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Singhal U, Hollenbeck BK, Kaffenberger SD, Salami SS, George AK, Skolarus TA, Montgomery JS, Wittmann DA, Miller DC, Wei JT, Palapattu GS, Montie JE, Dunn RL, Morgan TM. Comparing Patient-reported Functional Outcomes After Radical Prostatectomy in Historical and Contemporary Practice. J Urol 2023; 210:771-777. [PMID: 37566643 DOI: 10.1097/ju.0000000000003646] [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: 03/16/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Modifications to surgical technique, particularly the widespread adoption of robotic surgery, have been proposed to improve functional recovery after prostate cancer surgery. However, rigorous comparison of men in historical vs contemporary practice to evaluate the cumulative effect of these changes on urinary and sexual function after radical prostatectomy is lacking. MATERIALS AND METHODS We compared prospectively collected patient-reported urinary and sexual function from historical (PROSTQA [Prostate Cancer Outcomes and Satisfaction With Treatment Quality Assessment study], n=235) and contemporary (MUSIC-PRO [Michigan Urological Surgery Improvement Collaborative Patient Reported Outcome] registry, n=1,215) cohorts at the University of Michigan to understand whether modern techniques have resulted in functional improvements for men undergoing prostate cancer surgery. RESULTS We found significant differences in baseline function, with better urinary (median [IQR]; 100 [93.8-100] vs 93.8 [85.5-100], P < .001) and sexual scores (median [IQR]; 83.3 [66.7-100] vs 74.4 [44.2-87.5], P < .001) prior to treatment in PROSTQA compared to MUSIC-PRO patients, respectively. There was no statistically significant difference in the pattern of urinary incontinence recovery after surgery from 6-24 months between groups (P = .14). However, men in the contemporary MUSIC-PRO group did have significantly better recovery of sexual function compared to men in the historical PROSTQA group (P < .0001). Further, we found that contemporary practice consists of men with more unfavorable demographic and clinical characteristics compared to historical practice. CONCLUSIONS Our results demonstrate that the widespread alterations in prostate cancer surgery over the past 2 decades have yielded improvements in sexual, but not urinary, function recovery.
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Affiliation(s)
- Udit Singhal
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Brent K Hollenbeck
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Samuel D Kaffenberger
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Simpa S Salami
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Arvin K George
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ted A Skolarus
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
- Department of Surgery, University of Chicago, Chicago, Illinois
| | - Jeffrey S Montgomery
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Daniela A Wittmann
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - David C Miller
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - John T Wei
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Ganesh S Palapattu
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - James E Montie
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Rodney L Dunn
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Todd M Morgan
- Department of Urology, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
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Dhir A, Ellimoottil CS, Qi J, Zhu A, Wang RS, Montgomery JS, Salami SS, Wei JT, Shankar PR, Davenport MS, Curci NE, Millet JD, Wu CY, Johnson A, Miller DC, George AK. Intra-practice Urologist-level Variation in Targeted Fusion Biopsy Outcomes. Urology 2023; 177:122-127. [PMID: 37121355 DOI: 10.1016/j.urology.2023.04.017] [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] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To examine the extent to which the urologist performing biopsy contributes to variation in prostate cancer detection during fusion-guided prostate biopsy. METHODS All men in the Michigan Urological Surgery Improvement Collaborative (MUSIC) clinical registry who underwent fusion biopsy at Michigan Medicine from August 2017 to March 2019 were included. The primary outcomes were clinically significant cancer detection rate (defined as Gleason Grade ≥2) in targeted cores and clinically significant cancer detection on targeted cores stratified by PI-RADS score. Bivariate and multivariable logistic regression analyses were performed. RESULTS A total of 1133 fusion biopsies performed by 5 providers were included. When adjusting for patient age, PSA, race, family history, prostate volume, clinical stage, and PI-RADS score, there was no significant difference in targeted clinically significant cancer detection rates across providers (range = 38.5%-46.9%, adjusted P-value = .575). Clinically significant cancer detection rates ranged from 11.1% to 16.7% in PI-RADS 3 (unadjusted P = .838), from 24.6% to 43.4% in PI-RADS 4 (adjusted P = .003), and from 69.4% to 78.8% in PI-RADS 5 (adjusted P = .766) lesions. CONCLUSION There was a statistically significant difference in clinically significant prostate cancer detection in PI-RADS 4 lesions across providers. These findings suggest that even among experienced providers, variation at the urologist level may contribute to differences in clinically significant cancer detection rates within PI-RADS 4 lesions. However, the relative impact of biopsy technique, radiologist interpretation, and MR acquisition protocol requires further study.
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Affiliation(s)
- Apoorv Dhir
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Chad S Ellimoottil
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Ji Qi
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Alex Zhu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Robert S Wang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Jeffrey S Montgomery
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Simpa S Salami
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - John T Wei
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Prasad R Shankar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Matthew S Davenport
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI; Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Nicole E Curci
- Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - John D Millet
- Michigan Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI
| | - Chen-Yu Wu
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Anna Johnson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - David C Miller
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI
| | - Arvin K George
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI.
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Akula P, Lee A, Eslick J, Bhattacharyya D, Miller DC. A Modified Electrolyte
NRTL
Model with Analytical Expression for Excess Enthalpy: Application to the
MEA‐H
2
O‐CO
2
System. AIChE J 2022. [DOI: 10.1002/aic.17935] [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: 11/08/2022]
Affiliation(s)
- Paul Akula
- Department of Chemical and Biomedical Engineering West Virginia University Morgantown WV USA
| | - Andrew Lee
- KeyLogic Systems, National Energy Technology Laboratory, 626 Cochrans Mill Rd. Pittsburgh PA USA
| | - John Eslick
- National Energy Technology Laboratory, 626 Cochrans Mill Rd. Pittsburgh PA USA
| | - Debangsu Bhattacharyya
- Department of Chemical and Biomedical Engineering West Virginia University Morgantown WV USA
| | - David C. Miller
- National Energy Technology Laboratory, 626 Cochrans Mill Rd. Pittsburgh PA USA
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4
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Uličná S, Owen-Bellini M, Moffitt SL, Sinha A, Tracy J, Roy-Choudhury K, Miller DC, Hacke P, Schelhas LT. A study of degradation mechanisms in PVDF-based photovoltaic backsheets. Sci Rep 2022; 12:14399. [PMID: 36002472 PMCID: PMC9402549 DOI: 10.1038/s41598-022-18477-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/12/2022] [Indexed: 11/12/2022] Open
Abstract
Commercial backsheets based on polyvinylidene fluoride (PVDF) can experience premature field failures in the form of outer layer cracking. This work seeks to provide a better understanding of the changes in material properties that lead to crack formation and find appropriate accelerated tests to replicate them. The PVDF-based backsheet outer layer can have a different structure and composition, and is often blended with a poly(methyl methacrylate) (PMMA) polymer. We observed depletion of PMMA upon aging with sequential (MAST) and combined (C-AST) accelerated stress testing. In field-aged samples from Arizona and India, where PVDF crystallizes in its predominant α-phase, the degree of crystallinity greatly increased. MAST and C-AST protocols were, to some extent, able to replicate the increase in crystallinity seen in PVDF after ~ 7 years in the field, but no single-stress test condition (UV, damp heat, thermal cycling) resulted in significant changes in the material properties. The MAST regimen used here was too extreme to produce realistic degradation, but the test was useful in discovering weaknesses of the particular PVDF-based outer layer structure studied. No excessive β-phase formation was observed after aging with any test condition; however, the presence of β-phase was identified locally by Fourier transform infrared spectroscopy (FTIR). We conclude that both MAST and C-AST are relevant tests for screening outdoor failure mechanisms in PVDF backsheets, as they were successful in producing material degradation that led to cracking.
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Affiliation(s)
- Soňa Uličná
- SLAC National Accelerator Laboratory, Menlo Park, CA, USA.
| | | | | | - Archana Sinha
- SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - Jared Tracy
- DuPont Specialty Products LLC, Wilmington, DE, USA
| | | | | | - Peter Hacke
- National Renewable Energy Laboratory, Golden, CO, USA
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5
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Okoli CO, Parker R, Chen Y, Ostace A, Lee A, Bhattacharyya D, Tong A, Biegler LT, Burgard AP, Miller DC. Application of an equation‐oriented framework to formulate and estimate parameters of chemical looping reaction models. AIChE J 2022. [DOI: 10.1002/aic.17796] [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: 11/10/2022]
Affiliation(s)
- Chinedu O. Okoli
- National Energy Technology Laboratory Pittsburgh Pennsylvania USA
- NETL support contractor Pittsburgh Pennsylvania USA
| | - Robert Parker
- Department of Chemical Engineering Carnegie Mellon University Pittsburgh Pennsylvania USA
| | - Yu‐Yen Chen
- William G. Lowrie Department of Chemical and Biomolecular Engineering, Koffolt Laboratories The Ohio State University Columbus Ohio USA
| | - Anca Ostace
- National Energy Technology Laboratory Pittsburgh Pennsylvania USA
- NETL support contractor Pittsburgh Pennsylvania USA
| | - Andrew Lee
- National Energy Technology Laboratory Pittsburgh Pennsylvania USA
- NETL support contractor Pittsburgh Pennsylvania USA
| | - Debangsu Bhattacharyya
- Department of Chemical and Biomedical Engineering West Virginia University Morgantown West Virginia USA
| | - Andrew Tong
- William G. Lowrie Department of Chemical and Biomolecular Engineering, Koffolt Laboratories The Ohio State University Columbus Ohio USA
| | - Lorenz T. Biegler
- Department of Chemical Engineering Carnegie Mellon University Pittsburgh Pennsylvania USA
| | | | - David C. Miller
- National Energy Technology Laboratory Pittsburgh Pennsylvania USA
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6
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Vince RA, Jiang R, Qi J, Tosoian JJ, Takele R, Feng FY, Linsell S, Johnson A, Shetty S, Hurley P, Miller DC, George A, Ghani K, Sun F, Seymore M, Dess RT, Jackson WC, Schipper M, Spratt DE, Morgan TM. Impact of Decipher Biopsy testing on clinical outcomes in localized prostate cancer in a prospective statewide collaborative. Prostate Cancer Prostatic Dis 2022; 25:677-683. [PMID: 34285350 PMCID: PMC8770695 DOI: 10.1038/s41391-021-00428-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/04/2021] [Accepted: 06/29/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Decipher Biopsy is a commercially available gene expression classifier used in risk stratification of newly diagnosed prostate cancer (PCa). Currently, there are no prospective data evaluating its clinical utility. We seek to assess the clinical utility of Decipher Biopsy in localized PCa patients. METHODS A multi-institutional study of 855 men who underwent Decipher Biopsy testing between February 2015 and October 2019. All patients were tracked through the prospective Michigan Urological Surgery Improvement Collaborative and linked to the Decipher Genomics Resource Information Database (GRID®; NCT02609269). Patient matching was performed by an independent third-party (ArborMetrix Inc.) using two or more unique identifiers. Cumulative incidence curves for time to treatment (TTT) and time to failure (TTF) were constructed using Kaplan-Meier estimates. Multivariable Cox proportional hazard models were used to evaluate the independent association of high-risk Decipher scores with the conversion from AS to radical therapy and treatment failure (biochemical failure or receipt of salvage therapy). RESULTS AND LIMITATIONS Eight hundred fifty-five patients underwent Decipher Biopsy testing during the study period. Of the 855 men, 264 proceeded to AS (31%), and 454 (53%) received radical therapy. In men electing AS, after adjusting for NCCN risk group, age, PSA, prostate volume, body mass index, and percent positive cores, a high-risk Decipher score was independently associated with shorter TTT (HR 2.51, 95% CI 1.52-4.13 p < 0.001). Similarly, in patients that underwent radical therapy, a high-risk Decipher score was independently associated with TTF (HR 2.98, 95% CI 1.22-7.29, p = 0.01) on multivariable analysis. Follow-up time was a limitation. CONCLUSION In a prospective statewide registry, high-risk Decipher Biopsy score was strongly and independently associated with conversion from AS to definitive treatment and treatment failure. These real-world data support the clinical utility of Decipher Biopsy. An ongoing phase 3 randomized trial (NCT04396808) will provide level 1 evidence of the clinical impact of Decipher biopsy testing.
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Affiliation(s)
- Randy A. Vince
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Ralph Jiang
- Department of Biostatics, University of Michigan, Ann Arbor, Michigan 48109
| | - Ji Qi
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Jeffrey J. Tosoian
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Rebecca Takele
- Edward Via College of Osteopathic Medicine, Blacksburg, VA 24060
| | - Felix Y. Feng
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California 94158
| | - Susan Linsell
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Anna Johnson
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Sughand Shetty
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Patrick Hurley
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - David C. Miller
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Arvin George
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Khurshid Ghani
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Fionna Sun
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan 48309
| | - Mariana Seymore
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48109
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48109
| | - Matthew Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48109,Department of Biostatics, University of Michigan, Ann Arbor, Michigan 48109
| | - Daniel E. Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48109
| | - Todd M. Morgan
- Department of Urology, University of Michigan, Ann Arbor, Michigan 48109
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7
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Ostace A, Chen YY, Parker R, Mebane DS, Okoli CO, Lee A, Tong A, Fan LS, Biegler LT, Burgard AP, Miller DC, Bhattacharyya D. Kinetic model development and Bayesian uncertainty quantification for the complete reduction of Fe-based oxygen carriers with CH4, CO, and H2 for chemical looping combustion. Chem Eng Sci 2022. [DOI: 10.1016/j.ces.2022.117512] [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: 11/03/2022]
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8
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Miller DC, Lal RG, Marchetti LA, Arnold FH. Biocatalytic One-Carbon Ring Expansion of Aziridines to Azetidines via a Highly Enantioselective [1,2]-Stevens Rearrangement. J Am Chem Soc 2022; 144:4739-4745. [PMID: 35258294 PMCID: PMC9022672 DOI: 10.1021/jacs.2c00251] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We report enantioselective one-carbon ring expansion of aziridines to make azetidines as a new-to-nature activity of engineered "carbene transferase" enzymes. A laboratory-evolved variant of cytochrome P450BM3, P411-AzetS, not only exerts unparalleled stereocontrol (99:1 er) over a [1,2]-Stevens rearrangement but also overrides the inherent reactivity of aziridinium ylides, cheletropic extrusion of olefins, to perform a [1,2]-Stevens rearrangement. By controlling the fate of the highly reactive aziridinium ylide intermediates, these evolvable biocatalysts promote a transformation which cannot currently be performed using other catalyst classes.
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Affiliation(s)
- David C. Miller
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | - Ravi G. Lal
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | - Luca A. Marchetti
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
- Present Address: Department of Biosystems Science and Engineering, ETH Zürich, 4058 Basel, Switzerland
| | - Frances H. Arnold
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
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9
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Cary C, Tong Y, Linsell S, Ghani K, Miller DC, Weiner M, Koch MO, Perkins SM, Zimet G. Ranking Important Factors for Using Postoperative Chemotherapy in Nonmuscle Invasive Bladder Cancer: Conjoint Analysis Results From the Michigan Urological Surgery Improvement Collaborative (MUSIC). J Urol 2022; 207:293-301. [PMID: 34551594 PMCID: PMC8741637 DOI: 10.1097/ju.0000000000002233] [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] [Accepted: 08/24/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE National and international guidelines recommend the use of 1 dose of intravesical chemotherapy immediately following surgery for nonmuscle invasive bladder cancer, which is performed infrequently on a population level. We sought to understand the importance of potential environmental and clinical dimensions involved in the decision to offer this therapy. MATERIALS AND METHODS Urologists from the Michigan Urological Surgery Improvement Collaborative (MUSIC) rated 8 distinct clinical vignettes involving patients with nonmuscle invasive bladder cancer. A ratings-based conjoint analysis method was used to evaluate the clinical vignette responses. Each vignette included 4 clinical dimensions and 2 environmental dimensions, with each dimension consisting of 2 possible attributes. The relative importance of each attribute was derived from the regression model and ranked in order. RESULTS A total of 58 urologists answered the clinical vignettes which represents >75% of MUSIC sites. The median age of urologists was 53, most were male, and median years in practice was 20 years post residency. An environmental attribute, having a recovery room protocol for instilling and disposing of the chemotherapy, ranked as the most influential attribute for giving postoperative chemotherapy (utility=8.6). The clinical attribute yielding the strongest preference for giving chemotherapy was tumor grade (utility=4.9). These preferences varied by different subgroups of urologists, particularly regarding the type of practice a urologist was in. CONCLUSIONS This study demonstrates that urologists have clear preferences for when they offer postoperative immediate chemotherapy. Factors beyond just clinical variables play a role in this decision making process such as the structure of the recovery room.
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Affiliation(s)
- Clint Cary
- Indiana University Department of Urology
- Regenstrief Institute, Inc. Indianapolis, IN
| | - Yan Tong
- Indiana University Department of Biostatistics
| | | | | | | | - Michael Weiner
- Regenstrief Institute, Inc. Indianapolis, IN
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
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10
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Hanselman CL, Yin X, Miller DC, Gounaris CE. MatOpt: A Python Package for Nanomaterials Design Using Discrete Optimization. J Chem Inf Model 2022; 62:295-308. [PMID: 35023741 DOI: 10.1021/acs.jcim.1c00984] [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: 11/28/2022]
Abstract
Novel materials are being enabled by advances in synthesis techniques that achieve ever better control over the atomic-scale structure of materials. The pace of materials development has been further increased by high-throughput computational experiments guided by informatics and machine learning. We have previously demonstrated complementary approaches using mathematical optimization models to search through highly combinatorial design spaces of atomic arrangements, guiding the design of nanostructured materials. In this paper, we highlight the common features of materials optimization problems that can be efficiently modeled via mixed-integer linear optimization models. To take advantage of these commonalities, we have created MatOpt, a Python package that formalizes the process of representing the design space and formulating optimization models for the on-demand design of nanostructured materials. This tool serves to bridge the gap between practitioners with expertise in materials science and those with expertise in formulating and solving mathematical optimization models, effectively lowering the barriers for applying rigorous numerical optimization capabilities during nanostructured materials development.
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Affiliation(s)
- Christopher L Hanselman
- Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
| | - Xiangyu Yin
- Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
| | - David C Miller
- National Energy Technology Laboratory, Pittsburgh, Pennsylvania 15236, United States
| | - Chrysanthos E Gounaris
- Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, United States
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Abstract
Biocatalysis, the application of enzymes to solve synthetic problems of human import, has blossomed into a powerful technology for chemical innovation. In the past decade, a threefold partnership, where nature provides blueprints for enzymatic catalysis, chemists introduce innovative activity modes with abiological substrates, and protein engineers develop new tools and algorithms to tune and improve enzymatic function, has unveiled the frontier of new-to-nature enzyme catalysis. In this perspective, we highlight examples of interdisciplinary studies which have helped to expand the scope of biocatalysis, including concepts of enzymatic versatility explored through the lens of biomimicry, to achieve both activities and selectivities that are not currently possible with chemocatalysis. We indicate how modern tools, such as directed evolution, computational protein design and machine learning-based protein engineering methods, have already impacted and will continue to influence enzyme engineering for new abiological transformations. A sustained collaborative effort across disciplines is anticipated to spur further advances in biocatalysis in the coming years.
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Affiliation(s)
- David C Miller
- Division of Chemistry and Chemical Engineering, California Institute of Technology Pasadena, California, 91125
| | - Soumitra V Athavale
- Division of Chemistry and Chemical Engineering, California Institute of Technology Pasadena, California, 91125
| | - Frances H Arnold
- Division of Chemistry and Chemical Engineering, California Institute of Technology Pasadena, California, 91125
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12
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Herrel LA, Zhu Z, Ryan AM, Hollenbeck BK, Miller DC. Intensity of end-of-life care for dual-eligible beneficiaries with cancer and the impact of delivery system affiliation. Cancer 2021; 127:4628-4635. [PMID: 34428311 PMCID: PMC9199351 DOI: 10.1002/cncr.33874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/03/2021] [Revised: 07/13/2021] [Accepted: 08/03/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Dual-eligible beneficiaries, who qualify for Medicare and Medicaid, are a vulnerable population with much to gain from efforts to improve quality. Integrated delivery networks and cancer centers, with their emphasis on care coordination and communication, may improve quality of care for dual-eligible patients with cancer at the end of life. METHODS This study used Surveillance, Epidemiology, and End Results registry data linked with Medicare claims to evaluate quality for beneficiaries who died of cancer and were diagnosed from 2009 to 2014. High-intensity care was evaluated with 7 end-of-life quality measures according to dual-eligible status with multivariable logistic regression models. Regression-based techniques were used to assess the effect of delivery system affiliation (ie, cancer center or integrated delivery network vs no affiliation). RESULTS Among 100,549 beneficiaries who died during the study interval, 22% were dually eligible. Inferior outcomes were identified for dual-eligible beneficiaries in comparison with nondual beneficiaries across nearly every quality measure assessed, including >1 hospitalization in the last 30 days (12.6% vs 11.3%; P < .001) and a greater proportion of deaths occurring in a hospital setting (30.2% vs 26.2%; P < .001). Receipt of care in an affiliated delivery system was associated with reduced deaths in a hospital setting and increased hospice utilization for dual-eligible beneficiaries. CONCLUSIONS Dual-eligible status is associated with higher intensity care at the end of life. Delivery system affiliation has a modest impact on quality at the end of life, and this suggests that targeted efforts may be needed to optimize quality for this group of vulnerable patients.
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Affiliation(s)
- Lindsey A Herrel
- Department of Urology, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Ziwei Zhu
- Department of Urology, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Andrew M Ryan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Brent K Hollenbeck
- Department of Urology, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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13
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Stensland KD, Kaffenberger SD, George AK, Morgan TM, Miller DC, Salami SS, Dunn RL, Palapattu GS, Montgomery JS, Hollenbeck BK, Skolarus TA. Prostate cancer clinical trial completion: The role of geography. Contemp Clin Trials 2021; 111:106600. [PMID: 34673273 DOI: 10.1016/j.cct.2021.106600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/01/2021] [Revised: 09/23/2021] [Accepted: 10/14/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND/AIMS One in five cancer clinical trials fails with another third failing to meet enrollment goals. Prior efforts to improve enrollment focus on patient facing interventions, but geographic factors such as regional cancer incidence may doom trials before they even begin. For these reasons, we examined associations of regional prostate cancer incidence with trial termination, and identified scientifically-underserved areas where future trials might thrive. METHODS We merged US phase 2-3 prostate cancer clinical trial data from ClinicalTrials.gov with prostate cancer incidence data from statecancerprofiles.cancer.gov. We matched trial information from 293 closed and 560 active trials with incidence data for 2947 counties. Using multivariable logistic regression, we identified associations with trial termination. We identified 'scientifically-underserved' counties with the highest cancer incidence quintile (>61 annual cases) but lowest active trials quintile (0 or 1 trial). RESULTS Of 293 closed trials, one in three was terminated (n = 96, 32.8%). On multivariable analysis, only lower regional prostate cancer incidence was associated with higher likelihood of premature trial termination (OR 0.98, 95% CI [0.96-0.99] for every 100 cases, p = 0.03). We identified 188 counties with >61 annual prostate cancer cases but 0 or 1 active trials, indicating potential scientifically-underserved areas. CONCLUSIONS In this novel study, we found prostate cancer trials in areas with low prostate cancer incidence were more likely to fail. We also identified scientifically-underserved areas where trials might thrive. Our findings provide a more nuanced understanding of clinical trial feasibility and upstream opportunities for improvement.
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Affiliation(s)
- Kristian D Stensland
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | | | - Arvin K George
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, USA
| | - Todd M Morgan
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - David C Miller
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Simpa S Salami
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Rodney L Dunn
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA
| | - Ganesh S Palapattu
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Jeffrey S Montgomery
- Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Brent K Hollenbeck
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA
| | - Ted A Skolarus
- Department of Urology, Dow Division of Health Services Research, University of Michigan, USA; Department of Urology, Division of Urologic Oncology, University of Michigan, USA; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, USA.
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14
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Lee H, Punt JA, Miller DC, Nagpal A, Smith CC, Sayeed Y, Patel J, Stojanovic MP, Popescu A, McCormick ZL. Do Corticosteroid Injections for the Treatment of Pain Influence the Efficacy of mRNA COVID-19 Vaccines? Pain Med 2021; 22:994-1000. [PMID: 33605425 PMCID: PMC7928682 DOI: 10.1093/pm/pnab063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
MYTH Corticosteroid injection for the treatment of pain and inflammation is known to decrease the efficacy of the messenger ribonucleic acid (mRNA) vaccines for coronavirus disease 2019 (COVID-19). FACT There is currently no direct evidence to suggest that a corticosteroid injection before or after the administration of an mRNA COVID-19 vaccine decreases the efficacy of the vaccine.However, based on the known timeline of hypothalamic-pituitary-adrenal (HPA) axis suppression following epidural and intraarticular corticosteroid injections, and the timeline of the reported peak efficacy of the Pfizer-BioNTech and Moderna vaccines, physicians should consider timing an elective corticosteroid injection such that it is administered no less than 2 weeks prior to a COVID-19 mRNA vaccine dose and no less than 1 week following a COVID-19 mRNA vaccine dose, whenever possible.
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Affiliation(s)
- Haewon Lee
- University of California, San Diego, Department of Orthopedic Surgery, San Diego, California, USA
| | - Jennifer A Punt
- University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | | | - Ameet Nagpal
- Department of Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Clark C Smith
- Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, New York, USA
| | - Yusef Sayeed
- Uniformed Services University of the Health Sciences, Department of Physical Medicine and Rehabilitation, Department of Family Medicine, Eglin AFB, Florida, USA
| | - Jaymin Patel
- Emory University, Department of Orthopedics, Atlanta, Georgia, USA
| | - Milan P Stojanovic
- Anesthesiology, Critical Care and Pain Medicine Service, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - Adrian Popescu
- Hospital of University of Pennsylvania, Department of Physical Medicine and Rehabilitation, Philadelphia, Pennsylvania, USA
| | - Zachary L McCormick
- University of Utah, Division of Physical Medicine and Rehabilitation, Salt Lake City, Utah, USA
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15
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Akula P, Eslick J, Bhattacharyya D, Miller DC. Model Development, Validation, and Optimization of an MEA-Based Post-Combustion CO 2 Capture Process under Part-Load and Variable Capture Operations. Ind Eng Chem Res 2021. [DOI: 10.1021/acs.iecr.0c05035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul Akula
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, West Virginia 26506, United States
| | - John Eslick
- National Energy Technology Laboratory, 626 Cochrans Mill Road, Pittsburgh, Pennsylvania 15236, United States
| | - Debangsu Bhattacharyya
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, West Virginia 26506, United States
| | - David C. Miller
- National Energy Technology Laboratory, 626 Cochrans Mill Road, Pittsburgh, Pennsylvania 15236, United States
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16
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Auffenberg GB, Qi J, Dunn RL, Linsell S, Kim T, Miller DC, Tosoian J, Sarle R, Johnston WK, Kleer E, Ghani KR, Montie J, Peabody J. Evaluation of Patient- and Surgeon-Specific Variations in Patient-Reported Urinary Outcomes 3 Months After Radical Prostatectomy From a Statewide Improvement Collaborative. JAMA Surg 2021; 156:e206359. [PMID: 33471043 DOI: 10.1001/jamasurg.2020.6359] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Understanding variation in patient-reported outcomes following radical prostatectomy may inform efforts to reduce morbidity after this procedure. Objective To describe patient-reported urinary outcomes following radical prostatectomy in the diverse practice settings of a statewide quality improvement program and to explore whether surgeon-specific variations in observed outcomes persist after accounting for patient-level factors. Design, Setting, and Participants This prospective population-based cohort study included 4582 men in the Michigan Urological Surgery Improvement Collaborative who underwent radical prostatectomy as primary management of localized prostate cancer between April 2014 and July 2018 and who agreed to complete validated questionnaires prior to surgery and at 3, 6, and 12 months after surgery. Data were analyzed from 2019 to June 2019. Exposures Radical prostatectomy. Main Outcomes and Measures Patient- and surgeon-level analyses of patient-reported urinary function 3 months after radical prostatectomy. Outcomes were measured using validated questionnaires with results standardized using previously published methods. Urinary function survey scores are reported on a scale from 0 to 100 with good function established as a score of 74 or higher. Results For the 4582 men undergoing radical prostatectomy within the Michigan Urological Surgery Improvement Collaborative who agreed to complete surveys, mean (SD) age was 63.3 (7.1) years. Survey response rates varied: 3791 of 4582 (83%) responded at baseline, 3282 of 4137 (79%) at 3 months, 2975 of 3770 (79%) at 6 months, and 2213 of 2882 (77%) at 12 months. Mean (SD) urinary function scores were 88.5 (14.3) at baseline, 53.6 (27.5) at 3 months, 68.0 (25.1) at 6 months, and 73.7 (23.0) at 12 months. Regression analysis demonstrated that older age, lower baseline urinary function score, body mass index (calculated as weight in kilograms divided by height in meters squared) of 30 or higher, clinical stage T2 or higher, and lack of bilateral nerve-sparing surgery were associated with a lower probability of reporting good urinary function 3 months after surgery. When evaluating patients with good baseline function, the rate at which individual surgeons' patients reported good urinary function 3 months after surgery varied broadly (0% to 54.5%; P < .001). Patients receiving surgery from top-performing surgeons were more likely to report good 3-month function. This finding persisted after accounting for patient risk factors. Conclusions and Relevance In this study, patient- and surgeon-level urinary outcomes following prostatectomy varied substantially. Documenting surgeon-specific variations after accounting for patient factors may facilitate identification of surgical factors associated with superior outcomes.
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Affiliation(s)
- Gregory B Auffenberg
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ji Qi
- Department of Urology, University of Michigan, Ann Arbor
| | - Rodney L Dunn
- Department of Urology, University of Michigan, Ann Arbor
| | - Susan Linsell
- Department of Urology, University of Michigan, Ann Arbor
| | - Tae Kim
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor
| | | | - Richard Sarle
- Department of Urology, Sparrow Hospital, Lansing, Michigan
| | | | - Eduardo Kleer
- IHA Urology, St Joe's Ann Arbor, Ann Arbor, Michigan
| | | | - James Montie
- Department of Urology, University of Michigan, Ann Arbor
| | - James Peabody
- Department of Urology, Henry Ford Health System, Detroit, Michigan
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17
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Isenberg NM, Akula P, Eslick JC, Bhattacharyya D, Miller DC, Gounaris CE. A generalized
cutting‐set
approach for nonlinear robust optimization in process systems engineering. AIChE J 2021. [DOI: 10.1002/aic.17175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Natalie M. Isenberg
- Department of Chemical Engineering Carnegie Mellon University Pittsburgh Pennsylvania USA
| | - Paul Akula
- Department of Chemical and Biomedical Engineering West Virginia University Morgantown West Virginia USA
| | - John C. Eslick
- The National Energy Technology Laboratory Pittsburgh Pennsylvania USA
| | - Debangsu Bhattacharyya
- Department of Chemical and Biomedical Engineering West Virginia University Morgantown West Virginia USA
| | - David C. Miller
- The National Energy Technology Laboratory Pittsburgh Pennsylvania USA
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18
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Owen-Bellini M, Moffitt SL, Sinha A, Maes AM, Meert JJ, Karin T, Takacs C, Jenket DR, Hartley JY, Miller DC, Hacke P, Schelhas LT. Towards validation of combined-accelerated stress testing through failure analysis of polyamide-based photovoltaic backsheets. Sci Rep 2021; 11:2019. [PMID: 33479363 PMCID: PMC7820324 DOI: 10.1038/s41598-021-81381-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022] Open
Abstract
Novel methods for advancing reliability testing of photovoltaic (PV) modules and materials have recently been developed. Combined-accelerated stress testing (C-AST) is one such method which has demonstrated reliable reproduction of some field-failures which were not reproducible by standard certification tests. To increase confidence and assist in the development of C-AST, and other new testing protocols, it is important to validate that the failure modes observed and mechanisms induced are representative of those observed in the field, and not the product of unrealistic stress conditions. Here we outline a method using appropriate materials characterization and modelling to validate the failure mechanisms induced in C-AST such that we can increase confidence in the test protocol. The method is demonstrated by applying it to a known cracking failure of a specific polyamide (PA)-based backsheet material. We found that the failure of the PA-based backsheet was a result of a combination of stress factors. Photo-oxidation from ultra-violet (UV) radiation exposure caused a reduction in fracture toughness, which ultimately lead to the cracking failure. We show that the chemical and structural changes observed in the backsheet following C-AST aging were also observed in field-aged samples. These results increase confidence that the conditions applied in C-AST are representative of the field and demonstrates our approach to validating the failure mechanisms induced.
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Affiliation(s)
| | | | - Archana Sinha
- SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | | | | | - Todd Karin
- Lawrence Berkeley National Laboratory, Berkeley, CA, USA
| | - Chris Takacs
- SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | | | | | | | - Peter Hacke
- National Renewable Energy Laboratory, Golden, CO, USA
| | - Laura T Schelhas
- National Renewable Energy Laboratory, Golden, CO, USA.,SLAC National Accelerator Laboratory, Menlo Park, CA, USA
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19
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Singhal U, Tosoian JJ, Qi J, Miller DC, Linsell SM, Cher M, Lane B, Cotant M, Montie JE, Bazzi W, Jafri M, Rosenberg B, George AK. Overtreatment and Underutilization of Watchful Waiting in Men With Limited Life Expectancy: An Analysis of the Michigan Urological Surgery Improvement Collaborative Registry. Urology 2020; 145:190-196. [DOI: 10.1016/j.urology.2020.07.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
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20
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Miller DC, Pu J, Kukafka D, Bime C. Failure of High Flow Nasal Cannula and Subsequent Intubation Is Associated With Increased Mortality as Compared to Failure of Non-Invasive Ventilation and Mechanical Ventilation Alone: A Real-World Retrospective Analysis. J Intensive Care Med 2020; 37:41-45. [PMID: 33118405 DOI: 10.1177/0885066620968041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite the increasing use of high flow nasal cannula oxygenation systems (HFNC) in clinical practice, little is known about its role in all cause respiratory failure as compared to traditional non-invasive ventilation (BiPAP). Furthermore, the effect of HFNC on mortality is unknown. METHODS We conducted a retrospective analysis of 49,853 patients with respiratory failure treated with non-invasive respiratory support (HFNC or BiPAP) and/or invasive mechanical ventilation (IMV) between 2017 and 2018. RESULTS Patients initially treated with HFNC who underwent subsequent intubation and IMV had a higher mortality rate as compared to patients who were initially treated with BiPAP and underwent subsequent intubation and IMV (34.8% vs 26.3%, p < 0.0001, OR 1.49, 95% CI 1.26,1.76). Patients first treated with HFNC who underwent subsequent intubation and IMV had a significantly increased mortality compared to patients who underwent immediate intubation and IMV (34.8% vs. 21.5%, p ≤ 0.0001, OR 1.94, 95% CI 1.67, 2.27). Stratified based on ICD-10 diagnosis, patients with a diagnosis of COPD exacerbation or heart failure treated with HFNC and subsequent intubation and IMV had higher mortality as compared to those treated with immediate IMV alone. This trend did not hold true for patients with a diagnosis of pneumonia. CONCLUSION In a real-world retrospective analysis, use of HFNC was associated with increased mortality as compared to BiPAP and IMV alone. Further study is needed to confirm these associations.
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Affiliation(s)
- David C Miller
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jie Pu
- Banner Health, Phoenix, AZ, USA
| | | | - Christian Bime
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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21
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Perkins B, Huckleberry Y, Bogdanich I, Leelathanalerk A, Huckleberry A, Konecnik M, Miller DC, Bailey M, Bime C. Evaluation of Inpatient Opioid Prescribing Resulting in Outpatient Opioid Prescriptions for Previously Opioid-Naive Internal Medicine Patients. J Pharm Pract 2020; 35:179-183. [PMID: 33000671 DOI: 10.1177/0897190020961290] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little data exist regarding inpatient opioid prescriptions as a potential contribution to the current opioid crisis. While pain management is essential to inpatient care, the ease of which opioids may be prescribed for all levels of pain may contribute to unnecessary inpatient exposure and new outpatient prescriptions. The aim of this study was to observe patterns of opioid prescribing potentially leading to new opioid prescriptions at hospital discharge for previously opioid-naive patients. METHODS This study was a single-center observational study of opioid-naïve internal medicine patients who were prescribed inpatient opioids. Patient charts were reviewed to assess the patterns of inpatient opioid and non-opioid analgesic use, new opioid prescriptions upon discharge and medical record documentation justifying the need for outpatient therapy. RESULTS Among the 101 patients included in this study, 71 were prescribed IV opioids and 45 were prescribed both IV and oral opioids. Non-opioid analgesics were available for 78 patients. Twenty patients were discharged with a new prescription. The mean duration of outpatient prescriptions was 3.85 +/- 1.85 days with mean morphine milligram equivalents (MME) of 44.25 +/- 22.16. Among patients receiving these outpatient prescriptions, 11 had reference to the therapy in the discharge summary. CONCLUSIONS This observational study describes an opportunity to improve inpatient opioid prescribing practices which may reduce new prescriptions for continued outpatient therapy. Further work should focus on optimizing use of non-opioid analgesia, minimizing use of IV opioids and requiring prescribers to justify the indication for new opioid prescriptions upon hospital discharge.
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Affiliation(s)
- Bryce Perkins
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.,Banner University Medical Center, Tucson, AZ, USA
| | - Yvonne Huckleberry
- Banner University Medical Center, Tucson, AZ, USA.,College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Ivana Bogdanich
- Banner University Medical Center, Tucson, AZ, USA.,College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - Areerut Leelathanalerk
- Banner University Medical Center, Tucson, AZ, USA.,College of Pharmacy, University of Arizona, Tucson, AZ, USA.,Mahasarakham University, Maha Sarakham, Thailand
| | | | - Michaela Konecnik
- Banner University Medical Center, Tucson, AZ, USA.,College of Pharmacy, University of Arizona, Tucson, AZ, USA
| | - David C Miller
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.,Banner University Medical Center, Tucson, AZ, USA
| | - Morgan Bailey
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.,Banner University Medical Center, Tucson, AZ, USA
| | - Christian Bime
- Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA.,Banner University Medical Center, Tucson, AZ, USA
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22
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Miller DC, Patel J, Gill J, Mattie R, Saffarian M, Schneider BJ, Popescu A, Babaria V, McCormick ZL. Corticosteroid Injections and COVID-19 Infection Risk. Pain Med 2020; 21:1703-1706. [PMID: 32699893 PMCID: PMC7454880 DOI: 10.1093/pm/pnaa199] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | - Jaymin Patel
- Department of Orthopaedics, Emory University, Atlanta, Georgia
| | - Jatinder Gill
- Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ryan Mattie
- Department of Interventional Pain & Spine, Providence Cedars-Sinai Tarzana Medical Center, Los Angeles, California
| | - Mathew Saffarian
- Department of Physical Medicine and Rehabilitation, Michigan State University, East Lansing, Michigan
| | - Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, Tennessee
| | - Adrian Popescu
- Department of Physical Medicine and Rehabilitation, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vivek Babaria
- Orange County Spine and Sports, PC, Interventional Physiatry, Costa Mesa, California
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
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23
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Schneider BJ, Miller DC, Mattie R, McCormick ZL, Smith C. Anticoagulants for Lumbar Epidural Steroid Injections. Pain Med 2020; 21:1294-1295. [PMID: 32524141 DOI: 10.1093/pm/pnaa087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ryan Mattie
- Interventional Pain & Spine, Synovation Medical Group, Los Angeles, California, USA
| | - Zachary L McCormick
- Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Clark Smith
- Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York, USA
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24
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Miller DC, Beamer P, Billheimer D, Subbian V, Sorooshian A, Campbell BS, Mosier JM. Aerosol Risk with Noninvasive Respiratory Support in Patients with COVID-19. J Am Coll Emerg Physicians Open 2020; 1:521-526. [PMID: 32838370 PMCID: PMC7280651 DOI: 10.1002/emp2.12152] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives This study evaluates aerosol production with high‐flow nasal cannula (HFNC) and noninvasive positive pressure ventilation (NIPPV) compared to 6 L/min by low‐flow nasal cannula. Methods Two healthy volunteers were randomized to control (6 L/min by low‐flow nasal cannula), NIPPV, or HFNC using block randomization. NIPPV conditions were studied using continuous positive airway pressures of 5, 10, and 15 cm H2O with an FiO2 of 1.0 delivered via full‐face mask. HFNC conditions included flow rates of 30 and 40 L/min with an FiO2 of 1.0 with and without coughing. HFNC and low‐flow nasal cannula conditions were repeated with and without participants wearing a surgical mask. Six aerosol sizes (0.3, 1.0, 2.5, 5, and 10 µm) and total aerosol mass were measured at 2 and 6 ft from the participant's nasopharynx. Results There was no significant difference in aerosol production between either HFNC or NIPPV and control. There was also no significant difference with the use of a procedural mask over the HFNC. There was significant variation between the 2 participants, but in neither case was there a difference compared to control. There was an aerosol‐time trend, but there does not appear to be a difference between either flow rate, pressure, or control. Furthermore, there was no accumulation of total aerosol particles over the total duration of the experiment in both HFNC and NIPPV conditions. Conclusions HFNC and NIPPV did not increase aerosol production compared to 6 L/min by low‐flow nasal cannula in this experiment involving healthy volunteers.
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Affiliation(s)
- David C Miller
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine University of Arizona College of Medicine Tucson AZ
| | - Paloma Beamer
- Community, Environment & Policy Department, Mel & Enid Zuckerman College of Public Health University of Arizona Tucson AZ.,Department of Chemical & Environmental Engineering, College of Engineering University of Arizona Tucson AZ.,BIO5 Institute University of Arizona Tucson AZ.,Asthma and Airways Disease Research Center University of Arizona Tucson AZ
| | - Dean Billheimer
- BIO5 Institute University of Arizona Tucson AZ.,Asthma and Airways Disease Research Center University of Arizona Tucson AZ.,Epidemiology and Biostatistics Department, Mel & Enid Zuckerman College of Public Health University of Arizona Tucson AZ
| | - Vignesh Subbian
- BIO5 Institute University of Arizona Tucson AZ.,Systems and Industrial Engineering, College of Engineering University of Arizona Tucson AZ.,Biomedical Engineering, College of Engineering University of Arizona Tucson AZ
| | - Armin Sorooshian
- Department of Chemical & Environmental Engineering, College of Engineering University of Arizona Tucson AZ.,Department of Hydrology and Atmospheric Sciences University of Arizona Tucson AZ
| | - Beth Salvagio Campbell
- Department of Emergency Medicine University of Arizona College of Medicine Tucson Arizona
| | - Jarrod M Mosier
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine University of Arizona College of Medicine Tucson AZ.,Department of Emergency Medicine University of Arizona College of Medicine Tucson Arizona
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25
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Miller DC, Smith CC. Informed Consent. Pain Med 2020; 21:pnaa112. [PMID: 32374374 DOI: 10.1093/pm/pnaa112] [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: 02/28/2024]
Affiliation(s)
| | - Clark C Smith
- Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, New York, USA
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26
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Abstract
OBJECTIVE In the schematic design phase of a new freestanding children's hospital, Simulation-based Hospital Design Testing (SbHDT) was used to evaluate the proposed design of 11 clinical areas. The purpose of this article is to describe the SbHDT process and how it can help identify and mitigate safety concerns during the facility design process. BACKGROUND In the design of new healthcare facilities, the ability to mitigate risk in the preconstruction period is imperative. SbHDT in a full-scale cardboard mock-up can be used to proactively test the complex interface between people and the built environment. METHOD This study was a prospective investigation of SbHDT in the schematic design planning phase for a 400-bed freestanding children's hospital where frontline staff simulated episodes of care. Latent conditions related to design were identified through structured debriefing. Failure mode and effect analysis was used to categorize and prioritize simulation findings and was used by the architect team to inform design solutions. A second round of testing was conducted in order to validate design changes. RESULTS A statistically significant reduction in criticality scores between Round 1 (n = 201, median = 16.14, SD = 5.8) and Round 2 (n = 201, median score of 7.68, SD = 5.26, p < .001) was identified. Bivariate analysis also demonstrated a statistically significant reduction in very high/high criticality scores between Round 1 and Round 2. CONCLUSIONS SbHDT in the schematic phase of design planning was effective in mitigating risk related to design prototypes through effective identification of latent conditions and validation of design changes.
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Affiliation(s)
- Nora Colman
- Division of Pediatric Critical Care, Department of Pediatrics, 1367Children's Healthcare of Atlanta, GA, USA
| | - Mary Bond Edmond
- Advanced Analytics and Outcomes, 1367Children's Healthcare of Atlanta, GA, USA
| | - Ashley Dalpiaz
- Department of Pediatrics, 1367Children's Healthcare of Atlanta, GA, USA
| | - Sarah Walter
- EYP Architecture and Engineering, Atlanta, GA, USA
| | | | - Kiran Hebbar
- Division of Pediatric Critical Care, Department of Pediatrics, 1367Children's Healthcare of Atlanta, GA, USA
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Shah PK, Linsell S, Qi J, Hafron J, Sarle R, Lane B, Peabody J, Miller DC, Ghani KR, Dupree JM. Limiting Opioid Overprescription after Prostatectomy: How Payer-Provider Collaboration Can Lead to Improved Patient Safety and Reimbursement. ACTA ACUST UNITED AC 2020. [DOI: 10.1056/cat.20.0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Parth K. Shah
- Chief Resident, Michigan MedicineUrologist, USMD Urology
| | | | - Ji Qi
- Senior Statistician, Michigan Medicine
| | | | | | - Brian Lane
- Urologist, Spectrum Health Medical Group – UrologyAssociate Professor, Michigan State University College of Human Medicine
| | - James Peabody
- Urologist, Henry Ford Health System – Vattikuti Urology Institute
| | - David C. Miller
- Chief Clinical Officer, University Hospital/Cardiovascular CenterProfessor of Urology, Michigan Medicine
| | - Khurshid R. Ghani
- Program Director, MUSIC, Michigan MedicineAssociate Professor of Urology, Michigan Medicine
| | - James M. Dupree
- Associate Professor of Urology, Obstetrics, and Gynecology, Michigan Medicine
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Okoli CO, Ostace A, Nadgouda S, Lee A, Tong A, Burgard AP, Bhattacharyya D, Miller DC. A framework for the optimization of chemical looping combustion processes. POWDER TECHNOL 2020. [DOI: 10.1016/j.powtec.2019.04.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Miller DC, Bime C, Partharsarathy S, Mosier JM. High-Flow Oxygen Therapy Concepts: Time to Standardize Nomenclature and Avoid Confusion. J Intensive Care Med 2020; 35:519-523. [PMID: 32105158 DOI: 10.1177/0885066620908243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
High-flow nasal oxygen systems are rapidly being adopted as an initial noninvasive treatment for acute respiratory failure. However, the term "high-flow nasal cannula" is nonspecific and leads to imprecise communication between physicians, respiratory therapists, and nurses with the potential for patient harm. In this viewpoint and a brief review of the technology, we argue for a change in nomenclature in order to reduce the chance for future clinical, administrative, and research misunderstanding surrounding high-flow nasal oxygen systems.
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Affiliation(s)
- David C Miller
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Christian Bime
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Sairam Partharsarathy
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Jarrod M Mosier
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Arizona College of Medicine, Tucson, AZ, USA.,Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
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Agochukwu NQ, Wittmann D, Boileau NR, Dunn RL, Montie J, Kim T, Miller DC, Peabody J, Carlozzi NE. Reply to K.P. Weinfurt et al. J Clin Oncol 2020; 38:654-655. [PMID: 31895615 PMCID: PMC7030898 DOI: 10.1200/jco.19.02642] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nnenaya Q. Agochukwu
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Daniela Wittmann
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Nicholas R. Boileau
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Rodney L. Dunn
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - James Montie
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Tae Kim
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - David C. Miller
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - James Peabody
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Noelle E. Carlozzi
- Nnenaya Q. Agochukwu, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MIDepartment of Urology, University of California, San Francisco, San Francisco, CA; Daniela Wittmann, PhD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; Nicholas R. Boileau, MPH, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI; Rodney L. Dunn, MS; James Montie, MD; Tae Kim, BS; and David C. Miller, MD, Department of Urology, University of Michigan Health System, Ann Arbor, MIDow Division of Health Services Research, University of Michigan, Ann Arbor, MI; James Peabody, MS, Henry Ford Health System, Detroit, MI; and Noelle E. Carlozzi, PhD, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
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Herrel LA, Zhu Z, Griggs JJ, Kaye DR, Dupree JM, Ellimoottil CS, Miller DC. Association Between Delivery System Structure and Intensity of End-of-Life Cancer Care. JCO Oncol Pract 2020; 16:e590-e600. [PMID: 32069191 DOI: 10.1200/jop.19.00667] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine whether the type of delivery system is associated with intensity of care at the end of life for Medicare beneficiaries with cancer. PATIENTS AND METHODS We used SEER registry data linked with Medicare claims to evaluate intensity of end-of-life care for patients who died of one of ten common cancers diagnosed from 2009 through 2014. Patients were categorized as receiving the majority of their care in an integrated delivery system, designated cancer center, health system that was both integrated and a certified cancer center, or health system that was neither. We evaluated adherence to seven nationally endorsed end-of-life quality measures using generalized linear models across four delivery system types. RESULTS Among 100,549 beneficiaries who died of cancer during the study interval, we identified only modest differences in intensity of end-of-life care across delivery system structures. Health systems with no cancer center or integrated affiliation demonstrated higher proportions of patients with multiple hospitalizations in the last 30 days of life (11.3%), death in an acute care setting (25.9%), and lack of hospice use in the last year of life (31.6%; all P < .001). Patients enrolled in hospice had lower intensity care across multiple end-of-life quality measures. CONCLUSION Intensity of care at the end of life for patients with cancer was higher at delivery systems with no integration or cancer focus. Maximal supportive care delivered through hospice may be one avenue to reduce high-intensity care at the end of life and may impact quality of care for patients dying from cancer.
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Affiliation(s)
- Lindsey A Herrel
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Ziwei Zhu
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Jennifer J Griggs
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Deborah R Kaye
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - James M Dupree
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Chandy S Ellimoottil
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - David C Miller
- The University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI
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Abstract
INTRODUCTION The prevalence of childhood trauma, as measured by the Adverse Childhood Experiences (ACE) Study questionnaire, has been studied in a wide variety of community settings. However, little is known about physicians' familiarity with and use of the ACE questionnaire or the prevalence of childhood trauma in the physician community. OBJECTIVE To survey a convenience sample of community-based physicians and resident physicians to assess for familiarity with and use of the ACE questionnaire in clinical practice and to measure the prevalence of their own ACEs. METHODS An electronic survey was created and disseminated that included demographic questions, questions about physician awareness and use of the ACE questionnaire in clinical practice, and the 10-point ACE questionnaire. RESULTS Most physicians surveyed (81%) reported they had never heard of the ACE questionnaire. Even fewer (3%) reported using the questionnaire in clinical practice. Most physicians (55.5%) reported no personal history of ACEs. Physicians reporting a history of childhood trauma reported a wide range of ACE scores (1-9). Compared with men, women reported a statistically higher number of ACEs (p < 0.001). CONCLUSION In this sample of community physicians, familiarity with and clinical use of the ACE questionnaire was low. Most physicians surveyed reported no personal history of childhood trauma. Of physicians reporting a history of childhood trauma, women were disproportionately affected. Physicians in this study reported a lower prevalence of ACEs than the population they serve. Physicians must become better educated and actively address the effects of ACEs on their patients and on themselves.
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Affiliation(s)
- Brian R Stork
- Department of Urology, University of Michigan, Ann Arbor
| | | | - Yongmei Qin
- Department of Urology, University of Michigan, Ann Arbor
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor
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Abstract
Interest is growing within the urological surgery community for objective assessments of technical skill. Surgical video review relies on the use of objective assessment tools to evaluate both global and procedure-specific skill. These evaluations provide structured feedback to surgeons with the aim of improving technique, which has been associated with patient outcomes. Currently, skill assessments can be performed by using expert peer-review, crowdsourcing or computer-based methods. Given the relationship between skill and patient outcomes, surgeons might be required in the future to provide empirical evidence of their technical skill for certification, employment, credentialing and quality improvement. Interventions such as coaching and skills workshops incorporating video review might help surgeons improve their skill, with the ultimate goal of improving patient outcomes.
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Affiliation(s)
- Zachary J Prebay
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James O Peabody
- Center for Outcomes Research, Analytics and Evaluation, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, Ann Arbor, MI, USA.
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Affiliation(s)
- Clark Smith
- Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York
- Napa Pain Institute, Napa, California, USA
| | - David C Miller
- Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York
- Napa Pain Institute, Napa, California, USA
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Miller DC, Ganley JM, Musacchio AJ, Sherwood TC, Ewing WR, Knowles RR. Anti-Markovnikov Hydroamination of Unactivated Alkenes with Primary Alkyl Amines. J Am Chem Soc 2019; 141:16590-16594. [PMID: 31603324 DOI: 10.1021/jacs.9b08746] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report here a photocatalytic method for the intermolecular anti-Markovnikov hydroamination of unactivated olefins with primary alkyl amines to selectively furnish secondary amine products. These reactions proceed through aminium radical cation (ARC) intermediates and occur at room temperature under visible light irradiation in the presence of an iridium photocatalyst and an aryl thiol hydrogen atom donor. Despite the presence of excess olefin, high selectivities are observed for secondary over tertiary amine products, even though the secondary amines are established substrates for ARC-based olefin amination under similar conditions.
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Affiliation(s)
- David C Miller
- Department of Chemistry , Princeton University , Princeton , New Jersey 08544 , United States
| | - Jacob M Ganley
- Department of Chemistry , Princeton University , Princeton , New Jersey 08544 , United States
| | - Andrew J Musacchio
- Department of Chemistry , Princeton University , Princeton , New Jersey 08544 , United States
| | - Trevor C Sherwood
- Discovery Chemistry , Bristol-Myers Squibb , Lawrenceville , New Jersey 08543 , United States
| | - William R Ewing
- Discovery Chemistry , Bristol-Myers Squibb , Lawrenceville , New Jersey 08543 , United States
| | - Robert R Knowles
- Department of Chemistry , Princeton University , Princeton , New Jersey 08544 , United States
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Abstract
Here we report a cytochrome P450 variant that catalyzes C2-amidation of 1-methylindoles with tosyl azide via nitrene transfer. Before evolutionary optimization the enzyme exhibited two undesired side reactivities resulting in reduction of the putative iron-nitrenoid intermediate or cycloaddition between the two substrates to form triazole products. We speculated that triazole formation was a promiscuous cycloaddition activity of the P450 heme domain, while sulfonamide formation likely arose from surplus electron transfer from the reductase domain. Directed evolution involving mutagenesis of both the heme and reductase domains delivered an enzyme providing the desired indole amidation products with up to 8400 turnovers, 90% yield, and a shift in chemoselectivity from 2:19:1 to 110:12:1 in favor of nitrene transfer over reduction or triazole formation. This work expands the substrate scope of hemoprotein nitrene transferases to heterocycles and highlights the adaptability of the P450 scaffold to solve challenging chemoselectivity problems in non-natural enzymatic catalysis.
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Affiliation(s)
- Oliver F. Brandenberg
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | - David C. Miller
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | - Ulrich Markel
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | - Anissa Ouald Chaib
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
| | - Frances H. Arnold
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, California 91125, United States
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Affiliation(s)
- Ryan Mattie
- Providence Cedars-Sinai Tarzana Medical Center, Interventional Pain Management, Comprehensive Spine & Musculoskeletal Medicine, Tarzana, California
| | | | - Clark Smith
- Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, New York, USA
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Alyesh DM, Seth M, Miller DC, Dupree JM, Syrjamaki J, Sukul D, Dixon S, Kerr EA, Gurm HS, Nallamothu BK. Exploring the Healthcare Value of Percutaneous Coronary Intervention: Appropriateness, Outcomes, and Costs in Michigan Hospitals. Circ Cardiovasc Qual Outcomes 2019; 11:e004328. [PMID: 29853465 DOI: 10.1161/circoutcomes.117.004328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/05/2017] [Accepted: 04/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessments of healthcare value have largely focused on measuring outcomes of care at a given level of cost with less attention paid to appropriateness. However, understanding how appropriateness relates to outcomes and costs is essential to determining healthcare value. METHODS AND RESULTS In a retrospective cohort study design, administrative data from fee-for-service Medicare patients undergoing percutaneous coronary intervention (PCI) in Michigan hospitals between June 30, 2010, and December 31, 2014, were linked with clinical data from a statewide PCI registry to calculate hospital-level measures of (1) appropriate use criteria scores, (2) 90-day risk-standardized readmission and mortality rates, and (3) 90-day risk-standardized episode costs. We then used Spearman correlation coefficients to assess the relationship between these measures. A total of 29 839 PCIs were performed at 33 PCI hospitals during the study period. A total of 13.3% were for ST-segment-elevation myocardial infarction, 25.0% for non-ST-segment-elevation myocardial infarction, 47.1% for unstable angina, 9.8% for stable angina, and 4.7% for other. The overall hospital-level mean appropriate use criteria score was 8.4±0.2. Ninety-day risk-standardized readmission occurred in 23.7%±3.7% of cases, 90-day risk-standardized mortality in 4.3%±0.6%, and mean risk-standardized episode costs were $26 159±$1074. Hospital-level appropriate use criteria scores did not correlate with 90-day readmission, mortality, or episode costs. CONCLUSIONS Among Medicare patients undergoing PCI in Michigan, we found hospital-level appropriate use criteria scores did not correlate with 90-day readmission, mortality, or episode costs. This finding suggests that a comprehensive understanding of healthcare value requires multidimensional consideration of appropriateness, outcomes, and costs.
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Affiliation(s)
- Daniel M Alyesh
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.M.A., D.S., H.S.G., B.K.N.)
| | - Milan Seth
- University of Michigan Medical School, Ann Arbor. Blue Cross Blue Shield of Michigan Cardiovascular Collaborative, Ann Arbor, MI (M.S., H.S.G.)
| | - David C Miller
- Department of Urology (D.C.M., J.M.D., J.S.).,Blue Cross Blue Shield Michigan Value Collaborative, Ann Arbor, MI (D.C.M., J.M.D., J.S.)
| | - James M Dupree
- Department of Urology (D.C.M., J.M.D., J.S.).,Blue Cross Blue Shield Michigan Value Collaborative, Ann Arbor, MI (D.C.M., J.M.D., J.S.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., E.A.K., B.K.N. J.M.D.)
| | - John Syrjamaki
- Department of Urology (D.C.M., J.M.D., J.S.).,Blue Cross Blue Shield Michigan Value Collaborative, Ann Arbor, MI (D.C.M., J.M.D., J.S.)
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.M.A., D.S., H.S.G., B.K.N.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., E.A.K., B.K.N. J.M.D.)
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, MI (S.D.)
| | - Eve A Kerr
- Ann Arbor Veterans Affairs Center for Clinical Management Research, MI (E.A.K., H.S.G., B.K.N.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., E.A.K., B.K.N. J.M.D.)
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.M.A., D.S., H.S.G., B.K.N.).,University of Michigan Medical School, Ann Arbor. Blue Cross Blue Shield of Michigan Cardiovascular Collaborative, Ann Arbor, MI (M.S., H.S.G.).,Ann Arbor Veterans Affairs Center for Clinical Management Research, MI (E.A.K., H.S.G., B.K.N.)
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Medicine, Department of Internal Medicine (D.M.A., D.S., H.S.G., B.K.N.).,Ann Arbor Veterans Affairs Center for Clinical Management Research, MI (E.A.K., H.S.G., B.K.N.).,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor (D.S., E.A.K., B.K.N. J.M.D.)
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Wu RC, Prebay ZJ, Patel P, Kim T, Qi J, Telang J, Linsell S, Kleer E, Miller DC, Peabody JO, Ghani KR, Johnston WK. Using video review to understand the technical variation of robot-assisted radical prostatectomy in a statewide surgical collaborative. World J Urol 2019; 38:1607-1613. [PMID: 31444604 DOI: 10.1007/s00345-019-02906-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/23/2019] [Accepted: 08/09/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Video assessment is an emerging tool for understanding surgical technique. Patient outcomes after robot-assisted radical prostatectomy (RARP) may be linked to technical aspects of the procedure. In an effort to refine surgical approaches and improve outcomes, we sought to understand technical variation for the key steps of RARP in a surgical collaborative. METHODS The Michigan Urological Surgery Improvement Collaborative (MUSIC) is a statewide quality improvement collaborative with the aim of improving prostate cancer care. MUSIC surgeons were invited to submit representative complete videos of nerve-sparing RARP for blinded analysis. We also analyzed peri-operative outcomes from these surgeons in the registry. RESULTS Surgical video data from 20 unique surgeons identified many variations in technique and time to complete different steps. Common to all surgeons was a transperitoneal approach and a running urethrovesical anastomosis. Prior to anastomosis, 25% surgeons undertook a posterior reconstruction and 30% employed urethral suspension. 65% surgeons approached the seminal vesicle anteriorly. For control of the dorsal vein complex, suture ligation was used in 60%, and vascular stapler was 15%. The majority (80%) of surgeons employed clips for managing pedicles. In examining patient outcomes for surgeons, peri-operative outcomes were not correlated with surgeon's operative time; however, surgeons with an EBL > 400 ml had significant difference among the five different techniques employed. CONCLUSIONS Despite the worldwide popularity of RARP, the operation is still far from standardized. Correlating variation in technique with clinical outcomes may help provide objective data to support best practices with the goal to improve patient outcomes.
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Affiliation(s)
- Richard C Wu
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.,Department of Urology, E-Da Hospital, Kaohsiung, Taiwan
| | - Zachary J Prebay
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Parin Patel
- Department of Urology, Detroit Medical Center, Detroit, MI, USA
| | - Tae Kim
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Ji Qi
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Jaya Telang
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Susan Linsell
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Eduardo Kleer
- IHA-Urology, St. Joseph Healthcare, Ypsilanti, MI, USA
| | - David C Miller
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, North Campus Research Complex Building 16, 114W, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA.
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41
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Miller DC. Caution When Withholding Antithrombotic
and Antiplatelet Agents for Interventional
Spine Procedures and the Need for Further Risk
Stratification. Pain Physician 2019. [DOI: 10.36076/ppj/2019.22.413] [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: 11/25/2022]
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Hanselman CL, Tafen DN, Alfonso DR, Lekse JW, Matranga C, Miller DC, Gounaris CE. A framework for optimizing oxygen vacancy formation in doped perovskites. Comput Chem Eng 2019. [DOI: 10.1016/j.compchemeng.2019.03.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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43
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Miller DC, Schneider BJ, McCormick ZL. Caution When Withholding Antithrombotic and Antiplatelet Agents for Interventional Spine Procedures and the Need for Further Risk Stratification. Pain Physician 2019; 22:413-415. [PMID: 31337180] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Bryon J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
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44
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Agochukwu NQ, Wittmann D, Boileau NR, Dunn RL, Montie JE, Kim T, Miller DC, Peabody J, Carlozzi NE. Validity of the Patient-Reported Outcome Measurement Information System (PROMIS) Sexual Interest and Satisfaction Measures in Men Following Radical Prostatectomy. J Clin Oncol 2019; 37:2017-2027. [PMID: 31232671 DOI: 10.1200/jco.18.01782] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Patient-reported outcomes after radical prostatectomy have focused on erectile function. To date, no studies have validated the Patient-Reported Outcome Measurement Information System (PROMIS) Sexual Interest and Satisfaction single item measures in patients with prostate cancer, nor have studies examined how these measures relate to erectile function. In addition, data are lacking with regard to the clinical responsiveness of these measures to treatment. We sought to validate and examine the clinical utility of these measures in men after radical prostatectomy. PATIENTS AND METHODS We identified men who underwent a robotic radical prostatectomy from May 2014 to January 2016 in the Michigan Urological Surgery Improvement Collaborative. A single item from the PROMIS Global Satisfaction With Sex Life subdomain and a single item from the PROMIS Interest in Sexual Activity subdomain were administered. Erectile function was also assessed. Differences between baseline and 24-month T-scores for both PROMIS interest and satisfaction were examined. Multilevel models were constructed to examine change over time. RESULTS A total of 1,604 patients were included in the analysis. Convergent and discriminant validity of the PROMIS measures was supported. The mean PROMIS interest T-score decreased significantly from baseline to 3 months (P = .001) and significantly increased from 3 months to 24 months in this cohort, with 24-month scores exceeding baseline scores (P < .001). The mean PROMIS satisfaction T-score declined from baseline to 3 months and increased from 3 months to 24 months (P < .002). CONCLUSION PROMIS Global Satisfaction With Sex Life and Interest in Sexual Activity single-item measures are fundamental measures in prostate cancer survivorship. Patients are interested in sex despite functional losses and can salvage satisfaction, thereby giving insight into attainable patient-centered survivorship goals for sexual recovery after radical prostatectomy.
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Affiliation(s)
- Nnenaya Q Agochukwu
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - Daniela Wittmann
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | | | - Rodney L Dunn
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - James E Montie
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - Tae Kim
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - David C Miller
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
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45
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Auffenberg GB, Lane BR, Linsell S, Cher ML, Miller DC. Practice- vs Physician-Level Variation in Use of Active Surveillance for Men With Low-Risk Prostate Cancer: Implications for Collaborative Quality Improvement. JAMA Surg 2019. [PMID: 28636713 DOI: 10.1001/jamasurg.2017.1586] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Brian R Lane
- Division of Urology, Spectrum Health, Grand Rapids, Michigan
| | - Susan Linsell
- Department of Urology, University of Michigan, Ann Arbor
| | - Michael L Cher
- Department of Urology, Wayne State University, Detroit, Michigan
| | - David C Miller
- Department of Urology, University of Michigan, Ann Arbor
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46
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Miller DC, Smith C. The Safe Use of Multidose and Single-Dose Vials. Pain Medicine 2019; 20:1047-1048. [DOI: 10.1093/pm/pny314] [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: 11/13/2022]
Affiliation(s)
- David C Miller
- Centers for Pain Management, Indianapolis & Lafayette, Indiana, USA
| | - Clark Smith
- Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, New York, USA
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47
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Borza T, Oerline MK, Skolarus TA, Norton EC, Dimick JB, Jacobs BL, Herrel LA, Ellimoottil C, Hollingsworth JM, Ryan AM, Miller DC, Shahinian VB, Hollenbeck BK. Association Between Hospital Participation in Medicare Shared Savings Program Accountable Care Organizations and Readmission Following Major Surgery. Ann Surg 2019; 269:873-878. [PMID: 29557880 PMCID: PMC6146076 DOI: 10.1097/sla.0000000000002737] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effect of Medicare Shared Savings Program accountable care organizations (ACOs) on hospital readmission after common surgical procedures. SUMMARY BACKGROUND DATA Hospital readmissions following surgery lead to worse patient outcomes and wasteful spending. ACOs, and their associated hospitals, have strong incentives to reduce readmissions from 2 distinct Centers for Medicare and Medicaid Services policies. METHODS We performed a retrospective cohort study using a 20% national Medicare sample to identify beneficiaries undergoing 1 of 7 common surgical procedures-abdominal aortic aneurysm repair, colectomy, cystectomy, prostatectomy, lung resection, total knee arthroplasty, and total hip arthroplasty-between 2010 and 2014. The primary outcome was 30-day risk-adjusted readmission rate. We performed difference-in-differences analyses using multilevel logistic regression models to quantify the effect of hospital ACO affiliation on readmissions following these procedures. RESULTS Patients underwent a procedure at one of 2974 hospitals, of which 389 were ACO affiliated. The 30-day risk-adjusted readmission rate decreased from 8.4% (95% CI, 8.1-8.7%) to 7.0% (95% CI, 6.7-7.3%) for ACO affiliated hospitals (P < 0.001) and from 7.9% (95% CI, 7.8-8.0%) to 7.1% (95% CI, 6.9-7.2%) for non-ACO hospitals (P < 0.001). The difference-in-differences of the 2 trends demonstrated an additional 0.52% (95% CI, 0.97-0.078%) absolute reduction in readmissions at ACO hospitals (P = 0.021), which would translate to 4410 hospitalizations avoided. CONCLUSION Readmissions following common procedures decreased significantly from 2010 to 2014. Hospital affiliation with Shared Savings ACOs was associated with significant additional reductions in readmissions. This emphasis on readmission reduction is 1 mechanism through which ACOs improve value in a surgical population.
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Affiliation(s)
- Tudor Borza
- Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, Michigan
- Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, Michigan
| | - Mary K. Oerline
- Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, Michigan
| | - Ted A. Skolarus
- Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, Michigan
- Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, Michigan
- VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Edward C. Norton
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
- Department of Economics, University of Michigan, Ann Arbor, Michigan
- National Bureau of Economic Research, Cambridge, MA
| | - Justin B. Dimick
- Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
| | - Bruce L. Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Lindsey A. Herrel
- Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, Michigan
- Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, Michigan
| | - Chad Ellimoottil
- Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, Michigan
- Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, Michigan
| | - John M. Hollingsworth
- Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, Michigan
| | - Andrew M. Ryan
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan
- Department of Economics, University of Michigan, Ann Arbor, Michigan
| | - David C. Miller
- Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, Michigan
- Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, Michigan
| | - Vahakn B. Shahinian
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Brent K. Hollenbeck
- Department of Urology, Division of Oncology, University of Michigan, Ann Arbor, Michigan
- Dow Division for Urologic Health Service Research, University of Michigan, Ann Arbor, Michigan
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Affiliation(s)
- Wade King
- Mayo Private Hospital, Multidisciplinary Pain Clinic, Taree, New South Wales, Australia
| | | | - Clark C Smith
- Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, New York, USA
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49
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Patel J, Miller DC, Smith C. Bathing and Swimming After Interventional Spine Procedures. Pain Med 2019; 20:574-575. [PMID: 30476244 DOI: 10.1093/pm/pny242] [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: 11/12/2022]
Affiliation(s)
- Jaymin Patel
- Department of Orthopaedics, Emory University, Atlanta, Georgia
| | | | - Clark Smith
- Columbia University Medical Center, Rehabilitation and Regenerative Medicine, New York, New York, USA
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Kaye DR, Dunn RL, Li J, Herrel LA, Dupree JM, Miller DC, Ellimoottil C. Variation in Physician-Specific Episode Payments for Major Cancer Surgery and Implications for the Merit-Based Incentive Program. J Surg Res 2019; 236:30-36. [PMID: 30694769 DOI: 10.1016/j.jss.2018.09.073] [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: 05/14/2018] [Revised: 08/22/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nearly 1.5 million clinicians in the United States will be affected by Centers for Medicare and Medicaid Services' (CMS) new payment program, the Merit-based Incentive Program (MIPS), where clinicians will be penalized or rewarded based on the health care expenditures of their patients. We therefore examined expenditures for major cancer surgery to understand physician-specific variation in episode payments. METHODS We used Surveillance, Epidemiology and End Results-Medicare data to identify patients aged 66-99 y who underwent a prostatectomy, nephrectomy, lung, or colorectal resection for cancer from 2008 to 2012. We calculated 90-d episode payments, attributed each episode to a physician, and evaluated physician-level payment variation. Next, we determined which component (index admission, readmission, physician services, postacute care, hospice) drove differences in payments. Finally, we evaluated payments by geographic region, number of comorbidities, and cancer stage. RESULTS We identified 39,109 patients who underwent surgery by 1 of 7182 providers. There was wide variation in payments for each procedure (prostatectomy: $7046-$40,687; nephrectomy: $8855-$82,489; lung resection: $11,167-$223,467; colorectal resection: $9711-$199,480). The largest component difference in episode payments varied by condition: physician payments for prostatectomy (29%), postacute care for nephrectomy (38%) and colorectal resections (38%), and index hospital admission for lung resections (43%) but were fairly stable across region, comorbidity number, and cancer stage. CONCLUSIONS For patients undergoing major cancer surgery, 90-d episode payments vary widely across surgeons. The components driving such variation differ by condition but remain stable across region, number of comorbidities, and cancer stage. These data suggest that programs to reduce specific component payments may have advantages over those targeting individual physicians for decreasing health care expenditures.
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Affiliation(s)
- Deborah R Kaye
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
| | - Rodney L Dunn
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jonathan Li
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Lindsey A Herrel
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - James M Dupree
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - David C Miller
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Chad Ellimoottil
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
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