scholarly journals Cluster analysis of clozapine consumer perspectives and comparison to consumers on other antipsychotics

2021 ◽  
Author(s):  
Sumeet Sharma ◽  
Sarah L Kopelovich ◽  
Umair Janjua ◽  
Cristina Pritchett ◽  
Beth Broussard ◽  
...  
Keyword(s):  
Side Effects ◽  
The United States ◽  
High Rate ◽  
Hospital System ◽  
Previous Regimen ◽  
Consumer Perspectives ◽  
Clustering Approach ◽  
Specific Factors ◽  
Public Hospital System ◽  
Context Specific

Abstract Despite its unique efficacy, clozapine remains underutilized in the United States. Perceptions about clozapine and barriers to its use have been examined among prescribers, but insufficiently studied among consumers. We surveyed 211 antipsychotic consumers (86 on clozapine and 125 on other antipsychotics) on their medication-related perspectives in a public hospital system in Atlanta, Georgia, USA. In contrast to their previous regimen, 72% of clozapine consumers reported they were more satisfied with clozapine. When compared to consumers taking other antipsychotics, clozapine consumers reported more side effects, but did not differ on other measures of satisfaction or efficacy. We found Caucasians to be overrepresented among clozapine, as compared to other antipsychotic consumers. Side effects most strongly associated with poor safety ratings were sedation, limb jerking, and dizziness when standing. However, clozapine was only rated less safe by consumers who experienced more than one of these side effects. We used an unsupervised clustering approach to identify three major groups of clozapine consumers. Cluster A (19%) had the lowest safety ratings, aversion to blood work, and a high rate of side effects that associate with lower safety ratings. Cluster B (25%) experienced more hospitalizations and reported satisfaction with clozapine that correlated with efficacy ratings, irrespective of safety ratings. Cluster C (56%) experienced fewer hospitalizations, fewer previous drug trials, greater educational attainment, lower rates of smoking, and rated clozapine more highly. This work identifies common side effects that influence subjective safety of clozapine and suggests that attitudes toward clozapine depend on context-specific factors.

scholarly journals Characteristics and Outcomes of COVID-19 Patients in New York City’s Public Hospital System

2020 ◽  
Author(s):  
Roopa Kalyanaraman Marcello ◽  
Johanna Dolle ◽  
Sheila Grami ◽  
Richard Adule ◽  
Zeyu Li ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
New York ◽  
Kidney Disease ◽  
Public Hospital ◽  
Case Series ◽  
Ethnically Diverse ◽  
The United States ◽  
Hospital System ◽  
Public Hospital System

AbstractBackgroundNew York City (NYC) has borne the greatest burden of COVID-19 in the United States, but information about characteristics and outcomes of racially/ethnically diverse individuals tested and hospitalized for COVID-19 remains limited. In this case series, we describe characteristics and outcomes of patients tested for and hospitalized with COVID-19 in New York City’s public hospital system.MethodsWe reviewed the electronic health records of all patients who received a SARS-CoV-2 test between March 5 and April 9, 2020, with follow up through April 16, 2020. The primary outcomes were a positive test, hospitalization, and death. Demographics and comorbidities were also assessed.Results22254 patients were tested for SARS-CoV-2. 13442 (61%) were positive; among those, the median age was 52.7 years (interquartile range [IQR] 39.5-64.5), 7481 (56%) were male, 3518 (26%) were Black, and 4593 (34%) were Hispanic. Nearly half (4669, 46%) had at least one chronic disease (27% diabetes, 30% hypertension, and 21% cardiovascular disease). Of those testing positive, 6248 (46%) were hospitalized. The median age was 61.6 years (IQR 49.7-72.9); 3851 (62%) were male, 1950 (31%) were Black, and 2102 (34%) were Hispanic. More than half (3269, 53%) had at least one chronic disease (33% diabetes, 37% hypertension, 24% cardiovascular disease, 11% chronic kidney disease). 1724 (28%) hospitalized patients died. The median age was 71.0 years (IQR 60.0, 80.9); 1087 (63%) were male, 506 (29%) were Black, and 528 (31%) were Hispanic. Chronic diseases were common (35% diabetes, 37% hypertension, 28% cardiovascular disease, 15% chronic kidney disease). Male sex, older age, diabetes, cardiac history, and chronic kidney disease were significantly associated with testing positive, hospitalization, and death. Racial/ethnic disparities were observed across all outcomes.Conclusions and RelevanceThis is the largest and most racially/ethnically diverse case series of patients tested and hospitalized for COVID-19 in the United States to date. Our findings highlight disparities in outcomes that can inform prevention and testing recommendations.

Sulfinpyrazone or Acetylsalicylic Acid to Prevent Postoperative Thrombus Formation in Arteriovenous Fistulas of Haemodialysis Patients

1979 ◽  
Author(s):  
F Albert ◽  
U Schmidt
Keyword(s):  
Side Effects ◽  
Acetylsalicylic Acid ◽  
Thrombus Formation ◽  
Significant Inhibition ◽  
High Rate ◽  
Controlled Clinical Trial ◽  
Arteriovenous Fistulas ◽  
Arteriovenous Shunts ◽  
Gastrointestinal Side Effects ◽  
Antithrombotic Efficacy

The effect of sulfinpyrazone (200 mg three times a day) and acetylsalicylic acid (500 mg three times a day) on the incidence of thrombosis of arteriovenous shunts was investigated in a controlled clinical trial. In 36 patients with chronic renal failure scheduled to begin haemodialysis the same operating team constructed a subcutaneous fistula in the distal forearm. During the first six weeks after the operation the antithrombotic efficacy proved to be good for both substances. No differences of thrombotic events between the two treatment groups were statistically significant. But in contrast to acetylsalicylic acid sulfinpyrazone made no significant inhibition of platelet - aggregation; sulfinpyrazone probably will prevent the clot formation by prolonging the shortened platelet survival in uraemic patients. In a high rate of patients given acetylsalicylic acid (10 out of 17) there were local bleeding and gastrointestinal side effects. In consequence we should prefer sulfinpyrazone, because in the sulfinpyrazone group side effects were minimal and in none patient withdrawal from the study was necessitated.

Development and validation of risk stratification models for adult spinal deformity surgery

2019 ◽  
Vol 31 (4) ◽  
pp. 587-599 ◽  
Author(s):  
Ferran Pellisé ◽  
Miquel Serra-Burriel ◽  
Justin S. Smith ◽  
Sleiman Haddad ◽  
Michael P. Kelly ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
The United States ◽  
Adverse Outcomes ◽  
High Rate ◽  
Prognostic Models ◽  
Time To Event ◽  
European Continent ◽  
Event Risk ◽  
Risk Estimates

OBJECTIVEAdult spinal deformity (ASD) surgery has a high rate of major complications (MCs). Public information about adverse outcomes is currently limited to registry average estimates. The object of this study was to assess the incidence of adverse events after ASD surgery, and to develop and validate a prognostic tool for the time-to-event risk of MC, hospital readmission (RA), and unplanned reoperation (RO).METHODSTwo models per outcome, created with a random survival forest algorithm, were trained in an 80% random split and tested in the remaining 20%. Two independent prospective multicenter ASD databases, originating from the European continent and the United States, were queried, merged, and analyzed. ASD patients surgically treated by 57 surgeons at 23 sites in 5 countries in the period from 2008 to 2016 were included in the analysis.RESULTSThe final sample consisted of 1612 ASD patients: mean (standard deviation) age 56.7 (17.4) years, 76.6% women, 10.4 (4.3) fused vertebral levels, 55.1% of patients with pelvic fixation, 2047.9 observation-years. Kaplan-Meier estimates showed that 12.1% of patients had at least one MC at 10 days after surgery; 21.5%, at 90 days; and 36%, at 2 years. Discrimination, measured as the concordance statistic, was up to 71.7% (95% CI 68%–75%) in the development sample for the postoperative complications model. Surgical invasiveness, age, magnitude of deformity, and frailty were the strongest predictors of MCs. Individual cumulative risk estimates at 2 years ranged from 3.9% to 74.1% for MCs, from 3.17% to 44.2% for RAs, and from 2.67% to 51.9% for ROs.CONCLUSIONSThe creation of accurate prognostic models for the occurrence and timing of MCs, RAs, and ROs following ASD surgery is possible. The presented variability in patient risk profiles alongside the discrimination and calibration of the models highlights the potential benefits of obtaining time-to-event risk estimates for patients and clinicians.

scholarly journals Peculiarities of Neurostimulation by Intense Nanosecond Pulsed Electric Fields: How to Avoid Firing in Peripheral Nerve Fibers

2021 ◽  
Vol 22 (13) ◽  
pp. 7051
Author(s):  
Vitalii Kim ◽  
Emily Gudvangen ◽  
Oleg Kondratiev ◽  
Luis Redondo ◽  
Shu Xiao ◽  
...  
Keyword(s):  
Side Effects ◽  
Electric Fields ◽  
Pulsed Electric Fields ◽  
Opposite Polarity ◽  
Nerve Fibers ◽  
High Rate ◽  
Excitation Threshold ◽  
Compound Action Potentials ◽  
Supramaximal Stimulation ◽  
The Impact

Intense pulsed electric fields (PEF) are a novel modality for the efficient and targeted ablation of tumors by electroporation. The major adverse side effects of PEF therapies are strong involuntary muscle contractions and pain. Nanosecond-range PEF (nsPEF) are less efficient at neurostimulation and can be employed to minimize such side effects. We quantified the impact of the electrode configuration, PEF strength (up to 20 kV/cm), repetition rate (up to 3 MHz), bi- and triphasic pulse shapes, and pulse duration (down to 10 ns) on eliciting compound action potentials (CAPs) in nerve fibers. The excitation thresholds for single unipolar but not bipolar stimuli followed the classic strength–duration dependence. The addition of the opposite polarity phase for nsPEF increased the excitation threshold, with symmetrical bipolar nsPEF being the least efficient. Stimulation by nsPEF bursts decreased the excitation threshold as a power function above a critical duty cycle of 0.1%. The threshold reduction was much weaker for symmetrical bipolar nsPEF. Supramaximal stimulation by high-rate nsPEF bursts elicited only a single CAP as long as the burst duration did not exceed the nerve refractory period. Such brief bursts of bipolar nsPEF could be the best choice to minimize neuromuscular stimulation in ablation therapies.

scholarly journals Response to treatment with intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligo articular juvenile idiopathic arthritis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rana Harhay ◽  
Wajiha Jeelani ◽  
Barbine Tchamba Agbor Agbor ◽  
Teresa Hennon ◽  
Brian H. Wrotniak ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Side Effects ◽  
Triamcinolone Acetonide ◽  
The United States ◽  
Response To Treatment ◽  
Joint Injection ◽  
Triamcinolone Hexacetonide ◽  
Active Arthritis ◽  
General Response

Abstract Background Oligo-articular juvenile idiopathic arthritis (Oligo JIA) is the most common subtype of juvenile idiopathic arthritis. Intra-articular corticosteroid (IAC) injection is a mainstay treatment of oligo JIA providing pain relief, improving mobility and preventing further joint destruction in the majority of patients. In 2015, production of triamcinolone hexacetonide (TH) an intra-articular corticosteroid was discontinued in the United States leading to use of triamcinolone acetonide (TA) as an alternative. In this study, we compared response to treatment in children with oligo JIA who underwent therapy with intra-articular TA and TH injection. Methods Our study is a retrospective chart review of children with oligo JIA who were treated with IAC injections with TH between January 2012 and June 2015 and TA between J uly 2015 and December 2018. The two groups were followed at John R. Oishei Children’s Hospital of Buffalo and were evaluated for response to treatment, side effects and predictors of response including duration of disease before treatment, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Response to treatment was defined as at least 6 months follow up without evidence of active arthritis in injected joints. Patients were considered to be non-responders if they continued to show active arthritis during their first follow up after joint injection. The primary objective was to evaluate whether there was a significant difference in rate of response between TH and TA. Results Forty-nine patients, 38 female and 11 male with oligo JIA were included in the study. The average age was 6.7 years. A total of 111 joints were injected includin g 78 knees, 13 ankles, 9 wrists, 4 hips, 4 elbows, 2 TMJ and one subtalar joint. In the TA group, 49% (29/59) did not show response to injection compared to 27% (14/52) in the TH group. After 6 months, response rates were better for individuals injected with TH compared to TA (73% vs. 51%). In general, response to intra-articular TH was superior to TA with P = .016 using chi-square test of independence. This difference in outcome was not influenced by other variables such as duration of illness before treatment (P value 0.784) or elevated ESR and CRP. No difference in side effects between the two groups were noted. Conclusion Our results in conjunction with prior published data suggests that TH intra-articular joint injection in oligo JIA is superior to TA, although future controlled trials are necessary for confirmation. An effective, long lasting treatment can have a great impact on the outcome of these children.

Estimating the Electoral Effects of Voter Turnout

2010 ◽  
Vol 104 (2) ◽  
pp. 268-288 ◽  
Author(s):  
THOMAS G. HANSFORD ◽  
BRAD T. GOMEZ
Keyword(s):  
Voter Turnout ◽  
Instrumental Variable ◽  
Presidential Elections ◽  
Empirical Test ◽  
The United States ◽  
Electoral Outcomes ◽  
Level Data ◽  
Electoral Choice ◽  
High Turnout ◽  
Specific Factors

This article examines the electoral consequences of variation in voter turnout in the United States. Existing scholarship focuses on the claim that high turnout benefits Democrats, but evidence supporting this conjecture is variable and controversial. Previous work, however, does not account for endogeneity between turnout and electoral choice, and thus, causal claims are questionable. Using election day rainfall as an instrumental variable for voter turnout, we are able to estimate the effect of variation in turnout due to across-the-board changes in the utility of voting. We re-examine the Partisan Effects and Two-Effects Hypotheses, provide an empirical test of an Anti-Incumbent Hypothesis, and propose a Volatility Hypothesis, which posits that high turnout produces less predictable electoral outcomes. Using county-level data from the 1948–2000 presidential elections, we find support for each hypothesis. Failing to address the endogeneity problem would lead researchers to incorrectly reject all but the Anti-Incumbent Hypothesis. The effect of variation in turnout on electoral outcomes appears quite meaningful. Although election-specific factors other than turnout have the greatest influence on who wins an election, variation in turnout significantly affects vote shares at the county, national, and Electoral College levels.

scholarly journals 2019 Novel Coronavirus Vaccination among Post-graduate Residents and Fellows

2021 ◽  
Vol 12 ◽  
pp. 215013272110229
Author(s):  
Mostafa Abohelwa ◽  
Mohamed Elmassry ◽  
John Abdelmalek ◽  
Drew Payne ◽  
Kenneth Nugent
Keyword(s):  
Side Effects ◽  
Healthcare Workers ◽  
Healthcare Providers ◽  
The United States ◽  
Health Sciences ◽  
Institutional Review Board ◽  
Institutional Review ◽  
Texas Tech University ◽  
Novel Coronavirus ◽  
United States Healthcare

Background Coronavirus-2 (COVID-19) has caused a worldwide pandemic since December 2019. Since then, clinical trials with vaccines have been started and completed, and at present, 3 COVID-19 vaccines have been approved for use in the United States. Healthcare providers were among the first to get vaccinated, but the precise attitudes of healthcare workers toward vaccination are uncertain. Objective To understand residents and fellows’ attitudes toward vaccination and record any side effects after vaccination. Methods We conducted an anonymous survey that was open from 3-1-2021 to 3-12-2021 using distribution lists from the Graduate Medical Education office on the Lubbock campus of the Texas Tech University Health Sciences Center after getting approval from the Institutional Review Board (L21-088). Results Eighty-one residents and fellows (26.6% out of 304) responded to our survey. Among those who responded, 63 (77.8 %) were between 25 and 35 years old, and 41 (50.6%) were males. Seventy-seven (95.1%) received the vaccine (Pfizer-BioNTech), 78 (96.3%) reported that they supported vaccination, and 3 (3.7%) reported that they did not want vaccination. Eight members (9.8%) had tested positive for COVID-19 infection before vaccination, but only 1 (1.23%) had tested positive for COVID-19 antibodies. All residents and fellows reported side effects after the vaccination, including pain at the injection site (77; 100%), local redness (9; 11.6%), local swelling (13; 16.8%), fever (25; 32.5%), fatigue (25; 32.5%), chills (34; 44.1 %), headache (38; 49.4%). Conclusions Most medical trainees have a high interest in COVID-19 vaccination; however, a few reported that they did not want vaccination.

Critical Care in Critical Access Hospitals

2015 ◽  
Vol 35 (5) ◽  
pp. 62-67 ◽  
Author(s):  
Teresa J. Seright ◽  
Charlene A. Winters
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Rural Areas ◽  
Tertiary Care ◽  
Safety Net ◽  
The United States ◽  
Infusion Therapy ◽  
Critical Access Hospitals ◽  
Hospital System ◽  
Critical Access Hospital

What began as a grant-funded demonstration project, as a means of bridging the gap in rural health care, has developed into a critical access hospital system comprising 1328 facilities across 45 states. A critical access hospital is not just a safety net for health care in a rural community. Such hospitals may also provide specialized services such as same-day surgery, infusion therapy, and intensive care. For hospitals located near the required minimum of 35 miles from a tertiary care center, management of critically ill patients may be a matter of stabilization and transfer. Critical access hospitals in more rural areas are often much farther from tertiary care; some of these hospitals are situated within frontier areas of the United States. This article describes the development of critical access hospitals, provision of care and services, challenges to critical care in critical access hospitals, and suggestions to address gaps in research and collaborative care.

Professional values, job satisfaction, career development, and intent to stay

2016 ◽  
Vol 24 (6) ◽  
pp. 675-685 ◽  
Author(s):  
Susan Yarbrough ◽  
Pam Martin ◽  
Danita Alfred ◽  
Charleen McNeill
Keyword(s):  
United States ◽  
Job Satisfaction ◽  
Career Development ◽  
Intent To Stay ◽  
The United States ◽  
Early Career ◽  
Professional Values ◽  
Convenience Sample ◽  
Hospital System ◽  
The Future

Background: Hospitals are experiencing an estimated 16.5% turnover rate of registered nurses costing from $44,380 - $63,400 per nurse—an estimated $4.21 to $6.02 million financial loss annually for hospitals in the United States of America. Attrition of all nurses is costly. Most past research has focused on the new graduate nurse with little focus on the mid-career nurse. Attrition of mid-career nurses is a loss for the profession now and into the future. Research objective: The purpose of the study was to explore relationships of professional values orientation, career development, job satisfaction, and intent to stay in recently hired mid-career and early-career nurses in a large hospital system. Research design: A descriptive correlational study of personal and professional factors on job satisfaction and retention was conducted. Participants and research context: A convenience sample of nurses from a mid-sized hospital in a metropolitan area in the Southwestern United States was recruited via in-house email. Sixty-seven nurses met the eligibility criteria and completed survey documents. Ethical considerations: Institutional Review Board approval was obtained from both the university and hospital system. Findings: Findings indicated a strong correlation between professional values and career development and that both job satisfaction and career development correlated positively with retention. Discussion: Newly hired mid-career nurses scored higher on job satisfaction and planned to remain in their jobs. This is important because their expertise and leadership are necessary to sustain the profession into the future. Conclusion: Nurse managers should be aware that when nurses perceive value conflicts, retention might be adversely affected. The practice environment stimulates nurses to consider whether to remain on the job or look for other opportunities.

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