The Heart Failure Unit At Shaare Zedek Hospital Medical Center

Abstract Background The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years. Methods We conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019. Results Four hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4–5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001). Conclusion Our research reveals trends over time in patients’ characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization.

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Mortality trends in an ambulatory multidisciplinary heart failure unit from 2001 to 2018

Scientific Reports ◽

10.1038/s41598-020-79926-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Giosafat Spitaleri ◽

Josep Lupón ◽

Mar Domingo ◽

Evelyn Santiago-Vacas ◽

Pau Codina ◽

...

Keyword(s):

Heart Failure ◽

Linear Regression ◽

Cardiovascular Mortality ◽

Clinical Characteristics ◽

Real Life ◽

Cardiovascular Death ◽

Progressive Decrease ◽

Mortality Trends ◽

Heart Failure Unit ◽

Ambulatory Patients

AbstractTo assess mortality trends at 1 and 3 years from 2001 to 2018 in a real-life cohort of HF outpatients from different etiologies with depressed and preserved LVEF. A total of 2368 consecutive patients with HF (mean age 66.4 ± 12.9 years, 71% men, 15.4% with preserved LVEF) admitted to a HF clinic from August 2001 to September 2018 were included in the study. Patients were divided into five quintiles (Q) according to the period of admission. Trends for all-cause and cardiovascular mortality from Q1 to Q5 were assessed by linear regression. Patients with LVEF < 50% had a progressive decrease in the rates of all-cause and cardiovascular death at 1 year (12.1% in Q1 to 6.5% in Q5, p = 0.003; and 8.4% in Q1 to 3.8% in Q5, p = 0.007, respectively) and 3 years (30.5% in Q1 to 17.0% in Q5, p = 0.003; and 23.9% in Q1 to 9.8% in Q5, p = 0.003, respectively). These trends remained significant after adjusting for clinical characteristics and risk. No significant trend in mortality was observed in patients with LVEF ≥ 50%. In a cohort of real-life ambulatory patients with HF, mortality progressively declined in patients with LVEF < 50%, but the same trend was not observed in patients with preserved LVEF.

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Increasing Pediatric Audiology Services via Telehealth

Seminars in Hearing ◽

10.1055/s-0041-1731694 ◽

2021 ◽

Vol 42 (02) ◽

pp. 136-151

Author(s):

Tommy Evans ◽

Timothy Nejman ◽

Erin Stewart ◽

Ian Windmill

Keyword(s):

Health Care ◽

Service Delivery ◽

Case Studies ◽

Health Care Services ◽

Medical Center ◽

Access To Healthcare ◽

Hospital Medical ◽

Care Services ◽

Telehealth Service ◽

Pediatric Audiology

AbstractTelehealth as a means to deliver health care services has been used by physicians for many years, but the use of telehealth in audiology, specifically in pediatrics, has been minimal. Barriers such as licensure, reimbursement, technology, and equipment have been cited as reasons for audiologists not participating in telehealth. However, the COVID-19 pandemic created the need for telehealth services to be widely used to safely increase access to healthcare, and emergent orders helped reduce previous barriers so that audiologists could participate in telehealth service delivery. This article details three cases where audiologists delivered telehealth services to children. These case studies demonstrate portions of the Division of Audiology Telehealth Program of the Cincinnati Children's Hospital Medical Center and how they increased access to hearing healthcare in response to the COVID-19 pandemic.

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Abstract 147: Hypertension-related Admission and Mortality at a Referral Hospital in Tanzania - A Call to Action

Hypertension ◽

10.1161/hyp.60.suppl_1.a147 ◽

2012 ◽

Vol 60 (suppl_1) ◽

Author(s):

Naomi Shike ◽

Santosh Vardhana ◽

Judith Briant ◽

Robert Peck

Keyword(s):

Heart Failure ◽

Medical Center ◽

Tertiary Care ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

Hospital Death ◽

Care Hospital ◽

Common Cause ◽

Related Disease ◽

Reasonable Approach

Introduction The WHO has been increasingly emphasizing and calling for research on the vast unattended burden of non-communicable diseases in the developing world. Hypertension (HTN) in particular is thought to play a growing role in morbidity and mortality in these regions, but has yet to gain significant momentum in public health initiatives. Objective To determine what role HTN and comorbid diseases play in admission and mortality in Bugando Medical Center (BMC), a tertiary care hospital in Tanzania serving 13 million people. Methods We conducted a retrospective analysis of all patients admitted to the internal medicine service at BMC over 34 months between 2008 and 2011. Data on admission diagnoses and mortality had been collected prospectively by Tanzanian doctors in hand-written logs. For patients with heart failure or stroke, the ward logs specified if this was primarily related to hypertension or other risk factors. Data were copied into an Excel database and analyzed to determine the proportion of admissions and deaths primarily related to hypertension. Results In 34 months 8,037 patients were admitted and 1,508 died. HTN-related disease led to 1,997 admissions (25%), while HIV-related illness led to 2,076 (26%). Similarly, HTN led to 377 deaths (25%) and HIV to 579 (38%). HTN-related disease was second only to HIV-related disease as a cause of admission and death. Among hypertensives, the most common cause of admission was congestive heart failure (446; 27%) and of death was stroke (147; 49%). In non-hypertensives, HIV-related disease was the most common cause of both admission (2029; 32%) and death (566; 46%). Conclusions HTN-related disease was second only to HIV as a cause of admission to our hospital and in-hospital death. Better strategies for early diagnosis and treatment of HTN are desperately need in sub Saharan Africa to prevent this morbidity and mortality. Building HTN screening and treatment on top of the extensive infrastructure for HIV disease may be a reasonable approach.

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THE URINARY MANIFESTATIONS OF ANXIETY IN CHILD

PEDIATRICS ◽

10.1542/peds.52.6.818 ◽

1973 ◽

Vol 52 (6) ◽

pp. 818-822

Author(s):

Richard Galdston ◽

Alan D. Perlmutter

Keyword(s):

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Medical Center ◽

Children's Hospital ◽

Hospital Medical ◽

Intrapsychic Conflict ◽

Children’S Hospital ◽

Psychiatric Manifestations

This report comprises concurrent studies of the urologic and psychiatric manifestations of intrapsychic conflict among a group of children who had been admitted to the surgical wards of The Children's Hospital Medical Center, Boston, between 1965 to 1970 for complaints of disordered urination. Experience with these children indicates that anxiety can alter the frequency and disturb the adequacy of voiding to a degree sufficient to dispose the child to urinary tract infection. This effect of anxiety can occur both in the presence or absence of a demonstrable anatomic lesion. It suggests that an assessment of the degree and nature of the child's anxiety should be an integral part of the pediatric urologic examination.

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Indications for Naloxone in Lomotil Poisoning

PEDIATRICS ◽

10.1542/peds.54.5.658a ◽

1974 ◽

Vol 54 (5) ◽

pp. 658-658

Author(s):

Frederick H. Lovejoy

Keyword(s):

Medical Center ◽

Respiratory Effort ◽

Narcotic Antagonist ◽

Children's Hospital ◽

Narcotic Antagonists ◽

Hospital Medical ◽

Comatose State ◽

Children’S Hospital

Rumack and Temple in their thoughtful analysis of Lomotil poisoning1 note that narcotic antagonists should be used "as soon as adequate indications exist." From our experience with Lomotil toxicity in the last three years at Children's Hospital Medical Center and with other drugs producing narcotic like effects,2.3 we would like briefly to comment on the indications for the use of the narcotic antagonist, naloxone (Narcan) hydrochloride. Four prominent signs of naloxone efficacy exist: (1) dilatation of constricted pupils; (2) increase in depth and rate of respiratory effort; (3) reversal of hypotension; and (4) correction of an obtunded or comatose state.4

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