Digital Commons Network^™

A Comprehensive Review Of Covid-19: Associated Endocrine Manifestations, Saif Khan Md, Maryam Karim Mbbs, Vasu Gupta, Heenam Goel Md, Rohit Jain Md

Articles

Coronavirus disease 2019 (COVID-19) has played a significant part in systematic damage, affecting lives and leading to significant mortality. The endocrine system is one of the systems affected by this pandemic outbreak. The relationship between them has been identified in previous and ongoing research. The mechanism through which severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) can achieve this is similar to that for organs that express angiotensin-converting enzyme 2 receptors, which is the primary binding site of the virus. Endocrine cells widely express angiotensin-converting enzyme 2 receptors and transmembrane serine protease 2, the primary mediators initiating the acute phase of the disease. …

Acute Outcomes For The Full Us Cohort Of The Flash Mechanical Thrombectomy Registry In Pulmonary Embolism, Caitlin Toma, Wissam A. Jaber, Mitchell D. Weinberg, Matthew C. Bunte, Sameer Khandhar, Brian Stegman

Articles

Background

Evidence supporting interventional pulmonary embolism (PE) treatment is needed.

Aims

We aimed to evaluate the acute safety and effectiveness of mechanical thrombectomy for intermediate- and high-risk PE in a large real-world population.

Methods

FLASH is a multicentre, prospective registry enrolling up to 1,000 US and European PE patients treated with mechanical thrombectomy using the FlowTriever System. The primary safety endpoint is a major adverse event composite including device-related death and major bleeding at 48 hours, and intraprocedural adverse events. Acute mortality and 48-hour outcomes are reported. Multivariate regression analysed characteristics associated with pulmonary artery pressure and dyspnoea improvement.

Results …

Bidirectional Recanalization Of A Complete Postradiation Stricture Of The Hypopharynx And Esophagus, Fateh Bazerbachi Md, Georgios Mavrogenis Md, Konstantinos Markoglou, Sandro Porceddu

Articles

A 65-year-old patient was referred for endoscopic management of a complete radiation-induced stricture, 5 cm in length, of the hypopharynx and esophagus (Fig. 1, Video 1). He had a history of curative chemoradiation therapy for T2N1 squamous cell carcinoma of the larynx. His nutrition was exclusively maintained through a percutaneous gastrostomy. Recanalization of the esophagus was considered after a multidisciplinary discussion.

Familial Factors In The Development Of Social Anxiety Disorder, Christine M. Olson

Articles

The purpose of the current article is to explore familial factors that influence the development of social anxiety disorder (SAD) in children and adolescents, including parenting, sibling relationships, and family environment. A multitude of interrelated genetic and familial factors have been found to cause and maintain SAD in children and adolescents. There are many challenges in diagnosing and treating the disorder. Knowledge and awareness of familial factors provide insight on targeted treatments that prevent or ameliorate SAD.

A Review Of Bleeding Risk With Impella-Supported High-Risk Percutaneous Coronary Intervention, George W. Vetrovec, Amir Kaki, Thom G. Dahle

Articles

Complex, high-risk percutaneous coronary intervention (HR-PCI) is increasingly being performed, often with mechanical circulatory support (MCS), though to date, there are limited randomised data on the efficacy of MCS for HR-PCI. The majority of MCS is provided by intra-aortic balloon pumps, but increasingly Impella® (Abiomed, Danvers, MA, USA) heart pumps are being used. While the Impella pumps provide greater increases in cardiac output, these devices require large bore access, which has been associated with an increased risk of bleeding and vascular complications. Decisions regarding the use of Impella are often based on risk–benefit considerations, with Impella-related bleeding risk being a …

How To Address Tobacco Use In Minnesota's Mental Health And Substance Use Disorder Services: Tips From The Field, Meghan Bown, Jamie Andycha, Sophie Burnevik, Ruth Tripp, American Lung Association, Blue Cross Blue Shield, Leadership Academy Collaborative

Articles

The American Lung Association, Upper Midwest Region, developed and facilitates the Leadership Academy Collaborative, bringing together various health care stakeholders in Minnesota to collaborate on a shared vision to reduce commercial tobacco use among people living with mental illness and/or substance use disorders. The following areas were identified as strategies that would benefit from further collective action: social norms, delivery, policy

Distal Corporoplasty Using An Autologous Tunica In The Management Of Penile Prosthesis Pseudo Aneurysm, Michel Apoj, Elizabeth A. Phillips

Articles

Inflatable penile prosthesis placement is an effective and safe treatment option for erectile dysfunction. The 5-year revision rate is low (7%) and revisions are most likely due to infection or mechanical problems with the device.

Penile prosthesis aneurysm is a rare complication that is managed surgically. The choice of graft used during tunical reinforcement is critical to avoid subsequent complications. The use of autologous grafts from distant tissue often leads to deformations of penile tissue in addition to the increase in operative time, morbidity, and cost of the operation. The use of synthetics increases the susceptibility to infection and decreases …

Lipoid Proteinosis: Unfamiliar Skin Findings Delay Diagnosis, S Larkin, Elizabeth K. Blixit

Articles

Lipoid proteinosis (LP) is a rare, inherited condition that progresses gradually with multisystemic manifestations. Histopathologic characteristics can be understated, delaying the diagnosis if a high degree of suspicion is not present.

Impact Of Supplemental Oxygen On Obstructive Sleep Apnea Of Infants, Piyush Das, R Kashyap, S Kotagal

Articles

Abstract: Treatment options may be limited for infants with obstructive sleep apnea when there is no surgically correctable upper airway lesion. We therefore evaluated, retrospectively, the efficacy of low-flow oxygen as a therapeutic option for infant obstructive sleep apnea. We reviewed the medical charts of 23 infants who had undergone a therapeutic trial of low-flow oxygen during polysomnography. Split-night polysomnography was used in 21/23 subjects while 2/23 had undergone two separate, full-night polysomnography sleep architecture and respiratory findings on the baseline polysomnogram segment that was obtained in room air were compared with the segment on low-flow oxygen (0.25–1 L/min). Wilcoxon …

Partitioning Of Adipose Lipid Metabolism By Altered Expression And Function Of Ppar Isoforms After Bariatric Surgery, C Jahansouz, H Xu, A V. Hertzel, Kristin Ewing

Articles

BACKGROUND:

Bariatric surgery remains the most effective treatment for reducing adiposity and eliminating type 2 diabetes; however, the mechanism(s) responsible have remained elusive. Peroxisome proliferator-activated receptors (PPAR) encompass a family of nuclear hormone receptors that upon activation exert control of lipid metabolism, glucose regulation and inflammation. Their role in adipose tissue following bariatric surgery remains undefined.

RESULTS:

Within 7 days, bariatric surgery acutely drives a change in the activity and expression of PPARγ and PPARδ in subcutaneous adipose tissue thereby attenuating lipid storage, increasing lipolysis and potentiating lipid oxidation. This unique metabolic alteration leads to changes in downstream PPARγ/δ targets …

Supraclavicular Subclavian Access For Sapien Transcatheter Aortic Valve Replacement: A Novel Approach, Thom G. Dahle, John Castro, Jacob R. Dutcher, John M. Teskey, Wade Schmidt, Daren Danielson, Daniel Tiede

Articles

BACKGROUND:

Within the trans-subclavian approach, procedural techniques can vary widely, and reported access generally refers to an infraclavicular axillary approach. We describe and report the use of a novel supraclavicular true subclavian approach for transcatheter aortic valve replacement (TAVR) exclusively for implantation of Sapien 3 valves.

CASE PRESENTATION:

We report our first five consecutive patients undergoing TAVR with a Sapien 3 valve using a standardized subclavian approach at a single center. In-hospital and 30-day complications were reported. The use of this approach resulted in successful implantation in 100% of patients in a safe manner with 0% mortality, stroke, and vascular …

The New Diagnostic Team, Mark L. Graber, Diana Rusz, Melissa L. Jones

Articles

The National Academy of Medicine (NAM) in the recently issued report Improving Diagnosis in Health Care outlined eight major recommendations to improve the quality and safety of diagnosis. The #1 recommendation was to improve teamwork in the diagnostic process. This is a major departure from the classical approach, where the physician is solely responsible for diagnosis. In the new, patient-centric vision, the core team encompasses the patient, the physician and the associated nursing staff, with each playing an active role in the process. The expanded diagnostic team includes pathologists, radiologists, allied health professionals, medical librarians, and others. We review the …

Copd Management And Role Of The Nurse Coach: Increasing Referrals And Participation In Pulmonary Rehabilitation, Carol Upcraft, C. Hoover, Joy Plamann, Jessica Oman

Articles

Chronic obstructive pulmonary disease (COPD) remains a significant cause for hospitalization and with complex management issues upon discharge a significant portion are being re-admitted within 30-days of first hospitalization. The beneficial effects of pulmonary rehabilitation (PR) in the management of COPD is well documented but continues to be underutilized as an important management strategy to reduce hospital readmissions. Transitional care programs which include nurse coaches, have immerged to empower patients to manage their disease and facilitate transitions through multiple care environments. Little is known about the efficacy of such programs on referral and participation in PR and subsequent reductions in …

Open-Label Phase I Clinical Study To Assess The Safety And Efficacy Of Cilostazol In Patients Undergoing Internal Carotid Artery Stent Placement, A E. Hassan, H Zacharatos, M Grigoryan, Muhammed Suri, Adnan Qureshi

Articles

BACKGROUND:

One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel.

OBJECTIVE:

To evaluate the safety and clinical efficacy of cilostazol and aspirin therapy following internal carotid artery stent placement up to 1 month postprocedure.

METHODS:

A phase I open-label, nonrandomized two-center prospective study was conducted. All subjects received aspirin (325 mg/day) and cilostazol (200 mg/day) 3 days before extracranial stent placement. Two antiplatelet agents were continued for 1 …

Reduction Of Surgical Site Infections After Cesarean, Melissa Erickson Msn Ed, Bsn, Rnc-Mnn, Phn, Patricia Dumonceaux Msn, Phn, Cic

Articles

To decrease cesarean surgical site infection (SSI) rates to less than the National Healthcare Safety Network (NHSN) mean. By decreasing SSI rates, secondary goals included improving the patient experience, decreasing readmissions, and promoting bonding between the mother and newborn.

Ambulatory Hemodynamic Monitoring Reduces Heart Failure Hospitalizations In "Real-World" Clinical Practice, Akshay S. Desai, Arvind Bhimaraj, Rita Jermyn, Jamie M. Pelzel

Articles

BACKGROUND:

In the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in New York Heart Association [NYHA] Functional Class III Heart Failure Patients) trial, heart failure hospitalization (HFH) rates were lower in patients managed with guidance from an implantable pulmonary artery pressure sensor compared with usual care.

OBJECTIVES:

This study examined the effectiveness of ambulatory hemodynamic monitoring in reducing HFH outside of the clinical trial setting.

METHODS:

We conducted a retrospective cohort study using U.S. Medicare claims data from patients undergoing pulmonary artery pressure sensor implantation between June 1, 2014, and December 31, 2015. Rates of HFH …

Microangiopathic Occlusion Of A Perforating Prepontine Long Circumferential Artery Presenting With Lower Motor Neuron Facial Weakness: Clinical And Radiological Correlation, Archie Defillo Md, Muhammad Shah Miran Md, Kenneth Shea Md, Michelle Peterson Np, Leah Roering Np, Jerone Kennedy Md, M. Fareed, K. Suri

Articles

Case Description: A 79-year old male patient with myelodysplastic syndrome associated with severe neutropenia, thrombocytopenia, anemia, hypertension, and hyperlipidemia was admitted for pneumonia secondary to influenza A. Two weeks later he presented with new symptoms of acute dysarthria, and left facial weakness involving his upper and lower face; the following day he developed left arm weakness. Admission computed tomography (CT) and MRI scans revealed an acute ischemic stroke (AIS) in the right posterior frontal cortex. The initial MRI was reported negative for pontine lesions. Anatomically, the cortical infarct could not explain his left lower motor neuron cranial nerve VII (LMN …

Cerebral Venous Engorgement In Hydrops Fetalis, Adnan I. Qureshi, Thomas Kohl

Articles

A 34-year-old gravida was diagnosed with hydrops fetalis, hydrothorax with cardiac compression, hygroma, ascites, and subcutaneous edema at 20 weeks of gestation...

Hematoma Enlargement Among Patients With Traumatic Brain Injury: Analysis Of A Prospective Multicenter Clinical Trial, M Fareed K. Suri, Adnan I. Qureshi, Ahmed A. Malik, Malik M. Adil, Archie Defillo, Gregory T. Sherr

Articles

Observational studies suggest that hematomas continue to enlarge during hospitalization in patients with traumatic brain injury (TBI). There is limited data regarding factors associated with hematoma enlargement and on whether hematoma enlargement contributes directly to death and disability in patients with TBI.

We analyzed data collected as part of the Resuscitation Outcomes Consortium Hypertonic Saline and TBI Study. Hematoma enlargement was ascertained and collected as a predefined safety endpoint. We evaluated the effect of hematoma enlargement on the risk of death and disability at 6 months based on the Extended Glasgow Outcome Scale (GOSE) (dichotomized as >4 or ≤4) using …

Letter To The Editor: Perianeurysmal Edema, Archie Defillo Md, Jerone Kennedy Md

Articles

No abstract provided.

Bacteria On Shared Mobile Phones Can Lead To Infections, Roberta Basol, Jean Beckel, Judy Gilsdorf-Gracie, Amy Hilleren-Listerud, Terri Mccaffrey, Sherri Reischl, Pamela Rickbeil, Mary Schimnich, Kirsten Skillings, Mary A. Struffert

Articles

It's now a common practice for hospital-owned mobile phones to be shared among healthcare employees from shift to shift. Despite the benefit of increased, timely communication between caregivers, sharing mobile devices can lead to the spread of healthcare-associated infections (HAIs) if they aren't properly disinfected. The Guidelines for Disinfection and Sterilization in Healthcare Facilities describe "non-critical environmental surfaces" as items that are frequently touched by the hand and may pose a risk of secondary infection transmission.

You Missed A Spot! Disinfecting Shared Mobile Phones, Roberta Basol, Jean Beckel, Judy Gildsdorf-Gracie, Amy Hilleren-Listerud, Terri Mccaffrey, Sherri Reischl, Pamela Rickbeil, Mary Schimnich, Kirsten Skillings, Mary A. Struffert

Articles

The use of portable mobile devices has facilitated timely communication among healthcare team members. It's now a common practice for hospital-owned mobile phones to be shared among healthcare employees from shift to shift. Despite the benefit of increased, timely communication between caregivers, sharing mobile devices can lead to the spread of healthcare-associated infections (HAIs). This article looks at the efficacy of two types of cleaning products on shared mobile phones carried by RNs at a 489-bed, Magnet-designated, Midwestern regional medical center. The cleaning methods evaluated were 70% isopropyl alcohol wipes and ethyl alcohol wipes.

Comparison Of Manual Versus Automated Data Collection Method For An Evidence-Based Nursing Practice Study, Matthew D. Byrne, T R. Jordan, Tamara Welle

Articles

OBJECTIVE:

The objective of this study was to investigate and improve the use of automated data collection procedures for nursing research and quality assurance.

METHODS:

A descriptive, correlational study analyzed 44 orthopedic surgical patients who were part of an evidence-based practice (EBP) project examining post-operative oxygen therapy at a Midwestern hospital. The automation work attempted to replicate a manually-collected data set from the EBP project.

RESULTS:

Automation was successful in replicating data collection for study data elements that were available in the clinical data repository. The automation procedures identified 32 "false negative" patients who met the inclusion criteria described in …

Recommended Actions For Improved Care Transitions: Mental Ilnesses And/Or Substance Use Disorders, Chris Walker, Paul Goering, Cathy Brouwer, Kathy Knight, Karen Lloyd, Terry W. Crowson, Michael A. Trangle, Paul Davis, Jennifer Mcnertney, Sue Abderholden, Nancy Houlton, Kathy Cummings, Joann Foreman

Articles

The transition period between care settings is the most vulnerable time for patients and their caregivers. The unique vulnerabilities for patients with mental illnesses such as depression, mania, anxiety, schizophrenia and/or substance use disorders* heighten the need for coordinated transitions and aftercare. In 2010, depression was the fourth diagnosis by volume for readmissions in Minnesota according to the Potentially Preventable Readmissions data collected by the Minnesota Hospital Association.

Brief Report: A Phase Ii "Window-Of-Opportunity" Frontline Study Of The Mtor Inhibitor, Temsirolimus Given As A Single Agent In Patients With Advanced Nsclc, An Ncctg Study, Nicholas F. Reuter Md

Articles

BACKGROUND:

In an effort to evaluate the single agent activity of temsirolimus in previously untreated non-small-cell lung cancer, the North Central Cancer Treatment Group undertook a frontline "window-of-opportunity" study.

METHODS:

Patients received 25 mg of temsirolimus administered intravenously as a weekly 30 minute infusion, on a 4-week cycle. Based on a two-stage Fleming design, the treatment would be promising if at least four of the first 25 evaluable patients in stage I or at least six of the 50 evaluable patients at the end of stage II have a confirmed response. Fresh tumor biopsies were obtained to evaluate predictive markers …

Phase Iii, Randomized, Double-Blind, Placebo-Controlled Evaluation Of Pregabalin For Alleviating Hot Flashes, N07c1, Charles L. Loprinzi, Rui Qin, Ernie P. Baclueva, Donald J. Jurgens

Articles

PURPOSE:

Hot flashes are a common problem for which effective and safe treatments are needed. The current trial was conducted on the basis of preliminary promising data that pregabalin decreased hot flashes.

PATIENTS AND METHODS:

A double-blind, placebo-controlled, randomized trial design was used to compare pregabalin at target doses of 75 mg twice daily and 150 mg twice daily with a placebo. Hot flash frequencies and scores (frequency times mean severity) were recorded daily during a baseline week and for six treatment weeks. The primary end point for this study was the change-from-baseline hot flash score during treatment week 6 …

Molecular Analysis Expands The Spectrum Of Phenotypes Associated With Gli3 Mutations, Jennifer J. Johnston, Julie C. Sapp, Joyce T. Turner, David Tilstra Md

Articles

A range of phenotypes including Greig cephalopolysyndactyly and Pallister-Hall syndromes (GCPS, PHS) are caused by pathogenic mutation of the GLI3 gene. To characterize the clinical variability of GLI3 mutations, we present a subset of a cohort of 174 probands referred for GLI3 analysis. Eighty-one probands with typical GCPS or PHS were previously reported, and we report the remaining 93 probands here. This includes 19 probands (12 mutations) who fulfilled clinical criteria for GCPS or PHS, 48 probands (16 mutations) with features of GCPS or PHS but who did not meet the clinical criteria (sub-GCPS and sub-PHS), 21 probands (6 mutations) …

Implementing The 2005 American Heart Association Guidelines, Including Use Of The Impedance Threshold Device, Improves Hospital Discharge Rate After In-Hospital Cardiac Arrest, K Thigpen, Scott Davis, Roberta Basol, Peggy Lange, Sandeep Jain, John Olsen, Bernard Erickson, Timothy Schuchard

Articles

OBJECTIVE:

To determine the impact of the 2005 American Heart Association cardiopulmonary resuscitation (CPR) guidelines, including use of an impedance threshold device (ITD), on survival after in-hospital cardiac arrest.

METHODS:

Two community hospitals that tracked outcomes after in-hospital cardiac arrest pooled and compared their hospital discharge rate before and after implementing the 2005 American Heart Association CPR guidelines (including ITD) in standardized protocols. In CPR we used the proper ventilation rate, allowed full chest-wall recoil, conducted continuous CPR following intubation, and used an ITD. We compared historical control data from a 12-month period at St Cloud Hospital, St Cloud, Minnesota, …

Circadian Rhythms In Patients With St-Elevation Myocardial Infarction, Richard Aplin Md, Dr Holmes Md, Fv Acquirre

Articles

BACKGROUND:

Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle.

METHODS AND RESULTS:

The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was …

Letter By Harris Et Al Regarding Article, "Outcomes Of Patients With Acute Type A Aortic Intramural Hematoma, Jamie M. Pelzel

Articles

We read with interest the report by Song et al1 outlining the management of ascending aortic intramural hematoma (IMH) at the Asan Medical Center in Seoul, South Korea. This series, the largest of this life-threatening condition, demonstrated that at that institution, 84% of patients (n=85) could be treated with initial medical therapy, resulting in a mortality rate of 7.1%. These results are impressive but are observational rather than a randomized comparison of medical and surgical therapy.