Baylor University Medical Center Proceedings最新文献

{"title":"Implementation of an oxytocin bolus protocol for cesarean delivery at a Texas level IV maternal center: a single-center retrospective study.","authors":"Brittany Hood, Emily E Sharpe, Carmen Gomez Fitzpatrick, Annarose Dement, Claudia Serrano, Jessica C Ehrig, Chandni Raiyani, Michael P Hokfamp","doi":"10.1080/08998280.2024.2446021","DOIUrl":"10.1080/08998280.2024.2446021","url":null,"abstract":"<p><strong>Objective: </strong>We hypothesized that patients who underwent cesarean delivery and received oxytocin boluses followed by an infusion would have a lower incidence of secondary uterotonic administration compared to patients who had an oxytocin infusion without boluses.</p><p><strong>Methods: </strong>Patients who had cesarean deliveries at our hospital from September 1, 2021 through December 31, 2021 and from September 1, 2022 through December 31, 2022, corresponding to the oxytocin bolus and oxytocin infusion cohorts, respectively, were included. Patient demographic, physical, and clinical characteristic data were collected by a study investigator. Intramyometrial oxytocin, intramuscular methylergonovine, intramuscular carboprost tromethamine, and sublingual misoprostol were defined as secondary uterotonics.</p><p><strong>Results: </strong>There were 266 and 283 patients in the oxytocin bolus and oxytocin infusion cohorts, respectively. The odds ratio for patients in the oxytocin bolus cohort receiving a secondary uterotonic was 0.25 (95% confidence interval 0.16, 0.41; <i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>Patients in the oxytocin bolus cohort were approximately 75% less likely to receive a secondary uterotonic agent compared to patients in the oxytocin infusion cohort. A limitation of this study was that we defined intramyometrial administration of oxytocin as a secondary uterotonic, and our results may not be generalizable to hospitals that do not use intramyometrial oxytocin.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 2","pages":"149-154"},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482236","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":"Exploring current practices and perspectives on gastric varices management in the US.","authors":"Ahmad Moussawi, Ranjeeta Bahirwani","doi":"10.1080/08998280.2024.2446019","DOIUrl":"10.1080/08998280.2024.2446019","url":null,"abstract":"","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 2","pages":"135-136"},"PeriodicalIF":0.0,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482225","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":"Airway management for patients who underwent appendectomy for the indication of acute appendicitis at a Texas tertiary care center: a single center retrospective study.","authors":"Dylan Noble, Val Lumani, Macy Meyer, Lindsay Howe, Michael P Hofkamp","doi":"10.1080/08998280.2024.2443878","DOIUrl":"10.1080/08998280.2024.2443878","url":null,"abstract":"<p><strong>Background: </strong>The primary aim of our study was to determine the frequency of video laryngoscopy (VL) use on the first intubation attempt for patients who underwent appendectomy for acute appendicitis at our hospital.</p><p><strong>Methods: </strong>Patients who had an appendectomy for the indication of acute appendicitis at Baylor Scott & White Medical Center - Temple between January 1, 2021, and December 31, 2023, were included in our study. Study investigators extracted demographic, physical, and clinical data from our electronic medical record.</p><p><strong>Results: </strong>A total of 533 and 70 patients had direct laryngoscopy (DL) and VL for their first intubation attempts, respectively. Among these, 518 (97.2%) and 53 (75.7%) performed with DL and VL, respectively, were successful on the first attempt (<i>P</i> < 0.001). Patients who had VL for the first intubation attempt were more likely to be male, older, have a higher body mass index, and have a higher incidence of previous airway management with VL, appendiceal perforation, nasopharyngeal tube placement, and SARS-CoV-2 infection compared to patients who had DL.</p><p><strong>Conclusion: </strong>Approximately 12% of our patients who underwent appendectomy for acute appendicitis had VL on the first intubation attempt, and these patients were more complex than those who had DL.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 2","pages":"137-139"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482199","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 effect of tobacco use on clinical outcomes in total knee arthroplasty patients.","authors":"Dylan Parry, Jack Allen, Brennon Henderson, Jordan Kassab, Evan Hernandez, George Brindley","doi":"10.1080/08998280.2024.2441633","DOIUrl":"10.1080/08998280.2024.2441633","url":null,"abstract":"<p><strong>Introduction: </strong>Previous research has established that smoking significantly increases the complication rate of total knee arthroplasty (TKA). Risk of infection, prosthetic loosening, fractures, wound healing issues, and revisions are increased in smokers, but research is limited on the long-term clinical outcomes of pain, range of motion, stability, and functionality between smokers, nonsmokers, and former smokers, specifically utilizing Knee Society Scores (KSS).</p><p><strong>Methods: </strong>This was a retrospective chart review of primary TKA patients (n = 203) at a single university hospital. The patients were divided by smoking status: nonsmoker, current smoker, or former smoker. One-way analysis of variance with associated f ratios was performed to assess variance in KSS by smoking status over time. Relative risk ratio analyses were employed to assess patients' predictive risk of acquiring postoperative infection and requiring additional surgery following TKA based on smoking status.</p><p><strong>Results: </strong>Postoperative KSS were significantly lower in the smoker group compared to nonsmokers and former smokers at 6 weeks and 1 year. For every 20 months a former smoker used tobacco, an approximate 1-point decrease in KSS was expected. The relative risk ratios for postoperative infection rates and patients requiring additional surgery were 2.13 and 1.44, respectively, when current smokers were compared to nonsmokers.</p><p><strong>Conclusions: </strong>This analysis found that current smokers had lower KSS and higher infection rates following TKA when compared to nonsmoking controls. In addition, increased duration of smoking was correlated with poorer outcomes within the former smoker group.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 2","pages":"171-174"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481825","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":"Differences in Medicare payment and practice characteristics for orthopedic surgery subspecialties.","authors":"Jack Allen, Colton Shepherd, Tanner Heaton, Nate Behrens, Alexander Dorius, Jerry Grimes","doi":"10.1080/08998280.2024.2440282","DOIUrl":"10.1080/08998280.2024.2440282","url":null,"abstract":"<p><strong>Background: </strong>Medicare payment, practice, and patient characteristics give perspective on the lifestyle, challenges, and attractiveness unique to each orthopedic surgery subspecialty. Changes to Medicare reimbursement may also affect health care delivery, warranting policy change. We analyzed differences in orthopedic surgery subspecialty characteristics and Medicare payments.</p><p><strong>Methods: </strong>The Centers for Medicare and Medicaid Services data set was filtered by Current Procedural Terminology (CPT) codes unique to each orthopedic surgery subspecialty in 2019. After filtering by unique CPT codes, 100 randomized physicians were validated for each subspecialty: adult reconstruction and arthroplasty, trauma, sports medicine, hand surgery, shoulder and elbow surgery, foot and ankle surgery, and spine surgery. Data gathered included unique procedural codes, number of beneficiaries, services provided, and the total Medicare allowed amount. Differences were assessed with post hoc tests. Subspecialty changes in Medicare payment were assessed using the Physician Fee Schedule and compared using a single-factor analysis of variance.</p><p><strong>Results: </strong>On average, hand surgery recorded the most unique CPT codes (106) and the highest volume of beneficiaries (571). Adult reconstruction and arthroplasty had the fewest unique codes (60) and the greatest total Medicare payment ($328,000). Spine surgery had the lowest number of beneficiaries (387) and lowest number of services provided (1752). Lastly, sports medicine provided the largest volume of services (4221). Mean total codes, unique codes, and total patients differed between subspecialties. Varying differences in average Medicare payment, total billed codes, total unique codes, total patients, patient race, patient age, patient sex, and patient health were found for all orthopedic surgery subspecialties in 2019.</p><p><strong>Conclusions: </strong>These data may illustrate financial incentives for orthopedic surgery residents to pursue certain subspecialties.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 2","pages":"175-178"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482213","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":"Recombinant von Willebrand factor: a new tool to manage von Willebrand disease in obstetric patients.","authors":"Angie J He, Michael P Hofkamp","doi":"10.1080/08998280.2024.2443877","DOIUrl":"10.1080/08998280.2024.2443877","url":null,"abstract":"","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 2","pages":"148"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482168","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":"Portal vein thrombosis in patients with cirrhosis.","authors":"Michael L Volk, Gerald O Ogola, Patrick G Northup","doi":"10.1080/08998280.2024.2444145","DOIUrl":"10.1080/08998280.2024.2444145","url":null,"abstract":"<p><strong>Background and aims: </strong>Portal vein thrombosis (PVT) is common among patients with cirrhosis, but the independent impact on outcomes and management is uncertain. We aimed to determine whether the development of PVT is independently associated with mortality, bleeding, and hospitalization and whether anticoagulation improves these outcomes.</p><p><strong>Methods: </strong>Patients with cirrhosis and PVT were identified using billing codes from a large health system between 2016 and 2023 and compared to matched control cirrhosis patients without PVT. Among the cohort with PVT, those who received anticoagulation were compared to those who did not. Outcomes included mortality, gastrointestinal bleeding, and hospitalization. Adjustment for confounding was performed using propensity score analysis.</p><p><strong>Results: </strong>Among 48,596 patients with cirrhosis, 1332 formed the PVT cohort and 3440 formed the non-PVT matched cohort. On adjusted analysis, patients with PVT had higher mortality (hazard ratio [HR] 1.33, <i>P</i> < 0.001), bleeding (HR 1.41, <i>P</i> < 0.001), and hospitalization (incidence rate ratio [IRR] 1.25, <i>P</i> < 0.001). Among the 1161 PVT patients meeting inclusion criteria, 768 received no anticoagulation, 309 received anticoagulation for ≤90 days, and 84 received anticoagulation for >90 days. In the unadjusted analysis, anticoagulation was associated with lower mortality (log-rank <i>P</i> = 0.004), with a dose-response relationship. After propensity score adjustment, the association between anticoagulation and lower mortality persisted but no longer reached statistical significance (HR 0.8, <i>P</i> = 0.075). However, anticoagulation remained associated with higher bleeding (HR 1.67, <i>P</i> = 0.004) and hospitalization (IRR 1.43, <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Among patients with cirrhosis, PVT is independently associated with a higher risk of mortality, bleeding, and hospitalization. Anticoagulation may improve overall survival but is associated with a higher risk of bleeding and hospitalization.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 2","pages":"121-125"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482163","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":"Early termination and nonpublication of phase III/IV melanoma clinical trials: a cross-sectional study.","authors":"Abdulrahman Nasir Al Khatib, Rama Al Masri, Sa'ed Al Hayek, Sameer Yaser, Omar Jaber, Yacob Saleh","doi":"10.1080/08998280.2024.2439771","DOIUrl":"10.1080/08998280.2024.2439771","url":null,"abstract":"<p><strong>Introduction: </strong>Melanoma is a common cancer worldwide. Introduction of new treatments through clinical trials is essential to reduce the global burden from melanoma; however, it is estimated that 22% of oncological clinical trials are terminated early. We conducted the first cross-sectional study to assess melanoma clinical trial termination and nonpublication with an aim to guide scientists conducting such trials.</p><p><strong>Methods: </strong>We identified all phase III/IV clinical trials evaluating melanoma therapies in the ClinicalTrials.gov database between 2010 and 2024. For each trial, we extracted data on the trial's status, melanoma stage, melanoma subtype, included age, funding sources, trial locations, publication status, and reasons for termination. A descriptive and frequency analysis was performed in JASP 0.19 software.</p><p><strong>Results: </strong>A total of 108 trials were analyzed; the majority of trials included stage III/IV melanoma (n = 95), and cutaneous melanoma was the most common subtype. Only 15 trials included pediatric patients. Industrial funding accounted for 74% (n = 80) of trials' financing. Most of the trials were conducted internationally in North America, Europe, Australia, and New Zealand, with a few trials conducted in South Africa (n = 1), South America (n = 1), or China (n = 5). Early termination was observed in 21% (n = 23) of trials, with no association between early termination and melanoma stage, subtype, age, funding source, or trial locations. Notably, the most common reason for early termination was publication of interim efficacy and safety results (n = 14/23).</p><p><strong>Conclusion: </strong>Our study confirms that early termination of phase III and IV melanoma trials doesn't raise a significant concern; however, diversified funding and broader geographic representation are needed to create more equitable and inclusive trials. We also suggest conducting further cross-sectional studies on phase I/II melanoma trials.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 2","pages":"179-182"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482217","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":"Shoulder synovial sarcoma radical excision with pedicled inverted pectoralis major flap.","authors":"Luke Mascarenhas, Luke Villamaria, Rashmi Agarwal, Russell Ward","doi":"10.1080/08998280.2024.2435777","DOIUrl":"https://doi.org/10.1080/08998280.2024.2435777","url":null,"abstract":"<p><p>Synovial sarcoma, a rare soft tissue malignancy, predominantly affects adolescents and young adults, with a predilection for extremities. We present the case of a 19-year-old woman with a rapidly growing left shoulder synovial sarcoma, initially managed with neoadjuvant chemotherapy to reduce tumor size. Subsequently, she underwent radical surgical resection, necessitating complex anatomical dissection due to tumor involvement extending into the coracoid and deltoid. Given limitations in current literature regarding reconstructive options for shoulder defects following sarcoma resection, the use of a pedicled pectoralis major flap demonstrates feasibility and functional outcomes.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 3","pages":"346-349"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12026172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960562","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":"Effect of intracervical block on self-reported intrauterine device insertion pain: a single-center prospective survey study.","authors":"Micah Clay, Joyce Ku, Krystal N Fett, Michael P Hofkamp, Joanna K Stacey","doi":"10.1080/08998280.2024.2440285","DOIUrl":"10.1080/08998280.2024.2440285","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to determine the incidence of self-reported pain during office-based intrauterine device (IUD) placement.</p><p><strong>Methods: </strong>The study included patients who had IUD placement at our clinic from April 1, 2023, to March 31, 2024 with no prior history of vaginal delivery, who were between the ages of 14 and 48 years, did not have cervicitis, and were not pregnant. Informed consent was obtained, a prequestionnaire was completed, the IUD was placed in accordance with clinician preference, and a postquestionnaire was administered.</p><p><strong>Results: </strong>Thirty-seven patients answered the question about expected pain. Two (5%) reported that their pain during IUD placement was none, 22 (59%) reported that pain was better than expected, 10 (27%) reported that pain was just as bad as expected, two (5%) reported pain was worse than expected, and one (3%) indicated that their pain during IUD placement was much worse than expected. Thirty-three patients received an intracervical or paracervical block, and five patients did not receive an intracervical or paracervical block; these groups reported visual analog pain scores of 35 ± 25 mm and 58 ± 14 mm, respectively (<i>P</i> = 0.22).</p><p><strong>Conclusion: </strong>Approximately 8% of patients in our study reported worse or much worse than expected pain with IUD placement. Patients who received an intracervical or paracervical block reported less pain, but this difference was not statistically significant. Paracervical or intracervical blocks can decrease perceived pain with IUD insertion, increasing contraceptive options for those who are concerned about painful insertions; however larger studies are needed.</p>","PeriodicalId":8828,"journal":{"name":"Baylor University Medical Center Proceedings","volume":"38 2","pages":"155-158"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482222","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}