scholarly journals 36. Maternity-associated Infective Endocarditis in the United States: Similar Outcomes to Non-pregnant Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S19-S20
Author(s):  
Michael M Dagher ◽  
Emily Eichenberger ◽  
Kateena L Addae-Konadu ◽  
Sarah K Dotters-Katz ◽  
Vance G Fowler ◽  
...  
Keyword(s):  
Drug Abuse ◽  
Infective Endocarditis ◽  
Patient Characteristics ◽  
The United States ◽  
Adverse Outcomes ◽  
Categorical Variables ◽  
Thromboembolic Events ◽  
Continuous Variables ◽  
Research Support ◽  
Research Grant

Abstract Background Little is known about infective endocarditis (IE) occurring during pregnancy. In this analysis, we sought to define the patient characteristics, risk factors, and outcome of maternity-associated IE (maIE). Methods The National Readmissions Database was used to identify admissions for IE in female patients aged 12 – 55 years discharged between Oct. 2015 and Dec. 2017. Demographics, comorbidities, and outcomes were obtained. Differences between groups were analyzed using weighted Chi-squared test for categorical variables and weighted linear regression for continuous variables. Weighted multivariate regressions adjusted for demographics, hospital, etiologic organism, and comorbid conditions to assess the association between maternity status and outcomes. Results Out of 10,271 identified IE admissions (corresponding to a national estimate of 19,626 admissions), maIE accounted for 320 (national estimate 617) (3.1%). Of these maIE admissions, 41.2% were antepartum admissions, 26.3% resulted in delivery, 18.3% were postpartum, and 11.3% were an early or abnormal pregnancy. Patients with maIE were younger (28.4 ± 3.9 vs. 36.6 ± 8.0, P < 0.001) and more likely insured by Medicaid (73.3% vs. 46.6%, P < 0.001). Although generally healthier, patients with maIE had higher rates of drug abuse (75.7% vs. 58.5%, P < 0.001). In unadjusted comparisons maIE was associated with lower rates of 60-day mortality and thromboembolic events. In adjusted analysis only differences between rates of thromboembolic events were significant (adjusted incremental difference: -17.1%, 95% confidence interval: -22.7% to -11.6%). Differences in rates of valve procedures, mechanical ventilation, length of stay, and inpatient costs were not statistically significant (Figure). Regression-adjusted Outcomes Conclusion Compared with other reproductive aged female IE patients, patients with maIE are younger, healthier, more likely insured by Medicaid, and report higher rates of drug abuse. After adjustment, they receive similar management and do not appear to be at higher risk for adverse outcomes including mortality. Disclosures Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Actavis (Grant/Research Support)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Research Grant or Support)Affinium (Consultant)Allergan (Grant/Research Support)Ampliphi Biosciences (Consultant)Basilea (Consultant, Research Grant or Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Research Grant or Support)Contrafect (Consultant, Research Grant or Support)Cubist (Grant/Research Support)Debiopharm (Consultant)Destiny (Consultant)Durata (Consultant)Forest (Grant/Research Support)Genentech (Consultant, Research Grant or Support)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Research Grant or Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)Medimmune (Consultant, Research Grant or Support)Merck (Consultant, Research Grant or Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Research Grant or Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Research Grant or Support)Tetraphase (Consultant)Theravance (Consultant, Research Grant or Support)Trius (Consultant)xBiotech (Consultant)

scholarly journals 708. Infective Endocarditis Complicating Delivery in Pregnancy: Risk Factors, Complications, and Delivery Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S405-S405
Author(s):  
Michael M Dagher ◽  
Emily Eichenberger ◽  
Kateena L Addae-Konadu ◽  
Sarah K Dotters-Katz ◽  
Vance G Fowler ◽  
...  
Keyword(s):  
Drug Abuse ◽  
Infective Endocarditis ◽  
Hospital Costs ◽  
Administrative Database ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Research Support ◽  
Pregnancy Risk ◽  
Delivery Outcomes ◽  
Research Grant

Abstract Background Infective endocarditis (IE) is a rare but serious complication of pregnancy. Its impact on delivery outcomes is unknown. In this study, we use a national administrative database to compare outcomes of deliveries complicated by IE to non-IE deliveries. Methods The National Readmissions Database was used to identify discharges between Oct. 2015 and Dec. 2017 for deliveries in patients aged 12 – 55 years with concomitant IE, which were compared to those deliveries without IE. Demographics, comorbidities, and outcomes were obtained. Differences between groups were analyzed using weighted Chi-squared test for categorical variables and weighted linear regression for continuous variables. Weighted multivariate regression models adjusted for demographic, facility, and comorbidity conditions were used to evaluate the association between IE and delivery outcomes. Results We identified 88 individuals with IE complicating their delivery hospitalization, corresponding to a national estimate of 162 admissions during the study period, who were compared to 4,401,879 delivery hospitalizations not complicated by IE (weighted national estimate 8,375,536). Patients with IE were more likely to reside in ZIP codes with median incomes in the lowest national quartile (46.3% vs. 28.1%, P = 0.003) and were more likely to be insured by Medicaid (76.5% vs. 42.1%, P < 0.001). Rates of pre-existing cardiac valve disease (39.9% vs. 0.2%, P < 0.001) and congenital heart disease (6.6% vs 0.1%, P < 0.001) were higher in those with IE, as well as drug abuse (69.3% vs. 2.6%, P < 0.001). Unadjusted analyses demonstrated higher rates of in-hospital mortality for IE-associated admissions (12.1% versus 0.005%), along with high rates of severe maternal morbidity, stillbirth, preterm birth, and cesarean birth, and longer lengths of stay and total hospital costs. These differences persisted despite adjustment using multivariate methods (Table). Clinical and Resource Utilization Outcomes Conclusion The presence of IE during an admission for delivery is associated with poorer outcomes for both pregnant patients and their fetuses. The occurrence of IE during pregnancy was associated with lower income, a history of cardiac disease, and drug abuse. Disclosures Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Actavis (Grant/Research Support)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Research Grant or Support)Affinium (Consultant)Allergan (Grant/Research Support)Ampliphi Biosciences (Consultant)Basilea (Consultant, Research Grant or Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Research Grant or Support)Contrafect (Consultant, Research Grant or Support)Cubist (Grant/Research Support)Debiopharm (Consultant)Destiny (Consultant)Durata (Consultant)Forest (Grant/Research Support)Genentech (Consultant, Research Grant or Support)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Research Grant or Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)Medimmune (Consultant, Research Grant or Support)Merck (Consultant, Research Grant or Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Research Grant or Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Research Grant or Support)Tetraphase (Consultant)Theravance (Consultant, Research Grant or Support)Trius (Consultant)xBiotech (Consultant)

scholarly journals A multidisciplinary pulmonary embolism response team (PERT)—experience from a national multicenter consortium

2019 ◽  
Vol 9 (3) ◽  
pp. 204589401882456 ◽  
Author(s):  
Jacob Schultz ◽  
Nicholas Giordano ◽  
Hui Zheng ◽  
Blair A. Parry ◽  
Geoffrey D. Barnes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Patient Characteristics ◽  
Risk Groups ◽  
The United States ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Exact Test ◽  
Advanced Therapy ◽  
Chi Squared

Background We provide the first multicenter analysis of patients cared for by eight Pulmonary Embolism Response Teams (PERTs) in the United States (US); describing the frequency of team activation, patient characteristics, pulmonary embolism (PE) severity, treatments delivered, and outcomes. Methods We enrolled patients from the National PERT Consortium™ multicenter registry with a PERT activation between 18 October 2016 and 17 October 2017. Data are presented combined and by PERT institution. Differences between institutions were analyzed using chi-squared test or Fisher's exact test for categorical variables, and ANOVA or Kruskal-Wallis test for continuous variables, with a two-sided P value < 0.05 considered statistically significant. Results There were 475 unique PERT activations across the Consortium, with acute PE confirmed in 416 (88%). The number of activations at each institution ranged from 3 to 13 activations/month/1000 beds with the majority originating from the emergency department (281/475; 59.3%). The largest percentage of patients were at intermediate–low (141/416, 34%) and intermediate–high (146/416, 35%) risk of early mortality, while fewer were at high-risk (51/416, 12%) and low-risk (78/416, 19%). The distribution of risk groups varied significantly between institutions ( P = 0.002). Anticoagulation alone was the most common therapy, delivered to 289/416 (70%) patients with confirmed PE. The proportion of patients receiving any advanced therapy varied between institutions ( P = 0.0003), ranging from 16% to 46%. The 30-day mortality was 16% (53/338), ranging from 9% to 44%. Conclusions The frequency of team activation, PE severity, treatments delivered, and 30-day mortality varies between US PERTs. Further research should investigate the sources of this variability.

scholarly journals 1094. Infective Endocarditis During Index Hospitalization for Solid Organ Transplantation in the United States

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S576-S576
Author(s):  
Emily Eichenberger ◽  
Michael M Dagher ◽  
Vance G Fowler ◽  
Jerome Federspiel
Keyword(s):  
Infective Endocarditis ◽  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
The United States ◽  
Solid Organ ◽  
Adjusted Relative Risk ◽  
Transplant Recipients ◽  
Research Support ◽  
The Impact ◽  
Research Grant

Abstract Background The prevalence and impact of infective endocarditis (IE) on organ transplant recipients is unknown. We used a large cohort of transplant recipients to assess the impact of IE on outcomes during index transplant hospitalization. Methods We used data from the 2013-2017 Nationwide Readmissions Database (NRD). Hospitalizations associated with solid organ transplantation procedures (heart, liver, kidney, lung, intestines, pancreas) were included. Outcomes included 60-day rates of mortality, ECMO deployment, thromboembolic events, length of stay, and inpatient costs. For data obtained October 2015 and later, rates of graft rejection and graft failure were also measured. Regression models, weighted to account for the NRD sample design, were used to model associations between outcomes and transplant procedure, adjusting for patient age, sex, facility characteristics, comorbid conditions, and organs transplanted. Results A total of 75,069 hospitalizations for organ transplantation, corresponding to a national estimate of 160,368, were included. A diagnosis of IE was associated with 416 (weighted estimate = 898). IE cases were less likely to be female (22.2% vs. 37.9%, p&lt; 0.001), and had higher rates of underlying pulmonary disease. The most common organ transplanted in the hospitalization during which IE was diagnosed (allowing for multiple organs) was heart (84.5%) followed by kidney (8.9%) and liver (7.9%), (p&lt; 0.001). IE was associated with higher mortality [adjusted relative risk (aRR): 1.70, 95% confidence interval (CI) (1.09, 2.66)], prolonged ventilation (aRR 1.32 [1.06, 1.65], 4.6 additional inpatient days (CI: 1.5, 7.6) and $28,300 more inpatient cost (CI: $12,000, $44,700) (Table). 60-Day Outcomes, Stratified by IE During Index Transplant Hospitalization Conclusion IE complicating hospitalization for organ transplantation is associated with higher rates of morbidity and mortality. IE during index transplant hospitalization occurs most frequently in heart transplant recipients. Understanding the high rate of IE in heart recipients in the early post-transplant period requires further study. Disclosures Vance G. Fowler, Jr., MD, MHS, Achaogen (Consultant)Actavis (Grant/Research Support)Advanced Liquid Logics (Grant/Research Support)Affinergy (Consultant, Research Grant or Support)Affinium (Consultant)Allergan (Grant/Research Support)Ampliphi Biosciences (Consultant)Basilea (Consultant, Research Grant or Support)Bayer (Consultant)C3J (Consultant)Cerexa (Consultant, Research Grant or Support)Contrafect (Consultant, Research Grant or Support)Cubist (Grant/Research Support)Debiopharm (Consultant)Destiny (Consultant)Durata (Consultant)Forest (Grant/Research Support)Genentech (Consultant, Research Grant or Support)Integrated Biotherapeutics (Consultant)Janssen (Consultant, Research Grant or Support)Karius (Grant/Research Support)Locus (Grant/Research Support)Medical Biosurfaces (Grant/Research Support)Medicines Co. (Consultant)Medimmune (Consultant, Research Grant or Support)Merck (Consultant, Research Grant or Support)NIH (Grant/Research Support)Novadigm (Consultant)Novartis (Consultant, Research Grant or Support)Pfizer (Grant/Research Support)Regeneron (Consultant, Research Grant or Support)Tetraphase (Consultant)Theravance (Consultant, Research Grant or Support)Trius (Consultant)xBiotech (Consultant)

scholarly journals Testing telediagnostic obstetric ultrasound in Peru: a new horizon in expanding access to prenatal ultrasound

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marika Toscano ◽  
Thomas J. Marini ◽  
Kathryn Drennan ◽  
Timothy M. Baran ◽  
Jonah Kan ◽  
...  
Keyword(s):  
Excellent Agreement ◽  
Rural Areas ◽  
Intraclass Correlation ◽  
Standard Of Care ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Second Trimester ◽  
Obstetric Ultrasound ◽  
Biometric Measurements

Abstract Background Ninety-four percent of all maternal deaths occur in low- and middle-income countries, and the majority are preventable. Access to quality Obstetric ultrasound can identify some complications leading to maternal and neonatal/perinatal mortality or morbidity and may allow timely referral to higher-resource centers. However, there are significant global inequalities in access to imaging and many challenges to deploying ultrasound to rural areas. In this study, we tested a novel, innovative Obstetric telediagnostic ultrasound system in which the imaging acquisitions are obtained by an operator without prior ultrasound experience using simple scan protocols based only on external body landmarks and uploaded using low-bandwidth internet for asynchronous remote interpretation by an off-site specialist. Methods This is a single-center pilot study. A nurse and care technician underwent 8 h of training on the telediagnostic system. Subsequently, 126 patients (68 second trimester and 58 third trimester) were recruited at a health center in Lima, Peru and scanned by these ultrasound-naïve operators. The imaging acquisitions were uploaded by the telemedicine platform and interpreted remotely in the United States. Comparison of telediagnostic imaging was made to a concurrently performed standard of care ultrasound obtained and interpreted by an experienced attending radiologist. Cohen’s Kappa was used to test agreement between categorical variables. Intraclass correlation and Bland-Altman plots were used to test agreement between continuous variables. Results Obstetric ultrasound telediagnosis showed excellent agreement with standard of care ultrasound allowing the identification of number of fetuses (100% agreement), fetal presentation (95.8% agreement, κ =0.78 (p < 0.0001)), placental location (85.6% agreement, κ =0.74 (p < 0.0001)), and assessment of normal/abnormal amniotic fluid volume (99.2% agreement) with sensitivity and specificity > 95% for all variables. Intraclass correlation was good or excellent for all fetal biometric measurements (0.81–0.95). The majority (88.5%) of second trimester ultrasound exam biometry measurements produced dating within 14 days of standard of care ultrasound. Conclusion This Obstetric ultrasound telediagnostic system is a promising means to increase access to diagnostic Obstetric ultrasound in low-resource settings. The telediagnostic system demonstrated excellent agreement with standard of care ultrasound. Fetal biometric measurements were acceptable for use in the detection of gross discrepancies in fetal size requiring further follow up.

scholarly journals Age-stratified Analysis of Associations Between Participant’s Characteristics and NAFLD

2021 ◽  
Author(s):  
Syed H. Naqvi ◽  
Anthony P. Nunes
Keyword(s):  
Fatty Liver ◽  
Mexican Americans ◽  
Age Groups ◽  
Prevalence Ratio ◽  
Patient Characteristics ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Excessive Alcohol Consumption ◽  
Nonalcoholic Fatty Liver ◽  
Prevalence Ratios

Abstract Background: Nonalcoholic fatty liver disease (NAFLD) is highly prevalent and a leading cause of liver transplantation. In clinical settings, diagnosis is often inferred based on patient attributes and generalized algorithms that haven’t been tailored to patients’ age. This study aims to understand age-dependent associations between NAFLD and patient characteristics. Methods: Subjects were identified from the National Health and Nutrition Examination Survey (NHANES) 2007-2016. NAFLD status was established through the U.S. Fatty Liver Index in the absence of excessive alcohol consumption and viral etiology. Descriptive patient attributes' distributions are reported relying on the mean and standard deviation for continuous variables and proportions for categorical variables. Prevalence estimates and prevalence ratios for NAFLD are provided in the following age stratifications: 18 and younger, 19-49, 50-64, 65-74, and 75+. Results: A total of 4,560 NHANES participants from 2007-2016 were included, with a mean age of 42.9. Prevalence ratios of NAFLD in the context of clinical/demographic characteristics varied between age groups. The NAFLD prevalence ratio for Mexican Americans compared to Non-Hispanic White was 3.44 in respondents 18 years old or younger (95%CI: 2.48-4.77) and 1.60 in respondents 75 or older (95%CI: 1.30-1.97). The magnitude of the association between albumin and NAFLD was negative. It ranged from a prevalence ratio of 0.32 (0.20 – 0.51) for respondents under 19 years of age to 1.15 (0.86-1.53) over the age of 74. Conclusion: The significant differences between participant characteristics and NAFLD within different age groups suggest that age plays an essential role in the magnitude of the association between risk factors and NAFLD. This study highlights that the accuracy of a NAFLD diagnosis in the absence of imaging and histological conformation may depend on the patients' age. Additional work should evaluate the need for diagnostic and management guidelines formally tailored to patients’ age.

scholarly journals MO152CORRELATION OF PERCEIVED FRAILTY WITH MEASURED FRAILTY IN AN ADULT HAEMODIALYSIS POPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ruth Fergie ◽  
Jennifer McCaughan ◽  
Peter Eves ◽  
Siddesh Prabhavalkhar ◽  
Girish Shivashankar ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Basic Education ◽  
Physiological Stress ◽  
Care Home ◽  
Adverse Outcomes ◽  
Categorical Variables ◽  
Chronic Haemodialysis ◽  
Continuous Variables ◽  
Clinical Frailty Scale ◽  
Dialysis Unit

Abstract Background and Aims Frailty is a measure of physiological reserve and the ability to respond to physiological stress. Increasing frailty predicts adverse health outcomes in patients with end stage renal disease (ESRD) Despite this, frailty is not routinely measured in clinical practice where clinician perception of frailty is used to inform decision making. The Clinical Frailty Scale (CFS) is a clinical judgement-based score that is a useful screening tool for frailty. Increasing frailty measured by CFS is predictive of adverse outcomes in patients with advanced chronic kidney disease (CKD) including falls, worsening disability, care home admissions, hospitalizations and ultimately mortality. It has been widely used in the assessment of patients with COVID-19 to help inform decisions regarding ceiling of care. This study aimed to assess the correlation between clinician perception of frailty and frailty as measured using the CFS. Method Frailty was assessed for all patients undergoing in centre hospital haemodialysis (n=53) in a single dialysis unit in Northern Ireland. A CFS score was calculated for all patients by a clinician who routinely uses the CFS in clinical practice. Patients with a score of 1-3 were classified as not frail, 4-5 as intermediately frail and 6-9 as frail. Nephrologists received basic education about frailty. They were then asked to categorize their patients as non-frail, intermediately frail or frail. The relationship between measured and perceived frailty was assessed using percent agreement. Participant characteristics of frail patients who were misclassified as intermediately frail or non-frail by clinicians were compared to those patients correctly classified as non-frail by clinicians. Fisher’s exact test was employed for categorical variables and t-tests were employed for pseudo normally distributed continuous variables. Results Of the 53 participants, the median age was 59 years (26-89). 41.5% were women. The median time on dialysis was 1.6 years. According to the CFS, 6 patients were categorised as non-frail, 30 patients as intermediately frail and 17 as frail. Among frail participants, 41% were correctly perceived as frail by their nephrologist. Among non-frail participants, 100% were correctly perceived as non-frail by their nephrologist. Among those who were frail according to the CFS, those misclassified as intermediately frail or non-frail, were younger (median age of those misclassified 49 years vs 62 years of those not mis-classified, P=0.03) but did not differ by sex (P=1), time on dialysis (P=0.39), presence of diabetes (P=0.30) or presence of vascular disease (P=1). Conclusion In this study of adult patients undergoing chronic haemodialysis, perceived frailty correlated with measured frailty using the CFS less than 50% of the time. This suggests that clinical perception is not an accurate surrogate for frailty status in this population group. Additionally, this study suggests that younger patients with ESRD are less likely to be correctly perceived as frail. Such misclassification could influence clinical decisions for treatment, including candidacy for kidney transplantation.

scholarly journals P047: Emergency department practice patterns of UTI investigation among the delirious elderly: a retrospective chart review

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S81-S81
Author(s):  
R. Pinnell ◽  
P. Joo
Keyword(s):  
Emergency Department ◽  
Elderly Patients ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Patient Characteristics ◽  
Urinary Symptoms ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Indwelling Catheter ◽  
Exact Test

Introduction: Delirium is a common emergency department (ED) presentation in elderly patients. Urinary tract infection (UTI) investigation and treatment are often initiated in delirious patients in the absence of specific urinary symptoms, despite a paucity of evidence to support this practice. The purpose of this study is to describe the prevalence of UTI investigation, diagnosis and treatment in delirious elderly patients in the ED. Methods: We performed a retrospective chart review of elderly patients presenting to the ED at The Ottawa Hospital between January 15-July 30, 2018 with a chief complaint of confusion or similar. Exclusion criteria were pre-existing and current UTI diagnosis, Glasgow Coma Scale <13, current indwelling catheter or nephrostomy tube, transfers between hospitals, and leaving without being seen. The primary outcome was the proportion of patients for whom urine tests (urinalysis or culture) or antibiotic treatment were ordered. Secondary outcomes were associations between patient characteristics, rates of UTI investigation, and patient outcomes. Descriptive values were reported as proportions with exact binomial confidence intervals for categorical variables and means with standard deviations for continuous variables. Comparisons were conducted with Fischer's exact test for categorical variables and t-tests for continuous variables. Results: After analysis of 1039 encounters with 961 distinct patients, 499 encounters were included. Urine tests were conducted in 324 patients (64.9% [60.6-69.1]) and antibiotics were prescribed to 176 (35.2% [31.1-39.6]). Overall 57 patients (11.4% [8.8-14.5]) were diagnosed with UTI, of which only 12 (21.1% [11.4-33.9]) had any specific urinary symptom. For those patients who had no urinary symptoms or other obvious indication for antibiotics (n = 342), 199 (58.2% [52.8-63.5]) received urine tests and 62 (18.1% [14.2-22.6]) received antibiotics. Patients who received urine tests were older (82.4 ± 8.8 vs. 78.3 ± 8.4 years, p < 0.001) but did not differ in sex distribution from those than those who did not. Additionally, patients who received antibiotics were more likely to be admitted (OR = 2.6 [1.48-4.73]) and had higher mortality at 30 days (OR = 4.2 [1.35-12.91]) and 6 months (OR = 3.2 [1.33-7.84]) than those who did not. Conclusion: Delirious patient without urinary symptoms in the ED were frequently investigated and treated for UTI despite a lack of evidence regarding whether this practice is beneficial.

Does Incidental Appendectomy Increase the Risk of Complications after Abdominal Procedures?

2016 ◽  
Vol 82 (10) ◽  
pp. 885-889 ◽  
Author(s):  
Mohammed Al-Temimi ◽  
Charles Trujillo ◽  
John Agapian ◽  
Hanna Park ◽  
Ahmad Dehal ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Multivariate Logistic Regression Analysis ◽  
Patient Characteristics ◽  
Categorical Variables ◽  
Wound Complications ◽  
Continuous Variables ◽  
Improvement Program ◽  
Increased Risk ◽  
Chi Squared ◽  
Incidental Appendectomy

Incidental appendectomy (IA) could potentially increase the risk of morbidity after abdominal procedures; however, such effect is not clearly established. The aim of our study is to test the association of IA with morbidity after abdominal procedures. We identified 743 (0.37%) IA among 199,233 abdominal procedures in the National Surgical Quality Improvement Program database (2005–2009). Cases with and without IA were matched on the index current procedural terminology code. Patient characteristics were compared using chi-squared test for categorical variables and Student t test for continuous variables. Multivariate logistic regression analysis was performed. Emergency and open surgeries were associated with performing IA. Multivariate analysis showed no association of IA with mortality [odds ratio (OR) = 0.51, 95% confidence interval (CI) = 0.26–1.02], overall morbidity (OR = 1.16, 95% CI = 0.92–1.47), or major morbidity (OR = 1.20, 95% CI = 0.99–1.48). However, IA increased overall morbidity among patients undergoing elective surgery (OR = 1.31,95% CI = 1.03–1.68) or those ≥30 years old (OR = 1.23, 95% CI = 1.00–1.51). IA was also associated with higher wound complications (OR = 1.46,95% CI = 1.05–2.03). In conclusion, IA is an uncommonly performed procedure that is associated with increased risk of postoperative wound complications and increased risk of overall morbidity in a selected patient population.

scholarly journals Medical cannabis use in the United States: a retrospective database study

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
V. Kishan Mahabir ◽  
Jamil J. Merchant ◽  
Christopher Smith ◽  
Alisha Garibaldi
Keyword(s):  
United States ◽  
Medical Condition ◽  
Statistical Tests ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Medical Conditions ◽  
Comorbid Conditions ◽  
Medical Cannabis ◽  
Number Of Patients

Abstract Introduction Growing interest in the medicinal properties of cannabis has led to an increase in its use to treat medical conditions, and the establishment of state-specific medical cannabis programs. Despite medical cannabis being legal in 33 states and the District of Colombia, there remains a paucity of data characterizing the patients accessing medical cannabis programs. Methods We retrospectively reviewed a registry with data from 33 medical cannabis evaluation clinics in the United States, owned and operated by CB2 Insights. Data were collected primarily by face-to-face interviews for patients seeking medical cannabis certification between November 18, 2018 and March 18, 2020. Patients were removed from the analysis if they did not have a valid date of birth, were less than 18, or did not have a primary medical condition reported; a total of 61,379 patients were included in the analysis. Data were summarized using descriptive statistics expressed as a mean (standard deviation (SD)) or median (interquartile range (IQR)) as appropriate for continuous variables, and number (percent) for categorical variables. Statistical tests performed across groups included t-tests, chi-squared tests and regression. Results The average age of patients was 45.5, 54.8% were male and the majority were Caucasian (87.5%). Female patients were significantly older than males (47.0 compared to 44.6). Most patients reported cannabis experience prior to seeking medical certification (66.9%). The top three mutually exclusive primary medical conditions reported were unspecified chronic pain (38.8%), anxiety (13.5%) and post-traumatic stress disorder (PTSD) (8.4%). The average number of comorbid conditions reported was 2.7, of which anxiety was the most common (28.3%). Females reported significantly more comorbid conditions than males (3.1 compared to 2.3). Conclusion This retrospective study highlighted the range and number of conditions for which patients in the US seek medical cannabis. Rigorous clinical trials investigating the use of medical cannabis to treat pain conditions, anxiety, insomnia, depression and PTSD would benefit a large number of patients, many of whom use medical cannabis to treat multiple conditions.

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