This randomized open label clinical trial will evaluate the effect of continued denosumab alone over 18 months versus denosumab with added abaloparatide for 18 months. 70 postmenopausal women will be enrolled over a period of 18 months. The co-primary outcomes will be group differences in bone mineral density (BMD) of the total hip and lumbar spine at 18 months. Secondary outcomes will include group differences in bone mineral density (BMD) at the femoral neck, trochanter and wrist sites at 6, 12 and 18 months, spine and total hip bone mineral density (BMD) at 6 and 12 months and trabecular bone score (TBS) at 18 months. Secondary outcomes will also include within group changes from baseline for each of these variables. Bone turnover markers will also be measured to demonstrate that PINP levels will increase with administration of abaloparatide even in the setting of ongoing denosumab, while CTX levels will remain low.

开始日期2021-02-01

申办/合作机构

Hospital for Special Surgery

[+2]

NCT04517682 / CompletedN/A

SARS -CoV-2 Detection in Saliva Samples: A Test Validation Protocol

This study aims to validate the use of human saliva as a substrate for an assay to detect SARS-CoV-2 and define accuracy, analytical sensitivity and specificity of the TaqPath RT-PCR test.

开始日期2020-05-21

申办/合作机构

Ambry Genetics Corp.

[+3]

NCT03734471 / Unknown status临床3期IIT

Use of a Novel Chest Tube Insertion Device for Urgent Thoracostomy in an Emergency Department Setting

Tube thoracostomy is commonly performed in the emergency department for patients suffering from traumatic hemo- or pneumo-thorax. The procedure involves the use of a scalpel incision at the skin followed by blunt dissection through tissue, penetration into the thoracic cavity, dilation of a tract for tube placement, exploration of the thoracic cavity with a gloved finger, and finally insertion of a sterile tube into the intrathoracic space. The procedure is considered extremely painful despite the routine provision of systemic analgesics and local anesthetics.
Cadaver and animal studies have demonstrated the use of the Reactor chest tube device, a squeeze-activated thoracostomy trochar with placement of a clear sheath for chest tube insertion, to decrease procedure time, incision size, and blood loss. Case series and observational reports suggest lower rates of procedural complication and failure as well as increased patient satisfaction due to pain reduction.

开始日期2019-01-01

申办/合作机构

Crozer-Keystone Health System

100 项与 Crozer-Keystone Health System 相关的临床结果

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0 项与 Crozer-Keystone Health System 相关的专利（医药）

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419

项与 Crozer-Keystone Health System 相关的文献（医药）

2025-01-01·Journal of Trauma and Acute Care Surgery

Scanning the aged to minimize missed injury: An Eastern Association for the Surgery of Trauma multicenter study

Article

作者: Nahmias, Jeffry ; Ho, Vanessa P ; Biller, Jessica ; Ratnasekera, Asanthi ; O'Brien, Joseph ; Claridge, Jeffrey A ; Cuschieri, Joseph ; Pacheco, Tulio Brasileiro Silva ; Wu, Esther ; Damiano, Nicholas ; Mentzer, Caleb ; Dixon, Jacob K ; Ton, Trieu Hai ; Jacobson, Lewis E ; Miller, Samuel M ; Williams, Jennifer ; Colling, Kristin P ; Tann, Kimberly ; Chung, Timothy ; Morrissey, Shawna ; Veatch, Jessica M ; Doris, Stephanie ; Muller, Alison ; Diaz, Bernardo Fabian ; Hinojosa, Christopher J ; Burke, Rachel ; Piehl, Charles ; Lightwine, Kelly ; Seng, Sirivan Suon ; Capasso, Thomas J ; Harry, Melissa L ; Kodadek, Lisa M ; Petrone, Patrizio ; Butts, Christopher A ; Udekwu, Pascal O ; Hill, Hannah ; Haan, James ; Herzing, Karen ; Earley, Angela ; Moncrief, Melissa L ; Nebughr, Cole S ; Villa, Erica ; Kishawi, Sami K ; Kuncir, Eric J ; Egodage, Tanya ; Baltazar, Gerard A ; Williams, Jamie M ; Wilkinson, Michael C ; Altan, Defne ; Palmer, Brandi ; Tay-Lasso, Erika

BACKGROUND:

Despite the high incidence of blunt trauma in older adults, there is a lack of evidence-based guidance for computed tomography (CT) imaging in this population. We aimed to identify an algorithm to guide use of a pan-scan (head/cervical spine [C-spine]/torso) or a selective scan (head/C-spine ± torso). We hypothesized that a patient's initial history and examination could be used to guide imaging.

METHODS:

We prospectively studied blunt trauma patients 65 years or older at 18 Level I/II trauma centers. Patients presenting >24 hours after injury or who died upon arrival were excluded. We collected history and physical elements and final injury diagnoses. Injury diagnoses were categorized into CT body regions of head/C-spine or Torso (chest, abdomen/pelvis, and thoracolumbar spine). Using machine learning and regression modeling as well as a priori clinical algorithms based, we tested various decision rules against our data set. Our priority was to identify a simple rule, which could be applied at the bedside, maximizing sensitivity and negative predictive value (NPV) to minimize missed injuries.

RESULTS:

We enrolled 5,498 patients with 3,082 injuries. Nearly half (n = 2,587 [47.1%]) had an injury within the defined CT body regions. No rule to guide a pan-scan could be identified with suitable sensitivity/NPV for clinical use. A clinical algorithm to identify patients for pan-scan, using a combination of physical examination findings and specific high-risk criteria, was identified and had a sensitivity of 0.94 and NPV of 0.86. This rule would have identified injuries in all but 90 patients (1.6%) and would theoretically spare 11.9% (655) of blunt trauma patients a torso CT.

CONCLUSION:

Our findings advocate for head/C-spine CT in all geriatric patients with the addition of torso CT in the setting of positive clinical findings and high-risk criteria. Prospective validation of this rule could lead to streamlined diagnostic care of this growing trauma population.

LEVEL OF EVIDENCE:

Diagnostic Tests or Criteria; Level II.

2024-12-01·Cardiovascular & hematological agents in medicinal chemistry

Understanding the Relationship between the Ketogenic Diet and the Heart: A Novel Therapeutic Potential for Cardiovascular Health

Review

作者: Sawhney, Aanchal ; Kanagala, Sai Gautham ; Parikh, Kinna ; Garg, Nikita ; Shah, Priyanshi ; Anamika, FNU ; Jain, Rohit ; Mendpara, Vaidehi

Obesity and cardiovascular diseases are major health problems worldwide, and weight loss is used as a treatment strategy to enhance various aspects. While there are many weight loss methods, one of the most effective is through a dietary approach. The ketogenic diet (KD), which is characterized by low carbohydrates and high levels of fat and/or protein, is used in obese patients as it is a promising treatment option for weight loss as well as for controlling the risk factors for cardiovascular diseases, as seen in its effects on cardio-metabolic outcomes, particularly in obesity, heart failure, and hypertension. In this review, we summarize the clinical evidence of the efficacy and safety of the KD in controlling risk factors for cardiovascular diseases and discuss the possible mechanisms of action based on recent evidence in understanding the influence of the KD at the cellular and molecular levels.

2024-12-01·INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED

Incidence of deep vein thrombosis and pulmonary embolism in closed foot and ankle fractures treated with conservative versus surgical management: A nationwide analysis

Article

作者: Goyal, Aakash R. ; Atodaria, Kuldeepsinh P. ; Kohli, Meera ; Brahmabhatt, Shyam ; Patel, Rajeshkumar ; Raval, Neha ; Atodaria, Kuldeepsinh P ; Goyal, Aakash R

OBJECTIVES:

Though there is extensive research on recovery and outcomes of proximal joint fractures, such as hip and knee, there is a paucity of such research in foot and ankle fractures and a lack of uniform data on the incidence of venous thromboembolism (VTE). This is a retrospective cohort study that seeks to investigate the incidence of VTE following surgically versus conservatively treated foot and ankle fractures METHODS: This study included all adult-patient hospitalizations with International Classification of Disease 10th Revision diagnosis codes related to closed foot and ankle fractures as a primary diagnosis in the National Inpatient Sample, an administrative database part of the Healthcare Cost and Utilization Project, for a total of 209,595 cases. Multivariate binary logistic regression was performed to determine the effect of age, gender, past medical history of venous thromboembolism (PMHVTE), Charlson Comorbidity Index, race, surgery, and transfusion of red cell products on the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE).

RESULTS:

Our study found an overall incidence of DVT and PE to be 0.4 % and 0.3 %, respectively, following foot or ankle fracture. Conservative management was found to have an increased relative risk of DVT and PE of 2.02 and 1.15, respectively. This difference persisted on performing inverse probability treatment weighting (IPTW) analysis to account for confounders. PMHVTE and requirement of blood transfusion was associated with an increased odds ratio (OR) of 3.41 and 3.217, respectively. Cases identified as Black and Asian/Pacific Islander also had an increased OR of DVT.

CONCLUSIONS:

The results of this study demonstrate that surgical management of foot and ankle fractures is associated with a lower relative risk of VTE compared to medical management. PMHVTE and transfusion of red cell products increase the odds of VTE following either form of intervention.

项与 Crozer-Keystone Health System 相关的新闻（医药）

2023-06-13

·Business Wire

Taylor Healthcare Adds Mobile Signature Capture to VA’s iMedConsent™ System

NORTH MANKATO, Minn.--( BUSINESS WIRE )-- Taylor Healthcare announced it has reached an agreement with the U.S. Department of Veterans Affairs (VA) to add Mobile Signature Capture to the VA’s iMedConsent™ installation. The VA uses Taylor Healthcare’s proprietary iMedConsent solution for its surgical informed consent process in more than 140 medical facilities in all 50 states, Puerto Rico, Guam and the Philippines. “Adding our Mobile Signature Capture technology to the VA’s iMedConsent solution enhances the VA’s telehealth strategy,” says Scott Fleischman, vice president of federal programs for Taylor Healthcare. “VA patients will soon be able to sign surgical consent documents from anywhere using their own mobile devices. Allowing patients to review and sign consent forms while away from the VA facility is a huge win from a patient experience standpoint.” The Mobile Signature Capture implementation follows the successful 2022 migration of iMedConsent to the VA’s secure enterprise cloud. This latest enhancement will streamline document management for the entire VA health system going forward. “The VA processes millions of confidential patient documents each year,” notes Fleischman. “By providing consent forms and capturing signatures digitally, the VA is able to eliminate those paper documents and increase the efficiency of their new electronic health record.” iMedConsent is an informed consent documentation system that digitizes the process of obtaining patient consent prior to surgical procedures. Standardized consent forms describing more than 4,000 treatments in 37 clinical specialties are maintained in the iMedConsent solution’s digital library. The procedures and accompanying education, anatomical images and pre and post instructions help standardize the informed consent process. VA physicians simply access the appropriate consent form in iMedConsent, which is reached from the VA’s electronic health record (EHR). Physicians are able to customize the consent form as needed for each patient, use that document to describe the procedure to the patient, and obtain their consent. The patient signs the form electronically and the completed document is automatically stored in the VA’s EHR. The iMedConsent solution meets the VA’s Section 508 requirements and is currently used by VA facilities worldwide, numerous Defense Health Agency facilities and dozens of private hospital systems. About Taylor Healthcare Taylor Healthcare provides innovative document automation and patient engagement solutions that standardize and enhance communications across the continuum of care. They improve patient care by enabling healthcare organizations to engage patients with the right information at the right time. To learn more, visit www.taylor.com/solutions/healthcare .

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