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Andrew C Glatz - One of the best experts on this subject based on the ideXlab platform.
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relationship between hospital procedure volume and complications following congenital cardiac Catheterization a report from the improving pediatric and adult congenital treatment impact registry
American Heart Journal, 2017Co-Authors: Natalie Jayaram, John A Spertus, Michael L Obyrne, Paul Chan, Kevin F Kennedy, Lisa Bergersen, Andrew C GlatzAbstract:Background The association between institutional volume and outcomes has been demonstrated for cardiac Catheterization among adults, but less is known about this relationship for patients with congenital heart disease (CHD) undergoing cardiac Catheterization. Methods Within the IMPACT registry, we identified all Catheterizations between January 2011 and March 2015. Hierarchical logistic regression, adjusted for patient and procedural characteristics, was used to determine the association between annual Catheterization lab volume and occurrence of a major adverse event (MAE). Results Of 56,453 Catheterizations at 77 hospitals, an MAE occurred in 1014 (1.8%) of cases. In unadjusted analysis, a MAE occurred in 2.8% (123/4460) of cases at low-volume hospitals ( P P =.008), 0.62 (95% CI 0.41-0.95, P =.03), and 0.52 (95% CI 0.31-0.90, P =.02) at medium-, high-, and very-high-volume programs, respectively. Conclusions Although the risk of MAE after cardiac Catheterization in patients with CHD is low at all hospitals, it is higher among hospitals with fewer than 150 cases annually. These results support the notion that centers meeting this threshold volume for congenital cardiac Catheterizations may achieve improved patient outcomes.
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effect of center Catheterization volume on risk of catastrophic adverse event after cardiac Catheterization in children
American Heart Journal, 2015Co-Authors: Michael L Obyrne, Natalie Jayaram, Andrew C Glatz, Russell T Shinohara, Matthew J Gillespie, Yoav Dori, Jonathan J Rome, Steven M KawutAbstract:Background Procedural volume has been shown to be associated with outcome in cardiac Catheterization and intervention in adults. The impact of center-level factors (such as volume) and their interaction with subject- and procedure-level factors on outcome after cardiac Catheterization in children is not well described. We hypothesized that higher center Catheterization volume would be associated with lower risk of catastrophic adverse events. Methods We studied children and young adults 0 to 21 years of age undergoing one or more cardiac Catheterizations at centers participating in the Pediatric Health Information Systems database between 2007 and 2012. Using mixed-effects multivariable regression, we assessed the association between center Catheterization volumes and the risk of a composite outcome of death and/or initiation of mechanical circulatory support within 1 day of cardiac Catheterization adjusting for patient- and procedure-level factors. Results A total of 63,994 procedures performed on 40,612 individuals from 38 of 43 centers contributing data to the Pediatric Health Information Systems database were included. The adjusted risk of the composite outcome was 0.1%. Increasing annual Catheterization laboratory volume was independently associated with reduced risk of the composite outcome (odds ratio per a 100-procedure/y increment 0.78 [95% CI 0.65-0.93], P Conclusions Higher cardiac Catheterization laboratory volume was associated with reduced risk of catastrophic adverse outcome in the immediate postCatheterization period in children. The observed benefit of Catheterization at a larger volume center may be attributable to transmissible best practices or inextricable benefits of larger systems.
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prevalence of and risk factors for acute occlusive arterial injury following pediatric cardiac Catheterization a large single center cohort study
Catheterization and Cardiovascular Interventions, 2013Co-Authors: Andrew C Glatz, Samir S Shah, Ann L Mccarthy, Diana Geisser, Kaitlyn Daniels, Dawei Xie, Brian D Hanna, Robert W GrundmeierAbstract:Objectives To describe the prevalence of and identify risk factors for acute occlusive arterial injury (AOAI) in a large volume pediatric cardiac Catheterization laboratory. Background AOAI is a known complication after pediatric cardiac Catheterization. Prevalence and risk factors in the modern era are incompletely described. Methods A retrospective cohort study including all cardiac Catheterization procedures performed between January 1, 2005 and June 30, 2010 was performed. Case status was defined by ≥1 of the following: exam consistent with occlusive arterial injury, use of an anticoagulant within 48 hr of Catheterization to restore or maintain patency of the artery, or documented occlusive arterial injury by radiologic study. Results 3,254 patients had 5,715 Catheterization procedures, which included 3,859 arterial access events. 167 cases of AOAI were identified for an overall prevalence of 4.3% among arterial access events. Multiple logistic regression identified independent risk factors: weight category [<4 kg: odds ratio (OR) 4.5 (95% CI: 2.6–7.7), P < 0.001; 4–6 kg: OR 2.1 (1.3–3.5), P = 0.002, compared to 6–8 kg referent group]; largest catheter outer diameter French size [OR 1.6 (1.3–1.9), P < 0.001]; final activated clotting time (ACT) <250 sec [OR 1.9 (1.4–2.7), P < 0.001]; and need for arterial catheter exchange [OR 1.8 (1.02–3.2), P = 0.04]. Conclusions AOAI occurred in 4.3% of pediatric cardiac Catheterizations, and was most likely in smaller children and those with larger arterial catheters. Risk was also independently increased by arterial catheter exchange and having a final ACT <250 sec. These data act as an important benchmark and identify areas for intervention for future studies. © 2013 Wiley Periodicals, Inc.
Michael A Mont - One of the best experts on this subject based on the ideXlab platform.
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the effect of bladder Catheterization on ambulation and venous thromboembolism following total knee arthroplasty an institutional analysis
Journal of Arthroplasty, 2020Co-Authors: Peter A Gold, Luke J Garbarino, Hiba K Anis, Nipun Sodhi, Jonathan R Danoff, Sreevathsa Boraiah, Vijay J Rasquinha, Jamie C Heimroth, Michael A MontAbstract:Abstract Background Although intermittent catheters are immediately removed, indwelling Catheterization may lead to decreased ambulation and participation in physical therapy, critical components to post-total knee arthroplasty (TKA) management. Therefore, this study aimed to compare the effect of Catheterization treatments on (1) postoperative ambulation distances, (2) deep vein thromboses (DVTs), and (3) pulmonary emboli (PEs) following TKA. Methods A total of 9123 prospectively collected primary TKA patients were assessed based on postoperative catheter status. Patient demographics, Charlson Comorbidity Indices, body mass indices, DVT prophylaxes, first ambulation distances, DVTs, and PEs were collected at approximately mean 12 months of follow-up. Univariate and multivariate analyses were performed with independent t-tests and multiple linear regression models in order to compare Catheterization techniques. Results There were 1193 patients who had urinary retention and treated with either indwelling only (62%, n = 734), both indwelling and intermittent Catheterizations (13%, n = 160), or intermittent only (25%, n = 299). Multivariate analyses found that indwelling catheter-only use had an 11% decrease in ambulation distance (P Conclusion This study showed that the use of an indwelling catheter for treatment of urinary retention significantly decreased TKA patient ambulation distance and subsequently increased the risk for DVTs. This information is important as we would recommend the treatment with intermittent Catheterization rather than indwelling catheters to decrease the risk of immobilization and postoperative DVTs.
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does intermittent Catheterization compared to indwelling Catheterization decrease the risk of periprosthetic joint infection following total knee arthroplasty
Journal of Arthroplasty, 2020Co-Authors: Luke J Garbarino, Peter A Gold, Hiba K Anis, Nipun Sodhi, Jonathan R Danoff, Sreevathsa Boraiah, Vijay J Rasquinha, Michael A MontAbstract:Abstract Background Catheterization for the prophylaxis against or treatment for urinary retention commonly occurs after total knee arthroplasty (TKA). Recent studies have questioned the use of the indwelling Catheterization, especially in its potential role as a nidus for infection. We are still unsure of its downstream effects on periprosthetic joint infections (PJIs). Therefore, this study aimed to compare the risks of postoperative PJI following intermittent vs indwelling Catheterization after TKA. Methods Between 2017 and 2019, 15 hospitals in a large health system collected data on patients undergoing TKA. Patient treatments with indwelling catheter only, intermittent straight catheter only, and both indwelling and intermittent straight Catheterizations were recorded. Patient demographics, comorbidities, body mass indices, and PJIs were collected from time of surgery to time of data collection at mean 14 months of follow-up. Univariate and multivariate analyses were performed with independent t-tests and multiple linear regression models to compare Catheterization treatment types. Results A total of 9123 TKAs were performed, with patients receiving indwelling catheter only (62%, n = 734), intermittent straight catheter only (25%, n = 299), or both indwelling and intermittent Catheterizations (13%, n = 160). Univariate analyses showed that PJIs occurred in 1.1% of no-catheter patients and 2.3% of patients treated with bladder Catheterization (P = .002). Using multivariate analyses, indwelling catheter use (odds ratio [OR] 2.647, P Conclusion Urinary bladder Catheterization is commonly required for prophylaxis against or treatment for urinary retention following TKA. The use of a urinary catheter can provide a potential nidus for infection in these patients. This study found that indwelling Catheterization, but not intermittent Catheterization, was associated with an increased risk for PJI. Surgeons should therefore limit the duration of Catheterization in an effort to decrease the risk for PJI.
Chengkuo Lee - One of the best experts on this subject based on the ideXlab platform.
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toward self control systems for neurogenic underactive bladder a triboelectric nanogenerator sensor integrated with a bistable micro actuator
ACS Nano, 2018Co-Authors: Faezeh Arab Hassani, Roshini Priya Mogan, Gil Gerald Lasam Gammad, Hao Wang, Shihcheng Yen, Nitish V Thakor, Chengkuo LeeAbstract:Aging, neurologic diseases, and diabetes are a few risk factors that may lead to underactive bladder (UAB) syndrome. Despite all of the serious consequences of UAB, current solutions, the most common being ureteric Catheterization, are all accompanied by serious shortcomings. The necessity of multiple Catheterizations per day for a physically able patient not only reduces the quality of life with constant discomfort and pain but also can end up causing serious complications. Here, we present a bistable actuator to empty the bladder by incorporating shape memory alloy components integrated on flexible polyvinyl chloride sheets. The introduction of two compression and restoration phases for the actuator allows for repeated actuation for a more complete voiding of the bladder. The proposed actuator exhibits one of the highest reported voiding percentages of up to 78% of the bladder volume in an anesthetized rat after only 20 s of actuation. This amount of voiding is comparable to the common Catheterization m...
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Toward Self-Control Systems for Neurogenic Underactive Bladder: A Triboelectric Nanogenerator Sensor Integrated with a Bistable Micro-Actuator
2018Co-Authors: Faezeh Arab Hassani, Roshini Priya Mogan, Gil Gerald Lasam Gammad, Hao Wang, Shihcheng Yen, Nitish V Thakor, Chengkuo LeeAbstract:Aging, neurologic diseases, and diabetes are a few risk factors that may lead to underactive bladder (UAB) syndrome. Despite all of the serious consequences of UAB, current solutions, the most common being ureteric Catheterization, are all accompanied by serious shortcomings. The necessity of multiple Catheterizations per day for a physically able patient not only reduces the quality of life with constant discomfort and pain but also can end up causing serious complications. Here, we present a bistable actuator to empty the bladder by incorporating shape memory alloy components integrated on flexible polyvinyl chloride sheets. The introduction of two compression and restoration phases for the actuator allows for repeated actuation for a more complete voiding of the bladder. The proposed actuator exhibits one of the highest reported voiding percentages of up to 78% of the bladder volume in an anesthetized rat after only 20 s of actuation. This amount of voiding is comparable to the common Catheterization method, and its one time implantation onto the bladder rectifies the drawbacks of multiple Catheterizations per day. Furthermore, the scaling of the device for animal models larger than rats can be easily achieved by adjusting the number of nitinol springs. For neurogenic UAB patients with degraded nerve function as well as degenerated detrusor muscle, we integrate a flexible triboelectric nanogenerator sensor with the actuator to detect the fullness of the bladder. The sensitivity of this sensor to the filling status of the bladder shows its capability for defining a self-control system in the future that would allow autonomous micturition
Faezeh Arab Hassani - One of the best experts on this subject based on the ideXlab platform.
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toward self control systems for neurogenic underactive bladder a triboelectric nanogenerator sensor integrated with a bistable micro actuator
ACS Nano, 2018Co-Authors: Faezeh Arab Hassani, Roshini Priya Mogan, Gil Gerald Lasam Gammad, Hao Wang, Shihcheng Yen, Nitish V Thakor, Chengkuo LeeAbstract:Aging, neurologic diseases, and diabetes are a few risk factors that may lead to underactive bladder (UAB) syndrome. Despite all of the serious consequences of UAB, current solutions, the most common being ureteric Catheterization, are all accompanied by serious shortcomings. The necessity of multiple Catheterizations per day for a physically able patient not only reduces the quality of life with constant discomfort and pain but also can end up causing serious complications. Here, we present a bistable actuator to empty the bladder by incorporating shape memory alloy components integrated on flexible polyvinyl chloride sheets. The introduction of two compression and restoration phases for the actuator allows for repeated actuation for a more complete voiding of the bladder. The proposed actuator exhibits one of the highest reported voiding percentages of up to 78% of the bladder volume in an anesthetized rat after only 20 s of actuation. This amount of voiding is comparable to the common Catheterization m...
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Toward Self-Control Systems for Neurogenic Underactive Bladder: A Triboelectric Nanogenerator Sensor Integrated with a Bistable Micro-Actuator
2018Co-Authors: Faezeh Arab Hassani, Roshini Priya Mogan, Gil Gerald Lasam Gammad, Hao Wang, Shihcheng Yen, Nitish V Thakor, Chengkuo LeeAbstract:Aging, neurologic diseases, and diabetes are a few risk factors that may lead to underactive bladder (UAB) syndrome. Despite all of the serious consequences of UAB, current solutions, the most common being ureteric Catheterization, are all accompanied by serious shortcomings. The necessity of multiple Catheterizations per day for a physically able patient not only reduces the quality of life with constant discomfort and pain but also can end up causing serious complications. Here, we present a bistable actuator to empty the bladder by incorporating shape memory alloy components integrated on flexible polyvinyl chloride sheets. The introduction of two compression and restoration phases for the actuator allows for repeated actuation for a more complete voiding of the bladder. The proposed actuator exhibits one of the highest reported voiding percentages of up to 78% of the bladder volume in an anesthetized rat after only 20 s of actuation. This amount of voiding is comparable to the common Catheterization method, and its one time implantation onto the bladder rectifies the drawbacks of multiple Catheterizations per day. Furthermore, the scaling of the device for animal models larger than rats can be easily achieved by adjusting the number of nitinol springs. For neurogenic UAB patients with degraded nerve function as well as degenerated detrusor muscle, we integrate a flexible triboelectric nanogenerator sensor with the actuator to detect the fullness of the bladder. The sensitivity of this sensor to the filling status of the bladder shows its capability for defining a self-control system in the future that would allow autonomous micturition
Tony Nicholson - One of the best experts on this subject based on the ideXlab platform.
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Managing inadvertent arterial Catheterization during central venous access procedures.
CardioVascular and Interventional Radiology, 2003Co-Authors: Tony Nicholson, Duncan Ettles, Graham J. RobinsonAbstract:Purpose: Approximately 200,000 central venous Catheterizations are carried out annually in the National Health Service in the United Kingdom. Inadvertent arterial puncture occurs in up to 3.7%. Significant morbidity and death has been reported. We report on our experience in the endovascular treatment of this iatrogenic complication. Methods: Retrospective analysis was carried out of 9 cases referred for endovascular treatment of inadvertent arterial puncture during central venous Catheterization over a 5 year period. Results: It was not possible to obtain accurate figures on the numbers of central venous Catheterizations carried out during the time period. Five patients were referred with carotid or subclavian pseudoaneurysms and hemothorax following inadvertent arterial catheter insertion and subsequent removal. These patients all underwent percutaneous balloon tamponade and/or stent-graft insertion. More recently 4 patients were referred with the catheter still in situ and were successfully treated with a percutaneous closure device. Conclusion: If inadvertent arterial Catheterization during central venous access procedures is recognized and catheters removed, sequelae can be treated percutaneously. However, once the complication is recognized it is better to leave the catheter in situ and seal the artery percutaneously with a closure device.
