Niagara Falls Memorial Medical Center

Identify the effect size of mild and moderate levels of exertion on common sideline concussion assessment tool scores in healthy adolescent athletes. Three arm randomized controlled trial. High school training rooms. Forty-seven healthy adolescents who participate in school sports and have not had a concussion within the past month. Participants performed the Sport Concussion Assessment Tool 5 (SCAT5) and Vestibular Ocular Motor Screen (VOMS) at rest. Participants were randomized to perform No Exertion (n = 16, 15-minute seated rest), Mild Exertion [n = 16, 50%-55% of heart rate (HR) max for 15 minutes on a treadmill], or Moderate Exertion (n = 15, 70%-75% of HR max). Participants then repeated the SCAT5 and VOMS immediately after a 2-minute cool down. Effect size of change after exertion. Few differences were seen after mild and moderate levels of exertion. In the combined sample, there was a small increase in the number of modified balance error scoring system errors [d = -0.17 (-0.52, 0.19)], a medium degree of improvement in symptoms [d = 0.38 (0.01, 0.74)], and a small degree of improvement in cognitive scores [d = 0.20 (-0.16, 0.55)] after exercise. No differences on VOMS testing were observed. The SCAT5 and VOMS seem to be consistent measures even after mild and moderate levels of exertion (HR <75% of age-appropriate maximum). A future study should aim to identify the effect of maximal exertion.

Abstract Objectives Previous reports demonstrate conflicting findings regarding the relationship between mortality and hospital volume for acute pancreatitis (AP). Here we seek to reevaluate the impact of hospital admission volume on AP-specific mortality based on disease severity.Methods Patient demographics, clinical data, and hospital factors were collected from the Nationwide Inpatient Sample (NIS) for patients with AP between 2008–2011. Hospitals were divided into five volume groups based on the number of admissions for AP and severe acute pancreatitis (SAP) per year. The relationship between hospital volume and outcomes was evaluated with the primary endpoint being in-hospital mortality. Logistic regression was used to identify factors associated with mortality.Results Data from 182,331 admissions for AP were included in the analysis. The median number of annual hospital admissions per year was 35. SAP was present in 18,708 patients. There were no differences in-patient mortality by hospital volume groups for AP (0.69–0.94%, p = 0.19) or SAP (5.43–7.21%, p = 0.06). Factors found to be associated with increased risk of inpatient mortality included age ≥ 75 (OR: 5.18, CI 4.33–6.20), male gender (OR: 1.30, CI 1.17–1.44) comorbidities (OR: 3.77, CI: 2.61–5.44), and SAP (OR: 17.7, CI: 15.7–19.9).Conclusions Hospital volume of AP and SAP does not appear to be associated with inpatient mortality. Increasing age, male gender, comorbidities, and SAP are associated with increased risk of mortality. The complex relationship between hospital volume, disease severity and disparities in health care delivery and outcomes requires further scrutiny.

Mycobacterium szulgai is a non-tuberculous mycobacterium that is an uncommon cause of infection in humans. Risk factors for infection include immunosuppression and pre-existing lung pathology. Herein, we present a case of a 42-year-old male with chronic obstructive pulmonary disease with pulmonary infection caused by M. szulgai that was successfully treated with a regimen of rifampin, isoniazid, pyrazinamide and ethambutol for 2 months, followed by rifampin, isoniazid and azithromycin for an additional 8 months. Symptomatic and radiographic resolutions were achieved.

Heart disease continues to be the leading cause of death, and the prevalence of coronary artery disease is expected to increase as the population ages. It is important to understand the clinical utility of medical tests, or its lack thereof, in the aging population. The objective of this study was to understand the incremental prognostic value of positron emission tomographic (PET) myocardial perfusion imaging in the elderly (≥85 years of age). A total of 3343 patients enrolled in a multicenter observational PET registry were analyzed. Participants were initially divided into 3 age categories: 65 to 74.9, 75 to 84.9, and ≥85 years of age and followed for all-cause death. Median follow-up time was 3 years. Of the total patient population, 248 patients (49% men) were ≥85 years old. When compared with younger patients, individuals ≥85 years had a higher prevalence of hypertension (79%) and a lower incidence of dyslipidemia (54%) and diabetes mellitus (24%). On multivariable analysis, %left ventricular stress defect and %left ventricular ischemia were predictors of patient outcome for those <85 years of age but was not statistically significant in those ≥85 years of age. The prognostic value of PET (%left ventricular stress defect and %left ventricular ischemia) appeared to decrease with advancing age. The elderly is a high-risk population irrespective of PET myocardial perfusion imaging results, and incremental prognostic value of PET myocardial perfusion imaging appears to wane in those ≥85 years of age. Although PET myocardial perfusion imaging may be diagnostically useful in the elderly, its prognostic value in this population requires further evaluation.

Application of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework using mixed methods to evaluate a collaborative care practice implementation can inform the literature on real-world collaborative care experiences. Two primary care practices serving Niagara Falls, NY, implemented collaborative care. Adults age 18 and over were screened at least annually for depression, anxiety, and alcohol use using the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder questionnaire (GAD-7), and the AUDIT alcohol consumption questionnaire (AUDIT-C). Primary care clinicians referred patients screening positive to the on-site behavioral health care manager (BHCM) with warm handoffs; the BHCM used a mixed therapeutic approach, initiated consultations with a psychiatrist and a community resource liaison as needed, in collaboration with the clinician. External evaluators used mixed methods to assess collaborative care services' RE-AIM. Nearly 40% of patients screened positive for at least one behavioral healthcare (BH) concern or were referred to BH services upon clinician judgment. Of these patients, 43% were referred to integrated BH services, of whom 86% accepted and 54% actually participated in services. There were no differences in changes in symptoms between those who did and did not participate in services. Patients reported the services were valuable and helped build skills for coping with complex health conditions and psychosocial issues. Evaluation of collaborative care using the RE-AIM framework may help others systematically evaluate programs, identify local improvement opportunities, and contribute to the broad literature on integrated care dissemination and implementation. (PsycINFO Database Record

Background: Western New York is among the regions with the highest rate of heart disease and stroke in the United States. Multifactorial causes include hypertriglyceridemia and dyslipidemia, and additional therapies may be needed to reduce residual risk that remains even after treatment with statins or other lipid-lowering medications. The purpose of this study was to evaluate the effects of a switch from omega-3 fatty acid ethyl esters (OM3EE) to icosapent ethyl (IPE) on lipid profiles in patients with hyperlipidemia. Methods: This was a retrospective chart review of patient records extracted from multiple medical practices throughout Western New York (4 locations). Randomly selected patients (N = 15) were eligible if they were aged ≥ 18 years with diagnosis codes for high triglyceride (TG) levels or hyperlipidemia and were receiving OM3EE. They were switched from OM3EE to IPE, and lipid parameters were measured after ≥ 2 months. Results: The records of 15 patients were analyzed and lipid measurements were available for 14 patients; 10 were on statins and 4 were on ezetimibe. At ≥ 2 months after the switch to IPE, 13 patients experienced decreases in total cholesterol (TC) and non–high-density lipoprotein cholesterol (non–HDL-C) levels; 12 experienced a decrease in TG and low-density lipoprotein cholesterol (LDL-C) levels; and changes in HDL-C levels were varied, with no change in 1 patient, decreases in 9 patients, and increases in 4 patients. Conclusion: The results of this real-world retrospective analysis of 14 patients with hyperlipidemia demonstrated reductions in TG, LDL-C, TC, and non–HDL-C levels, with mixed results in HDL-C levels, after switching from OM3EE to IPE.