Kera F. Weiserbs

Usefulness of Neutrophil to Lymphocyte Ratio in Predicting Short- and Long-Term Mortality After Non–ST-Elevation Myocardial Infarction

Neutrophil/lymphocyte ratio (NLR) is the strongest white blood cell predictor of adverse outcomes in stable and unstable coronary artery syndromes. The aim of our study was to explore the utility of NLR in predicting long-term mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Consecutive patients with NSTEMI at Staten Island University Hospital were evaluated for study inclusion. Of the 1,345 patients with NSTEMI admitted from September 2004 to September 2006, 619 qualified for study inclusion. Survival analysis, stratified by NLR tertiles, was used to evaluate the predictive value of average inpatient NLR levels. Four-year vital status was accessed with electronic medical records and Social Security Death Index. Patients in the highest NLR tertile (NLR >4.7) had a higher 4-year mortality rate (29.8% vs 8.4%) compared to those in the lowest tertile (NLR <3, Wilcoxon chi-square 34.64, p <0.0001). After controlling for Global Registry of Acute Coronary Events risk profile scores, average NLR level remained a significant predictor of inpatient and 4-year mortality. Hazard ratios per unit increase of average NLR (log) increased by 1.06 (p = 0.0133) and 1.09 (p = 0.0006), respectively. In conclusion, NLR is an independent predictor of short-term and long-term mortalities in patients with NSTEMI with an average NLR >4.7. We strongly suggest the use of NLR rather than other leukocyte parameters (e.g., total white blood cell count) in risk stratification of the NSTEMI population.

An Inpatient Fall Prevention Initiative in a Tertiary Care Hospital

BACKGROUND In response to increasing inpatient fall rates, which reached 3.9 falls per 1000 inpatient-days in the last quarter of 2005, Staten Island University Hospital, a 714-bed, tertiary care hospital (Staten Island, New York), implemented a fall prevention initiative (FPI). The initiative was intended to decrease inpatient falls and associated injury by institutionalizing staff safety awareness; accountability, and critical thinking; eradicating historically acceptable system failures; and mandating a critical evaluation of safety precautions and application of fall prevention protocol. METHODS The intervention included two phases (1) a review phase, in which existing fall prevention efforts were evaluated, and (2) the FPI implementation phase, in which systems were implemented to ensure fall risk assessments, fall incident investigations, identifying and confronting problem issues, planning and adherence to corrective action, and accountability for missed preventive opportunities. For all 1,098,471 inpatient-days of persons aged 18 years and older, with an admission lasting at least one day, between April 2006 and March 2010, data were collected for inpatient falls and fall-associated injuries per 1000 inpatient-days. RESULTS Four-year inpatient fall rates decreased by 63.9% (p < .0001); the greatest reduction (72.3%) occurred between the first quarter (Q1) 2005 and Q4 2009. Minor and moderate fall-related injuries significantly decreased by 54.4% and 64.0%, respectively. Two falls with major injury occurred during the study. CONCLUSIONS The FPI was associated with a significant reduction in fall and fall-related injury rates. The results suggest that increasing commitment to continuous quality improvement through enhanced safety awareness and accountability contributed to the initiatives success and led to a change of normative behavior and a culture of safety.

Serum lipoprotein levels in takotsubo cardiomyopathy vs. myocardial infarction.

Background In the setting of myocardial infarction (MI) or acute coronary syndrome (ACS), current guidelines recommend early and aggressive lipid lowering therapy with statins, irrespective of the baseline lipoprotein levels. Takotsubo cardiomyopathy (TCM) patients have a clinical presentation similar to myocardial infarction and thus receive early and aggressive statin therapy during their initial hospitalization. However, the pathology of TCM is not atherosclerotic coronary artery disease and hence we assumed the lipid profiles in TCM would be healthier than coronary artery disease patients. Methods In this retrospective study, we assessed fasting serum lipoprotein levels of ten TCM patients and compared them with forty, age and sex-matched myocardial infarction (MI) patients. Results Comparing serum lipoprotein levels of TCM with MI group, there was no significant difference in mean total cholesterol between the two groups (174.5 mg/dL vs. 197.6 mg/dL, p = 0.12). However, in the TCM group, mean HDL-C was significantly higher (66.87 mg/dL vs. 36.5 mg/dL, p = 0.008), the mean LDL-C was significantly lower (89.7 mg/dL vs. 128.9 mg/dL, p = 0.0002), and mean triglycerides was also significantly lower (65.2 mg/dL vs. 166.8 mg/dL, p < 0.0001). Conclusions In this study, TCM patients in comparison to MI patients had significantly higher levels of HDL-C, lower levels of LDL-C levels and triglycerides. The lipid profiles in TCM were consistent with the underlying pathology of non-atherosclerotic, non-obstructive coronary artery disease. As lipoproteins in most TCM patients were within the optimal range, we recommend an individual assessment of lipid profiles along with their coronary heart disease risk factors for considering long term lipid-lowering therapy. A finding of hyperalphalipoproteinemia or hypotriglyceridemia in 40% of TCM patients is novel but this association needs to be confirmed in future studies with larger sample sizes. These findings may provide clues in understanding the pathogenesis of takotsubo cardiomyopathy.

A survey of optometry leadership: participation in disaster response.

Abstract Background A study was completed to assess the academic and state-level professional optometry leadership views regarding optometry professionals as surge responders in the event of a catastrophic event. Methods A cross-sectional survey was conducted using a 21-question, self-administered, structured questionnaire. All U.S. optometry school deans and state optometric association presidents were mailed a questionnaire and instructions to return it by mail on completion; 2 repeated mailings were made. Descriptive statistics were produced and differences between deans and association presidents were tested by Fisher exact test. Results The questionnaire response rate was 50% (25 returned/50 sent) for the state association presidents and 65% (11/17) for the deans. There were no statistically significant differences between the leadership groups for any survey questions. All agreed that optometrists have the skills, are ethically obligated to help, and that optometrists should receive additional training for participation in disaster response. There was general agreement that optometrists should provide first-aid, obtain medical histories, triage, maintain infection control, manage a point of distribution, prescribe medications, and counsel the “worried well.” Starting intravenous lines, interpreting radiographs, and suturing were less favorably supported. There was some response variability between the 2 leadership groups regarding potential sources for training. Conclusions The overall opinion of optometry professional leadership is that with additional training, optometrists can and should provide an important reserve pool of catastrophic event responders.