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Randhawa MK, Sultana S, Stib MT, Nagpal P, Michel E, Hedgire S. Role of Radiology in Assessment of Postoperative Complications of Heart Transplantation. Radiol Clin North Am 2024; 62:453-471. [PMID: 38553180 DOI: 10.1016/j.rcl.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Heart transplantation is a pivotal treatment of end-stage heart failure, and recent advancements have extended median posttransplant life expectancy. However, despite the progress in surgical techniques and medical treatment, heart transplant patients still face complications such as rejection, infections, and drug toxicity. CT is a reliable tool for detecting most of these complications, whereas MR imaging is particularly adept at identifying pericardial pathologies and signs of rejection. Awareness of these nuances by radiologists, cardiologists, and surgeons is desired to optimize care, reduce morbidities, and enhance survival.
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Affiliation(s)
- Mangun K Randhawa
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sadia Sultana
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew T Stib
- Division of Cardiothoracic Imaging, Department of Radiology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Prashant Nagpal
- Division of Cardiovascular Imaging, Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Rubin J, Witkin AS, Crowley JC, Michel E, Furfaro DM, Teijeiro-Paradis R, Ilg A, Seethala R, Zhao S, Fan E. Venovenous Extracorporeal Membrane Oxygenation Candidacy Decision-Making: Lessons and Hypotheses From a Single-Center Observational Analysis. Chest 2024:S0012-3692(24)00278-2. [PMID: 38423278 DOI: 10.1016/j.chest.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Use of venovenous extracorporeal membrane oxygenation (ECMO) is increasing, but candidacy selection processes are variable and subject to bias. RESEARCH QUESTION What are the reasons behind venovenous ECMO candidacy decisions, and are decisions made consistently across patients? STUDY DESIGN AND METHODS Prospective observational study of all patients, admitted or outside hospital referrals, considered for venovenous ECMO at a tertiary referral center. Relevant clinical data and reasons for candidacy determination were cross-referenced with other noncandidates and candidates and were assessed qualitatively. RESULTS Eighty-one consultations resulted in 44 noncandidates (54%), 29 candidates (36%; nine of whom subsequently underwent cannulation), and eight deferred decisions (10%). Fifteen unique contraindications were identified, variably present across all patients. Five contraindications were invoked as the sole reason to deny ECMO to a patient. In patients with three or more contraindications, additional contraindications were cited even if the severity was relatively minor. All but four contraindications invoked to deny ECMO to a patient were nonprohibitive for at least one other candidate. Contraindications documented in noncandidates were present but not mentioned in 21 other noncandidates (47%). Twenty-six candidates (90%) had at least one contraindication that was prohibitive in a noncandidate, including a contraindication that was the sole reason to deny ECMO. Contraindications were proposed as informing three prognostic domains, through which patterns of inconsistency could be understood better: (1) irreversible underlying pulmonary process, (2) unsurvivable critical illness, and (3) clinical condition too compromised for meaningful recovery. INTERPRETATION ECMO candidacy decisions are inconsistent. We identified four patterns of inconsistency in our center and propose a three-domain model for understanding and categorizing contraindications, yielding five lessons that may improve candidacy decision processes until further research can guide practice more definitively.
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Affiliation(s)
- Jonah Rubin
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, MA; Corrigan Minehan Heart Center ICU, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Alison S Witkin
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jerome C Crowley
- Division of Cardiac Anesthesia, Massachusetts General Hospital, Boston, MA; Corrigan Minehan Heart Center ICU, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Eriberto Michel
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA; Corrigan Minehan Heart Center ICU, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - David M Furfaro
- Harvard Medical School, Boston, MA; Division of Pulmonary & Critical Care, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ricardo Teijeiro-Paradis
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Annette Ilg
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Raghu Seethala
- Harvard Medical School, Boston, MA; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sophia Zhao
- Division of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Boston, MA; Analytica Now LLC, Brookline, MA
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Extracorporeal Life Support Program, Toronto General Hospital, Toronto, ON, Canada
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Abrahim O, Premkumar A, Kubi B, Wolfe SB, Paneitz DC, Singh R, Thomas J, Michel E, Osho AA. Does Failure to Rescue Drive Race/Ethnicity-based Disparities in Survival After Heart Transplantation? Ann Surg 2024; 279:361-365. [PMID: 37144385 DOI: 10.1097/sla.0000000000005890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE The objective was to assess whether race/ethnicity is an independent predictor of failure to rescue (FTR) after orthotopic heart transplantation (OHT). SUMMARY BACKGROUND DATA Outcomes following OHT vary by patient level factors; for example, non-White patients have worse outcomes than White patients after OHT. Failure to rescue is an important factor associated with cardiac surgery outcomes, but its relationship to demographic factors is unknown. METHODS Using the United Network for Organ Sharing database, we included all adult patients who underwent primary isolated OHT between 1/1/2006 snd 6/30/2021. FTR was defined as the inability to prevent mortality after at least one of the UNOS-designated postoperative complications. Donor, recipient, and transplant characteristics, including complications and FTR, were compared across race/ethnicity. Logistic regression models were created to identify factors associated with complications and FTR. Kaplan Meier and adjusted Cox proportional hazards models evaluated the association between race/ethnicity and posttransplant survival. RESULTS There were 33,244 adult, isolated heart transplant recipients included: the distribution of race/ethnicity was 66% (n=21,937) White, 21.2% (7,062) Black, 8.3% (2,768) Hispanic, and 3.3% (1,096) Asian. The frequency of complications and FTR differed significantly by race/ethnicity. After adjustment, Hispanic recipients were more likely to experience FTR than White recipients (OR 1.327, 95% CI[1.075-1.639], P =0.02). Black recipients had lower 5-year survival compared with other races/ethnicities (HR 1.276, 95% CI[1.207-1.348], P <0.0001). CONCLUSIONS In the US, Black recipients have an increased risk of mortality after OHT compared with White recipients, without associated differences in FTR. In contrast, Hispanic recipients have an increased likelihood of FTR, but no significant mortality difference compared with White recipients. These findings highlight the need for tailored approaches to addressing race/ethnicity-based health inequities in the practice of heart transplantation.
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Affiliation(s)
- Orit Abrahim
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114
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Wolfe SB, Singh R, Paneitz DC, Rabi SA, Chukwudi CC, Asija R, Michel E, Ganapathi AM, Osho AA. One Year Outcomes Following Transplantation with COVID-19-Positive Donor Hearts: A National Database Cohort Study. J Cardiovasc Dev Dis 2024; 11:46. [PMID: 38392260 PMCID: PMC10889800 DOI: 10.3390/jcdd11020046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
The current understanding of the safety of heart transplantation from COVID-19+ donors is uncertain. Preliminary studies suggest that heart transplants from these donors may be feasible. We analyzed 1-year outcomes in COVID-19+ donor heart recipients using 1:3 propensity matching. The OPTN database was queried for adult heart transplant recipients between 1 January 2020 and 30 September 2022. COVID-19+ donors were defined as those who tested positive on NATs or antigen tests within 21 days prior to procurement. Multiorgan transplants, retransplants, donors without COVID-19 testing, and recipients allocated under the old heart allocation system were excluded. A total of 7211 heart transplant recipients met the inclusion criteria, including 316 COVID-19+ donor heart recipients. Further, 290 COVID-19+ donor heart recipients were matched to 870 COVID-19- donor heart recipients. Survival was similar between the groups at 30 days (p = 0.46), 6 months (p = 0.17), and 1 year (p = 0.07). Recipients from COVID-19+ donors in the matched cohort were less likely to experience postoperative acute rejection prior to discharge (p = 0.01). National COVID-19+ donor heart usage varied by region: region 11 transplanted the most COVID-19+ hearts (15.8%), and region 6 transplanted the fewest (3.2%). Our findings indicate that COVID-19+ heart transplantation can be performed with safe early outcomes. Further analyses are needed to determine if long-term outcomes are equivalent between groups.
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Affiliation(s)
- Stanley B Wolfe
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA
| | - Ruby Singh
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Dane C Paneitz
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Seyed Alireza Rabi
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Chijioke C Chukwudi
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Richa Asija
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Department of Surgery, Community Memorial Hospital, Ventura, CA 93003, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Asvin M Ganapathi
- Division of Cardiac Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Asishana A Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Li SS, Funamoto M, Osho AA, Rabi SA, Paneitz D, Singh R, Michel E, Lewis GD, D'Alessandro DA. Acute rejection in donation after circulatory death (DCD) heart transplants. J Heart Lung Transplant 2024; 43:148-157. [PMID: 37717931 PMCID: PMC10873067 DOI: 10.1016/j.healun.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Donation after circulatory death (DCD) heart transplantation has promising early survival, but the effects on rejection remain unclear. METHODS The United Network for Organ Sharing database was queried for adult heart transplants from December 1, 2019, to December 31, 2021. Multiorgan transplants and loss to follow-up were excluded. The primary outcome was acute rejection, comparing DCD and donation after brain death (DBD) transplants. RESULTS A total of 292 DCD and 5,582 DBD transplants met study criteria. Most DCD transplants were transplanted at status 3-4 (61.0%) compared to 58.6% of DBD recipients at status 1-2. DCD recipients were less likely to be hospitalized at transplant (26.7% vs 58.3%, p < 0.001) and to require intra-aortic balloon pumping (IABP; 9.6% vs 28.9%, p < 0.001), extracorporeal membrane oxygenation (ECMO; 0.3% vs 5.9%, p < 0.001) or temporary left ventricular assist device (LVAD; 1.0% vs 2.7%, p < 0.001). DCD recipients were more likely to have acute rejection prior to discharge (23.3% vs 18.4%, p = 0.044) and to be hospitalized for rejection (23.4% vs 11.4%, p = 0.003) at a median follow-up of 15 months; the latter remained significant after propensity matching. On multivariable logistic regression, DCD donation was an independent predictor of acute rejection (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.00-2.15, p = 0.048) and hospitalization for rejection (OR 2.03, 95% CI 1.06-3.70, p = 0.026). On center-specific subgroup analysis, DCD recipients continued to have higher rates of hospitalization for rejection (23.4% vs 13.8%, p = 0.043). CONCLUSIONS DCD recipients are more likely to experience acute rejection. Early survival is similar between DCD and DBD recipients, but long-term implications of increased early rejection in DCD recipients require further investigation.
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Affiliation(s)
- Selena S Li
- Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | | | - Asishana A Osho
- Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Seyed A Rabi
- Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Dane Paneitz
- Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Ruby Singh
- Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Eriberto Michel
- Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory D Lewis
- Cardiology, Massachusetts General Hospital, Boston, Massachusetts
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Paneitz DC, Basha AM, Van Kampen A, Giao D, Thomas J, Rabi SA, Michel E, D'Alessandro DA, Osho AA. The effect of warm ischemia and donor ejection fraction on 30-day mortality after donation after circulatory death heart transplantation: A national database analysis. J Heart Lung Transplant 2023; 42:1493-1496. [PMID: 37506954 DOI: 10.1016/j.healun.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Donation after circulatory death (DCD) donor hearts recovered using the direct procurement and perfusion method experience variable durations of warm ischemia at the time of procurement (WIP). We used the Organ Procurement and Transplantation Network database to assess the effect of WIP on 30-day mortality after DCD heart transplantation. The analysis evaluated outcomes in 237 recipients of DCD heart transplantation, demonstrating an optimal WIP cut point of <36 minutes. Multivariable logistic regression modeling identified donor left ventricular ejection fraction (LVEF) <60% as an independent predictor of 30-day mortality. The area under the receiver operating characteristic curve for predicting 30-day mortality based on WIP ≥36 minutes and donor LVEF <60% was 0.90. Based on these findings, we do not recommend proceeding with DCD heart transplantation for patients with WIP ≥36 minutes, particularly in donors with LVEF <60%.
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Affiliation(s)
- Dane C Paneitz
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ameen M Basha
- Division of Cardiac Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Antonia Van Kampen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Duc Giao
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | | | - S Alireza Rabi
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eriberto Michel
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - David A D'Alessandro
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Asishana A Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Asija R, Singh R, Paneitz DC, Wolfe SB, Chukwudi C, Michel E, Rabi SA, Langer NB, Osho AA, Ganapathi AM. Is Transplantation With Coronavirus Disease 2019-Positive Donor Lungs Safe? A US Nationwide Analysis. Ann Thorac Surg 2023; 116:1046-1054. [PMID: 37506993 DOI: 10.1016/j.athoracsur.2023.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Since the beginning of the pandemic, coronavirus disease 2019 (COVID-19) has caused debilitating lung failure in many patients. Practitioners have understandably been hesitant to use lungs from donors with COVID-19 for transplantation. This study aimed to analyze the characteristics and short-term outcomes of lung transplantation from donors with recent positive COVID-19 testing results. METHODS Lung transplantations performed between January 2020 and June 2022 were queried from the United Network for Organ Sharing database. Pediatric, multiorgan, and repeat lung transplantations were excluded. Propensity scoring matched recipients of lungs from donors with recent positive COVID-19 testing results to recipients of lungs from donors with negative COVID-19 testing results, and comparisons of 30-day mortality, 3-month mortality, and perioperative outcomes were performed. RESULTS A total of 5270 patients underwent lung transplantation during the study dates, including 51 patients who received lungs from donors with recent positive COVID-19 testing results. Forty-five recipients of lungs from donors with recent positive COVID-19 testing results were matched with 135 recipients of lungs from donors with negative COVID-19 testing results. After matching, there was no difference in 30-day (log-rank P = .42) and 3-month (log-rank P = .42) mortality. The incidence of other perioperative complications was similar between the groups. CONCLUSIONS The 30-day and 3-month survival outcomes were similar between recipients of lungs from donors with recent positive COVID-19 testing results and recipients of lungs from donors with negative COVID-19 testing results. This finding suggests that highly selected COVID-19-positive donors without evidence of active infection may be safely considered for lung transplantation. Further studies should explore long-term outcomes to provide reassurance about the safety of this practice.
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Affiliation(s)
- Richa Asija
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Thoracic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Ruby Singh
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dane C Paneitz
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stanley B Wolfe
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chijioke Chukwudi
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Eriberto Michel
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Seyed Alireza Rabi
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nathaniel B Langer
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Asishana A Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Asvin M Ganapathi
- Division of Cardiac Surgery, Ohio State University Medical Center, Columbus, Ohio
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Delor L, Louzon M, Pelosi C, Michel E, Maillet G, Carronnier H. Ecotoxicity of single and mixture of perfluoroalkyl substances (PFOS and PFOA) in soils to the earthworm Aporrectodea caliginosa. Environ Pollut 2023; 335:122221. [PMID: 37543076 DOI: 10.1016/j.envpol.2023.122221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/30/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
Per and polyfluoroalkyl substances (PFAS) are persistent compounds that are massively used in industry, consumer goods and fire-fighting foams. Soil contamination by PFAS is a major environmental concern, and there is a lack of knowledge on both their ecotoxicological mechanisms and the concentrations that induce adverse effects especially to non-target organisms, particularly in the case of PFAS mixtures. This study contributes to filling these gaps by assessing and modelling the effects of PFAS (in single and in mixtures for PFOS and PFOA at different environmental doses) on juvenile endogeic earthworms of a common species in European soils (Aporrectodea caliginosa) at different levels of biological organization (sub-individual and individual). The results showed for the first time combined strong ecotoxicological effects of PFAS on earthworm survival, integumental integrity, growth, sexual maturity and on genomic stability notably with the induction of DNA breaks associated with no abnormal oxidative DNA-lesion levels. Our results demonstrated significant effects at 0.3 mg kg-1 and additive effects in case of mixtures.
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Affiliation(s)
- L Delor
- VALGO, 47 Rue de Ponthieu, 75008, Paris, France
| | - M Louzon
- Ecosystem Department, ENVISOL, 2 Rue Hector Berlioz, 38110, La Tour Du Pin, France
| | - C Pelosi
- UMR INRAE/Avignon Université EMMAH (Environnement Méditerranéen et Modélisation des Agrohydrosystèmes), 228 Route de l'Aérodrome, 84000, Avignon, France
| | - E Michel
- UMR INRAE/Avignon Université EMMAH (Environnement Méditerranéen et Modélisation des Agrohydrosystèmes), 228 Route de l'Aérodrome, 84000, Avignon, France
| | - G Maillet
- TOXEM, 12 Rue des Quatre Saisons, 76290, Montivilliers, France
| | - H Carronnier
- VALGO, 47 Rue de Ponthieu, 75008, Paris, France.
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Greig G, Cong D, Hurley N, Michel E, Youssef N. A Phase 1, Open-Label Evaluation Of The Pharmacokinetics (PK) And Safety Of A Single Dose Of Apraglutide In Subjects With Normal And Impaired Renal Function. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Zhou J, Sise M, D'Alessandro D, Wolfe S, Osho A, Drezek K, Prario M, Rabi S, Michel E, Tsao L, Coglianese E, Doucette M, Newton-Cheh C, Thomas S, Ton V, Sutaria N, Schoenike M, Christ A, Paneitz D, Villavicencio M, Madsen J, Pierson R, Lewis G, Zlotoff D. Early Renal Outcomes Following Cardiac Transplantation Using Organs Procured after Circulatory Death. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Ton V, Kahlon T, Drezek K, Soydara C, Rupert L, Camuso J, Milley K, Logan T, Dempsey A, Coglianese E, Mastoris I, Osho A, Michel E, D'Alessandro D, Lewis G. Distinct Pressure-Flow Phenotypes During Exercise in Patients Supported with Left Ventricular Assist Devices (lvad). J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Paneitz DC, Wolfe SB, Proudian J, Rabi SA, Li S, Michel E, Kataria R, Ton VK, D'Alessandro DA, Osho AA. Elimination of the "Increased Risk" Label Has Not Improved Donor Heart Utilization in the U.S. JACC Heart Fail 2022; 11:610-611. [PMID: 36752490 DOI: 10.1016/j.jchf.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/27/2022] [Indexed: 01/13/2023]
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D'Alessandro DA, Wolfe SB, Osho AA, Drezek K, Prario MN, Rabi SA, Michel E, Tsao L, Coglianese E, Doucette M, Zlotoff DA, Newton-Cheh C, Thomas SS, Ton VK, Sutaria N, Schoenike MW, Christ AM, Paneitz DC, Madsen JC, Pierson R, Lewis GD. Hemodynamic and Clinical Performance of Hearts Donated After Circulatory Death. J Am Coll Cardiol 2022; 80:1314-1326. [PMID: 36175050 DOI: 10.1016/j.jacc.2022.07.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/27/2022] [Accepted: 07/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Donor organ demand continues to outpace supply in heart transplantation. Utilization of donation after circulatory death (DCD) hearts could significantly increase heart donor availability for patients with advanced heart failure. OBJECTIVES The purpose of this study was to describe hemodynamic and clinical profiles of DCD hearts in comparison to standard of care (SOC) hearts donated after brain death (DBD). METHODS This single-center retrospective cohort study of consecutive heart transplant recipients analyzed right heart catheterization measurements, inotrope scores, echocardiograms, and clinical outcomes between DCD and DBD heart recipients. RESULTS Between April 2016 and February 2022, 47 DCD and 166 SOC hearts were transplanted. Median time from DCD consent to transplant was significantly shorter compared with SOC waiting list time (17 days [6-28 days] vs 70 days [23-240 days]; P < 0.001). Right heart function was significantly impaired in DCD recipients compared with SOC recipients 1 week post-transplant (higher median right atrial pressure (10 mm Hg [8-13 mm Hg] vs 7 mm Hg [5-11 mm Hg]; P < 0.001), higher right atrial pressure to pulmonary capillary wedge pressure ratio (0.64 [0.54-0.82] vs 0.57 [0.43-0.73]; P = 0.016), and lower pulmonary arterial pulsatility index (1.66 [1.27-2.50] vs 2.52 [1.63-3.82]; P < 0.001), but was similar between groups by 3 weeks post-transplant. DCD and SOC recipient mortality was similar at 30 days (DCD 0 vs SOC 2%; P = 0.29) and 1 year post-transplant (DCD 3% vs SOC 8%; P = 0.16). CONCLUSIONS DCD heart utilization is associated with transient post-transplant right heart dysfunction and short-term clinical outcomes otherwise similar to transplantation using DBD hearts.
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Affiliation(s)
- David A D'Alessandro
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Stanley B Wolfe
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Asishana A Osho
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kamila Drezek
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Monica N Prario
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S Alireza Rabi
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lana Tsao
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin Coglianese
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meaghan Doucette
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel A Zlotoff
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher Newton-Cheh
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sunu S Thomas
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Van-Khue Ton
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nilay Sutaria
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mark W Schoenike
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anastasia M Christ
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dane C Paneitz
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joren C Madsen
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Richard Pierson
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gregory D Lewis
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA. https://twitter.com/GLewisCardiol
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Kataria R, Khalil A, Coglianese E, Crowley J, Silverman MG, Shelton K, Michel E, D’Alessandro D, Ton VK. Effect of Impella 5.5 on Preexisting Functional Mitral Regurgitation in Patients with Heart Failure-Related Cardiogenic Shock. Struct Heart 2022; 6:100072. [PMID: 37288332 PMCID: PMC10242560 DOI: 10.1016/j.shj.2022.100072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/06/2022] [Accepted: 06/27/2022] [Indexed: 06/09/2023]
Abstract
Background Heart failure-related cardiogenic shock (HF-CS) is increasingly common. Moderate/severe functional mitral regurgitation (FMR) is commonly seen in patients presenting with decompensated heart failure and is associated with worse outcomes. Percutaneous mechanical circulatory support devices are increasingly used to provide hemodynamic support for ongoing CS. There is no description of the impact of Impella device on hemodynamic response when used in combination with preexisting FMR. Methods Retrospective review of patients aged ≥18 years, who underwent Impella 5.5 implant for HF-CS, and who had a transthoracic echocardiogram performed pre- and post-Impella. Results Of 24 patients, 33% had moderate-to-severe/severe FMR, 38% had mild-moderate/moderate FMR, and 29% had trace/mild FMR on pre-Impella transthoracic echocardiogram. Additional right ventricular assist device was simultaneously inserted in 3 patients, of whom 1 had severe, 1 had moderate, and another had mild FMR pre-Impella. Despite maximally tolerated Impella unloading, 6 patients (25%) had persistent moderate-severe/severe FMR, and 9 (37.5%) patients had persistent moderate FMR. Overall, however, there was a decrease in central venous pressure, pulmonary artery diastolic pressure, serum lactate, and vasoactive-inotrope score at 24 hours post-Impella, and survival was high at 83%. Conclusions In a retrospective cohort of patients admitted with HF-CS who underwent Impella 5.5 implant for hemodynamic support, Impella did not seem to acutely ameliorate FMR severity. Despite this, there was a significant improvement in hemodynamic response at 24 hours post-Impella. In carefully selected patients, especially those with isolated left ventricular failure, Impella 5.5 may provide adequate hemodynamic support even in the presence of higher severity FMR.
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Affiliation(s)
- Rachna Kataria
- Division of Advanced Heart Failure and Transplant Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdurrahman Khalil
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Erin Coglianese
- Division of Advanced Heart Failure and Transplant Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jerome Crowley
- Division of Critical Care and Pain Management, Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael G. Silverman
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth Shelton
- Division of Critical Care and Pain Management, Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David D’Alessandro
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Van-Khue Ton
- Division of Advanced Heart Failure and Transplant Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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15
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Wolfe SB, Calero T, Osho AA, Michel E, Sundt TM, D'Alessandro DA. Racial Disparities in Coronavirus Disease 2019 Mortality Are Present in Heart Transplant Recipients. Ann Thorac Surg 2022; 115:1009-1015. [PMID: 35820491 PMCID: PMC9270231 DOI: 10.1016/j.athoracsur.2022.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/11/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Studies have demonstrated the devastating effects of coronavirus disease 2019 (COVID-19) on vulnerable populations. Although they receive close follow-up, heart transplant recipients represent a particularly vulnerable population, given long-term immunosuppression and comorbid conditions. We sought to investigate the association between race/ethnicity and the probability of death due to COVID-19 in adult heart transplant recipients in the United States. METHODS Adult isolated heart transplant recipients were identified using the Organ Procurement and Transplantation Network database. Recipients who were described as deceased or lost to follow-up before January 2020 were excluded. Recipients were stratified into 4 cohorts by race/ethnicity. The primary outcome of interest was death due to COVID-19. RESULTS A total of 22 157 adult recipients were identified. During the course of follow-up, 153 recipients had COVID-19 reported as the primary cause of death. COVID-19 mortality was significantly different between race/ethnicity cohorts (Black, n = 34 [0.79%]; Hispanic, n = 23 [1.33%]; White, n = 92 [0.60%]; other, n = 4 [0.44%]; P = .007). COVID-19 was listed as a contributing cause of mortality in 0.12% of Black, 0.23% of Hispanic, 0.04% of White, and 0.33% of other recipients (P = .002). No significant difference in non-COVID mortality or all-cause mortality was observed. After multivariable adjustment, Black (hazard ratio, 2.78 [1.40-5.52]; P = .003) and Hispanic (hazard ratio, 3.92 [1.88-8.16]; P < .001) recipients were at higher risk of death due to COVID-19 compared with White recipients. CONCLUSIONS Compared with White recipients, Black and Hispanic recipients experienced higher rates of COVID-19 mortality after transplantation. These findings suggest that racial/ethnic disparities of COVID-19 mortality in the general population persist in adult heart transplant recipients.
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Affiliation(s)
- Stanley B Wolfe
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Tiffany Calero
- Center for Diversity and Inclusion, Massachusetts General Hospital, Boston, Massachusetts; Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Asishana A Osho
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Eriberto Michel
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - David A D'Alessandro
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts.
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16
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Michel E, Galen Hartwig M, Sommer W. Lung Retransplantation. Thorac Surg Clin 2022; 32:259-268. [PMID: 35512943 DOI: 10.1016/j.thorsurg.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Lung retransplantation remains the standard treatment of irreversible lung allograft failure. The most common indications for lung retransplantation are acute graft failure, chronic lung allograft dysfunction, and postoperative airway complications. Careful patient selection with regards to indications, anatomy, extrapulmonary organ dysfunction (specifically renal dysfunction), and immunologic consideration are of utmost importance. The conduct of the lung retransplantation operation is arduous with special considerations given to operative approach, type of surgery (single vs bilateral), use of extracorporeal circulatory support, and hematological management. Outcomes have improved significantly for most patients, nearing short and midterm outcomes of primary lung recipients in select cases.
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Affiliation(s)
- Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Cox 630, Boston, MA 02114, USA
| | - Matthew Galen Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University School of Medicine, DUMC 3863, Durham, NC 27710, USA.
| | - Wiebke Sommer
- Department of Cardiac Surgery, University of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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17
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Li S, Funamoto M, Wolfe S, Osho A, Moonsamy P, Michel E, D'Alessandro D. Effects of the New Heart Allocation System on Choice of Mechanical Circulatory Support as a Bridge to Transplant. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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18
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Wolfe S, Langer NB, Hedgire SS, Passeri JJ, Yucel E, Dal-Bianco J, Inglessis-Azuaje I, Kolte DS, Patel NK, Michel E, Sakhuja R, Elmariah S, Jassar AS. TRANSCATHETER AORTIC VALVE REPLACEMENT IS SAFE IN PATIENTS WITH ANOMALOUS ORIGIN OF CORONARY ARTERIES. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01773-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Finnemann H, Brehm J, Michel E, Volkert J. Multigrid solution of diffusion equations on distributed memory multiprocessor systems / Multigrid-Lösung der Diffusionsgleichungen auf Multiprozessorsystemen mit verteiltem Speicher. KERNTECHNIK 2021. [DOI: 10.1515/kern-1988-520313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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20
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Denk JA, Michel E, Clark AJ, Thinh Pham D, Mehta CK. Veno-Venous Extracorporeal Rewarming Using Dual-Lumen Cannula in Accidental Hypothermia. ASAIO J 2021; 68:e53-e55. [PMID: 33769347 DOI: 10.1097/mat.0000000000001424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Accidental hypothermia with a core temperature below 28°C is associated with an increased risk of hemodynamic instability. It is difficult to predict which patients will survive with a favorable neurologic outcome; therefore, decision-making regarding extracorporeal support is not straightforward. We report a case of rewarming using veno-venous dual-lumen cannula as an alternative to veno-arterial support with full recovery and normal neurologic examination. In centers where extracorporeal membrane oxygenation is available, rewarming using veno-venous dual-lumen extracorporeal support may be a useful strategy to mitigate the risks associated with veno-arterial extracorporeal support.
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Affiliation(s)
- Jennifer A Denk
- From the Division of Anesthesiology, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Illinois Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Illinois
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21
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Gay HC, Sinha A, Michel E, Mozer AB, Budd A, Feinstein MJ, Benzuly KH, Al-Qamari A, Pawale AA, Vorovich EE. Fulminant myocarditis in a patient with coronavirus disease 2019 and rapid myocardial recovery following treatment. ESC Heart Fail 2020; 7:4367-4370. [PMID: 33063450 PMCID: PMC7675750 DOI: 10.1002/ehf2.13041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 11/08/2022] Open
Abstract
Coronavirus disease 2019 (COVID‐19) is a global pandemic increasingly encountered in the clinical setting. It typically manifests as a respiratory illness, although cardiac involvement is common and portends a worse prognosis. We present the case of a 56‐year‐old male admitted with COVID‐19 fulminant myocarditis and cardiogenic shock. We discuss important aspects of the multidisciplinary and interventional care involved in treating cardiogenic shock as well as the likely mechanisms of, and potential treatment for, COVID‐19 myocarditis. The various pathways of myocardial injury, including direct viral damage, macrophage activation, and lymphocytic infiltration, are outlined in detail in addition to associated pathology such as cytokine release syndrome. COVID‐19 is a complex and multisystem disease process; in addition to supportive care, specific consideration should be given to the underlying mechanism of injury for each patient.
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Affiliation(s)
- Hawkins C Gay
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Medicine-Cardiology, Northwestern University, Chicago, IL, USA
| | - Arjun Sinha
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Medicine-Cardiology, Northwestern University, Chicago, IL, USA
| | - Eriberto Michel
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Surgery-Cardiothoracic, Northwestern University, Chicago, IL, USA
| | - Anthony B Mozer
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Surgery-Cardiothoracic, Northwestern University, Chicago, IL, USA
| | - Ashley Budd
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Anesthesia-Cardiothoracic, Northwestern University, Chicago, IL, USA
| | - Matthew J Feinstein
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Medicine-Cardiology, Northwestern University, Chicago, IL, USA
| | - Keith H Benzuly
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Medicine-Cardiology, Northwestern University, Chicago, IL, USA
| | - Abbas Al-Qamari
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Anesthesia-Cardiothoracic, Northwestern University, Chicago, IL, USA
| | - Amit A Pawale
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Surgery-Cardiothoracic, Northwestern University, Chicago, IL, USA
| | - Esther E Vorovich
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Medicine-Cardiology, Northwestern University, Chicago, IL, USA
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22
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Szlapka M, Michel E, Ricciardi MJ, Malaisrie SC. Valve-in-valve-prosthesis embolization and aortic dissection: single procedure, double complication. Eur J Cardiothorac Surg 2020; 56:204-205. [PMID: 30561574 DOI: 10.1093/ejcts/ezy424] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/31/2018] [Accepted: 11/09/2018] [Indexed: 11/14/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a recognized treatment method for high-risk patients with aortic stenosis. TAVI is also recommended for structural valve degeneration of a biological valve prosthesis. TAVI-specific complications, such as prosthesis embolization and aortic dissection, are uncommon but potential concerns. A 73-year-old woman presented with structural valve degeneration 14 years after aortic root replacement with a bioprosthetic valved conduit. The patient underwent TAVI valve-in-valve under monitored anaesthesia care. Intraoperatively, the self-expandable prosthesis was difficult to deploy within the valved conduit and ultimately migrated distally. During the technically difficult passage of the prosthesis delivery system through the tortuous aorta, the patient started reporting symptoms suggestive of aortic dissection. An emergency computed tomography scan confirmed type B dissection. Thoracic endovascular aortic repair followed by deployment of a balloon-expandable prosthesis below the self-expandable implant was performed. Careful prosthesis selection in valve-in-valve patients after aortic root replacement is crucial for procedural success.
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Affiliation(s)
- Michal Szlapka
- Division of Cardiac Surgery, Northwestern University, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Eriberto Michel
- Division of Cardiac Surgery, Northwestern University, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Mark J Ricciardi
- Division of Cardiology, Northwestern University, Northwestern Memorial Hospital, Chicago, IL, USA
| | - S Christopher Malaisrie
- Division of Cardiac Surgery, Northwestern University, Northwestern Memorial Hospital, Chicago, IL, USA
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23
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Dumont M, Pichevin L, Geibert W, Crosta X, Michel E, Moreton S, Dobby K, Ganeshram R. The nature of deep overturning and reconfigurations of the silicon cycle across the last deglaciation. Nat Commun 2020; 11:1534. [PMID: 32210225 PMCID: PMC7093442 DOI: 10.1038/s41467-020-15101-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 02/14/2020] [Indexed: 12/02/2022] Open
Abstract
Changes in ocean circulation and the biological carbon pump have been implicated as the drivers behind the rise in atmospheric CO2 across the last deglaciation; however, the processes involved remain uncertain. Previous records have hinted at a partitioning of deep ocean ventilation across the two major intervals of atmospheric CO2 rise, but the consequences of differential ventilation on the Si cycle has not been explored. Here we present three new records of silicon isotopes in diatoms and sponges from the Southern Ocean that together show increased Si supply from deep mixing during the deglaciation with a maximum during the Younger Dryas (YD). We suggest Antarctic sea ice and Atlantic overturning conditions favoured abyssal ocean ventilation at the YD and marked an interval of Si cycle reorganisation. By regulating the strength of the biological pump, the glacial-interglacial shift in the Si cycle may present an important control on Pleistocene CO2 concentrations.
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Affiliation(s)
- M Dumont
- School of Geosciences, University of Edinburgh, Edinburgh, UK.
- School of Earth and Environmental Sciences, University of St Andrews, St Andrews, UK.
| | - L Pichevin
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - W Geibert
- Alfred Wegener Institute, Bremerhaven, Germany
| | - X Crosta
- UMR 5805 EPOC, Universite de Bordeaux, Bordeaux, France
| | - E Michel
- Laboratoire des Sciences du Climat et l'Environnement/Institute Pierre-Simon Laplace, Laboratoire CNRS-CEA-UVSQ, Gif-sur-Yvette, France
| | - S Moreton
- Scottish Universities Environmental Research Centre, East Kilbride, UK
| | - K Dobby
- School of Geosciences, University of Edinburgh, Edinburgh, UK
| | - R Ganeshram
- School of Geosciences, University of Edinburgh, Edinburgh, UK
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24
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Affiliation(s)
| | | | - Colin Gillespie
- Division of Thoracic Surgery, Department of Surgery, and.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, and.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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25
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Kislitsina ON, Thomas JD, Crawford E, Michel E, Kruse J, Liu M, Andrei AC, Cox JL, McCarthy PM. Predictors of Left Ventricular Dysfunction After Surgery for Degenerative Mitral Regurgitation. Ann Thorac Surg 2019; 109:669-677. [PMID: 31830438 DOI: 10.1016/j.athoracsur.2019.10.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study was performed to determine whether strain can supplement the ability of left ventricular (LV) ejection fraction (LVEF) to predict postoperative ventricular dysfunction in patients undergoing mitral valve surgery for degenerative mitral regurgitation (DMR). METHODS From 2004 to 2017, 520 patients with an LVEF of 60% or more underwent mitral valve surgery (98% repair) for DMR. All patients had preoperative, predischarge, and follow-up (mean, 5.0 ± 3.6 years) echocardiograms. Speckle tracking was performed in 119 of 520 patients (22.9%) to determine LV strain, right ventricular free-wall strain, and left atrial longitudinal strain. Multivariate logistic and Cox regression models were used in this subgroup to evaluate associations with early postoperative LV dysfunction and medium-term overall survival, respectively. RESULTS Median preoperative LVEF of the entire cohort was 65%. Based on predischarge echocardiogram, 449 patients (86.3%) maintained postoperative LVEF of 50% or greater. Seventy-one patients (13.7%) had a predischarge LVEF of less than 50%, 49 (9.4%) had a predischarge LVEF of 40% to 49%, and 22 (4.2% overall) had a predischarge LVEF of less than 40%. Abnormal preoperative LV, right ventricular, and left atrial strain measurements were significantly associated with the development of postoperative LV dysfunction, but preoperative hemodynamic and non-strain echo parameters did not vary enough in absolute values to be clinically useful as predictors of postoperative LV dysfunction. CONCLUSIONS Preoperative strain measurements in DMR patients were significantly associated with superior capabilities of detecting underlying LV dysfunction despite preserved preoperative LVEF. Strain analysis may serve as another marker for optimal timing of surgical intervention in DMR patients.
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Affiliation(s)
- Olga N Kislitsina
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - James D Thomas
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin Crawford
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eriberto Michel
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jane Kruse
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Menghan Liu
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adin-Cristian Andrei
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James L Cox
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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26
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Nobile C, Houben D, Michel E, Firmin S, Lambers H, Kandeler E, Faucon MP. Phosphorus-acquisition strategies of canola, wheat and barley in soil amended with sewage sludges. Sci Rep 2019; 9:14878. [PMID: 31619720 PMCID: PMC6795825 DOI: 10.1038/s41598-019-51204-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/25/2019] [Indexed: 01/12/2023] Open
Abstract
Crops have different strategies to acquire poorly-available soil phosphorus (P) which are dependent on their architectural, morphological, and physiological root traits, but their capacity to enhance P acquisition varies with the type of fertilizer applied. The objective of this study was to examine how P-acquisition strategies of three main crops are affected by the application of sewage sludges, compared with a mineral P fertilizer. We carried out a 3-months greenhouse pot experiment and compared the response of P-acquisition traits among wheat, barley and canola in a soil amended with three sludges or a mineral P fertilizer. Results showed that the P-acquisition strategy differed among crops. Compared with canola, wheat and barley had a higher specific root length and a greater root carboxylate release and they acquired as much P from sludge as from mineral P. By contrast, canola shoot P content was greater with sludge than with mineral P. This was attributed to a higher root-released acid phosphatase activity which promoted the mineralization of sludge-derived P-organic. This study showed that contrasted P-acquisition strategies of crops allows increased use of renewable P resources by optimizing combinations of crop and the type of P fertilizer applied within the cropping system.
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Affiliation(s)
- C Nobile
- AGHYLE, SFR Condorcet FR CNRS 3417, UniLaSalle, 19 rue Pierre Waguet, 60026, Beauvais, France.
| | - D Houben
- AGHYLE, SFR Condorcet FR CNRS 3417, UniLaSalle, 19 rue Pierre Waguet, 60026, Beauvais, France
| | - E Michel
- AGHYLE, SFR Condorcet FR CNRS 3417, UniLaSalle, 19 rue Pierre Waguet, 60026, Beauvais, France
| | - S Firmin
- AGHYLE, SFR Condorcet FR CNRS 3417, UniLaSalle, 19 rue Pierre Waguet, 60026, Beauvais, France
| | - H Lambers
- School of Biological Sciences and Institute of Agriculture, The University of Western Australia, 35 Stirling Highway, Crawley (Perth), W A, 6009, Australia
| | - E Kandeler
- Institute of Soil Sciences and Land Evaluation, Soil Biology, University of Hohenheim, Emil-Wolff Str., 27, 70599, Stuttgart, Germany
| | - M-P Faucon
- AGHYLE, SFR Condorcet FR CNRS 3417, UniLaSalle, 19 rue Pierre Waguet, 60026, Beauvais, France
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Michel E, Gaudart J, Beaulieu S, Bulit G, Piarroux M, Boncy J, Dely P, Piarroux R, Rebaudet S. Première démonstration de l’efficacité d’interventions de réponse rapides contre les flambées de choléra : une étude quasi-expérimentale en Haïti. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kagan V, Mehta C, Michel E, Ward A, Jivan A, Ricciardi M, Anderson A, Pham D, Rich J. Approaches to Repairing Outflow Graft Stenosis in Left Ventricular Assist Devices. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Michel E, Malaisrie SC. Not All Bioprosthetic Valves Are Created Equal. Semin Thorac Cardiovasc Surg 2019; 31:359-360. [PMID: 30735712 DOI: 10.1053/j.semtcvs.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Christopher Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Michel E, Orozco Hernandez E, Enter D, Monge M, Nakano J, Rich J, Anderson A, Backer C, McCarthy P, Pham D. Bridge to Transplantation With Long-Term Mechanical Assist Devices in Adults With Transposition of the Great Arteries. Artif Organs 2018; 43:90-96. [PMID: 30129258 DOI: 10.1111/aor.13347] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/07/2018] [Accepted: 08/15/2018] [Indexed: 11/30/2022]
Abstract
Prior to the widespread adoption of the arterial switch operation, patients with transposition of the great arteries (TGA) commonly underwent atrial switch operation (Mustard or Senning). It is not uncommon for these patients to progress to end stage heart failure and increasingly ventricular assist devices (VADs) are used to support these patients as a bridge to transplantation, though there is limited experience with this worldwide. A retrospective review of our institution's VAD database was undertaken and revealed seven adult patients with a history of TGA and subsequent systemic ventricular failure were implanted with a VAD: four of whom received the VAD as a bridge to transplantation (BTT) at the time of implantation, two who were initially designated as destination therapy secondary to severe pulmonary hypertension, and one who was designated as destination therapy secondary to a high risk of life-threatening non-compliance. Seven patient cases who received a VAD for severe systemic ventricular failure were included in this study. The mean age of the patients was 40 years and the majority of patients were male (6/7, 85%). Five of the patients (71.4%) had previously undergone an atrial switch operation and all of these were Mustard procedures. Two of the seven patients (28.5%) had congenitally corrected transposition of the great arteries (CC-TGA). Two of the seven patients (28.5%) had supra-systemic pulmonary pressures before VAD implantation and were designated as destination therapy (DT). One of these patients was later designated as BTT as an improvement in his pulmonary vascular resistance was observed, and subsequently underwent heart transplantation. Because of anatomic considerations, four of the patients (57%) underwent redo-sternotomy with outflow cannula anastomosis to the ascending aorta, one patient underwent VAD implantation via a left subcostal incision with anastomosis of the outflow graft to the descending thoracic aorta, and two patients (28.5%) underwent VAD implantation via a left thoracotomy and anastomosis of the outflow cannula to the descending thoracic aorta. Six of the seven patients had a HeartWare HVAD VAD implanted; one received a Thoratec Heartmate II VAD. Two patients underwent VAD explant and orthotopic heart transplant, 222 days and 444 days after VAD implant, respectively. One patient died on postoperative day 17 after complications from recurrent VAD thrombosis despite multiple pump exchanges. Four patients remain on VAD support, three of these patients are awaiting transplantation at last follow-up (mean days on support, 513 days). Bridge to transplantation with a durable VAD is technically feasible and relatively safe in patients with TGA. Multiple redo-sternotomies can be avoided with a left posterior thoracotomy approach and outflow graft anastomosis to the descending thoracic aorta after careful anatomic considerations.
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Affiliation(s)
- Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Erik Orozco Hernandez
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel Enter
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael Monge
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Cardiovascular-Thoracic Surgery, Chicago, IL, USA
| | - Jota Nakano
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan Rich
- Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allen Anderson
- Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carl Backer
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Ann & Robert H. Lurie Children's Hospital of Chicago, Cardiovascular-Thoracic Surgery, Chicago, IL, USA
| | - Patrick McCarthy
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Duc Pham
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Bluhm Cardiovascular Institute, Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Hekman KE, Michel E, Blay E, Helenowski IB, Hoel AW. Evidence-Based Bundled Quality Improvement Intervention for Reducing Surgical Site Infection in Lower Extremity Vascular Bypass Procedures. J Am Coll Surg 2018; 228:44-53. [PMID: 30359836 DOI: 10.1016/j.jamcollsurg.2018.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical site infection (SSI) poses a significant burden to patients and healthcare resources. Vascular Quality Initiative (VQI) data identify a higher rate of SSIs for lower extremity bypass than other vascular procedures. Bundled interventions have successfully reduced SSIs in other surgical procedures. STUDY DESIGN We evaluated our institution-specific VQI data for modifiable risk factors associated with index hospitalization SSI from January 2012 through October 2015. We implemented an evidence-based lower extremity bypass operation SSI reduction bundle (ie perioperative chlorhexidine showers and transverse groin incisions) and prospectively enrolled all patients who had lower extremity bypass procedures, with a target adherence rate of 50% per bundle component. Bundle adherence and SSI events were measured from March 2016 through August 2017. We carried out a pre-post evaluation of bundle effectiveness in reducing index hospitalization SSI. RESULTS In the pre-intervention period, 43 of 234 (18%) patients had SSI events. The only risk factors associated with SSI (ie female sex, diabetes, overweight BMI) were not readily modifiable. In an 18-month period after introduction of our intervention, adherence rates to preoperative chlorhexidine showers, a transverse incision, and a postoperative chlorhexidine shower were 71% (52 of 73), 48% (24 of 50), and 88% (64 of 73), respectively. Compliance with all applicable bundle components was 36% (26 of 73). The SSI rate post-intervention decreased from 18% to 4% (3 of 73). Intention-to-treat multivariable analysis showed a 97% SSI risk reduction with the bundle (p = 0.002). As-treated analysis identified 85% (p = 0.02) and 62% (p = 0.047) SSI risk reductions from the preoperative and postoperative chlorhexidine showers, respectively. CONCLUSIONS In this evaluation study of the effectiveness of a quality improvement intervention, SSIs were markedly decreased after implementation of our evidence-based bundle for lower extremity vascular bypass procedures.
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Affiliation(s)
- Katherine E Hekman
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern Medicine, Chicago, IL
| | - Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern Medicine, Chicago, IL
| | - Eddie Blay
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern Medicine, Chicago, IL
| | - Irene B Helenowski
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Northwestern Medicine, Chicago, IL
| | - Andrew W Hoel
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Northwestern Medicine, Chicago, IL.
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Hekman KE, Michel E, Blay E, Helenowski IB, Yang AD, Hoel AW. Evaluation of the Effectiveness of an Evidence-Based Bundled Quality Improvement Intervention in Reducing Surgical Site Infections in Lower-Extremity Vascular Bypass Procedures. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kislitsina ON, Michel E, Bonow RO, Thomas JD, Liu M, Kruse J, Andrei AC, McCarthy PM. P3522Preoperative characteristics and late outcomes in patients who develop left ventricular dysfunction following mitral valve surgery for degenerative mitral regurgitation (DMR). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- O N Kislitsina
- Northwestern University, Cardiac Surgery and Cardiology, Chicago, United States of America
| | - E Michel
- Northwestern University, Cardiac Surgery and Cardiology, Chicago, United States of America
| | - R O Bonow
- Northwestern University, Cardiac Surgery and Cardiology, Chicago, United States of America
| | - J D Thomas
- Northwestern University, Cardiac Surgery and Cardiology, Chicago, United States of America
| | - M Liu
- Northwestern University, Cardiac Surgery and Cardiology, Chicago, United States of America
| | - J Kruse
- Northwestern University, Cardiac Surgery and Cardiology, Chicago, United States of America
| | - A C Andrei
- Northwestern University, Cardiac Surgery and Cardiology, Chicago, United States of America
| | - P M McCarthy
- Northwestern University, Cardiac Surgery and Cardiology, Chicago, United States of America
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Evans YN, Rafton SA, Michel E, Ebel BE. Provider Language Proficiency and Decision-Making When Caring for Limited English Proficiency Children and Families. J Natl Med Assoc 2018; 110:212-218. [DOI: 10.1016/j.jnma.2017.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/05/2017] [Accepted: 06/07/2017] [Indexed: 11/29/2022]
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Bethge M, Peters E, Michel E, Radoschewski FM, Spanier K. [Motivational and Volitional Determinants of Applying for Psychosomatic Rehabilitation: Findings of a Cohort Study]. REHABILITATION 2016; 55:341-347. [PMID: 27923239 DOI: 10.1055/s-0042-119631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Analyses of motivational and volitional determinants of applying for psychosomatic rehabilitation Methods: Determinants of a rehabilitation request were assessed by a questionnaire in 2013. Applications for psychosomatic rehabilitation measures until the end of 2014 were extracted from administrative data records. Included were employees with mental disorders. Results: Only 55 of 974 persons requested a rehabilitation measure. The intention to apply for a rehabilitation measure was strongest determined by self-efficacy and family and professional support. Planning was explained by intention and to a lesser extent by family and physician support. Persons with higher planning scores were more likely to apply for a rehabilitation measure. Physician support also increased the likelihood of a rehabilitation request. Conclusion: The analyses identified determinants of rehabilitation claims that are modifiable. This gives opportunities to support rehabilitation claims. However, the contribution of these factors to explain rehabilitation requests is only limited.
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Affiliation(s)
- M Bethge
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
| | - E Peters
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
| | - E Michel
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Bereich Rehabilitationsforschung, Charité - Universitätsmedizin Berlin
| | - F M Radoschewski
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Bereich Rehabilitationsforschung, Charité - Universitätsmedizin Berlin
| | - K Spanier
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
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Lehoux AP, Rodts S, Faure P, Michel E, Courtier-Murias D, Coussot P. Magnetic resonance imaging measurements evidence weak dispersion in homogeneous porous media. Phys Rev E 2016; 94:053107. [PMID: 27967061 DOI: 10.1103/physreve.94.053107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Indexed: 06/06/2023]
Abstract
We measure the dispersion coefficient through homogeneous bead or sand packings at different flow rates from direct magnetic resonance imaging (MRI) visualizations of the transport characteristics of a pulse of paramagnetic nanoparticles. Through two-dimensional imaging we observe homogeneous dispersion inside the sample, but we show that entrance effects may induce significant radial heterogeneities, which would affect the interpretation of the breakthrough curve. Another MRI approach then provides quantitative measurements of the evolution in time of the longitudinal particle distribution in the sample. These data can be analyzed to deduce the coefficient of dispersion independently of entrance effects. The values obtained for this "effective" dispersion coefficient are almost ten times lower than the commonly accepted values.
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Affiliation(s)
- A P Lehoux
- Université Paris-Est, Laboratoire Navier (ENPC, IFSTTAR, CNRS), Champs-sur-Marne 77420, France
- EMMAH, INRA, Université d'Avignon et des Pays de Vaucluse, Avignon 84000, France
| | - S Rodts
- Université Paris-Est, Laboratoire Navier (ENPC, IFSTTAR, CNRS), Champs-sur-Marne 77420, France
| | - P Faure
- Université Paris-Est, Laboratoire Navier (ENPC, IFSTTAR, CNRS), Champs-sur-Marne 77420, France
| | - E Michel
- EMMAH, INRA, Université d'Avignon et des Pays de Vaucluse, Avignon 84000, France
| | - D Courtier-Murias
- Université Paris-Est, Laboratoire Navier (ENPC, IFSTTAR, CNRS), Champs-sur-Marne 77420, France
| | - P Coussot
- Université Paris-Est, Laboratoire Navier (ENPC, IFSTTAR, CNRS), Champs-sur-Marne 77420, France
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Michel E, Meyerson SL. Resident Identification of Significant Learning Experiences: A Qualitative Analysis. Ann Thorac Surg 2016; 102:1731-1735. [PMID: 27460915 DOI: 10.1016/j.athoracsur.2016.05.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Practice-based learning is a core competency that is required of residency programs. This study uses a simple written system to encourage structured reflection and describes the experiences residents identify as significant for learning. METHODS Thoracic surgery residents were asked to submit a brief monthly written reflection, highlighting something they learned from a clinical experience. Qualitative analysis of these reflections was performed with grounded theory to generate categories of learning topics. These categories were then combined into themes used to develop theories about how residents learn from their experiences. The frequency of responses within each category was compared between senior and junior residents to examine differences in their approach to learning. RESULTS Seven residents submitted 56 learning experiences (19 by seniors, 37 by juniors) over a 1-year period. Open coding revealed 113 learning points in 12 unique categories. Procedure choice was the most common category reported. Senior residents were more likely to report learning points that involved procedure choice (31% versus 18%, p = 0.01) and procedure timing (8% versus 2%, p = 0.04) than junior residents. The 12 categories were combined into four themes: evaluation and management; technical skills; complication identification and management; and teamwork and communication. Seniors were more likely to report learning points in the preoperative phase (46% versus 32%, p = 0.01). CONCLUSIONS Brief written reflection is a feasible approach to encourage thoughtful reflection and practice-based learning. Faculty members should explicitly help residents improve their practice by using individualized guidance and can influence resident learning by asking targeted questions, clarifying decisions, and modeling behavior.
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Affiliation(s)
- Eriberto Michel
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shari L Meyerson
- Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Michel E, Votteler S, Schwarz S, Diedrich S, Wellinghausen N. An Unusual Case of Eczema. Klin Padiatr 2016; 228:96-7. [DOI: 10.1055/s-0042-100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Deheuvels S, Silva Aguirre V, Cunha MS, Appourchaux T, Ballot J, Brandão I, Lebreton Y, Michel E. An attempt to calibrate core overshooting using the seismic properties of low-mass stars. EPJ Web of Conferences 2015. [DOI: 10.1051/epjconf/201510101013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Peralta RA, Samadi R, Michel E. Test of a new method for seismic indices and granulation parameters extraction. EPJ Web of Conferences 2015. [DOI: 10.1051/epjconf/201510106052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Michel E, Weiss A. Kationenaustausch und eindimensionales, innerkristallines Quellungsvermögen bei den isotypen Verbindungen (M = P, As; X = Ti, Zr, Sn). ACTA ACUST UNITED AC 2014. [DOI: 10.1515/znb-1967-1104] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Es wurden die dem kristallinen, sauren Zirkonphosphat H2 [Zr (PO4) 2] · H2O analogen kristallinen Verbindungen Zirkonarsenat H2 [Zr (AsO4) 2] · H2O, Titanphosphat H2 [Ti (PO4) 2] · H2O, Titanarsenat H2 [Ti (AsO4) 2] · H2O, Zinnphosphat H2 [Sn (PO4)2] ·H2Ο und Zinnarsenat H2 [Sn (AsO4) 2] · H2O dargestellt. Alle genannten Verbindungen sind isotyp. Die bisher für das saure Zirkonphosphat angenommene hexagonale Symmetrie ist bei allen genannten Verbindungen nicht streng erfüllt. Das Kristallwasser ist reversibel gebunden. Amine werden als Ammoniumionen in das Kristallinnere aufgenommen. Diese Ammoniumverbindungen besitzen Ionenaustauschereigenschaften und die Fähigkeit zur eindimensionalen, innerkristallinen Quellung. Damit ist der schichtenförmige Gitteraufbau dieser Verbindungen nachgewiesen.
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Affiliation(s)
- E Michel
- Institut für Anorganische Chemie, Universität München
| | - Armin Weiss
- Institut für Anorganische Chemie, Universität München
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Lion KC, Rafton SA, Shafii J, Brownstein D, Michel E, Tolman M, Ebel BE. Association between language, serious adverse events, and length of stay among hospitalized children. Hosp Pediatr 2014; 3:219-25. [PMID: 24313090 DOI: 10.1542/hpeds.2012-0091] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the risk for serious/sentinel adverse events among hospitalized children according to race, ethnicity, and language and to evaluate factors affecting length of stay associated with serious/sentinel adverse events. METHODS We conducted a retrospective cohort study of all pediatric inpatients at a large children's hospital from October 2007 to October 2009. We evaluated the relationship between self-reported race, ethnicity, and primary language; with having a serious or sentinel adverse event, defined as an unexpected occurrence involving risk of death or serious injury; or a potentially harmful event resulting from nonstandard practice. We also examined length of stay. Clinical complexity was adjusted for by using Clinical Risk Groups. RESULTS Of 33885 patients, 8% spoke Spanish and 4% spoke other languages. Serious and sentinel events were rare; however, among patients with such events, 14% spoke Spanish. Adjusting for potential confounders, Spanish speakers trended toward an elevated odds of adverse event (odds ratio: 1.83 [95% confidence interval: 0.98-3.39]). Controlling for age, language, and clinical complexity, having an adverse event was associated with a nearly fivefold increase in length of stay (95% confidence interval: 3.87-6.12). Spanish-speaking patients with an adverse event were hospitalized significantly longer than comparable English speakers (26 vs 12.7 days; P = .03 for interaction between language and adverse event). CONCLUSIONS Hospitalized children from Spanish-speaking families had significantly longer hospital stays in association with an adverse event and may have increased odds of a serious or sentinel event. These findings suggest that an important component of patient safety may be to address communication barriers.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.
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Lion KC, Thompson DA, Cowden JD, Michel E, Rafton SA, Hamdy RF, Killough EF, Fernandez J, Ebel BE. Clinical Spanish use and language proficiency testing among pediatric residents. Acad Med 2013; 88:1478-1484. [PMID: 23969350 DOI: 10.1097/acm.0b013e3182a2e30d] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To describe patterns of clinical Spanish use by pediatric residents, and to compare self-assessment of language proficiency against an objective language test. METHOD In 2010, the authors e-mailed a survey to all 247 pediatric residents at three institutions, inviting those with any level of Spanish language ability to participate. Participants completed a survey reporting Spanish proficiency, interpreter use, and comfort using Spanish in a range of clinical scenarios. Clinical scenarios were grouped and analyzed by degree of complexity. Self-reported Spanish proficiency was compared with tested proficiency, as measured by a 20-minute telephone assessment of general language ability. Scores were categorized as "not proficient," "proficient," and "highly proficient." RESULTS Of the 247 residents, 78 (32%) participated, self-reporting a range of Spanish skills; 23% of those reported spoken proficiency ("proficient" or "fluent"). Participants at all levels of proficiency reported using Spanish without interpretation, including 63% of those who were not proficient. The majority (56%) of nonproficient residents reported comfort using Spanish in straightforward clinical scenarios, and 10% reported comfort in clinical scenarios with legal implications. Self-reported proficiency had a positive predictive value of 67% for testing at a proficient level and 22% for testing at a highly proficient level. CONCLUSIONS Regardless of level of Spanish proficiency, pediatric residents provide clinical care to patients in Spanish. Self-reported Spanish proficiency does not reliably predict tested ability, especially when using stringent criteria to define proficiency. Provider language "credentialing" is an important step in implementing a policy to improve care for limited English proficiency patients.
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Affiliation(s)
- K Casey Lion
- Dr. Lion is acting assistant professor, Department of Pediatrics, University of Washington, Seattle, Washington. Dr. Thompson is assistant professor, Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado. Dr. Cowden is assistant professor, Children's Mercy Hospitals and Clinics, Kansas City, Missouri. Mr. Michel is a medical student, University of Washington School of Medicine, Seattle, Washington. Ms. Rafton is administrative director, Odessa Brown Children's Clinic, Seattle Children's Hospital, Seattle, Washington. Dr. Hamdy is attending physician, Department of Pediatrics, Medstar Franklin Square Medical Center, Baltimore, Maryland. Dr. Killough is chief pediatric resident, Children's Mercy Hospitals and Clinics, Kansas City, Missouri. Mr. Fernandez is supervisor, Department of Interpreter Services, Seattle Children's Hospital, Seattle, Washington. Dr. Ebel is associate professor, Department of Pediatrics, University of Washington, Seattle, Washington, and director, Harborview Injury Research and Prevention Center, University of Washington, Seattle, Washington
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Abstract
OBJECTIVE This study investigates Latino parents' decision to seek pediatric emergency care for nonurgent health conditions. METHODS Three focus groups were conducted with Spanish-speaking parents. Eligible families had a pediatric primary care provider, and their child received emergency treatment for a nonurgent health condition in the previous year. Transcripts were transcribed, translated, and thematically coded. RESULTS Parents shared a heightened concern about symptoms such as fever or diminished energy. Many related experiences where delay resulted in serious illness or death. Other factors included low utilization of telephone triage and long clinic wait times. Nearly every family had managed the child's illness at home prior to seeking care, employing medical and natural remedies. CONCLUSIONS The study findings suggest that strengthening the connection with a child's medical home, eliminating barriers to receiving primary care in urgent situations and educating parents about management of common illnesses may improve care for Latino children.
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Affiliation(s)
- Aaron Grigg
- Center for Diversity and Health Equity, Seattle Children's Hospital, and the University of Washington, Harborview Injury Prevention & Research Center, 325 Ninth Ave, Box 359960, Seattle, WA 98104-2499, USA
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Doebeli A, Michel E, Reichler I. Induction of anaesthesia for canine caesarean section with alfaxalone. Reprod Biol 2013. [DOI: 10.1016/j.repbio.2013.01.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Michel E, Kook HP, Voss K, Boretti F, Reichler MI. Generalisierte metastatische intestinale und kutane Kalzinosis bei einem Hovawart-Welpen mit Leptospirose. SCHWEIZ ARCH TIERH 2013; 153:27-31. [DOI: 10.1024/0036-7281/a000139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lacoin F, Fourcade RO, Rouprêt M, Slama A, Le Fur C, Michel E, Sitbon A, Cotté FE. [Perceptions of benign prostatic hyperplasia according to the perspective of patients and general practitioners - the Trophée study]. Prog Urol 2013; 23:50-7. [PMID: 23287484 DOI: 10.1016/j.purol.2012.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/28/2012] [Accepted: 10/01/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the perception of benign prostatic hypertrophy (BPH) between patients and general practitioners (GPs) in terms of severity and evolution of symptoms and medication adherence. METHODOLOGY A cross-sectional observational study was performed in France in a sample of GPs who included patients for whom a BPH treatment was prescribed. Data were collected on patient and GP characteristics, diagnosis, BPH management, severity and evolution of symptoms and medication adherence. RESULTS One thousand and ninety-eight patients were recruited by 247 GPs. In 87.4% of cases, diagnosis was performed by GPs. Among them, 82.7% of patients were treated by monotherapy. The choice of a treatment was mainly based on treatment efficacy and the patient's opinion was taken into account by 5% of GPs. The patient's evaluation of symptoms severity was consistent with the GP's in 53.9% of cases. A worsening of symptoms was reported significantly more frequently by patients (18.5%) than by GPs (8.8%). Among 94 patients who reported poor adherence, GPs estimated that the level of medication adherence was good for 72 of these (77%). CONCLUSION There was discordance between the evaluation made by GPs and by patients on the perception of BPH symptoms and medication adherence. The patient's opinion was rarely taken into account in the therapeutic decision, reflecting a lack of shared medical decision-making, which would be helpful for the physician in order to optimize BPH management.
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Affiliation(s)
- F Lacoin
- Médecine générale, immeuble La Source, rue René-Cassin, 73410 Albens, France.
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Koch D, Wiestner T, Balli A, Montavon P, Michel E, Scharf G, Arnold S. Proposal for a new radiological index to determine skull conformation in the dog. SCHWEIZ ARCH TIERH 2012; 154:217-20. [PMID: 22547337 DOI: 10.1024/0036-7281/a000331] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- D Koch
- Clinic for Small Animal Surgery, University Zurich.
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Lion KC, Thompson DA, Cowden JD, Michel E, Rafton SA, Hamdy RF, Killough EF, Fernandez J, Ebel BE. Impact of language proficiency testing on provider use of Spanish for clinical care. Pediatrics 2012; 130:e80-7. [PMID: 22689864 DOI: 10.1542/peds.2011-2794] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To measure the impact of an objective evaluation of provider Spanish-language skills on self-reported language proficiency and comfort using Spanish in a range of clinical scenarios. METHODS We enrolled pediatric residents with any self-reported Spanish language ability from 3 residency programs. Participants completed a baseline survey, objective language testing, and a posttest survey. We gathered demographics, self-reported Spanish ability, and comfort using Spanish in various clinical scenarios, which were grouped and analyzed by degree of complexity. Between surveys, a language testing service administered a 20-minute, telephone-based assessment of general Spanish proficiency. Scores were reported on a scale from 1 to 12, with scores ≥ 9 designated "proficient." Participants received a numeric score and brief qualitative feedback on their language ability. RESULTS Following testing, residents (n = 76) were significantly less likely to report comfort using Spanish in straightforward clinical scenarios, from 64% to 51% (P = .007). That difference was accounted for entirely by residents who tested at a non-proficient level (56% to 39%, P = .006). Testing had no impact on comfort using Spanish in complex or medical-legal scenarios, at any proficiency level. We found no change in self-reported Spanish proficiency in any resident group. CONCLUSIONS Objective Spanish-language testing decreased nonproficient resident comfort using Spanish in straightforward clinical encounters, but it did not change comfort in complex or legal scenarios. In combination with education and enforceable policies, language testing may play an important role in decreasing nonproficient Spanish use and improving care for patients with limited English proficiency.
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Affiliation(s)
- K Casey Lion
- aDepartment of Pediatrics, University of Washington, Seattle, ashington 98104-2499, USA
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