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Predictors of Arrhythmias In the Population Hospitalized for SARS-CoV-2
No full textBackground: Studies exploring predictors of arrhythmias in the population primarily hospitalized for SARS-CoV-2 (COVID-19) are scarce. Understanding this is crucial for risk stratification and appropriate management.
Methods: Using the 2020 National Inpatient Sample (NIS) database, we identified primary admissions for COVID-19. A \u27greedy neighbor\u27 1:1 propensity-score matching (PSM) accounted for baseline differences. Then, multivariable logistic regression models were employed to account for confounders and estimate the probability of arrhythmia.
Results: There were a total of 1,058,815 admissions for COVID-19 (mean age 64.3 years ±16.8), 47.2% female, 52.5% (107698) White, 18.5% (37973) Blacks, and 20.7% (42,447) Hispanics. Atrial fibrillation was the most prevalent arrhythmia, 15.1% (31,942). After PSM, 166,405 arrhythmia hospitalizations were matched to 166,405 hospitalizations without arrhythmia. Sick sinus syndrome 4.9 (4.4-5.5), dyslipidemia 1.2 (1.2-1.3), cardiac arrest 1.3 (1.1-1.4), invasive mechanical ventilation 1.9 (1.8-2.0) and obesity 1.3 (1.2-1.4), (p\u3c0.0001, all) were all independent predictors of arrhythmias.
Conclusions: Our analysis revealed a notable proportion of hospitalized COVID-19 patients with arrhythmias. Dyslipidemia, obesity, sick sinus syndrome, invasive mechanical ventilation, and cardiac arrest were independent predictors of arrhythmias.
Keywords: Arrhythmias; COVID-19; Coronavirus; In-hospital Outcomes; National Inpatient Sample; Predictors; SARS-Cov-2
Outcomes of simultaneous left atrial appendage closure in atrial fibrillation patients undergoing transcatheter aortic valve replacement
No full textInpatients\u27 understanding of the hospitalist role and common medical terminology
No full textMany patients are unable to identify members of their hospital care team and experience confusion regarding some medical terminology used during hospitalization, including descriptions of the structure of their inpatient care team. This cross-sectional study sought to (1) examine inpatients\u27 understanding of the role of a hospitalist and (2) assess inpatients\u27 familiarity with other medical terminology commonly used in the hospital. We surveyed 172 patients admitted to the hospital medicine service at two academic medical centers. We found that almost half (47%) of respondents were unfamiliar with the term and/or role of a hospitalist, while the remaining patients had varied understanding of the role. Several other medical terms were frequently misunderstood (such as NPO, PA, and Attending ). Ongoing efforts are needed to improve communication to ensure that hospitalized patients understand the hospitalist\u27s role and the medical terms shared with them
Maximizing Minimally Invasive Cardiac Surgery With Enhanced Recovery (ERAS)
No full textWe convened a group of cardiac surgeons, intensivists, and anesthesiologists with extensive experience in minimally invasive cardiac surgery (MICS) and perioperative care to identify the essential elements of a MICS program and the relationship with Enhanced Recovery After Surgery (ERAS). The MICS incision should minimize tissue invasion without compromising surgical goals. MICS also requires safe management of hemodynamics and preservation of cardiac function, which we have termed myocardial management. Finally, comprehensive perioperative care through an ERAS program should be provided to allow patients to achieve optimal recovery. Therefore, we propose that MICS requires 3 elements: (1) a less invasive surgical incision (non-full sternotomy), (2) optimized myocardial management, and (3) ERAS. We contend that the full benefit of MICS can be achieved only by also utilizing an ERAS platform.
Keywords: cardiac surgery; enhanced recovery; minimally invasive; perioperative
Navigating Treatment Pathways in Metastatic Hormone Receptor-Positive, HER2-Negative Breast Cancer: Optimizing Second-Line Endocrine and Targeted Therapies
No full textThe Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors\u27 suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice
In-Hospital Disease Progression in Moderate to Severe Chronic Kidney Disease Patients with COVID-19 Treated with Nirmatrelvir/Ritonavir
No full textMedicaid Accountable Care Organizations and Disparities in Pediatric Asthma Care
No full textImportance: Nearly 6 million children in the US have asthma, and over one-third of US children are insured by Medicaid. Although 23 state Medicaid programs have experimented with accountable care organizations (ACOs), little is known about ACOs\u27 effects on longstanding insurance-based disparities in pediatric asthma care and outcomes.
Objective: To determine associations between Massachusetts Medicaid ACO implementation in March 2018 and changes in care quality and use for children with asthma.
Design, setting, and participants: Using data from the Massachusetts All Payer Claims Database from January 1, 2014, to December 31, 2020, we determined child-years with asthma and used difference-in-differences (DiD) estimates to compare asthma quality of care and emergency department (ED) or hospital use for child-years with Medicaid vs private insurance for 3 year periods before and after ACO implementation for children aged 2 to 17 years. Regression models accounted for demographic and community characteristics and health status. Data analysis was conducted between January 2022 and June 2024.
Exposure: Massachusetts Medicaid ACO implementation.
Main outcomes and measures: Primary outcomes were binary measures in a calendar year of (1) any routine outpatient asthma visit, (2) asthma medication ratio (AMR) greater than 0.5, and (3) any ED or hospital use with asthma. To determine the statistical significance of differences in descriptive statistics between groups, χ2 and t tests were used.
Results: Among 376 509 child-year observations, 268 338 (71.27%) were insured by Medicaid and 73 633 (19.56%) had persistent asthma. There was no significant change in rates of routine asthma visits for Medicaid-insured child-years vs privately insured child-years post-ACO implementation (DiD, -0.4 percentage points [pp]; 95% CI, -1.4 to 0.6 pp). There was an increase in the proportion with AMR greater than 0.5 for Medicaid-insured child-years vs privately insured in the postimplementation period (DiD, 3.7 pp; 95% CI, 2.0-5.4 pp), with absolute declines in both groups postimplementation. There was an increase in any ED or hospital use for Medicaid-insured child-years vs privately insured postimplementation (DiD, 2.1 pp; 95% CI, 1.2-3.0 pp), an 8% increase from the preperiod Medicaid use rate.
Conclusions and relevance: Introduction of Massachusetts Medicaid ACOs was associated with persistent insurance-based disparities in routine asthma visit rates; a narrowing in disparities in appropriate AMR rates due to reductions in appropriate rates among those with private insurance; and worsening disparities in any ED or hospital use for Medicaid-insured children with asthma compared to children with private insurance. Continued study of changes in pediatric asthma care delivery is warranted in relation to major Medicaid financing and delivery system reforms
Precipitated Withdrawal in the Era of Street Fentanyl-The Important Thing Is to Not Stop Questioning
No full textCollaboration Between Nurses & Engineers: Design of a Defibrillator Handle
Get PDFhttps://scholarlycommons.libraryinfo.bhs.org/nurs_presentations2024/1019/thumbnail.jp
Use of the Georgie Pediatric Gown to Improve Compliance to the Safe Sleep Bundle
Get PDFhttps://scholarlycommons.libraryinfo.bhs.org/nurs_presentations2024/1016/thumbnail.jp