Search

To measure univariate and covariate‐adjusted trends in children's mental health‐related emergency department (MH‐ED) use across geographically diverse areas of the U.S. during the first wave of the Coronavirus‐2019 (COVID‐19) pandemic. This is a retrospective, cross‐sectional cohort study using electronic health records from four academic health systems, comparing percent volume change and adjusted risk of child MH‐ED visits among children aged 3–17 years, matched on 36‐week (3/18/19–11/25/19 vs. 3/16/20–11/22/20) and 12‐week seasonal time intervals. Adjusted incidence rate ratios (IRR) were calculated using multivariate Poisson regression. Visits declined during spring‐fall 2020 (n= 3892 vs. n= 5228, −25.5%) and during spring (n= 1051 vs. n= 1839, −42.8%), summer (n= 1430 vs. n= 1469, −2.6%), and fall (n= 1411 vs. n= 1920, −26.5%), compared with 2019. There were greater declines among males (28.2% vs. females −22.9%), children 6–12‐year (−28.6% vs. −25.9% for 3–5 years and −22.9% for 13–17 years), and Black children (−34.8% vs. −17.7% to −24.9%). Visits also declined for developmental disorders (−17.0%) and childhood‐onset disorders (e.g., attention deficit and hyperactivity disorders; −18.0%). During summer‐fall 2020, suicide‐related visits rose (summer +29.8%, fall +20.4%), but were not significantly elevated from 2019 when controlling for demographic shifts. In contrast, MH‐ED use during spring‐fall 2020 was significantly reduced for intellectual disabilities (IRR 0.62 [95% CI 0.47–0.86]), developmental disorders (IRR 0.71 [0.54–0.92]), and childhood‐onset disorders (IRR 0.74 [0.56–0.97]). The early pandemic brought overall declines in child MH‐ED use alongside co‐occurring demographic and diagnostic shifts. Children vulnerable to missed detection during instructional disruptions experienced disproportionate declines, suggesting need for future longitudinal research in this population. Children's mental health (MH)‐related Emergency department (ED) use declined during spring‐fall 2020 (−25.5%) compared with 2019, with the greatest reduction during spring (−42.8%) and fall (−26.5%), and lesser reduction during summer (−2.6%)During summer‐fall 2020, suicide‐related visits rose (summer +29.8%, fall +20.4%), but were not significantly elevated from 2019 when controlling for demographic shifts in useChildren's MH‐related ED use during spring‐fall 2020 was significantly reduced for intellectual disabilities (incidence rate ratios [IRR] 0.62 [95% CI 0.47–0.86]), developmental disorders (IRR 0.71 [0.54–0.92]), and childhood‐onset disorders (IRR 0.74 [0.56–0.97]) Children's mental health (MH)‐related Emergency department (ED) use declined during spring‐fall 2020 (−25.5%) compared with 2019, with the greatest reduction during spring (−42.8%) and fall (−26.5%), and lesser reduction during summer (−2.6%) During summer‐fall 2020, suicide‐related visits rose (summer +29.8%, fall +20.4%), but were not significantly elevated from 2019 when controlling for demographic shifts in use Children's MH‐related ED use during spring‐fall 2020 was significantly reduced for intellectual disabilities (incidence rate ratios [IRR] 0.62 [95% CI 0.47–0.86]), developmental disorders (IRR 0.71 [0.54–0.92]), and childhood‐onset disorders (IRR 0.74 [0.56–0.97])

ABSTRACTObjective: At a large public university, we aimed to evaluate an intervention designed to increase serogroup B meningococcal (MenB) vaccine uptake and awareness.Methods:Using a pretest-posttest design with a double posttest, we evaluated an intervention conducted by a local foundation and the Florida Department of Health that distributed MenB vaccine on campus and conducted an educational campaign. Prior to intervention activities, we recruited students to complete a survey about their MenB knowledge and attitudes. For survey participants who provided contact information, we sent two follow-up surveys and assessed MenB vaccine records. We used chi-square tests, adjusted for nonindependence, to compare preintervention to postintervention (three-month and one-year) vaccination and attitudes.Results:Among the 686 students with accessible vaccine records, MenB vaccine initiation increased 9% (from 24% to 33%) and completion increased 8% (from 13% to 21%) from before the intervention to one year after the intervention. When restricting to students who completed the relevant follow-up surveys, the percentage of students who heard of the MenB vaccine increased by 15% (p> .001) from before the intervention to three months after (n = 188 students) and maintained a 10% increase (p> .001) one year after the intervention (n = 261 students). Among students that heard of the MenB vaccine, the percentage of students who thought they needed the MenB vaccine even though they received the MenACWY increased 14% (p= .03) by the three-month postintervention survey and up to 18% by the one-year follow-up (p= .002).Conclusions:A university-wide, on-campus vaccination and educational campaign increased college students’ MenB vaccine initiation, completion, and knowledge.Clinicaltrials.gov ID: NCT02975596.

Maternal and infant health (MIH) mobile applications (apps) are increasingly popular and frequently used for health education and decision making. Interventions grounded in theory-based behavior change techniques (BCTs) are shown to be effective in promoting healthy behavior changes. MIH apps have the potential to be useful tools, yet the extent to which they incorporate BCTs is still unknown. The objective of this study was to assess the presence of BCTs in popular MIH apps available in the Apple App and Google Play stores. Twenty-nine popular MIH apps were coded for the presence of 16 BCTs using the mHealth app taxonomy. Popular MIH apps whose purpose was to provide health education or decision-making support to pregnant women or parents/caregivers of infants were included in the final sample. On an average, the reviewed apps included seven BCTs (range 2–16). Techniques such as personalization, review of general or specific goals, macro tailoring, self-monitoring of goals, and health behavior linkages were most frequently present. No differences in the presence of BCTs between paid and free apps were observed. Popular MIH apps typically included only a minority of BCTs found to be useful for health promotion. However, apps developed by healthcare developers incorporated a higher number of BCTs within the app content. Therefore, app developers and policymakers may consider strategies to increase health expert involvement in app design and content delivery.

Sutureless aortic valve replacement (AVR) is a wide-spreading new technology that provides short clamping time and excellent hemodynamic outcomes. However, among its possible complications is the risk of paravalvular leak. We present the case of a 63-year-old woman who underwent minimally invasive right mini-thoracotomy AVR) with Perceval S sutureless valve (LivaNova, London, UK). Intraoperative transesophageal echocardiography revealed severe paravalvular leak with stent distortion. Rescue balloon valvuloplasty was performed through the right femoral artery, and resulted in the resolution of the paravalvular leak. This case illustrates the utility and feasibility of balloon valvuloplasty in trouble-shooting sutureless aortic valve stent distortion, thus avoiding a repeat aortic cross-clamp and valve replacement.

Hospitals and clinicians aim to deliver care that is safe. Simultaneously, they are ensuring that care is patient centered, meaning that it is respectful of patients’ values, preferences, and experiences. However, little is known about delivering care in cases in which these goals may not align. For example, hospitals and clinicians are facing the daunting challenge of balancing safe and patient-centered pain care for nonsurgical patients, due to lack of comprehensive care guidelines and complexity of this patient population.

Objective Conversion to sternotomy is a primary bailout method for robotically assisted coronary artery bypass grafting procedures. The aims of this study were to identify the primary reasons for conversion from robotically assisted coronary artery bypass grafting to sternotomy and to evaluate the in-hospital outcomes in such patients.Methods Prospectively collected data from February 2004 to April 2017 were reviewed for 72 patients (56 men; mean age = 63.8 years) who required conversion to sternotomy during a robotically assisted coronary artery bypass grafting procedure with planned endoscopic left internal thoracic artery harvest and anastomosis to the left anterior descending on the beating heart.Results The overall rate of conversion was 12.4% (72/581). Conversions occurred either during attempted endoscopic left internal thoracic artery harvest (31.9%), during endoscopic left anterior descending isolation (40.3%), during manual isolation and anastomosis of the left anterior descending (19.4%), or after anastomosis due to unsatisfactory flow (8.3%). Overall, the most common reason for conversion was an intramyocardial left anterior descending (43.1%). The median stay in the intensive care unit was 1 day (range = 0–20) and the median hospital length of stay was 5 days (range = 3–43). In-hospital complications included new atrial fibrillation (16.7%), need for blood transfusion (20.8%), mediastinitis (4.2%), postoperative myocardial infarction (2.8%), exploration for bleeding (2.8%), and 1 in-hospital death.Conclusions The reasons for conversion were primarily related to anatomical factors that created difficulties for endoscopic left internal thoracic artery harvesting and left anterior descending identification. Patients who required conversion to sternotomy from robotically assisted coronary artery bypass grafting demonstrated acceptable outcomes and low complication rates.

Supplemental Digital Content is available in the text

Carcinoid syndrome is a relatively rare condition that may affect the liver and the right heart. Some of these cases may require surgical treatment with a multidisciplinary approach.

El síndrome carcinoide es una condición relativamente rara que puede afectar el hígado y el corazón derecho. En algunos pacientes se requiere tratamiento quirúrgico y un manejo multidisciplinario.

Objective Contemporary anesthetic techniques have enabled shorter sedation and early extubation in off-pump and minimally invasive coronary artery bypass (CABG) surgery. Robotic-assisted CABG represents the optimal surgical approach for ultrafast track anesthesia, with patients able to bypass the cardiac surgical intensive care unit with recovery in the postanesthesia care unit (PACU) and inpatient ward.Methods In-hospital postoperative outcomes from ninety patients who underwent either elective or urgent robotically-assisted CABG at our institution were reviewed. These patients were carefully selected by a multidisciplinary team to undergo fast-track anesthesia: extubation in the operating room, 4-hour recovery in the postanesthesia care unit and transfer to the inpatient ward. Intrathecal, paravertebral local, and patient-controlled anesthesia techniques were used to facilitate transition to oral analgesics.Results Average patient age was 61 ± 9 years. Sixty-six patients (73%) were male. Seventy cases were elective, and 20 patients required urgent revascularization. All patients underwent intraoperative angiography after graft construction, which revealed Fitzgibbon class A grafts. There were no in-hospital mortalities. One patient required re-exploration for bleeding, through the same minimally invasive incision, did not require conversion to sternotomy for bleeding, and was transferred to the intensive care unit postexploration for bleeding for standard postoperative care. Postoperative complications were limited to one superficial wound infection. The mean hospital length of stay was 3.5 ± 1.17 days.Conclusions In patients undergoing robotic-assisted CABG, ultrafasttrack cardiac surgery with immediate postprocedure extubation and transfer to the inpatient ward has been demonstrated to be safe with no increase in perioperative morbidity or mortality. It requires a dedicated heart team with a carefully selected group of patients. Avoiding cardiac surgical intensive care unit expedites recovery, with possible avoidance of infection and early discharge from hospital.

Objective Contemporary anesthetic techniques have enabled shorter sedation and early extubation in off-pump and minimally invasive coronary artery bypass (CABG) surgery. Robotic-assisted CABG represents the optimal surgical approach for ultrafast track anesthesia, with patients able to bypass the cardiac surgical intensive care unit with recovery in the postanesthesia care unit (PACU) and inpatient ward.Methods In-hospital postoperative outcomes from ninety patients who underwent either elective or urgent robotically-assisted CABG at our institution were reviewed. These patients were carefully selected by a multidisciplinary team to undergo fast-track anesthesia: extubation in the operating room, 4-hour recovery in the postanesthesia care unit and transfer to the inpatient ward. Intrathecal, paravertebral local, and patient-controlled anesthesia techniques were used to facilitate transition to oral analgesics.Results Average patient age was 61 ± 9 years. Sixty-six patients (73%) were male. Seventy cases were elective, and 20 patients required urgent revascularization. All patients underwent intraoperative angiography after graft construction, which revealed Fitzgibbon class A grafts. There were no in-hospital mortalities. One patient required re-exploration for bleeding, through the same minimally invasive incision, did not require conversion to sternotomy for bleeding, and was transferred to the intensive care unit postexploration for bleeding for standard postoperative care. Postoperative complications were limited to one superficial wound infection. The mean hospital length of stay was 3.5 ± 1.17 days.Conclusions In patients undergoing robotic-assisted CABG, ultrafasttrack cardiac surgery with immediate postprocedure extubation and transfer to the inpatient ward has been demonstrated to be safe with no increase in perioperative morbidity or mortality. It requires a dedicated heart team with a carefully selected group of patients. Avoiding cardiac surgical intensive care unit expedites recovery, with possible avoidance of infection and early discharge from hospital.

Objective Hybrid coronary revascularization offers and combines the advantages of both surgical and percutaneous revascularization and eliminates at the same time the disadvantages of both procedures. The objective of this study was to assess graft and stent patency at 6 months, rate of bleeding, intensive care unit and hospital stay, rate of reintervention, and long-term clinical follow-up.Methods From March 2004 to November 2015, a total of 203 patients underwent robotic-assisted minimally invasive direct coronary artery bypass graft of the left internal thoracic artery to the left anterior descending artery and PCI of a non-left anterior descending vessel in a single or two stage, at three different centers. Patients underwent 6-month angiographic follow-up. The mean ± SD clinical follow-up was 77.82 ±41.4 months.Results Successful hybrid coronary revascularization occurred in 196 of the 203 patients. One hundred forty-six patients underwent simultaneous surgical and percutaneous intervention. Nineteen patients underwent PCI before surgery, and 38 patient underwent PCI after surgery. No in-hospital mortality occurred. The mean ± SD ICU stay was 1 ± 1 days and the mean ± SD hospital stay was 5 ± 2 days. Only 13.3% of the patients required a blood transfusion. Six-month angiographic follow-up has been performed in the 95 patients, and it demonstrated a left internal thoracic artery anastomotic patency of 97.9% and stent patency of 92.6%. A total of 77.8 ± 41.4-month clinical follow-up demonstrated 95.1% survival, 92.6% freedom from angina, and 90.7% freedom from any form of coronary revascularization.Conclusions Hybrid coronary revascularization seems to be a promising and safe revascularization strategy. It provides selected patients with an alternative, functionally complete revascularization with minimal surgical trauma and good long-term clinical outcomes.

Objective Hybrid coronary revascularization offers and combines the advantages of both surgical and percutaneous revascularization and eliminates at the same time the disadvantages of both procedures. The objective of this study was to assess graft and stent patency at 6 months, rate of bleeding, intensive care unit and hospital stay, rate of reintervention, and long-term clinical follow-up.Methods From March 2004 to November 2015, a total of 203 patients underwent robotic-assisted minimally invasive direct coronary artery bypass graft of the left internal thoracic artery to the left anterior descending artery and PCI of a non-left anterior descending vessel in a single or two stage, at three different centers. Patients underwent 6-month angiographic follow-up. The mean ± SD clinical follow-up was 77.82 ±41.4 months.Results Successful hybrid coronary revascularization occurred in 196 of the 203 patients. One hundred forty-six patients underwent simultaneous surgical and percutaneous intervention. Nineteen patients underwent PCI before surgery, and 38 patient underwent PCI after surgery. No in-hospital mortality occurred. The mean ± SD ICU stay was 1 ± 1 days and the mean ± SD hospital stay was 5 ± 2 days. Only 13.3% of the patients required a blood transfusion. Six-month angiographic follow-up has been performed in the 95 patients, and it demonstrated a left internal thoracic artery anastomotic patency of 97.9% and stent patency of 92.6%. A total of 77.8 ± 41.4-month clinical follow-up demonstrated 95.1% survival, 92.6% freedom from angina, and 90.7% freedom from any form of coronary revascularization.Conclusions Hybrid coronary revascularization seems to be a promising and safe revascularization strategy. It provides selected patients with an alternative, functionally complete revascularization with minimal surgical trauma and good long-term clinical outcomes.

To assess potential hypercoagulability during diabetic ketoacidosis in children.