RESUMO
Background The Critical Access Hospital (CAH) designation program was created in 1997 by the US Congress to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping fundamental services in rural communities. Methods This is a retrospective observational study. Information on CAHs in West Texas in rural counties was extrapolated from the Flex Monitoring Team between 2010 and 2020. The study population included adults aged ≥25 years with a known heart failure (HF) diagnosis who were identified using ICD-10 codes. Mortality rates were obtained from the CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER) database. The HF population was categorized by age, sex, and ethnicity. Mortality differences among these groups were analyzed using a two-sample t-test. The significance level was considered to be p < 0.05. Results The total study population analyzed was 1,348,001. A statistically significant difference in age-adjusted mortality rate (AAMR) was observed between the study and control groups, with a value of 3.200 (95% CI: 3.1910-3.2090, p < 0.0001) in favor of a lower mortality rate in rural counties with CAHs. When comparing gender-related differences, males and females had lower AAMRs in rural counties with CAHs. Among each gender, statistically significant differences were noted between males (95% CI: 2.181-2.218, p < 0.001) and females (95% CI: 3.382-3.417, p < 0.001). When examining the data by ethnicity, the most significant difference in mortality rate was observed within the Hispanic population, 6.400 (95% CI: 6.3770-6.4230, p < 0.0001). When adjusted to age, the crude mortality rate was calculated, which favored CAH admission in the younger population (10.200 (95% CI: 10.1625-10.2375, p < 0.001) and 11.500 (95% CI: 11.4168-11.5832, p < 0.001) in the 55-64 and 65-74 age groups, respectively). Conclusion The data clearly showed that West Texas rural county hospitals that received CAH designation performed better in terms of mortality rates in the HF population compared to non-CAH.
RESUMO
Subdermal contraceptive implants are usually inserted subdermally and carry the possibility to migrate within a small range, usually less than 2 cm from the insertion sites; significant migration over 2 cm is rare. This paper discusses the case of a 38-year-old female patient with a migrated subdermal Implanon contraceptive implant in the left pulmonary artery. On chest computed tomography, roughly a 4 cm long linear hyperdensity foreign body in the left lower lobe was found and was favored to be a migrated Implanon in a subsegmental pulmonary artery branch. An interventional radiologist performed an endovascular removal of the left pulmonary artery Implanon using a right common femoral vein access. Very few cases have been reported of complications with inserting and removing the subdermal contraceptive implants as it is considered a reasonably safe procedure in the hands of physicians familiar with the technique. Therefore, if a properly trained individual had carried out the correct procedure of inserting a subdermal implant, the migration of an implant over 2 cm should not occur.