Factors Associated With Influenza in an Emergency Department Setting.
The Journal of emergency medicine
BACKGROUND: Emergency departments (EDs) become more overcrowded during peak respiratory virus season. Distinguishing influenza from other viruses is crucial to implement social distancing practices, early treatment, and prompt disposition.OBJECTIVES: We sought to determine factors associated with influenza among a prospective cohort of consecutive ED patients with acute respiratory illness (ARI).METHODS: Between December 2016 and March 2017, trained research assistants screened consecutive ED patients with ARI symptoms. ARI criteria included measured fever at home or in the ED >38°C and a cough, sore throat, or rhinorrhea with a duration of symptoms >12hours and <1week. After consent, research assistants collected demographics and clinical history using a standardized data form, and patients had a polymerase chain reaction-based assay that is nearly 100% sensitive for influenza. Univariate analysis was conducted on all predictor variables. Significant variables were entered into a multivariate logistic regression model to find factors that were independently associated with influenza.RESULTS: One hundred nineteen patients consented to enrollment and 31% were found to be positive for influenza. Myalgia, the absence of gastrointestinal symptoms (no diarrhea or vomiting), sore throat, chills, headache, and oxygen saturation ?97% were significant on univariate analysis and were entered into the multivariate model. Myalgia (adjusted odds ratio [AOR] 3.9), the absence of gastrointestinal symptoms (AOR 4.7), and oxygen saturation ?97% (AOR 2.8) were significant independent factors of influenza.CONCLUSION: The presence of myalgia, the absence of gastrointestinal symptoms, and oxygen saturation ?97% are factors that can help distinguish influenza from other acute respiratory illnesses in the ambulatory ED population.
View details for PubMedID 30803847
Using a novel rapid viral test to improve triage of emergency department patients with acute respiratory illness during flu season.
Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology
2018; 108: 72?76
BACKGROUND: Acute respiratory illnesses (ARI) are mostly viral in etiology and cause significant morbidity and mortality. Point of care PCR (POC-PCR) is a promising new technology for rapid virus identification but utility in the Emergency Department (ED) is not yet defined.OBJECTIVES: Primarily, to investigate the value of POC-PCR in rapidly identifying RSV and influenza in the setting of ED triage. Additionally, to assess whether rapid knowledge of accurate test results would improve patient management by preventing nosocomial transmission and optimizing the prescription of antimicrobials for ARIs.STUDY DESIGN: A prospective cohort study of consecutive ED patients with ARI symptoms during peak flu season was conducted. Patient nasopharyngeal swabs were collected and tested using a POC-PCR device; physicians and patients were blinded to results. Virus positive and negative groups were compared by ED patient room placement and antimicrobial therapy ordered. Specificity and sensitivity were calculated using laboratory-PCR as the gold standard.RESULTS: Of 119 participants, 52.9% were POC-PCR positive - Influenza A (42.9%), RSV (41.3%), influenza B (15.9%). Nearly 70% of virus positive patients were placed rooms shared with non-ARI patients. Antibiotics were prescribed for 27.3% of virus positive patients, and 77.8% of oseltamivir-eligible patients did not receive therapy. POC-PCR was 100% sensitive (95% CI, 80.5-100.0%) and 95.2% specific (95% CI, 76.2-99.9%).CONCLUSIONS: Rapid POC-PCR for influenza and RSV in ED triage has excellent sensitivity and specificity and the potential to improve social distancing practices through better triage and increase appropriate prescription of antimicrobials.
View details for PubMedID 30261422
Impact of Rapid Molecular Respiratory Virus Testing on Real-Time Decision Making in a Pediatric Emergency Department
JOURNAL OF MOLECULAR DIAGNOSTICS
2017; 19 (3): 460-467
Acute respiratory illnesses (ARIs) are usually viral [influenza, respiratory syncytial virus (RSV)] and account for 25% of emergency department (ED) peak-season visits. Laboratory PCR testing is accurate albeit slow, whereas rapid antigen testing is inaccurate. We determined the impact of bedside PCR (molecular point-of-care test; mPOCT) on pediatric ARI management. This was a prospective cohort study of consecutive pediatric patients with ED-ordered respiratory PCR test, enrolled over 9 weeks during peak flu season. On ordering, ED physicians were interviewed to ascertain real-time plans if given immediate influenza/RSV PCR results for the current patient. Two groups were compared: actual management and management adjusted for mPOCT results. We compared ED length of stay (LOS), tests ordered, and antibiotic/antiviral ordering. One-hundred thirty-six respiratory PCR panels were ordered, 71 by admitting team, 61 for ED management. Of 61 ED-initiated tests, physicians indicated in 39 cases (64%) they would change patient management were bedside viral results available. Physicians would have decreased ED LOS by 33 minutes, ordered fewer tests (18%; P < 0.001) with average patient charge savings of $669, fewer antibiotics among discharged patients (17%; P = 0.043), and increased appropriate antiviral use (13%; P = 0.023). Rapid bedside ARI mPOCT PCR has the potential to decrease ED LOS, reduce diagnostic tests and patient charges, and increase appropriate use of antibiotics and antiviral agents.
View details for DOI 10.1016/j.jmoldx.2017.01.009
View details for Web of Science ID 000400314100011
View details for PubMedID 28341587
View details for PubMedCentralID PMC5417039
Characterizing Readmissions After Bariatric Surgery.
Journal of gastrointestinal surgery
2016; 20 (11): 1797-1801
Readmissions are an important quality metric for surgery. Here, we compare characteristics of readmissions across laparoscopic Roux-en-Y gastric bypass (LRYGB), sleeve gastrectomy (LSG), and adjustable gastric band (LAGB).Demographic, intraoperative, anthropometric, and laboratory data were prospectively obtained for 1775 patients at a single academic institution. All instances of readmissions within 1 year were recorded. Data were analyzed using STATA, release 12.For the 1775 patients, 113 (6.37 %) were readmitted. Mean time to readmission was 52.1 days. Of all the readmissions, 64.6 % were within 30 days, 22.1 % from 30 to 90 days, 1.77 % from 90 to 180 days, and 11.5 % from 180 to 365 days. Incidence of 30-day readmissions varied across surgeries (LRYGB: 7.17 %; LAGB: 3.05 %; LSG: 4.25 %, p?=?0.04). Time to readmission varied as well, with 90.0 % of LSG and 80.0 % of LABG patients within the first 30 days, versus 60.8 % of LRYGB (p?=?0.02). The most common causes of readmissions were gastrointestinal issues related to index procedure (34.5 %) and did not vary across surgeries. In multivariable logistic regression, index hospital length of stay (LOS) was associated with readmission (OR?=?1.07, 95 % CI 1.02-1.13, p?=?0.01).Readmissions after bariatric surgery are associated with high index hospital LOS, and a measureable proportion of procedure-related readmissions can occur up to 1 year, especially for LRYGB.
View details for PubMedID 27613733
The Influence of Resected Gastric Weight upon Weight Loss after Sleeve Gastrectomy.
2015; 81 (12): 1240-1243
Bariatric surgery is an effective and enduring treatment for obesity. Sleeve gastrectomy (SG) has emerged as an increasingly prevalent surgical intervention. Further investigation is required to determine optimal standardization of SG. Data were collected prospectively for 64 patients who underwent a laparoscopic vertical SG between December 2010 and February 2013 at a single academic institution. Demographic, intraoperative, and postoperative (postop) data were collected for all patients including weighing each resected stomach. The total resected gastric weight varied widely. Preoperatively, patients in the upper tercile for resected gastric weight were more likely to be male (lower 10%, middle 23%, upper 52%, P = 0.006) and had greater initial weights (lower 255.9%, middle 245.1%, upper 280.0%, P = 0.019). The resected gastric weight (g) varied by tercile (mean of all, 131.24 ± 39.8; lower, 93.9 ± 10.9; middle, 127.4 ± 11.7; upper 172.7 ± 37.9, P = 0.000). Patients were followed for 1-year postop with follow-up data for 94 per cent (60/64) of participants. Per cent excess weight loss (EWL) was obtained at three, six, and 12 months postop. At 12 months, there was a trend toward increased per cent EWL in the upper tercile (lower 61.1%, middle 54.1%, upper 90.5%, P = 0.057). In conclusion, while the amount of gastric sleeve resected can vary, this study shows that intraoperative assessment of resected sleeve weight can help evaluate adequacy of resection. Improved 12-month per cent EWL in patients with greater resected tissue demonstrate potentially improved outcomes.
View details for PubMedID 26736161
- The Influence of Resected Gastric Weight Upon Weight Loss After Sleeve Gastrectomy The American Surgeron 2015; 81 (12): 1240-1243
COMPARATIVE EFFECTIVENESS OF BARIATRIC SURGERY AMONG THE SUPER OBESE
19th World Congress of the International-Federation-for-the-Surgery-of-Obesity-and-Metabolic-Disorders (IFSO)
SPRINGER. 2014: 1215?16
View details for Web of Science ID 000339893200318
- Comparative Readmission Rates for Bariatric Surgery Gastroenterology 2014; 146 (5): S-1029
- Improved Glycemic Control Associated With Improvements in Excess Daytime Sleepiness After Bariatric Surgery Diabetes 2014; 63 (S1): A529
Developmental Regulation of Sam Pointed Domain Ets Factor (SPDEF) in Rat Ileum Cultured With Bile Acids
53rd Annual Meeting of the Society-for-Surgery-of-the-Alimentary-Tract (SSAT) / Digestive Disease Week (DDW) / Meeting of the Pancreas-Club
W B SAUNDERS CO-ELSEVIER INC. 2012: S91?S91
View details for Web of Science ID 000306994300348
Active transport of bile acids decreases mucin 2 in neonatal ileum: implications for development of necrotizing enterocolitis.
2011; 6 (12)
Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency of premature infants, but its etiology remains unclear. We have previously shown that mucin 2 (Muc2) positive goblet cells are significantly decreased in NEC. We have also shown that ileal bile acids (BAs) are significantly increased during the development of this disease. Because BAs can affect mucins, we hypothesized that elevated ileal BAs contribute to decreased Muc2 in experimental NEC. The role of Muc2 in NEC was evaluated in Winnie +/+ mice, a strain that produces aberrant Muc2. Muc2 and trefoil factor 3 (Tff3) were assessed in neonatal rats subjected to the NEC protocol when bile acids were removed, and in ileal explants from newborn and older rats cultured with and without BAs. Further, the role of active transport of BAs was determined using neonatal rats given the apical sodium dependent bile acid transporter (Asbt) inhibitor SC-435 and in neonatal Asbt knockout mice subjected to the NEC protocol. Mice with aberrant Muc2 had significantly greater incidence and severity of NEC. Using both in vivo and ex vivo techniques, we determined that BAs decrease Muc2 positive cells in neonatal but not older ileum. However, Tff3 positive cells are not decreased by BAs. In addition, active transport of BAs is required for BAs to decrease Muc2 in immature ileum. These data show that functional Muc2 plays a critical role in the prevention of NEC and BAs can potentiate the decreased Muc2 in disease development. Further, BAs have a more profound effect on Muc2 in immature versus older ileum, which may explain at least in part why NEC occurs almost exclusively in premature infants.
View details for DOI 10.1371/journal.pone.0027191
View details for PubMedID 22162748
View details for PubMedCentralID PMC3230578