Abstract 060: Cardiovascular Disease Burden In A Psychiatric Outpatient Population

Objective: To understand the burden of cardiovascular diseases (CVDs) in a psychiatric outpatient population. Methods: We used baseline data from the ongoing Penn State Psychiatry Clinical Assessment and Rating Evaluation System (PCARES) Registry, which is comprised of adult patients who were seen at a psychiatric outpatient clinic affiliated with the Department of Psychiatry and Behavioral Health and the Penn State Milton S. Hershey Medical Center. The Electronic Medical Record (EMR) data from 3,024 patients who sought psychiatric care between 02/17/2015 and 09/18/2019 were included in this report. We compared the prevalence of CVDs and the mean levels of major CVD risk factors in our sample with that reported in the 2013-2016 National Health and Nutrition Examination Survey (NHANES). Results: The mean age of the study population was 42.7 (16.7) years, with 63% female and 85% Caucasians. The most common psychiatric diagnoses at baseline were Major Depressive Disorder [ICD-10: F32 & F33] (45%), Generalized Anxiety Disorder [ICD-10: F41.1] (20%), and Bipolar Disorder [ICD-10: F31] (12%). Eighteen percent of patients reported using tobacco products and 1.7% reported using alcohol. The prevalence (%) of CVDs, type 2 diabetes, hypertension, and dyslipidemia in our sample were 9.1, 20, 48, and 41%, respectively (all significantly higher than the NHANES reports, all p < 0.0001). The baseline means (mg/dl) of total cholesterol (C), LDL-C, HDL-C, and triglycerides (TG) were 186, 108, 48, and 156, respectively (all are significantly lower than that reported from the NHANES, except for TG, which was higher than that of the NHANES, all p < 0.0001), while 22% of all patients had prescriptions for lipid-lowering medications. Baseline mean level of glucose and HbA1C were 111 mg/dl and 6.2% (both significantly higher than that from the NHANES, p < 0.0001). Conclusions: In this systematic registry of psychiatric outpatients from a mid-Atlantic academic medical center, the baseline CVD burden as measured by common cardiovascular diseases, comorbidities and risk factors are significantly higher than the CVD burden in the general US population. Considering that the mean age of this patient population is 5 years younger than that of the NHANES population, our data underscores the need for control and prevention of CVD in patients with psychiatric conditions, and suggests the potential of integrating mental and physical health care in this type of special population.

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Risk Factors and Outcomes Associated With Non–Enterococcus faecalis, Non–Enterococcus faeciumEnterococcal Bacteremia

Infection Control and Hospital Epidemiology ◽

10.1086/500000 ◽

2006 ◽

Vol 27 (1) ◽

pp. 28-33 ◽

Cited By ~ 30

Author(s):

Marie A. de Perio ◽

Paul R. Yarnold ◽

John Warren ◽

Gary A. Noskin

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Enterococcus Faecalis ◽

Hematologic Malignancy ◽

Medical Center ◽

Academic Medical Center ◽

Clinical Feature ◽

Retrospective Case ◽

Duration Of Hospital Stay ◽

The Mean

Objectives.To compare risk factors, clinical features, and outcomes in patients withEnterococcus avium,Enterococcus casseliflavus,Enterococcus durans,Enterococcus gallinarum, andEnterococcus mundtiibacteremia (cases) with those in patients withEnterococcus faecalisbacteremia (controls).Design.A retrospective case-control study.Setting.A 725-bed, university-affiliated, academic medical center.Patients.The clinical microbiology database at Northwestern Memorial Hospital from January 1994 to May 2003 was searched to identify cases; each case was matched to one control on the basis of date of admission.Results.Thirty-three cases were identified and matched with 33 controls. The mean duration of hospital stay was longer (29.7 vs 17.2 days;P= .03) and the mean time to acquisition of bacteremia was greater (16.5 vs 6.3 days;P= .003) for cases than controls. Cases were more likely to have underlying hematologic malignancies (P< .001), to have been treated with corticosteroids (P= .02), and to be neutropenic (P= .003). Controls were more likely to have an indwelling bladder catheter (P= .01), and cases were more likely to have the gastrointestinal tract as a source of infection (P= .007) and to have concurrent cholangitis (P= .002). There were no differences in severity of illness or in mortality rates.Conclusions.Compared with patients withE. faecalisbacteremia, patients with non-E. faecalis, non-Enterococcus faeciumenterococcal bacteremia were more likely to have a hematologic malignancy, prior treatment with corticosteroids, neutropenia, and cholangitis; longer duration of hospital stay was also identified as a clinical feature. However, non-E. faecalis, non-E. faeciumspecies are not associated with any differences in mortality.

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Risk factors associated with physician trainee concern over missed educational opportunities during the COVID-19 pandemic

BMC Medical Education ◽

10.1186/s12909-021-02665-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sunny S. Lou ◽

Charles W. Goss ◽

Bradley A. Evanoff ◽

Jennifer G. Duncan ◽

Thomas Kannampallil

Keyword(s):

Risk Factors ◽

Clinical Education ◽

Medical Center ◽

Clinical Care ◽

Academic Medical Center ◽

Clinical Work ◽

Educational Opportunities ◽

Missed Opportunities ◽

Physician Trainee ◽

At Home

Abstract Background The COVID-19 pandemic resulted in a transformation of clinical care practices to protect both patients and providers. These changes led to a decrease in patient volume, impacting physician trainee education due to lost clinical and didactic opportunities. We measured the prevalence of trainee concern over missed educational opportunities and investigated the risk factors leading to such concerns. Methods All residents and fellows at a large academic medical center were invited to participate in a web-based survey in May of 2020. Participants responded to questions regarding demographic characteristics, specialty, primary assigned responsibility during the previous 2 weeks (clinical, education, or research), perceived concern over missed educational opportunities, and burnout. Multivariable logistic regression was used to assess the relationship between missed educational opportunities and the measured variables. Results 22% (301 of 1375) of the trainees completed the survey. 47% of the participants were concerned about missed educational opportunities. Trainees assigned to education at home had 2.85 [95%CI 1.33–6.45] greater odds of being concerned over missed educational opportunities as compared with trainees performing clinical work. Trainees performing research were not similarly affected [aOR = 0.96, 95%CI (0.47–1.93)]. Trainees in pathology or radiology had 2.51 [95%CI 1.16–5.68] greater odds of concern for missed educational opportunities as compared with medicine. Trainees with greater concern over missed opportunities were more likely to be experiencing burnout (p = 0.038). Conclusions Trainees in radiology or pathology and those assigned to education at home were more likely to be concerned about their missed educational opportunities. Residency programs should consider providing trainees with research or at home clinical opportunities as an alternative to self-study should future need for reduced clinical hours arise.

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Demographic and Risk Factor Differences between Children with “One-Time” and “Repeat” Visits to the Emergency Department for Asthma

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020486 ◽

2021 ◽

Vol 18 (2) ◽

pp. 486

Author(s):

Pavani Rangachari ◽

Jie Chen ◽

Nishtha Ahuja ◽

Anjeli Patel ◽

Renuka Mehta

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Risk Factor ◽

Childhood Asthma ◽

Medical Center ◽

Academic Medical Center ◽

Retrospective Chart Review ◽

Primary Research ◽

Ed Visits ◽

The Individual

This retrospective study examines demographic and risk factor differences between children who visited the emergency department (ED) for asthma once (“one-time”) and more than once (“repeat”) over an 18-month period at an academic medical center. The purpose is to contribute to the literature on ED utilization for asthma and provide a foundation for future primary research on self-management effectiveness (SME) of childhood asthma. For the first round of analysis, an 18-month retrospective chart review was conducted on 252 children (0–17 years) who visited the ED for asthma in 2019–2020, to obtain data on demographics, risk factors, and ED visits for each child. Of these, 160 (63%) were “one-time” and 92 (37%) were “repeat” ED patients. Demographic and risk factor differences between “one-time” and “repeat” ED patients were assessed using contingency table and logistic regression analyses. A second round of analysis was conducted on patients in the age-group 8–17 years to match another retrospective asthma study recently completed in the outpatient clinics at the same (study) institution. The first-round analysis indicated that except age, none of the individual demographic or risk factors were statistically significant in predicting of “repeat” ED visits. More unequivocally, the second-round analysis revealed that none of the individual factors examined (including age, race, gender, insurance, and asthma severity, among others) were statistically significant in predicting “repeat” ED visits for childhood asthma. A key implication of the results therefore is that something other than the factors examined is driving “repeat” ED visits in children with asthma. In addition to contributing to the ED utilization literature, the results serve to corroborate findings from the recent outpatient study and bolster the impetus for future primary research on SME of childhood asthma.

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Association between Patients with Metabolic Syndrome and Other Various Factors Defining Metabolic Syndrome: A Cross-Sectional Study

International Journal of Research and Review ◽

10.52403/ijrr.20210402 ◽

2021 ◽

Vol 8 (4) ◽

pp. 12-17

Author(s):

Basavaraj PG ◽

Ashok P Yenkanchi ◽

Chidanand Galagali

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Metabolic Syndrome ◽

Cardiovascular Diseases ◽

Abdominal Obesity ◽

Positive History ◽

The Metabolic Syndrome ◽

Study Results ◽

History Of ◽

The Mean

Background: Risk factors can lead to clinical conditions, like metabolic syndrome, that predisposes the development of cardiovascular diseases. Objective: The goal of this population-based, prospective and non-randomised cohort study was to study the association between patients with metabolic syndrome and other various factors defining metabolic syndrome. Methods: All the patients referred to the department of Medicine, Al-Ameen Medical college hospital and District Hospital, Vijayapur, Karnataka, India over a period of twenty-two months extending from December 2013 to September 2015 were considered in this study. Results: In the current study, out of 100 patients, 62.9% patients had metabolic syndrome with positive family history of hypertension, diabetes mellitus. 70.8% patients had metabolic syndrome with positive history of smoking. 64.3% patients had metabolic syndrome with positive history of alcohol .73.9% patients had metabolic syndrome with positive history of IHD. 87% of the patients with metabolic syndrome had SBP> 130 mmHg, and 78.85% patients had DBP>85 mmHg. And metabolic syndrome was observed in 71.8% patients on anti hypertensive drugs. The mean level of total cholesterol, LDL cholesterol, triglyceride is increased whereas the mean level of anti-atherogenic HDL cholesterol is low in subjects with MS. At least one lipid abnormality was present in > 95 % of cases. Around 81% subjects with BMI <25 (out of 38) had metabolic syndrome and 58% subjects with BMI>25(out of 62) had metabolic syndrome. Conclusion: All the components defining the metabolic syndrome correlated positively with the abdominal obesity. Systolic blood pressure values were significantly higher than diastolic blood pressure in subjects with abdominal obesity. Metabolic syndrome has multiple risk factors determined by various aspects like the race, the life style, geographical factors larger study is needed to understand the correlation between various components defining it. A healthy lifestyle, that includes avoiding tobacco exposure and proper weight control, must be encouraged in this high-risk population. Keywords: Cardiovascular diseases; Overweight; Risk factors; Smoking.

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PERCENTILE DISTRIBUTION OF CAROTID INTIMA-MEDIA THICKNESS IN THE GENERAL WORKING-AGE POPULATION

Siberian Medical Journal ◽

10.29001/2073-8552-2019-34-1-145-151 ◽

2019 ◽

Vol 34 (1) ◽

pp. 145-151

Author(s):

Kaveshnikov Kaveshnikov ◽

V. N. Serebryakova ◽

I. A. Trubacheva

Keyword(s):

Risk Factors ◽

Cardiovascular Diseases ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Media Thickness ◽

Informed Consent Form ◽

Gender And Age ◽

Working Age ◽

The Mean ◽

Working Age Population

Objective.To study the gender- and age-specific percentile distribution of carotid intima-media thickness (cIMT) in the unorganized urban working-age population.Material and Methods. Presented data were obtained in the ESSE-RF study in the city of Tomsk (1,412 participants, 25–64 years old without cardiovascular diseases, 59% women). All the surveyed signed voluntary informed consent form to participate in the study. We studied distributions of the mean and maximum cIMT obtained by the automatic and manual measurements, respectively. An error probability of less than 5% was considered statistically significant.Results. Both indicators of cIMT consistently increased with age in both gender groups. Maximum cIMT (max-cIMT) increased stronger than the mean cIMT (mean-cIMT). Compared with data obtained in other studies, the mean-cIMT estimates were distributed closer to the upper pole of the spectrum presented and increased stronger in 35–55-year-old men compared with those in the populations of Central and Southwestern Europe; the mean-cIMT estimates showed the most pronounced gender effect. Similar trends were identified in relation to the max-cIMT distribution.Conclusion. Obtained data allowed for specific assessment of the individual cIMT values by gender and age within the framework of risk stratification among people of working age without cardiovascular diseases. Further studies aimed at clarifying the prognostic role of high cIMT values in general population, taking into account the influence of traditional and new cardiovascular risk factors, can broaden the understanding of the significance of vascular state assessment as one of the key points, linking risk factors to clinical events, for primary prevention of cardiovascular diseases in population.

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Abstract P320: Gender Disparities in Low Density Lipoprotein (LDL) Control for Secondary Prevention Among Patients with Coronary Heart Disease (CHD): Does Having a Caregiver Matter?

Circulation ◽

10.1161/circ.125.suppl_10.ap320 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Gmerice Hammond ◽

Heidi Mochari-Greenberger ◽

Ming Liao ◽

Lori Mosca

Keyword(s):

Secondary Prevention ◽

Gender Gap ◽

Medical Center ◽

Academic Medical Center ◽

Density Lipoprotein ◽

Gender Disparities ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Multivariable Adjustment ◽

Statin Use

Background: Despite the proven benefits of lipid lowering therapy for the prevention of recurrent CHD, research has consistently shown that women are less likely than men to be at established LDL targets. The reasons for the gender gap remain elusive. The purpose of this study was to test the hypothesis that having a caregiver is independently associated with adherence to Adult Treatment Panel (ATP) III LDL goals for secondary prevention, and to determine if the association varies by gender. Methods: We studied 2190 consecutive patients admitted to the cardiac service of an academic medical center as part of the NHLBI sponsored Family Cardiac Caregiver Investigation To Evaluate Outcomes (FIT-O) Study (93% participation rate). Patients with CHD or equivalent, and a documented LDL within 12 months of admission were included in this analysis (58% white, 66% male, mean age 67 yrs). Caregiver status was assessed by a standardized interviewer-assisted questionnaire and was classified as either paid (nurse/home aide) or informal (family member/friend). Lipid levels and statin use were obtained from a hospital-based informatics system and medical chart review. ATP III targets were classified as target (LDL<100 mg/dL) and aggressive target (LDL<70 mg/dL). The associations between caregiving and LDL were assessed using chi square statistics, overall and stratified by gender. Multivariable regression was used to adjust for confounders (age, marital status, race, gender, health insurance, statin use, comorbidities). Results: Males with CHD were more likely than females with CHD to be at target LDL <100 [79% (1149/1446) vs 69% (515/744) respectively; p=0.0001], and at LDL<70 [48% (688/1446) vs 36% (271/744); p<0.0001]. The prevalence of caregiving overall was 40% (N= 879/2190; 13% paid; 27% informal only), and did not differ by gender. Having an informal caregiver was significantly associated with LDL<70 (OR=1.35; 95%CI=1.07-1.70), and this remained significant after multivariable adjustment for confounders (OR=1.25; 95% CI=1.00-1.56). The association between caregiving and LDL<100 did not reach significance (OR=1.20; 95% CI=0.95-1.51). In stratified analysis, men with an informal caregiver were more likely than men without a caregiver to have an LDL<70 (OR=1.35; 95%CI=1.07-1.70); this remained significant after multivariable adjustment for confounders, including statin use (OR=1.37; 95%CI=1.04-1.80). The relation between caregiving and LDL control was not significant among women. Conclusion: Men with CHD were more likely to be at ATP III targets LDL <70 and <100 mg/dL than women with CHD. Having an informal caregiver was a significant predictor of being at aggressive target LDL <70mg/dL among men but not among women, even after adjustment for confounders. The potential role of caregiving as a novel contributor to gender disparities in LDL control deserves further study.

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Cancer inpatient malnutrition risk, documentation, and ICD-10 coding in an academic medical center.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12107 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12107-12107

Author(s):

Aynur Aktas ◽

Lenna Finch ◽

Danielle Boselli ◽

Declan Walsh ◽

Kunal C. Kadakia ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Stage Iv ◽

Academic Community ◽

Primary Site ◽

Disease Stage ◽

Cancer Site ◽

Black Race ◽

Stage Iv Disease ◽

Icd 10

12107 Background: Malnutrition (MN) is common in hospitalized cancer patients but often underdiagnosed. We evaluated the prevalence of MN risk, dietitian documented MN (DDMN), and physician coded malnutrition (PCMN) in a consecutive cohort of cancer inpatients in an academic, community-based medical center. Methods: Electronic medical records (EMR) were reviewed for inpatients with a solid tumor diagnosis staged I-IV and admitted to Atrium Health Carolinas Medical Center at least once between 1/1/2016 to 5/21/2019. All data were collected from the first admission EMR encounter closest to the cancer diagnosis date. High MN risk was a score ≥2 on the Malnutrition Screening Tool (MST) completed by an RN at admission. Registered Dietitian (RD) assessments were reviewed for DDMN and grade (mild, moderate, severe). PCMN diagnosis was based on MN ICD-10 codes extracted from the medical coder’s discharge summary. Multivariate logistic regression models identified associations between clinic-demographic factors and the prevalence of DDMN and PCMN with stepwise selection. Results: N=5,143; 48% females. Median age 63 (range 18-102) years. 70% White; 24% Black, 3% Latino. Most common cancers: thoracic 19% and digestive system (14% other, 11% colorectal). 28% had known stage IV disease. The MST was completed in 79%. Among those with MST ≥2 (N=1,005; 25%), DDMN and PCMN prevalence was 30% and 22%, respectively. In the entire cohort, 8% had DDMN; 7% PCMN; 4% both. Prevalence of MN risk, DDMN, and PCMN by cancer site are in the Table. DDMN (N=420) was mild 2%, moderate 16%; severe 66%; unspecified 16%. On discharge, PCMN (N=360) was mild 10%; moderate 0%; severe 69%; unspecified 21%. Male gender (OR 1.27 [1.01, 1.59]), Black race (OR 1.57 [1.25, 1.98]), stage IV disease (v. I-III) (OR 3.08 [2.49, 3.82]), and primary site were all independent predictors of DDMN (all p<0.05); Black race (OR 1.46 [1.14, 1.87]), stage IV disease (OR 2.70 [2.15, 3.39]), and primary site were independent predictors of PCMN (all p<0.05). Conclusions: 25% of cancer inpatients were at high risk for MN. Primary site, disease stage, and race were independent predictors of a greater risk. MN appears to be under-diagnosed compared to population studies. This is the first study to report the prevalence of MN in a large cancer inpatient database with a representative population.[Table: see text]

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History of Depression and Increased Risk of Sternal Wound Infection After Cardiothoracic Surgery: A Novel and Potentially Modifiable Risk Factor

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz083 ◽

2019 ◽

Vol 6 (3) ◽

Author(s):

Deborah A Theodore ◽

Renee D Goodwin ◽

Yuan (Vivian) Zhang ◽

Nancy Schneider ◽

Rachel J Gordon

Keyword(s):

Risk Factors ◽

Wound Infection ◽

Medical Center ◽

Academic Medical Center ◽

Cardiothoracic Surgery ◽

Sternal Wound Infection ◽

Composite Variable ◽

Increased Risk ◽

History Of ◽

History Of Depression

Abstract Background Sternal wound infection (SWI) is a leading cause of postoperative disease and death; the risk factors for SWI remain incompletely understood. The goal of the current study was to investigate the relationship between a preoperative history of depression and the risk of SWI after cardiothoracic surgery. Methods Among patients undergoing cardiothoracic surgery in a major academic medical center between 2007 and 2012, those in whom SWI developed (n = 129) were matched, by date of surgery, with those in whom it did not (n = 258). Multivariable logistic regression was used to examine the strength of relationships between risk factors and development of infection. History of depression was defined as a composite variable to increase the sensitivity of detection. Results History of depression as defined by our composite variable was associated with increased risk of SWI (adjusted odds ratio, 2.4; 95% confidence interval, 1.2–4.7; P = .01). Staphylococcus aureus was the most common organism isolated. Conclusions History of depression was associated with increased risk of SWI. Future prospective studies are warranted to further investigate this relationship. Depression is highly treatable, and increased efforts to identify and treat depression preoperatively may be a critical step toward preventing infection-related disease and death.

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Association between Interleukin-6 Levels and Perioperative Fatigue in Gastric Adenocarcinoma Patients

Journal of Clinical Medicine ◽

10.3390/jcm8040543 ◽

2019 ◽

Vol 8 (4) ◽

pp. 543 ◽

Cited By ~ 3

Author(s):

Jin-Ming Wu ◽

Hui-Ting Yang ◽

Te-Wei Ho ◽

Shiow-Ching Shun ◽

Ming-Tsan Lin

Keyword(s):

Confidence Interval ◽

Gastric Adenocarcinoma ◽

Cancer Cachexia ◽

Medical Center ◽

Academic Medical Center ◽

Gastric Surgery ◽

Time Points ◽

Cell Counts ◽

Cytokine Levels ◽

The Mean

Background: Gastric adenocarcinoma (GA), one of the most common gastrointestinal cancers worldwide, is often accompanied by cancer cachexia in the advanced stage owing to malnutrition and cancer-related symptoms. Although resection is the most effective curative procedure for GA patients, it may cause perioperative fatigue, worsening the extent of cancer cachexia. Although the relationship between cytokines and cancer fatigue has been evaluated, it is unclear which cytokines are associated with fatigue in GA patients. Therefore, this study aimed to investigate whether the changes in cytokine levels were associated with the perioperative changes in fatigue amongst GA patients. Methods: We included GA patients undergoing gastric surgery in a single academic medical center between June 2017 and December 2018. Fatigue-related questionnaires, serum cytokine levels (interferon-gamma, interleukin (IL)-1, IL-2, IL-5, IL-6, IL-12 p70, tumor necrosis factor-alpha, and granulocyte-macrophage colony-stimulating factor), and biochemistry profiles (albumin, prealbumin, C-reactive protein, and white blood cell counts) were assessed at three time points (preoperative day 0 (POD 0), post-operative day 1 (POD 1), and postoperative day 7 (POD 7)). We used the Brief Fatigue Inventory-Taiwan Form to assess the extent of fatigue. The change in fatigue scores among the three time points, as an independent variable, was adjusted for clinicopathologic characteristics, malnutrition risk, and cancer stages. Results: A total of 34 patients were included for analysis, including 12 female and 22 male patients. The mean age was 68.9 years. The mean score for fatigue on POD 0, POD 1, and POD 7 was 1.7, 6.2, and 3.6, respectively, with significant differences among the three time points (P < 0.001). Among the cytokines, only IL-6 was significantly elevated from POD 0 to POD 1. In the regression model, the change in IL-6 levels between POD 0 and POD 1 (coefficients = 0.01 for every 1 pg/mL increment; 95% confidence interval: 0.01–0.02; P = 0.037) and high malnutrition risk (coefficients = 2.80; 95% confidence interval: 1.45–3.52; P = 0.041) were significantly associated with changes in fatigue scores. Conclusions: The perioperative changes in plasma IL-6 levels are positively associated with changes in the fatigue scores of GA patients undergoing gastric surgery. Targeting the IL-6 signaling cascade or new fatigue-targeting medications may attenuate perioperative fatigue, and further clinical studies should be designed to validate this hypothesis.

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