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Maternal iodine excess: an uncommon cause of acquired neonatal hypothyroidism.

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Maternal iodine excess: an uncommon cause of acquired neonatal hypothyroidism.

J Pediatr Endocrinol Metab. 2018 Sep 25;31(9):1061-1064

Authors: Hamby T, Kunnel N, Dallas JS, Wilson DP

Abstract
Background Excessive iodine exposure is an often overlooked cause of neonatal hypothyroidism. Case presentation We present an infant with iodine-induced hypothyroidism, which was detected at age 15 days by newborn screening. The infant's iodine excess resulted from maternal intake of seaweed soup both during and after pregnancy. Treatment included discontinuation of seaweed soup, temporary interruption of breastfeeding and short-term levothyroxine therapy. By age 4 months, the infant's hypothyroidism had resolved, and her growth and development were normal. Conclusions This case illustrates the importance of considering excess dietary iodine as a possible cause of hypothyroidism in infants.

PMID: 30052521 [PubMed - indexed for MEDLINE]

Vitamin D Screening and Supplementation in Community-Dwelling Adults: Common Questions and Answers.

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Vitamin D Screening and Supplementation in Community-Dwelling Adults: Common Questions and Answers.

Am Fam Physician. 2018 Feb 15;97(4):254-260

Authors: LeFevre ML, LeFevre NM

Abstract
Measurement of vitamin D levels and supplementation with oral vitamin D have become commonplace, although clinical trials have not demonstrated health benefits. The usefulness of serum 25-hydroxyvitamin D levels to assess adequate exposure to vitamin D is hampered by variations in measurement technique and precision. Serum levels less than 12 ng per mL reflect inadequate vitamin D intake for bone health. Levels greater than 20 ng per mL are adequate for 97.5% of the population. Routine vitamin D supplementation does not prolong life, decrease the incidence of cancer or cardiovascular disease, or decrease fracture rates. Screening asymptomatic individuals for vitamin D deficiency and treating those considered to be deficient do not reduce the risk of cancer, type 2 diabetes mellitus, or death in community-dwelling adults, or fractures in persons not at high risk of fractures. Randomized controlled trials of vitamin D supplementation in the treatment of depression, fatigue, osteoarthritis, and chronic pain show no benefit, even in persons with low levels at baseline.

PMID: 29671532 [PubMed - indexed for MEDLINE]

Home-based Physical Activity Coaching, Physical Activity, and Health Care Utilization in Chronic Obstructive Pulmonary Disease. Chronic Obstructive Pulmonary Disease Self-Management Activation Research Trial Secondary Outcomes.

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Home-based Physical Activity Coaching, Physical Activity, and Health Care Utilization in Chronic Obstructive Pulmonary Disease. Chronic Obstructive Pulmonary Disease Self-Management Activation Research Trial Secondary Outcomes.

Ann Am Thorac Soc. 2018 04;15(4):470-478

Authors: Coultas DB, Jackson BE, Russo R, Peoples J, Singh KP, Sloan J, Uhm M, Ashmore JA, Blair SN, Bae S

Abstract
RATIONALE: Physical inactivity among patients with chronic obstructive pulmonary disease is associated with exacerbations requiring high-cost health care utilization including urgent, emergent, and hospital care.
OBJECTIVES: To examine the effectiveness of a behavioral lifestyle physical activity intervention combined with chronic obstructive pulmonary disease self-management education to prevent high-cost health care utilization.
METHODS: This was an analysis of secondary outcomes of the Chronic Obstructive Pulmonary Disease Self-Management Activation Research Trial, a two-arm randomized trial of stable adult outpatients with chronic obstructive pulmonary disease recruited from primary care and pulmonary clinics. Following a 6-week self-management education run-in period, participants were randomized to usual care or to a telephone-delivered home-based health coaching intervention over 20 weeks. Secondary outcomes of physical activity and health care utilization were determined by self-report 6, 12, and 18 months after randomization. Associations between treatment allocation arm and these secondary outcomes were examined using log-binomial and Poisson regression models.
RESULTS: A total of 325 outpatients with stable chronic obstructive pulmonary disease were enrolled in the trial. Their average age was 70.3 years (standard deviation, 9.5), and 50.5% were female; 156 were randomized to usual care and 149 to the intervention. A greater proportion of participants reported being persistently active over the 18-month follow-up period in the intervention group (73.6%) compared with the usual care group (57.8%) (mean difference, 15.8%; 95% confidence interval, 4.0-27.7%). This association varied by severity of forced expiratory volume in 1 second impairment (P for interaction = 0.09). Those in the intervention group with moderate impairment (forced expiratory volume in 1 second, 50-70% predicted), more frequently reported being persistently active compared with the usual care (86.0 vs. 65.1%; mean difference, 20.9%; 95% confidence interval, 5.7-36.1%). Patients with severe and very severe forced expiratory volume in 1 second impairment (forced expiratory volume in 1 second < 50% predicted) in the intervention group also reported being persistently active more frequently compared with usual care (63.3 vs. 50.8%; mean difference, 12.6%; 95% confidence interval, -4.7 to 29.8). The intervention was associated with a lower rate of lung-related utilization (adjusted rate ratio, 0.38; 95% confidence interval, 0.23-0.63) only among participants with severe spirometric impairment.
CONCLUSIONS: Our results demonstrate that a feasible and generalizable home-based coaching intervention may decrease sedentary behavior and increase physical activity levels. In those with severe chronic obstructive pulmonary disease, this intervention may reduce lung disease-related health care utilization. Clinical trial registered with www.clinicaltrials.gov (NCT01108991).

PMID: 29283670 [PubMed - indexed for MEDLINE]

Setting-Based Prioritization for Birth Cohort Hepatitis C Virus Testing in the United States.

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Setting-Based Prioritization for Birth Cohort Hepatitis C Virus Testing in the United States.

Clin Infect Dis. 2019 May 24;:

Authors: MacDonald BR, Chu TC, Stewart RA, Ojha RP

PMID: 31125407 [PubMed - as supplied by publisher]

Lower Abnormal Fecal Immunochemical Test Cutoff Values Improve Detection of Colorectal Cancer in System-Level Screens.

Mark Koch, MD - Thu, 05/16/2019 - 11:20
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Lower Abnormal Fecal Immunochemical Test Cutoff Values Improve Detection of Colorectal Cancer in System-Level Screens.

Clin Gastroenterol Hepatol. 2019 May 11;:

Authors: Berry E, Miller S, Koch M, Balasubramanian B, Argenbright K, Gupta S

Abstract
BACKGROUND & AIMS: Non-invasive tests used in colorectal cancer screening, such as the fecal immunochemical test (FIT), are more acceptable but detect neoplasias with lower levels of sensitivity than colonoscopy. We investigated whether lowering the cutoff concentration of hemoglobin for designation as an abnormal FIT result increased the detection of advanced neoplasia in a mailed outreach program.
METHODS: We performed a prospective study of 17,017 uninsured patients, 50-64 years old, who were not current with screening and enrolled in a safety-net system in Texas. We reduced the cutoff value for an abnormal FIT result from ≥ 20 to ≥ 10 μg hemoglobin/g feces a priori. All patients with abnormal FIT results were offered no-cost diagnostic colonoscopy. We compared proportions with abnormal FIT results and neoplasia yield for standard vs lower cutoff values, as well as absolute hemoglobin concentration distribution among 5838 persons who completed the FIT. Our primary aim was to determine the effects of implementing a lower hemoglobin concentration cutoff on colonoscopy demand and yield, specifically colorectal cancer (CRC) and advanced neoplasia detection, compared to the standard, higher, hemoglobin concentration cutoff value.
RESULTS: The proportions of patients with abnormal FIT results were 12.3% at the ≥ 10 μg hemoglobin/g feces and 6.6% at the standard ≥ 20 μg hemoglobin/g feces cutoff value (P=.0013). Detection rates for the lower vs the standard threshold were 10.2% vs 12.7% for advanced neoplasia (P=.12) and 0.9% vs 1.2% for CRC (P=.718). The positive predictive values were 18.9% for the lower threshold vs 24.4% for the standard threshold for advanced neoplasia (P=.053) and 1.7% vs 2.4% for CRC (P=.659). The number needed to screen to detect 1 case with advanced neoplasia was 45 at the lower threshold compared with 58 at the standard threshold; the number needed to scope to detect 1 case with advanced neoplasia increased from 4 to 5. Most patients with CRC (72.7%) or advanced adenoma (67.3%) had hemoglobin concentrations ≥ 20 μg/g feces. In the 10-19 μg hemoglobin/g feces range, there were 3 patients with CRC (3/11, 27.3%) and 36 with advanced adenoma (36/110, 32.7%) who would not have been detected at the standard positive threshold (advanced neoplasia Pcomparison <.001). The proportion of patients found to have no neoplasia after an abnormal FIT result (false positives) was not significantly higher with the lower cutoff value (44.4%) than the standard cutoff (39.1%) (P=.1103).
CONCLUSION: In a prospective study of 17,017 uninsured patients, we found that reducing the abnormal FIT result cutoff value (to the ≥ 10 μg hemoglobin/g feces) might increase detection of advanced neoplasia, but doubled the proportion of patients requiring a diagnostic colonoscopy. If colonoscopy capacity permits, health systems that use quantitative FITs should consider lowering the abnormal cutoff value, to optimize CRC detection and prevention. ClinicalTrials.gov no: NCT01946282.

PMID: 31085338 [PubMed - as supplied by publisher]

Lower Abnormal Fecal Immunochemical Test Cutoff Values Improve Detection of Colorectal Cancer in System-Level Screens.

Related Articles

Lower Abnormal Fecal Immunochemical Test Cutoff Values Improve Detection of Colorectal Cancer in System-Level Screens.

Clin Gastroenterol Hepatol. 2019 May 11;:

Authors: Berry E, Miller S, Koch M, Balasubramanian B, Argenbright K, Gupta S

Abstract
BACKGROUND & AIMS: Non-invasive tests used in colorectal cancer screening, such as the fecal immunochemical test (FIT), are more acceptable but detect neoplasias with lower levels of sensitivity than colonoscopy. We investigated whether lowering the cutoff concentration of hemoglobin for designation as an abnormal FIT result increased the detection of advanced neoplasia in a mailed outreach program.
METHODS: We performed a prospective study of 17,017 uninsured patients, 50-64 years old, who were not current with screening and enrolled in a safety-net system in Texas. We reduced the cutoff value for an abnormal FIT result from ≥ 20 to ≥ 10 μg hemoglobin/g feces a priori. All patients with abnormal FIT results were offered no-cost diagnostic colonoscopy. We compared proportions with abnormal FIT results and neoplasia yield for standard vs lower cutoff values, as well as absolute hemoglobin concentration distribution among 5838 persons who completed the FIT. Our primary aim was to determine the effects of implementing a lower hemoglobin concentration cutoff on colonoscopy demand and yield, specifically colorectal cancer (CRC) and advanced neoplasia detection, compared to the standard, higher, hemoglobin concentration cutoff value.
RESULTS: The proportions of patients with abnormal FIT results were 12.3% at the ≥ 10 μg hemoglobin/g feces and 6.6% at the standard ≥ 20 μg hemoglobin/g feces cutoff value (P=.0013). Detection rates for the lower vs the standard threshold were 10.2% vs 12.7% for advanced neoplasia (P=.12) and 0.9% vs 1.2% for CRC (P=.718). The positive predictive values were 18.9% for the lower threshold vs 24.4% for the standard threshold for advanced neoplasia (P=.053) and 1.7% vs 2.4% for CRC (P=.659). The number needed to screen to detect 1 case with advanced neoplasia was 45 at the lower threshold compared with 58 at the standard threshold; the number needed to scope to detect 1 case with advanced neoplasia increased from 4 to 5. Most patients with CRC (72.7%) or advanced adenoma (67.3%) had hemoglobin concentrations ≥ 20 μg/g feces. In the 10-19 μg hemoglobin/g feces range, there were 3 patients with CRC (3/11, 27.3%) and 36 with advanced adenoma (36/110, 32.7%) who would not have been detected at the standard positive threshold (advanced neoplasia Pcomparison <.001). The proportion of patients found to have no neoplasia after an abnormal FIT result (false positives) was not significantly higher with the lower cutoff value (44.4%) than the standard cutoff (39.1%) (P=.1103).
CONCLUSION: In a prospective study of 17,017 uninsured patients, we found that reducing the abnormal FIT result cutoff value (to the ≥ 10 μg hemoglobin/g feces) might increase detection of advanced neoplasia, but doubled the proportion of patients requiring a diagnostic colonoscopy. If colonoscopy capacity permits, health systems that use quantitative FITs should consider lowering the abnormal cutoff value, to optimize CRC detection and prevention. ClinicalTrials.gov no: NCT01946282.

PMID: 31085338 [PubMed - as supplied by publisher]

Recovery of Motor Function after Mixed and Motor Nerve Repair with Processed Nerve Allograft.

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Recovery of Motor Function after Mixed and Motor Nerve Repair with Processed Nerve Allograft.

Plast Reconstr Surg Glob Open. 2019 Mar;7(3):e2163

Authors: Safa B, Shores JT, Ingari JV, Weber RV, Cho M, Zoldos J, Niacaras TR, Nesti LJ, Thayer WP, Buncke GM

Abstract
Background: Severe trauma often results in the transection of major peripheral nerves. The RANGER Registry is an ongoing observational study on the use and outcomes of processed nerve allografts (PNAs; Avance Nerve Graft, AxoGen, Inc., Alachua, Fla.). Here, we report on motor recovery outcomes for nerve injuries repaired acutely or in a delayed fashion with PNA and comparisons to historical controls in the literature.
Methods: The RANGER database was queried for mixed and motor nerve injuries in the upper extremities, head, and neck area having completed greater than 1 year of follow-up. All subjects with sufficient assessments to evaluate functional outcomes were included. Meaningful recovery was defined as ≥M3 on the Medical Research Council scale. Demographics, outcomes, and covariate analysis were performed to further characterize this subgroup.
Results: The subgroup included 20 subjects with 22 nerve repairs. The mean ± SD (minimum-maximum) age was 38 ± 19 (16-77) years. The median repair time was 9 (0-133) days. The mean graft length was 33 ± 17 (10-70) mm with a mean follow-up of 779 ± 480 (371-2,423) days. Meaningful motor recovery was observed in 73%. Subgroup analysis showed no differences between gap lengths or mechanism of injury. There were no related adverse events.
Conclusions: PNAs were safe and provided functional motor recovery in mixed and motor nerve repairs. Outcomes compare favorably to historical controls for nerve autograft and exceed those for hollow tube conduit. PNA may be considered as an option when reconstructing major peripheral nerve injuries.

PMID: 31044125 [PubMed]

Real-world data on antiviral treatments for hepatitis C virus infections: Can we define intention to treat or per protocol analyses?

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Real-world data on antiviral treatments for hepatitis C virus infections: Can we define intention to treat or per protocol analyses?

J Hepatol. 2018 08;69(2):551-553

Authors: Ojha RP, Steyerberg EW

PMID: 29843905 [PubMed - indexed for MEDLINE]

Single-stage bilateral distal femur replacement for traumatic distal femur fractures.

Russell Wagner, MD - Thu, 05/02/2019 - 07:44
Related Articles

Single-stage bilateral distal femur replacement for traumatic distal femur fractures.

Arthroplast Today. 2019 Mar;5(1):26-31

Authors: Neal DC, Sambhariya V, Tran A, Rahman SK, Dean TJ, Wagner RA, Sanchez HB

Abstract
Treatment of periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that distal femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic distal femur fracture and closed right intraarticular distal femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery.

PMID: 31020017 [PubMed]

Single-stage bilateral distal femur replacement for traumatic distal femur fractures.

Hugo Sanchez, MD - Thu, 05/02/2019 - 07:44
Related Articles

Single-stage bilateral distal femur replacement for traumatic distal femur fractures.

Arthroplast Today. 2019 Mar;5(1):26-31

Authors: Neal DC, Sambhariya V, Tran A, Rahman SK, Dean TJ, Wagner RA, Sanchez HB

Abstract
Treatment of periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that distal femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic distal femur fracture and closed right intraarticular distal femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery.

PMID: 31020017 [PubMed]

Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Richard Robinson, MD - Thu, 05/02/2019 - 07:44
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Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Clin Exp Emerg Med. 2019 May 07;:

Authors: Huggins C, Robinson RD, Knowles H, Cizenski J, Mbugua R, Laureano-Phillips J, Schrader CD, Zenarosa NR, Wang H

Abstract
Objective: A common emergency department (ED) patient care outcome metric is 72-hour ED return visits (EDRVs). Risks predictive of EDRV vary in different studies. However, risk differences associated with related versus unrelated EDRV and subsequent EDRV disposition deviations (EDRVDD) are rarely addressed. We aim to compare the potential risk patterns predictive of related and unrelated EDRV and further determine those potential risks predictive of EDRVDD.
Methods: We conducted a large retrospective observational study from September 1, 2015 through June 30, 2016. ED Patient demographic characteristics and clinical metrics were compared among patients of 1) related; 2) unrelated; and 3) no EDRVs. EDRVDD was defined as obvious disposition differences between initial ED visit and return visits. A multivariate multinomial logistic regression was performed to determine the independent risks predictive of EDRV and EDRVDD after adjusting for all confounders.
Results: A total of 63,990 patients were enrolled; 4.65% were considered related EDRV, and 1.80% were unrelated. The top risks predictive of EDRV were homeless, patient left without being seen, eloped, or left against medical advice. The top risks predictive of EDRVDD were geriatric and whether patients had primary care physicians regardless as to whether patient returns were related or unrelated to their initial ED visits.
Conclusion: Over 6% of patients experienced ED return visits within 72 hours. Though risks predicting such revisits were multifactorial, similar risks were identified not only for ED return visits, but also for return ED visit disposition deviations.

PMID: 31036785 [PubMed - as supplied by publisher]

Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Hao Wang, MD - Thu, 05/02/2019 - 07:44
Related Articles

Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Clin Exp Emerg Med. 2019 May 07;:

Authors: Huggins C, Robinson RD, Knowles H, Cizenski J, Mbugua R, Laureano-Phillips J, Schrader CD, Zenarosa NR, Wang H

Abstract
Objective: A common emergency department (ED) patient care outcome metric is 72-hour ED return visits (EDRVs). Risks predictive of EDRV vary in different studies. However, risk differences associated with related versus unrelated EDRV and subsequent EDRV disposition deviations (EDRVDD) are rarely addressed. We aim to compare the potential risk patterns predictive of related and unrelated EDRV and further determine those potential risks predictive of EDRVDD.
Methods: We conducted a large retrospective observational study from September 1, 2015 through June 30, 2016. ED Patient demographic characteristics and clinical metrics were compared among patients of 1) related; 2) unrelated; and 3) no EDRVs. EDRVDD was defined as obvious disposition differences between initial ED visit and return visits. A multivariate multinomial logistic regression was performed to determine the independent risks predictive of EDRV and EDRVDD after adjusting for all confounders.
Results: A total of 63,990 patients were enrolled; 4.65% were considered related EDRV, and 1.80% were unrelated. The top risks predictive of EDRV were homeless, patient left without being seen, eloped, or left against medical advice. The top risks predictive of EDRVDD were geriatric and whether patients had primary care physicians regardless as to whether patient returns were related or unrelated to their initial ED visits.
Conclusion: Over 6% of patients experienced ED return visits within 72 hours. Though risks predicting such revisits were multifactorial, similar risks were identified not only for ED return visits, but also for return ED visit disposition deviations.

PMID: 31036785 [PubMed - as supplied by publisher]

Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Chet Schrader, MD - Thu, 05/02/2019 - 07:44
Related Articles

Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Clin Exp Emerg Med. 2019 May 07;:

Authors: Huggins C, Robinson RD, Knowles H, Cizenski J, Mbugua R, Laureano-Phillips J, Schrader CD, Zenarosa NR, Wang H

Abstract
Objective: A common emergency department (ED) patient care outcome metric is 72-hour ED return visits (EDRVs). Risks predictive of EDRV vary in different studies. However, risk differences associated with related versus unrelated EDRV and subsequent EDRV disposition deviations (EDRVDD) are rarely addressed. We aim to compare the potential risk patterns predictive of related and unrelated EDRV and further determine those potential risks predictive of EDRVDD.
Methods: We conducted a large retrospective observational study from September 1, 2015 through June 30, 2016. ED Patient demographic characteristics and clinical metrics were compared among patients of 1) related; 2) unrelated; and 3) no EDRVs. EDRVDD was defined as obvious disposition differences between initial ED visit and return visits. A multivariate multinomial logistic regression was performed to determine the independent risks predictive of EDRV and EDRVDD after adjusting for all confounders.
Results: A total of 63,990 patients were enrolled; 4.65% were considered related EDRV, and 1.80% were unrelated. The top risks predictive of EDRV were homeless, patient left without being seen, eloped, or left against medical advice. The top risks predictive of EDRVDD were geriatric and whether patients had primary care physicians regardless as to whether patient returns were related or unrelated to their initial ED visits.
Conclusion: Over 6% of patients experienced ED return visits within 72 hours. Though risks predicting such revisits were multifactorial, similar risks were identified not only for ED return visits, but also for return ED visit disposition deviations.

PMID: 31036785 [PubMed - as supplied by publisher]

Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Charles Huggins, MD - Thu, 05/02/2019 - 07:44
Related Articles

Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Clin Exp Emerg Med. 2019 May 07;:

Authors: Huggins C, Robinson RD, Knowles H, Cizenski J, Mbugua R, Laureano-Phillips J, Schrader CD, Zenarosa NR, Wang H

Abstract
Objective: A common emergency department (ED) patient care outcome metric is 72-hour ED return visits (EDRVs). Risks predictive of EDRV vary in different studies. However, risk differences associated with related versus unrelated EDRV and subsequent EDRV disposition deviations (EDRVDD) are rarely addressed. We aim to compare the potential risk patterns predictive of related and unrelated EDRV and further determine those potential risks predictive of EDRVDD.
Methods: We conducted a large retrospective observational study from September 1, 2015 through June 30, 2016. ED Patient demographic characteristics and clinical metrics were compared among patients of 1) related; 2) unrelated; and 3) no EDRVs. EDRVDD was defined as obvious disposition differences between initial ED visit and return visits. A multivariate multinomial logistic regression was performed to determine the independent risks predictive of EDRV and EDRVDD after adjusting for all confounders.
Results: A total of 63,990 patients were enrolled; 4.65% were considered related EDRV, and 1.80% were unrelated. The top risks predictive of EDRV were homeless, patient left without being seen, eloped, or left against medical advice. The top risks predictive of EDRVDD were geriatric and whether patients had primary care physicians regardless as to whether patient returns were related or unrelated to their initial ED visits.
Conclusion: Over 6% of patients experienced ED return visits within 72 hours. Though risks predicting such revisits were multifactorial, similar risks were identified not only for ED return visits, but also for return ED visit disposition deviations.

PMID: 31036785 [PubMed - as supplied by publisher]

Deconstructing dogma: Nonoperative management of small bowel obstruction in the virgin abdomen.

Related Articles

Deconstructing dogma: Nonoperative management of small bowel obstruction in the virgin abdomen.

J Trauma Acute Care Surg. 2018 07;85(1):33-36

Authors: Collom ML, Duane TM, Campbell-Furtick M, Moore BJ, Haddad NN, Zielinski MD, Ray-Zack MD, Yeh DD, Choudhry AJ, Cullinane DC, Inaba K, Escalante A, Wydo S, Turay D, Pakula A, Watras J, EAST SBO Workgroup:

Abstract
BACKGROUND: Management of small bowel obstruction (SBO) has become more conservative, especially in those patients with previous abdominal surgery (PAS). However, surgical dogma continues to recommend operative exploration for SBO with no PAS. With the increased use of computed tomography imaging resulting in more SBO diagnoses, it is important to reevaluate the role of mandatory operative exploration. Gastrografin (GG) administration decreases the need for operative exploration and may be an option for SBO without PAS. We hypothesized that the use of GG for SBO without PAS will be equally effective in reducing the operative exploration rate compared with that for SBO with PAS.
METHODS: A post hoc analysis of prospectively collected data was conducted for patients with SBO from February 2015 through December 2016. Patients younger than 18 years, pregnant patients, and patients with evidence of hypotension, bowel strangulation, peritonitis, closed loop obstruction or pneumatosis intestinalis were excluded. The primary outcome was operative exploration rate for SBO with or without PAS. Rate adjustment was accomplished through multivariate logistic regression.
RESULTS: Overall, 601 patients with SBO were included in the study, 500 with PAS and 101 patients without PAS. The two groups were similar except for age, sex, prior abdominal surgery including colon surgery, prior SBO admission, and history of cancer. Multivariate analysis showed that PAS (odds ratio [OR], 0.47; p = 0.03) and the use of GG (OR, 0.11; p < 0.01) were independent predictors of successful nonoperative management, whereas intensive care unit admission (OR, 16.0; p < 0.01) was associated with a higher likelihood of need for operation. The use of GG significantly decreased the need for operation in patients with and without PAS.
CONCLUSIONS: Patients with and without PAS who received GG had lower rates of operative exploration for SBO compared with those who did not receive GG. Patients with a diagnosis of SBO without PAS should be considered for the nonoperative management approach using GG.
LEVEL OF EVIDENCE: Therapeutic, level IV.

PMID: 29965940 [PubMed - indexed for MEDLINE]

Aromatase Inhibitors Such as Letrozole (Femara) vs. Clomiphene (Clomid) for Subfertile Women with PCOS.

Aromatase Inhibitors Such as Letrozole (Femara) vs. Clomiphene (Clomid) for Subfertile Women with PCOS.

Am Fam Physician. 2019 May 01;99(9):545-546

Authors: LeFevre N

PMID: 31038903 [PubMed - in process]

Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Related Articles

Large observational study on risks predicting emergency department return visits and associated disposition deviations.

Clin Exp Emerg Med. 2019 May 07;:

Authors: Huggins C, Robinson RD, Knowles H, Cizenski J, Mbugua R, Laureano-Phillips J, Schrader CD, Zenarosa NR, Wang H

Abstract
Objective: A common emergency department (ED) patient care outcome metric is 72-hour ED return visits (EDRVs). Risks predictive of EDRV vary in different studies. However, risk differences associated with related versus unrelated EDRV and subsequent EDRV disposition deviations (EDRVDD) are rarely addressed. We aim to compare the potential risk patterns predictive of related and unrelated EDRV and further determine those potential risks predictive of EDRVDD.
Methods: We conducted a large retrospective observational study from September 1, 2015 through June 30, 2016. ED Patient demographic characteristics and clinical metrics were compared among patients of 1) related; 2) unrelated; and 3) no EDRVs. EDRVDD was defined as obvious disposition differences between initial ED visit and return visits. A multivariate multinomial logistic regression was performed to determine the independent risks predictive of EDRV and EDRVDD after adjusting for all confounders.
Results: A total of 63,990 patients were enrolled; 4.65% were considered related EDRV, and 1.80% were unrelated. The top risks predictive of EDRV were homeless, patient left without being seen, eloped, or left against medical advice. The top risks predictive of EDRVDD were geriatric and whether patients had primary care physicians regardless as to whether patient returns were related or unrelated to their initial ED visits.
Conclusion: Over 6% of patients experienced ED return visits within 72 hours. Though risks predicting such revisits were multifactorial, similar risks were identified not only for ED return visits, but also for return ED visit disposition deviations.

PMID: 31036785 [PubMed - as supplied by publisher]

Cancer Screening in Li-Fraumeni Syndrome.

Related Articles

Cancer Screening in Li-Fraumeni Syndrome.

JAMA Oncol. 2017 12 01;3(12):1645-1646

Authors: Asdahl PH, Ojha RP, Hasle H

PMID: 28772307 [PubMed - indexed for MEDLINE]

Edwardsiella tarda Bacteremia in Untreated Hepatitis C: Alterations in Antimicrobial Therapy for a Pan-Susceptible Pathogen in a Critically Ill Patient.

Edwardsiella tarda Bacteremia in Untreated Hepatitis C: Alterations in Antimicrobial Therapy for a Pan-Susceptible Pathogen in a Critically Ill Patient.

Am J Ther. 2019 Feb 28;:

Authors: Morrisette T, Hewgley WP, Hewgley H

PMID: 31033487 [PubMed - as supplied by publisher]

Single-stage bilateral distal femur replacement for traumatic distal femur fractures.

Related Articles

Single-stage bilateral distal femur replacement for traumatic distal femur fractures.

Arthroplast Today. 2019 Mar;5(1):26-31

Authors: Neal DC, Sambhariya V, Tran A, Rahman SK, Dean TJ, Wagner RA, Sanchez HB

Abstract
Treatment of periprosthetic distal femur fractures and comminuted intraarticular distal femur fractures with previous arthritis remains a difficult challenge for orthopedic surgeons. Previous case series have shown that distal femur replacement (DFR) can effectively compensate for bone loss, relieve knee pain, and allow for early ambulation in both of these fracture patterns. Owing to the typical low-energy mechanism of these injuries, a bilateral injury treated with DFR is rarely encountered. We present a patient with traumatic open left Rorabeck III/Su III periprosthetic distal femur fracture and closed right intraarticular distal femur fracture (AO fcation 33-C2) with end-stage arthrosis treated with single-stage bilateral DFR. We suggest that in patients with similar injuries, single-stage bilateral DFR can provide the benefits of early mobilization and accelerated recovery.

PMID: 31020017 [PubMed]

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