Nevin Manimala

West J Emerg Med. 2021 Feb 8;22(2):234-243. doi: 10.5811/westjem.2020.12.49234.

ABSTRACT

INTRODUCTION: To describe the impact of COVID-19 on a large, urban emergency department (ED) in Los Angeles, California, we sought to estimate the effect of the novel coronavirus 2019 (COVID-19) and “safer-at-home” declaration on ED visits, patient demographics, and diagnosis-mix compared to prior years.

METHODS: We used descriptive statistics to compare ED volume and rates of admission for patients presenting to the ED between January and early May of 2018, 2019, and 2020.

RESULTS: Immediately after California’s “safer-at-home” declaration, ED utilization dropped by 11,000 visits (37%) compared to the same nine weeks in prior years. The drop affected patients regardless of acuity, demographics, or diagnosis. Reductions were observed in the number of patients reporting symptoms often associated with COVID-19 and all other complaints. After the declaration, higher acuity, older, male, Black, uninsured or non-Medicaid, publicly insured, accounted for a disproportionate share of utilization.

CONCLUSION: We show an abrupt, discontinuous impact of COVID-19 on ED utilization with a slow return as safer-at-home orders have lifted. It is imperative to determine how this reduction will impact patient outcomes, disease control, and the health of the community in the medium and long terms.

PMID:33856306 | DOI:10.5811/westjem.2020.12.49234

West J Emerg Med. 2020 Dec 7;22(2):204-212. doi: 10.5811/westjem.2020.9.47840.

ABSTRACT

INTRODUCTION: Our objective was to determine the proportion of patients in our emergency department (ED) who are unhoused or marginally housed and when they typically present to the ED.

METHODS: We surveyed patients in an urban, safety-net ED from June-August 2018, using a sampling strategy that met them at all times of day, every day of the week. Patients used two social needs screening tools with additional questions on housing during sampling shifts representing two full weeks. Housing status was determined using items validated for housing stability, including PRAPARE, the Accountable Health Communities Survey, and items from the United States Department of Health and Human Services. Propensity scores estimated differences among respondents and non-respondents.

RESULTS: Of those surveyed, 35% (95% confidence interval [CI], 31-38) identified as homeless and 28% (95% CI, 25-31) as unstably housed. Respondents and non-respondents were similar by propensity score. The average cumulative number of homeless and unstably housed patients arriving per daily 8-hour window peaks at 7 AM, with 46% (95% CI, 29-64) of the daily aggregate of those reporting homelessness and 44% (95% CI, 24-64) with unstable housing presenting over the next eight hours.

CONCLUSION: The ED represents a low-barrier contact point for reaching individuals experiencing housing challenges, who may interact rarely with other institutions. The current prevalence of homelessness and housing instability among urban ED patients may be substantially higher than reported in historical and national-level statistics. Housing services offered within normal business hours would reach a meaningful number of those who are unhoused or marginally housed.

PMID:33856301 | DOI:10.5811/westjem.2020.9.47840

West J Emerg Med. 2021 Jan 29;22(2):156-162. doi: 10.5811/westjem.2020.11.49030.

ABSTRACT

INTRODUCTION: We sought to examine the utility of self-reported pain scale by comparing emergency department (ED) triage pain scores of self-reported but non-verifiable painful conditions with those of verifiable painful conditions using a large, nationally representative sample.

METHODS: We analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) 2015. Verifiable painful conditions were identified based on the final diagnoses in the five included International Classification of Diseases 9th revision codes. Non-verifiable painful conditions were identified by the five main reasons for visit. Only adults 18 years of age or older were included. The primary outcome variable was the pain scale from 0 to 10 at triage. We performed descriptive and multivariate analyses to investigate the relationships between the pain scale and whether the painful condition was verifiable, controlling for patient characteristics.

RESULTS: There were 55 million pain-related adult ED visits in 2015. The average pain scale was 6.49. For verifiable painful diagnoses, which were about 24% of the total visits, the average was 6.27, statistically significantly lower than that for non-verifiable painful conditions, 6.56. Even after controlling for the confounding of patient characteristics and comorbidities, verifiable painful diagnoses still presented less pain than those with non-verifiable painful complaints. Older age, female gender, and urban residents had significantly higher pain scores than their respective counterparts, controlling for other confounding factors. Psychiatric disorders were independently associated with higher pain scores by about a half point.

CONCLUSION: Self-reported pain scales obtained at ED triage likely have a larger psychological component than a physiological one. Close attention to clinical appropriateness and overall patient comfort are more likely to lead to better health outcomes and patient experiences than focusing on self-reported pain alone.

PMID:33856295 | DOI:10.5811/westjem.2020.11.49030

Leuk Lymphoma. 2021 Apr 15:1-16. doi: 10.1080/10428194.2021.1907371. Online ahead of print.

ABSTRACT

Relapsed/refractory diffuse large B-cell lymphoma (DLBCL) is difficult to cure; non-germinal center B-cell-like (non-GCB) and activated B-cell-like (ABC) DLBCL have worse outcomes than GCB DLBCL. Ibrutinib and lenalidomide are synergistic in vitro in ABC DLBCL and may augment salvage chemotherapy. In part 1 of this phase 1b/2 study (NCT02142049), patients with relapsed/refractory DLBCL received ibrutinib 560 mg and escalating doses of lenalidomide on Days 1-7 with DA-EPOCH-R (Days 1-5) in 21-day cycles. In part 1 (N = 15), the maximum tolerated dose was not reached with lenalidomide 25 mg (recommended part 2 dose [RP2D]); most common grade ≥3 adverse events were anemia (73%) and febrile neutropenia (47%); the overall response rate (ORR) was 40%. At the RP2D (n = 26), ORR was 71% in non-GCB and 64% in ABC. Ibrutinib and lenalidomide with DA-EPOCH-R had a manageable safety profile and antitumor activity in relapsed/refractory DLBCL, especially the non-GCB subtype.

PMID:33856277 | DOI:10.1080/10428194.2021.1907371

Biomark Med. 2021 Apr 15. doi: 10.2217/bmm-2020-0615. Online ahead of print.

ABSTRACT

Aim: The study sought to determine the patterns of N-glycan profiles among Type 2 diabetes mellitus (T2DM) patients over a 6-month period. Materials & methods: Biochemical and clinical data were obtained from 253 T2DM patients at baseline and follow-up. Ultra-performance liquid chromatography and statistical methods were applied for N-glycan profiling. Results: The coefficients of variation were 28% and 29% at baseline and follow-up, respectively, whereas the range of N-glycan variability was from 11% to 56%. Apart from GP1 (FA2) and GP29 (FA3G3S [3,3,3]3), the intra-individual variations of N-glycan peaks were not statistically significant. Conclusion: N-glycan profiles were stable over 6-month period in T2DM patients and could be used to monitor biochemical changes in relation with T2DM comorbidities.

PMID:33856266 | DOI:10.2217/bmm-2020-0615

Int J Low Extrem Wounds. 2021 Apr 15:15347346211002351. doi: 10.1177/15347346211002351. Online ahead of print.

ABSTRACT

Venous leg ulcers (VLUs) are the most common chronic wound types in older populations, with many wounds not healing in the normal trajectory. Many older people with wounds are treated in their homes, currently assessed by monitoring the wound area over weeks to ascertain the potential for healing. A noncontact method using thermal imaging has been shown to predict the healing trajectory of diabetes-related foot ulcers, although has not been tested in VLU or the home setting. This project investigated the effectiveness of using thermal imaging to predict VLU healing in the homes of participants. Images of 78 ulcers were collected weekly using a thermal camera from 67 participants in their homes, at 5 consecutive time points. Final follow-up calls were undertaken at 12 weeks to ascertain healing status (healed/unhealed). Images were preprocessed and segmented and the area of the region of the wound was extracted. Kruskal-Wallis tests were performed to test the association of the change of areas over the 5 consecutive weeks with the healing status of the ulcers at 12 weeks. The 95% confidence interval plots were obtained to study the distribution of the area in the healed and unhealed cases. This study found that the difference in the imaged areas between unhealed ulcers at 12 weeks did not reach statistical significance using thermal imaging. Therefore, thermal images could not predict healing progression in VLUs when the images were taken in the homes of participants. Future research to improve the prediction of venous leg ulcer healing should include developing a protocol to standardize conditions, improve imaging process methods, and use machine learning.

PMID:33856237 | DOI:10.1177/15347346211002351

Am Fam Physician. 2021 Apr 15;103(8):453.

NO ABSTRACT

PMID:33856175

Prosthet Orthot Int. 2021 Mar 23. doi: 10.1097/PXR.0000000000000013. Online ahead of print.

ABSTRACT

BACKGROUND: There are alternative transfemoral (TF) socket interface designs that have not been compared with the standard of care, ischial ramus containment (IRC). The interface directly affects performance.

OBJECTIVES: To compare 3 TF interface designs, IRC, dynamic socket (DS), and subischial (Sub-I), regarding gait, balance, mobility, and preference. The authors hypothesized that these more active users may experience gait, mobility, and preference benefits from the less intrusive DS and Sub-I interface designs.

STUDY DESIGN: Single-blind, repeated-measures, 3-period randomized controlled crossover clinical trial.

METHODS: People with unilateral TF amputation with 1 year or longer prosthesis use experience, independent community ambulatory status, 18 to 60 years of age, of any race or ethnicity, with a body mass of 45 to 125 kg, and with a self-reported ability to walk for 20 minutes continuously were included in the study. Each participant was fit in all 3 interface designs.

RESULTS: Thirteen participants completed the clinical trial. Velocity, cadence, mobility, and balance were not statistically different between the 3 socket conditions. The DS demonstrated significantly greater symmetry in swing, stance, single support percentage, and toe angle compared with IRC and Sub-I. Sixty days after study completion, 7 participants changed interfaces, trending away from IRC.

CONCLUSIONS: Large differences were not observed. Small differences in spatiotemporal gait measures combined with patient preference may make a meaningful difference to individual patients and should be considered.

PMID:33856157 | DOI:10.1097/PXR.0000000000000013

Prosthet Orthot Int. 2021 Mar 25. doi: 10.1097/PXR.0000000000000008. Online ahead of print.

ABSTRACT

BACKGROUND: The medical community demands evidence for the benefits of medical devices such as bone-anchored prostheses (BAPs). MedTech20 is a novel instrument aiming to address general benefits of medical devices.

OBJECTIVE: To describe general patient-reported benefits of BAPs measured with MedTech20.

STUDY DESIGN: This is a cross-sectional descriptive survey.

METHODS: Patients treated in Sweden who had used a BAP for >1 year were mailed the MedTech20 Questionnaire. Responses to each attribute were described, and the MedTech20 Index (0-1), in which a higher figure represents larger benefits from the product, was calculated. Index values were compared based on demographic variables (sex, unilateral or bilateral transfemoral amputation (TFA), and those having experienced any complication of implant parts or the prosthetic connection device).

RESULTS: The response rate was 72%. The 62 participants (41 men and 21 women; mean age 57 years) had 11 ± 6.9 mean years of BAP experience. Single attributes stated as highly relevant and with high benefit for BAPs included perceived reliability, perceived safety, sense of control of the disability, facilitation of movement outside home, no discomfort at use, and ease of use. Attributes with less relevance included aid to remember tasks, reduction of barriers to a good sleep, and reduced sense of compromised integrity. The MedTech20 Index was 0.655 ± 0.188 and was not statistically significantly different based on any of the demographic variables.

CONCLUSIONS: By using a general measure on attributes of medical devices, this study provides new insights strengthening the evidence regarding the benefits that BAPs provide for patients with TFA who had difficulties with socket-suspended prostheses.

PMID:33856153 | DOI:10.1097/PXR.0000000000000008

Minerva Gastroenterol (Torino). 2021 Apr 15. doi: 10.23736/S2724-5985.21.02826-9. Online ahead of print.

ABSTRACT

BACKGROUND: There have been long debates on the introduction of proton pump inhibitors into acute pancreatitis therapy as standard treatment.

SETTINGS AND DESIGN: The aim of the study was to assess endoscopic lesions of the upper gastrointestinal tract in patients hospitalized for acute pancreatitis.

METHODS AND MATERIAL: We carried out a prospective analysis of patients hospitalized in one surgical centre who had an upper gastrointestinal tract endoscopic examination performed during the first 48 hours of hospitalization.

STATISTICAL ANALYSIS USED: We performed analysis of basic descriptive statistics along with the Shapiro-Wilk test, logistic order regression analysis, one-way analysis of variance, and Student’s t-test for independent trials.

RESULTS: From January 2016 to December 2019, 476 patients were hospitalized because of acute pancreatitis. The upper gastrointestinal tract endoscopic examination was performed in 85 patients (n) in the first 48 hours. From the examined group 45 patients (52.94%) developed mild acute pancreatitis, 28 (32.94%) – moderate pancreatitis and 12 (14.12%) – severe pancreatitis. Lesions in the endoscopic imaging were observed in 80 patients (94.12%).

CONCLUSIONS: A very high percentage of patients hospitalized for acute pancreatitis present lesions in the endoscopic imaging of the upper gastrointestinal tract. The standard treatment of AP is the administration of non-steroidal anti-inflammatory drugs, which themselves can cause gastric and duodenal mucosal defects. All these factors indicate the need for standard use of proton pump inhibitors in patients hospitalized for acute pancreatitis.

PMID:33856142 | DOI:10.23736/S2724-5985.21.02826-9