11210 research outputs found
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Abstract P1058: Parental stress and depression on child cardiovascular health: The young hearts study
No full textEstimated theoretical benefit of aggressive LDL lowering in patients with symptomatic intracranial atherosclerosis
No full textObjectives:Given the high risk of recurrent atherosclerotic vascular events in patients with stroke due to intracranial atherosclerotic disease (ICAD), we estimated the potential benefit of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in this population.
Methods:In this secondary analysis of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, we estimated the association between 30-day low-density lipoprotein (LDL) reduction and recurrent stroke or myocardial infarction (MI) beyond 30 days (primary outcome). Estimates were assessed using adjusted Cox proportional hazards regression. We applied relative LDL reduction estimates from PCSK9i trials to project adjusted incidence rate differences of the primary outcome with an equivalent LDL reduction.
Results:Of the 451 patients from SAMMPRIS, 378 met inclusion criteria. In adjusted Cox regression, every 10 mg/dL LDL improvement was associated with a 9% lower rate of the primary outcome (adjusted hazard ratio 0.91, 95% CI 0.83-0.997). Assuming an average projected effect of PCSK9i, estimating if half of SAMMPRIS patients were treated, PCSK9i use could reduce the annualized risk of the primary outcome by 33.2% in this trial population.
Discussion:Every 10 mg/dL reduction in LDL for patients with stroke due to ICAD is associated with lower rates of recurrent stroke or MI, and this theoretical framework suggests that PCSK9i can help achieve this goal.
Trial registration information:Secondary analysis of NCT00576693 prospectively registered interventional clinical trial. First registered December 7, 2007. Actual study start date: October 2008. https://clinicaltrials.gov/show/NCT00576693.
Classification of evidence:This study provides Class IV evidence that a higher absolute reduction in LDL was associated with a lower risk of recurrent cerebral infarction or MI in patients with recent stroke due to intracranial stenosis
Diagnosis of sub-centimeter nodules through shape-sensing robotic assisted bronchoscopy: Real-world outcomes from the Ion Registry: A2720
No full textPrescribing assistive technology: Focus on children with complex communication needs: Clinical report
No full textThe primary care pediatrician and other pediatric physicians play a critical role in the interdisciplinary team effort to provide appropriate augmentative and alternative communication (AAC) technology to children with absent or severely impaired verbal communication, recently recategorized as a complex communication need. This clinical report describes the different types of AAC technology, the device assessment process, and the training required for successful integration into a child\u27s communication. The report further describes the role of the pediatrician in acquisition and appropriate utilization of this technology with a focus on key specialists and funding sources. Decades of research confirm that use of AAC promotes language development; therefore, primary care physicians can reassure families that AAC will likely help their child to learn to communicate more effectively. There is an important need for key resources for AAC to be identified in every community; the majority of relevant professional organizations, including the American Academy of Pediatrics, recognize that these resources are a shared medical, educational, therapeutic, and family responsibility
Ultrasound in pulmonary embolism
No full textPulmonary embolism (PE) is a significant cause of illness and death. Computed Tomography pulmonary angiography is considered the gold standard for diagnosing PE, but it is costly, not practical in cases of shock and cardiac arrest, and exposes the patient to radiation. In this review, we will discuss the role and characteristics of lung, venous, and cardiac ultrasound in point-of-care diagnosis and risk assessment of PE and suggest how to incorporate them into a diagnostic algorithm. Point-of-care ultrasound has numerous benefits, nevertheless, it is complex, has low individual sensitivity, and requires extensive training
Abstract P1046: Positive and adverse school experiences and cardiovascular health (CVH) in the Young Hearts Study
No full textBrief coaching intervention to reverse weight regain during weight loss maintenance: a preliminary randomized controlled trial
No full textObjective:Most individuals who complete a behavioral weight loss intervention (BWLI) regain weight. The current study is a preliminary investigation into the efficacy of a telephone coaching intervention to aid recovery from weight regain during weight loss maintenance.
Methods:Participants (n = 77) who had recently completed a BWLI and had lost ≥ 5% of their initial body weight were instructed to engage in daily weighing using a smart scale. Participants were randomized to receive four consecutive weeks of brief coaching phone calls or no intervention. Randomization was activated when individuals regained \u3e 1.5% of their baseline weight. Assessments were completed at baseline and 12 months.
Results:Sixty-six participants (M ± SD age = 54.2 ± 9.9 years, 68% female) regained \u3e 1.5% and were included in analyses. Individuals who received coaching completed 3.9 ± 0.5 calls and showed statistically-significant improvements in weight compared to the control group in the short-term (i.e., from randomization activation to 40 days later; M±SE Coaching: -1.05%±0.30 vs. Control: 0.37%±0.31, p \u3c 0.001). However, there were not significant differences in weight regain by group at the 12-month study end (Coaching: 5.18%±0.72 vs. Control: 5.71%±0.76, p = 0.62).
Conclusions:Brief telephone coaching is a promising intervention for reversing short-term weight regain. Future research should focus on improving the coaching intervention to promote long-term weight loss maintenance, including exploration into offering multiple rounds of coaching.
Clinical trial registration:NCT04293055
Outpatient physical therapy attendance by older adults after emergency department discharge was a predictor for lower 30-day revisits-but demographic factors affected attendance
No full textObjective: Given the high risk of functional loss and revisits among older adults presenting to the emergency department (ED), there is a need to understand how post-ED discharge outpatient physical therapy affects outcomes. This study sought to examine patient demographics and their association with outpatient physical therapy utilization after ED discharge and physical therapy attendance with 30-day ED revisits among older adults discharged to home.
Methods: In this retrospective cohort study, we analyzed data from 1395 older adults (65 years old and older) who had a referral to outpatient physical therapy upon discharge from 15 EDs between January 2021 and December 2022. Descriptive statistics and multivariate logistic regression were used to evaluate the likelihood of attending outpatient physical therapy and the odds of a 30-day ED revisit.
Results: Of the sample, 39.3% attended outpatient physical therapy. Older adults in the first and second neighborhood income quintile had a 51% lower odds of attending outpatient physical therapy than those in the fourth quintile. Patients with a diagnosis of vertigo had a 67% higher odds of attending outpatient physical therapy (OR = 1.67; 95% CI = 1.21-2.29) than those with back pain. Older adults who did not attend outpatient physical therapy within 30 days of ED visit had a 88% higher odds of returning to the ED than those who did attend (OR = 1.88; 95% CI = 1.34-2.64). Older adults in the first and second income quintile had a 66% higher odds of revisiting the ED than those in the fourth quintile.
Conclusion: Outpatient physical therapy attendance after ED discharge was a predictor of revisit within 30 days. Patient diagnosis of vertigo and higher median household income were predictors of higher outpatient physical therapy attendance. However, a diagnosis of falls or mobility concerns and a lower household income status were associated with lower attendance.
Impact: Physical therapy after ED discharge has the potential to reduce 30-day ED revisit but requires strategies to improve access equity across diagnostic groups and household income levels
Medical mistrust and COVID-19 vaccine attitudes and behavior: Findings from a population-based cohort study in Michigan
No full textBackground: Uptake of COVID-19 vaccines has stalled in the U.S. Some studies suggest that medical mistrust may be a barrier, but evidence is limited due to cross-sectional designs or convenience sampling.
Methods: We examined associations of medical mistrust with COVID-19 vaccine attitudes at baseline and vaccination uptake at follow-up using a population-based sample of Michigan adults with PCR-confirmed SARS-CoV-2 infection. We summed ratings for three items of the Medical Mistrust Index (MMI) to measure trust in healthcare providers. For vaccine attitudes, we averaged ratings for two items on importance of getting the COVID-19 vaccine. For vaccination uptake as ever receiving at least one dose of a COVID-19 vaccine. We conducted (1) linear regression models to examine cross-sectional associations between MMI and vaccine attitudes ( n = 3865), (2) modified Poisson regression with robust standard errors to estimate prospective associations between MMI and vaccination uptake ( n = 3741), and (3) effect modification and stratified analyses by race and ethnicity.
Results: The mean MMI score was 1.89. The mean of positive vaccine attitudes measure at baseline was 3.45 and the prevalence of receiving a vaccine at follow-up was 75.3 %. Higher MMI was associated with worse vaccine attitudes at baseline (coefficient = -0.64, 95 % confidence interval [CI]: -0.71, -0.56), and lower vaccine uptake at follow-up (adjusted risk ratio: 0.83, 95 % CI: 0.80, 0.86). Both associations were pronounced among non-Hispanic White and another non-Hispanic race and ethnicity individuals.
Conclusions: Understanding drivers of medical mistrust may help rebuild public trust in healthcare systems to promote vaccine uptake and improve public health
