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Watson DP, Tillson M, Taylor L, Xu H, Ouyang F, Beaudoin FL, O'Donnell D, McGuire AB. Results From the POINT Pragmatic Randomized Trial: An Emergency Department-Based Peer Support Specialist Intervention to Increase Opioid Use Disorder Treatment Linkage and Reduce Recurrent Overdose. Subst Use Addctn J 2024:29767342231221054. [PMID: 38258819 DOI: 10.1177/29767342231221054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND People with opioid use disorder (OUD) frequently present at the emergency department (ED), a potentially critical point for intervention and treatment linkage. Peer recovery support specialist (PRSS) interventions have expanded in US-based EDs, although evidence supporting such interventions has not been firmly established. METHODS Researchers conducted a pragmatic trial of POINT (Project Planned Outreach, Intervention, Naloxone, and Treatment), an ED-initiated intervention for harm reduction and recovery coaching/treatment linkage in 2 Indiana EDs. Cluster randomization allocated patients to the POINT intervention (n = 157) versus a control condition (n = 86). Participants completed a structured interview, and all outcomes were assessed using administrative data from an extensive state health exchange and state systems. Target patients (n = 243) presented to the ED for a possible opioid-related reason. The primary outcome was overdose-related ED re-presentation. Key secondary outcomes included OUD medication treatment linkage, duration of medication in days, all-cause ED re-presentation, all-cause inpatient re-presentation, and Medicaid enrollment. All outcomes were assessed at 3-, 6-, and 12-months post-enrollment. Ad hoc analyses were performed to assess treatment motivation and readiness. RESULTS POINT and standard care participants did not differ significantly on any outcomes measured. Participants who presented to the ED for overdose had significantly lower scores (3.5 vs 4.2, P < .01) regarding readiness to begin treatment compared to those presenting for other opioid-related issues. CONCLUSIONS This is the first randomized trial investigating overdose outcomes for an ED peer recovery support specialist intervention. Though underpowered, results suggest no benefit of PRSS services over standard care. Given the scope of PRSS, future work in this area should assess more recovery- and harm reduction-oriented outcomes, as well as the potential benefits of integrating PRSS within multimodal ED-based interventions for OUD.
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Affiliation(s)
- Dennis P Watson
- Chestnut Health Systems, Lighthouse Institute, Chicago, IL, USA
| | - Martha Tillson
- Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY, USA
| | - Lisa Taylor
- Chestnut Health Systems, Lighthouse Institute, Chicago, IL, USA
| | - Huiping Xu
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Francesca L Beaudoin
- Francesca Beaudoin, Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Daniel O'Donnell
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Alan B McGuire
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
- Health Services Research and Development, Richard L Roudebush VAMC, Indianapolis, IN, USA
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Ouyang F, Wu Q, Duan B, Yuan X, Wang B, Chen Y, Yin M, Zeng X. Diagnosis of spinal dural arteriovenous fistula: a multimodal MRI assessment strategy. Clin Radiol 2023; 78:e958-e965. [PMID: 37821323 DOI: 10.1016/j.crad.2023.08.027] [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: 11/28/2022] [Revised: 07/11/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
AIM To identify more specific screening indicators at magnetic resonance imaging (MRI) for the diagnosis of spinal dural arteriovenous fistulas (SDAVFs) and to determine an efficient diagnostic strategy. MATERIALS AND METHODS This retrospective study analysed clinical and imaging data of patients diagnosed with SDAVF and alternative myelopathy who underwent conventional MRI examinations. Additionally, three-dimensional (3D) T2-weighted sampling perfection with application-optimised contrasts using different flip-angle evolutions (3D-T2-SPACE) and contrast-enhanced magnetic resonance angiography (CE-MRA) data from patients with SDAVF were compared with digital subtraction angiography (DSA) data. RESULTS The age of onset, perimedullary flow voids (PFV), distribution of lesions, syringomyelia, degree of spinal oedema, and cauda equina disorder (CED) were factors that showed statistically significance in the identification of SDAVF with alternative myelopathy. After controlling for age, gender, PFV, degree of spinal cord swelling, and syringomyelia, the multivariable ordinal logistic regression model showed that the CED sign (OR = 32.46; 95% confidence interval [CI]: 2.47-427.15; p=0.008) was an independent predictor for SDAVF. The diagnostic model constructed using the PFV and CED signs had better diagnostic performance, with an area under the curve of 0.957 (p<0.001), maximum Youden index of 0.844, sensitivity of 92.9%, and specificity of 91.5%. Both 3D-T2-SPACE (77.8%) and CE-MRA (83.3%) sequences had good localisation values for SDAVF. Combining the two imaging examinations had better diagnostic accuracy than that of DSA. CONCLUSION CED and PFV on conventional MRI were specific indicators for the diagnosis of SDAVF. To compensate for the lack of fistula localisation on conventional MRI, 3D-T2-SPACE and CE-MRA can be used. Together they complement each other and have good diagnostic potential.
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Affiliation(s)
- F Ouyang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Q Wu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - B Duan
- Class 211, Innovation Experiment, Nanchang University, 330031 Nanchang, Jiangxi, China
| | - X Yuan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - B Wang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - Y Chen
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - M Yin
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China
| | - X Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, 330006 Nanchang, Jiangxi, China.
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Leclercq N, Marshall L, Weekers T, Basu P, Benda D, Bevk D, Bhattacharya R, Bogusch P, Bontšutšnaja A, Bortolotti L, Cabirol N, Calderón-Uraga E, Carvalho R, Castro S, Chatterjee S, De La Cruz Alquicira M, de Miranda JR, Dirilgen T, Dorchin A, Dorji K, Drepper B, Flaminio S, Gailis J, Galloni M, Gaspar H, Gikungu MW, Hatteland BA, Hinojosa-Diaz I, Hostinská L, Howlett BG, Hung KLJ, Hutchinson L, Jesus RO, Karklina N, Khan MS, Loureiro J, Men X, Molenberg JM, Mudri-Stojnić S, Nikolic P, Normandin E, Osterman J, Ouyang F, Oygarden AS, Ozolina-Pole L, Ozols N, Parra Saldivar A, Paxton RJ, Pitts-Singer T, Poveda K, Prendergast K, Quaranta M, Read SFJ, Reinhardt S, Rojas-Oropeza M, Ruiz C, Rundlöf M, Sade A, Sandberg C, Sgolastra F, Shah SF, Shebl MA, Soon V, Stanley DA, Straka J, Theodorou P, Tobajas E, Vaca-Uribe JL, Vera A, Villagra CA, Williams MK, Wolowski M, Wood TJ, Yan Z, Zhang Q, Vereecken NJ. Global taxonomic, functional, and phylogenetic diversity of bees in apple orchards. Sci Total Environ 2023; 901:165933. [PMID: 37536603 DOI: 10.1016/j.scitotenv.2023.165933] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/05/2023]
Abstract
An essential prerequisite to safeguard pollinator species is characterisation of the multifaceted diversity of crop pollinators and identification of the drivers of pollinator community changes across biogeographical gradients. The extent to which intensive agriculture is associated with the homogenisation of biological communities at large spatial scales remains poorly understood. In this study, we investigated diversity drivers for 644 bee species/morphospecies in 177 commercial apple orchards across 33 countries and four global biogeographical biomes. Our findings reveal significant taxonomic dissimilarity among biogeographical zones. Interestingly, despite this dissimilarity, species from different zones share similar higher-level phylogenetic groups and similar ecological and behavioural traits (i.e. functional traits), likely due to habitat filtering caused by perennial monoculture systems managed intensively for crop production. Honey bee species dominated orchard communities, while other managed/manageable and wild species were collected in lower numbers. Moreover, the presence of herbaceous, uncultivated open areas and organic management practices were associated with increased wild bee diversity. Overall, our study sheds light on the importance of large-scale analyses contributing to the emerging fields of functional and phylogenetic diversity, which can be related to ecosystem function to promote biodiversity as a key asset in agroecosystems in the face of global change pressures.
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Affiliation(s)
- N Leclercq
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium.
| | - L Marshall
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium; Naturalis Biodiversity Center, Darwinweg 2, 2333 CR, Leiden, Netherlands
| | - T Weekers
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium
| | - P Basu
- Centre for Pollination Studies, University of Calcutta, Kolkata, India
| | - D Benda
- Department of Zoology, Faculty of Science, Charles University, Prague, Czech Republic; Department of Entomology, National Museum, Prague, Czech Republic
| | - D Bevk
- Department of Organisms and Ecosystems Research, National Institute of Biology, Ljubljana, Slovenia
| | - R Bhattacharya
- Centre for Pollination Studies, University of Calcutta, Kolkata, India
| | - P Bogusch
- Department of Biology, Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
| | - A Bontšutšnaja
- Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - L Bortolotti
- CREA Research Centre for Agriculture and Environment, Bologna, Italy
| | - N Cabirol
- Department of Ecology and Natural Resources, Faculty of Science, UNAM, México City, Mexico
| | - E Calderón-Uraga
- Department of Ecology and Natural Resources, Faculty of Science, UNAM, México City, Mexico
| | - R Carvalho
- Centre for Functional Ecology, Associate Laboratory TERRA, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - S Castro
- Centre for Functional Ecology, Associate Laboratory TERRA, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - S Chatterjee
- Centre for Pollination Studies, University of Calcutta, Kolkata, India
| | - M De La Cruz Alquicira
- Department of Ecology and Natural Resources, Faculty of Science, UNAM, México City, Mexico
| | - J R de Miranda
- Department of Ecology, Swedish University of Agricultural Sciences, Uppsala, 750 05, Sweden
| | - T Dirilgen
- School of Agriculture and Food Science and Earth Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Dorchin
- Laboratory of Zoology, Université de Mons, Mons, Belgium; The Steinhardt Museum of Natural History, Tel Aviv University, 69978 Tel Aviv, Israel; Department of Entomology, Royal Museum for Central Africa, Tervuren, Belgium
| | - K Dorji
- College of Natural Resources, Royal University of Bhutan, Punakha, Bhutan
| | - B Drepper
- Division of Forest, Nature and Landscape, University of Leuven, Leuven, Belgium
| | - S Flaminio
- CREA Research Centre for Agriculture and Environment, Bologna, Italy; Laboratory of Zoology, Université de Mons, Mons, Belgium
| | - J Gailis
- Institute for Plant Protection Research Agrihorts, Latvia University of Life Sciences and Technologies, Jelgava, Latvia
| | - M Galloni
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - H Gaspar
- Centre for Functional Ecology, Associate Laboratory TERRA, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - M W Gikungu
- Department of Zoology, National Museums of Kenya, Nairobi, Kenya
| | - B A Hatteland
- Division for Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research, Aas, Norway; Department of Biological Sciences, University of Bergen, Bergen, Norway
| | - I Hinojosa-Diaz
- Department of Zoology, Institute of Biology, UNAM, México City, Mexico
| | - L Hostinská
- Department of Biology, Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
| | - B G Howlett
- The New Zealand Institute for Plant & Food Research Limited, Lincoln, Canterbury, New Zealand
| | - K-L J Hung
- Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, ON M5S 3B2, Canada; Oklahoma Biological Survey, University of Oklahoma, Norman, OK 73019, USA
| | - L Hutchinson
- School of Agriculture, Policy and Development, University of Reading, Reading, United Kingdom
| | - R O Jesus
- Graduate Program in Ecology, State University of Campinas, Campinas, São Paulo, Brazil
| | - N Karklina
- Institute for Plant Protection Research Agrihorts, Latvia University of Life Sciences and Technologies, Jelgava, Latvia
| | - M S Khan
- Department of Entomology, University of Agriculture, Peshawar, Pakistan
| | - J Loureiro
- Centre for Functional Ecology, Associate Laboratory TERRA, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - X Men
- Institute of Plant Protection, Shandong Academy of Agricultural Sciences/Shandong Provincial Key Laboratory of Plant Virology,Jinan 250100, China
| | - J-M Molenberg
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium
| | - S Mudri-Stojnić
- Department of Biology and Ecology, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 2, 21000 Novi Sad, Serbia
| | - P Nikolic
- Faculty of Agriculture, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - E Normandin
- Centre sur la biodiversité, Département des sciences biologiques, Université de Montréal, QC, Québec H1X 2B2, Canada
| | - J Osterman
- General Zoology, Institute for Biology, Martin Luther University Halle-Wittenberg, Hoher Weg 8, 06120 Halle (Saale), Germany; Nature Conservation and Landscape Ecology, University of Freiburg, Tennenbacherstrasse 4, 79106, Freiburg im Breisgau, Germany
| | - F Ouyang
- State Key Laboratory of Integrated Management of Pest Insects and Rodents, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - A S Oygarden
- Department of Natural Sciences and Environmental Health, University of South-Eastern Norway, Bø, Norway
| | - L Ozolina-Pole
- Institute for Plant Protection Research Agrihorts, Latvia University of Life Sciences and Technologies, Jelgava, Latvia
| | - N Ozols
- Institute for Plant Protection Research Agrihorts, Latvia University of Life Sciences and Technologies, Jelgava, Latvia
| | - A Parra Saldivar
- Instituto de Entomología, Universidad Metropolitana de Ciencias de la Educación (UMCE), Santiago, Chile
| | - R J Paxton
- General Zoology, Institute for Biology, Martin Luther University Halle-Wittenberg, Hoher Weg 8, 06120 Halle (Saale), Germany
| | - T Pitts-Singer
- USDA Agricultural Research Service, Pollinating Insects Research Unit, Logan, UT 84322, USA
| | - K Poveda
- Department of Entomology, Cornell University, 4126 Comstock Hall, Ithaca, NY 14853, USA
| | - K Prendergast
- Molecular and Life Sciences, Curtin University, Bentley, WA 6102, Australia
| | - M Quaranta
- CREA Research Centre for Agriculture and Environment, Bologna, Italy
| | - S F J Read
- The New Zealand Institute for Plant & Food Research Limited, Lincoln, Canterbury, New Zealand
| | - S Reinhardt
- Department of Natural Sciences and Environmental Health, University of South-Eastern Norway, Bø, Norway
| | - M Rojas-Oropeza
- Department of Ecology and Natural Resources, Faculty of Science, UNAM, México City, Mexico
| | - C Ruiz
- Departamento Biología Animal, Edafología y Geología, Facultad de Ciencias, Universidad de La Laguna, La Laguna, 38206, Tenerife, Spain
| | - M Rundlöf
- Department of Biology, Lund University, Lund, Sweden
| | - A Sade
- Department of Evolutionary and Environmental Biology, University of Haifa, Mt. Carmel, 31905 Haifa, Israel
| | - C Sandberg
- Department of Biology, Lund University, Lund, Sweden; Calluna AB, Husargatan 3, Malmö, 211 28, Sweden
| | - F Sgolastra
- Department of Agricultural and Food Sciences, University of Bologna, Bologna, Italy
| | - S F Shah
- Department of Entomology, University of Agriculture, Peshawar, Pakistan
| | - M A Shebl
- Department of Plant Protection, Faculty of Agriculture, Suez Canal University, Ismailia 41522, Egypt
| | - V Soon
- Natural History Museum and Botanical Garden, University of Tartu, Vanemuise 46, 51003 Tartu, Estonia
| | - D A Stanley
- School of Agriculture and Food Science and Earth Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - J Straka
- Department of Zoology, Faculty of Science, Charles University, Prague, Czech Republic
| | - P Theodorou
- General Zoology, Institute for Biology, Martin Luther University Halle-Wittenberg, Hoher Weg 8, 06120 Halle (Saale), Germany
| | - E Tobajas
- Department of Biology, Lund University, Lund, Sweden; Department of Animal Biology, University of Salamanca, Campus Miguel de Unamuno, Salamanca, 37007, Spain
| | - J L Vaca-Uribe
- Laboratorio de Investigaciones en Abejas LABUN, Departamento de Biología, Facultad de Ciencias, Universidad Nacional de Colombia, Bogotá,111321, Colombia
| | - A Vera
- Departamento de Biología, Universidad Metropolitana de Ciencias de la Educación (UMCE), Santiago, Chile
| | - C A Villagra
- Instituto de Entomología, Universidad Metropolitana de Ciencias de la Educación (UMCE), Santiago, Chile
| | - M-K Williams
- Department of Biology, Utah State University, Logan, UT 84322, USA
| | - M Wolowski
- Institute of Natural Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - T J Wood
- Laboratory of Zoology, Université de Mons, Mons, Belgium
| | - Z Yan
- State Key Laboratory of Integrated Management of Pest Insects and Rodents, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - Q Zhang
- Beijing Biodiversity Conservation Research Center/Beijing Milu Ecological Research Center, Beijing 100076, China
| | - N J Vereecken
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium
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Sims EK, Kulkarni A, Hull A, Woerner SE, Cabrera S, Mastrandrea LD, Hammoud B, Sarkar S, Nakayasu ES, Mastracci TL, Perkins SM, Ouyang F, Webb-Robertson BJ, Enriquez JR, Tersey SA, Evans-Molina C, Long SA, Blanchfield L, Gerner EW, Mirmira RG, DiMeglio LA. Inhibition of polyamine biosynthesis preserves β cell function in type 1 diabetes. Cell Rep Med 2023; 4:101261. [PMID: 37918404 PMCID: PMC10694631 DOI: 10.1016/j.xcrm.2023.101261] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/23/2023] [Revised: 07/18/2023] [Accepted: 10/05/2023] [Indexed: 11/04/2023]
Abstract
In preclinical models, α-difluoromethylornithine (DFMO), an ornithine decarboxylase (ODC) inhibitor, delays the onset of type 1 diabetes (T1D) by reducing β cell stress. However, the mechanism of DFMO action and its human tolerability remain unclear. In this study, we show that mice with β cell ODC deletion are protected against toxin-induced diabetes, suggesting a cell-autonomous role of ODC during β cell stress. In a randomized controlled trial (ClinicalTrials.gov: NCT02384889) involving 41 recent-onset T1D subjects (3:1 drug:placebo) over a 3-month treatment period with a 3-month follow-up, DFMO (125-1,000 mg/m2) is shown to meet its primary outcome of safety and tolerability. DFMO dose-dependently reduces urinary putrescine levels and, at higher doses, preserves C-peptide area under the curve without apparent immunomodulation. Transcriptomics and proteomics of DFMO-treated human islets exposed to cytokine stress reveal alterations in mRNA translation, nascent protein transport, and protein secretion. These findings suggest that DFMO may preserve β cell function in T1D through islet cell-autonomous effects.
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Affiliation(s)
- Emily K Sims
- Division of Pediatric Endocrinology and Diabetology, Herman B. Wells Center for Pediatric Research, Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
| | - Abhishek Kulkarni
- Kovler Diabetes Center and Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Audrey Hull
- Division of Pediatric Endocrinology and Diabetology, Herman B. Wells Center for Pediatric Research, Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Nationwide Children's Hospital Pediatric Residency Program, Columbus, OH 43205, USA
| | - Stephanie E Woerner
- Division of Pediatric Endocrinology and Diabetology, Herman B. Wells Center for Pediatric Research, Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Susanne Cabrera
- Department of Pediatrics, Section of Endocrinology and Diabetes, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Lucy D Mastrandrea
- Division of Pediatric Endocrinology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Batoul Hammoud
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA
| | - Soumyadeep Sarkar
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Ernesto S Nakayasu
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Teresa L Mastracci
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN 46202, USA
| | - Susan M Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Fangqian Ouyang
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Jacob R Enriquez
- Kovler Diabetes Center and Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Sarah A Tersey
- Kovler Diabetes Center and Department of Medicine, The University of Chicago, Chicago, IL 60637, USA
| | - Carmella Evans-Molina
- Division of Pediatric Endocrinology and Diabetology, Herman B. Wells Center for Pediatric Research, Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Medicine and the Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - S Alice Long
- Benaroya Research Institute, Center for Translational Immunology, Seattle, WA 98101, USA
| | - Lori Blanchfield
- Benaroya Research Institute, Center for Translational Immunology, Seattle, WA 98101, USA
| | | | - Raghavendra G Mirmira
- Kovler Diabetes Center and Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA.
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology, Herman B. Wells Center for Pediatric Research, Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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5
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Pederson CA, Dir AL, Schwartz K, Ouyang F, Monahan PO, Tu W, Wiehe SE, Aalsma MC. Associations between outpatient treatment and the use of intensive psychiatric healthcare services. Clin Child Psychol Psychiatry 2023; 28:1380-1392. [PMID: 36737059 DOI: 10.1177/13591045231154106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization.
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Affiliation(s)
- Casey A Pederson
- Indiana University School of Medicine, Department of Psychiatry, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Allyson L Dir
- Indiana University School of Medicine, Department of Psychiatry, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Katherine Schwartz
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Patrick O Monahan
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Sarah E Wiehe
- Indiana University School of Medicine, Department of Pediatrics, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA
| | - Matthew C Aalsma
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
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Aalsma MC, Adams ZW, Smoker MP, Marriott BR, Ouyang F, Meudt E, Hulvershorn LA. Evidence-based Treatment for Substance Use Disorders in Community Mental Health Centers: the ACCESS Program. J Behav Health Serv Res 2023; 50:333-347. [PMID: 36859743 PMCID: PMC9977479 DOI: 10.1007/s11414-023-09833-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 03/03/2023]
Abstract
A significant gap remains in the availability and accessibility of evidence-based treatments (EBTs) in community substance use disorder (SUD) treatment. This study describes a 2-year statewide training initiative that sought to address this gap by training community-based therapists in motivational enhancement/cognitive behavioral therapy (MET/CBT). Therapists (N = 93) participated in a 2-day MET/CBT workshop followed by bi-weekly clinical consultation, fidelity monitoring, guided readings, and online resources. Therapists completed pre-training and follow-up assessments measuring knowledge, attitudes, confidence, and implementation barriers. Most therapists attended 10 or more consultation calls. Submission of session recordings for feedback was the least utilized training element. Therapists reported increased confidence in their ability to implement MET/CBT for SUD and demonstrated improvement in MI and CBT knowledge. Therapists reported several implementation barriers, including lack of time and opportunity to treat patients with MET/CBT. Recommendations for future training initiatives and addressing the barriers identified in this study are discussed.
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Affiliation(s)
- Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA.
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Zachary W Adams
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael P Smoker
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brigid R Marriott
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emily Meudt
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie A Hulvershorn
- Adolescent Behavioral Health Research Program, Indiana University School of Medicine, 410 West 10Th Street, Suite 2000, Indianapolis, IN, 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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7
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Dir AL, Pederson CA, Ouyang F, Monahan PO, Schwartz K, Wiehe SE, Aalsma MC. Examining Patterns of Psychotherapy Service Utilization Among Medicaid-Enrolled Adolescents. Psychiatr Serv 2023; 74:374-380. [PMID: 36597697 DOI: 10.1176/appi.ps.202100513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents. METHODS Medicaid claims for 8,197 adolescents (ages 10.0-13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent's first behavioral health visit. RESULTS A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001). CONCLUSIONS These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.
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Affiliation(s)
- Allyson L Dir
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Casey A Pederson
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Fangqian Ouyang
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Patrick O Monahan
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Katherine Schwartz
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Sarah E Wiehe
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Department of Pediatrics (Dir, Pederson, Schwartz, Aalsma), Department of Psychiatry (Dir), Department of Pediatrics, Section of Adolescent Medicine (Pederson, Schwartz, Aalsma), Department of Biostatistics (Ouyang, Monahan), and Department of Pediatrics (Wiehe), Indiana University School of Medicine, Indianapolis
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8
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Lemes C, Rottner L, Heeger CH, Maurer T, Reissmann B, Ouyang F, Mathew S, Metzner A, Schlueter M, Kuck KH. Acute and long-term success of left atrial anterior line and mitral isthmus line ablation in patients after mitral valve surgery. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Perimitral flutter and atrial fibrillation may occur in patients with prior surgical mitral valve (MV) repair or replacement and can be challenging for percutaneous catheter ablation.
Objective
This study sought to determine the feasibility, acute success and durability of catheter ablation of atrial fibrillation or atrial tachycardia by way of a mitral isthmus line (MIL) or an anterior line (AL).
Methods
A total of 81 patients (49 males, mean age 62±11 years) with prior MV replacement (n=30) or repair (n=51) underwent creation of a MIL (n=34) and/or an AL (n=72). Control group patients without prior surgery were matched 1:1 with the valve group (MIL, n=34; AL, n=72).
Results
Acute bidirectional block of the MIL was successfully achieved in 24/34 cases and of the AL in 64/72 patients with prior MV surgery. In the control group, acute bidirectional block was achieved in 31/34 MIL patients and 65/72 AL patients. In terms of durability, the MIL valve subgroup showed the poorest results (probability of long-term failure 2.224, as opposed to 0.605 in the MIL control subgroup; hazard ratio [HR]=0.27, 95% confidence interval [CI], 0.11–0.65; p=0.004). In the AL subgroups, long-term outcomes were similar (probability of failure in AL valve subgroup 0.844 vs. AL control subgroup 1.03; HR=1.22, 95% CI, 0.66–2.26; p=0.523).
Conclusions
Percutaneous creation of MIL and AL is feasible and safe in patients with prior MV replacement/repair. Because of poor long-term outcomes, MIL creation appears not advisable in patient with prior MV surgery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Lemes
- University Heart Center , Luebeck , Germany
| | - L Rottner
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - C H Heeger
- University Heart Center , Luebeck , Germany
| | - T Maurer
- Asklepios Clinic St. Georg , Hamburg , Germany
| | - B Reissmann
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - F Ouyang
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - S Mathew
- University Hospital Giessen and Marburg, Cardiology , Giessen , Germany
| | - A Metzner
- The University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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9
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McBrayer K, Ouyang F, Adams Z, Hulvershorn L, Aalsma MC. Rates of Tobacco Use Disorder, Pharmacologic Treatment, and Associated Mental Health Disorders in a Medicaid Claim Review Among Youth in Indiana, USA. Tob Use Insights 2022; 15:1179173X221119133. [PMID: 36052177 PMCID: PMC9424880 DOI: 10.1177/1179173x221119133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose This study delineates a number of Medicaid youth with tobacco use disorder (TUD), prescribing habits for treatment, and associated externalizing disorders. Methods Youth Medicaid claims from 2007-2017 processed in a large Midwestern city were analyzed for a diagnosis of TUD, related pharmacotherapy, and externalizing mental health and substance use disorders. Results Claims connected 6541 patients with 42 890 visits. Mean age was 16.4 with 40% female. 1232 of the 6541 charts contained a TUD diagnosis equating to 1848 visits. A comorbid diagnosis of ADHD, cannabis use, and conduct disorder were more common in males (3.9% vs 1.3% in females; 3.4% vs .8%; and 2.8% vs .8%; P < .05). 808 scripts were provided to 152 of the 1232 youths, with 4.7% of those scripts a nicotine replacement product. Conclusions Pharmacotherapy is underutilized in this Medicaid claims data set. Certain externalizing factors were associated with males with TUD more than females.
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Affiliation(s)
- Kimberly McBrayer
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Zachary Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew C Aalsma
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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10
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Obergassel J, Taraba S, Nies M, Atzor C, Lemoine MD, Rottner L, Schleberger R, Dinshaw LWH, Meyer C, Willems S, Reissmann B, Ouyang F, Metzner A, Kirchhof P, Rillig A. Why are redo AF ablations required and what does it take? Type of index PVI predicts pattern of redo ablations. Europace 2022. [DOI: 10.1093/europace/euac053.228] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Catheter ablation targeting isolation of the pulmonary veins (PVI) is the most effective treatment for atrial fibrillation (AF). Despite its high overall effectiveness, repeat AF ablations (re-do procedures, RDP) are often required to maintain sinus rhythm.
Purpose
Determine predictors for multiple and/or complex RDP, evaluate reference values for procedure duration and radiation exposure during index PVI (iPVI) and nth RDP in a large cohort.
Methods and Results
Data mining identified 934 (mean age 62.6 ± 12.3 years, 346 females) out of 6848 total AF ablation patients from a large German AF ablation center between 09/2008 and 09/2021 with an index PVI and at least one RDP. Analysis included 2152 procedures (out of 8750 total AF-related ablations). At iPVI, AF pattern was classified as paroxysmal AF (PAF) in 387 patients (41%). All others (59%) were classified as non-paroxysmal AF (Non-PAF). Non-PAF was significantly more frequent in males (64% vs. 49%, p<0.01). Median period between first PVI and RDP was 558 days (25th/75th percentiles 244.0/1175.5 days). Non-PAF patients had a significantly higher probability of multiple RDP compared to patients with PAF at iPVI (p<0.01, Figure 1A). 18% (8%) of patients with non-PAF had 2 (3) or more RDP while only 13% (3%) of pat. with PAF had 2 (3) or more RDP.
iPVI was classified as PVI-only or PVI with additional substrate modification (SM). 724/934 patients (78%) received PVI-only as initial procedure. Of these, 572 (79%) had only 1 RDP, 116 (16%) had 2 RDP and 36 (5%) had 3 or more RDP. This distribution was 77%, 15% and 8% for 1, 2 and 3 or more RDP for patients with complex PVI as iPVI.
An algorithm based on regular expressions classified all RDP as repeat PVI (Re-PVI) due to reconduction (PV reconduction), ablation of atrial tachycardia (AT) or SM, e. g. defragmentation of fractionated signals, or combinations. The results were manually quality-controlled. 798/934 (85%) patients required PV re-isolation due to PV reconduction, 298/934 (32%) required ablation for atrial tachycardia (AT) at least once during FU (Figure 1B). Comparing PVI-only iPVI patients with patients who received substrate modification during iPVI, significantly less patients with PVI-only iPVI had RDP for AT compared to those with SM during iPVI (27% vs. 50%, p<0.01). More PVI-only iPVI patients required PV-reisolation at any time during FU (87% vs 79%, p<0.01). Considering PVI-only (+/- CTI) iPVIs only, dose-area product decreased in RDP compared to first PVI, while procedure duration slightly increased (Figure 1C). Data on periprocedural complications will be reported.
Conclusion
Redo AF ablations procedures are mainly required due to reconnected pulmonary veins or AT. Patients with PAF at iPVI are less likely to require more than one RDP which provides indirect support for early rhythm control in treatment of AF. SM at iPVI might be a predictor for occurrence of AT in the further course.
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Affiliation(s)
- J Obergassel
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - S Taraba
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - M Nies
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - C Atzor
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - MD Lemoine
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Rottner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - R Schleberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - LWH Dinshaw
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - C Meyer
- Evangelical Hospital, Cardiology, Duesseldorf, Germany
| | - S Willems
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - B Reissmann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - F Ouyang
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Metzner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Rillig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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11
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Lemoine M, My I, Mencke C, Butt M, Schleberger R, Muenkler P, Rottner L, Moser F, Moser J, Dinshaw L, Reissmann B, Ouyang F, Kirchhof P, Rillig A, Metzner A. Comparison of left atrial lesion size and troponin release of two novel single shot devices for pulmonary vein isolation: pulsed field ablation vs. multi-electrode radiofrequency balloon. Europace 2022. [DOI: 10.1093/europace/euac053.253] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Pulsed-field ablation (PFA) and the multi-electrode radiofrequency balloon (RFB) are two novel ablation technologies to perform pulmonary vein isolation (PVI). It is currently unknown whether these technologies differ in lesion formation and lesion extent.
Purpose
We compared the acute lesion extent after PVI induced by PFA and RFB by measuring low-voltage area in high-density maps and the release of biomolecules reflecting cardiac injury.
Methods
PVI was performed with a pentaspline catheter (FARAPULSE) applying PFA or with the compliant multi-electrode radiofrequency balloon (HELIOSTAR). Before and after PVI high-density mapping with CARTO3 was performed. In addition, blood samples were taken before transseptal puncture and after post-PVI remapping. Serum concentrations of high-sensitive Troponin I (hsTropI) were quantified by Immunoassay.
Results
50 patients undergoing PVI by PFA (n=26, age 71±10 y, 58% males, 58% persistent AF) or RFB (n=24; age 64±13 y, 54% males, 25% persistent AF) were evaluated. Acute PVI was achieved in all patients in both groups. Mean number of PFA pulses were n=34±5 and mean number RFB applications were n=8±3. Total posterior ablation area was bigger in PFA (19.0±6.2 cm²) than in RFB (9.0±2.2 cm²; p<0.001). The posterior distance between septal and lateral lesions was shorter in PFA (23.7±10.5 mm) than in RFB (30.0±7.3 mm; p=0.021). In a total of 38 patients increase of hsTropI was higher after PFA (625±138 pg/ml, n=28) vs. RFB (148±36 pg/ml; n=10; p=0.049) supporting the evidence of larger lesion extent by PFA.
Conclusion
Pulse-field ablation delivers larger acute lesion areas and higher troponin release upon successful pulmonary vein isolation than multi-electrode array balloon-based pulmonary vein isolation in this single-center series.
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Affiliation(s)
- M Lemoine
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - I My
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - C Mencke
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - M Butt
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - R Schleberger
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - P Muenkler
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - L Rottner
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - F Moser
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - J Moser
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - L Dinshaw
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - B Reissmann
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - F Ouyang
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - P Kirchhof
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - A Rillig
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
| | - A Metzner
- University Heart Center Hamburg, Department of Cardiology and Electrophysiology, Hamburg, Germany
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12
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Winkelmann SJ, Lemoine MD, Wuerger T, Schleberger R, Rottner L, Dinshaw L, Moser JM, Muenkler P, Nikorowitsch J, Reissmann B, Ouyang F, Toennis T, Kirchhof P, Metzner A, Rillig A. Safety of pulsed-field ablation in patients with cardiac implantable electronic devices. A single-center pilot study. Europace 2022. [DOI: 10.1093/europace/euac053.234] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Pulsed-field ablation (PFA) is a novel energy source to perform pulmonary vein isolation (PVI) in patients with atrial fibrillation or cavo-tricuspid isthmus ablation (CTI) in patients with atrial flutter. Whether strong electrical fields generated by PFA could change the function and integrity of cardiac implantable electronic devices (CIED) is not known.
Aim
To assess the function and integrity of implanted devices before and after pulsed-field ablation.
Methods
This study included consecutive patients with CIED undergoing PFA at a large single center. Real-time CIED electrograms were recorded during PFA applications. CIED were interrogated before and after PFA assessing function (threshold, sensing), integrity (impedance), and arrhythmia episodes.
Results
We performed PFA in six patients (age 69±12 years, 1/6 female, left atrial diameter was 44±3 mm, left-ventricular ejection fraction 40±14%) for PVI in five patients with atrial fibrillation and CTI ablation in one patient with atrial flutter. All patients had CIEDs (one cardiac resynchronization device, two implantable cardioverter-defibrillators, three two-chamber pacemakers). Each patient undergoing PVI received 32 PFA applications of 2.5 s. (4x basket configuration and 4x flower configuration at each pulmonary vein), amounting to a total ablation time of 80 s and resulting in complete PVI in all five patients. For CTI ablation we applied 8 PFA applications of 2.5 s (20 s total ablation time) resulting in CTI blockade. Real-time intracardiac electrograms (iEGM) during PFA applications revealed sensing of single PFA application impulses in three patients and blanking of the iEGM in three patients. Postinterventional device testing revealed no changes in impedance, stimulation threshold or sensing. No leads were dislocated or damaged. No other device malfunctions occurred during the procedure, as well as no other major periprocedural complications occurred.
Conclusion
The function and integrity of pacemakers and defibrillators is not affected by PFA in our patient sample. Larger series are needed to confirm the apparent safety of PFA in patients with CIED.
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Affiliation(s)
- SJ Winkelmann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - MD Lemoine
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - T Wuerger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - R Schleberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Rottner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Dinshaw
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - JM Moser
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Muenkler
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - J Nikorowitsch
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - B Reissmann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - F Ouyang
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - T Toennis
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Metzner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Rillig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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Lemoine M, Mencke C, Schleberger R, Muenkler P, Wieboldt H, Scherschel C, Dinshaw L, Reissmann B, Ouyang F, Fabritz L, Zeller T, Meyer C, Rillig A, Metzner A, Kirchhof P. Pulmonary vein isolation by pulsed-field ablation induces smaller neurocardiac damage than cryoballoon ablation. Europace 2022. [DOI: 10.1093/europace/euac053.251] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): FARAPULSE, Inc.
Introduction
Thermal energy sources damage the entire atrial tissue during pulmonary vein isolation (PVI) including cardiac nerves and ganglia. This induces a postinterventional increase in heart rate. Pulsed-field ablation (PFA), a new non-thermal energy source for PVI, primarily damages cardiomyocytes by electroporation. Whether use of PFA reduces damage to cardiac nerves and ganglia and influences postinterventional increase of heart rate is not known.
Purpose
We compared the acute effects of PFA with a pentaspline catheter and cryoballoon ablation (CBA) on secretion of circulating biomolecules reflecting cardiomyocyte and neuronal injury and postinterventional increase in heart rate to estimate damage to the cardiac autonomic nervous system and autonomic dysfunction after PVI.
Methods
Blood samples were taken before and after PVI in consecutive patients undergoing PFA and CBA. All patients participated in the TRUST registry. Serum concentrations of high-sensitive Troponin I (hsTropI, Immunoassay) and S100b (ELISA), a surrogate marker for neuronal injury, were quantified in blood samples taken prior to PVI and directly after PVI. Pre- and postinterventional heart rates were measured in ECGs and Holter-ECGs.
Results
Fifty-six patients underwent PVI, either by PFA (n=28, age 63 [54; 75] y, 64% males, 57% persistent AF) or CBA (n=28, age 71 [62; 78] y, 61% males, 54% persistent AF). All 112 blood samples were analyzable. Acute success of PVI was 100% in both groups without major complications, especially, no TIA and no stroke. After CBA, one patient suffered from phrenic palsy, which reversed after 3 months. HsTropI increased 3.3-fold more after PFA compared to CBA (625±138 vs. 185±42 pg/ml; p=0.004) suggesting more damage to cardiomyocytyes. S100b increased 2.9-fold less after PFA compared to CBA (21.1±3.7 vs. 61.2±8.1 pg/ml; p<0.001). The ratio of ∆S100b/∆hsTropI was five-fold smaller after PFA compared to CBA (0.19±0.1 vs. 0.98±0.3; p=0.007), suggesting a lower neurocardiac injury in comparison to lesion size. Concomitantly, increase in heart rate at the postinterventional day was smaller in PFA (-0.2±3.0 bpm; n=45) than in CBA (+6.1±2.7 bpm, n=15; p=0.024).
Conclusion
This study in patients validates the experimental concept that PFA-based AF ablation leads to more specific damage to cardiomyocytes than to cardiac nerves and ganglia, reflected by lower S100B concentrations and no post-interventional heart rate increase compared to CBA.
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Affiliation(s)
- M Lemoine
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - C Mencke
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - R Schleberger
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - P Muenkler
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - H Wieboldt
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - C Scherschel
- Evangelical Hospital, Cardiology, Duesseldorf, Germany
| | - L Dinshaw
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - B Reissmann
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - F Ouyang
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - L Fabritz
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - T Zeller
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - C Meyer
- Evangelical Hospital, Cardiology, Duesseldorf, Germany
| | - A Rillig
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - A Metzner
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Cardiology, Hamburg, Germany
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Rottner L, Schleberger R, Lemoine M, My I, Moser F, Moser J, Dinshaw L, Kirchhof P, Ouyang F, Rillig A, Metzner A, Reissmann B. Catheter ablation of the mitral isthmus line using the novel DiamondTemp ablation system: first experience using two different ablation protocols. Europace 2022. [DOI: 10.1093/europace/euac053.070] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Mitral ishmus ablation is an established approach to treat perimitral reentrant tachycardia, and is often performed as substrat modification in patients with persistent atrial fibrillation (AF). Bidirectional block of the mitral isthmus line (MIL) is still a great challenge using conventional ablation catheters, but is essential to prevent recurrence of atrial arrhythmia.
Recently, the novel DiamondTempTM (DT) ablation system was introduced and allows for high-power, short-duration ablation in a temperature-controlled mode. Its use during pulmonary vein isolation (PVI) using a recommended ablation setting with a catheter-tip temperature limit of 60°C, a temperature-controlled power of 50 W and an application duration of 10 sec has shown to be effective and safe. However, data on DT ablation settings for substrate modification, i.e., creation of linear lesions are lacking.
Aim
The aim of the present study was to evaluate acute efficacy and safety of the novel DT ablation system for bidirectional block of the MIL using two different protocols.
Methods
The study population comprised 14 patients [67±8 years, 10/14 male (71%)] suffering from persistent AF and/or atrial tachycardia who underwent catheter re-ablation with creation of a MIL using the DT ablation system. Ablation settings were a catheter-tip temperature limit of 60°C, a temperature-controlled power of 50 W with an application duration of either 10 sec (group A, n=7) or 20 sec (group B, n=7). Additional epicardial ablation from within the coronary sinus with a temperature limit of 60°C, a temperature-controlled power of 20 W and an application duration of 20 sec was performed, if bidirectional block could not be achieved with endocardial ablation only.
Results
Mean procedure and fluoroscopy time, and dose area product for group A and group B were 103±24 vs. 119±38 min, 12±5 vs. 13±4 min, and 572±270 vs. 537±202 cGycm, respectively. Bidirectional block of the MIL was achieved in 7/7 (100%) patients in group A and in 6/7 (86%) patients in group B. Additional epicardial ablation was required in 6/7 patients (86%) in group A and in 4/7 (57%) patients in group B. In group B, bidirectional block of the MIL required fewer endocardial (31±11 vs. 26±10 applications) as well as epicardial RF-applications (10±6 vs. 7±3 applications). Pericardial effusion without hemodynamic relevance occurred in 1/7 (14%) patients of group B. No further complications occurred.
Conclusion
Catheter ablation of the MIL using the novel DT ablation system is safe and associated with high acute efficacy. A lower number of RF-applications and a less frequent need for additional epicardial ablation was observed when applying longer RF-applications of 20 sec. Further analyses are warranted to confirm these findings.
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Affiliation(s)
- L Rottner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - R Schleberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - M Lemoine
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - I My
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - F Moser
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - J Moser
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Dinshaw
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - F Ouyang
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Rillig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Metzner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - B Reissmann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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Rottner L, Moser F, Schleberger R, Moser J, My I, Lemoine M, Dinshaw L, Kirchhof P, Ouyang F, Reissmann B, Metzner A, Rillig A. Optimizing catheter ablation of atrial fibrillation by a novel wide-band dielectric imaging system: first experience on real-time wall thickness measurement. Europace 2022. [DOI: 10.1093/europace/euac053.059] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Conventional mapping systems do not provide wall-thickness data, which is, however, known to be a determinant of radiofrequency ablation lesion transmurality. KODEX-EPD is a novel open-platform system, which uses dielectric tissue properties to provide real-time, high-resolution cardiac images, tissue characteristics and wall-thickness measurement to guide ablation procedures.
Aim
The aim of this case series was to report on our first experiences with KODEX-EPD regarding estimation of myocardial wall-thickness during catheter ablation of atrial fibrillation (AF).
Methods
We retrospectively analyzed consecutive patients undergoing radiofrequency AF-ablation in combination with KODEX-EPD. A high-resolution image from the left atrium (LA) and the pulmonary veins (PV) was obtained prior to ablation using a spiral mapping catheter in conjunction with KODEX-EPD. Wall-viewer points were collected within the LA, the PVs and the left atrial appendage (LAA) using a standard radiofrequency non-contact force ablation catheter and analyzed for wall-thickness applying the latest KODEX-EPD software version (1.5.0, not yet commercially released). Wall-viewer points were divided into a total of 10 segments (PV ostia, anterior wall, posterior wall, LA roof, LA floor, LAA and PV carina, details see Figure 1) in order to characterize wall-thickness in respective areas.
Results
A total of 570 wall-viewer points in 5 patients were analyzed. Most of the wall-viewer points were collected at the PV ostia as well as along the posterior and anterior wall (449/570, 79%). Actual myocardial atrial thickness ranged from 1.6 to 3.9 mm. Thickest myocardial LA-tissue was measured at the anterior wall (median 3.1 mm) and thinnest at the LA-roof (median 2.2 mm). Figure 2 gives a detailed distribution of wall-thickness measurements at different sites in the LA and PVs.
Conclusion
Atrial wall thickness can be estimated in patients during AF ablation procedures using dielectric tissue properties. Further evaluation and validation of the method are needed to study its reliability and utility for clinical practice.
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Affiliation(s)
- L Rottner
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Moser
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Schleberger
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Moser
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I My
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Lemoine
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Dinshaw
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Kirchhof
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Ouyang
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B Reissmann
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Metzner
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rillig
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
BACKGROUND Little evidence has been available to support the use of thiazide diuretics to treat hypertension in patients with advanced chronic kidney disease. METHODS We randomly assigned patients with stage 4 chronic kidney disease and poorly controlled hypertension, as confirmed by 24-hour ambulatory blood-pressure monitoring, in a 1:1 ratio to receive chlorthalidone at an initial dose of 12.5 mg per day, with increases every 4 weeks if needed to a maximum dose of 50 mg per day, or placebo; randomization was stratified according to previous use of loop diuretics. The primary outcome was the change in 24-hour ambulatory systolic blood pressure from baseline to 12 weeks. Secondary outcomes were the change from baseline to 12 weeks in the urinary albumin-to-creatinine ratio, N-terminal pro-B-type natriuretic peptide level, plasma renin and aldosterone levels, and total body volume. Safety was also assessed. RESULTS A total of 160 patients underwent randomization, of whom 121 (76%) had diabetes mellitus and 96 (60%) were receiving loop diuretics. At baseline, the mean (±SD) estimated glomerular filtration rate was 23.2±4.2 ml per minute per 1.73 m2 of body-surface area and the mean number of antihypertensive medications prescribed was 3.4±1.4. At randomization, the mean 24-hour ambulatory systolic blood pressure was 142.6±8.1 mm Hg in the chlorthalidone group and 140.1±8.1 mm Hg in the placebo group and the mean 24-hour ambulatory diastolic blood pressure was 74.6±10.1 mm Hg and 72.8±9.3 mm Hg, respectively. The adjusted change in 24-hour systolic blood pressure from baseline to 12 weeks was -11.0 mm Hg (95% confidence interval [CI], -13.9 to -8.1) in the chlorthalidone group and -0.5 mm Hg (95% CI, -3.5 to 2.5) in the placebo group. The between-group difference was -10.5 mm Hg (95% CI, -14.6 to -6.4) (P<0.001). The percent change in the urinary albumin-to-creatinine ratio from baseline to 12 weeks was lower in the chlorthalidone group than in the placebo group by 50 percentage points (95% CI, 37 to 60). Hypokalemia, reversible increases in serum creatinine level, hyperglycemia, dizziness, and hyperuricemia occurred more frequently in the chlorthalidone group than in the placebo group. CONCLUSIONS Among patients with advanced chronic kidney disease and poorly controlled hypertension, chlorthalidone therapy improved blood-pressure control at 12 weeks as compared with placebo. (Funded by the National Heart, Lung, and Blood Institute and the Indiana Institute of Medical Research; CLICK ClinicalTrials.gov number, NCT02841280.).
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Affiliation(s)
- Rajiv Agarwal
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Arjun D Sinha
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Andrew E Cramer
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Mary Balmes-Fenwick
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Jazmyn H Dickinson
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Fangqian Ouyang
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Wanzhu Tu
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
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Rottner L, Moser F, Schleberger R, Weimann J, Moser J, Lemoine M, Muenkler P, Dinshaw L, Risius T, Kirchhof P, Ouyang F, Reissmann B, Metzner A, Rillig A. Accuracy and acute efficacy of a novel occlusion tool to guide cryoballoon-based pulmonary vein isolation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cryoballoon (CB)-based pulmonary vein isolation (PVI) currently requires to verify occlusion of each pulmonary vein (PV) using fluoroscopy and dye injection.
Objective
The current study evaluated whether the novel CB-occlusion tool integrated into the wide-band dielectric imaging system KODEX-EPD reliably verifies occlusion of PV according to a novel dye-injection based algorithm.
Methods
Consecutive patients suffering from symptomatic atrial fibrillation (AF) underwent CB-based PVI using the KODEX-EPD and the novel occlusion-tool (group I). To confirm accurate display of the PVs, selective PV-angiography was performed in the first half of the patients of group I (group Ia) in addition to a three-dimensional left atrial (LA) map using a spiral mapping catheter (Achieve, SMC1, Medtronic, MN, USA). PV-angiographies were waived for the following patients (group Ib). Procedural duration and radiation exposure were compared to a control group of patients undergoing conventional CB-based PVI.
Results
CB-based PVI was successful in 50/50 patients of group I (mean age 63±11 years, 18 paroxysmal (36%)) and 25/25 patients of group II (66±10 years, 9 paroxysmal (60%)). Concordance of PV-occlusion as assessed by either PV-occlusion-angiography or KODEX-EPD, was documented in 237/272 (87%) occlusion-analyses among 198 PVs (95% for left superior PV, 93% for left inferior PV, 86% for right inferior PV and 77% for right superior PV).
In the final evaluation phase (group Ib) LA fluoroscopy times and dose area products were comparable to the conventional CB-ablation group (10.5±5 vs 8.8±4 minutes (p=0.23) and 403±425 vs 321±202 cGycm2 (p=0.44), whereas the amount of dye could be significantly reduced (group Ib: 31±10 ml vs group II: 70±20 ml, p<0.0001).
Conclusion
The novel KODEX-EPD PV-occlusion tool allows for accurate PV-occlusion assessment in the majority of PVs and a high acute success rate. The system has the potential to reduce dye and radiation exposure. This should be evaluated in controlled clinical trials.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Rottner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - F Moser
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - R Schleberger
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - J Weimann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - J Moser
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - M Lemoine
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Muenkler
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - L Dinshaw
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - T Risius
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - F Ouyang
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - B Reissmann
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Metzner
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - A Rillig
- University Heart & Vascular Center Hamburg, Hamburg, Germany
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Dir AL, Magee LA, Clifton RL, Ouyang F, Tu W, Wiehe SE, Aalsma MC. The point of diminishing returns in juvenile probation: Probation requirements and risk of technical probation violations among first-time probation-involved youth. Psychol Public Policy Law 2021; 72:283-291. [PMID: 34588760 PMCID: PMC8475969 DOI: 10.1037/law0000282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Technical probation violations are common among probation-involved youth, and across many jurisdictions, may result in detention or residential placement. The current study examined prevalence of technical violations occurring during one's first probation period, the average time to technical violation, and individual-level and justice-related factors related to technical violations among probation-involved youth in a juvenile justice system. We analyzed electronic criminal records of 18,289 probation-involved youth following their first arrest (68.7% male, 53.9% Black, Mage=15.2). Technical violation was defined as a violation resulting from a non-criminal incident. We examined effects of charge severity, probation conditions (e.g., electronic monitoring) and program referrals (e.g., mental health) on likelihood of technical violation utilizing survival analysis stratified by race. Across 18,289 youth, 15.3% received a technical violation during their first probation; Black youth violated more quickly compared to White youth (log-rank test p<.001). In multivariate survival analyses, the hazard for time to technical violation was higher for Black youth compared to white youth (p<.001), males (p=.04), and younger youth (p<.001). Youth assigned to more probation requirements violated more quickly. Electronic monitoring and education, mental health, and drug programs were associated with shorter time to violation, controlling for race, ethnicity, and charge severity. Black youth violate more quickly compared to White youth. Across all youth, assignment to more probation requirements increased risk of technical violation and shorter time to violation. Despite the benefit of probation interventions, system-level efforts are needed to help youth adhere to probation requirements and successfully complete probation.
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Affiliation(s)
- Allyson L Dir
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
- Adolescent Behavioral Health Research Program, Department of Pediatrics, Section of Adolescent Medicine, Indianapolis, IN
| | - Lauren A Magee
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Richelle L Clifton
- Department of Psychology, Indiana University Purdue University - Indianapolis, Indianapolis, IN
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Sarah E Wiehe
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program, Department of Pediatrics, Section of Adolescent Medicine, Indianapolis, IN
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
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Agarwal R, Cramer AE, Balmes-Fenwick M, Sinha AD, Ouyang F, Tu W. Design and Baseline Characteristics of the Chlorthalidone in Chronic Kidney Disease (CLICK) Trial. Am J Nephrol 2020; 51:542-552. [PMID: 32663820 PMCID: PMC7409874 DOI: 10.1159/000508700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypertension often accompanies chronic kidney disease (CKD), and diuretics are widely prescribed to reduce blood pressure (BP). Chlorthalidone (CTD) is a thiazide-like diuretic and an effective antihypertensive drug, yet little data exist to support its use in treating hypertension in individuals with advanced CKD. METHODS Chlorthalidone in Chronic Kidney Disease (CLICK) is a phase II, single-institution, multicenter, double-blind randomized control trial to test the hypothesis that CTD improves BP, through reduction of extracellular fluid volume, and results in target organ protection in patients with stage 4 CKD and poorly controlled hypertension. After a single-blind placebo run-in for 2 weeks and confirmation of hypertension by 24-h ambulatory blood pressure (ABP), patients are randomized to either placebo or CTD 12.5 mg once daily (QD) followed by dose escalation. Randomization is stratified by prior loop diuretic use, and the double-blind phase lasts 12 weeks. With a total of 160 patients, the study will have ≥80% power to detect a 6 mm Hg difference in systolic 24-h ABP between the 2 treatment groups. RESULTS Between June 2016 and October 2019, 131 patients have been randomized. The baseline characteristics are as follows: average age 65.8 years, 79% men, 36% Black, 79% with diabetes, mean eGFR 23.2 mL/min/1.73 m2, median urine albumin/creatinine ratio 923 mg/g, average number of BP medications 3.4, 60% on loop diuretics, and 24-h ABP averaged 141.7/73.8 mm Hg. CONCLUSION Among patients with stage 4 CKD and uncontrolled hypertension, CLICK should answer the question whether CTD is safe and effective.
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Affiliation(s)
- Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA,
| | - Andrew E Cramer
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Mary Balmes-Fenwick
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Arjun D Sinha
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Fangqian Ouyang
- Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Wanzhu Tu
- Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Schenker N, Hashiguchi N, Maurer T, Lemes C, Rottner L, Reissmann B, Rillig A, Kuck KH, Ouyang F, Mathew S. P1361Impact of radiation/chemotherapy for breast cancer on the electroanatomic features in patients receiving catheter ablation for left atrial arrhythmia. Europace 2020. [DOI: 10.1093/europace/euaa162.177] [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: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is a common cardiac arrhythmia and catheter ablation a viable treatment option for patients with AF. Extensive left atrial (LA) scars, frequently seen in patients with persistent AF, can limit its efficacy. Radiation for breast cancer treatment is known to have serious long-term effects (e.g. fibrosis) on the targeted tissue. At the same time, chemotherapy often leads to organ dysfunction. We sought to examine the effects of radiation and chemotherapy on the electroanatomic features of the LA in patients who received catheter ablation for left atrial arrhythmias with prior breast cancer treatment.
Methods and Results
We compared 38 patients (mean age 68.4 ± 7.1 years) who underwent catheter ablation for LA arrhythmia and had a previous diagnosis of breast cancer with 38 patients (mean age 65.4 ± 7.3 years) without breast cancer who formed our control group. LA scar area, as well as its distribution was measured during the electrophysiology (EP) study and graded according to the Utah classification.
The existence of LA scarring did not differ significantly between both groups (71.1% vs. 76.3%, p = 0.602). LA scar area (excluding PVs) was 107.5cm2 ± 19.0cm2 in the breast cancer group compared to 110.1cm2 ± 18.5cm2 in the control group (p = 0.536). The distribution of the scar area revealed no significant difference between both groups, however an involvement of the anterior wall was common (65.8% vs. 73.7%; p = 0.454). We further investigated whether the location of breast cancer had an impact on the LA scar development of the patients in our study cohort. Here, we found no significant difference in the amount of LA scarring when comparing patients with left-sided breast cancer to patients with right-sided breast cancer (66.7% vs. 73.9%). In a sub-analysis patients with breast cancer and persistent AF showed a non-significant trend towards greater LA scar areas (17.4cm2 vs. 6.8cm2) in comparison to patients of the control group with similar LA volumes.
The patient’s age (>65 years) was the only independent predictor for greater LA scarring we could identify. Neither former radiotherapy, nor chemotherapy showed a positive correlation with greater LA scarring.
Conclusion
There is no change in the distribution as well as an increase of the extent of LA scars after thoracic irradiation and/or chemotherapy. A trend towards greater LA scar areas was seen in patients with breast cancer and persistent AF. The patient’s age was identified as an independent predictor for LA scar development.
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Affiliation(s)
- N Schenker
- Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - T Maurer
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - L Rottner
- University Heart Center Hamburg, Hamburg, Germany
| | - B Reissmann
- University Heart Center Hamburg, Hamburg, Germany
| | - A Rillig
- University Heart Center Hamburg, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - F Ouyang
- Fuwai Hospital, CAMS and PUMC, Beijing, China
| | - S Mathew
- Justus-Liebig University of Giessen, Giessen, Germany
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Li HL, Miao SY, Qiu L, Ouyang F, Xiao LP. Effect of Tin Dioxide Modified F-TiO2/SiO2 Nano-Powder Catalysts on Photocatalytic Degradation of Acrylonitrile. RUSS J APPL CHEM+ 2019. [DOI: 10.1134/s1070427219100161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Cheng YW, Phelps E, Ganapini V, Khan N, Ouyang F, Xu H, Khanna S, Tariq R, Friedman-Moraco RJ, Woodworth MH, Dhere T, Kraft CS, Kao D, Smith J, Le L, El-Nachef N, Kaur N, Kowsika S, Ehrlich A, Smith M, Safdar N, Misch EA, Allegretti JR, Flynn A, Kassam Z, Sharfuddin A, Vuppalanchi R, Fischer M. Fecal microbiota transplantation for the treatment of recurrent and severe Clostridium difficile infection in solid organ transplant recipients: A multicenter experience. Am J Transplant 2019; 19:501-511. [PMID: 30085388 PMCID: PMC6349556 DOI: 10.1111/ajt.15058] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [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: 04/04/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
Fecal microbiota transplant (FMT) is recommended for Clostridium difficile infection (CDI) treatment; however, use in solid organ transplantation (SOT) patients has theoretical safety concerns. This multicenter, retrospective study evaluated FMT safety, effectiveness, and risk factors for failure in SOT patients. Primary cure and overall cure were defined as resolution of diarrhea or negative C difficile stool test after a single FMT or after subsequent FMT(s) ± anti-CDI antibiotics, respectively. Ninety-four SOT patients underwent FMT, 78% for recurrent CDI and 22% for severe or fulminant CDI. FMT-related adverse events (AE) occurred in 22.3% of cases, mainly comprising self-limiting conditions including nausea, abdominal pain, and FMT-related diarrhea. Severe AEs occurred in 3.2% of cases, with no FMT-related bacteremia. After FMT, 25% of patients with underlying inflammatory bowel disease had worsening disease activity, while 14% of cytomegalovirus-seropositive patients had reactivation. At 3 months, primary cure was 58.7%, while overall cure was 91.3%. Predictors of failing a single FMT included inpatient status, severe and fulminant CDI, presence of pseudomembranous colitis, and use of non-CDI antibiotics at the time of FMT. These data suggest FMT is safe in SOT patients. However, repeated FMT(s) or additional antibiotics may be needed to optimize rates of cure with FMT.
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Affiliation(s)
- Yao-Wen Cheng
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emmalee Phelps
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Vincent Ganapini
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Noor Khan
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Huiping Xu
- Department of Biostatistics, The Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, IN, USA
| | - Sahil Khanna
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Raseen Tariq
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | | | - Michael H. Woodworth
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Tanvi Dhere
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Colleen S. Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA,Department of Pathology, Emory University, Atlanta, Georgia, USA
| | - Dina Kao
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Justin Smith
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lien Le
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Najwa El-Nachef
- Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nirmal Kaur
- Division of Gastroenterology, Department of Medicine, Henry Ford Medical Center, Detroit, MI, USA
| | - Sree Kowsika
- Division of Gastroenterology, Department of Medicine, Henry Ford Medical Center, Detroit, MI, USA
| | - Adam Ehrlich
- Division of Gastroenterology, Department of Medicine, Temple University, Philadelphia, PA, USA
| | - Michael Smith
- Division of Gastroenterology, Department of Medicine, Temple University, Philadelphia, PA, USA
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA,William S. Middleton Memorial Veterans Hospital, Madison WI, USA
| | - Elizabeth Ann Misch
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jessica R. Allegretti
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ann Flynn
- Division of Gastroenterology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Asif Sharfuddin
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Raj Vuppalanchi
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Monika Fischer
- Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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23
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Anderson VR, Ouyang F, Tu W, Rosenman MB, Wiehe SE, Aalsma MC. Medicaid Coverage and Continuity for Juvenile Justice–Involved Youth. Journal of Correctional Health Care 2019; 25:45-54. [DOI: 10.1177/1078345818820043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marc B. Rosenman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sarah E. Wiehe
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew C. Aalsma
- Division of Adolescent Medicine, Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
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24
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Watson DP, Ahonen EQ, Shuman V, Brown M, Tsemberis S, Huynh P, Ouyang F, Xu H. The housing first technical assistance and training (HFTAT) implementation strategy: outcomes from a mixed methods study of three programs. Subst Abuse Treat Prev Policy 2018; 13:32. [PMID: 30241546 PMCID: PMC6151066 DOI: 10.1186/s13011-018-0172-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/17/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND This paper discusses the initial testing of the Housing First Training and Technical Assistance (HFTAT) Program, a multifaceted, distance-based strategy for the implementation of the Housing First (HF) supportive housing model. HF is a complex housing intervention for serving people living with serious mental illness and a substance use disorder that requires significant individual- and structural-level changes to implement. As such, the HFTAT employs a combined training and consultation approach to target different levels of the organization. Training delivered to all organizational staff focuses on building individual knowledge and uses narrative storytelling to overcome attitudinal implementation barriers. Consultation seeks to build skills through technical assistance and fidelity audit and feedback. METHOD We employed a mixed method design to understand both individual-level (e.g., satisfaction with the HFTAT, HF knowledge acquisition and retention, and HF acceptability and appropriateness) and structural-level (e.g., fidelity) outcomes. Quantitative data were collected at various time points, and qualitative data were collected at the end of HFTAT activities. Staff and administrators (n = 113) from three programs across three states participated in the study. RESULTS Satisfaction with both training and consultation was high, and discussions demonstrated both activities were necessary. Flexibility of training modality and narrative storytelling were particular strengths, while digital badging and the community of practice were perceived as less valuable because of incompatibilities with the work context. HF knowledge was high post training and retained after 3-month follow-up. Participants reported training helped them better understand the model. Attitudes toward evidence-based interventions improved over 6 months, with qualitative data supporting this but demonstrating some minor concerns related to acceptability and appropriateness. Fidelity scores for all programs improved over 9 months. CONCLUSION The HFTAT was a well-liked and generally useful implementation strategy. Results support prior research pointing to the value of both (a) multifaceted strategies and (b) combined training and consultation approaches. The study also provides evidence for narrative storytelling as an approach for changing attitudinal implementation barriers. The need for compatibility between specific elements of an implementation strategy and the work environment was also observed.
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Affiliation(s)
- Dennis P Watson
- Center for Dissemination and Implementation Science, University of Illinois College of Medicine at Chicago, 1603 W Taylor St, Chicago, IL, 60612, USA.
| | - Emily Q Ahonen
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Valery Shuman
- Heartland Alliance Health, Midwest Harm Reduction Institute, 1207 W. Leland Ave, Chicago, IL, 60640, USA
| | - Molly Brown
- Department of Psychology, DePaul University, 1 E. Jackson, Chicago, IL, 60604, USA
| | - Sam Tsemberis
- Department of Psychiatry, NYPH, Columbia University Medical Center, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Philip Huynh
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
| | - Fangqian Ouyang
- Indiana University School of Medicine, 340 W. 10th St, Indianapolis, IN, 46202, USA
| | - Huiping Xu
- Indiana University Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN, 46202, USA
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25
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Gilbert AL, McCord AL, Ouyang F, Etter DJ, Williams RL, Hall JA, Tu W, Downs SM, Aalsma MC. Characteristics Associated with Confidential Consultation for Adolescents in Primary Care. J Pediatr 2018; 199:79-84.e1. [PMID: 29631769 PMCID: PMC6063778 DOI: 10.1016/j.jpeds.2018.02.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/15/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training. STUDY DESIGN This prospective cohort study was conducted as part of a larger study implementing computerized clinical decision support in 2 urban primary care clinics. Adolescents used tablets to complete screening questions for specified risk factors in the waiting room. Adolescent-reported risk factors included sexual activity, substance use, and depressive symptoms. Providers were prompted on encounter forms to address identified risk factors and indicate whether confidential consultation was provided. Provider types included adolescent medicine board certified pediatrics and general pediatrics. Differences in proportions of adolescents reporting risk factors by provider type were assessed using χ2 tests. Associations between adolescent characteristics, risk factors, and provider-reported confidential consultation were examined using logistic regression analyses. RESULTS The sample included 1233 English and Spanish-speaking adolescents 12-20 years of age (52% female; 60% black; 50% early adolescent). Patients seen by adolescent medicine board certified providers reported sexual activity, depressive symptoms, and substance use significantly more often than those seen by general pediatric providers. Among patients seen by board certified adolescent medicine providers, confidential consultation was provided to 90%. For those seen by general pediatric providers, confidential consultation was provided to 53%. Results of multiple logistic regression demonstrated that female sex, later adolescence, and clinic location were significantly associated with confidential consultation. CONCLUSIONS Provider training is needed to reinforce the importance of confidential consultation for all adolescents.
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Affiliation(s)
- Amy Lewis Gilbert
- Indiana University School of Medicine, Department of Pediatrics, Children’s Health Services Research Section, Indianapolis, IN, USA,Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Fangqian Ouyang
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Dillon J. Etter
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Medicine Section, Indianapolis, IN, USA
| | - Rebekah L. Williams
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Medicine Section, Indianapolis, IN, USA
| | - James A. Hall
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Medicine Section, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Stephen M. Downs
- Indiana University School of Medicine, Department of Pediatrics, Children’s Health Services Research Section, Indianapolis, IN, USA
| | - Matthew C. Aalsma
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Medicine Section, Indianapolis, IN, USA
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26
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Heeger CH, Metzner A, Schlueter M, Rillig A, Mathew S, Fink T, Reissmann B, Lemes C, Maurer T, Santoro F, Schmidt T, Ghanem A, Frerker C, Kuck KH, Ouyang F. 2117Cerebral protection during catheter ablation of ventricular tachycardia in patients with ischemic heart disease. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - M Schlueter
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Schmidt
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Ghanem
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Frerker
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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27
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Heeger CH, Rillig A, Geisler D, Fink T, Mathew S, Tilz RR, Reissmann B, Lemes C, Maurer T, Santoro F, Alessandrini H, Dotz I, Metzner A, Kuck KH, Ouyang F. P4827Wide area left atrial appendage isolation in patients non responding to pulmonary vein isolation: Benefit, risk and prevention of thromboembolism. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C H Heeger
- University of Luebeck, Medical clinic II, Luebeck, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - D Geisler
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - R R Tilz
- University of Luebeck, Medical clinic II, Luebeck, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - H Alessandrini
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - I Dotz
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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28
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Fischer M, Kao D, Kassam Z, Smith J, Louie T, Sipe B, Torbeck M, Xu H, Ouyang F, Mozaffarian D, Allegretti JR. Stool Donor Body Mass Index Does Not Affect Recipient Weight After a Single Fecal Microbiota Transplantation for Clostridium difficile Infection. Clin Gastroenterol Hepatol 2018; 16:1351-1353. [PMID: 29246701 DOI: 10.1016/j.cgh.2017.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Monika Fischer
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Dina Kao
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | | | - Justin Smith
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Thomas Louie
- Division of Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | | | - Michelle Torbeck
- Department of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Huiping Xu
- Department of Biostatistics, Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, Indiana
| | - Fangqian Ouyang
- Department of Biostatistics, Richard M. Fairbanks School of Public Health and School of Medicine, Indiana University, Indianapolis, Indiana
| | - Dariush Mozaffarian
- Tufts Friedman School of Nutrition Science and Policy, Boston, Massachusetts
| | - Jessica R Allegretti
- Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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29
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Heeger CH, Metzner A, Rillig A, Mathew S, Fink T, Reissmann B, Lemes C, Maurer T, Santoro F, Schmidt T, Frerker C, Ghanem A, Kuck KH, Ouyang F. 997Embolic debris captured by a cerebral protection system during catheter ablation of ventricular tachycardia in patients with ischemic heart disease. Europace 2018. [DOI: 10.1093/europace/euy015.546] [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: 11/13/2022] Open
Affiliation(s)
- C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Schmidt
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Frerker
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Ghanem
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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30
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Heeger CH, Tscholl V, Wissner E, Fink T, Bellmann B, Mathew S, Reissmann B, Lemes C, Maurer T, Goldmann B, Landmesser U, Ouyang F, Kuck KH, Rillig A, Metzner A. P278Acute efficacy, safety and clinical outcomes utilizing the second-generation cryoballoon for pulmonary vein isolation in patients with previously implanted cardiac devices for continuous atrial monito. Europace 2018. [DOI: 10.1093/europace/euy015.090] [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: 11/13/2022] Open
Affiliation(s)
- C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - V Tscholl
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - E Wissner
- University of Illinois at Chicago, Cardiology, Chicago, United States of America
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Bellmann
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Goldmann
- Asklepios Klinik Harburg, Cardiology, Hamburg, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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31
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Rottner L, Schmidt T, Dotz I, Lemes C, Heeger CH, Fink T, Mathew S, Reissmann B, Rexha E, Riedl J, Frerker C, Ouyang F, Kuck KH, Metzner A, Maurer T. P1212The clip and the tip: Long-term clinical outcome after ablation of atrial fibrillation in patients with MitraClip. Europace 2018. [DOI: 10.1093/europace/euy015.694] [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: 11/14/2022] Open
Affiliation(s)
- L Rottner
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - T Schmidt
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - I Dotz
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C H Heeger
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - E Rexha
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - J Riedl
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C Frerker
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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32
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Mathew S, Maurer T, Lemes C, Heeger C, Reissmann B, Santoro F, Metzner A, Rillig A, Kuck KH, Ouyang F. P296Ablation of ventricular tachycardia in patients with structural heart disease and electrical storm. Europace 2018. [DOI: 10.1093/europace/euy015.108] [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: 11/13/2022] Open
Affiliation(s)
- S Mathew
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - C Heeger
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Hamburg, Germany
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33
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Santoro F, Heeger CH, Heeger CH, Reissmann B, Reissmann B, Maurer T, Maurer T, Fink T, Fink T, Lemes C, Lemes C, Mathew S, Mathew S, Rillig A, Rillig A, Ouyang F, Ouyang F, Kuck KH, Kuck KH, Metzner A, Metzner A. P1155Left atrial appendage flow velocity is an independent predictor of recurrence in patients referred for cryoablation of atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.641] [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: 11/13/2022] Open
Affiliation(s)
- F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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Santoro F, Mathew S, Heeger CH, Fink T, Maurer T, Lemes C, Reissmann B, Rillig A, Metzner A, Kuck KH, Ouyang F. P293Prognostic significance of Ventricular Tachycardia clustering after catheter ablation in non-ischemic dilated cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.105] [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: 11/12/2022] Open
Affiliation(s)
- F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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Santoro F, Metzner A, Reissmann B, Maurer T, Fink T, Heeger CH, Lemes C, Mathew S, Ouyang F, Kuck KH, Rillig A. P365First in-human experience with ablation index to perform left atrial anterior line in patients with persistent atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.176] [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: 11/14/2022] Open
Affiliation(s)
- F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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Heeger CH, Rillig A, Tilz RR, Fink T, Mathew S, Reissmann B, Lemes C, Maurer T, Santoro F, Inaba O, Alessandrini H, Dotz I, Metzner A, Kuck KH, Ouyang F. 520Wide area left atrial appendage isolation for atrial fibrillation therapy: Long-term succes and incidence of stroke and thrombus formation. Europace 2018. [DOI: 10.1093/europace/euy015.287] [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: 11/13/2022] Open
Affiliation(s)
- C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - R R Tilz
- University of Luebeck, Medical clinic II, Luebeck, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - O Inaba
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - H Alessandrini
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - I Dotz
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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Sohns C, Heeger CH, Volkmer M, Metzner A, Nuernberg JH, Buchwalsky G, Ventura R, Reinhardt A, Jansen H, Kuck KH, Hebe JH, Ouyang F, Siebels JH. P298VT therapy in patients with noncompaction cardiomyopathy. Europace 2018. [DOI: 10.1093/europace/euy015.110] [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: 11/14/2022] Open
Affiliation(s)
- C Sohns
- Elektrophysiologie Bremen, Bremen, Germany
| | - C H Heeger
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - M Volkmer
- Elektrophysiologie Bremen, Bremen, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Hamburg, Germany
| | | | | | - R Ventura
- Elektrophysiologie Bremen, Bremen, Germany
| | | | - H Jansen
- Elektrophysiologie Bremen, Bremen, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - J H Hebe
- Elektrophysiologie Bremen, Bremen, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Hamburg, Germany
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Heeger CH, Bellmann B, Fink T, Mathew S, Reissmann B, Lemes C, Maurer T, Santoro F, Sultan A, Plenge T, Ouyang F, Kuck KH, Metzner A, Steven D, Rillig A. P286Safety and long-term clinical success of pulmonary vein isolation utilizing the second generation cryoballoon in patients over 75 years of age: A multicenter study. Europace 2018. [DOI: 10.1093/europace/euy015.098] [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: 11/14/2022] Open
Affiliation(s)
- C H Heeger
- University of Luebeck, Medical clinic II, Luebeck, Germany
| | - B Bellmann
- University of Cologne, Cardiology, Cologne, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Sultan
- University of Cologne, Cardiology, Cologne, Germany
| | - T Plenge
- University of Cologne, Cardiology, Cologne, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - D Steven
- University of Cologne, Cardiology, Cologne, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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Sohns C, Rottner L, Reissmann B, Heeger CH, Lemes CH, Fink T, Volkmer M, Ventura R, Wohlmuth P, Mathew S, Metzner A, Ouyang F, Kuck KH, Maurer T. P835The force awakens: one year clinical outcome after pulmonary vein isolation using the novel ThermoCool SmartTouch Surround Flow catheter. Europace 2018. [DOI: 10.1093/europace/euy015.439] [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: 11/13/2022] Open
Affiliation(s)
- C Sohns
- Elektrophysiologie Bremen, Bremen, Germany
| | - L Rottner
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - C H Heeger
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - C H Lemes
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - M Volkmer
- Elektrophysiologie Bremen, Bremen, Germany
| | - R Ventura
- Elektrophysiologie Bremen, Bremen, Germany
| | - P Wohlmuth
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Hamburg, Germany
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Heeger CH, Bellmann B, Fink T, Mathew S, Reissmann B, Lemes C, Maurer T, Santoro F, Sultan A, Plenge T, Ouyang F, Kuck KH, Metzner A, Steven D, Rillig A. P284Long-term clinical success of pulmonary vein isolation utilizing the second generation cryoballoon in patients with persistent atrial fibrillation: A multicenter study. Europace 2018. [DOI: 10.1093/europace/euy015.096] [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: 11/13/2022] Open
Affiliation(s)
- C H Heeger
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Bellmann
- University of Cologne, Cardiology, Cologne, Germany
| | - T Fink
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Sultan
- University of Cologne, Cardiology, Cologne, Germany
| | - T Plenge
- University of Cologne, Cardiology, Cologne, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
| | - D Steven
- University of Cologne, Cardiology, Cologne, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Department of Cardiology, Hamburg, Germany
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Fink T, Schlueter M, Heeger CH, Rillig A, Lemes C, Maurer T, Reissmann B, Rottner L, Santoro F, Tilz RR, Mathew S, Ouyang F, Kuck KH, Metzner A. P398Acute and long-term outcomes of epicardial left atrial appendage ligation with the second generation LARIAT device: A European high-volume electrophysiology center experience. Europace 2018. [DOI: 10.1093/europace/euy015.209] [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: 11/12/2022] Open
Affiliation(s)
- T Fink
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - M Schlueter
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C-H Heeger
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - A Rillig
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - C Lemes
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - T Maurer
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - B Reissmann
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - L Rottner
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - F Santoro
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - R R Tilz
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - S Mathew
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - F Ouyang
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - K H Kuck
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
| | - A Metzner
- Asklepios Clinic St. Georg, Cardiology, Hamburg, Germany
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Aalsma MC, Zerr AM, Etter DJ, Ouyang F, Gilbert AL, Williams RL, Hall JA, Downs SM. Physician Intervention to Positive Depression Screens Among Adolescents in Primary Care. J Adolesc Health 2018; 62:212-218. [PMID: 29174939 PMCID: PMC6053652 DOI: 10.1016/j.jadohealth.2017.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/03/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. METHODS We conducted a prospective cohort study within two clinics of the computer-based depression screening and physician feedback algorithm among youth aged 12-20 years between October 2014 and October 2015 in Marion County (Indianapolis), Indiana. RESULTS Our sample included 2,038 youth (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Over 20% of youth screened positive for depression on the Patient Health Questionnaire-2 and 303 youth (14.8%) screened positive on the Patient Health Questionnaire-9 (PHQ-9). The most common follow-up action by physicians was a referral to mental health services (34.2% mild, 46.8% moderate, and 72.2% severe range). Almost 11% of youth in the moderate range and 22.7% of youth in the severe range were already prescribed a selective serotonin reuptake inhibitor. When predicting mental health service referral, significant predictors in the multivariate analysis included clinic site (40.2% vs. 73.9%; p < .0001) and PHQ-9 score (severe range 77.8% vs. mild range 47.5%; p < .01). Similarly, when predicting initiation of selective serotonin reuptake inhibitors, only clinic site (28.6% vs. 6.9%; p < .01) and PHQ-9 score (severe range 46.7% vs. moderate range 10.6%; p < .001) were significant. CONCLUSIONS When a computer-based decision support system algorithm focused on adolescent depression was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care.
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Affiliation(s)
- Matthew C. Aalsma
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
| | - Ashley M. Zerr
- Department of Pediatrics, University of Louisville School of Medicine, Louisville KY
| | - Dillon J. Etter
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis IN
| | - Amy Lewis Gilbert
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
| | - Rebekah L. Williams
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
| | - James A. Hall
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
| | - Stephen M. Downs
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
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Luo X, Zhang B, Lian Z, Dong Y, Liu J, Pei S, Mo X, Zhang L, Huang W, Ouyang F, Guo B, Liang C, Zhang S. Value of two-cycle docetaxel, cisplatin, and 5-fluorouracil induction chemotherapy in hypopharyngeal carcinoma. Neoplasma 2018; 65:269-277. [PMID: 29368529 DOI: 10.4149/neo_2018_170213n102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Various studies have investigated laryngeal function and survival after induction chemotherapy in hypopharyngeal carcinoma, but potential factors to help predict response rates after induction chemotherapy remain unknown. This retro- spective study evaluated which factors are related to an ineffective response to two-cycle docetaxel, cisplatin, and 5-fluoro- uracil (TPF) induction chemotherapy in hypopharyngeal carcinoma to determine potential candidates for this treatment in clinical practice. From Jan 2005 to Dec 2015, 81 patients diagnosed with hypopharyngeal squamous cell carcinoma based on a pathological examination were analyzed. They were administered two-cycle TPF induction chemotherapy, and magnetic resonance imaging was performed before and after induction chemotherapy. The mean survival time was 5.7 years (95% confidence interval, 5.1-6.2 years). The 1, 3, 5 and 6-year survival rates were 98.8%, 80.1%, 64.5%, and 54.2%, respectively. TPF induction chemotherapy was well tolerated; the main adverse effects resolved with symptomatic treatment. A response to TPF induction chemotherapy was associated with lymph node size, tumor grade, invasion region, T stage, and primary tumor. The following issues were significantly associated with an increasing non-response rate to two-cycle induction chemotherapy: increasing lymph node size, moderately differentiated squamous cell carcinoma, invasion of the esophagus along with the thyroid cartilage, and primary tumor in the piriform sinus. Lymph nodes of ≥2.15 cm, moderately differenti- ated tumor grade, or thyroid cartilage invasion were the best cutoff values for patients who did not respond to induction chemotherapy. However, the initial cancer site, cancer stage, and degree of cancer differentiation were not closely related to the efficacy of induction chemotherapy.
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Imler TD, Sherman S, Imperiale TF, Xu H, Ouyang F, Beesley C, Hilton C, Coté GA. Provider-specific quality measurement for ERCP using natural language processing. Gastrointest Endosc 2018; 87:164-173.e2. [PMID: 28476375 PMCID: PMC5670027 DOI: 10.1016/j.gie.2017.04.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 04/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Natural language processing (NLP) is an information retrieval technique that has been shown to accurately identify quality measures for colonoscopy. There are no systematic methods by which to track adherence to quality measures for ERCP, the highest risk endoscopic procedure widely used in practice. Our aim was to demonstrate the feasibility of using NLP to measure adherence to ERCP quality indicators across individual providers. METHODS ERCPs performed by 6 providers at a single institution from 2006 to 2014 were identified. Quality measures were defined using society guidelines and from expert opinion, and then extracted using a combination of NLP and data mining (eg, ICD9-CM codes). Validation for each quality measure was performed by manual record review. Quality measures were grouped into preprocedure (5), intraprocedure (6), and postprocedure (2). NLP was evaluated using measures of precision and accuracy. RESULTS A total of 23,674 ERCPs were analyzed (average patient age, 52.9 ± 17.8 years, 14,113 were women [59.6%]). Among 13 quality measures, precision of NLP ranged from 84% to 100% with intraprocedure measures having lower precision (84% for precut sphincterotomy). Accuracy of NLP ranged from 90% to 100% with intraprocedure measures having lower accuracy (90% for pancreatic stent placement). CONCLUSIONS NLP in conjunction with data mining facilitates individualized tracking of ERCP providers for quality metrics without the need for manual medical record review. Incorporation of these tools across multiple centers may permit tracking of ERCP quality measures through national registries.
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Affiliation(s)
- Timothy D. Imler
- Division of Gastroenterology and Hepatology; Indiana University School of Medicine. Indianapolis, IN
- Department of Medicine; Indiana University School of Medicine. Indianapolis, IN
- Department of Biomedical Informatics; Regenstrief Institute, LLC. Indianapolis, IN
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology; Indiana University School of Medicine. Indianapolis, IN
- Department of Medicine; Indiana University School of Medicine. Indianapolis, IN
| | - Thomas F. Imperiale
- Division of Gastroenterology and Hepatology; Indiana University School of Medicine. Indianapolis, IN
- Department of Medicine; Indiana University School of Medicine. Indianapolis, IN
- Center of Innovation; Health Services Research and Development; Richard L. Roudebush VA Medical Center. Indianapolis, IN
- Health Services Research, Regenstrief Institute, LLC. Indianapolis, IN
| | - Huiping Xu
- Department of Biostatistics; Indiana University School of Medicine. Indianapolis, IN
| | - Fangqian Ouyang
- Department of Biostatistics; Indiana University School of Medicine. Indianapolis, IN
| | - Christopher Beesley
- Department of Biomedical Informatics; Regenstrief Institute, LLC. Indianapolis, IN
| | - Charity Hilton
- Department of Biomedical Informatics; Regenstrief Institute, LLC. Indianapolis, IN
| | - Gregory A. Coté
- Division of Gastroenterology and Hepatology; Indiana University School of Medicine. Indianapolis, IN
- Division of Gastroenterology and Hepatology; Medical University of South Carolina. Charleston, SC
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Wanner MR, Loder RT, Jennings SG, Ouyang F, Karmazyn B. Changes in femoral head size and growth rate in young children with severe developmental dysplasia of the hip. Pediatr Radiol 2017; 47:1787-1792. [PMID: 28765997 DOI: 10.1007/s00247-017-3938-2] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/25/2017] [Accepted: 06/30/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Developmental dysplasia of the hip (DDH) is known to result in smaller femoral head size in toddlers; however, alterations in femoral head size and growth have not been documented in infants. OBJECTIVE To determine with ultrasound (US) whether femoral head size and growth are altered in infants (younger than 1 year of age) with severe DDH. MATERIALS AND METHODS We identified all patients at our tertiary care children's hospital from 2002 to 2014 who underwent US for DDH. We included studies with at least one hip with severe DDH, defined as <25% coverage of the femoral head, and excluded teratological DDH. We constructed a control group of randomized patients with normal US studies. Two pediatric radiologists blinded to diagnosis measured bilateral femoral head diameter. Inter-reader variability and femoral head diameter difference between dislocated and contralateral normal femoral heads were evaluated. Mean femoral head diameters were compared across types of hip joint; femoral head growth rates per month were calculated. RESULTS Thirty-seven children with DDH (28 female) were identified (median age: 33 days). The control group contained 75 children (47 female) with a median age of 47 days. Fifty-three of the 74 hips in the study group had severe DDH. Twenty-four children with DDH had completely dislocated hips (nine bilateral, five with contralateral severe subluxations). Thirteen other children had severe subluxation, two bilaterally. There was good inter-reader agreement in the normal femoral head group and moderate agreement in the severe DDH group. In the study group, severe DDH femoral head diameter was significantly smaller than their contralateral normal hip. Severe DDH femoral head diameter was significantly smaller than normal femoral head diameter in the control group. The severe DDH femoral head growth rate was slightly less but not significantly slower than normal femoral head growth rate in the study group. CONCLUSION On US during infancy, femoral head size is significantly reduced in severe cases of DDH.
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Affiliation(s)
- Matthew R Wanner
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive, Room 1053, Indianapolis, IN, 46202, USA.
| | - Randall T Loder
- Department of Orthopaedic Surgery, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - S Gregory Jennings
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Boaz Karmazyn
- Department of Radiology and Imaging Sciences, Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive, Room 1053, Indianapolis, IN, 46202, USA
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Aalsma MC, Anderson VR, Schwartz K, Ouyang F, Tu W, Rosenman MB, Wiehe SE. Preventive Care Use Among Justice-Involved and Non-Justice-Involved Youth. Pediatrics 2017; 140:peds.2017-1107. [PMID: 28970371 PMCID: PMC5990959 DOI: 10.1542/peds.2017-1107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Youth involved in the juvenile justice system (ie, arrested youth) are at risk for health problems. Although increasing preventive care use by justice-involved youth (JIY) is 1 approach to improving their well-being, little is known about their access to and use of care. The objective of this study was to determine how rates of well-child (WC) and emergency department visits, as well as public insurance enrollment continuity, differed between youth involved in the justice system and youth who have never been in the system. We hypothesized that JIY would exhibit less frequent WC and more frequent emergency service use than non-justice-involved youth (NJIY). METHODS This was a retrospective cohort study of administrative medical and criminal records of all youth (ages 12-18) enrolled in Medicaid in Marion County, Indiana, between January 1, 2004, and December 31, 2011. RESULTS The sample included 88 647 youth; 20 668 (23%) were involved in the justice system. JIY had lower use rates of WC visits and higher use rates of emergency services in comparison with NJIY. JIY had more and longer gaps in Medicaid coverage compared with NJIY. For all youth sampled, both preventive and emergency services use varied significantly by Medicaid enrollment continuity. CONCLUSIONS JIY experience more and longer gaps in Medicaid coverage, and rely more on emergency services than NJIY. Medicaid enrollment continuity was associated with differences in WC and emergency service use among JIY, with policy implications for improving preventive care for these vulnerable youth.
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Affiliation(s)
- Matthew C. Aalsma
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | | | - Katherine Schwartz
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Fangqian Ouyang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
| | - Marc B. Rosenman
- Department of Pediatrics, Northwestern University School of Medicine, Chicago, IL
| | - Sarah E. Wiehe
- Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN
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Lemes C, Sohns C, Maurer T, Chmelevsky M, Budanova M, Mathew S, Fink T, Reissmann B, Heeger C, Ouyang F, Kuck K, Metzner A. P5513Rotor distribution and stability in atrial fibrillation using a non invasive body-surface mapping system. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Maurer T, Sohns C, Metzner A, Rottner L, Riedl J, Reissmann B, Heeger CH, Lemes C, Fink T, Santoro F, Mathew S, Kuck KH, Ouyang F. P1713A balancing act - contact force along the anterior aspect of the lateral pulmonary veins during catheter ablation of atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux161.023] [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: 11/14/2022] Open
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Hayashi K, Heeger CH, Saguner AM, Mathew S, Maurer T, Lemes C, Riedl J, Sohns C, Santoro F, Reissmann B, Tilz RR, Metzner A, Kuck KH, Ouyang F. P1054Antegrade-transseptal approach for left ventricular tachyarrhythmia in patients with previous mitraclip implantation. Europace 2017. [DOI: 10.1093/ehjci/eux151.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Heeger C, Wissner E, Knoell M, Knoop B, Reissmann B, Mathew S, Lemes C, Maurer T, Santoro F, Riedl J, Inaba O, Goldmann B, Ouyang F, Kuck KH, Metzner A. P326Three-year clinical outcome after second-generation cryoballoon based pulmonary vein isolation for the treatment of paroxysmal and persistent atrial fibrillation: A two-center experience. Europace 2017. [DOI: 10.1093/ehjci/eux141.053] [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: 11/13/2022] Open
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