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Greene SJ, Chambers R, Lerman JB, Harrington J, deFilippi CR, Wendell DC, Kim HW, Green CL, Butler J, Felker GM. Sacubitril/valsartan and cardiovascular biomarkers among patients with recent COVID-19 infection: The PARACOR-19 randomized clinical trial. Eur J Heart Fail 2024. [PMID: 38733160 DOI: 10.1002/ejhf.3199] [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: 01/24/2024] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 05/13/2024] Open
Abstract
AIMS The PARACOR-19 randomized controlled trial (RCT) was designed to examine the effects of sacubitril/valsartan on markers of cardiac injury, inflammation, structure, and function among patients who have recovered from acute coronavirus disease 2019 (COVID-19) infection. METHODS AND RESULTS PARACOR-19 was a single-centre, double-blind RCT of patients with cardiovascular risk factors and a history of COVID-19 infection 4-16 weeks prior to enrolment. Patients were randomized to sacubitril/valsartan (titrated to the maximum dose of 97/103 mg twice daily) versus matching placebo. Co-primary endpoints were change from baseline to 12 weeks in high-sensitivity cardiac troponin T (hs-cTnT) and soluble ST2 (sST2). Exploratory endpoints included change from baseline to 12 weeks in additional circulating biomarkers. Overall, 42 patients were randomized between August 2021 and March 2023 (n = 20 sacubitril/valsartan, n = 22 placebo). Median (25th-75th) time from COVID-19 diagnosis to enrolment was 67 (48-80) days. Median age was 67 (62-71) years, 48% were female, and 91% were White. Compared with placebo, sacubitril/valsartan did not have a significant effect on the co-primary endpoints of change from baseline in hs-TnT and sST2 (all p ≥ 0.29). In exploratory analyses, sacubitril/valsartan led to a 46% greater reduction in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and 51% greater reduction in C-terminal telopeptide of collagen type I (CITP). Permanent drug discontinuation occurred in four patients in the sacubitril/valsartan group and three patients in the placebo group. There were no deaths and one patient was hospitalized in each group. CONCLUSION In this pilot RCT of patients who recovered from acute COVID-19, sacubitril/valsartan did not lower hs-cTnT or sST2 compared with placebo. Exploratory analyses suggested potential benefits of sacubitril/valsartan on cardiac wall stress and collagen turnover as measured by NT-proBNP and CITP. Sacubitril/valsartan was well tolerated. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT04883528.
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Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, NC, USA
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | | | - Joseph B Lerman
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | | | | | - David C Wendell
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Han W Kim
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Cynthia L Green
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - G Michael Felker
- Duke Clinical Research Institute, Durham, NC, USA
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
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Covell NB, Chari T, Hendren S, Poehlein E, Green CL, Catanzano AA. A Framework for Studying Healthcare Equity in Adolescent Idiopathic Scoliosis: Scoping Review and Meta-Analysis of Existing Literature. J Am Acad Orthop Surg 2024; 32:e452-e465. [PMID: 37994490 DOI: 10.5435/jaaos-d-23-00296] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Health inequities remain a notable barrier for pediatric patients, especially in conditions such as adolescent idiopathic scoliosis (AIS), where the efficacy of nonsurgical treatment is dependent on early diagnosis and referral to a specialist. Social determinants of health (SDOH) are nonmedical factors that affect health outcomes, such as economic stability, neighborhood environment, and discrimination. Although these factors have been studied throughout the AIS literature, considerable inconsistencies remain across studies regarding the investigation of SDOH for this population. Through a scoping review, we analyze the existing literature to propose a comprehensive framework to consider when designing future prospective and retrospective studies of healthcare equity in AIS. METHODS A systematic review was executed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. A meta-analysis was performed for each reported SDOH (race, ethnicity, insurance provider, and socioeconomic status) including only studies with complete and consistent variables and outcomes. Cobb angle measurements were aggregated and summarized as the weighted mean difference with 95% confidence interval using a fixed or random-effects model (substantial heterogeneity identified). RESULTS Of 7,539 studies reviewed, nine studies met all the inclusion criteria. As expected, considerable inconsistencies were found across the nine studies making it difficult to aggregate data. Within the meta-analyses, the mean difference between White non-Hispanic and Hispanic patients was statistically significant (1.71; 95% confidence interval 0.78 to 2.65; P < 0.001). No other statistically significant differences were identified among the SDOH and presenting main Cobb angle magnitude. CONCLUSION These studies provide insight into healthcare inequities in AIS, although notable inconsistencies make it difficult to aggregate data and draw the conclusions needed to drive necessary public health changes. However, our proposed framework can provide a guideline for future prospective and retrospective studies to standardize data reporting and allow for improved collaboration, study design, and future systematic reviews and meta-analyses.
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Affiliation(s)
- Nikki Bensen Covell
- From the School of Osteopathic Medicine, Campbell University, Lillington, NC (Covell), the School of Medicine, Duke University, Durham, NC (Chari), the School of Medicine, Duke Medical Library, Durham, NC (Hendren), the Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (Poehlein and Green), and the Department of Orthopaedic Surgery, Duke University Health System, Durham, NC (Catanzano)
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Kirenga BJ, Chakaya J, Yimer G, Nyale G, Haile T, Muttamba W, Mugenyi L, Katagira W, Worodria W, Aanyu-Tukamuhebwa H, Lugogo N, Joloba M, Mersha TB, Bekele A, Makumbi F, Mekasha A, Green CL, de Jong C, Kamya M, van der Molen T. The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project. J Allergy Clin Immunol Glob 2024; 3:100209. [PMID: 38328803 PMCID: PMC10847773 DOI: 10.1016/j.jacig.2024.100209] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/29/2023] [Accepted: 09/30/2023] [Indexed: 02/09/2024]
Abstract
Background Severe asthma is associated with high morbidity, mortality, and health care utilization, but its burden in Africa is unknown. Objective We sought to determine the burden (prevalence, mortality, and activity and work impairment) of severe asthma in 3 countries in East Africa: Uganda, Kenya, and Ethiopia. Methods Using the American Thoracic Society/European Respiratory Society case definition of severe asthma, we analyzed for the prevalence of severe asthma (requiring Global Initiative for Asthma [GINA] steps 4-5 asthma medications for the previous year to achieve control) and severe refractory asthma (remains uncontrolled despite treatment with GINA steps 4-5 asthma medications) in a cohort of 1086 asthma patients who had been in care for 12 months and had received all GINA-recommended medications. Asthma control was assessed by the asthma control questionnaire (ACQ). Results Overall, the prevalence of severe asthma and severe refractory asthma was 25.6% (95% confidence interval [CI], 23.1-28.3) and 4.6% (95% CI, 3.5-6.0), respectively. Patients with severe asthma were (nonsevere vs severe vs severe refractory) older (39, 42, 45 years, P = .011), had high skin prick test reactivity (67.1%, 76.0%, 76.0%, P = .004), had lower forced expiratory volume in 1 second percentage (81%, 61%, 55.5%, P < .001), had lower quality of life score (129, 127 vs 121, P < .001), and had higher activity impairment (10%, 30%, 50%, P < .001). Factors independently associated with severe asthma were hypertension comorbidity; adjusted odds ratio 2.21 (1.10-4.47), P = .027, high bronchial hyperresponsiveness questionnaire score; adjusted odds ratio 2.16 (1.01-4.61), P = .047 and higher ACQ score at baseline 2.80 (1.55-5.08), P = .001. Conclusion The prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.
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Affiliation(s)
- Bruce J. Kirenga
- Makerere University Lung Institute, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Jeremiah Chakaya
- Kenya Association of Physicians Against TB and Lung Diseases, Nairobi, Kenya
| | - Getnet Yimer
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - George Nyale
- Kenya Association of Physicians Against TB and Lung Diseases, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Tewodros Haile
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Winters Muttamba
- Makerere University Lung Institute, Kampala, Uganda
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Levicatus Mugenyi
- Makerere University Lung Institute, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | | | | | | | - Njira Lugogo
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich
| | - Moses Joloba
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Tesfaye B. Mersha
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amsalu Bekele
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Fred Makumbi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Amha Mekasha
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Cynthia L. Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Corina de Jong
- Department of General Practice and Elderly Care, GRIAC-Primary Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Moses Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Thys van der Molen
- Department of General Practice and Elderly Care, GRIAC-Primary Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Mendiola Pla M, Chiang Y, Nicoara A, Poehlein E, Green CL, Gross R, Bryner BS, Schroder JN, Daneshmand MA, Russell SD, DeVore AD, Patel CB, Katz JN, Milano CA, Bishawi M. Surgical Treatment of Tricuspid Valve Regurgitation in Patients Undergoing Left Ventricular Assist Device Implantation: Interim analysis of the TVVAD trial. J Thorac Cardiovasc Surg 2024; 167:1810-1820.e2. [PMID: 36639288 PMCID: PMC10185708 DOI: 10.1016/j.jtcvs.2022.10.054] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Right heart failure remains a serious complication of left ventricular assist device therapy. Many patients presenting for left ventricular assist device implantation have significant tricuspid regurgitation. It remains unknown whether concurrent tricuspid valve surgery reduces postoperative right heart failure. The primary aim was to identify whether concurrent tricuspid valve surgery reduced the incidence of moderate or severe right heart failure within the first 6 months after left ventricular assist device implantation. METHODS Patients with moderate or severe tricuspid regurgitation on preoperative echocardiography were randomized to left ventricular assist device implantation alone (no tricuspid valve surgery) or with concurrent tricuspid valve surgery. Randomization was stratified by preoperative right ventricular dysfunction. The primary end point was the frequency of moderate or severe right heart failure within 6 months after surgery. RESULTS This report describes a planned interim analysis of the first 60 randomized patients. The tricuspid valve surgery group (n = 32) had mild or no tricuspid regurgitation more frequently on follow-up echocardiography studies compared with the no tricuspid valve surgery group (n = 28). However, at 6 months, the incidence of moderate and severe right heart failure was similar in each group (tricuspid valve surgery: 46.9% vs no tricuspid valve surgery: 50%, P = .81). There was no significant difference in postoperative mortality or requirement for right ventricular assist device between the groups. There were also no significant differences in secondary end points of functional status and adverse events. CONCLUSIONS The presence of significant tricuspid regurgitation before left ventricular assist device is associated with a high incidence of right heart failure within the first 6 months after surgery. Tricuspid valve surgery was successful in reducing postimplant tricuspid regurgitation compared with no tricuspid valve surgery but was not associated with a lower incidence of right heart failure.
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Affiliation(s)
| | - Yuting Chiang
- Division of Cardiothoracic Surgery, Columbia University, New York, NY
| | - Alina Nicoara
- Department of Anesthesiology, Duke University Medical Center
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Ryan Gross
- Division of Cardiothoracic Surgery, Duke University Medical Center
| | | | - Jacob N Schroder
- Division of Cardiothoracic Surgery, Duke University Medical Center
| | | | | | - Adam D DeVore
- Division of Cardiology, Duke University Medical Center
| | | | - Jason N Katz
- Division of Cardiology, Duke University Medical Center
| | - Carmelo A Milano
- Division of Cardiothoracic Surgery, Duke University Medical Center.
| | - Muath Bishawi
- Division of Cardiothoracic Surgery, Duke University Medical Center
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Atwater AR, Bembry R, Green CL, Warshaw EM, Belsito DV, DeKoven JG, Reeder MJ, Silverberg JI, Taylor JS, DeLeo VA, Sasseville D, Pratt MD, Zug KA, Dunnick C, Houle MC. Nonmedical Adhesive Allergens: Retrospective Analysis of Cross-Sectional Data From the North American Contact Dermatitis Group, 2001-2018. Dermatitis 2024. [PMID: 38593448 DOI: 10.1089/derm.2023.0134] [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] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Amber Reck Atwater
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Raina Bembry
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Erin M Warshaw
- Department of Dermatology, Minneapolis Veterans Affairs Medical Center, Park Nicollet Health Services, University of Minnesota, Minneapolis, MN, USA
| | - Donald V Belsito
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joel G DeKoven
- Division of Dermatology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Margo J Reeder
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - James S Taylor
- Department of Dermatology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Vincent A DeLeo
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Montreal, Canada
| | - Melanie D Pratt
- Division of Dermatology, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - Kathryn A Zug
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Cory Dunnick
- Department of Dermatology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Marie-Claude Houle
- Division of Dermatology, Centre Hospitalier Universitaire de Quebec, Laval University, Quebec City, Canada
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Starks MA, Blewer AL, Chow C, Sharpe E, Van Vleet L, Arnold E, Buckland DM, Joiner A, Simmons D, Green CL, Mark DB. Incorporation of Drone Technology Into the Chain of Survival for OHCA: Estimation of Time Needed for Bystander Treatment of OHCA and CPR Performance. Circ Cardiovasc Qual Outcomes 2024; 17:e010061. [PMID: 38529632 DOI: 10.1161/circoutcomes.123.010061] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 01/10/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Drone-delivered automated external defibrillators (AEDs) hold promises in the treatment of out-of-hospital cardiac arrest. Our objective was to estimate the time needed to perform resuscitation with a drone-delivered AED and to measure cardiopulmonary resuscitation (CPR) quality. METHODS Mock out-of-hospital cardiac arrest simulations that included a 9-1-1 call, CPR, and drone-delivered AED were conducted. Each simulation was timed and video-recorded. CPR performance metrics were recorded by a Laerdal Resusci Anne Quality Feedback System. Multivariable regression modeling examined factors associated with time from 9-1-1 call to AED shock and CPR quality metrics (compression rate, depth, recoil, and chest compression fraction). Comparisons were made among those with recent CPR training (≤2 years) versus no recent (>2 years) or prior CPR training. RESULTS We recruited 51 research participants between September 2019 and March 2020. The median age was 34 (Q1-Q3, 23-54) years, 56.9% were female, and 41.2% had recent CPR training. The median time from 9-1-1 call to initiation of CPR was 1:19 (Q1-Q3, 1:06-1:26) minutes. A median time of 1:59 (Q1-Q3, 01:50-02:20) minutes was needed to retrieve a drone-delivered AED and deliver a shock. The median CPR compression rate was 115 (Q1-Q3, 109-124) beats per minute, the correct compression depth percentage was 92% (Q1-Q3, 25-98), and the chest compression fraction was 46.7% (Q1-Q3, 39.9%-50.6%). Recent CPR training was not associated with CPR quality or time from 9-1-1 call to AED shock. Younger age (per 10-year increase; β, 9.97 [95% CI, 4.63-15.31] s; P<0.001) and prior experience with AED (β, -30.0 [95% CI, -50.1 to -10.0] s; P=0.004) were associated with more rapid time from 9-1-1 call to AED shock. Prior AED use (β, 6.71 [95% CI, 1.62-11.79]; P=0.011) was associated with improved chest compression fraction percentage. CONCLUSION Research participants were able to rapidly retrieve an AED from a drone while largely maintaining CPR quality according to American Heart Association guidelines. Chest compression fraction was lower than expected.
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Affiliation(s)
- Monique A Starks
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.A.S.., D.B.M.)
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.A.S., C.L.G., D.B.M.)
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (A.L.B)
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (A.L.B.)
| | - Christine Chow
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.A.S.., D.B.M.)
| | | | | | - Evan Arnold
- Institute for Transportation Research and Education, North Carolina State University, Raleigh, NC (E.A.)
| | - Daniel M Buckland
- Department of Emergency Medicine Duke University School of Medicine, Durham, NC (D.M.B.,A.J.)
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC (D.M.B.)
| | - Anjni Joiner
- Department of Emergency Medicine Duke University School of Medicine, Durham, NC (D.M.B.,A.J.)
- Durham County EMS, NC (L.V.V., A.J.)
| | - Denise Simmons
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC (D.S.)
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (C.L.G)
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.A.S., C.L.G., D.B.M.)
| | - Daniel B Mark
- Department of Medicine, Duke University School of Medicine, Durham, NC (M.A.S.., D.B.M.)
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (M.A.S., C.L.G., D.B.M.)
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Danilkowicz RM, Hurley ET, Hinton ZW, Meyer LE, Cheah JW, Hutyra C, Poehlein E, Green CL, Mather RC. Association between sleep dysfunction and Patient-Reported Outcomes Measurement Information System scores in patients with rotator cuff tears. J ISAKOS 2024; 9:143-147. [PMID: 38104945 DOI: 10.1016/j.jisako.2023.12.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES The purpose of this study was to utilize Patient-Reported Outcomes Measurement Information System (PROMIS) sleep scores to determine the prevalence of sleep dysfunction and its association with other PROMIS scores in patients with rotator cuff tears (RCT). METHODS Patients were retrospectively identified using the International Classification of Diseases-10 codes for RCT pathology, and PROMIS outcomes were assessed at multiple visits between November 2017 and February 2020. Generalized linear mixed effects models were fitted with PROMIS sleep score as the predictor variable and other PROMIS scores as the response variable. Additionally, models were fit using a clinically significant dichotomization of PROMIS sleep scores to assess differences in average PROMIS scores. RESULTS The study cohort included 481 patients, 201 (41.8 %) of whom had disrupted sleep at first visit. A higher percentage of those with disrupted sleep at first visit were female, nonwhite, and not married compared to those with normal sleep. PROMIS scores at first visit differed by sleep category. Higher PROMIS sleep scores were associated with higher anxiety, depression, fatigue, pain intensity, and pain interference scores and lower physical function, social participation, and upper extremity scores. Relationships were similar when dichotomous PROMIS sleep scores were considered. CONCLUSION There was a high prevalence of sleep dysfunction in patients with RCT. Sleep disturbance is associated with increased anxiety, depression, fatigue, pain intensity, pain interference and decreased physical function, social participation, and upper extremity function in patients with RCTs. LEVEL OF EVIDENCE III Retrospective Cohort Study.
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Affiliation(s)
- Richard M Danilkowicz
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Eoghan T Hurley
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA.
| | - Zoe W Hinton
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Lucy E Meyer
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Jonathan W Cheah
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Carolyn Hutyra
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
| | - Emily Poehlein
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, 311 Trent Drive, Durham, NC 27710, USA
| | - Cynthia L Green
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, 311 Trent Drive, Durham, NC 27710, USA
| | - Richard C Mather
- Duke University Hospital, Division of Orthopedic Surgery, Department of Sports Medicine, 311 Trent Drive, Durham, NC 27710, USA
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White MJ, Duke NN, Howard J, Rodriguez J, Truong T, Green CL, Nmoh A, Gorveh M, Perrin EM. Positive Outliers: A Mixed Methods Study of Resiliency to Childhood Obesity in High-Risk Neighborhoods. Acad Pediatr 2024:S1876-2859(24)00110-4. [PMID: 38521385 DOI: 10.1016/j.acap.2024.03.011] [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: 11/28/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Despite the high prevalence of obesity and the clustering of risk by neighborhood, few studies have examined characteristics which promote healthy child weight in neighborhoods with high obesity risk. We aimed to identify protective factors for children living in neighborhoods with high obesity risk. METHODS We identified neighborhoods with high obesity risk using geolocated electronic health record data with measured body mass index (BMI) from well child visits (2012-2017). We then recruited caregivers with children aged 5-13 years who lived in census tracts with mean child BMI percentile >72 (February 2020- August 2021). We used sequential mixed methods (quantitative surveys, qualitative interviews) to compare individual, interpersonal and perceived neighborhood factors among families with children at healthy weight (positive outliers, PO) vs. families with ≥1 child with overweight or obesity (controls). Regression models and comparative qualitative analysis were used to identify protective characteristics. RESULTS Seventy-three caregivers participated in the quantitative phase (41% PO; 34% preferred Spanish) and twenty in the qualitative phase (50% PO; 50% preferred Spanish). Frequency of healthy caregiver behaviors was associated with being a PO (Family Health Behavior Scale Parent Score adjusted β 3.67; 95% CI 0.52-6.81 and qualitative data). Protective factors also included caregivers' ability to minimize the negative health influences of family members and adhere to family routines. CONCLUSIONS There were few differences between PO and control families. Support for caregiver healthy habits and adherence to healthy family routines emerged as opportunities for childhood obesity prevention in neighborhoods with high obesity risk. WHAT'S NEW In neighborhoods with high risk of child obesity, families with healthy weight children and families with children with overweight/obesity are behaviorally and socially similar. Parental modeling and support for healthy behaviors across children's environments may promote healthy child weight.
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Affiliation(s)
- Michelle J White
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University Medical Center; 2301 Erwin Road; Durham, NC, 27705.
| | - Naomi N Duke
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University Medical Center; 2301 Erwin Road; Duke University Medical Center; Durham, NC, 27705.
| | - Janna Howard
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University Medical Center; 2301 Erwin Road; Duke University Medical Center; Durham, NC, 27705.
| | - Javier Rodriguez
- Department of Pediatrics and Duke Center for Childhood Obesity Research, Duke University Medical Center; 2301 Erwin Road; Duke University Medical Center; Durham, NC, 27705.
| | - Tracy Truong
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, 2424 Erwin Road, Duke University Medical Center; Durham, NC 27705.
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine; Duke Clinical Research Institute, Duke University Medical Center; 345 W Morgan St.; Durham, NC, 27701.
| | - Ashley Nmoh
- Duke University School of Medicine; 40 Duke Medicine Circle; Durham, NC, 27710.
| | - Moshen Gorveh
- Duke Clinical Research Institute (DCRI), Duke University; 300 W. Morgan Street, Suite 800; Durham, NC 27701.
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins Schools of Medicine and Nursing, 200 N. Wolfe Street, Rubenstein Building - 2075, Baltimore, MD 21287.
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Roggli VL, Pavlisko EN, Glass CH, Green CL, Liu B, Carney JM. Response to To the Editor-Environmental Research This letter is a critique of the paper by Roggli et al (1) regarding chronological trends of the fiber burden in mesothelioma cases. Environ Res 2024:118620. [PMID: 38447601 DOI: 10.1016/j.envres.2024.118620] [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] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
| | | | | | | | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University Medical Center
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Shultz CL, Poehlein E, Morriss NJ, Green CL, Hu J, Lander S, Amoo-Achampong K, Lau BC. Nonoperative Management, Repair, or Reconstruction of the Medial Collateral Ligament in Combined Anterior Cruciate and Medial Collateral Ligament Injuries-Which Is Best? A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:522-534. [PMID: 36960920 DOI: 10.1177/03635465231153157] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
BACKGROUND Combined injury of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) is a common injury pattern and accounts for 20% of all ligamentous knee injuries. Despite advancements in surgical technique, there is no up-to-date consensus regarding the superiority of nonoperative versus operative management in higher-grade MCL tears of combined ACL-MCL injuries. PURPOSE To interpret recent literature on treatment options and to provide an updated evidence-based approach for management of combined ACL-MCL knee injuries. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS We performed a systematic review on outcomes following treatment of concomitant ACL and MCL injuries. A computerized search was conducted in PubMed, Embase.com, and Scopus.com. Authors independently assessed eligible studies and screened titles and abstracts. Articles reporting on patients with concomitant ACL and MCL injuries with or without concomitant procedures were included. Data regarding study design, sample size, patient age and sex, length of follow-up, timing of surgery, indications, surgical methods, concomitant procedures, outcomes, and complications were recorded. Patient-reported outcomes (PROs) and functional outcomes, including Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee scores, Lysholm and Tegner scores, and range of motion, were estimated via meta-analysis and compared statistically by surgical approach. RESULTS In total, 18 studies were included in the systematic review with level 1 to level 4 evidence, with a total of 1,534 cases, were included in the systematic review. Of these, 16 studies with sufficient statistical reporting including 997 cases with sufficient follow-up were included in meta-analysis. Three different approaches to combined ACL-MCL injuries were identified: ACL reconstruction with (1) nonoperative MCL, (2) MCL repair, and (3) MCL reconstruction. There was no statistical difference between nonoperative versus surgically managed MCL injuries for PROs, range of motion at final follow up, or quadriceps strength. CONCLUSION Reconstruction of combined injury in a delayed fashion facilitates return of range of motion and may allow time for low-grade MCL tears to heal. If residual valgus or anteromedial rotatory laxity remains after a period of rehabilitation, then concomitant surgical management of ACL and MCL injuries is warranted. Avulsion MCL injuries and Stener-type lesions may benefit from early repair techniques.
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Affiliation(s)
- Christopher L Shultz
- Department of Orthopaedic Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nicholas J Morriss
- Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jessica Hu
- Department of Orthopaedic Surgery, Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah Lander
- Department of Orthopaedic Surgery, Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelms Amoo-Achampong
- Department of Orthopaedic Surgery, Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina, USA
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Atwater AR, Liu B, Walsh R, Bembry R, Ward JM, Green CL. Supplemental Patch Testing Identifies Allergens Missed by Standard Screening Series. Dermatitis 2024. [PMID: 38285482 DOI: 10.1089/derm.2023.0310] [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: 01/30/2024]
Abstract
Background: Supplemental patch testing is an adjunct to standard patch test screening series. Objective: To determine the demographics, characteristics, frequency, relevance, and interpretation of patch test reactions for supplemental patch testing. Methods: Retrospective study of patients tested 2017-2020 with North American Contact Dermatitis Group (NACDG) and supplemental screening series (Supplemental Series A [SSA], Supplemental Series B [SSB]). Demographics, characteristics, reaction strengths, relevance, and final interpretation were recorded. Results: Cohort included 791 patients; 73.5% female, 68.6% age >40 years. 74.1% were White, 15.2% Black, 5.7% Asian, and 1.5% Hispanic. The most common dermatitis sites were scattered/generalized (27.2%), face (24.0%), and hands (23.5%). For 2017-2018 and 2019-2020, respectively, 82% (318/388) and 78.4% (316/403) had ≥1 "allergic" reaction. In addition, 13.5% (52/385) and 11.7% (47/403) had SSA reactions, and 38.1% (115/302) and 31.5% (101/321) had SSB reactions. In the 87 (2017-2018) and 99 (2019-2020) patients with negative NACDG testing, 17 (19.5%) and 12 (12.1%) had supplemental reactions. Of the 34 supplemental allergens with reaction frequency ≥1%, 58.8% (20/34) are not part of the American Contact Dermatitis Society 90 (2020) or NACDG 2021-2022 screening series. The highest frequency allergens from this group were dodecyl and octyl gallate, cinnamic alcohol, phenyl salicylate, hexahydro-1,3,5-tris-(2-hydroxyethyl) triazine, and abitol. Conclusions: Supplemental patch testing identifies additional relevant allergens in patients with suspected allergic contact dermatitis.
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Affiliation(s)
- Amber Reck Atwater
- From the Departments of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Beiyu Liu
- Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
| | - Rabina Walsh
- From the Departments of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Raina Bembry
- From the Departments of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jordan Maxwell Ward
- From the Departments of Dermatology, Duke University Medical Center, Durham, North Carolina, USA
| | - Cynthia L Green
- Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, USA
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Bagheri K, Anastasio AT, Poehlein E, Green CL, Aitchison AH, Cantor N, Hendren S, Adams SB. Outcomes after total ankle arthroplasty with an average follow-up of 10 years: A systematic review and meta-analysis. Foot Ankle Surg 2024; 30:64-73. [PMID: 37775362 DOI: 10.1016/j.fas.2023.09.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The literature demonstrating positive outcomes after total ankle arthroplasty (TAA) is mounting. However, the long-term outcomes of TAA (≥ 10 years) remain minimally reported. The purpose of this systematic review and meta-analysis was to evaluate outcome metrics over multiple TAA studies with greater than 10 years of average follow-up. METHODS TAA studies were searched in Medline, Embase, and Scopus from the date of inception to September 12, 2022. Inclusion criteria included 1) studies of patients that underwent uncemented TAA, and 2) studies with an average follow-up time of at least ten years. Manuscripts in non-English languages and isolated abstracts were excluded. We collected American Orthopaedic Foot and Ankle Score (AOFAS) and Visual Analog Scale (VAS) scores from the included studies for pooled meta-analysis. Due to the varying definition of survivability between studies, this metric was not assessed in our final evaluation. RESULTS Our data included approximately 3651 patients (3782 ankles). Of the 25 studies with an average follow-up of 10 years included in the systematic review, 5 provided pre- and post-operative AOFAS means and 5 provided pre- and post-operative VAS means with associated measures of variability and were included in our meta-analysis. The weighted mean difference between pre-and post-operative AOFAS and VAS scores was -40.36 (95% CI -47.24 to -33.47) and 4.52 (95% CI: 2.26-6.43), respectively. The risk of bias was low to moderate for the included studies. CONCLUSION Outcomes following TAA are favorable and indicate patient-reported outcome improvement over long-term follow-up. However, a significant amount of heterogeneity exists between studies. Future, prospective, randomized research should focus on standardizing outcome measures, survivorship, and complication reporting methodologies to allow for pooled meta-analyses of these important outcome metrics.
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Affiliation(s)
- Kian Bagheri
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA; Campbell University School of Osteopathic Medicine, Lillington, NC, USA.
| | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Nicole Cantor
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | | | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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Lerman JB, Guidot DM, Green CL, Patel CB, Agarwal R, Sweitzer NK, Keenan JE, Milano CA, Schroder JN, DeVore AD. Longitudinal Trends in Donor and Recipient Risk Profile, and Clinical Outcomes, for Donation After Circulatory Death Heart Transplantation. Circ Heart Fail 2023; 16:e011213. [PMID: 37929577 PMCID: PMC10844982 DOI: 10.1161/circheartfailure.123.011213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Joseph B Lerman
- Division of Cardiology (J.B.L., C.B.P., R.A., A.D.D.), Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC (J.B.L., D.M.G., C.L.G., A.D.D.)
| | - Daniel M Guidot
- Duke Clinical Research Institute, Durham, NC (J.B.L., D.M.G., C.L.G., A.D.D.)
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics (C.L.G.), Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC (J.B.L., D.M.G., C.L.G., A.D.D.)
| | - Chetan B Patel
- Division of Cardiology (J.B.L., C.B.P., R.A., A.D.D.), Duke University School of Medicine, Durham, NC
| | - Richa Agarwal
- Division of Cardiology (J.B.L., C.B.P., R.A., A.D.D.), Duke University School of Medicine, Durham, NC
| | - Nancy K Sweitzer
- Department of Medicine, Washington University School of Medicine, St. Louis, MO (N.K.S.)
| | - Jeffrey E Keenan
- Department of Surgery (J.E.K., C.A.M., J.N.S.), Duke University School of Medicine, Durham, NC
| | - Carmelo A Milano
- Department of Surgery (J.E.K., C.A.M., J.N.S.), Duke University School of Medicine, Durham, NC
| | - Jacob N Schroder
- Department of Surgery (J.E.K., C.A.M., J.N.S.), Duke University School of Medicine, Durham, NC
| | - Adam D DeVore
- Division of Cardiology (J.B.L., C.B.P., R.A., A.D.D.), Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC (J.B.L., D.M.G., C.L.G., A.D.D.)
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Owolo E, Petitt Z, Rowe D, Luo E, Bishop B, Poehlein E, Green CL, Cook C, Erickson M, Goodwin CR. Sociodemographic Trends in Telemedicine Visit Completion in Spine Patients During the COVID-19 Pandemic. Spine (Phila Pa 1976) 2023; 48:1500-1507. [PMID: 37235789 DOI: 10.1097/brs.0000000000004617] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/11/2023] [Indexed: 05/28/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE This study identifies potential disparities in telemedicine utilization in the wake of the COVID-19 pandemic and its aftermath in patients receiving spine surgery. SUMMARY OF BACKGROUND DATA COVID-19 led to the rapid uptake of telemedicine in the spine surgery patient population. While previous studies in other medical subspecialties have identified sociodemographic disparities in telemedicine uptake, this is the first study to identify disparities in patients undergoing spine surgery. MATERIALS AND METHODS This study included patients who underwent spine surgery between June 12, 2018 and July 19, 2021. Patients were required to have at least one scheduled patient visit, either virtual (video or telephone visit) or in-person. Binary socioeconomic variables used for modeling included: urbanicity, age at the time of the procedure, sex, race, ethnicity, language, primary insurer, and patient portal utilization. Analyses were conducted for the entire cohort and separately for cohorts of patients who had visits scheduled within specific timeframes: Pre-COVID-19 surge, initial COVID-19 surge, and post-COVID-19 surge. RESULTS After adjusting for all variables in our multivariable analysis, patients who utilized the patient portal had higher odds of completing a video visit compared with those who did not (OR: 5.21; 95% CI: 1.28, 21.23). Hispanic patients (OR: 0.44; 95% CI: 0.2, 0.98) or those living in rural areas (OR: 0.58; 95% CI: 0.36, 0.93) had lower odds of completing a telephone visit. Patients with no insurance or on public insurance had higher odds of completing a virtual visit of either type (OR: 1.88; 95% CI: 1.10, 3.23). CONCLUSION This study demonstrates the disparity in telemedicine utilization across different populations within the surgical spine patient population. Surgeons may use this information to guide interventions aimed at reducing existing disparities and work with certain patient populations to find a solution.
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Affiliation(s)
- Edwin Owolo
- Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | - Zoey Petitt
- Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | - Dana Rowe
- Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | - Emily Luo
- Department of Neurosurgery, Duke University Medical Center, Durham, NC
| | - Brandon Bishop
- Kansas City University College of Osteopathic Medicine, Kansas City, MO
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Melissa Erickson
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC
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Sullivan AE, Holder TA, Beckman JA, Green CL, Patel MR, Fortin TA, Jones WS. Utility of electrocardiographic findings in acute pulmonary embolism. Eur Heart J Open 2023; 3:oead121. [PMID: 38105922 PMCID: PMC10724117 DOI: 10.1093/ehjopen/oead121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Alexander E Sullivan
- Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave S, Suite 5468A, Nashville, TN 37232, USA
| | - Tara A Holder
- Department of Medicine, Vanderbilt University Medical Center, 1215 21st Ave S, Suite 5468A, Nashville, TN 37232, USA
- Department of Medicine, Division of Cardiology, Prisma Health, Greenville, SC 29605, USA
| | - Joshua A Beckman
- Division of Vascular Medicine, Department of Medicine, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Cynthia L Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27701, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27701, USA
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27701, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Terry A Fortin
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 27701, USA
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
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Campbell KB, Eickman SD, Truong T, Black-Maier E, Barnett AS, Wang A, Green CL, Daubert JP, Lewis RK, Atwater BD, Al-Khatib SM, Bahnson TD, Thomas KL, Jackson KP, Jackson LR, Pokorney S, Frazier-Mills C, Piccini JP. Colchicine for the Prevention of Recurrent Arrhythmia After Catheter Ablation of Atrial Fibrillation: Results of a Single-Center, Retrospective Study. Am J Cardiovasc Drugs 2023; 23:709-719. [PMID: 37801260 DOI: 10.1007/s40256-023-00612-6] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND There is evidence to suggest that colchicine reduces the risk of recurrent atrial fibrillation (AF) after catheter ablation; however, the tolerability and safety of colchicine in routine practice is unknown. METHODS Patients undergoing catheter ablation for AF who received colchicine after ablation were matched 1:1 to patients who did not by age, sex, and renal function. Recurrent AF was compared between groups categorically at 12 months and via propensity weighted Cox proportional hazards models with and without a 3-month blanking period. RESULTS Overall, 180 patients (n = 90 colchicine and n = 90 matched controls) were followed for a median (Q1, Q3) of 10.3 (7.0, 12.0) months. Mean age was 65.3 ± 9.1 years, 33.9% were women, mean CHA2DS2-VASc score was 2.9 ± 1.5, and 51.1% had persistent AF. Most patients (70%) received colchicine 0.6 mg daily for a median of 30 days. In the colchicine group, 55 patients (61.1%) were receiving at least one known interacting medication with colchicine. After ablation, one patient required colchicine dose reduction and four patients required discontinuation. After adjusting for covariate imbalance using propensity weighting, no significant association between colchicine use and AF recurrence was identified (adjusted hazard ratio 0.94, 95% confidence interval [CI] 0.48-1.85; p = 0.853). No significant association was found between colchicine use and all-cause hospitalizations (adjusted odds ratio 0.74, 95% CI 0.28-1.96; p = 0.548). CONCLUSION Despite the frequent presence of drug-drug interactions, a 30-day course of colchicine is well-tolerated after AF ablation; however, we did not observe any association between colchicine and lower rates of AF recurrence or hospitalization.
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Affiliation(s)
- Kristen Bova Campbell
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA.
| | | | - Tracy Truong
- Duke Clinical Research Institute, Durham, NC, USA
- Duke Biostatistics, Epidemiology, and Research Design (BERD) Methods Core, Duke University Medical Center, Durham, NC, USA
| | - Eric Black-Maier
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Adam S Barnett
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Allen Wang
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Cynthia L Green
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - James P Daubert
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Robert K Lewis
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | | | - Sana M Al-Khatib
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Tristram D Bahnson
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Kevin L Thomas
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Kevin P Jackson
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Larry R Jackson
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Sean Pokorney
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Camille Frazier-Mills
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
| | - Jonathan P Piccini
- Duke University Medical Center (Electrophysiology), 2301 Erwin Road, 3174, Durham, NC, 27710, USA
- Duke Clinical Research Institute, Durham, NC, USA
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Lerman JB, Green CL, Molina MR, Maharaj V, Ortega-Legaspi JM, Sen S, Flattery M, Maziarz EK, Shah KB, Martin CM, Alexy T, Shah P, Morris AA, DeVore AD, Cole RT. Multicenter study of universal prophylaxis versus pre-emptive therapy for patients at intermediate risk (R+) for CMV following heart transplantation. Clin Transplant 2023; 37:e15065. [PMID: 37392192 PMCID: PMC10592402 DOI: 10.1111/ctr.15065] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Heart transplant (HT) recipients with prior exposure to cytomegalovirus (CMV R+) are considered intermediate risk for CMV-related complications. Consensus guidelines allow for either universal prophylaxis (UP) or preemptive therapy (PET) (serial CMV testing) approaches to CMV prevention in such patients. Whether an optimal approach to mitigate CMV related risks exists in this setting remains uncertain. We therefore assessed the utility of PET as compared to UP in CMV R+ HT recipients. METHODS Retrospective analysis of all CMV R+ HT recipients from 6 U.S. centers between 2010 and 2018 was performed. The primary outcome was the development of CMV DNAemia or end-organ disease resulting in the initiation/escalation of anti-CMV therapy. The secondary outcome was CMV-related hospitalization. Additional outcomes included incidence of acute cellular rejection (ACR) ≥ grade 2R, death, cardiac allograft vasculopathy (CAV), and leukopenia. RESULTS Of 563 CMV R+ HT recipients, 344 (61.1%) received UP. PET was associated with increased risk for the primary (adjusted HR 3.95, 95% CI: 2.65-5.88, p < .001) and secondary (adjusted HR 3.19, 95% CI: 1.47-6.94, p = .004) outcomes, and with increased ACR ≥ grade 2R (PET 59.4% vs. UP 34.4%, p < .001). Incidence of detectable CAV was similar at 1 year (PET 8.2% vs. UP 9.5%, p = .698). UP was associated with increased incidence of leukopenia within 6 months post-HT (PET 34.7% vs. UP 43.6%, p = .036). CONCLUSION The use of a PET CMV prophylaxis strategy in intermediate risk HT recipients associated with increased risk of CMV infection and CMV-related hospitalization, and may associate with worse post-HT graft outcomes.
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Affiliation(s)
- Joseph B. Lerman
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Cynthia L. Green
- Duke Clinical Research Institute, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Maria R. Molina
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Valmiki Maharaj
- Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Juan M. Ortega-Legaspi
- Department of Medicine, Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Maureen Flattery
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - Eileen K. Maziarz
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC
| | - Keyur B. Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA
| | - Cindy M. Martin
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, TX
| | - Tamas Alexy
- Division of Cardiology, University of Minnesota, Minneapolis, MN
| | - Palak Shah
- Heart Failure, MCS and Transplant, Inova Heart and Vascular Institute, Falls Church, VA
| | - Alanna A. Morris
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Adam D. DeVore
- Division of Cardiology, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Robert T. Cole
- Samsky Advanced Heart Failure Center, Piedmont Heart Institute, Atlanta, GA
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Navuluri N, Lagat DK, Birgen E, Kitur S, Kussin PS, Murdoch DM, Thielman NM, Parish A, Green CL, MacIntyre N, Egger JR, Wools-Kaloustian K, Que LG. Prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya: a single-centre, prospective cohort study. BMJ Open 2023; 13:e072111. [PMID: 37723111 PMCID: PMC10510888 DOI: 10.1136/bmjopen-2023-072111] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Global medical oxygen security is limited by knowledge gaps in hypoxaemia burden and oxygen access in low-income and middle-income countries. We examined the prevalence and phenotypic trajectories of hypoxaemia among hospitalised adults in Kenya, with a focus on chronic hypoxaemia. DESIGN Single-centre, prospective cohort study. SETTING National tertiary referral hospital in Eldoret, Kenya between September 2019 and April 2022. PARTICIPANTS Adults (age ≥18 years) admitted to general medicine wards. PRIMARY AND SECONDARY OUTCOME MEASURES Our primary outcome was proportion of patients who were hypoxaemic (oxygen saturation, SpO2 ≤88%) on admission. Secondary outcomes were proportion of patients with hypoxaemia on admission who had hypoxaemia resolution, hospital discharge, transfer, or death among those with unresolved hypoxaemia or chronic hypoxaemia. Patients remaining hypoxaemic for ≤3 days after admission were enrolled into an additional cohort to determine chronic hypoxaemia. Chronic hypoxaemia was defined as an SpO2 ≤ 88% at either 1-month post-discharge follow-up or, for patients who died prior to follow-up, a documented SpO2 ≤88% during a previous hospital discharge or outpatient visit within the last 6 months. RESULTS We screened 4104 patients (48.5% female, mean age 49.4±19.4 years), of whom 23.8% were hypoxaemic on admission. Hypoxaemic patients were significantly older and more predominantly female than normoxaemic patients. Among those hypoxaemic on admission, 33.9% had resolution of their hypoxaemia as inpatients, 55.6% had unresolved hypoxaemia (31.0% died before hospital discharge, 13.3% were alive on discharge and 11.4% were transferred) and 10.4% were lost to follow-up. The prevalence of chronic hypoxaemia was 2.1% in the total screened population, representing 8.8% of patients who were hypoxaemic on admission. Chronic hypoxaemia was determined at 1-month post-discharge among 59/86 patients and based on prior documentation among 27/86 patients. CONCLUSION Hypoxaemia is highly prevalent among adults admitted to a general medicine ward at a national referral hospital in Kenya. Nearly 1 in 11 patients who are hypoxaemic on admission are chronically hypoxaemic.
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Affiliation(s)
- Neelima Navuluri
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - David K Lagat
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Elcy Birgen
- Duke Global Health Institute, Durham, North Carolina, USA
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Sylvia Kitur
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Peter S Kussin
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David M Murdoch
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nathan M Thielman
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Neil MacIntyre
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joseph R Egger
- Duke Global Health Institute, Durham, North Carolina, USA
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Loretta G Que
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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19
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Pratt EH, Morrison S, Green CL, Rackley CR. Ability of the respiratory ECMO survival prediction (RESP) score to predict survival for patients with COVID-19 ARDS and non-COVID-19 ARDS: a single-center retrospective study. J Intensive Care 2023; 11:37. [PMID: 37658447 PMCID: PMC10472724 DOI: 10.1186/s40560-023-00686-z] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/25/2023] [Indexed: 09/03/2023] Open
Abstract
The respiratory ECMO survival prediction (RESP) score is used to predict survival for patients managed with extracorporeal membrane oxygenation (ECMO), but its performance in patients with Coronavirus Disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is unclear. We evaluated the ability of the RESP score to predict survival for patients with both non-COVID 19 ARDS and COVID-19 ARDS managed with ECMO at our institution. Receiver operating characteristic area under the curve (AUC) analysis found the RESP score reasonably predicted survival in patients with non-COVID-19 ARDS (AUC 0.76, 95% CI 0.68-0.83), but not patients with COVID-19 ARDS (AUC 0.54, 95% CI 0.41-0.66).
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Affiliation(s)
- Elias H Pratt
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA.
| | - Samantha Morrison
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Craig R Rackley
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, Durham, NC, USA
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20
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Sooy-Mossey M, DeRusso M, Green CL, Best DL. Sudden cardiac arrest response preparedness in Durham County schools. Cardiol Young 2023; 33:1561-1568. [PMID: 36047061 DOI: 10.1017/s1047951122002815] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sudden cardiac arrest is an uncommon event with high morbidity and mortality. There are improved outcomes with early access to an automated external defibrillator and cardiopulmonary resuscitation. We assessed the availability of automated external defibrillators and emergency cardiac arrest plans in schools. A cross-sectional electronic survey was conducted to determine the status of emergency cardiac arrest plans and automated external defibrillator presence. Most schools (88%) had access to an automated external defibrillator; however, trained staff and maintenance plans were highly variable. Automated external defibrillator availability did not differ by racial/ethnic or socio-economic composition; however, there was a relationship between number of automated external defibrillators and student population (p = 0.0030). The majority of schools either did not have (28%) or did not know if they had (36%) an emergency cardiac arrest plan. Even without state legislation, automated external defibrillators were largely available in schools. However, there remains a paucity of emergency cardiac arrest plans and automated external defibrillator maintenance plans.
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Affiliation(s)
- Meredith Sooy-Mossey
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University School of Medicine, 2301 Erwin Road, DUMC Box 3127, Durham, NC 27710, USA
| | - Michelle DeRusso
- Department of Pediatrics, Duke University, 2301 Erwin Road, DUMC Box 3046, Durham, NC 27710, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Duke Clinical Research Institute, 200 Morris St, Durham, NC 27701, USA
| | - Debra L Best
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Duke University, 2301 Erwin Rd. DUMC Box 3675, Durham, NC 27710, USA
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21
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Meservey A, Krishnan G, Green CL, Morrison S, Rackley CR, Kraft BD. U-Shaped Association Between Carboxyhemoglobin and Mortality in Patients With Acute Respiratory Distress Syndrome on Venovenous Extracorporeal Membrane Oxygenation. Crit Care Explor 2023; 5:e0957. [PMID: 37614802 PMCID: PMC10443764 DOI: 10.1097/cce.0000000000000957] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Background Carbon monoxide (CO) is an endogenous signaling molecule that activates cytoprotective programs implicated in the resolution of acute respiratory distress syndrome (ARDS) and survival of critical illness. Because CO levels can be measured in blood as carboxyhemoglobin, we hypothesized that carboxyhemoglobin percent (COHb%) may associate with mortality. OBJECTIVES To examine the relationship between COHb% and outcomes in patients with ARDS requiring venovenous extracorporeal membrane oxygenation (ECMO), a condition where elevated COHb% is commonly observed. DESIGN Retrospective cohort study. SETTING Academic medical center ICU. PATIENTS Patients were included that had ARDS on venovenous ECMO. MEASUREMENTS AND MAIN RESULTS We examined the association between COHb% and mortality using a Cox proportional hazards model. Secondary outcomes including ECMO duration, ventilator weaning, and hospital and ICU length of stay were examined using both subdistribution and causal-specific hazard models for competing risks. We identified 109 consecutive patients for analysis. Mortality significantly decreased per 1 U increase in COHb% below 3.25% (hazard ratio [HR], 0.35; 95% CI, 0.15-0.80; p = 0.013) and increased per 1 U increase above 3.25% (HR, 4.7; 95% CI, 1.5-14.7; p = 0.007) reflecting a nonlinear association (p = 0.006). Each unit increase in COHb% was associated with reduced likelihood of liberation from ECMO and mechanical ventilation, and increased time to hospital and ICU discharge (all p < 0.05). COHb% was significantly associated with hemolysis but not with initiation of hemodialysis or blood transfusions. CONCLUSIONS In patients with ARDS on venovenous ECMO, COHb% is a novel biomarker for mortality exhibiting a U-shaped pattern. Our findings suggest that too little CO (perhaps due to impaired host signaling) or excess CO (perhaps due to hemolysis) is associated with higher mortality. Patients with low COHb% may exhibit the most benefit from future therapies targeting anti-oxidant and anti-inflammatory pathways such as low-dose inhaled CO gas.
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Affiliation(s)
- Amber Meservey
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Govind Krishnan
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Samantha Morrison
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Craig R Rackley
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Bryan D Kraft
- Department of Medicine, Duke University School of Medicine, Durham, NC
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22
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Petty AJ, Emge DA, Blanchard SK, Selim MA, Scoggins K, Liu B, Green CL, Cardones AR. Pilot, open-label, single-arm clinical trial evaluating the efficacy of topical crisaborole for steroid refractory morphea. J Am Acad Dermatol 2023; 89:390-392. [PMID: 37054813 DOI: 10.1016/j.jaad.2023.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Affiliation(s)
- Amy J Petty
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Drew A Emge
- Department of Dermatology, Duke University, Durham, North Carolina
| | | | - Maria Angelica Selim
- Division of Dermatopathology, Department of Pathology, Duke University, Durham, North Carolina
| | - Kim Scoggins
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Adela R Cardones
- Division of Dermatology, Department of Internal Medicine, University of Kansas, Medical Center, Kansas City, Kansas.
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23
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Roggl VL, Green CL, Liu B, Carney JM, Glass CH, Pavlisko EN. Chronological trends in the causation of malignant mesothelioma: Fiber burden analysis of 619 cases over four decades. Environ Res 2023; 230:114530. [PMID: 36965800 PMCID: PMC10542945 DOI: 10.1016/j.envres.2022.114530] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/05/2022] [Indexed: 05/30/2023]
Abstract
Malignant mesothelioma is a relatively rare malignancy with a strong association with prior asbestos exposure. A percentage of cases is not related to asbestos, and fiber analysis of lung tissue is a useful methodology for identifying idiopathic or spontaneous cases. We have performed fiber analyses in more than 600 cases of mesothelioma over the past four decades and were interested in looking for trends in terms of fiber types and concentrations as well as percentages of cases not related to asbestos. Demographic information was also considered including patient age, gender, and tumor location (pleural vs. peritoneal). The histologic pattern of the tumor and the presence or absence of pleural plaques or asbestosis were noted. Fiber analysis was performed in 619 cases, using the sodium hypochlorite technique for digestion of lung tissue samples. Asbestos bodies were counted by light microscopy (LM) and coated and uncoated fibers by scanning electron microscopy (EM). The results were stratified over four decades. Trends that were observed included increasing patient age, increasing percentage of women, increasing percentage of peritoneal cases, and increasing percentage of epithelial histological type. There was a decreasing trend in the percentage of patients with concomitant asbestosis (p < 0.001). The percentage of cases with an elevated lung asbestos content decreased from 90.5% in the 1980s to 54.1% in the 2010s (p < 0.001). This trend also held when the analysis was limited to 490 cases of pleural mesothelioma in men (91.8% in the 1980s vs. 65.1% in the 2010s). There was a decrease in the median asbestos body count by LM from 1390 asbestos bodies per gram of wet lung in the 1980s to 38 AB/gm in the 2010s. Similar trends were observed for each of the asbestos fiber types as detected by EM. We conclude that there has been a progressive decrease in lung fiber content of mesothelioma patients during the past four decades, with an increasing percentage of cases not related to asbestos and an increase in median patient age.
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Affiliation(s)
- Victor L Roggl
- Department of Pathology, Duke University Medical Center, Durham, NC, 27710, USA.
| | - Cynthia L Green
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, 27710, USA
| | - Beiyu Liu
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, NC, 27710, USA
| | - John M Carney
- Department of Pathology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Carolyn H Glass
- Department of Pathology, Duke University Medical Center, Durham, NC, 27710, USA
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24
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Kittipibul V, Ganesh A, Coburn A, Coyne BJ, Gray JM, Molinger J, Ray N, Podgoreanu M, McCartney SL, Mamoun N, Fitzhugh RC, Lurz P, Green CL, Hernandez AF, Patel MR, Fudim M. Splanchnic Nerve Modulation Effects on Surrogate Measures of Venous Capacitance. J Am Heart Assoc 2023:e028780. [PMID: 37449573 PMCID: PMC10382122 DOI: 10.1161/jaha.122.028780] [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: 11/07/2022] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Background Splanchnic nerve modulation (SNM) is an emerging procedure to reduce cardiac filling pressures in heart failure. Although the main contributor to reduction in cardiac preload is thought to be increased venous capacitance in the splanchnic circulation, supporting evidence is limited. We examined changes in venous capacitance surrogates pre- and post-SNM. Methods and Results This is a prespecified analysis of a prospective, open-label, single-arm interventional study evaluating the effects of percutaneous SNM with ropivacaine in chronic heart failure with elevated filling pressures at rest and with exercise. Patients underwent cardiopulmonary exercise testing with invasive hemodynamic assessment pre- and post-SNM. Blood pressure changes with modified Valsalva maneuver and hemoconcentration, pre- and post-SNM were compared using a repeated measures model. Inferior vena cava diameter and collapsibility (>50% decrease in size with inspiration), and presence of bendopnea pre- and post-SNM were also compared. Fifteen patients undergoing SNM (age 58 years, 47% women, 93% with left ventricular ejection fraction ≤35%) were included. After SNM, changes in systolic blood pressure during Valsalva (peak-to-trough) were greater (41 versus 48 mm Hg, P=0.025). Exercise-induced hemoconcentration was unchanged (0.63 versus 0.43 g/dL, P=0.115). Inferior vena cava diameter was reduced (1.59 versus 1.30 cm, P=0.034) with higher collapsibility (33% versus 73%, P=0.014). Bendopnea was less (47% versus 13%, P=0.025). Conclusions SNM resulted in increased venous capacitance, associated decreased cardiac preload, and decreased bendopnea. Minimally invasive measures of venous capacitance could serve as markers of successful SNM. Long-term effects of SNM on venous capacitance warrant further investigation for heart failure management. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03453151.
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Affiliation(s)
| | - Arun Ganesh
- Department of Anesthesiology Duke University Medical Center Durham NC
| | - Aubrie Coburn
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - Brian J Coyne
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - James Matthew Gray
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - Jeroen Molinger
- Division of Cardiology, Department of Medicine Duke University Durham NC
| | - Neil Ray
- Department of Anesthesiology Duke University Medical Center Durham NC
| | - Mihai Podgoreanu
- Department of Anesthesiology Duke University Medical Center Durham NC
| | | | - Negmeldeen Mamoun
- Department of Anesthesiology Duke University Medical Center Durham NC
| | | | - Philipp Lurz
- Heart Center Leipzig at University Leipzig Leipzig Germany
| | - Cynthia L Green
- Biostatistics and Bioinformatics Duke University Medical Center Durham NC
- Duke Clinical Research Institute Durham NC
| | - Adrian F Hernandez
- Division of Cardiology, Department of Medicine Duke University Durham NC
- Duke Clinical Research Institute Durham NC
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine Duke University Durham NC
- Duke Clinical Research Institute Durham NC
| | - Marat Fudim
- Division of Cardiology, Department of Medicine Duke University Durham NC
- Duke Clinical Research Institute Durham NC
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25
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Rhon DI, Greenlee TA, Poehlein E, Beneciuk JM, Green CL, Hando BR, Childs JD, George SZ. Effect of Risk-Stratified Care on Disability Among Adults With Low Back Pain Treated in the Military Health System: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2321929. [PMID: 37410465 DOI: 10.1001/jamanetworkopen.2023.21929] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Importance Tailored treatments for low back pain (LBP) based on stratifying risk for poor prognosis have emerged as a promising approach to improve quality of care, but they have not been validated in trials at the level of individual randomization in US health systems. Objective To assess the clinical effectiveness of risk-stratified vs usual care on disability at 1 year among patients with LBP. Design, Setting, and Participants This parallel-group randomized clinical trial enrolled adults (ages 18-50 years) seeking care for LBP with any duration in primary care clinics within the Military Health System from April 2017 to February 2020. Data analysis was conducted from January to December 2022. Interventions Risk-stratified care, in which participants received physiotherapy treatment tailored for their risk category (low, medium, or high), or usual care, in which care was determined by participants' general practitioners and may have included a referral to physiotherapy. Main Outcomes and Measures The primary outcome was the Roland Morris Disability Questionnaire (RMDQ) score at 1 year, with planned secondary outcomes of Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) and Physical Function (PF) scores. Raw downstream health care utilization was also reported within each group. Results Analysis included 270 participants (99 [34.1%] female participants; mean [SD] age, 34.1 [8.5] years). Only 21 patients (7.2%) were classified as high risk. Neither group was superior on the RMDQ (least squares [LS] mean ratio of risk-stratified vs usual care: 1.00; 95% CI, 0.80 to 1.26), the PROMIS PI (LS mean difference, -0.75 points; 95% CI -2.61 to 1.11 points), or the PROMIS PF (LS mean difference, 0.05 points; 95% CI, -1.66 to 1.76 points). Conclusions and Relevance In this randomized clinical trial, using risk stratification to categorize and provide tailored treatment for patients with LBP did not result in better outcomes at 1 year compared with usual care. Trial Registration ClinicalTrials.gov Identifier: NCT03127826.
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Affiliation(s)
- Daniel I Rhon
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
- Department of Rehabilitation Medicine, Uniformed Services University, Bethesda, Maryland
| | - Tina A Greenlee
- Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Fort Sam Houston, Texas
| | - Emily Poehlein
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Jason M Beneciuk
- Department of Physical Therapy, College of Public Health & Health Professions, University of Florida, Gainesville
- Brooks Rehabilitation Clinical Research Center, Jacksonville, Florida
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics and Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Ben R Hando
- Department of Orthopaedics and Rehabilitation, Wilford Hall Ambulatory Surgical Center, JBSA Lackland, Texas
| | | | - Steven Z George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, School of Medicine, Durham, North Carolina
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26
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Catanzano AA, Hutyra C, Risoli TJ, Green CL, Mather RC, Alman B. Cast or Nail? Using a Preference-Based Tool for Shared Decision-Making in Pediatric Femoral Shaft Fracture Treatment. J Pediatr Orthop 2023:01241398-990000000-00316. [PMID: 37390506 DOI: 10.1097/bpo.0000000000002463] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND Femoral shaft fractures are common injuries in children 2 to 7 years of age, with treatments ranging from casting to flexible intramedullary nails (FIN). Each treatment has unique attributes and outcomes are overall similar. Given equivalent outcomes, we hypothesized that a shared decision-making process, using adaptive conjoint analysis (ACA), can be used to assess individual family situations to determine ultimate treatment choice. METHODS An interactive survey incorporating an ACA exercise to elicit the preferences of individuals was created. Amazon Mechanical Turk was used to recruit survey respondents simulating the at-risk population. Basic demographic information and family characteristics were collected. Sawtooth Software was utilized to generate relative importance values of five treatment attributes and determine subjects' ultimate treatment choice. Student's t-test or Wilcoxon rank sum test was used to compare relative importance between groups. RESULTS The final analysis included 186 subjects with 147 (79%) choosing casting as their ultimate treatment choice, while 39 (21%) chose FIN. Need for second surgery had the highest overall average relative importance (42.0), followed by a chance of serious complications (24.6), time away from school (12.9), effort required by caregivers (11.0), and return to activities (9.6). Most respondents (85%) indicated the generated relative importance of attributes aligned "very well or well" with their preferences. For those who chose casting instead of FIN, the need for secondary surgery (43.9 vs. 34.8, P<0.001) and the chance of serious complications (25.9 vs. 19.6, P<0.001) were the most important factors. In addition, returning to activities, the burden to caregivers, and time away from school were all significantly more important to those choosing surgery versus casting (12.6 vs. 8.7 P<0.001, 12.6 vs. 9.8 P=0.014, 16.6 vs. 11.7 P<0.001, respectively). CONCLUSIONS Our decision-making tool accurately identified subjects' treatment preferences and appropriately aligned them with a treatment decision. Given the increased emphasis on shared decision-making in health care, this tool may have the potential to improve shared decision-making and family understanding, leading to improved satisfaction rates and overall outcomes. LEVEL OF EVIDENCE Level-III.
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Affiliation(s)
| | | | | | - Cynthia L Green
- Division of Biostatistics, Department of Biostatistics, Epidemiology, and Research Design (BERD) Methods Core, Durham, NC
| | - R Chad Mather
- Department of Orthopaedic Surgery, Duke University Health System
| | - Benjamin Alman
- Department of Orthopaedic Surgery, Duke University Health System
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27
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Diamond C, Cardones AR, Liu B, Green CL, Lesesky E. Effects of virtual interviews on dermatology match trends: a retrospective cohort analysis. Dermatol Online J 2023; 29. [PMID: 37591278 DOI: 10.5070/d329361438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/23/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Carrie Diamond
- Duke University School of Medicine, Durham, North Carolina, USA
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28
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Navuluri N, Morrison S, Green CL, Woolson SL, Riley IL, Cox CE, Zullig LL, Shofer S. Racial Disparities in Lung Cancer Screening Among Veterans, 2013 to 2021. JAMA Netw Open 2023; 6:e2318795. [PMID: 37326987 PMCID: PMC10276308 DOI: 10.1001/jamanetworkopen.2023.18795] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Racial disparities in lung cancer screening (LCS) are often ascribed to barriers such as cost, insurance status, access to care, and transportation. Because these barriers are minimized within the Veterans Affairs system, there is a question of whether similar racial disparities exist within a Veterans Affairs health care system in North Carolina. Objectives To examine whether racial disparities in completing LCS after referral exist at the Durham Veterans Affairs Health Care System (DVAHCS) and, if so, what factors are associated with screening completion. Design, Setting, and Participants This cross-sectional study assessed veterans referred to LCS between July 1, 2013, and August 31, 2021, at the DVAHCS. All included veterans self-identified as White or Black and met the US Preventive Services Task Force eligibility criteria as of January 1, 2021. Participants who died within 15 months of consultation or who were screened before consultation were excluded. Exposures Self-reported race. Main Outcomes and Measures Screening completion was defined as completing computed tomography for LCS. The associations among screening completion, race, and demographic and socioeconomic risk factors were assessed using logistic regression models. Results A total of 4562 veterans (mean [SD] age, 65.4 [5.7] years; 4296 [94.2%] male; 1766 [38.7%] Black and 2796 [61.3%] White) were referred for LCS. Of all veterans referred, 1692 (37.1%) ultimately completed screening; 2707 (59.3%) never connected with the LCS program after referral and an informational mailer or telephone call, indicating a critical point in the LCS process. Screening rates were substantially lower among Black compared with White veterans (538 [30.5%] vs 1154 [41.3%]), with Black veterans having 0.66 times lower odds (95% CI, 0.54-0.80) of screening completion after adjusting for demographic and socioeconomic factors. Conclusions and Relevance This cross-sectional study found that after referral for initial LCS via a centralized program, Black veterans had 34% lower odds of LCS screening completion compared with White veterans, a disparity that persisted even after accounting for numerous demographic and socioeconomic factors. A critical point in the screening process was when veterans must connect with the screening program after referral. These findings may be used to design, implement, and evaluate interventions to improve LCS rates among Black veterans.
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Affiliation(s)
- Neelima Navuluri
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Samantha Morrison
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia L. Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | | | - Isaretta L. Riley
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Christopher E. Cox
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Leah L. Zullig
- Durham Veterans Affairs Medical Center, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Scott Shofer
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
- Durham Veterans Affairs Medical Center, Durham, North Carolina
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Sullivan AE, Barbery CE, Holder T, Green CL, Patel MR, Thomas KL, Jones WS. Association of race and in-hospital outcomes following acute pulmonary embolism: A retrospective cohort study. Clin Cardiol 2023. [PMID: 37255216 DOI: 10.1002/clc.24055] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Racial disparities in health care are well established, with Black patients frequently experiencing the most significant consequences of this inequality. Acute pulmonary embolism (PE) is increasing in incidence and an important cause of morbidity and mortality in the United States, but little is known about racial disparities in the inpatient setting. HYPOTHESIS Black and White patients admitted with acute PE will have different in-hospital outcomes. METHODS All PE patients from January 1, 2016 to June 30, 2017 were retrospectively identified using ICD-10 codes. Data were abstracted by manual chart review for all image-confirmed PEs. RESULTS A total of 782 patients with acute PE were identified, of which 319 (40.8%) were Black and 463 (59.2%) were White. Black patients had higher BMI (median [Q1-Q3]: 30.3 [25.4-36.6] vs. 29.3 [24.5-33.8] kg/m2 , p = .017), were younger (61 [48-74] vs. 67 [54-75] years, p = .001), and were more likely to have a history of heart failure (16.0 vs. 7.1%, p < .001), while White patients had higher rates of malignancy (46.9 vs. 34.5%, p = .001) and recent surgery (29.6 vs. 18.2%, p < .001). Black patients were more likely to receive systemic thrombolysis (3.1% vs. 1.1%, p = .040), while White patients had numerically higher rates of surgical embolectomy (0.3% vs. 1.1%, p = .41). No difference in inpatient mortality was observed; however, Black patients had longer hospital length of stay (5.0 [3-9] vs. 4.0 [2-9] days, p = .007) and were more likely to receive warfarin (23.5 vs. 12.1%, p < .001). CONCLUSIONS Similar in-hospital mortality rates were observed in Black and White patients following acute PE. However, Black patients had longer hospital stays, higher warfarin prescription, and fewer traditional PE-related risk factors.
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Affiliation(s)
- Alexander E Sullivan
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carlos E Barbery
- Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tara Holder
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Cynthia L Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kevin L Thomas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
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Grier AJ, Chen KJ, Paul AV, Green CL, Richard MJ, Ruch DS, Pidgeon TS. Impact of Time to Fixation on Outcomes of Operative Treatment of Intra-articular Distal Radius Fractures. Hand (N Y) 2023:15589447231174642. [PMID: 37243339 DOI: 10.1177/15589447231174642] [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] [Indexed: 05/28/2023]
Abstract
BACKGROUND The incidence of operative treatment of distal radius fractures (DRFs) has increased recently, but the optimal timing for surgical fixation remains unclear. We hypothesized that: (1) an increase in time to fixation of intra-articular DRFs would increase the likelihood of postoperative complications; and (2) increased time from injury to fixation would lead to longer surgical time and worse range of motion (ROM) outcomes. METHODS We retrospectively reviewed 299 fractures in 284 adult patients who underwent open reduction and internal fixation (ORIF) of a closed, intra-articular DRF at our institution over a 10.5-year period. Demographic information, time to surgery (TTS) from injury, surgical time, tourniquet time, complications, and final postoperative ROM were collected for logistic regression modeling to predict the risk of postoperative complication. RESULTS Twenty-seven (9.0%) patients experienced postoperative complications. The median TTS (Q1-Q3) for all patients was 7.0 (4.0-12.0) days. Patients who experienced an early postoperative complication had significantly longer median TTS (10.0 days) than those who did not (7.0 days). Patients with longer TTS were more likely to experience a complication (odds ratio, 1.11; 95% confidence interval, 1.04-1.19; P = .006). Tourniquet time and final wrist ROM were not related to TTS. A logistic regression analysis found that early complication rate doubles at 7.0 days after injury (from 3.5% to 6.9%). CONCLUSIONS Patients with operative intra-articular distal radius fractures should ideally be fixed within 7 to 10 days of injury to minimize the risk of early postoperative complications. The tourniquet time and final ROM were not associated with time to surgery.
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Affiliation(s)
| | - Kallie J Chen
- University Hospitals Cleveland Medical Center, OH, USA
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Morriss NJ, Kim BI, Poehlein E, Park CN, Lentz TA, Green CL, Lau BC. Association Between Preoperative Multidimensional Psychological Distress and Physical Function After Surgery for Sports-Related Injury. Orthop J Sports Med 2023; 11:23259671231163854. [PMID: 37113137 PMCID: PMC10126611 DOI: 10.1177/23259671231163854] [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: 12/14/2022] [Accepted: 01/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background Psychological distress after orthopaedic surgery can lead to worse outcomes, including higher levels of disability and pain and lower quality of life. The 10-item Optimal Screening for Prediction for Referral and Outcome-Yellow Flag (OSPRO-YF) survey screens for multiple psychological constructs relevant to recovery from orthopaedic injury and may be useful to preoperatively identify patients who may require further psychological assessment and possible intervention after surgery. Purpose/Hypothesis To determine the association between the OSPRO-YF and physiological patient-reported outcomes (PROs). It was hypothesized that higher OSPRO-YF scores (indicating worse psychological distress) would be associated with worse PRO scores at time of return to sport. Study Design Case series; Level of evidence, 4. Methods This study evaluated 107 patients at a single, academic health center who were assessed at a sports orthopaedics clinic and ultimately treated surgically for injuries to the knee, shoulder, foot, or ankle. Preoperatively, patients completed the OSPRO-YF survey as well as the following PRO measures: Patient-Reported Outcomes Measurement Information System (PROMIS), Single Assessment Numeric Evaluation, numeric rating scale for pain; American Shoulder and Elbow Surgeons standardized shoulder assessment form for patients with shoulder injuries, the International Knee Documentation Committee score (for patients with knee injuries), and the Foot and Ankle Ability Measure (FAAM; for patients with foot or ankle injuries). At the time of anticipated full recovery and/or return to sport, patients again completed the same PRO surveys. Multivariable regression was used to evaluate the association between total OSPRO-YF score at baseline and PRO scores at the time of functional recovery. Results The baseline OSPRO-YF score predicted postoperative PROMIS Physical Function and FAAM Sports scores only. A 1-unit increase in the OSPRO-YF was associated with a 0.55-point reduction in PROMIS Physical Function (95% CI, -1.05 to -0.04; P = .033) indicating worse outcomes. Among patients who underwent ankle surgery, a 1-unit increase in OSPRO-YF was associated with a 6.45-point reduction in FAAM Sports (95% CI, -12.0 to -0.87; P = .023). Conclusion The study findings demonstrated that the OSPRO-YF survey predicts certain long-term PRO scores at the time of expected return to sport, independent of baseline scores.
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Affiliation(s)
- Nicholas J. Morriss
- Duke University School of Medicine,
Durham, North Carolina, USA
- Nicholas J. Morriss, BA,
Duke University School of Medicine, Duke University Medical Center, 200 Trent
Drive, Durham, NC 27710, USA (
)
| | - Billy I. Kim
- Duke University School of Medicine,
Durham, North Carolina, USA
| | - Emily Poehlein
- Department of Biostatistics and
Bioinformatics, Duke University School of Medicine Durham, North Carolina,
USA
| | - Caroline N. Park
- Department of Orthopaedic Surgery, Duke
University School of Medicine, Durham, North Carolina, USA
| | - Trevor A. Lentz
- Department of Orthopaedic Surgery, Duke
University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke
University, Durham, North Carolina, USA
| | - Cynthia L. Green
- Department of Biostatistics and
Bioinformatics, Duke University School of Medicine Durham, North Carolina,
USA
- Duke Clinical Research Institute, Duke
University, Durham, North Carolina, USA
| | - Brian C. Lau
- Department of Orthopaedic Surgery, Duke
University School of Medicine, Durham, North Carolina, USA
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Green CL, Gulack BC, Keshavjee S, Singer LG, McCurry K, Budev MM, Reece TL, Lidor AO, Palmer SM, Davis RD. Reflux Surgery in Lung Transplantation: A Multicenter Retrospective Study. Ann Thorac Surg 2023; 115:1024-1032. [PMID: 36216086 DOI: 10.1016/j.athoracsur.2022.09.037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/06/2022] [Accepted: 09/26/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aspiration has been associated with graft dysfunction after lung transplantation, leading some to advocate for selective use of fundoplication despite minimal data supporting this practice. METHODS We performed a multicenter retrospective study at 4 academic lung transplant centers to determine the association of gastroesophageal reflux disease and fundoplication with bronchiolitis obliterans syndrome and survival using Cox multivariable regression. RESULTS Of 542 patients, 136 (25.1%) underwent fundoplication; 99 (18%) were found to have reflux disease without undergoing fundoplication. Blanking the first year after transplantation, fundoplication was not associated with a benefit regarding freedom from bronchiolitis obliterans syndrome (hazard ratio [HR], 0.93; 95% CI, 0.58-1.49) or death (HR, 0.97; 95% CI, 0.47-1.99) compared with reflux disease without fundoplication. However, a time-dependent adjusted analysis found a slight decrease in mortality (HR, 0.59; 95% CI, 0.28-1.23; P = .157), bronchiolitis obliterans syndrome (HR, 0.68; 95% CI, 0.42-1.11; P = .126), and combined bronchiolitis obliterans syndrome or death (HR, 0.66; 95% CI, 0.42-1.04; P = .073) in the fundoplication group compared with the gastroesophageal reflux disease group. CONCLUSIONS Although a statistically significant benefit from fundoplication was not determined because of limited sample size, follow-up, and potential for selection bias, a randomized, prospective study is still warranted.
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Affiliation(s)
- Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
| | - Brian C Gulack
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Shaf Keshavjee
- Toronto Lung Transplant Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Lianne G Singer
- Toronto Lung Transplant Program, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Kenneth McCurry
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Marie M Budev
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Tammy L Reece
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Anne O Lidor
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Scott M Palmer
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - R Duane Davis
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Navuluri N, Morrison S, Green CL, Zullig LL, Woolson SL, Cox C, Riley I, Shofer S. YIA23-091: Disparities in Lung Cancer Screening Among Black Veterans. J Natl Compr Canc Netw 2023. [DOI: 10.6004/jnccn.2022.7120] [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] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Jiang SW, Petty AJ, Jacobs JL, Robinson C, Bhatia SM, Kwock JT, Liu B, Green CL, Hall RP, Cardones AR, Jaleel T. Association between age at symptom onset and disease severity in older patients with hidradenitis suppurativa. Br J Dermatol 2023; 188:555-576. [PMID: 36715616 PMCID: PMC10561667 DOI: 10.1093/bjd/ljac121] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/22/2023]
Affiliation(s)
| | | | | | | | | | | | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27701, USA
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27701, USA
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Gorecki MC, Perrin EM, Orr CJ, White MJ, Yin HS, Sanders LM, Rothman RL, Delamater AM, Truong T, Green CL, Flower KB. Feeding, television, and sleep behaviors at one year of age in a diverse sample. Obes Pillars 2023; 5:100051. [PMID: 37990745 PMCID: PMC10662021 DOI: 10.1016/j.obpill.2022.100051] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 11/23/2023]
Abstract
Background Healthy lifestyle behaviors that can prevent adverse health outcomes, including obesity, are formed in early childhood. This study describes feeding, television, and sleep behaviors among one-year-old infants and examines differences by sociodemographic factors. Methods Caregivers of one-year-olds presenting for well care at two clinics, control sites for the Greenlight Study, were queried about feeding, television time, and sleep. Adjusted associations between sociodemographic factors and behaviors were performed by modified Poisson (binary), multinomial logistic (multi-category), or linear (continuous) regression models. Results Of 235 one-year-olds enrolled, 81% had Medicaid, and 45% were Hispanic, 36% non-Hispanic Black, 19% non-Hispanic White. Common behaviors included 20% exclusive bottle use, 32% put to bed with bottle, mean daily juice intake of 4.1 ± 4.6 ounces, and active television time 45 ± 73 min. In adjusted analyses compared to Hispanic caregivers, non-Hispanic Black caregivers were less likely to report exclusive bottle use (odds ratio: 0.11, 95% confidence interval [CI] 0.03-0.39), reported 2.4 ounces more juice (95% CI 1.0-3.9), 124 min more passive television time (95% CI 60-188), and 37 min more active television time (95% CI 10-64). Increased caregiver education and higher income were associated with 0.4 (95% CI 0.13-0.66) and 0.3 (95% CI 0.06-0.55) more servings of fruits and vegetables per day, respectively. Conclusion In a diverse sample of one-year-olds, caregivers reported few protective behaviors that reduce the risk for adverse health outcomes including obesity. Differences in behavior by race/ethnicity, income, and education can inform future interventions and policies. Future interventions should strive to create culturally effective messaging to address common adverse health behaviors.
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Affiliation(s)
- Michelle C. Gorecki
- Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Eliana M. Perrin
- Department of Pediatrics, Schools of Medicine and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Colin J. Orr
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michelle J. White
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - H. Shonna Yin
- Department of Pediatrics and Population Health, School of Medicine, New York University, New York, NY, USA
| | - Lee M. Sanders
- Department of Pediatrics, Center for Health Policy, Stanford University, Stanford, CA, USA
| | - Russell L. Rothman
- Departments of Pediatrics, Internal Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alan M. Delamater
- Department of Pediatrics, School of Medicine, University of Miami, Miami, FL, USA
| | - Tracy Truong
- Department of Biostatistics, Duke University, Durham, NC, USA
| | | | - Kori B. Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Wood CT, Truong T, Skinner AC, Armstrong SC, Perrin EM, Woo JG, Green CL. Timing and Magnitude of Peak Body Mass Index and Peak Weight Velocity in Infancy Predict Body Mass Index at 2 Years in a Retrospective Cohort of Electronic Health Record Data. J Pediatr 2023:S0022-3476(23)00115-4. [PMID: 36822510 DOI: 10.1016/j.jpeds.2023.01.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES To use growth data from electronic health records to describe and model infant growth (weight velocity and peak body mass index [pBMI]) characteristics. STUDY DESIGN We extracted data from all children born at ≥34 weeks of gestation within one health system between 2014 and 2017. After excluding implausible growth data with an algorithm created for childhood growth, we estimated pBMI, peak weight and length velocities, and the odds of obesity at 2 years, adjusted for race, sex, ethnicity, and birth weight, by the magnitude of peak weight velocity, peak length velocity, and pBMI. RESULTS Among 6425 children (41% White, 28% Black, 26% other race; 16% Hispanic ethnicity), mean pBMI was 17.9 kg/m2 (SD 1.5) and mean age at pBMI was 9.6 months (SD 2.7). Mean peak weight velocity was 949 g (SD 165) per 2 weeks, and the mean peak length velocity was 3.4 cm (SD 0.3) per 2 weeks. Children with obesity at 2 years (n = 931, 14.5%) were more likely to be Hispanic, had greater peak weight and peak length velocities, and had 2 kg/m2 greater magnitude of pBMI than children without obesity. For each unit increase in pBMI, children had more than 4 times greater odds of obesity at age 2 years. CONCLUSIONS In a large sample of infants with clinical growth data tracked via electronic health records, we found associations between the magnitude and timing of peak infant BMI and obesity at 2 years of age.
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Affiliation(s)
- Charles T Wood
- Division of General Pediatrics and Adolescent Health and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, Durham, NC.
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University Medical School, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Sarah C Armstrong
- Division of General Pediatrics and Adolescent Health and Duke Center for Childhood Obesity Research, Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Eliana M Perrin
- Department of Pediatrics, Johns Hopkins School of Medicine, and School of Nursing, Baltimore, MD
| | - Jessica G Woo
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
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Patel AD, Rundle CW, Liu B, Green CL, Bailey-Burke CL, Kheterpal M. Teledermatology May Benefit Marginalized Populations: National and Institutional Trends during the COVID-19 Pandemic. Dermatol Ther (Heidelb) 2023; 13:827-834. [PMID: 36752961 PMCID: PMC9906596 DOI: 10.1007/s13555-023-00900-8] [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: 11/12/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Limited data exist regarding demographic-specific teledermatology (TD) utilization during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to determine TD utilization trends during the pandemic. METHODS A retrospective cohort study for national and institutional populations was conducted. Patient encounters in the American Academy of Dermatology's DataDerm registry (DataDerm) were analyzed from 1 April 2020 through 30 June 2021. All dermatological patients seen by Duke University Health Systems (DUHS) were analyzed from 1 March 2020 through 30 April 2021. In-person clinic visits versus TD encounters (national and institutional) and no-show rates (institutional only) were collected for visit type (i.e., TD versus in-person), sex, race, age/generation, and in- versus out-of-state location (national only). TD utilization is defined as the cohort of interest using TD (e.g., females, whites) within a demographic group (i.e., sex, race) as a percentage of total TD users. This was compared with in-person utilization during the identical timeframe. RESULTS For US national data, 13,964,816 encounters were analyzed. Sex, race, age, and location each had a significant association with TD utilization (adjusted p < 0.001). For institutional data, 54,400 encounters were analyzed. Sex, race, and age had a significant association with TD utilization (adjusted p < 0.001). Both datasets revealed majority female populations for telehealth visits (DataDerm 66.0%; DUHS 61.7%). Non-white populations accounted for a higher percentage of TD utilizers (DataDerm 15.0%; DUHS 37.3%) when compared with in-person utilizers (DataDerm 11.7%; DUHS 22.3%). Younger patients utilized TD (DataDerm 63.6%; DUHS 62.6%) more than in-person services (DataDerm 26.3%; DUHS 43.8%). Institutional no-show rates between telehealth and in-person visits were lower for Black patients (11.8% versus 19.2%), other non-white races (10.6% versus 13.6%), and younger ages/generations (9.8% versus 12.8%), respectively. TD utilization decreased over time nationally as a percentage of total visits (2.9% versus 0.3%) in 2020 versus 2021, respectively. CONCLUSIONS AND RELEVANCE During the COVID-19 pandemic, certain populations (females, younger patients, non-white races) showed higher TD utilization. Understanding TD utilization trends is critical in defining the role of virtual care for improving universal care access, optimizing resources, and informing future healthcare models for all patient populations.
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Affiliation(s)
| | - Chandler W. Rundle
- Department of Dermatology, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC 27710 USA
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC USA
| | - Cynthia L. Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC USA
| | | | - Meenal Kheterpal
- Department of Dermatology, Duke University School of Medicine, 40 Duke Medicine Circle, Durham, NC, 27710, USA.
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Schultheis JM, Durham ME, Kram SJ, Kuhrt M, Gilstrap DL, Parish A, Green CL, Kram BL. Incidence and associated risk factors for systemic drug levels with inhaled aminoglycoside therapy. J Antimicrob Chemother 2023; 78:450-456. [PMID: 36512376 PMCID: PMC10169422 DOI: 10.1093/jac/dkac412] [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] [Received: 06/02/2022] [Accepted: 11/11/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To characterize the incidence of and risk factors for a detectable drug level (DDL) in patients that received inhaled aminoglycoside therapy. METHODS This retrospective, single-centre study included adult patients who received at least one dose of an inhaled aminoglycoside with a drug level during inpatient hospitalization. Patients were excluded if they received an aminoglycoside intravenously within 7 days or if the drug level was not drawn within 4 h of the next dose. A repeated measures logistic regression model evaluated the association between potential risk factors and a DDL. RESULTS Among 286 drug levels, 88 (30.8%) drug levels were detectable. In multivariable analysis, cystic fibrosis (CF) (OR: 3.03; 95% CI: 1.10-8.35), chronic kidney disease (CKD) (OR: 4.25; 95% CI: 1.84-9.83), lung transplant recipient (OR: 3.08; 95% CI: 1.09-8.73), mechanical ventilation (OR: 2.99; 95% CI: 1.25-7.15) and tobramycin (OR: 5.26; 95% CI: 2.35-11.78) were associated with higher odds of a DDL. Among those with a DDL, inhaled aminoglycoside type and drug level concentration were not associated with acute kidney injury (P = 0.161). CONCLUSIONS Among 286 drug levels identified among inpatients receiving inhaled aminoglycoside therapy, 88 (30.8%) unique drug levels were detectable. Based on the results of this study, periodic trough concentrations should be considered for patients receiving inhaled aminoglycoside therapy with CF, CKD, lung transplantation, mechanical ventilation or tobramycin.
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Affiliation(s)
| | - Mary E Durham
- Department of Pharmacy, Premier Inc., Charlotte, NC, USA
| | - Shawn J Kram
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA
| | - Michelle Kuhrt
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA
| | - Daniel L Gilstrap
- Department of Pulmonary, Allergy, and Critical Care Medicine, Duke University Hospital, Durham, NC, USA
| | - Alice Parish
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Bridgette L Kram
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA
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Shah NP, Page C, Green CL, Gao M, Cavalier J, McGarrah RW, DeWald TA, Sangvai D, Patel MR, Pagidipati NJ. Bending the Cardiovascular Event Curve by Evaluating the Potential Impact of Achieving Low-Density Lipoprotein Cholesterol Goal Across a Large Health System Among Secondary Prevention Patients. Am J Cardiol 2023; 186:91-99. [PMID: 36371856 PMCID: PMC10725565 DOI: 10.1016/j.amjcard.2022.10.033] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/05/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Abstract
Guidelines recommend aggressive low-density lipoprotein cholesterol (LDL-C) lowering in patients with atherosclerotic cardiovascular disease (ASCVD). However, the recommended threshold of LDL-C ≤70 mg/dL is often not achieved. We used data from the Duke University Health System electronic health record to characterize patterns of lipid levels and lipid management in patients with ASCVD to estimate the number of clinical events that could be prevented by achieving LDL-C ≤70 mg/dL . A multivariable logistic regression model was developed to predict the 1-year composite of all-cause mortality, myocardial infarction, stroke, or coronary revascularization and was validated through bootstrapping. The number needed to treat to prevent an event was then determined. Among 56,230 patients with ASCVD, the median (quartile 1, quartile 3) age was 68.6 years (59.9, 76.2), 47% were women, and 27% were non-Hispanic Black. LDL-C was >70 mg/dL in 39,566 of patients (70%); these patients were more frequently female (51% vs 36%), non-Hispanic Black (28% vs 23%), and less frequently on statin therapy (67% vs 91%) than those with LDL-C ≤70 mg/dL . A predictive model with reasonable discrimination (c-index 0.77, 95% confidence interval 0.760 to 0.77) and calibration (slope 0.99) determined that if the overall population achieved an LDL-C ≤70 mg/dL, 734 clinical events (455 myocardial infarctions, 186 strokes, and 93 coronary revascularizations) could be prevented in a year. Achieving LDL-C ≤70 mg/dL in patients with ASCVD across a health system could prevent significant clinical events within a single year. In conclusion, this study quantifies the potential benefit of a system-wide effort to achieve guideline-based LDL-C goals.
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Affiliation(s)
- Nishant P Shah
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Courtney Page
- Duke Clinical Research Institute, Durham, North Carolina
| | - Cynthia L Green
- Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Michael Gao
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina
| | - Joanna Cavalier
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina
| | - Robert W McGarrah
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina
| | - Tracy A DeWald
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina; Divisions of Clinical Pharmacology, Duke University Hospital, Durham, North Carolina
| | - Devdutta Sangvai
- Duke Population Health Management Office, Durham, North Carolina
| | - Manesh R Patel
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Neha J Pagidipati
- Divisions of Cardiology, Duke University Hospital, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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Patel AD, Sarver MM, Liu B, Green CL, Nicholas M, Chen SC. A retrospective algorithmic application of a dermatologic complexity tool. J Am Acad Dermatol 2023; 88:181-183. [PMID: 35364213 DOI: 10.1016/j.jaad.2022.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/06/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Akash D Patel
- Department of Dermatology, Duke University, School of Medicine, Durham, North Carolina
| | - Melissa M Sarver
- Department of Dermatology, Duke University, School of Medicine, Durham, North Carolina
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Matilda Nicholas
- Department of Dermatology, Duke University, School of Medicine, Durham, North Carolina
| | - Suephy C Chen
- Department of Dermatology, Duke University, School of Medicine, Durham, North Carolina; Division of Dermatology, Durham VA Medical Center, Durham, North Carolina.
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Ayer A, Truby LK, Schroder JN, Casalinova S, Green CL, Bishawi MA, Bryner BS, Milano CA, Patel CB, Devore AD. Improved Outcomes in Severe Primary Graft Dysfunction After Heart Transplantation Following Donation After Circulatory Death Compared With Donation After Brain Death. J Card Fail 2023; 29:67-75. [PMID: 36351494 DOI: 10.1016/j.cardfail.2022.10.429] [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: 06/23/2022] [Revised: 10/18/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Primary graft dysfunction (PGD), the leading cause of early mortality after heart transplantation, is more common following donation after circulatory death (DCD) than donation after brain death (DBD). We conducted a single-center, retrospective cohort study to compare the incidence, severity and outcomes of patients experiencing PGD after DCD compared to DBD heart transplantation. METHODS AND RESULTS Medical records were reviewed for all adult heart transplant recipients at our institution between March 2016 and December 2021. PGD was diagnosed within 24 hours after transplant according to modified International Society for Heart and Lung Transplant criteria. A total of 459 patients underwent isolated heart transplantation during the study period, 65 (14%) following DCD and 394 (86%) following DBD. The incidence of moderate or severe PGD in DCD and DBD recipients was 34% and 23%, respectively (P = 0.070). DCD recipients were more likely to experience severe biventricular PGD than DBD recipients (19% vs 7.4%; P = 0.004). Among patients with severe PGD, DCD recipients experienced shorter median (Q1, Q3) duration of post-transplant mechanical circulatory support (6 [4, 7] vs 9 [5, 14] days; P = 0.039), shorter median post-transplant hospital length of stay (17 [15, 29] vs 52 [26, 83] days; P = 0.004), and similar 60-day survival rates (100% [95% CI: 76.8%-100%] vs 80.0% [63.1%-91.6%]; P = 0.17) and overall survival (log-rank; P = 0.078) compared with DBD recipients. CONCLUSIONS DCD heart transplant recipients were more likely to experience severe, biventricular PGD than DBD recipients. Despite this, DCD recipients with severe PGD spent fewer days on mechanical circulatory support and in the hospital than similar DBD patients. These findings suggest that patterns of graft dysfunction and recovery may differ between donor types, and they support the expansion of the heart-donor pool with DCD.
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Affiliation(s)
- Austin Ayer
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Lauren K Truby
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Jacob N Schroder
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Sarah Casalinova
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | | | - Muath A Bishawi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Benjamin S Bryner
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Carmelo A Milano
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC
| | - Chetan B Patel
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Adam D Devore
- Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC.
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Goltz DE, Sicat CS, Levin JM, Helmkamp JK, Howell CB, Waren D, Green CL, Attarian D, Jiranek WA, Bolognesi MP, Schwarzkopf R, Seyler TM. A Validated Pre-operative Risk Prediction Tool for Extended Inpatient Length of Stay Following Primary Total Hip or Knee Arthroplasty. J Arthroplasty 2022; 38:785-793. [PMID: 36481285 DOI: 10.1016/j.arth.2022.11.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/03/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND As value-based reimbursement models mature, understanding the potential trade-off between inpatient lengths of stay and complications or need for costly postacute care becomes more pressing. Understanding and predicting a patient's expected baseline length of stay may help providers understand how best to decide optimal discharge timing for high-risk total joint arthroplasty (TJA) patients. METHODS A retrospective review was conducted of 37,406 primary total hip (17,134, 46%) and knee (20,272, 54%) arthroplasties performed at two high-volume, geographically diverse, tertiary health systems during the study period. Patients were stratified by 3 binary outcomes for extended inpatient length of stay: 72 + hours (29%), 4 + days (11%), or 5 + days (5%). The predictive ability of over 50 sociodemographic/comorbidity variables was tested. Multivariable logistic regression models were created using institution #1 (derivation), with accuracy tested using the cohort from institution #2 (validation). RESULTS During the study period, patients underwent an extended length of stay with a decreasing frequency over time, with privately insured patients having a significantly shorter length of stay relative to those with Medicare (1.9 versus 2.3 days, P < .0001). Extended stay patients also had significantly higher 90-day readmission rates (P < .0001), even when excluding those discharged to postacute care (P < .01). Multivariable logistic regression models created from the training cohort demonstrated excellent accuracy (area under the curve (AUC): 0.755, 0.783, 0.810) and performed well under external validation (AUC: 0.719, 0.743, 0.763). Many important variables were common to all 3 models, including age, sex, American Society of Anesthesiologists (ASA) score, body mass index, marital status, bilateral case, insurance type, and 13 comorbidities. DISCUSSION An online, freely available, preoperative clinical decision tool accurately predicts risk of extended inpatient length of stay after TJA. Many risk factors are potentially modifiable, and these validated tools may help guide clinicians in preoperative patient counseling, medical optimization, and understanding optimal discharge timing.
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Affiliation(s)
- Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Chelsea S Sicat
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Joshua K Helmkamp
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Claire B Howell
- Performance Services, Duke University Medical Center, Durham, North Carolina
| | - Daniel Waren
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York
| | - Cynthia L Green
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina
| | - David Attarian
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - William A Jiranek
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, New York University Langone Health, New York, New York
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Jackson LR, Holmqvist F, Parish A, Green CL, Piccini JP, Bahnson TD. Safety of continuous left atrial phased-array intracardiac echocardiography during left atrial ablation for atrial fibrillation. Heart Rhythm O2 2022; 3:673-680. [PMID: 36589913 PMCID: PMC9795249 DOI: 10.1016/j.hroo.2022.08.001] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Pulmonary vein (PV) isolation using radiofrequency ablation (RFA) to treat atrial fibrillation (AF) requires delivery of contiguous transmural lesions at the PV antra while avoiding injury to the esophagus. Continuous 2-dimensional phased-array intracardiac echocardiography (ICE) from within the left atrium (LA) can provide consistent high-resolution images of catheter tip contact and location during ablation. Objective The purpose of this study was to compare near-term safety outcomes of therapeutic AF ablation with and without ICE imaging from within the LA. Methods The study cohort included 590 consecutive patients undergoing RFA for AF including continuous ICE imaging during ablation from within either the right atrium (RA) or the LA. Subjects were followed prospectively, and periprocedural complications within 30 days were identified and recorded. Results All subjects had RA ICE imaging to guide transseptal catheterization. Ultrasound imaging from both RA and LA was used in 243 (41.2%). Respectively, the LA vs RA only imaging cohorts were comparable with respect to age (median 64 [interquartile range 57.4-71.2] years vs 64 [56.2-70.6] years; P = .425); history of hypertension (64.0% vs 67.2%; P = .421); diabetes mellitus (23.1% vs 19.4%; P = .268); previous cerebrovascular accident/transient ischemic attack (10.8% vs 8.4%; P = .331); and AF type (P = .241). There were no significant differences in major complications within 30 days between the 2 cohorts (P = .649) and no identified cases of esophageal or phrenic nerve injury or PV stenosis. Conclusions Routine continuous LA ICE imaging seems to be safe and holds potential to facilitate lesion delivery during RFA for AF.
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Affiliation(s)
- Larry R. Jackson
- Duke Center for Atrial Fibrillation and Clinical Cardiac Electrophysiology Section, Duke University Health System, Durham, North Carolina
| | - Fredrik Holmqvist
- Duke Center for Atrial Fibrillation and Clinical Cardiac Electrophysiology Section, Duke University Health System, Durham, North Carolina
- Department of Cardiology, Skane University Hospital, Lund, Sweden
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Cynthia L. Green
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Jonathan P. Piccini
- Duke Center for Atrial Fibrillation and Clinical Cardiac Electrophysiology Section, Duke University Health System, Durham, North Carolina
| | - Tristram D. Bahnson
- Duke Center for Atrial Fibrillation and Clinical Cardiac Electrophysiology Section, Duke University Health System, Durham, North Carolina
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Goltz DE, Burnett RA, Levin JM, Helmkamp JK, Wickman JR, Hinton ZW, Howell CB, Green CL, Simmons JA, Nicholson GP, Verma NN, Lassiter TE, Anakwenze OA, Garrigues GE, Klifto CS. A validated preoperative risk prediction tool for extended inpatient length of stay following anatomic or reverse total shoulder arthroplasty. J Shoulder Elbow Surg 2022; 32:1032-1042. [PMID: 36400342 DOI: 10.1016/j.jse.2022.10.016] [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: 08/15/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent work has shown inpatient length of stay (LOS) following shoulder arthroplasty to hold the second strongest association with overall cost (after implant cost itself). In particular, a preoperative understanding for the patients at risk of extended inpatient stays (≥3 days) can allow for counseling, optimization, and anticipating postoperative adverse events. METHODS A multicenter retrospective review was performed of 5410 anatomic (52%) and reverse (48%) total shoulder arthroplasties done at 2 large, tertiary referral health systems. The primary outcome was extended inpatient LOS of at least 3 days, and over 40 preoperative sociodemographic and comorbidity factors were tested for their predictive ability in a multivariable logistic regression model based on the patient cohort from institution 1 (derivation, N = 1773). External validation was performed using the patient cohort from institution 2 (validation, N = 3637), including area under the receiver operator characteristic curve (AUC), sensitivity, specificity, and positive and negative predictive values. RESULTS A total of 814 patients, including 318 patients (18%) in the derivation cohort and 496 patients (14%) in the validation cohort, experienced an extended inpatient LOS of at least 3 days. Four hundred forty-five (55%) were discharged to a skilled nursing or rehabilitation facility. Following parameter selection, a multivariable logistic regression model based on the derivation cohort (institution 1) demonstrated excellent preliminary accuracy (AUC: 0.826), with minimal decrease in accuracy under external validation when tested against the patients from institution 2 (AUC: 0.816). The predictive model was composed of only preoperative factors, in descending predictive importance as follows: age, marital status, fracture case, ASA (American Society of Anesthesiologists) score, paralysis, electrolyte disorder, body mass index, gender, neurologic disease, coagulation deficiency, diabetes, chronic pulmonary disease, peripheral vascular disease, alcohol dependence, psychoses, smoking status, and revision case. CONCLUSION A freely-available, preoperative online clinical decision tool for extended inpatient LOS (≥ 3 days) after shoulder arthroplasty reaches excellent predictive accuracy under external validation. As a result, this tool merits consideration for clinical implementation, as many risk factors are potentially modifiable as part of a preoperative optimization strategy.
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Affiliation(s)
- Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Robert A Burnett
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Jay M Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Joshua K Helmkamp
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John R Wickman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Zoe W Hinton
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Claire B Howell
- Performance Services, Duke University Medical Center, Durham, NC, USA
| | - Cynthia L Green
- Department of Biostatistics & Bioinformatics, Duke University, Durham, NC, USA
| | - J Alan Simmons
- Rush Research Core, Rush University Medical Center, Chicago, IL, USA
| | - Gregory P Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Tally E Lassiter
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Brown CL, Skinner AC, Steiner MJ, Truong T, Green CL, Wood CT. Prevalence of High Weight Status in Children Under 2 Years in NHANES and Statewide Electronic Health Records Data in North Carolina and South Carolina. Acad Pediatr 2022; 22:1353-1359. [PMID: 35342033 PMCID: PMC9508281 DOI: 10.1016/j.acap.2022.03.014] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES We evaluated the prevalence of high weight status in children ages 0 to 24 months (m) using data from electronic health records (EHR) and NHANES. We also examined relationships between weight status during infancy and obesity at 24 months of age. METHODS EHR data from 4 institutions in North and South Carolina included patients born January 1, 2013-October 10, 2017 (N = 147,290). NHANES data included study waves from 1999 to 2018 (unweighted N = 5121). We calculated weight-for-length (WFL), weight-for-age (WFA), and body mass index (BMI), excluding implausible values, and categorized weight status (<85th, 85th to <95th, or ≥95th percentile), assessing prevalence at birth, 6, 12, 18, and 24 months. Utilizing individual, longitudinal EHR data, we used separate regression models to assess obesity risk at 24 months based on anthropometrics at birth, 6, 12, and 18 months, adjusting for sex, race/ethnicity, insurance, and health system. RESULTS Prevalence of BMI ≥95th percentile in EHR data at 6, 12, 18, and 24 months were 9.7%, 15.7%, 19.6%, and 20.5%, respectively. With NHANES the prevalence was 11.6%, 15.0%, 16.0%, and 8.4%. For both, the prevalence of high weight status was higher in Hispanic children. In EHR data, high weight status at 6, 12, and 18 months was associated with obesity at 24 months, with stronger associations as BMI category increased and as age increased. CONCLUSIONS High weight status is common in infants and young children, although lower at 24 months in NHANES than EHR data. In EHR data, high BMI at 6, 12, and 18 months was associated with increased risk of obesity at 24 months.
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Affiliation(s)
- Callie L Brown
- Department of Pediatrics, Wake Forest School of Medicine (CL Brown), Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine (CL Brown), Winston-Salem, NC.
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University (AC Skinner), Durham, NC
| | - Michael J Steiner
- Department of Pediatrics, University of North Carolina at Chapel Hill (MJ Steiner), Chapel Hill, NC
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine (T Truong, CL Green), Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine (T Truong, CL Green), Durham, NC
| | - Charles T Wood
- Department of Pediatrics, Duke University (CT Wood), Durham, NC
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White MJ, Kay MC, Truong T, Green CL, Yin HS, Flower KB, Rothman RL, Sanders LM, Delamater AM, Duke NN, Perrin EM. Racial and Ethnic Differences in Maternal Social Support and Relationship to Mother-Infant Health Behaviors. Acad Pediatr 2022; 22:1429-1436. [PMID: 35227910 PMCID: PMC10078964 DOI: 10.1016/j.acap.2022.02.008] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To examine racial and ethnic differences in maternal social support in infancy and the relationship between social support and mother-infant health behaviors. METHODS Secondary analysis of baseline data from a multisite obesity prevention trial that enrolled mothers and their 2-month-old infants. Behavioral and social support data were collected via questionnaire. We used modified Poisson regression to determine association between health behaviors and financial and emotional social support, adjusted for sociodemographic characteristics. RESULTS Eight hundred and twenty-six mother-infant dyads (27.3% non-Hispanic Black, 18.0% Non-Hispanic White, 50.1% Hispanic and 4.6% Non-Hispanic Other). Half of mothers were born in the United States; 87% were Medicaid-insured. There were no racial/ethnic differences in social support controlling for maternal nativity. US-born mothers were more likely to have emotional and financial support (rate ratio [RR] 1.14 95% confidence interval [CI]: 1.07, 1.21 and RR 1.23 95% CI: 1.11, 1.37, respectively) versus mothers born outside the United States. Mothers with financial support were less likely to exclusively feed with breast milk (RR 0.62; 95% CI: 0.45, 0.87) yet more likely to have tummy time ≥12min (RR 1.28; 95% CI: 1.02, 1.59) versus mothers without financial support. Mothers with emotional support were less likely to report feeding with breast milk (RR 0.82; 95% CI: 0.69, 0.97) versus mothers without emotional support. CONCLUSIONS Nativity, not race or ethnicity, is a significant determinant of maternal social support. Greater social support was not universally associated with healthy behaviors. Interventions may wish to consider the complex nature of social support and population-specific social support needs.
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Affiliation(s)
- Michelle J White
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC.
| | - Melissa C Kay
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC; Duke Global Digital Health Science Center (MC Kay), Duke University, Durham, NC
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics (T Truong, CL Green), Duke University School of Medicine, Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics (T Truong, CL Green), Duke University School of Medicine, Durham, NC
| | - Hsiang Shonna Yin
- Departments of Pediatrics and Population Health (HS Yin), New York University Grossman School of Medicine, New York, NY
| | - Kori B Flower
- University of North Carolina at Chapel Hill School of Medicine (KB Flower), Chapel Hill, NC
| | - Russell L Rothman
- Department of Pediatrics (RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn
| | - Lee M Sanders
- Departments of Pediatrics and Health Policy (LM Sanders), Stanford University, Stanford, Calif
| | - Alan M Delamater
- Mailman Center for Child Development (AM Delamater), University of Miami Miller School of Medicine, Miami, Fla
| | - Naomi N Duke
- Department of Pediatrics and Duke Center for Childhood Obesity Research (MJ White, MC Kay, NN Duke), Duke University Medical Center, Durham, NC
| | - Eliana M Perrin
- Department of Pediatrics (EM Perrin), Johns Hopkins Schools of Medicine and Nursing, Baltimore, Md
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Taylor SM, Korwa S, Wu A, Green CL, Freedman B, Clapp S, Kirui JK, O’Meara WP, Njuguna FM. Monthly sulfadoxine/pyrimethamine-amodiaquine or dihydroartemisinin-piperaquine as malaria chemoprevention in young Kenyan children with sickle cell anemia: A randomized controlled trial. PLoS Med 2022; 19:e1004104. [PMID: 36215323 PMCID: PMC9591057 DOI: 10.1371/journal.pmed.1004104] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 10/24/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Children with sickle cell anemia (SCA) in areas of Africa with endemic malaria transmission are commonly prescribed malaria chemoprevention. Chemoprevention regimens vary between countries, and the comparative efficacy of prevention regimens is largely unknown. METHODS AND FINDINGS We enrolled Kenyan children aged 1 to 10 years with homozygous hemoglobin S (HbSS) in a randomized, open-label trial conducted between January 23, 2018, and December 15, 2020, in Homa Bay, Kenya. Children were assigned 1:1:1 to daily Proguanil (the standard of care), monthly sulfadoxine/pyrimethamine-amodiaquine (SP-AQ), or monthly dihydroartemisinin-piperaquine (DP) and followed monthly for 12 months. The primary outcome was the cumulative incidence of clinical malaria at 12 months, and the main secondary outcome was the cumulative incidence of painful events by self-report. Secondary outcomes included other parasitologic, hematologic, and general events. Negative binomial models were used to estimate incidence rate ratios (IRRs) per patient-year (PPY) at risk relative to Proguanil. The primary analytic population was the As-Treated population. A total of 246 children were randomized to daily Proguanil (n = 81), monthly SP-AQ (n = 83), or monthly DP (n = 82). Overall, 53.3% (n = 131) were boys and the mean age was 4.6 ± 2.5 years. The clinical malaria incidence was 0.04 episodes/PPY; relative to the daily Proguanil group, incidence rates were not significantly different in the monthly SP-AQ (IRR: 3.05, 95% confidence interval [CI]: 0.36 to 26.14; p = 0.39) and DP (IRR: 1.36, 95% CI: 0.21 to 8.85; p = 0.90) groups. Among secondary outcomes, relative to the daily Proguanil group, the incidence of painful events was not significantly different in the monthly SP-AQ and DP groups, while monthly DP was associated with a reduced rate of dactylitis (IRR: 0.47; 95% CI: 0.23 to 0.96; p = 0.038). The incidence of Plasmodium falciparum infection relative to daily Proguanil was similar in the monthly SP-AQ group (IRR 0.46; 95% CI: 0.17 to 1.20; p = 0.13) but reduced with monthly DP (IRR 0.21; 95% CI: 0.08 to 0.56; p = 0.002). Serious adverse events were common and distributed between groups, although compared to daily Proguanil (n = 2), more children died receiving monthly SP-AQ (n = 7; hazard ratio [HR] 5.44; 95% CI: 0.92 to 32.11; p = 0.064) but not DP (n = 1; HR 0.61; 95% CI 0.04 to 9.22; p = 0.89), although differences did not reach statistical significance for either SP-AQ or DP. Study limitations include the unexpectedly limited transmission of P. falciparum in the study setting, the high use of hydroxyurea, and the enhanced supportive care for trial participants, which may limit generalizability to higher-transmission settings where routine sickle cell care is more limited. CONCLUSIONS In this study with limited malaria transmission, malaria chemoprevention in Kenyan children with SCA with monthly SP-AQ or DP did not reduce clinical malaria, but DP was associated with reduced dactylitis and P. falciparum parasitization. Pragmatic studies of chemoprevention in higher malaria transmission settings are warranted. TRIAL REGISTRATION clinicaltrials.gov (NCT03178643). Pan-African Clinical Trials Registry: PACTR201707002371165.
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Affiliation(s)
- Steve M. Taylor
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Sarah Korwa
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Angie Wu
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Cynthia L. Green
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Betsy Freedman
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Sheila Clapp
- Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | | | - Wendy P. O’Meara
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Festus M. Njuguna
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Jiang SW, Flynn MS, Kwock JT, Liu B, Quow K, Blanchard SK, Breglio KF, Fresco A, Jamison MO, Lesesky E, Bellet JS, Green CL, Shearer SM, Nicholas MW. Quality and Perceived Usefulness of Patient-Submitted Store-and-Forward Teledermatology Images. JAMA Dermatol 2022; 158:1183-1186. [PMID: 35895039 PMCID: PMC9330374 DOI: 10.1001/jamadermatol.2022.2815] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Patient-submitted images vary considerably in quality and usefulness. Studies that characterize patient-submitted images in a real-life setting are lacking. Objective To evaluate the quality and perceived usefulness of patient-submitted images as determined by dermatologists and characterize agreement of their responses. Design, Setting, and Participants This survey study included patient images submitted to the Department of Dermatology at Duke University (Durham, North Carolina) between August 1, 2018, and December 31, 2019. From a total pool of 1200 images, 10 dermatologists evaluated 200 or 400 images each, with every image being evaluated by 3 dermatologists. Data analysis occurred during the year leading up to the article being written. Main Outcomes and Measures The primary outcomes were the responses to 2 questions and were analyzed using frequency counts and interrater agreement (Fleiss κ) to assess image quality and perceived usefulness. We performed a random-effects logistic regression model to investigate factors associated with evaluators' decision-making comfort. We hypothesized that most images would be of low quality and perceived usefulness, and that interrater agreement would be poor. Results A total of 259 of 2915 patient-submitted images (8.9%) did not depict a skin condition at all. The final analysis comprised 3600 unique image evaluations. Dermatologist evaluators indicated that 1985 images (55.1%) were useful for medical decision-making and 2239 (62.2%) were of sufficient quality. Interrater agreement for a given image's diagnostic categorization was fair to substantial (κ range, 0.36-0.64), while agreement on image quality (κ range, 0.35-0.47) and perceived usefulness (κ range, 0.29-0.38) were fair to moderate. Senior faculty had higher odds of feeling comfortable with medical decision-making than junior faculty (odds ratio [OR], 3.68; 95% CI, 2.9-4.66; P < .001) and residents (OR, 5.55; 95% CI, 4.38-7.04; P < .001). Images depicting wounds (OR, 1.75; 95% CI, 1.18-2.58; P = .01) compared with inflammatory skin conditions and that were in focus (OR, 5.56; 95% CI, 4.63-6.67; P < .001) had higher odds of being considered useful for decision-making. Conclusions and Relevance In this survey study including 10 dermatologists, a slight majority of patient-submitted images were judged to be of adequate quality and perceived usefulness. Fair agreement between dermatologists was found regarding image quality and perceived usefulness, suggesting that store-and-forward teledermatology initiatives should consider a physician's individual experiences and comfort level. The study results suggest that images are most likely to be useful when they are in focus and reviewed by experienced attending physicians for wound surveillance, but dermatologists may be burdened by irrelevant or unsuitable images.
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Affiliation(s)
- Simon W Jiang
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - M Seth Flynn
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Jeffery T Kwock
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Beiyu Liu
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Krystina Quow
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Sarah K Blanchard
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Kimberly F Breglio
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Amber Fresco
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Megan O'Brien Jamison
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Erin Lesesky
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Jane S Bellet
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina.,Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sabrina M Shearer
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Matilda W Nicholas
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
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Felker GM, Sharma A, Mentz RJ, She L, Green CL, Granger BB, Heitner JF, Cooper L, Teuteberg J, Grodin JL, Rosenfield K, Hudson L, Kwee LC, Ilkayeva O, Shah SH. A randomized controlled trial of mobile health intervention in patients with heart failure and diabetes. J Card Fail 2022; 28:1575-1583. [PMID: 35882260 DOI: 10.1016/j.cardfail.2022.07.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/11/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mobile health (mHealth) platforms can affect health behaviors but have not been rigorously tested in randomized trials. OBJECTIVES We sought to evaluate the effectiveness of a pragmatic mHealth intervention in patients with HF and DM Methods: We conducted a multicenter randomized trial in 187 patients with both HF and DM to assessing a mHealth intervention to improve physical activity and medication adherence compared to usual care. The primary endpoint was change in mean daily step count from baseline through 3 months. Other outcomes included medication adherence, health related quality of life, and metabolomic profiling. RESULTS The mHealth group had an increase in daily step count of 151 steps/day at 3 months whereas the usual care group had a decline of 162 steps/day (LS-mean between-group difference = 313 steps/day; 95% CI: 8, 619, p = 0.044). Medication adherence measured using the Voils Adherence Questionnaire did not change from baseline to 3 months (LS-mean change -0.08 in mHealth vs. -0.15 in usual care, p = 0.47). The mHealth group had an improvement in Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS) compared to the usual care group (LS-mean difference = 5.5 points, 95% CI: 1.4, 9.6, p = 0.009). Thirteen metabolites, primarily medium- and long-chain acylcarnitines, changed differently between treatment groups from baseline to 3 months (p < 0.05). CONCLUSIONS In patients with HF and DM, a 3-month mHealth intervention significantly improved daily physical activity, health related quality of life and metabolomic markers of cardiovascular health, but not medication adherence. CLINICALTRIALS gov Identifier: NCT02918175 Condensed Abstract: Heart failure (HF) and diabetes (DM) have overlapping biologic and behavioral risk factors. We conducted a multicenter randomized, clinical trial in 187 patients with both HF (regardless of ejection fraction) and DM to assess whether a mHealth intervention could improve physical activity and medication adherence. The mHealth group had an increase in mean daily step count and quality of life but not medication adherence. Medium- and long-chain acylcarnitines changed differently between treatment groups from baseline to 3 months (p < 0.05). These data have important implications for designing effective lifestyle interventions in HF and DM.
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Affiliation(s)
| | - Abhinav Sharma
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, North Carolina
| | - Lilin She
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Bradi B Granger
- Duke Clinical Research Institute, Durham, North Carolina; Duke University School of Nursing, Durham, North Carolina
| | - John F Heitner
- Duke Clinical Research Institute, Durham, North Carolina; New York University-Langone Health, New York, New York
| | - Lauren Cooper
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York; and Inova Heart & Vascular Institute, Inova Fairfax Hospital, Falls Church, Virginia
| | | | - Justin L Grodin
- University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | | | - Lori Hudson
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Olga Ilkayeva
- Duke Molecular Physiology Institute, Durham, North Carolina
| | - Svati H Shah
- Duke Molecular Physiology Institute, Durham, North Carolina
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Cheah JW, Danilkowicz R, Hutyra C, Lewis B, Olson S, Poehlein E, Green CL, Mather R. High Prevalence of Sleep Disturbance Is Associated with Femoroacetabular Impingement Syndrome. Arthrosc Sports Med Rehabil 2022; 4:e495-e501. [PMID: 35494310 PMCID: PMC9042751 DOI: 10.1016/j.asmr.2021.11.008] [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] [Received: 05/02/2021] [Accepted: 11/01/2021] [Indexed: 10/24/2022] Open
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