ABSTRACT
OBJECTIVES: This study was designed to compare efficiency and quality metrics between percutaneous coronary intervention (PCI) procedures using optical coherence tomography (OCT) guided by a variable workflow versus a standardized workflow in a real-world population. BACKGROUND: The LightLab (LL) Initiative was designed to evaluate the impact of a standardized OCT workflow during PCI to address barriers to adoption. METHODS: The LL Initiative was a multicenter, prospective, observational study. PCI efficiency data were collected from 1/21/19 to 1/8/21 from 45 physicians at 17 US centers. OCT-guided PCIs were compared between baseline phase (variable workflow; N = 383) and the LL workflow utilization phase (N = 447). The LL workflow uses OCT to assess lesion Morphology, Length and Diameter, and then optimize outcomes by correcting for Medial dissection, stent mal-Apposition, and under-eXpansion (MLD MAX). Matching based on propensity scores was used to control for differences between PCIs. RESULTS: After propensity matching, 291 paired procedures were included. Integration of the LL versus variable workflow resulted in no difference in procedure time (51 min vs. 51 min, p = 0.93). There was a reduction in radiation exposure (1124 mGy vs. 1493 mGy, p < 0.0001) and contrast volume (160 cc vs. 172 cc, p < 0.001). The LL workflow decreased the proportion of underexpanded lesions (34% vs. 54%, p < 0.0001) and improved minimum stent expansion (85% vs. 79%, p < 0.0001). Number of noncompliant balloons used was reduced with the LL workflow. (2.0 vs. 1.7, p < 0.01). CONCLUSIONS: These data suggest that standardizing imaging with the LL workflow may overcome barriers to imaging and improve PCI outcomes without prolonging procedures.
Subject(s)
Coronary Artery Disease , Percutaneous Coronary Intervention , Humans , Coronary Angiography/methods , Tomography, Optical Coherence/methods , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/methods , Prospective Studies , Workflow , Treatment Outcome , Stents , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Coronary Artery Disease/pathology , Coronary Vessels/diagnostic imaging , Coronary Vessels/pathologyABSTRACT
Drug eluting metallic stents have been the "gold standard" in the percutaneous management of coronary artery disease. Recent publications have suggested that the ABSORBTM bioresorbable vascular scaffold (BVS) may represent a reasonable alternative, in well selected cases.
Subject(s)
Absorbable Implants , Coronary Artery Disease , Coronary Vessels/diagnostic imaging , Drug-Eluting Stents , Percutaneous Coronary Intervention/instrumentation , Tissue Scaffolds , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Device Approval , Humans , Patient Selection , Percutaneous Coronary Intervention/methods , Product Surveillance, Postmarketing , Treatment Outcome , United StatesABSTRACT
In 2002, the office of the U.S. surgeon general published a report detailing the discrepancies between the quality of healthcare afforded to persons with and without mental retardation. This article examines the case of a female resident of a developmental center with profound mental retardation due to Down syndrome and degenerative hip disease. Although she was in urgent need of a total hip replacement, the operation was denied or delayed by several different surgeons. Using a survey of physician attitudes, we examine several possible motivations behind the surgeons' reluctance to perform the procedure and conclude that these reasons were not appropriate in this case. Finally, we reiterate the surgeon general's call to eradicate preconceptions held in the medical community about the population of persons with mental retardation that result in similar failures to provide adequate care.
Subject(s)
Arthroplasty, Replacement, Hip , Attitude of Health Personnel , Down Syndrome/complications , Intellectual Disability/complications , Osteoarthritis, Hip/surgery , Refusal to Treat , Adult , Female , Humans , Osteoarthritis, Hip/etiologyABSTRACT
This study reports a retrospective analysis of 16 patients to determine changes in medication costs associated with deep brain stimulation of the bilateral subthalamic nucleus (DBS B-STN). Antiparkinsonian medication (APMED) costs were evaluated pre- and post-operatively at 1 and 2 years, based on prescribed dosages. After treatment with DBS, patients experienced a 32% reduction in APMED costs after 1 year and a 39% reduction after 2 years. Hypothetical projections of total potential savings are presented, accounting for increasingly complex medication regimens and medication cost inflation. DBS patients may experience a significant long-term reduction in the cost of their pharmacologic treatment.
Subject(s)
Antiparkinson Agents/economics , Antiparkinson Agents/therapeutic use , Deep Brain Stimulation , Parkinson Disease/economics , Parkinson Disease/therapy , Subthalamic Nucleus/physiology , Amantadine/economics , Amantadine/therapeutic use , Antiparkinson Agents/administration & dosage , Catechol O-Methyltransferase Inhibitors , Combined Modality Therapy , Deep Brain Stimulation/economics , Drug Costs , Electrodes, Implanted , Enzyme Inhibitors/economics , Enzyme Inhibitors/therapeutic use , Humans , Levodopa/economics , Levodopa/therapeutic use , Models, Economic , Neurosurgical Procedures , Parkinson Disease/drug therapy , Retrospective StudiesABSTRACT
Primary generalized dystonia (PGD) associated with the early-onset generalized dystonia gene (DYT1) can cause severe disability, compromising an individual's ability to perform activities of daily living. Pharmacological treatment has been inadequate in alleviating the motor dysfunctions. Deep brain stimulation of the bilateral globus pallidus internus (DBS B-GPi) has been documented to reduce these debilitating motor abnormalities. This report details the successful treatment of a DYT1-positive 13 year-old boy suffering from PGD.
Subject(s)
Deep Brain Stimulation/methods , Dystonia/therapy , Globus Pallidus/surgery , Botulinum Toxins/therapeutic use , Child , Diazepam/therapeutic use , Dystonia/genetics , Dystonia/physiopathology , Humans , Male , Methadone/therapeutic use , Treatment OutcomeABSTRACT
Injection with botulinum toxin type A (Botox) is a safe and efficacious treatment for idiopathic cervical dystonia. We present the first case report of clinical Botox treatment during pregnancy. This patient underwent four apparently uncomplicated full-term pregnancies while receiving regular Botox treatments.