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Acad Med ; 95(12): 1876, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33234827
Acad Med ; 95(12): 1877, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33234828
Int J Artif Organs ; : 391398820948874, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32794429


INTRODUCTION: Adverse events (AEs) associated with left ventricular assist devices (LVADs) cause significant morbidity and mortality. Little is known about patient-specific factors that contribute to rates of AEs. The purpose of this study was to assess the association of cigarette smoking history and AEs following LVAD implantation. METHODS: This study was a single-center, observational examination of 355 consecutive patients who underwent continuous-flow LVAD implantation from May 1, 2008 to July 1, 2018. Based on self-report, 348 patients with available data were categorized as never, former, or current smokers. Pre-LVAD implantation baseline characteristics were obtained, and summary characteristics were calculated. Hospitalizations for gastrointestinal bleeds, driveline infections, strokes, pump thromboses, and acute heart failure were evaluated. The Cox proportional hazard model was used to estimate the association of smoking and AE-related hospital admissions. The cumulative incidence competing risk method was used for survival analysis. RESULTS: Current (8.22%, p 0.006) and former (4.75%, p 0.026) smokers had a greater proportion of admissions for pump thrombosis compared to never smokers (2.22%). Former smoking was associated with admission for driveline infection (HR 2.43, CI 1.08-5.46, p 0.03) on multivariate analysis. There were no significant associations between smoking and the other AEs of interest. There was no difference in survival among the three groups. CONCLUSIONS: Smokers had a higher proportion of admissions for pump thrombosis compared to never smokers, and former smoking was associated with admission for driveline infections in patients with LVADs.

JAMA Intern Med ; 180(7): 1030, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32478831
J Palliat Med ; 23(11): 1547-1548, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32584640
J Grad Med Educ ; 12(1): 74-79, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32064062


Background: Underrepresented minority (URM) trainees face unique challenges in academic medicine. Near-peer mentorship is an under-described method to support URM trainees. Objective: We created and evaluated the Student to Resident Institutional Vehicle for Excellence (STRIVE) program in a large urban medical school and associated residency programs. Methods: All URM residents were invited to participate in the STRIVE mentorship program consisting of 3 pillars of programming: medical school curriculum review sessions, panel discussions, and social events for medical students. The program was evaluated through participation rates and a 7-item survey delivered in May 2019 after 3 years of implementation. Results: The STRIVE initiative conducted 25 events. Thirty-five of 151 eligible (23%) URM residents participated as mentors for an average of 50 of 110 eligible (45%) URM medical students annually. Resident mentors participated for an average of 3 to 4 hours each year. Twenty of 32 eligible resident mentors (63%) completed the survey. Ninety-five percent (19 of 20) of survey respondents agreed that STRIVE made them a better mentor; 90% (18 of 20) reported that they would have appreciated an equivalent program during their medical school training; and 75% (15 of 20) agreed that the program helped them address the challenges of underrepresentation in medicine. Conclusions: Over a 3-year period, STRIVE required a modest amount of resident time and was valued by the URM residents and medical students who participated in the program.

Diversidade Cultural , Educação de Graduação em Medicina , Internato e Residência , Mentores , Grupos Minoritários , Avaliação de Programas e Projetos de Saúde , Estudantes de Medicina , Escolha da Profissão , Grupos de Populações Continentais , Currículo , Grupos Étnicos , Feminino , Humanos , Masculino , Desenvolvimento de Programas , Faculdades de Medicina , Inquéritos e Questionários
Ann Intern Med ; 171(5): 380-381, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31476228
Cleve Clin J Med ; 86(9): 621-632, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31498768


Cardiovascular disease has been the leading cause of death in the United States since the early 20th century. With advances in prevention and treatment, cardiovascular mortality rates are on the decline. Nevertheless, disparities in care persist, with devastating impact in select populations in the United States. This paper reviews the impact of disparate care on risk-factor burden, coronary artery disease, heart failure, and cardiovascular research.

Doenças Cardiovasculares/mortalidade , Doença da Artéria Coronariana/mortalidade , Disparidades em Assistência à Saúde/tendências , Doenças Cardiovasculares/etiologia , Doença da Artéria Coronariana/etiologia , Efeitos Psicossociais da Doença , Humanos , Fatores de Risco , Estados Unidos/epidemiologia
Catheter Cardiovasc Interv ; 89(5): 860-865, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27468705


OBJECTIVES: We studied the impact of operator experience on trans-radial (TR) cardiac catheterization performance in contemporary practice. BACKGROUND: TR cardiac catheterization offers advantages over trans-femoral (TF) cardiac catheterization, but the TR approach has been slowly adopted in the United States. METHODS: We reviewed all cases of attempted TR cardiac catheterization at a single tertiary care medical center from May 2008 until April 2015. We classified the attending operator TR case experience at the time of each case, and the control group constituted cases performed by operators with >300 TR cases. Study endpoints were TR cannulation failure, TF cross-over, contrast medium dose, and fluoroscopy time. RESULTS: Over the study period, 4177 attempted TR cardiac catheterization cases were performed. The percentage of TR cases performed with percutaneous coronary intervention (PCI) increased from 14.0% in 2009 to 30.2% in 2015 (P-trend <0.001). The rate of TR cannulation failure decreased from 4.3% in 2009 to 2.0% in 2015 (P-trend = 0.071), and the rate of TF cross-over decreased from 4.3% in 2009 to 3.2% in 2015 (P-trend = 0.034). Operators with over 100 cases had the lowest odds of TR cannulation failure, while operators with over 200 cases had the lowest odds of TF cross-over. Operators with over 200 cases used the lowest mean contrast medium dose and mean fluoroscopy time. CONCLUSIONS: Increasing operator TR experience is associated with lower odds of TR cannulation failure and TF cross-over, as well as lower contrast medium dose and fluoroscopy time. © 2016 Wiley Periodicals, Inc.

Cateterismo Cardíaco/métodos , Cardiologia/educação , Competência Clínica , Doença da Artéria Coronariana/diagnóstico , Educação Médica Continuada/métodos , Intervenção Coronária Percutânea/educação , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Artéria Radial , Estudos Retrospectivos , Fatores de Tempo
Can J Cardiol ; 32(12): 1419-1424, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27378595


BACKGROUND: Carotid artery stenosis is a risk factor for stroke after surgical aortic valve replacement, but it is unknown whether carotid and vertebral artery disease impacts the risk of stroke after transcatheter aortic valve replacement (TAVR). METHODS: We reviewed 294 consecutive cases of TAVR at a tertiary care medical centre. Thirty-one patients without preoperative carotid/vertebral duplex ultrasonograms were excluded. Carotid or vertebral artery disease was defined on the basis of >50% stenosis. Outcomes were stroke within 30 days after TAVR, 30-day mortality, and overall survival. RESULTS: Fifty-one patients (19%) had at least 50% stenosis of a carotid or vertebral artery. The carotid and vertebral artery disease group had higher rates of coronary artery disease, previous coronary artery bypass surgery, and peripheral artery disease compared with the control group. Transfemoral access was less common in the carotid and vertebral artery disease group (55% vs 77%; P < 0.01). Stroke occurred in 6.8% of patients (n = 18) within 30 days after TAVR, but no patients in the carotid and vertebral artery disease group had a stroke. The presence of at least 50% stenosis of a carotid or vertebral artery was not predictive of stroke by logistic regression. There was no difference in 30-day mortality (10% vs 4%; P = 0.11) and overall survival (log-rank test P = 0.84) between the groups. CONCLUSIONS: The presence or absence of carotid or vertebral artery stenosis was not significantly related to the occurrence of stroke after TAVR. Routine screening for carotid and vertebral artery disease before TAVR does not appear justified.

Estenose das Carótidas , Complicações Pós-Operatórias , Acidente Vascular Cerebral , Substituição da Valva Aórtica Transcateter , Insuficiência Vertebrobasilar , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Análise de Sobrevida , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Ultrassonografia Doppler Dupla/métodos , Estados Unidos , Insuficiência Vertebrobasilar/complicações , Insuficiência Vertebrobasilar/diagnóstico por imagem