. AU - Croce, M. A. AU - Magnotti, L. J. DA - Feb DO - 10.1097/ta.0000000000001740 DP - NLM ET - 2018/01/26 J2 - The journal of trauma and acute care surgery KW - Adult Angiography, Digital Subtraction Cerebral Angiography Cerebrovascular Trauma/diagnosis/*surgery Endovascular Procedures/*methods Female Humans Male Middle Aged Registries Retrospective Studies *Stents Tomography, X-Ray Computed Vertebral Artery/diagnostic imaging/*surgery Wounds, Nonpenetrating/diagnosis/*surgery LA - eng M1 - 2 N1 - 2163-0763 Shahan, Charles P Sharpe, John P Stickley, Shaun M Manley, Nate R Filiberto, Dina M Fabian, Timothy C Croce, Martin A Magnotti, Louis J Journal Article United States J Trauma Acute Care Surg. 2018 Feb;84(2):308-311. doi: 10.1097/TA.0000000000001740. PY - 2018 SN - 2163-0755 SP - 308-311 ST - The changing role of endovascular stenting for blunt cerebrovascular injuries T2 - J Trauma Acute Care Surg TI - The changing role of endovascular stenting for blunt cerebrovascular injuries VL - 84 ID - 760189 ER - TY - JOUR AB - Background: Stroke is among the leading causes of mortality and permanent disability in the world. Iran is located in the stroke belt and has a high age-adjusted stroke incidence rate. In this multistep prospective qualitative study, we aimed at investigating the status and challenges of stroke management in Iran and explore possible solutions. Methods: In the first and second phase, we attempted to define the status of stroke management in Iran by searching the relevant literature and conducting semi-structured interviews with health-care providers in thirteen hospitals located in seven large cities in Iran. In the third phase, we tried to recommend possible solutions based on international standards and experience, as well as interviews with stroke experts in Iran and the United States. Results: Little public awareness of stroke symptoms and its urgency, low prioritization for stroke management, and an inadequate number of stroke-ready hospitals are some of the major obstacles toward timely treatment of stroke in Iran. Every hospital in our pool except two hospitals had guideline-based algorithms for the administration of intravenous thrombolysis. However, there was no single call activation system for stroke alert. Data from some of the centers showed that hospital arrival of stroke patients to final decision-making took 116-160 minutes. Although there were four endovascular programs in our target areas, there was no center with 24-hour coverage. Conclusion: There are many challenges as well as potentials for improvement of stroke care in Iran. Improving public knowledge of stroke and establishing an organized and comprehensive stroke program in the hospitals will improve acute stroke management in Iran. The Iranian ministry of health should define and advocate the establishment of stroke centers, track the rate of death and disability from stroke, introduce pathways to improve the quality of stroke care through national data monitoring systems, and eliminate disparities in stroke care. AD - Department of Neurosurgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Department of Neurology, University of Alabama, Birmingham, Alabama, USA. Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece. Department of Neurology, Geisinger Health System, Danville, Pennsylvania, USA. AN - 28761627 AU - Shahjouei, S. AU - Bavarsad-Shahripour, R. AU - Assarzadegan, F. AU - Rikhtegar, R. AU - Mehrpour, M. AU - Zamani, B. AU - Tsivgoulis, G. AU - Alexandrov, A. AU - Alexandrov, A. AU - Zand, R. C2 - Pmc5526779 DA - Apr 4 DP - NLM ET - 2017/08/02 J2 - Iranian journal of neurology KW - Hospital Rapid Response Team Iran Quality Improvement Stroke Thrombolytic Therapy Tissue Plasminogen Activator LA - eng M1 - 2 N1 - 2252-0058 Shahjouei, Shima Bavarsad-Shahripour, Reza Assarzadegan, Farhad Rikhtegar, Reza Mehrpour, Masoud Zamani, Babak Tsivgoulis, Georgios Alexandrov, Andrei Alexandrov, Anne Zand, Ramin Journal Article Iran J Neurol. 2017 Apr 4;16(2):62-71. PY - 2017 SN - 2008-384X (Print) 2008-384x SP - 62-71 ST - Acute management of stroke in Iran: Obstacles and solutions T2 - Iran J Neurol TI - Acute management of stroke in Iran: Obstacles and solutions VL - 16 ID - 760314 ER - TY - JOUR AB - OBJECTIVE: To compare outcomes between planned and urgent cesarean hysterectomy for morbidly adherent placenta managed by a multidisciplinary team. METHODS: This is a retrospective case-control study of women with singleton pregnancies with antenatally suspected and pathologically confirmed morbidly adherent placenta who underwent cesarean hysterectomy between January 1, 2011, and February 30, 2017. Timing of delivery was classified as either planned (delivery at 34-35 weeks of gestation) or urgent (need for urgent delivery as a result of uterine contractions, bleeding, or both). The primary outcome variable was composite maternal morbidity. Logistic regression analysis was used to evaluate risk factors for urgent delivery. RESULTS: One hundred thirty patients underwent hysterectomy. Sixty (46.2%) required urgent delivery. Composite maternal morbidity was identified in 34 (56.7%) of the urgent and 26 (37.1%) of the planned deliveries (P=.03). Fewer units of red blood cells and fresh frozen plasma were transfused in the planned delivery group (red blood cells, median interquartile range 3 [0-8] versus 1 [0-4], P=.02; fresh frozen plasma, median interquartile range 1 [0-2] versus 0 [0-0], P=.001). Rates of low Apgar score and respiratory distress syndrome were higher in the urgent compared with the planned delivery group (5-minute Apgar score less than 7, 34 [59.6%] versus 14 [23.3%], P<.01; respiratory distress syndrome, 34 [61.8%] versus 16 [27.1%], P<.01). A history of two or more prior cesarean deliveries was an independent predictor of urgent delivery (adjusted odds ratio 11.4, 95% CI 1.8-71.1). CONCLUSION: Women with morbidly adherent placenta requiring urgent delivery have a worse outcome than women with planned delivery. Women with morbidly adherent placenta and two or more prior cesarean deliveries are at increased risk for urgent delivery. In such women, scheduling delivery before the standard 34- to 35-week timeframe may be reasonable. AD - A.A. Shamshirsaz, Division of Maternal-Fetal Medicine and Gynecologic Oncology, Inpatient Women's Service, Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Fetal Center, Texas Children's Hospital, 6651 Main Street, Suite F1020, Houston, TX, United States AU - Shamshirsaz, A. A. AU - Fox, K. A. AU - Erfani, H. AU - Clark, S. L. AU - Shamshirsaz, A. A. AU - Nassr, A. A. AU - Sundgren, N. C. AU - Jones, J. A. AU - Anderson, M. L. AU - Kassir, E. AU - Salmanian, B. AU - Buffie, A. W. AU - Hui, S. K. AU - Espinoza, J. AU - Tyer-Viola, L. A. AU - Rac, M. AU - Karbasian, N. AU - Ballas, J. AU - Dildy, G. A. AU - Belfort, M. A. DB - Embase Medline DO - 10.1097/AOG.0000000000002442 KW - fresh frozen plasma adult anastomosis Apgar score article cervical length measurement cesarean section clinical outcome colostomy controlled study deep vein thrombosis disease severity emergency surgery erythrocyte transfusion female fetus heart rate gestational age health care planning heart ventricle tachycardia hospital based case control study human hypoplastic left heart syndrome hysterectomy interdisciplinary research interventional radiology lung embolism lung hypoplasia major clinical study maternal morbidity morbidly adherent placenta newborn death omphalocele placenta placenta accreta preeclampsia premature labor prematurity priority journal renal artery aneurysm respiratory distress syndrome retroperitoneal hemorrhage retrospective study uterus contraction vagina bleeding LA - English M1 - 2 M3 - Article N1 - L622617604 2018-06-21 2018-10-19 PY - 2018 SN - 1873-233X 0029-7844 SP - 234-241 ST - Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta T2 - Obstetrics and Gynecology TI - Outcomes of planned compared with urgent deliveries using a multidisciplinary team approach for morbidly adherent placenta UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622617604&from=export http://dx.doi.org/10.1097/AOG.0000000000002442 VL - 131 ID - 760855 ER - TY - JOUR AU - Sharif Khan, H. AU - Javed, A. AU - Mohsin, M. AU - Kousar, S. AU - Malik, S. S. AU - Malik, J. DA - 2020/11/07 11/07 DB - Europe PubMed Central DO - 10.7759/cureus.10778 M1 - 10 PY - 2020 SN - 2168-8184 ST - Elevated D-Dimers and Right Ventricular Dysfunction on Echocardiography for Diagnosis of Pulmonary Embolism: A Validation Study T2 - Cureus TI - Elevated D-Dimers and Right Ventricular Dysfunction on Echocardiography for Diagnosis of Pulmonary Embolism: A Validation Study UR - http://europepmc.org/article/MED/33154846 VL - 12 ID - 762003 ER - TY - JOUR AB - The incorporation of a clinical pharmacist in daily rounding can help identify and correct errors related to anticoagulation dosing. Inappropriate anticoagulant dosing increases the risk of developing significant bleeding diathesis. Conversely, inappropriate dosing may also fail to produce a therapeutic response. We retrospectively reviewed electronic medical records of 41 patients to confirm and analyze the errors related to various anticoagulants. A clinical pharmacist in an integrated rounding between the period of February 2016 and April 2016 collected this data. We concluded that integrated rounding improves patient safety by recognizing anticoagulant dosage error used for the purpose of prophylaxis or treatment. It also allows us to make dose adjustments based on renal function of the patient. We think that it is prudent for physicians to pay particular attention to creatinine clearance when dosing anticoagulants in order to achieve the intended dosing effect and reduce the risk of adverse drug events. AD - M. Sharma, 2040 Lehigh Street, apt 506, Easton, PA, United States AU - Sharma, M. AU - Krishnamurthy, M. AU - Snyder, R. AU - Mauro, J. DB - Embase DO - 10.4081/cp.2017.953 KW - anticoagulant agent apixaban low molecular weight heparin rivaroxaban warfarin absence of side effects article atrial fibrillation cerebrovascular accident clinical article creatinine clearance deep vein thrombosis drug dose reduction human kidney failure kidney function loading drug dose lung embolism medication error point of care system prophylaxis retrospective study platelet count LA - English M1 - 2 M3 - Article N1 - L616984985 2017-07-05 2017-07-10 PY - 2017 SN - 2039-7283 2039-7275 SP - 72-74 ST - Reducing error in anticoagulant dosing via multidisciplinary team rounding at point of care T2 - Clinics and Practice TI - Reducing error in anticoagulant dosing via multidisciplinary team rounding at point of care UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616984985&from=export http://dx.doi.org/10.4081/cp.2017.953 VL - 7 ID - 760950 ER - TY - JOUR AB - Background: Venous thromboembolism is common in patients with cancer and the risk increases with advanced disease. Evidencebased treatment is administration of low-molecular-weight heparin daily by subcutaneous injection. Clinical uncertainty exists as to whether treating venous thromboembolism in advanced disease is in the patient's best interests. Aim: To explore the barriers faced by doctors when diagnosing and treating patients with cancer-associated thrombosis. Design: Qualitative, in-depth interview study using framework analysis. Participants: Forty-five UK doctors across urban and rural settings, from three specialties, oncology, palliative medicine and general practice, with a mixture of senior and junior staff. Results: Organisational constraints served to act as barriers to the diagnosis and treatment of this patient group. Issues were identified around access to diagnostic testing. A cancer-associated thrombosis patient having to wait for a scan as an inpatient was sometimes deemed unnecessary. Patient ambulance transport (especially transportation of hospice patients) was often viewed as inflexible and bureaucratic. Low-molecular-weight heparin prescribing had sometimes led to tension between the acute, community and hospice sectors about whose prescribing responsibility this was, with different areas having divergent 'rules' and practices. Finally, the doctors interviewed discussed the role of nurses. Conclusions: Multiple logistical barriers are hindering best patient care for people with cancer-associated thrombosis. There is scope for some of these barriers to be reduced to improve service delivery and ultimately patient care. The research team proposes practical recommendations, which could yield direct benefit for patients and the health services. © The Author(s) 2012. AD - L. Sheard, Department of Health Sciences, University of York, Seebohm Rowntree Building, York, YO10 5DD, United Kingdom AU - Sheard, L. AU - Prout, H. AU - Dowding, D. AU - Noble, S. AU - Watt, I. AU - Maraveyas, A. AU - Johnson, M. DB - Embase Medline DO - 10.1177/0269216312461678 KW - low molecular weight heparin adult advanced cancer ambulance anticoagulant therapy article cancer patient computed tomographic angiography Doppler ultrasonography female general practice hospital patient human interview lung angiography male medical specialist nurse oncology palliative therapy patient transport physician qualitative research rural area United Kingdom urban area venous thromboembolism LA - English M1 - 4 M3 - Article N1 - L368780418 2013-05-01 2013-05-07 PY - 2013 SN - 0269-2163 1477-030X SP - 339-348 ST - Barriers to the diagnosis and treatment of venous thromboembolism in advanced cancer patients: A qualitative study T2 - Palliative Medicine TI - Barriers to the diagnosis and treatment of venous thromboembolism in advanced cancer patients: A qualitative study UR - https://www.embase.com/search/results?subaction=viewrecord&id=L368780418&from=export http://dx.doi.org/10.1177/0269216312461678 VL - 27 ID - 761171 ER - TY - JOUR AB - BACKGROUND: Glanzmann thrombasthenia (GT) is an autosomal recessive disorder in which the platelet (PLT) glycoprotein IIb/IIIa complex is either deficient or dysfunctional. In its most severe form, GT may result in spontaneous bleeding, although most cases are first detected in the setting of an invasive procedure. CASE REPORT: A 59-year-old male with Type I GT and a history of transfusion reactions to PLT infusions developed severe aortic stenosis secondary to bicuspid valve disease. He successfully underwent open aortic valve replacement with cardiopulmonary bypass without perioperative bleeding complications. RESULTS: A multidisciplinary team (anesthesia, hematology, cardiac surgery, and transfusion medicine) was established to optimize perioperative hematologic management. Bleeding risk was assessed given the patient's prior history and a dosing timeline for administration of blood products and recombinant clotting factors was established. Successful management was achieved during the operation by prophylactic administration of HLA-matched PLTs and Factor VIIa. Prophylactic PLT administration was continued through the immediate postoperative period and no bleeding complications occurred. Thromboelastograms (TEGs) were used in conjunction with traditional hematologic laboratory analysis to optimize clinical management. CONCLUSION: Patients with GT requiring cardiac surgical procedures are at high risk for perioperative bleeding complications. This case report illustrates the importance of multidisciplinary planning, TEG analysis, and the judicious use of recombinant factors to minimize operative bleeding risk. AD - Departments of Cardiac Surgery, Anesthesiology, Pathology, and Medicine, Stanford University, Stanford, California. AN - 23710629 AU - Sheikh, A. Y. AU - Hill, C. C. AU - Goodnough, L. T. AU - Leung, L. L. AU - Fischbein, M. P. DA - Feb DO - 10.1111/trf.12275 DP - NLM ET - 2013/05/29 J2 - Transfusion KW - Aortic Valve Stenosis/*complications/*surgery Blood Loss, Surgical/*prevention & control *Heart Valve Prosthesis Implantation Humans Male Middle Aged Patient Care Team Perioperative Period Thrombasthenia/blood/*complications Treatment Outcome LA - eng M1 - 2 N1 - 1537-2995 Sheikh, Ahmad Y Hill, Charles C Goodnough, Lawrence T Leung, Lawrence L Fischbein, Michael P Case Reports Journal Article United States Transfusion. 2014 Feb;54(2):300-5. doi: 10.1111/trf.12275. Epub 2013 May 27. PY - 2014 SN - 0041-1132 SP - 300-5 ST - Open aortic valve replacement in a patient with Glanzmann's thrombasthenia: a multidisciplinary strategy to minimize perioperative bleeding T2 - Transfusion TI - Open aortic valve replacement in a patient with Glanzmann's thrombasthenia: a multidisciplinary strategy to minimize perioperative bleeding VL - 54 ID - 760477 ER - TY - JOUR AB - Background: Thrombolytic therapy (TPA) is used for managing life threatening blood clots. This type of therapy is rarely used in the pediatric population due to a risk of serious bleeding. However, it does provide therapeutic benefit to children who have serious blood clots. Lurie Children's Hospital (LCH), being a tertiary hospital, deals with children with complex medical conditions, including blood clots, and thrombolytic therapy has been used to treat these children. However, literature and studies about thrombolytic therapy are limited in pediatrics, and therefore we want to review and evaluate our use of TPA at LCH. We believe that evaluating this therapy will be very beneficial to the medical community, and help develop guidelines and provide insight as to the proper use of the therapy in pediatrics. Objective: To study the indications of TPA use at Lurie Children's Hospital, TPA dosing, administration strategy/ mode of administration, and outcome/complications of therapy. Method: Retrospective chart review, with study period being April 2010 to February 2013. Results: A total of twelve patients between the ages of 13 days and 18 years old were treated with TPA between April 2010 and February 2013. TPA was administered via one of two modes: systemic or catheter-directed. Dosing for TPA was extrapolated and determined from the existing CHEST guidelines, as well as other published studies. Of the twelve patients, three experienced partial resolution of their blood clot and five experienced complete or near complete resolution of their blood clot. There was one death due to pulmonary embolism, one death due to a clot and cardiac condition, and one case of pulmonary embolism due to clot dislodgement. As far as complications, there was one incident of a missed hemoglobin level where the patient experienced major bleeding from a scratch on the left ear and bleb under the eye; TPA was discontinued in this case. All other complications include minor hematuria, minimal bleeding at site of catheter, limited intraventricular hemorrhage, minor pleural effusion bleeding, and occasional oozing from old procedural sites. Two patient experienced nosebleeds, and four patients experienced no bleeding complications whatsoever. (See Results Table) Conclusion: Thrombolytic therapy safety and efficacy is yet guarded in the pediatric population, and therefore larger clinical trials are necessary to further determine dosing and establish guidelines regarding indications in children. In the meanwhile, it is crucial to practice a multidisciplinary team approach and utilize individual expertise when dosing TPA in pediatrics. AD - P. Sheth, Lurie Children's Hospital, Chicago, IL, United States AU - Sheth, P. DB - Embase DO - 10.1002/ajh.23759 KW - North America hemostasis fibrinolytic therapy thrombosis safety pediatric hospital human child patient blood clot bleeding therapy pediatrics lung embolism death population catheter hemoglobin blood level tertiary care center risk clinical trial (topic) epistaxis pleura effusion brain hemorrhage hematuria eye ear medical record review community L1 - http://onlinelibrary.wiley.com/doi/10.1002/ajh.23759/pdf LA - English M1 - 6 M3 - Conference Abstract N1 - L71747919 2015-02-03 PY - 2014 SN - 0361-8609 SP - E95 ST - Evaluating the safety and efficacy of thrombolytic therapy at lurie children's hospital T2 - American Journal of Hematology TI - Evaluating the safety and efficacy of thrombolytic therapy at lurie children's hospital UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71747919&from=export http://dx.doi.org/10.1002/ajh.23759 VL - 89 ID - 761110 ER - TY - JOUR AB - OBJECTIVE: To summarize the injury characteristics and therapeutic strategy of patients injured in "8·8" Jiuzhaigou earthquake. METHODS: The clinical data of 48 patients injured in "8·8" Jiuzhaigou earthquake who were admitted to Mianyang Central Hospital were analyzed retrospectively. There were 25 males and 23 females with an average age of 36 years (range, 5-87 years). The average interval from injury to admission was 30 hours (range, 3-53 hours). The patients from Sichuan province accounted for 45.8% (22 cases), from other province for 52.1% (25 cases), and from abroad for 2.1% (1 case). Patients were primarily hurted by collapsing houses and flying stones. Thirty-seven patients (77.1%) had single injury, mainly involving 36 patients (75.0%) in limbs, and the other 11 patients (22.9%) had multiple injuries. Ten patients (20.8%) had open fractures, including 1 case rated as typeⅠ, 2 as typeⅡ, 3 as type Ⅲa, 2 as type Ⅲb, and 2 as type Ⅲc according to Gustilo classification criteria. The abbreviated injury scale (AIS) score was 2-3 in 37 patients of single injury, and the injury severity score (ISS) was 8-22 (mean, 13.2) in 11 patients of multiple injuries. Sixteen patients (33.3%) were diagnosed as mental disorders by Hamilton rating scale for anxiety (HAMA), including 8 cases had their anxiety scores≥29, 4 cases of 21-28, 3 cases of 14-20, and 1 case of 7-13. Of the 16 patients, 2 showed suicidal tendency. RESULTS: Except 2 referrals, 30 patients received operation［28 patients (93.3%) for orthopaedic surgeries］and 16 patients received conservative treatment. The procedures included internal fixation, soft tissue debridement, external fixation, bipolar femoral head replacement, embolization of carotid cavernous sinus arteriovenous fistula, and amputation. Among the 46 patients treated in this hospital, 21 discharged from hospital at 2-12 days (mean, 6.7 days) after admission, the others received further rehabilitation in this hospital or local hospital. No undesirable consequence occurred in 16 patients with mental disorders. Five cases of infection occurred out of hospital were cured after debridement. No dead and nosocomial infection case reported. CONCLUSION: Intensive treatment, specialist management, multidisciplinary team, and early intervention of nosocomial infection and deep venous thrombosis are the key to improve the general level of successful earthquake medical rescue. AD - Department of Orthopedics, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China. . Department of Respiration, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China.liugang618@163.com. Department of Nephrology, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China. Department of Rehabilitation, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China. Department of Psychological Medicine, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China. Department of President's Office, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China. Department of Science and Education, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China. AN - 29806289 AU - Shi, B. AU - Liu, G. AU - Li, L. AU - Tang, S. AU - Wang, J. AU - Xie, M. AU - Dai, X. AU - He, J. AU - Zhang, Y. AU - Tang, Y. AU - Xianyu, J. AU - Wang, D. AU - He, M. AU - Xu, W. AU - Song, Z. AU - Ma, Y. AU - Huang, F. AU - Song, Y. DA - Mar 15 DO - 10.7507/1002-1892.201710077 DP - NLM ET - 2018/05/29 J2 - Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery KW - Adolescent Adult Aged Aged, 80 and over Child Child, Preschool China/epidemiology Debridement/methods *Earthquakes Extremities/*injuries Female Fracture Fixation, Internal/*methods Fracture Healing Fractures, Bone/epidemiology/*therapy Fractures, Open/diagnosis/*epidemiology Humans Injury Severity Score Male Middle Aged Multiple Trauma/*epidemiology/therapy Retrospective Studies Young Adult *Earthquake injury *epidemiology *multidisciplinary team LA - chi M1 - 3 N1 - Shi, Bo Liu, Gang Li, Lin Tang, Shitian Wang, Jun Xie, Mingrui Dai, Xiaoyu He, Jianyong Zhang, Yun Tang, Yi Xianyu, Jianbo Wang, Dong He, Mei Xu, Weiyun Song, Zhongjin Ma, Ying Huang, Fuguo Song, Yueming Journal Article China Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Mar 15;32(3):358-362. doi: 10.7507/1002-1892.201710077. PY - 2018 SN - 1002-1892 (Print) 1002-1892 SP - 358-362 ST - [Injury characteristics and therapeutic strategy of patients injured in "8·8" Jiuzhaigou earthquake] T2 - Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi TI - [Injury characteristics and therapeutic strategy of patients injured in "8·8" Jiuzhaigou earthquake] VL - 32 ID - 760252 ER - TY - JOUR AB - BACKGROUND: The Agency for Healthcare Research and Quality has adopted iatrogenic pneumothorax (IAP) as a Patient Safety Indicator. In 2006, in response to a low performance ranking for IAP rate from the University Healthsystem Consortium (UHC), the authors established a multidisciplinary team to reduce our institution's IAP rate. Root-cause analysis found that subclavian insertion of central venous catheterization (CVC) was the most common procedure associated with IAP OBJECTIVE: Our short-term goal was a 50% reduction of both CVC-associated and all-cause IAP rates within 18 months, with long-term goals of sustained reduction. DESIGN: Observational study. SETTING: Academic tertiary care hospital. PATIENTS: Consecutive inpatients from 2006 to 2014. INTERVENTION: Our multifaceted intervention included: (1) clinical and documentation standards based on evidence, (2) cognitive aids, (3) simulation training, (4) purchase and deployment of ultrasound equipment, and (5) feedback to clinical services. MEASUREMENTS: CVC-associated IAP, all-cause IAP rate. RESULTS: We achieved both a short-term (years 2006 to 2008) and long-term (years 2006 to 2008-2014) reduction in our CVC-associated and all-cause IAP rates. Our short-term reduction in our CVC-associated IAP was 53% (P = 0.088), and our long-term reduction was 85% (P < 0.0001). Our short-term reduction in the all-cause IAP rate was 26% (P < 0.0001), and our long-term reduction was 61% (P < 0.0001). CONCLUSIONS: A multidisciplinary team, focused on evidence, patient safety, and standardization, can use a set of multifaceted interventions to sustainably improve patient outcomes for several years after implementation. Our hospital was in the highest performance UHC quartile for all-cause IAP in 2012 to 2014. AD - Department of Medicine, Stanford University School of Medicine, Stanford, California. Department of Anesthesia, Brigham and Women's Hospital, Boston, Massachusetts. Center for Innovation to Implementation (Ci2i), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, and Center for Primary Care and Outcomes Research (PCOR), Stanford University, Stanford, California. Department of Surgery, Stanford University School of Medicine, Stanford, California. AN - 26041246 AU - Shieh, L. AU - Go, M. AU - Gessner, D. AU - Chen, J. H. AU - Hopkins, J. AU - Maggio, P. C2 - Pmc5548000 C6 - Nihms883841 DA - Sep DO - 10.1002/jhm.2388 DP - NLM ET - 2015/06/05 J2 - Journal of hospital medicine KW - Catheter-Related Infections/complications/prevention & control Catheterization, Central Venous/adverse effects Evidence-Based Practice Female Humans Iatrogenic Disease/prevention & control Intensive Care Units Male Middle Aged Pneumothorax/diagnostic imaging/*prevention & control/therapy *Quality Improvement Simulation Training/methods Ultrasonography United States LA - eng M1 - 9 N1 - 1553-5606 Shieh, Lisa Go, Minjoung Gessner, Daniel Chen, Jonathan H Hopkins, Joseph Maggio, Paul UL1 RR025744/RR/NCRR NIH HHS/United States Journal Article Observational Study Research Support, N.I.H., Extramural J Hosp Med. 2015 Sep;10(9):599-607. doi: 10.1002/jhm.2388. Epub 2015 Jun 3. PY - 2015 SN - 1553-5592 (Print) 1553-5592 SP - 599-607 ST - Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach T2 - J Hosp Med TI - Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach VL - 10 ID - 760361 ER - TY - JOUR AB - BACKGROUND: Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure. IIH causes significant morbidity marked by incapacitating headaches and visual disturbances. This study investigated the long-term outcomes of venous sinus stenting in a large group of patients with IIH. METHODS: We retrospectively reviewed all patients at our institution who underwent venous sinus stenting for IIH over 6 years (July 1, 2012-June 30, 2018). A particular focus was dedicated to collecting demographic, clinical, radiologic, and outcomes data. All patients had failed medical management. RESULTS: Of the 110 patients evaluated for IIH, 42 underwent venous sinus stenting, with a mean follow-up of 25.6 months (range, 8.7-60.7 months). The mean age was 32 years (range, 15-52 years), 38 (90%) were women, and the mean body mass index was 35.6 kg/m(2) (range, 18.6-47.5 kg/m(2)). Prior to the stenting procedure, all patients had headaches, visual disturbances, and papilledema. Of the 39 patients who had an ophthalmologic evaluation poststenting, 29 (74%) had resolution of their papilledema. Eighteen patients (43%) had complete resolution of their headaches after the stenting procedure, whereas 22 patients (52%) remained under a neurologist's care for chronic migraine and other types of headaches. Two patients underwent a restenting procedure for disease progression, and 1 patient experienced an in-stent thrombosis. CONCLUSIONS: A multidisciplinary approach involving neurosurgeons, ophthalmologists, radiologists, and neurologists is integral in the management of patients with IIH to prevent the complications of papilledema. Venous sinus stenting offers a safe and effective means of treating IIH. AD - Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA. Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA; Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA. Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky, USA. Electronic address: Shervin.Dashti@nortonhealthcare.org. AN - 30248468 AU - Shields, L. B. E. AU - Shields, C. B. AU - Yao, T. L. AU - Plato, B. M. AU - Zhang, Y. P. AU - Dashti, S. R. DA - Jan DO - 10.1016/j.wneu.2018.09.070 DP - NLM ET - 2018/09/25 J2 - World neurosurgery KW - Adolescent Adult Chronic Disease Constriction, Pathologic/surgery Cranial Sinuses/*surgery Endovascular Procedures/instrumentation/methods Female Graft Occlusion, Vascular/etiology Humans Male Middle Aged Migraine Disorders/etiology/surgery Neurosurgical Procedures/methods Papilledema/etiology/*surgery Patient Care Team Pseudotumor Cerebri/*complications Reoperation Retrospective Studies Stents Treatment Outcome Young Adult Endovascular Idiopathic intracranial hypertension Neurosurgery Pseudotumor cerebri Stent Venous sinus stenosis LA - eng N1 - 1878-8769 Shields, Lisa B E Shields, Christopher B Yao, Tom L Plato, Brian M Zhang, Yi Ping Dashti, Shervin R Journal Article Observational Study United States World Neurosurg. 2019 Jan;121:e165-e171. doi: 10.1016/j.wneu.2018.09.070. Epub 2018 Sep 21. PY - 2019 SN - 1878-8750 SP - e165-e171 ST - Endovascular Treatment for Venous Sinus Stenosis in Idiopathic Intracranial Hypertension: An Observational Study of Clinical Indications, Surgical Technique, and Long-Term Outcomes T2 - World Neurosurg TI - Endovascular Treatment for Venous Sinus Stenosis in Idiopathic Intracranial Hypertension: An Observational Study of Clinical Indications, Surgical Technique, and Long-Term Outcomes VL - 121 ID - 760171 ER - TY - JOUR AB - Introduction: Rapid dissemination and coordination of clinical and imaging data among multidisciplinary team members is essential for optimal acute stroke care. Standard desktop EMRs are ill-suited for this purpose, but mobile smartphone and tablet applications are highly promising platforms for accelerated, data-driven patient diagnosis and treatment. This study tested an advanced mobile integrated system for distribution of patient clinical and imaging information. Methods: We tested the iStroke/Synapse ERm system (Figure) for smartphone and tablet display and integration of clinical data, CT, MR, and catheter angiographic imaging, and real-time stroke team communications, in consecutive acute neurovascular patients at a Comprehensive Stroke Center. Results: From 5/2014 to 10/2014, the Synapse ERm application was installed and used by 33 stroke team members, in 84 Code Stroke ED patients. Patient age was 69.1 (±17.5), with 40.5% female. Final diagnosis was: ischemic stroke 66%, TIA 7%, ICH 6%, and CV mimic 21%. Each patient record was viewed on average 13 times by at least 3 team members. The most used feature was CT, MR and cath angio image display, viewed on average 4 times per patient by at least 2 users. In-app tweet team communications were sent by average 2 users per case and viewed by average 6 team members. Use of the system was associated with treatment times that exceeded national guideline targets for thrombolysis and endovascular thrombectomy, including door-to-needle 50 min (IQR 24-60) and door-to-groin 92 min (IQR 65-128). In user surveys, the mobile information platform was judged easy to employ in 91% of uses and of added help in stroke management in a substantial majority of cases. Conclusion: The Synapse ERm system, a smartphone/tablet platform for stroke team communication and distribution and integration of clinical and imaging data, showed high ease of use, substantial added management value, and association with rapid processes of care. AD - K. Shkirkova, David Geffen Sch of Medicine, UCLA, Los Angeles, CA, United States AU - Shkirkova, K. AU - Akam, E. Y. AU - Huang, J. F. AU - Sheth, S. A. AU - Nour, M. AU - Liang, C. AU - McManus, M. H. AU - Trinh, V. D. AU - Duckwiler, G. AU - Tarpley, J. AU - Vinuela, F. AU - Saver, J. L. DB - Embase KW - cerebrovascular accident emergency care nursing American imaging human heart patient interpersonal communication synapse nuclear magnetic resonance diagnosis tablet percutaneous thrombectomy blood clot lysis catheter image display medical record clinical study brain ischemia inguinal region needle female LA - English M3 - Conference Abstract N1 - L72211175 2016-03-21 PY - 2016 SN - 0039-2499 ST - Smartphone support system for mobile imaging display and management of acute stroke T2 - Stroke TI - Smartphone support system for mobile imaging display and management of acute stroke UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72211175&from=export VL - 47 ID - 761041 ER - TY - JOUR AB - Introduction: A 7.0 magnitude earthquake struck Haiti on January 12, 2010, resulting in 222,000 deaths and 300,000 injuries. Three weeks after the initial quake, the New Mexico Disaster Medical Assistance Team (NM DMAT-1) was deployed to Haiti for ongoing medical relief. During this deployment, a portable handheld ultrasound machine was tested for usefulness in aiding with patient care decisions. Objective: The utility of portable ultrasound to help with triage and patient management decisions in a major disaster setting was evaluated. Methods: Retrospective observational non-blinded images were obtained on 51 patients voluntarily presenting to the Gheskio Field clinic at Port-au-Prince. Ultrasound was used for evaluation of undifferentiated hypotension, torso trauma, pregnancy, non-traumatic abdominal pain, deep venous thrombosis and pulmonary embolism, and dyspnea-chest pain, as well as for assisting with procedures. Scans were obtained using a Signos personal handheld ultrasound machine with images stored on a microSD card. Qualitative data were reviewed to identify whether ultrasound influenced management decisions, and results were categorized in terms of percent of scans that influenced management. Results: Fifty-one ultrasound scans on 50 patients were performed, with 35% interpreted as positive, 41% as negative, and 24% as equivocal. The highest yields of information were for abdominal ultrasound and ultrasound related to pregnancy. Ultrasound influenced decisions on patient care in 70% of scans. Most of these decisions were reflected in the clinician's confidence in discharging a patient with or without non-emergent follow-up. Conclusion: The use of a handheld portable ultrasound machine was effective for patient management decisions in resource-poor settings, and decreased the need to triage selected patients to higher levels of care. Ultrasound was very useful for evaluation of non-traumatic abdominal pain. Dynamic capability is necessary for ultrasound evaluation of undifferentiated hypotension and cardiac and lung examinations. Ultrasound also was useful for guidance during procedural applications, and for aiding in the diagnosis of parasitic diseases. AD - [Shorter, Meghan; Macias, Darryl J.] Univ New Mexico, Dept Emergency Med, MSC 10 5560 1, Albuquerque, NM 87131 USA. Macias, DJ (corresponding author), Univ New Mexico, Dept Emergency Med, MSC 10 5560 1, Albuquerque, NM 87131 USA. dmacias@salud.unm.edu AN - WOS:000445125600012 AU - Shorter, M. AU - Macias, D. J. DA - Apr DO - 10.1017/s1049023x12000611 J2 - Prehospital Disaster Med. KW - abdominal ultrasound austere environment diagnostic equipment disaster response Gheskio Field Clinic Haiti handheld ultrasound humanitarian assistance natural disaster New Mexico Disaster Medical Assistance Team portable ultrasound procedural ultrasound qualitative study triage relief work ultrasonography undifferentiated hypotension Emergency Medicine LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: VG1AB Times Cited: 37 Cited Reference Count: 17 Shorter, Meghan Macias, Darryl J. 37 1 3 CAMBRIDGE UNIV PRESS NEW YORK PREHOSP DISASTER MED PY - 2012 SN - 1049-023X SP - 172-177 ST - Portable Handheld Ultrasound in Austere Environments: Use in the Haiti Disaster T2 - Prehospital and Disaster Medicine TI - Portable Handheld Ultrasound in Austere Environments: Use in the Haiti Disaster UR - ://WOS:000445125600012 VL - 27 ID - 761830 ER - TY - JOUR AB - Introduction A collaborative approach to patient management has been shown to improve patient outcomes. In a resource-limited NHS, critical care beds are at a premium, therefore preventing unnecessary admissions by optimising ward-based management is essential. The objective of this service quality improvement project was to improve collaboration between the critical care directorate and neurosurgical high care unit at a tertiary university teaching hospital. We proposed that the use of a simple ward round tool on collaborative rounds would facilitate systematic patient review, prompt early recognition of those critically unwell and improve patient outcomes. Methods An initial observation period of behaviours and practice on the neurosurgical unit was conducted with qualitative and quantitative data collection. Following analysis of these outcome measures a simple ward round tool was constructed, with the mnemonic 'DON'T FORGET', and we devised a programme for collaborative ward rounds to take place three times per week over a 1-month period. During this time further data were collected to assess whether our interventions resulted in modified behaviours and to document the number of changes made to patient management as a consequence of the collaborative approach to care. Results Our results showed that improvements were made in all assessed domains. Consultant-led ward rounds increased, attendance by members of the multidisciplinary team (MDT) dramatically improved and as a result MDT discussion was enhanced. In addition, documentation of structured plans improved and review of prescription charts significantly increased. As a consequence of collaborative rounds, a total of 343 changes were made to patient management under the domains of the ward round tool. This was an average of 21.4 changes per collaborative round, with most changes being made to medication charts or decisions regarding thromboprophylaxis. Conclusion The use of a simple ward round tool combined with a collaborative approach to ward rounds improved MDT involvement and discussion, promoted structured patient review and resulted in positive changes to multiple areas of patient management. In conclusion, structured collaborative rounds result in significant changes to patient management that may prevent admission, or readmission, to critical care which has the potential to reduce healthcare costs and morbidity. AD - C. Shute, University Hospital Wales, Cardiff, United Kingdom AU - Shute, C. AU - Saayman, A. DB - Embase DO - 10.1186/cc13203 KW - intensive care emergency medicine convalescence human ward patient care patient Tertiary (period) university health care cost hospital readmission morbidity total quality management prescription documentation consultation drug therapy information processing teaching hospital LA - English M3 - Conference Abstract N1 - L71506730 2014-06-28 PY - 2014 SN - 1364-8535 SP - S5-S6 ST - Convalescence via critical care collaboration T2 - Critical Care TI - Convalescence via critical care collaboration UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71506730&from=export http://dx.doi.org/10.1186/cc13203 VL - 18 ID - 761120 ER - TY - JOUR AB - Background: Reduction in door-to-needle (DTN) times in patients with acute ischemic stroke treated with tissue-type plasminogen activator is associated with improved outcomes. We hypothesized that a learning collaborative would rapidly reduce DTN times at Chicago's primary stroke centers.Methods and Results: We analyzed data from all adult patients with out-of-hospital ischemic stroke hospitalized between January 1, 2010 and March 31, 2015 and who received tissue-type plasminogen activator in the emergency department at 15 primary stroke centers in Chicago and 15 primary stroke centers in St. Louis. We implemented a structured learning collaborative in Chicago in quarter 1 of 2013 that included (1) a quality improvement leader, (2) stroke content expert, (3) multidisciplinary teams from each site, (4) a targeted goal for the program (DTN time <60 minutes in >50% of patients treated with tissue-type plasminogen activator), and (5) face-to-face meetings with on-site visits. We used interrupted time-series analysis to compare the impact of the learning collaborative on DTN times in Chicago pre- and post implementation and also concurrently versus St. Louis. We prespecified adjustment for mode of arrival, emergency medical services prenotification, and onset-to-arrival times. P values less than 0.05 were considered significant. In adjusted analysis, the reduction in DTN time within 1 quarter of implementation was 15.5 minutes (P=0.046) at Chicago sites versus 1.17 minutes at St. Louis sites (P=0.601).Conclusions: Using a learning collaborative model at Chicago's 15 primary stroke centers, we observed major reductions in DTN times within 1 quarter of implementation. Regional collaboration and best practices sharing should be a model for rapid and sustainable system-wide quality improvement. AD - Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, IL American Heart Association/American Stroke Association Midwest Affiliate, Chicago, IL From the Departments of Neurology (S.P.) and Preventive Medicine-Biostatistics (J.L.), Northwestern University Feinberg School of Medicine, Chicago, IL; and American Heart Association/American Stroke Association Midwest Affiliate, Chicago, IL (K.O.N.) AN - 118270167. Language: English. Entry Date: 20180723. Revision Date: 20191111. Publication Type: journal article AU - Shyam, Prabhakaran AU - Jungwha, Lee AU - O'Neill, Kathleen AU - Prabhakaran, Shyam AU - Lee, Jungwha DB - CINAHL DO - 10.1161/CIRCOUTCOMES.116.003222 DP - EBSCOhost KW - Thrombolytic Therapy -- Methods Personnel, Health Facility -- Education Tissue Plasminogen Activator -- Administration and Dosage Clinical Indicators Quality Improvement Fibrinolytic Agents -- Administration and Dosage Cerebral Ischemia -- Drug Therapy Patient Care Employee Orientation -- Methods Stroke -- Drug Therapy Multidisciplinary Care Team Education, Medical, Continuing Missouri Aged Nursing Staff, Hospital -- Education Cerebral Ischemia -- Diagnosis Female Education, Nursing, Continuing Aged, 80 and Over Treatment Outcomes Time Factors Cerebral Ischemia -- Physiopathology Learning Interprofessional Relations Fibrinolytic Agents -- Adverse Effects Program Evaluation Tissue Plasminogen Activator -- Adverse Effects Medical Staff, Hospital -- Education Stroke -- Physiopathology Human Stroke -- Diagnosis Male Middle Age Illinois Thrombolytic Therapy -- Adverse Effects Cooperative Behavior Validation Studies Comparative Studies Evaluation Research Multicenter Studies M1 - 5 N1 - research. Journal Subset: Biomedical; USA. NLM UID: 101489148. PMID: NLM27625405. PY - 2016 SN - 1941-7713 SP - 585-592 ST - Regional Learning Collaboratives Produce Rapid and Sustainable Improvements in Stroke Thrombolysis Times T2 - Circulation: Cardiovascular Quality & Outcomes TI - Regional Learning Collaboratives Produce Rapid and Sustainable Improvements in Stroke Thrombolysis Times UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=118270167&site=ehost-live&scope=site VL - 9 ID - 761377 ER - TY - JOUR AB - Background: Evidence has shown that risk stratification of patients (pts) with pulmonary embolism (PE) into low-risk, sub-massive (usually defined as PE with RV strain in the absence of shock) and massive PE may result in better outcomes as some pts with sub-massive PE may fare better with more aggressive therapy. Treating pts with ultrasound-assisted catheter directed thrombolysis (EKOS) has been shown to improve clinical parameters with acceptable safety rates We implemented a PERT at our community hospital and sought to review our experience. Methods: 40 consecutive pts undergoing EKOS at Swedish Covenant Hospital were followed as a prospective cohort for the outcome of death and major bleed. Secondary endpoints included assessment of pre/post pulmonary artery pressure (PAP). Clinical variables were ascertained by database query and endpoints by review of records. Data were analyzed using Excel and the paired-t test. Results: 40 pts (mean age 56.5 years) underwent EKOS for submassive PE. Baseline parameters included RV:LV ratio by CTA of 1.2, troponin positive in 61% of pts. 30-day and 1-year mortality was 0%. Major bleeding was seen in 2 pts (one pt needing transfusion for access site hematoma and one elderly pt with small ICH 3 days post- EKOS). Pre/post PAP were 48 mmHg and 39 mmHg respectively; paired p value: 0.014. Conclusions: Starting a PERT team can be successful in a community hospital setting and EKOS plays an important role. Safety endpoints were acceptable. Future directions include the role of EKOS in reducing length of stay and usage of direct oral anticoagulants. Additional data will be needed to help define optimal treatment for pts with higher-risk PE. (Figure Presented). AD - A. Siddiqui, Swedish Covenant Hospital, United States AU - Siddiqui, A. AU - Sharda, M. AU - Attanasio, S. DB - Embase DO - 10.1002/ccd.28216 KW - anticoagulant agent endogenous compound troponin adult aged blood clot lysis case report catheter clinical article cohort analysis community hospital conference abstract death drug safety female hematoma human length of stay lung artery pressure male middle aged mortality prospective study pulmonary embolism response team statistical significance teaching hospital ultrasound LA - English M3 - Conference Abstract N1 - L628160458 2019-06-24 PY - 2019 SN - 1522-726X SP - S155-S156 ST - Outcomes of patients with pulmonary embolism receiving ultrasound-assisted catheter directed thrombolysis after implementation of a pulmonary embolism response team in a community Teaching Hospital T2 - Catheterization and Cardiovascular Interventions TI - Outcomes of patients with pulmonary embolism receiving ultrasound-assisted catheter directed thrombolysis after implementation of a pulmonary embolism response team in a community Teaching Hospital UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628160458&from=export http://dx.doi.org/10.1002/ccd.28216 VL - 93 ID - 760718 ER - TY - JOUR AB - Background Fast-track surgery is a multidisciplinary approach to surgery that results in faster recovery from surgery and decreased length of stay (LOS). Aims The aims of this study were as follows: (i) to report on the processes required for the introduction of fast-track surgery to a gynaecological oncology unit and (ii) to report the results of a clinical audit conducted after the protocol's implementation. Methods A fast-track protocol, specific to our unit, was developed after a series of multidisciplinary meetings. The protocol, agreed upon by those involved in the care of women in our unit, was then introduced into clinical practice. An audit was conducted of all women undergoing laparotomy, with known or suspected malignancy. Information on LOS, complication and readmission rates was collected. Descriptive statistics and Poisson regression were used for statistical analysis. Results The developed protocol involved a multidisciplinary approach to pre-, intra- and postoperative care. The audit included 104 consecutive women over a 6-month period, who were followed for 6 weeks postoperatively. The median LOS was 4 days. The readmission rate was 7% and the complication rate was 19% (1% intraoperative, 4% major and 14% minor). Multivariate analysis revealed that increased duration of surgery and increasing age were predictors of longer LOS. Conclusion The development of a fast-track protocol is achievable in a gynaecological oncology unit, with input from a multidisciplinary team. Effective implementation of the protocol can result in a short LOS, with acceptable complication and readmission rates when applied non-selectively to gynaecological oncology patients. © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. AD - A.H. Brand, Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW 2145, Australia AU - Sidhu, V. S. AU - Lancaster, L. AU - Elliott, D. AU - Brand, A. H. DB - Embase Medline DO - 10.1111/j.1479-828X.2012.01451.x KW - analgesic agent abdominal hysterectomy adolescent adult aged article cancer surgery clinical practice clinical protocol cystectomy deep vein thrombosis fast track surgery female follow up female genital tract cancer gynecologic surgery gynecology hematoma hospital readmission human intestine resection laparotomy length of stay lung embolism lymph node dissection major clinical study clinical audit neuropathy omentectomy oncology peroperative care postoperative care postoperative pain preoperative care priority journal radical hysterectomy salpingooophorectomy surgical wound treatment duration urinary tract infection LA - English M1 - 4 M3 - Article N1 - L52056529 2012-06-15 2012-08-21 PY - 2012 SN - 0004-8666 1479-828X SP - 371-376 ST - Implementation and audit of 'Fast-Track Surgery' in gynaecological oncology surgery T2 - Australian and New Zealand Journal of Obstetrics and Gynaecology TI - Implementation and audit of 'Fast-Track Surgery' in gynaecological oncology surgery UR - https://www.embase.com/search/results?subaction=viewrecord&id=L52056529&from=export http://dx.doi.org/10.1111/j.1479-828X.2012.01451.x VL - 52 ID - 761193 ER - TY - JOUR AB - BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) may be treated with pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA) and medical therapy (MT). Assessment in a multidisciplinary team of experts (CTEPH team) is currently recommended for treatment decision making. The aim of the present study was to report the effects of such an interdisciplinary concept. METHODS AND RESULTS: A total of 160 patients were consulted by the CTEPH team between December 2015 and September 2018. Patient baseline characteristics, CTEPH team decisions and implementation rates of diagnostic and therapeutic procedures were analysed. Change in World Health Organization (WHO) functional class and survival rates were evaluated by treatment strategy. A total of 51 (32%) patients were assessed as operable and 109 (68%) were deemed inoperable. Thirty-one (61% of operable patients) underwent PEA. Patients treated with PEA, BPA(+MT) and MT alone were 50.9 ± 14.7, 62.9 ± 15.1 and 68.9 ± 12.7 years old, respectively. At the follow-up, PEA patients had the highest WHO functional class improvement. Patients treated with BPA(+MT) had significantly better survival than PEA (p = 0.04) and MT patients (p = 0.04; 2-year survival of 92%, 79% and 79%, respectively). CONCLUSIONS: The CTEPH team ensures that necessary diagnostic procedures are performed. A relatively low proportion of patients was assessed by the CTEPH team as operable and underwent surgery, which in survivors resulted in the best functional improvement. Although patients undergoing BPA(+MT) were older than patients treated with PEA, their survival was better than patients subjected to PEA or MT alone. The reviews of this paper are available via the supplemental material section. AD - 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland. Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, Fryderyk Chopin Hospital in European Health Centre Otwock, Borowa 14/18, Otwock, Mazowieckie, 05-400, Poland. Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, European Health Centre Otwock, Centre of Postgraduate Medical Education, Poland. Department of Cardiology, Cardinal Wyszynski' Hospital, Lublin, Poland. Department of Cardiology, Pomeranian Medical University, Szczecin, Poland. 1st Department of Cardiology, Biegański Hospital, Medical University of Łódź, Łódź, Poland. Department of Cardiology, Medical University of Lublin, Lublin, Poland. Department of Cardiology, Regional Specialist Hospital, Research and Development Center, Wrocław, Poland. University Clinical Centre, Medical University of Gdańsk, Gdańsk, Poland. 2nd Department of Cardiology, Faculty of Health Sciences, Collegium Medicum, Nicolaus, Copernicus University, Poland. Department of Cardiology, Medical University of Białystok, Białystok, Poland. First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland. Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland. Pulmonary Department, Pulmonary Hospital, University of Warmia and Mazury, Olsztyn, Poland. Department of Cardiology and Electrotherapy, Medical University of Gdansk, Gdansk, Poland. Department of Cardiac Surgery, Medicover Hospital, Warsaw, Poland. AN - 31878837 AU - Siennicka, A. AU - Darocha, S. AU - Banaszkiewicz, M. AU - Kędzierski, P. AU - Dobosiewicz, A. AU - Błaszczak, P. AU - Peregud-Pogorzelska, M. AU - Kasprzak, J. D. AU - Tomaszewski, M. AU - Mroczek, E. AU - Zięba, B. AU - Karasek, D. AU - Ptaszyńska-Kopczyńska, K. AU - Mizia-Stec, K. AU - Mularek-Kubzdela, T. AU - Doboszyńska, A. AU - Lewicka, E. AU - Ruchała, M. AU - Lewandowski, M. AU - Łukasik, S. AU - Chrzanowski, Ł AU - Zieliński, D. AU - Torbicki, A. AU - Kurzyna, M. C2 - Pmc6935880 DA - Jan-Dec DO - 10.1177/1753466619891529 DP - NLM ET - 2019/12/28 J2 - Therapeutic advances in respiratory disease KW - Adult Aged Aged, 80 and over Angioplasty, Balloon/*methods Chronic Disease Endarterectomy/*methods Female Humans Hypertension, Pulmonary/mortality/physiopathology/*therapy Male Middle Aged Patient Care Team/organization & administration Pulmonary Embolism/mortality/physiopathology/*therapy Retrospective Studies Survival Rate *balloon pulmonary angioplasty *chronic thromboembolic pulmonary hypertension *multidisciplinary team *pulmonary endarterectomy *survival fees from Actelion, MSD, Bayer and AOP Orphan. LC reports personal fees and conference participation fees from Actelion, MSD, Bayer, and AOP Orphan. The remaining authors have no conflicts of interest to declare. LA - eng N1 - 1753-4666 Siennicka, Anna Darocha, Szymon Orcid: 0000-0001-8298-9243 Banaszkiewicz, Marta Kędzierski, Piotr Dobosiewicz, Anna Błaszczak, Piotr Peregud-Pogorzelska, Małgorzata Kasprzak, Jarosław Damian Tomaszewski, Michał Mroczek, Ewa Zięba, Bożena Karasek, Danuta Ptaszyńska-Kopczyńska, Katarzyna Mizia-Stec, Katarzyna Mularek-Kubzdela, Tatiana Doboszyńska, Anna Lewicka, Ewa Ruchała, Marcin Lewandowski, Maciej Łukasik, Sylwia Chrzanowski, Łukasz Zieliński, Dariusz Torbicki, Adam Kurzyna, Marcin Comparative Study Journal Article Research Support, Non-U.S. Gov't Ther Adv Respir Dis. 2019 Jan-Dec;13:1753466619891529. doi: 10.1177/1753466619891529. PY - 2019 SN - 1753-4658 (Print) 1753-4658 SP - 1753466619891529 ST - Treatment of chronic thromboembolic pulmonary hypertension in a multidisciplinary team T2 - Ther Adv Respir Dis TI - Treatment of chronic thromboembolic pulmonary hypertension in a multidisciplinary team VL - 13 ID - 760126 ER - TY - JOUR AB - Pediatric deep vein thrombosis (DVT) is an increasingly recognized condition, related to the increasing number of children surviving complex medical and surgical procedures, often associated with invasive vascular procedures and devices. [1, 2] Peaks occur in the first year of life and adolescence, often related to sepsis, malignancy, or surgery. [3] Central venous catheters are associated with more than 50% of DVT cases in children and more than 80% in newborns. [2, 4, 5] Approximately 50% venous thrombotic events treated with anticoagulation therapy resolve within 3-6 months of treatment; however, the risk of post-thrombotic syndrome (PTS) persists. A PTS risk of nearly 80% was reported in a small study evaluating a cohort of young patients with DVT that can later cause severe morbidities. [6] Although thrombolytic agents have been more frequently used in the last few years in neonates and children, there are no well-established indications in pediatrics. The last guidelines of the American College of Chest Physicians (ACCP) suggest, coincidently with other published guidelines and recommendations, that thrombolytic therapy is not indicated for a majority of children with DVT; however, it should be considered for life or limb-threatening thrombosis, including presence of extensive thrombosis, particularly those involving the pelvic veins, SVC, IVC, or intracardiac sites as well as for selected children with PE. [1, 7] Percutaneous venous interventions using catheter-directed therapies (CDT), such as mechanical thrombectomy and infusion thrombolysis, have been used much less frequently in children despite showing good results in adults. [8] CDT techniques include mechanical thrombectomy and infusion thrombolysis as some of the more commonly performed treatments. [4] Indications and contraindications for CDT in children have been extrapolated from adults. As a consequence of these endovascular techniques, a significant lower prevalence of PTS among adults who underwent thrombolytic therapy compared with patients who received standard anticoagulation alone has been reported. [2, 8, 9] Very few data supporting the role of thrombolytic agents to prevent PTS development were reported in children. (9) The results of currently ongoing clinical trials are still pending. Modifications to standard CDT techniques should be considered in this pediatric population: • Techniques should be adapted to patient size and available equipment. Some devices limitations for CDT in children exist, mainly related to devices size. • Ultrasound guidance for venous access is frequently used and it is extremely helpful. • Thrombolytics doses should also be adapted, t-PA being the agent of choice in children. [1, 7] Frequently simultaneous administration of heparin and fresh frozen plasma for plasminogen deficiency is also necessary. [2, 4] The most commonly used regimen for CDT infusion is 0.01-0.03 mg/ kg/h with concurrently heparin administration (15 or 25 U/kg/h). [4] A multidisciplinary team including professionals from pediatric hematology, interventional radiology, and intensive care is necessary for proper management of venous thrombosis in children. [4] Further randomized clinical studies evaluating the role of interventional therapies in children for PTS prevention should be completed; however, in selected severe cases, CDT techniques should be considered as a valuable therapeutic option to avoid future severe sequelae. IVC filters in Pediatrics The use of IVC filters for prophylaxis against pulmonary embolism (PE) is well reported in adults, but long-term studies in children are lacking. The currently available retrievable filters and the increasing recognition of pediatric DVT and venous thromboembolic disease warrant evaluation of the role of IVC filters in children. Few studies have evaluated the role of IVC filters in children, but multiple case reports have demonstrated that IVC filters can be successfully placed in children as young as 2 years and with IVC diameters of less than 10 mm. [3, 10] Their use should be evaluat d and considered in selected patients, particularly in very young patients, because of alterations in optimal IVC flow and subsequent increase in the risk of aggregated DVT. [3, 7, 10, 11] IVC filters can be safely and successfully placed and retrieved in children. [3, 10-12] Indications for filter placement in children are similar to those in adults: contraindication to anticoagulation with known DVT, high risk for venous thromboembolism, recurrent DVT despite anticoagulation, and prophylaxis before endovascular thrombolysis, thus recommending a case-based evaluation in pediatric cases. Moreover, technical issues regarding placement and retrieval in children are very similar to those in adults. [3, 10-12] It has been suggested that in patients who have IVC filters inserted because of a contraindication to anticoagulation, a conventional course of anticoagulant therapy should be indicated in case the bleeding risks resolve, and if possible, the filter should be removed. Furthermore, a nonretrievable IVC filter is a controversial indication for extended anticoagulation that should be evaluated and discussed. [13] IVC filter placement in children is technically feasible with low IVC thrombosis and low overall complication rates. Retrievable filters should be used in the pediatric population to avoid long-term complications. AD - S. Sierre, Department of Interventional Radiology, Hospital de Pediatria Prof. Dr. J.P. Garrahan, Buenos Aires, Argentina AU - Sierre, S. DB - Embase KW - heparin fibrinolytic agent plasminogen fresh frozen plasma filter society Europe lysis human child adult patient anticoagulation risk thrombosis blood clot lysis devices infusion prophylaxis anticoagulant therapy population mechanical thrombectomy fibrinolytic therapy newborn pediatrics therapy postthrombosis syndrome surgical technique deep vein thrombosis venous thromboembolism catheter intracardiac drug administration central venous catheter pelvis lung embolism vein thromboembolism bleeding limb surgery prevalence vein thrombosis physician sepsis thorax college adolescence hematology interventional radiology intensive care morbidity clinical study prevention ultrasound clinical trial (topic) case report procedures LA - English M3 - Conference Abstract N1 - L71323216 2014-02-21 PY - 2013 SN - 0174-1551 SP - S184-S185 ST - Is there a role for lysis and IVC filters in paediatric DVT? T2 - CardioVascular and Interventional Radiology TI - Is there a role for lysis and IVC filters in paediatric DVT? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71323216&from=export VL - 36 ID - 761153 ER - TY - JOUR AB - Introduction: Successful whole pancreas transplantation is at the present the most effective treatment for type 1 diabetes but allograft dysfunction related with infection, vascular compromise or immunological causes are not uncommon. Usually, graft vascular thrombosis or haemorrhage, as well as infectious complications are responsible for early pancreas graft failure; late cases occur more frequently by immunological causes, either allograft rejection or recurrence of the 'auto-immunity' state that is characteristic of type 1 Diabetes. Objective: To discuss a case of pancreas graft loss with coexistent graft arterial thrombosis and newly elevated anti-GAD antibodies. Case report: A 43-year-old type 1 diabetic woman with end-stage renal disease and ischemic heart disease underwent a successful pancreas-kidney transplant and became free of insulin and dialysis for 5 years. Several days after coronariography there was a sudden appearance of hyperglycaemia (879 mg/dl), dehydration-related elevated serum creatinine (1.43 mg/dl), low C-peptide (0.37 ng/ml), normal serum amylase and lipase and newly elevated anti-GAD antibodies (120 U/ml). Vascular study was undertaken due to athero-embolization suspicion; angiography showed distal graft artery occlusion (donor's superior mesentery artery). No graft biopsy was made. Alteplase treatment was performed during the angiography and the patient was treated with metilprednisolone bolus but unfortunately there was no radiological or clinical improvement and insulin-dependence remained. Discussion: In the present case, graft loss seemed to occur due to arterial embolization after coronary catheterization. The rising of anti-GAD antibodies levels probably occurred due to antigenic expression because of the graft ischemia and not due to type 1 diabetes recurrence, but this complexity makes it very important to have a multidisciplinary team approach in the follow-up of these patients. AD - A.M. Silva, Hospital Santo Antonio, Centro Hospitalar Do Porto, Porto, Portugal AU - Silva, A. M. AU - Martins, L. S. AU - Dias, L. AU - Henriques, A. C. AU - Giestas, A. AU - Teixeira, S. AU - Oliveira, F. AU - Almeida, P. AU - Machado, R. AU - Freitas, C. AU - Almeida, R. AU - Teixeira, M. AU - Dores, J. DB - Embase KW - antibody alteplase insulin C peptide triacylglycerol lipase graft rejection pancreas artery thrombosis artery catheterization coronary artery endocrinology diabetes mellitus pancreas transplantation graft failure artificial embolization angiography patient insulin dependence amylase blood level catheterization ischemia follow up infection thrombosis bleeding infectious complication autoimmunity case report female kidney disease kidney pancreas transplantation dialysis hyperglycemia dehydration creatinine blood level ischemic heart disease artery occlusion donor superior mesenteric artery biopsy allograft L1 - http://www.endocrine-abstracts.org/ea/0020/ea0020p226.htm LA - English M3 - Conference Abstract N1 - L70165323 2010-06-14 PY - 2010 SN - 1470-3947 SP - P226 ST - Pancreatic graft arterial thrombosis after coronary artery catheterization - An unusual case of pancreas allograft rejection T2 - Endocrine Abstracts TI - Pancreatic graft arterial thrombosis after coronary artery catheterization - An unusual case of pancreas allograft rejection UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70165323&from=export VL - 22 ID - 761251 ER - TY - JOUR AB - This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of trabectedin for the treatment of advanced metastatic soft tissue sarcoma, in accordance with the licensed indication, based on the evidence submission from the manufacturer to NICE as part of the single technology appraisal (STA) process. The outcomes stated in the manufacturer's definition of the decision problem were overall survival (OS), progression-free survival (PFS), response rates, adverse effects of treatment, health-related quality of life, and cost per quality-adjusted life-year (QALY) gained. The clinical evidence was derived from one randomised controlled trial (RCT), in which the licensed dose of trabectedin was compared with a different dose of trabectedin, and three phase II studies. In the RCT, the median OS was 13.9 months for the licensed dose of trabectedin, which was not significantly different from that for the comparator dose of trabectedin, which was 11.8 months. From the phase II uncontrolled trials, median OS was reported as 9.2 or 12.8 months. The RCT reported significantly superior PFS for the licensed dose of trabectedin (median 3.3 months) over the comparator trabectedin dose (median 2.3 months). One phase II uncontrolled trial reported median PFS as 1.9 months in the licensed dose of trabectedin. The RCT reported PFS rates at 6 months were 35.5% for the licensed close of trabectedin, and 27.5% for the comparator dose of trabectedin. From the phase II uncontrolled trials, PFS rates at 6 months were 24.4% or 29%. For the RCT, deaths attributed to trabectedin occurred in 3.1% of the licensed close, and 2.3% of the comparator group. The most common severe adverse events were neutropenia, although with a low rate of febrile neutropenia, thrombocytopenia, and aspartate aminotransferase and alanine aminotransferase elevation, although these were reported to be non-cumulative and reversible. Following dialogue iterations with the ERG team, the manufacturer revised the model twice. However, despite revisions, errors/inconsistencies were found in the latest version of the model and were corrected by the ERG (only for the base case). In the latest manufacturer's submission, the cost per QALY gained of trabectedin compared with best supportive care (BSC) was estimated to be (sin)56,985 for the base case using effectiveness from the STS (Soft Tissue Sarcomas)-201 trial for trabectedin and a pool analysis of the European Organisation for Research and Treatment of Cancer data set for BSC. This analysis was constrained to patients with L sarcomas only. When the joint uncertainty between parameters was considered, the cost-effectiveness acceptability curve showed that: trabectedin has a very low probability of being cost-effective at a threshold of (sin)30,000 per QALY gained compared with BSC for any scenario. The guidance has yet to be issued by NICE. AD - [Simpson, E. L.; Rafia, R.; Stevenson, M. D.; Papaioannou, D.] Univ Sheffield, ScHARR, Sheffield S1 4DA, S Yorkshire, England. Simpson, EL (corresponding author), Univ Sheffield, ScHARR, 30 Regent St, Sheffield S1 4DA, S Yorkshire, England. e.l.simpson@sheffield.ac.uk AN - WOS:000279234300010 AU - Simpson, E. L. AU - Rafia, R. AU - Stevenson, M. D. AU - Papaioannou, D. DA - May DO - 10.3310/hta14suppl1/09 J2 - Health Technol. Assess. KW - PHASE-II ECTEINASCIDIN-743 Health Care Sciences & Services LA - English M3 - Article N1 - ISI Document Delivery No.: 616UC Times Cited: 29 Cited Reference Count: 8 Simpson, E. L. Rafia, R. Stevenson, M. D. Papaioannou, D. Barkham, Michael/A-2547-2010; Sutcliffe, Paul/AAB-7325-2020; Scope, Alison/E-5368-2010; Booth, Andrew/A-7872-2008 Booth, Andrew/0000-0003-4808-3880; Gilbody, Simon/0000-0002-8236-6983 HTA programme [08/92/01]; Department of Health [06/83/01] Funding Source: Medline The research reported in this article of the journal supplement was commissioned and funded by the HTA programme on behalf of NICE as project number 08/92/01. The assessment report began editorial review in July 2009 and was accepted for publication in July 2009. See the HTA programme website for further project information (www.hta.ac.uk). This summary of the ERG report was compiled after the Appraisal Committee's review. 31 0 4 NATL COORDINATING CENTRE HEALTH TECHNOLOGY ASSESSMENT SOUTHAMPTON HEALTH TECHNOL ASSES 1 PY - 2010 SN - 1366-5278 SP - 63-67 ST - Trabectedin for the treatment of advanced metastatic soft tissue sarcoma T2 - Health Technology Assessment TI - Trabectedin for the treatment of advanced metastatic soft tissue sarcoma UR - ://WOS:000279234300010 VL - 14 ID - 761876 ER - TY - JOUR AB - PMID:32862293 AU - Sin, David AU - McLennan, Gordon AU - Rengier, Fabian AU - Haddadin, Ihab AU - Heresi, Gustavo A. AU - Bartholomew, John R. AU - Fink, Matthias A. AU - Thompson, Dustin DA - 2020/08/30 08/30 DB - PubMed Central DO - 10.1007/s10554-020-01980-9 PY - 2020 SN - 1569-5794 SP - 1-1 ST - Acute pulmonary embolism multimodality imaging prior to endovascular therapy T2 - The International Journal of Cardiovascular Imaging TI - Acute pulmonary embolism multimodality imaging prior to endovascular therapy UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7456521&rendertype=abstract https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7456521 ID - 762028 ER - TY - JOUR AB - Rationale: Catheter-Directed Thrombolysis (CDT) is used to treat patients characterized, as per European Society of Cardiology (ESC) guidelines, at intermediate-risk (IR) and high-risk (HR) of mortality from acute Pulmonary Embolism (PE). The mortality rate of HR and IR PE is 30-60%, and 2-17% respectively. We established a PE response Team (PERT) to manage HR and IH risk patients, where there is controversy regarding the optimal management of these patients. Potential advantages of CDT include early improvement in pulmonary-artery hemodynamics, and being less invasive than surgical embolectomy, has less major bleeding compared to full dose thrombolysis. We hypothesized that use of CDT was associated with a low mortality rate and low major bleeding rate. METHODS: We performed a retrospective analysis of 37 consecutive IR and HR patients with an acute PE treated with CDT, admitted over a 33 month period to three urban teaching hospitals. Primary endpoints included in-hospital survival, 30-day survival, recurrent venous thromboembolism (VTE) and major bleeding. Standard CDT was employed with infusion of recombinant tissue plasminogen activator (rt-PA) at 0.75mg/h over 12 hours. RESULTS:Mean age was 58 ± 6 years (range 27-83 years), 41% were female. All were found to have central PE on Chest CT-pulmonary angiography; eight patients had saddle emboli, twenty and twenty-nine patients had main pulmonary artery and lobar involvement, respectively, and contrast reflux into the IVC was noted in ten patients. Transthoracic Echocardiography (TTE) revealed a calculated mean Pulmonary Artery Systolic Pressure (PASP) of 55.8 mmHg, with clot-in-transit noted in two patients. In twenty-four patients where PASP was directly measured, the mean PASP were 50 and 40 mmHg pre and post CDT, respectively, and in two patients the PASP normalized. Major bleeding occurred in 3 patients during the hospital stay. Three patients died during hospitalization, two from persistent shock from a massive PE, one from a massive GI bleed, and thirty were alive at 30-days. Three patients were readmitted at 30 days, for sepsis (n=1), dyspnea (n=1), and for recurrent VTE (n=1). Twenty-eight patients were discharged on Direct-Acting Oral Anticoagulants (DOAC). Twenty patients followed up in Pulmonary outpatient clinic. CONCLUSIONS: CDT is an effective and safe method of treating HR and IR patients with acute PE. Limitations of this retrospective study include a single arm, small population size, and a short follow up period. Longer term follow up with repeat TTE is recommended to determine the rate of Chronic Thromboembolic Pulmonary Hypertension (CTEPH). AD - A. Singh, Internal Medicine, Mount Sinai St Luke's and West Hospitals, New York, NY, United States AU - Singh, A. AU - Charran, O. AU - Filopei, J. AU - Shujaat, A. AU - Pan, D. AU - Lookstein, R. AU - Salonia, J. AU - Shapiro, J. M. AU - Isath, A. AU - Steiger, D. DB - Embase KW - alteplase anticoagulant agent adult aged artery blood flow blood clot lysis case report catheter chronic thromboembolic pulmonary hypertension clinical article conference abstract dyspnea embolectomy female follow up gastrointestinal hemorrhage high risk patient hospital discharge hospitalization human intermediate risk patient lung angiography male middle aged mortality rate multicenter study outpatient department population size pulmonary artery pulmonary embolism response team retrospective study risk assessment sepsis systolic blood pressure teaching hospital thorax transthoracic echocardiography LA - English M1 - 9 M3 - Conference Abstract N1 - L630347609 2020-01-01 PY - 2019 SN - 1535-4970 ST - Catheter-directed thrombolysis (CDT) for intermediate and high risk pulmonary embolism T2 - American Journal of Respiratory and Critical Care Medicine TI - Catheter-directed thrombolysis (CDT) for intermediate and high risk pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630347609&from=export VL - 199 ID - 760724 ER - TY - JOUR AB - SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Pulmonary embolism (PE) is the most common cause of preventable in-hospital death in the United States. We established a multidisciplinary Pulmonary Embolism Response Team (PERT) to optimize management of patients with intermediate and high-risk PE, in the absence of practice-based guidelines. We hypothesized that a multidisciplinary team composed of medical and surgical specialists would be associated with improved patient outcomes. METHODS: We performed a retrospective analysis of 54 consecutive PERT activations over 2018 from two urban tertiary academic hospitals. We analyzed patient demographics, risk factors for Venous Thromboembolism (VTE), PE characterization and severity, and PERT-directed treatment. Outcome endpoints included - major bleeding, 30-day survival, 30-day readmission, and clinic follow up within 30-days of discharge. RESULTS: Median age was 64 years, of which 52% were women. Risk factors for PE included decreased mobility (n=12,22%), hospitalization within the last 6 months (n=11,20%), non-trauma related surgery (n=10,19%), history of VTE (n=10,19%), malignancy (n=8,15%) and obesity (n=4,7%). Hypertension (n=31.4%), stroke (n=11.1%) and coronary artery disease (n=4,7%%) were the most common co-morbidities. Central PE was identified in 46 patients (85%), with radiographic evidence of right ventricular (RV) dysfunction on CT-pulmonary angiography (n=40,74%) and transthoracic echocardiography (n=36,67%). Elevated troponin (>0.04 ng/mL) and brain natriuretic peptide (>100 pg/mL) were noted in 40(74%) and 37(69%) patients, respectively. Based on European Society of Cardiology Guidelines, 10 patients were deemed high risk (19%), 32 intermediate-high (59%) and 3 intermediate-low risk (5.6%). Patients were treated with parenteral heparin or enoxaparin followed by a direct oral anticoagulant in 25(46%) patients and coumadin in 20(37%). Nine (17%) underwent catheter directed thrombolysis (CDT). Four (7%) received recombinant tissue plasminogen activator (rtPA), and one underwent surgical embolectomy. Nine patients (17%) received an inferior vena cava (IVC) filter. Over half (n=5,56%) patients undergoing CDT received an IVC filter. Major in-hospital bleeding was noted in 4(7.4%) patients. One (11%) patient who underwent CDT had major bleeding. 47(87%) patients were discharged, with 6(12%) patients requiring readmission within 30-days. Thirty-three(70%) patients were followed up in Medicine or Pulmonary clinics within 30-days of discharge. CONCLUSIONS: We provide our first, multi-center analysis of patients managed by PERT. The majority of patients with confirmed PE were at intermediate to high risk of mortality. Longer follow up is necessary to establish if PERT-directed management of life threatening PE significantly affects mortality. CLINICAL IMPLICATIONS: The high survival rate and low major bleeding rate suggest that PERT management of high risk patients may be safe and effective. DISCLOSURES: No relevant relationships by Caroline Dooley, source=Web Response No relevant relationships by Madeline Ehrlich, source=Web Response No relevant relationships by Jason Filopei, source=Web Response No relevant relationships by Ameesh Isath, source=Web Response No relevant relationships by James Salonia, source=Web Response No relevant relationships by Janet Shapiro, source=Web Response No relevant relationships by Adil Shujaat, source=Web Response No relevant relationships by Avinash Singh, source=Web Response No relevant relationships by David Steiger, source=Web Response AU - Singh, A. AU - Salonia, J. AU - Shapiro, J. AU - Shujaat, A. AU - Filopei, J. AU - Ehrlich, M. AU - Dooley, C. AU - Isath, A. AU - Steiger, D. DB - Embase DO - 10.1016/j.chest.2019.08.362 KW - alteplase brain natriuretic peptide endogenous compound enoxaparin heparin troponin warfarin adult bleeding blood clot lysis cancer patient cancer surgery cancer survival cardiology catheter cerebrovascular accident comorbidity conference abstract controlled study coronary artery disease drug therapy embolectomy female follow up heart right ventricle failure high risk patient hospital discharge hospital readmission hospitalization human hypertension lung angiography major clinical study male malignant neoplasm middle aged mortality risk multicenter study obesity practice guideline pulmonary embolism response team retrospective study risk assessment risk factor survival rate transthoracic echocardiography vena cava filter LA - English M1 - 4 M3 - Conference Abstract N1 - L2002983565 2019-10-02 PY - 2019 SN - 1931-3543 0012-3692 SP - A312-A313 ST - PULMONARY EMBOLISM RESPONSE TEAM EXPERIENCE: RETROSPECTIVE ANALYSIS OF DATA FROM 2018 T2 - Chest TI - PULMONARY EMBOLISM RESPONSE TEAM EXPERIENCE: RETROSPECTIVE ANALYSIS OF DATA FROM 2018 UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002983565&from=export http://dx.doi.org/10.1016/j.chest.2019.08.362 VL - 156 ID - 760663 ER - TY - JOUR AB - Objective: High rates of midterm failure of the Nellix EndoVascular Aneurysm Sealing (EVAS) system (Endologix, Irvine, Calif) led the UK Medicines and Health Regulatory Authority to recommend explantation of all devices. The study aim was to report outcomes of reintervention and explantation for failing EVAS. Methods: A retrospective review of EVAS procedures at a tertiary unit was performed. Device failure was defined as a triad of stent migration, stent separation, and secondary sac expansion or any intervention for type I endoleak, device rupture, or explantation. Reintervention was defined as any procedure required to maintain aneurysm exclusion. Results: There were 161 patients treated between February 2013 and August 2017. Median follow-up was 48 (interquartile range, 27-62) months. The 30-day mortality was 5.6%, with Kaplan-Meier estimate of survival at 5 years of 54.3%. There were 69 (42.9%) device failures, with freedom from device failure at 5 years of 48.7%. In those with a device failure, 41 had sac expansion, 36 caudal stent migration, 24 stent separation, 31 type I endoleak, 13 secondary sac ruptures, and 21 device explantations. Indications for explantation included failure (n = 17) and rupture (n = 4). Median time to explantation was 1224 days, and median length of stay after explantation was 10 days. There was no 30-day or in-hospital mortality after explantation, but two patients died later (31 and 183 weeks) from non-aneurysm-related causes. Freedom from explantation at 5 years was 86%. Fifteen (9.3%) patients presented with EVAS rupture, of whom only 33% are alive. Eleven patients presenting with rupture had no endovascular salvage option and were unsuitable for open repair; of these patients, nine died of the rupture and one died of another cause, and one patient is in palliative care. Three patients proceeded to open explantation and one underwent a Nellix-in-Nellix application procedure. Twenty-five patients were judged to be palliative cases after comprehensive discussion at the multidisciplinary team meeting. Of the patients turned down for further intervention, eight (32%) are dead. After Nellix-in-Nellix extension, two were successfully treated, one died of bowel infarction, and one required limb extensions for bilateral type IB endoleak. Proximal embolization was successful in 16.7%. Conclusions: This study demonstrates the high midterm failure rates of Nellix EVAS. EVAS explantation is an acceptable technique with favorable outcomes compared with reported endovascular aneurysm repair explantation data. Management with open explantation or Nellix-in-Nellix application should be considered early and offered to those with device failure. [Formula presented] AU - Singh, A. A. AU - Pope, T. AU - Harrison, S. C. AU - Winterbottom, A. J. AU - Boyle, J. R. DB - Embase DO - 10.1016/j.jvs.2020.04.055 KW - adult adverse device effect aneurysm sealing system artificial embolization cell migration conference abstract controlled study device failure endoleak endovascular aneurysm repair explant female follow up hospital mortality human incidence intestine infarction Kaplan Meier method length of stay limb major clinical study male multidisciplinary team palliative therapy retrospective study rupture stent migration LA - English M1 - 1 M3 - Conference Abstract N1 - L2006737418 2020-07-15 PY - 2020 SN - 1097-6809 0741-5214 SP - e27-e28 ST - Incidence and Management of the Failing Nellix Endovascular Aneurysm Sealing System T2 - Journal of Vascular Surgery TI - Incidence and Management of the Failing Nellix Endovascular Aneurysm Sealing System UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2006737418&from=export http://dx.doi.org/10.1016/j.jvs.2020.04.055 VL - 72 ID - 760561 ER - TY - JOUR AB - Background: Optimal use of retrievable inferior vena cava (IVC) filters is an important health care issue, and despite an exponential rise in the use of retrievable IVC filters, national trends suggest that most of these filters are not removed. The purpose of this study was to identify risk factors associated with nonretrieval of retrievable IVC filters at our institution. Methods: A retrospective institutional review of all patients undergoing IVC filter placement from June 2010 to June 2012 was performed. A number of patient parameters were studied, including relevant demographics, indication for filter placement, clinical history, related hospitalization, and whether filter retrieval was performed. Patient parameters were compared by univariate and multivariate logistic regression analyses. Results: There were 605 retrievable IVC filters placed over a 24-month period by vascular surgery, intervention radiology, and interventional cardiology. The follow-up retrieval rate was 25%. By indication, 272 (45%), 53 (9%), and 280 (46%) filters were placed for absolute, relative, and prophylactic indications, respectively. Independent predictors for nonretrieval by multivariate analysis were age >80 years (hazard ratio [HR], 5.0; 95% confidence interval [Cl], 1.7-20; P < 0.001), acute bleed (HR, 2.5; 95% Cl, 1.4-5; P < 0.001), current malignancy (HR, 2.0; 95% Cl, 1.3-3.3; P = 0.011), postfilter anticoagulation (HR, 0.5; 95% Cl, 0.28-0.9; P = 0.017), and history of pulmonary embolism and/or venous thromboembolism (HR, 0.5; 95% Cl, 0.28-0.35; P < 0.001). Filter placement team and indication were not identified as independent predictors of nonretrieval of IVC filters. Conclusions: Patient variables identified by univariate and multivariate analyses as risk for nonretrieval of retrievable IVC filters have several implications: first, some of these patients may represent a group of patients with a low life expectancy or unresolvable underlying condition in which filter retrieval has diminishing returns and may indicate the clinical option for permanence of the filter; second, identification of risk factors for nonretrieval in patients before filter placement will help to optimize use of retrievable IVC filters and enhance retrieval rates. AD - [Siracuse, Jeffrey J.; Al Bazroon, Ahmed; Gill, Heather L.; Meltzer, Andrew J.; Schneider, Darren B.; Parrack, Inkyong; Jones, Douglas W.; Connolly, Peter H.] Weill Cornell Med Coll, New York Presbyterian Hosp, Div Vasc & Endovasc Surg, New York, NY USA. Siracuse, JJ (corresponding author), Boston Univ, Sch Med, 88 East Newton St, Boston, MA 02218 USA. jeffrey.siracuse@bmc.org AN - WOS:000349200200020 AU - Siracuse, J. J. AU - Al Bazroon, A. AU - Gill, H. L. AU - Meltzer, A. J. AU - Schneider, D. B. AU - Parrack, I. AU - Jones, D. W. AU - Connolly, P. H. DA - Feb DO - 10.1016/j.avsg.2014.08.008 J2 - Ann. Vasc. Surg. KW - FOLLOW-UP PLACEMENT REMOVAL Surgery Peripheral Vascular Disease LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: CA8VY Times Cited: 10 Cited Reference Count: 13 Siracuse, Jeffrey J. Al Bazroon, Ahmed Gill, Heather L. Meltzer, Andrew J. Schneider, Darren B. Parrack, Inkyong Jones, Douglas W. Connolly, Peter H. Siracuse, Jeffrey/AAN-2987-2020 Jones, Douglas/0000-0002-8829-2831 10 0 4 ELSEVIER SCIENCE INC NEW YORK ANN VASC SURG PY - 2015 SN - 0890-5096 SP - 318-321 ST - Risk Factors of Nonretrieval of Retrievable Inferior Vena Cava Filters T2 - Annals of Vascular Surgery TI - Risk Factors of Nonretrieval of Retrievable Inferior Vena Cava Filters UR - ://WOS:000349200200020 VL - 29 ID - 761762 ER - TY - JOUR AB - Background: Vascular anomalies comprise highly variable pathophysiology and commonly pose diagnostic and management dilemmas. Consequently, patients often benefit from input from multiple specialists. This study describes the inception of a multidisciplinary team (MDT) Vascular Anomaly Clinic (VAC) in a tertiary paediatric centre, and the subsequent experience managing this complex patient group. Methods: This was a retrospective study of paediatric patients (< 18 years old) attending an MDT VAC from its inception in October 2012 until November 2019. Patient demographics, presentation, diagnosis and management were reviewed. Results: One hundred and thirty-three paediatric patients were seen over 7 years with a median age of 9.8 years. Vascular malformations were the most common diagnosis (88%), with venous malformations predominating (27%). The most common symptoms were pain (46%) and swelling (34%). Patients often required ≥ 2 investigations, with Doppler ultrasound (86%) and magnetic-resonance imaging (61%) being most common. Management included surgery (27%), sclerotherapy (26%), compression garments (23%), analgesia (12%), laser (15%), embolisation (5%) and sirolimus (3%). Conclusions: The complex nature of vascular anomalies and high proportion of patients requiring multi-specialty management justified the establishment of an MDT VAC in our centre. Our experience demonstrates the success of an efficient one-stop MDT environment in the management of these challenging conditions. Level of evidence: IV. AD - J.D. Sires, College of Medicine and Public Health, Flinders University, Adelaide, Australia AU - Sires, J. D. AU - Williams, N. AU - Huilgol, S. C. AU - Harvey, I. AU - Antoniou, G. AU - Dawson, J. DB - Embase Medline DO - 10.1007/s00383-020-04727-8 KW - compression garment neodymium YAG laser pulsed dye laser acetylsalicylic acid antibiotic agent anticoagulant agent antithrombocytic agent D dimer fibrinogen propranolol rapamycin warfarin adolescent adult analgesia angioosteohypertrophy syndrome arteriovenous malformation article artificial embolization Asian bleeding capillary hemangioma Caucasian child clinical article clinical feature computed tomographic angiography congenital blood vessel malformation demography digital subtraction angiography Doppler flowmetry epiphysiodesis female follow up human indigenous people infant low level laser therapy lymphatic malformation male multidisciplinary team nuclear magnetic resonance imaging pain pediatric patient priority journal retrospective study sclerotherapy swelling Torres Strait Islander vascular tumor workflow x-ray computed tomography LA - English M1 - 10 M3 - Article N1 - L2005800413 2020-08-14 PY - 2020 SN - 1437-9813 0179-0358 SP - 1149-1156 ST - An integrated multidisciplinary team approach to the management of vascular anomalies: challenges and benefits T2 - Pediatric Surgery International TI - An integrated multidisciplinary team approach to the management of vascular anomalies: challenges and benefits UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2005800413&from=export http://dx.doi.org/10.1007/s00383-020-04727-8 VL - 36 ID - 760535 ER - TY - JOUR AB - Pulmonary Embolism Response Teams (PERTs) have emerged to provide rapid multidisciplinary assessment and treatment of PE patients. However, descriptive institutional experience and preliminary outcomes data from such teams are sparse. PERT activations were identified through a retrospective review. Only confirmed submassive or massive PEs were included in the data analysis. In addition to baseline variables, the therapeutic intervention, length of stay (LOS), in-hospital mortality, and bleeding rate/severity were recorded. A total of 124 PERT activations occurred over 20 months: 43 in the first 10 months and 81 in the next 10. A total of 87 submassive (90.8%) and massive (9.2%) PE patients were included. The median age was 65 (51-75 IQR) years. Catheter-directed thrombolysis (CDT) was administered to 25 patients, systemic thrombolysis (ST) to six, and anticoagulation alone (AC) to 54. The median ICU stay and overall LOS were 6 (3-10 IQR) and 7 (4-14 IQR) days, respectively, with no association with any variables except a brain natriuretic peptide (BNP) >100 pg/mL ( p=0.008 ICU LOS; p=0.047 overall LOS). Twelve patients (13.7%) died in the hospital, nine of whom had metastatic or brain cancer, with a median overall LOS of 13 (11-17 IQR) days. There were five major bleeds: one in the CDT group, one in the ST group, and three in the AC group. Overall, (1) PERT activations increased after the first 10 months; (2) BNP >100 pg/mL was associated with a longer LOS; (3) rates of mortality and bleeding did not correlate with treatment; and (4) the majority of in-hospital deaths occurred in patients with advanced cancer. AD - 1 Department of Radiology, Division of Vascular and Interventional Radiology, New York University School of Medicine, New York, NY, USA. 2 Department of Surgery, Division of Cardiothoracic Surgery and Department of Medicine, Division of Pulmonary and Critical Care Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA. 3 Department of Radiology, Weill Cornell School of Medicine, New York, NY, USA. 4 Department of Health Policy & Research, Division of Biostatistics and Epidemiology, Weill Cornell School of Medicine, New York, NY, USA. 5 Department of Cardiothoracic Surgery, Weill Cornell School of Medicine, New York, NY, USA. 6 Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, NY, USA. AN - 28920554 AU - Sista, A. K. AU - Friedman, O. A. AU - Dou, E. AU - Denvir, B. AU - Askin, G. AU - Stern, J. AU - Estes, J. AU - Salemi, A. AU - Winokur, R. S. AU - Horowitz, J. M. DA - Feb DO - 10.1177/1358863x17730430 DP - NLM ET - 2017/09/19 J2 - Vascular medicine (London, England) KW - Aged Aged, 80 and over Female Fibrinolytic Agents/*therapeutic use Hemorrhage/chemically induced/drug therapy Hospital Mortality Humans Male Middle Aged Pulmonary Embolism/*drug therapy Retrospective Studies *Thrombolytic Therapy *Treatment Outcome *PE response team (PERT) *catheter-directed thrombolysis *hospital length of stay *massive PE *pulmonary embolism (PE) *submassive PE LA - eng M1 - 1 N1 - 1477-0377 Sista, Akhilesh K Friedman, Oren A Dou, Eda Denvir, Brendan Askin, Gulce Stern, Jamie Estes, Jaclyn Salemi, Arash Winokur, Ronald S Horowitz, James M Journal Article Research Support, Non-U.S. Gov't England Vasc Med. 2018 Feb;23(1):65-71. doi: 10.1177/1358863X17730430. Epub 2017 Sep 17. PY - 2018 SN - 1358-863x SP - 65-71 ST - A pulmonary embolism response team's initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism T2 - Vasc Med TI - A pulmonary embolism response team's initial 20 month experience treating 87 patients with submassive and massive pulmonary embolism VL - 23 ID - 760151 ER - TY - JOUR AB - Inherited bleeding disorders (IBD) affect up to 1 in 10,000 individuals for the most common disorder, von Willebrand disease, to only eight reported cases worldwide of alpha-2-antiplasmin deficiency. Those with an identifiable abnormality can be divided into disorders of coagulation factors (87%), platelet count and function (8%) and the fibrinolytic system (3%). The remaining 2% are unclassifiable (1-3). Next to bleeding symptoms, patients with an IBD can manifest abnormalities in other organ systems, warranting an accurate and complete diagnosis that reflects the underlying molecular pathology. This includes predisposition to renal impairment, deafness or acute myeloid leukaemia (4). Despite the fact that IBD can be diagnosed through a combination of careful clinical assessment and laboratory assays of varying degrees of complexity, there are many where conventional approaches are inadequate. Improvements in phenotyping assays have enhanced the diagnostic toolbox, however genotyping offers the most precise diagnosis for some of these conditions. In the past, obtaining a genetic diagnosis was often challenging. It was not always clear which genetic tests could be undertaken. These tests were based on Sanger sequencing, and were costly. Furthermore, the assays were time consuming. Genes were tested sequentially rather than in parallel, which meant that for some patients, it could take years to reach a diagnosis. Thanks to the development of targeted sequencing platforms, many genes can now be analysed routinely in a timely fashion. Thanks to the relative ease of use of these platforms, their use should be incorporated into the work-up of patients with an IBD. The traditional stepwise testing approach may require multiple hospital visits to discuss test results and to add additional investigations. The cost of these interventions, which may require the patient to attend a specialist laboratory, and the consequent delays in diagnosis are compelling reasons for introducing genetic testing much earlier in the diagnostic process. In order to make sense of the vast amount of data generated by NGS and particularly by whole genome sequencing (WGS) in a manner that is clinically useful, a multi-disciplinary approach is essential, involving clinicians, bioinformaticians and genetic scientists. One such panel is the ThromboGenomics (TG), a targeted NGS panel, that has been developed in Cambridge, UK (5). Version 3.0 of the platform contains 78 genes with a confirmed role in bleeding/ thrombotic disorders. These include coagulation pathways and platelet disorders due to defects important for platelet formation, morphology or function. By selecting only genes with an established role in inherited coagulation, platelet and thrombotic disorders, clinical utility is enhanced. The technology allows rapid addition of new genes once they have been approved by the Scientific and Standardization Committee (SSC) for Genomics as described below. To date, more than 1450 samples have been processed by the TG pipeline. The speed at which investigations can be undertaken, and the reducing WGS costs, will promote its role. In parallel, ongoing bio-banking efforts for peripheral blood samples and analysis of genome-wide markers will allow linkage of genetic loci to specific phenotypic traits. When a clinical question, such as the cause of abnormal bleeding arises, a bioinformatics pipeline will analyse genes related to IBD for pathological variants. In summary, we suggest the next approach for the investigation of patients with a suspected inherited bleeding disorder should be as follows (6): 1. Detailed history taking including a. Clinical assessment of presence and severity of bleeding symptoms using the International Society on Thrombosis and Haemostasis (ISTH) Bleeding Assessment Tool (BAT) (20), to generate scores from bleeding history. b. Age of symptoms onset. c. Family history; it is important to consider autosomal recessive inheritance of disorders in asymptomatic carriers, especially when parents are consanguineous. d. Platelet disor ers can be part of multi-system disorders. A full physical examination may give clues facilitating diagnosis. In addition, a systems history should be taken. e. Diet, and certain products including herbs and caffeine can affect platelet function. In addition, malnourishment can result in factor deficiencies. f. Current medication 2. First-line investigations are available at most centres treating patients with an IBD that include a full blood count, APTT, PT, TT, Fibrinogen, VWF antigen and VWF activity. If a platelet disorder is suspected, platelet morphology and light transmission aggregometry should be undertaken. 3. Second-line testing is dependent on the outcome of previous testing. If a coagulation defect is suspected based on abnormal clotting studies, this could be followed up with specific factor assays. If all factors are normal, factor XIII and Alpha-2-antiplasmin deficiency should be excluded. Findings can be confirmed using NGS. If a platelet disorder is suspected, rather than second-line testing, which is costly and time-consuming, NGS should be used. 4. A multidisciplinary team meeting to discuss patients, having input from clinicians, biomedical staff, geneticists and bioinformaticians. If there is ambiguity, or further phenotyping is required, then additional third-line tests could be suggested. The outcome should be documented and conveyed to the patient. AD - S. Sivapalaratnam, University of Cambridge and NHS Blood and Transplant, Long Road, Cambridge, United Kingdom AU - Sivapalaratnam, S. DB - Embase DO - 10.1111/hae.13478 KW - alpha 2 antiplasmin antigen blood clotting factor 13 caffeine endogenous compound fibrinogen von Willebrand factor activated partial thromboplastin time acute myeloid leukemia adult autosomal recessive inheritance bioinformatics bleeding cancer patient clinical assessment conference abstract congenital malformation controlled study diagnosis diet drug therapy family history female fibrinolysis gene locus genetic screening genomics genotype hearing impairment human human cell human tissue kidney disease major clinical study male molecular pathology mood disorder outcome assessment phenotype physical examination pipeline platelet count protein function Sanger sequencing scientist standardization thrombocyte disorder thrombocyte function thrombocyte structure thrombocytopoiesis thrombosis velocity von Willebrand disease whole genome sequencing LA - English M3 - Conference Abstract N1 - L622461225 2018-06-11 PY - 2018 SN - 1365-2516 SP - 8-9 ST - Diagnosis of inherited bleeding disorders in the genomic era T2 - Haemophilia TI - Diagnosis of inherited bleeding disorders in the genomic era UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622461225&from=export http://dx.doi.org/10.1111/hae.13478 VL - 24 ID - 760823 ER - TY - JOUR AB - Background: Several barriers exist for training and retention of clinician scientists, including difficulty in navigating research-related tasks in the workplace and insufficient mentorship. Objective: Our aim was to identify what core research knowledge and skills are important for the success of clinician scientists in thrombosis research, and trainees' perceived confidence in those skills, in order to develop a targeted educational intervention. Methods: A pre-tested online survey was administered to trainees and research faculty of the Canadian thrombosis research network, CanVECTOR, between September 2016 and June 2017. The importance (research faculty) and confidence (trainees) of 45 research knowledge/skills were measured using a 5-point Likert scale. Results: The survey response rate was 49% (28/57) for research faculty and 100% (10/10) for trainees. All research faculty rated developing a good research question, grant writing and writing strategies for successful publication as 'very' or 'extremely' important for trainees to learn to better transition in becoming independent researchers. Other important areas included practical aspects of research. A qualitative thematic analysis of open text responses identified 'time management' and 'leadership and teamwork' as additional important research skills. Confidence reported for each topic varied across trainees. There were three research knowledge and/or skills that >= 75% of research faculty deemed highly important and >= 50% of trainees reported lacking confidence in: grant writing, the peer-review grant process, and knowledge translation strategies. Conclusions: Developing a good research question, communicating research ideas and results and the practical aspects of research are important areas to focus future efforts in thrombosis research training. AD - [Skeith, Leslie; Carrier, Marc; Le Gal, Gregoire; Gonsalves, Carol] Univ Ottawa, Dept Med, Div Hematol, Ottawa, ON, Canada. [Skeith, Leslie; Carrier, Marc; Langlois, Nicole; Le Gal, Gregoire] Ottawa Hosp, Res Inst, Clin Epidemiol Program, Ottawa, ON, Canada. [Shivakumar, Sudeep] Dalhousie Univ, Dept Med, Div Hematol, Halifax, NS, Canada. [Harris, Ilene] Univ Illinois, Chicago Coll Med, Dept Med Educ, Chicago, IL USA. Skeith, L (corresponding author), Ottawa Hosp, Ctr Practice Changing Res, 501 Smyth Rd,Box 201, Ottawa, ON K1H 8L6, Canada. lskeith@toh.ca AN - WOS:000425999400013 AU - Skeith, L. AU - Carrier, M. AU - Shivakumar, S. AU - Langlois, N. AU - Le Gal, G. AU - Harris, I. AU - Gonsalves, C. DA - Feb DO - 10.1016/j.thromres.2017.12.008 J2 - Thromb. Res. KW - Research Education Needs assessment Thrombosis Curriculum CAREER-DEVELOPMENT Hematology Peripheral Vascular Disease LA - English M3 - Article N1 - ISI Document Delivery No.: FX3VC Times Cited: 2 Cited Reference Count: 28 Skeith, Leslie Carrier, Marc Shivakumar, Sudeep Langlois, Nicole Le Gal, Gregoire Harris, Ilene Gonsalves, Carol Langlois, Nicole/0000-0002-4953-6549; Skeith, Leslie/0000-0002-5587-398X CanVECTOR Training, Mentoring and Early Career Development platform; CanVECTOR Research Fellowship award; Scientific Steering Committee The study was supported by the CanVECTOR Training, Mentoring and Early Career Development platform. Leslie Skeith's research was supported by a CanVECTOR Research Fellowship award. The authors would like to thank the following investigators for providing additional insight and feedback on the project: Janet Riddle, PhD, University of Illinois-Chicago; Yoon Soo Park, PhD, University of Illinois-Chicago; Stephanie Johnston, MD, University of Manitoba, Winnipeg, Canada; and Taryn Taylor, MD, PhD, University of Ottawa, Ontario, Canada. We would like to thank the CanVECTOR members and Scientific Steering Committee for supporting this project. 2 0 1 PERGAMON-ELSEVIER SCIENCE LTD OXFORD THROMB RES PY - 2018 SN - 0049-3848 SP - 79-86 ST - Guiding curriculum development of a national research training program in thrombosis medicine: A needs assessment involving faculty and trainees T2 - Thrombosis Research TI - Guiding curriculum development of a national research training program in thrombosis medicine: A needs assessment involving faculty and trainees UR - ://WOS:000425999400013 VL - 162 ID - 761604 ER - TY - JOUR AB - Background: Over the last 30 years, traditional skill-based game teaching models have gradually been supplemented by instruction under an inclusive banner of Teaching Games for Understanding' (TGfU). This approach focuses on developing tactical understanding through modified games and a philosophy that places the learner rather than the game at the centre of instruction. A recent paper by Grehaigne, Caty, and Godbout, Modelling Ball Circulation in Invasion Team Sports: A Way to Promote Learning Games Through Understanding', had a threefold focus.center dot to report the results of a qualitative study on various offensive configurations of football play observed in Physical Education (PE) lessons with young novice players center dot to propose a model of game play based on the analysis of such configurations of play center dot to promote a radical constructivist teaching approach based on learning games through understanding' that challenges the long-established TGfU methodologyPurpose: This paper critically examines the contention of Grehaigne, Caty, and Godbout that the presentation of tactical data collected through the observation of novices playing sport in ill-structured domains, e.g. team games such as football, represent a useful pedagogical model that promotes learning games through understanding'. In rewording the familiar TGfU approach, and calling it learning games through understanding', Grehaigne, Caty, and Godbout challenge the evolving TGfU approach as too solutions based and not sufficiently student centred.Discussion: This paper challenges the use of radical constructivism as a construct for the development of a philosophy for instructing novices in team games, in this instance, football. It defines ill-structured and well-structured learning domains and suggests that effective pedagogy, the art of teaching, requires flexible attitudes towards the choice of pedagogy in games. By inference, it also challenges Grehaigne, Caty, and Godbout's assumption that the TGfU models previously published, e.g. TGfU, Game Sense, Play Practice, and interpreted in various texts, e.g. Transforming Play, Teaching Tactics and Game Sense, are not student-centred and teacher dominated.Conclusions: Grehaigne, Caty, and Godbout's work is important in the evolution of models of game instruction for use in PE contexts. The concept of learning games through understanding' is a timely reminder of the importance of pedagogies, for example, guided or discovery learning that induce effortful thinking. However, if we consider TGfU in its true philosophical light, that is, as a holistic and experiential approach to teaching, then it already encompasses learning games through understanding'. Because no two students learn or conceive knowledge in exactly the same way, teaching contexts require a flexible approach to instruction, based on a methodological continuum of empirical to radical constructivism. In short, providing novice learners with sufficient opportunities to learn, requires flexibility and a holistic experiential approach to teaching that is appropriate for the learner, activity and context. AD - [Slade, Dennis G.; Martin, Andrew J.] Massey Univ, Coll Hlth, Sch Sport & Exercise, Palmerston North, New Zealand. [Webb, Louisa A.] Loughborough Univ Technol, Sch Sport Exercise & Hlth Sci, Loughborough LE11 3TU, Leics, England. Slade, DG (corresponding author), Massey Univ, Coll Hlth, Sch Sport & Exercise, Palmerston North, New Zealand. d.g.slade@massey.ac.nz AN - WOS:000345339800005 AU - Slade, D. G. AU - Webb, L. A. AU - Martin, A. J. DO - 10.1080/17408989.2013.798405 J2 - Phys. Educ. Sport Pedag. KW - constraining games nonlinear pedagogy "Teaching Games for Understanding' radical constructivism ill-structured domains TEACHING GAMES PHYSICAL-EDUCATION COACHES INSTRUCTION CONSTRAINTS ASSUMPTIONS PEDAGOGY SPORTS MODEL PLAY Education & Educational Research LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: AU0UI Times Cited: 6 Cited Reference Count: 38 Slade, Dennis G. Webb, Louisa A. Martin, Andrew J. 6 2 33 ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD ABINGDON PHYS EDUC SPORT PEDA PY - 2015 SN - 1740-8989 SP - 67-78 ST - Providing sufficient opportunity to learn: a response to Grehaigne, Caty and Godbout T2 - Physical Education and Sport Pedagogy TI - Providing sufficient opportunity to learn: a response to Grehaigne, Caty and Godbout UR - ://WOS:000345339800005 VL - 20 ID - 761769 ER - TY - JOUR AB - Background and Objectives: High reliability organizations in health care must identify defects and systematically approach causal factors with subsequent process redesign to achieve goals important to patients, families, and staff. Root cause analysis (RCA) is a commonly leveraged strategy for reviewing adverse events and can yield immense benefits toward patient safety when applied alongside complementary change management strategies such as Lean and Six Sigma. We performed an RCA in response to a hospital-acquired venous thromboembolism (VTE) event in a postoperative patient for which pharmacologic VTE prophylaxis was not appropriately resumed following removal of an epidural catheter. Methods: A multidisciplinary stakeholder team was assembled to further understand the details of the event. A current process map was created and non-value-added steps were identified. Causal analysis revealed that frequent staff turnover, variable methods of communication between stakeholders, inconsistent responsibilities with respect to ordering and administering pharmacologic VTE prophylaxis, and lack of an established standard work process were key contributors toward the defect of concern. Several countermeasures were introduced to combat these identified root causes, including shifting responsibility for managing VTE prophylaxis orders periepidural catheter removal from the surgical house staff to our regional anesthesia service, and creation of an epidural catheter heparin restart order set, which in one step places an order to resume prophylaxis following catheter removal at a specific time. Recommendations from this session were disseminated to staff through previously established huddles that are a component of our daily management system. Results: Postintervention, review of our updated process demonstrated a reduction in variability through establishment of standard work that is primarily owned by a constant factor in this care pathway (our regional anesthesia team). On review of the subsequent 10 cases of patients with epidural catheters, all patients receiving pharmacologic VTE prophylaxis had a maximum of 1 dose stopped for epidural catheter removal, therefore minimizing time without VTE prophylaxis. Conclusions: RCA can be utilized in the aftermath of an adverse event to establish causal factors and identify countermeasures to prevent recurrence of such an event. It can be further augmented with additional change management strategies including Lean, Six Sigma, the Model for Improvement, and failure modes and effects analysis. These strategies allowed us to design effective error-reducing strategies to achieve a more reliable process, which yielded reduced VTE prophylaxis administration defects that in turn has prevented recurrence of hospital-acquired VTE in patients with epidural catheters. AD - [Slade, Justin J.] Stanford Univ, Dept Med, Stanford, CA 94305 USA. [Slade, Justin J.; Allaudeen, Nazima] Vet Affairs Palo Alto Hlth Care Syst, Med Serv, Palo Alto, CA 94304 USA. [Wrzesniewski, Carolyn E.] Vet Affairs Palo Alto Hlth Care Syst, Dept Pharm, Palo Alto, CA 94304 USA. [Hunter, Oluwatobi O.] Vet Affairs Palo Alto Hlth Care Syst, Anesthesiol & Perioperat Care Serv, Palo Alto, CA 94304 USA. Slade, JJ (corresponding author), Vet Affairs Palo Alto Hlth Care Syst, Palo Alto, CA 94304 USA. justin.slade@va.gov AN - WOS:000579208300011 AU - Slade, J. J. AU - Wrzesniewski, C. E. AU - Hunter, O. O. AU - Allaudeen, N. DA - Oct-Dec DO - 10.1097/qmh.0000000000000271 J2 - Qual. Manag. Health Care KW - adverse event Lean root cause analysis Six Sigma venous thromboembolism Health Care Sciences & Services Health Policy & Services LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: OC5PO Times Cited: 0 Cited Reference Count: 18 Slade, Justin J. Wrzesniewski, Carolyn E. Hunter, Oluwatobi O. Allaudeen, Nazima 0 1 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA QUAL MANAG HEALTH CA PY - 2020 SN - 1063-8628 SP - 253-259 ST - Complementing Root Cause Analysis With Improvement Strategies to Optimize Venous Thromboembolism Prophylaxis in Patients With Epidural Catheters T2 - Quality Management in Health Care TI - Complementing Root Cause Analysis With Improvement Strategies to Optimize Venous Thromboembolism Prophylaxis in Patients With Epidural Catheters UR - ://WOS:000579208300011 VL - 29 ID - 761404 ER - TY - JOUR AB - BACKGROUND Pulmonary embolism (PE) is the third most common potentially life-threatening cardiovascular disease. A new approach of pulmonary embolism response teams (PERTs) has been introduced to provide rapid multidisciplinary assessment and treatment of patients with PE. However, detailed data on institutional experience and clinical outcomes from such teams are missing. AIMS The aim of this study was to report our experience with the management of PE guided by the PERT-POZ within the first year of operation. METHODS We performed a prospective study of PERT-POZ activations at a university care center between October 2018 and October 2019. Patient characteristics, therapies, and clinical outcomes were evaluated. RESULTS There were 86 unique PERT-POZ activations, and PE was confirmed in 80 patients including: 9 patients (11.25%) classified as low-risk PE, 19 (23.75%) as intermediate-low risk, 38 (47.5%) as intermediate-high, and 14 (17.5%) as high-risk. Sixty patients (75%) received anticoagulation only, 28 (35%) direct oral anticoagulant, 7 (8.75%) vitamin K antagonist, 23 (28.75%) low-molecular-weight heparin, and 2 (2.50%) unfractionated heparin. Ten patients (12.5%) were treated with catheter-directed thrombectomy, 6 (7.5%) received systemic thrombolysis, 2 (2.5%) underwent surgical embolectomy, 2 (2.5%) were on extracorporeal membrane oxygenation support, and 2 (2.5%) underwent pharmacomechanical venous thrombectomy. There were 7 (8.75%) in-hospital deaths, and 2 (2.5%) deaths during a 3-month follow-up. Bleeding complications were rare: only 3 patients (3.75%) had major bleeding events, but none after administration of systemic thrombolysis. CONCLUSIONS Our study demonstrated that after the creation of PERT-POZ with a precise activation protocol, patients with intermediate and high-risk PE received most optimal treatment strategies. AD - [Slawek-Szmyt, Sylwia; Jankiewicz, Stanislaw; Smukowska-Gorynia, Anna; Janus, Magdalena; Klotzka, Aneta; Grygier, Marek; Mularek-Kubzdela, Tatiana; Lesiak, Maciej; Araszkiewicz, Aleksander] Poznan Univ Med Sci, Dept Cardiol 1, Ul Dluga 1-2, PL-61848 Poznan, Poland. [Puslecki, Mateusz; Jemielity, Marek] Poznan Univ Med Sci, Dept Cardiac Surg & Transplantol, Poznan, Poland. [Puslecki, Mateusz] Poznan Univ Med Sci, Dept Med Rescue, Poznan, Poland. [Krasinski, Zbigniew] Poznan Univ Med Sci, Gen & Vasc Surg Inst, Poznan, Poland. [Zabicki, Bartosz] Poznan Univ Med Sci, Dept Radiol, Poznan, Poland. [Elikowski, Waldemar] Jozef Strus Hosp, Dept Internal Med, Poznan, Poland. Slawek-Szmyt, S (corresponding author), Poznan Univ Med Sci, Dept Cardiol 1, Ul Dluga 1-2, PL-61848 Poznan, Poland. sylwia.slawek@skpp.edu.pl AN - WOS:000529814700006 AU - Slawek-Szmyt, S. AU - Jankiewicz, S. AU - Smukowska-Gorynia, A. AU - Janus, M. AU - Klotzka, A. AU - Puslecki, M. AU - Jemielity, M. AU - Krasinski, Z. AU - Zabicki, B. AU - Elikowski, W. AU - Grygier, M. AU - Mularek-Kubzdela, T. AU - Lesiak, M. AU - Araszkiewicz, A. DA - Apr DO - 10.33963/kp.15230 J2 - Kardiol. Pol. KW - pulmonary embolism pulmonary embolism response team catheter-directed thrombectomy systemic thrombolysis anticoagulation MECHANICAL THROMBECTOMY ASPIRATION THROMBECTOMY MULTICENTER TRIAL SINGLE-ARM THROMBOLYSIS FIBRINOLYSIS EMBOLECTOMY TIME CARE Cardiac & Cardiovascular Systems LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: LI9RY Times Cited: 2 Cited Reference Count: 42 Slawek-Szmyt, Sylwia Jankiewicz, Stanislaw Smukowska-Gorynia, Anna Janus, Magdalena Klotzka, Aneta Puslecki, Mateusz Jemielity, Marek Krasinski, Zbigniew Zabicki, Bartosz Elikowski, Waldemar Grygier, Marek Mularek-Kubzdela, Tatiana Lesiak, Maciej Araszkiewicz, Aleksander Slawek-Szmyt, Sylwia/AAT-4438-2020 Slawek-Szmyt, Sylwia/0000-0003-1143-2485; Puslecki, Mateusz/0000-0003-0015-2808 2 0 POLSKIE TOWARZYSTOWO KARDIOLOGICZNE WARSZAWA KARDIOL POL PY - 2020 SN - 0022-9032 SP - 300-310 ST - Implementation of a regional multidisciplinary pulmonary embolism response team: PERT-POZ initial 1-year experience T2 - Kardiologia Polska TI - Implementation of a regional multidisciplinary pulmonary embolism response team: PERT-POZ initial 1-year experience UR - ://WOS:000529814700006 VL - 78 ID - 761448 ER - TY - JOUR AB - BACKGROUND: Pulmonary embolism (PE) is the third most common potentially life‑threatening cardiovascular disease. A new approach of pulmonary embolism response teams (PERTs) has been introduced to provide rapid multidisciplinary assessment and treatment of patients with PE. However, detailed data on institutional experience and clinical outcomes from such teams are missing. AIMS: The aim of this study was to report our experience with the management of PE guided by the PERT-POZ within the first year of operation. METHODS: We performed a prospective study of PERT-POZ activations at a university care center between October 2018 and October 2019. Patient characteristics, therapies, and clinical outcomes were evaluated. RESULTS: There were 86 unique PERT-POZ activations, and PE was confirmed in 80 patients including: 9 patients (11.25%) classified as low‑risk PE, 19 (23.75%) as intermediate‑low risk, 38 (47.5%) as intermediate‑high, and 14 (17.5%) as high‑risk. Sixty patients (75%) received anticoagulation only, 28 (35%) direct oral anticoagulant, 7 (8.75%) vitamin K antagonist, 23 (28.75%) low-molecular-weight heparin, and 2 (2.50%) unfractionated heparin. Ten patients (12.5%) were treated with catheter‑directed thrombectomy, 6 (7.5%) received systemic thrombolysis, 2 (2.5%) underwent surgical embolectomy, 2 (2.5%) were on extracorporeal membrane oxygenation support, and 2 (2.5%) underwent pharmacomechanical venous thrombectomy. There were 7 (8.75%) in‑hospital deaths, and 2 (2.5%) deaths during a 3‑month follow‑up. Bleeding complications were rare: only 3 patients (3.75%) had major bleeding events, but none after administration of systemic thrombolysis. CONCLUSIONS: Our study demonstrated that after the creation of PERT-POZ with a precise activation protocol, patients with intermediate and high‑risk PE received most optimal treatment strategies. AD - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland. sylwia.slawek@skpp.edu.pl 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland; Department of Medical Rescue, Poznan University of Medical Sciences, Poznań, Poland Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland General and Vascular Surgery Institute, Poznan University of Medical Sciences, Poznań, Poland Department of Radiology, Poznan University of Medical Sciences, Poznań, Poland Department of Internal Medicine, Józef Struś Hospital, Poznań, Poland AN - 32165606 AU - Sławek-Szmyt, S. AU - Jankiewicz, S. AU - Smukowska-Gorynia, A. AU - Janus, M. AU - Klotzka, A. AU - Puślecki, M. AU - Jemielity, M. AU - Krasiński, Z. AU - Żabicki, B. AU - Elikowski, W. AU - Grygier, M. AU - Mularek-Kubzdela, T. AU - Lesiak, M. AU - Araszkiewicz, A. DA - Apr 24 DO - 10.33963/kp.15230 DP - NLM ET - 2020/03/14 J2 - Kardiologia polska LA - eng M1 - 4 N1 - 1897-4279 Sławek-Szmyt, Sylwia Jankiewicz, Stanisław Smukowska-Gorynia, Anna Janus, Magdalena Klotzka, Aneta Puślecki, Mateusz Jemielity, Marek Krasiński, Zbigniew Żabicki, Bartosz Elikowski, Waldemar Grygier, Marek Mularek-Kubzdela, Tatiana Lesiak, Maciej Araszkiewicz, Aleksander Journal Article Poland Kardiol Pol. 2020 Apr 24;78(4):300-310. doi: 10.33963/KP.15230. Epub 2020 Mar 12. PY - 2020 SN - 0022-9032 SP - 300-310 ST - Implementation of a regional multidisciplinary pulmonary embolism response team: PERT-POZ initial 1-year experience T2 - Kardiol Pol TI - Implementation of a regional multidisciplinary pulmonary embolism response team: PERT-POZ initial 1-year experience VL - 78 ID - 760350 ER - TY - GEN AU - Sławek-Szmyt, Sylwia AU - Jankiewicz, Stanisław AU - Smukowska-Gorynia, Anna AU - Janus, Magdalena AU - Klotzka, Aneta AU - Puślecki, Mateusz AU - Jemielity, Marek AU - Krasiński, Zbigniew AU - Żabicki, Bartosz AU - Elikowski, Waldemar AU - Grygier, Marek AU - Mularek-Kubzdela, Tatiana AU - Lesiak, Maciej AU - Araszkiewicz, Aleksander DA - 2020/01/01 DB - Federal Science Library - Canada PY - 2020 SN - 0022-9032 ST - Implementation of regional multidisciplinary pulmonary embolism response team – PERT-POZ initial one-year experience TI - Implementation of regional multidisciplinary pulmonary embolism response team – PERT-POZ initial one-year experience UR - https://fsl-bsf.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwtV3dbtowFLa6Vpt6U7Vbp_7LmtSLCaV14gaC1E6aWtptaBsbIFW9QQ44VRQSEBQherV32FvssfYkPceOQ0Iv2l3sJoITfHDwJx_78J3PhHDniFkLc0LZtSvdnsuY8DFoOBXX8exyxWcSImzgYd1wu81r1yfffqD2szmnZG77rwMPNhh6LKT9h8HPnIIBXgME4AoggOuzYKDUf-O0wEgtDfEoBpX-U1zCQlXucNKHjqn63Ngf9PH8jJHm0MoSgCEuGWoELzVqP1tW4_tNKUT2Ea5oE2nNUBVIZuLJ-YVvXfFecaIVeDDEOBJKIqrq5nMRzcNz99BzxFRGVvM-nqkA0Zz1p2EWPL6IJArlNOzea46aSMKxaTXPFk2iwRS-wroajGaJpgOjUnTOyURn2cUtEqrTO2nyA3a6yKTL50OxGKHKdIp0MRpwDrMLDFC9gac8pX__FBS3FyJhxk-EnZFq3Kk3OropCrHHvbB7dyYTq918QVYcWOggh_Ticz3b4Xtl2zby9NgrLWWlXB2bXuQWQJpyqwJza52spVsQ-lGDZYMsyeQ1efU1JVm8IX-KmKGDgBrM0EeYoaexGEUfMuScHqv3qdnAqGg1mCpaEWDG8vfXb2oQRlOEUYMwOkfYJnl_WWudf7LMs3aGWj2l8-i35W_JcgIutgj1bdwvix4rC5gkPFaVQbcS8B7jgnEpg23y7ml_O8_50C5ZneNpjyzfjSZyn7wMxn3LHwcHalgfAL3ghOE ID - 761977 ER - TY - JOUR AB - Background: Mechanical thrombectomy (MD for ischemic stroke can be performed under local anesthesia (LA), conscious sedation (CS), or general anesthesia (GA). The need for monitoring by anesthesia providers may be resource intensive. We sought to determine differences in outcomes of MT when sedation is performed by an anesthesia team compared to sedation-trained providers. Methods: We performed a retrospective analysis on patients who were screened by a pre-hospital stroke severity screening tool and underwent MT at two stroke centers. Baseline characteristics, time metrics, sedatives, pen-procedural intubation, complications, and outcomes were recorded. Good outcome was defined as modified Rankin score of <= 2. Results: We analyzed 104 patients (sedation-trained provider = 63, anesthesia team = 41) between July 2015 and December 2017. In the sedation-trained provider group, four patients required intervention by an anesthesia team. There were no differences in patients receiving LA (sedation-trained provider 24% vs. anesthesia team 27% p = 0.82), CS (70 vs. 63%, p = 0.53), or GA (6 vs. 10%, p = 0.71) between groups. Sedation-trained providers were more likely to use only one drug during the procedure (62 vs. 34%, p = 0.009). The rate of procedural complications (9.5 vs. 4.5%, p = 0.48), good outcome (56 vs. 39%, p = 0.11), and mortality (22 vs. 24%, p = 0.82) was similar between groups. Sedation by provider type did not predict functional outcome or mortality at 3 months. Conclusions: Sedation-trained providers are capable of delivering appropriate sedation without compromising patient safety. The use of "as needed" anesthesia teams for MT may have considerable effect on resource allocation and cost. AD - [Slawski, Diana E.; Salahuddin, Hisham; Saju, Linda; Korsnack, Andrea; Tietjen, Gretchen; Castonguay, Alicia C.; Kung, Vieh; Burgess, Richard; Zaidi, Syed F.; Jumaa, Mouhammad A.] Univ Toledo, Med Ctr, Dept Neurol, 2801 W Bancroft St, Toledo, OH 43606 USA. [Shawver, Julie] ProMed Toledo Hosp, Dept Neurol, Toledo, OH USA. [Papadimos, Thomas J.] Univ Toledo, Dept Anesthesiol, Med Ctr, 2801 W Bancroft St, Toledo, OH 43606 USA. Jumaa, MA (corresponding author), Univ Toledo, Med Ctr, Dept Neurol, 2801 W Bancroft St, Toledo, OH 43606 USA. mouhammad.jumaa@utoledo.edu AN - WOS:000462790000001 AU - Slawski, D. E. AU - Salahuddin, H. AU - Saju, L. AU - Shawver, J. AU - Korsnack, A. AU - Tietjen, G. AU - Papadimos, T. J. AU - Castonguay, A. C. AU - Kung, V. AU - Burgess, R. AU - Zaidi, S. F. AU - Jumaa, M. A. C7 - 296 DA - Mar DO - 10.3389/fneur.2019.00296 J2 - Front. Neurol. KW - stroke mechanical thrombectomy anesthesia sedation provider thrombectomy ACUTE ISCHEMIC-STROKE GENERAL-ANESTHESIA ENDOVASCULAR THERAPY CONSCIOUS SEDATION MANAGEMENT OUTCOMES Clinical Neurology Neurosciences LA - English M3 - Article N1 - ISI Document Delivery No.: HR0AM Times Cited: 1 Cited Reference Count: 21 Slawski, Diana E. Salahuddin, Hisham Saju, Linda Shawver, Julie Korsnack, Andrea Tietjen, Gretchen Papadimos, Thomas J. Castonguay, Alicia C. Kung, Vieh Burgess, Richard Zaidi, Syed F. Jumaa, Mouhammad A. Jumaa, Mouhammad/0000-0002-7165-797X 1 0 FRONTIERS MEDIA SA LAUSANNE FRONT NEUROL PY - 2019 SN - 1664-2295 SP - 8 ST - Monitored Anesthesia Care by Sedation-Trained Providers in Acute Stroke Thrombectomy T2 - Frontiers in Neurology TI - Monitored Anesthesia Care by Sedation-Trained Providers in Acute Stroke Thrombectomy UR - ://WOS:000462790000001 VL - 10 ID - 761533 ER - TY - JOUR AB - INTRODUCTION AND AIMS: The Constitution of the Patient Safety Program (PSP) in our dialysis units had the following objectives: 1 - promote safe care in the treatment of patients on chronic hemodialysis (HD), establishing barriers to prevent occurrences of adverse events; 2 -promote actions for risk management in the whole process of patient care; 3 - develop actions to integrate the multidisciplinary committee; 4 - Promoting mechanisms to identify and assess the existence of nonconformity (equipment, medicines and supplies); 5 - Develop and implement training programs for all professionals. Tools are required for the evaluation of measurable indicators in the established goals. Consolidation of data provides a vision of the treatment quality, identifying and mapping critical areas and in guiding the training of preventive action plans. METHODS: The PSP establishes security strategies in daily clinical practice of our dialysis units, through barriers that prevent adverse events. The management tool is the PDCA: Plan: development of targets, performance models and routines. DO: measure actual performance. Check: establish a balance between the objectives and performance. Act: execute and refine. We use the Ishikawa diagram for identification and correction of the main points of the dialysis process fragile.Active flaws related to persons who are part of the system and have instant impact on defense barrier. Are detectable with a proactive management. Latent conditions can remain hidden on the system, until its alignment with the active failures. Are more difficult to detect before the emergence of adverse events and require a reactive management. Based on the Pareto principle , the occurrence of main ADVERSE EVENTS is under continuous surveillance of the PSP. a) Venous Access: Infection, thrombosis, bleeding; b) Pyrogeny; c) Seroconversion for viral hepatitis; d) Biological accident; e) Fall post- HD; f) Clinical Events related to HD, with or without need of hospitalization; g) Adverse event resulting from the administration of medications RESULTS: Major Security protocols elaborated: Personal visual identification system with photo, including morbidities, allergies, disabilities, risk of falling, dosage of heparin, ultrafiltration limit, in place established for their treatment; Individualized prescription of HD; Continuing education program; Safe use of medicines; Diary Equipment checklist (hemodialysis machines, emergency equipment and water treatment); Prevention of risks related to Vascular Access. The Singularity therapeutic plan (STP) is a form of organization of patient care management, established in the process of work of all the members of the multidisciplinary team. Is an enabling tool of interactive dialogue between the professionals on attention to the patient, allowing the sharing of case studies and longitudinal follow-up of treatment. The singularity (the difference) is the central element of articulation, reminding that the syndromic diagnoses tend to group the patients and minimize the individualization of their differences. Clinical indicators - monthly (M), annual (A): Hospitalization rate (A), < 5%; Seroconversion rate for viral hepatitis, 0%; mortality rate (A), < 5%; Patients with Hemoglobin> 10 g/dl (M), 80%; Patient with serum albumin > 3 mg%, 90%; SpKt/V ≥ 1.4, 80%; Patients with normal serum values of P3+ (M), 60%; Patients with serum PTH < 400pg/ml, 70%; Rate of infection related to healthcare, (M) < 5%; Rate of HD complications (M), < 5% CONCLUSIONS: The PSP does data collection, and after statistical analysis, have a profile of quality of pacient care, determines the actions to no-conformity and can get daring clinical indicators. AD - S. Sloboda, Dialysis Renalduc, Rio de Janeiro, Brazil AU - Sloboda, S. AU - Sloboda, A. AU - Montero, C. DB - Embase DO - 10.1093/ndt/gfx175 KW - endogenous compound hemoglobin heparin serum albumin allergy attention biological accident bleeding case report checklist clinical indicator clinical practice continuing education diagnosis disability doctor patient relationship drug therapy female follow up hemodialysis machine hepatitis hospitalization human human tissue human versus animal comparison individualization infection rate information processing male morbidity mortality rate nonhuman patient care patient safety prescription prevention seroconversion statistical analysis thrombosis ultrafiltration vascular access water treatment LA - English M3 - Conference Abstract N1 - L617302557 2017-07-18 PY - 2017 SN - 1460-2385 SP - iii622 ST - Patient safety program: A program for management of patient care in chronic haemodialysis in a Brazilian clinic T2 - Nephrology Dialysis Transplantation TI - Patient safety program: A program for management of patient care in chronic haemodialysis in a Brazilian clinic UR - https://www.embase.com/search/results?subaction=viewrecord&id=L617302557&from=export http://dx.doi.org/10.1093/ndt/gfx175 VL - 32 ID - 760948 ER - TY - JOUR AB - Background: Pulmonary Embolism Response Team (PERT) initiatives are increasingly implemented, with the premise of improved outcomes after expedited, multidisciplinary, expert approach to the patient with severe PE. There is however paucity of comparative outcome data. A growingly recognized PE outcome is post-PE syndrome, defined by persistently abnormal RV function, functional status, and quality of life among PE survivors. Aims: To quantify the incidence of post-PE syndrome after PERT activation. Methods: We initiated a PERT registry that includes initial activation and outpatient follow up data. A follow up ECHO was ordered on patients with persistent symptoms after 3 months. Patients were classified as post-PE syndrome if the imaging right ventricular systolic pressure (RVSP) increased. Continuous variables are reported as median and categorical as percentages. We used SPSS for analysis. Results: A total of 58 patients required activation of PERT, age 70.5, most (65.5%) were female, PESI class III and 32.7% had cancer (Table 1). The RV was dilated by CT criteria in 48.9% of the patients and 40% had troponin elevation on presentation. PERT decided to do thrombolysis in 10%. A reported 8.5% of the patients died. Among survivors, 11% had an abnormal right ventricular systolic pressure per ECHO. Right heart ECHO variables are tabulated in Table 2. Positive troponin, increased RV/LV ratios, increased RVSP at diagnosis were not associated with post-PE syndrome incidence. Patients with PESI class V were more likely to have an abnormal ECHO at follow-up, but this result was not statistically significant (OR 2.1 95%CI 0.3-13.4). Conclusions: PERT activation selects more complex patients with a high incidence of post-PE syndrome. Given our results, accounting for a 20-30% of post PE syndrome reported in the literature, we estimate that a 500 patient comparative trial may define if there is clinical utility of PERT initiatives, and is needed as to justify its growing acceptance. AD - K. Smart, NorthShore University HealthSystem University of Chicago Pritzker, School of Medicine, Internal Medicine, Evanston, United States AU - Smart, K. AU - Ahsan, A. AU - Iftikhar, O. AU - Tafur, A. DB - Embase DO - 10.1002/rth2.12012 KW - endogenous compound troponin adult blood clot lysis cancer patient cancer survival conference abstract controlled study data analysis software diagnosis female follow up heart right ventricle human incidence major clinical study male malignant neoplasm outpatient pulmonary embolism response team survivor syndrome systolic blood pressure LA - English M3 - Conference Abstract N1 - L624158359 2018-10-09 PY - 2017 SN - 2475-0379 SP - 952-953 ST - Post-pulmonary embolism syndrome development among patients who needed pulmonary embolism response team assessment T2 - Research and Practice in Thrombosis and Haemostasis TI - Post-pulmonary embolism syndrome development among patients who needed pulmonary embolism response team assessment UR - https://www.embase.com/search/results?subaction=viewrecord&id=L624158359&from=export http://dx.doi.org/10.1002/rth2.12012 VL - 1 ID - 760929 ER - TY - JOUR AB - OBJECTIVE: To compare multidisciplinary team (MDT) decision making at our centre with the suggested management from the recently published Unruptured Intracranial Aneurysm Treatment Score (UIATS), with particular focus on disagreements between the two bodies of expert opinion. DESIGN: A retrospective audit of local practice. SUBJECTS: Adult patients with incidental cerebral saccular aneurysms referred to The National Hospital for Neurology and Neurosurgery Neurovascular MDT. METHODS: Review of MDT records from 2010-2015 and collection of UIATS criteria. MDT decisions for each aneurysm were designated as conservative or treatment group, then assessed for correlation with the UIATS. RESULTS: Data was collected on 398 aneurysms from 296 patients. 57% of aneurysms were managed conservatively and 43% were treated with endovascular or open repair. Total follow up was 8409 aneurysm months (mean: 21 months per aneurysm). The overall proportion of agreement (p0) was 66.6% (95% CI: 61.9-71.2). Cohen's Kappa (k) was 0.325 suggesting only a "fair" level of agreement between the two raters. Absolute agreement rates increased from 60% in 2010 to 74% in 2015. Aneurysm size was an important factor for disagreement, 77% of aneurysms treated following MDT, but not in agreement with the UIATS, were >7 mm, compared with only 70.5% in those treated following MDT and in agreement with UIATS. CONCLUSION: There was disagreement between the two expert opinions analysed in this study. A key factor was aneurysm size, with decision making at our centre seemingly more guided by older landmark papers such as work by the International Study of Unruptured Intracranial Aneurysms (ISUIA) group. However, agreement was at its highest at the end of the study period, suggesting increasing convergence between the two bodies of expert opinion. The reasons for disagreement and particularly clinicians' reliance on aneurysm size in decision making is something that needs consideration when planning and auditing aneurysm services. AD - a Victor Horsley Department of Neurosurgery , The National Hospital for Neurology and Neurosurgery , London , UK. b Lysholm Department of Neuroradiology , The National Hospital for Neurology and Neurosurgery , London , UK. AN - 29764206 AU - Smedley, A. AU - Yusupov, N. AU - Almousa, A. AU - Solbach, T. AU - Toma, A. K. AU - Grieve, J. P. DA - Oct DO - 10.1080/02688697.2018.1468019 DP - NLM ET - 2018/05/17 J2 - British journal of neurosurgery KW - Adult Aged Aneurysm, Ruptured/epidemiology/therapy *Clinical Decision-Making Conservative Treatment Endovascular Procedures Female Humans *Incidental Findings Intracranial Aneurysm/diagnostic imaging/surgery/*therapy Male Middle Aged Neurosurgical Procedures Observer Variation *Patient Care Team Retrospective Studies Treatment Outcome Aneurysm haemorrhage incidental subarachnoid unruptured LA - eng M1 - 5 N1 - 1360-046x Smedley, Alex Yusupov, Nate Almousa, Alaa Solbach, Thomas Toma, Ahmed K Grieve, Joan P Comparative Study Journal Article England Br J Neurosurg. 2018 Oct;32(5):536-540. doi: 10.1080/02688697.2018.1468019. Epub 2018 May 15. PY - 2018 SN - 0268-8697 SP - 536-540 ST - Management of incidental aneurysms: comparison of single Centre multi-disciplinary team decision making with the unruptured incidental aneurysm treatment score T2 - Br J Neurosurg TI - Management of incidental aneurysms: comparison of single Centre multi-disciplinary team decision making with the unruptured incidental aneurysm treatment score VL - 32 ID - 760267 ER - TY - JOUR AB - Objective In 2014, our hospital implemented an early warning score (EWS) to identify inpatients at risk for clinical deterioration. EWS ≥ 8 is associated with ≥ 10% mortality in medical admissions. Since postoperative hemodynamic changes may alter EWS, we evaluated EWS in post-laparotomy patients. Methods Gynecologic oncology patients admitted for laparotomy from 9/1/2014 to 7/31/2015 were categorized by highest EWS during admission: < 5, 5–7, and ≥ 8. The primary outcome was a composite including death, ICU transfer, rapid response team activation, pulmonary embolus, sepsis, and reoperation. For patients with the composite, highest EWS prior to that outcome was evaluated. Secondary outcomes were length of stay (LOS), readmission, and transfusion. Groups were compared using chi-square test for trend, analysis of variance, and Kruskal-Wallis tests. A receiver operating characteristic (ROC) curve estimated the association between EWS and the composite outcome. Results 411 patients were included: 217 (52.8%) with EWS < 5, 151 (36.7%) with EWS 5–7, and 43 (10.5%) with EWS ≥ 8. The composite occurred in 32.6% of patients with EWS ≥ 8, 7.3% with EWS 5–7, and 0% with EWS < 5 (p < 0.01). EWS ≥ 8 was associated with longer LOS, higher readmission rate, and more transfusions. For the composite, the area under the ROC curve was 0.89 (95% CI 0.84–0.94). EWS ≥ 5 had 100% sensitivity and 56.2% specificity for the primary outcome; EWS ≥ 8 had 56.0% sensitivity and 92.5% specificity for the primary outcome. Conclusions EWS ≥ 5 after laparotomy is associated with adverse outcomes. Future studies should evaluate the ability of EWS to predict and prevent these outcomes. AD - H.J. Smith, 176F, Room 5329, 619 19th Street South, Birmingham, AL, United States AU - Smith, H. J. AU - Pasko, D. N. AU - Haygood, C. L. W. AU - Boone, J. D. AU - Harper, L. M. AU - Straughn, J. M. DB - Embase Medline DO - 10.1016/j.ygyno.2016.08.153 KW - adult adverse outcome aged analysis of variance article blood transfusion cancer patient chi square test cohort analysis controlled study diagnostic test accuracy study early warning score endometrium cancer female female genital tract cancer hemodynamic parameters hospital admission hospital readmission human hysterectomy intensive care unit Kruskal Wallis test laparotomy length of stay lung embolism major clinical study middle aged outcome assessment ovariectomy ovary cancer patient transport postoperative period priority journal rapid response team receiver operating characteristic reoperation scoring system sensitivity and specificity sepsis surgical patient trend study uterine cervix cancer LA - English M1 - 1 M3 - Article N1 - L612620314 2016-10-14 2016-10-26 PY - 2016 SN - 1095-6859 0090-8258 SP - 105-108 ST - Early warning score: An indicator of adverse outcomes in postoperative patients on a gynecologic oncology service T2 - Gynecologic Oncology TI - Early warning score: An indicator of adverse outcomes in postoperative patients on a gynecologic oncology service UR - https://www.embase.com/search/results?subaction=viewrecord&id=L612620314&from=export http://dx.doi.org/10.1016/j.ygyno.2016.08.153 VL - 143 ID - 760994 ER - TY - JOUR AB - Objectives: In 2014, our hospital implemented an early warning score (EWS) system, which calculates an aggregate score based on vital signs and level of alertness. EWS of 8 or higher is associated with a mortality rate of 10% or greater in acute medical admissions. Postoperative pain or pain management may elevate EWS and decrease its specificity, therefore we evaluated EWS in postlaparotomy patients on a gynecologic oncology service.Methods: This retrospective cohort included gynecologic oncology patients who had a laparotomy between September 2014 and July 2015. Patients were categorized by highest EWS over admission: EWS less than 5, EWS of 5 to 7, and EWS of 8 or higher. The primary outcome was a composite of death, transfer to the intensive care unit (ICU), rapid response team (RRT) activation, major cardiac event, pulmonary embolus (PE), sepsis, and reoperation. Planned ICU admissions were not included in the composite. Secondary outcomes were length of stay (LOS), 30-day readmission, and transfusion. Groups were compared using the χ2 test for trend, analysis of variance, and Kruskal-Wallis tests, as appropriate. A receiver operating characteristic (ROC) curve was created to estimate the association of EWS with the composite outcome. Sensitivity and specificity of EWS for the composite outcome was determined.Results: A total of 411 patients were included: 217 (52.8%) with EWS less than 5, 150 (36.5%) with EWS of 5 to 7, and 44 (10.7%) with EWS of 8 or higher. Twenty-five patients (6.1%) had the composite outcome, including 2 deaths, 12 ICU admissions, 9 RRT activations, 2 cardiac events, 4 PEs, 14 sepsis diagnoses, and 3 reoperations. Increasing age, cancer diagnosis and stage, and bowel surgery were associated with higher EWS. The composite outcome occurred in 34.1% of patients with EWS of 8 or higher versus 6.7% with EWS of 5 to 7 and 0% with EWS less than 5 (P <.01). EWS of 8 or higher was associated with longer mean LOS (8.1 vs 4.6 vs 3.5 days, P <.01), readmission (25.0% vs 12.7% vs 6.9%, P <.01), and transfusion (29.6% vs 14.8% vs 5.5%, P <.01). For the primary outcome, the area under the ROC curve was 0.91 (95% CI 0.87-0.96, Fig. 1). EWS of 8 had 60.0% sensitivity and 92.5% specificity for the primary outcome.Conclusions: In gynecologic oncology patients, EWS of 8 or higher after laparotomy is associated with a significant increase in postoperative adverse outcomes, longer LOS, and more readmissions and transfusions. Future studies should evaluate the ability of EWS to predict and prevent these outcomes. (figure present). AD - H.J. Smith, University of Alabama at Birmingham, Birmingham, AL, United States AU - Smith, H. J. AU - Pasko, D. N. AU - Walters Haygood, C. L. AU - Boone, J. D. AU - Harper, L. M. AU - Straughn Jr, J. M. DB - Embase DO - 10.1016/j.ygyno.2016.04.350 KW - human oncology adverse outcome patient female neoplasm society hospital readmission transfusion sepsis receiver operating characteristic laparotomy death postoperative pain lung embolism mortality Kruskal Wallis test sensitivity and specificity surgery rapid response team alertness intensive care unit analysis of variance vital sign length of stay reoperation analgesia diagnosis cancer diagnosis intestine hospital LA - English M3 - Conference Abstract N1 - L72341264 2016-07-23 PY - 2016 SN - 1095-6859 SP - 132-133 ST - Early warning score: An indicator of adverse outcomes in postoperative patients on a gynecologic oncology service T2 - Gynecologic Oncology TI - Early warning score: An indicator of adverse outcomes in postoperative patients on a gynecologic oncology service UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72341264&from=export http://dx.doi.org/10.1016/j.ygyno.2016.04.350 VL - 141 ID - 761019 ER - TY - JOUR AB - Current guidelines state thrombolysis is first line therapy in hypotensive PE patients and may be of benefit in normotensive patients with right heart strain. There is, however, no specific guidance on selecting these patients. In 2010, St George's Hospital, under the guidance of a multidisciplinary team of specialists, initiated an algorithm for the management of patients with massive PE. The aim of this study was to determine whether the algorithm is an effective means of assessing a series of nine patients who received thrombolytic therapy over a two year period. The age range of the patients was 36-81 years, 5 were male.5 patients had identifiable thromboembolic risk factors: pregnancy and protein S deficiency (1), recent lower limb surgery (2), new cancer diagnosis (1) and chronic immobility (1). All 9 patients had a computed tomography pulmonary angiogram (CTPA) confirming large proximal PEs with elevated troponin I and NT-pro-BNP levels at diagnosis. Right heart strain was demonstrated on echocardiogram in five patients with evidence of intracardiac thrombus in two. The remaining patients had right heart strain demonstrated by CTPA. The indications for thrombolysis were cardiac arrest (1), hypotension (1), intracardiac thrombus (2) and significant right ventricular strain(5).There was one mortality within this cohort following retroperitoneal bleed. This patient underwent an echocardiogram 5 days post thrombolysis revealing severely dilated right heart and RVSP of 61mmHg. Patients achieved good resolution of thrombus on repeat CTPA, and no evidence of right heart strain on follow up echocardiogram. The majority of these patients had improved right ventricular function post thrombolysis. This small cohort study demonstrates the variability in the clinical presentations and physiological manifestations of massive PE, hence the need for early specialist input. The algorithm is an effective tool in identifying high mortality risk patients and those likely to develop pulmonary hypertension, thus allowing early specialist review and intervention. AD - V. Smith, St George's Hospital, London, United Kingdom AU - Smith, V. AU - Tunnicliffe, G. AU - Fiorino, G. AU - Draper, A. AU - Vlahos, I. AU - Shannon, M. AU - Madden, B. P. DB - Embase DO - 10.1136/thoraxjnl-2012-202678.432 KW - troponin I antihypertensive agent algorithm lung embolism heart case study society winter human female patient blood clot lysis medical specialist thrombus echocardiography intracardiac drug administration mortality thromboembolism fibrinolytic therapy hypotension follow up risk factor hospital computer assisted tomography male immobilization cancer diagnosis surgery diagnosis leg protein S deficiency cohort analysis heart arrest heart ventricle function pregnancy therapy pulmonary hypertension L1 - http://thorax.bmj.com/content/67/Suppl_2/A126.2.abstract?sid=7c828d23-77e7-42ba-a6bd-fa2a14c22257 LA - English M3 - Conference Abstract N1 - L71126326 2013-08-07 PY - 2012 SN - 0040-6376 SP - A126-A127 ST - Management algorithm for pulmonary embolism (PE) with right heart strain: A case series T2 - Thorax TI - Management algorithm for pulmonary embolism (PE) with right heart strain: A case series UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71126326&from=export http://dx.doi.org/10.1136/thoraxjnl-2012-202678.432 VL - 67 ID - 761185 ER - TY - JOUR AB - BACKGROUND: In-hospital stroke events account for 2% to 17% of all ischemic strokes in the United States. Current stroke guidelines do not provide guidance on how to care for in-hospital stroke. Use of checklists during high-acuity events reduces error and provides clarity for responding staff. We sought to determine whether the use of an evidence-based checklist to guide in-hospital stroke response improved intervention times and patient outcomes. METHODS: This study used a retrospective chart review of patients hospitalized between January 1, 2016, and December 31, 2018, at a community hospital certified as a primary stroke center with the Joint Commission. Encounters were sorted into preintervention and postintervention groups to evaluate for change in treatment rates, new or worsened disability, and mortality. Nursing staff who respond to in-hospital stroke calls ("response staff") were also surveyed regarding their perception of benefit and firsthand experience when using the checklist. RESULTS: A total of 168 patient charts were reviewed (18 prechecklist, 150 postchecklist). After checklist implementation, treatment with intravenous thrombolytics for in-hospital stroke events increased from 0% to 11%. All-cause mortality decreased from 23.1% to 15.0%, whereas ambulatory disability at discharge increased from 38.0% to 62.1%. The increase in disability likely reflects the reduction in mortality, improved data collection, and the increase in postimplementation reporting. CONCLUSIONS: Use of a checklist during inpatient stroke events can potentially increase adherence to guidelines for appropriate treatment and reduce mortality. Hospital response teams should consider use of a structured response system with an evidence-based checklist for high-acuity, low-frequency events such as in-hospital stroke. AD - Questions or comments about this article may be directed to Joshua Snavely, DNP ARNP ACNPC-AG CEN SCRN EMT-P, at joshuasnavely@chifranciscan.org. J.S. is a Neurovascular Nurse Practitioner, Franciscan Neurology Associates, Tacoma, WA. Hilaire Thompson, PhD ARNP AGACNP-BC CNRN FAAN, is Graduate Program Director, University of Washington School of Nursing; Joanne Montgomery Endowed Professor; Affiliate Professor of Biomedical Informatics and Medical Education, University of Washington School of Medicine, Seattle, WA. Elizabeth Bridges, PhD RN CCNS FCCM FAAN, is Professor, Biobehavioral Nursing and Health Informatics, University of Washington; Clinical Nurse Researcher, University of Washington Medical Center, Seattle, WA. Joelle Fathi, DNP ARNP ANP-BC, is Professor, Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA. AN - 32168017 AU - Snavely, J. AU - Thompson, H. AU - Bridges, E. AU - Fathi, J. DA - Jun DO - 10.1097/jnn.0000000000000508 DP - NLM ET - 2020/03/14 J2 - The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses LA - eng M1 - 3 N1 - 1945-2810 Snavely, Joshua Thompson, Hilaire Bridges, Elizabeth Fathi, Joelle Journal Article United States J Neurosci Nurs. 2020 Jun;52(3):136-142. doi: 10.1097/JNN.0000000000000508. PY - 2020 SN - 0888-0395 SP - 136-142 ST - Impact of a Structured Response and Evidence-Based Checklist on In-hospital Stroke Outcomes T2 - J Neurosci Nurs TI - Impact of a Structured Response and Evidence-Based Checklist on In-hospital Stroke Outcomes VL - 52 ID - 760410 ER - TY - JOUR AB - This investigation aimed to measure door-to-electrocardiogram (EKG) time in patients with acute myocardial infarction who were attended at the emergency room of a General Hospital. This is a cohort study which evaluated the time of arrival, EKG, nursing and thrombolytic care. Data were obtained from records from March to July of 2006. The sample was composed of 53 patients with an average age of 61.1 +/- 12.2 years, 64% male. The first attendance was performed by the nurse staff 50% of the patients were treated in eight minutes and the door-to-EKG time was within 20 minutes. There was no difference between the door-to-EKG time and the mean of transportation used to get to the hospital (P = 0.39). The shift and the medical specialty did not influence the EKG time (P = 0.23) and (P = 0.14). The study results show an increase in time for EKG performance. However it was not possible to identify the factors that delayed the EKG AD - Serviço de Terapia Intensiva e Hemodinâmica do Hospital Geral de Caxias do Sul, Rio Grande do Sul, Brasil. AN - 19653565 AU - Soares, T. AU - de Souza, E. N. AU - Moraes, M. A. AU - Azzolin, K. DA - Mar DP - NLM ET - 2009/08/06 J2 - Revista gaucha de enfermagem KW - Aged Cohort Studies Comorbidity Early Diagnosis *Electrocardiography Emergency Service, Hospital/organization & administration/*statistics & numerical data Female Hospitals, General/organization & administration Humans Male Middle Aged Myocardial Infarction/*diagnosis/drug therapy/nursing Patient Admission/*statistics & numerical data Patient Care Team Thrombolytic Therapy/statistics & numerical data Time Factors Transportation of Patients/methods/statistics & numerical data LA - por M1 - 1 N1 - Soares, Tatiana de Souza, Emiliane Nogueira Moraes, Maria Antonieta Azzolin, Karina Journal Article Brazil Rev Gaucha Enferm. 2009 Mar;30(1):120-6. OP - Tempo porta-eletrocardiograma (ECG): um indicador de eficácia no tratamento do infarto agudo do miocárdio. PY - 2009 SN - 0102-6933 (Print) 0102-6933 SP - 120-6 ST - [Door-to-electrocardiogram (EKG) time: an indicator of efficacy in the treatment of acute myocardial infarction] T2 - Rev Gaucha Enferm TI - [Door-to-electrocardiogram (EKG) time: an indicator of efficacy in the treatment of acute myocardial infarction] VL - 30 ID - 760500 ER - TY - JOUR AB - The Stroke Angel initiative investigates the implementation of telemedicine for improvement of preclinical communication between emergency medical services (EMS) and stroke units in cases of acute stroke. Stroke Angel is a technical system for the telemedical prenotification of patients in cases of suspected stroke at a stroke unit by the EMS. Within the framework of an observational study, the team has been investigating the effects of the system on door-to-computed tomography (CT) and door-to-needle times as well as the lysis rate in the neighboring regions of Rhon-Grabfeld and Bad Kissingen since 2005. The system supports the acute treatment of neurological emergencies and functions as a catalyst for the interlinking of medical institutions in the region as well as for communication between emergency physicians/EMS and hospital physicians. The use of a computer-based data collection enables a continuous improvement process leading to an acceleration of internal clinical procedures and an increase of the lysis rate with the mortality rate staying constant. Telemedicine is applicable in the preclinical care of acute stroke and, thanks to the computer-based data collection, leads to an increase in process transparency, which helps to improve the internal clinical processes in and around a stroke unit. AD - [Soda, H.; Ziegler, V.; Keidel, M.] Rhon Klinikum AG, Abt Akutneurol, Stroke Unit, Campus Bad Neustadt, Bad Neustadt an der Saale, Germany. [Soda, H.; Ziegler, V.; Keidel, M.] Rhon Klinikum AG, Neurol Intens Med, Neurol Klin, Campus Bad Neustadt, Bad Neustadt an der Saale, Germany. [Shammas, L.; Rashid, A.] Zentrum Telemed Bad Kissingen, Sieboldstr 7, D-97688 Bad Kissingen, Germany. [Griewing, B.] Rhon Klinikum AG, Bad Neustadt an der Saale, Germany. [Kippnich, U.] Bayer Rotes Kreuz, Bad Kissingen, Germany. Rashid, A (corresponding author), Zentrum Telemed Bad Kissingen, Sieboldstr 7, D-97688 Bad Kissingen, Germany. rashid@ztm-badkissingen.de AN - WOS:000394237400003 AU - Soda, H. AU - Ziegler, V. AU - Shammas, L. AU - Griewing, B. AU - Kippnich, U. AU - Keidel, M. AU - Rashid, A. DA - Feb DO - 10.1007/s00115-016-0266-y J2 - Nervenarzt KW - In-hospital mortality Stroke unit Emergency medicine Information systems Thrombolytic therapy IN-HOSPITAL MORTALITY ACUTE ISCHEMIC-STROKE MYOCARDIAL-INFARCTION THROMBOLYTIC THERAPY DATA FEEDBACK CARE SYSTEMS Clinical Neurology Psychiatry LA - German M1 - 2 M3 - Article N1 - ISI Document Delivery No.: EK9IK Times Cited: 3 Cited Reference Count: 23 Soda, H. Ziegler, V. Shammas, L. Griewing, B. Kippnich, U. Keidel, M. Rashid, A. 3 0 4 SPRINGER NEW YORK NERVENARZT PY - 2017 SN - 0028-2804 SP - 120-129 ST - Telemedical prenotification in acute stroke treatment. Experiences from the Stroke Angel initiative from 2004 until the present T2 - Nervenarzt TI - Telemedical prenotification in acute stroke treatment. Experiences from the Stroke Angel initiative from 2004 until the present UR - ://WOS:000394237400003 VL - 88 ID - 761669 ER - TY - CHAP A2 - Jha, P. K. A2 - Pratap, A. AB - The orthorhombic semi- conducting compound GeS0.25Se0.75 and GeS0.75Se0.25 possess interesting electrical properties and can been the subject of numerous investigations. The changes in solids under high pressure can reveal several new features of interatomic forces, which are responsible for their diverse physical properties. Authors have carried out growth of GeS0.25Se0.75 and GeS0.75Se0.25 crystals by Direct Vapor Transport (DVT) technique. For compositional confirmation energy dispersive analysis of X-ray (EDAX) has been used. EDAX results show that the grown crystals are nearly stoichiometrycally perfect. The grown crystals have been characterized by X-ray diffraction technique (using Philips X' Pert MID diffractometer) for structural characterization. These crystals are crystallized in orthorhombic structure. The values of lattice parameters, unit cell volume and X- ray density are calculated and presented. It is observed from lattice parameters, unit cell volume and X- ray density, that as the content of sulfur increases the value of all the lattice parameters decreases. High pressure study is also of great importance to visualize the mechanism governing the structural changes and to reveal solid state properties associated with different structure. For the room temperature measurement of resistance as a function of pressure, up to 7 GPa, the sample was set at the centre of the talc disc on the lower anvil. The pressure was generated by a hydraulic press on the Bridgman type tungsten carbide opposed anvil apparatus with in- situ Bismuth pressure calibration. The resistance was measured in several independent runs on these crystals as a function of pressure and was found to be reproducible. The results of variation of electrical resistance do not show presence of any phase transition up to 7 GPa. We investigate in GeS0.25Se0.75 and GeS0.75Se0.25 single crystals that as sulfur content increases, resistance of this compound increases. AD - [Solanki, G. K.; Patel, Dipika B.] Sardar Patel Univ, Dept Phys, Vallabh Vidyanagar 388120, Gujarat, India. [Unadkat, Sandip] BVM Engn Coll, Vallabh Vidyanagar, Gujarat, India. [Gosai, N. N.] Marwadi Educ Foundat Grp Inst, Fac Engn, Rajkot, Gujarat, India. [Mansur, Yunus Gafur] Patidar GIN Sci Coll, Bardoli, Gujarat, India. Solanki, GK (corresponding author), Sardar Patel Univ, Dept Phys, Vallabh Vidyanagar 388120, Gujarat, India. solankigunvant@yahoo.co.in AN - WOS:000320140000006 AU - Solanki, G. K. AU - Patel, D. B. AU - Unadkat, S. AU - Gosai, N. N. AU - Mansur, Y. G. AU - Jani, A. R. CY - Durnten-Zurich DO - 10.4028/www.scientific.net/AMR.665.37 KW - Crystal Growth from vapour EDAX XRD and hydraulic press GESE SNSE Materials Science, Multidisciplinary Physics, Condensed Matter LA - English N1 - ISI Document Delivery No.: BFJ66 Times Cited: 0 Cited Reference Count: 12 Solanki, G. K. Patel, Dipika B. Unadkat, Sandip Gosai, N. N. Mansur, Yunus Gafur Proceedings Paper 3rd Conference on Condensed Matter and Materials Physics (CMMP 2012) MAR 03-05, 2012 Vallabh Vidyanagar, INDIA Sardar Patel Univ, UGC, DST, MRSI, GUJCOST, IPR Unadkat, Sandip Rajnikant/AAR-6579-2020 Unadkat, Sandip Rajnikant/0000-0001-5857-5702 UGC, New Delhi, IndiaUniversity Grants Commission, India Authors are thankful to UGC, New Delhi, India for the sanctioned of a major research project to G. K. Solanki which provided the necessary financial help for carrying out this work. 0 KREUZSTRASSE 10, 8635 DURNTEN-ZURICH, SWITZERLAND PB - Trans Tech Publications Ltd PY - 2013 SN - 1022-6680 978-3-03785-625-3 SP - 37-+ ST - Adv mater res-switz T2 - Condensed Matter and Materials Physics T3 - Advanced Materials Research TI - Growth, Structural and High Pressure Study of GeS0.25Se0.75 and GeS0.75Se0.25 Single Crystals UR - ://WOS:000320140000006 VL - 665 ID - 761814 ER - TY - JOUR AB - Background. Cytoreductive surgery followed by hyper thermic intraperitoneal chemotherapy (HIPEC) has shown better oncological outcomes in peritoneal surface malignancies (PSM). We assessed the feasibility and perioperative outcomes of this procedure in Indian patients. Methods. In this prospective observational study from February 2013 to April 2015, we included 56 patients (41 females, 73.2%) with PSM. They had a good performance status, were either treatment-naive or previously treated by surgery and systemic chemotherapy. They underwent cytoreductive surgery followed by HIPEC using a hyperthermia pump, with the temperature at 42 degrees C for 30-90 minutes. The chemotherapy regimen was based on the primary malignancy. Perioperative outcome data were collected and analysed. We also analysed the short-term oncological outcomes. Results. Our patients included those with peritoneum confined ovarian carcinoma (32, 57.1%), colorectal carcinoma (9, 16.1%), pseudomyxoma peritonel (7, 12.5%), mesothelioma (2, 3.6%), gastric carcinoma (2, 3.6%) and others (4, 7.1%). The median duration of surgery including HIPEC was 9 hours and the median hospital stay was 12 days. The median time for gastrointestinal recovery was 5 days. One-fifth of patients (11, 19.7%) required an extended stay in the intensive care unit. The most common grades 3 and 4 complications were hypocalcaemia 32.1%, hypokalaemia 32.1%, anaemia 21.4% and thrombocytopenia 7.1%. Major morbidity requiring surgical intervention occurred in 8.9% of patients. The 60-day operative mortality was 1.8%. At a median follow-up of 16 months, 7.1% developed peritoneal recurrence, 8.9% had systemic recurrence and 7.1% succumbed to the disease. Patients with platinum-resistant ovarian carcinomas had more peritoneal recurrence (3.6%). Conclusion. In patients with PSM, surgical cytoreduction and HIPEC is feasible and potentially beneficial. It can be done with low mortality and acceptable morbidity. It requires a dedicated team of surgeons, anaesthetists and intensivists and proper infrastructure. AD - [Somashekhar, S. P.] Manipal Hosp, Manipal Comprehens Canc Ctr, Dept Surg Oncol & Robot Surg, 98 HAL Airport Rd, Bengaluru 560017, Karnataka, India. [Prasanna, G.; Jaka, Rajshekhar] Manipal Hosp, Manipal Comprehens Canc Ctr, Dept Surg Oncol, 98 HAL Airport Rd, Bengaluru 560017, Karnataka, India. [Rauthan, Amit] Manipal Hosp, Manipal Comprehens Canc Ctr, Dept Med Oncol, 98 HAL Airport Rd, Bengaluru 560017, Karnataka, India. [Murthy, H. S.] Manipal Hosp, Manipal Comprehens Canc Ctr, Dept Anaesthesiol, 98 HAL Airport Rd, Bengaluru 560017, Karnataka, India. [Karanth, Sunil] Manipal Hosp, Manipal Comprehens Canc Ctr, Dept Crit Care, 98 HAL Airport Rd, Bengaluru 560017, Karnataka, India. Somashekhar, SP (corresponding author), Manipal Hosp, Manipal Comprehens Canc Ctr, Dept Surg Oncol & Robot Surg, 98 HAL Airport Rd, Bengaluru 560017, Karnataka, India. somusp@yahoo.com AN - WOS:000397174600003 AU - Somashekhar, S. P. AU - Prasanna, G. AU - Jaka, R. AU - Rauthan, A. AU - Murthy, H. S. AU - Karanth, S. DA - Sep-Oct J2 - Natl. Med. J. India KW - CYTOREDUCTIVE SURGERY OVARIAN-CANCER CARCINOMATOSIS MORBIDITY MORTALITY OXALIPLATIN PERFUSION MANAGEMENT SURVIVAL OUTCOMES Medicine, General & Internal LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: EP1WI Times Cited: 8 Cited Reference Count: 34 Somashekhar, S. P. Prasanna, G. Jaka, Rajshekhar Rauthan, Amit Murthy, H. S. Karanth, Sunil Somashekhar, SP/AAR-1812-2020 Somashekhar, SP/0000-0002-7898-1625 8 0 ALL INDIA INST MEDICAL SCIENCES NEW DELHI NATL MED J INDIA PY - 2016 SN - 0970-258X SP - 262-266 ST - Hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: A single institution Indian experience T2 - National Medical Journal of India TI - Hyperthermic intraperitoneal chemotherapy for peritoneal surface malignancies: A single institution Indian experience UR - ://WOS:000397174600003 VL - 29 ID - 761696 ER - TY - JOUR AB - Background: Pleural effusions (PE) are frequently observed in patients with acquired immunodeficiency syndrome usually infections are the main cause. Some are due to non-infectious diseases with lymphoma being one of the more common causes. Nevertheless, other malignancies must be taken in account. Methods: The authors describe a changeling case of an HIV patient admitted to the ward with a symmetrical PE. The patient was a postmenopausal black women, aged 47, living in Portugal for 42 years, HIV-infected treated with HAART with CD4 count 466 and HIV viral load<20. She reported cough and dyspnea for 2 weeks. She had no fever. PE was documented on Chest-X-ray. Results: Pleural fluid (PF) analysis revealed an exudate; microbiological culture, smear for acid-fast bacilli and nucleic acid amplification test for Mycobacterium tuberculosis were all negative. Cytology and flow-cytometry of PF and histology of the pleural biopsy showed no evidence of malignancy. The chest, abdomen and pelvis CT scan revealed diffuse densification mediastinal fat tissue in peri-esophageal topography and a non-pure left ovary mass with 3.3cm. An Esophagogastroduodenoscopy showed signs of plastic linitis and biopsy revealed a gastric carcinoma. Conclusion: The main diagnostic hypotheses were Tuberculosis and lymphoma and were ruled out. Gastric cancer was diagnosed. We assume ovarian cancer or Krukenberg tumor as the most likely etiology of the adnexal mass. It was decided at a multidisciplinary team meeting that an exploratory laparotomy with biopsy should be done. Patient died before surgery from respiratory failure. We underline the importance of a careful evaluation of pleural effusions in HIV-infected patients. AD - O. Sónia, Internal Medicine, Department of Hospital Santo António dos Capuchos, CHLC, Portugal AU - Sónia, O. AU - Ângela, S. AU - Mariana, S. AU - Pedro, B. AU - Rita, R. AU - Cristina, C. AU - Eugénio, T. AU - Vítor, B. AU - António, C. DB - Embase DO - 10.1016/S0953-6205(11)60283-5 KW - plastic CD4 antigen pleura effusion internal medicine human patient Human immunodeficiency virus lymphoma biopsy infection cytology flow cytometry histology pleura biopsy smear thorax abdomen pelvis computer assisted tomography adipose tissue topography ovary esophagogastroduodenoscopy stomach carcinoma diagnosis hypothesis tuberculosis stomach cancer ovary cancer etiology laparotomy surgery respiratory failure Human immunodeficiency virus infected patient female acquired immune deficiency syndrome ward ovary carcinoma virus load coughing highly active antiretroviral therapy dyspnea fever thorax radiography pleura fluid exudate acid fast bacterium nucleic acid amplification Mycobacterium tuberculosis Portugal LA - English M3 - Conference Abstract N1 - L70559907 2011-10-21 PY - 2011 SN - 0953-6205 SP - S69 ST - Pleural effusion: What's behind? T2 - European Journal of Internal Medicine TI - Pleural effusion: What's behind? UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70559907&from=export http://dx.doi.org/10.1016/S0953-6205(11)60283-5 VL - 22 ID - 761222 ER - TY - JOUR AB - OBJECTIVE We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line-associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU). DESIGN A single center observational quasi-experimental study. SETTING A regional BICU in Maryland serving 300-400 burn patients annually. INTERVENTIONS In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes. RESULTS The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95% confidence interval, 8.54-22.48). CONCLUSIONS CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm. Infect Control Hosp Epidemiol 2017;38:1306-1311. AD - 1Division of Infectious Diseases,Department of Internal Medicine,Johns Hopkins University,School of Medicine,Baltimore,Maryland. 2Department of Plastic Surgery,Johns Hopkins University,School of Medicine,Baltimore,Maryland. 3Johns Hopkins Bayview Medical Center,Baltimore,Maryland. 4Johns Hopkins International,Johns Hopkins Aramco Hospital,Saudi Arabia. 5Department of Anesthesia and Critical Care Medicine,School of Medicine,Johns Hopkins University,Baltimore,Maryland. 8Department of Anesthesia and Critical Care Medicine School of Medicine,Johns Hopkins University,Johns Hopkins Bayview Medical Center,Baltimore,Maryland. 9Department of Medicine,Johns Hopkins University,Johns Hopkins Bayview Medical Center,Baltimore,Maryland. 10Anesthesiology and Critical Care Medicine,Johns Hopkins University,Johns Hopkins Medicine,Baltimore,Maryland. AN - 28899444 AU - Sood, G. AU - Caffrey, J. AU - Krout, K. AU - Khouri-Stevens, Z. AU - Gerold, K. AU - Riedel, S. AU - McIntyre, J. AU - Maragakis, L. L. AU - Blanding, R. AU - Zenilman, J. AU - Bennett, R. AU - Pronovost, P. DA - Nov DO - 10.1017/ice.2017.191 DP - NLM ET - 2017/09/14 J2 - Infection control and hospital epidemiology KW - Bacteremia/epidemiology/*prevention & control *Burn Units/statistics & numerical data Burns/therapy Catheter-Related Infections/epidemiology/microbiology/*prevention & control Catheterization, Central Venous/*adverse effects Humans Patient Care Team Quality Improvement LA - eng M1 - 11 N1 - 1559-6834 Sood, Geeta Caffrey, Julie Krout, Kelly Khouri-Stevens, Zeina Gerold, Kevin Riedel, Stefan McIntyre, Janet Maragakis, Lisa L Blanding, Renee Zenilman, Jonathan Bennett, Richard Pronovost, Peter Journal Article Observational Study United States Infect Control Hosp Epidemiol. 2017 Nov;38(11):1306-1311. doi: 10.1017/ice.2017.191. Epub 2017 Sep 13. PY - 2017 SN - 0899-823x SP - 1306-1311 ST - Use of Implementation Science for a Sustained Reduction of Central-Line-Associated Bloodstream Infections in a High-Volume, Regional Burn Unit T2 - Infect Control Hosp Epidemiol TI - Use of Implementation Science for a Sustained Reduction of Central-Line-Associated Bloodstream Infections in a High-Volume, Regional Burn Unit VL - 38 ID - 760155 ER - TY - JOUR AB - OBJECTIVE: The aim of this study is to evaluate the efficiency of a specific organizational model for early stroke management associated with repeated public awareness campaigns on stroke warning signs. METHOD: Our model is based on initial telephone triage of potential candidates for an intravenous thrombolysis by an emergency physician before a 3-party conference including basic life support team on scene and a stroke neurologist. We performed a time series analysis for a period of 5 years and a half, comparing the number of emergency telephone calls with that of intravenous thrombolysis treatment realized. RESULTS: In our organizational model, repeated awareness public campaigns increased both the number of emergency calls for suspected stroke and the selection of potential candidates for intravenous thrombolysis. Results from the time series analysis suggest that educational campaigns are a major factor influencing our emergency medical service activity. This result is correlated with the number of performed intravenous thrombolyses by the stroke center especially within a 3-hour delay (Spearman ρ, P = .621, P = .000 and P = .439, P = .000, respectively). CONCLUSION: Educational programs repeated each year are useful to the population for learning how to recognize stroke symptoms and send straight away an emergency call. Combining the emergency action with an early remote evaluation by the stroke center team and a direct admission in imaging department shortens the time-to-treatment delay. This model is reproducible in different health care systems. AD - Assistance Publique-Hôpitaux de Marseille, CHU Timone, SAMU 13, 13005 Marseille, France. OLEA Medical, 13600 La Ciotat, France; Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service d'urgences neurovasculaires, 13005 Marseille, France. Centre Hospitalier Henri Duffaut, SAMU 84, 84903 Avignon cedex 09, France. Assistance Publique-Hôpitaux de Marseille, CHU Timone, Service de Neuroradiologie, 13005 Marseille, France. Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Accueil des Urgences Médicales, 69003 Lyon, France. Electronic address: laurentjacquin@yahoo.fr. AN - 24361139 AU - Soulleihet, V. AU - Nicoli, F. AU - Trouve, J. AU - Girard, N. AU - Jacquin, L. DA - Mar DO - 10.1016/j.ajem.2013.11.018 DP - NLM ET - 2013/12/24 J2 - The American journal of emergency medicine KW - Acute Disease Administration, Intravenous *Critical Pathways Emergencies Emergency Medical Service Communication Systems/statistics & numerical data Emergency Service, Hospital/*organization & administration Fibrinolytic Agents/*therapeutic use France *Health Promotion Humans Models, Organizational Patient Care Team Retrospective Studies Stroke/diagnosis/*drug therapy Thrombolytic Therapy/*methods Time Factors Triage/methods LA - eng M1 - 3 N1 - 1532-8171 Soulleihet, Valéry Nicoli, François Trouve, Jacques Girard, Nadine Jacquin, Laurent Evaluation Study Journal Article United States Am J Emerg Med. 2014 Mar;32(3):225-32. doi: 10.1016/j.ajem.2013.11.018. Epub 2013 Nov 14. PY - 2014 SN - 0735-6757 SP - 225-32 ST - Optimized acute stroke pathway using medical advanced regulation for stroke and repeated public awareness campaigns T2 - Am J Emerg Med TI - Optimized acute stroke pathway using medical advanced regulation for stroke and repeated public awareness campaigns VL - 32 ID - 760455 ER - TY - JOUR AB - Purpose: To examine outpatient oncologic patients with venous thrombosis (VT) and correlate ultrasound findings with clinical characteristics and outcome. Materials and Methods: A retrospective study of 76 patients who had upper- and lower-extremity ultrasound examinations positive for VT formed the population, drawn from a total of 509 patients who presented over a 24-month period for non-invasive imaging. Clinical indication, demographics, sonographic findings, comorbidities, and development of pulmonary embolism in these patients were recorded. The Fisher-Freeman-Halton exact test was used to determine if test characteristics varied according to the location of VT (upper or lower extremity), the level of lower-extremity thrombosis (above the knee, below the knee, or both), the presence of active disease or remission, the chronicity or acuteness of thrombosis, and the presence of a central venous catheter (CVC). Results: In the study group, 64 patients had deep VT, and 12 had superficial VT. The most prevalent tumors in our study population were lymphoma and breast and lung cancers. The most common symptoms were swelling, pain, and erythema. Whereas 61 patients had active disease, 18 patients were in remission at the time of examination. Among 30 patients with upper-extremity VT, 18 had CVCs. Venous thrombosis involved the vessel containing the central venous line in 66% of studies. Pulmonary embolism developed in 8 patients who had lower-extremity VT despite an initiation of anticoagulation therapy. Patients with thrombus in the lower extremity had higher chance to develop pulmonary embolism, but there was no significant statistical difference in the level of lower-extremity thrombosis (above the knee, below the knee, or both), disease activity, and chronicity of thrombosis. Conclusions: Venous thrombosis is most commonly acute and involves the lower extremity and the deep venous system above the knee. When VT involves the upper extremity, it is usually associated with a CVC. Pulmonary embolism is almost exclusively associated with lower-extremity VT and can occur despite anticoagulation therapy. AD - Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA Department of Radiology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. ffsouza@partners.org AN - 105437327. Language: English. Entry Date: 20091106. Revision Date: 20170411. Publication Type: journal article AU - Souza, F. F. AU - Otero, H. J. AU - Erturk, M. AU - Rybicki, F. J. AU - Ramaiya, N. AU - Van den Abbeele, A. D. AU - Di Salvo, D. N. AU - Souza, Frederico F. AU - Otero, Hansel J. AU - Erturk, Mehmet AU - Rybicki, Frank J. AU - Ramaiya, Nikhil AU - Van den Abbeele, Annick D. AU - Di Salvo, Donald N. DB - CINAHL DO - 10.1097/RUQ.0b013e3181b24f6f DP - EBSCOhost KW - Cancer Patients Central Venous Catheters Pulmonary Embolism -- Diagnosis Ultrasonography -- Utilization Venous Thrombosis -- Diagnosis Electronic Health Records Education, Continuing (Credit) Equipment and Supplies Funding Source Massachusetts Neoplasms -- Complications Retrospective Design Venous Thrombosis -- Risk Factors Human M1 - 3 N1 - diagnostic images; research; tables/charts. Journal Subset: Allied Health; Biomedical; Blind Peer Reviewed; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed; USA. Grant Information: Pfizer and Novartis. NLM UID: 8809459. PMID: NLM19730077. PY - 2009 SN - 0894-8771 SP - 145-150 ST - Venous thrombosis in an outpatient oncologic center: distribution, type, and comorbidities T2 - Ultrasound Quarterly TI - Venous thrombosis in an outpatient oncologic center: distribution, type, and comorbidities UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=105437327&site=ehost-live&scope=site VL - 25 ID - 761400 ER - TY - JOUR AB - Background and objectives: Totally implantable central venous catheter has been increasingly used in cancer patients and is capable of minimizing complications resulting from peripheral intravenous therapy, being relevant for patient safety during the infusion of antineoplastic drugs. The aim of this study is to identify the manipulation behavior, to gather and synthesize avaliable evidences in the literature about measures of prevention and control of IRAS related to the use of totally implantable central venous catheter. Contents: An integrative review was carried out in the period from 2009 to 2016 through the databases MEDLINE (Literature Analysis and Retrieval System Online) and LILACS (Latin American and Caribbean Literature in Health Sciences), which resulted in the selection of 10 articles, of which the majority was national (six) and Portuguese (seven). The PICO strategy, which consists of an acrostic: Patient, Intervention, Comparison and Outcomes. Complications, management, maintenance of totally implantable central venous catheter and the relevance of the technoscientific knowledge of the nurse who handled this device were considered, aiming at quality and safety of care. Conclusion: According to the analyzed articles, the duration of the catheter, the complications inherent to the use as obstruction, infection, extravasation, thrombosis and displacement, as well as the handling, maintenance and puncture of the device were the subjects evidenced. For the purposes of intervention by the nurse, it is explicit that if there is a standardization through education and training of the nursing team, it is possible to work towards the prevention of the potential for infection of central venous catheterization totally implanted in cancer patients providing greater safety in the handling of the catheter and preventing the appearance of complications, which may guarantee qualified nursing care and, consequently, a better quality of life for the patients attended. AD - [Pinheiro e Souza, Raquel de Abreu; do Carmo, Thalita Gomes] Inst Nacl Ensino Pesquisa, Jacarei, SP, Brazil. Souza, RDPE (corresponding author), Inst Nacl Ensino Pesquisa, Jacarei, SP, Brazil. raquelabreups@gmail.com AN - WOS:000417370800011 AU - Souza, Rdpe AU - do Carmo, T. G. DA - Oct-Dec DO - 10.17058/reci.v7i4.9885 J2 - Rev. Epidemiol. Control. Infecc. KW - Catheter-Related Infections Catheterization Central Venous Nursing care Infection Control Neoplasms CARE MAINTENANCE PREVENTION CATHETERS Infectious Diseases LA - Portuguese M1 - 4 M3 - Review N1 - ISI Document Delivery No.: FP1KH Times Cited: 0 Cited Reference Count: 33 Pinheiro e Souza, Raquel de Abreu do Carmo, Thalita Gomes 0 2 UNIV SANTA CRUZ DO SUL SANTA CRUZ DO SUL REV EPIDEMIOL CONTRO PY - 2017 SN - 2238-3360 SP - 25 ST - Risk of infection for the cancer patient using totally implanted central venous cateter Integrative review T2 - Revista De Epidemiologia E Controle De Infeccao TI - Risk of infection for the cancer patient using totally implanted central venous cateter Integrative review UR - ://WOS:000417370800011 VL - 7 ID - 761631 ER - TY - JOUR AB - Introduction: Liver transplantation (LT) has been very successful in treating children with end-stage liver disease (ESLD), and offers the opportunity for a long healthy life. Method: Totally 24 pediatric liver transplantations were performed to 22 children, since 2006 at Gazi University Transplantation Center/Ankara/Turkey. Data retrospectively collected from patient charts and hospital files. Results: Among 24 LTs, 13 were boy and 11 were girl. Ten out of 24LTs were done from deceased donor, 14 were done from living donor (LDLT). Median age of the recipient 5 years old (5 months old-16 years old). Twelve out of 14 living LTs were done from 1st degree relatives, remaining two were from second and third degree relatives respectively. Reason for LTs were fulminant liver (n = 6), trisonemia (n = 4), bilier atresia (n = 3), cryptogenic cirrhosis (n = 3), PFIC (n = 2), Wilson (n = 2), neonatal hepatitis (n = 1), a1 anti-tripsin deficiency (n = 1) respectively. Totally 9 (37%) surgical complications encountered during follow-up: vascular (n = 3), biliary (n = 3), other (n = 3). As vascular complication: HAT (n = 2) and hepatic vein thrombosis (HVT) (n = 1). Biliary complication: biliary stenosis (n = 2), biliary leak (n = 1) and as others; post surgical bleeding (n = 2), spontaneous small bowel perforation (n = 1). One of the HAT case was required retransplantation, after retransplantation patient died due to sepsis on PO10. Other HAT case succesfully solved by conventional radiology using stents without any problem. HVT occurred in LDLT. Thrombosis detected mid-intraparanchimal site of left vein of the graft. Re-transplantation successfully performed at PO1. One of the postsurgical bleeding case was occurred at the Roux en-Y anastomosis and required anastomosis revision, after the surgery, patient did well. Other bleeding case was solved with medical treatment. Spontaneous bowel perforation diagnosed at the PO10 day. Surgery was performed succesfully. Totally 5 (22%) patients died during median 79 days (66- 2475 days); hepatic artery thrombosis (n = 1), DIC (n = 1), small for size syndrome (n = 1), sepsis (n = 1), unknown (n = 1) respectively. Conclusions: Pediatric liver transplantation is a challenging and rewarding field with continued improvements in patient and graft survival. A multidisciplinary team approach coupled with improvements in organ availability. AD - H. Sozen, Gazi University, Turkey AU - Sozen, H. AU - Sari, S. AU - Egritas, O. AU - Yagci, G. AU - Kalkan, G. AU - Dalgic, B. AU - Dalgic, A. DB - Embase KW - liver transplantation university human patient intestine perforation retransplantation sepsis transplantation bleeding child boy atresia liver stenosis liver vein thrombosis third-degree relative small intestine liver cirrhosis newborn hepatitis hospital first-degree relative male recipient hepatic artery thrombosis postoperative complication living donor female follow up operative blood loss anastomosis donor Roux Y anastomosis vein radiology stent thrombosis girl surgical patient therapy surgery end stage liver disease hospital patient graft survival LA - English M3 - Conference Abstract N1 - L71382863 2014-03-26 PY - 2014 SN - 1365-182X SP - 541 ST - Pediatric liver transplantation: Gazi University Experience T2 - HPB TI - Pediatric liver transplantation: Gazi University Experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71382863&from=export VL - 16 ID - 761125 ER - TY - JOUR AB - BACKGROUND: We conducted a survey in order to highlight the current trends in the management of diabetic foot among vascular specialists practicing in the Mediterranean region. METHODS: A survey Monkey was conducted from December 2013 to November 2014, including 10 main questions on the management of diabetic foot patients. The questionnaire was sent to vascular specialists included in the current mailing list of the Mediterranean League of Angiology and Vascular Surgery. Spearman's correlation analysis was used for statistical analysis. RESULTS: The response rate was 37.5% (150/400) and 52.6% of them were practicing in a Tertiary hospital service. The diabetic foot patient management and most of the amputations were performed in Tertiary hospitals. Most responders were experienced vascular specialists (55.3%). In general specialists with high work volume performed more major amputations in diabetic patients as compared to PAD patients and adopted equally all types of interventions (open, endovascular and hybrid). In particular the most experienced specialists required more diagnostic investigations, performed more minor amputations and used endovascular approach as first line treatment in diabetic patients. A lack of multidisciplinary approach was demonstrated as referral to other specialties was suboptimal. CONCLUSIONS: In the Mediterranean region, patients with diabetic foot are managed by the most experienced vascular physicians in Tertiary centers. Endovascular first approach seems to be the preferred strategy, but services were able to provide open as well as hybrid procedures. Finally, the multidisciplinary team approach has not been adopted as part of the standard care even in tertiary centers. AD - [Spanos, Konstantinos; Karathanos, Christos; Giannoukas, Athanasios D.] Univ Thessaly, Univ Hosp Larissa, Sch Hlth Sci, Dept Vasc Surg,Fac Med, Larisa, Greece. [Lachanas, Vasileios] Univ Thessaly, Univ Hosp Larissa, Sch Hlth Sci, Dept Otorhinolaryngol,Fac Med, Larisa, Greece. [Poredos, Pavel] Univ Med Ctr Ljubljana, Dept Vasc Dis, Ljubljana, Slovenia. [Hussein, Eman] King Fahad Cent Hosp, Dept Vasc Surg, Medina, Saudi Arabia. Spanos, K (corresponding author), Univ Thessaly, Univ Hosp Larissa, Sch Hlth Sci, Dept Vasc Surg,Fac Med, Larisa, Greece. spanos.kon@gmail.com AN - WOS:000375740600012 AU - Spanos, K. AU - Lachanas, V. AU - Karathanos, C. AU - Poredos, P. AU - Hussein, E. AU - Giannoukas, A. D. DA - Apr J2 - Int. Angiol. KW - Diabetic foot Mediterranean Region Amputation PERIPHERAL ARTERIAL-DISEASE CRITICAL LIMB ISCHEMIA AMPUTATIONS PREVENTION CONSENSUS POPULATION GUIDELINES REDUCTION MORTALITY SOCIETY Peripheral Vascular Disease LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: DL6HP Times Cited: 2 Cited Reference Count: 24 Spanos, Konstantinos Lachanas, Vasileios Karathanos, Christos Poredos, Pavel Hussein, Eman Giannoukas, Athanasios D. Spanos, Konstantinos/R-9550-2019; Lachanas, Vasileios A/H-6807-2019 Spanos, Konstantinos/0000-0003-2891-777X; Lachanas, Vasileios A/0000-0002-4501-3257 Mediterranean League of Angiology and Vascular Surgery (MLAVS) This survey was undertaken under the auspices of Mediterranean League of Angiology and Vascular Surgery (MLAVS). 2 0 1 EDIZIONI MINERVA MEDICA TURIN INT ANGIOL PY - 2016 SN - 0392-9590 SP - 192-197 ST - A survey on the status of the management of diabetic foot in the Mediterranean region T2 - International Angiology TI - A survey on the status of the management of diabetic foot in the Mediterranean region UR - ://WOS:000375740600012 VL - 35 ID - 761712 ER - TY - JOUR AB - Background and Purpose: The objective of this pooled analysis was to determine the level of agreement between central read and each of 2 groups (spoke radiologists and hub vascular neurologists) in interpreting head computed tomography (CT) scans of stroke patients presenting to telestroke network hospitals. Methods: The Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC and STRokE DOC-AZ TIME) trials were prospective, randomized, and outcome blinded comparing telemedicine and teleradiology with telephone-only consultations. In each trial, the CT scans of the subjects were interpreted by the hub vascular neurologist in the telemedicine arm and by the spoke radiologist in the telephone arm. We obtained a central read for each CT using adjudicating committees blinded to treatment arm and outcome. The data were pooled and the results reported for the entire population. Kappa statistics and exact agreement rates were used to assess interobserver agreement for radiographic contraindication to recombinant tissue plasminogen activator (rt-PA), presence of hemorrhage, tumor, hyperdense artery, acute stroke, prior stroke, and early ischemic changes. Results: Among 261 analyzed cases, the agreement with central read for the presence of radiological rt-PA contraindication was excellent for hub vascular neurologist (96.2%, kappa = .81, 95% CI .64-.97), spoke radiologist report (94.7%, kappa = .64, 95% CI .39-.88), and overall (95.4%, kappa = .74, 95% CI .59-.88). For rt-PA-treated patients (N = 65), overall agreement was 98.5%, and vascular neurologist agreement with central read was 100%. Conclusions: Both vascular neurologists and reports from spoke radiologists had excellent reliability in identifying radiologic rt-PA contraindications. These pooled findings demonstrate that telestroke evaluation of head CT scans for acute rt-PA assessments is reliable. AD - [Spokoyny, Ilana; Raman, Rema; Hemmen, Thomas M.; Guzik, Amy K.; Meyer, Brett C.] Univ Calif San Diego, Dept Neurosci, San Diego, CA 92103 USA. [Raman, Rema; Ernstrom, Karin] Univ Calif San Diego, Dept Family & Prevent Med, San Diego, CA 92103 USA. [Demaerschalk, Bart M.] Mayo Clin, Dept Neurosci, Phoenix, AZ USA. [Lyden, Patrick D.] Cedars Sinai Med Ctr, Dept Neurosci, Los Angeles, CA 90048 USA. [Chen, James Y.] Univ Calif San Diego, Dept Radiol, San Diego, CA 92103 USA. Spokoyny, I (corresponding author), Univ Calif San Diego, Dept Neurosci, 200 W Arbor Dr 8465, San Diego, CA 92103 USA. ispokoyn@ucsd.edu AN - WOS:000333053900033 AU - Spokoyny, I. AU - Raman, R. AU - Ernstrom, K. AU - Demaerschalk, B. M. AU - Lyden, P. D. AU - Hemmen, T. M. AU - Guzik, A. K. AU - Chen, J. Y. AU - Meyer, B. C. DA - Mar DO - 10.1016/j.jstrokecerebrovasdis.2013.04.023 J2 - J. Stroke Cerebrovasc. Dis. KW - Telemedicine stroke computed tomography CT interpretation by nonradiologists AMERICAN-HEART-ASSOCIATION DIGITAL OBSERVATION CAMERA ISCHEMIC-STROKE TELEMEDICINE RELIABILITY TRIAL CARE CT THROMBOLYSIS STATEMENT Neurosciences Peripheral Vascular Disease LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: AD2GZ Times Cited: 12 Cited Reference Count: 19 Spokoyny, Ilana Raman, Rema Ernstrom, Karin Demaerschalk, Bart M. Lyden, Patrick D. Hemmen, Thomas M. Guzik, Amy K. Chen, James Y. Meyer, Brett C. Guzik, Amy/0000-0003-3282-7611 National Institute of Neurological Disorders and StrokeUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Neurological Disorders & Stroke (NINDS) [P50NS044148] B.C.M., B. M. D., R. R., and K. E. received funding from the National Institute of Neurological Disorders and Stroke research grant-Specialized Programs of Translational Research in Acute Stroke (P50NS044148). 13 0 4 ELSEVIER SCIENCE BV AMSTERDAM J STROKE CEREBROVASC PY - 2014 SN - 1052-3057 SP - 511-515 ST - Pooled Assessment of Computed Tomography Interpretation by Vascular Neurologists in the STRokE DOC Telestroke Network T2 - Journal of Stroke & Cerebrovascular Diseases TI - Pooled Assessment of Computed Tomography Interpretation by Vascular Neurologists in the STRokE DOC Telestroke Network UR - ://WOS:000333053900033 VL - 23 ID - 761783 ER - TY - JOUR AB - Pulmonary embolism (PE) treatment depends on disease severity and risk of complications. Physician and institutional expertise may influence the use of reperfusion therapy (RT) such as systemic thrombolysis (SL) and catheter-directed interventions (CDI). We aimed to investigate the effects of a consensus-based treatment algorithm (TA) and subsequent implementation of PE response team (PERT) on RT modality choices and patient outcomes. A cohort of PE patients admitted to a tertiary care hospital between 2012 and 2017 was retrospectively evaluated. Demographics, clinical variables, RT selections, and patient outcomes during 3 consecutive 2-year periods (baseline, with TA, and with TA+PERT) were compared. Descriptive statistics were used for data analysis. A total of 1105 PE patients were admitted, and 112 received RT. Use of RT increased from 4.7% at baseline to 8.2% and 16.1% during the TA and TA+PERT periods. The primary RT modality transitioned from CDI to SL, and reduced-dose SL became most common. Treatment selection patterns remained unchanged after PERT introduction. Hospital length of stay decreased from 4.78 to 2.96 and 2.81 days (P < .001). Most of the hemorrhagic complications were minor, and their rates were similar across all 3 periods and between SL and CDI. No major hemorrhages occurred in patients treated with reduced-dose SL. In conclusion, TA and PERT represent components of a decision support system facilitating treatment modality selection, contributing to improved outcomes, and limiting complications. Treatment algorithm emerged as a factor providing consistency to PERT recommendations. PMID:32539524 AU - St. Hill, Catherine A. AU - Engstrom, Bjorn I. AU - Agboto, Vincent K. AU - Skeik, Nedaa DA - 2020/06/15 06/15 DB - PubMed Central DO - 10.1177/1076029620928420 KW - pulmonary embolism thrombolytics catheter-directed thrombolysis hemorrhage PY - 2020 SN - 1076-0296 ST - Effects of a Consensus-Based Pulmonary Embolism Treatment Algorithm and Response Team on Treatment Modality Choices, Outcomes, and Complications T2 - Clinical and Applied Thrombosis/Hemostasis TI - Effects of a Consensus-Based Pulmonary Embolism Treatment Algorithm and Response Team on Treatment Modality Choices, Outcomes, and Complications UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7427027 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=7427027&rendertype=abstract VL - 26 ID - 762044 ER - TY - JOUR AB - BACKGROUND: Shorter periods of hospitalisation and increasing warfarin use have placed stress on community-based healthcare services to care for patients taking warfarin after hospital discharge, a high-risk period for these patients. A previous randomised controlled trial demonstrated that a post-discharge service of 4 home visits and point-of-care (POC) International Normalised Ratio (INR) testing by a trained pharmacist improved patients' outcomes. The current study aims to modify this previously trialled service model to implement and then evaluate a sustainable program to enable the smooth transition of patients taking warfarin from the hospital to community setting. METHODS/DESIGN: The service will be trialled in 8 sites across 3 Australian states using a prospective, controlled cohort study design. Patients discharged from hospital taking warfarin will receive 2 or 3 home visits by a trained 'home medicines review (HMR)-accredited' pharmacist in their 8 to 10 days after hospital discharge. Visits will involve a HMR, comprehensive warfarin education, and POC INR monitoring in collaboration with patients' general practitioners (GPs) and community pharmacists. Patient outcomes will be compared to those in a control, or 'usual care', group. The primary outcome measure will be the proportion of patients experiencing a major bleeding event in the 90 days after discharge. Secondary outcome measures will include combined major bleeding and thromboembolic events, death, cessation of warfarin therapy, INR control at 8 days post-discharge and unplanned hospital readmissions from any cause. Stakeholder satisfaction will be assessed using structured postal questionnaire mailed to patients, GPs, community pharmacists and accredited pharmacists at the completion of their study involvement. DISCUSSION: This study design incorporates several aspects of prior interventions that have been demonstrated to improve warfarin management, including POC INR testing, warfarin education and home visits by trained pharmacists. It faces several potential challenges, including the tight timeframe for patient follow-up in the post-discharge period. Its strengths lie in a strong multidisciplinary team and the utilisation of existing healthcare frameworks. It is hoped that this study will provide the evidence to support the national roll-out of the program as a new Australian professional community pharmacy service. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry Number 12608000334303. AD - Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia. leanne.stafford@utas.edu.au AN - 21261998 AU - Stafford, L. AU - Peterson, G. M. AU - Bereznicki, L. R. AU - Jackson, S. L. C2 - Pmc3040704 DA - Jan 25 DO - 10.1186/1472-6963-11-16 DP - NLM ET - 2011/01/26 J2 - BMC health services research KW - Anticoagulants/*therapeutic use Australia Cohort Studies *Continuity of Patient Care Humans Outcome Assessment, Health Care Patient Discharge *Pharmacists *Professional Role Prospective Studies Surveys and Questionnaires Warfarin/*therapeutic use LA - eng N1 - 1472-6963 Stafford, Leanne Peterson, Gregory M Bereznicki, Luke R E Jackson, Shane L Comparative Study Journal Article Research Support, Non-U.S. Gov't BMC Health Serv Res. 2011 Jan 25;11:16. doi: 10.1186/1472-6963-11-16. PY - 2011 SN - 1472-6963 SP - 16 ST - A role for pharmacists in community-based post-discharge warfarin management: protocol for the 'the role of community pharmacy in post hospital management of patients initiated on warfarin' study T2 - BMC Health Serv Res TI - A role for pharmacists in community-based post-discharge warfarin management: protocol for the 'the role of community pharmacy in post hospital management of patients initiated on warfarin' study VL - 11 ID - 760396 ER - TY - JOUR AB - OBJECTIVES: To assess the impact of a quality assured planning and sizing process and the endovascular team briefing (preprocedure run through and brief - PRTB) on the delivery of endovascular aneurysm repair (EVAR), in Edinburgh. DESIGN: Prospective observational study, comparing parameters before and after the intervention. MATERIALS: Prospectively collected database recording infrarenal aneurysms treated with EVAR performed from January 2007 to April 2014 at our institution. The total screening time, iodinated contrast volume used, radiation dose, endovascular training opportunities, and hospital length of stay were recorded. METHODS: A comparison before (January 2007 to November 2011) and after (December 2011 to April 2014) the introduction of the PRTB was made for each of these variables. Multiple linear regression analysis was performed to account for the learning effect. RESULTS: In this study, 61 EVAR cases were performed prior to and 44 EVAR cases after the introduction of the PRTB. Univariate Mann-Whitney tests suggested a significant difference between before PRTB introduction and after PRTB introduction on all outcome variables except procedure time. Multiple linear regression analysis results showed a statistically significant improvement in outcomes after the change point for all outcomes except for radiation dose. Endovascular training opportunities were realized in 12/61 (20%) before compared to 42/44 cases (95%) after PRTB introduction. CONCLUSIONS: By introducing rigorous quality assurance and utilizing the principles of crew resource management to the EVAR process, it is possible to reduce screening times, contrast use, hospital length of stay, and improve endovascular training opportunities. AD - Department of Vascular & Endovascular Surgery, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom Present Address: David Grant Medical Center, 101 Boden Circle, Travis AFB, CA, USA. timstansfield@doctors.org.uk. Health Services Research Unit, University of Edinburgh, Centre for Population Health Sciences, Teviot Place, Edinburgh, United Kingdom. Department of Radiology, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, United Kingdom. Department of Vascular & Endovascular Surgery, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom. AN - 27207677 AU - Stansfield, T. AU - Parker, R. AU - Masson, N. AU - Lewis, D. DA - May DO - 10.1177/1538574416644527 DP - NLM ET - 2016/05/22 J2 - Vascular and endovascular surgery KW - Aged Aged, 80 and over Aortic Aneurysm/diagnostic imaging/*surgery *Aortography/adverse effects *Checklist Clinical Competence Clinical Protocols Contrast Media/*administration & dosage/adverse effects *Endovascular Procedures/adverse effects/education Female Humans Learning Curve Length of Stay Linear Models Male Middle Aged Models, Organizational Patient Care Team/organization & administration Program Evaluation Prospective Studies Quality Assurance, Health Care/organization & administration Quality Improvement/organization & administration *Radiation Dosage Radiation Exposure/adverse effects/*prevention & control *Radiography, Interventional/adverse effects Risk Factors Scotland Time Factors Treatment Outcome contrast media endovascular procedures patient care team radiation LA - eng M1 - 4 N1 - 1938-9116 Stansfield, Tim Parker, Richard Masson, Neil Lewis, David Comparative Study Journal Article Observational Study United States Vasc Endovascular Surg. 2016 May;50(4):241-6. doi: 10.1177/1538574416644527. PY - 2016 SN - 1538-5744 SP - 241-6 ST - The Endovascular Preprocedural Run Through and Brief: A Simple Intervention to Reduce Radiation Dose and Contrast Load in Endovascular Aneurysm Repair T2 - Vasc Endovascular Surg TI - The Endovascular Preprocedural Run Through and Brief: A Simple Intervention to Reduce Radiation Dose and Contrast Load in Endovascular Aneurysm Repair VL - 50 ID - 760202 ER - TY - JOUR AB - Full Text Available AU - Stefano, Barco AU - Stavros, V. Konstantinides DA - 2018/09/25 09/25 DB - J-STAGE (Japan) (English) DO - 10.3400/avd.ra.18-00054 M1 - 3 PY - 2018 SN - 1881-641X SP - 265-276 ST - Pulmonary Embolism: Contemporary Medical Management and Future Perspectives T2 - Annals of Vascular Diseases TI - Pulmonary Embolism: Contemporary Medical Management and Future Perspectives UR - https://www.jstage.jst.go.jp/article/avd/11/3/11_ra.18-00054/_article/-char/ja/ VL - 11 ID - 762096 ER - TY - JOUR AB - Background: Hospital-acquired venous thromboembolism (HA-VTE) is a predictable complication that increases morbidity and mortality. Despite overwhelming evidence supporting the effectiveness of VTE prophylaxis, safe, effective, and cost-efficient methods to prevent VTE remain underutilized. In the high-risk patient population of a surgical intensive care unit (ICU), we examined the effect on HA-VTE when a unit-based multidisciplinary team conducted bedside rounds using a dynamic dashboard designed to enable real-time visualization of VTE prophylaxis status. Methods: A retrospective, observational analysis was conducted of all patients cared for in a single 20-bed SICU for the 12 months before and after introduction of the dynamic dashboard (2008 vs. 2009). A total of 154 patients met inclusion criteria, having both a SICU stay and a diagnosis code for VTE. A total of 101 patients met exclusion criteria: 53 patients had VTE diagnosed prior to admission or within 48 hours of admission, and 48 patients had no radiographic evidence to confirm the diagnosis of VTE despite the diagnosis code for VTE. The primary outcome was the rate of HA-VTE per 1000 patient-days. Secondary outcomes were the rates of lower-extremity deep vein thrombosis (DVT), upper-extremity DVT, pulmonary embolism, and potentially preventable HA-VTE per 1000 patient-days, which was defined as development of a HA-VTE in the absence of VTE prophylaxis. Results: In 2008, 35 patients developed an HAVTE, compared with 18 in 2009. The rate of HA-VTE per 1000 patient-days decreased from 5.84 to 3.10 (RR, 1.89; CI, 1.04-3.53; P 5 0.036). The rate of potentially preventable HA-VTE per 1000 patient-days decreased from 2.00 to 0.52 (RR, 3.87; CI, 1.05-21.39; P 5 0.041). Other secondary outcomes were reduced but did not achieve statistical significance. Conclusions: The addition of real-time visualization of VTE prophylaxis status to multidisciplinary bedside rounds coincided with decreased rates of HA-VTE in a SICU. Combining real-time, actionable performance data with the structure and accountability afforded by daily unit-based multidisciplinary(Image presented) rounding teams may represent an important mechanism to improve hospital outcomes. AD - J. Stein, Emory University School of Medicine, Atlanta, GA, United States AU - Stein, J. AU - Chesson, M. AU - Killian, A. AU - Still, M. AU - Rykowski, J. AU - Leong, T. AU - Tong, D. DB - Embase DO - 10.1002/jhm.920 KW - hospital prophylaxis intensive care unit venous thromboembolism patient diagnosis leg arm deep vein thrombosis lung embolism morbidity mortality high risk patient population statistical significance L1 - http://onlinelibrary.wiley.com/doi/10.1002/jhm.920/pdf LA - English M1 - 4 M3 - Conference Abstract N1 - L70423299 2011-05-30 PY - 2011 SN - 1553-5592 SP - S75 ST - Combined effect of multidisciplinary bedside rounding and real-time visualization of prophylaxis status on hospital-acquired venous thromboembolism in a surgical intensive care unit T2 - Journal of Hospital Medicine TI - Combined effect of multidisciplinary bedside rounding and real-time visualization of prophylaxis status on hospital-acquired venous thromboembolism in a surgical intensive care unit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70423299&from=export http://dx.doi.org/10.1002/jhm.920 VL - 6 ID - 761237 ER - TY - JOUR AB - The present study aimed to determine the clinical presentation, the multimodal interdisciplinary treatment strategies and outcome of posterior fossa arterio-venous malformations (AVMs) in our neurovascular centre. Fifty-three patients with a posterior fossa AVM were seen between 1998 and 2012 and analysed retrospectively. Patients were either managed conservatively or treated with endovascular, microsurgical or radiosurgical procedures or in combination. Thirty-nine patients (74 %) presented with intracranial haemorrhage and 14 patients (26 %) with unspecific symptoms. In 22 cases with haemorrhage (56 %), an intracerebellar haematoma was found, whereas 17 patients (44 %) suffered from subarachnoid haemorrhage. AVMs were located in the cerebellum in 44 patients (83 %), in the brainstem in four patients (7.5 %) and the cerebello-pontine angle in another four individuals (7.5 %). Forty-two patients (79 %) were treated either by emboliziation (n = 12, 29 %), surgical resection (n = 16, 38 %), surgical resection with preoperative embolization (n = 12, 29 %) or radiotherapy alone (n = 2, 4 %). A total of eleven patients did not receive any treatment (21 %). Both, morbidity and mortality related to treatment were 12 %, whereas overall morbidity and mortality was 26 and 15 %, respectively. Complete AVM elimination was achieved in 81 % of the treated lesions. A multimodal treatment sequence nowadays represents the gold standard for posterior fossa AVMs. Patients are at high risk for morbidity and mortality, due to the impact of haemorrhage and treatment. Therefore, treatment has to be thoroughly indicated, especially for those patients without bleeding. The initial neurological condition seems to be crucial in terms of clinical outcome. AD - Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany, klaus-peter.stein@uk-essen.de. AN - 24811220 AU - Stein, K. P. AU - Wanke, I. AU - Schlamann, M. AU - Dammann, P. AU - Moldovan, A. S. AU - Zhu, Y. AU - Sure, U. AU - Sandalcioglu, I. E. DA - Oct DO - 10.1007/s10143-014-0551-9 DP - NLM ET - 2014/05/09 J2 - Neurosurgical review KW - Adolescent Adult Aged Aged, 80 and over Cerebral Hemorrhage/etiology/pathology/surgery Child Child, Preschool Cranial Fossa, Posterior/*pathology/*surgery Embolization, Therapeutic/adverse effects/methods Endovascular Procedures/adverse effects/methods Female Follow-Up Studies Humans Intracranial Arteriovenous Malformations/*pathology/*surgery Male Middle Aged Neuroimaging/methods Neurosurgical Procedures/adverse effects/*methods Patient Care Team Treatment Outcome Young Adult LA - eng M1 - 4 N1 - 1437-2320 Stein, Klaus-Peter Wanke, Isabel Schlamann, Marc Dammann, Philipp Moldovan, Alexia-Sabine Zhu, Yuan Sure, Ulrich Sandalcioglu, I Erol Journal Article Germany Neurosurg Rev. 2014 Oct;37(4):619-28. doi: 10.1007/s10143-014-0551-9. Epub 2014 May 9. PY - 2014 SN - 0344-5607 SP - 619-28 ST - Posterior fossa arterio-venous malformations: current multimodal treatment strategies and results T2 - Neurosurg Rev TI - Posterior fossa arterio-venous malformations: current multimodal treatment strategies and results VL - 37 ID - 760227 ER - TY - JOUR AB - BACKGROUND: There are insufficient data to assess the potential role of pulmonary embolectomy in patients with acute pulmonary embolism. METHODS: In-hospital all-cause case fatality rate with pulmonary embolectomy was assessed from the Nationwide Inpatient Sample from 1999 through 2008. RESULTS: Among unstable patients (in shock or ventilator-dependent), case fatality rate with embolectomy was 380 of 950 (40%). Among stable patients, case fatality rate was lower: 690 of 2820 (24%) (P <.0001). Case fatality rate in unstable patients was 39% in 1999-2003 and 40% in 2004-2008 (not significant), and in stable patients it was 27% in 1999-2003 and 23% in 2004-2008 (P=.01). Case fatality rates were lower in patients with a primary diagnosis of pulmonary embolism and even lower in patients with a primary diagnosis who had none of the comorbid conditions listed in the Charlson Index. Within each stratified group, patients with vena cava filters had a lower case fatality rate. CONCLUSIONS: Case fatality rate in unstable patients who underwent pulmonary embolectomy remained at 39%-40% from 1999-2003 to 2004-2008, and in stable patients it decreased only from 27% to 23%. Case fatality rates were lower in those with fewer comorbid conditions and in those who received a vena cava filter. Our data reflect average outcome in the US. It may be that experienced surgeons and an aggressive multidisciplinary team could obtain a lower case fatality rate. AD - Department of Research, St. Mary Mercy Hospital, Livonia, MI 48154, USA. steinp@trinity-health.org AN - 22482845 AU - Stein, P. D. AU - Matta, F. DA - May DO - 10.1016/j.amjmed.2011.12.003 DP - NLM ET - 2012/04/10 J2 - The American journal of medicine KW - Comorbidity Embolectomy/*adverse effects Humans Pulmonary Embolism/*complications/*surgery Respiration, Artificial Retrospective Studies Shock/complications LA - eng M1 - 5 N1 - 1555-7162 Stein, Paul D Matta, Fadi Journal Article United States Am J Med. 2012 May;125(5):471-7. doi: 10.1016/j.amjmed.2011.12.003. PY - 2012 SN - 0002-9343 SP - 471-7 ST - Case fatality rate with pulmonary embolectomy for acute pulmonary embolism T2 - Am J Med TI - Case fatality rate with pulmonary embolectomy for acute pulmonary embolism VL - 125 ID - 760156 ER - TY - JOUR AB - BACKGROUND Ultrasound-assisted, catheter-directed, low-dose thrombolysis (USAT) at an average alteplase dose of 20 mg infused over 24 hours reversed right ventricular (RV) dilatation and improved RV function and pulmonary haemodynamics in patients with acute, intermediate-high risk pulmonary embolism (IHR-PE). As the risk of haemorrhagic complications increases in proportion to thrombolytic dose, establishing a minimal effective dose is of clinical importance. AIMS To investigate haemodynamic effects of USAT with a very-low alteplase dose of 10 mg administered during reduced 5-hour infusion in patients with IHR-PE. METHODS In this prospective, observational, single-centre, pilot study we included consecutive patients presenting with IHR-PE of <14 days symptom duration and proximal location of thrombi visualized in computed pulmonary angio-tomography. Exclusion criteria were: (1) systolic blood pressure <90 mm Hg despite catecholamine support, (2) cardiopulmonary resuscitation upon qualification, (3) absolute contraindications to thrombolysis. Decision to employ USAT was made by Pulmonary Embolism Response Team. We used a fixed alteplase infusion rate of 1 mg/hour/catheter for 5 hours via EKOSD system catheters. Primary outcome was the change in invasively measured systolic (sPAP) and mean pulmonary artery pressure (mPAP) and cardiac index (CI) from USAT start to termination. Safety outcomes were cardiopulmonary decompensation and major bleeding within 72 hours from procedure initiation. RESULTS Eight patients (5 male; median age 66.5 [24-81] years) were included. Median delay from the onset of symptoms to USAT initiation was 12.5 (7.7-18) hours. Troponin T and NT-proBNP levels were elevated at presentation (0.148 [0.078-0.2] ng/mL; 5288 [3661-13 133] pg/mL, respectively). Median simplified pulmonary embolism severity index (sPESI) was 2 (2-3.5). Two patients were on catecholamine support. Bilateral pulmonary artery clots were present in all patients of whom 3 had additional saddle thrombus. Two EKOSD catheters and a total 10 mg alteplase dose were used in all patients. The sPAP and mPAP decreased from baseline to USAT completion (53.5 [46-59] mm Hg vs 37.5 [28-40] mm Hg; p = 0.01; 29 [25-31] mm Hg vs 21.5 [15-25] mm Hg; p = 0.01, respectively) and CI increased (1.7 [1.5-1.8] l/min/m2 vs 2.2 [2.0-2.4] l/min/m2; p = 0.01). No decompensations or need for therapy intensification occurred. There was one episode of access site bleeding requiring blood transfusion, which subsided after conservative management. No other bleeding complications appeared. CONCLUSIONS Reduced dose and duration USAT improved pulmonary hemodynamics and cardiac function leading to cardiopulmonary stabilization in patients with intermediate-high risk PE. AD - J. Stȩpniewski, Klinika Chorób Serca i Naczyń, Uniwersytet Jagielloński Collegium Medicum, Krakowski Szpital Specjalistyczny Im. Jana Pawła II, Kraków, Poland AU - Stȩpniewski, J. AU - Kopeć, G. AU - Musiałek, P. AU - Magoń, W. AU - Waligóra, M. AU - Jonas, K. AU - Sobczyk, D. AU - Podolec, P. DB - Embase DO - 10.33963/KP.15080 KW - alteplase amino terminal pro brain natriuretic peptide catecholamine endogenous compound troponin T aged bleeding blood pressure monitoring blood transfusion cardiac index case report catheter clinical article complication conference abstract conservative treatment contraindication dilatation drug therapy female heart right ventricle heart ventricle function human infusion rate low drug dose lung artery pressure lung hemodynamics male pilot study prospective study pulmonary embolism response team resuscitation sonothrombolysis systolic blood pressure thrombus tomography LA - English Polish M3 - Conference Abstract N1 - L631644688 2020-05-07 PY - 2019 SN - 1897-4279 SP - 50 ST - Haemodynamic effects of ultrasound-assisted, catheter-directed, very-low-dose, short-time duration thrombolysis in acute intermediate-high risk pulmonary embolism T2 - Kardiologia Polska TI - Haemodynamic effects of ultrasound-assisted, catheter-directed, very-low-dose, short-time duration thrombolysis in acute intermediate-high risk pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L631644688&from=export http://dx.doi.org/10.33963/KP.15080 VL - 77 ID - 760780 ER - TY - JOUR AB - BACKGROUND: Metabolic syndrome (MetS) has been associated with a procoagulant and hypofibrinolytic state. Current data exploring the role of MetS in venous thromboembolism (VTE) are limited. The objective was to measure the prevalence of MetS in patients with acute PE receiving catheter-directed thrombolysis (CDT) and to investigate its effect on mean pulmonary arterial pressure and overall treatment success. METHODS: We used a 3-year prospective registry of ED patients with acute PE with severity qualifying for activation of a PE response team (PERT). All patients had CDT with catheter-measured mPAP and angiography. The presence or absence of MetS components were extracted from chart review based on the following criteria: 1. body mass index (BMI) >30 kg/m(2); 2. diagnosed hypertension; 3. diabetes mellitus (including HbA1c >6.5%) and; 4. dyslipidemia (including triglycerides >150 mg/dL or high-density lipoprotein <40 mg/dL). RESULTS: Of the 134 patients, 85% met the criteria for at least one of four MetS components, with obesity being most common, present in 71%. Results demonstrated a positive concordance between the number of criteria for MetS and MPAP, both pre- and post-fibrinolysis, as pressures tended to increase with each additional MetS criterion. Multivariate regression analysis determined age (-), BMI (+) and hypertension (+) to be significant independent predictor variables for mPAP. CONCLUSIONS: MetS was common in patients with more severe manifestations of PE and was associated with higher mPAP values both at diagnosis and following treatment with CDT. AD - Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, United States of America. Department of Cardiology, University of Rochester Medical Center, Rochester, NY, United States of America. Department of Emergency Medicine, Department of Cellular and Integrative Physiology, Indiana University School of Medicine, 720 Eskenazi Ave, Indianapolis, IN 46202, United States of America. Electronic address: jefkline@iu.edu. AN - 31948673 AU - Stewart, L. K. AU - Beam, D. M. AU - Casciani, T. AU - Cameron, S. J. AU - Kline, J. A. C2 - Pmc7022200 C6 - Nihms1549711 DA - Mar 1 DO - 10.1016/j.ijcard.2019.12.043 DP - NLM ET - 2020/01/18 J2 - International journal of cardiology KW - *catheter-directed thrombolysis *metabolic syndrome *obesity *pulmonary embolism LA - eng N1 - 1874-1754 Stewart, Lauren K Beam, Daren M Casciani, Thomas Cameron, Scott J Kline, Jeffrey A K12 HL133310/HL/NHLBI NIH HHS/United States UM1 HL113203/HL/NHLBI NIH HHS/United States Journal Article Int J Cardiol. 2020 Mar 1;302:138-142. doi: 10.1016/j.ijcard.2019.12.043. Epub 2019 Dec 26. PY - 2020 SN - 0167-5273 (Print) 0167-5273 SP - 138-142 ST - Effect of metabolic syndrome on mean pulmonary arterial pressures in patients with acute pulmonary embolism treated with catheter-directed thrombolysis T2 - Int J Cardiol TI - Effect of metabolic syndrome on mean pulmonary arterial pressures in patients with acute pulmonary embolism treated with catheter-directed thrombolysis VL - 302 ID - 760176 ER - TY - JOUR AB - Background: Metabolic syndrome (MetSyn) has been previously demonstrated to be associated with a procoagulant and hypofibrinolytic state, which might impair the clot lysis effectiveness of tissue plasminogen activator (tPA). We measure the prevalence of metabolic syndrome in patients with acute pulmonary embolism (PE) receiving catheter-directed thrombolysis (CDT) and its effect on mean pulmonary arterial pressure (mPAP), clot burden and overall treatment success. Methods: We used a 2-year prospective registry of ED patients with acute PE with severity qualifying for activation of the PE response team. All patients had CDT with pre- and post-treatment catheter-measured mPAP and angiography. Two blinded physicians independently graded angiographic clot burden using the Miller score (0-16). MetSyn required 3 of the following characteristics: body mass index (BMI) >30 kg/m2, diagnosed hypertension, diabetes mellitus (or Hb A1c >6.5%) and dyslipidemia (triglycerides >150 mg/dL or high-density lipoprotein < 40 mg/dL). Data were analyzed with the unpaired t-test and Kendall's Tau rank correlation. Results: Of 53 patients, 15 (28%) met the criteria for MetSyn. Patients with MetSyn tended to have higher mPAP values than those without MetSyn both pre- (37±11 vs. 32±9 mmHg, p=0.24) and post-intervention (28±8 vs. 23±6 mmHg, p=0.02), with a smaller relative decrease in mPAP following fibrinolysis (22% vs. 30%). Post-treatment mPAP increased concordantly with the number of criteria for MetSyn (Tau=0.39, p < 0.01). Miller scores (mean of two graders) pretreatment for patients with MetSyn compared to those without were 13±2 vs. 13±2 (p=0.56), and post-treatment scores were 9±2 vs. 7±2 (p < 0.01), with decreased resolution of clot burden in the MetSyn group vs. non-MetSyn (29% vs. 45%). Conclusion: MetSyn was relatively common in patients with more severe PE and was associated with significantly higher mPAP values and persistent clot burden following treatment with CDT. These data support the hypothesis that MetSyn may lead to increased resistance to tPA fibrinolysis. AD - L.K. Stewart, Indiana University, School of Medicine, United States AU - Stewart, L. K. AU - Beam, D. M. AU - Kline, J. A. DB - Embase DO - 10.1111/acem.13203 KW - endogenous compound hemoglobin A1c high density lipoprotein tissue plasminogen activator triacylglycerol angiography body mass catheter clinical trial controlled clinical trial controlled study diabetes mellitus diagnosis dyslipidemia female fibrinolysis human lung artery pressure lung embolism major clinical study male metabolic syndrome X physician register single blind procedure Student t test LA - English M3 - Conference Abstract N1 - L616280196 2017-05-23 PY - 2017 SN - 1553-2712 SP - S19 ST - The effect of metabolic syndrome on fibrinolysis in acute pulmonary embolism T2 - Academic Emergency Medicine TI - The effect of metabolic syndrome on fibrinolysis in acute pulmonary embolism UR - https://www.embase.com/search/results?subaction=viewrecord&id=L616280196&from=export http://dx.doi.org/10.1111/acem.13203 VL - 24 ID - 760946 ER - TY - JOUR AB - Objective: To identify ways that provision of hemophilia care can be maximized at the local level, irrespective of available resources or cultural or geographic challenges. Methods: The SHIELD group used its multinational experience to share examples of local initiatives that have been employed to deliver optimal hemophilia care. Results: The examples were reviewed and categorized into four key themes: guidelines and algorithms for delivery of care; collaboration with patients and allied groups for care and education; registries for the monitoring of treatment and outcomes and health care planning and delivery; and opportunities for personalization of care. These themes were then incorporated into a road map for collaborative care in hemophilia that reflected the contribution of best practice. Discussion: Differing healthcare reimbursement systems, budgetary constraints, and geographical and cultural factors make it difficult for any country to fully deliver ideal care for people with hemophilia. The SHIELD approach for collaborative care provides illustrative examples of how four key themes can be used to optimize hemophilia care in any setting. Abbreviations: AHCDC: Association of Hemophilia Clinic Directors of Canada; AICE: Italian Association of Hemophilia Centres; ATHN: American Thrombosis and Hemostasis Network; EAHAD: European Association for Haemophilia and Allied Disorders; EHC: European Hemophilia Consortium; FIX: Coagulation Factor IX; FVIII: Coagulation Factor VIII; HAL: Haemophilia Activity List; HJHS: Haemophilia Joint Health Score; HTC: Hemophilia Treatment Centre; HTCCNC: Hemophilia Treatment Centre Collaborative Network of China; MASAC: Medical and Scientific Advisory Council; MDT: Multidisciplinary team; NHD: National Haemophilia Database; NHF: National Hemophilia Foundation; PK: Pharmacokinetics; POCUS: Point of care ultrasound; PWH: People with haemophilia; SHIELD: Supporting Hemophilia through International Education, Learning and Development; WFH: World Federation of Hemophilia. AD - J. Stoffman, Department of Pediatrics and Child Health, University of Manitoba, 675 McDermot Avenue, Winnipeg, MB, Canada AU - Stoffman, J. AU - Andersson, N. G. AU - Branchford, B. AU - Batt, K. AU - D’Oiron, R. AU - Escuriola Ettingshausen, C. AU - Hart, D. P. AU - Jiménez Yuste, V. AU - Kavakli, K. AU - Mancuso, M. E. AU - Nogami, K. AU - Ramírez, C. AU - Wu, R. DB - Embase Medline DO - 10.1080/10245332.2018.1505225 KW - recombinant blood clotting factor 8 algorithm article bleeding disorder cost effectiveness analysis cultural factor disease burden disease registry disease severity evidence based practice follow up health care delivery health care organization health care personnel health care planning health care system health insurance hemophilia hemophilia A hemophilia B hemophilic arthropathy human immunological tolerance joint destruction medical record muscle training patient care patient compliance patient monitoring physiotherapist point of care system practice guideline priority journal prognosis prophylaxis reimbursement vascular access LA - English M1 - 1 M3 - Article N1 - L623610618 2018-08-30 2019-12-18 PY - 2019 SN - 1607-8454 1024-5332 SP - 39-48 ST - Common themes and challenges in hemophilia care: a multinational perspective T2 - Hematology (United Kingdom) TI - Common themes and challenges in hemophilia care: a multinational perspective UR - https://www.embase.com/search/results?subaction=viewrecord&id=L623610618&from=export http://dx.doi.org/10.1080/10245332.2018.1505225 VL - 24 ID - 760767 ER - TY - JOUR AB - • Evaluation of day treatment and outpatient services for trauma exposed preschoolers. • Normalization Process Theory guided sustainability of program evaluation (PE) • Multi-modal needs assessment used to provide recommendations for PE. • Includes development and maintenance phase for implementing PE. • Lessons learned from researchers and community partners 5 years post implementation. Preschool-aged children who experience child maltreatment are at an increased risk for mental and behavioral problems compared to their non-maltreated peers (Scheeringa et al., 2004). Evaluating community-based therapeutic programs is crucial for ensuring that this vulnerable population is receiving adequate care; however, guidance on how to implement an effective evaluation of interventions continues to be limited. This paper aims to provide one example of how to design and implement a program evaluation of a therapeutic day treatment and outpatient program in a community-based agency that provides services to preschool-aged children who have been exposed to maltreatment. Researchers completed a multi-modal needs assessment of the agency's procedures (i.e., review of medical records, administration of an anonymous survey, and interviews with staff) and provided detailed recommendations for implementing a sustainable evaluation of their day treatment and outpatient programs. In collaboration with researchers, the agency implemented the recommendations; however, modifications were made overtime (e.g., decreased frequency of data collection). Several lessons were identified throughout the implementation and data collection phase of the program evaluation which may provide guidance for others interested in establishing similar evaluations. AD - Clinical Child Psychology Program, University of Kansas, Dole Human Development Center, 1000 Sunnyside Avenue, Lawrence, KS 66045, USA Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, 2716 South St., Philadelphia, PA 19146, USA University of Kansas School of Medicine, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA Department of Psychology, Associate Director of Child Maltreatment Solutions Network, The Pennsylvania State University, 140 Moore Building, University Park, PA 16801, USA The Children's Place, 2 East 59th Street, Kansas City, MO 64113, USA AN - 141754807. Language: English. Entry Date: 20200224. Revision Date: 20200227. Publication Type: Article AU - Stone, Katie J. AU - Kanine, Rebecca M. AU - Kuckelman, Sara AU - Jackson, Yo AU - Thomas, Ann DB - CINAHL DO - 10.1016/j.childyouth.2019.104583 DP - EBSCOhost KW - Program Development Outpatient Service -- In Infancy and Childhood Child Health Services Child Abuse -- Therapy Community Programs Child, Preschool Ambulatory Care Research Personnel Hospital Policies Electronic Health Records Record Review Collaboration Community Mental Health Services Needs Assessment N1 - tables/charts. Journal Subset: Biomedical; USA. NLM UID: 8110100. PY - 2020 SN - 0190-7409 SP - N.PAG-N.PAG ST - Methodological design and procedures of program evaluation of therapeutic day treatment and outpatient program for preschool-aged children exposed to maltreatment T2 - Children & Youth Services Review TI - Methodological design and procedures of program evaluation of therapeutic day treatment and outpatient program for preschool-aged children exposed to maltreatment UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=141754807&site=ehost-live&scope=site VL - 110 ID - 761351 ER - TY - JOUR AB - Context.--Biomedical terminologies such as Logical Observation Identifiers, Names, and Codes (LOINC) were developed to enable interoperability of health care data between disparate health information systems to improve patient outcomes, public health, and research activities. Objective.--To ascertain the utilization rate and accuracy of LOINC terminology mapping to 10 commonly ordered tests by participants of the College of American Pathologists (CAP) Proficiency Testing program. Design.--Questionnaires were sent to 1916 US and Canadian laboratories participating in the 2018 CAP coagulation (CGL) and/or cardiac markers (CRT) surveys requesting information on practice setting, instrument(s) and test method(s), and LOINC code selection and usage in the laboratory and electronic health records. Results.--Ninety of 1916 CGL and/or CRT participants (4.7%) responded to the questionnaire. Of the 275 LOINC codes reported, 54 (19.6%) were incorrect: 2 codes (5934-2 and 12345-1) (0.7%) did not exist in the LOINC database and the highest error rates were observed in the property (27 of 275, 9.8%), system (27 of 275, 9.8%), and component (22 of 275, 8.0%) LOINC axes. Errors in LOINC code selection included selection of the incorrect component (eg, activated clotting time instead of activated partial thromboplastin time); selection of panels that can never be used to obtain an individual analyte (eg, prothrombin time panel instead of international normalized ratio); and selection of an incorrect specimen type. Conclusions.--These findings of real-world LOINC code implementation across a spectrum of laboratory settings should raise concern about the reliability and utility of using LOINC for clinical research or to aggregate data. AD - Department of Forensic Medicine, New York University School of Medicine, New York Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota Department of Pathology, Yale University School of Medicine, New Haven, Connecticut Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha Department of Pathology, Children's Healthcare of Atlanta, Atlanta, Georgia Pacific Pathology Partners, Seattle, Washington Department of Pathology, University of Texas Southwestern Medical Center, Dallas AN - 142934472. Language: English. Entry Date: 20200430. Revision Date: 20200506. Publication Type: Article AU - Stram, Michelle AU - Seheult, Jansen AU - Sinard, John H. AU - Campbell, W. Scott AU - Carter, Alexis B. AU - de Baca, Monica E. AU - Quinn, Andrew M. AU - Hung, S. Luu DB - CINAHL DO - 10.5858/arpa.2019-0276-OA DP - EBSCOhost KW - Surveys Logical Observation Identifiers, Names and Codes -- Utilization College of American Pathologists Blood Coagulation Biological Markers Proficiency Testing, Laboratory Nomenclature Human Questionnaires United States Canada Laboratories Information Needs Electronic Health Records Record Review Descriptive Statistics Coding Prothrombin Time International Normalized Ratio M1 - 5 N1 - pictorial; research; tables/charts. Journal Subset: Allied Health; Biomedical; Peer Reviewed; USA. NLM UID: 7607091. PY - 2020 SN - 0003-9985 SP - 586-596 ST - A Survey of LOINC Code Selection Practices Among Participants of the College of American Pathologists Coagulation (CGL) and Cardiac Markers (CRT) Proficiency Testing Programs T2 - Archives of Pathology & Laboratory Medicine TI - A Survey of LOINC Code Selection Practices Among Participants of the College of American Pathologists Coagulation (CGL) and Cardiac Markers (CRT) Proficiency Testing Programs UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=142934472&site=ehost-live&scope=site VL - 144 ID - 761285 ER - TY - JOUR AB - Objective: Celiac artery compression syndrome, otherwise known as median arcuate ligament syndrome, is a rare anatomical condition where celiac trunk artery is compressed by a fibrous band of the diaphragm called median arcuate ligament. Most often asymptomatic when isolated, this condition mimics mesenteric angor with chronic postprandial abdominal pain and sequentially weight loss. The treatment is aimed at restoring the normal blood flow in the celiac artery. The first line option is open or laparoscopic decompression of median arcuate ligament followed by eventual revascularisation if symptoms persist. Methods: A 20 years-old male, had chronic intermittent abdominal pain for 1 year, enhanced by meals and a 20-Kg weight loss. He was submitted to haematological, infectious, metabolic, digestive and oncological investigations, but all of which were normal. An abdominal US-duplex showed a severe stenosis at origin of the celiac trunk with post-stenotic aneurysmal dilation and a signifi-cant peak systolic velocity enhance in expirium. Other mesenteric vessels were normal. Injected tomography confirmed US findings. The particular presentation, with both patents mesenteric arteries and a normal network of collaterals, brought us to make a treatment test. After agreement of the multidisciplinary team, in order to lower operation morbidity we decided to perform a percutaneous celiac trunk angioplasty followed by deployment of a bare metal stent with an immediate good revascularisation result at aortogram. The patient was discharged at first post-operative day under double antiplatelet treatment. At the 12 months follow-up, the patient was symptom-free with progressive regain of his lost weight. The US duplex showed a patent celiac artery stent with a normal peak systolic velocity although artery tortuosity. Conclusion: The celiac trunk lesion in median arcuate ligament syndrome can cause severe symptomes, even in case of both patent mesenteric arteries and a normal network of collaterals. It is usually treated by an hybrid approach comprising ligament decompression and a vascular procedure. An endovascular procedure alone can be considered as a treatment test offering good short-term results and confirming the etiology of the symptoms. AD - F. Strano, Morges, Switzerland AU - Strano, F. AU - Probst, H. DB - Embase DO - 10.1024/0301-1526/a000722 KW - abdominal pain adult angioplasty aortography arterial stent bare metal stent body weight loss celiac artery stenosis conference abstract controlled study decompression endovascular surgery follow up hospital discharge human human cell male mesenteric artery mesentery blood vessel morbidity multidisciplinary team patent peak systolic velocity revascularization thrombocyte tomography young adult LA - English M3 - Conference Abstract N1 - L629826384 2019-11-18 PY - 2018 SN - 1664-2872 SP - 27 ST - Endovascular procedure as treatment test for unclear median arcuate ligament syndrome T2 - Vasa - European Journal of Vascular Medicine TI - Endovascular procedure as treatment test for unclear median arcuate ligament syndrome UR - https://www.embase.com/search/results?subaction=viewrecord&id=L629826384&from=export http://dx.doi.org/10.1024/0301-1526/a000722 VL - 47 ID - 760793 ER - TY - JOUR AB - Due to the lack of evidence-based guidelines, management strategies for neonatal MI should be individualized and administered largely at the discretion of responsible treating teams. Supportive care with a focus on preserving adequate circulation and antithrombotic therapy with a view to restoring vascular patency are the mainstays of treatment. Thrombolytic therapy of neonatal MI includes a chance to completely restore myocardial function. Understanding the resilience of the neonatal heart and mechanism of cardiac cell repair in neonates may spark novel treatment strategies for severe MI in the large number of affected individuals in an aging population. AD - Ao. Univ.-Prof. Dr. Werner Streif, Medizinische Universität Innsbruck (MUI), Dept. für Kinder- und Jugendheilkunde, Pädiatrie 1, Anichstrasse 35, A - 6020 Innsbruck, Tel: +43-512-504 23600, Fax: +43-512-504 23484, E-Mail: werner.streif@i-med.ac.at. AN - 28318007 AU - Streif, W. DA - Aug 8 DO - 10.5482/hamo-16-09-0038 DP - NLM ET - 2017/03/21 J2 - Hamostaseologie KW - Aspirin/therapeutic use Cardiotonic Agents/therapeutic use Child, Preschool Combined Modality Therapy Coronary Thrombosis/blood/diagnosis/therapy Echocardiography Electrocardiography Extracorporeal Membrane Oxygenation Follow-Up Studies Heparin/therapeutic use Humans Infant Infant, Newborn Infant, Newborn, Diseases/blood/diagnostic imaging/*therapy Intensive Care, Neonatal Internal Medicine Male Myocardial Infarction/blood/diagnosis/*therapy Patient Care Team Precision Medicine Thrombolytic Therapy Tissue Plasminogen Activator/therapeutic use Troponin T/blood Alteplase Für die Behandlung des Herzinfarkts beim Neugeborenen gibt es keine auf Evidenz beruhende Empfehlung. Die Behandlung muss individuell gestaltet werden und obliegt weitestgehend dem jeweiligen Behandlungsteam. Die Behandlung besteht aus supportiven Maßnahmen und antithrombotischen Medikamenten mit dem Ziel der Wiedereröffnung verschlossener Gefäße. Eine Thrombolyse mit Alteplase birgt beim Neugeborenen die Chance einer vollständigen Erholung der Herzfunktion. Das bessere Verständnis der außerordentlichen Widerstandsfähigkeit und Regenerationskraft des Herzes von Neugeborenen kann zur Entwicklung neuer Behandlungsstrategien des Herzinfarkts in einer alternden Gesellschaft beitragen. Herzinfarkt Kind Thrombolyse myocardial infarction newborn tissue plasminogen activator Neugeborenes LA - eng M1 - 3 N1 - 2567-5761 Streif, Werner Case Reports Journal Article Germany Hamostaseologie. 2017 Aug 8;37(3):219-222. doi: 10.5482/HAMO-16-09-0038. Epub 2017 Mar 20. PY - 2017 SN - 0720-9355 SP - 219-222 ST - Myocardial infarction in a neonate. Lessons for neonatal and internal medicine T2 - Hamostaseologie TI - Myocardial infarction in a neonate. Lessons for neonatal and internal medicine VL - 37 ID - 760498 ER - TY - JOUR AB - PROBLEM: Venous thromboembolism (VTE) is a common cause of potentially preventable mortality, morbidity, and increased medical costs. Risk-appropriate prophylaxis can prevent most VTE events, but only a small fraction of patients at risk receive this treatment. DESIGN: Prospective quality improvement programme. SETTING: Johns Hopkins Hospital, Baltimore, Maryland, USA. STRATEGIES FOR CHANGE: A multidisciplinary team established a VTE Prevention Collaborative in 2005. The collaborative applied the four step TRIP (translating research into practice) model to develop and implement a mandatory clinical decision support tool for VTE risk stratification and risk-appropriate VTE prophylaxis for all hospitalised adult patients. Initially, paper based VTE order sets were implemented, which were then converted into 16 specialty-specific, mandatory, computerised, clinical decision support modules. KEY MEASURES FOR IMPROVEMENT: VTE risk stratification within 24 hours of hospital admission and provision of risk-appropriate, evidence based VTE prophylaxis. EFFECTS OF CHANGE: The VTE team was able to increase VTE risk assessment and ordering of risk-appropriate prophylaxis with paper based order sets to a limited extent, but achieved higher compliance with a computerised clinical decision support tool and the data feedback which it enabled. Risk-appropriate VTE prophylaxis increased from 26% to 80% for surgical patients and from 25% to 92% for medical patients in 2011. LESSONS LEARNT: A computerised clinical decision support tool can increase VTE risk stratification and risk-appropriate VTE prophylaxis among hospitalised adult patients admitted to a large urban academic medical centre. It is important to ensure the tool is part of the clinician's normal workflow, is mandatory (computerised forcing function), and offers the requisite modules needed for every clinical specialty. AD - Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. AN - 22718994 AU - Streiff, M. B. AU - Carolan, H. T. AU - Hobson, D. B. AU - Kraus, P. S. AU - Holzmueller, C. G. AU - Demski, R. AU - Lau, B. D. AU - Biscup-Horn, P. AU - Pronovost, P. J. AU - Haut, E. R. C2 - PMC4688421 www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: apart from the disclosures listed below, no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Disclosures: MBS has received research funding from Sanofi-Aventis and BristolMyersSquibb; honoraria for CME lectures from Sanofi-Aventis and Ortho-McNeil; consulted for Sanofi-Aventis, Eisai, Daiichi-Sankyo, and Janssen HealthCare; and has given expert witness testimony in various medical malpractice cases. DBH has given expert witness testimony in various medical malpractice cases. ERH is the primary investigator of a Mentored Clinical Scientist Development Award from the Agency for Healthcare Research and Quality entitled “Does screening variability make DVT an unreliable quality measure of trauma care?”; receives royalties from Lippincott Williams & Wilkins for the book Avoiding Common ICU Errors; and has given expert witness testimony in various medical malpractice cases. PJP receives consultancy fees from the Association for Professionals in Infection Control and Epidemiology; grant or contract support from the Agency for Healthcare Research and Quality, National Institutes of Health, Robert Wood Johnson Foundation, and the Commonwealth Fund; honoraria from various hospitals and the Leigh Bureau (Somerville NJ); and royalties from his book Safe Patients Smart Hospitals. CGH has received a honorarium from MCIC Vermont to speak about organising and writing a manuscript reporting patient safety or quality improvement research. DA - Jun 19 DO - 10.1136/bmj.e3935 DP - NLM ET - 2012/06/22 J2 - BMJ (Clinical research ed.) KW - Adult Anticoagulants/*therapeutic use Baltimore *Cooperative Behavior *Decision Making, Computer-Assisted Evidence-Based Medicine Hospitalization Humans Medical Order Entry Systems/organization & administration Organizational Innovation Patient Care Team Practice Guidelines as Topic Prospective Studies *Quality Improvement Risk Assessment Venous Thromboembolism/epidemiology/*prevention & control LA - eng N1 - 1756-1833 Streiff, Michael B Carolan, Howard T Hobson, Deborah B Kraus, Peggy S Holzmueller, Christine G Demski, Renee Lau, Brandyn D Biscup-Horn, Paula Pronovost, Peter J Haut, Elliott R Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. BMJ. 2012 Jun 19;344:e3935. doi: 10.1136/bmj.e3935. PY - 2012 SN - 0959-8138 (Print) 0959-8138 SP - e3935 ST - Lessons from the Johns Hopkins Multi-Disciplinary Venous Thromboembolism (VTE) Prevention Collaborative T2 - Bmj TI - Lessons from the Johns Hopkins Multi-Disciplinary Venous Thromboembolism (VTE) Prevention Collaborative VL - 344 ID - 760294 ER - TY - JOUR AB - Venous thromboembolism (VTE) is an important cause of preventable harm in hospitalized patients. The critical steps in delivery of optimal VTE prevention care include (1) assessment of VTE and bleeding risk for each patient, (2) prescription of risk-appropriate VTE prophylaxis, (3) administration of risk-appropriate VTE prophylaxis in a patient-centered manner, and (4) continuously monitoring outcomes to identify new opportunities for learning and performance improvement. To ensure that every hospitalized patient receives VTE prophylaxis consistent with their individual risk level and personal care preferences, we organized a multidisciplinary task force, the Johns Hopkins VTE Collaborative. To achieve the goal of perfect prophylaxis for every patient, we developed evidence-based, specialty-specific computerized clinical decision support VTE prophylaxis order sets that assist providers in ordering risk-appropriate VTE prevention. We developed novel strategies to improve provider VTE prevention ordering practices including face-to-face performance reviews, pay for performance, and provider VTE scorecards. When we discovered that prescription of risk-appropriate VTE prophylaxis does not ensure its administration, our multidisciplinary research team conducted in-depth surveys of patients, nurses, and physicians to design a multidisciplinary patient-centered educational intervention to eliminate missed doses of pharmacologic VTE prophylaxis that has been funded by the Patient Centered Outcomes Research Institute. We expect that the studies currently underway will bring us closer to the goal of perfect VTE prevention care for every patient. Our learning journey to eliminate harm from VTE can be applied to other types of harm. Journal of Hospital Medicine 2016;11:S8-S14. © 2016 Society of Hospital Medicine. AD - Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Armstrong Institute for Patient Safety, Johns Hopkins Medicine, Baltimore, Maryland. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Division of Health Sciences Informatics, Johns Hopkins University School of Medicine, Baltimore, Maryland. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland. Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Department of Pharmacy, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Johns Hopkins University School of Nursing, Baltimore, Maryland. Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. AN - 27925423 AU - Streiff, M. B. AU - Lau, B. D. AU - Hobson, D. B. AU - Kraus, P. S. AU - Shermock, K. M. AU - Shaffer, D. L. AU - Popoola, V. O. AU - Aboagye, J. K. AU - Farrow, N. A. AU - Horn, P. J. AU - Shihab, H. M. AU - Pronovost, P. J. AU - Haut, E. R. DA - Dec DO - 10.1002/jhm.2657 DP - NLM ET - 2016/12/08 J2 - Journal of hospital medicine KW - Anticoagulants/*therapeutic use *Cooperative Behavior Decision Support Systems, Clinical/*statistics & numerical data Hospitalization Humans Patient Care Team/statistics & numerical data Reimbursement, Incentive Risk Assessment Treatment Outcome Venous Thromboembolism/*prevention & control LA - eng N1 - 1553-5606 Streiff, Michael B Lau, Brandyn D Hobson, Deborah B Kraus, Peggy S Shermock, Kenneth M Shaffer, Dauryne L Popoola, Victor O Aboagye, Jonathan K Farrow, Norma A Horn, Paula J Shihab, Hasan M Pronovost, Peter J Haut, Elliott R Journal Article Review United States J Hosp Med. 2016 Dec;11 Suppl 2:S8-S14. doi: 10.1002/jhm.2657. PY - 2016 SN - 1553-5592 SP - S8-s14 ST - The Johns Hopkins Venous Thromboembolism Collaborative: Multidisciplinary team approach to achieve perfect prophylaxis T2 - J Hosp Med TI - The Johns Hopkins Venous Thromboembolism Collaborative: Multidisciplinary team approach to achieve perfect prophylaxis VL - 11 Suppl 2 ID - 760207 ER - TY - JOUR AB - SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Pulmonary embolism (PE) continues to be a significant cause of morbidity and mortality, responsible for 100,000 to 200,000 deaths per year in the US.This challenge requires awareness of proper risk stratification and the role of a Pulmonary Embolism Response Team (PERT) to optimize mortality, improve medical management, and reduce length of stay (LOS).The aim of this study is to: scrutinize patient risk stratification in respect to the 2019 European Society guidelines;Consider the difference in outcomes and quality measures when a PERT is activated;Investigate the role of clinical findings in proper risk stratification and treatment;To assess the impact of a PERT on acute PE management in a community teaching hospital while optimizing resources and reducing cost. METHODS: A sample of 250 PE cases confirmed by CT angiography or V/Q scan, presenting between July 2018 and November 2019, was selected from an electronic database.Out of these,129 patients met our inclusion criteria for the study. A retrospective analysis was performed on these patients by manual chart review. RESULTS: Out of 129 patients,79%(n=102) had the PERT activated.Of those with a confirmed PE,10 were Low Risk,77 Intermediate-Low Risk,12 Intermediate-High Risk, and 11 High Risk.Patient outcomes revealed mortality to be 3.9%(n=4) in the PERT and 7.4%(n=2) in the non-PERT group.14.8%(n=4) had a LOS of 7-10 days in the non-PERT, while only 11.7%(n=12) in the PERT group. Average time to anti-coagulation was 7:07 h in the PERT and 11:02 h in the non-PERT group, a 36% improvement in door time to anti-coagulation.In the PERT group,10% (n=10) received mechanical thrombolysis and 0% in the non-PERT. Appropriate risk stratification was found in 87% of the PERT group, while only 56% of the non-PERT. Active or history of malignancy in the Intermediate Risk group was present in 24.5% of the PERT group and 55.5% in the non-PERT. A central PE was present in 58%(n=7) and 54%(n=6) of the Intermediate-High and High Risk groups, respectively. CONCLUSIONS: Activating the PERT generated improvements in all patient outcomes and quality metrics analyzed- mortality, LOS, time to anti-coagulation, proper risk stratification and treatment. Malignancy was noted to be a risk factor in the Intermediate Risk group which was mainly admitted to the Heme-Oncology service.This finding offers a strategy to improve patient outcomes by identifying the importance of educating all healthcare professionals involved in acute PE management to allow for appropriate risk stratification and follow-up.The presence of a central PE was detected in over half of the Intermediate-High and High Risk groups suggesting the significance of mechanical thrombolysis in these groups. CLINICAL IMPLICATIONS: Activating the PERT will allow for prompt treatment, reduce LOS, improve use of resources, patient outcomes and follow-up, while utilizing a multidisciplinary treatment approach. DISCLOSURES: No relevant relationships by Wesley Earl, source=Web Response No relevant relationships by Yasmine Humeda, source=Web Response No relevant relationships by Luis Murillo, source=Web Response No relevant relationships by Madeline Strittmatter, source=Web Response AU - Strittmatter, M. AU - Humeda, Y. AU - Earl, W. AU - Murillo, L. DB - Embase DO - 10.1016/j.chest.2020.08.1207 KW - heme adult anticoagulation awareness cancer patient computed tomographic angiography conference abstract controlled study education female follow up high risk patient human human tissue intermediate risk population length of stay major clinical study male mechanical thrombectomy medical record review morbidity mortality practice guideline pulmonary embolism response team retrospective study risk assessment risk factor teaching hospital total quality management LA - English M1 - 4 M3 - Conference Abstract N1 - L2008025968 2020-10-19 PY - 2020 SN - 1931-3543 0012-3692 SP - A1327 ST - THE IMPACT OF A PULMONARY EMBOLISM RESPONSE TEAM ON QUALITY METRICS IN A COMMUNITY TEACHING HOSPITAL T2 - Chest TI - THE IMPACT OF A PULMONARY EMBOLISM RESPONSE TEAM ON QUALITY METRICS IN A COMMUNITY TEACHING HOSPITAL UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2008025968&from=export http://dx.doi.org/10.1016/j.chest.2020.08.1207 VL - 158 ID - 760539 ER - TY - JOUR AB - Background: Proper instruction during medical training regarding performing adequate physical examinations prior to urologic consultations greatly improves patient care. We evaluated the frequency of genitourinary (GU) physical examinations performed prior to urologic consultation to determine the influence of factors affecting the completion of these examinations. Methods: Between January 2013 and December 2014, 1,596 consultations were requested by primary providers and completed by the urology department at a major tertiary care teaching institution. We reviewed patient medical records retrospectively and recorded the number of GU examinations performed prior to consultation. Patient demographics were evaluated for trends in the rates of examination. A total of 9 available urology residents saw at least one consult each. Results: We identified a total of 1,596 urologic consultations during the study period, of which 233 of 407 (57.2%) (51 female and 182 male patients) received GU examinations prior to the urologic consult in the emergency department (ED) and 394 of 1,189 (33.1%) (118 female and 276 male patients) received GU examinations by the inpatient care team. Staff in the ED were 3.11 times more likely to perform a GU examination on a male patient than a female patient, and the inpatient teams were 1.48 times more likely to perform a GU examination on a male patient than a female patient. The likelihood of examination by either team was low in patients aged >= 65 years. Conclusion: Prior to urologic consultation, GU examinations are inconsistently performed. This variability may affect patient care and could be the subject of a future study. AD - [Stryker, Megan A.; Khaled, Dunia T.; Baksa, Brian] Univ Queensland, Sch Med, Ochsner Clin Sch, New Orleans, LA USA. [Patel, Raunak D.; Khaled, Dunia T.; Saltzman, Amanda F.; Konheim, Jeremy; May, Danica; Richman, Ashley; Montgomery, Melissa M.] Ochsner Clin Fdn, Dept Urol, 1514 Jefferson Hwy, New Orleans, LA 70121 USA. [Feibus, Allison; Fougerousse, Joseph; Chastant, William] Louisiana State Univ, Sch Med, New Orleans, LA USA. [Prats, Samantha] Louisiana State Univ, Hlth Sci Ctr, Dept Obstet & Gynecol, New Orleans, LA USA. Montgomery, MM (corresponding author), Ochsner Clin Fdn, Dept Urol, 1514 Jefferson Hwy, New Orleans, LA 70121 USA. memontgomery@ochsner.org AN - WOS:000436981800021 AU - Stryker, M. A. AU - Patel, R. D. AU - Khaled, D. T. AU - Saltzman, A. F. AU - Konheim, J. AU - May, D. AU - Feibus, A. AU - Fougerousse, J. AU - Richman, A. AU - Chastant, W. AU - Prats, S. AU - Baksa, B. AU - Montgomery, M. M. DA - Spr J2 - Ochsner J. KW - Inpatients physical examination referral and consultation urology DEEP-VEIN THROMBOSIS QUALITY-OF-CARE HOUSE STAFF TIME Medicine, General & Internal LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: GL2UV Times Cited: 0 Cited Reference Count: 13 Stryker, Megan A. Patel, Raunak D. Khaled, Dunia T. Saltzman, Amanda F. Konheim, Jeremy May, Danica Feibus, Allison Fougerousse, Joseph Richman, Ashley Chastant, William Prats, Samantha Baksa, Brian Montgomery, Melissa M. montgomery, melissa/0000-0002-2426-6693 0 OCHSNER CLINIC NEW ORLEANS OCHSNER J PY - 2018 SN - 1524-5012 SP - 72-75 ST - Factors Affecting the Completion of Genitourinary Physical Examinations Prior to Urologic Consultation T2 - Ochsner Journal TI - Factors Affecting the Completion of Genitourinary Physical Examinations Prior to Urologic Consultation UR - ://WOS:000436981800021 VL - 18 ID - 761598 ER - TY - JOUR AB - Objective: Postoperative delirium (POD) has a high prevalence among vascular surgery patients, increasing morbidity, mortality, and length of stay. We prospectively studied preoperative risk factors for delirium that can be assessed by the surgical team to identify high-risk patients and assessed its impact on hospital costs. Methods: There were 173 elective vascular surgery patients assessed preoperatively for cognitive function using the Montreal Cognitive Assessment (MoCA) and the Confusion Assessment Method for POD, which was verified by chart and clinical review. Demographic information, medications, and a history of substance abuse, psychiatric disorders, and previous delirium were prospectively recorded. An accompanying retrospective chart review of an additional 434 (elective and emergency) vascular surgery patients provided supplemental cost information related to sitter use and prolonged hospitalization secondary to three factors: delirium alone, dementia alone, and delirium and dementia. Results: Prospective screening of 173 patients (73.4% male; age, 69.9 +/- 10.97 years) identified that 119 (68.8%) had MoCA scores <24, indicating cognitive impairment, with 7.5% having severe impairment (dementia). Patients who underwent amputation had significantly (P < .000) lower MoCA scores (17 of 30) compared with open surgery and endovascular aneurysm repair patients (23.7 of 30). The incidence of delirium was 11.6% in the elective cohort. Regression analysis identified predictors of delirium to be type of surgical procedure, including lower limb amputation (odds ratio [OR], 16.67; 95% confidence interval [CI], 3.41-71.54; P < .000) and open aortic repair (OR, 5.33; 95% CI, 1.91-14.89; P < .000); cognitive variables (dementia: OR, 5.63; 95% CI, 2.08-15.01; P < .001); MoCA scores <= 15, indicating moderate to severe impairment (OR, 6.13; 95% CI, 1.56-24.02; P = .02); and previous delirium (OR, 2.98; 95% CI, 1.11-7.96; P = .03). Retrospective review (N = 434) identified differences in sitter needs for patients with both delirium and dementia (mean, 13.6 days), delirium alone (mean, 3.9 days), or dementia alone (mean, <1 day [17.7 hours]). Fifteen patients required >200 hours (8.3 days), accounting for 69.7% of sitter costs for the surgical unit; 43.7% of costs were accounted for by patients with pre-existing cognitive impairment. Conclusions: POD is predicted by type of vascular surgery procedure, impaired cognition (MoCA), and previous delirium. Costsandmorbidity related to delirium are greatest for those with impaired cognitive burden. PreoperativeMoCAscreening can identify those at highest risk, allowing procedure modification and informed care. AD - [Styra, Rima; Larsen, Elisabeth; Dimas, Michelle A.; Baston, Dorina; Elgie-Watson, Jeanne; Flockhart, Linda] Univ Hlth Network, Peter Munk Cardiac Ctr, Toronto, ON, Canada. [Lindsay, Thomas F.] Univ Hlth Network, Peter Munk Cardiac Ctr, Div Vasc Surg, Toronto, ON, Canada. [Styra, Rima] Univ Toronto, Dept Psychiat, Toronto, ON, Canada. [Lindsay, Thomas F.] Univ Toronto, Dept Surg, Toronto, ON, Canada. Styra, R (corresponding author), TGH Site,200 Elizabeth St,Ste 8EN-219, Toronto, ON M5G 2C4, Canada. rima.styra@uhn.ca AN - WOS:000453735300034 AU - Styra, R. AU - Larsen, E. AU - Dimas, M. A. AU - Baston, D. AU - Elgie-Watson, J. AU - Flockhart, L. AU - Lindsay, T. F. DA - Jan DO - 10.1016/j.jvs.2018.05.001 J2 - J. Vasc. Surg. KW - Preoperative Cognition Delirium Vascular surgery MoCA CONFUSION ASSESSMENT METHOD INTENSIVE-CARE UNIT LOWER-LIMB ISCHEMIA ELDERLY-PATIENTS CARDIAC-SURGERY RISK-FACTORS ASSESSMENT MOCA VALIDATION OUTCOMES PREVALENCE Surgery Peripheral Vascular Disease LA - English M1 - 1 M3 - Article; Proceedings Paper N1 - ISI Document Delivery No.: HE8ZA Times Cited: 7 Cited Reference Count: 43 Styra, Rima Larsen, Elisabeth Dimas, Michelle A. Baston, Dorina Elgie-Watson, Jeanne Flockhart, Linda Lindsay, Thomas F. Spring Meeting of the Vascular-and-Endovascular-Surgery-Society at the Vascular Annual Meeting of the Society-for-Vascular-Surgery (SVS) JUN 20-23, 2018 Boston, MA Soc Vasc Surg, Vasc & Endovascular Surg Soc Lindsay, Thomas/AAF-1039-2020 Peter Munk Cardiac Center Innovation Fund This work was funded by the Peter Munk Cardiac Center Innovation Fund. 7 0 11 MOSBY-ELSEVIER NEW YORK J VASC SURG PY - 2019 SN - 0741-5214 SP - 201-209 ST - The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications T2 - Journal of Vascular Surgery TI - The effect of preoperative cognitive impairment and type of vascular surgery procedure on postoperative delirium with associated cost implications UR - ://WOS:000453735300034 VL - 69 ID - 761554 ER - TY - JOUR AB - A primary strategy of central line-associated bloodstream infection (CLABSI) prevention is standardized, aseptic insertion of central lines. We compared hospital-wide CLABSI rate pre- and post-implementation of a dedicated procedure team as well as central line checklist completion and patient-specific variables between the procedure team and other providers. No significant differences were found. Further CLABSI prevention should focus on central line maintenance. AD - Virginia Commonwealth University School of Medicine, Richmond, VA. Electronic address: estyslinger@colgate.edu. The Division of Infectious Diseases, Virginia Commonwealth University Medical Center, Richmond, VA. Virginia Commonwealth University School of Medicine, Richmond, VA. Virginia Commonwealth University School of Medicine, Richmond, VA; The Division of Infectious Diseases, Virginia Commonwealth University Medical Center, Richmond, VA. Children's Hospital of Richmond at Virginia Commonwealth University Hospital, Richmond, VA. AN - 31324488 AU - Styslinger, E. AU - Nguyen, H. AU - Hess, O. AU - Srivastava, T. AU - Heipel, D. AU - Patrick, A. AU - Malik, M. AU - Doll, M. AU - Godbout, E. AU - Stevens, M. P. AU - Cooper, K. AU - Hemphill, R. AU - Bearman, G. DA - Nov DO - 10.1016/j.ajic.2019.05.030 DP - NLM ET - 2019/07/22 J2 - American journal of infection control KW - Bacteremia/prevention & control Catheter-Related Infections/*prevention & control Catheterization, Central Venous/*adverse effects Central Venous Catheters/*adverse effects Checklist Humans Infection Control/methods Patient Care Team *Clabsi *CLABSI rate *Checklist completion *Maintenance *Patient-specific variables LA - eng M1 - 11 N1 - 1527-3296 Styslinger, Emily Nguyen, Huong Hess, Olivia Srivastava, Tara Heipel, Diane Patrick, Amie Malik, Manpreet Doll, Michelle Godbout, Emily Stevens, Michael P Cooper, Kaila Hemphill, Robin Bearman, Gonzalo Journal Article United States Am J Infect Control. 2019 Nov;47(11):1400-1402. doi: 10.1016/j.ajic.2019.05.030. Epub 2019 Jul 16. PY - 2019 SN - 0196-6553 SP - 1400-1402 ST - Central line-associated bloodstream infections and completion of the central line insertion checklist: A descriptive analysis comparing a dedicated procedure team to other providers T2 - Am J Infect Control TI - Central line-associated bloodstream infections and completion of the central line insertion checklist: A descriptive analysis comparing a dedicated procedure team to other providers VL - 47 ID - 760385 ER - TY - JOUR AB - Background Atypical haemolytic uraemic syndrome (aHUS) is a severe life threatening disease with progression to end stage renal disease. Eculizumab, a humanised anti-C5 monoclonal antibody targeting the activated complement pathway, has been introduced as a therapy against aHUS. Purpose To demonstrate the efficacy and safety of eculizumab in brief and sustained interruption of the thrombotic microangiopathy process, increase in the number of platelets and significant improvement in renal function in the long term with important reductions in the need for dialysis and plasmapheresis. Material and methods Observational, retrospective and descriptive study of a patient with aHUS. The information was obtained from the electronic clinical history (SELENE) and the pharmacy service managing software (Farmatools). Results The patient was a 60-year-old woman who was hospitalised with renal failure symptoms (Cr 16.6 mg/dL) associated with severe anaemia (Hb 4.5 g/dL) and thrombopenia (platelets 111 000 U/mL) without previous infection. She was started on alternative renal therapy and red blood cell transfusion. Autoimmune studies were requested detecting ANCA+ antibodies and so steroid treatment was started, associated with cyclophosphamide with no response. Due to thrombopenia persistence, we decided to start plasmapheresis with good response, stabilising haemoglobin and increasing the platelet count; however, renal failure function and MAT parameters persisted. From the time of admission (7 January 2015 to 22 February 2015), she needed 14 plasmapheresis sessions and 2 cyclophosphamide boluses with active haemolysis pattern and so was dependent on substitutive renal therapy. The patient started this therapy on 22 February 2015 with 4 doses, 900 mg/week, with good response. No further transfusions or plasmapheresis were needed, with an increase in platelet count (50 000 to 135 000 U/μL) and creatinine (7 to 5.42 mg/ dL). After a week without this drug, analytical values got worse (platelets 111 000 U/μL and creatinine 11.71 mg/dL), and so eculizumad was authorised as maintenance therapy, 1200 mg/15 days. After a month with this maintenance therapy, the result was an increase in platelet count up to 182 000 mg/dL, haemoglobin increase to 9.1 g/dL and creatinine increase to 7.33 mg/dL. Conclusion FDA, EMA and AEMPS have approved the use of eculizumab for treating aHUA. With this good response in this clinical case, eculizumab was effective in aHUS. However, the treatment's high cost requires correct pathological identification in patients, so each case should be studied by a multidisciplinary team (haematology, nephrology and pharmacy). AD - M. Suárez González, Hospital Universitario NTRA. SRA. De Candelaria, Pharmacy Service, S. C. Tenerife, Spain AU - Suárez González, M. AU - Morales Barrios, J. A. AU - Gómez Melini, E. AU - Ramos Santana, E. AU - Betancor García, T. AU - Romero Delgado, C. AU - Navarro Dávila, M. A. AU - Fraile Clemente, C. AU - Montero Delgado, A. AU - Merino Alonso, J. DB - Embase DO - 10.1136/ejhpharm-2016-000875.285 KW - creatinine cyclophosphamide eculizumab endogenous compound hemoglobin neutrophil cytoplasmic antibody steroid adult case report drug therapy erythrocyte transfusion female hematology hemolysis hemolytic uremic syndrome hospital department human infection kidney failure maintenance therapy middle aged nephrology plasmapheresis software symptom platelet count thrombocytopenia LA - English M3 - Conference Abstract N1 - L614324912 2017-02-10 PY - 2016 SN - 2047-9964 SP - A125-A126 ST - Eculizumab in the atypical haemolytic uraemic syndrome: A case report T2 - European Journal of Hospital Pharmacy TI - Eculizumab in the atypical haemolytic uraemic syndrome: A case report UR - https://www.embase.com/search/results?subaction=viewrecord&id=L614324912&from=export http://dx.doi.org/10.1136/ejhpharm-2016-000875.285 VL - 23 ID - 761035 ER - TY - JOUR AB - Background: Thrombosis of a bioprosthetic valve in antiphospholipid syndrome (APS) presents a therapeutic dilemma for which there is a lack of clinical guidance. Case: A 33-year-old woman was admitted after an echocardiogram performed for recurrent transient ischemic attack (TIA) showed severe bioprosthetic aortic valve obstruction [mean gradient (MG), 69 mmHg; aortic valve area, 0.5 cm2]. She had undergone aortic valve replacement for severe aortic regurgitation due to Libman-Sacks endocarditis 6 months prior. Her past history was significant for systemic lupus erythematosus and APS on chronic anticoagulation with dalteparin (weight based), prior difficulty maintaining a therapeutic INR despite high warfarin doses (35-40 mg daily), and a possible TIA while on therapeutic weight-based enoxaparin dosing (68 kg; 100 mg daily). Decision Making: Intravenous unfractionated heparin was initiated after admission with titration to anti-Xa levels (0.7 to 1.2). An echo- Doppler study performed 6 days after admission demonstrated an aortic prosthesis MG of 57 mmHg. Given her prior issues with warfarin and enoxaparin, she was discharged on a higher dose dalteparin (1.25 times previous dose, based on anti-Xa) for outpatient follow up. Unfortunately, she was readmitted 4 days later with NYHA class III/IV symptoms. Repeat echo-Doppler showed a MG of 71 mmHg. Failing more intense anticoagulation left two options; thrombolysis vs bioprosthetic or mechanical valve replacement. In discussion with the patient and multidisciplinary team, she was treated with thrombolysis, resulting in mild symptom improvement and reduction of aortic valve MG to 39 mm Hg. Warfarin was restarted with dosing adjusted per chromogenic factor X and factor II levels (she required 20 mg alternating with 25 mg daily). Conclusions: This patient represents a therapeutic challenge and highlights the difficult and complex decision making process in management of patients with aortic bioprosthetic valve thrombosis in the setting of APS. This is a rare presentation for which there are no established guidelines to direct therapy. Multidisciplinary approach and shared decision-making is important in uncharted waters. AD - A. Sugrue, Mayo Clinic, Rochester, MN, United States AU - Sugrue, A. AU - Connolly, H. AU - Blauwet, L. AU - Maalouf, Y. DB - Embase KW - water warfarin enoxaparin dalteparin heparin blood clotting factor 10 prosthetic valve thrombosis antiphospholipid syndrome American college cardiology human doppler echo decision making patient aortic valve anticoagulation weight blood clot lysis endocarditis thrombosis aortic regurgitation aortic prosthesis aortic valve replacement obstruction titrimetry transient ischemic attack echocardiography systemic lupus erythematosus female outpatient follow up heart valve replacement therapy New York Heart Association class international normalized ratio LA - English M1 - 13 M3 - Conference Abstract N1 - L72242599 2016-04-13 PY - 2016 SN - 0735-1097 SP - 1096 ST - Aortic bioprosthetic valve thrombosis and antiphospholipid syndrome: Uncharted waters T2 - Journal of the American College of Cardiology TI - Aortic bioprosthetic valve thrombosis and antiphospholipid syndrome: Uncharted waters UR - https://www.embase.com/search/results?subaction=viewrecord&id=L72242599&from=export VL - 67 ID - 761026 ER - TY - JOUR AB - Background: Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use to decrease resistance and acquisition of hospital-acquired infections, improve patient outcomes, and reduce health care costs. We evaluated interventions and outcomes associated with a dedicated stewardship consult service staffed by physician assistant with supervision from infectious disease physician. Methods: This was a retrospective study of electronic medical records of adult patients evaluated by the ASP team from November 2012 to December 2013 in an 802-bed teaching hospital in Detroit, Mich. Hospice patients were excluded. Patient characteristics, type of infection, microbiological cultures, antimicrobials utilized, interventions performed, and clinical outcomes were assessed. Results: Three hundred thirty-five patients met the inclusion criteria. Median age was 67 years, and 52% were male. The most common infections were lower respiratory (28%) and urinary tract infections (21%). However, 24% were diagnosed as having no infection, and of these, 67% had asymptomatic bacteriuria. Escherichia coli (21%) and methicillin-resistant Staphylococcus aureus (14%) were most frequently isolated pathogens. The ASP team denied 38% of peripherally inserted central catheter requests and recommended intravenous-to-oral conversion in 38% cases, discontinuation of antibiotics in 27%, and de-escalation of therapy in 13%. Vancomycin (18%) and quinolones (16%) were the most commonly prescribed antibiotics. The majority of patients (95%) had clinical success, whereas very few developed Clostridium difficile infection (1.5%) or had infection-related readmission (2%) within 30 days. Conclusions: Our ASP consult service reduced unnecessary peripherally inserted central catheter placement and antimicrobial use with favorable clinical success and patient outcomes. In light of the new regulatory ASP requirements, a midlevel provider may be beneficial to and an integral part of an infectious disease physician-supervised stewardship team. AD - [Suleyman, Geehan] Univ Toledo, Med Ctr, Dept Infect Dis, Toledo, OH 43614 USA. [Grunwald, Jenny; Zervos, Marcus J.; Weinmann, Allison] Henry Ford Hosp, Dept Infect Dis, Detroit, MI 48202 USA. [Kenney, Rachel M.; Davis, Susan L.] Henry Ford Hosp, Dept Pharm, Detroit, MI 48202 USA. Suleyman, G (corresponding author), Univ Toledo, Med Ctr, 3000 Arlington Ave, Toledo, OH 43614 USA. geehan.suleyman@utoledo.edu AN - WOS:000408592300010 AU - Suleyman, G. AU - Grunwald, J. AU - Kenney, R. M. AU - Davis, S. L. AU - Zervos, M. J. AU - Weinmann, A. DA - Sep DO - 10.1097/ipc.0000000000000542 J2 - Infect. Dis. Clin. Pract. KW - antimicrobial resistance antimicrobial stewardship program midlevel provider INFECTIOUS-DISEASES SOCIETY HEALTH-CARE EPIDEMIOLOGY BLOOD-STREAM INFECTIONS PROGRAM AMERICA PREVENTION GUIDELINES PREDICTORS THROMBOSIS PATTERNS Immunology Infectious Diseases LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: FF0LD Times Cited: 0 Cited Reference Count: 16 Suleyman, Geehan Grunwald, Jenny Kenney, Rachel M. Davis, Susan L. Zervos, Marcus J. Weinmann, Allison 0 2 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA INFECT DIS CLIN PRAC PY - 2017 SN - 1056-9103 SP - 268-271 ST - Impact of Antimicrobial Stewardship Consultation Service at an Academic Institution T2 - Infectious Diseases in Clinical Practice TI - Impact of Antimicrobial Stewardship Consultation Service at an Academic Institution UR - ://WOS:000408592300010 VL - 25 ID - 761639 ER - TY - JOUR AB - Introduction and Objective: The diagnosis of inherited platelet disorders (IPDs) is challenging and often requires multimodality laboratory evaluation. Next Generation Sequencing (NGS) has allowed lower cost molecular analysis that is more widely accessible and affordable for clinicians. The utility of the test results in clinical practice depends on the interpretation of the sequencing results in light of clinical data. This process is difficult given the low incidence of these disorders and limited expertise outside of reference centers. We report the diagnostic yield of NGS panels using a multidisciplinary approach that includes correlation with history and laboratory findings. Materials and Methods: 40 consecutive patients were evaluated by our reference laboratory using one of three available IPD panels: thrombocytopenia, platelet function or comprehensive platelet disorder between 7/2017 and 11/2017. Detailed clinical and laboratory information was obtained and used to interpret the variants (Figure presented) following ACMG standards by a multidisciplinary team (scientists, physicians and genetic counselors). Results: Tests ordered, and results are presented in Figure 1. 38 variants were identified in 29 patients (73%). 21 (55%) were variants of uncertain significance (VUS) and 17 (45%) were pathogenic. A definitive diagnosis of an IPD was reached in 14 cases (35%). Eight of the identified variants were considered unlikely to explain the clinical phenotype. Conclusions: Despite a high proportion of cases having variants identified, an IPD was confirmed in only half of the positive cases. A high proportion of the non-diagnostic cases had novel variants that fit the phenotype but require segregation studies and/or functional data to confirm their pathogenicity. In a significant proportion of cases, the identified variant did not correlate with the phenotype and additional testing was recommended. The multidisciplinary approach is successful at providing clinically meaningful and actionable recommendations that enhance the scope of practice of the general practitioner. AD - M.J. Sullivan, BloodCenter of Wisconsin, Milwaukee, United States AU - Sullivan, M. J. AU - Friedman, K. D. AU - McCreery, J. AU - Springer, M. G. AU - Trapp-Stamborski, V. AU - Curtis, B. R. AU - Anderson, M. W. AU - Wang, L. AU - Botero, J. P. AU - Dugan, S. N. DB - Embase DO - 10.1111/hae.13478 KW - adult clinical article conference abstract controlled study counselor diagnosis diagnostic value female general practitioner human incidence male high throughput sequencing pathogenicity phenotype scientist scope of practice thrombocyte disorder thrombocyte function LA - English M3 - Conference Abstract N1 - L622461590 2018-06-11 PY - 2018 SN - 1365-2516 SP - 97-98 ST - Clinical correlation with a multidisciplinary approach facilitates the diagnosis of patients with a suspected inherited platelet disorder using next generation sequencing T2 - Haemophilia TI - Clinical correlation with a multidisciplinary approach facilitates the diagnosis of patients with a suspected inherited platelet disorder using next generation sequencing UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622461590&from=export http://dx.doi.org/10.1111/hae.13478 VL - 24 ID - 760824 ER - TY - JOUR AB - RATIONALE CT pulmonary angiograms (CTPAs) are routinely used in the investigation of suspected pulmonary emboli (PE). Incidental findings of lung parenchymal lesions are common. The significance of these incidental lung lesions is not clear. We present our experience in the management of incidental lung parenchymal lesions from CTPAs over a two year period from a UK district general hospital. METHODS We identified patients retrospectively by analyzing all CTPAs undertaken in 2009 and 2010. We used Picture Archiving and Communication System (PACS) for CTPA reports. Biopsy results were identified from our in house pathology database and lung cancer multidisciplinary team (MDT) dtaabase. Patient case records were used to confirm final clinical outcomes. RESULTS Incidental lung lesions were identified in 41/646 (6.35%) and 45/821 (5.5%) CTPA scans in 2009 and 2010, respectively. 7 patients in 2009 and 15 patients in 2010 already had a diagnosis of cancer when they had their CTPA scans. 27/34 patients in 2009 and 21/30 patients in 2010 were postulated to have a malignancy and proceeded to further investigations. 26/34 patients in 2009 and 17/30 patients in 2010 were thought to have primary lung cancer. In those that were considered medically unfit or declined investigation, a radiological diagnosis of lung cancer was provided for 4 patients in 2009 and 1 patient in 2010. 13/26 (50%) patients in 2009 and 9/17 (52.9%) patients in 2010 required radiological surveillance with serial CT thorax or positron emission tomography (PET). A histological diagnosis was sought in 9/34 patients in 2009 and 7/30 patients in 2010. A diagnosis of primary lung cancer was established in 8/9 patients in 2009 and 5/7 patients in 2010. In patients with incidental suspected malignant lung lesions on CTPA, 8/26 (30.1%) and 5/17 (29.4%) patients had a histological diagnosis of primary lung cancer in 2009 and 2010, respectively. CONCLUSIONS Incidental findings of lung lesions on CTPA scans require urgent follow-up in up to 1 in 20 patients. Time from CTPA to tissue diagnosis was almost halved, i.e., to less than 2 weeks, between 2009 and 2010. Half of patients with suspicious incidental lung lesions on CTPA require radiological monitoring with serial CT or PET imaging. In our two experience, under a third of incidental lung lesions were primary lung cancers. Patients with positive histology in our series had advanced lung carcinoma. The incidental finding of lung cancer was associated with a poor prognosis. (Table Presented). AD - S. Sundaram, Princess Alexandra Hospital, Harlow, United Kingdom AU - Sundaram, S. AU - Sallehuddin, S. AU - Isse, S. AU - Russell, P. DB - Embase KW - computer assisted tomography American society lung patient human lung cancer lung lesion diagnosis incidental finding histology lung embolism pathology biopsy data base prognosis picture archiving and communication system follow up positron emission tomography thorax general hospital radiodiagnosis neoplasm tissues monitoring imaging lung carcinoma United Kingdom L1 - http://www.atsjournals.org/doi/pdf/10.1164/ajrccm-conference.2012.185.1_MeetingAbstracts.A4418 LA - English M3 - Conference Abstract N1 - L71989053 2015-09-08 PY - 2012 SN - 1073-449X ST - Outcomes in identification of incidental lung parenchymal lesions from computed tomography pulmonary angiograms T2 - American Journal of Respiratory and Critical Care Medicine TI - Outcomes in identification of incidental lung parenchymal lesions from computed tomography pulmonary angiograms UR - https://www.embase.com/search/results?subaction=viewrecord&id=L71989053&from=export VL - 185 ID - 761194 ER - TY - JOUR AB - BACKGROUND/PURPOSE: Code stroke systems are widely implemented to expedite acute stroke treatment. Although this system requires considerable resources, so far no reimbursement has been provided by the Bureau of National Health Insurance (BNHI) in Taiwan. We investigated how often a code stroke was initiated and the percentage of patients treated with intravenous (IV) tissue plasminogen activator, and draw attention to the resulting mismatch. METHODS: From January 2010 to September 2011, we prospectively registered all consecutive code stroke patients. Patient characteristics, including demographic data, medical history, comorbidity conditions, treatments, and discharge diagnosis were collected, together with the exact time of onset (or last known normal time) and management. The eligibility of thrombolysis for each patient recorded originally on the chart was reviewed retrospectively on the basis of two sets of criteria, namely, the BNHI reimbursement criteria and the Taiwan Stroke Society (TSS) guideline. RESULTS: During the study period, code strokes were activated for 419 patients at an average of around 20 patients per month. About 57% of code strokes were initiated outside of office hours. Stroke was diagnosed in 377 (90%) patients and 304 (73%) patients had ischemic stroke or transient ischemic attack. A total of 42 (10%) patients according to the BNHI reimbursement criteria and 101 (24%) patients by the TSS guideline were eligible for IV thrombolytic therapy. Of all the code stroke patients, only 49 (12%) were actually treated. Before each additional patient was thrombolysed, about eight patients had been evaluated and excluded from treatment. CONCLUSION: The majority of code stroke patients were stroke patients; however, most of them could not be treated with thrombolytic therapy. These findings underscore the need for further support from the BNHI in order for health-care providers to implement the code stroke systems successfully. AD - Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan. Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan. Electronic address: mctseng@mail.nsysu.edu.tw. AN - 24961186 AU - Sung, S. F. AU - Tseng, M. C. DA - Jul DO - 10.1016/j.jfma.2012.07.029 DP - NLM ET - 2014/06/26 J2 - Journal of the Formosan Medical Association = Taiwan yi zhi KW - Acute Disease Aged Aged, 80 and over Brain Ischemia/diagnosis/*drug therapy Eligibility Determination Female Fibrinolytic Agents/adverse effects/*therapeutic use Hospital Rapid Response Team Humans Male Middle Aged Neurology/standards/*statistics & numerical data Practice Guidelines as Topic Practice Patterns, Physicians'/statistics & numerical data Prospective Studies Stroke/*drug therapy Taiwan Time-to-Treatment Tissue Plasminogen Activator/adverse effects/*therapeutic use acute stroke emergencies thrombolytic therapy LA - eng M1 - 7 N1 - Sung, Sheng-Feng Tseng, Mei-Chiun Journal Article Research Support, Non-U.S. Gov't Singapore J Formos Med Assoc. 2014 Jul;113(7):442-6. doi: 10.1016/j.jfma.2012.07.029. Epub 2012 Sep 7. PY - 2014 SN - 0929-6646 (Print) 0929-6646 SP - 442-6 ST - Code stroke: a mismatch between number of activation and number of thrombolysis T2 - J Formos Med Assoc TI - Code stroke: a mismatch between number of activation and number of thrombolysis VL - 113 ID - 760290 ER - TY - JOUR AB - Data from large case series of children with cerebral thrombotic events are pivotal to improve prevention, early recognition and treatment of these conditions. The Italian Registry of Pediatric Thrombosis (R. I. T. I.) was established in 2007 by a multidisciplinary team, aiming for a better understanding of neonatal and paediatric thrombotic events in Italy and providing a preliminary source of data for the future development of specific clinical trials and diagnostic-therapeutic protocols. We analysed data relative to the paediatric cerebral thrombotic events of the R. I. T. I. which occurred between January 2007 and June 2012. In the study period, 79 arterial ischaemic stroke (AIS) events (49 in males) and 91 cerebral sinovenous thrombosis (CSVT) events (65 in males) were enrolled in the R. I. T. I. Mean age at onset was 4.5 years in AIS, and 7.1 years in CSVT. Most common modes of presentation were hemiparesis, seizures and speech disturbances in AIS, and headache, seizures and lethargy in CSVT. Most common etiologies were underlying chronic diseases, vasculopathy and cardiopathy in AIS, and underlying chronic diseases and infection in CSVT. Time to diagnosis exceeded 24 hours in 46% AIS and 59% CSVT. Overall data from the Italian Registry are in substantial agreement with those from the literature, despite small differences. Among these, a longer time to diagnosis compared to other registries and case series poses the accent to the need of an earlier recognition of paediatric cerebrovascular events in Italy, in order to enable prompt and effective treatment strategies. AD - P. Simioni, Department of Medicine, University of Padua Medical School, Via Ospedale 105, Padua, Italy AU - Suppiej, A. AU - Gentilomo, C. AU - Saracco, P. AU - Sartori, S. AU - Agostini, M. AU - Bagna, R. AU - Bassi, B. AU - Giordano, P. AU - Grassi, M. AU - Guzzetta, A. AU - Lasagni, D. AU - Luciani, M. AU - Molinari, A. C. AU - Palmieri, A. AU - Putti, M. C. AU - Ramenghi, L. A. AU - Rota, L. L. AU - Sperlì, D. AU - Laverda, A. M. AU - Simioni, P. AU - Angriman, M. AU - Aru, A. B. AU - Barisone, E. AU - Bartalena, L. AU - Berta, M. AU - Bertoni, E. AU - Cancarini, P. AU - Cavaliere, E. AU - Celle, M. E. AU - Cerbone, A. M. AU - Cesaroni, E. AU - Via, L. D. AU - Dell’Oro, M. G. AU - Di Rosa, G. AU - Ferrari, G. M. AU - Fiori, S. AU - Gaffuri, M. AU - Gallina, M. R. AU - Gimmillaro, A. AU - Grandone, E. AU - Ladogana, S. AU - Laforgia, N. AU - La Piana, R. AU - Maschio, F. AU - Miniero, R. AU - Nosadini, M. AU - Panzeri, D. AU - Petrucci, A. AU - Piersigilli, F. AU - Sala, D. AU - Sangermani, R. AU - Santoro, N. AU - Tufano, A. AU - Ventura, G. AU - Vittorini, R. DB - Embase Medline DO - 10.1160/TH14-05-0431 KW - acetylsalicylic acid heparin low molecular weight heparin warfarin adolescent anticoagulation artery dissection article brain ischemia cerebral sinus thrombosis child chronic disease clinical trial (topic) disease registry Doppler ultrasonography female follow up headache hemiparesis hospital discharge human infant infection Italy lethargy major clinical study male moyamoya disease nuclear magnetic resonance imaging onset age outcome assessment papilledema preschool child priority journal relapse school child seizure speech disorder thrombocyte aggregation inhibition thrombophilia transthoracic echocardiography vasculitis venous thromboembolism LA - English M1 - 6 M3 - Article N1 - L604789673 2015-06-19 2019-12-20 PY - 2015 SN - 0340-6245 SP - 1270-1277 ST - Paediatric arterial ischaemic stroke and cerebral sinovenous thrombosis: First report from the italian registry of pediatric thrombosis (R. I. T. I., Registro Italiano Trombosi Infantili) T2 - Thrombosis and Haemostasis TI - Paediatric arterial ischaemic stroke and cerebral sinovenous thrombosis: First report from the italian registry of pediatric thrombosis (R. I. T. I., Registro Italiano Trombosi Infantili) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L604789673&from=export http://dx.doi.org/10.1160/TH14-05-0431 VL - 113 ID - 761088 ER - TY - JOUR AB - The aim of the present study was to clarify the characteristics of Japanese critical limb ischemia (CLI) patients and analyze the rates of real-world mortality and amputation-free survival (AFS) in all patients with Fontaine stage IV CLI who were treated with/without revascularization therapy by an intra-hospital multidisciplinary care team. All consecutive patients who presented with CLI at Showa University Fujigaoka Hospital between April 2008 and March 2014 were prospectively registered. The intra-hospital committee consisted of cardiologists, plastic surgeons, dermatologists, diabetologists, nephrologists, cardiovascular surgeons, and vascular technologists. The primary endpoint of this study was all-cause mortality and AFS during the follow-up period. The present study included 145 patients with Fontaine stage IV CLI. The mean age was 76.5 ± 10.2 years. The all-cause mortality rate during the follow-up period (15.5 ± 16.1 months) was 21.4 %. The AFS rate during the follow-up period (14.1 ± 16.4 months) was 58.6 %. A multivariate Cox proportional hazards regression analysis found that age >75 years and hemodialysis were significantly associated with all-cause mortality; and that age >75 years, Rutherford 6, and wound infection were significantly associated with AFS. A multidisciplinary approach and comprehensive care may improve the outcomes and optimize the collaborative treatment of CLI patients. However, all-cause mortality remained high in patients with Fontaine stage IV CLI and early referral to a hospital that can provide specialized treatment for CLI, before the occurrence of major tissue loss or infection, is necessary to avoid primary amputation. AD - Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan. hrsuzuki@med.showa-u.ac.jp. Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan. Department of Plastic Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan. Department of Dermatology, Showa University Fujigaoka Hospital, Yokohama, Japan. Department of Dermatology, Showa University School of Medicine, Tokyo, Japan. Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan. Division of Diabetes and Endocrinology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan. Department of Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan. Department of Internal Medicine, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan. AN - 27106919 AU - Suzuki, H. AU - Maeda, A. AU - Maezawa, H. AU - Togo, T. AU - Nemoto, H. AU - Kasai, Y. AU - Ito, Y. AU - Nakada, T. AU - Sueki, H. AU - Mizukami, A. AU - Takayasu, M. AU - Iwaku, K. AU - Takeuchi, S. AU - Tanaka, H. AU - Iso, Y. DA - Jan DO - 10.1007/s00380-016-0840-z DP - NLM ET - 2016/04/24 J2 - Heart and vessels KW - Aged Aged, 80 and over Cause of Death Critical Illness Endovascular Procedures Female Humans *Interdisciplinary Communication Ischemia/*physiopathology Japan Kaplan-Meier Estimate Limb Salvage/*methods Lower Extremity/blood supply Male Multivariate Analysis Patient Care Team/*organization & administration Peripheral Arterial Disease/*mortality/*surgery Proportional Hazards Models Registries Risk Factors Time Factors Treatment Outcome *Critical limb ischemia *Multidisciplinary care *Peripheral artery disease LA - eng M1 - 1 N1 - 1615-2573 Suzuki, Hiroshi Maeda, Atsuo Maezawa, Hideyuki Togo, Tomoichiro Nemoto, Hitoshi Kasai, Yoshiaki Ito, Yoshinori Nakada, Tokio Sueki, Hirohiko Mizukami, Aya Takayasu, Mamiko Iwaku, Kenji Takeuchi, Susumu Tanaka, Hiroyuki Iso, Yoshitaka Journal Article Japan Heart Vessels. 2017 Jan;32(1):55-60. doi: 10.1007/s00380-016-0840-z. Epub 2016 Apr 22. PY - 2017 SN - 0910-8327 SP - 55-60 ST - The efficacy of a multidisciplinary team approach in critical limb ischemia T2 - Heart Vessels TI - The efficacy of a multidisciplinary team approach in critical limb ischemia VL - 32 ID - 760194 ER - TY - JOUR AB - PURPOSE: We hypothesized that a multidisciplinary collaborative physician-pharmacist multiple myeloma clinic would improve adherence to treatment and supportive care guidelines as well as reduce delays in receiving oral antimyeloma therapy. METHODS: From March 2014 to February 2015, an oncology pharmacist provided consultation for all patients in a specialist myeloma clinic. This included reviewing medications, ensuring physician adherence to supportive care guidelines, managing treatment-related adverse effects, and navigating issues involving access to oral specialty medications (collaborative clinic). RESULTS: Outcome measures were retrospectively compared with those of patients being treated by the same physician during the previous year, in which ad hoc pharmacist consultation was available upon request (traditional clinic). The collaborative clinic led to significant improvements in adherence to supportive medications, such as bisphosphonates (96% v 68%; P < .001), calcium and vitamin D (100% v 41%; P < .001), acyclovir (100% v 58%; P < .001), and Pneumocystis jirovecii pneumonia prophylaxis (100% v 50%; P < .001). Appropriate venous thromboembolism prophylaxis in immunomodulatory drug-treated patients was prescribed in 100% versus 83% of cases ( P = .0035). The median time to initiation of bisphosphonate (5.5 v 97.5 days; P < .001) and P jirovecii pneumonia prophylaxis after autologous transplantation was shortened in the collaborative clinic (11 v 40.5 days; P < .001). Furthermore, the number (85% v 21%; P < .001) and duration (7 v 15 days; P = .002) of delays in obtaining immunomodulatory drug therapy were also significantly reduced. CONCLUSION: Our collaborative clinic model could potentially be applied to other practice sites to improve the management of patients with multiple myeloma. Prospective studies analyzing clinical outcomes, patient satisfaction, and cost effectiveness of this approach are warranted. AD - University of Illinois at Chicago, Chicago, IL. AN - 30423263 AU - Sweiss, K. AU - Wirth, S. M. AU - Sharp, L. AU - Park, I. AU - Sweiss, H. AU - Rondelli, D. AU - Patel, P. R. DA - Nov DO - 10.1200/jop.18.00085 DP - NLM ET - 2018/11/14 J2 - Journal of oncology practice KW - Adult Aged Aged, 80 and over Disease Management Female *Guideline Adherence Humans Male Middle Aged Multiple Myeloma/diagnosis/*epidemiology/therapy Outcome Assessment, Health Care *Patient Care Team *Pharmacists *Physicians Professional Role Quality of Health Care *Time-to-Treatment LA - eng M1 - 11 N1 - 1935-469x Sweiss, Karen Wirth, Scott M Sharp, Lisa Park, Irene Sweiss, Helen Rondelli, Damiano Patel, Pritesh R Journal Article United States J Oncol Pract. 2018 Nov;14(11):e674-e682. doi: 10.1200/JOP.18.00085. PY - 2018 SN - 1554-7477 SP - e674-e682 ST - Collaborative Physician-Pharmacist-Managed Multiple Myeloma Clinic Improves Guideline Adherence and Prevents Treatment Delays T2 - J Oncol Pract TI - Collaborative Physician-Pharmacist-Managed Multiple Myeloma Clinic Improves Guideline Adherence and Prevents Treatment Delays VL - 14 ID - 760131 ER - TY - JOUR AB - BACKGROUND: Deep vein thrombosis and pulmonary embolism are known collectively as venous thromboembolism (VTE). These conditions are possible complications in hospitalized patients that can extend hospital stay, result in unplanned readmission, and are associated with long-term disability and death. Despite strong evidence, many patients do not receive optimal thromboprophylaxis. VTE prevention is a top priority in healthcare systems worldwide. AIM: The aim of the project was to establish a standardized hospital-wide VTE prevention program and to improve awareness of, and compliance with, best practice standards in the prevention of VTE. METHODS: A multidisciplinary team utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System program to facilitate the collection of pre and post implementation audit data. The Getting Research into Practice program was also used to conduct a situational analysis to identify barriers, enablers, and implementation strategies while taking into account the context in which the changes were to occur. Hospital-acquired VTE data were collected to monitor the impact, if any, on patient outcomes. The project was conducted in three different phases over a 2.5-year period in an acute care public hospital. RESULTS: A comprehensive suite of professionally crafted guidelines, tools, and resources were developed to facilitate clinician acceptance of evidence-based practices. Comparison of compliance results showed variable improvements with four audit criteria. Formalized patient risk assessment improved to 7.5% with the introduction of a new form. High-risk patients receiving appropriate prophylaxis improved to 81% in medical and 83% in surgical patients, on an existing high background compliance rate. A total of 59% of staff attended a VTE update education in-service. No patients received information about adverse VTE events prior to discharge. The hospital-acquired VTE rate decreased slightly from 0.65 to 0.52 events per 1000 overnight bed days. CONCLUSION: Overall the project achieved improvements in compliance with best practice standards. A number of delays and barriers contributed to some of the planned interventions not being fully implemented at the time of the follow-up audit. Contributing factors included the lack of electronic capabilities, some processes not being fully embedded into routine clinical workflows, lack of staff time, and identification of an additional organizational barrier relating to practical issues in providing patient education at discharge. A second action cycle is recommended in an attempt to further improve compliance, ensure intervention fidelity, and embed practices into routine daily workflows to positively impact patient and organizational outcomes. AD - 1Centre for Education and Research, Royal Hobart Hospital, Hobart, Tasmania 2School of Health Sciences, University of Tasmania, and Tasmanian Health Service 3Department of Anaesthesia 4Safety and Quality Unit 5Pharmacy Department 6Department of Haematology, Royal Hobart Hospital, Hobart, Tasmania 7Department of Health and Human Services Tasmania, Australia. AN - 27167767 AU - Sykes, P. K. AU - Walsh, K. AU - Darcey, C. M. AU - Hawkins, H. L. AU - McKenzie, D. S. AU - Prasad, R. AU - Thomas, A. DA - Jun DO - 10.1097/xeb.0000000000000083 DP - NLM ET - 2016/05/12 J2 - International journal of evidence-based healthcare KW - Evidence-Based Practice/*organization & administration Guideline Adherence Hospitals, University Humans Medical Audit Medical Staff, Hospital/education Nursing Staff, Hospital/education Patient Discharge/*standards Patient Outcome Assessment Risk Assessment Tasmania Tertiary Care Centers Venous Thromboembolism/*prevention & control LA - eng M1 - 2 N1 - 1744-1609 Sykes, Pamela Kathleen Walsh, Kenneth Darcey, Chenqu Mimi Hawkins, Heather Lee McKenzie, Duncan Scott Prasad, Ritam Thomas, Anita Journal Article Australia Int J Evid Based Healthc. 2016 Jun;14(2):64-73. doi: 10.1097/XEB.0000000000000083. PY - 2016 SN - 1744-1595 SP - 64-73 ST - Prevention of venous thromboembolism amongst patients in an acute tertiary referral teaching public hospital: a best practice implementation project T2 - Int J Evid Based Healthc TI - Prevention of venous thromboembolism amongst patients in an acute tertiary referral teaching public hospital: a best practice implementation project VL - 14 ID - 760428 ER - TY - JOUR AB - Background: Pulmonary embolism (PE) is a common illness with significant mortality without appropriate treatment. Its disease severity is variable, difficult to prognosticate and triage of severe PE remains a patient safety concern. Some PE may benefit from invasive and advanced medical therapy, but these decisions require complex multi-disciplinary coordinated care. We have launched a multi-disciplinary rapid response team at the Foothills Medical Center Hospital (FMC) to assist prognostication, treatment, disposition planning, and followup for high-risk PE: The Pulmonary Embolism Response Team (PERT). Aim Statement: PERT has been implemented to improve patient-oriented outcomes however, as severe PE is infrequent, we initially target process measures. In the first year of PERT rollout, we aim for: 1) 100% of high risk PE be detected by emergency for PERT consult 2)PERT responsebewithin 45 minutes of activation 3) PERT treatment and disposition be made within 1 hour of consult. 4) > 80% of patient dispositions match those informed by evidence-based risk stratification tools. Measures &Design: Through collaboration between emergency medicine, radiology, cardiac sciences, medical specialties and critical care, a collective evidence-based PE risk stratification/treatment pathway was developed. This has been disseminated to providers and embedding into electronic medical records (EMR) for computer assisted decision-making support. EMR data has been harmonized with standardized radiographic reporting for PE to cue reporting of high risk imaging findings. Standardized imaging and EMR prognostic factors flag high risk PE suggesting PERT activation. PERT standard operating procedures have been developed, including evidenced-based pathways for further therapy, advanced imaging, and subspecialized disposition planning. Clinical services meet quarterly, and review dashboard summary data on clinical adverse events, resource utilization, and time data of patient flow to revise PE care pathways. Evaluation/Results: PERT activations occur approximately 2 times weekly. Adherence to operating procedures is high. Feedback post implementation cites improved adherence to evidence-based practice, clearer communication, and faster patient disposition. Quantitative analysis of performance is limited by infrequency of cases. Discussion/Impact: Our project shows feasibility of a PERT service. Pre-implementation data is collected, and we are currently measuring these post. We suspect signal of improved patient-oriented outcomes will be detected with more cases. AD - M. Szava-Kovats, University of Calgary, Calgary, AB, Canada AU - Szava-Kovats, M. AU - Andruchow, J. AU - Boiteau, P. AU - Herget, E. AU - Solverson, K. DB - Embase DO - 10.1017/cem.2020.228 KW - adult conference abstract decision making electronic medical record embedding emergency medicine evidence based practice center feasibility study follow up heart human intensive care patient safety pulmonary embolism response team quantitative analysis radiology thrombosis total quality management LA - English M3 - Conference Abstract N1 - L633284447 2020-11-06 PY - 2020 SN - 1481-8043 SP - S71-S72 ST - Development and early experience with the Foothills Medical Center Pulmonary Embolism Response Team (PERT) T2 - Canadian Journal of Emergency Medicine TI - Development and early experience with the Foothills Medical Center Pulmonary Embolism Response Team (PERT) UR - https://www.embase.com/search/results?subaction=viewrecord&id=L633284447&from=export http://dx.doi.org/10.1017/cem.2020.228 VL - 22 ID - 760576 ER - TY - JOUR AB - Background: Pulmonary embolism (PE) is a common illness with significant mortality without appropriate treatment. Its disease severity is variable, difficult to prognosticate and triage of severe PE remains a patient safety concern. Some PE may benefit from invasive and advanced medical therapy, but these decisions require complex multi-disciplinary coordinated care. We have launched a multi-disciplinary rapid response team at the Foothills Medical Center Hospital (FMC) to assist prognostication, treatment, disposition planning, and followup for high-risk PE: The Pulmonary Embolism Response Team (PERT). Aim Statement: PERT has been implemented to improve patient-oriented outcomes however, as severe PE is infrequent, we initially target process measures. In the first year of PERT rollout, we aim for: 1) 100% of high risk PE be detected by emergency for PERT consult 2) PERT response be within 45 minutes of activation 3) PERT treatment and disposition be made within 1 hour of consult. 4) > 80% of patient dispositions match those informed by evidence-based risk stratification tools. Measures & Design: Through collaboration between emergency medicine, radiology, cardiac sciences, medical specialties and critical care, a collective evidence-based PE risk stratification/treatment pathway was developed. This has been disseminated to providers and embedding into electronic medical records (EMR) for computer assisted decision-making support. EMR data has been harmonized with standardized radiographic reporting for PE to cue reporting of high risk imaging findings. Standardized imaging and EMR prognostic factors flag high risk PE suggesting PERT activation. PERT standard operating procedures have been developed, including evidenced-based pathways for further therapy, advanced imaging, and subspecialized disposition planning. Clinical services meet quarterly, and review dashboard summary data on clinical adverse events, resource utilization, and time data of patient flow to revise PE care pathways. Evaluation/Results: PERT activations occur approximately 2 times weekly. Adherence to operating procedures is high. Feedback post implementation cites improved adherence to evidence-based practice, clearer communication, and faster patient disposition. Quantitative analysis of performance is limited by infrequency of cases. Discussion/Impact: Our project shows feasibility of a PERT service. Pre-implementation data is collected, and we are currently measuring these post. We suspect signal of improved patient-oriented outcomes will be detected with more cases. AD - University of Calgary, Calgary, AB AN - 143168767. Language: English. Entry Date: 20200518. Revision Date: 20200518. Publication Type: Abstract AU - Szava-Kovats, M. AU - Andruchow, J. AU - Boiteau, P. AU - Herget, E. AU - Solverson, K. DB - CINAHL DO - 10.1017/cem.2020.228 DP - EBSCOhost KW - Pulmonary Embolism -- Therapy Severity of Illness Rapid Response Team Multidisciplinary Care Team Program Implementation Health Facilities -- Canada Congresses and Conferences -- Ontario Ontario Canada M1 - s1 N1 - abstract; proceedings; research. Supplement Title: Supplement12020. Journal Subset: Biomedical; Canada; Editorial Board Reviewed; Expert Peer Reviewed; Peer Reviewed. NLM UID: 100893237. PY - 2020 SN - 1481-8035 SP - S71-S72 ST - P020: Development and early experience with the Foothills Medical Center Pulmonary Embolism Response Team (PERT)...Canadian Association of Emergency Physicians (CAEP/ACMU) Conference, June 1-4, 2020, Ontario, Canada T2 - CJEM: Canadian Journal of Emergency Medicine TI - P020: Development and early experience with the Foothills Medical Center Pulmonary Embolism Response Team (PERT)...Canadian Association of Emergency Physicians (CAEP/ACMU) Conference, June 1-4, 2020, Ontario, Canada UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=143168767&site=ehost-live&scope=site VL - 22 ID - 761359 ER - TY - JOUR AB - BACKGROUND Pulmonary embolism (PE) is the third most common potentially life -threatening cardiovascular disease. A new approach of pulmonary embolism response teams (PERTs) has been introduced to provide rapid multidisciplinary assessment and treatment of patients with PE. However, detailed data on institutional experience and clinical outcomes from such teams are missing. AIMS The aim of this study was to report our experience with the management of PE guided by the PERT-POZ within the first year of operation. METHODS We performed a prospective study of PERT-POZ activations at a university care center between October 2018 and October 2019. Patient characteristics, therapies, and clinical outcomes were evaluated. RESULTS There were 86 unique PERT-POZ activations, and PE was confirmed in 80 patients including: 9 patients (11.25%) classified as low -risk PE, 19 (23.75%) as intermediate -low risk, 38 (47.5%) as intermediate- -high, and 14 (17.5%) as high -risk. Sixty patients (75%) received anticoagulation only, 28 (35%) direct oral anticoagulant, 7 (8.75%) vitamin K antagonist, 23 (28.75%) low-molecular-weight heparin, and 2 (2.50%) unfractionated heparin. Ten patients (12.5%) were treated with catheter -directed thrombectomy, 6 (7.5%) received systemic thrombolysis, 2 (2.5%) underwent surgical embolectomy, 2 (2.5%) were on extracorporeal membrane oxygenation support, and 2 (2.5%) underwent pharmacomechanical venous thrombectomy. There were 7 (8.75%) in -hospital deaths, and 2 (2.5%) deaths during a 3-month follow -up. Bleeding complications were rare: only 3 patients (3.75%) had major bleeding events, but none after administration of systemic thrombolysis. CONCLUSIONS Our study demonstrated that after the creation of PERT -POZ with a precise activation protocol, patients with intermediate and high -risk PE received most optimal treatment strategies. AD - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznań, Poland Department of Medical Rescue, Poznan University of Medical Sciences, Poznań, Poland General and Vascular Surgery Institute, Poznan University of Medical Sciences, Poznań, Poland Department of Radiology, Poznan University of Medical Sciences, Poznań, Poland Department of Internal Medicine, Józef Struś Hospital, Poznań, Poland 2nd Department of Cardiology and Cardiovascular Interventions, Institute of Cardiology, University Hospital, Kraków, Poland AN - 142934555. Language: English. Entry Date: 20200430. Revision Date: 20200430. Publication Type: Article AU - Szmyt, Sylwia Sławek AU - Jankiewicz, Stanisław AU - Gorynia, Anna Smukowska AU - Janus, Magdalena AU - Klotzka, Aneta AU - Puślecki, Mateusz AU - Jemielity, Marek AU - Krasiński, Zbigniew AU - Żabicki, Bartosz AU - Elikowski, Waldemar AU - Grygier, Marek AU - Kubzdela, Tatiana Mularek AU - Lesiak, Maciej AU - Araszkiewicz, Aleksander DB - CINAHL DO - 10.33963/KP.15230 DP - EBSCOhost KW - Pulmonary Embolism -- Therapy Disability Management Multidisciplinary Care Team Program Evaluation Poland Human Prospective Studies Anticoagulants Vitamin K -- Antagonists and Inhibitors Heparin, Low-Molecular-Weight Thrombectomy Thrombolytic Therapy Embolectomy Extracorporeal Membrane Oxygenation Hemorrhage M1 - 4 N1 - research; tables/charts. Journal Subset: Biomedical; Continental Europe; Europe. NLM UID: 0376352. PY - 2020 SN - 0022-9032 SP - 300-310 ST - Implementation of a regional multidisciplinary pulmonary embolism response team: PERT -POZ initial 1-year experience T2 - Polish Heart Journal / Kardiologia Polska TI - Implementation of a regional multidisciplinary pulmonary embolism response team: PERT -POZ initial 1-year experience UR - http://libproxy.temple.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=142934555&site=ehost-live&scope=site VL - 78 ID - 761337 ER - TY - JOUR AB - The life-threatening consequences of heparin induced thrombocytopenia (HIT) may be prevented with early recognition, prompt heparin withdrawal and direct thrombin inhibitor use. To determine the level of HIT awareness, electronic term recognition software can be used to query the electronic medical record (EMR) to assess the thought process and test ordering behavior of health care providers confronted with falling platelet counts. We sought to assess the awareness of HIT in a large teaching institution using these tools. Mayo Clinic databases were queried to identify a cohort of hospitalized adults receiving heparin (06/1/08-06/1/09). Serial platelet counts for each patient were scrutinized for a 50% decrement from baseline. "Clinician awareness" was defined by mention of HIT (determined by electronic term recognition software) within the hospital record by any member of the healthcare team or requisition of platelet factor 4/heparin antibody testing. During this time period, 34,694 adults were hospitalized and 24,956 received heparin. Only 3,239 (13%) patients had more than 1 platelet count during the hospital stay. Of 199 patients (6.1%) with >= 50% platelet count drop, clinician awareness was 36%. The absolute platelet count was the only independent variable associated with HIT awareness (P < 0.001). Both appropriate platelet count monitoring and HIT awareness are low at this large teaching institution. Software tools for monitoring awareness and providing realtime alerts of significant platelet count decrements may be useful. AD - [McBane, Robert D., II; Wysokinski, Waldemar E.] Mayo Clin, Div Cardiovasc Med, Rochester, MN 55905 USA. [McBane, Robert D., II; Wysokinski, Waldemar E.; Daniels, Paul R.; Mohr, David N.] Fdn Educ & Res, Rochester, MN 55905 USA. [Tafur, Alfonso J.] Univ Oklahoma, Oklahoma City, OK 73106 USA. McBane, RD (corresponding author), Mayo Clin, Div Cardiovasc Med, 200 SW 1st St, Rochester, MN 55905 USA. mcbane.robert@mayo.edu AN - WOS:000299775700014 AU - Tafur, A. J. AU - McBane, R. D. AU - Wysokinski, W. E. AU - Gregg, M. S. AU - Daniels, P. R. AU - Mohr, D. N. DA - Jan DO - 10.1007/s11239-011-0631-4 J2 - J. Thromb. Thrombolysis KW - Heparin Thrombocytopenia Awareness Natural language processor MOLECULAR-WEIGHT HEPARIN UNFRACTIONATED HEPARIN CARDIOPULMONARY BYPASS INFORMATION ANTIBODIES Cardiac & Cardiovascular Systems Hematology Peripheral Vascular Disease LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: 885JR Times Cited: 1 Cited Reference Count: 23 Tafur, Alfonso J. McBane, Robert D., II Wysokinski, Waldemar E. Gregg, Melissa S. Daniels, Paul R. Mohr, David N. Tafur, Alfonso/AAN-7950-2020; Daniels, Paul/AAU-5745-2020 McBane, Robert/0000-0001-8727-8029; Wysokinski, Waldemar/0000-0002-8119-6206 1 0 2 SPRINGER DORDRECHT J THROMB THROMBOLYS PY - 2012 SN - 0929-5305 SP - 95-100 ST - Natural language processor as a tool to assess heparin induced thrombocytopenia awareness T2 - Journal of Thrombosis and Thrombolysis TI - Natural language processor as a tool to assess heparin induced thrombocytopenia awareness UR - ://WOS:000299775700014 VL - 33 ID - 761837 ER - TY - JOUR AB - Background To meet the requirements imposed by the time-dependency of acute stroke therapies, it is necessary 1) to initiate structural and cultural changes in the breadth of stroke-ready hospitals and 2) to find new ways to train the personnel treating patients with acute stroke. We aimed to implement and validate a composite intervention of a stroke team algorithm and simulation-based stroke team training as an effective quality initiative in our regional interdisciplinary neurovascular network consisting of 7 stroke units. Methods We recorded door-to-needle times of all consecutive stroke patients receiving thrombolysis at seven stroke units for 3 months before and after a 2 month intervention which included setting up a team-based stroke workflow at each stroke unit, a train-the-trainer seminar for stroke team simulation training and a stroke team simulation training session at each hospital as well as a recommendation to take up regular stroke team trainings. Results The intervention reduced the network-wide median door-to-needle time by 12 minutes from 43,0 (IQR 29,8-60,0, n = 122) to 31,0 (IQR 24,0-42,0, n = 112) minutes (p < 0.001) and substantially increased the share of patients receiving thrombolysis within 30 minutes of hospital arrival from 41.5% to 59.6% (p < 0.001). Stroke team training participants stated a significant increase in knowledge on the topic of acute stroke care and in the perception of patient safety. The overall course concept was regarded as highly useful by most participants from different professional backgrounds. Conclusions The composite intervention of a binding team-based algorithm and stroke team simulation training showed to be well-transferable in our regional stroke network. We provide suggestions and materials for similar campaigns in other stroke networks. AD - [Tahtali, Damla; Bohmann, Ferdinand; Kurka, Natalia; Singer, Oliver; Steinmetz, Helmuth; Pfeilschifter, Waltraud] Univ Hosp Frankfurt, Dept Neurol, Frankfurt, Germany. [Rostek, Peter] Univ Hosp Frankfurt, NICU Nursing Staff, Frankfurt, Germany. [Todorova-Rudolph, Anelia; Buchkremer, Martin] Vitos Weil Lahn, Dept Neurol, Weilmunster, Germany. [Abruscato, Mario; Thonke, Sven] Klinikum Hanau, Dept Neurol, Hanau, Germany. [Hartmetz, Ann-Kathrin; Kuhlmann, Andrea; Meyding-Lamade, Uta] Krankenhaus NW Frankfurt, Dept Neurol, Frankfurt, Germany. [Henke, Christian] Helios HSK Wiesbaden, Dept Neurol, Wiesbaden, Germany. [Stegemann, Andre; Weidauer, Stefan] Sankt Katharinen Krankenhaus, Dept Neurol, Frankfurt, Germany. [Menon, Sanjay] Klinikum Aschaffenburg Alzenau, Dept Neurol, Aschaffenburg, Germany. [Misselwitz, Bjeorn; Reihs, Anke] GQH, Frankfurt, Germany. Pfeilschifter, W (corresponding author), Univ Hosp Frankfurt, Dept Neurol, Frankfurt, Germany. w.pfeilschifter@med.uni-frankfurt.de AN - WOS:000417110700009 AU - Tahtali, D. AU - Bohmann, F. AU - Kurka, N. AU - Rostek, P. AU - Todorova-Rudolph, A. AU - Buchkremer, M. AU - Abruscato, M. AU - Hartmetz, A. K. AU - Kuhlmann, A. AU - Henke, C. AU - Stegemann, A. AU - Menon, S. AU - Misselwitz, B. AU - Reihs, A. AU - Weidauer, S. AU - Thonke, S. AU - Meyding-Lamade, U. AU - Singer, O. AU - Steinmetz, H. AU - Pfeilschifter, W. C7 - e0188231 DA - Dec DO - 10.1371/journal.pone.0188231 J2 - PLoS One KW - ACUTE ISCHEMIC-STROKE CREW RESOURCE-MANAGEMENT THROMBOLYSIS HOSPITALS THERAPY TRENDS Multidisciplinary Sciences LA - English M1 - 12 M3 - Article N1 - ISI Document Delivery No.: FO8CU Times Cited: 5 Cited Reference Count: 17 Tahtali, Damla Bohmann, Ferdinand Kurka, Natalia Rostek, Peter Todorova-Rudolph, Anelia Buchkremer, Martin Abruscato, Mario Hartmetz, Ann-Kathrin Kuhlmann, Andrea Henke, Christian Stegemann, Andre Menon, Sanjay Misselwitz, Bjeorn Reihs, Anke Weidauer, Stefan Thonke, Sven Meyding-Lamade, Uta Singer, Oliver Steinmetz, Helmuth Pfeilschifter, Waltraud Boehringer IngelheimBoehringer Ingelheim Boehringer Ingelheim supported this study with a research grant of 10.000,00 Euros to WP. The funder had not role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 5 1 4 PUBLIC LIBRARY SCIENCE SAN FRANCISCO PLOS ONE PY - 2017 SN - 1932-6203 SP - 13 ST - Implementation of stroke teams and simulation training shortened process times in a regional stroke network-A network-wide prospective trial T2 - Plos One TI - Implementation of stroke teams and simulation training shortened process times in a regional stroke network-A network-wide prospective trial UR - ://WOS:000417110700009 VL - 12 ID - 761617 ER - TY - JOUR AB - BACKGROUND: To meet the requirements imposed by the time-dependency of acute stroke therapies, it is necessary 1) to initiate structural and cultural changes in the breadth of stroke-ready hospitals and 2) to find new ways to train the personnel treating patients with acute stroke. We aimed to implement and validate a composite intervention of a stroke team algorithm and simulation-based stroke team training as an effective quality initiative in our regional interdisciplinary neurovascular network consisting of 7 stroke units. METHODS: We recorded door-to-needle times of all consecutive stroke patients receiving thrombolysis at seven stroke units for 3 months before and after a 2 month intervention which included setting up a team-based stroke workflow at each stroke unit, a train-the-trainer seminar for stroke team simulation training and a stroke team simulation training session at each hospital as well as a recommendation to take up regular stroke team trainings. RESULTS: The intervention reduced the network-wide median door-to-needle time by 12 minutes from 43,0 (IQR 29,8-60,0, n = 122) to 31,0 (IQR 24,0-42,0, n = 112) minutes (p < 0.001) and substantially increased the share of patients receiving thrombolysis within 30 minutes of hospital arrival from 41.5% to 59.6% (p < 0.001). Stroke team training participants stated a significant increase in knowledge on the topic of acute stroke care and in the perception of patient safety. The overall course concept was regarded as highly useful by most participants from different professional backgrounds. CONCLUSIONS: The composite intervention of a binding team-based algorithm and stroke team simulation training showed to be well-transferable in our regional stroke network. We provide suggestions and materials for similar campaigns in other stroke networks. AD - Department of Neurology, University Hospital Frankfurt, Frankfurt am Main, Germany. NICU Nursing Staff, University Hospital Frankfurt, Frankfurt am Main, Germany. Department of Neurology, Vitos Weil-Lahn, Weilmünster, Germany. Department of Neurology, Klinikum Hanau, Hanau, Germany. Department of Neurology, Krankenhaus Nordwest, Frankfurt am Main, Germany. Department of Neurology, Helios HSK Wiesbaden, Wiesbaden, Germany. Department of Neurology, Sankt Katharinen-Krankenhaus, Frankfurt am Main, Germany. Department of Neurology, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany. Geschäftsstelle Qualitätssicherung Hessen (GQH), Eschborn, Frankfurt, Germany. AN - 29206838 AU - Tahtali, D. AU - Bohmann, F. AU - Kurka, N. AU - Rostek, P. AU - Todorova-Rudolph, A. AU - Buchkremer, M. AU - Abruscato, M. AU - Hartmetz, A. K. AU - Kuhlmann, A. AU - Henke, C. AU - Stegemann, A. AU - Menon, S. AU - Misselwitz, B. AU - Reihs, A. AU - Weidauer, S. AU - Thonke, S. AU - Meyding-Lamadé, U. AU - Singer, O. AU - Steinmetz, H. AU - Pfeilschifter, W. C2 - PMC5716597 Boehringer Ingelheim and Stryker Neurovascular; SW received speaker’s honoraria from Bayer Healthcare, Novartis, Bracco, b.e. Imaging GmbH, Merck Serono and consultant fees from Actelion; ST received speaker’s honoraria from UCB, Daiichi Sankyo and Bial and consultant fees from UCB and TEVA; UML received speaker’s honoraria from Bayer Health Care, Pfizer, Novartis, Genzyme, Roche, Merck Serono, Biogen Idec, Sanofi-Aventis, TEVA Pharma, Boehringer Ingelheim; HS received speaker’s honoraria from Bayer, Boehringer Ingelheim and Sanofi-Aventis; and WP received speaker’s honoraria from Boehringer Ingelheim, Stryker Neurovascular, research funding from Stryker Neurovascular, Novartis and consultant fees from Sanofi-Aventis. This does not alter our adherence to PLOS ONE policies on sharing data and materials. DO - 10.1371/journal.pone.0188231 DP - NLM ET - 2017/12/06 J2 - PloS one KW - Aged Female Humans Male Middle Aged *Patient Care Team Prospective Studies Stroke/*therapy Thrombolytic Therapy LA - eng M1 - 12 N1 - 1932-6203 Tahtali, Damla Bohmann, Ferdinand Kurka, Natalia Rostek, Peter Todorova-Rudolph, Anelia Buchkremer, Martin Abruscato, Mario Hartmetz, Ann-Kathrin Kuhlmann, Andrea Henke, Christian Stegemann, André Menon, Sanjay Misselwitz, Björn Reihs, Anke Weidauer, Stefan Thonke, Sven Meyding-Lamadé, Uta Singer, Oliver Steinmetz, Helmuth Pfeilschifter, Waltraud Orcid: 0000-0001-6935-8842 Journal Article PLoS One. 2017 Dec 5;12(12):e0188231. doi: 10.1371/journal.pone.0188231. eCollection 2017. PY - 2017 SN - 1932-6203 SP - e0188231 ST - Implementation of stroke teams and simulation training shortened process times in a regional stroke network-A network-wide prospective trial T2 - PLoS One TI - Implementation of stroke teams and simulation training shortened process times in a regional stroke network-A network-wide prospective trial VL - 12 ID - 760232 ER - TY - JOUR AB - Pulmonary embolism (PE) affects over 300,000 individuals each year in the United States and is associated with substantial morbidity and mortality. Improvements in the diagnostic performance and availability of computed tomographic pulmonary angiography and D-dimer testing have facilitated the evaluation of patients with suspected PE. High clinical suspicion is required in those with risk factors and/or those that manifest signs or symptoms of venous thromboembolic disease, with validated clinical risk scores such as the Wells and modified Wells score or the PE rule-out criteria helpful in estimating the likelihood for PE. For those with confirmed PE, patients should be categorized and triaged according to the presence or absence of shock or hypotension. Normotensive patients can be further risk-stratified using validated prognostic risk scores, as well as by using imaging and cardiac biomarkers, with those having either signs of right ventricular dysfunction on imaging studies and/or abnormal cardiac biomarkers categorized as being at intermediate-risk and requiring close monitoring and hospital admission. Early discharge and/or home therapy are possible in those that do not manifest any high-risk features. The initial treatment for most patients that are stable consists of anticoagulation, with advanced therapies such as thrombolysis, catheter-based therapies, or surgical embolectomy deferred for those at high risk. Given the heterogeneous presentations of PE and various management strategies available, the development of multidisciplinary PE response teams has emerged to help facilitate decision-making in these patients. PMID:31384107 AU - Tak, Tahir AU - Karturi, Swetha AU - Sharma, Umesh AU - Eckstein, Lee AU - Poterucha, Joseph T. AU - Sandoval, Yader DA - 2019/07/05 07/05 DB - PubMed Central DO - 10.1055/s-0039-1692636 KW - pulmonary embolism pulmonary hypertension deep venous thrombosis dyspnea anticoagulation thrombolytic echocardiography right heart strain tumor emboli vena cava filters M1 - 2 PY - 2019 SN - 1061-1711 SP - 100-100 ST - Acute Pulmonary Embolism: Contemporary Approach to Diagnosis, Risk-Stratification, and Management T2 - The International Journal of Angiology : Official Publication of the International College of Angiology, Inc TI - Acute Pulmonary Embolism: Contemporary Approach to Diagnosis, Risk-Stratification, and Management UR - https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6679967 https://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=6679967&rendertype=abstract VL - 28 ID - 762074 ER - TY - JOUR AB - Comprehensive and timely documentation on orthopedic ward rounds continues to be problematic, leading to delayed or inappropriate patient care and miscommunication between health care providers. The authors introduced a simple checklist to improve the documentation on orthopedic ward rounds in their institution. A prospective cohort study was performed. Standard care was provided for cohort A. During a 2-week period, the documentation of patient care by physicians following a ward round was assessed in terms of venous thromboembolism prophylaxis, fasting status, wound or dressing plan, weight-bearing status, and important surgical details. The physicians were blinded to this initial review. For cohort B, a structured ward round checklist was introduced during a 2-week period. A total of 132 patient encounters were recorded in cohort A. Important issues that were rarely discussed included vital signs (11.4%), venous thromboembolism prophylaxis (9.8%), and bowel status (3.8%). Issues that were poorly documented included fasting status (9.1%), wound or dressing plan (6.8%), and weight-bearing status (11.4%). After introduction of the checklist, daily documentation of surgical details improved from 38.6% to 85.3% of patient encounters. Fasting status documentation improved from 9.1% to 70.6% of patient encounters. Venous thromboembolism prophylaxis discussion increased from 9.8% to 45.6% of the time, while its documentation improved from 6.8% to 92.6%. Documentation of weight-bearing status improved from 11.4% to 83.8% (all P<.0001). The use of a structured checklist during orthopedic ward rounds led to significant improvement in both the consideration and the documentation of key aspects of surgical care. [Orthopedics. 2017; 40(4):e663-e667.]. AN - 28504810 AU - Talia, A. J. AU - Drummond, J. AU - Muirhead, C. AU - Tran, P. DA - Jul 1 DO - 10.3928/01477447-20170509-01 DP - NLM ET - 2017/05/16 J2 - Orthopedics KW - Bandages *Checklist *Documentation Fasting Hospital Units Humans Orthopedics/*methods *Patient Care Planning Patient Care Team Patient Handoff Postoperative Care Prospective Studies Venous Thromboembolism/prevention & control Weight-Bearing LA - eng M1 - 4 N1 - 1938-2367 Talia, Adrian J Drummond, James Muirhead, Cameron Tran, Phong Journal Article United States Orthopedics. 2017 Jul 1;40(4):e663-e667. doi: 10.3928/01477447-20170509-01. Epub 2017 May 15. PY - 2017 SN - 0147-7447 SP - e663-e667 ST - Using a Structured Checklist to Improve the Orthopedic Ward Round: A Prospective Cohort Study T2 - Orthopedics TI - Using a Structured Checklist to Improve the Orthopedic Ward Round: A Prospective Cohort Study VL - 40 ID - 760307 ER - TY - JOUR AB - Background: Management of patients presenting with sub-massive or massive acute pulmonary embolism (PE) may be challenging. A pulmonary embolism response team (PERT) was constructed to establish a standardized treatment pathway for multidisciplinary evaluation and treatment for acute PE at Lahey Hospital and Medical Center. Methods: We conducted a retrospective chart review on all patients admitted to our center who required activation of PERT during the first year of the program (October 2017 to October 2018). We extracted data pertaining to clinical presentation, imaging and echocardiographic findings, treatment modality, in-hospital and post- discharge follow-up plans. Descriptive and continuous variables were collected and analyzed. Patients were classified as low risk, sub-massive or massive PE. Results: Sixty-seven patients were evaluated by the PERT. Complete data were available in 65 patients: 34 (52%) were males and 31 (48%) were females. Mean age was 65.6. Right heart strain was confirmed by echocardiogram in 54 (83%) patients. One patient was classified as low-risk PE. Fifty (76%) were classified as sub-massive PE, and 14 (21%) as massive PE. Thirty-six (55%) patients received anticoagulation alone, 20 (31%) received catheter directed thrombolysis (CDT), and 9 (14%) received full dose rtPA (only used in massive PE). Four patients required ECMO. Mortality was higher in massive (46%) vs. sub-massive (0.02%) PE. Three patients had bleeding events (2 post TPA, 1 with heparin alone). Right ventricular function was normalized in 92% of patients on repeat echocardiograms within 1-3 months. Conclusions: The establishment of a PERT team at our center led to a more standardized approach that engages multiple specialists to deliver rapid, organized, and evidence-based care to patients with high-risk PE. Our data suggest that massive PE still has a high mortality rate despite receiving prompt TPA. Additionally, CDT can offer a safe and effective treatment of RV strain with low complication and mortality rates. Longer term study is required to determine whether CDT has any important effect on long-term morbidity and mortality. AD - F. Tamimi, Lahey Hospital and Medical Center, United States AU - Tamimi, F. AU - Montgomery, J. AU - Mintz, J. AU - Sarwar, A. AU - Levy, M. DB - Embase DO - 10.1002/ccd.28216 KW - alteplase heparin aged anticoagulation bleeding blood clot lysis catheter complication conference abstract deep vein thrombosis drug therapy echocardiography female follow up heart right ventricle heart ventricle function human major clinical study male medical record review morbidity mortality rate physiology pulmonary embolism response team retrospective study LA - English M3 - Conference Abstract N1 - L628160526 2019-06-24 PY - 2019 SN - 1522-726X SP - S160 ST - A multidisciplinary pulmonary embolism response team: Our initial 12-month experience T2 - Catheterization and Cardiovascular Interventions TI - A multidisciplinary pulmonary embolism response team: Our initial 12-month experience UR - https://www.embase.com/search/results?subaction=viewrecord&id=L628160526&from=export http://dx.doi.org/10.1002/ccd.28216 VL - 93 ID - 760719 ER - TY - JOUR AB - Early intravenous thrombolysis has proven to be a safe and effective therapy for selected patients with acute ischemic stroke (AIS). Nowadays, thrombolysis is usually delivered by neurologists in "hub" referral centers. However, only a few among eligible patients actually receive treatment. Barriers to early administration of thrombolysis are represented by delays in presentation to referral centers, in-hospital and transfer delays, as well as changes in symptoms during assessment time. The aim of this study is to evaluate the safety and rate of thrombolysis provided in Emergency Department (ED) of a district hospital without neurological stroke team. Consecutive patients with AIS treated with intravenous thrombolysis were prospectively enrolled in this observational study, conducted between May 2010 and December 2013. The main outcomes evaluated were: mortality, symptomatic intracerebral hemorrhage (ICH), systemic adverse events, and neurological recovery. Secondly, all patients admitted with ischemic stroke were retrospectively screened to assess the reasons for exclusion to treatment and the rate of thrombolysis delivered. During the study period, 43 patients with AIS received intravenous rt-PA treatment. The mortality rate at three months was 9.5 % (4/43; 95 % CI 2.6-22.1) and total ICH at any-time CT scan imaging was 18.6 % (8/43; 8.4-33.4). At seven days or at discharge, 35/43 patients (81.4 %; 66.6-91.6) presented a neurological improvement and 46.5 % (20/43; 31.2-62.3) a complete neurological recovery presenting a normal NIHSS, while 9.5 % of patients remained in steady conditions and other 9.5 % worsened (4/43; 2.6-22.1). Outcomes do not appear to be very different from those reported in SITS-MOST study cohort. Among the overall 732 patients with AIS, 117 (16.0 %; 13.4-18.8) were eligible for age and arrived within the three-hour window of time, and the thrombolysis rate was 5.9 % (43/732; 4.3-7.8). Administration of rt-PA in an ED setting without neurological specialized stroke unit seems to be feasible and safe after adequate training. Thrombolysis rate found seems to be favorably comparable with the national average in specialist stroke units. If such data were confirmed by studies of greater dimension, this may imply the ability to perform thrombolysis even in smaller centers without the neurologist, thus being able to treat a greater number of patients in the times proven effective for thrombolysis. AD - [Tampieri, Andrea; Giovannini, Eugenio; Rusconi, Anna Maria; Cristoni, Lorenzo; Bendanti, Daniela; Cenni, Patrizia; Lenzi, Tiziano] Osped Civile Santa Maria Scaletta Imola, Emergency Dept, I-40026 Bologna, Italy. Tampieri, A (corresponding author), Osped Civile Santa Maria Scaletta Imola, Emergency Dept, Via Montericco 4, I-40026 Bologna, Italy. andrea.tampieri@libero.it AN - WOS:000349954500013 AU - Tampieri, A. AU - Giovannini, E. AU - Rusconi, A. M. AU - Cristoni, L. AU - Bendanti, D. AU - Cenni, P. AU - Lenzi, T. DA - Mar DO - 10.1007/s11739-014-1153-9 J2 - Intern. Emerg. Med. KW - Thrombolysis Stroke Emergency Department Safety Treatment rate ACUTE ISCHEMIC-STROKE TISSUE-PLASMINOGEN ACTIVATOR HEMORRHAGIC TRANSFORMATION THROMBOLYSIS DELAY TRIAL CARE CLASSIFICATION ASSOCIATION GUIDELINES Medicine, General & Internal LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: CB9MA Times Cited: 0 Cited Reference Count: 31 Tampieri, Andrea Giovannini, Eugenio Rusconi, Anna Maria Cristoni, Lorenzo Bendanti, Daniela Cenni, Patrizia Lenzi, Tiziano cenni, patrizia/AAL-3588-2020 1 0 6 SPRINGER-VERLAG ITALIA SRL MILAN INTERN EMERG MED PY - 2015 SN - 1828-0447 SP - 181-192 ST - Safety and feasibility of intravenous rt-PA in the Emergency Department without a neurologist-based stroke unit: an observational study T2 - Internal and Emergency Medicine TI - Safety and feasibility of intravenous rt-PA in the Emergency Department without a neurologist-based stroke unit: an observational study UR - ://WOS:000349954500013 VL - 10 ID - 761760 ER - TY - JOUR AU - Tan, C. W. AU - Balla, S. AU - Ghanta, R. K. AU - Sharma, A. M. AU - Chatterjee, S. DA - 2020/05/05 05/05 DB - Europe PubMed Central DO - 10.1053/j.semtcvs.2020.04.002 M1 - 3 PY - 2020 SN - 1043-0679 SP - 396-403 ST - Contemporary Management of Acute Pulmonary Embolism T2 - Semin Thorac Cardiovasc Surg TI - Contemporary Management of Acute Pulmonary Embolism UR - http://europepmc.org/article/MED/32353408 VL - 32 ID - 762049 ER - TY - JOUR AB - Objective Little is known about the outcomes of cancer patients referred to palliative care (PC) teams in developing countries. Our aim was to examine the timing of PC access and outcomes of patients with advanced cancer referred to an inpatient PC consultation team in Brazil. Method Retrospective study of consecutive patients with advanced cancer admitted to a tertiary care general hospital (April 2015-December 2016) and referred for the first time to an inpatient PC consultation team. Patients' demographics, clinical features, time from first consult to death or discharge, and outcomes on medication use, clinical interventions, and end-of-life preferences were retrieved. An analysis was performed before and after PC. Result One hundred eleven patients were included. Median age was 68; 72% had an Eastern Cooperative Oncology Group performance status >= 3. The median timing of PC access was 9 days (first interquartile = 3, third interquartile = 19). The use of analgesics (from 75% to 85%, p = 0.001) and opioids (from 50% to 73%, p < .001) increased. A lower proportion was receiving antibiotics (68% vs 48%, p < 0.001), thromboprophylaxis (44% vs 26%, p < 0.001), antihypertensives (28% vs 15%, p = 0.001), and antiemetic agents (64% vs 54%, p = 0.027). Chemotherapy use was lower (39-25%, p < 0.001). More patients had an end-of-life preference (39% to 25%, p < 0.001) and were not willing to receive intubation (32% vs 60%, p < 0.001), intensive care treatment (30% vs 55%, p < 0.001), cardiopulmonary resuscitation (35% vs 62%, p < 0.001), and artificial nutrition (22% vs 34%, p < 0.001). AD - [Taniwaki, Leticia; Serrano Uson Junior, Pedro Luiz; Rodrigues de Souza, Polianna Mara; Prado, Bernard Lobato] Hosp Israelita Albert Einstein, Oncol & Hematol Dept, Sao Paulo, Brazil. Taniwaki, L (corresponding author), Hosp Israelita Albert Einstein, Ctr Oncol & Hematol, Av Albert Einstein 627, BR-05652900 Sao Paulo, Brazil. le_taniwaki@yahoo.com.br AN - WOS:000484388500009 AU - Taniwaki, L. AU - Uson, P. L. S. AU - de Souza, P. M. R. AU - Prado, B. L. C7 - Pii s1478951518000597 DA - Aug DO - 10.1017/s1478951518000597 J2 - Palliat. Support Care KW - Palliative care Quality of life Treatment outcomes OF-LIFE CARE ONCOLOGY CARE END INTEGRATION SOCIETY QUALITY IMPACT Health Policy & Services LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: IV6OU Times Cited: 0 Cited Reference Count: 40 Taniwaki, Leticia Serrano Uson Junior, Pedro Luiz Rodrigues de Souza, Polianna Mara Prado, Bernard Lobato Junior, Pedro Uson/O-2367-2019 Junior, Pedro Uson/0000-0001-6122-1374 0 CAMBRIDGE UNIV PRESS NEW YORK PALLIAT SUPPORT CARE PY - 2019 SN - 1478-9515 SP - 425-430 ST - Timing of palliative care access and outcomes of advanced cancer patients referred to an inpatient palliative care consultation team in Brazil T2 - Palliative & Supportive Care TI - Timing of palliative care access and outcomes of advanced cancer patients referred to an inpatient palliative care consultation team in Brazil UR - ://WOS:000484388500009 VL - 17 ID - 761506 ER - TY - JOUR AB - Despite the availability of safe and effective prophylaxis, appropriate use of venous thromboembolism (VTE) prophylaxis in surgical patients remains suboptimal. Multifaceted quality improvement (QI) activities are needed for sustained improvement at the individual institution level. This work describes a QI initiative for VTE prophylaxis in surgery that combined clinical education with Crew Resource Management (CRM)--a set of principles and techniques for communication, teamwork, and error avoidance used in the aviation industry. Surveys of clinicians participating in the initiative demonstrated immediate and retained confidence and increased knowledge in identifying process-related factors leading to errors, applying CRM to patient care, and identifying VTE prophylaxis candidates and guideline-recommended prophylaxis regimens. Reviews of patient charts preinitiative and postinitiative demonstrated performance improvement in meeting guideline recommendations for the timing, inpatient duration, and use of VTE prophylaxis beyond discharge. This new model joins continuing medical education with CRM to improve the appropriate use of VTE prophylaxis in surgery. AD - Duke University Medical Center, Durham, NC, USA.. AN - 21609940 AU - Tapson, V. F. AU - Karcher, R. B. AU - Weeks, R. DA - Nov-Dec DO - 10.1177/1062860611404694 DP - NLM ET - 2011/05/26 J2 - American journal of medical quality : the official journal of the American College of Medical Quality KW - Adult Aged Communication Education, Continuing/*organization & administration Female Guideline Adherence/organization & administration Hospital Bed Capacity, 100 to 299 Hospitals, Community/*organization & administration Humans Length of Stay Male Medical Errors/prevention & control Medical Staff, Hospital Middle Aged Nursing Staff, Hospital Patient Care Team/organization & administration Pharmacists Physicians Postoperative Complications/*prevention & control Practice Guidelines as Topic Quality Improvement/*organization & administration Risk Factors Venous Thromboembolism/*prevention & control LA - eng M1 - 6 N1 - 1555-824x Tapson, Victor F Karcher, Rachel Bongiorno Weeks, Randy Journal Article Research Support, Non-U.S. Gov't United States Am J Med Qual. 2011 Nov-Dec;26(6):423-32. doi: 10.1177/1062860611404694. Epub 2011 May 23. PY - 2011 SN - 1062-8606 SP - 423-32 ST - Crew resource management and VTE prophylaxis in surgery: a quality improvement initiative T2 - Am J Med Qual TI - Crew resource management and VTE prophylaxis in surgery: a quality improvement initiative VL - 26 ID - 760254 ER - TY - JOUR AB - BACKGROUND: Venous thrombotic events (VTE) occur at high ratesin HIV/AIDS patients and are likely under-diagnosed in rural sub-Saharan Africa. OBJECTIVE: To describe clinical presentations and challenges in the management of VTE in patients with advanced HIV/AIDS. DESIGN: Case series from patients enrolled in a prospective observational cohort study. SETTINGS: A clinical research centre in rural Kericho, Kenya. SUBJECTS: Two hundred patients with median age 38 (30-47) years, BMI 16.9 (12.4-20.3) kg/m2, haemoglobin 9.3 (6.8-13.4) g/dL, CD4+ T-cell count 27 (4-77) cells/mm and plasma HIV RNA 5.23 (3.70-5.88) log10 copies/mL. INTERVENTIONS: VTE cases were diagnosed by clinical presentation and Doppler/ radiographic confirmation. Anti-coagulation therapy was managed by a multidisciplinary team; patients were initiated on enoxaparin or heparin followed by warfarin. RESULTS: Over two years,11patients (5.5%) experienced VTE. All but one (10/11,90.9%) case occurred within six months of starting ART. Nine patients had peripheral VTE (five popliteal, four femoral) and two had cerebral sinus thromboses. VTE was diagnosed 52 (1-469) days after ART initiation, and 81.8% of cases were outpatients at presentation. All patients received at least one concomitant medication that could significantly interact with warfarin (efavirenz, nevirapine, lopinavir/ritonavir, rifampicin, trimethoprim-sulfamethoxazole, and fluconazole). A median of 39 (10-180) days and eight (4-22) additional clinic visits were required to achieve/maintain a therapeutic INR of 2-3. Two minor bleeding complications occurred. No recurrent VTE cases were observed. CONCLUSION: Consideration of VTE and preparedness for management in patients with advanced HIV/AIDS starting ART is critical in sub-Saharan Africa. Overcoming challenges in anti-coagulation is possible in rural settings using a multidisciplinary team approach. AD - Kenya Medical Research Institute/Walter Reed Project, Kericho, Kenya. AN - 26862618 AU - Tarus, N. K. AU - Pau, A. K. AU - Sereti, I. AU - Kirui, F. K. AU - Sawe, F. K. AU - Agan, B. K. AU - Momanyi, L. M. AU - Ngeno, H. C. AU - Koskei, G. K. AU - Shaffer, D. N. DA - Jul DP - NLM ET - 2013/07/01 J2 - East African medical journal KW - Adult Anticoagulants/administration & dosage/pharmacology Antiretroviral Therapy, Highly Active/*methods CD4 Lymphocyte Count/methods Disease Management Drug Interactions Drug Monitoring Female *HIV Infections/complications/epidemiology/physiopathology Humans International Normalized Ratio/methods Kenya/epidemiology Male Middle Aged Patient Acuity *Patient Care Team Rural Population/statistics & numerical data Ultrasonography, Doppler, Duplex/methods *Venous Thrombosis/diagnosis/drug therapy/epidemiology/etiology *Warfarin/administration & dosage/pharmacokinetics LA - eng M1 - 7 N1 - Tarus, N K Pau, A K Sereti, I Kirui, F K Sawe, F K Agan, B K Momanyi, L M Ngeno, H C Koskei, G K Shaffer, D N Y1-AI-5072/AI/NIAID NIH HHS/United States Intramural NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural Research Support, U.S. Gov't, Non-P.H.S. Kenya East Afr Med J. 2013 Jul;90(7):207-13. PY - 2013 SN - 0012-835X (Print) 0012-835x SP - 207-13 ST - CHALLENGES IN MANAGEMENT OF WARFARIN ANTI-COAGULATION IN ADVANCED HIV/AIDS PATIENTS WITH VENOUS THROMBOTIC EVENTS--A CASE SERIES FROM A RESEARCH CLINIC IN RURAL KERICHO, KENYA T2 - East Afr Med J TI - CHALLENGES IN MANAGEMENT OF WARFARIN ANTI-COAGULATION IN ADVANCED HIV/AIDS PATIENTS WITH VENOUS THROMBOTIC EVENTS--A CASE SERIES FROM A RESEARCH CLINIC IN RURAL KERICHO, KENYA VL - 90 ID - 760486 ER - TY - JOUR AB - 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 < 0.05 for each). Bleeding and clinical deterioration were independently associated with the mean score. Patients’ age, gender, and history of PE did not influence CDT scores (p = 0.083, p = 0.071, p = 0.257 respectively). For patients, 60% > 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. AD - B. Taslakian, Department of Radiology, NYU Langone Health, New York, NY, United States AU - Taslakian, B. AU - Li, C. AU - Goldhaber, S. Z. AU - Mikkelsen, K. Z. AU - Horowitz, J. M. AU - Kabrhel, C. AU - Barnes, G. D. AU - Sista, A. K. DB - Embase DO - 10.3390/jcm8020215 KW - catheter anticoagulant agent adult aged anticoagulation article bleeding blood clot lysis brain hemorrhage catheter directed thrombolysis clinical decision making comparative study controlled study deterioration exercise female health survey human interventional radiologist lung embolism male middle aged physician pulmonary embolism response team pulmonologist questionnaire randomized controlled trial risk factor scoring system six minute walk test venous thromboembolism LA - English M1 - 2 M3 - Article N1 - L2001561057 2019-03-08 2019-03-12 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.embase.com/search/results?subaction=viewrecord&id=L2001561057&from=export http://dx.doi.org/10.3390/jcm8020215 VL - 8 ID - 760759 ER - TY - JOUR AB - PURPOSE: To evaluate intraarterial catheter-directed thrombolysis for prediction and prevention of delayed surgical amputation as part of multidisciplinary management of frostbite injury. MATERIALS AND METHODS: A retrospective review was performed of 13 patients (11 men, 2 women; median age, 33.4 y; range, 8-62 y) at risk of tissue loss secondary to frostbite injury and treated with catheter-directed tissue plasminogen activator (t-PA) thrombolysis. Amputation data were assessed on follow-up (mean, 23 mo; range, 9-83 mo). Angiographic findings were classified into complete, partial, and no angiographic response and assessed for association with follow-up amputation rates. Correlation between amputation outcome and duration of cold exposure (mean, 23 h; range, 5-96 h), time between exposure and rewarming therapy (mean, 25.5 h; range, 7-95 h), and time between exposure and t-PA thrombolysis (mean, 32 h; range, 12-96 h) was assessed. Complications were recorded. RESULTS: Of 127 digits at risk on baseline angiography that were treated with catheter-directed thrombolysis, complete recovery was seen in 106 (83.4%). Total mean t-PA dose per extremity was 27.5 mg (range, 12-48 mg) over a mean period of 34 hours (range, 12-72 h). Patients with complete angiographic response (8 patients; 79.5% of digits) did not require amputations; 4 of 5 patients (80%) with partial angiographic response (20.5% of digits) underwent amputation (P = .007). There was no significant correlation between amputation rates and duration of cold exposure (P = .9), time to rewarming therapy (P = .88), and time to thrombolysis (P = .56). Femoral access site bleeding in 2 patients was managed conservatively. One patient underwent surgical exploration for brachial artery hematoma. CONCLUSIONS: Intraarterial catheter-directed thrombolysis should be included in initial management of frostbite injury, as it may prevent delayed amputations. The degree of angiographic response to thrombolysis can potentially predict amputation outcomes. AD - Division of Vascular and Interventional Radiology, Department of Radiology, University Hospitals and Case Western Reserve University School of Medicine, 11100 Euclid Avenue, BSH 5056, Cleveland, OH 44106. Electronic address: siddharth.tavri@gmail.com. Division of Interventional Radiology, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Department of Radiology, and Division of Burns, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. AN - 27363299 AU - Tavri, S. AU - Ganguli, S. AU - Bryan, R. G., Jr. AU - Goverman, J. AU - Liu, R. AU - Irani, Z. AU - Walker, T. G. DA - Aug DO - 10.1016/j.jvir.2016.04.027 DP - NLM ET - 2016/07/02 J2 - Journal of vascular and interventional radiology : JVIR KW - Adolescent Adult Amputation Angiography, Digital Subtraction *Catheterization, Peripheral/adverse effects Child Combined Modality Therapy Female Fibrinolytic Agents/*administration & dosage/adverse effects Fingers/*blood supply Frostbite/diagnostic imaging/physiopathology/*therapy Humans Infusions, Intra-Arterial Limb Salvage Male Middle Aged *Patient Care Team Radiography, Interventional Retrospective Studies Rewarming Risk Factors Thrombolytic Therapy/adverse effects/*methods Time Factors Tissue Plasminogen Activator/*administration & dosage/adverse effects Toes/*blood supply Treatment Outcome Young Adult LA - eng M1 - 8 N1 - 1535-7732 Tavri, Sidhartha Ganguli, Suvranu Bryan, Roy G Jr Goverman, Jeremy Liu, Raymond Irani, Zubin Walker, T Gregory Journal Article United States J Vasc Interv Radiol. 2016 Aug;27(8):1228-35. doi: 10.1016/j.jvir.2016.04.027. Epub 2016 Jun 28. PY - 2016 SN - 1051-0443 SP - 1228-35 ST - Catheter-Directed Intraarterial Thrombolysis as Part of a Multidisciplinary Management Protocol of Frostbite Injury T2 - J Vasc Interv Radiol TI - Catheter-Directed Intraarterial Thrombolysis as Part of a Multidisciplinary Management Protocol of Frostbite Injury VL - 27 ID - 760121 ER - TY - JOUR AB - BACKGROUND: Patients with end-stage renal disease account for about 0.2% of the population. Maintenance of a functioning arteriovenous fistula (AVF) is critical for their life and poses a challenge for health care team who manages this group of patients. The aim of the present paper is to evaluate the role of endovascular techniques in the management of AVF complications; outcome and results. METHODS: This is a prospective study on patients who attend the vascular out-patient clinic complaining of failing AVF or have AVF induced ischemia. Clinical assessment, angiography was performed in all patients. percutaneous transluminal angioplasty (PTA) with semi-compliant balloon angioplasty was performed for all patients. High-pressure balloon and/or stent used in lesions failed to be successfully managed. RESULTS: In 74 patients, the location of lesions were in out-flow vein in 50 patients, central veins in 20 patients, and forearm arteries in 4 patients. PTA was performed in all patients while (14.89%) stented. Anatomical and clinical success rate was 95.5%. No major complication related to the procedures. CONCLUSIONS: Endovascular intervention is a minimal invasive procedure extending the patency and maintain function of AVF in chronic renal failure patients on regular dialysis. AD - [Tawfik, Ahmed R.] Cairo Univ, Fac Med, Kasr Ani Hosp, Dept Vasc Surg, Kasr Ani St, Cairo 11553, Egypt. Tawfik, AR (corresponding author), Cairo Univ, Fac Med, Kasr Ani Hosp, Dept Vasc Surg, Kasr Ani St, Cairo 11553, Egypt. ahmed_r_towfiek@yahoo.com AN - WOS:000416955200004 AU - Tawfik, A. R. DA - Sep DO - 10.23736/s1824-4777.17.01300-6 J2 - Ital. J. Vasc. Endovasc. Surg. KW - Failing AVF Central venous occlusion AVF induced hand ischemia ARTERIOVENOUS-FISTULAS BALLOON ANGIOPLASTY TECHNICAL SUCCESS STENOSIS PATENCY INTERVENTIONS MECHANISMS SALVAGE GRAFTS Peripheral Vascular Disease LA - English M1 - 3 M3 - Article N1 - ISI Document Delivery No.: FO6EM Times Cited: 0 Cited Reference Count: 22 Tawfik, Ahmed R. Tawfik, Ahmed/H-1769-2016 Tawfik, Ahmed/0000-0003-2855-2168 0 1 EDIZIONI MINERVA MEDICA TURIN ITAL J VASC ENDOVASC PY - 2017 SN - 1824-4777 SP - 93-100 ST - Role of endovascular techniques in vascular access survival in hemodialysis patients T2 - Italian Journal of Vascular and Endovascular Surgery TI - Role of endovascular techniques in vascular access survival in hemodialysis patients UR - ://WOS:000416955200004 VL - 24 ID - 761635 ER - TY - JOUR AB - Background. Reliable central vein access is a fundamental issue in modern advanced oncological care. The aim of this study was to determine the incidence of complications and patient perception regarding central vein access ports. Methods. We prospectively studied 249 single lumen access ports implanted between 1 July 2008 and 15 March 2010 in a mixed patient population at a 500-bed secondary level hospital in Sweden. We determined the number of catheter days, infection rate and mechanical complications, as well as patient satisfaction regarding the access port, over a six-month follow-up period. Results. Two hundred and forty-four different patients received 249 ports yielding a total of 37 763 catheter days. Ultrasound and fluoroscopic guidance was used in 98% of procedures. Vein access was obtained percutanously by an anaesthesiologist in all cases. There was no case of pneumo- or haemothorax. The incidence of catheter-related bloodstream infection, was 0.05/1000 catheter days and the incidence of pocket/tunnel infection was 0.39/1000 catheter days. Clinically apparent deep vein thrombosis occurred in four patients (1.6%). Patient satisfaction was overall high. Conclusion. These results confirm that our team-based approach with written easily accessible evidence-based guidelines and a structured education programme leads to a very low complication rate and a high degree of patient satisfaction. AD - [Taxbro, Knut; Hammarskjold, Fredrik] Ryhov Cty Hosp, Dept Anaesthesia & Intens Care, Jonkoping, Sweden. [Berg, Soren] Linkoping Univ, Fac Hlth Sci, Dept Clin & Expt Med, Div Cardiovasc Anaesthesia, Linkoping, Sweden. [Hanberger, Hakan] Linkoping Univ, Fac Hlth Sci, Dept Clin & Expt Med, Div Infect Dis, Linkoping, Sweden. [Malmvall, Bo-Erik] Jonkoping Cty Council, Futurum Acad Healthcare, Jonkoping, Sweden. Taxbro, K (corresponding author), Lanssjukhuset Ryhov, OP IVA Kliniken, S-55185 Jonkoping, Sweden. knut.taxbro@lj.se AN - WOS:000318655300003 AU - Taxbro, K. AU - Berg, S. AU - Hammarskjold, F. AU - Hanberger, H. AU - Malmvall, B. E. DA - Jun DO - 10.3109/0284186x.2013.770601 J2 - Acta Oncol. KW - CENTRAL VENOUS CATHETER LONG-TERM INFECTIOUS COMPLICATIONS DEVICE PLACEMENT ATRIAL CATHETER RISK SYSTEM IMPLANTATION ULTRASOUND THROMBOSIS Oncology LA - English M1 - 5 M3 - Article N1 - ISI Document Delivery No.: 140LJ Times Cited: 8 Cited Reference Count: 26 Taxbro, Knut Berg, Soren Hammarskjold, Fredrik Hanberger, Hakan Malmvall, Bo-Erik Taxbro, Knut/P-1358-2019 Taxbro, Knut/0000-0001-8711-9044 Futurum - the Academy for Healthcare, Jonkoping County Council, Jonkoping, Sweden The study was supported by grants from Futurum - the Academy for Healthcare, Jonkoping County Council, Jonkoping, Sweden. 8 0 5 TAYLOR & FRANCIS LTD ABINGDON ACTA ONCOL PY - 2013 SN - 0284-186X SP - 893-901 ST - A prospective observational study on 249 subcutaneous central vein access ports in a Swedish county hospital T2 - Acta Oncologica TI - A prospective observational study on 249 subcutaneous central vein access ports in a Swedish county hospital UR - ://WOS:000318655300003 VL - 52 ID - 761805 ER - TY - JOUR AB - Despite improvement in acute stroke care, stroke remains the third major cause of death and leading cause of disability nationwide. An increase in the number of certified Primary Stroke Centers (PSC) over the past years has been credited for the improvement. Los Angeles County proactively implemented the Approved Stroke Center Network in which Emergency Medical Systems may passes non-certified PCS for acute stroke treatments. Our hospital's journey towards building a stroke program began in early 2008, and in 2009 a CODE STROKE algorithm was implemented. Over the past two years, the team has strived to continuously improve 'door to needle' times. Opportunity to improve door-to-lab results was recognized so we sought to investigate and identify barrier(s)/reason(s) for delays. Methods The LEAN Six Sigma team guided our multidisciplinary committee for identifying contributing delays. A review of the clinical pathway from the patient's arrival time (door) and activation of Code Stroke are time-stamped at every step. Phase I identified delays with phlebotomist transit times. The laboratory management addressed this issue by reinforcing the need to expedite the specimen collection, transit time and processing. Some improvement was noted in the door-to-lab results time but significant delays remained a problem. Phase II incorporated lab draws being performed prior to the patient going for their CT scan. Phase III involves utilization of an iStat unit within the emergency department for analysis of a CHEM 8 panel. Results Analysis of data initially showed door-to-lab results had a median time of 52 minutes, with 38% having results within 45 minutes. Ten patients received tPA within median times of 66 minutes, with 53% receiving tPA within 60 minutes. In 2010 action plans initiated yielded significant improvements with door-to-lab results median times of 44 minutes, 64% having lab results within 45 minutes. Twenty one patients received tPA within a median time of 55 minutes, and 70% having received tPA within 60 minutes. Conclusion The multidisciplinary stroke team identified barriers and implemented process changes yielding improvements in door-to-lab results that in turn resulted in overall improvements in tPA treatment times. Data collection and process evaluation continue. AD - D. Tay, Huntington Memorial Hosp, Pasadena, CA, United States AU - Tay, D. AU - Boyd, C. AU - Imbus, A. AU - Ohanian, A. AU - Graves, J. AU - Au, A. DB - Embase KW - human stroke patient cerebrovascular accident nursing laboratory patient algorithm hospital cause of death emergency phlebotomist computer assisted tomography needle clinical pathway United States processing disability emergency ward information processing LA - English M1 - 2 M3 - Conference Abstract N1 - L70925672 2012-11-26 PY - 2012 SN - 0039-2499 ST - A multidisciplinary team approach to improving laboratory results and thrombolytic treatment in acute code stroke patients T2 - Stroke TI - A multidisciplinary team approach to improving laboratory results and thrombolytic treatment in acute code stroke patients UR - https://www.embase.com/search/results?subaction=viewrecord&id=L70925672&from=export VL - 43 ID - 761214 ER - TY - JOUR AB - Introduction: Several studies have attempted to demonstrate that the Thrombolysis in Myocardial Infarction (TIMI) risk score has the ability to risk stratify emergency department (ED) patients with potential acute coronary syndromes (ACS). Most of the studies we reviewed relied on trained research investigators to determine TIMI risk scores rather than ED providers functioning in their normal work capacity. We assessed whether TIMI risk scores obtained by ED providers in the setting of a busy ED differed from those obtained by trained research investigators. Methods: This was an ED-based prospective observational cohort study comparing TIMI scores obtained by 49 ED providers admitting patients to an ED chest pain unit (CPU) to scores generated by a team of trained research investigators. We examined provider type, patient gender, and TIMI elements for their effects on TIMI risk score discrepancy. Results: Of the 501 adult patients enrolled in the study, 29.3% of TIMI risk scores determined by ED providers and trained research investigators were generated using identical TIMI risk score variables. In our low-risk population the majority of TIMI risk score differences were small; however, 12% of TIMI risk scores differed by two or more points. Conclusion: TIMI risk scores determined by ED providers in the setting of a busy ED frequently differ from scores generated by trained research investigators who complete them while not under the same pressure of an ED provider. AD - [Taylor, Brian T.] Lakeland HealthCare, Dept Emergency Med, 1234 Napier Ave, St Joseph, MI 49085 USA. Dept Emergency Med, St Joseph, MI USA. Taylor, BT (corresponding author), Lakeland HealthCare, Dept Emergency Med, 1234 Napier Ave, St Joseph, MI 49085 USA. btaylor@lakelandregional.org AN - WOS:000373109200005 AU - Taylor, B. T. AU - Mancini, M. DA - Jan DO - 10.5811/westjem.2014.9.21685 J2 - West. J. Emerg. Med. KW - Acute Coronary Syndrome Standard of Care Cardiology TIMI Score Chest Pain Unit ACUTE CORONARY SYNDROME EMERGENCY-DEPARTMENT PATIENTS INFARCTION RISK SCORE ELEVATION MYOCARDIAL-INFARCTION ACUTE CHEST-PAIN COMPUTED TOMOGRAPHIC ANGIOGRAPHY ADVERSE CARDIOVASCULAR OUTCOMES ARTIFICIAL NEURAL-NETWORK ACUTE CARDIAC ISCHEMIA PROSPECTIVE VALIDATION Emergency Medicine LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: DH9IH Times Cited: 2 Cited Reference Count: 84 Taylor, Brian T. Mancini, Michelino 2 0 WESTJEM ORANGE WEST J EMERG MED PY - 2015 SN - 1936-900X SP - 24-33 ST - Discrepancy Between Clinician and Research Assistant in TIMI Score Calculation (TRIAGED CPU) T2 - Western Journal of Emergency Medicine TI - Discrepancy Between Clinician and Research Assistant in TIMI Score Calculation (TRIAGED CPU) UR - ://WOS:000373109200005 VL - 16 ID - 761764 ER - TY - JOUR AB - Background: Safety climate and nurses' working conditions may have an impact on both patient outcomes and nurse occupational health, but these outcomes have rarely been examined concurrently. Objective: To examine the association of unit-level safety climate and specific nurse working conditions with injury outcomes for both nurses and patients in a single hospital. Research design: A cross-sectional study was conducted using nursing-unit level and individual-level data at an urban, level-one trauma centre in the USA. Multilevel logistic regressions were used to examine associations among injury outcomes, safety climate and working conditions on 29 nursing units, including a total of 723 nurses and 28 876 discharges. Measures: Safety climate was measured in 2004 using the Safety Attitudes Questionnaire (SAQ). Working conditions included registered nursing hours per patient day (RNHPPD) and unit turnover. Patient injuries included 290 falls, 167 pulmonary embolism/deep vein thrombosis (PE/DVT), and 105 decubitus ulcers. Nurse injury was defined as a reported needle-stick, splash, slip, trip, or fall (n=78). Working conditions and outcomes were measured in 2005. Results: The study found a negative association between two SAQ domains, Safety and Teamwork, with the odds of both decubitus ulcers and nurse injury. RNHPPD showed a negative association with patient falls and decubitus ulcers. Unit turnover was positively associated with nurse injury and PE/DVT, but negatively associated with falls and decubitus ulcers. Conclusions: Safety climate was associated with both patient and nurse injuries, suggesting that patient and nurse safety may actually be linked outcomes. The findings also indicate that increased unit turnover should be considered a risk factor for nurse and patient injuries. AD - [Taylor, Jennifer A.; Gerwin, Daniel] Drexel Univ, Sch Publ Hlth, Dept Environm & Occupat Hlth, Philadelphia, PA 19102 USA. [Agnew, Jacqueline] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Environm Hlth Sci, Div Occupat & Environm Hlth, Baltimore, MD USA. [Dominici, Francesca] Harvard Univ, Sch Publ Hlth, Dept Biostat, Boston, MA 02115 USA. [Morlock, Laura; Miller, Marlene R.] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Hlth Policy & Management, Baltimore, MD USA. [Miller, Marlene R.] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Pediat, Johns Hopkins Childrens Ctr, Baltimore, MD USA. Taylor, JA (corresponding author), Drexel Univ, Sch Publ Hlth, Dept Environm & Occupat Hlth, 1505 Race St,MS 1034, Philadelphia, PA 19102 USA. jat65@drexel.edu AN - WOS:000299324800003 AU - Taylor, J. A. AU - Dominici, F. AU - Agnew, J. AU - Gerwin, D. AU - Morlock, L. AU - Miller, M. R. DA - Feb DO - 10.1136/bmjqs-2011-000082 J2 - BMJ Qual. Saf. KW - ORGANIZATIONAL-CLIMATE NEEDLESTICK INJURIES HOSPITAL NURSES NEAR-MISSES OUTCOMES CARE HEALTH TURNOVER ATTITUDES CULTURE Health Care Sciences & Services Health Policy & Services LA - English M1 - 2 M3 - Article N1 - ISI Document Delivery No.: 879JF Times Cited: 45 Cited Reference Count: 60 Taylor, Jennifer A. Dominici, Francesca Agnew, Jacqueline Gerwin, Daniel Morlock, Laura Miller, Marlene R. NIOSH Education and Research Center for Occupational Safety and Health at the Johns Hopkins Bloomberg School of Public Health [T42OH00842428] This research was supported (in part) by funding from the NIOSH Education and Research Center for Occupational Safety and Health at the Johns Hopkins Bloomberg School of Public Health-a doctoral training program (#T42OH00842428). Dr Taylor was a trainee in this program from 2003 to 2007. 45 1 24 B M J PUBLISHING GROUP LONDON BMJ QUAL SAF PY - 2012 SN - 2044-5415 SP - 101-111 ST - Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions T2 - Bmj Quality & Safety TI - Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions UR - ://WOS:000299324800003 VL - 21 ID - 761834 ER - TY - JOUR AB - OBJECTIVE: To evaluate the success of an acute stroke program designed to streamline the evaluation and treatment of acute ischemic stroke patients, with particular regard to the risk of symptomatic intracerebral hemorrhage and discharge disposition based on age in those patients treated with acute stroke intervention. METHODS: Retrospective review of patients at Mission Hospitals in Asheville, North Carolina from January 2006 to October 2007 with sudden neurological deficit identified within six hours of onset. Data were obtained from Mission Hospital's in-house spreadsheet database and the American Stroke Association's "Get With the Guidelines" (GWTG) database. Patients were evaluated by a code stroke protocol that included early involvement of stroke-treating neurologists. A chart review of all code stroke patients established the number of patients treated with acute intervention, disposition, and follow-up information. RESULTS: Over the 22-month study period, there were 568 code stroke evaluations. Of all code stroke patients, 27.1% (n=154) were treated with an acute intervention for stroke, usually intravenous thrombolysis. We analyzed treated patients on the basis of age, with the younger age group (YAG) being 79 years or younger and the older age group (OAG) being 80 years or older. Of the patients treated with acute intervention, 58 (37.7%) were OAG. Discharge disposition varied with age: 42.7% of YAG patients went home alone or with home health assistance, whereas only 20.7% of OAG patients went home alone or with home health assistance. The inhospital mortality rate was 10.4% for YAG patients and 22.4% for OAG patients. Symptomatic intracerebral hemorrhage was noted in one patient under age 80 and one patient over age 80. This is a symptomatic hemorrhage rate of 1.3%. LIMITATIONS: This was a retrospective, observational, post hoc analysis without a standardized follow-up program. CONCLUSIONS: Our Code Stroke Team, with an inpatient neurology service, increased the proportion of stroke patients treated with acute intervention benchmarking with other GWTG participating hospitals in this time period. Aggressive stroke treatment with thrombolytic therapy in patients over age 80 did not show an increased rate of symptomatic intracerebral hemorrhage. AD - Mission Neurology Services, Mission Hospitals, Asheville, North Carolina, USA. reid.taylor@msj.org AN - 19835244 AU - Taylor, R. AU - Benton, C. AU - Buckner, A. AU - Jones, R. AU - Schneider, A. DA - Jul-Aug DP - NLM ET - 2009/10/20 J2 - North Carolina medical journal KW - Adult Age Factors Aged Aged, 80 and over *Aging Brain Ischemia/*drug therapy/mortality/therapy Cerebral Hemorrhage/*drug therapy/mortality/therapy Databases, Factual Female Humans Male Middle Aged North Carolina/epidemiology *Patient Care Team Patient Discharge Retrospective Studies Thrombolytic Therapy LA - eng M1 - 4 N1 - Taylor, Reid Benton, Cindy Buckner, Amy Jones, Robin Schneider, Alex Journal Article United States N C Med J. 2009 Jul-Aug;70(4):301-6. PY - 2009 SN - 0029-2559 (Print) 0029-2559 SP - 301-6 ST - Mission Hospital's code stroke team: implications for an aging population T2 - N C Med J TI - Mission Hospital's code stroke team: implications for an aging population VL - 70 ID - 760399 ER - TY - JOUR AB - Children who have undergone renal transplantation require regular imaging follow up and often have underlying medical conditions with multi-system involvement. These children benefit from multidisciplinary team input, a key component of which is Radiology. As the largest paediatric renal transplantation centre in the UK, the imaging department at Great Ormond Street Hospital are experienced at providing high quality imaging studies and technically complex interpretations in the immediate and long term follow up of renal transplantation patients. On average 26 transplant surgeries are performed each year with the figures exponentially increasing, leading to the demand for ultrasound rising with on average 62 studies per month. We present an educational review of imaging post renal transplantation. As the primary imaging modality used in these scenarios, we will focus on ultrasound and normal sono-graphic appearances of a renal graft after transplantation. We will review the benefits, technique and limitations of using ultrasound. We will also touch upon other imaging modalities that can be used in more complex cases. Our selection of cases with complications include perinephric collection, urine leak, thrombosis and a special complex case of autologous transplant rejection secondary to renal artery involvement in neurofibromatosis. Following this educational presentation, attendees should be able to: Correctly identify the normal anatomy of a kidney and relate this to structures seen on ultrasound Describe normal and abnormal Doppler waveforms in a transplanted kidney Identify early and late complications and their imaging correlates, including the limitation of ultrasound being unable to identify acute rejection/ATN. AD - M. Taylor-Allkins, Great Ormond Street Hospital, United Kingdom AU - Taylor-Allkins, M. AU - Meshaka, R. AU - Watson, T. DB - Embase DO - 10.1136/archdischild-2019-gosh.21 KW - acute graft rejection case report child clinical article complication conference abstract female follow up human human tissue kidney artery kidney graft male multidisciplinary team neurofibromatosis radiology surgery thrombosis touch ultrasound urine incontinence waveform LA - English M3 - Conference Abstract N1 - L630550908 2020-01-14 PY - 2019 SN - 1468-2044 SP - A8-A9 ST - Imaging in children after renal transplantation T2 - Archives of Disease in Childhood TI - Imaging in children after renal transplantation UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630550908&from=export http://dx.doi.org/10.1136/archdischild-2019-gosh.21 VL - 104 ID - 760655 ER - TY - JOUR AB - Background: Traumatic injuries and osteoarthritis are leading causes for functional deterioration, morbidity and mortality in the older population. Following orthopedic interventions, older patients are susceptible to various medical complications-wound and systemic infections, VTE, delirium, pressure sores, and exacerbation of chronic medical conditions. Delayed identification and treatment of these complications may increase length of stay, morbidity and mortality and increases the risk for functional deterioration and unwanted institutionalization. Geriatricians are trained to perform early identification and treatment of these complications as well as to direct a multidimensional discharge plans. In the current study we made an adjustment to the standard care of older patients by employing a proactive geriatric consultation. Geriatricians served as an integral part of a multidisciplinary team providing care for older patients in the orthopedic division. The geriatricians conducted early post-operative evaluation and continued follow-up in selected patients. Design: Retrospective single center cohort study. Setting: Orthopedic division of a large tertiary academic hospital. Methods: Retrospective data was collected for the years 2011-2015. (The intervention took place between 01.2015 and 31.12.2015). Time from operation to geriatric consultation, post-operative length of stay in the orthopedic division and perioperative mortality were compared for patients during the intervention period (n=736) and previous years (n=5786). Results: Time from operation to geriatric consultation decreased (93 hours to 67 hours median time, P<0.01). Post-operative length of stay decreased (6.8 days to 5.9 days, P value <0.01). During intervention year mortality rate was reduced significantly (38 to 34 yearly death rate, P<0.001). Conclusions: Integrating geriatricians into the multidisciplinary orthopedic team and applying a proactive geriatric approach led to reduced length of stay and mortality. AD - R. Tellem, Tel Aviv Medical Center, Tel Aviv, Israel AU - Tellem, R. DB - Embase KW - aged cohort analysis complication consultation controlled study female follow up geriatrician health care quality human length of stay major clinical study male mortality rate retrospective study statistical significance surgical mortality LA - English M3 - Conference Abstract N1 - L618532424 2017-10-09 PY - 2017 SN - 1878-7649 SP - S159 ST - Proactive geriatric consultation for elderly orthopedic patients reduces mortality and length of stay T2 - European Geriatric Medicine TI - Proactive geriatric consultation for elderly orthopedic patients reduces mortality and length of stay UR - https://www.embase.com/search/results?subaction=viewrecord&id=L618532424&from=export VL - 8 ID - 760912 ER - TY - JOUR AB - Background: Walled-off necrosis (WON) is a major complication of acute pancreatitis (AP) with a high mortality rate (15-20%), especially when infected. Minimally invasive treatment (MIT) is recommended as first step therapy before open surgical necrosectomy (OSN), due to its efficacy and lesser complication rate. Methods: Retrospective analysis of our series of WON cases treated by endoscopic ultrasound guided cysto-gastrostomy (EUS-CG) +/-direct endoscopic necrosectomy (DEN) during a 3-year period (June-2014 to May-2017). Results: There were 25 patients (84% men, mean age 63 years-old). Main etiology was biliary AP (56%). According to Atlanta classification, 44% were moderately-severe and 56% severe. Parenchymal necrosis was found in 88% of patients (45.5% involving >50% of the organ). Mean diameters of WON were 15.5x8.6 cm (7-28x4-17) and mean solid component was 51% (10-90). Main indication of treatment was infection (84%) although cultures were positive in 100%. EUS-CG was performed using lumen-apposing metal stents in 84% and plastic double-pigtail stents in 16%. DEN was carried out in 80% (mean number of 4 sessions; 1-10). Percutaneous drainage associated in 7%. Major complications occur in 4 cases (2 hemorrhages, 1 asymptomatic pneumoperitoneum and 1 pulmonary thromboembolism), all conservatively solved. Complete resolution by endoscopic treatment was achieved in 88%. OSN was required in 3 patients due to uncontrolled sepsis after 3, 5 and 7 DEN sessions, respectively. Overall mortality was 0%. Conclusions: Endoscopic treatment is an effective MIT for WON, considering DEN as an intermediate step between EUS-CG and OSN. This approach may have complications and should be only considered in tertiary centers within a multidisciplinary team. AD - A. Teran Lantaron, Digestive System Department, Hospital Univ. Marques de Valdecilla, Santander, Spain AU - Teran Lantaron, A. AU - Lopez Arias, M. J. AU - De La Pena García, J. AU - Olmos Martínez, J. M. AU - Gonzalez Martínez, M. AU - Castillo Suescun, F. AU - Fernandez Santiago, R. AU - Rodríguez Sanjuan, J. C. AU - Crespo García, J. DB - Embase KW - acute pancreatitis adult all cause mortality bleeding case report classification clinical article complication conference abstract double J stent endoscopic ultrasonography female gastrostomy human lung embolism male metal stent middle aged minimally invasive procedure pancreas necrosis percutaneous drainage pneumoperitoneum remission retrospective study sepsis surgery LA - English M1 - 5 M3 - Conference Abstract N1 - L620612980 2018-02-14 PY - 2017 SN - 1424-3911 SP - S17 ST - Endoscopic treatment of walled-off pancreatic necrosis: A single-center experience of 25 cases T2 - Pancreatology TI - Endoscopic treatment of walled-off pancreatic necrosis: A single-center experience of 25 cases UR - https://www.embase.com/search/results?subaction=viewrecord&id=L620612980&from=export VL - 17 ID - 760915 ER - TY - JOUR AB - OBJECTIVE: To evaluate a multidisciplinary and multifocal intervention in order to reduce catheter related bloodstream infections (CRBI), based on previously identified risk factors in non-critical patients. METHODS: A pre-post-intervention study, 2004-2006. POPULATION: patients with a central venous catheter (CVC). The primary endpoint was the CRBI. Other studied variables were patient characteristics, insertion, maintenance and removal of the catheter. The intervention consisted of baseline knowledge and identifying risk factors. In a second period, there was specific training on these identified risk factors and communication of the results, monitoring and evaluation of the CVC inserted. RESULTS: We analysed 175 and 200 CVC, respectively. The incidence of CRBI was 15.4% during the pre-intervention and 4.0% in the post-intervention period (P<.001). The incidence of BRC by CVC days in the first group was 8.8 infections 1.000 days of CVC and the second 2,3 (P=.0009). The multivariate analysis found an increased risk of CRBI during the first period (OR 4.32; 95% CI: 1.81-10.29) and the use of total parenteral nutrition (OR: 2.37; 95% CI: 1.10-5. 12). CONCLUSION: The application of specific measures directed at all non-critical patients in the entire hospital and involving a large number of professionals has achieved a decrease incidence of 73.9% of CRBI. An acceptable incidence of CRBI was obtained, and, with the completion of the project together with a new awareness, the situation will continue to improve. AD - Servei d'Avaluació i Epidemiologia Clínica-SAEC, Hospital del Mar Consorci Mar Parc de Salut, Departament de Medicina, UAB, Barcelona, España. Mterradas@hospitaldelmar.cat AN - 21194807 AU - Terradas, R. AU - Riu, M. AU - Segura, M. AU - Castells, X. AU - Lacambra, M. AU - Alvarez, J. C. AU - Segura, A. AU - Membrilla, E. AU - Grande, L. AU - Segura, G. AU - Knobel, H. DA - Jan DO - 10.1016/j.eimc.2010.06.007 DP - NLM ET - 2011/01/05 J2 - Enfermedades infecciosas y microbiologia clinica KW - Adult Aged Aged, 80 and over Bacteremia/*prevention & control Catheter-Related Infections/*prevention & control Catheterization, Central Venous/*adverse effects Female Hospitals, University Humans Male Middle Aged *Patient Care Team Risk Factors Young Adult LA - spa M1 - 1 N1 - 1578-1852 Terradas, Roser Riu, Marta Segura, Marcel Castells, Xavier Lacambra, Mónica Alvarez, Juan Carlos Segura, Agia Membrilla, Estela Grande, Luís Segura, Gemma Knobel, Hernando English Abstract Journal Article Research Support, Non-U.S. Gov't Spain Enferm Infecc Microbiol Clin. 2011 Jan;29(1):14-8. doi: 10.1016/j.eimc.2010.06.007. Epub 2010 Dec 30. OP - Resultados de un proyecto multidisciplinar y multifocal para la disminución de la bacteriemia causada por catéter venoso central, en pacientes no críticos, en un hospital universitario. PY - 2011 SN - 0213-005x SP - 14-8 ST - [Results of a multidisciplinary and multifocal project to reduce bacteraemia caused by central venous catheters in non critical patients in a university hospital] T2 - Enferm Infecc Microbiol Clin TI - [Results of a multidisciplinary and multifocal project to reduce bacteraemia caused by central venous catheters in non critical patients in a university hospital] VL - 29 ID - 760326 ER - TY - JOUR AB - Introduction: With increasing survival of children with HLHS and other single ventricle lesions, the complexity of medical care for these patients is substantial. Establishing and adhering to best practice models may improve outcome, but requires careful coordination and monitoring. Methods: In 2013 our Heart Center began a process to build a comprehensive Single Ventricle Team designed to target these difficult issues. Results: Comprehensive Single Ventricle Team in 2014 was begun, to standardize care for children with single ventricle heart defects from diagnosis to adulthood within our institution. The team is a multidisciplinary group of providers committed to improving outcomes and quality of life for children with single ventricle heart defects, all functioning within the medical home of our heart center. Standards of care were developed and implemented in five target areas to standardize medical management and patient and family support. Under the team 100 patients have been cared for. Since 2014 a decrease in interstage mortality for HLHS were seen. Using a team approach and the tools of Quality Improvement they have been successful in reaching high protocol compliance for each of these areas. Conclusions: This article describes the process of building a successful Single Ventricle team, our initial results, and lessons learned. Additional study is ongoing to demonstrate the effects of these interventions on patient outcomes. AD - [Texter, Karen; Davis, Jo Ann M.; Phelps, Christina; Cheatham, Sharon; Cheatham, John; Galantowicz, Mark; Feltes, Timothy F.] Nationwide Childrens Hosp, Div Cardiol, Columbus, OH USA. [Texter, Karen; Phelps, Christina; Cheatham, Sharon; Cheatham, John; Feltes, Timothy F.] Ohio State Univ, Dept Pediat, Columbus, OH 43210 USA. [Galantowicz, Mark] Nationwide Childrens Hosp, Div Cardiothorac Surg, Columbus, OH USA. Texter, K (corresponding author), Nationwide Childrens Hosp, Ctr Heart, 700 Childrens Dr, Columbus, OH 43205 USA. karen.texter@nationwidechildrens.org AN - WOS:000409247700003 AU - Texter, K. AU - Davis, J. A. M. AU - Phelps, C. AU - Cheatham, S. AU - Cheatham, J. AU - Galantowicz, M. AU - Feltes, T. F. DA - Jul-Aug DO - 10.1111/chd.12459 J2 - Congenit. Heart Dis. KW - care coordination hypoplastic left heart quality improvement HOME-MONITORING PROGRAM REDUCES INTERSTAGE MORTALITY NORWOOD PROCEDURE RECONSTRUCTION TRIAL FONTAN OPERATION JOINT COUNCIL PRIMARY THROMBOPROPHYLAXIS LEARNING NETWORK RANDOMIZED-TRIAL WEIGHT-GAIN Cardiac & Cardiovascular Systems LA - English M1 - 4 M3 - Article N1 - ISI Document Delivery No.: FF8EI Times Cited: 6 Cited Reference Count: 48 Texter, Karen Davis, Jo Ann M. Phelps, Christina Cheatham, Sharon Cheatham, John Galantowicz, Mark Feltes, Timothy F. Texter, Karen/0000-0002-7875-9266 6 0 WILEY HOBOKEN CONGENIT HEART DIS PY - 2017 SN - 1747-079X SP - 403-410 ST - Building a comprehensive team for the longitudinal care of single ventricle heart defects: Building blocks and initial results T2 - Congenital Heart Disease TI - Building a comprehensive team for the longitudinal care of single ventricle heart defects: Building blocks and initial results UR - ://WOS:000409247700003 VL - 12 ID - 761645 ER - TY - JOUR AB - Background. The significance of a clinical case of life-threatening complications of true ingrowth of placenta previa, such as massive hemorrhage and inferior vena cava thrombosis with a high risk for pulmonary embolism, is determined by the geometric increase in the incidence of abnormally invasive placenta and by the association of near-miss cases with the latter, which dictates the systematization of practical knowledge, the evaluation of the effectiveness of various options for obstetric tactics, and the elaboration of an interdisciplinary approach. Clinical case report. In the absence of antenatal diagnosis of placental ingrowth, complications, such as hemorrhage and thrombosis of the inferior vena cava, cannot be prevented in obstetric facilities of different medical care levels during staged treatment. The provision of care to the patient by the physicians of an emergency and planned counseling team and a pediatric neonatology team of the regional perinatal center in the central district hospital, followed by specialized treatment determined a favorable outcome for both the mother and the newborn. A separate analysis of complicating factors occurring in the management of pregnant and puerperal women with vital complications of placental ingrowth updates the issues of early diagnosis, optimal delivery tactics, preoperative readiness of a multidisciplinary team, and timely prevention of thromboembolic events. Conclusion. The accumulation of clinical experience and the elaboration of high-evidence-based treatment policy will undoubtedly make it possible to avoid critical conditions and to substantiate an organ-sparing approach as a determining one. AU - Tezikova, T. A. AU - Nechaeva, M. V. AU - Tezikov, Y. V. AU - Lipatov, I. S. AU - Belokoneva, T. S. AU - Shmakov, R. G. DB - Embase DO - 10.18565/aig.2019.9.198-203 KW - article bleeding human inferior cava vein inferior vena cava thrombosis medical care mother multidisciplinary team obstetric delivery placenta disorder placenta increta pregnant woman prenatal diagnosis puerperium thrombosis prevention vein thrombosis LA - Russian M1 - 9 M3 - Article N1 - L2002781594 2019-10-29 2019-11-04 PY - 2019 SN - 2412-5679 0300-9092 SP - 198-203 ST - Management of puerperal inferior vena cava thrombosis after massive hemorrhage due to placenta increta T2 - Akusherstvo i Ginekologiya (Russian Federation) TI - Management of puerperal inferior vena cava thrombosis after massive hemorrhage due to placenta increta UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2002781594&from=export http://dx.doi.org/10.18565/aig.2019.9.198-203 VL - 2019 ID - 760761 ER - TY - JOUR AB - Rationale: The goal of rapid response teams is to intervene early on in deteriorating nonintensive care unit patients to decrease morbidity and mortality. While rapid response teams are widely prevalent, standardization of their approach has not been studied well. Our goal was to assess residents' ability to think of adequate differential diagnoses in a high-pressure scenario. Methods: 18 Internal Medicine residents from the same residency program were given clinical vignettes and asked to list differential diagnoses for three hypothetical scenarios - acute hypoxia, acute change in mental status, and cardiopulmonary arrest. Their answers were compared to a standardized list of life-threatening differential diagnoses. Participants were also surveyed to see if they thought such checklists would be useful during rapid responses Results: Residents listed 16 different differential diagnoses for acute hypoxia. Most residents listed pulmonary embolism (PE) (94.4%), CHF exacerbation (89%), and COPD (67%) as one of the differential diagnoses of acute hypoxia. Only 50% residents listed pneumonia as a possible cause. Aspiration pneumonitis (33.3%) and pneumothorax (27.7%) were listed by fewer than half the residents; none thought of airway obstruction. A total of 16 different differential diagnoses were listed for an acute change in mental status, with intracranial hemorrhage (89%) and ischemic stroke (55.5%) being the only two listed by more than half the residents. Seizure (33%), hypoglycemia (27.8%), and adverse drug reaction (33%) were recognized by less than half the residents, while none CNS infection as a possible cause. A total of 19 different possibilities were listed as causes of cardiopulmonary arrest, with acute coronary syndrome (72.2%), PE (66.7%), and electrolyte abnormalities (50%) being the most common ones. Hypoxia (44.4%), acidosis (38.9%), cardiac tamponade (38.9%), toxins (27.8%), and hypothermia (16.7%) were included by less than half the residents. None thought of tension pneumothorax. In the secondary survey, 87.5% residents expressed that a checklist of differential diagnoses and clinical tests would be a useful addition to the rapid response team Conclusion: Findings from this pilot study indicate variability in the approach of residents towards common rapid response scenarios. Several critical diagnoses were missed even in a controlled testing environment. The use of checklists during rapid responses may lead to fewer missed or delayed diagnoses, thereby increasing patient safety. This study also suggests that residents would welcome such a measure. More research in this area is required. AD - P.J. Thacker, Internal Medicine, Abington Jefferson Health, Abington, PA, United States AU - Thacker, P. J. AU - Rafiq, A. AU - Schneider, D. DB - Embase KW - electrolyte toxin acidosis acute coronary syndrome adult aspiration pneumonia brain hemorrhage brain ischemia cardiopulmonary arrest central nervous system infection checklist chronic obstructive lung disease conference abstract congenital malformation controlled study delayed diagnosis diagnosis differential diagnosis disease exacerbation drug safety female heart tamponade human hypoglycemia hypothermia hypoxia internal medicine lung embolism male mental health patient safety pilot study rapid response team resident seizure side effect tension pneumothorax thinking vignette LA - English M1 - MeetingAbstracts M3 - Conference Abstract N1 - L622966957 2018-07-16 PY - 2018 SN - 1535-4970 ST - Rapid response checklists - A pilot study for a novel approach T2 - American Journal of Respiratory and Critical Care Medicine TI - Rapid response checklists - A pilot study for a novel approach UR - https://www.embase.com/search/results?subaction=viewrecord&id=L622966957&from=export VL - 197 ID - 760871 ER - TY - JOUR AB - Introduction Longer lifespan and newer imaging protocols have led to more older adults being diagnosed with pituitary adenomas. Herein, we describe outcomes of patients >= 65 years undergoing endoscopic adenoma removal. To address selection criteria, we also assess a conservatively managed cohort. Methods A retrospective analysis of 90-day outcomes of patients undergoing endoscopic pituitary adenomectomy from 2010 to 2019 by a neurosurgical/ENT team was performed. Tumor subtype, cavernous sinus invasion, extent of resection/early remission, endocrinology outcomes, complications, re-operations and readmissions were analyzed. A comparator cohort >= 65 years undergoing clinical surveillance without surgery was also analyzed. Results Of 468 patients operated on for pituitary adenoma, 123 (26%) were >= 65 years (range 65-93 years); 106 (86.2%) had endocrine-inactive adenomas; 18 (14.6%) had prior surgery. Of 106 patients with endocrine-inactive adenomas, GTR was achieved in 70/106 (66%). Of 17 patients with endocrine-active adenomas, early biochemical remission was: Cushing's 6/8; acromegaly 1/4; prolactinomas 1/5. Gland function recovery occurred in 28/58 (48.3%) patients with various degrees of preoperative hypopituitarism. New anterior hypopituitarism occurred in 3/110 (2.4%) patients; permanent DI in none. Major complications in 123 patients were: CSF leak 2 (1.6%), meningitis 1 (0.8%), vision decline 1 (0.8%). There were no vascular injuries, operative hematomas, anosmia, deaths, MIs, or thromboembolic events. Median length of stay was 2 days. Readmissions occurred in 14/123 (11.3%) patients, 57% for delayed hyponatremia. Intra-cohort analysis by age (65-69, 70-74, 75-79, >= 80 years) revealed no outcome differences. Cavernous sinus invasion (OR 7.7, CI 1.37-44.8; p = 0.02) and redo-surgery (OR 8.5, CI 1.7-42.8; p = 0.009) were negative predictors for GTR/NTR. Of 105 patients evaluated for presumed pituitary adenoma beginning in 2015, 72 (69%) underwent surgery, 8 (7%) had prolactinomas treated with cabergoline and 25 (24%) continue clinical surveillance without surgery, including two on new hormone replacement. Conclusion This study suggests that elderly patients carefully selected for endoscopic adenoma removal can have excellent short-term outcomes including high resection rates, low complication rates and short length of stay. Our experience supports a multidisciplinary approach and the concept of pituitary centers of excellence. Based on our observations, approximately 25% of elderly patients with pituitary adenomas referred for possible surgery can be monitored closely without surgery. AD - [Thakur, Jai Deep; Corlin, Alex; Mallari, Regin Jay; Huang, Weichao; Eisenberg, Amalia; Sivakumar, Walavan; Krauss, Howard; Griffiths, Chester; Rettinger, Sarah; Cohan, Pejman; Barkhoudarian, Garni; Araque, Katherine A.; Kelly, Daniel] Pacific Neurosci Inst, 2125 Arizona Ave, Santa Monica, CA 90404 USA. [Thakur, Jai Deep; Sivakumar, Walavan; Krauss, Howard; Griffiths, Chester; Barkhoudarian, Garni; Araque, Katherine A.; Kelly, Daniel] Providence St Johns Hlth Ctr, John Wayne Canc Inst, Santa Monica, CA USA. [Thakur, Jai Deep] Univ S Alabama, Dept Neurosurg, Mobile, AL 36688 USA. Kelly, D (corresponding author), Pacific Neurosci Inst, 2125 Arizona Ave, Santa Monica, CA 90404 USA.; Kelly, D (corresponding author), Providence St Johns Hlth Ctr, John Wayne Canc Inst, Santa Monica, CA USA. dkelly@pacificneuro.org AN - WOS:000570021800001 AU - Thakur, J. D. AU - Corlin, A. AU - Mallari, R. J. AU - Huang, W. C. AU - Eisenberg, A. AU - Sivakumar, W. AU - Krauss, H. AU - Griffiths, C. AU - Rettinger, S. AU - Cohan, P. AU - Barkhoudarian, G. AU - Araque, K. A. AU - Kelly, D. DO - 10.1007/s11102-020-01081-9 J2 - Pituitary KW - Elderly Endoscopic endonasal Pituitary adenoma Transsphenoidal surgery Hypopituitarism Hyperprolactinemia TRANSSPHENOIDAL SURGERY SKULL BASE PARASELLAR TUMORS HYPONATREMIA AVOIDANCE Endocrinology & Metabolism LA - English M3 - Article; Early Access N1 - ISI Document Delivery No.: NP2OY Times Cited: 0 Cited Reference Count: 40 Thakur, Jai Deep Corlin, Alex Mallari, Regin Jay Huang, Weichao Eisenberg, Amalia Sivakumar, Walavan Krauss, Howard Griffiths, Chester Rettinger, Sarah Cohan, Pejman Barkhoudarian, Garni Araque, Katherine A. Kelly, Daniel Pacific Neuroscience Institute Foundation; Saint John's Health Center Foundation The authors would like to acknowledge the support of Pacific Neuroscience Institute Foundation and Saint John's Health Center Foundation for their support. 0 1 SPRINGER NEW YORK PITUITARY SN - 1386-341X SP - 13 ST - Pituitary adenomas in older adults (>= 65 years): 90-day outcomes and readmissions: a 10-year endoscopic endonasal surgical experience T2 - Pituitary TI - Pituitary adenomas in older adults (>= 65 years): 90-day outcomes and readmissions: a 10-year endoscopic endonasal surgical experience UR - ://WOS:000570021800001 ID - 761409 ER - TY - JOUR AB - Introduction: Lower limb arterial injuries incidence has increased due to increase in road traffic accidents. Salvage of limb is a challenge due to delayed presentation which is the most common reason for limb loss, but time is not the only criteria, there are multiple other factors involved. Limb salvage can be achieved with good results even in patients who present in delayed fashion. The strategy to manage conservatively or to do expedite repair depends upon severity of injury to limb, patient factors and time of presentation. Methods: This is a prospective study of patients admitted at the trauma center of a tertiary care institute between January 2016 to February 2019. Patients with lower limb arterial injuries were followed from time of admission to 1 month following discharge. CT angiography was done in all patients where vascular intervention was planned. The management approaches were medical management, primary amputation, vascular repair and secondary amputations. Main outcomes analysed were time of presentation, mechanism of injury, type of injury, management procedures, and limb salvage rate. Results: During a 3-year period, a total of 104 patients with lower extremity arterial injuries were admitted. The study population was comprised of patients from 2 to 68 years of age (mean 32.5 years). Male patients were 7 times than female. 24% of patients presented within 8 hours and 21% patients presented after 24 hours. The majority of patients (76%) suffered concomitant musculoskeletal injuries. Arterial injuries were categorized into blunt (91%) and penetrating mechanisms (9%). The most common cause being road traffic accidents (92%). Involved arterial distribution was as follows: External iliac (4%), femoral (15%), popliteal (68%), anterior tibial (2%), posterior tibial (4%) and both anterior and posterior tibial (7%) arteries. The types of arterial injuries were as follows: contusion (48%), thrombosis (22%), transection/laceration (20%), compression/vasospasm (9%) and pseudoaneurysm (1%). Orthopedic surgeons performed amputations as primary procedures in 5% of patients. The majority (78%) of injuries receiving vascular management underwent surgical intervention, with procedure distribution as follows: bypass (saphenous vein 39% and prosthetic graft (1%); resection of contused segment and end to end anastomosis (16%); endovascular (1%); and isolated thrombectomy (14%) procedures. Conservative management was the primary strategy for 23% of patients of arterial injuries. Concomitant fasciotomy was performed in 38 % of cases. Subsequent major amputation was required for patients (9%) who initially received vascular management. Peri-operative mortality was 3%. Total Limb salvage rate was 84%. Limb salvage rate was 88% in patients presenting within 24 hours and 73% in patients presenting after 24 hours. In spite of delayed presentation, the limb salvage rate was not significantly different < 24 hours and >24 hours presentation group (p=0.103). Conclusion: The current multidisciplinary team management approach with prompt surgical management resulted in successful outcome in spite of significant patients presenting in delayed fashion. Comparable results can be achieved even in patients with delayed presentation, depending on limb status. Disclosure: Nothing to disclose AU - Thakur, U. K. AU - Savlania, A. AU - Sahoo, S. AU - Pandey, A. AU - Sandeep, M. AU - Reddy, P. A. DB - Embase DO - 10.1016/j.ejvs.2019.09.348 KW - adolescent adult aged amputation artery injury child compression computed tomographic angiography conference abstract conservative treatment controlled study contusion emergency health service end to end anastomosis false aneurysm fasciotomy female human iliac bone injury severity laceration limb salvage major clinical study male multidisciplinary team musculoskeletal injury orthopedic surgeon prospective study saphenous vein surgery surgical mortality tertiary health care thrombectomy thrombosis traffic vasospasm LA - English M1 - 6 M3 - Conference Abstract N1 - L2003904404 2019-12-12 PY - 2019 SN - 1532-2165 1078-5884 SP - e775-e776 ST - Lower Extremity Arterial Injuries: Impact of Time of Presentation, Type of Injury and Therapeutic Strategy With Limb Salvage at One Month T2 - European Journal of Vascular and Endovascular Surgery TI - Lower Extremity Arterial Injuries: Impact of Time of Presentation, Type of Injury and Therapeutic Strategy With Limb Salvage at One Month UR - https://www.embase.com/search/results?subaction=viewrecord&id=L2003904404&from=export http://dx.doi.org/10.1016/j.ejvs.2019.09.348 VL - 58 ID - 760646 ER - TY - JOUR AB - INTRODUCTION: Right heart thrombus in transit(RHT) in patients with an acute pulmonary embolism(PE) is rare(3-4%), but associated with increased rate of deterioration and high mortality(13-37%). We present a case where early recognition with point of care ultrasound(POCUS), and activation of Pulmonary Embolism Response Team(PERT) lead to successful management in a patient with RHT. CASE PRESENTATION: 48-year-old male frequent flyer to Peru with a recent history of a bleeding gastric ulcer presented with dyspnea. The patient was hemodynamically stable, with BP of 122/75mmHg, HR of 83 bpm. He was breathing 19 bpm with room air oxygen saturation of 97%. Initial troponin was 0.03ng/ml & BNP was 63pg/ml. A Chest CT angio showed an acute PE extending across the right and left main pulmonary arteries into lobar branches with signs of RV strain(Fig.1A). Pulmonary team performed POCUS which showed a large free floating RHT(Fig.1B) and bilateral deep vein thrombus(DVT). PERT was activated and the patient was seen by intensivists, cardiologists, interventional radiologists and cardiothoracic surgeons. TEE showed RHT with a patent foramen ovale(PFO)(Fig.1C). After interdisciplinary discussion, the patient received open pulmonary embolectomy(Fig.1D) with PFO closure and retrievable IVC filter placement. The patient was discharged after 8 days of hospitalization on therapeutic anticoagulation. DISCUSSION: The optimal management of RHT in the context of an acute PE is challenging due to the absence of prospective studies comparing management options including anticoagulation, systemic thrombolysis, and endarterectomy. Meta-analyses suggest that outcome is improved with aggressive approaches due to the high risk of clinical deterioration. In our patient, the large mobile RHT with a PFO, the recent history of GI bleeding and the concomitant saddle PE and bilateral DVT with potential risk of hemodynamic deterioration prompted open thrombectomy. While traditional risk predictors would have stratified this hemodynamically stable patient with normal biomarkers as being at low risk for complications, the POCUS finding and the rapid PERT activation facilitated escalation of therapy for RHT. CONCLUSIONS: This case illustrates the benefits of ultrasonography and early activation of a multidisciplinary team for the management of RHT. AD - S. Thomas, Mount Sinai Beth Israel, New York, NY, United States AU - Thomas, S. AU - Chakravarti, A. AU - Steiger, D. AU - Lee, Y. DB - Embase DO - 10.1016/j.chest.2016.08.1004 KW - endogenous compound troponin adult ambient air anticoagulation blood clot lysis cardiologist deterioration dyspnea echography embolectomy endarterectomy filter gastric ulcer bleeding hemodynamics hospitalization human intensivist interventional radiologist intracardiac thrombosis lung embolism male meta analysis middle aged oxygen saturation patent foramen ovale Peru prospective study pulmonary artery recognition thoracic surgeon thrombectomy vein thrombosis LA - English M1 - 4 M3 - Conference Abstract N1 - L613468208 2016-12-05 PY - 2016 SN - 1931-3543 SP - 904A ST - The utility of ultrasound and multidisciplinary teams for management of clot in transit T2 - Chest TI - The utility of ultrasound and multidisciplinary teams for management of clot in transit UR - https://www.embase.com/search/results?subaction=viewrecord&id=L613468208&from=export http://dx.doi.org/10.1016/j.chest.2016.08.1004 VL - 150 ID - 760999 ER - TY - JOUR AB - Objective: Celiac artery compression by the median arcuate ligament (MAL) is a potential cause of postprandial abdominal pain and weight loss that overlaps with other common syndromes. Robotic technology may alter the current paradigm for surgical intervention. Open MAL release is often performed with concurrent bypass for celiac stenosis due to the morbidity of reintervention, whereas the laparoscopic approach is associated with high rates of conversion to open due to bleeding. We hypothesized that a robot-assisted technique might minimize conversion events to open, decrease perioperative morbidity, and defer consideration of vascular bypass at the initial operative setting. Methods: We retrospectively analyzed patients treated for MAL syndrome by a multidisciplinary team at a tertiary medical center between September 2012 and December 2013. Diagnosis was based on symptom profile and peak systolic velocity (PSV) >200 cm/s during celiac artery duplex ultrasound imaging. All patients underwent robot-assisted MAL release with simultaneous circumferential neurolysis of the celiac plexus. Postoperative celiac duplex and symptom profiles were reassessed longitudinally to monitor outcomes. Results: Nine patients (67% women) were evaluated for postprandial pain (100%) and weight loss (100%). All patients had celiac stenosis by mesenteric duplex ultrasound imaging (median PSV, 342; range, 238-637 cm/s), and cross-sectional imaging indicated a fishhook deformity in five (56%). Robot-assisted MAL release was completed successfully in all nine patients (100%) using a standardized surgical technique. Estimated blood loss was <50 mL, with a median hospital stay of 2 days (range, 2-3 days). No postoperative complications of grade ≥3, readmissions or reoperations were observed. All patients (100%) improved symptomatically at the 25-week median follow-up. Three patients experienced complete resolution on postoperative celiac duplex ultrasound imaging, and six patients showed an improved but persistent stenosis (PSV >200 cm/s) compared with preoperative velocities (P <.05 by Wilcoxon signed rank). No patients required additional treatment. Conclusions: Robot-assisted MAL release can be performed safely and effectively with avoidance of conversion events and minimal morbidity. Potential factors contributing to success are patient selection by a multidisciplinary team and replication of the open surgical technique by means of robot-assisted dexterity and visualization. The need for delayed reintervention for persistently symptomatic celiac stenosis is uncertain. AD - A.J. Moser, Institute for Hepatobiliary and Pancreatic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Stoneman 9, 330 Brookline Ave, Boston, MA, United States AU - Thoolen, S. J. J. AU - Van Der Vliet, W. J. AU - Kent, T. S. AU - Callery, M. P. AU - Dib, M. J. AU - Hamdan, A. AU - Schermerhorn, M. L. AU - Moser, A. J. DB - Embase Medline DO - 10.1016/j.jvs.2014.10.084 KW - abdominal pain adult aged article bleeding blood vessel shunt celiac artery stenosis celiac plexus circumferential neurolysis clinical article echography female follow up hospital readmission human length of stay male medical record review mesenteric artery middle aged minimally invasive surgery morbidity operation duration peak systolic velocity perioperative period postoperative pain postoperative period postprandial state priority journal reoperation robot assisted median arcuate ligament release surgical technique tertiary health care treatment outcome very elderly body weight loss LA - English M1 - 5 M3 - Article N1 - L601381742 2015-01-22 2015-05-25 PY - 2015 SN - 1097-6809 0741-5214 SP - 1278-1284 ST - Technique and outcomes of robot-assisted median arcuate ligament release for celiac artery compression syndrome T2 - Journal of Vascular Surgery TI - Technique and outcomes of robot-assisted median arcuate ligament release for celiac artery compression syndrome UR - https://www.embase.com/search/results?subaction=viewrecord&id=L601381742&from=export http://dx.doi.org/10.1016/j.jvs.2014.10.084 VL - 61 ID - 761084 ER - TY - JOUR AB - Severe complications of unexpected Staphylococcus aureus mitral valve endocarditis in a previously healthy 22-year-old Introduction: Staphylococcus bacteremia is considered a risk factor for endocarditis. The current guidelines require an echocardiographic examination in the presence of an according bacteremia. Up to 30% of patients have endocarditis in a positive blood culture. Despite an initially negative echocardiographic finding, a control examination after 7-10 days is recommended. Case Presentation: A previously healthy 22-year-old patient was introduced to the emergency room with fever, confusion and spontaneous wetting. No drug abuse was known. Meningism and cutaneous hemorrhagic lesions were observed. A high-grade inflammatory constellation with an evolving sepsis was present. CCT was inconspicuous. Initially suspected meningitis was ruled out. MRI showed cerebral septic emboli. Blood culture revealed Staphylococcus aureus, which rose suspicion of endocarditis. Immediate transesophageal echocardiography (TEE) was inconspicuous except for a previously known mild mitral regurgitation. PET-CT was negative. Because of continuing high clinical suspicion, endocarditis therapy was initiated. Follow-up TEE 5 days later, revealed posterior mitral leaflet perforation with severe mitral regurgitation and mobile vegetation. Sepsis led to disseminated intravasal coagulation (DIC) with thrombocytopenia. Intracerebral hemorrhage (ICH) occurred due to septic emboli and trepanation was performed. Urgent cardiac surgery had to be postponed due to the ICH. Recurrent cardiopulmonary edema occurred due to the destructed mitral valve. Pleural effusion was positive for S.aureus. Finally, biological mitral valve replacement took place after 3 weeks of treatment. S.aureus was detected on the removed valve even after weeks of antibiotic treatment. On the 6th postoperative day headache and vigilance disturbance occurred due to subarachnoid bleeding in perforated de-novo mycotic basilar tip aneurysm. Due to difficult vascular conditions, the aneurysm was coiled stent-supported. Cerebral vasospasm were treated with nimodipine and ventriculoperitoneal shunt was necessary du to persistent non obstructive hydrocephalus. Due to aneurysm re-perfusion, re-coiling took place. Antibiotic therapy continued throughout the entire inpatient stay. Limb palsy diminished progressively, but motor aphasia remained. The case shows that imaging may not always confirm the diagnosis, especially in early stage of endocarditis. Therefore, start of empirical therapy with high clinical suspicion is of paramount importance. Systemic infections with S.aureus are associated with high mortality. Common embolic complications usually occur around diagnosis, after which the risk of embolization decreases significantly with adequate therapy. Treatment of a severe form should be carried out in a center of maximum care where all complications can be treated accordingly in multidisciplinary team. AD - T. Thottakara, University Heart Center Hamburg, Department of General and Interventional Cardiology, Hamburg, Germany AU - Thottakara, T. AU - Starekova, J. AU - Lettow, I. AU - Tahir, E. AU - Sinning, C. AU - Blankenberg, S. DB - Embase DO - 10.1093/ehjci/jey275 KW - nimodipine adult alertness aneurysm antibiotic therapy artificial embolization ataxic aphasia blood culture brain vasospasm brain ventricle peritoneum shunt case report clinical article complication conference abstract craniotomy diagnosis drug abuse drug therapy edema emergency ward endocarditis female fever follow up headache hospital patient human limb male meningism meningitis mitral valve regurgitation mitral valve replacement mortality multidisciplinary team nuclear magnetic resonance imaging obstructive hydrocephalus paralysis perforation pleura effusion positron emission tomography-computed tomography practice guideline reperfusion risk factor skin staphylococcal bacteremia stent subarachnoid hemorrhage surgery thrombocytopenia transesophageal echocardiography vegetation young adult LA - English M3 - Conference Abstract N1 - L630841808 2020-02-12 PY - 2019 SN - 2047-2412 SP - i1175 ST - Severe complications of unexpected staphylococcus aureus mitral valve endocarditis in a previously healthy 22-year-old T2 - European Heart Journal Cardiovascular Imaging TI - Severe complications of unexpected staphylococcus aureus mitral valve endocarditis in a previously healthy 22-year-old UR - https://www.embase.com/search/results?subaction=viewrecord&id=L630841808&from=export http://dx.doi.org/10.1093/ehjci/jey275 VL - 20 ID - 760776 ER - TY - JOUR AB - BACKGROUND AND PURPOSE: Shorter time-to-thrombolysis in acute ischemic stroke (AIS) is associated with improved functional outcome and reduced morbidity. We evaluate the effect of several interventions to reduce time-to-thrombolysis at an urban, public safety net hospital. METHODS: All patients treated with tissue plasminogen activator for AIS at our institution between 2008 and 2015 were included in a retrospective analysis of door-to-needle (DTN) time and associated factors. Between 2011 and 2014, we implemented 11 distinct interventions to reduce DTN time. Here, we assess the relative impact of each intervention on DTN time. RESULTS: The median DTN time pre- and postintervention decreased from 87 (interquartile range: 68-109) minutes to 49 (interquartile range: 39-63) minutes. The reduction was comprised primarily of a decrease in median time from computed tomography scan order to interpretation. The goal DTN time of 60 minutes or less was achieved in 9% (95% confidence interval: 5%-22%) of cases preintervention, compared with 70% (58%-81%) postintervention. Interventions with the greatest impact on DTN time included the implementation of a stroke group paging system, dedicated emergency department stroke pharmacists, and the development of a stroke code supply box. CONCLUSIONS: Multidisciplinary, collaborative interventions are associated with a significant and substantial reduction in time-to-thrombolysis. Such targeted interventions are efficient and achievable in resource-limited settings, where they are most needed. AD - Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, California; Department of Neurology, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. School of Medicine, University of California, San Francisco, San Francisco, California. Department of Radiology, University of California, San Francisco, San Francisco, California. Department of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, California. Department of Neurology, University of California, San Francisco, San Francisco, California; Department of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, California. Electronic address: Vineeta.Singh@ucsf.edu. AN - 28396187 AU - Threlkeld, Z. D. AU - Kozak, B. AU - McCoy, D. AU - Cole, S. AU - Martin, C. AU - Singh, V. DA - Jul DO - 10.1016/j.jstrokecerebrovasdis.2017.03.004 DP - NLM ET - 2017/04/12 J2 - Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association KW - Aged Aged, 80 and over Brain Ischemia/diagnostic imaging/*drug therapy Cerebral Angiography/methods Computed Tomography Angiography Cooperative Behavior Critical Pathways/organization & administration Delivery of Health Care, Integrated/*organization & administration Female Fibrinolytic Agents/*administration & dosage/adverse effects Hospitals, Public/*organization & administration Humans Interdisciplinary Communication Male Middle Aged Patient Care Team/organization & administration Retrospective Studies Safety-net Providers/*organization & administration Stroke/diagnostic imaging/*drug therapy Thrombolytic Therapy/adverse effects/*methods Time Factors *Time-to-Treatment Tissue Plasminogen Activator/*administration & dosage/adverse effects Treatment Outcome Workflow Stroke cerebrovascular disorders safety net hospital thrombolytic therapy LA - eng M1 - 7 N1 - 1532-8511 Threlkeld, Zachary D Kozak, Benjamin McCoy, David Cole, Sara Martin, Christine Singh, Vineeta Journal Article Observational Study United States J Stroke Cerebrovasc Dis. 2017 Jul;26(7):1500-1505. doi: 10.1016/j.jstrokecerebrovasdis.2017.03.004. Epub 2017 Apr 7. PY - 2017 SN - 1052-3057 SP - 1500-1505 ST - Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital T2 - J Stroke Cerebrovasc Dis TI - Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital VL - 26 ID - 760365 ER - TY - JOUR AB - Atrial fibrillation (AF) is a frequent cause of acute ischemic stroke that results in severe neurological disability and death despite treatment with intravenous thrombolysis (intravenous recombinant tissue plasminogen activator [rtPA]). We performed a retrospective review of a single-center registry of patients treated with intravenous rtPA for stroke. The purposes of this study were to compare intravenous rtPA treated patients with stroke with and without AF to examine independent predictors of poor hospital discharge outcome (in-hospital death or hospital discharge to a skilled nursing facility, long-term acute care facility, or hospice care). A univariate analysis was performed on 144 patients receiving intravenous rtPA for stroke secondary to AF and 190 patients without AF. Characteristics that were significantly different between the two groups were age, initial National Institutes of Health Stroke Scale score, length of hospital stay, gender, hypertension, hyperlipidemia, smoking status, presence of large cerebral infarct, and hospital discharge outcome. Bivariate logistic regression analysis indicated that patients with stroke secondary to AF with a poor hospital discharge outcome had a greater likelihood of older age, higher initial National Institutes of Health Stroke Scale scores, longer length of hospital stay, intubation, and presence of large cerebral infarct compared with those with good hospital discharge outcome (discharged to home or inpatient rehabilitation or signed oneself out against medical advice). A multivariate logistic regression analysis showed that older age, longer length of hospital stay, and presence of large cerebral infarct were independent predictors of poor hospital discharge outcome. These predictors can guide nursing interventions, aid the multidisciplinary treating team with treatment decisions, and suggest future directions for research. AD - [Tian, Melissa J.] Alleghney Gen Hosp, Pittsburgh, PA 15212 USA. [Tayal, Ashis H.] Alleghney Gen Hosp, Stroke Program, Pittsburgh, PA USA. [Schlenk, Elizabeth A.] Univ Pittsburgh, Sch Nursing, Pittsburgh, PA 15261 USA. Tian, MJ (corresponding author), Alleghney Gen Hosp, Pittsburgh, PA 15212 USA. mtian@wpahs.org AN - WOS:000347980200008 AU - Tian, M. J. AU - Tayal, A. H. AU - Schlenk, E. A. DA - Feb DO - 10.1097/jnn.0000000000000104 J2 - J. Neurosci. Nurs. KW - atrial fibrillation hospital discharge outcome intravenous rtPA ischemic stroke AMERICAN-HEART-ASSOCIATION ACUTE ISCHEMIC-STROKE CLINICAL-PRACTICE GUIDELINES PERIPHERAL VASCULAR-DISEASE QUALITY-OF-CARE ANTITHROMBOTIC THERAPY SCIENTIFIC STATEMENT CARDIOLOGY COUNCIL PREVENTION RELIABILITY Clinical Neurology Nursing LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: AZ1DJ Times Cited: 3 Cited Reference Count: 21 Tian, Melissa J. Tayal, Ashis H. Schlenk, Elizabeth A. Schlenk, Elizabeth/0000-0001-7361-1951 3 0 10 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J NEUROSCI NURS PY - 2015 SN - 0888-0395 SP - 20-26 ST - Predictors of Poor Hospital Discharge Outcome in Acute Stroke Due To Atrial Fibrillation T2 - Journal of Neuroscience Nursing TI - Predictors of Poor Hospital Discharge Outcome in Acute Stroke Due To Atrial Fibrillation UR - ://WOS:000347980200008 VL - 47 ID - 761763 ER - TY - JOUR AU - Tice, C. AU - Seigerman, M. AU - Fiorilli, P. AU - Pugliese, S. AU - Khandhar, S. AU - Giri, J. AU - Kobayashi, T. DA - 2020/10/11 10/11 DB - Europe PubMed Central M1 - 12 PY - 2020 SN - 1932-9520 ST - Management of Acute Pulmonary Embolism T2 - Curr Cardiovasc Risk Rep TI - Management of Acute Pulmonary Embolism UR - http://europepmc.org/article/PMC/PMC7538277 VL - 14 ID - 762011 ER - TY - JOUR AB - PURPOSE OF THE REVIEW: Over 100,000 cardiovascular-related deaths annually are caused by acute pulmonary embolism (PE). While anticoagulation has historically been the foundation for treatment of PE, this review highlights the recent rapid expansion in the interventional strategies for this condition. RECENT FINDINGS: At the time of diagnosis, appropriate risk stratification helps to accurately identify patients who may be candidates for advanced therapeutic interventions. While systemic thrombolytics (ST) is the mostly commonly utilized intervention for high-risk PE, the risk profile of ST for intermediate-risk PE limits its use. Assessment of an individualized patient risk profile, often via a multidisciplinary pulmonary response team (PERT) model, there are various interventional strategies to consider for PE management. Novel therapeutic options include catheter-directed thrombolysis, catheter-based embolectomy, or mechanical circulatory support for certain high-risk PE patients. Current data has established safety and efficacy for catheter-based treatment of PE based on surrogate outcome measures. However, there is limited long-term data or prospective comparisons between treatment modalities and ST. While PE diagnosis has improved with modern cross-sectional imaging, there is interest in improved diagnostic models for PE that incorporate artificial intelligence and machine learning techniques. SUMMARY: In patients with acute pulmonary embolism, after appropriate risk stratification, some intermediate and high-risk patients should be considered for interventional-based treatment for PE. AD - Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 USA. GRID: grid.411115.1. ISNI: 0000 0004 0435 0884 Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA. GRID: grid.411115.1. ISNI: 0000 0004 0435 0884 Michael J. Crescenz Veteran Affairs Medical Center, Philadelphia, PA 19104 USA. Center for Cardiovascular Outcomes, Quality, and Evaluative Research, Philadelphia, PA USA. Division of Pulmonology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104 USA. GRID: grid.411115.1. ISNI: 0000 0004 0435 0884 Division of Cardiovascular Medicine, Penn Presbyterian Medical Center, Philadelphia, PA 19104 USA. GRID: grid.412713.2. ISNI: 0000 0004 0435 1019 AN - 33042325 AU - Tice, C. AU - Seigerman, M. AU - Fiorilli, P. AU - Pugliese, S. C. AU - Khandhar, S. AU - Giri, J. AU - Kobayashi, T. C2 - Pmc7538277 DO - 10.1007/s12170-020-00659-z DP - NLM ET - 2020/10/13 J2 - Current cardiovascular risk reports KW - Catheter-directed embolectomy Catheter-directed thrombolysis Pulmonary embolism Pulmonary embolism response team Inari Medical, and Dr. Sameer Khandhar sit on the advisory board for Inari Medical. Dr. Connor Tice, Dr. Matthew Seigerman, Dr. Steven Pugliese, Dr. Paul Fiorilli, and Dr. Tai Kobayashi have no conflicts of interests to report. LA - eng M1 - 12 N1 - 1932-9563 Tice, Connor Seigerman, Matthew Orcid: 0000-0001-6188-5760 Fiorilli, Paul Pugliese, Steven C Khandhar, Sameer Giri, Jay Kobayashi, Taisei Journal Article Review Curr Cardiovasc Risk Rep. 2020;14(12):24. doi: 10.1007/s12170-020-00659-z. Epub 2020 Oct 6. PY - 2020 SN - 1932-9520 (Print) 1932-9520 SP - 24 ST - Management of Acute Pulmonary Embolism T2 - Curr Cardiovasc Risk Rep TI - Management of Acute Pulmonary Embolism VL - 14 ID - 760269 ER - TY - JOUR AB - There is a paucity of robust clinical trial data to guide the treatment of acute pulmonary embolism (PE) thus the clinical guidelines rely heavily on expert opinion. Pulmonary Embolism Response Teams (PERT) have been developed to streamline the care of patients with acute PE. We conducted a survey among 100 experts in the field of PE during the second annual meeting of the PERT Consortium. Respondents were queried with respect to their demographic information, clinical practice questions and clinical vignettes. Clinical practice questions were focused questions about the risk stratification and treatment of patients with acute submassive PE, anticoagulation strategies for patients receiving thrombolysis and the use of inferior vena cava filters. Clinical vignettes were designed to assess participants' preferred choice of treatment for a variety of commonly encountered clinical scenarios. Among physicians affiliated with a PERT, there is overall agreement with regards to the criteria used for risk classification of patients with PE and its application to patients in the provided clinical vignettes. In contrast, there is substantial variability in the treatment strategies of patients presenting with commonly encountered clinical scenarios. The results of this survey highlight the need for more clinical trial data along with accepted algorithms for treatment of acute PE. In the absence of this, PERTs can facilitate multidisciplinary discussions in order to standardize treatment and provide evidence-based therapies to patients with acute PE. AD - Division of Cardiology, Sections of Interventional Cardiology and Vascular Medicine, Medical University of South Carolina, 30 Courtenay Drive MSC 592, Charleston, SC, 29401, USA. todoran@musc.edu. Penn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. Frankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Division of Cardiology, Section of Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. AN - 29667126 AU - Todoran, T. M. AU - Giri, J. AU - Barnes, G. D. AU - Rosovsky, R. P. AU - Chang, Y. AU - Jaff, M. R. AU - Rosenfield, K. AU - Kabrhel, C. DA - Jul DO - 10.1007/s11239-018-1659-5 DP - NLM ET - 2018/04/19 J2 - Journal of thrombosis and thrombolysis KW - Emergency Treatment/methods Group Processes *Hospital Rapid Response Team Humans Patient Care Team *Practice Patterns, Physicians' Pulmonary Embolism/*therapy Surveys and Questionnaires Acute pulmonary embolism Pert PERT Consortium Pulmonary Embolism Response Team LA - eng M1 - 1 N1 - 1573-742x Todoran, Thomas M Giri, Jay Barnes, Geoffrey D Rosovsky, Rachel P Chang, Yuchiao Jaff, Michael R Rosenfield, Kenneth Kabrhel, Christopher PERT Consortium Journal Article Netherlands J Thromb Thrombolysis. 2018 Jul;46(1):39-49. doi: 10.1007/s11239-018-1659-5. PY - 2018 SN - 0929-5305 SP - 39-49 ST - Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the Pulmonary Embolism Response Team Consortium T2 - J Thromb Thrombolysis TI - Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the Pulmonary Embolism Response Team Consortium VL - 46 ID - 760130 ER - TY - JOUR AU - Todoran, T. M. AU - Giri, J. AU - Barnes, G. D. AU - Rosovsky, R. P. AU - Chang, Y. AU - Jaff, M. R. AU - Rosenfield, K. AU - Kabrhel, C. AU - Consortium, Pert DA - 2018/04/19 04/19 DB - Europe PubMed Central DO - 10.1007/s11239-018-1659-5 M1 - 1 PY - 2018 SN - 0929-5305 SP - 39-49 ST - Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the Pulmonary Embolism Response Team Consortium T2 - J Thromb Thrombolysis TI - Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the Pulmonary Embolism Response Team Consortium UR - http://europepmc.org/article/MED/29667126 VL - 46 ID - 761965 ER - TY - JOUR AB - There is a paucity of robust clinical trial data to guide the treatment of acute pulmonary embolism (PE) thus the clinical guidelines rely heavily on expert opinion. Pulmonary Embolism Response Teams (PERT) have been developed to streamline the care of patients with acute PE. We conducted a survey among 100 experts in the field of PE during the second annual meeting of the PERT Consortium. Respondents were queried with respect to their demographic information, clinical practice questions and clinical vignettes. Clinical practice questions were focused questions about the risk stratification and treatment of patients with acute submassive PE, anticoagulation strategies for patients receiving thrombolysis and the use of inferior vena cava filters. Clinical vignettes were designed to assess participants' preferred choice of treatment for a variety of commonly encountered clinical scenarios. Among physicians affiliated with a PERT, there is overall agreement with regards to the criteria used for risk classification of patients with PE and its application to patients in the provided clinical vignettes. In contrast, there is substantial variability in the treatment strategies of patients presenting with commonly encountered clinical scenarios. The results of this survey highlight the need for more clinical trial data along with accepted algorithms for treatment of acute PE. In the absence of this, PERTs can facilitate multidisciplinary discussions in order to standardize treatment and provide evidence-based therapies to patients with acute PE. AD - [Todoran, Thomas M.] Med Univ South Carolina, Sect Intervent Cardiol, Div Cardiol, 30 Courtenay Dr MSC 592, Charleston, SC 29401 USA. [Todoran, Thomas M.] Med Univ South Carolina, Sect Vasc Med, Div Cardiol, 30 Courtenay Dr MSC 592, Charleston, SC 29401 USA. [Giri, Jay] Univ Penn, Perelman Sch Med, Penn Cardiovasc Outcomes Qual & Evaluat Res Ctr, Philadelphia, PA 19104 USA. [Barnes, Geoffrey D.] Univ Michigan, Sch Med, Dept Internal Med, Frankel Cardiovasc Ctr, Ann Arbor, MI USA. [Barnes, Geoffrey D.] Univ Michigan, Sch Med, Dept Internal Med, Inst Healthcare Policy & Innovat, Ann Arbor, MI USA. [Rosovsky, Rachel P.] Harvard Med Sch, Div Hematol & Oncol, Massachusetts Gen Hosp, Boston, MA USA. [Chang, Yuchiao] Harvard Med Sch, Div Gen Internal Med, Massachusetts Gen Hosp, Boston, MA USA. [Jaff, Michael R.; Rosenfield, Kenneth] Harvard Med Sch, Div Cardiol, Massachusetts Gen Hosp, Sect Vasc Med,Dept Med, Boston, MA USA. [Kabrhel, Christopher] Harvard Med Sch, Massachusetts Gen Hosp, Ctr Vasc Emergencies, Dept Emergency Med, Boston, MA USA. Todoran, TM (corresponding author), Med Univ South Carolina, Sect Intervent Cardiol, Div Cardiol, 30 Courtenay Dr MSC 592, Charleston, SC 29401 USA.; Todoran, TM (corresponding author), Med Univ South Carolina, Sect Vasc Med, Div Cardiol, 30 Courtenay Dr MSC 592, Charleston, SC 29401 USA. todoran@musc.edu AN - WOS:000434801900008 AU - Todoran, T. M. AU - Giri, J. AU - Barnes, G. D. AU - Rosovsky, R. P. AU - Chang, Y. C. AU - Jaff, M. R. AU - Rosenfield, K. AU - Kabrhel, C. AU - Consortium, Pert DA - Jul DO - 10.1007/s11239-018-1659-5 J2 - J. Thromb. Thrombolysis KW - Acute pulmonary embolism Pulmonary Embolism Response Team PERT PERT Consortium PROGNOSTIC VALUE TRIAL THROMBOLYSIS FIBRINOLYSIS METAANALYSIS MANAGEMENT CARE Cardiac & Cardiovascular Systems Hematology Peripheral Vascular Disease LA - English M1 - 1 M3 - Article N1 - ISI Document Delivery No.: GI8UT Times Cited: 6 Cited Reference Count: 15 Todoran, Thomas M. Giri, Jay Barnes, Geoffrey D. Rosovsky, Rachel P. Chang, Yuchiao Jaff, Michael R. Rosenfield, Kenneth Kabrhel, Christopher Barnes, Geoffrey/AAK-1780-2020 Barnes, Geoffrey/0000-0002-6532-8440 6 1 2 SPRINGER DORDRECHT J THROMB THROMBOLYS PY - 2018 SN - 0929-5305 SP - 39-49 ST - Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the Pulmonary Embolism Response Team Consortium T2 - Journal of Thrombosis and Thrombolysis TI - Treatment of submassive and massive pulmonary embolism: a clinical practice survey from the second annual meeting of the Pulmonary Embolism Response Team Consortium UR - ://WOS:000434801900008 VL - 46 ID - 761582 ER - TY - JOUR AB - Purpose: To assess the use of cuffed peripherally inserted central catheters (PICCs) compared with uncuffed PICCs in children with respect to their ability to provide access until the end of therapy. Materials And Methods: A retrospective review of PICCs inserted between January 2007 and December 2008 was conducted. Data collected from electronic records included patient age, referring service, clinical diagnosis, inserting team (pediatric interventional radiologists or neonatal intensive care unit [NICU] nurse-led PICC team), insertion site, dates of insertion and removal, reasons for removal, and need for a new catheter insertion. A separate subset analysis of the NICU population was performed. Primary outcome measured was the ability of the PICCs to provide access until the end of therapy. Results: Cuffed PICCs (n = 1,201) were significantly more likely to provide access until the end of therapy than uncuffed PICCs (n = 303) (P = .0002). Catheter removal before reaching the end of therapy with requirement of placement of a new PICC occurred in 26% (n = 311) of cuffed PICCs and 38% (n = 114) of uncuffed PICCs. Uncuffed PICCs had a significantly higher incidence of infections per 1,000 catheter days (P = .023), malposition (P = .023), and thrombus formation (P = .022). In the NICU subset analysis, cuffed PICCs had a higher chance of reaching end of therapy, but this was not statistically significant. Conclusions: In this pediatric population, cuffed PICCs were more likely to provide access until the end of therapy. Cuffed PICCs were associated with lower rates of catheter infection, malposition, and thrombosis than uncuffed PICCs. AD - [Toh, Luke M. H. W.; Amaral, Joao; John, Philip R.; Temple, Michael J.; Parra, Dimitri; Connolly, Bairbre L.] Hosp Sick Children, Dept Diagnost Imaging, Div Intervent Radiol, Toronto, ON M5G 1X8, Canada. [Moineddin, Rahim] Univ Toronto, Dept Family & Community Med, Toronto, ON M5S 1A1, Canada. [John, Philip R.; Connolly, Bairbre L.] Univ Toronto, Dept Med Imaging, Toronto, ON, Canada. [Mavili, Ertugrul] Erciyes Univ, Fac Med, Dept Radiol, Kayseri, Turkey. Toh, LMHW (corresponding author), Hosp Sick Children, Dept Diagnost Imaging, Div Intervent Radiol, 555 Univ Ave, Toronto, ON M5G 1X8, Canada. hwtoh@hotmail.com AN - WOS:000324363600010 AU - Toh, Lmhw AU - Mavili, E. AU - Moineddin, R. AU - Amaral, J. AU - John, P. R. AU - Temple, M. J. AU - Parra, D. AU - Connolly, B. L. DA - Sep DO - 10.1016/j.jvir.2013.03.003 J2 - J. Vasc. Interv. Radiol. KW - CENTRAL VENOUS CATHETERS BLOOD-STREAM INFECTION RISK COMPLICATIONS EXPERIENCE ACCESS Radiology, Nuclear Medicine & Medical Imaging Peripheral Vascular Disease LA - English M1 - 9 M3 - Review N1 - ISI Document Delivery No.: 217MM Times Cited: 6 Cited Reference Count: 29 Toh, Luke M. H. W. Mavili, Ertugrul Moineddin, Rahim Amaral, Joao John, Philip R. Temple, Michael J. Parra, Dimitri Connolly, Bairbre L. Parra, Dimitri/AAH-7776-2020; Amaral, Joao Guilherme/AAV-2401-2020; Temple, Michael/E-4082-2013 Parra, Dimitri/0000-0003-0214-3382; Amaral, Joao Guilherme/0000-0002-2011-7826; Temple, Michael/0000-0002-5843-0519 6 0 16 ELSEVIER SCIENCE INC NEW YORK J VASC INTERV RADIOL PY - 2013 SN - 1051-0443 SP - 1316-1322 ST - Are Cuffed Peripherally Inserted Central Catheters Superior to Uncuffed Peripherally Inserted Central Catheters? A Retrospective Review in a Tertiary Pediatric Center T2 - Journal of Vascular and Interventional Radiology TI - Are Cuffed Peripherally Inserted Central Catheters Superior to Uncuffed Peripherally Inserted Central Catheters? A Retrospective Review in a Tertiary Pediatric Center UR - ://WOS:000324363600010 VL - 24 ID - 761799 ER - TY - JOUR AB - Objective: Cardiac disease is a significant contributor to severe maternal morbidity (SMM). The objective of our study was to assess obstetric and cardiac outcomes among pregnant women with cardiac disease managed by a multidisciplinary care team. Study Design: This retrospective cohort study was conducted in a single-center over a 6-year period (2012-2018). At our center, all pregnant patients with congenital and acquired cardiac disease are cared for by a multidisciplinary team of perinatologists, cardiologists, anesthesiologists, and nurses. Monthly in-person meetings are held to coordinate the care of pregnant patients and develop detailed delivery and postpartum care plans including intrapartum monitoring, labor analgesia, and postpartum location. Peripartum SMM at the time of delivery was defined based on CDC criteria. Results: Among 136 pregnancies in 117 women, 41 (35%) had arrhythmias, of which 26% were defibrillator or pacemaker dependent. Forty-five women (38%) had undergone open cardiac surgery with 44% of those receiving anticoagulation. Ten women (7%) developed pre-eclampsia, 10 (7%) had PPROM, and 36 (26 %) had preterm birth. Fifty-four women (39%) were induced, 26% of those for worsening cardiac function. Twenty women (14%) experienced an intrapartum cardiac or thrombotic event including one woman with pulmonary edema, three wi