Hobbsgarrison0243

At multivariate analysis, however, only PSA density, bioptic ISUP GG, total percentage of core, and Irani G score kept statistical significance. The area under the curve for the resulting model was 0.75. CONCLUSIONS This is the first study demonstrating that low-grade inflammation is associated with a significantly increased risk of AP at RP. These findings would support the concept of prostatic inflammation being inversely correlated with presence and aggressiveness of CaP. Further studies are needed to externally validate the role of this readily available parameter in the decision-making process of patients with low-grade CaP. BACKGROUND Interpretation of radiologic images is a critical skill for resident physicians in emergency medicine (EM), however, few training programs offer formal training in this realm. Time and money also need to be considered when adding to the curriculum of trainees. OBJECTIVE We sought to determine the utilization and benefit of an asynchronous curriculum in the interpretation of diagnostic imaging. METHODS Radiologic images were obtained from emergency department patients and presented to the trainees on a weekly basis from April to December 2017; discussion questions regarding the images were posed, all via the online workplace platform Slack. Trainees were surveyed prior to and 8 months after initiation of the curriculum to ascertain their confidence with radiologic image interpretation and their use of Slack. RESULTS Of the 36 potential resident physician participants in this study, 31 (86%) completed the pre-intervention survey and 28 (78%) completed the post-intervention survey. The curriculum was found to be beneficial to all respondents (100%) and increased their confidence with image interpretation from 2.93 ± 0.89 pre-intervention (5-point Likert scale) to 3.46 ± 0.83 post-intervention (p  less then  0.02). Seventy-five percent noted that they viewed the material "often" or "anytime new material was posted." CONCLUSIONS Use of an asynchronous curriculum in image interpretation increased the confidence of trainees and was well-utilized. The implications of this are far-reaching, given that a similar intervention could be undertaken for any topic in any specialty in medicine, and with no cost of money or didactic time. BACKGROUND The FlowTriever Pulmonary Embolectomy Clinical Study (FLARE) was a multicenter, single-arm trial that demonstrated effectiveness of the FlowTriever percutaneous pulmonary embolectomy system in reducing right ventricular/left ventricular (RV/LV) diameter ratio in patients with acute intermediate-risk pulmonary embolism (PE). Patients diagnosed in emergency departments (EDs) with acute PE may have a different presentation from those diagnosed in an in-hospital setting. OBJECTIVES The goal of this sub-study was to evaluate the safety and effectiveness of mechanical embolectomy in ED patients with acute intermediate-risk PE. METHODS ED patients with acute PE and RV/LV ratio ≥ 0.9 enrolled in the FLARE study were core laboratory analyzed. The primary efficacy endpoint was the change in RV/LV ratio from baseline to 48 h post procedure. The change in RV/LV ratio of patients with nonelevated cardiac troponin (cTn) and zero simplified PE Severity Index (sPESI) score (normal cTn-sPESI intermediate-low risk) was also examined. Major adverse events (MAEs) included major bleeding, device-related death or clinical deterioration, and vascular or cardiac injury. RESULTS Seventy-six ED patients were included. Thirty-nine had a sPESI score of ≥ 1 and 32 had elevated cTn. The median preprocedure RV/LV ratio for all ED patients was 1.50 (0.88-2.52), with a change by -0.37 postprocedure (p  less then  0.001.) Three patients experienced MAEs. Seventeen patients (22.4%) presented with normal cTn-sPESI and had an RV/LV ratio reduced by 0.27 (p  less then  0.001) after embolectomy. CONCLUSION ED patients with intermediate-risk PE had significant improvement in their RV/LV ratio and low complication rates when treated with mechanical embolectomy, irrespective of their baseline cTn-sPESI risk score. BACKGROUND Acute respiratory failure (ARF) is a common cause of emergency department (ED) and intensive care unit (ICU) admissions. High-flow nasal cannula oxygen therapy (HFNC) is widely used for patients with ARF. OBJECTIVE Our aim was to evaluate the latest evidence regarding the application of HFNC in immunocompromised patients with ARF. METHODS We searched PubMed, Embase, and Cochrane databases from inception to January 2019. The primary outcome was short-term mortality and the secondary outcomes were intubation rate and length of ICU stay. RESULTS Eight studies involving 2,179 immunocompromised subjects with ARF were included. No significant differences for short-term mortality were observed when comparing HFNC with conventional oxygen therapy (COT) (risk ratio [RR] 0.89; 95% confidence interval [CI] 0.73 to 1.09; p = 0.25, I2 = 47%) and with noninvasive ventilation (NIV) (RR 0.66; 95% CI 0.37 to 1.18; p = 0.16, I2 = 58%). Lower intubation rates were found when comparing HFNC with COT (RR 0.89; 95% CI 0.80 to 0.99; p = 0.03, I2 = 0%) and no significant difference was found between HFNC and NIV (RR 0.74; 95% CI 0.46 to 1.19; p = 0.22, I2 = 67%). The length of ICU stay was similar when comparing HFNC with COT (mean difference [MD] 0.59; 95% CI -1.68 to 2.85; p = 0.61, I2 = 56%), but was significantly shorter when HFNC was compared with NIV (MD -2.13; 95% CI -3.98 to -0.29; p = 0.02, I2 = 0%). CONCLUSIONS There was no significant difference in short-term mortality with use of HFNC when compared with COT or NIV for immunocompromised patients with ARF. A lower intubation rate than COT and a shorter length of ICU stay than NIV were observed in the HFNC group. learn more INTRODUCTION We tested whether frail patients may benefit from robot-assisted (RARC) relative to open radical cystectomy (ORC). MATERIALS AND METHODS Frail patients treated with RC were identified within the National Inpatient Sample database (2008-2015). The effect of RARC vs. ORC was tested in five separate multivariable models predicting complications, failure to rescue (FTR), in-hospital mortality, length of stay (LOS) and total hospital charges (THCs). As internal validity measure, analyses were repeated among non-frail patients. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. RESULTS Of 11,578 RC patients, 3477 (30.0%) were frail. RARC was performed in 488 (14.0%) frail patients and 1386 (17.1%) non-frail patients. Among frail, RARC was only independently associated with shorter LOS (median 8 vs. 9 days, relative ratio [RR] 0.79, p  less then  0.001). Conversely, among non-frail, RARC was independently associated with lower complications (57.