11210 research outputs found
Sort by
The Pulse, 2002, V13 N1, Winter
No full textDreyer Medical Clinic, Aurora, IL: An issue of The Pulse, a publication for Dreyer Medical Clinic patients. This was a newsletter published for patients reporting on Dreyer news, events, classes, and staffing updates.https://institutionalrepository.aah.org/alldocuments/2094/thumbnail.jp
Influence of recipient insurance on the outcome of simultaneous pancreas and kidney transplantation
No full textIntroduction:Simultaneous pancreas-kidney (SPK) transplantation is an established treatment for insulin-requiring diabetics with advanced chronic or end-stage kidney disease. Outcomes of SPK transplantation may vary according to socioeconomic factors such as funding sources. The aim of this study was to assess the association between insurance payer of transplant recipients and outcomes of SPK transplantation in the United States.
Methods:All adult primary SPK transplants performed in the United States between January 1, 1988, and December 31, 2017 were included, using data from the national Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients database. A total of 19,849 adult SPK transplant recipients were included in the study, after excluding patients who had insurance sources other than Medicaid, Medicare, or private; dual insurance; or were lost at 90-day follow-up. Post-transplant outcomes were analyzed in terms of allograft and recipient survival.
Results:Recipients with private insurance had significantly lower risks of late kidney graft loss (hazard ratio [HR], 0.74), late pancreas graft loss (HR, 0.77), and late death (HR, 0.73) compared with those with Medicaid. Recipients with Medicare had a higher risk of late death (HR, 1.05). Private insurance recipients had better 10-year and 15-year kidney, pancreas, and patient graft survival rates across most racial/ethnic groups.
Conclusions:Recipient insurance status significantly influenced long-term outcomes after SPK transplantation. Transplant programs should consider publicly sponsored insurance status as a marker of poorer post-transplant survival to implement changes in both pre- and post-transplant strategies
Genotype-phenotype correlations in hypertrophic cardiomyopathy: Insights from an HCM Center of Excellence
No full textBackground:Owing to the recognition of previously unknown pathogenic gene variants and reclassification of longer-known variants, gene distribution in patients with hypertrophic cardiomyopathy (HCM) is ever-changing. Conflicting data make the role of genotype in risk stratification unclear.
Methods:We evaluated genotype distribution and genotype-phenotype correlations in all adult patients with HCM seen at our HCM Center of Excellence from March 31, 2010, to April 30, 2023. We also evaluated a composite outcome, including all-cause mortality, stroke, implantable cardioverter-defibrillator placement, heart failure hospitalization, left ventricular assist device implantation, heart transplantation, septal myectomy, and alcohol septal ablation, based on genotype status. All-cause mortality was separately analyzed.
Results:Of 827 patients with HCM, genotyping was completed in 754 (91.2%). We identified 202 (27%) genotype-positive (Gen-P), 163 (22%) variant of unknown significance (VUS), and 389 (51%) genotype-negative (Gen-N) patients. Mean age was 47, 57, and 58 years, respectively. The most common gene implicated was MYBPC3 (63%). More patients were on optimal medical treatment after following up with our HCM Center. Electrocardiographic, Holter, echocardiographic, and cardiac magnetic resonance imaging characteristics differed based on genotype status. The composite outcome was worse in Gen-P than Gen-N (HR 1.84, p
Conclusion:MYBPC3 was the most common gene implicated. Outcomes were worse in Gen-P patients. Centers of Excellence play an important role in the optimal medical management of patients with HCM
HOCUS POCUS: Point of care ultrasound in pediatric hospital medicine - witchery or reality?
No full textManagement of monochorionic diamniotic twin gestation affected by Type-II selective fetal growth restriction: Cost-effectiveness analysis
No full textObjective:Monochorionic twin gestations affected by Type-II selective fetal growth restriction (sFGR) are at increased risk of intrauterine fetal demise, extreme preterm birth, severe neurodevelopmental impairment (NDI) and neonatal death of one or both twins. In the absence of a consensus on the optimal management strategy, we chose to evaluate which strategy was cost-effective in the setting of Type-II sFGR.
Methods:A decision-analytic model was used to compare expectant management (EM), bipolar cord occlusion (BCO), radiofrequency ablation (RFA) and fetoscopic laser photocoagulation (FLP) for a hypothetical cohort of 10 000 people with a monochorionic diamniotic twin pregnancy affected by Type-II sFGR. Probabilities and utilities were derived from the literature. Costs were derived from the Healthcare Cost and Utilization Project and adjusted to 2023 USD. The analytic horizon, taken from the perspective of the pregnant patient, extended throughout the life of the child or children. An incremental cost-effectiveness ratio of 50 000 USD per quality-adjusted life year defined the willingness-to-pay threshold. One-way and probabilistic sensitivity analysis was also performed.
Results:For base-case estimates, RFA was the most cost-effective strategy compared with all of the other interventions included, with an incremental cost-effectiveness ratio of 14 243 USD per quality-adjusted life year. One-way sensitivity analysis demonstrated that the utilities assigned to fetal demise and severe NDI, as well as the costs of preterm birth before 32 weeks, most strongly impacted the model outcomes. On probabilistic sensitivity analysis, RFA was the most cost-effective strategy in 78% of runs, followed by BCO at 20%, EM at 2% and FLP in 0% of runs. When compared with EM, RFA led to 58 fewer births before 28 weeks\u27 gestation, 273 fewer cases of severe NDI and 22 more deliveries after 32 weeks. When compared with FLP, RFA resulted in 259 fewer cases of severe NDI and 3177 more births after 32 weeks. When compared with BCO, RFA resulted in 1786 more neurologically intact neonates and 34 fewer cases of severe NDI.
Conclusions:On base-case analysis, RFA was found to be the most cost-effective strategy in the management of monochorionic diamniotic twin pregnancies affected by Type-II sFGR. However, these findings were not robust on sensitivity analysis, indicating the potential benefit of BCO and EM. In the absence of large clinical trials, these data should not be taken to guide management. Future studies should evaluate management strategies for Type-II sFGR related to long-term neonatal outcomes, inclusive of quality-of-life indicators, in a prospective multicenter cohort. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology
Late onset cerebellar ataxia syndrome after non-paraneoplastic Lambert-Eaton myasthenic syndrome: A case study
No full textThis is an unusual case of voltage gated calcium channel (VGCC) antibodies leading to two distinct and chronologically separated neurologic syndromes without the presence of an underlying neoplasm. Lambert Eaton Myasthenic Syndrome (LEMS) presented five years prior to cerebellar ataxia. Both LEMS and cerebellar ataxia were responsive to treatment, but not the same therapy. He was diagnosed with LEMS through history, exam, electromyography/nerve conduction studies (EMG/NCS) with repetitive nerve stimulation (RNS) and antibody testing. He was treated with 3,4 diaminopyridine (3,4 DAP) with an excellent response. Five years later, he developed acute ataxia. The patient required months of intensive and continued immunomodulating therapy
Dreyer Heartbeat, 1991-1992 December-January
No full textDreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.https://institutionalrepository.aah.org/alldocuments/1901/thumbnail.jp
Dreyer Heartbeat, 1992 June-July
No full textDreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.https://institutionalrepository.aah.org/alldocuments/1905/thumbnail.jp
Dreyer Heartbeat, 1993 June-July
No full textDreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.https://institutionalrepository.aah.org/alldocuments/1911/thumbnail.jp
Heartbeat, 1996 August
No full textDreyer Medical Clinic, Aurora, IL: An issue of Dreyer Heartbeat. This was an employee newsletter published by the marketing department, reporting on news, events, and staffing updates at Dreyer Medical Clinic.https://institutionalrepository.aah.org/alldocuments/1926/thumbnail.jp