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Metformin treatment: Pediatric weight management experience
No full textMetformin use in non-diabetic youth with obesity may improve weight status and reduce comorbidities. This retrospective review of 161 youth with obesity prescribed lifestyle changes and metformin in a pediatric weight management (PWM) program aims to evaluate patient-reported experiences of metformin use and assess the association between metformin use and changes in weight status. The 3 groups (metformin taken ≥6 months, metformin taken \u3c6 months, and metformin ordered not taken) had similar weight status at the start of the evaluation. Youth taking metformin ≥6 months started metformin at an earlier visit and more often had prediabetes and a parent with diabetes. Overall, 57.1% improved weight status (metformin taken ≥6 months, 69.0%; metformin taken \u3c6 months, 59.4%; and metformin ordered not taken, 32.4%; P \u3c .002). Among those who had taken metformin (n = 127), 35.4% reported side effects that did not vary by group status. This study provides perspective on metformin use for pediatric obesity care
Maternal social deprivation and risk of preeclampsia
No full textOBJECTIVES: We examined the use of an indicator of the cumulative effect of multiple community-level risk factors on risk of preeclampsia, a morbid maternal hypertensive disorder.
STUDY DESIGN: This was a retrospective cohort study of 41,834 singleton pregnancies from four urban hospitals.
MAIN OUTCOME MEASURES: We used the social deprivation index (SDI), which is a composite of seven neighborhood demographic characteristics collected by the American Community Survey. SDI quartile 1 (Q1) is the least deprived area and Q4 is the most deprived. A modified Poisson regression model with robust error variance was used to calculate the relative risk (RR) and 95% confidence interval for the association between SDI quartiles (using Q1 as a reference) and preeclampsia. Preeclampsia subtypes were examined as secondary outcomes (term preeclampsia and preterm preeclampsia). Models were adjusted for maternal age, education, insurance, chronic health diseases, tobacco use, and gravidity.
RESULTS: Overall, 8.7% of our population had a preeclampsia diagnosis. Majority of the population was Hispanic, had lower education levels, and were on public insurance. Those living in the highest quartile of social deprivation had increased risk of preeclampsia (RR 1.25, 95% CI 1.15-1.35). However, results were null after adjustments. In contrast, living in the highest quartile of social deprivation was associated with increased risk of preterm preeclampsia, even after adjustments (RR 1.26, 95% CI 1.05-1.50).
CONCLUSION: Using electronic health records, the SDI may be an easily calculable measure to identify patients at risk for the preterm preeclampsia subtype
Impact of a nurse-led in-hospital mobility intervention on older adult patient functional outcomes and perceptions
No full textHospital-associated disabilities in older adults are common. Few studies have used a performance measure to evaluate the impact of ambulation on patient functional status during and after discharge or investigated older adult perceptions of ambulation during a hospitalization. The purpose of this study was to evaluate the implementation of MOVIN (Mobilizing Older adults Via a systems-based INtervention) on older adult functional performance outcomes and to understand patients perceptions of mobility during their hospital stay. A non-randomized observational study using a quasi-experimental design was conducted. Multiple methods using quantitative and qualitative approaches were used. Functional measures included gait speed and self-report on the Katz Activities of Daily Living scale and the University of Alabama at Birmingham (UAB) Life Space Mobility Index. In-person interviews were used to collect qualitative data. The study was conducted on a 23-bed adult medical unit at an academic medical center. Older adults (N = 40) were recruited for data collection during their hospital stay and post-discharge. General linear mixed random-effects modeling was used to analyze functional outcomes. Inductive content analysis was used to analyze qualitative data. The intervention group had a significant increase in gait speed at discharge compared to admission (p = 0.022) and at 3 months (p = 0.006) compared to discharge and a significant increase in UAB score between admission to 3 months post-discharge (p = 0.049). Qualitative results identified four categories Maintaining Health, Being Connected, Filling Time and Ready to Go Home, which describe the patient perception. This study provides evidence that an in-hospital mobility intervention can have significant impacts on older adults functional performance and psycho-social outcomes
Inside Aurora Sinai Medical Center, 2003 August
No full textAurora Sinai Medical Center, Milwaukee, WI: Internal employee newsletter with workplace anniversaries, news, and events.https://institutionalrepository.aah.org/alldocuments/2254/thumbnail.jp
Multimodality imaging in hypertrophic cardiomyopathy
No full textThe diagnosis and management of hypertrophic cardiomyopathy (HCM) requires accurate and comprehensive imaging. Advances in imaging technology and clinical understanding have significantly enhanced the ability to characterize the phenotype, assess risk, monitor disease progression, and guide therapy. This article highlights the complementary roles of echocardiography, cardiac magnetic resonance, computed tomography, and nuclear imaging in the evaluation of HCM and explores emerging research and innovation that are shaping future diagnostic and therapeutic strategies
Troponins and echocardiography: Role in detecting myocardial injury in burn patients
No full textSevere burn injuries result in a massive systemic inflammatory and hypermetabolic response, often disrupting multiple organ systems, including the cardiovascular system. Cardiac troponins are frequently elevated in burn patients, but the interpretation of these elevations is hardly straightforward. Sometimes, elevated troponin means type 1 myocardial infarction (MI) due to an acute coronary event, but it might also reflect type 2 MI due to an imbalance between body oxygen demand and supply, or even non-ischemic myocardial injury from things like overwhelming inflammation, sepsis, or direct thermal effects on the heart itself. This narrative review explores the prevalence, underlying pathophysiological mechanisms, diagnostic challenges, and prognostic implications of troponin elevation in burn patients. We discussed the limitations of applying conventional MI diagnostic criteria in this unique population. The role of electrocardiographic and echocardiographic assessment, as well as the potential utility of high-sensitivity troponin assays, is also discussed. Understanding of how burn pathophysiology relates to myocardial injury is essential for accurate diagnosis, improved management, and better outcomes in this highly vulnerable group of patients
