52426 research outputs found
Sort by
Examining the Role of Corticosteroids in the Management of Acute Interstitial Pneumonia: A Systematic Review.
No full textBACKGROUND: Acute interstitial pneumonia (AIP), also known as Hamman-Rich syndrome, is a rapidly progressive interstitial lung disease. In addition to being challenging to diagnose, AIP is also difficult to treat. The mortality rate of AIP is greater than 70% due to the disease\u27s rapid progression. Furthermore, survivors are likely to develop chronic interstitial lung disease as a sequela. Treatment primarily focuses on supportive care, which consists of oxygenation through mechanical ventilation, administration of broad-spectrum antibiotics, and the use of corticosteroids. Although the use of steroids as empiric treatment is controversial and results on its mortality benefit are variable, some studies have shown high-dose pulse steroid therapy to be associated with better health outcomes. This review aimed to evaluate cases of AIP to better understand the role of corticosteroids in the management plan of these cases.
METHODS: A systematic review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines. Outcomes of interest included patient age, sex, autoimmune condition, corticosteroid use, survival or expiration of patients, and time from hospitalization to expiration.
RESULTS: Initial querying of the five databases yielded 376 articles. Following a thorough review, only 30 articles remained, comprising 42 patient cases. Of these cases, 62% of the patients survived, 36% expired, and 2% were unknown. The average stay from hospitalization to death was 20.2 days, and corticosteroid pulse doses were used as a first- or second-line treatment in 31% of patients.
CONCLUSION: The limitations of the evidence used in this study highlight the need for a greater output of higher-level evidence in the form of controlled trials and retrospective studies to help further elucidate the proper role and dosage of corticosteroids in the management plan of AIP with the ultimate goal of enhancing clinical decision-making and patient care. The findings of this systematic review, primarily based on observational data from case reports, highlight the critical need for treatment guidelines for this condition. The compilations of these cases also illustrated the diverse strategies employed by clinicians globally to save patients afflicted by this condition. While specific recommendations cannot be made based solely on these results, we anticipate that this comprehensive overview of varied clinical approaches from around the world will serve as a valuable resource for healthcare providers navigating the complexities of managing this condition
Global Results From the Optimize PRO Study: Standardized TAVR Technique and Care Pathway
No full textUsing network analysis to support fluid teams managing postpartum hemorrhage.
No full textTraditional approaches to improve teamwork during postpartum hemorrhage (PPH) may not be effective for dynamic situations with fluid team members. In this study, we use the Systems Engineering Initiative for Patient Safety (SEIPS) model as a framework to identify strategies to improve the teamwork of fluid teams managing PPH. We administered a close-ended survey to explore how clinicians in the obstetrics and gynecology department perceive their team membership, team interactions, and team effectiveness when managing PPH. Then, we used network analysis to understand how clinician interactions differ and describe the relationship between team membership and team effectiveness. Our results showed that the type and frequency of interactions differed between the participant roles. Additionally, our results showed a weak, positive correlation between team membership and effectiveness. From our findings, we identified two work system design strategies to improve teamwork: establish a decentralized communication structure and implement task-focused behaviors
Flow Diversion in Patients With Concurrent Anticoagulation: Multicenter Experience and Systematic Review of Literature.
No full textBACKGROUND AND OBJECTIVES: Dual antiplatelet therapy is used to minimize thromboembolic complications after flow diversion (FD). Oral anticoagulation (AC) has been associated with increased risk of hemorrhagic complications. Our multicenter study and systematic review of literature describes the safety and efficacy of FD in patients on concurrent AC.
METHODS: This was a retrospective study of patients on concurrent AC before FD for an intracranial aneurysm at 3 participating institutions between January 2018 and January 2024. Outcomes of interest were angiographic occlusion (assessed using the O\u27Kelly-Marotta (OKM) Grade), postoperative complications, in-stent stenosis, and functional outcome (measured using the modified Rankin Scale). PubMed was searched to identify articles that reported outcomes of interest in patients undergoing FD on AC.
RESULTS: Nineteen patients with 20 aneurysms underwent FD while on AC. The median age of the cohort was 71%, and 89.4% were female (n = 17). Forty percentage (n = 8) of aneurysms were completely occluded (OKM grade D) and 20% (n = 4) developed clinically asymptomatic in-stent stenosis at their last follow-up. Overall, 84.2% of patients (n = 16) were functionally independent, 1 patient was lost to follow-up and 2 patients experienced mortality. Our systematic review of literature identified 2 articles describing rates of occlusion ranging from 25% to 71.4%, with increased rates of delayed rupture and retreatment among patients on AC.
CONCLUSION: We report low rates of complete aneurysm obliteration after FD in patients on concurrent AC. Future research could help identify the appropriate antithrombotic regimen in this cohort
Evaluating Large Language Models for Automated CPT Code Prediction in Endovascular Neurosurgery.
No full textLarge language models (LLMs) have been utilized to automate tasks like writing discharge summaries and operative reports in neurosurgery. The present study evaluates their ability to identify current procedural terminology (CPT) codes from operative reports. Three LLMs (ChatGPT 4.0, AtlasGPT and Gemini) were evaluated in their ability to provide CPT codes for diagnostic or interventional procedures in endovascular neurosurgery at a single institution. Responses were classified as correct, partially correct or incorrect, and the percentage of correctly identified CPT codes were calculated. The Chi-Square test and Kruskal Wallis test were used to compare responses across LLMs. A total of 30 operative notes were used in the present study. AtlasGPT identified CPT codes for 98.3% procedures with partially correct responses, while ChatGPT and Gemini provided partially correct responses for 86.7% and 30% procedures, respectively (P \u3c 0.001). AtlasGPT identified CPT codes correctly in an average of 35.3% of procedures, followed by ChatGPT (35.1%) and Gemini (8.9%) (P \u3c 0.001). A pairwise comparison among three LLMs revealed that AtlasGPT and ChatGPT outperformed Gemini. Untrained LLMs have the ability to identify partially correct CPT codes in endovascular neurosurgery. Training these models could further enhance their ability to identify CPT codes and minimize healthcare expenditure
Postoperative Outcomes of Anti-Reflux Surgery in Lung Transplant Recipients.
No full textBACKGROUND: Gastroesophageal reflux disease (GERD) is a risk factor for aspiration and lung allograft rejection. Anti-reflux surgery (ARS) can be utilized for these patients to improve GERD and abate the decline of lung function. Accordingly, this study seeks to compare the efficacy of different accepted ARS techniques in lung transplant populations.
METHODS: A single-center retrospective cohort study of lung transplant recipients who underwent ARS between 2011 - 2023 was performed. GERD symptoms were based on proton-pump inhibitor (PPI) usage postoperatively. Pulmonary function testing, postoperative complications, dysphagia complaints, and endoscopic or surgical revisions were also evaluated and compared using Chi-square and Wilcoxon rank-sum tests. P≤0.05 denoted significance.
RESULTS: Ninety-six patients underwent Nissen (49.0%), Toupet (46.9%), or Dor (1.0%) fundoplication, or magnetic sphincter augmentation (MSA, 3.1%). Nissen fundoplication patients had increased rates of PPI usage at 3- (93% vs 54.8%, p\u3c 0.001) and 6-months (90.7% vs 40.5%, p\u3c 0.001) postoperatively with no significant differences at most recent follow up when compared with Toupet patients. Between Nissen and Toupet fundoplication patients, differences in rates of post-operative dysphagia (45.7% vs 42.2%, p=0.678), endoscopic dilation (17.4% vs 22.2%, p=0.219), and revisional surgery (8.7% vs 2.2%, p=0.140) were statistically insignificant. No significant differences in FEV1 (1.98L vs. 2.04L, p=0.470) or in median FEV1 percent change (1.96% vs. 0.98% respectively, p=0.524) pre- to post-ARS were identified when comparing Nissen vs. Toupet.
CONCLUSION: Considering lower PPI usage at 3- and 6- months post-ARS, Toupet fundoplication is superior to Nissen in decreasing PPI use in lung transplant recipients. Postoperative dysphagia, reintervention, and pulmonary function outcomes are similar between Toupet and Nissen patients
Mood Disorders and Dysautonomia in Patients Diagnosed with Idiopathic Hypersomnia: A Retrospective Analysis (2000–2023)
No full textAchromobacter xylosoxidans: An uncommon scalp infection leading to alopecia and biofilm formation.
No full textAchromobacter xylosoxidans is an emerging opportunistic pathogen causing respiratory and systemic infections, mainly in immunocompromised individuals. Cutaneous infections remain uncommon. We present a unique case of a 60-year-old immunocompetent female with a persistent, pruritic, and malodorous scalp infection for over a year, leading to alopecia and biofilm formation, complicating treatment by increasing antibiotic resistance. Despite lacking typical risk factors, wound culture identified A. xylosoxidans with susceptibility to trimethoprim-sulfamethoxazole, which led to successful treatment alongside surgical debridement. This case highlights the need for clinicians to consider A. xylosoxidans in differential diagnoses of unusual skin infections, especially when biofilm formation is evident, and underscores the importance of targeted antibiotic therapy due to this pathogen\u27s multidrug resistance
