1
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Velarde G, Bravo‐Jaimes K, Brandt EJ, Wang D, Douglass P, Castellanos LR, Rodriguez F, Palaniappan L, Ibebuogu U, Bond R, Ferdinand K, Lundberg G, Thamman R, Vijayaraghavan K, Watson K. Locking the Revolving Door: Racial Disparities in Cardiovascular Disease. J Am Heart Assoc 2023; 12:e025271. [PMID: 36942617 PMCID: PMC10227271 DOI: 10.1161/jaha.122.025271] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Racial disparities in cardiovascular disease are unjust, systematic, and preventable. Social determinants are a primary cause of health disparities, and these include factors such as structural and overt racism. Despite a number of efforts implemented over the past several decades, disparities in cardiovascular disease care and outcomes persist, pervading more the outpatient rather than the inpatient setting, thus putting racial and ethnic minority groups at risk for hospital readmissions. In this article, we discuss differences in care and outcomes of racial and ethnic minority groups in both of these settings through a review of registries. Furthermore, we explore potential factors that connote a revolving door phenomenon for those whose adverse outpatient environment puts them at risk for hospital readmissions. Additionally, we review promising strategies, as well as actionable items at the policy, clinical, and educational levels aimed at locking this revolving door.
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Affiliation(s)
- Gladys Velarde
- Department of CardiologyUniversity of FloridaJacksonvilleFL
| | | | | | - Daniel Wang
- Division of CardiologyUniversity of CaliforniaLos AngelesCA
| | - Paul Douglass
- Division of CardiologyWellstar Atlanta Medical CenterAtlantaGA
| | | | - Fatima Rodriguez
- Division of Cardiology and the Cardiovascular InstituteStanford University School of MedicinePalo AltoCA
| | | | - Uzoma Ibebuogu
- Division of CardiologyUniversity of Tennessee Health Science CenterMemphisTN
| | - Rachel Bond
- Division of CardiologyDignity HealthGilbertAZ
- Division Cardiology, Department of Internal MedicineCreighton University School of MedicineOmahaNE
| | - Keith Ferdinand
- Division of CardiologyTulane School of MedicineNew OrleansLA
| | | | - Ritu Thamman
- Division of CardiologyUniversity of PittsburghPittsburghPA
| | | | - Karol Watson
- Division of CardiologyUniversity of CaliforniaLos AngelesCA
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2
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Brandt EJ, Tobb K, Cambron JC, Ferdinand K, Douglass P, Nguyen PK, Vijayaraghavan K, Islam S, Thamman R, Rahman S, Pendyal A, Sareen N, Yong C, Palaniappan L, Ibebuogu U, Tran A, Bacong AM, Lundberg G, Watson K. Assessing and Addressing Social Determinants of Cardiovascular Health: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81:1368-1385. [PMID: 37019584 PMCID: PMC11103489 DOI: 10.1016/j.jacc.2023.01.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 04/07/2023]
Abstract
Social determinants of health (SDOH) are the social conditions in which people are born, live, and work. SDOH offers a more inclusive view of how environment, geographic location, neighborhoods, access to health care, nutrition, socioeconomics, and so on are critical in cardiovascular morbidity and mortality. SDOH will continue to increase in relevance and integration of patient management, thus, applying the information herein to clinical and health systems will become increasingly commonplace. This state-of-the-art review covers the 5 domains of SDOH, including economic stability, education, health care access and quality, social and community context, and neighborhood and built environment. Recognizing and addressing SDOH is an important step toward achieving equity in cardiovascular care. We discuss each SDOH within the context of cardiovascular disease, how they can be assessed by clinicians and within health care systems, and key strategies for clinicians and health care systems to address these SDOH. Summaries of these tools and key strategies are provided.
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Affiliation(s)
- Eric J Brandt
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
| | - Kardie Tobb
- Cone Health Medical Group, Greensboro, North Carolina, USA
| | | | - Keith Ferdinand
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Paul Douglass
- Wellstar Health System Center for Cardiovascular Care, Marietta, Georgia, USA
| | - Patricia K Nguyen
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA
| | | | - Sabrina Islam
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Ritu Thamman
- University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, USA
| | - Shahid Rahman
- Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA
| | - Akshay Pendyal
- University of North Carolina School of Medicine, Novant Health Charlotte Campus, Charlotte, North Carolina, USA
| | - Nishtha Sareen
- Ascension Medical Group, Ascension St Mary's Hospital, Saginaw, Michigan, USA
| | - Celina Yong
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Latha Palaniappan
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA
| | - Uzoma Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Andrew Tran
- The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Adrian M Bacong
- Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA
| | - Gina Lundberg
- Emory Women's Heart Center, Emory Heart and Vascular Center, Marietta, Georgia, USA
| | - Karol Watson
- Division of Cardiology, University of California, Los Angeles, California, USA
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3
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Stoneham MD, Barbosa A, Maher K, Douglass P, Desborough MJR, Von Kier S. Intraoperative cell salvage using swab wash and serial thromboelastography in elective abdominal aortic aneurysm surgery involving massive blood loss. Br J Haematol 2023; 200:652-659. [PMID: 36253085 DOI: 10.1111/bjh.18523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/29/2022]
Abstract
The loss of 50% blood volume is one accepted definition of massive haemorrhage, which ordinarily would trigger the massive transfusion protocol, involving the administration of high ratios of fresh frozen plasma and platelets to allogeneic red cells. We investigated 53 patients who experienced >50% blood loss during open elective abdominal aortic aneurysm surgery to assess allogeneic blood component usage and coagulopathy. Specialist patient blood management practitioners used a tailored cell salvage technique including swab wash to maximise blood return. We assessed the proportion of patients who did not require allogeneic blood components and develop evidence of coagulopathy by thromboelastography (TEG) parameters. Blood loss was 50%-174% (mean [SD] 68% [27%]) of blood volume. The mean (SD) intraoperative decrease in haemoglobin concentration, assessed by arterial blood gas analysis, was 5 (13) g/l. No patient received allogeneic red cells intraoperatively. Four of the 53 (8%) patients received blood components in the first 24 h postoperatively at the anaesthetists' discretion. No patient had intraoperative TEG changes indicative of fibrinolysis or coagulopathy. The 30-day mortality was 2% (one of 53). Reduction of allogeneic transfusion is one aim of patient blood management techniques. We have demonstrated virtual avoidance of allogeneic blood product transfusion despite massive blood loss. These data show possible alternatives to the current massive transfusion protocols to the management of elective vascular surgical patients.
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Affiliation(s)
- Mark D Stoneham
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antonio Barbosa
- Haemostasis and Blood Conservation Service, John Radcliffe Hospital, Oxford, Oxon, UK
| | - Keith Maher
- Haemostasis and Blood Conservation Service, John Radcliffe Hospital, Oxford, Oxon, UK
| | - Paul Douglass
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Michael J R Desborough
- Department of Clinical Haematology, Oxford University Hospitals NHS Foundation Trust and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Steve Von Kier
- Haemostasis and Blood Conservation Service, John Radcliffe Hospital, Oxford, Oxon, UK
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4
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Ridgeon E, Wilson K, Wilkinson D, Douglass P, Elrefaey A. Defining complexity in anaesthesia: description and validation of the Oxford Anaesthetic Complexity (OxAnCo) score. Anaesthesia 2022; 77:1251-1258. [PMID: 35974666 DOI: 10.1111/anae.15840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 01/07/2023]
Abstract
Increasing demand for surgery and anaesthesia has created an imperative to manage anaesthetic workforce and caseload. This may include changes to distribution of cases amongst anaesthetists of different grades, including non-physician anaesthetists. To achieve this safely, an assessment of case complexity is essential. We present a novel system for scoring complexity of cases in anaesthesia, the Oxford Anaesthetic Complexity score. This integrates patient, anaesthetic, surgical and systems factors, and is different from assessments of risk. We adopted an end-user development approach to the design of the score, and validated it using a dataset of anaesthetic cases. Across 688 cases, the median (IQR [range]) complexity score was 19 (17-22 [15-33]). Cases requiring a consultant anaesthetist had a significantly higher median (IQR [range]) score than those requiring a senior trainee at 22 (20-25 [15-33]) vs. 19(17-21 [15-28]), p < 0.001. Cases undertaken in a tertiary acute hospital had a significantly higher score than those in a district general hospital, the median (IQR [range]) scores being 20 (17-22 [15-33]) vs. 17 (16-19 [17-28]), p < 0.001. Receiver-operating characteristic analysis showed good prediction of complexity sufficient to require a consultant anaesthetist, with area under the curve of 0.84. Any rise in complexity above baseline (score > 15) was strongly predictive of a case too complex for a junior trainee (positive predictive value 0.93). The Oxford Anaesthetic Complexity score can be used to match cases to different grades of anaesthetist, and can help in defining cases appropriate for the expanding non-physician anaesthetist workforce.
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Affiliation(s)
- E Ridgeon
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K Wilson
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Trust, Oxford, UK
| | - D Wilkinson
- Department of Anaesthesia, Royal Berkshire Hospital, Reading, UK
| | - P Douglass
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Trust, Oxford, UK
| | - A Elrefaey
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Trust, Oxford, UK
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5
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Adeniyi A, Abadir S, Douglass P, Brown C. Late Complication of Quadricuspid Aortic Valve: Early Moderate to Severe Aortic Regurgitation. Cureus 2022; 14:e27312. [PMID: 36043006 PMCID: PMC9410703 DOI: 10.7759/cureus.27312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/05/2022] Open
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6
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Douglass P. One lung ventilation. Br J Hosp Med (Lond) 2022; 83:1-2. [DOI: 10.12968/hmed.2021.0547] [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: 11/11/2022]
Abstract
Anaesthetists might prefer two lungs for ventilation, but this is not always possible. One lung ventilation requires a good knowledge of physiology, anatomy and equipment. This article gives an overview of the basics.
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Affiliation(s)
- Paul Douglass
- Anaesthetic Department, Oxford University Hospitals, Oxford, UK
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7
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Lindley KJ, Aggarwal NR, Briller JE, Davis MB, Douglass P, Epps KC, Fleg JL, Hayes S, Itchhaporia D, Mahmoud Z, Moraes De Oliveira GM, Ogunniyi MO, Quesada O, Russo AM, Sharma J, Wood MJ. Socioeconomic Determinants of Health and Cardiovascular Outcomes in Women: JACC Review Topic of the Week. J Am Coll Cardiol 2021; 78:1919-1929. [PMID: 34736568 DOI: 10.1016/j.jacc.2021.09.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/07/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Socioeconomic disparities in cardiovascular risk factors and outcomes exist among women, particularly those of minority racial or ethnic backgrounds. Barriers to optimal cardiovascular health begin early in life-with inadequate access to effective contraception, postpartum follow-up, and maternity leave-and result in excess rates of myocardial infarction, stroke, and cardiovascular death in at-risk populations. Contributing factors include reduced access to care, low levels of income and social support, and lack of diversity among cardiology clinicians and within clinical trials. These barriers can be mitigated by optimizing care access via policy change and improving physical access to care in women with geographic or transportation limitations. Addressing structural racism through policy change and bolstering structured community support systems will be key to reducing adverse cardiovascular outcomes among women of racial and ethnic minorities. Diversification of the cardiology workforce to more closely represent the patients we serve will be beneficial to all women.
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Affiliation(s)
- Kathryn J Lindley
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA.
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/NitiCardio
| | - Joan E Briller
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. https://twitter.com/MelindaDavisMD
| | - Paul Douglass
- Division of Cardiology, Wellstar Atlanta Medical Center, Atlanta, Georgia, USA
| | - Kelly C Epps
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Jerome L Fleg
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Sharonne Hayes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dipti Itchhaporia
- Jeffrey M. Carlton Heart & Vascular Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, California, USA
| | - Zainab Mahmoud
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Modele O Ogunniyi
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA. https://twitter.com/modeldoc
| | - Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA. https://twitter.com/odayme
| | - Andrea M Russo
- Cardiovascular Division, Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA. https://twitter.com/AndreaRussoEP
| | - Jyoti Sharma
- Division of Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Malissa J Wood
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/drmalissawood
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8
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Quevedo S, Bekele C, Thompson PD, Philkhana M, Virani S, Consuegra A, Douglass P, Gertz AM. Peripartum cardiomyopathy and HELLP syndrome in a previously healthy multiparous woman: A case report. SAGE Open Med Case Rep 2021; 8:2050313X20979288. [PMID: 33425357 PMCID: PMC7758651 DOI: 10.1177/2050313x20979288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/11/2020] [Indexed: 01/19/2023] Open
Abstract
Peripartum cardiomyopathy is a type of dilated cardiomyopathy in which the exact etiology is uncertain. HELLP syndrome is characterized by a constellation of different clinical and laboratory findings, including hemolysis, elevated liver enzymes, and low platelets. Few case reports exist detailing successful diagnosis and management of postpartum HELLP syndrome, peripartum cardiomyopathy, and multisystem organ failure in a previously healthy woman. We herein report the case of a 39-year-old multiparous female with mild gestational hypertension, who presented in the third trimester with vaginal bleeding and was subsequently suspected to have intrapartum placental abruption leading to immediate Cesarean section, complicated by massive postpartum hemorrhage, necessitating care in the intensive care unit. HELLP syndrome, disseminated intravascular coagulation, and acute kidney injury requiring hemodialysis subsequently developed along with respiratory failure and peripartum cardiomyopathy. After diagnosis and proper management, the patient made a full recovery. Peripartum cardiomyopathy should remain on the differential for women with heart failure symptoms.
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Affiliation(s)
- Shany Quevedo
- Ross University School of Medicine, Miramar, FL, USA
| | - Caroline Bekele
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | - Patrice D Thompson
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | - Megan Philkhana
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | - Sana Virani
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | | | - Paul Douglass
- Wellstar Medical Group, Metro Atlanta Cardiovascular Medicine, Atlanta, GA, USA
| | - Alida M Gertz
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
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9
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Douglass P, Kazaks A, Gordon W. Assessing Registered Dietitian Nutritionists' Knowledge Regarding Nutrition and Health Care for Transgender and Gender Non-Binary (TGGNB) Individuals. J Acad Nutr Diet 2020. [DOI: 10.1016/j.jand.2020.06.201] [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: 10/23/2022]
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10
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Kris-Etherton PM, Petersen KS, Velarde G, Barnard ND, Miller M, Ros E, O'Keefe JH, Williams K, Horn LV, Na M, Shay C, Douglass P, Katz DL, Freeman AM. Barriers, Opportunities, and Challenges in Addressing Disparities in Diet-Related Cardiovascular Disease in the United States. J Am Heart Assoc 2020; 9:e014433. [PMID: 32200727 PMCID: PMC7428614 DOI: 10.1161/jaha.119.014433] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In the United States, cardiovascular disease (CVD) is the leading cause of death and disability. Suboptimal diet quality is responsible for a greater percentage of CVD-related morbidity and mortality than any other modifiable risk factor. Further troubling are the stark racial/ethnic and socioeconomic disparities in diet quality. This represents a major public health concern that urgently requires a coordinated effort to better characterize the barriers to healthy dietary practices in population groups disproportionally affected by CVD and poor diet quality to inform multifaceted approaches at the government (policy), community environment, sociocultural, and individual levels. This paper reviews the barriers, opportunities, and challenges involved in shifting population behaviors, especially in underserved populations, toward healthy dietary practices. It is imperative that public health policies address the social determinants of nutrition more intensively than previously in order to significantly decrease CVD on a population-wide basis.
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Affiliation(s)
- Penny M Kris-Etherton
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Kristina S Petersen
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Gladys Velarde
- Division of Cardiology Department of Medicine University of Florida Jacksonville FL
| | - Neal D Barnard
- Adjunct Faculty George Washington University School of Medicine Physicians Committee for Responsible Medicine Washington DC
| | - Michael Miller
- Department of Medicine University of Maryland School of Medicine Baltimore MD
| | - Emilio Ros
- Lipid Clinic Endocrinology and Nutrition Service Institut d'Investigacions Biomediques August Pi Sunyer Hospital Clinic University of Barcelona, and Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición Instituto de Salud Carlos III Madrid Spain
| | - James H O'Keefe
- Saint Luke's Mid America Heart Institute School of Medicine University of Missouri-Kansas City MO
| | | | - Linda Van Horn
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Muzi Na
- Department of Nutritional Sciences The Pennsylvania State University University Park PA
| | - Christina Shay
- Center for Health Metrics and Evaluation American Heart Association American Heart Association Dallas TX
| | - Paul Douglass
- Wellstar Medical Group, Metro Atlanta Cardiovascular Medicine Atlanta GA
| | - David L Katz
- Yale-Griffin Prevention Research Center Derby CT
| | - Andrew M Freeman
- Division of Cardiology Department of Medicine National Jewish Health Denver CO
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11
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Affiliation(s)
- Metesh N Acharya
- Clinical Fellow in Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Harefield Hospital, London UB9 6JH
| | - Paul Douglass
- Clinical Fellow in Intensive Care Medicine, Department of Intensive Care Medicine, Harefield Hospital, London
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12
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Tioum G, Olatunji-Bello T, Douglass P, Adeniyi A. QUADRICUSPID AORTIC VALVE PRESENTING AS NEW ONSET HEART FAILURE: A CASE REPORT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32903-1] [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: 10/27/2022]
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13
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Fergus I, Gillespie R, Douglass P, Williams K, Yancy CW. A Moment of Reflection on the Past and Future of the Association of Black Cardiologists. J Am Coll Cardiol 2015; 66:2149-2151. [DOI: 10.1016/j.jacc.2015.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Koris J, Douglass P, Allen F. Factors affecting blood transfusion requirements in patients undergoing surgical intervention for fractures of the proximal femur. Int J Surg 2014. [DOI: 10.1016/j.ijsu.2014.08.023] [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: 11/15/2022]
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15
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Appleby MF, Allen F, Dowsing B, Rich H, Douglass P. P84 Where do babies come from? A man's understanding of women's health: Abstract P84 Table 1. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.84] [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: 11/04/2022]
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16
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Affiliation(s)
- Prashanth R Sunkureddi
- Division of Rheumatology, Department of Internal Medicine, The University of Texas Medical Branch, Galveston 77555-1165, USA
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17
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Khanna M, Fan J, Pehler-Harrington K, Waters C, Douglass P, Stallock J, Kehl S, Henrickson KJ. The pneumoplex assays, a multiplex PCR-enzyme hybridization assay that allows simultaneous detection of five organisms, Mycoplasma pneumoniae, Chlamydia (Chlamydophila) pneumoniae, Legionella pneumophila, Legionella micdadei, and Bordetella pertussis, and its real-time counterpart. J Clin Microbiol 2005; 43:565-71. [PMID: 15695646 PMCID: PMC548062 DOI: 10.1128/jcm.43.2.565-571.2005] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Respiratory disease caused by atypical bacteria remains an important cause of morbidity and mortality for adults and children, despite the widespread use of effective antimicrobials agents. Culture remains the "gold standard" for the detection of these agents. However, culture is labor-intensive, takes several days to weeks for growth, and can be very insensitive for the detection of some of these organisms. Newer singleplex PCR diagnostic tests are sensitive and specific, but multiple assays would be needed to detect all of the common pathogens. Therefore, we developed the Pneumoplex assays, a multiplex PCR-enzyme hybridization assay (the standard assay) and a multiplex real-time assay to detect the most common atypical pathogens in a single test. Primer and probe sequences were designed from conserved regions of specific genes for each of these organisms. The limits of detection were as follows: for Bordetella pertussis, 2 CFU/ml; for Legionella pneumophila (serotypes 1 to 15) and Legionella micdadei, 9 and 80 CFU/ml, respectively; for Mycoplasma pneumoniae, 5 CFU/ml; and for Chlamydia (Chlamydophila) pneumoniae, 0.01 50% tissue culture infective doses. Recombinant DNA controls for each of these organisms were constructed, and the number of copies for each DNA control was calculated. The Pneumoplex could detect each DNA control down to 10 copies/ml. The analytical specificity demonstrated no cross-reactivity between 23 common respiratory pathogens. One hundred twenty-five clinical bronchoalveolar lavage fluid samples tested by the standard assay demonstrated that the Pneumoplex yielded a sensitivity and a specificity of 100 and 98.5%, respectively. This test has the potential to assist clinicians in establishing a specific etiologic diagnosis before initiating therapy, to decrease hospital costs, and to prevent inappropriate antimicrobial therapy.
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Affiliation(s)
- M Khanna
- Prodess Inc., Waukesha, Wisconsin, USA
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18
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Douglass P. What is new in cardiovascular health? Ethn Dis 2002; 12:S2-41-3. [PMID: 11913640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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19
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Abstract
While researchers try to elucidate the origins of idiopathic dilated cardiomyopathy, clinicians continue to face the challenges of identifying and treating the causes of this condition to improve symptoms and survival. We review classification schemes for dilated cardiomyopathy and the current range of diagnostic and therapeutic options and treatment goals.
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Affiliation(s)
- Siva B Mohan
- Department of Internal Medicine, Atlanta Medical Center, GA 30312, USA
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20
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Abstract
Care of ventilator-dependent patients requires considerable resources, yet the long-term outcomes of this type of care have rarely been described. We retrospectively investigated the posthospital course of elderly patients who survived an episode of prolonged ventilator dependency to describe survival rates, subsequent use of health care resources, and functional abilities. Our data suggest that the use of prolonged mechanical ventilation in the elderly produces few survivors at considerable expense. Poor overall outcomes occurred despite considerable consumption of medical and nursing resources by the survivors.
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Affiliation(s)
- E H Elpern
- Department of Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago
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Douglass P. Head hunting in London. Health Serv J 1989; 99:852-3. [PMID: 10294346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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