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Inside Aurora Sinai Medical Center, 2002 January
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2237/thumbnail.jp
Inside Aurora Sinai Medical Center, 2003 June
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2252/thumbnail.jp
Inside Aurora Sinai Medical Center, 2004 September
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2265/thumbnail.jp
Inside Aurora Sinai Medical Center, 2004 February
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2258/thumbnail.jp
Heterogeneity in HeartMate 3 implanting center infection management reveals opportunities for quality improvement and best practice initiatives during left ventricular assist device support
No full textBackground: There is marked variability in device-related (DR) infection frequencies across HeartMate 3 (HM3) centers.
Objectives: The goal is to correlate center driveline (DL) management and infection mitigation practices with DR-infection development, laying foundation for development of best practice recommendations for one facet of HM3 patient care.
Methods: Coordinators at 30 HM3 centers were surveyed about center practices for infection prophylaxis, intraoperative DL placement and postoperative care, and infection mitigation. Early (≤90 days) and late (\u3e90 day) center DR-infection frequencies were calculated from Society of Thoracic Surgeons Intermacs data linkage. Correlations between center practice patterns and incident DR-infection were examined with multivariable Cox modelling (clustering adjusted hazard ratio (aHR)).
Results: Within Intermacs (3725 patients), 1-year freedom from DR-infection was 87% (80.6-87.3%). Initially, DL dressing changes were performed daily, weekly, and variably at 48%, 21% and 31% of centers. After 4 weeks, 57% deescalated dressing changes to weekly. Chlorhexidine cleanser with a silver-impregnated dressing (Chl-Sil) was standard at 52.7% of programs; 47.3% used chlorhexidine alone or other supplies. Use of Chl-Sil was associated with reduced early (aHR 0.48, p=0.004) and late (aHR 0.64, p=0.02) DR-infection while frequent dressing changes conferred higher late DR-infection (aHR 1.4 p=0.05). Antibiotic prophylaxis, DL tunneling, and diabetes practices did not correlate with DR-infection.
Conclusions: Given the burden of DR-infections, best practice recommendations are needed to standardize care. Application of Chl-Sil DL dressings could be a first step in achieving care standardization, while frequent dressing changes following DL incorporation should be avoided
Psychological status and work rehabilitation program outcomes
No full textInjuries occurring at work can have consequences exceeding the physical impairments including an impact on one\u27s mental health. This retrospective cohort study aimed to determine whether components of mental health correlate to outcomes of a work rehabilitation program. The sample included 355 participants treated between 2017 and 2020 at Aurora BayCare Medical Center in Green Bay, Wisconsin. The OSPRO Yellow Flag Assessment Tool, Beck\u27s Depression Inventory, the Patient Health Questionnaire-2, Pain Anxiety Symptoms Scale, and the Tampa Scale of Kinesiophobia were administered to patients in the work rehabilitation program. The assessments indicated a weak positive correlation between the varying psychological factors assessed and the duration of stay within the work rehabilitation program and a weak negative correlation between the percentage of job demands met at discharge. A patient\u27s psychological status was found to be associated with outcomes with a work rehabilitation program
The Silk Vista Baby Study: A multicenter aneurysm report from North America and Europe
No full textBackground and objectives: The Silk Vista Baby (SVB) flow diverter (FD) stent (Balt SAS) is the first device designed for treating distally located brain aneurysms. It can be delivered through a 0.017-inch ID microcatheter, enabling access to small, distal vessels. The aim of this study was to evaluate the effectiveness, safety, technical success, occlusion rate, and clinical outcomes of the SVB device.
Methods: This retrospective, multicenter study included data from 18 centers from November 2023 to September 2024. Procedures were performed by experienced neurointerventionalists following institutional standards of care. Outcomes analyzed included effectiveness, safety, and aneurysm occlusion rates. Descriptive analyses and Pearson χ2 or Independent t-Test were used for statistical evaluation.
Results: A total of 95 patients, mean age 55.4 years, were included. A total of 31% of aneurysms were ruptured at admission. Most (58.3%) were located in the anterior circulation, and 45% had previous treatment, mainly coiling (69.4%). Complication rates were higher for ruptured aneurysms (24.1%) compared with unruptured ones (9.2%). Two deaths occurred, 1 (1.1%) related to the procedure. At discharge, 87% of patients had modified Rankin Scale ≤2. The latest follow-up showed overall complete/near-complete occlusion rates of 76.1%, with 81.14% for ruptured and 73.43% for unruptured aneurysms. Technical success was higher in unruptured cases (100% vs 93.1%).
Conclusion: Our case series demonstrated the efficacy of the SVB with a high rate of technical success. The occlusion rates for ruptured cases are comparable with those of other FDs. However, the rates are lower for unruptured cases. This discrepancy is likely due to the characteristics of the aneurysms, particularly in the presence of side branches in bifurcation lesions. The SVB safety profile is similar to other FDs in unruptured cases, while the ruptured group presented more complications
Angiotensin-neprilysin inhibition in acute decompensated heart failure: A meta-analysis of randomized controlled trials
No full textBackground: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF.
Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used.
Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; p \u3c 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p \u3c 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; p = 0.024).
Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk
Bridging the gap between evidence and practice: Nationwide retrospective analysis of lipid-modifying therapy prescription patterns in 5 million patients with type 2 diabetes mellitus
No full textIntroduction: Type 2 diabetes mellitus (T2DM) is associated with dyslipidemia and significantly increased cardiovascular risk, making lipid-modifying therapy a crucial preventive intervention in these patients. Despite clear guidelines recommending statin therapy for both primary and secondary prevention, real-world prescription routines and practices show gaps in clinical care. We aimed to evaluate the rates and patterns of lipid-modifying therapy under prescription among T2DM patients across U.S. healthcare facilities.
Methods: We conducted a retrospective observational analysis using the TriNetX US Collaborative Network database, including data from 69 healthcare organizations throughout the United States. Patients with T2DM patients aged 40-75 years were included in our cohort. Under-prescription rates were calculated and analyzed across demographic subgroups using standardized protocols within the TriNetX platform.
Results: Among 5,007,910 T2DM patients, we observed significant statin under-prescription rates. Our analysis showed a prescription rate of 55.1% for statins in eligible patients with T2DM.
Conclusions: Our findings revealed a significant under-prescription of lipid-modifying therapy in T2DM patients. The universal nature of under-prescription suggests barriers to guideline implementation. These results underscore the urgent need for systematic interventions, including automated identification systems, standardized protocols, and optimized provider education to improve cardiovascular risk management in patients with T2DM
Iron balance and cardiovascular health: The double-edged role of deficiency and overload
No full textCardiovascular disease is the leading cause of death worldwide, accounting for about a third of all deaths. Traditional risk factors like hypertension, diabetes, dyslipidemia, and obesity are well known, but iron also plays a crucial role in heart health. Iron is essential for oxygen transport, mitochondrial function, and heart muscle activity, and both deficiency and overload can harm cardiovascular outcomes. This review examines studies on iron metabolism, regulation via the hepcidin-ferroportin pathway, myocardial energy, oxidative stress, and clinical trials of iron supplementation or reduction in heart failure, chronic kidney disease, the elderly, women, and athletes. Iron deficiency affects over 60% of heart failure patients, leading to reduced energy, lower exercise capacity, and higher morbidity. Intravenous iron improves functional capacity, quality of life, and reduces hospitalizations, especially in patients with low transferrin saturation. Iron overload, on the other hand, increases oxidative stress, arrhythmias, and cardiomyopathy. Evidence shows a U-shaped relationship between iron and cardiovascular outcomes, emphasizing the importance of markers like transferrin saturation, soluble transferrin receptor, and hepcidin. Iron imbalance contributes to cardiovascular disease. Targeted assessment and treatment, including supplementation for deficiency and chelation or phlebotomy for overload, may improve outcomes. The ultimate aim of this review is to enhance perioperative management and long-term results for this highly vulnerable population by synthesizing current insights and addressing knowledge gaps