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Ware OD, Hussong A, Frey JJ, Daughters S, Cloeren M, Gryczynski J, Lister JJ, Jordan R. Decreases in Employer Referrals to First-Time Substance Use Treatment for Adults From 2004 to 2020. J Occup Environ Med 2024; 66:e87-e92. [PMID: 38151983 DOI: 10.1097/jom.0000000000003027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The aim of the study is to examine trends of employer/employee assistance program referred admissions to outpatient substance use disorder (SUD) treatment in the United States. METHODS The publicly available Treatment Episode Data Set was used. Full-time employed adults with no history of SUD treatment referred to outpatient treatment by an employer/employee assistance program from 2004 to 2020 were included ( N = 36,142). Joinpoint regression examined admission trends. RESULTS Employer/employee assistance program referred admissions to outpatient treatment decreased annually by 6.4% from 2004 to 2020 ( P < 0.001). Joinpoint analyses identified 2 linear segments from 2004 to 2008 (increased but not significant) and from 2008 to 2020. From 2008 to 2020, an average annual percent decrease of 8.7% ( P < 0.001) was identified. CONCLUSIONS Findings from this repeated cross-sectional study suggest a missed opportunity for workplaces to serve as a potential SUD treatment access point.
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McCrary LM, Roberts KE, Bowman MC, Castillo B, Darling JM, Dunn C, Jordan R, Young JE, Schranz AJ. Inpatient Hepatitis C Treatment Coordination and Initiation for Patients Who Inject Drugs. J Gen Intern Med 2023; 38:3428-3433. [PMID: 37653211 PMCID: PMC10682347 DOI: 10.1007/s11606-023-08386-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND With hepatitis C (HCV) incidence rising due to injection drug use, people who inject drugs (PWID) are a priority population for direct-acting antivirals (DAA). However, significant barriers exist. At our institution, hospitalized PWID were screened for HCV but not effectively linked to care. AIM To improve retention in HCV care among hospitalized PWID. SETTING Quaternary academic center in the Southeast US from August 2021 through August 2022. PARTICIPANTS Hospitalized PWID with HCV. PROGRAM DESCRIPTION E-consultation-prompted care coordination and HCV treatment with outpatient telehealth. PROGRAM EVALUATION Care cascades were constructed to assess retention and HCV treatment, with the primary outcome defined as DAA completion or sustained virologic response after week 4. Of 28 patients, 11 started DAAs inpatient, 8 initiated outpatient, and 9 were lost to follow-up or transferred care. Overall, 82% were linked to care and 52% completed treatment. For inpatient initiators, 73% achieved the outcome. Of non-inpatient initiators, 71% were linked to care, 53% started treatment, and 36% achieved the outcome. DISCUSSION Inpatient HCV treatment coordination, including DAA initiation, and telehealth follow-up, was feasible and highly effective for hospitalized PWID. Future steps should address barriers to inpatient DAA treatment and expand this model to other similar patient populations.
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Hardie CM, Jordan R, Forker O, Fort-Schaale A, Wade RG, Jones J, Bourke G. Prevalence and risk factors for nerve injury following shoulder dislocation. Musculoskelet Surg 2023; 107:345-350. [PMID: 36445531 PMCID: PMC10432320 DOI: 10.1007/s12306-022-00769-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The glenohumeral joint dislocation can be associated with major nerve injury. The reported prevalence and risk factors for major nerve injury are variable and this injury can have a severe and life-long impact on the patient. The objectives of this study were to analyse the prevalence of major nerve injury following shoulder dislocation and examine risk factors. Management and outcomes of nerve injury were explored. METHODS A 1 year retrospective cohort study of 243 consecutive adults who presented with a shoulder dislocation was performed. Data were collected on patient demographics, timings of investigations, treatment, follow-up, and nerve injury prevalence and management. The primary outcome measure was prevalence of nerve injury. Risk factors for this were analysed using appropriate tests with Stata SE15.1. RESULTS Of 243 patients with shoulder dislocation, 14 (6%) had neurological deficit. Primary dislocation (p = 0.004) and older age (p = 0.02) were significantly associated with major nerve injury. Sex, time to successful reduction and force of injury were not associated with major nerve injury in this cohort. Patients with nerve injury made functional recovery to varying degrees. Recurrent shoulder dislocation was common accounting for 133/243 (55%) attendances. CONCLUSIONS Shoulder dislocation requires careful assessment and timely management in the ED. A 6% rate of nerve injury following shoulder dislocation was at the lower border of reported rates (5-55%), and primary dislocation and older age were identified as risk factors for nerve injury. We emphasise the importance of referring patients with suspected major nerve injury to specialist services.
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Madeline McCrary L, Roberts K, Jordan R, Bowman MC, Schranz AJ. 1244. Inpatient vs. outpatient initiation of Hepatitis C treatment among hospitalized patients who inject drugs: Lessons from a quality improvement project. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Hepatitis C (HCV) diagnoses are rising, driven by infections in people who inject drugs (PWID). PWID are identified as a target population for treatment, but access to care is a barrier. At our institution, Addiction Medicine (AM) and Infectious Diseases (ID) routinely screen hospitalized PWID for HCV. Our novel quality improvement project assessed feasibility of starting HCV care processes for PWID inpatient. This included: (1) inpatient e-consults, (2) inpatient treatment initiation with direct acting antivirals (DAAs) when possible, and (3) post-discharge telehealth care.
Methods
The project was implemented at an academic hospital in the Southeast in August 2021, with results observed through April 2022. Patients seen by AM consultants with detectable HCV RNA and interest in treatment were eligible. AM recommended ID e-consults focused on HCV care, which began care coordination, including inpatient treatment initiation in select cases (based primarily on length of stay) (Fig 1). The primary outcome was “likely cure,” defined as treatment completion or SVR-4 (chosen due to concerns for loss to follow up). Cascades of care were constructed including: (1) completed HCV e-consult; (2) linkage to care (defined as telehealth visit for those not initiating inpatient); (3) treatment initiation; and (4) likely cure. Figure 1:Workflow
Results
Twenty patients had detectable HCV RNA and all were interested in treatment. Enrolled patients had a mean age of 33 years; 9/20 (45%) were female; and 17/20 (85%) were White. Of 20 patients (Fig 2), 16 (80%) were linked to care with 13 (81%, 65% overall) started on HCV treatment, of which 9 were started inpatient. Likely cure was achieved for 7, and 6 were still on treatment at the time of this report (Fig 2). Likely cure has so far been achieved in 66% of inpatient initiators (6 of 9), compared with 18% of others (2 of 11) (Figs 3 and 4). 6 patients were lost to follow-up. None of those initiating DAAs inpatient were lost.
Conclusion
Inpatient initiation of HCV treatment for PWID was feasible for patients with prolonged hospitalizations and may be effective at facilitating HCV treatment and cure among a vulnerable population with substantial barriers to care. Future steps should address inpatient barriers to DAAs, and examine models of HCV telehealth.
Disclosures
Asher J. Schranz, MD, MPH, UnitedHealthCare: Honoraria.
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Suvá M, Bastón J, Arnold V, Wiedenmann E, Jordan R, Moro L, Vichera G. 20 Birth of myostatin-edited calf generated by cloning using CRISPR-Cas9 protein technology. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Mell L, Torres-Saavedra P, Wong S, Chang S, Kish J, Minn A, Jordan R, Liu T, Truong M, Winquist E, Wise-Draper T, Rodriguez C, Musaddiq A, Beadle B, Henson C, Narayan S, Spencer S, Harris J, Yom S. Radiotherapy with Durvalumab vs. Cetuximab in Patients with Locoregionally Advanced Head and Neck Cancer and a Contraindication to Cisplatin: Phase II Results of NRG-HN004. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Annis IE, Jordan R, Thomas KC. Quickly identifying people at risk of opioid use disorder in emergency departments: trade-offs between a machine learning approach and a simple EHR flag strategy. BMJ Open 2022; 12:e059414. [PMID: 36104124 PMCID: PMC9476155 DOI: 10.1136/bmjopen-2021-059414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Emergency departments (EDs) are an important point of contact for people with opioid use disorder (OUD). Universal screening for OUD is costly and often infeasible. Evidence on effective, selective screening is needed. We assessed the feasibility of using a risk factor-based machine learning model to identify OUD quickly among patients presenting in EDs. DESIGN/SETTINGS/PARTICIPANTS In this cohort study, all ED visits between January 2016 and March 2018 for patients aged 12 years and older were identified from electronic health records (EHRs) data from a large university health system. First, logistic regression modelling was used to describe and elucidate the associations between patient demographic and clinical characteristics and diagnosis of OUD. Second, a Gradient Boosting Classifier was applied to develop a predictive model to identify patients at risk of OUD. The predictive performance of the Gradient Boosting algorithm was assessed using F1 scores and area under the curve (AUC). OUTCOME The primary outcome was the diagnosis of OUD. RESULTS Among 345 728 patient ED visits (mean (SD) patient age, 49.4 (21.0) years; 210 045 (60.8%) female), 1.16% had a diagnosis of OUD. Bivariate analyses indicated that history of OUD was the strongest predictor of current OUD (OR=13.4, CI: 11.8 to 15.1). When history of OUD was excluded in multivariate models, baseline use of medications for OUD (OR=3.4, CI: 2.9 to 4.0) and white race (OR=2.9, CI: 2.6 to 3.3) were the strongest predictors. The best Gradient Boosting model achieved an AUC of 0.71, accuracy of 0.96 but only 0.45 sensitivity. CONCLUSIONS Patients who present at the ED with OUD are high-need patients who are typically smokers with psychiatric, chronic pain and substance use disorders. A machine learning model did not improve predictive ability. A quick review of a patient's EHR for history of OUD is an efficient strategy to identify those who are currently at greatest risk of OUD.
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Tariq F, Remtulla M, Jordan R. 174 An Audit on First Time Shoulder Dislocations: Are We Following BESS Guidelines? Br J Surg 2022. [DOI: 10.1093/bjs/znac039.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Traumatic shoulder dislocations are the most common joint dislocation in the UK. They are often associated with concurrent injury to the joint and its stabilisers which can occasionally get missed. This can severely affect functional recovery and lead to chronic instability. Our aim was to assess adherence to the BESS guidelines for first time shoulder dislocations in a large acute general hospital.
Method
We conducted a retrospective review of all patients who attended the emergency department at Birmingham Heartlands Hospital between January and December 2019. A total of 20 patients were selected after verifying data received from the health informatics team. Patient notes, investigations and clinic letters were reviewed.
Results
The average age of our cohort was 50 with a male to female ratio of 13:7. The cohort was divided into three groups depending on their age i.e.,16–25, 25–40 and >40. Although 85% were seen in a fracture clinic only 25% were seen by a consultant. It was noted that among all three groups only 40% of appropriate imaging was requested. In addition, only 50% were correctly referred to a shoulder surgeon or shoulder clinic to assess shoulder function, however most patients were seen by a physiotherapist.
Conclusions
We found a large number of concomitant injuries in those investigated for a first-time dislocation. We have therefore designed a pathway to ensure that all patients with a first-time shoulder dislocation are followed up in fracture clinic and appropriate investigations ordered in a timely manner.
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Garbutt JC, Kampov-Polevoy AB, Pedersen C, Stansbury M, Jordan R, Willing L, Gallop RJ. Efficacy and tolerability of baclofen in a U.S. community population with alcohol use disorder: a dose-response, randomized, controlled trial. Neuropsychopharmacology 2021; 46:2250-2256. [PMID: 34155332 PMCID: PMC8580979 DOI: 10.1038/s41386-021-01055-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023]
Abstract
Identification of new medications for alcohol use disorder (AUD) is important for improving treatment options. Baclofen, a GABAB agonist, has been identified as a potential pharmacotherapy for AUD. In a 16-week double-blind, randomized, placebo-controlled trial, we investigated 30 and 90 mg/day of baclofen compared to placebo and examined effects of dose, sex, and level of pretreatment drinking. One hundred and twenty participants with DSM-IV alcohol dependence (age 46.1 (sd = 10.1) years, 51.7% male) were randomized after exclusion for unstable medical/psychiatric illness and/or dependence on drugs other than nicotine. Seventy-three participants completed the trial. A main effect of baclofen was found [%HDD (F(2,112) = 4.16, p = 0.018, d = 0.51 95%CI (0.06-0.95), 13.6 fewer HDD) and %ABST (F(2,112) = 3.68, p = 0.028, d = 0.49 95%CI (0.04-0.93), 12.9 more abstinent days)] and was driven by the 90 mg/day dose. A sex × dose interaction effect was present for both %HDD (F(2,110) = 5.48, p = 0.005) and %ABST (F(2,110) = 3.19, p = 0.045). Men showed a marginally positive effect for 90 mg/day compared to PBO (%HDD t(110) = 1.88, p = 0.063, d = 0.36 95%CI (-0.09-0.80), 15.8 fewer HDD days; %ABST t(110) = 1.68 (p = 0.096, d = 0.32 95%CI (-0.12-0.76), 15.7 more ABST)) with no effect for 30 mg/day. Women showed a positive effect for 30 mg/day (%HDD, t(110) = 3.19, p = 0.002, d = 0.61 95%CI (0.16-1.05), 26.3 fewer HDD days; %ABST t(110) = 2.73, p = 0.007, d = 0.52 95%CI (0.07-0.96), 25.4 more ABST days) with marginal effects for 90 mg/day on %ABST (p = 0.06) with drop-outs/dose reduction from sedative side-effects of 59% in women at 90 mg/day compared to 5% for men. These findings support the hypothesis that baclofen has efficacy in AUD and suggest that dose and sex be further explored as potential moderators of baclofen response and tolerability.
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Gertner AK, Roberts KE, Bowen G, Pearson BL, Jordan R. Universal screening for substance use by Peer Support Specialists in the Emergency Department is a pathway to buprenorphine treatment. Addict Behav Rep 2021; 14:100378. [PMID: 34938837 PMCID: PMC8664965 DOI: 10.1016/j.abrep.2021.100378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Evidence suggests emergency department (ED)-initiated buprenorphine as efficacious in connecting ED patients to Medications for Opioid Use Disorder (MOUD) utilizing peer support specialists (PSS). However, there are no reports of implementation of ED-initiated buprenorphine in practice. Such information is crucial to support the adoption of ED-initiated buprenorphine. METHODS In this quality improvement pilot study, a PSS screened ED patients over age 18 with the Tobacco, Alcohol, Prescription medication, and other Substance use - 1 (TAPS-1). The PSS considered the patient a positive screen if the patient met the following criteria: risky weekly alcohol use, illicit drugs, or prescription drugs. For patients who screened positive, the PSS delivered a brief intervention and assessed interest in treatment. An ED clinician assessed patients who screened positive for heroin/opioid use and were interested in treatment for buprenorphine induction. RESULTS From January through June 2019, 1037 patients were screened for risky substance use, and, of these, 238 (23%) screened positive. The distribution of primary substance used was: 51% alcohol, 26% cannabis, 7.5% cocaine, 7.5% heroin, and 3.3% prescription opioids. Of the 23 patients who screened positive for heroin/opioid use and requested treatment, seven were admitted to the hospital. Of the remaining 16 patients, 14 patients wanted buprenorphine treatment, seven were provided buprenorphine in the ED, and four of these attended their intake appointments for community-based MOUD treatment. CONCLUSION ED-initiated buprenorphine facilitated by a PSS is feasible and requires coordination and planning. Approaches to ED-initiated buprenorphine that screen only for opioid use will miss many patients interested in substance use treatment.
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Stein R, Roberts K, Wilson L, Brason FW, Murrow S, Pearson B, Jordan R. The Need for Syringe Services Programs Escalates as Opioid Overdoses Surge in North Carolina. N C Med J 2021; 82:302-303. [PMID: 34230191 DOI: 10.18043/ncm.82.4.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fiacco L, Pearson BL, Jordan R. Telemedicine works for treating substance use disorder: The STAR clinic experience during COVID-19. J Subst Abuse Treat 2021; 125:108312. [PMID: 34016299 PMCID: PMC8561322 DOI: 10.1016/j.jsat.2021.108312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/28/2020] [Accepted: 01/19/2021] [Indexed: 11/09/2022]
Abstract
The coronavirus disease 2019 has exposed many opportunities for improvement in treatment for substance use disorders. Regulators can ensure higher quality treatment for addiction when acknowledging telemedicine as a necessary treatment option and amending regulations to allow for telehealth parity across the United States.
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Pitchika V, Jordan R, Micheelis W, Welk A, Kocher T, Holtfreter B. Impact of Powered Toothbrush Use and Interdental Cleaning on Oral Health. J Dent Res 2020; 100:487-495. [PMID: 33213272 PMCID: PMC8058831 DOI: 10.1177/0022034520973952] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The long-term effectiveness of powered toothbrushes (PTBs) and interdental cleaning aids (IDAs) on a population level is unproven. We evaluated to what extent changes in PTB and IDA use may explain changes in periodontitis, caries, and tooth loss over the course of 17 y using data for adults (35 to 44 y) and seniors (65 to 74 y) from 3 independent cross-sectional surveys of the German Oral Health Studies (DMS). Oaxaca decomposition analyses assessed to what extent changes in mean probing depth (PD), number of caries-free surfaces, and number of teeth between 1) DMS III and DMS V and 2) DMS IV and DMS V could be explained by changes in PTB and IDA use. Between DMS III and V, PTB (adults: 33.5%; seniors: 28.5%) and IDA use (adults: 32.5%; seniors: 41.4%) increased along with an increase in mean PD, number of caries-free surfaces, and number of teeth. Among adults, IDA use contributed toward increased number of teeth between DMS III and V as well as DMS IV and V. In general, the estimates for adults were of lower magnitude. Among seniors between DMS III and V, PTB and IDA use explained a significant amount of explained change in the number of caries-free surfaces (1.72 and 5.80 out of 8.44, respectively) and the number of teeth (0.49 and 1.25 out of 2.19, respectively). Between DMS IV and V, PTB and IDA use contributed most of the explained change in caries-free surfaces (0.85 and 1.61 out of 2.72, respectively) and the number of teeth (0.25 and 0.46 out of 0.94, respectively) among seniors. In contrast to reported results from short-term clinical studies, in the long run, both PTB and IDA use contributed to increased number of caries-free healthy surfaces and teeth in both adults and seniors.
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Simon J, Clayton A, Kingsberg S, Portman D, Jordan R, Lucas J, Williams L, Krop J. 038 Effect Size of Bremelanotide Treatment in the Phase 3 RECONNECT Studies. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kingsberg S, Portman D, Clayton A, Revicki D, Jordan R, Sadiq A, Williams L, Krop J. 011 Correlation Between Validated Instruments Used in the RECONNECT Studies. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kingsberg S, Clayton A, Portman D, Jordan R, Revicki D, Williams L, Krop J. 012 Bremelanotide Treatment Provided Clinically Meaningful Benefits in Premenopausal Women With Hypoactive Sexual Desire Disorder. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Forsythe A, Lewis G, Jordan R, Thompson GR. US database study: burden and healthcare resource utilization in adults with systemic endemic mycoses and aspergillosis. J Comp Eff Res 2020; 9:573-584. [PMID: 32316748 DOI: 10.2217/cer-2020-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Aim: This study evaluated burden of illness in immunocompromised patients with systemic mycoses (SM) eligible for itraconazole treatment, specifically, histoplasmosis, blastomycosis and aspergillosis. Methods: A cross-sectional study used an electronic medical record network integrating information from 30 US hospitals, including >34 million patients, to evaluate burden and healthcare resource utilization over 6 months following initiation of antifungal therapy. Results: Symptomatic burden experienced by each of the otherwise healthy or age >65 or immunosuppressed cohorts receiving antifungal therapy for SM was comparable but significantly greater in cancer or HIV patients and transplant recipients. Across groups, there was substantially higher healthcare resource utilization in patients with SM versus matched controls without SM. Conclusion: The total impact of SM is particularly severe in high-risk or vulnerable populations.
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Schwendicke F, Krois J, Jordan R. Can We Predict Usage of Dental Services? An Analysis from Germany 2000 to 2015. JDR Clin Trans Res 2020; 5:349-357. [PMID: 32023133 PMCID: PMC7495688 DOI: 10.1177/2380084420904928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES We aimed to predict the usage of dental services in Germany from 2000 to 2015 based on epidemiologic and demographic data, and to compare these predictions against claims within the statutory health insurance. METHODS Indicators for operative (number of coronally decayed or filled teeth, root surface caries lesions, and fillings), prosthetic (number of missing teeth), and periodontal treatment needs (number of teeth with probing pocket depths (PPDs) ≥ 4 mm) from nationally representative German Oral Health Studies (1997, 2005, 2014) were cross-sectionally interpolated across age and time, and combined with year- and age-specific population estimates. These, as well as the number of children eligible for individual preventive services (aged 6 to 17 y), were adjusted for age- and time-specific insurance status and services' utilization to yield predicted usage of operative, prosthetic, periodontal, and preventive services. Cumulative annual usage in these 4 services groups were compared against aggregations of a total of 24 claims positions from the statutory German health insurance. RESULTS Morbidity, utilization, and demography were highly dynamic across age groups and over time. Despite improvements of individual oral health, predicted usage of dental services did not decrease over time, but increased mainly due to usage shifts from younger (shrinking) to older (growing) age groups. Predicted usage of operative services increased between 2000 and 2015 (from 52 million to 56 million, +7.8%); predictions largely agreed with claimed services (root mean square error [RMSE] 1.9 million services, error range -4.6/+3.8%). Prosthetic services increased (from 2.4 million to 2.6 million, +11.9%), with near perfect agreement to claimed data [RMSE 0.1 million services, error range -8.3/+3.9%]). Periodontal services also increased (from 21 million to 27 million, +25.9%; RMSE 5.2 million services, error range +21.9/+36.5%), as did preventive services (from 22 million to 27 million, +20.4%; RMSE 3 million, error range -13.7/-4.7%). CONCLUSION Predicting dental services seems viable when accounting for the joint dynamics of morbidity, utilization, and demographics. KNOWLEDGE TRANSFER STATEMENT Based on epidemiologic and demographic data, predicting usage of certain dental services is viable when accounting for the dynamics of morbidity, utilization, and demographics.
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Simon J, Clayton A, Kingsberg S, Portman D, Jordan R, Williams L, Krop J. 194 Effect Size of Bremelanotide Treatment in the Phase 3 RECONNECT Studies. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yom S, Torres-Saavedra P, Caudell J, Waldron J, Gillison M, Truong M, Jordan R, Subramaniam R, Yao M, Chung C, Geiger J, Chan J, O'Sullivan B, Blakaj D, Mell L, Thorstad W, Jones C, Banerjee R, Lominska C, Le Q. NRG-HN002: A Randomized Phase II Trial for Patients With p16-Positive, Non-Smoking-Associated, Locoregionally Advanced Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.08.038] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koochaki P, Revicki D, Wilson H, Pokrzywinski R, Jordan R, Lucas J. 080 Women’s Experiences With Bremelanotide Administered, On Demand, for the Treatment of Hypoactive Sexual Desire Disorder. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Clayton A, Simon J, Kingsberg S, Jordan R, Lucas J, Williams L, Krop J. 029 Bremelanotide for Hypoactive Sexual Desire Disorders in the RECONNECT Studies: Analysis of Baseline Free Testosterone Level Quartile Subgroups. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.03.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Clayton A, Kingsberg S, DeRogatis L, Simon J, Jordan R, Lucas J. 138 Bremelanotide for Hypoactive Sexual Desire Disorder in the RECONNECT Study: Analysis of Co-Primary Endpoints According to Baseline FSFI Total Scores. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yoon JY, Sigel K, Martin J, Jordan R, Beasley MB, Smith C, Kaufman A, Wisnivesky J, Kim MK. Evaluation of the Prognostic Significance of TNM Staging Guidelines in Lung Carcinoid Tumors. J Thorac Oncol 2018; 14:184-192. [PMID: 30414942 DOI: 10.1016/j.jtho.2018.10.166] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/09/2018] [Accepted: 10/18/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The TNM classification for lung cancer, originally designed for NSCLC, is applied to staging of bronchopulmonary carcinoid tumors. The validity of the eighth edition of the staging system for carcinoid tumors has not been assessed. In this study, we evaluated its prognostic accuracy by using data from a large national population-based cancer registry. METHODS Patients with typical and atypical bronchopulmonary carcinoids diagnosed between 2000 and 2013 were identified from the National Cancer Institute's Surveillance, Epidemiology and End Results registry. We used competing risks analysis to compare 10-year disease-specific survival (DSS) across stages. RESULTS Overall, 4645 patients with bronchopulmonary carcinoid tumors were identified. Worsening DSS with increasing TNM status and stage was demonstrated across both typical and atypical carcinoids, with overlaps between adjacent subcategories. The combined stages (I versus II, II versus III, and III versus IV) showed greater separation in DSS despite persistent overlaps between groups. For typical carcinoids, we found decreased DSS for stages II, III, and IV, with hazard ratios of 3.8 (95% confidence interval [CI]: 2.6-5.6), 4.3 (95% CI: 3.0-6.1), and 9.0 (95% CI: 6.1-13.1), respectively, compared with stage I. CONCLUSION The combined stage categories of the eighth edition of the TNM staging system provide useful information on outcomes for typical and atypical carcinoids. However, persistent overlaps in combined stage and subcategories of the staging system limit the usefulness of the TNM staging system, particularly in intermediate stages. These limitations suggest the need for future further study and refinement.
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Espinel D, Jordan R, Pinoni V, Martinez J, Verbanaz S, giorgio P, Eusebio M, Navarro K, Bustos A, Becker V, Giovanakis M, Heine A, Efron E. A prospective study on active surveillance of bacterial colonization in oncohaematological patients and its association with bacteraemias. Int J Infect Dis 2018. [DOI: 10.1016/j.ijid.2018.04.3484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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