Baylor University Medical Center Proceedings最新文献

Purpose: Herpes zoster ophthalmicus (HZO) following COVID-19 vaccination has been reported previously but the clinical characteristics, onset, treatment, and outcomes of these cases have not been previously systematically reviewed.

Methods: A systematic review, guided by PRISMA guidelines, surveyed PubMed and Embase databases from April 2021 to June 2023 for case reports and series detailing HZO following COVID-19 vaccination. Studies excluded were abstracts, reviews, and clinical trials. A subsequent descriptive analysis was performed, focusing on patient demographics, clinical characteristics, and outcomes.

Results: Sixteen publications involving 27 participants who developed HZO post-COVID-19 vaccination met the inclusion criteria. The onset of HZO averaged 13 days (SD 12) postvaccination, predominantly after the first dose (n = 20/27 HZO cases, 74%). Most patients (70%) had preexisting medical conditions. Antiherpetic antiviral therapy was utilized in all cases, with the majority achieving resolution of cutaneous and ocular symptoms. Long-term sequelae included postherpetic neuralgia in 7.4% of patients.

Conclusion: Cases of HZO following COVID-19 vaccination generally mirror the clinical trajectory of HZO in general. This review focused on case reports describing HZO occurring in an interval postvaccination; neither association nor causation can be addressed methodologically.

Introduction: The heart team approach is now the standard of care for patients with complex coronary artery disease; however, the definition of a heart team is variable. We embarked on a project to create an extended, multidisciplinary heart team to evaluate patients we deemed high risk for coronary revascularization. In doing so, we created a new service, workflow, and paradigm.

Methods: Herein, we describe the process through which we created our high-risk percutaneous coronary intervention team, our criteria for determining risk, our process for evaluating these patients, and quality assurance. Additionally, we describe the design of our prospective study assessing 200 patients with complex coronary artery disease. The primary outcomes include the final heart team revascularization decision, all-cause mortality, major adverse cardiac events, acute kidney injury, postintervention bleeding, and length of stay.

Conclusion: Establishing a multidisciplinary heart team may help with complex and high-risk patient and family scenarios and potentially improve patient outcomes. A study has been initiated to test this hypothesis formally.

Introduction: There is a paucity of information regarding providers' attitudes toward gastric-protective strategies with concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs). We aimed to assess gastric-protective strategies used upon prescribing NSAIDs and providers' awareness of societal guidelines for preventing NSAID-induced gastric complications.

Methods: A standardized 10-item questionnaire was sent to all orthopedic providers in North Carolina and South Carolina. The survey design and refinement were based on a literature review, item generation, and small and large focus group discussions.

Results: Forty-two orthopedists responded to the survey (response rate 16%). The most frequently used NSAIDs were meloxicam (79%), naproxen (69%), and ibuprofen (64%). NSAIDs were most commonly prescribed on an as-needed basis (52%), followed by <3 months (43%). The most common indications were degenerative arthritis (95%) and herniated disk (45%). Gastrointestinal adverse effects of NSAIDs were managed by discontinuing NSAID therapy (73%) or switching to a cyclooxygenase-2 (COX-2) inhibitor (40%). A small proportion were managed by referring to another physician (36%). Some clinicians prescribed gastric prophylaxis for patients at high risk for NSAID-induced gastric complications (24%). The academic setting was significantly associated with gastric prophylaxis and frequent assessment for NSAID-induced gastric adverse events. Providers with >20 years of experience showed similar trends. In low-risk patients, compliance with gastroprotective prophylaxis prescription was low (5%). Most providers were unaware of the societal guidelines for NSAID-induced gastric complications or the preventive strategies.

Conclusion: Prescription of gastric-protective medications with concurrent NSAID therapy is relatively low among orthopedists. Academic setting and higher years of experience showed a significant trend toward more gastric-protective medication prescription, COX-2 inhibitor use, and frequent assessments for gastric adverse events when prescribing NSAID therapy. Provider education on the latest societal guidelines and computer-based alerts can increase compliance and assessment for NSAID-induced gastric complications and preventive strategies.

Background: Risk assessment tools are used by clinicians to predict which patients might have excessive bleeding. We studied the association between a peripartum hemorrhage risk assessment score using peripartum quantified blood loss (QBL) among those with vaginal deliveries who are often at lower risk for peripartum hemorrhage.

Methods: In this retrospective analysis of 1221 patients with term vaginal deliveries at a public New York City hospital, the Association of Women's Health, Obstetric and Neonatal Nurses (AWOHNN) risk assessment tool was used to categorize patients as low risk, medium risk, or high risk for postpartum hemorrhage.

Results: Low-risk scores were present in 925 (75.8%) patients, medium-risk scores in 268 (21.9%) patients, and high-risk scores in 28 (2.3%) patients. Outcome variables consisted of QBL (M = 213.8, SD = 215.00 mL), QBL ≥ 500 mL (n = 89, 7.3%), and ratio of postdelivery hematocrit to predelivery hematocrit (M = 0.9, SD = 0.08). High-risk score (B = 0.14, SE = 0.07, P = 0.04) but not medium-risk score was significantly associated with increased QBL as compared to low-risk score. Body mass index (BMI) measured as a continuous variable was significantly associated with increased QBL (B = 0.004, SE = 0.002, P = 0.049). However, BMI measured as a categorical variable using the AWOHNN cutoff score of >35 was not significantly associated with QBL. AWOHNN score was not significantly associated with QBL ≥ 500 mL or with the ratio of postdelivery hematocrit with predelivery hematocrit.

Conclusion: We recommend revising the AWOHNN measure to better reflect medium risk and to consider a different approach for BMI use as part of the AWOHNN risk score.