Showing papers by "Jennifer S. Herrick published in 2020"
TL;DR: A high proportion of US adults with hypertension, including those with uncontrolled BP, are taking one antihypertensive medication class, and increasing the use of dual- and triple-therapy antihyertensive medication regimens may restore the upward trend in BP control rates among US adults.
Abstract: Blood pressure (BP) control rates among US adults taking antihypertensive medication have not increased over the past decade. Many adults require 2 or more classes of antihypertensive medication to...
69 citations
TL;DR: It is found that among 1294 patients without respiratory efforts, ΔP was significantly associated with 60-day hospital mortality, and that mechanical power retains a significant relationship with mortality, despite adjusting for driving pressure, may be because mechanical power relies on other components than driving pressure itself.
Abstract: Dear Editor, The postulated importance of mechanical power is that it provides a unifying concept combining the interaction of all the individual components of mechanical ventilation with the patient. Derived from the equation of motion, mechanical power calculates the energy delivered over time to the respiratory system by the ventilator [1]. Physiologically, mechanical power incorporates tidal volume, pressure, and additional parameters not included in driving pressure [2]. Previous studies demonstrated an association of power with mortality [3–5], but were primarily in non-ARDS populations [4], lacked consistent findings within all ARDS severities [3], or were unadjusted and descriptive of a single mechanical power threshold [5]. None assessed whether the association of mechanical power and mortality was independent from driving pressure. To assess the relative strength of association of mechanical power and driving pressure (ΔP) with mortality, we pooled patients from three randomized controlled trials of ARDS. Methods are detailed in the Online data supplement, but briefly, we reconstructed the adjusted Cox proportional hazards model from the Amato et al. driving pressure [2] study (Table E1) and examined the relationship between ΔP with mortality, mechanical power with mortality, and, after checking for correlation and multicollinearity, we combined both ΔP and mechanical power in the same model. We also visually examined the relationship of ΔP and mechanical power with mortality. We analyzed patients not making respiratory efforts, and did a sensitivity analysis on patients making respiratory efforts. We found that among 1294 patients without respiratory efforts (Figure E1, Table E2), ΔP was significantly associated, in adjusted analysis, with 60-day hospital mortality (hazard ratio [HR] 1.44 [95% CI 1.28, 1.62; p < 0.001]) (Table E2). Replacing ΔP with mechanical power, the HR was 1.39 (95% CI 1.28, 1.52; p < 0.001). Including both ΔP and mechanical power in the same model, each retained an independent significant relationship with mortality (ΔP: HR 1.2 [95% CI 1.03, 1.4; p = 0.018]; mechanical power: HR 1.26 [95% CI 1.11, 1.43; p < 0.001]) (Table E3). Sensitivity analyses among patients making respiratory efforts were unchanged (Table E6). Increasing quintiles of mechanical power, stratified on comparable levels of ΔP, were significantly associated with mortality (HR 1.19 [95% CI 1.1, 1.3; p < 0.001]) (Fig. 1a); the converse was also true (HR 1.12 [95% CI 1.03, 1.22; p = 0.007]) (Fig. 1b). That mechanical power retains a significant relationship with mortality, despite adjusting for driving pressure, may be because mechanical power relies on other components than driving pressure itself. Clinically modifiable parameters such as flow and respiratory rate could also have an effect on mortality in ARDS patients. Like ΔP, mechanical power is normalized to individual compliance, but additionally includes respiratory rate and flow to quantify and include repetitive and dynamic forces. Mechanical power thus captures an applied *Correspondence: joseph.tonna@hsc.utah.edu 1 Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, USA Full author information is available at the end of the article
27 citations
TL;DR: In individuals with SCI who stopped CIC, it was sought to determine how individual characteristics affect the bladder‐related quality of life (QoL) and the reasons for CIC cessation.
Abstract: Introduction Clean intermittent catheterization (CIC) is recommended for bladder management after spinal cord injury (SCI) since it has the lowest complication rate. However, transitions from CIC to other less optimal strategies, such as indwelling catheters (IDCs) are common. In individuals with SCI who stopped CIC, we sought to determine how individual characteristics affect the bladder-related quality of life (QoL) and the reasons for CIC cessation. Methods The Neurogenic Bladder Research Group registry is an observational study, evaluating neurogenic bladder-related QoL after SCI. From 1479 participants, those using IDC or urinary conduit were asked if they had ever performed CIC, for how long, and why they stopped CIC. Multivariable regression, among participants discontinuing CIC, established associations between demographics, injury characteristics, and SCI complications with bladder-related QoL. Results There were 176 participants who had discontinued CIC; 66 (38%) were paraplegic and 110 (63%) were male. The most common reasons for CIC cessation among all participants were inconvenience, urinary leakage, and too many urine infections. Paraplegic participants who discontinued CIC had higher mean age, better fine motor scores, and lower educational attainment and employment. Multivariable regression revealed years since SCI was associated with worse bladder symptoms (neurogenic bladder symptom score), ≥4 urinary tract infections (UTIs) in a year was associated with worse satisfaction and feelings about bladder symptoms (SCI-QoL difficulties), while tetraplegia was associated better satisfaction and feelings about bladder symptoms (SCI-QoL difficulties). Conclusions Tetraplegics who have discontinued CIC have an improved QoL compared with paraplegics. SCI individuals who have discontinued CIC and have recurrent UTIs have worse QoL.
25 citations
TL;DR: Unilateral SEMS placement is sufficient for relief of biliary obstruction secondary to cholangiocarcinoma, and bilateral stents had a higher risk of death and more adverse events.
Abstract: Background Endoscopic placement of hilar stents is an accepted palliative therapy for patients with advanced, unresectable cholangiocarcinoma. However, whether unilateral versus bilateral stent placement provides optimal relief continues to be a subject of debate. The aim of this study was to compare the technical and clinical outcomes in patients with inoperable cholangiocarcinoma who received unilateral or bilateral self-expanding metal stents (SEMS). Methods We conducted a multicenter, international retrospective study of 187 patients with cholangiocarcinoma who received unilateral or bilateral SEMS. Outcomes included, but were not limited to, technical success, clinical success, adverse events, stent occlusion, and survival time. Results were further stratified based on the Bismuth classification. Results Fifty patients received unilateral stents and 137 patients received bilateral stents. All patients achieved technical success. The clinical success rates were 86% for unilateral stents and 82.5% for bilateral stents (P>0.99). Clinical success was not statistically different for either group when stratified by the Bismuth classification (P=0.62 and P=0.72 respectively). There were significantly more adverse events in the bilateral stents group (11.7% vs. 0%, P=0.007). There was no greater risk of stent occlusion when bilateral stents were used (unadjusted P=0.71, adjusted P=0.81). There was a greater risk of death for patients who received bilateral SEMS (hazard ratio 1.78, 95% confidence interval 1.09-2.89; P=0.02). Conclusions Unilateral and bilateral drainage had similar technical and clinical success rates. However, bilateral stents had a higher risk of death and more adverse events. Therefore, unilateral SEMS placement is sufficient for relief of biliary obstruction secondary to cholangiocarcinoma.
18 citations