Nuclear charge radius of 26m^{26m}Al and its implication for Vud_{ud} in the quark-mixing matrix

Collinear laser spectroscopy was performed on the isomer of the aluminium isotope $^{26m}$Al. The measured isotope shift to $^{27}$Al in the 3s^{2}3p\;^{2}\!P^\circ_{3/2} \rightarrow 3s^{2}4s\;^{2}\!S_{1/2} atomic transition enabled the first experimental determination of the nuclear charge radius of $^{26m}$Al, resulting in $R_c$=\qty{3.130\pm.015}{\femto\meter}. This differs by 4.5 standard deviations from the extrapolated value used to calculate the isospin-symmetry breaking corrections in the superallowed $\beta$ decay of $^{26m}$Al. Its corrected $\mathcal{F}t$ value, important for the estimation of $V_{ud}$ in the CKM matrix, is thus shifted by one standard deviation to \qty{3071.4\pm1.0}{\second}.Comment: 5 pages, 2 figures, submitted to Phys. Rev. Let

18. Effect of standardized catheterization lab order forms on peri-procedural prescription errors, patient care and staff satisfaction

Medication errors are the most common cause of iatrogenic adverse events. They can lead to severe complications, including prolonged hospitalization, unnecessary diagnostic tests and treatments, and even death. Objective:We set to explore the impact of introducing standardized cath lab order forms on medication errors, quality of patient care and staff satisfaction. This was a single center observational study conducted in a tertiary cardiac center in Saudi Arabia. We enrolled a total of 100 consecutive patients who underwent diagnostic or interventional cardiac catheterization before or after the introduction of standardized order forms. The cohort was divided into two equal groups. We compared medication prescription errors (as defined by hospital formulary) between the two groups. We also studies the impact of the standardized order forms on peri-procedural care including laboratory tests order completion, peri-procedural fluid and diabetes management, anticoagulant, diuretic and analgesia management. We have also employed a structured questionnaire to assess staff satisfaction with the use of these forms implementation of standardized order forms resulted in significant reduction of prescription errors from 32.0% to 0.0% (p = 0.025). There was also a significant improvement in patient care as indicated by improvement in the rates of completion of laboratory orders that improved from 76.0% to 96.0% after the implementation of order forms (p = 0.004), proper fluid management (100% vs. 86.0%, p = 0.023) and better peri-procedural diabetic management (see attached table). There was also improvement in the monitoring of the vascular access site (80% vs. 100%, p = 0.004) that resulted in reduction in access site related complications (6% vs. 0%). We administered a satisfaction questionnaire to 61 participants (nurses, physicians and pharmacists). The mean total satisfaction score was 62.8 for pharmacists, 50.4 for nurses and 48.6 for physicians indicating that the pharmacists were most satisfied with the implementation of these order forms and the physicians were the least satisfied (p = 0.052). Our study shows that standardized order forms have the potential to decrease medication-prescribing errors and improve quality of patient care among patients undergoing diagnostic and interventional cardiac procedures

Racial Disparity in Utilization of High-Volume Hospitals for Surgical Treatment of Esophageal Cancer

© 2018 The Society of Thoracic Surgeons Background: Utilization of high-volume hospitals (HVH) for esophagectomy has been associated with improved perioperative outcomes and reduced mortality. We aimed to test the hypothesis that black-white racial disparities exist in HVH utilization and identify predictors of in-hospital surgical outcomes of esophageal cancer while adjusting for HVH utilization patterns. Methods: We queried the New York Statewide Planning and Research Cooperative System database (1995 to 2012) for esophageal cancer patients who underwent surgical resection exclusively. Only records for patients with self-reported white or black race and a valid New York State ZIP code were included (n = 2,895). Analysis was performed to identify factors associated with HVH hospital (≥20 esophagectomies/year) utilization and determine predictors of complications and in-hospital mortality. Results: Black patients (361 [12.5%]) were significantly different (p \u3c 0.001) than their white counterparts in the proportion of women, Medicaid, income distribution, and privately insured individuals. Although 55% patients overall utilized an HVH, blacks were significantly less likely to utilize an HVH than whites (odds ratio [OR], 0.18; 95% confidence interval [CI], 0.14 to 0.24), even though 74.5% resided within 8.9 miles of one. Operations performed at HVHs were associated with lower in-hospital mortality (OR, 0.48; 95% CI, 0.35 to 0.65); however, mortality remained higher for blacks (OR, 2.04; 95% CI, 1.65 to 3.30; propensity matched OR, 2.45; 95% CI, 1.5 to 4.03). Conclusions: Black patients were less likely to undergo esophagectomy at an HVH and experienced higher mortality. Efforts should be made to understand factors influencing patients’ decision process and improve referral practices to ensure optimal care is provided across all segments of the population, irrespective of race, insurance, or income status

31. Differential effects of intravenous bolus furosemide and continuous furosemide infusion on in-hospital management and outcomes among patients admitted with acute decompensated heart failure

Loop diuretics are a cornerstone in the management of Acute Decompensated Heart Failure (ADHF). However, the best therapeutic strategy in terms of intermittent boluses versus continuous infusion is still unclear.We set to examine the differences in hospital management and short-term and long-term mortality of patient receiving furosemide bolus or infusion treatment for ADHF.This is a retrospective cohort study of 207 patients admitted to KKUH with ADHF. Clinical data, labs, in-hospital outcomes and long-term mortality data were collected through review of medical records and HEARTS registry database. We stratified our cohort into two groups; furosemide infusion and bolus groups.The Mean age was 61.5 ± 13.87 years, and 66.2% were males. Approximately 42% had left ventricular ejection fraction LVEF <40%. Use of intravenous infusions furosemide and boluses during admission was 42.86% and 57.14%, respectively. Compared to patient received bolus therapy, patients on infusion therapy had more renal impairment at presentation (26.4% vs. 12.5%, p = 0.033) and anemia (18.1% vs. 4.25, P = 0.006). They had less diabetes (30.6% vs. 38.5%, p = 0.006) and prior MI (18.1% vs. 32.3%, p = 0.006). Infusion group received higher total daily diuretic dose (p < 0.001), more Metolazone (19.4% vs. 3.1%, p = 0.002) and mechanical ventilation (11.1% vs. 3.1, p = 0.038). There was no difference in total urine output and renal outcomes between the two groups. The infusion group had longer hospital stay (15.40 ± 12.14 vs. 10.26 ± 6.74 days, p < 0.001). The long-term mortality up to 3 years was significantly higher among patient who received infusion therapy (27.78% vs. 9.38%, p = 0.002). ADHF patients who received furosemide infusion needed higher diuretic dose, had significantly longer hospital stay and higher long-term mortality

Effect of Concomitant Atrial Fibrillation on In-Hospital Outcomes of Non-ST-Elevation-Acute Coronary Syndrome Related Hospitalizations in the United States

Atrial fibrillation (AF) is the most common arrhythmia in patients presenting with acute coronary syndrome (ACS). The present study examined the rates and trends of clinical outcomes and management strategies of non-ST-elevation ACS (NSTE-ACS) related hospitalizations in the United States, in patients with concomitant AF compared to those in sinus rhythm (SR). We analyzed the ‘Nationwide Inpatient Sample’ database (2004-2014) for patients with a primary discharge diagnosis of NSTE-ACS, and further stratified the cohort on the basis of diagnoses into SR and AF groups. Multivariate analysis was performed to examine the association between AF and major adverse cardiovascular and cerebrovascular events (MACCE; composite of mortality, stroke and cardiac complications) and its components. Out of 4,668,737 NSTE-ACS hospitalizations, the proportions of SR and AF groups were 82.4% (3,848,202) and 17.6% (820,535), respectively. The incidence of AF increased significantly over time from 16.5% (2004) to 19.3% (2014). The AF group was at a greater risk of adverse outcomes with higher rates and adjusted relative risk (RR) of MACCE (12.9% vs. 5.3%; RR:1.74 [1.72,1.75]), mortality (6.5% vs. 3.3%; RR:1.12 [1.11,1.13]), stroke (2.7% vs. 1.5%; RR:1.32 [1.30,1.34]) and bleeding (14.7% vs. 8.8%; RR:1.42 [1.41,1.43]). Furthermore, the AF group was less likely to receive coronary angiography (47.1% vs. 58%) and percutaneous coronary intervention (18.7% vs. 32.6%) in comparison to SR. (p<0.001 for all outcomes) In conclusion, patients with concomitant AF and NSTE-ACS are less likely to be offered an invasive management strategy for their ACS and are associated with worse complications and higher mortality

P3611The effect of concomitant AF on in-hospital clinical outcomes of NSTE-ACS related hospitalizations in the United States: an analysis of rates, trends and predictors from 2004 to 2014

BackgroundAtrial fibrillation (AF) is the most common arrhythmia in patients presenting with acute coronary syndrome (ACS).PurposeWe sought to examine the rates, trends, and clinical outcomes of non-ST Elevation acute coronary syndrome (NSTE-ACS) related hospitalisations in the United States in patients with AF compared to those with sinus rhythm (SR).MethodsWe analysed the Nationwide Inpatient Sample (NIS) database from 2004 to 2014 for patients with a primary discharge diagnosis of NSTEMI or UA, and further stratified the cohort on the basis of diagnoses into SR and AF groups. Multivariate analysis was performed to identify the association between AF and MACCE (composite of mortality, stroke and cardiac complications), mortality, stroke, and bleeding.ResultsA total of 4,668,737 NSTE-ACS admissions were included in our analysis. The proportions of SR and AF groups were 82.4% (3,848,202) and 17.6% (820,535), respectively. The incidence of AF increased significantly over time from 16.5% in 2004 to 19.3% in 2014 (p<0.001). The AF group was at a greater risk of adverse outcomes with higher overall rates and adjusted relative risk of MACCE (12.9% vs. 5.3%; RR: 1.74 [1.72, 1.75]), mortality (6.5% vs. 3.3%. RR: 1.12 [1.11, 1.13]), stroke (2.7% vs. 1.5%; RR: 1.32 [1.30, 1.34]) and bleeding (14.7% vs. 8.8%; RR: 1.42 [1.41, 1.43]). The AF group was less likely to receive coronary angiography (47.1% vs. 58%) and PCI (18.7% vs. 32.6%) and more likely to undergo CABG (13.9% vs. 7.6%) in comparison to SR

Emergency department cardiovascular disease encounters and associated mortality in patients with cancer: A study of 20.6 million records from the USA.

BACKGROUND: there is limited data on Emergency department (ED) cardiovascular disease (CVD) presentations and outcomes amongst cancer patients. OBJECTIVES: The present study aimed to describe the clinical characteristics, prevalence, and clinical outcomes of the most common cardiovascular ED admissions in patients with cancer. METHODS: All ED encounters with a primary CVD diagnosis from the US Nationwide Emergency Department Sample between January 2016 to December 2018 were stratified by cancer type as well as metastatic status. Multivariable logistic regression was performed to determine the adjusted odds ratios of in-hospital mortality in different groups. RESULTS: From a total of 20,737,247 ED encounters with a primary CVD diagnosis, cancer was present in 3.4%. In patients with cancer the most common CVDs were DVT/PE (20%), hypertensive heart or kidney disease (14.7%), and AF/flutter (11.2%). The distribution of CVDs varied by cancer type, with AF/flutter most common in patients with lung cancer, AMI most common in patients with prostate cancer, heart failure most common in those with haematological malignancies, and patients with colorectal cancer having the greatest frequency of DVT/PE. Cancer status was independently associated with significantly higher risk of mortality in almost all CVD categories, consistent across all the cancer types, amongst which lung cancer patients had the highest risk of mortality across all CVD categories, except intracranial haemorrhage and hypertensive crisis. CONCLUSIONS: Cardiovascular presentations to the ED varied by cancer subtype. Across all cancer subtypes, patients presenting with cardiovascular presentations carried a significantly increased risk of mortality compared to patients with no cancer