Anesthetic choice for arteriovenous access creation: A National Anesthesia Clinical Outcomes Registry analysis

Background: We sought to evaluate differences in primary anesthetic type used in arteriovenous access creation with the hypothesis that administration of regional anesthesia and monitored anesthesia care (MAC) with local anesthesia as the primary anesthetic has increased over time. Methods: National Anesthesia Clinical Outcomes Registry data were retrospectively evaluated. Covariates were selected a priori within multivariate models to determine predictors of anesthetic type in adults who underwent elective arteriovenous access creation between 2010 and 2018. Results: A total of 144,392 patients met criteria; 90,741 (62.8%) received general anesthesia. The use of regional anesthesia and MAC decreased over time (8.0%–6.8%, 36.8%–27.8%, respectively; both p < 0.0001). Patients who underwent regional anesthesia were more likely to have ASA physical status >III and to reside in rural areas (52.3% and 12.9%, respectively; both p < 0.0001). Patients who underwent MAC were more likely to be older, male, receive care outside the South, and reside in urban areas (median age 65, 56.8%, 68.1%, and 70.8%, respectively; all p < 0.0001). Multivariate analysis revealed that being male, having an ASA physical status >III, and each 5-year increase in age resulted in increased odds of receiving alternatives to general anesthesia (regional anesthesia adjusted odds ratios (AORs) 1.06, 1.12, and 1.26, MAC AORs 1.09, 1.2, and 1.1, respectively; all p < 0.0001). Treatment in the Midwest, South, or West was associated with decreased odds of receiving alternatives to general anesthesia compared to the Northeast (regional anesthesia AORs 0.28, 0.38, and 0.03, all p < 0.0001; MAC 0.76, 0.13, and 0.43, respectively; all p < 0.05). Conclusions: Use of regional anesthesia and MAC with local anesthesia for arteriovenous access creation has decreased over time with general anesthesia remaining the primary anesthetic type. Anesthetic choice, however, varies with patient characteristics and geography.

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Analyses of Nocturnal Temperature Cooling-Rate Response to Historical Local-Scale Urban Land-Use/Land Cover Change

Journal of Applied Meteorology and Climatology ◽

10.1175/jamc-d-10-05014.1 ◽

2011 ◽

Vol 50 (9) ◽

pp. 1872-1883 ◽

Cited By ~ 24

Author(s):

Winston T. L. Chow ◽

Bohumil M. Svoma

Keyword(s):

Land Use ◽

Land Cover ◽

Cooling Rate ◽

Rural Areas ◽

Urban Areas ◽

Local Scale ◽

Urban Land Use ◽

Cooling Rates ◽

Near Surface ◽

Over Time

AbstractUrbanization affects near-surface climates by increasing city temperatures relative to rural temperatures [i.e., the urban heat island (UHI) effect]. This effect is usually measured as the relative temperature difference between urban areas and a rural location. Use of this measure is potentially problematic, however, mainly because of unclear “rural” definitions across different cities. An alternative metric is proposed—surface temperature cooling/warming rates—that directly measures how variations in land-use and land cover (LULC) affect temperatures for a specific urban area. In this study, the impact of local-scale (<1 km2), historical LULC change was examined on near-surface nocturnal meteorological station temperatures sited within metropolitan Phoenix, Arizona, for 1) urban versus rural areas, 2) areas that underwent rural-to-urban transition over a 20-yr period, and 3) different seasons. Temperature data were analyzed during ideal synoptic conditions of clear and calm weather that do not inhibit surface cooling and that also qualified with respect to measured near-surface wind impacts. Results indicated that 1) urban areas generally observed lower cooling-rate magnitudes than did rural areas, 2) urbanization significantly reduced cooling rates over time, and 3) mean cooling-rate magnitudes were typically larger in summer than in winter. Significant variations in mean nocturnal urban wind speeds were also observed over time, suggesting a possible UHI-induced circulation system that may have influenced local-scale station cooling rates.

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THE INFLUENCE OF LONELINESS AND RURAL RESIDENCE ON DEPRESSION IN LATER LIFE

Innovation in Aging ◽

10.1093/geroni/igz038.3051 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S828-S828

Author(s):

Na Sun ◽

Cassandra Hua ◽

Xiao Qiu ◽

J Scott Brown

Keyword(s):

Older Adults ◽

Rural Areas ◽

Urban Areas ◽

Later Life ◽

Rural Residence ◽

Time Data ◽

Latent Curve ◽

Rural Residency ◽

Latent Curve Models ◽

Over Time

Abstract Loneliness is associated with depression among older adults. Limited research has examined the role of rurality in relationship to loneliness and depression; the extant research has mixed findings. The socioemotional selectivity theory states that as people age the quality of relationships become more important than the quantity (English & Carstensen, 2016). Individuals in rural areas may have a low quantity of relationships but deeper social ties within the community; thus, they may be less likely to become depressed over time. The association between loneliness and depression may be amplified for people in non-rural areas because they are surrounded by other people but lack close relationships that are most important during the aging process. This study examines the effect of living in rural areas on loneliness on predicting baseline depression and loneliness, as well as changes in these outcomes over time. Data are from the 2006-2014 waves of Health Retirement Study. Regression models examine the relationship between depression loneliness and rural residence controlling for health conditions and demographic characteristics. Latent curve models examine the disparity in trajectories of loneliness and depressive symptoms by urban and rural residence. Older adults who feel lonely (p<.001) and in urban areas (p<.0.05) are more likely to be depressed. Furthermore, the effect of loneliness on depression is weakened by rural residence (p<.05). It is salient to understand the protective effect of rural residency on depression among older adults in the U.S. We discuss implications for policy.

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General, regional or local anesthesia for successful radial cephalic arteriovenous fistula

The Journal of Vascular Access ◽

10.5301/jva.5000676 ◽

2017 ◽

Vol 18 (1_suppl) ◽

pp. S24-S28 ◽

Cited By ~ 3

Author(s):

David Shemesh ◽

Yefim Raikhinstein ◽

Ilya Goldin ◽

Oded Olsha

Keyword(s):

General Anesthesia ◽

Local Anesthesia ◽

Regional Anesthesia ◽

Vascular Access ◽

Early Failure ◽

Randomized Clinical Study ◽

Increased Risk ◽

Time Required ◽

Plexus Block ◽

Access Surgery

Autogenous fistulas and in particular radiocephalic fistulas are recommended as the first vascular access for hemodialysis. Unfortunately, the rates of early failure and non-maturation are very high. For more than a decade, brachial plexus block has been proposed as the anesthesia of choice for fistula creation due to its beneficial sympathectomy-like effect, causing vasodilation and attenuation of spasm. Until recently, there was not a single randomized clinical study supporting this proposition. Because performing regional anesthesia is time-consuming and requires expertise, many surgeons prefer local or general anesthesia for vascular access surgery. However, in August 2016 a randomized clinical trial was published showing that regional anesthesia significantly reduces early failure and improves primary and functional patency at 3 months compared to local anesthesia. The aging of the dialysis population, with their attendant morbidity and increased risk for general anesthesia, makes it clear that regional anesthesia is the recommended approach for fistula creation. The excess time required for this approach will decrease with increasing expertise along the learning curve, and will be compensated by a reduction in time that would otherwise be needed for new access construction due to failure of fistulas constructed under local anesthesia.

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Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617748550 ◽

2017 ◽

Vol 8 (1) ◽

pp. 8-14 ◽

Cited By ~ 4

Author(s):

Jan Mannsverk ◽

Terje Steigen ◽

Harald Wang ◽

Pål Morten Tande ◽

Birgitte Mannsverk Dahle ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Thrombolytic Therapy ◽

Clinical Outcomes ◽

Rural Areas ◽

Systolic Heart Failure ◽

Coronary Intervention ◽

Ambulance Personnel ◽

Percutaneous Coronary ◽

Over Time

Background: Prehospital thrombolytic therapy given by ambulance emergency medical services to patients with acute ST-segment elevation myocardial infarction (STEMI) may produce earlier reperfusion than percutaneous coronary intervention. Clinical results from prehospital thrombolytic therapy in rural areas are scarce. Methods: We studied outcomes during 11 years of a prehospital thrombolytic therapy system in rural sub-arctic Norway. Ambulance personnel gave protocol basic treatment and transmitted electrocardiograms to hospital physicians who made the decision for prehospital thrombolytic therapy. The study was divided into three time periods; 2000–2003, 2004–2007 and 2008–2011. Results: A total of 385 STEMI patients received prehospital thrombolytic therapy, median patient age was 61.2 years, and 77% were men. Time saved by prehospital reperfusion therapy was 131 minutes. The proportion who got prehospital thrombolytic therapy within 2 hours of symptom onset increased from 21% in 2000–2003 to 39% in 2008–2011 ( P=0.003). The proportion who underwent coronary angiography or percutaneous coronary intervention within 24 hours of first medical contact increased from 56.4% to 95.4% ( P<0.001). Post-STEMI systolic heart failure decreased from 19.4% to 8.1% ( P=0.02), while 1-year mortality fell, non-significantly, by 50% over time to reach 5.6%. Thirteen patients suffered acute out-of-hospital cardiac arrest; all were successfully defibrillated. Ten patients had major bleeding events (2.6%). Conclusion: A decentralised prehospital thrombolytic therapy system based on ambulance personnel, telemetry and centralised 7/24 invasive diagnosis and treatment service, combined with system maturation over time, was associated with earlier reperfusion, improved clinical outcomes and better survival. Prehospital thrombolytic therapy is a feasible and safe intervention used in rural settings with long evacuation lines to percutaneous coronary intervention facilities.

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The synchronicity of COVID-19 disparities: Statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America

PLoS ONE ◽

10.1371/journal.pone.0255063 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0255063

Author(s):

Brian E. Dixon ◽

Shaun J. Grannis ◽

Lauren R. Lembcke ◽

Nimish Valvi ◽

Anna R. Roberts ◽

...

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Urban Areas ◽

Minority Groups ◽

Mortality Rates ◽

Urban Environments ◽

Racial Minorities ◽

Morbidity And Mortality ◽

Multiple Time ◽

Over Time

Background Early studies on COVID-19 identified unequal patterns in hospitalization and mortality in urban environments for racial and ethnic minorities. These studies were primarily single center observational studies conducted within the first few weeks or months of the pandemic. We sought to examine trends in COVID-19 morbidity, hospitalization, and mortality over time for minority and rural populations, especially during the U.S. fall surge. Methods Data were extracted from a statewide cohort of all adult residents in Indiana tested for SARS-CoV-2 infection between March 1 and December 31, 2020, linked to electronic health records. Primary measures were per capita rates of infection, hospitalization, and death. Age adjusted rates were calculated for multiple time periods corresponding to public health mitigation efforts. Comparisons across time within groups were compared using ANOVA. Results Morbidity and mortality increased over time with notable differences among sub-populations. Initially, hospitalization rates among racial minorities were 3–4 times higher than whites, and mortality rates among urban residents were twice those of rural residents. By fall 2020, hospitalization and mortality rates in rural areas surpassed those of urban areas, and gaps between black/brown and white populations narrowed. Changes across time among demographic groups was significant for morbidity and hospitalization. Cumulative morbidity and mortality were highest among minority groups and in rural communities. Conclusions The synchronicity of disparities in COVID-19 by race and geography suggests that health officials should explicitly measure disparities and adjust mitigation as well as vaccination strategies to protect those sub-populations with greater disease burden.

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Deadly Tornadoes in Poland from 1820 to 2015

Monthly Weather Review ◽

10.1175/mwr-d-16-0146.1 ◽

2017 ◽

Vol 145 (4) ◽

pp. 1221-1243 ◽

Cited By ~ 9

Author(s):

Mateusz Taszarek ◽

Jakub Gromadzki

Keyword(s):

Spatial Distribution ◽

Digital Libraries ◽

Rural Areas ◽

Urban Areas ◽

Historical Sources ◽

South Central ◽

Tornado Damage ◽

Over Time

Abstract Using historical sources derived from 12 Polish digital libraries, an investigation into killer tornado events was carried out. Although some of the cases took place more than 150 years ago, it was still possible to identify tornado phenomena and the course of events. This study has shown that historical sources contain dozens of tornado reports, sometimes with information precise enough to reconstruct the tornado damage paths. In total, 26 newly identified deadly tornado cases were derived from the historical sources and the information on 11 currently known was expanded. An average of 1–2 killer tornadoes with 5 fatalities may be depicted for each decade and this rate is decreasing over time. It was estimated that 5%–10% of significant tornadoes in Poland have caused fatalities and the average number of fatalities per significant tornado was roughly 0.27. Most of the cases were reported in late July and early August. The majority of deaths and injuries were associated with victims being lifted or crushed by buildings (usually a wooden barn). Most of these cases took place in rural areas but some tornadoes hit urban areas, causing a higher number of fatalities. The spatial distribution of cases included maxima in the central lowland and south-central upland of Poland. In a noticeable fraction of cases (38%), large hail occurred either before or after passage of the tornado.

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Periprocedural safety and outcome after pump implantation for intravenous treprostinil administration in patients with pulmonary arterial hypertension

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01541-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jan C. Kamp ◽

Jan Fuge ◽

Jan F. Karsten ◽

Stefan Rümke ◽

Marius M. Hoeper ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

General Anesthesia ◽

Clinical Outcomes ◽

Local Anesthesia ◽

Primary Objective ◽

Related Complication ◽

Pulmonary Arterial ◽

Pump Implantation

Abstract Methods In this retrospective observational study, we analyzed all patients with pulmonary arterial hypertension undergoing LenusPro® pump implantation between November 2013 and October 2019 at our center. Periprocedural safety was assessed by describing all complications that occurred within 28 days after surgery; complications that occurred later were described to assess long-term safety. Clinical outcomes were measured by comparison of clinical parameters and echocardiographic measurements of right ventricular function from baseline to 6-months-follow-up. Results Fifty-four patients underwent LenusPro® pump implantation for intravenous treprostinil treatment during the investigation period. Periprocedural complications occurred in 5 patients; the only anesthesia-related complication (right heart failure with recovery after prolonged intensive care and death in the further course) occurred in the only patient who underwent general anesthesia. All other patients underwent local anesthesia with or without short-acting (analgo-) sedation. Eighteen long-term complications occurred in 15 patients, most notably pump pocket or catheter related problems. Transplant-free survival rates at 1, 2, and 3 years were 77 %, 56 %, and 48 %, respectively. Conclusions Subcutaneous pump implantation under local anesthesia and conscious analgosedation while avoiding intubation and mechanical ventilation is feasible in patients with advanced PAH. Controlled studies are needed to determine the safest anesthetic approach for this procedure. Background/Objectives Intravenous treprostinil treatment via a fully implantable pump is a treatment option for patients with advanced pulmonary arterial hypertension. However, there is no consensus on the preferred anesthetic approach for the implantation procedure. Primary objective was to assess periprocedural safety with particular attention to feasibility of local anesthesia and conscious analgosedation instead of general anesthesia. Long-term safety and clinical outcomes were secondary endpoints.

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Opioid Misuse in Missouri: Analyzing Emergency Department Use in Urban/Rural Areas

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v10i1.8338 ◽

2018 ◽

Vol 10 (1) ◽

Author(s):

Evan Mobley ◽

Andrew Hunter ◽

Whitney Coffey

Keyword(s):

Emergency Department ◽

Rural Areas ◽

Urban Areas ◽

The State ◽

Opioid Overdose ◽

Metro Area ◽

Urban Rural ◽

Ed Visits ◽

Changes Over Time ◽

Over Time

ObjectiveCompare rate changes over time for Emergency Department (ED) visits due to opioid overdose in urban versus rural areas of the state of Missouri.IntroductionLike many other states in the U.S., Missouri has experienced large increases in opioid abuse resulting in hundreds dying each year and thousands of ED visits due to overdose. Missouri has two major urban areas, St. Louis and Kansas City and a few smaller cities, while the remainder of the state is more rural in nature. The opioid epidemic has impacted all areas in the state but the magnitude of that impact varies as well as the type of opioid used. Missouri Department of Health and Senior Services (MODHSS) maintains the Patient Abstract System (PAS) which contains data from hospitals and ambulatory surgical centers throughout the state. PAS includes data from ED visits including information on diagnoses, patient demographics, and other information about the visit. MODHSS also participates in the Enhanced State Surveillance of Opioid-involved Morbidity and Mortality project (ESOOS). One major aspect of this surveillance project is the collection of data on non-fatal opioid overdoses from ED visits. Through this collection of data, MODHSS analyzed opioid overdose visits throughout the state, how rates compare across urban and rural areas, and how those rates have changed over time.MethodsThe 115 counties in Missouri were organized into the six-level urban-rural classification scheme developed by the National Center for Health Statistics (NCHS). The attached table shows the breakout of counties into the six different categories. The data years analyzed were 2012 through 2016. ED visits due to opioid overdose were identified using case definitions supplied by ESOOS. Overdoses were analyzed in three different categories—all opioids, heroin, and non-heroin opioids. The all opioid category combines heroin and non-heroin opioids. Non-heroin opioids includes prescription drugs such as oxycodone, hydrocodone, fentanyl, and fentanyl analogues. Annual rates per 10,000 were calculated for each county classification using population estimates. Confidence intervals (at 95%) were then calculated using either inverse gamma when the number of ED visits was under 500, or Poisson when the number was 500 or more. Changes over time were calculated using both a year over year method and a 5 year change method.ResultsOverall opioid rates have increased in all geographic areas during the 5 year period analyzed. Large Central Metro and Large Fringe Metro counties had the highest rates of ED visits due to opioid overdose. These two classifications also saw the largest increases in rates. The Large Central Metro counties collectively increased over 125%, while the Large Fringe Metro area increased 130%. Both areas experienced statistically significant increases year-to-year between 2014 and 2016 in addition to the overall 5 year period of 2012-2016.Analysis was also conducted for heroin and non-heroin subsets of opioid abuse. There were important differences in these two groups. For heroin ED visits, the highest rates were found in the Large Central Metro and Large Fringe Metro regions. However, the largest increase in percentage terms were found in the Medium Metropolitan, Micropolitan and Noncore regions which all saw increases of over 300%. Notably, every region experienced increases of over 150%. The Medium Metro had two consecutive years (2013/2014 and 2014/2015) where the heroin ED rate more than doubled.In contrast, non-heroin ED visits did not experience such a large increase over time. Most areas saw small fluctuations year-to-year with moderate overall increases over the 5-year time period. The exception to this trend is the Large Fringe Metro area, which saw increases every year most notably between 2014 and 2015 and had by far the largest 5 year increase at 82%.ConclusionsThe urban areas in Missouri continue to have the highest rates of opioid overdose, however all areas within the state have experienced very large increases in heroin ED visits within the past five years. The increase in heroin ED visits in the rural areas suggests the abuse of heroin has now spread throughout the state, as rates were much lower in 2012. The steady increase in non-heroin opioids unique to the Large Fringe Metro may be due to the availability of fentanyl in urban areas especially the St. Louis area. This possible finding would correspond with the increased deaths due to fentanyl experienced in and around the St. Louis urban area that has been identified through analysis of death certificate data.

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The COVID-19 health equity twindemic: Statewide epidemiologic trends of SARS-CoV-2 outcomes among racial minorities and in rural America

10.1101/2021.03.03.21252861 ◽

2021 ◽

Author(s):

Brian E. Dixon ◽

Shaun J. Grannis ◽

Lauren Lembcke ◽

Anna Roberts ◽

Peter J. Embi

Keyword(s):

Rural Communities ◽

Rural Areas ◽

Urban Areas ◽

Minority Groups ◽

Urban Environments ◽

Racial Minorities ◽

Morbidity And Mortality ◽

Multiple Time ◽

Per Capita ◽

Over Time

AbstractBackgroundEarly studies on COVID-19 identified unequal patterns in hospitalization and mortality in urban environments for racial and ethnic minorities. These studies were primarily single center observational studies conducted within the first few weeks or months of the pandemic. We sought to examine trends in COVID-19 morbidity and mortality over time for minority and rural populations, especially during the U.S. fall surge.MethodsStatewide cohort of all adult residents in Indiana tested for SARS-CoV-2 infection between March 1 and December 31, 2020, linked to electronic health records. Primary measures were per capita rates of infection, hospitalization, and death. Age adjusted rates were calculated for multiple time periods corresponding to public health mitigation efforts.ResultsMorbidity and mortality increased over time with notable differences among sub-populations. Initially, per capita hospitalizations among racial minorities were 3-4 times higher than whites, and per capita deaths among urban residents were twice those of rural residents. By fall 2020, per capita hospitalizations and deaths in rural areas surpassed those of urban areas, and gaps between black/brown and white populations narrowed. Cumulative morbidity and mortality were highest among minority groups and in rural communities.ConclusionsBurden of COVID-19 morbidity and mortality shifted over time, creating a twindemic involving disparities in outcomes based on race and geography. Health officials should explicitly measure disparities and adjust mitigation and vaccination strategies to protect vulnerable sub-populations with greater disease burden.

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Mortality and Urological Complications After Open Groin Hernia Repair in Local, General, and Regional Anesthesia: A Nationwide Linked Register Study

Scandinavian Journal of Surgery ◽

10.1177/1457496919877580 ◽

2019 ◽

pp. 145749691987758

Author(s):

J. H. H. Olsen ◽

K. Andresen ◽

S. Öberg ◽

L. Q. Mortensen ◽

J. Rosenberg

Keyword(s):

Confidence Interval ◽

Hernia Repair ◽

General Anesthesia ◽

Urinary Retention ◽

Local Anesthesia ◽

Regional Anesthesia ◽

Odds Ratio ◽

Groin Hernia ◽

Groin Hernia Repair ◽

Urological Complications

Background and Aims: The choice of anesthesia method may influence mortality and postoperative urological complications after open groin hernia repair. We aimed to investigate the association between type of anesthesia and incidence of urinary retention, urethral stricture, prostate surgery, and 1-year mortality after open groin hernia repair. Materials and Methods: Data were linked from the Danish Hernia Database, the national patient register, and the register of causes of death. We investigated data on male adult patients receiving open groin hernia repair from 1999 to 2013 with either local anesthesia, regional anesthesia, or general anesthesia. In relation to the type of anesthesia, we compared mortality and urological complications up to 1 year postoperatively. We adjusted for covariates in a logistic regression assessing urological complications and with the Cox regression assessing mortality. Results: We included 113,069 open groin hernia repairs in local anesthesia, regional anesthesia, or general anesthesia. The risk of urinary retention adjusted for covariates was higher after both general anesthesia (adjusted odds ratio = 1.64, 95% confidence interval = 1.05–2.57, p = 0.031) and regional anesthesia (odds ratio = 2.99, 95% confidence interval = 1.67–5.34, p < 0.0005) compared with local anesthesia. The adjusted risk of prostate surgery was also higher for both general anesthesia (odds ratio = 1.58, 95% confidence interval = 1.23–2.03, p < 0.0005) and regional anesthesia (odds ratio = 1.90, 95% confidence interval = 1.40–2.58, p < 0.0005) compared with local anesthesia. Type of anesthesia did not influence 1-year mortality or the risk for urethral stricture. Conclusion: Patients undergoing open groin hernia repair in local anesthesia experience the lowest rate of urological complications and have equally low mortality compared with patients undergoing repair in general anesthesia or regional anesthesia.

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