Objectives. We examined whether a home-based educational and environmental intervention delivered by lay health educators would improve asthma symptom control in inner-city children with asthma. Methods. Children 2 to 16 years of age with diagnosed asthma and at least 1 asthma-related hospitalization or 2 emergency visits in the prior year were randomly assigned into 2 groups (immediate and delayed intervention) in a crossover study. Each group participated in the active phase (intervention) and the inactive phase. Outcomes included asthma symptoms, albuterol use, emergency department visits, hospitalizations, and trigger reduction. Results. A total of 264 primarily Black (94%) children were enrolled. The mean number of emergency visits decreased by 30% and inpatient visits decreased by 53% (P < .001) after the intervention. Reductions were seen in pests, presence of carpets in bedrooms, and dust. Nighttime wheezing was significantly reduced after the intervention in both groups (P < .001). Conclusions. Lay health educators effectively reduced asthma triggers and increased caregiver asthma knowledge, which resulted in reduced emergency department visits, hospitalizations, and asthma symptoms. The relationships formed between the caregivers and the lay health educators appeared to positively impact asthma outcomes in this disadvantaged population.

Rationale: Patients with combined pulmonary fibrosis and emphysema (CPFE) may develop acute exacerbations of IPF (AE-IPF) or COPD (AE-COPD). The incidence and the characteristics of exacerbations in patients with CPFE (e.g., COPD vs IPF) have not been well described. Objectives: To compare the incidence and rate of exacerbations in patients with CPFE vs. IPF and evaluate their effect on clinical outcomes. Methods: Comprehensive clinical data from CPFE and IPF patients were retrospectively reviewed. Baseline characteristics including lung function data, oxygen requirements, and pulmonary hemodynamics, were collected. Acute exacerbation events in both groups were defined clinically and radiographically. In the CPFE group, two patterns of exacerbations were identified. AE-COPD was defined clinically by symptoms of severe airflow obstruction causing respiratory failure and requiring hospitalization. Radiographic data were also defined based on previously published literature. AE-IPF was defined clinically as an acute hypoxic respiratory failure, requiring hospitalization and treatment with high dose corticosteroids. Radiographically, patients had to have a change in baseline imaging including presence of ground-glass opacities, interlobular septal thickening or new consolidations; that is not fully explained by other etiologies. Results: Eighty-five CPFE patients were retrospectively compared to 112 IPF patients. Of 112 patients with IPF; 45 had AE-IPF preceding lung transplant (40.18%) compared to 12 patients in the CPFE group (14.1%) (p < 0.05). 10 patients in the CPFE group experienced AE-COPD (11.7%). Patients with AE-IPF had higher mortality and more likely required mechanical ventilation and extracorporeal membrane oxygenation (ECMO) compared to patients with AE-COPD, whether their underlying disease was IPF or CPFE. Conclusions: CPFE patients may experience either AE-IPF or AE-COPD. Patients with CPFE and AE-COPD had better outcomes, requiring less intensive therapy compared to patients with AE-IPF regardless if underlying CPFE or IPF was present. These data suggest that the type of acute exacerbation, AE-COPD vs AE-IPF, has important implications for the treatment and prognosis of patients with CPFE.

No abstract

Introduction: Endovascular thrombectomy (EVT) is the standard of care for the treatment of large vessel occlusion stroke (LVOS). Most patients arrive at an endovascular center (ESC) either directly by EMS or by transfer from a non-ESC hospital. Many LVOS patients receive intravenous thrombolysis (IVT) prior to EVT. However, the benefits of IVT in combination with EVT are uncertain. The effect of direct transport to an ESC for EVT (primary) versus patients transferred for EVT (secondary) is also uncertain. Our goal was to determine the association between the IVT, primary transport versus secondary transport, and 90-day functional outcomes in LVOS patients treated with EVT. Methods: This study is an analysis of the Optimizing Prehospital Stroke Systems of Care-Reacting to Changing Paradigm (OPUS-REACH) registry. The registry includes 2400 LVOS patients who underwent EVT from nine health systems in the United States. We included all patients with LVOS who arrived by EMS and had a last known well time to EVT of less than 10 hours. Results: 1171 patients were included in the analysis and 39.5% of patients had good outcomes at 90 days (mRS score of 0-2). We found a 9% improvement in good outcomes when patients received IVT prior to EVT (OR 1.65, 95% CI 1.31-2.07). This association held true up to 10 hours (Figure 1) and in both patients who were transported directly to an ESC and in those patients transferred from a non-ESC. Conclusion: This investigation supports the importance of LVOS patients receiving IVT prior to EVT treatment as it was associated with markedly better outcomes (NNT=9). Prehospital transport algorithms should maximize access to IVT even if it delays time to EVT.

INTRODUCTION: The benefits of breastfeeding for both a newborn and mother are well established. Parents often co-sleep with their children for ease of breastfeeding. However, co-sleeping is associated with sleep-related deaths. To alleviate this burden, Temple University Hospital (TUH) provided all newly delivered mothers with a Baby Box, a box with a firm mattress, for a safe sleeping environment. The purpose of this project was to study the impact of a safe sleeping environment on breastfeeding rates. METHODS: This is a retrospective study of patients between May 2016 and May 2018 who delivered at TUH and were provided a Baby Box prior to hospital discharge. A phone survey was performed after discharge. Categorical variables were analyzed using Pearson chi-squared test. This study on review by the TUH IRB was given exempt status. RESULTS: Of 4,394 eligible women, 26% reported exclusive breastfeeding of their infant. Approximately 26% of those exclusively breastfeeding reported using the Baby Box for infant sleep, and 54% reported that breastfeeding was easier while using the Baby Box. Approximately 32% of those who exclusively breastfed reported co-sleeping with their infant. There was no statistically significant difference between feeding method and use of the Baby Box. CONCLUSION: With the use of the baby box, the number of participants exclusively breastfeeding was low. Of those who exclusively breastfeed, there was a high rate of co-sleeping, despite being provided with a safe sleeping environment. This study demonstrates the need for continued efforts to promote breastfeeding and safe sleeping in this patient population.

Background: Patients with advanced lung disease who present with suspicious pulmonary nodules (SPNs) undergoing transthoracic needle aspiration pose a diagnostic challenge given risk for complications. Virtual bronchoscopic navigation (VBN) is an alternative means to biopsy patients. Study Design: The study was a retrospective chart review of all patients who underwent VBN with the Archimedes platform. Demographic information, radiographic evidence of parenchymal lung disease and pulmonary function testing were gathered. Peri-procedure complications and clinical data on biopsy results were gathered to assist in determining both adequate tissue sample (defined if adequate specimen was obtained as per pathology/cytology report) and diagnostic yield (defined as if after further testing/CT imaging from 1 year post-procedure the diagnosis did not change). Univariate analysis was performed to determine the impact of clinical factors on diagnostic yield. Results: Ninety-six patients with 110 nodules underwent VBN. Eight-eight patients (92%) had radiographic emphysema with 56% having moderate to severe. Fourteen patients (17%) had radiographic ILD. Adequate tissue sample at time of VBN was 93%. Overall diagnostic yield in 80 patients (excluding 16 patients who were initially benign/non-diagnostic that were lost to follow-up) was 72%. Overall complication rate was 7% with 1-pneumothorax (1%), 3-significant bleeding and 3-hospitalized for respiratory failure. Conclusion: In our cohort of patients the diagnostic yield and complication rate were comparable to other studies where there were fewer patients with advanced lung disease. This data suggests that VBN-guided bronchoscopic biopsy of SPNs is a viable diagnostic option with an acceptable safety profile.

No abstract

No abstract