Influence of Obesity, Race and Gender on Cardiac Catheterization after Stress Testing

Female gender and black race have been associated with lower use of cardiac resources however; these patients also have a higher prevalence of obesity. Therefore we determined their relation to cardiac catheterization after stress testing. Clinical characteristics were determined for all patients stress tested over one year at a safety-net, urban, teaching hospital. Subsequent cardiac catheterizations were identified. Univariate and multivariate analyses were performed to determine the factors associated with catheterization. 3644 patients underwent stress testing and 484 (13%) underwent cardiac catheterization. The population was 58% female, 33% black, 53% were obese and 32% lacked insurance. Obese patients were mostly female, disproportionately black and had more CAD risk factors. An ischemic stress test result was similar across all BMI categories. Obesity was not associated with receipt of catheterization. Although univariate analysis showed fewer catheterizations for female and black patients, multivariate analysis adjusting for stress data and clinical risk factors no longer showed this. Neither race, gender, nor obesity was associated with catheterization utilization when stress testing and clinical factors were considered in a center where financial obstacles to testing were minimized

Evaluating comfort measures for commonly performed painful procedures in pediatric patients.

Introduction: Management of pediatric pain from medical procedures is of great importance for improving both patient care and experience. In this study, we investigated methods of managing acute pain in infants and children by studying the correlation between the number of attempts to complete painful procedures, given different comfort measures. Methods: The study is a retrospective review of 74,276 procedures performed at two pediatric hospitals in an integrated academic children\u27s health system between 2013 and 2016. We compared three comfort measures most frequently offered: positions of comfort (POC), distraction (DIST), and pharmacological (PHARM). These methods were compared in the setting of four procedures: peripheral intravenous (PIV) catheter insertion, gastrointestinal tube placement, incision procedures, and bladder catheterization. We used the number of attempts needed to complete a procedure as a measure of efficacy minimizing distressing experience in an acutely painful setting (single attempt vs repeat attempts). Results: Among younger children, DIST appears superior to the other two methods; it performs significantly better for three of the four procedures (PIV catheterization, incision wound, and urinary catheterization) among infants agedchildren, POC tends to perform slightly better than the other two methods, although it is significantly better only for PIV catheterization among adolescents aged 13-21 years and urinary catheterization among children aged 9-12 years. Conclusion: Results from this study may be used to determine appropriate comfort measures for painful procedures in pediatric setting

Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter-Related Infections Study Group.

To identify avoidable risk factors for central venous catheter (CVC) infections in patients undergoing short-term catheterization

Clean intermittent self-catheterization as a treatment modality for urinary retention : perceptions of urologists

Purpose: Clean intermittent self-catheterization (CISC) is now considered the gold standard for the management of urinary retention. In the literature, several articles on patients' perspectives on CISC and adherence to this technique have been published. No studies have yet explored the points of view of professional caregivers, such as nurses and doctors. The aim of this study was to explore the opinions of urologists about CISC and to evaluate the need for dedicated nurses specialized in CISC through a self-administered questionnaire. Methods: A questionnaire was developed to explore the opinions of professional caregivers about self-catheterization and to evaluate the need to provide nurses with specialized education in CISC. Questionnaires were sent to 244 urologists through email. We received 101 completed questionnaires. The response rate was 41.4%. Results: Hand function, the presence or absence of tremor, and visual acuity were rated as the most important determinants for proposing CISC to a patient. Twenty-five percent of the urologists reported that financial remuneration would give them a greater incentive to propose CISC. The lack of dedicated nurses was reported by half of the urologists as a factor preventing them from proposing CISC. A meaningful number of urologists thought that patients perceive CISC as invasive and unpleasant. Although most urologists would choose CISC as a treatment option for themselves, almost 1 urologist out of 5 would prefer a permanent catheter. Conclusions: This questionnaire gave valuable insights into urologists' perceptions of CISC, and could serve as the basis for a subsequent broader international study. Further research should also focus on the opinions of nurses and other caregivers involved in incontinence management. Apart from financial remuneration, it is also clear that ensuring sufficient expertise and time for high-quality CISC care is important. This could be a potential role for dedicated nurses

An Early Holiday Surprise: Cholecystitis Wrapped in Takotsubo Cardiomyopathy

This is a novel case report of a 44-year-old woman who presented to the emergency department with epigastric pain wrapping around to her back. She had no risk factors for cardiac disease, but her initial electrocardiogram (ECG) showed a Wellens syndrome pattern and she was taken urgently to the catheterization lab. After a negative catheterization, she underwent cardiac magnetic resonance imaging, which was positive for Takotsubo cardiomyopathy (TC). Ultimately, abdominal computed tomography revealed that she had cholecystitis, which likely was the cause of her TC and ECG changes

Local DRLs and automated risk estimation in paediatric interventional cardiology

Introduction : Cardiac catheterization procedures result in high radiation doses and often multiple procedures are necessary for congenital heart disease patients. However, diagnostic reference levels (DRL) remain scarce. Our first goal was finding the optimal DRL parameter and determining appropriate DRLs. The second goal was to calculate organ doses (OD), effective doses (ED) and lifetime attributable risks (LAR) per procedure and to provide conversion factors based on dose area product (DAP). Materials and methods : DRLs are calculated for each procedure type, as the 75th percentile of the cumulative value per procedure from the corresponding parameter. All irradiation events in the DICOM Structured Reports were automatically processed and simulated using PCXMC, resulting in OD, ED and LAR. Using a Kruskal Wallis H test and subsequent pairwise comparisons, differences in median values of the DRL parameter between procedure types were assessed. Results : Linear regression showed a strong correlation and narrow confidence interval between DAP and product of body weight and fluoroscopy time (BWxFT), even when all procedures (diagnostic and interventional) are combined. Only 15% of the pairwise comparisons were statistically significant for DAP normalized to BWxFT (DAP(BWxFT)). The latter pairs contained less frequent procedure types with significant outliers. For DAP normalized to BW (DAP(BW)), 38% of the pairwise comparisons showed statistically significant differences. Conversion factors from DAP(BW) to OD and ED were reported for various weight groups, due to the higher correlation between DAP(BW) and both OD and ED than between DAP and both OD and ED. Conclusions : The P75 of DAP(BWxFT) for all procedures combined serves as an appropriate DRL value. This facilitates local DRL determination in smaller paediatric centres, which often have insufficient data to produce appropriate DRLs for different procedure types. Conversion factors are more reliable starting from DAP(BW) instead of DAP and should be used according to the appropriate BW group

RISK FACTORS ASSOCIATED WITH URINARY TRACT INFECTION IN GERIATRIC AND ITS MICROBIOLOGIC CHARACTHERISTICS

Background : Urinary Tract Infections(UTI) is a general understanding to describe invasion of microorganism in urinary tract. The severity of any functional disability, nature of underlying illnesses, anatomic or physiologic abnormalities of the genitourinary (GU) tract, and use of indwelling bladder catheters determine the types of organisms and chronicity of bacteriuria. Purpose : To analyze factors which associated with Urinary Tract Infections in geriatric patients. Methods : Observational retrospective study conducted by reviewing medical record on 2004 of geriatric patients in Dr.Kariadi Hospital. Independent variables consist of sex, catheterization, initial antibiotics, DM and urine stasis. Dependent variable is geriatric patients who are diagnose as UTIs patients based on urine culture result. Statistic analysis is conducted with descriptive analysis and logistic regression using SPSS 13.00 for windows. Results : Sex and catheterization (p<0.05) associated as the risk factors of UTIs in geriatric patient. Intial antibiotics, diabetes mellitus and urine stasis (p≥0.05) were not significant as risk factor of UTIs in geriatric patients. The pattern of microorganism was as follows, Eschericia coli(46.9%), Enterobacter aerogenes(27.1%), Staphylococcus epidermidis(10.4%), Pseudomonas aeruginosa(9.4%), yeast cell(3.1%), Staphylococcus aureus(2.1%) and Candida sp(1.0%). E.coli still be the most prevalent microorganism. Staphylococcus epidermidis should be considered as contamination. The sensitivity test shown that E.coli had antibiotic sensitivity to meropenem(100%), vancomycin(100%) and cefepim(92.9%). Conclusion : Sex and catheterization associated with UTIs in geriatric patients. Initial antibiotics, DM and urine stasis do not associated with UTIs in geriatric patients. Keywords : Urinary Tract Infections, geriatric patients

Mistriaged Advanced Life Support Patients in a Two-Tiered, Suburban Emergency Medical Services System

Introduction: Emergency medical services (EMS) systems exist to provide prehospital care in diverse environments throughout the world. Advanced Life Support (ALS) services can provide advanced care including 12-lead electrocardiogram (ECG), endotracheal intubation and parenteral medication administration. Basic Life Support (BLS) can provide basic care such as splinting, wound care and cardiopulmonary resuscitation. ALS can release patients to BLS for transport to the hospital, and this is an area of high risk. Our study examines patients who were triaged and admitted to a critical care location, including an intensive care unit (ICU), cardiac catheterization laboratory, or operating room (OR).Methods: The analysis included data from 2007–2015 of all patients who were triaged. We evaluated demographics, admission diagnoses, and dispositions using descriptive statistics. Diagnoses were grouped into categories based on the system.Results: We found that 372/17,639 (2%) of patients were mistriaged to BLS and admitted to a critical care location. The average age was 64. The most common diagnosis categories were neurological (24%), gastrointestinal (GI)/abdominal pain (15%), respiratory (12%), and cardiac (12%).Conclusion: It is uncommon for patients triaged from ALS to BLS to be admitted to an ICU, catheterization lab or OR, with a rate of 2%. Neurological, GI, sepsis, and trauma diagnoses were the most frequent categories of patient complaints that were mistriaged. This study should lead to further studies to examine this patient population