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Comparisons of risk factors and outcomes between abdominal aortic aneurysm and peripheral arterial disease: a case-control study

American journal of medicine open

Pub Date : 2025-01-14 DOI: 10.1016/j.ajmo.2025.100087

Ian Beeton , Jay Acharya , Bengisu Kesin Meric , James Hobden , Tahir Ali , Thang S. Han

Background

There is a paucity of data on direct comparison of clinical measures in patients with abdominal aortic aneurysm (AAA) and those with peripheral arterial disease (PAD). Here, we examine the risk factors and outcomes between these 2 conditions.

Methods

Group differences were examined by Fisher's exact tests with Bonferroni correction, postoperative complications (including delirium and pneumonia) and LOS by logistic regression, and mortality by Cox regression, adjusted for age, sex, smoking, co-morbidities and medications.

Results

In total, 160 men and 33 women aged 74.5years (SD = 9.4) were referred for preoperative cardiac assessment for AAA (n = 70) and PAD (n = 123). Vascular surgery was performed in 148 patients (70% of AAA; 80.5% of PAD). Myocardial infarct was more prevalent in AAA, and diabetes more in PAD, whilst atrial fibrillation, stroke, congestive heart failure and hypertension did not differ between groups. Compared to patients with PAD, there were higher proportions of patients with AAA prescribed with cardiovascular medications, and developed post-operative complications in hospital: odds ratio = 7.34 (95% CI, 2.26-23.84, P < .001), and stayed in hospital >1week: odds ratio = 2.60 (95% CI, 1.15-5.85, P = .021). Compared to those with AAA, patients with PAD were at greater risk of death in the entire sample: hazard ratio = 3.34 (95% CI, 1.64-6.79), and in those who underwent vascular surgery: hazard ratio = 4.90 (95% CI, 1.88-12.79). Left ventricular function did not relate to outcomes.

Conclusions

Differences between AAA and PAD in risk profile and management which may have a bearing on higher risk of death associated with PAD. More intensive cardiovascular management may help improve their outcomes.

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引用次数: 0

Development of a New Malnutrition Screening Tool for Patients: Human Key Tool of Nutrition

American journal of medicine open

Pub Date : 2025-01-04 DOI: 10.1016/j.ajmo.2024.100086

Kotono Oishi MSc, Arisa Inoue-Hamano PhD, Yasuhiro Hamada MD,PhD

Background and aims

Malnutrition is related to increased mortality and poor outcome. Therefore, early diagnosis and intervention of malnutrition are recommended. However, the optimal nutrition screening tool for diagnosing malnutrition remains undetermined. This study aimed to verify the discrimination and difficulty of nutrition screening items through item response theory (IRT) analysis and develop a simpler malnutrition screening tool.

Methods

This study enrolled 10,375 patients aged ≥18 years who were admitted at Tokushima University Hospital. Patients who were pregnant had short-term hospitalization (≤3 days), were hospitalized only in the weekend, could not hear clearly, and were hospitalized merely for examination were excluded. A skilled dietitian performed the Subjective Global Assessment, rating a good nutritional status as A, moderate malnutrition as B, and severe malnutrition as C.

Results

According to Subjective Global Assessment, we classified 7119 patients as A, 2892 as B, and 364 as C. Between these classes, the total number of application items was significantly lower in class A but significantly higher in class C. In the discrimination of each item calculated by IRT analysis, the highest discrimination item was “Has your food intake been less than usual?”, followed by “Have you had anorexia?”, “Have you had vomiting?”, “Have you had nausea?”, “Have you had dehydration?”, and “Have you lost weight?”.

Conclusions

Human Key Tool of Nutrition, which is based on the IRT analysis results, is a new simple nutrition screening tool developed by us. Human Key Tool of Nutrition can contribute to the widespread use of nutrition screening.

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引用次数: 0

Hyponatremia with an Osmolar Gap, Pseudohyponatremia or Hyper-Osmolar Hyponatremia? 低钠血症伴渗隙，假性低钠血症还是高渗性低钠血症？

American journal of medicine open

Pub Date : 2024-12-07 DOI: 10.1016/j.ajmo.2024.100081

Leonardo Pozo Garcia , Livia Frost , Bryan M. Tucker

Pseudohyponatremia is frequently misunderstood and often mistaken for other types of hyponatremia. In this study, we present a case of pseudohyponatremia resulting from hypertriglyceridemia. We provide an in-depth analysis of the pathophysiological mechanisms involved, comparing them with those of other hyponatremic disorders, and outline the diagnostic approach used to identify this atypical form of hyponatremia. Recognizing and accurately diagnosing non–hypo-osmolar hyponatremia is paramount, as these conditions are treated differently than other forms of hyponatremia.

假性低钠血症经常被误认为是其他类型的低钠血症。在这项研究中，我们提出了一例由高甘油三酯血症引起的假性低钠血症。我们提供了一个深入的病理生理机制的分析，比较他们与其他低钠血症疾病，并概述了诊断方法用于识别这种非典型形式的低钠血症。识别和准确诊断非低渗性低钠血症是至关重要的，因为这些情况的治疗与其他形式的低钠血症不同。

引用次数: 0

Gun-related mortality in children- seeing past geography 儿童与枪支有关的死亡率——看过去的地理

American journal of medicine open

Pub Date : 2024-12-01 DOI: 10.1016/j.ajmo.2022.100021

Stuart R. Chipkin MD

引用次数: 0

The David Sign, Revisited 大卫标志，重访

American journal of medicine open

Pub Date : 2024-12-01 DOI: 10.1016/j.ajmo.2023.100061

Daniel M. Gelfman MD

This commentary discusses a new, previously unrecognized, undocumented, anatomic finding concerning the jugular venous distention present on one of the world’s most famous statues, Michelangelo’s David. This finding is provocative as it involves of one of Michelangelo’s “messages” being demonstrated in The David, has clinical relevance, and, appears to reveal something about Michelangelo, himself.

引用次数: 0

Use of a Nutritional Risk Assessment Tool to Guide Early Enteral Nutrition among Mechanically Ventilated Trauma Patients 使用营养风险评估工具指导机械通气创伤患者早期肠内营养。

American journal of medicine open

Pub Date : 2024-11-22 DOI: 10.1016/j.ajmo.2024.100080

Julia Heizmann , Christopher Gross , Chelsea Yap , Mary Anne Walling , Moya Reid , Albert Hsu , Marie Crandall , Jin Ra

Background

The Modified Nutritional Risk in Critically Ill (mNUTRIC) score has been proposed as a tool to identify hospitalized patients at risk for malnutrition who may benefit from early enteral nutrition (EN) therapy.

Objective

Our goal was to determine if mNUTRIC scores could predict, at time of intensive care unit admission, which mechanically ventilated trauma patients were at risk for malnutrition and might benefit from early EN, as indicated by reduced mortality.

Methods

We conducted a retrospective chart review of all adult trauma patients requiring mechanical ventilation for at least 48 hours between 01/21/2012 and 12/31/2016, reviewing inpatient medical records, demographic data, disease markers, injury severity, and comorbidities. Bivariate statistics and multivariate regression analyses were used to investigate the correlation between time of EN initiation and mortality rates, as well as the relationship of mNUTRIC scores with EN commencement with early EN initiation being ≤48 hours and malnutrition risk mNUTRIC ≥5.

Results

Among 931 patients reviewed, bivariate analysis showed higher mNUTRIC scores correlated with older, sicker patients and higher mortality. However, multivariate analysis revealed no significant association between higher mNUTRIC scores and increased mortality (OR 1.2, 95% CI 0.7-2.1, p=0.52). Although most patients received EN within 48 hours, there was no association between mNUTRIC score and timing of EN initiation after adjusting for demographic variables and illness severity.

Conclusions

Our findings indicate that while the mNUTRIC score can effectively identify malnutrition risk, it does not meaningfully inform early EN initiation timing nor predict mortality in mechanically ventilated trauma patients.

背景：危重症患者改良营养风险（mNUTRIC）评分已被提出作为一种工具来识别有营养不良风险的住院患者，这些患者可能受益于早期肠内营养（EN）治疗。目的：我们的目的是确定在重症监护病房入院时，mNUTRIC评分是否可以预测机械通气创伤患者是否有营养不良的风险，并可能从早期EN中获益，这表明死亡率降低。方法：回顾性分析2012年1月21日至2016年12月31日期间所有需要机械通气至少48小时的成人创伤患者，回顾住院病历、人口统计资料、疾病标志物、损伤严重程度和合并症。采用双变量统计和多变量回归分析，探讨EN起始时间与死亡率的相关性，以及EN起始时间≤48小时、营养不良风险mNUTRIC≥5分与EN起始时间的关系。结果：在931例患者中，双变量分析显示，较高的mNUTRIC评分与年龄较大、病情较重的患者和较高的死亡率相关。然而，多变量分析显示较高的mNUTRIC评分与死亡率增加之间没有显著关联（OR 1.2, 95% CI 0.7-2.1, p=0.52）。虽然大多数患者在48小时内接受了EN，但在调整人口统计学变量和疾病严重程度后，mNUTRIC评分与EN开始时间之间没有关联。结论：我们的研究结果表明，尽管mNUTRIC评分可以有效地识别营养不良风险，但它并不能为机械通气创伤患者的早期EN起始时间提供有意义的信息，也不能预测死亡率。

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引用次数: 0

Lessons Learned From the Liver About the Undergraduate to Graduate Medical Education Transition 从肝脏学到的关于本科到研究生医学教育转型的经验教训。

American journal of medicine open

Pub Date : 2024-11-05 DOI: 10.1016/j.ajmo.2024.100079

Alexander Y. Pan , Pedram J. Khorsandi , Jeanne M. Farnan , Margarita N. German , Pranab M. Barman , Madeline A. Berschback , Michael Kriss , Ross McMillan , Omar Mousa , Frederick B. Peng , Tejinder Randhawa , Kamilah Scales , Adam E. Mikolajczyk

The burden of cirrhosis and chronic liver disease is growing, yet there is a projected worsening deficit in hepatology providers. As such, cirrhosis and liver disease have been important inclusions within the core curricula of Internal Medicine. Formal assessments of provider preparedness resulting from the curriculum are lacking though. Prior studies have demonstrated that exposure to cirrhosis in undergraduate medical education is insufficient, as are learner comfort and self-reported knowledge levels. These findings are further corroborated by a multicenter survey of incoming Internal Medicine interns showing that subjective comfort with and objective knowledge of various liver disease topics are lacking compared to other common Internal Medicine topics. This paper also demonstrates how similar surveys may be used to identify additional topics that may require adjustments for curricular improvement.

肝硬化和慢性肝病的负担正在增加，但肝病提供者的预期赤字正在恶化。因此，肝硬化和肝病已成为内科核心课程的重要内容。然而，缺乏对课程所产生的提供者准备情况的正式评估。先前的研究表明，在本科医学教育中，肝硬化的曝光是不够的，学习者的舒适度和自我报告的知识水平也是不够的。这些发现得到了一项多中心调查的进一步证实，该调查显示，与其他常见的内科主题相比，内科实习生缺乏对各种肝病主题的主观舒适度和客观知识。本文还演示了如何使用类似的调查来确定可能需要调整课程改进的其他主题。

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引用次数: 0

Postacute Sequelae of COVID-19 in Pediatric Patients Within the United States: A Scoping Review 美国儿童患者 COVID-19 后遗症：范围审查

American journal of medicine open

Pub Date : 2024-09-26 DOI: 10.1016/j.ajmo.2024.100078

Christine M. Miller , Carla Borre , Alex Green , Melissa Funaro , Carlos R Oliveira , Akiko Iwasaki

A subset of children and adolescents experience recurrent or persistent symptoms following SARS-CoV-2 infection, known as postacute sequelae of COVID-19 (PASC), however, the clinical epidemiology within the United States (US) is not yet well understood. This scoping review aims to synthesize the clinical epidemiology of pediatric PASC in the US. A comprehensive literature search was conducted and databases were queried from inception until January 29, 2024. Studies including US children and adolescents <21 years old were considered. From 1028 studies identified, 29 met the inclusion criteria. Prevalence of PASC ranged from less than 1%-27%. Risk factors included older age, female sex, asthma, obesity, and severe initial infection. Common symptoms were dyspnea, fatigue, headaches, and chest pain. A multidisciplinary approach for diagnosis and management was common across studies. Most studies had a high risk of bias and were limited by a lack of standardized definitions and short follow-up duration. This review establishes a foundation for understanding pediatric PASC and highlights the critical need for continued research to optimize prevention and treatment strategies.

一部分儿童和青少年在感染 SARS-CoV-2 后会出现反复或持续性症状，即 COVID-19 急性后遗症 (PASC)，但美国的临床流行病学尚不十分清楚。本范围综述旨在总结美国儿科 PASC 的临床流行病学。我们进行了全面的文献检索，并查询了从开始到 2024 年 1 月 29 日的数据库。研究对象包括美国 21 岁的儿童和青少年。在确定的 1028 项研究中，有 29 项符合纳入标准。PASC的发病率从不到1%到27%不等。风险因素包括年龄偏大、性别为女性、哮喘、肥胖和初期严重感染。常见症状为呼吸困难、疲劳、头痛和胸痛。各研究均采用多学科方法进行诊断和管理。大多数研究存在较高的偏倚风险，并因缺乏标准化定义和随访时间较短而受到限制。本综述为了解儿科 PASC 奠定了基础，并强调了继续开展研究以优化预防和治疗策略的迫切需要。

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引用次数: 0

Coaching People with Cardiovascular Disease to Close Their “Treatment Gaps” Reduces Hospital Utilization, Saves Lives, and Delivers Net Cost Savings Over 10 Years 指导心血管疾病患者缩小 "治疗差距"，可降低医院使用率、挽救生命，并在 10 年内实现净成本节约

American journal of medicine open

Pub Date : 2024-08-16 DOI: 10.1016/j.ajmo.2024.100075

Joshua Byrnes , Margarite J. Vale , Clifford Afoakwah , Pippa Grant , Sharmani Barnard

Background

Disease management programs are an essential tool in the fight against rising prevalence and costs associated with cardiovascular disease (CVD). However, there is a lack of evidence on the long-term impact of these programs on clinical outcomes, healthcare utilization, and cost. This study presents a long-term follow up of clinical, healthcare utilization and cost, and mortality consequences of The COACH Program, a 6-month telephone delivered CVD prevention program.

Methods

We conducted 10-year retrospective propensity score matched cohort study of potentially eligible participants comparing individuals that participated to those that did not receive the Program. Primary outcomes of interest were differences in mortality, private healthcare utilization and cost of private healthcare utilization sourced from private health insurance claims data.

Results

Of the 24,932 potentially eligible participants, 11,988 were invited to participate in The COACH Program between July 1, 2010, and December 31, 2020. The COACH Program participants (n = 2,271) were 1:1 matched with individuals who did not participate in the Program. Participation in The COACH Program was associated with a 34% reduction in the risk of mortality (HR: 0.66, 95% CI: 0.54, 0.79), an 8% reduction in the number of hospitalizations (IRR: 0.92, 95% CI: 0.85, 0.98), and an annual reduction in healthcare costs of $1,499 (95% CI: $1,909, $1,087). Results were robust to sensitivity analyses.

Conclusions

A structured 6-month telephone delivered coaching program focused on closing “treatment gaps” in people with a history of CVD saves lives and reduces hospital utilization, health care costs over 10-years follow-up.

背景疾病管理计划是应对心血管疾病（CVD）发病率和相关费用上升的重要手段。然而，关于这些项目对临床结果、医疗利用率和成本的长期影响却缺乏证据。本研究对 COACH 计划（一项为期 6 个月的电话心血管疾病预防计划）的临床结果、医疗保健利用率和成本以及死亡率进行了长期跟踪研究。方法我们对可能符合条件的参与者进行了为期 10 年的回顾性倾向得分匹配队列研究，比较了参与该计划的个人与未参与该计划的个人。研究的主要结果是死亡率、私人医疗保健使用率和私人医疗保健使用成本的差异，这些数据来源于私人医疗保险理赔数据。结果在 24932 名可能符合条件的参与者中，有 11988 人受邀在 2010 年 7 月 1 日至 2020 年 12 月 31 日期间参加 COACH 计划。COACH 计划参与者（n = 2,271 人）与未参加该计划的个人进行了 1:1 匹配。参加 COACH 计划可使死亡风险降低 34%（HR：0.66，95% CI：0.54, 0.79），住院次数减少 8%（IRR：0.92，95% CI：0.85, 0.98），每年医疗费用减少 1,499 美元（95% CI：1,909 美元，1,087 美元）。结论一项为期 6 个月的结构化电话指导计划侧重于缩小有心血管疾病史者的 "治疗差距"，在 10 年的随访过程中，可挽救生命并降低医院使用率和医疗费用。

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引用次数: 0

Characterization of Change in Cognition Before and After COVID-19 Infection in Essential Workers at Midlife 中年基本劳动者感染 COVID-19 前后认知变化的特点

American journal of medicine open

Pub Date : 2024-08-13 DOI: 10.1016/j.ajmo.2024.100076

Zennur Sekendiz , Olga Morozova , Melissa A. Carr , Ashley Fontana , Nikhil Mehta , Alina Ali , Eugene Jiang , Tesleem Babalola , Sean A.P. Clouston , Benjamin J. Luft

Background

Research into COVID-19-related cognitive decline has focused on individuals who are cognitively impaired following hospitalization for COVID-19. Our objective was to determine whether cognitive decline emerged after the onset of COVID-19 and was more pronounced in patients with postacute sequelae of SARS-CoV-2 infection (PASC).

Methods

We analyzed longitudinal cognitive data collected during a cohort study of essential workers at midlife that continued through the COVID-19 pandemic. We used longitudinal discontinuity models, a form of causal modeling, to examine the change in cognitive performance among 276 participants with COVID-19 in comparison to contemporaneously-collected information from 217 participants who did not have COVID-19. Cognitive performance across four domains was measured before and after the pandemic. Eligible study participants were those with validated COVID-19 diagnoses who were observed before having a verified COVID-19 infection who survived their initial infection, and for whom post-COVID-19 information was also available.

Results

The mean age of the COVID-19 group was 56.0 ± 6.6 years old, while the control group was 58.1 ± 7.3 years old. Longitudinal models indicated a significant decline in cognitive throughput (β = -0.168, P = .001) following COVID-19, after adjustment for pre-COVID-19 functioning, demographics, and medical factors. Associations were larger in those with more severe COVID-19 and those who reported PASC. Observed changes in throughput were equivalent to 10.6 years of normal aging.

Conclusion

Findings from this longitudinal causal modeling study revealed that COVID-19 and PASC appeared to cause clincially relevant cognitive deterioration.

背景对COVID-19相关认知功能下降的研究主要集中在因COVID-19住院后认知功能受损的患者身上。我们的目的是确定认知能力下降是否在 COVID-19 爆发后出现，以及是否在 SARS-CoV-2 感染急性后遗症（PASC）患者中更为明显。方法我们分析了在一项针对中年基本工人的队列研究中收集的纵向认知数据，该研究一直持续到 COVID-19 大流行期间。我们使用纵向不连续性模型（一种因果建模形式）研究了 276 名感染 COVID-19 的参与者与 217 名未感染 COVID-19 的参与者的同期资料相比认知能力的变化。研究人员对大流行前后四个领域的认知能力进行了测量。符合条件的研究参与者是那些在感染 COVID-19 病毒之前就已被确诊为 COVID-19 病毒的人，他们在最初感染 COVID-19 病毒后存活了下来，而且还能获得 COVID-19 病毒感染后的信息。结果COVID-19病毒感染组的平均年龄为（56.0 ± 6.6）岁，而对照组为（58.1 ± 7.3）岁。纵向模型显示，在对 COVID-19 前的功能、人口统计学和医疗因素进行调整后，COVID-19 后认知吞吐量明显下降（β = -0.168，P = .001）。在 COVID-19 更严重和报告 PASC 的人群中，相关性更大。观察到的吞吐量变化相当于正常衰老 10.6 年。结论这项纵向因果建模研究的结果显示，COVID-19 和 PASC 似乎会导致与临床相关的认知功能退化。

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