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Article ; Online: African American/Black race, apolipoprotein L1 , and serum creatinine among persons with HIV.

Shelton, Brittany A / Sawinski, Deirdre / Peter, Inga / Maclennan, Paul A / Pelletier, Nicole F / Nadkarni, Girish / Julian, Bruce / Saag, Michael / Fatima, Huma / Crane, Heidi / Lee, Wonjun / Moore, Richard D / Christopoulos, Katerina / Jacobson, Jeffrey M / Eron, Joseph J / Kumar, Vineeta / Locke, Jayme E

AIDS (London, England)

2023 Volume 37, Issue 15, Page(s) 2349–2357

Abstract: Objective: Accurate estimation of kidney function is critical among persons with HIV (PWH) to avoid under-dosing of antiretroviral therapies and ensure timely referral for kidney transplantation. Existing estimation equations for kidney function include ...

Abstract	Objective: Accurate estimation of kidney function is critical among persons with HIV (PWH) to avoid under-dosing of antiretroviral therapies and ensure timely referral for kidney transplantation. Existing estimation equations for kidney function include race, the appropriateness of which has been debated. Given advancements in understanding of race and the necessity of accuracy in kidney function estimation, this study aimed to examine whether race, or genetic factors, improved prediction of serum creatinine among PWH. Design: This cross-sectional study utilized data from the Center for AIDS Research Network of Integrated Clinical Systems cohort (2008-2018). The outcome was baseline serum creatinine. Methods: Ordinary least squares regression was used to examine whether inclusion of race or genetic factors [ apolipoprotein-L1 ( APOL1 ) variants and genetic African ancestry] improved serum creatinine prediction. A reduction in root mean squared error (RMSE) greater than 2% was a clinically relevant improvement in predictive ability. Results: There were 4183 PWH included. Among PWH whose serum creatinine was less than 1.7 mg/dl, race was significantly associated with serum creatinine ( β = 0.06, SE = 0.01, P < 0.001) but did not improve predictive ability. African ancestry and APOL1 variants similarly failed to improve predictive ability. Whereas, when serum creatinine was at least 1.7 mg/dl, inclusion of race reduced the RMSE by 2.1%, indicating improvement in predictive ability. APOL1 variants further improved predictive ability by reducing the RMSE by 2.9%. Conclusion: These data suggest that, among PWH, inclusion of race or genetic factors may only be warranted at higher serum creatinine levels. Work eliminating existing healthcare disparities while preserving the utility of estimating equations is needed.
MeSH term(s)	Humans ; Apolipoprotein L1/genetics ; Black or African American/genetics ; Creatinine/blood ; Cross-Sectional Studies ; HIV Infections/drug therapy ; Risk Factors
Chemical Substances	APOL1 protein, human ; Apolipoprotein L1 ; Creatinine (AYI8EX34EU)
Language	English
Publishing date	2023-08-30
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	639076-6
ISSN	1473-5571 ; 0269-9370 ; 1350-2840
ISSN (online)	1473-5571
ISSN	0269-9370 ; 1350-2840
DOI	10.1097/QAD.0000000000003708
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Article ; Online: A survey of Alabama eye care providers in 2010-2011.

Maclennan, Paul A / McGwin, Gerald / Searcey, Karen / Owsley, Cynthia

BMC ophthalmology

2014 Volume 14, Page(s) 44

Abstract: Background: State level information regarding eye care resources can provide policy makers with valuable information about availability of eye care services. The current study surveyed ophthalmologists, optometrists and vision rehabilitation providers ... ...

Abstract	Background: State level information regarding eye care resources can provide policy makers with valuable information about availability of eye care services. The current study surveyed ophthalmologists, optometrists and vision rehabilitation providers practicing in Alabama. Methods: Three mutually exclusive provider groups were identified, i.e., all ophthalmologists, optometrists, and vision rehabilitation providers working in Alabama in 2010. Eligible providers were contacted in 2010 and 2011 and information was requested regarding provider demographics and training, practice type and service characteristics, and patient characteristics. Descriptive statistics (e.g., means, proportions) were used to characterize provider groups by their demographic and training characteristics, practice characteristics, services provided and patients or clients served. In addition, county level figures demonstrate the numbers and per capita ophthalmologists and optometrists. Results: Ophthalmologists were located in 24 of Alabama's 67 counties, optometrists in 56, and 10 counties had neither an ophthalmologist nor an optometrist. Overall, 1,033 vision care professionals were identified as eligible to participate in the survey: 217 ophthalmologists, 638 optometrists, and 178 visual rehabilitation providers. Of those, 111 (51.2%) ophthalmologists, 246 (38.6%) optometrists, and 81 (45.5%) rehabilitation providers participated. Most participating ophthalmologists, optometrists, and vision rehabilitation providers identified themselves as non-Hispanic White. Ophthalmologists and optometrists estimated that 27% and 22%, respectively, of their patients had diabetes but that the proportion that adhered to eye care guidelines was 61% among ophthalmology patients and 53% among optometry patients. Conclusions: A large number of Alabama communities are isolated from eye care services. Increased future demand for eye care is anticipated nationally given the aging of the population and decreasing numbers of providers; however, Alabama also has a high and growing prevalence of diabetes which will result in greater numbers at risk for diabetic retinopathy, glaucoma, and cataracts.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Alabama/epidemiology ; Child ; Child, Preschool ; Diabetic Retinopathy/epidemiology ; Diabetic Retinopathy/rehabilitation ; Education, Medical, Continuing/statistics & numerical data ; Female ; Health Services Accessibility/organization & administration ; Health Services Accessibility/statistics & numerical data ; Health Services Needs and Demand/statistics & numerical data ; Health Services Research ; Humans ; Male ; Middle Aged ; Ophthalmology/education ; Ophthalmology/organization & administration ; Optometry/education ; Optometry/organization & administration ; Workforce ; Young Adult
Language	English
Publishing date	2014-04-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2050436-6
ISSN	1471-2415 ; 1471-2415
ISSN (online)	1471-2415
ISSN	1471-2415
DOI	10.1186/1471-2415-14-44
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Article ; Online: The effect of trauma care on the temporal distribution of homicide mortality in Jefferson County, Alabama.

Griffin, Russell L / Davis, Gregory G / Levitan, Emily B / Maclennan, Paul A / Redden, David T / McGwin, Gerald

The American surgeon

2014 Volume 80, Issue 3, Page(s) 253–260

Abstract: The distribution of time from acute traumatic injury to death has three peaks: immediate (less than or equal to one hour), early (6 to 24 hours), and late (days to weeks). It has been suggested that coordinated trauma care dampens the late peak; however, ...

Abstract	The distribution of time from acute traumatic injury to death has three peaks: immediate (less than or equal to one hour), early (6 to 24 hours), and late (days to weeks). It has been suggested that coordinated trauma care dampens the late peak; however, this research may be more reflective of unintentional than intentional deaths. This study examines whether a coordinated trauma system (TS) alters the temporal distribution for assault-related deaths. Data were obtained from homicides examined by the Jefferson County Coroner's/Medical Examiner's Office from 1987 to 2008. Homicides were categorized-based on year of death-as occurring in the presence of no TS, during TS implementation, in the early years of the TS, or in a mature TS. The temporal distribution of homicide mortality was compared among TS categories using a χ(2) test. A Cox Markov multistate model was used to estimate proportional changes in the temporal distribution of death adjusted for assault mechanism. With a TS, after adjusting for assault mechanism, a lower proportion of homicide victims survived through the first hour (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.54 to 1.03) and from one to six hours (HR, 0.68; 95% CI, 0.49 to 0.96). Additionally, the presence of a TS was associated with a proportional decrease in deaths after 24 hours (P = 0.0005). These results suggest that a trauma system is effective in preventing late homicide deaths; however, other means of preventing death (such as violence prevention programs) are needed to decrease the burden of immediate homicide-related deaths.
MeSH term(s)	Adult ; Alabama/epidemiology ; Cause of Death ; Databases, Factual ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital/organization & administration ; Female ; Homicide/statistics & numerical data ; Humans ; Incidence ; Injury Severity Score ; Male ; Markov Chains ; Middle Aged ; Multivariate Analysis ; Proportional Hazards Models ; Retrospective Studies ; Risk Assessment ; Survival Analysis ; Trauma Centers/organization & administration ; Wounds and Injuries/diagnosis ; Wounds and Injuries/mortality ; Wounds and Injuries/therapy
Language	English
Publishing date	2014-03
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
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Article ; Online: Effects of an acute care for elders unit on costs and 30-day readmissions.

Flood, Kellie L / Maclennan, Paul A / McGrew, Deborah / Green, Darlene / Dodd, Cindy / Brown, Cynthia J

JAMA internal medicine

2013 Volume 173, Issue 11, Page(s) 981–987

Abstract: Importance: Providing high-quality care while containing cost is essential for the economic stability of our health care system. The United States is experiencing a rapidly growing elderly population. The Acute Care for Elders (ACE) unit ... ...

Abstract	Importance: Providing high-quality care while containing cost is essential for the economic stability of our health care system. The United States is experiencing a rapidly growing elderly population. The Acute Care for Elders (ACE) unit interdisciplinary team model of care has been shown to improve outcomes in hospitalized older adults. The University of Alabama at Birmingham ACE unit incorporates evidence-based care processes. We hypothesized that the ACE model would also reduce costs. Objective: To examine variable direct costs from an interdisciplinary ACE compared with a multidisciplinary usual care (UC) unit. Design: Retrospective cohort study. Setting: Tertiary care academic medical center. Participants: Hospitalists' patients aged 70 years or older spending the entirety of their hospitalization in either the ACE or UC unit in fiscal year 2010. Main outcome measures: Using administrative data, we analyzed variable direct costs for ACE and UC patients. We also conducted a subset analysis restricted to the 25 most common diagnosis related groups (DRGs) shared by ACE and UC patients. Generalized linear regression was used to estimate cost ratios and 95% confidence intervals adjusted for age, sex, comorbidity score, and case mix index (CMI). Results: A total of 818 hospitalists' patients met inclusion criteria: 428 from the ACE and 390 from the UC unit. For this study group (all DRGs), the mean (SD) variable direct cost per patient was $2109 ($1870) for ACE and $2480 ($2113) for UC (P = .009). Adjusted cost ratios revealed significant cost savings for patients with low (0.82; 95% CI, 0.72-0.94) or moderate (0.74; 95% CI, 0.62-0.89) CMI scores; care was cost neutral for patients with high CMI scores (1.13; 95% CI, 0.93-1.37). Significantly fewer ACE patients than UC patients were readmitted within 30 days of discharge (7.9% vs 12.8%; P = .02). Subset analysis of the 25 most common DRGs revealed a significantly reduced mean (SD) variable direct cost per patient for ACE compared with UC patients ($1693 [$1063] vs $2138 [$1431]; P < .001); cost ratios for total (0.78; 95% CI, 0.70-0.87) and daily (0.89; 95% CI, 0.85-0.94) variable direct costs remained significant after adjustment. Conclusions and relevance: The ACE unit team model reduces costs and 30-day readmissions. In an era when improving care processes while reducing costs is a vital objective for the Medicare program and our nation as a whole, the ACE model meets these goals.
MeSH term(s)	Acute Disease/therapy ; Aged ; Cohort Studies ; Costs and Cost Analysis ; Female ; Health Services for the Aged/economics ; Health Services for the Aged/statistics & numerical data ; Hospital Units ; Humans ; Male ; Patient Readmission/economics ; Patient Readmission/statistics & numerical data ; Retrospective Studies ; Time Factors
Language	English
Publishing date	2013-06-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2013.524
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Article ; Online: Eye care use among a high-risk diabetic population seen in a public hospital's clinics.

Maclennan, Paul A / McGwin, Gerald / Heckemeyer, Christine / Lolley, Virginia R / Hullett, Sandral / Saaddine, Jinan / Shrestha, Sundar S / Owsley, Cynthia

JAMA ophthalmology

2013 Volume 132, Issue 2, Page(s) 162–167

Abstract: Importance: Little is known regarding eye care use among low-income persons with diabetes mellitus, especially African Americans.: Objective: To investigate eye care use among patients with diabetes who were seen in a county hospital clinic that ... ...

Abstract	Importance: Little is known regarding eye care use among low-income persons with diabetes mellitus, especially African Americans. Objective: To investigate eye care use among patients with diabetes who were seen in a county hospital clinic that primarily serves high-risk, low-income, non-Hispanic African American patients. Design, setting, and participants: A retrospective cohort study with 2 years of follow-up examined eye care use among adult patients with diabetes seen in 2007 in an outpatient medical clinic of a large, urban county hospital that primarily serves low-income, non-Hispanic African American patients. Patients with a history of retinopathy and macular edema or a current diagnosis indicating ophthalmic complications were excluded. Eye care use was defined dichotomously as whether or not patients had a visit to the eye clinic for any eye care examination or procedure. We estimated crude and adjusted rate ratios (aRRs) and 95% CIs for the association between eye care use and selected clinical and demographic characteristics. Results: There were 867 patients with diabetes identified: 61.9% were women, 76.2% were non-Hispanic African American, and 61.4% were indigent, with a mean age of 51.8 years. Eye care utilization rates were 33.2% within 1 and 45.0% within 2 years. For patients aged 19 to 39 years compared with those aged 65 years or older, significantly decreased eye care utilization rates were observed within 1 year (aRR, 0.48; 95% CI, 0.27-0.84) and within 2 years (aRR, 0.61; 95% CI, 0.38-0.99). Conclusions and relevance: Overall eye care utilization rates were low. Additional education efforts to increase the perception of need among urban minority populations may be enhanced if focused on younger persons with diabetes.
MeSH term(s)	Adult ; African Americans/ethnology ; Aged ; Aged, 80 and over ; Alabama/epidemiology ; Blindness/ethnology ; Blindness/prevention & control ; Diabetes Mellitus, Type 1/complications ; Diabetes Mellitus, Type 1/ethnology ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/ethnology ; Diabetic Retinopathy/diagnosis ; Diabetic Retinopathy/ethnology ; Diabetic Retinopathy/therapy ; European Continental Ancestry Group/ethnology ; Female ; Follow-Up Studies ; Health Services/statistics & numerical data ; Health Services Research ; Hospitals, Public/statistics & numerical data ; Humans ; Male ; Middle Aged ; Ophthalmology ; Outpatient Clinics, Hospital/statistics & numerical data ; Retrospective Studies ; Risk Factors ; Vision, Low/ethnology ; Vision, Low/prevention & control ; Young Adult
Language	English
Publishing date	2013-12-05
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2701705-9
ISSN	2168-6173 ; 2168-6165
ISSN (online)	2168-6173
ISSN	2168-6165
DOI	10.1001/jamaophthalmol.2013.6046
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Article ; Online: Accounting for differences in transfusion volume: Are all massive transfusions created equal?

Sharpe, John P / Weinberg, Jordan A / Magnotti, Louis J / Maclennan, Paul A / Schroeppel, Thomas J / Fabian, Timothy C / Croce, Martin A

The journal of trauma and acute care surgery

2012 Volume 72, Issue 6, Page(s) 1536–1540

Abstract: Background: Among patients subjected to massive transfusion (MT), some will require considerably more blood than others, depending on the rate and quantity of hemorrhage. In analyses concerning plasma to red blood cell (RBC) ratios and platelet to RBC ... ...

Abstract	Background: Among patients subjected to massive transfusion (MT), some will require considerably more blood than others, depending on the rate and quantity of hemorrhage. In analyses concerning plasma to red blood cell (RBC) ratios and platelet to RBC ratios, this has yet to be examined. We sought to evaluate the effect of the number of RBC units transfused on both plasma:RBC and platelet:RBC and their association with mortality in MT patients. Methods: Prospective data were collected on trauma patients taken directly to surgery from the resuscitation room who received ≥ 10 RBC units by completion of operation. MT protocol was in place for all patients. To account for survival bias, intra-operative deaths were excluded. Patients were stratified by plasma:RBC and platelet:RBC (HIGH > 0.5, MID 0.33-0.5, LOW < 0.33). Crude and adjusted risk ratios (RRs) for hospital mortality were determined, using the HIGH ratio as the reference group. Results: One hundred thirty-five patients met inclusion criteria. There were no significant differences with respect to demographics, injury characteristics, or shock severity. However, the mean number of intra-operative RBC units transfused was significantly different between plasma:RBC groups (HIGH: 16.2, MID: 19.7, LOW: 25.1; p < 0.001). The crude risk for mortality was significantly higher for the LOW group relative to the HIGH group (RR 1.99, 95% confidence interval [CI] 1.02-3.89). However, after adjustment for the number of RBCs transfused, the risk was not significantly different (RR 1.54, 95% CI 0.75-3.15). The adjusted mortality risk for the LOW versus HIGH platelet:RBC groups was also not statistically different (RR 1.92, 95% CI 0.99-3.71). Conclusions: Among patients subjected to MT, those who receive relatively higher quantities of RBCs are both more likely to receive a lower plasma:RBC and are more likely to die. Any analysis concerning transfusion ratios should take the potential confounding of this heterogeneity among MT patients into account. Level of evidence: Prognostic study, level III.
MeSH term(s)	Adult ; Aged ; Blood Transfusion/methods ; Blood Transfusion/mortality ; Cause of Death ; Cohort Studies ; Confidence Intervals ; Erythrocyte Count ; Erythrocyte Transfusion/methods ; Erythrocyte Transfusion/mortality ; Female ; Hemorrhage/diagnosis ; Hemorrhage/mortality ; Hemorrhage/therapy ; Hospital Mortality/trends ; Humans ; Injury Severity Score ; Intraoperative Complications/mortality ; Male ; Middle Aged ; Multivariate Analysis ; Postoperative Complications/mortality ; Preoperative Care/methods ; Prognosis ; Prospective Studies ; Registries ; Resuscitation/methods ; Resuscitation/mortality ; Risk Assessment ; Survival Analysis ; Trauma Centers ; Treatment Outcome ; Wounds and Injuries/diagnosis ; Wounds and Injuries/mortality ; Wounds and Injuries/therapy
Language	English
Publishing date	2012-06
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0b013e318251e253
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Article: The impact of combined trauma and burns on patient mortality.

Hawkins, Ashley / Maclennan, Paul A / McGwin, Gerald / Cross, James M / Rue, Loring W

The Journal of trauma

2005 Volume 58, Issue 2, Page(s) 284–288

Abstract: Background: Combined trauma and burn injuries are uncommon and seldom studied. There is a presumption that these patients fare worse than their trauma- and burn-only counterparts, but the mortality risk has not been quantified.: Methods: This was a ... ...

Abstract	Background: Combined trauma and burn injuries are uncommon and seldom studied. There is a presumption that these patients fare worse than their trauma- and burn-only counterparts, but the mortality risk has not been quantified. Methods: This was a retrospective cohort study using the 1994 to 2002 National Trauma Data Bank. Trauma- and burn-only patients were categorized according to Injury Severity Score (ISS) and burn severity (percentage body surface area burned [BSAB]), respectively, and combined trauma-burn patients were similarly categorized. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated comparing combined trauma-burn mortality to trauma-only and burn-only patients by corresponding trauma or burn severity. RRs were adjusted for age, gender, and ISS or burn severity. Results: Compared with minor trauma-only patients (ISS of 1-15), patients with minor trauma, when combined with burn injury, had significantly increased mortality (RR, 4.04; 95% CI, 3.51-4.66). Similarly, relative to minor burn-only patients (BSAB of 1-25%), combined trauma-burn patients with minor burns (RR, 5.00; 95% CI, 3.54-7.06) had significantly increased mortality. For combined trauma-burn patients with more severe burns or trauma, small but significant increased mortality risks were seen relative to major trauma-only patients (ISS of 26+; RR, 1.26; 95% CI, 1.05-1.51) and major burn-only patients (BSAB of 76+; RR, 1.45; 95% CI, 1.15-1.82). Conclusion: The large increased risk of death for those with combined minor injuries is of clinical interest because the majority of combined patients fall into this category. Future research should characterize specific causes and types of injury of increased mortality in the patient with combined injuries.
MeSH term(s)	Adolescent ; Adult ; Aged ; Alabama/epidemiology ; Burns/complications ; Burns/mortality ; Burns/pathology ; Child ; Child, Preschool ; Cohort Studies ; Female ; Humans ; Infant ; Infant, Newborn ; Injury Severity Score ; Male ; Middle Aged ; Multiple Trauma/complications ; Multiple Trauma/mortality ; Multiple Trauma/pathology ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2005-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	219302-4
ISSN	1529-8809 ; 0022-5282 ; 1079-6061
ISSN (online)	1529-8809
ISSN	0022-5282 ; 1079-6061
DOI	10.1097/01.ta.0000130610.19361.bd
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Article: The contribution of opiate analgesics to the development of infectious complications in burn patients.

Schwacha, Martin G / McGwin, Gerald / Hutchinson, Charles B / Cross, James M / Maclennan, Paul A / Rue, Loring W

American journal of surgery

2006 Volume 192, Issue 1, Page(s) 82–86

Abstract: Background: Immune and infectious complications are associated with burn injury. Opiate analgesics also can induce similar complications, however, their impact on postburn infectious complications is unknown.: Methods: A retrospective survey of ... ...

Abstract	Background: Immune and infectious complications are associated with burn injury. Opiate analgesics also can induce similar complications, however, their impact on postburn infectious complications is unknown. Methods: A retrospective survey of records from 1997 to 2002 from an academic burn center was conducted. Information on all opiate analgesic use was obtained and expressed as opiate equivalents (OEs). Total OEs were summed for each patient and then compared between cases and controls. Results: Patients who developed infections were more likely to be in the high OE group. This association was modified by burn severity. Patients with small burns and infection were more likely to be in the high OE group, whereas patients with moderate to large burns and infections were not associated significantly with opiate use. Conclusions: The results of this preliminary study suggest that opiate analgesics can contribute to the development of postburn infectious complications when the burn injury is of a less severe nature.
MeSH term(s)	Analgesics, Opioid/adverse effects ; Burns/drug therapy ; Female ; Follow-Up Studies ; Humans ; Immune Tolerance/drug effects ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Trauma Severity Indices ; United States/epidemiology ; Wound Infection/chemically induced ; Wound Infection/epidemiology ; Wound Infection/immunology
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2006-07
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2006.01.001
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