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1. The effect of batched patient–physician assignment on patient length of stay in the emergency department

Author

Bryan Imhoff, Kenneth D. Marshall, Joshua W. Joseph, Nima Sarani, Julie Kelman, and Niaman Nazir

Subjects
administration, batching, operations, provider assignment, throughput, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Abstract Objectives Queuing theory suggests that signing up for multiple patients at once (batching) can negatively affect patients’ length of stay (LOS). At academic centers, resident assignment adds a second layer to this effect. In this study, we measured the rate of batched patient assignment by resident physicians, examined the effect on patient in‐room LOS, and surveyed residents on underlying drivers and perceptions of batching. Methods This was a retrospective study of discharged patients from August 1, 2020 to October 27, 2020, supplemented with survey data conducted at a large, urban, academic hospital with an emergency medicine training program in which residents self‐assign to patients. Time stamps were extracted from the electronic health record and a definition of batching was set based on findings of a published time and motion study. Results A total of 3794 patients were seen by 28 residents and ultimately discharged during the study period. Overall, residents batched 23.7% of patients, with a greater rate of batching associated with increasing resident seniority and during the first hour of resident shifts. In‐room LOS for batched assignment patients was 15.9 minutes longer than single assignment patients (P value

Published
2022
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2. Autologous sapheno-saphenous bypass collateral development in the setting of chronic unilateral iliac vein occlusion

Author

Julie Kelman, Nicholas Xiao, Jeremy D. Collins, Jennifer K. Karp, Heron Rodriguez, and Kush R. Desai

Subjects
Chronic iliac vein occlusion, May-Thurner syndrome, Saphenous collaterals, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Chronic iliac vein occlusion can result in the development of a variety of collateral venous drainage pathways. While several drainage pathways have been well documented, autologous sapheno-saphenous bypass collateral drainage has not been described. This novel collateral drainage pathway is readily visible on cross sectional imaging, may serve as a diagnostic indicator of chronic obstructive venous pathology, and may hint at the underlying etiology. Case presentation This brief report depicts findings and technical considerations in two cases of venous recanalization of sapheno-saphenous collaterals in the setting of chronic unilateral iliac vein occlusion. In both cases at one-month follow-up, the patients’ pain had resolved, edema had improved, and computed tomographic venography demonstrated stent patency. Conclusions Identification of a sapheno-saphenous collateral can provide an important clue to the underlying venous obstructive pathology, therefore guiding corrective intervention.

Published
2018
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3. Associations of Unhealthy Food Environment With the Development of Coronary Artery Calcification: The CARDIA Study

Author

Julie Kelman, Lindsay R. Pool, Penny Gordon‐Larsen, J. Jeffrey Carr, James G. Terry, Jamal S. Rana, and Kiarri N. Kershaw

Subjects
atherosclerosis, coronary artery calcification, neighborhood, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background While prior studies have linked the neighborhood environment and development of subclinical atherosclerosis, it is unknown whether living in neighborhoods with greater availability of “unhealthy” food outlets (fast‐food chain restaurants and convenience stores) is associated with risk of developing coronary artery calcification (CAC). Methods and Results We included 2706 CARDIA study (Coronary Artery Risk Development in Young Adults) participants who underwent CAC measurement during follow‐up years 15 (2000–2001), 20 (2005–2006), and 25 (2010–2011). Neighborhood features examined included percentage of all food outlets that were convenience stores and fast‐food chain restaurants within a 3‐km Euclidean buffer distance from each participant's residence. Econometric fixed effects models, which by design control for all time‐invariant covariates, were used to model the longitudinal association between simultaneous within‐person change in percentage food outlet and change in CAC. At baseline (year 15), 9.7% of participants had prevalent CAC. During 10 years of follow‐up, 21.1% of participants developed CAC. Each 1‐SD increase in percentage of convenience stores was associated with a 1.34 higher odds of developing CAC (95% CI: 1.04, 1.72) after adjusting for individual‐ and neighborhood‐level covariates; however, there was no significant association between increased percentage of fast‐food chain restaurants and developing CAC (odds ratio=1.15; 95% CI: 0.96, 1.38). There were no significant associations between increases in either food outlet percentage and progression of CAC. Conclusions Our findings suggest that increases in the relative availability of convenience stores in participants' neighborhoods is related to the development of CAC over time.

Published
2019
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4. Contributors

Author

Axel Adams, Clara Affun-Adegbulu, Rakan S. Al-Rasheed, Yasser A. Alaska, Abdulaziz D. Aldawas, Saleh Ali Alesa, George A. Alexander, Abdullah Ahmed Alhadhira, Fahad Saleha Alhajjaj, Hazem H. Alhazmi, Zainab Abdullah Alhussaini, Nawfal Aljerian, Majed Aljohani, Khaldoon H. AlKhaldi, Eyad Alkhattabi, Bryant Allen, Austin Almand, Moza M. Alnoaimi, Mohammad Alotaibi, Evan Avraham Alpert, Yasir A. Alrusayni, Mai Alshammari, Loui K. Alsulimani, Siraj Amanullah, Arian Anderson, David Arastehmanesh, Ali Ardalan, Killiam A. Argote-Araméndiz, Andrew W. Artenstein, Olivia E. Bailey, Russell Baker, Satchit Balsari, Gregory T. Banner, Fermin Barrueto M, Susan A. Bartels, Joshua J. Baugh, Frederic Berg, Vijai Bhola, William Binder, Michelangelo Bortolin, Vincent Bounes, Michael Bouton, Natasha Brown, Frederick M. Burkle, Jr, Lynn Barkley Burnett, Michele M. Burns, Nicholas V. Cagliuso, Sr, John Cahill, David W. Callaway, Duane C. Caneva, Srihari Cattamanchi, Alejandra Caycedo, Edward W. Cetaruk, Sneha Chacko, James C. Chang, Crystal Chiang, David T. Chiu, Gregory R. Ciottone, Jonathan Peter Ciottone, Melissa A. Ciottone, Robert A. Ciottone, Robert G. Ciottone, Vigen G. Ciottone, Alexander Clark, Jonathan Clark, Sean P. Conley, Joanne Cono, Arthur Cooper, Scott B. Cormier, Michael F. Court, Cord W. Cunningham, Fabrice Czarnecki, Supriya Davis, Timothy E. Davis, Gerard DeMers, Sharon Dilling, Ahmadreza Djalali, Timothy Donahoe, Joseph Donahue, Caleb Dresser, Jason Dylik, Benjamin Easter, Alexander Eastman, Laura Ebbeling, Chigozie Emetarom, Nir Eyal, Andrew J. Eyre, David J. Freeman, Franklin D. Friedman, Christie Fritz, Frederick Fung, Fiona E. Gallahue, Stephanie Chow Garbern, Mark E. Gebhart, William A. Gluckman, Craig Goolsby, Robert M. Gougelet, Fredrik Granholm, P. Gregg Greenough, Jennifer O. Grimes, Steve Grosse, Shamai A. Grossman, John T. Groves Jr, Tee L. Guidotti, George Guo, Sarah Haessler, Matthew M. Hall, John W. Hardin, Mason Harrell, Alexander Hart, MD, Melissa Harvey, Attila J. Hertelendy, PhD, Nishanth S. Hiremath, Jordan Hitchens, Christopher P. Holstege, Simon T. Horne, Steven Horng, Amer Hosin, Hans R. House, Pier Luigi Ingrassia, Fadi S. Issa, Irving 'Jake' Jacoby, Rajnish Jaiswal, Gregory Jay, J. Lee Jenkins, Josh W. Joseph, Shane Kappler, Mark E. Keim, Julie Kelman, Andrew R. Ketterer, Anas A. Khan, Ramu Kharel, Chetan U. Kharod, Thomas D. Kirsch, Anita Knopov, Max Kravitz, J. Austin Lee, Jay Lemery, Evan L. Leventhal, Jesse Loughlin, Stephanie Ludy, Brian J. Maguire, Selwyn E. Mahon, Paul M. Maniscalco, Philip Manners, Leonard Jay Marcus, Colton Margus, Taha M. Masri, Jeff Matthews, Sean D. McKay, Zeke J. McKinney, Robert K. McLellan, Eric J. McNulty, Faroukh Mehkri, Mandana Mehta, Rebecca A. Mendelsohn, Ofer Merin, Andrew Milsten, Dale M. Molé, Michael Sean Molloy, Ilaria Morelli, Jerry L. Mothershead, John Mulhern, Nicole F. Mullendore, Nicholas J. Musisca, Sonya Naganathan, Larry A. Nathanson, Erica L. Nelson, Lewis S. Nelson, Bradford A. Newbury, Kimberly Newbury, Ansley O’Neill, Robert Obernier, Jacopo M. Olagnero, Leonie Oostrom-Shah, Catherine Y. Ordun, Scott Parazynski, Andrew J. Park, Robert Partridge, Jeffrey S, James P. Phillips, Emily Pinter, David P. Polatty IV, Patrick Popieluszko, William Porcaro, Lawrence Proano, Peter B. Pruitt, Moiz Qureshi, Luca Ragazzoni, Murtaza Rashid, Paul Patrick Rega, Michael J. Reilly, Marc C. Restuccia, James J. Rifino, Paul M. Robben, Joy L. Rosenblatt, Kevin M. Ryan, Heather Rybasack-Smith, Richard James Salway, Daniel Samo, Leon D. Sanchez, Shawn M. Sanford, Ritu R. Sarin, Deesha Sarma, Jesse Schacht, Valarie Schwind, Geoffrey L. Shapiro, Joshua Sheehan, Brian Shreve, Grigor Simonyan, Devin M. Smith, E. Reed Smith, MD, Jack E. Smith, MA, Montray Smith, Peter B. Smulowitz, Angela M. Snyder, Joshua J. Solano, Bryan A. Stenson, Charles Stewart, M. Kathleen Stewart, Patrick Sullivan, Jared S. Supple, Derrick Tin, Jonathan Harris Valente, Kathryn M. Vear, P.R. Vidyalakshmi, Faith Vilas, Gary M. Vilke, Janna H. Villano, Amalia Voskanyan, C. James Watson, Nancy Weber, Scott G. Weiner, Brielle Weinstein, Eric S. Weinstein, Jordan R. Werner, Roy Karl Werner, MD, James D. Whitledge, Sage W. Wiener, Lauren Wiesner, Kenneth A. Williams, Robyn Wing, Richard E. Wolfe, Wendy Hin-Wing Wong, Robert Woolard, Prasit Wuthisuthimethawee, and Nadine A. Youssef

Published
2024
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6. Associations of Unhealthy Food Environment With the Development of Coronary Artery Calcification: The CARDIA Study

Author

Penny Gordon-Larsen, Kiarri N. Kershaw, Jamal S. Rana, James G. Terry, Julie Kelman, Lindsay R. Pool, and J. Jeffrey Carr

Subjects
Adult, Male, Restaurants, Adolescent, Epidemiology, Coronary Artery Disease, Coronary Angiography, Risk Assessment, Food Supply, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Risk Factors, Environmental health, Medicine, Humans, 030212 general & internal medicine, cardiovascular diseases, Prospective Studies, Vascular Calcification, Neighbourhood (mathematics), Original Research, neighborhood, 2. Zero hunger, 030505 public health, business.industry, Incidence, Coronary Vessels, United States, coronary artery calcification, Unhealthy food, Subclinical atherosclerosis, Coronary artery calcification, cardiovascular system, Disease Progression, population characteristics, Female, atherosclerosis, 0305 other medical science, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies, Forecasting
Abstract

Background While prior studies have linked the neighborhood environment and development of subclinical atherosclerosis, it is unknown whether living in neighborhoods with greater availability of “unhealthy” food outlets (fast‐food chain restaurants and convenience stores) is associated with risk of developing coronary artery calcification ( CAC ). Methods and Results We included 2706 CARDIA study (Coronary Artery Risk Development in Young Adults) participants who underwent CAC measurement during follow‐up years 15 (2000–2001), 20 (2005–2006), and 25 (2010–2011). Neighborhood features examined included percentage of all food outlets that were convenience stores and fast‐food chain restaurants within a 3‐km Euclidean buffer distance from each participant's residence. Econometric fixed effects models, which by design control for all time‐invariant covariates, were used to model the longitudinal association between simultaneous within‐person change in percentage food outlet and change in CAC . At baseline (year 15), 9.7% of participants had prevalent CAC . During 10 years of follow‐up, 21.1% of participants developed CAC . Each 1‐SD increase in percentage of convenience stores was associated with a 1.34 higher odds of developing CAC (95% CI : 1.04, 1.72) after adjusting for individual‐ and neighborhood‐level covariates; however, there was no significant association between increased percentage of fast‐food chain restaurants and developing CAC (odds ratio=1.15; 95% CI : 0.96, 1.38). There were no significant associations between increases in either food outlet percentage and progression of CAC . Conclusions Our findings suggest that increases in the relative availability of convenience stores in participants' neighborhoods is related to the development of CAC over time.

Published
2019

7. Autologous sapheno-saphenous bypass collateral development in the setting of chronic unilateral iliac vein occlusion

Author

Jeremy D. Collins, Julie Kelman, J. Karp, Nicholas Xiao, Heron E. Rodriguez, and Kush R. Desai

Subjects
lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Collateral, Venography, Case Report, Saphenous collaterals, 030204 cardiovascular system & hematology, Stent patency, May-Thurner syndrome, 030218 nuclear medicine & medical imaging, Cross-sectional imaging, 03 medical and health sciences, 0302 clinical medicine, Edema, medicine, Radiology, Nuclear Medicine and imaging, Chronic iliac vein occlusion, medicine.diagnostic_test, business.industry, Interventional radiology, May–Thurner syndrome, medicine.disease, Vein occlusion, Surgery, lcsh:RC666-701, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Background Chronic iliac vein occlusion can result in the development of a variety of collateral venous drainage pathways. While several drainage pathways have been well documented, autologous sapheno-saphenous bypass collateral drainage has not been described. This novel collateral drainage pathway is readily visible on cross sectional imaging, may serve as a diagnostic indicator of chronic obstructive venous pathology, and may hint at the underlying etiology. Case presentation This brief report depicts findings and technical considerations in two cases of venous recanalization of sapheno-saphenous collaterals in the setting of chronic unilateral iliac vein occlusion. In both cases at one-month follow-up, the patients’ pain had resolved, edema had improved, and computed tomographic venography demonstrated stent patency. Conclusions Identification of a sapheno-saphenous collateral can provide an important clue to the underlying venous obstructive pathology, therefore guiding corrective intervention.

Published
2018

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