BACKGROUND:Access to specialized adult congenital heart disease (ACHD) care remains limited given workforce shortages and geographic concentration of accredited centers in urban regions. PROJECT RATIONALE:Southwest Florida lacked a board-certified ACHD specialist despite a growing population of adults with congenital heart disease. Patients frequently traveled long distances for subspecialty evaluation, contributing to delays in care, fragmented follow-up, and inequitable access to specialized services. PROJECT DESCRIPTION:A regional hub-and-spoke model was developed through collaboration between Lee Health and Memorial Healthcare System to expand access to ACHD expertise. The spoke site established a locally based ACHD clinic embedded within pediatric cardiology clinic and staffed by an advanced practice provider. ACHD physicians from the accredited hub center were credentialed within the local system and provided teleconsultation, telehealth support, weekly multidisciplinary conferences, and monthly onsite collaborative clinics. TAKE-HOME MESSAGES:Geographic and workforce disparities remain major barriers to equitable ACHD care. Hub-and-spoke models can extend specialized ACHD expertise into underserved regions.
Participation in sport can incur a risk of sport-related concussion (SRC). Media representation of SRC is frequently at odds with up-to-date scientific data. Our findings confirm a significant amount of false, confusing, or misleading terminology used in reporting on the topic, which is concerning as media is as a major source of SRC information. Individuals have a variable base of knowledge pertaining to this injury, and accurate understanding of SRC does not always correlate to appropriate action. Inaccurate portrayal of SRC media may contribute to the confusion surrounding it. Popular media presents an opportunity to convey evidence-based information on SRC.
This study aimed to examine the trends in the infant mortality rate (IMR) and the trends in the timing of death among periviable preterm infants at 22 to 24 weeks' gestational age (GA) in the United States from 2011 to 2020.Retrospective, serial cross-sectional analysis of periviable preterm infants born in the United States at 22 to 24 weeks' GA using the linked birth/infant death records from the Centers for Disease Control and Prevention. Data were analyzed from 2011 to 2020. The exposure was the year of death, and the outcome was the changes over time in the IMR and the timing of death. Further, we evaluated racial differences in the timing of death. We used nonparametric trend analysis to evaluate changes in mortality rate across the study period.The IMR was inversely related to GA, and for each GA and race/ethnicity, the IMR significantly declined during the study period. The IMR rate was highest in the first 7 days of life for all GAs and races/ethnicities. While Non-Hispanic White infants had a higher infant neonatal mortality rate than non-Hispanic Black infants, non-Hispanic Black infants had a higher postneonatal mortality rate.The IMR among periviable infants born at 22 to 24 weeks' GA improved for all GAs and races in the United States between 2011 and 2020. However, significant racial differences in the timing of death exist. · As expected, the IMR was inversely related to gestational age at 22 to 24 weeks.. · At each gestational age and for each racial/ethnic group, the overall IMR decreased during the study period.. · Non-Hispanic White infants had a higher neonatal mortality rate, whereas non-Hispanic Black infants had a higher postneonatal mortality rate..
To describe the impact on maternal and perinatal outcomes of the Delta variant of COVID-19 compared to the pre-Delta period in pregnant women with COVID-19 infections in one large public, non-profit hospital system. We conducted a retrospective chart review of identified COVID-19 diagnosed pregnant women with the outcome of pregnancy (livebirth or stillbirths). We assessed maternal and perinatal outcomes between the pre-delta and Delta variant time periods. A study cohort of 173 mother-baby dyads was identified from January 2020 to November 2021. Maternal outcomes showed a higher rate of cesarean section (33.8
Objective Studies exploring the relationship between neonatal abstinence syndrome (NAS) and congenital anomalies (CA) in the United States are limited given the small sample size or data prior to the opioid epidemic. We aimed to determine if there is an association between NAS and CA in a nationally representative cohort of newborn hospitalization in the United States. Study Design This was a cross-sectional analysis of NAS-related hospitalizations within the 2016 Kids Inpatient Database. International Classification of Diseases (ICD-10-CM) diagnostic codes were used to identify NAS hospitalizations and those with and without CA. The primary outcome was the odds of CAs in NAS hospitalizations. Multivariate survey logistic regression was used to analyze the relationship between NAS and CA. Results Among 3.7 million newborn hospitalizations, 25,394 had NAS (6.7 per 1,000). The prevalence of any CA was higher in those with NAS when compared with non-NAS hospitalizations (10.3 vs. 4.9%; odds ratio = 2.27; 95% confidence interval [CI]: 2.13-2.43). Adjusted analysis showed similar results (adjusted odds ratio: = 1.83, CI: 1.71-1.95). NAS hospitalizations with CA had a higher mortality rate (0.6 vs 0.04%, p < 0.0001) and higher resource use. Conclusion This nationwide study shows that NAS may be associated with increased odds of CAs, suggesting that NAS may be a risk factor for increased morbidity in the newborn period.
