Baylor University Medical Center Proceedings最新文献

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.

Aceruloplasminemia, which is a very rare iron metabolism disorder, may present with extremely nonspecific complaints, and disease screening should be considered, especially in patients with consanguineous marriages. We share four cases diagnosed with aceruloplasminemia and their characteristics. The first three cases were related to each other and have consanguineous marriages in their family history. Our first and fourth cases were diagnosed with aceruloplasminemia upon detecting hypochromic microcytic anemia, low transferrin saturation, and a high ferritin level in the examinations performed after a nonspecific complaint such as fatigue. Even though the second and third cases had no complaints, they were diagnosed during screening tests because they were relatives of the first case.

Implantable collamer lenses (ICL) have revolutionized the management of high refractive errors, yet they present unique challenges. We present a case of a fixed and dilated atonic pupil following acute-angle closure glaucoma from pupillary block after ICL implantation, known as Urrets-Zavalia syndrome. A 39-year-old woman developed acute ocular pain and headaches after surgery, leading to elevated intraocular pressure and subsequent complications necessitating ICL removal. This case highlights the need for prompt identification and management of elevated intraocular pressure to prevent irreversible complications such as Urrets-Zavalia syndrome following ICL implantation.