Didriksenengberg1989

BACKGROUND Isolated PE is associated with a higher burden of atherosclerotic disease than other manifestations of venous thromboembolism (VTE). RESEARCH QUESTION We hypothesized that the presence of isolated PE may signal a chronically elevated risk of arterial thrombotic disease. STUDY DESIGN AND METHODS Data from the VTEval Study, a prospective cohort study enrolling individuals with clinical suspicion and imaging-based diagnosis or exclusion of VTE, were analyzed. Patients with PE received whole-leg ultrasonography to assess presence of deep vein thrombosis (DVT). Regularized logistic regression identified features that discriminate between isolated PE and other VTE phenotypes at clinical presentation. Survival analyses were performed to evaluate the crude and adjusted 3-year risks of arterial thrombotic disease, recurrent VTE, and death. RESULTS The sample comprised 510 patients. Isolated PE patients (n=63) had a distinct clinical profile from patients with other VTE phenotypes (n=447). Chronic obstructive pulmonary disease (COPD), peripheral artery disease, atrial fibrillation and coronary artery disease were significantly more prevalent among patients with isolated PE. Isolated PE patients had significantly higher risk (incidence rate ratio vs DVT-associated PE 3.7 [95% confidence interval 1.3-10.8], p=0.009; vs isolated DVT 4.8 [1.7-14.3], p=0.001) of arterial thrombotic events (i.e. myocardial infarction, stroke/transient ischemic attack). After adjustment for clinical profile and medication intake, the risk of arterial thrombotic events for patients with isolated PE remained quadruple that of other VTE phenotypes (hazard ratio, HR 4.1 [1.4-11.7], p=0.009). INTERPRETATION Patients with isolated PE are at higher risk for arterial thrombosis, and may require screening for arterial disease and development of novel therapeutic strategies. BACKGROUND The current Centers for Medicare & Medicaid Services diagnosis-related group (DRG) bundled-payment model for upper-extremity arthroplasty does not differentiate between the type of arthroplasty (anatomic total shoulder arthroplasty [ATSA] vs. reverse total shoulder arthroplasty vs. total elbow arthroplasty [TEA] vs. total wrist arthroplasty) or the diagnosis and indication for surgery (fracture vs. degenerative osteoarthritis vs. inflammatory arthritis). METHODS The 2011-2014 Medicare 5% Standard Analytical Files (SAF5) database was queried to identify patients undergoing upper-extremity arthroplasty under DRG-483 and -484. Multivariate linear regression modeling was used to assess the marginal cost impact of patient-, procedure-, diagnosis-, and state-level factors on 90-day reimbursements. RESULTS Of 6101 patients undergoing upper-extremity arthroplasty, 3851 (63.1%) fell under DRG-484 and 2250 (36.9%) were classified under DRG-483. The 90-day risk-adjusted cost of an ATSA for degenerative osteoas and indication for surgery (fracture vs. degenerative pathology), despite each of these factors having different resource utilization and associated reimbursements. Lack of risk adjustment for fracture indications leads to strong financial disincentives within this model. BACKGROUND A comparison of self-reinforcement and footprint compression between standard- and wide-diameter suture material in double-row SutureBridge repair techniques has not been performed. The aim of this study was to compare the self-reinforcement and footprint contact pressure generated under progressive tensile loads between 2 double-row SutureBridge rotator cuff repair techniques 1 performed with FiberWire and 1 performed with FiberTape in a knotless technique. MATERIALS AND METHODS Rotator cuff repairs were performed in 10 pairs of ovine shoulders. One group underwent a double-row SutureBridge repair using FiberWire. The other group underwent an identical repair with FiberTape. Footprint contact pressure was measured from 0° to 60° of abduction under loads of 0-60 N. Pull-to-failure tests were then performed. RESULTS In both repair constructs at 0° of abduction, each 10-N increase in rotator cuff tensile load led to a significant increase in footprint contact pressure (P less then .05). The rate of increase in footprint contact pressure was greater in the FiberTape construct (ratio, 1.68; P = .00035). In both repair constructs, the highest values for footprint contact pressure were seen at 0° of abduction. No difference in pull to failure, peak load, or total energy was found between the groups. CONCLUSION Self-reinforcement was seen in both double-row SutureBridge repairs with standard- and wide-diameter suture material but was greater in the repair with the wide-diameter suture material construct. Footprint compression is greater in a knotless double-row SutureBridge repair with wide-diameter suture material than in a knotted double-row SutureBridge repair with standard-diameter suture material at 20° of abduction. BACKGROUND Limited data exist on the facilitators and barriers to implementing electronic systems for medicines management in hospitals. Whilst numerous studies advocate system use in improved patient safety and efficiency within the health service, their rate of adoption in practice has been slow. OBJECTIVE To explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing systems, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings using Normalization Process Theory as a theoretical framework. METHODS Individual face-to-face semi-structured interviews were conducted in three public hospitals in Ireland with 23 consenting participants nine nurses; four pharmacists; two pharmacy technicians; six doctors; and two Information Technology managers. RESULTS Enhanced patient safety and efficiency in healthcare delivery emerged as key facilitators to system implementation, as well as the need to have clinical champions and a multi-disciplinary implementation team to promote engagement and cognitive participation. Key barriers included inadequate training and organisational support, and the need for ease and confidence in system use to achieve collective action. CONCLUSIONS Many themes that are potentially transferable to other national settings have been identified and extend the evidence base. This will assist organisations around the world to better plan for implementation of medication-related eHealth systems. BACKGROUND Community pharmacists have an important role to play in providing medication adherence support (MAS) to older patients. However, research has shown that pharmacists rarely ask patients about adherence and offer limited solutions. The Theoretical Domains Framework (TDF) can guide the selection of behaviour change techniques (BCTs), to enhance behaviours such as MAS provision. OBJECTIVES This study aimed to (1) explore barriers/facilitators influencing community pharmacists' provision of MAS to older patients prescribed multiple medications; (2) Identify theoretical domains to target for behaviour change; (3) Select BCTs to deliver to pharmacists to enhance MAS provision. METHOD As part of a two-phase study, semi-structured interviews and a cross-sectional survey were conducted. In Phase 1, community pharmacists in Northern Ireland (NI) were recruited using purposive/snowball sampling. TDF-based interviews were audio-recorded, transcribed and analysed by two independent researchers using the frameworrget each of the seven key target domains identified in this study will be tested in a future pilot study of a patient-targeted intervention. BACKGROUND Globally, age-standardized incidence rates for most cancers at shared sites are substantially and consistently higher in men than in women. Differences in established risk factors are unable to account for much of the sex disparity. selleck compound We hypothesized that variability in height may be important in explaining sex differences in cancer risk. PATIENTS AND METHODS We included 49 372 men from the Health Professionals Follow-up Study (1986-2014) and 115 612 women from the Nurses' Health Study (1980-2014). Height was reported at baseline and biennial questionnaires were used to collect information on cancer risk factors. We examined the association between sex and cancer incidence at shared anatomic sites using Cox proportional hazards models and performed mediation analysis to determine the percent of the association that was accounted for by height. RESULTS Over up to 34 years of follow-up, 21 307 incident cases of cancers at shared sites (7705 men, 13 602 women) were documented. After adjusting for major cancer risk factors, men had a 39% increased risk of shared cancers overall (hazard ratio = 1.39; 95% confidence interval = 1.33-1.45) of which 35% (95% confidence interval = 24-46) was mediated by height. The excess risk of cancer for men was also partially explained by height for several specific cancers (gastrointestinal, melanoma, kidney, brain, hematologic). Mediation by height tended to be stronger among never smokers or those who adhered to a healthy lifestyle, and for cancers with fewer known environmental risk factors. CONCLUSIONS Differences in height among men and women partially mediated the association between sex and cancer incidence at several shared sites. Hence, mechanisms underlying the relationship between height and cancer may be important determinants of sex disparities in cancer incidence. RATIONALE AND OBJECTIVES To determine whether a single source computed tomography (CT) system utilizing fast kV switching and low dose settings can characterize (diameter and chemical composition) renal stones accurately when compared infrared spectroscopy. MATERIALS AND METHODS The chemical composition of 15 renal stones was determined using Fourier transform infrared spectroscopy. The stones were inserted into a porcine kidney and placed within a water tank for CT scanning using both fast kV switching dual energy and standard protocols. Effective atomic number of each stone was measured using scanner software. Stone diameter measurements were repeated twice to determine intra-rater variation and compared to actual stone diameter as measured by micro CT. RESULTS The chemical composition of three stones (one calcium phosphate and two carbonite apatite) could not be determined using the scanner software. The composition of 10/12 remaining stones was correctly identified using dual energy computed tomography (83% absolute agreement; k = 0.69). No statistical difference (p = 0.051) was noted in the mean stone diameter as measured by clinical CT and micro CT. CONCLUSION Dual energy computed tomography using fast kV switching may potentially be developed as a low dose clinical tool for identifying and classifying renal stones in vivo supporting clinical decision-making. RATIONALE AND OBJECTIVES Bronchiectasis (BE) is associated with chronic obstructive pulmonary disease (COPD), but emphysema and small airways disease, main pathologic features of COPD, have been sparsely studied in BE. We aimed to objectively assess those features in smokers with and without radiographic BE and examine its relationships to airflow obstruction and exercise capacity. MATERIAL AND METHODS We measured emphysema and small airways disease on paired inspiratory-expiratory computed tomography (CT) scans with the parametric response map (PRMEMPH and PRMSAD) method in 1184 smokers with and without radiographic BE. PRMSAD and PRMEMPH are expressed as the percentage of lung area. Clinical, spirometry, and exercise capacity data were measured with standardized methods. The differences in PRMSAD and PRMEMPH between subjects with and without radiographic BE were assessed using multivariable linear regression analysis, and their associations with FEV1 and six-minute walk test (6MWT) were assessed with generalized linear models.