Association of Rising Violent Crime With Blood Pressure and Cardiovascular Risk: Longitudinal Evidence From Chicago, 2014–2016

Abstract BACKGROUND The purpose of this study was to examine the longitudinal association between rising violent crime and elevated blood pressure (BP). METHODS We analyzed 217,816 BP measurements from 17,783 adults during a temporal surge in violent crime in Chicago (2014–2016). Serial observations were abstracted from the electronic health record at an academic medical center and paired to the City of Chicago Police Data Portal. The violent crime rate (VCR) was calculated as the number of violent crimes per 1,000 population per year for each census tract. Longitudinal multilevel regression models were implemented to assess elevated BP (systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg) as a function of the VCR, adjusting for patient characteristics, neighborhood characteristics, and time effects. Secondary dependent measures included elevated heart rate, obesity, missed outpatient appointments, all-cause hospital admissions, and cardiovascular hospital admissions. RESULTS At baseline, the median VCR was 41.3 (interquartile range: 15.2–66.8), with a maximum rise in VCR of 59.1 over the 3-year surge period. A 20-unit rise in the VCR was associated with 3% higher adjusted odds of having elevated BP (95% confidence interval [CI]: 1.01–1.06), 8% higher adjusted odds of missing an outpatient appointment (95% CI: 1.03–1.13), and 6% higher adjusted odds of having a cardiovascular-related hospital admission (95% CI: 1.01–1.12); associations were not significant for elevated heart rate and obesity. CONCLUSION Rising violent crime was associated with increased BP during a temporal crime surge.

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Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211021251 ◽

2021 ◽

pp. 000348942110212

Author(s):

Nathan Kemper ◽

Scott B. Shapiro ◽

Allie Mains ◽

Noga Lipschitz ◽

Joseph Breen ◽

...

Keyword(s):

Skull Base ◽

Medical Center ◽

Academic Medical Center ◽

Significant Proportion ◽

Internal Auditory Canal ◽

Patient Characteristics ◽

Management Plan ◽

Case Review ◽

Retrospective Case ◽

Lateral Skull Base

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.

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Abstract 16125: Impact of COVID-19 on Echocardiography Volume at a Large Academic Medical Center

Circulation ◽

10.1161/circ.142.suppl_3.16125 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Merilyn S Varghese ◽

Jordan B Strom ◽

Sarah Fostello ◽

Warren J Manning

Keyword(s):

Patient Outcomes ◽

Hospital Admissions ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

Hospital Systems ◽

The Impact ◽

At Home

Introduction: COVID-19 has significantly impacted hospital systems worldwide. The impact of statewide stay-at-home mandates on echocardiography volumes is unclear. Methods: We queried our institutional echocardiography database from 6/1/2018 to 6/13/2020 to examine rates of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) prior to and following the COVID-19 Massachusetts stay-at-home order on March 15, 2020. Results: Among 36,377 total studies performed during the study period, mean weekly study volume dropped from 332 + 3 TTEs/week, 30 + 1 SEs/week, and 21 + 1 TEEs/week prior to the stay-at-home order (6/1/2018-3/15/2020) to 158 + 13 TTEs/week, 8 + 2 SEs/week, and 8 + 1 TEEs/week after (% change, -52%, -73%, and -62% respectively, all p < 0.001 when comparing volume prior to March 15 versus after). Weekly TTEs correlated strongly with hospital admissions throughout the study period (r = 0.93, 95% CI 0.89-0.95, p < 0.001) ( Figure ). Outpatient TTEs declined more than inpatient TTEs (% change, -74% vs. -39%, p <0.001). As of 3 weeks following the cessation of the stay-at-home order, TTE, SE, and TEE weekly volumes have increased to 73%, 66%, and 81% of pre-pandemic levels, respectively. Conclusions: Echocardiography volumes fell precipitously following the Massachusetts stay-at-home order, strongly paralleling declines in overall hospitalizations. Outpatient TTEs declined more than inpatient TTEs. Despite lifting of the order, echocardiography volumes remain substantially below pre-pandemic levels. The impact of the decreased use of echocardiographic services on patient outcomes remains to be determined.

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Demographic Factors Associated with Anterior Tibial Tendon Pathology

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00274 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0027

Author(s):

Matt Levitsky ◽

Justin Greisberg ◽

J. Turner Vosseller

Keyword(s):

Tibialis Anterior ◽

Specific Activity ◽

Medical Center ◽

Academic Medical Center ◽

Patient Characteristics ◽

Tensile Failure ◽

Traumatic Rupture ◽

Single Institution ◽

Ankle Motion ◽

Tendon Ruptures

Category: Sports, tendon Introduction/Purpose: The tibialis anterior serves an important role in ankle motion as it provides the majority of strength with dorsiflexion. Despite the importance of this muscle, there is a relative dearth of information regarding risk factors and demographic information that might predispose people to tendinopathy or rupture. The goal of this study is to further investigate the features of patients in a single institution who presented with either tibialis anterior tendinopathy or rupture. We also examined the ways in which these patient characteristics might differ in traumatic (patient remembers feeling a pop after a specific activity) versus atraumatic tendon ruptures (happened spontaneously without patient realizing). Methods: We used ICD-9 and ICD-10 codes to find patients who presented with tibialis anterior pathology to two foot and ankle surgeons at one academic medical center from 2007-2018. We made note of patient characteristics such as age, gender, BMI, and medical comorbidities. Physical examination findings, such as gastrocnemius equinus, were noted as well. Characteristics of patients with traumatic and atraumatic tibialis anterior ruptures were compared using Student’s T-tests and chi-squared tests. Results: The characteristics of 93 consecutive patients between 2007 and 2018 were analyzed. There were 80 cases of tendinopathy, and 13 cases of tibialis anterior rupture. The average age of our patient group was 56 years, and the ratio of female to male was 73:20 (3.67:1). The average BMI was 27.2 kg/m2. 15 patients had a gastrocnemius equinus (16%). 75 patients had a neutral arch (81%), 16 patients had pes planus (17%), and two patients had pes cavus (2%). With regards to those who ruptured, there were two traumatic ruptures and 11 atraumatic ruptures. Average age for traumatic rupture was 39 years compared to 73 for atraumatic rupture (p<.05). Average BMI for traumatic rupture was 21 compared to 27 kg/m2 (p>.05). Conclusion: Our study investigates the features of patients in a single institution who presented with tibialis anterior pathology. This pathology was much more common in women and generally occurred in an older cohort. With regards to tendon ruptures, though, younger patients tend to suffer traumatic ruptures, while older patients are more likely to suffer more degenerative ruptures that required less energy for tensile failure of the tendon.

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Elevated Heart Rate in Combination with Elevated Blood Pressure Predicts Lower Cardiovascular Mortality in Acute Decompensated Heart Failure

International Heart Journal ◽

10.1536/ihj.19-521 ◽

2020 ◽

Vol 61 (2) ◽

pp. 308-315 ◽

Cited By ~ 1

Author(s):

Masaru Hiki ◽

Hiroshi Iwata ◽

Kiyoshi Takasu ◽

Shuko Nojiri ◽

Go Ishikawa ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Heart Rate ◽

Cardiovascular Mortality ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

Elevated Heart Rate

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Implementing clinic to home telehealth services to promote quality of life for ambulatory oncology palliative care patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.29_suppl.259 ◽

2020 ◽

Vol 38 (29_suppl) ◽

pp. 259-259

Author(s):

Megan Begnoche ◽

Dana Guyer ◽

Susan F. Korber ◽

Mary Anne Fenton

Keyword(s):

Palliative Care ◽

Behavioral Health ◽

Role Models ◽

Hospital Admissions ◽

Medical Center ◽

Academic Medical Center ◽

Community Partner ◽

Home Setting ◽

Ambulatory Oncology ◽

Home Telehealth

259 Background: The Lifespan Cancer Institute (LCI) identified strategies to improve the palliative care experience and outcomes by providing clinic to home telehealth services. LCI is an integrated academic medical center program combining three hospital programs operating at five outpatient sites. One quality goal is to embed and increase palliative care within the fabric of oncology by providing palliative telehealth in the home to avoid office visits, ED and hospital admissions. Methods: LCI’s multidisciplinary palliative care team, including administrators, physicians, advanced practice providers and community partner physicians assessed telehealth challenges with a vulnerable patient in the home setting. Process development included operations, technology, patient and staff education. The group modified existing Lifespan system workflows, clinic to clinic video for behavioral health and clinic to clinic for providers, to create the clinic to home method. This process benchmarked patient and behavioral health noting video differences with the clinic setting versus the home. Results: Outcome metrics include no show rate, chemotherapy within 14 days of death, ED/ICU within 30 days of death, patient and provider experience. Initial data shows no show rates decreased from 10% (January) to 6% (May) as telehealth increased. Patients marked deceased within 3 months of a LCI visit for January (n = 52) and May ( = 61) unfortunately did not have a negative trend for chemotherapy in the last 14 days of life (Jan: 8%, May 15%). ED and ICU visits both had modest decreases from January (ED 50%, ICU 29%) to May (ED 48%, ICU 21%). In anticipation of future Press Ganey results, patient feedback includes an increase of comfort while at home. Provider satisfaction increased with the ability to assess the patient in their own home instead of the sterile clinic environment. Encountered challenges include insurance restrictions for Rhode Island (not a rural state), technology, and remote trouble shooting. Conclusions: The success of clinic-to-home telehealth services set the foundation for the COVID-19 telehealth insurgence and led to the palliative team acting as role models to medical and radiation oncology. End of life oncology patients stayed home while having their palliative needs addressed remotely. The innovative approach to implementing telehealth services will serve as a model for future LCI telehealth programs including treatment education sessions, oral chemotherapy follow-up, survivorship and post hospital discharge assessments.

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High Blood Pressure In Children Is Paralleled By An Elevated Heart Rate During Exercise

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000273892.15395.59 ◽

2007 ◽

Vol 39 (Supplement) ◽

pp. S235

Author(s):

Reinhard G. Ketelhut ◽

Özcan Akman ◽

Kerstin Ketelhut ◽

Hanno Strang

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

High Blood Pressure ◽

Elevated Heart Rate

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Beta2-mediated hypotension and myocardial injury

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y82-165 ◽

1982 ◽

Vol 60 (8) ◽

pp. 1144-1148 ◽

Cited By ~ 1

Author(s):

Alison Brown-Lukacsko ◽

Peter Lukacsko

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Arterial Blood Pressure ◽

Myocardial Injury ◽

Elevated Serum ◽

Blocking Agent ◽

Arterial Blood ◽

Ganglionic Blocking ◽

Elevated Heart Rate ◽

Stimulation Of

This study was designed to investigate the importance of beta2 receptor mediated hypotension in the pathogenesis of myocardial injury. The effect of isoproterenol and the putative beta2 agonist albuterol on arterial blood pressure, heart rate, the myocardial content of ATP and cAMP, and the serum content of MB-CPK was examined in conscious rats. Isoproterenol (5.25 mg/kg, s.c.) and albuterol (45 mg/kg, s.c.) lowered blood pressure and elevated heart rate to the same extent. Also, both agonists increased the myocardial content of cAMP, decreased the myocardial content of ATP, and elevated serum MB-CPK. The beta1 antagonist practolol, but not the ganglionic blocking agent chlorisondamine, attenuated the elevation in heart rate to albuterol without reducing its effect on blood pressure. Practolol, but not chlorisondamine, abolished the effects of albuterol on cAMP, ATP, and MB-CPK. These data suggest that the myocardial injury which is associated with an increased heart rate and changes in cAMP, ATP, and MB-CPK following the administration of albuterol is not the result of beta2-mediated hypotension, but is due to stimulation of myocardial beta1 receptors.

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Contemporary Patient Characteristics and Referral Patterns to a Pulmonary Hypertension Clinic at an Academic Medical Center

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2017.07.338 ◽

2017 ◽

Vol 23 (8) ◽

pp. S115

Author(s):

William C. Harding ◽

Manu Mysore ◽

Jamie Kennedy ◽

Andrew Mihalek ◽

Kenneth Bilchick ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Medical Center ◽

Academic Medical Center ◽

Patient Characteristics ◽

Referral Patterns ◽

Hypertension Clinic ◽

Academic Medical

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Health Disparities of Black Americans Hospitalized for Decompensated Liver Cirrhosis

10.21203/rs.2.11421/v1 ◽

2019 ◽

Author(s):

Ted Spiewak ◽

Amir Taefi ◽

Shruti Patel ◽

Chin-Shang Li ◽

Eric Chak

Keyword(s):

Hospital Admissions ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Laboratory Data ◽

Black Americans ◽

Median Income ◽

Healthcare Outcomes ◽

High Quality ◽

Decompensated Liver Cirrhosis

Abstract Background & Aims: Racial disparities have been reported in liver transplantation and chronic hepatitis C treatment outcomes. Determining causes of these disparities is important given the racially diverse American population and the economic burden associated with chronic liver disease. Methods: A retrospective study was performed among 463 patients diagnosed with cirrhosis admitted from (January 1, 2013 to January 1, 2018) to a tertiary care academic medical center. Patients were identified based on the International Classification of Diseases (ICD-10) for cirrhosis or its complications. Demographic information, laboratory data, medical comorbidities, insurance and adherence to cirrhosis quality care indicators were recorded to determine their relationship to readmission rates and other healthcare outcomes. Results: A total of 463 individual patients with cirrhosis were identified including Whites (n=241), Hispanics (n=106), Blacks (n=50), Asian and Pacific Islander Americans (API, n=27) and Other (n=39). A significantly higher proportion of Blacks had Medicaid insurance compared to Whites (40% versus 20%, p=0.0002) and Blacks had lower median income than Whites ($45,710 versus $54,844, p=0.01). All groups received high quality cirrhosis care. Regarding healthcare outcomes, Black patients had the highest mean total hospital admissions (6.1±6.3, p=0.01) and the highest mean number of 30-day re-admissions (2.1±3.7, p=0.05) compared to all other racial groups. Multivariable proportional odds regression analysis showed that race was a statistically significant predictor of 90-day readmission (p=0.03). Conclusions: Black Americans hospitalized for complications of cirrhosis may experience significant disparities in healthcare outcomes compared to whites despite high quality cirrhosis care. Socioeconomic factors may contribute to these disparities.

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