Validation of a Retrospective Computing Model for Mortality Risk in the Intensive Care Unit.

Objective: To compare the predictive performance of Epic Systems Corporation's proprietary intensive care unit (ICU) mortality risk model (IMRM) with that of the Acute Physiology and Chronic Health Evaluation (APACHE) IV score.

Methods: This is a retrospective cohort study of patients treated from January 1, 2008, through January 1, 2018. This single-center study was performed at Mayo Clinic (Rochester, MN), a tertiary care teaching and referral center.

Disseminated infection in a left ventricular assist device recipient.

A 51-year-old man with a medical history of coronary artery disease and dyslipidaemia presented with acute myocardial infarction resulting in cardiogenic shock, necessitating intra-aortic balloon pump placement and extracorporeal membrane oxygenation (ECMO). His hospital course was complicated by several infectious complications including ECMO circuit bloodstream infection and presumed infected right atrial thrombus. He subsequently underwent urgent left ventricular assist device placement and had a prolonged hospital stay.

Clinical Presentation, Management, and Outcomes of Cardiovascular Implantable Electronic Device Infections Due to Gram-Negative Versus Gram-Positive Bacteria.

Objective: To describe and compare the clinical presentation, management, and outcomes of cardiovascular implantable electronic device (CIED) infections due to gram-negative bacteria (GNB) and CIED infections due to gram-positive bacteria (GPB).

Patients And Methods: We retrospectively reviewed all CIED infection cases at Mayo Clinic from January 1, 1992, through December 31, 2015. Cases were classified based on positive microbiology data from extracted devices or blood cultures.

Pre-travel counseling for immunocompromised travelers: A 12-year single-center retrospective review.

Background: Immunocompromised travelers (ICTs) are medically complex and challenging for travel medicine providers. Our study hypothesizes that ICTs have high-risk travel itineraries and do not have adequate immunity against vaccine-preventable infections.

Methods: This retrospective review of 321 ICTs from 2004 to 2015 included patients with solid organ transplant (SOT, n = 134), connective tissue disease (CTD, n = 121), inflammatory bowel disease (IBD, n = 46), and human immunodeficiency virus (HIV, n = 20).

Impact of pre-travel consultation on clinical management and outcomes of travelers' diarrhea: a retrospective cohort study.

Background: International travelers are at high risk of acquiring travelers' diarrhea. Pre-travel consultation has been associated with lower rates of malaria, hepatitis, and human immunodeficiency virus (HIV) infections. The objective was to study the impact of pre-travel consultation on clinical management and outcomes of travelers' diarrhea.

Efficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism: A Systematic Review and Meta-analysis of Cases, 1923-2016.

Background: Botulism is a rare, potentially severe illness, often fatal if not appropriately treated. Data on treatment are sparse. We systematically evaluated the literature on botulinum antitoxin and other treatments.

Diabetes Mellitus Management Among Patients with Limited English Proficiency: A Systematic Review and Meta-Analysis.

Background: Patients with limited English proficiency (LEP) and type 2 diabetes mellitus (T2DM) have several health disparities, including suboptimal patient-provider interactions, poorer glycemic control, and T2DM complications. Understanding existing interventions for improving T2DM outcomes in this population is critical for reducing disparities.

Methods: We performed a systematic review of randomized controlled trials (RCTs) and observational studies examining the effectiveness of interventions in improving T2DM outcomes among patients with LEP in North America.

Impacts of a care process model and inpatient electrophysiology service on cardiovascular implantable electronic device infections: a preliminary evaluation.

Purpose: Cardiovascular implantable electronic device infection (CIEDI) rates are rising. To improve outcomes, our institution developed an online care process model (CPM) and a specialized inpatient heart rhythm service (HRS).

Methods: This retrospective review compared hospital length of stay (LOS), mortality, and times to subspecialty consultation and procedures before and after CPM and HRS availability.

Incidence and Effects of Seasonality on Nonpurulent Lower Extremity Cellulitis After the Emergence of Community-Acquired Methicillin-Resistant Staphylococcus aureus.

Nonpurulent lower extremity cellulitis (NLEC) is a common clinical diagnosis, with β-hemolytic streptococci and Staphylococcus aureus considered to be the most frequent causes. In 1999, the US Public Health Service alerted clinicians to the presence of community-acquired methicillin-resistant S aureus (CA-MRSA) infections in 4 children in the upper Midwest. Since then, it has become a well-recognized cause of skin and soft-tissue infections, in particular, skin abscess.

Mycobacterium iranicum septic arthritis and tenosynovitis.

is a newly reported nontuberculous mycobacterial (NTM) species that has been previously isolated in twelve patients. Our report presents the thirteenth known case of , which caused septic arthritis of the right third proximal interphalangeal joint and associated tenosynovitis in a 39-year-old female following a rose thorn injury.

Outcomes in Patients With Cardiovascular Implantable Electronic Device Infection Managed With Chronic Antibiotic Suppression.

Background.: Most cardiovascular implantable electronic device (CIED) recipients are elderly, have multiple comorbid conditions, and are at increased risk of CIED infection (CIEDI). Current guidelines recommend complete device removal in patients with CIEDI to prevent relapse and mortality.

High Rates of Diabetes Mellitus, Pre-diabetes and Obesity Among Somali Immigrants and Refugees in Minnesota: A Retrospective Chart Review.

We examined the prevalence of cardiovascular risk factors among Somali refugees at a midwestern hospital in the U.S. This was a retrospective cohort study of 1007 adult Somali patients and an age and frequency-matched cohort of non-Somali patients actively empanelled to a large, academic primary care practice network in the Midwest United States between January 1, 2011 and December 31, 2012.

Assessment and improvement of HIV screening rates in a Midwest primary care practice using an electronic clinical decision support system: a quality improvement study.

Background: Universal human immunodeficiency virus (HIV) screening remains low in many clinical practices despite published guidelines recommending screening for all patients between ages 13-65. Electronic clinical decision support tools have improved screening rates for many chronic diseases. We designed a quality improvement project to improve the rate of universal HIV screening of adult patients in a Midwest primary care practice using a clinical decision support tool.

Poststernotomy Osteomyelitis Presenting with Severe Sepsis and Rhabdomyolysis.

A 39-year-old male, who recently underwent a composite valve graft of the aortic root and ascending aorta for bicuspid aortic valve and aortic root aneurysm, was hospitalized for severe sepsis, rhabdomyolysis (creatine kinase 29000 U/L), and severe liver dysfunction (AST > 7000 U/L, ALT 4228 U/L, and INR > 10). Cardiac magnetic resonance imaging (MRI) findings were consistent with sternal osteomyelitis with a 1.5 cm abscess at the inferior sternotomy margin, which was contiguous with pericardial thickening.

Is Abnormal Urine Protein/Osmolality Ratio Associated with Abnormal Renal Function in Patients Receiving Tenofovir Disoproxil Fumarate?

Background: Risk factors for and optimal surveillance of renal dysfunction in patients on tenofovir disoproxil fumarate (TDF) remain unclear. We investigated whether a urine protein-osmolality (P/O) ratio would be associated with renal dysfunction in HIV-infected persons on TDF.

Methods: This retrospective, single-center study investigated the relationship between parameters of renal function (estimated glomerular filtration rate (eGFR) and P/O-ratio) and risk factors for development of kidney dysfunction.

Mycobacterium avium intracellulare complex causing olecranon bursitis and prosthetic joint infection in an immunocompromised host.

Case: A 73-year-old immunocompromised male presented with recurrent left elbow swelling due to complex (MAC) olecranon bursitis. 3 years after completing MAC treatment, he underwent right total knee arthroplasty (TKA). 1 year later, he developed TKA pain and swelling and was diagnosed with MAC prosthetic joint infection (PJI).

Fever and Cardiac Arrest in a Patient With a Left Ventricular Assist Device.

A 68-year-old avid deer hunter with ischemic cardiomyopathy underwent left ventricular assist device (LVAD) implantation for destination therapy two years ago. He was living an active lifestyle, tracking deer and fishing in a Midwestern forest in November. His wife removed an engorged tick on his thorax.

Diagnostic Challenge in a Patient with Severe Anion Gap Metabolic Acidosis.

The approach to the patient with acute renal failure and elevated anion and osmolal gap is difficult. Differential diagnoses include toxic alcohol ingestion, diabetic or starvation ketoacidosis, or 5-oxoproline acidosis. We present a 76-year-old female with type 2 diabetes mellitus, who was found at home in a confused state.

Necrotising pyomyositis complicating intramuscular antipsychotic administration.

A 26-year-old woman with paranoid schizophrenia was admitted to the medical intensive care unit with septic shock requiring intubation and mechanical ventilation. The source of septic shock was not identified despite obtaining CT of the chest/abdomen/pelvis, bronchoalveolar lavage and microbiological results for tracheal secretions, blood, urine and cervix. An indium-111 tagged white cell count scan was subsequently performed, revealing increased right anterior deltoid uptake.