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Society for Healthcare Epidemiology of America position statement on pandemic preparedness for policymakers: mitigating supply shortages
No full textThe COVID-19 has had major direct (e.g., deaths) and indirect (e.g., social inequities) effects in the United States. While the public health response to the epidemic featured some important successes (e.g., universal masking ,and rapid development and approval of vaccines and therapeutics), there were systemic failures (e.g., inadequate public health infrastructure) that overshadowed these successes. Key deficiency in the U.S. response were shortages of personal protective equipment (PPE) and supply chain deficiencies. Recommendations are provided for mitigating supply shortages and supply chain failures in healthcare settings in future pandemics. Some key recommendations for preventing shortages of essential components of infection control and prevention include increasing the stockpile of PPE in the U.S. National Strategic Stockpile, increased transparency of the Stockpile, invoking the Defense Production Act at an early stage, and rapid review and authorization by FDA/EPA/OSHA of non-U.S. approved products. Recommendations are also provided for mitigating shortages of diagnostic testing, medications and medical equipment
Microvascular recovery with ultrasound in myocardial infarction post-PCI trial
No full textPurpose: Persistent microvascular obstruction (MVO) after successful percutaneous coronary intervention (PCI) in acute ST segment elevation myocardial infarction (STEMI) has been well-described. MVO predicts lack of recovery of left ventricular function and increased mortality. Sonothrombolysis utilizing diagnostic ultrasound induced cavitation of commercially available microbubble contrast has been effective at reducing infarct size and improving left ventricular ejection fraction (LVEF) when performed both pre- and post-PCI. However, the effectiveness of post-PCI sonothrombolysis alone after successful PCI has not been demonstrated.
Methods: A prospective randomized controlled trial was performed in 50 consecutive consenting patients with anterior STEMI who underwent a continuous microbubble infusion immediately following successful PCI. Intermittent high mechanical index (MI) impulses were applied only in the sonthrombolysis group. Delayed enhancement magnetic resonance imaging (MRI) was performed at 48 h and again at 6-8 weeks to assess for differences in infarct size, LVEF, and MVO.
Results: There were no differences between groups in age, gender, and cardiovascular risk factors. Significant (\u3e 2 segments) MVO following successful PCI was observed in 66% of patients. Although sonothrombolysis reduced the extent of MVO acutely, there were no differences in infarct size, LVEF, or extent of MVO by MRI at 48 h. Twenty-eight patients returned for a follow up MRI at 6-8 weeks. LVEF improved only in the sonothrombolysis group (∆LVEF 7.81 ± 4.57% with sonothrombolysis vs. 1.77 ± 7.02% for low MI only, p = .011).
Conclusion: Post-PCI sonothrombolysis had minimal effect on reducing myocardial infarct size but improved left ventricular systolic function in patients with acute anterior wall STEMI.
Keywords: ST elevation myocardial infarction; left ventricular ejection fraction; magnetic resonance imaging; microvascular obstruction; sonothrombolysis
Emergency Presentations of COVID-19: A Review of the Literature and Radiologic Perspective
No full textSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the debilitating global pandemic known as Coronavirus disease (COVID-19). In this paper, we highlight the widespread manifestations and complications across disease systems. In addition, we present their relevant imaging findings to inform appropriate investigations and management in patients presenting to the Emergency Department with COVID-19 and its respective sequalae. Of note, we outline considerations for diagnosis of long COVID, an important medium to long term sequalae in patients with previous COVID-19 infections
Intravenous Iron in Patients Hospitalized with Bacterial Infections: Utilization and Outcomes
No full textIntroduction: Given the uncertainties related to IV iron therapy and the potential risk of infection, health care providers may hesitate to use this preparation to treat hospitalized patients with bacterial infections, even if clinically indicated. The aim of this study was to examine patterns of prescribing IV iron in patients who were hospitalized and treated for a bacterial infection, and their associated clinical outcomes.
Methods: This retrospective chart review evaluated adult patients who received both IV iron sucrose and antibiotics during the same admission at Maine Medical Center in 2019. Data collected included iron studies, practices for prescribing IV iron, and clinical outcomes. Data were summarized using descriptive statistics.
Results: A total of 197 patients were evaluated. The median duration of antibiotic therapy was 5(4-9) days. Iron and antibiotic administration overlapped in 153(77.7%) patients, with a mean overlap of 2.7(1-7) days. In the 44 patients without overlap, 20(46%) received IV iron before antibiotics. More than half (57%) of infection types involved urinary tract and respiratory systems. Approximately 2% of patients had antibiotic therapy broadened or duration extended, 7% died, and 16% were readmitted within 30 days of discharge.
Discussion: Prior studies evaluating the risk of infection with IV iron published conflicting results. This is the only study that analyzed outcomes in patients receiving IV iron and antibiotics for infection but not undergoing hemodialysis during a hospital admission. Although our findings support that IV iron treatment is safe among patients with concomitant infection and iron deficiency, this finding may not be the case for all clinical subgroups.
Conclusions: This study showed that when patients were administered IV iron in the setting of acute bacterial infection in our facility, most patients did not have negative outcomes.
Keywords: Iron sucrose; bacterial infections; iron-deficiency anemia; patient admission
A standardized protocol using clinical adjudication to define true infection status in patients presenting to the emergency department with suspected infections and/or sepsis
No full textIn absence of a gold standard , a standardized clinical adjudication process was developed for a registrational trial of a transcriptomic host response (HR) test. Two physicians independently reviewed clinical data to adjudicate presence and source of bacterial and viral infections in emergency department patients. Discordant cases were resolved by a third physician. Agreement among 955 cases was 74.1% (708/955) for bacterial, 75.6% (722/955) for viral infections, and 71.2% (680/955) overall. Most discordances were minor (85.2%; 409/480) versus moderate (11.7%; 56/480) or complete (3.3%; 16/480). Concordance levels were lowest for bacterial skin and soft tissue infections (8.2%) and for viral respiratory tract infections (4.5%). This robust adjudication process can be used to evaluate HR tests and other diagnostics by regulatory agencies and for educating clinicians, laboratorians, and clinical researchers. Clinicaltrials.gov NCT04094818. SUMMARY: Without a gold standard for evaluating host response tests, clinical adjudication is a robust reference standard that is essential to determine the true infection status in diagnostic registrational clinical studies.
Keywords: Adjudication; Bacterial; Clinical; Viral
Sex Difference in Outcomes and Management of Cardiogenic Shock: A Systematic Review and Meta-Analysis
No full textBackground: Cardiogenic shock (CS) is associated with significant morbidity and mortality. Sex differences in the outcomes and management of cardiogenic shock are not well established. The primary objective of this study is to investigate the differences inik cardiogenic shock outcomes between males and females.
Methods: A systematic review and meta-analysis were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Studies were searched via the MEDLINE/PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases from inception to December 2022.
Results: The analysis included 24 studies comprising 1,567,660 patients. Compared to females, males with CS had a significantly lower risk of in-hospital all-cause mortality (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.85-0.90, p\u3c0.001) and 1-year mortality (RR 0.90, 95% CI 0.89-0.92, p\u3c0.001). Males were more likely to undergo percutaneous coronary intervention (RR 1.21, 95% CI 1.13-1.31, p\u3c0.0001) and intra-aortic balloon pump placement (RR 1.21, 95% CI 1.11-1.32, p\u3c0.0001), with no significant sex differences in the use of extracorporeal membrane oxygenation or Impella. During the index hospitalization, males were at higher risk of arrhythmias (RR 1.18, 95% CI 1.05-1.34, p=0.003) and less likely to develop acute kidney injury (RR 0.86, 95% CI 0.79-0.94, p\u3c0.001).
Conclusion: Men have a lower all-cause mortality risk in cardiogenic shock. Addressing disparities in management is crucial for improving CS outcomes, especially for women.
Keywords: Cardiogenic shock; gender disparities; men; sex disparities; women
Prevalence of Chronic Kidney Disease in a High-Risk Population in Urban Lahore, Pakistan: A Cross-sectional Study
No full textBackground Chronic kidney disease (CKD) is a globally increasing health concern, and there is a growing focus on early screening and prevention efforts. However, the availability of data on CKD prevalence in Pakistan, particularly in the urban area of Lahore district, is limited. The objective of the Kidney Early Evaluation Program (KEEP) Lahore was to assess the prevalence of CKD in a high-risk population residing in the urban area of Lahore, Pakistan. Methods A cross-sectional study was conducted involving 254 participants, who were over 18 years old and belonged to a high-risk population according to the pre-defined operational definitions. The participants were randomly selected from various towns in Lahore. Screening camps were set up to measure serum creatinine levels and urinary albumin to creatinine ratio (UACR), and then the estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration 2021 (CKD EPI) equation. Results Out of the total 254 participants, a diagnosis of CKD was made in 62 (24.2%) individuals. Significant associations were found between CKD and risk factors including hypertension, diabetes, family history of CKD, ischemic heart disease (IHD) or congestive heart failure (CHF), intake of painkillers, and herbal medicines. However, no association was found between obesity (BMI ≥ 30) and CKD. Participants diagnosed with CKD had a mean age of 49.9 years and a mean serum creatinine level of 1.2 mg/dL, while non-CKD participants had a mean age of 43.7 years and a mean serum creatinine level of 0.7 mg/dL. Conclusion Our study revealed that CKD was prevalent in about one-fourth of the participants from the high-risk population of Lahore, indicating a high prevalence of the disease within society. Moreover, hypertension, diabetes, family history of CKD, heart disease, painkillers, and the use of herbal medicines were all significantly linked to CKD in the surveyed sample population.
Keywords: chronic kidney disease factors; chronic kidney disease prevalence; chronic kidney disease (ckd); ckd in pakistani population; diabetic kidney disease (dkd); hypertensive ckd
Pediatric Presentations of COVID-19 and Pertinent Radiologic Findings
No full textSince the 2019 worldwide pandemic, Severe Acute Respiratory Syndrome coronavirus 2 responsible for COVID-19 disease, not only had global economic repercussions but millions of individuals health were also put at risk. Like any other respiratory illness, COVID-19 has a variety of presentations and radiological features. While COVID-19 infections in the pediatric population generally present with better prognosis and lower mortality rates when compared to those of adults, in the vulnerable populations however, severe presentations are often more frequent and can have catastrophic consequences. This paper will specifically address pediatric presentations of COVID-19 including those suffering from multisystem inflammation, along with their radiologic manifestations and image findings
Your BMP Voice - August 2024
No full textIn August’s episode: Your BMP Voice: responses to submissions from the Your BMP Voice digital suggestion box Recognitions: Clinical Documentation Improvement (CDI) team champions New Leader Spotlight: Dr. Yael Tarshish, Division Chief of Palliative Care Medicine Announcements: New Physician & Advanced Practitioner Welcome Receptionhttps://scholarlycommons.libraryinfo.bhs.org/bmp_voice/1007/thumbnail.jp
