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Kramer J, Perez D, Ramseier D, Morgan L, Wilens TE, Rao V, Yule AM. Patient Experiences Completing Patient Reported Outcome Measures in Behavioral Health Within a Health Safety-Net Setting. Community Ment Health J 2024:10.1007/s10597-024-01247-w. [PMID: 38430286 DOI: 10.1007/s10597-024-01247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/02/2024] [Indexed: 03/03/2024]
Abstract
Measurement based care (MBC), a practice that uses patient reported outcome measures (PROMs), is not widely used in behavioral health settings and little is known about the patient experience with MBC in safety-net settings. This study aimed to understand patient experiences completing PROMs on paper when presenting to an outpatient, behavioral health setting within a public safety-net hospital. Semi-structured interviews were conducted with 22 participants in English and Spanish. Participants were 42 years old (SD = 12.7), mostly white (36.4%) and Black (31.8%). Thematic analysis was used to analyze findings. Overall, participants were engaged with PROMs and described them as helpful for themselves and their clinicians. Participants also expressed themes focused on PROMs user-friendliness, including formatting, time to complete measures, and participant characteristics such as attention and literacy. These findings are important to consider to ensure equitable access to MBC when implemented in behavioral health in the health safety-net setting.
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Affiliation(s)
- Joanna Kramer
- Department of Psychiatry, Boston Medical Center, 801 Massachusetts Avenue, Boston, Massachusetts, 02118, USA
| | - Daisy Perez
- Department of Psychiatry, Boston Medical Center, 801 Massachusetts Avenue, Boston, Massachusetts, 02118, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Avenue, Boston, Massachusetts, 02118, USA
| | - Denisa Ramseier
- Department of Psychiatry, Boston Medical Center, 801 Massachusetts Avenue, Boston, Massachusetts, 02118, USA
| | - Lily Morgan
- Department of Psychiatry, Boston Medical Center, 801 Massachusetts Avenue, Boston, Massachusetts, 02118, USA
| | - Timothy E Wilens
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Vinod Rao
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center, 801 Massachusetts Avenue, Boston, Massachusetts, 02118, USA.
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Avenue, Boston, Massachusetts, 02118, USA.
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Warren Building 705, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA.
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Hoeppner BB, Simpson HV, Weerts C, Riggs MJ, Williamson AC, Finley-Abboud D, Hoffman LA, Rutherford PX, McCarthy P, Ojeda J, Mericle AA, Rao V, Bergman BG, Dankwah AB, Kelly JF. A Nationwide Survey Study of Recovery Community Centers Supporting People in Recovery From Substance Use Disorder. J Addict Med 2024:01271255-990000000-00290. [PMID: 38426533 DOI: 10.1097/adm.0000000000001285] [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] [Indexed: 03/02/2024]
Abstract
OBJECTIVE The medical community has become aware of its role in contributing to the opioid epidemic and must be part of its resolution. Recovery community centers (RCCs) represent a new underused component of recovery support. METHODS This study performed an online national survey of all RCCs identified in the United States, and used US Census ZIP code tabulation area data to describe the communities they serve. RESULTS Residents of areas with RCCs were more likely to be Black (16.5% vs 12.6% nationally, P = 0.005) and less likely to be Asian (4.7% vs 5.7%, P = 0.005), American Indian, or Alaskan Native (0.6% vs 0.8%, P = 0.03), or live rurally (8.5% vs 14.0%, P < 0.0001). More than half of RCCs began operations within the past 5 years. Recovery community centers were operated, on average, by 8.8 paid and 10.2 volunteer staff; each RCC served a median of 125 individuals per month (4-1,500). Recovery community centers successfully engaged racial/ethnic minority groups (20.8% Hispanic, 22.5% Black) and young adults (23.5% younger than 25 years). Recovery community centers provide addiction-specific support (eg, mutual help, recovery coaching) and assistance with basic needs, social services, technology access, and health behaviors. Regarding medications for opioid use disorder (MOUDs), RCC staff engaged members in conversations about MOUDs (85.2%) and provided direct support for taking MOUD (77.0%). One third (36.1%) of RCCs reported seeking closer collaboration with prescribers. CONCLUSIONS Recovery community centers are welcoming environments for people who take MOUDs. Closer collaboration between the medical community and community-based peer-led RCCs may lead to significantly improved reach of efforts to end the opioid epidemic.
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Affiliation(s)
- Bettina B Hoeppner
- From the Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA (BBH, CW, ACW, DF-A, LAH, BGB, ABD, JFK); Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom (HVS); Department of Neurology, Harvard Medical School, Boston, MA (MJR); Faces & Voices of Recovery, Washington, DC (PXR, PM); Massachusetts Bureau of Substance Addiction Services, Executive Office of Health and Human Services, Department of Public Health, Boston, MA (JO); Alcohol Research Group/Public Health Institute, Emeryville, CA (AAM); and West End Clinic, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA (VR)
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Kontos N, Rao V. Clinical harm reduction in substance use: An ethics-oriented primer and critique for hospital-based providers. J Eval Clin Pract 2024; 30:260-267. [PMID: 38018023 DOI: 10.1111/jep.13941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/09/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
AIMS AND OBJECTIVES Substance use-targeted harm reduction (HR) has successfully expanded from public health into clinical settings. Hospital-based providers are in positions to encounter, precipitate and/or mediate ethically fraught situations that can arise around clinical HR-informed interventions. We examine why these situations occur and how they might be better addressed. METHOD Literature focused on principles, ethics, and clinical implementation of HR are reviewed to identify core elements of this approach. Next, ethical vulnerabilities within those elements are identified and critiqued. A more productive discourse for acknowledging, voicing and addressing ethical dilemmas in HR is sought. RESULTS Public health orientation and humane concern for substance users, along with a strong anti-stigmatization mission and occasional aversion to a rigid medical model and 'establishment' contributed to HR's successes but can also frame any dissent over its methods as being stigma-fuelled. Practically distilled concepts from moral philosophy and the medical humanities can inform good faith discussions based on common-ground concern for patients. CONCLUSION HR's use in the general hospital and other clinical settings is a positive development, but one that brings with it new ethical demands. Broader knowledge of the principles of HR, of the application of those principles to the hospital setting, and of common-ground concepts from outside of HR could help facilitate productive ethical engagement around substance-using patients.
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Affiliation(s)
- Nicholas Kontos
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Vinod Rao
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Cance JD, Adams ET, D'Amico EJ, Palimaru A, Fernandes CSF, Fiellin LE, Bonar EE, Walton MA, Komro KA, Knight D, Knight K, Rao V, Youn S, Saavedra L, Ridenour TA, Deeds B. Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder. Prev Sci 2023; 24:30-39. [PMID: 37261635 PMCID: PMC10689575 DOI: 10.1007/s11121-023-01545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.
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Affiliation(s)
- J D Cance
- RTI International, Research Triangle Park, Durham, NC, USA.
| | - E T Adams
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | | | | | - L E Fiellin
- Yale University School of Medicine, New Haven, CT, USA
| | - E E Bonar
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - M A Walton
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - K A Komro
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - D Knight
- Texas Christian University, Fort Worth, TX, USA
| | - K Knight
- Texas Christian University, Fort Worth, TX, USA
| | - V Rao
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S Youn
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L Saavedra
- RTI International, Research Triangle Park, Durham, NC, USA
| | - T A Ridenour
- RTI International, Research Triangle Park, Durham, NC, USA
| | - B Deeds
- National Institute on Drug Abuse, MD, Bethesda, USA
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Dunlap LJ, Kuklinski MR, Cowell A, McCollister KE, Bowser DM, Campbell M, Fernandes CSF, Kemburu P, Livingston BJ, Prosser LA, Rao V, Smart R, Yilmazer T. Economic Evaluation Design within the HEAL Prevention Cooperative. Prev Sci 2023; 24:50-60. [PMID: 35947282 PMCID: PMC9364296 DOI: 10.1007/s11121-022-01400-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/01/2022]
Abstract
The rapid rise in opioid misuse, disorder, and opioid-involved deaths among older adolescents and young adults is an urgent public health problem. Prevention is a vital part of the nation's response to the opioid crisis, yet preventive interventions for those at risk for opioid misuse and opioid use disorder are scarce. In 2019, the National Institutes of Health (NIH) launched the Preventing Opioid Use Disorder in Older Adolescents and Young Adults cooperative as part of its broader Helping to End Addiction Long-term (HEAL) Initiative ( https://heal.nih.gov/ ). The HEAL Prevention Cooperative (HPC) includes ten research projects funded with the goal of developing effective prevention interventions across various settings (e.g., community, health care, juvenile justice, school) for older adolescent and young adults at risk for opioid misuse and opioid use disorder (OUD). An important component of the HPC is the inclusion of an economic evaluation by nine of these research projects that will provide information on the costs, cost-effectiveness, and sustainability of these interventions. The HPC economic evaluation is integrated into each research project's overall design with start-up costs and ongoing delivery costs collected prospectively using an activity-based costing approach. The primary objectives of the economic evaluation are to estimate the intervention implementation costs to providers, estimate the cost-effectiveness of each intervention for reducing opioid misuse initiation and escalation among youth, and use simulation modeling to estimate the budget impact of broader implementation of the interventions within the various settings over multiple years. The HPC offers an extraordinary opportunity to generate economic evidence for substance use prevention programming, providing policy makers and providers with critical information on the investments needed to start-up prevention interventions, as well as the cost-effectiveness of these interventions relative to alternatives. These data will help demonstrate the valuable role that prevention can play in combating the opioid crisis.
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Affiliation(s)
- Laura J Dunlap
- RTI International, E. Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | | | - Alexander Cowell
- The University of North Carolina at Chapel Hill, School of Government of Chapel Hill, NC, USA
| | - Kathryn E McCollister
- Soffer Clinical Research Center, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diana M Bowser
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | | | - Pranav Kemburu
- RTI International, E. Cornwallis Rd, PO Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | | | - Lisa A Prosser
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | | | - Tansel Yilmazer
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, USA
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Rao V, Lanni S, Yule AM, DiSalvo M, Stone M, Berger AF, Wilens TE. Diagnosing major depressive disorder and substance use disorder using the electronic health record: A preliminary validation study. J Mood Anxiety Disord 2023; 2:100007. [PMID: 37693103 PMCID: PMC10486184 DOI: 10.1016/j.xjmad.2023.100007] [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: 09/12/2023]
Abstract
Background One mechanism to examine if major depressive disorder (MDD) is related to the development of substance use disorder (SUD) is by leveraging naturalistic data available in the electronic health record (EHR). Rules for data extraction and variable construction linked to psychometrics validating their use are needed to extract data accurately. Objective We propose and validate a methodologic framework for using EHR variables to identify patients with MDD and non-nicotine SUD. Methods Proxy diagnoses and index dates of MDD and/or SUD were established using billing codes, problem lists, patient-reported outcome measures, and prescriptions. Manual chart reviews were conducted for the 1-year period surrounding each index date to determine (1) if proxy diagnoses were supported by chart notes and (2) if the index dates accurately captured disorder onset. Results The results demonstrated 100% positive predictive value for proxy diagnoses of MDD. The proxy diagnoses for SUD exhibited strong agreement (Cohen's kappa of 0.84) compared to manual chart review and 92% sensitivity, specificity, positive predictive value, and negative predictive value. Sixteen percent of patients showed inaccurate SUD index dates generated by EHR extraction with discrepancies of over 6 months compared to SUD onset identified through chart review. Conclusions Our methodology was very effective in identifying patients with MDD with or without SUD and moderately effective in identifying SUD onset date. These findings support the use of EHR data to make proxy diagnoses of MDD with or without SUD.
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Affiliation(s)
- Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sylvia Lanni
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy M. Yule
- Department of Psychiatry, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA 02118, USA
| | - Maura DiSalvo
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Mira Stone
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Amy F. Berger
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Timothy E. Wilens
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
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Woodward D, Wilens TE, Glantz M, Rao V, Burke C, Yule AM. A systematic review of substance use screening in outpatient behavioral health settings. Addict Sci Clin Pract 2023; 18:18. [PMID: 36967381 PMCID: PMC10041696 DOI: 10.1186/s13722-023-00376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Despite the frequent comorbidity of substance use disorders (SUDs) and psychiatric disorders, it remains unclear if screening for substance use in behavioral health clinics is a common practice. The aim of this review is to examine what is known about systematic screening for substance use in outpatient behavioral health clinics. METHODS We conducted a PRISMA-based systematic literature search assessing substance use screening in outpatient adult and pediatric behavioral health settings in PubMed, Embase, and PsycINFO. Quantitative studies published in English before May 22, 2020 that reported the percentage of patients who completed screening were included. RESULTS Only eight articles met our inclusion and exclusion criteria. Reported prevalence of screening ranged from 48 to 100%, with half of the studies successfully screening more than 75% of their patient population. There were limited data on patient demographics for individuals who were and were not screened (e.g., gender, race) and screening practices (e.g., electronic versus paper/pencil administration). CONCLUSIONS The results of this systematic review suggest that successful screening for substance use in behavioral health settings is possible, yet it remains unclear how frequently screening occurs. Given the high rates of comorbid SUD and psychopathology, future research is necessary regarding patient and clinic-level variables that may impact the successful implementation of substance use screening. Trial registry A methodological protocol was registered with the PROSPERO systematic review protocol registry (ID: CRD42020188645).
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Affiliation(s)
- Diana Woodward
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | | | - Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Colin Burke
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center, 850 Harrison Avenue, Boston, MA, 02118, USA.
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Sastry RA, Poggi J, King VA, Rao V, Spake CSL, Abdulrazeq H, Shao B, Kwan D, Woo AS, Klinge PM, Svokos KA. Superficial temporal artery injury and delayed post-cranioplasty infection. Neurochirurgie 2023; 69:101422. [PMID: 36868135 DOI: 10.1016/j.neuchi.2023.101422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE Complications after cranioplasty after decompressive craniectomy (DC) have been reported to be as high as 40%. The superficial temporal artery (STA) is at substantial risk for injury in standard reverse question-mark incisions that are typically used for unilateral DC. The authors hypothesize that STA injury during craniectomy predisposes patients to post-cranioplasty surgical site infection (SSI) and/or wound complication. METHODS A retrospective study of all patients at a single institution who underwent cranioplasty after decompressive craniectomy and who underwent imaging of the head (computed tomography angiogram, magnetic resonance imaging with intravenous contrast, or diagnostic cerebral angiography) for any indication between the two procedures was undertaken. The degree of STA injury was classified and univariate statistics were used to compare groups. RESULTS Fifty-four patients met inclusion criteria. Thirty-three patients (61%) had evidence of complete or partial STA injury on pre-cranioplasty imaging. Nine patients (16.7%) developed either an SSI or wound complication after cranioplasty and, among these, four (7.4%) experienced delayed (>2 weeks from cranioplasty) complications. Seven of 9 patients required surgical debridement and cranioplasty explant. There was a stepwise but non-significant increase in post-cranioplasty SSI (STA present: 10%, STA partial injury: 17%, STA complete injury: 24%, P=0.53) and delayed post-cranioplasty SSI (STA present: 0%, STA partial injury: 8%, STA complete injury: 14%, P=0.26). CONCLUSIONS There is a notable but statistically non-significant trend toward increased rates of SSI in patients with complete or partial STA injury during craniectomy.
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Affiliation(s)
- R A Sastry
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States.
| | - J Poggi
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - V A King
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - V Rao
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - C S L Spake
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - H Abdulrazeq
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - B Shao
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - D Kwan
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - A S Woo
- Department of Plastic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - P M Klinge
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
| | - K A Svokos
- Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, United States
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Zack Ishikawa R, Steere R, Conteh N, Cramer MA, Rao V, Sprich S, Cohen JN. Treating PTSD and Alcohol Use Disorder: Concurrent Cognitive Processing Therapy and Psychopharmacology. J Clin Psychiatry 2022; 84. [PMID: 36350590 DOI: 10.4088/jcp.22ct14636] [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: 02/28/2023]
Abstract
Comorbidity is common with posttraumatic stress disorder, and alcohol use disorder (AUD) is among the most common co-occurring disorders. When viewed through the lens of avoidance behaviors, AUD can shape an individual's response to distressing trauma reminders by dulling the emotional response and promoting disengagement from the traumatic memory. Over time, this response strengthens posttraumatic distress by reinforcing the belief that traumatic memories and their emotional responses are themselves dangerous and intolerable. In turn, this belief may impede treatment progress. Concurrent trauma-focused therapy and AUD treatment can serve to establish more adaptive coping strategies. Reducing reliance on alcohol for coping while engaging safely and effectively with trauma memories allows the individual to process the memories, build tolerance to emotional distress, and ultimately reframe maladaptive trauma-related beliefs and decrease the intensity of reactions. This case presents concurrent psychopharmacology and cognitive processing therapy for co-occurring posttraumatic stress disorder and AUD. We explore how alcohol use, and emotional avoidance more broadly, become targets for change.
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Affiliation(s)
- Rachel Zack Ishikawa
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Corresponding author: Rachel Zack Ishikawa, PhD, MPH, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02131
| | - Rachel Steere
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Nkechi Conteh
- Center for Women's Mental Health, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Margaret A Cramer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Vinod Rao
- West End Clinic, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Susan Sprich
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonah N Cohen
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, Massachusetts
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Rao V, Giczewska A, Chiswell K, Felker GM, Wang A, Parikh K, Vemulapalli S. Clinical outcomes among distinct groups of patients with severe tricuspid valve regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1656] [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
Introduction
Severe tricuspid valve regurgitation (TR) is associated with increased 1-year morbidity and mortality. Characterization by valve etiology (primary, secondary, and lead-associated), a classification borrowed from mitral valve disease, has not been universally shown to correlate with outcomes.
Purpose
Among a large, racially diverse cohort with newly identified severe TR, we aimed to 1) characterize outcomes of severe TR by etiology, and 2) assess whether unsupervised phenoclustering or supervised outcome-driven prediction trees were more effective in establishing subgroups of TR with differential clinical risk profiles.
Methods
We retrospectively analyzed outcomes of 5-year all-cause death and a composite of death or heart failure hospitalization (HFH) among adult patients with new severe TR identified by echocardiography between 2007 to 2018 at a large academic tertiary referral center in the United States. Patients were initially categorized by etiology of TR, including primary, secondary, and lead-associated. Second, we separately applied unsupervised hierarchical clustering to identify distinct clusters using demographics, clinical, and echo data at the time of diagnosis. Third, we applied a supervised recursive partitioning algorithm (survival trees) by each outcome to identify distinct TR subgroups. We estimated the cumulative incidence of death and composite death or HFH over 5 years by 1) etiology of TR, 2) distinct clusters, and 3) groups identified by supervised learning (prediction trees).
Results
Among 2,379 consecutive patients with newly identified severe TR, the median age was 70 years, 61% were female, and 40% were Black. Event rates (95% CI) were 30.9 (29.0 to 32.8) events/100 PY for death and 49.0 (45.9 to 52.2) events/100 PY for composite death or HFH over median follow-up of 1.6 years. Event rates were similarly high across TR etiology groups for both death and composite death or HFH (Figure 1). Multiple methods of unsupervised clustering did not yield distinct clusters by patient demographic and imaging characteristics. After applying supervised survival tree modeling, four phenoclusters with distinct clinical prognoses were separately identified for death and composite death or HFH (Figure 2). Variables identified to partition the cohort to discriminate both death and composite death or HFH were age, albumin, blood urea nitrogen, right ventricular contractility, and right ventricular systolic pressure (all p<0.05).
Conclusions
Five-year cumulative incidence of adverse events among patients with newly diagnosed severe TR was 69% for death and 80% for composite death or HFH. TR etiology did not stratify prognosis, while supervised survival tree models identified phenoclusters with distinct clinical risk. The identified subgroups of severe TR with differential outcomes offer insights towards enrichment in clinical trials of TR and risk/benefit analysis in patients undergoing TR therapies.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
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Affiliation(s)
- V Rao
- Duke Clinical Research Institute , Durham , United States of America
| | - A Giczewska
- Duke Clinical Research Institute , Durham , United States of America
| | - K Chiswell
- Duke Clinical Research Institute , Durham , United States of America
| | - G M Felker
- Duke Clinical Research Institute , Durham , United States of America
| | - A Wang
- Duke University Medical Center , Durham , United States of America
| | - K Parikh
- Duke Clinical Research Institute , Durham , United States of America
| | - S Vemulapalli
- Duke University Medical Center , Durham , United States of America
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Bray M, Krieg A, Esagoff A, Bryant B, Salas R, Rao V, Peters M. Polysomnography Following Traumatic Brain Injury: A Systematic Review and Meta-Analysis. Eur Psychiatry 2022. [PMCID: PMC9567999 DOI: 10.1192/j.eurpsy.2022.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Sleep disturbances are common following traumatic brain injury (TBI) worsening morbidity and other neuropsychiatric symptoms. Post-TBI alterations in sleep architecture require further study.
Objectives
(1) To evaluate polysomnographic measures of sleep architecture in participants with history of TBI compared to controls and as meta-analyses of pooled means. (2) To evaluate effects of timing and severity of TBI on polysomnographic outcomes.
Methods
PRISMA compliant systematic review was conducted of MEDLINE, PsycINFO, EMBASE and Scopus. Inclusion criteria: 1) reporting polysomnography in the context of TBI and 2) operationalizing TBI using clear/formalized criteria. Data were pooled in random-effects meta-analyses with outcomes expressed as mean differences (MD).
Results
In participants with TBI, sleep was comprised of 19.39% REM sleep, 8.13% N1, 51.18% N2, and 17.53% N3, as determined by meta-analyses of single means. Total sleep time was reduced in chronic (>6 months) TBI compared to acute-intermediate TBI (<6 months) (p=0.01). Compared to controls, participants with TBI differed with increased N1 sleep (MD=0.64%; 95%CI=0.02,1.25; p=0.04), reduced sleep efficiency (MD=-1.65%; 95%CI=-3.18,-0.12; p=0.03), and reduced sleep latency on the multiple sleep latency test (MD=-5.90mins; 95%CI=-10.09,-1.72; p<0.01). On sub-group analyses, participants with mild TBI differed from controls with reduced total sleep time (MD=-29.22mins, 95%CI=-54.16,-4.27; p=0.02). Similarly, participants with acute-intermediate TBI exhibited increased sleep latency compared to controls (MD=8.96mins; 95%CI=4.07,13.85; p<0.01) and differed significantly from participants with chronic TBI (X2(1,N=608)=6.54; p=0.01).
Conclusions
Sleep architecture is altered following TBI with potential implications regarding functional outcomes and recovery. These alterations appear to differ based on severity of injury and time since injury.
Disclosure
No significant relationships.
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Pasupneti S, Tulu Z, Rao V, MacArthur J, Mooney J, Dhillon G. Comparing Outcomes of COVID-19 vs NonCOVID-19 Lung Transplant Recipients on ECMO as a Bridge to Transplant. J Heart Lung Transplant 2022. [PMCID: PMC8988582 DOI: 10.1016/j.healun.2022.01.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Purpose Methods Results Conclusion
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Armstrong SM, Basso C, Bendeck M, Berthiaume J, Bonafiglia QA, Buja LM, Butany J, d’Amati G, Fishbein GA, Fishbein MC, Giordano C, Gotlieb AI, Hammers J, Hoit B, Jensen B, Kirk J, Lai CK, Lau RP, Lelenwa L, Lyon R, Maleszewski JJ, McDonald M, McManus B, Michaud K, Mitchell RN, Mori M, Nair V, Ottaviani G, Ranek M, Rao V, Rizzo S, Rodriguez ER, Romero ME, Sakamoto A, Sampson B, Santos-Martins C, Sato Y, Schoen FJ, Segura A, Seidman MA, Seki A, Sheikh F, Singaravel S, Stone JR, Stram M, Tan CD, Thavendiranathan P, Thiene G, Tolend M, Vaideeswar P, Veinot JP, Virmani R, Wang J, Willis M, Zhao B. List of contributors. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00029-3] [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: 11/30/2022] Open
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McKowen J, Woodward D, Yule AM, DiSalvo M, Rao V, Greenbaum J, Joshi G, Wilens TE. Characterizing autistic traits in treatment-seeking young adults with substance use disorders. Am J Addict 2021; 31:108-114. [PMID: 34957636 DOI: 10.1111/ajad.13247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/04/2021] [Accepted: 12/11/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recent work highlights an increase in the overlap of autism spectrum disorder (ASD) and substance use disorder (SUD). Little is known about the presence of ASD symptoms in SUD-treatment-seeking populations. METHODS The informant-rated Social Responsiveness Scale-2 (SRS-2) was completed at intake to an outpatient SUD clinic for youth aged 16-26 (N = 69). Comparisons were made between those with elevated SRS-2 scores on demographic, psychiatric, and substance use variables. RESULTS Parents of sixty-nine patients with SUD completed the SRS-2. Fourteen (20%) (average age 18.7 ± 2.5) had elevated SRS-2 Total T-scores (≥66) and 55 (average age 18.1 ± 2.8) had non-clinical SRS-2 Total T-scores. There were few differences between groups; however, those with elevated SRS-2 Total T-scores were more likely to have a stimulant use disorder (odds ratio [OR] = 7.59, 95% confidence interval [CI] = 0.77, 101.88; p = 0.05) or an opioid use disorder (OR = 5.02, 95% CI = 0.59, 43.27; p = 0.08) than patients with normal SRS-2 Total T-scores as well as alcohol use in the week prior to intake. DISCUSSION AND CONCLUSIONS A significant proportion of treatment-seeking SUD outpatients suffer from clinically elevated autistic traits. These findings highlight the importance of assessing for autistic traits in SUD treatment settings yet additional research is needed to determine if these findings are specific to the presence of ASD or secondary to sequelae of specific SUD presentations. SCIENTIFIC SIGNIFICANCE This study is, to our knowledge, the first to have examined the prevalence, morbidity, or clinical characteristics, associated with ASD symptoms in a SUD-specific population.
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Affiliation(s)
- James McKowen
- Addiction Recovery Management Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Woodward
- Addiction Recovery Management Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy M Yule
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Pharmacology and Adult ADHD, Boston, Massachusetts, USA
| | - Vinod Rao
- Addiction Recovery Management Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Greenbaum
- Clinical and Research Programs in Pediatric Pharmacology and Adult ADHD, Boston, Massachusetts, USA
| | - Gagan Joshi
- Clinical and Research Programs in Pediatric Pharmacology and Adult ADHD, Boston, Massachusetts, USA
| | - Timothy E Wilens
- Addiction Recovery Management Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Clinical and Research Programs in Pediatric Pharmacology and Adult ADHD, Boston, Massachusetts, USA
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Lohith G, Sekar K, Patil S, Bandemagal M, Murugan K, M V, Thungappa S, Rao V, Kudpaje A, Ramasamy M, Ramachandrappa S, Bharathan A, Rao G, Rao D, kumar B. A Randomized Control Trial Comparing Time to Healing of Radiation Induced Acute Skin Reactions Using Biological Membrane Dressing or Topical Methyl Pararosaniline Dye. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.626] [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: 10/20/2022]
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Clemens P, Connolly A, Harper A, Mah J, McDonald C, Rao V, Smith E, Zaidman C, Nakagawa T, Hoffman E. DMD - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.165] [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: 11/15/2022]
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Rao V, Byrne B, Shieh P, Salabarria S, Berthy J, Corti M, Redican S, Lawrence J, Brown K, Shanks C, Spector S, Gonzalez P, Schneider J, Morris C, Clary C. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Green J, Rao V, Currie M. D2-Hydroxyglutaric Aciduria Type II with Subdural Hemorrhage Identified in a 3-Month-Old Infant: A Case Report. Journal of Pediatric Neurology 2021. [DOI: 10.1055/s-0040-1716566] [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: 10/23/2022]
Abstract
AbstractSubdural hemorrhage in association with D2-hydroxyglutaric aciduria (D2-HGA) Type II has only been described once in the medical literature in a 15-month-old child (1). Our case report describes a much younger 3-month-old infant previously diagnosed with D2-HGA Type II, who presented clinically with seizures and identified to have bilateral subdural hematomas concerning for possible physical abuse. This case report discusses the genetic diagnosis of D2-HGA and interpretation of subdural hemorrhage in context of evaluating possible physical abuse concerns. When an underlying medical condition is known to be present and a child presents with findings that may be concerning for physical abuse, it is critical to consider the possibility that the underlying medical condition may contribute to or may be the cause of the findings.
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Affiliation(s)
- Jennie Green
- Department of Norton Children's Pediatric Protection Specialists, Norton Children's Medical Group, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Vinod Rao
- Department of Norton Children's Pediatric Protection Specialists, Norton Children's Medical Group, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Melissa Currie
- Department of Norton Children's Pediatric Protection Specialists, Norton Children's Medical Group, School of Medicine, University of Louisville, Louisville, Kentucky, United States
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Brahmbhatt D, Vishram-Nielsen J, Lee D, Alhussein M, Moayedi Y, Posada JD, Ross H, Rakowski H, Rao V, Billia F. Continuous-Flow Left Ventricular Assist Device Support for Patients with Hypertrophic Cardiomyopathy: A Single Centre Experience. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.542] [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: 10/21/2022] Open
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Vishram-Nielsen J, Lambadaris M, Amadio J, Husain S, Rao V, Billia F, Alba A. Association between Continuous Flow Left Ventricular Assist Device Infections Requiring Long-Term Antibiotic Use and Post Heart Transplant Morbidity and Mortality. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1155] [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: 10/21/2022] Open
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Bertic M, Worme M, Foroutan F, Ross H, Rao V, Alba A, Billia F. Predictors of Mortality in Patients with Cardiac Arrest Treated with ECPR. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.610] [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: 11/29/2022] Open
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Kast KA, Rao V, Wilens TE. Pharmacotherapy for Attention-Deficit/Hyperactivity Disorder and Retention in Outpatient Substance Use Disorder Treatment: A Retrospective Cohort Study. J Clin Psychiatry 2021; 82. [PMID: 33988929 PMCID: PMC8351325 DOI: 10.4088/jcp.20m13598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To assess the relationship between short- and longer-term retention in outpatient substance use disorder (SUD) treatment and pharmacotherapy for comorbid attention-deficit/hyperactivity disorder (ADHD). METHODS In this retrospective cohort study conducted in a single addiction psychiatry clinic, electronic health record data from July 14, 2014, through January 15, 2020, were queried for clinical ADHD diagnosis (DSM-5 criteria), ADHD pharmacotherapy, treatment duration, demographic variables, comorbid psychiatric and SUD diagnoses, and buprenorphine therapy. Individuals with ADHD (n = 203) were grouped by ADHD pharmacotherapy status (171 receiving medication compared to 32 receiving none). Kaplan-Meier and Cox proportional hazards regression analyses were performed and assessed for significance. RESULTS ADHD was clinically diagnosed in 9.4% of outpatients and was associated with younger age, comorbid cocaine use, and private insurance (P < .001). Individuals receiving no ADHD pharmacotherapy were younger than those receiving medication (P = .003). Compared to no ADHD medication, ADHD pharmacotherapy was associated with greater long-term retention, with apparent group half-lives of 9 months and 36 months, respectively (P < .001). Individuals receiving no ADHD medication had a 4.9-fold increased likelihood of attrition within 90 days (P = .041). Regression analysis showed only ADHD pharmacotherapy to be significantly associated with treatment retention (hazard ratio = 0.59; 95% CI, 0.40-0.86; P = .008). CONCLUSIONS ADHD pharmacotherapy is robustly associated with improved short- and longer-term retention in outpatient SUD treatment. The retrospective, nonrandomized naturalistic study design limits causal inference. Further studies addressing unmeasured covariates and associated risks of treatment in adults with ADHD and SUD are necessary.
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Affiliation(s)
- Kristopher A Kast
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.,Corresponding author: Kristopher A. Kast, MD, 1601 23rd Ave South, Nashville TN, 37212
| | - Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
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Yu F, Alvarez J, Ribeiro R, Rosales R, Adamson M, Xin L, Gellner B, Meenakshi S, Chopra C, Wu J, Zhang Y, Rahmani A, Alie E, Rao V, Badiwala M. DIALYSIS IMPROVES MYOCARDIAL PRESERVATION DURING EX SITU HEART PERFUSION. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.224] [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: 10/23/2022] Open
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Krosschell K, Brown L, Hoffman K, Weigel C, Munson H, Bidwell J, DiDonato C, Kuntz N, Rao V. SMA: REGISTRIES, BIOMARKERS & OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.178] [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: 10/23/2022]
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Gomes B, Ribeiro R, Alvarez J, Ribeiro R, Honjeu A, Gazzalle A, Bissoondath V, Yu F, Adamson M, Meineri M, Rao V, Badiwala M, Keshavjee S, Cypel M. Normothermic Regional Perfusion (NRP) during Heart DCD Recovery: Is Lung Quality Impacted? A Pre-Clinical Study. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Netuka I, Pya Y, Zimpfer D, Potapov E, Garbade J, Rao V, Morshuis M, Marasco S, Beyersdorf F, Gazzola C, Sood P, Schmitto J. First Long-Term 5-years Experience with the HeartMate 3 LVAS in Multicentric Clinical Trial. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Alba A, Foroutan F, Buchan T, Alvarez J, Kinsella A, Clark K, Lau K, Zhu A, McGuinty C, Aleksova N, Vishram-Nielsen J, Malik A, Francis T, Stanimirovic A, Bielecki J, Fan E, Rao V, Ross H, Rac V, Billia F. Mortality in Patients with Cardiogenic Shock Supported with Veno-Arterial Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis Evaluating the Impact of Etiology. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.773] [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: 10/24/2022] Open
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Ribeiro R, Alvarez J, Gomes B, Hondjeu A, Yu F, Adamson M, Ribeiro R, Bissoondath V, Meineri M, Rao V, Cypel M, Badiwala M. Assessment of Cerebral Perfusion and Activity during Normothermic Regional Perfusion in a Porcine Model of Donation after Circulatory Death. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Chang J, Guo X, Rao V, Gromisch E, Chung S, Kluger H, Cha C, Gorelick F, Testani J, Safirstein R, Crowley S, Peixoto A, Desir G. Identification of Two Forms of Human Plasma Renalase, and Their Association With All-Cause Mortality. Kidney Int Rep 2020; 5:362-368. [PMID: 32154458 PMCID: PMC7056858 DOI: 10.1016/j.ekir.2019.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/15/2019] [Accepted: 12/06/2019] [Indexed: 01/13/2023] Open
Affiliation(s)
- J. Chang
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - X. Guo
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - V. Rao
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - E.S. Gromisch
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Mandell Center for Multiple Sclerosis, Mount Sinai Rehabilitation Hospital, Trinity Health of New England, Hartford, Connecticut, USA
- Department of Rehabilitative Medicine, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
- Department of Medical Sciences, Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, Connecticut, USA
| | - S. Chung
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - H.M. Kluger
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut, USA
| | - C. Cha
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - F. Gorelick
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
- Department of Cell Biology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - J. Testani
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - R. Safirstein
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - S. Crowley
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - A.J. Peixoto
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - G.V. Desir
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affairs Connecticut Health System, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Fukunaga N, Ribeiro R, Bissoondath V, Billia F, Badiwala M, Rao V. GHRELIN INHIBITS INFLAMMATORY RESPONSE AND APOPTOSIS DURING ISCHEMIA-REPERFUSION INJURY FOLLOWING A MURINE HEART TRANSPLANTATION MODEL. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.605] [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: 11/30/2022] Open
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Ribeiro R, Yu F, J Alvarez, Adamson M, Paradiso E, Xin L, Gellner B, Bissoondath V, Meineri M, Rao V, Badiwala M. EX SITU HEART PERFUSION IMPROVES PRESERVATION OF ENDOTHELIAL FUNCTION IN BOTH DBD AND DCD HEARTS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.063] [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: 11/30/2022] Open
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Clemens P, Rao V, Connolly A, Zaidman C, Harper A, Mah J, Morgenroth L, Yamashita T, Hoffman E. P.337Dystrophin restoration by exon 53 skipping in patients with Duchenne muscular dystrophy after viltolarsen treatment: phase 2 study update. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.451] [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: 11/25/2022]
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Ribeiro R, Alvarez J, Paradiso E, Yu F, Adamson M, Foroutan F, Bissoondath V, Meineri M, Rao V, Badiwala M. FUNCTIONAL ASSESSMENT OF DCD HEARTS FOLLOWING NORMOTHERMIC REGIONAL PERFUSION CAN PREDICT POST-TRANSPLANTATION CONTRACTILITY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.595] [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: 11/17/2022] Open
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Ribeiro R, Gomes B, Hondjeu A, Yu F, Adamson M, R Ribeiro, J Alvarez, Bissoondath V, Meineri M, Rao V, M Cypel, Badiwala M. ASSESSMENT OF CEREBRAL PERFUSION AND ACTIVITY DURING NORMOTHERMIC REGIONAL PERFUSION IN A PORCINE MODEL OF DONATION AFTER CIRCULATORY DEATH. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.064] [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: 11/29/2022] Open
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Ivey-Miranda J, Stewart B, Gomez N, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Barnett J, Raghavendra P, Mahoney D, Griffin M, Rao V, Testani J. Discordance between Estimate Glomerular Filtration Rate with Creatinine and Cystatin is Associated with Inflammation and Worsened Survival in Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.057] [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: 10/26/2022]
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Barnett J, Stewart B, Gomez N, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. Urine Growth Differentiation Factor-15 is Not an Independent Biomarker of Cardio-Renal Interactions in Patients with Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.063] [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: 11/26/2022]
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Griffin M, Flemming J, Pattoli M, Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Struyk G, Shamlian P, Mahoney D, Ivey-Miranda J, Ivey-Miranda J, Rao V, Testani J. Safety and Efficacy of an Auto-Titrating Diuretic Protocol: A Pilot. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.147] [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: 10/26/2022]
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Ivey-Miranda J, Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Griffin M, Rao V, Testani J. Sarcopenia Strongly Affects Serum Levels of Cystatin C in Patients with Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.059] [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: 10/26/2022]
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Rao V, Turner J, Mahoney D, Griffin M, Asher J, Ivey-Miranda J, Gomez N, Finkelstein F, Testani J. First in Human Experience with Direct Sodium Removal Using a Zero Sodium Peritoneal Solution. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.027] [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: 10/26/2022]
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Stewart B, Gomez N, Barnett J, Thomas A, Wycallis E, Pattoli M, Struyk G, Fleming J, Shamlian P, Raghavendra P, Mahoney D, Ivey-Miranda J, Griffin M, Rao V, Testani J. FGF-23 and Cardio-Renal Interactions in Heart Failure. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.545] [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: 11/28/2022]
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Rao V, Guo X, Chang J, Peixoto A, Testani J, Desir G. MON-334 TWO FORMS OF RENALASE (BOUND AND FREE) IDENTIFIED IN HUMAN PLASMA BY A NEW ELISA. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.180] [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: 10/26/2022] Open
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Strati P, Alcedo Andreade P, Sano D, Rao V, Singh P, Miranda R, Gunther J, Pinnix C, Dabaja B, Lee H, Steiner R. RELAPSED AND REFRACTORY NODULAR LYMPHOCYTE-PREDOMINANT HODGKIN LYMPHOMA (NLPHL): A US ANALYSIS FROM MD ANDERSON CANCER CENTER. Hematol Oncol 2019. [DOI: 10.1002/hon.182_2631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P. Strati
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | | | - D. Sano
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | - V. Rao
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | - P. Singh
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | - R. Miranda
- Hematopathology; MD Anderson Cancer Center; Houston United States
| | - J. Gunther
- Radiation Oncology; MD Anderson Cancer Center; Houston United States
| | - C. Pinnix
- Radiation Oncology; MD Anderson Cancer Center; Houston United States
| | - B. Dabaja
- Radiation Oncology; MD Anderson Cancer Center; Houston United States
| | - H.J. Lee
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
| | - R. Steiner
- Lymphoma and Myeloma; MD Anderson Cancer Center; Houston United States
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Birriel D, Ulahannan A, Ma J, Lazarte J, Martinu T, Singer L, Rao V, Keshavjee S, Delgado D, Tikkanen J, Juvet S. Recipient HLA-G Single Nucleotide Polymorphisms Predict Post-Lung Development of Donor Specific Antibodies. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.372] [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: 10/27/2022] Open
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Stein M, O'Brien K, Foroutan F, Rao V, Ross H, Alba A. The Impact of Frailty on Survival in Patients Undergoing Advanced Therapies for Heart Failure. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.189] [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: 10/27/2022] Open
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45
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Ho LTS, Lenihan M, McVey MJ, Karkouti K, Wijeysundera DN, Rao V, Crowther M, Grocott HP, Pinto R, Scales DC, Achen B, Brar S, Morrison D, Wong D, Bussières JS, Waal T, Harle C, Médicis É, McAdams C, Syed S, Tran D, Waters T. The association between platelet dysfunction and adverse outcomes in cardiac surgical patients. Anaesthesia 2019; 74:1130-1137. [PMID: 30932171 DOI: 10.1111/anae.14631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
Haemostatic activation during cardiopulmonary bypass is associated with prothrombotic complications. Although it is not possible to detect and quantify haemostatic activation directly, platelet dysfunction, as measured with point-of-care-assays, may be a useful surrogate. In this study, we assessed the association between cardiopulmonary bypass-associated platelet dysfunction and adverse outcomes in 3010 cardiac surgical patients. Platelet dysfunction, as measured near the end of the rewarming phase of cardiopulmonary bypass, was calculated as the proportion of non-functional platelets after activation with collagen. Logistic regression and multivariable analyses were applied to assess the relationship between platelet dysfunction and a composite of in-hospital death; myocardial infarction; stroke; deep vein thrombosis or pulmonary embolism; and acute kidney injury (greater than a two-fold increase in creatinine). The outcome occurred in 251 (8%) of 3010 patients. The median (IQR [range]) percentage platelet dysfunction was less for those without the outcome as compared with those with the outcome; 14% (8-28% [1-99%]) vs. 19% (11-45% [2-98%]), p < 0.001. After risk adjustment, platelet dysfunction was independently associated with the composite outcome (p < 0.001), such that for each 1% increase in platelet dysfunction there was an approximately 1% increase in the composite outcome (OR 1.012; 95%CI 1.006-1.018). This exploratory study suggests that cardiopulmonary bypass-associated platelet dysfunction has prognostic value and may be a useful clinical measure of haemostatic activation in cardiac surgery.
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Affiliation(s)
- L T S Ho
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada
| | - M Lenihan
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada
| | - M J McVey
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, ON, Canada
| | - K Karkouti
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, ON, Canada.,Toronto General Research Institute and the Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, ON, Canada
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Kinsella A, Rao V, Fan C, Manlhiot C, Stehlik J, Ross H, Alba A. Survival Outcomes in Heart Transplant Patients; Specific Focus on ACHD Patients and Their Outcomes as Compared to Dilated and Ischemic Cardiomyopathy Patients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.445] [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: 10/27/2022] Open
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47
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Ribeiro R, Alvarez J, Gellner B, Xin L, Paradiso E, Yu F, Adamson M, Foroutan F, Bissoondath V, Meineri M, Rao V, Badiwala M. Contractility versus Metabolic Cardiac Assessment during Ex Situ Heart Perfusion: A Pre-Clinical Transplant Study. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.592] [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: 11/27/2022] Open
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Yu F, Alvarez J, Ribeiro R, Adamson M, Amin F, Degen M, Foroutan F, Posada JD, Yau T, Cusimano R, Billia F, Alba C, Badiwala M, Rao V. Does Left Atrial Appendage Occlusion in LVAD Patients Impact Outcomes: A Single Centre Study. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.414] [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: 10/27/2022] Open
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49
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Ribeiro R, Yu F, Alvarez J, Adamson M, Paradiso E, Xin L, Gellner B, Bissoondath V, Meineri M, Rao V, Badiwala M. Ex Situ Heart Perfusion Improves Preservation of Endothelial Function in Both DBD and DCD Hearts. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.589] [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: 11/26/2022] Open
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Shokuhfar T, Nazari P, Ansari S, Hurley M, Azmi S, Kuntz N, Rao V, Shaibani A. 03:54 PM Abstract No. 205 Transforaminal intrathecal access for injection of nusinersen in patients with spinal muscular atrophy. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.261] [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: 10/27/2022] Open
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