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NGS and phenotypic ontology-based techniques increase the analysis yield inside syndromic retinal diseases.
We sought to determine whether a prospective audit and feedback intervention decreased antibiotic utilization in a pediatric cardiac ICU and to describe the characteristics of prospective audit and feedback audits and recommendations.
Before-after study.
Pediatric cardiac ICU of a freestanding children's hospital.
All patients admitted to the cardiac ICU.
A prospective audit and feedback program was established in our hospital's pediatric cardiac ICU on December 7, 2015. The antimicrobial stewardship program audited IV antibiotics, communicated prospective audit and feedback recommendations to the cardiac ICU, and regularly reviewed recommendation adherence. Mean monthly antibiotic utilization 18 months before ("preprospective audit and feedback"; from June 1, 2014 to November 30, 2015) and 24 months after ("prospective audit and feedback"; from January 1, 2016 to December 31, 2017) prospective audit and feedback implementation was compared. Antibiotic audit data during the prospective audit and feetric cardiac ICU. Over one-third of antibiotics audited in our cardiac ICU were associated with a prospective audit and feedback recommendation, revealing important targets for future antimicrobial stewardship efforts in this population.
There was a significant reduction in antibiotic use following implementation of a prospective audit and feedback program in our pediatric cardiac ICU. Over one-third of antibiotics audited in our cardiac ICU were associated with a prospective audit and feedback recommendation, revealing important targets for future antimicrobial stewardship efforts in this population.
To determine the bivariable associations between abnormalities of 28 common laboratory tests and hospital mortality and determine how mortality risks changes when the ranges are evaluated in the context of commonly used laboratory test panels.
A 2009-2016 cohort from the Health Facts (Cerner Corporation, Kansas City, MO) database.
Hospitals caring for children in ICUs.
Children cared for in ICUs with laboratory data.
None.
There were 2,987,515 laboratory measurements in 71,563 children. The distribution of laboratory test values in 10 groups defined by population percentiles demonstrated the midrange of tests was within the normal range except for those measured predominantly when significant abnormalities are suspected. Logistic regression analysis at the patient level combined the population-based groups into ranges with nonoverlapping mortality odds ratios. The most deviant test ranges associated with increased mortality risk (mortality odds ratios > 5.0) included variables associated with apment.
The relative importance of laboratory test ranges vary widely, with some ranges strongly associated with mortality and others strongly associated with survival. When evaluated in the context of test panels rather than isolated tests, the mortality odds ratios for the test ranges decreased but generally remained significant as risk was distributed among the components of the test panels. These data are useful to develop critical values for children in ICUs, to identify risk factors previously underappreciated, for education and training, and for future risk score development.
To determine the impact of standardized PICU work rounds on the frequency of ideal teaming behaviors, rounds comprehensiveness, shared mental model index development, and rate of completed end-of-shift goals.
A single-center, pre-post, prospective cohort study.
A 259-bed, quaternary, pediatric referral center.
Children 0-18 years old from November 2018 to January 2020.
Standardized, bedside, nurse-led PICU work rounds, emphasizing ideal teaming behaviors using a collaboratively developed rounding script and quality/safety checklist.
Study data were collected by direct observation and immediate postrounds participant questionnaire data. Primary outcomes were frequency of observed ideal teaming behaviors, rounds comprehensiveness, efficiency (rounds content divided by duration), shared mental model index (congruence among rounds participants regarding key healthcare data and planning), rounds face validity, and achievement rate of rounds-established, end-of-shift goals. During study, 154 encounters noted a positive association between the shared mental model index and the rate of achieved rounds-established, end-of-shift goals (odds ratio, 8.9; 95% CI, 1.7-46; p < 0.01).
Standardization of PICU work rounds may encourage ideal teaming behaviors, enhance rounds comprehensiveness, strengthen the congruence of participant shared mental model, and affect the rate of achieved goals established during rounds without compromising workplace efficiency.
Standardization of PICU work rounds may encourage ideal teaming behaviors, enhance rounds comprehensiveness, strengthen the congruence of participant shared mental model, and affect the rate of achieved goals established during rounds without compromising workplace efficiency.
The role of aortic valve Lambl's excrescence (LEs) in determining ischemic events has not been well clarified, but they can represent a potential embolic source during procedures with catheter/device manipulation through the aortic valve. Aim of our study was to assess the prevalence of LEs and the rate of embolism in patients with aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI).
Our population was divided into two groups, named LEs and no-LEs. In each group, the rate of cerebral embolic events was assessed, as well as other TAVI-related complications.
In our study population 28 patients (37%) had aortic strands and 48 (63%) did not have them. A cerebral protection device was used in 4 patients of LEs group (14% vs 0, p=0.03). The mean procedural time was similar in the two groups 50±19 and 55±26 minutes (p=0.38) in LEs and no-LEs groups, respectively. The device success was achieved in 96% of LEs and 88% of no-LEs patients (p=0.37). Two patients of no-LEs group died during the procedure. Major complications were observed in both groups without any significant differences. Only one case of stroke occurred in the population without LEs (0 LEs vs 2% no-LEs, 0.78). No cases of peripheral embolism were observed.
In our population the observation of LEs is not uncommon. Despite the presumed high risk of embolism, we have not observed an increase in the rate of cerebral ischemic events or other TAVI related complications in patients with LEs.
In our population the observation of LEs is not uncommon. Despite the presumed high risk of embolism, we have not observed an increase in the rate of cerebral ischemic events or other TAVI related complications in patients with LEs.
Cognitive decline and dementia recognize multiple risk factors and pathophysiological mechanisms, often involved simultaneously with complex interactions. Several studies have shown that both arterial hypertension and hypotension are associated with a greater risk of cognitive decline and dementia, but clinical evidence on this point is conflicting. Our aim was to conduct an umbrella review on cognitive function, dementia, and blood pressure, with particular attention to epidemiological, prognostic and therapeutic aspects.
We conducted a dedicated literature search on PubMed for systematic reviews and meta-analyses that focused on arterial pressure, hypertension, hypotension and similar conditions, and cognitive function, cognitive decline and dementia. The internal validity of systematic reviews and meta-analyses was formally analysed using the OQAQ tool. The umbrella review was planned in accordance with current international recommendations and was described as specified by the PRISMA guidelines.
17 treatments.
To date, the evidence on the relationship between blood pressure, cognitive decline and dementia provides somewhat heterogeneous data. Further studies are clearly needed, with explicit inclusion criteria as objective as possible, adequate follow-up and precise characterization of implemented cardiovascular and cognitive treatments.
Permanent cardiac pacing is the therapy of choice for treating severe and/or symptomatic bradyarrhythmia. During the COVID-19 outbreak, it has been reported a decrease in the incidence of acute coronary syndrome, but few data are available about pacemaker implantation rates. This study aimed to analyse patients referred to our centre with permanent cardiac pacing indication during the COVID-19 outbreak.
We compared the number, the characteristics and the outcomes of patients who underwent urgent pacemaker implantation between March and April 2019 (Group I) with those performed in the corresponding 2020 period (Group II).
A total of 27 patients (Group I) were implanted in March-April 2019 and 34 patients (Group II) in the corresponding 2020 period. In both groups, about half of the patients received a dual-chamber pacemaker. No significant differences in baseline patients' characteristics were observed. The most frequent indication was advanced atrio-ventricular block with a prevalence of 78% and 62% in Group I and II, respectively. Polyinosinic acid-polycytidylic acid molecular weight The rate of procedural complications, the in-hospital and 1-month mortality were also similar between the two groups.
In our regional referral center, we observed a routine activity in terms of urgent pacemaker implantations for the treatment of symptomatic bradyarrhythmia during the COVID-19 outbreak.
In our regional referral center, we observed a routine activity in terms of urgent pacemaker implantations for the treatment of symptomatic bradyarrhythmia during the COVID-19 outbreak.
COPD patients have higher recurrence of adverse events and worse prognosis after acute coronary syndrome (ACS). The underlying pathophysiological mechanism is not fully elucidated.
In screening for COPD in ACS (SCAP) trial (NCT02324660), ACS patients with smoking habit underwent a predischarge screening procedure to detect undiagnosed chronic obstructive pulmonary disease (UCOPD) confirmed with spirometry at 60 days. Patients were then categorized as UCOPD or no-COPD. In 65 NSTE-ACS patients, we performed near infrared spectroscopy (NIRS) in the culprit and at least one non-culprit vessel (151 vessels overall), and we calculated the SYNTAX I score. Primary endpoint was max lipid core burden index (LCBI) 4 mm. Secondary endpoints were SYNTAX score I and vessel LCBI.
Max LCBI 4 mm and vessel LCBI were significantly higher in the UCOPD compared to the no-COPD group (UCOPD 388±122, no-COPD 264±131, p <0.001; UCOPD 118±50, no-COPD 82±42, p<0.001, respectively). UCOPD patients showed higher max LCBI 4 mm and LCBI vessel both in culprit and non-culprit vessels. SYNTAX score I was comparable between the two groups (UCOPD 13.5 [5.5-24], no-COPD 12.5 [5-24.5], p=0.7).
NSTE-ACS patients with UCOPD showed a higher LCBI compared to those without COPD, while SYNTAX score I was comparable between the two groups.
NSTE-ACS patients with UCOPD showed a higher LCBI compared to those without COPD, while SYNTAX score I was comparable between the two groups.
The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction who underwent PV isolation and its implication for AF catheter ablation.
Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure ≥ 15 mm Hg.
A total of 98 consecutive patients (71 males, 72%; mean age 60.3±8.4 years) were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 11.7±5.5 mmHg; LAH occurred in 24 (24.5%) patients. At a mean follow up of 14.6±7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.
Website: https://www.selleckchem.com/products/polyinosinic-acid-polycytidylic-acid.html
We sought to determine whether a prospective audit and feedback intervention decreased antibiotic utilization in a pediatric cardiac ICU and to describe the characteristics of prospective audit and feedback audits and recommendations.
Before-after study.
Pediatric cardiac ICU of a freestanding children's hospital.
All patients admitted to the cardiac ICU.
A prospective audit and feedback program was established in our hospital's pediatric cardiac ICU on December 7, 2015. The antimicrobial stewardship program audited IV antibiotics, communicated prospective audit and feedback recommendations to the cardiac ICU, and regularly reviewed recommendation adherence. Mean monthly antibiotic utilization 18 months before ("preprospective audit and feedback"; from June 1, 2014 to November 30, 2015) and 24 months after ("prospective audit and feedback"; from January 1, 2016 to December 31, 2017) prospective audit and feedback implementation was compared. Antibiotic audit data during the prospective audit and feetric cardiac ICU. Over one-third of antibiotics audited in our cardiac ICU were associated with a prospective audit and feedback recommendation, revealing important targets for future antimicrobial stewardship efforts in this population.
There was a significant reduction in antibiotic use following implementation of a prospective audit and feedback program in our pediatric cardiac ICU. Over one-third of antibiotics audited in our cardiac ICU were associated with a prospective audit and feedback recommendation, revealing important targets for future antimicrobial stewardship efforts in this population.
To determine the bivariable associations between abnormalities of 28 common laboratory tests and hospital mortality and determine how mortality risks changes when the ranges are evaluated in the context of commonly used laboratory test panels.
A 2009-2016 cohort from the Health Facts (Cerner Corporation, Kansas City, MO) database.
Hospitals caring for children in ICUs.
Children cared for in ICUs with laboratory data.
None.
There were 2,987,515 laboratory measurements in 71,563 children. The distribution of laboratory test values in 10 groups defined by population percentiles demonstrated the midrange of tests was within the normal range except for those measured predominantly when significant abnormalities are suspected. Logistic regression analysis at the patient level combined the population-based groups into ranges with nonoverlapping mortality odds ratios. The most deviant test ranges associated with increased mortality risk (mortality odds ratios > 5.0) included variables associated with apment.
The relative importance of laboratory test ranges vary widely, with some ranges strongly associated with mortality and others strongly associated with survival. When evaluated in the context of test panels rather than isolated tests, the mortality odds ratios for the test ranges decreased but generally remained significant as risk was distributed among the components of the test panels. These data are useful to develop critical values for children in ICUs, to identify risk factors previously underappreciated, for education and training, and for future risk score development.
To determine the impact of standardized PICU work rounds on the frequency of ideal teaming behaviors, rounds comprehensiveness, shared mental model index development, and rate of completed end-of-shift goals.
A single-center, pre-post, prospective cohort study.
A 259-bed, quaternary, pediatric referral center.
Children 0-18 years old from November 2018 to January 2020.
Standardized, bedside, nurse-led PICU work rounds, emphasizing ideal teaming behaviors using a collaboratively developed rounding script and quality/safety checklist.
Study data were collected by direct observation and immediate postrounds participant questionnaire data. Primary outcomes were frequency of observed ideal teaming behaviors, rounds comprehensiveness, efficiency (rounds content divided by duration), shared mental model index (congruence among rounds participants regarding key healthcare data and planning), rounds face validity, and achievement rate of rounds-established, end-of-shift goals. During study, 154 encounters noted a positive association between the shared mental model index and the rate of achieved rounds-established, end-of-shift goals (odds ratio, 8.9; 95% CI, 1.7-46; p < 0.01).
Standardization of PICU work rounds may encourage ideal teaming behaviors, enhance rounds comprehensiveness, strengthen the congruence of participant shared mental model, and affect the rate of achieved goals established during rounds without compromising workplace efficiency.
Standardization of PICU work rounds may encourage ideal teaming behaviors, enhance rounds comprehensiveness, strengthen the congruence of participant shared mental model, and affect the rate of achieved goals established during rounds without compromising workplace efficiency.
The role of aortic valve Lambl's excrescence (LEs) in determining ischemic events has not been well clarified, but they can represent a potential embolic source during procedures with catheter/device manipulation through the aortic valve. Aim of our study was to assess the prevalence of LEs and the rate of embolism in patients with aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI).
Our population was divided into two groups, named LEs and no-LEs. In each group, the rate of cerebral embolic events was assessed, as well as other TAVI-related complications.
In our study population 28 patients (37%) had aortic strands and 48 (63%) did not have them. A cerebral protection device was used in 4 patients of LEs group (14% vs 0, p=0.03). The mean procedural time was similar in the two groups 50±19 and 55±26 minutes (p=0.38) in LEs and no-LEs groups, respectively. The device success was achieved in 96% of LEs and 88% of no-LEs patients (p=0.37). Two patients of no-LEs group died during the procedure. Major complications were observed in both groups without any significant differences. Only one case of stroke occurred in the population without LEs (0 LEs vs 2% no-LEs, 0.78). No cases of peripheral embolism were observed.
In our population the observation of LEs is not uncommon. Despite the presumed high risk of embolism, we have not observed an increase in the rate of cerebral ischemic events or other TAVI related complications in patients with LEs.
In our population the observation of LEs is not uncommon. Despite the presumed high risk of embolism, we have not observed an increase in the rate of cerebral ischemic events or other TAVI related complications in patients with LEs.
Cognitive decline and dementia recognize multiple risk factors and pathophysiological mechanisms, often involved simultaneously with complex interactions. Several studies have shown that both arterial hypertension and hypotension are associated with a greater risk of cognitive decline and dementia, but clinical evidence on this point is conflicting. Our aim was to conduct an umbrella review on cognitive function, dementia, and blood pressure, with particular attention to epidemiological, prognostic and therapeutic aspects.
We conducted a dedicated literature search on PubMed for systematic reviews and meta-analyses that focused on arterial pressure, hypertension, hypotension and similar conditions, and cognitive function, cognitive decline and dementia. The internal validity of systematic reviews and meta-analyses was formally analysed using the OQAQ tool. The umbrella review was planned in accordance with current international recommendations and was described as specified by the PRISMA guidelines.
17 treatments.
To date, the evidence on the relationship between blood pressure, cognitive decline and dementia provides somewhat heterogeneous data. Further studies are clearly needed, with explicit inclusion criteria as objective as possible, adequate follow-up and precise characterization of implemented cardiovascular and cognitive treatments.
Permanent cardiac pacing is the therapy of choice for treating severe and/or symptomatic bradyarrhythmia. During the COVID-19 outbreak, it has been reported a decrease in the incidence of acute coronary syndrome, but few data are available about pacemaker implantation rates. This study aimed to analyse patients referred to our centre with permanent cardiac pacing indication during the COVID-19 outbreak.
We compared the number, the characteristics and the outcomes of patients who underwent urgent pacemaker implantation between March and April 2019 (Group I) with those performed in the corresponding 2020 period (Group II).
A total of 27 patients (Group I) were implanted in March-April 2019 and 34 patients (Group II) in the corresponding 2020 period. In both groups, about half of the patients received a dual-chamber pacemaker. No significant differences in baseline patients' characteristics were observed. The most frequent indication was advanced atrio-ventricular block with a prevalence of 78% and 62% in Group I and II, respectively. Polyinosinic acid-polycytidylic acid molecular weight The rate of procedural complications, the in-hospital and 1-month mortality were also similar between the two groups.
In our regional referral center, we observed a routine activity in terms of urgent pacemaker implantations for the treatment of symptomatic bradyarrhythmia during the COVID-19 outbreak.
In our regional referral center, we observed a routine activity in terms of urgent pacemaker implantations for the treatment of symptomatic bradyarrhythmia during the COVID-19 outbreak.
COPD patients have higher recurrence of adverse events and worse prognosis after acute coronary syndrome (ACS). The underlying pathophysiological mechanism is not fully elucidated.
In screening for COPD in ACS (SCAP) trial (NCT02324660), ACS patients with smoking habit underwent a predischarge screening procedure to detect undiagnosed chronic obstructive pulmonary disease (UCOPD) confirmed with spirometry at 60 days. Patients were then categorized as UCOPD or no-COPD. In 65 NSTE-ACS patients, we performed near infrared spectroscopy (NIRS) in the culprit and at least one non-culprit vessel (151 vessels overall), and we calculated the SYNTAX I score. Primary endpoint was max lipid core burden index (LCBI) 4 mm. Secondary endpoints were SYNTAX score I and vessel LCBI.
Max LCBI 4 mm and vessel LCBI were significantly higher in the UCOPD compared to the no-COPD group (UCOPD 388±122, no-COPD 264±131, p <0.001; UCOPD 118±50, no-COPD 82±42, p<0.001, respectively). UCOPD patients showed higher max LCBI 4 mm and LCBI vessel both in culprit and non-culprit vessels. SYNTAX score I was comparable between the two groups (UCOPD 13.5 [5.5-24], no-COPD 12.5 [5-24.5], p=0.7).
NSTE-ACS patients with UCOPD showed a higher LCBI compared to those without COPD, while SYNTAX score I was comparable between the two groups.
NSTE-ACS patients with UCOPD showed a higher LCBI compared to those without COPD, while SYNTAX score I was comparable between the two groups.
The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction who underwent PV isolation and its implication for AF catheter ablation.
Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure ≥ 15 mm Hg.
A total of 98 consecutive patients (71 males, 72%; mean age 60.3±8.4 years) were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 11.7±5.5 mmHg; LAH occurred in 24 (24.5%) patients. At a mean follow up of 14.6±7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.
Website: https://www.selleckchem.com/products/polyinosinic-acid-polycytidylic-acid.html
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