Gallstone Pancreatitis: A Benign Disease in Hispanics

Little is known about ethnic differences among patients with gallstone pancreatitis in the United States. The purpose of this study was to compare Hispanic and non-Hispanic patients with gallstone pancreatitis with regard to severity of disease, level of care required, length of hospital stay, and clinical outcomes. A retrospective cohort study of 198 consecutive patients with gallstone pancreatitis was performed from 2003 to 2005. Overall, 161 patients were Hispanic and 37 were non-Hispanic. The average age of Hispanic patients was 41 years versus 47.5 years in the non-Hispanic group ( P = 0.02). Only 16 (10%) Hispanic patients had a Ranson score of 2 or greater versus nine (24%) of the non-Hispanic group ( P = 0.03). Only 39 (24%) Hispanic patients were admitted to an intensive care unit or stepdown unit versus 17 (46%) of the non-Hispanic group ( P = 0.01). Hispanic patients underwent cholecystectomy at an average of 5.8 days after admission versus 6.6 days for non-Hispanic patients ( P = 0.07). There was a 4 per cent complication rate and a 2 per cent readmission rate overall with no statistically significant differences between the two groups and no mortality. The majority of Hispanic patients with gallstone pancreatitis have a benign disease process, presenting at a younger age, with less severe disease that infrequently requires intensive care unit admission.

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Evolving oxygenation management reasoning in COVID-19

Diagnosis ◽

10.1515/dx-2020-0099 ◽

2020 ◽

Vol 7 (4) ◽

pp. 381-383

Author(s):

Steven Liu ◽

Cara Sweeney ◽

Nalinee Srisarajivakul-Klein ◽

Amanda Klinger ◽

Irina Dimitrova ◽

...

Keyword(s):

United States ◽

Intensive Care Unit ◽

New York ◽

New York City ◽

Intensive Care ◽

Initial Phase ◽

The United States ◽

Lessons Learned ◽

Hypoxemic Respiratory Failure ◽

Hospital Wards

AbstractThe initial phase of the SARS-CoV-2 pandemic in the United States saw rapidly-rising patient volumes along with shortages in personnel, equipment, and intensive care unit (ICU) beds across many New York City hospitals. As our hospital wards quickly filled with unstable, hypoxemic patients, our hospitalist group was forced to fundamentally rethink the way we triaged and managed cases of hypoxemic respiratory failure. Here, we describe the oxygenation protocol we developed and implemented in response to changing norms for acuity on inpatient wards. By reflecting on lessons learned, we re-evaluate the applicability of these oxygenation strategies in the evolving pandemic. We hope to impart to other providers the insights we gained with the challenges of management reasoning in COVID-19.

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Healthcare-Associated Infections among Patients in a Large Burn Intensive Care Unit: Incidence and Pathogens, 2008–2012

Infection Control and Hospital Epidemiology ◽

10.1086/678067 ◽

2014 ◽

Vol 35 (10) ◽

pp. 1304-1306 ◽

Cited By ~ 16

Author(s):

David J. Weber ◽

David van Duin ◽

Lauren M. DiBiase ◽

Charles Scott Hultman ◽

Samuel W. Jones ◽

...

Keyword(s):

United States ◽

Intensive Care Unit ◽

Intensive Care ◽

The United States ◽

Burn Injuries ◽

Morbidity And Mortality ◽

Common Source ◽

Healthcare Associated Infections ◽

Burn Patients ◽

Healthcare Associated

Burn injuries are a common source of morbidity and mortality in the United States, with an estimated 450,000 burn injuries requiring medical treatment, 40,000 requiring hospitalization, and 3,400 deaths from burns annually in the United States. Patients with severe burns are at high risk for local and systemic infections. Furthermore, burn patients are immunosuppressed, as thermal injury results in less phagocytic activity and lymphokine production by macrophages. In recent years, multidrug-resistant (MDR) pathogens have become major contributors to morbidity and mortality in burn patients.Since only limited data are available on the incidence of both device- and nondevice-associated healthcare-associated infections (HAIs) in burn patients, we undertook this retrospective cohort analysis of patients admitted to our burn intensive care unit (ICU) from 2008 to 2012.

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Candidemia in an intensive care unit

Medicina ◽

10.3390/medicina45050044 ◽

2008 ◽

Vol 45 (5) ◽

pp. 351

Author(s):

Dalia Adukauskienė ◽

Aida Kinderytė ◽

Asta Dambrauskienė ◽

Astra Vitkauskienė

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Risk Factor ◽

Intensive Care ◽

Urinary Bladder ◽

Intensive Care Units ◽

Severe Disease ◽

Candida Spp ◽

Lethal Outcome ◽

Bladder Catheter

Candidemia is becoming more actual because of better survival of even critically ill patients, wide use of antimicrobials, and increased numbers of invasive procedures and manipulations. Diagnosis of candidemia remains complicated, and costs of treatment and mortality rates are increasing. Objective. To evaluate the pathogens of candidemia, risk factors and their influence on outcome. Material and methods. Data of 41 patients with positive blood culture for Candida spp., who were treated in the intensive care units at the Hospital of Kaunas University of Medicine, were analyzed retrospectively. Results. Candidemia was caused by Candida albicans (C. albicans) in 48.8% (n=20) of patients and by non-albicans Candida in 51.2% (n=21) of patients. The main cause of candidemia was C. albicans in 2004 (83.3%, n=5), but in 2005 (63.6%, n=7), in 2006 (57.1%, n=4), and in 2007 (52.9%, n=9), the main cause was non-albicans Candida spp. The number of candidemia cases caused by C. albicans was decreased in 2005, 2006, and 2007 as compared with 2004, and the number of candidemia caused by non-albicans Candida spp. was decreased, respectively (P<0.05). More than 65% (n=34) of patients had severe disease (P<0.05). Lethal outcome was recorded in 58.5% of patients with candidemia. Mechanical ventilation was used in 76.9% (n=20) and urinary bladder catheter in 72.1% (n=19) of non-survivors and in 23.1% (n=6) and 26.9% (n=7) of survivors, respectively (P<0.05). Conclusions. There is an increase in the prevalence of candidemia in the intensive care units during the 4-year period; half of candidemia cases were caused by non-albicans Candida spp., and patients with candidemia caused by non-albicans Candida spp. are at higher risk of mortality. Therefore, for the empirical treatment of septic conditions in an intensive care unit, when invasive fungal infection is suspected, we recommend using an antifungal agent of non-azole class until a pathogen of candidemia is determined. Severe disease is evaluated as a risk factor for candidemia. Patients with oncological diseases are at significantly higher risk for candidemia caused by non-albicans Candida spp. Use of mechanical ventilation and urinary bladder catheter is a risk factor for lethal outcome.

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Advances in the Management of Sepsis and the Understanding of Key Immunologic Defects

Anesthesiology ◽

10.1097/aln.0b013e31823422e8 ◽

2011 ◽

Vol 115 (6) ◽

pp. 1349-1362 ◽

Cited By ~ 27

Author(s):

Lee P. Skrupky ◽

Paul W. Kerby ◽

Richard S. Hotchkiss

Keyword(s):

United States ◽

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Operating Room ◽

The United States ◽

Difficult Problem ◽

Treatment Algorithms ◽

New Treatment ◽

Overall Mortality

Anesthesiologists are increasingly confronting the difficult problem of caring for patients with sepsis in the operating room and in the intensive care unit. Sepsis occurs in more than 750,000 patients in the United States annually and is responsible for more than 210,000 deaths. Approximately 40% of all intensive care unit patients have sepsis on admission to the intensive care unit or experience sepsis during their stay in the intensive care unit. There have been significant advances in the understanding of the pathophysiology of the disorder and its treatment. Although deaths attributable to sepsis remain stubbornly high, new treatment algorithms have led to a reduction in overall mortality. Thus, it is important for anesthesiologists and critical care practitioners to be aware of these new therapeutic regimens. The goal of this review is to include practical points on important advances in the treatment of sepsis and provide a vision of future immunotherapeutic approaches.

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The prevalence of and attitudes toward neonatal functional echocardiography use and training in the United States: A survey of neonatal intensive care unit medical directors

Journal of Neonatal-Perinatal Medicine ◽

10.3233/npm-1474013 ◽

2014 ◽

Vol 7 (2) ◽

pp. 125-130 ◽

Cited By ~ 5

Author(s):

S. Schachinger ◽

R.B. Stansfield ◽

G. Ensing ◽

R. Schumacher

Keyword(s):

United States ◽

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

The United States ◽

Medical Directors ◽

And Training

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Sedation in the Pediatric Intensive Care Unit: Challenges, Outcomes, and Future Strategies in the United States

Pediatric Sedation Outside of the Operating Room ◽

10.1007/978-1-4939-1390-9_16 ◽

2014 ◽

pp. 275-328

Author(s):

Joseph D. Tobias

Keyword(s):

United States ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

The United States

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Association of Healthcare Access With Intensive Care Unit Utilization and Mortality in Patients of Hispanic Ethnicity Hospitalized With COVID-19

Journal of Hospital Medicine ◽

10.12788/jhm.3717 ◽

2021 ◽

Vol 16 (11) ◽

Author(s):

Ferdinand Velasco ◽

Donghan M Yang ◽

Minzhe Zhang ◽

Tanna Nelson ◽

Thomas Sheffield ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Outcomes ◽

Disease Severity ◽

Healthcare System ◽

Multivariable Analysis ◽

Hospital Death ◽

Primary Language ◽

Hispanic Patients ◽

English Speaking

BACKGROUND: Racial and ethnic minority groups in the United States experience a disproportionate burden of COVID-19 deaths. OBJECTIVE: To evaluate whether outcome differences between Hispanic and non-Hispanic COVID-19 hospitalized patients exist and, if so, to identify the main malleable contributing factors. DESIGN, SETTING, PARTICIPANTS: Retrospective, cross-sectional, observational study of 6097 adult COVID-19 patients hospitalized within a single large healthcare system from March to November 2020. EXPOSURES: Self-reported ethnicity and primary language. MAIN OUTCOMES AND MEASURES: Clinical outcomes included intensive care unit (ICU) utilization and in-hospital death. We used age-adjusted odds ratios (OR) and multivariable analysis to evaluate the associations between ethnicity/language groups and outcomes. RESULTS: 32.1% of patients were Hispanic, 38.6% of whom reported a non-English primary language. Hispanic patients were less likely to be insured, have a primary care provider, and have accessed the healthcare system prior to the COVID-19 admission. After adjusting for age, Hispanic inpatients experienced higher ICU utilization (non-English-speaking: OR, 1.75; 95% CI, 1.47-2.08; English-speaking: OR, 1.13; 95% CI, 0.95-1.33) and higher mortality (non-English-speaking: OR, 1.43; 95% CI, 1.10-1.86; English-speaking: OR, 1.53; 95% CI, 1.19-1.98) compared to non-Hispanic inpatients. There were no observed treatment disparities among ethnic groups. After adjusting for age, Hispanic inpatients had elevated disease severity at admission (non-English-speaking: OR, 2.27; 95% CI, 1.89-2.72; English-speaking: OR, 1.33; 95% CI, 1.10-1.61). In multivariable analysis, the associations between ethnicity/language and clinical outcomes decreased after considering baseline disease severity (P < .001). CONCLUSION: The associations between ethnicity and clinical outcomes can be explained by elevated disease severity at admission and limited access to healthcare for Hispanic patients, especially non-English-speaking Hispanics.

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Eosinopenie als Biomarker des Schweregrads einer COVID-19-Infektion

Karger Kompass Autoimmun ◽

10.1159/000520189 ◽

2021 ◽

pp. 1-2

Author(s):

Panagiota Xanthouli

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Disease Severity ◽

Respiratory Diseases ◽

Severe Disease ◽

Public Hospitals ◽

Chronic Respiratory Diseases ◽

Lack Of Information ◽

Obstructive Sleep ◽

Increased Risk

Background: Studies on the role of eosinophils in coronavirus disease 2019 (COVID-19) are scarce, though available findings suggest a possible association with disease severity. Our study analyzes the relationship between eosinophils and COVID-19, with a focus on disease severity and patients with underlying chronic respiratory diseases. Methods: We performed a retrospective analysis of 3,018 subjects attended at two public hospitals in Madrid (Spain) with PCR-confirmed SARS-CoV-2 infection from January 31 to April 17, 2020. Patients with eosinophil counts less than 0.02 × 109/L were considered to have eosinopenia. Individuals with chronic respiratory diseases (n = 384) were classified according to their particular underlying condition, i.e., asthma, chronic pulmonary obstructive disease, or obstructive sleep apnea. Results: Of the 3018 patients enrolled, 479 were excluded because of lack of information at the time of admission. Of 2539 subjects assessed, 1,396 patients presented an eosinophil count performed on admission, revealing eosinopenia in 376 cases (26.93%). Eosinopenia on admission was associated with a higher risk of intensive care unit (ICU) or respiratory intensive care unit (RICU) admission (OR:2.21; 95% CI:1.42–3.45; p < 0.001) but no increased risk of mortality (p > 0.05). Conclusion: Eosinopenia on admission conferred a higher risk of severe disease (requiring ICU/RICU care), but was not associated with increased mortality. In patients with chronic respiratory diseases who develop COVID-19, age seems to be the main risk factor for progression to severe disease or death.

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Shiva’s Babies

Religion and Ethics in the Neonatal Intensive Care Unit ◽

10.1093/med/9780190636852.003.0008 ◽

2019 ◽

pp. 124-141

Author(s):

Swasti Bhattacharyya

Keyword(s):

United States ◽

Intensive Care Unit ◽

Intensive Care ◽

High Risk ◽

Neonatal Intensive Care ◽

Newborn Infants ◽

Nationwide Survey ◽

The United States ◽

Cultural Humility ◽

Religious Perspectives

Discussing religious views from within any tradition is challenging because they are not monolithic. However, it is worth exploring religious perspectives because they are often the foundation, whether conscious or not, of the reasoning underlying people’s decisions. Following a brief discussion on the importance of cultural humility and understanding the worldview of patients, the author focuses on Hindu perspectives regarding the care of infants in the neonatal intensive care unit. Along with applying six elements of Hindu thought (underlying unity of all life, multivalent nature of Hindu traditions, dharma, emphasis on societal good, karma, and ahimsa), the author incorporates perspectives of Hindu adults, living in the United States, who responded to a nationwide survey regarding the care of high-risk newborn infants in the hospital.

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