4,769 results on '"Term (time)"'
Search Results
202. PD49-10 LONG-TERM FUNCTIONAL OUTCOMES OF INFERIOR VENA CAVA RESECTION COMPARED TO THROMBECTOMY IN RENAL CELL CARCINOMA PATIENTS: A RETROSPECTIVE, CASE- CONTROLLED STUDY
- Author
-
Reza Nabavizadeh, Dattatraya Patil, Shishir K. Maithel, Lillian Xie, Kenneth Cardona, Viraj A. Master, Fangyi Lin, Cecilia G. Ethun, Gordon Hong, and Kenneth Ogan
- Subjects
medicine.medical_specialty ,medicine.vein ,business.industry ,Renal cell carcinoma ,Urology ,medicine ,Case-control study ,business ,medicine.disease ,Inferior vena cava ,Resection ,Surgery ,Term (time) - Published
- 2020
203. MP37-16 ASSESSING THE IMPACT OF SALVAGE RADIATION THERAPY FIELD AFTER RADICAL PROSTATECTOMY: A LONG-TERM ANALYSIS FROM A LARGE MULTI-INSTITUTIONAL SERIES
- Author
-
Hendrik Van Poppel, Alberto Briganti, Daniele Robesti, Gregor Goldner, Giovanni Motterle, Shahrokh F. Shariat, Barbara Noris Chiorda, Giorgio Gandaglia, Simone Scuderi, Steven Joniau, Nicola Fossati, Elio Mazzone, Charlien Berghen, Cesare Cozzarini, Nadia Di Muzio, Gert De Meerleer, Francesco Montorsi, Jeffrey Karnes, T. Kumar, Detlef Bartkowiak, Stephen A. Boorjian, Alberto Bossi, Francesco Barletta, Thomas Wiegel, and Gaëtan Devos
- Subjects
Series (stratigraphy) ,medicine.medical_specialty ,Salvage radiation ,business.industry ,Curative treatment ,Prostatectomy ,Urology ,medicine.medical_treatment ,Medicine ,Radiology ,business ,human activities ,Term (time) - Abstract
INTRODUCTION AND OBJECTIVE:Salvage radiation therapy (SRT) represents a curative treatment option for patients with prostate-specific antigen (PSA) rise after radical prostatectomy (RP). However, a...
- Published
- 2020
204. MP02-20 BENEFIT FINDING AND PERCEIVED SEVERITY OF THE DISEASE IN LONG-TERM PROSTATE CANCER SURVIVORS
- Author
-
Andreas Dinkel, Jürgen E. Gschwend, Helga Schulwitz, Irène Lassmann, Kathleen Herkommer, and Birgitt Marten-Mittag
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Urology ,Life events ,Cancer ,Disease ,medicine.disease ,Term (time) ,Prostate cancer ,Internal medicine ,Medicine ,sense organs ,business - Abstract
INTRODUCTION AND OBJECTIVE:Benefit finding (BF) refers to positive effects that may arise in the aftermath of a traumatic life event such as a cancer diagnosis. It involves disease-induced changes ...
- Published
- 2020
205. PD13-04 LONG-TERM COMPETING RISKS OF MORTALITY AMONG MEN WITH BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY
- Author
-
Matthew R. Cooperberg, Zachary Klaassen, Martha K. Terris, Stephen J. Freedland, Timothy J. Daskivich, Lauren E. Howard, Christopher L. Amling, William J. Aronson, and Christopher J. Kane
- Subjects
Biochemical recurrence ,Oncology ,medicine.medical_specialty ,business.industry ,Prostatectomy ,Urology ,Internal medicine ,medicine.medical_treatment ,Medicine ,business ,Competing risks ,Term (time) - Abstract
INTRODUCTION AND OBJECTIVE:Men with biochemical recurrence (BCR) after radical prostatectomy (RP) have little information on long-term competing risks of mortality to inform prognosis and guide tre...
- Published
- 2020
206. MP41-19 URINARY TRACT FISTULAE AFTER PROSTATE CANCER RADIATION: A LONG-TERM EXPERIENCE
- Author
-
Martin Kathrins, Valary T. Raup, Alexandra Berger, Emily J. Ji, and Jairam R. Eswara
- Subjects
Prostate cancer ,medicine.medical_specialty ,business.industry ,Urology ,Urinary system ,medicine ,medicine.disease ,business ,Term (time) - Published
- 2020
207. MP40-20 MEDIUM TO LONG TERM SURGICAL RE-INTERVENTION RATE IN MALE SLING: A SINGLE CENTRE UK EXPERIENCE
- Author
-
Michelle Pipe, Ridwaan Sohawon, Mohammed Belal, Thomas F J King, and Ishtiakul Gani Rizvi
- Subjects
Single centre ,medicine.medical_specialty ,business.industry ,Male sling ,Urology ,General surgery ,Medicine ,business ,Re intervention ,Term (time) - Published
- 2020
208. PD39-10 LONG-TERM SURVIVORS WITH SARCOMATOID RENAL CELL CARCINOMA
- Author
-
Renzo G. DiNatale, A. Ari Hakimi, Kyle A. Blum, Satish K. Tickoo, Stanley Weng, Kate Weiss, Jonathan A. Coleman, Julian Marcon, Roy Mano, Victor E. Reuter, Andrew W. Silagy, Sounak Gupta, and Paul Russo
- Subjects
Oncology ,medicine.medical_specialty ,business.industry ,Urology ,Internal medicine ,Long term survival ,Sarcomatoid Renal Cell Carcinoma ,Medicine ,business ,Term (time) - Abstract
INTRODUCTION AND OBJECTIVE:Long term survival in sarcomatoid renal cell carcinoma (sRCC) is unusual with median survivals reported between 6-10 months. However, some patients live well past median ...
- Published
- 2020
209. PD02-03 TRIFECTA ACHIEVEMENT AFTER PARTIAL NEPHRECTOMY HELPS PREDICTING LONG TERM ONCOLOGIC AND FUNCTIONAL OUTCOMES: A MULTICENTER STUDY
- Author
-
Mariaconsiglia Ferriero, Umberto Capitanio, Alexander Mottrie, Giuseppe Simone, Aldo Brassetti, Juan Garisto, Alfredo Maria Bove, Gabriele Tuderti, Riccardo Mastroianni, Francesco Montorsi, Jihad H. Kaouk, Alessandro Larcher, Riccardo Autorino, Umberto Anceschi, and Riccardo Bertolo
- Subjects
medicine.medical_specialty ,Multicenter study ,Renal cell carcinoma ,business.industry ,Urology ,medicine.medical_treatment ,medicine ,urologic and male genital diseases ,medicine.disease ,business ,Nephrectomy ,Term (time) - Abstract
INTRODUCTION AND OBJECTIVE:The best follow-up (FU) strategy following partial nephrectomy (PN) for localized renal cell carcinoma (RCC) remains unclear, being an intensive imaging-based strategy un...
- Published
- 2020
210. Long-Term Histological Findings of Autologous Fat Grafting in the Upper Eyelid
- Author
-
Xi Chen, Guangpeng Liu, Lei Sun, and Wentao Zou
- Subjects
Blepharoplasty ,medicine.medical_specialty ,business.industry ,Eyelids ,Dermatology ,General Medicine ,Transplantation, Autologous ,Surgery ,Term (time) ,medicine.anatomical_structure ,Adipose Tissue ,Humans ,Medicine ,Female ,Autologous fat grafting ,Eyelid ,business ,Aged - Published
- 2020
211. Associations Between Long‐Term Fine Particulate Matter Exposure and Mortality in Heart Failure Patients
- Author
-
David Diaz-Sanchez, Emily R. Pfaff, Anne M. Weaver, Joel Schwartz, Matthew Buranosky, Lucas M. Neas, Qian Di, Wayne E. Cascio, Cavin K. Ward-Caviness, and Robert B. Devlin
- Subjects
Male ,Time Factors ,Epidemiology ,Fine particulate ,air pollution ,Air pollution ,030204 cardiovascular system & hematology ,medicine.disease_cause ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Data Warehousing ,Risk Factors ,Electronic health record ,Environmental health ,North Carolina ,medicine ,Electronic Health Records ,Humans ,030212 general & internal medicine ,Aged ,Original Research ,Aged, 80 and over ,Heart Failure ,business.industry ,Environmental Exposure ,electronic health record ,Middle Aged ,Prognosis ,medicine.disease ,mortality ,Term (time) ,Heart failure ,PM 2.5 ,Female ,Particulate Matter ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Background Environmental health risks for individuals with heart failure ( HF ) have been inadequately studied, as these individuals are not well represented in traditional cohort studies. To address this we studied associations between long‐term air pollution exposure and mortality in HF patients. Methods and Results The study population was a hospital‐based cohort of individuals diagnosed with HF between July 1, 2004 and December 31, 2016 compiled using electronic health records. Individuals were followed from 1 year after initial diagnosis until death or the end of the observation period (December 31, 2016). We used Cox proportional hazards models to evaluate the association of annual average fine particulate matter ( PM 2.5 ) exposure at the time of initial HF diagnosis with all‐cause mortality, adjusted for age, race, sex, distance to the nearest air pollution monitor, and socioeconomic status indicators. Among 23 302 HF patients, a 1 μg/m 3 increase in annual average PM 2.5 was associated with an elevated risk of all‐cause mortality (hazard ratio 1.13; 95% CI, 1.10–1.15). As compared with people with exposures below the current national PM 2.5 exposure standard (12 μg/m 3 ), those with elevated exposures experienced 0.84 (95% CI, 0.73–0.95) years of life lost over a 5‐year period, an observation that persisted even for those residing in areas with PM 2.5 concentrations below current standards. Conclusions Residential exposure to elevated concentrations of PM 2.5 is a significant mortality risk factor for HF patients. Elevated PM 2.5 exposures result in substantial years of life lost even at concentrations below current national standards.
- Published
- 2020
212. Abstract P227: Psychosocial Predictors of Physical Capacity in Cardiac Rehabilitation
- Author
-
Robert Zecchin, Binu Koirala, Patricia M. Davidson, Yenna Salamonson, and Bronwyn Everett
- Subjects
medicine.medical_specialty ,Rehabilitation ,business.industry ,Physiology (medical) ,medicine.medical_treatment ,medicine ,Physical therapy ,Cardiology and Cardiovascular Medicine ,business ,Psychosocial ,Term (time) - Abstract
Introduction: Despite the impressive gains achieved by those who attend cardiac rehabilitation, many patients fail to maintain the gains in physical capacity in the longer term. There are likely psychosocial characteristics that can be leveraged to sustain behavior change. Hypothesis: Patients with higher perceived cardiac control, social support, and exercise self-efficacy, without depression, and those who received motivational interviewing (MI) sessions, adjunctive to cardiac rehabilitation, will have a significantly higher physical capacity. Methods: This is a secondary analysis of the data from a randomized controlled trial of MI as a tool to enhance secondary prevention strategies in cardiovascular disease (MICIS study) conducted at three hospitals in Sydney, Australia who attended 6-week phase II cardiac rehabilitation. Two, 1-hour sessions of a nurse-delivered motivational interview focused on increasing physical capacity was implemented and the participants were followed at 6-weeks and 12-months. The outcome for the study was physical capacity measured by distance walked on the six-minute walk test (6MWT). Multiple imputations were used to handle missing data. Descriptive statistics, t-tests, chi-square tests and linear regression for cluster data were used for data analysis. Results: The mean (SD) age of participants (n=110) at baseline was 60.1 (10.57) years and the majority were male (71.8%). (Table). In the adjusted analysis, motivational interviewing (p =0.57), perceived cardiac control (p=0.30), self-efficacy for exercise (p = 0.06) and level of depressive symptoms were not related to 6MWT. With every unit increase in perceived social support score, there was a decrease in distance walked in 6MWT by 1.30 meters (b = -1.30; p= 0.007). Conclusion: In this sample, psychosocial predictors, except social support, were not likely to influence physical capacity. Investigating barriers and facilitators to sustaining the effects of cardiac rehabilitation are needed.
- Published
- 2020
213. Abstract P453: Short-term Air Pollution Exposures, Lifestyle Risk Factors, and Glucose Levels: A Family-based Study in China
- Author
-
Yonghua Hu, Zijing Wang, Yao Wu, Xiaowen Wang, Mengying Wang, Yaohua Tian, Junhui Wu, and Tao Wu
- Subjects
Ambient air pollution ,business.industry ,Physiology (medical) ,Environmental health ,Air pollution ,Medicine ,Cardiology and Cardiovascular Medicine ,China ,Family based ,business ,medicine.disease_cause ,Term (time) - Abstract
Introduction: Previous studies have reported the association between ambient air pollution exposures and glucose levels. However, less is known about whether usual lifestyles could modify the association. Hypothesis: We assessed the hypothesis that lifestyles may modify the association between short-term exposure to ambient air pollution and fasting blood glucose levels among Chinese populations. Methods: The analysis was based on a family-based study in Northern China. In addition, data of air pollution from 2014 to 2017 were obtained from the Beijing Municipal Environmental Monitoring Center. A generalized additive model was adopted to estimate the change in blood glucose levels with a 10 μg/m 3 increase in 2-day moving average concentrations of air pollutants (lag0-1) (considering the potential lag pattern effect of air pollution on glucose levels). Interaction analyses were conducted by including a cross-product term of PM 2.5 or PM 10 by lifestyles (smoking, alcohol consumption, BMI, and sedentary lifestyles) in the models. Results: A total of 4,151 participants (2259 females, 1892 males, 58.9±8.7 years) without antidiabetic drugs on the survey day were included in the analysis. We found a 10 μg/m 3 increase in PM 2.5 concentrations and PM 10 concentrations corresponded to 0.06 (95% CI: 0.04-0.09) and 0.06 (95% CI: 0.04-0.08) mmol/L increase in glucose levels, respectively after adjusting for sex, age, education levels, BMI (kg/m 3 ), smoking, alcohol consumption, sedentary lifestyles, family history of diabetes, use of antidiabetic drugs, temperature, and relative humidity. Besides, the results showed higher risks of PM 2.5 and PM 10 among the overweight and obese when compared with the normal weight ( P for interaction less than 0.05). However, drinking status and sedentary lifestyles did not modify the association between PM and glucose levels. Conclusions: Short-term exposures to air pollution were associated with higher blood glucose levels, which could be modified by BMI. Populations with higher BMI may be more susceptible to the adverse effects.
- Published
- 2020
214. Abstract WP2: Long-Term Functional Outcomes Following Mechanical Thrombectomy Stratified by Race- Insights From the STAR Collaboration
- Author
-
Reade De Leacy, Travis M. Dumont, Sami Al Kasab, Diego J Lozano, David J McCarthy, Salah G. Keyrouz, Peter Kan, Vasu Saini, Marios-Nikos Psychogios, Ansaar T Rai, Eyad Almallouhi, Ali Alawieh, Robert M. Starke, Adam S Arthur, Alejandro M Spiotta, Kyle M Fargen, and Joon-Tae Kim
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Vascular risk ,medicine.disease ,Endovascular therapy ,Term (time) ,Mechanical thrombectomy ,Race (biology) ,Emergency medicine ,medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Introduction: Previous research reported higher prevalence of vascular risk factors and worse outcomes after stroke in non-white patients compared to whites. Whether similar results still apply in the post mechanical thrombectomy era remains unknown. Methods: The STAR registry combined the prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe, and Asia. Consecutive patients who underwent MT were included in these analyses. Baseline features, risk factors, location of occlusion, time from symptom onset, tPA receipt, procedural complication rates, symptomatic hemorrhage, and long-term functional outcome were compared between white and non-white patients. Multivariate logistic regression analysis was performed to evaluate the impact of race on long-term outcome. Results: Total of 2,284 patients were included in this analysis. Of those, 1,436 (62.9%) were white. Baseline features and outcomes are summarized in table 1. Non-white patients were older ( 71 Vs 66, p= Conclusion: In this study, white race was independent predictor of good 90-day outcome. This finding could be due to higher prevalence of vascular risk factors in non-white patients.
- Published
- 2020
215. Abstract 52: Case Reports of Short-Term Outcome Following Mechanical Thrombectomy for Childhood Stroke May Be Overly Optimistic
- Author
-
Dwight Barry, Tipster Investigators, and Catherine Amlie-Lefond
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Childhood stroke ,medicine.disease ,Arterial Ischemic Stroke ,Endovascular therapy ,Term (time) ,Mechanical thrombectomy ,medicine ,Pediatric stroke ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Abstract
Background: Meta-analyses of case reports and case series of mechanical thrombectomy in childhood arterial ischemic stroke (AIS) suggest that mechanical thrombectomy is associated with good short-term outcomes in approximately three-quarters of children. Methods: Retrospective data on 38 children treated between 2010-2019 with mechanical thrombectomy for stroke were collected from former Thrombolysis in Pediatric Stroke (TIPS) sites. To minimize reporting bias, sites were required to report all patients ≤ 17 years treated with mechanical thrombectomy either at the study site or at an outside hospital prior to transfer. Short-term outcomes, defined as change in NIHSS prior to and following mechanical thrombectomy (MT), were compared with 85 children from case reports/case series published between 2010-2019. Results: The mean age of children from former TIPS sites was 11.9 years, 50% male, 34% treated with IV tPA prior to thrombectomy. The mean age of published cases was 10.4 years, 65% males, 19% treated with IV tPA prior to thrombectomy. Case reports had a wider distribution of before-MT NIHSS scores, and a steeper decrease in distributions of after-MT NIHSS scores than those from study sites within 24 hours of MT (Figure 1A; medians: 15 to 4 in published cases, 12 to 8 in cases from sites) and at discharge (Figure 1B; medians: 15 to 3 in published cases, 12 to 5 in cases from sites). Conclusion: Patients reported to former TIPS sites had discernably lower rates of good short-term outcomes compared with published case reports and case series, suggesting publication bias. Capturing key metrics of safety and effectiveness of MT in children with AIS, including variations in care delivery in actual practice, will be critical in the creation of evidence-based guidelines for acute management of pediatric AIS.
- Published
- 2020
216. Abstract TMP6: Optimal Early Clinical Endpoints for Long-Term Functional Outcome Prediction After Thrombectomy
- Author
-
Felipe De Los Rios La Rosa, Tapan Mehta, Amy K Starosciak, Eva Mistry, Katarina Dakay, James E. Siegler, Niraj Arora, Shadi Yaghi, Sharon D Yeatts, Akshitkumar M. Mistry, Pooja Khatri, and Rohan Chitale
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,Stroke patient ,Surrogate endpoint ,business.industry ,medicine.disease ,Outcome (game theory) ,Term (time) ,Clinical endpoint ,medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Outcome prediction ,Intensive care medicine ,business ,Stroke - Abstract
Background: Early neurological recovery (ENR) is an attractive surrogate marker for long-term functional outcome of endovascularly-treated stroke patients. However, the optimal definition of 24-hour ENR that best predicts 90-day functional independence (modified Rankin Scale, mRS, 0-2) has not been established. We sought to determine ENR measure that best predicts 90-day mRS 0-2. Methods: The prospective BEST cohort study includes consecutive adult patients treated with endovascular therapy at 12 comprehensive stroke centers. In this post-hoc analysis, we measured the ability of various thresholds of both 24-hour NIHSS and αNIHSS (baseline minus 24-hour) to predict 90-day mRS 0-2 using Youden’s index. The strength of the associations were assessed using logistic regression adjusted for age, glucose, hypertension, ASPECT score, time to recanalization, recanalization status, and thrombolytic treatment. Results: Of 485 patients in the BEST cohort, 447 with 90-day follow-up were included in this study (228 females, mean age 68.05 ±15 years). The optimal Youden’s Index was achieved at 24 hour NIHSS of ≤7 (sensitivity 80.1%, specificity 80.4%, area under the curve [AUC] 0.855 [0.819-0.887], p Conclusions: A 24-hour NIHSS ≤7 was the optimal measure to predict functional independence at 90 days in our multicenter, prospective cohort. Among αNIHSS thresholds, ≥4 points was optimal but performed less well. These findings should be validated in independent endovascular cohorts to establish a standard short-term outcome measure for both clinical and research scenarios.
- Published
- 2020
217. Abstract WP130: Long Term Outcome of Large and Giant Unruptured Intracranial Aneurysms
- Author
-
Soichiro Fujimura, Yuichi Murayama, Koreaki Irie, Shogo Kaku, Toshihiro Ishibashi, Ikki Kajiwara, Kengo Nishimura, Masayuki Ebara, Hideki Arakawa, Naoki Kato, Ichiro Yuki, Yuya Uchiyama, Issei Kan, and Tomonobu Kodama
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Outcome (game theory) ,Surgery ,Term (time) - Abstract
Objectives: Long term outcome of large / giant unruptured intracranial aneurysms (LG-UIAs) after endovascular therapy is still unknown. We retrospectively analyzed long-term results of patients with LG-UIAs who were followed up more than 5 years after endovascular therapy. Methods: We included patients from our complete database with UIAs greater than 10mm and treated at our hospital from January 2003 to December 2013. Retreatment rate of targeted aneurysms, rupture rate, and the modified Rankin scale (mRS) at last visit were evaluated till December 2018. Results: From 142 patients treated during the period were excluded 3 patients with perioperative rupture and 38 patients with less than 5 years follow-up period, finally analyzing 101 patients. The median aneurysm size was 12.0 mm (IQR 10.8-15). The median follow-up period was 9.4 years (IQR: 7-11), the longest being 13.3 years. Retreatment was performed on 36 patients (35.6%). Comparing cumulative re-treatment rates in groups with aneurysm sizes 20 mm, it was predominantly higher for aneurysms> 20 mm (P = 0.02, Figure1 ). Rupture of targeted aneurysms was observed in 2 cases (1.98%, Figure2 ), and the longest period from last treatment was up to 12 years. The mRS 0-1 at the first treatment and the final visit were 98% and 93%, respectively, and mRS deterioration remained at 5%. Conclusion: The retreatment rate tended to increase in proportion to the size of the aneurysm, however the final neurological outcome was favorable when considering the natural history of these aneurysms. Since aneurysmal rupture could occur after 12 years of treatment, long-term follow-up should be considered for LG-UIAs.
- Published
- 2020
218. Abstract WP376: Candidates for Long Term Anticoagulation Among Hospitalized Patients With Atrial Fibrillation in United States
- Author
-
Iryna Lobanova, Wei Huang, Nitish Kumar, Brandi R French, Camilo R Gomez, Farhan Siddiq, Sachin M. Bhagavan, Vamshi Balasetti, and Adnan I Qureshi
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,Hospitalized patients ,business.industry ,Atrial fibrillation ,Context (language use) ,medicine.disease ,Term (time) ,Internal medicine ,Ischemic stroke ,medicine ,Cardiology ,cardiovascular diseases ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke - Abstract
Context: Long-term anticoagulation has been consistently shown to reduce the rate of ischemic stroke among selected patients with atrial fibrillation (AFib). There is paucity of data regarding number of eligible patients with AFib in United States who could benefit from long-term anticoagulation. Objective: To provide national estimate of eligible hospitalized patients with AFib who could benefit from long-term anticoagulation. Methods: We analyzed data from Nationwide Inpatient Sample (NIS) for the year 2016. NIS represents the largest all payer nationally representative dataset of hospitalizations in United States. We identified patients with primary or secondary diagnosis of AFib who were aged 75 years or greater, women aged 65-74 years, men aged 65-74 years with history of ischemic stroke/transient cerebral ischemia( TIAs), and patients aged 18-64 years with AF and ischemic stroke/TIAs (CHA2DS2-VASc score of 2 or greater) who were hospitalized and discharged alive to provide national estimates. Results: A total of 871,391 patients (163,236 aged between 18-64 years, 216,645 aged between 65-74 years, and 491,107 aged 75 years or greater) were admitted with a diagnosis of AFib in 2016. The number of patients with atrial fibrillation who also had history of ischemic stroke/TIAs was 38,051 (4.37%). Of the Afib patients, aged 75 years or greater, 25,050 (2.87 %) had a history of ischemic stroke/TIAs. Of the patients aged 65-74 years, 3,534 women (0.41%) and 4,341 men (0.50%) had history of ischemic stroke/TIAs. Also, there were 91,364 (10.48%) women between age 65-74 years who had AFib but did not have stroke.5,117 (=n,0.59%) patients between age 18-64 years had AFib and history of ischemic stroke/TIAs. The total number of potentially eligible patients with AFib who could benefit from the anticoagulation (based on CHA2DS2-VASc) was 564,030(65% of all patients admitted with AFib). Conclusions: Over half a million hospitalized patients with atrial fibrillation who are under medical care can benefit from long-term anticoagulation. Most are stroke free at time of hospitalization in United States and thus associated death and disability from new strokes can be prevented by timely initiation of long-term anticoagulation.
- Published
- 2020
219. Abstract WP115: Cilostazol Addition to Aspirin Does Not Alter the Short-Term Neurological Outcome in Each Clinical Subtype of Acute Stroke
- Author
-
Junya Aoki, Yasumasa Yamamoto, Kazumi Kimura, Hiroshi Yamagami, Toshiro Yonehara, Hideki Matsuoka, Takao Urabe, Yoshiki Yagita, Takeshi Inoue, Yasushi Okada, Shigeru Fujimoto, Uno Masaaki, Koji Abe, and Sen Yamagata
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,Aspirin ,business.industry ,Outcome (game theory) ,Term (time) ,Cilostazol ,Internal medicine ,Cardiology ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Acute stroke - Abstract
Hypothesis: Our previous study, ADS reported that dual antiplatelet therapy (DAPT) using cilostazol and aspirin did not reduce the rate of short-term neurological worsening in non-cardioembolic stroke patients. The aim of the present study is to investigate 1) whether the impact of cilostazol addition to aspirin differ among each stroke subtype, and 2) factors associated with neurological deterioration and/or stroke recurrence in order to find therapeutic target. Methods: This is a retrospective analysis using the ADS databank. Neurological worsening and the rates of stroke recurrence within 14 day of onset were evaluated. Stroke subtype included large-artery atherosclerosis (LAA), lacunae infarct (LI), branch atheromatous disease (BAD), other, and undetermined. Results: Data on 1,160 patients (773 [67%] men; median age, 69 [61-77] years, NIHSS score was 2 [1-4]) were analyzed. At discharge, 167 (14%) were diagnoses as having LAA; LI, 532 (46%); BAD, 173 (15%); other, 132 (11%); and undetermined, 156 (14%). Neurological deterioration and/or recurrence were seen in 130 (11%) patients, and the rates were not different between patients treated with DAPT and aspirin in any stroke subtypes: LAA, 19% (DAPT) vs. 11% (aspirin alone), (p=0.185); LI, 4% vs. 3% (p=0.645); BAD, 33% vs.34%, (p=0.872), other, 8% vs.14% (p=0.272); undetermined, 13% vs. 8% (p=0.301). When we evaluated factors related to the deterioration/recurrence, age (p1.5cm (p Conclusions: Dual antiplatelet therapy using cilostazol and aspirin does not reduce the rate of short-term neurological worsening in each clinical stroke subtype. Improvement of hyperacute therapy targeting the elder patients with elevated blood pressure, large infarct and intracranial stenosis/occlusion should be required.
- Published
- 2020
220. Abstract WP500: Long-Term Cognitive Outcome Among Aneurysmal Subarachnoid Hemorrhage Survivors: Need for Cognitive Rehabilitation?
- Author
-
Swathy Chandrashekhar, Lance Ford, Claire Delpirou Nouh, Chao Xu, Danny G. Samkutty, and Bappaditya Ray
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,Subarachnoid hemorrhage ,business.industry ,Cognition ,medicine.disease ,Outcome (game theory) ,Term (time) ,Physical therapy ,Medicine ,Neurology (clinical) ,Cognitive rehabilitation therapy ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high in-patient mortality and with long-term cognitive deficits among survivors. With widespread adoption of standard neurocritical care practice in-hospital mortality has decreased while long-term cognitive impairment (CI) among survivors is not well characterized. Hypothesis: To investigate whether temporal change in practice has resulted in improvement in long-term CI. Methods: Single-center retrospective chart review of aSAH patients admitted to a comprehensive stroke center between January 2012 and December 2016, were identified from a prospective database. Cognitive status was evaluated between January and December 2018 using Telephone Interview of Cognitive Status (TICS). The study cohort was divided into two 2.5 year periods and TICS score of >32, 28-32 and Results: 252 patients were admitted during the study period of which 46 patients could be reached and consented to participate in TICS. Median TICS score was lower in earlier study period compared to later period [31.5 (IQR 22, 36) vs. 33 (IQR 27, 38), p=0.038]. Similarly, TICS score Conclusion: Smoking and hyperlipidemia are identified as risk factors for CI among aSAH survivors alluding to a role of vascular pathogenesis. Progressive CI over time might justify long-term cognitive rehabilitation in this population of patients.
- Published
- 2020
221. Abstract TP301: Gender Differences in Short- and Long-Term Outcome of Patients With Suspected Acute Stroke
- Author
-
Debby Morgan, Yahia Imam, Ashfaq Shuaib, Sujatha Joseph, Numan Amir, Laxmi Ojha, Namitha Jose, Maher Saqqur, Paula Bourke, Saadat Kamran, Blessy Babu, Zain A. Bhutta, Naveed Akhtar, and Rajvir Singh
- Subjects
Advanced and Specialized Nursing ,Pediatrics ,medicine.medical_specialty ,business.industry ,Medicine ,cardiovascular diseases ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Outcome (game theory) ,Term (time) ,Acute stroke - Abstract
Background: There are gender differences in the short-term prognosis following acute stroke suggesting that outcome is less favorable in women. Factors contributing to this poor outcome include preexisting morbidity, stroke severity and higher age. Most previous studies have looked at short-term prognosis. PURPOSE: We investigated whether gender differences have a differential impact on incidence of short-term outcome and long-term major adverse cardiovascular events (MACE) including stroke, myocardial infarction, unstable angina, coronary revascularization procedure, and death in patients with suspected acute stroke. Methods: The study used a prospective cohort of Qatari patients with suspected acute stroke between January 2014 and February 2019. We calculated the modified Rankin score (mRS) at discharge and 90-days (short-term) and MACE (long-term) outcomes in both genders. To determine the independent predictor for MACE, the Cox proportional hazards regression analysis was used and summarized as hazard ratio and 95% confidential interval. Results: A total of 1372 patients identified. At 90-days, women found to have significantly poorer outcome (34.0% vs 23.4%, p Conclusion: Our results show that despite higher mortality and poor outcome at 90-days, the long-term outcome in women did not show any significant difference from men in this cohort. This may be related to older age and presence of cardiovascular risk factors.
- Published
- 2020
222. Abstract TP452: Long Term Opioid Use in Patients With Aneurysmal Subarachnoid Hemorrhage
- Author
-
Ashutosh Kaushal, Bradford B Thompson, Idrees Azher, Scott Moody, Katarina Dakay, Leana Mahmoud, Karen L. Furie, Shawna Cutting, Ali Mahta, Brian Mac Grory, Matthew W. Anderson, Michael Reznick, Shadi Yaghi, Nicholas S Potter, Shyam Rao, and Linda C. Wendell
- Subjects
Advanced and Specialized Nursing ,Subarachnoid hemorrhage ,business.industry ,Anesthesia ,Opioid use ,Medicine ,In patient ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Term (time) - Abstract
Background: Headache and neck pain are common in patients with aneurysmal subarachnoid hemorrhage (aSAH) throughout their course. Because pain is often a sequela, these patients are at risk for opioid dependence. Long term opioid use has not been well studied in this population. Methods: We analyzed a cohort of consecutive patients who were admitted with diagnosis of aSAH to an academic referral center from 2015 to 2018. We excluded patients who died during hospitalization or were discharged to hospice or were previously taking any opioids. The following variables were collected: demographics, any opioid use during hospitalization, short-term low-dose steroid use (mostly for headache management but some cases for immediate post craniotomy for aneurysm clipping), opioid prescription at the time of discharge and 3-month or longer opioid use verified by pharmacy and any follow up out patient records. Results: Of 200 patients with aSAH, 144 patients (72%) met our inclusion criteria. Mean age was 58 years (SD 14.8); Ninety-four patients (65%) were women; All patients received opioids at some point during hospitalization but 66% (96/144) were discharged with opioid prescription. Of these, 31% (30/96) continued to use opioids at ≥3 months. The overall rate of chronic opioid use was 20% (30/144). The rate of opioid prescription at discharge was 72% (52/72) in patients who received short course steroids and 61% (44/72) in patients who did not receive steroids. (p=0.21; OR 2.6, 95% CI 0.82-3.3). Steroids did not prevent long term opioid use. (p=0.30; OR 0.6, 95% CI 0.26-1.3) Conclusion: Opioids are regularly used as the main treatment option for pain control in patients with aSAH. A noteworthy number of patients continue to use opioids beyond their initial hospitalization. Steroid use does not prevent long term opioid use in these patients. Non-opioid pain control strategies should be explored in the future.
- Published
- 2020
223. Abstract 17: An Evaluation of Patient Disposition and Long-term Health-related Quality of Life In MISTIE III: Opportunities to Improve Decision Making for Critically Ill Intracerebral Hemorrhage Patients
- Author
-
Richard E. Thompson, Lourdes Carhuapoma, Issam A. Awad, Daniel F. Hanley, Karen Lane, Juan R. Carhuapoma, Noeleen Ostapkovich, Radhika Avadhani, Nichol McBee, and Wendy C. Ziai
- Subjects
Advanced and Specialized Nursing ,Health related quality of life ,Intracerebral hemorrhage ,medicine.medical_specialty ,business.industry ,Critically ill ,medicine.disease ,Term (time) ,Quality of life (healthcare) ,Patient disposition ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine - Abstract
Introduction: Recovery in intracerebral hemorrhage (ICH) is prolonged and unpredictable, resulting in challenges in estimating health-related quality of life (HRQoL). We describe HRQoL and patient disposition for ICH survivors with similar clinical characteristics to ICH patients who had withdrawal of life-sustaining treatment (WoLST). Methods: Using MISTIE III trial data (N = 499), we performed a matched cohort analysis using a published modified severity index (mSI) to compare ICH survivors (N = 379) with WoLST patients (N = 61). We used multivariable logistic regression adjusting for age, Glasgow Coma Score, deep ICH location, stability ICH and intraventricular hemorrhage volume and ≥ 3 comorbidities to create the mSI. After matching survivors with equal mSI to WoLST patients, we compared EuroQoL (EQ) visual analog scale (VAS) scores (US norm 69-76; range 0-100) by mSI quartile and patient disposition. Results: We matched 224 survivors to WoLST patients by mSI (range 0-6.5), with data at all timepoints. Given the large mSI range, EQ VAS scores and patient disposition were evaluated by mSI quartile groups. The median (interquartile range [IQR]) EQ VAS score increase for all mSI groups from day 30 (D30) to 180 (D180) was 20 (0-35.5, p < 0.0001), and 23.5 (5-40, p < 0.0001) for D30 to 365 (D365). The highest percentage of survivors for all mSI groups were home by D365 (G1 55%, G2 88%, G3 84.5%, G4 90%). Median (IQR) EQ VAS scores by mSI quartile, patient disposition and timepoint are reported below. Conclusion: ICH survivors, matching WoLST individuals, in all mSI groups demonstrated improvement in HRQoL over time, and the majority were home by D365. This study challenges current practice of identifying poor outcomes in concert with decision making employing WoLST in ICH. If goals of care are to include return to home and HRQoL, these results strongly suggest that prognostication can be improved. Prospective studies of ICH prognostication and decision making are needed.
- Published
- 2020
224. Abstract 67: Effects of Single vs Dual Antiplatelet Therapy on Long Term Stroke and Death After Carotid Endarterectomy
- Author
-
Nathan Belkin, Alexander S. Fairman, Scott M. Damrauer, Grace J. Wang, Ronald M. Fairman, Paul J. Foley, and Benjamin M. Jackson
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Carotid endarterectomy ,medicine.disease ,Term (time) ,Internal medicine ,Cardiology ,Medicine ,cardiovascular diseases ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Perioperative stroke - Abstract
Introduction: Current evidence suggests that dual antiplatelet therapy (DAPT) reduces perioperative stroke, but increases bleeding after carotid endarterectomy (CEA). The long term effects of antiplatelet therapy after CEA have yet to be studied. Methods: A retrospective review of patients undergoing CEA in the national Vascular Quality Initiative database (2003-2018) was performed. Based on antiplatelet regimen at discharge, patients were propensity score matched on aspirin monotherapy vs. DAPT. Multivariable logistic regression and Kaplan-Meier analyses were used to investigate the long term effects of antiplatelet regimen on mortality and stroke/TIA. Results: Of the 72,122 patients undergoing CEA, 64.6% were discharged on aspirin, and 35.4% on DAPT. The DAPT group had higher frequencies of comorbidities (COPD, HTN, CHF, smoking, diabetes) as well as atherosclerotic diseases (PAD, CAD, prior PCI, prior CABG). After propensity score matching, two groups of 8,722 patients with comparable comorbidities were formed. While unmatched Kaplan-Meier analysis showed the DAPT cohort to have higher mortality (p=0.001), this difference dissipated after matching. The resultant matched DAPT cohort did not differ from the aspirin group in one year stroke/TIA (1.7% vs. 1.6%, p=0.70), or mortality (3.1% vs. 3.3%, p=0.55). At 5 years, however, patients treated with DAPT did exhibit a mortality benefit (6.4% vs. 7.3%, p=0.02) with multivariable logistic regression identifying DAPT as an independent predictor of reduced mortality (OR 0.94, 95% CI 0.88-0.99, p=0.04). Conclusions: Patients discharged on DAPT after CEA represent a significantly different cohort than those discharged on aspirin monotherapy. After propensity score matching, there was no difference at one year stroke/TIA or mortality outcomes, but DAPT was found to be protective against long-term mortality. Further study is warranted to investigate this finding.
- Published
- 2020
225. Abstract TP211: Long-Term Trends in Ischemic Stroke Risk Factors and Outcomes in a Multiethnic Population
- Author
-
Dawn Cheah, Huili Zheng, Andrew Fw Ho, Marcus Eng Hock Ong, Joshua Tc Tan, Benjamin Yong-Qiang Tan, Sherry H. Young, Aftab Ahmad, Bernard P.L. Chan, Leonard L.L. Yeo, Pin Pin Pek, Hui Meng Chang, Keng He Kong, Kok Foo Tang, Deidre A De Silva, and Narayanaswamy Venketasubramanian
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Emergency medicine ,Ischemic stroke ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Multiethnic population ,Term (time) - Abstract
Introduction: Stroke medicine has evolved over time, with changing demographics and improving outcomes. We aimed to evaluate trends in incidence, risk factors, treatment and case fatality of acute ischemic stroke (AIS) in a multiethnic population. Methods: Data was obtained from the Singapore Stroke Registry. 60,325 AIS cases that presented to Singapore’s public hospitals from 2005-16 were studied. Trends were analyzed with Poisson regression, logistic regression and Cox regression. Results: The AIS age-standardized incidence rate has decreased by 11.6% (126.5 to 111.8 per 100,000 person-years from 2005-07 to 2014-16, p < 0.001). This was observed in all gender and ethnic groups except in those younger than 65, which saw a 2.5% increase (51.0 to 52.4 per 100,000 person-years, p = 0.017). In terms of risk factors, hypertension, hyperlipidemia, and atrial fibrillation have increased in prevalence, while history of stroke, ischemic heart disease, diabetes, and smoking have decreased (Figure A). Treatment-wise, thrombolysis utilization rates have increased significantly from 0.8% in 2005-2007 to 6.7% in 2014-2016 (p < 0.001). While atrial fibrillation (AF) has become more prevalent (15.8% to 25.2%, p < 0.001), anticoagulant prescription has not increased by the same magnitude (13.2% to 14.4%, p = 0.014). Case fatality has reduced by 25.6% (8.2% to 6.1%, p < 0.001). Conclusion: In a multi-ethnic population, whilst we found that AIS age-standardized incidence rate has been declining, we demonstrate a temporal trend of changing risk factors. Further research is needed to investigate the causes and implications of these trends, so as to better strategize prevention efforts.
- Published
- 2020
226. An Executive Strategy to Support Long-Term Clinician Engagement Amid the COVID-19 Pandemic
- Author
-
Steven Berkow, Katherine Virkstis, Karl Whitemarsh, Lauren Rewers, and Anne Herleth
- Subjects
Adult ,Coronavirus disease 2019 (COVID-19) ,Leadership and Management ,Pneumonia, Viral ,Commit ,Nursing Staff, Hospital ,Burnout ,03 medical and health sciences ,Employee engagement ,Pandemic ,Humans ,Nurse Administrators ,Workplace ,Burnout, Professional ,Pandemics ,030504 nursing ,business.industry ,COVID-19 ,General Medicine ,Resilience, Psychological ,Public relations ,Work environment ,Term (time) ,Resilience (organizational) ,Coronavirus Infections ,0305 other medical science ,business - Abstract
The COVID-19 pandemic has left frontline staff burned out and exhausted. Meanwhile, executives need to ask more of their staff to ensure organizational viability. In this article, the authors propose that executives commit to taking specific actions to create a more supportive work environment and form an executive-clinician compact. This article outlines the 5 actions executives should take to bolster staff engagement and resilience long-term.
- Published
- 2020
- Full Text
- View/download PDF
227. Response by Novotny et al to Letters Regarding Article, 'Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories'
- Author
-
Nicola Logallo, Halvor Naess, and Vojtech Novotny
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Cerebral infarction ,MEDLINE ,Arteries ,Cerebral Infarction ,medicine.disease ,Brain Ischemia ,Term (time) ,Brain ischemia ,Internal medicine ,Cardiology ,Humans ,Medicine ,Neurology (clinical) ,Cerebral infarcts ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
228. Letter by Wu et al Regarding Article, 'Short-Term Outcome and In-Hospital Complications After Acute Cerebral Infarcts in Multiple Arterial Territories'
- Author
-
Chuanjie Wu, Xunming Ji, and Wenbo Zhao
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,Cerebral infarction ,business.industry ,MEDLINE ,medicine.disease ,Term (time) ,Brain ischemia ,Internal medicine ,medicine ,Cardiology ,Neurology (clinical) ,Cerebral infarcts ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
229. Long-term (10 yr) MRI follow-up of paraspinal muscle quality after posterior fusion for adolescent idiopathic scoliosis
- Author
-
Michael Faloon, Matthew E. Cunningham, Bernard A. Rawlins, John S. Blanco, Daniel W. Green, and Roger F. Widmann
- Subjects
030222 orthopedics ,medicine.medical_specialty ,Posterior fusion ,business.industry ,Idiopathic scoliosis ,General Medicine ,Term (time) ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Orthopedics and Sports Medicine ,Radiology ,business ,030217 neurology & neurosurgery ,Paraspinal Muscle - Published
- 2018
230. Long-term Challenges After Solid Organ Transplantation
- Author
-
Luciano Potena, Christophe Legendre, Nuria Masnou, Isabelle Binet, Ingela Fehrman-Ekholm, John O'Grady, Richard Viebahn, Vedat Schwenger, Martina Guthoff, Dirk Kuypers, Fritz Diekmann, Marina Berenguer, Lars Wennberg, and Eric Epailly
- Subjects
Transplantation ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,business.industry ,030232 urology & nephrology ,medicine ,030230 surgery ,Intensive care medicine ,Solid organ transplantation ,business ,Term (time) - Published
- 2018
231. Long-term comparative study between transforaminal and interlaminar epidural injection of steroids in lumbar radiculopathy due to single-level disc herniation
- Author
-
Mahmoud Fahmy and Amr Atteya Soliman
- Subjects
medicine.medical_specialty ,Disc herniation ,Lumbar radiculopathy ,business.industry ,General Medicine ,Single level ,Term (time) ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Medicine ,Orthopedics and Sports Medicine ,business ,030217 neurology & neurosurgery - Published
- 2018
232. Association of Follow-Up Care With Long-Term Death and Subsequent Hospitalization in Patients With Atrial Fibrillation Who Receive Emergency Care in the Province of Ontario
- Author
-
Paula A. Rochon, Bing Yu, Michael J. Schull, Peter C. Austin, Douglas S. Lee, Cynthia A. Jackevicius, Clare L. Atzema, and Noah Ivers
- Subjects
Male ,Emergency Medical Services ,medicine.medical_specialty ,Time Factors ,Aftercare ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,Patient Admission ,0302 clinical medicine ,Risk Factors ,Cause of Death ,Physiology (medical) ,Atrial Fibrillation ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Ontario ,business.industry ,Atrial fibrillation ,Emergency department ,Middle Aged ,Prognosis ,medicine.disease ,Patient Discharge ,Follow up care ,Term (time) ,Emergency medicine ,Propensity score matching ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Currently, 11% of patients seen in the emergency department for atrial fibrillation die within 1 year of the visit. Our objective was to examine the association of rapid (within 3 days), early (7 days), and basic (30 days) outpatient physician follow-up with short- and long-term outcomes in patients with atrial fibrillation discharged from an emergency department. Methods: This retrospective cohort study included all adult patients discharged from one of the 163 emergency departments in Ontario, Canada with a primary diagnosis of atrial fibrillation, 2007 to 2014. We used a landmark analysis with propensity score matching, and logistic regression, to assess all-cause mortality and cardiovascular hospitalizations at 1 year and 90 days, 30-day return emergency visits, and 1-year oral anticoagulation prescription fills. Results: In the 10 657 patients with rapid follow-up care who were propensity score matched to a patient with follow-up between days 4 and 7, the hazard of a return emergency visit was reduced by 11% (HR, 0.89 [95% CI, 0.80–0.98]). It was not associated with mortality or hospitalization. In the 17 234 patients with early follow-up who were matched to a patient with care between days 8 and 30, the rate of 1-year mortality was 11% lower (HR, 0.89 [95% CI, 0.81–0.97]) and 1-year hospitalization was 6% lower (HR, 0.94 [95% CI, 0.89–1.00]). Relative to no 30-day care, basic follow-up care was associated with an increased hazard of 90-day hospitalization (HR, 1.32 [95% CI, 1.12–1.56]) but was no longer associated with mortality. In patients with early follow-up, the odds of filling an oral anticoagulation prescription a year later were 64% higher than those without it (OR, 1.64 [95% CI, 1.54–1.78]). Conclusions: Compared with follow-up care between days 8 and 30, follow-up within a week after discharge from an emergency department with atrial fibrillation was associated with a reduction in the rate of death and hospitalization within 1 year, an association that was not present with 30-day follow-up.
- Published
- 2019
233. Abstract 418: Categorization of Post-Cardiac Arrest Patients According to the Pattern of Amplitude-Integrated Electroencephalography After Return of Spontaneous Circulation: Analysis of Long-Term Prognosis
- Author
-
Kazuhiro Sugiyama, Yuichi Hamabe, and Kazuki Miyazaki
- Subjects
medicine.medical_specialty ,Categorization ,business.industry ,Physiology (medical) ,Internal medicine ,Cardiology ,Medicine ,Post cardiac arrest ,Return of spontaneous circulation ,Cardiology and Cardiovascular Medicine ,business ,Amplitude integrated electroencephalography ,Term (time) - Abstract
Introduction: Amplitude-integrated electroencephalography (aEEG) is a type of quantitative EEG easily interpreted by emergency physicians and intensivists at the bedside. We previously reported that categorizing post-cardiac arrest patients according to the pattern of aEEG, after return of spontaneous circulation (ROSC), could help predict the neurological function at hospital discharge (Critical Care. 2018;20:226). In post-cardiac arrest patients, increasing importance is being placed on long-term prognosis. In this study we evaluated the neurological outcome of patients in each category from our previous study, one year after cardiac arrest. Methods: We assessed the outcomes of patients who received post-cardiac arrest care, including targeted temperature management (TTM) and aEEG monitoring, in our tertiary emergency center, between March 2013 and April 2017. The patients were divided into four categories: C1 included those who displayed continuous normal voltage (CNV), within 12 hours of ROSC, and the best aEEG pattern in post-cardiac arrest patients; C2 included those who recovered CNV between 12 and 36 hours after ROSC; C3 included those with no CNV up to 36 hours after ROSC; and C4 included those who revealed burst suppression any time after ROSC. A good outcome was defined as a cerebral performance category (CPC) of 1 or 2, one year after cardiac arrest. Results: A total of 60 patients, with a median age of 60 years, were assessed; of them, 41 (68%) had an initial shockable rhythm. A good outcome was recorded in 18/19 (95%) C1 patients, 8/14 (57%) C2 patients, 1/10 (10%) C3 patients, and 0/14 C4 patients. Three patients could not be categorized because the recording period was too short. Conclusion: The categorization of post-cardiac arrest patients according to the pattern of aEEG after ROSC may be useful to predict long-term neurological function. C1 patients had excellent prognosis, while C3 and C4 patients had poor prognosis. However, one patient in the C3 group had CPC 3 at hospital discharge and then recovered to CPC 2 within one year. Withdrawal of care should be considered cautiously, using a multimodal approach, for patients in this category. C2 patients have borderline prognosis and are targets for intensive post-cardiac neurological care.
- Published
- 2019
234. Long-term progression of rhythm and conduction disturbances in pacemaker recipients
- Author
-
Matteo Ziacchi, Michele Accogli, Giuseppe Boriani, Giampiero Maglia, Pietro Palmisano, Ernesto Ammendola, Alessandro Capucci, Eraldo Occhetta, Vittorio Aspromonte, Gerardo Nigro, Gabriele Dell'Era, Renato Pietro Ricci, Mauro Biffi, Federico Guerra, Palmisano, P., Ziacchi, M., Ammendola, E., Dellera, G., Guerra, F., Aspromonte, V., Boriani, G., Nigro, G., Occhetta, E., Capucci, A., Ricci, R. P., Maglia, G., Biffi, M., and Accogli, M.
- Subjects
Male ,Pacemaker, Artificial ,medicine.medical_specialty ,Cardiac pacing ,MEDLINE ,Kaplan-Meier Estimate ,sinus node disease ,030204 cardiovascular system & hematology ,Pacemaker implantation ,03 medical and health sciences ,0302 clinical medicine ,Rhythm ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,030212 general & internal medicine ,Atrioventricular Block ,Aged ,Aged, 80 and over ,Sick Sinus Syndrome ,bradyarrhythmia ,permanent pacing ,business.industry ,Risk Factor ,Disease progression ,Cardiac Pacing, Artificial ,General Medicine ,Middle Aged ,pacemaker ,Term (time) ,Treatment Outcome ,Italy ,Multicenter study ,chronic bifascicular block ,syncope ,Disease Progression ,Cardiology ,Female ,Observational study ,rhythm disorder ,Cardiology and Cardiovascular Medicine ,business ,Human - Abstract
Aims Knowledge of the long-term progression of rhythm disorders requiring pacemaker implantation could have significant implications for the choice of device and its management during follow-up. Accordingly, we conducted an observational study to analyse the long-term progression of rhythm disorders requiring pacemaker implantation. Methods This multicentre, observational study enrolled 1810 pacemaker patients (age 71.6W13.3 years, men 53.8%) consecutively evaluated during scheduled pacemaker follow-up visits. To evaluate the long-term progression of rhythm disorders, we analysed the patient's rhythm disorders at the time of device implantation and during follow-up. After pacemaker implantation, the rhythm disorders were reassessed and recorded at each scheduled pacemaker follow-up visit, and the spontaneous rhythm was analysed during pacemaker interrogation. Results During a median follow-up of 61.6 months, we observed a progression of the primary rhythm disorder in 295 patients (16.3%; worsening of the preexisting rhythm disorder in 7.7%; occurrence of a new rhythm disorder added to the preexisting one in 8.6%). Specifically, the cumulative per-year risks of developing the following disorders were: Atrioventricular block (AVB) in patients implanted for sinus node disease (SND), 0.3%; permanent atrial fibrillation in SND patients, 2.9%; SND in AVB patients, 0.7%; and persistent AVB in patients implanted for chronic bifascicular block 3.0%. Conclusion Our results revealed that rhythm disorders requiring pacemaker implantation show long-term progression in a significant number of cases. In many cases, the progression is substantial and may require a change in pacing mode.
- Published
- 2018
235. The Effect of Leisure Activities, Purpose in Life, and Spirituality on Short-Term Outcomes of Geriatric Rehabilitation
- Author
-
Merav Ben Natan, Irina Seleznev, and Doron Merims
- Subjects
Gerontology ,030506 rehabilitation ,Geriatric rehabilitation ,business.industry ,Rehabilitation ,Physical Therapy, Sports Therapy and Rehabilitation ,Term (time) ,03 medical and health sciences ,0302 clinical medicine ,Spirituality ,Medicine ,Geriatrics and Gerontology ,0305 other medical science ,business ,030217 neurology & neurosurgery ,Purpose in life - Published
- 2018
236. Short‐Term Changes in Cardiorespiratory Fitness in Response to Exercise Training and the Association with Long‐Term Cardiorespiratory Fitness Decline: The STRRIDE Reunion Study
- Author
-
Vijay Agusala, Cris A. Slentz, William E. Kraus, Ambarish Pandey, Johanna L. Johnson, Leanna M. Ross, and Jarett D. Berry
- Subjects
Adult ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Oxygen Consumption ,0302 clinical medicine ,Exercise Physiology ,Humans ,Medicine ,030212 general & internal medicine ,Association (psychology) ,Aged ,Retrospective Studies ,Original Research ,exercise ,business.industry ,aging ,Cardiorespiratory fitness ,Middle Aged ,Prognosis ,Exercise Therapy ,Term (time) ,Cardiorespiratory Fitness ,Cardiovascular Diseases ,Physical Fitness ,Disease Progression ,Physical therapy ,Female ,Cardiology and Cardiovascular Medicine ,business ,exercise training ,hormones, hormone substitutes, and hormone antagonists ,Follow-Up Studies ,Forecasting - Abstract
Background Substantial heterogeneity exists in the cardiorespiratory fitness (CRF) change in response to exercise training, and its long‐term prognostic implication is not well understood. We evaluated the association between the short‐term supervised training‐related changes in CRF and CRF levels 10 years later. Methods and Results STRRIDE (Studies of a Targeted Risk Reduction Intervention Through Defined Exercise) trial participants who were originally randomized to exercise training for 8 months and participated in the 10‐year follow‐up visit were included. CRF levels were measured at baseline, after training (8 months), and at 10‐year follow‐up as peak oxygen uptake ( vo 2 , mL/kg per min) using the maximal treadmill test. Participants were stratified into low, moderate, and high CRF response groups according to the training regimen–specific tertiles of CRF change. The study included 80 participants (age: 52 years; 35% female). At 10‐year follow‐up, the high‐response CRF group had the least decline in CRF compared with the moderate‐ and low‐response CRF groups (−0.35 versus −2.20 and −4.25 mL/kg per minute, respectively; P =0.02). This result was largely related to the differential age‐related changes in peak oxygen pulse across the 3 groups (0.58, −0.23, and −0.86 mL/beat, respectively; P =0.03) with no difference in the peak heart rate change. In adjusted linear regression analysis, high response was significantly associated with greater CRF at follow‐up independent of other baseline characteristics (high versus low [reference] CRF response: standard β=0.25; P =0.004). Conclusions Greater CRF improvement in response to short‐term training is associated with higher CRF levels 10 years later. Lack of CRF improvements in response to short‐term training may identify individuals at risk for exaggerated CRF decline with aging.
- Published
- 2019
237. Atrial Fibrillation Burden Signature and Near-Term Prediction of Stroke
- Author
-
Lichy Han, Mintu P. Turakhia, Susan K. Schmitt, Sanjiv M. Narayan, Russ B. Altman, Jun Fan, Mariam Askari, and Jason Bentley
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Proof of Concept Study ,Risk Assessment ,Article ,Machine Learning ,Text mining ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Electronic Health Records ,Humans ,Telemetry ,Medicine ,Diagnosis, Computer-Assisted ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Signal Processing, Computer-Assisted ,Atrial fibrillation ,Middle Aged ,Prognosis ,medicine.disease ,United States ,Term (time) ,Logistic Models ,Veterans Health Services ,Cardiology ,Female ,Neural Networks, Computer ,Cardiology and Cardiovascular Medicine ,business ,Administrative Claims, Healthcare - Abstract
Background: Atrial fibrillation (AF) increases the risk of stroke 5-fold and there is rising interest to determine if AF severity or burden can further risk stratify these patients, particularly for near-term events. Using continuous remote monitoring data from cardiac implantable electronic devices, we sought to evaluate if machine learned signatures of AF burden could provide prognostic information on near-term risk of stroke when compared to conventional risk scores. Methods and Results: We retrospectively identified Veterans Health Administration serviced patients with cardiac implantable electronic device remote monitoring data and at least one day of device-registered AF. The first 30 days of remote monitoring in nonstroke controls were compared against the past 30 days of remote monitoring before stroke in cases. We trained 3 types of models on our data: (1) convolutional neural networks, (2) random forest, and (3) L1 regularized logistic regression (LASSO). We calculated the CHA 2 DS 2 -VASc score for each patient and compared its performance against machine learned indices based on AF burden in separate test cohorts. Finally, we investigated the effect of combining our AF burden models with CHA 2 DS 2 -VASc. We identified 3114 nonstroke controls and 71 stroke cases, with no significant differences in baseline characteristics. Random forest performed the best in the test data set (area under the curve [AUC]=0.662) and convolutional neural network in the validation dataset (AUC=0.702), whereas CHA 2 DS 2 -VASc had an AUC of 0.5 or less in both data sets. Combining CHA 2 DS 2 -VASc with random forest and convolutional neural network yielded a validation AUC of 0.696 and test AUC of 0.634, yielding the highest average AUC on nontraining data. Conclusions: This proof-of-concept study found that machine learning and ensemble methods that incorporate daily AF burden signature provided incremental prognostic value for risk stratification beyond CHA 2 DS 2 -VASc for near-term risk of stroke.
- Published
- 2019
238. Long-term neurocognitive outcomes following surgery and anaesthesia in early life
- Author
-
Tom Hansen and Thomas Engelhardt
- Subjects
medicine.medical_specialty ,education ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,030225 pediatrics ,Journal Article ,medicine ,Animals ,Humans ,Anesthesia ,Child ,Intensive care medicine ,Anesthetics ,business.industry ,Infant, Newborn ,Infant ,Early life ,Term (time) ,Anesthesiology and Pain Medicine ,Child, Preschool ,Surgical Procedures, Operative ,Nervous System Diseases ,Cognition Disorders ,business ,Neurocognitive - Abstract
PURPOSE OF REVIEW: Repeated controversial and alarming statements of the potential dangers of anaesthetic agents on neurological outcomes in children continue to be issued based primarily on preclinical studies. This review assesses the current evidence of laboratory and clinical data and identifies areas of concerns.RECENT FINDINGS: Published animal and laboratory data consistently indicate that prolonged and excessive use of anaesthetic agents can lead to morphological changes and neurocognitive impairment in animals without a clear cut-off age or a superiority of one technique over another. Retrospective human studies and prospective clinical trials indicate that short exposures to anaesthesia and surgery are safe and have no effect on long-term neurological outcomes. Small and consistent continuing improvements in the perioperative period (aggregation of marginal gains) will impact on long-term neurological morbidity in humans.SUMMARY: It is biologically plausible that anaesthetic agents may induce structural changes during mammalian brain development and beyond. However, in the absence of alternatives the impact of the choice of anaesthetic drugs on long-term neurocognitive outcomes is almost certainly to be of limited relevance in humans. The underlying disease processes, surgical intervention, and trauma as well as other known perioperative factors more significantly affect these outcomes.
- Published
- 2018
239. Evidence transfer
- Author
-
Edoardo Aromataris, Craig Lockwood, Kylie Porritt, Zachary Munn, Cindy Stern, and Zoe Jordan
- Subjects
Knowledge management ,030504 nursing ,Information Dissemination ,business.industry ,Process (engineering) ,End user ,Communication ,Health Policy ,Public Health, Environmental and Occupational Health ,Information delivery ,Term (time) ,Translational Research, Biomedical ,03 medical and health sciences ,0302 clinical medicine ,Evidence-Based Practice ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,medicine.symptom ,0305 other medical science ,business ,Evidence synthesis ,Confusion - Abstract
The Joanna Briggs Institute Model of evidence-based healthcare (EBHC) states that the main phases of EBHC include evidence synthesis, transfer, and implementation. There has been some confusion regarding the term 'evidence transfer', with this term previously being considered by many as synonymous with knowledge or evidence translation. The aim of this paper is to discuss a proposed definition of evidence transfer and the pivotal role it plays as part of the EBHC process. 'Evidence transfer' can be thought of simply as getting the message (evidence) across and at its core it is all about information delivery. We specifically define evidence transfer as a process that helps communicate or convey the results of research or evidence, or brings evidence to the forefront. It is focused on ensuring people are aware of, have access to and understand evidence.
- Published
- 2018
240. Lean Mass and Functional Recovery in Men With Hip Fracture
- Author
-
Marco Di Monaco, Silvia Di Carlo, and Carlotta Castiglioni
- Subjects
Adult ,Male ,Rehabilitation hospital ,medicine.medical_specialty ,Activities of daily living ,MEDLINE ,Pilot Projects ,Physical Therapy, Sports Therapy and Rehabilitation ,Body Mass Index ,03 medical and health sciences ,Absorptiometry, Photon ,0302 clinical medicine ,Activities of Daily Living ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Muscle, Skeletal ,Prospective cohort study ,Hip fracture ,Hip Fractures ,business.industry ,Rehabilitation ,Recovery of Function ,Middle Aged ,medicine.disease ,Term (time) ,Body Composition ,Physical therapy ,Lean body mass ,business ,Body mass index ,030217 neurology & neurosurgery - Abstract
The aim of the study was to assess the capability of different definitions of low appendicular lean mass (aLM) to predict the short-term functional recovery in men with hip fracture.We investigated 80 of 95 men with hip fracture admitted consecutively to a rehabilitation hospital. Body composition was assessed by dual-energy x-ray absorptiometry. Functional recovery after inpatient rehabilitation was evaluated using Barthel Index scores.The patients with aLM above the cutoff value of 19.75 kg indicated by the Foundation for the National Institutes of Health (FNIH) had significantly higher Barthel Index scores than those with aLM below the cutoff value (P = 0.002). Patients' categorization according to the same threshold (aLM = 19.75 kg) was significantly associated with a Barthel Index score of 85 or higher after adjustment for age, cognitive impairment, hip fracture type, co-morbidities, and medications (odds ratio = 7.17, 95% confidence interval = 1.43-35.94, P = 0.017). Conversely, patients' categorization according to neither Baumgartner's cutoff value (7.26 kg/m(2)) for aLM/height(2) nor Foundation for the National Institutes of Health cutoff value (0.789) for aLM divided by body mass index was significantly associated with the Barthel Index scores.Categorization according to the Foundation for the National Institutes of Health threshold for aLM, but not to the Foundation for the National Institutes of Health threshold for aLM/body mass index or Baumgartner's threshold for aLM/height, was associated with the short-term recovery in activities of daily living after a hip fracture in men.
- Published
- 2018
241. The Effects of Long-term Storage on Commonly Measured Serum Analyte Levels
- Author
-
Cynthia Kleeberger, Clarice R. Weinberg, Dale P. Sandler, David Shore, and Elaine W. Gunter
- Subjects
Serum ,Analyte ,Time Factors ,Chromatography ,Epidemiology ,business.industry ,Article ,Specimen Handling ,Term (time) ,03 medical and health sciences ,0302 clinical medicine ,Specimen collection ,030220 oncology & carcinogenesis ,Humans ,Medicine ,030212 general & internal medicine ,business ,Serum chemistry ,Cohort study - Abstract
BACKGROUND: Cohort studies typically bank biospecimens for many years prior to assay and investigators do not know whether levels of analytes have degraded. METHODS: We collected control samples from 22 non-study participants using the same enrollment criteria and specimen collection, processing, and storage protocols as The Sister Study. Serum samples were assayed for 21 analytes at collection and 6 years later. For each sample, the difference between the result at baseline and at 6 years was calculated for each analyte. RESULTS: Some of the analytes experienced a marked decrease in concentration after six years of frozen storage in liquid nitrogen vapor, compared to their baseline value. The confidence interval for the mean paired difference excluded 0 for 8 of the 21 analytes tested (aspartate transaminase, total cholesterol, estradiol, glucose, HDL cholesterol, luteinizing hormone, protein, and triglycerides). Two analytes, lactate dehydrogenase and sex hormone binding globulin, increased substantially in concentration over time (confidence interval excluded 0). For compounds substantially affected by storage time, the internal laboratory control variance was greater than the estimated mean percent change for HDL cholesterol and luteinizing hormone, indicating that extent of degradation for these analytes did not exceed technical variation. CONCLUSIONS: Despite evidence for systematic changes over long-term storage, correlations between baseline and later measures were high with little relation between size of the correlation and estimated mean difference across time points. QC experiments to assess the impact of long-term storage on anticipated analytes of interest are important in planning cohort studies with banked samples.
- Published
- 2018
242. Influence of a Cluster Set Configuration on the Adaptations to Short-Term Power Training
- Author
-
Antonio J. Morales-Artacho, Alejandro Pérez-Castilla, Paulino Padial, Belén Feriche, and Amador García-Ramos
- Subjects
Adult ,Male ,Physical Therapy, Sports Therapy and Rehabilitation ,Disease cluster ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Statistics ,Linear regression ,Humans ,Orthopedics and Sports Medicine ,Muscle Strength ,Muscle, Skeletal ,Set (psychology) ,Exercise ,Mathematics ,Training period ,Resistance training ,Training (meteorology) ,Resistance Training ,030229 sport sciences ,General Medicine ,Adaptation, Physiological ,Biomechanical Phenomena ,Power (physics) ,Term (time) ,030217 neurology & neurosurgery - Abstract
Morales-Artacho, AJ, Padial, P, García-Ramos, A, Pérez-Castilla, A, and Feriche, B. Influence of a cluster set configuration on the adaptations to short-term power training. J Strength Cond Res 32(4): 930-937, 2018-This study investigated the effects of a traditional (TT) vs. cluster (CT) resistance training on the lower-body force, velocity, and power output. Nineteen males were allocated to a CT or a TT group and took part of a 3-week resistance training (2 weekly sessions). CT involved 6 sets of 3 × 2 repetitions (30 seconds rest every 2 repetitions and 4 minutes 30 seconds between sets). TT comprised 6 sets of 6 continuous repetitions (5 minutes rest between sets). Before and after the training period, force (F25, F50, F75), velocity (V25, V50, V75), and power (P25, P50, P75) were obtained during the countermovement jump (CMJ) exercise at 3 external loading conditions (25, 50, and 75% of body mass). Individual linear regressions were used to determine the force-velocity profile including the Slope, estimated maximal theoretical force (F0), velocity (V0), and power (P0). After CT, very-likely moderate increments in P25 were observed compared with TT (p = 0.011, ES = 0.55) because of a very-likely moderate rise in V25 (p = 0.001, ES = 0.71). No significant differences were observed in any of the F-v profile variables between the TT and CT groups (p ≥ 0.207, ES ≤ 0.31). Our results suggest that 3 weeks of muscle power training including cluster set configurations are more efficient at inducing velocity and power adaptations specific to the training load.
- Published
- 2018
243. Longer-Term Effects of Anesthesia and Analgesia After Total Knee Replacement
- Author
-
Ellen Hoffmeister
- Subjects
business.industry ,Anesthesia ,Total knee replacement ,Medicine ,business ,Term (time) - Published
- 2018
244. The Impact of Primary Antiphospholipid Syndrome on Long-term Cardiovascular Outcomes After Percutaneous Coronary Intervention and Stenting in Patients With Myocardial Infarction
- Author
-
Mauricio Mora-Ramírez, Luis M. Amezcua-Guerra, and Héctor González-Pacheco
- Subjects
030203 arthritis & rheumatology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,030204 cardiovascular system & hematology ,medicine.disease ,Primary antiphospholipid syndrome ,Term (time) ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Rheumatology ,Internal medicine ,medicine ,Cardiology ,In patient ,Myocardial infarction ,business ,Cardiovascular outcomes - Published
- 2018
245. Supported self-management for cancer survivors to address long-term biopsychosocial consequences of cancer and treatment to optimize living well
- Author
-
Doris D. Howell
- Subjects
Biopsychosocial model ,Gerontology ,Decision Making ,MEDLINE ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Patient Education as Topic ,medicine ,Humans ,Healthy Lifestyle ,030212 general & internal medicine ,Self-efficacy ,Self-management ,Oncology (nursing) ,business.industry ,Self-Management ,Repertoire ,Cancer ,General Medicine ,medicine.disease ,Self Efficacy ,Term (time) ,Chronic disease ,Oncology ,030220 oncology & carcinogenesis ,business ,Stress, Psychological - Abstract
As individuals are living longer with cancer as a chronic disease, they face new health challenges that require the application of self-management behaviors and skills that may not be in their usual repertoire of self-regulatory health behaviors. Increasing attention is focused on supported self-management (SSM) programs to enable survivors in managing the long-term biopsychosocial consequences and health challenges of survivorship. This review explores current directions and evidence for SSM programs that enable survivors to manage these consequences and optimize health.Cancer survivors face complex health challenges that affect daily functioning and well being. Multiple systematic reviews show that SSM programs have positive effects on health outcomes in typical chronic diseases. However, the efficacy of these approaches in cancer survivors are in their infancy; and the 'one-size' fits all approach for chronic disease self-management may not be adequate for cancer as a complex chronic illness. This review suggests that SSM has promising potential for improving health and well being of cancer survivors, but there is a need for standardizing SSM for future research.Although there is increasing enthusiasm for SSM programs tailored to cancer survivors, there is a need for further research of their efficacy on long-term health outcomes.
- Published
- 2018
246. Short-Term Medical Missions Done Well: What Every Sponsoring Institution Should Understand
- Author
-
John Oliphant
- Subjects
Medical education ,Inservice Training ,Medical missions ,Medical Missions ,06 humanities and the arts ,0603 philosophy, ethics and religion ,Education ,Term (time) ,03 medical and health sciences ,Physician Assistants ,Policy ,0302 clinical medicine ,Institution (computer science) ,Humans ,060301 applied ethics ,030212 general & internal medicine ,Cultural Competency ,Psychology ,Developing Countries ,Confidentiality ,Medical Assisting and Transcription - Published
- 2018
247. Body Weight Status, Clinical Factors, and Short-term Outcomes Among Head and Neck Radiation Oncology Patients
- Author
-
D. Erickson, Whitney C. Wallace, Janet Pope, Steven J. Feigenberg, Jennifer Hanson, and Tiffani N. Tyer
- Subjects
Pediatrics ,medicine.medical_specialty ,Nutrition and Dietetics ,business.industry ,Body weight ,Term (time) ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Radiation oncology ,Medicine ,030212 general & internal medicine ,business ,Head and neck - Published
- 2018
248. Re: Can Long-Term LUTS/BPH Pharmacological Treatment Alter the Outcomes of Surgical Intervention?
- Author
-
Steven A. Kaplan
- Subjects
Male ,medicine.medical_specialty ,business.industry ,Urology ,Prostatic Hyperplasia ,030232 urology & nephrology ,MEDLINE ,medicine.disease ,Term (time) ,Pharmacological treatment ,03 medical and health sciences ,0302 clinical medicine ,Lower Urinary Tract Symptoms ,Lower urinary tract symptoms ,030220 oncology & carcinogenesis ,Internal medicine ,Intervention (counseling) ,medicine ,Humans ,business - Published
- 2018
249. Short-Term Outcomes of Apixaban Versus Warfarin in Patients With Atrial Fibrillation
- Author
-
Ahsan A. Khan, Brian Olshansky, and Gregory Y.H. Lip
- Subjects
arfarin ,medicine.medical_specialty ,business.industry ,Editorials ,apixaban ,Warfarin ,Atrial fibrillation ,thromboembolism ,medicine.disease ,Term (time) ,atrial fibrilliation ,Physiology (medical) ,Internal medicine ,Cardiology ,Medicine ,In patient ,Apixaban ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2019
250. Summary: The National Strength and Conditioning Association Position Statement on Long-Term Athletic Development
- Author
-
Rick Howard, Joey C. Eisenmann, and Anthony Moreno
- Subjects
Gerontology ,Position statement ,Association (psychology) ,Psychology ,Term (time) - Published
- 2019
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.