Abstract 17477: Delay in ST Elevation Myocardial Infarction Presentation During the COVID-19 Pandemic in New York

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eitezaz Mahmood ◽  
Arvind Devanabanda ◽  
Avneet Singh ◽  
rajiv jauhar
Keyword(s):  
New York ◽  
Statistical Significance ◽  
The United States ◽  
Cardiovascular Death ◽  
Categorical Variables ◽  
Chronic Obstructive ◽  
Continuous Variables ◽  
Chi Square ◽  
Obstructive Pulmonary Disease ◽  
Time Period

Introduction: The Covid-19 pandemic has been associated with a reduction in STEMI volume in cardiac catheterization centers around the United States; yet a paradoxical increase in cardiovascular death within the same time period. Hypothesis: We hypothesized that reduction in STEMI volume during the COVID-19 pandemic may have been secondary to patient reluctance to present to the hospital. Methods: We performed a retrospective review of patients who presented to the emergency department from March 1st-April 19th, 2020 and March 1st-April 19th, 2019 across Northwell Health. Data on clinical comorbidities, time from symptoms onset, and patient outcomes was abstracted through manual chart review. The primary outcome of our study was time from onset of chest pain to presentation to the emergency room. Patients with COVID-19 were excluded from analysis. Variables were compared using the Chi-square test for categorical variables and the student-t for continuous variables. Results: In total 197 patients met our inclusion criteria, with 135 (69%) admitted in 2019 as compared to 62 (31%) presenting during the same time period in during the COVID-19 pandemic. There were no significant differences in the age of our patients and in comorbidities such as hypertension, hyperlipidemia, coronary artery disease, diabetes, chronic kidney disease, or chronic obstructive pulmonary disease. Patients who presented for STEMI during the COVID-19 waited significantly longer from time of onset of symptoms as compared to patients in 2019, (13.5 hours vs. 6.5 hours, p = .05). Patients who presented for STEMI in 2020 were more likely to die during hospitalization, but this did not reach statistical significance (9.7% vs 6.7%, p = .45). Conclusions: Reduction in STEMI volume during the COVID-19 pandemic may be related to patient reluctance to present to the hospital. Efforts to reduce the stigma of hospitalizations during the pandemic is important.

Vanishing congenital lung malformations: What is the incidence of true regression?

2021 ◽  
pp. 1-7
Author(s):  
C. Griggs ◽  
M. Schmaedick ◽  
C. Gerall ◽  
W. Fan ◽  
C. Orlas ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Exact Test ◽  
Congenital Lung Malformation ◽  
Nicu Admission

BACKGROUND: A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a “vanishing” CLM. OBJECTIVE: The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of “vanishing” lesions treated at our institution. METHODS: We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher’s exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS: Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION: Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.

scholarly journals The association between neutrophil-to-albumin ratio and mortality in patients with cardiogenic shock: a cohort study

2019 ◽  
Author(s):  
Yangpei Peng ◽  
Yangjing Xue ◽  
Jinsheng Wang ◽  
Huaqiang Xiang ◽  
Kangting Ji ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiogenic Shock ◽  
Primary Outcome ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Albumin Ratio

Abstract Background Cardiogenic shock (CS) is a lethal complication. Given the poor outcome of CS, we performed a retrospective cohort study to identify whether the neutrophil-to-albumin ratio (NAR) was significantly associated with mortality from CS. Methods All patient data were extracted from the MIMIC III version 1.3. Comparisons between groups was made using the chi-square or Fisher’s exact tests for categorical variables and the variance analysis or the Kruskal-Wallis test was used for continuous variables. The primary outcome was 30-day mortality and the secondary ones were 90-day and 365-day mortality. We used Cox proportional hazards models to evaluate the association between the various categories of NAR and survival. To further identify the association, subgroup analyses were performed. Results A total of 475 patients with CS were enrolled. A significant positive correlation between NAR levels and 30-day, 90-day or 365-day mortality was observed. For the primary outcome of 30-day mortality, the HR (95% CI) values given NAR levels 23.54–27.86 and > 27.86 were 1.72 (1.17, 2.53) and 1.96 (1.34, 2.87) compared with the reference (NAR < 23.47) in tertile analysis. In multivariate analyses, the HR (95% CI) values were still of statistical significance[1.98 (1.25, 3.15) and 2.03 (1.26, 3.26)]. When quintiles were applied to grouping patients according to NAR level, similar associations were also observed. For the secondary outcomes, the upward trend remained statistically significant. Conclusions NAR level was associated with survival from CS. NAR appeared to be an independent and readily-available prognostic biomarker of mortality in patients with CS.

scholarly journals Comparison of Uncomfortable Loudness Level in Stapedotomy with or without Stapedial Tendon Preservation

2021 ◽  
Vol 27 (2) ◽  
pp. 117-123
Author(s):  
Tamanna Nawshin ◽  
Kanu Lal Saha ◽  
Shah Sohel ◽  
Sabyasachi Talukdar ◽  
Sheikh Mohammad Tanjil Ul Alam
Keyword(s):  
Statistical Significance ◽  
Pure Tone Audiometry ◽  
Neck Surgery ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Group I ◽  
Loudness Level ◽  
Group Ii

Background: Otosclerosis is one of the commonest diseases of the ear mostly involves the otic capsule. Most often otosclerotic foci appear in stapes region leading to stapes fixation, predominantly affect the adolescence female. The most common presenting symptom of clinical otosclerosis is conductive deafness. The mainstay of treatment for otosclerosis is surgery. Surgical options include stapedectomy, stapedotomy with or without stapedial tendon preservation. The latter being is the procedure of choice. Aim: The aim of this study is to compare the outcome of uncomfortable loudness level in stapedotomy with or without stapedial tendon preservation. Methods: A prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months in patients with otosclerosis. Total 30 subjects were selected based on the inclusion and exclusion criteria. All patients were assessed pre-operatively by clinical examination, otoscopy and microscopic examination. Hearing was assessed by pure tone audiometry. Uncomfortable level and stapedial reflex threshold were tested in all cases. The selected cases were placed into two groups. Stapedial tendon resection in Group-I and stapedial tendon preservation in Group-II. Post-operative follow up was done at 3 months and 6 months. Hearing and uncomfortable loudness level were evaluated with PTA during follow up by calculating the average of 500Hz, 1000Hz, 2000Hz and 4000HZ. The data were calculated manually. The statistical significance was set to P< 0.05. Results of the study were expressed as mean, standard deviation (± SD), frequency and percentages. Means and standard deviations were reported for continuous variables. Frequencies and percentages were reported for categorical variables. Unpaired Student’s t test was done to compare the continuous variables and Chi Square test was done to compare the categorical variables. Results: In this study preoperative average ABG for group I and group II were 35 ± 4.57 dB and 34 ± 4.17 dB respectively. In group I, post operative average ABG after 3 months and 6 months were 14 ± 3.7 dB and 13±3.3 dB respectively. Post operative average ABG after 3 months was 13 ± 5.7 dB and was 12 ± 4.4 dB for group II. But the hearing improvement between two groups was not statistically significant. In case of preoperative mean UCL was 95 ± 1.8 dB and 96 ± 2.5 dB for group I and group II respectively. Postoperative mean UCL after 3 months was 96 ± 3.57 dB and after 6 months was 99 ± 6.28 dB in group I. For group II, postoperative mean UCL after 3 months and 6 months was 107±4.2 dB and 113 ± 3.2 dB respectively. Here mean UCL was on average 11 dB higher for group II in 3 months and additional 6 dB improvement noted after 6 months, but show minimal change in group I. This finding was statistically significant. Conclusion: Preservation of the stapedial tendon is the choice in the surgical treatment of otosclerosis which helps to improve functional outcomes as well as to provide the more physiologic protection of middle ear. Postoperative discomfort threshold levels were increased in patients who had their stapedial tendon restored. Bangladesh J Otorhinolaryngol 2021; 27(2): 117-123

MO513CLINICAL AND ECONOMIC BURDEN OF FOCAL SEGMENTAL GLOMERULOSCLEROSIS (FSGS) IN THE UNITED STATES: A RETROSPECTIVE, OBSERVATIONAL COHORT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Kam Kalantar-Zadeh ◽  
Christine Baker ◽  
J Brian Copley ◽  
Daniel Levy ◽  
Stephen Berasi ◽  
...  
Keyword(s):  
Economic Burden ◽  
Medical Costs ◽  
The United States ◽  
Treatment Modalities ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Prescription Costs ◽  
The Impact ◽  
Nephrotic Range Proteinuria

Abstract Background and Aims The burden of disease associated with FSGS has not been well characterized, especially with regard to health care resource utilization (HCRU) and related costs. The aim of this study was to evaluate all-cause HCRU and estimate associated costs in patients with FSGS compared with a matched non-FSGS cohort; a secondary aim was to evaluate the impact of nephrotic range proteinuria on these outcomes. Method Data were from the Optum Clinformatics® Data Mart Database. Patients with ≥ 1 claim (1st claim = index event) for FSGS between April 2016 and December 2018 were identified based on ICD-10-CM codes and matched 1:2 (FSGS:controls) on index date, age, sex, and race to non-FSGS controls; continuous enrollment 6 months pre- and 12 months post-index was required. FSGS nephrotic range (either UPCR &gt;3000 mg/g or ACR &gt;2000 mg/g) and non-nephrotic subpopulations were also identified. Quan-Charlson Comorbidity Index (CCI) and individual comorbidities at baseline, and 12-month post-index all-cause HCRU and associated costs (per patient per year [PPPY]) as well as medication prescriptions related to FSGS treatment were compared between the matched cohorts and between the FSGS subpopulations; t-tests were used for continuous variables and chi-square tests for categorical variables. Results 844 patients with FSGS were matched with 1688 non-FSGS controls; 57.4% male, 56.9% white, mean (SD) age 54.7 (18.4) years. Mean (SD) CCI was higher in the FSGS cohort relative to matched controls (2.72 [2.12] vs 0.55 [1.29]; P &lt; .0001), with prevalence of most individual comorbidities higher in the FSGS cohort. Only 308 FSGS patients (36.5%) had UPCR or ACR tests with available results during the review period; 112 (36.4%) were in the nephrotic range and 196 were non- nephrotic (63.6%). The FSGS cohort was characterized by higher rates of all-cause HCRU across resource categories (all P &lt; .0001) (Table 1); outpatient visits was the most frequently used category (99.1% vs 69.0%), followed by prescription medications. Among patients who used these resources, units of use were significantly higher in FSGS vs matched controls except for length of stay (Table 1). Readmission rates following 1st post-index hospitalization were higher in the FSGS cohort vs matched controls at 30 days (16.1% vs 6.0%; P &lt; .05) and 365 days (39.1% vs 22.9%; P &lt; .05). Glucocorticoids were the most frequently prescribed FSGS-related medication in both cohorts, with a higher rate in FSGS vs matched controls (50.6% vs 23.3%; P &lt; .0001); other FSGS-related medications were infrequently prescribed (&lt; 14%). Inpatient, outpatient, and prescription costs were higher in the FSGS cohort vs matched controls (all P &lt; .0001) resulting in mean total annual medical costs of $59,753 vs $8,431 PPPY (P &lt; .0001) that were driven by outpatient costs (Fig. 1A). Nephrotic range proteinuria was associated with higher all-cause inpatient, outpatient, and prescription costs vs non-nephrotic patients (all P &lt; .0001; Fig. 1B), resulting in higher total costs ($70,481 vs $36,099 PPPY; P &lt; .0001). A higher proportion of nephrotic range patients were prescribed FSGS-modifying medications (73.2% vs 54.1%; P = 0.001), with glucocorticoids the most frequent medication. However, 26.8% of nephrotic range patients were not prescribed any FSGS-related medications. Conclusion FSGS is associated with significant clinical and economic burdens with total annual medical costs &gt; 7-fold higher than matched controls that were driven by outpatient costs. The presence of nephrotic range proteinuria substantially and significantly increased the economic burden. New treatment modalities leading to lower rates of proteinuria may help improve patient outcomes while reducing HCRU and their associated costs.

Abstract 15463: Pre-procedural Inr, Bleeding, and Mortality in the Catheterization Lab: Does INR Still Matter in the Radial First Era?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shantum Misra ◽  
Bruce W Andrus ◽  
James T Devries
Keyword(s):  
Hospital Mortality ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Mitigation Strategies ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Access Site ◽  
Chi Square ◽  
Increased Risk ◽  
Chi Square Analysis

Background: Warfarin anticoagulation presents a common barrier to undergoing cardiac catheterization procedures. Using radial access and other bleeding mitigation strategies, it is not known if elevated INR truly portends an increased risk of adverse events. We sought to understand the relationship between in hospital mortality and bleeding with INR in patients undergoing coronary interventional catheterization procedures. Methods: The prospectively-collected Dartmouth Dynamic Registry was queried for all patients who underwent catheterization with coronary intervention from 2014 to 2018. Of the 5015 patients identified, 2120 patients had a recorded INR value within 24 hours of the procedure. Demographics, procedural variables, and in hospital outcomes were collected. Patients were divided into two groups: INR &lt1.8 and INR &gt1.8. Incidence of bleeding (access site hematoma &gt5cm, post procedure blood transfusion) as well as in-hospital mortality were queried for each group. Stata was used to determine statistical significance, using chi-square analysis for categorical variables and standard t-test for continuous variables. Results: Of the 2120 patients with INR values, 1968 patients were identified with INR &lt1.8 (median INR 1.1; range 0.7-1.7) and 152 patients with INR &gt1.8 (median INR 2.2; range 1.8-11.1). Patients with elevated INRs had higher acuity (urgent or emergent cases) and were older. Other baseline and procedural characteristics were similar. Outcomes between those with elevated INR and those with lower INR values were similar, including access site injury, hematoma, and need for transfusion (Table I). Overall mortality did not differ between the two groups. Conclusion: When compared to patients with INR &lt1.8, patients with INR &gt1.8 are more likely to undergo coronary intervention on an urgent or emergent basis. Despite this, there is no difference in bleeding, need for transfusion, or overall in-hospital mortality.

Shift Length and Shift Length Preference Among Acute Care Surgeons

2021 ◽  
pp. 000313482110257
Author(s):  
John Kepros ◽  
Susan Haag ◽  
Karen Lewandowski ◽  
Frank Bauer ◽  
Hirra Ali ◽  
...  
Keyword(s):  
Acute Care ◽  
Trauma Center ◽  
The United States ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Significant Difference ◽  
And Gender ◽  
High Level ◽  
Shift Length

Background Work hour restrictions have been imposed by the Accreditation Council for Graduate Medical Education since 2003 for medical trainees. Many acute care surgeons currently work longer shifts but their preferred shift length is not known. Methods The purpose of this study was to characterize the distribution of the current shift length among trauma and acute care surgeons and to identify the surgeons’ preference for shift length. Data collection included a questionnaire with a national administration. Frequencies and percentages are reported for categorical variables and medians and means with SDs are reported for continuous variables. A chi-square test of independence was performed to examine the relation between call shift choice and trauma center level (level 1 and level II), age, and gender. Results Data from 301 surgeons in 42 states included high-level trauma centers. Assuming the number of trauma surgeons in the United States is 4129, a sample of 301 gives the survey a 5% margin of error. The median age was 43 years (M = 46, SD = 9.44) and 33% were female. Currently, only 23.3% of acute care surgeons work a 12-hour shift, although 72% prefer the shorter shift. The preference for shorter shifts was statistically significant. There was no significant difference between call shift length preference and trauma center level, age, or gender. Conclusion Most surgeons currently work longer than 12-hour shifts. Yet, there was a preference for 12-hour shifts indicating there is a gap between current and preferred shift length. These findings have the potential to substantially impact staffing models.

scholarly journals Publication Numbers are Increasing at American Research Universities

2019 ◽  
Vol 14 (4) ◽  
pp. 185-187
Author(s):  
Jennifer Kaari
Keyword(s):  
Research Universities ◽  
Statistical Significance ◽  
The United States ◽  
Chi Square ◽  
Research Libraries ◽  
Association Of Research Libraries ◽  
Time Period ◽  
The Mean ◽  
Per Capita ◽  
Number Of Publications

A Review of: Budd, J. (2017). Faculty publications and citations: a longitudinal examination. College & Research Libraries, 78(1), 80–89. https://doi.org/10.5860/crl.78.1.80 Abstract Objective – To study the publishing output and citation activity of faculty at research universities. Design – Bibliometric and citation analysis. Setting – Academic citation databases. Subjects – Institutions in the United States that are members of the Association of Research Libraries (ARL). Methods – This study builds on three previous studies conducted by the author looking at faculty publication productivity, which were conducted for three different time periods beginning in 1991. For the present study, the author searched Scopus by institution to collect the total number of publications and citations for the faculty of more than 100 Association of Research Libraries (ARL) member universities, covering the years 2011 to 2013. The author acquired the total number of faculty at each institution from the ARL website. The faculty number from the ARL website and publication and citation data from Scopus were used to calculate the per capita publication and citation numbers for each institution. The author calculated the total mean number of publications and the mean number of per capita publications per university. Chi tests were used to compare the means for statistical significance.  Main Results – The number of both total and per capita publications for each institution went up over the course of all three studies. The mean number of total publications per university for 1991 to 1993, the first time period studied, was 4,595.8; for the time period of the current study, 2011 to 2013, the mean was 9,662.0. For per capita publications, the mean for 1991 to 1993 was 3.56 and the mean for the present study was 5.96. Based on chi-square tests, the results were found to be statistically significant. Conclusions – The study found that the number of total publications increased significantly over time, exceeding the author’s statistical expectations based on previous work.

scholarly journals A comparative study of chest CT findings regarding the effects of regional dust exposure on patients with COPD living in urban areas and rural areas near cement plants

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Junghyun Kim ◽  
Bom Kim ◽  
So Hyeon Bak ◽  
Yeon-Mok Oh ◽  
Woo Jin Kim
Keyword(s):  
Sex Education ◽  
Rural Areas ◽  
Urban Areas ◽  
Smoking Status ◽  
Statistical Significance ◽  
Dust Exposure ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Wall Area ◽  
Copd Patients

Abstract Background The clinical and radiological presentation of chronic obstructive pulmonary disease (COPD) is heterogenous depending on the characterized sources of inflammation. This study aimed to evaluate COPD phenotypes associated with specific dust exposure. Methods This study was designed to compare the characteristics, clinical outcomes and radiological findings between two prospective COPD cohorts representing two distinguishing regions in the Republic of Korea; COPD in Dusty Area (CODA) and the Korean Obstructive Lung Disease (KOLD) cohort. A total of 733 participants (n = 186 for CODA, and n = 547 for KOLD) were included finally. A multivariate analysis to compare lung function and computed tomography (CT) measurements of both cohort studies after adjusting for age, sex, education, body mass index, smoking status, and pack-year, Charlson comorbidity index, and frequency of exacerbation were performed by entering the level of FEV1(%), biomass exposure and COPD medication into the model in stepwise. Results The mean wall area (MWA, %) became significantly lower in COPD patients in KOLD from urban and metropolitan area than those in CODA cohort from cement dust area (mean ± standard deviation [SD]; 70.2 ± 1.21% in CODA vs. 66.8 ± 0.88% in KOLD, p = 0.028) after including FEV1 in the model. COPD subjects in KOLD cohort had higher CT-emphysema index (EI, 6.07 ± 3.06 in CODA vs. 20.0 ± 2.21 in KOLD, p < 0.001, respectively). The difference in the EI (%) was consistently significant even after further adjustment of FEV1 (6.12 ± 2.88% in CODA vs. 17.3 ± 2.10% in KOLD, p = 0.002, respectively). However, there was no difference in the ratio of mean lung density (MLD) between the two cohorts (p = 0.077). Additional adjustment for biomass parameters and medication for COPD did not alter the statistical significance after entering into the analysis with COPD medication. Conclusions Higher MWA and lower EI were observed in COPD patients from the region with dust exposure. These results suggest that the imaging phenotype of COPD is influenced by specific environmental exposure.

scholarly journals Relationship of Hydroxychloroquine and Ophthalmic Complications in Patients with Type 2 Diabetes in Taiwan

2021 ◽  
Vol 18 (15) ◽  
pp. 8154
Author(s):  
Hung-Chih Chen ◽  
Hung-Yu Lin ◽  
Michael Chia-Yen Chou ◽  
Yu-Hsun Wang ◽  
Pui-Ying Leong ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Conditional Logistic Regression ◽  
Categorical Variables ◽  
Control Group ◽  
Case Group ◽  
Research Database ◽  
Continuous Variables ◽  
Chi Square ◽  
Increased Risk

The purpose of this study is to evaluate the relationship between hydroxychloroquine (HCQ) and diabetic retinopathy (DR) via the national health insurance research database (NHIRD) of Taiwan. All patients with newly diagnosed type 2 diabetes (n = 47,353) in the NHIRD (2000–2012) were enrolled in the study. The case group consists of participants with diabetic ophthalmic complications; 1:1 matching by age (±1 year old), sex, and diagnosis year of diabetes was used to provide an index date for the control group that corresponded to the case group (n = 5550). Chi-square test for categorical variables and Student’s t-test for continuous variables were used. Conditional logistic regression was performed to estimate the adjusted odds ratio (aOR) of DR. The total number of HCQ user was 99 patients (1.8%) in the case group and 93 patients (1.7%) in the control group. Patients with hypertension (aOR = 1.21, 95% CI = 1.11–1.31) and hyperlipidemia (aOR = 1.65, 95% CI = 1.52–1.79) significantly increased the risk of diabetic ophthalmic complications (p < 0.001). Conversely, the use of HCQ and the presence of rheumatoid diseases did not show any significance in increased risk of DR. HCQ prescription can improve systemic glycemic profile, but it does not decrease the risk of diabetic ophthalmic complications.

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