-
Progress in Cardiovascular Diseases 2019Functional tricuspid regurgitation (FTR) has been neglected for a long time, however its prevalence and clinical relevance is not negligible. In presence of FTR, a... (Review)
Review
Functional tricuspid regurgitation (FTR) has been neglected for a long time, however its prevalence and clinical relevance is not negligible. In presence of FTR, a certain quote of annular dilatation is present thus contributing to the mechanism of regurgitation. Historically, surgical annuloplasty has been the main treatment to correct FTR; however surgical repair is limited by a high risk of mortality and morbidity. For this reason, percutaneous tricuspid annuloplasty is an attractive tool for the treatment of FTR in patients at high surgical risk. A number of both direct and indirect percutaneous annuloplasty systems are currently under pre-clinical and clinical development. This review will discuss the Cardioband system, a novel direct annuloplasty device with promising result in terms of clinical safety and efficacy.
Topics: Cardiac Catheterization; Cardiac Valve Annuloplasty; Equipment Design; Heart Valve Prosthesis; Humans; Risk Adjustment; Severity of Illness Index; Tricuspid Valve Insufficiency
PubMed: 31669500
DOI: 10.1016/j.pcad.2019.10.002 -
Journal of Pediatric Orthopedics Jul 2021Pediatric orthopaedic patients have the potential for significant radiation exposure from the use of imaging studies, such as computed tomography and bone scintigraphy.... (Review)
Review
INTRODUCTION
Pediatric orthopaedic patients have the potential for significant radiation exposure from the use of imaging studies, such as computed tomography and bone scintigraphy. With the potential for long-term treatment, such as is required for scoliosis or osteogenesis imperfecta, patients are at even greater risk of radiation-induced carcinogenesis.
DISCUSSION
Although an association between radiation and cancer risk is evident, causation is difficult to prove because comorbidities or genetic predispositions may play a role in the higher baseline rates of malignancy later in life. Efforts have been made over the years to reduce exposure using more modern imaging techniques and simple radiation reduction strategies. Educational efforts and clinical practice guidelines are decreasing the rate of computed tomography scan use in pediatrics. Although considerable work is being done on the development of radiation-free imaging modalities, imaging that uses ionizing radiation will, in the near term, be necessary in specific circumstances to provide optimal care to pediatric orthopaedic patients.
CONCLUSION
Knowledge of the ionizing radiation exposure associated with commonly used tests as well as radiation-reduction strategies is essential for the optimal and safe care of pediatric orthopaedic patients.
Topics: Child; Diagnostic Imaging; Humans; Orthopedics; Pediatrics; Radiation Exposure; Radiologic Health; Risk Adjustment; Tomography, X-Ray Computed
PubMed: 34096542
DOI: 10.1097/BPO.0000000000001822 -
European Journal of Cardio-thoracic... Dec 2021
Topics: Adult; Cardiac Surgical Procedures; Heart Defects, Congenital; Humans; Risk Adjustment
PubMed: 34448825
DOI: 10.1093/ejcts/ezab266 -
The Journal of Maternal-fetal &... Dec 2022To determine whether adjusting for healthcare utilization and comorbidity diagnosed in the year before delivery improves the prediction of adverse maternal outcomes.
OBJECTIVE
To determine whether adjusting for healthcare utilization and comorbidity diagnosed in the year before delivery improves the prediction of adverse maternal outcomes.
METHODS
The Truven Health MarketScan database was used to determine whether healthcare utilization and comorbidity diagnosed in the year before pregnancy improved prediction of acute organ injury or death during the delivery hospitalization through 30 days postpartum in this retrospective cohort study. In an initial model, we analyzed the risk for adverse outcomes controlling for underlying comorbidity, obesity, and demographic risk factors present during pregnancy. Subsequent models included diagnoses from the year before pregnancy as well as whether patients had emergency department encounters, inpatient hospitalizations, or received medications from a pharmacy. We compared risk estimates and whether prediction of acute organ injury or death improved with data from the year before pregnancy. Unadjusted and adjusted log-linear regression models were performed to demonstrate the association between exposures and outcomes with unadjusted (RR) and adjusted risk ratios (aRR) with 95% CIs as measures of effects. Logistic regression was performed to calculate the c-statistic of the adjusted models. Separate analyses were performed for patients with Medicaid and commercial insurance. An analysis of Medicaid patients by maternal race and ethnicity was performed to determine if diagnoses and utilization before pregnancy accounted for maternal disparities.
RESULTS
A total of 740,002 patients were analyzed in this study. In unadjusted analyses of patients with commercial insurance, ≥2 compared to 0 emergency department encounters (RR = 1.82, 95% CI = 1.61, 2.07), ≥2 compared to 0 inpatient hospitalizations (RR = 4.43, 95% CI = 3.20, 6.13), and receipt of medications from ≥5 prescription groups compared to no prescriptions (RR = 1.97, 95% CI = 1.74, 2.24) were all associated with increased risk for acute organ injury or death. Higher underlying comorbidity and obesity were also associated with increased risk. These risks were attenuated in adjusted analyses but retained significance. Risk estimates were similar for patients with Medicaid insurance with the exception of receipt of medications from ≥5 prescription groups which was non-significant in adjusted analyses (aRR = 1.12, 95% CI = 0.90, 1.40). -statistics from logistic regression models were similar for models with and without pre-pregnancy data. When race was added to the adjusted models, risk among black women in the adjusted models did not differ significantly from the unadjusted estimate.
CONCLUSION
ED encounters and inpatient admissions the year before pregnancy were associated with increased risk of adverse maternal outcomes. However, adding these risk factors to adjusted models did not meaningfully improve the amount of variance accounted for. Further research is indicated to determine to what degree longitudinal care quality is associated with maternal risk.
Topics: Pregnancy; United States; Humans; Female; Retrospective Studies; Risk Adjustment; Postpartum Period; Ethnicity; Obesity
PubMed: 33874835
DOI: 10.1080/14767058.2021.1911999 -
Clinical Obstetrics and Gynecology Jun 2020Up to 2% of pregnant women develop a disease that requires nonobstetrical operative intervention during pregnancy. We discuss the issues unique to pregnant patients as... (Review)
Review
Up to 2% of pregnant women develop a disease that requires nonobstetrical operative intervention during pregnancy. We discuss the issues unique to pregnant patients as they pertain to the presentation, diagnosis, and management of nonobstetric surgical disease, with an emphasis on 2 of the most common diseases that affect pregnant women: appendicitis and cholecystitis. Surgery has been demonstrated to be safe and effective during pregnancy, provided proper precautions are taken into account. It is the consensus of multiple professional committees and societies that no pregnant women should be delayed or denied a necessary surgery because of pregnancy.
Topics: Appendectomy; Appendicitis; Cholecystectomy; Cholecystitis; Diagnostic Imaging; Evidence-Based Medicine; Female; Humans; Postoperative Complications; Pregnancy; Pregnancy Complications; Risk Adjustment; Time-to-Treatment
PubMed: 32187083
DOI: 10.1097/GRF.0000000000000529 -
Acta Cardiologica Aug 2020
Topics: Aged, 80 and over; Anti-Bacterial Agents; Clinical Deterioration; Dementia; Fatal Outcome; Female; Frailty; Humans; Pacemaker, Artificial; Palliative Care; Prosthesis-Related Infections; Risk Adjustment; Sick Sinus Syndrome; Time-to-Treatment
PubMed: 30893006
DOI: 10.1080/00015385.2019.1587139 -
Advances in Chronic Kidney Disease Nov 2020Nephrologists are routinely involved in the care of pregnant women with glomerulonephritis. Prepregnancy counseling is vital to inform women of the potential risks of... (Review)
Review
Nephrologists are routinely involved in the care of pregnant women with glomerulonephritis. Prepregnancy counseling is vital to inform women of the potential risks of pregnancy and to reduce those risks by optimizing clinical status and medications. In general, for all glomerulonephritides, the best pregnancy outcomes are achieved when the disease is in remission and the woman has preserved renal function with no proteinuria or hypertension. Each glomerulonephritis has specific considerations, for example in lupus nephritis, mycophenolate is teratogenic and must be stopped at least 6 weeks before conception, hydroxychloroquine is recommended for all pregnant women, and flares are frequently encountered and must be treated appropriately. De novo glomerulonephritis should be considered when significant proteinuria is found early in pregnancy or an acute kidney injury with active urine is encountered. Biopsy can be safely undertaken in the first trimester. Treatment is often with corticosteroids, azathioprine, and/or tacrolimus. Rituximab is increasingly used for severe disease. Women with glomerulonephritis should ideally be managed in a joint renal-obstetric clinic. This review details the approach to the care of women with glomerulonephritis from prepregnancy counseling, through antenatal care and delivery, to the postpartum period. Special attention is given to medications and treatment of glomerulonephritis in pregnancy.
Topics: Female; Glomerulonephritis; Humans; Kidney Glomerulus; Patient Care; Pregnancy; Pregnancy Complications; Pregnancy, High-Risk; Risk Adjustment
PubMed: 33328063
DOI: 10.1053/j.ackd.2020.08.001 -
Advances in Chronic Kidney Disease Nov 2020Women with chronic kidney disease (CKD) are at high risk for adverse outcomes in pregnancy. In the United States, pregnancy rates in women with risk factors for CKD such... (Review)
Review
Women with chronic kidney disease (CKD) are at high risk for adverse outcomes in pregnancy. In the United States, pregnancy rates in women with risk factors for CKD such as obesity and advanced maternal age are increasing; thus, more pregnancies are likely to be affected by CKD. Strategies that involve coordinated multidisciplinary care to optimize preconception health, perform meticulous antenatal monitoring, and provide continued care in the postpartum "fourth trimester" appear to be most beneficial for both the mother and baby. Discussions surrounding preconception risk stratification should be individualized based on CKD stage/serum creatinine level, degree of hypertension and proteinuria, and comorbid conditions. Preparation for pregnancy should include optimization of comorbidities and medication adjustments to those compatible with pregnancy. Unless contraindicated, all women with CKD should be prescribed low-dose aspirin in pregnancy to reduce risk of preeclampsia. After delivery, women with CKD may benefit from an early postpartum visit (within 7-10 days) for blood pressure check and may require serial monitoring of serum creatinine and proteinuria as appropriate. Breastfeeding is safe and can be recommended for most women with CKD. A contraceptive plan that includes patients' preferences, feasibility, medical eligibility, duration, and effectiveness of the contraceptive method should be implemented.
Topics: Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, High-Risk; Renal Insufficiency, Chronic; Risk Adjustment
PubMed: 33328062
DOI: 10.1053/j.ackd.2020.04.003 -
Cardiology Clinics Feb 2021Cardiovascular disease and cardiovascular disease-related disorders remain among the most common causes of maternal morbidity and mortality in the United States. Due to... (Review)
Review
Cardiovascular disease and cardiovascular disease-related disorders remain among the most common causes of maternal morbidity and mortality in the United States. Due to increased rates of obesity, delayed childbearing, and improvements in medical technology, greater numbers of women are entering pregnancy with preexisting medical comorbidities. Use of cardiovascular medications in pregnancy continues to increase, and medical management of cardiovascular conditions in pregnancy will become increasingly common. Obstetricians and cardiologists must familiarize themselves with the pharmacokinetics of the most commonly used cardiovascular medications in pregnancy and how these medications respond to the physiologic changes related to pregnancy, embryogenesis, and lactation.
Topics: Cardiovascular Agents; Cardiovascular Diseases; Female; Heart Disease Risk Factors; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Adjustment
PubMed: 33222813
DOI: 10.1016/j.ccl.2020.09.011 -
Journal of the American Geriatrics... Feb 2020
Topics: Geriatricians; Geriatrics; Humans; Medicare; Quality Indicators, Health Care; Risk Adjustment; United States
PubMed: 31880311
DOI: 10.1111/jgs.16295