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https://www.readbyqxmd.com/read/29150468/prevalence-and-recognition-of-obesity-and-its-associated-comorbidities-cross-sectional-analysis-of-electronic-health-record-data-from-a-large-us-integrated-health-system
#1
Kevin M Pantalone, Todd M Hobbs, Kevin M Chagin, Sheldon X Kong, Brian J Wells, Michael W Kattan, Jonathan Bouchard, Brian Sakurada, Alex Milinovich, Wayne Weng, Janine Bauman, Anita D Misra-Hebert, Robert S Zimmerman, Bartolome Burguera
OBJECTIVE: To determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis of obesity, via International Classification of Diseases, Ninth Revision (ICD-9) documentation among patients with body mass index (BMI) ≥30 kg/m(2). DESIGN: The electronic health record system at Cleveland Clinic was used to create a cross-sectional summary of actively managed patients meeting minimum primary care physician visit frequency requirements...
November 16, 2017: BMJ Open
https://www.readbyqxmd.com/read/29143416/plasma-renin-activity-response-to-aliskiren-and-clinical-outcomes-in-patients-hospitalized-for-heart-failure-the-astronaut-trial
#2
Muthiah Vaduganathan, Baljash Cheema, Erin Cleveland, Kamya Sankar, Haris Subacius, Gregg C Fonarow, Scott D Solomon, Eldrin F Lewis, Stephen J Greene, Aldo P Maggioni, Michael Böhm, Faiez Zannad, Javed Butler, Mihai Gheorghiade
AIMS: The direct renin inhibitor, aliskiren, is known to reduce plasma renin activity (PRA), but whether the efficacy of aliskiren varies based on an individual's baseline PRA in patients hospitalized for heart failure (HF) is presently unknown. We characterized the prognostic value of PRA and determined if this risk is modifiable with use of aliskiren. METHODS AND RESULTS: This pre-specified neurohormonal substudy of ASTRONAUT analysed all patients hospitalized for HF with ejection fraction (EF) ≤40% with available baseline PRA data (n = 1306, 80...
November 16, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29142955/improving-the-prediction-of-cardiac-surgery-associated-acute-kidney-injury
#3
Jordan Crosina, Jordyn Lerner, Julie Ho, Navdeep Tangri, Paul Komenda, Brett Hiebert, Nora Choi, Rakesh C Arora, Claudio Rigatto
Introduction: Acute kidney injury (AKI) is a potentially fatal complication of cardiac surgery. The inability to predict cardiac surgery-associated AKI is a major barrier to prevention and early treatment. Current clinical risk models for the prediction of cardiac surgery-associated AKI are insufficient, particularly in patients with preexisting kidney dysfunction. Methods: To identify intraoperative variables that might improve the performance of a validated clinical risk score (Cleveland Clinic Score, CCS) for the prediction of cardiac surgery-associated AKI, we conducted a prospective cohort study in 289 consecutive elective cardiac surgery patients at a tertiary care center...
March 2017: KI Reports
https://www.readbyqxmd.com/read/29136649/discordance-between-actual-and-scheduled-check-in-times-at-a-heart-failure-clinic
#4
Eiran Z Gorodeski, Emer Joyce, Benjamin T Gandesbery, Eugene H Blackstone, David O Taylor, W H Wilson Tang, Randall C Starling, Rory Hachamovitch
INTRODUCTION: A 2015 Institute Of Medicine statement "Transforming Health Care Scheduling and Access: Getting to Now", has increased concerns regarding patient wait times. Although waiting times have been widely studied, little attention has been paid to the role of patient arrival times as a component of this phenomenon. To this end, we investigated patterns of patient arrival at scheduled ambulatory heart failure (HF) clinic appointments and studied its predictors. We hypothesized that patients are more likely to arrive later than scheduled, with progressively later arrivals later in the day...
2017: PloS One
https://www.readbyqxmd.com/read/29135987/determining-the-optimal-screening-interval-for-type-2-diabetes-mellitus-using-a-risk-prediction-model
#5
Andrei Brateanu, Thomas Barwacz, Lei Kou, Sihe Wang, Anita D Misra-Hebert, Bo Hu, Abhishek Deshpande, Nana Kobaivanova, Michael B Rothberg
BACKGROUND: Progression to diabetes mellitus (DM) is variable and the screening time interval not well defined. The American Diabetes Association and US Preventive Services Task Force suggest screening every 3 years, but evidence is limited. The objective of the study was to develop a model to predict the probability of developing DM and suggest a risk-based screening interval. METHODS: We included non-diabetic adult patients screened for DM in the Cleveland Clinic Health System if they had at least two measurements of glycated hemoglobin (HbA1c), an initial one less than 6...
2017: PloS One
https://www.readbyqxmd.com/read/29128046/preoperative-anemia-in-cardiac-operation-does-hemoglobin-tell-the-whole-story
#6
Lu Dai, Stephanie L Mick, Keith R McCrae, Penny L Houghtaling, Joseph F Sabik, Eugene H Blackstone, Colleen G Koch
BACKGROUND: Preoperative anemia, defined by hemoglobin level, is associated with elevated risk after cardiac operation. Better understanding of anemia requires characterization beyond this. This investigation focuses on red cell size and its association with patient characteristics and outcomes after cardiac operation. METHODS: From January 2010 to January 2014, 10,589 patients underwent elective cardiac operations at Cleveland Clinic. Anemia was characterized as normocytic, microcytic, or macrocytic based on mean corpuscular volume (MCV)...
November 8, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29124900/unsatisfactory-exfoliative-anal-cytology-samples-15-year-experience-with-histologic-cytologic-and-molecular-follow-up
#7
Ruba Khattab, Emily McMeekin, Alan J Taege, James M Hekman, Jennifer A Brainard, Dawn Underwood, Gary W Procop, Charles D Sturgis
BACKGROUND: The incidence of anal carcinoma has risen in recent decades. Exfoliative cytology screening of selected high risk patients is performed in many centers. Unsatisfactory cytology results are frustrating to patients, clinicians, and laboratorians. The aim of this study is to ascertain outcomes of patients with non-diagnostic anal cytology. METHODS: A retrospective review of anal cytology testing performed at the Cleveland Clinic between 01/01/2001 and 12/31/2015 was performed...
November 10, 2017: Diagnostic Cytopathology
https://www.readbyqxmd.com/read/29121296/are-perioperative-therapeutic-doses-of-statins-associated-with-postoperative-pain-and-opioid-consumption-after-hip-surgery-under-spinal-anaesthesia
#8
W Saasouh, S Leung, H O Yilmaz, O Koyuncu, J You, N M Zimmerman, K Ruetzler, A Turan
Background: The anti-inflammatory effects of statins have been suggested to relieve postoperative pain. This retrospective study tested the association between the perioperative routine use of statins in therapeutic doses, and opioid requirements and pain scores, after hip replacement surgery. Methods: With IRB approval, data was obtained for adult patients who had elective hip replacement surgery under spinal anaesthesia at Cleveland Clinic between 2005 and 2015...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29115980/anal-incontinence-and-quality-of-life-following-operative-treatment-of-simple-cryptoglandular-fistula-in-ano-a-prospective-study
#9
Umesh Jayarajah, Dakshitha Praneeth Wickramasinghe, Dharmabandhu Nandadeva Samarasekera
BACKGROUND: Anal incontinence is a known complication following operative treatment of fistula-in-ano which can significantly impact the quality of life. This study was aimed to objectively assess the impact of operative treatment of simple fistula-in-ano on quality of life related to anal incontinence. Therefore, a prospective study was conducted in 34 patients who underwent surgery for fistula-in-ano over a period of 24 months. Quality of life and incontinence were assessed using fecal incontinence quality of life (FIQL) scale and Cleveland clinic incontinence score (CCIS) preoperatively and after a minimum of 12 months follow up (mean-27 months, range 12-40 months)...
November 7, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/29104126/long-term-quality-of-life-associated-with-early-surgical-complications-in-patients-with-ulcerative-colitis-after-ileal-pouch-anal-anastomosis-a-single-center-retrospective-study
#10
Weimin Xu, Hairong Ye, Yilian Zhu, Wenjun Ding, Jihong Fu, Long Cui, Peng Du
BACKGROUND: Ileal pouch-anal anastomosis (IPAA) is recommended for patients with ulcerative colitis (UC) in terms of surgical treatment. Measuring surgical complications of IPAA and long-term quality of life (QOL) are important to achieve an acceptable risk/benefit ratio for patients with UC. MATERIALS AND METHODS: Patients with UC who underwent total proctocolectomy (TPC) with IPAA from February 2008 to July 2016 at our institute were included. Early surgical complications were defined as mechanical/infectious events within one month after IPAA...
November 7, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/29100648/erythropoietin-s-beta-common-receptor-mediates-neuroprotection-in-spinal-cord-neurons
#11
Lisa S Foley, David A Fullerton, Joshua Mares, Mitchell Sungelo, Michael J Weyant, Joseph C Cleveland, T Brett Reece
BACKGROUND: Paraplegia from spinal cord ischemia-reperfusion (SCIR) remains an elusive and devastating complication of complex aortic operations. Erythropoietin (EPO) attenuates this injury in models of SCIR. Upregulation of the EPO beta common receptor (βcR) is associated with reduced damage in models of neural injury. The purpose of this study was to examine whether EPO-mediated neuroprotection was dependent on βcR expression. We hypothesized that spinal cord neurons subjected to oxygen-glucose deprivation would mimic SCIR injury in aortic surgery and EPO treatment attenuates this injury in a βcR-dependent fashion...
October 31, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29095423/association-of-statins-with-decreased-acute-pancreatitis-severity-a-propensity-score-analysis
#12
Peter J Lee, Kunjam Modha, Tiffany Chua, Amitabh Chak, Daniel Jang, Rocio Lopez, Amir Gougol, Georgios I Papachristou, Tyler Stevens
BACKGROUND: Statins possess anti-inflammatory properties and have a protective effect in certain inflammatory conditions; however, their effect on the natural history of pancreatitis is unknown. AIM: The aim of this study is to assess the effect of statin exposure on the severity of pancreatitis and incidence of organ failure using a propensity-matched approach. METHODS: A historical cohort study was conducted of adult patients with acute pancreatitis (AP) admitted in the Cleveland Clinic Health System between 2007 and 2014...
October 31, 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/29089343/impact-of-atrial-fibrillation-on-exercise-capacity-and-mortality-in-heart-failure-with-preserved-ejection-fraction-insights-from-cardiopulmonary-stress-testing
#13
Mohamed B Elshazly, Todd Senn, Yuping Wu, Bruce Lindsay, Walid Saliba, Oussama Wazni, Leslie Cho
BACKGROUND: Atrial fibrillation (AF) has been objectively associated with exercise intolerance in patients with heart failure with reduced ejection fraction; however, its impact in patients with heart failure with preserved ejection fraction has not been fully scrutinized. METHODS AND RESULTS: We identified 1744 patients with heart failure and ejection fraction ≥50% referred for cardiopulmonary stress testing at the Cleveland Clinic (Cleveland, OH), 239 of whom had AF...
October 31, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29079383/surgery-type-and-psychosocial-factors-contribute-to-poorer-weight-loss-outcomes-in-persons-with-a-body-mass-index-greater-than-60-kg-m-2
#14
Ryan J Marek, Gail A Williams, Samantha H Mohun, Leslie J Heinberg
BACKGROUND: The current investigation aims to predict 3-year postoperative percent total weight loss among a sample of bariatric surgery patients with super-super obesity. OBJECTIVE: Previous research implies that persons with presurgical super-super obesity (body mass index [BMI] ≥60 kg/m(2)) tend to have poorer loss outcomes compared with those with a lower presurgical BMI after bariatric surgery. SETTING: Cleveland Clinic, Bariatric & Metabolic Institute, Cleveland, OH...
September 14, 2017: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/29078894/the-utility-of-presacral-drainage-in-penetrating-rectal-injuries-in-adult-and-pediatric-patients
#15
Kate B Savoie, Thomas M Beazley, Brent Cleveland, Sina Khaneki, Troy A Markel, Peter M Hammer, Stephanie Savage, Regan F Williams
BACKGROUND: With changing weaponry associated with injuries in civilian trauma, there is no clinical census on the utility of presacral drainage (PSD) in penetrating rectal injuries (PRIs), particularly in pediatric patients. METHODS: Patients with PRI from July 2004-June 2014 treated at two free-standing children's hospitals and two adult level 1 trauma centers were compared by age (pediatric patients ≤16 years) and PSD. A stratified analysis was performed based on age...
November 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29077945/minimally-clinically-important-change-in-the-activity-measure-for-post-acute-care-am-pac-a-generic-patient-reported-outcome-tool-in-people-with-low-back-pain
#16
Natalie Lee, Nicolas R Thompson, Sandra Passek, Mary Stilphen, Irene L Katzan
Background: The Activity Measure for Post-Acute Care (AM-PAC) is a generic metric of patient-reported functional status. The minimal clinically important difference (MCID) in the AM-PAC score has not been determined. Objective: The study objective was to determine the MCID for AM-PAC in people with low back pain. Design: This was a retrospective cohort study. Methods: Anchor-based and distribution-based methods were used to estimate the MCID...
November 1, 2017: Physical Therapy
https://www.readbyqxmd.com/read/29068307/and-the-oscar-health-goes-to-cleveland-clinic
#17
Susan Ladika
Oscar Health, a small insurer with big ambitions, has been enlisted to assist the storied Cleveland Clinic launch its own health plan. Each member of the plan will be matched with a care team made up of primary care provider, physician assistants, and other health care professionals.
September 2017: Managed Care
https://www.readbyqxmd.com/read/29066584/predicting-30-day-all-cause-readmission-risk-for-subjects-admitted-with-pneumonia-at-the-point-of-care
#18
Umur Hatipoğlu, Brian J Wells, Kevin Chagin, Dhruv Joshi, Alex Milinovich, Michael B Rothberg
BACKGROUND: The pneumonia 30-d readmission rate has been endorsed by the National Quality Forum as a quality metric. Hospital readmissions can potentially be lowered by improving in-hospital care, transitions of care, and post-discharge disease management programs. The purpose of this study was to create an accurate prediction model for determining the risk of 30-d readmission at the point of discharge. METHODS: The model was created using a data set of 1,295 hospitalizations at the Cleveland Clinic Main Campus with pneumonia over 3 y...
October 24, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29063219/treatment-of-obstructed-defecation-syndrome-due-to-rectocele-and-rectal-intussusception-with-a-high-volume-stapler-tst-starr-plus
#19
G Naldini, B Fabiani, C Menconi, I Giani, G Toniolo, D Mascagni, J Martellucci
BACKGROUND: In recent years, stapled transanal resection (STARR) has been adopted worldwide with convincing short-term results. However, due to the high recurrence rate and some major complications after STARR, there is still controversy about when the procedure is indicated. The aim of this study was to assess the safety, efficacy and feasibility of STARR performed with a new dedicated device for tailored transanal stapled surgery. METHODS: All the consecutive patients affected by obstructed defecation syndrome (ODS) due to rectocele or/and rectal intussusception, who underwent STARR with the TST STARR-Plus stapler, were included in a prospective study...
October 23, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/29062861/pneumocystis-pcr-it-is-time-to-make-pcr-the-test-of-choice
#20
Laura Doyle, Sherilynn Vogel, Gary W Procop
BACKGROUND: The testing strategy for Pneumocystis at the Cleveland Clinic changed from toluidine blue staining to polymerase chain reaction (PCR). We studied the differences in positivity rates for these assays and compared each with the detection of Pneumocystis in companion specimens by cytology and surgical pathology. METHODS: We reviewed the results of all Pneumocystis test orders 1 year before and 1 year after the implementation of a Pneumocystis-specific PCR...
2017: Open Forum Infectious Diseases
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