605 results on '"Darrell R. Schroeder"'
Search Results
2. Longitudinal Progression of Patients with Long COVID Treated in a Post-COVID Clinic: A Cross-Sectional Survey
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Ryan T. Hurt, Siddhant Yadav, Darrell R. Schroeder, Ivana T. Croghan, Michael R. Mueller, Stephanie L. Grach, Christopher A. Aakre, Elizabeth A. Gilman, Christopher R. Stephenson, Joshua Overgaard, Nerissa M. Collins, Donna K. Lawson, Ann M. Thompson, Lasonya T. Natividad, Osman Mohamed Elfadil, and Ravindra Ganesh
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Background: In addition to the morbidity and mortality associated with acute infection, COVID-19 has been associated with persistent symptoms (>30 days), often referred to as Long COVID (LC). LC symptoms often cluster into phenotypes, resembling conditions such as fibromyalgia, postural orthostatic tachycardiac syndrome (POTS), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). LC clinics have been established to best address the needs of LC patients and continuity of care. We developed a cross-sectional survey to assess treatment response through our LC Clinic (LCC). Methods: A 25-question survey (1-10 Likert scale) was expert- and content-validated by LCC clinicians, patients, and patient advocates. The survey assessed LC symptoms and the helpfulness of different interventions, including medications and supplements. A total of 852 LCC patients were asked to complete the survey, with 536 (62.9%) responding. Results: The mean time from associated COVID-19 infection to survey completion was 23.2 ± 6.4 months. The mean age of responders was 52.3 ± 14.1 (63% females). Self-reported symptoms were all significantly improved ( P
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- 2024
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3. Sugammadex and urinary retention after hysterectomy: A propensity-matched cohort study
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Mariana L. De Lima Laporta Miranda, Michelle A. Ochs Kinney, Jamie N. Bakkum-Gamez, Darrell R. Schroeder, Juraj Sprung, and Toby N. Weingarten
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General anesthesia ,glycopyrrolate ,neuromuscular blocking drugs ,sugammadex ,urinary retention ,Biology (General) ,QH301-705.5 - Abstract
Postoperative urinary retention (POUR) is a well-known complication after gynecologic surgery. Our objective was to investigate whether the choice of pharmacologic agent for reversing neuromuscular blockade at the end of a hysterectomy is a risk factor for POUR. Among adult patients undergoing hysterectomy with general anesthesia from 2012 to 2017, those who received aminosteroid nondepolarizing neuromuscular agents followed by pharmacologic reversal were identified, and electronic health records were reviewed. The cohort was dichotomized into two groups by reversal agent: 1) sugammadex and 2) neostigmine with glycopyrrolate. The primary outcome, POUR, was defined as unplanned postoperative bladder recatheterization. A propensity-adjusted analysis was performed to investigate the association between POUR and reversal agent by using inverse probability of treatment weighting to adjust for potential confounders. We identified 1,974 patients, of whom 1,586 (80.3%) received neostigmine-glycopyrrolate and 388 (19.7%) received sugammadex for reversal of neuromuscular blockade. The frequency of POUR was 24.8% (393/1,586) after reversal with neostigmine-glycopyrrolate and 18.3% (71/388) with sugammadex. Results from the propensity-adjusted analysis showed that sugammadex was associated with a lower POUR risk than neostigmine-glycopyrrolate (odds ratio 0.53, 95% confidence interval [CI] 0.37 - 0.76, P < 0.001). A post hoc analysis of sugammadex recipients who received glycopyrrolate for another indication showed a higher POUR risk than among those who did not receive glycopyrrolate (odds ratio 1.86, 95% CI 1.07 - 3.22, P = 0.03). Use of sugammadex to reverse aminosteroid neuromuscular blocking agents is associated with decreased risk of POUR after hysterectomy. A potential mechanism is the omission of glycopyrrolate, which is coadministered with neostigmine to mitigate unwanted cholinergic effects.
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- 2024
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4. Postdischarge Video Visits for Adherence to Hospital Discharge Recommendations: A Randomized Clinical Trial
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Sagar B. Dugani, MD, PhD, MPH, Shangwe A. Kiliaki, CNP, DNP, Megan L. Nielsen, MSN, CNP, Karen M. Fischer, MPH, Megan Lunde, Gina M. Kesselring, MPAS, PA-C, Donna K. Lawson, CCRP, Trevor J. Coons, MHA, Holly A. Schenzel, CNP, DNP, Riddhi S. Parikh, MBBS, Sandeep R. Pagali, MD, MPH, Anne Liwonjo, MD, Ivana T. Croghan, MS, PhD, Darrell R. Schroeder, MS, and M. Caroline Burton, MD
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Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Objective: To determine whether a postdischarge video visit with patients, conducted by hospital medicine advanced practice providers, improves adherence to hospital discharge recommendations. Patients and Methods: We conducted a single-institution 2-site randomized clinical trial with 1:1 assignment to intervention vs control, with enrollment from August 10, 2020, to June 23, 2022. Hospital medicine patients discharged home or to an assisted living facility were randomized to a video visit 2-5 days postdischarge in addition to usual care (intervention) vs usual care (control). During the video visit, advanced practice providers reviewed discharge recommendations. Both intervention and control groups received telephone follow-up 3-6 days postdischarge to ascertain the primary outcome of adherence to all discharge recommendations for new and chronic medication management, self-management and action plan, and home support. Results: Among 1190 participants (594 intervention; 596 control), the primary outcome was ascertained in 768 participants (314 intervention; 454 control). In intervention vs control, there was no difference in the proportion of participants with the primary outcome (76.7% vs 72.5%; P=.19) or in the individual domains of the primary outcome: new and chronic medication management (94.1% vs 92.8%; P=.50), self-management and action plan (76.5% vs 71.5%; P=.18), and home support (94.1% vs 94.3%; P=.94). Women receiving intervention vs control had higher adherence to recommendations (odds ratio, 1.77; 95% CI, 1.08-2.91). Conclusion: In hospital medicine patients, a postdischarge video visit did not improve adherence to discharge recommendations. Potential gender differences in adherence require further investigation.Clinicaltrials.gov number, NCT04547803.
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- 2023
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5. Development of a Visit Facilitator Role to Assist Physicians in an Ambulatory Consultative Medical Practice
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Elizabeth A. Gilman, MD, Christopher Aakre, MD, Adam Meyers, MBA, Nerissa Collins, MD, Chrissy VerNess, MA, Brian Dougan, MD, Xiomari Davis, MEd, Lindsey Philpot, PhD, MPH, Priya Ramar, MPH, Ivana Croghan, PhD, Darrell R. Schroeder, MS, Erin Pagel, MS, MHI, Karthik Ghosh, MD, and Ryan T. Hurt, MD, PhD
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Medicine (General) ,R5-920 - Abstract
Objective: To decrease the electronic health record (EHR) clerical burden and improve patient/clinician satisfaction, allied health staff were trained as visit facilitators (VFs) to assist the physician in clinical and administrative tasks. Patients and Methods: From December 7, 2020, to October 11, 2021, patients with complex medical conditions were evaluated by an internal medicine physician in an outpatient general internal medicine (GIM) consultative practice at a tertiary care institution. A VF assisted with specific tasks before, during, and after the clinical visit. Presurvey and postsurvey assessments were performed to understand the effect of the VF on clinical tasks as perceived by the physician. Results: A total of 57 GIM physicians used a VF, and 41 (82%) physicians and 39 (79%) physicians completed the pre-VF and post-VF surveys, respectively. Physicians reported a significant reduction in time reviewing outside materials, updating pertinent information, and creating/modifying EHR orders (P
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- 2023
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6. Gabapentinoid Prescribing Practices at a Large Academic Medical Center
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Linda L. Huang, PharmD, Jessica A. Wright, PharmD, Karen M. Fischer, MPH, Ivana T. Croghan, PhD, Sanjeev Nanda, MD, Darrell R. Schroeder, MS, and Ann Vincent, MD
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Medicine (General) ,R5-920 - Abstract
Objective: To evaluate indications for gabapentinoid prescription at an academic medical center. Patients and Methods: We retrospectively reviewed patients aged 18 years or older who were prescribed gabapentinoids (gabapentin or pregabalin) during the 2019 calendar year at an academic medical center in the US Midwest. Patient demographic characteristics, indications for gabapentinoid prescription, and prescribing clinician specialities were abstracted from a random sample, and the findings were extrapolated to the overall cohort. Results: A total of 6205 prescriptions for gabapentinoids were initially identified. In the random sample of prescriptions (n=721), 89.5% were for gabapentin and 10.5% were for pregabalin. More women than men were prescribed gabapentinoids, and the mean ± SD patient age was 58.6±16.9 years. The top 5 indications for gabapentinoid prescriptions were neuropathic pain, musculoskeletal pain, restless legs syndrome, anxiety, and headache. A majority (66.7%) of prescriptions had substantial-to-modest evidence, but 29.0% of prescriptions had conflicting or insufficient evidence. Conclusion: To our knowledge, this study is one of the first to manually review clinical notes from multiple clinical specialities to ascertain indications for gabapentinoid prescriptions. Although most prescriptions had modest evidence to support their use, a high percentage of gabapentinoid prescriptions were issued for indications not supported by robust evidence. This suggests that prescribers are gravitating toward gabapentinoid use for reasons that are currently not fully understood. Clinician intent for off-label gabapentinoid prescriptions at the point of care should be further studied to understand the factors that lead to these clinical decisions.
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- 2023
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7. Varenicline and Lorcaserin for Smoking Cessation and Weight Gain Prevention: A Randomized Clinical Trial
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Ryan T. Hurt, MD, PhD, Ivana T. Croghan, PhD, Darrell R. Schroeder, MS, Doo-Sup Choi, PhD, Karen Fischer, MA, Shawn Fokken, CCRP, and Jon O. Ebbert, MD
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Medicine (General) ,R5-920 - Abstract
Objective: To evaluate the safety and effectiveness of combination varenicline with lorcaserin in preventing post-cessation weight gain. Participants and Methods: We conducted a randomized (varenicline for 12 weeks + lorcaserin for 24 weeks vs varenicline for 12 weeks + placebo for 24 weeks) phase II clinical study to obtain preliminary data on the safety and effectiveness of combination varenicline and lorcaserin in preventing post-cessation weight gain in overweight and obese smokers. Eighty-four overweight and obese (body mass index [BMI], 27-40 kg/m2) cigarette smokers were randomized before study termination (lorcaserin: n=40; placebo: n=44). The primary outcomes were weight and waist circumference (WC) changes at 12 and 24 weeks in smokers meeting criteria for prolonged smoking abstinence. Results: Thirty-nine participants met criteria for prolonged smoking abstinence at 12 weeks (46%) and 21 at 24 weeks (25%). No significant treatment effect was observed at 12 weeks with lorcaserin compared with placebo (weight difference, −0.7 kg; 90% CI, −2.6 to 1.1 kg; P=.51; WC difference, −1.9 cm; 90% CI, −4.2 to 0.5 cm; P=.18; or BMI difference, −0.4 kg/m2; 90% CI, −1.1 to 0.3 kg/m2; P=.33). No significant treatment effect was observed between lorcaserin at 24 weeks compared with placebo (weight, 1.4 kg; 90% CI, −3.8 to 6.7 kg; P=.65; WC, −0.9 cm; 90% CI, −5.8 to 4.0 cm; P=.75; or BMI 0.29 kg/m2; 90% CI, −1.5 to 2.12 kg/m2; P=.79). Conclusion: Weight gain and WC increases after prolonged smoking abstinence were not reduced using combination varenicline and lorcaserin. The results do not support further research in the obese and weight-concerned smoking population using lorcaserin or similar drugs. Trial Registration: clinicaltrials.gov Identifier: NCT02412631
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- 2022
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8. Mindfulness Using a Wearable Brain Sensing Device for Health Care Professionals During a Pandemic: A Pilot Program
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Karthik Ghosh, Sanjeev Nanda, Ryan T. Hurt, Darrell R. Schroeder, Colin P. West, Karen M. Fischer, Brent A. Bauer, Shawn C. Fokken, Ravindra Ganesh, Jennifer L. Hanson, Stephanie A. Lindeen, Sandhya Pruthi, and Ivana T. Croghan
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: The purpose of this feasibility pilot study was to evaluate safety and adherence of a wearable brain sensing wellness device designed to reduce stress among healthcare professionals (HCP). Methods: A total of 40 HCP were invited to participate in an open-label pilot study. Participants were asked to use a brain sensing wearable device (MUSE-S™) on a daily basis to reduce their stress, for a total of 90 days. Total study participation duration was 180 days. Study enrollment began in August 2021 and ended December 2021. The exploratory outcomes included stress, depression, sleep, burn-out, resilience, quality of life, and cognition. Results: Among the 40 HCP in study, the majority were female (85%), white (87.5%) and with an average age of 41.3 ± 11.0 years (SD). Participants used the wearable device an average of 23.8 times over a 30-day period with a mean duration of 5.8 min with each use. Study results demonstrate the positive impact of guided mindfulness using the wearable device MUSE-S™ and its accompanying application (APP). A statistically significant improvement was found for a reduction in stress ( P
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- 2023
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9. A model of weight‐based stigma in health care and utilization outcomes: Evidence from the learning health systems network
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Sean M. Phelan, Katherine W. Bauer, David Bradley, Steven M. Bradley, Irina V. Haller, Manpreet S. Mundi, Lila J. Finney Rutten, Darrell R. Schroeder, Kristin Fischer, and Ivana Croghan
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health care utilization ,obesity ,obesity bias ,patient‐centered care ,social stigma ,Internal medicine ,RC31-1245 - Abstract
Abstract Objective Obesity is stigmatized and people with obesity report experiencing stigmatizing situations when seeking health care. The implications of these experiences are not well understood. This study tests an indirect effects model of negative care experiences as an intermediate variable between obesity and care avoidance/utilization and switching primary care doctors. Methods A survey was completed by 2380 primary care patients in the Learning Health Systems Network (LHSNet) Clinical Data Research Network with a BMI >25 kg/m2. Measures included scales assessing stigmatizing situations, perceived patient‐centered communication, perceived respect, having delayed needed care, and having looked for a new primary doctor in the past 12 months. Sequential and serial indirect effects of care experiences and respect in the association between BMI and care utilization outcomes was modeled. Results The hypothesized model was supported by findings. The associations between BMI and delaying needed care (OR = 1.06, p
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- 2022
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10. The feasibility and value of assessing patient‐reported outcomes in pulmonary arterial hypertension
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Hilary M. DuBrock, Yogesh N. Reddy, Louise A. Durst, Darrell R. Schroeder, Grace Park, Hector R. Cajigas, Garvan C. Kane, Sudhir S. Kushwaha, Robert B. McCully, Joseph G. Murphy, Vidhu Anand, Michael J. Krowka, and Robert P. Frantz
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PAH‐SYMPACT ,patient‐reported outcomes ,pulmonary arterial hypertension ,quality of life ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Pulmonary arterial hypertension (PAH) is a progressive pulmonary vascular disease that negatively impacts health‐related quality of life (HRQOL). The PAH‐symptoms and impact (PAH‐SYMPACT) questionnaire is a validated disease‐specific patient‐reported outcome (PRO) instrument that assesses a patient's symptoms and the impact of PAH and its treatment on well‐being. We performed a single‐center prospective cohort study of patients with PAH to determine the feasibility of assessing PROs in clinical practice and to determine the association between PAH‐SYMPACT domains and clinical characteristics and outcomes. One hundred and ten patients completed the 1‐day version of the PAH‐SYMPACT questionnaire which consists of 22 Likert‐scale questions that assess HRQOL across four domains: cardiopulmonary (CP) symptoms, cardiovascular (CV) symptoms, physical impact (PI), and cognitive and emotional (CE) impact. Higher scores indicate worse HRQOL. Patients were predominantly female (n = 86, 78%) with a mean age of 57.8 ± 16.2 years. While several patient characteristics were associated with CP and PI domains, few were associated with CV and CE domains. PI and CE impact scores were associated with recent hospitalizations and mortality and CE impact score was independently associated with an increased risk of death after adjustment for disease severity (hazard ratio: 3.29, 95% confidence interval: 1.56–6.91, p = 0.002). In conclusion, the assessment of PROs in clinical practice using the PAH‐SYMPACT questionnaire is both feasible and valuable. PAH‐SYMPACT scores have independent prognostic value and are not adequately reflected by traditional measures of disease severity. These findings underscore the importance of assessing HRQOL in clinical practice.
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- 2022
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11. The Association of Current Tobacco Status With Pain and Symptom Severity in Fibromyalgia Patients
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Ivana T. Croghan, PhD, Ryan T. Hurt, MD, Ravindra Ganesh, MBBS, MD, Ojas Bhagra, Karen M. Fischer, MPH, Ann Vincent, MD, J. Taylor Hays, MD, Dennis M. Bierle, MD, Darrell R. Schroeder, MS, Debbie L. Fuehrer, LPCC, and Sanjeev Nanda, MD
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Medicine (General) ,R5-920 - Abstract
Objective: To describe current tobacco use among patients with newly confirmed fibromyalgia and evaluate the association between tobacco use status and severity of reported pain and other fibromyalgia symptoms. Patients and Methods: Participants in this study were adult patients (N=1068) with fibromyalgia who met American College of Rheumatology 2010/2011 clinical criteria for fibromyalgia at the time of initial presentation to a Midwest fibromyalgia clinic (June 1, 2018, through May 31, 2019). Multiple linear regression analyses were performed to assess the association of tobacco use status with the Widespread Pain Index (WPI) and Symptom Severity Scale (SSS) scores. Covariates included in these analyses included age, sex, body mass index, depression, opioid medication use, and use of fibromyalgia-specific pharmacotherapy. Results: The patients were largely women (87.0%; n=929), white (87.9%; n=939), and with an average ± SD age of 46.6±13.9 years. The WPI and SSS scores were significantly greater in current tobacco users compared with never tobacco users (WPI effect estimate [EE] = 1.03; 95% CI, 0.30 to 1.76; type III P=.020; SSS EE = 0.47; 95% CI, 0.11 to 0.84; type III P=.036). The WPI score was negatively associated with age (EE = −0.02 per year; 95% CI, −0.03 to −0.001 per year; P=.037) and no use of opioid medication (EE = −1.08; 95% CI, −1.59 to −0.57; P
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- 2021
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12. Virtual Reality for Health Care Professionals During a Pandemic: A Pilot Program
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Ivana T. Croghan, Ryan T. Hurt, Christopher A. Aakre, Shawn C. Fokken, Karen M. Fischer, Stephanie A. Lindeen, Darrell R. Schroeder, Ravindra Ganesh, Karthik Ghosh, and Brent A. Bauer
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: The purpose of this pilot study was to evaluate the safety and use of a nature-based virtual reality (VR) experience among health care providers (HCP) during a pandemic. Methods: Twenty-four frontline HCP participated in this crossover pilot where the viewing order of the experiences were randomized. All participants attended in-person consent, baseline, and end-of-study visits. The intervention consisted of viewing 2 nature-based scenes (“walk in the woods” and “forest of focus”) through 3-D VR and with computer 4K graphic imagery. Randomization took place with regards to the viewing order (VR vs 4K computer video, scene 1 and 2). Outcomes measured were safety, acceptability and changes in intensity of anxiety feelings, resilience, emotional distress, cognitive function, and self-efficacy. Results: Among the 26 HCP expressing interest in the study, 24 enrolled in this study. The majority were male (58.3%), white (66.7%) and of an average age of 46.3 ± 10.5 years (standard deviation (SD)). End of the study survey showed that almost all participants (96%) would participate in the study again and recommend it to others. Twenty-three of the 24 participants also felt relaxed after seeing the imagery. With respect to anxiety (as measured by the STAI Y1), the VR “walk in the woods” had the greatest reduction from pre to post (6.4 points, SD = 5.98) followed by VR “forest of focus” (5.8 points, SD = 9.29), computer screen “forest of focus” (5.0 points, SD = 8.89), and computer screen “walk in the woods” (4.1 points, SD = 6.22). All 4 sessions had a significant decrease in score from pre to post (P-values ≤.005), but there was no significant difference in the change from pre- to post-session between the 4 groups (P-value = .5835). Conclusion: The use of the VR among HCP has promise for reducing stress among health care providers during a high stress period, such as a pandemic but much larger studies are needed.
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- 2022
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13. Symptoms COVID 19 Positive Vapers Compared to COVID 19 Positive Non-vapers
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David D. McFadden, Shari L. Bornstein, Robert Vassallo, Bradley R. Salonen, Mohammed Nadir Bhuiyan, Darrell R. Schroeder, and Ivana T. Croghan
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objectives: The purpose of the present study was to assess and describe the severity of symptoms reported by Covid-19 positive patients who vaped (smoked e-cigarettes) when compared to those who did not vape or smoke at the time of the diagnosis of Covid-19. Methods: Patients from this study are from a well-characterized patient cohort collected at Mayo Clinic between March 1, 2020 and February 28, 2021; with confirmed COVID-19 diagnosis defined as a positive result on reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays from nasopharyngeal swab specimens. Among the 1734 eligible patients, 289 patients reported current vaping. The cohort of vapers (N = 289) was age and gender matched to 1445 covid-19 positive patients who did not vape. The data analyzed included: date of birth, gender, ethnicity, race, marital status, as well as lifestyle history such as vaping and smoking and reported covid-19 symptoms experienced. Results: A logistic regression analysis was performed separately for each symptom using generalized estimating equations (GEE) with robust variance estimates in order to account for the 1:5 age, sex, and race matched set study design. Patients who vaped and developed Covid-19 infection were more likely to have chest pain or tightness (16% vs 10%, vapers vs non vapers, P = .005), chills (25% vs 19%, vapers vs non vapers, P = .0016), myalgia (39% vs 32%, vapers vs non vapers, P = .004), headaches (49% vs 41% vapers vs non vapers, P = .026), anosmia/dysgeusia (37% vs 30%, vapers vs non vapers, P = .009), nausea/vomiting/abdominal pain (16% vs 10%, vapers vs non vapers, P = .003), diarrhea (16% vs 10%, vapers vs non vapers, P = .004), and non-severe light-headedness (16% vs 9%, vapers vs non vapers, P
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- 2022
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14. Utilization of an Electronic Health Record Integrated Risk Score to Predict Hospitalization Among COVID-19 Patients
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Mark A. Nyman, Thulasee Jose, Ivana T. Croghan, Mark A. Parkulo, Charles D. Burger, Darrell R. Schroeder, Ryan T. Hurt, and John C. O’Horo
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: To evaluate the performance of an Electronic Health Record (EHR) integrated risk score for COVID-19 positive outpatients to predict 30-day risk of hospitalization. Patients and Methods: A retrospective observational study of 67 470 patients with COVID-19 confirmed by polymerase chain reaction (PCR) test between March 12, 2020 and February 8, 2021. Risk scores were calculated based on data in the chart at the time of the incident infection. Results: The Mayo Clinic COVID-19 risk score consisted of 13 components included age, sex, chronic lung disease, congenital heart disease, congestive heart failure, coronary artery disease, diabetes mellitus, end stage liver disease, end stage renal disease, hypertension, immune compromised, nursing home resident, and pregnant. Univariate analysis showed all components, except pregnancy, have significant ( P
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- 2022
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15. Improving Physical Activity and Body Composition in a Medical Workplace Using Brief Goal Setting
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Sanjeev Nanda, MD, Ryan T. Hurt, MD, PhD, Ivana T. Croghan, MS, PhD, Manpreet S. Mundi, MD, Sarah L. Gifford, MS, Darrell R. Schroeder, MS, Karen M. Fischer, MPH, and Sara L. Bonnes, MD
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Medicine (General) ,R5-920 - Abstract
Objective: To evaluate the use of a wearable activity tracker and brief feedback in the workplace to motivate employees to improve activity. Patients and Methods: A total of 135 adult participants were randomized to 1 of 3 groups: control group (blinded to their step activity), intervention group (received counseling based on their step count), or no step-tracking device group. Participants were recruited from June 27, 2016, through February 21, 2018. Results: Most of the 135 participants were women (84%), with a mean ± SD age of 42.6±10.1 years. Most participants (96%) completed 11 of the 12 weeks of step counts. Comparing treatment groups at week 12 (end of treatment), the intervention group (vs the control group) had significantly more steps (644.8; P
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- 2019
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16. COVID-19 Care Clinic in a Medical Center: Lessons Learned
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Sidna M. Tulledge-Scheitel, Thomas A. Billings, Karen M. Fischer, Jason H. Homme, Jennifer M. Miller, Frederick North, Rachael L. Sanderson, Darrell R. Schroeder, Marvin A. Vaughan, and Ivana T. Croghan
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: The purpose of this report is to describe the elements of a Covid-19 Care Clinic (CCC), patient demographics, and outcomes. Methods: Descriptive statistics were used to describe demographics, clinical characteristics, and outcomes. This report is based on 4934 unique patients seen in the CCC who provided research authorization within a 10-month period of time (April 1, 2020-January 31, 2021). The CCC infection control processes consisted of a rooming process that mitigated SARS-COV-2 transmission, preparing examination rooms, using PPE by staff, in room lab drawing, and escorting services to minimize the time in clinic. Results: Of the 4934 unique patients seen (age range newborn-102 years), 76.8% were tested for COVID-19. Of those tested, 11.8% were positive for SARS-CoV-2. Ninety-two percent of the patients with the reason for the visit documented had COVID-19 type symptoms. Cough, shortness of breath, and chest pain were the most common presenting symptom in those with COVID-19. At the time of the visit in the CCC, 5.8% of the patients were actively contagious. Thirty days after being seen in the CCC, 9.1% of the patients were seen in the emergency department (ED) and 0.2% died. During the 10-month period there were no known occupationally related COVID-19 infections. Conclusion: The COVID-19 Care Clinic provided face-to-face access for all ages with COVID-19 type symptoms. A minority of patients had COVID-19 who were seen in the clinic. The clinic provided an additional venue of care outside of the ED. The infectious control measures employed were highly effective in protecting the staff. Lessons learned allow for decentralization of COVID-19 symptom care to the primary care practices employing the infection control measures.
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- 2021
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17. Couples’ Use of Online Stress Management and Resiliency Training for Sexual Health Concerns: A Randomized Controlled Trial
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Jordan E. Rullo, PhD, LP, Richa Sood, MD, MS, Shawn C. Fokken, CCRP, Amit Sood, MD, MS, Karla S. Frohmader, PhD, Ivana T. Croghan, PhD, Darrell R. Schroeder, MS, and Stephanie S. Faubion, MD, MBA
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Couples ,Mindfulness ,Online ,Orgasm ,Psychoeducation ,Resilience ,Medicine - Abstract
Introduction: Mindfulness is a promising intervention for female sexual dysfunction (FSD); however, of the mindfulness interventions studied, few treat the woman and her partner. Aim: We developed a brief online mindfulness, resilience, and psychoeducation intervention, Stress Management and Resiliency Training for Sexuality (Sex SMART), for women with sexual health concerns and their partners. Methods: Women with female sexual interest/arousal disorder and their partners were recruited between February 24, 2015, and October 6, 2016, and randomized to treatment or control groups (received educational pamphlets). The treatment intervention comprised of an online SMART and sexual health psychoeducation module. Main Outcome Measures: The Female Sexual Function Index (FSFI), Female Sexual Distress Scale-Revised (FSDS-R), Sexual Desire Inventory-2 (SDI-2), Revised Dyadic Adjustment Scale (RDAS), International Index of Erectile Function (IIEF), and other subjective measures were used to assess sexual function and sexual distress at baseline and 12 weeks. Results: The study included 60 women and their partners (30 couples in each group). In both groups, sexual function by total FSFI scores and sexual distress scores significantly improved at 12 weeks compared with baseline, with no significant between-group differences (FSFI effect estimate for Sex SMART vs control = +1.4 (90% CI [–0.6 to +3.4]; P=.13). Both participants and partners randomized to the intervention reported significantly improved attitude and feelings, comfort as a sexual person, and subjective sexual functioning at 12 weeks. The findings provide preliminary evidence for efficacy of an online intervention for couples with sexual health problems. Conclusions: A brief online mindfulness, resilience, and psychoeducation–based intervention showed no significant improvement in many outcomes (FSFI, FSDS-R, SDI-2, RDAS) of sexual health versus controls. Although this is the first online randomized controlled trial to evaluate a mindfulness-based therapy intervention, it was limited by its lack of population diversity and high attrition rate. Significant improvements in subjective sexual health and partner sexual function by the International Index of Erectile Function were reported only in the intervention group.Rullo JE, Sood R, Fokken SC, et al. Couples’ Use of Online Stress Management and Resiliency Training for Sexual Health Concerns: A Randomized Controlled Trial. Sex Med 2021;9:100404.
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- 2021
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18. Electronic Cigarette Use Is Not Associated with COVID-19 Diagnosis
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Thulasee Jose, Ivana T. Croghan, J. Taylor Hays, Darrell R. Schroeder, and David O. Warner
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
This analysis tested the hypothesis that current e-cigarette use was associated with an increased risk of SARS-CoV-2 infection in patients seeking medical care. E-cigarette and conventional cigarette use were ascertained using a novel electronic health record tool, and COVID-19 diagnosis was ascertained by a validated institutional registry. Logistic regression models were fit to assess whether current e-cigarette use was associated with an increased risk of COVID-19 diagnosis. A total of 69,264 patients who were over the age of 12 years, smoked cigarettes or vaped, and were sought medical care at Mayo Clinic between September 15, 2019 and November 30, 2020 were included. The average age was 51.5 years, 62.1% were females and 86.3% were white; 11.1% were currently smoking cigarettes or using e-cigarettes and 5.1% tested positive for SARS-CoV-2. Patients who used only e-cigarettes were not more likely to have a COVID-19 diagnosis (OR 0.93 [0.69-1.25], P = .628), whereas those who used only cigarettes had a decreased risk (OR 0.43 [0.35-0.53], P
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- 2021
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19. Postoperative respiratory depression after hysterectomy
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Mariana L. Laporta, Michelle O. Kinney, Darrell R. Schroeder, Juraj Sprung, and Toby N. Weingarten
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Postoperative respiratory depression ,postoperative complication ,anesthesia recovery period ,opioid-induced respiratory depression ,hysterectomy ,Biology (General) ,QH301-705.5 - Abstract
To investigate if sex-specific physiologic characteristics could impact postoperative respiratory depression risks in women, we studied incidence and risk factors associated with postoperative respiratory depression in a gynecologic surgical cohort. Only hysterectomies performed under general anesthesia from 2012 to 2017 were included to minimize interprocedural variability. Respiratory depression was defined as episodes of apnea, hypopnea, hypoxemia, pain-sedation mismatch, unplanned positive airway pressure device application, or naloxone administration in the post-anesthesia care unit. Multivariable logistic regression was used to explore the association with clinical characteristics. From 1,974 hysterectomies, 253 had postoperative respiratory depression, yielding an incidence of 128 (95% confidence interval, 114–144) per 1,000 surgeries. Risk factors associated with respiratory depression were older age (odds ratio 1.22 [95% confidence interval 1.02–1.46] per decade increase, p = 0.03), lower body weight (0.77 [0.62–0.94] per 10 kg/m2, p = 0.01), and higher intraoperative opioid dose (1.05 [1.01–1.09] per 10 mg oral morphine equivalents, p = 0.01); while sugammadex use was associated with a reduced risk (0.48 [0.30–0.75], p = 0.002). Respiratory depression was not associated with increased hospital stay, postoperative complications, or mortality. Postoperative respiratory depression risk in women increased with age, lower weight, and higher intraoperative opioids and decreased with sugammadex use; however, it was not associated with postoperative pulmonary complications.
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- 2021
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20. Obesity Management Education Needs Among General Internists: A Survey
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Sanjeev Nanda, Jayanth Adusumalli, Ryan T. Hurt, Karthik Ghosh, Karen M. Fischer, Martha C. Hagenbrock, Ravindra Ganesh, Basem M. Ratrout, David Raslau, Darrell R. Schroeder, Elizabeth C. Wight, Carol L. Kuhle, Lori A. Thicke, Natalia Lazik, and Ivana T. Croghan
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective The purpose of this study was to determine self-reported knowledge, attitudes, prior experience, and perceived needs for the management of overweight and obese patients within a General Internal Medicine Practice. Patients and Methods An emailed cross-sectional survey was sent between June 20, 2019 and September 12, 2019 to 194 healthcare workers (93 primary care providers (PCPs) and 101 nurses) which focused on management of patients with weight issues. Results In total, 80 of the eligible 194 participants completed the survey (nurses = 42, PCPs = 38). Up to 87% were white, 74.7% female (74.7%). Most of the responders were either in the age group of 30’s (30%) or 50’s (30%). Among the responders, 48.8% reported some type of specialty training in weight management since their medical training with lectures being the most common form of training (36%). When asked about their interest in either weight management training or strategies to initiate weight conversations, 79% of the respondents reported an interest in education on weight management or strategies to initiate weight conversations, while 65.8% indicated they would be interested in both topics. Conclusion Our study suggests that healthcare workers have a self-reported need for further training in management of overweight and obese patients, irrespective of previous training in this area.
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- 2021
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21. Body Mass Index, Multi-Morbidity, and COVID-19 Risk Factors as Predictors of Severe COVID-19 Outcomes
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Sanjeev Nanda, Audry S. Chacin Suarez, Loren Toussaint, Ann Vincent, Karen M. Fischer, Ryan Hurt, Darrell R. Schroeder, Jose R. Medina Inojosa, John C. O’Horo, Ramona S. DeJesus, Haitham S. Abu Lebdeh, Manpreet S. Mundi, Salma Iftikhar, and Ivana T. Croghan
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Purpose The purpose of the present study was to investigate body mass index, multi-morbidity, and COVID-19 Risk Score as predictors of severe COVID-19 outcomes. Patients Patients from this study are from a well-characterized patient cohort collected at Mayo Clinic between January 1, 2020 and May 23, 2020; with confirmed COVID-19 diagnosis defined as a positive result on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays from nasopharyngeal swab specimens. Measures Demographic and clinical data were extracted from the electronic medical record. The data included: date of birth, gender, ethnicity, race, marital status, medications (active COVID-19 agents), weight and height (from which the Body Mass Index (BMI) was calculated, history of smoking, and comorbid conditions to calculate the Charlson Comorbidity Index (CCI) and the U.S Department of Health and Human Services (DHHS) multi-morbidity score. An additional COVID-19 Risk Score was also included. Outcomes included hospital admission, ICU admission, and death. Results Cox proportional hazards models were used to determine the impact on mortality or hospital admission. Age, sex, and race (white/Latino, white/non-Latino, other, did not disclose) were adjusted for in the model. Patients with higher COVID-19 Risk Scores had a significantly higher likelihood of being at least admitted to the hospital (HR = 1.80; 95% CI = 1.30, 2.50; P
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- 2021
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22. Effects of Sugammadex∗ on Time of First Postoperative Bowel Movement
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Atousa Deljou, MD, Darrell R. Schroeder, MS, Beth A. Ballinger, MD, Juraj Sprung, MD, PhD, and Toby N. Weingarten, MD
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Medicine (General) ,R5-920 - Abstract
Objective: To determine whether time to first postoperative bowel movement after intraperitoneal surgery differs among neuromuscular blockade reversal with either anticholinesterase/anticholinergic combination vs sugammadex. Patients and Methods: Sugammadex was introduced to our practice in October 2016. Patients were identified who underwent intraperitoneal surgery between January 1, through June 30, 2016, and January 1 through June 30, 2017, and received aminosteroid neuromuscular blockade for paralysis. Reversal was initiated with neostigmine, coadministered with glycopyrrolate (neostigmine/glycopyrrolate) for control participants and sugammadex for patients. Time to first bowel movement was determined from nursing documentation for study cohorts (2016 and 2017). We compared times to first bowel movement between cases and controls using raw and inverse probability of treatment weighting (IPTW) analyses. Results: In the 2016 cohort, 2583 received neostigmine/glycopyrrolate. Of 2750 patients in 2017, sugammadex reversal technique was administered to 1500 patients and neostigmine/glycopyrrolate to 1250 participants. Without weighting, the groups were relatively balanced for most baseline characteristics, and after IPTW, all standardized differences were
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- 2019
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23. Perioperative opioid requirements of patients receiving sublingual buprenorphine-naloxone: a case series
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Yvette N. Martin, Atousa Deljou, Toby N. Weingarten, Darrell R. Schroeder, and Juraj Sprung
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Anesthesia ,Buprenorphine-naloxone ,Pain ,Sublingual administration ,Suboxone ,Surgery ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background Buprenorphine, a partial opioid agonist, displaces full opioid agonists from receptors and may impede surgical pain management. We report the effects of a sublingual formulation of buprenorphine-naloxone, Suboxone (SL-BUP), on perioperative pain management. Methods We identified all adult surgical patients from December 31, 2004, to January 1, 2016, who received SL-BUP within 30 days prior to procedures performed with general, regional, or combined general/regional anesthesia. We recorded opioid use during the procedure, in the post-anesthesia care unit (PACU), and during the 24 h following PACU discharge. We also examined opioid use in those who continued SL-BUP until the day of surgery vs those who preoperatively discontinued SL-BUP. Results Thirty-two patients were treated preoperatively with SL-BUP. Three patients had regional anesthesia only, and opioid requirements were case dependent. Requirements were minimal for creation of an arteriovenous fistula and high following knee replacement and cesarean section. Twelve patients received combined general/regional anesthesia, and 17 received general anesthesia only. Intraoperative and PACU opioid use in these 2 groups were not significantly different (P = .10 and P = .93, respectively). In both groups opioid use increased after discharge from the PACU, and remained comparable between the general and combined general/regional group through the first 24 h after PACU discharge (P = .78). Although median [interquartile range] 24-h opioid doses were higher among patients who discontinued SL-BUP, the difference was not statistically significant in the general anesthesia–only group (SL-BUP discontinued, 199 [110–411] mg IV-MEq [intravenous morphine equivalent] vs SL-BUP continued, 106 [58–160] mg IV-MEq; P = .15) or in the combined general/regional group (SL-BUP discontinued, 140 [100–157] mg IV-MEq vs SL-BUP continued, 100 [73–203] mg IV-MEq; P = .94). Conclusions Regardless of the type of anesthesia used, physicians treating patients with SL-BUP must be prepared to administer large doses of opioids during the early postoperative period. No difference in opioid requirements was noted between patients who perioperatively stopped SL-BUP versus those who continued SL-BUP.
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- 2019
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24. Needs Assessment for Weight Management: The Learning Health System Network Experience
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Ivana T. Croghan, PhD, Sean M. Phelan, PhD, David P. Bradley, MD, Katherine W. Bauer, PhD, MS, Seung-Young-Han, PhD, Steven M. Bradley, MD, MPH, Beret A. Casey, MD, Manpreet S. Mundi, MD, Ryan T. Hurt, MD, PhD, Darrell R. Schroeder, MS, and Lila J. Finney Rutten, PhD
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Medicine (General) ,R5-920 - Abstract
Objective: To assess patients’ weight management needs and experiences across multiple sites within the Learning Health System Network. Patients and Methods: A total of 19,964 surveys were sent to patients identified with overweight or obesity through medical record query at 5 health care systems throughout 11 states. The survey collected patients’ experiences with and opinions about weight management in clinical care from October 27, 2017, through March 1, 2018. Results: Among the 2380 responders, being younger, female, nonwhite, and single and having some college education or less were all significantly associated with higher body mass index (BMI). The most frequent weight loss barriers included food cravings (30.7%-49.9%) and having a medical condition limiting physical activity (17.7%-47.1%) (P
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- 2018
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25. Hemodynamic instability during percutaneous ablation of extra-adrenal metastases of pheochromocytoma and paragangliomas: a case series
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Atousa Deljou, Jacob D. Kohlenberg, Toby N. Weingarten, Irina Bancos, William F. Young Jr, Darrell R. Schroeder, David P. Martin, and Juraj Sprung
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Ablation ,Hypertension ,Metastatic paragangliomas ,Metastatic pheochromocytomas ,Radiology suite ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background Surgical manipulation of pheochromocytomas and paragangliomas (PPGLs) may induce large hemodynamic oscillations due to catecholamine release. Little is known regarding hemodynamic instability during percutaneous ablation of PPGLs. We examined intraprocedural hemodynamic variability and postoperative complications related to percutaneous ablation of extra-adrenal metastases of PPGL. Methods From institutional PPGL registry we identified patients undergoing ablation of extra-adrenal PPGL metastases from January 1, 2000, through December 31, 2016. We reviewed medical records for clinical characteristics and hospital outcomes. Tumors were categorized as functional or nonfunctional based on preprocedural fractionated catecholamine and metanephrine profiles. Results Twenty-one patients (14 female [67%]) underwent 38 ablations. Twenty-four ablations were performed in patients with functional metastatic lesions, and 14 were in nonfunctional lesions. Intraprocedural use of potent vasodilators for hypertension was higher for patients with functional tumors (P = 0.02); use of vasopressors for hypotension was similar for functional and nonfunctional tumors (P = 0.74). Mean (±SD) intraprocedural blood pressure range (maximum–minimum blood pressure) during 38 procedures was greater for functional than nonfunctional tumors [systolic: 106 (±48) vs 64 (±30) mm Hg, P = 0.005; diastolic: 58 (±22) vs 35 (±14) mm Hg, P = 0.002; mean arterial: 84 (±43) vs 47 (±29) mm Hg, P = 0.007]. Complications included 5 unplanned intensive care unit admissions (3 for precautionary monitoring, 1 for recalcitrant hypotension, and 1 for hypertensive crisis), 1 case of postoperative bleeding, and 1 death. Conclusions Substantial hemodynamic instability may develop during ablation of functional and nonfunctional PPGL metastases. When anesthesia is provided for ablation of metastatic PPGLs in radiology suites, preparation for hemodynamic management should match standards used for surgical resection.
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- 2018
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26. Stress, Resilience, and Coping of Healthcare Workers during the COVID-19 Pandemic
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Ivana T. Croghan, Sherry S. Chesak, Jayanth Adusumalli, Karen M. Fischer, Elizabeth W. Beck, Shruti R. Patel, Karthik Ghosh, Darrell R. Schroeder, and Anjali Bhagra
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective To estimate the health care workers (HCWs) self-reported stress, resilience, and coping during the COVID-19 pandemic, and to determine inter-professional differences. Participants and Methods An email survey was sent to 474 HCW at a Midwestern HealthCare facility between April 9, 2020 and April 30, 2020. A total of 311 (65.6%) responses were received by May 31, 2020. The survey utilized 3 validated instruments: Perceived Stress Scale (PSS), Brief Resilience Scale (BRS), Brief Resilience Coping Scale (BRCS). Results Of the 311 responses, 302 were evaluated: 97 from nonmedical staff with patient contact (NMPC); 86 from nonmedical staff with no patient contact (NMNPC); 62 from medical doctors (MD), physician assistants (PA) and nurse practitioners (NP); and 57 from nurses. Significant differences were noted across job categories for stress and resilience, with nurses reporting highest PSS scores (effect estimates: −2.72, P = .009 for NMNPC; −2.50, P = .015 for NMPC; −3.21, P = .006 for MD/NP/PA respectively), and MD/NP/PA group with highest BRS scores: nurses (−0.31, P = .02); NMPC (−0.3333, P = .01); and NMNPC (−0.2828, P = .02). Younger personnel had higher stress (−1.59 per decade of age, P
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- 2021
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27. A Midwest COVID-19 Cohort for the Evaluation of Multimorbidity and Adverse Outcomes from COVID-19
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Sanjeev Nanda, Loren Toussaint, Ann Vincent, Karen M. Fischer, Ryan Hurt, Darrell R. Schroeder, Audry S. Chacin Suarez, Jose R. Medina Inojosa, John C. O’Horo, Ramona S. DeJesus, Haitham S. Abu Lebdeh, Manpreet S. Mundi, Salma Iftikhar, and Ivana T. Croghan
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective To describe the process and outcome of creating a patient cohort in the early stages of the COVID-19 pandemic in order to better understand the process of and predict the outcomes of COVID-19. Patients and Methods A total of 1169 adults aged 18 years of age or older who tested positive in Mayo Clinic Rochester or the Mayo Clinic Midwest Health System between January 1 and May 23 of 2020. Results Patients were on average 43.9 years of age and 50.7% were female. Most patients were white (69.0%), and Blacks (23.4%) and Asians (5.8%) were also represented in larger numbers. Hispanics represented 16.3% of the sample. Just under half of patients were married (48.4%). Common comorbid conditions included: cardiovascular diseases (25.1%), dyslipidemia (16.0%), diabetes mellitus (11.2%), chronic obstructive pulmonary disease (6.6%), asthma (7.5%), and cancer (5.1%). All other comorbid conditions were less the 5% in prevalence. Data on 3 comorbidity indices are also available including the: DHHS multi-morbidity score, Charlson Comorbidity Index, and Mayo Clinic COVID-19 Risk Factor Score. Conclusion In addition to managing the ever raging pandemic and growing death rates, it is equally important that we develop adequate resources for the investigation and understanding of COVID-19-related predictors and outcomes.
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- 2021
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28. Understanding User Acceptance of Clinical Decision Support Systems to Promote Increased Cancer Screening Rates in a Primary Care Practice
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Elizabeth A. Kelsey, Jane W. Njeru, Rajeev Chaudhry, Karen M. Fischer, Darrell R. Schroeder, and Ivana T. Croghan
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: Clinical decision support systems (CDDSs) in the electronic medical record (EMR) have been implemented in primary care settings to identify patients due for cancer screening tests, while functioning as a real time reminder system. There is little known about primary care providers (PCPs) perspective or user acceptance of CDSS. The purpose of this study was to investigate primary care provider perceptions of utilizing CDSS alerts in the EMR to promote increased screening rates for breast cancer, cervical cancer, and colorectal cancer. Methods: An electronic survey was administered to PCPs in a Midwest Health Institution community internal medicine practice from September 25, 2019 through November 27, 2019. Results: Among 37 participants (9 NP/Pas and 28 MD/DOs), the NP/PA group was more likely to agree that alerts were helpful (50%; P -value = .0335) and the number of alerts (89%; P = .0227) in the EMR was appropriate. The NP/PA group also was more likely to find alerts straightforward to use (78%, P = .0239). Both groups agreed about feeling comfortable using the health maintenance alerts ( MD/DO = 79%; NP/PA = 100%). Conclusion: CDSSs can promote and facilitate ordering of cancer screening tests. The use of technology can promptly identify patients due for a test and act as a reminder to the PCP. PCPs identify these alerts to be a beneficial tool in the EMR when they do not interrupt workflow and provide value to patient care. More work is needed to identify factors that could optimize alerts to be even more helpful, particularly to MD/DO groups.
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- 2020
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29. Clinical Utility of Serial Measurements of Antineutrophil Cytoplasmic Antibodies Targeting Proteinase 3 in ANCA-Associated Vasculitis
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Gwen E. Thompson, Lynn A. Fussner, Amber M. Hummel, Darrell R. Schroeder, Francisco Silva, Melissa R. Snyder, Carol A. Langford, Peter A. Merkel, Paul A. Monach, Philip Seo, Robert F. Spiera, E. William St. Clair, John H. Stone, and Ulrich Specks
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ANCA-associated vasculitis ,PR3-ANCA ,remission ,relapse activity ,biomarker ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Background: The utility of ANCA testing as an indicator of disease activity in ANCA-associated vasculitis (AAV) remains controversial. This study aimed to determine the association of ANCA testing by various methods and subsequent remission and examine the utility of a widely used automated addressable laser-bead immunoassay (ALBIA) to predict disease relapses.Methods: Data from the Rituximab vs. Cyclophosphamide for ANCA-Associated Vasculitis (RAVE) trial were used. ANCA testing was performed by direct ELISA, capture ELISA, and ALBIA. Cox proportional hazards regression models were used to evaluate the association of PR3-ANCA level and subsequent remission or relapse. The ALBIA results are routinely reported as >8 when the value is high. For this study, samples were further titrated. A decrease and increase in PR3-ANCA were defined as a halving or doubling in value, respectively.Results: A decrease in ANCA by ALBIA at 2 months was associated with shorter time to sustained remission (HR 4.52, p = 0.035). A decrease in ANCA by direct ELISA at 4 months was associated with decreased time to sustained remission (HR 1.77, p = 0.050). There were no other associations between ANCA decreases or negativity and time to remission. An increase in PR3-ANCA by ALBIA was found in 78 of 93 subjects (84%). Eleven (14%) had a PR3-ANCA value which required titration for detection of an increase. An increase of ANCA by ALBIA was associated with severe relapse across various subgroups.Conclusions: A decrease in ANCA by ALBIA at 2 months and by direct ELISA at 4 months may be predictive of subsequent remission. These results should be confirmed in a separate cohort with similarly protocolized sample and clinical data collection. A routinely used automated ALBIA for PR3-ANCA measurement is comparable to direct ELISA in predicting relapse in PR3-AAV. Without titration, 14% of the increases detected by ALBIA would have been missed. Titration is recommended when this assay is used for disease monitoring. The association of an increase in PR3-ANCA with the risk of subsequent relapse remains complex and is affected by disease phenotype and remission induction agent.
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- 2020
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30. Exposure to surgery with regional anesthesia and cortical thickness in older adults
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Juraj Sprung, David S. Knopman, Ronald C. Petersen, Prashanthi Vemuri, Michelle M. Mielke, Toby N. Weingarten, Phillip J. Schulte, Darrell R. Schroeder, and David O. Warner
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Neurology. Diseases of the nervous system ,RC346-429 ,Geriatrics ,RC952-954.6 - Published
- 2020
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31. Outpatient Dismissal With a Responsible Adult Compared With Structured Solo Dismissal: A Retrospective Case-Control Comparison of Safety Outcomes
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David P. Martin, MD, PhD, Mary E. Warner, MD, Rebecca L. Johnson, MD, Marlea A. Judd, APRN, CRNA, DNP, Michael T. Walsh, MD, Andrew C. Hanson, BS, Darrell R. Schroeder, MS, and Christopher M. Burkle, MD, JD
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Medicine (General) ,R5-920 - Abstract
Objective: To test the hypothesis that patients dismissed alone in a sedation dismissal process (SDP) have no greater risk of adverse outcome compared with those who were dismissed with a responsible adult. Patients and Methods: We compared 2441 SDP patients undergoing 2703 procedures with 4923 unique control patients who underwent 5133 procedures between June 1, 2012, and March 31, 2017. Results: The rate of unplanned readmission related to the procedure was 0.11% (n=9), and there was no difference between SDP (0.07%) and controls (0.14%). Similarly, there was no difference in complication rates between SDP patients and controls when restricting to “all causes” unplanned readmissions within 24 hours and unplanned readmissions related to procedure. Conclusion: With proper preparation, short-acting anesthetic/sedation medications, and sound clinical judgment, the presence of a responsible adult escort is not associated with reduced risk following discharge after ambulatory anesthesia. This practice may lessen the hardships reported by patients in needing to obtain an escort and the inconveniences and delays experienced by ambulatory procedural facilities when patients arrive without a designated escort.
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- 2018
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32. The use of flumazenil for benzodiazepine associated respiratory depression in postanesthesia recovery: risks and outcomes
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Troy G. Seelhammer, Eric M. DeGraff, Travis J. Behrens, Justin C. Robinson, Kristen L. Selleck, Darrell R. Schroeder, Juraj Sprung, and Toby N. Weingarten
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Flumazenil ,Benzodiazepine ,Postanesthesia care unit ,Postoperative complications ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background and objectives The primary aim was to determine risk factors for flumazenil administration during postanesthesia recovery. A secondary aim was to describe outcomes among patients who received flumazenil. Methods Patients admitted to the postanesthesia recovery room at a large, academic, tertiary care facility after surgery under general anesthesia from January 1, 2010, to April 30, 2015, were identified and matched to 2 controls each, by age, sex, and surgical procedure. Flumazenil was administered in the recovery phase immediately after general anesthesia, according to the clinical judgment of the anesthesiologist. Demographic, procedural, and outcome data were extracted from the electronic health record. Conditional logistic regression, accounting for the 1:2 matched-set case-control study designs, was used to assess characteristics associated with flumazenil use. Results The incidence of flumazenil administration in the postanesthesia care unit was 9.9 per 10,000 (95% CI, 8.4-11.6) general anesthetics. History of obstructive sleep apnea (Odds Ratio [OR] = 2.27; 95% CI 1.02-5.09), longer anesthesia (OR = 1.13; 95% CI 1.03-1.24 per 30 minutes), use of total intravenous anesthesia (OR = 6.09; 95% CI 2.60-14.25), and use of benzodiazepines (OR = 8.17; 95% CI 3.71-17.99) were associated with risk for flumazenil administration. Among patients who received midazolam, cases treated with flumazenil received a higher median (interquartile range) dose than controls: 3.5 mg (2.0-4.0 mg) vs. 2.0 mg (2.0-2.0 mg), respectively (p < 0.001). Flumazenil use was correlated with a higher rate of unanticipated noninvasive positive pressure ventilation, longer postanesthesia care unit stay, and increased rate of intensive care unit admissions. Conclusions Patients who required flumazenil postoperatively had received a higher dosage of benzodiazepines and utilized more postoperative health care resources. More conservative perioperative use of benzodiazepines may improve postoperative recovery and use of health care resources.
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- 2018
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33. Health-related quality of life in children and adolescents with congenital diaphragmatic hernia: a cross-sectional study
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Katarina Bojanić, Ruža Grizelj, Jurica Vuković, Lana Omerza, Marina Grubić, Tomislav Ćaleta, Toby N. Weingarten, Darrell R. Schroeder, and Juraj Sprung
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Congenital diaphragmatic hernia ,Survivors ,Health-related quality of life ,Cross-sectional studies ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Background Patients with congenital diaphragmatic hernia (CDH) have a high residual morbidity rate. We compared self-reported health-related quality of life (HRQoL) between patients with CDH and healthy children. Methods Forty-five patients with CDH who were born from January 1, 1990, through February 15, 2015, were matched to healthy, age-matched control participants at a 1:2 ratio. The health records of the study participants were reviewed to determine comorbid conditions, and HRQoL was assessed by both the participants and their parents with the Pediatric Quality of Life Inventory (PedsQL). The HRQoL scores of the patients with CDH and the control participants were compared by using analysis of variance to adjust for age group and sex. Among patients with CDH, analysis of variance was used to compare HRQoL scores across groups defined according to their characteristics at initial hospitalization, postdischarge events, and comorbid conditions. Results Compared with control participants, patients with CDH had lower mean PedsQL scores, as reported by the parent and child, for the physical and psychosocial domains (P
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- 2018
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34. An integrated digital/clinical approach to smoking cessation in lung cancer screening: study protocol for a randomized controlled trial
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Amanda L. Graham, Michael V. Burke, Megan A. Jacobs, Sarah Cha, Ivana T. Croghan, Darrell R. Schroeder, James P. Moriarty, Bijan J. Borah, Donna F. Rasmussen, M. Jody Brookover, Dale B. Suesse, David E. Midthun, and J. Taylor Hays
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Cancer screening ,Lung cancer ,Smoking cessation ,Internet ,Text messages ,Tobacco use cessation ,Medicine (General) ,R5-920 - Abstract
Abstract Background Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask–Advise–Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration ClinicalTrials.gov, NCT03084835 . Registered on 9 March 2017.
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- 2017
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35. Conference presentation to publication: a retrospective study evaluating quality of abstracts and journal articles in medical education research
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Christopher R. Stephenson, Brianna E. Vaa, Amy T. Wang, Darrell R. Schroeder, Thomas J. Beckman, Darcy A. Reed, and Adam P. Sawatsky
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Medical education ,Medical education–outcomes research ,Quality assessment ,Special aspects of education ,LC8-6691 ,Medicine - Abstract
Abstract Background There is little evidence regarding the comparative quality of abstracts and articles in medical education research. The Medical Education Research Study Quality Instrument (MERSQI), which was developed to evaluate the quality of reporting in medical education, has strong validity evidence for content, internal structure, and relationships to other variables. We used the MERSQI to compare the quality of reporting for conference abstracts, journal abstracts, and published articles. Methods This is a retrospective study of all 46 medical education research abstracts submitted to the Society of General Internal Medicine 2009 Annual Meeting that were subsequently published in a peer-reviewed journal. We compared MERSQI scores of the abstracts with scores for their corresponding published journal abstracts and articles. Comparisons were performed using the signed rank test. Results Overall MERSQI scores increased significantly for published articles compared with conference abstracts (11.33 vs 9.67; P
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- 2017
- Full Text
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36. Identifying Opportunities for Advancing Weight Management in Primary Care
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Ivana T. Croghan, Jon O. Ebbert, Jane W. Njeru, Tamim I. Rajjo, Brian A. Lynch, Ramona S. DeJesus, Michael D. Jensen, Karen M. Fischer, Sean Phelan, Tara K. Kaufman, Darrell R. Schroeder, Lila J. Finney Rutten, Sarah J. Crane, and Sidna M. Tulledge-Scheitel
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Computer applications to medicine. Medical informatics ,R858-859.7 ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: Much has been written about the patients’ perspective concerning weight management in health care. The purpose of this survey study was to assess perspectives of primary care providers (PCPs) and nurses toward patient weight management and identify possible areas of growth. Patients and Methods: We emailed a weight management–focused survey to 674 eligible participants (437 [64.8%] nurses and 237 [35.2%] PCPs) located in 5 outpatient primary care clinics. The survey focused on opportunities, practices, knowledge, confidence, attitudes, and beliefs. A total of 219 surveys were returned (137 [62.6%] from nurses and 82 [34.4%] from PCPs). Results: Among 219 responders, 85.8% were female and 93.6% were white non-Hispanic. In this study, PCPs and nurses believed obesity to be a major health problem. While PCPs felt more equipped than nurses to address weight management ( P < .001) and reported receiving more training than nurses (50.0% vs 17.6%, respectively), both felt the need for more training on obesity (73.8% and 79.4%, respectively). Although, PCPs also spent more patient contact time providing weight management services versus nurses ( P < .001), the opportunity/practices score was lower for PCPs than nurses (−0.35 ± 0.44 vs −0.17 ± 0.41, P < .001) with PCPs more likely to say they lacked the time to discuss weight and they worried it would cause a poor patient-PCP relationship. The knowledge/confidence score also differed significantly between the groups, with nurses feeling less equipped to deal with weight management issues than PCPs (−0.42 ± 0.43 vs −0.03 ± 0.55, P < .001). Neither group seemed very confident, with those in the PCP group only answering with an average score of neutral. Conclusion: By asking nurses and PCP general questions about experiences, attitudes, knowledge, and opinions concerning weight management in clinical care, this survey has identified areas for growth in obesity management. Both PCPs and nurses would benefit from additional educational training on weight management.
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- 2019
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37. Adapting the Surgical Apgar Score for Perioperative Outcome Prediction in Liver Transplantation: A Retrospective Study
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Amy C. S. Pearson, MD, Arun Subramanian, MBBS, Darrell R. Schroeder, MS, and James Y. Findlay, MB, ChB
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Surgery ,RD1-811 - Abstract
Background. The surgical Apgar score (SAS) is a 10-point scale using the lowest heart rate, lowest mean arterial pressure, and estimated blood loss (EBL) during surgery to predict postoperative outcomes. The SAS has not yet been validated in liver transplantation patients, because typical blood loss usually exceeds the highest EBL category. Our primary aim was to develop a modified SAS for liver transplant (SAS-LT) by replacing the EBL parameter with volume of red cells transfused. We hypothesized that the SAS-LT would predict death or severe complication within 30 days of transplant with similar accuracy to current scoring systems. Methods. A retrospective cohort of consecutive liver transplantations from July 2007 to November 2013 was used to develop the SAS-LT. The predictive ability of SAS-LT for early postoperative outcomes was compared with Model for End-stage Liver Disease, Sequential Organ Failure Assessment, and Acute Physiology and Chronic Health Evaluation III scores using multivariable logistic regression and receiver operating characteristic analysis. Results. Of 628 transplants, death or serious perioperative morbidity occurred in 105 (16.7%). The SAS-LT (receiver operating characteristic area under the curve [AUC], 0.57) had similar predictive ability to Acute Physiology and Chronic Health Evaluation III, model for end-stage liver disease, and Sequential Organ Failure Assessment scores (0.57, 0.56, and 0.61, respectively). Seventy-nine (12.6%) patients were discharged from the ICU in 24 hours or less. These patients’ SAS-LT scores were significantly higher than those with a longer stay (7.0 vs 6.2, P < 0.01). The AUC on multivariable modeling remained predictive of early ICU discharge (AUC, 0.67). Conclusions. The SAS-LT utilized simple intraoperative metrics to predict early morbidity and mortality after liver transplant with similar accuracy to other scoring systems at an earlier postoperative time point.
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- 2017
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38. Pectoral Fascial Plane Versus Paravertebral Blocks for Minimally Invasive Mitral Valve Surgery Analgesia
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Nathan J. Vinzant, Jon M. Christensen, Suraj M. Yalamuri, Mark M. Smith, Gregory A. Nuttall, Arman Arghami, Allison M. LeMahieu, Darrell R. Schroeder, William J. Mauermann, and Matthew J. Ritter
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Anesthesiology and Pain Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2023
39. Validation and Recalibration of Modified Mayo Delirium Prediction Tool in a Hospitalized Cohort
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Sandeep R. Pagali, Karen M. Fischer, Deanne T. Kashiwagi, Darrell R. Schroeder, Kemuel L. Philbrick, Maria I. Lapid, Robert J. Pignolo, and M. Caroline Burton
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Psychiatry and Mental health ,Clinical Psychology - Abstract
Delirium prediction can augment and optimize care of older adults. Mayo Delirium Prediction (MDP) tool is a robust tool, developed from a large retrospective data set. The MDP tool predicts delirium risk for hospitalized older adults, within 24 hours of hospital admission, based on risk factor information available from electronic health record.We intend to validate the prediction performance of this tool and optimize the tool for clinical use.This is an observational cohort study conducted at Mayo Clinic Hospitals, Rochester, MN. All hospitalized older adults (age50 years) from December 2019 to June 2020 were included. Patients with an admitting diagnosis of substance use disorder were excluded. The original MDP tool was modified to adjust for the fall risk variable as a binary variable that will facilitate broader applicability across different fall risk tools. The modified MDP tool was validated in the retrospective derivation and validation data set which yielded similar prediction capability (area under the receiver operating curve = 0.85 and 0.83, respectively). Diagnosis of delirium was captured by flowsheet diagnosis of delirium documented by nursing staff in the medical record. Predictive variable data were collected daily.A total of 8055 patients were included in the study (median age 71 y). Delirium prediction of the modified MDP tool compared to delirium occurrence was 4% in the low-risk group, 17.8% in the medium-risk group, and 45.3% in the high-risk group (area under receiver operating curve of 0.80). Recalibration of the tool was attempted to further optimize the tool which resulted in both simplification and increased performance (area under receiver operating curve 0.82). The simplified tool was able to predict delirium in hospitalized patients admitted to both medical and surgical services.Validation of the modified MDP tool revealed good prediction capabilities. Recalibration resulted in simplification with increased performance of the tool in both medical and surgical hospitalized patients.
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- 2022
40. Hemodynamics in Patients With Pheochromocytoma or Paraganglioma Undergoing Non-neuroendocrine Operations
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Diana J. Valencia Morales, Mariana L. Laporta, Simon Zec, Kai Yu, Irina Bancos, David P. Martin, Yvette N. Martin McGrew, Toby N. Weingarten, Andrew C. Hanson, Junzhi Sun, Darrell R. Schroeder, and Juraj Sprung
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Paraganglioma ,Adrenal Gland Neoplasms ,Hemodynamics ,Humans ,Blood Pressure ,Surgery ,Pheochromocytoma - Abstract
Surgical resection of pheochromocytoma and paraganglioma (PPGL) may be associated with excessive hemodynamic variability. Whether hemodynamic variability occurs in patients with undiagnosed PPGL undergoing unrelated, non-neuroendocrine, operations is unknown.We identified patients who underwent non-neuroendocrine surgical procedures up to 5 y before pathologic diagnosis of PPGL. For each PPGL, two non-PPGL patients were matched based on sex, age, type, and year of operation. Electronic medical records were reviewed for intraoperative blood pressures, heart rates, and hemodynamic variability was assessed with range (maximum-minimum), standard deviation, coefficient of variation, and average real variability.Thirty-seven PPGL patients underwent operations preceding the diagnosis of PPGL: 25 pheochromocytomas, 11 paragangliomas, and one metastatic pheochromocytoma. Median interquartile range tumor size at diagnosis was 35 mm (23 to 60). The time from index operation to PPGL diagnosis was ≤12 mo in 21 (56.8%) patients. In 23 (62.2%) patients, the subsequently diagnosed PPGL was functional. Fifteen (40.5%) PPGL and 20 (27.0%) control patients were preoperatively treated for hypertension (P = 0.149). Maximum intraoperative systolic BP was180 mmHg for 4 (10.8%) PPGL patients and 3 (4.1%) controls (P = 0.219). Two PPGL patients had intraoperative systolic BP230 mmHg. No significant differences were found with all other measures of intraoperative hemodynamic variability. Similarly, in secondary analysis there was no significant difference in intraoperative hemodynamic variability between biochemically active PPGL and their respective controls.Patients with undiagnosed PPGL undergoing a wide variety of non-neuroendocrine operations had intraoperative hemodynamic variability comparable to non-PPGL patients undergoing the same type of procedures.
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- 2022
41. Prothrombin Complex Concentrate vs Plasma for Post-Cardiopulmonary Bypass Coagulopathy and Bleeding: A Randomized Clinical Trial
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Mark M. Smith, Darrell R. Schroeder, James A. Nelson, William J. Mauermann, Ian J. Welsby, Alberto Pochettino, Beth L. Montonye, Chalailak Assawakawintip, and Gregory. A. Nuttall
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Male ,Cardiopulmonary Bypass ,Blood Loss, Surgical ,Blood Coagulation Disorders ,Middle Aged ,Postoperative Hemorrhage ,Blood Coagulation Factors ,Humans ,Surgery ,Female ,Prospective Studies ,Aged ,Retrospective Studies ,Original Investigation - Abstract
IMPORTANCE: Post–cardiopulmonary bypass (CPB) coagulopathy and bleeding are among the most common reasons for blood product transfusion in surgical practices. Current retrospective data suggest lower transfusion rates and blood loss in patients receiving prothrombin complex concentrate (PCC) compared with plasma after cardiac surgery. OBJECTIVE: To analyze perioperative bleeding and transfusion outcomes in patients undergoing cardiac surgery who develop microvascular bleeding and receive treatment with either PCC or plasma. DESIGN, SETTING, AND PARTICIPANTS: A single-institution, prospective, randomized clinical trial performed at a high-volume cardiac surgical center. Patients were aged 18 years or older and undergoing cardiac surgery with CPB. Patients undergoing complex cardiac surgical procedures (eg, aortic replacement surgery, multiple procedures, or repeated sternotomy) were preferentially targeted for enrollment. During the study period, 756 patients were approached for enrollment, and 553 patients were randomized. Of the 553 randomized patients, 100 patients met criteria for study intervention. INTERVENTIONS: Patients with excessive microvascular bleeding, a prothombin time (PT) greater than 16.6 seconds, and an international normalized ratio (INR) greater than 1.6 were randomized to receive treatment with either PCC or plasma. The PCC dose was 15 IU/kg or closest standardized dose; the plasma dose was a suggested volume of 10 to 15 mL/kg rounded to the nearest unit. MAIN OUTCOMES AND MEASURES: The primary outcome was postoperative bleeding (chest tube output) from the initial postsurgical intensive care unit admission through midnight on postoperative day 1. Secondary outcomes were PT/INR, rates of intraoperative red blood cell (RBC) transfusion after treatment, avoidance of allogeneic transfusion from the intraoperative period to the end of postoperative day 1, postoperative bleeding, and adverse events. RESULTS: One hundred patients (mean [SD] age, 66.8 [13.7] years; 61 [61.0%] male; and 1 [1.0%] Black, 1 [1.0%] Hispanic, and 98 [98.0%] White) received the study intervention (49 plasma and 51 PCC). There was no significant difference in chest tube output between the plasma and PCC groups (median [IQR], 1022 [799-1575] mL vs 937 [708-1443] mL). After treatment, patients in the PCC arm had a greater improvement in PT (effect estimate, −1.37 seconds [95% CI, −1.91 to −0.84]; P
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- 2023
42. Stress Resilience Program for Health Care Professionals During a Pandemic: A Pilot Program
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Ivana T. Croghan, Ryan T. Hurt, Shawn C. Fokken, Karen M. Fischer, Stephanie A. Lindeen, Darrell R. Schroeder, Ravindra Ganesh, Karthik Ghosh, Nina Bausek, and Brent A. Bauer
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Nursing (miscellaneous) ,Public Health, Environmental and Occupational Health - Abstract
Background: The COVID-19 pandemic has led to increased burnout and staff turnover for health care providers (HCPs). The purpose of this pilot study was to evaluate the safety and acceptability of a Stress Resilience Program (SRP) for reducing perceived stress and improving resilience among HCPs during a pandemic. Method: Of the 12 HCPs expressing interest in the study, 10 were enrolled in this study. Participants attended three in-person visits (consent/screen, baseline, and end-of-study). The SRP consisted of education related to resilience enhancement and a breathing device ( BreatherFit®) for combined respiratory muscle training (cRMT). Participants completed 4 weeks of cRMT and applied situational breathing strategies as needed. Outcomes measured were changes in stress (PSS-10), resilience (BRS), depression (PRIME-MD), and sleep (PSQI and Ōura Ring®). Findings: The majority of participants were male (60%) and White (60%) with an average age of 39.7 years. Changes from baseline to end-of-treatment indicated a positive trend with significant stress reduction (−3.2 ± 3.9, p = .028) and nonsignificant depression reduction (−0.5 ± 0.7, p = .05). Resilience was high at baseline and continued to stay high during the study with a nonsignificant increase at end-of-study (+0.07 ± 0.7, p = .77). No changes in overall sleep scores were noted. All participants agreed the study was worthwhile, 80% indicated they would repeat the experience, while 90% indicated they would recommend the study to others. Conclusion/Application to Practice: Because of its size and portability, SRP is an easily applicable and promising option for reducing stress among HCPs during a high-stress period, such as a pandemic. Larger studies are needed.
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- 2022
43. Intraoperative Ventilatory Pressures During Robotic Assisted vs Open Radical Cystectomy
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Alexandra L. Anderson, Matthew K. Tollefson, Igor Frank, Nathan D. Peffley, Darrell R. Schroeder, and Bhargavi Gali
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Adult ,Sleep Apnea, Obstructive ,Postoperative Complications ,Treatment Outcome ,Robotic Surgical Procedures ,Urinary Bladder Neoplasms ,Urology ,Humans ,Cystectomy ,Retrospective Studies - Abstract
To investigate whether Robotic assisted radical cystectomy (RARC) is associated with increased postoperative pulmonary complications compared to open radical cystectomy (ORC). RARC poses challenges for ventilation with positioning and abdominal insufflation. Conventionally protective mechanical ventilation may be challenging, especially in patients with obesity or pulmonary comorbidities. Given the proven benefits of RARC compared to ORC, the risk of postoperative pulmonary complications merits further investigation.Adult patients consented for research who underwent RARC and ORC for invasive bladder cancer from 2013-2018 were identified for retrospective chart review. Perioperative and patient variables were looked at along with postoperative course and outcomes.328 patients who underwent ORC and 108 patients who underwent RARC were identified. Despite findings of higher peak airway pressures throughout surgery, patients who underwent RARC did not have a higher rate of pulmonary complications than patients who underwent ORC. Patients with obstructive sleep apnea (OSA) who underwent ORC had a higher rate of postoperative pulmonary complications. Patients who underwent RARC had a less intraoperative fluid administration, fewer ICU admissions, and decreased length of hospital stay.Despite mechanical ventilation challenges, RARC was not associated with increased post-operative pulmonary complications compared to ORC. This was also found in patients with BMI30 or with diagnosis or high suspicion of OSA. These findings suggest ventilation at higher pressures does not increase risk for ventilator induced lung injury in patients undergoing RARC, even in conventionally higher risk patients.
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- 2022
44. Effect of Messaging Content on Engagement With a Short Messaging Service for Perioperative Smoking Cessation
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Thulasee Jose, Sarah Cha, Amanda L Graham, Michael S Amato, Darrell R Schroeder, and David O Warner
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Public Health, Environmental and Occupational Health - Abstract
Introduction We determined whether a tobacco cessation intervention targeting brief perioperative abstinence (“quit for a bit”) increased engagement of surgical patients with treatment compared with an intervention targeting long-term postoperative abstinence (“quit for good”). Aims and Methods Surgical patients who smoke were stratified according to intended duration of postoperative abstinence, and then randomized within strata to receive either a “quit for a bit” or a “quit for good” intervention. Both employed initial brief counseling and short message service (SMS) to deliver treatment up to 30 days after surgery. The primary outcome of treatment engagement was defined as the rate at which subjects actively responded to system requests delivered via SMS. Results The engagement index did not differ between intervention groups (median [25th, 75th] of 23.7% [8.8, 46.0] for “quit for a bit” group (n = 48) and 22.2% [4.8, 46.0] for “quit for good” group (n = 50), p = .74), nor did the proportion of patients continuing SMS use after study completion (33% and 28%, respectively). Exploratory abstinence outcomes on the morning of surgery and 7 and 30 days after surgery did not differ between groups. Program satisfaction was high in both groups and did not differ. There was no significant interaction between intended abstinence duration and any outcome, ie, alignment of intent with intervention did not affect engagement. Conclusions Tobacco cessation treatment delivered via SMS was well accepted by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates. Implications Treatment of surgical patients for tobacco use is efficacious and reduces postoperative complications. However, implementation in clinical practice has proved challenging, and new methods of engaging these patients in cessation treatment are needed. We found that tobacco use treatment delivered via SMS was feasible and well utilized by surgical patients. Tailoring an SMS intervention to focus on the benefits of short-term abstinence for surgical patients did not increase engagement in treatment or perioperative abstinence rates. Clinical Trial Number NCT03839043. Registry URL: https://clinicaltrials.gov/ct2/show/NCT03839043
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- 2023
45. Wellness of hospitalists and hospital medicine advanced practice providers during the COVID‐19 pandemic, 2020–2021
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Sagar B. Dugani, Karen M. Fischer, Darrell R. Schroeder, Holly L. Geyer, Michael J. Maniaci, Ivana T. Croghan, Daniel Kashani, and M. Caroline Burton
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Hospital Medicine ,Hospitalists ,Leadership and Management ,Health Policy ,COVID-19 ,Humans ,Fundamentals and skills ,General Medicine ,Assessment and Diagnosis ,Pandemics ,Care Planning ,Hospitals - Abstract
The early phase of the coronavirus disease 2019 (COVID-19) pandemic had a negative impact on the wellness of hospitalists and hospital medicine advanced practice providers (APPs). However, the burden of the pandemic has evolved and the change in hospitalist and hospital medicine APP wellness is unknown.To evaluate the longitudinal trend in wellness of hospitalists and hospital medicine APPs during the COVID-19 pandemic and guide wellness interventions.Between May 4, 2020, and June 6, 2021, we administered three surveys to Internal Medicine hospitalists (physicians) and hospital medicine APPs (nurse practitioners and physician assistants) at 16 Mayo Clinic hospitals in four U.S. states.We evaluated the association of hospitalist and hospital medicine APP characteristics with PROMIS® measures of global wellbeing-mental health, global wellbeing-social activities and relationships, anxiety, social isolation, and emotional support, using logistic and linear regression models.The response rates were 52.2% (n=154/295; May 2020), 37.1% (n=111/299; October 2020) and 35.5% (n=114/321; May 2021). In mixed models that included hospitalist and hospital medicine APP characteristics and survey period, APPs, compared with physicians, had lower odds of top global wellbeing-social activities and relationships (adjusted odds ratio 0.42 [0.22-0.82]; p = .01), whereas survey period showed no association. The survey period showed an independent association with higher anxiety (May 2020 vs. others) and higher social isolation (October 2020 vs. others), whereas profession showed no association. Concern about contracting COVID-19 at work was significantly associated with lower odds of top global wellbeing-mental health and global wellbeing-social activities and relationships, and with higher anxiety and social isolation. Hospitalist and hospital medicine APP characteristics showed no association with levels of emotional support.In this longitudinal assessment of hospitalists and hospital medicine APPs, concern about contracting COVID-19 at work remained a determinant of wellness. The trend for global wellbeing, anxiety, and social isolation may guide wellness interventions.
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- 2022
46. Association of Indication for Hospitalization With Subsequent Amyloid Positron Emission Tomography and Magnetic Resonance Imaging Biomarkers
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Juraj Sprung, Mariana L Laporta, David S Knopman, Ronald C Petersen, Michelle M Mielke, Clifford R Jack, David P Martin, Andrew C Hanson, Darrell R Schroeder, Phillip J Schulte, Scott A Przybelski, Diana J Valencia Morales, Toby N Weingarten, Prashanthi Vemuri, and David O Warner
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Aging ,THE JOURNAL OF GERONTOLOGY: Medical Sciences ,Geriatrics and Gerontology - Abstract
Background Hospitalization in older age is associated with accelerated cognitive decline, typically preceded by neuropathologic changes. We assess the association between indication for hospitalization and brain neurodegeneration. Methods Included were participants from the Mayo Clinic Study of Aging, a population-based longitudinal study, with ≥1 brain imaging available in those older than 60 years of age between 2004 and 2017. Primary analyses used linear mixed-effects models to assess association of hospitalization with changes in longitudinal trajectory of cortical thinning, amyloid accumulation, and white matter hyperintensities (WMH). Additional analyses were performed with imaging outcomes dichotomized (normal vs abnormal) using Cox proportional hazards regression. Results Of 2 480 participants, 1 966 had no hospitalization and 514 had ≥1 admission. Hospitalization was associated with accelerated cortical thinning (annual slope change −0.003 mm [95% confidence interval (CI) −0.005 to −0.001], p = .002), but not amyloid accumulation (0.003 [95% CI −0.001 to 0.006], p = .107), or WMH increase (0.011 cm3 [95% CI −0.001 to 0.023], p = .062). Interaction analyses assessing whether trajectory changes are dependent on admission type (medical vs surgical) found interactions for all outcomes. While surgical hospitalizations were not, medical hospitalizations were associated with accelerated cortical thinning (−0.004 mm [95% CI −0.008 to −0.001, p = .014); amyloid accumulation (0.010, [95% CI 0.002 to 0.017, p = .011), and WMH increase (0.035 cm3 [95% CI 0.012 to 0.058, p = .006). Hospitalization was not associated with developing abnormal cortical thinning (p = .407), amyloid accumulation (p = .596), or WMH/infarctions score (p = .565). Conclusions Medical hospitalizations were associated with accelerated cortical thinning, amyloid accumulation, and WMH increases. These changes were modest and did not translate to increased risk for crossing the abnormality threshold.
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- 2022
47. Longitudinal assessment of cognitive function in young children undergoing general anaesthesia
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Yu, Shi, Andrew C, Hanson, Darrell R, Schroeder, Kelly M, Haines, Alexandra C, Kirsch, Sarah, Macoun, Michael J, Zaccariello, and David O, Warner
- Subjects
Male ,Cognition ,Memory, Short-Term ,Time Factors ,Anesthesiology and Pain Medicine ,Motor Skills ,Child, Preschool ,Humans ,Female ,Longitudinal Studies ,Anesthesia, General ,Neuropsychological Tests ,Child - Abstract
Exposure to general anaesthesia in children may be related to deficits in certain areas of cognition. It is unclear if these deficits could be measured in the immediate postoperative period in young children. The goal of the current study was to evaluate the trajectory of cognitive function in the domains of processing speed, working memory, and fine motor skills amongst children aged 2.5-6 yr who underwent general anaesthesia for elective surgery.Children who were scheduled to receive general anaesthesia for surgery were recruited for assessment of cognitive function at three times: preoperatively, 1-2 weeks postoperatively, and 3 months postoperatively. Assessments included processing speed, working memory, and fine motor skills. To assess longitudinal changes in the cognitive outcomes, linear mixed models were built with visit number included as a categorical variable and subject-specific random intercepts.Sixty-one children (33 girls [54%]) enrolled in the study. Twenty-three children (38%) had received general anaesthesia previously. Significant improvements in picture memory, cancellation, and the processing speed composite were found at Visit 2. The improvement in cancellation and processing speed composite remained significant at Visit 3. Statistically significant improvement in Mullen fine motor score was noticed at Visit 3 compared with Visit 1. The pattern of results did not depend upon prior anaesthesia exposure.General anaesthesia for elective surgery in young children was not associated with declines in working memory, processing speed, and fine motor skills in the first 3 months postoperatively, including in children with prior exposure to anaesthesia.
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- 2022
48. Perioperative Opioid Consumption and Clinical Outcomes in Surgical Patients With a Pre-existing Opioid-Based Intrathecal Drug Delivery System
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Darrell R. Schroeder, William D. Mauck, Matthew A. Warner, Kalli K. Schaefer, Danette L. Bruns, Brendan Langford, Ryan S D'Souza, Nafisseh S. Warner, and Oludare O Olatoye
- Subjects
Adult ,Male ,Pain medicine ,Pacu ,Drug Delivery Systems ,Interquartile range ,Naloxone ,Medicine ,Humans ,Pain Management ,Postoperative Period ,Perioperative Period ,Injections, Spinal ,Aged ,Retrospective Studies ,Pain, Postoperative ,biology ,business.industry ,Chronic pain ,Perioperative ,Drug Tolerance ,Middle Aged ,medicine.disease ,biology.organism_classification ,Confidence interval ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Treatment Outcome ,Opioid ,Anesthesia ,Multivariate Analysis ,Regression Analysis ,Female ,Chronic Pain ,business ,medicine.drug - Abstract
BACKGROUND Intrathecal drug delivery systems (IDDS) have been utilized for over 3 decades for management of chronic pain and spasticity. Patients with IDDS may present for surgical procedures unrelated to the IDDS device, although data are limited regarding perioperative outcomes. METHODS This is a historical matched cohort study conducted between January 1, 2007 and December 31, 2016 of patients with an opioid-based IDDS versus matched control patients undergoing surgery excluding interventional pain procedures. Patients in the IDDS group were matched with up to 2 patients without an IDDS. Multivariable regression analyses were utilized to assess differences in the primary outcome of cumulative perioperative opioid consumption (ie, intraoperative and postanesthesia care unit [PACU] opioid consumption), and opioid consumption during the first 24 and 72 postoperative hours. Postoperative clinical outcomes were also assessed including escalating oxygen requirements, naloxone administration, pain-sedation mismatch, and perioperative pain service consultation. RESULTS A total of 321 surgeries were included, 112 with IDDS and 209 controls, with median (interquartile range [IQR]) age of 57 (49-64) years. Compared to matched controls, patients with an IDDS had greater perioperative opioid consumption (median [IQR] oral morphine milligram equivalents [OME] of 110 [60-163] vs 93 [IQR, 53-142]; adjusted multiplicative increase 1.27 [95% confidence interval {CI}, 1.03-1.57]; P = .029). IDDS patients also had greater opioid consumption in the first 24 and 72 postoperative hours (multiplicative increases of 2.18 [95% CI, 1.35-3.53], P = .002, and 2.39 [95% CI, 1.38-4.15], P = .002, respectively). There were no significant differences in postoperative oxygen requirements, naloxone administration, or pain-sedation mismatch. Inpatient pain medicine consultation was more frequent in IDDS patients compared to controls (51.8% vs 6.2%; P < .001). CONCLUSIONS Patients with opioid-based IDDS received more perioperative opioids and were more likely to receive postoperative pain service consultation compared to matched controls. There were no significant differences in clinical safety outcomes, suggesting tolerance for higher opioid doses. Further research is warranted to optimize perioperative outcomes in those with IDDS.
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- 2023
49. Moderators of the association between attention-deficit/hyperactivity disorder and exposure to anaesthesia and surgery in children
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Darrell R. Schroeder, Randall P. Flick, Yu Shi, Hayley J. Dykhoff, David O. Warner, Michael J. Zaccariello, Lindsay R Hunter Guevara, and Lindsey R. Sangaralingham
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Male ,medicine.medical_specialty ,Patient characteristics ,Affect (psychology) ,White People ,Cohort Studies ,Risk Factors ,mental disorders ,Humans ,Medicine ,Attention deficit hyperactivity disorder ,Anesthesia ,Child ,Association (psychology) ,Retrospective Studies ,business.industry ,Incidence ,Incidence (epidemiology) ,Racial Groups ,Hazard ratio ,medicine.disease ,Confidence interval ,Surgery ,Anesthesiology and Pain Medicine ,Attention Deficit Disorder with Hyperactivity ,Child, Preschool ,Surgical Procedures, Operative ,Cohort ,Female ,business - Abstract
Background Children's exposure to anaesthesia has been associated with risk of developing attention-deficit/hyperactivity disorder (ADHD). The goal of this study was to determine if selected patient characteristics moderate the association between exposure to anaesthesia and ADHD. Methods In a cohort of children born in between 2006 and 2012, exposure to anaesthesia before the age of 5 yr was categorised into unexposed, singly, or multiply exposed. Weighted proportional hazard regression was performed to evaluate the hazard ratios (HRs) of ADHD diagnosis related to anaesthesia exposure. Interaction analyses were performed to evaluate potential moderators. Results Among 185 002 children in the cohort, 9179 were diagnosed with ADHD. Compared with unexposed children, a single exposure to anaesthesia was associated with a HR of 1.39, (95% confidence interval [CI], 1.32–1.47) for ADHD. Multiple exposures were associated with a HR of 1.75 (95% CI, 1.62–1.87). In the analyses evaluating moderators of the association between exposure and ADHD, only the interaction for race was statistically significant (P=0.006); exposure increased the incidence of ADHD to a greater extent in non-White compared with White children. Among children with a single exposure, the age at exposure did not affect the relationship between exposure and incidence of ADHD (P=0.78). Conclusions Exposure of young children to anaesthesia and surgery is associated with an increased incidence of ADHD, with more exposures associated with greater risk. Compared with White children, non-White children are at greater risk for reasons that are unknown but need to be further explored.
- Published
- 2021
50. Association of Blood Pressure Variability with Delirium in Patients with Critical Illness
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Nika Zorko Garbajs, Diana J. Valencia Morales, Tarun D. Singh, Vitaly Herasevich, Andrew C. Hanson, Darrell R. Schroeder, Toby N. Weingarten, Ognjen Gajic, Juraj Sprung, and Alejandro A. Rabinstein
- Subjects
Neurology (clinical) ,Critical Care and Intensive Care Medicine - Published
- 2022
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