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PubMed | Thomas Jefferson University, University of Colorado at Denver, University of Chicago, Mayo Medical School and 7 more.
Type: | Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation | Year: 2016

Recommended structured clinical practices including implant technique, anti-coagulation strategy, and pump speed management (PREVENT [PREVENtion of HeartMate II Pump Thrombosis Through Clinical Management] recommendations) were developed to address risk of early (<3 months) pump thrombosis (PT) risk with HeartMate II (HMII; St. Jude Medical, Inc. [Thoratec Corporation], Pleasanton, CA). We prospectively assessed the HMII PT rate in the current era when participating centers adhered to the PREVENT recommendations.PREVENT was a prospective, multi-center, single-arm, non-randomized study of 300 patients implanted with HMII at 24 participating sites. Confirmed PT (any suspected PT confirmed visually and/or adjudicated by an independent assessor) was evaluated at 3 months (primary end-point) and at 6 months after implantation.The population included 83% men (age 57 years 13), 78% destination therapy, and 83% Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profile 1-3. Primary end-point analysis showed a confirmed PT of 2.9% at 3 months and 4.8% at 6 months. Adherence to key recommendations included 78% to surgical recommendations, 95% to heparin bridging, and 79% to pump speeds 9,000 RPMs (92% >8,600 RPMs). Full adherence to implant techniques, heparin bridging, and pump speeds 9,000 RPMs resulted in a significantly lower risk of PT (1.9% vs 8.9%; p < 0.01) and lower composite risk of suspected thrombosis, hemolysis, and ischemic stroke (5.7% vs 17.7%; p < 0.01) at 6 months.Adoption of all components of a structured surgical implant technique and clinical management strategy (PREVENT recommendations) is associated with low rates of confirmed PT.


PubMed | Wayne State University, Memorial Hermann Texas Medical Center, Forest Laboratories, d Cerexa Inc. and c Alabama Infectious Disease Center
Type: Journal Article | Journal: Journal of chemotherapy (Florence, Italy) | Year: 2016

The Clinical Assessment Program and Teflaro() Utilization Registry (CAPTURE) is a multicenter registry study of acute bacterial skin and skin structure infection (ABSSSI) and community-acquired bacterial pneumonia (CABP) patients treated with ceftaroline fosamil in the US. Data for this analysis were collected between August 2011 and February 2013 at US study centres by randomly ordered chart review. Clinical success rates among ABSSSI patients were >81% when ceftaroline fosamil was used as first- or second-line therapy, including monotherapy and concurrent therapy. Among CABP patients, clinical success rates were >77% among first-line and second-line patients and patients who received first-line concurrent therapy or second line monotherapy or concurrent therapy. For CABP patients treated with ceftaroline fosamil as first-line monotherapy, the clinical success rate was 70%. Ceftaroline fosamil is an effective treatment option for patients with ABSSSI or CABP with similar clinical success rates when used as first-line or second-line treatment.


Lee Y.,Memorial Hermann Texas Medical Center | Weeks P.A.,Memorial Hermann Texas Medical Center
ASAIO Journal | Year: 2015

The purpose of this analysis is to assess the effectiveness of heparin anticoagulation in cardiogenic shock patients with TandemHeart percutaneous ventricular assist device support for which the institution's TandemHeart heparin protocol was implemented compared to those managed without protocol. This retrospective analysis included 15 patients in the protocol group and 10 patients in the nonprotocol group. Patients in the protocol group had a higher percentage of therapeutic activated partial thromboplastin time (aPTT) and lower percentage of supra-therapeutic aPTT values compared to the nonprotocol group. We conclude that TandemHeart anticoagulation may be more effectively managed through the use of a protocol than without any protocol. © 2014 by the American Society for Artificial Internal Organs.


Ostrosky-Zeichner L.,University of Houston | Ostrosky-Zeichner L.,Memorial Hermann Texas Medical Center
American Journal of Medicine | Year: 2012

Despite the availability of newer antifungal drugs, outcomes for patients with invasive fungal infections (IFIs) continue to be poor, in large part due to delayed diagnosis and initiation of appropriate antifungal therapy. Standard histopathologic diagnostic techniques are often untenable in at-risk patients, and culture-based diagnostics typically are too insensitive or nonspecific, or provide results after too long a delay for optimal IFI management. Newer surrogate markers of IFIs with improved sensitivity and specificity are needed to enable earlier diagnosis and, ideally, to provide prognostic information and/or permit therapeutic monitoring. Surrogate assays should also be accessible and easy to implement in the hospital. Several nonculture-based assays of newer surrogates are making their way into the medical setting or are currently under investigation. These new or up-and-coming surrogates include antigens/antibodies (mannan and antimannan antibodies) or fungal metabolites (d-arabinitol) for detection of invasive candidiasis, the Aspergillus cell wall component galactomannan used to detect invasive aspergillosis, or the fungal cell wall component and panfungal marker β-glucan. In addition, progress continues with use of polymerase chain reaction or other nucleic acid or molecular-based assays for diagnosis of either specific or generic IFIs, although the various methods must be better standardized before any of these approaches can be more fully implemented into the medical setting. Investigators are also beginning to explore the possibility of combining newer surrogate markers with each other or with more standard diagnostic approaches to improve sensitivity, specificity, and capacity for earlier diagnosis, at a time when fungal burden is still relatively low and more responsive to antifungal therapy.


Weeks P.A.,Memorial Hermann Texas Medical Center | Sieg A.,Memorial Hermann Texas Medical Center | Gass J.A.,Memorial Hermann Texas Medical Center | Rajapreyar I.,University of Texas Health Science Center at Houston
Heart Failure Reviews | Year: 2016

Sudden cardiac death remains a significant threat to the survival of patients with heart failure. Long-term cardiac remodeling predisposes these patients to develop malignant ventricular arrhythmias. Permanent implantable and temporary external defibrillators remain a mainstay for the prevention of sudden cardiac death in this population. For decades, researchers have attempted to identify reliable drug therapies to avoid such arrhythmias; however, to date, success has been inconsistent. This review aims to explore the evidence defining the role of drug therapies for direct and indirect suppression of arrhythmias that may cause sudden cardiac death in patients with heart failure. © 2016, Springer Science+Business Media New York.


PubMed | Memorial Hermann Texas Medical Center and University of Houston
Type: Journal Article | Journal: Pharmacotherapy | Year: 2016

To determine the safety and efficacy of high-dose subcutaneous unfractionated heparin (UFH) for prevention of venous thromboembolism (VTE) in overweight and obese patients.Single-center retrospective observational cohort study.Large academic tertiary care medical center.A total of 1335 adults who weighed more than 100 kg on admission and received either subcutaneous UFH 7500 units every 8 hours (751 patients [high-dose group]) or 5000 units every 8 hours (584 patients [low-dose group]) for VTE prophylaxis during their hospitalization between January 1, 2013, and August 31, 2014.The incidences of VTE and bleeding complications were assessed in each group. Each group was further divided into four groups based on their body mass index (BMI): overweight (BMI 25-29.9 kg/m(2) ), obese class I (BMI 30-34.9 kg/m(2) ), obese class II (BMI 35-39.9 kg/m(2) ), and obese class III (BMI 40 kg/m(2) ). The incidence of VTE was similar for patients in the high-dose group versus those in the low-dose group for all BMI categories. Bleeding complications were significantly higher for patients in the high-dose group. The proportion of patients with at least a 2-g/dl hemoglobin drop from admission was higher in patients in the high-dose groups in obese classes II and III: obese class II, 46 (30%) of 152 patients in the high-dose group versus 30 (18%) of 171 patients in the low-dose group (p<0.01); obese class III, 109 (25%) of 432 patients in the high-dose group versus 31 (12%) of 249 patients in the low-dose group (p<0.01). In addition, the proportion of patients who received at least 2 units of packed red blood cell transfusion was significantly higher in patients in the high-dose group who were in obese class III: 47 (11%) of 432 in the high-dose group versus 13 (5%) of 249 in the low-dose group (p<0.01).Administering a higher dose of heparin to patients weighing more than 100 kg may not impart additional efficacy in reducing the incidence of VTE. However, it may increase the risk for bleeding.


Jurado L.V.,Memorial Hermann Texas Medical Center | Gulbis B.E.,Memorial Hermann Texas Medical Center
Pharmacotherapy | Year: 2011

Study Objective. To compare the effects of vecuronium administered as an intravenous continuous infusion versus intermittent bolus doses in patients treated with therapeutic hypothermia after sudden cardiac arrest (SCA). Design. Retrospective medical record review. Setting. Cardiac care unit of a university-affiliated, level I trauma center. Patients. Of 123 adults treated with therapeutic hypothermia after SCA, 80 received continuous-infusion vecuronium 0.8 μg/kg/minute started 2 hours after cooling began or if shivering occurred (January 1, 2004-December 31, 2007), and 43 received intermittent boluses of vecuronium 0.05 mg/kg every 2 hours (January 1, 2008-September 30, 2009). Measurements and Main Results. The degree of neuromuscular blockade was measured with a train-of-four (TOF) test. Primary outcomes evaluated were time to achieve goal TOF response and percentage of time the TOF response was maintained at goal. Secondary outcomes included total daily dose of vecuronium, the vecuronium dose needed to achieve goal TOF response, percentage of TOF measurements above or below goal, and time to return of spontaneous respirations and time to extubation after the last dose of vecuronium. The goal TOF response was achieved significantly earlier in the bolus group than the continuous-infusion group (mean 5.9 vs 11.3 hrs, p=0.008). The mean total daily dose of vecuronium administered in the bolus group was significantly lower than that in the continuous-infusion group (51.7 vs 76.9 mg, p=0.002). The mean percentage of TOF measurements above goal was higher in the continuous-infusion group (33% vs 16%, p<0.0001), and the mean percentage of TOF measurements below goal was higher in the bolus group (43% vs 29%, p<0.0001). The median time to return of spontaneous respirations (6 vs 11 hrs, p=0.017) and time to extubation (29.5 vs 89.5 hrs, p<0.0001) were significantly shorter in the continuous-infusion group than the bolus group. Conclusion. Intermittent boluses of vecuronium were more effective in reaching a goal TOF response earlier compared with continuous-infusion vecuronium in patients treated with therapeutic hypothermia. The two dosing strategies were equally effective at maintaining a goal TOF response despite patients receiving a significantly lower daily dose of vecuronium in the intermittent-bolus group.


PubMed | Memorial Hermann Texas Medical Center and University of Houston
Type: Journal Article | Journal: Journal of thrombosis and thrombolysis | Year: 2016

Publications regarding early initiating venous thromboembolism (VTE) prophylaxis have been available since the early 1990s. These recommendations became available in current guidelines on and after 2012. The purpose of this study is to review the practice change in reducing the incidence of VTE in brain injury patients from 2008 to 2014. This was a single-center, retrospective, observational, cohort study. Data was extracted from our data base that included patients over 100kg from January 2008 to August 2014. Included were all patients admitted with a primary diagnosis of acute brain and spinal injury to neurocritical care unit. Clinical endpoints examined were incidence of bleeding and VTE. A total of 509 patients who met the inclusion criteria were divided into two groups: The previous group (n=212) included patients from 2008 to 2010, and the recent group (n=297) included patients from 2011 to 2014. The time for initiating VTE prophylaxis from admission was (median, IQR) 73h (37-140) vs. 34h (20-46); p<0.01. There were no differences in major and minor bleeding complications. Discontinuation of VTE prophylaxis for association with progressive bleeding was not documented in any of the study patients. The incidence of VTE was 10% (22/212) vs. 5% (15/297); p=0.02. In hospital LOS in days was 16 (10-26) vs. 7 (4-15); P<0.01. In multivariable logistic regression analysis, only the time of the initiation VTE prophylaxis after admission was significantly associated with the occurrence of VTE (median, IQR) 70h (37-158) vs. 36h (20-63); OR 1.004, 95% CI 1.001-1.007; P<0.01. In this 6-year review of data, early initiation of VTE prophylaxis has decreased the incidence of VTE without clinically documented bleeding complications.


PubMed | University of Texas Health Science Center at Houston, Memorial Hermann Texas Medical Center and Rush University Medical Center
Type: Journal Article | Journal: Medical physics | Year: 2017

There are a number of commercially available flow phantoms for evaluating Doppler ultrasound systems. However, it may be hard to justify purchasing these phantoms if a hospital has a small number of ultrasound units to evaluate. In this study, we developed a simple flow phantom with parts available in a hospital to evaluate Doppler ultrasound systems.To create a flow reserve, one end of an IV line was connected to a 100 ml saline bag and the line was filled with saline. 20 ml of glycerin was injected into the saline bag to simulate blood like flow characteristics. The other end of the IV line was also connected to the saline bag to create a loop. The IV line was fed into an infusion pump (programmable up to 999 ml/hr) and was also placed between a uniform ultrasound phantom and a standoff gel pad. To minimize impedance differences, acoustic gel was used between the phantom and the gel pad. Doppler measurements were performed on two Philips iU22 ultrasound units using the L12-5 probes.The pulsatile flow of the solution in the IV line could be seen in the Doppler mode when the infusion pump was running. The color Doppler also indicated the direction of the flow via overlaid red or blue color on the grayscale B-mode ultrasound image of the IV line. The directionality of the flow could be confirmed by reversing the direction of the probe. The peak flow rates (cm/s) observed on the waveforms were reproducible within %10 when the measurements were repeated.A simple flow phantom can be developed from materials available in a hospital for routine evaluation of Doppler ultrasound systems.


PubMed | UT Health Medical School at Houston and Memorial Hermann Texas Medical Center
Type: Case Reports | Journal: Mycoses | Year: 2016

Cryptococcal infection is the third most common invasive fungal infection (IFI) among solid-organ transplant (SOT) recipients and is considered an important opportunistic infection due to its significant morbidity and mortality. To determine whether a cluster of cryptococcosis in heart transplant patients was of nosocomial nature, three cases of orthotopic heart transplant recipients with postoperative disseminated cryptococcal infection were investigated and paired with an environmental survey in a tertiary care hospital. The infection prevention department conducted a multidisciplinary investigation, which did not demonstrate any evidence of health care-associated environmental exposure. Moreover, multilocus sequence typing showed that one isolate was unique and the two others, although identical, were not temporally related and belong to the most common type seen in the Southern US. Additionally, all three patients had preexisting abnormalities of the CT chest scan and various degrees of acute and chronic rejection. Reactivation was suggested in all three patients. Screening methods may be useful to identify at risk patients and trigger a prophylactic or preemptive approach. However, more data is needed.

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