Introduction: Expanding on data concerning emergency department (ED) use and avoidance by the sexual minority (those who identify as lesbian, gay, bisexual, queer, other [LGTBQ+]) and gender minority (those who identify as transgender, gender nonconforming, other) community may inform future ED LGTBQ+ training and clinical practice. Investigation objectives included characterizing rates of emergency care avoidance, identifying barriers to emergency care, and assessing emergency care quality and cultural competency for sexual and gender minorities. Methods: In this population-based, cross-sectional needs assessment, sexual minority, gender minority, and/or cisgender heterosexual-identified participants were selected based on participants’ subscription to newsletters or social media accounts for One Colorado, an LGBTQ+ advocacy organization. Each participant completed a single digital survey that collected qualitative and quantitative data about ED perception, use, and demographics. Results: A total of 477 LGBTQ+ or heterosexual-identified individuals (mean age = 44.3 (standard deviation [SD] = 16.7)) participated in the study. Lifetime emergency care avoidance rates for gender minorities were markedly increased (odds ratio [OR] 3.8, 95% confidence interval [CI], 2.2 – 6.6; P <.001), while avoidance rates for sexual minorities were similar to those of cisgender heterosexual respondents (17% vs 14%; P <.001). Gender minorities were more likely than sexual minorities to both avoid emergency care due to fear of discrimination (43% vs 15%; P =.002) and to have experienced discrimination during their last ED visit (OR 11, [95% CI, 5–24]; P <.001). No significant differences were observed between participants in care avoidance due to financial reasons or prior negative experiences. No cited ED factors that influenced identity disclosure decisions were distinctly predictive. Conclusion: Gender minorities are more likely than sexual minorities and heterosexual cisgender individuals to report ED avoidance and discrimination at last ED visit. Future work characterizing deficits in LGBTQ+ ED care might reduce these avoidance and discrimination rates, enhancing the level of patient care provided to this population.
Preincision versus postincision frequent door openings during total joint arthroplasty.
Introduction: Idiopathic Pulmonary Arterial Hypertension (PH-Type I) and PH due to pulmonary disease (PH-Type III) arise from different pathophysiologic processes, yet they both culminate in increased right ventricular (RV) afterload and eventual RV failure. Previous work has demonstrated that 4D-Flow MRI-derived intracardiac vorticity (ω) correlates with markers of ventricular interdependency and diastolic dysfunction in PH. However, no investigation has attempted to use both ω and standard markers of ventricular function to phenotype PH subgroups. Hypothesis: 4D-Flow MRI can detect differences in diastolic dysfunction that make it possible to phenotype patients with Type I and Type III PH. Methods: Type I PH patients (n=12, mean age 61yrs), Type III PH patients (n=15, mean age 63yrs), and healthy controls (n=10, mean age 58yrs) underwent standard cardiac MRI as well as 4D-Flow MRI to determine RV intracardiac flow markers including early (ω-E) and late (ω-A) diastolic vorticity. Standard MRI-based RV and LV size and function markers were also collected. Results: ω-E was decreased in the Type I PH group compared to the Type III PH group (P=0.035) and to controls (P<0.001). There was no difference in ω-E between the Type III group and controls (P=0.216). RVEF was decreased in both the Type I (P<0.001) and Type III (P=0.012) group compared to controls. There was no difference in RVEF between the Type I and Type III groups (P=0.917). RVEDV was increased in both the Type I (P=0.008) and Type III (P=0.006) groups compared to controls. No significant differences were noted between groups when assessing (ω-A) and other RV or LV standard volume and functional indices. Conclusion: Our results indicate that 4D-Flow MRI can distinguish among different PH subtypes using intracardiac diastolic vorticity. Comparative studies with standard echocardiography and catheterization are necessary to assess the sensitivity of 4D-Flow MRI to detect diastolic dysfunction.
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