scholarly journals Association Between Characteristics of Injurious Falls and Fall Preventive Interventions in Acute Medical and Surgical Units

2020 ◽  
Vol 75 (10) ◽  
pp. e152-e158
Author(s):  
Jacqueline Francis-Coad ◽  
Anne-Marie Hill ◽  
Angela Jacques ◽  
A Michelle Chandler ◽  
Phyllis A Richey ◽  
...  
Keyword(s):  
Physical Restraint ◽  
Case Series ◽  
The United States ◽  
Falls Prevention ◽  
Preventive Interventions ◽  
Lengths Of Stay ◽  
Injurious Falls ◽  
Surgical Units ◽  
Prevention Interventions ◽  
Injurious Fall

Abstract Background Hospital falls remain common and approximately 30% of falls in hospital result in injury. The aims of the study were the following: (i) to identify the association between fall interventions present at the time of the injurious fall and injurious faller characteristics and (ii) to identify the association between fall preventive interventions present at the time of the injurious fall and the injurious fall circumstances. Methods Secondary data analysis of deidentified case series of injurious falls across 24 acute medical/surgical units in the United States. Variables of interest were falls prevention interventions (physical therapy, bed alarm, physical restraint, room change, or a sitter) in place at the time of fall. Data were analyzed using logistic regression and hazard ratios. Results There were 1,033 patients with an injurious fall, occurrence peaked between Day 1 and Day 4, with 46.8% of injurious falls having occurred by Day 3 of admission. Injurious fallers with a recorded mental state change 24 hours prior to the fall were more likely to have a bed alarm provided (adjusted odds ratio [OR] 2.56, 95% confidence interval [CI] 1.61, 4.08) and receive a physical restraint as fall prevention interventions (adjusted OR 6.36, 95% CI 4.35, 9.30). Injurious fallers restrained fell later (stay Day 6) than those without a restraint (stay Day 4) (p = .007) and had significantly longer lengths of stay (13 days vs 9 days). Conclusions On medical/surgical units, injurious falls occur early following admission suggesting interventions should be commenced immediately. Injurious fallers who had a physical restraint as an intervention had longer lengths of stay.

scholarly journals In-Hospital Sequelae of Injurious Falls in 24 Medical/Surgical Units in Four Hospitals in the United States

2019 ◽  
Vol 45 (2) ◽  
pp. 91-97 ◽  
Author(s):  
Anne-Marie Hill ◽  
Angela Jacques ◽  
A. Michelle Chandler ◽  
Phyllis A. Richey ◽  
Lorraine C. Mion ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Injurious Falls ◽  
Surgical Units

scholarly journals Medications Are Associated with Falls in People with Multiple Sclerosis

2015 ◽  
Vol 17 (5) ◽  
pp. 207-214 ◽  
Author(s):  
Michelle H. Cameron ◽  
Lisa Karstens ◽  
Phu Hoang ◽  
Dennis Bourdette ◽  
Stephen Lord
Keyword(s):  
Multiple Sclerosis ◽  
The United States ◽  
Relative Odds ◽  
Disease Modifying Therapy ◽  
Disease Modifying Therapies ◽  
Active Medication ◽  
Injurious Falls ◽  
Injurious Fall ◽  
Disease Modifying ◽  
The Relationship

Background: Medication use is associated with falls in many populations, but the relationship between medications and falls in people with multiple sclerosis (MS) is not well understood. Methods: The number and types of medications used by 248 ambulatory adults with MS in the United States (n = 53) and Australia (n = 195) were assessed. Participants completed fall diaries for 6 months. Associations between number and type of medications reported and falls, adjusting for age, disease severity, comorbidities, sex, and country, were evaluated using multiple logistic regression. Results: Participants reported taking a median of three medications and two supplements. A total of 143 participants (58%) fell at least once in the 6 months, and 110 (44%) experienced one or more injurious falls. The adjusted relative odds of a fall or an injurious fall increased by 13% (P = .048) and 11% (P = .049), respectively, for each medication and by 43% (P = .015) and 55% (P = .001) for each neurologically active medication. Reported use of MS disease-modifying therapy was associated with 48% decreased odds of falling (P = .035) but not significantly decreased odds of injurious falls. Conclusions: Reporting use of more medications and more neurologically active medications is associated with falls and injurious falls in people with MS. Close evaluation of the need for each medication, with associated minimization of neurologically active medications in patients with MS, may help prevent falls. Use of MS disease-modifying therapies may be associated with fewer falls. This relationship needs further evaluation.

Clinical Characteristics of Patients Diagnosed with Strongyloidiasis in a United States Urban Outpatient Dermatology Department: A Case Series

2017 ◽  
Vol 1 (3) ◽  
pp. 156-160
Author(s):  
Jacqueline Watchmaker ◽  
Sean Legler ◽  
Dianne De Leon ◽  
Vanessa Pascoe ◽  
Robert Stavert
Keyword(s):  
United States ◽  
Case Series ◽  
The United States ◽  
Screening Tools ◽  
Dermatology Department ◽  
Cutaneous Manifestations ◽  
Serologic Testing ◽  
Patient Reported ◽  
History Of ◽  
Endemic Areas

Background: Although considered a tropical disease, strongyloidiasis may be encountered in non-endemic regions, primarily amongst immigrants and travelers from endemic areas.  Chronic strongyloides infection may be under-detected owing to its non-specific cutaneous presentation and the low sensitivity of commonly used screening tools. Methods: 18 consecutive patients with serologic evidence of strongyloides infestation who presented to a single urban, academic dermatology clinic between September 2013 and October 2016 were retrospectively included.  Patient age, sex, country of origin, strongyloides serology titer, absolute eosinophil count, presenting cutaneous manifestations, and patient reported subjective outcome of pruritus after treatment were obtained via chart review.  Results: Of the 18 patients, all had non-specific pruritic dermatoses, 36% had documented eosinophila and none were originally from the United States. A majority reported subjective improvement in their symptoms after treatment. Conclusion:  Strongyloides infection and serologic testing should be considered in patients living in non-endemic regions presenting with pruritic dermatoses and with a history of exposure to an endemic area.Key Points:Chronic strongyloidiasis can be encountered in non-endemic areas and clinical manifestations are variableEosinophilia was not a reliable indicator of chronic infection in this case series Dermatologists should consider serologic testing for strongyloidiasis in patients with a history of exposure and unexplained pruritus

scholarly journals 696. Bartonella quintana Endocarditis, A Case Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S400-S400
Author(s):  
Thomas D Dieringer ◽  
Glen Huang ◽  
Paul R Allyn ◽  
Jeffrey Klausner
Keyword(s):  
Renal Failure ◽  
Infective Endocarditis ◽  
Los Angeles ◽  
Aortic Valve ◽  
Literature Review ◽  
Case Series ◽  
The United States ◽  
Aortic Insufficiency ◽  
Homeless Population ◽  
Bartonella Quintana

Abstract Background Homelessness has been a growing issue in the United States and worldwide. Bartonella quintana, the causative agent of “Trench fever”, is a well known illness among homeless populations in urban centers. While many cases of B. quintana are self limited, the disease can have advanced presentations including endocarditis. We present a short case series of three cases of B. quintana infective endocarditis (IE) in homeless individuals in Los Angeles and review the literature of cases of B. quintana IE in the homeless population. Methods Here we report three cases of B. quintana IE encountered in homeless individuals at the University of California, Los Angeles (UCLA) hospital system. A literature review was also conducted. PubMed was searched for published cases of human IE secondary to B. quintana in homeless individuals. Results All three patients were male with ages ranging from 39 to 57 years old with a history of homelessness and alcohol use. Presentations were subacute to chronic in nature consisting of constitutional symptoms as well as a range of symptoms corresponding with heart and renal failure. Each patient was found to have varying degrees of aortic insufficiency with either identified aortic valve vegetation or valvular thickening. Diagnosis was made with a combination of Bartonella serologies and whole genome sequencing PCR. All three patient’s courses were complicated by renal failure at varying points limiting the use of gentamicin for the full treatment course. Two patients ultimately underwent aortic valve replacement due to severe aortic insufficiency and completed therapy with doxycycline and rifampin. A single patient was discharged with plan to complete doxycycline and rifampin therapy however was lost to follow up. A literature review of 10 manuscripts describing 13 cases of B. quintana IE were identified. All the patients were male and the median age was 45. Six of the cases were in Europe and eight were in North America. All cases had left sided valve involvement (10 aortic, 6 mitral, 3 both valves). No cases of right sided IE were identified. Conclusion B. quintana IE should be considered in homeless patients with a clinical presentation concerning for IE. A combination of serology and PCR testing can be useful in diagnosis of this uncommon cause of infective endocarditis. Disclosures Jeffrey Klausner, MD, MPH, Nothing to disclose

scholarly journals A 26-Year Study of Restraint Fatalities Among Children and Adolescents in the United States: A Failure of Organizational Structures and Processes

2021 ◽  
Author(s):  
Michael A. Nunno ◽  
Lisa A. McCabe ◽  
Charles V. Izzo ◽  
Elliott G. Smith ◽  
Deborah E. Sellers ◽  
...  
Keyword(s):  
United States ◽  
Physical Restraint ◽  
Organizational Structures ◽  
The United States ◽  
Community Schools ◽  
Disability Services ◽  
Advocacy Groups ◽  
Governmental Agencies ◽  
Practice Recommendations ◽  
Mechanical Restraints

Abstract Background Physical and mechanical restraints used in treatment, care, education, and corrections programs for children are high-risk interventions primarily due to their adverse physical, emotional, and fatal consequences. Objective This study explores the conditions and circumstances of restraint-related fatalities in the United States by asking (1) Who are the children that died due to physical restraint? and (2) How did they die? Method The study employs internet search systems to discover and compile information about restraint-related fatalities of children and youth up to 18 years of age from reputable journalism sources, advocacy groups, activists, and governmental and non-governmental agencies. The child cohort from a published study of restraint fatalities in the United States from 1993 to 2003 is combined with restraint fatalities from 2004 to 2018. This study’s scope has expanded to include restraint deaths in community schools, as well as undiscovered restraint deaths from 1993 to 2003 not in the 2006 study. Results Seventy-nine restraint-related fatalities occurred over the 26-year period from across a spectrum of children’s out-of-home child welfare, corrections, mental health and disability services. The research provides a data snapshot and examples of how fatalities unfold and their consequences for staff and agencies. Practice recommendations are offered to increase safety and transparency. Conclusions The study postulates that restraint fatalities result from a confluence of medical, psychological, and organizational causes; such as cultures prioritizing control, ignoring risk, using dangerous techniques, as well as agencies that lack structures, processes, procedures, and resources to promote learning and to ensure physical and psychological safety.

scholarly journals Standing on the shoulders of Giants: a citation analysis of the paediatric congenital heart disease literature

2021 ◽  
pp. 1-9
Author(s):  
Daniel P. Sew ◽  
Nigel E. Drury
Keyword(s):  
Citation Analysis ◽  
San Francisco ◽  
Citation Count ◽  
Case Series ◽  
Scientific Progress ◽  
The United States ◽  
Original Research ◽  
Prolific Author ◽  
Journal Citation Reports ◽  
The Impact

Abstract Objective: The citation history of a published article reflects its impact on the literature over time. We conducted a comprehensive bibliometric analysis to identify the most cited papers on CHD in children. Methods: One-hundred and ninety journals listed in Journal Citation Reports were accessed via Web of Science. Publications with 250 or more citations were identified from Science Citation Index Expanded (1900–2020), and those relating to structural CHD in children were reviewed. Articles were ranked by citation count and the 100 most cited were analysed. Results: The number of citations ranged from 2522 to 309 (median 431, IQR 356–518), with 35 published since 2000. All were written in English, most originated from the United States (74%), and were published in cardiovascular journals, with Circulation (28%) the most frequent. There were 86 original research articles, including 50 case series, 14 cohort studies, and 10 clinical trials. The most cited paper was by Hoffman JI and Kaplan S on the incidence of CHD. Thirteen authors had 4 or more publications in the top 100, all of whom had worked in Boston, Philadelphia, San Francisco, or Dallas, and the most prolific author was Newburger JW (9 articles). Conclusions: Citation analysis provides a historical perspective on scientific progress by assessing the impact of individual articles. Our study highlights the dominant position of US-based researchers and journals in this field. Most of the highly cited articles remain case series, with few randomised controlled trials in CHD appearing in recent years.

scholarly journals Football concussion case series using biomechanical and video analysis

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S2.2-S2
Author(s):  
Mirellie Kelley ◽  
Jillian Urban ◽  
Derek Jones ◽  
Alexander Powers ◽  
Christopher T. Whitlow ◽  
...  
Keyword(s):  
Video Analysis ◽  
Case Series ◽  
Linear Acceleration ◽  
The United States ◽  
Head Impact ◽  
Rotational Acceleration ◽  
Impact Location ◽  
Injury Mechanisms ◽  
The Mean ◽  
Impact Data

Approximately 1.1–1.9 million sport-related concussions among athletes ≤18 years of age occur annually in the United States, but there is limited understanding of the biomechanics and injury mechanisms associated with concussions among lower level football athletes. Therefore, the objective of this study was to combine biomechanical head impact data with video analysis to characterize youth and HS football concussion injury mechanisms. Head impact data were collected from athletes participating on 22 youth and 6 HS football teams between 2012 and 2017. Video was recorded, and head impact data were collected during all practices and games by instrumenting players with the Head Impact Telemetry (HIT) System. For each clinically diagnosed concussion, a video abstraction form was completed, which included questions concerning the context in which the injury occurred. Linear acceleration, rotational acceleration, and impact location were used to characterize the concussive event and each injured athlete's head impact exposure on the day of the concussion. A total of 9 (5 HS and 4 youth) concussions with biomechanics and video of the event were included in this study. The mean [range] linear and rotational acceleration of the concussive impacts were 62.9 [29.3–118.4] g and 3,056.7 [1,046.8–6,954.6] rad/s2, respectively. Concussive impacts were the highest magnitude impacts for 6 players and in the top quartile of impacts for 3 players on the day of injury. Concussions occurred in both practices (N = 4) and games (N = 5). The most common injury contact surface was helmet-to-helmet (N = 5), followed by helmet-to-ground (N = 3) and helmet-to-body (N = 1). All injuries occurred during player-to-player contact scenarios, including tackling (N = 4), blocking (N = 4), and collision with other players (N = 1). The biomechanics and injury mechanisms of concussions varied among athletes in our study; however, concussive impacts were among the highest severity for each player and all concussions occurred as a result of player-to-player contact.

scholarly journals Immunometabolic Status of COVID-19 Cancer Patients

2020 ◽  
Vol 100 (4) ◽  
pp. 1839-1850
Author(s):  
A. Sica ◽  
M. P. Colombo ◽  
A. Trama ◽  
L. Horn ◽  
M. C. Garassino ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cancer Progression ◽  
Macrophage Activation ◽  
Viral Infections ◽  
Immune Cell ◽  
Case Series ◽  
The United States ◽  
Alternative Activation ◽  
Nad Metabolism ◽  
Increased Risk

Cancer patients appear to be more likely to be diagnosed with coronavirus disease 2019 (COVID-19). This is supported by the understanding of immunometabolic pathways that intersect patients with infection and cancer. However, data derived by case series and retrospective studies do not offer a coherent interpretation, since data from China suggest an increased risk of COVID-19, while data from the United States and Italy show a prevalence of COVID-19 in cancer patients comparable with the general population. Noteworthy, cancer and COVID-19 exploit distinct patterns of macrophage activation that promote disease progression in the most severe forms. In particular, the alternative activation of M2-polarized macrophages plays a crucial role in cancer progression. In contrast, the macrophage-activation syndrome appears as the source of M1-related cytokine storm in severe COVID-19 disease, thus indicating macrophages as a source of distinct inflammatory states in the two diseases, nonetheless as a common therapeutic target. New evidence indicates that NAMPT/NAD metabolism can direct both innate immune cell effector functions and the homeostatic robustness, in both cancer and infection. Moreover, a bidirectional relationship exists between the metabolism of NAD and the protective role that angiotensin converting enzyme 2, the COVID-19 receptor, can play against hyperinflammation. Within this immunometabolic framework, the review considers possible interference mechanisms that viral infections and tumors elicit on therapies and provides an overview for the management of patients with cancer affected by COVID-19, particularly for the balance of risk and benefit when planning normally routine cancer treatments and follow-up appointments.

Safety of a Protective Funnel in Primary Breast Augmentation: A Retrospective Analysis of 380 Multicenter Cases in the United States

2021 ◽  
Author(s):  
Aldo Lombardo ◽  
Alfred R Antonetti ◽  
Joel Studin ◽  
Frank Stile ◽  
Dudley Giles ◽  
...  
Keyword(s):  
Breast Augmentation ◽  
Case Series ◽  
The United States ◽  
Future Research ◽  
Control Group ◽  
Superficial Infection ◽  
Class 1 ◽  
Median Volume ◽  
Implant Size ◽  
Potential Risk Factors

Abstract Background Protective funnels devices are commonly used to deliver implants in primary breast augmentation (BA) yet there is a paucity of evidence-based data describing their safety in the literature. Objectives The purpose of the study was to assess the safety of protective funnels in primary BA within the first 30-days postoperatively. Methods This multi-center, Level 3 study retrospectively reviewed the surgical records of 380 consecutive patients (760 breasts) who underwent primary BA by nine board-certified plastic surgeons using the iNPLANT Funnel (Proximate Concepts LLC, Allendale, NJ, USA) for implant delivery between November 2019 and December 2020. Data was collected pertaining to demographics, implant information, surgery details, and postoperative complications. Results The mean patient age was 33 years and 76% patients had a BMI < 25. Of this cohort, 11.4% were smokers, 0.8% had diabetes, and 83% were ASA class 1. All patients received smooth implants with a median volume of 375cc. A total of 8 (2.1%) complications were reported including: 3 hematomas (0.79%), 1 seroma (0.26%) and 1 superficial infection (0.26%). No patient required explantation. We identified ASA class, BMI, surgery duration, and implant size as potential risk factors. Conclusions The data suggest that use of protective funnels, such as the iNPLANT Funnel, in primary BA are a safe option when used according to the manufacturer’s IFU. Its use led to a low infection rate (0.26%) and a complication rate (2.1%) consistent with the average reported in the literature (2%-2.5%). 1 Implications for clinical practice are encouraging and future research will include a prospective analysis with a larger case series and potentially a control group.

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