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https://www.readbyqxmd.com/read/29346176/rapid-response-to-scan-or-not-to-scan-the-utility-of-noncontrast-ct-head-for-altered-mental-status
#1
Purujit J Thacker, Mansha Sethi, Jonathan Sternlieb, Doron Schneider, Mary Naglak, Rajeshkumar R Patel
OBJECTIVES: The aims of the study were the following: (1) to determine how often computed tomography (CT) scans of the head are obtained on rapid responses called for altered mental status (AMS), (2) to determine whether CT imaging of the head is required during all rapid responses called for AMS, (3) to determine which patients would benefit from CT scans of the head in this setting, (4) to note whether an adequate neurologic exam was documented, (5) to determine the cost of CT scans that did not change management, and (6) to examine the role of medications leading to AMS...
January 17, 2018: Journal of Patient Safety
https://www.readbyqxmd.com/read/29346039/evaluation-of-a-french-regional-telemedicine-network-dedicated-to-neurological-emergencies-a-14-year-study
#2
Elisabeth Medeiros de Bustos, Eric Berthier, Didier Chavot, Benjamin Bouamra, Thierry Moulin
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-Comté, France...
January 18, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
https://www.readbyqxmd.com/read/29345529/effects-of-telestroke-on-thrombolysis-times-and-outcomes-a-meta-analysis
#3
Alireza Baratloo, Leila Rahimpour, Abdelrahman Ibrahim Abushouk, Saeed Safari, Chung Wing Lee, Ali Abdalvand
OBJECTIVE: Telestroke systems are tools, used to provide an advanced stroke care in regions without sufficient neurologic services. We performed this meta-analysis to assess the effects of telemedicine on treatment times and clinical outcomes of acute stroke care. METHODS: A literature search of PubMed, SCOPUS, and Cochrane CENTRAL was conducted for original studies investigating telemedicine applications in acute stroke care. Dichotomous data on treatment outcomes were pooled as odds ratios (ORs), while continuous data on thrombolysis times were pooled as mean differences (MDs) with 95% confidence interval (CI), using RevMan software (version 5...
January 18, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29341066/cerebral-near-infrared-spectroscopy-nirs-for-perioperative-monitoring-of-brain-oxygenation-in-children-and-adults
#4
REVIEW
Yun Yu, Kaiying Zhang, Ling Zhang, Huantao Zong, Lingzhong Meng, Ruquan Han
BACKGROUND: Various techniques have been employed for the early detection of perioperative cerebral ischaemia and hypoxia. Cerebral near-infrared spectroscopy (NIRS) is increasingly used in this clinical scenario to monitor brain oxygenation. However, it is unknown whether perioperative cerebral NIRS monitoring and the subsequent treatment strategies are of benefit to patients. OBJECTIVES: To assess the effects of perioperative cerebral NIRS monitoring and corresponding treatment strategies in adults and children, compared with blinded or no cerebral oxygenation monitoring, or cerebral oxygenation monitoring based on non-NIRS technologies, on the detection of cerebral oxygen desaturation events (CDEs), neurological outcomes, non-neurological outcomes and socioeconomic impact (including cost of hospitalization and length of hospital stay)...
January 17, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29335343/association-between-glucocorticoid-exposure-and-healthcare-expenditures-for-potential-glucocorticoid-related-adverse-events-in-patients-with-rheumatoid-arthritis
#5
Jennie H Best, Amanda M Kong, Gregory M Lenhart, Khaled Sarsour, Marni Stott-Miller, Yong Hwang
OBJECTIVE: Oral glucocorticoid (OGC) use for rheumatoid arthritis (RA) is debated because of the adverse event (AE) profile of OGC. We evaluated the associations between cumulative doses of OGC and potential OGC-related AE, and quantified the associated healthcare expenditures. METHODS: Using the MarketScan databases, patients ≥ 18 years old who have RA with continuous enrollment from January 1 to December 31, 2012 (baseline), and from January 1 to December 31, 2013 (evaluation period), were identified...
January 15, 2018: Journal of Rheumatology
https://www.readbyqxmd.com/read/29321107/can-i-send-this-patient-with-stroke-home-strategies-managing-transient-ischemic-attack-and-minor-stroke-in-the-emergency-department
#6
Bernard P Chang, Sara Rostanski, Joshua Willey, Benjamin Kummer, Eliza Miller, Mitchell Elkind
BACKGROUND: While transient ischemic attack and minor stroke (TIAMS) are common conditions evaluated in the emergency department (ED), there is controversy regarding the most effective and efficient strategies for managing them in the ED. Some patients are discharged after evaluation in the ED and cared for in the outpatient setting, while others remain in an observation unit without being admitted or discharged, and others experience prolonged and potentially costly inpatient admissions...
January 8, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29316820/cost-effectiveness-of-access-to-critical-cerebral-emergency-support-services-access-a-neuro-emergent-telemedicine-consultation-program
#7
Justin Whetten, David N van der Goes, Huy Tran, Mark Moffett, Colin Semper, Howard Yonas
AIMS: Access to Critical Cerebral Emergency Support Services (ACCESS) was developed as a low-cost solution to providing neuro-emergent consultations to rural hospitals in New Mexico that do not offer comprehensive stroke care. ACCESS is a two-way audio visual program linking remote emergency department physicians and their patients to stroke specialists. ACCESS also has an education component in which hospitals receive training from stroke specialists on the triage and treatment of patients...
January 9, 2018: Journal of Medical Economics
https://www.readbyqxmd.com/read/29312714/off-vs-on-pump-coronary-artery-bypass-graft-surgery-on-hospital-outcomes-in-134-117-octogenarians
#8
Umberto Benedetto, Gianni D Angelini, Massimo Caputo, Dmitriy N Feldman, Luke K Kim, Christopher Lau, Antonino Di Franco, Leonard N Girardi, Mario Gaudino
Background: In octogenarian patients there is a potential for more tangible clinical benefits from off-pump coronary artery bypass (OPCAB) compared to conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) (COCAB). We aimed to investigate whether, compared to COCAB, OPCAB is associated with better operative outcomes in octogenarians by analyzing the Nationwide Inpatient Sample (NIS) databases 2003-2011. Methods: Of the 134,117 discharge records from 797 hospitals analyzed of patients aged ≥80 years undergoing first time isolated CABG from 2003 to 2011, 70...
December 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29304049/cost-and-affordability-of-non-communicable-disease-screening-diagnosis-and-treatment-in-kenya-patient-payments-in-the-private-and-public-sectors
#9
Sujha Subramanian, Robai Gakunga, Joseph Kibachio, Gladwell Gathecha, Patrick Edwards, Elijah Ogola, Gerald Yonga, Naftali Busakhala, Esther Munyoro, Jeremiah Chakaya, Nancy Ngugi, Nyawira Mwangi, Daniel Von Rege, Lili-Marie Wangari, David Wata, Robert Makori, Julius Mwangi, Walter Mwanda
INTRODUCTION: The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services. METHODS AND FINDINGS: We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center-a public outpatient facility, and private sector practitioners and hospitals...
2018: PloS One
https://www.readbyqxmd.com/read/29276557/safety-and-costs-of-stroke-unit-admission-for-select-acute-intracerebral-hemorrhage-patients
#10
Corey R Fehnel, Kimberly M Glerum, Linda C Wendell, N Stevenson Potter, Brian Silver, Muhib Khan, Ali Saad, Shadi Yaghi, Richard N Jones, Karen Furie, Bradford B Thompson
Background and Purpose: There are limited data to guide intensive care unit (ICU) versus dedicated stroke unit (SU) admission for intracerebral hemorrhage (ICH) patients. We hypothesized select patients can be safely cared for in SU versus ICU at lower costs. Methods: We conducted a retrospective cohort study of consecutive patients with predefined minor ICH (≤20 cm3, supratentorial, no coagulopathy) receiving care in either an ICU or an SU. Multiple linear regression and inverse probability weighting were used to adjust for differences in patient characteristics and nonrandom ICU versus SU assignment...
January 2018: Neurohospitalist
https://www.readbyqxmd.com/read/29275452/mild-troponin-elevation-in-patients-admitted-to-the-emergency-department-with-atrial-fibrillation-30-day-post-discharge-prognostic-significance
#11
João Augusto, Miguel Borges Santos, David Roque, Daniel Faria, Joana Urzal, José Morais, Victor Gil, Carlos Morais
Patients with atrial fibrillation (AF) often undergo troponin (Tn) testing in the emergency department (ED), but the clinical significance of mildly elevated values remains unclear. We evaluated short-term 30-day post-discharge outcomes in AF patients according to troponin levels. Out of 2181 AF patients evaluated in the ED (June 2014 to June 2015), we included consecutive admitted patients. Patients were grouped into those with normal Tn values (≤ 0.05 ng/mL), mild elevations (> 0.05-0.5 ng/mL, 10× URL) and marked elevations (> 0...
December 23, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29262428/bringing-emergency-neurology-to-ambulances-mobile-stroke-unit
#12
Ritvij Bowry, James C Grotta
Ischemic stroke results from blocked arteries in the brain, with earlier thrombolysis with intravenous tissue plasminogen activator (tPA) and/or mechanical thrombectomy resulting in improved clinical outcomes. Mobile Stroke Unit (MSU) can speed up the treatment with tPA and facilitate faster triage for patients to hospitals for mechanical thrombectomy. The first registry-based MSU study in Germany demonstrated faster treatment times with tPA using a MSU, a higher proportion of patients being treated within the first "golden hour," and a suggestion of improved 3-month clinical outcomes...
December 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/29251337/-analysis-of-the-direct-costs-associated-with-mechanical-thrombectomy-and-intravenous-fibrinolysis-in-the-hospital-universitario-central-de-asturias
#13
P Vega-Valdes, E Murias-Quintana, E Morales-Santos, H Cigarran-Sexto, D Larrosa-Campo, L Benavente-Fernandez, M Gonzalez-Delgado, S Calleja-Puerta, F Garcia-Arias
INTRODUCTION: The increase in the indications for mechanical thrombectomy and its implementation in Spanish hospitals makes it necessary to determine the costs related to this treatment so as to be able to streamline economic resources and allow them to be distributed in an appropriate manner. AIMS: To analyse the direct costs associated with patients with acute ischaemic stroke who are treated with intravenous fibrinolysis and with mechanical thrombectomy, and to assess the effectiveness and safety of both treatments during the first 90 days of progression in the Hospital Universitario Central de Asturias...
January 1, 2018: Revista de Neurologia
https://www.readbyqxmd.com/read/29248284/cost-of-individual-complications-following-coronary-artery-bypass-grafting
#14
J Hunter Mehaffey, Robert B Hawkins, Matthew Byler, Eric J Charles, Clifford Fonner, Irving Kron, Mohammed Quader, Alan Speir, Jeff Rich, Gorav Ailawadi
OBJECTIVE: The financial implications of postoperative complications in cardiac surgery remain poorly understood. The purpose of this study was to define the cost of surgery without complications and demonstrate the incremental cost of each complication. METHODS: All patients undergoing isolated coronary artery bypass grafting (CABG) were evaluated (2006-2015) from a statewide Society of Thoracic Surgeons database collaborative (N = 36,588). Patients were stratified by presence of postoperative complications, including major morbidities as defined by the Society of Thoracic Surgeons (ie, prolonged ventilation, renal failure, reoperation, stroke, and deep sternal wound infection)...
December 13, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29237922/outcomes-of-coronary-artery-bypass-graft-surgery-versus-percutaneous-coronary-intervention-in-patients-aged-18-45-years-with-diabetes-mellitus
#15
Yang Li, Ran Dong, Kun Hua, Tao-Shuai Liu, Shao-You Zhou, Ning Zhou, Hong-Jia Zhang
BACKGROUND: Debate on treatment for young patients with coronary artery disease still exists. This study aimed to investigate the intermediate- and long-term outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients aged 18-45 years with diabetes mellitus (DM). METHODS: Between January 2006 and March 2016, a total of 2018 DM patients aged 18-45 years including 517 cases of CABG and 1501 cases of PCI were enrolled in the study...
December 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/29237706/patient-characteristics-resource-use-and-outcomes-associated-with-general-internal-medicine-hospital-care-the-general-medicine-inpatient-initiative-gemini-retrospective-cohort-study
#16
Amol A Verma, Yishan Guo, Janice L Kwan, Lauren Lapointe-Shaw, Shail Rawal, Terence Tang, Adina Weinerman, Peter Cram, Irfan A Dhalla, Stephen W Hwang, Andreas Laupacis, Muhammad M Mamdani, Steven Shadowitz, Ross Upshur, Robert J Reid, Fahad Razak
BACKGROUND: The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. METHODS: This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr...
December 11, 2017: CMAJ Open
https://www.readbyqxmd.com/read/29230625/systemic-lupus-erythematosus-and-the-risk-of-perioperative-major-adverse-cardiovascular-events
#17
Nathaniel R Smilowitz, Gregory Katz, Jill P Buyon, Robert M Clancy, Jeffrey S Berger
Systemic lupus erythematosus (SLE) is a significant risk factor for cardiovascular disease. The relationship between SLE and perioperative cardiovascular risks following non-cardiac surgery is uncertain. We investigated associations between a diagnosis of SLE and outcomes following major non-cardiac surgery in a large national database from the United States. Patients age ≥ 18 years requiring major non-cardiac surgery were identified from Healthcare Cost and Utilization Project's National Inpatient Sample data from 2004 to 2014...
December 11, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/29217008/endovascular-versus-surgical%C3%A2-revascularization-for-chronic%C3%A2-mesenteric%C3%A2-ischemia-insights-from-the-national-inpatient-sample-database
#18
Fabio V Lima, Dhaval Kolte, Kevin F Kennedy, David W Louis, J Dawn Abbott, Peter A Soukas, Omar N Hyder, Shafiq T Mamdani, Herbert D Aronow
OBJECTIVES: This study sought to compare in-hospital major adverse cardiac and cerebrovascular events (MACCE) following endovascular therapy with open surgery for chronic mesenteric ischemia (CMI). BACKGROUND: There are limited contemporary data on in-hospital cardiovascular outcomes among patients with CMI undergoing revascularization via endovascular therapy versus open surgery in the United States. METHODS: Patients with CMI undergoing endovascular or surgical (mesenteric bypass or endarterectomy) revascularization between 2007 and 2014 were identified from the National Inpatient Sample...
December 11, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29215510/timing-and-risk-factors-of-postpartum-stroke
#19
Gloria Too, Timothy Wen, Amelia K Boehme, Eliza C Miller, Lisa R Leffert, Frank J Attenello, William J Mack, Mary E DʼAlton, Alexander M Friedman
OBJECTIVE: To characterize risk and timing of postpartum stroke readmission after delivery hospitalization discharge. METHODS: The Healthcare Cost and Utilization Project's Nationwide Readmissions Database for calendar years 2013 and 2014 was used to perform a retrospective cohort study evaluating risk of readmission for stroke within 60 days of discharge from a delivery hospitalization. Risk was characterized as odds ratios (ORs) with 95% CIs based on whether patients had hypertensive diseases of pregnancy (gestational hypertension or preeclampsia), or chronic hypertension, or neither disorder during the index hospitalization...
January 2018: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29211225/off-pump-versus-on-pump-coronary-artery-bypass-grafting-in-frail-patients-study-protocol-for-the-fragile-multicenter-randomized-controlled-trial
#20
Omar Asdrúbal Vilca Mejía, Michel Pompeu Barros Oliveira Sá, Maurilio Onofre Deininger, Luís Roberto Palma Dallan, Rodrigo Coelho Segalote, Marco Antonio Praça de Oliveira, Fernando Antibas Atik, Magaly Arrais Dos Santos, Pedro Gabriel Melo de Barros E Silva, Rodrigo Mussi Milani, Alexandre Ciappina Hueb, Rosangela Monteiro, Ricardo Carvalho Lima, Luiz Augusto Ferreira Lisboa, Luís Alberto Oliveira Dallan, John Puskas, Fabio Biscegli Jatene
INTRODUCTION: Advances in modern medicine have led to people living longer and healthier lives. Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. When it comes to CABG surgery, randomized controlled clinical trials have primarily focused on low-risk (ROOBY, CORONARY), elevated-risk (GOPCABE) or high-risk patients (BBS), but not on frail patients. Therefore, we believe that off-pump CABG could be an important technique in patients with limited functional capacity to respond to surgical stress...
September 2017: Brazilian Journal of Cardiovascular Surgery
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