Mercy Health Saint Mary's

The use of transcatheter edge-to-edge repair (TEER) for symptomatic mitral regurgitation is steadily increasing. However, the outcomes of TEER among patients with atrial fibrillation (AF), including readmission trends, remain unknown. The Nationwide Readmissions Database was queried between 2016 and 2020 to identify TEER patients with and without AF. The 2 groups were then compared using propensity score matching and multivariate regression models. The outcomes included inhospital mortality, ` (AKI), heart failure (HF), acute stroke, myocardial infarction, postprocedure bleeding, and cardiac tamponade. A total of 39,867 TEER procedure recipients were included over the study period, of which, 24,729 (62%) had AF compared to 15,138 (38%) with no AF diagnosis. On adjusted analysis, the AF group had a higher rate of inpatient mortality, AKI, HF, and postprocedural bleeding. On the contrary, TEER with AF group had lower odds of myocardial infarction. The risk of stroke and cardiac tamponade was similar between the 2 groups. The median length of stay (LOS) at index hospitalization was longer in the AF cohort in comparison with those without [2 days (interquartile range: 5-1) vs. 1 day (interquartile range: 3-1)]. AF in TEER procedure recipients was associated with worse outcomes including a higher rate of inpatient mortality, AKI, and HF compared with the patients without AF. Readmission rates at 30, 90, and 180 days were similar between the 2 groups.

To describe four cases of Responsive Neurostimulation (RNS) in the bilateral pulvinar nuclei (PUL) in individuals with drug resistant epilepsy (DRE). This will show that due to widespread PUL connectivity, bilateral PUL RNS may be an option for some individuals with bilateral multifocal epilepsy. This study comprises two centers' experience with bilateral PUL RNS for DRE. Patients treated with bilateral PUL RNS at Westchester Medical Center (Valhalla, NY) and Corewell Health (Grand Rapids, MI) between the years 2019 and 2022 were analyzed and described. Presented here are methods for target selection, device programming, and clinical outcomes. Two patients with Lennox-Gastaut phenotype (aged 13 and 21 years) with posteriorly dominant discharges were implanted with bilateral PUL electrodes. Additionally, two patients (aged 20 and 31 years) with independent left and right occipital bilateral multifocal seizure onsets were implanted with bilateral RNS devices targeting the ipsilateral PUL and ipsilateral occipital cortex. Subclinical and clinical seizures were captured by RNS electrocorticography (ECoG) in all patients. RNS implantation and treatment was well-tolerated without adverse effects in all patients. Relative to baseline, two patients had 25% and 50% reduction in disabling seizures, and two patients had 71% and 100% reduction in disabling seizures. Stimulation paradigms utilized high frequency stimulation in both Lennox-Gastaut phenotype patients. Low frequency (individualized to the terminal ictal frequencies) stimulation was effective in the two bioccipital patients. RNS with electrode placement targeting bilateral PUL is safe, and no adverse effects have been attributable to the pulvinar electrode placement. PUL responsive neurostimulation is potentially effective for patients with bilateral multifocal, posteriorly dominant DRE. Both high and low frequency responsive stimulation are treatment options. Longer follow-up will shed light on the ultimate reduction of seizure burden. We describe four cases where stimulation devices were placed in the Pulvinar area of the thalamus (central sensory area in the brain). This is very unique and different location than where these devices are typically placed. These patients all had great outcomes with marked seizure reduction, demonstrating that this placement is both safe and effective.

Addressing common sources of chronic disease leads to improved patient health, as well as presenting a scalable target for the improvement of value-based care outcomes. Improving patients’ self-management skills and quality of life is the key goal of chronic disease management. Mitigating high-costs and slowing disease progression create mutual success for both patients and health care systems. By training nurses to deliver a refined model of longitudinal care management, Corewell Health West was able to achieve improved chronic disease control and create additional capacity among primary care providers. The initial focus of the longitudinal care program was diabetes and hypertension management. Corewell Health created a Multidisciplinary Approach to Disease Over Time (MADOT) framework to guide care management for patients with multiple chronic conditions or who are facing long recovery journeys. The framework emphasizes timely and actionable patient identification, regular contact between patients and health care staff that prioritizes patient goals and assesses their “readiness to change,” and specialized skills development for health care staff. The framework has shown success among patients with uncontrolled diabetes (A1c ≥8.0). Of the targeted interventions carried out for more than 1,000 patients since January 2022, 608 patients fully completed the program; these patients demonstrated an average 2.24-percentage point reduction in hemoglobin A1c. Of those 608 patients, 364 had a pre-intervention hemoglobin A1c level ≥9.0 and achieved an average 3.02-percentage point reduction in hemoglobin A1c. Similarly, patients who graduated from the program saw greater improvement in systolic blood pressure than patients who disenrolled or declined interventions.

ObjectiveTo report epidemiological data regarding injury and illness among the Team USA staff during the Tokyo 2020 Summer Olympic and Paralympic Games and Beijing 2022 Winter Olympic and Paralympic Games.MethodsA retrospective review of all Team USA staff (total staff, N=1703 (62.5% female); total staff days (SD)=34 489) medical encounters during the Tokyo 2020 Games and Beijing 2022 Games was conducted. Details related to injury and illness were evaluated. Incidence with 95% CI per 1000 staff days were calculated.ResultsA total of 32 illnesses (incidence [95% CI] 0.9 [0.6, 1.2]) and 23 injuries (incidence 0.7 [0.4, 0.9]) were sustained by the Team USA delegation staff members during the Tokyo 2020 Games and Beijing 2022 Games. Female staff reported more illnesses (illnesses proportion (IP) 2.9%; incidence 1.4 [0.8, 2.0]), while male staff incurred more injuries (IP 1.8%; incidence 0.9 [0.5, 1.3]). When stratified by physiological system, dermatological and infectious were the most common systems involved with illness (IP 0.5%; incidence 0.2 [0.1, 0.4]). Injuries to the upper limb were most common (IP 0.3%; incidence 0.3 [0.1, 0.5]).ConclusionInjury and illness rates among the Team USA staff during the Tokyo 2020 Games and Beijing 2022 Games were low, but notable. Knowledge of injury and illness risks contributes to staffing decisions and prevention strategies for staff supporting athletes during competition.

Background: Pharmacist order verification is a critical step in ensuring medication safety for patients. While the second pharmacist verification (SPV) before dispensing anticancer therapies has been a longstanding practice, its continued necessity in the context of modern electronic health systems lacks robust evidence. Objective: This study aimed to assess the frequency of interventions performed by a second pharmacist to determine the ongoing effectiveness of the SPV process. Methods: This retrospective chart review was conducted at the Mayo Clinic, encompassing all anticancer therapy orders that necessitated an SPV. The study period extended from January 1, 2019, to June 30, 2021, and included inpatient and outpatient anticancer orders. The quantification and reporting of alterations made to discrete order fields subsequent to initial pharmacist verification of clinical significance were performed, utilizing the total number of anticancer therapy orders as the denominator. Results: Approximately 300 000 anticancer therapy orders were screened for inclusion criteria and 2.6% (N = 7634) of orders were modified on the SPV. Most changes were in the categories of rate (N = 1962), order start time (N = 1219), and pharmacy communication note (N = 777). Dosing changes greater than 10% accounted for 0.03% (N = 99) of the orders, with 10 anticancer therapies responsible for more than 50% of these changes. Conclusion and relevance: This study represents the largest report on the impact of SPV in a modern era. Our results suggest the SPV may be valuable for a small proportion of chemotherapy orders but raises questions about the necessity for broad application of this practice.

Emergent decompressive craniotomy/craniectomy can be a lifesaving surgical intervention for select patients with traumatic brain injury. Prompt management is critical as early decompression can impact traumatic brain injury outcomes. This study aims to describe the feasibility and clinical impact of a new pathway for transporting patients with severe traumatic brain injury directly to the operating room from the trauma bay for decompressive craniotomy/craniectomy. This is a retrospective cohort preintervention and postintervention study of severe traumatic brain injury patients undergoing decompressive craniectomy/craniotomy at a Midwestern U.S. Level I trauma center between 2016 and 2022. In the new pathway, the in-house trauma surgeon takes the patient directly to the operating room with the neurosurgery advanced practice provider to drape and prepare the patient for surgery while the neurosurgeon is en route to the hospital. A total of 44 patients were studied, five (5/44, 11.4%) of which were in the preintervention group and 39 (39/44, 88.6%) in the postintervention group. The median arrival-to-operating room time was shorter in the postintervention cohort (1.4 hr) than in the preintervention cohort (1.5 hr). In examining night shifts only, the preintervention cohort had shorter arrival-to-operating room times (1.2 hr) than the postintervention cohort (1.5 hr). The study demonstrated that the new pathway is feasible and expedites patient transport to the operating room while awaiting the arrival of the on-call neurosurgeon.

<h3>Objective:</h3> NA <h3>Background:</h3> Perfusion neuroimaging has become crucial to acute stroke treatment due to its ability to identify areas of reduced perfusion and salvageable tissue. In select situations, current guidelines recommend the use of perfusion imaging to identify patients with a favorable profile for candidates for mechanical thrombectomy. The applicability of perfusion findings in other acute stroke scenarios is less established. <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 77 year old female with hypertension and obesity presented with altered mental status to the emergency room as a pre-arrival stroke alert after being found unarousable by her partner in bed. Her last known well time was 2 hours prior to presentation. On arrival she had a blood pressure of 127/92 and was afebrile. Neurologic exam showed a decreased level of alertness. She did not respond to loud auditory stimuli. She grimaced to sternal rub and was able to briefly follow requests to give a thumbs up bilaterally. She produced no speech and withdrew all extremities from protopathic stimulation. Reflexes were 2+ and symmetric. Initial head computed tomography (CT) showed no abnormality. CT perfusion showed a perfusion deficit of 4mL in the posterior circulation. CT angiogram of the head and neck showed no abnormality. She was administered intravenous alteplase and admitted. MRI of the brain showed diffusion restriction in bilateral thalami. No embolic source was identified and she was placed on a long term cardiac monitor. One month following discharge she continued to have persistent aphasia, impaired cognition, and required 24-hour care. <h3>Conclusions:</h3> The clinical utility of perfusion neuroimaging extends beyond current clinical guidelines. Proficiency in study interpretation and correlation between patient presentation and neuroanatomical structures affected by perfusion deficits may allow additional stroke patients to receive treatment, particularly in atypical presentations of stroke such as altered mental status. <b>Disclosure:</b> Dr. Qureshi has nothing to disclose. Dr. Qaiser has nothing to disclose. Ms. Lozano has nothing to disclose. Dr. Farooq has nothing to disclose.

BackgroundIn the outpatient setting, IDSA guidelines recommend a 3-day course of highly bioavailable oral antibiotics (abx) for treatment of uncomplicated urinary tract infections(uUTI); however, hospitalized patients often receive IV abx and longer durations. Ceftriaxone (CRO) is well tolerated and has a favorable spectrum of activity making it an ideal antibiotic for inpatient uUTI treatment. The purpose of this study was to compare a short, 3-day course of ceftriaxone with longer durations of therapy for inpatients with uUTI.MethodsThis retrospective cohort study included adult inpatients receiving abx for symptomatic uUTI with a positive urine culture between July 1, 2015 and June 30, 2021. The primary objective was to compare clinical cure between patients treated with 3-days of CRO (CRO 3-day) vs longer durations of abx therapy (Longer DOT). Clinical cure was defined as resolution of uUTI symptoms at completion of abx and no new documented symptoms within 24 hours following completion. Secondary outcomes included comparing hospital length of stay (LOS), 30-day return visit due to UTI, and development of Clostridiodes difficile within 30 days of abx treatment. Patients empirically treated with an anti-pseudomonal abx, microbiological resistance to CRO, co-infection, or complicated UTI were excluded.ResultsA total of 100 patients were included in the study (CRO 3-days, n=51; Longer DOT, n=49). Baseline characteristics were similar between groups. There was no difference in the primary endpoint between groups as all patients in the sample population achieved clinical cure (p=1.0). Additionally, no differences in median hospital LOS (5 [4-7] vs 4 [3-6.5] days, p=0.372), 30-day return visit due to UTI (13.7% vs 6.1%, p=0.319), or development of C. difficile within 30 days of treatment (2% vs 6.1%, p=0.357) were observed between the CRO 3-days vs Longer DOT groups, respectively.ConclusionThere were no differences in efficacy or safety endpoints between short-course CRO and longer durations of therapy. Short-course IV CRO is likely an effective treatment strategy for inpatient treatment of uUTI and may limit prolonged antibiotic durations.DisclosuresAll Authors: No reported disclosures.