JVS-vascular insights最新文献

{"title":"Vascular surgery experience for major vascular injuries in the Beirut Blast: Lessons learned","authors":"Makram Abou Ghaida MD ,&nbsp;Naji Abou Ali MD ,&nbsp;Mazen Basbous MD ,&nbsp;Kaissar Yammine MD ,&nbsp;Chahine Assi MD ,&nbsp;Fadi Hayek MD","doi":"10.1016/j.jvsvi.2024.100104","DOIUrl":"10.1016/j.jvsvi.2024.100104","url":null,"abstract":"<div><h3>Background</h3><p>The Beirut Port Blast on August 4, 2020, was the largest non-nuclear blast in history. It heavily affected the fragile population already facing an ongoing political and socioeconomic crisis, and the coronavirus diease 2019 pandemic. This article is a review of major vascular injury patterns and mechanism, strategies of treatment, and physician experience.</p></div><div><h3>Methods</h3><p>This retrospective review was performed on all patients who presented to the Lebanese American University Medical Center—Rizk Hospital after the Beirut Blast owing to vascular injuries. All patients presenting with major vascular injuries requiring admission, operations, or who were deceased owing to vascular injuries were included. Basic identification and medical history data were extracted. The surgical procedures and postoperative care and outcomes were also recorded.</p></div><div><h3>Results</h3><p>Eigtheen patients who presented to our institution during the day of the blast were included. Two patients passed away in the emergency room. The remaining 16 patients required surgeries. Most vascular injuries were caused by debris and shattered standard glass. The location of the vascular injuries were diverse; six patients (33.3%) had neck injuries, nine patients (50%) had upper extremity injuries, and three patients (16.6%) had lower extremity injuries. Furthermore, all patients had venous injuries (100%), and nine patients (50%) had arterial injuries.</p></div><div><h3>Conclusions</h3><p>After the Beirut Blast, the major vascular injury seen was in the upper extremity, followed by the neck and lower extremity, mostly owing to shattered nonlaminated glass. Laminated or tempered glass should be considered superior to standard nonlaminated glass during Beirut renovation and areas at high risk for bombing, wars, and natural disasters like earthquakes. Awareness and knowledge of bleeding control is a must for people living in such risky environments. Venous injuries were more common and managed safely by ligation. Arterial injuries required a more extensive approach based on the location and extent of injury, but damage control surgery remains the mainstay strategy in disastrous situations.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000527/pdfft?md5=938e3fc425d8596eef36dd0d9678fc93&pid=1-s2.0-S2949912724000527-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141394029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specialty acuity should be a consideration while assessing operating room block time metrics","authors":"Aakanksha Gupta MD,&nbsp;Joseph V. Lombardi MD, MBA,&nbsp;Mikael Fadoul MD,,&nbsp;Bruce L. Tjaden MD,&nbsp;Philip Batista MD,&nbsp;Jeffery Carpenter MD,&nbsp;Katherine McMackin MD","doi":"10.1016/j.jvsvi.2024.100080","DOIUrl":"10.1016/j.jvsvi.2024.100080","url":null,"abstract":"<div><h3>Objective</h3><p>Operating room (OR) utilization is a key metric of productivity for surgeons and surgical services. It is defined as total hours of elective surgery performed within OR block time, including turnover time, divided by the hours of allocated block time. To maximize this metric, hospitals have OR release times built in, which often trigger 72 hours prior to the start of the day. Vascular surgery is among several disciplines that carry a high number of urgent case bookings that require last minute OR availability. The purpose of this study was to examine OR release policy within our own institution in the context of the number of cases booked after the release period by vascular surgery and other surgical services.</p></div><div><h3>Methods</h3><p>A single-center retrospective review of all cases done by the Department of Surgery between October 2021 and October 2022 at a tertiary care university hospital was performed. Urgent cases were defined as those booked within 48 hours of the procedure. Total cases, inpatient vs outpatient/preadmit designation, number of urgent cases booked, OR utilization, and surgeon division were collated. included divisions were vascular (5 surgeons), colorectal (3 surgeons), bariatrics (2 surgeons), breast (7 surgeons), acute care (10 surgeons), general (8 surgeons), plastics (8 surgeons), otolaryngology (5 surgeons), and urology (6 surgeons). Additionally, we propose a novel method to calculate OR utilization based on the number of urgent cases performed by each specialty.</p></div><div><h3>Results</h3><p>A total of 9295 surgeries were performed by 54 surgeons. Of the surgeries, 1849 were performed on inpatients. Vascular surgeons accounted for 9% of surgeons in the study and booked 372 urgent cases (26%), representing the highest of all divisions including acute care surgery, who booked 180 urgent cases (13%). In addition, vascular surgery performed 26% (n = 476) of all inpatient surgeries during the study period, which made up over one-half (55%) of the total vascular volume of 865 cases. This was the highest percentage of inpatients throughout the surgical service line. Despite this, vascular surgery had one of the lowest OR utilizations at 65% during this time period. However, after accounting for number of urgent cases using the proposed formula, vascular surgery's adjusted OR utilization was found to be 115.7%.</p></div><div><h3>Conclusions</h3><p>Ensuring OR availability for services that have high urgency and substantial inpatient volume may allow greater system throughput, patient satisfaction, decreased length of stay, and lower surgeon stress burden. Vascular surgeons had the highest urgent and inpatient case volume of all examined surgical specialties. Hybrid OR availability and allocation of block time for vascular services should be reflected in the need to accommodate this operative climate.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294991272400028X/pdfft?md5=927b3561182af332fd7fb829650c04fe&pid=1-s2.0-S294991272400028X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140763554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Running a quality-focused office-based laboratory","authors":"Krishna Jain MD, FACS","doi":"10.1016/j.jvsvi.2024.100076","DOIUrl":"10.1016/j.jvsvi.2024.100076","url":null,"abstract":"","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000242/pdfft?md5=3a636999f7bc5ff195db4ce1a0ae360d&pid=1-s2.0-S2949912724000242-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of artificial intelligence in three-dimensional imaging modalities and diabetic foot disease: A systematic review","authors":"Manal Ahmad MBBCh BAO, MRCS, MMedSc, PGCMedEd, MAcadMEd ,&nbsp;Matthew Tan MBBS, BSc (Hon), MRCS, AFHEA ,&nbsp;Henry Bergman MBBS, MRCS ,&nbsp;Joseph Shalhoub BSc, MBBS, FHEA, PhD, Med, FRCS, FEBVS ,&nbsp;Alun Davies MA (Oxon & Cantab), BM, BCh (Oxon), DM (Oxon), DSC (Oxon)","doi":"10.1016/j.jvsvi.2024.100057","DOIUrl":"10.1016/j.jvsvi.2024.100057","url":null,"abstract":"<div><h3>Background</h3><p>Diabetic foot disease (DFD) is serious complication of diabetes with a multifactorial etiology and carries a significant risk of lower limb amputations. The prevalence of DFD continues to grow globally. Artificial intelligence has been proposed in aiding early detection and risk stratification for ulceration and other major complications, including sepsis, minor or major lower limb amputation, and death. We systematically reviewed the literature available on the use of artificial intelligence in three-dimensional imaging modalities in DFD.</p></div><div><h3>Methods</h3><p>A literature review was conducted in accordance with PRISMA guidelines. Embase and Medline (via the Ovid interface), CINAHL (via Ebsco Host), Web of Science, and Scopus databases were searched. The gray literature was also reviewed on <span>ClinicalTrials.gov</span><svg><path></path></svg> and the National Institute for Health Research journals library. The medical subject headings terms “diabetes” AND “diabetic foot disease” AND “artificial intelligence” and various permutations of three-dimensional imaging modalities, including “computed tomography,” “magnetic resonance imaging” and “positron emission tomography” were used in the primary search string. The articles were independently screened and reviewed by two reviewers.</p></div><div><h3>Results</h3><p>We identified 4865 studies and removed 102 duplicates. We excluded 4721 during title and abstract screening. Overall, 42 articles underwent full text review and 1 article was included in the final review, which used computed tomography scanning in patients with DFD to create a risk prediction model.</p></div><div><h3>Conclusions</h3><p>The use of machine learning and deep learning models is still being explored and evaluated in this context. Current methodologies focus on wound imaging classification, plantar thermography and plantar pressures. Specialized models that evaluate three-dimensional imaging are currently primitive and limited in their use; however, they have potential for the generation of suprahuman insights into existing imaging, extraction of novel metadata features, and prediction using integration of multidimensional patient characteristics.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100057"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000059/pdfft?md5=8e18cf59a95abde499db2d220f904714&pid=1-s2.0-S2949912724000059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139887435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and potential solutions to enrollment in a clinical trial of arteriovenous fistula vs arteriovenous graft vascular access strategy","authors":"Matthew P. Goldman MD ,&nbsp;Dipal M. Patel MD ,&nbsp;Kevin Z. Chang MD ,&nbsp;Ross P. Davis MD ,&nbsp;Matthew S. Edwards MD ,&nbsp;Justin B. Hurie MD ,&nbsp;Ashlee Sutsrim MD ,&nbsp;Gabriela Velazquez-Ramirez MD ,&nbsp;Timothy K. Williams MD ,&nbsp;Oscar H. Grandas MD ,&nbsp;Michael B. Freeman MD ,&nbsp;Michael M. McNally MD ,&nbsp;Scott L. Stevens MD ,&nbsp;Kyla M. Bennett MD ,&nbsp;Karen Woo MD ,&nbsp;Christopher G. Carsten MD ,&nbsp;Mark P. Androes MD ,&nbsp;Joseph-Vincent V. Blas MD ,&nbsp;Brian Jones MD ,&nbsp;R. Michael Patton MD ,&nbsp;Sherry Leung","doi":"10.1016/j.jvsvi.2024.100108","DOIUrl":"10.1016/j.jvsvi.2024.100108","url":null,"abstract":"<div><p>This article presents the rationale, challenges, and adaptive strategies employed during the initiation and execution of the arteriovenous (AV) access trial—a multicenter randomized controlled trial (RCT) comparing AV fistulas and AV grafts for hemodialysis in older adults with major comorbidities. Motivated by shifts in epidemiologic landscapes and evolving guidelines moving away from a fistula-first approach and to more patient-centric approaches, the objective of this randomized controlled trial was to fill critical knowledge gaps in determining the optimal vascular access for this complex patient population. We outline the challenges encountered in patient recruitment along with measures employed to overcome these obstacles in recruitment. We emphasize the pivotal role of continuous research in overcoming these challenges, underscoring its necessity to achieve a thorough comprehension of optimal vascular access strategies for this complex patient population.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000564/pdfft?md5=1f78d1daf6f46fa5ce435b9f3cb137ac&pid=1-s2.0-S2949912724000564-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141408050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphologic characteristics of painful varicose veins in women: possible role of disordered collagen and endothelial cells","authors":"Shivani Thakur BA ,&nbsp;Jasmin Dominguez Cervantes BS ,&nbsp;Ahmed Zabiba BS","doi":"10.1016/j.jvsvi.2024.100105","DOIUrl":"10.1016/j.jvsvi.2024.100105","url":null,"abstract":"<div><h3>Objective</h3><p>This study examines to what extent vein wall thickness, collagen arrangements, muscular layers distribution, immunohistochemical presentation of endothelial cell arrangement, and adventitia layer placement differed in patients with small painful veins vs large painful symptomatic varicose veins (VVs).</p></div><div><h3>Methods</h3><p>This study was conducted from June 2022 to September 2022 at Valley Vein Health Center, a rural phlebology outpatient clinic. Ten samples from each of the three subjects were collected (n = 3): five were small symptomatic veins, and five were large symptomatic veins. All tissue blocks were cut transversely, perpendicular to the vessel axis, into 5-μm-thick sections. Three stains were chosen: Masson trichrome, hematoxylin and eosin, and a cluster of differentiation 31 (CD31). Statistical analysis was performed with the GraphPad statistical program. Comparisons between vein wall thicknesses were made using Student’s <em>t</em> test.</p></div><div><h3>Results</h3><p>The average thickness of small veins was less than that of large veins (426 μm ± 26.1 μm vs 480 μm ± 19.2 μm, respectively; <em>P</em> &lt; .001). Histologic and immunohistochemical (CD31) analysis of small symptomatic VVs by hematoxylin and eosin and trichrome stain showed an endothelial layer overlying the media, mostly of elastic tissue fibers, and smooth muscle bundles. CD31 expression analysis demonstrated more endothelial channels in the tunica media of the enlarged veins compared with smaller vessels. The larger vein’s microscopic structure was variable with irregular collagen arrangement, clumped elastin layer appearance, feathered muscular layer distribution, and thickened adventitia layer placement.</p></div><div><h3>Conclusions</h3><p>The morphological distinctions in VVs highlighted in this study need to be considered to develop potential drug therapies tailored to women.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000539/pdfft?md5=63839d47b8fcbe37eb5758b347ea414b&pid=1-s2.0-S2949912724000539-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141412089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation and industry partnership in vascular surgery education","authors":"","doi":"10.1016/j.jvsvi.2024.100082","DOIUrl":"10.1016/j.jvsvi.2024.100082","url":null,"abstract":"<div><h3>Objective</h3><p>Simulation training improves resident open and endovascular technique and increases efficiency in the operating room, meeting costs and allocating time to curriculum development are obstacles for the leadership of surgical residencies. In this paper, we provide a narrative review of the types of simulation and the role industry has in simulation. We also explain how our institution utilized medical device sponsorship in a cost-efficient, non-biased way.</p></div><div><h3>Methods</h3><p>Vascular surgery trainees and surgeons were invited to two local, in-person simulation events, focusing on the management of aortic aneurysms and peripheral vascular disease. Pre- and post-surveys were sent to participants, and the results were analyzed with descriptive statistics. Survey score means were compared via paired <em>t</em>-test with significance set at <em>P</em> &lt; .05.</p></div><div><h3>Results</h3><p>Benchtop anastomotic models, animal/cadaveric models, and virtual reality have been adopted in many surgical programs and can each provide practice to different levels of skill. Although industry is supportive of simulation curriculums, little is published regarding the role it plays and ways to reduce conflict of interest. At our local simulation events, trainees showed significant improvement in confidence ratings.</p></div><div><h3>Conclusions</h3><p>Industry sponsorship has been able to support many educational endeavors. In our experience, we attempted to reduce conflict of interest by focusing on device company participation and nonpartisan, physician-lead didactics. There is a great need for future research in surgical education and industry partnership.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000308/pdfft?md5=3c3391a04600bb1e8efadfdc887d8b94&pid=1-s2.0-S2949912724000308-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141033527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing burnout in surgery and vascular surgery","authors":"","doi":"10.1016/j.jvsvi.2024.100062","DOIUrl":"10.1016/j.jvsvi.2024.100062","url":null,"abstract":"<div><h3>Objective</h3><div>By exploring the scientific literature, this article seeks to equip health care professionals with the knowledge to identify solutions to burnout within surgery and vascular surgery.</div></div><div><h3>Methods</h3><div>A narrative literature review included French and English articles and was conducted in April 2023 with the help of PubMed and Google Scholar databases. Our search included specific Medical Subject Heading terms such as “burnout,” “solution,” and “healthcare.” The review focused on surgical specialties, with a particular lens toward vascular surgery when evidence was available. However, it was broadened to include non-surgical specialties to address knowledge gaps. Through the literature review, we canvased information about operational interventions against burnout, which was then described descriptively.</div></div><div><h3>Results</h3><div>We presented a summary of interventions to mitigate burnout as a tiered approach, categorized into three groups that encompass the individual, the team, and the system. Research supports individual-focused interventions that enhance work-life balance and the use of other tools such as peer support groups, coaching, and counseling. Team-based strategies encompass relationships and mentorship as vital positive factors that curb burnout rates. Finally, the literature advocates for organizational support through good leadership and institutional investment into the workforce’s culture and well-being for solutions to burnout at the system level.</div></div><div><h3>Conclusions</h3><div>The prevalence of burnout in health care professionals is a public health crisis. Contemporary evaluations in the vascular surgery specialty demonstrate that nearly one-half of the workforce has experienced burnout. This paper explores the current literature to identify solutions that could help address burnout for vascular surgeons. Current literature supports a tiered approach to mitigate burnout that encompasses elements at the individual, team, and organizational levels.</div></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100062"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140280533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of hospitalist comanagement on vascular surgery inpatient outcomes","authors":"Kaavya Adam MD ,&nbsp;Vamsi Potluri MD ,&nbsp;Sean Greenhalgh MD ,&nbsp;Bernadette Aulivola MD","doi":"10.1016/j.jvsvi.2024.100120","DOIUrl":"10.1016/j.jvsvi.2024.100120","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;In recent years, hospitalists have been increasingly involved in the medical management of hospitalized surgical patients. This trend has been impacted by the goal of offloading inpatient care from the primary care provider in addition to the presence of an increasing burden of inpatient comorbidities and broader trends in multidisciplinary team-based care of the surgical patient. Multiple studies have demonstrated the clinical benefits associated with the implementation of a hospitalist comanagement service for surgical patients, whereas others have highlighted increases in cost and strain on understaffed medical teams. We aimed to assess the impact of the implementation of a dedicated hospitalist comanagement agreement on outcomes in an academic medical center vascular surgery inpatient service.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Institutional review board approval was obtained before data collection. The inpatient database was queried for all admissions to the vascular surgery service between January 1, 2007, and December 31, 2017. Given that a hospitalist comanagement agreement was established in 2014, we collected data and compared cohorts admitted to the vascular surgery service before and after January 1, 2014. Patients admitted to the intensive care unit during their hospital stay were excluded, as the hospitalist team was not involved in intensive care unit patient care. We collected data on patient demographics, admission diagnosis, comorbid diseases, and clinical outcomes including hospital length of stay, cardiac morbidity, and mortality. Data were assessed via logistic regression models to investigate the impact on clinical outcomes after the start date of the hospitalist comanagement program.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;A total of 1438 patients were included in the analysis, including 866 pre- and 572 posthospitalist comanagement agreement. The mean age was 66.1 (standard deviation 14.0) years, similar in both groups. Overall, 822 (57.2%) patients were male, and 616 (42.8%) were female, similar in both groups. Overall, 67.5% were White, 25.6% Black, and 6.9% were classified as other race. The mean length of stay was 8.2 days overall and was lower in the comanagement group at 7.6 vs 8.6 days in the non-comanagement group (&lt;em&gt;P&lt;/em&gt; = .0022). Overall 30-day mortality was 2.5%, similar in both groups (&lt;em&gt;P&lt;/em&gt; = .36). The incidence of myocardial infarction was lower in the comanagement group at 2.6% vs 6.0% in the non-comanagement group (&lt;em&gt;P&lt;/em&gt; = .0001). Logistic regression modeling controlling for comorbidities demonstrated a 61% odds reduction rate for cardiac events in patients who were comanaged by the hospitalist medicine team (&lt;em&gt;P&lt;/em&gt; &lt; .01). Linear regression modeling showed an overall reduced length of stay in the comanagement group by 1.45 days (&lt;em&gt;P&lt;/em&gt; &lt; .01) with benefits shown specifically for patients undergoing major amputation, thromboembolectomy, and those with infected va","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000680/pdfft?md5=fbffbb8955041280e7606c42e2c7703b&pid=1-s2.0-S2949912724000680-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141706365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing ankle-brachial index measurement for peripheral arterial disease screening in mobile clinics","authors":"Shahida N. Balaparya EdD, MBA, RVT ,&nbsp;Rosemary G. Cobb BA ,&nbsp;Jaeyoung Lee BS ,&nbsp;Jessica P. Simons MD, MPH ,&nbsp;Douglas W. Jones MD, MS ,&nbsp;Andres Schanzer MD ,&nbsp;Tammy T. Nguyen MD, PhD","doi":"10.1016/j.jvsvi.2024.100125","DOIUrl":"10.1016/j.jvsvi.2024.100125","url":null,"abstract":"<div><h3>Objective</h3><p>Multidisciplinary mobile clinics (MMCs) provide a robust venue to provide health care access and peripheral arterial disease (PAD) screening to underserved populations. The ankle-brachial index (ABI) can facilitate PAD diagnosis; however, traditional supine ABI measurements may be challenging technically in a mobile outreach clinic with limited infrastructure, whereas seated ABI offers technical ease. In this study, the usefulness and feasibility of performing supine ABI, seated ABI, and seated ABI with a calculation to account for seated hydrostatic pressure (seated-adjusted ABI) were compared in a mobile outreach setting.</p></div><div><h3>Methods</h3><p>Prospective data were collected from patients at five independent MMCs focused on diabetic foot and PAD screening with ABI for underserved communities. Three techniques were used to measure the ABI: seated ABI, seated-adjusted ABI using a formula to account for hydrostatic ankle pressure, and traditional supine ABI using a foldable massage table that is 5% of the cost of a medical stretcher. Comparative analysis was performed using the Student <em>t</em> test analysis and one-way analysis of variance. The frequency of completed seated ABI, seated-adjusted ABI, and supine ABI examinations performed at independent MMCs was quantified to determine feasibility.</p></div><div><h3>Results</h3><p>In 166 individuals experiencing homelessness or housing instability who were screened over the course of five MMCs, 89 underwent PAD screening with ABI. Of the patients screened, 38 patients had seated, seated-adjusted, and supine ABIs measured (43% of total number of patients undergoing any ABI measurement). PAD (ABI &lt; 0.9) was identified in one patient using all three ABI methods. Noncompressible ABI (ABI ≥ 1.3) were identified in 32 patients (32/38 [84%]) screened with seated ABI. Of these 32 patients, 24 (75%) continued to have noncompressible ABIs using seated-adjusted ABI. Of these 24 patients, 4 (17%) continued to have noncompressible ABI using supine ABI. The average seated ABI significantly differed from supine ABI (1.34 vs 1.14; <em>P</em> &lt; .0001). The average seated ABI also significantly differed from seated-adjusted ABI (1.34 vs 1.29; <em>P</em> = .026). The average seated-adjusted ABI significantly differed from supine ABI (1.29 vs 1.14; <em>P</em> = .0204).</p></div><div><h3>Conclusions</h3><p>We found that seated and seated-adjusted ABI are grossly inaccurate and more often lead to falsely elevated noncompressible ABI (32/38 [84%] and 24/38 [75%], respectively) compared with supine ABI (6/38 [16%]). We recommend using supine ABI on patients for PAD screening. Supine measurement is technically feasible in outreach mobile clinics using a transportable folding massage table and is a more accurate tool for PAD screening.</p></div>","PeriodicalId":74034,"journal":{"name":"JVS-vascular insights","volume":"2 ","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949912724000734/pdfft?md5=da62ca4c731cbff75ed88e3e43918a87&pid=1-s2.0-S2949912724000734-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}