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Cleveland clinic review

George Tse, Trevor Cleveland, Stephen Goode
PURPOSE: A significant proportion of patients undergoing surgery have an increased incidence of acute pulmonary embolus (PE). We analyzed all patients who had a retrievable inferior vena cava (IVC) filter placed preoperatively for PE prophylaxis and investigated the long-term outcomes of the patients who did not have their filter removed. METHODS: Patients who underwent retrievable IVC filter insertion and attempted removal were identified from the radiology information systems database in a large tertiary referral university teaching hospital...
January 17, 2017: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Margaret I Hammond, Andrew G Miner, Melissa P Piliang
BACKGROUND: Angioleiomyoma is a benign neoplasm thought to derive from the tunica media of small venous vessels. Angioleiomyomata most frequently occur in the lower extremities with less common occurrences on the trunk, head, and upper extremities. Few cases of acral and digital angioleiomyoma have been described in the literature. METHODS: We add a series of twenty-one patients with acral angioleiomyoma including six cases of digital angioleiomyoma to the body of clinical and histologic findings along with a review of the literature of digital angioleiomyomata...
January 5, 2017: Journal of Cutaneous Pathology
Leonel T Takada, Mee-Ohk Kim, Ross W Cleveland, Katherine Wong, Sven A Forner, Ignacio Illán Gala, Jamie C Fong, Michael D Geschwind
Although prion diseases are generally thought to present as rapidly progressive dementias with survival of only a few months, the phenotypic spectrum for genetic prion diseases (gPrDs) is much broader. The majority have a rapid decline with short survival, but many patients with gPrDs present as slowly progressive ataxic or parkinsonian disorders with progression over a few to several years. A few very rare mutations even present as neuropsychiatric disorders, sometimes with systemic symptoms such as gastrointestinal disorders and neuropathy, progressing over years to decades...
January 2017: American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics
Zubair A Ahmed, Dimitrios A Nacopoulos, Seby John, Nancy Papesh, David Levine, Cynthia C Bamford
OBJECTIVE: To develop and implement an algorithm for the management of headaches presenting to the emergency department (ED) in order to decrease the frequency of opioid and barbiturate treatment both acutely as well as on discharge. BACKGROUND: Headache is the fifth leading cause of ED visits in the United States. In the case of primary headache, particularly migraine, treatment in the ED can be highly variable. Patients with migraine continue to be treated with opioids more commonly than nonopioid, migraine specific medications...
January 2017: Headache
Irina Podkorytova, Ajay Gupta, Elaine Wyllie, Ahsan Moosa, William Bingaman, Richard Prayson, Elia M Pestana Knight
The optimal treatment for medically refractory epilepsy in Aicardi syndrome (AS) is still unclear. Palliative surgical treatment, including vagus nerve stimulation and corpus callosotomy, has therefore been used. There is limited data on the role of resective epilepsy surgery as a treatment choice in patients with AS. Here, we describe the seizures, anatomo-pathological findings, and neurodevelopmental outcome of palliative epilepsy surgery in two children with AS who had resective epilepsy surgery at the Cleveland Clinic...
December 1, 2016: Epileptic Disorders: International Epilepsy Journal with Videotape
Gabriel Loor, Sara J Shumway, Kenneth R McCurry, Suresh Keshavamurthy, Syed Hussain, Garry D Weide, John R Spratt, Mazin Al Salihi, Colleen G Koch
BACKGROUND: Donor organs are often procured by junior staff in stressful, unfamiliar environments where a single adverse event can be catastrophic. A formalized checklist focused on preprocedural processes related to thoracic donor organ procurement could improve detection and prevention of near miss events. METHODS: A checklist was developed centered on patient identifiers, organ compatibility and quality, and team readiness. It went through five cycles of feedback and revision using a panel of expert procurement surgeons...
December 2016: Annals of Thoracic Surgery
Jason K Hsieh, Jarrod E Dalton, Dongsheng Yang, Ehab S Farag, Daniel I Sessler, Andrea M Kurz
BACKGROUND: Intraoperative hypotension may contribute to perioperative strokes. We therefore tested the hypothesis that intraoperative hypotension is associated with perioperative stroke. METHODS: After institutional review board approval for this case-control study, we identified patients who had nonneurological, noncardiac, and noncarotid surgery under general anesthesia at the Cleveland Clinic between 2005 and 2011 and experienced a postoperative stroke. Control patients not experiencing postoperative stroke were matched in a 4-to-1 ratio using propensity scores and restriction to the same procedure type as stroke patients...
October 2016: Anesthesia and Analgesia
Moshe C Ornstein, Laura Wood, Paul Elson, Kimberly Allman, Jennifer Beach, Allison Martin, Timothy Gilligan, Jorge A Garcia, Brian I Rini
BACKGROUND: Given the variability in drug levels with tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma (mRCC), dose escalation at the occurrence of progressive disease (PD) might have antitumor effects. PATIENTS AND METHODS: The data from patients with mRCC who were treated at the Cleveland Clinic with TKIs and received a dose escalation after PD in accordance with Response Evaluation Criteria In Solid Tumors (RECIST), version 1...
August 18, 2016: Clinical Genitourinary Cancer
Hiren Vallabh, Denise Konrad, Robert DeChicco, Gail Cresci, Rocio Lopez, Ezra Steiger, Donald F Kirby
BACKGROUND: Reducing hospital readmissions decreases healthcare costs and improves quality of care. There are no published studies examining the rate of, and risk factors for, 30-day readmissions for patients discharged with home parenteral support (HPS). OBJECTIVE: Determine the rate of 30-day readmissions for patients discharged with HPS and whether malnutrition and other demographic or clinical factors increase the risk. MATERIALS AND METHODS: Retrospective review of patients discharged with HPS from the Cleveland Clinic between July 1, 2013, and June 30, 2014, and followed by the Cleveland Clinic Home Nutrition Support Service...
August 18, 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Rovnat Babazade, Thilak Sreenivasalu, Pankaj Jain, Matthew T Hutcherson, Amanda J Naylor, Jing You, Hesham Elsharkawy, Ali Sakr Esa Wael, Alparslan Turan
PURPOSE: Sciatic nerve block (SNB) is commonly performed in combination with femoral nerve block (FNB) for postoperative analgesia following total knee arthroplasty (TKA). Despite the fact that 10-20 % of TKA patients require SNB for postoperative posterior knee pain, there are no existing studies that suggest a model to predict the need for SNB. The aim of our study was to develop a prediction tool to measure the likelihood of patients undergoing TKA surgery requiring a postoperative SNB...
October 2016: Journal of Anesthesia
X Ji, J Liu
BACKGROUND: Sleep disturbances in adolescents have received significant attention because of their high prevalence and the negative health outcomes. Relative to objective measures, subjective sleep instruments have been the most practical tools used to identify sleep problems and assess responses to interventions in research and clinical settings. This systematic review aims to examine the psychometric properties of subjective measures that are used to assess sleep quality and disturbances among adolescents, identify the strength and limitation of each measurement and inform recommendations for practice...
August 6, 2016: Child: Care, Health and Development
Prashanthi Nagavenkata Thota, Zubin Arora, Tanmayee Benjamin, Mangesh Pagadala, Rocio Lopez, Madhusudhan Rao Sanaka
OBJECTIVE: High body mass index (BMI) is a risk factor for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). Our aim was to determine if prevalence of dysplasia in BE varies by BMI and study the effect of BMI on progression to high-grade dysplasia (HGD) or EAC. MATERIALS AND METHODS: This is a retrospective review of patients with endoscopic evidence of BE confirmed by presence of intestinal metaplasia on histology from January 2000 to December 2012 at Cleveland Clinic...
November 2016: Scandinavian Journal of Gastroenterology
Michael O'Connell
Cleveland Clinic has used a collaborative approach in seeking ways to make care more affordable by identifying approaches to create better value by improving quality and decreasing costs. It is possible to achieve cost savings and create better value without compromising quality. By engaging caregivers and creating multidisciplinary teams to evaluate cost savings, over $500 million was saved, and hundreds of ideas were implemented. This article reviews 30 cost-saving ideas that any medical practice could use...
May 2016: Journal of Medical Practice Management: MPM
Shima Nakanishi, John L Cleveland
The unique amino acid hypusine is present in only two proteins in eukaryotic cells, eukaryotic translation initiation factor 5A-1 (eIF5A1), and eIF5A2, where it is covalently linked to the lysine-50 residue of these proteins via a post-translational modification coined hypusination. This unique modification is directed by two highly conserved and essential enzymes, deoxyhypusine synthase (DHPS), and deoxyhypusine hydroxylase (DOHH), which selectively use the polyamine spermidine as a substrate to generate hypusinated eIF5A...
October 2016: Amino Acids
Jennifer L Cleveland, Shellie Kolavic Gray, Jennifer A Harte, Valerie A Robison, Anne C Moorman, Barbara F Gooch
BACKGROUND: During the past decade, investigators have reported transmissions of blood-borne pathogens (BBPs) in dental settings. In this article, the authors describe these transmissions and examine the lapses in infection prevention on the basis of available information. METHODS: The authors reviewed the literature from 2003 through 2015 to identify reports of the transmission of BBPs in dental settings and related lapses in infection prevention efforts, as well as to identify reports of known or suspected health care-associated BBP infections submitted by state health departments to the Centers for Disease Control and Prevention...
September 2016: Journal of the American Dental Association
Aynur Aktas, Declan Walsh, Marianne Galang, Niamh O'Donoghue, Lisa Rybicki, Barbara Hullihen, Ellen Schleckman
INTRODUCTION: Malnutrition (MN) often goes unrecognized due to ineffective screening techniques. Published standards for multidisciplinary care exist but no consensus on best nutritional assessment for hospitalized patients. Malnutrition is common in cancer and adversely affects clinical outcomes. The Cleveland Clinic Nutrition Therapy Department used in-house criteria to classify MN in hospitalized patients. This study aimed to evaluate the registered dietitian (RD)'s role, the use of these criteria in the acute care palliative medicine unit (ACPMU), and investigate MN prevalence and severity among admitted patients with cancer...
April 10, 2016: American Journal of Hospice & Palliative Care
Alberto J Montero, James Stevenson, Amy E Guthrie, Carolyn Best, Lindsey Martin Goodman, Shiva Shrotriya, Abdel-Ghani Azzouqa, Armida Parala, Ruth Lagman, Brian J Bolwell, Matt E Kalaycio, Alok A Khorana
PURPOSE: Reducing 30-day unplanned hospital readmissions is a national policy priority. We examined the impact of a quality improvement project focused on reducing oncology readmissions among patients with cancer who were admitted to palliative and general medical oncology services at the Cleveland Clinic. METHODS: Baseline rates of readmissions were gathered during the period from January 2013 to April 2014. A quality improvement project designed to improve outpatient care transitions was initiated during the period leading to April 1, 2014, including: (1) provider education, (2) postdischarge nursing phone calls within 48 hours, and (3) postdischarge provider follow-up appointments within 5 business days...
May 2016: Journal of Oncology Practice
Mohammad Bilal, Abhishek Gulati, Kofi Clarke
BACKGROUND AND AIMS: IgG4-mediated pouchitis was first described in 2011. The aetiology and pathogenesis of IgG4-associated pouchitis is unknown. Over the last four years, less than seventy cases of IgG-associated pouchitis have been reported from a pouchitis clinic in Cleveland. METHODS: We report the first two cases of IgG4-associated pouchitis from our inflammatory bowel disease clinic and outside of Cleveland. CONCLUSION: This highlights the fact that this entity could be more common than we think...
July 2016: Digestive and Liver Disease
Terri Christensen, James K Stoller
OBJECTIVE: We aim to describe the rationale for and spectrum of leadership development programs, highlighting experience at a large healthcare institution (Cleveland Clinic, Cleveland, Ohio, USA). CONCLUSIONS: Developing leaders is a universal priority to sustain organizational success. In health care, significant challenges of ensuring quality and access and making care affordable are widely shared internationally and demand effective physician leadership. Yet, leadership competencies differ from clinical and scientific competencies and features of selecting and training physicians-who have been called "heroic lone healers" -often conspire against physicians being effective leaders or followers...
June 2016: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
Tammy M Owings, Nicole Nicolosi, Jessica M Suba, Georgeanne Botek
BACKGROUND: Total-contact casting is an effective method to treat various pathologic abnormalities in patients with diabetic neuropathy, but its use is frequently associated with iatrogenic complications. METHODS: The largest retrospective review to date of iatrogenic complications of total-contact casts was conducted over an 8-year period at Cleveland Clinic. RESULTS: In the past 8 years, 23% of patients developed complications, and the most common complication was a new heel ulcer formation...
January 2016: Journal of the American Podiatric Medical Association
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