Michael E. Rezaee

The Effect of Computers for Weight Loss: A Systematic Review and Meta-analysis of Randomized Trials

ABSTRACTBACKGROUNDThe use of computers to deliver education and support strategies has been shown to be effective in a variety of conditions. We conducted a systematic review and meta-analysis to evaluate the impact of computer-based technology on interventions for reducing weight.METHODSWe searched MEDLINE, CENTRAL, CINAHL, PsycINFO, Google Scholar and ClinicalTrials.gov (all updated through June 2010) for randomized controlled trials evaluating the effect of computer-based technology on education or support interventions aimed at reducing weight in overweight or obese adults. We calculated weighted mean differences (WMD) and 95% confidence intervals (CI) using random effects models.RESULTSEleven trials with 13 comparisons met inclusion criteria. Based on six comparisons, subjects who received a computer-based intervention as an addition to the standard intervention given to both groups lost significantly more weight (WMD −1.48xa0kg, 95% CI −2.52, –0.43). Conversely, based on six comparisons, subjects for whom computer-based technology was substituted to deliver an identical or highly comparable intervention to that of the control group lost significantly less weight (WMD 1.47xa0kg, 95% CI 0.13, 2.81). Significantly different weight loss seen in “addition” comparisons with less than six months of follow-up (WMD −1.95xa0kg, 95% CI −3.50, –0.40, two comparisons) was not seen in comparisons with longer follow-up (−1.08xa0kg, 95% CI −2.50, 0.34, four comparisons). Analyses based on quality and publication date did not substantially differ.CONCLUSIONSWhile the addition of computer-based technology to weight loss interventions led to statistically greater weight loss, the magnitude (<1.5xa0kg) was small and unsustained.

Primary percutaneous coronary intervention for patients presenting with ST-elevation myocardial infarction: process improvements in rural prehospital care delivered by emergency medical services.

BACKGROUNDnSafe and effective patient care for ST-elevation myocardial infarction (STEMI) relies on prompt emergency medical service (EMS) and established care coordination with receiving hospitals to conduct primary percutaneous coronary intervention (PCI). Likewise, a new emphasis has been placed on first medical contact-to-balloon (E2B) times as opposed to door-to-balloon times, identifying prehospital care as an important contributing factor for high-quality STEMI care. Therefore, we evaluated EMS processes of care before and after a period of continuous quality improvement to improve E2B times in our rural tertiary care medical center.nnnMETHODSnA retrospective, consecutive cohort study was conducted on 177 patients who received primary PCI at Dartmouth-Hitchcock Medical Center, a rural hospital, from January 1, 2006 to October 31, 2009. This cohort was stratified from January 1, 2008 to May 1, 2008 (n = 88) and May 1, 2008 to October 31, 2009 (n = 89), to acknowledge periods of no improvement (pre) and continuous quality improvement (post) in STEMI care. Primary outcome measures included frequency of non-PCI-capable hospital bypass, E2B, and frequency of prehospital electrocardiogram (ECG) and cardiac catheterization laboratory (CCL) activation. Descriptive statistics and log-rank tests were used to determine whether measures differed significantly by time period. A time-to-event analysis was conducted using a Cox proportional hazards model to assess the impact of outcomes measures on E2B pre/post-May 1, 2008.nnnRESULTSnPatients who presented before May 1, 2008 had longer E2B times compared with patients in the post-May 1, 2008 cohort (145.1 minutes vs 115.2 minutes, t test P = .01). A log-rank test confirmed this (pre: 130 minutes vs post: 106 minutes, χ(2) = 5.3, log-rank P = .02). Similarly, patients who presented before May 1, 2008 had lower percentages of prehospital ECGs (49% vs 80%, P = .001) and CCL activations (4% vs 32%, P < .001). When prehospital ECGs (140 minutes vs 106 minutes, χ(2) = 5.9, log-rank P = .01) or CCL activations (125 minutes vs 98 minutes, χ(2) = 4.2, log-rank P = .04) were conducted, E2B times were significantly reduced. Patients who received both prehospital ECGs and prehospital CCL activations had significantly reduced E2B times compared with those who did not (125 minutes vs 91 minutes, χ(2) = 4.8, P = .02).nnnCONCLUSIONSnThe time saving benefits of prehospital ECGs may not be fully realized unless prehospital CCL activations also occur. EMS providers achieved further reductions in median E2B of approximately 24 minutes when prehospital ECGs were combined with prehospital CCL activation. Every effort should be made by PCI-capable medical centers to assess prehospital STEMI care and to integrate EMS providers into regional STEMI care quality improvement initiatives and education.

Hospital Mortality in the United States following Acute Kidney Injury.

Acute kidney injury (AKI) is a common reason for hospital admission and complication of many inpatient procedures. The temporal incidence of AKI and the association of AKI admissions with in-hospital mortality are a growing problem in the world today. In this review, we discuss the epidemiology of AKI and its association with in-hospital mortality in the United States. AKI has been growing at a rate of 14% per year since 2001. However, the in-hospital mortality associated with AKI has been on the decline starting with 21.9% in 2001 to 9.1 in 2011, even though the number of AKI-related in-hospital deaths increased almost twofold from 147,943 to 285,768 deaths. We discuss the importance of the 71% reduction in AKI-related mortality among hospitalized patients in the United States and draw on the discussion of whether or not this is a phenomenon of hospital billing (coding) or improvements to the management of AKI.

Sex disparities in pre-hospital and hospital treatment of ST-segment elevation myocardial infarction.

Abstract Objective: To determine whether sex disparities exist in pre-hospital and hospital time to treatment in patients with ST-segment elevation myocardial infarction (STEMI). Background: Evidence suggests that women experience poorer quality of care for STEMI. Methods: A retrospective cohort study was conducted on 177 consecutive patients with STEMI who received primary percutaneous coronary intervention at a rural, tertiary medical center between January 2006 and October 2009. A subgroup analysis was conducted to evaluate time to treatment during a period of no-focused process improvement compared with a time period of focused, non–sex-specific process improvement; the post period included implementation of the STEMI process upgrade (STEP-UP) quality-improvement (QI) program. Results: Median first-emergency-medical-services-contact-to-balloon (E2B) angioplasty time was significantly longer for women compared with men. A Cox proportional hazards model revealed that men had a significantly shorter E2B time than women. After adjustment for differences between sex groups at presentation, the effect of sex on E2B was no longer statistically significant. A similar effect was observed in door-to-balloon (D2B) angioplasty time. The subgroup analysis revealed that from baseline, both men and women experienced improvement in E2B time after implementation of the STEP-UP QI program. Men and women also experienced improvement in D2B time after implementation of the STEP-UP QI program. Conclusions: Women with STEMI experienced significantly longer E2B and D2B times compared with men with STEMI, although these differences did not persist after adjustment for differences between sex groups at presentation. In addition to standard STEMI-care QI practices, sex-specific processes and interventions at the systems level may be needed to improve time to treatment for women with STEMI.

Incidence and In‐Hospital Mortality of Acute Kidney Injury (AKI) and Dialysis‐Requiring AKI (AKI‐D) After Cardiac Catheterization in the National Inpatient Sample

Background Acute kidney injury (AKI) and dialysis‐requiring AKI (AKI‐D) are common, serious complications of cardiac procedures. Methods and Results We evaluated 3 633 762 (17 765 214 weighted population) cardiac catheterization or percutaneous coronary intervention (PCI) hospital discharges from the nationally representative National Inpatient Sample to determine annual population incidence rates for AKI and AKI‐D in the United States from 2001 to 2011. Odds ratios for both conditions and associated in‐hospital mortality were calculated for each year in the study period using multiple logistic regression. The number of cardiac catheterization or PCI cases resulting in AKI rose almost 3‐fold from 2001 to 2011. The adjusted odds of AKI and AKI‐D per year among cardiac catheterization and PCI patients were 1.11 (95% CI: 1.10–1.12) and 1.01 (95% CI: 0.99–1.02), respectively. Most importantly, in‐hospital mortality significantly decreased from 2001 to 2011 for AKI (19.6–9.2%) and AKI‐D (28.3–19.9%), whereas odds of associated in‐hospital mortality were 0.50 (95% CI: 0.45–0.56) and 0.70 (95% CI: 0.55–0.93) in 2011 versus 2001, respectively. The population‐attributable risk of mortality for AKI and AKI‐D was 25.8% and 3.8% in 2001 and 41.1% and 6.5% in 2011, respectively. Males and females had similar patterns of AKI increase, although males outpaced females. Conclusions The Incidence of AKI among cardiac catheterization and PCI patients has increased sharply in the United States, and this should be addressed by implementing prevention strategies. However, mortality has significantly declined, suggesting that efforts to manage AKI and AKI‐D after cardiac catheterization and PCI have reduced mortality.

Reduced Mortality Associated with Acute Kidney Injury Requiring Dialysis in the United States

Background: Dialysis-requiring acute kidney injury (AKI-D) is a documented complication of hospitalization and procedures. Temporal incidence of AKI-D and related hospital mortality in the US population has not been recently characterized. We describe the epidemiology of AKI-D as well as associated in-hospital mortality in the US. Methods: Retrospective cohort of a national discharge data (n = 86,949,550) from the Healthcare Cost and Utilization Projects National Inpatient Sample, 2001-2011 of patients hospitalization with AKI-D. Primary outcomes were AKI-D and in-hospital mortality. We determined the annual incidence rate of AKI-D in the US from 2001 to 2011. We estimated ORs for AKI-D and in-hospital mortality for each successive year compared to 2001 using multiple logistic regression models, adjusted for patient and hospital characteristics, and stratified the analyses by sex and age. We also calculated population-attributable risk of in-hospital mortality associated with AKI-D. Results: The adjusted odds of AKI-D increased by a factor of 1.03 (95% CI 1.02-1.04) each year. The number of AKI-D-related (19,886-34,195) in-hospital deaths increased almost 2-fold, although in-hospital mortality associated with AKI-D (28.0-19.7%) declined significantly from 2001 to 2011. Over the same period, the adjusted odds of mortality for AKI-D patients were 0.60 (95% CI 0.56-0.67). Population-attributable risk of mortality associated with AKI-D increased (2.1-4.2%) over the study period. Conclusions: The incidence rate of AKI-D has increased considerably in the US since 2001. However, in-hospital mortality associated with AKI-D hospital admissions has decreased significantly.

Preoperative serum ST2 level predicts acute kidney injury after adult cardiac surgery

Objective The purpose of this study was to evaluate the relationship between preoperative levels of serum soluble ST2 (ST2) and acute kidney injury (AKI) after cardiac surgery. Previous research has shown that biomarkers facilitate the prediction of AKI and other complications after cardiac surgery. Methods Preoperative ST2 proteins were measured in 1498 patients undergoing isolated coronary artery bypass graft surgery at 8 hospitals participating in the Northern New England Biomarker Study from 2004 to 2007. AKI severity was defined using the Acute Kidney Injury Network (AKIN) definition. Preoperative ST2 levels were measured using multiplex assays. Ordered logistic regression was used to examine the relationship between ST2 levels and levels of AKI severity. Results Participants in this study showed a significant association between elevated preoperative ST2 levels and acute kidney risk. Before adjustment, the odds of patients developing AKIN stage 2 or 3, compared with AKIN stage 1, are 2.43 times higher (95% confidence interval, 1.86‐3.16; P < .001) for patients in the highest tercile of preoperative ST2. After adjustment, patients in the highest tercile of preoperative ST2 had significantly greater odds of developing AKIN stage 2 or 3 AKI (odds ratio, 1.99; 95% confidence interval, 1.50‐2.65; P < .001) compared with patients with AKIN stage 1. Conclusions Preoperative ST2 levels are associated with postoperative AKI risk and can be used to identify patients at higher risk of developing AKI after cardiac surgery.

Bibliometric Analysis of Erectile Dysfunction Publications in Urology and Sexual Medicine Journals

INTRODUCTIONnScientific literature has experienced a significant growth in the number of authors per publication each year. Erectile dysfunction (ED) is one of the most common urologic conditions, accounting for over 2.9 million outpatient visits per year. Given the prevalence of ED and the large literature base available on this condition, bibliometric analysis of the ED literature could provide urologists and sexual medicine specialists with a better understanding of publication trends in this topic area.nnnAIMnThe purpose of this study was to investigate trends in authorship, citations, and impact score for ED original and review articles published in urology and sexual medicine journals.nnnMETHODSnWe analyzed ED original research and review articles indexed in MEDLINE between January 1, 2006, and December 31, 2016. Descriptive statistics were used to evaluate the mean number of authors for articles by journal type and time period (2006 vs 2016). Linear regression was used to examine the relationship between number of authors, number of citations, and relative citation ratio (RCR).nnnMAIN OUTCOME MEASUREnThe primary outcomes of interest included mean number of authors, citations, and RCR per manuscript by journal type and time period.nnnRESULTSnA total of 3,516 articles were analyzed, 2,938 (83.6%) original and 578 (16.4%) review articles. The mean number of authors among ED publications increased from 4.8 in 2006 to 6.4 in 2016, a 34.4% increase. Original articles had a greater mean number of authors compared to review articles (6.0 vs 4.3, P < .001). The mean number of authors for original articles significantly increased from 5.0 in 2006 to 7.0 in 2016 (P < .001), an increase of 38.9%. A positive linear relationship was observed between mean number of authors and number of citations per manuscript (rxa0= 0.015, P < .01) as well as RCR (rxa0= 0.37, P < .0001). The largest authorship increases were observed in European Urology (78.8%), BJU International (78.6%), and Journal of Sexual Medicine (58.1%).nnnCLINICAL IMPLICATIONSnAuthorship trends should be taken into consideration when urologists and sexual medicine experts review ED articles for the purpose of informing patient care.nnnSTRENGTH AND LIMITATIONSnPrimary strengths include a large literature base spanning multiple years for analysis and a systematic literature search to identify relevant ED literature. Findings are limited to ED literature published in the urology and sexual medicine journals analyzed.nnnCONCLUSIONnThe number of authors per ED manuscript has significantly increased over time, most notably among original research articles. Increasing authorship was associated with more citations and higher RCR in the ED literature. Rezaee ME, Johnson HA, Munarriz RM, etxa0al. Bibliometric Analysis of Erectile Dysfunction Publications in Urology and Sexual Medicine Journals. J Sex Med 2018;15:1426-1433.

The Association Between Novel Biomarkers and 1-Year Readmission or Mortality After Cardiac Surgery

BACKGROUNDnNovel cardiac biomarkers including soluble suppression of tumorigenicity 2, galectin-3, and the N-terminal prohormone of brain natriuretic peptide may be associated with long-term adverse outcomes after cardiac surgery. We sought to measure the association between cardiac biomarker levels and 1-year hospital readmission or mortality.nnnMETHODSnPlasma biomarkers from 1,047 patients discharged alive after isolated coronary artery bypass graft surgery from 8 medical centers were measured in a cohort from the Northern New England Cardiovascular Disease Study Group between 2004 and 2007. We evaluated the association between preoperative and postoperative biomarkers and 1-year readmission or mortality using Kaplan-Meier estimates and Cox proportional hazards modeling, adjusting for covariates used in The Society of Thoracic Surgeons 30-day readmission model.nnnRESULTSnThe median follow-up time was 365 days. After adjustment for established risk factors, above-median levels of postoperative galectin-3 (median 10.35 ng/mL; hazard ratio, 1.40; 95% confidence interval, 1.08 to 1.80; pxa0= 0.010) and N-terminal prohormone of brain natriuretic peptide (medianxa0= 15.21 ng/mL, hazard ratio, 1.42; 95% confidence interval, 1.07 to 1.87; pxa0= 0.014) were each significantly associated with 1-year readmission or mortality.nnnCONCLUSIONSnIn patients undergoing cardiac surgery, novel cardiac biomarkers were associated with readmission or mortality independent of established risk factors. Measurement of these biomarkers may improve our ability to identify patients at highest risk for readmission or mortality before discharge. This will also allow resource allocation accordingly, while implementing strategies for personalized medicine based on the biomarker profile of the patient.

Elevated preoperative Galectin-3 is associated with acute kidney injury after cardiac surgery

BackgroundPrevious research suggests that novel biomarkers may be used to identify patients at increased risk of acute kidney injury following cardiac surgery. The purpose of this study was to evaluate the relationship between preoperative levels of circulating Galectin-3 (Gal-3) and acute kidney injury after cardiac surgery.MethodsPreoperative serum Gal-3 was measured in 1498 patients who underwent coronary artery bypass graft (CABG) surgery and/or valve surgery as part of the Northern New England Biomarker Study between 2004 and 2007. Preoperative Gal-3 levels were measured using multiplex assays and grouped into terciles. Univariate and multinomial logistic regression was used to assess the predictive ability of Gal-3 terciles and AKI occurrence and severity.ResultsBefore adjustment, patients in the highest tercile of Gal-3 had a 2.86-greater odds of developing postoperative KDIGO Stage 2 or 3 (pxa0<u20090.001) and 1.70-greater odds of developing KDIGO Stage 1 (pxa0=xa0<u20090.001), compared to the first tercile. After adjustment, patients in the highest tercile had 2.95-greater odds of developing KDIGO Stage 2 or 3 (pxa0<xa00.001) and 1.71-increased odds of developing KDIGO Stage 1 (pxa0=u20090.001), compared to the first tercile. Compared to the base model, the addition of Gal-3 terciles improved discriminatory power compared to without Gal-3 terciles (test of equalityu2009=u20090.042).ConclusionElevated preoperative Gal-3 levels significantly improves predictive ability over existing clinical models for postoperative AKI and may be used to augment risk information for patients at the highest risk of developing AKI and AKI severity after cardiac surgery.