The Experts below are selected from a list of 243 Experts worldwide ranked by ideXlab platform
Maureen Achebe - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology and Predictors of all-cause 30-Day readmission in patients with Sickle Cell Crisis.
Scientific reports, 2020Co-Authors: Vivek Kumar, Neha Chaudhary, Maureen AchebeAbstract:The 30-day readmission rate after hospitalization for a Sickle Cell Crisis (SCC) is extremely high. Accurate information on readmission diagnoses, total readmission costs and factors associated with readmission is required to effectively plan resource allocation and to plan interventions to reduce readmission rates. The present study aimed to examine readmission diagnoses and factors associated with all-cause 30-day readmission after hospitalization for SCC. We analyzed 2016 nationwide readmission database (NRD) to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for SCC. We estimated the percentage and most common readmission diagnoses for 30-day and 7-day readmissions after discharge. We studied the relationship between risk factors and readmission and the impact of readmission on patient outcomes and resulting financial burden on health care in dollars. In 2016, of 67,887 discharges after index hospitalizations, 18099 (26.9%) were readmitted within 30-days. Of all readmissions, 5166 (7.6%) were readmitted within 7 days. The spectrum of readmission diagnoses was largely similar in both 30-day and 7-day readmission with more than 80% patients in both time periods readmitted with diagnoses related to SCC. The mean length of stay for readmitted patients was significantly longer than the index hospitalization (5.3 days (5.1–5.5) vs 4.9 days (CI 4.8–5.1, p
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epidemiology and predictors of all cause 30 day readmission in patients with Sickle Cell Crisis
Scientific Reports, 2020Co-Authors: Vivek Kumar, Neha Chaudhary, Maureen AchebeAbstract:The 30-day readmission rate after hospitalization for a Sickle Cell Crisis (SCC) is extremely high. Accurate information on readmission diagnoses, total readmission costs and factors associated with readmission is required to effectively plan resource allocation and to plan interventions to reduce readmission rates. The present study aimed to examine readmission diagnoses and factors associated with all-cause 30-day readmission after hospitalization for SCC. We analyzed 2016 nationwide readmission database (NRD) to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for SCC. We estimated the percentage and most common readmission diagnoses for 30-day and 7-day readmissions after discharge. We studied the relationship between risk factors and readmission and the impact of readmission on patient outcomes and resulting financial burden on health care in dollars. In 2016, of 67,887 discharges after index hospitalizations, 18099 (26.9%) were readmitted within 30-days. Of all readmissions, 5166 (7.6%) were readmitted within 7 days. The spectrum of readmission diagnoses was largely similar in both 30-day and 7-day readmission with more than 80% patients in both time periods readmitted with diagnoses related to SCC. The mean length of stay for readmitted patients was significantly longer than the index hospitalization (5.3 days (5.1–5.5) vs 4.9 days (CI 4.8–5.1, p < 0.01). Also, the mean cost of hospitalization in readmitted patients $8485 was significantly higher than the index hospitalization $8064 p < 0.01. In 2016, readmission among patients with SCC incurred an additional 95,445 hospitalization days resulting a total charge of $609 million and a total cost of $152 million in the US. On Multivariate analysis, age group 18–30 years, discharge against medical advice, higher Charlson comorbidity index, low socioeconomic status and admission at high volume centers were associated with a higher likelihood of 30-day readmission. Among patients hospitalized for SCC, 30-day readmissions were frequent throughout the month post hospitalization and resulted in an enormous financial burden on the United States healthcare system.
Samir K. Ballas - One of the best experts on this subject based on the ideXlab platform.
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Clinically Significant Differences in the Visual Analog Pain Scale in Acute Vasoocclusive Sickle Cell Crisis
Hemoglobin, 2007Co-Authors: Bernard L. Lopez, Pamela Flenders, Linda Davis-moon, Theodore Corbin, Samir K. BallasAbstract:This study sought to determine the minimum clinically significant change in the visual analog scale (VAS) during the Emergency Department (ED) treatment of adult vasoocclusive Sickle Cell Crisis (VOC). Sickle Cell anemia patients presenting to the ED with their typical VOC pain had a 100 mm VAS administered prior to each of up to three standard analgesic injections administered as part of a treatment protocol. At each assessment, subjects were asked to describe their pain as “much better,” a “little better,” “the same,” “a little worse,” or “much worse.” The change in the VAS (ΔVAS) between assessments was measured. The main outcome of the measurement was change in the VAS associated with a description of a change in pain of “a little less” or “a little more.”Seventy four subjects presented with initially high pain scores [VAS = 79.47 mm, 95% confidence interval (CI) = 75.99 to 82.95 mm]. In the “little better/little worse” combined group, the ΔVAS was 13.5 mm (95% CI = 11.25 cm to 15.74 cm).A change in t...
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Sequential nitric oxide measurements during the emergency department treatment of acute vasoocclusive Sickle Cell Crisis.
American journal of hematology, 2000Co-Authors: Bernard L. Lopez, Linda Davis-moon, Samir K. BallasAbstract:This prospective study was designed to examine the relationship between serial serum nitric oxide (NO) levels and pain during the emergency department (ED) treatment of acute vasoocclusive Sickle Cell Crisis (SCC). 102 patient visits, age ♢18 years of age, presenting to the ED with uncomplicated, typical SCC pain had serum NO levels obtained at 2-hr intervals during treatment of pain and were measured using an NO-specific chemiluminesence technique. Pain was measured prior to each NO measurement using a 10 cm visual analog scale (VAS), and subjects were divided into a persistent pain group and an improved pain group. Patients with persistent pain had significantly low initial NO levels (11.51 µM ± 2.8, P < 0.05) while those with pain improvement had higher initial NO levels (18.1 µM ± 3.08, P < 0.05). There was no significant correlation between changes in NO and changes in pain scores. These results suggest that the initial NO level may serve as a marker for the severity of tissue ischemia. Sequential NO levels do not appear useful in predicting the course of SCC. Am. J. Hematol. 64:15‐19, 2000. © 2000 Wiley-Liss, Inc.
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Nitric oxide metabolite levels in acute vaso-occlusive Sickle-Cell Crisis.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 1996Co-Authors: Bernard L. Lopez, Samir K. Ballas, Jordan Barnett, Theodore A. Christopher, Linda Davis-moonAbstract:OBJECTIVES 1) To measure nitric oxide (NO) metabolite levels in patients presenting to the ED in acute vaso-occlusive Sickle-Cell Crisis (SCC), and 2) to determine whether a relationship exists between NO metabolite levels and pain. METHODS A prospective, observational study of patients with documented Sickle-Cell anemia (SCA), aged > or = 18 years, presenting in typical, acute SCC was conducted in an urban, university teaching hospital. Excluded were those with atypical pain or acute, coexistent disease (as evidenced by fever, tachycardia, tachypnea, or hypotension). Pain scores were measured by a 10-cm visual analog scale (VAS). Blood NO metabolite levels for SCC patients and control subjects (healthy volunteers, n = 9; SCA control subjects not in SCC, n = 10) were determined using an NO-specific chemiluminescence technique that measured plasma nitrite and nitrate, the stable end-products of NO. The acute SCC patients were divided into 3 groups, with the range for the SCC-normal (n = 5) group defined as within 2 SD of the healthy volunteer control patients. The SCC-low patients (n = 21) had NO metabolite levels below this range and the SCC-high (n = 21) patients had levels above this range. RESULTS The SCA and healthy volunteer control groups had similar NO metabolite levels (25.3 vs 22.6 mumol; p = 0.10). The 3 acute SCC groups had the following mean NO levels: 1) SCC-normal = 21.3 +/- 1.6 mumol; 2) SCC-low = 7.2 +/- 1.1 mumol; and 3) SCC-high = 43.7 +/- 3.5 mumol. The SCC-high NO-level group had significantly lower VAS pain scores when compared with the SCC-low and SCC-normal NO-level groups (6.52 +/- 1.85 cm vs 8.76 +/- 0.83 cm, and 8.62 +/- 1.29 cm, p = 0.02). CONCLUSION NO metabolite levels vary in SCC patients. Elevated levels are associated with lower pain scores, while lower levels are associated with higher pain scores, indicating that NO metabolites may potentially represent a marker for compensatory mechanisms in SCC tissue ischemia. Further work is needed to delineate the usefulness of NO metabolites in assessing the severity of SCC.
Vivek Kumar - One of the best experts on this subject based on the ideXlab platform.
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Epidemiology and Predictors of all-cause 30-Day readmission in patients with Sickle Cell Crisis.
Scientific reports, 2020Co-Authors: Vivek Kumar, Neha Chaudhary, Maureen AchebeAbstract:The 30-day readmission rate after hospitalization for a Sickle Cell Crisis (SCC) is extremely high. Accurate information on readmission diagnoses, total readmission costs and factors associated with readmission is required to effectively plan resource allocation and to plan interventions to reduce readmission rates. The present study aimed to examine readmission diagnoses and factors associated with all-cause 30-day readmission after hospitalization for SCC. We analyzed 2016 nationwide readmission database (NRD) to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for SCC. We estimated the percentage and most common readmission diagnoses for 30-day and 7-day readmissions after discharge. We studied the relationship between risk factors and readmission and the impact of readmission on patient outcomes and resulting financial burden on health care in dollars. In 2016, of 67,887 discharges after index hospitalizations, 18099 (26.9%) were readmitted within 30-days. Of all readmissions, 5166 (7.6%) were readmitted within 7 days. The spectrum of readmission diagnoses was largely similar in both 30-day and 7-day readmission with more than 80% patients in both time periods readmitted with diagnoses related to SCC. The mean length of stay for readmitted patients was significantly longer than the index hospitalization (5.3 days (5.1–5.5) vs 4.9 days (CI 4.8–5.1, p
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epidemiology and predictors of all cause 30 day readmission in patients with Sickle Cell Crisis
Scientific Reports, 2020Co-Authors: Vivek Kumar, Neha Chaudhary, Maureen AchebeAbstract:The 30-day readmission rate after hospitalization for a Sickle Cell Crisis (SCC) is extremely high. Accurate information on readmission diagnoses, total readmission costs and factors associated with readmission is required to effectively plan resource allocation and to plan interventions to reduce readmission rates. The present study aimed to examine readmission diagnoses and factors associated with all-cause 30-day readmission after hospitalization for SCC. We analyzed 2016 nationwide readmission database (NRD) to identify patterns of 30-day readmission by patient demographic characteristics and time after hospitalization for SCC. We estimated the percentage and most common readmission diagnoses for 30-day and 7-day readmissions after discharge. We studied the relationship between risk factors and readmission and the impact of readmission on patient outcomes and resulting financial burden on health care in dollars. In 2016, of 67,887 discharges after index hospitalizations, 18099 (26.9%) were readmitted within 30-days. Of all readmissions, 5166 (7.6%) were readmitted within 7 days. The spectrum of readmission diagnoses was largely similar in both 30-day and 7-day readmission with more than 80% patients in both time periods readmitted with diagnoses related to SCC. The mean length of stay for readmitted patients was significantly longer than the index hospitalization (5.3 days (5.1–5.5) vs 4.9 days (CI 4.8–5.1, p < 0.01). Also, the mean cost of hospitalization in readmitted patients $8485 was significantly higher than the index hospitalization $8064 p < 0.01. In 2016, readmission among patients with SCC incurred an additional 95,445 hospitalization days resulting a total charge of $609 million and a total cost of $152 million in the US. On Multivariate analysis, age group 18–30 years, discharge against medical advice, higher Charlson comorbidity index, low socioeconomic status and admission at high volume centers were associated with a higher likelihood of 30-day readmission. Among patients hospitalized for SCC, 30-day readmissions were frequent throughout the month post hospitalization and resulted in an enormous financial burden on the United States healthcare system.
Robert M Ehsanipoor - One of the best experts on this subject based on the ideXlab platform.
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Epidural analgesia for treatment of a Sickle Cell Crisis during pregnancy.
Obstetrics and gynecology, 2011Co-Authors: Abigail D Winder, Stacie Johnson, Jamie Murphy, Robert M EhsanipoorAbstract:More than 50% of obstetric patients with Sickle Cell disease will have a pain Crisis during pregnancy, and the management of these cases can be challenging. A 20-year-old African American with Sickle Cell disease presented at 29 4/7 weeks of gestation with severe, debilitating leg and back pain. Large doses of intravenous narcotics did not result in significant pain relief, so a lumbar epidural was placed. This resulted in complete pain relief within several minutes. The patient's symptoms resolved over several days and after a short course of narcotics she was discharged to home, and the remainder of her pregnancy was uncomplicated. Epidural anesthesia should be considered as a potentially effective treatment for a severe Sickle Cell Crisis in obstetric patients.
Bernard L. Lopez - One of the best experts on this subject based on the ideXlab platform.
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Clinically Significant Differences in the Visual Analog Pain Scale in Acute Vasoocclusive Sickle Cell Crisis
Hemoglobin, 2007Co-Authors: Bernard L. Lopez, Pamela Flenders, Linda Davis-moon, Theodore Corbin, Samir K. BallasAbstract:This study sought to determine the minimum clinically significant change in the visual analog scale (VAS) during the Emergency Department (ED) treatment of adult vasoocclusive Sickle Cell Crisis (VOC). Sickle Cell anemia patients presenting to the ED with their typical VOC pain had a 100 mm VAS administered prior to each of up to three standard analgesic injections administered as part of a treatment protocol. At each assessment, subjects were asked to describe their pain as “much better,” a “little better,” “the same,” “a little worse,” or “much worse.” The change in the VAS (ΔVAS) between assessments was measured. The main outcome of the measurement was change in the VAS associated with a description of a change in pain of “a little less” or “a little more.”Seventy four subjects presented with initially high pain scores [VAS = 79.47 mm, 95% confidence interval (CI) = 75.99 to 82.95 mm]. In the “little better/little worse” combined group, the ΔVAS was 13.5 mm (95% CI = 11.25 cm to 15.74 cm).A change in t...
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Sequential nitric oxide measurements during the emergency department treatment of acute vasoocclusive Sickle Cell Crisis.
American journal of hematology, 2000Co-Authors: Bernard L. Lopez, Linda Davis-moon, Samir K. BallasAbstract:This prospective study was designed to examine the relationship between serial serum nitric oxide (NO) levels and pain during the emergency department (ED) treatment of acute vasoocclusive Sickle Cell Crisis (SCC). 102 patient visits, age ♢18 years of age, presenting to the ED with uncomplicated, typical SCC pain had serum NO levels obtained at 2-hr intervals during treatment of pain and were measured using an NO-specific chemiluminesence technique. Pain was measured prior to each NO measurement using a 10 cm visual analog scale (VAS), and subjects were divided into a persistent pain group and an improved pain group. Patients with persistent pain had significantly low initial NO levels (11.51 µM ± 2.8, P < 0.05) while those with pain improvement had higher initial NO levels (18.1 µM ± 3.08, P < 0.05). There was no significant correlation between changes in NO and changes in pain scores. These results suggest that the initial NO level may serve as a marker for the severity of tissue ischemia. Sequential NO levels do not appear useful in predicting the course of SCC. Am. J. Hematol. 64:15‐19, 2000. © 2000 Wiley-Liss, Inc.
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Nitric oxide metabolite levels in acute vaso-occlusive Sickle-Cell Crisis.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 1996Co-Authors: Bernard L. Lopez, Samir K. Ballas, Jordan Barnett, Theodore A. Christopher, Linda Davis-moonAbstract:OBJECTIVES 1) To measure nitric oxide (NO) metabolite levels in patients presenting to the ED in acute vaso-occlusive Sickle-Cell Crisis (SCC), and 2) to determine whether a relationship exists between NO metabolite levels and pain. METHODS A prospective, observational study of patients with documented Sickle-Cell anemia (SCA), aged > or = 18 years, presenting in typical, acute SCC was conducted in an urban, university teaching hospital. Excluded were those with atypical pain or acute, coexistent disease (as evidenced by fever, tachycardia, tachypnea, or hypotension). Pain scores were measured by a 10-cm visual analog scale (VAS). Blood NO metabolite levels for SCC patients and control subjects (healthy volunteers, n = 9; SCA control subjects not in SCC, n = 10) were determined using an NO-specific chemiluminescence technique that measured plasma nitrite and nitrate, the stable end-products of NO. The acute SCC patients were divided into 3 groups, with the range for the SCC-normal (n = 5) group defined as within 2 SD of the healthy volunteer control patients. The SCC-low patients (n = 21) had NO metabolite levels below this range and the SCC-high (n = 21) patients had levels above this range. RESULTS The SCA and healthy volunteer control groups had similar NO metabolite levels (25.3 vs 22.6 mumol; p = 0.10). The 3 acute SCC groups had the following mean NO levels: 1) SCC-normal = 21.3 +/- 1.6 mumol; 2) SCC-low = 7.2 +/- 1.1 mumol; and 3) SCC-high = 43.7 +/- 3.5 mumol. The SCC-high NO-level group had significantly lower VAS pain scores when compared with the SCC-low and SCC-normal NO-level groups (6.52 +/- 1.85 cm vs 8.76 +/- 0.83 cm, and 8.62 +/- 1.29 cm, p = 0.02). CONCLUSION NO metabolite levels vary in SCC patients. Elevated levels are associated with lower pain scores, while lower levels are associated with higher pain scores, indicating that NO metabolites may potentially represent a marker for compensatory mechanisms in SCC tissue ischemia. Further work is needed to delineate the usefulness of NO metabolites in assessing the severity of SCC.
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The complete blood count and reticulocyte count--are they necessary in the evaluation of acute vasoocclusive Sickle-Cell Crisis?
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 1996Co-Authors: Bernard L. Lopez, Sharon Griswold, Anke Navek, Linda UrbanskiAbstract:OBJECTIVE To assess the usefulness of the complete blood count (CBC) and the reticulocyte count in the evaluation of adult patients with acute vasoocclusive Sickle-Cell Crisis (SCC) presenting to the ED. METHODS A 2-part study was performed. Part 1 was retrospective chart review of patients with a sole ED diagnosis of acute SCC. Part 2 was a prospective evaluation of consecutive patients presenting in SCC. In both parts of the study, patients with coexisting acute disease were excluded. The remaining patients were divided into 2 groups: admitted and released. The mean values for white blood Cell (WBC) count, hemoglobin (Hb) level, and reticulocyte count were compared. In Part 2, the change (delta) from the patient's baseline in WBC count, Hb level, and reticulocyte count also was determined. Data were analyzed by 2-tailed Student's t-test. RESULTS Part 1: There was no difference between the admitted (n = 33) and the released (n = 86) groups in mean WBC count (p = 0.10), Hb level (p = 0.25), or reticulocyte count (p = 0.08). Part 2: There was no difference between the admitted (n = 44) and the released (n = 160) groups in mean Hb level (p = 0.88), reticulocyte count (p = 0.47), delta Hb level (p = 0.88), and delta reticulocyte count (p = 0.76). There was a difference in mean WBC counts (15.8 +/- 4.9 x 10(9)/L admitted vs 12.8 +/- 4.9 x 10(9)/L released, p = 0.003) and delta WBC counts (5.1 +/- 4.6 x 10(9)/L admitted vs 1.8 +/- 4.6 x 10(9)/L released, p < 0.002). CONCLUSION Determination of the Hb level and the reticulocyte count do not appear useful in the evaluation of acute SCC in the ED. Admission decisions appear associated with elevations in the WBC count. Further study is required to determine the true value of the WBC count in such decisions.