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1,333 results on '"Alexander, Karen P."'

1. Training health professionals to reduce overreporting of birthing people who use drugs to child welfare.

Author

Roberts, Sarah, Taylor, Kimá, Alexander, Karen, Goodman, Daisy, Martinez, Noelle, and Terplan, Mishka

Subjects
Birth history, Child welfare, Opioid, Parenting, Substance use disorder, Humans, Female, Pregnancy, Health Personnel, Child Welfare, Male, Substance-Related Disorders, Adult, Child, Infant, Mandatory Reporting, Attitude of Health Personnel
Abstract

BACKGROUND: Health care providers are a key source of reports of infants to child welfare related to birthing peoples substance use. Many of these reports are overreports, or reports that exceed what is legally mandated, and reflect racial bias. We developed and evaluated a webinar for health professionals to address overreporting related to birthing peoples substance use. METHODS: This evaluation study collected data from health professionals registering to participate in a professional education webinar about pregnancy, substance use, and child welfare reporting. It collected baseline data upon webinar registration, immediate post-webinar data, and 6 month follow-up data. Differences in both pre-post-and 6 month follow-up data were used to examine changes from before to after the webinars in beliefs, attitudes, and practices related to pregnant and birthing people who use drugs and child welfare reporting. RESULTS: 592 nurses, social workers, physicians, public health professionals, and other health professionals completed the baseline survey. More than half of those completing the baseline survey (n = 307, 52%) completed one or both follow-up surveys. We observed statistically significant changes in five of the eleven opioid attitudes/beliefs and in four of the nine child welfare attitudes/beliefs from baseline to follow-ups, and few changes in control statements, i.e. beliefs we did not expect to change based on webinar participation. All of the changes were in the direction of less support for child welfare reporting. In particular, the proportion agreeing with the main evaluation outcome of I would rather err on the side of overreporting to child welfare than underreporting to child welfare decreased from 41% at baseline to 28% and 31% post-webinar and at 6-month follow up (p = 0.001). In addition, fewer participants endorsed reporting everyone at the 6 month follow-up than at baseline (12% to 22%) and more participants endorsed reporting no one at the 6-month follow-up than at baseline (28% to 18%), p = 0.013. CONCLUSIONS: Webinars on the legal, scientific, and ethical aspects of reporting that are co-developed with people with lived experience may be a path to reducing health professional overreporting to child welfare related to birthing peoples substance use.

Published
2024

2. Limited English Proficiency in Older Adults Referred to the Cardiovascular Team.

Author

Medrano, Francisco J, Fernandez, Alicia J, Sudore, Rebecca L, Kirkpatrick, James N, Benda, Natalie C, Creber, Ruth Masterson, Goyal, Parag, Beavers, Craig, Maurer, Mathew S, Rich, Michael W, Alexander, Karen P, Krishnaswami, Ashok, and Geriatric Cardiology and Cardiovascular Team Councils of the American College of Cardiology

Subjects
Geriatric Cardiology and Cardiovascular Team Councils of the American College of Cardiology, Humans, Communication Barriers, Language, Aged, Limited English Proficiency, Cardiovascular disease, Geriatrics, Language barriers, Language interpreter services, Limited English proficiency, Older adults, Technology, Clinical Research, Patient Safety, Aging, Health Services, Cardiovascular, 8.1 Organisation and delivery of services, Health and social care services research, 7.3 Management and decision making, Management of diseases and conditions, Good Health and Well Being, Medical and Health Sciences, General & Internal Medicine
Abstract

Limited English proficiency (LEP) is defined as individuals in whom English is not the primary language and who have limited ability to read, speak, write, or understand the English language. Cardiovascular (CV) team members routinely encounter language barriers in their practice. These barriers have a significant impact on the quality of CV care that patients with LEP receive. Despite evidence demonstrating the negative association between language barriers and health disparities, the impact on CV care is insufficiently known. In addition, older adults with CV disease and LEP are facing increasing risk of adverse events when complex medical information is not optimally delivered. Overcoming language barriers in CV care will need a thoughtful approach. Although well recognized, the initial step will be to continue to highlight the importance of language needs identification and appropriate use of professional interpreter services. In parallel, a health system-level approach is essential that describes initiatives and key policies to ensure a high-level quality of care for a growing LEP population. This review aims to present the topic of LEP during the CV care of older adults, for continued awareness along with practical considerations for clinical use and directions for future research.

Published
2023

3. Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association

Author

Damluji, Abdulla A, Forman, Daniel E, Wang, Tracy Y, Chikwe, Joanna, Kunadian, Vijay, Rich, Michael W, Young, Bessie A, Page, Robert L, DeVon, Holli A, Alexander, Karen P, and Health, on behalf of the American Heart Association Cardiovascular Disease in Older Populations Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing Council on Cardiovascular Radiology and Intervention and Council on Lifestyle and Cardiometabolic

Subjects
Health Services, Aging, Heart Disease, Clinical Research, Cardiovascular, Atherosclerosis, Heart Disease - Coronary Heart Disease, Aetiology, Management of diseases and conditions, 7.3 Management and decision making, 2.1 Biological and endogenous factors, Good Health and Well Being, United States, Humans, Aged, Acute Coronary Syndrome, Risk Factors, American Heart Association, Risk Assessment, Prognosis, AHA Scientific Statements, acute coronary syndrome, cardiovascular diseases, frailty, geriatric assessment, multimorbidity, polypharmacy, American Heart Association Cardiovascular Disease in Older Populations Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Radiology and Intervention, and Council on Lifestyle and Cardiometabolic Health, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Public Health and Health Services, Cardiovascular System & Hematology
Abstract

Diagnostic and therapeutic advances during the past decades have substantially improved health outcomes for patients with acute coronary syndrome. Both age-related physiological changes and accumulated cardiovascular risk factors increase the susceptibility to acute coronary syndrome over a lifetime. Compared with younger patients, outcomes for acute coronary syndrome in the large and growing demographic of older adults are relatively worse. Increased atherosclerotic plaque burden and complexity of anatomic disease, compounded by age-related cardiovascular and noncardiovascular comorbid conditions, contribute to the worse prognosis observed in older individuals. Geriatric syndromes, including frailty, multimorbidity, impaired cognitive and physical function, polypharmacy, and other complexities of care, can undermine the therapeutic efficacy of guidelines-based treatments and the resiliency of older adults to survive and recover, as well. In this American Heart Association scientific statement, we (1) review age-related physiological changes that predispose to acute coronary syndrome and management complexity; (2) describe the influence of commonly encountered geriatric syndromes on cardiovascular disease outcomes; and (3) recommend age-appropriate and guideline-concordant revascularization and acute coronary syndrome management strategies, including transitions of care, the use of cardiac rehabilitation, palliative care services, and holistic approaches. The primacy of individualized risk assessment and patient-centered care decision-making is highlighted throughout.

Published
2023

4. Interventions to Support Engagement in Addiction Care Postpartum: Principles and Pitfalls.

Author

Mazel, Shayna, Alexander, Karen, Cioffi, Camille, and Terplan, Mishka

Subjects
harm reduction, medication for OUD, pregnancy, substance use disorder, Brain Disorders, Substance Misuse, Health Services, Drug Abuse (NIDA only), Clinical Research, 8.1 Organisation and delivery of services, Health and social care services research, 7.1 Individual care needs, Management of diseases and conditions, Reproductive health and childbirth, Good Health and Well Being, Clinical Sciences, Pharmacology and Pharmaceutical Sciences
Abstract

There is a fundamental disconnect between the optimal management of addiction in general and care delivery in pregnancy and postpartum. Addiction is a chronic condition requiring some degree of management across the life course. Yet, in the US, reproductive care is episodic and centers more on pregnancy than at other stages of the reproductive life course. Pregnancy is prioritized in access to insurance as almost all pregnant people are Medicaid eligible but access ends at varying points postpartum. This results in a structural mismatch: the episodic management of the chronic condition of addiction only within gestational periods. Though people with substance use disorder (SUD) may access care in pregnancy, treatment attrition is common postpartum. Postpartum is a time of increased vulnerabilities where insurance churn and newborn caretaking responsibilities collide in a context of care withdrawal from the health system and health providers. In part in consequence, return to use, SUD recurrence, overdose, and overdose death are more common postpartum than in pregnancy, and drug deaths have become a leading cause of maternal deaths in the US. This review addresses interventions to support engagement in addiction care postpartum. We begin with a scoping review of model programs and evidence-informed interventions that have been shown to increase continuation of care postpartum. We then explore the realities of contemporary care through a review of clinical and ethical principles, with particular attention to harm reduction. We conclude with suggestions of strategies (clinical, research, and policy) to improve care postpartum and highlight potential pitfalls in the uptake of evidence-based and person-centered services.

Published
2023

5. Factors Associated With Coronary Angiography Performed Within 6 Months of Randomization to the Conservative Strategy in the ISCHEMIA Trial

Author

Pracoń, Radosław, Spertus, John A., Broderick, Samuel, Bangalore, Sripal, Rockhold, Frank W., Ruzyllo, Witold, Demchenko, Elena, Nageh, Thuraia, Grossman, Gabriel Blacher, Mavromatis, Kreton, Manjunath, Cholenahally N., Smanio, Paola E.P., Stone, Gregg W., Mancini, G.B. John, Boden, William E., Newman, Jonathan D., Reynolds, Harmony R., Hochman, Judith S., Maron, David J., Doan, John, Linefsky, Jason, Lee, Raven, Patel, Risha, Miller, Todd, Yang Cho, So, Milbrandt, Susan, Shelstad, Dawn, Banerjee, Subhash, Kamath, Preeti, Tejani, Ishita, Cobos, Stanley E., Quiles, Kirsten J., Dwyer, Raven R., Donnino, Robert M., Espinosa, Dalisa, Phillips, Lawrence M., Saric, Muhamed, Abdul-Nour, Khaled, Schley, Allison, Golden, Heather, Stone, Peter H., Osseni, Hermine, Wiyarand, Charlene, Douglass, Peter, Pomeroy, Hayley, Craft, Alexandra, Harvey, Bethany, Jang, James J., Anaya, Olivia, Yee, Gennie, Goold, Phoebe, Weitz, Steven, Giovannone, Steven, Pritchard, Lori, Arnold, Suzanne, Gans, Rosann, Henry O’Keefe, Jr, James, Kennedy, Paul, Shapiro, Michael D., Ganesan, Shobana, Schlichting, David, Naher, Aynun, El-Hajjar, Mohammad, Sidhu, Mandeep S., Fein, Steven A., Stewart, Wendy L., Torosoff, Mikhail T., Salmi, Kristin M., Lyubarova, Radmila, Mookherjee, Sulagna, Drzymalski, Krzysztof, McFalls, Edward O., Garcia, Santiago A., Bertog, Stefan C., Johnson, Debra K., Siddiqui, Rizwan A., Herrmann, Rebekah R., Ishani, Areef, Hansen, Ronnell A., Georges Khouri, Michel, Arges, Kristine, LeFevre, Melissa, Tomfohr, Jennifer, Goldberg, Jonathan L., Ann Byrne, Kimberly, Zappernick, Taissa, Goldweit, Richard, Canada, Sallie, Kakade, Meghana, Mieses, Patricia, Cobos, Stanley E., Dwyer, Raven R., Cohen, Ronny A., Espinosa, Dalisa, Mirrer, Brooks, Quiles, Kirsten J., Navarro, Victor, Rantinella, Magdalena, Rodriguez, Jessica, Mancilla, Olivia, Winchester, David E., Stinson, Susan, Kronenberg, Marvin, Weyand, Terry, Rogal, Philip, Crook, Sherron C., McFarren, Christopher, Heitner, John F., Ho, Jean, Khan, Saadat, Mohamed, Mahmoud, Dauber, Ira M., Soltau, Mary R., Rose, Delsa K., Wimmer, Rebecca J., Siegel, Kathy E., Derbyshire, Susan, Cannan, Charles, Dixon, Michelle, Leonard, Gerald, Sudarshan, Sriram, Heard, Ciarra, Gabriel, Viviana, Desire, Sukie, Mehta, Puja K., McDaniel, Michael, Rashid, Fauzia, Lerakis, Stamatios, Asier, Senait, Quyyumi, Arshed, Patel, Keyur, Wenger, Nanette K., Hedgepeth, Chester M., Gillis, Jennifer, Hurlburt, Heather, Manocchia, Megan, Rosen, Alan, Moore, Susan, Congdon, Elizabeth, Sahul, Zakir, Brandt, Gail, Marchelletta, Nora, Wippler, Kristina, Booth, David, Taul, Yvonne, Leung, Steve, Isaacs, Jennifer, Abdel-Latif, Ahmed, Bulkley, Viktoria, Reda, Hassan, Rodgers, Caroline, Ziada, Khaled, Setty, Sampoornima, Halverson, Kimberly E., Roraff, Christine, Thorsen, Jonean, Barua, Rajat S., Ojajuni, Amarachi, Olurinde, Oni, Surineni, Kamalakar, Hage, Fadi, Valaiyapathi, Badhma, Caldeira, Christiano, Davies, James E., Leesar, Massoud, Heo, Jaekyeong, Iskandrian, Amy, Al Solaiman, Firas, Singh, Satinder, Dajani, Khaled, Kartje, Carol M., El-Hajjar, Mohammad, Mesropian, Paul Der, Sacco, Joseph, Rawlins, Michele, McCandless, Brian, Thomson, Jennifer, Orgera, Marisa, Sidhu, Mandeep S., Colleen Rogge, Mary, Arif, Imran, Bunke, Julie, Kerr, Hanan, Unterbrink, Kendra, Fannon, Jacqueline, Burman, Cynthia, Trejo, Jorge F., Dubin, Marcia F., Fletcher, Gerald, Lane, Gary E., Neeson, Lynn M., Parikh, Pragnesh P., Pollak, Peter M., Shapiro, Brian P., Landolfo, Kevin, Gemignani, Anthony, Beaudry, Sarah, O’Rourke, Daniel, Meadows, Judith L., Tirado, Stephanie A., Halliday, Janet, Julian, Pamela, Call, Jason T., Lane, Stephanie M., Stanford, Jennifer L., Hannan, Joseph, Bojar, Robert, Arsenault, Patricia, Kumar, Deepti, Sigel, Pamela, Mukai, John, Martin, Edward T., Brooks, Miriam, Vorobiof, Gabriel, Douangvila, Ladda, Gevorgyan, Rubine, Moorman, Alec, Ranjbaran, Fatima, Smith, Bryn, Ohmart, Carly, Kinlay, Scott, Hamburger, Robert J., Rocco, Thomas P., Ly, Samantha, Bhatt, Deepak L., Quinn, Margot C., Croce, Kevin, Temiyasathit, Sara, Quin, Jacquelyn A, Do, Jacquelyn, Anumpa, Jati, Tobin, Desiree, Zenati, Marco, Faxon, David P, Rayos, Glenn, Langdon, Jennifer, Werner Bayer, Marcia, Seedhom, Ashraf, O’Malley, Amanda, Sullenberger, Lance, Orvis, Erin, Kumkumian, Gregory, Murphy, Mandy, Greenberg, Ann, Iraola, Margaret, Sedlis, Steven P., Maranan, Leandro C., Donnino, Robert M., Lorin, Jeffrey, Tamis-Holland, Jacqueline E., Malinay, Ammy, Kornberg, Robert, Leber, Robert, Saba, Souheil, Edillo, Candice P., Lee, Michael W., Small, Delano R., Nona, Wassim, Alexander, Patrick B., Rehman, Iram, Badami, Umesh, Ostrander, Ann, Wasmiller, Stephanie, Marzo, Kevin, Drewes, Wendy, Patel, Dipti, Robbins, Inga H., Levite, Howard A., White, Jackie M, Shetty, Sanjay, Hallam, Alison, Patel, Mayuri, Hamroff, Glenn S., Spooner, Benjamin J, Hollenweger, Linda M, Little, Raymond W., Little, Holly, Zimbelman, Brandi D., Little, Tiffany, Lui, Charles Y., Eskelson, Nona A, Smith, Brigham R., Vezina, Daniel P., Khor, Lillian L., Abraham, Josephine D., Bull, David A., McKellar, Stephen H., Booth, David, Taul, Yvonne, Kotter, John, Rodgers, Caroline, Abdel-Latif, Ahmed, Isaacs, Jennifer, Bulkley, Viktoria, Hu, Bob, Kaneshiro, Renee, Labovitz, Arthur J., Berlowitz, Michael, Kirby, Bonnie J., Rogal, Philip, Tran, Nhi N., McFarren, Christopher, Jahrsdorfer, Catherine, Matar, Fadi, Caldeira, Christiano, Rodriguez, Fatima, Yunis, Reem, Schnittger, Ingela, Patro, Jhina, Fearon, William F., Deedwania, Prakash, Vega, Antonia, Reddy, Kiran, Sweeny, Joseph, Bloise-Adames, Hugo, Jimenez, Santa, Saint Vrestil, Nicole, Bhandari, Reyna, Spizzieri, Christopher, Schade, Danielle, Yost, Roxanne, Hochberg, Claudia P, Beardsley, Paula, Fine, Denise, Salerno, William D., Tancredi, Jana, Arakelian, Patricia, Mathus, Susan, O’Neill, Deborah, Wyman, Ray, Burkhardt, Joy, Hosino, Suellen, Lubyanaya, Oksana A., Salas, Jose D., Zarka, Amer, Aguirre, Maria, Shah, Anil V., Dhawan, Manu, Parra, Diana, Tran, Tri, Haldis, Thomas, Weick, Catherine, Fowler-Lehman, Katie, Spitzer, Natalie, Riedberger, Casey, Weick, Catherine, Kohn, Jeffrey A., Cobos, Stanley E., Dwyer, Raven R., Espinosa, Dalisa, Quiles, Kirsten J., Girotra, Saket, Drum, Carrie, Miller-Cox, Kimberly, Ollinger, Amy, Almousalli, Omar, Capasso-Gulve, Elizabeth, Melanie Loehr, Alaine, Mosley, Marlowe, Krishnam, Mayil S., Heydari, Shirin, Milliken, Jeffrey C., Lundeen, Andrea M., Patel, Pranav M., Karanjah, Edgar, Seto, Arnold H., Marfori, Wanda C., Harley, Kevin T., Hernandez-Rangel, Eduardo, Gibson, Michael A., Singh, Pam, Allen, Byron J., Coram, Rita, Marie Webb, Anne, Fridell, Ellie, Wilson, Heidi, Thomas, Sabu, Kim, Angela, Schwartz, Ronald G, Wilmot, Patrick, Chen, Wei, El Shahawy, Mahfouz, Stevens, Ramona, Stafford, James, Black, Loriane, Abernethy, William B., Hull, Amber B., Lim, Olivia J., Tucker, Helen C., Putnam, Natasha C., Hall, Linda L., Cauthren, Tia, Tucker, Trish, Zurick, Andrew, Horton, Hollie, Orga, Jan, Meyer, Thomas M., White, Joyce R., Morford, Ronald G., Baumann, Cynthia, Rutkin, Bruce, Seeratan, Vidya, Bokhari, Sabahat, Jimenez, Magnolia, Sokol, Seth I., Schultz, Cidney, Meisner, Jay, Russo, Jeanne, Hamzeh, Ihab, Misra, Arunima, Huda, Zohra, Wall, Matthew, Boan, Araceli, Lenges De Rosen, Veronica, Alam, Mahboob, Turner, Michael C., Hinton, Christine R, Mulhearn, Thomas J., Good, Arnold P., Archer, Beth A., Dionne, Julia S., Allardyce, Cheryl A., Sikora, Lindsey N., Czerniak, Jennifer H., Mull, Jennifer A., Ferguson, Elizabeth, Laube, Frances, Shammas, Nicolas W., Shammas, Gail A, Christensen, Lori, Park, Holly, Chilton, Robert, Hecht, Joan, Nguyen, Patricia K., Vo, Davis, Hirsch, James, Jezior, Matthew, Bindeman, Jody, Salkind, Sara, Espinosa, Dalisa, Desimone, Lori-Ann, Gordon, Paul C., Felix-Stern, Lina, Crain, Thomas, Gomes, Jassira, Gordon, Catherine, Stenberg, Robert, Mann, Aimee, McCreary, Theresa, Pedalino, Ronald P., Cobos, Stanley E., Dwyer, Raven R., Espinosa, Dalisa, Quiles, Kirsten J., Wiesel, Joseph, Cobos, Stanley E., Dwyer, Raven R., Espinosa, Dalisa, Quiles, Kirsten J., Juang, George J., Gopaul, Candace, Hultberg, Karen, Huk, Tauqir, Hussain, Afshan, Al-Amoodi, Mohammed, Zambrano, Yesenia, Medina Rodriguez, Sarah, Milner, Trudie, Wohns, David, Mulder, Abbey, Van Oosterhout, Stacie, Lader, Ellis W., Meyer, Martha, Mumma, Michael, Clapp, Nancy L., Barrentine, Heather, Dharmarajan, Lekshmi, Jose, Jenne M., Cobos, Stanley E., Dwyer, Raven R., Espinosa, Dalisa, Quiles, Kirsten J., Manchery, Jenne, McGarvey Jr, Joseph F.X., McKinney, Vera, Schwarz, Linda, Downes, Thomas R., Kaczkowski, Scott M., Luckasen, Gary J., Jaskowiak, Adam J., Klitch, Joel, Cheong, Benjamin, Dees, Debra, Potluri, Srinivasa, Vasquez, Precilia, Mastouri, Ronald A., Breall, Jeffery A., Hannemann, Elise L., Revtyak, George E., Mae Foltz, Judy, Bazeley, Jonathan W., Li, Dayuan, DeRosa, Emily, Jorgenson, Beth, Riestenberg-Smith, Joyce, Giedd, Kenneth, Old, Wayne, Bariciano, Rebecca, Burt, Francis, Sokhon, Kozhaya, Waldron, Jessica, Mayon, Michelle, Gopal, Deepika, Valeti, Uma S., Ann Peichel, Gretchen, Kobashigawa, Jon, Starks, Brandy, Garcia, Lucilla, Thottam, Maria, Bhargava, Balram, Anand, Anjali, Chakanalil Govindan, Sajeev, Raj, Janitha, Gopalan Nair, Rajesh, Ravindran, Reshma, Rajalekshmi, VS, Nataraj, Nandita, Moorthy, Nagaraja, Nayak, Soundarya, Mylarappa, Mahevamma, Narayanappa, Suryaprakash, Pandit, Neeraj, Bajaj, Sheromani, Kumar Nath, Ranjit, Yadav, Vandana, Mishra, Girish, Dwivedi, S.K., Tewari, Roma, Narain, V.S., Mishra, Meenakshi, Chandra, Sharad, Patel, Shivali, Singh, Suman, Wander, Gurpreet S., Tandon, Rohit, Ralhan, Sarju, Kaur, Baljeet, Aslam, Naved, Gupta, Sonika, Goyal, Abhishek, Bhargava, Balram, Suvarna, Chandini, Karthikeyan, G., Ramakrishnan, S., Seth, Sandeep, Yadav, Rakesh, Singh, Sandeep, Roy, Ambuj, Parakh, Neeraj, Kumar Verma, Sunil, Narang, Rajiv, Mishra, Sundeep, Naik, Nitish, Sharma, Gautam, Kumar Choudhary, Shiv, Patel, Chetan, Gulati, Gurpreet, Sharma, Sanjeev, Bahl, V K, Mathew, Anoop, Mannekkattukudy Kurian, Binoy, Punnoose, Eapen, Avdhoot Gadkari, Milind, Rupesh Karwa, Sheetal, Gadage, Siddharth, Kolhe, Suvarna, Umesh Pillay, Tapan, Satheesh, Santhosh, Vindhya, R. J., Jain, Peeyush, Seth, Ashok, Singh Meharwal, Zile, Mathur, Atul, Verma, Atul, Kaul, Upendra, Bhatia, Mona, Sachdeva, Ankush, Indira Devi, Thounaojam, Jungla, Nungshi, Christopher, Johann, Manjula Rani, K., Menon, Rajeev, Sowjanya Reddy, M., Kumar, Nirmal, Preethi, K., Oomman, Abraham, sidh, Rinu R, Mao, Robert, Ramakrishnan, T., Solomon, Hilda, Francis, Rajesh, Naik, Sudhir, Vamshi, Priya P., Parveen Khan, Sajeeda, Christopher, Johann, Preethi, Kotiboinna, Kumar, Nirmal, Grant, Purvez, Hande, Shweta, Sonawane, Poonam, Kachru, Ranjan, Dubey, Abhishek, Rawat, Kavita, Kumar, Ajit, Ganapathi, Sanjay, K, Jayakumar, CP, Vineeth, Sivadasanpillai, Harikrishnan, Chacko, Manas, Sasidharan, Bijulal, Babu, Suresh, TR, Kapilamoorthy, Christopher, Johann, Reddy, Sowjanya, Polamuri, Praneeth, Rani, Manjula, Kaul, Upendra, Arambam, Priyadarshani, Singh, Bebek, Senior, Roxy, Fox, Keith AA, Young, Grace M., Carruthers, Kathryn, Senior, Roxy, Elghamaz, Ahmed, Gurunathan, Sothinathan, Karogiannis, Nikolaos, Young, Grace M., Shah, Benoy N, Kinsey, Christopher, Trimlett, Richard HJ, Kavalakkat, Raisa, Rubens, Michael B, Evans, Jo, Nicol, Edward D, Hassan, Ikraam, Mittal, Tarun K, Hampson, Reinette, Andreas Gamma, Reto, Williams, Sarah, Holland, Kim, Swan, Karen, de Belder, Mark A, Atkinson, Bev, Thambyrajah, Jeet, Kunhunny, Swapna, Davies, John R, Lindsay, Steven J., Atkinson, Craig, Kurian, John, Krannila, Carita, Jamil, Haqeel, Vinod, Manitha, Raheem, Osama, Hoye, Angela, Chaytor, Lisa, Cox, Leanne, Morrow, Julie, Rowe, Kay, Donnelly, Patrick, Kelly, Stephanie, Valecka, Bernardas, Regan, Susan, Turnbull, Dawn, Chauhan, Anoop, Fleming, Catherine, Ghosh, Arijit, Gratrix, Karen, Preston, Stephen, Barr, Craig, Cartwright, Anne, Alfakih, Khaled, Knighton, Abigail, Byrne, Jonathan, Martin, Katherine, Webb, Ian, Henriksen, Peter, Flint, Laura, Harrison, James, OKane, Peter, Lakeman, Nicki, Ljubez, Anja, de Silva, Ramesh, Conway, Dwayne S. G., Wright, Judith, Exley, Donna, Sirker, Alexander A, Andiapen, Mervyn, Richards, Amy J., Hoole, Stephen P, Wong, Lisa, Witherow, Fraser N., Munro, Melanie J., Johnston, Nicola, Harbinson, Mark, McEvoy, Michelle, Walsh, Simon, Brown, Caroline, Douglas, Hanna, Luckie, Matthew, Charles, Thabitha, Kolakaluri, Laurel, Phillips, Hannah, Sobolewska, Jolanta, Morby, Louise, Hallett, Karen, Corbett, Carolyn, Winstanley, Lynne, Jeetley, Paramjit, Smit, Angelique, Patel, Niket, Kotecha, Tushar, Travill, Christopher, Gent, Susan, Karimullah, Iqbal, Hussain, Nafisa, Al-Bustami, Mahmud, Braganza, Denise, Haines, Fiona, Taaffe, Joanne, Henderson, Robert, Burton, Jane, Pointon, Kate, Colton, Maria, Naik, Surendra, King, Rachel, Mathew, Thomas, Brown, Ammani, Docherty, Andrew, Berry, Colin, McCloy, Lisa, Collison, Damien, Robb, Kate, Roditi, Giles, Paterson, Craig, Crawford, Wenda, Kelly, Joanne, McGregor, Lorraine, Moriarty, Andrew J, Mackin, Anne, Glover, Jason D., Knight, Janet P, Pradhan, Jiwan, Mikhail, Ghada, Bose, Tuhina, Francis, Darrel P., Dzavik, Vladimir, Goodman, Shaun, Gosselin, Gilbert, Gosselin, Gilbert, Proietti, Anna, Brousseau, Myriam, Corfias, Magalie, Blaise, Patricia, Harvey, Luc, Diaz, Ariel, Rheault, Philippe, Barrero, Miguel, Gagné, Carl-Éric, Alarie, Patricia, Pépin-Dubois, Yanek, Arcand, Linda, Costa, Ricardo, Roy, Isabelle, Tung Sia, Ying, Montpetit, Estelle, Lemay, Catherine, Gisbert, Alejandro, Gervais, Pierre, Rheault, Alain, Drouin, Katia, Carl Phaneuf, Denis, Bergeron, Christine, Gosselin, Gilbert, Shelley, Christine, Masson, Christine, Garg, Pallav, Carr, Sandy, Bone, Catherine, Chow, Benjamin J.W., Moga, Ermina, Hessian, Renee C., Kourzenkova, Janetta, Beanlands, Rob S., Walter, Olga, Davies, Richard F., Bainey, Kevin R., Hogg, Norma, Welsh, Suzanne, Cheema, Asim N., Bagai, Akshay, Wald, Ron, Goodman, Shaun, Kushniriuk, Khrystyna, Joseph Graham, John, Hussain, Mohammed, Peterson, Mark, Bello, Olugbenga, Chow, Chi-Ming, Abramson, Beth, Nazir Cheema, Asim, Syed, Ishba, Hussain, Mohammed, Kushniriuk, Khrystyna, Cha, James, Otis, Judy, Otis, Rebecca, Howarth, Andrew G, Seib, Michelle M, Rivest, Sandra M, Sandonato, Rosa, Wong, Graham, Chow, Jackie, Starovoytov, Andrew, Uchida, Naomi, Meadows, Ngaire, Uxa, Amar, Asif, Nadia, Tavares, Suzana, Galiwango, Paul, Bozek, Bev, Kassam, Saleem, Shier, Maria, Mukherjee, Ashok, Larmand, Lori-Ann, Ricci, A. Joseph, Janmohamed, Amir, Hart, Brenda, Lam, Andy, Marucci, Jane, Tai, Sharon, Mehta, Shamir, Brons, Sonya, Beck, Chris, Wong, Glenda, Etherington, Krystal, Arumairajah, Thippeekaa, Udell, Jacob, Aprile, Maria, Karlsson, Sara, Webber, Susan, Généreux, Philippe, Mercure, Chantale, Hameed, Adnan, Aedy, Nancy, Daba, Ledjalem, Farquharson, Fran, Siddiqui, Anam, Carlos Carvalho, Antonio, Lopes, Renato D., Hueb, Whady, Emy Takiuti, Myrthes, Cury Rezende, Paulo, Eustáquio Ribeiro Silva, Expedito, Ciappina Hueb, Alexandre, Pizzol Caetano, Leonardo, Schaan de Quadros, Alexandre, Abdala Karam Kalil, Renato, Peixoto Deiro, Aline, Luiz da Costa Vieira, José, Manica Muller, Alice, Antonieta Pereira de Moraes, Maria, Píccaro de Oliveira, Pedro, Maria Ascoli, Bruna, Bridi, Leonardo, Zottis Poletti, Sílvia, Savaris, Simone, Vitola, João V, Cerci, Rodrigo J, Zier, Sandra S., Farias, Fabio R, Veiga Jr, Vilmar, Fernandes, Miguel M, Antonio Marin-Neto, José, Schmidt, André, de Oliveira Lima Filho, Moysés, Franca da Cunha, Diego, Mendes Oliveira, Ricardo, Reynaldo Abbud Chierice, João, Polanczyk, Carísi A., Rucatti, Guilherme G, Furtado, Mariana V., Igansi, Fernanda, Smidt, Luis F., Haeffner, Mauren P, Carlos Carvalho, Antonio, Almeida, Viviane, Pucci, Gustavo, Sanchez de Souza, Gabriela, Lyra, Flavio, Rabelo Alves Junior, Alvaro, Almeida, Mayana, dos Santos, Viviane, Dracoulakis, Marianna D. A., Oliveira, Natalia S, Lima, Rodolfo G. S. 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2024
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9. The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review

Author

Alexander, Karen, Pogorzelska-Maziarz, Monika, Gerolamo, Angela, Hassen, Nadia, Kelly, Erin L, and Rising, Kristin L

Subjects
Health Services and Systems, Health Sciences, Prevention, Brain Disorders, Clinical Research, Substance Misuse, Health Services, Neurosciences, Drug Abuse (NIDA only), Health and social care services research, 8.1 Organisation and delivery of services, Good Health and Well Being, Buprenorphine, COVID-19, Cross-Sectional Studies, Drug Overdose, Emergency Medical Services, Health Services Accessibility, Humans, Methadone, Narcotic Antagonists, Opiate Substitution Treatment, Opioid-Related Disorders, Pandemics, Patient Satisfaction, SARS-CoV-2, Telemedicine, Opioid use, Healthcare delivery, Pandemic, Psychology, Substance Abuse, Public health, Clinical and health psychology
Abstract

Research objectiveThe COVID-19 pandemic disrupted healthcare delivery worldwide with likely negative effects on people who use opioids (PWUO). This scoping review of the original research literature describes the impact of the COVID-19 pandemic on healthcare delivery for PWUO and identifies gaps in the literature.MethodsThis scoping review of the original research literature maps the available knowledge regarding the impact of the COVID-19 pandemic on healthcare delivery for PWUO. We utilized the methodology developed by the Joanna Briggs Institute for scoping reviews, and content analyses methodology to characterize the current state of the literature.ResultsOf the 14 included studies, administrative database (n = 11), cross-sectional (n = 1) or qualitative (n = 2) studies demonstrated service gaps (n = 7), patient/provider experiences (n = 3), and patient outcomes for PWUO (n = 4). In March 2020, healthcare utilization dropped quickly, sharply increasing only for reasons of opioid overdose by May 2020. Service gaps existed in accessing treatment for new patients during the pandemic due to capacity and infrastructure limits. Physicians reported difficulty referring patients to begin an outpatient opioid treatment program due to increased restrictions in capacity and infrastructure. Patients also reported uncertainty about accessing outpatient treatment, but that telehealth initiation of buprenorphine increased access to treatment from home. Disproportionate increases in overdose rates among African Americans were reported in two studies, with differences by race and gender not examined in most studies. Fatal overdoses increased 60% in African Americans during the pandemic, while fatal overdoses in Non-Hispanic White individuals decreased.ConclusionsIn summary, this beginning evidence demonstrates that despite early reluctance to use the healthcare system, opioid overdose-related use of healthcare increased throughout the pandemic. Service delivery for medications to treat OUD remained at or above pre-pandemic levels, indicating the ability of telehealth to meet demand. Yet, racial disparities that existed pre-pandemic for PWUO are intensifying, and targeted intervention for high-risk groups is warranted to prevent further mortality. As the pandemic progresses, future research must focus on identifying and supporting subgroups of PWUO who are at heightened risk for experiencing negative outcomes and lack of access to care.

Published
2021

10. Myocardial Infarction in the ISCHEMIA Trial

Author

Chaitman, Bernard R, Alexander, Karen P, Cyr, Derek D, Berger, Jeffrey S, Reynolds, Harmony R, Bangalore, Sripal, Boden, William E, Lopes, Renato D, Demkow, Marcin, Perna, Gian Piero, Riezebos, Robert K, McFalls, Edward O, Banerjee, Subhash, Bagai, Akshay, Gosselin, Gilbert, O’Brien, Sean M, Rockhold, Frank W, Waters, David D, Thygesen, Kristian A, Stone, Gregg W, White, Harvey D, Maron, David J, Hochman, Judith S, and Group, On behalf of the ISCHEMIA Research

Subjects
Clinical Trials and Supportive Activities, Clinical Research, Cost Effectiveness Research, Heart Disease, Cardiovascular, Heart Disease - Coronary Heart Disease, Good Health and Well Being, Aged, Aged, 80 and over, Coronary Artery Bypass, Creatine Kinase, MB Form, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Myocardial Infarction, Myocardial Ischemia, Percutaneous Coronary Intervention, Prognosis, Proportional Hazards Models, Risk Factors, Severity of Illness Index, Survival Analysis, catheterization, drug therapy, myocardial infarction, myocardial ischemia, myocardial revascularization, ISCHEMIA Research Group, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Public Health and Health Services, Cardiovascular System & Hematology
Abstract

BackgroundIn the ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), an initial invasive strategy did not significantly reduce rates of cardiovascular events or all-cause mortality in comparison with a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia. The most frequent component of composite cardiovascular end points was myocardial infarction (MI).MethodsISCHEMIA prespecified that the primary and major secondary composite end points of the trial be analyzed using 2 MI definitions. For procedural MI, the primary MI definition used creatine kinase-MB as the preferred biomarker, whereas the secondary definition used cardiac troponin. Procedural thresholds were >5 times the upper reference level for percutaneous coronary intervention and >10 times for coronary artery bypass grafting. Procedural MI definitions included (1) a category of elevated biomarker only events with much higher biomarker thresholds, (2) new ST-segment depression of ≥1 mm for the primary and ≥0.5 mm for the secondary definition, and (3) new coronary dissections >National Heart, Lung, and Blood Institute grade 3. We compared MI type, frequency, and prognosis by treatment assignment using both MI definitions.ResultsProcedural MIs accounted for 20.1% of all MI events with the primary definition and 40.6% of all MI events with the secondary definition. Four-year MI rates in patients undergoing revascularization were more frequent with the invasive versus conservative strategy using the primary (2.7% versus 1.1%; adjusted hazard ratio [HR], 2.98 [95% CI, 1.87-4.73]) and secondary (8.2% versus 2.0%; adjusted HR, 5.04 [95% CI, 3.64-6.97]) MI definitions. Type 1 MIs were less frequent with the invasive versus conservative strategy using the primary (3.40% versus 6.89%; adjusted HR, 0.53 [95% CI, 0.41-0.69]; P

Published
2021

11. Impact of Complete Revascularization in the ISCHEMIA Trial

Author

Boden, William, Harrington, Robert, Williams, David, Alexander, Karen P., Berger, Jeffrey, Mark, Daniel, Ballantyne, Christie, Beyar, Rafael, Bhargava, Balram, Buller, Chris, Carvalho, Antonio (Tony), Diaz, Rafael, Doerr, Rolf, Dzavik, Vladimir, Goodman, Shaun, Gosselin, Gilbert, Hachamovitch, Rory, Hamm, Christian, Held, Claes, Helm, Malte, Huber, Kurt, Jiang, Lixin, Keltai, Matyas, Kohsaka, Shun, Lang, Irene, Lopes, Renato, Lopez-Sendon, Jose, Maggioni, Aldo, Mancini, John, Bairey Merz, C. Noel, Min, James, Peterson, Eric, Ruzyllo, Witold, Selvanayagam, Joseph, Senior, Roxy, Sharir, Tali, Steg, Gabriel, Szwed, Hanna, Van de Werf, Frans, Weintraub, William, White, Harvey, Calfas, Karen, Champagne, Mary Ann, Davidson, Michael, Fleg, Jerome, McCullough, Peter A., Newman, Jonathan, Stone, Peter, Menasche, Philippe, Fremes, Stephen, Guyton, Robert, Mack, Michael, Mohr, Fred, Rao, Anupama, Sabik, Joe, Shapira, Oz, Taggart, David, Tatoulis, James, Blankenship, Jim, Brener, Sorin, Colombo, Antonio, de Bruyne, Bernard, Kereiakes, Dean, Lefevre, Thierry, Moses, Jeffrey, Mahaffey, Ken, Cruz-Flores, Salvador, Danchin, Nicholas, Feen, Eli, Garcia, Mario J., Hauptman, Paul, Laddu, Abhay A., Passamani, Eugene, Pina, Ileana L., Simoons, Maarten, Skali, Hicham, Thygesen, Kristian, Waters, David, Endsley, Patricia, Esposito, Gerard, Kanters, Jeffrey, Pownall, John, Stournaras, Dimitrios, Friedrich, Matthias, Kwong, Raymond, Oliver, Dana, Harrell, Frank, Blume, Jeffrey, Lee, Kerry, Kullo, Iftikhar, McManus, Bruce, Newby, Kristin, Cohen, David, Bugiardini, Raffaele, Celutkiene, Jelena, Escobedo, Jorge, Hoye, Angela, Lyubarova, Radmila, Mattina, Deirdre, Peteiro, Jesus, Smanio, Paola, Berman, Dan, Leipsic, Jonathan, Mathew, Roy, Sidhu, Mandeep, Friedman, Lawrence, Anderson, Jeffrey, Berg, Jessica, DeMets, David, Gibson, C. Michael, Lamas, Gervasio, Deming, Nicole, Himmelfarb, Jonathan, Ouyang, Pamela, Woodard, Pamela, Nwosu, Samuel, Kirby, Ruth, Jeffries, Neal, Denaro, Jean E., Mavromichalis, Stephanie, Chan, Kevin, Cobb, Gia, Contreras, Aira, Cukali, Diana, Ferket, Stephanie, Gabriel, Andre, Hansen, Antonietta, Roberts, Arline, Naumova, Anna, Chang, Michelle, Islam, Sharder, Wayser, Graceanne, Yakubov, Solomon, Yee, Michelle, Callison, Caroline, Hogan, Isabelle, Qelaj, Albertina, Pirro, Charlotte, Van Loo, Kerrie, Wisniewski, Brianna, Gilsenan, Margaret, Lang, Bevin, Mohamed, Samaa, Esquenazi-Karonika, Shari, Mathews, Patenne, Setang, Vincent, Xavier, Mark, Bagai, Akshay, Broderick, Samuel, Crowder, Michelle, Cyr, Derek, Garg, Jyotsna, Gu, Xiangqiong, Hatch, Lisa, Heath, Anne, Huang, Zhen, Leimberger, Jeff, Marcus, Jill, Page, Courtney, Parker, Wanda, Pennachi, Wayne, Rockhold, Frank, Stevens, Susanna, Stone, Allegra, Thompson, Omar, Ussery, Sheri, White, Jennifer, Williams, Mary (Kaye), Xing, Weibing, Zhu, Songlin, Anstrom, Kevin, Baloch, Khaula, Blount, Janet, Cowper, Patricia, Davidson-Ray, Linda, Drew, Laura, Harding, Tina, Knight, J David, Minshall Liu, Diane, O’Neal, Betsy, Redick, Thomas, Jones, Philip, Nugent, Karen, Jingyan Wang, Grace, Phillips, Lawrence, Goyal, Abhinav, Hetrick, Holly, Hayes, Sean W., Friedman, John D., Gerlach, R. James, Hyun, Mark, Miranda-Peats, Romalisa, Slomka, Piotr, Thomson, Louise, Kwong, Raymond Y., Mongeon, Francois Pierre, Michael, Steven, Hung, Judy, Scherrer-Crosbie, Marielle, Zeng, Xin, Eckstein, Jane, Guruge, Bandula, Streif, Mary, Alfonso, Maria A., Corral, Maria P., Garcia, Javier J., Jankovic, Ivana, Konigstein, Maayan, Lustre, Mitchel B., Peralta, Yolayfi, Sanchez, Raquel, Arsanjani, Reza, Budoff, Matthew, Elmore, Kimberly, Gomez, Millie, Hague, Cameron, Hindoyan, Niree, Mancini, GB John, Nakanishi, Rine, Srichai-Parsia, M. Barbara, Yeoh, Eunice, Youn, Tricia, Maggioni, Aldo P., Bianchini, Francesca, Ceseri, Martina, Lorimer, Andrea, Magnoni, Marco, Orso, Francesco, Sarti, Laura, Tricoli, Martinia, Carvalho, Antonio, Barbosa, Lilian Mazza, Bello Duarte, Tauane, Colaiácovo Soares, Tamara, de Aveiro Morata, Julia, Carvalho, Pedro, de Carvalho Maffei, Natalia, Egydio, Flávia, Kawakami, Anelise, Oliveira, Janaina, Restelli Piloto, Elissa, Pozzibon, Jaqueline, Camara, Diane, Mowafy, Neamat, Spindler, Caroline, Dai, Hao, Feng, Fang, Li, Jia, Li, Li, Liu, Jiamin, Xie, Qiulan, Zhang, Haibo, Zhang, Jianxin, Zhang, Lihua, Zhang, Liping, Zhang, Ning, Zhong, Hui, Escobar, Claudia, Martin, Maria Eugenia, Pascual, Andrea, Lopez-Sendon, José, Moraga, Paloma, Hernandez, Victoria, Castro, Almudena, Posada, Maria, Fernandez, Sara, Narro Villanueva, José Luis, Selgas, Rafael, Abergel, Helene, Juliard, Jean Michel, Alsweiler, Caroline, Claes, Kathleen, Goetschalckx, Kaatje, Luyten, Ann, Robesyn, Valerie, Selvanayagam, Joseph B., Murphy, Deirdre, Garcevic, Nevena, Stojkovic, Jelena, Ahmed, Asker, Bhatt, Richa, Chadha, Nitika, Kumar, Vijay, Lubna, Sadath, Naik, Pushpa, Pandey, Shruti, Ramasamy, Karthik, Saleem, Mohammed, Sharma, Pratiksha, Siddaram, Hemalata, Stone, Gregg W., Ali, Ziad A., O’Brien, Sean M., Rhodes, Grace, Genereux, Philippe, Bangalore, Sripal, Mavromatis, Kreton, Horst, Jennifer, Dressler, Ovidiu, Poh, Kian Keong, Nath, Ranjit K., Moorthy, Nagaraja, Witkowski, Adam, Dwivedi, Sudhanshu K., Bockeria, Olga, Chen, Jiyan, Smanio, Paola E.P., Picard, Michael H., Chaitman, Bernard R., Berman, Daniel S., Shaw, Leslee J., Boden, William E., White, Harvey D., Fremes, Stephen E., Rosenberg, Yves, Reynolds, Harmony R., Spertus, John A., Hochman, Judith S., and Maron, David J.

Published
2023
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12. Life’s Essential 8: Optimizing Health in Older Adults

Author

Kumar, Manish, Orkaby, Ariela, Tighe, Caitlan, Villareal, Dennis T., Billingsley, Hayley, Nanna, Michael G., Kwak, Min Ji, Rohant, Namit, Patel, Shreya, Goyal, Parag, Hummel, Scott, Al-Malouf, Christina, Kolimas, Amie, Krishnaswami, Ashok, Rich, Michael W., Kirkpatrick, James, Damluji, Abdulla A., Kuchel, George A., Forman, Daniel E., and Alexander, Karen P.

Published
2023
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15. Management of Atrial Fibrillation in Older Patients by Morbidity Burden: Insights From Get With The Guidelines‐Atrial Fibrillation

Author

Dalgaard, Frederik, Xu, Haolin, Matsouaka, Roland A, Russo, Andrea M, Curtis, Anne B, Rasmussen, Peter Vibe, Ruwald, Martin H, Fonarow, Gregg C, Lowenstern, Angela, Hansen, Morten L, Pallisgaard, Jannik L, Alexander, Karen P, Alexander, John H, Lopes, Renato D, Granger, Christopher B, Lewis, William R, Piccini, Jonathan P, and Al‐Khatib, Sana M

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Aging, Cardiovascular, Heart Disease, Clinical Research, Management of diseases and conditions, 7.1 Individual care needs, Administration, Oral, Age Factors, Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Cross-Sectional Studies, Female, Hospitalization, Humans, Logistic Models, Male, Multimorbidity, Odds Ratio, Practice Guidelines as Topic, Practice Patterns, Physicians', Registries, anticoagulation, atrial fibrillation, comorbidities, multimorbidity, oral anticoagulants, prescription, quality of care, Cardiorespiratory Medicine and Haematology, Cardiovascular medicine and haematology
Abstract

Background Knowledge is scarce regarding how multimorbidity is associated with therapeutic decisions regarding oral anticoagulants (OACs) in patients with atrial fibrillation. Methods and Results We conducted a cross-sectional study of hospitalized patients with atrial fibrillation using the Get With The Guidelines-Atrial Fibrillation registry from 2013 to 2019. We identified patients ≥65 years and eligible for OAC therapy. Using 16 available comorbidity categories, patients were stratified by morbidity burden. A multivariable logistic regression model was used to determine the odds of receiving OAC prescription at discharge by morbidity burden. We included 34 174 patients with a median (interquartile range) age of 76 (71-83) years, 56.6% women, and 41.9% were not anticoagulated at admission. Of these patients, 38.6% had 0 to 2 comorbidities, 50.7% had 3 to 5 comorbidities, and 10.7% had ≥6 comorbidities. The overall discharge OAC prescription was high (85.6%). The prevalence of patients with multimorbidity increased from 59.7% in 2014 to 64.3% in 2019 (P trend=0.002). Using 0 to 2 comorbidities as the reference, the adjusted odds ratio (95% CI) of OAC prescription were 0.93 (0.82, 1.05) for patients with 3 to 5 comorbidities and 0.72 (0.60, 0.86) for patients with ≥6 comorbidities. In those with ≥6 comorbidities, the most common reason for nonprescription of OACs were frequent falls/frailty (31.0%). Conclusions In a contemporary quality-of-care database of hospitalized patients with atrial fibrillation eligible for OAC therapy, multimorbidity was common. A higher morbidity burden was associated with a lower odds of OAC prescription. This highlights the need for interventions to improve adherence to guideline-recommended anticoagulation in multimorbid patients with atrial fibrillation.

Published
2020

18. Deprescribing in Older Adults With Cardiovascular Disease

Author

Krishnaswami, Ashok, Steinman, Michael A, Goyal, Parag, Zullo, Andrew R, Anderson, Timothy S, Birtcher, Kim K, Goodlin, Sarah J, Maurer, Mathew S, Alexander, Karen P, Rich, Michael W, Tjia, Jennifer, and Council, American College of Cardiology Geriatric Cardiology Section Leadership

Subjects
Pharmacology and Pharmaceutical Sciences, Biomedical and Clinical Sciences, Heart Disease, Cardiovascular, Clinical Research, Aging, Prevention, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Good Health and Well Being, Aged, Cardiovascular Diseases, Comorbidity, Deprescriptions, Drug-Related Side Effects and Adverse Reactions, Global Health, Humans, Inappropriate Prescribing, Incidence, deprescribing, geriatrics, medications, multimorbidity, multiple chronic conditions, older adults, polypharmacy, Geriatric Cardiology Section Leadership Council, American College of Cardiology, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

Deprescribing, an integral component of a continuum of good prescribing practices, is the process of medication withdrawal or dose reduction to correct or prevent medication-related complications, improve outcomes, and reduce costs. Deprescribing is particularly applicable to the commonly encountered multimorbid older adult with cardiovascular disease and concomitant geriatric conditions such as polypharmacy, frailty, and cognitive dysfunction-a combination rarely addressed in current clinical practice guidelines. Triggers to deprescribe include present or expected adverse drug reactions, unnecessary polypharmacy, and the need to align medications with goals of care when life expectancy is reduced. Using a framework to deprescribe, this review addresses the rationale, evidence, and strategies for deprescribing cardiovascular and some noncardiovascular medications.

Published
2019

19. The Association of Frailty With In-Hospital Bleeding Among Older Adults With Acute Myocardial Infarction Insights From the ACTION Registry

Author

Dodson, John A, Hochman, Judith S, Roe, Matthew T, Chen, Anita Y, Chaudhry, Sarwat I, Katz, Stuart, Zhong, Hua, Radford, Martha J, Udell, Jacob, Bagai, Akshay, Fonarow, Gregg C, Gulati, Martha, Enriquez, Jonathan R, Garratt, Kirk N, and Alexander, Karen P

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Heart Disease, Patient Safety, Prevention, Heart Disease - Coronary Heart Disease, Cardiovascular, Clinical Research, Aging, Activities of Daily Living, Aged, Aged, 80 and over, Cardiac Catheterization, Cognition, Female, Frail Elderly, Frailty, Geriatric Assessment, Hemorrhage, Humans, Inpatients, Male, Mobility Limitation, Myocardial Infarction, Patient Admission, Percutaneous Coronary Intervention, Registries, Risk Assessment, Risk Factors, Treatment Outcome, United States, Walking, bleeding, geriatric, myocardial infarction, older adults, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

ObjectivesThe aim of this study was to determine whether frailty is associated with increased bleeding risk in the setting of acute myocardial infarction (AMI).BackgroundFrailty is a common syndrome in older adults.MethodsFrailty was examined among AMI patients ≥65 years of age treated at 775 U.S. hospitals participating in the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry from January 2015 to December 2016. Frailty was classified on the basis of impairments in 3 domains: walking (unassisted, assisted, wheelchair/nonambulatory), cognition (normal, mildly impaired, moderately/severely impaired), and activities of daily living. Impairment in each domain was scored as 0, 1, or 2, and a summary variable consisting of 3 categories was then created: 0 (fit/well), 1 to 2 (vulnerable/mild frailty), and 3 to 6 (moderate-to-severe frailty). Multivariable logistic regression was used to examine the independent association between frailty and bleeding.ResultsAmong 129,330 AMI patients, 16.4% had any frailty. Frail patients were older, more often female, and were less likely to undergo cardiac catheterization. Major bleeding increased across categories of frailty (fit/well 6.5%; vulnerable/mild frailty 9.4%; moderate-to-severe frailty 9.9%; p < 0.001). Among patients who underwent catheterization, both frailty categories were independently associated with bleeding risk compared with the non-frail group (vulnerable/mild frailty adjusted odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.23 to 1.44; moderate-to-severe frailty adjusted OR: 1.40, 95% CI: 1.24 to 1.58). Among patients managed conservatively, there was no association of frailty with bleeding (vulnerable/mild frailty adjusted OR: 1.01, 95% CI: 0.86 to 1.19; moderate-to-severe frailty adjusted OR: 0.96, 95% CI: 0.81 to 1.14).ConclusionsFrail patients had lower use of cardiac catheterization and higher risk of major bleeding (when catheterization was performed) than nonfrail patients, making attention to clinical strategies to avoid bleeding imperative in this population.

Published
2018

20. Geriatric Cardiology: Coming of Age

Author

Goyal, Parag, Kwak, Min Ji, Al Malouf, Christina, Kumar, Manish, Rohant, Namit, Damluji, Abdulla A., Denfeld, Quin E., Bircher, Kim K., Krishnaswami, Ashok, Alexander, Karen P., Forman, Daniel E., Rich, Michael W., Wenger, Nanette K., Kirkpatrick, James N., and Fleg, Jerome L.

Published
2022
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22. Sarcopenia and Cardiovascular Diseases

Author

Damluji, Abdulla A., Alfaraidhy, Maha, AlHajri, Noora, Rohant, Namit N., Kumar, Manish, Al Malouf, Christina, Bahrainy, Samira, Ji Kwak, Min, Batchelor, Wayne B., Forman, Daniel E., Rich, Michael W., Kirkpatrick, James, Krishnaswami, Ashok, Alexander, Karen P., Gerstenblith, Gary, Cawthon, Peggy, deFilippi, Christopher R., and Goyal, Parag

Published
2023
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23. Causes of cardiovascular and noncardiovascular death in the ISCHEMIA trial

Author

Sidhu, Mandeep S., Alexander, Karen P., Huang, Zhen, O'Brien, Sean M., Chaitman, Bernard R., Stone, Gregg W., Newman, Jonathan D., Boden, William E., Maggioni, Aldo P., Steg, Philippe Gabriel, Ferguson, Thomas B., Demkow, Marcin, Peteiro, Jesus, Wander, Gurpreet S., Phaneuf, Denis C., De Belder, Mark A., Doerr, Rolf, Alexanderson-Rosas, Erick, Polanczyk, Carisi A., Henriksen, Peter A., Conway, Dwayne S.G., Miro, Vicente, Sharir, Tali, Lopes, Renato D., Min, James K., Berman, Daniel S., Rockhold, Frank W., Balter, Stephen, Borrego, David, Rosenberg, Yves D., Bangalore, Sripal, Reynolds, Harmony R., Hochman, Judith S., and Maron, David J.

Published
2022
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24. Clinical events classification (CEC) in clinical trials: Report on the current landscape and future directions — proceedings from the CEC Summit 2018

Author

Sharma, Abhinav, Mahaffey, Kenneth W., Gibson, Charles Michael, Hicks, Karen A., Alexander, Karen P., Ali, Maria, Chaitman, Bernard R., Held, Claes, Hlatky, Mark, Jones, WIlliam Schuyler, Mehran, Roxana, Menon, Venu, Rockhold, Frank W., Seltzer, Jonathan, Spitzer, Ernest, Wilson, Matthew, and Lopes, Renato D.

Published
2022
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26. Connecting to the oceans: supporting ocean literacy and public engagement

Author

Kelly, Rachel, Evans, Karen, Alexander, Karen, Bettiol, Silvana, Corney, Stuart, Cullen-Knox, Coco, Cvitanovic, Christopher, de Salas, Kristy, Emad, Gholam Reza, Fullbrook, Liam, Garcia, Carolina, Ison, Sierra, Ling, Scott, Macleod, Catriona, Meyer, Amelie, Murray, Linda, Murunga, Michael, Nash, Kirsty L., Norris, Kimberley, Oellermann, Michael, Scott, Jennifer, Stark, Jonathan S., Wood, Graham, and Pecl, Gretta T.

Published
2022
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27. Ocean resource use: building the coastal blue economy

Author

Bax, Narissa, Novaglio, Camilla, Maxwell, Kimberley H., Meyers, Koen, McCann, Joy, Jennings, Sarah, Frusher, Stewart, Fulton, Elizabeth A., Nursey-Bray, Melissa, Fischer, Mibu, Anderson, Kelli, Layton, Cayne, Emad, Gholam Reza, Alexander, Karen A., Rousseau, Yannick, Lunn, Zau, and Carter, Chris G.

Published
2022
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28. Oceans and society: feedbacks between ocean and human health

Author

Nash, Kirsty L., van Putten, Ingrid, Alexander, Karen A., Bettiol, Silvana, Cvitanovic, Christopher, Farmery, Anna K., Flies, Emily J., Ison, Sierra, Kelly, Rachel, Mackay, Mary, Murray, Linda, Norris, Kimberley, Robinson, Lucy M., Scott, Jennifer, Ward, Delphi, and Vince, Joanna

Published
2022
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30. The future of ocean governance

Author

Haas, Bianca, Mackay, Mary, Novaglio, Camilla, Fullbrook, Liam, Murunga, Michael, Sbrocchi, Carla, McDonald, Jan, McCormack, Phillipa C., Alexander, Karen, Fudge, Maree, Goldsworthy, Lyn, Boschetti, Fabio, Dutton, Ian, Dutra, Leo, McGee, Jeffrey, Rousseau, Yannick, Spain, Erica, Stephenson, Robert, Vince, Joanna, Wilcox, Chris, and Haward, Marcus

Published
2022
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32. Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial

Author

Reynolds, Harmony R., primary, Cyr, Derek D., additional, Merz, C. Noel Bairey, additional, Shaw, Leslee J., additional, Chaitman, Bernard R., additional, Boden, William E., additional, Alexander, Karen P., additional, Rosenberg, Yves D., additional, Bangalore, Sripal, additional, Stone, Gregg W., additional, Held, Claes, additional, Spertus, John, additional, Goetschalckx, Kaatje, additional, Bockeria, Olga, additional, Newman, Jonathan D., additional, Berger, Jeffrey S., additional, Elghamaz, Ahmed, additional, Lopes, Renato D., additional, Min, James K., additional, Berman, Daniel S., additional, Picard, Michael H., additional, Kwong, Raymond Y., additional, Harrington, Robert A., additional, Thomas, Boban, additional, O'Brien, Sean M., additional, Maron, David J., additional, Hochman, Judith S., additional, Mavromatis, Kreton, additional, Linefsky, Jason, additional, Miller, Todd, additional, Banerjee, Subhash, additional, Reynolds, Harmony R., additional, Donnino, Robert M., additional, Phillips, Lawrence M., additional, Saric, Muhamed, additional, Abdul‐Nour, Khaled, additional, Stone, Peter H., additional, Jang, James J., additional, Yee, Gennie, additional, Weitz, Steven, additional, Arnold, Suzanne, additional, O’Keefe, James Henry, additional, Shapiro, Michael D., additional, El‐Hajjar, Mohammad, additional, Sidhu, Mandeep S., additional, Fein, Steven A., additional, Torosoff, Mikhail T., additional, Lyubarova, Radmila, additional, Mookherjee, Sulagna, additional, Drzymalski, Krzysztof, additional, McFalls, Edward O., additional, Garcia, Santiago A., additional, Bertog, Stefan C., additional, Siddiqui, Rizwan A., additional, Ishani, Areef, additional, Hansen, Ronnell A., additional, Khouri, Michel Georges, additional, Goldberg, Jonathan L., additional, Goldweit, Richard, additional, Cohen, Ronny A., additional, Mirrer, Brooks, additional, Navarro, Victor, additional, Winchester, David E., additional, Kronenberg, Marvin, additional, Rogal, Philip, additional, McFarren, Christopher, additional, Heitner, John F., additional, Dauber, Ira M., additional, Cannan, Charles, additional, Sudarshan, Sriram, additional, Mehta, Puja K., additional, McDaniel, Michael, additional, Lerakis, Stamatios, additional, Quyyumi, Arshed, additional, Wenger, Nanette K., additional, Hedgepeth, Chester M., additional, Hurlburt, Heather, additional, Rosen, Alan, additional, Sahul, Zakir, additional, Booth, David, additional, Leung, Steve, additional, Abdel‐Latif, Ahmed, additional, Reda, Hassan, additional, Ziada, Khaled, additional, Setty, Sampoornima, additional, Barua, Rajat S., additional, Hage, Fadi, additional, Caldeira, Christiano, additional, Davies, James E., additional, Leesar, Massoud, additional, Heo, Jaekyeong, additional, Iskandrian, Amy, additional, Al Solaiman, Firas, additional, Singh, Satinder, additional, Dajani, Khaled, additional, Der Mesropian, Paul, additional, Sacco, Joseph, additional, McCandless, Brian, additional, Orgera, Marisa, additional, Arif, Imran, additional, Kerr, Hanan, additional, Trejo (Gutierrez), Jorge F., additional, Fletcher, Gerald, additional, Lane, Gary E., additional, Neeson, Lynn M., additional, Parikh, Pragnesh P., additional, Pollak, Peter M., additional, Shapiro, Brian P., additional, Landolfo, Kevin, additional, Gemignani, Anthony, additional, O’Rourke, Daniel, additional, Meadows, Judith L., additional, Call, Jason T., additional, Hannan, Joseph, additional, Bojar, Robert, additional, Kumar, Deepti, additional, Mukai, John, additional, Martin, Edward T., additional, Vorobiof, Gabriel, additional, Moorman, Alec, additional, Kinlay, Scott, additional, Hamburger, Robert J., additional, Rocco, Thomas P., additional, Bhatt, Deepak L., additional, Croce, Kevin, additional, Quin, Jacquelyn A., additional, Anumpa, Jati, additional, Zenati, Marco, additional, Faxon, David P., additional, Rayos, Glenn, additional, Seedhom, Ashraf, additional, Sullenberger, Lance, additional, Kumkumian, Gregory, additional, Sedlis, Steven P., additional, Donnino, Robert M., additional, Lorin, Jeffrey, additional, Tamis‐Holland, Jacqueline E., additional, Kornberg, Robert, additional, Leber, Robert, additional, Saba, Souheil, additional, Lee, Michael W., additional, Small, Delano R., additional, Nona, Wassim, additional, Alexander, Patrick B., additional, Rehman, Iram, additional, Badami, Umesh, additional, Marzo, Kevin, additional, Robbins, Inga H., additional, Levite, Howard A., additional, Shetty, Sanjay, additional, Patel, Mayuri, additional, Hamroff, Glenn S., additional, Little, Raymond W., additional, Zimbelman, Brandi D., additional, Lui, Charles Y., additional, Smith, Brigham R., additional, Vezina, Daniel P., additional, Khor, Lillian L., additional, Abraham, Josephine D., additional, Bull, David A., additional, McKellar, Stephen H., additional, Kotter, John, additional, Hu, Bob, additional, Labovitz, Arthur J., additional, Berlowitz, Michael, additional, Matar, Fadi, additional, Rodriguez, Fatima, additional, Schnittger, Ingela, additional, 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Marin, additional, Chávarri, M. Valdés, additional, Montolliu, A. Tello, additional, Bermudez, E. 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Grazia, additional, Abdelhamid, Magdy, additional, Adel, Ahmed, additional, Kamal, Ahmed, additional, Mahrous, Hossam, additional, El Kaffas, Sameh, additional, El Fishawy, Hussien, additional, Pop, Calin, additional, Claudia, Matei, additional, Popescu, Bogdan A., additional, Ginghina, Carmen, additional, Deleanu, Dan, additional, Iliescu, Vlad A., additional, Al‐Mallah, Mouaz H., additional, Aljzeeri, Ahmed, additional, Najm, Hani, additional, Alghamdi, Ali, additional, Ramos, Walter Enrique Mogrovejo, additional, Kuanprasert, Srun, additional, Prommintikul, Arintaya, additional, Nawarawong, Weerachai, additional, Woragidpoonpol, Surin, additional, Tepsuwan, Thitipong, additional, Taksaudom, Noppon, additional, Rimsukcharoenchai, Chataroon, additional, Euathrongchit, Juntima, additional, Wannasopha, Yutthaphan, additional, Yamwong, Sukit, additional, Sritara, Piyamitr, additional, Aramcharoen, Suthara, additional, Meemuk, Krissada, additional, Khairuddin, Ahmad, additional, Hadi, Hafidz Abd, additional, and Yahaya, Shaiful Azmi, additional

Published
2024
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33. Effects of albiglutide on myocardial infarction and ischaemic heart disease outcomes in patients with type 2 diabetes and cardiovascular disease in the Harmony Outcomes trial

Author

Krychtiuk, Konstantin A, primary, Marquis-Gravel, Guillaume, additional, Murphy, Shannon, additional, Alexander, Karen P, additional, Chiswell, Karen, additional, Green, Jennifer B, additional, Leiter, Lawrence A, additional, Lopes, Renato D, additional, Del Prato, Stefano, additional, Jones, William Schuyler, additional, McMurray, John J V, additional, Hernandez, Adrian F, additional, and Granger, Christopher B, additional

Published
2024
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35. Gerotechnology for Older Adults With Cardiovascular Diseases: JACC State-of-the-Art Review

Author

Krishnaswami, Ashok, Beavers, Craig, Dorsch, Michael P., Dodson, John A., Masterson Creber, Ruth, Kitsiou, Spyros, Goyal, Parag, Maurer, Mathew S., Wenger, Nanette K., Croy, Deborah S., Alexander, Karen P., Batsis, John A., Turakhia, Mintu P., Forman, Daniel E., Bernacki, Gwen M., Kirkpatrick, James N., Orr, Nicole M., Peterson, Eric D., Rich, Michael W., Freeman, Andrew M., and Bhavnani, Sanjeev P.

Published
2020
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37. Improved Cardiovascular Disease Outcomes in Older Adults

Author

Forman, Daniel E, Alexander, Karen, Brindis, Ralph G, Curtis, Anne B, Maurer, Mathew, Rich, Michael W, Sperling, Laurence, and Wenger, Nanette K

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Aging, Cardiovascular, Clinical Research, Heart Disease, Heart Disease - Coronary Heart Disease, Prevention, Good Health and Well Being, Geriatric, HFpEF, Biochemistry and Cell Biology, Clinical Sciences, Oncology and Carcinogenesis
Abstract

Longevity is increasing and the population of older adults is growing. The biology of aging is conducive to cardiovascular disease (CVD), such that prevalence of coronary artery disease, heart failure, valvular heart disease, arrhythmia and other disorders are increasing as more adults survive into old age.  Furthermore, CVD in older adults is distinctive, with management issues predictably complicated by multimorbidity, polypharmacy, frailty and other complexities of care that increase management risks (e.g., bleeding, falls, and rehospitalization) and uncertainty of outcomes.  In this review, state-of-the-art advances in heart failure, acute coronary syndromes, transcatheter aortic valve replacement, atrial fibrillation, amyloidosis, and CVD prevention are discussed.  Conceptual benefits of treatments are considered in relation to the challenges and ambiguities inherent in their application to older patients.

Published
2016

38. New statin use, mortality, and first cardiovascular events in older US Veterans by frailty status

Author

Orkaby, Ariela R., primary, Lu, Bing, additional, Ho, Yuk‐Lam, additional, Treu, Timothy, additional, Galloway, Ashley, additional, Wilson, Peter W. F., additional, Cho, Kelly, additional, Gaziano, J. Michael, additional, Alexander, Karen P., additional, Gagnon, David R., additional, Djousse, Luc, additional, Forman, Daniel E., additional, and Driver, Jane A., additional

Published
2023
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42. New statin use, mortality, and first cardiovascular events in older US Veterans by frailty status.

Author

Orkaby, Ariela R., Lu, Bing, Ho, Yuk‐Lam, Treu, Timothy, Galloway, Ashley, Wilson, Peter W. F., Cho, Kelly, Gaziano, J. Michael, Alexander, Karen P., Gagnon, David R., Djousse, Luc, Forman, Daniel E., and Driver, Jane A.

Subjects
CARDIOVASCULAR disease prevention, MORTALITY prevention, CARDIOVASCULAR disease related mortality, AMERICAN veterans, STATINS (Cardiovascular agents), CAUSES of death, RESEARCH, FRAIL elderly, STROKE, TRANSIENT ischemic attack, CONFIDENCE intervals, MAJOR adverse cardiovascular events, REVASCULARIZATION (Surgery), RETROSPECTIVE studies, MYOCARDIAL infarction, ACQUISITION of data, COMPARATIVE studies, RESEARCH funding, QUESTIONNAIRES, DESCRIPTIVE statistics, MEDICAL records, DEATH, STATISTICAL correlation, PROPORTIONAL hazards models, LONGITUDINAL method, OLD age
Abstract

Background: Statins are part of long‐term medical regimens for many older adults. Whether frailty modifies the protective relationship between statins, mortality, and major adverse cardiovascular events (MACE) is unknown. Methods: This was a retrospective study of US Veterans ≥65, without CVD or prior statin use seen in 2002–2012, followed through 2017. A 31‐item frailty index was used. The co‐primary endpoint was all‐cause mortality or MACE (MI, stroke/TIA, revascularization, or cardiovascular death). Cox proportional hazards models were developed to evaluate the association of statin use with outcomes; propensity score overlap weighting accounted for confounding by indication. Results: We identified 710,313 Veterans (mean age (SD) 75.3(6.5), 98% male, 89% white); 86,327 (12.1%) were frail. Over mean follow‐up of 8 (5) years, there were 48.6 and 72.6 deaths per 1000 person‐years (PY) among non‐frail statin‐users vs nonusers (weighted Incidence Rate Difference (wIRD)/1000 person years (PY), −24.0[95% CI, −24.5 to −23.6]), and 90.4 and 130.4 deaths per 1000PY among frail statin‐users vs nonusers (wIRD/1000PY, −40.0[95% CI, −41.8 to −38.2]). There were 51.7 and 60.8 MACE per 1000PY among non‐frail statin‐users vs nonusers (wIRD/1000PY, −9.1[95% CI, −9.7 to −8.5]), and 88.2 and 102.0 MACE per 1000PY among frail statin‐users vs nonusers (wIRD/1000PY, −13.8[95% CI, −16.2 to −11.4]). There were no significant interactions by frailty for statin users vs non‐users by either mortality or MACE outcomes, p‐interaction 0.770 and 0.319, respectively. Statin use was associated with lower risk of all‐cause mortality (HR, 0.61 (0.60–0.61)) and MACE (HR 0.86 (0.85–0.87)). Conclusions: New statin use is associated with a lower risk of mortality and MACE, independent of frailty. These findings should be confirmed in a randomized clinical trial. See related editorial by Aliberti et al. in this issue. [ABSTRACT FROM AUTHOR]

Published
2024
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43. Evaluation of indirect transfer mechanisms of semen under varying test conditions.

Author

Finnis, Jonathan, Davidson, Geraldine, Alexander, Karen, Lewis, Jennie, Boyce, Maggie, Kennedy, Finlay, Casey, David, Clayson, Nicola, Fraser, Isla, Murphy, Charlotte, Hargreaves, Charlotte, Stevenson, Nighean, Doole, Sharon, and Rogers, Carol

Subjects
ACID phosphatase, SPERMATOZOA, FORENSIC sciences, FLUORESCENCE, MICROSCOPY
Abstract

• Semen transfers more readily when wet than dry. • Semen transfers more readily from a non-porous primary surface than from a porous primary surface. • Examination findings can assist in determining whether a stain was wet or dry when a transfer occurred. • Low levels of sperm cells can be detected from transfers even in the absence of acid phosphatase reactions. There is limited data available on the subject of indirect transfer of non-visible body fluids, particularly semen, and often forensic science practitioner experience alone must be used to guide expectations. It can be difficult to assess the likelihood of proposed transfer scenarios without knowledge of how different variables can affect a transfer. The following work carried out by the Association of Forensic Service Providers UK and Ireland Body Fluid Forum explores how the features of transferred semen change with differences in the primary and secondary surface (porous and non– porous), different contact types (passive, pressure and pressure+) and with wet and dry primary stains. It was concluded that the primary surface type and whether the stain was wet or dry when contact occurred had the most significant effect on the transfer of semen, with wet transfers and transfers from the tested non-porous surface producing significantly more, and larger, visible stains under white light, stains with stronger fluorescence as viewed using Crime-lite® ML2, stains with stronger and faster acid phosphatase reactions and greater numbers of spermatozoa viewed using high power microscopy, compared to dry transfers and transfers from the tested porous surface. Pressure with movement transfers resulted in significantly more visible stains under white light and greater numbers of spermatozoa viewed using high power microscopy compared to passive transfers, however this only occurred when transfers were from a porous primary surface. The secondary surface type was not found to have a significant effect on the numbers of spermatozoa viewed using high power microscopy. [ABSTRACT FROM AUTHOR]

Published
2024
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44. Life’s Essential 8

Author

Kumar, Manish, primary, Orkaby, Ariela, additional, Tighe, Caitlan, additional, Villareal, Dennis T., additional, Billingsley, Hayley, additional, Nanna, Michael G., additional, Kwak, Min Ji, additional, Rohant, Namit, additional, Patel, Shreya, additional, Goyal, Parag, additional, Hummel, Scott, additional, Al-Malouf, Christina, additional, Kolimas, Amie, additional, Krishnaswami, Ashok, additional, Rich, Mike W., additional, Kirkpatrick, James, additional, Damluji, Abdulla A., additional, Kuchel, George A., additional, Forman, Daniel E., additional, and Alexander, Karen P., additional

Published
2023
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