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Huang CY, Lai CY, Reeves KD, Lam KHS, Li TY, Cheng CI, Wu YT. Volume Effect of Nerve Hydrodissection for Carpal Tunnel Syndrome: A Prospective, Randomized, and Single-Blind Study. J Ultrasound Med 2024; 43:161-169. [PMID: 37873682 DOI: 10.1002/jum.16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES This study compared ultrasound-guided nerve hydrodissection (HD) outcomes using two commonly used injectate volumes (10 and 5 mL) of normal saline to explore if there is a volume effect of HD for patients with moderate carpal tunnel syndrome (CTS). METHODS Twenty-four participants were randomly assigned to treatment with HD using ultrasound-guidance and either 10 mL or 5 mL of normal saline (HD-10 and HD-5 groups respectively). Our primary outcome measures were the change scores of the two subscales of the Boston Carpal Tunnel Syndrome Questionnaire: The Symptom Severity Scale (SSS) and Functional Status Scale (FSS). We conducted a one-way repeated analysis of variance for 3 time points (4, 12, and 24 weeks) for both SSS and FSS, respectively, for change scores from time 0, and percentage change from time 0. RESULTS All participants (n = 12 per group) completed the study. From 0 to 24 weeks the HD-10 group outperformed the HD-5 group for improvement in SSS (median ± IQR; -0.8 ± 0.4 versus -0.5 ± 0.5; P = .024) and FSS scores (mean ± SD; -0.8 ± 0.2 versus -0.5 ± 0.5; P = .011). The HD-10 group improvement in FSS subtest significantly exceeded the MCID percentage-change-based threshold of 27% (34%; P = .039). CONCLUSIONS Despite the limitations of small study size, a largely inert injectate, and a single injection approach, these findings in favor of the 10 mL group suggest that the volume used for ultrasound-guided HD in moderate CTS matters, and a higher volume is more effective.
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Affiliation(s)
- Chien-Yao Huang
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
| | - Chia-Ying Lai
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
| | | | - King Hei Stanley Lam
- The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong
- Department of Family Medicine, The Chinese University of Hong Kong, Hong Kong
- Department of Family Medicine, The University of Hong Kong, Hong Kong
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsung-Ying Li
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI, USA
| | - Yung-Tsan Wu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Centers, Taipei, Taiwan
- Integrated Pain Management Center, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Research and Development, School of Medicine, National Defense Medical Center, Taipei, Taiwan
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Hiltzik DM, Cin MD, Hamama BA, Pawl CJ, Haley HR, Cheng CI, Taha TA. Comparison of Pelvic Landmarks for Leg Length Discrepancy Measurement With Robotic Arm-Assisted Total Hip Arthroplasty. Arthroplast Today 2023; 24:101252. [PMID: 38023649 PMCID: PMC10665703 DOI: 10.1016/j.artd.2023.101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/03/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Leg length discrepancy (LLD) is a common complication after total hip arthroplasty (THA) leading to significant morbidity and dissatisfaction for patients. A popular system for robotic arm-assisted THA utilizes preoperative computed tomography (CT) scans for surgical planning. Accurate measurement of leg length is crucial for restoring appropriate patient anatomy during the procedure. This study investigates the interobserver and interlandmark reliability of 3 different pelvic landmarks for measuring preoperative LLD. Methods We compiled preoperative pelvic CT scans from 99 robotic arm-assisted THAs for osteoarthritis. Radiologic leg length measurement was performed using the robotic arm-assisted THA application by 2 orthopaedic residents using reference lines bisecting the following pelvic landmarks: the anterior superior iliac spines, acetabular teardrops, and most inferior aspect of the ischial rami. Results On multivariate analysis, there was no significant difference found (P value = .924) for leg length measurement based on the 3 different pelvic anatomical landmarks. Leg length measurements showed interobserver reliability with significant Pearson correlation coefficients (r = 1.0, 0.94, 0.96, respectively) and nonsignificant differences in LLD means between subjects on paired sample (P value = .158, .085, 0.125, respectively) as well as between landmarks on pairwise comparison. Conclusions The 3 pelvic landmarks used in this study can be used interchangeably with the lesser trochanter as the femoral reference point to evaluate preoperative LLD on pelvic CT in patients undergoing robotic-arm assisted THA. This study is the first of its kind to evaluate the interobserver and interlandmark reliability of anatomical landmarks on pelvic CT scans and suggests interchangeability of 3 pelvic landmarks for comparing leg length differences.
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Affiliation(s)
- David M. Hiltzik
- Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Mitchell D. Cin
- Central Michigan University College of Medicine, Saginaw, MI, USA
| | | | - Caleb J. Pawl
- Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Henry R. Haley
- Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Chin-I Cheng
- Central Michigan University Statistical Consulting Center, Mt Pleasant, MI, USA
| | - Tarek A. Taha
- Ascension Michigan St. Mary’s Hospital, Orthopedics and Sports Medicine, Saginaw, MI, USA
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Soni A, Yekula A, Dahiya DS, Sundararajan R, Dutta P, Singh Y, Cheng CI, Abraham G. Influence of nonalcoholic fatty liver disease on inflammatory bowel disease hospitalizations in the United States. Ann Gastroenterol 2023; 36:646-653. [PMID: 38023970 PMCID: PMC10662065 DOI: 10.20524/aog.2023.0839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background The reported prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with inflammatory bowel disease (IBD) is 32%. We assessed the influence of NAFLD on IBD hospitalizations in the United States (US). Methods We utilized the National Inpatient Sample database, from 2016-2019, to identify the total IBD hospitalizations in the US and we further subdivided them according to the presence or absence of NAFLD. Hospitalization characteristics, comorbidities and outcomes were compared. Statistical significance was set at P<0.05. Results There were 1,272,260 IBD hospitalizations in the US, of which 5.04% involved NAFLD. For IBD hospitalizations with NAFLD, the mean age was 50-64 years, and the proportion of males was 46.97%. IBD hospitalizations with NAFLD had a lower proportion of African Americans (8.7% vs. 11.38%, P<0.001). Comorbidities such as hypertension (50.34% vs. 44.04%, P<0.001) and obesity (18.77% vs. 11.81%, P<0.001) were significantly higher in the NAFLD cohort. Overall, based on the Charlson Comorbidity Index, patients with NAFLD had a higher number of comorbidities (52.77% vs. 20.66%, P<0.001). Mortality was higher in the NAFLD compared to the non-NAFLD cohort (3.14% vs. 1.44%, P<0.001). Patients with NAFLD also incurred significantly higher hospital charges ($69,536 vs. $55,467, p<0.001) and had a longer mean length of stay (6.10 vs. 5.27 days, P<0.001) compared to the cohort without NAFLD. Complications and inpatient procedure requirements were also higher in the NAFLD cohort. Conclusion Our study revealed greater mortality, morbidity, and healthcare resource utilization in patients with IBD who were hospitalized with a concomitant diagnosis of NAFLD.
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Affiliation(s)
- Aakriti Soni
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (Aakriti Soni, Anuroop Yekula, Yuvaraj Singh, George Abraham)
| | - Anuroop Yekula
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (Aakriti Soni, Anuroop Yekula, Yuvaraj Singh, George Abraham)
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI (Dushyant Singh Dahiya)
| | - Ramaswamy Sundararajan
- Department of Gastroenterology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (Ramaswamy Sundararajan)
| | - Priyata Dutta
- Department of Internal Medicine, Trinity Health, Ann Arbor, MI (Priyata Dutta)
| | - Yuvaraj Singh
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (Aakriti Soni, Anuroop Yekula, Yuvaraj Singh, George Abraham)
| | - Chin-I Cheng
- Department of Statistics, Actuarial, and Data Science, Central Michigan University, Mt. Pleasant, MI (Chin-I Cheng)
| | - George Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA (Aakriti Soni, Anuroop Yekula, Yuvaraj Singh, George Abraham)
- Department of Infectious Diseases, Saint Vincent Hospital, Worcester, MA (George Abraham), USA
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Harrison TE, Bowler J, Cheng CI, Reeves KD. Optimizing Platelet-Rich Plasma: Spin Time and Sample Source. Bioengineering (Basel) 2023; 10:1270. [PMID: 38002394 PMCID: PMC10669393 DOI: 10.3390/bioengineering10111270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
The buff-colored layer separating the plasma from red blood cells (RBCs) in centrifuged blood was named the "buffy coat" in the late 19th century. The division of platelets (PLTs) and leukocytes (WBCs) between the buffy coat, plasma, and RBC layers in centrifuged blood has not been described before. In this study, we centrifuged 8.5 mL anticoagulated blood samples at 1000× g for 1, 2, 3, 5, 10, and 20 min. We then divided each sample into ten layers and analyzed each layer for cellular composition and mean platelet volume (MPV). Our results show that even after 20 min of centrifugation, about 15% of platelets remain in the plasma layers and 65% in the RBC layers. We found that the platelet count achieved from aspiration of 1 mL volume was optimal, with aspiration beginning 1/2 mL below the buffy coat and extending 1/2 mL above the buffy coat rather than beginning at the buffy coat itself and aspirating only plasma. Using this method of aspiration, we found that the total platelet count means reached a maximum in the 1 mL around the buffy coat after only 5 min of centrifugation.
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Affiliation(s)
| | | | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI 48859, USA;
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Sanaka KO, Dahiya D, Chaaban N, Cheng CI, Xu B. Contemporary Outcomes and Predictors of Inpatient Mortality for Infective Endocarditis Occurring in Renal Transplant Recipients in the United States. Am J Cardiol 2023; 203:55-63. [PMID: 37481813 DOI: 10.1016/j.amjcard.2023.06.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/25/2023]
Abstract
Renal transplant (RT) recipients are susceptible to infections because of immunosuppression. The literature regarding the epidemiology and outcomes of infective endocarditis (IE) in RT recipients is limited. We analyzed the National Inpatient Sample in the United States to study IE in RT and identify risk factors for inpatient mortality and IE development in RT patients. All patients ≥18 years who had IE with and without RT between 2007 and 2019 were identified from the National Inpatient Sample. The demographics, co-morbidities, length of stay, hospital costs, and mortality of IE patients with RT were compared with IE patients without RT. Predictors of inpatient mortality for RT recipients with IE were analyzed. Between 2007 and 2019, there were 777,245 hospitalizations for IE, of which 3,782 had RT. The IE in RT cohort was younger than the general IE population and had higher proportions of males, non-White races, and Hispanic ethnicity, and higher burden of co-morbidities, but similar inpatient mortality rates. On multivariate analysis, Staphylococcal IE (adjusted odds ratio [aOR] 2.26, 95% confidence interval [CI] 1.2 to 4.3, p = 0.015), stroke (aOR 6.4, 95% CI 2.7 to 15.3, p <0.001), anemia (aOR 2.3, 95% CI 1.3 to 4.0, p = 0.004), and shock (aOR 6.3, 95% CI 3.3 to 11.9, p <0.001) were associated with greater inpatient mortality, whereas Streptococcal endocarditis (aOR 0.37, 95% CI 0.1 to 0.9, p = 0.038) was associated with lower inpatient mortality. In conclusion, RT patients with IE were younger and had more severe co-morbidities compared with IE patients without RT. Staphylococcal IE, presence of shock and stroke worsened the prognosis in these patients.
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Affiliation(s)
- Krishna O Sanaka
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dushyant Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, Michigan
| | - Nourhan Chaaban
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Sciences, Central Michigan University, Mount Pleasant, Michigan
| | - Bo Xu
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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Dahiya DS, Jahagirdar V, Chandan S, Gangwani MK, Merza N, Ali H, Deliwala S, Aziz M, Ramai D, Pinnam BSM, Bapaye J, Cheng CI, Inamdar S, Sharma NR, Al-Haddad M. Acute pancreatitis in liver transplant hospitalizations: Identifying national trends, clinical outcomes and healthcare burden in the United States. World J Hepatol 2023; 15:797-812. [PMID: 37397932 PMCID: PMC10308289 DOI: 10.4254/wjh.v15.i6.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/19/2023] [Accepted: 05/06/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Acute pancreatitis (AP) in liver transplant (LT) recipients may lead to poor clinical outcomes and development of severe complications.
AIM We aimed to assess national trends, clinical outcomes, and the healthcare burden of LT hospitalizations with AP in the United States (US).
METHODS The National Inpatient Sample was utilized to identify all adult (≥ 18 years old) LT hospitalizations with AP in the US from 2007–2019. Non-LT AP hospitalizations served as controls for comparative analysis. National trends of hospitalization characteristics, clinical outcomes, complications, and healthcare burden for LT hospitalizations with AP were highlighted. Hospitalization characteristics, clinical outcomes, complications, and healthcare burden were also compared between the LT and non-LT cohorts. Furthermore, predictors of inpatient mortality for LT hospitalizations with AP were identified. All P values ≤ 0.05 were considered statistically significant.
RESULTS The total number of LT hospitalizations with AP increased from 305 in 2007 to 610 in 2019. There was a rising trend of Hispanic (16.5% in 2007 to 21.1% in 2018, P-trend = 0.0009) and Asian (4.3% in 2007 to 7.4% in 2019, p-trend = 0.0002) LT hospitalizations with AP, while a decline was noted for Blacks (11% in 2007 to 8.3% in 2019, P-trend = 0.0004). Furthermore, LT hospitalizations with AP had an increasing comorbidity burden as the Charlson Comorbidity Index (CCI) score ≥ 3 increased from 41.64% in 2007 to 62.30% in 2019 (P-trend < 0.0001). We did not find statistically significant trends in inpatient mortality, mean length of stay (LOS), and mean total healthcare charge (THC) for LT hospitalizations with AP despite rising trends of complications such as sepsis, acute kidney failure (AKF), acute respiratory failure (ARF), abdominal abscesses, portal vein thrombosis (PVT), and venous thromboembolism (VTE). Between 2007–2019, 6863 LT hospitalizations with AP were compared to 5649980 non-LT AP hospitalizations. LT hospitalizations with AP were slightly older (53.5 vs 52.6 years, P = 0.017) and had a higher proportion of patients with CCI ≥ 3 (51.5% vs 19.8%, P < 0.0001) compared to the non-LT cohort. Additionally, LT hospitalizations with AP had a higher proportion of Whites (67.9% vs 64.6%, P < 0.0001) and Asians (4% vs 2.3%, P < 0.0001), while the non-LT cohort had a higher proportion of Blacks and Hispanics. Interestingly, LT hospitalizations with AP had lower inpatient mortality (1.37% vs 2.16%, P = 0.0479) compared to the non-LT cohort despite having a higher mean age, CCI scores, and complications such as AKF, PVT, VTE, and the need for blood transfusion. However, LT hospitalizations with AP had a higher mean THC ($59596 vs $50466, P = 0.0429) than the non-LT cohort.
CONCLUSION In the US, LT hospitalizations with AP were on the rise, particularly for Hispanics and Asians. However, LT hospitalizations with AP had lower inpatient mortality compared to non-LT AP hospitalizations.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI 48601, United States
| | - Vinay Jahagirdar
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, United States
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE 68131, United States
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States
| | - Nooraldin Merza
- Department of Internal Medicine, The University of Toledo, Toledo, OH 43606, United States
| | - Hassam Ali
- Department of Internal Medicine, East Carolina University, Greenville, NC 27858, United States
| | - Smit Deliwala
- Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, The University of Toledo, Toledo, OH 43606, United States
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, The University of Utah School of Medicine, Salt Lake City, UT 84112, United States
| | - Bhanu Siva Mohan Pinnam
- Department of Internal Medicine, John H. Stroger Hospital of Cook County, Chicago, IL 60612, United States
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, United States
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI 48859, United States
| | - Sumant Inamdar
- Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
| | - Neil R Sharma
- Interventional Oncology and Surgical Endoscopy Programs, Parkview Cancer Institute, Fort Wayne, IN 46845, United States
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
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Dahiya DS, Nivedita F, Perisetti A, Goyal H, Inamdar S, Gangwani MK, Aziz M, Ali H, Cheng CI, Sanaka MR, Al-Haddad M, Sharma NR. Clinical Outcomes and Complications for Achalasia Patients Admitted After Per-Oral Endoscopic Myotomy. Gastroenterology Res 2023; 16:141-148. [PMID: 37351078 PMCID: PMC10284641 DOI: 10.14740/gr1617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/13/2023] [Indexed: 06/24/2023] Open
Abstract
Background Per-oral endoscopic myotomy (POEM) is a rapidly emerging minimally invasive procedure for management of achalasia. Same-day discharge after POEM is safe and feasible; however, some patients may need hospitalization. We aimed to identify characteristics and outcomes for achalasia patients requiring hospitalizations after POEM in the United States (US). Methods The US National Inpatient Sample was utilized to identify all adult achalasia patients who were admitted after POEM from 2016 to 2019. Hospitalization characteristics and clinical outcomes were highlighted. Results From 2016 to 2019, we found that 1,885 achalasia patients were admitted after POEM. There was an increase in the total number of hospitalizations after POEM from 380 in 2016 to 490 in 2019. The mean age increased from 54.2 years in 2016 to 59.3 years in 2019. Most POEM-related hospitalizations were for the 65 - 79 age group (31.8%), females (50.4%), and Whites (68.4%). A majority (56.2%) of the study population had a Charlson Comorbidity Index of 0. The Northeast hospital region had the highest number of POEM-related hospitalizations. Most of these patients (88.3%) were eventually discharged home. There was no inpatient mortality. The mean length of stay decreased from 4 days in 2016 to 3.2 days in 2019, while the mean total healthcare charge increased from $52,057 in 2016 to $65,109 in 2019. Esophageal perforation was the most common complication seen in 1.3% of patients. Conclusion The number of achalasia patients needing hospitalization after POEM increased. There was no inpatient mortality conferring an excellent safety profile of this procedure.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Fnu Nivedita
- Section of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School and UT Health Sciences Center at UT Health Houston, Houston, TX, USA
| | - Abhilash Perisetti
- Division of Gastroenterology and Hepatology, Kansas Veterans Affairs Medical Centre, Kansas City, MO, USA
| | - Hemant Goyal
- Section of Endoluminal Surgery and Interventional Gastroenterology, McGovern Medical School and UT Health Sciences Center at UT Health Houston, Houston, TX, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, The University of Toledo Medical Center, Toledo, OH, USA
| | - Hassam Ali
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI, USA
| | - Madhusudhan R. Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Neil R. Sharma
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
- Interventional Oncology & Surgical Endoscopy Programs (IOSE), Parkview Health, Fort Wayne, IN, USA
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Effiong U, Umana I, Haley H, Garcia J, Cheng CI, Ragina N, Eruo F. Acceptance, Intent, Hesitance, and Attitudes Towards SAR-CoV-2 Vaccines Among Healthcare Workers in Michigan, USA. Cureus 2023; 15:e41225. [PMID: 37525763 PMCID: PMC10387375 DOI: 10.7759/cureus.41225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are critical infrastructure workers for whom COVID-19 vaccination was prioritized. It is believed that healthcare workers would have little or no hesitancy to take the COVID-19 vaccines given the risks of the pandemic to them, their families, and their patients. OBJECTIVE The study aims to understand the acceptance and attitudes toward COVID-19 vaccines among the HCWs in Michigan. METHODS A cross-sectional survey was fielded from January 11, 2021, through February 28, 2021. We obtained a representative sample of HCWs at MidMichigan Health. The participants were approximately 1500 clinical and non-clinical HCWs. COVID-19 vaccination acceptance and the intent to be vaccinated were measured with a questionnaire. HCWs indicating hesitance were asked to enter their reasons for hesitance as a free text response. RESULTS A total of 1,467 HCWs responded to the survey. Overall, 62% indicated they had received both shots; 19.7% reported that they had received the first shot and would take the second; 2.3% noted that they were yet to receive the vaccine but would take both shots; 0.4% reported that they had received the first shot but would not take the second; 5.7% noted that they were unsure; and 9.9% indicated they did not intend to take the vaccine. Factors associated with vaccine hesitance included being female, younger age, having administrative staff or other health workers, having a larger household size, and having received no vaccines in the past year. Vaccine hesitancy concerns included safety, efficacy, antivaccine beliefs, the need for additional information, and a lack of trust. CONCLUSION This survey revealed that 16% of HCWs in central and northern Michigan were hesitant about COVID-19 vaccines. Vaccine education is needed to increase the acceptance of COVID-19 vaccines among HCWs.
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Affiliation(s)
- Utibe Effiong
- Internal Medicine, Central Michigan University (CMU) College of Medicine, Mt. Pleasant, USA
| | - Ifiok Umana
- Urology Division, Jos University Teaching Hospital, Jos, NGA
| | - Henry Haley
- Internal Medicine, Central Michigan University (CMU) College of Medicine, Mt. Pleasant, USA
| | | | - Chin-I Cheng
- Statistics, Central Michigan University (CMU) College of Medicine, Mt. Pleasant, USA
| | - Neli Ragina
- Medical Discipline, Central Michigan University (CMU) College of Medicine, Mt. Pleasant, USA
| | - Frederick Eruo
- Obstetrics and Gynecology, Northeast Ohio Medical University, Rootstown, USA
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Dahiya DS, Perisetti A, Goyal H, Inamdar S, Singh A, Garg R, Cheng CI, Al-Haddad M, Sanaka MR, Sharma N. Endoscopic versus surgical management for colonic volvulus hospitalizations in the United States. Clin Endosc 2023:ce.2022.166. [PMID: 37070205 DOI: 10.5946/ce.2022.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/16/2022] [Indexed: 04/19/2023] Open
Abstract
Background/Aims Colonic volvulus (CV), a common cause of bowel obstruction, often requires intervention. We aimed to identify hospitalization trends and CV outcomes in the United States. Methods We used the National Inpatient Sample to identify all adult CV hospitalizations in the United States from 2007 to 2017. Patient demographics, comorbidities, and inpatient outcomes were highlighted. Outcomes of endoscopic and surgical management were compared. Results Between 2007 and 2017, there were 220,666 CV hospitalizations. CV-related hospitalizations increased from 17,888 in 2007 to 21,715 in 2017 (p=0.001). However, inpatient mortality decreased from 7.6% in 2007 to 6.2% in 2017 (p<0.001). Of all CV-related hospitalizations, 13,745 underwent endoscopic intervention, and 77,157 underwent surgery. Although the endoscopic cohort had patients with a higher Charlson comorbidity index, we noted lower inpatient mortality (6.1% vs. 7.0%, p<0.001), mean length of stay (8.3 vs. 11.8 days, p<0.001), and mean total healthcare charge ($68,126 vs. $106,703, p<0.001) compared to the surgical cohort. Male sex, increased Charlson comorbidity index scores, acute kidney injury, and malnutrition were associated with higher odds of inpatient mortality in patients with CV who underwent endoscopic management. Conclusions Endoscopic intervention has lower inpatient mortality and is an excellent alternative to surgery for appropriately selected CV hospitalizations.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Abhilash Perisetti
- Department of Gastroenterology, Parkview Cancer Institute, Fort Wayne, IN, USA
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, PA, USA
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Neil Sharma
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, USA
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10
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Rain MZ, Cremat D, Cheng CI, McClintock A, Perzhinsky J. Retrospectively evaluating trends in opioid prescriptions and medication-assisted treatment in a mid-Michigan region. J Opioid Manag 2023; 19:117-132. [PMID: 37270419 DOI: 10.5055/jom.2023.0766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate opioid prescribing and monitoring trends for musculoskeletal (MSK) conditions and the use of medication-assisted treatment (MAT) for opioid-related disorders in mid-Michigan. DESIGN Retrospective chart review of 500 randomly selected charts coded for MSK conditions and opioid-related disorders based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes during the time frame of January 1 to June 30, 2019. Data were compared to baseline data collected in a previous 2016 study to evaluate prescribing trends. SETTING Outpatient clinics and emergency departments. MAIN OUTCOME MEASURES Variables included prescription of opioid, nonopioid, use of prescription monitoring such as assessing urine drug screens (UDSs), a Prescription Drug Monitoring Program (PDMP), pain agreements, prescription of MAT, and sociodemographic factors. RESULTS 31.3 percent of patients in 2019 had a new or current opioid prescription, which is a significant decrease compared to opioid prescriptions in 2016 (65.7 percent) (p = 0.001). Monitoring of opioid prescribing using PDMP and pain agreements increased, whereas UDS monitoring remained low. MAT prescribing for patients with opioid use disorder in 2019 was 31.4 percent. State-sponsored insurance was associated with a higher odds of using PDMP and pain agreements with an odds ratio (OR) of 1.72 (0.97, 3.13), while alcohol misuse had a lower odds of using PDMP (OR 0.40). CONCLUSION Opioid prescribing guidelines have been effective in reducing opioid prescribing and increasing opioid prescription monitoring. MAT prescribing is low in 2019 and does not reflect a declining trend of opioid prescriptions during a public health crisis.
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Affiliation(s)
- Mariam Zunnu Rain
- Central Michigan (CMU) College of Medicine, Mt. Pleasant, Michigan. ORCID: https://orcid.org/0000-0002-4679-5991
| | - Danielle Cremat
- Central Michigan (CMU) College of Medicine, Mt. Pleasant, Michigan. ORCID: https://orcid.org/0000-0001-9710-5375
| | - Chin-I Cheng
- CMU Department of Statistics, Actuarial and Data Sciences, Mt. Pleasant, Michigan. ORCID: https://orcid.org/0000-0002-0273-8135
| | - Alyson McClintock
- CMU College of Health Professions, Mt. Pleasant, Michigan. ORCID: https://orcid.org/0000-0002-4996-9782
| | - Juliette Perzhinsky
- CMU College of Medicine, Mt. Pleasant, Michigan. ORCID: https://orcid.org/0000-0002-9739-8881
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Sanaka K, Dahiya D, Chaaban N, Cheng CI, Xu B. CONTEMPORARY OUTCOMES AND PREDICTORS OF INPATIENT MORTALITY FOR INFECTIVE ENDOCARDITIS OCCURRING IN RENAL TRANSPLANT RECIPIENTS: A NATIONAL INPATIENT SAMPLE DATABASE STUDY FROM THE UNITED STATES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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12
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Dahiya DS, Sharma NR, Perisetti A, Singh A, Chandan S, Pisipati S, Gangwani MK, Garg R, Aggarwal M, Vennikandam M, Cheng CI, Ali H, Inamdar S, Sanaka M, Al-Haddad M. The Influence of Obesity on Acute Pancreatitis Hospitalizations: Does Body Mass Index Matter? Pancreas 2023; 52:e171-e178. [PMID: 37716011 DOI: 10.1097/mpa.0000000000002243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
OBJECTIVE To identify the influence of body mass index (BMI) on Acute Pancreatitis (AP) hospitalizations in the United States (US). METHODS The National Inpatient Sample was utilized to identify normal weight, overweight and obese AP hospitalizations in the US from 2016-2019 based on BMI. Hospitalization characteristics and outcomes were compared. RESULTS Between 2016-2019, there were 314,215 (74.7%) obese, 27,005 (6.4%) overweight and 79,380 (18.9%) normal weight AP hospitalizations. Obese AP hospitalizations were younger (51.5 vs 56.5 years, p < 0.0001) compared to the normal weight cohort. However, normal weight AP hospitalizations had a higher proportion of Blacks and Asians compared to the obese subgroup. We also noted a higher all-cause inpatient mortality for normal weight AP hospitalizations (3.4% vs 2.8% vs 1.8%, p < 0.0001) compared to the overweight and obese cohorts, respectively. Furthermore, normal weight AP hospitalizations had a higher proportion of patients with pancreatic pseudocyst formation and pancreatic necrosis compared to the overweight and obese cohorts. The mean length of stay (5.8 vs 8.2 days, p < 0.0001) and mean total healthcare costs ($66,742 vs $82,319, p < 0.0001) were lower for obese compared to normal weight AP hospitalizations. CONCLUSIONS Normal weight AP hospitalizations had higher inpatient mortality and complications compared to obese hospitalizations.
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Affiliation(s)
- Dushyant Singh Dahiya
- From the Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, KS
| | - Neil R Sharma
- Interventional Oncology and Surgical Endoscopy Programs, GI Oncology Tumor Site Team, Parkview Cancer Institute, Parkview Health, Fort Wayne, IN
| | - Abhilash Perisetti
- Division of Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, Kansas City, MO
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE
| | - Sailaja Pisipati
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | | | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | - Manik Aggarwal
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Madhu Vennikandam
- Department of Gastroenterology and Hepatology, Sparrow Hospital/Michigan State University College of Human Medicine, Lansing, MI
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI
| | - Hassam Ali
- Department of Internal Medicine, East Carolina University/Brody School of Medicine, Greenville, NC
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Madhusudhan Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN
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13
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Dahiya DS, Mandoorah S, Gangwani MK, Ali H, Merza N, Aziz M, Singh A, Perisetti A, Garg R, Cheng CI, Dutta P, Inamdar S, Sanaka MR, Al-Haddad M. A Comparative Analysis of Bleeding Peptic Ulcers in Hospitalizations With and Without End-Stage Renal Disease. Gastroenterology Res 2023; 16:17-24. [PMID: 36895703 PMCID: PMC9990529 DOI: 10.14740/gr1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/11/2023] Open
Abstract
Background End-stage renal disease (ESRD) patients are highly susceptible to peptic ulcer bleeding (PUB). We aimed to assess the influence of ESRD status on PUB hospitalizations in the United States (USA). Methods We analyzed the National Inpatient Sample to identify all adult PUB hospitalizations in the USA from 2007 to 2014, which were divided into two subgroups based on the presence or absence of ESRD. Hospitalization characteristics and clinical outcomes were compared. Furthermore, predictors of inpatient mortality for PUB hospitalizations with ESRD were identified. Results Between 2007 and 2014, there were 351,965 PUB hospitalizations with ESRD compared to 2,037,037 non-ESRD PUB hospitalizations. PUB ESRD hospitalizations had a higher mean age (71.6 vs. 63.6 years, P < 0.001), and proportion of ethnic minorities i.e., Blacks, Hispanics, and Asians compared to the non-ESRD cohort. We also noted higher all-cause inpatient mortality (5.4% vs. 2.6%, P < 0.001), rates of esophagogastroduodenoscopy (EGD) (20.7% vs. 19.1%, P < 0.001), and mean length of stay (LOS) (8.2 vs. 6 days, P < 0.001) for PUB ESRD hospitalizations compared to the non-ESRD cohort. After multivariate logistic regression analysis, Whites with ESRD had higher odds of mortality from PUB compared to Blacks. Furthermore, the odds of inpatient mortality from PUB decreased by 0.6% for every 1-year increase in age for hospitalizations with ESRD. Compared to the 2011 - 2014 study period, the 2007 - 2010 period had 43.7% higher odds (odds ratio (OR): 0.696, 95% confidence interval (CI): 0.645 - 0.751) of inpatient mortality for PUB hospitalizations with ESRD. Conclusions PUB hospitalizations with ESRD had higher inpatient mortality, EGD utilization, and mean LOS compared to non-ESRD PUB hospitalizations.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.,These authors contributed equally to this article
| | - Sohaib Mandoorah
- Division of Pulmonary and Critical Care Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.,These authors contributed equally to this article
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Hassam Ali
- Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| | - Nooraldin Merza
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, The University of Toledo Medical Center, Toledo, OH, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abhilash Perisetti
- Division of Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, Kansas City, MO, USA
| | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI, USA
| | - Priyata Dutta
- Department of Internal Medicine, Trinity Health, Ann Arbor, MI, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine Indianapolis, IN, USA
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14
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Blebea J, Jain K, Cheng CI, Pittman C, Daugherty S. Expected changes in physician outpatient interventional practices as a result of coronavirus disease 2019 and recent changes in Medicare physician fee schedule. J Vasc Surg Venous Lymphat Disord 2023; 11:1-9.e4. [PMID: 36179786 PMCID: PMC9514954 DOI: 10.1016/j.jvsv.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/22/2022] [Accepted: 08/18/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We examined the economic and practice effects of the coronavirus disease 2019 (COVID-19) pandemic and decreased Medicare physician payments on outpatient vascular interventional procedures. METHODS A 21-point survey was constructed and sent electronically to the physician members of the Outpatient Endovascular and Interventional Society and the American Vein and Lymphatic Society. The survey responses were converted to a Likert scale and statistical analyses performed to examine the associations between the response variables and the characteristics and practice patterns of the physician respondents. RESULTS A total of 165 physicians responded to the survey, of whom 33% were vascular surgeons, 18% were radiologists, and 15% were general surgeons. For slightly more than one half (55%), their interventional practice was limited to the office setting, with the remainder also performing procedures in an office-based laboratory (OBL), ambulatory surgery center (ASC), or hospital. Almost all respondents had performed superficial venous interventions, with slightly more than one third also performing either deep venous procedures and/or peripheral arterial interventions. The COVID-19 pandemic had affected 98% of the practices, with a staff shortage reported by 63%. The most-established physicians, those with the longest interval since training completion, were the least likely to have experienced staff shortages. Almost all (94%) the respondents expected that the recent Medicare payment changes will have a negative effect on their practice. Physicians with only an office-based practice were less likely to add a physician associate compared with those with an OBL (P = .036). More than one quarter reported that it was likely they would close or sell their interventional practice in the next 2 years and 43% reported they were planning to retire early. The anticipated ameliorative responses to the decreased Medicare physician payments included adding wound care (24%) or other clinical services (36%) to their practices, with the alternatives considered more by younger physicians (P = .002) and nonsurgeons (P = .047). Only 10% expected to convert their practices to an ASC or hybrid ASC/OBL (16%). CONCLUSIONS The emotional and economic effects of the COVID-19 pandemic and the decreased Medicare physician reimbursement rates for vascular outpatient interventionalists have been significant. Even greater challenges for the financial viability of office practices and OBLs can be expected in the near future if additional further planned cuts are put into effect.
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Affiliation(s)
- John Blebea
- Department of Surgery, College of Medicine, Central Michigan University, Saginaw, MI.
| | - Krishna Jain
- Department of Surgery, Homer Stryker MD School of Medicine, Western Michigan University, Kalamazoo, MI
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI
| | - Chris Pittman
- Department of Radiology, Morsani College of Medicine, University of South Florida, Tampa, FL
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15
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Dahiya DS, Perisetti A, Sharma N, Inamdar S, Goyal H, Singh A, Rotundo L, Garg R, Cheng CI, Pisipati S, Al-Haddad M, Sanaka M. Racial disparities in endoscopic retrograde cholangiopancreatography (ERCP) utilization in the United States: are we getting better? Surg Endosc 2023; 37:421-433. [PMID: 35986223 DOI: 10.1007/s00464-022-09535-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/04/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND We identified trends of inpatient therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in the United States (US), focusing on outcomes related to specific patient demographics. METHODS The National Inpatient Sample was utilized to identify all adult inpatient ERCP in the US between 2007-2018. Trends of utilization and adverse outcomes were highlighted. P-values ≤ 0.05 were considered statistically significant. RESULTS We noted a rising trend for total inpatient ERCP in the US from 126,921 in 2007 to 165,555 in 2018 (p = 0.0004), with a significant increase in utilization for Blacks, Hispanics, and Asians. Despite an increasing comorbidity burden [Charlson Comorbidity Index (CCI) score ≥ 2], the overall inpatient mortality declined from 1.56% [2007] to 1.46% [2018] without a statistically significant trend (p = 0.14). Moreover, there was a rising trend of inpatient mortality for Black and Hispanic populations, while a decline was noted for Asians. After a comparative analysis, we noted higher rates of inpatient mortality for Blacks (2.4% vs 1.82%, p = 0.0112) and Hispanics (1.17% vs 0.83%, p = 0.0052) at urban teaching hospitals between July toand September compared to the October to June study period; however, we did not find a statistically significant difference for the Asian cohort (1.9% vs 2.10%, p = 0.56). The mean length of stay (LOS) decreased from 7 days in 2007 to 6 days in 2018 (p < 0.0001), while the mean total hospital charge (THC) increased from $48,883 in 2007 to $85,909 in 2018 (p < 0.0001) for inpatient ERCPs. Compared to the 2015-2018 study period, we noted higher rates of post-ERCP pancreatitis (27.76% vs 17.25%, p < 0.0001) from 2007-2014. CONCLUSION Therapeutic ERCP utilization and inpatient mortality were on the rise for a subset of the American minority population, including Black and Hispanics.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.
| | | | - Neil Sharma
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, USA.,Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, PA, USA.,Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Laura Rotundo
- Section of Digestive Diseases, Yale New Haven Hospital, New Haven, CT, USA
| | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI, USA
| | - Sailaja Pisipati
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Mohammad Al-Haddad
- Division Chief and Professor of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Madhusudhan Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
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Sahyoun L, Dahiya DS, Cheng CI, Sultan K. Letter: fighting the battle but losing the war-inflammatory bowel disease and venous thromboembolism. Aliment Pharmacol Ther 2022; 56:1425-1426. [PMID: 36221159 DOI: 10.1111/apt.17203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Laura Sahyoun
- Department of Digestive Diseases, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine East Campus, Mount Pleasant, Michigan, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial, and Data Science, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Keith Sultan
- Zucker School of Medicine at Hofstra/Northwell, Division of Gastroenterology, North Shore University Hospital, Manhasset, and Long Island Jewish Medical Center, Queens, New York, USA
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17
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Dahiya DS, Jahagirdar V, Gangwani MK, Aziz M, Cheng CI, Inamdar S, Sanaka MR, Al-Haddad M. Peroral endoscopic myotomy versus Heller's myotomy for achalasia hospitalizations in the United States: what does the future hold? Clin Endosc 2022; 55:826-828. [PMID: 36464831 PMCID: PMC9726431 DOI: 10.5946/ce.2022.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA,Correspondence: Dushyant Singh Dahiya Department of Internal Medicine, Central Michigan University College of Medicine, 1000 Houghton Ave, Saginaw, MI 48603, USA E-mail:
| | - Vinay Jahagirdar
- Department of Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Manesh Kumar Gangwani
- Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA
| | - Muhammad Aziz
- Department of Gastroenterology, The University of Toledo Medical Center, Toledo, OH, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Madhusudhan R. Sanaka
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
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18
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Dahiya DS, Inamdar S, Perisetti A, Goyal H, Singh A, Garg R, Cheng CI, Kichloo A, Al-Haddad M, Sharma N. The Conundrum of Obesity and Gastroparesis Hospitalizations: A Retrospective Comparative Analysis of Hospitalization Characteristics and Disparities Amongst Socioeconomic and Racial Backgrounds in the United States. J Neurogastroenterol Motil 2022; 28:655-663. [PMID: 36250372 PMCID: PMC9577565 DOI: 10.5056/jnm21232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 12/24/2022] Open
Abstract
Background/Aims We aim to assess the influence of obesity on gastroparesis (GP) hospitalizations in the United States (US). Methods The National Inpatient Sample was analyzed from 2007-2017 to identify all adult hospitalizations with a primary discharge diagnosis of GP. They were subdivided based on the presence or absence of obesity (body mass index > 30). Hospitalization characteristics, procedural differences, all-cause inpatient mortality, mean length of stay (LOS), and mean total hospital charge (THC) were identified and compared. Results From 2007-2017, there were 140 293 obese GP hospitalizations accounting for 13.75% of all GP hospitalizations in the US. Obese GP hospitalizations were predominantly female (76.11% vs 64.36%, P < 0.001) and slightly older (51.9 years vs 50.8 years, P < 0.001) compared to the non-obese cohort. Racial disparities were noted as Blacks (25.49% vs 22%, P < 0.001) had higher proportions of GP hospitalizations with obesity compared to the non-obese cohort. Furthermore, we noted higher rates of inpatient upper endoscopy utilization (6.05% vs 5.42%, P < 0.001), longer mean LOS (5.71 days vs 5.32 days, P < 0.001), and higher mean THC ($53 373 vs $45 040, P < 0.001) for obese GP hospitalizations compared to the non-obese group. However, obese GP hospitalizations had lower rates of inpatient mortality (0.92% vs 1.33%, P < 0.001), and need for nutritional support with endoscopic jejunostomy (0.25 vs 0.56%, P < 0.001) and total parenteral nutrition (1.46% vs 2.33%, P < 0.001) compared to the non-obese cohort. Conclusions In the US, compared to non-obese, a higher proportion of obese GP hospitalizations were female and Blacks. Obese GP hospitalizations also had higher THC, LOS, and rates of upper endoscopy.
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Affiliation(s)
- Dushyant S Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, PA, USA.,Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Chin-I Cheng
- Central Michigan University College of Science and Engineering, Mt Pleasant, MI, USA
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Neil Sharma
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.,Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, USA
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Pawl C, Hong A, McClintock A, Cheng CI, Perzhinsky J. Michigan Marijuana Legalization: Correlations Among Cannabis Use, Mental Health, and Other Factors. Cureus 2022; 14:e27510. [PMID: 36060373 PMCID: PMC9426715 DOI: 10.7759/cureus.27510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction: There are health implications with the statewide legalization of recreational marijuana that are still not fully understood and require further examination. This study evaluates the prevalence of marijuana use in patients being treated for a variety of conditions and whether correlations exist between marijuana use, mental health conditions, and concomitant use of psychotropic medications. Methods: Data were collected from an electronic medical record (EMR) as part of a retrospective chart audit. A total of 500 charts were reviewed during a six-month timeframe from December 1, 2018 to May 31, 2019 with the start date approximating the timing of when marijuana became recreationally legalized in the State of Michigan. Results: This study demonstrated a point prevalence of 15.8% since 79 of the 500 charts reviewed had marijuana use documented. Additionally, marijuana users were more likely to have a history of cocaine use, schizophrenia, antipsychotic use, and tobacco use. Conclusion: Trends identified in this study provide a comparison point for the local prevalence of marijuana use immediately post state-wide legalization, with a projected increasing trend due to the removal of legal barriers.
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Pinnamaneni M, Payne L, Jackson J, Cheng CI, Cascio MA. Disparities in Chronic Physical Health Conditions in Sexual and Gender Minority People using the United States Behavioral Risk Factor Surveillance System. Prev Med Rep 2022; 28:101881. [PMID: 35855927 PMCID: PMC9287429 DOI: 10.1016/j.pmedr.2022.101881] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 06/27/2022] [Accepted: 07/01/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Lauren Payne
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Jordan Jackson
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Chin-I Cheng
- Central Michigan University, Department of Statistics, Actuarial and Data Science, Mt. Pleasant, MI, USA
| | - M. Ariel Cascio
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
- Corresponding author at: Central Michigan University College of Medicine, Foust 127, 600 East Preston Street, Mt. Pleasant, MI 48859, USA.
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Wang V, Liu SE, Fuller R, Cheng CI, Ragina N. Discerning Fact From Fiction: An Assessment of Coronavirus-19 Misinformation Among Patients in Rural Michigan. Cureus 2022; 14:e21710. [PMID: 35242476 PMCID: PMC8884155 DOI: 10.7759/cureus.21710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/05/2022] Open
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Dahiya DS, Al-Haddad M, Perisetti A, Singh A, Goyal H, Cheng CI, Garg R, Pisipati S, Ameyi J, Sanaka MR, Inamdar S. Celiac disease hospitalizations: an emerging challenge in the United States. Ann Gastroenterol 2022; 35:383-392. [PMID: 35784629 PMCID: PMC9210776 DOI: 10.20524/aog.2022.0724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to assess the trends and characteristics of celiac disease (CeD) hospitalizations in the United States (US). Methods The National Inpatient Sample was analyzed from 2007-2017 to identify all adult hospitalizations with a primary discharge diagnosis of CeD. Demographic trends, associations, and other aspects of CeD hospitalizations were analyzed. SAS 9.4 was used for statistical analysis and P-values ≤0.05 were considered statistically significant. Results From 2007-2017, we noted an increasing trend of CeD hospitalizations from 19,385 in 2007 to 38,395 in 2017 (P-trend <0.001). The mean age was 57.85 years, with a declining trend. Females and patients with a Charlson Comorbidity Index score ≥3 had a rising trend of CeD hospitalizations from 70.68% in 2007 to 73% in 2017 (P-trend <0.001) and from 16.96% in 2007 to 26.59% in 2017 (P-trend <0.001), respectively. Additionally, a White predominance was seen in the study cohort. Furthermore, for CeD hospitalizations, all-cause inpatient mortality increased from 1.30% in 2007 to 1.58% in 2017 (P-trend <0.001) and the mean total hospital charge increased from $26,299 in 2007 to $49,282 in 2017 (P-trend <0.001). However, we noted a decline in the mean length of stay (LOS) from 4.88 days in 2007 to 4.59 days in 2017 (P-trend=0.0015) and rates of esophagogastroduodenoscopy performed from 2.09% in 2007 to 1.89% in 2017 (P-trend <0.001). Conclusion We noted a rising trend in hospitalizations, inpatient mortality, and hospital costs for CeD hospitalizations in the US; however, inpatient EGDs performed and mean LOS showed a decline.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI (Dushyant Singh Dahiya)
- Correspondence to: Dushyant Singh Dahiya, MD, Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, 1015 S Washington Ave, Saginaw, MI 48601, USA, e-mail:
| | - Mohammad Al-Haddad
- Division Chief and Professor of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (Mohammad Al-Haddad)
| | | | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH (Amandeep Singh, Rajat Garg)
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, PA (Hemant Goyal)
- Department of Internal Medicine, Mercer University School of Medicine, Macon, GA (Hemant Goyal)
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI (Chin-I-Cheng, Justice Ameyi)
| | - Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH (Amandeep Singh, Rajat Garg)
| | - Sailaja Pisipati
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ (Sailaja Pisipati)
| | - Justice Ameyi
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI (Chin-I-Cheng, Justice Ameyi)
| | - Madhusudhan R. Sanaka
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, OH (Madhusudhan R. Sanaka)
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR (Sumant Inamdar), USA
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Dahiya DS, Perisetti A, Al-Haddad M, Kichloo A, Sharma R, Cheng CI, Inamdar S. Obese gastroparesis inpatient admissions: trends and outcomes from 2007-2017 in the United States. Ann Gastroenterol 2022; 35:249-259. [PMID: 35599928 PMCID: PMC9062847 DOI: 10.20524/aog.2022.0702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to investigate obese gastroparesis (GP) hospitalizations in the United States (US). Methods We analyzed the National Inpatient Sample (NIS) from 2007-2017 to identify all adult obese (body mass index ≥30 kg/m2) GP hospitalizations. These were compared with non-obese GP hospitalizations. The demographic trends, adverse outcomes, and healthcare burden were analyzed. Results From 2007-2017, obese GP hospitalizations accounted for 13.75% of all GP hospitalizations in the US. There was an increasing trend in obese GP hospitalizations, from 2286 in 2007 to 47,265 in 2017 (P=0.0019), and in the proportion of obese GP hospitalizations, from 6.16% in 2007 to 17.96% in 2017 (P<0.001). Males, Blacks, Hispanics, and Asians showed a rising trend in obese GP hospitalizations. Although rates of upper endoscopy declined from 8.28% in 2007 to 5.36% in 2017 (P<0.001), obese GP hospitalizations had higher rates of upper endoscopy utilization (6.05 vs. 5.42%, P<0.001) compared to the non-obese cohort. Inpatient mortality for obese GP hospitalizations increased from 0.64% in 2007 to 1.10% in 2017 (P<0.001). Furthermore, we noted a rising trend in mean length of stay (LOS), from 4.64 in 2007 to 6.05 days in 2017 (P=0.0029), and mean total hospital charge (THC), from $22,306 in 2007 to $62,220 in 2017 (P<0.001) for obese GP hospitalizations. Conclusions The prevalence of obese GP hospitalizations along with inpatient mortality, LOS, and THC rose significantly. However, the overall rate of upper endoscopy utilization has decreased for these patients.
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Affiliation(s)
- Dushyant S. Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA (Dushyant S. Dahiya, Asim Kichloo)
- Correspondence to: Dushyant Singh Dahiya, MD, Department of Internal Medicine, Central Michigan University College of Medicine, 1000 Houghton Ave, Saginaw, MI, 48603, USA, e-mail:
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology, Parkview Cancer Institute, Fort Wayne, IN, USA (Abhilash Perisetti)
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA (Mohammad Al-Haddad)
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA (Dushyant S. Dahiya, Asim Kichloo)
| | - Rahul Sharma
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA (Rahul Sharma, Sumant Inamdar)
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University College, Mt Pleasant, MI, USA (Chin-I Cheng)
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA (Rahul Sharma, Sumant Inamdar)
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Nituica C, Bota OA, Blebea J, Cheng CI, Slotman GJ. Factors influencing resilience and burnout among resident physicians - a National Survey. BMC Med Educ 2021; 21:514. [PMID: 34587948 PMCID: PMC8479707 DOI: 10.1186/s12909-021-02950-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 09/11/2021] [Indexed: 05/04/2023]
Abstract
BACKGROUND Residency training exposes young physicians to a challenging and high-stress environment, making them vulnerable to burnout. Burnout syndrome not only compromises the health and wellness of resident physicians but has also been linked to prescription errors, reduction in the quality of medical care, and decreased professionalism. This study explored burnout and factors influencing resilience among U.S. resident physicians. METHODS A cross-sectional study was conducted through an online survey, which was distributed to all accredited residency programs by Accreditation Council of Graduate Medical Education (ACGME). The survey included the Connor-Davidson Resilience Scale (CD-RISC 25), Abbreviated Maslach Burnout Inventory, and socio-demographic characteristics questions. The association between burnout, resilience, and socio-demographic characteristics were examined. RESULTS The 682 respondents had a mean CD-RISC score of 72.41 (Standard Deviation = 12.1), which was equivalent to the bottom 25th percentile of the general population. Males and upper-level trainees were more resilient than females and junior residents. No significant differences in resilience were found associated with age, race, marital status, or training program type. Resilience positively correlated with personal achievement, family, and institutional support (p < 0.001) and negatively associated with emotional exhaustion and depersonalization (p < 0.001). CONCLUSIONS High resilience, family, and institutional support were associated with a lower risk of burnout, supporting the need for developing a resilience training program to promote a lifetime of mental wellness for future physicians.
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Affiliation(s)
- Cristina Nituica
- Department of Surgery, College of Medicine, Central Michigan University, 912 S Washington Ave, Suite 1, Saginaw, MI, 48601, USA.
| | - Oana Alina Bota
- Department of Psychology, Education and Teacher Training, Faculty of Psychology and Education Sciences, Transylvania University, 56 Nicolae Balcescu, 500019, Brasov, BV, Romania
| | - John Blebea
- Department of Surgery, College of Medicine, Central Michigan University, 912 S Washington Ave, Suite 1, Saginaw, MI, 48601, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial, and Data Sciences, Central Michigan University, 1200 S. Franklin St., Mount Pleasant, Saginaw, MI, 48859, USA
| | - Gus J Slotman
- Department of Surgery, Inspira Medical Center Vineland, Inspira Medical Group Surgical Oncology, 1505 West Sherman Avenue, Suite B, Vineland, NJ, 08360, USA
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Abstract
Background This study investigated patients’ attitudes about severe acute respiratory syndrome coronavirus 2 in rural Michigan. Despite increasing cases in rural communities across America, surveys have revealed that residents may feel less threatened by the virus compared to their urban counterparts. This difference in attitude and information appraisal can negatively affect rural health by discouraging coronavirus disease (COVID-19) preventative behaviors. Understanding social influences that contribute to the formation of opinions about the pandemic can help public health officials and clinicians better address rural health. Methodology This cross-sectional study surveyed 299 participants from three primary care clinics in Shiawassee County of Michigan during a seven-week interval. Statistical analysis, primarily through SAS version 9.4 (SAS Institute Inc., Cary, NC, USA), included descriptive statistics, multiple linear regression models, paired t-tests, and correlation coefficients. A p-value less than or equal to 0.05 was considered significant. Results Patients believed the risk COVID-19 posed to their family was significantly higher than the risk it posed to themselves (p < 0.001). Patients who reported that they would follow their provider’s advice for treatment of a non-COVID-19 medical illness were found to be more likely to follow a provider’s advice on COVID-19 (p < 0.001). However, patients overall were more agreeable with following provider advice for non-COVID-19 medical illnesses than they were for COVID-19 (p < 0.001). Conclusions As patients were more agreeable with following medical advice on chronic conditions than COVID-19, there may be extrinsic factors influencing patient views of COVID-19. Polarization of COVID-19 in the media has heavily influenced attitudes toward the virus in America. Initiatives to provide reliable patient education is key to encouraging constructive discussions and a healthy rural community. In a strong patient-provider relationship, primary care providers can share and encourage appropriate healthy behaviors regarding COVID-19, which have a direct impact on community health.
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Affiliation(s)
- Vaishali Kapila
- Family Medicine, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Ibrahim Baida
- Family Medicine, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Adriana Calderon
- Family Medicine, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Thomas Stuut
- Family Medicine, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University College of Medicine, Mount Pleasant, USA
| | - Wendy S Biggs
- Family Medicine, Central Michigan University College of Medicine, Mount Pleasant, USA
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Ittoop T, Jeffrey K, Cheng CI, Reddy S. The Relationship Between Adverse Childhood Experiences and Diabetes in Central Michigan Adults. Endocr Pract 2020; 26:1425-1434. [PMID: 33471734 DOI: 10.4158/ep-2020-0239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/18/2020] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) predispose individuals to poor health outcomes as adults. Although a dose-response relationship between the number of ACEs and certain chronic illnesses has been shown, the impact of ACEs on diabetes is not thoroughly understood. We investigated the prevalence of ACEs in patients with diabetes and the potential relationship to the severity of diabetes. METHODS Patients with diabetes (both type 1 and type 2) or obesity were surveyed from the Endocrinology & Diabetes Center at McLaren Central Michigan in Mount Pleasant, Michigan. A validated, standard ACE questionnaire was administered to quantify the number of adverse childhood events that patients have experienced. A retrospective chart analysis was then conducted, addressing the relationship of ACEs with the severity of disease in the diabetes group and the obesity group. The number of ACEs was correlated with disease comorbidities, complications, and measurable quantities, such as body mass index (BMI) and hemoglobin A1c (HbA1c). RESULTS ACE scores in both diabetes and obesity groups were shown to have a greater prevalence compared to the general ACE average in Michigan. ACE scores also positively correlated to BMI and HbA1c in the diabetes group. Those with higher ACE scores in the diabetes group were also more likely to have depression and anxiety. CONCLUSION ACE screening may lead to a greater understanding of the severity of and progression of diabetes. Ultimately, these results could provide support to potential interventional studies leading to the altered management of diabetes in patients with ACEs, or preventative intervention to children with ACEs. ABBREVIATIONS ACE = adverse childhood experiences; BMI = body mass index; HbA1c = hemoglobin A1c; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus.
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Affiliation(s)
- Thomas Ittoop
- From (1)Central Michigan University, College of Medicine, Mount Pleasant, Michigan
| | - Kimberly Jeffrey
- McLaren Central Michigan, Endocrinology, Mount Pleasant, Michigan, and
| | - Chin-I Cheng
- Central Michigan University, Department of Statistics, Actuarial and Data Science, Mount Pleasant, Michigan
| | - Sethu Reddy
- From (1)Central Michigan University, College of Medicine, Mount Pleasant, Michigan,; McLaren Central Michigan, Endocrinology, Mount Pleasant, Michigan, and.
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Matar GW, Abdou MM, Lyons ME, Alani F, Cheng CI, Ragina NP. The effects of geriatric aortic stenosis education and its implications on heart failure prevention in medically underserved communities. Eur J Prev Cardiol 2020; 27:2134-2137. [DOI: 10.1177/2047487319863505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- George W Matar
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Merna M Abdou
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Maryssa E Lyons
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Firas Alani
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
| | - Chin-I Cheng
- Central Michigan University, Department of Mathematics, Mount Pleasant, MI, USA
| | - Neli P Ragina
- Central Michigan University, College of Medicine, Mount Pleasant, MI, USA
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Megaly M, Alani F, Cheng CI, Ragina N. Risk Factors for the Development of Carotid Artery In-Stent Restenosis: Multivariable Analysis. Cardiovasc Revasc Med 2020; 24:65-69. [PMID: 32928694 DOI: 10.1016/j.carrev.2020.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/04/2020] [Accepted: 09/01/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES In this study, we evaluated the relationship between certain patient and stent characteristics with regards to their association with the development of restenosis. BACKGROUND Carotid artery stenosis is a major cause of stroke. Carotid artery stenting is an FDA approved method for the treatment of carotid artery stenosis. However, carotid artery stenting has been fraught with lumen loss and in-stent restenosis. The literature is limited in regard to variables affecting long term patency after carotid artery stenting. METHODS This is a retrospective chart review study investigating the variables affecting the long term patency in patients who underwent carotid artery stenting. The data was analyzed using a Multivariable logistic regression models. RESULTS 148 patients were included in the study. 123 patients did not develop signs of restenosis after 1 year, while 25 patients developed restenosis defined on annual follow up carotid duplex ultrasound. The odds ratio of developing restenosis for current/former smokers vs. never smokers was 10.1 (p = 0.018), closed vs. open cell design stents was 12.5 (p = 0.008). The odds ratio of developing restenosis decreases by 50.1% for every 1 mm increase in the diameter (p = 0.021). Data was collected and reanalyzed at 3 years to look for any changes in risk factors that become significant which showed that the chance of developing restenosis increases by 11.2% for every 1 mm increase in the length of the stent. CONCLUSIONS Our data suggest that the risk of developing restenosis is elevated in those with a history of previous/current tobacco use; those treated with closed-cell as opposed to open-cell design. We also found that restenosis is positively associated with stent length and inversely associated with stent diameter. The aforementioned factors should be considered in the management of carotid artery stenosis.
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Affiliation(s)
- Michael Megaly
- Central Michigan University, College of Medicine, United States of America
| | - Firas Alani
- Central Michigan University, College of Medicine, United States of America; Covenant Hospital, Saginaw, MI, United States of America
| | - Chin-I Cheng
- Central Michigan University, Department of Statistics, Actuarial, and Data Science, United States of America
| | - Neli Ragina
- Central Michigan University, College of Medicine, United States of America.
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Nosewicz J, Cavallin C, Cheng CI, Ragina N, Weiss AW, Zacharek A. Factors associated with trigger digit following carpal tunnel release. World J Orthop 2019. [DOI: 10.5312/wjo.v10.i12.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Nosewicz J, Cavallin C, Cheng CI, Ragina N, Weiss AW, Zacharek A. Factors associated with trigger digit following carpal tunnel release. World J Orthop 2019; 10:454-462. [PMID: 31908994 PMCID: PMC6937424 DOI: 10.5312/wjo.v10.i12.454] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/30/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Trigger digit is a common disorder of the hand associated with carpal tunnel syndrome. Carpal tunnel release (CTR) surgery may be a risk factor for trigger digit development; however, the association between surgical approach to CTR and postoperative trigger digit is equivocal.
AIM To investigate patient risk factors for trigger digit development following either open carpal tunnel release (OCTR) or endoscopic carpal tunnel release (ECTR).
METHODS This retrospective chart analysis evaluated 967 CTR procedures from 694 patients for the development of postoperative trigger digit. Patients were stratified according to the technique utilized for their CTR, either open or endoscopic. The development of postoperative trigger digit was evaluated at three time points: within 6 mo following CTR, between 6 mo and 12 mo following CTR, and after 12 mo following CTR. Firth’s penalized likelihood logistic regression was conducted to evaluate sociodemographic and patient comorbidities as potential independent risk factors for trigger digit. Secondary regression models were conducted within each surgical group to reveal any potential interaction effects between surgical approach and patient risk factors for the development of postoperative trigger digit.
RESULTS A total of 47 hands developed postoperative trigger digit following 967 CTR procedures (4.9%). In total, 64 digits experienced postoperative triggering. The long finger was most commonly affected. There was no significant difference between the open and endoscopic groups for trigger digit development at all three time points following CTR. Furthermore, there were no significant independent risk factors for postoperative trigger digit; however, within group analysis revealed a significant interaction effect between gender and surgical approach (P = 0.008). Females were more likely to develop postoperative trigger digit than males after OCTR(OR = 3.992), but were less likely to develop postoperative trigger digit than males after ECTR (OR = 0.489).
CONCLUSION Patient comorbidities do not influence the development of trigger digit following CTR. Markedly, gender differences for postoperative trigger digit may depend on surgical approach to CTR.
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Affiliation(s)
- Jacob Nosewicz
- Central Michigan University College of Medicine, Mt. Pleasant, MI 48858, United States
| | - Carla Cavallin
- Central Michigan University College of Medicine, Mt. Pleasant, MI 48858, United States
| | - Chin-I Cheng
- Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt. Pleasant, MI 48858, United States
| | - Neli Ragina
- Central Michigan University College of Medicine, Mt. Pleasant, MI 48858, United States
| | - Arno W Weiss
- Covenant Plastic Surgery, Saginaw, MI 48602, United States
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Abstract
The purpose of this study is to examine the treatment of noncancer musculoskeletal pain in different clinical settings by assessing patient demographics, pain diagnoses, opioid analgesic monitoring, and alternative treatments.Data was collected in a retrospective chart review involving 300 randomly selected charts with an active musculoskeletal diagnosis based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes. The population consisted of primary care outpatient clinic and emergency department encounters during the timeframe of January 1, 2016 to March 31, 2016 in a predominantly rural community in Michigan. Variables included prescription medications, musculoskeletal conditions, and prescription drug monitoring modalities. Statistical analysis was accomplished using means, standard deviations, proportions, 2-sample proportional tests, multivariable logistic regression, and multinomial regression models.Opioid prescribing was observed in 64% of outpatient and 68.9% of emergency department encounters. Back pain was the most common problem with 61.9% patients prescribed opioids having at least 1 diagnosis of back pain. Patients on opioids were older (mean age 58) than patients taking nonopioids (mean age 50). For every year of increasing age, there is a 3.1% increase in the odds of an opioid being prescribed (odds ratio 1.03, confidence interval 1.012-1.049, P = .001). Documentation was extremely low with only 15.2%, 1.5%, and 1.5% of patient charts prescribed opioids demonstrating documentation of urine drug screens, pain agreements, and review of a state prescription drug monitoring program, respectively.Despite drug monitoring recommendations, low rates of monitoring were observed. Back pain was the largest contributing pain location and had higher opioid use compared to other sites. Many patients had additional pain medications being concurrently prescribed with opioids suggesting that musculoskeletal pain is not often controlled by a single medication type. Reported alcohol abuse, active tobacco use, and illicit substance use can serve as predictors when assessing patients for pain management options. The use of alternative measures and integrative treatment modalities (which saw low utilization in this study) should be implemented as either primary or supplementary therapy as a way to reduce the pharmacologic burden on the patient.
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Affiliation(s)
- Derek P.R. Pierce
- Central Michigan University (CMU) College of Medicine, Mt. Pleasant, MI
| | | | | | - Juliette Perzhinsky
- Central Michigan University (CMU) College of Medicine, Mt. Pleasant, MI
- CMU Health
- Aleda E. Lutz VA Medical Center, Saginaw, MI
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Singleton W, McLean M, Smale M, Alkhalifah M, Kosahk A, Ragina N, Cheng CI, Figg BJ. An Analysis of the Temperature Change in Warmed Intravenous Fluids During Administration in Cold Environments. Air Med J 2017; 36:127-130. [PMID: 28499682 DOI: 10.1016/j.amj.2016.07.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 06/07/2023]
Abstract
This nonhuman simulation study was conducted to determine the decrease in temperature that occurred to 1-L bags of normal saline in a cold environment. The bags were warmed to 39°C and administered through intravenous (IV) tubing at a set flow rate while in a cold environment. The goal was to determine if there was a significant decrease in fluid temperature from the bag to the catheter site. Three trials were completed at temperatures of 0°C, -7°C, -12°C, and 22°C (control). Each bag of normal saline was warmed to 39°C using the SoftSack IV Fluid Warmer (Smithworks Med Inc, Lindale, TX). Fluid was collected and temperatures recorded at 5-minute intervals. The results showed a statistically significant (P = .003) change in temperature between the IV bag and the administration site. The most rapid change occurred within the first 5 minutes. The temperature change was more significant with colder ambient temperatures, with an average of a 28.7°C difference at -7°C and -12°C after 30 minutes. It appears that the most significant heat loss occurs through the IV tubing itself. Therefore, it may be beneficial to insulate the tubing on a trauma patient receiving warmed IV fluids in a cold environment to help prevent hypothermia.
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Affiliation(s)
| | - Michelle McLean
- Central Michigan University College of Medicine, Saginaw, MI
| | | | | | - Ahmad Kosahk
- Central Michigan University College of Medicine, Saginaw, MI
| | - Neli Ragina
- Central Michigan University College of Medicine, Saginaw, MI
| | - Chin-I Cheng
- Central Michigan University College of Medicine, Saginaw, MI
| | - Bethany J Figg
- Central Michigan University College of Medicine, Saginaw, MI
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Lien JC, Cheng CI, Lien SC. A team approach to a disease survey on an aboriginal island (Orchid Island, Taiwan). IV. Mosquitos and chiggers on Lan-yü (Orchid Island), Taitung Hsien, Taiwan. Zhonghua Min Guo Wei Sheng Wu Xue Za Zhi 1974; 7:36-41. [PMID: 4153585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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