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Concordance of 30-Day Mortality and In-Hospital Mortality or Hospice Discharge After Sepsis
No full textThis study uses a multihospital cohort to evaluate 2 candidate outcome measures being considered for benchmarking by the CDC and CMS for community-onset sepsis hospitalizations: 30-day mortality after admission and composite in-hospital mortality or hospice discharge
Longitudinal Associations Between Peritraumatic Oestradiol and Fear Responding in Women and Men
No full textPTSD is more prevalent in women than men and associated with autonomic dysfunction. Higher oestradiol levels have been associated with decreased PTSD severity, however, the impact of oestradiol on autonomic function is not well characterised. We examined associations among peritraumatic oestradiol levels and autonomic function in the multi-site AURORA study. Participants (n = 283, 69.6% female) were recruited from the emergency department (ED) following trauma exposure. Skin conductance (SC) was measured during trauma recall at the ED. Oestradiol was assayed from blood collected at ED, 2-week and 6-month. Fear conditioning, including fear potentiated startle (FPS), was completed at 2-week and 6-month. In women, ED oestradiol was significantly positively associated with ED SC and FPS at 6-month. In men, significant negative correlations between ED oestradiol and SC were found. Among women in the study, peritraumatic oestradiol was positively associated with fear responding 6-month. Findings suggest that the protective effects of oestradiol on PTSD may depend on other factors, such as time since trauma. Additional research is needed to elucidate how peritraumatic oestradiol and autonomic function may interact to confer risk for PTSD
Characterizing the Design of and Emerging Evidence for Health Care Organization-Based Lung Cancer Screening Interventions: A Systematic Review
No full textBackground. Implementing a lung cancer screening (LCS) program with low-dose computed tomography (LDCT) is complex, requiring health care organizations to consider several steps along the screening continuum from eligibility assessment to recommended follow-up testing adherence. The evidence to support LDCT screening implementation remains unclear. Purpose. To summarize interventions facilitating LCS initiation, adoption, or improvement within health care organizations. Data Sources. Librarian-assisted literature reviews identified published studies between January 1, 2011, and December 31, 2023, using CINAHL, Cochrane Library, Embase, Ovid Medline, PsycINFO, and Scopus. Study Selection. Published interventions focusing on any step in the LCS process before lung cancer diagnosis, including risk/eligibility assessment, shared decision making (SDM), and annual screening or diagnostic testing. Data Abstraction. We used a title/abstract review process, full-text review, and risk-of-bias assessments. We characterized studies by design, unit of observation, participant sociodemographic characteristics, primary outcome, and step in the LCS process. DistillerSR and Covidence were used for data management. Data Synthesis. We identified 64 study-eligible published articles, including 19 randomized and 45 nonrandomized studies. SDM interventions were most frequently studied (n = 20) followed by initial LCS uptake (n = 12). Most studies (n = 33) evaluated educational interventions, typically in one-on-one settings. Studies assessed at either low or moderate/some risk of bias reported statistically significant findings in the domains of improved knowledge (n = 7) and other aspects of decision making (n = 8), such as perceived risk or decisional conflict. Findings regarding LCS uptake were more variable. Limitations. The review includes only English-language studies published prior to 2024. The risk of bias was high among 5 of the randomized clinical trials and serious among 27 of the quasi-experimental design studies. Conclusions. LCS intervention strategies have focused on SDM and initial LCS uptake, leaving gaps in knowledge about how to support risk and eligibility assessment, adherence to annual screening, or diagnostic testing. Expanding interventions beyond those that are education focused and with single-level targets would expand the LDCT screening implementation evidence base. HIGHLIGHTS: Most lung cancer screening (LCS) interventions evaluated to date have been educational in nature and focused primarily on shared decision making or the initial uptake of screening, with some interventions demonstrating statistically significant improvements in patient knowledge and initial LCS order/uptake.A critical gap in knowledge remains regarding how to effectively support LCS eligibility assessment as well as adherence to annual screening and appropriate diagnostic testing.Findings underscore the need for the field to expand beyond education-focused interventions and incorporate multilevel targets when designing interventions to support high-quality LCS in practice
Prevalence of Very-High HDL-C and Association with Incident Atherosclerotic Cardiovascular Disease and All-Cause Mortality
No full textResearch priorities for peripheral artery disease: A statement from the Society for Vascular Medicine
No full textLower-extremity peripheral artery disease (PAD) affects approximately 236 million people worldwide and at least eight million people in the United States (US). Despite availability of new therapies that prevent major adverse cardiovascular events (MACE), these and major adverse limb events (MALE) remain common and occur more frequently in people with PAD, either with or without coronary artery disease (CAD), compared to people with CAD who do not have PAD. The most effective therapies to prevent cardiovascular events are not identical in people with PAD and those with CAD. Walking impairment and the risk of lower-extremity amputation are significantly greater in people with PAD compared to those without PAD. This report from the Society for Vascular Medicine (SVM) proposes and summarizes high-priority topics for scientific investigation in PAD, with the goal of improving health outcomes in people with PAD. To develop this report, a multidisciplinary team of scientists and clinicians reviewed literature, proposed high-priority topics for scientific investigation, and voted to rank the highest priority topics for scientific investigation. Priorities for clinical scientific investigation include: determine the current prevalence of PAD in the US by age, sex, race, and ethnicity; improve methods to diagnose PAD; develop new medical therapies to eliminate walking impairment; and improve implementation of established therapies to reduce rates of MACE and MALE in people with PAD. Priorities in basic science and translational science investigation include: developing animal models that closely resemble the vascular, skeletal muscle, and platelet pathology in patients with PAD and defining the genetic and epigenetic contributors to PAD and PAD-associated outcomes. Successful investigation of these research priorities will require more well-trained investigators focused on scientific investigation of PAD, greater and more efficient enrollment of diverse patients with PAD in randomized clinical trials, and increased research funding dedicated to PAD
A Comprehensive Review of Left Atrial Venoarterial Extracorporeal Membrane Oxygenation
No full textCardiogenic shock (CS) in patients with structural heart disease (SHD) and severe valvular abnormalities poses unique challenges to traditional mechanical circulatory support (MCS) strategies, such as intra-aortic balloon pumps and ventricular assist devices. These devices may fail to address the complex interplay between ventricular unloading and systemic perfusion. Left atrial venoarterial extracorporeal membrane oxygenation (LAVA-ECMO) incorporating left atrial (LA) drainage into the ECMO circuit to reduce left ventricular (LV) preload, mitigate pulmonary congestion, and maintain systemic perfusion. This review explores the pathophysiologic principles and clinical applications associated with LAVA-ECMO. Studies have demonstrated its efficacy in managing CS due to severe valvular disease, biventricular failure, and complex hemodynamic profiles, such as those complicated by aortic regurgitation or ventricular septal defect. Although traditional venoarterial ECMO can incorporate LA drainage, LAVA-ECMO offers distinct advantages by actively unloading the left ventricle, thereby preventing such complications as LV distension and pulmonary edema. Clinical evidence suggests its role as a bridge to definitive interventions, including transcatheter and surgical valve replacements. Despite these benefits, challenges remain, including high in-hospital mortality and complications such as bleeding. LAVA-ECMO represents a transformative advancement in MCS, offering superior hemodynamic stabilization and myocardial recovery for patients with refractory CS and severe valvular disease. Its ability to address LV unloading directly positions it as a pivotal tool in critical care and SHD management; however, significant gaps in evidence, particularly in long-term outcomes and optimal patient selection, underscore the need for further research
Outcomes of Left Atrial Appendage Occlusion in Hispanic/Latino Patients: Insights From the National Inpatient Sample
No full textBACKGROUND: Left atrial appendage occlusion (LAAO) is an established therapy for stroke prevention in non-valvular atrial fibrillation (NVAF), but outcomes in Hispanic populations remain underexplored.
OBJECTIVE: The objective of our study was to evaluate the inpatient outcomes of Hispanic patients undergoing LAAO as compared to non-Hispanic white patients.
METHODS: We conducted a retrospective cohort study using the National Inpatient Sample (NIS). From 157 434 LAAO hospitalizations identified, 133 517 were non-Hispanic white and 6814 were Hispanic/Latino. The primary outcome was in-hospital mortality.
RESULTS: Unadjusted odds in the Hispanic/Latino group were higher for mortality (OR 1.78, 95% CI 1.18-2.68, p 0.006), stroke (OR 1.64, 95% CI 1.26-2.14, p \u3c 0.001), infectious complications (OR 3.89, 95% CI 3.03-4.99, p \u3c 0.001), major bleeding (OR 1.22, 95% CI 1.11-1.33, p \u3c 0.001), DVT/PE (OR 2.15, 95% CI 1.58-2.93, p \u3c 0.001), and vascular complications (OR 1.81, 95% CI 0.53-0.93, p \u3c 0.001). After adjusting for covariates and comorbidities, Hispanic/Latino patients had still greater odds of mortality (aOR 1.20, 95% CI 0.75-1.92, p 0.445), infectious complications (aOR 3.54, 95% CI 2.62-4.55, p \u3c 0.001), and vascular complications (aOR 1.57, 95% CI 1.22-2.03, p \u3c 0.001). Non-Hispanic white patients had higher adjusted odds of pericardial effusion/tamponade (aOR 0.64, 95% CI 0.52-0.95, p 0.03), while Hispanic/Latino patients also had higher adjusted odds of cardiac arrest (aOR 1.99, 95% CI 1.15-3.42, p 0.46).
CONCLUSION: Hispanic/Latino patients undergoing LAAO experience higher odds of infectious and vascular complications compared to non-Hispanic white patients. These findings highlight the need to further investigate disparities in procedural outcomes
Efficacy and Safety of Clindamycin Phosphate 1.2%/Adapalene 0.15%/Benzoyl Peroxide 3.1% Gel: Post Hoc Analysis by Baseline Disease Severity
No full textINTRODUCTION: Clindamycin phosphate (CLIN) 1.2%/adapalene (ADAP) 0.15%/benzoyl peroxide (BPO) 3.1% gel (CAB) is the only triple-combination topical approved for acne. These post hoc analyses assessed efficacy and safety of CAB gel compared with component dyads and branded ADAP 0.3%/BPO 2.5% gel in participants stratified by baseline acne severity.
METHODS: Data were pooled from two phase 2 and two phase 3 12-week studies. Participants were randomized to once-daily CAB or vehicle; one phase 2 study included dyad combinations of CAB active ingredients (ADAP/BPO, CLIN/BPO, and CLIN/ADAP) and the other included a head-to-head comparison with branded ADAP 0.3%/BPO 2.5%. Assessments included percent changes from baseline in inflammatory/noninflammatory lesions (IL/NIL) and treatment success (≥ 2-grade reduction from baseline in Evaluator\u27s Global Severity Score [EGSS] and clear/almost clear skin). Treatment-emergent adverse events (TEAEs) and cutaneous safety/tolerability were assessed.
RESULTS: At week 12, IL reductions in moderate participants (EGSS = 3; n = 1557) were significantly greater with CAB vs vehicle, dyads, and branded ADAP/BPO (77.1% vs 54.1%, 64.4-69.4%, and 72.8%, respectively; P \u3c 0.05, all). IL reductions in severe participants (EGSS = 4; n = 230) were significantly greater with CAB vs vehicle, ADAP/BPO, and CLIN/BPO (74.5% vs 44.4%, 63.9%, and 61.3%; P \u3c 0.05, all), and similar to CLIN/ADAP and branded ADAP/BPO (73.7%/75.4%). IL reductions were greater than NIL. Moderate participants achieved greater treatment success rates with CAB vs vehicle, dyads, or branded ADAP/BPO (53.9% vs 19.5%, 31.5-35.3%, and 38.1%; P ≤ 0.001, all); only CAB- and CLIN/ADAP-treated severe participants had significantly greater rates vs vehicle (30.9% and 34.0% vs 9.0%; P \u3c 0.05). Most TEAEs were of mild to moderate severity. All mean cutaneous safety/tolerability scores were ≤ 1 (1 = mild).
CONCLUSIONS: CAB demonstrated superior efficacy to three dyads and branded ADAP 0.3%/BPO 2.5% in moderate acne participants, and generally numerically greater efficacy in severe acne participants. To our knowledge, these analyses include data from the only double-blind, vehicle-controlled, head-to-head study.
TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03170388, NCT04892706, NCT04214639, and NCT04214652