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João Rocha Neves, Marta Casal Moura, André Ferreira, Joel Sousa, Luís Gamas, Mário Vieira, Alcídia Pereira, Hélio Alves, José Teixeira
INTRODUCTION: Minimally invasive revascularization of the left anterior descending coronary artery has gained popularity. Recently, the emergence of new surgical instruments and the improvement of the technique, allowed its use by routine. Its use in Heart Team allows excellent results. Our aim is to present the results of patients undergoing this technique in our center. METHODS: Retrospective study of patients submitted to minimally invasive revascularization of the left anterior descending coronary artery at our center...
January 2018: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Tiago R Velho, Hugo Duarte Ferreira, Catarina Carvalheiro, André Sena, Nádia Juqueira, Nuno Guerra, Javier Gallego, Ângelo Nobre
BACKGROUND: Aortic valve disease is the most common valvular heart disease. Surgical aortic valve replacement remains the gold-standard of treatment. Recently, minimally invasive approaches have been developed to reduce surgical trauma and to compete with percutaneous treatment of valvular heart disease. Minimally invasive approaches are associated with reduced perioperative morbidity and mortality. METHODS: Single-center retrospective study comparing clinical data of patients submitted to surgical treatment of aortic stenosis by limited sternotomy versus conventional sternotomy between January 2014 and August 2016...
January 2018: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Ryan D Horsley, Ellen D Vogels, Daaron A P McField, David M Parker, Charles Medico, James Dove, Marcus Fluck, Jon D Gabrielsen, Michael R Gionfriddo, Anthony T Petrick
BACKGROUND: Opioids have been the mainstay for postoperative pain relief for many decades. Recently, opioid-related adverse events and death have been linked to postoperative dependency. Multimodal approaches to postoperative pain control may be part of the solution to this health care crisis. The safety and effectiveness of multimodal pain control regimens after laparoscopic Roux-en-Y gastric bypass (LRYGB) has not been well studied. The primary aim of our study was to determine if an evidence-based, multimodal pain regimen during hospitalization could decrease the total oral morphine equivalent (TME) use after LRYGB...
October 13, 2018: Obesity Surgery
Katherine J Baxter, Heather L Short, Curtis D Travers, Kurt F Heiss, Mehul V Raval
PURPOSE: The purpose of this study was to implement a novel surgeon-reported categorization (SRC) for pediatric appendicitis severity and determine if SRC was associated with outcomes. METHODS: We conducted a retrospective review of appendectomies by 15 surgeons within a single center from January to December 2016. The SRC was defined as: simple (category 1), gangrenous or adherent (category 2A), perforation with localized abscess (category 2B), and perforation with gross contamination (category 2C)...
October 13, 2018: Pediatric Surgery International
Kathleen Kearney, Charles Maynard, Bryn Smith, Thomas D Rea, Alexis Beatty, James M McCabe
AIMS: Out of Hospital Cardiac Arrest (OHCA) is frequently attributed to coronary artery disease, thus guidelines recommend coronary angiography (CAG) for survivors of OHCA. However, the real-world application of these guidelines is unknown, and we sought to evaluate CAG practices in the contemporary OHCA population. METHODS: The Clinical Outcomes Assessment Program (COAP), a Washington State public reporting system, and the Cardiac Arrest Registry to Enhance Survival (CARES), a national registry of OHCA, were matched to characterize OHCA presentations between 2014 and 2015...
October 11, 2018: Resuscitation
John E Strobeck, Jonathan Feldschuh, Wayne L Miller
OBJECTIVES: This study performed a retrospective outcome analyses of a large cohort of mixed ejection fraction patients admitted for acute heart failure (HF), whose inpatient care was guided by individual quantitative blood volume analysis (BVA) results. BACKGROUND: Decongestion strategies in patients hospitalized for HF are based on clinical assessment of volume and have not integrated a quantitative intravascular volume metric. METHODS: Propensity score control matching analysis was performed in 245 consecutive HF admissions to a community hospital (September 2007 to April 2014; 78 ± 10 years of age; 50% with HF with reduced ejection fraction [HFrEF]; and 30% with Stage 4 chronic kidney disease)...
October 4, 2018: JACC. Heart Failure
Colleen K McIlvennan, Daniel D Matlock, Jocelyn S Thompson, Shannon M Dunlay, Laura Blue, Shane J LaRue, Eldrin F Lewis, Chetan B Patel, Diane L Fairclough, Erin C Leister, Keith M Swetz, Vicie Baldridge, Mary Norine Walsh, Larry A Allen
OBJECTIVES: This study aims to characterize caregivers of patients considering destination therapy left ventricular assist device (DT-LVAD) and evaluate the effectiveness of a shared decision-making (SDM) intervention. BACKGROUND: Caregivers play an integral role in the care of patients with chronic illness. At the extreme, pursuing a DT-LVAD is a major preference-sensitive decision that requires high-level caregiver engagement. Yet, little is known about caregivers of patients considering DT-LVAD, and there is a paucity of research on the involvement of caregivers in medical decision-making...
October 4, 2018: JACC. Heart Failure
Siddhant K Mehta, Wood W Dale, Michael D Dedwylder, Patrick F Bergin, Clay A Spitler
PURPOSE: The purpose of this study is to evaluate the incidence of neurovascular injuries, compartment syndrome, early postoperative infection as well as the injury factors predictive of neurovascular injury following ballistic fractures of the radius and ulna. METHODS: A retrospective review was performed to identify all ballistic fractures of the radius and ulna in skeletally mature patients over a 5-year period at a single level-1 trauma center. Chart and radiographic review was performed to identify patient and injury demographics, associated neurologic or vascular injuries, and fracture characteristics...
October 6, 2018: Injury
M Shrestha, D Singh, M R Sigdel, M P Kafle
BACKGROUND: Increasing graft survival is the prime focus of every transplantation program. Detection of subclinical abnormalities with the help of protocol renal graft biopsies performed at predetermined intervals after transplantation has been one of the approaches. The objective was to study the abnormalities in protocol renal graft biopsy specimens at 6 months posttransplantation. METHODS: This was a hospital-based observational descriptive study. It included the recipients who underwent kidney transplantation between October 2014 and September 2015...
October 2018: Transplantation Proceedings
Ellen M Denzen, Jaime M Preussler, Elizabeth A Murphy, K Scott Baker, Linda J Burns, Jackie Foster, Lensa Idossa, Heather K Moore, Tammy J Payton, Darlene Haven, Balkrishna Jahagirdar, Naynesh Kamani, J Douglas Rizzo, Lizette Salazar, Barry A Schatz, Karen L Syrjala, John R Wingard, Navneet S Majhail
PURPOSE: This study aimed to develop a survivorship care plan (SCP) that could be individualized to facilitate long-term follow-up care of hematopoietic cell transplantation (HCT) survivors. METHODS: A sample SCP was developed that included two documents- a treatment summary and preventive care recommendations that combined data on treatment exposures routinely submitted by HCT centers to the Center for International Blood and Marrow Transplant Research (CIBMTR) with long-term follow-up guidelines...
October 10, 2018: Biology of Blood and Marrow Transplantation
Chengliang Luo, Qiang Yang, Yuancai Liu, Shuanhu Zhou, Jiying Jiang, Russel J Reiter, Pallab Bhattacharya, Yongchun Cui, Hongwei Yang, He Ma, Jiemin Yao, Sean E Lawler, Xinmu Zhang, Jianfang Fu, Renato Rozental, Hany Aly, Mark D Johnson, E Antonio Chiocca, Xin Wang
Melatonin is a neurohormone associated with sleep and wakefulness and is mainly produced by the pineal gland in animals. Numerous physiological functions of melatonin have been demonstrated including anti-inflammation, suppressing neoplastic growth, circadian and endocrine rhythm regulation, and its potent antioxidant activity as well as its role in regeneration of various tissues including the nervous system, liver, bone, kidney, bladder, skin, and muscle, among others. In this review, we summarize the recent advances related to the multiple protective roles of melatonin receptor agonists, melatonin and N-acetylserotonin (NAS) in brain injury, liver damage, and bone health...
October 10, 2018: Free Radical Biology & Medicine
Sarah Chuzi, Sarah Hale, Jason Arnold, Amy Zhou, Rebecca Harap, Kathleen L Grady, Jonathan D Rich, Clyde W Yancy, Adeboye Ogunseitan, Eytan Szmuilowicz, Jane E Wilcox
INTRODUCTION: In 2013 the Centers for Medicare and Medicaid Services (CMS) issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team prior to surgery. Subsequently, many VAD programs implemented a mandatory pre-implantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. METHODS: All patients undergoing DT VAD at Northwestern Memorial Hospital from October 30, 2013 (the CMS decision date) through March 1, 2018 were included...
October 10, 2018: Journal of Pain and Symptom Management
Bernard Prado, Ali Haider, Syed Naqvi, Roberto C Pestana, Janet L Williams, Seyedeh Dibaj, Diane Liu, Julio Allo, Vera De La Cruz, Eduardo Bruera
CONTEXT: Optimal benefits from Palliative Cancer Care (PC) are achieved when first consults (PC1) occur early, in the outpatient setting. Late PC1, like those in the intensive care unit (ICU), limit these benefits. OBJECTIVES: To determine the proportion of PC1 over time in the outpatient, ICU, and inpatient non-ICU settings. We also examined patients' baseline characteristics and the timing of PC access (from PC1 to death) by the setting of PC1. METHODS: We retrospectively evaluated consecutive cancer patients' records at our cancer center to ascertain the annual number of PC1 and its distribution across settings (2011 to 2017)...
October 10, 2018: Journal of Pain and Symptom Management
David Wang, Caleb Ing, Craig Blinderman, May Hua
CONTEXT: In the intensive care unit (ICU), 14% of patients meet criteria for specialized palliative care, but whether subgroups of patients differ in their palliative care needs is unknown. OBJECTIVES: To use latent class analysis (LCA) to separate ICU patients into different classes of palliative care needs, and determine if such classes differ in their palliative care resource requirements. METHODS: Retrospective cohort study of ICU patients who received specialized palliative care, August 2013 - August 2015...
October 10, 2018: Journal of Pain and Symptom Management
Manon Gijtenbeek, Enrico Lopriore, Sylke J Steggerda, Arjan B Te Pas, Dick Oepkes, Monique C Haak
BACKGROUND: Newborns with anemia are at increased risk of persistent pulmonary hypertension of the newborn (PPHN), yet reports on the association between fetomaternal hemorrhage (FMH) and PPHN are rare. To optimize care for pregnancies complicated by FMH, clinicians should be aware of the risks of FMH and the possible diagnostic and therapeutic options. To increase the current knowledge, the incidence of PPHN and short-term neurologic injury in FMH cases were studied. STUDY DESIGN AND METHODS: We included all FMH cases (≥30 mL fetal blood transfused into the maternal circulation) admitted to our neonatal unit between 2006 and 2018...
October 13, 2018: Transfusion
Lene Joensen, Lawrence Fisher, Timothy Skinner, Yvonne Doherty, Ingrid Willaing
AIMS: To identify challenges and solutions to integrating psychosocial support into routine diabetes care from the perspective of stakeholders with an expertise in diabetes self-management education and support. METHODS: Ninety-four people attended the annual international Diabetes Self-management Alliance meeting in 2016, including plenary sessions and workshops around self-management education, support and prevention. One workshop focused on how to integrate psychosocial support into routine diabetes care, which was run four times consecutively allowing all conference participants to attend the workshops in groups of 20-25 people...
October 13, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Adam Carmel, Elena Logvinenko, Erin S Valenti
OBJECTIVE: Dialectical behavior therapy (DBT) is a widely disseminated evidence-based treatment for patients with borderline personality disorder (BPD). This evaluation of a community psychiatry residency rotation compared a DBT training program to a standard care training program to determine the levels of confidence in treating patients with BPD, willingness to treat patients with BPD, and attitudes towards this patient population. METHODS: Participants were 57 psychiatry residents who completed a 3-month community psychiatry rotation in a DBT clinic (N = 33), or standard care clinic (N = 24) based in a partial hospitalization program in a community mental health center...
October 12, 2018: Academic Psychiatry
K Rivet Amico, Jessica Miller, Christopher Balthazar, Pedro Alonso Serrano, Jennifer Brothers, Sarah Zollweg, Sybil Hosek
Pre-exposure prophylaxis (PrEP) for the prevention of HIV infection among young men who have sex with men is a critical part of the HIV prevention landscape in the US. Given the unique challenges and resources of young MSM negotiating safer sex practices, including PrEP, counseling and supportive discussions to optimize both PrEP use and sexual health protection more generally may facilitate reaching HIV prevention goals. Within the context of a large, open-label PrEP study (ATN110/113), support for sexual health promotion and PrEP use was provided through use of integrated Next Step Counseling (iNSC) as part of study visits...
October 9, 2018: AIDS and Behavior
Xue-Qing Yu, Meng-Hua Chen, Jie Dong, Hong Liu, Zhang-Suo Liu, Qiang Yao, James A Sloand, Mark Marshall
BACKGROUND: The aim of this study was to determine if there were centers in China with unusually high levels of risk-adjusted mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: We analyzed an inception cohort commencing CAPD between 1 January 2005 and 13 August 2015, followed until death, dropout defined as discontinuation of Baxter products, loss to follow-up, or 13 November 2015, whichever occurred first. We calculated standardized mortality ratios (SMRs) from Cox proportional hazards models, adjusting for age, gender, employment status, insurance status, primary renal disease, size of peritoneal dialysis (PD) program, and year of dialysis inception...
October 12, 2018: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Mark Froats, Andrew Reed, Richard Dionne, Justin Maloney, Susan Duncan, Rob Burns, Julie Sinclair, Michael Austin
BACKGROUND: Most patients transferred from a non-percutaneous coronary intervention (PCI) facility for primary PCI do not meet target reperfusion times. Direct transportation of patients with ST-elevation myocardial infarction (STEMI) from the scene by advanced life support (ALS) paramedics has been shown to improve reperfusion times and outcomes. OBJECTIVE: The aim of this study was to determine whether it is safe to bypass the closest hospital and transport by basic life support (BLS) provider to a PCI facility...
October 9, 2018: Journal of Emergency Medicine
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