LIVIVO - Search results -

Search results

Result 1 - 10 of total 215

Search options

Article ; Online: Validation of the Clinicians' Cultural Sensitivity Survey for Use in Pediatric Primary Care Settings.

Loo, Stephanie / Brady, Keri J S / Ragavan, Maya I / Griffith, Kevin N

Journal of immigrant and minority health

2023 Volume 25, Issue 4, Page(s) 790–802

Abstract: Incorporating cultural sensitivity into healthcare settings is important to deliver high-quality and equitable care, particularly for marginalized communities who are non-White, non-English speaking, or immigrants. The Clinicians' Cultural Sensitivity ... ...

Abstract	Incorporating cultural sensitivity into healthcare settings is important to deliver high-quality and equitable care, particularly for marginalized communities who are non-White, non-English speaking, or immigrants. The Clinicians' Cultural Sensitivity Survey (CCSS) was developed as a patient-reported survey assessing clinicians' recognition of cultural factors affecting care quality for older Latino patients; however, this instrument has not been adapted for use in pediatric primary care. Our objective was to examine the validity and reliability of a modified CCSS that was adapted for use with parents of pediatric patients. A convenience sampling approach was used to identify eligible parents during well-child visits at an urban pediatric primary care clinic. Parents were administered the CCSS via electronic tablet in a private location. We first conducted exploratory factor analyses (EFAs) to explore the dimensionality of survey responses in the adapted CCSS, and then conducted a series of confirmatory factor analyses (CFAs) using maximum likelihood estimation based on the results of the EFAs. Exploratory and confirmatory factor analyses (N = 212 parent surveys) supported a three-factor structure assessing racial discrimination ([Formula: see text]=0.96), culturally-affirming practices ([Formula: see text]=0.86), and causal attribution of health problems ([Formula: see text]=0.85). In CFAs, the three-factor model also outperformed other potential factor structures in terms of fit statistics including scaled root mean square error approximation (0.098), Tucker-Lewis Index (0.936), Comparative Fit Index (0.950), and demonstrated adequate fit according to the standardized root mean square residual (0.061). Our findings support the internal consistency, reliability, and construct validity of the adapted CCSS for use in a pediatric population.
MeSH term(s)	Humans ; Child ; Cultural Competency ; Reproducibility of Results ; Surveys and Questionnaires ; Delivery of Health Care ; Primary Health Care ; Psychometrics/methods
Language	English
Publishing date	2023-03-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2220162-2
ISSN	1557-1920 ; 1557-1912
ISSN (online)	1557-1920
ISSN	1557-1912
DOI	10.1007/s10903-023-01469-2
Database	MEDical Literature Analysis and Retrieval System OnLINE

Order via subito

This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.

Article ; Online: Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic.

Auty, Samantha G / Aswani, Monica S / Wahbi, Rafik N / Griffith, Kevin N

Medical care

2022 Volume 61, Issue 1, Page(s) 45–49

Abstract: Background: The intersecting crises of the COVID-19 pandemic, job losses, and concomitant loss of employer-sponsored health insurance may have disproportionately affected health care access within minorized and lower-socioeconomic status communities.: ...

Abstract	Background: The intersecting crises of the COVID-19 pandemic, job losses, and concomitant loss of employer-sponsored health insurance may have disproportionately affected health care access within minorized and lower-socioeconomic status communities. Objective: To describe changes in access to care during the COVID-19 pandemic, stratified by race/ethnicity, household income, and state Medicaid expansion status. Research design: We used interrupted time series and difference-in-differences regression models, controlling for respondent characteristics and preexisting trends. Subjects: Data were extracted for all adults aged 18-64 surveyed in the 2015-2020 Behavioral Risk Factor Surveillance System (N=1,731,699) from all 50 states and the District of Columbia. Measures: Our outcomes included indicators for whether respondents had any health insurance coverage or avoided seeking care because of cost within the prior year. The primary exposure was the onset of the COVID-19 pandemic in the United States in March 2020. Results: The pandemic was associated with a 1.2 percentage point (pp) decline in uninsurance for Medicaid expansion states (95% CI, -1.8, -0.6); these reductions were concentrated among respondents who were Black, multiracial, or low income. The rates of uninsurance were generally stable in nonexpansion states. The rates of avoided care because of cost fell by 3.5 pp in Medicaid expansion states (95% CI, -3.9, -3.1), and by 3.6 pp (95% CI, 4.3-2.9) in nonexpansion states. These declines were concentrated among respondents who were Hispanic, Other Race, or low income. Conclusions: Our findings reinforce the value of Medicaid expansion as one tool to improve access to health insurance and care for marginalized and vulnerable populations.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Pandemics ; Poverty ; Social Class ; Health Services Accessibility
Language	English
Publishing date	2022-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	411646-x
ISSN	1537-1948 ; 0025-7079
ISSN (online)	1537-1948
ISSN	0025-7079
DOI	10.1097/MLR.0000000000001788
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.B 518: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 63: Show issues

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Impact of notification policy on patient-before-clinician review of immediately released test results.

Steitz, Bryan D / Padi-Adjirackor, Nana Addo / Griffith, Kevin N / Reese, Thomas J / Rosenbloom, S Trent / Ancker, Jessica S

Journal of the American Medical Informatics Association : JAMIA

2023 Volume 30, Issue 10, Page(s) 1707–1710

Abstract: The 21st Century Cures Act mandates immediate availability of test results upon request. The Cures Act does not require that patients be informed of results, but many organizations send notifications when results become available. Our medical center ... ...

Abstract	The 21st Century Cures Act mandates immediate availability of test results upon request. The Cures Act does not require that patients be informed of results, but many organizations send notifications when results become available. Our medical center implemented 2 sequential policies: immediate notifications for all results, and notifications only to patients who opt in. We used over 2 years of data from Vanderbilt University Medical Center to measure the effect of these policies on rates of patient-before-clinician result review and patient-initiated messaging using interrupted time series analysis. When releasing test results with immediate notification, the proportion of patient-before-clinician review increased 4-fold and the proportion of patients who sent messages rose 3%. After transition to opt-in notifications, patient-before-clinician review decreased 2.4% and patient-initiated messaging decreased 0.4%. Replacing automated notifications with an opt-in policy provides patients flexibility to indicate their preferences but may not substantially alleviate clinicians' messaging workload.
MeSH term(s)	Humans ; Hospitals ; Workload ; Academic Medical Centers ; Interrupted Time Series Analysis
Language	English
Publishing date	2023-07-05
Publishing country	England
Document type	Journal Article
ZDB-ID	1205156-1
ISSN	1527-974X ; 1067-5027
ISSN (online)	1527-974X
ISSN	1067-5027
DOI	10.1093/jamia/ocad126
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 4128: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 312: Show issues

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.

Auty, Samantha G / Griffith, Kevin N

Drug and alcohol dependence

2022 Volume 232, Page(s) 109340

Abstract: ... and non-expansion states after the onset of the COVID-19 pandemic.: Results: The U.S. experienced ...

Abstract	Background: The COVID-19 pandemic caused disruptions in the delivery of health services, which may have adversely affected access to substance use disorder (SUD) treatment services. Medicaid expansion has been previously associated with increased access to SUD services for low-income adults. Thus, the pandemic may have differentially impacted overdose mortality depending on expansion status. This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. Methods: State-level data on overdose mortality were obtained from the Centers for Disease Control and Prevention's WONDER database for 2013-2020 (N = 408 state-years). The primary outcomes were drug and opioid overdose deaths per 100,000 residents. The primary exposure was Medicaid expansion status as of January 1st, 2020. Difference-in-difference (DID) models were used to compare changes in outcomes between expansion and non-expansion states after the onset of the COVID-19 pandemic. Results: The U.S. experienced 91,799 drug overdose deaths in 2020, a 29.9% relative increase from 2019. Expansion states experienced an adjusted increase of 7.0 drug overdose deaths per 100,000 residents (95% CI 3.3, 10.7) and non-expansion states experienced an increase of 4.3 deaths (95% CI 1.5, 8.2) from 2019 to 2020. Similar trends were observed in opioid overdose deaths. In DID models, Medicaid expansion was not associated with changes in drug (0.9 deaths, 95% CI -2.0, 3.7) or opioid overdose deaths (0.8 deaths, 95% CI -1.8, 3.5). Conclusions: The increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.
MeSH term(s)	Adult ; Analgesics, Opioid/therapeutic use ; COVID-19 ; Drug Overdose/epidemiology ; Humans ; Medicaid ; Pandemics ; SARS-CoV-2 ; United States/epidemiology
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-02-02
Publishing country	Ireland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2022.109340
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 1310: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.

Feyman, Yevgeniy / Avila, Cecille Joan / Auty, Samantha / Mulugeta, Martha / Strombotne, Kiersten / Legler, Aaron / Griffith, Kevin

Health services research

2022 Volume 58, Issue 3, Page(s) 642–653

Abstract: ... among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans ...

Abstract	Objective: The COVID-19 pandemic disproportionately affected racial and ethnic minorities among the general population in the United States; however, little is known regarding its impact on U.S. military Veterans. In this study, our objectives were to identify the extent to which Veterans experienced increased all-cause mortality during the COVID-19 pandemic, stratified by race and ethnicity. Data sources: Administrative data from the Veterans Health Administration's Corporate Data Warehouse. Study design: We use pre-pandemic data to estimate mortality risk models using five-fold cross-validation and quasi-Poisson regression. Models were stratified by a combined race-ethnicity variable and included controls for major comorbidities, demographic characteristics, and county fixed effects. Data collection: We queried data for all Veterans residing in the 50 states plus Washington D.C. during 2016-2020. Veterans were excluded from analyses if they were missing county of residence or race-ethnicity data. Data were then aggregated to the county-year level and stratified by race-ethnicity. Principal findings: Overall, Veterans' mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. However, there was substantial variation by racial and ethnic group. Non-Hispanic White Veterans experienced the smallest relative increase in mortality (17%, 95% CI 11%-24%), while Native American Veterans had the highest increase (40%, 95% CI 17%-73%). Black Veterans (32%, 95% CI 27%-39%) and Hispanic Veterans (26%, 95% CI 17%-36%) had somewhat lower excess mortality, although these changes were significantly higher compared to White Veterans. Disparities were smaller than in the general population. Conclusions: Minoritized Veterans experienced higher rates excess of mortality during the COVID-19 pandemic compared to White Veterans, though with smaller differences than the general population. This is likely due in part to the long-standing history of structural racism in the United States that has negatively affected the health of minoritized communities via several pathways including health care access, economic, and occupational inequities.
MeSH term(s)	Humans ; COVID-19/epidemiology ; COVID-19/ethnology ; Ethnicity/statistics & numerical data ; Hispanic or Latino/statistics & numerical data ; Pandemics ; United States/epidemiology ; Veterans/statistics & numerical data ; White/statistics & numerical data ; Black or African American/statistics & numerical data ; American Indian or Alaska Native/statistics & numerical data ; Health Status Disparities ; Healthcare Disparities/economics ; Healthcare Disparities/ethnology ; Healthcare Disparities/statistics & numerical data ; Systemic Racism/ethnology ; Systemic Racism/statistics & numerical data ; Health Services Accessibility ; Employment/economics ; Employment/statistics & numerical data ; Occupations/economics ; Occupations/statistics & numerical data
Language	English
Publishing date	2022-12-30
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	410435-3
ISSN	1475-6773 ; 0017-9124
ISSN (online)	1475-6773
ISSN	0017-9124
DOI	10.1111/1475-6773.14112
Database	MEDical Literature Analysis and Retrieval System OnLINE

Full text online

Accessible to users with ZB MED library card

In stock of ZB MED Cologne/Königswinter

Zs.A 582: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾

Article ; Online: Engagement with Traditional Healers for Early Detection of Plague in Uganda.

Apangu, Titus / Candini, Gordian / Abaru, Janet / Candia, Bosco / Okoth, Felix J / Atiku, Linda A / Griffith, Kevin S / Hayden, Mary H / Zielinski-Gutiérrez, Emily / Schwartz, Amy M / McCormick, David W / Mead, Paul S / Kugeler, Kiersten J

The American journal of tropical medicine and hygiene

2023 Volume 109, Issue 5, Page(s) 1129–1136

Abstract: In rural Uganda, many people who are ill consult traditional healers prior to visiting the formal healthcare system. Traditional healers provide supportive care for common illnesses, but their care may delay diagnosis and management of illnesses that can ...

Abstract	In rural Uganda, many people who are ill consult traditional healers prior to visiting the formal healthcare system. Traditional healers provide supportive care for common illnesses, but their care may delay diagnosis and management of illnesses that can increase morbidity and mortality, hinder early detection of epidemic-prone diseases, and increase occupational risk to traditional healers. We conducted open-ended, semi-structured interviews with a convenience sample of 11 traditional healers in the plague-endemic West Nile region of northwestern Uganda to assess their knowledge, practices, and attitudes regarding plague and the local healthcare system. Most were generally knowledgeable about plague transmission and its clinical presentation and expressed willingness to refer patients to the formal healthcare system. We initiated a public health outreach program to further improve engagement between traditional healers and local health centers to foster trust in the formal healthcare system and improve early identification and referral of patients with plaguelike symptoms, which can reflect numerous other infectious and noninfectious conditions. During 2010-2019, 65 traditional healers were involved in the outreach program; 52 traditional healers referred 788 patients to area health centers. The diagnosis was available for 775 patients; malaria (37%) and respiratory tract infections (23%) were the most common diagnoses. One patient had confirmed bubonic plague. Outreach to improve communication and trust between traditional healers and local healthcare settings may result in improved early case detection and intervention not only for plague but also for other serious conditions.
MeSH term(s)	Humans ; Uganda/epidemiology ; Traditional Medicine Practitioners ; Plague/diagnosis ; Plague/epidemiology ; Plague/therapy ; Delivery of Health Care ; Referral and Consultation ; Medicine, African Traditional
Language	English
Publishing date	2023-10-02
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.23-0101
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Ud II Zs.61: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Gene Therapy Restores Balance and Auditory Functions in a Mouse Model of Usher Syndrome.

Isgrig, Kevin / Shteamer, Jack W / Belyantseva, Inna A / Drummond, Meghan C / Fitzgerald, Tracy S / Vijayakumar, Sarath / Jones, Sherri M / Griffith, Andrew J / Friedman, Thomas B / Cunningham, Lisa L / Chien, Wade W

Molecular therapy : the journal of the American Society of Gene Therapy

2022 Volume 30, Issue 2, Page(s) 975

Language	English
Publishing date	2022-01-20
Publishing country	United States
Document type	Published Erratum
ZDB-ID	2010592-7
ISSN	1525-0024 ; 1525-0016
ISSN (online)	1525-0024
ISSN	1525-0016
DOI	10.1016/j.ymthe.2022.01.026
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.A 5640: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
Jg. 1995 - 2021: Lesesall (2.OG)
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Changes in Insurance Coverage and Access to Care for Young Adults in 2017.

Griffith, Kevin N

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2019 Volume 66, Issue 1, Page(s) 86–91

Abstract: ... to Trump administrations.: Methods: Data on noninstitutionalized U.S. young adults (18-24 years) was ...

Abstract	Purpose: Previous work has demonstrated the Affordable Care Act (ACA) increased young adults' health care access during its first years. However, it is unclear if these trends continued through 2017; recent policies enacted by the Trump administration may have decreased the ACA's effectiveness. Our purpose was to determine changes in young adults' health care access during the transition from Obama to Trump administrations. Methods: Data on noninstitutionalized U.S. young adults (18-24 years) was obtained from the Behavioral Risk Factor Surveillance System 2011-2017 (N = 173,848). We used interrupted time series and difference-in-differences analysis to quantify changes in self-reported insurance coverage, access to a primary care physician, and unmet care because of cost from 2013 to 2017. Results: Young adults' health care access continued to improve through 2016; for instance, the percentage of respondents experiencing uninsurance declined by 8.7 points from 2013 to 2016 (95% confidence interval [CI] -9.4 to -8.0). However, these trends began to reverse and from 2016 to 2017, the percentage of young adults who experienced uninsurance increased by 1.4 points (95% CI .6-2.1), not having a personal doctor increased by 1.1 points (95% CI .2-2.0), and unmet care because of cost increased by 1.0 points (95% CI .3-1.7). The 2017 declines in access were concentrated in states which did not expand Medicaid and in households earning above 138% of federal poverty level. Conclusions: Health care access declined for young adults in 2017, after several years of improvements. These changes correspond with recent policy actions, which may have weakened the ACA's reforms.
MeSH term(s)	Adolescent ; Health Policy ; Health Services Accessibility ; Humans ; Insurance Coverage/trends ; Insurance, Health ; Medicaid ; Patient Protection and Affordable Care Act ; Politics ; United States ; Young Adult
Language	English
Publishing date	2019-07-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2019.05.020
Database	MEDical Literature Analysis and Retrieval System OnLINE

Full text online

Accessible to users with ZB MED library card

In stock of ZB MED Cologne/Königswinter

Zs.B 2453: Show issues

Location:
Je nach Verfügbarkeit (siehe Angabe bei Bestand)
bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
ab Jg. 2022: Lesesaal (EG)

Order via subito

Details ▾

Article ; Online: An Economic Analysis of the Implementation of Team-based Collaborative Care in Outpatient General Mental Health Clinics.

Miller, Christopher J / Griffith, Kevin N / Stolzmann, Kelly / Kim, Bo / Connolly, Samantha L / Bauer, Mark S

Medical care

2020 Volume 58, Issue 10, Page(s) 874–880

Abstract: Background: Collaborative Chronic Care Models represent an evidence-based way to structure care for chronic conditions, including mental health conditions. Few studies, however, have examined the cost implications of collaborative care for mental health. ...

Abstract	Background: Collaborative Chronic Care Models represent an evidence-based way to structure care for chronic conditions, including mental health conditions. Few studies, however, have examined the cost implications of collaborative care for mental health. Objective: We aimed to conduct an economic analysis of implementing collaborative care in 9 outpatient general mental health clinics. Research design: Analyses were derived from a stepped wedge hybrid implementation-effectiveness trial. We conducted cost-minimization analyses from the health system perspective, incorporating implementation costs, outpatient costs, and inpatient costs for the year before collaborative care implementation and the implementation year. We used a difference-in-differences approach and conducted 1-way sensitivity analyses to determine the robustness of results to variations ±15% in model parameters, along with probabilistic sensitivity analysis using Monte Carlo simulation. Subjects: Our treatment group included 5507 patients who were initially engaged in care within 9 outpatient general mental health teams that underwent collaborative care implementation. We compared costs for this group to 45,981 control patients who received mental health treatment as usual at the same medical centers. Results: Collaborative care implementation cost about $40 per patient and was associated with a significant decrease in inpatient costs and a nonsignificant increase in outpatient mental health costs. This implementation was associated with $78 in cost savings per patient. Monte Carlo simulation suggested that implementation was cost saving in 78% of iterations. Conclusions: Collaborative care implementation for mental health teams was associated with significant reductions in mental health hospitalizations, leading to substantial cost savings of about $1.70 for every dollar spent for implementation.
MeSH term(s)	Adult ; Aged ; Ambulatory Care Facilities/economics ; Ambulatory Care Facilities/organization & administration ; Costs and Cost Analysis ; Female ; Health Care Costs ; Hospitalization/economics ; Humans ; Male ; Mental Disorders/therapy ; Mental Health Services/economics ; Mental Health Services/organization & administration ; Middle Aged ; Models, Organizational ; Outcome Assessment, Health Care/economics ; Patient Care Team/economics ; Patient Care Team/organization & administration ; United States ; United States Department of Veterans Affairs
Language	English
Publishing date	2020-08-10
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	411646-x
ISSN	1537-1948 ; 0025-7079
ISSN (online)	1537-1948
ISSN	0025-7079
DOI	10.1097/MLR.0000000000001372
Database	MEDical Literature Analysis and Retrieval System OnLINE

In stock of ZB MED Cologne/Königswinter

Zs.B 518: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
Zs.MO 63: Show issues

Order via subito

Details ▾
- See ZB MED holdings
- Order with fees

Article ; Online: Risk factors and treatment interventions associated with incomplete thrombus resolution and pulmonary hypertension after pulmonary embolism.

Fang, Adam / Mayorga-Carlin, Minerva / Han, Paul / Cassady, Steven / John, Thomas / LaRocco, Allison / Etezadi, Vahid / Jones, Kevin / Nagarsheth, Khanjan / Toursavadkohi, Shahab / Jeudy, Jean / Anderson, Douglas / Griffith, Bartley / Sorkin, John D / Sarkar, Rajabrata / Lal, Brajesh K / Cires-Drouet, Rafael S

Journal of vascular surgery. Venous and lymphatic disorders

2023 Volume 12, Issue 1, Page(s) 101665

Abstract: Background: Residual pulmonary vascular occlusion (RPVO) affects one half of patients after a pulmonary embolism (PE). The relationship between the risk factors and therapeutic interventions for the development of RPVO and chronic thromboembolic ... ...

Abstract	Background: Residual pulmonary vascular occlusion (RPVO) affects one half of patients after a pulmonary embolism (PE). The relationship between the risk factors and therapeutic interventions for the development of RPVO and chronic thromboembolic pulmonary hypertension is unknown. Methods: This retrospective review included PE patients within a 26-month period who had baseline and follow-up imaging studies (ie, computed tomography [CT], ventilation/perfusion scans, transthoracic echocardiography) available. We collected the incidence of RPVO, percentage of pulmonary artery occlusion (%PAO), baseline CT %PAO, most recent CT %PAO, and difference between the baseline and most recent %PAO on CT (Δ%PAO). Results: A total of 354 patients had imaging reports available; 197 with CT and 315 with transthoracic echocardiography. The median follow-up time was 144 days (interquartile range [IQR], 102-186 days). RPVO was present in 38.9% of the 354 patients. The median Δ%PAO was -10.0% (IQR, -32% to -1.2%). Fewer patients with a provoked PE developed RPVO (P ≤ .01), and the initial troponin level was lower in patients who developed RPVO (P = .03). The initial thrombus was larger in the patients who received advanced intervention vs anticoagulation (baseline CT %PAO: median, 61.2%; [IQR, 27.5%-75.0%] vs median, 12.5% [IQR, 2.5%-40.0%]; P ≤ .0001). Catheter-directed thrombolysis (CDT; median Δ%PAO, -47.5%; IQR, -63.7% to -8.7%) and surgical pulmonary embolectomy (SPE; median Δ%PAO, -42.5; IQR, -68.1% to -18.7%) had the largest thrombus reduction compared with anticoagulation (P = .01). Of the 354 patients, 76 developed pulmonary hypertension; however, only 14 received pulmonary hypertension medications and 12 underwent pulmonary thromboendarterectomy. Cancer (odds ratio [OR], 1.7) and planned prolonged anticoagulation (>1 year; OR, 2.20) increased the risk of RPVO. In contrast, the risk was lower for men (OR, 0.61), patients with recent surgery (OR, 0.33), and patients treated with SPE (OR, 0.42). A larger Δ%PAO was found in men (coefficient, -8.94), patients with a lower body mass index (coefficient, -0.66), patients treated with CDT (coefficient, -18.12), and patients treated with SPE (coefficient, -21.69). A lower Δ%PAO was found in African-American patients (coefficient, 7.31). Conclusions: The use of CDT and SPE showed long-term benefit in thrombus reduction.
MeSH term(s)	Male ; Humans ; Hypertension, Pulmonary/diagnostic imaging ; Hypertension, Pulmonary/therapy ; Hypertension, Pulmonary/complications ; Pulmonary Embolism/diagnostic imaging ; Pulmonary Embolism/therapy ; Pulmonary Embolism/complications ; Risk Factors ; Thrombosis/drug therapy ; Arterial Occlusive Diseases ; Retrospective Studies ; Anticoagulants/therapeutic use ; Thrombolytic Therapy/adverse effects ; Thrombolytic Therapy/methods ; Treatment Outcome
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-08-16
Publishing country	United States
Document type	Journal Article
ISSN	2213-3348
ISSN (online)	2213-3348
DOI	10.1016/j.jvsv.2023.08.006
Database	MEDical Literature Analysis and Retrieval System OnLINE

Order via subito

Inter-library loan at ZB MED

Your chosen title can be delivered directly to ZB MED Cologne location if you are registered as a user at ZB MED Cologne.

To top

More links

Kategorien

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

Full text online

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

Full text online

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

In stock of ZB MED Cologne/Königswinter

Order via subito

More links

Kategorien

Order via subito

Inter-library loan at ZB MED