Factors Associated With Diagnostic Error: An Analysis of Closed Medical Malpractice Claims.

Introduction: Missed and delayed diagnoses have received substantial attention as a quality and patient safety priority. To the extent that electronic health records, team-based care, and other mitigation strategies have been successful in improving diagnosis since the last large-scale study, we would expect that the contributing factors to diagnostic claims may have changed.

Methods: This study sought to examine paid medical malpractice claims as a proxy to identify contributing factors that reflect a clear diagnostic error.

Spatial environmental factors predict cardiovascular and all-cause mortality: Results of the SPACE study.

Background: Environmental exposures account for a growing proportion of global mortality. Large cohort studies are needed to characterize the independent impact of environmental exposures on mortality in low-income settings.

Methods: We collected data on individual and environmental risk factors for a multiethnic cohort of 50,045 individuals in a low-income region in Iran.

Primary Care Provider Density and Elective Total Joint Replacement Outcomes.

Background: Primary care physicians (PCPs) are often gatekeepers to specialist care. This study assessed the relationship between PCP density and total knee (TKA) and total hip arthroplasty (THA) outcomes.

Methods: We obtained patient-level data from an institutional registry on patients undergoing elective primary TKA and THA for osteoarthritis, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years.

Hospital readmission in systemic sclerosis associated pulmonary hypertension: Results from the PHAROS registry.

Objective: To identify individual-level factors associated with hospital readmission among individuals with SSc-associated pulmonary hypertension (SSc-PH).

Methods: Individuals enrolled in the Pulmonary Hypertension Assessment and Recognition of Outcomes in Scleroderma (PHAROS) registry contributed clinical data related to SSc-PH disease severity and hospital admissions. Readmission was defined as a subsequent hospitalization within 12 months of any hospital discharge.

Cardiovascular disease risk prediction for people with type 2 diabetes in a population-based cohort and in electronic health record data.

Objective: Electronic health records (EHRs) have become a common data source for clinical risk prediction, offering large sample sizes and frequently sampled metrics. There may be notable differences between hospital-based EHR and traditional cohort samples: EHR data often are not population-representative random samples, even for particular diseases, as they tend to be sicker with higher healthcare utilization, while cohort studies often sample healthier subjects who typically are more likely to participate. We investigate heterogeneities between EHR- and cohort-based inferences including incidence rates, risk factor identifications/quantifications, and absolute risks.

Relationship of soluble ST2 to pulmonary hypertension severity in patients undergoing cardiac resynchronization therapy.

Background: Pulmonary hypertension (PH) is an adverse prognostic marker in patients undergoing cardiac resynchronization therapy (CRT). We sought to determine the relation of biomarkers of fibrosis [soluble ST2 (sST2), galectin-3], wall stretch [amino terminal pro-brain natriuretic peptide (NT-proBNP)], and necrosis [high-sensitivity troponin-I (hsTnI)] to PH severity in CRT patients.

Methods: Biomarkers and right ventricular systolic pressure (RVSP) were measured at CRT implant and 6-month later (n=111).

Validation of the Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score Pain and Function Subscales for Use in Total Hip Replacement and Total Knee Replacement Clinical Trials.

Background: Total hip replacement (THR)/total knee replacement (TKR) studies do not uniformly measure patient centered domains, pain, and function. We aim to validate existing measures of pain and function within subscales of standard instruments to facilitate measurement.

Methods: We evaluated baseline and 2-year pain and function for THR and TKR using Hip disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), with primary unilateral TKR (4796) and THR (4801).

Left ventricular wall thickness assessed by cardiac computed tomography and cardiac resynchronization therapy outcomes.

Aims: Up to 30% of selected heart failure patients do not benefit clinically from cardiac resynchronization therapy (CRT). Left ventricular (LV) wall thickness (WT) analysed using computed tomography (CT) has rarely been evaluated in response to CRT and mitral regurgitation (MR) improvement. We examined the association of LVWT and the ability to reverse LV remodelling and MR improvement after CRT.

Impact of Aortomitral Continuity Calcification on Need for Permanent Pacemaker After Transcatheter Aortic Valve Replacement.

Background: By virtue of its proximity to structures vital to cardiac conduction, aortomitral continuity calcification (AMCC) may help identify patients at highest risk for developing atrioventricular conduction disease requiring permanent pacemaker implantation (PPMI). We aim to determine the association of AMCC and need for PPMI after transcatheter aortic valve replacement.

Methods: Of 614 patients who underwent transcatheter aortic valve replacement (11.

Utility of Computed Tomography to Predict Ventricular Arrhythmias in Patients With Nonischemic Cardiomyopathy Receiving Cardiac Resynchronization Therapy.

The residual risk of ventricular arrhythmia (VA) after cardiac resynchronization therapy (CRT) implantation in patients with nonischemic cardiomyopathy (NICM) remains difficult to evaluate. The impact of left ventricular (LV) wall thickness (WT) measured using computed tomography (CT) on the occurrence of VA after CRT implantation has never been investigated. In this pilot study, we examined the association of LV WT and the occurrence of VA in NICM patients receiving CRT.

PROMIS Computer Adaptive Tests and Their Correlation With Disease Activity in Juvenile Idiopathic Arthritis.

Background/objective: The importance of patient-reported outcomes, like the Patient-Reported Outcomes Measurement Information System (PROMIS) measures, is increasingly recognized both in clinical care and in research. While "short forms" have been studied in juvenile idiopathic arthritis (JIA), study of PROMIS computer adaptive tests (CATs) in JIA is limited. This cross-sectional study evaluates whether PROMIS CATs correlate with disease activity in patients with JIA.

Procalcitonin Differs in Children With Infection and Children With Disease Flares in Juvenile Idiopathic Arthritis.

Background/objective: Patients with juvenile idiopathic arthritis (JIA) often present with signs and symptoms suggestive of serious bacterial infection (SBI). Procalcitonin (PCT) is a biomarker that is elevated in SBI. We conducted a comparative cohort study to test the hypothesis that PCT levels will differ between active JIA, quiescent JIA, and bacteremic patients and healthy controls.

Performance of Dynamic Automated CT Annular Measurements Compared to Standard Manual Measurements for Transcatheter Aortic Valve Replacement Sizing.

Purpose: We sought to determine the performance of an automated computed tomography (CT) software that provides dynamic annular measurements of all available cardiac phases for transcatheter aortic valve replacement (TAVR) sizing as compared to the standard single manual measurement.

Materials And Methods: In 60 TAVR patients (84±7 years, 60% male) who underwent pre-procedural CT scans, we measured the aortic annular diameters, perimeter, and area using (1) the dynamic automated CT measurements and (2) standard single manual measurement from the cardiac phase of maximum systolic opening by visual estimate.

Results: The automated software was successful in providing annular measurements in 43/60 (72%) of cases, with the remainder requiring semi-automated contours.

Association of Traditional Chinese Medicine Use With Adherence to Prescribed Western Rheumatic Medications Among Chinese American Patients: A Cross-Sectional Survey.

Objective: Chinese Americans are a fast-growing immigrant group with worse rheumatic disease outcomes compared to white populations and frequently use traditional Chinese medicine (TCM). Whether TCM use is associated with lower adherence to Western rheumatic medications is unknown. The present study was undertaken to examine adherence to Western medications for systemic rheumatic diseases in the Chinese American immigrant population and its association with TCM use.

Racial Disparities in Total Knee Replacement Failure As Related to Poverty.

Objective: To determine whether racial disparities in total knee replacement (TKR) failure are explained by poverty.

Methods: Black and white New York state residents, enrolled in a prospective single-institution TKR registry January 1, 2008 to February 6, 2012, who underwent primary unilateral TKR (n = 4,062) were linked to the New York Statewide Planning and Research Cooperative System database (January 1, 2008 to December 31, 2014) to capture revisions performed at outside institutions. Patients were linked by geocoded addresses to residential census tracts.

Responsiveness of the Patient-Reported Outcomes Measurement Information System Global Health Short Form in Outpatients With Systemic Lupus Erythematosus.

Objective: To evaluate the longitudinal responsiveness (sensitivity to change) of the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Short Form (PROMIS10) in outpatients with systemic lupus erythematosus (SLE).

Methods: Outpatients with SLE who were receiving care at an academic medical center completed the PROMIS10 at 2 visits that were a minimum of 1 month apart. Responsiveness of the PROMIS10 global physical and mental health domains to Patient-Reported improvement or deterioration of health status was evaluated, as measured by standard validated instruments.

Is Traditional Chinese Medicine Use Associated with Worse Patient-reported Outcomes among Chinese American Rheumatology Patients?

Objective: Chinese Americans are a fast-growing immigrant group with more severe rheumatic disease manifestations than whites and often a strong cultural preference for traditional Chinese medicine (TCM). We aimed to examine TCM use patterns and association with patient-reported outcomes (PRO) among Chinese American rheumatology patients.

Methods: Chinese Americans actively treated for systemic rheumatic diseases were recruited from urban Chinatown rheumatology clinics.

Effect of Neprilysin Inhibition on Various Natriuretic Peptide Assays.

Background: With sacubitril/valsartan treatment, B-type natriuretic peptide (BNP) concentrations increase; it remains unclear whether change in BNP concentrations is similar across all assays for its measurement. Effects of sacubitril/valsartan on atrial natriuretic peptide (ANP) concentrations in patients are unknown. Lastly, the impact of neprilysin inhibition on mid-regional pro-ANP (MR-proANP), N-terminal pro-BNP (NT-proBNP), proBNP, or C-type natriuretic peptide (CNP) is not well understood.

Diagnosing Prosthetic Joint Infections in Patients With Inflammatory Arthritis: A Systematic Literature Review.

Background: Patients with inflammatory arthritis (IA) are at increased risk of prosthetic joint infections (PJI), yet differentiating between septic and aseptic failure is a challenge. The aim of our systematic review is to evaluate synovial biomarkers and their efficacy at diagnosing PJI in patients with IA.

Methods: A comprehensive literature search was performed in the following databases from inception to January 2018: Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library.

Histologic and Transcriptional Evidence of Subclinical Synovial Inflammation in Patients With Rheumatoid Arthritis in Clinical Remission.

Objective: Patients with rheumatoid arthritis (RA) in clinical remission may have subclinical synovial inflammation. This study was undertaken to determine the proportion of patients with RA in remission or with low disease activity at the time of arthroplasty who had histologic or transcriptional evidence of synovitis, and to identify clinical features that distinguished patients as having subclinical synovitis.

Methods: We compared Disease Activity Score in 28 joints (DAS28) to synovial histologic features in 135 patients with RA undergoing arthroplasty.

Living in immigrant communities does not impact total knee arthroplasty outcomes: experience from a high-volume center in the United States.

Background: Community characteristics such as poverty affect total knee arthroplasty (TKA) outcomes. However, it is unknown whether other community factors such as immigrant proportion (IP) also affect outcomes. Our objective was to determine the association of neighborhood IP on preoperative (pre-op) and 2-year postoperative (post-op) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function after elective TKA.