DigitalCommons@KCU (Kansas City Univ.)
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Is Aspirin Safe for Thromboprophylaxis After Surgery for Lower Extremity Neoplastic Pathologic Fractures?
No full textBackground and objectives: Both malignancy and orthopedic surgery are known risk factors for developing venous thromboembolism (VTE). Therefore, this study aimed to compare VTE rates among patients receiving enoxaparin, apixaban, rivaroxaban, or aspirin (ASA).
Methods: The Premier Healthcare Database was utilized to identify all patients who underwent surgery for neoplastic pathologic fractures of the lower extremities from 2015 to 2021. Four cohorts based on receipt of ASA, apixaban, enoxaparin, or rivaroxaban were identified. Propensity matching with the enoxaparin cohort as the comparator was performed. Patient demographics, hospital factors, comorbidities, and 90-day complications were compared.
Results: From 2015 to 2021, 3762 patients underwent surgical intervention for neoplastic pathologic fracture of the lower extremities. Enoxaparin recipients showed significantly lower aggregate VTE rates than those on apixaban (p = 0.008) while exhibiting higher VTE occurrence than ASA-treated patients (p = 0.050).
Conclusion: Our study demonstrates that the administration of enoxaparin in patients undergoing surgical intervention for neoplastic pathologic fractures of the lower extremities may lead to significantly higher rates of aggregate VTE postoperatively compared to ASA. This data suggests that further research is warranted to determine if surgeons may safely consider using ASA in patients with no other reported risk factors or need for anticoagulation postoperatively, even in active malignancy
Complexities, Benefits, Risks, and Clinical Implications of Sodium Bicarbonate Administration in Critically Ill Patients: A State-of-the-Art Review
Get PDFSodium bicarbonate has been used in the treatment of different pathologies, such as hyperkalemia, cardiac arrest, tricyclic antidepressant toxicity, aspirin toxicity, acute acidosis, lactic acidosis, diabetic ketoacidosis, rhabdomyolysis, and adrenergic receptors\u27 resistance to catecholamine in patients with shock. An ongoing debate about bicarbonate\u27s efficacy and potential harm has been raised for decades because of the lack of evidence supporting its potential efficacy. Despite the guidelines\u27 restrictions, sodium bicarbonate has been overused in clinical practice. The overuse of sodium bicarbonate could be because of the desire to correct the arterial blood gas parameters rapidly instead of achieving homeostasis by treating the cause of the metabolic acidosis. Moreover, it is believed that sodium bicarbonate may reverse acidosis-induced myocardial depression, hemodynamic instability, ventricular arrhythmias, impaired cellular energy production, resistance to catecholamines, altered metabolism, enzyme suppression, immune dysfunction, and ineffective oxygen delivery. On the other hand, it is crucial to pay attention to the potential harm that could be caused by excessive sodium bicarbonate administration. Sodium bicarbonate may cause paradoxical respiratory acidosis, intracellular acidosis, hypokalemia, hypocalcemia, alkalosis, impaired oxygen delivery, cerebrospinal fluid acidosis, and neurologic dysfunction. In this review, we discuss the pathophysiology of sodium bicarbonate-induced adverse effects and potential benefits. We also review the most recent clinical trials, observational studies, and guidelines discussing the use of sodium bicarbonate in different pathologies
External Validation and Performance Analysis of a Deep Learning-Based Model for the Detection of Intracranial Hemorrhage
No full textPurpose: We aimed to investigate the external validation and performance of an FDA-approved deep learning model in labeling intracranial hemorrhage (ICH) cases on a real-world heterogeneous clinical dataset. Furthermore, we delved deeper into evaluating how patients\u27 risk factors influenced the model\u27s performance and gathered feedback on satisfaction from radiologists of varying ranks.
Methods: This prospective IRB approved study included 5600 non-contrast CT scans of the head in various clinical settings, that is, emergency, inpatient, and outpatient units. The patients\u27 risk factors were collected and tested for impacting the performance of DL model utilizing univariate and multivariate regression analyses. The performance of DL model was contrasted to the radiologists\u27 interpretation to determine the presence or absence of ICH with subsequent classification into subcategories of ICH. Key metrics, including accuracy, sensitivity, specificity, positive predictive value, and negative predictive value, were calculated. Receiver operating characteristics curve, along with the area under the curve, were determined. Additionally, a questionnaire was conducted with radiologists of varying ranks to assess their experience with the model.
Results: The model exhibited outstanding performance, achieving a high sensitivity of 89% and specificity of 96%. Additional performance metrics, including positive predictive value (82%), negative predictive value (97%), and overall accuracy (94%), underscore its robust capabilities. The area under the ROC curve further demonstrated the model\u27s efficacy, reaching 0.954. Multivariate logistic regression revealed statistical significance for age, sex, history of trauma, operative intervention, HTN, and smoking.
Conclusion: Our study highlights the satisfactory performance of the DL model on a diverse real-world dataset, garnering positive feedback from radiology trainees
Authors’ Response to Peer Reviews of “COVID-19 National Football League (NFL) Injury Analysis: Follow-Up Study”
Get PDFComparative Treatment of Homeless Persons With an Infectious Disease in the US Emergency Department Setting: A Retrospective Approach
Get PDFBackground: Research has long documented the increased emergency department usage by persons who are homeless compared with their housed counterparts, as well as an increased prevalence of infectious diseases. However, there is a gap in knowledge regarding the comparative treatment that persons who are homeless receive. This study seeks to describe this potential difference in treatment, including diagnostic services tested, procedures performed and medications prescribed.
Methods: This study used a retrospective, cohort study design to analyse data from the 2007-2010 United States National Hospital Ambulatory Medical Care Survey database, specifically looking at the emergency department subset. Complex sample logistic regression analysis was used to compare variables, including diagnostic services, procedures and medication classes prescribed between homeless and private residence individuals seeking emergency department treatment for infectious diseases. Findings were then adjusted for potential confounding variables.
Results: Compared with private residence individuals, persons who are homeless and presenting with an infectious disease were more likely (adjusted OR: 10.99, CI 1.08 to 111.40, p\u3c0.05) to receive sutures or staples and less likely (adjusted OR: 0.29, CI 0.10 to 0.87, p\u3c0.05) to be provided medications when presenting with an infectious disease in US emergency departments. Significant differences were also detected in prescribing habits of multiple anti-infective medication classes.
Conclusion: This study detected a significant difference in suturing/stapling and medication prescribing patterns for persons who are homeless with an infectious disease in US emergency departments. While some findings can likely be explained by the prevalence of specific infectious organisms in homeless populations, other findings would benefit from further research
Severe Pneumatosis Intestinalis and Hepatic Portal Venous Gas in a Patient With Methamphetamine Use: Early Recognition and Management
Get PDFPneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) are rare but potentially life-threatening conditions characterized by the presence of gas within the bowel wall and portal venous system, respectively. This case report presents a 45-year-old male with a history of methamphetamine use who developed severe metabolic and hemodynamic instability, marked by altered mental status, metabolic acidosis, and ST elevations. Despite aggressive resuscitation and intensive care, the patient unfortunately succumbed to his condition, highlighting the gravity of these complications. This report underscores the importance of early recognition, comprehensive management, and timely surgical consultation to improve outcomes. It also emphasizes the need for a multidisciplinary approach and further research to better understand these conditions and the significant role of methamphetamine use as a contributing factor
Worth the Risk? Standardized Screening to Identify Substance Use Among Patients Prior to Surgery
No full textObjective: We sought to compare identification of unhealthy substance use before surgery using The Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS), a standardized 4-item instrument, versus routine clinical documentation in the electronic medical record (EHR).
Summary background data: Over 20% of individuals exhibit unhealthy substance use before elective surgery. Routine EHR documentation is often based on non-standard questions that may not fully capture the extent of substance use and is subject to bias. In contrast, brief standardized screening could provide a more efficient and systematic approach.
Methods: We conducted a cross-sectional study among adults (≥18 y) at a preoperative clinic from August to September, 2021. Positive screens for unhealthy substances by TAPS were compared to data from the EHR. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were reported. Receiver operating characteristic curves (ROCs) were used to assess diagnostic ability. Multivariable logistic regression was used to estimate the predictors of positive screens by TAPS.
Results: The cohort included 240 surgical patients. TAPS screening identified significantly more positive screens than EHR documentation (43.3% vs. 14.2%). Patients with unhealthy substance use were younger (50.8 vs. 56.7 y; P=0.003), and TAPS revealed alcohol misuse in 30.8% of cases, contrasting with 0% in clinician documentation (P
Conclusion: Standardized TAPS screening detected preoperative unhealthy substance use more frequently than routine clinician documentation, emphasizing the need for integrating standardized measures into surgical practice to ensure safer perioperative care and outcomes
Frailty Status, Not Just Age, is Associated With Postoperative Opioid Consumption: A Retrospective, Population-based Analysis
Get PDFObjective:To assess the relationship between postoperative opioid consumption and frailty status.
Background:Physiologic reserve can be assessed through both chronologic age as well as measures of frailty. Although prior studies suggest that older individuals may require less opioid following surgery, chronologic age, and frailty do not always align, and little is known regarding postoperative opioid consumption patterns by frailty.
Methods:We conducted a retrospective analysis of opioid-naïve adult patients undergoing common general, vascular, and gynecologic procedures across a statewide quality improvement program from November 6, 2017 to February 28, 2021. Our primary outcome was postoperative patient-reported opioid consumption within 30 days of surgery in oral morphine equivalents (OME). Our primary exposure was frailty status defined by the modified frailty index (mFi-5) criteria. Other covariates included patient demographic and clinical attributes, procedural factors, discharge opioid prescription size, and postoperative complications. Linear regression was performed to assess the association of frailty status and opioid consumption, stratified by age.
Results: In this cohort of 34,854 patients, 10,596 had an mFi-5 score of ≤1 and 3,635 had a score of \u3e1. A score of \u3e1 was associated with increased patient-reported opioid consumption (OMEs 3.3 greater; 95% CI = 1.5–5.1). This held true for individuals over 65 (OMEs 2.7 greater; 95% CI = 0.2–5.1). Frailty status, regardless of score, was negatively associated with an opioid prescription at discharge.
Conclusions:Frailty status is associated with increased opioid consumption after common operations. Future prescribing guidelines and outcomes analyses should consider this marker when reviewing opioid consumption data and related adverse outcomes
PatientsLikeMe and Online Patient Support Communities in Dermatology
Get PDFOnline patient-oriented platforms such as PatientsLikeMe (PLM) offer a venue for individuals with various diagnoses to share experiences and build community, though they may not be representative of the larger patient population. This potentially limits generalizability and raises concerns about the spread of misinformation, emphasizing the need for informed use and health care provider engagement