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Failed closed reduction of hip arthroplasty secondary to prosthetic incarceration in the pelvis.

Russell Wagner, MD - Wed, 01/30/2019 - 08:34
Related Articles

Failed closed reduction of hip arthroplasty secondary to prosthetic incarceration in the pelvis.

J Arthroplasty. 2004 Jun;19(4):513-5

Authors: Weight MA, Wagner RA

Abstract
This report describes a patient with dislocation of a unipolar hemiarthroplasty that could not be reduced by closed reduction methods because of perforation of the prosthesis through the ileum.

PMID: 15188115 [PubMed - indexed for MEDLINE]

Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

Roderick Y. Kim DDS, MD - Wed, 01/30/2019 - 08:33
Related Articles

Preoperative Vascular Interventions to Improve Donor Leg Perfusion: A Report of Two Fibula Free Flaps Used in Head and Neck Reconstruction.

J Oral Maxillofac Surg. 2018 Nov 01;:

Authors: Kim RY, Burkes JN, Broker HS, Williams FC

Abstract
PURPOSE: For reconstruction of head and neck defects, the fibula free flap is the first choice at many institutions. The main contraindication for fibula harvest is the lack of 3-vessel runoff, which leads to postoperative vascular compromise of the lower extremity. Atherosclerosis is the most common disease, which can limit the use of this donor site. In general, vascular interventions, which include angioplasty, atherectomy, and stenting, have been used to fix arterial supplies using endovascular methods. The purpose of this study was to report on the outcome of a preliminary cohort of patients after vascular interventions to re-establish vessel patency to allow safe use of the free fibula free flap in head and neck reconstruction.
MATERIALS AND METHODS: A single-institution retrospective case review using electronic medical records was designed. The study population was composed of patients who underwent a fibula free flap procedure for head and neck reconstruction from 2015 through 2017. Inclusion criteria were patients who underwent conventional angiography and required vascular interventions. There were no specific exclusion criteria. The primary outcome of interest was vascular compromise of the donor site. Additional variables of interest included success of reconstruction and perioperative donor or recipient site complications.
RESULTS: Two patients who underwent preoperative vascular interventions of the superficial femoral artery and posterior tibial artery were identified. The mean age was 65 years, and these patients underwent resection and reconstruction for mandibular carcinoma. For these patients, fibula flaps were harvested from the left lower extremity and included skin paddles. The fibula flaps survived and the donor feet maintained adequate perfusion. One patient had poor take of the split-thickness skin graft. No long-term functional deficit was noted.
CONCLUSIONS: Vascular interventions could be a safe method to re-establish vascular flow and 3-vessel runoff for select patients initially unable to undergo fibula free flap harvest.

PMID: 30471961 [PubMed - as supplied by publisher]

Twelve-Month Follow-up of a Randomized Clinical Trial Comparing Intradiscal Biacuplasty to Conventional Medical Management for Discogenic Lumbar Back Pain.

Robert Menzies, MD - Wed, 01/30/2019 - 08:33
Related Articles

Twelve-Month Follow-up of a Randomized Clinical Trial Comparing Intradiscal Biacuplasty to Conventional Medical Management for Discogenic Lumbar Back Pain.

Pain Med. 2017 04 01;18(4):751-763

Authors: Desai MJ, Kapural L, Petersohn JD, Vallejo R, Menzies R, Creamer M, Gofeld M

Abstract
Objective: This report conveys 12-month outcomes of subjects treated with intradiscal biacuplasty (IDB) and conservative medical management (CMM) for chronic low back pain of discogenic origin, and results for subjects who elected to receive IDB + CMM 6 months after CMM-alone.
Methods: Sixty-three subjects were originally randomized to the IDB + CMM group (N = 29) or CMM-alone (N = 34). Six months following continuous CMM-alone treatment, participants in this study group were permitted to "cross-over" to IDB + CMM (N = 25), and followed for an additional 6 months. The original IDB + CMM study subjects were followed for a total of 12 months (N = 22).
Results: Pain reduction at 12 months was statistically significant and clinically meaningful in the original IDB + CMM group compared to baseline. Functional and disability outcomes were also improved statistically and clinically. Fifty-five percent of the IDB + CMM patients responded to treatment with a mean VAS reduction of 2.2 points at 12 months. Furthermore, 50% and 64% of subjects reported clinically significant improvements in SF36-PF and in ODI, respectively. There was a 1.7-point reduction (improvement) on a 7-point PGIC scale, and a 0.13-point increase (improvement) in the EQ-5D Health Index. Fifty-percent of cross-over subjects responded to IDB + CMM intervention. Mean outcome scores for cross-over subjects were similar to those of the originally-treated subjects, and functional and disability endpoints were improved statistically and clinically compared to respective baseline values.
Conclusions: The study demonstrated long-term clinical effectiveness of IDB + CMM for treating chronic lumbar discogenic pain. Furthermore, the cross-over study subjects experienced similar improvements in pain, function, disability, and satisfaction.

PMID: 27570246 [PubMed - indexed for MEDLINE]

A Prospective, Randomized, Multicenter, Open-label Clinical Trial Comparing Intradiscal Biacuplasty to Conventional Medical Management for Discogenic Lumbar Back Pain.

Robert Menzies, MD - Wed, 01/30/2019 - 08:33
Related Articles

A Prospective, Randomized, Multicenter, Open-label Clinical Trial Comparing Intradiscal Biacuplasty to Conventional Medical Management for Discogenic Lumbar Back Pain.

Spine (Phila Pa 1976). 2016 Jul 01;41(13):1065-74

Authors: Desai MJ, Kapural L, Petersohn JD, Vallejo R, Menzies R, Creamer M, Gofeld M

Abstract
STUDY DESIGN: This study was a prospective, randomized, crossover, multicenter trial for the evaluation of comparative effectiveness of intradiscal biacuplasty (IDB) versus conventional medical management (CMM) in the treatment of lumbar discogenic pain.
OBJECTIVE: The objective was to demonstrate the superiority of IDB over CMM in the treatment of discogenic pain with respect to the primary outcome measure.
SUMMARY OF BACKGROUND DATA: Current therapeutic options for the treatment of chronic low back pain of discogenic origin are limited. CMM is often unsatisfactory with regard to the treatment of discogenic pain. IDB offers a minimally invasive treatment that has been demonstrated to be superior to placebo in the past.
METHODS: A total of 63 subjects with lumbar discogenic pain diagnosed via provocation discography were randomized to IDB + CMM (n = 29) or CMM-alone (n = 34). At 6 months, patients in the CMM-alone group were eligible for crossover if desired. The primary outcome measure was the change in visual analog scale (VAS) from baseline to 6 months. Secondary outcome measures included treatment "responders," defined as the proportion of subjects with a 2-point or 30% decrease in VAS scores. Other secondary measures included changes from baseline to 6 months in (1) short form (SF) 36-physical functioning, (2) Oswestry Disability Index, (3) Beck Depression Inventory, (4) Patient Global Impression of Change, (5) EQ-5D VAS, and (6) back pain-related medication usage.
RESULTS: In the IDB cohort, the mean VAS score reduction exceeded that in the CMM cohort (-2.4 vs. -0.56; P = 0.02), and the proportion of treatment responders was substantially greater (50% vs. 18%). Differences in secondary measures favored IDB. No differences in opioid utilization were noted between groups.
CONCLUSION: Superior performance of IDB with respect to all study outcomes suggests that it is a more effective treatment for discogenic pain than CMM-alone.
LEVEL OF EVIDENCE: 2.

PMID: 26689579 [PubMed - indexed for MEDLINE]

Analgesia and Improved Performance in a Patient Treated by Cooled Radiofrequency for Pain and Dysfunction Postbilateral Total Knee Replacement.

Robert Menzies, MD - Wed, 01/30/2019 - 08:33
Related Articles

Analgesia and Improved Performance in a Patient Treated by Cooled Radiofrequency for Pain and Dysfunction Postbilateral Total Knee Replacement.

Pain Pract. 2015 Jul;15(6):E54-8

Authors: Menzies RD, Hawkins JK

Abstract
Total knee replacement (TKR) is a terminal therapy for osteoarthritis (OA) of the knee. While TKR results are generally satisfactory, a significant proportion of patients experience persistent pain lasting > 3 months following surgery, even after a technically acceptable operation. Knee pain of any kind post-TKR has been reported in up to 53% of patients, while 15% of patients have reported severe pain. Pain post-TKR is worse than preoperative pain in 7%, often resulting in surgical revision. The clinical experience of a patient that originally presented to an orthopedic surgeon with OA of both knees demonstrates an alternative relatively noninvasive pain management strategy: cooled radiofrequency (CRF) ablation of sensory nerves.

PMID: 25857719 [PubMed - indexed for MEDLINE]

Referrals from a primary care-based sports medicine department to an orthopaedic department: a retrospective cohort study.

Robert Menzies, MD - Wed, 01/30/2019 - 08:33
Related Articles

Referrals from a primary care-based sports medicine department to an orthopaedic department: a retrospective cohort study.

Br J Sports Med. 2011 Oct;45(13):1064-7

Authors: Menzies RD, Young RA

Abstract
OBJECTIVE: To describe the impact of an expanded primary care-based sports medicine clinic on referrals to an orthopaedics clinic and to describe the patients seen and procedures performed.
DESIGN: Retrospective cohort study.
SETTING: Primary care-based sports medicine clinic and orthopaedics clinic at a tax-supported American safety net healthcare system.
PARTICIPANTS: All patients referred to the sports medicine clinic by other primary care physicians over a 1-year time period of July 2006-June 2007.
MAIN OUTCOME MEASURES: The referral rate from sports medicine clinic to orthopaedics clinic, the percentage of referred patients who were recommended surgery by the orthopaedists, the change in average waiting time to be seen in orthopaedics clinic and the most common conditions and procedures.
RESULTS: 4925 patients were seen by the sports medicine department; 118 (2.4%) of those patients were referred to the orthopaedic department. Of the referred patients, surgery was offered by orthopaedists to 80 (68%) patients. The average wait for initial consultation by the orthopaedic spine clinic decreased from 199 to 70 days; the wait for general orthopaedic clinic decreased from 97 to 19 days. No single patient complaint or musculoskeletal pathology predominated: knee degenerative joint disease (25.3%), mechanical low back pain (21.6%) and lumbar disc disease (19.9%). Knee injections and epidural steroid injections were the most common procedures performed.
CONCLUSIONS: Very few patients with musculoskeletal pathology were referred by a primary care-based sports medicine clinic to an orthopaedics clinic. Of the referred patients, sports medicine physicians and orthopaedists frequently agreed on the need for surgery. Expansion of a primary care-based sports medicine service could help relieve overburdened orthopaedics departments of patients with conditions not requiring surgery.

PMID: 20961919 [PubMed - indexed for MEDLINE]

Kawasaki disease causing giant saccular aneurysms of the coronary arteries: echocardiographic and 64-slice computed tomographic angiographic findings.

Rim Bannout, MD - Wed, 01/30/2019 - 08:32
Related Articles

Kawasaki disease causing giant saccular aneurysms of the coronary arteries: echocardiographic and 64-slice computed tomographic angiographic findings.

Tex Heart Inst J. 2008;35(3):369-70

Authors: Naiser JA, Schaller FA, Bannout R, Tak T

PMID: 18941607 [PubMed - indexed for MEDLINE]

An unusual case of chest pain.

Rim Bannout, MD - Wed, 01/30/2019 - 08:32
Related Articles

An unusual case of chest pain.

J Fam Pract. 2007 Dec;56(12):1037-8

Authors: Rana H, Bannout R

PMID: 18053444 [PubMed - indexed for MEDLINE]

A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era.

Richard Young, MD - Wed, 01/30/2019 - 08:32
Related Articles

A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era.

Fam Med. 2018 02;50(2):91-99

Authors: Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF

Abstract
BACKGROUND AND OBJECTIVES: Electronic health records (EHRs) have had mixed effects on the workflow of ambulatory primary care. In this study, we update previous research on the time required to care for patients in primary care clinics with EHRs.
METHODS: We directly observed family physician (FP) attendings, residents, and their ambulatory patients in 982 visits in clinics affiliated with 10 residencies of the Residency Research Network of Texas. The FPs were purposely chosen to reflect a diversity of patient care styles. We measured total visit time, previsit chart time, face-to-face time, non-face time, out-of-hours EHR work time, and total EHR work time.
RESULTS: The mean (SD) visit length was 35.8 (16.6) minutes, not counting resident precepting time. The mean time components included 2.9 (3.8) minutes working in the EHR prior to entering the room, 16.5 (9.2) minutes of face-to-face time not working in the EHR, 2.0 (2.1) minutes working in the EHR in the room (which occurred in 73.4% of the visits), 7.5 (7.5) minutes of non-face time (mostly EHR time), and 6.9 (7.6) minutes of EHR work outside of normal clinic operational hours (which occurred in 64.6% of the visits). The total time and total EHR time varied only slightly between faculty physicians, third-year and second-year residents. Multivariable linear regression analysis revealed many factors associated with total visit time including patient, physician, and clinic infrastructure factors.
CONCLUSIONS: Primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits.

PMID: 29432623 [PubMed - indexed for MEDLINE]

Risks predicting prolonged hospital discharge boarding in a regional acute care hospital.

Richard Robinson, MD - Wed, 01/30/2019 - 08:31
Related Articles

Risks predicting prolonged hospital discharge boarding in a regional acute care hospital.

BMC Health Serv Res. 2018 01 30;18(1):59

Authors: Shaikh SA, Robinson RD, Cheeti R, Rath S, Cowden CD, Rosinia F, Zenarosa NR, Wang H

Abstract
BACKGROUND: Prolonged hospital discharge boarding can impact patient flow resulting in upstream Emergency Department crowding. We aim to determine the risks predicting prolonged hospital discharge boarding and their direct and indirect effects on patient flow.
METHODS: Retrospective review of a single hospital discharge database was conducted. Variables including type of disposition, disposition boarding time, case management consultation, discharge medications prescriptions, severity of illness, and patient homeless status were analyzed in a multivariate logistic regression model. Hospital charges, potential savings of hospital bed hours, and whether detailed discharge instructions provided adequate explanations to patients were also analyzed.
RESULTS: A total of 11,527 admissions was entered into final analysis. The median discharge boarding time was approximately 2 h. Adjusted Odds Ratio (AOR) of patients transferring to other hospitals was 7.45 (95% CI 5.35-10.37), to court or law enforcement custody was 2.51 (95% CI 1.84-3.42), and to a skilled nursing facility was 2.48 (95% CI 2.10-2.93). AOR was 0.57 (95% CI 0.47-0.71) if the disposition order was placed during normal office hours (0800-1700). AOR of early case management consultation was 1.52 (95% CI 1.37-1.68) versus 1.73 (95% CI 1.03-2.89) for late consultation. Eighty-eight percent of patients experiencing discharge boarding times within 2 h of disposition expressed positive responses when questioned about the quality of explanations of discharge instructions and follow-up plans based on satisfaction surveys. Similar results (86% positive response) were noted among patients whose discharge boarding times were prolonged (> 2 h, p = 0.44). An average charge of $6/bed/h was noted in all hospital discharges. Maximizing early discharge boarding (≤ 2 h) would have resulted in 16,376 hospital bed hours saved thereby averting $98,256.00 in unnecessary dwell time charges in this study population alone.
CONCLUSION: Type of disposition, case management timely consultation, and disposition to discharge dwell time affect boarding and patient flow in a tertiary acute care hospital. Efficiency of the discharge process did not affect patient satisfaction relative to the perceived quality of discharge instruction and follow-up plan explanations. Prolonged disposition to discharge intervals result in unnecessary hospital bed occupancy thereby negatively impacting hospital finances while delivering no direct benefit to patients.

PMID: 29378577 [PubMed - indexed for MEDLINE]

Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function.

Paul Bhella - Wed, 01/30/2019 - 08:31
Related Articles

Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function.

Clin Cardiol. 2017 Dec;40(12):1247-1255

Authors: Jake Samuel T, Beaudry R, Haykowsky MJ, Sarma S, Park S, Dombrowsky T, Bhella PS, Nelson MD

Abstract
BACKGROUND: Cycle exercise echocardiography is a useful tool to "unmask" diastolic dysfunction; however, this approach can be limited by respiratory and movement artifacts. Isometric handgrip avoids these issues while reproducibly increasing afterload and myocardial oxygen demand.
HYPOTHESIS: Isometric handgrip echocardiography (IHE) can differentiate normal from abnormal diastolic function.
METHODS: First recruited 19 young healthy individuals (mean age, 24 ± 4 years) to establish the "normal" response. To extend these observations to a more at-risk population, we performed IHE on 17 elderly individuals (mean age, 72 ± 6 years) with age-related diastolic dysfunction. The change in the ratio of mitral valve inflow velocity to lateral wall tissue velocity (E/e'), a surrogate for left ventricular filling pressure, was used to assess the diastolic stress response in each group.
RESULTS: In the young subjects, isometric handgrip increased heart rate and mean arterial pressure (25 ± 12 bpm and 26 ± 17 mmHg, respectively), whereas E/e' changed minimally (0.6 ± 0.9). In the elderly subjects, heart rate and mean arterial pressure were similarly increased with isometric handgrip (19 ± 16 bpm and 25 ± 11 mmHg, respectively), whereas E/e' increased more dramatically (2.3 ± 1.7). Remarkably, 11 of the 17 elderly subjects had an abnormal diastolic response (ΔE/e': 3.4 ± 1.1), whereas the remaining 6 elderly subjects showed very little change (ΔE/e': 0.3 ± 0.7), independent of age or the change in myocardial oxygen demand.
CONCLUSIONS: IHE is a simple, effective tool for evaluating diastolic function during simulated activities of daily living.

PMID: 29247511 [PubMed - indexed for MEDLINE]

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.

Neal Richmond, MD - Wed, 01/30/2019 - 08:30
Related Articles

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.

JAMA. 2018 08 28;320(8):769-778

Authors: Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, Colella MR, Herren H, Hansen M, Richmond NJ, Puyana JCJ, Aufderheide TP, Gray RE, Gray PC, Verkest M, Owens PC, Brienza AM, Sternig KJ, May SJ, Sopko GR, Weisfeldt ML, Nichol G

Abstract
Importance: Emergency medical services (EMS) commonly perform endotracheal intubation (ETI) or insertion of supraglottic airways, such as the laryngeal tube (LT), on patients with out-of-hospital cardiac arrest (OHCA). The optimal method for OHCA advanced airway management is unknown.
Objective: To compare the effectiveness of a strategy of initial LT insertion vs initial ETI in adults with OHCA.
Design, Setting, and Participants: Multicenter pragmatic cluster-crossover clinical trial involving EMS agencies from the Resuscitation Outcomes Consortium. The trial included 3004 adults with OHCA and anticipated need for advanced airway management who were enrolled from December 1, 2015, to November 4, 2017. The final date of follow-up was November 10, 2017.
Interventions: Twenty-seven EMS agencies were randomized in 13 clusters to initial airway management strategy with LT (n = 1505 patients) or ETI (n = 1499 patients), with crossover to the alternate strategy at 3- to 5-month intervals.
Main Outcomes and Measures: The primary outcome was 72-hour survival. Secondary outcomes included return of spontaneous circulation, survival to hospital discharge, favorable neurological status at hospital discharge (Modified Rankin Scale score ≤3), and key adverse events.
Results: Among 3004 enrolled patients (median [interquartile range] age, 64 [53-76] years, 1829 [60.9%] men), 3000 were included in the primary analysis. Rates of initial airway success were 90.3% with LT and 51.6% with ETI. Seventy-two hour survival was 18.3% in the LT group vs 15.4% in the ETI group (adjusted difference, 2.9% [95% CI, 0.2%-5.6%]; P = .04). Secondary outcomes in the LT group vs ETI group were return of spontaneous circulation (27.9% vs 24.3%; adjusted difference, 3.6% [95% CI, 0.3%-6.8%]; P = .03); hospital survival (10.8% vs 8.1%; adjusted difference, 2.7% [95% CI, 0.6%-4.8%]; P = .01); and favorable neurological status at discharge (7.1% vs 5.0%; adjusted difference, 2.1% [95% CI, 0.3%-3.8%]; P = .02). There were no significant differences in oropharyngeal or hypopharyngeal injury (0.2% vs 0.3%), airway swelling (1.1% vs 1.0%), or pneumonia or pneumonitis (26.1% vs 22.3%).
Conclusions and Relevance: Among adults with OHCA, a strategy of initial LT insertion was associated with significantly greater 72-hour survival compared with a strategy of initial ETI. These findings suggest that LT insertion may be considered as an initial airway management strategy in patients with OHCA, but limitations of the pragmatic design, practice setting, and ETI performance characteristics suggest that further research is warranted.
Trial Registration: ClinicalTrials.gov Identifier: NCT02419573.

PMID: 30167699 [PubMed - indexed for MEDLINE]

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Natasha Singh, MD - Wed, 01/30/2019 - 08:30
Related Articles

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Am J Emerg Med. 2018 Jun 18;:

Authors: Singh N, Robinson RD, Duane TM, Kirby JJ, Lyell C, Buca S, Gandhi R, Mann SM, Zenarosa NR, Wang H

Abstract
OBJECTIVE: Trauma Quality Improvement Program participation among all trauma centers has shown to improve patient outcomes. We aim to identify trauma quality events occurring during the Emergency Department (ED) phase of care.
METHODS: This is a single-center observational study using consecutively registered data in local trauma registry (Jan 1, 2016-Jun 30, 2017). Four ED crowding scores as determined by four different crowding estimation tools were assigned to each enrolled patient upon arrival to the ED. Patient related (age, gender, race, severity of illness, ED disposition), system related (crowding, night shift, ED LOS), and provider related risk factors were analyzed in a multivariate logistic regression model to determine associations relative to ED quality events.
RESULTS: Total 5160 cases were enrolled among which, 605 cases were deemed ED quality improvement (QI) cases and 457 cases were ED provider related. Similar percentages of ED QI cases (10-12%) occurred across the ED crowding status range. No significant difference was appreciated in terms of predictability of ED QI cases relative to different crowding status after adjustment for potential confounders. However, an adjusted odds ratio of 1.64 (95% CI, 1.17-2.30, p < 0.01) regarding ED LOS ≥2 h predictive of ED related quality issues was noted when analyzed using multivariate logistic regression.
CONCLUSION: Provider related issues are a common contributor to undesirable outcomes in trauma care. ED crowding lacks significant association with poor trauma quality care. Prolonged ED LOS (≥2 h) appears to be linked with unfavorable outcomes in ED trauma care.

PMID: 30139579 [PubMed - as supplied by publisher]

Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note.

Michael Warner, DDS - Wed, 01/30/2019 - 08:30
Related Articles

Sinus slot technique for simplification and improved orientation of zygomaticus dental implants: a technical note.

Int J Oral Maxillofac Implants. 2000 Nov-Dec;15(6):889-93

Authors: Stella JP, Warner MR

Abstract
The zygomaticus dental implant, designed by Nobel Biocare for the Brånemark System, is indicated primarily for the severely resorbed maxilla. Though the zygomaticus implant has had a remarkable success rate in a very difficult patient population, there are some shortcomings to the protocol for placement. The sinus slot technique described herein provides a simplified approach to zygomaticus implant placement, as compared to the currently recommended protocol.

PMID: 11151591 [PubMed - indexed for MEDLINE]

The coming "sepsis boom..." and the available but underutilized diagnostic tools that could avert it.

Mark Oltermann, MD - Wed, 01/30/2019 - 08:29
Related Articles

The coming "sepsis boom..." and the available but underutilized diagnostic tools that could avert it.

MLO Med Lab Obs. 2012 Feb;44(2):36-7

Authors: Oltermann MH

PMID: 22452167 [PubMed - indexed for MEDLINE]

Tracheal obstruction as a complication of tracheostomy tube malfunction: case report and review of the literature.

Mark Oltermann, MD - Wed, 01/30/2019 - 08:29
Related Articles

Tracheal obstruction as a complication of tracheostomy tube malfunction: case report and review of the literature.

J Bronchology Interv Pulmonol. 2010 Jul;17(3):253-7

Authors: Lois M, Oltermann M

Abstract
Tracheostomy is a procedure frequently used in the intensive care unit for prolonged ventilatory support, long-term airway maintenance, and to prevent the complications of long-term translaryngeal intubation. It is believed that it eases patient care and improves the process of weaning from mechanical ventilation. The timing of tracheostomy is controversial and most physicians prefer translaryngeal intubation for needs of up to 10 days and a tracheostomy if an artificial airway for more than 21 days is anticipated. Tracheostomy can be associated with numerous acute (perioperative or postoperative) complications. Some of these complications continue to be a problem after the placement of the tracheostomy tube, and there are specific late complications that have clinical relevance. To our knowledge, there has been no description of a malfunctioning tracheostomy tube leading directly to complications and we are reporting the first case.

PMID: 23168895 [PubMed]

Nutrition support in the acutely ventilated patient.

Mark Oltermann, MD - Wed, 01/30/2019 - 08:29
Related Articles

Nutrition support in the acutely ventilated patient.

Respir Care Clin N Am. 2006 Dec;12(4):533-45

Authors: Oltermann MH

Abstract
Although the nutrition support literature is limited and therefore does not provide robust evidence to promote grade A or strong recommendations, there is a "signal" from all of these studies taken a a whole that critically ill patients may benefit from nutritional manipulation. The acutely ventilated patient that is likely to still be intubated by day three is a classic example of the critically ill patient who has the potential to achieve positive outcomes with nutritional support. Initiating nutrition support early improves the chances of benefit. However, nutrition cannot be provided in a vacuum. It is only one part of a multitude of treatments and therapies that must be optimally applied by a multidisciplinary team of professionals dedicated to the care of ICU patients. The exact makeup of the enteral (or parenteral) formula that is most likely to improve survival is unclear. More research is needed. Further study may demonstrate the possibility for nutritional manipulation to be one of the most important treatments physicians can offer to critically ill ventilated patients. Nutrition may have as much survival benefit as activated protein C, a drug costing over $7000 per course of therapy. No longer can it be said that nutrition makes no difference.

PMID: 17150430 [PubMed - indexed for MEDLINE]

Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function.

Mark Nelson, MD - Wed, 01/30/2019 - 08:29
Related Articles

Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function.

Clin Cardiol. 2017 Dec;40(12):1247-1255

Authors: Jake Samuel T, Beaudry R, Haykowsky MJ, Sarma S, Park S, Dombrowsky T, Bhella PS, Nelson MD

Abstract
BACKGROUND: Cycle exercise echocardiography is a useful tool to "unmask" diastolic dysfunction; however, this approach can be limited by respiratory and movement artifacts. Isometric handgrip avoids these issues while reproducibly increasing afterload and myocardial oxygen demand.
HYPOTHESIS: Isometric handgrip echocardiography (IHE) can differentiate normal from abnormal diastolic function.
METHODS: First recruited 19 young healthy individuals (mean age, 24 ± 4 years) to establish the "normal" response. To extend these observations to a more at-risk population, we performed IHE on 17 elderly individuals (mean age, 72 ± 6 years) with age-related diastolic dysfunction. The change in the ratio of mitral valve inflow velocity to lateral wall tissue velocity (E/e'), a surrogate for left ventricular filling pressure, was used to assess the diastolic stress response in each group.
RESULTS: In the young subjects, isometric handgrip increased heart rate and mean arterial pressure (25 ± 12 bpm and 26 ± 17 mmHg, respectively), whereas E/e' changed minimally (0.6 ± 0.9). In the elderly subjects, heart rate and mean arterial pressure were similarly increased with isometric handgrip (19 ± 16 bpm and 25 ± 11 mmHg, respectively), whereas E/e' increased more dramatically (2.3 ± 1.7). Remarkably, 11 of the 17 elderly subjects had an abnormal diastolic response (ΔE/e': 3.4 ± 1.1), whereas the remaining 6 elderly subjects showed very little change (ΔE/e': 0.3 ± 0.7), independent of age or the change in myocardial oxygen demand.
CONCLUSIONS: IHE is a simple, effective tool for evaluating diastolic function during simulated activities of daily living.

PMID: 29247511 [PubMed - indexed for MEDLINE]

Financial Incentives for Promoting Colorectal Cancer Screening: A Randomized, Comparative Effectiveness Trial.

Mark Koch, MD - Wed, 01/30/2019 - 08:28
Related Articles

Financial Incentives for Promoting Colorectal Cancer Screening: A Randomized, Comparative Effectiveness Trial.

Am J Gastroenterol. 2016 Nov;111(11):1630-1636

Authors: Gupta S, Miller S, Koch M, Berry E, Anderson P, Pruitt SL, Borton E, Hughes AE, Carter E, Hernandez S, Pozos H, Halm EA, Gneezy A, Lieberman AJ, Sugg Skinner C, Argenbright K, Balasubramanian B

Abstract
OBJECTIVES: Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population.
METHODS: We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis.
RESULTS: FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups.
CONCLUSIONS: Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.

PMID: 27481306 [PubMed - indexed for MEDLINE]

Iowa Gambling Task scores predict future drug use in bipolar disorder outpatients with stimulant dependence.

Marija Djokovic, MD - Wed, 01/30/2019 - 08:28
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Iowa Gambling Task scores predict future drug use in bipolar disorder outpatients with stimulant dependence.

Psychiatry Res. 2013 Dec 30;210(3):871-9

Authors: Nejtek VA, Kaiser KA, Zhang B, Djokovic M

Abstract
Poor decision-making is associated with poor recovery in persons with bipolar disorder and drug relapse in persons with stimulant dependence. Cognitive predictors of stimulant use in those with comorbid bipolar and stimulant dependence are surprisingly absent. Our goal was to determine if a single baseline assessment of decision-making (Iowa Gambling Task, IGT) would predict future drug use in bipolar disorder outpatients with comorbid stimulant dependence. Ninety-four men and women of multiple race/ethnic origins consented to participate in a 20-week study. Data analyses were performed on 63 comorbid bipolar outpatients completing at least four study weeks and 28 cocaine dependent volunteers without a mood disorder who participated as cocaine controls. There were no significant differences in IGT scores between comorbid patients and cocaine controls. In the comorbid group, IGT scores significantly predicted future drug use during the study. Age, sex, race, years of mental illness, or mood state did not significantly influence IGT scores. This is the first longitudinal study to show that IGT scores obtained at a single baseline assessment predicts future objective drug use in comorbid bipolar disorder outpatients with cocaine or methamphetamine dependence. Evaluating decision-making with the IGT may provide clinicians with valuable insight about the trajectory of their patients' risk for future drug use. These data suggest a need to augment existing treatment with cognitive restructuring to prevent slips and relapses in comorbid bipolar patients. The lack of a bipolar control group and a modest sample size may limit data interpretations.

PMID: 24012163 [PubMed - indexed for MEDLINE]

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