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Krish C Dewan, Karan S Dewan, Jay J Idrees, Suparna M Navale, Brad F Rosinski, Lars G Svensson, A Marc Gillinov, Douglas R Johnston, Faisal Bakaeen, Edward G Soltesz
Importance: Persistent opioid use is currently a major health care crisis. There is a lack of knowledge regarding its prevalence and effect among patients undergoing cardiac surgery. Objective: To characterize the national population of cardiac surgery patients with opioid use disorder (OUD) and compare outcomes with the cardiac surgery population without OUD. Design, Setting, and Participants: In this retrospective population-based cohort study, more than 5...
December 5, 2018: JAMA Surgery
Jae Heon Kim, Shufeng Li, Yash Khandwala, Kyung Jin Chung, Hyung Keun Park, Benjamin I Chung
Importance: Although the intent of nephron-sparing surgery is to eradicate malignant tumors found on preoperative imaging, benign masses often cannot be differentiated from malignant tumors. However, in the past there have been discrepancies in the reported percentages of benign masses removed by partial nephrectomy (PNx). Objective: To investigate the annual trend of prevalence of benign pathologic findings after PNx and to investigate what potential factors are associated with this prevalence...
December 5, 2018: JAMA Surgery
Sala Abdalla, Rosaria Scarpinata
The optimal timing of loop ileostomy reversal remains largely unknown, but evidence that delayed ileostomy closure may increase postoperative complication rates is increasing. PURPOSE: Retrospective research was conducted to compare outcomes between patients who had early (<6 months) or late (>6 months) loop ileostomy closure. METHODS: Records of patients >18 years of age who underwent circumstomal reversal of a loop ileostomy over a period of 5 years in 1 hospital's colorectal unit were abstracted and analyzed...
December 2018: Ostomy/wound Management
Sarah Alexandra Lynar, Claire Helen Robinson, Craig Steven Boutlis, Robert James Commons
BACKGROUND: An increasing prevalence of diabetes mellitus has led to a high risk of diabetic foot infections (DFI) and associated morbidity. However, little is known about the relationship between DFI and mortality. AIMS: To investigate the risk of mortality and associated factors in patients with DFI in an Australian context. METHODS: A prospective cohort study of inpatients with DFI between May 2012 and October 2016, at Royal Darwin Hospital, a tertiary referral hospital for the Top End of the Northern Territory...
December 4, 2018: Internal Medicine Journal
Adeyinka C Adejumo, Olalekan Akanbi, Lydie Pani
BACKGROUND AND AIMS: Clinical conditions resulting in hypoxia, hypoperfusion, anaerobic milieu within the gut, and intestinal epithelial breakdown, such as seen in heart failure, precipitates Clostridium difficile infection (CDI). Given that ischemic bowel disease (IB) typically results in similar changes within the gut, we investigated the relationship between CDI and IB, and the impact of CDI on the clinical outcomes of IB. PATIENTS AND METHODS: We initially performed a cross-sectional analysis on the 2014 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (NIS) patient's discharge records of ages 18 years and older, by estimating the crude and adjusted odds ratio (aOR) of CDI and IB as the outcome and predictor respectively...
January 2019: European Journal of Gastroenterology & Hepatology
Ayoola C Adigun, Kelly Maguire, Yisong Jiang, Haiyan Qu, Shamly Austin
The objective was to identify predictors of utilization for urgent care centers (UCCs), emergency departments (EDs), or for both services for non-emergent health conditions among beneficiaries from a managed care organization (MCO) who resided within a 10-mile radius of UCCs. A cross-sectional design was used to analyze 2016 administrative claims data from an MCO that contracted with a UCC with 12 locations (n = 20,107). Outcome variables were number of visits to UCC, ED, or both. The MCO used the New York University ED algorithm to identify non-emergent health conditions...
December 4, 2018: Population Health Management
Titilola M Afolabi, Kathleen A Fairman
BACKGROUND: To support families managing the complex requirements of home parenteral nutrition (HPN) in pediatric patients, health professionals need information about HPN indications and complications. Nationally representative information is limited. METHODS: A retrospective cohort analysis of the Truven Health Market Scan Commercial Claims and Encounters Database was performed and identified 683 patients aged ≤18 years receiving HPN during dates of service from January 2013 through September 2015...
December 3, 2018: Nutrition in Clinical Practice
A Biazzo, F Masia, F Verde
BACKGROUND: Bilateral unicompartmental knee arthroplasty (UKA) may be performed as one- or two-stage procedure. Previous reports suggest that UKA provides a more rapid functional recovery than total knee arthroplasty. However, little data exist on whether bilateral UKA can be performed without increasing the perioperative risk compared with unilateral cases. METHODS: We retrospectively compared 51 patients treated between January 2014 and March 2017 with single-stage UKA (group A) with 51 patients who underwent unilateral procedure (group B) to evaluate perioperative complications...
December 3, 2018: Musculoskeletal Surgery
E Concannon, S Carr, A Doherty, S J McInerney, J Birrane, L Kearney, A J Hussey, S M Potter, J L Kelly, N M McInerney
Self-harm is a common source of referral to plastic and hand surgery services. Appropriate management of these patients is complex and includes the need for close liaison with mental health services. Self-harm is the single biggest risk factor for completed suicide, thereby increasing the risk by a factor of 66.1 This study aimed to analyse the clinical pathway and demographics of patients referred to plastic surgeons following self-harm. This 6-year retrospective series included patients referred to plastic surgeons following self-harm within the Galway University Hospital group...
November 13, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Michael Bogart, Mrudula B Glassberg, Tyler Reinsch, Richard H Stanford
BACKGROUND: It is unknown whether there is a benefit to initiating triple therapy (TT; inhaled corticosteroids combined with long-acting β2 -agonists and long-acting muscarinic antagonists) promptly (within 30 days) following a chronic obstructive pulmonary disease (COPD)-related hospitalization or emergency-department (ED) visit compared with delaying treatment (31-180 days). METHODS: This retrospective, observational study (GSK: HO-15-15256) used healthcare claims from a commercial and Medicare claims database (January 1, 2008-December 31, 2015)...
December 2018: Respiratory Medicine
Romesh P Nalliah, Deepti Shroff, Kyle Stein, Sangeetha Chandrasekaran, Sankeerth Rampa, Veerajalandhar Allareddy, Veerasathpurush Allareddy
PURPOSE: In the United States, 2.1 million people develop substance abuse disorders that are associated with prescribed opioids. The objective of the present study was to identify the factors associated with opioid abuse and dependence (OAD) in those hospitalized for head and neck cancer (HNC). Although measures are being implementing to reduce opioid prescribing, the use of these drugs in individuals with HNC can be valuable. However, little is known about OAD among this cohort of individuals...
December 2018: Journal of Oral and Maxillofacial Surgery
Innie Chen, Abdul Jamil Choudhry, David Schramm, D William Cameron, Victor Leung, Sukhbir S Singh, Laura Hopkins, Kristina Arendas, Ranjeeta Mallick
STUDY OBJECTIVE: To quantify the relationship between type of benign pelvic disease and risk of surgical site infection (SSI) after hysterectomy DESIGN: Retrospective Cohort (Classification II-2) SETTING: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) PATIENT(S): Women who underwent hysterectomy from 2006-2015 and recorded in NSQIP database INTERVENTION: None MEASUREMENTS AND MAIN RESULTS: SSI risk was compared for type of benign pelvic diseases, patient characteristics (age, race and selected comorbidities) and process of care variables (admission status, type of hysterectomy, and operative time)...
November 30, 2018: Journal of Minimally Invasive Gynecology
Amanda C Bennett, Crystal Gibson, Angela M Rohan, Julia F Howland, Kristin M Rankin
INTRODUCTION: Mental health and substance use are growing public health concerns, but established surveillance methods do not measure the burden of these conditions among women of reproductive age. We developed a standardized indicator from administrative data to identify inpatient hospitalizations related to mental health or substance use (MHSU) among women of reproductive age, as well as co-occurrence of mental health and substance use conditions among those hospitalizations. MATERIALS AND METHODS: We used inpatient hospital discharge data from 2012-2014 for women aged 15-44 residing in Illinois and Wisconsin...
December 3, 2018: Public Health Reports
Cara L Sedney, Uzer Khan, Patricia Dekeseredy
CONTEXT: Medicaid has been linked to worse outcomes in a variety of diagnoses such as lung cancer, uterine cancer, and cardiac valve procedures. It has furthermore been linked to the reduced health-related quality of life outcomes after traumatic injuries when compared to other insurance groups. In spinal cord injury (SCI), the care provided in the subacute setting may vary based upon payor status, which may have implications on outcomes and cost of care. DESIGN: A retrospective review utilizing the institutional trauma databank was performed for all adult patients with spinal cord injury since 2009...
December 3, 2018: Journal of Spinal Cord Medicine
M K Nichols, M K Andrew, L Ye, T F Hatchette, A Ambrose, G Boivin, W Bowie, G Dos Santos, M Elsherif, K Green, F Haguinet, K Katz, J Leblanc, M Loeb, D MacKinnon-Cameron, A McCarthy, J E McElhaney, A McGeer, J Powis, D Richardson, M Semret, R Sharma, V Shinde, D Smyth, S Trottier, L Valiquette, D Webster, S A McNeil
Background: Recent studies have demonstrated the possibility of negative associations between prior influenza vaccines and subsequent influenza vaccine effectiveness (VE), depending on season and strain. We investigated this association over 4 consecutive influenza seasons (2011/2012-2014/2015) in Canada. Methods: Using a matched test-negative design, laboratory-confirmed influenza cases and matched test-negative controls admitted to hospitals were enrolled. Patients were stratified into four groups according to influenza vaccine history (not vaccinated current and prior season [referent], vaccinated prior season only, vaccinated current season only, and vaccinated both current and prior season)...
December 3, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Shail Rawal, Janice L Kwan, Fahad Razak, Allan S Detsky, Yishan Guo, Lauren Lapointe-Shaw, Terence Tang, Adina Weinerman, Andreas Laupacis, S V Subramanian, Amol A Verma
Importance: Trauma of hospitalization refers to the depersonalizing and stressful experience of a hospital admission and is hypothesized to increase the risk of readmission after discharge. Objectives: To characterize the trauma of hospitalization by measuring patient-reported disturbances in sleep, mobility, nutrition, and mood among medical inpatients, and to examine the association between these disturbances and the risk of unplanned return to hospital after discharge...
December 3, 2018: JAMA Internal Medicine
Robert Howard, Elizabeth Cort, Rosie Bradley, Emma Harper, Linda Kelly, Peter Bentham, Craig Ritchie, Suzanne Reeves, Waleed Fawzi, Gill Livingston, Andrew Sommerlad, Sabu Oomman, Ejaz Nazir, Ramin Nilforooshan, Robert Barber, Chris Fox, Ajay Macharouthu, Pranathi Ramachandra, Vivek Pattan, John Sykes, Valerie Curran, Cornelius Katona, Tom Dening, Martin Knapp, Renee Romeo, Richard Gray
BACKGROUND: Very late-onset (aged ≥ 60 years) schizophrenia-like psychosis (VLOSLP) occurs frequently but no placebo-controlled, randomised trials have assessed the efficacy or risks of antipsychotic treatment. Most patients are not prescribed treatment. OBJECTIVES: The study investigated whether or not low-dose amisulpride is superior to placebo in reducing psychosis symptoms over 12 weeks and if any benefit is maintained by continuing treatment thereafter...
November 2018: Health Technology Assessment: HTA
Bashkim Kadriu, Wen Gu, Panagiota Korenis, Jeffrey M Levine
BACKGROUND: Numerous studies shown that structural hippocampal alterations are present in subjects at high risk of developing psychosis or schizophrenia. These findings indicate that in a subset of patients undergoing first-psychosis episode (FPE), hippocampal volume alterations are accompanied by associated cognitive and neuropsychological deficits. The combination of psychological deficits and neuroanatomical alterations, in turn, appears to increase treatment complexity and worsen clinical outcomes...
December 3, 2018: CNS Spectrums
Vanessa P Ho, Nicholas K Schiltz, Andrew P Reimer, Elizabeth A Madigan, Siran M Koroukian
BACKGROUND/OBJECTIVES: Over a million older patients in the United States are admitted yearly for emergency general surgery (EGS) conditions. Seven procedure types dominate: colon, small bowel, gallbladder, ulcer disease, adhesiolysis, appendix, and laparotomy operations. A higher comorbidity burden is known to increase mortality in this population, but the impact of specific comorbidity combinations is unknown. Our objectives were to (1) characterize the distribution of procedures, comorbidities, and outcomes for older patients undergoing EGS; and (2) apply a data-driven approach (association rule mining) to identify comorbidity combinations associated with disproportionately high mortality...
December 2, 2018: Journal of the American Geriatrics Society
L E Wachtel
OBJECTIVE: To review the treatment courses of 22 autistic patients diagnosed with catatonia over a 12-year period, including treatment with benzodiazepines and electroconvulsive therapy. METHOD: Retrospective review of inpatient and outpatient records of 22 autistic youth presenting to a neurobehavioral service who were treated for catatonia. RESULTS: Six girls and 16 boys ranging from ages 8 to 26 years old presenting for neurobehavioral assessment were found to meet criteria for catatonia according to the DSM5 and were treated for such...
December 2, 2018: Acta Psychiatrica Scandinavica
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