Ellis S.G.,Cleveland Clinic |
Kereiakes D.J.,Christ Hospital |
Metzger D.C.,Wellmont Holston Valley Medical Center |
Caputo R.P.,St Josephs Hospital Health Center |
And 12 more authors.
New England Journal of Medicine | Year: 2015
BACKGROUND: In patients with coronary artery disease who receive metallic drug-eluting coronary stents, adverse events such as late target-lesion failure may be related in part to the persistent presence of the metallic stent frame in the coronary-vessel wall. Bioresorbable vascular scaffolds have been developed to attempt to improve long-term outcomes. METHODS: In this large, multicenter, randomized trial, 2008 patients with stable or unstable angina were randomly assigned in a 2:1 ratio to receive an everolimus-eluting bioresorbable vascular (Absorb) scaffold (1322 patients) or an everolimus-eluting cobalt-chromium (Xience) stent (686 patients). The primary end point, which was tested for both noninferiority (margin, 4.5 percentage points for the risk difference) and superiority, was target-lesion failure (cardiac death, target-vessel myocardial infarction, or ischemia-driven target-lesion revascularization) at 1 year. RESULTS: Target-lesion failure at 1 year occurred in 7.8% of patients in the Absorb group and in 6.1% of patients in the Xience group (difference, 1.7 percentage points; 95% confidence interval, -0.5 to 3.9; P = 0.007 for noninferiority and P = 0.16 for superiority). There was no significant difference between the Absorb group and the Xience group in rates of cardiac death (0.6% and 0.1%, respectively; P = 0.29), target-vessel myocardial infarction (6.0% and 4.6%, respectively; P = 0.18), or ischemia-driven target-lesion revascularization (3.0% and 2.5%, respectively; P = 0.50). Device thrombosis within 1 year occurred in 1.5% of patients in the Absorb group and in 0.7% of patients in the Xience group (P = 0.13). CONCLUSIONS: In this large-scale, randomized trial, treatment of noncomplex obstructive coronary artery disease with an everolimus-eluting bioresorbable vascular scaffold, as compared with an everolimus-eluting cobalt-chromium stent, was within the prespecified margin for noninferiority with respect to target-lesion failure at 1 year. © 2015 Massachusetts Medical Society. All rights reserved.
Pratts M.,St Josephs Hospital Health Center |
Citrome L.,New York Medical College |
Grant W.,Syracuse University |
Leso L.,St Josephs Hospital Health Center |
Opler L.A.,Columbia University
Acta Psychiatrica Scandinavica | Year: 2014
Objective: To assess sublingual asenapine for acute agitation. Method: Agitated adults 18-65 years (any diagnosis) presenting for treatment in an emergency department and found to have a score of ≥14 on the Positive and Negative Syndrome Scale-Excited Component (PANSS-EC) were randomized to receive either a single dose of a sublingual 10 mg tablet of asenapine or placebo. Primary outcome measure was change in the PANSS-EC score from baseline to 2 h after medication or placebo administration. Secondary outcomes included the percentage of responders with a ≥ 40% reduction from baseline on the PANSS-EC score at 2 h. Results: A total of 120 subjects were randomized, 60 each to sublingual asenapine or placebo. Mean (SE) baseline PANSS-EC scores for the asenapine-treated and placebo-treated subjects were 19.4 ± 0.66 and 20.1 ± 0.61, respectively. Mean PANSS-EC scores at endpoint (LOCF) was 7.4 ± 0.65 for the asenapine-treated subjects and 14.7 ± 0.98 for the placebo-treated subjects. Change in PANSS-EC score at 2 h was statistically significantly greater for the asenapine-treated subjects compared with the placebo-treated subjects. NNT for response vs. placebo was 3 (95% CI 2-4). Conclusion: Sublingual asenapine was efficacious in the treatment of agitation with an effect size comparable to that observed in prior studies of intramuscular antipsychotics. © 2014 John Wiley & Sons A/S.
Avery L.M.,St. John Fisher College |
Avery L.M.,St Josephs Hospital Health Center |
Steed M.E.,Anti Infective Research Laboratory |
Steed M.E.,University of Kansas |
And 4 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2012
We report two cases of daptomycin (DAP)-nonsusceptible (DNS) vancomycin-intermediate Staphylococcus aureus (VISA) vertebral osteomyelitis cases complicated by bacteremia treated with high-dose daptomycin and trimethoprim-sulfamethoxazole. Both patients responded rapidly and favorably to this combination. The clinical isolates from the two patients were tested post hoc in an in vitro pharmacokinetic/pharmacodynamic (PK/PD) model to confirm the bactericidal activity and enhancement of daptomycin and trimethoprim- sulfamethoxazole. The combination of high-dose daptomycin and trimethoprim-sulfamethoxa-zole should be explored further for the treatment of DNS VISA strains. Copyright © 2012, American Society for Microbiology. All Rights Reserved.
Lagoe R.J.,Hospital Executive Council |
Johnson P.E.,Community General Hospital |
Murphy M.P.,St Josephs Hospital Health Center
BMC Research Notes | Year: 2011
Background: Increasingly, efforts are being made to link health care outcomes with more efficient use of resources. The current difficult economic times and health care reform efforts provide incentives for specific efforts in this area. Findings. This study defined relationships between inpatient complications for urinary tract infection and pneumonia and hospital lengths of stay in three general hospitals in the metropolitan area of Syracuse, New York. It employed the Potentially Preventable Complications (PPC) software developed by 3M Health Information Services to identify lengths of stay for patients with and without urinary tract infection and pneumonia. The patient populations included individuals assigned to the same All Patients Refined Diagnosis Related Groups and severity of illness. The comparisons involved two nine month periods in 2008 and 2009. The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of urinary tract infection stayed a mean of 8.9 - 11.9 days or 161 - 216 percent longer than those who did not for the two time periods. This increased stay produced 2,020 - 2,427 additional patient days. The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of pneumonia stayed a mean of 13.0 - 16.3 days or 232 - 281 percent longer than those who did not for the two time periods. This increased stay produced 2,626 - 3,456 additional patient days. Similar differences were generated for median lengths of stay. Conclusions: The differences in hospital stays for patients in the same APR DRGs and severity of illness with and without urinary tract infection and pneumonia in the Syracuse hospitals were substantial. The additional utilization for these complications was valued at between $2,000,000 - $3,000,000 for a three month period. These differences in the use of hospital resources have important implications for reduction of health care costs among providers and payors of care. © 2011 Lagoe et al; licensee BioMed Central Ltd.
Lagoe R.J.,Hospital Executive Council |
Nanno D.,Syracuse University |
Luziani M.,St Josephs Hospital Health Center
BMC Research Notes | Year: 2013
Background: Increased interest in hospital outcomes has supported the need for clear and useful identification of patients who are readmitted. These patients have frequently been identified by the principal diagnosis of the initial admission. Findings. In order to evaluate the effectiveness of identifying patients who were subsequently readmitted, those with two frequently encountered conditions, principal diagnoses of congestive heart failure and pneumonia, in the hospitals of Syracuse New York were evaluated. Both populations had large proportions of readmissions involved with principal diagnoses other than pneumonia. For patients with heart failure, a majority of readmitted patients had other diagnoses for two of the hospitals. For patients with pneumonia, a majority of patients had other diagnoses for all of the hospitals. Conclusions: The data suggested that many patients who were subsequently readmitted are best identified as medicine patients with multiple diagnoses, rather than a single one. This approach addresses the need to manage a wide range of conditions for hospital readmissions, rather than a narrow approach on individual diagnosis. © 2013 Lagoe et al.; licensee BioMed Central Ltd.
Lagoe R.J.,Hospital Executive Council |
Nanno D.S.,Crouse Hospital |
Luziani M.E.,St Josephs Hospital Health Center
BMC Research Notes | Year: 2012
Background: Increased interest in health care cost containment is focusing attention on reduction of hospital readmissions. Major payors have already developed financial penalties for providers that generate excess readmissions. This subject has benefitted from the development of resources such as the Potentially Preventable Readmissions software. This process has encouraged hospitals to renew efforts to improve these outcomes. The aim of this study was to describe quantitative tools such as definitions, risk estimation, and tracking of patients for reducing hospital readmissions. Findings. This study employed the Potentially Preventable Readmissions software to develop quantitative tools for addressing hospital readmissions. These tools included two definitions of readmissions that support identification and management of patients. They also included analytical approaches for estimation of the risk of readmission for individual patients by age, discharge status of the initial admission, and severity of illness. They also included patient specific spreadsheets for tracking of target populations and for evaluation of the impact of interventions. Conclusions: The study demonstrated that quantitative tools including the development of definitions of readmissions, estimation of the risk of readmission, and patient specific spreadsheets could contribute to the improvement of patient outcomes in hospitals. © 2012 Lagoe et al.; licensee BioMed Central Ltd.
Carniciu A.L.,St Josephs Hospital Health Center
Ophthalmic Plastic and Reconstructive Surgery | Year: 2016
PURPOSE:: This study retrospectively reviews preseptal cellulitis and abscesses involving the eyebrow to elucidate the bacteriology and potential causative factors. METHODS:: A retrospective chart review was conducted to identify patients who had been diagnosed with preseptal cellulitis or abscess involving the eyebrow at the Massachusetts Eye and Ear Infirmary between 2008 and 2015. Demographic, clinical, and microbiological data were collected. RESULTS:: Eighty patients with eyebrow infections were identified, of whom 49 (61.3%) were female and 31 (38.7%) were male. The median age was 37 years (range 14–67 years). Eyebrow abscess was present in 54 cases (67.5%), while 26 cases (32.5%) were limited to preseptal cellulitis without abscess formation. Methicillin-resistant Staphylococcus aureus was found in 20 abscesses (39.2% of culture results), and methicillin-sensitive S. aureus was found in 12 abscesses (23.5% of culture results). Coagulase-negative staphylococci were present in 7 eyebrow abscesses (13.7% of culture results). Clinical history was remarkable for eyebrow hair removal (tweezing, waxing, threading, or shaving) in 17 cases (21.3%), manipulation of acne lesions (“popping,” “picking,” or “squeezing”) in 6 cases (7.5%), and both brow hair removal and acne manipulation in 1 case (1.3%). CONCLUSIONS:: There is a high incidence of methicillin-resistant Staphylococcus aureus in the bacteriology of eyebrow infections. Empirical antibiotic coverage for methicillin-resistant Staphylococcus aureus should be strongly considered in any patient with an eyebrow area abscess or preseptal cellulitis. Individuals who practice cosmetic eyebrow grooming should be encouraged to consider hygiene practices, which could reduce the risk of infection. © 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.
Arasheben A.,St Josephs Hospital Health Center |
Barzee K.A.,New York University |
Morley C.P.,New York University
Journal of the American Board of Family Medicine | Year: 2011
Purpose: In a number of small studies focused on one or two sports, exercise and competitive level has been observed to favor attainment of higher bone mineral density (BMD) in otherwise healthy athletes. We analyzed merged data from 10 studies to determine the effects of competitive level on upper extremity BMD in female athletes across multiple sports. Methods: This study is a meta-analysis of 10 articles reporting results of similar case-control and cross-sectional studies of BMD in female athletes and nonathletes reporting an effect of athletic participation level. Upper extremity BMD was modeled as an outcome of the level of athleticism using a categorical weighted least squares model and controlling for upper-body impact, age, and body mass index. Results: Upper extremity BMD significantly increased for each level of participation (β ∇ 0.140; 95% CI, 0.047- 0.234), Age and body mass index approached significance but the level of upper extremity impact was not significant in the final model. Conclusions: Clinicians may see iteratively greater BMD in female patients who compete at increasingly intense athletic levels, with elite athletes having much higher BMD than other patients who are either active or not. Further research is needed to identify direction and causality of the relationship between competitive level and BMD.
Avery L.,St. John Fisher College |
Hasan M.,St Josephs Hospital Health Center
Clinical Microbiology Newsletter | Year: 2013
Clostridium difficile treatment failures and recurrences occur at rates of 22.3% and 22.1%, respectively. For patients who have refractory/recurrent disease, there are limited treatment options. The use of a fecal suspension from a healthy donor instilled via a nasogastric tube, during colonoscopy, or by enema in a patient with recurrent or refractory C. difficile infection has shown a response rate of 75 to 100% with minimal adverse effects. There are multiple published case series that provide variations in administration procedures. The main barrier is the need for institutions and clinics to develop protocols to ensure this treatment modality is available to patients with this debilitating and potentially fatal disease. © 2013 Elsevier Inc.
Kowal C.D.,St Josephs Hospital Health Center
The Journal of the New York State Nurses' Association | Year: 2010
Utilization of the Iowa Model of evidence-based practice (EBP) helps to facilitate change in nursing care. This was observed when an alteration in pain-rating assessment scales needed to be implemented at St. Joseph's Hospital Health Center in Syracuse, NY Research showed that the Critical Care Pain Observation Tool (CPOT) was psychometrically sound in assessing pain in the nonverbal (unconscious, unresponsive, and sedated) intensive care unit patient population. Successful implementation of a CPOT pilot program in the surgical intensive care unit at St. Joseph's was undertaken using the Iowa Model of EBP. Application of the Iowa Model provided a systematic framework for changing nursing practice by incorporating critical thinking, clinical inquiry and judgment, multidisciplinary collaboration, and facilitation of learning. As evidenced by implementation of the CPOT, organizational implementation of EBP using the Iowa Model positively impacts change across an entire healthcare continuum through the improvement of patient care processes.