1,303 results on '"Jeffrey A. Katz"'
Search Results
202. Diagnostic accuracy of administrative data algorithms in the diagnosis of osteoarthritis: a systematic review.
- Author
-
Swastina Shrestha, Amish J. Dave, Elena Losina, and Jeffrey N. Katz
- Published
- 2016
- Full Text
- View/download PDF
203. Societal Cost of Opioid Use in Symptomatic Knee Osteoarthritis Patients in the United States
- Author
-
A. David Paltiel, Robert R. Edwards, Shuang Song, Tuhina Neogi, Jeffrey N. Katz, Elena Losina, David J. Hunter, James K. Sullivan, Jamie L. Huizinga, and Elizabeth E. Stanley
- Subjects
Adult ,medicine.medical_specialty ,Population ,Beneficiary ,Osteoarthritis ,Medicare ,Rheumatology ,Cost of Illness ,Medicine ,Humans ,Computer Simulation ,education ,Productivity ,Aged ,education.field_of_study ,business.industry ,Public health ,Opioid use disorder ,Health Care Costs ,Middle Aged ,Osteoarthritis, Knee ,medicine.disease ,Opioid-Related Disorders ,United States ,Analgesics, Opioid ,Cohort ,business ,Demography ,Criminal justice - Abstract
Symptomatic knee osteoarthritis (SKOA) is a chronic, disabling condition, requiring long-term pain management; over 800,000 SKOA patients in the US use opioids on a prolonged basis. We aimed to characterize the societal economic burden of opioid use in this population.We used the Osteoarthritis Policy Model, a validated computer simulation of SKOA, to estimate the opioid-related lifetime and annual cost generated by the US SKOA population. We included direct medical, lost productivity, criminal justice, and diversion costs. We modeled the SKOA cohort with a mean ± SD age of 54 ± 14 years and Western Ontario and McMaster Universities Osteoarthritis Index pain score of 29 ± 17 (0-100, 100 = worst). We estimated annual costs of strong ($1,381) and weak ($671) opioid regimens using Medicare fee schedules, Red Book, the Federal Supply Schedule, and published literature. The annual lost productivity and criminal justice costs of opioid use disorder (OUD), obtained from published literature, were $11,387 and $4,264, per-person, respectively. The 2015-2016 Medicare Current Beneficiary Survey provided OUD prevalence. We conducted sensitivity analyses to examine the robustness of our estimates to uncertainty in input parameters.Assuming 5.1% prevalence of prolonged strong opioid use, the total lifetime opioid-related cost generated by the US SKOA population was estimated at $14.0 billion, of which only $7.45 billion (53%) were direct medical costs.Lost productivity, diversion, and criminal justice costs comprise approximately half of opioid-related costs generated by the US SKOA population. Reducing prolonged opioid use may lead to a meaningful reduction in societal costs that can be used for other public health causes.
- Published
- 2020
204. Dogs demonstrate memory of incidentally encoded information
- Author
-
Sarah, Krichbaum and Jeffrey S, Katz
- Subjects
Dogs ,Behavior, Animal ,Animals - Abstract
Fugazza, Pongrácz, Pogány, Lenkei, and Miklósi (Scientific Reports, 10(1), 1-8, 2020) recently showed that dogs can repeat incidentally encoded behaviors using unexpected tests. These results suggest that dogs may possess episodic-like memories for their own actions.
- Published
- 2020
205. Same/different concept learning by primates and birds
- Author
-
Anthony A, Wright, Debbie M, Kelly, and Jeffrey S, Katz
- Subjects
Memory ,Concept Formation ,Animals ,Conditioning, Operant ,Learning ,Columbidae - Abstract
Same/different abstract-concept learning experiments were conducted with two primate species and three avian species by progressively increasing the size of the training stimulus set of distinctly different pictures from eight to 1,024 pictures. These same/different learning experiments were trained with two pictures presented simultaneously. Transfer tests of same and different learning employed interspersed trials of novel pictures to assess the level of correct performance on the very first time of subjects had seen those pictures. All of the species eventually performed these tests with high accuracy, contradicting the long-accepted notion that nonhuman animals are unable to learn the concept of same/different. Capuchin and rhesus monkeys learned the concept more readily than did pigeons. Clark's nutcrackers and black-billed magpies learned as readily as monkeys, and even showed a slight advantage with the smallest training stimulus sets. Those tests of same/different learning were followed by delay procedures, such that a delay was introduced after the subjects responded to the sample picture and before the test picture. In the sequential same/different task, accuracy was shown to diminish when the stimulus on a previous trial matched the test picture previously shown on a different trial. This effect is known as proactive interference. The pigeons' proactive interference was greater at 10-s delays than 1-s delays, revealing time-based interference. By contrast, time delays had little or no effect on rhesus monkeys' proactive interference, suggesting that rhesus monkeys have better explicit memory of where and when they saw the potential interfering picture, revealing better event-based memory.
- Published
- 2020
206. Cost-effectiveness of dental antibiotic prophylaxis in total knee arthroplasty recipients with type II diabetes mellitus
- Author
-
Taylor P. Trentadue, Karen C. Smith, Thomas S. Thornhill, Jeffrey K. Lange, Elena Losina, James K. Sullivan, Elizabeth E. Stanley, and Jeffrey N. Katz
- Subjects
medicine.medical_specialty ,education.field_of_study ,business.industry ,Cost effectiveness ,Dental procedures ,Population ,Total knee arthroplasty ,Type II diabetes Mellitus ,Osteoarthritis ,Diseases of the musculoskeletal system ,medicine.disease ,Type ii diabetes ,RC925-935 ,Internal medicine ,Medicine ,Cost-effectiveness ,Antibiotic prophylaxis ,business ,education ,Dental antibiotic prophylaxis ,health care economics and organizations - Abstract
Objective Type II diabetes mellitus (T2DM) is prevalent in knee osteoarthritis (OA) patients undergoing total knee arthroplasty (TKA) and increases risk for prosthetic joint infection (PJI). We examined the cost-effectiveness of antibiotic prophylaxis (AP) before dental procedures to reduce PJI in TKA recipients with T2DM. Design We used the Osteoarthritis Policy Model, a validated computer simulation of knee OA, to compare two strategies among TKA recipients with T2DM (mean age 68 years, mean BMI 35.4 kg/m2): 1) AP before dental procedures and 2) no AP. Outcomes included quality-adjusted life expectancy (QALE) and lifetime medical costs. We used published efficacy of AP. We report incremental cost-effectiveness ratios (ICERs) and considered strategies with ICERs below well-accepted willingness-to-pay (WTP) thresholds cost-effective. We conducted sensitivity analyses to examine the robustness of findings to uncertainty in model input parameters. We used a lifetime horizon and healthcare sector perspective. Results We found that AP added 1.0 quality-adjusted life-year (QALY) and $66,000 for every 1000 TKA recipients with T2DM, resulting in an ICER of $66,000/QALY. In sensitivity analyses, reduction of the probability of PJI, T2DM-associated risk of infection, or attribution of infections to dental procedures by 50% resulted in ICERs exceeding $100,000/QALY. Probabilistic sensitivity analyses showed that AP was cost-effective in 32% and 58% of scenarios at WTP of $50,000/QALY and $100,000/QALY, respectively. Conclusions AP prior to dental procedures is cost-effective for TKA recipients with T2DM. However, the cost-effectiveness of AP depends on the risk of PJI and efficacy of AP in this population.
- Published
- 2020
207. Evaluating ambulatory function as an outcome following treatment for spinal metastases: a systematic review
- Author
-
Marco Ferrone, Jeffrey N. Katz, Lananh Nguyen, Andrew J. Schoenfeld, and Nicole D Agaronnik
- Subjects
Adult ,030222 orthopedics ,medicine.medical_specialty ,Spinal Neoplasms ,Adult patients ,business.industry ,Medical record ,Context (language use) ,Outcome (game theory) ,Article ,03 medical and health sciences ,0302 clinical medicine ,Sample size determination ,Ambulatory ,Physical therapy ,medicine ,Humans ,Surgery ,Orthopedics and Sports Medicine ,Neurology (clinical) ,Prospective Studies ,Spinal metastases ,business ,Prospective cohort study ,030217 neurology & neurosurgery - Abstract
BACKGROUND CONTEXT Studies regarding treatment of spinal metastases are critical to evidence-based decision-making. However, variation exists in how a key outcome, ambulatory function, is assessed. PURPOSE To characterize the sources and tools investigators have used to evaluate ambulatory function as an outcome following treatment of spinal metastases. We also sought to understand the ways ambulatory function has been conceptualized in prior studies. STUDY DESIGN Systematic review of the literature. PATIENT SAMPLE We identified 44 published studies for inclusion. Samples within these investigations ranged from 20 to 2,096 subjects. OUTCOME MEASURES We describe the methods investigators have used to evaluate ambulatory function following treatment for spinal metastases. METHODS We conducted a systematic review through PubMed, Scopus and Web of Science following PRISMA guidelines. We included studies that consisted of adult patients receiving operative or non-operative treatment for spinal metastases. We also required that study investigators specified post-treatment ambulatory function as an outcome. We recorded year of publication, study design, types of spinal metastases included in the study, treatments employed, and sample size. We also described the source (medical record, study-specific observer and/or provider, patient and/or participant), tool (standardized measure, quantitative, qualitative) and concept (eg, ambulatory vs. non-ambulatory; independent ambulation vs. ambulatory with assistance vs. non-ambulatory) used to assess ambulatory function. RESULTS We found the plurality of studies relied on medical record documentation as their source. Amongst prospective studies, only a minority used a quantitative measure (eg, prespecified degree of walking ability) to assess ambulatory function. Most studies conceptualized ambulatory function as a dichotomized outcome, typically ambulatory versus non-ambulatory or a similar equivalent. CONCLUSIONS Wide variation exists in how ambulatory function is defined in studies involving patients with spinal metastases. We suggest several improvements that will allow a more robust assessment of the quality and quantity of ambulatory function among patients treated for spinal metastases.
- Published
- 2020
208. National Utilization and Inpatient Safety Measures of Lumbar Spinal Fusion Methods by Race/Ethnicity
- Author
-
Angel M. Reyes, Andrew J. Schoenfeld, Elena Losina, Jeffrey N. Katz, Yuchiao Chang, and James D. Kang
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Ethnic group ,Context (language use) ,Logistic regression ,Article ,03 medical and health sciences ,0302 clinical medicine ,Lumbar ,Internal medicine ,Ethnicity ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Retrospective Studies ,030222 orthopedics ,Inpatients ,Lumbar Vertebrae ,business.industry ,Retrospective cohort study ,Odds ratio ,Hispanic or Latino ,Middle Aged ,Confidence interval ,Spinal Fusion ,Spinal fusion ,Surgery ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
BACKGROUND CONTEXT Degenerative lumbar conditions are prevalent, disabling, and frequently managed with decompression and fusion. Black patients have lower spinal fusion rates than White patients. PURPOSE Determine whether specific lumbar fusion procedure utilization differs by race/ethnicity and whether length of stay (LOS) or inpatient complications differ by race/ethnicity after accounting for procedure performed. STUDY DESIGN Large database retrospective cohort study PATIENT SAMPLE Lumbar fusion recipients at least age 50 in the 2016 National Inpatient Sample with diagnoses of degenerative lumbar conditions. OUTCOME MEASURES Type of fusion procedure used and inpatient safety measures including LOS, prolonged LOS, inpatient medical and surgical complications, mortality, and cost. METHODS We examined the association between race/ethnicity and the safety measures above. Covariates included several patient and hospital factors. We used multiple linear or logistic regression to determine the association between race and fusion type (PLF, P/TLIF, ALIF, PLF + P/TLIF, and PLF + ALIF [anterior-posterior fusion]) and to determine whether race was associated independently with inpatient safety measures, after adjustment for patient and hospital factors. RESULTS Fusion method use did not differ among racial/ethnic groups, except for somewhat lower anterior-posterior fusion utilization in Black patients compared to White patients (crude odds ratio [OR]: 0.81 [0.67–0.97]). Inpatient safety measures differed by race/ethnicity for rates of prolonged LOS (Blacks 18.1%, Hispanics 14.5%, and Whites 11.7%), medical complications (Blacks 9.9%, Hispanics 8.7%, and Whites 7.7%), and surgical complications (Blacks 5.2%, Hispanics 6.9%, and Whites 5.4%). Differences persisted after adjustment for procedure type as well as patient and hospital factors. Blacks and Hispanics had higher risk for prolonged LOS compared to Whites (adjusted OR Blacks 1.39 [95% confidence interval {CI} 1.22–1.59]; Hispanics 1.24 [95% CI 1.02–1.52]). Blacks had higher risk for inpatient medical complications compared to Whites (adjusted OR 1.24 [95% CI 1.05–1.48]), and Hispanics had higher risk for inpatient surgical complications compared to Whites (adjusted OR 1.34 [95% CI 1.06–1.68]). CONCLUSIONS Fusion method use was generally similar between racial/ethnic groups. Inpatient safety measures, adjusted for procedure type, patient and hospital factors, were worse for Blacks and Hispanics.
- Published
- 2020
209. Dissociating the effects of delay and interference on dog (Canis familiaris) working memory
- Author
-
Emma Cox, Jeffrey S. Katz, Adam Davila, Sarah Krichbaum, Jordan G. Smith, and Lucia Lazarowski
- Subjects
medicine.medical_specialty ,Forgetting ,Working memory ,Interference theory ,Experimental and Cognitive Psychology ,Olfaction ,Audiology ,Stimulus (physiology) ,Interference (genetic) ,Stimulus modality ,Dogs ,Memory, Short-Term ,Odorants ,medicine ,Animals ,Set (psychology) ,Psychology ,Ecology, Evolution, Behavior and Systematics - Abstract
Delayed matching-to-sample (dMTS) is commonly used to study working memory (WM) processes in non-humans. Previous procedures for studying dog WM, including versions of the dMTS, did not separate the impact of delay and interference on memory performance. These studies were also limited to auditory and spatial stimuli, neglecting dogs' dominant sensory modality (i.e., olfaction). Therefore, we designed the first olfactory dMTS in dogs, with systematically varied delays and number of odors in a session, to dissociate the effects of delay and within-session proactive interference on dog WM. Dogs (n = 5) initially trained on matching-to-sample with 48 odors, with a zero-second delay, were tested on four delay lengths (0, 30, 60, and 90 s), counterbalanced across three, trial-unique, sessions. Although there was a slight decrease in accuracy across delays, dogs performed above chance on delays up to 60 s, suggesting a WM duration of at least 60 s. To explore the effect of within-session proactive interference on WM duration, the size of the stimulus set was reduced to six and two odors. There was no effect on the memory function with six odors compared to the trial-unique sessions. However, the interference caused by the two-odor set was enough to decrease accuracy at each delay length. These findings suggest that forgetting in dog working memory for odors can be simultaneously influenced by delay and within-session proactive interference.
- Published
- 2020
210. Interdisciplinary treatment of posterior fossa dural arteriovenous fistulas
- Author
-
Ivo, Peto, Hussam, Abou-Al-Shaar, Timothy G, White, Kevin, Kwan, Katherine, Wagner, Giyarpuram N, Prashant, David, Chalif, Jeffrey M, Katz, and Amir R, Dehdashti
- Subjects
Central Nervous System Vascular Malformations ,Treatment Outcome ,Humans ,Middle Aged ,Combined Modality Therapy ,Embolization, Therapeutic ,Retrospective Studies - Abstract
Posterior fossa dural arteriovenous fistulas (dAVFs) are rare vascular lesions with variable risk of hemorrhage, mostly depending on the pattern of the venous drainage. While endovascular embolization is the mainstay treatment for most dAVFs, some posterior fossa lesions require a multidisciplinary approach including surgery. The goal of our study was to examine the outcome of an interdisciplinary treatment for posterior fossa dAVFs.A retrospective review of patients treated for posterior fossa dAVFs was conducted.A total of 28 patients with a mean age of 57.8 years were included. Patients presented with a Cognard grade I in 2 (7%), II a in 5 (18 %), II b in 7 (25%), II a + b in 5 (18%), III in 3 (11%), and IV in 6 (21%) cases. Hemorrhage was the initial presentation in 2 (22%) patients with Cognard grade IV, in 3 with Cognard grade III (33%), in 1 (11%) with Cognard II a + b, and 3 (33%) with Cognard II b. A complete angiographic cure was achieved in 24 (86%) patients-after a single-session embolization in 16 (57%) patients, multiple embolization sessions in 2 (7%), a multimodal treatment with embolization and surgical disconnection in 3 (11%), and with an upfront surgery in 3 (11%). Complete long-term obliteration was demonstrated in 18/22 (82%) at the mean follow-up of 17 months. Fistulas were converted into asymptomatic Cognard I lesion in 4 (14%) patients.Posterior fossa dAVFs represent a challenging vascular pathology; however, despite their complexity, an interdisciplinary treatment can achieve high rates of angiographic and symptomatic cure with low morbidity and mortality rates. Long-term surveillance is warranted as late recurrences may occur.
- Published
- 2020
211. Clinician Experiences in Treatment Decision-Making for Patients with Spinal Metastases: A Qualitative Study
- Author
-
Matthew W. Colman, Elena Losina, Andrew J. Schoenfeld, C. Rory Goodwin, Justin A. Blucher, Kaetlyn R. Arant, Ilya Laufer, Tracy A. Balboni, John H. Shin, Rick Placide, Danielle L. Sarno, Lauren B. Barton, Daniel M. Sciubba, Jeffrey N. Katz, and Kristin J. Redmond
- Subjects
Male ,medicine.medical_specialty ,Clinical Decision-Making ,MEDLINE ,Disease ,Article ,Specialties, Surgical ,Interviews as Topic ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Multidisciplinary approach ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Qualitative Research ,Patient Care Team ,030222 orthopedics ,Spinal Neoplasms ,business.industry ,Patient Preference ,General Medicine ,Focus Groups ,Middle Aged ,Focus group ,Family medicine ,Cohort ,Quality of Life ,Surgery ,Female ,Thematic analysis ,business ,Decision Making, Shared ,030217 neurology & neurosurgery ,Qualitative research - Abstract
Background Effective management of metastatic disease requires multidisciplinary input and entails high risk of disease-related and treatment-related morbidity and mortality. The factors that influence clinician decision-making around spinal metastases are not well understood. We conducted a qualitative study that included a multidisciplinary cohort of physicians to evaluate the decision-making process for treatment of spinal metastases from the clinician's perspective. Methods We recruited operative and nonoperative clinicians, including orthopaedic spine surgeons, neurosurgeons, radiation oncologists, and physiatrists, from across North America to participate in either a focus group or a semistructured interview. All interviews were audiorecorded and transcribed verbatim. We then performed a thematic analysis using all of the available transcript data. Investigators sequentially coded transcripts and identified recurring themes that encompass overarching patterns in the data and directly bear on the guiding study question. This was followed by the development of a thematic map that visually portrays the themes, the subthemes, and their interrelatedness, as well as their influence on treatment decision-making. Results The thematic analysis revealed that numerous factors influence provider-based decision-making for patients with spinal metastases, including clinical elements of the disease process, treatment guidelines, patient preferences, and the dynamics of the multidisciplinary care team. The most prominent feature that resonated across all of the interviews was the importance of multidisciplinary care and the necessity of cohesion among a team of diverse health-care providers. Respondents emphasized aspects of care-team dynamics, including effective communication and intimate knowledge of team-member preferences, as necessary for the development of appropriate treatment strategies. Participants maintained that the primary role in decision-making should remain with the patient. Conclusions Numerous factors influence provider-based decision-making for patients with spinal metastases, including multidisciplinary team dynamics, business pressure, and clinician experience. Participants maintained a focus on shared decision-making with patients, which contrasts with patient preferences to defer decisions to the physician, as described in prior work. Clinical relevance The results of this thematic analysis document the numerous factors that influence provider-based decision-making for patients with spinal metastases. Our results indicate that provider decisions regarding treatment are influenced by a combination of clinical characteristics, perceptions of patient quality of life, and the patient's preferences for care.
- Published
- 2020
212. The resolute Onyx drug eluting stent for neurointervention: A technical series
- Author
-
Timothy G. White, Kevin A. Shah, Prateeka Koul, Thomas Link, Amir R. Dehdashti, Jeffrey M. Katz, Athos Patsalides, and Henry H. Woo
- Abstract
Introduction Current methods for angioplasty and stenting of the intracranial vasculature for neurointervention are limited. The Wingspan Stent System is Food and Drug Administration (FDA) approved with human device exemption for a limited patient group and despite numerous prospective registries and trials demonstrating reasonable safety, still carries warnings from the FDA for its use. Given these limitations, we present the technical nuances and outcomes of the off-label use of the Resolute Onyx drug-eluting stent (DES) for neurointerventional purposes. Methods Retrospective chart review of all patients undergoing a neurointerventional procedure with the Resolute Onyx DES was done from January 2017–2021. The Resolute Onyx is a coronary balloon-mounted drug-eluting (zotarolimus) single wire laser cut stent. Technical details and procedural outcomes were collected. Results In total 40 patients had attempted placement of the Resolute Onyx DES with procedural success in 95% of patients. The most common vessel stented was the basilar artery, 30% (12/40). The most common indication was intracranial atherosclerotic disease in 62.5% (25/40) patients, followed by acute stroke in 17.5% (7/40) of patients. The technical and procedural outcomes were excellent with only one technical complication (2.5%). Conclusions This series describes the initial technical safety and utility of utilizing a new generation balloon-mounted drug-eluting stent for neurointerventional purposes. This stent offers the potential for improved navigability, delivery, and outcomes compared to current neurointerventional options and warrants further study.
- Published
- 2022
213. Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa.
- Author
-
Paul K Drain, Elena Losina, Gary Parker, Janet Giddy, Douglas Ross, Jeffrey N Katz, Sharon M Coleman, Laura M Bogart, Kenneth A Freedberg, Rochelle P Walensky, and Ingrid V Bassett
- Subjects
Medicine ,Science - Abstract
BackgroundAfter observing persistently low CD4 counts at initial HIV diagnosis in South Africa, we sought to determine risk factors for late-stage HIV disease presentation among adults.MethodsWe surveyed adults prior to HIV testing at four outpatient clinics in Durban from August 2010 to November 2011. All HIV-infected adults were offered CD4 testing, and late-stage HIV disease was defined as a CD4 count ResultsAmong 3,669 adults screened, 830 were enrolled, newly-diagnosed with HIV and obtained a CD4 result. Among those, 279 (33.6%) presented with late-stage HIV disease. In multivariate analyses, participants who lived ≥5 kilometers from the test site [adjusted odds ratio (AOR) 2.8, 95% CI 1.7-4.7], reported competing needs to healthcare (AOR 1.7, 95% CI 1.2-2.4), were male (AOR 1.7, 95% CI 1.2-2.3), worked outside the home (AOR 1.5, 95% CI 1.1-2.1), perceived health service delivery barriers (AOR 1.5, 95% CI 1.1-2.1), and/or had poor emotional health (AOR 1.4, 95% CI 1.0-1.9) had higher odds of late-stage HIV disease presentation.ConclusionsIndependent risk factors for late-stage HIV disease presentation were from diverse domains, including geographic, economic, demographic, social, and psychosocial. These findings can inform various interventions, such as mobile testing or financial assistance, to reduce the risk of presentation with late-stage HIV disease.
- Published
- 2013
- Full Text
- View/download PDF
214. Missed opportunities: refusal to confirm reactive rapid HIV tests in the emergency department.
- Author
-
Ishani Ganguli, Jamie E Collins, William M Reichmann, Elena Losina, Jeffrey N Katz, Christian Arbelaez, Laurel A Donnell-Fink, and Rochelle P Walensky
- Subjects
Medicine ,Science - Abstract
HIV infection remains a major US public health concern. While HIV-infected individuals now benefit from earlier diagnosis and improved treatment options, progress is tempered by large numbers of newly diagnosed patients who are lost to follow-up prior to disease confirmation and linkage to care.In the randomized, controlled USHER trial, we offered rapid HIV tests to patients presenting to a Boston, MA emergency department. Separate written informed consent was required for confirmatory testing. In a secondary analysis, we compared participants with reactive results who did and did not complete confirmatory testing to identify factors associated with refusal to complete the confirmation protocol.Thirteen of 62 (21.0%, 95% CI (11.7%, 33.2%)) participants with reactive rapid HIV tests refused confirmation; women, younger participants, African Americans, and those with fewer HIV risks, with lower income, and without primary care doctors were more likely to refuse. We projected that up to four true HIV cases were lost at the confirmation stage.These findings underscore the need to better understand the factors associated with refusal to confirm reactive HIV testing and to identify interventions that will facilitate confirmatory testing and linkage to care among these populations.ClinicalTrials.gov NCT00502944; NCT01258582.
- Published
- 2013
- Full Text
- View/download PDF
215. Placing a price on medical device innovation: the example of total knee arthroplasty.
- Author
-
Lisa G Suter, A David Paltiel, Benjamin N Rome, Daniel H Solomon, Thomas S Thornhill, Stanley K Abrams, Jeffrey N Katz, and Elena Losina
- Subjects
Medicine ,Science - Abstract
Total knee arthroplasty (TKA) is common, effective, and cost-effective. Innovative implants promising reduced long-term failure at increased cost are under continual development. We sought to define the implant cost and performance thresholds under which innovative TKA implants are cost-effective.We performed a cost-effectiveness analysis using a validated, published computer simulation model of knee osteoarthritis. Model inputs were derived using published literature, Medicare claims, and National Health and Nutrition Examination Survey data. We compared projected TKA implant survival, quality-adjusted life expectancy (QALE), lifetime costs, and cost-effectiveness (incremental cost-effectiveness ratios or ICERs) of standard versus innovative TKA implants. We assumed innovative implants offered 5-70% decreased long-term TKA failure rates at costs 20-400% increased above standard implants. We examined the impact of patient age, comorbidity, and potential increases in short-term failure on innovative implant cost-effectiveness.Implants offering ≥50% decrease in long-term TKA failure at ≤50% increased cost offered ICERs
- Published
- 2013
- Full Text
- View/download PDF
216. Factors associated with self-reported repeat HIV testing after a negative result in Durban, South Africa.
- Author
-
Susan Regan, Elena Losina, Senica Chetty, Janet Giddy, Rochelle P Walensky, Douglas Ross, Helga Holst, Jeffrey N Katz, Kenneth A Freedberg, and Ingrid V Bassett
- Subjects
Medicine ,Science - Abstract
Routine screening for HIV infection leads to early detection and treatment. We examined patient characteristics associated with repeated screening in a high prevalence country.We analyzed data from a cohort of 5,229 adults presenting for rapid HIV testing in the outpatient departments of 2 South African hospitals from November 2006 to August 2010. Patients were eligible if they were ≥18 years, reported no previous diagnosis with HIV infection, and not pregnant. Before testing, participants completed a questionnaire including gender, age, HIV testing history, health status, and knowledge about HIV and acquaintances with HIV. Enrollment HIV test results and CD4 counts were abstracted from the medical record. We present prevalence of HIV infection and median CD4 counts by HIV testing history (first-time vs. repeat). We estimated adjusted relative risks (ARR's) for repeat testing by demographics, health status, and knowledge of HIV and others with HIV in a generalized linear model.Of 4,877 participants with HIV test results available, 26% (N = 1258) were repeat testers. Repeat testers were less likely than first-time testers to be HIV-infected (34% vs. 54%, p
- Published
- 2013
- Full Text
- View/download PDF
217. Intra-articular Corticosteroid Injections for the Treatment of Hip and Knee Osteoarthritis-related Pain: Considerations and Controversies with a Focus on Imaging
- Author
-
Ali, Guermazi, Tuhina, Neogi, Jeffrey N, Katz, C Kent, Kwoh, Philip G, Conaghan, David T, Felson, and Frank W, Roemer
- Subjects
Reviews and Commentary ,Adrenal Cortex Hormones ,Humans ,Osteoarthritis, Knee ,Osteoarthritis, Hip ,Injections, Intra-Articular - Abstract
Current management of osteoarthritis (OA) is primarily focused on symptom control. Intra-articular corticosteroid (IACS) injections are often used for pain management of hip and knee OA in patients who have not responded to oral or topical analgesics. Recent case series suggested that negative structural outcomes including accelerated OA progression, subchondral insufficiency fracture, complications of pre-existing osteonecrosis, and rapid joint destruction (including bone loss) may be observed in patients who received IACS injections. This expert panel report reviews the current understanding of pain in OA, summarizes current international guidelines regarding indications for IACS injection, and considers preinterventional safety measures, including imaging. Potential profiles of those who would likely benefit from IACS injection and a suggestion for an updated patient consent form are presented. As of today, there is no established recommendation or consensus regarding imaging, clinical, or laboratory markers before an IACS injection to screen for OA-related imaging abnormalities. Repeating radiographs before each subsequent IACS injection remains controversial. The true cause and natural history of these complications are unclear and require further study. To determine the cause and natural history, large prospective studies evaluating the risk of accelerated OA or joint destruction after IACS injections are needed. However, given the relatively rare incidence of these adverse outcomes, any clinical trial would be challenging in design and a large number of patients would need to be included. © RSNA, 2020
- Published
- 2020
218. The Effects of Vitamin D and Marine Omega-3 Fatty Acid Supplementation on Chronic Knee Pain in Older U.S. Adults: Results from a Randomized Trial
- Author
-
JoAnn E. Manson, Maura D. Iversen, David Gordon, Lindsey A MacFarlane, Karen H. Costenbader, Eunjung Kim, Julie E. Buring, I-Min Lee, Nancy R. Cook, and Jeffrey N. Katz
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Randomization ,WOMAC ,Immunology ,Osteoarthritis ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Randomized controlled trial ,law ,Internal medicine ,medicine ,Vitamin D and neurology ,Immunology and Allergy ,030212 general & internal medicine ,030203 arthritis & rheumatology ,business.industry ,Therapeutic effect ,Repeated measures design ,medicine.disease ,Knee pain ,medicine.symptom ,business ,human activities - Abstract
Objective Knee pain from osteoarthritis is frequent in the adult population. Prior trials have had conflicting results concerning the therapeutic effects of vitamin D on knee pain, and few trials have investigated marine Omega-3 fatty acids (n-3 FA). Methods In the double-blind, placebo-controlled Vitamin D and Omega-3 Trial (VITAL), 25,871 US adults were randomized in a 2-by-2 factorial design to receive vitamin D or n-3 FA. We identified a subgroup with chronic knee pain prior to randomization and assessed knee pain at baseline and annually during follow-up using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (graded on a 0-100 scale, where 100 indicates worst symptoms). Repeated measures modeling was used to test the effect of randomized treatment on WOMAC pain scores over follow-up after adjustment for age and sex. Analyses were repeated for WOMAC function and stiffness. Results This study included 1,398 participants who returned at least one knee pain questionnaire. The mean age was 67.7 years, 66% were women, and the mean ± SD WOMAC pain score was 37 ± 19. The mean ± SD follow-up time was 5.3 ± 0.7 years. WOMAC pain did not differ between the active vitamin D group and the vitamin D placebo group or between the active n-3 FA group and the n-3 FA placebo group at any time point during follow-up. Linear time-by-treatment interactions were not significant for either treatment (vitamin D, P = 0.41; n-3 FA, P = 0.77). Vitamin D and n-3 FA supplementation did not significantly affect WOMAC function or stiffness scores over time. Conclusion Our findings indicate that vitamin D and n-3 FA supplementation for a mean of 5.3 years does not reduce knee pain or improve function or stiffness in a large sample of US adults with chronic knee pain.
- Published
- 2020
219. Development of Patient Education Materials for Total Joint Replacement During an International Surgical Brigade
- Author
-
Roya Ghazinouri, Aliesha Wisdom, Jeffrey N. Katz, Carolyn Beagan, Lauren V Ready, and Derek S. Stenquist
- Subjects
Medical education ,Internationality ,business.industry ,Health Personnel ,Education theory ,MEDLINE ,Readability ,Underserved Population ,Patient Education as Topic ,Work (electrical) ,Humans ,Medicine ,TRIPS architecture ,Orthopedics and Sports Medicine ,Surgery ,Total joint replacement ,Arthroplasty, Replacement ,Comprehension ,business ,Research Article ,Patient education - Abstract
Background Temporary brigade trips to deliver international surgical care are increasingly common. For the purposes of this work, we use the term brigade to describe self-contained short-term medical or surgical mission trips where healthcare professionals are brought in from foreign regions to provide care to an underserved population. Many brigade programs have begun to collect and publish data on outcomes and complications, but few have examined their own patient education practices. Methods We used evidence-based readability and suitability analyses along with patient interviews to develop improved patient education materials for a total joint replacement surgical brigade in the Dominican Republic. Results Existing patient education materials required an eighth grade reading level and lacked suitability based on the principles of educational theory. The redesigned materials required fifth grade reading skills or less and had superior suitability. Pilot testing with patients from the target population suggested that the materials were appealing and appropriate. Conclusions Patient education may play an important role in optimizing outcomes in the setting of medical or surgical brigades where resources and access to follow-up care are limited. More research is needed to bring attention to the importance of patient education during brigades, and programs should work with patients to develop educational materials that are suitable and effective.
- Published
- 2020
220. Association between changes in muscle strength and pain in persons with meniscal tear and osteoarthritis
- Author
-
Elena Losina, Jamie E. Collins, Jeffrey N. Katz, Swastina Shrestha, James K. Sullivan, and Clare E. Safran-Norton
- Subjects
medicine.medical_specialty ,Multivariable linear regression ,business.industry ,Pain relief ,Mean age ,Osteoarthritis ,Diseases of the musculoskeletal system ,medicine.disease ,Multiple factors ,RC925-935 ,Muscle strength ,medicine ,Physical therapy ,Knee injuries ,business ,Hamstring - Abstract
Summary Objective Strengthening-based physical therapy (PT) is frequently recommended for persons with knee osteoarthritis (OA) and meniscal tear. On average, knee OA patients experience pain improvement while undergoing PT, but whether these changes are accompanied by changes in muscle strength remains an important research question. Design We used data from subjects randomized to PT in the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial. Key elements, measured at baseline and 3 months, included quadriceps and hamstrings strength (in pounds) and Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subscale (0–100; 100 worst). We examined the linear association between change in strength and change in pain over 3 months. Results 111 subjects (mean age 57.1, average baseline hamstrings strength 27.5 (SD 14.7), average baseline KOOS 48.0 (SD 17.0)) experienced an average increase in hamstring strength of 3.5 lbs (SD 9.4) and an average decrease in KOOS Pain of 17.1 points (SD 17.4). The correlation between change in hamstrings strength and change in KOOS Pain was weak (Pearson r = 0.17; 95% CI-0.016–0.345). A multivariable linear regression model adjusting for baseline pain showed that a 10-pound increase in hamstrings strength was associated with a 2.9-point (95% CI−0.05−5.9) reduction in KOOS Pain. The association between changes in quadriceps strength and pain was even weaker than that for hamstrings pain. Conclusion We observed small increases in strength and weak associations between strengthening and pain relief, suggesting that pain relief achieved during PT likely arises from multiple factors beyond strengthening alone.
- Published
- 2020
221. Cerebrovascular Complications of COVID-19
- Author
-
Jeffrey M. Katz, Jason J. Wang, Ruben Kuzniecky, Michele Gribko, Richard B. Libman, Souhel Najjar, Steven V. Pacia, Christopher G. Filippi, Pina C. Sanelli, and Salman Azhar
- Subjects
Adult ,Male ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,demography ,Coronavirus disease 2019 (COVID-19) ,Treatment outcome ,Pneumonia, Viral ,New York ,Neuroimaging ,Hospital mortality ,pandemics ,Brain Ischemia ,Risk Factors ,Pandemic ,medicine ,Ethnicity ,Humans ,odds ratio ,Hospital Mortality ,Intensive care medicine ,Stroke ,Aged ,Retrospective Studies ,Advanced and Specialized Nursing ,Aged, 80 and over ,business.industry ,Age Factors ,COVID-19 ,Retrospective cohort study ,cerebrovascular disorders ,Middle Aged ,medicine.disease ,Cerebral Angiography ,Treatment Outcome ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Female ,Brief Reports ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Coronavirus Infections ,Intracranial Hemorrhages - Abstract
Supplemental Digital Content is available in the text., Background and Purpose: Coronavirus disease 2019 (COVID-19) evolved quickly into a global pandemic with myriad systemic complications, including stroke. We report the largest case series to date of cerebrovascular complications of COVID-19 and compare with stroke patients without infection. Methods: Retrospective case series of COVID-19 patients with imaging-confirmed stroke, treated at 11 hospitals in New York, between March 14 and April 26, 2020. Demographic, clinical, laboratory, imaging, and outcome data were collected, and cases were compared with date-matched controls without COVID-19 from 1 year prior. Results: Eighty-six COVID-19–positive stroke cases were identified (mean age, 67.4 years; 44.2% women). Ischemic stroke (83.7%) and nonfocal neurological presentations (67.4%) predominated, commonly involving multivascular distributions (45.8%) with associated hemorrhage (20.8%). Compared with controls (n=499), COVID-19 was associated with in-hospital stroke onset (47.7% versus 5.0%; P
- Published
- 2020
222. The experiences of adult patients receiving treatment for femoral shaft fractures at Kamuzu Central Hospital, Malawi: a qualitative analysis
- Author
-
Kiran Jay Agarwal-Harding, Louise Atadja, Linda Chokotho, Leonard Ngoie Banza, Nyengo Mkandawire, and Jeffrey Neil Katz
- Abstract
Background: There is a growing burden of musculoskeletal trauma in Malawi, and a lack of surgical capacity to manage common, debilitating injuries like femoral shaft fractures (FSFs). Non-operative treatment with skeletal traction remains the standard of care, with surgery available only at central hospitals. Patients experience myriad barriers to care, which can result in delayed treatment and complications. We sought to understand how patients navigate the Malawian health system and the barriers they face while seeking care. Methods: We performed in-depth, semi-structured interviews of 15 adults with closed FSFs during their inpatient hospitalization at Kamuzu Central Hospital (KCH), a public referral hospital in Lilongwe, Malawi. We additionally interviewed one patient who left KCH to seek care at a private hospital. An English-speaking study investigator performed all interviews accompanied by a Chichewa-speaking medical interpreter. Interviews focused on patients’ pathways from injury to present treatment (health system navigation); impressions of the hospital and care received; and the effects of injury/treatment on patients and their families. Interviews were audio-recorded, translated, and transcribed in English. We coded the transcripts and performed a thematic analysis. Results: We identified 6 themes: high variability in health system navigation; frustrations with the biopsychosocial effects of hospitalization; lack of participation in decision-making and uncertainty about treatment course; preference for surgery (vs. traction) based on patients’ own experiences and observations; frustrations with the inequitable provision of surgery ; and patients’ resignation, acceptance, and resilience in the face of hardship. Many patients receiving non-operative treatment described the devastating financial burden imposed upon them and their families by their injury and prolonged hospitalization. They felt they were receiving inferior treatment compared to surgery and suspected that richer patients were receiving more timely care. Conclusion: This qualitative study suggests a need to standardize care for FSF in Malawi, increase availability and timeliness of surgery, and increase transparency and communication between providers and patients. These remedies should focus on improving quality of care and achieving equity in access to care.
- Published
- 2020
223. Short-Term Surgical Missions: Role of Pharmacist Volunteers
- Author
-
Jeffrey N. Katz, Roya Ghazinouri, Megan E Barra, Luis Alcantara Abreu, Anne M. McDonnell, and Thomas S. Thornhill
- Subjects
Volunteers ,Accrual ,health care facilities, manpower, and services ,education ,Pharmacist ,Pharmacy ,Pharmacists ,030226 pharmacology & pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Professional Role ,Clinical support ,Health care ,Medicine ,Humans ,Pharmacology (medical) ,In patient ,030212 general & internal medicine ,health care economics and organizations ,Specialized knowledge ,business.industry ,Medical Missions ,social sciences ,medicine.disease ,Purchasing ,Pharmaceutical Services ,Medical emergency ,business - Abstract
Health care professionals often participate in short-term surgical missions in underserved areas of the world. Surgical missions often rely on the use of medications to provide health care to these underserved areas in patients with multiple comorbid conditions. The direct role a pharmacist may have in surgical missions is not well described in the literature; however, numerous opportunities exist for pharmacist involvement to improve patient care and operational processes throughout medication planning and delivery of surgical missions. Pharmacists have specialized knowledge in medication acquisition, preparation, and distribution that result in a unique position to contribute positively to the mission’s clinical and operational dynamics. Pharmacists may assist in various activities such as medication ordering, accrual, purchasing and preparing during the surgical mission. Pharmacists may also provide clinical support and offer alternative medications in the setting of drug intolerance or allergies. In 2008, Operation Walk Boston, a short-term surgical mission was established to provide hip and knee joint replacements to patients in the Dominican Republic. Pharmacists and pharmacy residents play a crucial role as members of this surgical mission. Based on our experience, this article aims to describe the evolving role of pharmacists as a member of a surgical mission.
- Published
- 2020
224. Comparing pet and detection dogs (Canis familiaris) on two aspects of social cognition
- Author
-
Gopikrishna Deshpande, Andie M Thompkins, Lucia Lazarowski, Sarah Krichbaum, L. Paul Waggoner, and Jeffrey S. Katz
- Subjects
Social Cognition ,Cognitive Neuroscience ,Experimental and Cognitive Psychology ,Communicative behavior ,Task (project management) ,03 medical and health sciences ,Behavioral Neuroscience ,0302 clinical medicine ,Dogs ,Social cognition ,Working Dogs ,Selection (linguistics) ,Animals ,0501 psychology and cognitive sciences ,050102 behavioral science & comparative psychology ,Human society ,Problem Solving ,biology ,Behavior, Animal ,Gestures ,05 social sciences ,biology.organism_classification ,Canis ,Cues ,Psychology ,030217 neurology & neurosurgery ,Cognitive psychology ,Gesture - Abstract
Interspecific communication between dogs and humans enables dogs to occupy significant roles in human society, both in companion and working roles. Dogs excel at using human communicative signals in problem-solving tasks, and solicit human contact when unable to solve a problem. Dogs’ sociocognitive behavior likely results from a selection for attention to humans during domestication, but is highly susceptible to environmental factors. Training for particular tasks appears to enhance dog–human communication, but effects may depend on the nature of the relationship determined by their role. Our aim was to examine two types of social cognition (responsiveness to human gestures, and human-directed communicative behavior in an unsolvable task) in pet dogs (n = 29) and detection dogs (n = 35). The groups did not differ in their ability to follow human signals, but pets were less responsive to signals given by a stranger than by their owner. Pets also exhibited more human-directed gazing in the unsolvable task, showing a bias for gazing at their owner compared with the stranger, whereas detection dogs showed greater persistence in attempting to solve the task compared with pets. Thus, different aspects of dogs’ sociocognitive behavior may differentially vary as a function of selection or training for particular roles.
- Published
- 2020
225. Designing a Participatory Total Worker Health® Organizational Intervention for Commercial Construction Subcontractors to Improve Worker Safety, Health, and Well-Being: The 'ARM for Subs' Trial
- Author
-
Jeffrey N. Katz, Justin Manjourides, Susan Peters, Hao D Trieu, and Jack T. Dennerlein
- Subjects
Process management ,health promotion ,Health, Toxicology and Mutagenesis ,Psychological intervention ,Article ,03 medical and health sciences ,0302 clinical medicine ,Population Groups ,Vetting ,Humans ,030212 general & internal medicine ,musculoskeletal pain ,Organizations ,construction industry ,Public Health, Environmental and Occupational Health ,Stakeholder ,Capacity building ,030210 environmental & occupational health ,Focus group ,stomatognathic diseases ,Intervention (law) ,Health promotion ,workplace ,ergonomics ,Needs assessment ,occupational health ,Business ,Needs Assessment - Abstract
Background: Evidence supports organizational interventions as being effective for improving worker safety, health and well-being, however, there is a paucity of evidence-based interventions for subcontracting companies in commercial construction. Methods: A theory-driven approach supplemented by formative research through key stakeholder interviews and focus groups and an iterative vetting process with stakeholders, resulted in the development of an intervention for subcontractors in the commercial construction industry. We piloted the intervention in one subcontracting commercial construction company. We used these findings to adapt and finalize the intervention design to be tested in a future large-scale trial. Results: There were several key findings from the formative research, including challenges faced by companies and assets that should be considered in the intervention design. This resulted in a communication infrastructure company-based, continual improvement, participatory intervention design, consisting of a needs assessment and report, committee-led prioritization, action planning and implementation, and worker communication/feedback cycle. The pilot contributed to the final intervention design with modifications made with respect to timing, implementation support, capacity building, adaptability and sustainability. Conclusions: The use of a theory-driven participatory approach to developing an integrated organizational intervention for commercial construction subcontracting companies was important and necessary. It allowed us to consider the empirical evidence and relevant theories and tailor these to meet the needs of our target population. This study gives pragmatic insight into the early development of a complex intervention, with practical experience of how we adapted our intervention at each stage. This intervention will be tested in a future randomized trial.
- Published
- 2020
226. Cost-effectiveness of duloxetine for knee OA subjects: the role of pain severity
- Author
-
David J. Hunter, Elena Losina, Edward H. Yelin, Jeffrey N. Katz, Robert R. Edwards, Jamie L. Huizinga, Tuhina Neogi, and James K. Sullivan
- Subjects
0301 basic medicine ,musculoskeletal diseases ,medicine.medical_specialty ,WOMAC ,Cost effectiveness ,Cost-Benefit Analysis ,Total knee replacement ,Biomedical Engineering ,Pain relief ,Osteoarthritis ,Duloxetine Hydrochloride ,Article ,Injections, Intra-Articular ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Rheumatology ,medicine ,Duloxetine ,Humans ,Orthopedics and Sports Medicine ,Computer Simulation ,Arthroplasty, Replacement, Knee ,Glucocorticoids ,health care economics and organizations ,Aged ,Pain Measurement ,030203 arthritis & rheumatology ,Analgesics ,business.industry ,Middle Aged ,Osteoarthritis, Knee ,medicine.disease ,humanities ,Analgesics, Opioid ,030104 developmental biology ,chemistry ,Pain severity ,Physical therapy ,Quality-Adjusted Life Years ,business ,Medical costs - Abstract
OBJECTIVE: Establish the impact of pain severity on the cost-effectiveness of generic duloxetine for knee osteoarthritis (OA) in the United States. DESIGN: We used a validated computer simulation of knee OA to compare usual care (UC) – intra-articular injections, opioids, and total knee replacement (TKR) - to UC preceded by duloxetine in those no longer achieving pain relief from non-steroidal anti-inflammatory drugs (NSAIDs). Outcomes included quality-adjusted life years (QALYs), lifetime medical costs, and incremental cost-effectiveness ratios (ICERs). We considered cohorts with mean ages 57–75 years and Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain 25–55 (0–100, 100-worst). We derived inputs from published data. We discounted costs and benefits 3% annually. We conducted sensitivity analyses of duloxetine efficacy, duration of pain relief, toxicity, and costs. RESULTS: Among younger subjects with severe pain (WOMAC pain=55), duloxetine led to an additional 9.6 QALYs per 1000 subjects (ICER=$88,500/QALY). The likelihood of duloxetine being cost-effective at willingness-to-pay (WTP) thresholds of $50,000/QALY and $100,000/QALY was 40% and 54%. Offering duloxetine to older patients with severe pain led to ICERs >$150,000/QALY. Offering duloxetine to subjects with moderate pain (pain=25) led to ICERs $88,500/QALY.
- Published
- 2020
227. Contralateral Transfalcine Approach to Deep Parasagittal Arteriovenous Malformations-Technical Note
- Author
-
Amir R. Dehdashti, Ivo Peto, Henry Woo, Mohsen Nouri, and Jeffrey M. Katz
- Subjects
Adult ,Intracranial Arteriovenous Malformations ,Male ,medicine.medical_specialty ,Eloquent Brain Areas ,Complete resection ,Neurosurgical Procedures ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Gyrus ,Modified Rankin Scale ,medicine ,Humans ,Surgical approach ,business.industry ,Arteriovenous malformation ,Technical note ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Arteriovenous Fistula ,Surgery ,Female ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery ,Brain retraction - Abstract
Background Resection of deep medial frontal and parietal arteriovenous malformations (AVMs) is often challenging due to a tangential angle of attack and deep, narrow working corridor. Adequate visualization of the AVM and its feeding arteries without brain retraction is of particular importance when operating in or near eloquent cortical areas, where brain manipulation could inadvertently result in neurologic deficits. The aim of this paper is to provide a step-by-step description of surgical approach and report our experience with the contralateral transfalcine approach for resection of deep-seated parasagittal AVMs. Methods Contralateral transfalcine resection of deep frontal, parietal, and cingulate gyrus AVMs was performed with the unaffected hemisphere positioned in a gravity-dependent manner in 5 cases. Surgical procedures were video documented, and an illustrative case is presented. All 5 patients had a modified Rankin Scale score of 0 or 1 at the last follow-up. Results Complete resection of the AVM was achieved in all 5 cases. No permanent major neurologic deficit was observed postoperatively. This approach allowed a superior visualization of arterial feeders, the parenchymal side of the AVM, and an early control of small parenchymal feeders while minimizing retraction of the brain. Conclusions The contralateral transfalcine approach is a useful technique in the cerebrovascular surgeon’s armamentarium for management of deep-seated medial frontal, parietal, and cingulate gyrus AVMs in or around eloquent brain areas, allowing to minimize normal brain retraction and avoid associated neurologic deficits.
- Published
- 2020
228. Palliative Care Consultations in Trauma Patients and Role of Do-Not-Resuscitate Orders: Propensity-Matched Study
- Author
-
Susan Koff, Richard L. Teitzman, Ivan Puente, Jeffrey K. Katz, Joanna Wycech, Alexander A Fokin, and Alexander Tymchak
- Subjects
medicine.medical_specialty ,Palliative care ,business.industry ,Palliative Care ,030208 emergency & critical care medicine ,General Medicine ,Do Not Resuscitate Order ,03 medical and health sciences ,0302 clinical medicine ,Trauma Centers ,030220 oncology & carcinogenesis ,medicine ,Humans ,Intensive care medicine ,business ,Referral and Consultation ,Resuscitation Orders ,Retrospective Studies - Abstract
Objective: To delineate characteristics of trauma patients associated with a palliative care consultation (PCC) and to analyze the role of do-not-resuscitate (DNR) orders and related outcomes. Methods: Retrospective study included 864 patients from 2 level one trauma centers admitted between 2012 and 2019. Level 1 trauma centers are designated for admission of the most severe injured patients. Palliative care consultation group of 432 patients who received PCC and were compared to matched control (MC) group of 432 patients without PCC. Propensity matching covariates included Injury Severity Score, mechanism of injury, gender, and hospital length of stay (HLOS). Analysis included patient demographics, injury parameters, intensive care unit (ICU) admissions, ICU length of stay (ICULOS), duration of mechanical ventilation, timing of PCC and DNR, and mortality. Palliative care consultation patients were further analyzed based on DNR status: prehospital DNR, in-hospital DNR, and no DNR (NODNR). Results: Palliative care consultation compared to MC patients were older, predominantly Caucasian, with more frequent traumatic brain injury (TBI), ICU admissions, and mechanical ventilation. The average time to PCC was 5.3 days. Do-not-resuscitate orders were significantly more common in PCC compared to MC group (71.5% vs 11.1%, P < .001). Overall mortality was 90.7% in PCC and 6.0% in MC ( P < .001). In patients with DNR, mortality was 94.2% in PCC and 18.8% in MC. In-hospital DNR-PCC compared to NODNR-PCC patients had shorter ICULOS (5.0 vs 7.3 days, P = .04), HLOS (6.2 vs 13.2 days, P = .006), and time to discharge (1.0 vs 6.3 days, P = .04). Conclusions: Advanced age, DNR order, and TBI were associated with a PCC in trauma patients and resulted in significantly higher mortality in PCC than in MC patients. Combination of DNR and PCC was associated with shorter ICULOS, HLOS, and time from PCC to discharge.
- Published
- 2020
229. A Provider Perspective of Psychosocial Predictors of Upper-Extremity Vascularized Composite Allotransplantation Success
- Author
-
Nora K. Lenhard, Sarah Kinsley, Sejal B. Shah, Robert R. Edwards, Emma E Williams, Simon G. Talbot, and Jeffrey N. Katz
- Subjects
Vascularized Composite Allotransplantation ,Coping (psychology) ,business.industry ,Focus group ,Transplantation ,Upper Extremity ,Social support ,Nursing ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Thematic analysis ,business ,Psychosocial ,Qualitative research - Abstract
Purpose We performed a qualitative study to understand the psychosocial factors associated with success in upper-extremity vascularized composite allotransplantation from the perspective of transplant providers. Methods We recruited 13 providers actively involved in upper-extremity vascularized composite allotransplantation. Participants included physicians, nurses, social workers, occupational therapists, and research administrators. We conducted semistructured face-to-face focus group interviews using a guide that explored providers’ perceptions of qualities contributing to transplant outcome. Topics included social support networks and their influence on recovery, barriers to treatment compliance and successful posttransplant rehabilitation, and the process of setting patients’ expectations. We performed a thematic analysis that produced a list of themes, subthemes, and proposed hypotheses explaining how the themes related to the study’s guiding questions. Results The analysis identified numerous factors that contribute to transplant success: (1) recipients’ prior experiences modify their ability to cope and adapt after transplantation, (2) behaviors and characteristics such as positivity influence candidacy and may be predictive of successful outcomes, and (3) social support is essential for improved function and compliance. The provider care team cited difficulty in predicting recipient compliance and in setting realistic expectations. Conclusions Motivated recipients with developed coping and resiliency, a positive attitude, and stable, physically-able caregivers are perceived by providers to have greater success after transplantation. Clinical Relevance Findings from this work may help providers determine optimal candidates for upper-extremity vascularized composite allotransplantation.
- Published
- 2020
230. Long-term clinical and economic outcomes of a short-term physical activity program in knee osteoarthritis patients
- Author
-
Elena Losina, James K. Sullivan, Jeffrey N. Katz, Genevieve S. Silva, Stephen P. Messier, and David J. Hunter
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Time Factors ,Cost effectiveness ,Cost-Benefit Analysis ,Population ,Biomedical Engineering ,Physical activity ,Osteoarthritis ,Health benefits ,Article ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Quality of life ,Medicine ,Humans ,Orthopedics and Sports Medicine ,education ,Exercise ,health care economics and organizations ,030203 arthritis & rheumatology ,education.field_of_study ,business.industry ,Models, Theoretical ,Osteoarthritis, Knee ,medicine.disease ,Economic benefits ,030104 developmental biology ,Treatment Outcome ,Physical therapy ,Quality of Life ,business ,Medical costs - Abstract
Summary Objective Physical activity (PA) in the US knee osteoarthritis (OA) population is low, despite well-established health benefits. PA program implementation is often stymied by sustainability concerns. We sought to establish parameters that would make a short-term (3-year efficacy) PA program a cost-effective component of long-term OA care. Method Using a validated computer microsimulation (Osteoarthritis Policy Model), we examined the long-term clinical (e.g., comorbidities averted), quality of life (QoL), and economic impacts of a 3-year PA program, based upon the SPARKS (Studying Physical Activity Rewards after Knee Surgery) Trial, for inactive knee OA patients. We determined the cost, efficacy, and impact of PA on QoL and medical costs that would make a PA program a cost-effective addition to OA care. Results Among the 14 million with knee OA in the US, >4 million are inactive. Participation of 10% in the modeled PA program could save 200 cases of cardiovascular disease, 400 cases of diabetes, and 6,800 quality-adjusted life-years (QALYs). The program had an incremental cost-effectiveness ratio (ICER) of $16,100/QALY. Tripling PA program cost ($860/year) raised the ICER to $108,300/QALY; varying QoL benefits from PA yielded ICERs of $8,800/QALY–$99,900/QALY; varying background cost savings from PA did not qualitatively impact ICERs. Offering the PA program to any adults with knee OA (not only inactive) yielded $31,000/QALY. Conclusion A PA program with 3-year efficacy in the knee OA population carried favorable long-term clinical and economic benefits. These results offer justification for policymakers and payers considering a PA intervention incorporated into knee OA care.
- Published
- 2020
231. Convergent Strategy for the Synthesis of Oxa-, Thia-, and Selena[5]helicenes by Acetylene-Activated S
- Author
-
Samuel M, Hoenig, Youmian, Yan, Emily A, Dougherty, Reuben, Hudson, Sava, Petovic, Christopher K, Lee, Yusheng, Hu, Lucas S, Gomez, and Jeffrey L, Katz
- Abstract
A tandem acetylene-activated S
- Published
- 2020
232. Abstract P258: Factors Associated With Imaging Choice of Acute Ischemic Stroke Patients and the Related Health Outcomes
- Author
-
Angela Hoang, Gabriela Martinez, Jason J Wang, Jeffrey M. Katz, Pina C. Sanelli, and Artem Boltyenkov
- Subjects
medicine.medical_specialty ,business.industry ,Perfusion scanning ,Population health ,medicine.disease ,Health outcomes ,Physiology (medical) ,Emergency medicine ,Health care ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Stroke ,Acute ischemic stroke - Abstract
Introduction: Acute ischemic stroke (AIS) presents an ongoing challenge for population health and availability of healthcare resources. Imaging plays a critical role in both diagnosis and treatment decisions in AIS, but optimal utilization regarding advanced imaging with angiography and perfusion using either CTAP or MRAP remain uncertain according to national guidelines. Consequently, wide variation in AIS imaging exists in clinical practice, mostly defaulted to physician preferences and institutional factors, without a clear understanding of the benefits and risks involved in stroke care. Although CTAP and MRAP each have unique benefits and risks in the AIS setting, the effect of this risk-benefit tradeoff on health outcomes and utilization of resources is unknown. This study analyses the factors associated with imaging preferences and the related health outcomes. Method: We performed a retrospective study on an AIS registry consisting of consecutive patients admitted to our institution from November 1, 2011, through October 1, 2018. Imaging and treatment selections and modified Rankin Score (mRS) at discharge were the main outcomes. Independent variables include age, gender, race-ethnicity, and NIH stroke score (NIHSS) at admission. Multivariable logistic regression models were performed. P Results: 1884 patients with curated imaging data during hospitalization were included. Among them, 32% were ≥80 years old, 47.4% female, 15.53% black, 60.3% white, and 24.4% with NIHSS≥10 at admission. CTAP and MRAP were performed in 21.1% and 72.2% patients, respectively. 46.1% received thrombolytics (IV-tPA), 1.3% had endovascular therapy (EVT), and 52.7% were not treated. The two clinical outcomes were independent functionality at discharge (mRS0-2) at 48.4%, and patients expired in hospital at 7.1%. Adjusted by all the factors, regression models showed that patients with NIHSS≥10 were more likely to receive CTAP (p Conclusion: Higher NIHSS was positively associated with mortality and utilization of CTAP, while it is negatively associated with MRAP. MRAP was positively related to independent functionality at discharge. Older age was negatively associated with CTAP or MRAP utilization.
- Published
- 2020
233. Mobile health clinics in the United States
- Author
-
Caterina Hill, Jennifer Bennet, Nelson C. Malone, Mary C. Smith Fawzi, Mollie M. Williams, Nancy E. Oriol, and Jeffrey N. Katz
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Population health ,Health Services Accessibility ,Mobile health unit ,03 medical and health sciences ,Social determinants of health ,Young Adult ,0302 clinical medicine ,Health care ,medicine ,Ethnicity ,Humans ,030212 general & internal medicine ,Child ,Health policy ,Minority Groups ,Mobile clinics ,Medically Uninsured ,030505 public health ,Primary Health Care ,business.industry ,Health Policy ,Public health ,lcsh:Public aspects of medicine ,Research ,Financing, Organized ,Racial Groups ,Public Health, Environmental and Occupational Health ,Health services research ,Infant ,lcsh:RA1-1270 ,Middle Aged ,Health equity ,United States ,Socioeconomic Factors ,Family medicine ,Child, Preschool ,Mobile clinic ,Health care access ,Female ,Business ,Health disparities ,0305 other medical science ,Mobile Health Units - Abstract
Background Mobile health clinics serve an important role in the health care system, providing care to some of the most vulnerable populations. Mobile Health Map is the only comprehensive database of mobile clinics in the United States. Members of this collaborative research network and learning community supply information about their location, services, target populations, and costs. They also have access to tools to measure, improve, and communicate their impact. Methods We analyzed data from 811 clinics that participated in Mobile Health Map between 2007 and 2017 to describe the demographics of the clients these clinics serve, the services they provide, and mobile clinics’ affiliated institutions and funding sources. Results Mobile clinics provide a median number of 3491 visits annually. More than half of their clients are women (55%) and racial/ethnic minorities (59%). Of the 146 clinics that reported insurance data, 41% of clients were uninsured while 44% had some form of public insurance. The most common service models were primary care (41%) and prevention (47%). With regards to organizational affiliations, they vary from independent (33%) to university affiliated (24%), while some (29%) are part of a hospital or health care system. Most mobile clinics receive some financial support from philanthropy (52%), while slightly less than half (45%) receive federal funds. Conclusion Mobile health care delivery is an innovative model of health services delivery that provides a wide variety of services to vulnerable populations. The clinics vary in service mix, patient demographics, and relationships with the fixed health system. Although access to care has increased in recent years through the Affordable Care Act, barriers continue to persist, particularly among populations living in resource-limited areas. Mobile clinics can improve access by serving as a vital link between the community and clinical facilities. Additional work is needed to advance availability of this important resource.
- Published
- 2020
234. Animal Cognition
- Author
-
Sarah Krichbaum, Adam Davila, Lucia Lazarowski, and Jeffrey S. Katz
- Abstract
The contemporary field of animal cognition began over 150 years ago when Charles Darwin posed questions regarding the abilities of the animal mind. Animal cognition is a science dedicated to understanding the processes and mechanisms that allow nonhumans to think and behave. The techniques that are used and the species that are studied are diverse. The historical questions originally proposed by ethologist Nikolas Tinbergen as a framework for studying animal behavior remain at the core of the field. These questions are reviewed along with the domains and methods of animal cognition with a focus on concept learning, memory, and canine cognition. Finally, ideas on how a field rich in tradition and methodological strength should proceed in the future are presented.
- Published
- 2020
235. Reply
- Author
-
Elena Losina, Savannah R. Smith, and Jeffrey N. Katz
- Subjects
medicine.medical_specialty ,business.industry ,Cost-Benefit Analysis ,Total knee arthroplasty ,Anticoagulants ,Health Services ,Rheumatology ,Intervention (counseling) ,Internal medicine ,Medicine ,Humans ,Limit (mathematics) ,Postoperative Period ,business ,Arthroplasty, Replacement, Knee ,Event (probability theory) - Published
- 2020
236. MALINI (Machine Learning in NeuroImaging): A MATLAB toolbox for aiding clinical diagnostics using resting-state fMRI data
- Author
-
Michael N. Dretsch, Gopikrishna Deshpande, Pradyumna Lanka, D. Rangaprakash, Jeffrey S. Katz, Sai Sheshan Roy Gotoor, and Thomas S. Denney
- Subjects
Resting-state functional MRI ,Computer science ,Autism ,Feature extraction ,Machine learning ,computer.software_genre ,lcsh:Computer applications to medicine. Medical informatics ,03 medical and health sciences ,Functional connectivity ,0302 clinical medicine ,Neuroimaging ,medicine ,ADHD ,Supervised machine learning ,lcsh:Science (General) ,030304 developmental biology ,Diagnostic classification ,0303 health sciences ,Multidisciplinary ,Resting state fMRI ,medicine.diagnostic_test ,business.industry ,PTSD ,Alzheimer's disease ,medicine.disease ,Toolbox ,Computer Science ,lcsh:R858-859.7 ,Artificial intelligence ,business ,Functional magnetic resonance imaging ,computer ,030217 neurology & neurosurgery ,Population variance ,Test data ,lcsh:Q1-390 - Abstract
Resting-state functional Magnetic Resonance Imaging (rs-fMRI) has been extensively used for diagnostic classification because it does not require task compliance and is easier to pool data from multiple imaging sites, thereby increasing the sample size. A MATLAB-based toolbox called Machine Learning in NeuroImaging (MALINI) for feature extraction and disease classification is presented. The MALINI toolbox extracts functional and effective connectivity features from preprocessed rs-fMRI data and performs classification between healthy and disease groups using any of 18 popular and widely used machine learning algorithms that are based on diverse principles. A consensus classifier combining the power of multiple classifiers is also presented. The utility of the toolbox is illustrated by accompanying data consisting of resting-state functional connectivity features from healthy controls and subjects with various brain-based disorders: autism spectrum disorder from autism brain imaging data exchange (ABIDE), Alzheimer's disease and mild cognitive impairment from Alzheimer's disease neuroimaging initiative (ADNI), attention deficit hyperactivity disorder from ADHD-200, and post-traumatic stress disorder and post-concussion syndrome acquired in-house. Results of classification performed on the above datasets can be obtained from the main article titled “Supervised machine learning for diagnostic classification from large-scale neuroimaging datasets” [1]. The data was divided into homogeneous and heterogeneous splits, such that 80% could be used for training, model building and cross-validation, while the remaining 20% of the data could be used as a hold-out independent test data for replication of the classification performance, to ensure the robustness of the classifiers to population variance in image acquisition site and age of the sample. Keywords: Resting-state functional MRI, Supervised machine learning, Diagnostic classification, Functional connectivity, Autism, ADHD, Alzheimer's disease, PTSD
- Published
- 2020
237. Design Features and Rationale of the BEAR-MOON (Bridge-Enhanced ACL Restoration Multicenter Orthopaedic Outcomes Network) Randomized Clinical Trial
- Author
-
Kurt P, Spindler, Peter B, Imrey, Sercan, Yalcin, Gerald J, Beck, Gary, Calbrese, Charles L, Cox, Paul D, Fadale, Lutul, Farrow, Robert, Fitch, David, Flanigan, Braden C, Fleming, Michael J, Hulstyn, Morgan H, Jones, Christopher, Kaeding, Jeffrey N, Katz, Peter, Kriz, Robert, Magnussen, Ellen, McErlean, Carrie, Melgaard, Brett D, Owens, Paul, Saluan, Greg, Strnad, Carl S, Winalski, and Rick, Wright
- Subjects
ACL reconstruction ,instrumented knee laxity ,Orthopedics and Sports Medicine ,ACL repair ,Article ,IKDC ,RCT - Abstract
Background: BEAR (bridge-enhanced anterior cruciate ligament [ACL] restoration), a paradigm-shifting technology to heal midsubstance ACL tears, has been demonstrated to be effective in a single-center 2:1 randomized controlled trial (RCT) versus hamstring ACL reconstruction. Widespread dissemination of BEAR into clinical practice should also be informed by a multicenter RCT to demonstrate exportability and compare efficacy with bone--patellar tendon–bone (BPTB) ACL reconstruction, another clinically standard treatment. Purpose: To present the design and initial preparation of a multicenter RCT of BEAR versus BPTB ACL reconstruction (the BEAR: Multicenter Orthopaedic Outcomes Network [BEAR-MOON] trial). Design and analytic issues in planning the complex BEAR-MOON trial, involving the US National Institute of Arthritis and Musculoskeletal and Skin Diseases, the US Food and Drug Administration, the BEAR implant manufacturer, a data and safety monitoring board, and institutional review boards, can usefully inform both clinicians on the trial’s strengths and limitations and future investigators on planning of complex orthopaedic studies. Study Design: Clinical trial. Methods: We describe the distinctive clinical, methodological, and operational challenges of comparing the innovative BEAR procedure with the well-established BPTB operation, and we outline the clinical motivation, experimental setting, study design, surgical challenges, rehabilitation, outcome measures, and planned analysis of the BEAR-MOON trial. Results: BEAR-MOON is a 6-center, 12-surgeon, 200-patient randomized, partially blinded, noninferiority RCT comparing BEAR with BPTB ACL reconstruction for treating first-time midsubstance ACL tears. Noninferiority of BEAR relative to BPTB will be claimed if the total score on the International Knee Documentation Committee (IKDC) subjective knee evaluation form and the knee arthrometer 30-lb (13.61-kg) side-to-side laxity difference are both within respective margins of 16 points for the IKDC and 2.5 mm for knee laxity. Conclusion: Major issues include patient selection, need for intraoperative randomization and treatment-specific postoperative physical therapy regimens (because of fundamental differences in surgical technique, initial stability construct, and healing), and choice of noninferiority margins for short-term efficacy outcomes of a novel intervention with evident short-term advantages and theoretical, but unverified, long-term benefits on other dimensions.
- Published
- 2022
238. Adipokine hormones and hand osteoarthritis: radiographic severity and pain.
- Author
-
Mei Massengale, Bing Lu, John J Pan, Jeffrey N Katz, and Daniel H Solomon
- Subjects
Medicine ,Science - Abstract
Obesity's association with hand osteoarthritis cannot be fully explained by mechanical loading. We examined the relationship between adipokines and radiographic hand osteoarthritis severity and pain.In a pilot study of 44 hand osteoarthritis patients (39 women and 5 men), serum adipokine concentrations and hand x-ray Kallman-scores were analyzed using linear regression models. Secondary analyses examined correlates of hand pain.The cohort had a mean age of 63.5 years for women and 72.6 for men; mean (standard deviation) Kallman-scores were 43.3(17.4) for women and 46.2(10.8) for men. Mean body-mass-index was 30 kg/m(2) for women and men. Mean leptin concentration was 32.2 ng/ml (women) and 18.5 ng/ml (men); mean adiponectin-total was 7.9 ng/ml (women) and 5.3 ng/ml (men); mean resistin was 7.3 ng/ml (women) and 9.4 ng/ml (men). No association was found between Kallman-scores and adipokine concentrations (R(2) = 0.00-0.04 unadjusted analysis, all p-values>0.22). Secondary analyses showed mean visual-analog-scale pain of 4.8(2.4) for women and 6.6(0.9) for men. Leptin, BMI, and history of coronary artery disease were found to be associated with visual-analog-scale scores for chronic hand pain (R(2) = 0.36 unadjusted analysis, p-values≤0.04).In this pilot study, we found that adipokine serum concentrations were not associated with hand osteoarthritis radiographic severity; the most important correlates of joint damage were age and disease duration. Leptin serum concentration, BMI, and coronary artery disease were associated with the intensity of chronic hand OA pain.
- Published
- 2012
- Full Text
- View/download PDF
239. Separate brain areas for processing human and dog faces as revealed by awake fMRI in dogs (Canis familiaris)
- Author
-
Bhavitha Ramaiahgari, Andie M Thompkins, Sinan Zhao, Thomas S. Denney, Gopikrishna Deshpande, Jeffrey S. Katz, Sai Sheshan Roy Gotoor, and Paul Waggoner
- Subjects
Male ,0301 basic medicine ,Cognitive Neuroscience ,Experimental and Cognitive Psychology ,behavioral disciplines and activities ,03 medical and health sciences ,Behavioral Neuroscience ,Superior temporal gyrus ,Dogs ,0302 clinical medicine ,medicine ,Animals ,Humans ,Wakefulness ,Valence (psychology) ,Temporal cortex ,Brain Mapping ,Resting state fMRI ,biology ,medicine.diagnostic_test ,Functional Neuroimaging ,Recognition, Psychology ,Cognition ,biology.organism_classification ,Magnetic Resonance Imaging ,Temporal Lobe ,Facial Expression ,030104 developmental biology ,Canis ,Neural processing ,Female ,Psychology ,Functional magnetic resonance imaging ,Facial Recognition ,Neuroscience ,030217 neurology & neurosurgery - Abstract
Functional magnetic resonance imaging (fMRI) has emerged as a viable method to study the neural processing underlying cognition in awake dogs. Working dogs were presented with pictures of dog and human faces. The human faces varied in familiarity (familiar trainers and unfamiliar individuals) and emotional valence (negative, neutral, and positive). Dog faces were familiar (kennel mates) or unfamiliar. The findings revealed adjacent but separate brain areas in the left temporal cortex for processing human and dog faces in the dog brain. The human face area (HFA) and dog face area (DFA) were both parametrically modulated by valence indicating emotion was not the basis for the separation. The HFA and DFA were not influenced by familiarity. Using resting state fMRI data, functional connectivity networks (connectivity fingerprints) were compared and matched across dogs and humans. These network analyses found that the HFA mapped onto the human fusiform area and the DFA mapped onto the human superior temporal gyrus, both core areas in the human face processing system. The findings provide insight into the evolution of face processing.
- Published
- 2018
240. Toward the Selection of Sustainable Catalysts for Suzuki–Miyaura Coupling: A Gate-to-Gate Analysis
- Author
-
Jeffrey L. Katz and Reuben Hudson
- Subjects
Materials science ,010405 organic chemistry ,Renewable Energy, Sustainability and the Environment ,General Chemical Engineering ,Aryl ,chemistry.chemical_element ,General Chemistry ,010402 general chemistry ,01 natural sciences ,Combinatorial chemistry ,Chloride ,0104 chemical sciences ,Catalysis ,chemistry.chemical_compound ,chemistry ,Coupling (computer programming) ,Suzuki reaction ,Reagent ,medicine ,Environmental Chemistry ,Phenylboronic acid ,medicine.drug ,Palladium - Abstract
Reports of homogeneous and heterogeneous methods for Pd-catalyzed Suzuki–Miyaura coupling provide a vast data set to establish sustainability targets and parameters for future catalyst development. In this gate-to-gate inventory we estimate energy and palladium usage along with reaction mass efficiency (RME) for a range of palladium catalysts (both single- and multiuse) for the generation of (a) 4-phenylphenol from 4-iodophenol and phenylboronic acid or (b) 4-methoxybiphenyl from 4-chloroanisole and phenylboronic acid. Small differences were found in calculated energy usage, RME values, and non-palladium reagent toxicities. Palladium usage, however, varied substantially and stood out as the main differentiating consideration from a sustainability standpoint. Reusable heterogeneous catalysts still use more palladium when compared to ultra-low-loading homogeneous techniques that are effective for conversion of aryl iodides. For aryl chloride substrates, highly active and reusable heterogeneous catalysts bec...
- Published
- 2018
241. Structural Modification in Osteoarthritis: Dawn of a New Day?
- Author
-
Jeffrey N. Katz
- Subjects
medicine.medical_specialty ,Urology ,Osteoarthritis ,Placebo ,01 natural sciences ,Bone resorption ,Bone remodeling ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal Medicine ,Cathepsin K ,Medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,biology ,business.industry ,Cartilage ,010102 general mathematics ,General Medicine ,medicine.disease ,medicine.anatomical_structure ,Osteocalcin ,biology.protein ,business - Abstract
Conaghan and colleagues report the findings of a randomized trial comparing placebo with 2 different doses of MIV-711, a reversible inhibitor of cathepsin K, in persons with moderately severe knee ...
- Published
- 2019
242. Patient Experiences of Decision-Making in the Treatment of Spinal Metastases: A Qualitative Study
- Author
-
Justin A. Blucher, Elena Losina, Jeffrey N. Katz, Andrew J. Schoenfeld, Joseph H. Schwab, Emma C. Lape, Genevieve S. Silva, Angela T. Chen, and Tracy A. Balboni
- Subjects
Male ,medicine.medical_specialty ,Decision Making ,Psychological intervention ,Context (language use) ,Disease ,Conservative Treatment ,Article ,03 medical and health sciences ,0302 clinical medicine ,Renal Dialysis ,Agency (sociology) ,medicine ,Humans ,Orthopedics and Sports Medicine ,Qualitative Research ,030222 orthopedics ,Spinal Neoplasms ,business.industry ,Treatment options ,Middle Aged ,Patient Outcome Assessment ,Family medicine ,Surgery ,Female ,Neurology (clinical) ,Thematic analysis ,Spinal metastases ,business ,030217 neurology & neurosurgery ,Qualitative research - Abstract
BACKGROUND In the treatment of spinal metastases the risks of surgery must be balanced against potential benefits, particularly in light of limited life-expectancy. Patient experiences and preferences regarding decision-making in this context are not well explored. PURPOSE We performed a qualitative study involving patients receiving treatment for spinal metastatic disease. We sought to understand factors that influenced decision-making around care for spinal metastases. STUDY SETTING Three tertiary academic medical centers. PATIENT SAMPLE We recruited patients presenting for treatment of spinal metastatic disease at one of three tertiary centers in Boston, MA. OUTCOME MEASURES We conducted semistructured interviews using a guide that probed participants’ experiences with making treatment decisions. METHODS We performed a thematic analysis that produced a list of themes, subthemes, and statement explaining how the themes related to the study's guiding questions. Patients were recruited until thematic saturation was reached. RESULTS We interviewed 23 participants before reaching thematic saturation. The enormity of treatment decisions, and of the diagnosis of spinal metastases itself, shaped participant preferences for who should take responsibility for the decision and whether to accept treatments bearing greater risk of complications. Pre-existing participant beliefs about decision-making and about surgery interacted with the clinical context in a way that tended to promote accepting physician recommendations and delaying or avoiding surgery. CONCLUSIONS The diagnosis of spinal metastatic disease played an outsized role in shaping participant preferences for agency in treatment decision-making. Further research should address strategies to support patient understanding of treatment options in clinical contexts—such as spinal metastases—characterized by ominous underlying disease and high-risk, often urgent interventions.
- Published
- 2019
243. Associations among knee muscle strength, structural damage, and pain and mobility in individuals with osteoarthritis and symptomatic meniscal tear
- Author
-
Clare E. Safran-Norton, Elena Losina, Brittney A. Luc-Harkey, Lisa A. Mandl, and Jeffrey N. Katz
- Subjects
Male ,medicine.medical_specialty ,Activities of daily living ,lcsh:Diseases of the musculoskeletal system ,Sports medicine ,Knee Joint ,medicine.medical_treatment ,Pain ,Osteoarthritis ,Quadriceps Muscle ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Activities of Daily Living ,Chi-square test ,medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Muscle Strength ,Timed up and go ,Mobility Limitation ,Range of Motion, Articular ,Aged ,Pain Measurement ,Hamstrings ,030203 arthritis & rheumatology ,Rehabilitation ,business.industry ,Middle Aged ,Osteoarthritis, Knee ,medicine.disease ,Tibial Meniscus Injuries ,Cross-Sectional Studies ,Quadriceps ,Quartile ,Orthopedic surgery ,Physical therapy ,Female ,lcsh:RC925-935 ,business ,human activities ,KOOS ,activities of daily living ,Research Article - Abstract
Background Sufficient lower extremity muscle strength is necessary for performing functional tasks, and individuals with knee osteoarthritis demonstrate thigh muscle weakness compared to controls. It has been suggested that lower muscle strength is associated with a variety of clinical features including pain, mobility, and functional performance, yet these relationships have not been fully explored in patients with symptomatic meniscal tear in addition to knee osteoarthritis. Our purpose was to evaluate the associations of quadriceps and hamstrings muscle strength with structural damage and clinical features in individuals with knee osteoarthritis and symptomatic meniscal tear. Methods We performed a cross-sectional study using baseline data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial. We assessed structural damage using Kellgren-Lawrence grade and the magnetic resonance imaging osteoarthritis knee score (MOAKS) for cartilage damage. We used the Knee Injury and Osteoarthritis Outcomes Score (KOOS) to evaluate pain, symptoms, and activities of daily living (ADL), and the Timed Up and Go (TUG) test to assess mobility. We assessed quadriceps and hamstrings strength using a hand-held dynamometer and classified each into quartiles (Q). We used Chi square tests to evaluate the association between strength and structural damage; and separate analysis of covariance models to establish the association between pain, symptoms, ADL and mobility with strength, after adjusting for demographic characteristics (age, sex and BMI) and structural damage. Results Two hundred fifty two participants were evaluated. For quadriceps strength, subjects in the strongest quartile scored 14 and 13 points higher on the KOOS Pain and ADL subscales, respectively, and completed the TUG two seconds faster than subjects in the weakest quartile. For hamstrings strength, subjects in the strongest quartile scored 13 and 14 points higher on the KOOS pain and ADL subscales, respectively, and completed the TUG two seconds faster than subjects in the weakest quartile. Strength was not associated with structural damage. Conclusions Greater quadriceps and hamstrings muscle strength was associated with less pain, less difficulty completing activities of daily living, and better mobility. These relationships should be evaluated longitudinally.
- Published
- 2018
244. Clinical classification criteria for neurogenic claudication caused by lumbar spinal stenosis. The N-CLASS criteria
- Author
-
Marc Marty, Kika Konstantinou, Thomas D. Cha, M. Norberg, James Rainville, Stéphane Genevay, Jean-François Kaux, Jeffrey N. Katz, Francisco M. Kovacs, Delphine S. Courvoisier, and Steven J. Atlas
- Subjects
Adult ,Male ,medicine.medical_specialty ,Context (language use) ,Physical examination ,Neurogenic claudication ,Severity of Illness Index ,03 medical and health sciences ,Spinal Stenosis ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,ddc:616 ,Neurologic Examination ,030203 arthritis & rheumatology ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Lumbosacral Region ,Lumbar spinal stenosis ,Cauda equina ,Intermittent Claudication ,Middle Aged ,medicine.disease ,R1 ,Low back pain ,medicine.anatomical_structure ,Radicular pain ,Physical therapy ,Female ,Surgery ,Neurology (clinical) ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Because imaging findings of lumbar spinal stenosis (LSS) may not be associated with symptoms, clinical classification criteria based on patient symptoms and physical examination findings are needed.The objective of this study was to develop clinical classification criteria that identify patients with neurogenic claudication (NC) caused by LSS.This study is a two-stage process that includes Phase 1, the Delphi process, and Phase 2, the cross-sectional study.Outpatients were recruited from spine clinics in five countries.The outcome measure includes items from the patients' history and physical examination.In Phase 1, a list of potential predictors of NC caused by LSS was based on the available literature and was evaluated through a Delphi process involving 17 spine specialists (surgeons and non-surgeons) from eight countries. In Phase 2, 19 different clinical spine specialists from five countries identified patients they classified as having (1) NC caused by LSS, (2) radicular pain caused by lumbar disc herniation (LDH), or (3) non-specific low back pain (NSLBP) with radiating leg pain. The patients completed survey items and the specialists documented the examination signs. Coefficients from general estimating equation models were used to select predictors, to generate a clinical classification score, and to obtain a receiver operating characteristic curve. Conduction of the Delphi process, data management, and statistical analysis were partially supported by an unrestricted grant of less than 15,000 US dollars from Merck SharpDohme. No fees were allocated to participating spine specialists.Phase 1 generated a final list of 46 items related to LSS. In Phase 2, 209 patients with leg pain caused by LSS (n=63), LDH (n=89), or NSLBP (n=57) were included. Criteria that independently predicted NC (p.05) were age over 60 years, positive 30-second extension test, negative straight leg test, pain in both legs, leg pain relieved by sitting, and leg pain decreased by leaning forward or flexing the spine. A classification score using a weighted set of these criteria was developed. The proposed N-CLASS score ranged from 0 to 19 and had an area under the curve of 0.92, and the cutoff (10/19) to obtain a specificity of90.0% resulted in a sensitivity of 82.0%.Clinical criteria independently associated with neurogenic claudication due to LSS were identified. The use of these symptom and physical variables as a classification score for clinical research could improve homogeneity among enrolled patients.
- Published
- 2018
245. Cost-effectiveness of generic celecoxib in knee osteoarthritis for average-risk patients: a model-based evaluation
- Author
-
Ilana M. Usiskin, Karen C. Smith, Elena Losina, Stephen P. Messier, A. D. Paltiel, James K. Sullivan, Savannah R. Smith, David J. Hunter, and Jeffrey N. Katz
- Subjects
Male ,musculoskeletal diseases ,Naproxen ,medicine.medical_specialty ,WOMAC ,Cost effectiveness ,Cost-Benefit Analysis ,Biomedical Engineering ,Osteoarthritis ,Article ,Drug Costs ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Internal medicine ,medicine ,Drugs, Generic ,Humans ,Computer Simulation ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Medical prescription ,health care economics and organizations ,Aged ,030203 arthritis & rheumatology ,business.industry ,Osteoarthritis, Knee ,medicine.disease ,Discontinuation ,Treatment Outcome ,Celecoxib ,Cohort ,Female ,business ,medicine.drug - Abstract
Summary Objective The cost-effectiveness of the recently-introduced generic celecoxib in knee OA has not been examined. Method We used the Osteoarthritis Policy (OAPol) Model, a validated computer simulation of knee OA, to evaluate long-term clinical outcomes, costs, and cost-effectiveness of generic celecoxib in persons with knee OA. We examined eight treatment strategies consisting of generic celecoxib, over-the-counter (OTC) naproxen, or prescription naproxen, with or without prescription or OTC proton-pump-inhibitors (PPIs) to reduce gastrointestinal (GI) toxicity. In the base case, we assumed that annual cost was $130 for OTC naproxen, $360 for prescription naproxen, and $880 for generic celecoxib. We considered a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) and discounted costs and benefits at 3% annually. In sensitivity analyses we varied celecoxib toxicity, discontinuation, cost, and pain level. Results In the base case analysis of the high pain cohort (WOMAC 50), celecoxib had an incremental cost-effectiveness ratio (ICER) of $284,630/QALY compared with OTC naproxen. Only under highly favorable cost, toxicity, and discontinuation assumptions (e.g., annual cost below $360, combined with a reduction in the cardiovascular (CV) event rates below baseline values) was celecoxib likely to be cost-effective. Celecoxib might also be cost-effective at an annual cost of $600 if CV toxicity were eliminated completely. In subjects with moderate pain (WOMAC 30), at the base case CV event rate of 0.2%, generic celecoxib was only cost-effective at the lowest plausible cost ($190). Conclusion In knee OA patients with no comorbidities, generic celecoxib is not cost-effective at its current price.
- Published
- 2018
246. Financial Incentives and Health Coaching to Improve Physical Activity Following Total Knee Replacement: A Randomized Controlled Trial
- Author
-
Griffin L. Michl, Heidi Y. Yang, Kristina Klara, Ilana M. Usiskin, Amelia R. Winter, Bhushan R. Deshpande, Savannah R. Smith, Elena Losina, Faith Selzer, Jamie E. Collins, and Jeffrey N. Katz
- Subjects
Male ,musculoskeletal diseases ,medicine.medical_specialty ,Health coaching ,medicine.medical_treatment ,Total knee replacement ,Physical activity ,Osteoarthritis ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Reward ,Rheumatology ,Financial incentives ,Randomized controlled trial ,law ,mental disorders ,medicine ,Humans ,Step count ,030212 general & internal medicine ,Arthroplasty, Replacement, Knee ,Exercise ,Aged ,030203 arthritis & rheumatology ,Motivation ,business.industry ,Mentoring ,Middle Aged ,medicine.disease ,Arthroplasty ,Treatment Outcome ,Physical therapy ,Female ,Guideline Adherence ,business - Abstract
Objective: Most persons who undergo total knee replacement (TKR) do not increase their physical activity following surgery. We assessed whether financial incentives and health coaching would improve physical activity in persons undergoing TKR. Methods: We designed a factorial randomized controlled trial among persons undergoing TKR for osteoarthritis. Subjects underwent normal perioperative procedures, including post-operative physical therapy, and were assigned to one of four arms: attention control, telephonic health coaching (THC), financial incentives (FI), or THC+FI. We objectively measured step counts and minutes of physical activity with a commercial accelerometer (Fitbit Zip) and compared the changes from pre-TKR to 6 months post-TKR across the four study arms. Results: Of the 202 randomized subjects, 150 (74%) provided both pre-TKR and 6 months post-TKR accelerometer data. Among completers, the average daily step count at 6 months ranged from 5619 (SD 381) in the THC arm to 7152 (SD 407) in the THC+FI arm (adjusting for baseline values). Daily step count 6 months post-TKR increased by 680 (95% CI: -94 – 1,454) in the control arm, 274 (95% CI: -473 – 1021) in the THC arm, 826 (95% CI: 89 – 1563) in the FI arm, and 1808 (95% CI: 1010 – 2606) in the THC+FI arm. Physical activity increased by 14 (SD 10), 14 (SD 10), 16 (SD 10), and 39 (SD 11) minutes in the control, THC, FI, and THC+FI arms, respectively. Conclusions: A dual THC+FI intervention led to substantial improvements in step count and physical activity following TKR. This article is protected by copyright. All rights reserved.
- Published
- 2018
247. Implementation of Treat-to-Target for Rheumatoid Arthritis in the US: Analysis of Baseline Data From a Randomized Controlled Trial
- Author
-
Elena Losina, Leslie R. Harrold, Zhi Yu, Asaf Bitton, Daniel H. Solomon, Cassandra Corrigan, Jeffrey N. Katz, Liana Fraenkel, Bing Lu, and Jenifer Agosti
- Subjects
Adult ,Male ,medicine.medical_specialty ,education ,MEDLINE ,Disease ,Article ,law.invention ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Randomized controlled trial ,law ,Internal medicine ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,030203 arthritis & rheumatology ,business.industry ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Rheumatoid arthritis ,Physical therapy ,Female ,Guideline Adherence ,business - Abstract
A treat-to-target (TTT) strategy is recommended in rheumatoid arthritis (RA). However, health care providers' adherence to TTT in clinical practice remains unclear. We examined adherence to TTT in RA at US rheumatology sites.We used baseline information from the randomized controlled Treat-to-Target in RA: Collaboration to Improve Adoption and Adherence trial, which recruited 641 patients from 46 providers practicing at 11 US sites. We obtained data on the implementation of TTT, patient covariates, provider characteristics, and site variables. We examined the implementation of TTT using 4 cardinal features: recording a disease target, recording a disease activity measure, engaging in shared decision-making, and changing treatment if not at disease target. These features were assessed across sites and providers. We calculated a TTT implementation score as the percentage of features noted. We examined the association between patient, provider, and site covariates and TTT implementation score using proportional odds models.The implementation of TTT at baseline was suboptimal: 64.3% of visits had none of the TTT components present, 33.1% had 1 component, 2.3% had 2 components, and 0.3% had all components. The implementation of TTT was significantly different across providers and sites (P0.0001 for all). In the multivariable model, we observed that more experience as a rheumatologist was associated with a higher implementation score (P = 0.01 for trend). Compared with fellows, providers with20 years of experience in practice were more likely to have more TTT components recorded (odds ratio 7.68 [95% confidence interval 1.46-40.52]).We found that adherence to a TTT strategy in RA was suboptimal, and it differed across providers and sites.
- Published
- 2018
248. Paediatric musculoskeletal disease in Kumi District, Uganda: a cross-sectional survey
- Author
-
Coleen S. Sabatini, Olive Kobusingye, Norgrove Penny, Robert Olupot, Kristin Alves, and Jeffrey N. Katz
- Subjects
Male ,Pediatrics ,Cross-sectional study ,Pediatric orthopaedics ,Cohort Studies ,0302 clinical medicine ,Cost of Illness ,Surveys and Questionnaires ,Prevalence ,Paralysis ,Uganda ,Orthopedics and Sports Medicine ,Musculoskeletal Diseases ,030212 general & internal medicine ,Child ,Pediatric ,education.field_of_study ,Pediatric musculoskeletal health ,Rehabilitation ,Child, Preschool ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,Infection ,medicine.medical_specialty ,Adolescent ,Clinical Sciences ,Population ,Article ,Cerebral palsy ,03 medical and health sciences ,Clinical Research ,Post-injection paralysis ,medicine ,Humans ,Preschool ,education ,Disease burden ,Retrospective Studies ,Muscle contracture ,Gluteal fibrosis ,business.industry ,Neurosciences ,Infant ,Retrospective cohort study ,medicine.disease ,Brain Disorders ,MSK burden ,Cross-Sectional Studies ,Orthopedics ,Musculoskeletal ,Orthopedic surgery ,Surgery ,business - Abstract
PurposeThe purpose of this study is to estimate the burden of musculoskeletal disease among children treated in Kumi District, Uganda, to inform training, capacity-building efforts, and resource allocation.MethodsWe conducted a retrospective cohort study by reviewing the musculoskeletal (MSK) clinic and community outreach logs for children (age
- Published
- 2018
249. Comparing cognition by integrating concept learning, proactive interference, and list memory
- Author
-
Jeffrey S. Katz, Debbie M. Kelly, and Anthony A. Wright
- Subjects
Nutcrackers ,Concept Formation ,Cognitive Neuroscience ,Event based ,Interference theory ,Experimental and Cognitive Psychology ,Stimulus (physiology) ,050105 experimental psychology ,Birds ,Discrimination Learning ,03 medical and health sciences ,Behavioral Neuroscience ,Cognition ,0302 clinical medicine ,Species Specificity ,Memory task ,Memory ,Concept learning ,Animals ,Learning ,0501 psychology and cognitive sciences ,biology ,05 social sciences ,Haplorhini ,biology.organism_classification ,Psychology ,030217 neurology & neurosurgery ,Cognitive psychology ,Delay time - Abstract
This article describes an approach for training a variety of species to learn the abstract concept of same/different, which in turn forms the basis for testing proactive interference and list memory. The stimulus set for concept-learning training was progressively doubled from 8, 16, 32, 64, 128 . . . to 1,024 different pictures with novel-stimulus transfer following learning. All species fully learned the same/different abstract concept: capuchin and rhesus monkeys learned more readily than pigeons; nutcrackers and magpies were at least equivalent to monkeys and transferred somewhat better following initial training sets. A similar task using the 1,024-picture set plus delays was used to test proactive interference on occasional trials. Pigeons revealed greater interference with 10-s than with 1-s delays, whereas delay time had no effect on rhesus monkeys, suggesting that the monkeys' interference was event based. This same single-item same/different task was expanded to a 4-item list memory task to test animal list memory. Humans were tested similarly with lists of kaleidoscope pictures. Delays between the list and test were manipulated, resulting in strong initial recency effects (i.e., strong 4th-item memory) at short delays and changing to a strong primacy effect (i.e., strong 1st-item memory) at long delays (pigeons 0-s to 10-s delays; monkeys 0-s to 30-s delays; humans 0-s to 100-s delays). Results and findings are discussed in terms of these species' cognition and memory comparisons, evolutionary implications, and future directions for testing other species in these synergistically related tasks.
- Published
- 2018
250. Prevalence and Risk Factors for Paroxysmal Atrial Fibrillation and Flutter Detection after Cryptogenic Ischemic Stroke
- Author
-
Richard B. Libman, Karen Black, Daniel Golyan, Claire Carrazco, Jeffrey M. Katz, and Michael Kahen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,New York ,Comorbidity ,030204 cardiovascular system & hematology ,Brain Ischemia ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Atrial Fibrillation ,Odds Ratio ,Prevalence ,medicine ,Humans ,Telemetry ,Risk factor ,PR interval ,Prospective cohort study ,Stroke ,Aged ,Retrospective Studies ,Aged, 80 and over ,Chi-Square Distribution ,business.industry ,Rehabilitation ,Anticoagulants ,Atrial fibrillation ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Confidence interval ,Logistic Models ,Atrial Flutter ,Multivariate Analysis ,Remote Sensing Technology ,Cardiology ,Female ,Surgery ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Introduction Long-term cardiac monitoring with implantable loop recorders (ILRs) has revealed occult paroxysmal atrial fibrillation and flutter (PAF) in a substantial minority of cryptogenic ischemic stroke (CIS) patients. Herein, we aim to define the prevalence, clinical relevance, and risk factors for PAF detection following early poststroke ILR implantation. Materials and methods A retrospective study of CIS patients (n = 100, mean age 65.8 years; 52.5% female) who underwent ILR insertion during, or soon after, index stroke admission. Patients were prospectively followed by the study cardiac electrophysiologist who confirmed the PAF diagnosis. Univariate and multivariate analyses compared clinical, laboratory, cardiac, and imaging variables between PAF patients and non-PAF patients. Results PAF was detected in 31 of 100 (31%) CIS patients, and anticoagulation was initiated in almost all (30 of 31, 96.8%). Factors associated with PAF detection include older age (mean [year] 72.9 versus 62.9; P = .003), white race (odds ratio [OR], 4.5; confidence interval [CI], 1.8-10.8; P = .001), prolonged PR interval (PR > 175 ms; OR, 3.3; CI, 1.2-9.4; P = .022), larger left atrial (LA) diameter (mean [cm] 3.7 versus 3.5; P = .044) and LA volume index (mean [cc/m 2 ]; 30.6 versus 24.2; P = .014), and lower hemoglobin (Hb)A1c (mean [%] 6.0 versus 6.4; P = .036). Controlling for age, obesity (body mass index > 30 kg/m 2 ; OR, 1.2; CI, 1.1-1.4; P = .033) was independently associated with PAF detection. Discussion PAF was detected with high prevalence following early postcryptogenic stroke ILR implantation and resulted in significant management changes. Older age, increased PR interval, LA enlargement, and lower HbA1c are significantly associated with PAF detection. Controlling for age, obesity is an independent risk factor. A larger prospective study is warranted to confirm these findings.
- Published
- 2018
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.