Tertiary Care Medical Center Research Articles

Prevalence and Clinical Outcome of Inpatient Hyperglycemia in a Tertiary Care Medical Centre

Aim: To determine the association between hyperglycaemia and clinical outcome in children admitted to a tertiary care medical centre Methods: A retrospective observational study was carried out on pediatric patients admitted to a tertiary care medical centre. A total of 160 cases were included. The details were recorded and the prevalence of hyperglycaemia and its association with clinical outcome was analysed. Results: A total of 120 patients (75%) had an admission blood glucose ≤ 120 mg/dl [(mean 97 ± 1 mg/dl (± SEM)], 31 children (19.3%) had an admission blood glucose level between 121–179 mg/dl (mean 151 ± 2 mg/dl), and 9 patients (5.6%) had a blood glucose level ≥ 180 mg/dl (mean 270 ± 14 mg/dl). Children with hyperglycemia were more likely to be admitted to the ICU (p<0.001) and had a longer length of ICU stay (p<0.001), but admission hyperglycemia was not associated with longer hospital stay or higher hospital mortality. Conclusion: Hyperglycemia is present in one-fourth of children admitted to the hospital, most of them without a history of diabetes prior to admission. There was no in-hospital mortality but however there was a greater need for ICU care and longer ICU stay in hyperglycemic patients. Keywords: Hyperglycemia, children, paediatrics, mortality, hospital stay

2001. Clinical management changes after positive multiplex gastrointestinal pathogen panel testing for evaluation of diarrhea

Abstract Background IDSA guidelines for diarrhea include pathogen-specific management. Compared to non-molecular tests, multiplex gastrointestinal pathogen panels (GIPPs) may allow for more timely and cost-effective diagnoses and care. However, this has yet to be definitively demonstrated. Our objective was to determine the impact of positive GIPP results on clinical management, including antimicrobial use. Methods We performed a retrospective study of patients with diarrhea and a positive GIPP result (xTAG Gastrointestinal Pathogen Panel, Luminex) at an academic, tertiary-care medical center from January-December 2018. We excluded immunocompromised patients (solid organ or stem cell transplant, HIV with absolute CD4 count < 200 cells/µL, primary immunodeficiency, and immunosuppressive medications including biologics). We collected patient and clinical data via electronic medical record review. Our primary outcome of interest was change in antimicrobial usage. Results A total of 2,333 GIPP tests were performed of which 266 (11.4%) were positive. Of 193 patients who met inclusion criteria, 34% were tested in an emergency room, 38% in outpatient clinics, and 29% on inpatient wards. Of these, 55% were men, 65% were white, and the median age was 31 years (interquartile range, IQR 5-56). The median turnaround time from GIPP collection to result was 31 hours (IQR 24-53). The most frequently identified pathogens were norovirus, Salmonella, and Campylobacter (Figure 1). In 43% of patients, results led to one or more management changes including antibiotic discontinuation (8%) and antibiotic initiation (25%). Antibiotics were most often discontinued for norovirus (Figure 1A) and started for Campylobacter (Figure 1B). Other management changes occurred in 13% of patients, including avoidance of further diagnostic testing and isolation precaution change. The median turnaround time did not differ for GIPPs that were (30 hours; IQR 22-50) or were not (32 hours; IQR 25-56) associated with management change. Conclusion Positive GIPP results can prompt changes in antimicrobial treatment in non-immunocompromised patients with diarrhea. Future efforts will evaluate the appropriateness of these management changes. Disclosures Melissa B. Miller, PhD, Abbott Molecular: Grant/Research Support|Agena Biosciences: Board Member|ArcBio: Grant/Research Support|Cepheid: Board Member|Luminex Molecular Diagnostics: Board Member|QIAGEN: Board Member|QIAGEN: Grant/Research Support|Sherlock Biosciences: Advisor/Consultant|Talis Biomedical: Board Member|Thermo Fisher: Honoraria|Werfen: Board Member.

1972. Sources of COVID-19 Exposure Among Health Care Personnel in a Large Tertiary Care Medical Center.

Abstract Background Introduction: Health care personnel (HCP) are at increased risk for SARS-CoV-2 exposure. However, the exposure sources among HCP are poorly understood. Methods Design: We conducted active surveillance for all employed HCP newly diagnosed with COVID-19 between March 2020 and February 2022. We inquired about their sources of exposure using a standardized health department checklist and CDC guidance for managing healthcare personnel with SARS-CoV-2 infection or exposure. Results Among all 8,766 HCP, 2,220 (25.3%) tested positive. Among positive cases, 749 (33.7%), 651 (29.3%), and 221 (10%) were among ancillary services HCP, RNs, and allied HCP, respectively (Table 1). The majority of the sources of exposures were unknown (57.8%), followed by household (26.2%), community (10.5%), and health care (5.5%), respectively. The incidence of COVID-19 increased with level of patient contact regardless of source of exposure. The majority of the cases, N=1054 (47.5%), occurred among HCP who were not up-to-date on COVID-19 vaccines and had unknown exposure, and vaccination status varied by source of exposure (Table 2). HCP COVID-19 cases mirrored transmission in the community (Figure). Table 1.Incidence of COVID-19 Among Employed HCP Overall and by Exposure Type (N=8766)Table 2.Vaccine status among Employed HCP Covid-19 Cases by Source of Exposure (N=2220)Figure.HCP COVID-19 cases by exposure type (Left Axis) in the Central New York region (Right Axis) between March 2020 and February 2022. Conclusion The majority of HCP cases had no known exposure to SARS-CoV-2 and were not up-to-date on COVID-19 vaccines highlighting the importance of vaccination as the single most effective mean to COVID-19 prevention among HCP. Disclosures Jana Shaw, MD,MS,MPH, Pfizer: Advisor/Consultant Stephen J. Thomas, MD, Clover: case adjudication committee (compensated for time)|EdJen: Advisor/Consultant|Icosavax: data monitoring (compensated for time)|Island Pharma: Ownership Interest|Merck: Advisor/Consultant|Moderna: chair, safety monitoring committee (compensated for time)|New Day Diagnostics: Honoraria|Pfizer: Advisor/Consultant|PrimeVax: Ownership Interest|Sanofi Pasteur: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: case adjudication committee (compensated for time)|Vaxxinity: data monitoring committee (compensated for time).

1084. Comparison of Pediatric SARS-CoV-2 Infections During Spring 2020 and Spring 2021

Abstract Background Data is lacking regarding the clinical manifestations of children with SARS-CoV-2 infection during Spring 2021 and how that clinical presentation compares to children who presented during the early months of the pandemic. We sought to compare the presentation and severity of illness among children with a positive PCR test result for SARS-CoV-2 who presented during the Spring 2020 to those who presented for testing during Spring 2021. Methods We identified all patients < 18 years old who had a positive nasopharyngeal polymerase chain reaction (PCR) result for SARS-CoV-2 from 4/1/2020-6/30/2020 and from 4/1/2021-6/30/2021 through a laboratory-based database at a rural academic tertiary care medical center. Data collected included demographics; underlying medical comorbidities; symptoms at the time of SARS-CoV-2 testing; results of SARS-CoV-2 testing and other tests performed at the same time; treatments administered; imaging studies performed; need for hospitalization; and, for those requiring hospitalization, hospital length of stay, and respiratory support. We excluded patients who were hospitalized for reasons other than COVID-19 infection in our hospitalization statistics. Results We identified 331 children with a positive SARS-CoV-2 PCR result who met our inclusion criteria. Among children presenting during the Spring 2021 time period, upper respiratory tract infection (URI) symptoms were much less common than those presenting in Spring 2020 (2% vs 19%, p< 0.001). Additionally, fever and cough were more common among children presenting in Spring 2021 (34% vs 22%, p=0.01) (Table 1). Hospitalization for COVID-19 care occurred in 4% of children overall: 3% of children during the Spring 2020 era and 5% of children during Spring 2021, P=0.587 (Table 2). Self-reported symptoms among children with a positive SARS-CoV-2 polymerase chain reaction test, Spring 2020 vs. Spring 2021. Association of year, patient, and clinical characteristics with hospital admission for care of COVID-19. Conclusion Our study offers insights into the differences in the clinical presentation and outcomes of pediatric patients infected with SARS-CoV-2 during Spring 2020 and Spring 2021, respectively. We found that children infected during Spring 2021 had fever and cough more often and rhinorrhea and nasal congestion less often than children infected during the Spring 2020. Hospitalization was uncommon and was similar in both time periods. Most children requiring hospital admission had an underlying medical comorbidity. Disclosures Jessica E. Ericson, MD, MPH, Abbvie: Advisor/Consultant.

The need for systematic quality controls in implementing N95 reprocessing and sterilization

Due to increased requirement for personal protective equipment during the coronavirus disease 2019 pandemic, many medical centres utilized sterilization systems approved under Food and Drug Administration Emergency Use Authorization for single-use N95 mask re-use. However, few studies have examined the real-world clinical challenges and the role of ongoing quality control measures in successful implementation. To demonstrate successful implementation of quality control measures in mask reprocessing, and the importance of continued quality assurance. A prospective quality improvement study was conducted at a tertiary care medical centre. In total, 982 3M 1860 masks and Kimberly-Clark Tecnol PFR95 masks worn by healthcare workers underwent sterilization using a vaporized hydrogen peroxide gas plasma-based reprocessing system. Post-processing qualitative fit testing (QFT) was performed on 265 masks. Mannequin testing at the National Institute for Occupational Safety and Health (NIOSH) laboratory was used to evaluate the impact of repeated sterilization on mask filtration efficacy and fit. A locally designed platform evaluated the filtration efficiency of clinically used and reprocessed masks. In total, 255 N95 masks underwent QFT. Of these, 240 masks underwent post-processing analysis: 205 were 3M 1860 masks and 35 were PFR95 masks. Twenty-five (12.2%) of the 3M masks and 10 (28.5%) of the PFR95 masks failed post-processing QFT. Characteristics of the failed masks included mask deformation (N=3, all 3M masks), soiled masks (N=3), weakened elastic bands (N=5, three PFR95 masks), and concern about mask shrinkage (N=3, two 3M masks). NIOSH testing demonstrated that while filter efficiency remained >98% after two cycles, mask strap elasticity decreased by 5.6% after reprocessing. This study demonstrated successful quality control implementation for N95 mask disinfection, and highlights the importance of real-world clinical testing beyond laboratory conditions.

Detection of early cardiac disease manifestation in propionic acidemia - Results of a monocentric cross-sectional study.

In propionic acidemia (PA) myocardial involvement is common and includes development of cardiomyopathy, life-threatening acute heart failure, and acquired long-QT syndrome. We sought to investigate which echocardiographic parameters of left ventricular systolic and diastolic function indicate early cardiac disease manifestation in PA. This is a prospective observational study (cross-sectional design) in a Tertiary Medical Care Center. Individuals with confirmed PA were enrolled and the following cardiac investigations were performed in all study individuals: echocardiographic measurements of systolic and diastolic left ventricular (LV) function (LV fractional shortening (LV-FS), LV ejection fraction by biplane modified Simpson's (LV-EF), mitral annular plane systolic excursion (MAPSE), LV global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE), pulsed Doppler analyses of mitral valve (MV) inflow velocities (MV E/A) and MV deceleration time (DT-E), tissue doppler imaging (TDI) of the mitral annulus (MV E/e'), and LV myocardial performance index (LV-MPI). LV and left atrial (LA) diameters were assessed. 12‑lead electrocardiograms (ECG) were recorded and corrected QT intervals (QTc) calculated. Clinical phenotype and laboratory parameters at the time of cardiac investigation were assessed. Besides descriptive analyses we analyzed frequency, onset, and combinations of echocardiographic and ECG data as well as their correlations with clinical and biochemical findings. The effects of 'age at visit' and LV functional parameters on QTc were analyzed with multiple regression. A total of 18 patients with confirmed PA were enrolled. Median age at PA onset was 6 days (range 1-357 days). Median age at visit for cardiac evaluation was 13.1 years (range 0.6-28.1 years). LV-GLS was abnormal in 72.2%, LV-EF in 61.1%, MAPSE in 50%, MV E/e' in 44.4%, LV-MPI in 33.3%, LV-FS in 33.3%, and MV E/A in 27.8%. In cases with normal or near normal LV-FS, LV-GLS was pathological in 5/10, LV-EF in 4/10, and MAPSE in 3/10. The probability of developing LV dysfunction - systolic and diastolic - increases with age. LV-MPI is a reliable parameter to indicate systolic LV-dysfunction in combination with a dilated LV, i. e. dilated cardiomyopathy (DCM) in PA. Multiple regression reveals a significant positive association between LV diameters and QTc. Abnormal LV-GLS significantly correlates with reduced muscle strength, muscle tone and/or abnormal gross motor function. Our data suggests a high prevalence of cardiac disease manifestation in PA, considerably higher than in previous studies, where only LV-FS was used to assess LV function. Usage of advanced echocardiographic techniques, such as LV-GLS assessment, may allow for early detection of subtle LV dysfunction in PA, and may lead to timely cardiac treatment but also consideration of liver transplantation to prevent development of manifest cardiac complications.

Assessment of the validity of international classification of disease tenth revision codes for atopic dermatitis.

Little is known about the validity of ICD-10-CM codes for atopic dermatitis (AD) in healthcare claims databases. We assessed the validity of ICD-10-CM codes for identifying adult patients with AD. The healthcare claims database from a large metropolitan tertiary care medical center was queried for diagnostic codes of L20.x and L30.9. Medical records were reviewed for demographics, comorbidities, Hanifin & Rajka (H-R), and United Kingdom Working Party (UKWP) criteria. Sensitivity, specificity, and positive predictive values (PPVs) were calculated. Overall, 833 patients were identified with ≥ 1 occurrence of the aforementioned ICD-10 codes for AD. Using H-R and UKWP criteria as the gold-standard definitions of AD, the PPV of any aforementioned L20.x ICD-10 codes was 39.1% and 51.4%, with sensitivity of 98.1% and 97.4%, respectively. The PPV was 25% and 50% for L20.82; 66.7% and 100% for L20.84; 37.5% and 62.5% for L20.89; 60.1% and 51.4% for L20.9, respectively. PPV generally increased when case definitions combined ICD-10 codes with coexistent ICD-10 codes for asthma or hay fever, food allergy, and allergic rhinitis, and to a lesser extent coding of the ICD-10 code for AD by a dermatologist. Among patients with all these criteria, PPV increased to 100% and 80% based on H-R and UKWP criteria, but sensitivity decreased to 83.3% and 80.0%, respectively. In conclusion, ICD-10-CM codes for AD alone had poor PPV for identifying AD in a healthcare claims database. Combined ICD-10 codes for AD and comorbid atopic disease improved PPV and specificity of classification at the expense of sensitivity.

Abstract 15227: Decreased Left Atrial Emptying Fraction is Associated With Increased Odds of Diagnosing Atrial Fibrillation Within 1 Year of ESUS

Introduction: A significant proportion of patients with embolic stroke of unknown source (ESUS) are subsequently diagnosed with atrial fibrillation (AF). Left atrial myopathy characterized by mechanical left atrial dysfunction has been associated with development of AF. Hypothesis: Decreased left atrial emptying fraction (LAEF) is independently associated with AF in patients with ESUS. Methods: Patients admitted at a tertiary care medical center for ESUS treated with implantable loop recorders from 2015-2022 were included. Patients were excluded for lack of an interpretable transthoracic echocardiogram during sinus rhythm and electrocardiogram with 6 months of ESUS. Patients were also excluded for lack of clinical follow-up. Co-variates (table) were ascertained from chart review. LAEF was calculated by Simpson’s method of discs. Results: 153 patients were included. The mean(standard deviation) LAEF of patients who developed and did not develop AF within 1 year post ESUS was 48.0%(17.0%) and 57.6%(13.1%), respectively (P<0.001). The odds of diagnosing atrial fibrillation within 1 year post ESUS were 7.18-fold greater in patients with LAEF<40%. Conclusions: LAEF is independently associated with increased odds of AF within 1 year post ESUS. Future research is needed to validate these findings.

Reducing Wait Times for Radiology Exams Around Holiday Periods: A Monte Carlo Simulation.

Reducing patient wait times is a key operational goal and impacts patient outcomes. The purpose of this study is to explore the effects of different radiology scheduling strategies on exam wait times before and after holiday periods at an outpatient imaging facility using computer simulation.An idealized Monte Carlo simulation of exam scheduling at an outpatient imaging facility was developed based on the actual distribution of scheduled exams at outpatient radiology sites at a tertiary care medical center. Using this simulation, we examined three scheduling strategies: (1) no scheduling modifications, (2) increase imaging capacity before or after the holiday (i.e. increase facility hours), and (3) use a novel rolling release scheduling paradigm. In the third scenario, a fraction of exam slots are blocked to long-term follow-up exams and made available only closer to the exam date, thereby preventing long-term follow-up exams from filling the schedule and ensuring slots are available for non-follow-up exams. We examined the effect of these three scenarios on utilization and wait times, which we defined as the time from order placement to exam completion, during and after the holiday period.The baseline mean wait time for non-follow-up exams was 5.4days in our simulation. When no scheduling modifications were made, there was a significant increase in wait times in the week preceding the holiday when compared to baseline (10.0days vs 5.4days, p < 0.01). Wait times remained elevated for 4weeks following the holiday. Increasing imaging capacity during the holiday and post-holiday period by 20% reduced wait times by only 6.2% (9.38days vs 10.0days, p < 0.01). Increasing capacity by 50% resulted in a 7.1% reduction in wait times (9.28days, p < 0.01), and increasing capacity by 100% resulted in a 13% reduction in wait times (8.75days, p < 0.01). In comparison, using a rolling release model produced a reduction in peak wait times equivalent to doubling capacity (8.76days, p < 0.01) when 45% of slots were reserved. Improvements in wait times persisted even when rolling release was limited to the 3weeks preceding or 1week following the holiday period. Releasing slots on a rolling basis did not significantly decrease utilization or increase wait times for long-term follow-up exams except in extreme scenarios where 80% or more of slots were reserved for non-follow-up exams.A rolling release scheduling paradigm can significantly reduce wait time fluctuations around holiday periods without requiring additional capacity or impacting utilization.

Social and structural determinants of emergency department use among Arab and Jewish patients in Jerusalem

BackgroundA growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing structurally competent care. This study aims to identify the major social and structural factors related to patterns of ED visits by Arab and Jewish patients in Israel, where access to health services is covered by universal national health insurance.MethodsA cross-sectional study was conducted using questionnaires of ED patients in a tertiary care medical center in Jerusalem. The hospital is the largest of the three EDs in Jerusalem with over 90,000 adult patient visits a year. The sample was stratified by ethnicity, including 257 Jewish patients and 170 Arab patients. The outcome variable was repeat visits for the same reason to the ED within 30 days.ResultsThere were differences between Jewish and Arab patients’ social and structural characteristics, including health status, socioeconomic status, feeling of safety, and social support. There were also significant differences in some of the characteristics of health service utilization patterns, including ED repeat visits, language barriers when seeking healthcare in the community, and seeking information about medical rights. The variables associated with repeat visits were different between the two groups: among the Arab patients, repeat visits to the ED were associated with concerns about personal safety, whereas among the Jewish patients, they were associated with poverty.ConclusionThe study illustrates the gaps that exist between the Arab and Jewish population in Israel. The findings demonstrated significant differences between populations in both health status and access to health services. In addition, an association was found in each ethnic group between different structural factors and repeat ED requests. This study supports previous theories and findings of the relationship between structural and social factors and patterns of health services utilization.

7984 Primary Hysteroscopic Treatment of First Trimester Miscarriage Using Resectoscope - a Pilot Study

<h3>Study Objective</h3> To determine the feasibility and safety of hysteroscopic resection using standard resectoscope for uterine evacuation of first-trimester miscarriage. <h3>Design</h3> A prospective feasibility study. <h3>Setting</h3> Academic, tertiary-care medical center. <h3>Patients or Participants</h3> Women diagnosed with early miscarriage up to 12 weeks from last menstrual period. <h3>Interventions</h3> Overall, in this pilot study, 15 women were recruited for hysteroscopic evacuation of the uterine cavity between April 2021 and October 2021. All procedures were performed under general anesthesia by Versapoint 2 Bipolar Resectoscope 24Fr (J&J, Germany). <h3>Measurements and Main Results</h3> Collected data, including demographic characteristics, pregnancy-sac size and location, length of procedure, as well as intra and postoperative adverse events, were recorded. The mean duration of the procedure was 14.3 ± 3.7 minutes. Complete evacuation was recorded in all cases, and no adverse events occurred during any procedure. Post- procedure follow-up was conducted by office hysteroscopy in 10 women and by ultrasonography in 5 women. In one case, retained products of conception were diagnosed in the office hysteroscopy and were removed using the "see-and-treat" technique without anesthesia. The diagnosis was confirmed pathologically. <h3>Conclusion</h3> Hysteroscopic evacuation using resectoscope for the treatment of early miscarriage is a safe and feasible technique. Randomized trials are needed to examine the efficacy of hysteroscopic treatment compared with traditional dilation and curettage.

8605 Gynecologic Laparoscopy in the Bariatric Patient: A Retrospective Review of Abdominal Access and Associated Complications

<h3>Study Objective</h3> To provide clinical direction on laparoscopic abdominal entry techniques in women with known history of laparoscopic Roux-en-Y Gastric Bypass (RYGB) undergoing gynecologic surgery and to identify any associated complications. <h3>Design</h3> Retrospective Chart Review and Case Series. <h3>Setting</h3> Community-based tertiary care medical center. <h3>Patients or Participants</h3> All patients who underwent RYGB between 2013 and 2020 and had a subsequent gynecologic procedure. <h3>Interventions</h3> Abdominal access. <h3>Measurements and Main Results</h3> Thirty-one patients were identified, of which 18 had an adnexal surgery and 13 a hysterectomy. At time of surgery, the mean age was 44 years and body mass index was 32 kg/m². The average interval time from RYGB to gynecologic surgery was 29 months. The majority of women (71%) had additional abdominal surgeries, among them 82% had prior laparotomies. Three entry sites were identified at the initial attempt to access the abdominal cavity; umbilical (71%), left upper quadrant (LUQ, 26%) and left lower quadrant (LLQ, 3%). Closed entry technique using the Veress needle was the most commonly used entry technique (68% versus 29% for optical trocar entry and 3% for open entry). There were no injuries resulting from abdominal access irrespective of the entry site or technique chosen. However, access was unsuccessful in 25% (2 out of 8) of the cases when attempted in the LUQ, resulting in conversion to alternative entry sites. <h3>Conclusion</h3> Successful and safe abdominal access in the bariatric patient can sometimes be challenging and preoperative surgical planning is essential. While no injuries during entry were reported regardless of site chosen, closed entry at the umbilicus using the Veress needle was the technique the most practiced and was associated with fewer attempts and conversions to alternative sites as compared to LUQ entry.

The Effect of Patient Positioning on Ureteral Efflux during Intraoperative Cystoscopy: A Randomized Controlled Trial

<h3>Study Objective</h3> To identify the relationship between patient position during surgery and time to confirmation of ureteral patency on cystoscopy. <h3>Design</h3> Randomized controlled trial. <h3>Setting</h3> Academic tertiary care medical center. <h3>Patients or Participants</h3> A total of 91 adult women undergoing laparoscopic (either conventional or robotic) hysterectomy between February 2021 and February 2022 were randomized to control (n=46) or intervention (n=45). Exclusion criteria included known kidney disease or anomaly, current ureteral stent, pregnancy, malignancy, and recognized intraoperative urinary tract injury. <h3>Interventions</h3> Subjects in the control group were placed in a 0-degree supine position during cystoscopy. Subjects in the intervention group were placed in a 10–20-degree angle in reverse Trendelenburg (RT) during cystoscopy. <h3>Measurements and Main Results</h3> The primary outcome, the time to confirmation of bilateral ureteral patency, was measured at the time the second ureteral jet was viewed during intraoperative cystoscopy. There was no significant difference in mean time to confirmation (66.5 seconds in supine vs 67 seconds in RT, p=0.2), nor in total cystoscopy time (111 seconds in supine vs 104.5 seconds in RT, p=0.39). There were no significant differences in need for alternative modalities to aid in ureteral efflux visualization, delayed diagnosis of ureteric injury, and operative time. RT position seemed to have reduced the time to confirmation for the small group of patients with high confirmation time (>120 seconds). <h3>Conclusion</h3> Reverse Trendelenburg position does not change time to confirmation of bilateral ureteral patency compared to supine position. However, there may be benefit in position change if time to confirmation is >120 seconds.

Surgical Outcomes for Laparoscopic Hysterectomy Based on Surgeon Gender

<h3>Study Objective</h3> To compare surgical outcomes for laparoscopic hysterectomy between male and female gynecologic surgeons. <h3>Design</h3> Retrospective comparative cohort study. <h3>Setting</h3> Single-site academic tertiary care medical center. <h3>Patients or Participants</h3> A total of 494 women age >18 years old who underwent laparoscopic (either conventional or robotic) hysterectomy for benign indications between January 2019 and December 2020. <h3>Interventions</h3> A total of 560 laparoscopic hysterectomies were performed by 24 surgeons, which included 244 cases by 14 female surgeons and 316 cases by 10 male surgeons. Surgical outcomes were analyzed between the two genders. <h3>Measurements and Main Results</h3> Female surgeons performed significantly more traditional laparoscopic hysterectomies, while male surgeons performed more robotic hysterectomies. No statistically significant differences in the primary outcomes of hospital readmission rates, surgical complications, and postoperative complications were noted between the two groups. Also, no significant differences were noted in length of surgery, length of hospital stay, estimated blood loss, conversion to other surgical approach, emergency department visits in first 60 days, and 30-day mortality. Surgeon characteristics, such as sub-specialty, surgical volume, years since residency, and practice setting were obtained and controlled for. <h3>Conclusion</h3> Female and male gynecologic surgeons have equivalent surgical outcomes, suggesting they are equally capable of providing patients with high-quality surgical management. This is the first study to analyze the impact of surgeon gender on patient outcomes in gynecologic surgery.

Use of lacosamide in children: experience of a tertiary medical care center in Brazil.

Lacosamide (LCM) is a third-generation anti-seizure drug approved in Europe and the United States, either as a monotherapy or adjunctive therapy, to treat partial-onset seizures in adults, adolescents, and children. In Brazil, LCM is licensed for treatment only in patients older than 16 years of age. To evaluate a cohort of children presenting with refractory epilepsy who received LCM as an add-on therapy and observe the response and tolerability to the LCM treatment. A retrospective cohort study conducted in a tertiary health care facility, which included 26 children, aged up to 16 years, who presented with refractory epilepsy and received LCM as an add-on treatment. The follow-up visits were scheduled every 3 months until 9 months of treatment with LCM. After 3 months of LCM administration, in 73.1% of the children, there was a reduction of > 50% in the frequency of seizures, and this clinical improvement was maintained in most patients (73.9%) for the following 9 months. Mild (such as, somnolence and behavioral changes) or severe (seizure worsening) adverse effects were observed in two and three children respectively. Among responders to LCM, there was a higher prevalence of males, fewer concomitant anti-seizure drugs, and lower percentage of patients using sodium channel blockers. Lacosamide should be considered as an early treatment option in pediatric patients with refractory epilepsy, mainly focal seizures.

Development and Psychometric Validation of the Olfactory Dysfunction Outcomes Rating

Olfactory dysfunction (OD) is an increasingly common and morbid condition, especially given the ongoing COVID-19 pandemic. Thus, the ability to reproducibly measure smell loss-associated quality of life (QOL) and its response to treatment is paramount. To develop and validate a concise and visually appealing smell loss-associated QOL patient-reported outcome measure for OD. A secondary analysis of comments to an online survey by 1000 patients with olfactory dysfunction published in 2013 was used as the primary source to generate items of the Olfactory Dysfunction Outcomes Rating (ODOR). In addition, 30 patients with OD enrolled in 2 clinical studies at a tertiary care medical center (Washington University) were asked to identify their main concerns associated with smell loss. And finally, 4 otolaryngologists reviewed the items generated from the online survey and the patients' interviews to identify any additional items. Prospective study design was used for data collection from the 30 patients and 4 otolaryngologists. Prospective study design was used for survey validation. Validation of the ODOR was performed with 283 patients enrolled in several prospective studies at a single institution that completed the ODOR as an outcome measure. Item generation and selection were the outcomes of ODOR development. The psychometric and clinimetric measures evaluated for validation were internal consistency, test-retest reliability, face and content validity, concurrent validity, and discriminant validity. Minimal clinically important difference was also determined. The ODOR is a 28-item instrument with each item scored as either no difficulty or very rarely bothered (0) to complete difficulty or very frequently bothered (4) with a total instrument score range of 0 to 112 points. Higher scores indicate higher degree of dysfunction and limitation. Validation in the cohort of 283 patients (mean [SD] age, 47.0 [14.4] years; 198 female participants [73%]; 179 White participants [80%]) revealed that the instrument has high internal consistency (Cronbach α = 0.968), test-retest reliability (r = 0.90 [95% CI, 0.81-0.95]), face validity, content validity, concurrent validity (r = 0.87 [95% CI, 0.80-0.91] compared with the Questionnaire of Olfactory Disorders-Negative Statements; ρ = -0.76 [95% CI, -0.81 to -0.71] compared with a patient-reported symptom severity scale), and divergent validity (mean score difference, -33.9 [95% CI, -38.3 to -29.6] between normosmic patients and hyposmic/anosmic patients). The minimal clinically important difference was 15 points. The estimated time for survey completion was approximately 5 minutes. In this survey creation and validation study, the ODOR was shown to be a novel, concise, reliable, and valid patient-reported outcome measure of OD-associated QOL. It can be used to measure physical problems, functional limitations, and emotional consequences associated with OD and how they change after a given intervention, which is clinically applicable and particularly pertinent given the growing burden of OD associated with COVID-19.

Powered Intracapsular Tonsillotomy and Adenoidectomy in Infants ≤36 Months Compared to Older Children: A Retrospective Analysis.

To evaluate the safety and outcomes of powered intracapsular tonsillotomy and adenoidectomy (PITA) for the treatment of sleep disordered breathing in infants up to 36 months of age compared to older children. This retrospective analysis included children who underwent PITA from 2013 to 2019 at a single tertiary care medical center. The patients were divided into 2 groups: up to 36 months, and 36 to 72 months. The data were collected from electronic medical records and from a telephone survey based on a modified version of the OSA-18 questionnaire. Post-operative complications, and short- and long-term outcomes were compared. A total of 48 patients met the inclusion criteria for the main study group (up to 36 months of age). They were compared to 59 children 36 to 72 months of age. There were no differences in subjective outcomes between age groups (P = .65). There were no differences in the frequency of post-operative complications between age groups (P = .8) or in the number of hospitalization days (P = .91). The short- and long-term outcomes and safety of PITA for the treatment of sleep disordered breathing in infants up to 36 months of age are similar to those of older children.

Interscalene block with liposomal bupivacaine versus continuous interscalene catheter in primary total shoulder arthroplasty.

Multimodal pain regimens in total shoulder arthroplasty (TSA) now include regional anesthetic techniques. Historically, regional anesthesia for extended postoperative pain control in TSA was administered using a continuous interscalene catheter (CIC). Liposomal bupivacaine (LB) is used for its potential for similar pain control and fewer complications compared with indwelling catheters. We evaluated the efficacy of interscalene LB compared with a CIC in postoperative pain control for patients undergoing TSA. This was a retrospective cohort study at a tertiary-care academic medical center including consecutive patients undergoing primary anatomic or reverse TSA from 2016 to 2020 who received either single-shot LB or a CIC for perioperative pain control. Perioperative and outcome variables were collected. The primary outcome was postoperative pain control, whereas the secondary outcome was health care utilization. The study included 565 patients, with 242 in the CIC cohort and 323 in the LB cohort. Demographic characteristics including sex (P=.99) and race (P=.81) were similar between the cohorts. The LB cohort had significantly lower mean pain scores at 24 hours (3 vs. 2, P<.001) and 36 hours (3 vs. 2, P<.001) postoperatively. The CIC cohort showed a higher percentage of patients experiencing a pain score of 9 or 10 postoperatively (29% vs. 17%, P=.001), whereas the LB cohort had a significantly greater proportion of opioid-free patients (32% vs. 10%, P<.001). Additionally, a greater proportion of CIC patients required opioid escalation to patient-controlled analgesia (7% vs. 2%, P=.002). The CIC cohort experienced a greater length of stay (2.3 days vs. 2.1 days, P=.01) and more 30-day emergency department visits (5% vs. 2%, P=.038). LB demonstrated lower mean pain scores at 24 and 36 hours postoperatively and lower rates of severe postoperative pain. Additionally, LB patients showed significantly higher rates of opioid-free pain regimens. These results suggest that as part of a multimodal pain regimen in primary shoulder arthroplasty, LB may provide greater reductions in pain and opioid use when compared with CICs.

Association between serum alkaline phosphatase and bacteraemia in haemodialysis outpatients: a multicentre retrospective cross-sectional study

ObjectivesElevated baseline serum alkaline phosphatase (ALP) may correlate with higher medium-term to long-term mortality in the general population and in patients with chronic kidney disease. However, few data are available...

ANGIOGRAPHIC PREDICTORS OF CTO PCI SUCCESS: HOW TO GUIDE DECISION MAKING BEYOND THE J-CTO SCORE

ANGIOGRAPHIC PREDICTORS OF CTO PCI SUCCESS: HOW TO GUIDE DECISION MAKING BEYOND THE J-CTO SCORE